Priority health risk behaviors are defined as those interrelated and preventable behaviors that contribute to the leading causes of morbidity and mortality among youths and adults and are frequently established during childhood and adolescence and extend into adulthood. The Center for Disease Control (CDC) and the Youth Risk Behavior Surveillance System (YRBSS), established in 1991, monitors six categories of priority health risk behaviors among youth and young adults:
- Behaviors that contribute to unintentional injuries and violence
- Sexual behaviors that contribute to human immunodeficiency virus (HIV) infection, other sexually transmitted diseases, and unintended pregnancy
- Tobacco use
- Alcohol and other drug use
- Unhealthy dietary behaviors
- Physical inactivity
Sexual Minority Youth–LGBTQ
The current study by Caputi, et al (JAMA 2018) has suggested that sexual minority youth are more likely to experience a number of behavioral and health-related risk factors due to their exposure to negative attitudes and beliefs about sexual minorities. There is a dearth of studies that have scientifically examined the prevalence of suicidality among sexual minority youth.
In the current study and analysis by Caputi, et al, self identified sexual minority (lesbian, gay, bisexual, or questioning) adolescents were believed to have elevated suicide risks, primarily due to stigma and discrimination. Studies supporting this claim are not nationally representative, which is a major study flaw given that stigma varies across communities and available resources also vary by state and regions. When nationally representative studies are available, they are not recent and do not reflect the dynamic nature of societal attitudes regarding sexual minority students. In addition, most studies have ignored the diversity within sexual minorities and have failed to recognize that young people are a widely diverse group.
To assess suicide risk in the past year, participants were asked if they had seriously considered or planned an attempted suicide. Study participant (N=15,624).
After adjusting for confounding variables, results indicate that sexual minority youth were more likely to consider, (Risk Ratio 2.45 at 95% CI, 212-281).
Plan or attempt suicide 2.59 (95% CI. 218-304) planning and 3.37 (CI, 2.73-4.09) for attempting when compared to heterosexuals.
These data are limited by a 60% response rate which limits generalizing the findings. Yet these data demand further investigation as to the underlying mechanism that increase risk beyond self-reported stigma. For example, additional data from The Youth Risk Behavior Surveillance System (YRBSS) have identified significant health disparities between sexual minority youth. Specifically, human immunodeficiency virus (HIV) infection, sexually transmitted infections, and pregnancy occur more frequently among sexual minority youth than nonsexual minority youth. These factors certainly contribute to emotional and psychological well-being and are known risk factors for depression and suicidality among all youth.
Why Does This Matter?
Clearly, not enough is known about health-related behaviors that contribute to suicidality among sexual minority youth and how the prevalence of these health-related behaviors compare with the prevalence of health-related behaviors among nonsexual minority youth. The underlying historical assumption that psychopathology associated with adolescent sexual minorities is the result of stigma and social rejection and systemic discrimination is inadequate, if we really want to understand how to help these young people.
Caputi TL, Smith D, Ayers JW Suicide Risk Behaviors Among Sexual Minority Adolescents in the United States, 2015. JAMA. 2017 Dec 19;318(23):2349-2351. doi: 10.1001/jama.2017.16908.
MMWR Weekly Report: Methodology of the Youth Risk Behavior Surveillance System | Request PDF. Available from: https://www.researchgate.net/publication/279766311 MMWR Weekly_Report Methodology of the Youth Risk Behavior Surveillance System [accessed Mar 02 2018].