CDC Report Finds Gay, Lesbian and Bisexual Students At Greater Risk for Unhealthy, Unsafe Behaviors

CDC Report Finds Gay, Lesbian and Bisexual Students At Greater Risk for Unhealthy, Unsafe Behaviors

Students who report being gay, lesbian or bisexual and students who report having sexual contact only with persons of the same sex or both sexes are more likely than heterosexual students and students who report having sexual contact only with the opposite sex to engage in unhealthy risk behaviors such as tobacco use, alcohol and other drug use, sexual risk behaviors, suicidal behaviors, and violence, according to a study by the Centers for Disease Control and Prevention.
"This report should be a wake-up call for families, schools and communities that we need to do a much better job of supporting these young people. Any effort to promote adolescent health and safety must take into account the additional stressors these youth experience because of their sexual orientation, such as stigma, discrimination, and victimization," said Howell Wechsler, Ed.D, M.P.H, director of CDC's Division of Adolescent and School Health (DASH). "We are very concerned that these students face such dramatic disparities for so many different health risks."
This report represents the first time that the federal government has conducted an analysis of this magnitude across a wide array of states, large urban school districts, and risk behaviors.
Researchers analyzed data from Youth Risk Behavior Surveys conducted during 2001–2009 in seven states—Connecticut, Delaware, Maine, Massachusetts, Rhode Island, Vermont, and Wisconsin—and six large urban school districts—Boston, Chicago, Milwaukee, New York City, San Diego, and San Francisco. These sites collected data on high school students' sexual identity (heterosexual, gay or lesbian, bisexual, or unsure), sex of sexual contacts (sexual contact with the opposite sex only, with the same sex only, or with both sexes), or both.
The study, "Sexual Identity, Sex of Sexual Contacts, and Health Risk Behaviors Among Students in Grades 9–12 in Selected Sites—Youth Risk Behavior Surveillance, United States, 2001–2009," was published as a Morbidity and Mortality Weekly Report Surveillance Summary. Findings across 76 health risks in the following 10 categories are highlighted:

• Behaviors that contribute to unintentional injuries (e.g., rarely or never wore a seat belt)
• Behaviors that contribute to violence (e.g., did not go to school because of safety concerns)
• Behaviors related to attempted suicide (e.g., made a suicide plan)
• Tobacco use (e.g., ever smoked cigarettes)
• Alcohol use (e.g., binge drinking)
• Other drug use (e.g., current marijuana use)
• Sexual behaviors (e.g., condom use)
• Dietary behaviors (e.g., ate vegetables 3 or more times per day)
• Physical activity and sedentary behaviors (e.g., physically active at least 60 minutes per day for 7 days)
• Weight management (e.g., did not eat for 24 hours or more to lose weight or to keep from gaining weight)

Across the sites that assessed sexual identity, gay or lesbian students had higher prevalence rates for 49 percent to 90 percent of all health risks measured. Specifically, gay or lesbian students had higher rates for seven of the 10 health risk categories (behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight management).
Similarly, bisexual students had higher prevalence rates for 57 percent to 86 percent of all health risks measured. They also had higher rates for eight of the 10 health risk categories (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 youth to thrive in their schools and communities, they need to feel socially, emotionally, and physically safe and supported," said Laura Kann, Ph.D., chief, Surveillance and Evaluation Research Branch, DASH. "Schools and communities should take concrete steps to promote healthy environments for all students, such as prohibiting violence and bullying, creating safe spaces where young people can receive support from caring adults, and improving health education and health services to meet the needs of lesbian, gay, and bisexual youth."
National, state, and local YRBSs are conducted every two years among high school students throughout the United States. These surveys monitor health risk behaviors, including unintentional injuries and violence; tobacco, alcohol, and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, including HIV infection; unhealthy dietary behaviors; and physical inactivity. These surveys also monitor the prevalence of obesity and asthma. Interested states and large urban school districts may add questions to measure sexual identity and the sex of sexual contacts.

Health Risks Among Sexual Minority Youth

Sexual minority youth—those who identify as gay, lesbian, or bisexual or who have sexual contact with persons of the same or both sexes—are part of every community and come from all walks of life. They are diverse, representing all races, ethnicities, socioeconomic statuses, and parts of the country.
While many sexual minority youth cope with the transition from childhood to adulthood successfully and become healthy and productive adults, others struggle as a result of challenges such as stigma, discrimination, family disapproval, social rejection, and violence. Sexual minority youth are also at increased risk for certain negative health outcomes. For example, young gay and bisexual males have disproportionately high rates of HIV, syphilis, and other sexually transmitted diseases (STDs), and adolescent lesbian and bisexual females are more likely to have ever been pregnant than their heterosexual peers.

A New CDC Report

Related Resources

• Report (PDF)  [pdf 3M] Report (HTML)
• Backgrounder  [pdf 138K]
• HIV and Young Men Who Have Sex With Men  [pdf 521K]

To understand more about behaviors that can contribute to negative health outcomes among sexual minority students, CDC analyzed data from the Youth Risk Behavior Surveillance System (YRBSS). The findings of this analysis are described in a new CDC Morbidity and Mortality Weekly Report, “Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors Among Students in Grades 9–12 in Selected Sites—Youth Risk Behavior Surveillance, United States, 2001–2009.” The report documents the disproportionate rates at which sexual minority students reported many health risks, including tobacco, alcohol, and other drug use; sexual risk behaviors; and violence.
For this report, CDC analyzed data from Youth Risk Behavior Surveys conducted during 2001–2009 in seven states—Connecticut, Delaware, Maine, Massachusetts, Rhode Island, Vermont, and Wisconsin—and six large urban school districts—Boston, Chicago, Milwaukee, New York City, San Diego, and San Francisco—that collected data on high school students’ sexual identity (heterosexual, gay, lesbian, bisexual, or unsure), sex of sexual contacts (sexual contact with the opposite sex only, with the same sex only, or with both sexes), or both.
Sexual minority students were defined as those who identified themselves as gay, lesbian, or bisexual; who had had sexual contact only with persons of the same sex; or who had had sexual contact with persons of both sexes. Collecting information about students’ sexual identity and about the sex of their sexual contacts is necessary because some students identify themselves as heterosexual but report having sexual contact only with persons of the same sex, whereas some students who identify themselves as gay, lesbian or bisexual have not had sexual contact. Therefore, questions about sexual identity and sex of sexual contacts can help identify a broader range of individuals as sexual minority students.

What this Report Shows

The findings from this report show the disproportionate rates at which sexual minority students experience many health risks, compared with non-sexual minority students. This disproportionate risk is most apparent among students who identify themselves as gay, lesbian, or bisexual and who have had sexual contact with both sexes.
This report represents the first time that the federal government has conducted an analysis of this magnitude across such a wide array of states, large urban school districts, and risk behaviors. Specifically, the report summarizes results by sexual minority status across 13 sites and 76 health risks in the following 10 categories:

Behaviors that contribute to violence (e.g., did not go to school because of safety concerns) Behaviors related to attempted suicide (e.g., made a suicide plan) Behaviors that contribute to unintentional injuries (e.g., rarely or never wore a seat belt) Tobacco use (e.g., ever smoked cigarettes) Alcohol use (e.g., binge drinking)

Other drug use (e.g., current marijuana use) Sexual behaviors (e.g., condom use) Dietary behaviors (e.g., ate vegetables 3 or more times per day) Physical activity and sedentary behaviors (e.g., physically active at least 60 minutes per day for 7 days) Weight management (e.g., did not eat for 24 or more hours to lose weight or to keep from gaining weight)

Risks by sexual identity

Nine states and large urban school districts assessed sexual identity. Across these locations, the percentage of all health risks for which the prevalence was higher for gay or lesbian students than it was for heterosexual students ranged from 49% to 90%. Gay and lesbian students had higher prevalence rates than heterosexual students for health risks in seven of the 10 health risk categories (behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight management).

For example—

• The prevalence of current cigarette use ranged from 8% to 19% among heterosexual students but ranged from 20% to 48% among gay and lesbian students.

Similarly, the percentage of all health risks for which the prevalence was higher for bisexual students than it was for heterosexual students ranged from 57% to 86% across the nine locations. Bisexual students had higher prevalence rates than heterosexual students for health risks in eight of the 10 health risk categories (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—

• The prevalence of students who did not go to school because of safety concerns on at least 1 day during the 30 days before the survey ranged from 4% to 11% among heterosexual students but ranged from 11% to 25% among bisexual students.

Risks by sex of sexual contacts

Twelve states and large urban school districts assessed sex of sexual contacts. Across these locations, the percentage of all health risks for which the prevalence was higher for students who had sexual contact with both sexes than it was for students who only had sexual contact with the opposite sex ranged from 32% to 86%. Students who had sexual contact with both sexes had higher prevalence rates than those who only had sexual contact with the opposite sex for health risks in six of the 10 health risk categories (behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, and weight management).

For example—

• The prevalence of binge drinking ranged from 16% to 44% among students who only had sexual contact with the opposite sex, but from 33% to 63% among students who had sexual contact with both sexes.

Recommendations from this Report

Policies and Practices

• Public health and school health policies and practices should be developed to support the establishment of safe and supportive environments for sexual minority students.
  • By addressing the challenges sexual minority students face, such as stigma, discrimination, family disapproval, social rejection, and violence, schools can help to improve health outcomes and reduce the prevalence of health-risk behaviors.

Professional Development

• Professional development should be provided for school staff and others who work with sexual minority youth, and effective programs should be implemented.
  • School staff members and others can benefit from training to help them understand the needs of sexual minority students and implement effective programs and services to reduce health risks among these young people.

Future Surveys

• The results of this report highlight the disproportionate impact of negative health outcomes on sexual minority students and indicate a need to include questions on sexual identity and the sex of sexual contacts when monitoring health risks and selected health outcomes among high school students.
  • In 2009, 10 states and 7 large urban school districts added questions to their YRBS questionnaire about sexual identity, sex of sexual contacts, or both.

Going to the ER

Almost everyone who lives with pain has been to the emergency room at some time.
You may have gone because your pain was out of control and you could not reach your own health care team.  You may have gone because you feared that your pain was a sign of a new medical problem.   You may have gone because you have no insurance. Or your own doctor may have sent you there.
A randomized survey conducted by the ACPA and the American College of Emergency Medicine Physicians found these reason and more among the 500 people with recurring or chronic pain who visited the emergency department (ED) once or more in the last two years. To see the full survey results, click here.
While most of the people surveyed were satisfied with their treatment in the ED, there were important gaps between what people expected from their visit and what they experienced.  This site can help you know what to expect in case you need to go to the ED in the future. When you are prepared, you are likely to have a more positive experience.

Clostridium difficile infection rate has risen among hospitalized children since late 1990s

Child/Adolescent Health

Clostridium difficile infection rate has risen among hospitalized children since late 1990s The number of cases of Clostridium difficile infection (CDI) among hospitalized children in the United States more than doubled over a 10-year period, according to a new study. A bacterium that can colonize the gastrointestinal tract, C. difficile can cause symptoms ranging from nothing to severe diarrhea, inflammation of the colon, bowel perforation, and even death. The researchers found that the incidence of CDI in hospitalized children increased from 3,565 cases in 1997 to 7,779 cases in 2006. Children with CDI had a 20 percent greater risk of death and a 36 percent higher risk of requiring surgery to remove part of or the entire colon. In addition, children diagnosed with CDI were four times more likely to have an extended hospital stay and twice as likely to have higher hospital costs than hospitalized children not infected by C. difficile. The researchers found no trend in the severity of CDI over time, despite the disease's increased incidence. However, patients with inflammatory bowel disease were 11.4 times as likely to have CDI compared with childlren without this condition. Solid-organ transplants, HIV infection, and transplantation of blood-forming stem cells—all requiring or resulting in immune suppression—increased the odds of CDI 3.3- to 4.5-fold in adjusted multivariable analysis. The researchers used data from the AHRQ-funded Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP-KID) for 1997, 2000, 2003, and 2006. HCUP-KID is a stratified random sample of 5.8 million inpatient discharges for children from 22 to 38 States (depending on the year). For 2006, it represented an estimated 89 percent of all pediatric hospital discharges in the United States. The study was funded in part by the Agency for Healthcare Research and Quality (HS016957). More details are in "Clostridium difficile infection in hospitalized children in the United States," by Cade M. Nylund, M.D., Anthony Goudie, Ph.D., Jose M. Garza, M.D., and others in the May 2011 Archives of Pediatrics and Adolescent Medicine 165(5), pp. 451-457.

No greater risk or mortality observed for endoscopic vein harvesting for coronary bypass surgery

Patient Safety and Quality

No greater risk or mortality observed for endoscopic vein harvesting for coronary bypass surgery During coronary artery bypass surgery, a vein is taken from the leg to replace blocked arteries in the heart. Today, the majority of vein harvesting is done endoscopically rather than using an open surgical procedure. By using this minimally invasive approach, the surgeon can reduce pain and infection. Recently, some experts have questioned whether this approach to leg vein harvesting may expose patients to the risk of vein-graft failure, death, heart attack, and repeated blockages after surgery. A new study that compared the two techniques over a 4-year period found no increase in harm to patients who underwent endoscopic vein harvesting. Between 2001 and 2004, 8,542 patients underwent coronary artery bypass grafting procedures in northern New England. More than half (52.5 percent) had endoscopic vein harvesting. Over the study period, endoscopic vein harvesting grew in popularity, from 34 percent in 2001 to 75 percent in 2004. Patients receiving endoscopic vein harvesting were more likely to be male, have vascular disease, and have two-vessel disease. They were less likely to have a history of a heart attack or congestive heart failure. In terms of hospital outcomes, open surgical harvesting was associated with an increase in postoperative leg wound infections. On the other hand, endoscopic harvesting resulted in an increase in patients being returned to the operating room to correct postoperative bleeding. With respect to long-term outcomes, there was a significant reduction in long-term mortality with endoscopic harvesting. The relatively small increased risk of repeat revascularization over four years with endoscopic harvesting was non-significant. The study was supported in part by the Agency for Healthcare Research and Quality (HS15663). See "Long-term outcomes of endoscopic vein harvesting after coronary artery bypass grafting," by Lawrence J. Dacey, M.D., John H., Braxton, Jr., M.D., Robert S. Kramer, M.D., and others in the January 18, 2011, Circulation 123(2), pp. 147-153.

Lung Diseases and Conditions

Many steps are involved in breathing. If injury, disease, or other factors affect any of the steps, you may have trouble breathing.
For example, the fine hairs (cilia) that line your upper airways may not trap all of the germs you breathe in. These germs can cause an infection in your bronchial tubes (bronchitis) or deep in your lungs (pneumonia). These infections cause a buildup of mucus and/or fluid that narrows the airways and limits airflow in and out of your lungs.
If you have asthma, breathing in certain substances that you're sensitive to can trigger your airways to narrow. This makes it hard for air to flow in and out of your lungs.
Over a long period, breathing in cigarette smoke or air pollutants can damage the airways and the air sacs. This can lead to a condition called COPD (chronic obstructive pulmonary disease). COPD prevents proper airflow in and out of your lungs and can hinder gas exchange in the air sacs.
An important step to breathing is the movement of your diaphragm and other muscles in your chest, neck, and abdomen. This movement lets you inhale and exhale. Nerves that run from your brain to these muscles control their movement. Damage to these nerves in your upper spinal cord can cause breathing to stop, unless a machine is used to help you breathe. (This machine is called a ventilator or a respirator.)
A steady flow of blood in the small blood vessels that surround your air sacs is vital for gas exchange. Long periods of inactivity or surgery can cause a blood clot called a pulmonary embolism (PE) to block a lung artery. A PE can reduce or block the flow of blood in the small blood vessels and hinder gas exchange.

Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they’re widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don’t directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You’ll learn about treatments and tests you may receive, and the benefits and risks they may pose. You’ll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you’ll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to your disease or condition, talk with your doctor.