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ARTICLES: Caitlin Ryan, David Huebner, Rafael M. Diaz, and Jorge Sanchez Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay, and Bisexual Young Adults Pediatrics 2009; 123: 346-352 [Abstract] [Full text] [PDF]

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eLetters published:

Important Cotribution as We Move Toward Healthy People 2020

Maurice N. Gattis   (30 December 2008)

Hopes for further research

Diane J. Klein   (12 January 2009)

Providers Must Learn to Support Lesbian, Gay and Bisexual Youth

Jennifer G. Vanderleest, Carol Q. Galper EdD, Assistant Dean, Office of Medical Student Education, University of Arizona College of Medicine   (12 January 2009)

Important Cotribution as We Move Toward Healthy People 2020 30 December 2008
Maurice N. Gattis, Fulbright Visiting Scholar University of Toronto - Factor Inwentash Faculty of Social Work Send letter to journal: Re: Important Cotribution as We Move Toward Healthy People 2020 mgattis{at}wustl.edu Maurice N. Gattis	To the Editor – I read with great interest the recent article in Pediatrics “Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay and Bisexual Young Adults.” The ecological approach and results have important implications for the public health agenda being considered by Healthy People 2020. Although there was no heterosexual comparison group or representative sample used, Ryan et. al1 found within group disparities on key indicators regarding the mental health, substance use and sexual behavior of sexual minority adolescents with regards to family rejection. A heterosexual comparison group and representative sample would have given a clearer basis of comparison for the disparities nationally, however the results are worthy of serious consideration. Perhaps one of the most severe forms of family rejection for sexual minority adolescents is being kicked out of or running away from the home due to negative consequences of disclosure of sexual minority status. A report issued by the National Gay and Lesbian Task Force2 estimates that between 20 and 40 % of all homeless youths identify as gay, lesbian, bisexual or transgendered (GLBT). The report also states that family conflict over a youth’s sexual orientation or gender identity is a major factor that leads to homelessness among sexual minorities. Compared to heterosexual homeless youths, homeless sexual minority youths are at increased risk for all of the issues cited in the present article including suicide, depression, and unprotected sex3. These issues were targeted in sexual minorities in Healthy People 2010 and it appears that more work remains. The existing disparities appear complex: between homeless sexual minority adolescents and homeless heterosexual adolescents and among sexual minority adolescents with higher rates of family rejection versus lower levels of family rejection. It is imperative that providers discuss family intervention as a way of reducing and eventually eliminating existing health disparities among sexual minorities and between sexual minorities and their heterosexual counterparts. Practitioners can work to ensure that their practices don’t have policies that further alienate these vulnerable members of our society. 1. Ryan C, Huebner D, Diaz RM, Sanchez J. Family rejection as a predictor of negative health outcomes in white and latino lesbian, gay, and bisexual young adults. Pediatrics 2009; 123:346-352 2. Ray N. Lesbian, gay, bisexual youths: An epidemic of homelessness. New York: National Gay and Lesbian Task Force Policy Institute and the National Coalition for the Homeless. 2006 3. Cochran BN, Stewart AJ, Ginzler JA, Cauce AM. Challenges faced by homeless sexual minorities: Comparison of gay, lesbian, bisexual, and transgender homeless adolescents with their heterosexual counterparts. American Journal of Public Health, 2002; 92:773-777. Conflict of Interest: None declared
Hopes for further research 12 January 2009
Diane J. Klein, law professor La Verne College of Law Send letter to journal: Re: Hopes for further research kleind{at}law.ucla.edu Diane J. Klein	This research is tremendously valuable not just to those who treat GLB youth medically, but also for those who interact with them legally. We can certainly hope this information is promulgated to attorneys and others involved in the juvenile justice system. Also, for those of us involved in research in the transgender and gender variant community, although many of these results seem generalizable, it is hoped that further research will be conducted on those populations, who anecdotally certainly appear to be at equal, if not greater risk, of family rejection. It would also be helpful to include other racial and ethnic minority groups. Conflict of Interest: None declared
Providers Must Learn to Support Lesbian, Gay and Bisexual Youth 12 January 2009
Jennifer G. Vanderleest, Assistant Professor of Clinical Family and Community Medicine Department of Family and Community Medicine University of Arizona College of Medicine, Carol Q. Galper EdD, Assistant Dean, Office of Medical Student Education, University of Arizona College of Medicine Send letter to journal: Re: Providers Must Learn to Support Lesbian, Gay and Bisexual Youth jgvander{at}email.arizona.edu Jennifer G. Vanderleest, et al.	We read with interest the article by Ryan et al. on the relationship between family rejection and negative health outcomes for lesbian, gay and bisexual (LGB) adolescents. We appreciate the recommendations for practice in which providers are encouraged to “ask LGB adolescents about family reactions to their sexual orientation…advise parents about negative reactions to their child’s LGB identity…and expand anticipatory guidance to include the need for support and the link between family rejection and negative health problems.” Although the Association of American Medical Colleges, American Academy of Pediatrics, and the Society of Teachers of Family Medicine all encourage the inclusion of LGB health content in medical training programs, there is no standardization about what content should be included or how this content should be taught. Lack of standardized content or presentation of overly focused information (only mentioning LGB youth when discussing STIs, for example) in medical schools and residencies can lead to trainee confusion and discomfort when attempting to ask important questions and trying to make supportive recommendations for these youth. Heterosexist assumptions still exist in medical education including the notion that patients do not want to disclose non-dominant sexual orientations to medical providers. A paper by Garth et al.,(1) however, found that although the majority of LGB identified youth thought it was important that their physician know their sexual orientation, they were rarely asked. It is clear that without asking appropriate questions, providers will not be able to accurately assess health status of their patients, and may miss something of significant health consequence. This data reminds us that medical educators must do a better job of educating medical students and residents with regard to talking with sexual minority youth about the reality of their lives, which of course also includes their relationships with family members. We encourage clerkship and residency program directors to review their curricula to ensure the inclusion of medically accurate information about LGB youth and their families, and that they are given the respect that all of our patients deserve. 1. Meckler GD, Elliott MN, Kanouse DE, et al. Non disclosure of sexual orientation to a physician among a sample of gay, lesbian and bisexual youth. Arch Pediatr Adolesc Med. 2006;160(12):1248-1254. Conflict of Interest: None declared