Peer Victimization and Sexual Risk Differences Between Lesbian, Gay, Bisexual, Transgender, or Questioning and Nontransgender Heterosexual Youths in Grades 7–12

摘要

Objectives. Before and after accounting for peer victimization, we estimated sexual risk disparities between students who self-identified as lesbian, gay, bisexual, transgender, or questioning (LGBTQ) and students who self-identified as nontransgender heterosexual. Methods. Students in grades 7 through 12 in Dane County, Wisconsin, were given the Web-administered Dane County Youth Assessment. One set of analyses was based on a sample that included 11?337 students. Subsequent analyses were based on a sample from which we screened out students who may not have been responding to survey items truthfully. Various multilevel-modeling and propensity-score-matching strategies ensured robustness of the results, examined disparities at lower and higher victimization rates, and explored heterogeneity among LGBTQ-identified youths. Finally, propensity-score-matching strategies estimated LGBTQ–heterosexual disparities in 2 matched samples: a sample that reported higher victimization and one that reported lower victimization. Results. Across 7 sexual risk outcomes, and in middle and high school, LGBTQ-identified youths reported engaging in riskier behavior than did heterosexual-identified youths after we accounted for peer victimization. Risk differentials were present in middle and high school. The LGBTQ group was heterogeneous, with lesbian/gay- and bisexual-identified youths generally appearing most risky, and questioning-identified youths least risky. In the matched sample with lower average victimization rates, LGBTQ-identified youths perceived a greater risk of sexually transmitted infections despite not engaging in sexually risky behavior at significantly higher rates; in the matched sample with higher average victimization rates, all outcomes were significantly different. Conclusions. Demonstrated LGBTQ–heterosexual risk differentials in grades 7 through 8 suggest that interventions need to be implemented during middle school. These interventions should also be differentiated to address the unique risk patterns among LGBTQ subgroups. Finally, models of sexual risk disparities must expand beyond peer victimization. High school–aged youths who self-identify as lesbian, gay, bisexual, transgender, or questioning (LGBTQ) tend to exhibit more risk with regard to sexual behavior (such as the number of sex partners, use of protection, and prevalence of sexually transmitted infections [STIs]) than do their self-identified, nontransgender heterosexual peers. 1,2 Across middle and high school, LGBTQ youths are also disproportionately the victims of bullying. 3–7 Given LGBTQ youths’ high levels of both sexual risk and victimization, a recent meta-analysis suggested that abuse (including peer victimization, but also parental physical abuse and childhood sexual abuse) may actually contribute to sexual risk disparities between LGBTQ and heterosexual youths. 2 Victimization may lead to increased sexually risky behavior through several pathways, including heightened feelings of isolation leading to increased desires for sexual fulfillment, 8 psychological distress leading to unprotected sex, 9 and stigmatization leading to lack of knowledge about sexual-minority identity 10 in turn leading to seeking out same-sex activities to navigate identity. In a recent retrospective study of LGBT young adults, those who recalled greater peer victimization during their teenage years were more likely to have ever had an STI and to have been at HIV risk in the past 6 months. 11 The focus on victimization has also caught on in the media and in some education reform. 12,13 However, researchers have noted that victimization may be only one component in explaining LGBTQ–heterosexual suicide-related risk disparities 14,15 ; thus, it stands to reason that victimization may explain part of LGBTQ–heterosexual sexual risk disparities, but that substantial disparities may remain after victimization is accounted for. We sought to provide a rigorous assessment of sexually risky attitudes and behaviors before and after accounting for peer victimization among a large population-based sample of LGBTQ- and heterosexual-identified youths in middle and high school. In the process, we implemented a novel procedure for screening out potentially mischievous survey responders and a series of propensity-score-matching analyses to estimate LGBTQ–heterosexual sexual risk disparities among matched LGBTQ- and heterosexual-identified students with the same demographic characteristics and levels of peer victimization. The methodological advances implemented here provide a more nuanced view of LGBTQ-identified youths and, thus, may improve the effectiveness of future prevention efforts.