Intersecting Identities: Health Disparities for LGBTQ Youth

1. Intersecting Identities:Health Disparities for LGBTQ Youth Abra Bankendorf Vigna, M.S. Youth Development Specialist, Teens Like Us Youth Services of Southern Wisconsin, Briarpatch

2. Common Vocabulary: LGBTQ . . . • Lesbian: identify as girl, like girl • Gay: identify as boy, like boy • Bisexual: like either sex • Queer: gender identity of self or prospective partners (or both) is fluid • Questioning: haven’t committed to an identity • Transgender: Gender identity doesn’t match that assigned at birth • Cisgender: gender identity matches that assigned at birth • Gender non-conforming: express or self identity in ways that do not match your culturally-specific expectations of a person based upon their perceived gender • Sexual Minority: someone who identifies as LGB or T

3. Basic Claims: • Sex = Gender • Gender = Sexuality • Gender non-conformity is culturally/temporally specific • Sexism + Racism + Classism -> Different outcomes associated with Transphobia & Homophobia

4. Gender Transgender Woman Gender conformingCisgenderWoman Gender Non-conforming Woman Biological Sex Male Female Gender Roles (societal expectation of gender) Male Female GenderExpression (communication of gender) masculine androgynous feminine Gender Identity (psychological sense of self) man two spirited/third gender woman

5. Gender = Sexuality

6. Sexuality Sexual Orientation (physical &/or romantic attraction) same sex or gender bisexual/asexual opposite sex or gender SexualExpression (sexual behavior) same sex or gender both sexes/neither sex opposite sex or gender Sexual Identity (self-identification) gay/lesbian bisexual/asexual/queer heterosexual Same-gender-loving straight

7. Different Outcomes:Evidence of Health Disparitiesbetween LGBT & Gender Non-conforming Youth and Heterosexual & Cisgender Youth in Wisconsin and Across the Nation

8. Converging Evidence of Risk • “Hatred in the Hallways” (2001) Human Rights Watch Report • Documented pervasive violence and discrimination based on actual or perceived sexual orientation through in-depth interviews with 140 youth and 130 teachers nationwide. • “They Don’t Even Know Me: A Report on the Five-Year Anti-Violence Research Project of the Safe Schools Coalition of Washington” • 80% of students harassed on the basis of actual or perceived sexual orientation were in fact heterosexual. • Sexual Identity, Sex of Sexual Contacts and Health Risk Behaviors Among Students in Grades 9-12 YRBS-selected sites

9. Sources of Data on WI WI Youth Risk Behavior Survey (2007-2011) Dane County Youth Assessment (DCYA) (2011) Gay Lesbian Straight Education Network (GLSEN) School Climate Survey (2009)

12. YRBS National Data2001-2009 • 9 sites (7 different states) across the country asked about sexual identity • 12 sites asked about the sex of the sexual contact • NO DATA about gender identity or gender expression based harassment

13. Health Disparities by Activity2001-2009 Nat’l Data

14. Health Disparities by Identity2001-2009 Nat’l Data

25. Sexual Activity vs Sexual Identity Comparisons

27. WI YRBS Implications: • Youth engaging in same-sex behavior comprise a substantial percentage of high school students in WI—MORE than who identify as LGBTQ! • Sexual minority youth (via identity or behavior) in WI experience significant and persistent disparities in physical, mental and emotional health in comparison to hetero- sexually active youth LIMITATION: Doesn’t ask about gender identity or expression

28. K-12 Experiences for Transgender & Gender Non-Conforming Youth • The Safe Place to Learn Report (2004) • 49% of students harassed based on actual or perceived sexual orientation were also harassed for not being “masculine enough” or “feminine enough,” compared to 27% of students overall. • The Anchorage LGBT Discrimination Survey (2012) • In the Anchorage report 40% reported being bullied or harassed by other students and 24% reported being bullied or harassed by teachers and other school staff • The National Transgender Discrimination Survey (2011) was the first comprehensive study to document discrimination and bias against transgender persons in the U.S. • Nearly 1/3 of the respondents to the NTDS reported being bullied or harassed by school staff, nearly 1/6 felt forced to leave from harassment and 6% were expelled for their identity/gender expression

29. A Report of the California Safe Schools Coalition and the4-H Center for Youth Development, University of California, Davis 2004

30. Methodology California Healthy Kids Survey • does not ask students to identify their sexual orientation or their gender identity. • were you harassed “because you are gay or lesbian, or someone thought you were?” Preventing School Harassment (PSH) survey • Asked about sexual orientation (gay/lesbian, straight/heterosexual, bisexual, queer, questioning, or other) • Gender? (male, female, transgender, questioning, or other) • Have you experienced harassment “because you are gay, lesbian, or bisexual or someone thought you were?” • Have you experienced harassment “because you weren’t ‘masculine enough’” or “because you weren’t ‘feminine enough’?”

31. Lrgst Study on LGBTQ Youth Harassment based on actual or perceived sexual orientation is more frequent in middle school than in high school Harassment based on actual or perceived sexual orientation occurs in ALL racial or and ethnic groups 91% of ALL students reported hearing students make negative comments based on sexual orientation 44% reported hearing teachers or staff make negative comments based on sexual orientation. 53% of ALL students said their schools were unsafe for “guys who aren’t as masculine as other guys,” and 34%said their schools were unsafe for “girls who aren’t as feminine as other girls.”

32. 27% of ALL students surveyed reported being harassed because they were “not masculine enough” or “not feminine enough.”

33. Experiences of the harassed… • 2/3 students who identified as LGBT reported harassment based on actual or perceived sexual orientation. • Students who report harassment are: • More than 2x’s as likely to report seriously considering suicide/make a plan • More likely to report low grades, to smoke cigarettes, drink alcohol, use other illicit drugs, or be victims of violence • Report less support at home, at school and in their community

34. Anchorage Transgender Discrimination Survey • Snowball sampling technique • What sex were you assigned at birth? What is your primary gender identity? What is your sexual orientation?

35. Anchorage Transgender Discrimination Survey

36. National Transgender Discrimination Survey • Released February 2011 joint effort of National Center for Transgender Equality & the National Gay and Lesbian Task Force • Transgender= those who transition from one gender to another (transsexuals), and those who may not, including genderqueer people, cross-dressers, the androgynous, and those whose gender non-conformity is a part of their identity

37. National Transgender Discrimination Survey • N=6,450 transgender (75%) and gender non-conforming respondents (25%) • Sample age: 18+ • 70 question survey • Snowballing technique/convenience sample • Nearly 2,000 paper surveys were distributed to hard-to-reach transgender and gender-nonconforming populations.

38. National Trans Discrimination Study

39. National Trans Discrimination Survey

40. Consistently Heightened Risk • Experiencing violence and harassment from schools • Lessened sense of belonging at school • Experiencing teen dating violence and sexual violence • Being ‘thrown away’: 26% of youth are kicked out when the come out* • Homelessness: 20-40% of all homeless youth identify as LGBT* • Truancy • Depression, suicidal ideation and suicide attempts • Drug and tobacco usage • Risky Sexual behavior: HIV transmission Coker, T. R., Austin, S. B., & Schuster, M. A. (2010). The health and health care of lesbian, gay, and bisexual adolescents. Annual Review of Public Health, 31, 457-477. *Lesbian, Gay, Bisexual and Transgender youth: An epidemic of homelessness - a January 30, 2007 report from theNational Gay and Lesbian Task Force in collaboration with the National Coalition for the Homeless. *Thompson, S. J., Safyer, A. W. & Pollio, D. E. (2001). Differences and predictors of family reunification among subgroups of runaway youths using shelter services. Social Work Research, 25(3).

41. Data about Intersections of Oppression: Black and Transgender Findings from the National Trans Discrimination Survey

42. Why are there health disparities? • Minority stress model (Meyer, 2003) Individuals from disadvantaged social positions experience chronic unique stressors related to these positions, founded in oppressive structures. • Homophobic victimization • Fewer rights/protections • Socially sanctioned reminders of inferiority/perversity • internalized homophobia

44. The need to be seen as we are and accepted • Need confirmation of our self-views for psychological coherence • Need to authentically belong • Not having this need met causes distress, despair and depression

45. Minority Stress Arithmetic: Sexism + Cisgenderism + Racism + Classism = Different individual experiences and thus outcomes

47. How is being Transgender different from being L,G, B, or Q? • Additional discrimination • Fewer protections • Confusion between gender identity and sexuality

48. Protective Factors

50. Family Support Matters! 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 Nursing : Official Publication of the Association of Child and Adolescent Psychiatric Nurses, Inc, 23(4), 205-13.