A report out of the UK gives some promising news, or is it depressing. I'm not sure.
The authors surveyed 1,328 shrinks of various sorts about how they would deal with a client whose main goal was to change from lesbian, gay, or bisexual into a heterosexual.
Only 55 (4%) said that they would help an LGB person try to become straight.
I don't know if it's promising that so few (UK) psychiatrists and therapists would help someone try to change their sexual orientation, or depressing that so many would.
It gets more depressing when you read on to discover that an additional 10% would try to refer the prospective client to someone else who would be willing to help them try to change.
This comes 52 years after the British Wolfenden Report concluded that "none of our medical witnesses were able ... to provide any reference in the medical literature to a complete change".
I think the most interesting part of the report, though, is the justifications that the shrinks who said they would try to help someone change their sexual orientation gave.
Although they reported a wide range of justifications, I want to focus on the idea of promoting patient autonomy. A quick sample of these follow:
“We have a responsibility to assist our patients with self-determination.”
“It is up to the person themselves to decide which direction to go in. I am just the sounding board for them to make their own decisions.”
“Client ultimately knows best and may have deep religious beliefs that influence them enormously.”
“(the) client is ‘the expert’ and I deal with their realities rather than mine.”
“People should be given the opportunity to choose to redirect their sexual feelings depending on their circumstances. For example the homosexual man I helped to become heterosexual came from a working class background where it was completely unacceptable to deviate from the norm. It was extremely important to him to be accepted by that community.”
The dilemma for me is that I'm a big proponent of autonomy and self-determination; that health care providers should spend more time helping people get where they want to go, and less time telling them where to go.
So, on the one hand, I agree with this (small minority) of shrinks that patient autonomy is a very strong ethic that should not be violated.
Any yet, I wonder how many of these shrinks would be such strong defenders of patient autonomy when presented with someone who wanted to become lesbian or gay? How many would assist someone who wanted to develop the ability to see through walls? Or who felt that their life would be so much better if they were just three inches taller?
Would these shrinks be such forceful advocates of patient autonomy when a person wants help to live as the gender they feel they are, not the body they were born into?
I believe the kindest thing to do would be to explain that the change they are trying to undertake is not possible, but perhaps it is better to humor someone's interest in trying to change their orientation long enough to develop a deeper therapeutic relationship that can begin to help them find more realistic ways to live in their bodies, in their minds, and in their communities in a more harmonious fashion.
Hmmm. Certainly has me confused about what the "right" thing to do is.
Annie Bartlett, Glenn Smith, Michael King. (2009). The response of mental health professionals to clients seeking help to change or redirect same-sex sexual orientation. BMC Psychiatry 9:11. http://www.biomedcentral.com/1471-244X/9/11
Report of the Committee on Homosexual Offences and Prostitution. (1957). Her Majesty's Stationary Office, London.
Tuesday, March 31, 2009
Thursday, March 12, 2009
What Explains the General Health Advantage of Gay Men in New York City?
In 2007, the New York City Community Health Survey asked men (and women) how they identified their sexual orientation, and also the standard question "Would you say that your health in general is: Excellent, Very Good, Good, Fair, or Poor?"
44 of 153 self-identified gay men (29%) said they were in excellent health, while 563 of 3,049 self-identified heterosexual men (18%) said they were in excellent health. So, gay men were almost twice as likely to report excellent health (odds ratio = 1.95, 95% confidence interval 1.36-2.79).
What gives? Well, aside from gay men being in better health, there might be a lot of other potential explanations. Like, what if men who identify as gay are just on average younger? Or less likely to live in poverty? Or less likely to be unemployed? All those things are strongly associated with one's subjective assessment of health.
So, I tried controlling for age, race/ethnicity, employment status, educational attainment, being foreign-born, and the ratio of the household's income to the poverty level set for a household of that composition (the poverty threshold for a household with two adults and three kids is a lot higher than the poverty threshold for someone living alone).
Of these, controlling for the ratio of income to poverty made the biggest difference. After controlling for the income:poverty ratio, self-identified gay men were 60% more likely to report excellent health (odds ratio 1.60, with a confidence range of 1.11-2.31).
Controlling for all of them simultaneously explained more of the gap, with gay men being almost half-again as likely as straight men to report excellent health (odds ratio 1.46, confidence range 0.99-2.16).
Still, all things equal, wouldn't you rather be gay in New York City?
Then, I decided to break it down by borough. Gay men in Manhattan were 67% more likely to report excellent health (odd ratio 1.67, confidence range 0.99-2.80), gay men in Brooklyn were 37% more likely to report excellent health (odds ratio 1.37, confidence range 0.58-3.23), and gay men in Queens were only 15% more likely to report excellent health (odds ratio 1.15, confidence range 0.40-3.28). There weren't enough men in this particular sample to say anything worthwhile about the Bronx or Staten Island.
Hmmm... looks like where you live as a gay man has a big influence on how you feel.
44 of 153 self-identified gay men (29%) said they were in excellent health, while 563 of 3,049 self-identified heterosexual men (18%) said they were in excellent health. So, gay men were almost twice as likely to report excellent health (odds ratio = 1.95, 95% confidence interval 1.36-2.79).
What gives? Well, aside from gay men being in better health, there might be a lot of other potential explanations. Like, what if men who identify as gay are just on average younger? Or less likely to live in poverty? Or less likely to be unemployed? All those things are strongly associated with one's subjective assessment of health.
So, I tried controlling for age, race/ethnicity, employment status, educational attainment, being foreign-born, and the ratio of the household's income to the poverty level set for a household of that composition (the poverty threshold for a household with two adults and three kids is a lot higher than the poverty threshold for someone living alone).
Of these, controlling for the ratio of income to poverty made the biggest difference. After controlling for the income:poverty ratio, self-identified gay men were 60% more likely to report excellent health (odds ratio 1.60, with a confidence range of 1.11-2.31).
Controlling for all of them simultaneously explained more of the gap, with gay men being almost half-again as likely as straight men to report excellent health (odds ratio 1.46, confidence range 0.99-2.16).
Still, all things equal, wouldn't you rather be gay in New York City?
Then, I decided to break it down by borough. Gay men in Manhattan were 67% more likely to report excellent health (odd ratio 1.67, confidence range 0.99-2.80), gay men in Brooklyn were 37% more likely to report excellent health (odds ratio 1.37, confidence range 0.58-3.23), and gay men in Queens were only 15% more likely to report excellent health (odds ratio 1.15, confidence range 0.40-3.28). There weren't enough men in this particular sample to say anything worthwhile about the Bronx or Staten Island.
Hmmm... looks like where you live as a gay man has a big influence on how you feel.
Sunday, March 1, 2009
Excellent Health among Polish MSM
In the Polish General Social Survey, they asked about the gender of sexual partners in 1994.
Extreme caution should be used interpreting these numbers, because I'm sure there are cultural and linguistic differences in how the questions are interpreted and answered between the US and Poland.
That and the numbers are fairly small. In general I try to avoid combining gay and bi, or MSM with MSMW, but in this case, the numbers were small enough that I wanted to get more stable estimates.
Only 2 of 31 men who said they had sex with at least one man since age 18 reported excellent health (6% {0%-15%}), while 48 of 322 men who said they never had sex with a man since age 18 reported excellent health (15% {11%-19%}).
I'm nervous about saying much of anything about this data, but it seems like the proportion of men reporting excellent health is lower than the US data, but I would attribute that to language differences until proven otherwise. However, within that context, it does appear that men who have had sex with men in Poland are less likely to report excellent health, perhaps speaking to the general attitudes towards homosexuality in Poland - although not having been to Poland I'm not in a position to say. Anyone with more relevant experience want to comment?
Also interesting is that 31 of 322 men said they had had sex with a man, a much higher percentage than we usually see in US telephone surveys. Should I interpret that to mean that more men have sex with men in Poland, that more are willing to admit it during a telephone survey, or that the question wording is confusing enough that a relatively large proportion gave answers incongruent with their experiences?
I got this data from ICPSR.
Extreme caution should be used interpreting these numbers, because I'm sure there are cultural and linguistic differences in how the questions are interpreted and answered between the US and Poland.
That and the numbers are fairly small. In general I try to avoid combining gay and bi, or MSM with MSMW, but in this case, the numbers were small enough that I wanted to get more stable estimates.
Only 2 of 31 men who said they had sex with at least one man since age 18 reported excellent health (6% {0%-15%}), while 48 of 322 men who said they never had sex with a man since age 18 reported excellent health (15% {11%-19%}).
I'm nervous about saying much of anything about this data, but it seems like the proportion of men reporting excellent health is lower than the US data, but I would attribute that to language differences until proven otherwise. However, within that context, it does appear that men who have had sex with men in Poland are less likely to report excellent health, perhaps speaking to the general attitudes towards homosexuality in Poland - although not having been to Poland I'm not in a position to say. Anyone with more relevant experience want to comment?
Also interesting is that 31 of 322 men said they had had sex with a man, a much higher percentage than we usually see in US telephone surveys. Should I interpret that to mean that more men have sex with men in Poland, that more are willing to admit it during a telephone survey, or that the question wording is confusing enough that a relatively large proportion gave answers incongruent with their experiences?
I got this data from ICPSR.
Measuring Well-Being
While looking for more data on the well-being of gay men relative to str8 men, I came across this initiative in Europe to measure national (and individual) well-being. I don't ordinarily put much stock in these quiz yourself things, but I think the questions they are asking are useful, and it was kind of fun to compare myself to the various European nations that participate.
Although I have Polish, Irish, Scottish, English & Norwegian heritage (and probably more), my own profile more closely resembles the Hungarians - anhedonic but satisfied. Maybe I should visit there, when I can afford to travel again.
And I score really high on autonomy, which is probably a main (non-material) component of why wealthier people generally have much better health than poorer people.
Wednesday, February 25, 2009
more on gay blood donors
A few months back, I posted about the existence of gay blood donors, at least in the General Social Survey.
Now, I have more information from a more authoritative source, with fewer obvious data problems.
The National Health And Nutrition Survey (NHANES) has been periodically conducted, recently on a two year basis.
By combining several surveys together (1988-1994, 1999-2000, 2001-2002, 2003-2004 & 2005-2006), I was able to look at a reasonable number of sexual minority males' blood donation histories in comparison to heterosexual males.
Like GSS, you can break down sexual orientation in different ways in these datasets, each way yields slightly different sample sizes.
sexual orientation identity
Among 75 men who say they are gay, 2 (3%) said that they donated blood in the previous year, and 2 of 56 men who said they were bisexual did (4%), while 214 of 3,873 heterosexually-identifying men gave blood in the previous year (6%).
men who have had sex with men
Among 65 men who have only had sex with men, 2 (3%) said they donated blood in the previous year. 5 of 264 men who had sex with men and women (2%) said they gave blood. 667 of 9,560 men (7%) who have never had sex with a man gave blood.
men who have had sex with a man in the last year
It's one thing for a man who had sex with another man a long time ago to give blood, it's another thing to consider recent sexual activity. Of 117 men who say they had had sex with a man in the last year, 2 said they gave blood (2%), while 209 of 3,626 men who said they had not had sex with a man in the last year did (6%).
Banning gay men isn't working
These figures suggest that the US ban on blood donations from any man who has had sex with a man since 1978 is not working, and should therefore be re-worked in order to create a more sensible donation policy. One that doesn't feel discriminatory. One that doesn't encourage lying. One that isn't so ridiculous that it brings other more reasonable exclusions into doubt. One that doesn't conflate homosexuality with risk.
The numbers from these surveys are more credible than the ones I got from the GSS, which showed an implausibly high rate of blood donations regardless of sexual orientation.
NHANES is based on an in-person survey (the NHANES people literally drive up to your house with an 18-wheeler containing a mobile medical examination center), rather than the random digit dialing of the GSS.
My interest in pulling these data together is merely to document the existence of gay/bi blood donors, and that it is not an especially rare phenomenon, not to say exactly how many gay/bi men donate blood (or straight men for that matter). For that, we'd need even larger samples...
Now, I have more information from a more authoritative source, with fewer obvious data problems.
The National Health And Nutrition Survey (NHANES) has been periodically conducted, recently on a two year basis.By combining several surveys together (1988-1994, 1999-2000, 2001-2002, 2003-2004 & 2005-2006), I was able to look at a reasonable number of sexual minority males' blood donation histories in comparison to heterosexual males.
Like GSS, you can break down sexual orientation in different ways in these datasets, each way yields slightly different sample sizes.
sexual orientation identity
Among 75 men who say they are gay, 2 (3%) said that they donated blood in the previous year, and 2 of 56 men who said they were bisexual did (4%), while 214 of 3,873 heterosexually-identifying men gave blood in the previous year (6%).
men who have had sex with men
Among 65 men who have only had sex with men, 2 (3%) said they donated blood in the previous year. 5 of 264 men who had sex with men and women (2%) said they gave blood. 667 of 9,560 men (7%) who have never had sex with a man gave blood.
men who have had sex with a man in the last year
It's one thing for a man who had sex with another man a long time ago to give blood, it's another thing to consider recent sexual activity. Of 117 men who say they had had sex with a man in the last year, 2 said they gave blood (2%), while 209 of 3,626 men who said they had not had sex with a man in the last year did (6%).
Banning gay men isn't working
These figures suggest that the US ban on blood donations from any man who has had sex with a man since 1978 is not working, and should therefore be re-worked in order to create a more sensible donation policy. One that doesn't feel discriminatory. One that doesn't encourage lying. One that isn't so ridiculous that it brings other more reasonable exclusions into doubt. One that doesn't conflate homosexuality with risk.
The numbers from these surveys are more credible than the ones I got from the GSS, which showed an implausibly high rate of blood donations regardless of sexual orientation.
NHANES is based on an in-person survey (the NHANES people literally drive up to your house with an 18-wheeler containing a mobile medical examination center), rather than the random digit dialing of the GSS.My interest in pulling these data together is merely to document the existence of gay/bi blood donors, and that it is not an especially rare phenomenon, not to say exactly how many gay/bi men donate blood (or straight men for that matter). For that, we'd need even larger samples...
Wednesday, February 11, 2009
Proud of my grandfathers...
So, the other day I heard about the boost in wind power that's likely to come about as part of the stimulus. I figure that GE's turbines are probably likely to be heavily favored in the US now matter how they stack up to the turbines from Denmark & Spain.
I had a faint memory that my grandfather had something to do with turbines at GE, so I called my mom, and she confirmed that her dad worked at GE in Schenectady as a turbine inspector, doing the final inspections on these enormous pieces of equipment before they got shipped out.
So, finally something to be proud about GE for, despite decades of harsh layoffs that severely affected my extended family in upstate NY.
A little more about my mom's dad. He arrived in the US as an infant in the arms of a single mother from Krakov, Poland just before the turn of the 20th century. I'm not sure how he and his wife met, but they settled on a small subsistence farm in Schohaire county, outside Albany/Schenectady, that my uncle continues to maintain to this day.
They raised eight children on that farm, my granddad working nights at the GE plant inspecting turbines, and working days on the farm with his wife and kids.
Somehow, they managed to keep all those kids fed and clothed, no mean feat in itself, but their proudest achievement was sending each and every one of those kids through college.
And now I'm teaching college. Pretty dang cool.
So, my mom and dad met while teaching at Ithaca High School, where they both started teaching after college. My dad was also a crew coach at Cornell, but that's another story.
His dad was a chemical salesman for Monsanto for most of his life, towards the end of his career he got into training other chemical salesmen. He was for a brief period the head of the New England Chemical Club, who used to invite various of the Red Sox out to the
ir dinners and watch them make asses of themselves getting drunk among the various employees of the chemical industries.
And now I do research on the impact of chemicals on people's health. Pretty dang cool.
His dad (my great-granddad) in turn was someth
ing of an inventor, which I didn't know until various patents started showing up on the internet - an umbrella design - one of the early designs for a carbeurator - and a modular box design. I don't know if he made money off any of these inventions or not, and I don't know much else about the man at all. But an umbrella design, how cool is that. I'm tempted to go out and have one special-made for me using his design.
I had a faint memory that my grandfather had something to do with turbines at GE, so I called my mom, and she confirmed that her dad worked at GE in Schenectady as a turbine inspector, doing the final inspections on these enormous pieces of equipment before they got shipped out.
So, finally something to be proud about GE for, despite decades of harsh layoffs that severely affected my extended family in upstate NY.
A little more about my mom's dad. He arrived in the US as an infant in the arms of a single mother from Krakov, Poland just before the turn of the 20th century. I'm not sure how he and his wife met, but they settled on a small subsistence farm in Schohaire county, outside Albany/Schenectady, that my uncle continues to maintain to this day.
They raised eight children on that farm, my granddad working nights at the GE plant inspecting turbines, and working days on the farm with his wife and kids.
Somehow, they managed to keep all those kids fed and clothed, no mean feat in itself, but their proudest achievement was sending each and every one of those kids through college.
And now I'm teaching college. Pretty dang cool.
So, my mom and dad met while teaching at Ithaca High School, where they both started teaching after college. My dad was also a crew coach at Cornell, but that's another story.
His dad was a chemical salesman for Monsanto for most of his life, towards the end of his career he got into training other chemical salesmen. He was for a brief period the head of the New England Chemical Club, who used to invite various of the Red Sox out to the
ir dinners and watch them make asses of themselves getting drunk among the various employees of the chemical industries.And now I do research on the impact of chemicals on people's health. Pretty dang cool.
His dad (my great-granddad) in turn was someth
ing of an inventor, which I didn't know until various patents started showing up on the internet - an umbrella design - one of the early designs for a carbeurator - and a modular box design. I don't know if he made money off any of these inventions or not, and I don't know much else about the man at all. But an umbrella design, how cool is that. I'm tempted to go out and have one special-made for me using his design.
Saturday, February 7, 2009
The Case of Sally Goodman
Just found out that a short entered in the National Film Challenge 2008 48 hour competition The Case of Sally Goodman was shot in the house I live in. Apparently my dog gave a bunch of the crew allergies, so they had to cut out some scenes with sniffling in them.
John park's office is my roomie's bedroom, the cafe is our kitchen, and everything was shot right here in the span of one day. Pretty impressive!
John park's office is my roomie's bedroom, the cafe is our kitchen, and everything was shot right here in the span of one day. Pretty impressive!
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