Health Risks Among Sexual Minority Youth
Sexual minority youth—those who identify as gay, lesbian, or bisexual or who have sexual contact with persons of the same or both sexes—are part of every community and come from all walks of life. They are diverse, representing all races, ethnicities, socioeconomic statuses, and parts of the country.
While many sexual minority youth cope with the transition from childhood to adulthood successfully and become healthy and productive adults, others struggle as a result of challenges such as stigma, discrimination, family disapproval, social rejection, and violence. Sexual minority youth are also at increased risk for certain negative health outcomes. For example, young gay and bisexual males have disproportionately high rates of HIV, syphilis, and other sexually transmitted diseases (STDs), and adolescent lesbian and bisexual females are more likely to have ever been pregnant than their heterosexual peers.
In 2017, ten states (Colorado, Delaware, Hawaii, Massachusetts, Maryland, Maine, Michigan, Rhode Island, Vermont, Wisconsin) and nine large urban school districts (Boston, Cleveland, District of Columbia, Detroit, Broward County, Los Angeles, New York City, San Diego, San Francisco) piloted a question to measure the proportion of high school students who identify as transgender.
Survey data from population-based samples of selected state and urban school districts (n=19 sites) indicate that an average of 1.8% of high school students identify as transgender. Transgender students are more likely than cisgender students to report violence victimization, substance use, and suicide risk, and although generally more likely to report sexual risk behaviors, were also more likely to report being tested for HIV.
Follow the links below to examine differences in health behaviors among transgender and cisgender students, in select U.S. states and large urban school districts.
- 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 2019;68(3);67-71.
- Select U.S. States High School Surveys Risk Behaviors and Transgender Report pdf icon[PDF – 772 KB]
- Select U.S. Large Urban School Districts High School Surveys Risk Behaviors and Transgender Report pdf icon[PDF – 785 KB]
- Select U.S. States and Large Urban School Districts High School Surveys Risk Behaviors and Transgender Report pdf icon[PDF – 796 KB]
CDC analyzed data from the 2015 national survey (conducted among more than 15,000 students in grades 9–12) plus data from 25 state surveys, and 19 large urban school district surveys. The findings are described in a CDC Morbidity and Mortality Weekly Report, “Sexual Identity, Sex of Sexual Contacts, and Health-related Behaviors Among Students in Grades 9-12—United States and Selected Sites, 2015.” The report documents the rates at which LGB students reported experiencing substantially higher levels of physical and sexual violence and bullying than other students.
In the report, sexual minority students were defined as those—
- who identified themselves as gay, lesbian, or bisexual;
- who had had sexual contact with only persons of the same sex; or
- who had had sexual contact with persons of both sexes.
Collecting information about students’ sexual identity and about the sex of their sexual contacts is necessary because some students identify themselves as heterosexual but report having sexual contact with only persons of the same sex, whereas some students who identify themselves as gay, lesbian or bisexual have not had sexual contact or have had sexual contact with only persons of the opposite sex. This dissonance is well documented in other research and can be a normal part of the developmental process that occurs during adolescence.
The findings from this report show the rates at which LGB high school students experience many health risks, compared with heterosexual students. These health risks are most apparent among students who identify themselves as LGB. Specifically, this report found that compared to their heterosexual peers, LGB students are significantly more likely to report:
- Being physically forced to have sex (18% LGB vs. 5% heterosexual)
- Experiencing sexual dating violence (23% LGB vs. 9% heterosexual)
- Experiencing physical dating violence (18% LGB vs. 8% heterosexual)
- Being bullied at school or online (at school: 34% LGB vs. 19% heterosexual; online: 28% LGB vs. 14% heterosexual)
While physical and sexual violence and bullying are serious health dangers on their own, a combination of complex factors can place young people at high risk for suicide, depression, addiction, poor academic performance, and other severe consequences. Data demonstrate that LGB students may be at substantial risk for these serious outcomes:
- More than 40% of LGB students have seriously considered suicide, and 29% reported having attempted suicide during the past 12 months.
- Sixty percent of LGB students reported having been so sad or hopeless they stopped doing some of their usual activities.
- LGB students are up to five times more likely than other students to report using illegal drugs.
- More than 1 in 10 LGB students reported missing school during the past 30 days due to safety concerns. While not a direct measure of school performance, absenteeism has been linked to low graduation rates, which can have lifelong consequences.
Although there are no simple solutions to address the health risks LGB students’ face, research demonstrates the importance of school, community, and family support for LGB youth.
- Focused public health and school-based actions and policies that support safe and supportive environments for LGB students are key.
- Youth-serving agencies and organizations, including schools, communities and youth-friendly health care centers and providers, can help facilitate access to education and information, health care services, and evidence-based programs and interventions designed to address the health-related behaviors that impact LGB youth.
- Outreach efforts and educational programs can provide parents and families with the information and skills they need to help support LGB youth.
Because many health-related behaviors initiated during adolescence often extend into adulthood, they can potentially have a life-long negative effect on health outcomes, educational attainment, employment, housing, and overall quality of life. Many LGB students, therefore, need coordinated action to meet their needs and improve their health and well-being.
- Developing policies and practices that support the establishment of safe and supportive environments for all students, including LGB students.
- Facilitating access to education, health care, and evidence-based interventions designed to address priority health-risk behaviors among LGB students.
- Implementing programs and providing training for those who work with LGB students to better understand needs and services.
- Summarizing and applying survey results to increase the effectiveness of interventions and programs for LGB teens.
- Providing funding and technical assistance to develop, implement, and evaluate interventions that reduce health risk behaviors and promote healthy practices among LGB students.
- Monitoring the impact of broad policy and programmatic interventions on the health-related behaviors of LGB students.
CDC calls for accelerated action to protect the health and well-being of these young people. Coordinated action by schools and communities is needed to protect LGB students and address the health risks they face.
CDC and its partners are taking action by funding, implementing, and evaluating programs that address many of these health risks and supporting the solutions, including violence prevention, developing tools for education partners to promote healthy school environments for all students, forging national partnerships, and providing scientific leadership.
For this report, CDC analyzed data from Youth Risk Behavior Surveys conducted during 2001–2009 in seven states—Connecticut, Delaware, Maine, Massachusetts, Rhode Island, Vermont, and Wisconsin—and six large urban school districts—Boston, Chicago, Milwaukee, New York City, San Diego, and San Francisco—that collected data on high school students’ sexual identity (heterosexual, gay, lesbian, bisexual, or unsure), sex of sexual contacts (sexual contact with the opposite sex only, with the same sex only, or with both sexes), or both.
Sexual minority students were defined as those who identified themselves as gay, lesbian, or bisexual; who had had sexual contact only with persons of the same sex; or who had had sexual contact with persons of both sexes. Collecting information about students’ sexual identity and about the sex of their sexual contacts is necessary because some students identify themselves as heterosexual but report having sexual contact only with persons of the same sex, whereas some students who identify themselves as gay, lesbian or bisexual have not had sexual contact. Therefore, questions about sexual identity and sex of sexual contacts can help identify a broader range of individuals as sexual minority students.
This report represents the first time that the federal government has conducted an analysis of this magnitude across such a wide array of states, large urban school districts, and risk behaviors. Specifically, the report summarizes results by sexual minority status across 13 sites and 76 health risks in the following 10 categories:
- Behaviors that contribute to violence (e.g., did not go to school because of safety concerns)
- Behaviors related to attempted suicide (e.g., made a suicide plan)
- Behaviors that contribute to unintentional injuries (e.g., rarely or never wore a seat belt)
- Tobacco use (e.g., ever smoked cigarettes)
- Alcohol use (e.g., binge drinking)
- Other drug use (e.g., current marijuana use)
- Sexual behaviors (e.g., condom use)
- Dietary behaviors (e.g., ate vegetables 3 or more times per day)
- Physical activity and sedentary behaviors (e.g., physically active at least 60 minutes per day for 7 days)
- Weight management (e.g., did not eat for 24 or more hours to lose weight or to keep from gaining weight)
Risks by sexual identity
Nine states and large urban school districts assessed sexual identity. Across these locations, the percentage of all health risks for which the prevalence was higher for gay or lesbian students than it was for heterosexual students ranged from 49% to 90%. Gay and lesbian students had higher prevalence rates than heterosexual students for health risks in seven of the 10 health risk categories (behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight management).
- The prevalence of current cigarette use ranged from 8% to 19% among heterosexual students but ranged from 20% to 48% among gay and lesbian students.
Similarly, the percentage of all health risks for which the prevalence was higher for bisexual students than it was for heterosexual students ranged from 57% to 86% across the nine locations. Bisexual students had higher prevalence rates than heterosexual students for health risks in eight of the 10 health risk categories (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, and weight management).
- The prevalence of students who did not go to school because of safety concerns on at least 1 day during the 30 days before the survey ranged from 4% to 11% among heterosexual students but ranged from 11% to 25% among bisexual students.
Risks by sex of sexual contacts
Twelve states and large urban school districts assessed sex of sexual contacts. Across these locations, the percentage of all health risks for which the prevalence was higher for students who had sexual contact with both sexes than it was for students who only had sexual contact with the opposite sex ranged from 32% to 86%. Students who had sexual contact with both sexes had higher prevalence rates than those who only had sexual contact with the opposite sex for health risks in six of the 10 health risk categories (behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, and weight management).
- The prevalence of binge drinking ranged from 16% to 44% among students who only had sexual contact with the opposite sex, but from 33% to 63% among students who had sexual contact with both sexes.
Policies and Practices
Public health and school health policies and practices should be developed to support the establishment of safe and supportive environments for sexual minority students.
- By addressing the challenges sexual minority students face, such as stigma, discrimination, family disapproval, social rejection, and violence, schools can help to improve health outcomes and reduce the prevalence of health-risk behaviors.
Professional development should be provided for school staff and others who work with sexual minority youth, and effective programs should be implemented.
- School staff members and others can benefit from training to help them understand the needs of sexual minority students and implement effective programs and services to reduce health risks among these young people.
The results of this report highlight the disproportionate impact of negative health outcomes on sexual minority students and indicate a need to include questions on sexual identity and the sex of sexual contacts when monitoring health risks and selected health outcomes among high school students.
- In 2009, 10 states and 7 large urban school districts added questions to their YRBS questionnaire about sexual identity, sex of sexual contacts, or both.
- Collecting data on risk behaviors among sexual minority students and school health policies and practices to prevent risk behaviors.
- Ensuring that health education curricula include prevention information relevant to sexual minority students.
- Providing training for school district and school staff to help them understand the special concerns and needs of this population.
- Supporting schools in establishing gay-straight alliances (student-run clubs that work to create safe and supportive school environments for all students, regardless of sexual identity) or similar groups.
- Linking schools to community organizations that provide physical health and mental health services for gay, lesbian, and bisexual youth.
Specific program activities are described at www.cdc.gov/lgbthealth/youth-programs.htm.
Schools are not the only societal institutions that should help address the health risks of sexual minority youth. CDC also funds health agencies and community organizations to promote the use of evidence-based HIV prevention programs, some of which are geared toward young men who have sex with men. Information about these interventions is available at www.cdc.gov/hiv/research/interventionresearch/compendium/index.html.
- Understanding Unequal Health Risks of LGBT Students
- NCHHSTP Strategic Plan Through 2020
- NCHHSTP Social Determinants of Health
- The National HIV/AIDS Strategy: Updated to 2020external icon
- JAMA Viewpoint: Lesbian, Gay, and Bisexual Adolescentsexternal icon
- Sexual Minority Youth YRBS Palm Card pdf icon[PDF - 1 MB]
- MMWR: “Sexual Risk Behavior Differences Among Sexual Minority High School Students — United States, 2015 and 2017"
- MMWR: “Violence Victimization, Substance Use, and Suicide Risk Among Sexual Minority High School Students — United States, 2015–2017”