This post is the third in our series focusing on presentations that were delivered at a special panel session at APHA16 on the childhood roots of health inequity [part 1, part 2].
Our third presenter, Kerith Conron, ScD, MPH, is currently the Blachford-Cooper Distinguished Scholar and Research Director at The Williams Institute of UCLA’s School of Law. Dr. Conron’s work focuses on reducing health inequities that impact sexual and gender minority populations, and the title of her presentation was A Health Equity Agenda to Reduce Childhood Adversity and Promote the Health of Diverse LGBTQ Youth.
Dr. Conron, who is also affiliated with the Fenway Institute, started by observing that about 6-8% of 13- to 29-year-olds self-identify as LGBTQ+ (2/3 of whom are female). LGBTQ+ youth in the US are racially and ethnically diverse – 62% white, 23% Latinx, 14% African American, and 5% Asian/Pacific Islander. In addition to sexual orientation and gender identity (SOGI) stigma, LGBTQ+ youth of color also experience racism and discrimination. Thus, research and policy efforts to understand and promote health among diverse LGBTQ+ youth must also address social determinants of health.
Specifically:
- High rates of victimization
- High rates of homelessness
- Disproportionately reside in low-income neighborhoods
- Disproportionately come from low-income families
In a community-based participatory study (CBPR) of 294 LGBTQ youth (aged 13-25) of color (42% Black, 33% Latinx, 22% Asian/Pacific Islander, 3% American Indian or Other) in the Boston area (conducted by The Fenway Institute, JRI Health, and BAGLY Inc. with support from NIMHD), 45% reported discrimination related to their race/ethnicity; 41% about their sexual orientation, 35% about their gender expression, 31% about their age, 30% about their sex, 26% about their height/weight, and 17% about their socioeconomic status. Fully 58% reported that parental psychological abuse had occurred more than once or twice, and 37% reported more than one or two episodes of parental physical abuse. More than one in ten of those under age 18 reported unstable housing, and 18% of those 19-25 years old.
In addition:
- 21% of 19-25 year olds and 8% of 13-18 year olds reported exchanging sex for a place to sleep, money, food, drugs or other resources in the prior 3 months.
- 31% of all youth reporting cutting the size of meals or skipping meals because there wasn’t enough money for food either some months or almost every month in the prior 12.
In multivariable regression analyses, these exposures were associated with significant increases in risk for depression, anxiety, and attempted suicide within 12 months.
The agenda for working toward health equity for LGBTQ+ people includes concrete actions, among them:
- Ensure that culturally competent and affirming mental health and substance use prevention and treatment services are available to all youth who need them.
- Monitor the health of LGBTQ youth of color in high school and beyond by including questions on assigned sex at birth, gender identity, and sexual orientation in all surveillance systems and oversampling racial‐ethnic and sexual and gender minorities.
- Fund and conduct studies, like the Our Health Matters study discussed in this post, that include youth as active partners — CBPR works.
- Include youth as partners in developing strategies to improve the health and social conditions of their lives.
- Pay them to participate in program development and delivery, research, and policy-making.
One participant said, “Show people it’s OK to accept and be accepted. Show people ‘I know what you’re going through,’ so people don’t feel so alone.” In that spirit, here’s a link to more information on how anyone can be an ally of the LGBTQ+ community.
Lisa M. Lines
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