Lesbian, Gay, Bisexual, and Transgender Health
Most lesbian, gay, bisexual, transgender, and questioning
(LGBTQ)* youth are happy and thrive during their adolescent years. Going to a school that creates a safe and supportive learning environment for all students and having caring and accepting parents are especially important. This helps all youth achieve good grades and maintain good mental and physical health. However, some LGBTQ youth are more likely than their heterosexual peers to experience difficulties in their lives and school environments, such as violence.
* Variations of this acronym are used throughout the Web page to reflect relevant populations. Many studies consider lesbian, gay, and bisexual youth but do not include transgender and questioning youth.
Experiences with Violence
Negative attitudes toward lesbian, gay, and bisexual (LGB) people put these youth at increased risk for experiences with violence, compared with other students.1 Violence can include behaviors such as bullying, teasing, harassment, physical assault, and suicide-related behaviors.
According to data from Youth Risk Behavior Surveys (YRBS) conducted during 2001‒2009 in seven states and six large urban school districts, the percentage of LGB students (across the sites) who were threatened or injured with a weapon on school property in the prior year ranged from 12% to 28%. In addition, across the sites―
- 19% to 29% of gay and lesbian students and 18% to 28% of bisexual students experienced dating violence in the prior year.
- 14% to 31% of gay and lesbian students and 17% to 32% of bisexual students had been forced to have sexual intercourse at some point in their lives.2
LGBTQ youth are also at increased risk for suicidal thoughts and behaviors, suicide attempts, and suicide. A nationally representative study of adolescents in grades 7–12 found that lesbian, gay, and bisexual youth were more than twice as likely to have attempted suicide as their heterosexual peers.3 More studies are needed to better understand the risks for suicide among transgender youth. However, one study with 55 transgender youth found that about 25% reported suicide attempts.4
Another survey of more than 7,000 seventh- and eighth-grade students from a large Midwestern county examined the effects of school [social] climate and homophobic bullying on lesbian, gay, bisexual, and questioning (LGBQ) youth and found that
- LGBQ youth were more likely than heterosexual youth to report high levels of bullying and substance use;
- Students who were questioning their sexual orientation reported more bullying, homophobic victimization, unexcused absences from school, drug use, feelings of depression, and suicidal behaviors than either heterosexual or LGB students;
- LGB students who did not experience homophobic teasing reported the lowest levels of depression and suicidal feelings of all student groups (heterosexual, LGB, and questioning students); and
- All students, regardless of sexual orientation, reported the lowest levels of depression, suicidal feelings, alcohol and marijuana use, and unexcused absences from school when they were
- In a positive school climate and
- Not experiencing homophobic teasing.5
Effects on Education and Health
Exposure to violence can have negative effects on the education and health of any young person. However, for LGBT youth, a national study of middle and high school students shows that LGBT students (61.1%) were more likely than their non-LGBT peers to feel unsafe or uncomfortable as a result of their sexual orientation.6 According to data from CDC’s YRBS, the percentage of gay, lesbian, and bisexual students (across sites) who did not go to school at least one day during the 30 days before the survey because of safety concerns ranged from 11% to 30% of gay and lesbian students and 12% to 25% of bisexual students.2
The stresses experienced by LGBT youth also put them at greater risk for depression, substance use, and sexual behaviors that place them at risk for HIV and other sexually transmitted diseases (STDs).1,2,7 For example, HIV infection among young men who have sex with men aged 13‒24 years increased by 26% over 2008‒2011.8
What Schools Can Do
For youth to thrive in their schools and communities, they need to feel socially, emotionally, and physically safe and supported. A positive school climate has been associated with decreased depression, suicidal feelings, substance use, and unexcused school absences among LGBQ students.9
Schools can implement clear policies, procedures, and activities designed to promote a healthy environment for all youth. For example, research has shown that in schools with LGB support groups (such as gay-straight alliances), LGB students were less likely to experience threats of violence, miss school because they felt unsafe, or attempt suicide than those students in schools without LGB support groups.10 A recent study found that LGB students had fewer suicidal thoughts and attempts when schools had gay-straight alliances and policies prohibiting expression of homophobia in place for 3 or more years.11
To help promote health and safety among LGBTQ youth, schools can implement the following policies and practices:
- Encourage respect for all students and prohibit bullying, harassment, and violence against all students.
- Identify “safe spaces,” such as counselors’ offices, designated classrooms, or student organizations, where LGBTQ youth can receive support from administrators, teachers, or other school staff.
- Encourage student-led and student-organized school clubs that promote a safe, welcoming, and accepting school environment (e.g., gay-straight alliances, which are school clubs open to youth of all sexual orientations).
- Ensure that health curricula or educational materials include HIV, other STD, or pregnancy prevention information that is relevant to LGBTQ youth (such as, ensuring that curricula or materials use inclusive language or terminology).
- Encourage school district and school staff to develop and publicize trainings on how to create safe and supportive school environments for all students, regardless of sexual orientation or gender identity, and encourage staff to attend these trainings.
- Facilitate access to community-based providers who have experience providing health services, including HIV/STD testing and counseling, to LGBTQ youth.
- Facilitate access to community-based providers who have experience in providing social and psychological services to LGBTQ youth.
What Parents Can Do
How parents respond to their LGB teen can have a tremendous impact on their adolescent’s current and future mental and physical health.12,13 Supportive reactions can help youth cope with the challenges of being an LGBTQ teen. However, some parents react negatively to learning that they may have an LGBTQ daughter or son. In some cases, parents no longer allow their teens to remain in the home. In other situations, stress and conflict at home can cause some youth to run away. As a result, LGB youth are at greater risk for homelessness than their heterosexual peers.1
To be supportive, parents should talk openly with their teen about any problems or concerns and be watchful of behaviors that might indicate their child is a victim of bullying or violence―or that their child may be victimizing others. If bullying, violence, or depression is suspected, parents should take immediate action, working with school personnel and other adults in the community.
» More resources for parents to help them better understand and respond to the needs of LGBTQ adolescents.
Ways Parents Can Influence the Health of Their LGB Youth
More research is needed to better understand the associations between parenting and the health of LGB youth. Following are selected research-based steps parents can take to support the health and well-being of their LGB teen:
Talk and listen. Parents who talk with and listen to their teen in a way that invites an open discussion about sexual orientation can help their teen feel loved and supported. Parents should have honest conversations with their teens about sex, and about how to avoid risky behavior and unsafe or high-risk situations.
Provide support. Parents who take time to come to terms with how they feel about their teen’s sexual orientation will be more able to respond calmly and use respectful language. Parents should develop common goals with their teen, including being healthy and doing well in school.
Stay involved. Parents who make an effort to know their teen’s friends and know what their teen is doing can help their teen stay safe and feel cared about.
Be proactive. Parents can access many organizations and online information resources to learn more about how they can support their LGB teen, other family members, and their teen’s friends.
» Get more information from the CDC Fact Sheet: Parents’ Influence on the Health of Lesbian, Gay, and Bisexual Teens.
- Coker TR, Austin SB, Schuster MA. The health and health care of lesbian, gay, and bisexual adolescents. Annual Review of Public Health 2010;31:457–477.
- Centers for Disease Control and Prevention. 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. MMWR. 2011.
- Russell ST, Joyner K. Adolescent sexual orientation and suicide risk: Evidence from a national study. American Journal of Public Health 2001;91:1276–1281.
- Grossman AH, D'Augelli AR. Transgender youth and life-threatening behaviors. Suicide & life-threatening behavior 2007;37:527-537.
- Birkett M, Espelage DL, Koenig B. LGB and questioning students in schools: The moderating effects of homophobic bullying and school climate on negative outcomes. Journal of Youth and Adolescence 2009;38:989–1000.
- Kosciw JG, Greytak EA, Diaz EM, Bartkiewicz MJ. The 2009 National School Climate Survey: The Experiences of Lesbian, Gay, Bisexual and Transgender Youth in Our Nation’s Schools. New York: Gay, Lesbian Straight Education Network; 2010.
- Russell ST, Ryan C, Toomey RB, Diaz RM, Sanchez J. Lesbian, gay, bisexual, and transgender adolescent school victimization: implications for young adult health and adjustment. Journal of School Health. 2011;81(5):223-30.
- Centers for Disease Control and Prevention. HIV surveillance in men who have sex with men (MSM). 2012. Available from the HIV/AIDS Resource Library Slide Sets web page.
- Espelage DL, Aragon SR, Birkett M. Homophobic teasing, psychological outcomes, and sexual orientation among high school students: What influence do parents and schools have? School Psychology Review 2008;37:202–216.
- Goodenow C, Szalacha L, Westheimer K. School support groups, other school factors, and the safety of sexual minority adolescents. Psychology in the Schools 2006;43:573–89.
- Saewcy EM, Konishi C, Rose HA, Homma Y. School-based strategies to reduce suicidal ideation, suicide attempts, and discrimination among sexual minority and heterosexual adolescents in Western Canada. International Journal of Child, Youth and Family Studies 2014;1:89‒112.
- Ryan C, Huebner D, Diaz RM, Sanchez J. Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics 2009;123:346–352.
- Bouris A, Guilamo-Ramos V, Pickard A, Shiu C, Loosier PS, Dittus P, Gloppen K, Waldmiller JM. A systematic review of parental influences on the health and well-being of lesbian, gay, and bisexual youth: time for a new public health research and practice agenda. Journal of Primary Prevention 2010;31:273–309.