Health Risks That Are Higher Among LGBTQ Youth

What's causing increased risk for certain health problems?

Lesbian girls holding hands
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Sexual minority youth are young people who identify as gay, lesbian, and bisexual. The description also includes those who don't identify as one of these categories but who experience same-sex sexual attraction. Gender minority youth are individuals who identify as a gender other than the one they were assigned at birth. They may or may not also identify as sexual minorities. However, the two groups tend to be clumped together by researchers.

The category of youth tends to extend through the end of high school (~17 to 18 years old). 

Sexual and gender minority youth come from all communities. They also are found in all racial and ethnic groups. In fact, sexual and gender minority youth who are also racial minorities tend to experience even greater difficulties. This can be seen in their health outcomes as well as in their experiences of stigma and prejudice. Many young people talk about their identities and experiences as intersectional. They recognize that many, varied facets of life affect their day to day experiences. It's not just race, class, or sexual orientation. It's all three, and maybe some other factors alongside. 

Intersectionality is defined as "The interconnected nature of social categorizations such as race, class, and gender as they apply to a given individual or group, regarded as creating overlapping and interdependent systems of discrimination or disadvantage." - The Oxford Dictionaries

Approximately once every year or two, the Centers for Disease Control and Prevention does a national survey of young people in grades 9 to 12. This survey is known as the Youth Risk Behavior Survey, or YRBS. It's one of the best ways to get a snapshot of young people's health in the U.S. While it's not perfect, it looks at a much larger and more diverse sample than most studies can manage.

It's also run on a regular basis, and many questions remain consistent over time. This provides researchers a unique opportunity to look at trends. Those trends include health risks among sexual and gender minority youth. 

Health Disparities Among LGBTQ Youth

National studies have identified a number of health concerns that disproportionately affect lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth and adults. These include health concerns that are clearly linked to minority stigma.

For example, suicide risk, substance use, and depression are much higher in these population. However, they also include other health concerns such as obesity and asthma. These conditions may be related to minority stigma, but the link is not quite so black and white. Sexual and gender minority youth also experience more violence, sexually transmitted diseases, HIV, and pregnancies than their heterosexual and cisgender peers.  

The long-term effects of these health disparities may be made worse by difficulty accessing affirming healthcare.

Healthcare discrimination is a big problem for sexual and gender minorities. That's particularly true for transgender people of color. 

Heath Risk Factors for Lesbian, Gay, Bisexual, and Transgender Youth

The 2016 release of the YRBS put a spotlight on health risk factors for sexual minority youth. The study found that nationwide, 1.7 percent of 9th to 12th graders had had sexual contact with only the same sex, 48 percent with only the opposite sex, and 4.6 percent with both sexes. Those categories were not necessarily aligned with sexual identity. People identified as gay or lesbian even when they'd only had sex with the opposite sex and vice versa. Overall, 2 percent of youth identified as gay or lesbian, 6 percent as bisexual, and 3.2 were uncertain of their sexual identity. In other words, more than one in 10 high school students has a sexual identity that is not heterosexual. 

The YRBS is specifically interested in health risk behaviors. They look at risk across six types of behavior:

  1. those that contribute to unintentional injuries and violence
  2. tobacco use
  3. alcohol and other drug use
  4. sexual behaviors related to STDs and unintended pregnancy
  5. unhealthy eating
  6. physical inactivity

In four of those categories, the vast majority of risk behaviors occurred more often in sexual minority youth. The only areas where sexual minority youth weren't consistently at increased risk were physical activity, food choices, and birth control use. 

Some of the areas where sexual minority youth had higher risk may surprise you. For example, young people who identified as sexual minorities or who had same sex sexual partners were more likely to:

  • skip wearing a seatbelt when someone else was driving 
  • ride in a car where the driver was under the influence of alcohol or drive while drinking
  • carry a weapon on school property (although they were less likely to carry a gun)
  • be threatened or injured with a weapon while on school property
  • avoid school because of safety concerns
  • experience e-bullying or bullying at school
  • try smoking cigarettes 
  • smoke or drink alcohol before they turned 13
  • try marijuana, cocaine, ecstasy, methamphetamine and/or heroin at least once
  • misuse prescription drugs
  • have sexual intercourse for the first time before the age of 13
  • drink alcohol or use drugs before sex
  • be physically forced to have unwanted sex
  • experience physical or sexual dating violence

In other words they experience violence at the hands of others more often. They may also be in more situations where they are at risk. As such, it is perhaps unsurprising that sexual minority students were more than twice as likely to feel sad or hopeless or seriously consider suicide. Gay, lesbian, and bisexual students were almost five times more likely to attempt suicide than their heterosexual peers, and unsure students were more than twice as likely. Such increased risk has been found time and time again, across studies. 

A Word From Verywell

In many areas of the U.S., the environment for sexual and gender minority youth has improved over time. However, there's still a long way to go. It's also important to know that these young people are at risk, in large part, because of the actions of people around them. Fortunately, there are things that everyone can do to help. These range from encouraging respect for people with diverse identities to creating visible, safe spaces for sexual and gender minority youth to gather.

It's also important to remember that sexual and gender minority youth and adults are everywhere. That's why kindness isn't a "sometime" thing. Creating healthy, accepting environments is something we should strive for every day and in every way. That means not just eliminating overt hostility to these and other minority groups but improving the content of sex and health education to include material that is both fact-based and inclusive of everyone.

It's not only the public at large that needs additional education. Medical students and other providers also receive inadequate information about sexual health and sexual orientation. Fortunately, there is an ongoing movement to make that happen in medical schools and other professional training programs. Unfortunately, there's still a long way to go.

Sources:

Coleman E. Sexual health education in medical school: a comprehensive curriculum. Virtual Mentor. 2014 Nov 1;16(11):903-8. doi: 10.1001/virtualmentor.2014.16.11.medu1-1411.

Grant, Jaime M., Lisa A. Mottet, Justin Tanis, Jack Harrison, Jody L. Herman, and Mara Keisling. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011.

Kann L, Olsen EO, McManus T, Harris WA, Shanklin SL, Flint KH, Queen B, Lowry R, Chyen D, Whittle L, Thornton J, Lim C, Yamakawa Y, Brener N, Zaza S. Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9-12 - United States and Selected Sites, 2015. MMWR Surveill Summ. 2016 Aug 12;65(9):1-202. doi: 10.15585/mmwr.ss6509a1.

Oxford Dictionaries. "Definition of Intersectionality in English:." Intersectionality: Definition of Intersectionality in Oxford Dictionary (American English) (US). Oxford Dictionaries, 2016. Web. 22 Aug. 2016.

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