Parental Acceptance and Illegal Drug Use among ... - Oxford Journals

Parental Acceptance and Illegal Drug Use among Gay, Lesbian, and Bisexual Adolescents: Results from a National Survey Yolanda C. Padilla, Catherine Crisp, and Donna Lynn Rew Although gay, lesbian, and bisexual (GLB) adolescents face many of the same developmental challenges as do heterosexual adolescents, they must also deal with the stress of being part of a stigmatized group. The purpose of this study was to examine the extent to which family support and involvement with the queer community may buffer the effects of life stress on substance use among GLB youths. Drawing on a large national online survey, the authors examined drug use in 1,906 GLB youths 12 to 17 years of age. Overall, 20 percent of the youths reported using illegal substances in the past 30 days. Results from multivariate analyses revealed that stress, as measured by suicidal ideation, significantly increased the risk of drug use. A positive reaction from the mother to the youth’s coming out served as a significant protective factor, whereas involvement in a queer youth group had no effect. The authors found evidence that, for GLB adolescents, parental acceptance of sexual identity is an important aspect of a strong family relationship and, thus, has important ramifications for their healthy development. Implications of the findings for social work practice are discussed. Key words: adolescent; gay; family

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ay, lesbian, and bisexual (GLB) adolescents face many of the same developmental challenges as do heterosexual adolescents, but they must also deal with a stigmatized identity. In one of the more important studies on minority stress in gay men, Meyer (1995) demonstrated the destructive mental health effects of chronic stress related to stigmatization. He showed that internalized homophobia, expectations of rejection, and experiences with discrimination and violence are significantly associated with feelings of demoralization and irrational guilt as well as suicidal ideation. According to the National Child Traumatic Stress Network (Killen-Harvey, 2006), in the case of gay youths the effects are considered traumatic, affecting gay youths’ ability to cope and leading to feelings of fear and helplessness in their daily lives. Sexual minority youths experience and are exposed to trauma in multiple ways. They are not only vulnerable to the traumatic events of all youth but also have to contend with family rejection, school harassment, and physical, sexual, and/or emotional abuse in response to suspicion or declaration of their emerging sexual orientation and gender identity. (p. 1)

CCC Code: 0037-8046/10 $3.00 ©2010 National Association Social Workers Padilla, Crisp, and Rew / Parental Acceptanceofand Illegal Drug

support; illegal drug use; lesbian

Exposure to stress is considered a major factor behind substance use and the main cause of relapse (National Institute on Drug Abuse, 2006). Among adolescents, sexual minorities are particularly at risk for drug use due to multiple life stressors. The sometimes severe distress experienced by sexual minority youths came to the attention of researchers, educators, and practitioners following a 1989 report suggesting that gay and lesbian youths were two to three times more likely than their heterosexual peers to attempt suicide (Gibson, 1989). Indeed, a closer examination of the lives of sexual minority youths shows that they face greater stress and have less access to social supports than do their heterosexual peers (Hart & Heimberg, 2001), are subjected to harassment in their schools and other forms of victimization on the basis of their sexual orientation (Gay and Lesbian Medical Association, 2000; Kosciw & Díaz, 2006), and have higher rates than do heterosexual youths of high school dropout, physical illness, and family discord (Lock & Steiner, 1999). As the literature discussed later shows, the response of gay, lesbian, and bisexual adolescents to the exacerbated stress associated with being members of a sexual minority often involves substance use. In the face of such pressures, are there factors

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that enhance their resiliency? Based on a large national sample, this study investigates whether family support associated with coming out and access to social networks in the queer (inclusive term for gay, lesbian, bisexual, transgender, and questioning, or GLBTQ) community help decrease drug use in sexual minority youths by buffering the negative effects of life stress. Substance Use in Sexual Minority Youths: Prevalence and Underlying Mechanisms

Research has revealed that along with other health risk behaviors, such as unprotected sex and suicide, the burden of life stress places GLB youths at increased risk for substance use (Gay and Lesbian Medical Association, 2000; Ryan & Hunter, 2001). GLB youths may use substances to help them deal with the stigma and shame of a GLB identity, to deny feelings of same-gender attraction, or to cope with antigay verbal and physical violence (Ryan & Hunter, 2001; Savin-Williams, 1994). A comprehensive review of eight population-based studies on antigay harassment and the safety and well-being of sexual minority students revealed a consistent relationship between school harassment and drug use, along with other self-destructive behaviors, such as eating disorders and suicidal ideation and attempts (Reis & Saewyc, 1999). Family support and acceptance of same-gender orientation have been found to be associated with overall mental health and self-esteem in studies of gay men (Díaz, Ayala, Bein, Henne, & Marin, 2001; Elizur & Ziv, 2001). Although the lack of population-based studies on GLB adolescent drug use prevents reliable comparisons with the general population, various studies suggest that GLB youths turn to drugs at significantly higher rates than do their heterosexual peers (for a detailed review of the literature on substance abuse among sexual minorities, see Hughes & Eliason, 2002). An ambitious four-year study sponsored by the Centers for Disease Control and Prevention (CDC) of 3,492 young gay men ages 15 to 22 showed that one in three used substances such as crystal methamphetamine, ecstasy, marijuana, or cocaine at least once a week and that their drug use was three times as high as that of a national sample of men in the general population (Thiede et al., 2003). Other smaller scale studies have revealed similar results. Orenstein (2001) found that youths who reported same-gender be-

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havior or attraction had higher levels of substance use than did youths who did not. Faulkner and Cranston (1998) found that students who reported exclusively same-sex contact were more likely to report marijuana, cocaine, and intravenous drug use. However, most studies on drug use among GLB youths are limited by their small and largely male samples and are often school-based or restricted to specific geographic areas. Despite the higher risk for substance use among GLB youths and its assocation with stress, there is limited research on the role played by family and other contextual factors. Although social support is considered a mechanism that can enhance resiliency when dealing with stress (Thoits, 1995), little is known about how family and community support may affect the likelihood of substance use among sexual minority adolescents. Are GLB adolescents whose parents are accepting of their sexual orientation less likely to engage in the use of substances? Does access to social networks in the queer community serve as a protective factor? Expanding our understanding of these dynamics can help in the assessment, prevention, and treatment of substance use among sexual minority adolescents. Conceptual Framework

According to the literature (Hawkins, Catalano, & Miller, 1992), risk factors for drug use in adolescence include a variety of stressors that lie within the individual, interpersonal, and social environments. Physiological and genetic factors, family history of drug use, association with drug-using peers, and social norms are predisposing factors that place youths at risk for drug use. Protective factors are viewed as mechanisms that inhibit drug use among those at risk. Although various risks make youths vulnerable to negative outcomes, protective factors facilitate a resilient response. In our study, we focused on contextual factors that may moderate substance use among GLB youths by using a social ecological conceptual model. According to the literature, familial and community support have been shown to serve as protective factors against the risk of adolescent drug use (Hawkins et al., 1992).We focused on the role of social support as a protective factor at the family level, specifically parental support, and at the community level. Social support is viewed as a mechanism for the adolescent to form strong relationships: At the parental level, support fosters strong parent–child attachment; at the community

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level, support provides opportunities for involvement, skills development, and reinforcement. As discussed earlier, for GLB adolescents, minority stress adds an additional threat to mental health, which in turn exposes them to the risk of substance use. In our study, we used suicidal ideation and selfesteem as measures of life stress. Extensive research provides evidence that social support serves as a protective, or buffering, mechanism against stressors. According to a thorough review of the literature by Thoits (1995), empirical studies show that social support buffers the damaging mental and physical health impact of major life events and chronic strains. Furthermore, both family and communitylevel systems (for example, senior citizen centers for elderly people) provide a network that facilitates access to various kinds of assistance and the perception of the availability of support. Research on the relationship between social support and adolescent substance use in the general population indicates that parental emotional and instrumental support is inversely related to substance use (Wills, Vaccaro, & McNamara, 1992). However, to our knowledge, research on the role of social support in drug use among adolescents who are gay, lesbian, or bisexual has not been conducted. In our study, we examined factors specific to sexual minorities, such as coming out, and also included global measures of stress and well-being, such as suicidal ideation and self-esteem. Method

Data

To address our research questions, we conducted a secondary analysis of data from a large online Internet survey of GLBTQ youths collected by OutProud: The National Coalition for Gay, Lesbian, Bisexual and Transgender Youth (in collaboration with Oasis Magazine, an online magazine for queer youths) (Kryzan, 2000). Data were collected from September 1 to October 31, 2000. The survey was developed in collaboration with experts in the field of gay and lesbian studies, mental health, and other relevant areas. It included more than 260 questions designed to provide a picture of sexual minority youths and how their sexual orientation has shaped their worldviews and experiences (Kryzan, 2000). Included were questions about the respondents’ demographic characteristics, coming out, family, school, relationships, sexuality, the media, harassment, the community, and risk behaviors (including

questions based on CDC’s Youth Risk Behavior Surveillance system). Links to the survey were made available on various locations, including Out in America, OutProud, Youth Action, Beautiful Boy, and others. An introductory letter was provided online identifying the goals of the survey as well as OutProud’s privacy policy. No identifying information was collected from the respondents.When respondents completed the survey, a thank-you letter, which included a link to a page of helpful Web sites, was displayed. The survey took 37.5 minutes on average to complete. Responses were collected from 6,872 youths ages 25 years and under. Respondents from the United States and its territories totaled 5,281. For purposes of this study, the data were limited to GLB youths 12 to 17 years of age from the United States and its territories, for a total of 1,906 respondents. Of the reduced sample, 1,040 youths identified as gay, 206 as lesbian, and 660 as bisexual. Eighty-one percent identified as white, and 19 percent as another race or ethnicity. We were unable to divide race and ethnicity into more precise categories because of the relatively small proportion of youths of color responding to the survey. The average age of the respondents in the sample used for this analysis was 16. As shown in Table 1, GLB youths did not differ significantly in terms of race, ethnicity, or age. Respondents who identified as questioning or transgender were not included in the analysis because of their very low numbers in the survey. It is not possible to determine the extent to which the sample used for this study is representative of GLB adolescents due to the lack of data on their numbers in the population. Because of its national scope, the current sample is likely to have broader representation than samples limited to particular geographic regions or drawn from organizational settings (such as schools or youth centers). However, because the survey respondents were self-selected, they may represent a group more willing to discuss issues concerning their sexual identity. A major source of bias for the study is that respondents needed to have access to a computer that was connected to the Internet. As a result, it is possible that more affluent youths may be represented (information on parental socioeconomic status [SES] is not included in the data). According to OutProud investigators (Kryzan, 2000), bias may have been introduced by the length of the survey (nearly 38 minutes). About

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Table 1: Descriptive Analysis of Gay, Lesbian, and Bisexual Adolescents Ages 12 to 17 Years Gay Lesbian Bisexual Total (n = 1,040) (n = 206) (n = 660) (N = 1,906) % % % %

Dependent variable Substance use Demographics White (versus other) Mean age (years) Life stress indicators Sexual orientation as obstacle* Suicidal ideation* Self-esteem Family support Out to mother Out to father Out to neither* Mother positive (to coming out) Father positive (to coming out)* Parental religion as barrier Community involvement Queer youth group member* Feel part of queer community*

18

24

81 16

22

77 16

20

79 16

80 16

63 61 12

58 73 12

50 61 12

58 63 12

37 26 61 92 93 47

56 40 40 89 91 42

21 13 78 93 97 44

33 23 64 92 94 45

16 44

29 56

11 30

16 40

*p ≤ .05 (statistically significant differences across groups based on chi-square analyses).

one-third of the youths who began the survey did not complete it. Finally, the survey overrepresents gay teenagers over lesbian teenagers at a rate of five times. Thus, the breakdown of GLB adolescents in this study does not represent the overall population distribution. For the purposes of this study, however, we attempted not to make estimates of drug use for the population of GLB teenagers but, rather, to examine the mechanisms associated with drug use within the population. Measures and Data Analysis

Our dependent variable was a dichotomous variable for illegal drug use and was coded 1 (and 0 otherwise) if the youth used any of the following substances in the past 30 days: marijuana, cocaine, ecstasy, or crystal methamphetamine. This definition is comparable with that used by the Substance Abuse and Mental Health Services Administration (SAMHSA) and allows for comparisons of drug use with the general population of youths 12 to 17 years of age. We grouped the independent variables into three levels. First, we included three measures indicative

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of the youth’s level of stress.We included one stressor specific to sexual orientation: “Do you feel that your sexual orientation will be an obstacle in your life?” We also included two global indicators of stress: suicidal ideation—a variable indicating whether the respondent had ever seriously considered taking his or her own life—and a self-esteem score. The self-esteem score was based on a subscale of the Rosenberg (1965) 10-item self-esteem scale. The Rosenberg self-esteem scale has been validated for use with adolescents and for substance abusers and other clinical groups (Crandal, 1973). The survey included four statements: (1) I feel that I do not have much to be proud of, (2) I take a positive attitude toward myself, (3) at times, I think I am no good at all, and (4) on the whole, I am satisfied with myself. Respondents reported their agreement with these statements on a four-point scale ranging from strongly agree to strongly disagree. For items 1 and 3, scores were reversed and the numbers were added to obtain a total score, ranging from a low of 4 to a high of 16. Higher scores represent higher levels of self-esteem (a more positive self-image).


The reduced four-item scale has shown excellent psychometric properties in prior sampling studies (Nezleck & Plesko, 2001). Internal consistency of the self-esteem scale in our study was high, with a Cronbach’s alpha coefficient of .82. The second level included three measures of family acceptance and supportiveness of the youths’ sexual orientation based on the youths’ perceptions. The first was whether they had disclosed to their mother or father that they were gay, lesbian, or bisexual (“Have you ever told your [mother/ father] that you are queer?”). The second was how the father and mother (coded separately) reacted to their coming out. For the multivariate analysis, we combined the responses into a dummy variable in which 1 is a positive reaction (very good, good, or okay) and 0 is negative reaction (very bad, bad, or has not come out to the parent). We conceptualized not having come out to parents as representing a perception on the part of the youths that their parents would not be accepting of them if they disclosed their sexual orientation. According to the literature on the developmental stages of the coming out process (Coleman, 1982; D’Augelli & Patterson, 2001), the pre-coming out stage is a period often characterized by anxiety, feelings of family rejection, and insecurity concerning parental acceptance. We also accounted for cases in which the youths had not come out by including a control variable for not having disclosed their sexual orientation to either parent, which accounts for the majority (64 percent) of the youths. The third variable was whether their parents’ religious beliefs made them feel uncomfortable about being open with them about their sexual orientation (“Have your parents’ religious beliefs made it more difficult to tell them about your sexual orientation?”). Finally, the third level, access to community support related to sexual identity, included two measures: whether they had ever attended a queer youth group and whether they felt a part of the queer community (“Do you feel as though you are a part of the queer community?”). In addition to these three sets of variables, we included controls for three demographic characteristics: sexual orientation, race or ethnicity, and age. Except for self-esteem and age, which were coded as continuous variables, all variables were coded as dichotomous. We conducted quantitative analyses of the survey data, starting with descriptive statistics of all variables by sexual orientation.Then, we used logistic regres-

sion to estimate the likelihood (odds) that respondents engaged in substance use as a function of life stress indicators, family support, and community ties. First, the effect of each set of variables on substance use was estimated in separate models. Second, we included all variables in a full model simultaneously to determine whether social support moderated the effects of life stress on drug use. Results

Descriptive Analysis

Among GLB adolescents ages 12 to 17, 20 percent reported having used at least one substance within the past 30 days: 18 percent among gay youths, 24 percent among lesbian youths, and 22 percent among bisexual youths (see Table 1).There were no significant differences in substance use by sexual orientation. Consistent with national trends (SAMHSA, 2008, Table H.3), the most commonly used drug was marijuana (18.5 percent), followed by ecstasy (4.0 percent), cocaine (1.5 percent), and crystal methamphetamine (0.9 percent). Indicators of social stress revealed that GLB adolescents were experiencing high levels of stress based on two measures. Over half of adolescents (58 percent) felt that their sexual orientation will be an obstacle in their life, with the highest percentage found among gay youths and the lowest among bisexual youths. In addition, a very high percentage of the youths, 63 percent, had seriously thought about taking their own life, with the highest percentage (73 percent) found among lesbian youths. Self-esteem scores were relatively high.The average score across the board was 12 (out of a possible 16 points), indicating a positive level of self-esteem. A score of 12 means that on average youths indicated agreement with questions concerning a positive self-image. Fewer than half of the adolescents were out to their parents: 33 percent were out to their mothers, and 23 percent were out to their fathers. (The percentages of youths who were out versus those who were not out to either parent do not add up to 100 percent because some youths were out to their father or mother and others were out to both.) Significant differences existed in terms of those who were out to neither parent: Lesbian youths were least likely and bisexual youths were far more likely not to be out to either parent. Of the youths who were out to their mother or father, the vast majority received a positive reaction (ranging from 89 percent


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to 97 percent). GLB youths considered parental religious beliefs as a major barrier to their coming out. Nearly half agreed that they felt their parents’ religious beliefs made it more difficult for them to come out to them, with no statistically significant differences based on sexual orientation. Finally, access to queer youth services and the perception of connectedness to the queer community varied significantly on the basis of sexual orientation. On average, only 16 percent of the youths had attended a queer youth group, although there were significant differences by sexual orientation. Lesbians had the highest likelihood of having attended (29 percent), followed by gay youths (16 percent) and bisexual youths (11 percent).When asked if they felt as though they were part of the queer community, 40 percent indicated that they did. Lesbians were the most likely to feel a part of the queer community (56 percent), but the percentage was much lower among bisexual adolescents (30 percent). Multivariate Analysis

Results of multivariate analyses estimating the protective effects of family support and community involvement on the likelihood of GLB drug use are shown in Table 2. We conducted a separate logistic regression equation on each set of variables: demographic characteristics, indicators of stress, perceived family support, and community involvement. A final model includes all the variables. The first model shows that two of the demographic characteristics, sexual orientation and race or ethnicity, did not influence substance use, but age was positively related to drug use. The odds of using drugs increased by 0.21 with each additional year of age. In the second model, we focused on the effects of risk factors on drug use, measured by two indicators of life stress: suicidal ideation and self-esteem. GLB adolescents who had experienced suicidal ideation had 0.62 higher likelihood of substance use.A second indicator of stress, believing that sexual orientation will be an obstacle in life, was not included in the regression analysis because of its strong relationship with suicidal ideation. Separate analysis of sexual orientation as an obstacle in which we excluded suicidal ideation (not shown here) indicated that it was not a significant predictor of drug use. Not controlling for other variables, one measure of family support, the mother’s reaction to the adolescent’s coming out, had a significant effect on substance use. Adolescents whose mothers reacted

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positively were 39 percent less likely to use substances compared with those who were not out to their parents or whose mothers or fathers did not react positively. Other measures of family support (whether they were out to their parents, the reaction of the father to their coming out, and whether they perceived that their parent’s religion was a barrier to their being out) were not significantly associated with drug use. In terms of the effects of community involvement, we found that being a member of a queer youth group significantly increased the odds of using drugs by 0.23. Whether the youths felt that they were a part of the queer community had no effect. In the final model, shown in column 5 of Table 2, we included all variables in the equation simultaneously to determine the extent to which family and community support serve as a protective factor in adolescent drug use when controlling for relevant factors. First, accounting for demographic characteristics and risk factors, parental acceptance served as a protective factor for drug use, but community involvement had no effect. Given similar risk conditions, adolescents whose mothers reacted positively to their coming out were 35 percent less likely to use substances than were those who were not out to their parents or whose mother or father did not react positively. However, community involvement did not serve as a protective factor.When controlling for age, involvement in a queer youth group was no longer statistically significant. Involvement in a youth group was highly associated with age (older youths were more likely to be have attended a youth group). Thus, age explains the positive relationship between youth group involvement and substance use previously found in the reduced model. Finally, the relationship between suicidal ideation and drug use was moderated by family and community involvement.The odds ratio for suicidal ideation decreased from 1.63 to 1.46 when measures of family and community involvement were included, although the relationship between suicidal ideation and drug use remained significant. Using a hypothetical case and calculating the probabilities from the odds ratios (not shown here) suggests the magnitude of the effect of selected independent variables on illegal drug use. For example, the probability of illegal drug use for a 16-year-old white lesbian youth is 10 percent. For one with suicidal ideation, the probability increases to 14 percent; however, maternal support of her


Table 2: Logistic Regression of Illegal Drug Use among GLB Youths as a Function of Life Stress and Social Support (N = 1,784)

1,846 4 19.526 0.001 .017

1,821 2 15.804 0.000 .014

1,823 4 10.393 0.034 .009

1,824 2 7.601 0.022 .007

1,784 12 45.261 0.000 .040

1.312 (0.165) 1.076 (0.131)

0.911 (0.149) 0.646 (0.220)* 1.245 (0.268) 1.039 (0.124)

1.456 (0.141)* 0.987 (0.023)

0.799 (0.197) 1.148 (0.208) .901 (.149) 1.200 (0.056)**

0.017 (0.976)**

Notes: GLB = gay, lesbian, and transgender. The Nagelkerke R2 statistic is a measure of the strength of the model. The odds ratio indicates the odds of teenage drug use: An odds ratio greater than 1 indicates that drug use is more likely to occur in the specified group; an odds ratio less than 1 indicates that it is less likely to occur. For an odds ratio less than 1, subtracting the odds ratio from 1 provides the percentage decrease in the likelihood of drug use (for example, an odds ratio of 0.615 indicates a decreases of 38.500 percent). a Reference category is lesbian. b Reference category is not white. *p < .05. **p < .001.

No. of observations Degrees of freedom χ 2 Prob > χ2 Nagelkerke R2

Constant 0.017 (0.867)** 0.191 (0.306)** 0.375 (0.267)** 0.230 (0.079)** Demographics Gaya 0.726 (0.188) Bisexuala 0.949 (0.194) Whiteb 0.856 (0.142) Age 1.208 (0.053)** Life stress indicators Suicidal ideation 1.626 (0.136)** Self-esteem 0.995 (0.022) Family support Not out to either parent 0.833 (0.134) Mother positive reaction to coming out 0.615 (0.215)* Father positive reaction to coming out 1.169 (0.262) Parental religion as barrier 1.042 (0.120) Community involvement Queer youth group member 1.469 (0.154)* Feel part of queer community 1.076 (0.122)

Model 1 Model 2 Model 3 Model 4 Demographics Stress Indicators Family Support Community Ties Full Model Odds ratio (SE) Odds ratio (SE) Odds ratio (SE) Odds ratio (SE) Odds ratio (SE)

Adolescent perception of parental acceptance of sexual identity plays a protective role in GLB drug use in the context of life stressors.

coming out decreases her probability of drug use to 7 percent. Discussion and Implications for Practice

Using a large national sample, this study investigated whether social support from immediate family and community serves as a protective factor against life stressors associated with drug use among GLB adolescents. Consistent with prior studies, the data showed a high level of substance use among 12- to 17-year-old GLB youths. Overall, 20 percent of youths had engaged in some drug use within the past 30 days, twice the national rate of 9.7 percent among the general population of youth in the same age range (SAMHSA, 2008, Table H.3). The study demonstrated that adolescent perception of parental acceptance of sexual identity plays a protective role in GLB drug use in the context of life stressors. We found that GLB youths face high levels of stress. Over half worried that their sexual orientation will be an obstacle in their life, and about two-thirds had experienced suicidal thoughts at some time in their life. Youths who reported suicidal ideation were at significantly higher risk for drug use. However, parental acceptance significantly reduced the impact of life stress on drug use. Mothers’ positive reaction to their children’s coming out had a negative effect on drug use among these youths compared with youths who faced a negative response from their mother or father or who were not out to either parent. Although suicidal ideation remained a strong predictor of drug use among GLB youths, its effect was decreased in the context of both parental acceptance and community involvement. It is important to note, however, that the vast majority of youths lacked access to both family and community supports. Most were not out to their parents, and very few had participated in a queer youth group, which may be related to GLB youths’ expectations of rejection. Lack of participation in queer youth groups may also reflect the lack of availability of such supports in many communities. Although the data revealed some important dynamics, the model

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explained only a small proportion of the variance in substance use, suggesting that other factors may play a larger role. This study has some important data limitations. In the face of the nonexistence of nationally representative U.S. surveys of sexual-minority youths containing in-depth data related to sexual orientation (that is, the coming-out process), we relied on a nonrandom sample of youths drawn from an Internet survey. Thus, we are unable to confidently generalize to the population of GLB youths. Furthermore, we were not able to stratify by racial and ethnic background or to include transgender youths, which would have required that the survey oversample these groups because of their small numbers in the population. Nevertheless, a recent analysis shows that Internet data have important strengths and that such data are not weaker than data gathered by traditional methods (Vazire, Srivastava, & John, 2004). For example, data provided by Internet methods are of comparable quality to those obtained through paper-and-pencil methods, and the data are generally not adversely affected by nonserious or repeat respondents. Another strength of Internet surveys is that they are relatively diverse with respect to gender, SES, geographic region, and age. Despite its limitations, the survey used in this study provided a large national sample of GLB youths and data relevant to sexual identity, including their coming out and parental reactions, self-concept concerning their sexual orientation, and involvement in the queer community. Although the positive effects of parental acceptance were documented by this study, the complexity of the dynamics involved, and the contradictory findings, make it difficult to understand why some forms of support are important and others are not. We did not find that involvement in community youth groups played a significant role in decreasing drug use among gay youths. In-depth evaluation studies of different types of community support organizations offering services to GLB youths would provide more precise information on their effectiveness in preventing substance use and otherwise promoting positive development. According to the Gay and Lesbian Medical Association (2000), school-based and other community-level programs that have been shown to work in reducing drug use in the general population of youths have not been assessed with GLB youths. Given the significance of


the effect of family acceptance of GLB adolescent sexual identity on their drug use, additional measures of family relations and longitudinal studies are needed to assess short- and long-term effects. For example, what is the relationship between overall healthy family functioning and parental acceptance of GLB children? Finally, in addition to effects on substance use, it is important to understand the effect of parental support of sexual identity on other aspects of adolescent health and development. The findings have important implications for social work practice. Previous studies suggest that social support and acceptance play a role in the mental health and self-esteem of sexual minorities (Díaz et al., 2001; Elizur & Ziv, 2001). Furthermore, positive family relationships have been shown to decrease the risk of substance use among adolescents in the general population. In our study, we found evidence that for GLB adolescents, a positive reaction by others to their coming out buffers the effect of life stress on drug use. This suggests that parental acceptance of sexual identity is an important aspect of strong family relationships for GLB youths and, thus, may have important ramifications for their healthy development. A related study recently revealed that GLB individuals who experienced family rejection during adolescence were significantly more likely to report illegal drug use and other negative health outcomes well into young adulthood (Ryan, Huesbner, Díaz, & Sanchez, 2009). Our study shows that social workers may be able to identify these patterns and intervene much earlier in the lives of GLB youths. Perhaps the most widely used intervention to address the needs of sexual minority youths as a strategy both to provide support and to help reduce high-risk behaviors has been community support, including community centers, parent groups, queer youth groups, school-based groups, and gay–straight alliances. For example, the Web sites of various GLBTQ youth organizations (for example, http://glsen.org, http://nyacyouth.org, http://youthresource.com) include databases of local community resources. Such services are viewed as safe places where GLBTQ youths can come out, obtain peer support, and develop social skills (Robinson, 1991). Beyond general community supports, however, the finding that suicidal ideation significantly increases the risk of drug use in GLB youths suggests that preventive and interventive mental health services are needed for this population. Indeed, according to the Healthy

People 2010 Companion Document for LGBT Health (Gay and Lesbian Medical Association, 2000), being served by a continuum of care ranging from preventive services to identification of risk conditions or disease, treatment, referral or rehabilitation or maintenance is essential for a group that has an increased probability of risk for developing chronic and costly conditions. (p. 29)

It is possible that community supports may provide the greatest benefit to GLB youths when working in partnership with parents, because parents are the primary support for their children. Yet, as Wilber, Ryan, and Marksamer (2006) asserted,“despite the importance of family support to promote the health and well-being of LGBT youth, most programs and providers serve them as individuals rather than members of families and communities” (p. 15). At present, there is limited research on how families affect their GLB children’s risk or resilience or on evidence-based practices to help families provide support for their children. Nevertheless, beyond creating a safety net for children who are part of nonsupportive families, social workers can draw on existing studies on how family relations affect the well-being of GLB. On the basis of what we know, we can draw the following three recommendations for social work practice:

1. Although family relations related to sexual orientation can significantly affect the wellbeing of sexual-minority youths, risk factors unrelated to sexual orientation (for example, SES, family mental health problems, family functioning, other stressful events) can sometimes play a more important role in emotional distress and high-risk behaviors in sexual minority youths (Elze, 2002). Social workers need to take into account a broad range of factors when assessing GLB adolescents and their families. 2. Severe rejection and victimization of sexualminority children by parents can lead to serious mental health symptoms, including trauma symptoms and posttraumatic stress disorder (D’Augelli, Grossman, & Starks, 2006), and it can result in high-risk behaviors. In developing interventions with sexual-minority youths, social workers need to be cognizant of


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possible long-term consequences of harmful family relationships. 3. A significant proportion of sexual-minority youths who enter the child welfare or juvenile justice system do so as a result of family conflict related to their sexual orientation (Wilber et al., 2006). Social workers must be knowledgeable about the legal system to serve as advocates for GLB children and to ensure that decisions are made in their best interest.

Clearly, the importance of understanding the role of family acceptance of sexual identity in the quality of parent–child attachment of GLB adolescents cannot be overstated. Our study indicates that, for sexual-minority youths, parental support is a critical aspect in their ability to develop a strong relationship with parents, which in turn helps form the basis for their successful and healthy development. Ultimately, the challenge remains: how to engage parents who are not accepting of their children’s sexual identity in the context of educational, religious, and other social institutional forces that for the most part do not adequately prepare families to do so. References Coleman, E. (1982). Developmental stages of the comingout process. American Behavioral Scientist, 25, 469–482. Crandal, R. (1973). The measurement of self-esteem and related constructs. In J. P. Robinson & P. R. Shaver (Eds.), Measures of social psychological attitudes (Rev. ed., pp. 80–82). Ann Arbor, MI: ISR. D’Augelli, A. R., Grossman, A. H., & Starks, M. T. (2006). Childhood gender atypicality, victimization, and PTSD among lesbian, gay, and bisexual youth. Journal of Interpersonal Violence, 21, 1462–1482. D’Augelli, A. R., & Patterson, C. (2001). Lesbian, gay, and bisexual identities and youth: Psychological perspectives. New York: Oxford University Press. Díaz, R. M., Ayala, G., Bein, E., Henne, J., & Marin, B.V. (2001). The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: Findings from 3 U.S. cities. American Journal of Public Health, 91, 927–932. Elizur,Y., & Ziv, M. (2001). Family support and acceptance, gay male identity formation, and psychological adjustment: A path model. Family Process, 40(2), 125–144. Elze, D. E. (2002). Risk factors for internalizing and externalizing problems among gay, lesbian, and bisexual adolescents. Social Work Research, 26, 89–100. Faulkner, A. H., & Cranston, K. (1998). Correlates of same-sex sexual behavior in a random sample of Massachusetts high school students. American Journal of Public Health, 88, 262–266. Gay and Lesbian Medical Association. (2000). Healthy People 2010: Companion document for lesbian, gay, bisexual, and transgender (LGBT) health. Retrieved from http://www.lgbthealth.net/side_hp2010.shtml

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Yolanda C. Padilla, PhD, MSSW, LMSW-AP, is professor, Social Work and Women’s Studies, University of Texas at Austin, 1 University Station D3500, Austin, TX 78712; e-mail: [email protected]. Catherine Crisp, PhD, MSW, is assistant professor and BSW coordinator, School of Social Work, University of Arkansas at Little Rock. Donna Lynn Rew, EdD, MSN, is professor, School of Nursing, University of Texas at Austin. The project described was supported by grant number P30NR005051 from the National Institute of Nursing Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health. Original manuscript received July 13, 2007 Final revision received May 29, 2009 Accepted January 11, 2010


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