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Monday, August 15, 2011
Mass General psychiatrist weighs in
BJ Beck, MSN, MD, psychiatrist in Dept. of Psychiatry at Mass General
A recent study by the Centers for Disease Control and Prevention (CDC), entitled “Sexual Identity, Sex of Sexual Contacts, and Health Risk Behaviors Among Students in Grades 9-12 in Selected Sites – Youth Risk Behavior Surveillance, United States, 2001-2009,” published in a June 2011 issue of CDC’s Morbidity and Mortality Weekly Report Surveillance, reveals that students who report being gay, lesbian or bisexual and students who report having sexual contact only with persons of the same sex or both sexes, may not be making the healthiest choices when it comes to alcohol, tobacco, sex, weight management, and other health related issues.
CDC researchers looked at unhealthy risk behaviors and compared gay, lesbian and bisexual student data with peers who report being heterosexual and students who report having sexual contact only with the opposite sex. Data were pulled from 2001-2009 Youth Risk Behavior Surveys (YRBS) in seven states and six large urban school districts. Massachusetts and Boston were both in the study. Other states included in the report were Connecticut, Delaware, Maine, Rhode Island, Vermont and Wisconsin. The study also looked at city results from Chicago, Milwaukee, New York City, San Diego, and San Francisco.
Mass General psychiatrist, BJ Beck, MSN, MD, says the CDC findings should get the public’s attention. “It’s alarming to identify a group and say they have a greater risk. Even if it wasn’t as extreme, it would still be alarming,” She says the numbers, however, may lean on the high side, because teenagers willing to identify themselves as being gay, lesbian or bisexual in a survey are already taking a risk, and thus may be higher on the risk taking scale. Or, those students who are honest about reporting their sexual identity are apt to be more open and honest about their risky behaviors.
The health categories analyzed ranged from violence all the way to nutrition and healthy eating habits. The CDC found that gay and lesbian students had higher prevalence rates for 49 percent to 90 percent of all health risks measured, and they had higher rates for seven out of the 10 health risk categories. Bisexual students had higher rates in eight of the 10 categories, with higher prevalence rates for 57 percent to 86 percent of all health risks measured. An area that was especially high was serious attempts at suicide. In Massachusetts, the percentage of attempts differed from 13.2 in heterosexuals versus 43.4 in gays or lesbians; the percentage was 46.2 in students who self-identified as being bisexual. The difference when looking at sex of sexual contacts, was not quite as sharp (16.4 opposite sex compared to 25.3 for same sex only).
Beck says data from the category of violence are important to analyze. In particular, one of the questions asked in the survey deals with school attendance. The percentage of high school students who did not go to school because they felt unsafe at school or on their way home from school (on at least one day during the 30 days before the survey) was markedly higher in the gay, lesbian and bisexual groups compared to the heterosexual group. In Massachusetts, the percentage was 4.3 in heterosexual, 24.8 for the gay or lesbian group and 11.3 in bisexuals. With sex of sexual contacts data, the percentage was 5.4 for heterosexuals, 12.6 in same sex only and 14.3 in both sexes.
Regarding a question on the survey about bringing weapons to school, students who reported being gay or lesbian also had higher numbers. Looking at the Boston data, the percentage was 6.9 in heterosexuals, 23.4 in gay or lesbian and 14.4 in bisexuals. Sex of sexual contacts data showed 9.9 percent in opposite sex only, 11.7 percent in same sex only and 17.5 in both sexes.
Beck wonders about the overlap between students not feeling safe at school and those carrying weapons. “The numbers are concerning. Students need to feel safe. They shouldn’t have to protect themselves at school.”
Beck is encouraged that school bullying and violence are getting more attention from the public and media now, but says bullying has been around for a while.
“Despite this new awareness, we know there’s always been bullying. That it is just now being publically addressed means it has long gone unnoticed, or that people just turned a blind eye to it.”
While the CDC report sheds light on unhealthy risk behaviors, Beck says additional studies could be useful. One major limitation of this study, she says, is the data breakdown does not include gender-specific information. “Gays and lesbians are different phenomena. There are a lot of ways in which they are very different,” Beck says testosterone, and other hormonal or genetic differences, may predispose gay men to certain more risky behaviors (e.g. multiple sexual partners), while lesbians may be more prone to other unhealthy conditions (e.g. obesity). She points out that anorexia in men is more common in the gay population, while lesbians are more inclined to be overweight.
Beck emphasizes the disservice done by public denial of LGBT issues. She says it is important to identify and accept LGBT youth, and to recognize their unique needs. Most importantly, she says there should be more resources for these students, and advocates that more groups and health professionals should be a part of school sex education programs.
“There might be a role to involve outside groups or health professional in high school sex education, especially if local teachers feel unprepared or reticent to address these issues. This might add credibility, and increase GLBT students’ sense of safety. Imagine sitting in school where the very people who are grading you and guiding your career are perceived to be negatively judging you or woefully ignorant of the issues that affect your life.”Another important group that needs resources, Beck says, is parents. “There definitely needs to be education for parents, as well. I think a lot of well-meaning parents suffer under the misperception that this is a choice. These teens have no more choice than straight teens have. They no more choose their orientation than they do their height or natural hair color. Choice of expression is not the same as choice of orientation. Denial may be both unfulfilling and an even greater risk for GLBT teens.”
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