Health care issues of gay and lesbian youth.

Gay and lesbian youth are adolescents who, in many ways, are no different from their peers. What distinguishes homosexual youth from other adolescent populations is the emotional, psychological and physical trauma resulting from the homophobia they experience in their daily lives. Although suicide, HIV infection, substance use, and violence appear to disproportionately affect this population, most homosexual youth grow up healthy and happy. Frequently lost in discussions of risk and risk behaviors is an appreciation of the strengths very much present in these young people. Health care providers must remain aware of the unique issues and health risks of homosexual youth but must also remember to address each patient as an individual within the context of general adolescent development. By doing so, pediatricians can play a vital role in preserving and enhancing the health of this "at-risk" population.     

Nondisclosure of sexual orientation to a physician among a sample of gay, lesbian, and bisexual youth

BACKGROUND: The American Medical Association, the American Academy of Pediatrics, and the Society for Adolescent Medicine recommend discussing sexual orientation as part of the health supervision of all adolescents. Little is known about whether lesbian, gay, and bisexual (LGB) youth hide their orientation from health care providers, which can potentially lead to missed opportunities in identifying individual health risks and provide appropriate screening and counseling. OBJECTIVES: To describe the health care experiences of a nonclinical sample of LGB youth and identify factors associated with disclosure and nondisclosure of orientation to physicians. DESIGN: Community-based participatory study using a self-administered questionnaire. SETTING: Los Angeles youth empowerment conference held in October 2003 targeting high school-aged LGB youth. PARTICIPANTS: One hundred thirty-one youth aged 14 to 18 years who identified themselves as LGB. Main Outcome Measure Physician's knowledge of participant's sexual orientation. RESULTS: Thirty-five percent of the sample reported that their physician knew they were LGB. Bisexual youth were less likely than gay and lesbian youth to have disclosed. The strongest predictor of disclosure was having discussed sex or sexual health of any kind with a physician (odds ratio, 15.47; 95% confidence interval, 4.34-55.18). When asked what a physician could do to make talking about being LGB more comfortable, 64% of participants chose the survey response, "Just ask me." CONCLUSIONS: Even among a nonclinical sample of LGB youth who were open enough about their orientation to attend a conference on the subject, only 35% reported that their physician knew their orientation. The results indicate that physicians had not discussed sexuality with most LGB youth in the study and that most youth would welcome such a discussion.     

Risk factors for attempted suicide in gay and bisexual youth

Studies of human sexuality have noted high rates of suicidality among homosexual youth, but the problem has not been systematically examined. This work was undertaken to identify risk factors for suicide attempts among bisexual and homosexual male youth. Subjects were 137 gay and bisexual males, 14 through 21 years of age, from the upper Midwest and Pacific Northwest. Forty-one subjects (41/137) reported a suicide attempt; and almost half of them described multiple attempts. Twenty-one percent of all attempts resulted in medical or psychiatric admissions. Compared with non-attempters, attempters had more feminine gender roles and adopted a bisexual or homosexual identity at younger ages. Attempters were more likely than peers to report sexual abuse, drug abuse, and arrests for misconduct. The findings parallel previous studies' results and also introduce novel suicide risk factors related to gender nonconformity and sexual milestones.     

Bacterial sexually transmitted infections in gay, lesbian, and bisexual adolescents: medical and public health perspectives

Gay, lesbian, and bisexual adolescents, like all adolescents who engage in high-risk sexual behaviors, are at elevated risk for acquiring sexually transmitted infections (STIs). Personal sexual risk factors and issues related to access to care complicate the lives of youth who engage in same-gender sexual activity and who may or may not self-identify as gay, lesbian, or bisexual. Whereas epidemiologic rates of gonorrhea, chlamydia, and syphilis generally have trended downward in adolescents as a whole during the past 15 years, rates for these common reportable bacterial STIs have increased overall during recent years among men who have sex with men. This article focuses on bacterial STIs in youth with same-gender sexual activity. An understanding of trends among gay, lesbian, and bisexual youth remains incomplete, given the absence of consistent and uniform mechanisms for collecting data on sexual behaviors in adolescents and difficulties in associating these behaviors with reportable STIs. Special attention should be given to the screening, diagnosis, and treatment of bacterial STIs in those who engage in same-sex behavior, as new recommendations from the Centers for Disease Control and Prevention have been made available. It is critical that healthcare providers who work with adolescents be aware of the assortment of specific healthcare needs of gay, lesbian, and bisexual youth and address them appropriately in the clinical setting. Medical providers may be one of few true advocates for this often-marginalized adolescent population and have the power to have a positive influence on health promotion and education efforts.     

Gay and lesbian issues in pediatric health care

Physicians, nurses, and other health care professionals can exert a powerful influence in support of gay and lesbian parents and their children, and of both gay and nongay adolescents and parents of teenagers in their community. We can do this by avoiding and challenging assumptions of heterosexuality in the process of clinical care for children of all ages; by helping children and their families to understand the wide range of normal variation in sexual orientation; by helping schools and community organizations in their efforts to provide information and support to all children and families whatever their particular constellation. Within our own professional organizations we can work against homonegative attitudes that reinforce discrimination and the personal and professional limitations caused by stigma. Expansion of medical education and research regarding issues central to gay and lesbian individuals and their families requires the creation of a context of support, visibility, and concern within medical centers and schools of medicine, nursing, and allied health professions.     

Assessing youth sprint ability-methodological issues, reliability and performance data

The primary purpose of this paper was to provide insight into the methodological issues and associated reliability of assessments used to quantify running sprint ability in youth athletes aged 8-18 years. Over-ground sprinting was the most reliable and common used choice of assessment to measure sprint performance of youth. In addition, the performance data of those athletes over distances ranging from 5 to 40 meters was collated from 34 published articles and tabulated with regards to the athlete's chronological age. Torque or nonmotorized treadmills have been used to quantify sprint performance in youth with acceptable reliability, this technology providing deeper insight into sprint kinetics and kinematics; however there is limited performance data on youth using the torque and the nonmotorized treadmill. It is suggested that future research should use this technology in youth to better understand changes associated with growth, maturation and training.