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Gay / Bisexual Male Youth Suicide Problems
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To: The Table of Content - The Changing Social Construction of Western Male Homosexuality and Worsening Youth Suicide Problems

By Pierre J. Tremblay & Richard Ramsay
Faculty of Social Work, University of Calgary.

An updated interim paper prepared in support of a Poster Presentaton with the same name at the 2004 CASP (Canadian Association For Suicide Prevention) Conference held in Edmonton, Alberta. Original Paper.

Homosexually Oriented Male Youth: Ongoing Suicide Problems?


Bell and Weinberg (1978) reported that out of 105 homosexually oriented males who had attempted suicide at least once, 62 percent said "homosexuality" was a factor in their first suicide attempt. Hammelman replicated this percentage (1993: Note 9). Of the first time attempters, 43 percent were related to problems in a homosexual relationship. The first time attempts were distributed over a range of ages with half (52%) occurring by the age of 20 years, 27 percent by the age of 17 years and 25 percent between 18 and 20 years. Of those over 20 years, 27 percent of the first attempts were between 21 and 25 years, and 22 percent after the age of 25 years.

In addition, 39 percent of the male attempters (7% of the sample) were repeat attempters, thus indicating consistency over the last 50 years given that recent studies show 44.2 percent of homosexually oriented male youth who attempt suicide (13.3 percent of the sample population) to be repeat attempters (Table 3). This doubling of the male incidence for repeated suicide attempts in the sampled populations suggest ongoing and increasing suicide problems over time. My experiences in gay communities suggest that male suicidality remains as a fact of life for some homosexually oriented youth after they have made contact with gay communities.

The question of ongoing suicide problems in gay communities has received little attention since Bell and Weinberg found that homosexual relationship problems were a factor in about 27 percent of first time suicide attempts for white males, and 49 percent of these attempts occurred after the age of 20 years.

A further analysis of the Bell and Weinberg data by Tremblay and Ramsay (2002) provided an amendment to these results (Table 7). The incidence distribution for first time attempts in four age groups indicates that their proportion (51.4%) by the age of 20 years is an illusion. This is because of the age ranges in the sample and the resulting non contribution of the youngest males to suicide attempts occurring in later years, meaning after their 1969 interview for the Bell and Weinberg study. The data indicates that, between the 1930s and the 1960s, about 70 to 80 percent of first time attempts by White predominantly homosexual males were occurring after the age of 20 years, and little is known about males attempting suicide after the age of 20 years since the late 1960s.
 
 

Table 7 - Suicidality of White Predominantly Homosexual Males by Age Categories: Bell & Weinberg (1978): 1969 Sample Data 1
Age Groups /
Categories
All Ages
N = 575
> 46 Years
n = 132
37-46 Years
n = 146
27-36 Years
n = 142
16-26 Years
n = 155
First Attempt
by Age 20 2
9.4%
54/575
1920-69
2.3%
3/132
1920-42
5.5%
8/146
1936-52
10.6%
15/142
1946-62
18.1%
28/155
1956-69
First Attempt
Age 21-25
4.9%
28/575
1926-69
2.3%
3/132
1926-47
3.4%
5/146
1941-57
9.8%
14/142
1951-67
15-16%3
Attempts to
Age 16-26
First Attempt
Age > 25
4.0%
23/575
1931-69
(>) 6.8%
9/132
Attempts to ages 46 +
(>) 6.2%
9/146
Attempts to ages 37-46
(>) 14%4
Attempts
Only to Ages 27 to 36
Attempts
Only to Age
26
First Attempt
Age > 20
% Attempters
48.6%
51/105
> 80.0% 5
12/15
>>63.6% 5
14/22
>>52.3%
???
>15%
1. Analysis of Bell and Weinberg (1978) study sample data by Tremblay and Ramsay (2002). Comparison with the control sample of 284 predominantly heterosexual males used in this study was not possible given that only two of these males had attempted suicide by the age of 20 years, and only seven after the age of 20 years. .
2. The time ranges (i.e. 1956-69) given for reported attempts in each age category are approximated, the assumption being that most attempts would have occurred from the ages of 13 and 20 years. One or more of the suicide attempts could have occurred before the age of 13 years.
3. For this group ranging in age from 16 to 26 years, only about half of the group could contribute to attempts in the 21 to 25 year range, and the average age for the contributors is 22.5-years-old. This means that there is only about a 50% contribution from this group to possible "first time suicide attempts" in the 21 to 25 year range. The analysis produced 6 suicide attempters that would have occurred in and estimated 39 individuals (25% of 155 individuals), for an estimated suicide attempt incidence of 15.4%, or the 15-16% estimated given in the table.
4. For this group ranging in age from 27 to 36 years, the group could only contribute suicide attempts to the average age of 31 years, the incidence to this age already being 3.5% (5/142). Assuming a similar incidence for similar age periods to the age of about 50 years results in the conservative "14%" estimate that is given. Some first time suicide attempts would be occurring after the age of 50 years.
5. In both these cases, the actual "first time suicide attempts" incidence in the lifetime of the men studied would be greater given their ages when interviewed in 1969. For the group ranging in age from 27 to 36 years in 1969, the percentage of first time suicide attempters between the ages of 21 and 25 years (9.8%) is almost equal to the percentage of first time attempters up to the age of 20 years (10.6%). Therefore many years remain during which first time suicide attempts will occur. That such suicide attempts will occur and likely have majority status is indicated by the D'Augelli et al. (2001) suicidality results.

The information in Table 7 and the related estimates for incomplete age categories for "first time suicide attempts" lead to the conclusion / speculation that the majority of North American gay male suicidality has been occurring after the age of 20 years. Only one recent study (D'Augelli et al, 2001) has produced information supporting this speculation. From a sample of 416 elderly gay, lesbian, and bisexual individuals (297 males and 119 females) ranging in age from 60 to 91 years in 1997-98 (mean = 68.5 years, SD = 5.8), it was found that 13% had attempted suicide in their lifetime (52 suicide attempters). They did not report suicide attempt incidences to the age of 20 years, from the ages of 21 to 59 years, and from 60 years onward. Instead, they added all the suicide attempts by the suicide attempters and reported their distribution in the given age categories: 27 percent to the age of 21 years, 69 percent between the ages of 22 and 59 years, and 4 percent at or after age 60 years. There were 27 individuals who attempted suicide once, and 23 who attempted suicide more than once, meaning that two suicide attempters are missing given that 52 individuals were previously noted to have attempted suicide. The tally of 97 was given for suicide attempts that were then distributed over the three age categories noted above.

An important caveat in this respect is the reporting of information not separated on the basis of sex, and the authors do not give the suicide attempt incidences for males and females separately, although it seems that the differences may be insignificant. Given the average age of 68.5 years for this study sample, these individuals would have had a mean age of about 39 years in 1969 when the Bell and Weinberg sample was taken for study. Therefore these results shed some light on the ongoing suicidality situation that has continued to exist in gay communities at least since the Bell and Weinberg study: most of the suicidality problems for gay and bisexual individuals has been occurring after the age of 20 years. Therefore, attempting suicide has been an ongoing problem in gay communities and significant numbers of suicides appear to have occurred as suggested by a community leader writing in a gay and lesbian magazine distributed throughout the Canadian Prairie Provinces:

"But AIDS isn’t the only thing that is killing our friends. While I'm not aware of any [Canadian] statistics on the subject I believe we've lost many more lives to suicide than to AIDS. I certainly know considerably more people in our community who have taken their own life than I know who have died from AIDS" (Hellquist, 1993: 8).
This conclusion, based on the examination of the existing research data and on anecdotal evidence was confirmed in 2003 by research carried out in one of the world's most gay-positive countries where a registry for same-sex couples has existed since 1994. Qin et al. (2003) studied deaths from suicide in Denmark from 1981 to 1997, with knowledge about same-sex orientation of some individuals being available for the period 1994 to 1997 via the same-sex partners registry. Sufficient counts were available for the author to report:
"...registered [same-sex] partners included as a separate category in the analysis had an odds ratio of 4.31 (95% CI = 2.23–8.36) in the crude analysis and 3.63 (95% CI = 1.71-7.67) in analyses with adjustment for other factors in the full model [for having committed suicide compared to opposite-sex married couples]".
The importance of these results must be underligned because same-sex couples would likely be self-identifying adult gay or lesbian individuals and that other ORs in the analysis (ajusting for other factors) were lower in magnitude for cohabitating heterosexual couples versus married heterosexual couples (OR = 1.32, CI = 1.24-1.41) and for single individuals versus  married heterosexual couples (OR = 1.87, CI = 1.80-1.94). The same also applies in for the crude analysis: for cohabitating heterosexual couples versus married heterosexual couples (OR = 1.54, CI = 1.45–1.63) and for single individuals versus married heterosexual couples: (OR = 3.17, CI = 3.08-3.27). These results therefore represent the first confirmation that gay and lesbian people not only are great risk for attempting suicide during adulthood (Most first time suicide attempts have occurred during this period as noted above.), but that even those who are in registered partnerships - that could be perceived as a protective factor relative to gay and lesbian people not in registered partnerships, as it applies for heterosexual individuals, their lifetime risk for suicide remains very high compared to heterosexual married couples, or compared to cohabitating heterosexual individuals. For the latter, the exact crude analysis OR is not given, but it would be about 2.0, "2.0" being the risk ratio for lifetime deaths from suicide by Aboriginal people in Canada compared to other groups; this higher risk for suicide is recognized to be a serious problem that must be address as it was noted at the meeeting of Health Ministers in Canada in September, 2004. Left unsaid with respect to the Qin et al. (2003) results, is the likelihood that homosoexually oriented individuals would be greatly overrepresented in the Danish "single" population, given that most gay and lesbian individuals are not in registered partnerships, and that most gay and lesbian individuals report having never married nor having cohabitated with an opposite sex individual. Furthermore, single gay and lesbian individuals may also be at much greater risk for suicide than are those in same-sex registered partnerships. Therefore, the OR for lifetime suicides by all homosexually oriented adults compared to their heterosexual counterparts may well be in the range of 5 to 20 as it has been argued and estimated for male youth on the basis of the Bagley and Tremblay (1997) study of male who reported serious suicide attempts.

The information that is most relevant to the issues addressed in this paper, however,  is related to "first time suicide attempts" occurring before the age of 21 years (Table 6, 7). The data suggests there has been a 13-fold increase in the suicide attempt incidence for homosexually oriented adolescent males between the 1930s and 1990s: from 2.3 percent to the current average of about 30 percent.

Remafedi et al. (1991) with a sample of 137 gay and bisexual males (14- to 21-years-old) reported that 39 percent had been runaways; 39 percent sexually abused; 35 percent arrested; and 20 percent had engaged in prostitution. The attempted suicide percentages for males having these often overlapping attributes are 37 (20/54), 47 (25/53), 44 (21/48), and 43 (12/28) percent respectively. The average was 30 percent. With respect to gender attributes, 23 percent of the males were classified "feminine;" 26 percent were "undifferentiated;" 31 percent were "androgynous;" and 20 percent were rated as "masculine." Their respective suicide attempt incidences are 48 (15/31), 34 (12/35), 26 (11/42), and 11 (3/28) percent. There is therefore a general "suicide attempt" risk decrease from males being "feminine," to males being "masculine," the former having a 4.4 times greater risk for attempting suicide than their "masculine" counterparts (48% vs. 11%).

Many gay and bisexual identified adolescent males have a history of being runaways or throwaways (Galst, 1992) and some of them venture into prostitution, as do other homosexually oriented youth. As a group, they also form a sector of the more visible "gay communities" given that they are relating sexually with homosexually oriented men; Bell and Weinberg (1978: 311) reported that 27 percent of predominantly homosexual males studied had paid for sex, and 25 percent had been paid for sex. Not all gay and bisexual male adolescents making contact with gay communities, however, are in these categories, and little had been studied or written about their experiences and problems, including their possible ongoing risks for suicide problems and suicide. Real life story segments are nonetheless occasionally encountered within the context of researchers reporting on significant problems for which gay and bisexual male adolescents are at risk:

"...[Y]outh who received the intervention [a lengthy safer sex education program] said that they would engage in unsafe sex when they felt particularly distressed because they thought it was hopeless for them to protect themselves from becoming HIV positive. In addition, youths who were overwhelmed by emotional distress would bring to the group problems regarding their latest crisis, for example, being involved with a partner who was suicidal or who was being threatened by a previous partner; for these youth these problems took precedence over making behaviour changes toward less unprotected sex" (Rotheram-Borus, 1995: 593).
A significant number of homosexually oriented male adolescents are attracted (commonly enough "only attracted") to older males and they will seek to have sexual relationships with them, often with the hope that love will be a major part of the relationship. This aspiration for love is an integral part of the adolescent male prostitution world. Gabe Kruks describes "many youth" that have ventured into the Los Angeles Youth Service Center.
"The 'sugar daddy' usually present himself to the youth in a loving caretaker manner. For street youth who have a past history of rejection and/or abuse, the promise to be loved and cared for is a compelling one. [These youth usually have many of these relationships and] each of these is a cycle of falling in love, believing that life will now be wonderful forever and that this older adult truly loves the young person, discovering that in fact it is just sex that the adult wants, feeling the impact of one more betrayal, and ending up on the streets again. This whole cycle lasts an average of 1-2 months, and the youth often becomes extremely suicidal at the end of each cycle" (Kruks, 1991: 518).
Gay and bisexual male adolescents and young adults engaging in prostitution are reported to be at higher risk for suicide attempts (Nicholas and Howard, 1998), but they have not been the only ones attracted to older males and acting accordingly. Others have also been seeking sex (with the hope of love) relationships with older gay men as illustrated in the special "Love" issue of San Francisco's gay youth XY Magazine:
"But when I came out, the closeness I was looking for wasn't what I found. Instead, I fell into the gay community's 'if you're gay, young and cute, you have to be one of those guys who sleeps around' stigma... And I learned from all the wonderful people I met that sex was just sex and that the whole closeness thing was merely a pipe dream - certainly unattainable [if not via sex]... My problem arises when people just coming out see our community as only sexual. That affects me. They learn, like young people in every culture, from their peers and elders. What they see, hear and experience is what they are going to assume the gay community is. With this type of base, they are going to have a very difficult time making their love lives flourish... There are some people who want more than sex and don't feel 'sex is just sex'" (Weldon, 1997: 53).
Marc describes his encounters from the age of 17 when he illegally ventured into gay clubs on a quest to find the males he was most attracted to: the ones about 10 years older than himself.
[By the age of 19, he had]" had two 'official' relationships... lasting no more than a couple of months, [and he has not been impressed with what he learned.] Maybe this pattern simply indicates bad choices on my part. I guess I can see why older men think 19-year-olds have nothing more than sex to offer. But it surprises me that the older crowd want shallow, detached physical contacts while their younger counterparts are searching so very, very hard for something more substantial (Foster, 1997: 21).
The attraction of young gay males for older males is described in the "Older Partner" section of the report, Dangerous Inhibitions: How America is letting AIDS become an epidemic of the young. The section begins with: "Many young people find older partners attractive. All the young men and women participating in one series of PMI focus groups said that they prefer their sexual partners to be at least five years older than them" (Collins, 1997). Rotheram-Borus et al. (1995) reports that "many homosexual male adolescents have sexual relationships with homosexual men..., the group with the highest prevalence for AIDS" (p. 589), but most researchers have not been up front about this reality. For example, the Povinelli et al. (1996) study reports on a sample of 501 males aged 13 to 21 years "who self-identified as homosexual or bisexual or as having sex with men" (p. 33), the implication being that 13- to 16-year-old males are "men." The Remafedi (1994) study of a sample of 239 males aged 13 to 21 years uses similar terminology. The males in the sample were "self-identified as gay or bisexual and/or had sex with men... High risk sex between men account for the largest proportion of AIDS cases among adolescents (13 to 21 years of age)" (p. 163). More honestly, however, Morris et. al. (1995) reports "that younger gay men with older partners are the leading edge of the [HIV-AIDS] epidemic in their cohort" (p. 24), and this problem would have begun in early adolescence for some of the youngest males in the sample who were 18 years of age when studied.

Most researchers have remained silent about the significant numbers of gay and bisexual males in their studies who have reported as children or adolescents that they related sexually with at least one older male in ways deemed to be positive and enjoyable (Jay and Young, 1977; Spada, 1979; Hart, 1995; Fellows, 1996). This fact may also be inferred from the Kruks (1991) report for boys who had been seeking a man to love them, and the same would have applied for many of the boys studied by Remafedi et al (1991), but the authors did not specifically address this issue. Some studies, however, have reported specifically on relationships between boys and men (Wilson, 1981; Sandfort, 1982, 1983; Rossman. 1985; Sandfort et al., 1990; Leahy, 1992), the conclusion being that such relationships were not detrimental to the boys involved who were most often gay identified. Recently, Rind (2001) tackled this issue via a study of the gay / bisexual male sample studied by Savin-Williams who had reported some findings in the 1997 book "...And Then I Became Gay:" Young Men's Stories.

From this non-random volunteer sample of mostly white gay and bisexual male college students, it was concluded, on the basis of implications from the indicators used (self-esteem and comfort with being gay), "that ADSR's [age discrepant sexual relations] were not associated with psychological maladjustment. This finding is inconsistent with conventional professional and lay views, which reflect the incest model, but is consistent with empirical findings on willing boy-adult sex based on a college sample." The study sample consisted of 129 men with a mean age of about 21 years, and 26 males in the sample (22.5%) had reported ADSR occurring between the ages of 12 and 17 years (Rind, 2001: 357, 345). Bruce Rind's study therefore replicates the results of earlier studies: a significant number of gay and bisexual adolescent males have positively experienced sexual relations with men. His study sample, however, would not have included many of the adolescent males negatively affected by factors directly of indirectly associated with their sexual and/or love related quest for men. That is, the life experiences of many boys studied by Kruks (1991) and Remafedi et al. (1991) such as dropping out of school, being street youth, and venturing into street prostitution would have likely precluded the academic success required for entrance to a university. A high level academic success in high school was therefore an implicit selection criteria for the Rind (2001) study sample.

A more representative sample of the boys who have had willing sexual relationships with men would produce a number of life situations, and some of these would be associated with negative life events and negative outcomes. Dorais (1997) supplies an example of what may happen to a boy who is discovered to be having sexual relationships with men.

"My father would not give me any money. My mother was hospitalisedfor psychiatric problems. I had no one to turn to. I began going with men by the age of 12 or 13, to be spoiled by them, and my father took notice. One day, when I was taking a shower, he came to join me. Surprised, I tried to fight him off. He said: 'What? Don't want to do with your father what you are doing with other men? I will also reward you, if you are nice to me.' I was caught and he must have followed me to discover what I had been doing... From that time on, I had no choice." (Dorais, 1997: 40. Translation by Pierre Tremblay. The book is to become available in English from McGill/Queens University Press early in 2002.)
Boys who end up experiencing "unwanted sexual acts" (sexual abuse, as defined by these boys) vary with respect to their experiences, but they have one problem in common. They are growing up in a world where they know that same-sex relationships with males of one's own age is not what they would want others to know, and they would certainly not want their activities be become public knowledge in something like a courtroom situation. With respect to their sexual / love desires for older men, however, the "revelation" fear is even greater because any revelation of their desires and related activities would be a major confirmation of their "fag" status. Therefore, when sexual abuse is inflicted on these boys, they find themselves in a socially constructed double bind that only benefits his abuser(s), almost like society was the abusers' best friend given that the abused boys will likely not report such abuse to social authorities. In the above case, for example, the boy's thoughts would have been something like: "If I tell anyone (about this physical or sexual abuse, rape, etc.), he will certainly tell on me - tell everyone what I have been doing with men - then everyone will know about me!" The following life events reported to me in Calgary during the 1990s illustrate how society, its professionals, and even gay communities contribute to the double bind. Their refusal to acknowledge the reality of boys having sex with men (often well known to gay community leaders) are, in the final analysis, the ally and best friends of men who sexually abuse boys.
Case 1: A boy's brother-in-law had left his wife and began living with his wife's teenage brother who was going to school. A "interested" teacher befriended the boy, soon discovered the boy's living arrangements, and then made his move. [Such boys commonly give out certain signals often read by men who seek to have sex with boys as reported in some sexual abuse cases documented by Dorais (1997).] The teacher told the boy that he would do well in the course being taught if he had sex with him. If not, then he could expect a poor grade. To 'solve' this problem, given that the boy did not want to report the incident because the teacher could then reveal the boy's living arrangement and thereby harm the man he lived with and loved, his only "out" from this situation was to quit school and enrol in another school. When this individual told me his experience, he was 20 years of age.
Case 2: A Calgary male at the age of 30 years reported on his first-time sexual experience with a man after he decided to treat himself to such an experience on his fourteenth birthday. He lived in a neighbourhood and attended a school where he would have not wanted his peers to know about his same-sex desires. This need for secrecy meant that he had to go 'somewhere' where males make themselves available for sexual encounters with other males, this being Calgary's well known downtown cruising area: the Devonian Gardens. There, he met a man who suggested that they go somewhere else and the outcome in the situation was equivalent to rape. His related thoughts were something like this: 'If I tell, they will then all learn about where I was and what I was seeking, and that will include my parents! Then everyone will know about me! That I was out to not even have sex with male my own age, but with adult men!' For these boys, reporting a rape to police is precluded by the thoughts that public knowledge of their sexual desires and related activities would result in even more frightening and damaging outcomes.
Case 3: A Calgary male was thrown out of his home at the age of 12 years because his stepfather discovered that he was gay. On the streets he had a major homeless problem to solve, and the solution became apparent when he was befriended by a man who offered him a home, the implicit price being his sexual access to the boy. When interviewed, he was 17 years of age and, by then, he has been passed around to a number of gay identified men who, given their interest in young boys, often get to know each other and pass on the boy to others once their sexual interest wane. These relationships had permitted the boy to have a roof over his head, to have the type of sex that he enjoyed, and to also continue going to school, the latter being most important to him. He would also not have reported his living arrangements to anyone, even if serious abuse had occurred. His string of relationships with men, however, had been negatively affecting his mental health, but he knew that he could not talk to professionals about this, given their common policies of interference in such situations and maybe also seeking to have the men that he had loved convicted. Alone, he was therefore attempting to deal with episodes of major depression that would be associated with seeking to have sex with many men, almost as if such activities were an antidepressant.
Remafedi et al. (1991) reported high rates of sexual abuse for gay and bisexual male youth (39%), but they also noted that sexual abuse generally post-dated sexual identification as gay or bisexual. Furthermore, sexual abuse did not predict attempting suicide after the researchers had controlled for feminine gender role, age of homosexual of bisexual self-identification, and illicit drug use in the regression analysis. The implications, as noted by Holmes and Slap (1998: 1858-9) in their "sexual abuse of boys" review, is that the sexual abuse likely occurred after these boys had made themselves available for sexual experiences often occurring via making contact with some gay community attribute such as the "public sex" arena. It is also possible that sexual abuse experiences were associated with prostitution for some of these boys

Little is known about the sexual lives of gay and bisexual male adolescents even though most researchers would know that anonymous sexual encounters are common for these adolescents, as are related "sexual abuse" experiences. The fact that a significant number of boys are having sex with men, however, is generally ignored by researchers, most likely because producing related research information may not be in the political interest of 'gay communities', even though a few rare reports on related problems have been published. For example, the "at risk" status of homosexually oriented adolescent males was noted in a 1992 article titled "America’s Worst-Kept Secret: AIDS is Devastating the Nation’s Teenagers, and Gay Kids Are Dying by the Thousands." Gabe Kruks, the director of public policy and planning for the Los Angeles Gay and Lesbian Community Services Center, is quoted on the subject:

"Gay boys and straight girls who are having sex for money, shelter, love - they are at risk. And our community, the gay and lesbian community - and I particularly fault gay men here - has done nothing to try to help our youth. Gay men view these boys as recreational toys to be used. I have heard many stories of HIV-positive men having unprotected sex with boys. They don’t think it matters. If there is a single reason why so little is being done in this country about adolescent AIDS, it is that as a nation we are terribly afraid of the sexuality of our teens. These kids, no matter how they identify, gay or straight, need more than condoms and instructions on how to use them. They need someone to talk to, a support network, a place where they can feel safe and secure and where their confidentiality and personal histories are going to be protected and respected." (Brownworth, 1992: 41)
Such reports are uncommon, but they indicate that relevant knowledge is available on the subject, even if only anecdotal. Nonetheless, the problems experienced by these boys, including possible suicide problems, have remained largely unknown and unreported because a related policy of "silence" has been in effect in the research world, even with respect to their more recognised high risk for contracting HIV. Recommendations that research should be carried out on boys who are relating sexually with older men have also been rare. Connell et al. (1993) did make such a recommendation because they knew that these boys existed, citing Leahy (1992) in this respect. Furthermore, great HIV-related epidemiological knowledge is not needed to recognise that these gay and bisexual boys, as a group, would likely be the most at risk for contracting HIV at the youngest age. In spite of this fact, however, researchers have consistently avoided the collection of information that would permit the identification of serious "at risk" problems for boys who are relating sexually with older gay men as evidenced in the following review of HIV risk factors for gay and bisexual males:
"In their review of age and HIV risk behaviour among gay men Mansergh and Marks [1998] concluded that younger age was fairly consistently found to be associated with unprotected anal sex in North America, while only limited evidence was found for the association in European and Australian samples. Reasons for this are unclear. In order to assess more accurately the HIV risk for young gay men, it would be helpful to examine the degree of sexual 'mixing' across age groups and HIV status more closely. Although some studies have included assessments of perceived or known HIV status of young men's sexual partners, none of the studies reported the age ranges of the young men's sexual partners" (Stall et al., 2000: 5103, emphasis mine)
Twenty to 39 percent of homosexually oriented males report experiences of unwanted sexual acts (sexual abuse, sexual assault) by the age of 16 or 17 years (Remafedi et al., 1991; Doll et al., 1992; Caballo-Dieguez and Dolezal, 1995; Holmes, 1997, Lenderking et al., 1997; Kalichman et al., 2001). Results are also within this range (26.9%) by the average age of 14.5 years for American Indian males reporting themselves to be "100% homosexual" (Saewyc et al., 1998a: Table 8), and the incidence would be 20.4% if the "100% homosexual" and "mostly homosexual" boys had been grouped together.
 
 
Table 8 - American Indian Adolescent Males on Reservations:
Sexual Orientation & Sexual Abuse: Saewyc et al. (1998a)
Categories
Counts /
Percentage
Sexual Abuse %
100% Heterosexual
3,078
59.3%
2.8%
Mostly Heterosexual
264
5.1%
3.0%
Not Sure
1,716
33.1%
3.0%
Bisexual
88
1.7%
9.1% 1
Mostly Homosexual
18
0.4%
10.5% 2
100% Homosexual
26
0.5%
26.9% 3
Non-random sample from 55 tribes in 8 of the 12 Indian Health Service areas. N = 5191 adolescent males who answered the "sexual orientation" question (81.8% of males in study sample). Mean Age = 14.5 years.. "Not Sure" refers to the individual not being sure about one's sexual orientation.

Approximate Greater Risk (95% Confidence Intervals) for sexual abuse, comparing with 100% heterosexual males: 1. RR = 2.2<4.1<7.6 (c2 = 21.4, p < .0000), 2. RR = 1.0<4.0<14.9 (c2 = 4.5, p = .034), 3. RR = 4.9<9.6<18.8 (c2 = 51.6 (p < .0000).

Note: A study of suicidality of this large samples of American Indian adolescent males and females by Borowsky et al. (1999) did not report any statistics related to sexual orientation and sexual abuse, in associations with attempting suicide. However, they did report that adolescent males with only same-sex individuals in their sexual fantasies had a suicide attempt incidence of 25.0 percent (17/68). The incidence for those reporting both sexes in their sexual fantasies was 10.9 percent (21/196) and the mean incidence 11.8 percent for all males (Borowsky et al., 1999: 577, Table 4). Compared to males reporting only females in their sexual fantasies, those reporting only same-sex individuals in their sexual fantasies were significantly more at risk (p = .003) for attempting suicide. However, in the logistic regression analysis, having a homosexual orientation was not a predictor for attempting suicide.

Sexual abuse experiences have been linked to a lifetime higher incidence of suicidal behaviours, including suicide attempts in males. In their review of related "male child sexual abuse" studies, Holmes and Slap (1998: 1858) reported the suicidality results of 14 studies: sexually abused males were 1.5 to 14 times at greater risk for attempting suicide, compared to males not reporting sexual abuse. It is known that sexual abuse incidences range from 2 to 16 percent for boys (MacMillan et al., 1997; Holmes and Slap, 1998), and that rates for sexual abuse are much higher in samples of homosexually oriented males (20 to 39%). Based on this knowledge,it is likely that homosexually oriented males have been over-represented in study populations of sexually abused males. As a rule, however, these studies have not solicited "sexual orientation" information, and this lack of information makes it impossible to explore the likelihood that some negative associations with "sexual abuse," such as attempting suicide, may be more strongly associated with other negative life events.

For example, Remafedi et al. (1991) reported that factors such as "coming out at a young age" and "being feminine" were more associated to attempting suicide for gay and bisexual identified male youth than were "child sexual abuse" events. On the other hand, Kalichman et al. (2001) reported that both child sexual coercion (to the age of 16 years) and adult sexual coercion (after the age of 16 years) were independently and collectively associated with borderline characteristics in a sample of 595 mostly gay men (mean age = 33 years). Although the authors did not solicit suicidality information, it may be suspected that these males have had elevated rates of suicidal behaviour given the reported associations with borderline personality disorder (Appleby and Joseph, 1991; Hawley et al., 1991). In fact,

"borderline personality disorder is the only DSM-III-R personality diagnosis that includes suicidal behaviour as a criterion" (Soloff et al., 1994: 1316). "In several studies [of completed suicides], the most prevalent category was DSM-III-R borderline personality disorder ranging from 11% in Finland to 34.3% in Goteborg, Sweden" (Cheng et al., 1997: 445)
In the Kalichman et al. (2001) study, it must be noted that distress associated factors sometimes reported to be associated with child sexual abuse, such as high dissociative and trauma scores, were only associated with sexual assaults after the age of 16 years. Sexual coercion in childhood and adulthood was reported by 20.3% and 21.7% of these men, respectively, the overlap being 6.7% for reports of both child and adult sexual coercion. The latter group also had significantly higher mean scores score for symptoms of borderline personality disorder (F = 6.09, p < .01). This would suggest that gay males who have experienced sexual abuses before and after the age of 16 years are likely to beat higher risk for also experiencing suicide problems. In their study sample of 105 gay male youth (mean age = 22 years), Nicholas and Howard (2001) report that "unwanted sexual contacts" after the age of 16 years was significantly associated with gay males attempting suicide. Twenty-two (21.9%) of the gay males studied reported such "unwanted sexual contacts," the incidence being 45.8 percent for suicide attempters and 15.8% for nonattempters. Twenty-one percent (20.8%) of the gay males had attempted suicide.

Support for the proposition that homosexually oriented males would be overrepresented in groups of males reporting child sexual abuse is offered by Finkelhor (1979) who estimated that boys sexually abused before the age of 13 years were 4 times more likely to be homosexual than boys not sexually abused. A study of an adolescent medicine clinic population by Johnson and Shrier (1985, 1987) reported that sexually abused adolescent males were up to 7 times more likely to report a gay or bisexual orientation. This higher multiplier factor is associated with reports of sexual abuse perpetrated by another male (Holmes and Slap, 1998: 1859). In the Calgary study of 750 young adult males, the first paper published reported that 6 out of the 8 suicide attempters had been sexually abused (Bagley et al., 1994). The second paper reported that 5 of the 8 attempters were homosexually oriented (defined on the basis of homosexual or bisexual self-labelling and/or being currently homosexually active) (Bagley and Tremblay, 1997). In this study, an intersection therefore existed between reports of "unwanted sexual acts" and being homosexually oriented, and the relationship was most pronounced for the homosexually oriented males who had attempted suicide. They all reported having experienced "unwanted sexual acts" to the age of 16 years (Bagley, 2001: personal communication). Developing a deeper understanding of the relationship between having a homosexual or bisexual orientation, having experienced "unwanted sexual acts" before and after the age of 16 years, and attempting suicide may require qualitative research methods. It is possible that both "having a homosexual orientation" and "having been sexually abused / assaulted," or either one of these factors, along with other factors such as anti-gay harassment (Dorais, 2000), are implicated in serious suicide attempts for homosexually oriented male youth.

In their study of Australian gay young men, Nicholas and Howard (1998) reported a significant association between young men who attempted suicide and sexual assault, but problems with having a homosexual orientations were also implicated as indicated by the title of the study: "Better be dead than gay?" The 57 young gay men studied, compared to a control group of 54 heterosexual males, were more likely to report thinking there was no point to living and how they would kill themselves, frequent suicidal thoughts, intrusive suicidal thoughts, and having access to the chosen means to kill themselves. Sixteen of the gay males (28.1%) had attempted suicide, compared to 4 of the heterosexual males (7.4%). For the gay males, attempting suicide was related to a younger age of becoming sexually interested in men, younger age of identifying internally as gay, perception of greater levels of violence in the household the person grew up in, experiencing sexual assault, and engaging in sex work.

Adolescent males who identify as gay or bisexual at the youngest age are at the greatest risk for suicide attempts (Remafedi et al., 1991; Schneider et al., 1989; D'Augelli et al., 1993; Hershberger et al, 1997; Nicholas and Howard, 1998). Adolescent males are most likely to be the youngest individuals to become associated with some aspect of gay communities, including youth groups from which many study samples have been obtained (e.g., Schneider et al., 1989; D'Augelli et al., 1993; Hershberger et al, 1997; Proctor and Groze, 1994). For many homosexually oriented male adolescents, however, their first contact is with a well known part of gay communities known as the "public sex" or "anonymous sex" arena which has been participated in by about 50 percent of gay and bisexual males (Tewksbury, 1996; Krahé et al., 2000). Uribe and Harbeck (1992) report on the related experiences of adolescent males:

"Of the 37 males [in high school ranging in age from 16- to 18-years-old], 35 were already sexually active with other males. The average for the first sexual experience was 14 years, and in the majority of the cases this was with an unknown male... None of the males in this sample had his first sexual experience in a 'safe' manner, and none was still with his first sexual partner. [Furthermore], half of the study participants acknowledged engaging in suicide attempts in the year prior to the interview... Fifteen of these boys were living with friends, two admitted to living with 'sugar daddies,' and three were in residential or foster homes for gay adolescents" (p. 21-22).
Family problems, reported to be almost universal for these males, are a factor significantly associated with suicide attempts (Schneider et al., 1989: Nicholas and Howard, 1998). Family problems and lack of services for these adolescents often result in a "lack of support" situation also linked to suicide attempts (Schneider et al., 1989; D'Augelli et al., 1993; Hershberger et al, 1997). Associated factors such as becoming homeless, dropping out of school, stress, and having friends who attempted suicide, have been linked to suicide attempts by gay and bisexual male youth visiting the Hetrick and Martin Institute in New York (Rotheram-Borus, 1994). About 25 to 40 percent of male street youth may be homosexually oriented (Kruks, 1991; Savin-Williams, 1994; Kipke et al., 1995). Runaway youth have elevated lifetime suicide attempt incidences ranging from 15 to 29 percent (Stiffman, 1989; Rotheram-Borus, 1993), and homeless gay youth were estimated to be three times more at risk for suicide attempts than their heterosexual counterparts (Gibson, 1989). One sample of 53 GB male street youth had a 53 percent lifetime suicide attempted incidence (Kruks, 1991).

Substance abuse is also associated with suicide attempts of gay and bisexual male youth (Remafedi et al., 1991), as is alcohol abuse (D'Augelli and Hersberger, 1993). Both problems are well recognised risk factors for both suicide attempts and suicides in mainstream youth populations (Brent, 1995; Mazza, 1997). Youth Risk Behaviour Survey studies reveal that homosexually oriented adolescents (self-identified as gay, lesbian, or bisexual and/ or being homosexually active) are many times more at risk for multiple drug and/or alcohol use and abuse than their heterosexual counterparts (Garofalo et al. 1998; Faulkner et al., 1998; Note 10). Using five measures indicating that an adolescent may have a homosexual orientation, Orenstein (2001) reported that greater use of drugs was associated with the greater number of positive responses on these measures (Note 10). The suggestion offered for this phenomenon was that these were the youth most likely to have ventured into gay communities where such multiple drug use is common (p. 13). Support for this proposition is given, for example, in Halkitis et al. (2001) study titled "A double epidemic: crystal methamphetamine drug use in relationship to HIV transmission among gay men."

Psychiatric symptoms such as depression have also been linked to suicide attempts for homosexually oriented youth (Nicholas and Howard, 1998; Hershberger et al, 1997; D'Augelli et al., 1993). Depression has been linked to suicide attempts and suicide in mainstream adolescent and youth populations (Brent, 1995; Mazza, 1997). For homosexually oriented adolescents, however, psychiatric symptoms are likely related to, or exacerbated by, many of their most negative life events, and these symptoms should not be deemed "biological" in origin. For some males, negative life events may be related to family problems, while for other males their most negative experiences are related to aspect of their lives in gay communities.

The Seal at al. (2000) qualitative study of seventy-two 16- to 25-year old young men who have sex with men (YMSM) from two Midwest American cities reports on the multifaceted socially imposed problems of these youth. "Low self-esteem and self-worth, a lack of self-care and self-love, hopelessness and depression and teen suicide factors were believed to underlie unsafe sexual behaviour:

'There are times when I wished to God I would have just been dead. I couldn't go through the pain of who I was or the pain of trying to live my life. There was so much hurt. It wouldn't have mattered if I had gotten HIV. To be that would have been the simplest solution. I wouldn't have had to do a thing. I just would have had to lay there. I wouldn't have had to slit my wrists or commit suicide any other way. It's a more painful way, but if you're on a suicide mission it doesn't matter.'

Participants further pointed out that may YMSM, and particularly YMSM of Color, lived with a pervasive sense of hopelessness in multiple aspects of their lives. Consideration of adverse long-term consequences of behavior was difficult for men who lived with daily violence, poverty, and despair and who held few expectations about a lengthy life:

'When it comes down to it, the guys I talk to just don't care about life. They say life has nothing to offer them. A lot of times their mothers and fathers have disowned them and their family won't deal with them anymore because they are gay. They have no life, no family no future'" (p. 10).

'...Some YMSM derived excitement from conscious unsafe sex: 'There's times with anonymous pickups that I won't use a condom. The thrill of not knowing whether he (an anonymous pickup) is gay or straight makes it difficult for me to stay safe.' Several respondents reported that more and more YMSM found sexual excitement in the 'Fuck of Death', that is, conscious unprotected receptive anal sex with a known HIV-positive partner or 'bug giver'" (p. 11).

An association between a history of suicide attempts and practising unsafe sex by gay males was reported by Lewis (1988), but individual cases of gay males contracting HIV as a way to commit suicide had been reported as early as 1985 (Frances et al., 1985; Flavin et al., 1986). By the late 1990s, the phenomenon was reported in association with gay youth (Tompkins-Rosenblatt, 1997: Intentional HIV contraction: implications for direct child and youth care), and from an analysis of Vancouver's Vanguard Project cohort of young men who have sex with men ranging in age from 18 to 30 years. A history of attempting suicide was the second most statistically significant association differentiating males who were "risk takers" compared to males who were not risk takers with respect to placing themselves at risk for contracting HIV (Martindale, 1997). Seal et al. (2000) report a similar phenomenon as noted above, but another factor is apparently also associated with desires for death by young men who have sex with men (YMSM):
"They [YMSM] figure that they will have as much fun as they can now because they see old guys sitting in Venue X who like 40 and 50 and 60 years old and who haven't done anything with their life. Or, if they have, they're single and sitting in Venue X hitting on the young guys. The [YMSM] figure if they die young they wouldn't have to worry about that. It's the fear of age that many kids don't want to face - that they will get old. They figure that they have do lots of things before their beauty fades" (Seal et al., 2000, pp. 10-11).
In a Salon Magazine interview, Edmund White commented on the gay community ageism factor possibly implicated in a conscious desire to contract HIV as a form of suicide, which could also be more unconscious for some gay males:
"If you say you're going to be dead by 40, they say, "So what? There's no gay life after 40, anyway." Especially in France, but even here. You can easily be a gay in his 20s and never meet a gay over 40 because you don't see them in the bars. They don't go out, they're not part of your world, and if you do see them, you consider them pathetic" (Reitz, 1997).
Homosexually oriented adolescent and young adult males have been at high risk for suicide problems. This fact is also reflected in HIV-related cohort studies reporting high rates of major depressive disorder (MDD) in adult gay male psychiatric histories (Atkinson et al., 1988; Williams et al., 1991; Rosenberger et al., 1993; Perkins et al., 1994; Dew et al., 1997). These studies and the Bagley and Tremblay (1998) study have nonetheless reported normal rates of current depressive mental health problems for adult gay males, and the same applies for one sample of HIV-positive and HIV-negative African-American men (Peterson, 1996). For a larger similar sample of African-American males, however, elevated current rates of depression were reported (Richardson, 1997), and Schneider et al. (1991) reported that 30 percent of gay men studied experienced suicidal ideation within a 6-month period.

Adult gay males have psychiatric histories characterised by elevated rates of drug and/or alcohol abuse (Atkinson et al., 1988; Williams et al., 1991; Rosenberger et al., 1993; Johnson et al., 1996; Dew et al., 1997). These problems seem to be eventually overcome (Bux, 1996), but McKirnan and Peterson (1989) report higher levels of current alcohol problems for gay males, and the same applies for a large sample of African-American gay and bisexual males (Richardson et al., 1997). Adult gay males apparently have elevated rates of personality disorders (Perkins, 1993; Johnson, 1996) and neuroticism (Kelly et al., 1998) that is an indicator of certain personality disorders. Based on these mental disorder rates and evidence that a link exists between personality disorders and alcoholism (Morgenstern et al., 1997), a subgroup of adult gay males with significant ongoing substance abuse problems may exist. Bailey (1999) comments: "Homosexual people are at a substantially higher risk for some forms of emotional problems, including suicidality, major depression, and anxiety disorder. Preliminary results from a large, equally well conducted Dutch study [Sandfort et al, 1999] generally corroborate these findings" (p. 883).

The Sandfort et al. (2001) study reported on the homosexual men in a sample of 7,060 Dutch males ranging in age from 18 to 64 years, the determination of "homosexuality" being based on reports of same-sex activity in the past year. "Homosexual men had a higher 12-month prevalence of mood disorders (odds ratio [OR] = 2.93; 95% confidence interval [CI] = 1.54-5.57) and anxiety disorders (OR = 2.61; 95% CI = 1.44-4.74) than heterosexual men." More homosexual men than heterosexual men "had 2 or more disorders during their lifetimes (OR = 2.70; 95% CI = 1.66-4.41) (p. 85). In the United States, the NAHNES III study of 3848 men from 17 to 39 years reported that homosexually oriented men (defined on the basis or having had same-sex partners) were at greater risk for attempting suicide (Logistic Regression OR = 6.45, 95% CI = 2.7-15.2) when factors such as age, race/ethnicity, and family income was controlled for (Logistic Regression OR = 5.36, 95% CI = 2.2-13.0).

Such research, however, has limitations. For example, the Dutch study by Sandfort et al. (2001) would have likely been criticised by Savin-Williams (2001) because selecting a homosexually oriented male sample only on the basis of "being homosexually active in the past year" represents only a subset of the homosexually oriented male population. Here, the assumption may be that such negative associations (a greater risk for mental health problems) with homosexual males would maybe disappear if a more representative sample was studied. This may not be the case, however, if the Dutch study has also solicited homosexual self-labelling information and therefore included homosexual men who had been celibate during the past year. These celibate males may account for about 15 percent of the homosexual male population. They were reported to have ongoing mental health problems (Bell and Weinberg, 1978), including elevated rates of current depression compared to other homosexual males (Bagley and Tremblay, 1998). These problems may be related to the gay identification process. Not having passed the "tolerance" stage in the coming out process (the next stage being self-acceptance) is associated with mental health problems in adulthood as reported in one study of 196 adult gay and bisexual males (mean age = 28.8 years). The most significant discriminator on a psychological well-being scale (with twice the F-ratio of the next most significant measure, p < .0000) was the greater suicidality scores of males still at the "tolerance" stage (Brady and Busse, 1994).

Adult gay males are also at risk for experiencing minority stress that, in part, may be related to their high likelihood for having experienced psychological and physical abuse in society (Herek et al., 1997). Stigmatisation-related negative life events predict psychological dysfunction in gay men (Ross, 1990), and "minority stress" negatively affects their mental health, increasing their risk for suicidal problems (Meyer, 1995, 2003). Increasing levels of gay-related stressful life events were moderately associated with emotional distress and the multiple problem behaviours in a sample of 136 predominantly Hispanic and Black gay and bisexual male youth (Rosario et al., 1996). An association with minority stressors was also reported in a master's thesis study of a non-random sample of 329 mostly white South African gay and bisexual males below 30 years of age, and 16.5% of these males reported having "attempted suicide because they were gay" (Theuninck, 2000: vii). Such information is increasingly making possible a better understanding of homosexually oriented males and their problems but much remains unknown about adolescent and adult homosexually oriented males with respect to mental health issues and suicidality. The same applies for the resolutions of problems from the high-risk period of adolescence and young adulthood to middle and old age. In this respect recommendations have been made by a number of researchers. Remafedi (1999) emphasised the need for "[p]rospective, longitudinal studies... [required] to examine the evolving risk of suicide across the lifespan of homosexual persons." He noted that "although the understanding of gay, lesbian, and bisexual youth suicide is increasing, many questions remain regarding sex and ethnic differences, predisposing social and psychiatric conditions, protective factors, and constructive interventions." Remafedi concluded that "[f]uture population-based surveys should routinely inquire about sexual orientation to retest prior findings in diverse settings" (p. 1291), but most mainstream researchers have an ongoing history of ignoring homosexuality issues in research related to almost all human problems.

The data presented in this section has outlined one part of the story related to suicide problems experienced by many homosexually oriented male adolescents and young adults. There is, however, one high risk attribute that may be related to early identification as gay or bisexual, possibly dropping out of school, and venturing into the identifiable parts of gay communities at an early age. This common attribute of gay and bisexual identified male adolescents is a high level of "femininity" that, on the basis of multivariate analysis, resulted in "feminine" males having a 3-times greater risk for a suicide attempt than their counterparts (Remafedi et al., 1991).
 
 

NOTES
 

Note 9

For a sample of 28 male and 20 female homosexual (88%) and bisexual (12%) individuals, Hammelman (1993) reported that 64% of the suicide attempters had identified their homosexuality to have been a part (35%) or most (29%) of the problem linked to their suicide attempt. Information was not solicited, however, to permit a reporting on the possible relationship of some suicide attempts to homosexual relationship problems.
 

Note 10

Drug use and abuse by homosexually oriented adolescents in school compared to heterosexually oriented adolescents.

Garofalo et al. (1998): Results for grades 9 to 12 Massachusetts' students (1995 sample), comparing 2.5 percent of gay, lesbian, and bisexual identified students with heterosexually identified students in grades 9 to 12:
 

1. Cocaine use before the age of 13 (17.3% vs. 1.2%: 14.4 times).

2. Cocaine use in last 30 days (25.3% vs. 2.7%: 9.4 times).

3. Cocaine use in lifetime (33% vs. 6.9%; 4.8 times).

4. Crack or freebase use in lifetime (35.3% vs. 3.5%: 8.9 times).

5. Shared needles for illicit drug use in lifetime (15.5% vs. 1.1%: 14.1 times).

6. Anabolic steroids use in lifetime (25% vs. 3.9%: 8.4 times).

7. Injected illegal drugs in lifetime (22.2% vs. 2.3%: 9.6 times).


Levine and Beeler (1997) [Related published paper: Faulkner et al. (1998)]: Results for Grade 9 to 12 students in Massachusetts (1993 sample), comparing 3.7 percent of students who reported having been homosexually active to students who had been only heterosexually active:
 

1. Involved in episodic heavy drinking (15.0%% vs. 3.8%: 4 times).

2. Currently consuming alcohol every day (10.9% vs. 1.2%: 8.7 times).

3. Used cocaine at least once (19.2% vs. 3.2%: 6.0 times).

4. Used cocaine 10 or more times (13.3 vs. 0.7%: 19 times).

5. Used illegal drugs other than alcohol, marijuana, or cocaine (17.8% vs. 3.5%: 5.1 times).

6. Injected illegal drug (20.8% vs. 3.1%; 6.7 times).


Smith et al (1999): Six percent of a sample of 3,387 Australian students in grades 10 to 12 reported same-gender sexual attraction. "Being attracted to members of the same-sex was associated with more frequent binge drinking among boys and girls, and a three- to four-fold increase in the likelihood of reporting injecting drug use both over the lifetime and within the previous 12 months" (p. 643).
 

Orenstein, Alan (2001): To Graphing of Results.
 

Table 9a - Substance Use During Last Month
Grade 9 to 12 Students in Massachusetts - 1992/94**
Number of Homosexual Orientation Indicators*
% GLB in Category
0

(0% GLB)

1

(8% GLB)

2

(31% GLB)

3-5

(74% GLB)

A. Alcohol
31%
30%
42%
47%
B. 5+ Drinks in a Row
20%
22%
33%
30%
         
C. Marijuana
14%
13%
20%
40%
         
D. Inhalants
2%
3%
3%
19%
E. Cocaine or Crack
1%
2%
6%
18%
F. LSD
2%
2%
6%
17%
G. Other Psychedelics
1%
2%
4%
18%
H. Amphetamines
1%
2%
6%
19%
I. Barbiturates
1%
2%
3%
19%
J. Tranquilizers
1%
2%
3%
14%
K. Heroin
1%
2%
3%
16%
L. Other Narcotics
1%
2%
4%
20%
         
M. Any Drug: D to L
4%
7%
12%
32%
         
Number (%)

in Category

2,432

(82.5%)

334

(11.3%)

90

(3.0%)

90

(3.0%)


 
Table 9b - Substance Use in Lifetime by Sexual Orientation*
Grade 9 to 12 Students in Massachusetts - 1992/94**
Number of Homosexual Orientation Indicators*
0
1
2
3-5
A. Alcohol
67%
60%
68%
66%
         
C. Marijuana
25%
25%
33%
46%
         
D. Inhalants
5%
8%
16%
26%
E. Cocaine or Crack
2%
4%
10%
27%
F. LSD
5%
8%
11%
31%
G. Other Psychedelics
3%
7%
10%
24%
H. Amphetamines
3%
5%
7%
26%
I. Barbiturates
2%
2%
7%
27%
J. Tranquilizers
3%
3%
7%
22%
K. Heroin
1%
1%
4%
21%
L. Other Narcotics
2%
3%
8%
27%
         
M. Any Drug: D to L
11%
18%
22%
44%
         
N. Ever Injected Drugs
1%
1%
0%
9%
         
Number (%)
in Category
2,432
(82.5%)
334
(11.3%)
90
(3.0%)
90
(3.0%)

*The Homosexual Orientation Indicators are based on responses indicating a possible homosexual orientation on the following five measures:

GLB = Consider self to be gay, lesbian, or bisexual.

**Study Sample: Grade 9 to 12 male and female respondents in a health survey carried out in one high school in a working-class, multi-ethnic Massachusetts community. For analysis, the respondents in the 1992 survey (n = 1,514) were combined with the respondents in the 1994 survey (n = 1,434). Data source: Table 2 and Table 3, pp. 7-9.  

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