Contrary to hypothesis, SGM adolescents did not score significantly lower on health literacy variables compared with cisgender heterosexual adolescents, while adolescents questioning their sexual identity scored significantly lower on all four health literacy scales compared with both SGM and cisgender heterosexual adolescents.
Key Findings
Results
SGM adolescents scored significantly higher on knowledge of STIs and knowledge of sexual health rights compared with cisgender heterosexual young men.
This finding was contrary to the study's hypothesis that SGM adolescents would score lower on health literacy variables
The comparison group was specifically cisgender heterosexual young men, not cisgender heterosexual adolescents overall
Data came from a cross-sectional survey of N = 1,438 adolescents at 15 public high schools in the Bronx, NYC
Linear regression analysis was used to test predictors of health literacy
Results
Adolescents questioning their sexual identity scored significantly lower on all four health literacy scales compared with both SGM and cisgender heterosexual adolescents.
The four health literacy scales were: (1) knowledge of STIs, (2) knowledge of sexual health rights in New York State, (3) health access literacy and self-efficacy, and (4) health communication
Questioning adolescents scored lower than both SGM peers and cisgender heterosexual peers across all four domains
This pattern held consistently across all health literacy measures examined
The authors identified questioning adolescents as a particularly vulnerable subgroup requiring targeted intervention
Results
SGM adolescents did not score significantly lower than cisgender heterosexual adolescents on any of the four health literacy variables.
This result was contrary to the study's initial hypothesis
Health literacy was defined as the capacity to acquire, understand, appraise, and apply health information, especially in health decision-making
The study sample was drawn from 15 high schools in the Bronx, NYC using a quantitative cross-sectional survey design
Sexual orientation and gender identity were tested as predictors of health literacy using linear regression
Results
The study identified cisgender heterosexual young men as a group with lower health literacy scores compared to SGM adolescents on STI knowledge and health rights knowledge.
SGM adolescents outperformed cisgender heterosexual young men specifically on knowledge of STIs and knowledge of sexual health rights in New York State
The authors recommend in-school curricula interventions that address health literacy among cisgender heterosexual young men
This suggests health literacy disparities exist within the heterosexual/cisgender population by gender
Methods
The study explored four distinct aspects of health literacy among adolescents: STI knowledge, knowledge of sexual health rights, health access literacy and self-efficacy, and health communication.
The survey was collected from N = 1,438 adolescents across 15 high schools in the Bronx, NYC
A cross-sectional quantitative design was used
Linear regression analysis was used to test sexual orientation and gender identity as predictors across all four health literacy domains
Health literacy was specifically defined as 'the capacity to acquire, understand, appraise, and apply health information, especially in health decision-making'
What This Means
This study examined whether LGBTQ+ (sexual and gender minority, or SGM) teenagers had lower health knowledge and skills compared to their straight, cisgender peers. Researchers surveyed nearly 1,500 high school students in the Bronx, New York City, measuring four areas of health literacy: knowledge about sexually transmitted infections (STIs), knowledge about their health rights in New York State, their ability to access healthcare and confidence in doing so, and their ability to communicate about health topics. Contrary to what the researchers expected, LGBTQ+ students did not score lower than heterosexual cisgender students — in fact, they scored higher on STI knowledge and health rights knowledge compared to heterosexual cisgender boys specifically.
The most notable finding was that teenagers who were questioning their sexual identity scored significantly lower than all other groups on every single health literacy measure. These questioning youth — adolescents who are unsure about or still exploring their sexual identity — appear to be a particularly underserved group when it comes to health education. The researchers suggest this may be especially important because adolescence is a critical time for decision-making about sexuality and health.
This research suggests that school-based health education programs may need to be redesigned to better reach two specific groups: questioning adolescents (who lagged behind on all health literacy measures) and heterosexual cisgender boys (who scored lower than their LGBTQ+ peers on some measures). Simply focusing on LGBTQ+ students as the primary group needing support may miss the adolescents who are struggling most with health knowledge and skills.
Marshall A, Mackson G, Kaighobadi F, Hoffman N, Ciarleglio A, Sandfort T. (2025). Health Literacy Among Sexual and Gender-Diverse Adolescents in New York City.. Health education & behavior : the official publication of the Society for Public Health Education. https://doi.org/10.1177/10901981241307616