Understanding the Well-Being of LGBTQI+ Populations

By: Charlotte Patterson

Highlights:

  • Over the past decade, there have been remarkable changes in the social, political, and legal status of lesbian, gay, bisexual, and transgender (LGBT) individuals, especially in the United States.
  • There are over 11 million LGBT individuals in the U.S., but many data collection efforts lack measures that capture the diversity of sexual orientation and gender identity.
  • To address these and other issues, I co-edited a new report that identifies the need for heightened attention to the social and structural inequities that exist for LGBTQI+ people and argues for new research on the full range of sexual and gender diversity.

In the fall of 2020, the National Academies of Sciences, Engineering, and Medicine released a landmark report on the well-being of lesbian, gay, bisexual, transexual, queer, intersex (e.g., persons with differences of sexual development), and other sexual and gender diverse people (LGBTQI+). The study updates and considerably expands a 2011 National Academies’ report on the health of LGBT people by also examining life experiences in multiple domains, such as law, education, public policy, and employment.

In a recent opinion piece for JAMA Pediatrics, my colleague and I shared the report’s review of the current state of knowledge on children and youths in several areas and offer some considerations on these subjects for pediatricians and other healthcare providers who work with children and youth. I highlight here a few areas of focus that may be of interest to educators, developmental psychologists, and other researchers.

Demography

Demographic data on sexual orientation and gender identity for people younger than 18 years remain sparse, since many data collection instruments still fail to assess these in pediatric populations. However, surveys that do collect this information show a consistent pattern of increasing disclosure of sexual orientation and gender identity (coming out) by adolescents over time. For example, findings from 10 US states using the US Centers for Disease Control and Prevention’s Youth Risk Behavior Surveillance System show significant increases in adolescents (ages 14-18 years) identifying as nonheterosexual (lesbian, gay, bisexual, other, or questioning) over time (ie, 7.3% in 2009 and 14.3%in 2017). This change reflects greater affirmation of minority sexual and gender identities by younger people. This is happening in a context of growing societal acceptance of sexual and gender diverse individuals that has been characterized by increased visibility of sexual and gender diverse populations, more positive media coverage, improved legal protections, and more supportive school policies.

Education

By reinforcing societal expectations of sexual and gender normativity in behavior and appearance, schools play vital roles in the cognitive, social, and emotional development of children and youths. Educational environments that are not inclusive, supportive, and protective of sexual and gender diverse students expose them to stigma, violence, abuse and other mistreatment that may promote negative academic outcomes, such as delinquency, lower academic achievement, and lower high school graduation rates. For example, a study matching 900 LGBTQ students with a comparison group of heterosexual youths found a higher rate of school suspensions among LGBTQ students that were not explained by punishable behavior at school. In contrast, schools that offer supportive policies and practices, training for teachers and other school personnel, and support for gender-sexuality alliances (sometimes called gay-straight alliances, or simply GSAs) have been shown to have less bullying. In these schools, LGBTQ students report feeling safer and having higher self-esteem, fewer mental health problems, less substance use, and less suicidal ideation.

Health

Consistent with earlier studies, recent research on the physical health of LGBTQI children and youth reveals their earlier initiation and higher prevalence rates of cigarette smoking, use of alcohol and other substances, as well as higher risk for HIV and other sexually transmitted infections. There has been a significant increase in research and knowledge of mental health over recent years. These data extend earlier findings of significant disparities in depression and suicidality, demonstrating higher rates of anxiety disorders, posttraumatic stress disorder, eating disorders, and suicide attempts compared with heterosexual youths. In addition, there is now evidence that mental health disparities in adolescence can persist into adulthood, increasing the risk of LGBTQI adults for mood, anxiety, and eating disorders.

Final Thoughts

The current report underscores the urgent need to integrate measures of sexual and gender diversity into major public and private survey instruments. The report also emphasizes that while acronyms such as LGBTQI are used to describe this population, LGBTQI people actually have many other identities as well, and they are more diverse than this acronym suggests. I hope that our report will deepen understanding of the experiences of these youth and help to support constructive discussions among LGBTQI youngsters and their family members.

To read the full opinion piece, please see the JAMA Pediatrics Viewpoint entitled “LGBTQI Youths Today—New Knowledge, Better Understanding.” The views represented here are those of the authors.

To read the full report and highlights from the National Academies of Sciences, Engineering, and Medicine, please see Understanding the Well-Being of LGBTQI+ Populations. Note that the report can be downloaded free of charge from the National Academies Press website.


References

Patterson CJ, Sepúlveda M-J, White J, eds; National Academies of Sciences, Engineering, and Medicine. Understanding the Well-Being of LGBTQI+ Populations. The National Academies Press; 2020. doi:10.17226/25877

Sepúlveda M, Patterson CJ. LGBTQI Youths Today—New Knowledge, Better Understanding. JAMA Pediatrics. Published online May 24, 2021. doi:10.1001/jamapediatrics.2021.0893


Youth-Nex also hosted a virtual panel discussion on this topic on September 17th, 2021. The video from this panel is now available online. You can also download a copy of the slide deck (PDF).

If you have any comments or questions about this post, please email Youth-Nex@virginia.edu. Please visit the Youth-Nex Homepage for up to date information about the work happening at the center.

Author Bio: Charlotte J. Patterson is a Professor in the UVA Department of Psychology. Her research focuses on the psychology of sexual orientation, with an emphasis on sexual orientation, human development, and family lives. In the context of her research, Patterson has worked with children, adolescents, couples, and families; she is best known for her studies of child development in the context of lesbian- and gay-parented families.

Keeping Students Safe: Talking about Alcohol and Hazing

By Susie Bruce, M.Ed.

Highlights:

  • Alcohol overdose and hazing can be prevented.
  • Educating youth on the signs of alcohol overdose can reduce risk of death.
  • Encouraging students to learn about organizations before they join can reduce hazing experiences.
  • Successful conversations with teens focus on openness, honesty, mutual respect, and trust. 

“It never occurred to me that he wouldn’t be able to handle a situation. I really didn’t have any worries.”

– Leslie Lanahan, mother of hazing victim Gordie Bailey

Lynn Gordon (“Gordie”) Bailey died 3 weeks into his freshman year of college from an alcohol overdose related to hazing. After a bid night tradition where pledges were encouraged to drink large quantities of alcohol, Gordie passed out at his fraternity house. His new “brothers” put him on a couch, wrote all over his body with permanent marker, gave him a bucket for vomit, and then left him alone. By the time someone checked on him the next morning, it was too late.

“Everybody thinks it’s not going to happen to them. We were in that crowd. It wouldn’t happen to us.  We want parents to learn from our tragedy.” 

– Michael Lanahan, Gordie’s step-father

Most parents and schools talk with students about the dangers of drinking and driving, but far fewer discuss the lethal risks of drinking too much alcohol too quickly or the prevalence and risks of hazing. Teens are unlikely to initiate conversations on these topics with adults, and it can be easy for parents and caregivers to avoid these uncomfortable topics. However, it’s worth noting that parental expectations and opinions do have an impact on student behaviors, both positively and negatively.

How can you prepare for these conversations? Be factual and straightforward about your expectations as well as your concerns. Teens want to talk with adults if the conversation is structured for openness, honesty, mutual respect, and trust. Focus more on strategies to protect health and safety and less on legal consequences.

Ready to get started? Here are some initial topics to cover.

Make sure youth know the signs of overdose

Even if a student doesn’t drink, or is under the legal drinking age of 21, knowing the “PUBS” overdose symptoms could save someone’s life. Seeing even one sign is an indication of a medical emergency requiring a call to 911. 

  • P – puking while passed out
  • U – unresponsive to a pinch of shaking
  • B – breathing is slow, shallow or has stopped
  • S – skin is blue, cold or clammy.  If the person has darker skin, check their lips or nailbeds to see if they are getting pale.

Consider showing the Gordie Center’s 1-minute PUBS video and ask:

  • “How likely is it that you’d call 911 if you’re in a situation where someone has one of the PUBS symptoms?”
  • “What would you do if friends minimize your concerns and tell you not to call?”

Encourage youth to add the national Poison Control hotline to their contact list

Students may be scared of getting themselves, their friends or their group in trouble and hesitate in a situation where seconds count. The Poison Control hotline (1-800-222-1222) connects to a national network of regional centers that provide confidential, expert advice 24/7. Talking with a medical expert can make the difference between life and death by giving students someone to “blame” for calling 911.

Talk with youth about how to choose groups that don’t haze

As Gordie’s story illustrates, hazing can happen to anyone. Hazing is perpetuated in all types of organizations, and nearly half of college students endured some level of physical or psychological hazing in high school. Students want to feel like they worked hard to achieve the privilege of being part of a group, so how can parents and other adults provide guidance in choosing groups that don’t haze?

The discussion starters below are also provided in an animated Gordie Center video:

  • Which types of groups or organizations have you thought about joining, and why?
  • What do you know about the group you are joining? How can you find out more?
  • Is this group included on your school’s hazing violation list?
  • What kinds of activities are required to join? Will it take away from academics? Is drinking involved?
  • How comfortable are you with those activities, or the unknowns of the membership process?
  • Will you promise to tell me if any activities cause you physical pain or emotional distress, even if the group swears you to secrecy?

Viewing HAZE to start the conversation

The Gordie Center’s 37-minute HAZE documentary film tells Gordie’s story through interviews with his friends and family, as well as with national experts on alcohol misuse and hazing prevention. The film is available for purchase or rental to schools and anyone who wants to view HAZE with their family can request a link to stream the film for free.  A free discussion guide is available.

The first discussion on a challenging issue is often the most difficult, so don’t try to cover every topic at once.  Spreading out conversations on alcohol, hazing, and other safety issues will have a more long-lasting impact than one marathon session.  Keep your focus on having a two-way discussion where your teen gets to share their thoughts and ideas instead of a one-sided lecture. Sometimes the best question can be a simple, “What do you know about…?” and see where the conversation goes.

“Before Gordie died, I’d never given any thought to death by alcohol. I’d received almost no education about it—teachers never talked about it.”

-Serena Keith, close friend of Gordie’s

If you have any comments or questions about this post, please email Youth-Nex@virginia.edu. Please visit the Youth-Nex Homepage for up to date information about the work happening at the center.

Author Bio: Susie Bruce, M.Ed., is director of the University of Virginia’s Gordie Center, which works to end hazing and substance misuse among high school and college students.  She is a Faculty Affiliate of Youth-Nex, and directs the NCAA-funded APPLE Training Institutes: the leading national strategic training program for substance misuse prevention and health promotion for student-athletes and athletics departments.

Self-Regulation and Toxic Stress: A Comprehensive Review

By Aleta L. Meyer, PhD

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Aleta L. Meyer is Senior Social Science Research Analyst, Office of Planning, Research and Evaluation Administration for Children and Families, U.S. Department of Health and Human Services. Meyer’s work focuses on the translation of theory and empirical research across multiple health outcomes into effective and feasible prevention programs for communities. At Administration for Children and Families (ACF) this includes the translation of research on early adversity to ACF programs, community-based-participatory-research to evaluate early childhood programs within American Indian/Alaska Native communities, and positive youth development.

In March 2015 we featured the first of 4 inter-related reports on self-regulation and toxic stress published by the Duke Center for Child and Family Policy, titled Seven Key Principles Identified in New Report on Self-Regulation Development, by Meyer who conceived the project, led the effort, and is the project’s program officer.

Since that time, the project published a second report, A Review of Ecological, Biological, and Developmental Studies of Self-Regulation and Stressa literature review on the impact of early adversity and chronic stress on self-regulation development from birth to young adulthood.

This post by Meyer, highlights the recently released 3rd report, Self-Regulation and Toxic Stress Report 3: A Comprehensive Review of Self-Regulation Interventions from Birth Through Young Adulthood. Key authors: Desiree W. Murray, Katie self-reg-coverRosanbalm, Christina Christopoulos, Center for Child and Family Policy, Duke University.
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Ethnicity and Health: How Can We Maximize Urban Green Space for Health Promotion?

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by Jenny Roe, Ph.D. and Alice Roe
Originally published on The Centre for Urban Design and Mental Health (UD/MH) blog, here. [Jenny Roe, Ph.D., is Director of the Center for Design and Health, School of Architecture, University of Virginia. Her recent talk, at our sponsored lecture series, can be found here.]

 

Access to parks and urban green space facilitates exposure to nature, exercise and social opportunities that have positive impacts on both physical and mental health. In the last decade, rates of migration have risen dramatically across the globe: by 2038, it’s expected that half of London’s residents will be of a black and minority ethnic origin (BME). Our cities, towns and communities are becoming increasingly multicultural and, yet there are inequalities. A recent report by the Equalities and Human Rights Commission showed that in the UK, ethnic minorities are experiencing worse health outcomes. This is particularly the case for mental health: in 2012, the proportion of adults in England who were at risk of poor mental health was found to be higher among Pakistani/Bangladeshi and African/Caribbean/Black respondents than White respondents, and there were inequalities in accessing healthcare.

Hence, it is increasingly important that research reflects the diverse make-up of these populations. A new study has sought to better understand the differences in use and perception of urban green space among BME groups in the UK, and illustrated the need for park facilitators to accommodate the needs, attitudes and interests of our multicultural population.

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Good Sports and PYD

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SuperStarters Tennis & Teamwork Activity

Ellen Markowitz is a social entrepreneur who uses sports to help youth become their “super selves.” She studied Sport Psychology and Positive Youth Development through sport at the Curry School of Education. She founded SuperStarters Sports which offers sports-based youth development programs and consulting. Markowitz received a BA from Yale University, an MBA from New York University, and a Ph.D. from the University of Virginia’s Curry School of Education, in 2010.

Playing sports as a young girl, changed my life. When I was in high school, being part of a team helped me feel good about myself, and gave me tools to connect with others. So it has been my passion to help other girls feel connected and competent through physical activity and sport.

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SuperStarters Tennis & Teamwork Activity

In the ‘90’s, when I started working in the world of after school programs in New York City, there were no acronyms like “PYD” or “SBYD (sports-based youth development).” Practitioners and researchers understood that after school programs could provide many diverse opportunities — as safe spaces for youth to connect with peers and adults, as growth places for youth to explore new activities and identities, and as home bases where youth could learn skills and competencies that could open doors to unimagined futures.

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Down and Dirty – Impacting Youth Wellness

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Students with onions from the garden project – a University-school partnership.

Eleanor V. Wilson, Associate Professor in the Curry School of Education, has been a faculty advisor for three “Wellness and Gardening” projects, all a part of a University-elementary school partnership which she says is having a cumulative impact on the community. Charlottesville’s Burnley Moran Elementary school and university students co-lead the work and “it is an example of not only school-university cooperation,” says Wilson, “but as examples of ways to incorporate principles of healthy living as a part of Positive Youth Development at the elementary school level.” Following is her summary of the projects.

Ellie Wilson_edit_4322 copyFor the past three years, U.Va. students have participated in projects initiated by a Charlottesville non-profit organization and then, a Community Based Undergraduate Grant, (funded by the Office of Undergraduate Research at the University of Virginia) and followed by two Jefferson Public Citizens grants have collaborated to enrich the Charlottesville City Schools “City Schoolyard Garden Project.” Initiated in 2009, the City Schoolyard Garden (CSG) was a non-profit venture dedicated to cultivating academic achievement, health, environmental stewardship and community engagement through garden-based, experiential learning. A pilot garden program was founded at Buford Middle School and in 2011 the partnership was extended to all city elementary schools. Once this project was underway, University students became involved as partners in expanding the goal of creating healthy living habits for elementary school students. View video: “Wellness and Gardening.”  Continue reading

Health Effects Of Physical Activity In Youth – Russell Pate, Ph.D.

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The annual Youth-Nex Conference on Physical Health & Well-Being, was held October 11 & 12, 2013 at the University of Virginia.

The following is a summary of the presentation by Russell Pate, Ph.D., by Jeanette Garcia, graduate student in the Curry School of Education’s Department of Kinesiology, under the direction of Art Weltman, Ph.D., conference chair. Video also available here.

Russell Pate, Ph.D., is Professor and Director, Children’s Physical Activity Research Group, University of South Carolina Arnold School of Public Health. He is also the current president of the National Physical Activity Plan Alliance. His research interests include physical activity and physical fitness in children and the health implications of physical activity. 

There is evidence that the following strategies are effective:

  • Multi-component school interventions
  • Physical education in school

There is evidence that the following strategies are emerging or suggestive:

  • Activity breaks in school
  • Pre-school and childcare settings

Community and built environment

The following strategies have insufficient evidence at this time:

  • School physical environment and after-school
  • Camps, youth organizations, and other programs in the community
  • Family and home
  • Primary care settings

Current Physical Activity Guidelines for Adolescents and Youths Continue reading

News from the Virginia Driving Safety Lab

The YN Blog will feature the research and experiences of  five U.Va. undergraduates working in the University of Virginia Health System’s Virginia Driving Safety Laboratory.

Student contributors, Melissa Avalos, Annie Friedell, Emily Meissel, Glenda Ngo and Julia Thrash work with Ann Lambert and Youth-Nex Associate Director, Daniel Cox.

About the Virginia Driving Safety Laboratory: In order to improve the safety on our roadways, the lab conducts driving safety research and provides patients with the opportunity receive comprehensive assessments of their driving abilities.

Related posts will be found under Driving; and Ann Lambert, Dan Cox.

It is widely acknowledged that driving while under the influence of alcohol is dangerous. However, what many fail to realize is that distracted driving, or simultaneously making use of two of our most useful innovations, the cell phone and motor vehicle, is just as dangerous as drinking and driving, but in different ways, according to Strayer, Drews, and Crouch (2006). Continue reading

What’s New in the Research on Childhood Obesity?

2030: Adult Obesity Rates if the Current Trajectory Continues

Trajectory of Adult Obesity Rates in the U.S project Virginia to be 50%-55% Obese by 2030. Research shows obese children are very likely to become obese adults.

 Arthur Weltman presented “Obesity in Children and Adolescents: Effects of Lifestyle Intervention” at the September’s Works In Progress Meeting.

Related posts are available under Research, Works In Progress Meetings, Health

Presentation Audio and Slides

Key Points from Weltman’s Talk:

  • Obese youth who do not show signs for Metabolic Syndrome are still at risk for several health conditions. A Type 2 diabetic diagnosis is just “the tip of the iceberg” with many health problems lying below the surface. There is a constellation of risk factors are already there. Continue reading