LGB-Affirming School Climates and Sexual Health Outcomes Among U.S. High School Students 2015–2017: Differences by Sex and Sexual Identity

Purpose: Lesbian, gay, and bisexual (LGB) adolescents face disparities in sexual health outcomes compared to their heterosexual peers, which has implications for health outcomes and developmental trajectories. We examined whether adolescents living in jurisdictions with school climates that were more exclusionary toward LGB individuals engaged in higher risk sexual behaviors than those in jurisdictions with more inclusive school climates. Methods: Data on sexual identity, age at first sex, condom use at last sex and the number of lifetime partners came from the 2015 (20 jurisdictions) and 2017 (19 jurisdictions) Youth Risk Behavior Surveillance Surveys. Data on LGB climates in schools, aggregated to the state level, came from the School Health Profile Survey of the Centers for Disease Control and Prevention. Multilevel multivariable regressions examined the association between LGB school climate and sexual behaviors, including effect modification. Results: Overall, living in jurisdictions with more exclusionary LGB school climates was significantly associated with a lower age at first sex (β = –.04[–.07, –.02]) and a lower likelihood of condom use (OR =.94[.90,.98]), but not the number of lifetime partners. Associations differed by subgroup: sexual identity modified the relationship between school climate and age at first sex (β = –.09[–.15, –.03]) for bisexual adolescents, and school climate and condom use for bisexual (OR =.86[.76,.98]) and gay adolescents (OR =.66[.64,.68]). Conclusions: Exclusionary LGB school climates are associated with a lower age at first sex and a lower likelihood of condom use for all adolescents, and particularly bisexual individuals. Additional research and practice should address school-level climates to support adolescents’ healthy sexual development.