One in four US adolescents identify as non-heterosexual, comparative analysis finds
A recent Northwestern Medicine comparative analysis of national survey results found that 1 in 4 U.S. adolescents in grades 9 through 12 reported their sexual identity as non-heterosexual, according to findings published in JAMA Pediatrics.
The study, led by Gregory Phillips II, Ph.D., associate professor of Medical Social Sciences and of Preventive Medicine in the Division of Epidemiology, emphasizes the need for inclusive approaches when working with sexual and gender minority youth in academic and health care settings, among others.
"These findings indicate that every single person who works with youth needs to be aware of and competent with addressing LGBTQIA+ youth as a general competency in practice," said Lauren Beach, JD, Ph.D., assistant professor of assistant professor of Medical Social Sciences and of Preventive Medicine in the Division of Epidemiology and senior author of the study.
The Youth Risk Behavior Surveillance System is a biennial set of surveys conducted by the Centers for Disease Control and Prevention (CDC). Established in 1991, the survey measures health-related behaviors and experiences that can lead to poor health in U.S. high school students.
In 2015, the CDC added a question to the included a question about sexual identity, with response options including "heterosexual," "gay or lesbian," "bisexual" or "not sure." In 2021, the CDC expanded the survey's "not sure" response to include the current three options:
- I describe my sexual identity some other way.
- I am not sure about my sexual identity (questioning).
- I do not know what this question is asking.
In the current study, Phillips and colleagues explored whether the number individuals who responded with "not sure" about their sexual identity changed between 2019 and 2021.
This survey included 12,847 respondents (51% female and 49% male) in 2019, and 16,357 respondents (48% female and 52% male) in 2021.
From 2019 to 2021, the investigators identified a significant decrease in youth who identified as heterosexual (84.5% versus 74.7%), an increase those who identified as gay or lesbian (2.5% versus 3%) and an increase in those who identified as bisexual (8.6% versus 12%). More youths in 2021 than in 2019 also selected "not sure" for their sexual identity (5.1% versus 4.4%).
In 2019, 5.6% of females and 3.3% of males selected "not sure" in response to the sexual identity question, while in 2021, 8% of females and 2.3% of males selected "not sure."
"There's this notion that the people who identify as something other than heterosexual has been increasing over time, so that's part of the reason that we see these numbers go up. But it's also possibly due to the clarity with the question that we see greater proportions of people," Phillips said.
"People feel more comfortable saying that they're not heterosexual and don't feel forced into that category," Phillips said.
The findings also suggest that the CDC should revisit their question further because of these percentage changes, according to Beach.
"It suggests that there are other additional response options that might be really salient to this age range of people that aren't being captured right now," Beach said, adding that the current findings underscore the importance of inclusive approaches when working with sexual and gender minority youth.
"If you a health care provider serving youth in this age range, then you should be thinking about asking them questions to know more about who they are, their sexual identity and their sexual behavior, their gender identity, whether or not they're transgender: It's all really relevant to be talking to youth about to understand who they are," Beach said.
The investigators are now studying differences in responses by race, ethnicity, region, age and other factors, and how these factors impact risks for certain health outcomes among sexual minority youth.
"This will help us have more targeted messaging on the health needs of non-heterosexual youth populations for health care providers, school officials and many other audiences," Beach said.
More information: Gregory L. Phillips et al, Changes to Sexual Identity Response Options in the Youth Risk Behavior Survey, JAMA Pediatrics (2024). DOI: 10.1001/jamapediatrics.2024.0024
Journal information: JAMA Pediatrics
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