At the Top of the Triangle: The LGBT Community at a High Risk

1. At the Top of the Triangle:The LGBT Community at a High Risk Danny Glassmann Assistant Director of Residence Life & Multicultural Center Elon University Substance Educator Peer Mentors Training 15 January 2008

2. Overview of Presentation • Activity #1 – LGBT Bingo • Definitions • Identity Development Models • Why High Risk? • Activity #2 – Magazines • Issues • Research on Alcohol Abuse • Tobacco Use • Drugs • Body Image • Mental Health • Risk Factors • Special Needs/Recommendations

3. Activity #1 – LGBT Bingo Chicora Martin, University of Oregon, 2008

4. LGBT Population Size • Reliable information about the size of the LGBT population is not available. • Reasons: • Lack of research • Fear of LGBT people to self-identify • Variances in the acceptance of the LGBT labels

5. Definitions • “As an oppressed and often invisible population, we don’t even know how many of us there really are, much less what percentage of us fall into any category.” • “But there is one fact we know for sure… there is an appalling and unacceptable absence of substance abuse services and competencies throughout the continuum of care to meet the needs of America’s LGBT women and men. It’s up to us to change that.” NALGAP Board Member, June 2000, as cited on NCADI Website, www.healthy.org/features/lgbt/substance.html

6. Definitions (continued) • Sexual orientation and gender identity are complicated constructs • Individuals may not agree with labels • Tremendous variability and diversity exist

7. Definitions (continued) • Gay or Lesbian • Primary sexual and emotional attachments to persons of the same gender • Bisexual • Individuals who have sexual and/or emotional attachments to both men and women • Transgender or Gender Variant • Individuals who experiences lack of fit between societal expectations for sex (male/female) or gender (masculine/feminine) • Intersex • A person who is born with “sex chromosomes,” external genitalia, or an internal reproductive system that is not considered “standard” for either male or female (preferred term to “hermaphrodite”). About one in 2,000 children, or five children per day in the United States, are born visibly intersex.

8. Definitions (continued) • Heterosexism • The cultural, institutional, and individual beliefs and practices that privilege heterosexuals and subordinate and denigrate LGB people. • Heterosexual Privilege • The benefits and advantages that heterosexuals receive in a heterosexist culture. Also, the benefits that lesbians, gay men, and bisexuals receive as a result of claiming a heterosexual identity and denying a lesbian, gay, or bisexual identity. • Homophobia (also Internalized) • The fear, hatred, or intolerance of people who identify or are perceived as lesbian or gay, including the fear of being seen as lesbian or gay yourself. • Biphobia • The fear, hatred, or intolerance of people who identify or are perceived as bisexual.

9. Definitions (continued) • Circuit Party • Weekend dance party usually attended by urban gay males. These parties typically occur on a holiday weekend, and just as with many dance clubs and bars, many of their patrons are involved in substance use and abuse. • Rave • Type of dance party at which many of the patrons are involved in substance use and abuse.

10. Coming Out • Individual and personal process by which a person accepts his or her gay, lesbian, or bisexual orientation and transforms it from a negative to a positive thing in a culture that is homophobic and does not validate and affirm diversity and difference. • About two thirds (64%) of college students 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.

11. Cass Model of Lesbian and Gay Identity Development (1979) • Stage I: Identity Confusion • Occurs when a person begins to realize that he or she may relate to and/or identify with being gay or lesbian; a process of personalizing the identity. • Stage II: Identity Comparison • Occurs when a person accepts the possibility that he or she might be gay or lesbian. • Stage III: Identity Tolerance • Occurs when a person comes to accept the probability that he or she is gay or lesbian.

12. Cass Model of Lesbian and Gay Identity Development (1979) • Stage IV: Identity Acceptance • Occurs when a person fully accepts rather than tolerates being gay or lesbian. • Stage V: Identity Pride • Occurs when a person immerses himself or herself in the lesbian and gay community and culture to live out his or her identity. • Stage VI: Identity Synthesis • Occurs when a person develops a fully internalized and integrated lesbian or gay identity and experiences himself or herself as whole when interacting with others in every environment.

14. Why is LGBT High-Risk? • Shame • Fear • Harassment • Non-acceptance from family members • Uncertain about sexuality • Depression • Anxiety • Social events involve drugs/alcohol

15. Different Types of Isolation • 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 • How they solve relationship problems • Social Isolation • Lack of contact with positive role models reinforces the negative value that society places on gays and lesbians

16. Different Types of Isolation • Emotional Isolation • Poor social support and few resources • Lower social support from families • Fewer resources in the community • Stigmatization • Legal discrimination (some behavior is still considered illegal in many states)

17. Overall Health Risks • LGBT youth who self-identity during high school report higher rates of: • 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 LGBT population.

18. Activity #2 Magazines

19. Research Limitations for LGBT Studies on Substance Abuse

20. Prevalence of Gay/Lesbian Alcohol Use: Early Research

21. Prevalence of Gay/Lesbian Alcohol Use: Recent Research Bradford & Ryan (1988) • Lesbian respondents only (no comparisons) • N=1,852 • 83% drink occasionally • 25% drink more than once per week • 6% drink daily • 14% worried about drinking

22. Prevalence of Gay/Lesbian Alcohol Use: Recent Research Stall & Wiley (1988) N=748 gay men • 19% frequent heavy drinking in past 12 months • 6% abstained in past 12 months N=286 heterosexual men • 11% frequent heavy drinking in past 12 months • 3% abstained in past 12 months

23. Prevalence of Gay/Lesbian Alcohol Use: Recent Research Skinner (1994) {Trilogy Project, KY}

24. Research Findings: Lesbians • Fewer lesbians than heterosexual women abstain from alcohol • Lesbians report more alcohol-related problems than heterosexual women at comparable levels of drinking • Lesbian drinking does not decline with age as it does among heterosexuals • Use among lesbians appears to be declining with changes in drinking norms in some communities

25. Research Findings: Gay Men • Gay men are less likely to abstain or to drink heavily than heterosexual men • Gay men report more alcohol-related problems than heterosexual men at lower levels of use • Alcohol use norms among gay men appear to be declining, similar to the pattern with lesbians

26. Smoking for Gay/Bi Men • A 1999 house-hold based survey found that 48.5% of gay and bisexual men reported smoking. The national average for straight men is 28.6%. (www.gaysmokeout.net) • A recent gay.com article on gay smoking cites 36% of LGBT adults are smokers, compared with 25% percent of all adults. (www.gay.com) • The LGBT community is approximately 40-70% more likely to smoke than non-LGBT individuals.

27. The Ways the Tobacco Industry Targets the LGBT Community… • Direct Advertisement • Indirect Advertisement • Event and Organization Sponsorship • Outreach Efforts and Community Promotions

28. Project SCUM • One major tobacco company planned on boosting sales of its cigarettes in the mid-90s by targeting a new consumer market: gays and homeless people. They called their plan "Project Sub Culture Urban Marketing," also known as "Project SCUM." http://www.americanlegacy.org/117.htm

29. LGBT Use of Drugs • Crystal Meth in combination with Viagra has drastically increased the spread of HIV among men that have sex with men. • Gay, lesbian, and bisexual orientation was associated with an increased lifetime frequency of use of cocaine, crack, anabolic steroids, inhalants, “illegal,” and inject able drugs. • LGB youth were more likely to report using tobacco, marijuana, and cocaine before 13 years of age.

30. LGBT Body Image Issues • Data supports the hypothesis that homosexual orientation is associated with greater body dissatisfaction and problem eating behaviors in males. • However, less body dissatisfaction in females. • Research confirms that lesbians have higher body mass than heterosexual women. • Gay men are more likely to experience an eating disorder. • Overweight and obesity are problems that also affect a large subset of the gay community.

31. Mental Health Issues for LGBT • Suicide • LGBT and 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 suicide may be mediated by drug use and violence/victimization behaviors. • Depression • Almost 75 percent of the 1,200 gay and lesbian respondents to a health survey conducted at the Millennium March in Washington believed that depression was more common among gay men and lesbians than in the general population. • Anxiety • Women reporting same-sex partners are more than three times more likely to suffer from generalized anxiety disorder in their lifetime than heterosexual women. • Abuse • Women reporting same-sex partners are more than four times more likely to experience drug abuse in their lifetime than heterosexual women. • Men reporting same-sex partners are close to three times more likely to experience drug abuse in their lifetime than heterosexual men. http://www.healthyplace.com/Communities/Gender/Site/depression/depression_in_community.htm

32. Risk Factors • Centrality of gay bar/club for socialization and support • Conflicts related to gay/lesbian identity • Internalized homophobia • Heterosexism • Stressors inherent to gay/lesbian lifestyles • Incongruities in gender roles and expectancies

33. Risk Factors (continued) • Lifestyle: • Homophobia/heterosexim • Gay bar/club • Coming out/identity • Demographics: • Age • Gender • Race/ethnicity • Social roles/responsibilities (e.g., parenting, civil unions) • Psychosocial: • Depression • Stress • Interpersonal: • Childhood sexual abuse • Intimate partner/ domesticviolence • Peer and partner drinking

34. Special Educational Needs • Language • Safe environment • Specific mental health issues/needs • Positive role models

35. Recommendations for Prevention to LGBT Individuals • Public education and policy advocacy aimed at eliminating heterosexism and homophobia. • LGBT cultural competency training for community-based agencies, programs, and services. • Safer, alternative venues for LGBT youth and those in the process of forming their sexual identities to “come out.” Alcohol, Tobacco, & Other Drug Problems & LGBT Individuals, NALGAP, July 2002

36. Recommendations for You! • Keep educating yourself! • Understand that this community is unique and has their own special needs. • Recruit them! • Educate others on campus: • Faculty, Staff, Health Care Providers, Counseling Staff • Co-sponsor events with Spectrum. • Become an Ally! • Attend Safe Zone Training in the fall! • Look at policies/procedures that may discriminate against LGBT students • Educate Resident Assistants! • Bring in speakers that address this population! • Refer students to an LGBT Ally, Multicultural Center, Counseling Center, Truitt Center, or Spectrum.