See Related Article p. 27
There is now a sizeable literature documenting elevated risk-taking and poorer health status among youth who have same-sex attractions, experience same-sex sexual relationships, and/or identify as gay, lesbian, or bisexual. These disparities are evident across multiple domains, including substance use, sexual risk behaviors, depression, and suicide ideation and attempts (see Coker et al [
[1]
] for a recent, brief review). Several studies further indicate that adolescents who are attracted to both males and females might be at particular risk [2
, 3
]. The higher likelihoods of experiencing stigma, harassment, victimization, and of witnessing and perpetrating violence — and the stress these experiences can cause — are considered to be important contributors to these behavioral and health differences [4
, 5
, 6
]. The suicides of five boys aged 13–18 years between July and September 2010, which were apparently the results of anti-gay bullying and abuse, are tragic personal testimonies of the pain and desperation such victimization may inflict.In their study published in this issue of the Journal of Adolescent Health, Parkes et al [
[7]
] demonstrate that these health differences are not limited to the population of the United States. Using two large longitudinal datasets from the United Kingdom, they demonstrated that early sexual experiences with same-sex partners are associated with sexual risk-taking, pregnancy, and for boys, with experiencing forced sex. Given historical changes in tolerance of same-sex partnerships, Parkes et al noted the age of their datasets as one of the limitations of their study. However, newer data would almost certainly yield similar associations. Analyses of more recently collected data in the Netherlands, where the social acceptance of homosexuality is relatively high, found similar disparities linked to same-sex attraction in young adolescents [[8]
].Given the prevalence, salience, and severe implications of stigma and hostility toward sexual minorities, and the desire to monitor and improve the welfare of this population, it is tempting to talk about the “unique vulnerabilities” of sexual minority youth. Determining whether there is something unique to sexual minority individuals, or their experiences, that could account for risk-taking and heightened cognitive-emotional vulnerability has been a vexing question [
[9]
]. It is not clear whether, when, or for whom same-sex attraction, behavior, or identity play distinctive roles in the developmental processes that underlie risk-taking and poorer health indicators. In fact, it is not clear that the strategy of categorizing adolescents according to sexual orientation, and comparing heterosexual, bisexual, and homosexual youth, will facilitate our understanding of patterns of sexual development and their health implications. By definition, categories entail absolutes (that is, no overlap), conformity, and continuity, however this is not a reflection of the lived experience of many adolescents and adults [10
, 11
, 12
]. Categories (e.g., “bisexuals”) often include heterogeneous youth with such wide ranges of romantic and sexual experiences that it is not obvious exactly what is being assessed and compared, and therefore what we may conclude about the health implications of sexual orientation.We should reconsider whether continuing to compare individuals on the basis of sexual orientation categories, versus considering multiple facets of sexuality, is an approach that is likely to move this field forward. Categories typically fail to capture the change and complexity of sexuality, and might inadvertently contribute to both the persistence of stigma and to limit our scientific progress. Although sexual minority categories may no longer be binary, categories seem to imply a static “us-them” dichotomy that can enable intolerance. Categories may also reflect an assumption that there are distinctive developmental processes that differentially affect the health of adolescents who “belong” to different sexual orientation categories. However, not all sexual minority youth are depressed and not all heterosexual youth are happy. Suicide, sadly, is the third leading cause of death among individuals aged 15–24 years in the United States [
[13]
]. Thinking more about “within-group” variation through application of core principles of developmental science can be the foundation for moving forward to promote healthy adolescent sexual development [[9]
].Sexual orientation is about relationships and the sociocultural contexts in which they are embedded [
14
, 15
]. Developing appropriate peer relationships, including romantic partnerships, has been considered as a key developmental task of adolescence since the recognition of adolescence as a distinct developmental period of the life course. Recognizing this commonality across youth, we may better serve adolescents by approaching research, youth programs, and health care provision from an integrated perspective that does not assume that the biological sex of the person to whom an adolescent is attracted, or partners with, dictates the processes that lead to healthy sexual development.Although still aiming to account for differences in the behavior and health of youth with and without same-sex relationships, by applying broadly applicable theories of adolescent development and behavior, Parkes et al [
[7]
] took a step in the direction of not assuming the developmental primacy of same-sex attraction. Although they did not find that what have been proposed as the “core” contributors to healthy development [[16]
] measured in their study (e.g., quality of communication with parents) completely eliminate between-group differences, they do find that these contributors are important for sexual minority youth, just as they are for the broader adolescent population. Other studies examining healthy development among youth with same-sex attractions [5
, 8
, 17
] have also documented the fundamental importance of “internal and external assets” [[18]
] (e.g., social competency, familial and extra-familial contexts that offer support, limits, and positive expectations) deemed critical to healthy adolescent development. It seems more promising to place sexuality in the broader context of development if our goal is to understand healthy sexual development, and thereby promote it. This means starting our investigations from the premise that adolescents with same-sex attractions need the same assets that youth without same-sex attractions need, and that more nuanced assessment of factors, such as the quality, timing, and meaning of sexual experiences – rather than the biological sex of one's partner – are the keys to understand and promote healthy sexuality.References
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- Web-Based Injury Statistics Query and Reporting System (WISQARS) [Online].(Accessed October 24, 2010)
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© 2011 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
