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Sexual and gender minority (SGM, or LGBTQ) adolescents are at risk for harassment and discrimination, depression and anxiety, risky behaviors such as alcohol and drug use, and rejection by parents or family members. Notably, lesbian, gay, and bisexual youth attempt suicide at four times the rate of non-SGM youth. For transgender youth, the suicide attempt rate is even higher. Pediatricians can play a critical role in providing a safe space for adolescents to discuss their sexual orientation or gender identity, and in so doing, can provide appropriate counseling, prevention, and referrals for SGM adolescents. In prior studies, both SGM and non-SGM youth have indicated that they want their healthcare providers to be open to such discussions. However, little is known about the extent to which pediatricians routinely bring up sexual orientation and gender identity issues during visits with their adolescent patients.
Methods
We surveyed all practicing general pediatricians in the ambulatory sites of a Midwest health system in April 2017. Eligible pediatricians (N=50) were emailed a link to a 15-minute online survey. Survey topics included demographics as well as topics addressed in routine practice with adolescents. Respondents received a $10 gift card as a thank you for their time. 21 providers responded (42% response rate). Descriptive statistics were conducted (means/standard deviations and frequencies).
Results
Respondents were 81% female and 67% had been in practice for 20 years or more. Half of respondents were white, about 1/3 were Asian, and 14% were African American. The majority (67%) identified their religion as Christian. In terms of discussions with adolescent patients at wellness or preventive visits, 100% of respondents indicated that they always discussed nutrition, 86% always discussed tobacco use, 80% always discussed mental health, 100% always discussed sexual activity, and 91% always discussed safer sex.
However, only 5% always discuss gender identity and only 29% always discuss sexual orientation with adolescent patients at wellness or preventive visits. Furthermore, none of the providers indicated that their intake or assessment forms had inclusive gender identity options, and only 10% included sexual orientation questions on their intake or assessment forms. While 67% asked about sexual behavior on intake forms, only about half of these asked in an inclusive way (asking about sex with male partners, female partners, or both).
Conclusions and Implications
While pediatricians reported routinely discussing topics such as sexual behavior and mental health with their adolescent patients, most did not explicitly bring up sexual orientation or gender identity – nor did they provide inclusive intake forms for adolescents to disclose SGM status. The findings of this pilot study point to a missed opportunity for pediatricians to explore an important part of young people’s identities. Social workers in pediatric or primary care settings can advocate for inclusive forms and assessment processes as well as other avenues for incorporating opportunities for discussing diverse sexual orientations and gender identities with adolescent patients.