Protective Factors in the Lives of Bisexual Adolescents in North America

Objectives. We compared protective factors among bisexual adolescents with those of heterosexual, mostly heterosexual, and gay or lesbian adolescents.Methods. We analyzed 6 school-based surveys in Minnesota and British Columbia. Sexual orientation was measured by gender of sexual partners, attraction, or self-labeling. Protective factors included family connectedness, school connectedness, and religious involvement. General linear models, conducted separately by gender and adjusted for age, tested differences between orientation groups.Results. Bisexual adolescents reported significantly less family and school connectedness than did heterosexual and mostly heterosexual adolescents and higher or similar levels of religious involvement. In surveys that measured orientation by self-labeling or attraction, levels of protective factors were generally higher among bisexual than among gay and lesbian respondents. Adolescents with sexual partners of both genders reported levels of protective factors lower than or similar to those of adolescents with same-gender partners.Conclusions. Bisexual adolescents had lower levels of most protective factors than did heterosexual adolescents, which may help explain their higher prevalence of risky behavior. Social connectedness should be monitored by including questions about protective factors in youth health surveys.Adolescence is a key developmental period with long-term effects on physical and psychological health, and adolescents negotiate a variety of environmental challenges during these years. Although public health practice often focuses on preventing or decreasing health risks, in the past decade increasing attention has been paid to identifying protective factors that can foster healthy development. Protective factors are events, circumstances, and life experiences that promote confidence and competence among adolescents and help to protect them from negative developmental risks and health outcomes.^1,2 Such protective resources enhance resilience among adolescents who face adversities,³ and they arise from individual characteristics and social environments such as families, schools, and communities.⁴Several individual assets and external resources have been identified as protective factors that reduce the likelihood of risky behaviors such as suicidality, substance use, unprotected sexual behavior, and disordered eating. Individual-level protective factors include higher levels of self-esteem, psychological well-being, and religiosity.^5–8 Relational factors such as strong connectedness to family^5,7–13 and school^{5,7,9,10,12,13} also reduce the likelihood of engaging in behaviors that compromise health. Some community-level factors also appear to be protective against risk taking among adolescents; these include the presence of a caring adult role model outside the family^8,13 and community involvement, including volunteering.⁸Most studies focus on adolescents in general, but some populations, such as lesbian, gay, and bisexual adolescents, face greater environmental challenges in negotiating adolescence and navigating developmental tasks. LGB adolescents are disproportionately subjected to violence and harassment at school^14–16 and to physical and sexual abuse.^17,18 In addition, LGB adolescents are more likely than their heterosexual peers to be involved in health-compromising behaviors, including substance use,^14–17 risky sexual behaviors and injection drug use,^14,19,20 and suicide attempts.^{10,14,15,17,21–24}Researchers have recently started illuminating relationships between lower levels of protective factors and negative health outcomes among LGB adolescents. In an analysis of the 2004 Minnesota Student Survey, Eisenberg and Resnick found that LGB students were less likely than were other students to report high levels of family connectedness, teacher caring, other adult caring, and perceived safety at school.²⁵ However, these protective factors, when present, decreased the likelihood of suicidal ideation and attempts, and protective factors accounted for more of the variation in suicide behaviors than did sexual orientation. Similarly, in his analysis of the National Longitudinal Study of Adolescent Health, Ueno found that less-positive relationships with parents, school, and friends explained higher levels of psychological distress among sexual-minority students than among heterosexual students.²⁶ Homma and Saewyc found that higher levels of perceived family caring and more-positive perceptions of school climate were linked to lower levels of emotional distress among Asian American LGB high school students in Minnesota.²⁷These studies provide some evidence that protective factors may work in similar ways for LGB adolescents as for other adolescents, but not consistently; for example, high levels of religious involvement in a faith with negative attitudes about nonheterosexual orientations might actually be more harmful than protective. Further, if LGB adolescents as a group experience lower levels of these assets, this might help explain their higher risks. Only a handful of population-based studies have focused on sexual-minority adolescents and protective factors, and they provide limited information about protective factors among bisexual adolescents separately from gay or lesbian adolescents; most research combines these groups because of small samples. Measuring sexual orientation during adolescence can be difficult; sexual identity development is a task of adolescence, and many youths engage in exploration of romantic attraction, sexual behavior, or identity labels during the adolescent years. Behavior and self-labeling may be discordant at various times, and there is evidence that some adolescents’ perception of their orientation and labels will shift during adolescence and young adulthood.In the few studies that have disaggregated the groups, bisexual adolescents were more likely than were heterosexual peers to report risky sexual behaviors,^19,20 suicide attempts,¹⁶ victimization,¹⁶ delinquency,²⁸ and substance use^16,28; in some cases gay and lesbian adolescents did not significantly differ from their heterosexual peers in these risks.^16,19,28 Some studies used romantic attraction as a measure of orientation,^23,24,26 some used self-labels,^18,22 and some used gender of sexual partners.^{16,20,25,27,28} Few studies offer the opportunity to incorporate correlates for orientation measured in different ways in the same data set.No matter how it is measured, it is important to examine levels of protective factors among bisexual adolescents separately, given the greater likelihood of risk-taking behavior and negative experiences at school among bisexual students. Drawing on data from different waves of the National Longitudinal Study of Adolescent Health, 2 studies have found lower levels of connectedness to family and school and lower perceived caring by other adults among bisexual than among heterosexual adolescents.^29,30 Bisexual and gay or lesbian adolescents generally did not differ in their levels of protective factors, but this may have been partly attributable to relatively small samples of LGB adolescents in the longitudinal study cohort, which limits statistical power for comparisons between the 2 groups. Furthermore, the study is nationally representative of US adolescents in general but may not reflect the full ethnic diversity of LGB populations across the United States or Canada. Studies analyzing larger regional population-based surveys offer opportunities to confirm those findings for specific regions.Identifying whether protective factors work similarly for bisexual adolescents and their peers is useful, but it is equally important to monitor whether bisexual adolescents have the same levels of those protective factors in their lives. We therefore explored levels of protective factors among bisexual adolescents compared with heterosexual, mostly heterosexual, and gay or lesbian peers in 6 school-based surveys in the midwestern United States and western Canada. We posed 3 questions: (1) Are levels of protective factors different between bisexual adolescents and heterosexual adolescents? (2) Are levels of protective factors different between bisexual adolescents and gay or lesbian adolescents? (3) Are these patterns consistent across varying measures of sexual orientation?