Promoting the Health of Gender and Sexual Minorities _ ____________________________________________
LGBTQIA events, such as pride events, the odds of substance use among sexual minority adolescents was lower compared with sexual minority adolescents living in communities with fewer such supports [135]. The pressure of coming of age in a society that says that LGBTQIA individuals should not exist or act on their feelings contributes to the use of alcohol and drugs [136]. Internal- ized homophobia develops and creates feelings of denial, fear, anxiety, and even revulsion about being gay, socializing in the GSM community, and having gay sex. Substance use temporarily relieves these negative feelings, allowing feelings to be acted upon. The homophobic feelings return during drug withdrawal. Substance use occurs again, contributing to the self-hatred. Depression leading to a worsening self-esteem may result from the use of alcohol and many other drugs [136]. Participating in Alcoholics Anonymous and other recovery programs may be difficult for the LGBTQIA individual. Some of the programs suggest giving up old friends, especially fellow substance users, and staying away from parties and bars. These actions may be too difficult for an individual who has limited social contacts and no other available avenues of social outlet [136]. Someone who is socially withdrawn or insecure with his or her own social skills may have difficulty limiting contact with any friends they do have. Other concerns related to recovery groups exist. Heterosexism in support groups makes coming out difficult for LGBTQIA participants. The difficulty of coming out or accepting one’s own sexual orientation may become an excuse to resume alcohol or drug abuse [30]. National organizations, such as the National Gay and Lesbian Health Association and the Gay and Lesbian Medical Association, can assist with referrals to appropriate recovery groups [136]. Tobacco use among sexual minorities may be higher than in the general population, resulting in an increased rate of tobacco- related health problems [137]. Because LGBTQIA individuals may experience difficulty accessing the healthcare system, they are at an increased risk for missing health promotion activi- ties. As a result, illness detection and treatment are delayed. Domestic Violence Despite the myth that intimate partner violence (IPV) is exclu- sively an issue in heterosexual relationships, many studies have revealed the existence of IPV among same-sex couples and found its incidence to be comparable to or higher than that among heterosexual couples. Additionally, unique features and dynamics are present in IPV among same-sex couples, such as identification and treatment of same-sex IPV in the community and the need to take into consideration the role of sexual minority stressors. The lack of studies that address same-sex couple IPV is partly attributable to the silence that has historically existed around violence in the LGBTQIA community, which has obstructed a public discussion on the phenomenon [138]. Homophobia makes accessing informa- tion and support services problematic for LGBTQIA individu-
The U.S. Preventive Services Task Force asserts that lesbian, gay, bisexual, transgender, and queer (LGBTQ) teens are at increased risk of depression and recommends screening for major depressive disorder in adolescents 12 to
18 years of age. (https://www.uspreventiveservicestaskforce.org/uspstf/ recommendation/screening-depression-suicide-risk- children-adolescents. Last accessed September 27, 2024.) Level of Evidence : B (There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.) Clinical studies have indicated that sexual orientation may be a significant predictor of eating disorders. Gay men have demonstrated more dissatisfaction and a greater desire to be thin than heterosexual men [132]. Studies of the role that masculinity and femininity play in relation to men and women who develop eating disorders have shown that men and women with higher levels of femininity have greater levels of dieting behaviors [133]. A negative and inaccurate sense of body image (body dysmorphic disorder) is a primary cause of eating disorders in women and men [132]. Support systems and networks are known to be important to one’s mental health maintenance. While social institutions, such as church, family, and the legal system, are generally thought to be less supportive of GSM individuals than they are of heterosexual individuals, important helpful changes have been occurring in many of these institutions [134]. Selected church leadership has been in public view related to the accep- tance of openly LGBTQ theologians in the church. Families, as an institution, have spoken publicly and given support to their gay family members through organizations such as PFLAG. Also, where legal decisions in favor of the GSM community have been made, public awareness of potentially dangerous environments for GSM youth has increased. Sampling difficulties have made it challenging to research the prevalence of substance use in the LGBTQIA community. For example, studies of alcoholism and drug use have sampled gay and lesbian individuals in bars, a location where higher alcohol and drug use might be expected [8]. Substance use rates for gay and lesbian individuals have been reported as high as 20% to 30%, compared to a rate of 10% among the general public when based on this sampling methodology [30]. However, studies using other sampling methodologies have generally disputed the high incidence of alcoholism and substance use [8]. Research suggests that sexual minority adolescents who reside in communities with a more supportive climate had lower odds of lifetime illegal drug use, marijuana use, and smoking. Specifically, in communities with more frequent
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MDDC1026
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