HIV Insight: A Personal Reflection on the History of Population-Based Research with Sexual Minority Youths

As a first-year pediatrics fellow I published my very first academic article in a peer-reviewed journal in the spring of 1998. That article in Pediatrics used data collected as part of the 1995 Massachusetts Youth Risk Behavior Survey (YRBS).1 It was one of the first to examine the association between sexual orientation and health risk behaviors among a representative or population-based sample of youths. Prior to that point in my career I had never written an article, conducted statistical analyses, nor considered myself a researcher of any variety (a label that to this day I remain a bit uncomfortable with). But this one article not only was a catalyst for my own career devoted to working with and for sexual and gender minority youths, but also more importantly, it was a catalyst for a growing body of population-based research conducted with lesbian, gay, and bisexual (LGB) youths. As such, it is with a considerable amount of amazement, a hint of pride, and a great deal of humility that I write a brief historical and personal reflection to provide context for several current articles using pooled YRBS data sets from across the United States.

Less than 20 years ago, population-based data on youths in any US jurisdiction or on any relevant adolescent health disparity were essentially unavailable. Having to rely on self-selected or convenience samples in research, to a large extent the lack of representative data and research crippled the ability of leaders in the field of sexual and gender minority health to effectively use research either to craft public policies promoting the health of our community’s youths or to advocate for the creation of developmentally tailored services directed at reducing health disparities among LGB young people. In 1995, as a third-year pediatrics resident, I attended my first Society for Adolescent Medicine conference and met adolescent medicine physicians such as Bob Deischer and Gary Remafedi, who were trailblazers in working with LGB and transgender youths. It was also there in Vancouver, Canada, during the research presentations of the conference, that I first heard the phrase or limitation:

Unfortunately, research designed to examine the risk and needs of sexual minority youth is often hampered by societal stigmas about homosexuality and difficulties identifying a representative sample. Much of what is known concerning the association between gay youth and health risk behaviors is derived from studies of self-selected samples such as homeless/runaway youth, youth presenting to sexually transmitted disease clinics, or youth responding to advertisements in gay-oriented newspapers, dance clubs, or social venues.

I suspect a version of this limitation has been written and spoken by many of us who do and have done academic work related to the health and well-being of LGB and transgender youths. At that time, examinations of the association between sexual orientation and adolescent risk behaviors using representative population-based data such as the landmark work presented in the current supplement were almost entirely nonexistent.

In the following year as a first-year fellow in the Division of General Pediatrics at Boston Children’s Hospital, I found myself in the right place at the right time. With the leadership of the Massachusetts Department of Education as well as the political will under Republican Governor William Weld, the state became the first to add a sexual identity or sexual orientation question to their existing Centers for Disease Control and Prevention–sponsored YRBS survey instrument in 1995…

Below: A young [transgender woman] at night in Phrae, Thailand..