Tag Archives: Sexual activity

Two girls kissing

Do sexual minority teenagers have greater health risks?

People who identify as gay or bisexual have long been known to be more likely than others to be at risk from behaviour which can affect their health, such as drug-taking, drinking and not doing enough exercise. But how does this affect today’s teenagers? In an era of greater social liberalism might these differences be disappearing? Professor Yvonne Kelly and Dr Cara Booker discuss new research which sheds light on the issue.

Numerous studies have shown people from sexual minorities tend to suffer disproportionately from a range of health issues, yet until now there has been a paucity of up-to-date, comprehensive evidence about the level of risk faced by this group in the UK. A recent report by the Equalities and Human Rights Commission called for more research.

Two studies have been able to shed new light on the issue. Evidence from Understanding Society, the UK Household Longitudinal Study, examines its impact on adults and suggests problems still persist despite recent social change. And research based on the Millennium Cohort Study (MCS), which has followed almost 12,000 children since their birth between 2000 and 2002, has presented an ideal opportunity to look at the health outcomes of young people while they are still growing up. 

Sexual minority adolescents

MCS is a birth cohort study which has followed up children born in the UK just after the Millennium, and it has followed up its participants at nine months, 3, 5, 7, 11 and 14 years. So using this last sweep, it was possible to look at whether sexual minority adolescents experienced more adverse outcomes than their heterosexual peers. 

Between January 2015, and April 2016, 9885 adolescents in the MCS provided a response about their sexual attraction. Six per cent identified themselves as experiencing same-sex or bisexual attraction. Of these, the large majority were female – particularly among those who said they were bisexual.

Among the 629 respondents in this group, 50 (29 female and 21 male) reported same-sex attraction only and 576 (451 female and 125 male) reported bisexual attraction – this was not the case in the samples taken for Understanding Society, where the gender split was more even.

This may be because there is a lot of fluidity in sexual orientation at younger ages – so girls who say they are bisexual at this age may not say so in the future. But the rates of young people who identify as non-heterosexual have increased over time and so we may expect more young people to be bisexual or non-heterosexual in the MCS sample, who are younger than those in the Understanding Society study.

In order to assess mental health, MCS respondents were asked if they had self-harmed in the past year; how they rated their self-esteem and their subjective wellbeing, and about their general life satisfaction. They were asked if they experienced depressive symptoms, and if they felt they were bullied or victimised. They were also asked if they had been involved in anti-social behaviour such as stealing or violence, how close they felt to their parents, whether they smoked, drank or took illegal drugs, and whether they had had unprotected sex. Their levels of physical activity and diet were also assessed.

Range of problems

The findings suggested sexual minority adolescents were more likely to suffer from a range of problems including high depressive symptoms, self-harm, lower life satisfaction, lower self-esteem and all forms of bullying and victimisation. Young people from sexual minorities also had higher odds of being less physically active, of perceiving themselves as overweight and of having dieted to lose weight. And they were more likely to suffer from more than one of these issues than their heterosexual peers were. 

However, they were no more likely to engage in violence using a weapon, regular smoking, regular cannabis use, regular drinking, or other drug use. Sexual minority adolescents did not have increased odds of engaging in sexual activity or of engaging in risky sexual behaviour, and there was no difference between sexual minority adolescents and heterosexual adolescents regarding whether they had close friendships.

It has been suggested in the past that disparities may occur because sexual minorities experience stress factors such as bullying as well as facing the stress of navigating their identity. Their experience of prejudice and possible absence of support from family and others may be linked to mental distress, and this may lead to potentially risky behaviours such as substance misuse. However, activities such as drinking, smoking, drugs and sex are also part of normal adolescent development – so we would not want to suggest they’re always a major problem.

The teenage years are a time for experimenting and pushing boundaries, something discussed in an earlier Child of our Time blog on sexual behaviour.

Sexual minorities in adulthood

All this has implications for lifelong health and social outcomes. Recent research led by Dr Cara Booker used Understanding Society data from over 40,000 individuals aged 16 and over to explore the health inequalities of sexual minority UK adults. 

Unlike the MCS study, this research included respondents who identified as ‘other’ and those who preferred not to say. And a distinction was drawn between those who identified as gay and those who identified as bisexual. Participants were asked about their physical and mental functioning, minor psychological distress, self-rated health, substance use and disability. 

Overall, heterosexual respondents had the best health while bisexual respondents had the worst. Gay and lesbian respondents reported poorer health than heterosexuals, specifically with regard to mental functioning, distress and illness. 

There were no differences in either mental or physical health between lesbian and gay respondents once socio-demographic characteristics were controlled for, and there were also some indicators on which bisexuals did not differ from other groups.

Those who were ‘other’ or preferred not to say were similar to each other and generally experienced fewer health inequalities than gay and lesbian respondents, but still had poorer health than heterosexuals. This suggests that health promotion interventions are needed for these individuals, who might not participate in interventions targeted toward known sexual minority groups. 

Range of disparities

In conclusion, these two pieces of research suggest that a range of disparities based on sexual attraction are visible as early as 14 years of age, and are likely to persist through adult life.

These results highlight the need for further prevention efforts and intervention at the school, community, and policy level to ensure that sexual minority adolescents do not face lifelong negative social, economic, and health outcomes.

Health and educational practitioners should be aware of the increased risk for adverse outcomes in sexual minority adolescents.

Schools provide an ideal infrastructure to implement effective public health change and social policies. In light of this, a new UK curriculum that teaches students about gender and relationship diversity has been developed, but the guidance around its implementation currently lacks clarity. Therefore, at the policy level, clearer guidelines for schools are needed. 

Better support for families could help, too, to alleviate tensions between parents and sexual minority adolescents. This needs further investigation. 

In conclusion, despite high-profile UK policies such as the legalisation of same sex marriage in 2013 and the introduction of sexual orientation as a protected characteristic during the lifetime of the young people in this study, the evidence presented here indicates that large inequalities in social and health outcomes still exist for sexual minority adolescents growing up in the 21st century.

Mental health, social adversity, and health-related outcomes in sexual minority adolescents: a contemporary national cohort study, by Rebekah Amos, Eric Julian Manalastas, Ross White, Henny Bos and Praveetha Patalay, was published in Lancet Child Adolescent Health 2020; 4: 36–45 https://doi.org/10.1016/ S2352-4642(19)30339-6

Sexual orientation health inequality: Evidence from Understanding Society, the United Kingdom Household Longitudinal Study, by Cara L Booker, Gerulf Rieger and Jennifer B Unger, was published in Preventive Medicine 101, 2017, 126-132.

Author affiliations: 

Professor Yvonne Kelly, ESRC International Centre for Lifecourse Studies, Institute of Epidemiology and Health Care, University College, London

Dr Cara L Booker, Institute for Social and Economic Research, University of Essex.

Girls growing up – questions of early puberty

The early onset of puberty in girls has been linked with better bone health in older women, but it is also associated with a host of negative outcomes including teenage pregnancy and serious ill health in mid-life. With girls over the last few decades starting their periods earlier and earlier, this is a real cause for concern. A better understanding is needed of who is affected and how if this trend is to be reversed and the long-term health of girls and women is to be secured. Researchers at the ESRC International Centre for Lifecourse Studies at UCL have investigated whether a girl’s socioeconomic background or ethnicity are associated with early puberty and have looked in detail at more commonly supposed links with weight and stress. Yvonne Kelly explains more.

Sexual activity whilst still young, teenage pregnancy, mental health problems, heart disease and breast cancer later in life are just some of the things linked to early puberty in girls. Over the last few decades, girls have started their periods earlier and earlier (in 2016 at around age 11, according to the NHS).

This research is the first to look over time at whether and how a girl’s social and economic circumstances and her ethnicity might be linked to the early onset of puberty. We suspected that any link that did emerge would, most likely, be explained away by other factors such as being overweight or suffering from stress.

Using information on 5,839 girls from the Millennium Cohort Study, which has been tracking the lives of nearly 20,000 children born at or around the start of the century, it was possible to know, at age 11 whether they had started their period or not.

Details of their birth weight, ethnicity, family income when they were aged 5 and height and weight when they were 7 were also available. This rich information gathered across 11 years of the girls’ lives really enabled us to put together a detailed picture over time of how these factors come together to influence the early onset of puberty.

The girls’ mothers completed questionnaires any social or emotional problems their daughter might be facing, and their own mental health.

Puberty facts and figures

Nearly one in ten of the girls, a total of 550, had started their period at age 11, with girls from the poorest families twice as likely as their most well-off peers to have done so (14.1 per cent v 6.8 per cent). Those from the second poorest group were also nearly twice as likely to have started their period.

Indian, Bangladeshi and Black African girls were most likely to have started their period at age 11, with Indian girls three and a half times more likely than their White counterparts to have done so.

Other factors

On average, girls who were heavier at age 7 and suffered stress in early childhood were more likely to have begun menstruating. Those who had started their periods early also tended to have mothers with higher stress levels, were from single parent families, and tended to have had some social and emotional difficulties themselves.

However, even when we took all these things into account, girls from the poorest and second poorest groups were still one and a half times more likely to have started their periods early.

As far as ethnicity was concerned, income, excess body weight and stress accounted for part or all of the differences in most cases. Interestingly, though with most Indian girls coming from more advantaged backgrounds than their White peers, the likelihood of them having started their period was not explained after we took all the above factors into account.

Lived experiences

Our findings highlight the different lived experiences of ethnic minority groups in the UK: for example Indians are relatively advantaged whereas Pakistanis tend to be materially disadvantaged, Bangladeshis and Black Africans are materially and psychosocially disadvantaged and have a tendency to be overweight compared with the majority ethnic group. They also demonstrate the complex and potentially opposing factors at play for the onset of puberty.

All that considered, we can say with considerable confidence that socioeconomic and ethnic disparities are indeed apparent in the UK. Given the short and long term implications for early puberty on women’s health and well being, improving our understanding of these underlying processes could help identify opportunities for interventions with benefits right across the lifecourse, not just for the girls in our study, but for future generations.

It was also encouraging to note that in the decade or so covered by the data we used, there appears to have been no further decline in the average age that girls begin puberty.

Early puberty in 11-year-old girls: Millennium Cohort Study findings is research by Yvonne Kelly, Afshin Zilanawala, Amanda Sacker, Robert Hiatt andRussell Viner and is published in Archives of Disease in Childhood.

Photo credit: Afla