LGBTQ youth talk about healthcare experiences

By Communities Count in collaboration with Public Health Insider

Photographer, Ned Ahrens

In a first-of-its-kind effort, King County hospitals reached out to lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) youth and young adults to learn about their experiences with healthcare. King County Hospitals for a Healthier Community, which is a collaborative of 11 hospitals and health systems, joined with Public Health – Seattle & King County to identify the greatest needs and assets of the communities they serve and develop plans to address those needs. More than 1 in 10 King County youth identifies as lesbian, gay, or bisexual.

A series of listening sessions with LGBTQ youth and young adults age 13-24 living throughout King County, plus interviews with advocates who work with LGBTQ youth, revealed consistent themes that were also supported by survey data. The themes at the heart of the just-released LGBTQ Community Spotlight include:

  1. Lack of control of their own health

For many LGBTQ youth, lack of family support affected mental health, self-esteem, and their ability to effectively navigate the healthcare system. Youth who had stable and nurturing relationships with their families and trusted adults felt safe and supported. Those without these trusting relationships had extreme difficulty getting their health and healthcare needs met. One youth said, “… this is my body, this is my mental health, this is me; I feel like I’m not in control over any of it.”

Many youth would like more opportunities to speak privately with their providers, without family present, and feel strongly that providers should take the lead in suggesting this option. A listening session participant offered a positive example: “One thing my [provider] does to make me feel safe is asking me about telling my mom. He’ll always give me the option, ‘Do you want your mom to come along?’ or if she’s there [he’ll ask] if she should leave. He always leaves it up to me.”

  1. With providers, a need for safety, trust, and information

Youth said they needed to feel safe and develop trusting relationships with their providers before they could comfortably talk with them about their physical, mental, and emotional health needs – all topics that are broader than just sexual health. According to one participant, “[My pediatrician]’s really supportive of everything. Before she asks questions, she says ‘do you feel comfortable if I ask this?’ and it’s really nice.”

Participants also stressed the importance of a safe and supportive clinical environment where inclusive language on intake forms and behaviors from staff and providers acknowledge the possibility of gender diversity

Youth also said they needed more information – about diverse aspects of human sexuality and healthy interpersonal relationships, as well as patient rights, confidentiality, and the kinds of services that can be accessed without parental consent.

  1. Kudos for school-based health centers

Middle and high school students with access to one of the 23 King County School Based Health Centers  greatly valued the services and the privacy they provided. This is one of many enthusiastic endorsements: “They’re not only treating what’s wrong with you internally – they care about you all the way.”

  1. Safety concerns across multiple settings

In addition to explaining their need for “non-judgmental safe spaces” for healthcare services, youth expressed strong concerns about safety in their responses on a statewide survey of 8th, 10th, and 12th graders. Compared to students who identified as heterosexual, those who identified as lesbian, gay, or bisexual were significantly more likely to report feeling unsafe at school and on dates; they were also more likely to report that they had been bullied and that an adult had intentionally hurt them.

These safety concerns were echoed by the finding that more than half of LGBTQ+ respondents to the 2018 Count-Us-In survey of King County’s homeless population reported a history of domestic abuse or partner abuse.

Acknowledging the universal challenges of transitioning from childhood to adulthood, the report highlights the considerable variation in the ways this plays out with LGBTQ youth.  Findings from the report can raise awareness among the parents, teachers, healthcare providers, and other trusted adults whose support is important to these youth as they navigate a vulnerable stage of development. Check out the full report to learn more about the findings and to read more from the participating youth and advocates.

For interpreted data about LGBTQ youth in King County, click the “demographics” and “custom demographics” tabs on the following Communities Count indicators:  teen binge drinking, teen obesity, teen overweight, teen physical activity,  teen cigarette smoking and tobacco use, teen depression, teen substance use, and teen marijuana use.   The same information, without interpretation, is presented on King County’s Community Health Indicators website.

How are guns stored in King County homes?

Across all of King County, more than 1 in 5 adults reported keeping a gun in or around their homes, including in a car or other motor vehicle.  But where they lived made a big difference: Keeping a gun at home was least likely in Seattle neighborhoods (14%) and most likely in rural areas in east and south King County, with the highest rate (43%) in Covington / Maple Valley and Newcastle / Four Creeks.

To help gun owners protect their children and neighbors against accidental shooting, access by children, firearm suicides, and firearm theft, Public Health – Seattle & King County is partnering with firearms retailers, elected and tribal leaders, local hospitals, and law enforcement on the LOK-IT-UP safe storage initiative.

The same survey that asked about keeping guns around the home also asked how those guns were stored. In 2015 —

  • 43% of respondents with guns at home (about 150,000 people) said they stored at least one gun unlocked
  • 31% (about 105,000 people) stored at least one gun loaded
  • 15% (about 51,000 people) stored at least one gun unlocked and loaded

So we have room for improvement. While opinions are divided about gun legislation, we are united in wanting our children, families, schools, and communities to be safe.  

For more information about LOK-IT-UP, see the 10/31/2017 Public Health Insider blog; for background information about gun-violence prevention, see King County’s Gun Violence Prevention Initiative. Communities Count has just introduced two new indicators, with interpretive narrative, under the Public Safety topic: Homes with guns  and Carrying weapons at school.  These indicators, plus data on Not feeling safe at school, are also available at Public Health’s Community Health Indicators site. The LOK-IT-UP site provides information on how to get discounts on storage devices and lock boxes through December of 2018.

Child poverty moves south from Seattle

Twenty years ago, 1 in 5 Seattle children aged 5-17 years old (>12,000) lived in poverty. Poverty among school-aged Seattle children peaked in 1997 – 13 to 16 years before all school districts in the county experienced recession-linked surges in student poverty.  By the “post-recession” year of 2016, the picture had changed dramatically, according to data prepared by the Census Bureau’s Small Area Income and Poverty Estimates (SAIPE).

The rates and numbers of school-aged children living in poverty have continued to decline in Seattle, and have returned to pre-recession levels in many King County school districts.  But the overall number has increased – from 28,971 in 1997 to 31,259 in 2016 – with most of the increase coming from a cluster of South Region districts that are accommodating the county’s re-distribution of poverty.

On one end of the see-saw, Seattle’s share of the county’s low-income children dropped from 42% in 1997 to 21% in 2016.  On the other end, the South Region school districts of Auburn, Federal Way, Highline, Kent, Renton, and Tukwila, which together contributed only 39% of school-aged poverty in 1997, are now responsible for educating 55% of the county’s students living in poverty.  All 6 districts have double-digit rates of student poverty, from 13% in Kent to 29% in Tukwila.  And none have returned to pre-recession levels of school-aged poverty.

Given the stratospheric rise in Seattle housing costs, it seems likely that child poverty in Seattle schools has declined (down to 10%, from a high of 19%) because poor families couldn’t afford to stay.  Families – and school districts – in Seattle and many East Region cities benefit from the region’s strong economic recovery. In future blogs, we will look school funding, health, and academic progress to see how South Region school districts are coping with an influx of children whose families aren’t doing as well economically.

See recent updates by school district to Communities Count education indicators and Best Starts for Kids indicators.

La La Land on economic equality

Yale University researchers recently revealed a striking mismatch between perceptions of inequality and actual inequality.  Asked to estimate progress toward black-white economic equality, participants in several studies consistently overestimated racial equality for annual income, wealth, employee benefits, and hourly wages.  “The headline finding,” according to City Observatory, “is that the average respondent thinks that black wealth is about 80 percent that of whites; whereas Census data suggest that black wealth is about 5 percent that of whites.”

As reported by The New York Times, the study’s authors attribute these overestimates of racial economic equality to several factors:  continued economic and racial segregation, unconscious denial of a reality that doesn’t fit our idealized version of a fair democracy, and overgeneralization from other signs of progress toward racial equality (such as passage of civil rights laws and election of a black president). Blacks and whites alike overestimated economic equality, but estimates made by wealthy whites were furthest from the mark.

Although the Yale researchers didn’t collect data on geographic differences in perceptions of racial inequality, we can compare racial economic inequality in King County to national figures.  While the national black/white income gap is substantial ($22,794 in 2016, according to the American Community Survey), it pales in comparison to King County’s whopping 2016 disparity of $45,733.

And the disparity in King County has gotten worse.  Nationally, from 2006 to 2016 median household income grew by about 19% for blacks and for whites, preserving a consistent (and large) racial gap: at both times blacks earned $63 for every $100 earned by whites.  Over the same period in King County, black median income grew by 20%, lagging considerably behind the 36% growth of white median income.  While in 2006 King County blacks earned $56 for every $100 earned by whites, by 2016 the gap had widened, with King County blacks earning only $50 for every $100 earned by whites.

Many King County residents support the goal of achieving economic security for all.  Before we can do that, however, we first need to acknowledge our increasing racial disparities in the face of explosive economic growth.  Only then will we be able to rationally make policy choices that will move our region toward greater equity.

Communities Count has just updated King County data on income by race/ethnicity, and also presents recent national wealth trends by race/ethnicity and national black/white wealth trends for the cohort born between 1943 and 1951 (in their 30s, the mean wealth of whites in this cohort exceeded the wealth of blacks by less than $150,000; by the time they reached their 60s, the difference had grown to more than $1 million).  Other data on economic inequality can be found in a data spotlight, The rising fortunes of the top 1%, and charts on wealth trends by income tier.

Food crisis for seniors?

Concerns about hunger in King County have primarily focused on families with children.  Since the Great Recession, however, the need for food assistance among King County seniors has increased dramatically.

Food bank visits by seniors rose as visits by younger residents declined.

In 2016, for example, adult age 55 and older accounted for almost 1 in 3 food bank visits, up from 1 in 5 in 2010.  In the time period, the number of food bank visits decreased for all age groups except seniors, for whom the numbers of both new and returning clients increased.

The jump in use of food banks among King County seniors was paralleled by an increase in participation in Washington’s Basic Food program (formerly known as food stamps), which grew from 17,931 King County residents age 65+ in 2010 (9% of the 65+ population) to 28,426 (12%) in 2016.

Basic Food participation among seniors has increased in all major King County cities.

Increases have been especially steep in Tukwila, where 30% of seniors age 65+ participated in Basic Food in 2016.  Sharp increases have also occurred in the South Region cities of Kent, Seatac, Federal Way, Renton, Burien, and Auburn, with participation rates ranging from 15% to 22%.   All major cities in King County have experienced participation increases among seniors.  For other age groups, use of Basic Food peaked between 2012 and 2013 and has declined thereafter.

This trend isn’t just about food.  Steep increases in the cost of living in the Puget Sound region have exacerbated our homelessness problem, and can be difficult to afford on a fixed income.   It’s easy to understand why seniors might go without food or medication to keep a roof over their heads.  Even in times of economic expansion, food benefits may become increasingly important for the older members of our communities.

For more information, see Communities Count data on Basic Food, food hardship, and food bank trends, plus a link to an interactive map of food bank locations.