Running head: SEXUAL MINORITY YOUTH HEALTH DISPARITIES Student Name: Joan Kronlein

Health Care Disparities and Health Care Policy Paper Rubric Guidelines Possible Points Clearly defines the population under Population and 10% consideration disparity defined Describes the health disparity(ies) experienced by this population. Supports all data with reliable resources. Section Review of social determinants What social determinants a r e relevant t o the identified disparity? The connection between the social determinants and the disparity is clearly explained. Support the data, explain the reasoning. Identify policies that negatively or positively affect the disparities and the social determinants. Source the policies Make the connection between the policies and the outcomes on health. Content Grade Writing FINAL GRADE less Deductions: DEDUCTION OF UP TO 30 points (-30%) will be made for APA/writing/grammatical/punctuation errors. What underlying beliefs or values might contribute to the disparities? This is the tough critical thinking part. What values held by those in power might influence the health status of a particular population. Clarify your thinking. 15%

Earned Points

10

15

Policies contributing to disparities

15%

15

Contributing factors

30%

30

100% -30%

100 -0

100 Good job. This is a very relevant topic. This population is continually struggling with todays healthcare challenges. You touched on some great areas of concern. Jo

Total

100%

SEXUAL MINORITY YOUTH HEALTH DISPARITIES

Sexual Minority Youth Health Disparities By Joan Kronlein RN April 8, 2012 NUR 340/Doerr

SEXUAL MINORITY YOUTH HEALTH DISPARITIES Abstract Disparities of homeless gay/lesbian, bisexual, and transgender (GLBT or sexual minority) youth are a combination of both disparities of homeless youth and GLBT/sexual minority youth. The disparities are increased risk of; suicide, homelessness, decreased access to and sensitive health care. The biggest social determinant for this population is the lack of a parental or significant adult figure in their lives. The lack of the parental figure impacts access to care and all other disparities. Negative biases of individuals and policy makers, negatively affects sexual minority homeless youth.

SEXUAL MINORITY YOUTH HEALTH DISPARITIES Sexual Minority Youth Health Disparities Health disparities, according to Harkness & Demarco (2012), are racial or ethnic differences in the quality of healthcare (p. 25). According to Frieden (2011), health disparities are differences in health outcomes between groups that reflect social inequalities (p. 1). The following is information about health disparities in the homeless gay/lesbian, bisexual, and transgender youth population as well as social determinants, policies, biases, and political influences. Health Disparities Homeless Gay/lesbian, bisexual, and transgender youth, or sexual minority youth, is a population with many disparities. GLBT (gay/lesbian, bisexual, transgender) youth have disparities without being homeless. According to the United States Department of Health and Human Services (DHS) (2012), LGBT youth are 2 to 3 times more likely to attempt suicideand are more likely to be homeless (Healthy People 2020, Understanding LGBT Health, para. 4) than heterosexual youth. Being a homeless youth has its own disparities. According to homeless youth (not necessarily GLBT), quality healthcare disparities involve the lack of health care services that take into account the lives of homeless youth (Ensign, 2004,

Findings, para.1), like access to and quality of the health care encounter[for] improvements in functional status, symptoms of disease, and increase in trust and connections with adults and the community... (Ensign, 2004, Conceptual links and suggested measures, para. 2); basically, lack of health care that is sensitive to the needs of homeless youth. One homeless youth admitted that a sign of quality of health care is if they survive being homeless (Ensign, 2004). Being GLBT, homeless, and a youth carries many more disparities than separately. The disparities combined

SEXUAL MINORITY YOUTH HEALTH DISPARITIES between homeless and GLBT youth are increased risk of; suicide, homelessness, decreased access to and sensitive health care. Social Determinants Social determinants are conditions in which people live and work (Harkness, &

DeMarco, 2012, p. 3) that affect health. According to Rew, Whittaker, Taylor-Seehafer, & Smith (2005), sexual health risks and protective resources differed between those self-identified as GLB and those self-identified as heterosexual. More G/L youth reported a history of sexual abuse and being tested and treated for HIV, and more scored lower on the assertive communication measure than did bisexual or heterosexual youth (Abstract). According to Corliss, Goodenow, & Nichols (2011), the sexual-minority youths greater likelihood of being homeless was driven by their increased risk of living separately from their parents or guardians (p. 1683). Rejection and victimization within the family related to minority sexual orientation status likely contribute[d] to a greater risk of homelessness among sexual minority youths (Corliss, Goodenow, & Nichols, 2011, p. 1686).The authors also stated that these youth are at greater risk of health threats such as victimization, physical and sexual abuse, mental health and substance use problems, and sexual risk behaviors (Corliss, Goodenow, & Nichols, 2011, p. 1683). The link between health disparities and the social determinants is easily seen. Because homeless GLBT youth are youth, with no adult or parental involvement, youth have difficulty accessing and understanding health care. This contributes to risky sexual behavior to survive homelessness, which contributes to increases in sexually transmitted diseases and HIV. Because of no permanent home or parental involvement, this starts and leads to greater incidence of mortality and morbidity in this population.

SEXUAL MINORITY YOUTH HEALTH DISPARITIES Policy A policy that is affecting sexual minority youth who are homeless is the McKinneyVento Homeless Assistance Act as part of the No child Left Behind legislation (United States Department of Education, 2004). All homeless youth, including sexual minority youths will be given assistance, and not discriminated against while they are being educated. The students are paired with a liaison, or a parenting figure to help them get thru school, and therefore life. Also, one goal of Healthy People 2020 is to increase the percentage of adolescents who are connected to a parent or other positive adult caregiver (Healthy People 2020 2009 Draft School Objectives, AH HP20208) to keep them from becoming homeless with poor health outcomes. In other words keeping homeless sexual minority youth within families or with at least one parent or guardian can significantly decrease poor health outcomes from homelessness in this population. Biases

The biases of individuals about sexual orientation and homelessness can affect the sexual minority youth population. These biases can be from religious backgrounds or from fear. Some view GLBT individuals as sinning and eroding the traditional heterosexual relationship and/or marriage. Some people are fearful of GLBT relationships because of lack of knowledge. Some people view homeless youth as having run away, and that they are just bad kids on drugs. These biases contribute to disparities by disallowing these individuals to claim relational health insurance, especially in the GLBT population. Homeless youth are denied health care because there is no one to apply for them, or tell them how to get it, or even if they are still on their parents health insurance. Political Influence

SEXUAL MINORITY YOUTH HEALTH DISPARITIES Political parties lean towards supporting policies to help the GLBT or away from this population. All political agendas seem to want to help homeless youth, but when the phrase GLBT is added, that is when there is much debate which creates more disparities. Conclusion Homeless youth are youth, no matter the sexual preference and deserve access to sensitive care, and relationships that will decrease the risk of homelessness, disease, and death. As the homeless youth above surmised, a sign of quality of health care is if they survive being homeless (Ensign, 2004). This is the key; survival.

SEXUAL MINORITY YOUTH HEALTH DISPARITIES References Corliss, H. L., Goodenow, C. S., & Nichols, L. (2011). High Burden of homelessness among sexual-minority adolescents: findings from a representative Massachusetts high school sample. American Journal of Public Health, 101(9), pp. 1683-1689.

Ensign, J. (2004).Quality of health care: the views of homeless youth. Health Services Research. P. 695+. Retrieved from Academic OneFile at http://0go.galegroup.com.libcat.ferris.edu/ps/i.do?id=GALE%7CA119950467&v=2.1&u =lom_ferrissu&it=r&p=AONE&sw=w. GALE|A119950467 Frieden, T. R. (2011). Supplement. Forward. Morbidity and Mortality Weekly Report, 60, p. 1. Retrieved from http://www.cdc.gov/mmwr/pdf/other/su6001.pdf Healthy People 2020 2009 Draft School Objectives. (2009). AH HP20208. Retrieved from http://www.ashaweb.org/files/public/Pulse_11_09/Proposed_HP2020_Objectives.pdf Rew, L., Whittaker, T. A., Taylor-Seehafer, M. A. and Smith, L. R. (2005). Sexual Health Risks and Protective Resources in Gay, Lesbian, Bisexual, and Heterosexual Homeless Youth. Journal for Specialists in Pediatric Nursing, 10, p. 1119. doi: 10.1111/j.1088145X.2005.00003.x United States Department of Education, (2004). Education for homeless children and youth program, Title VII-B of the McKinney-Vento Homeless Assistance Act, as amended by the No Child Left Behind Act of 2001.