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Being a teenager is hard.
Beyond petty adolescent grievances, there are real challenges going on in teenagers' lives - negotiating a place in the social hierarchy of peers, navigating changing friendships, dealing with pressures of family, school and dating.
This period of social, emotional and physical development can be even more challenging for lesbian, gay, bisexual or transgender (LGBT) youth.
These youth deal with all the same issues as their straight counterparts, but they have the added burden of being "different" in a way that many of their peers, family and friends may not understand or accept. The danger is that LGBT youth may not seek (or find) the support they need.
Gap in Care
When it comes to healthcare, LGBT youth is particularly at risk.
LGBT youth may feel uncomfortable disclosing their sexual orientation or sexual status to their healthcare provider, or may worry that anything said to a healthcare provider could get disclosed to their parents (either directly or through insurance claims).
 "LGBT youth are very economically and emotionally dependent on the adults around them, making them very vulnerable," said Clair Kaplan, MSN, RN, APRN(WHNP), MHS, MT(ASCP), director of clinical research, Planned Parenthood of Southern New England, New Haven, CT.
This population may also be at greater risk for certain medical conditions.1,2
"While we don't have a lot of solid epidemiology (we have mostly smaller studies), we know that LGBT youth tend to be at higher risk for depression, anxiety, substance use, eating disorders and suicide," said Scott Weber, EdD, MSN, RN, assistant professor of nursing and public health, University of Pittsburgh.
LGBT teens may also be at high risk for bullying and peer violence, said Kaplan.
Sexually transmitted diseases are also a very real health concern and HIV remains a top concern for young gay males.
"It's very significant when they get infected with HIV now, because they can get a drug-resistant strain," Kaplan said.
Finally, LGBT youth are at risk for homelessness (which could give rise to a host of health problems), if they are kicked out of the house by family members.3
How Can Nurses Help?
Nurses, whether in a primary care, hospital or community health clinic setting, can play a vital role in reaching out to the young LGBT population. "The biggest thing nurses can do is not make assumptions," said Kaplan.
By not assuming that all teenage patients are straight and have the same sexual health and reproductive concerns, nurses can play a big role in drawing LGBT youth into the healthcare system. Asking questions that are inclusive of different sexual orientations is a good place to start.
Additionally, don't be afraid to ask patients potentially uncomfortable questions, albeit in a caring and open manner, said Weber, also a board member for the Gay and Lesbian Medical Association (GLMA), based in San Francisco.
Getting good information from patients can help nurses provide LGBT teenagers with the care they need. For instance, even though a patient identifies herself as a lesbian, she may still be experimenting sexually, at times with men.
"These patients may still need to be counseled on birth control" said Kaplan. Young lesbian patients also need information on protecting themselves from sexually transmitted diseases that can be spread between females.
Finally, maintain an adequate referral list for LGBT youth, suggested Kaplan. Knowing where to steer this population for additional information and services is important.
Kaplan recommended keeping the local Planned Parenthood on the referral list for reproductive primary care, including birth control, pregnancy testing, and STD testing and care. For patients without insurance, fees are based on a sliding scale.
Need for Education
Weber suggests nurses periodically educate themselves on basic sexual orientation and gender identity issues.
A recent study of articles in nursing journals found that only 0.16 percent of articles focused on lesbian, gay, bisexual and transgender health (8 of nearly 5,000 articles searched) and were biased toward authors outside of the U.S., underscoring the need for ongoing education on this population.4
Weber likes The Fenway Guide to Lesbian, Gay, Bisexual and Transgender Health, one of the first American medical textbooks dedicated to LGBT health, created by The Fenway Institute in Boston, and published by the American College of Physicians, for its accessibility.
There are also many educational materials available online, including learning modules on the Fenway Health website http://www.fenwayhealth.org/ and the GLMA website http://www.glma.org/.
Nurses can be a source of education to other clinicians in their own facilities, said Weber. "Invite LGBT speakers to your facility or clinic for in-services. People in LGBT are often used to doing outreach and are often happy to go to a facility to speak with clinicians."
Nurses can also be the primary point of education for families of LGBT youth and school administrators. Creating a dialogue about young LGBT patients is the first step in closing the gap in care.
References for this article can be accessed here.
Diana Friedman is regional editor at ADVANCE.
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