Reaching LGBTQ youth where they are: On their phones
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The document discusses developing digital resources to support the health and well-being of LGBTQ youth. It summarizes focus groups and interviews with 92 LGBTQ youth ages 15-19. Key themes included social and emotional health concerns predominating over physical health issues. Youth felt isolated and wanted more support from both peers and parents. Coming out was a significant source of anxiety. Sex education resources did not address LGBTQ experiences. Youth relied on Google, YouTube, and social media for information and community. A digital resource is needed to reduce isolation and address emotional, social, and physical health concerns. Next steps proposed convening advisors and LGBTQ youth to develop and test initial digital tools.
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Reaching LGBTQ youth where they are: On their phones
- 1. Reaching LGBTQ Youth Where They Are: On Their Phones Deborah S. Levine, April 28th, 2015
- 2. Digital Education Tools • Nine digital tools to provide sex education on mobile phones for both younger and older heterosexual adolescents • Combine the science of what helps young people to engage in healthy behaviors and what they like to do online • Emphasis on ensuring they are relevant to African-American and Latino youth
- 3. Digital Education Tools for Middle School Teens
- 4. Digital Education Tools for High School Teens
- 5. Challenges for LGBTQ Youth • Decisions about coming out to peers, parents, and other community members • Bullying or violence in schools and online, ranging from verbal harassment to outright physical assault • Pressure to engage in heterosexual behaviors, resulting in increased risk of pregnancy and exposure to STDs • High rates of HIV and STDs among teen MSM
- 6. Digital Opportunity with LGBTQ Youth
- 7. Digital Resources for LGBTQ Youth ? ? ? ? ?? ? ? ? • Partnership with Human Rights Campaign Foundation • Seeking additional partners as we move forward
- 8. LGBTQ Focus Groups and Interviews • LGBTQ youth (n= 92) ages 15-19 from across the United States • 8 virtual focus groups (on the phone) • 4 in-person focus groups in Seattle and Dallas • 20 individual interviews (on the phone) 52% 16% 14% 11% 5% 1% White Latino Black Mixed Asian Native Ethnicity Male 34% Female 34% Gender Queer, Gender Fluid or Non-binary 18% Transgender 14% Gender Identity 36% 27% 25% 18% 17% 10% 7% Gay Man Queer Lesbian Questioning Bi Female Pansexual Bi Male Sexual Orientation Multiple identities allowed
- 9. Key Themes • Social and emotional health concerns predominate and can be an obstacle to physical health and taking care of oneself • Youth consistently express a need for support and community • Youth need their parents to be more supportive, understanding, and accepting • Issues for different identity groups are different • Youth can and do find support and community online, and they want more and better resources to do this
- 10. . LGBTQ Youth Feel Strongly about Social and Emotional Health Issues, and View Their Peers as At-Risk for Mental Health Concerns Mostly when I think of being healthy I think of emotional health more, and in my experience LGBTQ teens have more problems like anxiety and depression and more mental health issues. With me, I have really bad anxiety. I think that LGBTQ teens experience it a lot more because you grow up in a world knowing that you’re different. Participant 65 (Age 16) Sometimes I get really, really stressed out and really severe anxiety. It stops me from doing things that are body healthy or mentally/emotionally/physically healthy for me. Sometimes I’ll just sleep all day long instead of doing things about it, if that makes sense. Participant 20 (Age 18) I think that if there was a research study conducted about mental health and transgender-identified teens, the results would be so shocking and so disturbing that nobody would know what to say. I think there are a ton of people that identify as transgender that really need counseling right now. This is a problem right now. Participant 81 (Age 19) Social and Emotional Health Concerns of LGBTQ Youth
- 11. Mostly, the problem for me is just I get lonely, when you’re a queer person or a person in a minority, I think you want people in that same specific minority dealing with the same stuff. It’s hard to find that, especially as a queer person, so it gets lonely. Participant 46 (Urban Washington) It’s pretty much a really lonely existence in a rural community when you’re gay in high school…Isolation. I don’t have many friends in my hometown. It gets pretty lonely. Participant 84 (Rural Oklahoma) Out in high school and it was awful. I had all girl friends, because none of the guys wanted to be friends with a gay because if I was to be like, “How are you doing on that test?” or “I hate that teacher,” if I said any of that to them, they’d be like, “Bro, don’t come onto me.” Participant 38 (Urban Texas) I have a group of friends. We’re pretty much all LGBTQ. We somehow managed to drift to each other. Participant 6 (Small City New Jersey) Most LGBTQ Teens Feel Isolated Social and Emotional Health Concerns of LGBTQ Youth
- 12. My mother would not react very well. She would disown me. My dad would be accepting, and he would defend me if my mother were to get mad…not going to be a good situation. Participant 48 (Age 16) My dad was in the Marines. I kind of expected him to be like, “I don’t want this at my house.” I thought yeah, this is pretty much it. But no—like right away, he’s like “Okay. Are you dating anybody?” My parents are so accepting and understanding” Participant 36 (Age 17) I was definitely thinking with my parents to not come out until college, until I’m a little more financially independent. My parents are great, and I love them, and I know that they love me… slight possibility that something might happen, so I just want to be prepared. Participant 89 (Age 17) Especially if you are financially supported by your parents, it’s difficult to come out to family because you don’t know how they’re going to react. Participant 20 (Age 18) . Most Parents are Supportive, but LGBTQ Youth Have Strong Anxiety about Parental Reactions Social and Emotional Health Concerns of LGBTQ Youth
- 13. The Coming Out Process is a Time of Significant Anxiety Definitely more of an identity crisis when you’re growing up LGBTQ. Not only are you having to go through puberty, you start to question things about yourself, like what am I attracted to? What are other people seeing? Why do I not feel the same way as other people? I think that’s one of the biggest obstacles I’ve had personally faced. Participant 22 (Lesbian) With me, I recently came out like this summer. During these two months my head has just been busting with all the thoughts, and that put me in a bit of a depression. Participant 48 (Gay) The first person I told, I felt so alone. I cried for three hours after I told them because I was so afraid that they were going to hate me. Participant 83 (Bisexual Female) Social and Emotional Health Concerns of LGBTQ Youth
- 14. My mom, the last thing that I mentioned to her was that I was gender queer. I tried to print out some information so that she could better understand what that meant and that that really didn’t make me any different as a person. We don’t really talk about it ever since I said anything, so I guess she’s neutral. As far as my father goes, he’s a lost cause. I don’t even plan on ever, never ever—even after I’m financially able to support myself. Participant 27 (Transgender) As a gender-fluid individual it’s kind of hard for people to take me seriously like with moving between I guess technically moving between the two genders and then some days being neither of them. Participant 72 (Gender Fluid) With me, I tried coming out to my parents a couple months ago and they heavily implied that it was just a phase. My mom has told me that my gender identity is just something I’ve read about on the Internet. Participant 65 (Gender Fluid) Coming Out as Transgender or Gender Fluid is Even More Difficult Social and Emotional Health Concerns of LGBTQ Youth
- 15. Protection is something you need, blah, blah, blah, but it’s always taught with straight sex, so I think a lot of gay teens get a little confused or they get a little like, “Oh, well, I’m not going to get that.” Participant 5 (Urban Delaware) I went to a progressive high school. We had comprehensive sexual education. The only issue was they talked about gay men briefly. Then, when it came to queer female sex, that did not come up at all. Participant 21 (Small City Virginia) For me as Transgender, when I identified as gay, that was so alienating to open a pamphlet and not see myself in this pamphlet. Even in just the pictures you see. It doesn’t matter about the text. Participant 81 (Urban Washington) There’s absolutely no mention of transgender health in health classes. I feel like trans youth have an even more of a deficit of information and support than LGB youth. Participant 81 (Urban Washington) LGBTQ Teens do not Relate to Current Sexual Health Education Sexual Health of LGBTQ Youth
- 16. I have a really close group of about four friends, and we tell each other about everything, even including sex. If it’s something like really serious, I’ll go to my sister before I go to my parents, because I trust her more. Participant 16 (Age 17) As far as going to parents… I feel like I could never do that. Participant 11 (Age 18) I don’t go to that many health-related things, specifically seeking that out. I use Google a lot when I need help finding things. Participant 24 (Age 18) I would also suspect that among my transgendered peers, I think it’s far less likely to feel comfortable approaching doctors or anybody that you perceive to be in a position of power. Participant 81 (Age 19) LGBTQ Teens Talk to a Limited Number of People About Sexual Health Sexual Health of LGBTQ Youth
- 17. There was Sex Ed in middle school… the teacher just didn’t care very much…they have all this stuff on the Internet anyway now. Participant 46 (Age 15) I’m very open with my best friend. His name is Google. Yeah, I don’t really talk to my parents about that kind of stuff. Participant 51 (Age 17) I found two YouTube channels that I find particularly helpful. I think one of them has a site affiliated. I think it’s called Sex Plus. It’s a little show and it’s taught by this girl who is a Peer Sex Educator. She has all sorts of videos. Participant 6 (Age 17) LGBTQ Youth Get Their Health Info Through Google and YouTube Sexual Health of LGBTQ Youth
- 18. I came out over Facebook. The reception on Facebook was totally accepting and I got a lot of likes and a lot of comments about support and acceptance for it. Participant 92 (Gay) Tumblr, I’ve had a lot of good experience with. I met this really nice girl who lives four hours away. Tumblr is really cool. I want to just meet people to talk with, not necessarily date. Participant 47 (Pansexual Female) I use a lot of social media. I use Facebook and I use Instagram. I use Twitter. I use Tumblr, and I go on YouTube a lot and Snapchat. Participant 30 (Gay) Make it a more positive outlet for youth instead of something that diminishes and brings down the confidence and pushes people back into the closet. Participant 71 (Transgender) LGBTQ Youth Use Social Media Extensively LGBTQ Youth’s Digital Experiences
- 19. I would like to see a way to be able to chat with other LGBTQ youth, either in your area or just around other countries to talk and discuss issues we’re having or have forums where they can post their problems and just discuss them. Participant 15 (Age 16) I would like to see it more towards mental health. Just because a lot of LGBTQ members go through a lot of different things. Maybe their parents don’t accept them or their friends don’t accept them, there should be someplace that they can go to where they don’t have to feel alone or anything. Participant 18 (Age 17) I think now what I really need is community, and it’s tough to find. I think when I was younger my needs were more about coming to terms with my identity and accepting myself and really coming to understand myself. Now, I’m to the place where I mostly understand myself and I’m not looking for that one-on-one support, as much as I’m looking for the support of a really networked community—ideally, LGBTQ community— but there are some real issues in finding a community that fits with me just because they’re so dispersed and they’re so centered on gay men. Participant 81 (Age 19) A Digital Resource Is Needed that Reduces Isolation LGBTQ Youth’s Digital Experiences
- 20. In all honesty, I kind of think that a lot of apps or services geared towards LGBT teens have been doing it quite wrong, focused towards the sex of LGBT teens or something like that. Personally, I haven’t had a struggle with that. I’ve struggled more with people calling me rude names or threatening to kill me or something like that more than I’ve had a risk of STDs. Participant 19 (Age 17) Mental health, physical, emotional health, and relationships and how to treat others and yourself. Maybe some hotlines, give links to the Trevor Project or any other useful hotlines that they can call and get some help and advice. Participant 30 (Age 15) I would like to see more mental health subjects or something like an app or a website, because I think that would help people more than just saying all of this stuff about STDs and HIV and AIDS and stuff, because that’s not what being LGBTQ is all about. Participant 15 (Age 16) LGBTQ Youth Express a Need for a Digital Resource that Addresses Emotional, Social and Physical Health Concerns LGBTQ Youth’s Digital Experiences
- 21. Next Steps Reconvene National Advisory Board to inform next steps Determine audience, format, and content of resources Meet with LGBTQ youth and their families to vet ideas and get input Develop beta version and test with LGBTQ youth and their families Adapt and improve the resources
Editor's Notes
- BUT out of this we learned that our target audience wouldn’t accept inclusive tools (for example use of “partner” rather than boyfriend or girlfriend), so we made a commitment to create resources for LGBTQ youth when we were done. Have opportunity to inform you briefly about original existing DET for heterosexual youth, so a quick glance right now.
- “Awkward or Not?” allows teens to explore their feelings and beliefs about talking with their parents about sex and relationships and helps them make a plan to initiate a conversation. The tool uses a format that young people find engaging — a quiz similar to those that are found in magazines and online. Teens answer a set of questions that are based on scientific research about what influences young people to discuss sexuality with their parents. Teens are also asked to choose how they will start a conversation with their parents. The tool also provides teens with a message that is tailored to their level of comfort that can be copied and texted or e-mailed to their parents. Used to help teens identify their long-term goals for the future, this tool asks them to consider what impact having a child as a teen could have on those plans, without stigmatizing or shaming the choice to become a teen parent. It also gives them an opportunity to set short-term goals to help them meet their long-term objectives, which is appropriate for early adolescent development.
- Awkward or Not same as for middle school. Used to help teens identify their long-term goals for the future, this tool asks them to consider what impact having a child as a teen could have on those plans, without stigmatizing or shaming the choice to become a teen parent. It also gives them an opportunity to set short-term goals to help them meet their long-term objectives, which is appropriate for early adolescent development.
- Decisions about coming out to peers, parents, and other community members. Bullying or violence in schools and online, ranging from verbal harassment to outright physical assault. Pressure to engage in heterosexual behaviors, resulting in increased risk of pregnancy and exposure to STDs. Studies have found that gay and lesbian teens are two to three times as likely as heterosexual teens to report having been or gotten someone pregnant., High rates of HIV and STDs among teen MSM. Among teen males aged 13–19, about 93% of all diagnosed HIV infections are from male-to-male sexual contact. 58% of diagnosed HIV infections in young MSM aged 13–24 in 2011 were among black teen males, who only account for 17% of the population in that age group. Gay, Lesbian & Straight Education Network–GLSEN. (2012). The 2011 National School Climate Survey: The Experiences of Lesbian, Gay, Bisexual and Transgender Youth in Our Nation’s Schools. New York: GLSEN. [Online]. http://glsen.org/nscs. Saewyc, Elizabeth M., et al. (1999). “Sexual Intercourse, Abuse and Pregnancy Among Adolescent Women: Does Sexual Orientation Make a Difference?” Family Planning Perspectives, 31(3), 127–31. Blake, Susan M., et al. (2001). “Preventing Sexual Risk Behaviors among Gay, Lesbian, and Bisexual Adolescents: The Benefits of Gay-Sensitive HIV Instruction in Schools.” American Journal of Public Health, 91(6), 940-946. Centers for Disease Control and Prevention – CDC.(2014, July).HIV and Young Men Who Have Sex With Men. Atlanta, GA: CDC. [Online].http://www.cdc.gov/HealthyYouth/sexualbehaviors/pdf/hiv_factsheet_ymsm.pdf. Ibid.
- 5 times as likely to look for information about sexuality or sexual attraction online (62% compared to 12% of non-LGBTQ youth) 4 times as likely to have searched for information about HIV/AIDS and other STDs (19% vs. 5%) Much more likely to have searched for general health and medical information online (81% vs. 46%) Gay, Lesbian & Straight Education Network–GLSEN. (2013). Online: The Experiences of Lesbian, Gay, Bisexual and Transgender Youth on the Internet. New York: GLSEN. [Online]. http://b.3cdn.net/glsen/30f597304753f6759f_4nm6268oj.pdf.
- To plan for this project, we conducted qualitative research with LGBTQ identified and questioning teens to: Find out the main concerns and challenges facing LGBTQ youth; Learn about the existing digital resources that are interesting to LGBTQ youth; Develop ideas for a set of compelling, interactive tools for teens.
- 8 virtual focus groups (on the phone) Two groups of females, 15-17 and 18-19 Two groups of males, 15-17 and 18-19 Two groups of gender expansive, 15-17 and 18-19 (gender expansive – any youth that didn’t identify as male or female) One group with 15 year olds mixed gender (because we hadn’t had as many of them in the earlier groups) One group with 15-17 y.o. youth from Southern states (because we hadn’t as many from South in earlier groups) 4 in-person focus groups in Seattle and Dallas Two groups of 15-17, mixed gender Two groups of 18-19, mixed gender 20 individual interviews on the phone
- If you know anything about LGBTQ youth, these won’t be very surprising.
- One of the most consistent findings is that LGBTQ young people perceive themselves and their peers to be at greater risk for mental health concerns. Nearly all of the youth participants discussed this issue and felt strongly that fear, isolation, lack of support, verbal harassment and sometimes physical abuse has a negative impact on their mental state. Nearly all of the LGBTQ youth in the research either have experienced or can identify LGBTQ peers experiencing anxiety, depression, self-mutilation, and suicidal ideation. When discussing health, LGBTQ youth relate more to and want to talk more about mental health concerns, such as depression and stress, over physical health concerns, such as substance abuse and unsafe sex. In focus groups, concern about mental health was especially significant among younger teens (age 15/16). Younger group discussion was primarily about mental health concerns over physical/sexual health concerns. Older group discussion (age 18/19) was more balanced between discussion of mental health and physical/sexual health. Some youth expressed that their need to concentrate on mental health concerns may negatively impact their ability to focus on physical health concerns.
- Most LGBTQ youth find themselves at least somewhat socially isolated in high school, and isolation feelings often persist as a young adult. Most LGBTQ youth do find some peer support systems, often a group of other LGBTQ young people at their schools. They create for themselves a group of friends to protect and accept them unconditionally, despite their home/school challenges. However, many reported that it is just a couple of LGBTQ peers, and that they wished they had a larger support structure. Many youth reported that their dating and romance options are limited because there are few or no other “out” LGBTQ youth in their school or community. Many young gay men and some lesbians reported that once they are “out,” it can be difficult to establish friendships with other same-gender peers at their schools. Many LGBTQ youth indicated that they and their LGBTQ peers are excluded from activities that other youth enjoy. LGBTQ isolation tends to be amplified for young people living outside of big cities, even in supportive schools, as there are just not many other LGBTQ youth to interact with.
- Most LGBT youth participants reported positive to neutral reactions from their parents when coming out. However, many report short-term negative reactions by parents after coming out, and/or an awkwardness in relations with their parents. LGBTQ youth have strong anxiety about negative consequences from parents if they were to come out. The strongest fears are being thrown out of their house, loss of financial support or being emotionally cut off by their parents. This fear is often reinforced by negative comments parents make about other LGBT people before their child discloses their sexual orientation or gender identity. Negative consequences did happen to some youth in the study. Some youth were disowned by their parents or endured months to years of negative cohabitation with their parents after coming out. While many of the concerns of LGBTQ youth may prove to be wrong, the persistent fear leads to significant stress, and keeps many youth closeted at home and in schools.
- The coming out process, which often takes years for an LGBTQ young person, is a time of significant anxiety. It is a time when the young person feels isolated and feels tremendous fear of what their sexual orientation or gender identity may mean for their future. Many youth expressed frustration that coming out is not a once and done process. It is a continuous, almost daily process, that gives them persistent anxiety and stress. In addition, sometimes LGBTQ youth change their identity multiple times during the coming out process which can feel confusing to both the youth and their parents/peers. During the coming out process, most LGBTQ youth turn to the internet as their first source of information and support, long before talking to friends and family. Depending on the youth’s circumstances, LGBTQ youth make an assessment of where to come out first based on perceived safety. Sometimes they come out first to parents or siblings, at school, to friends or to strangers on the internet.
- Transgender, gender queer, gender fluid and gender expansive youth reported having a much harder time coming out to parents than gay and lesbian youth. While parents had some education and understanding of gay and lesbian issues, the gender expansive youth reported that their parents are quite clueless about transgender issues. Transgender youth sometimes come out to parents as gay, lesbian or gender fluid to test the water before coming out as transgender. These youth report that there is little education for parents about transgender youth, and that parents have a hard time even grasping gender identity concepts.
- Many LGBTQ participants, especially those teens in more conservative areas, indicated that there was no sexual health education in their schools. For those teens receiving sexual health education in schools, that education was not only missing the mark, but because it is pregnancy-focused, it may be contributing to LGBTQ teens feeling that they do not need to use protection against STIs. One of the most common comments made by study participants was that the sexual health education they received in school was so focused on heterosexual couples, that the LGBTQ teens felt that it just did not relate to their sexual experiences/ activities. Furthermore, since the education was so focused on pregnancy, it further emphasized that LGBTQ teens do not need to worry about protection. The teens indicated that current sexual education in schools is contributing to increased sexually transmitted infections among LGBTQ youth.
- LGBTQ teens rarely approach parents, teachers or school counselors to talk about dating, romance or sexual health. They firmly feel that these adult resources would not understand LGBTQ relationships or sexuality. LGBTQ youth are most likely to turn to the internet (especially general internet searches), their peers (LGBTQ and straight female friends), and siblings for information and advice. A few participants did indicate positive relationships with their parents, and that they could talk about dating and sexual health, but it was rare. LGBTQ teens obtain information about sexual health from the internet and share it with each other, with little adult supervision or insight.
- LGBTQ youth most often turn to the internet to learn about their physical health concerns. Mostly they Google search, which brings them to a wide number of both credible and less credible sources of information. Few youth participating in the research could identify a specific sexual health website that they felt was credible or that they returned to frequently, and indicated that they are scanning information from multiple random digital resources. Of mainstream health websites, only WebMD received many mentions by the youth, most likely because it performs well in search. The most consistent digital place where LGBTQ youth find both sexual health information and emotional support is YouTube. YouTube allows LGBTQ youth to see videos of other young people in similar situations. Furthermore, LGBTQ-friendly video bloggers such as Laci Green are very popular with LGBTQ youth, providing them with sexual health information and acceptance in a fun digital format. Most indicated that there is a need for a trustworthy source of sexual health information for LGBTQ youth.
- LGBTQ youth spend most of their digital time on social media, especially YouTube, Tumblr and Facebook. Instagram, Twitter and dating sites are also important. These digital spaces provide connection with their peers (LGBTQ and straight) and with older mentors within the LGBTQ community Of note, the youth indicated that they rarely spend time on health websites or websites designed for the older LGBTQ community. They can be found on social media sites popular with the general youth population. Since LGBTQ youth stressed that they spend most of their digital time on social media sites, any new resource should be a social media format. A few particpants noted that social media can also be quite mean spirited. Any new digital resource should have a way to monitor negative comments or people. It should be used as a way to empower youth.
- For younger LGBTQ youth, one of the most consistent requests is for a digital resource that will help LGBTQ teens feel less alone. This need is especially true for rural LGBTQ youth. A digital resource that reduces isolation can be accomplished though videos, chat rooms, hotlines, posts and even articles written by peers and mentors. A few youth emphasized that it would be best if any social media site could be supervised/monitored as a way to keep out predators and unsupportive people.
- LGBTQ youth participants expressed that they need a digital resource that looks at the full picture of what it means to grow up LGBTQ in America. Mental, social and physical health are related topics which strongly influence each other. LGBTQ participants understood that all three go together, and they expressed that they need a digital resource that fully addresses all three topics. LGBTQ youth can be very focused on mental health, sometimes to the detriment of physical health. However, developing a digital resource that provides for their mental health needs may be a good way to also influence their physical health needs. LGBTQ youth expressed that they need social advice, such as how to come out in school and to parents. They also expressed that they could use advice on how to navigate dating and romance or how does one actually talk to partner about safer sex.