PRB

Sexual and gender minority youth in the United States experience greater adversity in childhood than their straight, cisgender peers. A new, nationally representative analysis finds differences in exposure to adverse childhood experiences (ACEs) based on high school students’ sexual orientation and gender identity, with LGBTQ+ students reporting more total ACES and higher rates of each type of adversity measured.¹

Because maltreatment, household challenges, and other forms of childhood adversity are linked to poor health across the life course, and because health risks increase sharply with the number of ACEs, these new findings highlight the need to prioritize ACEs prevention in efforts to address population health disparities, according to Joel Mittleman of the University of Pennsylvania, the author of the study.

A First-of-Its-Kind Data Collection

Mittleman’s analysis used data from the 2023 Youth Risk Behavior Survey (YRBS)—the first YRBS to collect self-reported information on both ACEs and gender identity from a nationally representative sample of public and private high school students. Another first for the 2023 YRBS was the addition of an American Indian/Alaska Native (AI/AN) supplemental sample, allowing more precise estimates for AI/AN students.

YRBS surveyed students in grades 9 through 12 about eight ACE types, asking if at any point in their lives they:

• Lived with a parent/guardian who abused alcohol or drugs
• Lived with a parent/guardian who was mentally ill
• Lived with a parent/guardian who was incarcerated or detained
• Witnessed intimate partner violence at home
• Experienced physical neglect at home
• Experienced physical abuse at home
• Experienced emotional abuse at home
• Experienced sexual abuse

To identify LGBTQ+ youth, Mittleman used students’ responses to separate survey questions about sexual orientation and gender identity. Sexual minority students were those who selected a sexual identity other than heterosexual (straight):

• Gay or lesbian
• Bisexual
• Some other sexual identity
• Not sure (questioning)

Gender minority students were those who selected a gender identity other than cisgender (sex at birth matching the way they think or feel about their gender):

• Transgender
• Not sure (questioning)

LGBTQ+ students were identified as those who were a sexual minority, gender minority, or both. Cisgender heterosexual (cishet) students were neither a sexual minority nor a gender minority.

The Burden of ACEs Falls Disproportionately on LGBTQ+ Youth, Particularly AI/AN, Transgender/Gender-Questioning Groups

Mittleman found that LGBTQ+ youth were more likely than their cishet peers to have experienced each of YRBS’s eight ACE types. These differences held even after controlling for students’ sex assigned at birth, age, and race/ethnicity.

Transgender and gender-questioning LGBTQ+ students consistently reported higher ACEs exposure than other LGBTQ+ groups. Almost half (46%) of gender minorities had experienced four or more ACEs, compared with around one in three cisgender sexual minorities (35%) and one in seven cishet students (15%). Having four or more ACEs is associated with a higher risk of cancer, substance use disorders, and suicide later in life.

After controlling for demographic characteristics, transgender and gender-questioning youth were at least twice as likely to report physical abuse and household mental illness than their cishet peers, and more than three-and-a-half times as likely to report sexual abuse. Overall, more than one in five gender minority high school students in 2023 had experienced sexual abuse at some point in their lives, compared with around one in 25 cishet youth.

Nationally, high school students reported on average 2.1 total ACEs in 2023—1.8 for cishet youth and 3.0 for LGBTQ+ youth. Among LGBTQ+ groups, transgender/gender-questioning students and AI/AN LGBTQ+ students reported the highest average number of ACEs, at 3.5.

Addressing Disparities Through Ongoing Tracking, Trauma-Informed Services

Mittleman’s results point to potentially serious long-term health challenges for the nearly one in four high schoolers who identify as LBGTQ+, according to YRBS data. Continuing to collect up-to-date, nationally representative data on ACEs can inform prevention efforts and interventions that are tailored to the specific needs of young people who are most likely to experience abuse and other adversities.

LGBTQ+ groups, for example, are uniquely at risk for a range of traumatic stressors not captured in YRBS, including homophobia, transphobia, and conversion therapy. For these young people, the true burden of childhood adversity is likely higher than the results of this study suggest. In this context, trauma-informed approaches to care for sexual and gender minority youth emerge as another urgent public health need, writes Mittleman.

“Amid a political and policy environment that is growing increasingly hostile to LGBTQ+ youths, monitoring LGBTQ+ youths’ exposure to abuse is likely to become even more important in the years to come,” he adds.