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218 Cultural Competence in Health Education and Health Promotion

confident teaching about sexual orientation (Larson, 2003). In another study, students

who identified as gay or lesbian reported that the subject of homosexuality was virtu-

ally absent from classroom instruction. The same study revealed strong support for
sexuality education, but homosexuality was the least - supported subject in the survey
(Lindley & Reininger, 2001).

HEALTH ISSUES COMMON TO ALL LGBT GROUPS
One of the biggest issues common to LGBT communities is substance abuse, includ-
ing smoking tobacco, drinking alcohol, and using drugs. According to one study,
LGBT people are 40 percent more likely to smoke than their heterosexual counterparts
(Ryan, Wortley, Easton, Pederson, & Greenwood, 2001). Several factors contribute to
this high rate of smoking, including participating in the “ bar scene ” in order to be part
of an LGBT community and using smoking to deal with the stress of homophobia,
transphobia, and LGBT discrimination and oppression (GLMA et al., 2001).
Peterkin and Risdon (2003) found that along with higher rates of smoking, lesbi-
ans and gay men have higher rates of alcohol consumption than heterosexual people
do. Most of the research in this area has focused on lesbians and gay men; there is little
research about the alcohol consumption rates of bisexual and transgender people. As
in the general population in the United States, substance abuse in the LGBT commu-
nity is associated with a myriad of challenges, including HIV and AIDS, sexually
transmitted diseases (STDs), violence (of particular concern are acts committed by
and against the LGBT community), and chronic disease conditions, such as cirrhosis
of the liver.
LGBT youths use alcohol and other drugs for many of the same reasons as their
heterosexual peers do: to experiment and assert independence, to relieve tension, to
increase feelings of self - esteem and adequacy, and to self - medicate for underlying
depression or other mental health problems (GLMA et al., 2001). Although alcohol
consumption has decreased in these communities throughout the past two decades,
there is still widespread alcohol use among young gay and lesbian communities
(GLMA et al., 2001).
Depression and mental health issues also affect LGBT people at a higher level
than found among heterosexual people. Although homosexuality is no longer charac-
terized by the American Psychiatric Association as a mental disorder, gender identity
disorder (GID) is listed in the Diagnostic and Statistical Manual of Mental Disorders,
Volume Four ( DSM - IV ). Simply stated, GID is the condition of signifi cant discomfort
with one ’ s assigned gender (Peterkin & Risdon, 2003).
Therefore, in order to receive health services, some transgender people are forced
to identify themselves as having a mental illness. This is not true for lesbian, gay, and
bisexual people who do not identify as transgender. Regardless, studies show cases of
depression among LGBT populations (GLMA et al., 2001). Like substance abuse, this
depression can be directly related to individuals ’ LGBT identification, which can

involve navigating through the threat of hate crimes and violence, homophobic and

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