School Environment, Health Risk Behavior and Academic Failure: Linked for LGBT Youth Print

Including Sexual Orientation and Behavior Questions on the YRBS Can Help Educators Break the Cycle and Improve Academic Success


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The Centers for Disease Control and Prevention (CDC) has approved two optional questions regarding sexual orientation for inclusion in state and/or local school districts’ Youth Risk Behavior Surveys (YRBS). One or both of these questions are currently administered in some form in states such as Connecticut, Delaware, Hawaii, Maine, Massachusetts, Rhode Island, Vermont, and Wisconsin, as well as in cities such as Boston, Milwaukee, New York City, and Chicago. It is essential that more states and local school districts include these questions on the YRBS to track trends and implement programs that assist lesbian, gay and bisexual (LGB) youth to succeed academically.

Research shows that LGB youth often suffer from disparate rates of substance abuse, depression, suicide ideation, harassment, abuse, sexually transmitted infections, including HIV, and teenage pregnancy. This increased risk is often the result of, and in reaction to, negative environmental stressors LGB youth face in their schools, homes and communities. Recent research also shows that youth suffering from such health risks are at greater academic risk than are other youth. State and local education agencies that include sexual orientation questions on the YRBS are better positioned to understand these linkages, to seek funding for, and to implement, programs that can help redresses them and as such, help these youth to succeed academically. Studies indicate that programs, including those that redress homophobia, promote inclusive education and foster safety at school for LBG youth, can help these young people remain healthy and successful in school. Because of the complex relationship between sexual orientation and gender identity, especially for youth enduring bullying and harassment in school, it is imperative that future steps to address these issues also explicitly include transgender and gender-variant youth. Efforts are ongoing to facilitate the development and broad utilization of a question or questions addressing gender identity.

The Standardized Questions regarding Sexual Orientation and Behavior: Fidelity to Language across Regions is Essential

The questions approved by the CDC to be administered as optional YRBS questions have been created to capture two components of sexual orientation; behavior and identity and are as follows:

  • During your life, with whom have you had sexual contact?
    ____I have never had sexual contact; ____Females; ____Males; ____Females and Males

  • Which of the following best describes you?
    ____Heterosexual (straight); ____ Gay or Lesbian; ____Bisexual; ____Not sure

Some state and local school districts have included one or both of these questions on the YRBS. Other states have used similar questions, but have changed the wording slightly. It is important that each state and local school district words these questions exactly as proposed by CDC to allow researchers at CDC along with state and local education agencies to track trends and disparities in risk behavior for LGB youth.

School Environment, Risky Health Behaviors and
Academic Failure are Linked

  • In a nationwide survey, over 86 percent of lesbian, gay, bisexual, and transgender (LGBT) students reported verbal harassment at school. Over 44 percent of all LGBT youth reported being physically harassed at school because of their sexual orientation while over 30 percent of LGBT youth reported physical attacks because of their gender identity or gender expression.[1]

  • More than 80 percent of LGBT students of color in one survey were verbally harassed in school because of their sexual orientation. More than half of Native American LGBT students (54 percent) experienced physical violence because of their sexual orientation, and substantial percentages of African American (33 percent), Latino/a (45 percent), Asian/Pacific Islander (41 percent) and multiracial (45 percent) students also reported these experiences.[2]

  • The consequences of physical and verbal abuse directed at LGBT students include truancy, dropping out of school, poor grades, and having to repeat a grade.[3]

  • One study showed that of LGBT youth, 32 percent reported missing a class and 33 percent reported missing a day of school in the past month because they felt unsafe at their school.[1]

  • Almost half of all transgender students reported skipping a class at least once in the past month (47%) and missing at least one day of school in the past month (46%) because they felt unsafe or uncomfortable.[5]

  • In a study of 8th grade students in Washington state, those who felt unsafe at school were almost twice as likely to be at academic risk (receiving mostly Cs, Ds, or Fs in school) than those who felt safe at school.[4]

  • LGBT students who experienced more frequent harassment had grade point averages half a grade lower than those who were harassed less frequently.[1]

  • Transgender students who experienced high levels of harassment had significantly lower grade point averages than those who experienced lower levels of harassment (verbal harassment based on sexual orientation: 2.2. vs. 3.0; gender expression: 2.3 vs. 2.8; gender: 2.2 vs. 2.7).[5]

  • LGB youth are twice as likely as their heterosexual peers to report depression and more than twice as likely to attempt suicide.[6]

  • In the Washington state study, those students that suffered from depression were almost twice as likely to be at academic risk than were their peers who did not experience depression.[4]

  • Research also shows a link between substance abuse and school failure. One study showed that substance abuse was associated with school drop out even after adjusting for demographic differences.[7]

  • A study of Washington State schools found that those with a lower prevalence of substance abuse also had higher scores on the state assessment tests.[8]

  • Studies of high school students found that those who suffered harassment because of their real or perceived sexual orientation were more likely than non-harassed youth to use crack cocaine, cocaine, anabolic steroids, and inhalants.[9,10]

  • One study showed that while bisexual and lesbian teenage females were about as likely as heterosexual peers to have had intercourse, they reported twice the rate of pregnancy as heterosexual and questioning young women (12 percent vs. five to six percent respectively).[11]

  • Teens that give birth are less likely to graduate high school – only 51 percent of these teens graduate compared to 89 percent of non-parenting teens.[12]

  • AdisproportionatenumberofLGBTyoutharehomeless: one nationwide report found that while only about three to five percent of the population is estimated to be LGBT, 42 percent of homeless youth are LGBT.[13]

  • Runaway or homeless youth experience higher rates of absenteeism, lower reading and math test scores, and are much less likely to complete high school than their never-homeless peers.[14]

  • A recent longitudinal study indicated that youth with poorer general health were found to be less likely than healthier students to graduate from high school on time and to attend college.[15]

YRBS Data Can Assist Schools in Understanding the Needs of LGB Youth and Improving their Academic Success

  • Data from the YRBS administered in Chicago publicschools suggests that LGB students are subject to differential rates of school absence, physical violence, sexual assault, depression, and drug use.[16]

  • A study using data from the Massachusetts YRBS found that LGB students in schools with LGB support groups reported lower rates of victimization and suicide attempts than those in other schools. Perceived support from school staff was inversely related to suicide ideation.[17]


LGBT youth, who are often targets of bullying, harassment, and discrimination, can feel threatened or victimized, and therefore are at greater academic risk than other students. LGB youth suffer disparate rates of a variety of social and health morbidities. State and local school districts should include CDC approved sexual orientation questions on the YRBS to identify local, state and national LGB youth needs and to meet those needs head on to improve the health and academic success of these young people.

Written by Debra Hauser, MPH, June 2010


1. Kosciw, J. G., Diaz, E. M., and Greytak, E. A. (2008). The 2007 National School Climate Survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. New York: GLSEN.

2. Kosciw, J. G., Diaz, E. M. (2009). Shared Differences: The experiences of lesbian, gay, bisexual, and transgender students of color in our nation’s schools. New York: GLSEN.

3. Savin-Williams RC. Verbal and physical abuse as stressors in the lives of lesbian, gay male, and bisexual youths: associations with school problems, running away, substance abuse, prostitution, and suicide. J Consult Clin Psychol 1994; 62:261-69.

4. Dilley J. Research Review: School-Based Health Interventions and Academic Achievement. Washington State Board of Health, 2009.

5. Greytak, E. A., Kosciw, J. G., and Diaz, E. M. (2009). Harsh Realities: The Experiences of Transgender Youth in Our Nation’s Schools. New York: GLSEN.

6. Russell ST, Joyner K. Adolescent sexual orientation and suicide risk: evidence from a national study. Am J Public Health. 2001 Aug; 91(8):1276-81.

7. Townsend, L., A.J. Flisher and G. King. 2007. A systematic review of the relationship between high school dropout and substance abuse. Clinical Child and Family Psychology 10(4):295–317.

8. Arthur, M.W., EC Brown and J.S> Briney. July 2006. Multilevel Examination of the Relationships Between Risk/Protective Factors and Academic Test Scores. Social Development Research Group, School of Social Work, University of Washington. www.dshs. (accessed April 7, 2009)

9. Garofalo R et al. The association between health risk behaviors and sexual orientation among a school-based sample of adolescents. Pediatrics 1998; 101:895-902.

10. California Safe Schools Coalition. Safe Place to Learn: Consequences of Harassment Based on Actual or Perceived Sexual Orientation and Gender Non-Conformity and Steps for Making Schools Safer. San Francisco, CA: The Coalition, 2004.

11. Saewyc EM et al. Sexual intercourse, abuse and pregnancy among adolescent women: does sexual orientation make a difference? Fam Plann Perspect 1999; 31:127-131.

12. Perper, K., Peterson, K., & Manlove, J., Diploma Attachment Among Teen Mothers, 2010. Child Trends, Fact Sheet: Washington, DC. DiplomaAttainment.pdf

13. Lesbian, Gay, Bisexual, and Transgender Youth: An Epidemic of Homelessness. Washington DC: National Gay and Lesbian Task Force, 2006.

14. Aratani, Y. Homeless Children and Youth: Causes and Consequences. National Center for Children in Poverty, Columbia University.

15. Hass, SA and NE Fossee. 2008 Health and the educational attainment of adolescents. Evidence from the NLSY97. J Health Soc Behav (49(2):178-92

16. Chicago Public High Schools. Differential Risk Factors for Lesbian, Gay, Bisexual Identified Students. 2005 Youth Risk Behavior Survey Results.

17. Goodenow, Carol, Laura Szalacha, Kim Westheimer, School Support Groups, Other School Factors and the Safety of Sexual Minority Adolescents. Massachusetts Dept of Education, 2010.

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