LGBTQ+ HEALTH IN THE UNITED STATES:

DISPARITIES IN HEALTH OUTCOMES IN SEXUAL MINORITIES

John Rafferty

Political Science 169: Special Topics in Comparative Politics – Global Health Politics

12 June 2018
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There are large disparities in health outcomes observed between sexual minorities and

sexual non-minorities in the United States. LGBTQ+ individuals are at incredibly higher risk for

substance abuse, suicide, homelessness, and diagnosis for mental illnesses and disorders in

childhood alone. There is also significant variation in health outcomes within the different

subgroups of the acronym itself. Stigmas continue to hinder sexual minorities’ access to

healthcare and health outcomes especially among bisexual and transgender individuals. Along

with dangerous stigmas, other societal factors which contribute to poorer health outcomes among

LGBTQ+ individuals are the lack of attention to sexual minority youth in the American

education system, detrimental attitudes from the out-group which exacerbate rates of bullying,

depression and suicide among LGBTQ+ youth, and a culture of substance abuse associated with

lack of belonging, homelessness, criminalization, and low self-esteem. Appropriate interventions

to rectify the treatment gap among the LGBTQ+ minority population include a higher visibility

of LGBTQ+ information and resources in the American education system, cultural competency

programs for medical professionals to adequately address the woes of in-need sexual minority

patients, training for educational professionals to properly address sexual orientation and gender

identity in health education curriculum, increased sensitivity training for medical professionals to

reduce harmful stigmas against sexual minorities which hinder access to proper care, and

community-based programs to foster a higher degree of inclusivity for sexual minorities,

especially in urban environments.

LGBTQ+ individuals experience an elevated risk of conducting substance abuse

compared to their heterosexual counterparts. One statistical study suggests that bisexual men in

the United States were nearly twice as likely to be “heavy current drinkers” and one-and-a-half
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times as likely to be “heavy current smokers” than their heterosexual counterparts.1 Lesbian and

bisexual women seemed to follow the same pattern in substance consumption. From the same

study, lesbian women were almost twice as likely to be “heavy current drinkers” and one-and-a-

half times as likely to be “heavy current smokers.” Bisexual women were almost two-and-a-half

times as likely to be “heavy current drinkers.” In either of the substance consumption categories,

gay men failed to present a statistically significant difference from the heterosexual group, which

can be seen to act as the “norm” or average for the country as whole. This may signify a

difference in attitudes toward smoking and drinking as a coping mechanism or a pastime in gay

men as opposed to other subgroups of the LGBTQ+ community. A similar study denoted that

bisexual males had a statistically significant greater chance of being binge drinkers compared to

gay men and heterosexual men both. Bisexual women also had a statistically significant greater

chance of being binge drinkers compared to heterosexual women, while not necessarily the same

in comparison with lesbian women with an alpha level of 0.025.2 Sexual minorities, on average,

are also more likely to be illicit drug users – of marijuana, ecstasy, cocaine, heroin,

amphetamines, and LSD – and are more likely to use a variety of drugs in comparison to their

heterosexual counterparts. 3 In studies where more than one age group was examined, the

youngest group, on average, deviated from the mean more than the rest. 4 Sexual minority youth

are at an “elevated risk of past-year drug use during adolescence and emerging adulthood,” and

disparities are “amplified during adolescence” as LGBTQ+ youth have a more difficult time

1 Gilbert Gonzales, Julia Przedworski, and Carrie Henning-Smith, “Comparison of Health and Health Risk Factors
Between Lesbian, Gay, and Bisexual Adults and Heterosexual Adults in the United States,” Jama Internal Medicine
(September 2016): 1349.
2 Mitchell R. Lunn et al., “Sociodemographic Characteristics and Health Outcomes Among Lesbian, Gay, and

Bisexual U.S. Adults Using Health People 2020 Leading Health Indicators,” LGBT Health 4, vol. 4 (2017): 289.
3 Heather L. Corliss et al., “Sexual Orientation and Drug Use in a Longitudinal Cohort Study of U.S. Adolescents,”

Addictive Behavior 35, no. 5 (May 2010): 518-520.

4 Ibid, 519.
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coping with the stress of a “stigmatizing environment.”5 These cofounding stressors include

bullying, harassment, lack of peer acceptance, disapproval in family unit, and much more.

Having to cope with these stressors leads LGBTQ+ youth to these drugs at a young age, which

many studies describes as a “robust predictor of later substance dependence.” 6

There are many possible reasons why substance abuse was exacerbated in bisexual men

and women. Bisexuals as sexual minorities have been subject to the same wave of criticism and

structural discrimination as the rest of the LGBTQ+ community, but often receive scrutiny from

other sexual minorities themselves. Whether open bisexuality is being regarded as a

“transitioning period” to full-fledged attraction to the same sex or as a gateway to promiscuous

adventures, bisexuality is subject to harmful generalizations by both sexual minorities and

heterosexual individuals combined which places stress on the bisexual sub-group itself.

Bisexuality in the face of the medical community and society itself faces an invisibility problem

as well. As one comprehensive study on bisexual female youth states, “little has been written

about the particular needs and experiences of bisexual youth.” 7 The same researchers concluded

that “bisexual girls have higher pregnancy rates than heterosexual girls” and are tested for and

diagnosed with STIs more than heterosexual girls. Many young women from this study believed

their physician has a default assumption that their patient was heterosexual which reinforces self-

damaging stigmas against bisexuals and likewise across the LGBTQ+ community. Another study

assessed levels of bi-negative outlooks from heterosexual individuals and also homosexual men

5 Ibid.
6 Ibid.
7 Miriam R. Arbeit, Celia B. Fisher, Kathryn Macapagal, and Brian Mustanski, “Bisexual Invisibility and the Sexual

Health Needs of Adolescent Girls,” LGBT Health 3, no.5 (2016): 342.

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and women.8 To no surprise, gay and lesbian-identified individuals responded with less negative

outlooks and greater acceptance than heterosexual-identified individuals, however the gay and

lesbian subgroups still responded with statistically significant less accepting opinions (with a P-

value of 0.05) to bisexuality. This illustrates, as poised by Reuel et al., that “nominally inclusive

‘LGBT’ support mechanisms may not be as relevant to bisexual individuals as they are to gay

men and lesbian women.”9 This concurrently exposes the “unique ‘double discrimination’

experienced by bisexual individuals” and degrades the traditional view that bisexual individuals

are more accepted for deviating from heteronormativity less than the rest of the community.10

There are plentiful indicators that LGBTQ+ youth are at elevated risk for suicidal

behavior, suicide attempts, and successful acts of suicide as well. “Relative to comparable

heterosexual respondents,” the likelihood of suicide attempts among lesbian, gay, and bisexual

individuals range from twice as likely to more than three times as likely. 11 On the lower end,

lesbian women had suicide attempt rates twice as high as heterosexual women and on the higher

end, bisexual men had suicide attempt rates over three times as high as heterosexual men.

Suicide attempt rates appear to be highest among gay/bisexual men of lower socioeconomic

status.12 The innate stressors of low socioeconomic status such as insecure food, poor housing,

poor job prospects, income instability, etc. compounded with the stressors of self-identifying as a

sexual minority place these youth at exponentially higher likelihood to exert suicide behavior

than the standard heterosexual counterpart. “Social stigma, prejudice, and discrimination

8 M. Reuel Friendman et al., “From Bias to Bisexual Health Disparities: Attitudes Toward Bisexual Men and
Women in the United States,” LGBT Health 1, vol. 4 (December 2014): 315.
9 Ibid.
10 Ibid.
11 Ann. P Haas et al., “Suicide and Suicide Risk in Lesbian, Gay, Bisexual and Transgender Populations: Review

and Recommendations,” Journal of Homosexuality 58, (2011): 21.

12 Ibid, 20.
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associate with minority sexual orientation” all exacerbate the stressors linked to elevated risk of

suicidal behavior. 13 This discrimination comes in the form of personal rejection, hostility,

harassment, bullying, physical violence, neglect from school officials. However, the worst

behavior and the arguably most detrimental to the mental health of sexual minorities can happen

in the household. “One especially powerful stressor for LGB youth is rejection by parents,” as

disapproving parents often take an active role in shaming, voicing disapproval of, or disowning

their LGBT-identifying children.14 Young Latino gay and bisexual men reported the highest rate

of rejection from their households and are more likely than any Latina female and White

subgroup to report suicide attempts.15 The vast majority of these attempts occur before the age of

20, which is consistent with the aforementioned trends of substance abuse occurring most

frequently in adolescence and young adulthood.

The most drastic rates of suicide attempts, however, occur in the transgender population.

Negative behavior such as bullying, harassment, discrimination, and violence occur most in gay

youth with “cross-gender appearance, traits, and behaviors.” 16 However, transgender youth are at

consistent odds with these negative behaviors because their gender identity does not coincide

with their biological sex. As a result, transgender individuals have a lesser chance of concealing

these non-desirable acts of defying their assigned gender as do gay males of concealing their

effeminate traits, behaviors, and personalities. This puts transgender individuals at greater risk

for victimization in the form of violence, assault, bullying, etc. Transgender individuals are at the

center of systematic dehumanization from media and only recently has there been an adequate

13 Ibid, 22.
14 Ibid, 22.
15 Ibid, 22.
16 Ibid, 23.
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movement for transgender inclusivity. Transgenderism has been cloaked by conservative media

as an agent for pedophilia and has been referred to in many discussions as a mental illness. As a

result, transgender individuals typically suffer from negative self-images and have a harder time

than other sexual minorities in garnering public acceptance. Average suicide attempt rates among

transgender populations have been as high as 25%, or every one out of four transgender-

identifying individuals having reported at least one suicide attempt.17 Some representative

samples illustrate that nearly half of U.S. transgender individuals have reported a negative action

from an employer explicitly due to their transgender status, and this does not even account

negative actions from hirers or hiring committees. We could expect adverse actions from hirers

and hiring committees to be way more frequent toward transgender individuals than someone

who has already hired a transgender individual. This job insecurity and lack of acceptance on the

job market is a profound indicator on poor socioeconomic status for transgender individuals and

acts as a cofounding factor for suicidal behavior and substance abuse. Since the United States has

a decentralized health care system and unique reliance on the private sector and various HMOs,

common access to health insurance is given through job providers. With the aforementioned

discrimination from employers and hirers, transgender individuals have a difficult time securing

a job long enough to secure medical benefits. Those who do have eminent access to medical care

also face stigmas and lack of comfortability with medical professionals. Some studies suggest

that 51% of transgender individuals feel “uncomfortable discussing their gender status or their

transgender-specific health care needs with a doctor they did not know.” 18 Medical personnel,

deliberately or not, have historically tended to ignore the urgency of transgender individuals’

17Ibid, 27.
18Jessica Xavier, Julie A. Honnold, and Judith Bradford, “The Health, Health-Related Needs, and Lifecourse
Experiences of Transgender Virginians,” Virginia Commonwealth University, January 2007, 18.
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quasi-dependence on hormones and other drugs. A temporary absence of hormones which help

upkeep an appearance consistent with an individual’s self-identification on gender can have

severe physiological consequences and eventual ware on mental health. This helps explain the

inflated rates of substance abuse in transgender individuals and why rates of depression, trauma,

and suicidal behavior are considerably higher in this subgroup.

“Fifty-six percent of gay individuals and 70 percent of transgender individuals report” an

adverse action in the form of discrimination in housing due to their sexual orientation, gender

identity, or both.19 This difficulty in receiving proper housing is a key barrier to achieving proper

well-being and a significant hindrance on positive self-esteem and prospects for sexual

minorities in young adulthood. This is only one dimension to the epidemic of homelessness in

LGBTQ+ youth in the United States. Some LGBTQ+ youth find themselves homeless before

even becoming adults. “The most commonly cited reason” for LGBTQ+ youth becoming

homeless is rejection from their family unit and consequently running away from home. 20 The

second most common reason, with an important distinction on the initiating actor in the situation,

is “being forced out of [the] family,” after conducting the colloquial “coming-out” and self-

identifying as a sexual minority. 21 Another troubling statistic is that among LGBTQ+ youth, the

“mean age of becoming homeless for the first time is 14 years old” and many of these

individuals do not disclose their sexual identity to others until after homelessness. This

exemplifies that disclosure to the family unit is a pivotal process in proper development of sexual

identity, and when given an adverse response such as being kicked out, many of these

19 Jerome Hunt, “Why the Gay and Transgender Population Experiences Higher Rates of Substance Use: Many Use
to Cope with Discrimination and Prejudice,” Center for American Progess March 9, 2012, 4.
20
Alex S. Keuroghlian, Derri Shtasel, Ellen L. Bassuk, “Out on the Street: A Public Health and Policy Agenda for
Lesbian, Gay, Bisexual, and Transgender Youth Who Are Homeless,” American Journal of Orthopsychiatry 84, no.
1 (2014): 67.
21 Ibid.
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adolescents will regress in mental health and experience trauma. Homeless LGBTQ+ youth have

significantly higher rates of “mental health and substance use problems, suicidal acts, violent

victimization, and a range of HIV risk behaviors.” 22 According to one study, 26 percent of gay

teens are kicked out of their home when they came out and as much as half the sample received

some sort of negative reaction. 23 The grim reality of homelessness for sexual minorities is that

while they consist of an estimated 3 to 5 percent of the U.S. population as a whole, they consist

of 20 to 40 percent of the homeless population in the United States. 24

Hateful rhetoric toward the LGBTQ+ community such as the labeling of transgenderism

as a mental illness from the political right is most obviously damaging. With a longitudinal lens,

the stigmas that stem from this disparaging rhetoric unfortunately leads sexual minorities to

develop actual mental illnesses and be diagnosed with mood, anxiety, and eating disorders

alongside depression. It is a grim cycle that allows for opponents of the LGBTQ+ community to

dehumanize its members and uphold the institutional discrimination that leads to these

discouraging disparities in health outcomes in the first place. These self-reinforcing stigmas

allow for opponents to paint the LGBTQ+ lifestyle negatively. This in turn encourages sexual

minorities to repress their identity longer and encourages the outgroup (heterosexual peers,

family, educators, medical personnel) to likewise be disapproving and steer inquisitive youth

away from self-acceptance.

There has been some progress in achieving acceptance and tearing down traditional social

norms of rightness, however the health disparities in LGBT youth still deserve acute attention,

22 Ibid.
23 Nicholas Ray, “Lesbian, gay, bisexual, and transgender youth: An epidemic of homelessness,” National Gay and
Lesbian Task Force Policy Institute and the National Coalition for the Homeless, 2006, 2.
24 Ibid, 1.
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especially for mental illnesses and various disorders. Men who identify as gay or bisexual have

higher rates of reporting mood or anxiety disorders than heterosexual men, but men who reported

being “unsure about their sexual identity” had significantly higher rates than all – gay, bisexual,

and heterosexual – subgroups.25 This fact illustrates the omnipresence of stress on concealing

identity for sexual minorities. A recent study of United States LGBT young adults from age

group 16-20 indicated that nearly “one-third of participants met the diagnostic criteria for a

mental disorder and/or reported a suicide attempt in their lifetime.” 26 Likewise 18% of the

“lesbian and gay participants met the criteria for major depression,” 11% for PTSD and 31% of

the whole sample reported suicidal behavior at some point in their life. 27 The national rates for

these aforementioned illnesses/disorders among youth of the same age “are 8.2%, 3.9% and

4.1% respectively,” exemplifying great deviation from the mean in the LGBT sample. 28 These

mood, anxiety, and depressive disorders most often show up during the key developmental phase

in sexual identity, adolescence, and thus persist into adulthood where they exacerbate into eating

disorders, suicidal behavior, and substance abuse as mentioned earlier. This places what is (or

should be) a great burden on the American education system to alleviate the stressors and

catalysts of these disorders when they are still suppressible. The cliché of “nip it in the bud” that

parents often make in ignorance in reference to preventing their effeminate sons or emasculate

daughters from exhibiting non-heteronormative behaviors should instead be used by the

American educators in alleviating the stressors that sexual minorities are burdened with which

25 Haas et al., “Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and
Recommendations,” 21.
26 Stephen T. Russell and Jessica N. Fish, “Mental Health in Lesbian, Gay, Bisexual, and Transgender Youth,”

Annual Review of Clinical Psychology, no. 12 (March 2016): 469.

27 Ibid.
28 Ibid.
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eventually becoming staggering. The school system should work to alleviate the stressors of

bullying, harassment, unrest, and stigma that are omnipresent in the average high school setting.

Furthermore, the school system should strengthen its counseling units and availability of

LGBTQ+ resources to ensure the Monday-through-Friday activity of attending high school can

be a hospitable environment if the household cannot.

The issue with the observed disparities in health outcomes for sexual minorities is not an

issue of the United States’ state capacity, it is a cultural and institutional one. The United States’

bureaucratic effectiveness and its large potential for state capacity have been maximized in times

when the political elites unified on one issue. This has often left one or more factions of political

elites with ex-post regrets on allowing unanimity on said issue, however these exhibitions of

great state capacity show that the absence of state capacity is not prevalent in this context as it

may be in tackling famine, dependence on exports, disease control, etc. in developing nations.

The Nixon Administration successfully catalyzed the birth of the private sector of the health

industry and gave birth to the HMO with the Health Maintenance Organization Act of 1973

which was seen as a grand experiment to bring change to the existing healthcare system.29 The

Reagan Administration successfully deinstitutionalized the healthcare system on a mission to

reduce government spending, reduce federal taxes, tighten monetary policy, balance a federal

budget slanted toward increased spending in the defense sector. 30 Then, beloved Ronald and

Nancy deliberately launched a campaign called the “War on Drugs” which was a nation-wide

fight on decreasing street drug consumption and vending, but the campaign in retrospect

disproportionally criminalized urban ethnic minorities. For better or for worse, these examples of

29 Joseph L. Dorsey, “The Health Maintenance Organization Act of 1973 (P.L. 93-222) and Prepaid Group Plans,”
Medical Care 8, no. 1 (January 1975): 1.
30 Karen Davis, “Reagan Administration Health Policy,” Journal of Health Policy 2, no. 4 (December 1981): 313.
 11

state capacity in implementing health policy reflect that the United States has had the capability

to reform the healthcare system in the past.

For these reasons, healthcare policy interventions to rectify disparities in LGBTQ+ health

would be most effective on a local and state government level, targeted community-based level,

and targeted medical personnel level. Implementing national policy on these issues would

require widespread attention and concern and a massive change in beliefs amongst conservative

regions of the American electorate. This is obviously not feasible for a short-term timeline.

My policy intervention focuses on three prominent actors in the LGBTQ+ lifestyle: the

education system, medical personnel, and the community social structure. The American

education system must accomplish multiple things to reduce health disparities in sexual

minorities. The high school setting is extremely stigmatizing and acts as a catalyst for many

negative behaviors later in adolescence and young adulthood such as a substance abuse, suicidal

behaviors, and mood and anxiety disorders. For this reason, it should be a focal point in helping

to improve the well-being of sexual minorities. Educators, counselors, and administrators should

be mandated to inflict harsher punishments and enact zero tolerance policies on acts of bullying,

harassment, and assault on sexual minorities. Concurrently, counselors should arrange more

LGBTQ+-centered events to foster higher inclusivity amongst sexual minorities in high schools.

If the stressors that are unique to LGBTQ+ youth are addressed as early as freshman year of high

school, it would likely prevent the onset and exacerbation of mood and anxiety disorders and

suicidal behaviors in sexual minorities later on. It will give sexual minorities more information

and resources to cope with stressors and divert them from abusing pharmaceuticals or streets

drugs to cope. If LGBTQ+ youth achieve a healthy social web of peers, friends, faculty, and

mentors, it would likely divert them from depression and suicidal behaviors and increase a
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sentiment of belonging. Introductory health education courses should include the mention of

sexuality and help reduce traditional heteronormative lore in health education. If the

acceptability of varying sexual identity is made clear at a younger age, it would likely allow

heterosexual peers to be more accepting and make the notion of deviating sexual identity as more

normal in the high school environment.

Medical personnel should also be given cultural competency and sensitivity training

programs to help bridge the gap in healthcare access for LGBTQ+ individuals. Therapists and

psychiatrists must be more persistent with caring for sexual minorities. While this requires many

of these professionals to curb their inevitable biases and beliefs, the immediate value of

exhibiting love and support for distressed sexual minorities is large, especially in the face of

large rates of attempt suicide, substance abuse, and depression. These medical professionals

should also play a role in eliminating negative outlooks in parents and help get rid of myths that

plague parents’ minds when their kids perform the traditional “coming-out” stage. Debunking

self-reinforcing stigmas that come from harmful myths on LGBTQ+ culture in the parent

population will bring about better health outcomes in LGBTQ+ youth. Psychologists and other

medical personnel must be “aware of the historical context and remain informed about these

sociocultural changes” in LGBTQ+ literature.31 Professionals must also be aware that the

minority stress model is applicable to the LGBTQ+ population and thus sexual minorities and

racial minorities have their stress amplified due to the burden of two worlds or “spheres” of

stigmas, discrimination, and hate. 32 Medical personnel should also be given sensitivity training

and be evaluated on their ability to treat patients who are sexual minorities in a way that does not

31 Michael S. Boroughs et al., “Toward Defining, Measuring, and Evaluating LGBT Cultural Competence for
Psychologists,” Clinical Psychology 22, no. 2 (June 2015), 154.
32 Ibid, 155.
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hinder comfortability and fosters positivity and trust in the doctor-patient relationship. One way

to do this is to give medical personnel extenuated information on the historical context of STDs

in the LGBTQ+ community. For decades, starting with the neglect from the Reagan

Administration, the HIV/AIDS epidemic was ignored and it allowed urban subgroups of gay,

bisexual, and transgender men to be at especially high rates of HIV exposure and transmission.

This was detrimental for the LGBTQ+ community in terms of mental health and the

reinforcement of stigmas for decades to come. If medical professionals are more educated on the

prevalence of STDs in the LGBTQ+ community, they can handle their patients with care and

open arms rather than with judgment and scrutiny.

A final component to my intervention is community-based intervention. If local

townships can encourage the intermingling of social groups and clubs with LGBTQ+ clubs and

organizations, it would expose many unaccepting people to sexual minorities and hopefully tear

down barriers that separate LGBTQ+ individuals and their unaccepting heterosexual

counterparts. This is called the contact hypothesis, and it is often “one prominent method of

attitude change” in smaller populations. 33 This would encourage comfortability between sexual

minorities and non-minorities and create a more inclusive and fluid environment. The contact

hypothesis illustrates that distance in social spaces creates a fear of the outgroup by not

understanding the context for which they exist, so by bridging that distance and encouraging

gradual contact between two groups, it will foster cohesion and mutual acceptance and

understanding. By creating more inclusive and unifying spaces, sexual minorities can be

33
Melissa A. Deese and Brayn L. Dawson, “Changing Attitudes toward LGBT Students: An Analysis of an
Awareness Training Paradigm Aimed at increasing Pro-LGBT Attitudes,” Papers & Publications: Interdisciplinary
Journal of Undergraduate Research 2, no. 7 (2013): 3.
 14

alleviated of judgment, harassment, and individual-based discrimination that stigmatizes their

everyday lives.

The desired timeline for assessment on this policy intervention would be 5 years. A short

timeline is preferable as the elevated risk of suicide observed in the LGBTQ+ community is

urgent and deserves attention. Five years is also a crucial timeline as it allows for the passing of

all high school students at the starting time and allows for a whole new batch of high school

students to enter under the new policy program. Through census-like surveys of high school

students at the start of the intervention and again at the end, we could test the effectiveness that

revised health curriculum and professional development has done to improve the self-image and

mental health of sexual minorities. This policy intervention would need to be backed by NGOs

such as the Human Rights Campaign (HRC), the Lesbian and Gay Law Association (NLGLA),

and the Family Equality Council to reach out to state assemblymen and governorships to make

this policy intervention feasible in the least bit. These are just some common national NGOs and

there are plenty more on the state and local levels that can further put pressure on their

assemblymen. These changes in policy intervention are not expensive with respect to the

education system. California teachers meet frequently as-is to revise curriculum on yearly or

semi-yearly bases. The training programs for school counselors and important medical

professionals such as therapists, psychologists, practitioners, and physicians would require some

funding, which can be done through charity donations through NGOs. Policy actors such as

assemblymen can redirect money from the general state tax fund to do so. The community-based

intervention can be done in targeted communities such as San Francisco, San Antonio, Atlanta,

Chicago, and other LGBTQ+ dense large cities with diverse suburbs to act on. If successful,

these community-based interventions can be used on a trial-and-error basis further outward into
 15

more traditionally conservative rural populations and hopefully national attention will be given

to the issue. Once the policy intervention achieves nominal success in some regions, hopefully it

would garner enough attention to reach efficacy in the national Congress.

It is evident that there are significant disparities in health outcomes between sexual

minorities and non-minorities. Sexual minorities are at an elevated risk to exert suicidal

behaviors, conduct substance abuse, experience mood and anxiety disorders, and become

homeless all due to a myriad of environmental stressors and stigmas that plague the LGBTQ+

community. My intervention program helps to tackle these stressors through key actors such as

education professionals, medical personnel, and the local community system. Hopefully, these

actions will help garner nation attention to the issue and a future policy intervention will be

possible through Congress to give full-fledged institutional attention on this matter.

 16

Bibliography

Arbeit, Miriam R., Celia B. Fisher, Kathryn Macapagal, and Brian Mustanski. “Bisexual
Invisibility and the Sexual Health Needs of Adolescent Girls.” LGBT Health 3, no.5
(2016): 342-349.

Boroughs, Michael S. et al. “Toward Defining, Measuring, and Evaluating LGBT Cultural
Competence for Psychologists.” Clinical Psychological 22, no. 2 (June 2015), 151-171.

Corliss, Heather L. et al. “Sexual Orientation and Drug Use in a Longitudinal Cohort Study of
U.S. Adolescents.” Addictive Behavior 35, no. 5 (May 2010): 517-521.

Davis, Karen. “Reagan Administration Health Policy.” Journal of Health Policy 2, no. 4
(December 1981): 312-332.

Deese, Melissa A. and Brayn L. Dawson. “Changing Attitudes toward LGBT Students: An
Analysis of an Awareness Training Paradigm Aimed at increasing Pro-LGBT Attitudes.”
Papers & Publications: Interdisciplinary Journal of Undergraduate Research 2, no. 7
(2013): 1-13.

Dorsey, Joseph L. “The Health Maintenance Organization Act of 1973 (P.L. 93-222) and Prepaid
Group Plans.” Medical Care 8, no. 1 (January 1975): 1-9.

Friendman, M. Reuel et al. “From Bias to Bisexual Health Disparities: Attitudes Toward
Bisexual Men and Women in the United States.” LGBT Health 1, no. 4 (December 2014):
309-318.

Gonzales, Gilbert, Julia Przedworski, and Carrie Henning-Smith, “Comparison of Health and
Health Risk Factors Between Lesbian, Gay, and Bisexual Adults and Heterosexual
Adults in the United States.” Jama Internal Medicine (September 2016): 1344-1351.

Haas, Ann P. et al. “Suicide and Suicide Risk in Lesbian, Gay, Bisexual and Transgender
Populations: Review and Recommendations.” Journal of Homosexuality 58, (2011): 10-
51.

Hunt, Jerome. “Why the Gay and Transgender Population Experiences Higher Rates of
Substance Use: Many Use to Cope with Discrimination and Prejudice.” Center for
American Progess March 9, 2012, 1-9.

Keuroghlian, Alex S., Derri Shtasel, Ellen L. Bassuk. “Out on the Street: A Public Health and
Policy Agenda for Lesbian, Gay, Bisexual, and Transgender Youth Who Are Homeless.”
American Journal of Orthopsychiatry 84, no. 1 (2014): 66-72.
 17

Lunn, Mitchell R. et al. “Sociodemographic Characteristics and Health Outcomes Among

Lesbian, Gay, and Bisexual U.S. Adults Using Health People 2020 Leading Health
Indicators.” LGBT Health 4, no. 4 (2017): 283-294.

Ray, Nicholas. “Lesbian, gay, bisexual, and transgender youth: An epidemic of homelessness.”
National Gay and Lesbian Task Force Policy Institute and the National Coalition for the
Homeless, 2006, 1-7.

Russell, Stephen T. and Jessica N. Fish. “Mental Health in Lesbian, Gay, Bisexual, and
Transgender Youth.” Annual Review of Clinical Psychology, no. 12 (March 2016): 465
487.

Xavier, Jessica, Julie A. Honnold, and Judith Bradford, “The Health, Health-Related Needs, and
Lifecourse Experiences of Transgender Virginians,” Virginia Commonwealth University,
January 2007, 1-48.