Ethnic and sexual identities: inequalities in adolescent health and wellbeing in a national population-based study

Purpose This study employed an intersectional framework to examine impact of inequities related to sexual and ethnic minority identities in risk for health, wellbeing, and health-related behaviors in a nationally representative sample. Methods The study sample comprised 9,789 (51% female) adolescents aged 17 years from the UK-wide Millennium Cohort Study, with data on self-identified sexual- and ethnic-identities. Adolescents were grouped into White-Heterosexual, White sexual minority (White-SM), ethnic minority (EM)-heterosexual, and ethnic- and sexual minority (EM-SM) categories. Mental health (e.g., self-reported psychological distress, doctor-diagnosed depression, attempted suicide, victimisation), general health (self-rated health, chronic illness, Body mass index) and a range of health-related behaviors (e.g., smoking, substance use) were assessed by questionnaires. Associations were analysed using logistic and linear regression (adjusted for sex and parental income). Results Sexual minority individuals (White:18% and ethnic minority:3%) had increased odds for mental ill-health and attempted suicide, with higher odds in White-SM than EM-SM. Compared to White-heterosexual individuals, White-SM and EM-SM had higher risk for psychological distress (Odds ratios [OR]3.47/2.24 for White-SM/EM-SM respectively), and emotional problems (OR3.17/1.65). They had higher odds for attempted suicide (OR2.78/2.02), self-harm (OR3.06/1.52), and poor sleep quality (OR1.88/1.67). In contrast, White-Heterosexual and White-SM groups had similarly high proportions reporting risky behaviors except for drug use (OR1.34) and risky sex (OR1.40) which are more common in White-SM individuals. EM-Heterosexual and EM-SM individuals had decreased odds for health-related behaviors. Conclusions Sexual minority (White and EM) individuals had substantially worse mental health compared to their heterosexual peers. Adverse health-related behaviors were more common in White sexual minority individuals. Investigation into the mechanisms leading to these differences is needed.