Health Disparities Research with LGBTQ Youth

Find out more about researchers focusing on LGBTQ youth who are at risk for negative health outcomes.

 By Elizabeth McConnell, Michelle Birkett, & Brian Mustanski

Growing up queer in South Carolina, I felt pretty alone, often unsure of the future, and at times hopeless about finding a community that affirmed my identity. I was a pretty nerdy kid, so it may not be surprising that I dealt with this physical and cultural isolation by scouring the internet (back in the days of dial-up AOL) for information about what my life and future might look like. At 14, I could not have imagined being lucky enough to be able to work with a strong community of like-minded researchers who study the unique challenges faced by LGBTQ youth in the hopes of making things better for future generations.

Social Support and Wellbeing for LGBTQ Youth
When I was in high school, the people who cared about me did their best to be supportive, but they were not always in a place to provide that support. My friends adjusted pretty quickly to my coming out, but my parents took much more time (and some painful work in therapy) to accept who I was. I was very fortunate to have parents who recognized we needed some help along the way, stuck with this process, and eventually hosted my wedding fifteen years after I came out. However, this is not the case for many LGBTQ youth who lack support from important people in their lives.

Recently, I worked with my research mentors, Dr. Michelle Birkett and Dr. Brian Mustanski, to take a look at the social support LGBTQ youth receive from friends, families, and significant others (McConnell, Birkett, & Mustanski, 2015). Our data were from Project Q2, the longest running longitudinal study of LGBTQ youth. We used cluster analysis to identify “clusters” of people based on patterns of variables – in this case the three sources of support. We found three social support clusters : those who reported high support from all sources, those who reported low support from all sources, and those who reported non-family support (i.e., moderate support from friends and significant others, but low support from families).

Notably, three-fifths of the study participants reported low family support, placing them in either the low or non-family support clusters. This is an upsetting finding, as participants in the low and non-family support clusters reported more loneliness and depression than youth in the high support cluster. This association remained while accounting for LGBT victimization experiences, such as verbal and physical threats and assault. These forms of victimization are  experienced by many LGBTQ youth (Kosciw, Greytak, Palmer, & Boesen, 2014) and have documented negative mental health outcomes (Mustanski, Andrews, & Puckett, 2016).

In a more recent project (McConnell, Birkett, & Mustanski, under revision), we examined trajectories of mental health outcomes across adolescence and young adulthood for these clusters. In this project, we found that:

·         Youth in the low and non-family clusters reported greater psychological distress across adolescence and young adulthood. However, they also showed a sharper decline in distress relative to youth in the high support cluster.
·         Youth in the non-family support cluster reported an increase in family support over time, so that they more closely resembled the high support cluster by early adulthood. This finding is hopeful, as it shows how families who may not be supportive early on may come around over time.

Overall, our findings from both projects support work being done by other researchers on the importance of family support in promoting wellbeing for LGBTQ youth (Mustanski & Liu, 2013; Newcomb, Heinz, & Mustanski, 2012; Ryan, Russell, Huebner, Diaz, & Sanchez, 2010). This work on social support and mental health is one small part of a larger body of research on mental and physical health disparities experienced by LGBTQ youth. Researchers are investigating a number of other health disparities experienced by LGBTQ youth, such as alcohol use (Newcomb, Heinz, & Mustanski, 2012), suicide risk (Liu & Mustanski, 2012; Mustanski & Liu, 2013), cigarette smoking (Corliss, Rosario, Birkett, Newcomb, Buchting, & Matthews, 2014), cancer related-risk behaviors (Rosario et al., 2014), and homelessness (Durso & Gates, 2012). Due to limited research with LGBTQ youth, there is still a lot we don’t know about the range and extent of health disparities they experience. However, the need for more research with LGBTQ populations is increasingly being recognized as a national priority (Institute of Medicine, 2011).

 The field of LGBTQ youth health disparities research is varied and rewarding. In addition to our work on social support and mental health, our team is working on a number of other research questions using different methodological approaches. To illustrate, we discuss some of the work we are currently doing on LGBTQ health below. We are grateful to be part of a community of researchers engaged in this work, and hope our experiences start to illustrate how diverse and important this work is.

Our Research

 
Elizabeth McConnell, MA

I am interested in the relationships between identity and wellbeing, with LGBTQ health disparities being just one example. Identity and wellbeing are related in complicated ways. Systems of privilege and oppression operate on multiple levels: in our families, our schools, our communities, and in public policy and economic systems. This impacts how we walk through the world: how we see ourselves, how others see and respond to us, what kinds of resources we have access to. I am passionate about identifying how these systems impact our wellbeing and using research to inform social change.

I also very much believe in the importance of intersectionality. Intersectionality acknowledges that our multiple identities shape each other, and these complex interactions shape how we experience settings (McConnell, Todd, Odahl-Ruan, & Shattell, 2016) and ultimately impact our health and wellbeing. My current research as a doctoral student in Clinical-Community Psychology at DePaul University explores how race, gender, and sexual orientation intersect to shape HIV risk among young men who have sex with men (MSM).

 It is very important to me to engage the lived experiences of the populations I research. For my dissertation, I will conduct interviews with young MSM of different racial groups about their experiences of stigma, discrimination, and health risk behaviors in different areas in Chicago. I will use a mixed methods design by first using data visualization techniques from social network analysis and geographic information systems (GIS) to illustrate some patterns we see in our quantitative data. Then, in the interviews, I  will ask young men in the study what they see in these images and how they relate to their experiences (McConnell, Birkett, & Shattell, 2015). This work is supported by the National Institute on Drug Abuse under award number 1F31DA040524. In the future, I hope to apply mixed methods approaches to deepen our understanding of the complex relationships between intersectional identities and health for LGBTQ youth.

Michelle Birkett, PhD

I’m an Assistant Professor at Northwestern University and lead a research program around using network and systems approaches to understand the complex mechanisms that produce health disparities. I believe that network science in particular is a powerful tool for examining the impact of context on health and wellbeing because it allows us to examine the relationships, groups, and communities people belong to. For example, my research on LGBTQ youth in schools examined how peer groups influence the socialization of homophobic behavior in adolescents (Birkett & Espelage, 2015).

More recently, I have applied network science to increase understanding of how racial disparities in HIV might be linked to experiences of stigma and discrimination. Black MSM are more impacted by HIV than MSM of other races, even though they show fewer individual risk behaviors (Millett et al., 2012). My research moves beyond the individual level to examine how sexual network and neighborhood characteristics might impact HIV risk (Birkett, Kuhns, Latkin, Muth, & Mustanski, 2015; Birkett, Phillips, Janulis, McConnell, & Mustanski, 2015; Phillips, Birkett, Kuhns, Hatchel, Garofalo, & Mustanski, 2015). I’m also interested in developing innovative tools for collecting network data, such as our software, netCanvas.

Brian Mustanski, PhD

My research focuses on the mental and behavioral health of LGBT youth, including mental health, HIV/AIDS, and substance use. I very much believe in the importance of translational research, which converts research findings into practices and interventions that promote health and wellbeing. My research program uses many approaches to addressing LGBTQ health disparities, including epidemiological studies of prevalence, longitudinal studies examining risk and protective factors, developing and testing interventions, and disseminating and implementing interventions with this population.

As a senior scholar at Northwestern University, and the Director of the IMPACT LGBT Health and Development Program, my work is focused not only on directly conducting research, but also on building infrastructure, resources, and leadership for other LGBTQ health research scholars. To this end, one of the most exciting new directions in my research has been the establishment of the Institute for Sexual and Gender Minority Health and Wellbeing. This newly-created institute is the first university-wide institute in the nation to focus on sexual and gender minority (SGM) health and wellbeing. The Institute houses several research programs focused on different areas of SGM health and provides high-level research and training for the next generation of SGM scholars. In my role as the Director, I will not only contribute directly to research on SGM health, but also support others who are passionate about conducting similar work.

References
Birkett, M., & Espelage, D. L. (2015). Homophobic name-calling, peer-groups, and masculinity: The socialization of homophobic behavior in adolescents. Social Development, 24, 184-205.
Birkett, M., Kuhns, L. M., Latkin, C., Muth, S., & Mustanski, B. (2015). The sexual networks of racially diverse young men who have sex with men. Archives of Sexual Behavior, 44, 1787-1797.
Birkett, M., Phillips, G., Janulis, P., McConnell, E., & Mustanski, B. (2015, November). Structure of Chicago neighborhoods: How race, class, and geography influence the sexual tie formation of YMSM. Paper presented at the American Public Health Association Conference, Chicago, IL.
Corliss, H. L., Rosario, M., Birkett, M. A., Newcomb, M. E., Buchting, F. O., & Matthews, A. K. (2014). Sexual orientation disparities in adolescent cigarette smoking: intersections with race/ethnicity, gender, and age. American Journal of Public Health104, 1137-1147.
Durso, L.E., & Gates, G.J. (2012). Serving our youth: Findings from a national survey of service providers working with lesbian, gay, bisexual, and transgender youth who are homeless or at risk of becoming homeless. Los Angeles: The Williams Institute with True Colors Fund and The Palette Fund.
Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: National Academies Press.
Kosciw, J. G., Greytak, E. A., Bartkiewicz, M. J., Boesen, M. J., & Palmer, N. A. (2012). The 2011 National School Climate Survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. New York: Gay, Lesbian and Straight Education Network (GLSEN).
Liu, R. T., & Mustanski, B. (2012). Suicidal ideation and self-harm in lesbian, gay, bisexual, and transgender youth. American Journal of Preventive Medicine42, 221-228.
McConnell, E. A.,Birkett, M., & Mustanski, B. (2015). Typologies of social support and associations with mental health outcomes among LGBT youth. LGBT Health, 2, 55-61.
McConnell, E. A.,Birkett, M., & Mustanski, B. (under review). Families matter: Social support and mental health trajectories among LGBT youth.
McConnell, E. A.,Birkett, M., & Shattell, M. (2015). The future of big data: Innovative methodological approaches to LGBT health disparities. Issues in Mental Health Nursing, 36, 478-480.
McConnell, E. A.,Todd, N. R., Odahl-Ruan, C., & Shattell, M. (in press). Complicating counterspaces: Intersectionality and the Michigan Womyn’s Music Festival. American Journal of Community Psychology.
Millett, G. A., Peterson, J. L., Flores, S. A., Hart, T. A., Jeffries, W. L., Wilson, P. A., … & Remis, R. S. (2012). Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: A meta-analysis. The Lancet380, 341-348.
Mustanski, B., Andrews, R., & Puckett, J. A. (2016). The effects of cumulative victimization on mental health among lesbian, gay, bisexual, and transgender adolescents and young adults. American Journal of Public Health, 106, 527-533.
Mustanski, B., & Liu, R. T. (2013). A longitudinal study of predictors of suicide attempts among lesbian, gay, bisexual, and transgender youth. Archives of Sexual Behavior42, 437-448.
Newcomb, M. E., Heinz, A. J., & Mustanski, B. (2012). Examining risk and protective factors for alcohol use in lesbian, gay, bisexual, and transgender youth: A longitudinal multilevel analysis. Journal of Studies on Alcohol and Drugs73, 783-793.
Phillips II, G., Birkett, M., Kuhns, L., Hatchel, T., Garofalo, R., & Mustanski, B. (2015). Neighborhood-level associations with HIV infection among young men who have sex with men in Chicago. Archives of Sexual Behavior,44, 1773-1786.
Rosario, M., Corliss, H. L., Everett, B. G., Russell, S. T., Buchting, F. O., & Birkett, M. A. (2014). Mediation by peer violence victimization of sexual orientation disparities in cancer-related tobacco, alcohol, and sexual risk behaviors: Pooled youth risk behavior surveys. American Journal of Public Health104, 1113-1123.
Ryan, C., Russell, S. T., Huebner, D., Diaz, R., & Sanchez, J. (2010). Family acceptance in adolescence and the health of LGBT young adults. Journal of Child and Adolescent Psychiatric Nursing23, 205-213.