WINSTON-SALEM, N.C. -- Sexually active adolescent boys who have had multiple male partners are more likely than other teens to be threatened or beaten up at school and to abuse drugs and alcohol, according to a study by a team of pediatricians from Brenner Children's Hospital at the Wake Forest University Baptist Medical Center.
Armed with such knowledge, pediatricians and school counselors may be able to intervene and provide appropriate screening and support for gay teens, the team said.
The results were based on the Youth Risk Behavior Survey that was conducted in Vermont at 79 randomly selected public and private schools, said Robert H. DuRant, Ph.D., professor and vice chairman of pediatrics at Wake Forest and team leader. The results were published in the July issue of The Journal of Pediatrics.
DuRant's analysis of the voluntary and confidential survey, developed by the Centers for Disease Control and Prevention, focused on the 3,886 boys who said they were sexually active. Of these, 8.7 percent reported one or more male sexual partners.
"The number of male sexual partners reported by sexually active male adolescents correlated with a higher frequency of victimization, use of violence, and drug use at school," DuRant and his colleagues reported. "Frequency of suicide attempts and fighting outside of school were also correlated with the number of same-sex sexual partners."
They said much of the violence -- such as fighting -- appears to be more in self defense than offensive.
When they compared male students with five or more male sexual partners with those with five or more female sex partners, they confirmed the pattern. "Male students with multiple male sexual partners were significantly more likely be the victims of or threatened with physical violence, suffer property victimization at school, and be absent from school because of fear. In addition, these young men were more likely to carry weapons both in and out of school, a factor that places them at risk for involvement in violence."
The survey indicated that substance abuse was higher among male students with multiple male sex partners.
They offered a possible explanation: male students with multiple same-sex partners are more likely to be identified as having a homosexual lifestyle.
The authors also believe that simply surveying high school students may not be enough. "This study probably underestimates the true prevalence of same-sex sexual behavior among this age group because this behavior occurs more often among homeless or partially homeless adolescents who are not in school."
The researchers, who also included Daniel P. Krowchuk, M.D., associate professor of pediatrics and dermatology, and Sara H. Sinal, M.D., associate professor of pediatrics and family and community medicine, said that clinicians can apply the results of this study and another reported by DuRant in May to their practices.
"Gay adolescents may seek care from pediatricians and other health care providers regarding issues of sexual orientation, depression, substance abuse and sexually transmitted diseases."
They said such sessions may provide opportunities for appropriate screening.
"Male adolescents who are being evaluated for depression, for example, should be interviewed about substance abuse, victimization, fear of attending school, number of sexual partners and suicide risk," DuRant and his colleagues said.
"Counseling, including the need for referral to mental health providers and appropriate communication with school personnel, may also allow the provider to have an impact on the adolescent's wellbeing."
The pediatricians said community action may be helpful. "Peer support programs to promote mutual respect for gay and straight lifestyles may be helpful in decreasing victimization of gay adolescents and may thus decrease other associated high risk behavior and improve school attendance."
In the May issue of Pediatrics, DuRant had reported that more than one-third of all gay, lesbian or bisexual teenagers in a comparable Massachusetts survey reported they had attempted suicide within the previous 12 months, compared to 9.9 percent of straight teenagers.
The Massachusetts study showed youth who identify themselves as gay, lesbian or bisexual during high school are more likely to report engaging in multiple risky behaviors -- such as alcohol, drug and cigarette use, and multiple sexual partners -- and to start them at an earlier age than other teens.
But these teens also feel threatened. More than one-fourth of the gay, lesbian or bisexual teenagers in the survey reported missing school because of fear in the previous 30 days, strikingly different from just 5.1 percent among straight teens. Among the gay teens, 32.7 percent said they had been threatened with a weapon in the previous 30 days, compared to 7.1 percent among straight teens.
Journal
The Journal of Pediatrics