1. Using Lesbian, Gay, Bisexual Youth Data from the Oregon Healthy Teens Survey to Address Health Inequities Molly Franks, MPH Oregon Public Health Division molly.c.franks@state.or.us April 2008

2. 2 Purpose Data collection Analysis Interpretation Use Use 2007 Oregon Healthy Teens (OHT) data to: o Discuss key issues in o Address health issues faced by lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth.

3. 3 Question #1: Sexual orientation Which of the following best describes you? FemalesMalesTotal Heterosexual90.1%95.3%92.6% Gay or Lesbian1.3%1.4%1.3% Bisexual6.1%1.7%4% Not sure2.5%1.5%2% Total 100% (n=2855) 100% (n=2705) 100% (n=5560) 2007 Oregon Healthy Teen Survey, 11 th grade data

4. 4 During your life, with whom have you had sexual contact? FemalesMales I have never had sexual contact39.9%37.8% Females3.5%56.6% Males49.5%3.4% Both males and females7%2.2% Total 100% (n=2852) 100% (n=2696) Question #2: Sexual contact 2007 Oregon Healthy Teen Survey, 11 th grade data

5. 5 Adding them all up… Sexual Orientation/Sexual Behavior% of Total Heterosexual ID (No same-sex contact) 88.1% Lesbian, Gay, or Bisexual ID (With or without same-sex contact) 5.3% Same-sex contact (Hetero or Not sure ID) 5.0% Not sure (No same sex contact) 1.6% Total 100.0% (n=5560) 2007 Oregon Healthy Teen Survey, 11 th grade data

6. 6 Sexuality data collection issues  Lack of LGBTQ data limits understanding and ability to improve public health interventions  Presence and content of questions reflect current thinking about sexuality Discomfort discussing sexuality openly Changing language/concepts – e.g. queer, trans Increasing acceptance of LGB experience  Negative vs. positive focus of questions Risks vs. strengths/what helps people succeed  Stigma/social desirability may affect how people answer

7. 7 Data analysis issues  Making generalizations based on a sample Sampling frame Sampling strategy Sample size Weighting Prevalence of specific subgroups  Statistically significant vs. clinically significant differences  Combining behavior and ID questions in OHT data

8. 8 Should we combine questions? Both female and male Non-concordants are between, and significantly different from, Hetero Concordants and LGB identified youth on outcomes such as: mental health, physical health, suicide attempts, forced sex, harassment. Males only – Sexual Identity by Sexual Contact No sexual contact Sexual Contact Total FemalesMales Males and Females Heterosexual38.1%58.3%2.5%1.0%100% (n=2556) Gay3.5%24.6%44.7%27.2%100% (n=27) Bisexual35.2%11.7%13.1%40.0%100% (n=43) Not sure46.6%39.1%4.5%9.8%100% (n=47)

9. 9 *Higher values are more positive. All comparisons showed significant differences between hetero and LGBQ identified youth on within gender comparisons, p<.01 Female Male 2007 Oregon Healthy Teen Survey, 11 th grade data

10. 10 LGBQ youth were significantly less likely to meet the PYD benchmark, p<.01 Ns are number of youth who meet the benchmark. Female Male 2007 Oregon Healthy Teen Survey, 11 th grade data

11. 11 LGBQ youth were significantly more likely to report harassment, p<.01 Ns are number of youth who report harassment. Female Male 2007 Oregon Healthy Teen Survey, 11 th grade data

12. 12 LGBQ youth were significantly more likely to report smoking in the past 30 days, p<.01 Ns are number of youth who report smoking. Female Male 2007 Oregon Healthy Teen Survey, 11 th grade data

13. 13 Substance abuse in past 30 days Chi-squares for cross-tabulations between substance and sexual orientation, split by gender. Shaded pairs show significant differences, p<.05. FemalesMales HeteroLBQHeteroGBQ Binge drinking 26% (N=634) 25% (N=60) 29% (N=702) 39% (N=38) Marijuana 16% (N=403) 31% (N=68) 20% (N=440) 24% (N=27) Other drugs 7% (N=128) 17% (N=31) 9% (N=169) 29% (N=27) Prescription drugs 7% (N=155) 15% (N=32) 7% (N=160) 13% (N=16) 2007 Oregon Healthy Teen Survey, 11 th grade data

14. 14 LGBQ youth were significantly more likely to report a suicide attempt in the past 12 months, p<.001. Ns are number of youth who report any suicide attempts. 2007 Oregon Healthy Teen Survey, 11 th grade data

15. 15 Female Male * values are significantly different from one another, and ** values are significantly different from one another, p<.01. Ns are number of youth who report intercourse, forced sex, drug use, and being hurt. 2007 Oregon Healthy Teen Survey, 11 th grade data. * * * * ** * *

16. 16 Interpretation issues  Correlation vs. causality Two things happening simultaneously doesn’t mean one causes the other  Mediating variables A third variable may effect how dependent and independent variables relate  Confounders An extraneous variable may be causing the effect shown  Small numbers Small samples may limit generalizability or statistical power  Cross-sectional sample Looking at only a single point in time limits ability to determine causality

17. 17 Using OHT results - key messages  Sexuality is fluid and difficult to categorize with discrete labels.  Almost 12% of Oregon 11th graders identify as LGBQ or have had same-sex sexual contact.  It appears there are significant differences among LGBQ youth, but small numbers necessitate combining the groups for analyses.

18. 18 Key messages (continued)  Many youth who challenge heterosexual norms experience harassment and violence and are more likely to struggle with poor mental health, smoking and other drug use, and unsafe sexual behavior.  It’s important to take these problems seriously, but we shouldn’t only dwell on negative outcomes.

19. 19 Moving forward - recommendations  Include positive, strengths-based indicators in data collection and interventions.  Expand data collection, e.g., include gender identity, focus on subgroups such as youth of color.  Combine qualitative and quantitative methodologies.  Use data to increase awareness of LGBTQ issues and motivate action in support of LGBTQ youth.  Use data to inform policy development on a state and local level.  Work with LGBTQ youth to develop and evaluate targeted programs, e.g., using “youth action research.”

20. 20 More recommendations…  Include gender identity, sexual orientation and same-sex sexual behavior questions on intake and screening forms.  Support development of gay straight alliances.  Develop and systematically implement anti-bias curricula in schools.  Include sexual orientation and gender identity in anti-bullying policies.  Tailor drug and violence prevention programs to meet the needs of LGBTQ youth.  Develop supportive resources for parents to increase their support for their LGBTQ children.