Identifying Sexual Orientation Health Disparities in Adolescents: Analysis of Pooled Data From the Youth Risk Behavior Survey, 2005 and 2007

We studied sexual orientation disparities in health outcomes among US adolescents by pooling multiple Youth Risk Behavior Survey (YRBS) data sets from 2005 and 2007 for 14 jurisdictions. Here we describe the methodology for pooling and analyzing these data sets.Sexual orientation–related items assessed sexual orientation identity, gender of sexual contacts, sexual attractions, and harassment regarding sexual orientation. Wording of items varied across jurisdictions, so we created parallel variables and composite sexual minority variables.We used a variety of statistical approaches to address issues with the analysis of pooled data and to meet the aims of individual articles, which focused on a range of health outcomes and behaviors related to cancer, substance use, sexual health, mental health, violence, and injury.RESEARCH ON THE HEALTH OF lesbian, gay, and bisexual (LGB) youths has primarily come from nonprobability samples.1,2 Such studies have been crucial for identifying health issues, their developmental course, and risk and protective factors, but their designs are less suited to describing health disparities. Their primary limitation is the inability to ensure that the LGB and heterosexual youths are drawn from the same or even comparable populations. When sexual orientation questions are included, probability-based sampling approaches can ameliorate this problem because individuals are sampled from a known population (e.g., students in schools). However, until recently very few large federal and state health surveillance surveys included sexual orientation items.1Even when sexual orientation items are included in population health studies, the low prevalence of LGB identities and same-sex sexual behaviors often leads to too few individuals represented in the cells of interest. Small numbers of LGB individuals prevent analysis of sexual orientation subgroups (e.g., lesbian–gay vs bisexual) or comparisons of effects across other key social characteristics such as age, race, and gender. This is problematic because evidence shows heterogeneity in the health of LGB subgroups. For example, a review of multiple school-based samples found bisexuals to have higher risk for suicidality than heterosexuals, but results were mixed for gay and lesbian youths.3 Very few studies have looked at the intersections of sexual orientation and other sociodemographic characteristics, such as race.1When large health surveys measure sexual orientation, they frequently use a single item that assesses either sexual orientation identity or the gender of past sexual partners.4 Such single items fail to capture the multiple dimensions of sexual orientation—including attractions, behaviors, and identity—that may not align with one another, particularly among youths.4–6 The relationship between these dimensions and various health outcomes may also differ. For example, one study found that LGB sexual orientation identity was associated with increased mood and anxiety disorders, but that women reporting only same-sex partners had the lowest rates of most disorders.3 Therefore, population-based studies that assess more than 1 component of sexual orientation are at a considerable advantage in understanding its relationship with health outcomes. The set of articles in this special issue extend the literature by focusing on sexual orientation disparities in several health domains through analysis of data from population-based samples.     

Alcohol-Related Risk Behaviors and Sports Participation Among Adolescents: An Analysis of 2005 Youth Risk Behavior Survey Data

Using 2005 Youth Risk Behavior Survey data, we examined alcohol-related behaviors among adolescent sports participants. Male sports participants were more likely to report heavy drinking and driving after drinking in the past month. Females were less likely to report ever drinking, early drinking, and drinking in the past month.     

Sexual Behaviors of Middle School Students: 2009 Youth Risk Behavior Survey Results From 16 Locations

BACKGROUND: The potential negative consequences of engaging in sexual risk behaviors at a young age are well documented. Unfortunately, there is a dearth of information about the prevalence of sexual behaviors among middle school students. This article provides an overview of the sexual risk behaviors of middle school students from 16 districts and states throughout the country, and examines these risks by demographic variables. METHODS: In 2009, 10 states and 6 districts administered the Youth Risk Behavior Survey‐Middle School and included sexual behavior questions. Data were examined using the Centers for Disease Control and Prevention's Youth Online database. Frequencies were run for 4 sexual behaviors and an HIV/AIDS education question for each location. A series of t‐tests were calculated for these 5 items by gender, age, and race for each location. RESULTS: Data show that 5–20% of sixth graders and 14–42% of eighth graders have engaged in sexual intercourse. A concerning percentage of students have also engaged in other sexual risk behaviors and many are not receiving HIV/AIDS education. Additionally, there were significant differences by gender, race, and age. CONCLUSION: Consistent with previous studies, males, minorities, and older students are more likely to engage in sexual risk behaviors. There is also variation in the percentage of students engaging in sexual behaviors across locations. Sexual risk reduction education is important for middle school youth, particularly for minorities, males and those from southern and/or larger, urban cities as those are the populations with generally higher sexual risk behaviors.     

Risk factors for multiple forms of violent experiences: Analyses of the 2009 Youth Risk Behavior Survey

There is a growing body of empirical research indicating a significant co-occurrence of multiple forms of experiences with violence among US youth. However, very little information is available about shared risk factors across forms of violence. Current analyses were based on cross-sectional data from the 2009 Youth Risk Behavior Survey (YRBS). The YRBS includes a nationally representative sample (n = 16,410) of high-school students in 9–12th grades in the US. Multinomial regression analyses were conducted to test the associations between risk factors and reports of multiple violence exposures (i.e. physical fights, dating violence, forced sex, and being bullied at school). Among high-school students, 33.0% reported one experience, 11.4% reported two experiences, and 4.0% reported 3–4 experiences with violence. Multinomial regression analyses indicate that experience with 3–4 forms of violence were highly associated with sadness, feeling too unsafe to go to school, early alcohol use, binge drinking, drug use, weapon carrying, asthma, low academic grades, and suicide attempts relative to those who did not report any experience with violence. These findings underscore that multiple experiences with violence are relatively common among US high-school students. Moreover, multiple experiences with violence are associated with a relatively broad range of risk factors. Youth who report multiple experiences with violence seem to be particularly vulnerable and in need of assistance, in particular because of the strong association between multiple violent experiences and suicidal behaviors.     

青少年危险行为问卷信效度研究

目的编制青少年危险行为问卷（Youth Risk Behavior Survey Questionnaire,YRBS）中文版,并考察其信度与效度。方法 依据我国具体的文化特征,对美国的2009版本的青少年危险行为问卷进行改编为中文版的青少年危险行为问卷。通过分层整群抽样从2008年汶川特大地震9个极重灾区的110所学校的4～9年级的学生中纳入5 486人进行问卷调查。结果 内部一致,中文版青少年危险行为问卷总量表的Cronbach sα为0.730,10项分量表的Cronbach sα为-0.415～0.857。区分度,11个分量表与总量表分相关系数为0.288～0.641,每个分量表与各自分量表中的条目的相关系数为0.176～0.892,P均为0.000。因子分析：规则安全及暴力行为分量表均提取了2个公因子,其余的8个分量表,均提取1个公因子。内容效度即精神科医师及临床心理学家对该量表的内容进行评估,确保该量表有较好的内容效度。结论 青少年危险行为问卷在地震后幸存的青少年中具有较好的信度与效度,可作为该群体行为问题的一个较好的筛查工具,该结论仍有待进一步的验证及完善。     

Perceived Overweight, BMI, and Risk for Suicide Attempts: Findings from the 2007 Youth Risk Behavior Survey

Among U.S. youth (N = 14,041), perceived (odds ratio [OR]adj. = 1.45, 95% confidence interval [CI]: 1.18–1.72) and actual overweight (ORadj. = 1.31, 95% CI: 1.07–1.60) were associated with suicide attempts in analyses controlling for demographic characteristics and potential confounders. There is a need to better understand associations between perceived and actual overweight and risk for suicide attempts and to develop appropriate strategies for prevention.     

Using the Youth Risk Behavior Survey to Compare Risk Behaviors of Texas High School and College Students

ABSTRACT: This study used the Youth Risk Behavior Survey (YRBS) to assess selected health behaviors of Texas high school and college students. The YRBS was administered during 1993 in paper and pencil form to 6,015 high school students representing 329 classrooms from 78 school districts. A total of 1,408 college students representing 23 college and universities were surveyed by telephone in 1993 using a modified version of YRBS. Texas college students reported a higher percentage who had experienced sexual intercourse (82% versus 55.4%), but Texas high school students reported a younger age of first sexual intercourse. High school students also initiated alcohol consumption at a younger age, although college students were more likely to binge drink (33.5% versus 31%). Regular cigarette use also was higher among college students (25.4% versus 19.3%), but was initiated at a younger age by high school students. Study results indicate that health education programs must begin much earlier than during the high school years. Due to early initiation of negative health behaviors, emphasis must be placed on abstinence and risk-reduction techniques for both populations.     

Sexually Coercive Behavior in Male Youth: Population Survey of General and Specific Risk Factors

Little is known about risk/protective factors for sexually coercive behavior in general population youth. We used a Swedish school-based population survey of sexual attitudes and experiences (response rate 77%) and investigated literature-based variables across sexually coercive (SEX), non-sexual conduct problem (CP), and normal control (NC) participants to identify general and specific risk/protective factors for sexual coercion. Among 1,933 male youth, 101 (5.2%) reported sexual coercion (ever talked or forced somebody into genital, oral, or anal sex) (SEX), 132 (6.8%) were classified as CP, and the remaining 1,700 (87.9%) as NC. Of 29 tested variables, 25 were more common in both SEX and CP compared to NC youth, including minority ethnicity, separated parents, vocational study program, risk-taking, aggressiveness, depressive symptoms, substance abuse, sexual victimization, extensive sexual experiences, and sexual preoccupation. When compared to CP youth only, SEX youth more often followed academic study programs, used less drugs and were less risk-taking. Further, SEX more frequently than CP youth reported gender stereotypic and pro-rape attitudes, sexual preoccupation, prostitution, and friends using violent porn. Finally, in a multivariate logistic regression, academic study program, pro-rape attitudes, sexual preoccupation, and less risk-taking independently remained more strongly associated with SEX compared to CP offending. In conclusion, several sociodemographic, family, and individual risk/protective factors were common to non-sexual and sexually coercive antisocial behavior in late adolescence. However, pro-rape cognitions, and sexual preoccupation, were sexuality-related, specific risk factors. The findings could inform preventive efforts and the assessment and treatment of sexually coercive male youth.     

Indicators of Victimization and Sexual Orientation Among Adolescents: Analyses From Youth Risk Behavior Surveys

Objectives. We used nuanced measures of sexual minority status to examine disparities in victimization and their variations by gender, age, and race/ethnicity.Methods. We conducted multivariate analyses of pooled data from the 2005 and 2007 Youth Risk Behavior Surveys.Results. Although all sexual minorities reported more fighting, skipping school because they felt unsafe, and having property stolen or damaged at school than did heterosexuals, rates were highest among youths who identified as bisexual or who reported both male and female sexual partners. Gender differences among sexual minorities appeared to be concentrated among bisexuals and respondents who reported sexual partners of both genders. Sexual minority youths reported more fighting than heterosexual youths, especially at younger ages, and more nonphysical school victimization that persisted through adolescence. White and Hispanic sexual minority youths reported more indicators of victimization than did heterosexuals; we found few sexual minority differences among African American and Asian American youths.Conclusions. Victimization carries health consequences, and sexual minorities are at increased risk. Surveys should include measures that allow tracking of disparities in victimization by sexual minority status.Public attention to and scholarship on sexual minority youths grew significantly during the past decade1; victimization has been the subject of a great deal of this interest. Numerous studies have documented higher rates of victimization of sexual minority, or lesbian, gay, bisexual, and transgender (LGBT), youths than of their heterosexual peers. Most previous studies relied on community samples or on samples of sexual minority youths recruited through LGBT organizations or online. Most notable among those is the biannual National School Climate Survey, conducted by the Gay, Lesbian, and Straight Education Network, which has documented school-based victimization of LGBT youths for more than a decade. The 2011 survey of more than 7000 students, aged 13 to 21 years, showed that nearly 9 out of 10 LGBT students experience harassment at school.2Although a few population-based studies have examined victimization of sexual minority youths, these studies typically have several limitations. Some are limited to single-item measures of sexual minority status.3 Experts argue that studies should measure multiple dimensions of sexual orientation (i.e., identity as well as behavior),1 but studies that incorporate multiple measures are rare. Even in fairly large population-based samples, the prevalence of sexual minorities is low enough that LGB youths are combined into a single category for statistical analyses.4,5Multiple studies have documented strong gender differences in victimization among sexual minority youths: sexual minority adolescent boys report more victimization than do sexual minority adolescent girls.5 Few studies have been able to disaggregate victimization experiences of sexual minority youths by age and race. A recent school-based population survey in Wisconsin found that homophobic attitudes decline from 7th to 12th grades.6 Furthermore, analyses of the National School Climate Survey 2007 data showed that younger LGBT youths reported significantly more school victimization than did their older peers.7 Data from the 2005 wave of the same survey showed that White, Native American, and multiracial LGBT students reported having property stolen or damaged at school more often than did other LGBT students.8 Data from the 2007 wave of the survey showed that African American LGBT students were more likely than Whites to report anti-LGBT victimization at school.7 This research from Gay, Lesbian, and Straight Education Network was the first to show racial/ethnic group differences among LGBT students; we know of no published studies that make use of population-based data to examine racial/ethnic group differences in victimization.We used pooled Youth Risk Behavior Survey (YRBS) data to examine differences in indicators of victimization by sexual identity and sexual behavior, as well as variability among sexual minorities by gender, age, and race/ethnicity.     

Youth risk behavior surveillance. National Alternative High School Youth Risk Behavior Survey, United States, 1998

Alternative high schools serve approximately 280,000 students nationwide who are at high risk for failing or dropping out of regular high school or who have been expelled from regular high school because of illegal activity or behavioral problems. Such settings provide important opportunities for delivering health promotion education and services to these youth and young adults. However, before this survey, the prevalence of health-risk behaviors among students attending alternative high schools nationwide was unknown. The Youth Risk Behavior Surveillance System (YRBSS) monitors the following six categories of priority health-risk behaviors among youth and young adults: behaviors that contribute to unintentional and intentional injuries; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs) (including human immunodeficiency virus [HIV] infection); unhealthy dietary behaviors; and physical inactivity. The national Alternative High School Youth Risk Behavior Survey (ALT-YRBS) is one component of the YRBSS; it was conducted in 1998 to measure priority health-risk behaviors among students at alternative high schools. The 1998 ALT-YRBS used a three-stage cluster sample design to produce a nationally representative sample of students in grades 9-12 in the United States who attend alternative high schools. The school response rate was 81.0%, and the student response rate was 81.9%, resulting in an overall response rate of 66.3%. This report summarizes results from the 1998 ALT-YRBS. The reporting period is February-May 1998. In the United States, 73.6% of all deaths among youth and young adults aged 10-24 years results from only four causes--motor vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 1998 ALT-YRBS demonstrate that many students at alternative high schools engage in behaviors that increase their likelihood of death from these four causes. During the 30 days preceding the survey, 51.9% had ridden with a driver who had been drinking alcohol, 25.1% had driven a vehicle after drinking alcohol, 32.9% had carried a weapon, 64.5% had drunk alcohol, and 53.0% had used marijuana. During the 12 months preceding the survey, 15.7% had attempted suicide, and 29.0% had rarely or never worn a seat belt. Substantial morbidity among school-aged youth and young adults also results from unintended pregnancies and STDs, including HIV infection. ALT-YRBS results indicate that in 1998, a total of 87.8% of students at alternative high schools had had sexual intercourse, 54.1% of sexually active students had not used a condom at last sexual intercourse, and 5.7% had ever injected an illegal drug. Among adults aged > or = 25 years, 66.5% of all deaths result from two causes--cardiovascular disease and cancer. Most risk behaviors associated with these causes of death are initiated during adolescence. In 1998, a total of 64.1% of students at alternative high schools had smoked cigarettes during the 30 days preceding the survey, 38.3% had smoked a cigar during the 30 days preceding the survey, 71.2% had not eaten > or = 5 servings of fruits and vegetables during the day preceding the survey, and 81.0% had not attended physical education (PE) class daily. Comparing ALT-YRBS results with 1997 national YRBS results demonstrates that the prevalence of most risk behaviors is higher among students attending alternative high schools compared with students at regular high schools. Some risk behaviors are more common among certain sex and racial/ethnic subgroups of students. ALT-YRBS data can be used nationwide by health and education officials to improve policies and programs designed to reduce risk behaviors associated with the leading causes of morbidity and mortality among students attending alternative high schools.     

Violence and drug use in rural teens: national prevalence estimates from the 2003 Youth Risk Behavior Survey

Objectives: The purpose of this study was to compare national estimates of drug use and exposure to violence between rural and urban teens. Methods: Twenty‐eight dependent variables from the 2003 Youth Risk Behavior Survey were used to compare violent activities, victimization, suicidal behavior, tobacco use, alcohol use, and illegal drug use across rural, urban, and suburban teens across the country. Results: Overall, rural teens were equally or more likely than both suburban and urban teens to report experiencing many measures of violent behavior, victimization, suicide behaviors, and drug use. Among all teens, nonwhites reported equal or higher rates of violent behavior and victimization than whites, but these associations disappeared within the rural‐only population. Conclusions: Rural areas do not appear to provide a strongly protective effect against risk behaviors in teens and may be a risk factor in itself. Community prevention efforts should focus on reaching rural areas and segmenting program content based on need. Where white teens might benefit from an emphasis on preventing tobacco and alcohol use, nonwhite teens would benefit from an emphasis on preventing violence and victimization.     

Physical Inactivity and the Role of Bullying Among Gender Minority Youth Participating in the 2017 and 2019 Youth Risk Behavior Survey

PurposeEvidence from small-scale studies suggests that transgender youth are less physically active than nontransgender youth, putting them at risk for worse health outcomes. This study examined the relationship between gender modality and participation in physical activity, physical education (PE), and sports teams in a multistate sample of high school youth and assessed whether bullying impacted this relationship.MethodsMultiple regression was used to analyze data from the state and local Youth Risk Behavior Survey from 2017 to 2019 to examine the relationship between the gender modality and participation in physical activity, PE, and sports teams. The sample was stratified by sex and adjusted for demographics and in-school and online bullying victimization.ResultsTransgender participants who reported a male or female sex, respectively, reported lower odds of physical activity (adjusted odds ratio [aOR] 0.46, p < .001; aOR 0.46, p < .001, respectively) but similar odds of PE participation. Female transgender students were less likely to participate in sports (aOR 0.55, p = .007); however, this relationship was not seen in adjusted models. Adjusting for demographics, male transgender students were significantly more likely to participate in sports (aOR 2.1, p = .002). Adjusting for bullying experiences did not significantly change these results.DiscussionTransgender youth are less likely to participate in physical activity but participate similarly or more than cisgender peers in PE and sports. Factors other than bullying may limit physical activity among transgender youth, and the Youth Risk Behavior Survey may not capture experiences of trans-specific victimization. Increased inclusion and safety may help increase physical activity and amplify its benefits for transgender students.     

Assessing Youth Risk Behavior in a Clinical Trial Setting: Lessons From the Infant Health and Development Program

PurposeThe purpose of this article was to describe the use of the Youth Risk Behavior Surveillance System (YRBSS) with known 17–18-year-old patients in follow-up of a multisite randomized clinical trial, and to develop a new scoring algorithm indicating the degree of risk-taking behavior for between-group analyses.MethodsSeventy-five questions from the YRBSS were incorporated into the study questionnaire, with the development of safety plans to guide the disposition of participants. The YRBSS questions were grouped into two categories (with three subdomains each) named problem behaviors (conduct problems, sexual behavior, and suicide/hopelessness) and substance use (cigarettes, alcohol, and marijuana use), with scores for each subdomain indicating high, moderate, and low risk.ResultsOf the 677 participants, the safety plan was activated 215 times for 199 (29.4%) of participants. Risk behaviors included binge drinking (149), alcohol/substance use and driving (41), depression (22), hopelessness (37), and suicidal ideation (13; all in the past). No emergency room evaluations were required. The subdomain scaling was analyzed by demographic characteristics, and findings were consistent with the literature; for example, higher rates of conduct problems in males, more suicidal ideation in females, greater sexual risk in African Americans, more substance use in males and whites, and more alcohol use in youth with mothers with higher levels of education.ConclusionsYRBSS can be administered in a research setting with appropriate safety precautions. These results should provide a useful guide to the application of the YRBSS to other adolescent populations in the future.