1. The Other High Risk Group: GLBT Students At Risk Kari Kuka M.S. Associate Director of Operations

2. Overview Why are GLBT students at higher risk behavior and other health issues than the general student population Data collection and research What peer education groups can do

3. Cultural Gay Trivia

4. Why They Are High Risk? oShame oFear oHarassment oNon-acceptance from family members oUncertain about sexuality oDepression oAnxiety oSocial events involve drugs and alcohol

5. Why They Are High-Risk Cognitive Isolation - lack of information about gays and lesbians, how gay and lesbian couples function, how long they stay coupled, how they determine gender roles, and how they solve relationship problems. Social Isolation - lack of contact with positive role models reinforces the negative value that society places on homosexuals. Emotional Isolation - poor social support and few resources. For example, lower social support from families, fewer resources in the community, stigmatization (may increase the impact of stressful life events), and legal discrimination (homosexual behavior is still considered illegal in 24 of the United States).

6. Five Substance Abuse-Specific Risk Factors for LGBT Adolescents: 1. Sense of self as worthless or bad. 2. Lack of Connectedness to supportive adults and peers 3. Lack of alternative ways to view “differentness” 4. Lack of access to role models 5. Lack of opportunities to socialize with other GLBT’s outside of bars 6. Risk of contracting HIV http://www.nalgap.org/PDF/Resources/LGBT.pdf

7. Violence/Abuse Nearly two-thirds of LGBT students (64%) said they feel unsafe in school because of their sexual orientation, according to the 2005 National School Climate Survey. Additionally, four out of five LGBT students reported experiencing physical, verbal or sexual harassment at school during the past year.

8. Coming Out About two thirds (64%) report having first come out by age 21, including one third (32%) who came out by age 18. A majority (59%) report that nearly all their lesbian, gay and bisexual friends are out.

9. Coming Out Stages Self-recognition as GLBT Disclosure to others Socialization with other GLBT students Positive self-identification Integration and acceptance

10. On Campus College campuses are often stereotyped as liberal meccas of progressive ideals. But lesbian, gay, bisexual and transgender (LGBT) students, staff and faculty are not immune to harassment and discrimination. Among those on campus, 20 percent fear for their physical safety due to their perceived sexual orientation or gender identity.

11. About the Data Limited surveys ask about sexual orientation Surveying a small, hidden population Terminology used in survey questions Limited funding is available to research this population

12. Why Separate from the General Population What are their special educational needs? Language Safe environment Special mental health needs Positive roll models

13. Health Disparities Revealed Alcohol and drug abuse Tobacco use Exercise, Nutrition and Eating Disorders Mental Health issues

14. Over All Health Risks GLBT youth who self-identify during high school report disproportionate risk for a variety of health risk and problem behaviors –suicide –victimization –sexual risk behaviors –multiple substance use These findings suggest that educational efforts, prevention programs, and health services must be designed to address the unique needs of the GLBT population

15. Alcohol Los Angeles Pride - Bud Light and Smirnoff Denver Pride - Coors Light and Stoli San Diego Pride - Bud Light and Smirnoff Boston Pride -Bud Light and Smirnoff

16. Alcohol Alcohol dependence and alcohol- related consequences differ by sexual orientation, particularly among women. There is a need for the inclusion of sexual-orientation items in population-based surveys so that prevalence rates within these subgroups can be effectively monitored.

17. Alcohol Homosexual and bisexual women and men spend more time than heterosexual individuals in heavier drinking environments. Being in heavy drinking environments does not appear to be associated with heavier drinking for men, but may be related to heavier drinking among some groups of women.

18. Drug Use There is a moderate elevation of drug, particularly marijuana, use and dependence in gay and bisexual men and women when compared to heterosexual men and women. Gay men use substances at a higher rate than the general population, and not just in larger communities such as New York, San Francisco, and Los Angeles. These include a number of substances ranging from amyl nitrate ("poppers"), to marijuana, Ecstasy, and amphetamines.

19. Drug Use Crystal Meth in combination with Viagra has drastically increased the spread of HIV among MSM Gay, lesbian, and bisexual orientation was associated with an increased lifetime frequency of use of cocaine, crack, anabolic steroids, inhalants, “illegal,” and injectable drugs Gay, lesbian, and bisexual youth were more likely to report using tobacco, marijuana, and cocaine before 13 years of age

20. Tobacco Use Tobacco companies promote specific brands to LGB populations through outdoors advertising, ads in gay-oriented magazines, nightclub promotions, and event sponsorships. In the mid-1990s, tobacco control professionals discovered documents that revealed the tobacco industries marketing campaign, Project SCUM (Sub Culture urban Marketing). This campaign was an aggressive attempt to increase smoking and brand loyalty of homeless people and lesbian, gay, and bisexual adults in San Francisco’s Castro district. Top ad categories in Out magazine: tobacco, alcohol, HIV treatments, arrangements to sell life insurance http://www.smokefreeglbt.org/factsheet.html

21. Tobacco Use The GLBT community is approximately 40-70% more likely to smoke than non-GLBT individuals Lesbians, bisexual females, and gay men had significantly higher cigarette smoking prevalence rates than their heterosexual counterparts. Several factors such as higher levels of social stress, frequent patronage of bars and clubs, higher rates of alcohol and drug use, and direct targeting of LGB consumers by the tobacco industry may be related to higher prevalence rates of tobacco use among some LGB groups.

22. Exercise, Nutrition, and Eating Disorders Data supports the hypothesis that homosexual orientation is associated with greater body dissatisfaction and problem eating behaviors in males, but less body dissatisfaction in females. The possible role of sociocultural influences or gender identification on these relationships is discussed.

23. Exercise, Nutrition, and Eating Disorders Research confirms that lesbians have higher body mass than heterosexual women. Obesity is associated with higher rates of heart disease, cancers, and premature death. Gay men are much more likely to experience an eating disorder such as bulimia or anorexia nervosa. The use of substances such as anabolic steroids and certain supplements can adversely affect health. Overweight and obesity are problems that also affect a large subset of the gay community.

24. Mental Health Suicide Depression Anxiety Abuse

25. Mental Health Gay, lesbian, bisexual, or not sure youth report a significantly increased frequency of suicide attempts. Sexual orientation has an independent association with suicide attempts for males. For females the association of sexual orientation with suicidality may be mediated by drug use and violence/victimization behaviors.

26. Mental Health Lesbian and bisexual women were found to have a higher prevalence of several important risk factors for breast cancer, CVD, and poor mental health and functioning outcomes.

27. What Can You Do? Keep educating yourself Understand this community is unique and has their own special needs Recruit them Educate others on campus –Faculty –Staff –Health care providers –Counseling staff

28. What Can You Do? Co-sponsor events with the GLBT club/office Provide safe zone training annually Look at polices that may discriminate against GLBT students Educate resident assistants Bring in speakers that address the issues of this population

29. Resources http://www.psychpage.com/learning/library/gay/gayadol.html Tang H, Greenwood GL, Cowling DW, Lloyd JC, Roeseler AG, Bal DG. Cigarette smoking among lesbians, gays, and bisexuals: how serious a problem? Cancer Causes Control. 2004 Oct;15(8):797-803 Garofalo R, Wolf RC, Kessel S, Palfrey SJ, DuRant RH. The association between health risk behaviors and sexual orientation among a school- based sample of adolescents. Pediatrics. 1998 May;101(5):895-902 Drabble L, Midanik LT, Trocki K. Reports of alcohol consumption and alcohol-related problems among homosexual, bisexual and heterosexual respondents: results from the 2000 National Alcohol Survey. J Stud Alcohol. 2005 Jan;66(1):111-20 Trocki KF, Drabble L, Midanik L. Use of heavier drinking contexts among heterosexuals, homosexuals and bisexuals: results from a National Household Probability Survey. J Stud Alcohol. 2005 Jan;66(1):105-10. Cochran SD, Ackerman D, Mays VM, Ross MW. Prevalence of non-medical drug use and dependence among homosexually active men and women in the US population. Addiction. 2004 Aug;99(8):989-98. http://thetaskforce.org/downloads/reports/reports/CampusClimate.pdf

30. Resources Continued French SA, Story M, Remafedi G, Resnick MD, Blum RW. Sexual orientation and prevalence of body dissatisfaction and eating disordered behaviors: a population-based study of adolescents. Int J Eat Disord. 1996 Mar;19(2):119-26. http://www.brown.edu/Student_Services/Health_Services/Health_Educatio n/general_health/lgbt_msm.htmhttp://www.brown.edu/Student_Services/Health_Services/Health_Educatio n/general_health/lgbt_msm.htm The Kaiser Family Foundation Inside-OUT: A Report on the Experiences of Lesbians, Gays and Bisexuals in America and the Public’s Views on Issues and Policies Related to Sexual Orientation http://www.glsen.org/cgi-bin/iowa/all/news/record/2058.html Garofalo R, Wolf RC, Wissow LS, Woods ER, Goodman E. Sexual orientation and risk of suicide attempts among a representative sample of youth. Arch Pediatr Adolesc Med. 1999 May;153(5):487-93. Case P. Austin SB. Hunter DJ. Manson JE. Malspeis S. Willett WC. Spiegelman D. Sexual orientation, health risk factors, and physical functioning in the Nurses' Health study II. [Journal Article] Journal of Women's Health. 13(9):1033-47, 2004 Nov.