Bisexual Students Research Articles

College Student Social Network Characteristics and Alcohol Use: Differences (and Similarities) Based on Sexual Identity and Attraction.

Sexual minority (SM) college students have higher alcohol use and alcohol-related consequences than heterosexual students. Peers are salient determinants of young adult drinking, and examining social network characteristics is useful for understanding peer influence. This study used social network methods to understand network characteristics, alcohol use (i.e., max drinks), and alcohol consequences of SM and heterosexual college students. Sexual minority and heterosexual junior-year college students (N = 1,150) were compared on (1) social network features (eigenvector centrality, indegree, outdegree, mutuality, closeness), and (2) alcohol use and consequences. We also determined (3) whether social network characteristics were associated with alcohol use and consequences, and (4) whether these associations differed based on sexual identity or attraction. Students reporting a bisexual identity or same-gender attraction had greater eigenvector centrality (global popularity or prestige) than heterosexual or students reporting exclusively other-gender attraction, respectively. Students reporting same-gender attraction had higher outdegree (expansiveness) and more reciprocated ties (mutuality) than individuals reporting exclusively other-gender attraction, but heterosexual students and students with other-gender attraction reported higher relationship closeness; they also reported a higher number of drinks than bisexual students and students with same-gender attraction. One significant interaction showed that outdegree (expansiveness) was associated with alcohol consequences for students who reported any same-gender attraction, but not for students who reported exclusively opposite-gender attraction. SM college students' greater network prominence differs from research with adolescents and might reflect students' efforts to establish more affirming social connections in a college environment.

Social media use and mental health indicators among US adolescents: A population-based study

Social media use among young people has raised concerns about its potential impact on mental health. However, research is limited regarding whether certain subgroups may be differently affected. This study uses data from the 2022 National Youth Tobacco Survey, a nationally representative sample of middle and high school students aged approximately 11–18 years (n = 23,366). Mental health conditions were assessed using the Patient Health Questionnaire-4, and social media use was categorized by frequency levels. We employed multinomial logistic regression and a finite mixture Poisson model to explore the relationship between social media use, sexual identity, and mental health status. The study found a consistent association between social media use and mental health conditions, particularly among frequent users. The finite mixture model revealed two latent groups based on mental health status: a ‘better’ group with minimal or no poor mental health indicators and a ‘worse’ group with more indicators. For both groups, social media use was associated with mental health conditions, with a stronger association among frequent users. Notably, sexual minorities, especially bisexual students, were more likely to report poor mental health indicators. This study suggests that frequent social media use may adversely affect young people's mental health and that different youth subgroups may respond differently to social media use and mental health conditions.

Investigating preservice teachers’ attitudes toward lesbian, gay, and bisexual students in Luxembourg

AbstractLesbian, gay, and bisexual (LGB) students face victimization in multiple contexts, including the educational context. Here, teachers can serve as an important resource for LGB students. However, teachers who are prejudiced against students from sexual minorities might not be able to fulfill this role. Accordingly, it is important to find out more about teachers' attitudes and their correlates, as such information can provide starting points for sensitization interventions in teacher education programs, which have the potential to improve the situation of LGB students in the school setting. In the present preregistered questionnaire study, we investigated the attitudes of 138 preservice teachers from the University of Luxembourg toward LGB students and tried to identify predictors of teachers’ attitudes. Results suggested that Luxembourgish preservice teachers hold mostly positive attitudes toward LGB students. Using correlation and multiple regression analyses, we identified the frequency of participants’ contact with LGB people in family or friend networks, hypergendering tendencies, sexual orientation, and religiosity as reliable predictors of attitudes toward LGB students. Age, gender, and right-wing conservatism did not reliably predict preservice teachers’ attitudes in the regression models. Our findings thus offer support for intergroup contact theory and have implications for teacher education in Luxembourg.

“Just Shut Up and Take It”: South African University Students on Sexual Harassment

Sexual harassment and gender-based violence have become pervasive and normal within South African society. This trend is of grave concern at colleges and universities. Drawing on the social construction of the gender theory approach, this study explored the perceptions and experiences of sexual harassment among students at a South African university. The nature and causes of sexual harassment were examined. Twenty undergraduate students—twelve females, five males, one queer and two bisexual students—participated in this study. Data was generated using individual interviews and focus group discussions. Sexual harassment was prevalent at the university in the form of verbal, non-verbal and physical harassment. We argue that harassment stems from broader constructs of masculinity and patriarchal power that challenge and effectively silence victims. Non-reporting of harassment largely sanctions sexual harassment at the university. Female students were the main victims of gender-based violence with male students being the main perpetrators. LGBTQIA students were found to be vulnerable to harassment, mainly because of their sexual preference. The study revealed the need to create better awareness of what constitutes sexual harassment and gender-based violence and suggests that victims, perpetrators and university staff collaborate to tackle the scourge. We propose the necessity for focused and ongoing education and awareness campaigns on campus.

“Bisexuality’s never enough…”: using composite narratives to explore bisexual students’ experiences within LGBTQ campus spaces

Despite ongoing efforts to improve campus climate for marginalized students, queer- and trans-spectrum students continue to experience their college campuses as hostile and unwelcoming spaces. Bisexual students in particular face unique challenges and struggle to fully engage in campus communities that did not fully recognize their bisexual identity. To create safer and more inclusive campuses, colleges and universities often rely on LGBTQ campus spaces, like resource centers and student organizations, to offer affirmation, support, resources, and education for and about queer- and trans-spectrum students, but these spaces are not always inclusive of and affirming to bisexual students despite their mission. Using first-person composite narratives composed of interviews with nine bisexual college students, this study highlights bisexual students’ experiences within LGBTQ campus spaces. The findings can deepen higher education professionals’ understanding of these unique intracommunity dynamics to cultivate more welcoming, affirming, and supportive LGBTQ campus spaces for bisexual students.

Strategic Navigations of Identity in the Face of Bi-Erasure: Narratives of Bisexual College Student Identity Negotiation

Despite constituting the largest segment of the LGBTQ + community, limited research exists on the experiences of bisexual university students, and that which does often includes them among aggregated samples of lesbian, gay, bisexual, transgender, and queer people. Using data from a critical poststructural narrative inquiry study guided by a queer theoretical framework, I sought to understand the unique experiences of bisexual students relative to their sexual identities and how they negotiate their bisexuality on the college campus. Sixteen participants engaged in semi-structured interviews and a drawing activity. Thematic and dialogic/performance analyses resulted in one contextual pattern: pervasive binegativity. Thematic analysis further revealed four patterns characterizing identity negotiation strategies, enacted within this broader context: (a) settling for simplicity, (b) downplaying bisexuality, (c) subtly signaling sexuality, and (d) outness as advocacy. Implications for research, theory, and practice are offered.

Condoms on Campus: Understanding College Students' Embarrassment, Self-Efficacy, and Beliefs About Distribution Programs.

Condom distribution programs are a structural-level intervention implemented on college campuses to reduce sexually transmitted infections and unplanned pregnancies. Understanding students' beliefs about these programs and attitudes that can affect condom use is critical. Students at 6 different universities (n = 2809) completed items related to beliefs about campus condom distribution programs and their personal condom embarrassment and condom self-efficacy levels. Surveys were completed both in classroom and online. T Tests and analysis of variance were used to examine differences based on demographics. Logistic regression was used to examine predictors of condom use. College students support the distribution of condoms on campus (97.4%) but express moderate levels of embarrassment in condom acquisition and possession (mean, 19.37). Lower rates of embarrassment were reported for condom negotiation (mean, 9.13) and actual condom use (mean, 8.48). Lower overall rates of embarrassment were reported by condom users, men and individuals in relationships compared with noncondom users, women, and single individuals. Heterosexual students were more embarrassed than bisexual students about acquiring condoms and negotiating condom use. Condom users, men, and individuals in relationships had higher rates of condom self-efficacy compared with nonusers, women, and single students. There were no differences in self-efficacy based on sexual orientation. Embarrassment about acquiring and actual use of condoms, condom self-efficacy and demographics were all significant predictors of condom use. Campus condom distribution programs are supported by college students. Interventions to address embarrassment and increase condom self-efficacy need to be tailored to different students based on gender, experience with condoms, and relationship status.

The relationship between physical activity, stress, and resilience in sexual and gender minority college students

Objective To assess the role of sexual orientation and gender identity in the relationship between physical activity (PA), stress and resilience. Participants A nationally-representative sample of students (n = 91,718) from United States postsecondary institutions. Methods Students reported aerobic and strength training (ST) behaviors, stress, resilience, gender identity and sexual orientation. Moderated regressions examined the influence of gender identity and sexual orientation on the relationship between PA and stress or resilience. Results Men and heterosexual students reported higher PA and resilience and lower stress than did women, gender minorities, and sexual minorities. Significant moderation was found for women, queer students, bisexual students, trans women and lesbians in the various models. Conclusions Gender minority and sexual minority students display poorer levels of PA and mental health than cisgender and heterosexual counterparts, but this relationship varies by identity group.

Electronic Vapor Product Use Among High School Students — Youth Risk Behavior Survey, United States, 2021

Commercial tobacco use is the leading cause of preventable disease and death in the United States. Despite declines in overall tobacco product use among youths, disparities persist. This report uses biennial data from the 2015-2021 cycles of the nationally representative Youth Risk Behavior Survey to assess prevalence and trends in electronic vapor product (EVP) use among high school students, including ever use, current use (past 30 days), and daily use. Data from 2021 also included usual source of EVPs among students who currently used EVPs. Overall, in 2021, 36.2% had ever used EVPs, 18.0% currently used EVPs, and 5.0% used EVPs daily, with variation in prevalence by demographic characteristics. Prevalence of ever use and current use of EVPs was higher among female students than male students. Prevalence of ever use, current use, and daily use of EVPs was lower among Asian students than Black or African American (Black), Hispanic, Native Hawaiian or other Pacific Islander, White, and multiracial students. Prevalence of ever use, current use, and daily use of EVPs was higher among bisexual students than among students who were not bisexual. During 2015-2021, although ever use of EVPs decreased overall (from 44.9% to 36.2%) and current use of EVPs was stable overall, daily EVP use increased overall (from 2.0 to 5.0%) and among female (from 1.1% to 5.6%), male (from 2.8% to 4.5%), Black (from 1.1% to 3.1%), Hispanic (from 2.6% to 3.4%), multiracial (from 2.8% to 5.3%) and White (from 1.9% to 6.5%) students. Among students who currently use EVPs, 54.1% usually got or bought EVPs from a friend, family member, or someone else. Continued surveillance of EVP and other tobacco product use is necessary to document and understand youth tobacco product usage. These findings can be used to inform youth-focused tobacco prevention and control strategies at the local, state, tribal, and national levels.

Witnessing Community Violence, Gun Carrying, and Associations with Substance Use and Suicide Risk Among High School Students — Youth Risk Behavior Survey, United States, 2021

Community violence, including homicides involving firearms, is a significant public health concern. From 2019 to 2020, firearm-related homicides increased by 39% for youths and young adults aged 10-24 years, and rates of suicide by firearm increased by approximately 15% among the same age group. Findings from the nationally representative 2021 Youth Risk Behavior Survey were used to analyze disparities and correlates of witnessing community violence and gun carrying among a nationally representative sample of high school students. Chi-square tests and logistic regression accounting for the complex sampling of the survey were used to assess demographic differences by student sex, race and ethnicity, age, and sexual identity in ever witnessing community violence, gun carrying in the past 12 months, and their associations with substance use and suicide risk. Measures of substance use included current binge drinking and marijuana use and lifetime prescription opioid misuse and illicit drug use. Suicide risk included seriously considered attempting suicide and attempted suicide in the past 12 months. Overall, approximately 20% of students witnessed community violence and 3.5% of students carried a gun. American Indian or Alaska Native, Black, and Hispanic students were more likely to witness community violence and to report carrying a gun than their White peers. Males were more likely to witness community violence and carry a gun than females. Lesbian, gay, or bisexual students were more likely to witness community violence than their heterosexual peers. Also, witnessing community violence consistently was associated with increased odds of gun carrying, substance use, and suicide risk for both males and females and when comparing Black, White, and Hispanic students. These findings highlight the importance of comprehensive violence prevention strategies that incorporate health equity to mitigate the effects of violence exposure on substance use and suicide risk among youths.

The relationship between school bullying victimization and mental health among high school sexual minority students in China: A cross-sectional study

BackgroundSchool bullying has become a matter of global concern for the general public. Sexual minority youth (SMY) may experience minority stress and victimization which are known to adversely affect mental health and happiness. However, a few scholars explored and linked sexual orientation with campus bullying, depression, and anxiety symptoms under the specific cultural background of China. ObjectiveThis study was to examine the effect of traditional and cyber bullying victimization on depression and anxiety among Chinese sexual minority adolescents. MethodsThis is a cross-sectional survey with a total of 3841 subjects among senior high school students in Hunan Province, China. Related information was collected through a series of self-reported questionnaires. The association between variables was examined via a set of logistic regressions. ResultsHomosexuality (OR: 6.398; 95 % CI: 3.321 to 12.325), bisexuality (OR: 3.146; 95 % CI: 1.499 to 6.603) and uncertainty of sexual orientation (OR: 2.341; 95 % CI: 1.516 to 3.615) were significantly associated with a combination of traditional and cyber bullying victimization. Compared to the heterosexual group, the sexual minority students, especially the bisexual students has a higher risk of depressive mood (OR: 2.349; 95 % CI: 1.664 to 3.316) and anxiety mood (OR: 3.049; 95 % CI: 2.150 to 4.324). Further multivariate binary hierarchical regression showed that the effects of sexual orientation and mental health were statistically significant only among those who are not involved in bullying victimization, OR values are from 1.929 (95 % CI: 1.061 to 3.507) to 3.209 (95 % CI: 2.090 to 4.927). ConclusionsHomosexuals are most likely to be victims of a combination of traditional and cyber bullying victims. Bisexuals are most at risk for emotional problems. Sexual minorities in particular, showed differences in mental health risks between bullied and non-bullied groups. More attention needs to be paid to bullying and mental health among sexual minority students in China.

Sexual minority status, illicit drug use, and depressive symptoms

Youth who are lesbian, gay, bisexual, and who identify with other sexual orientations (LGB+) are at higher risk for illicit drug use and have higher rates of mental illness. The current study examined the prevalence of illicit drug use among LGB + persons and assessed the moderating effect of mental illness. Cross-sectional data from the 2015, 2017, and 2019 Youth Risk Behavioral Surveillance System were aggregated. The outcome was any reported use of cocaine, inhalants, heroin, methamphetamines, ecstasy, or hallucinogens. The primary exposure was self-reported sexual orientation category (i.e. heterosexual, gay/lesbian, bisexual, and not sure). Self-reported depressive symptoms were tested as a moderator. Logistic regression models assessed main and interactive effects. Gay or lesbian students [AOR = 1.87 95% CI: 1.45, 2.43], bisexual students [AOR = 2.07 95% CI: 1.77, 2.42], and those unsure of their sexual orientation [AOR = 1.99 95% CI: 1.65, 2.39] had increased odds of illicit drug use. Odds were higher among LGB + youth who did not have depressive symptoms (p < 0.001). Odds of illicit substance use was significantly greater in youth identifying as gay and lesbian, bisexual, and students who were not sure about their sexual orientation and among LGB + youth without depressive symptoms. Targeted, but non-stigmatizing, prevention programs are needed.

Exploring the Mental Health Challenges and Coping Behaviour of Lesbian, Gay, and Bisexual Students at an Institution of Higher Learning

The South African university community is predominantly heterosexual, which fosters stigmatisation and discrimination against LGBTQI students despite the efforts to create conditions where LGBTQI students can succeed academically, socially, and personally. The study aimed to explore and describe the challenges experienced by LGBTQI students and their mental well-being as well as the coping behaviours adopted in a university in South Africa. This was accomplished using a descriptive phenomenological approach. A snowballing sampling method was used to select ten students who identified themselves as gay, lesbian, and bisexual (LGB). Semi-structured one-on-one interviews were conducted, and data were analysed thematically. The students perceived character defects stigma from fellow students and lecturers in and out of class. The mental health challenges experienced included a diminished sense of safety, lack of a sense of belonging, low self-esteem, and acting out of character. As a result, confrontation, passive withdrawal, and active dependent behaviour were utilised as different types of coping behaviour. The LGB students were subjected to stigma that negatively affected their mental health. Therefore, creating awareness about the rights of LGBTQI students to education, safety, and self-determination is recommended.

A rapid realist review of universal interventions to promote inclusivity and acceptance of diverse sexual and gender identities in schools

Universal interventions to promote inclusivity and acceptance of diverse sexual and gender identities in schools could help to prevent mental health problems in this population. We reviewed evidence and developed programme theories to explain which universal interventions work, for whom, in which contexts and why. We conducted a rapid realist review and extracted data in context–mechanism–outcome configurations, to develop and refine programme theories. We included 53 sources and identified five intervention themes: student pride clubs, inclusive antibullying and harassment policies, inclusive curricula, workshops and staff training. Here, we show that these interventions could work by reducing discrimination, bullying and marginalization. Interventions appear to work best when school staff are trained and the school climate is supportive and may be less effective for boys, gender minority students and bisexual students. Our findings provide guiding principles for schools to develop interventions and should encourage primary research to confirm, refute or refine our programme theories.

Teacher attitudes toward lesbian, gay, and bisexual students: Evidence for intergroup contact theory and secondary transfer effects

This article presents two studies that tested the predictive validity of intergroup contact theory and secondary transfer effects related to pre-service teacher attitudes toward sexual minority youth in classrooms. Multiple regression of feeling thermometer scores in Study 1 (N = 989) suggested that more favorable attitudes are present among younger, female, bisexual or homosexual, less religious, politically left-wing pre-service teachers with lesbian, gay, and bisexual contacts. Associations with family membership and hometown size were nonsignificant. Analyses of variance in Study 2 (N = 406) showed statistically significant secondary transfer effects. For instance, teacher candidates with no lesbian women contacts showed less sexual prejudice toward lesbian students if they were in social contact with gay men and bisexual people. Implications for teacher education, teacher professionalism, and the need to create safe spaces in school for LGBTQIA+ students are discussed.

Sexuality and Gender Identity Inequities in Substance Use Disorder and Its Treatment among American Indian, Alaska Native, and Native Hawaiian College Students

Background The aim of this study was to investigate inequities in substance use disorder (SUD) diagnosis, opioid misuse, marijuana misuse, SUD treatment utilization, and utilization of university mental health services among sexual and gender minority (SGM) American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) college students. Methods Data consisting of 8,103 AI/AN/NH students’ responses to the American College Health Association’s National College Health Assessment survey from fall 2015 through spring 2019 were utilized for this study. Multivariable logistic regression models were used to compare the odds of SUD diagnosis, opioid misuse, and marijuana misuse in SGM AI/AN/NH students to cisgender, heterosexual peers. Unadjusted odds of SUD treatment utilization and utilization of university mental health services were also evaluated. Results Compared to cisgender females, transgender (aOR = 4.43, 95% CI = 2.67–7.34) and gender diverse (aOR = 2.86, 95% CI = 1.61–5.07) students had significantly higher odds of SUD diagnosis. Similarly, significantly higher odds of SUD diagnosis were observed among sexual minorities, including gay/lesbian (aOR = 2.95, 95% CI = 1.71–5.09) and bisexual (aOR = 1.97, 95% CI = 1.30–2.99) students compared to heterosexual peers. Sexual minority students had significantly higher odds of utilizing university mental health services (uOR = 2.43, 95% CI = 1.22–4.84) than heterosexual peers. Odds of opioid misuse and marijuana misuse were also significantly increased among sexual minority students. Conclusions AI/AN/NH college students who identify as SGM have higher odds of SUD diagnosis, opioid misuse, and marijuana misuse than their cisgender, heterosexual peers. These findings highlight the need to consider tailored programming for SGM AI/AN/NH students in substance use prevention and intervention efforts in U.S. college settings.

A quantitative exploration of Queer-spectrum students' experiences in introductory undergraduate mathematics courses.

Research into the experiences of students in mathematics with a marginalized sexual identity has remained largely underexplored, relegating these experiences and individuals to remain invisible. In this study, we leverage Queer Theory to address this gap in research by reporting on the experiences of Queer-spectrum undergraduate students (n = 2,454) enrolled in introductory mathematics courses (Precalculus, Calculus 1, and Calculus 2) across the United States. Drawing on student data (n = 24,327) from the Student Post-Secondary Instructional Practices Survey, we examine reported outcomes of math learning experiences and access to learning environments. Overall, within introductory math courses, sexual identity had a significant relationship with accessing learning environments and mathematical learning experiences. Asexual students were among those that reported higher levels of interactions with peers and instructors, a greater sense of community & participation, positive math affect, and were more likely to access learning environments external to the course yet anticipated receiving a lower course grade when compared to straight students. Bisexual students reported lower levels of interactions with instructors, a diminished sense of community & participation, math engagement, positive math affect, and were less likely to access learning environments compared to straight students. These findings suggest that Queer-spectrum students experience mathematical learning in a different manner than their straight peers and in relation to other Queer spectrum identities. Queer-spectrum students with a sexualized identity perceive that mathematics environments are not normative places to be a part of the community, resulting in negative dispositions, reduced interactions, and lower academic success. The impact of sexual identity, although small, contributes to negative indicators of positive mathematical experiences and suggests that the normative discourses in mathematics that are identity neutral, heteronormative, and aligned with binary thinking are differentially impacting Queer-spectrum students.

Lesbian, Gay, and Bisexual Students Experiencing Homelessness and Substance Use in the School Context: A Statewide Study.

This study explored differences between lesbian, gay, and bisexual (LGB)-housed and homeless students regarding substance use patterns on and off school grounds and the unique contribution of homelessness to substance use in school. Data were from the 2013-2015 California Healthy Kids Survey, a statewide survey of school protective factors and risk behaviors. A representative sample of 9th- and 11th-grade students (N=20,337) was used. Comparisons between housed (n=19,456) and homeless (doubled up: n=715; acute homeless: n=166) LGB students were conducted. We used chi-square tests to compare rates of lifetime, past-30-day, and in-school substance use and conducted multivariate logistic regression models for each substance use variables. Chi-square test results indicated significant differences in rates of substance use among students experiencing homelessness (both categories) and housed LGB students. Lesbian, gay, and bisexual students experiencing homelessness were more likely to report substance use off and on school grounds. Results from logistic regression analyses indicated that LGB students who experience homelessness were significantly more likely to report recent and in-school substance use. For example, students experiencing acute homelessness were about 3 times as likely to report heavy episodic drinking (adjusted odds ratio [AOR]=3.13; 95% confidence interval [CI]=2.13, 4.26) and more than 5 times as likely to smoke marijuana in school (AOR=5.38; 95% CI=3.46, 8.36), compared to housed LGB students. LGB students who experience homelessness are at higher risk than housed LGB students of substance use on and off school grounds. Findings highlight the need to provide support in the school context for this subpopulation.

Sexual violence among male sexual minority college students in Guangdong, China: a cross-sectional study

This study aims to provide an estimate of lifetime sexual violence (SV) among male sexual minority college students with differing sexual orientations and contribute to the evidence base on the association between SV experience, stress, and depressive symptoms. The data stemmed from the 2019 Internet Survey on HIV/AIDS and Sexual Health in Colleges and Universities in Guangdong province, China. Lifetime SV victimisation (including non-sexual harassment, physical contact sexual harassment, and rape), level of stress, and depressive symptoms were examined among 1441 male sexual minority students from 37 colleges and universities in Guangdong province. Linear regression analyses were adopted to examine associations between independent variables and depressive symptoms. 23.4% (337/1441) of the participants reported lifetime non-contact harassment, while 8.8% (127/1441) and 2.4% (35/1441) of the participants reported physical contact sexual harassment and rape, respectively. Homosexual students reported the most physical contact sexual harassment (48/127, 37.8%) and bisexual students reported the most non-contact sexual harassment (102/337, 30.3%) and rape (10/35, 28.6%) among sexual minority participants; 85.6% participants reported high levels of stress. The experience of SV and the level of stress were significantly associated with depressive symptoms, and stress completely mediated the path from SV experiences to depressive symptoms. This study specifically showcases SV as a pervasive problem affecting Chinese male sexual minority college students and highlighting the severity of stress and depressive symptoms among this population. These findings emphasise the urgency of implementing effective practices and policies to address SV and depressive symptoms among male sexual minority college students in China.

Burnout and Perception of Medical School Learning Environments Among Gay, Lesbian, and Bisexual Medical Students

The perspectives of gay, lesbian, bisexual (sexual minority [SM]) students about their medical school learning environment and how they relate to burnout is poorly understood. To understand SM medical students' perceptions of the medical school learning environment and how this is associated with reported burnout. This cross-sectional study included medical students graduating from Association of American Medical Colleges (AAMC)-accredited allopathic US medical schools in 2016 and 2017 and responding to the AAMC Graduation Questionnaire. Data analysis was conducted from June 2021 to March 2022. Sexual orientation, based on self-identification, and categorized as bisexual, gay or lesbian, or heterosexual or straight. Primary outcomes included burnout as measured by Oldenburg Burnout Inventory for Medical Students (OLBI-MS; two 24-point scales [range, 0-48], with higher scores indicating greater burnout) and student perceptions of the medical school learning environment (0-5-point scales for emotional climate [range, 0-20] and student-faculty interactions [range, 0-15], with higher scores indicating more positive perceptions). Logistic regression was used to model the association between burnout, SM status, and learning environment while controlling for demographic characteristics. A total of 25 757 respondents (12 527 [48.6%] women; 5347 [20.8%] Asian; 2255 [8.8%] underrepresented in medicine; 15 651 [60.8%] White; 10 726 [41.6%] aged ≤26 years) were included in the analysis: 568 (2.2%) self-identified as bisexual, 854 (3.3%) as gay or lesbian, and 24 335 (94.5%) as heterosexual or straight. Both bisexual students and gay or lesbian students reported less favorable perceptions of their learning environments than heterosexual students (mean [SD] emotional climate score, bisexual students: 8.56 [3.29]; gay or lesbian students: 9.22 [3.33]; heterosexual or straight students: 9.71 [3.20]; P < .001; mean [SD] faculty-student interaction score, bisexual students: 13.46 [3.69]; gay or lesbian students: 14.07 [3.45]; heterosexual or straight students: 14.32 [3.37]; P < .001). Bisexual and gay or lesbian students were more likely to be in the top quartile for burnout scores (bisexual: odds ratio [OR], 1.71; 95% CI, 1.42-2.07; P < .001; gay or lesbian: OR, 1.53; 95% CI, 1.31-1.79; P < .001). This association was attenuated when accounting for student perceptions of the learning environment (bisexual: OR, 1.37; 95% CI, 1.11-1.67; P < .001; gay or lesbian: OR, 1.42; 95% CI, 1.19-1.68; P < .001), with poorer perceptions of the medical school learning environment associated with higher burnout symptoms. In this cross-sectional study, SM students had less favorable perceptions of the medical school learning environment compared with heterosexual students. Results suggest the medical school environment may be associated with higher rates of burnout in SM students. Future research should explore interventions to improve the learning environment for SM students.