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Sexual minority youth: Epidemiology and health concerns

Michelle Forcier, MD, MPH
Johanna Olson-Kennedy, MD
Section Editor
Diane Blake, MD
Deputy Editor
Mary M Torchia, MD


The term "sexual minority" encompasses a variety of gender and sexual identities and expressions that differ from cultural norms (eg, lesbian, gay, bisexual, transgender), as well as identities and expressions that defy discrete labels [1].

This topic will focus on the epidemiology and health concerns of sexual minority youth who identify themselves as lesbian, gay, bisexual, or unsure (questioning) of their sexual identity, who avoid discrete sexual orientation labels, and who have had sexual contact with persons of the same sex or persons of both sexes. An overview of primary care for such youth is presented separately. (See "Sexual minority youth: Overview of primary care".)

Gender nonconformity in children and adolescents is discussed separately. (See "Overview of gender development and clinical presentation of gender nonconformity in children and adolescents" and "Overview of the management of gender nonconformity in children and adolescents".)


Sexual orientation – Sexual orientation is an individual's pattern of physical and emotional arousal (including fantasies, activities, and behaviors) and the gender(s) of persons to whom an individual is physically or sexually attracted [2].

Homosexual sexual orientation refers to sexual attraction to same sex individuals


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  1. Goldfried MR, Bell AC. Extending the boundaries of research on adolescent development. J Clin Child Adolesc Psychol 2003; 32:531.
  2. Committee On Adolescence. Office-based care for lesbian, gay, bisexual, transgender, and questioning youth. Pediatrics 2013; 132:198.
  3. Adelson SL, American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). Practice parameter on gay, lesbian, or bisexual sexual orientation, gender nonconformity, and gender discordance in children and adolescents. J Am Acad Child Adolesc Psychiatry 2012; 51:957.
  4. Spigarelli MG. Adolescent sexual orientation. Adolesc Med State Art Rev 2007; 18:508.
  5. Austin SB, Conron K, Patel A, Freedner N. Making sense of sexual orientation measures: findings from a cognitive processing study with adolescents on health survey questions. J LGBT Health Res 2007; 3:55.
  6. Chandra A, Mosher WD, Copen C, Sionean C. Sexual behavior, sexual attraction, and sexual identity in the United States: data from the 2006-2008 National Survey of Family Growth. Natl Health Stat Report 2011; :1.
  7. Goodenow C, Szalacha LA, Robin LE, Westheimer K. Dimensions of sexual orientation and HIV-related risk among adolescent females: evidence from a statewide survey. Am J Public Health 2008; 98:1051.
  8. Mustanski B, Birkett M, Greene GJ, et al. The association between sexual orientation identity and behavior across race/ethnicity, sex, and age in a probability sample of high school students. Am J Public Health 2014; 104:237.
  9. Igartua K, Thombs BD, Burgos G, Montoro R. Concordance and discrepancy in sexual identity, attraction, and behavior among adolescents. J Adolesc Health 2009; 45:602.
  10. McCabe J, Brewster KL, Tillman KH. Patterns and correlates of same-sex sexual activity among U.S. teenagers and young adults. Perspect Sex Reprod Health 2011; 43:142.
  11. Pathela P, Hajat A, Schillinger J, et al. Discordance between sexual behavior and self-reported sexual identity: a population-based survey of New York City men. Ann Intern Med 2006; 145:416.
  12. Bell DL, Breland DJ, Ott MA. Adolescent and young adult male health: a review. Pediatrics 2013; 132:535.
  13. Coker TR, Austin SB, Schuster MA. Health and healthcare for lesbian, gay, bisexual, and transgender youth: reducing disparities through research, education, and practice. J Adolesc Health 2009; 45:213.
  14. Coker TR, Austin SB, Schuster MA. The health and health care of lesbian, gay, and bisexual adolescents. Annu Rev Public Health 2010; 31:457.
  15. Bullough VL. Children and adolescents as sexual beings: a historical overview. Child Adolesc Psychiatr Clin N Am 2004; 13:447.
  16. Kinsey AC, Pomeroy WB, Martin CE. Sexual behavior in the human male, WB Saunders, Philadelphia 1948.
  17. Levine DA, Committee On Adolescence. Office-based care for lesbian, gay, bisexual, transgender, and questioning youth. Pediatrics 2013; 132:e297.
  18. Green R. The “Sissy Boy Syndrome" and the Development of Homosexuality, Yale University Press, New Haven, CT 1987.
  19. Money J, Russo AJ. Homosexual outcome of discordant gender identity/role in childhood: Longitudinal follow-up. J Pediatr Psychol 1979; 4:29.
  20. Zucker KJ, Bradley SJ. Gender Identity Disorder and Psychosexual Problems in Children and Adolescents, Guilford Press, New York 1995.
  21. Zuger B. Early effeminate behavior in boys. Outcome and significance for homosexuality. J Nerv Ment Dis 1984; 172:90.
  22. Ryan C, Futterman D. Lesbian and Gay Youth: Care and Counseling. Adolesc Med 1997; 8:207.
  23. Remafedi G, Resnick M, Blum R, Harris L. Demography of sexual orientation in adolescents. Pediatrics 1992; 89:714.
  24. Rosario M, Schrimshaw EW, Hunter J. Predicting different patterns of sexual identity development over time among lesbian, gay, and bisexual youths: a cluster analytic approach. Am J Community Psychol 2008; 42:266.
  25. Fasula AM, Oraka E, Jeffries WL 4th, et al. Young Sexual Minority Males in the United States: Sociodemographic Characteristics And Sexual Attraction, Identity and Behavior. Perspect Sex Reprod Health 2016; 48:3.
  26. Mallon GP, DeCrescenzo T. Transgender children and youth: a child welfare practice perspective. Child Welfare 2006; 85:215.
  27. Plummer DC. The quest for modern manhood: masculine stereotypes, peer culture and the social significance of homophobia. J Adolesc 2001; 24:15.
  28. Piper J, Mannino M. Identity formation for individuals in transition: A narrative family therapy model. J GLBT Fam Stud 2008; 4:75.
  29. Moser C, Kleinplatz PJ, Zuccarini D, Reiner WG. Situating unusual child and adolescent sexual behavior in context. Child Adolesc Psychiatr Clin N Am 2004; 13:569.
  30. Kann L, Olsen EO, McManus T, et al. Sexual identity, sex of sexual contacts, and health-risk behaviors among students in grades 9-12--youth risk behavior surveillance, selected sites, United States, 2001-2009. MMWR Surveill Summ 2011; 60:1.
  31. Austin SB, Ziyadeh N, Fisher LB, et al. Sexual orientation and tobacco use in a cohort study of US adolescent girls and boys. Arch Pediatr Adolesc Med 2004; 158:317.
  32. Kann L, Olsen EO, McManus T, et al. Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9-12 - United States and Selected Sites, 2015. MMWR Surveill Summ 2016; 65:1.
  33. IOM (Institute of Medicine). The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding, National Academies Press, Washington, DC 2011.
  34. Society for Adolescent Health and Medicine. Recommendations for promoting the health and well-being of lesbian, gay, bisexual, and transgender adolescents: a position paper of the Society for Adolescent Health and Medicine. J Adolesc Health 2013; 52:506.
  35. Pathela P, Schillinger JA. Sexual behaviors and sexual violence: adolescents with opposite-, same-, or both-sex partners. Pediatrics 2010; 126:879.
  36. Kosciw JG, Greytak EA, Bartkiewicz MJ, et al. The 2011 National School Climate Survey. The experiences of lesbian, gay, bisexual, and transgender youth in our nation's schools. http://www.glsen.org/sites/default/files/2011%20National%20School%20Climate%20Survey%20Full%20Report.pdf (Accessed on November 02, 2013).
  37. Marshal MP, Dietz LJ, Friedman MS, et al. Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review. J Adolesc Health 2011; 49:115.
  38. Oshri A, Handley ED, Sutton TE, et al. Developmental trajectories of substance use among sexual minority girls: associations with sexual victimization and sexual health risk. J Adolesc Health 2014; 55:100.
  39. Strutz KL, Herring AH, Halpern CT. Health disparities among young adult sexual minorities in the U.S. Am J Prev Med 2015; 48:76.
  40. Friedman MS, Marshal MP, Guadamuz TE, et al. A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals. Am J Public Health 2011; 101:1481.
  41. Herrick AL, Egan JE, Coulter RW, et al. Raising sexual minority youths' health levels by incorporating resiliencies into health promotion efforts. Am J Public Health 2014; 104:206.
  42. Herrick AL, Lim SH, Plankey MW, et al. Adversity and syndemic production among men participating in the multicenter AIDS cohort study: a life-course approach. Am J Public Health 2013; 103:79.
  43. Duncan DT, Hatzenbuehler ML. Lesbian, gay, bisexual, and transgender hate crimes and suicidality among a population-based sample of sexual-minority adolescents in Boston. Am J Public Health 2014; 104:272.
  44. Hatzenbuehler ML, Birkett M, Van Wagenen A, Meyer IH. Protective school climates and reduced risk for suicide ideation in sexual minority youths. Am J Public Health 2014; 104:279.
  45. Eccles TA, Sayegh MA, Fortenberry JD, Zimet GD. More normal than not: a qualitative assessment of the developmental experiences of gay male youth. J Adolesc Health 2004; 35:425.e11.
  46. Friedman MS, Marshal MP, Stall R, et al. Gay-related development, early abuse and adult health outcomes among gay males. AIDS Behav 2008; 12:891.
  47. Frost DM, Parsons JT, Nanín JE. Stigma, concealment and symptoms of depression as explanations for sexually transmitted infections among gay men. J Health Psychol 2007; 12:636.
  48. Bruce D, Stall R, Fata A, Campbell RT. Modeling minority stress effects on homelessness and health disparities among young men who have sex with men. J Urban Health 2014; 91:568.
  49. Austin A, Herrick H, Proescholdbell S. Adverse Childhood Experiences Related to Poor Adult Health Among Lesbian, Gay, and Bisexual Individuals. Am J Public Health 2016; 106:314.
  50. Ryan C, Huebner D, Diaz RM, Sanchez J. Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics 2009; 123:346.
  51. Ryan C, Russell ST, Huebner D, et al. Family acceptance in adolescence and the health of LGBT young adults. J Child Adolesc Psychiatr Nurs 2010; 23:205.
  52. Hatzenbuehler ML, Jun HJ, Corliss HL, Bryn Austin S. Structural stigma and sexual orientation disparities in adolescent drug use. Addict Behav 2015; 46:14.
  53. Hatzenbuehler ML, Jun HJ, Corliss HL, Austin SB. Structural stigma and cigarette smoking in a prospective cohort study of sexual minority and heterosexual youth. Ann Behav Med 2014; 47:48.
  54. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 2003; 129:674.
  55. Frost DM, Lehavot K, Meyer IH. Minority stress and physical health among sexual minority individuals. J Behav Med 2015; 38:1.
  56. Shilo G, Mor Z. The impact of minority stressors on the mental and physical health of lesbian, gay, and bisexual youths and young adults. Health Soc Work 2014; 39:161.
  57. Pachankis JE, Hatzenbuehler ML, Starks TJ. The influence of structural stigma and rejection sensitivity on young sexual minority men's daily tobacco and alcohol use. Soc Sci Med 2014; 103:67.
  58. Eliason M. Introduction to special issue on suicide, mental health, and youth development. J Homosex 2011; 58:4.
  59. Haas AP, Eliason M, Mays VM, et al. Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations. J Homosex 2011; 58:10.
  60. Mustanski BS, Garofalo R, Emerson EM. Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths. Am J Public Health 2010; 100:2426.
  61. King M, Semlyen J, Tai SS, et al. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry 2008; 8:70.
  62. Stone DM, Luo F, Ouyang L, et al. Sexual orientation and suicide ideation, plans, attempts, and medically serious attempts: evidence from local Youth Risk Behavior Surveys, 2001-2009. Am J Public Health 2014; 104:262.
  63. Talley AE, Hughes TL, Aranda F, et al. Exploring alcohol-use behaviors among heterosexual and sexual minority adolescents: intersections with sex, age, and race/ethnicity. Am J Public Health 2014; 104:295.
  64. Newcomb ME, Birkett M, Corliss HL, Mustanski B. Sexual orientation, gender, and racial differences in illicit drug use in a sample of US high school students. Am J Public Health 2014; 104:304.
  65. Bird JD, Kuhns L, Garofalo R. The impact of role models on health outcomes for lesbian, gay, bisexual, and transgender youth. J Adolesc Health 2012; 50:353.
  66. Dyer JG, McGuinness TM. Resilience: analysis of the concept. Arch Psychiatr Nurs 1996; 10:276.
  67. Croll J, Neumark-Sztainer D, Story M, Ireland M. Prevalence and risk and protective factors related to disordered eating behaviors among adolescents: relationship to gender and ethnicity. J Adolesc Health 2002; 31:166.
  68. Vesely SK, Wyatt VH, Oman RF, et al. The potential protective effects of youth assets from adolescent sexual risk behaviors. J Adolesc Health 2004; 34:356.
  69. Resnick MD, Bearman PS, Blum RW, et al. Protecting adolescents from harm. Findings from the National Longitudinal Study on Adolescent Health. JAMA 1997; 278:823.
  70. Eisenberg ME, Resnick MD. Suicidality among gay, lesbian and bisexual youth: the role of protective factors. J Adolesc Health 2006; 39:662.
  71. Cohn TJ, Hastings SL. Resilience among rural lesbian youth. J Lesbian Stud 2010; 14:71.
  72. Russell ST, Muraco A, Subramaniam A, Laub C. Youth empowerment and high school Gay-Straight Alliances. J Youth Adolesc 2009; 38:891.
  73. Turanovic JJ, Pratt TC. Longitudinal effects of violent victimization during adolescence on adverse outcomes in adulthood: a focus on prosocial attachments. J Pediatr 2015; 166:1062.
  74. Hussen SA, Harper GW, Bauermeister JA, et al. Psychosocial influences on engagement in care among HIV-positive young black gay/bisexual and other men who have sex with men. AIDS Patient Care STDS 2015; 29:77.
  75. Whitaker K, Shapiro VB, Shields JP. School-Based Protective Factors Related to Suicide for Lesbian, Gay, and Bisexual Adolescents. J Adolesc Health 2016; 58:63.
  76. Rew L, Whittaker TA, Taylor-Seehafer MA, Smith LR. Sexual health risks and protective resources in gay, lesbian, bisexual, and heterosexual homeless youth. J Spec Pediatr Nurs 2005; 10:11.
  77. Bouris A, Guilamo-Ramos V, Pickard A, et al. A systematic review of parental influences on the health and well-being of lesbian, gay, and bisexual youth: time for a new public health research and practice agenda. J Prim Prev 2010; 31:273.
  78. Tornello SL, Riskind RG, Patterson CJ. Sexual orientation and sexual and reproductive health among adolescent young women in the United States. J Adolesc Health 2014; 54:160.
  79. Thurston IB, Dietrich J, Bogart LM, et al. Correlates of sexual risk among sexual minority and heterosexual South African youths. Am J Public Health 2014; 104:1265.
  80. Herrick A, Stall R, Egan J, et al. Pathways towards risk: syndemic conditions mediate the effect of adversity on HIV risk behaviors among young men who have sex with men (YMSM). J Urban Health 2014; 91:969.
  81. Lyons A, Hosking W. Health disparities among common subcultural identities of young gay men: physical, mental, and sexual health. Arch Sex Behav 2014; 43:1621.
  82. Busseri MA, Willoughby T, Chalmers H, Bogaert AF. On the association between sexual attraction and adolescent risk behavior involvement: Examining mediation and moderation. Dev Psychol 2008; 44:69.
  83. Shields JP, Whitaker K, Glassman J, et al. Impact of victimization on risk of suicide among lesbian, gay, and bisexual high school students in San Francisco. J Adolesc Health 2012; 50:418.
  84. Priebe G, Svedin CG. Online or off-line victimisation and psychological well-being: a comparison of sexual-minority and heterosexual youth. Eur Child Adolesc Psychiatry 2012; 21:569.
  85. van Bergen DD, Bos HM, van Lisdonk J, et al. Victimization and suicidality among Dutch lesbian, gay, and bisexual youths. Am J Public Health 2013; 103:70.
  86. Patrick DL, Bell JF, Huang JY, et al. Bullying and quality of life in youths perceived as gay, lesbian, or bisexual in Washington State, 2010. Am J Public Health 2013; 103:1255.
  87. Birkett M, Newcomb ME, Mustanski B. Does it get better? A longitudinal analysis of psychological distress and victimization in lesbian, gay, bisexual, transgender, and questioning youth. J Adolesc Health 2015; 56:280.
  88. O'Malley Olsen E, Kann L, Vivolo-Kantor A, et al. School violence and bullying among sexual minority high school students, 2009-2011. J Adolesc Health 2014; 55:432.
  89. Schuster MA, Bogart LM, Elliott MN, et al. A longitudinal study of bullying of sexual-minority youth. N Engl J Med 2015; 372:1872.
  90. Robinson JP, Espelage DL, Rivers I. Developmental trends in peer victimization and emotional distress in LGB and heterosexual youth. Pediatrics 2013; 131:423.
  91. Birkett M, Russell ST, Corliss HL. Sexual-orientation disparities in school: the mediational role of indicators of victimization in achievement and truancy because of feeling unsafe. Am J Public Health 2014; 104:1124.
  92. Rosario M, Corliss HL, Everett BG, et al. Mediation by peer violence victimization of sexual orientation disparities in cancer-related tobacco, alcohol, and sexual risk behaviors: pooled youth risk behavior surveys. Am J Public Health 2014; 104:1113.
  93. Ueno K, Roach TA, Peña-Talamantes AE. The dynamic association between same-sex contact and educational attainment. Adv Life Course Res 2013; 18:127.
  94. Garofalo R, Wolf RC, Kessel S, et al. The association between health risk behaviors and sexual orientation among a school-based sample of adolescents. Pediatrics 1998; 101:895.
  95. Austin SB, Roberts AL, Corliss HL, Molnar BE. Sexual violence victimization history and sexual risk indicators in a community-based urban cohort of "mostly heterosexual" and heterosexual young women. Am J Public Health 2008; 98:1015.
  96. Corliss HL, Cochran SD, Mays VM. Reports of parental maltreatment during childhood in a United States population-based survey of homosexual, bisexual, and heterosexual adults. Child Abuse Negl 2002; 26:1165.
  97. Saewyc EM, Skay CL, Pettingell SL, et al. Hazards of stigma: the sexual and physical abuse of gay, lesbian, and bisexual adolescents in the United States and Canada. Child Welfare 2006; 85:195.
  98. D'Augelli AR, Grossman AH, Starks MT. Childhood gender atypicality, victimization, and PTSD among lesbian, gay, and bisexual youth. J Interpers Violence 2006; 21:1462.
  99. Rothman EF, Exner D, Baughman AL. The prevalence of sexual assault against people who identify as gay, lesbian, or bisexual in the United States: a systematic review. Trauma Violence Abuse 2011; 12:55.
  100. Cramer RJ, McNiel DE, Holley SR, et al. Mental health in violent crime victims: Does sexual orientation matter? Law Hum Behav 2012; 36:87.
  101. Egan SK, Perry DG. Gender identity: a multidimensional analysis with implications for psychosocial adjustment. Dev Psychol 2001; 37:451.
  102. Yunger JL, Carver PR, Perry DG. Does gender identity influence children's psychological well-being? Dev Psychol 2004; 40:572.
  103. Carver PR, Egan SK, Perry DG. Children who question their heterosexuality. Dev Psychol 2004; 40:43.
  104. Shearer A, Herres J, Kodish T, et al. Differences in Mental Health Symptoms Across Lesbian, Gay, Bisexual, and Questioning Youth in Primary Care Settings. J Adolesc Health 2016; 59:38.
  105. Cardom R, Rostosky S, Danner F. Does "it get better" for depressed sexual minority youth in young adulthood? J Adolesc Health 2013; 53:671.
  106. Almazan EP, Roettger ME, Acosta PS. Measures of sexual minority status and suicide risk among young adults in the United States. Arch Suicide Res 2014; 18:274.
  107. Burns MN, Ryan DT, Garofalo R, et al. Mental health disorders in young urban sexual minority men. J Adolesc Health 2015; 56:52.
  108. Lytle MC, De Luca SM, Blosnich JR, Brownson C. Associations of racial/ethnic identities and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning individuals. J Affect Disord 2015; 178:39.
  109. Marshal MP, Friedman MS, Stall R, et al. Sexual orientation and adolescent substance use: a meta-analysis and methodological review. Addiction 2008; 103:546.
  110. Corliss HL, Rosario M, Birkett MA, et al. Sexual orientation disparities in adolescent cigarette smoking: intersections with race/ethnicity, gender, and age. Am J Public Health 2014; 104:1137.
  111. Kerr D, Ding K, Burke A, Ott-Walter K. An alcohol, tobacco, and other drug use comparison of lesbian, bisexual, and heterosexual undergraduate women. Subst Use Misuse 2015; 50:340.
  112. Kecojevic A, Wong CF, Corliss HL, Lankenau SE. Risk factors for high levels of prescription drug misuse and illicit drug use among substance-using young men who have sex with men (YMSM). Drug Alcohol Depend 2015; 150:156.
  113. Newcomb ME, Ryan DT, Greene GJ, et al. Prevalence and patterns of smoking, alcohol use, and illicit drug use in young men who have sex with men. Drug Alcohol Depend 2014; 141:65.
  114. Halkitis PN, Siconolfi DE, Stults CB, et al. Modeling substance use in emerging adult gay, bisexual, and other YMSM across time: the P18 cohort study. Drug Alcohol Depend 2014; 145:209.
  115. Rosario M, Reisner SL, Corliss HL, et al. Sexual-orientation disparities in substance use in emerging adults: a function of stress and attachment paradigms. Psychol Addict Behav 2014; 28:790.
  116. Corliss HL, Rosario M, Wypij D, et al. Sexual orientation disparities in longitudinal alcohol use patterns among adolescents: findings from the Growing Up Today Study. Arch Pediatr Adolesc Med 2008; 162:1071.
  117. Russell ST, Driscoll AK, Truong N. Adolescent same-sex romantic attractions and relationships: implications for substance use and abuse. Am J Public Health 2002; 92:198.
  118. Storholm ED, Halkitis PN, Siconolfi DE, Moeller RW. Cigarette smoking as part of a syndemic among young men who have sex with men ages 13-29 in New York City. J Urban Health 2011; 88:663.
  119. Freeman P, Walker BC, Harris DR, et al. Methamphetamine use and risk for HIV among young men who have sex with men in 8 US cities. Arch Pediatr Adolesc Med 2011; 165:736.
  120. Newcomb ME, Mustanski B. Developmental change in the relationship between alcohol and drug use before sex and sexual risk behavior in young men who have sex with men. AIDS Behav 2014; 18:1981.
  121. Noell JW, Ochs LM. Relationship of sexual orientation to substance use, suicidal ideation, suicide attempts, and other factors in a population of homeless adolescents. J Adolesc Health 2001; 29:31.
  122. Kruks G. Gay and lesbian homeless/street youth: special issues and concerns. J Adolesc Health 1991; 12:515.
  123. Corliss HL, Goodenow CS, Nichols L, Austin SB. High burden of homelessness among sexual-minority adolescents: findings from a representative Massachusetts high school sample. Am J Public Health 2011; 101:1683.
  124. Rice E, Barman-Adhikari A, Rhoades H, et al. Homelessness experiences, sexual orientation, and sexual risk taking among high school students in Los Angeles. J Adolesc Health 2013; 52:773.
  125. Cochran BN, Stewart AJ, Ginzler JA, Cauce AM. Challenges faced by homeless sexual minorities: comparison of gay, lesbian, bisexual, and transgender homeless adolescents with their heterosexual counterparts. Am J Public Health 2002; 92:773.
  126. Whitbeck LB, Chen X, Hoyt DR, et al. Mental disorder, subsistence strategies, and victimization among gay, lesbian, and bisexual homeless and runaway adolescents. J Sex Res 2004; 41:329.
  127. Van Leeuwen JM, Boyle S, Salomonsen-Sautel S, et al. Lesbian, gay, and bisexual homeless youth: an eight-city public health perspective. Child Welfare 2006; 85:151.
  128. Marshall BD, Shannon K, Kerr T, et al. Survival sex work and increased HIV risk among sexual minority street-involved youth. J Acquir Immune Defic Syndr 2010; 53:661.
  129. Weber AE, Boivin JF, Blais L, et al. Predictors of initiation into prostitution among female street youths. J Urban Health 2004; 81:584.
  130. Weber AE, Boivin JF, Blais L, et al. HIV risk profile and prostitution among female street youths. J Urban Health 2002; 79:525.
  131. Zou H, Prestage G, Fairley CK, et al. Sexual behaviors and risk for sexually transmitted infections among teenage men who have sex with men. J Adolesc Health 2014; 55:247.
  132. Stults CB, Javdani S, Greenbaum CA, et al. Intimate partner violence and substance use risk among young men who have sex with men: The P18 cohort study. Drug Alcohol Depend 2015; 154:54.
  133. Stults CB, Javdani S, Greenbaum CA, et al. Intimate Partner Violence and Sex Among Young Men Who Have Sex With Men. J Adolesc Health 2016; 58:215.
  134. Ybarra ML, Rosario M, Saewyc E, Goodenow C. Sexual Behaviors and Partner Characteristics by Sexual Identity Among Adolescent Girls. J Adolesc Health 2016; 58:310.
  135. Herrick AL, Marshal MP, Smith HA, et al. Sex while intoxicated: a meta-analysis comparing heterosexual and sexual minority youth. J Adolesc Health 2011; 48:306.
  136. Centers for Disease Control and Prevention (CDC). Vital signs: HIV infection, testing, and risk behaviors among youths - United States. MMWR Morb Mortal Wkly Rep 2012; 61:971.
  137. CDC. HIV surveillance in adolescents and young adults. http://www.cdc.gov/hiv/topics/surveillance/resources/slides/adolescents/index.htm (Accessed on June 13, 2011).
  138. Halkitis P, Kapadia F, Ompad D. Incidence of HIV Infection in Young Gay, Bisexual, and Other YMSM: The P18 Cohort Study. J Acquir Immune Defic Syndr 2015; 69:466.
  139. Johnson AS, Hall HI, Hu X, et al. Trends in diagnoses of HIV infection in the United States, 2002-2011. JAMA 2014; 312:432.
  140. Koh AS, Gómez CA, Shade S, Rowley E. Sexual risk factors among self-identified lesbians, bisexual women, and heterosexual women accessing primary care settings. Sex Transm Dis 2005; 32:563.
  141. Kwakwa HA, Ghobrial MW. Female-to-female transmission of human immunodeficiency virus. Clin Infect Dis 2003; 36:e40.
  142. Chan SK, Thornton LR, Chronister KJ, et al. Likely female-to-female sexual transmission of HIV--Texas, 2012. MMWR Morb Mortal Wkly Rep 2014; 63:209.
  143. Saewyc EM, Bearinger LH, Blum RW, Resnick MD. Sexual intercourse, abuse and pregnancy among adolescent women: does sexual orientation make a difference? Fam Plann Perspect 1999; 31:127.
  144. Saewyc EM, Poon CS, Homma Y, Skay CL. Stigma management? The links between enacted stigma and teen pregnancy trends among gay, lesbian, and bisexual students in British Columbia. Can J Hum Sex 2008; 17:123.
  145. Herrick AL, Matthews AK, Garofalo R. Health risk behaviors in an urban sample of young women who have sex with women. J Lesbian Stud 2010; 14:80.
  146. Blake SM, Ledsky R, Lehman T, et al. Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: the benefits of gay-sensitive HIV instruction in schools. Am J Public Health 2001; 91:940.
  147. Lindley LL, Walsemann KM. Sexual Orientation and Risk of Pregnancy Among New York City High-School Students. Am J Public Health 2015; 105:1379.
  148. Goldberg SK, Reese BM, Halpern CT. Teen Pregnancy Among Sexual Minority Women: Results From the National Longitudinal Study of Adolescent to Adult Health. J Adolesc Health 2016; 59:429.
  149. Saewyc EM, Pettingell S, Magee LL. The prevalence of sexual abuse among adolescents in school. J Sch Nurs 2003; 19:266.
  150. Blashill AJ, Safren SA. Sexual orientation and anabolic-androgenic steroids in U.S. adolescent boys. Pediatrics 2014; 133:469.
  151. Matthews-Ewald MR, Zullig KJ, Ward RM. Sexual orientation and disordered eating behaviors among self-identified male and female college students. Eat Behav 2014; 15:441.
  152. Robin L, Brener ND, Donahue SF, et al. Associations between health risk behaviors and opposite-, same-, and both-sex sexual partners in representative samples of vermont and massachusetts high school students. Arch Pediatr Adolesc Med 2002; 156:349.
  153. Austin SB, Ziyadeh NJ, Corliss HL, et al. Sexual orientation disparities in purging and binge eating from early to late adolescence. J Adolesc Health 2009; 45:238.
  154. Ackard DM, Fedio G, Neumark-Sztainer D, Britt HR. Factors associated with disordered eating among sexually active adolescent males: gender and number of sexual partners. Psychosom Med 2008; 70:232.
  155. Austin SB, Ziyadeh N, Kahn JA, et al. Sexual orientation, weight concerns, and eating-disordered behaviors in adolescent girls and boys. J Am Acad Child Adolesc Psychiatry 2004; 43:1115.
  156. Hadland SE, Austin SB, Goodenow CS, Calzo JP. Weight misperception and unhealthy weight control behaviors among sexual minorities in the general adolescent population. J Adolesc Health 2014; 54:296.
  157. Katz-Wise SL, Blood EA, Milliren CE, et al. Sexual orientation disparities in BMI among U.S. adolescents and young adults in three race/ethnicity groups. J Obes 2014; 2014:537242.
  158. Reisner SL, Van Wagenen A, Gordon A, Calzo JP. Disparities in safety belt use by sexual orientation identity among US high school students. Am J Public Health 2014; 104:311.
  159. Needham BL, Austin EL. Sexual orientation, parental support, and health during the transition to young adulthood. J Youth Adolesc 2010; 39:1189.
  160. Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation. 2009 http://www.apa.org/pi/lgbt/resources/therapeutic-response.pdf (Accessed on January 23, 2014).
  161. APA. Commission on Psychotherapy by Psychiatrists.. Position statement on therapies focused on attempts to change sexual orientation (reparative or conversion therapies). Am J Psychiatry 2000; 157:1719.
  162. Rossi NE. "Coming out" stories of gay and lesbian young adults. J Homosex 2010; 57:1174.
  163. D'Augelli AR, Hershberger SL, Pilkington NW. Lesbian, gay, and bisexual youth and their families: disclosure of sexual orientation and its consequences. Am J Orthopsychiatry 1998; 68:361.
  164. Kosciw JG, Palmer NA, Kull RM. Reflecting resiliency: openness about sexual orientation and/or gender identity and its relationship to well-being and educational outcomes for LGBT students. Am J Community Psychol 2015; 55:167.
  165. McLaughlin KA, Hatzenbuehler ML, Xuan Z, Conron KJ. Disproportionate exposure to early-life adversity and sexual orientation disparities in psychiatric morbidity. Child Abuse Negl 2012; 36:645.
  166. Higgitt N, Wingert S, Ristock J, et al. Voices from the Margins: Experiences of Street-Involved Youth in Winnipeg. University of Winnipeg, 2003. Available at: www.uwinnipeg.ca/faculty/ius/iusweb_backup/pdf/Street-kidsReportfinalSeptember903.pdf (Accessed on May 30, 2013).
  167. Biegel S, Kuehl SJ. Safe at School: Addressing the School Environment and LGBT Safety through Policy and Legislation. National Education Policy Center October 2010. Available at: www.scribd.com/doc/48054580/Biegel-LGBT#archive (Accessed on May 30, 2013).
  168. Birkett M, Espelage DL, Koenig B. LGB and questioning students in schools: the moderating effects of homophobic bullying and school climate on negative outcomes. J Youth Adolesc 2009; 38:989.
  169. McGuire JK, Anderson CR, Toomey RB, Russell ST. School climate for transgender youth: a mixed method investigation of student experiences and school responses. J Youth Adolesc 2010; 39:1175.
  170. Russell ST, Ryan C, Toomey RB, et al. Lesbian, gay, bisexual, and transgender adolescent school victimization: implications for young adult health and adjustment. J Sch Health 2011; 81:223.
  171. Russell ST, McGuire JK. The school climate for lesbian, gay, bisexual, and transgender (LGBT) students. In: Toward Positive Youth Development: Transforming Schools and Community Programs, Shinn M, Yoshikawa H (Eds), Oxford University Press, Oxford, UK 2008. p.133.
  172. O’Shaughnessy M, Russell ST, Heck K, et al. Safe Place to Learn: Consequences of Harassment Based on Actual or Perceived Sexual Orientation and Gender Non-Conformity and Steps for Making Schools Safer. California Safe Schools Coalition, 2004. www.casafeschools.org/SafePlacetoLearnLow.pdf (Accessed on January 29, 2014).
  173. Szalacha L. Safe sexual diversity climates: lessons learned from an evaluation of Massachusetts Safe Schools Program for Gay and Lesbian Students. Am J Educ 2003; 110:58.
  174. Toomey RB, Ryan C, Diaz RM, et al. Gender-nonconforming lesbian, gay, bisexual, and transgender youth: school victimization and young adult psychosocial adjustment. Dev Psychol 2010; 46:1580.