Examining Sexual Identity, Mental Health Outcomes, Victimization, and Health Risk Behaviors Among Black LGBQ Adolescents in the United States

Background and Purpose: Lesbian, gay, bisexual, and questioning (LGBQ) adolescents in the United States (U.S.) face a disproportionate number of health risks compared to their heterosexual peers. Research indicates that compared to heterosexual peers, LGBQ adolescents are at greater risk of experiencing mental health challenges, multiple forms of victimization, and engagement in risky health behaviors. Yet, less is known about adolescents who self-identify as both LGBQ and Black. Accordingly, this study is grounded in core aspects of the Health Equity Promotion Model and examined the association between sexual identity and a broad range of health risk behaviors and outcomes among Black adolescents.

Methods: Data for this study were obtained from the 2017 and 2019 Youth Risk Behavior Survey (YRBS). An analytic sample of 4,798 Black adolescents (51.2% female) was analyzed using multivariate logistic regression. The 24 outcome variables investigated were categorized into broader domains of mental health (e.g., suicidal behavior), victimization (e.g., cyberbullying), violent behaviors (e.g., physical fighting), risky driving behaviors (e.g., driving while intoxicated), risky sexual behaviors (e.g., sex before age 13), and substance use (e.g., misuse of prescription pain medication). The main explanatory variable was sexual identity. All analyses controlled for the effects of age and sex.

Results: Among participants, 82.6% self-identified as heterosexual/straight, 3.7% gay/lesbian, 9.3% bisexual, and 4.5% were not sure about their sexual identity. Compared to those who self-identified as heterosexual/straight, Black adolescents who self-identified as LGBQ had between 1.78 to 3.01 times higher odds of reporting worse mental health, 1.84 to 2.7 times higher odds of being victimized, and 1.70 to 2.11 times higher odds of engaging in violence-related behaviors. Black adolescents who self-identified as gay/lesbian had 4.84 times higher odds of driving while intoxicated compared to those who self-identified as heterosexual/straight (AOR = 4.84; 95% CI=1.65-14.14; p < .001). With respect to risky sexual behaviors, Black adolescents who self-identified as gay/lesbian had 3.98 times higher odds of having sex before age 13 compared to those who self-identified as heterosexual/straight (AOR = 3.98; 95% CI=1.86-8.53; p < .01). Black adolescents who self-identified as LGBQ had between 1.68 to 9.21 times higher odds of engaging in substance use compared to those who self-identified as heterosexual/straight.

Conclusions and Implications: Findings from this study demonstrate that Black LGBQ adolescents were more likely to experience worse mental health, victimization, and behavioral outcomes compared to their Black heterosexual/straight peers. Therefore, Black adolescents who belong to both racial and sexual minoritized groups deserve unique support and resources within their respective communities to facilitate healthy development. Study results also emphasize that health risk within the Black LGBQ adolescent population is heterogeneous and should not be addressed with “one size fits all” strategies. Future studies should examine school-based interventions that promote school safety and behavioral interventions that might be beneficial for adolescents with multiple marginalized identities.