The Delaware Journal of Public Health: LGBT Health Equity

This issue of the Delaware Journal of Public Health is devoted to LGBT Health Equity and features several articles relevant to trans and gender nonbinary youth and adults. Several are listed below, and others in the journal are interesting as well.

Most notable are:

Keeping Youth Alive: Considerations for Suicide Prevention of Gender Diverse Youth. Author: Elise Mora, LCSW.

“Objective. This article examines suicidality of gender expansive youth and identifies evidence=based practical interventions for healthcare professionals and other adults who interact with gender expansive youth…

“Results. Gender expansive youth are at significantly heightened risk of suicide compared to their cisgender peers. Nonbinary youth are the most vulnerable of all subgroups.

“Conclusion: Explicit recommendations for enhancing resilience for this population complete the article. More research is critical for this demographic, as current literature is severely limited.”

A Mother’s Story. Author: Sally McBride.

“Sally and David McBride’s youngest child came out as transgender on Christmas Day 2011 as a junior at American University. The news rocked their world. Here is their story as told by Sally.”

Building Resilience, Reducing Risk: Four Pillars to Creating Safer, More Supportive Schools for LGBT Youth. Author: Rev Karla Fleshman, LCSW, M.Div.

“Abstract. In 2017 Delaware, LGBTQ+ Youth reported that almost 1 out of 3 were bullied on school grounds. Additionally, over 50% reported feeling sad/hopeless, and almost as many seriously considered suicide as an option, while 32% planned for suicide with almost 1 in 4 reported having acted on their suicide plan at least once. Of all the students who reported a suicide attempt, 10% required medical treatment as a result of their attempt. The Delaware Department of Education does not have comprehensive statewide protections in place to support some of our most vulnerable youth, yet school districts can make a positive difference in implementing policy/practices to build resilience and reduce risk.

“This article will focus on four key areas where schools and school districts may implement changes toward creating safer, more supportive schools: (1) policy/procedures that protect LGBTQ+ students at the administrative level; (2) comprehensive cultural sensitivity training for serving LGBTQ+ students and their families; (3) incorporating inclusive curriculum on LGBTQ+ history into the classroom; (4) and creating, supporting, and sustaining gender and sexuality alliances in both the middle and high schools.”

https://www.academia.edu/39955943/LGBTQ_Health_Equity

Substance Use Among a National Sample of Sexual and Gender Minority Adolescents: Intersections of Sex Assigned at Birth and Gender Identity

Substance Use Among a National Sample of Sexual and Gender Minority Adolescents: Intersections of Sex Assigned at Birth and Gender Identity

A study published just this week documenting the very high rates of alcohol and substance use in sexual and gender minority populations.  While this study does not address possible motivations for that use, it is well documented by other research that such use is most often the result of the stigma, discrimination, and abuse to which these LGBTQIA+ youth are subjected.  We are posting it here because this data may be useful as part of advocacy and service development for these vulnerable youth.

Published in LGBT Health. January 13, 2020.  Authors: Ryan J. Watson, Jessica N. Fish, Timothy McKay, Samuel H. Allen, Lisa Eaton, Rebecca M. Puhl.

 

“Purpose:We examined how substance use differed as a function of sex assigned at birth and gender identity (cisgender, transgender, or nonbinary/genderqueer) by type of substance. We sought to test whether current gender identity and sex assigned at birth were key factors in substance use among a large contemporary sample that included transgender and nonbinary/genderqueer adolescents.

“Methods:We analyzed data from a large national U.S. sample of sexual and gender minority (SGM) adolescents (n = 11,129) collected between April and December 2017. Chi-square tests of independence were used to test whether substance use behaviors varied by sex assigned at birth and gender identity. A series of multivariate logistic regression models tested the odds of substance use by sex assigned at birth and gender identity, as well as the interaction between sex assigned at birth and gender identity.

“Results:More than half of our sample reported lifetime alcohol use, and one-fourth of the sample reported lifetime marijuana use. Adolescents assigned male at birth had higher prevalence of substance use compared with adolescents assigned female at birth (AFAB). Multivariate models elucidated greater risk for most substance use outcomes for transgender adolescents compared with cisgender adolescents. We found significant interaction effects between gender identity and sex assigned at birth for recent alcohol use and lifetime and recent cigarette use among adolescents AFAB.

“Conclusions:These findings have implications for stakeholders who develop nationally representative surveys, researchers who examine substance use disparities among SGM adolescents, and mental health professionals who treat underage substance use among vulnerable populations.”

https://www.liebertpub.com/doi/10.1089/lgbt.2019.0066?utm_source=sfmc&utm_medium=email&utm_campaign=LGBT%20FP%20JAN%2016%202020&d=1/16/2020&mcid=1865740788

 

Understanding lesbian, gay, bisexual and trans (LGBT) adolescents’ suicide, self-harm and help-seeking behaviour 

Understanding lesbian, gay, bisexual and trans (LGBT) adolescents’ suicide, self-harm and help-seeking behaviour 

 

Another report, this one from the UK, again documenting that hostile social forces and lack of social supports – not the LGBTQ+ identity – are the primary driver of LGBTQ+ suicide.  Create a more affirming and nurturing environment, and these youth can thrive. 

 

Department of Health Policy Research Programme Project Understanding Lesbian, Gay, Bisexual and Trans (LGBT) Adolescents' Suicide, Self-Harm and Help-Seeking Behaviour. June 30, 2016.  Authors: Elizabeth McDermott (Lancaster University), Elizabeth Hughes (University of Huddersfield) & Victoria Rawlings (Lancaster University).

 

 

“Executive summary 

“Background 

“International research demonstrates that LGBT youth are at much higher risk of suicide and self-harm compared to their heterosexual or cisgender counterparts. Evidence in the UK is sparse and only beginning to establish sexual and gender identity as a risk factor for adolescent suicide and self-harm, and as a result of this research scarcity we also know very little about help seeking behavior. The Suicide Prevention Strategy (2012) has identified LGBT youth as a high risk group but currently there is limited evidence to develop effective suicide prevention policy and practice.”

 

“Key findings 

“Understanding LGBT youth self-harm and suicide 

“Similar to findings from other studies on youth suicide, those who had self-harmed and/or had a disability had an increased likelihood of planned or attempted suicide. Gender identity was also a risk factor for self-harm and suicide. Those who were gender diverse (Trans/unsure) were nearly twice as likely to have self-harmed and one and a half times more likely to have planned or attempted suicide than cisgender participants. Cisgender males were the least likely to plan or attempt suicide, or self-harm compared to other gender identities. There were five interconnecting areas which explained the elevated risk of suicide and self-harm in LGBT youth: 1) homophobia, biphobia or transphobia; 2) sexual and gender norms; 3) managing sexual orientation and gender identity across multiple areas of life; 4) being unable to talk and; 5) other life crises.” 

 

“1. Homophobia, biphobia and transphobia 

“The majority (70.8%, n=527) of the sample had experienced direct abuse or negative interactions about their sexual or gender identity when they were self-harming or feeling suicidal. A great number of these incidents had occurred in schools but the participants experienced this hostility across all areas of life e.g. in public, leisure spaces, work, religious places and on the internet. Those who experienced abuse were one and a half times more likely to plan or attempt suicide. Bisexual participants were least likely to experience abuse compared to other sexual orientation groupings. Trans and disabled participants were twice as likely to experience abuse related to their sexual orientation/ gender identity than those who were not. They were also more likely to indicate that the abuse influenced their self-harm and suicidal feelings. Those who reported they were affected by homophobic abuse had double the odds of planning or attempting suicide.” 

 

“2. Sexual and gender norms 

“Sexual and gender norms that made many participants feel that something was wrong with them (because they were not heterosexual or cisgender), without being told or abused directly, also caused distress. Almost half the questionnaire participants felt negative about their sexual or gender identity during the time they were self-harming or felt suicidal; a far lower proportion felt positive about their sexual orientation or gender identity. Gender diverse participants were most likely to feel negative, and bisexual young people least likely to feel negative, about their sexual orientation and gender identity. Those who felt negative about their sexual and/or gender identity were more likely to have planned or attempted suicide.”

 

“3. Managing sexual orientation and gender identity across multiple areas of life 

“Making decisions about whether to disguise or hide their sexual orientation or gender identity in different contexts (e.g. school, home, public, internet, leisure places) and to a variety of people, impacted negatively on the participants’ mental health. The majority of young people found hiding their sexuality and gender identity distressing. Gender diverse participants were over three and a half times more likely to feel distressed about hiding their sexual orientation/gender identity compared to cisgender young people. Bisexual  participants were significantly less distressed than other sexual identity groupings. Those who found hiding their sexual orientation and gender identity distressing were nearly two times more likely to self-harm. Young people who reported that keeping their sexual orientation/ gender identity a secret strongly affected their self-harm and suicidal feelings were significantly more likely to attempt or plan suicide.” 

 

“4. Being unable to talk 

“Almost three quarters of participants (74.1%, n=533) indicated that not being able to talk about their feelings and emotions (in relation to their mental health, sexuality and gender identity) strongly influenced their self-harm and suicidal feelings. Those young people who felt more affected by not being able to talk about their emotions had significantly higher rates of self-harm and were nearly two and a half times more likely to report they had attempted or planned suicide” 

 

“5. Other life crises 

“Participants experienced a range of additional reasons for distress that were unrelated to sexual orientation/ gender identity. The most common were academic pressure, problems with friends, bullying, family breakdown, participant illness, financial problems, romantic relationships ending, and previous experiences of abuse…”

 

 

“Conclusions 

“To develop effective public health policy to prevent suicide in LGBT young people, the social factors that heighten risk need to be addressed, and supportive services put in place. As a priority this would entail tackling homophobic, biphobic and transphobic abuse in schools, addressing the continuing sexual and gender norms which marginalise those who are not heterosexual and cisgender, and providing support and space for LGBT youth to disclose and discuss their emotions and experiences in secure environments. Key policy areas to focus upon are schools and education, the role of the internet, increasing LGBT youth provision, developing online and face-to face LGBT youth specific mental health support, and improving mental health and gender identity NHS services…”

https://www.academia.edu/26625951/Understanding_lesbian_gay_bisexual_and_trans_LGBT_adolescents_suicide_self-harm_and_help-seeking_behaviour_Final_Report?email_work_card=title

 

A Viral Fake News Story Linked Trans Health Care to 'Thousands' of Deaths

A Viral Fake News Story Linked Trans Health Care to ‘Thousands’ of Deaths

Hormone blockers used by some transgender people have multiple uses, including treating prostate cancer in terminally ill patients.

To be clear: Lupron has been widely used in thousands of trans youth, and members of the Gender Dysphoria Affirmative Working Group are NOT AWARE OF ANY DEATHS attributable to Lupron use in trans and gender noxnbinary youth.

As people may have already seen, an ultra conservative Catholic website (Lifesite News) spread misleading news that some 6,300 deaths over 40 years were attributed to leuprolide acetate (Lupron), a medication also used as a puberty blocker in trans youth. Articles and other information released about this issue minimized or did not mention that Lupron is commonly used in palliative care for long-term and terminally ill cancer patients, and instead implied that this medication has been widely killing transgender youth. Multiple conservative outlets further distributed this story (including Breitbart and Daily Wire). We have become aware that parent groups have reported this article (and similar ones reflecting the same misinformation) being sent by "well meaning" relatives to parents of trans youth. We also are concerned that this issue will be used as a ‘talking point’ in other venues like school board meetings and such by those opposed to policies supporting trans youth.

Thus far only one article in mainstream journalism outlet has debunked this misleading press. The "good" article is linked below.

Sadly, we all may be obligated to push back against the further discrimination, hatred, and transphobia only encouraged by these stories. We encourage you to remember that affirmative care - including puberty blockers such as Lupron - have been demonstrated to have vastly improved outcomes for trans youth including dramatic decreases in depression, anxiety, substance use, school dropout, obesity, smoking rates, suicidal ideation and gestures.

“A recent article published by Catholic news outlet LifeSiteNews alleged that the drugs used to treat gender dysphoria in some transgender children are linked to “thousands” of deaths.

“The story went viral on right-wing news websites such as the Christian Postand the Daily Wire. According to CrowdTangle, a social media metric platform, these posts — including shares by Daily Wire founder Ben Shapiroand commentator Matt Walsh— are currently some of the top performing LGBTQ-related content on Facebook and Twitter.

“The problem is: the “thousands” of people who die while taking these drugs are likely the terminally ill cancer patients who receive hormone blockers to fight hormone-sensitive cancers, like prostate cancer, according to experts.”

https://www.nbcnews.com/feature/nbc-out/viral-fake-news-story-linked-trans-healthcare-thousands-deaths-n1059831

Describing Roles that Gay-Straight Alliances Play in Schools

Yet another study making clear the link between supporting LGBT youth and better mental health outcomes...

Published in: Addictive Behaviors. April 2014. Authors: Nicholas Heck, Nicholas Liivngston, Annesa Fletne, Katherine Oost, Brandon Steward, Bryan Cochran

"After controlling for demographic variables and risk factors associated with illicit drug use, the results of 12 logistic regression analyses revealed that LGBT youth attending a high school without a GSA evidenced increased risk for using cocaine... hallucinogens... and marijuana... relative to peers attending a high school with a GSA. Youth without a GSA also evidenced increased risk for the misuse of ADHD medication... and prescription pain medication. The present findings underscore the importance of providing LGBT youth with school-based support groups and highlight the potential damaging effects of not having these resources in our nation's schools."

“Highlights:

  • "Assessed association between high school gay-straight alliances (GSA) and illicit drug use."

  • "LGBT youth evidence lower risk for illicit substance use when their school has a GSA."

  • " Inclusive school-based programs may be protective factors for LGBT youth."

"These findings extend the research base related to GSAs and further demonstrate the importance of providing LGBT youth with opportunities for socialization and support within the school setting."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4066611/

Family Rejection as a Predictor of Suicide Attempts and Substance Misuse Among Transgender and Gender Nonconforming Adults

Published in: LGBT Health. May 25, 2016. Authors: Augustus Klein and Sarit Golub.

"42.3% of [transgender adults] reported a suicide attempt and 26.3% reported misusing drugs or alcohol to cope with transgender-related discrimination… family rejection was associated with increased odds of both behaviors. Odds increased significantly with increasing levels of family rejection."

https://www.liebertpub.com/doi/abs/10.1089/lgbt.2015.0111?journalCode=lgbt

Analysis finds strong consensus on effectiveness of gender transition treatment

Published in: Cornell Chronicle. April 9, 2018

"Of 56 peer-reviewed studies, 52 (93 percent) found that gender transition improves the overall well-being of transgender people. The other 7 percent reported mixed or null findings. None of the reviewed studies showed that gender transition harms well-being."

"The positive outcomes of gender transition and related medical treatments include improved quality of life, greater relationship satisfaction, higher self-esteem and confidence, and reductions in anxiety, depression, suicidal tendencies and substance use."

"The positive impact of gender transition has grown considerably in recent years, as surgical techniques and social support have improved."

"Regrets following gender transition are extremely rare and have become increasingly rarer."

http://news.cornell.edu/stories/2018/04/analysis-finds-strong-consensus-effectiveness-gender-transition-treatment