Substance use in an underserved population: Focus group exploration of ball community members' opinions

Background: Originating in the 1930's transgendered subculture of NYC, contemporary “balls” feature gay and/or transgendered youth who “walk” for trophies in various performance categories. Aside from competitive aspects, ball culture also serves a social-networking function for a subgroup of gay youth, most of whom belong to one of several “houses” headed by “mothers” and “fathers” who serve as mentors/organizers. One challenge for these mentors is substance use within their houses. Methods: In fall 2006, a trained facilitator conducted 2 focus groups—one consisting of 10 teens and the other of 13 “parents”--all of whom belong to one of Chicago's “houses”. Discussions focused on most popular substances, definitions of abuse, and feasibility of intervention with known users. Sessions were recorded, transcribed, and analyzed for common themes. Results: The groups agreed on several points: 1. While substance use (particularly “weed”, ecstasy, and alcohol) is common at events, people use for various reasons, including treatment of depression or performance stress, peer expectations, or enhancement of self-esteem. 2. Casual use is well accepted, but more compulsive use was thought to carry significant risk. 3. Both community role models and recovered users can potentially impact attitudes about use. 4. Youth comfort with health providers is related to the cultural competence, confidentiality, and non-directional compassion of the provider. Conclusions: Although participants agreed that substance use within the ball community is common and sometimes useful, both adults and youth recognized a number of negative aspects, and grapple with the challenge of how to mentor or intervene.