Fenway and Harvard researchers identify sexual orientation as a key social determinant of safety belt non-use in adolescents

According to the February 2014 issue of American Journal of Public Health, sexual orientation identity is a key social determinant of safety belt non-use in adolescents (Reisner et al., 2014). The study was conducted by Sari Reisner, ScD of The Fenway Institute and Harvard School of Public Health and Aimee Van Wagenen, PhD of Fenway, in collaboration with colleagues Allegra Gordon, MPH at Harvard School of Public Health and Jerel Calzo, PhD at Harvard Medical School and Boston Children’s Hospital.

The study team investigated the prevalence of passenger safety belt use among US high school students and tested for differences in safety belt use by sexual orientation identity. Pooled data were analyzed from the Youth Risk Behavior Survey (YRBS) conducted in 2005 and 2007 across 9 jurisdictions that included a measure of sexual orientation identity (Boston, MA; Chicago, IL; Delaware; Maine; Massachusetts; New York City, NY; San Francisco, CA; Vermont; and Rhode Island) (for detailed Methodology please see Mustanski et al., 2014). The pooled data were made available for analysis by an initiative of Fenway’s Center for Population Research in LGBT Health.

Male bisexuals had 48% increased odds of nonuse of safety belts relative to male heterosexuals. Lesbians had 85% increased odds, bisexual women 46% increased odds, and women unsure of their sexual orientation 51% increased odds than female heterosexuals of safety belt nonuse. These models accounted for other known risk factors associated with safety belt non-use, including sociodemographics (age, race/ethnicity), individual risk factors (body mass index, depression, binge drinking, passenger of drunk driver, academic achievement), and contextual risk factors (secondary versus primary safety belt legislation, percentage of the jurisdiction’s population living below poverty and same-sex couples per 1,000 households).

Lead investigator Dr. Sari Reisner said, “Safety belt nonuse among sexual minorities is an unexplored research area. There are studies that document disparities in safety belt nonuse in youth by other social determinants – for example, by race/ethnicity – but these studies do not consider sexual orientation. This is the first study, to our knowledge, that has been able to say that sexual minority adolescents are at-risk.”

The team’s findings did replicate previous research showing racial/ethnic disparities in safety belt non-use. Black, Latino, and other minority race/ethnicity male and female youth each had elevated prevalence of safety belt non-use compared to white (non-Hispanic) males and females, respectively. In addition, consistent with prior research, secondary safety laws (police ticket unbelted drivers only when they are stopped for other reasons, such as speeding) versus primary laws (police stop and ticket drivers solely for not wearing a safety belt) were associated with safety belt nonuse, suggesting primary safety belt laws effectively increase safety belt use. However, the team found sexual orientation was uniquely associated with safety belt nonuse, adjusting for race/ethnicity and for safety belt laws.

In light of the disproportionate rates of safety belt nonuse among sexual minority youth in this study, it is possible that sexual minorities are overrepresented in the adverse effects of motor vehicle crashes. U.S data are not available on motor vehicle crashes by sexual orientation identity. Thus, it is not known whether sexual orientation health disparities exist in death, disability, and injuries from motor vehicle crashes. No data have been collected on safety belt use in gender minority youth who are transgender and gender nonconforming.

A key goal of Healthy People 2020 is to reduce health disparities. Sexual orientation and gender identity are not standardized demographic questions routinely included in US health surveillance efforts. Given the ubiquity of health disparities in LGBT adolescent populations across a variety of health outcomes, including safety belt nonuse (see the February 2014 AJPH issue for evidence of health disparities in different domains), survey questions that identify LGBT youth are no longer optional—they are mandatory. Monitoring the health of sexual and gender minority youth, including progress toward reducing health disparities, necessitates that U.S. surveillance systems ask inclusive questions to identify sexual and gender minority youth in order to improve the health and wellbeing of all people.


Reisner SL, Van Wagenen A, Gordon A, Calzo JP. (2014). Disparities in Safety Belt Use by Sexual Orientation Identity Among US High School Students. American Journal of Public Health, 104 (2), 311-318.

Mustanski B, Van Wagenen A, Birkett M, Eyster S,  Corliss HL. (2014). Identifying Sexual Orientation Health Disparities in Adolescents: Analysis of Pooled Data From the Youth Risk Behavior Survey, 2005 and 2007. American Journal of Public Health, 104(2), 211-217.





Leave a Reply