Measuring the lives of LGBT youth

The last several years have featured many encouraging strides for lesbian, gay, bisexual, and transgender (LGBT) people: the nationwide victory for marriage equality, the end of Don’t Ask, Don’t Tell, supportive policy guidance from the Departments of Education and Justice, and other policy-level and grassroots initiatives have all established new policy standards for LGBT equality. In many ways, today’s LGBT youth are growing up in a much more broadly supportive society than the one I faced years ago. But while societal norms are shifting toward equality, a new study from the U.S. Centers for Disease Control and Prevention (CDC) finds that lesbian, gay, and bisexual (LGB) high school students still face significant obstacles to achieving well-being. (The study did not include transgender students.)

The report, “Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9–12 — United States and Selected Sites, 2015,” is an analysis of data from the biannual Youth Risk Behavior Survey (YRBS). This new report is the first nationally representative study on the health risks among U.S. LGB adolescents, and the findings are grim: LGB youth are nearly 4 times as likely to report having been physically forced to have sex when compared to their heterosexual peers (18 percent vs. 5 percent). They are also more than twice as likely to experience sexual dating violence (23 percent vs. 9 percent) and nearly twice as likely to report being bullied at school (34 percent vs. 19 percent). Additionally, 3 out of 10 LGB youth report that they have attempted suicide in the past 12 months.

Greater visibility of LGBT youth in respected data sets like the YRBS helps researchers and policymakers better understand the experiences of these youth. Having this information can enable productive, data-driven decisions about how to address some of the disparities that are highlighted in the CDC report. In other words, these data are crucial to fulfilling all three core functions of public health: assessment, policy development, and assurance.

This report is a step in the right direction, and provides a preliminary answer to the question, “How are LGB youth faring at a national level?” However, the answer to that question is troubling. These young people are faring much worse than their heterosexual peers.

The next steps in improving the lives of LGBT youth

While including sexual orientation items in the YRBS is a giant step forward, there is still work to be done in assessing the experiences of LGBT youth. It is important to note that the YRBS did not ask youth to report their gender identity, a critical gap that was recently highlighted in light of the new Title IX guidance for transgender students from the Department of Education. And the YRBS data that the CDC analyzed relied on the following two questions, which have been used to assess sexual orientation among adults:

“Which of the following best describes you?”  Response options: “heterosexual (straight),” “gay or lesbian,” “bisexual,” and “not sure.”

“During your life, with whom have you had sexual contact?” Response options: “I have never had sexual contact,” “females,” “males,” and “females and males.”

However, just because these items have been used with adults does not mean they will work for youth. By definition, adolescents are in the process of figuring out who they are, some may be reluctant to choose a permanent label and others may not yet have had any sexual contact.

A recent study published in The Journal of Adolescent Health focused on mental health symptoms among LGBTQ youth, and included questions about sexual attraction.[1] The authors of the study classified youth as lesbian, gay, bisexual, or questioning based on their responses to a question about gender and sexual attraction. A laudatory editorial by the Journal’s editors[2] rightly pointed out that sexual orientation is generally seen as an identity, and that sexual attraction and sexual identity may not always overlap, highlighting the challenges in measuring such a complex construct.

Here at Child Trends, a group of researchers (with funding from the Arcus Foundation) are developing empirically validated items to help guide the way we ask youth about their sexual orientation and gender identity. Part of this work will involve interviewing youth to understand how they perceive and interpret questions about constructs like sexual identity, sexual attraction, and gender identity.

As demonstrated by the disparities that are presented in the CDC report, the stakes are high. As we seek to improve the lives and prospects for LGBT youth, we must build on these data with validated measures to ensure that our priorities are based on the best evidence available.

[1] Shearer, A., Herres, J., Kodish, T., Squitieri, H., James, K., Russon, J., Atte, T. & Diamond, G. S. (2016). Differences in Mental Health Symptoms Across Lesbian, Gay, Bisexual, and Questioning Youth in Primary Care Settings.Journal of Adolescent Health.59(1), 38-43.

[2] Baams, L. (2016). Attracting Attention to Sexual Minority Youth. The Journal of adolescent health: official publication of the Society for Adolescent Medicine59(1), 3-4.