Intersectionality and Health Behaviors Among US High School Students: Examining Race/Ethnicity, Sexual Identity, and Sex

ABSTRACT BACKGROUND Little research exists examining the impact of multiple minority identities, particularly sexual orientation, race/ethnicity, and sex on health‐risk behaviors like mental health, substance use, violence, and sexual risk among high school students in the United States. In this study, we use a nationally representative dataset to examine differences between non‐Hispanic white heterosexuals (HSs) and non‐Hispanic white sexual minority, black HS, black sexual minority, Hispanic HS, and Hispanic sexual minority students. METHODS Data from the 2015 wave of the Youth Risk Behavioral Surveillance System were used in this study. Chi‐square and hierarchical logistic regression models examined differences between the groups on outcomes including: (1) mental health and suicide, (2) alcohol, tobacco, and illicit substances, (3) sexual risk and protective factors, and (4) school and physical and/or sexual violence. RESULTS Whereas sexual minority youth (SMY) generally demonstrate poorer health outcomes compared to HSs, SMY who are also racial/ethnic minorities often have even poorer health outcomes, particularly relating to substance use, sexual risk behaviors, physical/sexual violence, and suicide. CONCLUSIONS The need for culturally tailored education and school‐based interventions that consider intersections between race/ethnicity, sexual identity, and biological sex are warranted to address health disparities related to mental health and suicide, substance use, sexual risk, and violence.