Fostering acceptance of sexual minorities in the Hispanic community

Coming out to your parents can be a difficult and sensitive process for a person at any age. But for Hispanic teens, sharing that information can become even more challenging.

Statistics from the U.S. Centers for Disease Control (CDC) indicate that Hispanic adolescents who identify as gay, lesbian, bisexual, or transgender—also known as sexual minorities—are struggling to share their authentic selves with their families.

Figures from the CDC's 2021 Youth Risk Behavior Survey show that Hispanic teens who consider themselves sexual minorities are more likely to experience symptoms of depression or attempt suicide than their Hispanic heterosexual peers. Hispanic sexual minorities are also more likely to use drugs or alcohol than Hispanic teens who identify as straight.

Recognizing these troubling figures, in early 2019, professor of nursing and health studies Guillermo "Willy" Prado and public health graduate student Alyssa Lozano decided they wanted to explore the issue more. Lozano interviewed Hispanic youth who identified as sexual minorities to better understand the process of disclosing their sexual orientation and gender identity to their parents and families. She also wanted to unpack why they were using drugs and getting depressed.

Prado was well suited to lead this effort, as much of his research has centered on Hispanic adolescents. With colleagues, he created an intervention more than 20 years ago called "Familias Unidas" to help improve family dynamics and communication among Hispanic parents and their adolescent children. The highly successful program now has been adapted to virtual platforms and is used in several states, as well as in countries like Chile and Ecuador.

But Prado had never delved into crafting an intervention for sexual minority youth.

"We tried to understand why these kids were using substances and getting depressed and a lot of it came down to the stigma they still experienced," said Prado, who is also dean of the University of Miami Graduate School, the University's vice provost for faculty affairs, and holds faculty appointments in nursing and health studies, public health sciences, and psychology. "We also saw that drug use and depression were higher among teens who reported that their disclosure process was not a positive one."

Armed with this information, Prado, Lozano, and their colleagues, set out to design a new intervention called "Familias con Orgullo," or Families with Pride, which aimed to counteract the harmful implications of coming out on Hispanic youth who identify as sexual minorities. They asked Maria Tapia, a senior research associate, and Yannine Estrada, research assistant professor at the School of Nursing and Health Studies—who implemented Familias Unidas—to collaborate with them. While Familias con Orgullo takes some cues from Familias Unidas, it is vastly different, Prado noted.

A pilot study of Familias con Orgullo began in late 2019 with 30 local families in three cohorts.

"This is a population where there is so much need," said Prado. "We want to be able to prevent and reduce drug use, as well as to reduce rates of depression, and to improve family dynamics to help youth and parents navigate this coming out process."

After the pilot, many of the families involved reported improved communication overall, and most teen participants said their mental health had improved, according to Lozano.

Prado and his team plan to expand the program during the next five years, building upon the initial pilot study. Starting this fall, they hope to recruit 306 Hispanic families from across South Florida with teens who recently have divulged their sexual orientation to one of their primary caregivers.

"Long-term, assuming the results are positive, I would like to see this program—much like Familias Unidas—implemented and accepted across the United States as a standard of care for Hispanic sexual minority youth who have recently disclosed to their parents," Prado said. "These parents are at different stages of acceptance, so a key goal is to increase that level of acceptance, regardless of where the parents are on that continuum."

Familias Con Orgullo is a 12-week program that includes parent-only group sessions, child-only group sessions, and individualized parent-child sessions. For some youth in the pilot, Lozano said, it was helpful for them to be among peers.

Lozano remains in touch with many of the youth participants from the pilot and marvels at how their lives changed afterward. One former participant, Javier Gomez, even spoke at the White House last spring when President Joseph Biden signed an executive order advancing equality for LGTBQ+ individuals. Lozano looks forward to working with more Hispanic families in the fall.

"I was able to learn so much about the challenges these youth face and how resilient they are, which is so inspiring to me," said Lozano, who graduates this summer and will join the School of Nursing and Health Studies as a research assistant professor in the fall. "I want to continue to focus on this population because these kids were so open and candid about what they went through—no literature review could give that level of detail. And it's really important to be doing this work right now."