Objectives. To determine how sensitive estimates of lesbian, gay, bisexual, or questioning (LGBQ)–heterosexual youth health disparities are to the presence of potentially mischievous responders. Methods. We used US data from the 2015 Youth Risk Behavior Survey, pooled across jurisdictions that included a question about sexual identity for a total sample of 148 960 students. We used boosted regressions (a machine-learning technique) to identify unusual patterns of responses to 7 screener items presumably unrelated to LGBQ identification, which generated an index of suspected mischievousness. We estimated LGBQ–heterosexual youth disparities on 20 health outcomes; then we removed 1% of suspected mischievous responders at a time and re-estimated disparities to assess the robustness of original estimates. Results. Accounting for suspected mischievousness reduced estimates of the average LGBQ–heterosexual youth health disparity by up to 46% for boys and 23% for girls; however, screening did not affect all outcomes equally. Drug- and alcohol-related disparities were most affected, particularly among boys, but bullying and suicidal ideation were unaffected. Conclusions. Including screener items in public health data sets and performing rigorous sensitivity analyses can support the validity of youth health estimates.
Background Alcohol use among underage youth is a significant public health concern. According to the National Institute on Alcohol Abuse and Alcoholism, alcohol is the “drug of choice” among adolescents, meaning more youth use and abuse alcohol than any other substance. Prevalence of alcohol use is disproportionately higher among sexual minority youth (SMY) than among their heterosexual peers. We examined sexual identity and sexual behavior disparities in alcohol use, and the mediational role of bullying in a sample of high school students. Methods Data from the 2015 National Youth Risk Behavior Survey were used to assess the association between sexual minority status (identity and behavior) and alcohol use with weighted logistic regression. Due to well-documented differences between males and females, we stratified models by gender. Physical and cyberbullying were examined as mediators of the relationship between sexual minority status and alcohol use. Results We detected associations between certain subgroups of sexual minority youth and alcohol use across all four drinking variables (ever drank alcohol, age at first drink, current alcohol use, and binge drinking). Most of these associations were found among bisexual-identified youth and students with both male and female sexual partners; these individuals had up to twice the odds of engaging in alcohol use behaviors when compared with sexual majority students. Associations were strongest among females. Bullying mediated sexual minority status and alcohol use only among bisexual females. Conclusions As disparities in alcohol use differ by gender, sexual identity, and sexual behavior, interventions should be targeted accordingly.
Sexual orientation is a multidimensional construct which is increasingly recognized as an important demographic characteristic in population health research. For this study, weighted Youth Risk Behavior Survey (YRBS) data were pooled across 47 jurisdictions biennially from 2005 to 2015, resulting in a national sample of 98 jurisdiction-years (344,815 students). Respondents were a median of 15.5 years, 49.9% male, and 48.8% White. Sexual identity and behavior trends from 2005 to 2015 were assessed with logistic regression analysis. Overall, 13.9% of females and 7.0% of males identified as lesbian, gay, bisexual (LGB), or not sure, while 9.1% of females and 4.2% of males indicated both same-and-different-sex behavior or same-sex behavior. In total, 17.0% of female and 8.5% of male youth reported non-heterosexual (LGB or not sure) sexual identity, same-sex sexual behavior, or both. LGB youth were approximately twice as likely as other youth to report lifetime sexual behavior. White and Asian youth were less likely to report nonheterosexual identity and/or have engaged in same-sex sexual behaviors than youth of other races/ ethnicities. Prevalence of non-heterosexual identities increased over time for both sexes, but only female youth reported significantly more same-sex behavior over time. This is the first study to simultaneously assess adolescent sexual identity and behavior over time within a national dataset. These findings are critical for understanding the sexual health needs of adolescents, and for informing sexual health policy and practice.
Purpose: To identify sex-stratified trends in victimization risk specific to heterosexual, lesbian, gay, bisexual, and questioning youth, while considering changes in sexual orientation-disparities from 2009 to 2017. Methods:Youth Risk Behavior Survey (YRBS) data collected biennially (5 waves; 2009-2017) were pooled across 56 jurisdictions and 454,715 students for one of the most nationally representative samples of heterosexual and sexual minority youth to date. We analyzed a 7-item victimization risk assessment using the CDC's recommended trend analysis approach. We used logistic regression with year-by-identity interactions to test whether sexual orientation-based disparities widened, narrowed, or were maintained over time.Results: Victimization risk declined significantly for male and female bisexual and questioning youth, lesbian, gay, and heterosexual youth. Disparities narrowed between bisexual, questioning, and lesbian females and heterosexual females, and between bisexual and heterosexual males. Nevertheless, sexual orientation-based disparities remained significant for all sexual minority youth in 2017.Conclusions: Distinct patterns of change in victimization risk for specific groups of sexual minority youth underscore the need to consider variability within sexual minority youth
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