Violence, Substance Use and Suicide Risk Among Sexual Minority Students, 2015–2017

Sexual minority youth — students who identify as lesbian, gay, bisexual or another non-heterosexual identity — report more violence, substance use and suicide risk than heterosexual youth. The gaps are generally attributed to minority stress: the way stigma against sexual minorities affects health. But no nationally representative study had looked at differences within sexual minority youth.

The study

CDC pooled the 2015 and 2017 national Youth Risk Behavior Surveys (YRBS) — 30,389 students in grades 9–12 (response rate 60% each year), weighted to be nationally representative. Students were grouped as gay or lesbian, bisexual, not sure, or heterosexual, and compared with heterosexual students of the same sex, adjusting for race and ethnicity and grade.

• Victimization (7 items): feeling unsafe at or on the way to school; ever forced to have sex; and in the past year, threatened or injured with a weapon at school, sexual or physical dating violence, bullying at school, electronic bullying.
• Substance use: lifetime cigarettes, alcohol, marijuana; and high-risk drugs — cocaine, heroin, methamphetamines, ecstasy, inhalants.
• Suicide risk (past year): feeling sad or hopeless, considering suicide, making a plan, attempting, and an attempt treated by a doctor or nurse.

Victimization

Bisexual girls, compared with heterosexual girls, were more likely to report (adjusted prevalence ratio):

They also reported more sexual dating violence than lesbian girls, and more forced sex and bullying than lesbian girls or girls not sure of their identity.

Gay, bisexual and not-sure boys were more likely than heterosexual boys to report all seven forms of victimization — and the links were stronger for boys than girls for forced sex, dating violence and bullying.

Substance use

• Lesbian girls: more cigarette (APR 1.8) and marijuana (1.5) use than heterosexual girls.
• Bisexual girls: more cigarettes (1.8), alcohol (1.2) and marijuana (1.6).
• Girls not sure of their identity: more cigarettes (1.2) but less alcohol (0.9).
• Boys: bisexual boys smoked more cigarettes (1.4); not-sure boys used less marijuana (0.8); otherwise few differences — the links with cigarettes and marijuana were stronger for girls.
• High-risk drugs — cocaine, heroin, methamphetamines, ecstasy, inhalants — were used more by every sexual minority group, girls and boys, than by heterosexual peers.

Suicide risk

• All sexual minority girls were more likely to feel sad or hopeless, consider suicide, plan it and attempt it. An attempt treated by a doctor or nurse was more likely among lesbian (APR 3.7) and bisexual (3.7) girls.
• All sexual minority boys had higher rates on all five measures, and the link with attempted suicide was stronger for boys.

What it means

Sexual minority youth generally face health disparities, and there are important differences among them. Violence prevention may need to address the particular pressures on bisexual girls and sexual minority boys; prevention of high-risk drug use and suicide needs to be relevant and effective for all sexual minority youth. Prevention efforts may benefit from recognizing these within-group differences — for example through CDC's technical packages for violence prevention, programs building safe, supportive schools and communities and stable, nurturing relationships, and training for educators and health providers on how lesbian or gay, bisexual and not-sure youth differ.

Limitations: the data are cross-sectional (association, not cause); what "not sure" meant to students is unclear; answers are self-reported; the survey didn't ask about gender identity, so transgender students couldn't be studied; and students who had dropped out — perhaps those at highest risk — weren't surveyed.

If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline in the United States.

Sources

Based on Johns MM, Lowry R, Rasberry CN, Dunville R, Robin L, Pampati S, Stone DM, Mercer Kollar LM, "Violence Victimization, Substance Use, and Suicide Risk Among Sexual Minority High School Students — United States, 2015–2017," MMWR Morbidity and Mortality Weekly Report, volume 67, Centers for Disease Control and Prevention; a work of the United States government in the public domain.