Gay and lesbian issues in pediatric health care

The experiences of gender and sexually diverse parents using support and services for their young children: An integrative review

AIM

To address: What are the experiences of 2SLGBTQQIA+ parents using parenting supports and services to meet their children's early childhood development needs (<5 years of age)?

DESIGN

Whittemore and Knafl's (2005) integrative review methodology.

METHODS

Electronic databases were searched from 2000 to October 14, 2022 for empirical studies or reviews addressing the research question. The title and abstract of 12,158 articles were screened for inclusion in the review by two independent researchers; 175 of these articles underwent full-text review. Studies selected were critically appraised using a Joanna Briggs Institute Critical Appraisal tool. Relevant key findings were extracted from each study and entered into N-VIVO-12. Thematic content analysis was employed and PRISMA guidelines were adhered to.

RESULTS

A total of 18 articles (15 qualitative and three multi-method studies) met the inclusion criteria and were selected for the review. Seven themes were revealed from analysis of the studies: (1) 2SLGBTQQIA+ Status kept a secret; (2) Forced to come out; (3) Heteronormative messaging; (4) Feeling excluded; (5) Stigmatised; (6) Parents act as educators; and (7) Positive experiences.

CONCLUSION

This integrative review provides nurses with insight into the experiences of 2SLGBTQQIA+ parents using health care services for their young child.

IMPLICATIONS FOR THE PROFESSION

This article highlights what changes nurses need to make to their practice to ensure appropriate, inclusive care for clients of diverse sexual and gender identities and their families.

IMPACT

Health care providers, especially nurses, have an opportunity to improve the experiences of these families and positively impact their health and well-being. Additionally, there is a need for research with the 2SLGBTQQIA+ parent community and the use of rigorous methodological techniques, including clearly linking participants' gender and sexual identities with study findings, to improve our understanding of 2SLGBTQQIA+ parent experiences.

PATIENT OR PUBLIC CONTRIBUTION

Although there was no direct patient contribution to the work since it was an integrative review of the literature, indirectly patient contributions are incorporated from the original research results of studies incorporated into this review.

Attachment-based family therapy for sexual and gender minority young adults and their nonaccepting parents

This pilot open trial examined the efficacy of attachment-based family therapy (ABFT) for Israeli sexual and gender minority (SGM) young adults and their persistently nonaccepting parents. Thirty families received up to 26 weeks of treatment, with parental rejection, parental acceptance, and young adults' attachment avoidance and attachment anxiety assessed at baseline, 8, 16, 24, and 36 weeks (three months post-treatment). Analyses using multilevel growth models revealed that both young adults and their mothers independently reported increases in mothers' acceptance of their young adult's same-sex orientation or noncisgender identity. In addition, young adults reported decreases in both parents' levels of rejection. Also, mothers, but not fathers, reported decreases in their own level of rejection. Finally, young adults reported a decrease in attachment avoidance in their relationships with both mothers and fathers, but not a decrease in attachment anxiety. Importantly, these treatment gains were maintained three months after the end of treatment. Together, these results suggest that ABFT-SGM, a manualized, affirmative, experiential, family-based treatment, may be effective in reducing long-standing parental rejection, promoting parental acceptance, and improving the quality of LGBTQ+ young adults' relationships with their parents. These findings are encouraging in light of the urgent need for efficacious interventions to reduce family generated minority stress and promote safer, more supportive environments for sexual and gender minority people.

Qualitative exploration of lesbian parents' experiences of accessing healthcare for their adopted children in England

OBJECTIVE

To explore the experiences of lesbian parents accessing healthcare for their adopted children in England.

DESIGN

A qualitative inductive design, using narrative inquiry with a critical incident recall interview approach. Interviews were analysed using merged tools of critical event analysis and broadening, burrowing, storying and restorying.

SETTING

Participants were recruited from a British lesbian, gay, bisexual and transgender fostering and adoption charity.

PARTICIPANTS

Six lesbian adoptive parents with experience of accessing healthcare for their adopted children in England.

RESULTS

Following data analysis, five themes were identified: navigating heteronormativity, navigating healthcare settings and professionals and having an 'adopted' status, intersectional identity of lesbian-parented adoptive families accessing healthcare, reflective imagery of lesbian parents and adoptive families and professional expectations. Self-imposed strategies instigated by the parents to strengthen and protect their familial identities were also discovered.

CONCLUSIONS

The needs and challenges of lesbian adoptive families may be different to those of heterosexual and biological families when accessing healthcare. There was an undercurrent of discriminatory practice, shown by various healthcare professionals, and a lack of understanding of the adoption process, knowledge surrounding the child's history and legal stance with regards to parental responsibility. Further training is needed for healthcare professionals.

Experiences of LGBT parents when accessing healthcare for their children: a literature review

There are increasing numbers of parents who identify as lesbian, gay, bisexual and transgender (LGBT), but there is little research on the experiences of LGBT parents when accessing healthcare for their children. The aims of this literature review were to identify existing articles on the topic, explore LGBT parents' experiences and draw implications for practice. The review included ten studies published from 1995 onwards and conducted in Australia, Sweden, the US and Finland. Many LGBT parents had positive experiences while others had encountered overt homophobia. However, there remained an underlying sense of heteronormativity, with many healthcare professionals making heterosexist assumptions and healthcare forms being heterocentric. The documentation used in healthcare settings should be adapted and healthcare professionals should improve their awareness on this issue and have training on how to recognise and include LGBT families. The review did not identify any studies on this subject from the UK, which suggests that research on the healthcare experiences of families with LGBT parents in the UK is required.

Social Justice and the Future of Healthy Families: Sociocultural Changes and Challenges

Given the pace of social changes, meanings of "family" and what makes a family healthy are changing. How can these changing meanings and understandings contribute to social justice for all families? First, I acknowledge how my personal history has intersected with research I do on youth and families. I define social justice with respect to healthy families, and then consider how contemporary scholarship helps define, redefine, and refine what is meant by "family." Examples are presented from research on cultural influences on parenting; parenting in same-sex couple or lesbian, gay, bisexual, transgender, or queer (LGBTQ) families; and coming out in adolescence as LGBTQ. These examples illustrate how the notion of family is defined, redefined, and refined to provide new vantage points on the complexities, possibilities, and potential for social justice among contemporary families, especially those that are marginalized.

The Significance of Parenting and Parent-Child Relationships for Sexual and Gender Minority Adolescents

Adolescents in 21st century America are experiencing the emergence of their sexual and gender identities in a heteronormative society that is steadily adopting more progressive views and policies related to sexual orientation and gender. However, despite these sociocultural changes, parent-child relationships remain as one of the strongest predictors of LGBT adolescent adjustment. This article reviews the extant literature on this topic from family systems and attachment perspectives while highlighting the significance of family experiences within a minority stress framework. The presentation is oriented around the coming out process, including factors influencing this experience and how postdisclosure parenting affects the health and well-being of LGBT adolescents. We end by discussing future directions and the challenges inherent to this research.

Perceived Parental Attitudes of Gender Expansiveness: Development and Preliminary Factor Structure of a Self-Report Youth Questionnaire

Purpose: Parental acceptance of gender identity/expression in lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) youth moderates the effects of minority stress on mental health outcomes. Given this association, mental health clinicians of gender-expansive adolescents often assess the degree to which these youth perceive their parents/primary caregivers as accepting or nonaffirming of their gender identity and expression. While existing measures may reliably assess youth's perceptions of general family support, no known tool aids in the assessment an adolescent's perceived parental support related to adolescent gender-expansive experiences. Methods: To provide both clinicians and researchers with an empirically derived tool, the current study used factor analysis to explore an underlying factor structure of a brief questionnaire developed by subject-matter experts and pertaining to multiple aspects of perceived parental support in gender-expansive adolescents and young adults. Respondents were gender-expansive adolescents and young adults seeking care in an interdisciplinary gender-health clinic within a pediatric academic medical center in the Midwestern United States. Results: Exploratory factor analysis resulted in a 14-item questionnaire comprised of two subscales assessing perceived parental nonaffirmation and perceived parental acceptance. Internal consistency and construct validity results provided support for this new questionnaire. Conclusion: This study provides preliminary evidence of the factor structure, reliability and validity of the Parental Attitudes of Gender Expansiveness Scale for Youth (PAGES-Y). These findings demonstrate both the clinical and research utility of the PAGES-Y, a tool that can yield a more nuanced understanding of family-related risk and protective factors in gender-expansive adolescents.

High Rates of Same-Sex Attraction/Gender Nonconformity in the Offspring of Mothers with Thyroid Dysfunction During Pregnancy: Proposal of Prenatal Thyroid Model

Both youngsters and adults with same-sex attraction are at greater risk for negative health outcomes. Despite mounting efforts to determine the biological background, a satisfactory conclusion has not been reached and there is a need to explore alternate factors like functioning of thyroid system during pregnancy. A retrospective chart review was undertaken of 790 eligible children and adolescents who had been admitted to child psychiatry between 2005 and 2013. This population consisted of 520 (65%) males and 270 (35%) females, aged 8 to 17 years. Fifteen mothers (1.8%) were found to have a history of thyroid dysfunction during pregnancy. Sixteen youngsters (2%) had a history of same-sex attraction. Twelve overlapping cases with both same-sex attraction and maternal thyroid dysfunction during pregnancy were identified, which was extremely significant (P<0.0001, by Fisher’s exact test). The association was also significant for each sex (P<0.0001, by Fisher’s exact test). There is evidence that thyroid gland plays a crucial and decisive role in determining sexual orientation in people. Maternal thyroid dysfunctions during pregnancy may result in homosexual orientation in the offspring.

Adolescents' comfort answering questions about sexuality asked by their physicians

OBJECTIVE

To evaluate the attitudes of adolescents toward communicating with their doctor about different aspects of their sexuality.

METHODS

The present descriptive survey was conducted with the participation of teenagers from four high schools in Sherbrooke, Quebec. In each school, the students of two grade 8 classes (≤14 years of age) and two grade 10 classes (≥15 years of age) anonymously completed a self-administered questionnaire. Permission from the school board and parental consent for every participant was obtained.

RESULTS

A total of 387 adolescents completed the self-administered questionnaire. The response rate for the study was 98%. Only 27% of the respondents remembered being questioned by their doctor about sexuality, and 17% of the respondents had already brought up the topic of sexuality themselves with their doctor. More than one-half (57%) of the adolescents reported they would be moderately comfortable to totally comfortable discussing sexuality with their doctor if they felt the need to. Overall, when asked to evaluate their degree of comfort if questioned on specific questions about their sexuality, 73.8% to 99.5% believed they would be moderately to totally comfortable responding. Nevertheless, there was a statistically significant difference between age groups, with the older age group being more comfortable than the younger age group (P<0.001). There was no difference between the level of comfort among boys and girls answering the same questions. Respondents believed that their treating physician should discuss sexuality with them (73.8%) and, in the majority of cases (78%), that he/she should initiate the conversation.

CONCLUSION

Regardless of age or sex, teenagers considered themselves to be at ease discussing sexuality with their doctor and found it an important topic best brought up by their practitioner.

Meeting the challenge: responding to health care needs of homeless youth

PURPOSE

This article presents a worldview of youth who are victims of homelessness. A view of family dynamics and how they affect the emotional, psychological, social, and physical health of homeless youth is presented.

RESULTS

Homeless youth and their families are at high risk for poor health outcomes. Those who present for health care services are least likely to return to the same site for follow-up care.

CONCLUSION

Understanding the dynamics of homelessness and its effect on youth and family will facilitate efforts to engage the family and increase the likelihood for follow-up with the same provider. A patient-centered cognitive approach when managing these youth and their family will improve communication, potentiate engagement, whet creative decision making, and facilitate continuity of care.

Promoting the well-being of children whose parents are gay or lesbian

To promote optimal health and well-being of all children, the American Academy of Pediatrics (AAP) supports access for all children to (1) civil marriage rights for their parents and (2) willing and capable foster and adoptive parents, regardless of the parents' sexual orientation. The AAP has always been an advocate for, and has developed policies to support, the optimal physical, mental, and social health and well-being of all infants, children, adolescents, and young adults. In so doing, the AAP has supported families in all their diversity, because the family has always been the basic social unit in which children develop the supporting and nurturing relationships with adults that they need to thrive. Children may be born to, adopted by, or cared for temporarily by married couples, nonmarried couples, single parents, grandparents, or legal guardians, and any of these may be heterosexual, gay or lesbian, or of another orientation. Children need secure and enduring relationships with committed and nurturing adults to enhance their life experiences for optimal social-emotional and cognitive development. Scientific evidence affirms that children have similar developmental and emotional needs and receive similar parenting whether they are raised by parents of the same or different genders. If a child has 2 living and capable parents who choose to create a permanent bond by way of civil marriage, it is in the best interests of their child(ren) that legal and social institutions allow and support them to do so, irrespective of their sexual orientation. If 2 parents are not available to the child, adoption or foster parenting remain acceptable options to provide a loving home for a child and should be available without regard to the sexual orientation of the parent(s).

A Review of Gay Men’s Health

This article focuses on how health practitioners can better understand and intervene with gay men. Gay men’s health is situated within 3 prominent theoretical models (ie, minority stress, gender socialization, and identity development) and associated with 3 constructs (ie, internalized homonegativity, internalized homophobia, and internalized heterosexism) to contextualize gay men’s health concerns. Throughout the article, the authors draw particular attention to research that emphasizes the strengths of gay men, as this is a notable gap in the extant literature. Furthermore, HIV/AIDS is a central concern of gay men, and this article focuses on how cultural identities and factors may intersect with HIV/AIDS status among gay men and have implications for health decision making. Affirmative clinical interventions based on theory and research are presented throughout the article, which can be applied by health professionals in various settings. Given the confusion around terminology, lack of knowledge of available resources, and prevailing negative societal myths about gay men, the article provides a glossary of definitions for unclear terms, actively disputes myths that are not empirically supported, and provides a list of available resources.

Health concerns of sexual minority adolescent girls

PURPOSE OF REVIEW

The goal of this article is to provide an overview of up-to-date health information about sexual minority female youth so that healthcare practitioners can better serve their healthcare needs.

RECENT FINDINGS

Sexual minority adolescent girls may follow diverse sexual developmental trajectories. Many in this population are quite healthy, but some may be disproportionately vulnerable to health risks, perhaps because of the stigma associated with minority sexuality in society. If sexually active, girls in this population often have sex with boys as well as girls and confront risks attendant with sex with both genders. They may demonstrate fluidity in their sexual identity as they move through adolescence. Data suggest that sexual minority adolescent girls are more likely to smoke cigarettes, drink alcohol, or use illicit drugs compared with girls who are heterosexual. They may be more likely to be victims of violence or victimization or to be depressed or suicidal.

SUMMARY

Sexual minority adolescent girls may be quite resilient, but they face a range of possible adverse health risks. Healthcare practitioners should keep their health issues in mind so they can offer healthcare and counseling that is sensitive, comprehensive, and appropriate.