Background Collection of demographic information about sexual orientation (SO) and gender identity (GI) is crucial to address inequitable health outcomes for lesbian, gay, bisexual, transgender and queer/questioning (LGTBQ) youth.1,2 To begin to understand the needs of LGBTQ patients, this study describes SO and health behaviors at a pediatric emergency department (ED). Methods We administered a survey to 12-18 year olds presenting to the ED between December, 2018 and June, 2019. The survey contained questions adapted from the Minnesota Student Survey about SO, mental and sexual health, substance use, and violence.2 We grouped youth who identified as something other than “heterosexual/straight” in one category labeled “SO Minority” and “heterosexual/straight” youth as the “SO Majority.” Data were analyzed using Chi-square, Fisher’s exact, or Kruskal-Wallis tests. In total, 358 youth provided data on SO. Results There were two demographic differences in this study; SO Minority youth (24.5%) are more likely be assigned female at birth (74.4% vs. 61.5%, p=0.03) and identify as equally feminine and masculine (23.2% vs. 7.5%, p<0.01) than SO Majority youth. This study found that SO Minority youth are more likely to report being bullied than the SO Majority (37.5% vs. 21.8%, p<0.01) and of those who were bullied, they were more likely to be bullied for their religion (5.7% vs. 0.7%, p=0.01), gender (6.8% vs. 1.1%, p=0.01), gender expression (12.5% vs. 3.7%, p<0.01), size/weight (19.3% vs. 9.3%, p=0.01), and SO (15.9% vs. 0.7%, p<0.01). SO Minority youth were more likely to be depressed more than half of the days over the past two weeks (32.6% vs. 9.2%, p<0.01), experience verbal abuse (30.9% vs. 18.3%, p=0.03) and/or physical abuse in relationships (47.6% vs. 21.2%, p=0.04), and to experience homelessness without an adult (3.4% vs. 0.4%, p=0.05). The proportion of youth who were sexually active did not differ, however, SO Minority youth were more likely to have had sex with both males and females (48% vs. 2%, p<0.0001) and to have used drugs or alcohol before the last time they had sex (24.0% vs. 3.9%, p=0.01). SO Minority youth are more likely to have tried smoking (18.4% vs. 10.3%, p=0.05), smoked in the last month (68.7% vs. 18.5%, p<0.01), vaped (35.3% vs. 21.6%, p=0.01), and drank alcohol (27.6% vs. 16.7%, p=0.03). The majority of both SO Minority (68.3%) and SO Majority (83.7%) youth are comfortable talking to their providers about SO. SO Minority (37.2%, p=0.02) and SO Majority youth (40.9%, p<0.01) reported that they want to be asked about SO, but not at every visit. Discussion This research explores SO health disparities and their relationship to clinical care in the pediatric ED. The ED may be a unique and opportune place for the provision of critical resources for SO minority youth.

Figure 1

Figure 1Health Outcomes by Sexual Orientation (%)

Figure 1

Figure 1Health Outcomes by Sexual Orientation (%)

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