Protective Factors for LGBTQ Youth

Information for Health and Education Professionals

Group Of High School Students Standing In Corridor

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth are more likely to experience poor health than their heterosexual (straight) or cisgender peers.1-4  Supporting the health of LGBTQ youth has usually involved trying to understand and reduce factors that increase their risk. Much less attention has been paid to protective factors—the characteristics, conditions, and behaviors that directly improve positive health outcomes or reduce the effects of stressful life events and other risk factors.

Funding from the Arcus Foundation to the CDC Foundation supported the Centers for Disease Control and Prevention’s (CDC) Division of Adolescent and School Health (DASH) to review the published literature on protective factors for LGBTQ youth to identify gaps and opportunities for research and intervention. DASH focused on factors that promote sexual health for LGBTQ (i.e., sexual minority) youth. For transgender youth, we considered a broader set of factors that promote mental health and academic success in addition to sexual health. This page summarizes key findings that can strengthen programs and research that support LGBTQ youth.

What research has been done?

Very little research was found on sexual health-related protective factors for LGBTQ youth age 15-24 years. A search for articles about individual-level factors (things like knowledge, attitudes and skills) that promote positive sexual health outcomes for LGBTQ youth identified 20 articles reporting on 12 studies.5 A second search for articles about relationship-level protective factors (things like how people communicate with partners and parents) for the sexual health of LGBTQ youth identified 42 articles reporting on 32 studies.6 Most of this research on LGBTQ youth looks at young gay and bisexual men and does not include young lesbian, bisexual, and other women who have sex with women.5,6 Only 21 articles, reporting on the results of 19 studies, addressed protective factors that support sexual and mental health and positive education outcomes for transgender and other gender diverse youth.7

The published articles looked at a variety of different factors; however, many of these factors only appeared in one or two studies. Some factors that have been found to be protective for heterosexual youth were not studied at all.  While most studies of individual-level factors focused on beliefs and attitudes; only a few considered skills and competencies.

Opportunities for Researchers

To guide programs, we need more research on protective factors for LGBTQ youth. Based on the gaps identified in the DASH reviews, the following is needed:

  • More research on protective factors for young lesbian, bisexual, and other women who have sex with women
  • Examination of differences between young bisexual men and women and their gay and lesbian peers
  • Designed and implemented longitudinal studies
  • Consistent measurement of potential protective factors affecting LGBTQ youth health
  • Examination of LGBTQ youth’s skills and competencies related to sexual health promotion
  • Examination of LGBTQ youth’s relationships with medical providers and other trusted adults

What factors are protective?

Given the limits of existing research, it is hard to say what factors promote sexual health and positive outcomes among  LGBTQ youth. However, some factors had protective effects in multiple studies.

For gay and bisexual young men, these include:

  • Positive attitudes about condoms, such as thinking that condoms are pleasurable or important for healthy relationships.
  • Increased peer group acceptance of safer sex, meaning that friends support condom use and other behaviors that reduce risk.

For transgender youth, these include:

  • Acceptance and support from parents and peers, particularly when it comes to sexual orientation and gender identity.
  • Gay-straight alliances, which are student-led clubs that provide a safe place for students to support each other around issues related to sexual orientation and gender identity.

What can health and education professionals do?

Teenage friends spending time together

Health and education professionals engaged in practice or research should pay more attention to protective factors for LGBTQ youth. In addition to reducing risk, developing the assets of LGBTQ youth gives them resources to successfully navigate challenges. The articles included in the reviews and the broader literature suggest promising practices for doing so. Health and education professionals working to support programs in community and school settings can promote:

  • Positive youth development. Positive youth development (PYD) involves strengthening protective factors, including skills, competencies and supportive relationships. PYD programs have improved sexual health8 and should be open and welcoming to LGBTQ youth. Resources on PYD are available via
  • Inclusive sexual health education. Sex education that is relevant to LGBTQ youth can increase their ability to use condoms and talk with their partner about safer sex.9
  • Gay-straight alliances. Gay-straight alliances (GSAs) have been found to help LGBTQ youth as well as heterosexual, cisgender youth.10,11 The Genders Sexualities Alliance Network has developed tools for creating and supporting GSAs.
  • Parent engagement. Family acceptance has been linked to positive health outcomes for sexual and gender minority youth.12,13 The Family Acceptance Project offers resources to strengthen family support of LGBTQ youth.
  1. Johns, M. M., Lowry, R., Andrzejewski, J., Barrios, L., C., Demissie, Z., McManus, T., Rasberry, C. N., Robin, L., Underwood, J. M. (2019). Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students—19 states and large urban school districts, 2017. MMWR, 68(3), 67-71.
  1. CDC. Youth Risk Behavior Surveillance—United States, 2017. MMWR  2018;67(No. SS-8).
  2. Zaza S, Kann L, Barrios LC. Lesbian, Gay, and Bisexual Adolescents: Population Estimate and Prevalence of Health Behaviors. JAMA 2016.
  3. Reisner SL, Greytak EA, Parsons JT, Ybarra ML. Gender minority social stress in adolescence: Disparities in adolescent bullying and substance use by gender identity. J Sex Res. 2015;52(3):243-256.
  4. Armstrong HL, Steiner RJ, Jayne PE, Beltran O. Individual-level protective factors for sexual health outcomes among sexual minority youth: a systematic review of the literature. Sex Health 2016.
  5. Johns MM, Liddon N, Jayne PE, Beltran O, Steiner RJ, Morris E. Systematic mapping of relationship-level protective factors and sexual health outcomes among sexual minority youth: The role of peers, parents, and partners, and providers. LGBT Health. 2018;5(1). Available at
  6. Johns MM, Beltran O, Armstrong H, Jayne P, Barrios L. Protective factors among transgender and gender variant youth: A systematic review by socioecological level. J Primary Prev. 2018. 39(3):263-301. Available at
  7. Gavin LE, Catalano RF, David-Ferdon C, Gloppen KM, Markham CM. A review of positive youth development programs that promote adolescent sexual and reproductive health. J Adolesc Health 2010; 46(3 Suppl): S75-91.
  8. Mustanski B, Greene GJ, Ryan D, Whitton SW. Feasibility, Acceptability, and Initial Efficacy of an Online Sexual Health Promotion Program for LGBT Youth: The Queer Sex Ed Intervention. J Sex Res 2015; 52(2): 220-30.
  9. Marx RA, Kettrey HH. Gay-Straight Alliances are Associated with Lower Levels of School-Based Victimization of LGBTQ+ Youth: A Systematic Review and Meta-analysis. J Youth Adolesc 2016; 45(7): 1269-82.
  10. Saewyc 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. Int J Child Youth Family Stud 2014; 5(1): 89-112.
  11. Ryan C, Russell ST, Huebner D, Diaz R, Sanchez J. Family acceptance in adolescence and the health of LGBT young adults. J Child Adolesc Psychiatr Nurs 2010; 23(4): 205-13.
  12. Simons L, Schrager SM, Clark LF, Belzer M, Olson J. Parental support and mental health among transgender adolescents. Journal of Adolescent Health 2013; 53(6): 791-3.