Lesbian, gay, bisexual, and transgender adolescent school victimization: implications for young adult health and adjustment

BACKGROUND: Adolescent school victimization due to lesbian, gay, bisexual, or transgender (LGBT) status is commonplace, and is associated with compromised health and adjustment. Few studies have examined the long‐term implications of LGBT school victimization for young adult adjustment. We examine the association between reports of LGBT school victimization and young adult psychosocial health and risk behavior. METHODS: The young adult survey from the Family Acceptance Project included 245 LGBT young adults between the ages of 21 and 25 years, with an equal proportion of Latino and non‐Latino White respondents. A 10‐item retrospective scale assessed school victimization due to actual or perceived LGBT identity between the ages of 13 and 19 years. Multiple regression was used to test the association between LGBT school victimization and young adult depression, suicidal ideation, life satisfaction, self‐esteem, and social integration, while controlling for background characteristics. Logistic regression was used to examine young adult suicide attempts, clinical levels of depression, heavy drinking and substance use problems, sexually transmitted disease (STD) diagnoses, and self‐reported HIV risk. RESULTS: Lesbian, gay, bisexual, and transgender‐related school victimization is strongly linked to young adult mental health and risk for STDs and HIV; there is no strong association with substance use or abuse. Elevated levels of depression and suicidal ideation among males can be explained by their high rates of LGBT school victimization. CONCLUSIONS: Reducing LGBT‐related school victimization will likely result in significant long‐term health gains and will reduce health disparities for LGBT people. Reducing the dramatic disparities for LGBT youth should be educational and public health priorities.     

At the intersection of marginalised identities: lesbian,gay, bisexual and transgender people's experiences of injecting drug use and hepatitis C seroconversion

Although the levels of injecting drug use among lesbian, gay, bisexual and transgender (LGBT) populations are high, we know little about their experiences of injecting drugs or living with hepatitis C virus (HCV) infection. The loss of traditional family and cultural ties means connection to community is important to the well‐being of LGBT populations. Although some kinds of drug use are normalised within many LGBT communities, injecting drug use continues to be stigmatised. This exploratory qualitative study of people with newly acquired HCV used semi‐structured interviews to explore participants' understandings and awareness of HCV, seroconversion, testing, diagnosis and treatment. We present a secondary thematic analysis of eight LGBT participants of the experience of injecting drugs, living with HCV and having a marginalised sexual or gender identity. Community was central to the participants' accounts. Drug use facilitated connection to a chosen community by suppressing sexual or gender desires allows them to fit in to the mainstream; enacting LGBT community norms of behaviour; and connection through shared drug use. Participants also described feeling afraid to come out about their drug use to LGBT peers because of the associated stigma of HCV. They described a similar stigma associated with HIV within the people who inject drugs (PWID) community. Thus, the combination of being LGBT/living with HIV (a gay disease) and injecting drugs/living with HCV (a junkie's disease) left them in a kind of no‐man's‐land. Health professionals working in drug and HCV care services need to develop capacity in providing culturally appropriate health‐care for LGBT PWID.     

Epidemiology of participation: an Australian community study

STUDY OBJECTIVE: To determine the levels of participation in social and civic community life in a metropolitan region, and to assess differential levels of participation according to demographic, socioeconomic and health status. To contribute to policy debates on community participation, social capital and health using these empirical data. DESIGN: Cross sectional, postal, self completed survey on health and participation. SETTING: Random sample of the population from the western suburbs of Adelaide, the capital city of South Australia, a population of approximately 210 000. PARTICIPANTS: 2542 respondents from a sample of 4000 people aged 18 years and over who were registered on the electoral roll. MAIN RESULTS: The response rate to the survey was 63.6% (n=2542). Six indices of participation, on range of social and civic activities, with a number of items in each, were created. Levels of participation were highest in the informal social activities index (46.7-83.7% for individual items), and lowest in the index of civic activities of a collective nature (2.4-5.9% for individual items). Low levels of involvement in social and civic activities were reported more frequently by people of low income and low education levels. CONCLUSIONS: Levels of participation in social and civic community life in an urban setting are significantly influenced by individual socioeconomic status, health and other demographic characteristics. An understanding of the pattern of participation is important to inform social and health policy making. Increasing levels of participation will reduce social exclusion and is likely to improve the overall quality of community life.     

A map of community‐based obesity prevention initiatives in Australia following obesity funding 2009–2013

Objective: Obesity is the single biggest public health threat to developed and developing economies. In concert with healthy public policy, multi‐strategy, multi‐level community‐based initiatives appear promising in preventing obesity, with several countries trialling this approach. In Australia, multiple levels of government have funded and facilitated a range of community‐based obesity prevention initiatives (CBI), heterogeneous in their funding, timing, target audience and structure. This paper aims to present a central repository of CBI operating in Australia during 2013, to facilitate knowledge exchange and shared opportunities for learning, and to guide professional development towards best practice for CBI practitioners. Methods: A comprehensive search of government, non‐government and community websites was undertaken to identify CBI in Australia in 2013. This was supplemented with data drawn from available reports, personal communication and key informant interviews. The data was translated into an interactive map for use by preventive health practitioners and other parties. Results: We identified 259 CBI; with the majority (84%) having a dual focus on physical activity and healthy eating. Few initiatives, (n=37) adopted a four‐pronged multi‐strategy approach implementing policy, built environment, social marketing and/or partnership building. Conclusion: This comprehensive overview of Australian CBI has the potential to facilitate engagement and collaboration through knowledge exchange and information sharing amongst CBI practitioners, funders, communities and researchers. Implications: An enhanced understanding of current practice highlights areas of strengths and opportunities for improvement to maximise the impact of obesity prevention initiatives.     

‘A lot better than medicine’ - Self-organised ocean swimming groups as facilitators for healthy ageing

Exercise, spending time in nature and feeling part of a supportive community all contribute to better physical and mental health and to healthy ageing. This focused ethnography investigates how participation in self-organised ocean swimming groups contributes to healthy ageing amongst older men and women in the Australian coastal city of Perth. It explores the ways marine life, personal experiences and social connectedness mediate their group use of public blue space, and highlights that group membership promotes participants’ enhanced health and wellbeing, and supports development of self-efficacy and resilience. These findings suggest that more inclusive access to ocean swimming and other forms of active or adventure-based leisure activities should be advocated from a public health perspective.     

Is tobacco a gay issue? Interviews with leaders of the lesbian,gay, bisexual and transgender community

This study examined the extent of tobacco industry funding of lesbian, gay, bisexual and transgender (LGBT) organisations and whether leaders of these organisations thought tobacco was a priority health issue for their community. We interviewed leaders of 74 LGBT organisations and publications in the USA, reflecting a wide variety of groups. Twenty‐two percent said they had accepted tobacco industry funding and few (24%) identified tobacco as a priority issue. Most leaders did not perceive tobacco as an issue relevant to LGBT identity. They saw smoking as a personal choice and individual right rather than as a health crisis fuelled by industry activities. As such, they were reluctant to judge a legal industry, fearing it might lead to having to evaluate other potential funders. They saw tobacco control as divisive, potentially alienating their peers who smoke. The minority who embraced tobacco control saw the industry as culpable and viewed their own roles as protecting the community from all harms, not just those specific to the gay community. Lesbian, gay, bisexual and transgender tobacco‐control advocates should reframe smoking as an unhealthy response to the stresses of homophobia to persuade leaders that tobacco control is central to LGBT health.     

Factors related to preference for participation and degree of commitment in community activities among older adults in Japanese depopulated areas

To address the rapid increase in the ageing population, Japan implemented the Long‐Term Care Insurance System (LTCS) in 2000. Additionally, a community‐based integrated community care system was released in 2012. The purpose of these policies was to help older people who need care or support to continue to live their preferred lifestyles in their own communities. According to this paradigm, older residents are themselves considered members of the community caregiving team and expected to participate in volunteer activities to help the neighbourhood. One such activity is social participation including community activities. Many factors influencing social participation have been found in previous literature. However, knowledge of specific factors about community activities is limited, even though these kinds of activities have attracted policy attention. Our study examined factors related to thoughts about community activities among people aged >40 years. We conducted random sampling in two depopulated areas in Japan and used an anonymous mail survey method. Our survey consisted of three parts: social demographics, health and life, and medical/long‐term care. A total of 2,466 individuals participated in the study (response rate 52.2%), whose average age was 64.2 (SD = 10.3) and 46.5% (n = 1,146) were female. Items including talking with neighbours frequently (social demographics), higher self‐rated health (health and life), the need for health consultations and the desire to take care of family members when they need help (medical/long‐term care) were significantly related to both preference for participation and degree of commitment in community activities. To encourage participation in community activities among older citizens, we recommend interventions related to health literacy and family ties.     

Ordinary and effective: the Catch‐22 in managing the public voice in health care?

Introduction Joseph Heller’s Catch‐22 is regularly invoked to critique the irrationality inherent in supposedly rational bureaucracy. We explore a Catch‐22 for policy concerning public involvement in English health care: you have to be ordinary to represent the community effectively, but, if you are ordinary, you cannot effectively represent your community. The nature of public participation groups Starting with community health councils, we trace government policy about involving local people in health care, up to the current arrangements for local involvement networks and show how the above Catch‐22 works. We do this in two principal ways. First, by an analysis of some of the unrecognized paradoxes in current government policies designed to populate health‐care participation groups and second, by providing a series of narrative vignettes, drawn from our own experiences of working in such groups, which illustrate the nature of the dilemmas members face. Conclusions Our proposal to get out of the worst of the Catch‐22 for effective public involvement groups is (paradoxically) to suggest focusing less on effectiveness, or more precisely, focusing less on those conventional, managerially defined notions of effectiveness that are now pretty much taken for granted within public services. This is because, if bodies like LINks are to do more than provide unthreatening, homogenous and tokenistic public perspectives, they need to be given space and time to pursue their own agendas.     

Rapid assessment: an international review of diffusion, practice and outcomes in the substance use field

'Rapid assessment' (RA) methods have the potential to generate important public health information. This potential is now the subject of debate within the substance use field. Despite this, much remains unknown about the application and outcomes of RAs on substance use, a situation compounded by the absence of published studies. Consequently, we undertook a retrospective review of the use of RA in the substance use field drawing on three methods: literature review (n=300 published and unpublished documents); survey of RA practitioners/commissioners (n=1200 contacts); in-depth expert consultation (n=10 interviews). Study findings indicated: (i) earliest identified RAs were conducted in 1993, with 83 identified studies conducted by 2001; (ii) RAs have been conducted in 70 countries, with seven out of 10 assessments undertaken between 1998 and 2001; (iii) RAs were reported as taking 9-486 days (69 weeks) to complete; and (iv) important outcomes can follow RA on substance use--one in two studies were followed by medical or non-medical interventions, workshops, training, policy change, community participation, network building, or other outcomes (45/83; 54%), whilst more than one in four RAs were followed by medical and non-medical interventions, or policy impact and change (25/83; 30%). In conclusion, we argue that to fully realise the potential of RA in the substance use field, investment has to be made in RA's evidence and knowledge base: in short, a culture of learning, reflection and discussion has to be introduced into a methodology currently premised on rapidity and pragmatism.     

Women's participation in community health education: an empirical study

This study identifies reasons for participation in community health education and determines if selected sociodemographic variables correlate with reasons for participation. The subjects were women (N = 400) who had attended hospital-based health education programs in a midwest urban area. An instrument was developed containing 36 items describing the concept "reasons for participation." Factor analysis revealed six interpretable factors: social acceptance, professional/personal advancement, personal insight, personal satisfaction, fulfillment of responsibilities, and self-enrichment. Age, marital status, occupation, number of children, educational attainment, and family income correlated with three of the six factors.     

Alcohol and other substance use among a sample of young people in the Solomon Islands

Objective: Investigate alcohol and other substance use, with a focus on harmful alcohol use patterns, among young people in the Solomon Islands. Methods: A structured, interviewer‐administered questionnaire was administered to respondents aged 15–24 years across four of the country's provinces in late 2015. Results: Four hundred young people completed the questionnaire across urban, peri‐urban and rural communities. The most common substances ever used by participants were betel nut (94%), licit/store‐bought and/or illicit alcohol (79%) and tobacco (76%). Lifetime and recent substance use was particularly common among male respondents; e.g. 89% of male participants reported ever using any alcohol versus 54% of females (p<0.001). Harmful alcohol use patterns were common. Conclusions: Our sample generally reported higher levels of substance use compared to previous research in the Solomon Islands, including in relation to the country's relatively recent (2012/13) Household Income and Expenditure Survey. Implications for public health: Our study made considerable advances in addressing key knowledge gaps regarding alcohol and other substance use among young people in the Solomon Islands. Evidence‐based initiatives to address early initiation of alcohol and other substance use and the progression to more problematic use patterns among young people in the Solomon Islands need to be explored.     

Stigma correlates in individuals with mental health conditions versus community members enrolled in a nationwide integrated arts‐based community rehabilitation program in Israel

Two of the most prominent challenges faced by people with mental health conditions (MHCs) are experiencing stigma and personal recovery. This study focused on the analysis of baseline data from registrants for integrated arts‐based groups in a nationwide psychosocial rehabilitation program in Israel. The aim of the study was to examine the possible associations between self‐stigma, personal recovery and creative self‐efficacy (CSE) in people with MHCs, and the associations between public stigma, desire for social distance, familiarity with mental illness and CSE in community members. Cross‐sectional data were collected by online survey software in October‐November 2017 from 114 people with MHCs and 117 community members who enrolled in 15 integrated arts‐based groups, and 68 people with MHCs who were not enrolled in integrated groups. The main findings suggest that individuals with MHCs who reported high self‐stigma also reported a low sense of personal recovery and low CSE. The CSE of those with MHCs correlated positively with their personal recovery. Among community members, high public stigma was associated with a greater desire for social distance in women, but less contact with MHCs in men. Individuals with MHCs who had previously participated in integrated arts‐based groups reported greater personal recovery than those who had not. Community members reported higher CSE and public stigma than the CSE and self‐stigma of individuals with MHCs. The findings help characterise both individuals with MHCs and non‐clinical community members who decide to enrol in integrated groups, as well as individuals with MHCs who chose not to enrol, enabling similar community‐based programs to better identify their conditions and meet their needs. Future research should examine the contribution of integrated arts‐based groups to promoting recovery and reducing stigma.     

IMPROVING THE QUALITY OF COMMUNITY HEALTH SURVEYS AND COMMUNITY HEALTH PROMOTION CAMPAIGNS BY FEEDBACK FROM THE COMMUNITY: EXPERIENCE FROM THE WALLSEND COMMUNITY AND HEALTH PROJECT

A lifestyle and health risk survey was conducted in two socially disadvantaged Collector's Districts, as the basis for a health promotion intervention in one of the Districts. After community input into the planning, and local advance publicity, 395 people responded to the survey (a response rate of 39%). Three sources of community feedback were used: (i) reasons for refusal to participate; (ii) written comments solicited at a two-month follow-up; (iii) later, in-depth interviews with a subset of respondents. The data from this feedback related both to the process and outcomes of the survey; the latter included increased personal and community awareness of health, as well as lifestyle changes. The data are discussed in terms of their representativeness and the factors influencing participation, the implications of the low response rate, the stages of health behaviour change, and the potential conflict between scientific and human value-systems in community research.     

Family and community involvement in schools: results from the School Health Policies and Programs Study 2006

BACKGROUND: Family and community involvement in schools is linked strongly to improvements in the academic achievement of students, better school attendance, and improved school programs and quality. METHODS: The Centers for Disease Control and Prevention conducts the School Health Policies and Programs Study every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in all 50 states plus the District of Columbia and among a nationally representative sample of school districts (n=461). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=1029) and with a nationally representative sample of teachers of required health education classes and courses (n=912) and required physical education classes and courses (n=1194). RESULTS: Although family and community involvement in states, districts, and schools was limited, many states, districts, and schools collaborated with community groups and agencies to promote and support school health programs. More than half of districts and schools communicated information to families on school health program components. Teachers in 55.5% of required health education classes and courses and 30.8% of required physical education classes and courses gave students homework or projects that involved family members. CONCLUSIONS: Although family and community involvement occurred at all levels, many schools are not doing some of the fundamental things schools could do to increase family involvement. Improvements in family and community involvement can support school health programs in states, districts, schools, and classrooms nationwide.     

Community views on health sector reform and their participation in health priority setting: case of Lushoto and Muheza districts, Tanzania

BACKGROUND: Community participation (CP) is a key concept under 'primary health care' programmes and 'Health Sector Reform' (HSR) in many countries. However, international literature with current empirical evidence on CP in health priority setting and HSR in Tanzania is scanty. OBJECTIVES: To explore and describe community views on HSR and their participation in setting health priorities. METHODS: A multistage sampling of wards and villages was done, involving group discussions with members of households, Village Development Committees (VDCs) and Ward Development Committees (WDCs). RESULTS: Respondents at village and ward levels in both districts related HSR with a cost sharing system at public health facilities. Views on the advantages or disadvantages of HSR were mixed, most of the residents pointing out that user charges burden the poor, there is a shortage of drugs at peripheral health facilities, the performance of government health service staff and village health workers does not satisfy community needs, health insurance is promoted more than people actually benefit, VDC and WDC poorly function as compared to local community-participatory priority-setting structures. CONCLUSION: HSR may not meet the desired health needs unless more efforts are made to enhance the performance of the existing HSR structures and community knowledge and enhance trust and participation in the health sector programmes at all levels.     

“You Live Where?!” Lesbian Mothers' Attachment to Nonmetropolitan Communities

A positive attachment to one's residential community has been linked to better mental health ( McLaren, 2009 ), stronger social support ( Young, Russell, & Powers, 2004 ), and a higher quality of life ( Mak, Cheung, & Law, 2009 ). Attachment to residential community has been understudied in research on lesbian, gay, bisexual, and transgender (LGBT) families. The current study attempts to fill this gap by using family and minority stress theories to examine the predictors of residential community attachment among 77 lesbian mothers living in nonmetropolitan communities. Our findings indicate that stronger residential community attachment is predicted by more frequent contact with family of origin, low religiosity, and an interaction between close LGBT friendships and the presence of at least one local LGBT organization. Contrary to expectations, anti‐LGBT victimization perpetrated by community members did not have an effect on residential community attachment.     

The evolution of the Fenway Community Health model

Fenway Community Health was founded by community activists in 1971 in the Fenway neighborhood of Boston, Mass, and within a decade had rapidly expanded its medical services for gay men in response to the AIDS epidemic. Increased expertise and cultural competence in lesbian, gay, bisexual, and transgender (LGBT) care led to expansion of medical services to address broader community concerns, ranging from substance use to parenting issues to domestic and homophobic violence, as well as specialized programs for lesbians, bisexuals, and transgendered individuals. Fenway began as a grassroots neighborhood clinic. In 1975, the center recorded 5000 patient care visits; in 2000, Fenway's clinical departments recorded 50,850 visits by 8361 individuals, including more than 1100 individuals receiving HIV-associated care. The center now has more than 170 staff people responsible for clinical programs, community education, research, administration, planning, and development. Over the past few years, Fenway's annual budget has exceeded $10 million. Fenway has established standards for improved cultural competence about LGBT health issues for other health providers and has developed programs to educate the general community about specific LGBT health concerns. This health center may provide a model of comprehensive LGBT health services that have a local impact.     

Associations between youth assets and sexual activity: does adult supervision play a role?

Background Youth participation in sexual risk behaviours continues to be a critically important public health topic. Additionally, as youth are frequently being left alone during the day without adult supervision, there are increased opportunities for sexual risk‐taking behaviour. This study examined how the relationships of nine youth assets and sexual activity may vary according to the stratification of youth into two groups: self‐care and supervised. Methods Data were collected through at‐home, in‐person interviews from a random sample of inner‐city youth (mean age = 15.4 years; 51.5% female; 48.8% White; 22.4% Black; 18.5% Hispanic; 10% Native American) and their parents (n = 1079 parent/youth pairs). Nine youth assets were analysed using multiple logistic regression. Examples of assets youth may possess are: positive role models, family communication, school connectedness, constructive use of time and aspirations for the future. The item used to assess sexual intercourse was ‘Have you ever had sexual intercourse (“done it”, “had sex”, “made love”, “gone all the way”)?’. Asset/risk behaviour associations that were unique to one of the two strata were the focus of the study. Results Thirty‐seven per cent of youth spent two or more hours per day home alone. Youth who were supervised had a greater number of unique significant associations between assets and sexual activity than youth who were in the self‐care group. Conclusions Youth in supervised settings may be less likely to participate in sexual activity because of the presence of assets. Certain assets may also be important in deterring sexual activity for youth who are in self‐care.     

What do women gain from volunteering? The experience of lay Arab and Jewish women volunteers in the Women for Women’s Health programme in Israel

Ambiguous feelings regarding women engaging in formal volunteering and concerns about their exploitation might explain the dearth of studies regarding the volunteering benefits specifically experienced by low socioeconomic status women. The current study examined benefits of volunteering among women participating in Women for Women’s Health (WWH), a lay health volunteers (LHV) programme implemented in Jewish and Arab communities in Israel, and aiming at empowering such women to become active volunteers and promote health activities in their communities. Two years after the introduction of WWH in each community, all 45 Jewish and 25 Arab volunteers were contacted by phone and invited to participate in the focus group discussions. Five focus group discussions were conducted with 25/42 Jewish volunteers in 2003 and four with 20/25 Arab volunteers in 2005. The other volunteers could not attend the scheduled meetings or became inactive for personal reasons. Four benefit categories were identified in both ethnic groups: 1. Personal benefits of having increased knowledge, feeling self‐satisfaction, mastering new skills and performing healthy behaviours; 2. Group‐social benefits of social support and sense of cohesion; 3. Purposive benefits of achieving the WWH mission and goals; 4. Sociopolitical benefits of learning to accept the other and experiencing increased solidarity. However, the relatively less privileged Arab volunteers enumerated more benefits within the personal and purposive categories. They also identified the unique sociocultural category of improving women’s status in the community by creating a legitimate space for women by public sphere involvement, traditionally solely a male domain. We conclude that volunteering in community‐based health promotion programmes can be an empowering experience for lay women without being exploitative. Positive volunteering benefits will be even more discernable among underprivileged women who enjoy fewer opportunities in the personal and public domains. More studies need to explore volunteering benefits as reported by LHVs, making these benefits more visible and desirable.