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official position statements 

National Association of School Nurses, NASN

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POSITION STATEMENT - Sexual Orientation and Gender Identity/Expression



Lesbian, gay, bisexual, and transgender adolescents, as well as youth who desire or engage in same-sex sexual behavior* face the same growth and development issues as other adolescents. They have the same health education needs and safety and health concerns (Bakker & Cavender, 2003). Most develop into healthy productive adults (Harrison, 2003). However, there are unique health risks for this population, both physically and emotionally. An awareness of these risks is beginning to develop among school health personnel, educators, and administrators (Bakker & Cavender, 2003).

Youth who are lesbian, gay, bisexual, transgender, or questioning (LGBTQ) are at significantly higher risk than their heterosexual peers for sexually transmitted infection (including HIV), unwanted pregnancy, substance abuse, harassment, ostracism, and violence. These youth report higher rates of suicidal ideation and suicide attempts than their heterosexual peers (Russell & Joyner, 2002). Sexually active males who have sex with males account for 34% of all new AIDS cases among 13-24 year olds in the United States (CDC, 2000). LGBTQ youth are reported to have double the rates of tobacco use, four times the rates of cocaine use, and significantly increased use of alcohol and marijuana (CDC & Massachusetts Department of Education, 1999). Young women who identify themselves as lesbian or bisexual are at twice the risk for unwanted pregnancy as their heterosexual peers (Saewyc, Bearinger, Blum, & Resnick,1999).

LGBTQ adolescents are frequent targets of harassment and abuse at school as well as in the community. Lesbian, gay, and bisexual youth report significantly higher rates of victimization in school, and LGBTQ youth who have been victimized appear to be at greater risk than non-victimized youth for unsafe sex, alcohol and drug use, and skipping school due to feeling unsafe (Bontempo & D’Augelli, 2002). Up to 70% experience verbal and/or physical assault at school with 28% eventually becoming school dropouts (Lindley & Reininger, 2001). One fifth of LGBTQ youth are injured in a fight significantly enough to need medical attention, compared to 4.2% of their peers (CDC & Massachusetts Department of Education, 1999).

*Questioning is often used as a shorthand term for this diverse population of young people who do not identify as being lesbian, gay, or bisexual.


Development of sexual identity is a natural part of growth and development. This process is more stressful for students who are LGBTQ (Harrison, 2003). In both society and our school systems this group of students continues to be stigmatized and marginalized (Bakker & Cavender, 2002; Harrison, 2003). All students are equally deserving of respect and fair treatment and have the right to a school environment that is safe and supportive.


School nurses are skillful in identifying at-risk populations of students and developing programs to promote health and safety (Bakker & Cavender, 2003). Students who are LGBTQ have been an invisible population in our schools and school nurses need to consider the unique needs of this group of students in school program development. Discrimination based on sexual orientation, gender expression and gender identity is difficult to eradicate, and all students are entitled to a safe and supportive environment. The stress brought about by discrimination and stigmatization of LGBTQ youth lead to increased health and safety risks.


It is the position of the National Association of School Nurses that all students, regardless of sexual orientation, gender expression, and gender identity are entitled to equal opportunities in the educational system. The school nurse needs to be aware of students who are lesbian, gay, bisexual, transgender and questioning; sensitive to their needs; knowledgeable about the health needs of this group of students; and effective in interventions to reduce risk factors. The school nurse should be actively involved in fostering a safe environment, demonstrating an understanding of the issues and modeling respect for diversity.


Bakker, L. J., & Cavender, A. (2003). Promoting culturally competent care for gay youth. Journal of School Nursing, 19(2), 65-72.

Bontempo, D., & D’Augelli, A. (2002). Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths’ health risk behavior. Journal of Adolescent Health, 30, 364-374.

Massachusetts Department of Education, (1999) Massachusetts high school students and sexual orientation. Results of the 1999 youth risk behavior survey. Boston, MA, Retrieved October 23, 2002, from http://www.state.ma.us/gcgly/yrbsfl99.html 

Centers for Disease Control and Prevention. (1999 August). Young people at risk: HIV/AIDS among America’s youth. Atlanta, GA: Author.

Centers for Disease Control and Prevention (2000). HIV among African Americans. Atlanta, GA: Author.

Harrison, T.W. (2003). Adolescent homosexuality and concerns regarding disclosure. Journal of School Health, 73(3), 107-112.

Lindley, L. L. & Reininger, B. M. (2001). Support for instruction about homosexuality in South Carolina public schools. Journal of School Health, 71(1), 17-22.

Russell, S. T. & Joyner, K. (2002). Adolescent sexual orientation and suicide risk: Evidence from a national study. American Journal of Public Health, 91(8), 1276-1281.

Saewyc, E. M., Bearinger, L. H., Blum, R. W. and Resnick, M. D. (1999). Sexual intercourse, abuse, and pregnancy among adolescent women: Does sexual orientation make a difference?
Family Planning Perspectives
, 31(3), 127-131.

Adopted: September 1994
Revised: June 2003

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