Ethnic and Sexual Identity-Related Inequalities in Adolescent Health and Well-Being in a National Population-Based Study

"We're not one-box issue people": Intersectional perspectives on LGBTQ+ mental health in schools: A UK qualitative study with students, staff and training providers

There is limited intersectionality-informed, contextually diverse qualitative research on school experiences of LGBTQ+ students and links to mental health. Focusing on racialized, ethnic minority and religious/faith groups, this coproduced UK study examines how: 1) sexual and/or gender diverse students with intersecting minoritized identities experience school; 2) school environments could better support their mental health; and 3) what shapes school inclusion initiatives. In-depth interviews and focus groups were conducted with 22 staff members, 32 students (13-19 years), and nine LGBTQ+ school inclusion training providers. The sample was diverse across gender and sexual identity, race/ethnicity, religion and context. Data were analysed using reflexive thematic analysis, identifying three themes (and subthemes): 1) "What's important is putting the young person first" ('Minority stress: it's more stressful for me', 'We're in this together but who's in charge?', 'Prioritising students' needs and lived reality'), 2) "Move beyond viewing religious beliefs and culture versus LGBTQ+ inclusion as a zero-sum game" ('Faith clashes?', 'Fears about going there maintain distance'), and 3) "We need to talk: engaging with parents and school communities" ('Credible messengers', 'Finding ways into the conversation'). Findings emphasize the importance of intersectional perspectives. Also, a need to acknowledge historic and current oppressions shaping current perspectives on gender and sexual diversity; reflexivity and intersubjectivity in communication with parents, students and communities; greater intersectional representation; and raised awareness and disruption of inequity-creating norms. This requires policy-level support, guidance and resourcing to avoid widening inequities on socio-economic grounds and to prepare students to live within a mutually tolerant society.

Sexual identity-related inequalities in associations between adverse childhood experiences and health in late adolescence-A national cohort study

This study examined associations between adverse childhood experiences (ACEs) and mental health and health-risk behaviours, including differences by sexual minority (SM) identity. We included 8,686 adolescents (males = 50.7%, SM = 10.3%) from the UK-wide Millennium Cohort Study with data on eight ACEs (e.g., domestic violence, parental psychological distress, bullying) recorded between ages 3-14 and a wide-range of health indicators and health-risk behaviours at age 17. Associations between 1) Sexual identity and ACEs were analysed using multinomial logistic regression and 2) Cumulative ACE scores and all outcomes were analysed using linear/logistic regression (with appropriate interactions assessing differences in ACE-outcome associations by sexual identity and adjusted for sex, ethnicity, and parental income). Results showed SM individuals had a higher prevalence of bullying (33.9% vs. 20.3%) and experiencing ≥3ACEs [Bisexual: RRR 1.87 (95% CI 1.35, 2.57), Gay/Lesbian RRR 2.08 (1.24, 3.48)]. The number of individuals experiencing adverse mental health outcomes increased in relation to greater ACE exposure with evidence for effect-moderation by sexual identity in certain outcomes. For example, among individuals with 0 ACEs, 8% of heterosexual adolescents reported psychological distress vs. 22% in bisexual and 17% in gay/lesbian peers, increasing to 16% in heterosexual vs. 41% in bisexual and 45% in gay/lesbian adolescents with ≥3 ACEs. Similar patterns were observed for other health indicators (e.g., self-harm, suicidality, sleep quality) and health-risk behaviours (e.g., risky sex). Our findings indicate that ACEs are associated (with a gradient) with worse mental health and well-being, and higher risk of some health-risk behaviours. However, the detrimental effect of ACEs on health is worse in SM adolescents compared to heterosexual peers.

24-Hour Movement Behaviors of LGBTQA+ Young People: A Systematic Review

BACKGROUND

The movement behaviors of LGBTQA+ young people, who encounter specific health, and other, challenges are not well understood. This systematic review examines the 24-hour movement behaviors of LGBTQA+ young people compared with population estimates of meeting the 24-hour movement guidelines.

METHODS

Seven electronic databases were searched from inception to January 2024. Observational studies published in English and reporting quantitative data for physical activity, sedentary behavior, or sleep duration for LGBTQA+ individuals <24 years old were included. Data were narratively synthesized for children/adolescents (<18 years) and young adults (18-24 years), guided by the Cochrane Synthesis Without Meta-analysis guidelines.

RESULTS

Fifty-six studies were included; 46 were of "fair" quality and 37 were conducted in the United States. Physical activity, sedentary behavior, and sleep outcomes were reported in 46, 11, and 14 studies, respectively. Ninety unique LGBTQA+ terms were identified. Based on outcomes reported in ≥1 study, and compared to population estimates, LGBTQA+ young people were less likely to meet aerobic physical activity and strength/resistance training guidelines. LGBTQA+ children/adolescents were less likely to meet the sleep guidelines. Young adults demonstrated similar adherence to sleep guidelines as population estimates.

CONCLUSIONS

Overall, our results suggest that LGBTQA+ young people have suboptimal 24-hour movement behaviors; in some cases, worse than population estimates. Utilization of more robust measures of exposure and outcome variables is recommended, with a focus on sleep and sedentary behavior.

Ethnic and sexual orientation inequalities in mental health-obesity comorbidity, self-harm, and attempted suicide among British adolescents

PURPOSE

Mental illness and obesity (MH-OB) may co-occur in adolescence and have a strong risk to track into adulthood. Using an intersectional framework, we explored associations between ethnic-sexual identities and MH-OB comorbidity in adolescents. We examined the risk of self-harm (SH) and attempted suicide (AS) by comorbidity status and ethnic-sexual identities.

METHODS

Participants included 9,789 adolescents (aged 17 years) from the UK-wide Millennium Cohort Study with data on self-identified ethnicity and sexuality. Participants were categorised as White-heterosexual, White-sexual minority (SM), Ethnic Minority (EM) heterosexual or EM-SM adolescents. We used multivariable logistic regression to examine associations between 1.dual ethnic-sexual identities and MH-OB comorbidity, 2.risk for self-harm (or attempted suicide) in relation to comorbidity and ethnic-sexual identities (including interactions between the comorbidity and ethnic-sexual identities variables to assess whether risk for self-harm differed by ethnic-sexual identities and comorbidity status).

RESULTS

Comorbidity was higher among White-SM (OR = 3.73, 95%CI 2.42-5.75) and EM-SM (OR = 1.96, 1.03-3.73) adolescents. SM identities (OR = 3.02, 2.41-3.78 for White-SM) and having comorbidity (OR = 2.83, 2.03-3.95) were independently associated with SH or AS. Risk of SH among White-heterosexual individuals was greater among comorbid individuals (40%) relative to non-comorbid individuals (19%). Risk of SH was higher in SM individuals (58% vs. 41% in White-SM and 50% vs. 29% in EM-SM individuals with and without comorbidity, respectively). Risk of AS was 5% and 19% in comorbid and non-comorbid White-heterosexual individuals, respectively; the corresponding figures for White-SM individuals were 14% and 17%.

CONCLUSION

Irrespective of ethnicity, SM adolescents have a significantly greater risk of SH and AS. Comorbidity further amplifies this risk.