Health inequalities in sexual minority adolescents other than gay, lesbian and bisexual – consequences of exclusion. Findings from a national cross-sectional study

Health inequalities in sexual minority adolescents other than gay, lesbian and bisexual – consequences of exclusion. 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Findings from a national cross-sectional study Amal R. Khanolkar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6572439/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Research demonstrates that sexual minority individuals who identify with sexual identities other than lesbian, gay, bisexual (LGB) have increased risk for poor mental health. However, traditionally most health research focuses on the LGB groups and other sexual minority identities are often excluded. There is limited knowledge on health and health-related behaviours in other sexual minority identities (OSI, including those who do not disclose their sexual identity) and in comparison, to LGB and heterosexual peers. Methods This study included 9,966 adolescents (53% males, 19.8% LGB and 2% OSI) aged 17 years from the UK-wide Millennium Cohort Study. Sexual identity was self-reported, and individuals were grouped into heterosexual [reference], sexual minority [LGB] and OSI (other sexual minorities, did not disclose, not known). Multinomial logistic regression examined sociodemographic characteristics (sex, gender, ethnicity and socioeconomic position [SEP]) of the OSI group. Associations between sexual identity and a range of mental and general health, and health related behaviours were analysed using multivariable logistic regression. Outcomes included mental (like psychological distress, self-harm, attempted suicide) and general (like obesity) health, and health-related behaviours (like smoking, alcohol frequency, risky sex). Results OSI individuals were more likely to be female (Relative risk ration [RRR]2.62, 95% CI 1.81–3.77) and from families with lower parental income, compared to heterosexuals. OSI individuals had increased odds for all mental health (example, OR3.7, 2.55–5.35 for psychological distress, OR2.73, 1.71–4.35 for attempted suicide), and general health indicators (example, OR1.77, 1.22–2.57 for obesity), most often similar in strength to LGB peers. OSI individuals had lower odds for most health-related behaviours (example, OR0.46, 0.32–0.67 for ever smoking, OR0.60, 0.39–0.93 for ever drug use, OR0.25, 0.17–0.39 for ever had sex). Conclusions Adolescents who identify with ‘other’ sexual identities have significant and substantially increased odds for a wide range of mental and general health problems. Future studies should include these individuals in research on sexual minority health. There also needs to be increased efforts to recruit more or oversample sexual minority individuals in future research studies and surveys, to ensure better representation of all sexual identities facilitating more effective research to reduce health inequalities. sexual minority gender minority mental health health behaviour self-harm attempted suicide asexual adolescence Figures Figure 1 Figure 2 Figure 3 Introduction Recent decades have witnessed an exponential increase in interest and research in sexual and gender minority (SGM) health[ 1 , 2 ]. A substantial portion of this research has focused on mental health and health-related behaviours[ 1 ]. SGM individuals continue to report substantially worse mental health (for example, depression, anxiety, self-harm and suicidality) compared to heterosexual and cisgender peers[ 1 , 3 , 4 ]. This is despite considerable and positive changes in legislation recognising SGM rights in many countries around the world. Alongside, in many countries, societies have witnessed greater understanding of sexuality and acceptance of SGM groups. Nonetheless, contemporary SGM individuals, including those from younger generations, continue to report substantially worse mental health including in the UK[ 5 – 7 ]. In the UK, the 2010 Equality Act made it compulsory to collect information on SGM identities in national surveys and research studies which was extended to the national census for the first time in 2021, a move welcomed by LGBTQ + rights groups and researchers[ 3 , 8 ]. This has enabled more substantive research including examining a wider range and prevalence of health conditions, comorbidities, access to healthcare and other services among SGM individuals[ 9 , 10 ]. Prior to the 2010 Equality Act, some UK research studies like the Millennium Cohort Study, ALSPAC, and Next Steps already collected data on SGM identities. The most common way to collect data on SGM identities in the UK is self-report which is largely standardised as a single question most often with three to five possible options to choose from (see Table 1 )[ 8 ]. Traditionally, research defines SGM individuals as lesbian, gay or bisexual (LGB) and gender minority (those identifying with a gender different from that assigned at birth). In most studies and surveys, individuals have the options to not provide their sexual identity (‘prefer not to say’), opt for an option not listed (i.e., sexual minority identities other than gay, lesbian and bisexual) or state they do not know their identity (‘do not know’). Till date, for historical and practical reasons, most research on sexual minority (SM) health has focused on those individuals who identify as LGB, and individuals choosing any of the other options are most often excluded from studies. In fact, the majority of studies published between 2015 and 2024 in the UK and examining sexual identity as the main exposure or key factor of interest (primarily using data from the UK birth cohorts and other research studies) only included gay, lesbian and heterosexual individuals while excluding other sexual minority groups and those who chose not to answer or did not know their sexual identity[ 5 , 11 – 20 ]. In other cases, the other group is combined with the LGB groups in analysis to create a broader SM group which masks differences between subgroups[ 21 , 22 ]. Some studies do not provide options other than heterosexual and LGB for sexual identities[ 23 ]. Only one study on adolescents using data from the Millennium Cohort Study examined health in adolescents with ‘other sexual identities’ as a separate category[ 24 ]. Another UK study using data from the Adult Psychiatric Morbidity Survey (APMS) found adults identifying with the ‘other sexual identity’ group had increased odds for self-harm and attempted suicide, but estimates were not significant[ 7 ]. Table 1 Options for sexual identity in some of the commonly used UK datasets for sexual minority health research United Kingdom 2021 Census Millennium Cohort Study Understanding Society ALSPAC Next Steps National surveys: GP Patient Survey APMS Health Survey for England Straight/ heterosexual Completely heterosexual/ straight Heterosexual or straight 100% heterosexual (straight) Heterosexual or straight Heterosexual or straight Heterosexual or straight Heterosexual Mainly heterosexual/ straight Mostly heterosexual Gay or lesbian Completely gay or lesbian Gay or lesbian 100% homosexual (gay) Gay or lesbian Gay or lesbian Gay or lesbian Gay/lesbian, Mainly gay or lesbian Mostly homosexual Bisexual Bisexual Bisexual Bisexual Bisexual Bisexual Bisexual Bisexual Other sexual orientation Other Other Other Other Other other Prefer not to say/Do not know Prefer not to say I would prefer not to say Table 2 Distribution of study participants by key sociodemographic variables and sexual/gender identities. Estimates are N and frequencies (in italics). Sociodemographic variable Heterosexual Sexual minority Other sexual identities Total p-Value a Sex at birth Males 4,137 680 66 4,883 < 0.001 52.96 34.31 32.35 48.84 Females 3,675 1,302 138 5,115 47.04 65.69 67.65 51.16 Ethnicity White 6,193 1,727 162 8,082 < 0.001 79.31 87.22 79.41 80.88 Ethnic-minority 1,616 253 42 1,911 20.69 12.78 20.59 19.12 Parental education NVQ1 366 71 9 446 < 0.001 4.69 3.59 4.41 4.46 NVQ2 1,671 393 48 2,112 21.4 19.85 23.53 21.14 NVQ3 1,227 260 32 1,519 15.72 13.13 15.69 15.2 NVQ4 2,865 833 60 3,758 36.7 42.07 29.41 37.61 NVQ5 858 304 23 1,185 10.99 15.35 11.27 11.86 Overseas/other 820 119 32 971 10.5 6.01 15.69 9.72 Parental income Quintile 1 1,620 346 43 2,009 < 0.001 20.77 17.48 21.08 20.12 Quintile 2 1,626 367 53 2,046 20.85 18.54 25.98 20.49 Quintile 3 1,578 380 41 1,999 20.23 19.2 20.1 20.02 Quintile 4 1,480 402 43 1,925 18.97 20.31 21.08 19.28 Quintile 5 1,496 484 24 2,004 19.18 24.46 11.76 20.07 Sexual attraction Definite sexual attraction 7,634 1,927 97 9,658 < 0.001 97.72 97.23 47.55 96.6 No sexual attraction 157 51 76 284 2.01 2.57 37.25 2.84 Do not know/no answer 21 4 31 56 0.27 0.2 15.2 0.56 Gender identity Male 4,122 672 52 4,846 < 0.001 52.81 33.97 25.62 48.52 Female 3,675 1,254 98 5,027 47.08 63.4 48.28 50.34 Androgynous/GF/Non-binary/other 0 32 23 55 0 1.62 11.33 0.55 PNTS/refused 9 20 30 59 0.12 1.01 14.78 0.59 a Test for differences in proportions using Chi 2 tests (or Fisher’s exact test for variables with categories having < 5 observations) There has been little understanding of the characteristics and composition of individuals who choose not to disclose, identify with other SM identities or do not know their sexual identity. This may have significant implications as we are potentially excluding individuals from studies who could be undecided or confused about their sexual identities, choose not to disclose their sexual identity due to diverse possible reasons or identify with non-LGB sexual minority identities. This could be further compounded in younger individuals like adolescents who could still yet be undecided about their sexual identity and who are more likely to identify with asexuality and other non-LGB identities. Furthermore, the current structure of the question on sexual identities does not provide an option for other sexual minority identities like queer, pansexual and asexual or undecided. It is reasonably possible that individuals with any of these identities choose the ‘other’ option. Thus, it is possible that the group of individuals who choose any of these options is potentially a mixed group of individuals that could also include sexual minority individuals who do not proactively identify as LGB, as well as those who are undecided. Minority stress theory is the seminal and most cited theoretical framework for examining health disparities in SM groups[ 25 ]. SM individuals experience consistent and excessive stress (over and above regular stress experienced by everyone) associated with their minority identities in a largely heteronormative society, and often simultaneously experience external stressors (e.g., discrimination, harassment, stigma) and internal stressors (e.g., negative thoughts/feelings, internalised heterosexism, homophobia). External stressors include structural forms of discrimination but also include interpersonal experiences of prejudice[ 26 ]. This excessive stress ultimately leads to poor mental health (depression, anxiety and self-harm) and health risk behaviours[ 5 , 11 ]. While there is limited research on potential and unique stressors experienced by asexual and other non-LGB sexual minority individuals, recent research showed that asexual individuals reported higher levels of internalised homophobia and self-perceived stress compared to LGB peers[ 27 ]. While the minority stress theory is the dominant framework to explain worse health in SM groups, it is important to note that it is primarily based on evidence on LGB groups. Limited studies have found that asexual individuals report significantly worse mental health compared to heterosexual peers but similar to LGB peers. Other studies have found conflicting results for self-harm and attempted suicide, with some showing no differences but others finding elevated levels compared to heterosexual and LGB peers[ 27 – 29 ]. Asexual individuals are a heterogenous population, and asexuality is a spectrum including individuals with no or minimal sexual attraction to others (asexuality), individuals who require an emotional bond before experiencing sexual attraction (demisexuality), individuals who want to have romantic partners (romantic orientation) and other diverse sexual identities[ 30 , 31 ]. Given the large exclusion of non-LGB sexual minority individuals from most studies in the UK, there is little information on their sociodemographic characteristics and health. This study aimed to address this gap in a nationally representative sample of older adolescents aged 17 from the Millennium Cohort Study. Main aims included: 1) Examining the sociodemographic characteristics and 2) Mental and general health, and health related-behaviours of non-LGB sexual minority individuals and in comparison, to LGB and heterosexual peers. Materials & Methods Data and setting This cross-sectional study uses data from the Millennium Cohort Study (MCS), a nationally representative birth cohort following 19,517 children born Sept 2000-Jan 2002 and followed-up over seven sweeps (ages 9 months, 3, 5, 7, 11, 14 and 17 years) [ 36 ]. Detailed information on the MCS, along with relevant documentation can be obtained from https://cls.ucl.ac.uk/cls-studies/millennium-cohort-study/ . This study used data from the age 17 sweep (undertaken in 2018–2019) which included 10,757 children (from 10,625 families or 73.6% of the eligible sample at this sweep). The final study sample included 9,980 adolescents with information on sexual identity and sociodemographic variables (sex, ethnicity, parental income and education). MCS was oversampled for higher proportions of ethnic minorities and socioeconomically disadvantaged participants (with sample weighting ensuring national representativeness). Attrition at age 17 sweep was predicted by single-parent families, lower-income occupation and lower educational level, Black ethnicity, and male sex. Ethics approval for the MCS was obtained from the National Research Ethics Service Committee London— Central (reference 13/LO/1786). All data are anonymized and available to researchers via the UK Data Service. Cohort members ≥ 16 years provided verbal consent to take part in the study. Sexual and gender identities Based on participants’ self-reported answers on sexuality (from eight options listed in Supplementary Table 1), they were categorized into 1. Completely heterosexual, 2. SM (mainly heterosexual/straight, bisexual, mainly gay/lesbian, and completely gay/lesbian) and 3. Other/do not know/prefer not to say (hereafter ‘Other sexual identities’ or OSI). We also created a second sexual identity variable for sensitivity analysis which included 4 categories: 1. Completely heterosexual, 2. SM, 3. Other and 4. Do not know/prefer not to say. This was done to assess whether individuals identifying with sexual identities other than heterosexual or SM differed in their risk for outcomes of interest. This was conducted as a sensitivity analysis due to the small number of individuals in the ‘other’ category. We could not create more detailed SM variable with sub-groups (for example, gay, lesbian, bisexual) for analysis due to smaller numbers of individuals who identified with sub-group identities. Gender identity was assessed by the question ‘Which of the following describes how you think of yourself?’ Participants could choose from one of six options. For analysis, we collapsed these six categories into male, female, other (androgynous, non-binary, gender fluid) and those who preferred not to say or refused. For sexual attraction, participants could choose from one of seven options. For analysis, we categorised participants into those who had a 1. ‘Definite sexual attraction’ – either to the same or opposite sex, 2. ‘No sexual attraction’ and 3. ‘Do not know’. The original categories for sexual and gender identities, and sexual attraction including the final categories used in the analysis are listed in Supplemental Table 1. Key sociodemographic variables : Parents (or guardians) reported participant’s ethnicity at age 3 which was available for over 95% of participants. Information on ethnicity from subsequent sweeps (ages 7, 11 and 14) was used to replace any missing ethnicity at age 3. Subjects were grouped into either 1. White (ethnic majority) and 2. Ethnic minority (mixed, South Asian, Black and ‘other’). The ‘other’ group included participants from Asia (excluding South Asia), the Middle East and South America. Parental income and educational level were used as indicators of familial socioeconomic position. Household income (Organisation for Economic Co-operation and Development UK) was categorised into equalised quintiles (where quintiles 1 and 5 represent the lowest and highest income quintiles respectively). Parental education was based on the highest educational level of either parent or guardian and categorised according to the National Vocational Qualifications (NVQ) scheme: 1. General Certificate of Secondary Education grade D-G or lower/no qualifications, 2. General Certificate of Secondary Education grades A*-C and other equivalent, 3. A-levels and other equivalent, 4. earning a degree; 5. having a higher degree or diploma and 6. Overseas or no educational level recorded. Sex was based on sex at birth. Outcomes of interest Mental and general health indicators: (further explained in detail in Supplemental Table 2) At age 17, survey questionnaires assessed health and health-related behaviours answered by MCS participants. Mental health indicators included the binary variables of the 6-item Kessler Psychological Distress Scale for nonspecific psychological distress (K6), and the Strengths and Difficulties Questionnaire (SDQ-S) which assesses behavioural markers of mental health difficulties in young people (including its 5 subscales assessing conduct problems, hyperactivity/inattention, emotional problems [depression/anxiety], peer problems and prosocial behaviour). The K6 assessed symptoms of nonspecific psychological distress (for example, “how often do you feel depressed?’’ ) in the preceding 4 weeks[ 32 ]. Participants could choose from five options (none of the time, a little of the time, some of the time, most of the time or all the time). Items were scored to create an overall score (higher scores indicate greater levels of depression and anxiety symptoms). The total score was categorised into a binary variable (with scores ≥ 13 considered to indicate nonspecific serious psychological distress or a high likelihood of having a diagnosable mental illness)[ 33 ]. The SDQ-S is a brief emotional and behavioural screening tool for young people, consisting of 25 items divided into 5 subscales, and assesses a range of ‘strengths and difficulties’ as behavioural markers of mental health difficulties[ 34 ]. Each subscale comprises 5 items with a minimum to maximum score range of 0 to 10. Participants reported their behaviour in the previous six months with one of three possible responses: Not true, somewhat true, or certainly true (each item assigned a value of 0, 1, or 2, respectively). For each subscale, scores were summed to create an overall score ranging from 0 to 10 (higher scores reflecting higher levels of problems, except for the prosocial subscale, where higher scores indicate fewer difficulties in behaviour). Each of the 5 total scores were categorised into binary variables based on recommended cut-off points to indicate participants with ‘close to average’ vs. ‘high and very high levels’ of difficulties[ 35 ]. Internal consistency of the different scales was assessed using Cronbach’s alpha and was found to be acceptable (α > 0.7). Other mental health indicators included doctor diagnosed depression or anxiety (lifetime), self-harm (actions like burning, bruising/pinching, taking an overdose of tablets and pulling out hair) in previous 12 months, and attempted suicide (anytime previously or lifetime). Quality of sleep in the previous month was assessed by the question “During the past month, how would you rate your sleep quality overall? ” Participants could choose from one of four options: Very good, fairly good, fairly bad or very bad? Categories were combined to create a binary variable very good/fairly good vs fairly bad/very bad. General health (current) was assessed by the question ‘’How would you describe your health generally?’’ with possible answers being excellent, very good, good, fair, or poor. Chronic physical or mental health conditions was assessed by the question ‘’Do you have any physical or mental health conditions or illnesses lasting or expected to last 12 months or more?’’ . Height and weight were recorded by trained interviewers using standardized instruments used to calculate body mass index (BMI = weight/[height2]). BMI values > 50kg/m2 and < 10kg/m2 were considered implausible and coded as missing. BMI was categorised into normal vs obesity (including overweight) using the International Obesity Task Force age- and sex-specific cut-offs for 2- to 18-year-olds[ 36 ]. Health related-behaviours These were coded as binary indicators (never tried/experienced/none vs. yes) and included smoking habits (ever smokers, and current smokers), alcohol consumption, frequency of alcohol consumption in previous 12 months, any drug use, and specifically cannabis use, and frequency of cannabis use in the previous 12 months. Sexual behaviour was assessed by sexual activity (ever had intercourse) and risky sex (ever had sex without any contraception). We also examined frequency of physical activity in the previous week (none vs. any). Antisocial behavior was assessed by one or more of the following acts in the previous 12 months: Pushed or shoved/hit/slapped/punched someone, hit someone with or used a weapon, stolen something from someone, harassed someone via mobile phone/email, sent pictures or spread rumours about someone and made unwelcome sexual approaches/sexually assaulted someone. The original questions, complete component items of each scale and all health-related indicators, and how they were categorised (including references) are explained in detail in Supplementary Table S2. Statistical analysis We examined differences in proportions of sexual identities by sociodemographic variables of interest. Differences in proportions between categorical variables were tested using the chi-square test. First, we assessed associations between each sociodemographic variable (sex, parental education, parental income, ethnicity, sex, gender and sexual attraction) and sexual identities using multinomial logistic regression. We then ran a multivariable multinomial logistic regression model which was mutually adjusted for all sociodemographic variables. These multinomial regression models did not include gender identity and sexual attraction due to small numbers (< 5 individuals) in some categories. Second, we assessed associations between sexual identities and risk for all outcomes using multivariable logistic regression adjusting for sex, parental income and ethnicity. Estimates (odds ratios) were plotted for visualisation. All models were weighted with non-response weights from the birth sweep to account for the stratified cluster design of the MCS and attrition over time (using the Stata ‘svy’ command for survey data). All models were also run with the second sexual identity variable with four categories with adjustment for covariates as above. All analyses were conducted in Stata V18 (StataCorp LP, College Station, Texas). Results Of 9,789 adolescents included in the study, 1,979 (19.8%) individuals identified as sexual minority and 204 (2%) identified as other, did not disclose their sexual identity or were unsure (OSI). Further, individuals in the OSI group were more likely to be female than male (67.7% vs 47%), from families with lower income, and have parents with lower levels of education. A higher proportion of adolescents in the OSI group were ethnic minority (20.6%) compared to sexual minority (12.8%). A substantially greater proportion of the OSI adolescents reported no sexual attraction (37.3%) compared to SM (2.6%) and heterosexuals (2%). For gender identity, greater number of OSI adolescents chose the ‘prefer not to say or refused’ options (14.8%) compared to SM (1%) and heterosexual (0.12%) peers. Table 3 displays RRR for multinomial logistic regression models on associations between sociodemographic variables and sexual identities. Females (RRR 2.25, 95% CI 2.00-2.55) were more than twice as likely to identify as SM compared to males. Compared to heterosexual and White adolescents, South Asian (RRR 0.42, 0.32–0.56) and Black (RRR 0.60, 0.44–0.81) peers were less likely to identify as SM. Compared to adolescents with parents having the highest educational level (NVQ5), adolescents of parents of all other educational levels were less likely to identify as SM (with a clear gradient with decreasing educational levels). A similar pattern was observed with parental income. Females were also more than twice as likely (RRR 2.63, 1.83–3.77) to identify with the OSI category compared to males but there were no significant associations with ethnicity or parental education. However, adolescents from families with lower income (for example, RRR 2.17, 1.25–3.75 for income quintile 2) were more likely to be in the OSI group compared to peers from high income families. Mutual adjustment for sociodemographic factors made almost no difference to estimates. Table 3 Associations between sociodemographic variables and sexual identities in 9,789 young individuals aged 17 from the Millennium Cohort Study. Estimates are from multivariable multinomial logistic regression models. Sex Ethnicity Parental education Parental income All a RRR 95% CI RRR 95% CI RRR 95% CI RRR 95% CI RRR 95% CI Heterosexual Ref Ref Ref Ref Ref Sexual minority Males Ref Ref Females 2.25 2.00,2.55 2.28 2.02,2.58 Ethnicity White Ref Ref Mixed 1.44 1.07,1.95 1.36 0.99,1.87 South Asian 0.42 0.32,0.56 0.42 0.31,0.56 Black 0.60 0.44,0.81 0.58 0.43,0.78 Other 1.25 0.82,1.92 1.27 0.82,1.98 Parental education Overseas/other 0.50 0.38,0.66 0.49 0.37,0.66 NVQ1 0.54 0.39,0.74 0.49 0.35,0.69 NVQ2 0.64 0.52,0.78 0.61 0.49,0.76 NVQ3 0.56 0.44,0.69 0.53 0.42,0.67 NVQ4 0.78 0.65,0.93 0.78 0.65,0.94 NVQ5 Ref Ref Parental income Quintile 1 0.8 0.67,0.95 1.2 1.00,1.45 Quintile 2 0.79 0.66,0.94 1.08 0.90,1.30 Quintile 3 0.78 0.65,0.93 0.95 0.80,1.14 Quintile 4 0.87 0.74,1.03 0.97 0.82,1.14 Quintile 5 (Highest) Ref Ref Other sexual identities Males Ref Ref Females 2.63 1.83,3.77 2.61 1.81,3.77 Ethnicity White Ref Mixed 1.29 0.50,3.38 1.19 0.44,3.20 South Asian 1.1 0.66,1.84 0.88 0.51,1.50 Black 0.46 0.17,1.22 0.39 0.15,1.04 Other 1.24 0.53,2.88 1.05 0.43,2.59 Parental education Overseas/other 1.59 0.87,2.91 1.22 0.54,2.74 NVQ1 1.05 0.47,2.31 0.74 0.31,1.78 NVQ2 1.14 0.64,2.05 0.87 0.47,1.62 NVQ3 0.98 0.51,1.87 0.74 0.38,1.44 NVQ4 0.85 0.47,1.55 0.76 0.41,1.41 NVQ5 Ref Ref Parental income Quintile 1 1.71 0.95,3.10 1.62 0.77,3.39 Quintile 2 2.17 1.25,3.75 2.15 1.19,3.88 Quintile 3 1.47 0.81,2.68 1.54 0.82,2.90 Quintile 4 1.68 1.02,2.75 1.75 1.09,2.83 Quintile 5 (Highest) Ref Ref Observations 9983 9983 9983 9983 9983 a Model including all predictors of interest (i.e., mutually adjusted). Text in bold indicate 95% confidence intervals that do not include a relative risk ratio (RRR) = 1 Associations with health outcomes Results from logistic regression models on associations between sexual identity and health outcomes are presented in Figs. 1 and 2 , and Supplemental Tables 3–5. Compared to heterosexual individuals, SM adolescents and those in the OSI category had significantly higher OR for poorer mental (observed for all indicators) and general health. OR were similar for both groups (for example, SDQ emotional symptoms sub-scale: adjusted OR 2.5 [2.19–2.86] and OR 3.2 [2.17–4.72], attempted suicide: OR 3.1 [2.44–3.82] and OR 2.73 [1.71–4.35], for SM and OSI groups, respectively). Similarly, both groups had significantly worse general health compared to heterosexual peers (SM: OR 2.1 [1.73–2.54 and OSI: OR 2.88 [1.80–4.61]). However, the ORs for peer problems (SM: OR 2.17 [1.86–2.52], OSI: OR4.16 [2.88-6]), prosocial behaviour, mental/physical health problems, and poor sleep quality were more than twice has high in OSI individuals as compared to SM individuals (i.e., non-overlapping 95% CIs). Associations with health-related behaviours Estimates for associations between sexual identity and health-related behaviours are presented in Fig. 3 and Supplemental Table 5. SM individuals had significantly higher OR for most health-related behaviours (for example, OR 1.32 [1.12–1.56] for regular smoking, 1.61 [1.43–1.80] for cannabis use, 1.45 [1.20–1.75] for risky sex) compared to heterosexual peers. However, this was not the case for the OSI adolescents who had significantly lower OR for most health-related behaviours (e.g., drug use) or no observable difference from the heterosexual group (e.g., risky behaviour). The only exception was higher OR for lack of exercise (OR 1.60 [1.12–2.27]). Sensitivity analysis (models which included the ‘other’ and ‘prefer not to say/don’t know’ as separate categories) In these models (Supplemental Tables 6, 7 and 8), individuals with ‘other’ sexual identities had significantly higher OR for poorer mental and general health which was consistent with all indicators. In fact, ORs for peer problems, prosocial behaviour, poor sleep quality and mental/physical health problems were ≥ 2 times higher in other sexual identity individuals compared to sexual minority (LGB) individuals. Those that did not disclose their sexual identities or did not know also had higher OR for some mental health indicators (for example, peer problems OR 2.8, 1.17–6.67, mental/physical health problems OR 3.68, 1.77–7.63). However, they did not have higher odds for symptoms of depression/anxiety, self-harm, and attempted suicide compared to heterosexual peers. Similar to findings described above, both the ‘other’ and ‘prefer not to say/don’t know’ groups had significantly lower OR for almost all health-related behaviours (like ever smoking and ever had sex) or there were no differences from the heterosexual group. The only exception was lack of exercise (OR 1.76, 1.18–2.61) in the ‘Other’ group. Discussion This large study including nearly 10,000 adolescents from an ongoing UK-wide birth cohort study found that individuals who identify with SM identities other than LGB and those unsure of their sexual identity have similarly increased risk for poor mental health and consistent with multiple indicators including psychological distress, self-harm and attempted suicide as LGB peers. Interestingly, this group of individuals did not have increased risk for adverse health-related behaviours as observed for LGB peers (except for lack of physical exercise). When the non-LGB sexual minority group was split into ‘other sexual identities’ and ‘do not know/do not want to disclose’ categories, the former category had the same pattern for health and health-related behaviours as described above but less so in the latter. Main strengths include a relatively large study sample drawn from a nationally representative, highly studied and contemporary birth cohort with rich social, health and economic data, thereby facilitating generalisability to the UK adolescent population. Mental health indicators like the K6 and SDQ are widely used in studies on adolescent mental health increasing comparability with other studies both in the UK and internationally. We found associations for poorer mental health with multiple indicators which reduces the risk of chance findings. In general, missing data on all covariates (sociodemographic, mental and general health and most health-related behaviours) were relatively low (< 5%) but we did have higher levels of missing data on two HRBs, and 9% of the sample were missing data on sexual identity. Like most cohort studies, the MCS has significant attrition over follow-up (of the original 19,517 children, 10,757 attended the age 17 sweep). However, some studies have indicated that the MCS remains representative of its original birth cohort, and we used survey weights to adjust for this and ensure population-representativeness. We could not examine important factors like access to mental health services, peer-group support, SM-specific issues like rejection sensitivity, internalised stigma, gender-role strain, identity associated stigma and perceived burdensomeness which are strongly linked to mental and general health and wellbeing and are known to differ between heterosexual and SM individuals. As this is a cross-sectional study, we cannot disentangle the direction of association between sexual identities and all studied outcomes. Nonetheless, we hypothesised that sexual identities evolve over time from early adolescence and for a significant proportion these are formed before age 17. Further, the cross-sectional design precludes causality. There are some limitations with using self-reported data. Participants may not accurately recall the frequency of certain health-related behaviours like alcohol consumption and drug use during the past year leading to measurement error, but we do not expect this to vary between the different sexual identity groups. Some participants may not want to think about and/or report distressing past events like self-harm or attempted suicide leading to an underestimation of these outcomes. Data on self-harm, attempted suicide and some health-related behaviours were ascertained using single questions which may limit capturing nuanced behaviours. Nonetheless, these data are routinely captured using single questions in both research studies and national surveys and have shown to be robust indicators in adolescents and adults. Another limitation is the small numbers of individuals in some of the sexual attraction (no sexual attraction) and gender identity (androgynous/non-binary/refused) categories which precluded more nuanced analysis of gender and sexual attraction in relation to the OSI group. The small number of individuals in the OSI group (N = 204) precluded more nuanced analysis with key sociodemographic variables like SEP and ethnicity (for example, testing interactions to assess whether health in these individuals differed across intersectional categories). The age 17 questionnaire did not include explicit options for non-LGB SM individuals like asexual, pansexual, demisexual etc. which is a limitation. While we cannot be certain about the sexual identity of individuals who chose the ‘other’ option, they are more likely to identify with one of these SM identities. Further, a substantial proportion (37.3%) of the OSI group reported no sexual attraction suggesting that these individuals are more likely to identify as asexual. Our study confirms previous findings that individuals who identify with non-LGB SM identities have substantially higher risk for poorer mental health compared to heterosexual peers[ 28 ]. While evidence is consistent for depression and anxiety, findings have been mixed for self-harm and attempted suicide[ 7 ]. In fact, a recent meta-analysis found that asexual individuals had higher risk for depressive symptoms compared to heterosexual peers, but there were no differences in self-harm and attempted suicide[ 28 , 37 ]. Further, a recent UK study using data from the national APMS survey found that individuals identifying with ‘other’ sexual identities did not have increased risk for self-harm or attempted suicide[ 7 ]. However, the estimates indicated increased risk but lacked statistical significance which could be due to the small number of ‘other’ sexual identity individuals making it difficult to draw firm conclusions. This study also found that adults of ‘other’ sexual identities had greater proportions of women, were less likely to have degrees, and were socioeconomically more deprived but these findings were examined using descriptive statistics only[ 7 ]. The lower risk of health-related behaviours observed in the OSI group in this study has been reported previously in North American studies[ 27 ]. A previous study also using the age 17 MCS data found that adolescents with ‘other’ sexual identities reported higher mean psychological distress (i.e. worse mental health) and significantly higher rates of worse self-rated general health compared to heterosexual peers but similar to LGB adolescents. However, this study did not examine differences across multiple mental and general health indicators or health-related behaviours and only used descriptive statistics[ 38 ]. In contrast to our study, a large USA study with 34,273 adults found that individuals (N = 164) unsure about their sexual identity were three times more likely to report deliberate self-harm compared to heterosexual peers but direct comparisons are limited as the study did not present findings stratified by age[ 39 ]. To our knowledge, this is the first study to report a wide range of health-related behaviours in ‘other’ sexual minority adolescents in the UK and also globally. A key implication of our findings is that adolescents identifying with non-LGB SM identities should be included in studies on SM health. This group tends to be excluded from studies due to their smaller numbers (which impact statistical power) but also because of the traditional emphasis on focusing on LGB groups and lesser knowledge on their higher risk for worse health compared to heterosexual peers. In fact, this study showed that despite the small numbers in the OSI group, we found statistically significant associations with relatively narrow confidence intervals for a wide range of outcomes. Traditionally, SM health research has largely focused on LGB identities both for historical and practical reasons (most importantly that LGB identities are the most captured SM identities when sexual identity is included in surveys and studies)[ 28 ]. Less common identities like asexual, demisexual, pansexual amongst others are rarely collected, or are often collected under the broader ‘other identities’ like in the MCS. This has implications as it prevents studying health and risk factors in these groups. There needs to be a paradigm shift in both policy and research culture. For example, while there has been substantial improvement in collecting sexual identity information in surveys and research studies more generally in the UK, this can be further improved in electronic health records in both primary and secondary care. Including sufficient numbers of individuals from SM subgroups including LGB groups in large scale studies can be challenging. But methods to oversample other minority groups like ethnic minorities and socioeconomically disadvantaged groups have been successfully developed and must also be applied to SM groups who continue to encounter significant stigma, discrimination and inequities across multiple domains of life. There needs to be concerted effort to set-up dedicated large scale surveys and cohort studies specifically on SM groups. Currently, this is a serious limitation and will require both government and research funding bodies to act together. Until then, SM health research is dependent on existing studies which are not designed for this research purpose. In summary, this study using data on nearly 10,000 adolescents from an ongoing UK birth cohort study found that compared to heterosexual peers, sexual minority adolescents identifying with non-LGB identities have substantially higher risk for a wide range of mental health problems including psychological distress, self-harm and attempted suicide, similar in strength and direction as observed for LGB peers. They also report worse general health but not higher risk for health-related behaviours. This highlights the public health importance of including these individuals in studies on sexual minority health. Abbreviations SGM sexual and gender minority SM sexual minority LGB Lesbian, gay and bisexual MCS Millennium Cohort Study OSI Other sexual identities K6 Kessler Psychological Distress Scale for nonspecific psychological distress SDQ S –Strengths and Difficulties Questionnaire Declarations Ethical approval and consent to participate Ethics approval for the MCS was obtained from the National Research Ethics Service Committee London— Central (reference 13/LO/1786). All data are anonymized and available to researchers via the UK Data Service. Cohort members ≥16 years provided verbal consent to take part in the study Availability of data and materials: The data used in this study is from the Millennium Cohort Study, and the data can be downloaded via special license and after registering on the UK Data Service website (https://ukdataservice.ac.uk/) and agreeing to all terms and conditions. All data used in this study are completely anonymized and participants cannot be identified. Further information on the Millennium Cohort Study can be found on the study’s website: https://cls.ucl.ac.uk/cls-studies/millennium-cohort-study/ Competing interests: The author declares that he has no competing interests. Funding: This study was not supported by any specific source of funding. Author’s contribution: ARK conceived the research idea, was responsible for data preparation and analysis and wrote the manuscript. Acknowledgements Not applicable References Moagi MM, van Der Wath AE, Jiyane PM, Rikhotso RS: Mental health challenges of lesbian, gay, bisexual and transgender people: An integrated literature review. Health SA 2021, 26:1487. Ploderl M, Tremblay P: Mental health of sexual minorities. A systematic review. Int Rev Psychiatry 2015, 27(5):367–385. Khanolkar AR: Sexual minority health inequalities — why are we unable to do more? BMC Global Public Health 2024, 2. 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Sexual orientation, further personal characteristics, England and Wales: Census 2021. In.; 2023. Saunders CL, MacCarthy S, Meads C, Massou E, Mant J, Saunders AM, Elliott MN: Long-term conditions among sexual minority adults in England: evidence from a cross-sectional analysis of responses to the English GP Patient Survey. BJGP Open 2021, 5(5). McManus S, Gunnell D, Cooper C, Bebbington PE, Howard LM, Brugha T, Jenkins R, Hassiotis A, Weich S, Appleby L: Prevalence of non-suicidal self-harm and service contact in England, 2000-14: repeated cross-sectional surveys of the general population. Lancet Psychiatry 2019, 6(7):573–581. Khanolkar AR, Mazhari T: Ethnic and sexual orientation inequalities in mental health-obesity comorbidity, self-harm, and attempted suicide among British adolescents. Soc Psychiatry Psychiatr Epidemiol 2024. White J, Borgia S, Rehkopf DH: Socioeconomic inequalities in the risk of suicide attempts among sexual minority adolescents: Findings from the UK's Millennium Cohort Study. Lancet Reg Health Eur 2023, 26:100570. Amos R, Manalastas EJ, White R, Bos H, Patalay P: Mental health, social adversity, and health-related outcomes in sexual minority adolescents: a contemporary national cohort study. Lancet Child Adolesc Health 2020, 4(1):36–45. Becares L, Kneale D: Inequalities in mental health, self-rated health, and social support among sexual minority young adults during the COVID-19 pandemic: analyses from the UK Millennium Cohort Study. Soc Psychiatry Psychiatr Epidemiol 2022, 57(10):1979–1986. Xu Y, Norton S, Rahman Q: A longitudinal birth cohort study of early life conditions, psychosocial factors, and emerging adolescent sexual orientation. Dev Psychobiol 2020, 62(1):5–20. Chandrasekar R, Karamanos A, Learoyd A, Khanolkar AR: Sexual identity-related inequalities in associations between adverse childhood experiences and health in late adolescence-A national cohort study. PLoS One 2024, 19(12):e0312161. Andrews JL, Astle DE, Jones JS, Blakemore SJ: Mapping the role of sexuality in adolescent mental health and substance use. R Soc Open Sci 2024, 11(6):230955. Corcoran E, Althobaiti A, Lewis G, Solmi F, McCloud T, Lewis G: The association between sexual orientation and psychotic like experiences during adolescence: a prospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2024, 59(12):2351–2360. Warren AS, Goldsmith KA, Rimes KA: Childhood gender-typed behaviour, sexual orientation, childhood abuse and post-traumatic stress disorder: a prospective birth-cohort study. Int Rev Psychiatry 2022, 34(3–4):360–375. Booker CL, Meads C: Sexual Orientation and the Incidence of COVID-19: Evidence from Understanding Society in the UK Longitudinal Household Study. Healthcare (Basel) 2021, 9(8). Moreno-Agostino D, Woodhead C, Ploubidis GB, Das-Munshi J: A quantitative approach to the intersectional study of mental health inequalities during the COVID-19 pandemic in UK young adults. Soc Psychiatry Psychiatr Epidemiol 2024, 59(3):417–429. Booth C, Fitzsimons E: The onset of mental health disparities in sexual minority and majority youth: evidence from the UK Millennium Cohort Study. Dev Psychopathol 2025, 37(1):504–514. Irish M, Solmi F, Mars B, King M, Lewis G, Pearson RM, Pitman A, Rowe S, Srinivasan R, Lewis G: Depression and self-harm from adolescence to young adulthood in sexual minorities compared with heterosexuals in the UK: a population-based cohort study. Lancet Child Adolesc Health 2019, 3(2):91–98. Ricardo LIC, Smith AD, Hesketh KR, Chavez-Ugalde Y, Lee EY, van Sluijs EMF: Cross-sectional associations of gender identity and sexual orientation, with co-occurrence and clustering of health-related behaviours among British adolescents: Millennium cohort study. Prev Med 2024, 186:108084. Meyer IH: Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 2003, 129(5):674–697. Russell ST, Fish JN: Mental Health in Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth. Annu Rev Clin Psychol 2016, 12:465–487. McInroy LBB, B; Leung, V.W.Y.; Craig, S.L.; Eaton, A.D.; and Austin, A: Comparing asexual and non-asexual sexual minority adolescents and young adults: stressors, suicidality and mental and behavioural health risk outcomes. Psychology & Sexuality 2020, 13(2):387–403. Xu Y, Ma Y, Rahman Q: Comparing asexual with heterosexual, bisexual, and gay/lesbian individuals in common mental health problems: A multivariate meta-analysis. Clin Psychol Rev 2023, 105:102334. Chan RCH, Leung JSY: Experiences of minority stress and their impact on suicidality among asexual individuals. J Affect Disord 2023, 325:794–803. Brotto LA, Yule M: Asexuality: Sexual Orientation, Paraphilia, Sexual Dysfunction, or None of the Above? Arch Sex Behav 2017, 46(3):619–627. de Oliveira L, Carvalho J, Sarikaya S, Urkmez A, Salonia A, Russo GI, group E-YMsHW: Patterns of sexual behavior and psychological processes in asexual persons: a systematic review. Int J Impot Res 2021, 33(6):641–651. Kessler RC, Green JG, Gruber MJ, Sampson NA, Bromet E, Cuitan M, Furukawa TA, Gureje O, Hinkov H, Hu CY et al : Screening for serious mental illness in the general population with the K6 screening scale: results from the WHO World Mental Health (WMH) survey initiative. Int J Methods Psychiatr Res 2010, 19 Suppl 1(Suppl 1):4–22. Kim G, DeCoster J, Bryant AN, Ford KL: Measurement Equivalence of the K6 Scale: The Effects of Race/Ethnicity and Language. Assessment 2016, 23(6):758–768. Goodman R, Meltzer H, Bailey V: The Strengths and Difficulties Questionnaire: a pilot study on the validity of the self-report version. Int Rev Psychiatry 2003, 15(1–2):173–177. Information for researchers and professionals about the Strengths & Difficulties Questionnaires [https://sdqinfo.org/] Cole TJ, Bellizzi MC, Flegal KM, Dietz WH: Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000, 320(7244):1240–1243. Hill AO, Lyons A, Power J, Amos N, Ferlatte O, Jones J, Carman M, Bourne A: Suicidal Ideation and Suicide Attempts Among Lesbian, Gay, Bisexual, Pansexual, Queer, and Asexual Youth: Differential Impacts of Sexual Orientation, Verbal, Physical, or Sexual Harassment or Assault, Conversion Practices, Family or Household Religiosity, and School Experience. LGBT Health 2022, 9(5):313–324. Tabor E, Kneale D, Patalay P: Mainly heterosexual, bisexual, or other?: The measurement of sexual minority status and its impact on analytic sample, demographic distribution and health outcomes. PLoS One 2024, 19(9):e0303100. Mann AJ, Patel TA, Elbogen EB, Calhoun PS, Kimbrel NA, Wilson SM: Sexual orientation, attraction and risk for deliberate self-harm: Findings from a nationally representative sample. Psychiatry Res 2020, 286:112863. Additional Declarations No competing interests reported. Supplementary Files OtherprefernottosaystudyTablesfigures.docx OtherprefernottosaystudySupplementaldata.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6572439","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":452786373,"identity":"d58cac45-d88a-44b9-ab9d-dff0de185aee","order_by":0,"name":"Amal R. Khanolkar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIie3RMWvCQBjG8fcI6CK4RlrqV7gQSBHT9qskBMzi0NExctAugW5+jjgWOrzhhXYJ7Ro4Bycnh4wWO3iHLg5n6OZw/yEhgR95jgDYbNcZQ0BUd0eoS8ihe3zNL5kTYZpMODj/JNRO+gtaI1Sr4X13Lvjvx4/fF8CaHZBvIq6ccIR6473npYjzjQxcAmeQAwXGVTJSpCFW1LHAHsqQq2E3amFoEkOZNpo8aVL+4bcmzv4S4XKqh1GsSdJDDBTp6K8Yh3ly+oxRRUlRlcK/xcR3ib2Mcp4aj38n0+W6+aSH4kvQYIuP3turoHo3G3uZ8fyq6PyRZS0/0maz2WxtHQBmc2KXa1LFFQAAAABJRU5ErkJggg==","orcid":"","institution":"King’s College London","correspondingAuthor":true,"prefix":"","firstName":"Amal","middleName":"R.","lastName":"Khanolkar","suffix":""}],"badges":[],"createdAt":"2025-05-01 14:23:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6572439/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6572439/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82170822,"identity":"bc3d96d5-7183-4b9c-847c-0c02347e0700","added_by":"auto","created_at":"2025-05-07 09:59:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":41200,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAssociations between sexual identity and mental health in 9927 individuals ages 17 years from the Millennium Cohort Study. Estimates are from multivariable logistic regression models.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6572439/v1/42ef15aa5fef96c52e1aab36.png"},{"id":82171088,"identity":"7afc2987-a214-4c04-8e0d-c08831f14d46","added_by":"auto","created_at":"2025-05-07 10:07:34","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":25276,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAssociations between sexual identity and general health in 9927 individuals ages 17 years from the Millennium Cohort Study. Estimates are from multivariable logistic regression models.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6572439/v1/6ae3aa4b86995bc025b61434.png"},{"id":82170824,"identity":"d76190a6-35cc-4731-9dab-aedee800c4f1","added_by":"auto","created_at":"2025-05-07 09:59:34","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":38537,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eEstimates for associations between sexual identiy and health-related behaviours in 9927 individuals ages 17 years from the Millennium Cohort Study. 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Findings from a national cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRecent decades have witnessed an exponential increase in interest and research in sexual and gender minority (SGM) health[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A substantial portion of this research has focused on mental health and health-related behaviours[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. SGM individuals continue to report substantially worse mental health (for example, depression, anxiety, self-harm and suicidality) compared to heterosexual and cisgender peers[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This is despite considerable and positive changes in legislation recognising SGM rights in many countries around the world. Alongside, in many countries, societies have witnessed greater understanding of sexuality and acceptance of SGM groups. Nonetheless, contemporary SGM individuals, including those from younger generations, continue to report substantially worse mental health including in the UK[\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the UK, the 2010 Equality Act made it compulsory to collect information on SGM identities in national surveys and research studies which was extended to the national census for the first time in 2021, a move welcomed by LGBTQ\u0026thinsp;+\u0026thinsp;rights groups and researchers[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This has enabled more substantive research including examining a wider range and prevalence of health conditions, comorbidities, access to healthcare and other services among SGM individuals[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Prior to the 2010 Equality Act, some UK research studies like the Millennium Cohort Study, ALSPAC, and Next Steps already collected data on SGM identities. The most common way to collect data on SGM identities in the UK is self-report which is largely standardised as a single question most often with three to five possible options to choose from (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Traditionally, research defines SGM individuals as lesbian, gay or bisexual (LGB) and gender minority (those identifying with a gender different from that assigned at birth). In most studies and surveys, individuals have the options to not provide their sexual identity (\u0026lsquo;prefer not to say\u0026rsquo;), opt for an option not listed (i.e., sexual minority identities other than gay, lesbian and bisexual) or state they do not know their identity (\u0026lsquo;do not know\u0026rsquo;). Till date, for historical and practical reasons, most research on sexual minority (SM) health has focused on those individuals who identify as LGB, and individuals choosing any of the other options are most often excluded from studies. In fact, the majority of studies published between 2015 and 2024 in the UK and examining sexual identity as the main exposure or key factor of interest (primarily using data from the UK birth cohorts and other research studies) only included gay, lesbian and heterosexual individuals while excluding other sexual minority groups and those who chose not to answer or did not know their sexual identity[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In other cases, the other group is combined with the LGB groups in analysis to create a broader SM group which masks differences between subgroups[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Some studies do not provide options other than heterosexual and LGB for sexual identities[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Only one study on adolescents using data from the Millennium Cohort Study examined health in adolescents with \u0026lsquo;other sexual identities\u0026rsquo; as a separate category[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Another UK study using data from the Adult Psychiatric Morbidity Survey (APMS) found adults identifying with the \u0026lsquo;other sexual identity\u0026rsquo; group had increased odds for self-harm and attempted suicide, but estimates were not significant[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOptions for sexual identity in some of the commonly used UK datasets for sexual minority health research\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnited Kingdom 2021 Census\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMillennium Cohort Study\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnderstanding Society\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eALSPAC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNext Steps\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eNational surveys:\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGP Patient Survey\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAPMS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHealth Survey for England\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStraight/\u003c/p\u003e \u003cp\u003eheterosexual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCompletely heterosexual/ straight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHeterosexual or straight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100% heterosexual (straight)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHeterosexual or straight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHeterosexual or straight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHeterosexual or straight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHeterosexual\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMainly heterosexual/ straight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMostly heterosexual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGay or lesbian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCompletely gay or lesbian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGay or lesbian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100% homosexual (gay)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGay or lesbian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGay or lesbian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGay or lesbian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eGay/lesbian,\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMainly gay or lesbian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMostly homosexual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBisexual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBisexual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBisexual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBisexual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBisexual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBisexual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBisexual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBisexual\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther sexual orientation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eother\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrefer not to say/Do not know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrefer not to say\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI would prefer not to say\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of study participants by key sociodemographic variables and sexual/gender identities. Estimates are N and frequencies (in italics).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSociodemographic variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHeterosexual\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSexual minority\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOther sexual identities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-Value\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex at birth\u003c/b\u003e Males\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e680\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4,883\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e52.96\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e34.31\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e32.35\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e48.84\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5,115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e47.04\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e65.69\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e67.65\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e51.16\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8,082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e79.31\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e87.22\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e79.41\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e80.88\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthnic-minority\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,911\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e20.69\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e12.78\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e20.59\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e19.12\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParental education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNVQ1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e366\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e4.69\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e3.59\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e4.41\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e4.46\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNVQ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,671\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e393\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e21.4\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e19.85\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e23.53\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e21.14\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNVQ3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,519\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e15.72\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e13.13\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e15.69\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e15.2\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNVQ4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,865\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e833\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,758\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e36.7\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e42.07\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e29.41\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e37.61\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNVQ5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e858\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e10.99\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e15.35\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e11.27\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e11.86\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverseas/other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e820\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e971\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e10.5\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e6.01\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e15.69\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e9.72\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParental income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuintile 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e20.77\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e17.48\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e21.08\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e20.12\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuintile 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,626\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e367\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e20.85\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e18.54\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e25.98\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e20.49\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuintile 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e20.23\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e19.2\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e20.1\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e20.02\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuintile 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,480\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e402\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,925\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e18.97\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e20.31\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e21.08\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e19.28\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuintile 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,496\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e484\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e19.18\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e24.46\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e11.76\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e20.07\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSexual attraction\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDefinite sexual attraction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7,634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,927\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9,658\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e97.72\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e97.23\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e47.55\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e96.6\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo sexual attraction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e2.01\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e2.57\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e37.25\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e2.84\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo not know/no answer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e0.27\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e0.2\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e15.2\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.56\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender identity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e672\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4,846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e52.81\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e33.97\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e25.62\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e48.52\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5,027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e47.08\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e63.4\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e48.28\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e50.34\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAndrogynous/GF/Non-binary/other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e0\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e1.62\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e11.33\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.55\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePNTS/refused\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e0.12\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e1.01\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e14.78\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.59\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003ea\u003c/sup\u003eTest for differences in proportions using Chi\u003csup\u003e2\u003c/sup\u003e tests (or Fisher\u0026rsquo;s exact test for variables with categories having\u0026thinsp;\u0026lt;\u0026thinsp;5 observations)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere has been little understanding of the characteristics and composition of individuals who choose not to disclose, identify with other SM identities or do not know their sexual identity. This may have significant implications as we are potentially excluding individuals from studies who could be undecided or confused about their sexual identities, choose not to disclose their sexual identity due to diverse possible reasons or identify with non-LGB sexual minority identities. This could be further compounded in younger individuals like adolescents who could still yet be undecided about their sexual identity and who are more likely to identify with asexuality and other non-LGB identities. Furthermore, the current structure of the question on sexual identities does not provide an option for other sexual minority identities like queer, pansexual and asexual or undecided. It is reasonably possible that individuals with any of these identities choose the \u0026lsquo;other\u0026rsquo; option. Thus, it is possible that the group of individuals who choose any of these options is potentially a mixed group of individuals that could also include sexual minority individuals who do not proactively identify as LGB, as well as those who are undecided.\u003c/p\u003e \u003cp\u003eMinority stress theory is the seminal and most cited theoretical framework for examining health disparities in SM groups[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. SM individuals experience consistent and excessive stress (over and above regular stress experienced by everyone) associated with their minority identities in a largely heteronormative society, and often simultaneously experience external stressors (e.g., discrimination, harassment, stigma) and internal stressors (e.g., negative thoughts/feelings, internalised heterosexism, homophobia). External stressors include structural forms of discrimination but also include interpersonal experiences of prejudice[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This excessive stress ultimately leads to poor mental health (depression, anxiety and self-harm) and health risk behaviours[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. While there is limited research on potential and unique stressors experienced by asexual and other non-LGB sexual minority individuals, recent research showed that asexual individuals reported higher levels of internalised homophobia and self-perceived stress compared to LGB peers[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. While the minority stress theory is the dominant framework to explain worse health in SM groups, it is important to note that it is primarily based on evidence on LGB groups. Limited studies have found that asexual individuals report significantly worse mental health compared to heterosexual peers but similar to LGB peers. Other studies have found conflicting results for self-harm and attempted suicide, with some showing no differences but others finding elevated levels compared to heterosexual and LGB peers[\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Asexual individuals are a heterogenous population, and asexuality is a spectrum including individuals with no or minimal sexual attraction to others (asexuality), individuals who require an emotional bond before experiencing sexual attraction (demisexuality), individuals who want to have romantic partners (romantic orientation) and other diverse sexual identities[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven the large exclusion of non-LGB sexual minority individuals from most studies in the UK, there is little information on their sociodemographic characteristics and health. This study aimed to address this gap in a nationally representative sample of older adolescents aged 17 from the Millennium Cohort Study. Main aims included: 1) Examining the sociodemographic characteristics and 2) Mental and general health, and health related-behaviours of non-LGB sexual minority individuals and in comparison, to LGB and heterosexual peers.\u003c/p\u003e"},{"header":"Materials \u0026 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData and setting\u003c/h2\u003e \u003cp\u003eThis cross-sectional study uses data from the Millennium Cohort Study (MCS), a nationally representative birth cohort following 19,517 children born Sept 2000-Jan 2002 and followed-up over seven sweeps (ages 9 months, 3, 5, 7, 11, 14 and 17 years) [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Detailed information on the MCS, along with relevant documentation can be obtained from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://cls.ucl.ac.uk/cls-studies/millennium-cohort-study/\u003c/span\u003e\u003cspan address=\"https://cls.ucl.ac.uk/cls-studies/millennium-cohort-study/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. This study used data from the age 17 sweep (undertaken in 2018\u0026ndash;2019) which included 10,757 children (from 10,625 families or 73.6% of the eligible sample at this sweep). The final study sample included 9,980 adolescents with information on sexual identity and sociodemographic variables (sex, ethnicity, parental income and education). MCS was oversampled for higher proportions of ethnic minorities and socioeconomically disadvantaged participants (with sample weighting ensuring national representativeness). Attrition at age 17 sweep was predicted by single-parent families, lower-income occupation and lower educational level, Black ethnicity, and male sex.\u003c/p\u003e \u003cp\u003e Ethics approval for the MCS was obtained from the National Research Ethics Service Committee London\u0026mdash; Central (reference 13/LO/1786). All data are anonymized and available to researchers via the UK Data Service. Cohort members\u0026thinsp;\u0026ge;\u0026thinsp;16 years provided verbal consent to take part in the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSexual and gender identities\u003c/h3\u003e\n\u003cp\u003eBased on participants\u0026rsquo; self-reported answers on sexuality (from eight options listed in Supplementary Table\u0026nbsp;1), they were categorized into 1. Completely heterosexual, 2. SM (mainly heterosexual/straight, bisexual, mainly gay/lesbian, and completely gay/lesbian) and 3. Other/do not know/prefer not to say (hereafter \u0026lsquo;Other sexual identities\u0026rsquo; or OSI). We also created a second sexual identity variable for sensitivity analysis which included 4 categories: 1. Completely heterosexual, 2. SM, 3. Other and 4. Do not know/prefer not to say. This was done to assess whether individuals identifying with sexual identities \u003cem\u003eother than\u003c/em\u003e heterosexual or SM differed in their risk for outcomes of interest. This was conducted as a sensitivity analysis due to the small number of individuals in the \u0026lsquo;other\u0026rsquo; category. We could not create more detailed SM variable with sub-groups (for example, gay, lesbian, bisexual) for analysis due to smaller numbers of individuals who identified with sub-group identities.\u003c/p\u003e \u003cp\u003eGender identity was assessed by the question \u003cem\u003e\u0026lsquo;Which of the following describes how you think of yourself?\u0026rsquo;\u003c/em\u003e Participants could choose from one of six options. For analysis, we collapsed these six categories into male, female, other (androgynous, non-binary, gender fluid) and those who preferred not to say or refused.\u003c/p\u003e \u003cp\u003eFor sexual attraction, participants could choose from one of seven options. For analysis, we categorised participants into those who had a 1. \u0026lsquo;Definite sexual attraction\u0026rsquo; \u0026ndash; either to the same or opposite sex, 2. \u0026lsquo;No sexual attraction\u0026rsquo; and 3. \u0026lsquo;Do not know\u0026rsquo;.\u003c/p\u003e \u003cp\u003eThe original categories for sexual and gender identities, and sexual attraction including the final categories used in the analysis are listed in Supplemental Table\u0026nbsp;1.\u003c/p\u003e \u003cp\u003e \u003cem\u003eKey sociodemographic variables\u003c/em\u003e: Parents (or guardians) reported participant\u0026rsquo;s ethnicity at age 3 which was available for over 95% of participants. Information on ethnicity from subsequent sweeps (ages 7, 11 and 14) was used to replace any missing ethnicity at age 3. Subjects were grouped into either 1. White (ethnic majority) and 2. Ethnic minority (mixed, South Asian, Black and \u0026lsquo;other\u0026rsquo;). The \u0026lsquo;other\u0026rsquo; group included participants from Asia (excluding South Asia), the Middle East and South America.\u003c/p\u003e \u003cp\u003eParental income and educational level were used as indicators of familial socioeconomic position. Household income (Organisation for Economic Co-operation and Development UK) was categorised into equalised quintiles (where quintiles 1 and 5 represent the lowest and highest income quintiles respectively). Parental education was based on the highest educational level of either parent or guardian and categorised according to the National Vocational Qualifications (NVQ) scheme: 1. General Certificate of Secondary Education grade D-G or lower/no qualifications, 2. General Certificate of Secondary Education grades A*-C and other equivalent, 3. A-levels and other equivalent, 4. earning a degree; 5. having a higher degree or diploma and 6. Overseas or no educational level recorded. Sex was based on sex at birth.\u003c/p\u003e\n\u003ch3\u003eOutcomes of interest\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eMental and general health indicators: (further explained in detail in Supplemental Table\u0026nbsp;2)\u003c/h2\u003e \u003cp\u003eAt age 17, survey questionnaires assessed health and health-related behaviours answered by MCS participants. Mental health indicators included the binary variables of the 6-item Kessler Psychological Distress Scale for nonspecific psychological distress (K6), and the Strengths and Difficulties Questionnaire (SDQ-S) which assesses behavioural markers of mental health difficulties in young people (including its 5 subscales assessing conduct problems, hyperactivity/inattention, emotional problems [depression/anxiety], peer problems and prosocial behaviour).\u003c/p\u003e \u003cp\u003eThe K6 assessed symptoms of nonspecific psychological distress (for example, \u003cem\u003e\u0026ldquo;how often do you feel depressed?\u0026rsquo;\u0026rsquo;\u003c/em\u003e) in the preceding 4 weeks[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Participants could choose from five options (none of the time, a little of the time, some of the time, most of the time or all the time). Items were scored to create an overall score (higher scores indicate greater levels of depression and anxiety symptoms). The total score was categorised into a binary variable (with scores\u0026thinsp;\u0026ge;\u0026thinsp;13 considered to indicate nonspecific serious psychological distress or a high likelihood of having a diagnosable mental illness)[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The SDQ-S is a brief emotional and behavioural screening tool for young people, consisting of 25 items divided into 5 subscales, and assesses a range of \u0026lsquo;strengths and difficulties\u0026rsquo; as behavioural markers of mental health difficulties[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Each subscale comprises 5 items with a minimum to maximum score range of 0 to 10. Participants reported their behaviour in the previous six months with one of three possible responses: Not true, somewhat true, or certainly true (each item assigned a value of 0, 1, or 2, respectively). For each subscale, scores were summed to create an overall score ranging from 0 to 10 (higher scores reflecting higher levels of problems, except for the prosocial subscale, where higher scores indicate fewer difficulties in behaviour). Each of the 5 total scores were categorised into binary variables based on recommended cut-off points to indicate participants with \u0026lsquo;close to average\u0026rsquo; vs. \u0026lsquo;high and very high levels\u0026rsquo; of difficulties[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Internal consistency of the different scales was assessed using Cronbach\u0026rsquo;s alpha and was found to be acceptable (α\u0026thinsp;\u0026gt;\u0026thinsp;0.7).\u003c/p\u003e \u003cp\u003eOther mental health indicators included doctor diagnosed depression or anxiety (lifetime), self-harm (actions like burning, bruising/pinching, taking an overdose of tablets and pulling out hair) in previous 12 months, and attempted suicide (anytime previously or lifetime).\u003c/p\u003e \u003cp\u003eQuality of sleep in the previous month was assessed by the question \u003cem\u003e\u0026ldquo;During the past month, how would you rate your sleep quality overall?\u003c/em\u003e\u0026rdquo; Participants could choose from one of four options: Very good, fairly good, fairly bad or very bad? Categories were combined to create a binary variable very good/fairly good vs fairly bad/very bad.\u003c/p\u003e \u003cp\u003eGeneral health (current) was assessed by the question \u003cem\u003e\u0026lsquo;\u0026rsquo;How would you describe your health generally?\u0026rsquo;\u0026rsquo;\u003c/em\u003e with possible answers being excellent, very good, good, fair, or poor. Chronic physical or mental health conditions was assessed by the question \u003cem\u003e\u0026lsquo;\u0026rsquo;Do you have any physical or mental health conditions or illnesses lasting or expected to last 12 months or more?\u0026rsquo;\u0026rsquo;\u003c/em\u003e. Height and weight were recorded by trained interviewers using standardized instruments used to calculate body mass index (BMI\u0026thinsp;=\u0026thinsp;weight/[height2]). BMI values\u0026thinsp;\u0026gt;\u0026thinsp;50kg/m2 and \u0026lt;\u0026thinsp;10kg/m2 were considered implausible and coded as missing. BMI was categorised into normal vs obesity (including overweight) using the International Obesity Task Force age- and sex-specific cut-offs for 2- to 18-year-olds[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eHealth related-behaviours\u003c/h3\u003e\n\u003cp\u003eThese were coded as binary indicators (never tried/experienced/none vs. yes) and included smoking habits (ever smokers, and current smokers), alcohol consumption, frequency of alcohol consumption in previous 12 months, any drug use, and specifically cannabis use, and frequency of cannabis use in the previous 12 months. Sexual behaviour was assessed by sexual activity (ever had intercourse) and risky sex (ever had sex without any contraception). We also examined frequency of physical activity in the previous week (none vs. any). Antisocial behavior was assessed by one or more of the following acts in the previous 12 months: Pushed or shoved/hit/slapped/punched someone, hit someone with or used a weapon, stolen something from someone, harassed someone via mobile phone/email, sent pictures or spread rumours about someone and made unwelcome sexual approaches/sexually assaulted someone.\u003c/p\u003e \u003cp\u003eThe original questions, complete component items of each scale and all health-related indicators, and how they were categorised (including references) are explained in detail in Supplementary Table S2.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eWe examined differences in proportions of sexual identities by sociodemographic variables of interest. Differences in proportions between categorical variables were tested using the chi-square test.\u003c/p\u003e \u003cp\u003eFirst, we assessed associations between each sociodemographic variable (sex, parental education, parental income, ethnicity, sex, gender and sexual attraction) and sexual identities using multinomial logistic regression. We then ran a multivariable multinomial logistic regression model which was mutually adjusted for all sociodemographic variables. These multinomial regression models did not include gender identity and sexual attraction due to small numbers (\u0026lt;\u0026thinsp;5 individuals) in some categories.\u003c/p\u003e \u003cp\u003eSecond, we assessed associations between sexual identities and risk for all outcomes using multivariable logistic regression adjusting for sex, parental income and ethnicity. Estimates (odds ratios) were plotted for visualisation.\u003c/p\u003e \u003cp\u003eAll models were weighted with non-response weights from the birth sweep to account for the stratified cluster design of the MCS and attrition over time (using the Stata \u003cem\u003e\u0026lsquo;svy\u0026rsquo;\u003c/em\u003e command for survey data). All models were also run with the second sexual identity variable with four categories with adjustment for covariates as above.\u003c/p\u003e \u003cp\u003eAll analyses were conducted in Stata V18 (StataCorp LP, College Station, Texas).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOf 9,789 adolescents included in the study, 1,979 (19.8%) individuals identified as sexual minority and 204 (2%) identified as other, did not disclose their sexual identity or were unsure (OSI). Further, individuals in the OSI group were more likely to be female than male (67.7% vs 47%), from families with lower income, and have parents with lower levels of education. A higher proportion of adolescents in the OSI group were ethnic minority (20.6%) compared to sexual minority (12.8%). A substantially greater proportion of the OSI adolescents reported no sexual attraction (37.3%) compared to SM (2.6%) and heterosexuals (2%). For gender identity, greater number of OSI adolescents chose the \u0026lsquo;prefer not to say or refused\u0026rsquo; options (14.8%) compared to SM (1%) and heterosexual (0.12%) peers.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e displays RRR for multinomial logistic regression models on associations between sociodemographic variables and sexual identities. Females (RRR 2.25, 95% CI 2.00-2.55) were more than twice as likely to identify as SM compared to males. Compared to heterosexual and White adolescents, South Asian (RRR 0.42, 0.32\u0026ndash;0.56) and Black (RRR 0.60, 0.44\u0026ndash;0.81) peers were less likely to identify as SM. Compared to adolescents with parents having the highest educational level (NVQ5), adolescents of parents of all other educational levels were less likely to identify as SM (with a clear gradient with decreasing educational levels). A similar pattern was observed with parental income. Females were also more than twice as likely (RRR 2.63, 1.83\u0026ndash;3.77) to identify with the OSI category compared to males but there were no significant associations with ethnicity or parental education. However, adolescents from families with lower income (for example, RRR 2.17, 1.25\u0026ndash;3.75 for income quintile 2) were more likely to be in the OSI group compared to peers from high income families. Mutual adjustment for sociodemographic factors made almost no difference to estimates.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociations between sociodemographic variables and sexual identities in 9,789 young individuals aged 17 from the Millennium Cohort Study. Estimates are from multivariable multinomial logistic regression models.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eParental education\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eParental income\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eAll\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRRR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRRR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRRR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRRR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRRR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeterosexual\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSexual minority\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.25\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2.00,2.55\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e2.28\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e2.02,2.58\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.44\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1.07,1.95\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.99,1.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouth Asian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.42\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.32,0.56\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.42\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.31,0.56\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.60\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.44,0.81\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.58\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.43,0.78\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.82,1.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.82,1.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParental education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverseas/other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.50\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.38,0.66\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.49\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.37,0.66\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNVQ1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.54\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.39,0.74\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.49\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.35,0.69\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNVQ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.64\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.52,0.78\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.61\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.49,0.76\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNVQ3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.56\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.44,0.69\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.53\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.42,0.67\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNVQ4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.78\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.65,0.93\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.78\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.65,0.94\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNVQ5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParental income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuintile 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.67,0.95\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e1.2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e1.00,1.45\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuintile 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.79\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.66,0.94\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.90,1.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuintile 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.78\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.65,0.93\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.80,1.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuintile 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.74,1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.82,1.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuintile 5 (Highest)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther sexual identities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.63\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.83,3.77\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e2.61\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e1.81,3.77\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.50,3.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.44,3.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouth Asian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.66,1.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.51,1.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.17,1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.15,1.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.53,2.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.43,2.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParental education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverseas/other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.87,2.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.54,2.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNVQ1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.47,2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.31,1.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNVQ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.64,2.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.47,1.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNVQ3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.51,1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.38,1.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNVQ4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.47,1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.41,1.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNVQ5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParental income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuintile 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.95,3.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.77,3.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuintile 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e2.17\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e1.25,3.75\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e2.15\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e1.19,3.88\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuintile 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.81,2.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.82,2.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuintile 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e1.68\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e1.02,2.75\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e1.75\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e1.09,2.83\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuintile 5 (Highest)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eObservations\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e9983\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e9983\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e9983\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e9983\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cem\u003e9983\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003e\u003csup\u003ea\u003c/sup\u003eModel including all predictors of interest (i.e., mutually adjusted). Text in bold indicate 95% confidence intervals that do not include a relative risk ratio (RRR)\u0026thinsp;=\u0026thinsp;1\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eAssociations with health outcomes\u003c/h3\u003e\n\u003cp\u003eResults from logistic regression models on associations between sexual identity and health outcomes are presented in Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, and Supplemental Tables\u0026nbsp;3\u0026ndash;5. Compared to heterosexual individuals, SM adolescents and those in the OSI category had significantly higher OR for poorer mental (observed for all indicators) and general health. OR were similar for both groups (for example, SDQ emotional symptoms sub-scale: adjusted OR 2.5 [2.19\u0026ndash;2.86] and OR 3.2 [2.17\u0026ndash;4.72], attempted suicide: OR 3.1 [2.44\u0026ndash;3.82] and OR 2.73 [1.71\u0026ndash;4.35], for SM and OSI groups, respectively). Similarly, both groups had significantly worse general health compared to heterosexual peers (SM: OR 2.1 [1.73\u0026ndash;2.54 and OSI: OR 2.88 [1.80\u0026ndash;4.61]). However, the ORs for peer problems (SM: OR 2.17 [1.86\u0026ndash;2.52], OSI: OR4.16 [2.88-6]), prosocial behaviour, mental/physical health problems, and poor sleep quality were more than twice has high in OSI individuals as compared to SM individuals (i.e., non-overlapping 95% CIs).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAssociations with health-related behaviours\u003c/h2\u003e \u003cp\u003eEstimates for associations between sexual identity and health-related behaviours are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Supplemental Table\u0026nbsp;5. SM individuals had significantly higher OR for most health-related behaviours (for example, OR 1.32 [1.12\u0026ndash;1.56] for regular smoking, 1.61 [1.43\u0026ndash;1.80] for cannabis use, 1.45 [1.20\u0026ndash;1.75] for risky sex) compared to heterosexual peers. However, this was not the case for the OSI adolescents who had significantly lower OR for most health-related behaviours (e.g., drug use) or no observable difference from the heterosexual group (e.g., risky behaviour). The only exception was higher OR for lack of exercise (OR 1.60 [1.12\u0026ndash;2.27]).\u003c/p\u003e \u003cp\u003e \u003cb\u003eSensitivity analysis (models which included the \u0026lsquo;other\u0026rsquo; and \u0026lsquo;prefer not to say/don\u0026rsquo;t know\u0026rsquo; as separate categories)\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIn these models (Supplemental Tables\u0026nbsp;6, 7 and 8), individuals with \u0026lsquo;other\u0026rsquo; sexual identities had significantly higher OR for poorer mental and general health which was consistent with all indicators. In fact, ORs for peer problems, prosocial behaviour, poor sleep quality and mental/physical health problems were \u0026ge;\u0026thinsp;2 times higher in other sexual identity individuals compared to sexual minority (LGB) individuals. Those that did not disclose their sexual identities or did not know also had higher OR for some mental health indicators (for example, peer problems OR 2.8, 1.17\u0026ndash;6.67, mental/physical health problems OR 3.68, 1.77\u0026ndash;7.63). However, they did not have higher odds for symptoms of depression/anxiety, self-harm, and attempted suicide compared to heterosexual peers.\u003c/p\u003e \u003cp\u003eSimilar to findings described above, both the \u0026lsquo;other\u0026rsquo; and \u0026lsquo;prefer not to say/don\u0026rsquo;t know\u0026rsquo; groups had significantly lower OR for almost all health-related behaviours (like ever smoking and ever had sex) or there were no differences from the heterosexual group. The only exception was lack of exercise (OR 1.76, 1.18\u0026ndash;2.61) in the \u0026lsquo;Other\u0026rsquo; group.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis large study including nearly 10,000 adolescents from an ongoing UK-wide birth cohort study found that individuals who identify with SM identities other than LGB and those unsure of their sexual identity have similarly increased risk for poor mental health and consistent with multiple indicators including psychological distress, self-harm and attempted suicide as LGB peers. Interestingly, this group of individuals did not have increased risk for adverse health-related behaviours as observed for LGB peers (except for lack of physical exercise). When the non-LGB sexual minority group was split into \u0026lsquo;other sexual identities\u0026rsquo; and \u0026lsquo;do not know/do not want to disclose\u0026rsquo; categories, the former category had the same pattern for health and health-related behaviours as described above but less so in the latter.\u003c/p\u003e \u003cp\u003eMain strengths include a relatively large study sample drawn from a nationally representative, highly studied and contemporary birth cohort with rich social, health and economic data, thereby facilitating generalisability to the UK adolescent population. Mental health indicators like the K6 and SDQ are widely used in studies on adolescent mental health increasing comparability with other studies both in the UK and internationally. We found associations for poorer mental health with multiple indicators which reduces the risk of chance findings. In general, missing data on all covariates (sociodemographic, mental and general health and most health-related behaviours) were relatively low (\u0026lt;\u0026thinsp;5%) but we did have higher levels of missing data on two HRBs, and 9% of the sample were missing data on sexual identity.\u003c/p\u003e \u003cp\u003eLike most cohort studies, the MCS has significant attrition over follow-up (of the original 19,517 children, 10,757 attended the age 17 sweep). However, some studies have indicated that the MCS remains representative of its original birth cohort, and we used survey weights to adjust for this and ensure population-representativeness. We could not examine important factors like access to mental health services, peer-group support, SM-specific issues like rejection sensitivity, internalised stigma, gender-role strain, identity associated stigma and perceived burdensomeness which are strongly linked to mental and general health and wellbeing and are known to differ between heterosexual and SM individuals. As this is a cross-sectional study, we cannot disentangle the direction of association between sexual identities and all studied outcomes. Nonetheless, we hypothesised that sexual identities evolve over time from early adolescence and for a significant proportion these are formed before age 17. Further, the cross-sectional design precludes causality.\u003c/p\u003e \u003cp\u003eThere are some limitations with using self-reported data. Participants may not accurately recall the frequency of certain health-related behaviours like alcohol consumption and drug use during the past year leading to measurement error, but we do not expect this to vary between the different sexual identity groups. Some participants may not want to think about and/or report distressing past events like self-harm or attempted suicide leading to an underestimation of these outcomes. Data on self-harm, attempted suicide and some health-related behaviours were ascertained using single questions which may limit capturing nuanced behaviours. Nonetheless, these data are routinely captured using single questions in both research studies and national surveys and have shown to be robust indicators in adolescents and adults. Another limitation is the small numbers of individuals in some of the sexual attraction (no sexual attraction) and gender identity (androgynous/non-binary/refused) categories which precluded more nuanced analysis of gender and sexual attraction in relation to the OSI group. The small number of individuals in the OSI group (N\u0026thinsp;=\u0026thinsp;204) precluded more nuanced analysis with key sociodemographic variables like SEP and ethnicity (for example, testing interactions to assess whether health in these individuals differed across intersectional categories). The age 17 questionnaire did not include explicit options for non-LGB SM individuals like asexual, pansexual, demisexual etc. which is a limitation. While we cannot be certain about the sexual identity of individuals who chose the \u0026lsquo;other\u0026rsquo; option, they are more likely to identify with one of these SM identities. Further, a substantial proportion (37.3%) of the OSI group reported no sexual attraction suggesting that these individuals are more likely to identify as asexual.\u003c/p\u003e \u003cp\u003eOur study confirms previous findings that individuals who identify with non-LGB SM identities have substantially higher risk for poorer mental health compared to heterosexual peers[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. While evidence is consistent for depression and anxiety, findings have been mixed for self-harm and attempted suicide[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In fact, a recent meta-analysis found that asexual individuals had higher risk for depressive symptoms compared to heterosexual peers, but there were no differences in self-harm and attempted suicide[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Further, a recent UK study using data from the national APMS survey found that individuals identifying with \u0026lsquo;other\u0026rsquo; sexual identities did not have increased risk for self-harm or attempted suicide[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, the estimates indicated increased risk but lacked statistical significance which could be due to the small number of \u0026lsquo;other\u0026rsquo; sexual identity individuals making it difficult to draw firm conclusions. This study also found that adults of \u0026lsquo;other\u0026rsquo; sexual identities had greater proportions of women, were less likely to have degrees, and were socioeconomically more deprived but these findings were examined using descriptive statistics only[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The lower risk of health-related behaviours observed in the OSI group in this study has been reported previously in North American studies[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. A previous study also using the age 17 MCS data found that adolescents with \u0026lsquo;other\u0026rsquo; sexual identities reported higher mean psychological distress (i.e. worse mental health) and significantly higher rates of worse self-rated general health compared to heterosexual peers but similar to LGB adolescents. However, this study did not examine differences across multiple mental and general health indicators or health-related behaviours and only used descriptive statistics[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. In contrast to our study, a large USA study with 34,273 adults found that individuals (N\u0026thinsp;=\u0026thinsp;164) unsure about their sexual identity were three times more likely to report deliberate self-harm compared to heterosexual peers but direct comparisons are limited as the study did not present findings stratified by age[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. To our knowledge, this is the first study to report a wide range of health-related behaviours in \u0026lsquo;other\u0026rsquo; sexual minority adolescents in the UK and also globally.\u003c/p\u003e \u003cp\u003eA key implication of our findings is that adolescents identifying with non-LGB SM identities should be included in studies on SM health. This group tends to be excluded from studies due to their smaller numbers (which impact statistical power) but also because of the traditional emphasis on focusing on LGB groups and lesser knowledge on their higher risk for worse health compared to heterosexual peers. In fact, this study showed that despite the small numbers in the OSI group, we found statistically significant associations with relatively narrow confidence intervals for a wide range of outcomes. Traditionally, SM health research has largely focused on LGB identities both for historical and practical reasons (most importantly that LGB identities are the most captured SM identities when sexual identity is included in surveys and studies)[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Less common identities like asexual, demisexual, pansexual amongst others are rarely collected, or are often collected under the broader \u0026lsquo;other identities\u0026rsquo; like in the MCS. This has implications as it prevents studying health and risk factors in these groups. There needs to be a paradigm shift in both policy and research culture. For example, while there has been substantial improvement in collecting sexual identity information in surveys and research studies more generally in the UK, this can be further improved in electronic health records in both primary and secondary care. Including sufficient numbers of individuals from SM subgroups including LGB groups in large scale studies can be challenging. But methods to oversample other minority groups like ethnic minorities and socioeconomically disadvantaged groups have been successfully developed and must also be applied to SM groups who continue to encounter significant stigma, discrimination and inequities across multiple domains of life. There needs to be concerted effort to set-up dedicated large scale surveys and cohort studies specifically on SM groups. Currently, this is a serious limitation and will require both government and research funding bodies to act together. Until then, SM health research is dependent on existing studies which are not designed for this research purpose.\u003c/p\u003e \u003cp\u003eIn summary, this study using data on nearly 10,000 adolescents from an ongoing UK birth cohort study found that compared to heterosexual peers, sexual minority adolescents identifying with non-LGB identities have substantially higher risk for a wide range of mental health problems including psychological distress, self-harm and attempted suicide, similar in strength and direction as observed for LGB peers. They also report worse general health but not higher risk for health-related behaviours. This highlights the public health importance of including these individuals in studies on sexual minority health.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSGM\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003esexual and gender minority\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSM\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003esexual minority\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eLGB\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLesbian, gay and bisexual\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eMCS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMillennium Cohort Study\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eOSI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOther sexual identities\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eK6\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eKessler Psychological Distress Scale for nonspecific psychological distress\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSDQ\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e \u003cb\u003eS\u003c/b\u003e\u0026ndash;Strengths and Difficulties Questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval for the MCS was obtained from the National Research Ethics Service Committee London\u0026mdash; Central (reference 13/LO/1786). All data are anonymized and available to researchers via the UK Data Service. Cohort members \u0026ge;16 years provided verbal consent to take part in the study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The data used in this study is from the Millennium Cohort Study, and the data can be downloaded via special license and after registering on the UK Data Service website (https://ukdataservice.ac.uk/) and agreeing to all terms and conditions. All data used in this study are completely anonymized and participants cannot be identified. Further information on the Millennium Cohort Study can be found on the study\u0026rsquo;s website: https://cls.ucl.ac.uk/cls-studies/millennium-cohort-study/\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The author declares that he has no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This study was not supported by any specific source of funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contribution:\u003c/strong\u003e ARK conceived the research idea, was responsible for data preparation and analysis and wrote the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMoagi MM, van Der Wath AE, Jiyane PM, Rikhotso RS: Mental health challenges of lesbian, gay, bisexual and transgender people: An integrated literature review. 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Lancet Child Adolesc Health 2019, 3(2):91\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRicardo LIC, Smith AD, Hesketh KR, Chavez-Ugalde Y, Lee EY, van Sluijs EMF: Cross-sectional associations of gender identity and sexual orientation, with co-occurrence and clustering of health-related behaviours among British adolescents: Millennium cohort study. Prev Med 2024, 186:108084.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeyer IH: Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 2003, 129(5):674\u0026ndash;697.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRussell ST, Fish JN: Mental Health in Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth. Annu Rev Clin Psychol 2016, 12:465\u0026ndash;487.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcInroy LBB, B; Leung, V.W.Y.; Craig, S.L.; Eaton, A.D.; and Austin, A: Comparing asexual and non-asexual sexual minority adolescents and young adults: stressors, suicidality and mental and behavioural health risk outcomes. Psychology \u0026amp; Sexuality 2020, 13(2):387\u0026ndash;403.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu Y, Ma Y, Rahman Q: Comparing asexual with heterosexual, bisexual, and gay/lesbian individuals in common mental health problems: A multivariate meta-analysis. Clin Psychol Rev 2023, 105:102334.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan RCH, Leung JSY: Experiences of minority stress and their impact on suicidality among asexual individuals. J Affect Disord 2023, 325:794\u0026ndash;803.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrotto LA, Yule M: Asexuality: Sexual Orientation, Paraphilia, Sexual Dysfunction, or None of the Above? Arch Sex Behav 2017, 46(3):619\u0026ndash;627.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Oliveira L, Carvalho J, Sarikaya S, Urkmez A, Salonia A, Russo GI, group E-YMsHW: Patterns of sexual behavior and psychological processes in asexual persons: a systematic review. Int J Impot Res 2021, 33(6):641\u0026ndash;651.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKessler RC, Green JG, Gruber MJ, Sampson NA, Bromet E, Cuitan M, Furukawa TA, Gureje O, Hinkov H, Hu CY \u003cem\u003eet al\u003c/em\u003e: Screening for serious mental illness in the general population with the K6 screening scale: results from the WHO World Mental Health (WMH) survey initiative. 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BMJ 2000, 320(7244):1240\u0026ndash;1243.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHill AO, Lyons A, Power J, Amos N, Ferlatte O, Jones J, Carman M, Bourne A: Suicidal Ideation and Suicide Attempts Among Lesbian, Gay, Bisexual, Pansexual, Queer, and Asexual Youth: Differential Impacts of Sexual Orientation, Verbal, Physical, or Sexual Harassment or Assault, Conversion Practices, Family or Household Religiosity, and School Experience. LGBT Health 2022, 9(5):313\u0026ndash;324.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTabor E, Kneale D, Patalay P: Mainly heterosexual, bisexual, or other?: The measurement of sexual minority status and its impact on analytic sample, demographic distribution and health outcomes. PLoS One 2024, 19(9):e0303100.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMann AJ, Patel TA, Elbogen EB, Calhoun PS, Kimbrel NA, Wilson SM: Sexual orientation, attraction and risk for deliberate self-harm: Findings from a nationally representative sample. Psychiatry Res 2020, 286:112863.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"sexual minority, gender minority, mental health, health behaviour, self-harm, attempted suicide, asexual, adolescence","lastPublishedDoi":"10.21203/rs.3.rs-6572439/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6572439/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eBackground\u003c/b\u003e Research demonstrates that sexual minority individuals who identify with sexual identities other than lesbian, gay, bisexual (LGB) have increased risk for poor mental health. However, traditionally most health research focuses on the LGB groups and other sexual minority identities are often excluded. There is limited knowledge on health and health-related behaviours in other sexual minority identities (OSI, including those who do not disclose their sexual identity) and in comparison, to LGB and heterosexual peers.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMethods\u003c/b\u003e This study included 9,966 adolescents (53% males, 19.8% LGB and 2% OSI) aged 17 years from the UK-wide Millennium Cohort Study. Sexual identity was self-reported, and individuals were grouped into heterosexual [reference], sexual minority [LGB] and OSI (other sexual minorities, did not disclose, not known). Multinomial logistic regression examined sociodemographic characteristics (sex, gender, ethnicity and socioeconomic position [SEP]) of the OSI group. Associations between sexual identity and a range of mental and general health, and health related behaviours were analysed using multivariable logistic regression. Outcomes included mental (like psychological distress, self-harm, attempted suicide) and general (like obesity) health, and health-related behaviours (like smoking, alcohol frequency, risky sex).\u003c/p\u003e \u003cp\u003e \u003cb\u003eResults\u003c/b\u003e OSI individuals were more likely to be female (Relative risk ration [RRR]2.62, 95% CI 1.81\u0026ndash;3.77) and from families with lower parental income, compared to heterosexuals. OSI individuals had increased odds for all mental health (example, OR3.7, 2.55\u0026ndash;5.35 for psychological distress, OR2.73, 1.71\u0026ndash;4.35 for attempted suicide), and general health indicators (example, OR1.77, 1.22\u0026ndash;2.57 for obesity), most often similar in strength to LGB peers. OSI individuals had lower odds for most health-related behaviours (example, OR0.46, 0.32\u0026ndash;0.67 for ever smoking, OR0.60, 0.39\u0026ndash;0.93 for ever drug use, OR0.25, 0.17\u0026ndash;0.39 for ever had sex).\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusions\u003c/b\u003e Adolescents who identify with \u0026lsquo;other\u0026rsquo; sexual identities have significant and substantially increased odds for a wide range of mental and general health problems. Future studies should include these individuals in research on sexual minority health. There also needs to be increased efforts to recruit more or oversample sexual minority individuals in future research studies and surveys, to ensure better representation of all sexual identities facilitating more effective research to reduce health inequalities.\u003c/p\u003e","manuscriptTitle":"Health inequalities in sexual minority adolescents other than gay, lesbian and bisexual – consequences of exclusion. 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