For the health of sexual minority youth

The Centers for Disease Control and Prevention has recently published their landmark study, Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors Among Students in Grades 9–12 — Youth Risk Behavior Surveillance, Selected Sites, United States, 2001–2009. A 136 page pdf of the full publication can be found by clicking the link above or you can read below for salient details, summary and recommendations. The main point to take away from this study is that sexual minority youth are at an exceedingly elevated risk of a multitude of dangerous and self-destructive behaviors. The reasons for these risks are beyond the scope of the study however other studies have elucidated several of these factors to include family rejection and school victimization. The point is that America is failing its LGBTQI youth. While campaigns exist within the various LGBTQI communities to reach out to these often isolated youth (ie The Trevor Project and It Gets Better Project), it is HIGH time that our scholastic and religious communities open their eyes, educate themselves with actual scientific evidence (ie American Psychological Association and American Academy of Pediatricians) instead of hate group propaganda (ie American Family Association and Family Research Council), step up to the plate and start actively working to improve the lives of our greatest national treasure, our YOUTH.

Summary of the CDC’s study: Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors Among Students in Grades 9–12.

NOTE: Most of what follows is copied verbatim from said report with minor additions (ie sentence truncations and verb tense changes) to further compact this important document.

INTRODUCTION

Sexual minority youths may be defined in at least two ways: by sexual identity or by the sex of their sexual contacts. Sexual minority youths defined by sexual identity include those who identify themselves as gay, lesbian, or bisexual or who are unsure of their sexual identity. Sexual minority youths defined by the sex of their sexual contacts include those who have only had sexual contact with persons of the same sex or with both sexes. Youths who identify themselves as heterosexual, gay, lesbian, or bisexual might not have had any sexual contact. Furthermore, youths who have only had sexual contact with persons of the same sex or with both sexes might identify themselves as heterosexual, and youths who have only had sexual contact with persons of the opposite sex might identify themselves as gay, lesbian, or bisexual. Some youths who eventually identify themselves as a sexual minority or only have sexual contact with persons of the same sex or both sexes might not identify themselves as a sexual minority and might not have had any sexual contact. This dissonance between sexual identity and sex of sexual contacts is well documented, particularly among youths.

Sexual minority youths have specific health needs and are at disproportionate risk for certain health problems. However, as described in a recent Institute of Medicine (IOM) report, more data about sexual minority youths are needed. CDC developed the Youth Risk Behavior Surveillance System (YRBSS) to monitor priority health-risk behaviors and selected health outcomes among all youths and young adults. The YRBSS includes biennial, school-based Youth Risk Behavior Surveys (YRBSs) conducted among population-based samples of students in grades 9–12 in participating states and large urban school districts. To address the lack of knowledge about the health-risk behaviors and selected health outcomes among sexual minority students at the state and local levels, state and local agencies participating in YRBSS may add questions to their YRBS questionnaire to measure sexual identity, sex of sexual contacts, or both. Understanding state-level and local-level differences in the prevalence of health-risk behaviors and health outcomes by sexual minority status (defined by sexual identity or by sex of sexual contacts) as reported by large population-based samples of high school students will provide additional information about sexual minority youths and might help reduce the health disparities they experience. This report summarizes results from YRBSs conducted during 2001–2009 from seven states and six large urban school districts that included questions on sexual identity, sex of sexual contacts, or both. The prevalence of health-risk behaviors and obesity and overweight is compared among subgroups of students defined by sexual identity and by sex of sexual contacts. All surveys were conducted during the spring semester of each survey year.

PROBLEM

Sexual minority youths are youths who identify themselves as gay or lesbian, bisexual, or unsure of their sexual identity or youths who have only had sexual contact with persons of the same sex or with both sexes. Population-based data on the health-risk behaviors practiced by sexual minority youths are needed at the state and local levels to most effectively monitor and ensure the effectiveness of public health interventions designed to address the needs of this population.

DESCRIPTION OF THE SYSTEM

The Youth Risk Behavior Surveillance System (YRBSS) monitors priority health-risk behaviors (behaviors that contribute to unintentional injuries, behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, dietary behaviors, physical activity and sedentary behaviors, and weight management) and the prevalence of obesity and asthma among youths and young adults. YRBSS is the only public health surveillance system in the United States that monitors, among interested states and large urban school districts, the prevalence of health-risk behaviors and selected health outcomes among population-based samples of sexual minority youths defined by sexual identity and by the sex of sexual contacts. This report summarizes results from YRBSs conducted during 2001–2009 in seven states and six large urban school districts that included questions on sexual identity (i.e., heterosexual, gay or lesbian, bisexual, or unsure), sex of sexual contacts (i.e., same sex only, opposite sex only, or both sexes), or both of these variables. The surveys were conducted among large population-based samples of public school students in grades 9–12. Detailed information about the state and local YRBSs has been published elsewhere.

Measured health-risk behaviors were the following:

Behaviors that Contribute to Unintentional Injuries: Seatbelt, Bicycle Helmet, Rode with a Driver Who Had Been Drinking Alcohol, Drove When Drinking Alcohol
Behaviors that Contribute to Violence: Carried a Weapon, Carried a Gun, In a Physical Fight, Injured in a Physical Fight, Dating Violence, Forced to Have Sexual Intercourse, Carried a Weapon on School Property, Threatened or Injured with a Weapon on School Property, In a Physical Fight on School Property, Did Not Go to School Because of Safety Concerns
Behaviors Related to Attempted Suicide: Felt Sad or Hopeless, Seriously Considered Attempting Suicide, Made a Suicide Plan, Attempted Suicide, Suicide Attempt Treated by a Doctor or Nurse
Tobacco Use: Ever Smoked Cigarettes, Smoked a Whole Cigarette Before Age 13 Years, Ever Smoked Cigarettes Daily, Current Cigarette Use, Current Frequent Cigarette Use, Smoked More than 10 Cigarettes per Day, Smoked Cigarettes on School Property, Tried to Quit Smoking Cigarettes, Current Smokeless Tobacco Use, Used Smokeless Tobacco on School Property, Current Cigar Use, Current Tobacco Use
Alcohol Use: Ever Drank Alcohol, Drank Alcohol Before Age 13 Years, Current Alcohol Use, Binge Drinking, Drank Alcohol on School Property
Other Drug Use: Ever Used Marijuana, Tried Marijuana Before Age 13 Years, Current Marijuana Use, Used Marijuana on School Property, Ever Used Cocaine, Current Cocaine Use, Ever Used Inhalants, Ever Used Ecstasy, Ever Used Heroin, Ever Used Methamphetamines, Ever Took Steroids Without a Doctor’s Prescription, Ever Injected Any Illegal Drug, Offered, Sold, or Given an Illegal Drug on School Property
Sexual Behaviors that Contribute to Unintended Pregnancy and Sexually Transmitted Diseases, Including HIV Infection: Ever Had Sexual Intercourse, Had First Sexual Intercourse Before Age 13 Years, Had Sexual Intercourse with Four or More Persons During Their Life, Currently Sexually Active, Condom Use, Birth Control Pill Use, Depo-Provera Use, Birth Control Pill Use or Depo-Provera Use, Condom Use and Birth Control Pill or Depo-Provera Use, Drank Alcohol or Used Drugs Before Last Sexual Intercourse, Were Taught in School About AIDS or HIV Infection
Dietary Behaviors: Ate Fruit or Drank 100% Fruit Juices Two or More Times per Day, Ate Vegetables Three or More Times per Day, Ate Fruits and Vegetables Five or More Times per Day, Drank Three or More Glasses per Day of Milk, Drank Soda or Pop at Least One Time per Day
Physical Activity and Sedentary Behavior: Physically Active at Least 60 Minutes per Day on All 7 Days, Physically Active at Least 60 Minutes per Day on 5 or More Days, Did Not Participate in at Least 60 Minutes of Physical Activity on Any Day, Used Computers 3 or More Hours per Day, Watched Television 3 or More Hours per Day, Attended Physical Education Classes, Attended Physical Education Classes Daily, Played on at Least One Sports Team
Weight Control: Did Not Eat for 24 or More Hours to Lose Weight or to Keep From Gaining Weight, Took Diet Pills, Powders, or Liquids to Lose Weight or to Keep From Gaining Weight, Vomited or Took Laxatives to Lose Weight or to Keep From Gaining Weight
Health Outcomes: Obesity, Overweight

RESULTS

Sexual identity
Across the nine sites that assessed sexual identity, the percentage of students who identified themselves as heterosexual ranged from 90.3% to 93.6% (median: 93.0%), as gay or lesbian ranged from 1.0% to 2.6% (median: 1.3%), and as bisexual ranged from 2.9% to 5.2% (median: 3.7%) (Table 3). The percentage of students who were unsure of their sexual identity ranged from 1.3% to 4.7% (median 2.5%). Across the 12 sites that assessed sex of sexual contacts, the percentage of students who only had sexual contact with the opposite sex ranged from 37.2% to 60.9% (median: 53.5%), only had sexual contact with the same sex ranged from 0.7% to 3.9% (median: 2.5%), and had sexual contact with both sexes ranged from 1.9% to 4.9% (median: 3.3%). The percentage of students who had no sexual contact ranged from 30.4% to 59.3% (median: 40.5%).

Across the eight sites that assessed both sex of sexual contacts and sexual identity, the percentage of students who identified themselves as heterosexual ranged from 94.9% to 97.7% (median: 96.3%) among students who only had sexual contact with the opposite sex, from 17.0% to 77.8% (median: 61.7%) among students who only had sexual contact with the same sex, and from 17.3% to 63.4% (median: 29.8%) among students who had sexual contact with both sexes. The percentage of students who identified themselves as gay or lesbian ranged from 0.0% to 0.8% (median: 0.4%) among students who only had sexual contact with the opposite sex, from 10.8% to 60.0% (median: 21.7%) among students who only had sexual contact with the same sex, and from 2.3% to 14.7% (median: 9.1%) among students who had sexual contact with both sexes. The percentage of students who identified themselves as bisexual ranged from 1.2% to 3.3% (median: 2.0%) among students who only had sexual contact with the opposite sex, from 6.6% to 22.3% (median: 11.3%) among students who only had sexual contact with the same sex, and from 24.9% to 61.9% (median: 50.9%) among students who had sexual contact with both sexes. The percentage of students who were unsure of their sexual identity ranged from 0.6% to 2.1% (median: 1.4%) among students who only had sexual contact with the opposite sex, from 0.7% to 6.6% (median: 4.4%) among students who only had sexual contact with the same sex, and from 6.1% to 15.9% (median: 10.1%) among students who had sexual contact with both sexes.

Differences by Sex Subgroups
Across the nine sites (Delaware, Maine, Massachusetts, Rhode Island, Vermont, Boston, Chicago, New York City, and San Francisco) that assessed sexual identity, the prevalence among sexual minority male students (as defined by sexual identity [i.e., gay and bisexual]) was higher than the prevalence among heterosexual male students for a range of 46.0% to 87.5% (median: 65.8%) of all the risk behaviors measured, the same as the prevalence among heterosexual male students for a range of 8.9% to 51.4% (median: 34.2%) of all the risk behaviors measured, and lower than the prevalence among heterosexual male students for a range of 0.0% to 3.6% (median: 0.0%) of all the risk behaviors measured. Similarly, the prevalence among sexual minority female students (i.e., lesbian and bisexual) was higher than the prevalence among heterosexual female students for a range of 60.5% to 90.0% (median: 72.0%) of all the risk behaviors measured, the same as the prevalence among heterosexual female students for a range of 8.6% to 39.1% (median: 26.7%) of all the risk behaviors measured, and lower than the prevalence among heterosexual female students for a range of 0.0% to 3.9% (median: 0.0%) of all the risk behaviors measured.

Across the 12 sites (Connecticut, Delaware, Maine, Massachusetts, Rhode Island, Vermont, Wisconsin, Boston, Chicago, Milwaukee, New York City, and San Diego) that assessed sex of sexual contacts, the prevalence among sexual minority male students, as defined by sex of sexual contacts (i.e., male students who only had sexual contact with males and male students who had sexual contact with both sexes), was higher than the prevalence among male students who only had sexual contact with females for a range of 16.7% to 78.9% (median: 48.2%) of all the risk behaviors measured, the same as the prevalence as among male students who only had sexual contact with females for a range of 17.5% to 83.3% (median: 51.1%) of all the risk behaviors measured, and lower than the prevalence among male students who only had sexual contact with females for a range of 1.5% to 4.2% (median: 0.0%) of all the risk behaviors measured. The prevalence among sexual minority female students, as defined by sex of sexual contacts (i.e., female students who only had sexual contact with females and female students who had sexual contact with both sexes), was higher than the prevalence among female students who only had sexual contact with males for a range of 34.2% to 82.9% (median: 68.5%) of all the risk behaviors measured, the same as the prevalence among female students who only had sexual contact with males for a range of 8.8% to 60.5% (median: 30.1%) of all the risk behaviors measured, and lower than the prevalence among female students who only had sexual contact with males for a range of 0.0% to 10.5% (median: 0.0%) of all the risk behaviors measured.

Differences by Race/Ethnicity Subgroups
In New York City, 6.1% of black students, 7.5% of Hispanic students, and 4.5% of white students comprised the sexual minority subgroup as defined by sexual identity (i.e., gay or lesbian and bisexual). The prevalence among these sexual minority black students was higher than the prevalence among heterosexual black students for 46.7% of all the risk behaviors measured, the same as the prevalence among heterosexual black students for 50.7% of all the risk behaviors measured, and lower than the prevalence among heterosexual black students for 2.7% of all the risk behaviors measured. The prevalence among these sexual minority Hispanic students was higher than the prevalence among heterosexual Hispanic students for 66.7% of all the risk behaviors measured, the same as the prevalence among heterosexual Hispanic students for 32.0% of all the risk behaviors measured, and lower than the prevalence among heterosexual Hispanic students for 1.3% of all the risk behaviors measured. The prevalence among these sexual minority white students was higher than the prevalence among heterosexual white students for 58.7% of all the risk behaviors measured, the same as the prevalence among heterosexual white students for 40.0% of all the risk behaviors measured, and lower than the prevalence among heterosexual white students for 1.3% of all the risk behaviors measured.

In Massachusetts, 10.5% of black students, 10.4% of Hispanic students, and 8.9% of white students comprised the sexual minority subgroup as defined by sex of sexual contacts (i.e., students who only had sexual contact with the same sex and students who had sexual contact with both sexes). The prevalence among these sexual minority black students was higher than the prevalence among black students who only had sexual contact with the opposite sex for 56.5% of all the risk behaviors measured, the same as the prevalence among black students who only had sexual contact with the opposite sex for 43.5% of all the risk behaviors measured, and lower than the prevalence among black students who only had sexual contact with the opposite sex for 0.0% of all the risk behaviors measured. The prevalence among these sexual minority Hispanic students was higher than the prevalence among Hispanic students who only had sexual contact with the opposite sex for 60.9% of all the risk behaviors measured, the same as the prevalence among Hispanic students who only had sexual contact with the opposite sex for 39.1% of all the risk behaviors measured, and lower than the prevalence among Hispanic students who only had sexual contact with the opposite sex for 0.0% of all the risk behaviors measured.

The prevalence among these sexual minority white students was higher than the prevalence among white students who only had sexual contact with the opposite sex for 74.3% of all the risk behaviors measured, the same as the prevalence among white students who only had sexual contact with the opposite sex for 25.7% of all the risk behaviors measured, and lower than the prevalence among white students who only had sexual contact with the opposite sex for 0.0% of all the risk behaviors measured.

Similarly in New York City, 10.5% of black students, 12.0% of Hispanic students, and 12.5% of white students comprised the sexual minority subgroup as defined by sex of sexual contacts (i.e., students who only had sexual contact with the same sex and students who had sexual contact with both sexes). The prevalence among these sexual minority black students was higher than the prevalence among black students who only had sexual contact with the opposite sex for 40.0% of all the risk behaviors measured, the same as the prevalence among black students who only had sexual contact with the opposite sex for 58.7% of all the risk behaviors measured, and lower than the prevalence among black students who only had sexual contact with the opposite sex for 1.3% of all the risk behaviors measured. The prevalence among these sexual minority Hispanic students was higher than the prevalence among Hispanic students who only had sexual contact with the opposite sex for 61.3% of all the risk behaviors measured, the same as the prevalence among Hispanic students who only had sexual contact with the opposite sex for 37.3% of all the risk behaviors measured, and lower than the prevalence among Hispanic students who only had sexual contact with the opposite sex for 1.3% of all the risk behaviors measured. The prevalence among these sexual minority white students was higher than the prevalence among white students who only had sexual contact with the opposite sex for 46.7% of all the risk behaviors measured, the same as the prevalence among white students who only had sexual contact with the opposite sex for 53.3% of all the risk behaviors measured, and lower than the prevalence among white students who only had sexual contact with the opposite sex for 0.0% of all the risk behaviors measured.

SUMMARY

These YRBSS results document the disproportionate rates at which sexual minority students practice many health-risk behaviors. This disparity is most apparent among students who identify themselves as gay or lesbian or bisexual. Across the nine sites that assessed sexual identity, the prevalence among gay or lesbian students was higher than the prevalence among heterosexual students for a median of 63.8% of all the risk behaviors measured, and the prevalence among bisexual students was higher than the prevalence among heterosexual students for a median of 76.0% of all the risk behaviors measured.

PUBLIC HEALTH ACTION RECOMMENDATIONS

Effective state and local public health and school health policies and practices should be developed to help reduce the prevalence of health-risk behaviors and improve health outcomes among sexual minority youths. In addition, more state and local surveys designed to monitor health-risk behaviors and selected health outcomes among population-based samples of students in grades 9–12 should include questions on sexual identity and sex of sexual contacts. Various approaches to achieve these aims are the following:

Create safe and welcoming school environments with the formation of Gay-Straight Alliances (GSAs) in schools.
School staff members and others who work with sexual minority youths can benefit from training to help them understand the needs of sexual minority youths and shape behavioral health messages accordingly. CDC funded the American Psychological Association (APA) Healthy Lesbian, Gay, and Bisexual Students Project to help schools and youth-serving organizations improve health and mental health outcomes for sexual minority youths. APA provided science-based workshops for school counselors, nurses, psychologists, and social workers on how to effectively reach sexual minority youths with HIV prevention messages and other health information. Individual state and local agencies also are implementing policies and practices to reduce sexual and other health-risk behaviors among sexual minority students.

Schools are not the only societal institutions that should help address the health-risk behaviors of sexual minority students. CDC funds health departments and community organizations to promote the use of evidence-based HIV interventions, some of which are geared toward young men who have sex with men and young racial/ethnic minorities. Information about these interventions is available here.

Health-care providers also can play an important role in addressing the medical needs and reducing the health-risk behaviors of sexual minority students. Health care should be provided openly and nonjudgmentally, be culturally sensitive, and address both the physical and mental health issues that sexual minority students might have.

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