Service Use Patterns among Sexual Minority Youth: Findings from a National Study

Background and Purpose: School-based studies estimate between 1 and 3% of adolescents self-identify as gay, lesbian or bisexual, while another 5 to 10% report some degree of same-sex romantic attraction and/or relationships (Savin-Williams, 2005). Referred to as sexual minority youth, these young people appear to be at higher risk for poor health and mental health outcomes compared to their heterosexual peers perhaps because of higher rates of victimization, risk-taking behaviors, becoming pregnant or fathering a pregnancy, and experiencing depressive symptoms (Morrow, 2006). Yet, little is known about service use in this vulnerable population. This paper presents findings from the first representative study on service use among sexual minority youth and addresses two questions: 1) How does service use vary as a function of individual characteristics (i.e., sexual orientation, service need, perceived barriers to services, gender, age, family characteristics, and parent and school connectedness)? 2) What is the relationship between school characteristics/climate, school and parent connectedness, and service use? Methods: Data is taken from Wave I of the National Longitudinal Study of Adolescent Health (Add Health) consisting of a core sample of 20,745 students in grades 7 -12 with a subsample of 1,441 sexual minority youth from 125 schools. Focusing on sexual minority youth and schools as the units of analysis, this study uses a two-level hierarchical linear model (HLM) to estimate the unique and interactive effects of sexual orientation, need for services, perceived barriers to services, gender, age, family characteristics, and parent and school connectedness on level one nested within estimates of general school characteristics and aggregate school climate ratings on level two. Service need among sexual minority youth was determined based on reports of risk behaviors, victimization and other life experiences, and mental health symptoms. Youth were asked about a variety of real and perceived barriers that prevented them from seeing a service provider when needed such as not having insurance/ability to pay, not knowing whom to see, not wanting parents to know, fear of what the provider would say or do. School climate was derived from a 7-item school climate scale (Resnick, Bearman, Blum, Bauman, Harris, Jones et al., 1997). Four school characteristics were independently examined: school type (public or private); school size; school level (middle, high school, comprehensive) and urbanicity. In addition, the availability of school-based services was assessed in relation to school climate, connectedness, and service use outcomes. Results: On the school-level, findings are consistent with prior literature suggesting that positive school climate is associated with availability of comprehensive school-based health services among sexual minority youth. Further, sexual minority youth who feel more connected to school access services more frequently when they have a need. On the individual level, concerns about confidentiality appear to play a key role in accessing care. Findings also suggest that parent and school connectedness interact to facilitate access to services among sexual minority youth. Conclusions and Implications: These findings underscore calls for the presence of comprehensive school-based health care for adolescents and the important niche these programs fill for vulnerable populations.