A scoping review of 21 studies found that most observed significant associations between policy and health for sexual and gender minority youth, but identified major gaps including insufficient gender identity data collection, limited longitudinal methods, and near-absence of research specifically on transgender youth.
Key Findings
Methods
Twenty-one studies met the inclusion criteria for testing the relationship between policy and health for sexual and gender minority youth (SGMY) in the United States.
Seven databases were searched for English peer-reviewed studies published between 2000 and 2023.
Studies were required to test the association between individual or composite measures of policy and mental health, substance use, or sexual health.
Eligible participants were SGMY aged 26 or younger.
The review was guided by the Population, Concept, and Context framework and the PRISMA Extension for Scoping Reviews checklist.
Results
Eighteen of the 21 included studies observed significant associations between policy and health for SGMY.
18 out of 21 studies (approximately 86%) found significant policy-health associations.
The health outcomes examined included mental health, substance use, and sexual health.
Policies examined included both individual and composite policy measures.
The studies covered SGMY aged 13–26 living in the United States.
Results
Only two of the 21 studies assessed the policy-health association specifically for transgender youth.
This represents a major gap given that transgender youth are a distinct subgroup with unique policy-relevant exposures.
The authors identified improved gender identity data collection as a key priority to address this gap.
The near-absence of transgender-specific research was highlighted as a limitation of the existing literature.
Results
Most included studies were cross-sectional and heavily relied on Youth Risk Behavior Survey (YRBS) data.
Cross-sectional study designs were the predominant methodology across the 21 included studies.
Heavy reliance on YRBS data was noted as a characteristic of the existing literature.
The authors identified a need for greater use of longitudinal and quasiexperimental methods to advance the field.
Cross-sectional designs limit causal inference about policy effects on health.
Discussion
The authors identified improved sexual orientation and gender identity (SOGI) data collection in national data sources as a critical need for advancing SGMY health policy research.
Gender identity data collection was specifically highlighted as a particular gap compared to sexual orientation data.
The authors also called for measurement guidance and design testing to improve research quality.
Assessment of proximal mechanisms and implementation strategies through which policies impact health was identified as a further research need.
These gaps were identified through synthesis of the 21 included studies.
Conclusions
The scoping review documented that SGMY health policy research would benefit from longitudinal and quasiexperimental study designs.
The current heavy reliance on cross-sectional designs was identified as limiting the field's ability to establish causal relationships between policy and health.
Quasiexperimental methods were specifically recommended as an advancement opportunity.
Longitudinal approaches were identified alongside quasiexperimental methods as needed improvements.
These methodological gaps were framed as 'opportunities to advance research in SGMY health policy.'
What This Means
This research conducted a scoping review — a broad survey of existing studies — to understand what scientists have learned about how laws and policies affect the health of sexual and gender minority young people (such as lesbian, gay, bisexual, transgender, and queer youth) in the United States. The researchers searched seven academic databases and found 21 studies published between 2000 and 2023 that tested how policies relate to mental health, substance use, or sexual health in this population. The large majority of those studies — 18 out of 21 — found that policies were significantly associated with health outcomes for these youth, suggesting that the legal and policy environment meaningfully shapes their wellbeing.
Despite this overall positive finding, the review revealed important gaps. Almost all studies used cross-sectional data (a snapshot in time rather than following people over time), and most relied on the same national survey — the Youth Risk Behavior Survey. Critically, only two studies specifically looked at transgender youth, even though this group faces distinct policy environments and health challenges. The data tools available to researchers also largely lack good measures of gender identity, making it difficult to study transgender and nonbinary youth at all.
This research suggests that the science connecting policy to SGMY youth health is still in early stages and needs significant improvement. Better data collection on gender identity in national surveys, more studies that track youth over time, stronger research designs that can better establish cause and effect, and research that examines how and why policies affect health would all help build the evidence base needed to inform laws and programs that support the health of sexual and gender minority young people.
Fish J, Dunkwu L, Tchangalova N, McFarlane S. (2025). Associations Between Policy and Health for Sexual and Gender Minority Youth in the United States: A Scoping Review.. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. https://doi.org/10.1016/j.jadohealth.2025.02.018