The Study

The LGBTQ+ Adolescent Health Study was conducted in partnership with the School of Public Health and Information Sciences and the Kent School of Social Work at the University of Louisville in Louisville, Kentucky. Beginning in 2017, the study is the first to examine the health needs of LGBTQ+ youth in Louisville, Kentucky.

Background

LGBTQ+ youth are at the center of extensive social and legal debates in the United States. While they are more visible than ever, they face significant health challenges such as social stigma, abuse, and lack of culturally competent health care services. Depression, suicide, drug and alcohol use, violence, sexual health and homelessness are critical health and social concerns for LGBTQ+ youth. Furthermore, health information targeting this group is limited and often inaccurate.

Methods

Quantitative Data (surveys) and Qualitative Data (focus groups)

Our research team conducted a mixed-methods study on LGBTQ+ adolescent health with residents of Louisville, Kentucky. The goals of the study were to (1) understand health issues affecting local LGBTQ+ youth; (2) to determine the barriers and facilitators of good health for this group; and (3) to develop an intervention that would improve health experiences and outcomes for LGBTQ+ youth in Louisville, KY. A sample of LGBTQ+ youth, ages 13 – 18, were surveyed for demographic information, health experiences, and adverse childhood experiences (ACEs). An “adverse childhood experience” is any event taking place during childhood or adolescence that is traumatic or difficult to understand, such as violence, parental drug use, or sexual assault. The youth then took part in focus groups to talk about their experiences with health. Interviews were also conducted with adult stakeholders such as parents, educators, health care and mental health providers, and social workers to explore health beliefs, experiences, knowledge, and local priorities concerning LGBTQ+ youth. 

Results

Overall, the LGBTQ+ youth participants reported very negative experiences at school. 100% of youth had heard homophobic, biphobic, or transphobic remarks. 65% of the youth had experienced harassment themselves; 61% reported feeling unsafe, and 27% reported that they had experienced physical violence at school. Their self-reported health was worse than expected, with 42.% reporting their general health as “fair,” and 7.7% rating their health as “poor.” They also reported that the days in which they felt “mentally unhealthy” far outweighed their self-rated “physically unhealthy” days, and the average ACEs score for the youth was 3.7. 

In the focus groups, the youth discussed mental health extensively. They reported that their mental health was heavily influenced by their social environments: particularly, the behavior and attitudes of their peers, family and other adults towards them. They also experienced barriers to physical health, such as exclusionary policies about group sports and unfriendly environments. The adult stakeholders who were interviewed affirmed the narratives of the LGBTQ+ youth, and shared concerns about mental health and social exclusion. Adult participants expressed a desire for more resources, inclusive environments, positive role models, and mental health support for youth. 

Boot Camp Translation 

Following the initial rounds of data collection, the research team then invited local health providers, public health professionals, LGBTQ+ youth and community members to participate in a boot-camp translation (BCT) group with the goal of creating and developing a health campaign to be featured around Louisville and Jefferson County. BCT is an evidence-based research process designed to include and engage with community members in “translating” pertinent clinical topics into locally relevant and culturally appropriate messaging designated as a priority in a community. The BCT group worked together to determine how to best communicate positive messaging about the importance of bolstering and supporting the mental health of LGBTQ+ youth. During the BCT process, it was determined that the campaign would target parents of LGBTQ+ adolescents for their unique role in supporting the mental wellbeing of LGBTQ+ youth, would feature images of LGBTQ+ youth, and would be titled “Embrace the Journey.” 

Focus Groups 

Following the BCT, two additional focus groups were held. The research team held one focus group with the Louisville chapter of PFLAG (Parents and Friends of Lesbians and Gays), and another with students participating in the University of Louisville’s LGBT Center’s housing program, Rustin Community Living. The research team decided that supplementary qualitative data was necessary to concretize and validate decisions made in the BCT group about the direction and purpose of the “Embrace the Journey” health campaign. During these focus groups, advice for parents of LGBTQ+ adolescents was collected to be featured on a website associated with the “Embrace the Journey” public health campaign. 

Writing Contest and Art Workshop 

To populate the “Embrace the Journey” associated website, and also to engage with the local community, the research team hosted a writing contest for LGBTQ+ youth aged 13 – 21. Six monetary prizes were given to youth who participated. The submitted works will be featured on the “Embrace the Journey” associated website, and serve to use the words of GSM youth themselves to inspire parents of LGBTQ+  adolescents to “embrace the journey.” Additionally, the research team held a facilitated art workshop for local LGBTQ+ adolescents to engage with this community and to generate content for the “Embrace the Journey” associated website. 

Discussion

Mental health care and social inclusion are the most pressing needs of LGBTQ+ adolescents in Louisville, KY. Addressing these issues will require collaboration between agencies. The results have implications for the development of health services and resources to meet the needs of LGBTQ+ youth locally and nationally. Next steps include collaborating with the local health department and school system to develop a health communication campaign on LGBTQ+ adolescent mental health. This campaign will be launched in fall 2019.

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