Reducing Risk-Taking Behaviors Among Bisexual Youths

A person wearing sneakers stands on a wooden ledge high over a city.

Adolescence can be a difficult time for everyone, but the struggles of this developmental period are especially pronounced for LGBT young people. A study conducted by the Centers for Disease Control and Prevention (CDC) from 2001-2009 examined the risk-taking behaviors of students in grades 9-12 and found that across a variety of activities–from smoking cigarettes to drinking while driving, to getting in physical fights–bisexual students were more likely to engage in risky behaviors than heterosexual or gay or lesbian students.1Kann L, Olsen EO, McManus T, Kinchen S, Chyen D, Harris WA, et al. Sexual identity, sex of sexual contacts, and health-risk behaviors among students in grades 9-12–youth risk behavior surveillance, selected sites, United States, 2001-2009. MMWR Surveill Summ. 2011;60(7):1-133. Epub 2011/06/11. PubMed PMID: 21659985.

According to the CDC study, bisexual students had higher rates of risk-taking behavior than heterosexual students in eight of the 10 risk categories assessed: behaviors that contribute to unintentional injuries, behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight management. For example, 86.5 percent of bisexual students reported drinking alcohol–over 10 percentage points more than gay or lesbian students and 16 percentage points more than heterosexual students. Bisexual students additionally reported binge drinking at rates 7 percentage points higher than gay or lesbian students and 13 percentage points higher than heterosexual students. Bisexual students were also the most likely to report not eating for 24 or more hours in order to lose weight or keep from gaining weight.

A 2014 Human Rights Campaign (HRC) survey of more than 10,000 LGBT youths had similar findings: 56 percent of bisexual young people responded that they had experimented with alcohol and drugs, compared to 50 percent of gay or lesbian youths and 22 percent of straight youths.2Andre A, Brown J, Delpercio A, Kahn E, Nicoli A, Sherouse B. Supporting and Caring for Our Bisexual Youth [Internet]. District of Columbia: The Human Rights Campaign Foundation; 2014. Available from: https://assets2.hrc.org/files/assets/resources/Supporting_and_Caring_for_Bisexual_Youth.pdf?_ga=2.64819180.2104289509.1551916550-1835297834.1551916550 In the survey, 38 percent of youths identified as bisexual, more than any other identity category, so determining how health care providers can help mitigate these behaviors of utmost importance.

Sexual identity versus sexual partners: a distinction with a difference

In several instances throughout the previously mentioned CDC study, the number of youths who identified as bisexual differed substantially from those who reported having sex with people of multiple genders, and many students who had sex with both male and female partners identified as heterosexual. This distinction highlights the need for health care providers to take a thorough history of patients’ sexual behaviors as well as determine what sexual orientation and other labels mean to individual patients, as providers may be missing at-risk youths if risk is assessed by self-identified sexual orientation alone. The study’s authors also point out that it is possible young people at this point in their lives either do not know their sexual identity or do not feel comfortable disclosing it on a questionnaire, making it difficult to interpret data on risk-taking behaviors among sexual minority youths.

Providers may be missing at-risk youths if risk is assessed by self-identified sexual orientation alone.

The HRC survey also points out that more young people are using identifiers outside of gay, lesbian, and bisexual to describe themselves, using terms such as queer or pansexual. The survey included youth who identified as pansexual in its report on bisexual youth because, broadly speaking, someone who identifies as pansexual is likely to experience many of the same aspects of biphobia as someone who identifies as bisexual and is therefore likely to be at risk for some of the same physical, mental, and sexual health problems. As providers, it’s important that we listen to, understand, and use the language that our young patients are using for themselves not only so that we can better assess what types of sexual health risks they may have, but also so that they feel that their identities are legitimate and respected by adults whom they may see as authority figures. Since only 56 percent of bisexual youths say that they know a caring adult outside of their families, making it clear that their health care provider is on their side could go a long way toward helping these young people feel that they are supported by adults in their lives.

Providers’ role in reducing risk taking among bisexual youths

The link between family acceptance and mental health, physical well-being, and risk-taking behaviors among LGBT adolescents is well-established.3Katz-Wise SL, Rosario M, Tsappis M. Lesbian, Gay, Bisexual, and Transgender Youth and Family Acceptance. Pediatr Clin North Am. 2016;63(6):1011-25. Epub 2016/11/21. doi: 10.1016/j.pcl.2016.07.005. PubMed PMID: 27865331; PubMed Central PMCID: PMCPMC5127283. The Family Acceptance Project (FAP), based at San Francisco State University, demonstrated that LGBT children who lack family acceptance are eight times more likely to attempt suicide, three times more likely to use recreational drugs, and three times more likely to be at high risk for contracting HIV.4Ryan, C. Generating a revolution in prevention, wellness & care for LGBT children & youth. Temple Political & Civil Rights Law Review. 2014;23(2):331-344. This research also indicated that family acceptance is protective against suicidal behavior, depression, and substance abuse.

Based on their scholarly work, the FAP created the FAPrisk Screener, a tool for providers to assess the level of family rejection and related health risks in LGBT youths. This resource is designed to quickly identify risk for depression, suicide, substance abuse problems, and risk for HIV and STIs. Using the FAPrisk, providers can identify areas in which youths might be at risk and can then appropriately engage with patients and their families to address these risks.

We know that the accessibility of role models is important for LGBT youths and that having inaccessible role models is associated with increased psychological stress.5Bird JD, Kuhns L, Garofalo R. The impact of role models on health outcomes for lesbian, gay, bisexual, and transgender youth. J Adolesc Health. 2012;50(4):353-7. Epub 2012/03/27. doi: 10.1016/j.jadohealth.2011.08.006. PubMed PMID: 22443838; PubMed Central PMCID: PMCPMC3313463. Working to strengthen community programs with specific representation of bisexual youths and adults is paramount to reducing this psychological stress. Since fewer bisexual youths than gay or lesbian youths reported in the HRC survey that they were aware of a place in their community that is accepting of LGBT young people, ensuring that young bisexual patients are connected with these programs is equally important.

BiNet USA has created an interactive map of the groups that exist specifically for bisexual individuals across the entire country. The Bisexual Organizing Project in Minneapolis, MN, for example, holds an annual Bisexual Empowerment Conference as well as monthly bisexual book clubs, discussion groups, and activity nights. This type of program serves as an example of the variety of resources that health care providers can support and recommend to their young bisexual patients.

With more youths identifying as bisexual than ever before, putting in the effort to address the disparities in bisexual youths’ risk-taking behaviors is a necessity and could have an enormous immediate and long-term impact on the well-being of the LGBT community.

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Juliana Madzia

Juliana Madzia is an M.D./Ph.D. student at the University of Cincinnati College of Medicine. She is pursuing a Ph.D. in sociology with a focus on environmental health disparities and urban inequality. In her free time, Juliana enjoys listening to wonky policy podcasts, running competitively, and exploring the city of Cincinnati, one coffee shop at a time.

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