ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Lesbian, gay, bisexual, and other sexual minoritized youth: Epidemiology and health concerns

Lesbian, gay, bisexual, and other sexual minoritized youth: Epidemiology and health concerns
Authors:
Michelle Forcier, MD, MPH
Johanna Olson-Kennedy, MD
Section Editor:
Renata Arrington Sanders, MD, MPH, ScM
Deputy Editor:
Diane Blake, MD
Literature review current through: Jan 2024.
This topic last updated: Oct 25, 2023.

INTRODUCTION — The term "sexual minoritized" encompasses a variety of sexual identities that differ from cultural norms (eg, lesbian, gay, bisexual), as well as identities that defy discrete labels [1].

This topic will focus on the epidemiology and health concerns of sexual minoritized youth who:

●Identify themselves as lesbian, gay, bisexual, pansexual, asexual, or other sexual identities

●Are unsure (questioning) of their sexual identity and have had sexual contact with persons of the same gender, or with persons of the same gender as well as persons of different genders

●Avoid discrete sexual orientation labels and have had sexual contact with persons of the same gender, or with persons of the same gender as well as persons of different genders

An overview of primary care for such youth is presented separately, and gender diversity in children and adolescents is also discussed separately.

●(See "Lesbian, gay, bisexual, and other sexual minoritized youth: Primary care".)

●(See "Gender development and clinical presentation of gender diversity in children and adolescents".)

●(See "Management of transgender and gender-diverse children and adolescents".)

TERMINOLOGY

●Sexuality – A developmental process that continues into and throughout adulthood, and becomes increasingly important as youth approach and progress through adolescence. It encompasses attraction, identity, and behavior.

Sexuality involves the capacity to pursue, express, and enjoy sexual pleasure. It can change and evolve over time and may be affected by a variety of factors that are unique to each individual, including personal, social, and cultural.

Sexuality intersects with gender identity but is not the same as gender identity (figure 1). Transgender or gender-diverse people might report a variety of sexual identities and behaviors. It is usually best to ask the patient about what they mean specifically rather than assume or extrapolate.

•Sexual attraction – An individual's pattern of physical and emotional attraction and arousal (including fantasies, activities, and behaviors) and the gender(s) of persons to whom an individual is physically or sexually attracted (figure 1) [2].

•Sexual orientation – An individual's assessment of their sexual identity

-Gay or lesbian – Sexual attraction to same-gender individuals

-Heterosexual/straight – For female individuals, sexual attraction to males; for male individuals, sexual attraction to females

-Bisexual – Sexual attraction to both same-gender and other-gender individuals

-Pansexual – Sexual attraction to individuals of any gender identity

-Asexual – Lack of sexual attraction to any individuals

-Unsure – Unsure of or struggle with sexual identity; may be referred to as "questioning"

The individual youth is the best person to describe and define their identity. Some adolescents prefer the terms "mostly heterosexual" or "mostly gay," to reflect their feeling of being between categories [3]. Others may avoid categorization, preferring more diffuse terminology such as queer, pansexual, or fluid regarding their sexuality.

•Sexual behavior – Refers to particular sexual activities with both self (masturbation) and others and incorporates the gender(s) of sexual partners.

Sexual behavior does not necessarily indicate sexual orientation; it may represent experimentation, exploration, or exploitation [4]. Sexual behaviors are more important than self-identified labels when offering screening tests and assessing health risk.

●Sexual minoritized – Encompasses a variety of sexual identities that differ from cultural norms (eg, lesbian, gay, bisexual identity), as well as identities that defy discrete labels [1].

DEVELOPMENTAL PERSPECTIVE — Gender and sexuality are independent, but intersecting, facets of human development that evolve rapidly during the adolescent and young adult years [5-7]. Sexual exploration, experimentation, and discovery are part of the normal process of incorporating sexuality into one's sexual identity [8-10]. Before puberty, many children experiment with other-gender play and expression. Other-gender interests and expression in the prepubertal years are neither necessarily nor predictably associated with adolescent or adult sexual orientation.

The sexual orientation trajectory of children with diverse gender identity or expression is discussed separately. (See "Gender development and clinical presentation of gender diversity in children and adolescents", section on 'Sexual orientation trajectory'.)

As children approach puberty and adolescence, sexuality (ie, attraction, orientation, and behaviors) becomes relevant to the life tasks of developing relationships, intimacy, and creating family. Defining one's sexual orientation occurs over time. First awareness of same-sex attraction, which may or may not persist, has been described as early as age 9 for cis-identified males and 10 for cis-identified females, but sexual minoritized youth may self-identify orientation at later ages than heterosexual peers [11,12]. (See "Sexual development and sexuality in children and adolescents", section on 'Development of sexuality'.)

Formation of sexual identity among youth may be fluid [9,13,14]. Adolescents explore their emerging sexuality through attractions, fantasies, and behaviors [9,15]. Adolescent sexual identity and self-identified orientation does not necessarily correlate with sexual behaviors [16-20]. Adolescents may have same-gender attractions and fantasies but not identify as gay or lesbian; they may identify as gay or lesbian but remain sexually inexperienced; or they may identify as heterosexual but engage in same-gender behaviors.

Strong family and societal expectations may influence the experience and expression of sexuality in children and adolescents [21,22]. Some caregivers and families may try to redirect same-gender attractions, identity, or behavior to fit into heteronormative social parameters (ie, those that view heterosexual relationships as the only "normal" relationships in society) [23]. Peer pressure may lead adolescents to behaviors that have little to do with attraction. Externalized and internalized sexual prejudice (also known as "homophobia" or "homonegativity") may lead adolescents to avoid sexual activity altogether, adopt heterosexual activity, or mistreat others who they perceive as gay or lesbian [24].

EPIDEMIOLOGY — Although epidemiologic studies of sexual minoritized youth use widely different measures [7], in several large surveys, 5 to 12 percent of high school youth report same-sex attractions or behaviors [25-27]. In a nationwide survey of high school students, approximately 35 percent reported sexual contact with only the opposite sex, 2 percent with only the same sex, 6 percent with both sexes, and 57 percent reported no sexual contact [28].

POTENTIAL PSYCHOSOCIAL AND HEALTH CONCERNS — Although the majority of sexual minoritized youth are healthy and well adjusted, some sexual minoritized youth are at increased risk for adverse psychosocial and health outcomes [29]. The increased risks of adverse outcomes are not intrinsic to sexual minoritized status but appear to be related to stigmatization and lack of acceptance of specific sexual behaviors, identities, and orientations [30-35].

Stigmatization and minority stress — Sexual minoritized youth may be stigmatized and marginalized by individuals or in communities and cultures that are dismissive, openly rejecting, or hostile [7]. Stigmatization is an important moderator of the disparities in psychosocial and health outcomes of sexual minoritized youth [30-35]. In surveys of sexual minoritized young adults, high levels of family rejection during adolescence was associated with suicidality, depression, drug use, and engaging in unprotected sex; family acceptance was associated with greater self-esteem and social support and decreased depression, substance abuse, and suicidality [34,36,37]. Other surveys found an association between structural stigma at the state level (eg, lack of nondiscrimination policies for sexual minoritized status) and disparities in drug and cigarette use [38,39].

Minority stress models propose that being minoritized is linked to bias, discrimination, and lack of support that can lead to stress, anxiety, and depression, which contribute to adverse long-term psychosocial and health outcomes (figure 2) [40-43]. Structural stigma in the sociocultural environment may interact with individual psychological characteristics, impacting decision-making and behaviors among sexual minoritized youth [44]. Whether or not the minority stress model is correct, multiple observational studies demonstrate that rates of mental health problems (eg, anxiety, depression, suicide and self-harm, conduct disorder, substance use, and posttraumatic stress disorder) are increased among sexual minoritized youth compared with heterosexual youth [45-49].

Potential protective factors — Factors that contribute to resilience and counteract stigmatization include [30,50-56]:

●Acceptance

●Competence

●Higher levels of self-esteem and psychological well-being

●Strong sense of self and self-acceptance

●Strong ethnic identification

●Strong connections to family and school

●Caring adult role models outside the family

●Community involvement

Personal, family, and societal acceptance of sexual identity may provide protection against some of the adverse psychosocial and health outcomes for sexual minoritized youth. Family acceptance is particularly salient [2,6,29]. In multiple observational studies, caregiver support and acceptance of sexual minoritized youth are correlated with positive mental health outcomes, and caregiver rejection and lack of support are correlated with negative mental health outcomes [37,57].

Health care providers may contribute to resilience by serving as role models and demonstrating openness, support, and respect for diversity. They also can provide information and a safe place for caregiver and child discussion and help caregivers overcome their fears and biases to more fully accept and nurture their sexual minoritized children. (See 'Caregivers and family' below.)

Health risks

Victimization and violence — Sexual minoritized youth are at higher risk than their heterosexual peers for sexual prejudice ("homophobia"); verbal harassment; physical threats, harassment, or assault; and physical and sexual abuse [58]. Victimization is an important mediator of psychological distress and mental health outcomes, including suicidality, among sexual minoritized youth [59-66]. Sexual minoritized youth may experience victimization and violence at home, school, or in the community [26,67-71]. Victimization and psychological distress appear to decrease with age and over time [66,72].

In a 2011 meta-analysis of school-based studies, sexual minoritized youth were 1.2 times more likely to report parental physical abuse and 3.8 times more likely to report sexual abuse (the site of abuse and perpetrator were not addressed) than their heterosexual peers [68]; they also were 1.7 times more likely to have been assaulted at school and 2.4 times more likely to miss school out of fear.

In a nationwide survey of high school students, 28 percent reported being the victim of cyberbullying; 19 percent reported having been forced to have sexual intercourse at some point in their lives; and among those who had dated or went out with someone during the 12 months before the survey, 16 percent reported sexual dating violence and 13 percent reported physical dating violence [26]. These rates were generally approximately twice as high as those among heterosexual students.

School victimization — In a 2019 national survey of high school students, sexual minoritized students were more likely than their heterosexual peers to report being threatened or injured with a weapon (12 versus 6 percent) or bullied (32 versus 17 percent) on school property in the previous 12 months or to report not going to school for at least 1 of the previous 30 days because of safety concerns (14 versus 8 percent) [26].

In a 2021 national survey of 22,298 lesbian, gay, bisexual, transgender, and queer students (13 to 20 years of age) [73]:

●44 to 68 percent reported hearing sexual prejudicial remarks (eg, "that's so gay," "dyke," "faggot") frequently or often at school; 58 percent reported hearing such remarks from teachers or other staff

●50.6 percent felt unsafe at school because of their sexual orientation

●61 percent were verbally harassed (called names or threatened), 22 percent were physically harassed (eg, pushed or shoved), and 9 percent were physically assaulted (eg, punched, kicked, injured with a weapon) at school in the past year because of their sexual orientation

●Among students who attended school online during the 2020-2021 academic year, 37 percent were harassed online during the school day because of their sexual orientation

●32 percent missed at least one day of school in the past month because they felt unsafe or uncomfortable; 11 percent missed ≥4 days.

Middle school sexual minoritized youth were more likely than high school sexual minoritized youth to experience harassment and assault based on sexual orientation or gender expression [73]. School characteristics associated with discrimination included public or religious schools (versus private/nonreligious schools), location in the Southern or Midwestern United States, and location in rural areas.

In a prospective survey from England, rates of bullying and victimization of lesbian, gay, and bisexual youth decreased with increasing age [72]. However, there were differences between males and females: By the final wave of the survey, lesbian/bisexual females were no more likely to report bullying than their heterosexual peers, whereas gay/bisexual males were more likely to report bullying than their heterosexual peers.

School victimization is associated with truancy, feeling unsafe, and decreased school engagement and academic achievement, as well as long-term health and behavioral risk factors, emphasizing the importance of early interventions that decrease school victimization and promote life-long educational attainment [74-77]. (See 'School' below.)

Sexual victimization — Rates of sexual violence and victimization (eg, dating violence, child and adolescent sexual abuse) are higher in sexual minoritized youth than in their peers [78-80]. Adolescents who identify as having partners of multiple sexes seem to be at highest risk [81]. In a 2011 systematic review of 75 studies (139,635 participants) evaluating sexual assault against sexual minoritized persons, lifetime sexual assault ranged from 16 to 85 percent for females and 12 to 54 percent for males [82]. Lesbian/bisexual females were more likely to report childhood sexual assault, adult sexual assault, and intimate partner violence than gay/bisexual males. Gay/bisexual males were more likely to report hate-crime related assault than lesbian/bisexual females.

Mental health and self-harm — Adolescence is a challenging time for all youth. Sexual minoritized youth have the same mental health needs as their heterosexual peers but face the additional challenge of societal bias against sexual minoritized individuals.

Sexual minoritized youth report higher levels of social isolation, low self-esteem, impaired self-concept, and a variety of internalizing (eg, anxiety, depression) and/or externalizing (eg, aggression) symptoms than their peers [83-86]. These symptoms may be induced by stigmatization and minority stress or victimization [72,87,88]. (See 'Stigmatization and minority stress' above.)

Sexual minoritized youth also report higher levels of suicidality and nonsuicidal self-injury than their peers [26,47,89-93]. In a 2018 meta-analysis of 22 observational studies from 10 countries, the risk of suicide attempt was greater in sexual minoritized than heterosexual youth (23.7 versus 6.4 percent, odds ratio [OR] 3.5, 95% CI 3.0-4.1); in subgroup analysis, the risk was greater among bisexual than gay or lesbian youth (OR 4.9 versus 3.7) [94]. In another national survey, sexual minoritized adolescents had earlier onset of suicidal ideation and faster progression from ideation to plan than their heterosexual peers [93]. In a national survey of high school students in the United States, the prevalence of nonsuicidal self-injury ranged from 38 to 53 percent among sexual minoritized youth between 2005 and 2017 (compared with 11 to 20 percent among heterosexual youth) [91].

Use of multiple measures of sexual minoritized status and factors related to racial/ethnic background, religious affiliation, and self-identification may help to explain within-group disparities in rates of mental health problems (eg, depression, substance use, eating disorders) and suicidal ideation [95-97].

Tobacco and substance use — Sexual minoritized youth appear to be at increased risk for tobacco, alcohol, and drug use compared with their heterosexual peers, but the risk varies with the subgroup, substance, and other factors such as race/ethnicity, socioeconomic status, victimization, and family support [48,98-102].

In a national survey, female sexual minoritized youth (self-categorized as lesbian, bisexual, or "mostly heterosexual") and "mostly heterosexual" males were at least two times more likely to use tobacco than heterosexual youth; tobacco use was not increased among self-categorized gay/bisexual males [103]. In other national surveys, bisexual youth report greater substance use than gay or lesbian youth [48,49,104,105].

Tobacco and/or substance use may be a marker for other behaviors that increase health risks (eg, exchange sex, sex with drug users, more than one partner, unprotected sex) [106-108]. In a survey of young men who have sex with men (MSM) in New York City, tobacco use was associated with increased use of illicit substances, alcohol, abuse of prescription drugs, and more casual and transactional sex partners [106]. Young MSM tobacco users were also more likely to use substances before or during sex. In a cross-sectional survey of young MSM, use of methamphetamine was associated with use of other illicit drugs, sex with drug users, more than one partner, lower rates of condom use, and higher rates of sexually transmitted infections (STIs) [107].

Unstable housing (homelessness) — Sexual minoritized youth who are rejected by their caregivers and families may run away or be forced to leave home [109]. In convenience samples of youth who were unstably housed, sexual minoritized youth are disproportionately represented [110,111]. The 2021 Youth Risk Behavior Survey, a cross-sectional nationally administered school-based survey conducted every two years, reported that 5 percent of students identifying as lesbian or gay and 4 percent of students identifying as bisexual endorsed homelessness/unstable housing compared with 2 percent of students identifying as heterosexual [112].

Youth who are unstably housed may be forced to engage in behaviors associated with increased health risks to survive [109]. Compared with heterosexual peers, runaway and sexual minoritized youth who are unstably housed report higher rates of substance use, suicide attempts, sexual behaviors associated with health risks (eg, prostitution, survival sex, unprotected intercourse), and sexual victimization [113-119].

Sexually transmitted infections — Although many adolescents become sexually active during high school, sexual minoritized youth are more likely to report engaging in behaviors, or being forced to engage in behaviors, that increase their risk of STIs (eg, more than one partner, lack of condom use, using alcohol or drugs before sexual activity) [120-126]. Sexual minoritized youth may begin experimenting with sex earlier than their heterosexual peers (ie, before age 13 years), use alcohol or drugs with intercourse, lack medically accurate information regarding same-sex safer sex, and lack social support or access to services [120,127]. In a meta-analysis of six studies, sexual minoritized youth were almost twice as likely to report sex while intoxicated as heterosexual peers [128].

Young MSM account for a disproportionate number of new human immunodeficiency virus (HIV) infections in the United States. Young women who have sex with women also may be at risk for HIV depending upon their sexual history and behaviors (eg, coerced sexual contact; exchange sex; digital-vaginal or digital-anal contact, particularly with shared penetrative sex items) [129-133]. HIV infection in adolescents is discussed separately. (See "The adolescent with HIV infection", section on 'Epidemiology'.)

Unplanned pregnancy — Unplanned pregnancy may occur in sexual minoritized females. Sexual minoritized females may have sex with cisgender males as they explore their sexual identity. They also may engage in heterosexual dating and sexual behaviors to avoid being identified as lesbian or bisexual, may engage in exchange sex, or may have coerced sexual contact [129,134-137]. (See "Contraception: Counseling and selection" and "Emergency contraception".)

Several population-based surveys have documented higher rates of pregnancy involvement among lesbian, gay, and bisexual youth than their heterosexual peers [135,138-142]. In one survey, lesbian and bisexual respondents were as likely to have had penile-vaginal intercourse as heterosexual or unsure adolescents; they were more likely to have used an ineffective method of contraception or no method of contraception and to become pregnant [134]. Adolescents who self-identified as lesbian also reported higher rates of a history of sexual abuse and prostitution [143]. In the National Survey of Family Growth (2006 to 2010), lesbian and bisexual young females (15 to 20 years of age) reported earlier heterosexual debut, more male sexual partners, more female sexual partners, and more forced sexual encounters by a male partner than heterosexual young females [138].

Weight control and anabolic steroids — Sexual minoritized youth are more likely than their heterosexual peers to report unhealthy weight control behaviors (eg, not eating for ≥24 hours; taking diet pills, powders, or liquids; vomiting or taking laxatives) and misuse of anabolic-androgenic steroids [120,144,145].

Patterns of disordered eating appear to differ by subgroup, but data are limited [146-151]. Female sexual minoritized youth are more likely to report binging with or without purging than their heterosexual female peers.

Male sexual minoritized youth are more likely to report symptoms of eating disorders (dissatisfaction and idealized body image, dieting, binging and purging, using weight control products) than heterosexual male peers [148-150].

Male sexual minoritized youth also are more likely to misuse anabolic-androgenic steroids than their heterosexual peers. In a national survey of high school students (2005 to 2007), misuse of anabolic-androgenic steroids was more common among sexual minoritized than heterosexual males (21 versus 4 percent, OR 5.8, 95% CI 4.1-8.2) [144]. Secondary analysis suggested that depression/suicidality, victimization, and substance use contributed to misuse of steroids; body dissatisfaction was not assessed.

Unintentional injury — Other risk behaviors that have been more frequently reported among sexual minoritized than heterosexual youth in the Youth Risk Behavior Surveillance System include behaviors that contribute to unintentional injury (eg, rarely/never wore seatbelt, rode with a driver who had been drinking alcohol, drove when drinking alcohol) [120,152].

SUPPORT AND ADVOCACY — Medical providers are in a unique position to provide and model respect, support, and open acceptance of youth of all sexual orientations and identities. Health care providers who accept and support sexual and gender diversity can serve as models for caregivers and other family members. Negative messaging from adults about sexual minoritized individuals is picked up by youth of all ages, whether it is subtle or overt. Prepubertal children are particularly sensitive to social cues and often learn to hide their interests, preferences, and play after getting negative feedback from peers and adults.

Normalization of sexuality — Health care professionals who provide developmental screening and anticipatory guidance can integrate conversations around sexuality into their education and counseling for caregivers (table 1), prepubertal and peripubertal adolescents (table 2), and older adolescents (table 3). Ongoing conversations about sexuality may allow earlier identification and support for sexual minoritized youth and their families. Normalization of sexuality is discussed separately. (See "Sexual development and sexuality in children and adolescents", section on 'Normalize sexuality'.)

Early identification of gender or sexual diversity — Early identification of gender or sexual diversity may permit earlier supportive interventions for the child and family. Asking the child and caregiver(s) about how the child might view their gender, their body, and their femininity or masculinity is usually well tolerated (table 1 and table 2). Caregivers may be reassured to hear that most children explore and experiment with gender and sexuality to some extent during childhood. The provider can then encourage the caregivers to focus on supporting their child as they explore and develop their sexuality rather than trying to predict future sexual orientation. (See "Gender development and clinical presentation of gender diversity in children and adolescents", section on 'Gender development in childhood'.)

Obtaining a more detailed exploration of gender and sexuality may be warranted for children and adolescents who present with suicidality, mood, behavior, or school problems. Sexual minoritized children may initially present with depression, anxiety, behavior problems, or school problems rather than explicitly identifying or verbalizing more complex constructs of same-sex sexual attractions or brain and body gender incongruence.

Caregivers and family — The caregivers and family of sexual minoritized youth play an important role in healthy adolescent development [4,36,57,153-155]. However, they may have difficulty accepting having a sexual minoritized child or family member. Their difficulty may be related to fear of the unknown, fear of social stigma, and fear for their child's or relative's safety. These concerns may reflect their own biases and personal, cultural, religious, and historical background. Caregivers should understand that their concerns may be communicated to the child, both explicitly and implicitly, and affect how the child views themself.

Health care providers can help caregivers work through their values and beliefs in a way that consistently supports the child. Education, caregiver-to-caregiver support groups, or therapy may be helpful in this regard. In the experience of the authors of this topic review, caregivers appreciate and value a health care provider who acknowledges their confusion or distress. Providers can guide caregivers towards resources that may be helpful to them and other family members and help them to focus on creating an accepting and safe environment for their child (table 4).

It may be helpful to explain that same-gender attractions are a normal variant of sexuality; being attracted to members of the same gender is not a mental disorder [2,6,40,156]. Familial support and acceptance (ie, affirmation) of the sexual minoritized youth helps adolescents explore their sexual identities in a safe environment [29]. Interventions that attempt to change sexual orientation (ie, "reparative" or "conversion" therapy) are ineffective, coercive, and potentially harmful (by increasing internalized stigma, distress, and depression) [2,29,40,156,157].

Health care providers of sexual minoritized youth can model consistent, positive, and strength-based acceptance and support for caregivers and family members who want to be more supportive of their sexual minoritized youth. They can also explore and address caregiver concerns and provide early referrals to community and advocacy resources. (See 'Resources' below.)

Disclosure — Sexual minoritized youth may or may not feel initial confusion, discomfort, or emotional turmoil as they come to terms with their sexual attractions, desires, and behaviors.

It is important to allow children, youth, and adults the freedom and autonomy to choose, consciously or unconsciously, the right time to disclose their sexual minoritized status ("come out") to their provider, family members, or peers. The process of coming out can be lifelong, as youth meet new people and experience new social situations. Sexual minoritized youth typically first disclose to a friend [158]. When a sexual minoritized youth has disclosed to a provider, maintaining privacy, confidentiality, and respecting the youth's plan for disclosure is paramount [2].

Health care providers may be asked to address questions or concerns about disclosure to family or friends [4]. Discussions about disclosure should include the timing, approach, and potential repercussions (table 5). Providers can help adolescents think through the pros and cons of disclosure, whom to tell, how to make the disclosure, and provide other guidance in revealing, asserting, and feeling good about their sexual orientation or other sexual minoritized status.

Given the potential for discrimination and bias against sexual minoritized youth, disclosure can be an enormous challenge. Reactions to disclosure (positive or negative) are not always predictable. Positive and accepting, or negative and rejecting, family reactions have long-term implications on the health and well-being of sexual minoritized youth [36,57,153]. (See 'Potential protective factors' above.)

Coming out can be an opportunity as well as a challenge. Potential benefits of disclosure include improved communication, support, and intimacy with family and friends; decreased fears and worry about inadvertent disclosure; increased opportunities to access care, social networks, and resources; more authentic internal and external presentation; and acceptance of one's true self [159]. Negative reactions should be discussed and anticipated. Disclosure may increase the rate of victimization [159]. The safety of the youth is paramount. There are particular situations where it may not be safe, helpful, or advisable to disclose. Some youth have significant and real concerns regarding physical safety or abuse from a caregiver or guardian due to sexual minoritized status. Others may not be physically unsafe but may be rejected, emotionally and verbally abused, or coerced financially. Dependence on caregivers for housing, schooling, food, and other expenses is a real concern for many youth. If a youth is uncertain how a caregiver or guardian will react, it may be safer to wait to disclose until the youth is in a more independent or supported position. Sexual minoritized youth are disproportionately represented among youth who are homeless, suggesting that many were rejected or not safe at home in their asserted sexual identity [113,160,161]. (See 'Unstable housing (homelessness)' above.)

Health care providers can help sexual minoritized youth who do not have supportive families identify and engage in other social and support networks (eg, genders and sexualities alliances [GSAs], community organizations). It is helpful for providers to be familiar with local groups or agencies that offer a positive environment and support for sexual minoritized youth; providers may identify local groups through national organizations or networking with local providers or groups (table 6). It is also helpful for the agencies to know which providers in the community provide safe and appropriate health services for sexual minoritized youth. (See 'Resources' below and "Lesbian, gay, bisexual, and other sexual minoritized youth: Primary care", section on 'Resources'.)

School — Difficult school environments for sexual minoritized youth may result in lower educational achievement and increased risk for depression and suicide [31,67,162]. Schools that institute specific policies and programs promoting safety and diversity create an opportunity for all students to achieve both academic and social goals [163].

A tolerant and supportive school climate includes a leadership plan with staff who are trained, committed, and can implement strategies designed to promote zero tolerance of harassment and reduce victimization. School personnel who promote tolerance of diversity improve sexual minoritized students' feelings of connectedness and safety [164]. Protective school environments have been correlated with lower risks of substance use and suicidality among sexual minoritized youth [31,165].

Schools can promote a safer climate for sexual minoritized youth when [72,139,166-169]:

●Antidiscrimination and antiharassment policies include sexual minoritized youth and are strongly enforced, with staff actively intervening to enforce the policies whenever it is necessary.

●They have identified an individual (eg, guidance counselor, principal) and/or a process to addresses concerns of sexual minoritized youth.

●There are social opportunities such as GSAs integrated into the school setting; GSAs are student-led clubs that provide a place for sexual minoritized youth to gather, socialize, and educate in a safe and supportive context. The GSAnetwork can provide resources for students who would like to start a GSA. Participation in and perceived effectiveness of a GSA may decrease victimization and its effects on well-being [170].

●Issues related to sexual minoritized status are integrated into the larger school curriculums (eg, discussion of same-gender relationships in sex education courses, discussion of sexual prejudice in athletics programs and physical education classes) [139,171,172]. In one study, teacher training was associated with a lower odds that sexual minoritized students experienced bias-based school violence, lack of safety at school, and feelings of depression and sadness [172].

A detailed discussion of policy recommendations to increase the safety of sexual minoritized youth at school is beyond the scope of this review but is available in Safe at School: Addressing the School Environment and LGBT Safety through Policy and Legislation [162].

Resources — The tables provide lists of resources that may be helpful to sexual minoritized youth (table 6), caregivers and family members (table 4), and clinicians (table 7).

SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Adolescent sexual health and pregnancy" and "Society guideline links: Sexually transmitted infections" and "Society guideline links: HIV infection in adolescents" and "Society guideline links: Contraception" and "Society guideline links: Medical care for homeless persons" and "Society guideline links: Health care for lesbian, gay, and other sexual minority populations".)

SUMMARY

●Terminology – Sexual orientation has multiple dimensions, including attractions, identity, behaviors, and the gender(s) of partners. Sexual identity is an individual's assessment of their sexual orientation. It is best defined by the individual adolescent; many avoid discreet labels. (See 'Terminology' above.)

The term "sexual minoritized" encompasses a variety of sexual identities that differ from cultural norms. (See 'Terminology' above.)

●Developmental perspective – Adolescents explore their emerging sexuality through attractions, fantasies, and behaviors. Adolescent sexual identity and self-identified orientation does not necessarily correlate with sexual behaviors. (See 'Developmental perspective' above.)

●Epidemiology – In large surveys, 4 to 7 percent of high school youth report same-sex attractions or behaviors. (See 'Epidemiology' above.)

●Potential health concerns – The majority of sexual minoritized youth are healthy and well adjusted. However, compared with heterosexual peers, sexual minoritized youth are at increased risk of adverse psychosocial and health outcomes, including victimization, depression, suicide, substance use, homelessness/unstable housing, sexually transmitted infections, and unplanned pregnancy. (See 'Potential psychosocial and health concerns' above.)

Adverse psychosocial and health outcomes may be related to stigmatization and lack of acceptance by individuals, communities, and cultures (figure 2). Factors that may counteract stigmatization include acceptance, competence, increased self-esteem, strong connections to family and school, caring adult role models, and involvement in a community. (See 'Stigmatization and minority stress' above and 'Potential protective factors' above.)

●Support and advocacy – Health care providers can support sexual minoritized youth by (see 'Support and advocacy' above):

•Normalizing sexuality throughout childhood by integrating conversations around sexuality into their education and counseling for caregivers (table 1), prepubertal and peripubertal adolescents (table 2), and older adolescents (table 3) (see "Sexual development and sexuality in children and adolescents", section on 'Normalize sexuality')

•Early identification of gender or sexual diversity and associated psychosocial and health concerns

•Helping caregivers support their child

•Helping the youth with decisions about disclosure (table 5)

•Advocating for schools that provide safety for sexual minoritized youth

•Providing educational and support resources to the sexual minoritized youth (table 6) and their family (table 4)

  1. Goldfried MR, Bell AC. Extending the boundaries of research on adolescent development. J Clin Child Adolesc Psychol 2003; 32:531.
  2. Committee On Adolescence. Office-based care for lesbian, gay, bisexual, transgender, and questioning youth. Pediatrics 2013; 132:198.
  3. Austin SB, Conron K, Patel A, Freedner N. Making sense of sexual orientation measures: findings from a cognitive processing study with adolescents on health survey questions. J LGBT Health Res 2007; 3:55.
  4. Bell DL, Breland DJ, Ott MA. Adolescent and young adult male health: a review. Pediatrics 2013; 132:535.
  5. Coker TR, Austin SB, Schuster MA. Health and healthcare for lesbian, gay, bisexual, and transgender youth: reducing disparities through research, education, and practice. J Adolesc Health 2009; 45:213.
  6. Adelson SL, American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). Practice parameter on gay, lesbian, or bisexual sexual orientation, gender nonconformity, and gender discordance in children and adolescents. J Am Acad Child Adolesc Psychiatry 2012; 51:957.
  7. Coker TR, Austin SB, Schuster MA. The health and health care of lesbian, gay, and bisexual adolescents. Annu Rev Public Health 2010; 31:457.
  8. Bullough VL. Children and adolescents as sexual beings: a historical overview. Child Adolesc Psychiatr Clin N Am 2004; 13:447.
  9. Kinsey AC, Pomeroy WB, Martin CE. Sexual behavior in the human male, WB Saunders, Philadelphia 1948.
  10. Levine DA, Committee On Adolescence. Office-based care for lesbian, gay, bisexual, transgender, and questioning youth. Pediatrics 2013; 132:e297.
  11. Ryan C, Futterman D. Lesbian and Gay Youth: Care and Counseling. Adolesc Med 1997; 8:207.
  12. Remafedi G, Resnick M, Blum R, Harris L. Demography of sexual orientation in adolescents. Pediatrics 1992; 89:714.
  13. Berona J, Stepp SD, Hipwell AE, Keenan KE. Trajectories of Sexual Orientation from Adolescence to Young Adulthood: Results from a Community-Based Urban Sample of Girls. J Adolesc Health 2018; 63:57.
  14. Katz-Wise SL, Perry NS, Nelson KM, et al. Sexual Fluidity in Identity and Behavior Among Cisgender Youth: Findings from the Longitudinal Growing up with Media Study. J Pediatr 2023; 257:113355.
  15. Rosario M, Schrimshaw EW, Hunter J. Predicting different patterns of sexual identity development over time among lesbian, gay, and bisexual youths: a cluster analytic approach. Am J Community Psychol 2008; 42:266.
  16. Chandra A, Mosher WD, Copen C, Sionean C. Sexual behavior, sexual attraction, and sexual identity in the United States: data from the 2006-2008 National Survey of Family Growth. Natl Health Stat Report 2011; :1.
  17. Mustanski B, Birkett M, Greene GJ, et al. The association between sexual orientation identity and behavior across race/ethnicity, sex, and age in a probability sample of high school students. Am J Public Health 2014; 104:237.
  18. Igartua K, Thombs BD, Burgos G, Montoro R. Concordance and discrepancy in sexual identity, attraction, and behavior among adolescents. J Adolesc Health 2009; 45:602.
  19. McCabe J, Brewster KL, Tillman KH. Patterns and correlates of same-sex sexual activity among U.S. teenagers and young adults. Perspect Sex Reprod Health 2011; 43:142.
  20. Fasula AM, Oraka E, Jeffries WL 4th, et al. Young Sexual Minority Males in the United States: Sociodemographic Characteristics And Sexual Attraction, Identity and Behavior. Perspect Sex Reprod Health 2016; 48:3.
  21. Mallon GP, DeCrescenzo T. Transgender children and youth: a child welfare practice perspective. Child Welfare 2006; 85:215.
  22. Plummer DC. The quest for modern manhood: masculine stereotypes, peer culture and the social significance of homophobia. J Adolesc 2001; 24:15.
  23. Piper J, Mannino M. Identity formation for individuals in transition: A narrative family therapy model. J GLBT Fam Stud 2008; 4:75.
  24. Moser C, Kleinplatz PJ, Zuccarini D, Reiner WG. Situating unusual child and adolescent sexual behavior in context. Child Adolesc Psychiatr Clin N Am 2004; 13:569.
  25. Parmar DD, Alabaster A, Vance S Jr, et al. Identification of Sexual Minority Youth in Pediatric Primary Care Settings Within a Large Integrated Healthcare System Using Electronic Health Records. J Adolesc Health 2020; 66:255.
  26. Johns MM, Lowry R, Haderxhanaj LT, et al. Trends in Violence Victimization and Suicide Risk by Sexual Identity Among High School Students - Youth Risk Behavior Survey, United States, 2015-2019. MMWR Suppl 2020; 69:19.
  27. Rapoport E, Athanasian CE, Adesman A. Prevalence of Nonheterosexual Identity and Same-Sex Sexual Contact Among High School Students in the US From 2015 to 2019. JAMA Pediatr 2021; 175:970.
  28. Mpofu JJ, Underwood JM, Thornton JE, et al. Overview and Methods for the Youth Risk Behavior Surveillance System - United States, 2021. MMWR Suppl 2023; 72:1.
  29. Society for Adolescent Health and Medicine. Recommendations for Promoting the Health and Well-being of Sexual and Gender-diverse Adolescents Through Supportive Families and Affirming Support Networks. J Adolesc Health 2022; 70:692.
  30. Herrick AL, Egan JE, Coulter RW, et al. Raising sexual minority youths' health levels by incorporating resiliencies into health promotion efforts. Am J Public Health 2014; 104:206.
  31. Hatzenbuehler ML, Birkett M, Van Wagenen A, Meyer IH. Protective school climates and reduced risk for suicide ideation in sexual minority youths. Am J Public Health 2014; 104:279.
  32. Alderman EM, Breuner CC, COMMITTEE ON ADOLESCENCE. Unique Needs of the Adolescent. Pediatrics 2019; 144.
  33. Bruce D, Stall R, Fata A, Campbell RT. Modeling minority stress effects on homelessness and health disparities among young men who have sex with men. J Urban Health 2014; 91:568.
  34. Veale JF, Peter T, Travers R, Saewyc EM. Enacted Stigma, Mental Health, and Protective Factors Among Transgender Youth in Canada. Transgend Health 2017; 2:207.
  35. Clark KA, Cochran SD, Maiolatesi AJ, Pachankis JE. Prevalence of Bullying Among Youth Classified as LGBTQ Who Died by Suicide as Reported in the National Violent Death Reporting System, 2003-2017. JAMA Pediatr 2020; 174:1211.
  36. Ryan C, Huebner D, Diaz RM, Sanchez J. Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics 2009; 123:346.
  37. Ryan C, Russell ST, Huebner D, et al. Family acceptance in adolescence and the health of LGBT young adults. J Child Adolesc Psychiatr Nurs 2010; 23:205.
  38. Hatzenbuehler ML, Jun HJ, Corliss HL, Bryn Austin S. Structural stigma and sexual orientation disparities in adolescent drug use. Addict Behav 2015; 46:14.
  39. Hatzenbuehler ML, Jun HJ, Corliss HL, Austin SB. Structural stigma and cigarette smoking in a prospective cohort study of sexual minority and heterosexual youth. Ann Behav Med 2014; 47:48.
  40. IOM (Institute of Medicine). The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding, National Academies Press, Washington, DC 2011.
  41. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 2003; 129:674.
  42. Frost DM, Lehavot K, Meyer IH. Minority stress and physical health among sexual minority individuals. J Behav Med 2015; 38:1.
  43. Shilo G, Mor Z. The impact of minority stressors on the mental and physical health of lesbian, gay, and bisexual youths and young adults. Health Soc Work 2014; 39:161.
  44. Pachankis JE, Hatzenbuehler ML, Starks TJ. The influence of structural stigma and rejection sensitivity on young sexual minority men's daily tobacco and alcohol use. Soc Sci Med 2014; 103:67.
  45. Mustanski BS, Garofalo R, Emerson EM. Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths. Am J Public Health 2010; 100:2426.
  46. King M, Semlyen J, Tai SS, et al. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry 2008; 8:70.
  47. Stone DM, Luo F, Ouyang L, et al. Sexual orientation and suicide ideation, plans, attempts, and medically serious attempts: evidence from local Youth Risk Behavior Surveys, 2001-2009. Am J Public Health 2014; 104:262.
  48. Newcomb ME, Birkett M, Corliss HL, Mustanski B. Sexual orientation, gender, and racial differences in illicit drug use in a sample of US high school students. Am J Public Health 2014; 104:304.
  49. Fish JN, Baams L. Trends in Alcohol-Related Disparities Between Heterosexual and Sexual Minority Youth from 2007 to 2015: Findings from the Youth Risk Behavior Survey. LGBT Health 2018; 5:359.
  50. Bird JD, Kuhns L, Garofalo R. The impact of role models on health outcomes for lesbian, gay, bisexual, and transgender youth. J Adolesc Health 2012; 50:353.
  51. Eisenberg ME, Resnick MD. Suicidality among gay, lesbian and bisexual youth: the role of protective factors. J Adolesc Health 2006; 39:662.
  52. Turanovic JJ, Pratt TC. Longitudinal effects of violent victimization during adolescence on adverse outcomes in adulthood: a focus on prosocial attachments. J Pediatr 2015; 166:1062.
  53. Whitaker K, Shapiro VB, Shields JP. School-Based Protective Factors Related to Suicide for Lesbian, Gay, and Bisexual Adolescents. J Adolesc Health 2016; 58:63.
  54. Steiner RJ, Sheremenko G, Lesesne C, et al. Adolescent Connectedness and Adult Health Outcomes. Pediatrics 2019; 144.
  55. Perales F, Campbell A. Health Disparities Between Sexual Minority and Different-Sex-Attracted Adolescents: Quantifying the Intervening Role of Social Support and School Belonging. LGBT Health 2020; 7:146.
  56. Heath RD, Keene L. The Role of School and Community Involvement in the Psychosocial Health Outcomes of Black and Latinx LGBTQ Youth. J Adolesc Health 2023; 72:650.
  57. Bouris A, Guilamo-Ramos V, Pickard A, et al. A systematic review of parental influences on the health and well-being of lesbian, gay, and bisexual youth: time for a new public health research and practice agenda. J Prim Prev 2010; 31:273.
  58. Baams L. Disparities for LGBTQ and Gender Nonconforming Adolescents. Pediatrics 2018; 141.
  59. Oshri A, Handley ED, Sutton TE, et al. Developmental trajectories of substance use among sexual minority girls: associations with sexual victimization and sexual health risk. J Adolesc Health 2014; 55:100.
  60. Duncan DT, Hatzenbuehler ML. Lesbian, gay, bisexual, and transgender hate crimes and suicidality among a population-based sample of sexual-minority adolescents in Boston. Am J Public Health 2014; 104:272.
  61. Busseri MA, Willoughby T, Chalmers H, Bogaert AF. On the association between sexual attraction and adolescent risk behavior involvement: Examining mediation and moderation. Dev Psychol 2008; 44:69.
  62. Shields JP, Whitaker K, Glassman J, et al. Impact of victimization on risk of suicide among lesbian, gay, and bisexual high school students in San Francisco. J Adolesc Health 2012; 50:418.
  63. Priebe G, Svedin CG. Online or off-line victimisation and psychological well-being: a comparison of sexual-minority and heterosexual youth. Eur Child Adolesc Psychiatry 2012; 21:569.
  64. van Bergen DD, Bos HM, van Lisdonk J, et al. Victimization and suicidality among Dutch lesbian, gay, and bisexual youths. Am J Public Health 2013; 103:70.
  65. Patrick DL, Bell JF, Huang JY, et al. Bullying and quality of life in youths perceived as gay, lesbian, or bisexual in Washington State, 2010. Am J Public Health 2013; 103:1255.
  66. Birkett M, Newcomb ME, Mustanski B. Does it get better? A longitudinal analysis of psychological distress and victimization in lesbian, gay, bisexual, transgender, and questioning youth. J Adolesc Health 2015; 56:280.
  67. Kosciw JG, Greytak EA, Bartkiewicz MJ, et al. The 2011 National School Climate Survey. The experiences of lesbian, gay, bisexual, and transgender youth in our nation's schools. http://www.glsen.org/sites/default/files/2011%20National%20School%20Climate%20Survey%20Full%20Report.pdf (Accessed on November 02, 2013).
  68. Friedman MS, Marshal MP, Guadamuz TE, et al. A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals. Am J Public Health 2011; 101:1481.
  69. O'Malley Olsen E, Kann L, Vivolo-Kantor A, et al. School violence and bullying among sexual minority high school students, 2009-2011. J Adolesc Health 2014; 55:432.
  70. Schuster MA, Bogart LM, Elliott MN, et al. A longitudinal study of bullying of sexual-minority youth. N Engl J Med 2015; 372:1872.
  71. Caputi TL, Shover CL, Watson RJ. Physical and Sexual Violence Among Gay, Lesbian, Bisexual, and Questioning Adolescents. JAMA Pediatr 2020; 174:791.
  72. Robinson JP, Espelage DL, Rivers I. Developmental trends in peer victimization and emotional distress in LGB and heterosexual youth. Pediatrics 2013; 131:423.
  73. Kosciw JG, Clark CM, Menard L. The 2021 Natinal School Climate Survey. The experiences of LGBTQ+ youth in our nation' schools. https://www.glsen.org/research/2021-national-school-climate-survey (Accessed on February 09, 2023).
  74. Birkett M, Russell ST, Corliss HL. Sexual-orientation disparities in school: the mediational role of indicators of victimization in achievement and truancy because of feeling unsafe. Am J Public Health 2014; 104:1124.
  75. Rosario M, Corliss HL, Everett BG, et al. Mediation by peer violence victimization of sexual orientation disparities in cancer-related tobacco, alcohol, and sexual risk behaviors: pooled youth risk behavior surveys. Am J Public Health 2014; 104:1113.
  76. Ueno K, Roach TA, Peña-Talamantes AE. The dynamic association between same-sex contact and educational attainment. Adv Life Course Res 2013; 18:127.
  77. Bouris A, Everett BG, Heath RD, et al. Effects of Victimization and Violence on Suicidal Ideation and Behaviors Among Sexual Minority and Heterosexual Adolescents. LGBT Health 2016; 3:153.
  78. Austin SB, Roberts AL, Corliss HL, Molnar BE. Sexual violence victimization history and sexual risk indicators in a community-based urban cohort of "mostly heterosexual" and heterosexual young women. Am J Public Health 2008; 98:1015.
  79. D'Augelli AR, Grossman AH, Starks MT. Childhood gender atypicality, victimization, and PTSD among lesbian, gay, and bisexual youth. J Interpers Violence 2006; 21:1462.
  80. Walls NE, Atteberry-Ash B, Kattari SK, et al. Gender Identity, Sexual Orientation, Mental Health, and Bullying as Predictors of Partner Violence in a Representative Sample of Youth. J Adolesc Health 2019; 64:86.
  81. Pathela P, Schillinger JA. Sexual behaviors and sexual violence: adolescents with opposite-, same-, or both-sex partners. Pediatrics 2010; 126:879.
  82. Rothman EF, Exner D, Baughman AL. The prevalence of sexual assault against people who identify as gay, lesbian, or bisexual in the United States: a systematic review. Trauma Violence Abuse 2011; 12:55.
  83. Luk JW, Gilman SE, Haynie DL, Simons-Morton BG. Sexual Orientation and Depressive Symptoms in Adolescents. Pediatrics 2018; 141.
  84. Shearer A, Herres J, Kodish T, et al. Differences in Mental Health Symptoms Across Lesbian, Gay, Bisexual, and Questioning Youth in Primary Care Settings. J Adolesc Health 2016; 59:38.
  85. Irish M, Solmi F, Mars B, et al. Depression and self-harm from adolescence to young adulthood in sexual minorities compared with heterosexuals in the UK: a population-based cohort study. Lancet Child Adolesc Health 2019; 3:91.
  86. Bettis AH, Liu RT. Population-Based Analysis of Temporal Trends in the Prevalence of Depressed Mood Among Sexual Minority and Heterosexual Youths From 1999 Through 2017. JAMA Pediatr 2019; 173:1201.
  87. Hill AO, Lyons A, Power J, et al. Suicidal Ideation and Suicide Attempts Among Lesbian, Gay, Bisexual, Pansexual, Queer, and Asexual Youth: Differential Impacts of Sexual Orientation, Verbal, Physical, or Sexual Harassment or Assault, Conversion Practices, Family or Household Religiosity, and School Experience. LGBT Health 2022; 9:313.
  88. de Lange J, Baams L, van Bergen DD, et al. Minority Stress and Suicidal Ideation and Suicide Attempts Among LGBT Adolescents and Young Adults: A Meta-Analysis. LGBT Health 2022; 9:222.
  89. Marshal MP, Dietz LJ, Friedman MS, et al. Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review. J Adolesc Health 2011; 49:115.
  90. Caputi TL, Smith D, Ayers JW. Suicide Risk Behaviors Among Sexual Minority Adolescents in the United States, 2015. JAMA 2017; 318:2349.
  91. Liu RT. Temporal Trends in the Prevalence of Nonsuicidal Self-injury Among Sexual Minority and Heterosexual Youth From 2005 Through 2017. JAMA Pediatr 2019; 173:790.
  92. Kingsbury M, Hammond NG, Johnstone F, Colman I. Suicidality among sexual minority and transgender adolescents: a nationally representative population-based study of youth in Canada. CMAJ 2022; 194:E767.
  93. Luk JW, Goldstein RB, Yu J, et al. Sexual Minority Status and Age of Onset of Adolescent Suicide Ideation and Behavior. Pediatrics 2021; 148.
  94. di Giacomo E, Krausz M, Colmegna F, et al. Estimating the Risk of Attempted Suicide Among Sexual Minority Youths: A Systematic Review and Meta-analysis. JAMA Pediatr 2018; 172:1145.
  95. Almazan EP, Roettger ME, Acosta PS. Measures of sexual minority status and suicide risk among young adults in the United States. Arch Suicide Res 2014; 18:274.
  96. Burns MN, Ryan DT, Garofalo R, et al. Mental health disorders in young urban sexual minority men. J Adolesc Health 2015; 56:52.
  97. Lytle MC, De Luca SM, Blosnich JR, Brownson C. Associations of racial/ethnic identities and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning individuals. J Affect Disord 2015; 178:39.
  98. Kerr D, Ding K, Burke A, Ott-Walter K. An alcohol, tobacco, and other drug use comparison of lesbian, bisexual, and heterosexual undergraduate women. Subst Use Misuse 2015; 50:340.
  99. Kecojevic A, Wong CF, Corliss HL, Lankenau SE. Risk factors for high levels of prescription drug misuse and illicit drug use among substance-using young men who have sex with men (YMSM). Drug Alcohol Depend 2015; 150:156.
  100. Rosario M, Reisner SL, Corliss HL, et al. Sexual-orientation disparities in substance use in emerging adults: a function of stress and attachment paradigms. Psychol Addict Behav 2014; 28:790.
  101. Dai H. Tobacco Product Use Among Lesbian, Gay, and Bisexual Adolescents. Pediatrics 2017.
  102. Phillips Ii G, Turner B, Felt D, et al. Trends in Alcohol Use Behaviors by Sexual Identity and Behavior Among High School Students, 2007-2017. J Adolesc Health 2019; 65:760.
  103. Austin SB, Ziyadeh N, Fisher LB, et al. Sexual orientation and tobacco use in a cohort study of US adolescent girls and boys. Arch Pediatr Adolesc Med 2004; 158:317.
  104. Corliss HL, Rosario M, Wypij D, et al. Sexual orientation disparities in longitudinal alcohol use patterns among adolescents: findings from the Growing Up Today Study. Arch Pediatr Adolesc Med 2008; 162:1071.
  105. Russell ST, Driscoll AK, Truong N. Adolescent same-sex romantic attractions and relationships: implications for substance use and abuse. Am J Public Health 2002; 92:198.
  106. Storholm ED, Halkitis PN, Siconolfi DE, Moeller RW. Cigarette smoking as part of a syndemic among young men who have sex with men ages 13-29 in New York City. J Urban Health 2011; 88:663.
  107. Freeman P, Walker BC, Harris DR, et al. Methamphetamine use and risk for HIV among young men who have sex with men in 8 US cities. Arch Pediatr Adolesc Med 2011; 165:736.
  108. Newcomb ME, Mustanski B. Developmental change in the relationship between alcohol and drug use before sex and sexual risk behavior in young men who have sex with men. AIDS Behav 2014; 18:1981.
  109. Gambon TB, Gewirtz O'Brien JR, COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, COUNCIL ON COMMUNITY PEDIATRICS. Runaway Youth: Caring for the Nation's Largest Segment of Missing Children. Pediatrics 2020; 145.
  110. Noell JW, Ochs LM. Relationship of sexual orientation to substance use, suicidal ideation, suicide attempts, and other factors in a population of homeless adolescents. J Adolesc Health 2001; 29:31.
  111. Kruks G. Gay and lesbian homeless/street youth: special issues and concerns. J Adolesc Health 1991; 12:515.
  112. McKinnon II, Krause KH, Robin L, et al. Experiences of Unstable Housing Among High School Students - Youth Risk Behavior Survey, United States, 2021. MMWR Suppl 2023; 72:29.
  113. Rice E, Barman-Adhikari A, Rhoades H, et al. Homelessness experiences, sexual orientation, and sexual risk taking among high school students in Los Angeles. J Adolesc Health 2013; 52:773.
  114. Cochran BN, Stewart AJ, Ginzler JA, Cauce AM. Challenges faced by homeless sexual minorities: comparison of gay, lesbian, bisexual, and transgender homeless adolescents with their heterosexual counterparts. Am J Public Health 2002; 92:773.
  115. Whitbeck LB, Chen X, Hoyt DR, et al. Mental disorder, subsistence strategies, and victimization among gay, lesbian, and bisexual homeless and runaway adolescents. J Sex Res 2004; 41:329.
  116. Van Leeuwen JM, Boyle S, Salomonsen-Sautel S, et al. Lesbian, gay, and bisexual homeless youth: an eight-city public health perspective. Child Welfare 2006; 85:151.
  117. Marshall BD, Shannon K, Kerr T, et al. Survival sex work and increased HIV risk among sexual minority street-involved youth. J Acquir Immune Defic Syndr 2010; 53:661.
  118. Weber AE, Boivin JF, Blais L, et al. Predictors of initiation into prostitution among female street youths. J Urban Health 2004; 81:584.
  119. Weber AE, Boivin JF, Blais L, et al. HIV risk profile and prostitution among female street youths. J Urban Health 2002; 79:525.
  120. Centers for Disease Control and Prevention. High School YRBS. Youth Online. Supplementary tables. https://www.cdc.gov/healthyyouth/data/yrbs/2019_tables/index.htm (Accessed on September 09, 2020).
  121. Thurston IB, Dietrich J, Bogart LM, et al. Correlates of sexual risk among sexual minority and heterosexual South African youths. Am J Public Health 2014; 104:1265.
  122. Zou H, Prestage G, Fairley CK, et al. Sexual behaviors and risk for sexually transmitted infections among teenage men who have sex with men. J Adolesc Health 2014; 55:247.
  123. Stults CB, Javdani S, Greenbaum CA, et al. Intimate partner violence and substance use risk among young men who have sex with men: The P18 cohort study. Drug Alcohol Depend 2015; 154:54.
  124. Stults CB, Javdani S, Greenbaum CA, et al. Intimate Partner Violence and Sex Among Young Men Who Have Sex With Men. J Adolesc Health 2016; 58:215.
  125. Ybarra ML, Rosario M, Saewyc E, Goodenow C. Sexual Behaviors and Partner Characteristics by Sexual Identity Among Adolescent Girls. J Adolesc Health 2016; 58:310.
  126. Perry NS, Nelson KM, Carey MP. Diversity of Psychosocial Syndemic Indicators and Associations with Sexual Behavior with Male and Female Partners Among Early Adolescent Sexual Minority Males. LGBT Health 2019; 6:386.
  127. Garofalo R, Wolf RC, Kessel S, et al. The association between health risk behaviors and sexual orientation among a school-based sample of adolescents. Pediatrics 1998; 101:895.
  128. Herrick AL, Marshal MP, Smith HA, et al. Sex while intoxicated: a meta-analysis comparing heterosexual and sexual minority youth. J Adolesc Health 2011; 48:306.
  129. Goodenow C, Szalacha LA, Robin LE, Westheimer K. Dimensions of sexual orientation and HIV-related risk among adolescent females: evidence from a statewide survey. Am J Public Health 2008; 98:1051.
  130. Koh AS, Gómez CA, Shade S, Rowley E. Sexual risk factors among self-identified lesbians, bisexual women, and heterosexual women accessing primary care settings. Sex Transm Dis 2005; 32:563.
  131. Kwakwa HA, Ghobrial MW. Female-to-female transmission of human immunodeficiency virus. Clin Infect Dis 2003; 36:e40.
  132. Chan SK, Thornton LR, Chronister KJ, et al. Likely female-to-female sexual transmission of HIV--Texas, 2012. MMWR Morb Mortal Wkly Rep 2014; 63:209.
  133. Committee Opinion No 708: Improving Awareness of and Screening for Health Risks Among Sex Workers. Obstet Gynecol 2017; 130:e53.
  134. Saewyc EM, Bearinger LH, Blum RW, Resnick MD. Sexual intercourse, abuse and pregnancy among adolescent women: does sexual orientation make a difference? Fam Plann Perspect 1999; 31:127.
  135. Saewyc EM, Poon CS, Homma Y, Skay CL. Stigma management? The links between enacted stigma and teen pregnancy trends among gay, lesbian, and bisexual students in British Columbia. Can J Hum Sex 2008; 17:123.
  136. Herrick AL, Matthews AK, Garofalo R. Health risk behaviors in an urban sample of young women who have sex with women. J Lesbian Stud 2010; 14:80.
  137. Charlton BM, Nava-Coulter B, Coles MS, Katz-Wise SL. Teen Pregnancy Experiences of Sexual Minority Women. J Pediatr Adolesc Gynecol 2019; 32:499.
  138. Tornello SL, Riskind RG, Patterson CJ. Sexual orientation and sexual and reproductive health among adolescent young women in the United States. J Adolesc Health 2014; 54:160.
  139. Blake SM, Ledsky R, Lehman T, et al. Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: the benefits of gay-sensitive HIV instruction in schools. Am J Public Health 2001; 91:940.
  140. Lindley LL, Walsemann KM. Sexual Orientation and Risk of Pregnancy Among New York City High-School Students. Am J Public Health 2015; 105:1379.
  141. Goldberg SK, Reese BM, Halpern CT. Teen Pregnancy Among Sexual Minority Women: Results From the National Longitudinal Study of Adolescent to Adult Health. J Adolesc Health 2016; 59:429.
  142. Charlton BM, Roberts AL, Rosario M, et al. Teen Pregnancy Risk Factors Among Young Women of Diverse Sexual Orientations. Pediatrics 2018; 141.
  143. Saewyc EM, Pettingell S, Magee LL. The prevalence of sexual abuse among adolescents in school. J Sch Nurs 2003; 19:266.
  144. Blashill AJ, Safren SA. Sexual orientation and anabolic-androgenic steroids in U.S. adolescent boys. Pediatrics 2014; 133:469.
  145. Matthews-Ewald MR, Zullig KJ, Ward RM. Sexual orientation and disordered eating behaviors among self-identified male and female college students. Eat Behav 2014; 15:441.
  146. Robin L, Brener ND, Donahue SF, et al. Associations between health risk behaviors and opposite-, same-, and both-sex sexual partners in representative samples of vermont and massachusetts high school students. Arch Pediatr Adolesc Med 2002; 156:349.
  147. Austin SB, Ziyadeh NJ, Corliss HL, et al. Sexual orientation disparities in purging and binge eating from early to late adolescence. J Adolesc Health 2009; 45:238.
  148. Ackard DM, Fedio G, Neumark-Sztainer D, Britt HR. Factors associated with disordered eating among sexually active adolescent males: gender and number of sexual partners. Psychosom Med 2008; 70:232.
  149. Austin SB, Ziyadeh N, Kahn JA, et al. Sexual orientation, weight concerns, and eating-disordered behaviors in adolescent girls and boys. J Am Acad Child Adolesc Psychiatry 2004; 43:1115.
  150. Hadland SE, Austin SB, Goodenow CS, Calzo JP. Weight misperception and unhealthy weight control behaviors among sexual minorities in the general adolescent population. J Adolesc Health 2014; 54:296.
  151. Katz-Wise SL, Blood EA, Milliren CE, et al. Sexual orientation disparities in BMI among U.S. adolescents and young adults in three race/ethnicity groups. J Obes 2014; 2014:537242.
  152. Reisner SL, Van Wagenen A, Gordon A, Calzo JP. Disparities in safety belt use by sexual orientation identity among US high school students. Am J Public Health 2014; 104:311.
  153. Needham BL, Austin EL. Sexual orientation, parental support, and health during the transition to young adulthood. J Youth Adolesc 2010; 39:1189.
  154. Puckett JA, Woodward EN, Mereish EH, Pantalone DW. Parental Rejection Following Sexual Orientation Disclosure: Impact on Internalized Homophobia, Social Support, and Mental Health. LGBT Health 2015; 2:265.
  155. Huebner DM, Roche KM, Rith KA. Effects of Family Demographics and the Passage of Time on Parents' Difficulty with Their Lesbian, Gay, or Bisexual Youth's Sexual Orientation. Arch Sex Behav 2019; 48:1581.
  156. Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation. 2009 http://www.apa.org/pi/lgbt/resources/therapeutic-response.pdf (Accessed on January 23, 2014).
  157. APA. Commission on Psychotherapy by Psychiatrists.. Position statement on therapies focused on attempts to change sexual orientation (reparative or conversion therapies). Am J Psychiatry 2000; 157:1719.
  158. Rossi NE. "Coming out" stories of gay and lesbian young adults. J Homosex 2010; 57:1174.
  159. Kosciw JG, Palmer NA, Kull RM. Reflecting resiliency: openness about sexual orientation and/or gender identity and its relationship to well-being and educational outcomes for LGBT students. Am J Community Psychol 2015; 55:167.
  160. McLaughlin KA, Hatzenbuehler ML, Xuan Z, Conron KJ. Disproportionate exposure to early-life adversity and sexual orientation disparities in psychiatric morbidity. Child Abuse Negl 2012; 36:645.
  161. Higgitt N, Wingert S, Ristock J, et al. Voices from the Margins: Experiences of Street-Involved Youth in Winnipeg. University of Winnipeg, 2003. Available at: www.uwinnipeg.ca/faculty/ius/iusweb_backup/pdf/Street-kidsReportfinalSeptember903.pdf (Accessed on May 30, 2013).
  162. Biegel S, Kuehl SJ. Safe at School: Addressing the School Environment and LGBT Safety through Policy and Legislation. National Education Policy Center October 2010. Available at: www.scribd.com/doc/48054580/Biegel-LGBT#archive (Accessed on May 30, 2013).
  163. Birkett M, Espelage DL, Koenig B. LGB and questioning students in schools: the moderating effects of homophobic bullying and school climate on negative outcomes. J Youth Adolesc 2009; 38:989.
  164. McGuire JK, Anderson CR, Toomey RB, Russell ST. School climate for transgender youth: a mixed method investigation of student experiences and school responses. J Youth Adolesc 2010; 39:1175.
  165. De Pedro KT, Esqueda MC, Gilreath TD. School Protective Factors and Substance Use Among Lesbian, Gay, and Bisexual Adolescents in California Public Schools. LGBT Health 2017; 4:210.
  166. Russell ST, Ryan C, Toomey RB, et al. Lesbian, gay, bisexual, and transgender adolescent school victimization: implications for young adult health and adjustment. J Sch Health 2011; 81:223.
  167. Russell ST, McGuire JK. The school climate for lesbian, gay, bisexual, and transgender (LGBT) students. In: Toward Positive Youth Development: Transforming Schools and Community Programs, Shinn M, Yoshikawa H (Eds), Oxford University Press, Oxford, UK 2008. p.133.
  168. O’Shaughnessy M, Russell ST, Heck K, et al. Safe Place to Learn: Consequences of Harassment Based on Actual or Perceived Sexual Orientation and Gender Non-Conformity and Steps for Making Schools Safer. California Safe Schools Coalition, 2004. www.casafeschools.org/SafePlacetoLearnLow.pdf (Accessed on January 29, 2014).
  169. Szalacha L. Safe sexual diversity climates: lessons learned from an evaluation of Massachusetts Safe Schools Program for Gay and Lesbian Students. Am J Educ 2003; 110:58.
  170. Toomey RB, Ryan C, Diaz RM, et al. Gender-nonconforming lesbian, gay, bisexual, and transgender youth: school victimization and young adult psychosocial adjustment. Dev Psychol 2010; 46:1580.
  171. Proulx CN, Coulter RWS, Egan JE, et al. Associations of Lesbian, Gay, Bisexual, Transgender, and Questioning-Inclusive Sex Education With Mental Health Outcomes and School-Based Victimization in U.S. High School Students. J Adolesc Health 2019; 64:608.
  172. Ioverno S. Inclusive National Educational Policies as Protective Factors for LGBTI Youth Adjustment: An European Cross-National Study. J Adolesc Health 2023; 72:845.
Topic 90691 Version 48.0

References

1 : Extending the boundaries of research on adolescent development.

2 : Office-based care for lesbian, gay, bisexual, transgender, and questioning youth.

3 : Making sense of sexual orientation measures: findings from a cognitive processing study with adolescents on health survey questions.

4 : Adolescent and young adult male health: a review.

5 : Health and healthcare for lesbian, gay, bisexual, and transgender youth: reducing disparities through research, education, and practice.

6 : Practice parameter on gay, lesbian, or bisexual sexual orientation, gender nonconformity, and gender discordance in children and adolescents.

7 : The health and health care of lesbian, gay, and bisexual adolescents.

8 : Children and adolescents as sexual beings: a historical overview.

9 : Children and adolescents as sexual beings: a historical overview.

10 : Office-based care for lesbian, gay, bisexual, transgender, and questioning youth.

11 : Lesbian and Gay Youth: Care and Counseling.

12 : Demography of sexual orientation in adolescents.

13 : Trajectories of Sexual Orientation from Adolescence to Young Adulthood: Results from a Community-Based Urban Sample of Girls.

14 : Sexual Fluidity in Identity and Behavior Among Cisgender Youth: Findings from the Longitudinal Growing up with Media Study.

15 : Predicting different patterns of sexual identity development over time among lesbian, gay, and bisexual youths: a cluster analytic approach.

16 : Sexual behavior, sexual attraction, and sexual identity in the United States: data from the 2006-2008 National Survey of Family Growth.

17 : The association between sexual orientation identity and behavior across race/ethnicity, sex, and age in a probability sample of high school students.

18 : Concordance and discrepancy in sexual identity, attraction, and behavior among adolescents.

19 : Patterns and correlates of same-sex sexual activity among U.S. teenagers and young adults.

20 : Young Sexual Minority Males in the United States: Sociodemographic Characteristics And Sexual Attraction, Identity and Behavior.

21 : Transgender children and youth: a child welfare practice perspective.

22 : The quest for modern manhood: masculine stereotypes, peer culture and the social significance of homophobia.

23 : Identity formation for individuals in transition: A narrative family therapy model

24 : Situating unusual child and adolescent sexual behavior in context.

25 : Identification of Sexual Minority Youth in Pediatric Primary Care Settings Within a Large Integrated Healthcare System Using Electronic Health Records.

26 : Trends in Violence Victimization and Suicide Risk by Sexual Identity Among High School Students - Youth Risk Behavior Survey, United States, 2015-2019.

27 : Prevalence of Nonheterosexual Identity and Same-Sex Sexual Contact Among High School Students in the US From 2015 to 2019.

28 : Overview and Methods for the Youth Risk Behavior Surveillance System - United States, 2021.

29 : Recommendations for Promoting the Health and Well-being of Sexual and Gender-diverse Adolescents Through Supportive Families and Affirming Support Networks.

30 : Raising sexual minority youths' health levels by incorporating resiliencies into health promotion efforts.

31 : Protective school climates and reduced risk for suicide ideation in sexual minority youths.

32 : Unique Needs of the Adolescent.

33 : Modeling minority stress effects on homelessness and health disparities among young men who have sex with men.

34 : Enacted Stigma, Mental Health, and Protective Factors Among Transgender Youth in Canada.

35 : Prevalence of Bullying Among Youth Classified as LGBTQ Who Died by Suicide as Reported in the National Violent Death Reporting System, 2003-2017.

36 : Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults.

37 : Family acceptance in adolescence and the health of LGBT young adults.

38 : Structural stigma and sexual orientation disparities in adolescent drug use.

39 : Structural stigma and cigarette smoking in a prospective cohort study of sexual minority and heterosexual youth.

40 : Structural stigma and cigarette smoking in a prospective cohort study of sexual minority and heterosexual youth.

41 : Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence.

42 : Minority stress and physical health among sexual minority individuals.

43 : The impact of minority stressors on the mental and physical health of lesbian, gay, and bisexual youths and young adults.

44 : The influence of structural stigma and rejection sensitivity on young sexual minority men's daily tobacco and alcohol use.

45 : Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths.

46 : A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people.

47 : Sexual orientation and suicide ideation, plans, attempts, and medically serious attempts: evidence from local Youth Risk Behavior Surveys, 2001-2009.

48 : Sexual orientation, gender, and racial differences in illicit drug use in a sample of US high school students.

49 : Trends in Alcohol-Related Disparities Between Heterosexual and Sexual Minority Youth from 2007 to 2015: Findings from the Youth Risk Behavior Survey.

50 : The impact of role models on health outcomes for lesbian, gay, bisexual, and transgender youth.

51 : Suicidality among gay, lesbian and bisexual youth: the role of protective factors.

52 : Longitudinal effects of violent victimization during adolescence on adverse outcomes in adulthood: a focus on prosocial attachments.

53 : School-Based Protective Factors Related to Suicide for Lesbian, Gay, and Bisexual Adolescents.

54 : Adolescent Connectedness and Adult Health Outcomes.

55 : Health Disparities Between Sexual Minority and Different-Sex-Attracted Adolescents: Quantifying the Intervening Role of Social Support and School Belonging.

56 : The Role of School and Community Involvement in the Psychosocial Health Outcomes of Black and Latinx LGBTQ Youth.

57 : A systematic review of parental influences on the health and well-being of lesbian, gay, and bisexual youth: time for a new public health research and practice agenda.

58 : Disparities for LGBTQ and Gender Nonconforming Adolescents.

59 : Developmental trajectories of substance use among sexual minority girls: associations with sexual victimization and sexual health risk.

60 : Lesbian, gay, bisexual, and transgender hate crimes and suicidality among a population-based sample of sexual-minority adolescents in Boston.

61 : On the association between sexual attraction and adolescent risk behavior involvement: Examining mediation and moderation.

62 : Impact of victimization on risk of suicide among lesbian, gay, and bisexual high school students in San Francisco.

63 : Online or off-line victimisation and psychological well-being: a comparison of sexual-minority and heterosexual youth.

64 : Victimization and suicidality among Dutch lesbian, gay, and bisexual youths.

65 : Bullying and quality of life in youths perceived as gay, lesbian, or bisexual in Washington State, 2010.

66 : Does it get better? A longitudinal analysis of psychological distress and victimization in lesbian, gay, bisexual, transgender, and questioning youth.

67 : Does it get better? A longitudinal analysis of psychological distress and victimization in lesbian, gay, bisexual, transgender, and questioning youth.

68 : A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals.

69 : School violence and bullying among sexual minority high school students, 2009-2011.

70 : A longitudinal study of bullying of sexual-minority youth.

71 : Physical and Sexual Violence Among Gay, Lesbian, Bisexual, and Questioning Adolescents.

72 : Developmental trends in peer victimization and emotional distress in LGB and heterosexual youth.

73 : Developmental trends in peer victimization and emotional distress in LGB and heterosexual youth.

74 : Sexual-orientation disparities in school: the mediational role of indicators of victimization in achievement and truancy because of feeling unsafe.

75 : Mediation by peer violence victimization of sexual orientation disparities in cancer-related tobacco, alcohol, and sexual risk behaviors: pooled youth risk behavior surveys.

76 : The dynamic association between same-sex contact and educational attainment.

77 : Effects of Victimization and Violence on Suicidal Ideation and Behaviors Among Sexual Minority and Heterosexual Adolescents.

78 : Sexual violence victimization history and sexual risk indicators in a community-based urban cohort of "mostly heterosexual" and heterosexual young women.

79 : Childhood gender atypicality, victimization, and PTSD among lesbian, gay, and bisexual youth.

80 : Gender Identity, Sexual Orientation, Mental Health, and Bullying as Predictors of Partner Violence in a Representative Sample of Youth.

81 : Sexual behaviors and sexual violence: adolescents with opposite-, same-, or both-sex partners.

82 : The prevalence of sexual assault against people who identify as gay, lesbian, or bisexual in the United States: a systematic review.

83 : Sexual Orientation and Depressive Symptoms in Adolescents.

84 : Differences in Mental Health Symptoms Across Lesbian, Gay, Bisexual, and Questioning Youth in Primary Care Settings.

85 : Depression and self-harm from adolescence to young adulthood in sexual minorities compared with heterosexuals in the UK: a population-based cohort study.

86 : Population-Based Analysis of Temporal Trends in the Prevalence of Depressed Mood Among Sexual Minority and Heterosexual Youths From 1999 Through 2017.

87 : Suicidal Ideation and Suicide Attempts Among Lesbian, Gay, Bisexual, Pansexual, Queer, and Asexual Youth: Differential Impacts of Sexual Orientation, Verbal, Physical, or Sexual Harassment or Assault, Conversion Practices, Family or Household Religiosity, and School Experience.

88 : Minority Stress and Suicidal Ideation and Suicide Attempts Among LGBT Adolescents and Young Adults: A Meta-Analysis.

89 : Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review.

90 : Suicide Risk Behaviors Among Sexual Minority Adolescents in the United States, 2015.

91 : Temporal Trends in the Prevalence of Nonsuicidal Self-injury Among Sexual Minority and Heterosexual Youth From 2005 Through 2017.

92 : Suicidality among sexual minority and transgender adolescents: a nationally representative population-based study of youth in Canada.

93 : Sexual Minority Status and Age of Onset of Adolescent Suicide Ideation and Behavior.

94 : Estimating the Risk of Attempted Suicide Among Sexual Minority Youths: A Systematic Review and Meta-analysis.

95 : Measures of sexual minority status and suicide risk among young adults in the United States.

96 : Mental health disorders in young urban sexual minority men.

97 : Associations of racial/ethnic identities and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning individuals.

98 : An alcohol, tobacco, and other drug use comparison of lesbian, bisexual, and heterosexual undergraduate women.

99 : Risk factors for high levels of prescription drug misuse and illicit drug use among substance-using young men who have sex with men (YMSM).

100 : Sexual-orientation disparities in substance use in emerging adults: a function of stress and attachment paradigms.

101 : Tobacco Product Use Among Lesbian, Gay, and Bisexual Adolescents.

102 : Trends in Alcohol Use Behaviors by Sexual Identity and Behavior Among High School Students, 2007-2017.

103 : Sexual orientation and tobacco use in a cohort study of US adolescent girls and boys.

104 : Sexual orientation disparities in longitudinal alcohol use patterns among adolescents: findings from the Growing Up Today Study.

105 : Adolescent same-sex romantic attractions and relationships: implications for substance use and abuse.

106 : Cigarette smoking as part of a syndemic among young men who have sex with men ages 13-29 in New York City.

107 : Methamphetamine use and risk for HIV among young men who have sex with men in 8 US cities.

108 : Developmental change in the relationship between alcohol and drug use before sex and sexual risk behavior in young men who have sex with men.

109 : Runaway Youth: Caring for the Nation's Largest Segment of Missing Children.

110 : Relationship of sexual orientation to substance use, suicidal ideation, suicide attempts, and other factors in a population of homeless adolescents.

111 : Gay and lesbian homeless/street youth: special issues and concerns.

112 : Experiences of Unstable Housing Among High School Students - Youth Risk Behavior Survey, United States, 2021.

113 : Homelessness experiences, sexual orientation, and sexual risk taking among high school students in Los Angeles.

114 : Challenges faced by homeless sexual minorities: comparison of gay, lesbian, bisexual, and transgender homeless adolescents with their heterosexual counterparts.

115 : Mental disorder, subsistence strategies, and victimization among gay, lesbian, and bisexual homeless and runaway adolescents.

116 : Lesbian, gay, and bisexual homeless youth: an eight-city public health perspective.

117 : Survival sex work and increased HIV risk among sexual minority street-involved youth.

118 : Predictors of initiation into prostitution among female street youths.

119 : HIV risk profile and prostitution among female street youths.

120 : HIV risk profile and prostitution among female street youths.

121 : Correlates of sexual risk among sexual minority and heterosexual South African youths.

122 : Sexual behaviors and risk for sexually transmitted infections among teenage men who have sex with men.

123 : Intimate partner violence and substance use risk among young men who have sex with men: The P18 cohort study.

124 : Intimate Partner Violence and Sex Among Young Men Who Have Sex With Men.

125 : Sexual Behaviors and Partner Characteristics by Sexual Identity Among Adolescent Girls.

126 : Diversity of Psychosocial Syndemic Indicators and Associations with Sexual Behavior with Male and Female Partners Among Early Adolescent Sexual Minority Males.

127 : The association between health risk behaviors and sexual orientation among a school-based sample of adolescents.

128 : Sex while intoxicated: a meta-analysis comparing heterosexual and sexual minority youth.

129 : Dimensions of sexual orientation and HIV-related risk among adolescent females: evidence from a statewide survey.

130 : Sexual risk factors among self-identified lesbians, bisexual women, and heterosexual women accessing primary care settings.

131 : Female-to-female transmission of human immunodeficiency virus.

132 : Likely female-to-female sexual transmission of HIV--Texas, 2012.

133 : Committee Opinion No 708: Improving Awareness of and Screening for Health Risks Among Sex Workers.

134 : Sexual intercourse, abuse and pregnancy among adolescent women: does sexual orientation make a difference?

135 : Stigma management? The links between enacted stigma and teen pregnancy trends among gay, lesbian, and bisexual students in British Columbia.

136 : Health risk behaviors in an urban sample of young women who have sex with women.

137 : Teen Pregnancy Experiences of Sexual Minority Women.

138 : Sexual orientation and sexual and reproductive health among adolescent young women in the United States.

139 : Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: the benefits of gay-sensitive HIV instruction in schools.

140 : Sexual Orientation and Risk of Pregnancy Among New York City High-School Students.

141 : Teen Pregnancy Among Sexual Minority Women: Results From the National Longitudinal Study of Adolescent to Adult Health.

142 : Teen Pregnancy Risk Factors Among Young Women of Diverse Sexual Orientations.

143 : The prevalence of sexual abuse among adolescents in school.

144 : Sexual orientation and anabolic-androgenic steroids in U.S. adolescent boys.

145 : Sexual orientation and disordered eating behaviors among self-identified male and female college students.

146 : Associations between health risk behaviors and opposite-, same-, and both-sex sexual partners in representative samples of vermont and massachusetts high school students.

147 : Sexual orientation disparities in purging and binge eating from early to late adolescence.

148 : Factors associated with disordered eating among sexually active adolescent males: gender and number of sexual partners.

149 : Sexual orientation, weight concerns, and eating-disordered behaviors in adolescent girls and boys.

150 : Weight misperception and unhealthy weight control behaviors among sexual minorities in the general adolescent population.

151 : Sexual orientation disparities in BMI among U.S. adolescents and young adults in three race/ethnicity groups.

152 : Disparities in safety belt use by sexual orientation identity among US high school students.

153 : Sexual orientation, parental support, and health during the transition to young adulthood.

154 : Parental Rejection Following Sexual Orientation Disclosure: Impact on Internalized Homophobia, Social Support, and Mental Health.

155 : Effects of Family Demographics and the Passage of Time on Parents' Difficulty with Their Lesbian, Gay, or Bisexual Youth's Sexual Orientation.

156 : Effects of Family Demographics and the Passage of Time on Parents' Difficulty with Their Lesbian, Gay, or Bisexual Youth's Sexual Orientation.

157 : Position statement on therapies focused on attempts to change sexual orientation (reparative or conversion therapies).

158 : "Coming out" stories of gay and lesbian young adults.

159 : Reflecting resiliency: openness about sexual orientation and/or gender identity and its relationship to well-being and educational outcomes for LGBT students.

160 : Disproportionate exposure to early-life adversity and sexual orientation disparities in psychiatric morbidity.

161 : Disproportionate exposure to early-life adversity and sexual orientation disparities in psychiatric morbidity.

162 : Disproportionate exposure to early-life adversity and sexual orientation disparities in psychiatric morbidity.

163 : LGB and questioning students in schools: the moderating effects of homophobic bullying and school climate on negative outcomes.

164 : School climate for transgender youth: a mixed method investigation of student experiences and school responses.

165 : School Protective Factors and Substance Use Among Lesbian, Gay, and Bisexual Adolescents in California Public Schools.

166 : Lesbian, gay, bisexual, and transgender adolescent school victimization: implications for young adult health and adjustment.

167 : Lesbian, gay, bisexual, and transgender adolescent school victimization: implications for young adult health and adjustment.

168 : Lesbian, gay, bisexual, and transgender adolescent school victimization: implications for young adult health and adjustment.

169 : Safe sexual diversity climates: lessons learned from an evaluation of Massachusetts Safe Schools Program for Gay and Lesbian Students

170 : Gender-nonconforming lesbian, gay, bisexual, and transgender youth: school victimization and young adult psychosocial adjustment.

171 : Associations of Lesbian, Gay, Bisexual, Transgender, and Questioning-Inclusive Sex Education With Mental Health Outcomes and School-Based Victimization in U.S. High School Students.

172 : Inclusive National Educational Policies as Protective Factors for LGBTI Youth Adjustment: An European Cross-National Study.

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟