“Questionnaire development is both an art and a science.” The CDC won’t know until October how many states and cities decided to include the pilot question in their surveys, but if enough do, and the question graduates from the “pilot” phase, the US will be able to count, for the first time, of how many trans kids are in its high schools. Getting the wording right took “several years,” Kann says. In 2017, for the first time, the CDC sent out its annual survey with a new, pilot question on gender identity and expression. The next group to be counted will be transgender teens. You’d think that having legal equality you’d have improvement in health, but we don’t see that,” Cahill says. “We’ve had all this pro-gay advancement in Massachusetts we had marriage equality in 2003.
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That’s some improvement, says Sean Cahill, the director of health policy research at the Fenway Institute, a research and LGBT health advocacy center in Boston, but it’s not nearly enough. In 2015, 13% of LGBT kids said they didn’t go to school for a day or more because they felt unsafe, compared to 25% of LGBT kids who said the same in 1995. The data also tell us about how all these LGBT teens in Massachusetts are doing: in 2015, 25% of LGBT youth reported attempting suicide (versus 5% of straight kids), compared to 35% in 1995 (versus 9% of straight kids), when sexual orientation questions first appeared. By 2015, the most recent year of data, that had grown to 18% of girls and almost 9% of boys. Thanks to Massachusetts’ efforts, we know the state’s population of teens identifying as LGBT is growing: In the mid-1990s, about 6% of girls and 7% of boys in Massachusetts high schools reported being sexual minorities. In 1995, Massachusetts became the first state to ask high schoolers in its state-level health survey. There was some progress at the state level in the 1990s. The American Teenage Survey, for example, which was meant to be the first major longitudinal study on US adolescents, was scuttled completely in 1993 after Congress got wind that the NIH was funding research on teen sex. In the 1990s, gay characters began to appear in mainstream culture, but at the same time Ryan watched the rise of religious conservatism in the US sideline efforts to include questions about sexuality on national surveys. “Part of the reason we had no good science on sexuality since Kinsey is that when they tried to do follow up studies they were blocked.” The field, as a whole, was stunted, with no major research investment since Alfred Kinsey’s famous “Kinsey Reports” in the 1940s. Friends of mine were affected,” Ryan says. “There was a time when program officers at the NIH were telling proposers not to put words like ‘gay’ in their proposals because they would not get funded. When Ryan began researching the US LGBT community in the early 1980s, at the height of the AIDS crisis, homosexuality was so taboo that scientists were resorting to euphemisms in their work.
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The American Psychiatric Association voted to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders in 1973, but the effects of years of pathologizing being gay rippled on for decades.
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People were dying alone, because their partners would not be allowed to be with them.” Health providers would provide painful care-they would inflict pain on a gay patient, if they knew they were gay. The level of antipathy, of anger, of prejudice, was higher. “There were very few young people who were out. In the 1970s, “gay people were considered to be mentally ill, so no one was thinking about physical health,” says Caitlyn Ryan, a clinical social worker who has been working on LGBT health issues for nearly 40 years in California.
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For decades, while homosexuality was on the books as a mental disorder, the US turned a blind eye to the actual mental and physical health needs of LGBT people, while continuing to pathologize them-homophobia was basically enshrined in the medical literature. The struggle to get LGBT health taken seriously as a distinct category of risk goes back several generations. The numbers made very clear what activists have been saying for decades: The public health of queer youth must be documented, recognized, and protected.