LGB Youth Research Articles

Outness, Acceptance, and Victimization: A Longitudinal Study of Depressive Symptoms and Suicidality of Lesbian, Gay, and Bisexual and Transgender and Gender Diverse Youth

PurposeLGBTQ+ youth are at higher risk for poorer mental health. Studies are typically cross-sectional and categorize cisgender lesbian, gay, and bisexual (LGB) and transgender and gender diverse (TGD) youth as a combined group (i.e., LGBTQ+). There is a need for longitudinal studies that examine differences between LGB and TGD youth for a better understanding of their mental health needs. MethodsData come from a 4-wave longitudinal community-based study collected between 2011 and 2015. Hierarchical Linear Models examined trajectories of depressive symptoms and suicidality, comparing LGB and TGD youth. Between-person and within-person associations were examined, accounting for cumulative experiences of victimization, outness to family, and family acceptance in association with depressive symptoms and suicidality. ResultsThe study included a diverse sample of 543 LGB and 118 TGD youth. Although TGD youth had, overall, higher levels of depression and suicidality, both LGB and TGD youth experienced improvement in mental health. Youth who were more out and accepted in family were less depressed and suicidal than youth who were less out and accepted in family. Within individuals, when youth become more out and accepted in family, they concurrently reported less depressive symptoms. The accumulation of victimization experiences was associated with higher levels of depression and suicidality, and more depression for youth across time. DiscussionTGD youth face higher stigmatization than LGB youth, contributing to poorer mental health and disparities. Findings suggest that both LGB and TGD youth develop resilience despite victimization, and many find support within their families to cope with stigma.

A Scoping Review of Trends in the Size of Lesbian, Gay, and Bisexual Tobacco Use Disparities, 1996-2020, United States and Canada.

Purpose: Tobacco use is a major health disparity for lesbian, gay, bisexual, and transgender (LGBT) populations compared with heterosexual/cisgender populations. In this scoping review, we aimed to determine if LGBT tobacco use disparities are improving or worsening over time and if trends in disparities differed across subgroups. Methods: We included articles that longitudinally explored youth and adult LGB tobacco use in the United States and Canada after searching four databases and capturing records through July 2022. Two reviewers independently screened the title/abstract and full text of 2326 and 45 articles, respectively. Eleven articles from 18 larger assessments met inclusion criteria, spanning data collection from 1996 to 2020. Results: All studies consistently demonstrated tobacco disparities for LGB populations. No articles examined longitudinal transgender tobacco disparities. Most studies focused on smoking combustible cigarettes. Disparities in heavy or daily use for all LGB youth subgroups compared with heterosexual samples appear to be shrinking longitudinally. Results for early-onset, current, and lifetime smoking were less consistent. Adult evidence was relatively sparse; however, after 2010, studies show diminishing disparities over time, except for current smoking by bisexual women. Conclusions: Large tobacco use disparities persist for LGB populations, although the size of disparities may be decreasing for some groups. Initiatives for lesbian and bisexual women and girls should be prioritized, in addition to interventions addressing LGB smoking broadly. Surveillance instruments should uniformly and consistently assess LGBT identities and tobacco use behaviors.

Trends in Suicidality and Bullying among New York City Adolescents across Race and Sexual Identity: 2009–2019

Despite evidence showing rising suicidality among lesbian, gay, and bisexual (LGB) and Black adolescents, separately, there is scant research on suicide risk trajectories among youth groups across both racial and sexual identities. Thus, we examined trajectories of self-reported suicidal ideation and attempt and their associations with bullying among New York City-based adolescents. We analyzed 2009–2019 NYC Youth Risk Behavior Survey data. We ran weighted descriptive and logistic regression analyses to test for trends in dichotomous suicidal ideation, suicide attempt, bullying at school, and e-bullying variables among students across both race/ethnicity and sexual identity. We assessed associations between suicidality trends and bullying with logistic regressions. Models controlled for age and sex. Suicidal ideation and attempt were 2 and 5 times more likely among LGB than heterosexual participants, respectively. Bullying at school and e-bullying were 2 times more likely among LGB than heterosexual participants. Black LGB participants were the only LGB group for which both suicidal ideation (AOR = 1.04, SE = .003, p < .001) and attempt (AOR = 1.04, SE = .004, p < .001) increased over time. Both increased at accelerating rates. Conversely, White LGB participants were the only LGB group for which both suicidal ideation (AOR = 0.98, SE = .006, p < .001) and attempt (AOR = 0.92, SE = .008, p < .001) decreased over time. These changes occurred in parallel with significant bullying increases for Black and Latina/o/x LGB adolescents and significant bullying decreases for White LGB adolescents. Bullying was positively associated with suicidal ideation and attempt for all adolescents. Findings suggest resources aimed at curbing rising adolescent suicide should be focused on Black LGB youth.

Gender Differences in the Relationship between Coming Out as LGB to Family and Depression in South Korea

Previous studies on the coming out and the mental health of sexual minorities have often overlooked experiences in non-Western societies and the various patterns of coming out within the immediate families. Using the most recent and comprehensive data on 2,381 LGB youths in South Korea, this study examined whether different patterns of coming out to family members are related to different levels of depression and whether these relationships differ between men (gay and bisexual man) and women (lesbian and bisexual woman). Contrary to the prevalent view of coming out as a universally liberating process, our findings indicate that coming out to family is related to increased depressive symptoms in South Korea. Moreover, this coming out stress shows a gendered pattern. Among sexual minority men, compared with those who did not come out, youths who came out to everyone, mother and father, and only siblings report a higher depression level. Being bisexual among men did not provide any protective effect. In contrast, there is no difference observed across coming out patterns among sexual minority women. These findings highlight the importance of considering to whom and in what cultural contexts one comes out to understand the mental health of sexual minorities.

Associations Between Structural Stigma and Psychopathology Among Early Adolescents

ABSTRACT Objective Ample evidence demonstrates that structural stigma – defined as societal-level conditions, cultural norms, and institutional policies and practices that constrain opportunities, resources, and well-being of stigmatized populations – is associated with psychopathology in adults from marginalized groups. Yet there is limited research on whether structural stigma is similarly associated with internalizing and externalizing symptoms among youth. Method Structural stigma related to sex, sexual orientation, race, and Latinx ethnicity was measured using indicators of state-level policy and aggregated attitudes. Using data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 10,414; M age = 12 years, SD = 0.66; 48% female, 6.8% lesbian, gay, and bisexual (LGB), 13.4% Black, 20% Latinx), we examined associations of structural stigma with internalizing and externalizing symptoms among female, LGB, Black, and Latinx youth. Results LGB youth living in higher (vs. lower) structural stigma states had elevated levels of internalizing and externalizing symptoms. In lower structural stigma states, there were no differences in externalizing symptoms between LGB and heterosexual youth. Similarly, Latinx youth and females living in higher (vs. lower) structural stigma states had elevated levels of externalizing symptoms. In lower structural stigma states, there were no differences in externalizing symptoms between Latinx youth and non-Latinx White youth. Structural stigma related to race was unrelated to internalizing or externalizing symptoms for Black youth. Conclusions This study provides novel evidence that macro-level social environments, in the form of structural stigma, contribute to adverse mental health outcomes for marginalized youth and partly explain disparities in externalizing symptoms.

The caseworker as an external locus of hope for LGB youth in foster care

ABSTRACT Research with youth has demonstrated that a hopeful mind-set is associated with resilience and well-being and is influenced by our supportive caregivers and adults. Lesbian, gay, and bisexual (LGB) youth experience a very high frequency of adverse childhood experiences (ACE) and may lack supportive caregivers throughout their foster care experience. This study tests the theory that child welfare caseworkers are a source of hope among LGB youth in foster care. Quantitative analysis was used to examine differences in ACE exposure and differences in the caseworker as a source of hope. LGB youth with eight or more ACEs have a significant positive association with hope in their caseworkers than non-LGB youth.

Family Functioning and Youth Outness: Indirect Effect of Sexuality Specific Family Social Support

Outness can be associated with benefits for lesbian, gay, and bisexual (LGB) youth, such as better mental health and increased self-esteem, but little is known about its predictors. Family functioning and family social support are important for many youth outcomes, though their relationship with outness is unknown. This study explored whether family functioning and family social support predicted youth outness longitudinally. Family functioning consisted of flexibility (ability to shift roles and rules in response to change), cohesion (closeness between family members), and communication. In addition to examining direct links with outness, sexuality specific and non-sexuality specific family social support were examined as mediators of the relationship between family functioning and outness, testing the hypothesis that only sexuality specific support would be significant. Data were used from a longitudinal study of LGB youth (N = 168). As predicted, adaptive family functioning was associated with outness one year later; this relationship was mediated by sexuality specific family social support, but not non-sexuality specific family social support. Results are discussed in relation to current events (such as the Covid-19 pandemic) that disproportionately impact LGB youth. Future research may investigate how to assist families in providing sexuality specific support.

Associations of a Multilevel School Health Program and Health Outcomes Among Lesbian, Gay, and Bisexual Youth.

Lesbian, gay, and bisexual (LGB) adolescents are often at higher risk than their heterosexual peers for adverse sexual health, violence, mental health, and substance use outcomes. Schools are a vital resource for enhancing protective behaviors and reducing risk behaviors. Sixteen school districts selected schools to implement a sexual health program (exposed) or usual programming (unexposed). We analyzed LGB student health outcomes using 2015 and 2017 Youth Risk Behavior Surveys. Analyses compared LGB student health outcomes by exposure status across time points using a multilevel approach. Program exposure was associated with decreased odds of ever having sex, ever testing for HIV, and using effective hormonal birth control, and an increased odds of condom use. There were no significant findings among secondary violence, mental health, and substance use outcomes. This evaluation highlights the potential for schools to reduce sexual risk behaviors among LGB youth, and opportunities to improve access to health services.

In/Out of the Closet: Perceived Social Support and Outness Among LGB Youth

In/Out of the Closet: Perceived Social Support and Outness Among LGB Youth

Examining the Knowledge, Skills, and Dispositions of 4-H Professionals Related to LGBTQ+ Youth

Despite its status as the largest youth-serving organization in the United States, there is a dearth of empirical scholarship about LGBTQ+ youth within 4-H; research examining 4-H professionals’ competencies to effectively support LGBTQ+ youth is even more scarce. To address this gap in the literature, this quantitative study explored the knowledge, skills, and dispositions of 4-H professionals in North Carolina as they relate to working with LGBTQ+ youth. Seventy-five professionals responded to an online survey. Professionals displayed higher levels of knowledge than skills or dispositions, were more knowledgeable about how to support LGB youth compared to transgender and gender expansive youth, and expressed the need for and substantial interest in professional development. Rural professionals tended to report lower knowledge, skills, and dispositions compared to professionals working in urban/suburban settings. This article presents the study’s findings and explores implications for future research and practice.

Analysis of Reported Health Care Use by Sexual Orientation Among Youth

In the United States, adolescents who are lesbian, gay, or bisexual (LGB) face disparities across physical and mental health outcomes compared with non-LGB youth, yet few studies have looked at patterns of health care utilization by sexual orientation. To compare health care utilization indicators for LGB and non-LGB youth. This cohort study analyzed wave 3 data from Healthy Passages, a longitudinal observational study of diverse public school students in Birmingham, Alabama; Houston, Texas; and Los Angeles County, California. Multivariable logistic regression models tested sexual-orientation differences in the past 12-month health care utilization measures, controlling for youth age, gender, race and ethnicity, household education, income, and marital status. Data collection began in 2010 when students were in the 5th grade (mean [SE] age, 11.13 [0.01] years) (wave 1) and continued 2 years later (wave 2, 7th grade) and 5 years later (wave 3, 10th grade). Permission to be contacted was provided for 6663 children, and 5147 (77%) participated in audio computer-assisted self-administered interviews. This study included 4256 youth (640 LGB, 3616 non-LGB) who completed interviews at wave 1 and wave 3 and answered key items used in this analysis. Analyses were completed in June 2021. Sexual orientation (LGB vs non-LGB). Health care utilization and communication difficulty with a physician in the past 12 months. Among 4256 youths included in the study at baseline in 5th grade (wave 1), 2171 (48.9%) were female; 1502 (44.5%) were Hispanic or Latino; 1479 (28.9%) were Black; the mean (SE) age was 11.19 (0.03) years; and 640 (14.5%) were LGB at wave 3. Compared with non-LGB youth, a higher proportion of LGB youth reported not receiving needed medical care in the last 12 months (adjusted odds ratio [aOR], 1.68; 95% CI,1.38-2.05), most commonly for sexually transmitted infections, contraception, and substance use. LGB youth more frequently reported difficulty communicating with their physician (aOR, 1.71; 95% CI, 1.27-2.30) than non-LGB youth. This study's results found that health care utilization differs by sexual orientation for youth. These findings suggest that clinician training is needed to address the health care needs of LGB youth. Routinely capturing sexual orientation data might enable tracking of health care utilization indicators for LGB youth.

Tobacco use and mental health disparities in LGB youth.

In 2019, the Youth Risk Behavioral Survey (YRBS) collected sexual orientation data for the first time in Kentucky. Tobacco use behaviors and mental health status among Lesbian, Gay, and Bisexual (LGB) youth is infrequently documented in southern states such as Kentucky. This study aimed to analyze self-reported tobacco use and mental health in youth by sexual orientation. Cross-sectional survey. All participants, aged 12-19, of the 2019 Kentucky YRBS that indicated a sexual orientation. Differences in response distributions for tobacco use and mental health measures were analyzed via chi square by sexual orientation, with additional stratification by sex. A total of n=1996 respondents were 12.8% LGB-identified and 82.1% heterosexual-identified. No disparities between LGB and heterosexual youth were observed in tobacco-related behaviors for male students, but disparities were persistent for female students (p=.005 for "tried tobacco before age 13"; p=.007 for "current smoking", p=.012 for "ever smoked"). Mental health disparities between LGB and heterosexual youth were significant for males and females (p<.05, all mental health measures). Findings suggest that tobacco disparities in this most recent data are narrower than in previous years; however, mental health disparities persist between LGB and heterosexual youth in Kentucky.

Homophobic Verbal and Bullying Victimization: Overlap and Emotional Impact

IntroductionA relationship between homophobic verbal and bullying victimization has been established in the scientific literature, yet its findings remain debated. Similarly, the emotional impact of these phenomena may cross over, although not enough evidence is available to confirm this hypothesis. The study sought to examine this overlap of phenomena as well as their emotional impact, both independently and jointly, in a community-based school sample of adolescents with varying sexual orientations.MethodsA total of 2089 Spanish students aged 11 to 18 years (M = 13.68, SD = 1.31) completed self-report measures assessing homophobic verbal and bullying victimization, sexual orientation, and emotional impact during 2017.ResultsLesbian, gay, and bisexual (LGB) adolescents reported greater homophobic verbal and bullying victimization than their non-LGB peers. No differences were found in emotional impact based on sexual orientation or gender. However, differences were found for victimization type, with LGB youth overrepresented in the poly-victim group. A mediation effect of homophobic verbal victimization was observed between bullying victimization and negative emotional impact.ConclusionsLGB students more frequently experience more types of victimization than their non-LGB peers. Homophobic victimization amplifies the likely emotional impact of bullying victimization, which should be considered in prevention programs and psychological interventions.Policy ImplicationsThese findings highlight the importance of sexual diversity in the study of bullying behavior. It is also identified as a key area when developing prevention programs aimed at eradicating this type of violence from our schools.

LGB prevalence in schools is associated with unhealthy weight-control behaviors in lesbian, gay, and bisexual youth: a multilevel analysis

BackgroundPrevious studies have found that a school climate of more heteronormativity is associated with adverse effects on the mental health of LGB students. Accordingly, our aim was to assess the association between lower LGB prevalence in schools and unhealthy weight-control behaviors among LGB youth.MethodsA cross-sectional, multilevel study based in public high schools in the city of Olinda, Northeast Brazil. A multilevel logistic regression was performed, including 2500 adolescents enrolled in 27 schools. The contextual variable was the prevalence of LGB youth in each school (as a proxy for heteronormativity in schools), while the outcome was unhealthy weight-control behaviors (fasting, purging, and taking diet pills). We controlled for socioeconomic characteristics (age, sex, receiving a family allowance), obesity, and self-reported happiness.ResultsLower LGB prevalence in schools was associated with higher odds of engaging in unhealthy weight-control behaviors (OR: 1.5, 95%CI: 1.0, 2.2) among all youth, regardless of sexual orientation. No cross-level interactions between school context and individual characteristics were statistically significant.ConclusionLower LGB prevalence in schools was associated with a higher risk of unhealthy weight-control behaviors in youth regardless of sexual orientation, which may reflect either the contextual influence of school climate, or may be due to residual confounding.

Pornography Consumption and Condomless Sex among Emerging U.S. Adults: Results from Six Nationally Representative Surveys

ABSTRACT Using six samples of unmarried U.S. residents aged 18–24 who were part of a larger biennial nationally representative survey (2008–2018), the present study examined whether pornography consumption is a risk factor for condomless sex during emerging adulthood. Condomless sex is the norm in popular, commonly consumed, pornography. Further, emerging adulthood is a time of heightened sexual experimentation and risk taking, and many emerging adults view pornography. Consistent with a sexual scripting perspective on media processes and effects, emerging adults who viewed pornography were more likely to have condomless sex than their peers who did not consume pornography. The link between pornography use and condomless sex was similar for men and women, white youth and youth of color, as well as heterosexual and LGB youth. The link was not moderated by age. Further, the link was robust even when indicators of both sexual and nonsexual sensation seeking predilections were included in analyses. These results are consistent with recent suggestions from public health experts that sex education programs need to include modules on pornography literacy.

Associations between tobacco use patterns and demographic characteristics of sexual minority and heterosexual youth: Results from a nationwide online survey.

INTRODUCTIONYouth are at risk for tobacco use, and previous research has pointed to increased vulnerabilities associated with sexual minority identity. For example, LGB youth have increased odds for using tobacco than their heterosexual peers, and bisexual youth have higher odds of smoking than other sexual identity groups. As new tobacco products proliferate and health risks from dual/poly use grow, increased understanding of tobacco use patterns by sexual minority youth is needed.METHODSFor 3117 youth, aged 13–18 years, who completed an online questionnaire in 2017 and identified their sexual orientation [minority (e.g. lesbian/gay, bisexual, or pansexual) vs majority (heterosexual)] and gender, we classified current tobacco use into four categories: e-cigarette only, other product only (such as cigarette, cigar, or smokeless tobacco; not an e-cigarette), dual/poly use, and no use. Analyses were conducted separately for male and female participants. Multinomial logistic regression was employed.RESULTSFemale sexual minority youth had nearly twofold odds of dual/ poly tobacco use (OR=1.95; 95% CI: 1.12–3.40), compared to their heterosexual counterparts. For male youth, sexual minority identification was not significantly associated with dual/poly use. No significant differences were found in sexual minority and heterosexual youth e-cigarette only or other tobacco only use groups. Tobacco use patterns also significantly differed by age, race, place of residence, and parental education level.CONCLUSIONSStudy findings reveal greater odds of dual/poly tobacco use for female sexual minority youth. Tailored tobacco prevention and cessation programs or interventions are needed for sexual minority youth most at risk of tobacco use, especially multiple product use.

Contextualizing LGB youth’s support experiences: The conceptualization of LGB-specific social support

Introduction Social support is valuable for preventing and mitigating a range of harms among youth, including victimization and negative mental health outcomes. However, social support research has historically centered heterosexual individuals’ needs and experiences. This paper examines how social support is conceptualized by LGB youth. Methods: The present study utilizes in-depth interviews from 20 self-identified LGB individuals between the ages of 18 and 25. Results: Interviews suggest that LGB youth social support includes help with normalizing, processing, and navigating their identity. Conclusions: The data suggest that the support needs of LGB youth are distinct, and understandings of LGB social support need to be couched within heteronormativity, a wider, macro level social phenomenon. Implications for the scholars and practitioners are discussed.

Suicidal as Normal - A Lesbian, Gay, and Bisexual Youth Script?

Background: Lesbian, gay, and bisexual (LGB) youth are more likely to report suicidal thoughts and/or behavior (STB) than heterosexual youth. The elevated suicidality of LGB youth is not fully accounted for by sexual-minority stress, according to a meta-analysis. A less-tested explanation is that suicidality has become an expected idiom of LGB youth distress. This explanation is consistent with suicide script theory and evidence that suicidal behavior is most likely when it is relatively acceptable. Aims: Building on suicide script theory and evidence, two studies were designed: one of LGB youth attitudes about suicidal behavior, and the other of LGB youth attitudes about suicidal individuals. Method: Surveys of LGB and heterosexual youth (total N = 300; M age = 20; 51% female) were conducted. Results: LGB youth were more accepting of and empathic toward suicidal behavior than heterosexual youth. They also viewed suicidal individuals as more emotionally adjusted. Limitations: Attitudes were not examined by sexual-minority subgroups. Conclusion: LGB youth's understanding attitudes may translate into less judgmental behavior toward suicidal peers, but also into normalizing suicidality as a way to express distress and cope with life problems. There may be utility in evaluating LGB youth suicide attitudes in suicide prevention initiatives.

A retrospective analysis of sex education messages received by LGB youth

Using focus groups, this qualitative study asked thirty-five gay, lesbian, and bisexual (LGB) young adults to reflect on messages they received about sex and sexuality around the time they first had sex. Focus groups were conducted, recorded, transcribed, and analyzed. Through thematic analysis, the authors identified two messaging sources identified by participants: (1) formal education sources (i.e., school and parents), and (2) informal education sources (e.g., internet, peers). Formal sources often included messages perpetuating heteronormative assumptions, emphasizing abstinence, pregnancy and HIV/STI prevention, or silence as a form of messaging. Informal sources consisted of LGB specific information. These findings suggest informal sources may provide more useful and relevant information to LGB youth, further suggesting a need for more inclusive and comprehensive sexuality education.

Trends in Violence Victimization and Suicide Risk by Sexual Identity Among High School Students — Youth Risk Behavior Survey, United States, 2015–2019

Lesbian, gay, and bisexual (LGB) youths continue to experience more violence victimization and suicide risk than heterosexual youths; however, few studies have examined whether the proportion of LGB youths affected by these outcomes has varied over time, and no studies have assessed such trends in a nationally representative sample. This report analyzes national trends in violence victimization and suicide risk among high school students by self-reported sexual identity (LGB or heterosexual) and evaluates differences in these trends among LGB students by sex (male or female) and race/ethnicity (non-Hispanic black, non-Hispanic white, or Hispanic). Data for this analysis were derived from the 2015, 2017, and 2019 cycles of CDC’s Youth Risk Behavior Survey (YRBS), a cross-sectional, school-based survey conducted biennially since 1991. Logistic regression models assessed linear trends in prevalence of violence victimization and indicators of suicide risk among LGB and heterosexual students during 2015–2019; in subsequent models, sex-stratified (controlling for race/ethnicity and grade) and race/ethnicity-stratified (controlling for sex and grade) linear trends were examined for students self-identifying as LGB during 2015–2019. Results demonstrated that LGB students experienced more violence victimization and reported more suicide risk behaviors than heterosexual youths. Among LGB youths, differences in the proportion reporting violence victimization and suicide risk by sex and race/ethnicity were found. Across analyses, very few linear trends in these outcomes were observed among LGB students. Results highlight the continued need for comprehensive intervention strategies within schools and communities with the express goal of reducing violence victimization and preventing suicide risk behaviors among LGB students.