Health and social issues of gay, lesbian, and bisexual adolescents

HOMOPHOBIA IS AN IRRATIONAL FEAR of being gay, lesbian, or bisexual or of being in contact with someone who is same-sex oriented. Acts of prejudice and overt hostility toward gays may be witnessed by impressionable people who then recreate these same actions, thus perpetuating homophobia (Fricke, 1981). Many people in our society do not perceive it as wrong to physically or emotionally abuse gays (Whitlock, 1989). In subtle support of homophobia, 24 states and Washington, D.C., have laws stating that homosexual behavior is wrong and criminal (Cohn, 1992). In a 1992 Newsweek poll, 53% of respondents considered homosexuality unacceptable, and 45% felt that gay civil rights were a threat to the American family and family values (Wilson, 1992).

Despite these prejudices, 10% of our population is believed to be gay, lesbian, or bisexual. In the past several decades, the gay community has become stronger and certainly more political. Without the support of society in general, the gay and lesbian community has developed its own internal supports. The gay and lesbian community, as well as society, however, have failed to help and support the 10% of youth who are just becoming aware of their sexual orientation (Sanford, 1989).

On average, lesbians experience their first same-sex activity at the age of 20 years and identify themselves as lesbians within the next three years (Troiden, 1988). The majority of gay males have had homosexual experiences by age 15. Many gay adolescent males recall identifying themselves as gay at the approximate age of 14. Although it is true that from 17% to 37% of American males engage in some homosexual experimentation, adolescent homosexuality is not a passing phase on the road to adult heterosexuality. It is the persistence of same-sex attractions and sexual experimentation that result in a gay or bisexual identification (Remafedi, 1987).

IMPEDIMENTS TO ACHIEVING ADOLESCENT IDENTITY

Developmentally, adolescence is a difficult period. The essential task of adolescence is to find and develop one's personal identity, which includes developing meaningful peer relationships, integrating emotional and physical changes, and separating from parents. Social skills are practiced and learned (Cranston, 1992).

Because gay adolescents perceive themselves as different from the majority of their peers, adolescence is even more traumatic for them. Traditional social structures, such as schools, do not support these individuals. These youth are denied access to accurate and comprehensive information about human sexuality and alternative life-styles because of unrealistic fears of "promoting" homosexuality (Uribe & Harbeck, 1992). Teachers, counselors, and school administrators lack information about homosexuality, and their attitudes frequently reflect the general attitudes of a homophobic society (Martin & Hetrick, 1988). They can be just as guilty as students are of emotionally abusing gay adolescents and often they fail to intervene or take a stance when gay youth are physically and emotionally abused by their peers (Sanford, 1989). By tolerating such behavior, the school fails to educate its students about homophobia and homophobic violence, and students learn it is all right to tolerate and participate in such prejudicial behaviors (Whitlock, 1989).

Gay and lesbian youth find it difficult to establish a positive identity because they lack positive role models to emulate. They are aware of homosexual stereotypes: Homosexuals cannot form loving relationships, they are sexually promiscuous, they are unhappy, and they prey on and seduce children. They do not learn about the many gay individuals who are successful, happy, and important people involved in loving, long-term relationships. Many gay and lesbian adults are open within the gay community but closeted to the general public. They fail to support gay youth out of legitimate fears of being accused of sexual exploitation or abuse and of "promoting" homosexuality (Sanford, 1989).

In addition, homosexual youth lack peer support. These adolescents frequently hide behind heterosexual facades, roles, and behaviors (Kourany, 1987), a strategy used to deny their sexual identity to themselves and others (Troiden, 1988). Although some males are obviously effeminate and some females obviously masculine, homosexual adolescents cannot generally be identified by outward physical or behavioral characteristics. Many successfully blend in with their straight peers and families; they may date and even become sexually involved with individuals of the opposite sex. Some gay adolescents may become sexually promiscuous or purposely get pregnant in an effort to deny their sexual orientation to themselves and to others (Sanford, 1989). Others may become passionately involved in academics, sports, or extracurricular activities. Still others may withdraw from typical teenage social experiences and activities (Gonsiorek, 1988).

ISOLATION

Isolation is a critical problem for these adolescents. Denied access to accurate information regarding their same-sex orientation, they have little opportunity to learn about what it means to be gay, lesbian, or bisexual. Negative misconceptions of homosexuality are continually presented to them and their non-gay peers (Martin & Hetrick, 1988). Silence with regard to the subject of homosexuality discredits homosexual adolescents' existence and self-worth and interferes with their achieving a positive gay identity. To their non-gay peers, labels and stereotypes become a justification for homophobic beliefs and behaviors. For gay and non-gay adolescents, silence and stereotypes distort the varied realities of human lives, relationships, and families and promote the presumption that heterosexual love is the only lasting and significant love (Whitlock, 1989).

Social isolation facilitates poor self-esteem, self-hatred, and self-abusive behaviors (Sanford, 1989). The negative attitudes attached to homosexuality challenge the adolescent's fragile self-concept of masculinity or femininity and can induce internalized homophobia (Remafedi, 1990), which may present itself as feelings of inferiority, being evil, lacking self-worth and social value (Gonsiorek, 1988), guilt, shame, depression, self-defeating behaviors, and self-destructiveness (Remafedi, 1990). Being gay, lesbian, or bisexual is a stigma that limits the individual's ability to act in other social roles. For example, open gays and lesbians cannot serve in the military, and society clearly persecutes gay teachers out of fear that they will promote homosexuality to children (Martin & Hetrick, 1988).

Sexual desire, an issue central to adolescent development, is a threat to gay teenagers. They are denied opportunities to establish nonerotic and nonthreatening interactions with gay peers (e.g., openly gay couples generally are not welcomed at school activities such as proms and homecoming), which in turn causes them to separate sexual behavior from all other aspects of their lives and encourages them to seek sexual gratification in hazardous places. Casual and/or anonymous sex and exploitation are risky sexual behaviors that merely reinforce beliefs that homosexuals are deviant (Martin & Hetrick, 1988).

Finally, these adolescents feel emotionally isolated. In their aloneness and internalized homophobic thoughts, they feel that no one else is like them, that no one can love them because being gay is wrong and sick, and that it would be better to die. A sense of desperation often prevails (Martin & Hetrick, 1988).

REMAINING IN THE CLOSET

Gay adolescents internalize the negative images of homosexuality presented by schools, peers, family, and society very early in their development (Borhek, 1988). They realize that openness about their sexual orientation is likely to bring physical, verbal, and emotional abuse; rejection by family and/or friends; discrimination; and religious condemnation (Remafedi, 1987).

The socialization process of gay adolescents involves learning to hide; in other words, they attempt to pass as heterosexuals (Uribe & Harbeck, 1992). Efforts to hide their sexual orientation represent an attempt at self-preservation. The thought of coming out of the closet (identifying oneself as gay, lesbian, or bisexual) or of being discovered is terrifying to these teens. Disclosing their sexual identity to parents is a primary concern (Borhek, 1988). Many parents make disparaging remarks about same-sex-oriented individuals, causing gay children to view their parents as nonsupportive and to anticipate the probability that their parents would withdraw their love and economic support if the child's sexual orientation were known. Rather than confront their parents with their sexual identity, homosexual adolescents build a protective wall between themselves and their parents and friends (Clark, 1987). Separating their sexual orientation and identity from the rest of their personality requires them to self-monitor their actions and conversations in order to avoid disclosure (Uribe & Harbeck, 1992).

These concealment strategies are emotionally and socially crippling (Uribe & Harbeck, 1992). In their efforts to deny their homosexual feelings, homosexual adolescents may deny other feelings as well. Because their sexual feelings are "wrong," their other feelings are logically suspect as well. Thus, homosexual adolescents become cut off from their own emotional life. Each time they pretend to be straight, they reinforce the idea that it is bad or wrong to be gay, lesbian, or bisexual. They must protect their secret at all costs. Because a fundamental aspect of their identity is supported by denial and lying, these youth end up believing that all aspects of their life are based on a lie (Uribe & Harbeck, 1992). These negative dynamics damage their self-esteem, alienate them further from family and friends, and increase their sense of isolation (Uribe & Harbeck, 1992).

FOUR STAGES OF GAY, LESBIAN, AND BISEXUAL IDENTITY

The first stage, that of sensitization, begins before puberty. These children realize that they are different from their peers, which they infer from their gender-inappropriate behaviors or interests. However, children at this age rarely perceive themselves as being sexually different, in that being gay, lesbian, or bisexual has no meaning for them (Troiden, 1988).

During the second stage, identity confusion, adolescents begin to associate their differentness with being "gay," "lesbian," or "bisexual." They feel troubled by heightened anxiety and inner anguish and typically deny their homosexual orientation and feelings. They avoid situations that may intensify their same-sex desires and fantasies and assume heterosexual roles, rationalizing that they are going through a phase (Troiden, 1988). Many gay adolescents attempt to escape their conflicted feelings through drug and alcohol abuse (Sanford, 1989).

Homosexual identity is assumed and shared with selected people during the third stage--identity assumption. Typically, this stage occurs for males between the ages of 19 and 21 years old and for females between the ages of 21 and 23 years old. At this stage, gay individuals define themselves as homosexual, tolerate or accept this identity, make social contacts with other gays, explore the gay subculture, and are involved in sexual experimentation. Positive contacts with others like themselves facilitate their homosexual-identity formation. Meaningful contacts with the gay community enable them to achieve a sense of belonging to a community and help alleviate their feelings of alienation. Many in this stage lead double lives, separating their social worlds into those who know who they are and those who do not know, hoping the two worlds never collide (Troiden, 1988).

The final stage, identity commitment, usually begins when the person is in his or her twenties and involves commitment to adopt homosexuality as a way of life (Troiden, 1988). At this point, the individual finds it easier to live as a gay, lesbian, or bisexual than to try to "pass" as a heterosexual (Sanford, 1989). Homosexuality is perceived as an essential part of the person's identity and as a way of being rather than as merely sexual orientation. In other words, persons in this stage feel that they would not want to change their identity even if they were able to do so. They may become committed to a same-sex loving relationship, which offers a source of love and romance as well as sexual gratification. Their commitment to homosexuality as a way of life allows them to "come out" to an expanded heterosexual audience.

COMING OUT OF THE CLOSET

Openly acknowledging one's homosexual identity becomes feasible when the individual is able to resolve personal confusion about his or her sexual orientation (Remafedi, 1990). Generally, people attempt to choose an empathetic audience when they disclose their sexual orientation. Selected friends are usually told first, and mothers are generally told before fathers (Remafedi, 1987). Disclosure commonly occurs when the individual is in his or her twenties. In professional settings people generally disclose when they are in their early thirties (Troiden, 1988).

A 1987 study of adult gay men indicated that approximately half of them lost friends and encountered negative or ambivalent responses from their parents when they disclosed their sexual orientation. Most stated that they experienced some degree of verbal abuse, physical violence, religious condemnation, discrimination, and rejection because of their gay identity (Remafedi, 1987). Many adolescents who disclose experience these same problems. However, rejection by family members and eviction from the home obviously has a greater impact on adolescents than on older individuals who are more likely to be economically and emotionally mature. On the other hand, many adolescents have found that their fear of disclosure was worse than the actual reactions of family and friends.

HEALTH AND SOCIAL RISKS

Gay, lesbian, and bisexual youth are significantly at risk for psychological dysfunction, suicide, substance abuse, homelessness, dropping out of school, prostitution, being a victim of violence and sexual abuse, and acquiring sexually transmitted diseases (STDs) and AIDS (Harbeck, 1992; Martin & Hetrick, 1988; Remafedi, 1990; Sanford, 1989; Uribe & Harbeck, 1992). Many of these problems are not related directly to the adolescent's homosexual identity but are a consequence of the hatred directed toward them by others and of the adolescents' internalization of this hatred (Martin & Hetrick, 1988).

Psychological Dysfunction

Gay adolescents are likely to experience greater psychological dysfunction than are their non-gay peers. They have no one to talk to, and parents and school staff are perceived as unable to provide emotional support. Homophobic attitudes in the school and antigay attitudes expressed at home make it difficult for gay adolescents to approach adults (Uribe & Harbeck, 1992). If by chance they do approach an adult, the adult's own lack of knowledge regarding homosexuality, ingrained negative attitudes toward gays, and feelings that somehow he or she has failed or caused the child's homosexuality interfere with the person's ability to assist and support these teens.

Depression is a common manifestation of dysfunction. Depression results from suppression of anger, denial of self, and emotional fatigue (Clark, 1987). During the identity-confusion stage, homosexual feelings as well as other feelings are suppressed. Feelings of anger are repressed and eventually must be dealt with if the individual is to develop a healthy emotional life (Clark, 1987).

When gay teens hide their identity, they unconsciously undermine their self-worth (Gonsiorek, 1988). Each time an antigay joke is told or a suspected/known gay is ridiculed, the gay teen feels personally devalued. If the teen chuckles at the joke or agrees with the negative comment, he or she betrays him- or herself as well as other gays.

Concealing one's sexual identity, building protective walls around oneself, and continually monitoring one's actions and conversations is emotionally draining (Clark, 1987). Borhek (1988) believes that homosexual individuals must undergo a grief process before they are able to accept their gay identity. They need to grieve the loss of heterosexual identity assumed by parents, friends, and society in general.

Psychosomatic complaints may result from depression, inner turmoil, and suppressed, confused feelings. Such complaints may include frequent headaches, gastrointestional problems such as stomachaches, sleep disturbances, and physical fatigue.

Suicide

Suicide is the third leading cause of death among teenagers (Fikar, 1992). However, researchers have failed to examine sexual orientation in their inquiries about adolescent suicide (Remafedi, Farrow, Deisher, 1991), and the media often identify many suicides as accidents to avoid the issue of homosexuality (Sanford, 1989). The U.S. Public Health Service's "Report of the Secretary's Task Force on Youth Suicide" stated that gay and lesbian youth account for 30% of all teen suicides (Fikar, 1992). Whereas 1 in 10 heterosexual teens attempts suicide, 2 to 3 of every 10 gay teens attempt suicide (Whitlock, 1989). A 1991 study of gay and bisexual males 14-21 years of age reported a 30% incidence rate for at least one suicide attempt by gay teens. Fifty percent of gay persons who attempted suicide reported more than one attempt. The mean age of the first attempt was 15 years, and the method used was prescription/nonprescription drugs or self-laceration. Thirty percent of first suicide attempts occurred during the same year the adolescent identified him- or herself as gay, lesbian, or bisexual. Although the primary precipitating cause was family problems (44%), 30% identified personal and interpersonal turmoil regarding their homosexual identity as the precipitating cause (Remafedi et al., 1991). Risk factors for gay adolescent suicide include disclosure of gay identity at an early age, low self-esteem, running away, substance abuse, prostitution, depression, and atypical gender behavior (Bidwell & Deisher, 1991).

Substance Abuse

Many gay, lesbian, and bisexual youth abuse drugs and alcohol in an effort to decrease or temporarily alleviate their emotional pain (Whitlock, 1989). In a nonclinical sample of gay teens, 58% reported that they regularly abused substances (Sanford, 1989). Consequences of substance abuse include drug trafficking and prostitution to support their habit and impaired decision-making capabilities (Whitlock, 1989; Zenilman, 1988).

Running Away, Dropping out of School, and Prostitution

Forty-eight percent of gay teens in a nonclinical sample reported running away from home. It is estimated that one-third to one-half of homeless youth are gay (Sanford, 1989). Running away is a self-protective, self-defeating behavior in response to disapproval and/or rejection from the family or from the fear of rejection (Remafedi, 1990).

Many homosexual adolescents experience physical and emotional abuse at school and lack support and protection from school administrators and staff. As a result, they drop out of school. The educational system often fails to provide a safe learning environment and dropping out becomes the only rational coping strategy for survival (Martin & Hetrick, 1988). Homeless and without adequate education, some teens turn to prostitution and drug trafficking for survival. They become easy targets for sexual abuse, assault, or sexual exploitation by adult males, most of whom are heterosexual (Whitlock, 1989).

Violence

Antigay violence is a frequently occurring problem for gay adolescents. According to Martin and Hetrick (1988), 40% of a client population suffered some form of violence as a result of their homosexual orientation. Family members accounted for 49% of the violence, which included incest. Schools and social service agencies, including emergency shelters, often fail to protect gay adolescents from violence. Rape is a common form of violence in group shelters (Martin & Hetrick, 1988).

STDs and AIDS

The adolescent population has the highest incidence of STDs, reflecting the "it can't happen to me" attitude so pervasive throughout adolescence. Teens are very impulsive and have a limited perspective on the future, failing to see that today's behaviors affect their future. They are poorly informed about prevention of STDs and lack the assertiveness and strong sense of identity that would enable them to learn about and take protective measures (Remafedi, 1990).

Lesbians, if they do not engage in heterosexual behaviors, have a low incidence of STDs. Gay males, on the other hand, are at high risk. Anal penetration and associated trauma provide a portal of entry for diseases. These young males often suffer from poor self-esteem and missed opportunities for healthy socialization (Remafedi, 1990). They are likely to engage in high-risk behaviors such as substance abuse, which diminishes their ability to make appropriate decisions and often leads to unprotected sexual activity (Zenilman, 1988). Teens who internalize societal stereotypes of homosexuality are at risk for behaving in negative and harmful ways. They may seek sexual relationships in unsafe places and with men whom they do not know (Uribe & Harbeck, 1992).

Despite the fact that the gay population has had the highest incidence of AIDS, AIDS is not a gay disease; it does not discriminate (Uribe & Harbeck, 1992). Since the advent of the AIDS epidemic, the adult gay community has dramatically changed sexual behaviors through extensive educational efforts. Unfortunately, gay adolescents are not junior members of the adult gay community and thus lack gay men's resources for information and support (Zenilman, 1988).

As of October 1993, 1,412 cases of AIDS were reported among adolescents. Although this number is low and represents only 0.4% of all AIDS cases in the United States, it is very probable that many young adults with AIDS were infected as teens (Centers for Disease Control, 1993, October). Twenty-five percent of infected adolescents acquired HIV through gay sexual activity and another 4% through gay sexual activity and the use of intravenous drugs (Centers for Disease Control, 1993, February); Remafedi, 1988).

The barriers to AIDS prevention among gay adolescents are similar to those faced by non-gay adolescents. Adolescents tend to think concretely and feel invulnerable (Remafedi, 1988). Education about AIDS prevention, which stresses that AIDS is not a gay disease, is not reaching gay youth, partly because of assumed heterosexualism in schools and because homosexuality is not discussed in relation to AIDS (Cranston, 1992). Gay teens, like heterosexual teens, tend to avoid confronting the realities and risks of sexual experimentation (Remafedi, 1988).

HEALTH CARE IMPLICATIONS

"A child's personality cannot grow without self-esteem, without feelings of emotional security, without faith in the world's willingness to make room for him [or her] to live as a human being" (Whitlock, 1989, p. 1). These words, spoken in the 1940s by a civil rights activist, are applicable to gay adolescents today. Gay, lesbian, and bisexual teens are persons who deserve comprehensive, sensitive, and culturally appropriate physical and mental health care.

Practitioners must examine their own attitudes toward and beliefs about homosexuality. They need to become knowledgeable about gay and lesbian issues in order to provide competent, sensitive services to this population (Sanford, 1989). If they cannot provide such care, they must refer gay adolescents to practitioners who can do so. Teens need to believe that their practitioners are nonjudgmental, accepting professionals who will maintain confidentiality. The essential first step in promoting physical and emotional health for this population is for practitioners to attempt to understand the meaning and experience of being gay and a teenager (Remafedi, 1987). Therapeutic goals should be to promote physical, social, and emotional development in order to facilitate a healthy transition to adulthood (Remafedi, 1990).

Practitioners need to be wary of making assumptions regarding clients' sexual orientation and behavior. Complete sexual histories, including queries about sexual orientation, should be taken (Sanford, 1989). Medical decisions need to be based on sexual behaviors, not sexual orientation. Periodic testing for STDs and HIV is needed for sexually active adolescents (Zenilman, 1988),

Gay youth need to be identified and assessed for suicidal risks, substance abuse, home and school problems that may precipitate running away or dropping out of school, and emotional problems (Sanford, 1989). Generally, only severely troubled teens need referral for psychotherapy (Remafedi, 1990). Most of these teens just need someone to talk to, someone who seems to care and can be trusted, and someone who will accept them. Gay adolescents benefit when they are given accurate and complete information about sexual issues and clear, consistent messages that sexual orientation does not determine personal value or quality of life (Gonsiorek, 1988).

Practitioners need to become aware of community resources and make referrals as needed. Gay youth groups can be an invaluable resource for adolescents. They provide opportunities for gay, lesbian, and bisexual teens to learn and practice social skills, share and exchange information, develop friendships, obtain peer support, explore the meaning of their sexual identity, and find positive role models (Gonsiorek, 1988). Such groups decrease emotional and social isolation, help members clarify values, and encourage responsible decision making (Remafedi, 1990).

All adolescents need comprehensive sex and AIDS-prevention education. Information should be presented in ways that show respect for youth, regardless of sexual orientation (Sanford, 1989). Education must go beyond factual information to include facilitating and building personal skills needed to make better choices, form healthy relationships, and develop negotiating skills (Cranston, 1992).

Factual information about HIV transmission and prevention needs to be discussed within the context of the special concerns of the gay adolescent. Gay teens need a broad-based individual and group "empowerment" education that addresses not only issues of self-esteem and positive identity but also facilitates the development of social skills and support systems. In order to make healthy choices teens must recognize the severity of AIDS, understand their own vulnerability, and use preventive measures and practice safe sex to reduce their risk (Cranston, 1992). Safe-sex practices should be discussed in depth with these adolescents (Zenilman, 1988).

Homosexuality should be addressed in school sex-education classes, AIDS-prevention programs, and health care environments. Misconceptions and stereotypes regarding homosexuality need to be discussed openly and discarded. Teens need to learn how to approach their parents and friends regarding their sexuality as well as how to protect themselves against homophobic violence and discrimination (Remafedi, 1990).

Finally, practitioners need to educate families, friends, and colleagues about gay issues and health care. Political advocacy is needed to improve health and social services for this population (Gonsiorek, 1988).

REFERENCES

Bidwell, R. J.,& Deisher, R. W. (1991). Sexual identity issues in adolescents (Videotape). Secaucus, NJ: Network on Continuing Medical Education.

Borhek, M. V. (1988). Helping gay and lesbian adolescents and their families. Journal of Adolescent Health Care, 9, 123-138.

Centers for Disease Control and Prevention. (1993, February). Facts about adolescents and HIV/AIDS. Atlanta, GA: U.S. Department of Health and Human Services.

Centers for Disease Control and Prevention. (1993, October). HIV/AIDS Surveillance Report, 5(3). Atlanta, GA: U.S. Department of Health and Human Services.

Clark, D. (1987). Loving someone gay. Berkeley, CA: Celestial Arts.

Cohn, B. (1992, September 14). Discrimination: The limits of the law. Newsweek, pp. 38-39.

Cranston, K. (1992). HIV education for gay, lesbian, and bisexual youth: Personal risk, personal power, and the community of conscience. Journal of Homosexuality, 22(3-4), 247-259.

D'Angelo, L. (1992). HIV in teens: Is this an epidemic? Health and Sexuality, 3(2), 7.

Fikar, C R. (1992). Gay teens and suicide. Pediatrics, 89, 519-520.

Fricke, A. (1981). Reflections of a rock lobster. Boston: Alyson Publications.

Gonsiorek, J. C. (1988). Mental health issues of gay and lesbian adolescents. Journal of Adolescent Health Care, 9, 115-122.

Harbeck, K. M. (1992). Introduction. Journal of Homosexuality, 22(3-4), 1-7.

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Martin, A. D., & Hetrick, E. S. (1988). he stigmatization of the pay and lesbian adolescent. Journal of Homosexuality, 15(1-2), 163-183.

Remafedi, G. (1987). Male homosexuality: The adolescent's perspective. Pediatrics, 79, 326-330.

Remafedi, G. (1988). Preventing the sexual transmission of AIDS during adolescence. Journal of Adolescent Health Care, 9, 139-143.

Remafedi, G. (1990). Fundamental issues in the care of homosexual youth. Medical Clinics of North America, 74, 1169-1179.

Remafedi, G., Farrow, J. A., & Deisher, R. W. (1991). Risk factors for attempted suicide in gay and bisexual youth. Pediatrics, 87, 869-875.

Sanford, N. D. (1989). Providing sensitive health care to gay and lesbian youth. Nurse Practitioner, 14(5), 30-47.

Troiden, R. R. (1988). Homosexual identity development. Journal of Adolescent Health Care, 9, 105-113.

Uribe, V., & Harbeck, K. M. (1992). Addressing the needs of lesbian, pay, and bisexual youth: The origins of Project 10 and school-based intervention. Journal of Homosexuality, 22(3-4), 9-27.

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Cleta L. Dempsey is a nurse practitioner, USAF Medical Center Scott, Scott AFB, Illinois. This article does not represent the opinions of the United States Air Force or the U.S. Department of Defense.

Copyright Family Service America Mar 1994
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