Scarcity of Scientific Studies on Interventions to Reduce Health Inequities in LGBTQ Youth

Newswise — PITTSBURGH, Aug. 19, 2019 – There is a dearth of scientifically investigated, evidence-based interventions to address substance use, mental health conditions and violence victimization in sexual and gender minority youth, according to a research review led by the University of Pittsburgh Graduate School of Public Health and published today in the journal Pediatrics. 

After poring over thousands of research publications spanning nearly two decades, the scientists identified only nine studies that evaluated such interventions, and most of these used suboptimal study designs, thereby limiting the validity of the findings. None of the programs would be sufficient to mitigate the substantial inequities faced by lesbian, gay, bisexual, transgender and queer (LGBTQ) youth, the scientists concluded. 

“While this knowledge gap is distressing, I think we can look at it as an opportunity,” said lead author Robert W.S. Coulter, Ph.D., M.P.H., assistant professor in Pitt Public Health’s Department of Behavioral and Community Health Sciences. “Promising programs are being created by community-based organizations that are ripe for rigorous evaluation by scientists to determine if they are successfully improving health among LGBTQ youth and, if so, whether they can be replicated in other communities.” 

Compared with their heterosexual peers, sexual minority youth have up to 623% higher odds of substance use in their lifetimes; up to 317% higher odds of mental health conditions, such as suicidality and depression; and up to 280% higher odds of violence victimization, such as being bullied at school, or sexually or physically abused. Due to these health inequities, the federal government has designated LGBTQ youth as a priority population for research focused on preventing, reducing and treating these health issues. 

Despite this designation, the few studies Coulter and his team found primarily focused on individual therapy and only a couple on population-level interventions designed to reduce inequities in the communities where LGBTQ youth live, attend school and play. 

“One-on-one therapy can be an effective intervention, but it is inherently focused on treating the victim, rather than preventing the larger societal problems, such as discrimination, that can lead to substance abuse, bullying and mental health issues,” said Coulter. “Our study identified a need for evaluation of larger interventions targeting an entire population — such as at schools — to bring about cultural changes promoting acceptance and celebration of differences. Such programs may prevent problems from ever arising and make youth more resilient from a health perspective in the future.” 

Coulter noted that just because his team’s literature review didn’t find studies evaluating such programs, that doesn’t mean they don’t exist. It’s more likely that limited funding prompted organizers to put their resources into programming, with nothing left for scientific evaluation into whether the programs made a positive impact. 

However, Coulter said, rigorous scientific evaluation of health interventions to validate whether or not they work is crucial to securing future funding that can allow successful programs to continue and expand, as well as to improve or halt unsuccessful interventions. 

He also said that it is possible they didn’t find many interventions because his team was specifically focused on children younger than 18, a population that can be more difficult to include in research studies because they haven’t reached the age of consent. 

“But adolescent brains are at a crucial developmental stage,” Coulter said. “Interventions that successfully prevent undue stress, increase support and build resilience, can pay dividends down the line.” 

Coulter recently received a grant from the National Institute on Alcohol Abuse and Alcoholism to create a school-based intervention to train staff in ways to better support LGBTQ youth. He intends to incorporate a community-based stakeholder advisory group and apply the scientific method to evaluating the intervention. 

Elizabeth Miller, M.D., Ph.D., chief of the Division of Adolescent and Young Adult Medicine at UPMC Children’s Hospital of Pittsburgh, is senior author on this study. Additional authors are James E. Egan, Ph.D., M.P.H., Suzanne Kinsky, Ph.D., M.P.H., M. Reuel Friedman, Ph.D., Kristen L. Eckstrand, M.D., Ph.D., Jessica Frankeberger, M.P.H., Barbara L. Folb, M.M., M.L.S., M.P.H., Christina Mair, Ph.D., Nina Markovic, Ph.D., Anthony Silvestre, Ph.D., and Ron Stall, Ph.D., M.P.H., all of Pitt. 

This research was supported by National Institutes of Health grants F31DA037647, TL1TR001858, K01AA027564 and K24HD075862. 

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