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The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding 4 Childhood/Adolescence To understand the context of a person’s life course, it is critical to understand the age cohort to which that individual belongs. Youth growing up today will see changes that earlier generations of lesbians and gay men would never have expected in their lifetimes, including politicians, business leaders, and educators who are openly gay; marriage between same-sex couples; and an evolving popular and artistic culture that provides many positive portrayals of lesbian and gay characters in movies and plays, on television, and in literature. Today’s youth are able to use the Internet to retrieve online information about LGBT issues, providing social networking opportunities and access to knowledge in a way that was not available to older cohorts. At the same time, young LGBT people searching the Internet and interacting with their peers will be aware of the pervasive negative views of sexual and gender minorities. Likewise, many transgender elders did not even know as children that other transgender people existed, and certainly received little acknowledgment of their transgender feelings. By contrast, many transgender children and adolescents today have role models (either in the media or in real life), and their gender-variant expression is often sufficient for parents to obtain more information and access existing networks of families with gender-variant children. Moreover, transgender youth today have access to early medical intervention to alleviate any gender dysphoria (defined as discomfort with one’s sex assigned at birth) they might experience. In this report, childhood and adolescence encompasses the life course through the emergence of adulthood, generally understood by the committee to occur in the early 20s. During this phase of life, a person, regardless
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The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding of his or her sexual orientation or gender identity, develops from a child who must be cared for to a self-reliant individual. The developmental changes that occur are complex, particularly with the onset of puberty. LGBT youth face the same challenges as their heterosexual peers, but also stigma that may contribute to the identified disparities in health status between sexual- and gender-minority youth and heterosexual youth. The ability to address these disparities is hampered by our lack of knowledge about LGBT youth. One of the challenges of discussing the development of children and adolescents who are LGBT is that beliefs and biases have often precluded substantive research. Not long ago, for example, a prevailing notion was that one’s sexual identity and orientation did not emerge until late adolescence and that an attraction to people of the same sex was likely a passing phase (Money, 1990). Moreover, efforts to survey young people about their sexual orientation have been fraught with difficulties at both the institutional review board and community levels. These barriers have impeded important developmental research. While the current state of knowledge regarding the health of LGBT youth is derived from limited research, it is worth noting that much of this research has focused on mental health; little research has been conducted on the physical health of LGBT youth because, like most other youth, they generally do not struggle with chronic diseases that impact their physical health. As mentioned in previous chapters, the disparities in both mental and physical health that are seen between LGBT and heterosexual and non-gender-variant youth are influenced largely by their experiences of stigma and discrimination during the development of their sexual orientation and gender identity and throughout the life course. This chapter begins with a discussion of the development of sexual orientation and gender identity in LGBT youth. The chapter then reviews the research on mental health and then physical health in these youth. Risk and protective factors and health services are then addressed in turn. The chapter next examines contextual influences, such as demographic characteristics and the role of the family. The chapter concludes with a summary of key findings and research opportunities. Of note, the chapter emphasizes adolescence rather than childhood because of the limited research available on younger children’s and pre-adolescents’ awareness of, feelings about, and experiences with being LGBT. DEVELOPMENT OF SEXUAL ORIENTATION AND GENDER IDENTITY Adolescents are engaged in an ongoing process of sexual development (Rosario et al., 2008); many adolescents may be unsure of their sexual orientation, while others have been clear about it since childhood. This ongo-
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The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding ing process suggests that for some adolescents, self-identification of sexual orientation and the sex of sexual partners may change over time and may not necessarily be congruent (Saewyc et al., 2004). The development of sexual identity in lesbian, gay, and bisexual individuals is a unique process that has been widely reported in the scientific literature and popular culture but has received surprisingly little empirical attention. Early models of sexual identity development were generated on the basis of retrospective descriptions by adults. Models of homosexual identity development proposed by Cass (1979) and Troiden (1989) describe a staged process that (1) recognizes the impact of stigma that affects both the formation and expression of homosexual identity, (2) unfolds over a period of time, (3) involves increasing acceptance of a homosexual identity, and (4) includes disclosure to other persons. However, these models were developed at a time in which access to information about sexual orientation was limited; negative attitudes about homosexuality were more prevalent; and few resources existed for the study of LGB populations, particularly adolescents. Furthermore, the development of these theoretical models was based on the retrospective experiences of white adults. The first study to explore the development of adolescent lesbian and gay identity in depth included 202 LGB adolescents, more than half of whom were racial minority youth (Herdt and Boxer, 1993). The mean age of self-identification as lesbian or gay was 16.7 years for males and 16 years for females. Gay males were, on average, aware of same-sex attraction at about age 9; the average age for lesbians was 10. Based on the results of their study, the researchers concluded that sexual identity development should be viewed as an ongoing process rather than as a series of stages or phases. Investigators who conducted early work on the development of sexual orientation identity argued that coming out or self-identifying as lesbian or gay during adolescence may be a developmental process seen only in contemporary LGB youth—one that may have unique consequences for later life-course development compared with lesbian and gay adults who did not come out during adolescence (Boxer and Cohler, 1989). Herdt and Boxer (1993) document the process of transition from a heterosexual to a gay identity in the context of LGB cultural supports (social institutions, a gay youth program, lesbian and gay adult role models). Boxer and Cohler (1989) observe that one of the major developmental tasks for lesbian and gay youth is the deconstruction of previously internalized heterosexual expectations and the construction of a new set of future expectations of the gay and lesbian life course. A range of investigators have focused on “milestones” as indicators of sexual identity development among LGB adolescents. These include age of awareness of sexual attraction; age of self-labeling as lesbian, gay, or
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The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding bisexual; age of disclosure of same-sex orientation; and age of first sexual experience. Research subsequent to Herdt and Boxer’s early work found comparable ages of first awareness of sexual attraction (i.e., approximately age 10) (e.g., D’Augelli, 2006; D’Augelli and Hershberger, 1993; Rosario et al., 1996). “Coming out” or self-identifying and subsequently sharing that identity with others is a process that occurs in a social and historical context. Earlier literature indicates that this experience may be especially challenging for young people who come out during adolescence, given the need to integrate an LGB identity with other aspects of identity development in the context of social stigma and discrimination. However, little current research is available to show how this process might differ for contemporary adolescents as a result of increased awareness, greater access to information, and changes in media representation of LGB people. More research is needed to understand the process of coming out for diverse populations of LGB youth. Similarly, little research has focused on sexual identity development among ethnically diverse LGB adolescents. Development experiences may differ as adolescents negotiate both ethnic and sexual orientation identity. One community-based study of 145 white, black, and Latino LGB youth aged 14–21 found no differences in sexual identity, current sexual orientation, or comfort with and acceptance of sexual identity among the three racial groups (Rosario et al., 2004). However, black youth were involved in fewer gay-related social activities, were less comfortable with others knowing about their sexual identity, and disclosed their sexual orientation to fewer persons than their white peers. While Latino youth disclosed their LGB identity to fewer people than white or black youth, they were more comfortable with others knowing about their LGB identity than members of the other racial groups. More recent research examined ethnic and sexual identity development during adolescence among 22 black and Latino gay youth aged 16–22 (Jamil et al., 2009). The researchers found that ethnic and sexual identity developed concurrently during adolescence, but the processes were different and not related. Ethnic identity development was shaped by growing awareness of the youth’s ethnic and cultural heritage and was supported by peers; family members; and cultural markers such as food, music, and holidays. Sexual identity development was supported by community-based organizations, peers, and information from the Internet. Sexual identity development was described as a private process, while ethnic identity development was viewed as a more public process. The ongoing process of sexual development among adolescents presents challenges to the collection of data on the size of the population of LGB youth, although some studies using large samples of adolescents have examined the prevalence of same-sex attraction, same-sex sexual behavior,
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The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding and LGB identities. In the 1999 wave of the Growing Up Today Study (n = 10,685), a national survey of adolescents aged 12–17, approximately 1 percent of adolescents identified as homosexual or bisexual (n = 103), with 5 percent identifying as mostly heterosexual (n = 511) and 2 percent identifying as unsure (n = 226) (Austin et al., 2004a). In the first wave of the National Longitudinal Study of Adolescent Health, conducted among 7th- through 12th-grade adolescents (n = 11,940), 5 percent of females and about 7.3 percent of males reported same-sex romantic or sexual attractions (Russell and Joyner, 2001). DuRant and colleagues (1998), reporting on the prevalence of reported same-sex sexual behavior using the 1995 wave of the Vermont Youth Risk Behavior Survey (n = 3,886 sexually active 8th-through 12th-grade males), found that 8.7 percent of high school males reported having had at least one same-sex partner (DuRant et al., 1998). Similar to sexual orientation identity, gender expression is not necessarily constant throughout childhood development. Gender variance, as it relates to expressing and exploring gender identity and gender roles, is a part of normal development. A relatively small percentage of gender-variant children develop an adult transgender identity (Green, 1987; Wallien and Cohen-Kettenis, 2008; Zucker and Bradley, 1995). However, research shows that the majority of adolescents with a gender-variant identity develop an adult transgender identity (Wallien and Cohen-Kettenis, 2008). Data on the prevalence of childhood gender-variant or transgender identities are severely limited, largely because there is no national database available to collect such data. A relatively small number of studies using nonprobability samples have attempted to assess the incidence of childhood gender-variant identities. One such study, discussed in Chapter 2, found that 1 percent of parents of boys aged 4–11 reported that their son wished to be of the other sex; for girls, the percentage was 3.5 percent (Zucker et al., 1997). Other studies using small nonprobability samples have documented trends in referrals to gender identity clinics by gender and persistence of gender identity concerns into adolescence and adulthood. One study examining children aged 3–12 with gender identity issues in a Toronto clinic (n = 358) and a Utrecht clinic (n = 130) showed that boys were referred more often and at an earlier age than girls for such concerns (Cohen-Kettenis et al., 2003). In another small study (n = 77) examining psychosexual outcomes of gender-dysphoric children at age of referral and then at follow-up approximately 10 years later, 27 percent of those with childhood gender identity concerns were still gender dysphoric (Wallien and Cohen-Kettenis, 2008). (It should be noted that at follow-up, 30 percent of the sample failed to respond to recruitment letters or were not traceable.) Research with small clinical samples of gender-variant children has shown that, compared with controls, gender-variant children have more difficulties with peer relationships (Zucker et al., 1997); this is the case particularly for
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The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding boys compared with girls (Cohen-Kettenis et al., 2003). Poor peer relations was found to be the strongest predictor of behavior problems in both gender-variant boys and girls (Cohen-Kettenis et al., 2003). One small study showed that children with gender identity disorder (n = 25) may have a more anxious nature than gender-conforming children (n = 25) (Wallien et al., 2007). Grossman and D’Augelli (2006) conducted focus groups with young self-identified transgender males and females aged 15–21 and explored factors related to physical and mental health. In this qualitative study, most of the youth reported experiences of family and peers reacting negatively toward their gender-atypical behaviors. Therapy or counseling that aims to change an individual’s sexual orientation, often based on the presumption that LGBT orientation/identity is abnormal or unhealthy, is known as conversion or reparative therapy (Just the Facts Coalition, 2008). The nation’s most prominent medical and mental health professional organizations, including the American Medical Association, the American Psychiatric Association, and the American Psychological Association, oppose the use of conversion therapy with both youth and adults (AMA, 2010; American Psychiatric Association, 2000a). The American Psychological Association formed a task force to review peer-reviewed studies on efforts to change sexual orientation. The task force concluded that evidence is lacking for the effectiveness of efforts to change sexual orientation and that conversion therapy may cause harm to LGBT individuals by increasing internalized stigma, distress, and depression (American Psychological Association, 2009). Instead, the task force expressed support for the use of affirmative, culturally competent therapy that helps those facing distress related to their sexual orientation cope with social and internalized stigma and strengthen their social support networks (American Psychological Association, 2009). MENTAL HEALTH STATUS As noted, most of the research conducted among LGBT youth has examined their mental health status. Although a small amount of the literature explores the process of sexual orientation and gender identity development among LGBT youth (see the preceding section), a greater portion of the literature focuses on sexual-minority youth’s risk for suicidality and depression; few studies examine the prevalence of mood, anxiety, or eating disorders in these populations. As discussed below, the lack of data in many areas of mental health demonstrates the need for further research on the mental health status of LGBT youth. It is important to note that LGBT youth are typically well adjusted and mentally healthy. Research based on probability samples with LGB youth consistently indicates that the majority do not report mental health
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The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding problems (Mustanski et al., 2010b; Russell and Joyner, 2001). Regarding transgender youth, although no data from national probability samples are available, studies with sizable convenience samples indicate that many, if not most, of these youth do not report mental health problems (Clements-Nolle et al., 2001; Nuttbrock et al., 2010). Mood and Anxiety Disorders Most of the research that has been conducted on mental health disorders among LGBT youth has relied on symptom or distress scales rather than formal clinical diagnoses (Mustanski et al., 2010b). To the committee’s knowledge, only two published studies have assessed LGBT adolescents diagnostically. Fergusson and colleagues (1999) conducted a study in New Zealand on the risk of psychiatric disorder and suicidal behavior using data from a birth cohort. They found that, relative to youth who identified as heterosexual, youth who identified as lesbian, gay, or bisexual were between 1.8 and 2.9 times more likely to experience generalized anxiety disorder, major depression, and conduct disorder. It should be noted, however, that of the 1,007 youth surveyed, only 28 self-identified as LGB or described past relationships with same-sex partners (Fergusson et al., 1999). More recently, Mustanski and colleagues (2010b) administered a structured diagnostic interview to a community sample of 246 LGBT youth. They found that, although the youth in the sample showed a higher prevalence of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnoses compared with national data, the prevalence was similar to that among another sample of urban, ethnically diverse youth from the same geographic area. Depression and Suicidality Over the past decade, an increasing number of studies based on large probability samples have consistently found that LGB youth and youth who report same-sex romantic attraction are at increased risk for suicidal ideation and attempts, as well as depressive symptoms, in comparison with their heterosexual counterparts. These include both school-based, state-based, and national studies (Almeida et al., 2009; Birkett et al., 2009; Bontempo and D’Augelli, 2002; Garofalo et al., 1999; Jiang et al., 2010; Russell and Joyner, 2001; Saewyc et al., 2007). The results of these studies suggest increased rates of suicidal ideation and attempts among LGB youth in comparison with heterosexual youth even after controlling for potentially confounding factors such as substance use and depression. These population-based studies followed more than two decades of community-based studies of LGB youth that showed elevated reported rates of suicidal
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The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding ideation and attempts and identified predictors of suicidality in these populations, although it should be noted that, much as with the larger population of young people, it is a small group of LGB youth who report suicidal behavior. With few exceptions, the increased rate of suicidality among LGB youth in comparison with heterosexual youth is consistent across age groups (i.e., middle school, high school, and young adult populations), gender (i.e., male, female, transgender), race/ethnicity (e.g., white, black, Latino, Asian/ Pacific Islander, American Indian/Alaska Native), and differing definitions of sexual orientation (i.e., same-sex attraction, self-identification, and behavior) (Almeida et al., 2009; Birkett et al., 2009; Bontempo and D’Augelli, 2002; Faulkner and Cranston, 1998; Garofalo et al., 1998, 1999; Jiang et al., 2010; Saewyc et al., 2007). However, evidence from longitudinal studies on suicidality over time among LGB youth is lacking. Some older evidence disputes the idea of increased rates of completed suicide among LGB youth. Two studies using postsuicide data found no association between suicide and sexual orientation (Rich et al., 1986; Shaffer et al., 1995). However, capturing information about sexual orientation is especially difficult postsuicide since adolescents who are highly conflicted about their sexual orientation may not share these concerns with others. Moreover, these studies examined completed suicides from more than 20 years ago, when it was more difficult to be openly gay during adolescence. In addition, results of two community-based studies suggest that some of the suicide attempts reported by LGB youth may not be life-threatening, but rather low-risk suicidal ideation or plans (Savin-Williams, 2001). These studies have been challenged for potentially drawing on relatively low-risk populations, however (Russell, 2003). Many risk factors, both general and LGB-specific, have been implicated in the increased rates of suicidal behavior among LGB youth (see the detailed discussion of risk factors for the health of LGBT youth later in this chapter). General risk factors have been implicated in suicidal behavior in the larger population of youth and tend to be high among LGB youth. They include depression, substance use, early sexual initiation, not feeling safe at school, cigarette smoking, and inadequate social support. These factors may partially mediate the increased risk of suicidality for LGB youth, although results of studies on this association are mixed (Fergusson et al., 1999; Garofalo et al., 1999; Russell and Joyner, 2001). Specific factors related to sexual-minority status, including homophobic victimization and stress (Huebner et al., 2004; Safren and Heimberg, 1999; Savin-Williams and Ream, 2003), are associated with suicidal behavior. In a study of 528 self-identified LGB youth aged 15–19, D’Augelli and colleagues (2005) found that recognizing same-sex attraction, initiating same-sex sexual activity, or appearing gender nonconforming at earlier ages was associated
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The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding with reported suicide attempts in LGB youth; this association may be exacerbated by experiences of victimization and maltreatment (Corliss et al., 2009; Friedman et al., 2006). Family rejection due to sexual orientation may also be associated with increased risk of suicidality. In the previously mentioned study of 528 LGB youth, greater childhood parental psychological abuse and parental efforts to discourage gender-atypical behavior were associated with increased risk of suicide attempts (D’Augelli et al., 2005). Similarly, a study of 224 self-identified LGB youth aged 21–25 found that higher rates of family rejection were associated with increased rates of reports of attempted suicide, high levels of depression, and risk behaviors (Ryan et al., 2009). Conversely, findings from a study of 245 Latino and non-Latino white self-identified LGBT youth (aged 21–25) suggest that family acceptance of and supportive reactions to an adolescent’s LGBT identity may be protective against depression and suicidal ideation and attempts (Ryan et al., 2010). Using data from the 2004 Minnesota Student Survey of 9th and 12th graders (n = 21,927), Eisenberg and Resnick (2006) found that family connectedness, adult caring, and school safety may also be protective against suicidal ideation and attempts. Evidence from several large samples of middle and high school students suggests that the above LGB-specific factors, including victimization and perceived discrimination, largely mediate the association between sexual-minority status and both depressive symptoms and suicidal behavior (Almeida et al., 2009; Birkett et al., 2009; Bontempo and D’Augelli, 2002). Because large data sets have not measured whether people are transgender, information on suicidal behavior and depressive symptoms among transgender youth is limited to relatively small convenience samples. In a nonprobability sample of 515 transgender people (n = 392 male-to-female and n = 123 female-to-male), Clements-Nolle and colleagues (2006) found that 47 percent of participants younger than 25 (n = 66) had a history of attempted suicide. Another study, of 55 transgender youth aged 15–21, found that 45 percent seriously thought about taking their lives, and 26 percent reported a history of life-threatening behavior (Grossman and D’Augelli, 2007). These studies suggest there is an elevated risk for depression and attempted suicide among transgender youth. Limited cross-sectional research has explored mental health–related disparities among urban samples of transgender youth. Nuttbrock and colleagues (2010) examined the life course of 571 transgender females aged 19–59 (separated into two age groups: 19–39 and 40–59). The authors found that gender-related interpersonal abuse was a significant health problem in the sample. Among the younger group of transgender women, 15.6 percent reported an attempted suicide during adolescence. Among the older
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The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding group, 23.5 percent experienced major depression during adolescence. In addition, interpersonal abuse associated with gender atypicality, not infrequently at the hands of parents or other family members, was associated with both major depression and suicidality as defined by DSM-IV. These associations, particularly with depression, were extremely strong during adolescence, and tended to decline over time but remain significant over the life course. Interventional approaches to prevent suicidality among LGBT youth have not been widely tested. The published literature includes suggestions to encourage greater awareness and appropriate treatment by health care providers (Kitts, 2005), psychotherapists (Hart, 2001), and school personnel (Bontempo and D’Augelli, 2002); to educate and counsel parents and families to decrease rejecting and increase supportive behaviors (Ryan et al., 2010); or to use specific media to reach isolated youth, such as Web-based social networks (Silenzio et al., 2009). To the committee’s knowledge, however, no specific interventions have been tested. In addition, little research has examined suicidality by race/ethnicity. Eating Disorders/Body Image A large cohort study provides some evidence that eating disorders follow gender-specific patterns among LGB youth. In data from the previously mentioned 1999 Growing Up Today Study (n = 10,583 youth), lesbian and bisexual girls, who were combined in the study (n = 59), were found to be more content with their bodies and less likely to report trying to look like images of women in the media than were heterosexual girls. On the other hand, the study found that gay and bisexual boys, also combined in the study (n = 38), were more likely than heterosexual boys to report trying to look like images of men in the media (Austin et al., 2004b). In another study, using the 1998–2005 waves of the Growing Up Today Study (n = 13,795), youth who described themselves as lesbian/gay, bisexual, and “mostly” heterosexual had higher rates of binge eating than their heterosexual peers, and all subgroups with the exception of lesbians had higher rates of purging (vomiting and/or using laxatives to control weight) throughout adolescence (Austin et al., 2009a). While these are provocative findings, they come from only two studies; more research is required to either confirm or refute them. Additionally, if these findings are accurate, more research is needed to understand the mechanisms that put these youth at increased risk for eating disorders. Results of one study using data from the 1995 and 1997 waves of the Vermont (n = 14,623) and Massachusetts (n = 8,141) Youth Risk Behavior Surveys suggest that youth who reported having sex with both males and females were at greatest risk for a variety of problem behaviors, including
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The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding disordered eating. In Vermont, 25.6 percent of youth with sexual partners of both sexes reported using unhealthy weight control practices, compared with 12.3 percent of those with exclusively same-sex sexual partners and 7.1 percent of those with exclusively opposite-sex sexual partners. In Massachusetts these practices were reported by 37.4 percent of students with sexual partners of both sexes, compared with 15.3 percent of those with exclusively same-sex sexual partners and 7.0 percent of those with exclusively opposite-sex sexual partners. This study was based on sexual behavior, not identity (Robin et al., 2002). The literature on eating disorders among LGBT youth is based on large data sets, unlike most of the literature on these populations, which often relies on small convenience samples. However, the research on eating disorders in these populations is still sparse. Transgender-Specific Mental Health Status DSM-IV includes diagnoses of gender identity disorder for children as well as for adolescents (and adults) (American Psychiatric Association, 2000b). The criteria for diagnosis of childhood gender identity disorder are listed in Box 4-1. This diagnosis has been controversial, particularly when applied to children. One objection raised is that including this phenomenon as a psychiatric diagnosis identifies gender-variant identity and expression as pathological, even though many gender-variant children do not report emotional distress; rather, distress may be related to the reaction of the social environment to the child’s gender variance. Also, as noted earlier in this chapter, most children with gender-variant expression do not develop an adolescent or adult transgender identity (Wallien and Cohen-Kettenis, 2008), and many adults with a transgender identity do not report symptoms of childhood gender identity disorder (Lawrence, 2010). More specifically, this diagnosis has been criticized for conflating gender-variant expression with gender-variant identity. At least four of the five criteria are required to qualify for the diagnosis, and only one of these explicitly refers to crossgender identification, allowing children with gender-variant expression but without a variant gender identity to qualify for the diagnosis (see also Bockting and Ehrbar, 2006). The approach to treatment of gender identity disorder among children includes early therapeutic interventions with the child, and perhaps with the family, school, and/or community, to broaden the child’s gender role interests and behavior and/or provide a safe environment to allow gender identity to develop while preventing rejection, ridicule, and abuse from peers (Benestad, 2009; Brill and Pepper, 2008; Menvielle and Tuerk, 2002; Meyer-Bahlburg, 2002; Rosenberg, 2002; Zucker, 2008). The approach to treatment of gender identity disorder among adolescents includes
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The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding American Psychiatric Association. 2000a. Therapies focused on attempts to change sexual orientation (reparative or conversion therapies): Position statement. http://www.psych.org/Departments/EDU/Library/APAOfficialDocumentsandRelated/PositionStatements/200001.aspx (accessed September 2, 2010). American Psychiatric Association. 2000b. Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV-TR). Washington, DC: American Psychiatric Association. American Psychological Association. 2009. Report of the task force on appropriate therapeutic responses to sexual orientation. Washington, DC: American Psychological Association. Austin, S. B., N. Ziyadeh, L. B. Fisher, J. A. Kahn, G. A. Colditz, and A. L. Frazier. 2004a. Sexual orientation and tobacco use in a cohort study of US adolescent girls and boys. Archives of Pediatrics & Adolescent Medicine 158(4):317–322. Austin, S. B., N. Ziyadeh, J. A. Kahn, C. A. Camargo, Jr., G. A. Colditz, and A. E. Field. 2004b. Sexual orientation, weight concerns, and eating-disordered behaviors in adolescent girls and boys. Journal of the American Academy of Child & Adolescent Psychiatry 43(9):1115–1123. Austin, S. B., A. L. Roberts, H. L. Corliss, and B. E. Molnar. 2008. Sexual violence victimization history and sexual risk indicators in a community-based urban cohort of “mostly heterosexual” and heterosexual young women. American Journal of Public Health 98(6):1015–1020. Austin, S., N. J. Ziyadeh, H. L. Corliss, M. Rosario, D. Wypij, J. Haines, C. A. Camargo, Jr., and A. E. Field. 2009a. Sexual orientation disparities in purging and binge eating from early to late adolescence. Journal of Adolescent Health 45(3):238–245. Austin, S. B., N. J. Ziyadeh, H. L. Corliss, J. Haines, H. R. Rockett, D. Wypij, and A. E. Field. 2009b. Sexual orientation disparities in weight status in adolescence: Findings from a prospective study. Obesity 17(9):1776–1782. Benestad, E. E. P. 2009. Addressing the disturbed, like ripples in water: Intervention with the social networks of children who transe. Sexual and Relationship Therapy 24(2):207–216. Birkett, M., D. L. Espelage, and B. Koenig. 2009. LGB and questioning students in schools: The moderating effects of homophobic bullying and school climate on negative outcomes. Journal of Youth & Adolescence 38(7):989–1000. Blake, S. M., R. Ledsky, T. Lehman, C. Goodenow, R. Sawyer, and T. Hack. 2001. Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: The benefits of gay-sensitive HIV instruction in schools. American Journal of Public Health 91(6):940–946. Bockting, W. O., and R. Ehrbar. 2006. Commentary: Gender variance, dissonance, or identity disorder. Journal of Psychology and Human Sexuality 17(3/4):125–134. Bontempo, D. E., and A. R. D’Augelli. 2002. Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths’ health risk behavior. Journal of Adolescent Health 30(5):364–374. Boxer, A. M., and B. J. Cohler. 1989. The life course of gay and lesbian youth: An immodest proposal for the study of lives. Journal of Homosexuality 17(3-4):315–355. Brill, S. A., and A. Pepper. 2008. The transgender child: A handbook for families and professionals. Berkeley, CA: Cleis Press. Cass, V. C. 1979. Homosexual identity formation: A theoretical model. Journal of Homosexuality 4(3):219–235. CDC (Centers for Disease Control and Prevention). 2008. Trends in HIV/AIDS diagnoses among men who have sex with men—33 states, 2001–2006. Morbidity and Mortality Weekly Report 57(25):681–686. CDC. 2009. Sexual and reproductive health of persons aged 10–24 years—United States, 2002–2007. http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5806a1.htm (accessed July 17, 2009).
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The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Child Welfare League of America. 2006. Out of the margins: A report on regional listening forums highlighting the experiences of lesbian, gay, bisexual and transgender youth in care. Washington, DC: Child Welfare League of America. Choi, K.-H., D. Operario, S. E. Gregorich, W. McFarland, D. MacKellar, and L. Valleroy. 2005. Substance use, substance choice, and unprotected anal intercourse among young Asian American and Pacific Islander men who have sex with men. AIDS Education & Prevention 17(5):418–429. Clatts, M. C., L. Goldsamt, H. Yi, and M. V. Gwadz. 2005. Homelessness and drug abuse among young men who have sex with men in New York City: A preliminary epidemiological trajectory. Journal of Adolescence 28(2):201–214. Clements-Nolle, K., R. Marx, R. Guzman, and M. Katz. 2001. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: Implications for public health intervention. American Journal of Public Health 91(6):915–921. Clements-Nolle, K., R. Marx, and M. Katz. 2006. Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. Journal of Homosexuality 51(3):53–69. Cochran, B. N., A. J. Stewart, J. A. Ginzler, and A. M. Cauce. 2002. Challenges faced by homeless sexual minorities: Comparison of gay, lesbian, bisexual, and transgender homeless adolescents with their heterosexual counterparts. American Journal of Public Health 92(5):773–777. Cohen-Kettenis, P. T., and S. H. M. van Goozen. 1997. Sex reassignment of adolescent transsexuals: A follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry 36(2):263. Cohen-Kettenis, P. T., A. Owen, V. G. Kaijser, S. J. Bradley, and K. J. Zucker. 2003. Demographic characteristics, social competence, and behavior problems in children with gender identity disorder: A cross-national, cross-clinic comparative analysis. Journal of Abnormal Child Psychology 31(1):41. Cohen-Kettenis, P. T., H. A. Delemarre-van de Waal, and L. J. G. Gooren. 2008. The treatment of adolescent transsexuals: Changing insights. The Journal of Sexual Medicine 5(8):1892–1897. Coker, T. R., S. B. Austin, and M. A. Schuster. 2010. The health and health care of lesbian, gay, and bisexual adolescents. Annual Review of Public Health 31:457–477. Corliss, H. L., S. D. Cochran, V. M. Mays, S. Greenland, and T. E. Seeman. 2009. Age of minority sexual orientation development and risk of childhood maltreatment and suicide attempts in women. American Journal of Orthopsychiatry 79(4):511–521. Corliss, H. L., M. Rosario, D. Wypij, S. A. Wylie, A. L. Frazier, and S. B. Austin. 2010. Sexual orientation and drug use in a longitudinal cohort study of U.S. adolescents. Addictive Behaviors 35(5):517–521. D’Augelli, A. R. 2002. Mental health problems among lesbian, gay, and bisexual youths ages 14 to 21. Clinical Child Psychology and Psychiatry 7(3):433–456. D’Augelli, A. R. 2006. Developmental and contextual factors and mental health among lesbian, gay, and bisexual youths. In Sexual orientation and mental health: Examining identity and development in lesbian, gay, and bisexual people, edited by A. M. Omoto and H. S. Kurtzman. Washington, DC: American Psychological Association. Pp. 37–53. D’Augelli, A. R., and S. L. Hershberger. 1993. Lesbian, gay, and bisexual youth in community settings: Personal challenges and mental health problems. American Journal of Community Psychology 21(4):421–448. D’Augelli, A. R., S. L. Hershberger, and N. W. Pilkington. 1998. Lesbian, gay, and bisexual youth and their families: Disclosure of sexual orientation and its consequences. American Journal of Orthopsychiatry 68(3):361–371.
OCR for page 176
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding D’Augelli, A. R., N. W. Pilkington, and S. L. Hershberger. 2002. Incidence and mental health impact of sexual orientation victimization of lesbian, gay, and bisexual youths in high school. School Psychology Quarterly 17(2):148–167. D’Augelli, A. R., A. H. Grossman, N. P. Salter, J. J. Vasey, M. T. Starks, and K. O. Sinclair. 2005. Predicting the suicide attempts of lesbian, gay, and bisexual youth. Suicide & Life-Threatening Behavior 35(6):646–660. D’Augelli, A. R., J. H. Rendina, K. O. Sinclair, and A. H. Grossman. 2006/2007. Lesbian and gay youth’s aspirations for marriage and raising children. Journal of LGBT Issues in Counseling 1(4):77–98. D’Augelli, A. R., A. H. Grossman, M. T. Starks, and K. O. Sinclair. 2010. Factors associated with parents’ knowledge of gay, lesbian, and bisexual youths’ sexual orientation. Journal of LGBT Family Studies 6(2):178–198. de Vries, A. L., T. D. Steensma, T. A. Doreleijers, and P. T. Cohen-Kettenis. 2010. Puberty suppression in adolescents with gender identity disorder: A prospective follow-up study. Journal of Sexual Medicine. http://onlinelibrary.wiley.com/doi/10.11.11/j.1743-6109.2010.09143.x/full (accessed May 25, 2011). Delemarre-van de Waal, H. A., and P. T. Cohen-Kettenis. 2006. Clinical management of gender identity disorder in adolescents: A protocol on psychological and paediatric endocrinology aspects. European Journal of Endocrinology 155(Suppl. 1):S131–137. Di Ceglie, D. 2009. Engaging young people with atypical gender identity development in therapeutic work: A developmental approach. Journal of Child Psychotherapy 35(1):3–12. Diamond, C., H. Thiede, T. Perdue, G. M. Secura, L. Valleroy, D. Mackellar, L. Corey, and T. Seattle Young Men’s Survey. 2003. Viral hepatitis among young men who have sex with men: Prevalence of infection, risk behaviors, and vaccination. Sexually Transmitted Diseases 30(5):425–432. Do, T. D., S. Chen, W. McFarland, G. M. Secura, S. K. Behel, D. A. MacKellar, L. A. Valleroy, and K. H. Cho. 2005. HIV testing patterns and unrecognized HIV infection among young Asian and Pacific Islander men who have sex with men in San Francisco. AIDS Education & Prevention 17(6):540–554. DuRant, R. H., D. P. Krowchuk, and S. H. Sinal. 1998. Victimization, use of violence, and drug use at school among male adolescents who engage in same-sex sexual behavior. Journal of Pediatrics 133(1):113–118. East, J. A., and F. El Rayess. 1998. Pediatricians’ approach to the health care of lesbian, gay, and bisexual youth. Journal of Adolescent Health 23(4):191–193. Easton, A., K. Jackson, P. Mowery, D. Comeau, and R. Sell. 2008. Adolescent same-sex and both-sex romantic attractions and relationships: Implications for smoking. American Journal of Public Health 98(3):462–467. Eisenberg, M. E., and M. D. Resnick. 2006. Suicidality among gay, lesbian and bisexual youth: The role of protective factors. Journal of Adolescent Health 39(5):662–668. Eisenberg, M. E., and H. Wechsler. 2003a. Substance use behaviors among college students with same-sex and opposite-sex experience: Results from a national study. Addictive Behaviors 28(5):899–913. Eisenberg, M. E., and H. Wechsler. 2003b. Social influences on substance-use behaviors of gay, lesbian, and bisexual college students: Findings from a national study. Social Science & Medicine 57(10):1913–1923. Faulkner, A. H., and K. Cranston. 1998. Correlates of same-sex sexual behavior in a random sample of Massachusetts high school students. American Journal of Public Health 88(2):262–266. Fergusson, D. M., L. J. Horwood, and A. L. Beautrais. 1999. Is sexual orientation related to mental health problems and suicidality in young people? Archives of General Psychiatry 56(10):876–880.
OCR for page 177
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Ford, J. A., and J. L. Jasinski. 2006. Sexual orientation and substance use among college students. Addictive Behaviors 31(3):404–413. Frankowski, B. L., and American Academy of Pediatrics Committee on Adolescence. 2004. Sexual orientation and adolescents. Pediatrics 113(6):1827–1832. Freedner, N., L. H. Freed, Y. W. Yang, and S. B. Austin. 2002. Dating violence among gay, lesbian, and bisexual adolescents: Results from a community survey. Journal of Adolescent Health 31(6):469–474. Friedman, M. S., G. F. Koeske, A. J. Silvestre, W. S. Korr, and E. W. Sites. 2006. The impact of gender-role nonconforming behavior, bullying, and social support on suicidality among gay male youth. Journal of Adolescent Health 38(5):621–623. Gangamma, R., N. Slesnick, P. Toviessi, and J. Serovich. 2008. Comparison of HIV risks among gay, lesbian, bisexual and heterosexual homeless youth. Journal of Youth & Adolescence 37(4):456–464. Garofalo, R., R. C. Wolf, S. Kessel, S. J. Palfrey, and R. H. DuRant. 1998. The association between health risk behaviors and sexual orientation among a school-based sample of adolescents. Pediatrics 101(5):895–902. Garofalo, R., R. C. Wolf, L. S. Wissow, E. R. Woods, and E. Goodman. 1999. Sexual orientation and risk of suicide attempts among a representative sample of youth. Archives of Pediatrics & Adolescent Medicine 153(5):487–493. Garofalo, R., J. Deleon, E. Osmer, M. Doll, and G. W. Harper. 2006. Overlooked, misunderstood and at-risk: Exploring the lives and HIV risk of ethnic minority male-to-female transgender youth. Journal of Adolescent Health 38(3):230–236. Garofalo, R., A. Herrick, B. S. Mustanski, and G. R. Donenberg. 2007a. Tip of the iceberg: Young men who have sex with men, the internet, and HIV risk. American Journal of Public Health 97(6):1113–1117. Garofalo, R., B. S. Mustanski, D. J. McKirnan, A. Herrick, and G. R. Donenberg. 2007b. Methamphetamine and young men who have sex with men: Understanding patterns and correlates of use and the association with HIV-related sexual risk. Archives of Pediatrics & Adolescent Medicine 161(6):591–596. Garofalo, R., B. Mustanski, and G. Donenberg. 2008. Parents know and parents matter: Is it time to develop family-based HIV prevention programs for young men who have sex with men? Journal of Adolescent Health 43(2):201–204. Garofalo, R., B. Mustanski, A. Johnson, and E. Emerson. 2010. Exploring factors that underlie racial/ethnic disparities in HIV risk among young men who have sex with men. Journal of Urban Health 87(2):318–323. Ginsburg, K. R., R. J. Winn, B. J. Rudy, J. Crawford, H. Zhao, and D. F. Schwarz. 2002. How to reach sexual minority youth in the health care setting: The teens offer guidance. Journal of Adolescent Health 31(5):407–416. Goodenow, C., L. Szalacha, and K. Westheimer. 2006. School support groups, other school factors, and the safety of sexual minority adolescents. Psychology in the Schools 43(5): 573–589. Goodenow, C., L. A. Szalacha, L. E. Robin, and K. Westheimer. 2008. Dimensions of sexual orientation and HIV-related risk among adolescent females: Evidence from a statewide survey. American Journal of Public Health 98(6):1051–1058. Green, R. 1987. The “sissy boy syndrome” and the development of homosexuality. New Haven, CT: Yale University Press. Grossman, A. H., and A. R. D’Augelli. 2006. Transgender youth: Invisible and vulnerable. Journal of Homosexuality 51(1):111–128. Grossman, A. H., and A. R. D’Augelli. 2007. Transgender youth and life-threatening behaviors. Suicide & Life-Threatening Behavior 37(5):527–537.
OCR for page 178
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Grossman, A. H., A. R. D’Augelli, T. J. Howell, and S. Hubbard. 2005. Parents’ reactions to transgender youths’ gender nonconforming expression and identity. Journal of Gay and Lesbian Social Services 18(1):3–16. Guenther-Grey, C. A., S. Varnell, J. I. Weiser, R. M. Mathy, L. O’Donnell, A. Stueve, G. Remafedi, and Community Intervention Trial for Youth Study. 2005. Trends in sexual risk-taking among urban young men who have sex with men, 1999–2002. Journal of the National Medical Association 97(Suppl. 7):S38–S43. Gwadz, M. V., M. C. Clatts, N. R. Leonard, and L. Goldsamt. 2004. Attachment style, childhood adversity, and behavioral risk among young men who have sex with men. Journal of Adolescent Health 34(5):402–413. Harawa, N. T., S. Greenland, T. A. Bingham, D. F. Johnson, S. D. Cochran, W. E. Cunningham, D. D. Celentano, B. A. Koblin, M. LaLota, D. A. MacKellar, W. McFarland, D. Shehan, S. Stoyanoff, H. Thiede, L. Torian, and L. A. Valleroy. 2004. Associations of race/ ethnicity with HIV prevalence and HIV-related behaviors among young men who have sex with men in 7 urban centers in the United States. Journal of Acquired Immune Deficiency Syndromes: JAIDS 35(5):526–536. Hart, T. 2001. Lack of training in behavior therapy and research regarding lesbian, gay, bisexual, and transgendered individuals. The Behavior Therapist 24(10):217–218. Hembree, W. C., P. Cohen-Kettenis, H. A. Delemarre-van de Waal, L. J. Gooren, W. J. Meyer, III, N. P. Spack, V. Tangpricha, and V. M. Montori. 2009. Endocrine treatment of transsexual persons: An endocrine society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism 94(9):3132–3154. Herbst, J. H., R. T. Sherba, N. Crepaz, J. B. DeLuca, L. Zohrabyan, R. D. Stall, C. M. Lyles, and HIV/AIDS Prevention Research Synthesis Team. 2005. A meta-analytic review of HIV behavioral interventions for reducing sexual risk behavior of men who have sex with men. Journal of Acquired Immune Deficiency Syndromes: JAIDS 39(2):228–241. Herdt, G., and A. Boxer. 1993. Children of horizons: How gay and lesbian teens are leading a new way out of the closet. Boston, MA: Beacon Press. Herrick, A. L., A. K. Matthews, and R. Garofalo. 2010. Health risk behaviors in an urban sample of young women who have sex with women. Journal of Lesbian Studies 14(1):80–92. Himmelstein, K. E. W., and H. Bruckner. 2010. Criminal-justice and school sanctions against nonheterosexual youth: A national longitudinal study. Pediatrics 2009–2306. Hoffman, N. D., K. Freeman, and S. Swann. 2009. Healthcare preferences of lesbian, gay, bisexual, transgender and questioning youth. Journal of Adolescent Health 45(3):222–229. Huebner, D. M., G. M. Rebchook, and S. M. Kegeles. 2004. Experiences of harassment, discrimination, and physical violence among young gay and bisexual men. American Journal of Public Health 94(7):1200–1203. IOM (Institute of Medicine). 2009. Adolescent health services: Missing opportunities. Washington, DC: The National Academies Press. Jamil, O. B., G. W. Harper, and M. I. Fernandez. 2009. Sexual and ethnic identity development among gay-bisexual-questioning (GBQ) male ethnic minority adolescents. Cultural Diversity and Ethnic Minority Psychology 15(3):203–214. Jiang, Y., D. K. Perry, and J. E. Hesser. 2010. Adolescent suicide and health risk behaviors: Rhode Island’s 2007 Youth Risk Behavior Survey. American Journal of Preventive Medicine 38(5):551–555. Johnson, B. T., M. P. Carey, K. L. Marsh, K. D. Levin, and L. A. J. Scott-Sheldon. 2003. Interventions to reduce sexual risk for the human immunodeficiency virus in adolescents, 1985–2000: A research synthesis. Archives of Pediatrics & Adolescent Medicine 157(4):381–388. Just the Facts Coalition. 2008. Just the facts about sexual orientation and youth: A primer for principals, educators, and school personnel. Washington, DC: American Psychological Association.
OCR for page 179
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Kaiser Family Foundation. 2002. National Survey of Physicians Part I: Doctors on disparities in medical care. Washington, DC: The Kaiser Family Foundation. Kegeles, S. M., R. B. Hays, and T. J. Coates. 1996. The mpowerment project: A community-level HIV prevention intervention for young gay men. American Journal of Public Health 86(8):1129–1136. Kipke, M. D., K. Kubicek, G. Weiss, C. Wong, D. Lopez, E. Iverson, and W. Ford. 2007. The health and health behaviors of young men who have sex with men. Journal of Adolescent Health 40(4):342–350. Kitts, R. L. 2005. Gay adolescents and suicide: Understanding the association. Adolescence 40(159):621–628. Kitts, R. L. 2010. Barriers to optimal care between physicians and lesbian, gay, bisexual, transgender, and questioning adolescent patients. Journal of Homosexuality 57(6):730–747. Klamen, D. L., L. S. Grossman, and D. R. Kopacz. 1999. Medical student homophobia. Journal of Homosexuality 37(1):53–63. Koblin, B. A., M. J. Husnik, G. Colfax, Y. Huang, M. Madison, K. Mayer, P. J. Barresi, T. J. Coates, M. A. Chesney, and S. Buchbinder. 2006. Risk factors for HIV infection among men who have sex with men. AIDS 20(5):731–739. Kosciw, J. G., E. S. Byard, S. N. Fischer, and C. Joslin. 2007. Gender equity and lesbian, gay, bisexual, and transgender issues in education. In Handbook for achieving gender equity through education (2nd ed.), edited by S. S. Klein, B. Richardson, D. A. Grayson, L. H. Fox, C. Kramarae, D. S. Pollard, and C. A. Dwyer. Mahwah, NJ: Lawrence Erlbaum Associates Publishers. Pp. 553–571. Kosciw, J. G., A. Diaz, and E. A. Greytak. 2008. 2007 National School Climate Survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. New York: The Gay, Lesbian and Straight Education Network. Lawrence, A. A. 2010. Sexual orientation versus age of onset as bases for typologies (subtypes) for gender identity disorder in adolescents and adults. Archives of Sexual Behavior 39(2):514–545. Lena, S. M., T. Wiebe, S. Ingram, and M. Jabbour. 2002. Pediatricians’ knowledge, perceptions, and attitudes towards providing health care for lesbian, gay, and bisexual adolescents. Annals of the Royal College of Physicians & Surgeons of Canada 35(7):406–410. Leslie, M. B., J. A. Stein, and M. J. Rotheram-Borus. 2002. Sex-specific predictors of suicidality among runaway youth. Journal of Clinical Child & Adolescent Psychology 31(1):27–40. MacKellar, D. A., L. A. Valleroy, G. M. Secura, W. McFarland, D. Shehan, W. Ford, M. La-Lota, D. D. Celentano, B. A. Koblin, L. V. Torian, H. Thiede, and R. S. Janssen. 2001. Two decades after vaccine license: Hepatitis B immunization and infection among young men who have sex with men. American Journal of Public Health 91(6):965–971. Marshal, M. P., M. S. Friedman, R. Stall, and A. L. Thompson. 2009. Individual trajectories of substance use in lesbian, gay and bisexual youth and heterosexual youth. Addiction 104(6):974–981. Marshall, B. D. L., K. Shannon, T. Kerr, R. Zhang, and E. Wood. 2010. Survival sex work and increased HIV risk among sexual minority street-involved youth. Journal of Acquired Immune Deficiency Syndromes: JAIDS 53(5):661–664. McCabe, S. E., T. L. Hughes, W. Bostwick, and C. J. Boyd. 2005. Assessment of difference in dimensions of sexual orientation: Implications for substance use research in a college-age population. Journal of Studies on Alcohol & Drugs 66(5):620–629. McGuire, J. K., C. R. Anderson, R. B. Toomey, and S. T. Russell. 2010. School climate for transgender youth: A mixed method investigation of student experiences and school responses. Journal of Youth & Adolescence 39:1175–1188. Meckler, G. D., M. N. Elliott, D. E. Kanouse, K. P. Beals, and M. A. Schuster. 2006. Nondisclosure of sexual orientation to a physician among a sample of gay, lesbian, and bisexual youth. Archives of Pediatrics & Adolescent Medicine 160(12):1248–1254.
OCR for page 180
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Menvielle, E. J., and C. Tuerk. 2002. A support group for parents of gender- nonconforming boys. Journal of the American Academy of Child & Adolescent Psychiatry 41(8): 1010–1013. Meyer, W. J. I., W. Bockting, P. Cohen-Kettenis, C. Coleman, D. DiCeglie, H. Devor, L. Gooren, J. J. Hage, S. Kirk, B. Kuiper, D. Laub, A. A. Lawrence, Y. Menard, S. Monstrey, J. Patton, L. Schaefer, A. Webb, and C. C. Wheeler. 2001. Standards of care for gender identity disorders, sixth version. http://www.wpath.org/Documents2/socv6.pdf (accessed March 25, 2011). Meyer-Bahlburg, H. F. L. 2002. Gender identity disorder in young boys: A parent- and peer-based treatment protocol. Clinical Child Psychology and Psychiatry 7(3):360–376. Milburn, N. G., G. Ayala, E. Rice, P. Batterham, and M. J. Rotheram-Borus. 2006. Discrimination and exiting homelessness among homeless adolescents. Cultural Diversity and Ethnic Minority Psychology 12(4):658–672. Millett, G. A., S. A. Flores, J. L. Peterson, and R. Bakeman. 2007. Explaining disparities in HIV infection among black and white men who have sex with men: A meta-analysis of HIV risk behaviors. AIDS 21(15):2083–2091. Money, J. 1990. Gay, straight, and in-between: The sexology of erotic orientation. New York: Oxford University Press. Mullen, P. D., G. Ramirez, D. Strouse, L. V. Hedges, and E. Sogolow. 2002. Meta-analysis of the effects of behavioral HIV prevention interventions on the sexual risk behavior of sexually experienced adolescents in controlled studies in the United States. Journal of Acquired Immune Deficiency Syndromes: JAIDS 30(Suppl. 1):S94–S105. Mustanski, B. S. 2007. Are sexual partners met online associated with HIV/STI risk behaviours? Retrospective and daily diary data in conflict. AIDS Care 19(6):822–827. Mustanski, B. S., T. Lyons, and S. C. Garcia. 2010a. Internet use and sexual health of young men who have sex with men: A mixed-methods study. Archives of Sexual Behavior [Epub ahead of print]. Mustanski, B. S., R. Garofalo, and E. M. Emerson. 2010b. Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths. American Journal of Public Health 100(12):2426–2432. Needham, B. L., and E. L. Austin. 2010. Sexual orientation, parental support, and health during the transition to young adulthood. Journal of Youth & Adolescence 39(10):1189–1198. Noell, J. W., and L. M. Ochs. 2001. Relationship of sexual orientation to substance use, suicidal ideation, suicide attempts, and other factors in a population of homeless adolescents. Journal of Adolescent Health 29(1):31–36. Nuttbrock, L., S. Hwahng, W. Bockting, A. Rosenblum, M. Mason, M. Macri, and J. Becker. 2010. Psychiatric impact of gender-related abuse across the life course of male-to-female transgender persons. Journal of Sex Research 47(1):12–23. Ogden, C. L., M. D. Carroll, L. R. Curtin, M. M. Lamb, and K. M. Flegal. 2010. Prevalence of high body mass index in us children and adolescents, 2007–2008. Journal of the American Medical Association 303(3):242–249. O’Shaughnessy, M., S. Russell, K. Heck, C. Calhoun, and C. Laub. 2004. Safe place to learn: Consequences of harassment based on actual or perceived sexual orientation and gender non-conformity and steps for making schools safer. San Francisco, CA: California Safe Schools Coalition. Pedlow, C., and M. Carey. 2004. Developmentally appropriate sexual risk reduction interventions for adolescents: Rationale, review of interventions, and recommendations for research and practice. Annals of Behavioral Medicine 27(3):172–184. Peterson, J. L., and K. T. Jones. 2009. HIV prevention for black men who have sex with men in the United States. American Journal of Public Health 99(6):976–980. Poon, C. S., and E. M. Saewyc. 2009. Out yonder: Sexual-minority adolescents in rural communities in British Columbia. American Journal of Public Health 99(1):118–124.
OCR for page 181
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Rew, L., R. T. Fouladi, and R. D. Yockey. 2002. Sexual health practices of homeless youth. Journal of Nursing Scholarship 34(2):139–145. Rew, L., T. A. Whittaker, M. A. Taylor-Seehafer, and L. R. Smith. 2005. Sexual health risks and protective resources in gay, lesbian, bisexual, and heterosexual homeless youth. Journal for Specialists in Pediatric Nursing 10(1):11–19. Rich, C. L., R. C. Fowler, D. Young, and M. Blenkush. 1986. San Diego suicide study: Comparison of gay to straight males. Suicide & Life-Threatening Behavior 16(4):448–457. Robin, L., N. D. Brener, S. F. Donahue, T. Hack, K. Hale, and C. Goodenow. 2002. Associations between health risk behaviors and opposite-, same-, and both-sex sexual partners in representative samples of Vermont and Massachusetts high school students. Archives of Pediatrics & Adolescent Medicine 156(4):349–355. Robin, L., P. Dittus, D. Whitaker, R. Crosby, K. Ethier, J. Mezoff, K. Miller, and K. Pappas-Deluca. 2004. Behavioral interventions to reduce incidence of HIV, STD, and pregnancy among adolescents: A decade in review. Journal of Adolescent Health 34(1):3–26. Rosario, M., H. F. L. Meyer-Bahlburg, J. Hunter, T. M. Exner, M. Gwadz, and A. M. Keller. 1996. The psychosexual development of urban lesbian, gay, and bisexual youths. Journal of Sex Research 33(2):113–126. Rosario, M., E. W. Schrimshaw, and J. Hunter. 2004. Ethnic/racial differences in the coming-out process of lesbian, gay, and bisexual youths: A comparison of sexual identity development over time. Cultural Diversity and Ethnic Minority Psychology 10(3): 215–228. Rosario, M., E. W. Schrimshaw, and J. Hunter. 2008. Predicting different patterns of sexual identity development over time among lesbian, gay, and bisexual youths: A cluster analytic approach. American Journal of Community Psychology 42(3-4):266–282. Rosario, M., E. W. Schrimshaw, and J. Hunter. 2009. Disclosure of sexual orientation and subsequent substance use and abuse among lesbian, gay, and bisexual youths: Critical role of disclosure reactions. Psychology of Addictive Behaviors 23(1):175–184. Rosenberg, M. 2002. Children with gender identity issues and their parents in individual and group treatment. Journal of the American Academy of Child & Adolescent Psychiatry 41(5):619–621. Russell, S. T. 2003. Sexual minority youth and suicide risk. American Behavioral Scientist 46(9):1241–1257. Russell, S. T. 2005. Beyond risk: Resilience in the lives of sexual minority youth. Journal of Gay & Lesbian Issues in Education 2(3):5–18. Russell, S. T., and K. Joyner. 2001. Adolescent sexual orientation and suicide risk: Evidence from a national study. American Journal of Public Health 91(8):1276–1281. Russell, S. T., H. Seif, and N. L. Truong. 2001. School outcomes of sexual minority youth in the United States: Evidence from a national study. Journal of Adolescence 24(1): 111–127. Russell, S. T., A. K. Driscoll, and N. Truong. 2002. Adolescent same-sex romantic attractions and relationships: Implications for substance use and abuse. American Journal of Public Health 92(2):198–202. Ryan, C., D. Huebner, R. M. Diaz, and J. Sanchez. 2009. Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics 123(1):346–352. Ryan, C., S. T. Russell, D. M. Huebner, R. Diaz, and J. Sanchez. 2010. Family acceptance in adolescence and the health of LGBT young adults. Journal of Child and Adolescent Psychiatric Nursing 23(4):205–213. Saewyc, E. M., C. L. Skay, L. H. Bearinger, R. W. Blum, and M. D. Resnick. 1998. Sexual orientation, sexual behaviors, and pregnancy among American Indian adolescents. Journal of Adolescent Health 23(4):238–247.
OCR for page 182
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Saewyc, E. M., L. H. Bearinger, R. W. Blum, and M. D. Resnick. 1999. Sexual intercourse, abuse and pregnancy among adolescent women: Does sexual orientation make a difference? Family Planning Perspectives 31(3):127–131. Saewyc, E. M., G. R. Bauer, C. L. Skay, L. H. Bearinger, M. D. Resnick, E. Reis, and A. Murphy. 2004. Measuring sexual orientation in adolescent health surveys: Evaluation of eight school-based surveys. Journal of Adolescent Health 35(4):345 e1–e15. Saewyc, E. M., C. L. Skay, S. L. Pettingell, E. A. Reis, L. Bearinger, M. Resnick, A. Murphy, and L. Combs. 2006. Hazards of stigma: The sexual and physical abuse of gay, lesbian, and bisexual adolescents in the United States and Canada. Child Welfare 85(2):195–213. Saewyc, E. M., C. L. Skay, P. Hynds, S. Pettingell, L. H. Bearinger, M. D. Resnick, and E. Reis. 2007. Suicidal ideation and attempts in North American school-based surveys: Are bisexual youth at increasing risk? Journal of LGBT Health Research 3(2):25–36. Saewyc, E. M., C. S. Poon, Y. Homma, and C. L. Skay. 2008. Stigma management? The links between enacted stigma and teen pregnancy trends among gay, lesbian, and bisexual students in british columbia. Canadian Journal of Human Sexuality 17(3):123–139. Saewyc, E. M., Y. Homma, C. L. Skay, L. H. Bearinger, M. D. Resnick, and E. Reis. 2009. Protective factors in the lives of bisexual adolescents in North America. American Journal of Public Health 99(1):110–117. Safren, S. A., and R. G. Heimberg. 1999. Depression, hopelessness, suicidality, and related factors in sexual minority and heterosexual adolescents. Journal of Consulting & Clinical Psychology 67(6):859–866. Sanchez, N. F., J. Rabatin, J. P. Sanchez, S. Hubbard, and A. Kalet. 2006. Medical students’ ability to care for lesbian, gay, bisexual, and transgendered patients. Family Medicine 38(1):21–27. Savin-Williams, R. C. 1989a. Coming out to parents and self-esteem among gay and lesbian youths. Journal of Homosexuality 18(1):1–35. Savin-Williams, R. C. 1989b. Parental influences on the self-esteem of gay and lesbian youths: A reflected appraisals model. Journal of Homosexuality 17(1/2):93–109. Savin-Williams, R. C. 2001. Suicide attempts among sexual-minority youths: Population and measurement issues. Journal of Consulting & Clinical Psychology 69(6):983–991. Savin-Williams, R. C., and G. L. Ream. 2003. Suicide attempts among sexual-minority male youth. Journal of Clinical Child & Adolescent Psychology 32(4):509–522. Shaffer, D., P. Fisher, R. H. Hicks, M. Parides, and M. Gould. 1995. Sexual orientation in adolescents who commit suicide. Suicide & Life-Threatening Behavior 25(Suppl.):64–71. Sheets, R. L., Jr., and J. J. Mohr. 2009. Perceived social support from friends and family and psychosocial functioning in bisexual young adult college students. Journal of Counseling Psychology 56(1):152–163. Silenzio, V. M., P. R. Duberstein, W. Tang, N. Lu, X. Tu, and C. M. Homan. 2009. Connecting the invisible dots: Reaching lesbian, gay, and bisexual adolescents and young adults at risk for suicide through online social networks. Social Science & Medicine 69(3):469–474. Smith, D. M., and W. C. Mathews. 2007. Physicians’ attitudes toward homosexuality and HIV: Survey of a California medical society-revisited (PATHH-II). Journal of Homosexuality 52(3–4):1–9. Smith, Y. L., S. H. van Goozen, and P. T. Cohen-Kettenis. 2001. Adolescents with gender identity disorder who were accepted or rejected for sex reassignment surgery: A prospective follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry 40(4):472–481. Smith, Y. L. S., S. H. M. Van Goozen, A. J. Kuiper, and P. T. Cohen-Kettenis. 2005. Sex reassignment: Outcomes and predictors of treatment for adolescent and adult transsexuals. Psychological Medicine 35(1):89–99.
OCR for page 183
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Solorio, M. R., N. G. Milburn, R. E. Weiss, and P. J. Batterham. 2006. Newly homeless youth STD testing patterns over time. Journal of Adolescent Health 39(3):443 e449–443 e416. Szalacha, L. A. 2003. Safer sexual diversity climates: Lessons learned from an evaluation of Massachusetts safe schools program for gay and lesbian students. American Journal of Education 110(1):58–88. Toomey, R., C. Ryan, R. Diaz, N. A. Card, and S. T. Russell. 2010. Gender nonconforming lesbian, gay, bisexual, and transgender youth: School victimization and young adult psychosocial adjustment. Developmental Psychology 46(6):1580–1589. Troiden, R. R. 1989. The formation of homosexual identities. Journal of Homosexuality 17(1–2):43–73. Tucker, J. S., P. L. Ellickson, and D. J. Klein. 2008. Understanding differences in substance use among bisexual and heterosexual young women. Womens Health Issues 18(5):387–398. Valleroy, L. A., D. A. MacKellar, J. M. Karon, D. H. Rosen, W. McFarland, D. A. Shehan, S. R. Stoyanoff, M. LaLota, D. D. Celentano, B. A. Koblin, H. Thiede, M. H. Katz, L. V. Torian, and R. S. Janssen. 2000. HIV prevalence and associated risks in young men who have sex with men. Young Men’s Survey Study Group. Journal of the American Medical Association 284(2):198–204. Van Leeuwen, J. M., S. Boyle, S. Salomonsen-Sautel, D. Baker, J. Garcia, A. Hoffman, and C. J. Hopfer. 2006. Lesbian, gay, and bisexual homeless youth: An eight-city public health perspective. Child Welfare Journal 85(2):151–170. Waldo, C. R., W. McFarland, M. H. Katz, D. MacKellar, and L. A. Valleroy. 2000. Very young gay and bisexual men are at risk for HIV infection: The San Francisco Bay Area Young Men’s Survey II. Journal of Acquired Immune Deficiency Syndromes: JAIDS 24(2):168–174. Wallien, M. S. C., and P. T. Cohen-Kettenis. 2008. Psychosexual outcome of gender-dysphoric children. Journal of the American Academy of Child & Adolescent Psychiatry 47(12):1413–1423. Wallien, M. S. C., S. H. M. Van Goozen, and P. T. Cohen-Kettenis. 2007. Physiological correlates of anxiety in children with gender identity disorder. European Child & Adolescent Psychiatry 16(5):309–315. Whitbeck, L. B., X. Chen, D. R. Hoyt, K. A. Tyler, and K. D. Johnson. 2004. Mental disorder, subsistence strategies, and victimization among gay, lesbian, and bisexual homeless and runaway adolescents. Journal of Sex Research 41(4):329–342. Wilbur, S., C. Ryan, and J. Marksamer. 2006. Serving LGBT youth in out-of-home care: Best practices guide. Washington, DC: Child Welfare League of America. Wilson, E. C., R. Garofalo, R. D. Harris, A. Herrick, M. Martinez, J. Martinez, and M. Belzer. 2009. Transgender female youth and sex work: HIV risk and a comparison of life factors related to engagement in sex work. AIDS & Behavior 13(5):902–913. Wilson, E. C., R. Garofalo, D. R. Harris, and M. Belzer. 2010. Sexual risk taking among transgender male-to-female youths with different partner types. American Journal of Public Health 100(8):1500–1505. Wong, C. F., M. D. Kipke, and G. Weiss. 2008. Risk factors for alcohol use, frequent use, and binge drinking among young men who have sex with men. Addictive Behaviors 33(8):1012–1020. Wright, E. R., and B. L. Perry. 2006. Sexual identity distress, social support, and the health of gay, lesbian, and bisexual youth. Journal of Homosexuality 51(1):81–110. Ziyadeh, N. J., L. A. Prokop, L. B. Fisher, M. Rosario, A. E. Field, C. A. Camargo, Jr., and S. B. Austin. 2007. Sexual orientation, gender, and alcohol use in a cohort study of U.S. adolescent girls and boys. Drug & Alcohol Dependence 87(2–3):119–130.
OCR for page 184
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Zucker, K. J. 2008. Children with gender identity disorder: Is there a best practice? Neuropsychiatrie de l’Enfance et de l’Adolescence 56(6):358–364. Zucker, K. J., and S. J. Bradley. 1995. Gender identity disorder and psychosexual problems in children and adolescents. New York: Guilford Press. Zucker, K. J., S. J. Bradley, and M. Sanikhani. 1997. Sex differences in referral rates of children with gender identity disorder: Some hypotheses. Journal of Abnormal Child Psychology 25(3):217.