Association between sexual identity, health risk behaviors, and mental health outcomes among Black adolescents: Findings from a population-based study

Purpose: Although research shows that lesbian, gay, bisexual, and questioning (LGBQ) adolescents are at greater risk of experiencing poor mental health outcomes, few studies have investigated the association between sexual identity and health risk behaviors among Black adolescents. The objective of this study was to investigate the association between sexual identity and a broad range of health risk behaviors and mental health outcomes among Black adolescents. Methods: Data were obtained from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 4,798 Black adolescents (51.2% female) was analyzed using weighted binary logistic regression. We examined the association between sexual identity and 24 outcome variables grouped into: mental health (four variables), substance use (six variables), risky driving behaviors (four variables), risky sexual behaviors (four variables), violent behaviors (three variables), and victimization (three variables). Results: Of the 4,798 Black adolescents, 82.6% self-identified as heterosexual/straight, 3.7% gay/lesbian, 9.3% bisexual, and 4.5% questioning their sexual identity. Controlling for age and sex, Black adolescents who self-identified as LGBQ were more likely to have engaged in risky driving behaviors, risky sexual behaviors, violent behaviors, been victimized, experienced poor mental health, and engaged in substance use when compared to their counterparts who self-identified as heterosexual/straight. Conclusions: The findings of this study indicate that Black LGBQ adolescents were more likely to have been exposed to or engaged in high-risk behaviors. School staff, parents, and community-based providers should work to create environments that feel safe and welcoming to racially and sexually diverse students.