U.S. high school students who identify as gay, lesbian, bisexual, or questioning – “sexual minorities” – faced twice the risk of physical or sexual assault in the past year compared with their heterosexual peers, according to findings reported in a research letter.
Sexual-minority females were particularly more likely to experience physical violence while sexual-minority boys had a fourfold increased risk of sexual violence.
“The results of our study suggest the existence of a crisis of violence against sexual minority adolescents,” Theodore L. Caputi, MPH, of Harvard Medical School, Boston, and colleagues reported in. “Given the substantial physical and emotional consequences of violence for those subjected to it and the large existing health disparities among sexual minority adolescents, addressing both physical and sexual violence against sexual minority adolescents should become a public health priority.”
Joshua D. Safer, MD, executive director of the Center for Transgender Medicine and Surgery in the Mount Sinai Health System, New York, said he was not surprised by the findings because adolescents who may feel more vulnerable relative to their peers are likely to be more of a target. They may not have the supports they need, he said, which will affect their resiliency and their ability to push back.
“These patients are at ages where their parents might be among their supporters,” Dr. Safer said in an interview. “People in their circle may not be aware of their circumstances.”
He emphasized the need for physicians to ensure their offices are safe places for sexual-minority youth to talk to adolescent patients about their gender and sexual identity as well as any history of victimization, and to involve parents in being an ally of their child.
The researchers analyzed data from the nationally representative 2015 and 2017 National Youth Risk Behavior Surveys administered to public and private high school students in grades 9-12 by the Centers for Disease Control and Prevention. The 28,811 total respondents represented a 60% response rate both years.
After indicating their sex as male or female and their sexual orientation, respondents reported whether, in the past year, they had experienced a physical fight at school, a physical fight anywhere, or physical violence from a romantic partner. They also reported whether they had been sexually assaulted in the past year by a romantic partner or ever been forced to have intercourse. The 2017 survey included an additional question about sexual assault by anyone in the past year.
Most youth (87%) identified themselves as heterosexual while 2% were gay/lesbian, 7% were bisexual, and 4% were unsure. Sexual minorities reported a higher prevalence of all forms of violence and assault, compared with their heterosexual counterparts. Although risk of a physical fight in the past year differed by a small amount (28% of sexual-minority youth vs. 22% of heterosexual youth), the gap was considerably greater for risk of physical violence by a romantic partner (12% of sexual-minority youth vs. 5% of heterosexual youth).
More than three times as many sexual-minority adolescents (18%) as heterosexual adolescents (5%) said they had ever been forced to have intercourse, and a similarly high proportion of sexual-minority students (21%) had been sexually assaulted in the past year, compared with heterosexual students (8%). After accounting for survey year, sex, age, race/ethnicity, English language proficiency, and grade level, youth who identified as anything other than heterosexual were about twice as likely as their heterosexual counterparts to have experienced physical or sexual violence, including physical violence by a romantic partner (adjusted risk ratio, 1.97) or sexual assault by anyone (aRR, 2.10), in the past year. The risk of physical violence by a romantic partner or sexual assault by anyone was even greater for bisexual youth (aRR, 2.22 and aRR, 2.36, respectively).
The increased likelihood of physical violence and sexual violence differed by sex. Girls who identified as lesbian, bisexual, or questioning were more likely than heterosexual girls to have been in a fight at school or anywhere else (aRR, 1.91 and aRR, 1.74, respectively). Boys who were gay, bisexual, or questioning, meanwhile, were over four times more likely than heterosexual boys to have had forced intercourse or any kind of sexual assault (aRR, 4.70 and aRR, 4.64, respectively).
These findings point to the need for physicians to be “specifically talking to youth about gender identity and sexual orientation. Validating what kids are feeling is important,” Dr. Safer said in an interview.
Key to that process is making sure the physician’s office feels like a safe place for LGBTQ youth to have these kinds of conversations. “Most primary care and pediatric and adolescent care practices are not feeling well equipped to take care of these kids and are not necessarily serving as a good resource for these kids,” Dr. Safer said.
It’s also important for physicians to ask youth about potential violence or abuse they have experienced, including depression and sequelae from lack of support, for which gender- and sexual-minority youth are at greater risk, he said. Finally, doctors need to engage parents in the conversation.
“As a medical professional, you need to be asking the questions and really be out there as an ally, especially for pediatric and adolescent patients, and you need to be helping the parents of your patients be allies too,” Dr. Safer said.
The study was limited by having a binary question only about respondent’s sex and no data collection about transgender youth. The study’s cross-sectional design also precludes the ability to claim causation about any of the associations.
The research was funded by the Marshall Aid Commemoration Commission, Stanford (Calif.) University, and the National Institutes of Health. The authors had no disclosures.
SOURCE: Caputi TL et al. JAMA Pediatr. 2019 Mar 9. .