Healthcare Preferences of Lesbian, Gay, Bisexual, Transgender and Questioning Youth

doi:10.1016/j.jadohealth.2009.01.009

Journal of Adolescent Health

Volume 45, Issue 3, September 2009, Pages 222-229

https://doi.org/10.1016/j.jadohealth.2009.01.009 Get rights and content

Purpose

Lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth appear to be at higher risk for certain adverse health outcomes, and to have several personal, cultural and structural barriers to accessing healthcare. Little is known, however, about the experiences of LGBTQ youth with healthcare providers and healthcare services. Our goal was to recruit a sample of LGBTQ youth and to determine their preferences regarding healthcare providers, healthcare settings and the health issues that they consider important to discuss with a healthcare provider.

Methods

We conducted a cross-sectional Internet-based survey. Respondents ages 13-21 years and living in the U.S. or Canada were asked to review three lists of items pertaining to qualities of healthcare providers, qualities of offices or health centers, and concerns or problems to discuss with a healthcare provider, and then to assign for each item a relative importance. Items in each of the three lists were then ranked, and differences among ranks were assessed. Inter-group differences by age, gender, and race/ethnicity were also assessed.

Results

733 youth met eligibility criteria. Youth indicated as most important competence overall and specifically in issues unique to taking care of youth and LGBTQ persons, as well as being respected and treated by providers the same as other youth. Notably, youth ranked as least important the provider's gender and sexual orientation. Youth ranked accessibility issues higher than specific services provided. As health concerns to discuss with a provider, youth ranked preventive healthcare, nutrition, safe sex, and family as important as common morbidities.

Conclusions

Youth placed as much importance on provider qualities and interpersonal skills as provider knowledge and experience, and placed little importance on a provider's gender and sexual orientation. Youth indicated the importance of providers addressing not only health risks, but also wellness and health promotion, and to do so within the context of home and family. Subgroup analyses underscore the need for greater sensitivity to both cultural and developmental differences among LGBTQ youth. These results provide a foundation for further research about healthcare services and delivery systems for youth, training initiatives for healthcare providers, and the role of utilizing the Internet for health research purposes to access and recruit hard-to-reach youth.

Section snippets

Sample

To include a heterogeneous group of LGBTQ youth, we placed the survey within an established Internet Web site, Youth Guardian Services (www.youth-guard.org), a youth-run, 501(c)(3) nonprofit organization that provides support services on the Internet to LGBTQ and straight supportive youth through creating secure, age-specific e-mail groups, and by providing lists of resources, and links to other youth-supportive Web sites. The top 10 search phrases or keywords for the YGS site include youth,

Results

A total of 788 youth responded to the Web-based survey, with no duplicates noted. Of the respondents, 15 were excluded because of age outside of required range and 25 because they were living outside the U.S. or Canada. Nine were excluded due to missing age, and 10 due to missing location of residence (four were missing both age and geographic location).

Of the 733 remaining (Table 1), the average age was 16.9 (SD = 2.2) years, and 84% were currently in school, with 5% out of school before

Discussion

This study targeted an often hard to reach subpopulation of youth, with special health risks and special barriers to fully accessing healthcare services. The sample of LGBTQ youth is uniquely heterogeneous in three ways: (1) geographic diversity: across North America and both urban and nonurban settings; (2) affiliation diversity: one-fourth attended LGBTQ youth–serving agencies and three-fourths did not; and (3) healthcare use diversity: three-fourths reported having had a routine healthcare

Acknowledgments

The authors acknowledge Jason Hungerford, Executive Director, Youth Guardian Services for his pro-bono work to transforming the study into a secure on-line questionnaire on the YGS website, an act of generosity consistent with his dedication to promoting the well-being of LGBT youth; and Dr. Hal Strelnick for his thoughtful and discerning review of the manuscript. This work was supported by a grant from Bronx CREED (1 P60 MD000514-01), National Center on Minority Health & Health Disparities.

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LGBTQ young adults are at increased risk for food insecurity and disordered eating behaviors. Food literacy is a related construct that may also impact disordered eating; however, research on these relationships is limited. It is also not well understood if food security and food literacy relate to disordered eating behaviors differently for LGBTQ and heterosexual individuals. The current study examined these constructs in a sample of college students (n = 572; 22 % LGBTQ), as well as examined sexual orientation as a moderator in the relationship between food insecurity/food literacy and disordered eating outcomes. Results showed that LGBTQ individuals reported greater dieting/restricting, bulimia symptoms, oral control, and binge eating symptoms than heterosexual peers. LGBTQ students were also more likely to be food insecure and had significantly lower food literacy than heterosexual students. Sexual orientation significantly moderated the relationships between food insecurity and overall disordered eating, and between food insecurity and dieting/restricting behaviors. These relationships showed that very low food security was strongly related to disordered eating symptoms for LGBTQ individuals. Sexual orientation did not moderate the relationship between food literacy and disordered eating outcomes. These findings contribute to the overall literature on food insecurity and disordered eating for the LGBTQ community through replicating past findings, and also provide new information about relationships between food literacy, food insecurity, disordered eating, and the role of sexual orientation.
Safe spaces that matter: Material semiotics, affective bodies and queer readings of clinical spaces in Winnipeg, Canada
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Communities that claim “2SLGBTQ+” (Two Spirit, Lesbian, Gay, Bisexual, Trans, and Queer plus) identities experience profound inequities within healthcare settings. In response, scholars and advocates have engaged in conversations about creating “safe space,” for them. These “safe spaces” are said to be produced through the display of objects such as pride flag stickers and queer inclusive posters, as well as through “queer friendly” staff trained to meet the healthcare needs associated with 2SLGBTQ + people. Such literature, however, often underplays the dynamic heteronormative spacialities of the clinic, and in particular the ways in which gender and/or sexual nonconforming patients negotiate feelings of safety within unequal social fields that assemble an array of human and non-human actors that present in medical space. Drawing on a qualitative study with 42 people identifying as queer and lesbian women and non-binary people living in a mid-sized Canadian city, we employ material semiotics to think through the networked effects of human and non-human entanglements that participants narrate as “safe” or “unsafe.” We argue that current understandings of “safe space” flatten the complex and textured interactions and affective dispositions emergent between queer patients and the clinical environment, and develop the concept of safe spaces that matter – sites of complex bodily and spatial engagements which are highly productive in rendering multiple accounts of the body as either legible in its (hetero)normativity or pathological in its alterity and unreadability. As such, a more spatially embodied and contingent picture of “clinical care” comes into view which, we maintain, is necessary in creating spaces that are truly open to the multiplicity of nonconforming embodiments which present themselves daily in medical space.
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Compared to transfeminine adolescents, more non-affirming healthcare experiences were reported by nonbinary (β = 1.41, 95% confidence interval [CI]: 0.49, 2.33) and transmasculine adolescents (β = 0.78, 95% CI: 0.02, 1.53). Gender-affirming healthcare experiences did not differ by demographics. Transmasculine adolescents had over three times the odds of lifetime healthcare avoidance (adjusted odds ratio [aOR] = 3.58, 95% CI: 1.41, 9.08) than transfeminine peers. Only younger age was associated with past-year well visit (aOR = 3.83, 95% CI: 1.44, 10.17). Non-affirming healthcare experiences were positively associated with healthcare avoidance (aOR = 1.85, 95% CI: 1.47, 2.34). Gender-affirming healthcare experiences were not associated with healthcare avoidance or past-year well visit.
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Citation Excerpt :
Responses were on a five-point Likert scale ranging from always to never, with responses of rarely and never collapsed into a single category for analysis. Participants were asked if they had previously experienced any of 6 nonaffirming interactions or 8 affirming interactions (yes/no), derived from prior studies.8-11 Youth were asked to indicate settings where they were “made to feel uncomfortable” because of their gender identity, “felt forced to disclose” their gender identity, or had “purposely altered their gender expression due to fear of discrimination.”
Results of an Online Survey about Food Insecurity and Eating Disorder Behaviors Administered to a Volunteer Sample of Self-Described LGBTQ+ Young Adults Aged 18 to 35 Years
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There are few published studies addressing food insecurity and eating disorders in lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) individuals.
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Members of the LGBTQ+ community are at greater risk for food insecurity, eating disorders, and depression, particularly those who identify as trans males. These findings denote the need to focus future research efforts on effective prevention and treatment strategies that are specific to sexual and gender identity groups within the LGBTQ+ community.

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Original articleHealthcare Preferences of Lesbian, Gay, Bisexual, Transgender and Questioning Youth

Purpose

Methods

Results

Conclusions

Section snippets

Sample

Results

Discussion

Acknowledgments

J Adolesc Health

J Pediatr Adolesc Gynecol

J Adolesc

J Adolesc Health

J Adolesc Health

Association between health risk behaviors and sexual orientation among a school-based sample of adolescents

Pediatrics

Sexual Orientation and Adolescents

Pediatrics

Healthcare needs of gay men and lesbians in the United States

J Am Med Assoc

Adolescents' perceptions of factors affecting their decisions to seek healthcare

J Am Med Assoc

Searching for solutions. The importance of including teenagers in the research process

J Dev Behav Pediatr

Group Techniques for Program Planning: A Guide to Nominal Group and Delphi Processes

Original article
Healthcare Preferences of Lesbian, Gay, Bisexual, Transgender and Questioning Youth