Literature Reviews Related to the Likely "At Risk" status of Homosexually Oriented Individuals

Bagley C, and Tremblay P (2000). Elevated rates of suicidal behavior in gay, lesbian and bisexual youth. Crisis, 21(3): 111-17. PubMed Abstract. Online Draft.

Erwin K (1993). Interpreting the evidence: competing paradigms and the emergence of lesbian and gay suicide as a "social fact". International Journal of Health Services, 23(3): 437-53. PubMed Abstract.

Julien D, Chartrand (2005). Recension des études utilisant un échantillon probabiliste sur la santé des personnes gaies, lesbiennes et bisexuelles. Canadian Psychology/Psychologie canadienne, 46(4): 235-250. APA Abstract.

Kulkin HS, Chauvin EA, Percle GA (2000). Suicide among gay and lesbian adolescents and young adults: a review of the literature. Journal of Homosexuality, 40(1): 1-29. (Review) PubMed Abstract.

Lebson M (2002). Suicide among homosexual youth. Journal of Homosexuality, 42(4): 107-17. PubMed Abstract.

McAndrew S, Warne T (2004). Ignoring the evidence dictating the practice: sexual orientation, suicidality and the dichotomy of the mental health nurse. Journal of Psychiatric and Mental Health Nursing, 11(4): 428-34. PubMed Abstract.

McDaniel JS, Purcell DW, D'Augelli AR (2001). The relationship between sexual orientation and risk for suicide: research findings and future directions for research and prevention. Suicide and Life-Threatening Behavior, 31(Suppl.): 84-105. (Review)  PubMed Abstract.

Meyer, IH (2003). Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence. Psychological Bulletin, 129(5): 674–697. Summary.

Morrison LL, L'Heureux J (2001). Suicide and gay / lesbian / bisexual youth: implications for clinicians. Journal of Adolescence, 24(1): 39-49. PubMed Abstract. Full Test: PDF Download.

Remafedi G (1999). Sexual orientation and youth suicide. JAMA, 282(13): 1291-2. Full Text (Must Scroll): PDF Download.

Russell ST (2003). Sexual minority youth and suicide risk. American Behavioral Scientist,  46, 1241-1257. Full Text: PDF Download.

Tremblay P, and Ramsay R (2000). Orientations homosexuelles ou bisexuelles chez les jeunes présentant des problème suicidaires: recherche, problématique et propositions. Le Vis-À-Vie, 10(2): 5-8. Internet English version of the paper: Full Text.

CS/RESORS Consulting Ltd (2001). Gap Analysis of Research Literature on Issues Related to Street-Involved Youth. Prepared by CS/RESORS Consulting Ltd. for Research and Statistics Division. Ottawa: Department of Justice Canada. Internet: http://justice.gc.ca/en/ps/rs/rep/2002/rr2002-8.pdf. 

Public Health Agency of Canada (2006a). Street Youth in Canada: Findings from Enhanced Surveillance of Canadian Street Youth, 1999-2003. Ottawa: Ministry of Health.  Internet: http://www.publichealth.gc.ca/sti. - http://www.phac-aspc.gc.ca/std-mts/reports_06/youth_e.html. - http://www.phac-aspc.gc.ca/std-mts/reports_06/pdf/street_youth_e.pdf.

Background Information (http://www.phac-aspc.gc.ca/sti-its-surv-epi/qf-fr/pdf/qa-qr_e.pdf): "A pilot project was launched in 1998 to investigate the feasibility of studying the street youth population. Data collection was conducted in large urban centres across Canada, starting in 1999 and continuing in 2001, 2003 and 2005–06. Three sites, Vancouver, Ottawa and Halifax, were involved in the initial phase of the project. The surveillance system has now been expanded to seven urban centres. Current and past participating cities are Vancouver, Edmonton, Calgary, Saskatoon, Winnipeg, Toronto, Ottawa and Halifax."

Comment: Nothing is essentially mentioned in the document about homosexuality, except for the following: "In 2001 males were significantly more likely to report not using condoms with their male partners (homosexual encounters) than with their female partners (heterosexual encounters)", thus suggesting that some information about the homosexuality of the participants was solicited. Information on the 'race'/ethnicity of participants is given (reproduced below) but study results are only reported on the basis of gender, suggesting that differences based on ethnicity, age or sexual orientation (bisexual/homosexual identity/behavior) were deemed irrelevant. Only two results based on age are reported: "Older youth (20–24 years) were significantly more likely to report being assigned a social worker for access to shelter and welfare than younger youth (15–19 years)... Older youth were found to be more likely than younger youth to report having had a probation/parole officer or having been in jail. This may be a consequence of exposure, as older youth would have been on the streets longer than younger youth."

Street Youth in Canada: Ethnicity Results of Three Canada-Wide Surveys

Data Source: Public Health Agency of Canada (2006a): Table 4

Public Health Agency of Canada (2006b). Sexually Transmitted Infections in Canadian Street Youth: Findings from Enhanced Surveillance of Canadian Street Youth, 1999-2003. Ottawa: Ministry of Health. Internet: http://dsp-psd.pwgsc.gc.ca/Collection/HP5-14-2006E.pdf. - http://www.phac-aspc.gc.ca/std-mts/reports_06/sti-youth_e.html. - http://www.phac-aspc.gc.ca/std-mts/reports_06/pdf/sti-street_youth_e.pdf.

Comment: Homosexuality is only mentioned in one section (reproduced below). It is also noted that about 33% of study participants were aboriginal but study results are generally only given on the basis of gender. Information on the 'race'/ethnicity of participants is given - as done in Public Health Agency of Canada (2006a) -but study results are only given on the basis of gender, suggesting that differences based on ethnicity, age or sexual orientation were generally deemed to be irrelevant. Below, the following is stated: "Overall, 19.9% of street youth reported having engaged in GLB* [gay, lesbian, and bisexual] activities in their lifetime." It should be noted, however, that the expression "GLB" is generally used to represent identities, not same-sex activities. Furthermore, to speak about "GLB activities" as meaning same-sex sexual activities is about as 'wise' (or unwise) as speaking of "Roman Catholic identity," with the assumption being that all who identify as Roman Catholic are attending church regularly (meaning practicing their religion), when the majority likely do not. One can also wonder about authors who restrict the concept of "GLB activities" to only meaning "sexual activities," when there is much more to identifying as GLB than only what one does sexually.

Source: Public Health Agency of Canada (2006b) ****MSM: Men Who Have Sex With Men *GLB: Gay, Lesbian, Bisexual

Canadian Public Health Association Conference (2004): 13. "Substance Use in Canadian Street Youth". By: Jennifer Phelan, Rhonda Kropp, Cara Bowman, Susanne Shields, Tom Wong, CAID, CIDPC, Health Canada, Ottawa (Internet: http://www.cpha.ca/english/conf/cpha04/pdf/Posters_Tuesday.pdf). "It is hypothesized that a large percentage of Canadian street youth (SY) use substances as a coping strategy for life on the street. In 2001, Health Canada in partnership with provincial and local community health organisations, undertook the third cycle of the Enhanced Surveillance of Canadian Street Youth. This national cross-sectional surveillance initiative examines risk behaviours and STD rates in street youth SY (N=1427). Overall, 82.5% of SY reported smoking everyday and 93.9% reported ever using non-injection drugs, with no significant difference by gender or age. Binge drinking, reported by 42.0% of SY, was more common among males (46.1% vs. 36.5%, p=0.0010). No difference was found by age. Injection drug use (IDU), ever in lifetime, was reported by 18.5% of SY. While IDU did not vary by gender, SY aged 20-24 were more likely to report IDU than those aged 15-19 (29.0% vs. 13.5%, p<0.0001). SY who reported parent IDU were more likely to report IDU themselves than SY who reported no parent IDU (26.3% vs. 16.5%, p<0.0001). This data indicates a high level of substance use in SY. Information gathered from surveillance is essential in the development of effective programs, policies and services to address substance use in SY.

Comment: Some "at risk" variables in the "Enhanced Surveillance of Canadian Street Youth" do seem to vary on the basis of gender and age. They would likely also vary on the basis of ethnicity, and especially Aboriginal ethnicity. The same would likely also apply on the basis of sexual orientation as suggested from the American eight-city study of street youth by van Leeuwen et al. (2006): See Table of Results below.

Gratix J, LaBoucane-Benson P (2005). Tracking Our Youth: A Comprehensive Review of the Literature on Research Conducted with Homeless Youth in Edmonton. Edmonton: Joint Planning Committee on Housing.Project carried out by BearPaw Research. A Department of: Native Counselling Services of Alberta. Internet: http://www.moresafehomes.net/images/research/Homeless%20Youth%20Lit%20Review%20(OLV).pdf.

'Street Youth In Canada, Phase 2, 2001 (Edmonton, n = 271): Heterosexual Identity (100%), Same-Sex Sex (9%).
Street Youth In Canada, Phase 3, 2003 (Edmonton, n = 352): Heterosexual Identity (99%), Same-Sex Sex (15%).'

Comment: The Edmonton estimate for Same-Sex Sex (Average = 12%: 9% + 15%) is well below the national average reported in Public Health Agency of Canada (2006b): 19.9%, lifetime. However, the 9% and 15% could be associated with "more current" (as opposed to "lifetime") homo-sex activities, and even specific current sexual behaviors as suggested below when noting that males engaging in "oral sex between males" are more at risk HSV-2 (Canadian Public Health Association Conference (2004a). The fact that 100% (2001) and 99% (2002) of Edmonton participants reported heterosexual identity is also at odds with many American and Canadian studies that have generally reported that at least about 10% of street youth identify as gay/lesbian or bisexual, with an American 8-City study reporting that 22.4% of Street Youth (Ages = 14-24 Years) identified as gay, lesbian, or bisexual (GLB). One percent (1%) identified as transgender (van Leeuwen et al., 2006).

Canadian Public Health Association Conference (2004a): 19. "Herpes Simplex Virus Type 2 Infection Among Canadian Street Youth: Demographic and Behavioural Correlates." By: Rhonda Kropp, Cara Bowman, Jennifer Phelan, Suzanne Shields, Tom Wong, CAID, CIDPC, Health Canada, Ottawa. (Internet: http://www.cpha.ca/english/conf/cpha04/pdf/Posters_Tuesday.pdf). "Canadian street youth (SY) are at risk for herpes simplex virus type 2 (HSV-2) infection due to involvement in high-risk behaviours. In 2001, the Enhanced Surveillance of Canadian Street Youth recruited SY between the ages of 15-24 years (n=1481) from seven urban centres across Canada. Interviews covering demographics and risk behaviour were administered and blood was drawn from consenting participants (n=1037) for serological testing (EIA). Of those tested, 14.2% had antibodies to HSV-2; however, only 1.7% reported a history of herpes infection. Factors associated with HSV-2 seropositivity included female gender (OR=3.6, 95% CI, 2.4-5.1), First Nations ethnicity (OR=3.0, 95% CI, 2.1-4.2), high school attendance (OR=.56, 95% CI, .39-.82), injection drug use (OR=3.0, 95% CI, 2.0-4.6), sex trade involvement (OR=3.5, 95% CI, 2.4-5.1), oral sex between males (OR=3.2, 95% CI, 1.2-8.3), history of STD (OR=4.3, 95% CI, 3.0-6.2), frequency of sex (p=.01), and lifetime number sex partners (p<.0001). Condom use overall, and anal, vaginal, and oral sex (except male to male) in prior 3 months were not associated with HSV-2 seropositivity. Efforts to reduce HSV-2 infection and promote HSV-2 screening among SY are needed. Knowledge of risk factors for HSV-2 infection among this marginalized population will help target such efforts."

Comment: The "oral sex between males" reported indicates that homosexuality may be important in the at-risk lives of street youth, at least for males. This information also indicates that homosexuality related information solicited in the "Enhanced Surveillance of Canadian Street Youth" was, at least in some case, very specific. Information has not yet been located that reports the sexual minority results for the participants in "Enhanced Surveillance of Canadian Street Youth" study(ies).

Canadian Public Health Association Conference (2004b): 13. "Substance Use in Canadian Street Youth. By: Jennifer Phelan, Rhonda Kropp, Cara Bowman, Susanne Shields, Tom Wong, CAID, CIDPC, Health Canada, Ottawa (Internet: http://www.cpha.ca/english/conf/cpha04/pdf/Posters_Tuesday.pdf). "It is hypothesized that a large percentage of Canadian street youth (SY) use substances as a coping strategy for life on the street. In 2001, Health Canada in partnership with provincial and local community health organisations, undertook the third cycle of the Enhanced Surveillance of Canadian Street Youth. This national cross-sectional surveillance initiative examines risk behaviours and STD rates in street youth SY (N=1427). Overall, 82.5% of SY reported smoking everyday and 93.9% reported ever using non-injection drugs, with no significant difference by gender or age. Binge drinking, reported by 42.0% of SY, was more common among males (46.1% vs. 36.5%, p=0.0010). No difference was found by age. Injection drug use (IDU), ever in lifetime, was reported by 18.5% of SY. While IDU did not vary by gender, SY aged 20-24 were more likely to report IDU than those aged 15-19 (29.0% vs. 13.5%, p<0.0001). SY who reported parent IDU were more likely to report IDU themselves than SY who reported no parent IDU (26.3% vs. 16.5%, p<0.0001). This data indicates a high level of substance use in SY. Information gathered from surveillance is essential in the development of effective programs, policies and services to address substance use in SY."

Cooper M, Guyn Cooper Research Associates (2006). Vulnerable Youth in Calgary: Environmental Scan. Calgary, AB: United Way of Calgary and Area. Internet: http://www.calgaryunitedway.org/pdfs/Reports/CalgaryVulnerableYouthScanJuly2006.pdf. Homosexuality is only mentioned in the following context: "Older research shows that the majority of girls who resort to “survival sex” do not consider themselves to be engaging in prostitution. Most boys who engage in homosexual sex for money or a bed do define their activities as prostitution but do not consider themselves to be homosexual; it is simply a way to survive. 180" Basically, homosexuality issues are ignored in the report.

McCreary Centre (2002). Between the Cracks: Homeless Youth in Vancouver. Vancouver, B. C.: McCreary Centre. Internet: http://www.ihpr.ubc.ca/media/McCreary2002.pdf.

325 Vancouver Street Youth: To Age of 24 Years Sexual Orientation & Risk Attributes
Categories	Males (n = 204)* Attempted Suicide (In Past Year): Under Age 19: 15% 19-24 Year Old: 20%					Females (n = 119) * Attempted Suicide (In Past Year): Under Age 19: 38% 19-24 Year Old: 26%
% Non- Aboriginal	68% Attempted Suicide:  ?					58% Attempted Suicide: 25%
% Aboriginal	32% Attempted Suicide:  ?					42% Attempted Suicide: 42%
Same-Sex Sex, Ever	Age < 19 Years: 27% Age = 19-24 years: 31%					Age < 19 Years: 52% Age = 19-24 years: 57%
Sexual Orientation	100% Hetero	Mostly Hetero	Bi- sexual	Homo	Un- sure	100% Hetero	Mostly Hetero	Bi- sexual	Homo	Un- sure
Percentages	69%	12%	8%	4%	8%	38%	20%	32%	1%	10%
Percentages	69%	31%				38%	62%
Attempted Suicide	13%	21%				?	?
Sexually Abused	21%	52%				?	?
Physically Abused	57%	89%				?	?
Traded Sex	20%	69%				?	?
Traded Sex	Age < 19 Years: 35% Age = 19-24 years: 30%					Age < 19 Years: 24% Age = 19-24 years: 53%
Traded Sex Native	?					49%
Traded Sex Non-Native	?					32%
Traded Sex	Attempted Suicide: 28%
Did Not Trade Sex	Attempted Suicide: 19%
Data Source: McCreary Centre (2002) * Note: % Males and % Females is not given for whole sample. 145 Youth < 19 Years Old [57% male (n = 83), 42% Female (n = 61)], remainder (180) = 19-24 years old [67% Male (n = 121), 32% Female (n = 58)]. Counts are estimated from given percentages. About 1% are transgender.

van Leeuwen JM, Boyle S, Salomonsen-Sautel S, Baker DN, Garcia JT, Hoffman A, Hopfer CJ (2006). Lesbian, gay, and bisexual homeless youth: an eight-city public health perspective. Child Welfare, 85(2): 151-70. PubMed Abstract.

American Street Youth: 14-24 Years-Old A Same-Day Eight-City Sample
Categories	All N = 670 (100%)	GLB n = 150 (22.4%)	Non-GLB n = 520 77.6%	Odds Ratio (95%CI)	p
Social Services In Custody, Ever	227 / 666 34.1%	64 / 147 43.5%	163 / 519 31.6%	1.7 (1.1, 2.4)	0.008
Asked to Exchange Sex	199 / 656 30.3%	65 / 147 44.2%	134 / 509 26.3%	2,2 (1.5, 3.2)	0.0005
Trade Sex, Ever	67 / 656 10.2%	27 / 147 18.8%	40 / 509 7.9%	2.7 (1.6, 4.6)	0.0005
5 Alcohol Drinks, At Once, Past 2 Weeks	198 / 661 30.0%	62 / 147 42.2%	136 / 514 26.5%	2.0 (1.4, 3.0)	0.0005
Intravenous Drug Use (IDU), Ever	98 / 659 14.9%	34 / 147 23.1%	64 / 512 12.5%	2.1 (1.3, 3.4)	0.002
Family Member, Severe Drug / Alcohol Problem	432 / 661 65.4%	108 / 145 74.5%	324 / 516 62.9%	1.7 1.1, 2.6)	0.011
Ever In Drug / Alcohol Treatment Program	193 / 651 29.6%	56 / 138 37.8%	137 / 513 26.7%	1.7 (1.1, 2.5)	0.010
Attempted Suicide, Ever	241 / 662 36.2%	93 / 149 62.4%	148 / 513 28.8%	4.1 (2.8, 6.0)	0.0005
Data Source: van Leeuwen et al. (2006) Odd Ratios Calculated by Author of Web Page Note: 7 / 677 Transgender Individuals Were in the Sample (1%), but They Were Removed From the Analysis.

In British Columbia, the following formal report on the 2003 Adolescent Health Survey (AHS) only reported on the "At Risk" status of BC adolescents on the basis of sex and information was not reported on their sexual orientation.

McCreary Centre Society (2004). Healthy Youth Development: Highlights from the 2003 Adolescent Health Survey III. Vancouver, BC. The McCreary Centre Society. Internet: http://www.mcs.bc.ca/retrieve.cfm?Document=AHS-3_provincial.pdf. Download Page: http://www.mcs.bc.ca/r_ahs.htm.

Sexual orientation results for BC students in the 2003 AHS were located in this document:

Gilbert M (2004). The Health of Lesbian, Gay, Bisexual, Transgendered, Two-spirited and Questioning Youth in British Columbia and the Influence of the School Environment: A resource document for Medical Health Officers. Internet: http://www.galebc.org/The%20health%20of%20GLBT.pdf.

In 2005, Aboriginal result from the 2003 AHS - including sexual orientation results - were published  in this report:

 van der Woerd, KA, Dixon BL, McDiarmid T, Chittenden M, Murphy A, The McCreary Centre Society (2005). Raven's Children II: Aboriginal Youth Health in BC. Vancouver, BC: The McCreary Centre Society. Internet:  http://www.mcs.bc.ca/retrieve.cfm?Document=Ravens_children_2-web.pdf.

In 2006, some "Attempted Suicide" results - related to the sexual orientation of students - were presented by Elizabeth Saewyc at a Conference. As the result of a related controversy, the results were reported in the media. For example, in this news item:

Gorham B (2006). B.C. researcher says American group distorting her research on teen suicide. The Canadian Press. Internet: http://www.cbc.ca/cp/health/060619/x061932.html.

Some information from the above documents are in the following table:

The British Columbia 2003 Adolescent Health Survey Sexual Orientation & Attempting Suicide Results
Categories	All Students - N = + 30,500 Grade 7 - 12			Aboriginal - N = 2,478 Grade 7 to 12
	Males	Females	All	Males	Females	All
All Students	[4%]	[10%]	{?}	[6%]	[16%]
100% Heterosexual	[3.3%] *	[8.2%]	85.4%	[?]	[?]	80%
Not 100% Heterosexual			14.6%			20%
Mostly Heterosexual			6.2%			7%
Bisexual	[12.8%]	[30.4%]	2.0%	[?]	[?]	5%
Mostly Homosexual			0.2%
Homosexual	[8.8%] **	[38.0%]	0.3%	[?]	[?]
Unsure			5.9%			9%
Data Sources: van der Woerd (2005): Aboriginal Data Gorham (2006): "Attempted Suicide" In The Past Year - 2003 AHS ** Note: Definition of "Homosexual" Not Given. Could be Homosexual + Mostly Homosexual. * "Heterosexual" Could Include "Mostly Heterosexual". Gilbert (2004): Sexual Orientation Percentages - 2003 AHS "Attempted Suicide" Incidence (Past Year) Given in Square Brackets: [4%]

Study results were also given by van der Woerd et al. (2005) for Aboriginal Street Youth (n = 178) and Aboriginal students in schools...

Source: van der Woerd et al. (2005) Aboriginal Students = 2,478

It was noted by van der Woerd et al. (2005) that more "Aboriginal males (85%) were 100% heterosexual than females (76%)," meaning that about 15% of Aboriginal adolescent males in schools (15% x 2,478 = 372) and 24% of Aboriginal adolescent females (24% x 2,478 = 596) were not classifying themselves as 100% heterosexual. There were about 5% of males and females classifying themselves to be being bisexual to homosexual (5% x 2,478 = 124), meaning that some information could have been reported on related associations, such as "Attempting Suicide," for example. But results on the basis of "Sexual Orientation" were not reported, noting here that about twice as many Aboriginal Students (5%) identified as bisexual to homosexual, compared to all other students (2.5%) that also includes the Aboriginal counts. If the Aboriginal counts are removed, only about 2.2% of Non-Aboriginal students reported being bisexual to homosexual. An approximate 2x2 calculation of the Odds Ratio for Aboriginal Students more likely being bisexual to homosexual is: 2.2 (95%CI: 1.8, 2.7), the assumption being that all students replied to the sexual orientation question.

The "Aboriginal" and the "Sexual Orientation" representation in the 2001 BC Street Youth study (McCreary Centre Society, 2001) are given below but associations with "At Risk" attributes were not reported on the basis of either variable. It seems like it was assumed that "Being Aboriginal," having had a history of "Homosexual Sex ," or not identifying as "Heterosexual" was irrelevant with respect to issues such as "Attempting Suicide." However, other research results suggest otherwise. It is possible that there were no differences on the basis of the two above specified variables, but this is not mentioned in the McCreary Centre Society (2001) study.

McCreary Centre Society (2001). No Place to Call Home: A Profile of Street Youth in British Columbia. Vancouver, BC. The McCreary Centre Society. http://www.ihpr.ubc.ca/media/McCreary2001.pdf.

Street Youth In British Columbia: 12-19 Years Old Mean Age = 16 Years
Categories	Van- couver	Vic- toria	Abbots- ford/ Mission	South Frazer	Sun- shine Coast	Prince Rupert	Males	Fe- males	All
Sample Size: N's	145	94	113	61	50	60			100% 523
Aboriginal	54 37%	15 16%	20 18%	8 13%	10 19%	46 76%			29% 153
Females	61 42%	41 44%	54 48%	25 41%	26 52%	32 54%		239	239 45.7%
Males	83 57%	52 55%	57 50%	36 59%	24 48%	28 46%	280		280 53.5%
Transgender	2 1%	1 1%	2 2%	0%	0%	0%	5		5 0.96%
Males	57%	55%	51%
Sexual Orientation
Males: Same-Sex Sex, Ever	27%	21%	15%				19%	N/A	* 27%
Females: Same-Sex Sex, Ever	52%	41%	30%				N/A	37%
100% Heterosexual	50%	63%	50%	78%	76%	76%	196 70%	79 33%
Mostly Heterosexual	18%	15%	10%	2%	7%	4%
Bisexual	20%	11%	13%	7%	7%	0%			16.5%
100% Homosexual	3%	1%	16%	2%	0%	0%
Unsure	10%	10%	11%	11%	10%	20%
Not 100% Heterosexual	50%	37%	50%	22%	24%	24%	84 30%	160 67%
Data Source: McCreary Centre Society (2001) Note: Only the combined male & female counts in each specified BC location are given. All other counts in the Table are estimated from given percentages. * An Estimate.