Abstract
Youth homelessness has been demonstrated to disproportionately affect sexual and gender minority (SGM) youth compared to heterosexual cisgender peers. In this context, we aimed to compare health risks between service-seeking SGM and heterosexual cisgender youth experiencing homelessness, including harmful risks stemming from substance use and severity of symptoms of mental health disorders. We recruited 100 racially diverse, unstably housed participants aged 18–24 who access services at an urban non-profit organization in San Francisco, CA. Data analysis included 56 SGM participants who identified as gay, lesbian, bisexual, pansexual, unsure, transgender, and nongender, and 44 heterosexual cisgender participants. In contrast to previous studies reporting significantly higher frequency of substance use and more severe symptoms of depression, generalized anxiety, and post-traumatic stress disorder among SGM youth compared to heterosexual cisgender peers, many of these health disparities were not observed in our diverse study population of service-seeking youth. Furthermore, with the exception of methamphetamine, SGM participants did not exhibit greater harmful risks resulting from substance use, such as health, social, financial, and legal complications. We discuss the reduced burden of health disparities between SGM and heterosexual cisgender youth in our service-seeking study population within the context of gender- and sexuality-affirming programming offered at the partnering community organization. We conclude that longitudinal data on these tailored community-level interventions are needed to further explore the reduced burden of health disparities observed among service-seeking SGM youth experiencing homelessness in San Francisco in order to continue supporting pathways out of homelessness for youth of all sexual and gender identities nationwide.
Highlights
It is estimated that homelessness affects 3.5 million youth between the ages of 18 to 25 annually in the United States [1]
Our results stand in contrast to previous findings that the overall prevalence of substance use is significantly higher among homeless youth who identify as Sexual and gender minority (SGM) as compared to heterosexual cisgender homeless youth
While more evidence is needed, future research may support replication of the sexuality- and genderaffirming service model used at Larkin Street: if SGM homeless youth are to build resiliency and overcome the stigma and discrimination that can perpetuate cycles of youth homelessness, culturally-tailored services will be important in addressing substance use and other health issues
Summary
It is estimated that homelessness affects 3.5 million youth between the ages of 18 to 25 annually in the United States [1]. With regards to mental health, lesbian, gay, bisexual, and transgender (LGBT) youth who are homeless are more likely to experience substance use and use a greater number of substances than heterosexual cisgender peers experiencing homelessness [2,3,4]. Given these documented disparities, SGM homeless youth may be at higher risk for negative health outcomes related to substance use, such as HIV and viral hepatitis, which can further serve as a barrier to maintaining stable housing [5]. Sexual and gender minority youth experiencing homelessness report worse mental health outcomes, including increased suicidal ideation and more severe depressive symptoms [6], increased anxiety [7], and higher rates of post-traumatic stress disorder (PTSD) [8]
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