Childhood Experiences of Identity-Related Discrimination and Associated Health Risks in the United States, 2021-2023

To estimate the prevalence of parent-reported sexual orientation and gender identity (SOGI) discrimination among US children and adolescents and examine associated demographic, health, and adversity-related characteristics.

We analyzed 2021 to 2023 National Survey of Children's Health (NSCH) data, a cross-sectional, caregiver-reported survey of U.S. children. We compared sociodemographic characteristics, health conditions, adverse childhood experiences (ACEs), co-occurring discrimination, and family context by SOGI discrimination status among children ages 6 to 17. Multivariable logistic regression identified characteristics independently associated with SOGI discrimination. Analyses incorporated survey weights and were stratified by age group.

Among 93,982 children ages 6 to 17, 2.2% were reported to have experienced SOGI-based discrimination. Relative to those without reported discrimination, they were more frequently female, older, and less likely to live in 2-parent households. They had significantly higher rates of co-occurring discrimination based on race or health status, bullying, depression, anxiety, ADHD, and learning disabilities, and their caregivers reported greater stress. ACEs-including economic hardship, parental divorce, parental incarceration, and household violence-were significantly more prevalent among those with SOGI-based discrimination. In multivariable regression, co-occurring race- and health-based discrimination, female sex, and older age showed the strongest independent associations; most ACEs and neurodevelopmental conditions did not remain significant after adjustment. Adolescents had higher rates of SOGI-based discrimination (3.5%) compared to children ages 6 to 11 (0.7%).

SOGI-based discrimination is strongly associated with co-occurring adversity and mental health concerns beginning in childhood. These findings highlight the importance of early, trauma-informed, and affirming approaches within pediatric settings.