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.