Lesbian, Gay, Bisexual and Transgender Health
Many lesbian, gay, bisexual, and transgender (LGBT) youth are happy and thrive during their adolescent years. Going to a school that creates a safe and supportive learning environment for all students and having caring and accepting parents are especially important. This helps all youth achieve good grades and maintain good mental and physical health. However, some LGBT youth are more likely than their heterosexual peers to experience difficulties in their lives and school environments, such as violence.
Experiences with Violence
Negative attitudes toward gays, lesbians, bisexuals, and transgender people put LGBT youth at increased risk for experiences with violence, compared with other students . Violence can include behaviors such as bullying, teasing, harassment, physical assault, and suicide-related behaviors.
A 2009 survey* of more than 7,000 LGBT middle and high school students aged 13–21 years found that in the past year, because of their sexual orientation—
- Eight of ten students had been verbally harassed at school;
- Four of ten had been physically harassed at school;
- Six of ten felt unsafe at school; and
- One of five had been the victim of a physical assault at school .
*Survey participants were recruited online and through community-based groups and service organizations serving LGBT youth.
LGBT youth are also at increased risk for suicidal thoughts and behaviors, suicide attempts, and suicide. A nationally representative study of adolescents in grades 7–12 found that lesbian, gay, and bisexual youth were more than twice as likely to have attempted suicide as their heterosexual peers . More studies are needed to better understand the risks for suicide among transgender youth.
Another survey of more than 7,000 seventh- and eighth-grade students from a large Midwestern county examined the effects of school climate and homophobic bullying on lesbian, gay, bisexual, and questioning (LGBQ) youth and found that
- LGBQ youth were more likely than heterosexual youth to report high levels of bullying and substance use;
- Students who were questioning their sexual orientation reported more bullying, homophobic victimization, unexcused absences from school, drug use, feelings of depression, and suicidal behaviors than either heterosexual or LGB students;
- LGB students who did not experience homophobic teasing reported the lowest levels of depression and suicidal feelings of all student groups (heterosexual, LGB, and questioning students); and
- All students, regardless of sexual orientation, reported the lowest levels of depression, suicidal feelings, alcohol and marijuana use, and unexcused absences from school when they were
- In a positive school climate and
- Not experiencing homophobic teasing .
Effects on Education and Health
Exposure to violence can have negative effects on the education and health of LGBT youth. In a national study of middle and high school students, LGBT students (61.1%) were more likely than their non-LGBT peers to feel unsafe or uncomfortable as a result of their sexual orientation. LGBT students (over 25%) reported missing classes or days of school because of feeling unsafe in their school environment .
Overall, the stresses experienced by LGBT youth also put them at greater risk for mental health problems, substance use, and physical health problems .
What Schools Can Do
For youth to thrive in their schools and communities, they need to feel socially, emotionally, and physically safe and supported. A positive school climate has been associated with decreased depression, suicidal feelings, substance use, and unexcused school absences among LBGT students [5,6].
School personnel, leaders of community organizations, parents, and youth have a role to play in building positive, supportive, and healthy environments for youth. Such environments promote acceptance and respect and help youth feel valued . Schools can assist by implementing clear policies, procedures, and activities designed to prevent violence. For example, a study, found that, in schools with LGB support groups (such as gay-straight alliances), LGB students were less likely to experience threats of violence, miss school because they felt unsafe, or attempt suicide than those students in schools without LGB support groups .
To help promote health and safety among LGBTQ youth, schools can implement the following policies and practices:
- Encourage respect for all students and prohibit bullying, harassment, and violence against all students.
- Identify “safe spaces,” such as counselors’ offices, designated classrooms, or student organizations, where LGBTQ youth can receive support from administrators, teachers, or other school staff.
- Encourage student-led and student-organized school clubs that promote a safe, welcoming, and accepting school environment (e.g., gay-straight alliances, which are school clubs open to youth of all sexual orientations).
- Ensure that health curricula or educational materials include HIV, other STD, or pregnancy prevention information that is relevant to LGBTQ youth; such as, ensuring that curricula or materials use inclusive language or terminology.
- Encourage school district and school staff to develop and publicize trainings on how to create safe and supportive school environments for all students, regardless of sexual orientation or gender identity and encourage staff to attend these trainings.
- Facilitate access to community-based providers who have experience providing health services, including HIV/STD testing and counseling, to LGBTQ youth.
- Facilitate access to community-based providers who have experience in providing social and psychological services to LGBTQ youth.
What Parents Can Do
Parents should talk openly with their children about any problems or concerns and be watchful of behaviors that might indicate their children are victims or perpetrators of bullying or violence or are depressed or suicidal. If bullying, violence, or depression is suspected, parents should take immediate action, working with school personnel and other adults in the community.
Also, how parents respond to their LGBTQ child can have a tremendous impact on their child’s current and future mental and physical health [1,6,9,10]. Supportive reactions can help youth cope with the challenges of being an LGBTQ teen. However, some parents react negatively to learning that they may have an LGBTQ daughter or son. In some cases, children are thrown out of the house or stress and conflict at home can cause some youth to run away. As a result, LGBT youth are at greater risk for homelessness than their heterosexual peers .
Even less severe reactions can have long-lasting negative effects. Research published in the journal Pediatrics found significantly higher rates of mental and physical health problems among LGBT young adults who experienced high levels of rejection from their parents while they were adolescents . Compared with LGBT young adults who experienced very little or no parental rejection, LGBT young adults who experienced high levels of rejection were
- Nearly 6 times as likely to have high levels of depression;
- More than 8 times as likely to have attempted suicide;
- More than 3 times as likely to use illegal drugs; and
- More than 3 times as likely to engage in unprotected sexual behaviors that put them at increased risk for HIV and other sexually transmitted infections.
The resources provided below can help parents better understand and respond to the needs of LGBTQ adolescents.
- Coker TR, Austin SB, Schuster MA. The health and health care of lesbian, gay, and bisexual adolescents. Annual Review of Public Health 2010;31:457–477.
- Kosciw JG, Greytak EA, Diaz EM, Bartkiewicz MJ. The 2009 National School Climate Survey: The Experiences of Lesbian, Gay, Bisexual and Transgender Youth in Our Nation’s Schools. New York: Gay, Lesbian Straight Education Network; 2010. Available at www.glsen.org/binary-data/GLSEN_ATTACHMENTS/file/000/001/1675-5.PDF .
- Russell ST, Joyner K. Adolescent sexual orientation and suicide risk: Evidence from a national study. American Journal of Public Health 2001;91:1276–1281.
- Birkett M, Espelage DL, Koenig B. LGB and questioning students in schools: The moderating effects of homophobic bullying and school climate on negative outcomes. J Youth Adolescence 2009;38:989–1000.
- Eisenberg ME, Resnick MD. Suicidality among gay, lesbian and bisexual youth: The role of protective factors. Journal of Adolescent Health 2006;39:662–668.
- Espelage DL, Aragon SR, Birkett M. Homophobic teasing, psychological outcomes, and sexual orientation among high school students: What influence do parents and schools have? School Psychology Review 2008;37:202–216.8.
- FindYouthInfo.gov [Internet]. Bullyinfo.org Bullying Prevention and Response. [cited 2010 Nov 29]. Interagency Working Group on Youth Programs; [1 screen]. Available at www.findyouthinfo.org/topic_bullying.shtml.
- Goodenow C, Szalacha L, Westheimer K. School support groups, other school factors, and the safety of sexual minority adolescents. Psychology in the Schools 2006;43:573–89.
- Ryan C, Huebner D, Diaz RM, Sanchez J. Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics 2009;123:346–352.
- Bouris A, Guilamo-Ramos, Pickard A, Shiu C, Loosier PS, Dittus P, Gloppen K, Waldmiller JM. A systematic review of parental influences on the health and well-being of lesbian, gay, and bisexual youth: time for a new public health research and practice agenda. Journal of Primary Prevention 2010;31:273–309.