A recent Northwestern Medicine comparative analysis of national survey results found that one in four U.S. adolescents in grades 9 through 12 reported their sexual identity as non-heterosexual, according to findings published in JAMA Pediatrics.
The study, led by Gregory Phillips II, PhD, associate professor of Medical Social Sciences and of Preventive Medicine in the Division of Epidemiology, emphasizes the need for inclusive approaches when working with sexual and gender minority youth in academic and healthcare settings, among others.
“These findings indicate that every single person who works with youth needs to be aware of and competent with addressing LGBTQIA+ youth as a general competency in practice,” said Lauren Beach, JD, PhD, assistant professor of Medical Social Sciences and of Preventive Medicine in the Division of Epidemiology and senior author of the study.
The Youth Risk Behavior Surveillance System is a biennial set of surveys conducted by the Centers for Disease Control and Prevention (CDC). Established in 1991, the survey measures health-related behaviors and experiences that can lead to poor health in U.S. high school students.
In 2015, the CDC added a question to the included a question about sexual identity, with response options including “heterosexual,” “gay or lesbian,” “bisexual” or “not sure.” In 2021, the CDC expanded the survey’s “not sure” response to include the current three options:
- I describe my sexual identify some other way
- I am not sure about my sexual identify (questioning)
- I do not know what this question is asking
In the current study, Phillips and colleagues explored whether the number individuals who responded with “not sure” about their sexual identity changed between 2019 and 2021.
This survey included 12,847 respondents (51 percent female and 49 percent male) in 2019, and 16,357 respondents (48 percent female and 52 percent male) in 2021.
From 2019 to 2021, the investigators identified a significant decrease in youth who identified as heterosexual (84.5 percent versus 74.7 percent), an increase those who identified as gay or lesbian (2.5 percent versus 3 percent) and an increase in those who identified as bisexual (8.6 percent versus 12 percent). More youths in 2021 than in 2019 also selected “not sure” for their sexual identity (5.1 percent versus 4.4 percent).
In 2019, 5.6 percent of females and 3.3 percent of males selected “not sure” in response to the sexual identity question, while in 2021, 8 percent of females and 2.3 percent of males selected “not sure.”
“There’s this notion that the people who identify as something other than heterosexual has been increasing over time, so that’s part of the reason that we see these numbers go up. But it’s also possibly due to the clarity with the question that we see greater proportions of people,” Phillips said.
“People feel more comfortable saying that they’re not heterosexual and don’t feel forced into that category,” Phillips said.
The findings also suggest that the CDC should revisit their question further because of these percentage changes, according to Beach.
“It suggests that there are other additional response options that might be really salient to this age range of people that aren’t being captured right now,” Beach said, adding that the current findings underscore the importance of inclusive approaches when working with sexual and gender minority youth.
“If you a healthcare provider serving youth in this age range, then you should be thinking about asking them questions to know more about who they are, their sexual identity and their sexual behavior, their gender identity, whether or not they’re transgender: It’s all really relevant to be talking to youth about to understand who they are,” Beach said.
The investigators are now studying differences in responses by race, ethnicity, region, age and other factors, and how these factors impact risks for certain health outcomes among sexual minority youth.
“This will help us have more targeted messaging on the health needs of non-heterosexual youth populations for healthcare providers, school officials and many other audiences,” Beach said.
Shahin Davoudpour, PhD, research assistant professor of Medical Social Sciences, was a co-author of the study.
This work was supported by grants R01AA024409 and R01AA020944 from the National Institute on Alcohol Abuse and Alcoholism.