SERVICE LEARNING: Options for This semester

Organ Transplant: Culture and Disease

To understand the connection between culture and our notions of HEALTH and ILLNESS, it is interesting to look at the phenomenon of organ transplant and the way that it is understood and received cross-culturally and within diverse communities in American Culture:

VIEWS OF ORGAN TRANSPLANT

• Hegemonic Views from Allopathy:
• Body is an organic machine with replaceable parts
• Mind and body are separate aspects of human beings, the body may be understood as an interrelated set of components whose function is mechanistic (Gordon 1995)
• parts are absent "identity" 
• parts are equal in their value and have no other cultural meaning attributes
• heart
• face
• eyes
• hand
• brain?
• blood
• are there cultural meanings here? 
• What might their potential significance be?
• organs and the embodiment of SELFHOOD, notions of CONTAGIOUS MAGIC and enbodiment
• meeting the donor's family-special significance?
• how might this impact organ donation rates and attitudes about organ transplants
• ORGANS are COMMODIFIED as are other parts of the body
• organ sales
• exploitation of the poor and vulnerable (Dirty Pretty Things)
• access to "lists" as a product of Racism and privilege
• Redefinition of DEATH as BRAIN DEATH in order to facilitation transplantation
• resistance to this definition
• abuse perceptions subject to this definition
• COST is justified as "war" on the body as "controlled" by culture.
• Drs. especially surgeons are HEROIC and at the "frontiers" of medicine 
• seen as "miracle workers"
• artificial heart experiments and Dr. DeVries
• separation of conjoined twins
• "GIFT OF LIFE"
• Mauss (1954) and the notion of gift giving and the cultural importance of reciprocation in exchange.
• no reciprocation is possible (dilemma culturally) 

THE LGBTQIA COMMUNITY---Cultural Presuppositions

• Notions of health and wellbeing related to embodiment
• how do these differ from the hegemonic culture
• are the body and mind distinct and separate unrelated entities?
• Is gender purely a "social/cultural construction"?
• How are gender and sexuality and sex and sexual preference interrelated concepts?
• do these have alternate meanings in the LGBTQIA community?
• how will this impact their access to healthcare, services and wellbeing?

Health and Wellness in the News (ongoing updates for discussion)

Zika's Likely to Spread Across Americas
MORE on Zika
STILL MORE on Zika

Environmental Racism

http://www.medpagetoday.com/MeetingCoverage/SMFM/56079

http://www.cnn.com/2016/02/08/health/birth-bags-around-the-world-photos/index.html

http://www.wbfinder.com/home.aspx

http://www.gallup.com/poll/188810/hawaii-reclaims-top-spot.aspx

http://www.cdc.gov/hrqol/wellbeing.htm

Twitching Epidemic!

What's So Alternative About Alternative Medicine?

Why is there alternative medicine?

• The view that biomedicine should be the only legitimate practice of healing has been challenged.
• alternative healing is not a fashionable trend, it is a WELL-ESTABLISHED CULTURAL STRATEGY and a dynamic, heterogenous feature of most contemporary medical landscapes---a way that people seek to maximize their chances for wellbeing and adapt to the rapidly changing and unfavorable circumstances, by drawing on multiple sources and resources of knowledge and authority.
• WHAT IS IT?-hard to define
• there is such a variety of options which are quickly disseminated on the internet and an integration of various alternatives with biomedicine
• ORTHODOX (biomedicine) defended from "heroic medicine " of the colonial era, which endorsed aggressive measures such as sweating, purging, and toxic drugs. It was in contrast to heterodox medicine "sects" which upheld the gentler methods and the view that healing involved the strengthening of ones VITAL FORCE and required more than just mechanistic interventions
• homeopathy-
• the treatment of disease by minute doses of natural substances (distillations) that in a healthy person would symptoms of disease
• botanic medicine-
• use of healing through plants and other natural compounds
• osteopathy-
• healing through the manipulation of the bones of the body.
• hydropathy-
• the treatment of illness through the use of water, internally and externally (baths, steams & spas)
• chiropractic-
• like osteopathy, but focusing on spinal misalignments
• Christian Science-
• sin and illness are illusions that can be overcome by prayer. refuse any other intervention
• various folk medicines
• The practice of alternative therapies has always been deeply rooted in in class and ethnic distinctions and relations, and therefore a highly political process
• they have also become VENUES OF CULTURAL CRITICISM AND RESISTANCE and EMPOWERMENT in many parts of the world
• What constitutes the mainstream at any one particular time may be questionable or alternative a century later
• leeches
• blood letting
• electric shock
• hysterectomy
• zoo-therapies (Parasites ingested for Crohn's disease, e.g.)
• saltwater rinses and gargles
• neti pot or ear candeling
• Practices that originate elsewhere until they become familiar are always alternative
• Chinese medicine
• acupuncture
• DOUBLE-BLIND PLACEBO CONTROLLED MEDICAL TRIALS (gold standard for in Western medicine) are elaborate and expensive, so rarely available to prove the efficacy of alternative therapies
• SO..."different from the usual or conventional: existing or functioning outside the established cultural, social, or economic system" ALTERNATIVE
• subversive
• grassroots
• lack of standardization
• Sickness and suffering are not just natural processes. They are socially produced and shaped by local and global patterns of social inequality and power relations.

THE RISE OF INTEGRATIVE MEDICINE

• 1 in 3 people in the US use some sort of alternative therapy
• ethnographic studies have shown that traditional practices and beliefs involving health, illness and healing were NEVER fully extinguished. They live on, though they may be frowned upon
• are we in "a golden age of quackery"?
• governments are eager to assess and regulate these practices which can provide additional sources of income and novel cost containment solutions, as the cost of biomedicine rises.
• DANGERS OF MAINSTREAMING CAM?
• the loss of self-help and grass-roots ethos that have historically characterized alternative medicine-EXPENSIVE (as practitioners become bureaucratized, professionalized and commercialized they become luxuries for the wealthy)
• practitioners are understandably distrustful of biomedical specialists getting training and licenses in  hybrid, inauthentic fields like "oriental medicine" so that they can compete in the market

THE ANTHROPOLOGICAL APPROACH

•  explores the diversity of popular methods in cultural context
• seeks to clarify the VALUE and MEANING that these methods contribute to the lives of patients, practitioners, and communities
• seeks to understand how these meanings and values (etiologies) and therapeutic methods are constructed, imagined or contested in time and space.
• seeks to validate the experiences and testimonies of non-biomedical therapies rather than prove or disprove their objective validity in quantitative terms

THEMES TO BE EXPLORED

• diverse approaches to health and illness and healing engage mindful social , and political bodies which are shifting and permeable
• flow and circulation are central to biological and social life, wellness and healing.
• healing experiences are mediated through EMOTION, INTER-RELATIONS, MOVEMENT, SENSUAL EXPERIENCE, while they are rooted in local contexts
• the senses act and interact with the world in dynamic and complex ways. Their role in healing goes well beyond current Western conceptions and approaches

HISTORY OF ANTHROPOLOGY & MEDICINE

• Western medical training prioritizes the workings of the MACROSCOPIC PHYSICAL & BIOLOGICAL SCIENCES, and the notion of the NEUTRAL OBSERVER.
• This makes Western medical students and doctors uneasy with models that do not employ these notions. (non-Western systems) 
• if you cant measure and compare it, it aint real!
• medical anthropology developed out of the attempt to understand the health-related beliefs and practices in their local cultural context.
• medical anthropologists explore culturally situated ideas, norms and practics related to health and illness, natural and supernatural. 
• health and healing are approached as CULTURAL CONSTRUCTS (not scientific facts), expressed symbolically through language, informed by particular historical, socioeconomic, and political circumstances. 

HEALING AND THE POWER OF AGENCY

• the ability to heal confers high status in all societies (social and cultural)
• traditional healers are often born into families or lineages of healers and apprentice through family members who are also healers 
• may be "odd" people or have an ecstatic experience early in life, suffer from unusual conditions (epilepsy) or show signs of special healing powers from birth
• Western medicine believes in a SINGLE CURE for every illness, so it is difficult for us to understand the traditional healers may suggest a number of different herbal cures, for instance.
• Herbal medicine (traditionally)
• different parts of the same plant prepared in different ways and used in different combinations with other aspects of curing are used for different purposes 

• In Western hierarchtical medical systems, the distance between patient and biomedical doctors is vast and communication is impeded by terminology and social awkwardness, such as hesitancy of patients to ask questions. 

THE DOCTOR PATIENT RELATIONSHIP AND THE ROLE OF THE PATIENT

• Models:
• ENGINEERING MODEL
•  patient directs his/her own care; doctor assists
• this model has the highest agency of the patient and is now beginning to be encouraged , has led to the rise of CAM 
• PRIESTLY MODEL
•  patient is passive, trusting and obedient; doctor has full authority
• paternalistic
• describes traditional western medicine 
• CONTRACTUAL MODEL
•  legal agreement between to parties who share the same goal
• COLLEGIAL MODEL 
•  trust between patient and doctor with equal effort

• THE SICK ROLE (in sociology-Parsons)

• Parsons was a functionalist sociologist, who argued that being sick means that the sufferer enters a role of 'sanctioned deviance'. This is because, from a functionalist perspective, a sick individual is not a productive member of society. Therefore this deviance needs to be policed, which is the role of the medical profession. 
  • The general idea is that the individual who has fallen ill is not only physically sick, but now adheres to the specifically patterned social role of being sick. 
  • ‘Being Sick’ is not simply a ‘state of fact’ or ‘condition’, it contains within itself customary rights and obligations based on the social norms that surround it. 
  • The doctor patient role is inherently hierarchical  
  • The theory outlined two rights of a sick person and two obligations:
• Rights:
  • The sick person is exempt from normal social roles
  • The sick person is not responsible for their condition

• Obligations:
  • The sick person should try to get well
  • The sick person should seek technically competent help and cooperate with the medical professional

AGENCY: CAM versus BIOMEDICINE

• CAM practitioners spend more time with patients perceptions and experience of illness.
• individualized attention, and a greater willingness to listen to patents concerns have contributed to the popularity of many alternative therapies (Mediation) >Agency

• BIOMEDICINE: spend little time with patients
• seek to elicit specific complaints  (symptoms)dominate conversations and expect unswerving obedience from patients (Coercion) <Agency

CULTURAL CONSTRUCTIONS AND WHY THEY MATTER TO HEALTHCARE 

• drapetomania, hysteria, onanism...and...
• speaking against a repressive state=mentally ill
• alcoholism ? PTSD? PMS? "pre-diabetes"? 
• These are created, deleted and legitimated through overt and covert channels of power...as are policies, programs and drugs to treat them.
• resources and blame are also redirected, everyone is encouraged to take stock and seek treatment
• deeply embedded in modern capitalist society

CORE CONCEPTS -DEFINITIONS OF "HEALTH"

• BIOMEDICAL PERSPECTIVE: health : the absence of disease -NEGATIVE
• disease: the malfunction or disturbance, usually physical or biochemical in nature
• may have a disease (arthritis) but feel "healthy...never hurt and visa versa
• HOLISTIC PERSPECTIVE: health is a state of harmony and balance and wellbeing (includes physical as well as emotional, mental, social and spiritual aspects of a person) -POSITIVE
• from the holistic perspective if someone is feeling ill, something is out of balance-there is disharmony
• roots of suffering are social, emotional or supernatural, depending on your cultural beliefs
• healing traditions have a way of addressing the discomfort and re-balancing a person to restore health. HEALTH IS A NATURAL STATE
• analogy of beauty: if beauty is defined in positive terms as harmonius and balanced or pleasant appearance, those blemishes may matter less.

There is a Japanese art form called Kintsukuroi which literally means “to repair with gold.” It is a potter’s art. When a clay bowl or vase falls to the ground and shatters, the potter gathers the pieces and artfully reassembles it using gold or silver lacquer. The result? A functional piece with elaborate veins of gold and silver holding it together making it even more beautiful for having been broken.
Kintsukuroi expresses a profound eternal truth… when we stop pretending to be strong and allow ourselves to be loved in our weakness, we become strong. When we collapse into our insecurity, we become secure. When we allow love to flow into us instead of fear and self-consciousness, we transform it into genuine other-centeredness, connected to everything and everyone. Our wounds and scars become the cracks that most brightly reflect the presence of this connection (treasures in jars of clay).

Much like beauty, health is not a hard fact of life, but a personal judgement and a subjective experience in the mind of the beholder

FIVE MODELS OF HEALTH (Owen)

1. PATHOGENIC MODEL: looks at an external cause (aetiology)
2. BIOLOGICAL MODEL: focuses on symptoms, recognizing that a single cause may produce different effects in different systems
3. HOLISTIC MODEL: many aspects of the patient and the environment are involved and connected through a mutual feedback, and that illness may be necessary to affect a change in that environment or person
4. HOLOGRAPHIC MODEL: symptoms reflect the "whole picture" and the "essence of the person" no matter where they occur in the body
5. RELATIONAL MODEL: highlights the role of the "context" of symptoms and the patients relationships, including the relationship with the healer

disease (biological) versus illness (subjective experience)?????? regardless of whether there is confirmation of the illness or not, to the sufferer it represents the personal and social experience of malfunction or discomfort in particular cultural contexts

the EXPERIENCE of illness is based on the cultural context of illness and suffering.

CURING OR HEALING:

• HEALING 

• Healing is the therapeutic process or action that addresses the whole suffering person and the illness rather than just the specific body part or a particular problem-includes emotional, mental, social and spiritual needs and concerns in the treatment plan. 
• Healing aims at bringing about improvement 
• no enemy, nothing to be destroyed, making whole- may not return to original state

• CURING 

• Curing has the goal of removing a particular problem completely and permanently, whether that may be a disease, social or spiritual disorder mental or emotional dysfunction, etc.
• curing aims to eliminate condition, healing aims to restore balance
• in traditional settings, FAMILY and COMMUNITY are usually involved in healing and curing. 
• biomedicine: kill the enemy, elimination or destruction of external illness-return to original state

Harikari: suicide as social healing in japan-since the ki resides in the abdomen ( and it redresses social imbalance and disruption through dishonor)

BIOMEDICINE VERSUS TRADITIONAL MEDICINE (summary)

• Biomedicine
• employs mechanical model of the human body
• treats each organ and each person in isolation
• emphasizes causation and responsibility (blame)
• sees TARGET MEASURES for health (height, weight, red blood cell count, blood pressure
• focus is on "magic bullet" (drug)
• Ethnomedicine
• illness results from a complex combination of natural and supernatural causes
• requires a combination of therapies to achieve a cure
• aim is to restore harmony (which may not be original state)
• no magic bullet, community and family are important considerations (social world)

NORMALITY:

normality is shaped by cultural forces

• MEDICALIZATION -what used to be normal can come under the domain of biomedicine and medical surveillance
• pregnancy and child birth
• aging
• menstruation (the curse) 
• constitutional states
• alcoholism
• ADHD
• PMS 
• altered states of consciousness
• infertility
• defiant disorders
• "micromastia" small breasts
• menopause (hormone deficiency) 

• "TYRANNY OF NORMAL" overemphasis on "normality" that leads to excessive interference with the minds and bodies of people who do not meet these measures, or social stigma
• abort abnormal fetuses (Dwarfism)
• Southern Europe and Middles East: light eyes: give the evil eye, red hair=witchcraft
• Africa: albinos: may be kidnapped and killed for their body parts (magical)
• CORRECT ABNORMALITIES MEDICALLY IF WE CAN
• south africa: schizophrenia=healer
• PLACEBO: the "nothing" given of the placebo is far from nothing at all...it is the impact of the anticipation, meaning, and cultural context of healing-GENUINE AND POWERFUL HEALING FORCE IN ITS OWN RIGHT
• The nocebo effect is the adverse reaction experienced by a patient who receives a nocebo. Conversely, a placebo effect is an inert substance that creates either a beneficial response or no response in a patient. The phenomenon by which a placebo creates a beneficial response is called the placebo effect. In contrast to the placebo effect, the nocebo effect is relatively obscure. 
• Both nocebo and placebo effects are psychogenic. Rather than being caused by a biologically active component of the placebo, these reactions result from a patient's expectations and perceptions of how the substance will affect him or her. Though they originate from psychological sources, nocebo effects can be either psychological or physiological. 

 GENDER AND MEDICINE 

• women
• more likely to be accused of witchcraft when they are successful in ways that are not available for women
• Reproduction: regulated
• women's bodies :regulated more than men's 

TWO TYPES OF ILLNESSES RECOGNIZED IN ANTHROPOLOGY

• NATURALISTIC
• emphasize the physical body and the environment as causative and therapeutic agents 
• unintentional harm 
• PERSONALISTIC
• prioritize the role of social and supernatural factors
• tend to point to intentional harm 

FACTS and TRUTHS: understanding others

• EMIC vs ETIC perspectives
• post-rationalism: holds that there is no one truth, but many truths, so there is an interest insharing perspectives and experiences in CAM and alternative medical camps (KLASS)
• growing mindset in American culture which allows people to believe in and make use of alternative practices while also using biomedicine 

HYGIENE HYPOTHESIS:

• biomedicine has waged a war on viruses, bacteruia and parasites, but can some of these be beneficial? Can soone be "healthy" with these present?
• MODERN LIFE is seen as the cause of many diseases instead (asthma, fibromyalgia, allergiescrohn's disease. HYGEIENE itself is to blame
• the birth canal: what is lost in a C-section?
• what is killed with antibacterial soaps?
• what is good about kids getting pin-worms?
• what is lost in genetic engineering of food plants and commodification of seeds by bio corporations?

PINWORMS ARE GOOD?

CRITIQUE OF WESTERN SPIRITUALITY/WELL-BEING (Richard King)

• "spirituality" in the West are a"silent takeover of religion and Asian wisdom traditions by the forces of market capitolism which promote INDIVIDUALISM and CONSUMERIST SPIRITUALITIES"
• Yoga & Toaism originally sought to extinguish self-centeredness and the attachment to material things while fostering RENUNCIATION COMPASSION and SIMPLICITY-
• have been adopted and rebranded for Western tastes and agendas; becoming primary tools for HEALTH, LONGEVITY, and PROFESSIONAL ACHIEVEMENT.

• The World's Traditional Religions and practices provide a vital source for RESISTANCE to the way that these forces are operating in biomedicine (unrestrained commercialism & commodification of life itself)
• ALTERNATIVE MEDICINES arise from these traditions, creating hybrid therapies

Healers and Healing Professionals

Societies may have few or a number of overlapping healers and healing professionals. There are various TYPES of healing dynamics in societies:

• Everybody Can Heal:
• in small scale societies (like H/G bands) curing knowledge and therapeutic practices is known and practiced by most adults in the group.It is a common knowledge
• Part-Time Specialists:
• among village based horticulturalists, some individuals may be known for special healing skills, but they only carry out healing as a part time occupation (spare time after subsistence activities are met)
• Plural Medical Systems:
• societies that have many distinct healing roles
• more highly stratified societies with wider political integration
• full-time professionals
• healing roles compete and interrelate with each other in these plural medical systems

HEALING ROLES: Organizing the Diversity

• Authur Kleinman (1980) distinguishes between three kinds of healthcare sectors:
• Popular Healthcare Sector
• general body of knowledge available to the populace as a whole
• sickness is usually managed at the the level of the household
• usually under the supervene of females (mothers, and other adult females)
• not a privileged activity
• Professional Healthcare Sector
• healing is carried out by persons with specialized training and knowledge 
• standardized formal training based on an organized body of knowledge
• credentials or licenses required to practice
• structured relationship among those in the profession
• organizations which reinforce the standards of practice, share knowledge and protect the profession from competitors
• EXAMPLES: Ayuvedic medicine, Biomedicine, Accupuncture, Japanese Herbal Specialists
• Folk Sector
• nonprofessional, non-bureacratic specialists
• informal education often by apprenticeship 

The boundaries between these three sectors are highly contested:

• practices and knowledge may be borrowed and adapted across sectors
• folk healers initiate processes of professionalization
• competition within and between sectors
• professionals attempt to discredit the practices of their competitors by discrediting the quality of their training and knowledge on which their STATUS is based
• examples: Biomedicine versus: Homeopathy, Osteopathy, chiropractic

SOCIAL AND CULTURAL DIMENSIONS: General Concepts

• Sociologist Paul Starr (1982) Healing roles do not always come with high social status. healing professions gain POWER and PRESTIGE when they acquire social and cultural authority and convert that authority into economic and political control over the medical domain.
• DEFINITIONS
• AUTHORITY: the possession of some status, quality or claim that compels trust or obedience-may be grounded in the threat of physical coercion (violence or imprisonment), persuasion (indoctrination), or on willing consent
• when subordinates must depend on those that have authority over them (depend on the doctor for the treatment)
• the superior role must be culturally legitimated by shared values and interpretation of reality. (the body, the meaning of illness, etc.)
• SOCIAL AUTHORITY: the control of action through the giving of commands (resides in people)
• CULTURAL AUTHORITY:the construction of reality through definitions of fact and value, can reside in people, products (religious texts, standards, scientific works, folk wisdom)
• these two kinds of authority are not always combined. They may act without accompanying each other.

THERAPY OUTCOMES AND HEALER AUTHORITY

• The ability to CURE is the greatest source of authority of both kinds: anything that appears to his/her clients to be a cure
• But it is difficult to assess therapeutic results as a researcher because:
• many illness heal themselves, but curer may be credited with the healing
• patients do not necessarily apply the same criteria as healers or investogators when assassing the results of their therapy
• an individual case of sickness may have social significance that a successful cure would have to address in addition to the physical symptoms
• chronic conditions may have no clear point at which a therapy may be said to have ended and its results achieved. 

• when the results are ambiguous or negative, the healers authority can suffer.:

 When European colonists brought a plethora of new diseases to the new world, the resulting sickness and death was staggering. Shamans and other healers were useless in the face of these new diseases, and the quickly lost credibility in their communities. This represented a significant loss of social and cultural authority.This undermined the religious beliefs and entire social fabric on which their cultural authority rested.

AUTHORITY & FOLK HEALERS

• Folk healers operate in legal and social marginality=SOCIAL AUTHORITY
• strategies
• maintain a very low profile to avoid the notice of local officials
• some bank on the support of well-known clients who have power 

• Cultural authority rests on:
• the capacity of the healing tradition to adapt to changing social circumstances
• generally have relatively HIGH CULTURAL AUTHORITY and low social authority in plural medical societies

AUTHORITY OF BIOMEDICINE

• what sets biomedicine apart, so that it has gained widespread authority, transcending cultural boundaries?
•  19th century=weak
• 20th century=solidified authority by:
• standardizing medical education
• improving the structure and function of hospitals
• lobbying for legislation against the healing practices of its competitors
• essentially creating a new SOCIAL AUTHORITY and a resulting ECONOMIC MONOPOLY for the profession

• developed a close relationship with COLONIAL ADMINISTRATIONS and therefore DEVELOPMENT and the GLOBAL SPREAD OF CAPITALISM. 
• this has created a linkage between biomedicine and Western political-economic goals-domestically and internationally

• OUTCOMES OF BIOMEDICINE
• improved therapeutic outcomes resulting from scientific and technological developments, aimed at understanding disease and human physiology=RECIEVED THE CREDIT
•  notable: bacterial infection and the development of antibiotics
• improved surgical techniques
• "miracles of modern medicine", "medicine will find a cure"
• BUT how many of these statistics are linked to improvements in the standards of living, construction of a public health infrastructure?

• Cultural Authority & Biomedicine
• "PROGRESS" -biomedicine is bundles with international development and Western science and technology
• "MODERNIZATION"

CHALLENGES TO BIOMEDICAL AUTHORITY

• "crisis in American Medicine"
• COST prohibitive/access unequal
• have fought attemps at universal coverage at every turn since the 1920s
• seen as a challenge to the autonomy of the individual dr 
• source of unequal or lack of access for many
• questionable ethics
• feminist critique: medical control of women and their reproduction
• lack of research for women and minorities 
• impersonal treatment of patients
• increasingly devoted to technology & specialization of experts rather than patients 
• unjustified claims
• IATROGENIC DISEASES:those caused by the process of treatment
  • Longer lifespan due to changes in the standards of living, not Western medicine
  • decline of crowd diseases occurred well before the development of vaccines and antibiotic treatments due to improved sanitary conditions and practices and better nutrition
  • BAD DRUGS: Thalidimide, chemotherapy, interactive drugs, psychactive drugs overprescribed. antibiotics overused

  IMPACT OF CRITIQUE
  • Loss of Cultural Authority
  • malpractice lawsuits
  • resurgence of "Alternative healing"
  • distrust of doctors

Community Partners

These Community Partners will help us to understand the health and well-being of LGBTQIA youth in Atlantic County and in their service area in Atlantic City. Each of these organizations offers a different perspective on the youth in the LGBTQIA community, and will be a valuable resource for us as we begin to fully understand the health challenges of LGBTQIA youth.

We will be dividing into 6 groups and conducting ethnographic interviews at the following sites:
1. Atlantic City High School- explore the existing institutional support for LGBTQ youth. Interview service providers. Not student groups and organizations and their role either as LGBTQ or ally organizations.
2. Pleasantville High School-explore the existing institutional support for LGBTQ youth. Interview service providers. Not student groups and organizations and their role either as LGBTQ or ally organizations.
3. South Jersey AIDS Alliance/Oasis
4. GLBT Alliance: Interviewing adult members about their experiences coming out, accessing healthcare and health information, experiences with homelessness, challenges to the community.
5. Covenant House: Explore services already offered at this faith based organization along with the number of LGBTQ youth served. Interview staff, service providers and those over 18 if possible
6. Google Survey: Design and implement google survey to collect data from LGBTQ teens. This will be supported by Dr. Erbaugh's class as we develop a survey to collect QUALITATIVE data.

1. SJAA/OASIS: 

Mission Statement
The South Jersey AIDS Alliance is a caring, compassionate Organization dedicated to the fight against HIV/AIDS.

Vision Statement
To be recognized as a dynamic organization that is able to efficiently and effectively provide the diverse and integrated program delivery needed to meet the challenges of the rapidly changing nature of the worldwide HIV/AIDS epidemic.

Drop in Center
Oasis, located in Atlantic City, providing assistance to individuals living in the Atlantic City Area. It provides services such as; snacks, showers, laundry services, telephone use and more.

Contact: COO Georgett Watson gwatson@sjaids.org

2. COVENANT HOUSE:

Covenant House New Jersey Mission Statement:

We who recognize God's providence and fidelity to His people are dedicated to living out His covenant among ourselves and those children we serve, with absolute respect and unconditional love. That commitment calls us to serve suffering children of the street, and to protect and safeguard all children. Just as Christ in His humanity is the visible sign of God's presence among His people, so our efforts together in the covenant community are a visible sign that effects the presence of God, working through the Holy Spirit among ourselves and our kids.Residential Crisis Center 

929 Atlantic Avenue
Atlantic City, NJ 08401
609-348-4070
Our Residential Crisis Center welcomes kids 24-hours-a-day offering a compassionate welcome, a hearty meal, a shower, a fresh set of clothes, a warm bed, and other basic needs and vital social services. The shelter, also offering services for moms with young children, provides a safe haven for youth to live while they stabilize their crises and work on a plan to transition to a stable living environment where they can continue to progress in their life goalsRights of Passage 227 N. South Carolina AvenueAtlantic City, NJ 08401609-348-1421Rights of Passage (ROP) is a 12-18 month transitional living program that provides young men and women between 18 and 21 with the chance they need to make a life for themselves away from the street. The program is designed to provide young people with the tools they need in order to become self-sufficient, productive members of society. With the help of staff, mentors and volunteers, Rights of Passage residents are provided with educational and vocational opportunities and the skills needed to live on their own. Resident advisors facilitate life skills workshops on topics such as money management, cooking, building healthy relationships and improving self-esteem. 

Contact:

3. At lantic City High School
Contact in Guidance Department: Laurie Carter 609.343.7300 X2098

4. Pleasantville High School
Contact in Guidance Department: Michael Pilate 609.383.6900 X4125

5. AC XCLUSIVE: 
Afterschool arts and dance program and community-based youth motivation
Contact: Latoya Dunston 609.385.2238

6. GLBT Allaince AC
Contact: Rich Guilite
rgulite@atlanticare.org  



SAMPLE EMAIL CONTACT:

Dear Community Partner,

As Stockton University expands its campus into Atlantic City in 2018, a focus of curricular and mission development will be on growing connections between the campus and community. In this service, Stockton is exploring plans to create an  LGBTQ Safe Space, which will provide much needed services, social and extracurricular activities, protection and advocacy for LGBTQIA youth and teens in Atlantic  City and Atlantic County. 

In this effort, Stockton is partnering with [organizations  like yours] in order to gather information about existing services, assess needs, and identify challenges that impact LGBTQ youth. We are a group of anthropology/sociology students enrolled in World Perspectives on Health with Professor Laurie Greene (609.214.6596, laurie.greene@stockton.edu). We would like to find time at your convenience to meet with you to interview[your staff/support personnel/guidance professional/any other relevant staff] that we might gain from your experience working with LGBTQ youth at [organization].

Please contact us at your earliest convenience. We are tasked with collecting this information in the next 60 days, so that the process of establishing the safe space can move forward. Prof. Greene can be contacted as our supervisor with any questions or concerns.

Thank you for helping to improve Stockton University's positive impact on our community.

Sincerely,
names
________________________
Researchers in groups:

(1) you are charged with doing library research to support the data collection and analysis of your research groups.this will include searching published articles for data on LGBTQ youth and the programs which support them in organizations that you are studying.

(2) Schools: please make sure to look at the PROGRAMMING and SUPPORT SERVICES offered to students in AC HIGH and Plaesantville, along with BEST PRACTICES found around the country. How do our schools in this county measure up to these best practices?

(3) GLBT Alliance ; search for LGBTQ organizations here in AC and compare these to what is found in surrounding area (100 mile radius, rest of NJ)

(4) Community Organizations: search our area and surrounding area to see what services are offered and how we measure up 

Health Concerns of LGBTQ Youth-Starting point

10 Physical and Emotional Health Concerns of LGBTQ Students

posted on June 17, 2013

by Ric Chollar, LCSW

CW: discussion of homo-/bi-/transphobia, mental illnesses and mental disorders, depression, anxiety, suicide, STI and HIV stigma, substance and drug abuse, and body image/body shaming

LGBTQ STUDENTS FACE unique challenges related to physical and emotional health care. College counselors and health care providers need to be aware of these concerns. Many of the issues are interrelated, impacting one another, with a common theme of coping in a potentially hostile, homophobic, anti-LGBTQ world. Keep in mind that the vast majority of queer students arrive and thrive at college as extremely healthy, confident, strong, and resilient young adult. Thus not all LGBTQ students will experience these physical and emotional health problems, but a number of students might (and some with life-threatening severity). The following resource identifies ten area of concern regarding the health care and counseling of LGBTQ students. By actively being aware of these concerns, a campus can be better prepared to offer support and possibly prevent escalation of a particular issue or concern.

1. ACCESS, COMFORT, AND TRUST IN PROVIDERS      For campus health and counseling centers, creating a welcoming environment for LGBTQ students includes outreach, visual cues in office space, language and questions on intake forms, policies for nondiscrimination and confidentiality, and provider’s verbal and nonverbal communication. Because of negative past experiences with counselors and health providers, the power imbalance between provider/counselor and student, and student’s history and fear of anti-LGBTQ oppression – many LGBTQ students will not disclose their orientations, same-sex behavior, or gender variance in initial counseling or health care sessions. Others avoid seeking health care altogether. It is up to the provider to demonstrate an atmosphere of openness, inclusion, and affirmation with students of all genders and sexual orientations. Ways providers can contribute to a trusting relationship include: using open questions in their assessment interviews (e.g., “Are you attracted to men, women, or both?”); being explicit about protecting privacy and confidentiality; and learning about LGBTQ campus/community resources.

2. COMING OUT      The “coming out process” speaks to the experiences of many, but not all, LGBTQ students as they discover, accept, explore, and disclose to others their sexual orientation or gender identity. Understanding sexual and gender identity development is a step in gaining knowledge and perspective about the unique health and counseling issues young LGBTQ people may face. There is no one correct way or single process of coming out – in fact, some LGBTQ people do not come out at all. The process is unique for each individual, and every coming-out-related decision is a personal choice. Many queer youth come out long before they get to college. Research on sexual orientation currently suggests that the average age of initial awareness of same-sex attraction is between 10 or 11 years, while the average for self-identifying is ages 13-15. Many transgender students report having experienced conflict over the gender assigned to them, throughout childhood and puberty. Additionally, many transsexual youth report extreme discomfort with the sex of their bodies, starting in early childhood. But LGBTQ students experience much of their identity exploration and development in college years, and even for those who first came out much earlier, their coming out process continues through college life. Students face whether or not to out themselves to their family, friends, roommates, classmates, teammates, faculty, and staff. Over time, students realize that coming out is an ongoing process of decision-making, with a situation-by-situation assessment of risks versus benefits of publicly identifying oneself. These decisions are even more complicated for some subgroups of LGBTQ students: students who reject labels and/or experience their identities as fluid; students who are exploring both sexual orientation and gender variance; and/or youth who hold additional marginalized identities, such as students of color, international students, and students with cultural and religious backgrounds outside of middle-upper class, Western-European, Christian traditions.

3. HEALING FROM OPPRESSION (HOMO-, BI or TRANS-PHOBIA)      The experience of anti-LGBTQ discrimination, violence, and hate can lead to problems in physical and mental health. Victimization can take away an LGBTQ survivor’s sense of trust, safety, and security in the world; with potential after-effects of sleeping difficulties, headaches, digestive problems, agitation, substance abuse, post traumatic stress disorder, hyper-vigilance, and expectations of future rejection and discrimination. Even in the absence of external or overt experiences of violence, discrimination, or hate, LGBTQ people are also at risk of directing negative social attitudes toward themselves. This internalized oppression – homo-, bi-, or trans-phobia – can contribute to a devaluing of one’s self and poor self-regard. Although it is often most strongly felt early in one’s coming out process, it is unlikely that internalized oppression completely disappears even if the LGBTQ person has accepted his or her sexual orientation  or gender identity. Because of the strength of early socialization and continued exposure to anti-LGBTQ attitudes, internalized oppression can remain a factor in the LGBTQ students’ adjustment throughout college.

4. COPING WITH STRESS, ANXIETY, AND DEPRESSION      As previously mentioned, coming out (or not) strategies and dealing with oppression can add tremendous stress to an LGBTQ student’s already stressful college life. Research suggests that queer people may literally embody these stresses, leading to higher rates of anxiety and depression. One study found that gay and bisexual men were three times more likely to have had major depression, and four times more likely to have a panic disorder than heterosexual men. Lesbian and bisexual women showed greater prevalence (four times more likely) of generalized anxiety disorder than heterosexual women. Researchers suggested potential reasons for these difference: (a) social stigma of homosexuality, (b) ways that LGBTQ lives differ from heterosexuals, (c) experiences of discrimination, and (d) lack of social support. Through coming out, accepting themselves, and reaching out for support from family, peers, and professions, LGBTQ students can learn to cope effectively with stress. Studies have shown that family support and self-acceptance reduce the impact of anti-LGBTQ abuse on anxiety and depression; and that LGBTQ people counteract stress by establishing alternative structures and values that enhance their community. Thus, the presence of active LGBTQ student organizations, resource centers, and affirmative counseling and health centers all play crucial roles in countering stress, anxiety, and depression in LGBTQ college students.

5. SURVIVING SUICIDAL THOUGHTS, PLANS, OR ATTEMPTS      Decades of research have consistently documented a link between LGBTQ young people and suicide (thoughts, plans, and/or attempts). In a Massachusetts survey of high school students, students who described themselves as gay, lesbian, or bisexual were over five times more likely to have attempted suicide in the past year, and over eight times likely to have required medical attention as a result of a suicide attempt. One potential factor in higher suicide rates in LGBTQ youth may be gender identity and/or expression. In one study, college students who reported “cross gender roles” – having gender traits or expressions more often associated with the other sex – were at higher risk for suicidal symptoms, regardless of their sexual orientation. And among self-identified transgender youth, some experts estimate that many as 50 to 88 percent  have seriously considered or attempted suicide.

6. SEXUAL HEALTH CONCERNS      Sexually transmitted infections (STIs) are a consequence of specific risk-taking behaviors, not sexual orientation or gender identity themselves. Regardless of how a student self-identifies providers should inquire about a range of sexual behaviors, number and gender of sexual partners, and safer sex practices. Health care providers should be aware of the STIs for which LGBTQ college students are at risk and the necessary screening, testing, and treatment. However, while it is vital to recognize that LGBTQ students are at risk for STIs, it is also important not to view the youth restrictively within this narrow perspective. Many of today’s LGBTQ students understand the importance of condom use (although do not always practice it) during vaginal and anal sex; however, they seldom use barrier protection (condoms, gloves, or dams) in sexual contact involving mouths, fingers, hands, and toys used in penetration. In a recent internet survey, 89 percent of U.S. LGBTQ college students reported having sex with someone of the same sex and 45 percent had six or more sex partners during their lifetime. Most reported using a condom consistently during penile-vaginal (61 percent) and anal sex (63 percent). However, only 4 percent used a condom or other barrier consistently during oral sex. While epidemiological rates of gonorrhea, chlamydia, and syphilis have generally decreased in adolescents over the past fifteen years, the rates for all three of these STIs have increased in the populations of young men who have sex with men (MSM). Many women who partner with women believe they are not at risk of STI transmission. Yet sex between women can transmit herpes (HSV) chlamydia (gonorrhea, hepatitis A and B, trichomonas, and human papilloma virus (HPV). Sexual health education of lesbian and bi women should correct the assumptions that sex between women carries at risk. Most cervical cancers are linked to the presence of HPV. Yearly pap smears are the best defense against cervical cancer because they reveal HPV and other precancerous changes that can be stopped and they detect cancer at its earliest stages, when it is much easier to treat – and defeat. Yet many women are not properly screened for HPV, and health care providers don’t always tell women that they need pep tests. Regular gynecological exams (including pap, pelvic, and breast exams) are important for queer women because they can detect many kinds of abnormalities which, if undetected, could lead to serious health problems. A student’s gender presentation does not necessarily equate with the sexual and reproductive organs in his or her body. For example, not all sexual organs from birth may have been surgically removed in postoperative transsexual individuals, and there may be consequent screening exams that need to be performed. Students of all genders who have female genitalia requre regular pap tests. Also it would be appropriate to conduct prostate exams for students born male who have prostate glands (including post-operative M-toFs.). Respectfully ask the student what sex they were born with, and which surgeries, if any, they have undergone.

7. HIV/AIDS       In the United States, the rates of new HIV infection among men who have sex with men have recently begun to increase (up 8 percent in 2004) after over thirteen years of decreasing and stable infection rates. Center for Disease Control (CDC) data showed that 61 percent of new male diagnoses came from men who had sex with other men, compared to 17 percent of transmissions from heterosexual sex and 16 percent from intravenous drug use. The survey found the rate of infection was eight times higher for black men than white men, and black men make up more that half of all HIV diagnoses. Transgender youth, particularly M-to-F transsexuals, are at extremely high risk for HIV infection. Studies of urban transgender populations have found HIV seroprevalence rates ranging from 14 to 70 percent, and once again, people of color are disproportionately affected (in the Washington, D.C. Area, the rate is four times higher than white trans youth.In queer communities in the United States, not using a condom during anal inter-course continues to represent the greatest risk of HIV transmission. Research points to the following possible factors for increases in unprotected anal sex: improvements in HIV treatment, substance abuse, complex sexual decision making, seeking sex partners on the internet, and failure to maintain prevention practices. The rates of risky behaviors are higher among queer youth than older LGBT people. Not having seen firsthand the toll of AIDS, young people may be less motivated to practice safer sex. Almost twenty-five years into the HIV epidemic, today’s generation of queer youth seem to underestimate their risk, have trouble maintaining safer sexual practices, and require new and creative HIV prevention efforts. Given the disproportionate rate of HIV infection within young MSM and M-to-F transsexuals of color, culturally competent prevention and education services are crucial.

8. SMOKING       The effects of smoking kill more LGBTQ people than HIV/AIDS, hate crimes, suicide, and breast cancer combined. In the first statewide survey in the United States to assess tobacco use in the LGBTQ population, the California Department of Health Services found that over 43 percent of young gay men and lesbians (aged 18 – 24 years-old) smoke, compared with approximately 17 percent of the general population of 18 – 24 year-olds (2.5 times higher). Researchers suggest several possible factors for the high smoking rates in LGBTQ youth: (1) The tobacco industry has targeted initiatives and advertising directly at LGBTQ communities, (2) many queer youth spend significant time in the clubs where cigarettes are a social connection, (3) smoking may be used to medicate stress and feelings of loneliness and alienation, and to alleviate depression (nicotine affects the same neurotransmitters as many antidepressants). Suggestions for successful tobacco cessation programming for LGBTQ college students include: (1) involve LGBTQ students in program design and implementation, (2) address positive LGBTQ identity development and coming issues, (3) be entertaining, supportive, and interactive, (4) address the LGBTQ-related psychosocial and cultural underpinnings of tobacco use, (5) offer practical nonsmoking alternatives and tools, and (6) include options of pharmacological smoking cessation aids.

9. DRINKING AND OTHER DRUG USE       Studies indicate that, when compared with the general population, LGBTQ people are morel likely to use alcohol and other drugs, have higher rates of substance abuse, and are less likely to abstain from use. Studies that compared gay men and lesbians with heterosexuals have found that from 20 to 25 percent of gay men and lesbians are heavy alcohol users, compared with 3 to 10 percent of the heterosexuals studied. Within the transgender community, one urban study found that 34 percent reported alcohol problems. Risk factors for abusing alcohol include relying on clubs for socializing and peer support; the negative effects of homophobia, heterosexism, biphobia, transphobia, and/or internalized oppression; additional stress related to coming out or hiding/concealing one’s identity; and the effects of trauma from history of violence or abuse. Some drugs seem to be more popular in the LGBTQ communities than in majority populations. Greater marijuana and cocaine use has been found among lesbians than among heterosexual women. Studies have also found that gay and bisexual men, and other MSM are more likely to have used marijuana, psychedelics, hallucinogens, stimulants, sedatives, cocaine, barbituates, MDMA (methylenedioxymethamphetamine, also known as ecstacy, XTC, or X), Special K (ketamine), and GHB (gamma hydroxybutyrate) than are heterosexual men. Party or club drugs (including ecstasy, Special K, GHB, and crystal meth (methamphetamine) – often used during raves and circuit parties – decrease inhibition, impair judgment, and increase risky sexual behavior.

10. BODY IMAGE      Bi and lesbian women’s experience of body image and what they expect of themselves can be complicated, as they are socialized as women, but also influenced by their LGBTQ communities. They are exposed to conflicting ideals of beauty espoused by both mainstream and queer communities. Women in the queer community may reject traditional standards of beauty for women, while embracing alternative ideals. Some queer women may feel pressure from heir community to reject concerns about weight, or to believe that wanting to lose weight is wrong – potentially at the expense of physical health and well-being. While queer women may fight with conflicting ideals about body image and femininity, queer men may struggle to achieve an exaggerated sense of male attractiveness. Gay and bisexual men are expected (by both mainstream and gay cultures) to be fit, muscular, well-dressed, and into trends and fashion. Some queer men report fearing that being to fat, too thin, too unattractive, or too old will prevent them from finding partners and/or achieving loving relationships. Others describe feeling that working out and being physically fit will help them regain control of their own lives and bodies, which are all too often taken over by discussions of what men should or should not look like.