In 2017, researchers, advocates, and community members formed the Strengthening Colors of Pride team and set out to understand the lived experiences of lesbian, gay, bisexual, transgender, queer, and other gender and sexual minority (LGBTQ+) people in the San Antonio Metro Area. Project leaders, with the help of a research team and community advisory board members, developed the largest survey of LGBTQ+ identified individuals ever conducted in South Texas. The survey provides important insight about the demographics of LGBTQ+ people in the area and their experiences with housing and homelessness, healthcare, employment, familial rejection and support, financial stability, resiliency, and much more.
The one thing that was clear is that the LGBTQ+ community is extremely resilient and community members often have strong social networks. Around 80% of respondents agree that they have a special friend who cares about their feelings and they can share their joys and sorrows, being around when they are in need, and be a real source of comfort to them.
However, this resilience is often needed to recover from high rates of family trauma that impact the health of LGBTQ+ people in San Antonio. Adverse childhood experiences (ACEs) are potentially traumatic events that children experience which can have negative, lasting effects on health and well-being. ACEs are measured through a set of ten questions about physical abuse, emotional abuse, sexual abuse, neglect, emotional neglect, divorce, parental mental health issues, parental substance use, incarceration of family members, and domestic violence. An ACEs score is a number from 0 to 10 that represents how many of these questions respondents answered positively. An ACEs score of 4 or more items is associated with negative health outcomes like mental or physical health issues and tendencies towards substance abuse.
We found that LGBTQ+ residents of the San Antonio metro area have three times the national average of ACEs scores than the general population, which may significantly impact adult physical and mental health. 55% of the LGBTQ+ respondents have an ACEs score of 4 or more, and 30% have a score of 6 or more.
Readers should not conclude that ACEs create gender or sexual identity differences. Instead, LGBTQ+ children may be targeted for child abuse and neglect based on family reactions to sexuality or gender non-conformity. There are large differences between the average ACEs scores of respondents who have not come out to their families (3.14), those who came out as adults over the age of 21 years old (3.7), and respondents who came out as teenagers or children (5.8).
Gender non-conforming and racial minorities in the LGBTQ+ community have the highest ACEs scores, which impact adult health. Transgender, non-binary, and gender non-conforming respondents reported some of the highest ACEs scores (5.7 vs 3.6 for cisgender people), suggesting that some of these adverse childhood experience like neglect may be a family response to gender non-conformity. Average ACEs scores above 5 were reported by lesbian women, American Indian, Asian/South Asian, pansexual, asexual, and queer individuals.
In addition to these findings, we identified a new preliminary set of ACEs that are specific to the childhoods of gender and sexual minorities, which we call Queer Adverse Childhood Experiences (Q-ACEs). These experiences included bullying at school, punishment for gender non-conformity, and institutionalization in foster care, juvenile detention or a mental hospital. We are still investigating the impact these childhood experiences have on adult health, but other scholars have found that experiences like bullying and institutionalization contribute to poor mental and physical health for LGBTQ+ adults and youth.
How do we address the pernicious impact of childhood trauma on LGBTQ+ health? We argue that more work needs to be done to intervene when LGBTQ+ adults are children. We propose more training of social workers and employees of youth-serving institutions about the detrimental impact of ACEs and Q-ACEs on the health and well-being of LGBTQ+ youth. This training could include learning to mediate parental punishment of gender-nonconformity and general neglect of LGBTQ+ youth. School district training could include information about the impact of ACEs and Q-ACEs on LGBTQ+ youth. We also support the development of health public service announcements and programming for family members about the impact of family support on the health of LGBTQ+ youth.
Amy L. Stone is an IRL fellow from Cohort 2017-2020 of Interdisciplinary Research Leaders (IRL). To learn more about Amy and Team San Antonio, read about their research project: Building a Stronger Community: Resilience Among LGBTQ+ People in South Texas
The views represented in this post are those of the authors, not of Interdisciplinary Research Leaders or the Robert Wood Johnson Foundation.