Comment

June 10, 2013
Summer King, SAMHSA Reports Clearance Officer
Room 2-1057
One Choke Cherry Road
Rockville, MD 20857
Re: Pretesting of Substance Abuse Prevention and Treatment and Mental
Health Services Communication Messages—(OMB No. 0930-0196)—
Extension
The Trevor Project greatly appreciates the opportunity to comment on SAMHSA’s
efforts to pretest substance abuse prevention and treatment and mental health services
communication messages on target audiences. We urge you to pretest these messages
on lesbian, gay, bisexual, transgender, and questioning (LGBTQ) audiences,
including LGBTQ young people, to ensure that SAMHSA’s important work can
most effectively help put an end to the health disparities facing LGBTQ populations.
We commend your ongoing support of LGBTQ communities, as evidenced by your
leadership in addressing LGBTQ health disparities in your resource materials and
research, through your commitment to collecting data on transgender individuals through
your programmatic forms, and through the proposed addition of sexual orientation data
collection questions to the National Survey on Drug Use and Health.
The Trevor Project is the leading nonprofit, national organization providing crisis
intervention and suicide prevention services to lesbian, gay, bisexual, transgender, and
questioning (LGBTQ) young people under 24. The Trevor Project saves young lives
through its accredited free and confidential lifeline, secure instant messaging services
which provide live help and intervention, a social networking community for LGBTQ
youth, in-school workshops, educational materials, online resources, and advocacy. The
Trevor Project is a leader and innovator in suicide prevention.
Sources such as the Institute of Medicine,i Healthy People 2020,ii the Substance Abuse
and Mental Health Services Administration,iii and the National Healthcare Disparities
Reportiv indicate that LGBTQ individuals and their families are disproportionately likely
to live in poverty, to be uninsured, and to face substantial barriers to quality health care,
including refusals of care, substandard care, inequitable policies and practices, and
exclusion from health outreach or education efforts.v With regard to mental health,
suicidality is an especially critical issue for LGBTQ youth populations. Research has
shown that LGB youth are 4 times more likely to attempt suicide as their straight peers,
and questioning youth are 3 times more likely.vi Nearly half of young transgender people
have seriously thought about taking their lives and one quarter report having made a
suicide attempt.vii Young people who experience family rejection based on their sexual
orientations face especially serious health risks. In one study, lesbian, gay, and bisexual
young adults who reported higher levels of family rejection during adolescence were 8.4
times more likely to report having attempted suicide, 5.9 times more likely to report high
levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely
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to report having engaged in unprotected sexual intercourse compared with peers from families that
reported no or low levels of family rejection.viii
As a result, the LGBTQ population experiences significant disparities in health indicators such as
smoking, obesity, experiences of abuse and violence, mental and behavioral health concerns, and HIV
infection. These inequities may be even more pronounced for LGBTQ people who are also members of
other groups that are disadvantaged on the basis of factors such as race, ethnicity, geography, or
disability.
In order to effectively reduce these disparities, targeted and culturally competent health messaging
that addresses the specific needs of the LGBTQ population should be tested and disseminated.
Generic messaging should also be tested on LGBTQ audiences to ensure that SAMHSA’s resources
are accessible to diverse communities.
The Trevor Project supports SAMHSA’s efforts to pretest substance abuse prevention and treatment and
mental health services communication messages on target audiences. We encourage you to help meet the
specific needs of LGBTQ communities by pretesting your messages on LGBTQ audiences. If you should
have any questions regarding these comments, please contact myself or Elliot Kennedy, Government
Affairs Counsel, at 202-380-1181 or by email at [email protected].
Sincerely,

Abbe Land
Executive Director & CEO

The Trevor Project
1875 Eye Street NW, 11th Floor | Washington, DC 20006
202.204.4730 t 202.659.0105 f
www.thetrevorproject.org
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i

Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better
Understanding. Available from http://www.iom.edu/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and-TransgenderPeople.aspx
ii
Department of Health and Human Services. 2010. “Lesbian, Gay, Bisexual, and Transgender Health.” Available from
http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=25
iii
Substance Abuse and Mental Health Services Administration. 2012. “Top Health Issues for LGBTQ Populations.” Available
from http://store.samhsa.gov/product/Top-Health-Issues-for-LGBTQ-Populations/SMA12-4684
iv
Agency for Healthcare Research and Quality. 2012. National Healthcare Disparities Report. Available from
http://www.ahrq.gov/qual/nhdr11/nhdr11.pdf
v
The Joint Commission. 2011. “Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered
Care for the LGBT Community: A Field Guide.” Available from
http://www.jointcommission.org/assets/1/18/LGBTFieldGuide.pdf
vi
Kann, L, et al. 2011. “Sexual identity, sex of sexual contacts, and health‐risk behaviors among students in grades 9‐12 – Youth
Risk Behavior Surveillance, selected sites, United States, 2001‐2009.” MMWR 60(SS07): 1‐133. Available from
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6007a1.htm
vii
Arnold H. Grossman & Anthony R. D’Augelli, Transgender Youth and Life-Threatening Behaviors, 37(5) SUICIDE LIFE
THREAT BEHAV. 527 (2007).
viii
Caitlyn Ryan et al, “Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay, and
Bisexual Young Adults,” 123 PEDIATRICS 346 (2009). Available from
http://pediatrics.aappublications.org/content/123/1/346.full.pdf+html