Concordance and Discrepancy in Sexual Identity, Attraction, and Behavior Among Adolescents

doi:10.1016/j.jadohealth.2009.03.019

Journal of Adolescent Health

Volume 45, Issue 6, December 2009, Pages 602-608

https://doi.org/10.1016/j.jadohealth.2009.03.019 Get rights and content

Abstract

Purpose

Nonheterosexual youth are at greater risk for mental and physical health problems than heterosexual youth. Definitions of nonheterosexual youth, however, are not consistent between studies, variably including sexual identity, attraction, and/or behavior. This study's objective was to describe the concordance and discrepancy between sexual identification, attraction, and behavior in adolescents.

Methods

A total of 1,951 students aged 14 and older from 14 high schools in Montreal, Quebec, were surveyed anonymously using the Quebec Youth Risk Behaviour Survey. The survey included three items assessing sexual orientation (sexual identity, sexual attraction, sexual behavior).

Results

Twelve percent of adolescents (n = 237) endorsed at least one measure of nonexclusive heterosexuality. A total of 3.4% reported gay/lesbian or bisexual (GLB) identity (another 3.4% were unsure), 9.0% reported same-gender attraction, and 4.0% same-gender behavior. There was no consistent pattern of overlap between the three measures, and no single dimension effectively captured this population. The question about attraction identified 71%; identity identified 52%; and behavior only 31%. In raw numbers, more heterosexually identified students reported same-gender attraction (n = 95) or same-gender behavior (n = 33) than GLB-identified students (n = 44 and 29, respectively).

Conclusions

“Nonheterosexual” youth are a heterogeneous group that cannot be identified accurately using a single question. In both research and clinical settings, the best way to assess sexual orientation, consistent with American Academy of Pediatrics, is to ask multiple questions that address the dimensions of identity, attraction, and behavior. All youth who endorse any combination of nonexclusively heterosexual identity, behavior, or attraction are potentially at risk for the ill effects of direct and indirect discrimination.

Section snippets

Sample design and population

Participants in the study were students aged 14 and older, enrolled in grades 9 to 11 in either public or private schools in Montreal (Canada). In 2004, principals from 59 public high schools in Montreal (39 French school board, 20 English school board) and 2 private high schools were notified about the study by mail and then contacted by phone and invited to participate. The survey was approved and administered in 14 high schools (8 French school board, 4 English school board, 2 private).

Sample characteristics

No parents refused permission, and all eligible students consented to participate. A total of 1,951 adolescents completed the QYRBS (mean of 5.4 classrooms and 139.4 students per school). Of these, 16 surveys were discarded because of mostly empty or defaced answer sheets, and data from 1,935 of 1,951 eligible students (99.2%) were included in the analyses. Respondents were 51% male (49% female), 61% Caucasian (16% Asian, 10% black), 33% allophone (39% French, 27% English) with a mean age of

Discussion

Approximately 1 in 10 Montreal high school students sampled endorsed nonheterosexual identity, attraction, and/or behavior. This “nonexclusively-heterosexual” subgroup however was quite heterogeneous, lending credence to Kinsey's statement that “The world is not to be divided into sheep and goats” [23]. Although 9% reported same-gender attraction, 7% reported GLB or unsure sexual identity and 4% reported same-gender behavior, these groups were not concentric circles and no single question

Conclusion

The results of this study indicate that “nonheterosexual” youth are a heterogeneous group that cannot be identified accurately using a single question. In both research and clinical settings, the best way to assess sexual orientation, consistent with AAP guidelines, is to ask multiple questions that address the dimensions of identity, attraction, and behavior. All youth who endorse any combination of nonexclusively heterosexual identity, behavior or attraction are potentially at risk for the

Financial Interests

None of the authors have financial disclosures or conflicts of interest to declare.

Acknowledgments

This study was supported by funds from the McGill University Department of Psychiatry's One in Three Foundation awarded to Dr. Richard Montoro. Dr. Thombs is supported by a New Investigator Award from the Canadian Institutes of Health Research and an Établissement de Jeunes Chercheurs award from the Fonds de la Recherche en Santé Québec.

References (33)

A.M. Smith et al.
Sex in Australia: sexual identity, sexual attraction and sexual experience among a representative sample of adults
Aust N Z J Public Health
(2003)
R. Garofalo et al.
The association between health risk behaviors and sexual orientation among a school-based sample of adolescents
Pediatrics
(1998)
R. Garofalo et al.
Sexual orientation and risk of suicide attempts among a representative sample of youth
Arch Pediatr Adolesc Med
(1999)
A.H. Faulkner et al.
Correlates of same-sex sexual behavior in a random sample of Massachusetts high school students
Am J Public Health
(1998)
S.T. Russell et al.
Adolescent sexual orientation and suicide risk: evidence from a national study
Am J Public Health
(2001)
G. Remafedi
Sexual orientation and youth suicide
JAMA
(1999)
G. Remafedi et al.
The relationship between suicide risk and sexual orientation: results of a population-based study
Am J Public Health
(1998)
B.L. Frankowski
Committee on Adolescence. Sexual orientation and adolescents
Pediatrics
(2004)
Committee on Adolescence. Sexuaity education for children and adolescents
Pediatrics
(2001)
E.M. Saewyc et al.
Measuring sexual orientation in adolescent health surveys: evaluation of eight school-based surveys
J Adolesc Health
(2004)

M. Rosario et al.

Sexual identity development among gay, lesbian, and bisexual youths: consistency and change over time

J Sex Res

(2006)

R.C. Savin-Williams et al.

Prevalence and stability of sexual orientation components during adolescence and young adulthood

Arch Sex Behav

(2007)

L. Wichstrom et al.

Sexual orientation and suicide attempt: a longitudinal study of the general Norwegian adolescent population

J Abnorm Psychol

(2003)

M. Eskin et al.

Same-sex sexual orientation, childhood sexual abuse, and suicidal behaviour in university students in Turkey

Arch Sex Behav

(2005)

P. Pathela et al.

Discordance between sexual behavior and self-reported sexual identity: a population-based survey of New York City men

Ann Intern Med

(2006)

E. Laumann et al.

The Social Organization of Sexuality: Sexual Practices in the United States

(1994)

Cited by (112)

Sexual orientation and prevalence of mental health difficulties among emergency services employees
2021, Journal of Affective Disorders
Citation Excerpt :
we present these findings with the caveat that the survey design could not perfectly capture the population in question. Sexual orientation is a complex and multifaceted construct which combines factors of identity, attraction and engagement in sexual and romantic behavior (Igartua et al., 2009). These factors are not always aligned in individuals; individuals who are attracted to the same gender do not always identify as such.
LGBQ+ people (Lesbian, Gay, Bisexual, Queer) are at-risk of discrimination and developing mental health issues within general populations. Limited research has assessed their mental health in emergency services occupations, a population which are known to experience poorer mental health. The current study explores the extent to which sexual orientation is associated with higher rates of mental health issues among emergency personnel.
A stratified random sample of employees from twenty-nine police (N = 8,088), ambulance (N = 3,473), and fire and rescue (N = 2,975) agencies from around Australia participated in a cross-sectional mental health survey (N = 14,536, male = 64.2%, 42.7% over 45 years of age, heterosexual = 92.7%).
Employees with a bisexual/pansexual orientation or those who were not sure about their sexual orientation were significantly more likely to report suicidal thoughts, suicide plans, psychological distress, and illicit drug use when compared with heterosexual employees. LGBQ+ employees reported significantly higher rates of lifetime suicide plans and attempts. Specifically, LGBQ+ fire and rescue personnel were roughly six times more likely to report lifetime suicide attempts, and approximately five times more likely to use illicit drugs weekly than their heterosexual colleagues in the fire and rescue sector. Female LGBQ+ personnel were significantly less likely to consume illicit drugs weekly and monthly than male LGBQ+ personnel.
Emergency services personnel are already at-risk of developing pervasive mental health difficulties. It is important that organisations foster positive working environments, particularly for LGBQ+ people who may be more marginalized within organisations.
Suicide thought and behaviors, non-suicidal self-injury, and perceived life stress among sexual minority Mexican college students
2021, Journal of Affective Disorders
Sexual minority college students are at a higher risk for suicidal thoughts and self-injurious behaviors compared to heterosexual students. Minority stress theory proposes sexual minority individuals experience higher stress due to stigma. Using a sample of Mexican college students, this study tested perceived life stress as a mediator of suicide and self-injury outcomes across various sexual orientation groups.
The sample of college students (N=7882) was recruited from nine Mexican universities as part of the WHO World Mental Health International College Student (WMH-ICS) initiative. Participants completed an online survey including demographic questions, measure of perceived life stress, suicide outcomes, and non-suicidal self-injury (NSSI) in the past 12 months.
Logistic regression analyses revealed identifying as a sexual minority significantly predicted a higher likelihood of suicide ideation (ORs 2.05-3.00), suicide attempts (ORs 2.48-8.73), and NSSI (ORs 2.92-4.18) compared to heterosexual students reporting no same-gender attraction. Significant indirect effects from mediation path analyses showed perceived life stress mediated the relationship between a sexual minority identity and suicide ideation (range of proportion mediated 10.48-31.48%), attempts (10.48-31.48%), and NSSI (7.69-20.09%) across each group except among asexual students.
The cross-sectional nature of the survey design precludes drawing causal inferences.
Findings from this study contribute to minority stress theory by elucidating the role of perceived life stress as a mediator of suicide ideation and attempts and NSSI among sexual minority college students. Clinical interventions may benefit in focusing on experiences of stress across various life areas when supporting sexual minority college students.
Exploring childhood temperament as a moderator of the association between adolescent sexual minority status and internalizing and externalizing behavior problems
2020, Journal of Adolescence
Sexual minority youth experience worse mental health compared to their heterosexual peers, reflecting the consequences of sexual minority-based stigma. Previous research has focused on contextual variation to understand variability within this vulnerability. Childhood temperament factors such as negative affect, effortful control and surgency/extraversion are important for understanding differential susceptibility to environmental stressors. The objective of the current study was to understand how childhood temperament factors, measured prior to the most difficult developmental period for sexual minority youth, moderated the association between sexual minority status and internalizing and externalizing behavior problems.
Youth reporting same-sex attraction in an ongoing longitudinal project on the development of conduct problems in Quebec, Canada were matched with heterosexual peers, for an analytic sample of 280 youth (62% girls). Structural equation models were used to examine (1) the association between youth-reported same-sex attraction (ages 13–16) and parent and youth-reported internalizing and externalizing problems a year later at ages 14–17, and (2) the moderating role of temperament (ages 6–9) in this association between sexual minority status and internalizing and externalizing problems.
Same-sex attraction was associated with higher levels of youth-reported internalizing and externalizing behavior problems. Surgency/extraversion moderated the association between sexual minority status and youth-reported internalizing and externalizing problems.
These findings suggest that temperament linked to individual visibility may be important for understanding variation in self-reported mental health among sexual minority youth, and supports the use of developmental constructs like temperament to better understand vulnerability to psychosocial difficulties within this population.
Health-Related Lifestyles, Substance-Related Behaviors, and Sexual Habits Among Italian Young Adult Males: An Epidemiologic Study
2020, Sexual Medicine
Citation Excerpt :
The present study highlighted a lower percentage of young males who defined themselves as non-heterosexual (2.9%), as compared to similar studies. In a study by Igartua et al, participants were adolescents aged above 16 years; 90.8% self-defined as heterosexual, 4.5% as lesbian, gay, or bisexual, 3.2% “uncertain,” and 1.5% did not provide any answer.15 The YouGov UK survey focused on young people aged 18–24 years and found that 54% of respondents self-defined themselves as “not completely heterosexual to a certain extent”; the same survey conducted in the United States found a percentage of 36% in the same age cohort.16
Young adult males are more likely to demonstrate health-risk behaviors than other individuals. The use of specific data about health-risk behaviors within this population might be important to promote effective preventive psychosocial and educational programs and interventions.
To provide a detailed description of health-related lifestyles, substance-related behaviors, and sexual habits that can negatively affect fertility, sexual sphere, and health in a large sample of Italian young adult males.
A sample comprising 2,170 males aged 18–21 years, attending the last year of high school, was administered an online questionnaire made up of 39 multiple-choice questions. The questionnaire explored health-related lifestyles, substance-related behaviors, and sexuality and sexual habits. Descriptive analyses were conducted.
The outcome measures included data about health-related lifestyles, substance-related behaviors, and sexuality and sexual habits reported by Italian young adult males.
Health-related lifestyles: 92.9% of the sample reported practicing some physical activity during the week. 90.3% declared a Mediterranean diet and 8.1% a hyperproteic diet. Substance-related behaviors: 33.8% of the sample reported having smoked tobacco at least once in their lives; among them, 71% reported current daily smoking. 40.2% declared drinking alcohol from 5 to 7 days in a week. 32.9% of the sample reported currently using a substance. Sexuality and sexual habits: 97.1% of the sample self-defined themselves as heterosexual. 73.3% of participants rated their knowledge about sexuality as “excellent/good,” 58.7% about sexually transmitted infections. Only 4.8% reported having had a seminal liquid examination. Half of the sample (52.2%) declared having had sexual intercourses, in the largest proportion protected sex. 14.7% of the sample reported having at least one sexual dysfunction. 88.6% of participants reported having used pornography, 18.7% every day.
The present study highlighted the need to empower the number and efficacy of preventive interventions to promote health-related behaviors among Italian young male population.
Flesia L, Cavalieri F, Angelini S, et al. Health-Related Lifestyles, Substance-Related Behaviors, and Sexual Habits Among Italian Young Adult Males: An Epidemiologic Study. Sex Med 2020;8:361–369.
Sexual orientation, attraction and risk for deliberate self-harm: Findings from a nationally representative sample
2020, Psychiatry Research
To date, there has been limited investigation identifying predictors of deliberate self-harm (DSH) among sexual minority adults. The present study examined the likelihood of DSH by sexual minority status as measured by self-reported sexual identity and sexual attraction in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Among respondents who answered both the sexual identity and attraction items on the NESARC (N = 34,273), the link between sexual minority status and DSH was examined. Univariate analyses yielded greater risk of DSH for all sexual minority identities compared to heterosexual identity. Individuals with same-sex only attraction did not differ from those with different-sex only attraction. At the multivariate level, respondents reporting bisexual and unsure identity and bisexual attraction were at two to three times greater risk of DSH compared to their heterosexual/different-sex counterparts. Same-sex attracted and gay/lesbian individuals did not differ from different-sex attracted or heterosexual individuals in adjusted multivariate models. Findings from this nationally representative sample are consistent with previous research suggesting that sexual minority status is a risk factor for DSH. There is a vital need to incorporate varying measures of sexual minority status within research and in clinics, as well as to inquire about DSH among sexual minorities.
Gender identity and sexual attraction among Canadian youth: findings from the 2019 Canadian Health Survey on Children and Youth
2023, Health Promotion and Chronic Disease Prevention in Canada

View all citing articles on Scopus

View full text

Original articleConcordance and Discrepancy in Sexual Identity, Attraction, and Behavior Among Adolescents

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Sample design and population

Sample characteristics

Discussion

Conclusion

Financial Interests

Acknowledgments

Aust N Z J Public Health

The association between health risk behaviors and sexual orientation among a school-based sample of adolescents

Pediatrics

Sexual orientation and risk of suicide attempts among a representative sample of youth

Arch Pediatr Adolesc Med

Correlates of same-sex sexual behavior in a random sample of Massachusetts high school students

Am J Public Health

Adolescent sexual orientation and suicide risk: evidence from a national study

Am J Public Health

Sexual orientation and youth suicide

JAMA

The relationship between suicide risk and sexual orientation: results of a population-based study

Am J Public Health

Committee on Adolescence. Sexual orientation and adolescents

Pediatrics

Committee on Adolescence. Sexuaity education for children and adolescents

Pediatrics

Measuring sexual orientation in adolescent health surveys: evaluation of eight school-based surveys

J Adolesc Health

Sexual identity development among gay, lesbian, and bisexual youths: consistency and change over time

J Sex Res

Prevalence and stability of sexual orientation components during adolescence and young adulthood

Arch Sex Behav

Sexual orientation and suicide attempt: a longitudinal study of the general Norwegian adolescent population

J Abnorm Psychol

Same-sex sexual orientation, childhood sexual abuse, and suicidal behaviour in university students in Turkey

Arch Sex Behav

Discordance between sexual behavior and self-reported sexual identity: a population-based survey of New York City men

Ann Intern Med

The Social Organization of Sexuality: Sexual Practices in the United States

Original article
Concordance and Discrepancy in Sexual Identity, Attraction, and Behavior Among Adolescents