J Primary Prevent (2010) 31:273309

DOI 10.1007/s10935-010-0229-1

LITERATURE REVIEW

A Systematic Review of Parental Influences on the Health

and Well-Being of Lesbian, Gay, and Bisexual Youth: Time
for a New Public Health Research and Practice Agenda
Alida Bouris Vincent Guilamo-Ramos Angela Pickard

Chengshi Shiu Penny S. Loosier Patricia Dittus

Kari Gloppen J. Michael Waldmiller

Published online: 15 December 2010

 Springer Science+Business Media, LLC 2010

Abstract Relatively little is known about how
parents influence the health and well-being of lesbian,
gay, and bisexual (LGB) adolescents and young
adults. This gap has led to a paucity of parent-based
interventions for LGB young people. A systematic
literature review on parental influences on the health
of LGB youth was conducted to better understand
how to develop a focused program of applied public
health research. Five specific areas of health among
A. Bouris (&)
C. Shiu
University of Chicago School of Social Service
Administration, 969 E. 60th St., Chicago, IL 60637, USA
e-mail: abouris@uchicago.edu
V. Guilamo-Ramos
New York University Silver School of Social Work,
1 Washington Square North, New York, NY 10003, USA
e-mail: vincent.ramos@nyu.edu
A. Pickard
University of Toronto Dalla Lana School of Public
Health, Toronto, Canada
e-mail: angela.pickard@utoronto.ca
P. S. Loosier
P. Dittus
K. Gloppen

J. Michael Waldmiller
Centers for Disease Control and Prevention,
Atlanta, GA, USA
e-mail: plf4@cdc.gov
P. Dittus
e-mail: pdd6@cdc.gov
K. Gloppen
e-mail: kmgloppen@gmail.com
LGB young people aged 1024 years old were
examined: (a) sexual behavior; (b) substance use;
(c) violence and victimization; (d) mental health; and
(e) suicide. A total of 31 quantitative articles were
reviewed, the majority of which were cross-sectional
and relied on convenience samples. Results indicated
a trend to focus on negative, and not positive,
parental influences. Other gaps included a dearth of
research on sexual behavior, substance use, and
violence/victimization; limited research on ethnic
minority youth and on parental influences identified
as important in the broader prevention science
literature; and no studies reporting parent perspec-
tives. The review highlights the need for future
research on how parents can be supported to promote
the health of LGB youth. Recommendations for
strengthening the research base are provided.
Keywords Parental influences
Gay
Lesbian

Bisexual
Same-sex attraction
Adolescents
Young
adults
Health risk behavior
Sexual behavior

Mental health
Violence
Victimization
Suicide

Substance use
Introduction
Research on the health and well-being of lesbian, gay,
and bisexual (LGB) adolescents and young adults
(i.e., youth) has grown considerably in the past

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20 years (Anhalt and Morris 1998; Maher et al. 2010).
In part, the increase has reflected concern over data
indicating that LGB youth are a vulnerable group
whose health warrants a significant public health
focus. For example, studies indicate that many LGB
youth encounter stigma, verbal harassment, or phys-
ical violence in response to their sexual orientation
(Bontempo and DAugelli 2002; Huebner et al. 2004).
Experiences with victimization and discrimination
have been associated with mental health distress
(Hershberger and DAugelli 1995), and research has
shown that, compared to heterosexual youth, LGB
youth are at an increased risk for suicide (Russell and
Joyner 2001; Silenzio et al. 2007) and report elevated
rates of sexual risk behavior and substance use
(Garofalo et al. 1998; Marshall et al. 2008). In
addition, epidemiological data show that young men
who have sex with men, especially young men of
color, continue to be disproportionately affected by
HIV/AIDS (Campsmith et al. 2008; Hall et al. 2008).
In response to this growing body of evidence,
prevention scientists have sought to identify mecha-
nisms that can be targeted to support LGB youths
health and well-being. In general, this research has
tended to focus on the identification of risk factors,
with limited attention to protective factors that may
support resilience in the lives of LGB young people
(Savin-Williams 2001). In addition, studies with LGB
youth have tended to neglect key developmental
contexts that have been identified as important corre-
lates of youth health in the broader prevention science
literature. For example, there now exists a large body
of research on the importance of parents for under-
standing the health and well-being of young people
(Steinberg 2001; Wood et al. 2004). Both the National
Institutes Health and the Centers for Disease Control
and Prevention (CDC) have identified parents as a
critical site for promoting young peoples health (CDC
2006; Pequegnat and Szapocznik 2000), and numerous
parent-based interventions have been developed and
evaluated with promising results (Guilamo-Ramos
et al. 2010; Stanton et al. 2004; Turrisi et al. 2001).
In contrast, the majority of research on LGB
youth has not included similar parental approaches
(Garofalo et al. 2008). To date, most research has
examined the context, process, and outcomes associ-
ated with parents responses to learning about a childs
sexual orientation (for reviews, see Heatherington
and Lavner 2008; Savin-Williams 1998), with limited
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J Primary Prevent (2010) 31:273309
attention to the dimensions of parenting commonly
studied in prevention science research with heterosex-
ual youth. This paucity of research is striking given
that parents and families are widely recognized as
one of the most salient developmental contexts for
young people (Collins et al. 2000; Steinberg 2001).
Developmental theorists agree that parents can
influence children through numerous mechanisms,
including the transmission of parental values and
expectations, role modeling, external reinforcement,
parenting style, and the use of different parenting
practices (Bandura 1975; Kasser et al. 1995; Steinberg
2001). Although a comprehensive review of this
literature is beyond the scope of the present review,
we briefly discuss key findings below.
Research on the role of parents in shaping youth
health has tended to focus on two potential mecha-
nisms of influence: (a) parenting style and (b)
parenting practices. Although sometimes used inter-
changeably, important differences exist between the
two (Darling and Steinberg 1993; Mize et al. 1998).
Parenting style encapsulates the overall emotional
climate between a parent and child and is character-
ized by the extent to which parents exhibit warmth
and control in the parentchild relationship (Mize
et al. 1998). Initially, three parenting styles were
identified: (a) authoritative, characterized by a bal-
ance between control and warmth; (b) authoritarian,
featuring high levels of parental psychological con-
trol and low levels of parental warmth; and (c)
permissive, in which parents give children too much
freedom and too little supervision (Baumrind 1971).
Subsequent research has since divided permissive
parenting into two distinct styles: (a) indulgent and
(b) neglectful (Maccoby and Martin 1983). Across
research studies with diverse youth, children of
authoritative parents tend to engage in less health
risk behaviors and report better psychosocial out-
comes than children of authoritarian or permissive
parents (Montgomery et al. 2008; Pettit et al. 2001;
Steinberg 2001).
In contrast to the more global nature of parenting
style, parenting practices refer to the specific and
goal-oriented strategies that parents employ as they
raise their child (Mize et al. 1998). These include
practices such as parentchild communication about
sex, as when a father talks with his young adult son
about why he should use a condom during sex with
the goal of helping his son avoid HIV, or parental
J Primary Prevent (2010) 31:273309
monitoring of an adolescents friends, so that a
mother can buffer her child from potentially negative
peer influences. Parenting practices identified as
important correlates for young peoples health
include (a) parentchild connectedness and the
establishment of a close parentchild relationship
(Markham et al. 2010); (b) parents psychological
and behavioral control (Barber et al. 2005); (c)
parental support (Barber et al. 2005); (d) parental
attitudes and values that discourage risk taking, such
as parental disapproval or the endorsement of educa-
tional and career goals (Ford et al. 2005; Frisco
2005); (e) parentchild communication (Guilamo-
Ramos et al. 2007); and (f) parental monitoring and
supervision (Stattin and Kerr 2000).
In general, research has found that higher levels of
positive parenting practices are inversely associated
with health risk behaviors and maladaptive health
outcomes (Markham et al. 2010). For example, studies
show that parenting practices such as establishing a
close, involved, and loving parentchild relationship
is associated lower levels of youth suicidality (Flouri
2005). Although most research examines direct
effects, both moderated and mediated relationships
have been observed (Turrisi et al. 2007), as have non-
linear relationships (Barber et al. 2005). Research also
has noted that parenting and the parentchild relation-
ship are dynamic processes that change over time. For
their part, parents use different practices for sons and
daughters, for older and younger children, and in
response to a childs unique characteristics and needs
(Crouter and Booth 2003). In return, youth often
engage in specific behaviors, such as open or selective
disclosure of information about their life, that seek to
influence how their parents respond to and parent them
(Crouter and Booth 2003). Finally, studies also show
that parents can remain important, even as peers,
school, and work become increasingly salient (Turrisi
et al. 2001; Wood et al. 2004).
As the evidence base on the protective role of
parents has grown, so too has support for interventions
that target parents as a primary mechanism through
which to improve youth health. There now are
promising parent-based interventions for sexual risk
behavior (for a review, see Robin et al. 2004), smoking
(for a review, see Thomas et al. 2007), drug and alcohol
use (Kumpfer and Alvarado 2003; Turrisi et al. 2001),
mental health (for a review, see Hoagwood 2005), and
violence (Kumpfer and Alvarado 2003). Typically,
275
these interventions seek to strengthen specific parent-
ing practices, such as the nature and quality of a
parents monitoring efforts (Stanton et al. 2004).
Although there are differences across interventions,
all aim to provide parents with the knowledge, skills,
and support necessary to support their childs health,
and they all capitalize on the parentchild relationship
as a primary mechanism through which to effect
change.
In comparison, we know far less about parenting in
families with an LGB child. In general, research with
LGB youth has tended to reflect strained parentchild
relationships (Darby-Mullins and Murdock 2007),
parental rejection of youth (Ryan et al. 2009), or an
assumption that parents are not positively involved in
their childs life (Garofalo et al. 2008). Although
these experiences are true for some LGB youth, not
all LGB young people experience parental rejection
and hostile family environments (Garofalo et al.
2008). Indeed, emerging research indicates that many
parents are aware of their childs unique needs
(LaSala 2007), are open to understanding how their
responses influence their childs well-being (Ryan
et al. 2009), and want assistance in supporting their
childs health (LaSala 2007). Despite these factors,
there are currently no known parent-based interven-
tions that have been developed to help parents
support the health and well-being of their LGB child.
The lack of research in this area represents a
critical gap in the prevention science literature as
LGB young people are similar to their heterosexual
peers in many waysthey date and form romantic
relationships, they develop friendships and interact
with their peers, they attend school and plan for
their future, and they encounter situations that
present opportunities for engaging in risk behaviors
(Bauermeister et al. 2010; Savin-Williams 2001). In
these contexts, it is plausible that LGB youth may
benefit from their parents efforts in ways that are
similar to their heterosexual peers, especially when
these practices occur in the context of a good parent
child relationship and are tailored for needs of LGB
youth. At the same time, LGB youth are different
from their heterosexual peers in that they often
explore their sexual orientation in settings that lack
formal guidance or may be dangerous for their mental
and physical health (Bontempo and DAugelli 2002).
Experiences with homophobia have implications not
only for youth but also for parents as they are tasked
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with responding to their LGB child as he or she moves
through the coming out process. Here, parents can
play two particularly important roles. First, they can
serve as an important source of support by accepting
their child unconditionally and by buffering them
from negative and harmful responses to their sexual
orientation. They can improve their own knowledge
base on the needs of LGB youth and make positive
adaptations to their parenting practices to reflect this
new information (DAugelli 2005). Alternatively,
parents may serve as a source of stress as they express
ambivalence, intolerance, or rejection after learning of
their childs sexual orientation and, in some cases,
perpetrate sexual orientation-related victimization
against their LGB child (DAugelli 2005).
In this regard, there are two interrelated dimensions
to parenting LGB youth: (a) one that focuses on the
types of parenting practices traditionally studied in the
prevention science literature, such as parentchild
connectedness, communication, or monitoring, and
(b) one that focuses on the unique aspects of parenting
an LGB child, namely, parents responses to their
childs sexual orientation and the extent to which
parents serve as a source of support or stress in this
domain. Currently, we know relatively little about
how these domains of parenting work together as
theoretical frameworks of parenting that bring these
dimensions together are rare. To date, we know of only
one conceptual framework that has attempted to
integrate broader parentchild interactions with those
specific to having an LGB child (see Heatherington
and Lavner 2008), and it has not yet been evaluated in
empirical research.
As research on LGB youth continues to grow,
researchers are calling for greater attention to the
contextual influences that shape their health and
well-being, especially parents and family systems
(DAugelli 2005; Garofalo et al. 2008; Horn et al.
2009), and for the development of parent-based inter-
ventions to support LGB youths health (Garofalo
et al. 2008). The overall purpose of the present
review was to assess the current state of knowledge
on parental influences on the health and well-being
of LGB adolescents and young adults in order to
develop a set of focused recommendations for a
parent-based research agenda. In doing so, we sought
to understand the nature of parental influences on the
health of LGB youth, assess how parental influences
are studied in relation to the larger body of empirical
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research on heterosexual youth, identify key gaps in the
literature, and support prevention scientists to begin
the process of developing parent-based interventions
for LGB youth. The review targets five specific areas of
LGB health: (a) sexual risk behaviors and related
health outcomes, e.g., sexually transmitted infections
(STIs) and HIV; (b) experiences with violence and
victimization; (c) substance use including alcohol,
tobacco, and other drug use; (d) suicide; and (e) mental
health and well-being, including clinical indicators of
mental health, such as depression or anxiety, and more
general indicators of youth well-being, such as self-
esteem. These areas were targeted because (a) they
represent key health behaviors and outcomes for all
young people, regardless of their sexual orientation; (b)
research suggests that LGB youth experience health
disparities in each domain; and (c) studies indicate that
parents can play an important role in promoting youth
health in each area (Resnick et al. 1997).
Method
Literature Search
Peer-reviewed articles examining parental influences
on LGB youth health were identified via three
primary methods. First, a computer-based search of
the following databases was conducted: PubMed,
PsycInfo, PsycArticles, the Institute for Scientific
Information Web of Science, and Social Service
Abstracts (a full list of the search terms is available
from the second author). Second, an ancestral
approach was used (White 1994), which entailed
reviewing the reference lists of each included article
to identify studies for possible inclusion. Finally,
literature reviews on LGB youth and on adolescent
and young adult health were examined in order to
identify other potentially relevant articles.
Inclusion Criteria
Articles were included if they (a) were quantitative
research published in a peer-reviewed journal
between 1980 and 2010, (b) sampled U.S. youth
primarily between the ages of 1024 years old, and
(c) examined parental influences as a correlate of one
of the five targeted health areas. A broad age range
was selected for several reasons. First, adolescents
J Primary Prevent (2010) 31:273309
and young adults were targeted in order to ensure that
a representative sample of the literature was obtained.
This was particularly important given our interest in
making applied recommendations. Although there are
differences in the parentchild relationship across the
ages of 1024, research suggests that parents can
influence their childs health behaviors in early
adulthood (Turrisi et al. 2001) and that parenting
practices encountered in adolescence are associated
with health indicators in early adulthood (e.g., Frisco
2005). Retrospective studies of older adults reporting
on adolescent and young adult experiences were
excluded due to the bias associated with long recall
periods. Studies with transgender youth and with
homeless and runaway LGB youth also were
excluded as we hypothesized that both groups of
young people experienced family and health concerns
that were distinct from the larger population of LGB
youth.
The term parents was operationalized to include
biological, resident, non-resident, and step- and
adoptive parents, as well as legal guardians and
primary caregivers. Although the nature of parental
influences may differ as a function of the particular
composition of a parentchild dyad, the diversity of
American families and the sparseness of the literature
necessitated a broad definition of parents. In turn, the
construct of parental influences was operationalized
to encompass a range of parenting behaviors, includ-
ing individual parenting practices, parenting style,
and parents knowledge of and responses to a childs
sexual orientation. No criteria on the nature of
parental influences were imposed, and studies with
positive, negative, or no significant associations were
included.
Results
A total of 31 articles met the study inclusion criteria.
Of the 31 studies, 26 were cross-sectional, 2 were
retrospective, and 3 were prospective. All three
prospective studies utilized data from the National
Longitudinal Study of Adolescent Health (Add
Health). No experimental studies were located. Apart
from the Add Health studies, only one other article
utilized a probability sample (ODonnell et al. 2002).
Most studies obtained a waiver of parental consent
when working with youth under age 18. Exceptions
277
occurred when study data was drawn from nationally
representative or school-based studies where LGB
youth were not the primary focus of the research.
None of the identified studies reported on parenting
data collected from parents; thus, all results represent
LGB youths perceptions of their parents. The
sampling characteristics for each article are presented
in Tables 1, 2, 3, 4, 5.
The total number of articles that examined each
health topic was as follows: 6 examined sexual
behavior, 5 studied violence and victimization, 5
focused on substance use, 16 examined mental health,
and 15 examined suicide. Below, we discuss the
results within each targeted health area. Key results
are presented in Tables 1, 2, 3, 4, 5. Given the scope
of the results, it is not possible to discuss each finding
in detail. Within each section, we therefore highlight
key trends and limitations within a given health area
as well as the types of parental influences that were
studied. Results from methodologically rigorous
studies are highlighted, as are patterns of results
across numerous studies.
Sexual Risk Behaviors, STIs, and HIV
In total, six articles examined parental influences on
the sexual risk behaviors and related health outcomes
of LGB youth. Table 1 summarizes the key findings.
Across the six articles, parental influences were
explored in three primary areas: (a) emotional
dimensions of the parentchild relationship, namely
parentchild connectedness; (b) parental values that
discourage risk taking, such as disapproval; and (c)
parents knowledge of and responses to their childs
sexual orientation. Across these studies, there were
several trends. First, only one article reported
prospective data (i.e., Ford et al. 2005). Half of the
articles reported findings based on probability sam-
ples of LGB young people (Ford et al. 2005;
ODonnell et al. 2002; Resnick et al. 1997), whereas
the other half relied on convenience samples. In
addition, the study by ODonnell et al. (2002) was the
only non-Add Health article in the review to utilize a
probability sample of LGB youth. With two nation-
ally representative studies and one statewide survey
(i.e., Ackard et al. 2008), the articles included data
from urban, rural, and suburban youth.
Of the six articles, two emerged as methodolog-
ically superior in that they were based on Add Health
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 Table 1 Parental influences on LGB sexual behavior and health outcomes
278

Citation Study design Sampling strategy Sample characteristics Age Parental Sexual behavior and outcomes
influences

123
Ackard Cross-sectional Saturated sample: state-wide N = 10,095 1319 Parentfamily Negatively associated with
et al. 2004 Minnesota Student school-based sample of all 100% male M = 16.7 connectedness the number of sexual partners
(2008) Survey youth in school on day of among all sexually active males
82.9% White; 6.7% Black; 4.3% SD = 1.5
survey who reported disordered eating,
Subsample of youth in Asian; 6.1% Other/mixed
88% of school districts regardless of sexual orientation
grades 6, 9, and 12; 11.1% men who have sex with men
excluded sexually participated: equivalent to
and women; 1.5% men who have
inactive males 75% of 9th grade and 55% of
sex with men; 87.5% men who
12th grade students in
Passive parental consent have sex with women
Minnesota
(active if required by
school or district) Refusal bias not reported
Self-administered
closed-ended survey
during class period
Ford Prospective Multistage, stratified, N = 14,332 1828 Results control for same-sex
et al. Add Health: Wave I and probability sample 50.8% male Mean age sexual attraction/behaviors,
(2005) III in-home interviews Nationally representative not reported demographic, school, individual,
49.2% female
school-based sample and other parent/family factors
Wave I: Parental 67.6% White; 16% African 1820: 28.6%
consent and 75.7% of Wave I respondents Parentfamily Not associated with being
American; 11.9% Latino; 3.7% 21: 16.5%
adolescent assent. located and participated in connectedness diagnosed with STI
Asian or Pacific Islander; 0.8% 22: 16.6%
Wave III: Young adult Wave III Native American Parental For females, negatively associated
consent 23: 15.4% disapproval of with odds of being diagnosed
Refusal bias not reported 7.6% same-sex sexual attraction/
CAPI and A-CASI 2428: 22.8% sex with STI
behavior; 92.4% heterosexual
surveys For males, not associated with
odds of being diagnosed with
STI
Parental Not associated with being
disapproval of diagnosed with an STI in early
adolescent adulthood
contraception
J Primary Prevent (2010) 31:273309
 Table 1 continued
Citation Study design Sampling strategy Sample characteristics Age Parental influences Sexual behavior and outcomes

Garofalo Cross-sectional Convenience sample N = 302 1624 Parentfamily Negatively associated with odds of
et al. (2008) Subsample of YMSM Multiple recruitment strategies 100% male M = 20.3 connectedness being HIV-positive, controlling
from a larger survey in Chicago: snowball for age and race/ethnicity
30% White; 33% Black; SD = 2.34
of 496 LGBT youth: sampling; email ads on high 26% Latino; 3% Asian; Not associated with odds of having
excluded females and school and college list- had unprotected anal sex in past
8% Other / Multiracial
transgender youth serves; handed out palm 12 months, controlling for age,
cards in gay neighborhoods; 100% MSM race/ ethnicity and HIV
Waiver of parental
consent obtained; flyers in retail areas and gay serostatus
youth provided verbal youth serving organizations Not associated with having had
J Primary Prevent (2010) 31:273309

Computer-assisted self- No recruitment from high-risk multiple anal sex partners in past
administered venues, e.g., bars, clubs or 3 months, controlling for age,
interview bathhouses race/ ethnicity and HIV
Participation rate and refusal serostatus
bias not reported
ODonnell Cross-sectional Venue-based probability N = 465 1525 All results control for demographic
et al. (2002) Baseline survey of sampling of high and low 100% male M = 21.4 factors, gay self-identification,
Hermanos Jovenes, attendance venues (bars, peer knowledge about MSM
100% Latino; 40% foreign SD = 2.5
Community cafes, parks, LGB social behavior, social support, and
born
Intervention Trial for service programs/events) in ethnic and gay community
New York City: Bronx, 74% gay; 22% bisexual; attachments
Youth
Queens, and Washington 4% other
Subsample of youth Parental knowledge of Not associated with unprotected
Heights/Upper Manhattan MSM behavior anal sex in past 3 months
reporting sexual
activity in past Bronx/Wash. Heights: 578 Not associated with unprotected
3 months approached; 93% screened; anal sex during last sex with a
48% eligible; 99.6% enrolled main partner
Interviewers obtained
informed consent. Queens: 637 approached; 89% Not associated with unprotected
Parental consent screened; 46% eligible; 99% anal sex at last sex with a non-
procedures not enrolled main partner
reported
Field staff interviewed
respondents
279

123
 Table 1 continued
280

Citation Study design Sampling strategy Sample characteristics Age Parental Sexual behavior and outcomes
influences

123
Resnick Cross-sectional Multistage, stratified, N = 11,572 7th12th All results control for same-sex
et al. Add Health: Wave I in- probability sample Gender not reported grade sexual attraction/behaviors,
(1997) home interviews; Nationally representative students demographic factors, school
Race/ethnicity not reported:
excluded youth school-based sample factors, individual factors, and
nationally representative sample Mean age
reporting sexual debut 79.5% participation rate; not other parent and family factors:
Sexual orientation not reported
before age 11 refusal bias not reported reported Parentfamily Associated with older age of
Parental consent and connectedness sexual debut for all 7th12th
adolescent assent grade youth
CAPI and A-CASI Parental Associated with older age of
surveys disapproval sexual debut for all 7th12th
of sex grade youth
Parental Associated with an older age of
disapproval sexual debut for all 7th12th
of adolescent grade youth
contraception
Ryan et al. Retrospective Convenience sample N = 224 2125 All results control for gender and
(2009) Family Acceptance Recruited from 249 LGB 51% male; M = 22.82 race/ethnicity
Project venues located 100 miles of 49% female SD not Parentfamily Positively associated with odds of
Subsample from larger project office in urban city: reported rejection having had unprotected sex with
48% non-Latino white;
study (N = 245); 50% clubs/bars and 50% a casual partner in past 6 months
52% Latino
excluded transgender social service and community Positively associated with odds of
Lesbian, gay and bisexual
young adults (n = 21) organizations having had unprotected sex at
Consent procedures not Participation rate and refusal last sex with a casual partner
reported bias not reported Not associated with having ever
Computer assisted or been diagnosed with an STD
pencil-and-paper self-
administered surveys
J Primary Prevent (2010) 31:273309
 Table 2 Parental influences on LGB violence and victimization
Citation Study design Sampling strategy Sample characteristics Age Parental influences Violence/victimization
results

DAugelli et al. Cross-sectional Convenience sample N = 105 1421 Parental knowledge of Among youth who had
(1998) Data analyzed from a larger Recruited from LGB social, 71% male M = 18.4 sexual orientation disclosed, greater
sample of N = 194 LGB recreational, and support percentage of males than
29% female SD = 1.7 females reported that
youth; only included youth groups in 14 metropolitan
who lived with parents areas in the U.S. 68% White; parents offered to protect
them from sexual
Waiver of parental consent Participation rate and refusal 32% youths of color orientation-related attacks
obtained bias not reported 100% lesbian, gay or bisexual
Lower percentage of family
Professional counselor
J Primary Prevent (2010) 31:273309

members offered to protect

approved by IRB at each
site; excluded sites without
a trained adult
Self-administered closed-
ended survey
DAugelli et al. Cross-sectional
(2005a) First wave of longitudinal
study of victimization
among LGB youth
Data analyzed from larger
sample of N = 528 youth
Waiver of parental consent
obtained
Youth advocate at each site
ensured informed consent
Convenience sample N = 361
Recruited from three
community-based
organizations in New York
City and two surrounding
suburbs
Participation rate and refusal almost totally G/L; 21%
bias not reported
1519
56% male; 44% female M = 17
41% Black/African SD not
American; 29% Hispanic; reported
27% White
28% G/L; 20% Bisexual but
Bisexual but mostly G/L;
15% Bisexual but equally
G/L and hetero-sexual;
16% Bisexual but mostly
heterosexual; 2 questioning
youth from sexual
orientation-based attacks
among youth who did not
disclose compared to youth
who disclosed
Lower levels of family verbal
abuse and physical threats
and attacks among youth
who had not disclosed
compared to youth who
disclosed
Parents awareness of Positively correlated with
sexual orientation sexual orientation
victimization by parents
and fear of harassment
Youth whose parents were
aware of sexual orientation
reported a higher mean
level of parental verbal
abuse due to sexual
orientation than youth
whose parents did not know
Youth with aware parents
reported a higher mean
level of family support and
a lower mean level of fear
of parental harassment or
rejection
281

123
 Table 2 continued
Citation Study design
123
DAugelli et al. Cross-sectional
(2005b) First phase of a two-year
longitudinal study
Subsample of larger study of
528 LGB youth: only
included youth living with
parents who had raised
them
Consent procedures not
reported
Face-to-face interview with a
masters level mental health
clinician using a structured
interview protocol
DAugelli et al. Cross-sectional
(2006) First phase of a two-year
longitudinal study on
sexual orientation related
victimization
Waiver of parental consent
obtained
Youth advocate available to
answer questions
Face-to-face interview with a
same-sex masters level
clinician
Sampling strategy
Convenience sample
Recruited from drop-in
centers of 3 community-
based organizations
providing social,
educational and
recreational services to
LGB youth in New York
City and two suburbs
Participation rate and refusal
bias not reported
Convenience sample
Recruited from 3 community- 52% male; 48% female
based organizations: 1 in
New York City and 2 in
New York City suburbs;
and snowball sampling to
diversify sample
Participation rate and refusal Asian; 2 American Indian/
bias not reported
Sample characteristics
N = 293 1519
47% male; 53% female
43% Hispanic: 85% White;
10% African American;
5% Mixed
57% Non-Hispanic: 41%
White; 34% Black/ African
American; 5% Asian /
Pacific Islander; 19%
Mixed; n = 1 American
Indian; n = 2 unavailable
23% G/L; 20% Bisexual but
almost totally G/L; 21%
Bisexual but mostly G/L;
17% Bisexual, but equally
G/L and hetero-sexual;
19% Bisexual but mostly
heterosexual; 1 questioning
N = 528 1519
Ethnicity: 45% Hispanic;
55% non-Hispanic
Race: 62% White; 25%
Black/African American;
10% Multi-racial; 3%
Alaskan Native
Lesbian, gay, and bisexual
youth
282
Age Parental influences Violence/victimization
results
Parents awareness of No differences in parents
M = 16.83 childs sexual psychological abuse
orientation between youth with aware
SD = 1.21 parents and youth with
Male unaware parents
M = 16.79 Youth with aware parents
reported a higher mean
SD = 1.25
level of parental
Female
victimization due to sexual
M = 16.86 orientation than youth with
SD = 1.17 unaware parents
Youth with aware parents
reported a lower mean level
of fear of parental
harassment or rejection
than youth with unaware
parents
Parents called youth a Youth whose parents called
M = 17.03 sissy or a tomboy them a sissy or a tomboy
had a higher mean level of
SD = 1.27 lifetime victimization and
physical victimization than
youth whose parents did not
Youth whose parents called
them a sissy or a tomboy
had an earlier mean age of
first verbal victimization
and first physical
victimization than youth
whose parents did not
Not associated with lifetime
sexual victimization or with
age of first sexual
victimization
J Primary Prevent (2010) 31:273309
 Table 2 continued
Citation Study design
DAugelli et al.
(2006)
(continued)
DAugelli et al. Cross-sectional
(2008) First phase of a two-year
longitudinal study
Subsample of larger study of
528 LGB youth: only
included youth living with
parents who had raised
them
Waiver of parental consent
obtained
Face-to-face interview with a
masters level mental health
clinician using a structured
interview protocol
123
Sampling strategy
Convenience sample
Recruited from drop-in
centers of 3 community-
based organizations
providing social,
educational and
recreational services to
LGB youth in New York
City and two suburbs
Participation rate and refusal
bias not reported
Sample characteristics Age
N = 516 1519
52% male; 48% female M = 17.03
44% Hispanic: 86% White; SD = 1.21
11% African American; 3% Males
Mixed
M = 16.79
55% Non-Hispanic: 44%
White; 35% Black/ African SD = 1.25
American; 5% Asian/ Females
Pacific Islander; 19% M = 16.86
Mixed, n = 1 American
SD = 1.17
Indian, n = 2 unavailable
28% totally G/L; 20% almost
totally G/L; 21% Bisexual
but mostly G/L; 21%
Bisexual but equally G/L
and heterosexual; 16%
Bisexual but mostly
heterosexual; n = 2
uncertain / questioning
Parental influences Violence/victimization
results
Parents discouraged Youth whose parents
gender atypicality discouraged gender
atypicality had a higher
mean level of lifetime
victimization and physical
victimization than youth
whose parents did not
Youth whose parents
J Primary Prevent (2010) 31:273309
discourage gender
atypicality had an earlier
mean age of first physical
victimization than youth
whose parents did not
Not associated with lifetime
sexual victimization or with
age of first verbal or first
sexual victimization
Parental knowledge of Youth with aware parents
sexual orientation reported a higher mean
level of sexual orientation
victimization from parents
and from siblings
Youth with aware parents
reported a lower mean level
of fear of rejection from
parents and from siblings
Youth with aware parents
reported a higher mean
level of family support
Positive parental Youth reporting positive
responses to youth parental responses reported
sexual orientation a lower mean level of
lifetime sexual orientation
victimization from parents
than youth with negative
parents
Youth reporting positive
parental responses reported
a higher mean level of
family support
283
 Table 3 Parental influences on LGB substance use
284

Citation Study design Sampling strategy Sample characteristics Age Parental influences Substance use results

123
Espelage Cross-sectional Saturated sample: N = 13,921 High school Parental support as a Parental support moderated the
et al. 2000 Dane County Youth county-wide school-based 49.7% male students moderator of relationship between
(2008) Survey: students from 18 sample of all youth in M = 15.8 homophobic teasing homophobic teasing and
50.3% female
high schools in a school on day of survey alcohol-marijuana use among
78.6% White; SD not
Midwestern county Participating schools LGB and questioning
5.4% Biracial; reported
returned surveys for students
Passive parental consent 4.8% Asian; 4.8% Black;
and adolescent assent 9095% of student Students with high levels of
3.6% Hispanic
population homophobic teasing and low
Self-administered closed- 7.7% lesbian, gay
Refusal bias not reported levels of parental support
ended survey given or bisexual; reported the highest levels of
during single class period 6.7% questioning; alcohol-marijuana use
86% heterosexual
Needham Cross-sectional Multistage, stratified, N = 11,153 1826 Separate analysis for males and
and Add Health: Subsample of probability sample 49.4% male; 50.6% female Males females. All results control
Austin Wave III in-home Nationally representative for age, race/ethnicity,
121 Gay males: 53.8% Gay
(2010) interviews; excluded school-based sample parental education, and living
White; 46.2% Non-White M = 22.2
young adults if married; Subsample: 73.4% of all at home at Wave III
40 Bisexual males: SD = 1.60
missing data on sexual youth interviewed at Parental support as a For males, there was no
55% White;
orientation; no contact Wave III Bisexual mediator between association between sexual
45% Non-White
with parents or parent-like M = 21.3 sexual orientation and orientation and substance use
Wave III participation rate 5,352 Heterosexual males:
figures at Wave III substance use For lesbians, there was no
and refusal bias not 55.3% White; SD = 1.59
Wave III: Young adult reported association between sexual
44.7% Non-White Heterosexual
consent orientation and frequent
72 Lesbians: 56% White; M = 21.8 heavy drinking
CAPI and A-CASI surveys
43% Non-White. SD = 1.73 Among bisexual females,
152 Bisexual females: Females parental support did not
67.1% White; mediate the association
32.9% Non-White Lesbian
between sexual orientation
5,416 Heterosexual M = 21.8 and frequent heavy drinking
females: 54.3% White; SD = 1.75 Among bisexual and lesbian
45.7% Non-White Bisexual females, parental support
M = 21.5 partially mediated the
association between sexual
SD = 1.67 orientation and marijuana use
Heterosexual Among bisexual and lesbian
M = 21.6 females, parental support
SD = 1.73 partially mediated the
association between sexual
orientation and hard drug use
J Primary Prevent (2010) 31:273309
 Table 3 continued
Citation Study design Sampling strategy Sample characteristics Age Parental influences Substance use results

Padilla Cross-sectional Convenience sample N = 1,906 1217 All results control for
et al. Internet survey by Survey links available on Gender not reported M = 16 demographic factors, self-
(2010) OutProud: The National LGB websites, including esteem, suicidal ideation,
81% White; 19% Other SD not
Coalition for Gay, OutProud, Youth Action, community involvement and
55% gay; 25% lesbian; reported
Lesbian, Bisexual and Out in American, other parent factors
34% bisexual
Transgender Youth Beautiful Boy, and others Neither parent knows Not associated with odds of
Subsample from larger Participation rate and sexual orientation using illegal drugs
sample of 6,872 youths refusal bias not reported Mothers positive reaction Negatively associated with
aged 25 and under to coming out odds of using illegal drugs
J Primary Prevent (2010) 31:273309

Consent procedures not Fathers positive reaction Not associated with odds of
reported: no identifying to coming out using illegal drugs
information collected Parental religion is a Not associated with odds of
Self-administered survey barrier to coming out using illegal drugs
completed online
Resnick Cross-sectional Multistage, stratified, N = 11,572 7th12th All results control for same-sex
et al. Add Health: Wave I probability sample Gender not reported grade sexual attraction / behaviors,
(1997) in-home interviews; Nationally representative students demographic, school,
Race/ethnicity not reported:
excluded youth reporting school-based sample individual, and other parent/
nationally representative Mean age
sexual debut before not family factors:
79.5% participation rate; sample
age 11 refusal bias not reported reported Parentfamily Negatively associated with
Sexual orientation not
Parental consent and connectedness alcohol use and marijuana for
reported
adolescent assent all 9th12th grade youth
CAPI and A-CASI surveys Parental presence (waking Negatively associated with
up, after school, at alcohol use and marijuana for
dinner and bedtime) all 9th12th grade youth
Ryan et al. Retrospective Convenience sample N = 224 2125 All results control for gender
(2009) Family Acceptance Project Recruited from 249 LGB 51% male; 49% female M = 22.82 and race/ethnicity
Subsample from larger venues located 100 miles 48% non-Latino White; SD not Parentfamily rejection Positively associated with odds
study (N = 245); of project office in urban 52% Latino reported of having used illicit
excluded transgender city: 50% clubs/bars and substances in the past
Lesbian, gay and bisexual
young adults (n = 21) 50% social service and 6 months
community organizations Positively associated with odds
Consent procedures not
reported Participation rate and of having had any substance-
refusal bias not reported related problems
Computer assisted or
pencil-and-paper self- Not associated with the odds of
administered surveys having engaged in heavy
drinking in the past 6 months
285

123
 Table 4 Parental influences on LGB mental health and well-being
Citation Study design
123
DAugelli Cross-sectional
(2002) Two separate waves of data
collection:
Wave I: 19871989
Wave II: 19951997
Combined two waves of data
Waiver of parental consent
obtained
Adults at each group vetted by
IRB to assure informed
consent compliance
Self-administered closed-ended
survey completed in group
settings
DAugelliet al. Cross-sectional
(2005b) First phase of a two-year
longitudinal study
Subsample of larger study of
528 LGB youth: only
included youth living with
parents who had raised them
Consent procedures not
reported
Face-to-face interview with a
masters level mental health
clinician using a structured
interview protocol
Sampling strategy
Convenience sample
Wave I: Sent letters to adult
group coordinators of LGB
youth serving organizations.
Interested groups contacted
researchers
Wave II: Posted project
description on internet for
LGB youth serving
organizations. Identified adult
contact for each group
Participation rate and refusal
bias not reported
Convenience sample
Recruited from drop-in centers 47% male; 53% female
of 3 community-based
43% Hispanic: 85% White;
organizations providing
social, educational and
recreational services to LGB
youth in New York City and 57% Non-Hispanic:
two suburbs
Participation rate and refusal
bias not reported
Sample characteristics
N = 542
62% male; 38% female
More than 75% White;
8% African American;
4% Hispanic; 1% Native
American or Canadian;
remaining % identified as
multiple backgrounds
Youth from U.S., Canada and
New Zealand
74% gay or lesbian;
20% bisexual, mostly gay
or lesbian; 6% bisexual but
equally gay/lesbian and
heterosexual
N = 293
10% African American;
5% Mixed
41% White; 34% African
American/Black;
5% Asian/Pacific Islander;
19% Mixed; 1 American
Indian; 2 no information
23% G/L; 20% bisexual but
almost totally G/L; 21%
bisexual but mostly G/L;
17% bisexual, but equally
G/L and hetero-sexual;
19% bisexual but mostly
heterosexual; 1 questioning
286
Age Parental influences Mental health and well-being
1421 Parental knowledge of childs Youth reporting neither parent
M = 19.08 sexual orientation knows had higher psychoticism
and interpersonal sensitivity
SD = 1.5 scores on Brief Symptom
Inventory (BSI) than youth with
two knowing parents or one
knowing parent
Parental rejection of childs No relationship with other BSI
sexual orientation subscales or General Severity
Index (GSI)
Youth reporting both parents reject
had higher scores on GSI and on
all BSI subscales than youth with
two accepting parents
Youth reporting both parents reject
had higher scores on GSI and BSI
anxiety, phobic anxiety, and
somatization subscales than
youth with one accepting and one
rejecting parent
No association with GSI,
controlling for SOV, fear of
losing friends, and fears of
physical or verbal abuse at home
and school
1519 Parental awareness of childs No difference in BSI scores
M = 16.83 sexual orientation between youth whose parents
were aware and youth whose
SD = 1.21 parents were unaware
No difference in self-esteem
between youth whose parents
were aware and youth whose
parents were unaware
J Primary Prevent (2010) 31:273309
 Table 4 continued
Citation Study design
DAugelli et al. Cross-sectional
(2006) First phase of a two-year
longitudinal study on SOV
Waiver of parental consent
obtained
Youth advocate available to
answer questions
Face-to-face interview with a
same-sex masters level
clinician
123
Sampling strategy
Convenience sample
Recruited from 3 community-
based organizations: 1 in
New York City and 2 in
suburbs of New York City
Snowball sampling to diversify
sample
Participation rate and refusal
bias not reported
Sample characteristics
N = 528
52% male; 48% female
Ethnicity: 45% Hispanic;
55% non-Hispanic
Race: 62% White;
25% Black/African
American; 10% Multi-racial;
3% Asian; n = 2 American
Indian/ Alaskan Native
Lesbian, gay and bisexual
youth
Age Parental influences Mental health and well-being
1519 Parents called youth a sissy or Youth whose parents called them a
M = 17.03 a tomboy sissy or tomboy had a higher
mean score on BSI than youth
SD = 1.27 whose parents did not
Youth whose parents called them a
sissy or tomboy had a higher
mean score on Trauma Symptom
Checklist (TSC) than youth
whose parents did not
Males whose parents called them a
J Primary Prevent (2010) 31:273309
sissy had higher mean level of
distress about first experience of
sexual SOV than males whose
parents did not (small n for
sexual SOV)
Females whose parents called them
a tomboy had a lower mean level
of distress about first experience
of sexual SOV than females
whose parents did not (small
n for sexual SOV)
Not associated with distress about
first verbal, physical or sexual
SOV
Positively associated with PTSD
Parents discouraged gender Youth whose parents discouraged
atypicality gender atypicality had higher
mean BSI score than youth whose
parents did not
Youth whose parents discouraged
gender atypicality had higher
mean score on TSC than youth
whose parents did not
Not associated with distress at first
verbal, physical or sexual
victimization SOV
287
 Table 4 continued
Citation Study design
123
DAugelli and Cross-sectional
Hershberger Waiver of parental consent
(1993) obtained
Adult with professional
counseling experience vetted
by IRB at each site to ensure
informed consent; excluded
sites without a trained adult 44% return rate on surveys
Self-administered closed-ended Refusal bias not reported
survey mailed to groups and
completed in group setting
supervised by adult
Espelage et al. Cross-sectional
(2008) 2000 Dane County Youth
Survey: students from 18
high schools in a Midwestern
county
Passive parental consent and
adolescent assent
Self-administered closed-ended Refusal bias not reported
survey given during single
class period
Floyd et al. Cross-sectional
(1999) Waiver of parental consent
obtained
Two part interviews: Part 1
consisted of structured
interviews with open- and
closed-ended questions. Part
2 consisted of a self-
administered closed-ended
survey
Sampling strategy
Convenience sample
Recruited via 14 LGB
community centers with
informal support groups.
Only one center per city,
representing major urban
areas in U.S.
Saturated sample: county- N = 13,921
wide school-based sample of
all youth in school on day of
survey
Participating schools returned
surveys for 9095% of
student population
Convenience sample
Recruited from youth support 50% male; 50% female
groups, flyers, newspaper ads 79% White; 7% Asian-
and articles, and campus
organizations in the upper
Midwest and Southeast
Participation rate and refusal Lesbian, gay or bisexual
bias not reported
Sample characteristics
N = 194
73% male; 27% female
66% White; 14% African
American; 5% Asian
American; 6% Hispanic
American; 4% American
Indian
75% lesbian or gay;
19% bisexual, but mostly
lesbian or gay; 6% bisexual
and equally lesbian/gay and
heterosexual
High
49.7% male
50.3% female
78.6% White; 5.4% Biracial;
4.8% Asian; 4.8% Black;
3.6% Hispanic
7.7% lesbian, gay or bisexual;
6.7% questioning; 86%
heterosexual
N = 72
American; 6% African-
American; 3% Native
American; 6% other
288
Age Parental influences Mental health and well-being
1521 Parental knowledge and Not associated with BSI
M = 18.9 acceptance of childs sexual
orientation
SD = 1.6
Males
M = 19.2
SD = 1.6
Females
M = 18.1
SD = 1.5
Parental support as a Did not moderate the association
school moderator of homophobic between homophobic teasing and
students teasing depression-suicidal feelings
among LGB and questioning
M = 15.8
students
SD not
reported
1627 Mothers positive attitudes Positively correlated with self-
M = 20.88 about childs sexual esteem
orientation Negatively correlated with BSI
SD = 2.94
depression
Negatively correlated with BSI
anxiety for daughters
Not correlated with BSI hostility
Fathers positive attitudes Not correlated with self-esteem,
about childs sexual BSI depression, anxiety, and
orientation hostility
Relatedness to mother Positively correlated with self-
esteem
Not correlated with BSI hostility
Negatively correlated with BSI
anxiety and depression
Relatedness to father Positively correlated with self-
esteem
Negatively correlated with BSI
anxiety, depression, and hostility
J Primary Prevent (2010) 31:273309
 Table 4 continued
Citation Study design Sampling strategy Sample characteristics Age Parental influences Mental health and well-being

Floyd et al. Autonomy from mother Not correlated with self-esteem,

(1999 )
(continued)
Autonomy from mother
moderated by relatedness
to mother
Autonomy from mother
moderated by youth gender
Autonomy from father
BSI anxiety, depression, and
hostility
Negatively correlated with self-
esteem only when maternal
relatedness was low
Positively correlated with self-
esteem for daughters but not sons
Positively correlated with self-
J Primary Prevent (2010) 31:273309

esteem
Not correlated with BSI anxiety,
depression, and hostility
Less conflictual independence Positively correlated with self-
with mother esteem
Negatively correlated with BSI
depression
Not correlated with BSI anxiety
or hostility
Less conflictual independence Negatively correlated with BSI
with mother moderated by hostility for sons but not
youth gender daughters
Less conflictual independence Negatively correlated with BSI
with father anxiety and hostility
Not correlated with self-esteem
or BSI depression
Less conflictual independence Negatively correlated with BSI
with father moderated by hostility for younger adolescents
youth age but not for older adolescents
Homma and Cross-sectional Saturated sample: state-wide N = 91 1319 Parentfamily caring Low levels of parental caring were
Saewyc 2001 MN Student Survey school-based sample of all 63% male; 37% female Mean age associated with low levels of self-
(2007) youth in school on day of not esteem, which were associated
Subsample of 9th and 12th survey 84% of males reported with greater emotional distress
grade Asian American both-gender partners reported
Survey of all public school (e.g., self-esteem mediated the
students with a same-sex 76% of females reported 56% 9th association between perceived
sex partner in past year students in grades 6, 9, graders
and 12 both-gender partners parental caring and emotional
Consent procedures not 44% 12th distress)
reported 92% of schools participated: graders
represents 97% of MN
Paper-and-pencil survey students in grades 6, 9,
completed in classroom and 12
Refusal bias not reported
289

123
 Table 4 continued
Citation Study design
123
Maguen et al. Cross-sectional
(2002) Waiver of parental consent
obtained. Adult at each site
asked to serve in loco
parentis
Adolescents were not asked to
provide name for consent
Self-administered closed-ended 98% participation rate
survey completed at either
conference or community
center
Needham and Cross-sectional
Austin (2010) Add Health: Subsample of
Wave III in-home interviews; Nationally representative
excluded young adults if
married; missing data on
sexual orientation; no contact
with parents or parent-like
figures at Wave III
Wave III: Young adult consent
CAPI and A-CASI surveys
Sampling strategy Sample characteristics
Convenience N = 117
Multiple strategies: recruited 54% male; 46% female
from LGBT conference at a
75% European American;
southeastern university 11% African American;
(n = 103) and from 5% Latino; 4% Biracial;
southeastern GL community 3% Asian; and 1% Other;
service center (n = 14) n = 1 unreported
46% gay; 29% lesbian;
Refusal bias not reported 22% bisexual; 3% queer;
n = 1 unreported
Multistage, stratified, N = 11,153
probability sample 49.4% male; 50.6% female
121 Gay males: 53.8% White;
school-based sample 46.2% Non-White
Subsample: 73.4% of all youth 40 Bisexual males: 55% White; SD = 1.60
interviewed at Wave III
45% Non-White
Wave III participation rate and
5,352 Heterosexual males:
refusal bias not reported 55.3% White;
44.7% Non-White
72 Lesbians: 56% White;
43% Non-White.
152 Bisexual females:
67.1% White;
32.9% Non-White
5,416 Heterosexual females:
54.3% White;
45.7% Non-White
290
Age Parental influences Mental health and well-being
1427 Parental knowledge of No differences in mean self-esteem
M = 20 childs sexual orientation if youth reported that one parent
knew or that two parents knew
SD = 2.78 their sexual orientation
Youth who reported that their
fathers knew their sexual
orientation had a higher mean
level of self-esteem than youth
whose fathers did not know
1826 All results control for age, race/
Males ethnicity, parental education, and
living in parental home at
Gay Wave III
M = 22.2 Parental support Association between sexual
orientation and depression was
fully mediated by parental
Bisexual
support for bisexual but not
M = 21.3
lesbian females
SD = 1.59
Among males in the subsample,
Heterosexual there were no mean differences in
M = 21.8 depression at Wave III as a
function of sexual orientation
SD = 1.73
Females
Lesbian
M = 21.8
SD = 1.75
Bisexual
M = 21.5
SD = 1.67
Heterosexual
M = 21.6
SD = 1.73
J Primary Prevent (2010) 31:273309
 Table 4 continued
Citation Study design
Resnick Cross-sectional
et al. Add Health: Wave I in-home
(1997) interviews; excluded youth
reporting sexual debut before
age 11
Parental consent and adolescent
assent
CAPI and A-CASI surveys
Ryan et al. Retrospective
(2009) Family Acceptance Project
Subsample from larger study
(N = 245); excluded
transgender young adults
(n = 21)
Consent procedures not
reported
Computer assisted or pencil-
and-paper self-administered
surveys
123
Sampling strategy
Multistage, stratified,
probability sample
Nationally representative
school-based sample
79.5% participation rate;
refusal bias not reported
Convenience sample
Recruited from 249 LGB
venues located 100 miles of 51% male;
project office in urban city: 49% female
50% clubs/bars and 50%
social service and community 48% non-Latino White;
organizations
Participation rate and refusal
bias not reported
Sample characteristics
N = 11,572
Gender not reported
Race/ethnicity not reported:
nationally representative
sample
Sexual orientation not reported
N = 224 lesbian, gay and
bisexual young adults
52% Latino
Age Parental influences Mental health and well-being
7th12th All results control for same-sex
grade sexual attraction/behaviors,
students demographic factors, school
factors, individual factors, and
Mean age
not other parent and family factors
reported Parentfamily connectedness Negatively associated with
emotional distress for all
9th12th grade youth
Parentadolescent shared activities Positively associated with
emotional distress for all
J Primary Prevent (2010) 31:273309
9th12th grade youth
Parental presence (waking up, Negatively associated with
after school, at dinner and emotional distress for all
bedtime) 9th12th grade youth
Parental school expectations Negatively associated with
emotional distress for all
9th12th grade youth
2125 Results control for gender and race/
M = 22.82 ethnicity
SD not Parentfamily rejection Positively associated with odds of
reported being currently depressed
291
 Table 4 continued
Citation Study design Sampling strategy
123
Savin-Williams Cross-sectional Convenience sample
(1989a) Self-administered closed-ended Multiple recruitment strategies:
survey LGB picnic; LGB college
campus meetings; GL activist
conference; college course;
and snowball sampling in
local and out-of-state
friendship networks
Participation rates:
LGB Picnic: Not reported; 7%
of sample
Campus meetings: 100%
participation rate; 15% of
sample
Conference: 92.5%
participation rate; 20% of
sample
College course: Not reported;
2% of sample
Snowball sampling: not
reported; Local: 43% of
sample; Out-of-state: 14% of
sample
Refusal bias not reported
292
Sample characteristics Age Parental influences Mental health and well-being
N = 317 1423 Separate analyses for male versus
68% male; 32% female Mean age not female youth and parent gender.
reported Results control for other parental
91% White; 9% Not reported influences
68% gay males; 32% lesbian Maternal knowledge of Not associated with self-esteem for
sexual orientation females
Positively associated with self-
esteem for rural males
Satisfaction with maternal Positively associated with self-
relationship esteem for all youth (males and
females)
Infrequent contact with Not associated with self-esteem for
mother all females
Positively associated with self-
esteem for urban males
Paternal knowledge of Not associated with self-esteem for
sexual orientation all youth (males and females)
Satisfaction with paternal Not associated with self-esteem for
relationship all females
Positively associated with self-
esteem for all males
Infrequent contact with Not associated with self-esteem for
father all females
Positively associated with self-
esteem for all males
J Primary Prevent (2010) 31:273309
 Table 4 continued
Citation Study design Sampling strategy
Savin- Cross-sectional Multiple recruitment strategies: N = 317 adolescents and
Williams Self-administered closed-ended LGB picnic; LGB college
(1989b) survey campus meetings; GL activist 68% male; 32% female
conference; college course;
and snowball sampling in
local and out-of-state
friendship networks
Participation rates:
LGB Picnic: Not reported;
7% of sample
Campus meetings: 100%
participation rate;
15% of sample
Conference: 92.5%
participation rate;
20% of sample
College course: Not reported;
2% of sample
Snowball sampling:
not reported; Local:
43% of sample; Out-of-state:
14% of sample
Refusal bias not reported
Sheets and Cross-sectional Convenience sample
Mohr Self-administered internet Recruited from electronic
(2009) survey mailing lists of LGBT student 81% White; 5% Black / African SD = 1.77
Subsample from larger survey organizations on 32 public
of 301 young adults: university/ college campuses
excluded if missing data, representing all major regions
outside age range, not of U.S.
bisexual, transgender, or Electronic signature of consent
failed survey validity checks
123
Sample characteristics Age Parental influences Mental health and well-being
1423 Separate analyses for youth and
young adults Mean age not parent gender
reported Maternal acceptance of sexual Not associated with self-esteem for
orientation moderated by females
91% White; 3% Hispanic; 3% high
3% Black; 2% Asian school: youth comfort with being
gay
American; 1% Native 1417 years
American; 1% International old Maternal acceptance Not associated with self-esteem for
moderated by perceived females
46% exclusively homosexual; 70% college:
31% predominantly 1723 years maternal importance for
youth self-worth
J Primary Prevent (2010) 31:273309
homosexual; 33% reported old
both homosexual and 8% in grad Paternal acceptance moderated Not associated with self-esteem for
heterosexual interests school: by youth comfort females
2123 years Paternal acceptance moderated Positively associated with self-
old by perceived paternal esteem for females
19% not in importance
school: Maternal acceptance mediated Direct effect of acceptance on the
1623 years by perceived maternal self-esteem of males is
old importance completely mediated by
perceived maternal importance
Paternal acceptance mediated Direct effect of acceptance on the
by perceived paternal self-esteem of males is
importance completely mediated by
perceived paternal importance
N = 210 young adults 1825 Results control for gender and other
85% female; 15% male M = 20.96 social support factors
Parentfamily general social Negatively associated with
American; 4% Hispanic; support (GSS) depression
3% Asian or Pacific Islander; Parentfamily sexuality Not associated with depression
1% Native American; specific support (SSS)
6% Other Parentfamily GSS as a Did not moderate relationship
moderator of friend GSS between friend GSS and
depression
Parentfamily SSS as a Did not moderate relationship
moderator of friend SSS between friend SSS and
depression
293
 Table 4 continued
294

Citation Study design Sampling strategy Sample characteristics Age Parental influences Mental health and well-being

123
Teasdale Prospective Multistage, stratified, N = 11,911 Grades Results control for demographic
and Add Health: Wave I and II in- probability sample 48% male; 52% female 712 factors and for peer and school
Bradley- home interviews Nationally representative M = 15.90 support variables
Engen 42% White, 20% Black,
Subsample of same-sex school-based sample 24% Hispanic, 14% Other SD = 1.54 Perceived parental caring Negatively associated with
(2010) depression for SSA youth
attracted (SSA) and Participation rate and refusal 7% Same-Sex Attracted
heterosexual youth bias not reported (n = 787) Partially mediated relationship
Waves I and II: Parental between sexual orientation and
98% Heterosexual depression for SSA youth
consent and adolescent assent (n = 101,124)
CAPI and A-CASI surveys Mediated relationship between
stress at home and depression for
SSA youth
Ueno Prospective Multistage, stratified, N = 11,571 Grades Arguing with parents Positively associated with
(2005) Add Health: Wave I and II in- probability sample Sexual Minority Youth 712 psychological distress for all
home interviews Nationally representative Sexual youth
7.67% (n = 887)
Subsample of youth who were school-based sample minority: Attachment to parents Negatively associated with
56% male; 44% female psychological distress for all
older than age 13 and Participation rate and refusal M = 15.81
classified as sexual minority bias not reported 63% White; 18% Black; youth
13% Hispanic; 3% Asian; SD = 1.56
youth based on reports of Arguing with parents moderated by No statistically significant
same-sex or both-sex 3% Other Sexual Majority Sexual number of friends moderated by difference in psychological
attraction or dating; or sexual Youth majority:sexual minority status distress between sexual minority
majority youth based on 92.33% (n = 10,684) M = 15.61 and sexual majority youth
reports of only opposite-sex 56% male; 44% female SD = 1.61 Arguing with parents moderated by Number of sexual minority friends
attraction or dating. Excluded number of sexual minority buffers against the negative effect
69% White; 15% Black;
youth reporting no attraction friends moderated by sexual of arguing with parents on
12% Hispanic; 3% Asian;
or dating experience minority status psychological distress for sexual
1% Other.
Waves I and II: Parental minority but not for sexual
consent and adolescent assent majority youth
CAPI and A-CASI surveys
J Primary Prevent (2010) 31:273309
 Table 5 Parental influences on LGB suicide
Citation Study design
DAugelli et al. Cross-sectional
(1998) Data analyzed from larger
sample of N = 194 LGB
youth; only included youth
who lived with parents
Waiver of parental consent
obtained
Professional counselor
approved by IRB at each
site; excluded sites without
a trained adult
Self-administered closed-
ended survey
DAugelli et al. Cross-sectional
(2005a) First wave of longitudinal
study of victimization
among LGB youth
Data analyzed from larger
sample of N = 528 youth.
Waiver of parental consent
obtained
Youth advocate at each site
ensured informed consent
123
Sampling strategy
Convenience sample
Recruited from LGB social,
recreational, and support
groups in 14 metropolitan
areas in the U.S.
Participation rate and refusal
bias not reported
Convenience Sample
Recruited from three
community-based
organizations in New York
City and two surrounding
suburbs
Participation rate and refusal
bias not reported
Sample characteristics
N = 105
71% male
29% female
68% White;
32% youths of color
100% lesbian, gay or bisexual
N = 361
56% male; 44% female
41% Black/African
American; 29% Hispanic;
27% White
28% G/L; 20% Bisexual
but almost totally G/L;
21% Bisexual but mostly
G/L; 15% Bisexual but
equally G/L and
heterosexual; 16% Bisexual
but mostly heterosexual;
2 questioning
Age Parental influences Suicide results
1421 Parental knowledge of childs Higher percentage of suicide
M = 18.4 sexual orientation attempts among youth who
had disclosed sexual
SD = 1.7 orientation to parents
compared to youth who had
not disclosed
Greater frequency of suicidal
thoughts among youth who
had disclosed their sexual
orientation to their parents
J Primary Prevent (2010) 31:273309
compared to youth who had
not disclosed
1519 Results control for
M = 17 demographic factors, sexual
orientation factors, and
SD = not other parent and family
reported
factors
Parents psychological abuse Discriminated sexual
orientation-related (SOR)
suicide attempters from
non-SOR suicide attempters
and non-attempters
Parents discouraged gender- Discriminated SOR suicide
atypical behavior attempters from non-SOR
suicide attempters and non-
attempters
Parent calls child LGB Did not discriminate SOR
suicide attempters from
non-SOR suicide attempters
and non-attempters
Parents called youth a sissy or Discriminated SOR suicide
a tomboy attempters from non-SOR
suicide attempters and non-
attempters
295
 Table 5 continued
296

Citation Study design Sampling strategy Sample characteristics Age Parental influences Suicide results

123
DAugelli and Cross-sectional Convenience sample N = 194 1521 Parental awareness of childs Lack of parental awareness
Hershberger Waiver of parental consent Recruited via 14 LGB 73% male; 27% female M = 18.9 sexual orientation positively associated with
(1993) obtained community centers with suicidal thoughts
66% White; 14% African SD = 1.6
Adult with professional informal support groups. American; 5% Asian Compared to suicide non-
Only one center per city, Males attempters, suicide
counseling experience American; 6% Hispanic
vetted by IRB at each site to representing major urban American; 4% American M = 19.2 attempters were more likely
ensure informed consent; areas in U.S. Indian SD = 1.6 to have disclosed sexual
excluded sites without a 44% return rate on surveys orientation to a family
75% lesbian or gay; 19% Females
trained adult member other than a parent
Refusal bias not reported bisexual, but mostly lesbian M = 18.1
Self-administered closed- or gay; 6% bisexual and Compared to suicide
SD = 1.5 attempters, parents of non-
ended survey mailed to equally lesbian/gay and
groups and completed in heterosexual attempters were less aware
group setting supervised by of their childs sexual
adult orientation
Parents reaction (positive or Did not differentiate between
negative) to disclosure of suicide attempters and non-
sexual orientation attempters
DAugelli et al. Cross-sectional Convenience sample N = 350 1421 Parental knowledge of childs Among youth reporting
(2001) Data from project examining Recruited from 39 56% male; 44% female Mean age sexual orientation suicide attempts, 54%
how LGB youth cope with community-based not occurred before a parent
78% White; 8% African knew sexual orientation,
sexual orientation-related organizations and 20 American; 4% Asian; reported
challenges. Excluded data colleges in U.S., Canada, 26% occurred during same
3% Chicano or Mexican; year as disclosure to a
from mostly heterosexual, and New Zealand using 7% Other
hetero-sexual, uncertain, no multiple recruitment parent, and 20% occurred
answer youth strategies: letters, internet Males: within a year of disclosure
postings, and telephone 83% gay; 17% bisexual to a parent
IRB approved adult required
to be at each site to ensure Participation rate and refusal Females: Parental rejection or Youth with intolerant or
informed consent. Parental bias not reported intolerance of youths rejecting fathers were twice
64% lesbian; 36% bisexual
consent procedures not sexual orientation as likely to report a past
reported suicide attempt
Self-administered closed- Of suicide attempters, 48%
ended survey completed in reported intolerant or
group setting rejecting fathers, compared
to 28% of non-suicide
attempting youth
No difference in maternal
rejection or intolerance
between suicide attempters
and non-suicide attempters
J Primary Prevent (2010) 31:273309
 Table 5 continued
Citation Study design
Espelage et al. Cross-sectional
(2008) 2000 Dane County Youth
Survey: students from 18
high schools in a
Midwestern county
Passive parental consent and
adolescent assent
Self-administered closed-
ended survey given during
single class period
Eisenberg and Cross-sectional
Resnick (2006) 2004 Minnesota Student
Survey
Subsample of 6th, 9th and
12th grade students;
excluded youth reporting no
sexual partners
Passive parental consent
(active if required by school students participated
or district)
Self-administered closed-
ended survey during class
period
Friedman et al. Retrospective
(2006) Consent procedures not
reported
Self-administered closed-
ended survey
123
Sampling strategy Sample characteristics
Saturated sample: county- N = 13,921
wide school-based sample 49.7% male; 50.3% female
of all youth in school on day
of survey 78.6% White; 5.4% Biracial;
4.8% Asian; 4.8% Black;
Participating schools returned
3.6% Hispanic
surveys for 9095% of
student population 7.7% lesbian, gay or bi;
6.7% questioning;
Refusal bias not reported 86% heterosexual
Saturated sample: state- N = 21,927
wide school-based sample 10.28% LGB (n = 2,255)
of all youth in school on day
of survey 64% male; 36% female
88% of school districts in 67% White; 6% Black /
African American;
Minnesota participated
5% Hispanic; 5% Asian;
Statewide: 75% of 9th grade 2% Native American;
and 55% of 12 grade
15% Mixed/Other
90.13% heterosexual
Refusal bias not reported
(n = 19,672)
47% male; 53% female
81 White; 4% Black / African
American; 3% Hispanic;
3% Asian; 1% Native
American; 7% Mixed/Other
Convenience sample N = 96
Recruited from gay 100% male
university- or community-
73% White; 10% African-
based organizations American; 6% Latino;
Participation rate and refusal 5% Asian / Pacific Islander;
bias not reported 6% Mixed
88% gay; 8% bisexual;
4% other
Age Parental influences Suicide results
High school Homophobic teasing Parental support did moderate
students moderated by parental the relationships between
M = 15.8 support homophobic teasing and
depression-suicidal feelings
SD not
among LGB and
reported questioning students
J Primary Prevent (2010) 31:273309
Grades 9 Results control for sexual
and 12 orientation, demographic
Full factors, teacher caring, other
adult caring, and school
sample:
safety
35.3% 9th
grade Parentfamily connectedness Parentfamily connectedness
negatively associated with
65.7% 12th
the odds of suicidal ideation
grade and suicidal attempts
Parentfamily connectedness
accounted for a greater
amount of variance in
suicidal behaviors than
sexual orientation or any
other protective factor
1825 Parental social support Higher levels of parental
M = 20.32 support in elementary,
junior and high school
SD = 1.83 independently protected
against current suicidality
Parental social support as a Parental social support did not
moderator of bullying and moderate the relationship
suicidality between bullying and
suicidality
297
 Table 5 continued
Citation Study design
123
Hershberger Cross-sectional
et al. (1997) Adult human services
professional at each site
explained study, ensured
informed consent and
administered survey
Self-administered closed-
ended survey
Needham and Cross-sectional
Austin (2010) Add Health: Subsample of
Wave III in-home
interviews; excluded young
adults if married; missing
data on sexual orientation;
no contact with parents or
parent-like figures at
Wave III
Wave III: Young adult
consent
CAPI and A-CASI surveys
Sampling strategy
Convenience sample
Recruited from 14 youth 73% male; 27% female
groups in LG community 66% White; 15% African
centers in major U.S. urban
areas
44% survey return rate
Human service professional at
each site reported that no
youth given a survey
refused participation
Multistage, stratified,
probability sample
Nationally representative
school-based sample
Subsample: 73.4% of all
youth interviewed
at Wave III
Wave III participation rate
and refusal bias not reported Heterosexual males
Sample characteristics
N = 104
American; 5% Asian
American; 5% Hispanic;
4% Native American
N = 11,153 49.4% male;
50.6% female Gay males
(n = 121)
53.8% White; 46.2% Non-
White
Bisexual males (n = 40):
55% White; 45% Non-
White
(n = 5,352): 55.3% White;
44.7% Non-White
Lesbians (n = 72): 56%
White; 43% Non-White.
Bisexual females (n = 152):
67.1% White; 32.9% Non-
White
Heterosexual females
(n = 5,416): 54.3% White;
45.7% Non-White
298
Age Parental influences Suicide results
1521 Mother and father knows Associated with a higher odds
M = 18.86 sexual orientation of having attempting suicide
SD = 1.64 Not associated with suicide
attempts, controlling for
Males demographic factors, sexual
M = 19.16 orientation experiences and
SD = 1.57 behaviors, victimization,
disclosure, and mental
Females
health
M = 18.06
Mother knows sexual Did not distinguish between
SD = 1.54 orientation non-attempters and single
and multiple suicide
attempters
Father knows sexual Distinguished between non-
orientation attempters and single and
multiple suicide attempters
1826 Separate analyses by gender
Males All results control for age,
race/ ethnicity, parental
Gay
education, and living in
M = 22.2 parental home at Wave III
SD = 1.60 Parental support as a mediator Association between sexual
Bisexual between sexual orientation orientation and suicidal
and suicidal thoughts thoughts was partially
M = 21.3
mediated by parental
SD = 1.59
support for bisexual and
Heterosexual lesbian females
M = 21.8 Association between sexual
SD = 1.73 orientation and suicidal
Females thoughts was partially
mediated by parental
Lesbian support for gay but not
M = 21.8 bisexual males
SD = 1.75
Bisexual
M = 21.5
SD = 1.67
Heterosexual
M = 21.6
SD = 1.73
J Primary Prevent (2010) 31:273309
 Table 5 continued
Citation Study design
Proctor and Cross-sectional
Groze (1994) Adult at each site obtained
informed consent. Parental
consent not reported
Self-administered closed-
ended survey completed in
youth group setting
Remafedi et al. Cross-sectional
(1991) Verbal and written consent
obtained
Self-administered structured
interview
Rotheram- Cross-sectional
Borus et al. Lesbian youth excluded due
(1994) to funding concerns
Voluntary informed consent.
Parental consent not
reported
Semi-structured face-to-face
interview and self-
administered closed-ended
survey
123
Sampling strategy
Convenience
Recruited via 56 LGB youth
groups in US and Canada:
groups mailed letter,
instrument copy and
consent forms
24 groups agreed to
participate. No other
participation rate reported
Refusal bias not reported
Convenience sample
Multiple recruitment 100% male
strategies used: ads in gay 82% White; 13% African
publications (30% of total
sample); bars (5%); LGB
youth social support groups
(29%); universities (15%); a 88% gay; 12% bisexual
youth drop-in center (19%);
peer referrals (11%)
No recruitment or referrals
from mental health
treatment facilities
Participation rate and refusal
bias not reported
Convenience sample
Recruited from Hetrick-
Martin Institute in New
York City
Three youths refused to
participate. No refusal bias
reported
Sample characteristics Age Parental influences Suicide results
N = 221 Range not Good parentchild Having a good relationship
71.9% male; 28.1% female reported; relationship discriminated between
No youth youth who had neither
69.1% White; 7.3% African over age considered nor attempted
American; 6.8% Latino;
21 suicide and youth who had
5% Native American; considered and attempted
4.5% Asian; 0.5% Pacific M = 18.5
suicide
Islander; 6.8% Other SD not
62.9% gay; 23.5% lesbian; reported
13.6% bisexual
J Primary Prevent (2010) 31:273309
90.5% from U.S.;
9.5% from Canada
N = 137 1421 Maternal knowledge of sexual Did not discriminate between
Suicide orientation suicide attempters and non-
attempters attempters
American; 4% Hispanic; M = 19.25 Paternal knowledge of sexual Did not discriminate between
1% Asian orientation suicide attempters and non-
SD = 1.63 attempters
Non- Supportive maternal response Did not discriminate between
attempters suicide attempters and non-
M = 19.83 attempters
SD = 1.63 Supportive paternal response Did not discriminate between
suicide attempters and non-
attempters
N = 131 1419 Parental knowledge of sexual Disclosure of sexual
100% male M = 16.8 orientation orientation was positively
associated with the odds of
51% Hispanic; 30% Black; SD = 1.4 reporting a past suicide
12% White; 7% Other attempt
66% gay; 25% bisexual;
Parents discovered adolescent Parental discovery of sexual
3% straight; 6% did not was gay orientation was positively
identify as gay, bisexual associated with the odds of
or straight reporting a past suicide
attempt
299
 Table 5 continued
Citation Study design
123
Ryan et al. (2009) Retrospective
Family Acceptance Project
Subsample from larger study
(N = 245); excluded
transgender young adults
(n = 21)
Consent procedures not
reported
Computer assisted or pencil-
and-paper self-administered
surveys
Teasdale and Prospective
Bradley-Engen Add Health: Wave I and II
(2010) in-home interviews
Subsample of same-sex
attracted (SSA) and
heterosexual youth
Waves I and II: Parental
consent and adolescent
assent
CAPI and A-CASI surveys
Sampling strategy
Convenience sample
Recruited from 249 LGB
venues located 100 miles of 49% female
project office in urban city:
50% LGB-serving clubs and 48% non-Latino White;
bars and 50% LGB social
service and community
organizations
Participation rate and refusal
bias not reported
Multistage, stratified,
probability sample
Nationally representative
school-based sample
Participation rate and refusal
bias not reported
300
Sample characteristics Age Parental influences Suicide results
N = 224 young adults 2125 All results control for gender
51% male; M = 22.82 and race/ethnicity
SD not Parentfamily rejection Associated with a higher odds
reported of suicidal ideation
Associated with a higher
52% Latino
likelihood of previous
suicide attempts
N = 11,911 Grades Results control for
48% male; 52% female 712 demographic factors and for
M = 15.90 peer and school support
42% White; 20% Black; variables
24% Hispanic; 14% Other SD = 1.54
Perceived parental caring Negatively associated with
7% Same-Sex Attracted odds of reporting suicidal
(n = 787) tendencies for SSA youth
98% Heterosexual
For SSA youth, partially
(n = 101,124) mediated the relationship
between sexual orientation
and the odds of reporting
suicidal tendencies
J Primary Prevent (2010) 31:273309
J Primary Prevent (2010) 31:273309
data and controlled for a number of potentially
important variables (Ford et al. 2005; Resnick et al.
1997). In general, there was modest support for
parentchild connectedness and strong support for
parental disapproval on LGB youths sexual behav-
iors and health. A protective association for parent
child connectedness was observed by a number of
studies (i.e., Ackard et al. 2008; Garofalo et al. 2008;
Resnick et al. 1997). More specifically, Resnick et al.
(1997) found that connectedness and parental disap-
proval were associated with an older age of sexual
debut when controlling for other protective and
demographic factors, including sexual orientation
(Resnick et al. 1997). However, in a subsequent
longitudinal study replicating Resnick et al.s (1997)
study on the likelihood of being diagnosed with an
STI in early adulthood, only parental disapproval was
significant (Ford et al. 2005).
In the only other study using a probability sample,
there was no support for an association between
parental knowledge and the sexual behavior of urban
Latino men who have sex with men (MSM; ODon-
nell et al. 2002). Although limited by a retrospective
study design and the use of an urban convenience
sample, Ryan et al. (2009) found that perceived
parental/caregiver rejection during adolescence was
positively associated with sexual risk behaviors in
early adulthood, with high levels of rejection emerg-
ing as particularly important.
Substance Use
A total of five articles focused on the influence of
parents on substance use among LGB youth. The
results are summarized in Table 2 and highlight four
trends. First, the included articles focused on two
areas of parental influences. These were emotional
dimensions of the parentchild relationship, such as
support and connectedness (Espelage et al. 2008;
Needham and Austin 2010; Resnick et al. 1997), and
parental knowledge of and responses to a childs
sexual orientation (Padilla et al. 2010; Ryan et al.
2009). Second, there were no prospective studies, and
third, only two articles were based on probability
samples (Needham and Austin 2010; Resnick et al.
1997). Despite these limitations, two mechanisms of
influence emerged as important across the five
studies. These were the benefits of a good parent
child relationship characterized by connectedness,
301
warmth, and support, and the harm associated with
parental rejection of youths sexual orientation.
Two methodologically strong articles analyzed
Add Health data to examine parental influences in
adolescence and early adulthood (Needham and
Austin 2010; Resnick et al. 1997). Consistent with
the idea that parents can buffer their child from
sexual orientation-related stressors, Needham and
Austin (2010) examined parental support in early
adulthood as a potential mediator of the association
between sexual orientation and substance use during
this same developmental period. Although LGB
young adults reported lower mean levels of parental
support than their heterosexual peers, parental sup-
port partially mediated the association between
sexual orientation and substance use among lesbian
and bisexual females, with some exceptions (Need-
ham and Austin 2010). Notably, there was no
association between sexual orientation and substance
use among males (Needham and Austin 2010).
In contrast, parents negative responses to their
childs sexual orientation emerged as having a
positive association with young adults substance
use, an association that was particularly strong when
young adults reported high levels of parental rejec-
tion during adolescence (Ryan et al. 2009). With no
prospective studies, it is difficult to draw firm
conclusions about the influence of parents on the
substance use of LGB youth. While the findings
suggest that support, connectedness, and rejection are
important correlates of substance use in both adoles-
cence and early adulthood, additional research is
needed to better understand the temporal nature of the
observed associations.
Violence and Victimization
Five articles were located for parental influences on
LGB youths experiences with violence and victim-
ization (see Table 3). All five examined how parents
knowledge of and responses to their childs sexual
orientation were associated with sexual orientation-
related victimization (SOV). Considered together,
there was some support that these two dimensions of
parenting were positively associated with young
peoples reports of SOV both within (DAugelli
et al. 1998, 2005a, b) and outside of (DAugelli et al.
2006) the family context. Notably, only one article
examined the role of positive parental responses
123
302
(DAugelli et al. 2008), which were negatively
associated with SOV and positively associated with
youths reports of family support. In addition, family
support and offers to protect youth from SOV were
higher when parents were aware of their childs
sexual orientation (DAugelli et al. 2005a, 2008).
Taken together, the studies suggested that parents
can serve as victimizers and protectors of their
children. However, methodological limitations tem-
per the strength of the findings. All of the studies
were cross-sectional and utilized convenience sam-
ples recruited from LGB-serving organizations
located in and around urban, metropolitan areas.
Four were based on the same sample of LGB youth
(DAugelli et al. 2005a, b, 2006, 2008) whereas the
fifth drew upon LGB youth residing in 14 major
metropolitan areas in the U.S. (DAugelli et al. 1998).
None reported participation rates or refusal bias. As
such, it is difficult to make causal inferences about
the nature of the observed associations or to gener-
alize the findings to youth residing in non-urban
settings and to those not attending LGB-serving
organizations.
Mental Health and Well-Being
Sixteen articles examined parental influences on the
mental health and well-being of LGB youth. Similar
to previous areas, the majority focused on two types
of parental influences: (a) parents knowledge of and
responses to their childs sexual orientation and (b)
emotional dimensions of the parentchild relation-
ship. In addition, a very small number examined
parental victimization of LGB youth (DAugelli
2002) and patterns of autonomy and independence
in the parentchild relationship (Floyd et al. 1999).
Table 4 summarizes the results.
Multiple studies examined how emotional dimen-
sions of the parentchild relationship, such as
support, caring, connectedness, and conflict, shaped
youths mental health. Across studies, a supportive
and caring parentchild relationship emerged as an
important correlate (Floyd et al. 1999; Homma and
Saewyc 2007; Needham and Austin 2010; Resnick
et al. 1997; Savin-Williams 1989a, b; Sheets and
Mohr 2009; Teasdale and Bradley-Engen 2010; Ueno
2005). The strongest support was offered by Ueno
(2005) and Teasdale and Bradley-Engen (2010), who
prospectively examined parental influences on youth
123
J Primary Prevent (2010) 31:273309
well-being in Add Health. Teasdale and Bradley-
Engen (2010) found that parental support in adoles-
cence was negatively correlated with depression
1 year later and could mediate the relationship
between sexual orientation and mental health. Sim-
ilarly, Ueno (2005) found that parentchild attach-
ment was negatively correlated with youths
psychological distress whereas arguing with parents
was positively correlated. Although LGB youth
reported a higher mean level of distress than heter-
osexual youth, the difference was small in magnitude,
leading Ueno (2005) to note that LGB youth may
experience less stressful environments than what is
portrayed in the literature.
Across separate articles, negative parental responses
were inversely associated with young peoples mental
well-being (DAugelli 2002; DAugelli et al. 2006;
Ryan et al. 2009; Savin-Williams 1989b). Mental
health was one of the few health areas where studies
reported on both mother and father data, with different
associations emerging for each parent (Floyd et al.
1999; Savin-Williams 1989a). In addition, data on
youths perceptions of both parents allowed for an
examination of how patterns of parental responses
shaped young peoples mental health. Findings indi-
cated that parents often responded differently and that
having two accepting parents was associated with
better mental health outcomes than having one accept-
ing and one rejecting parent (DAugelli 2002).
Although the overall pattern of results suggested
that negative parental responses and a strong parent
child relationship are both important, there were
important limitations. Of the 16 articles, the major-
ity relied on convenience samples (n = 12) and pre-
sented cross-sectional data (n = 13). As with previ-
ous health areas, probability samples of LGB youth
were only found in studies using Add Health data
(e.g., Needham and Austin 2010; Resnick et al.
1997; Teasdale and Bradley-Engen 2010; Ueno
2005). Apart from these four studies, both rural
and ethnic minority youth were underrepresented, as
were youth not attending LGB organizations or
social venues.
Suicide
A total of 14 articles examined how parents influence
LGB youths experiences with suicide. Across the
included studies, parental influences were again
J Primary Prevent (2010) 31:273309
examined in two primary domains: (a) parental
knowledge of and responses to their childs sexual
orientation and (b) emotional dimensions of the
parentchild relationship. In addition, one study
examined abuse within the parentchild relationship
(DAugelli et al. 2005a). Table 5 presents the results.
A small number of studies examined parents
negative responses to their childrens sexual orienta-
tion, which were positively associated with suicide
(DAugelli et al. 2001; Ryan et al. 2009). A larger
number (n = 6) examined the role of parental
knowledge of a childs sexual orientation and tended
to indicate that knowledge was positively associated
with suicidal thoughts and attempts (DAugelli and
Hershberger 1993; DAugelli et al. 1998, 2001;
Rotheram-Borus et al. 1994). However, the cross-
sectional study designs of these studies make it
difficult to draw firm conclusions as it is possible that
parents became aware of their childs sexual orien-
tation after their child had expressed suicidal
thoughts or attempted suicide. Some support for this
alternative was offered by DAugelli et al. (2001),
who found that among LGB youth reporting suicide
attempts, 54% of attempts occurred when parents
were unaware of their childs sexual orientation, 26%
occurred in the same year as disclosure to a parent
(before or after disclosure is unknown), and 20%
occurred within a year of disclosing ones sexual
orientation to a parent. The period prior to and
immediately following youths disclosure of their
sexual orientation can be a stressful time for LGB
youth (DAugelli 2005), and future research should
better explore how parental knowledge operates in
these instances. In addition, many of the articles did
not control for other potentially important explana-
tory factors and may be affected by left out variable
error (Mauro 1990).
Not surprisingly, parentchild relationships char-
acterized by closeness and support again emerged as
having a protective association with suicide among
LGB youth (Friedman et al. 2006; Needham and
Austin 2010; Proctor and Groze 1994; Resnick et al.
1997; Teasdale and Bradley-Engen 2010). For exam-
ple, in a statewide school-based sample of adoles-
cents, Eisenberg and Resnick (2006) found that
family connectedness was negatively associated with
suicide and accounted for a greater amount of
variance in suicidal behavior than sexual orientation
or any other protective factor. The strongest support
303
was offered by the single prospective study, which
found that perceived parental caring was negatively
associated with suicidal tendencies for LGB youth
and partially mediated the association between sexual
orientation and suicidal tendencies in a nationally
representative sample of LGB youth (Teasdale and
Bradley-Engen 2010).
Taken together, there was modest support that
parental knowledge and negative parental responses
were important correlates of suicidal thoughts and
attempts among LGB youth and adolescents. How-
ever, prospective research is needed to clarify the
precise relationship between parental knowledge and
suicidality among LGB youth. Stronger support was
offered for the benefits of having a supportive,
connected, and caring parentchild relationship. As
with other health domains, the findings are limited by
the use of convenience sampling strategies (n = 13),
limited prospective research (n = 1), and limited
attention to ethnic minority and rural youth.
Discussion
Our purpose was to assess the current state of
knowledge on parental influences on LGB youth
health. In total, we identified 31 articles that met our
inclusion criteria. Overall, we find support that
parents can be an important influence on LGB
youths health and well-being. However, there were
notable limitations. Below, we summarize the key
findings and limitations and provide recommenda-
tions on how to improve the research base.
A key limitation in the extant literature is the
reliance on convenience samples of LGB youth
recruited via LGB-serving organizations or social
venues or via snowball sampling techniques. In
addition, few studies reported data on participation
rates and refusal bias. As such, it is difficult to
generalize many of the findings to the broader popu-
lation of LGB young people. A number of researchers
have suggested that maladaptive health behaviors and
outcomes may be overestimated by the use of conve-
nience samples (Binson et al. 2007; Savin-Williams
1998). In addition, it has been suggested that youth
recruited from LGB-serving organizations are more
open about their sexual orientation (Hershberger and
DAugelli 1995; Hershberger et al. 1997) and experi-
ence higher rates of victimization (Elze 2003). LGB
123
304
populations have long been considered difficult to
reach (Binson et al. 2007), and LGB youth may be
especially difficult as many are still developing their
sexual orientation (Savin-Williams 1998). Thus,
though potentially difficult, there are probability
sampling methods that can be utilized to improve the
methodological rigor of scholarship in this domain (for
a review of available methods, see Binson et al. 2007).
Future research should employ these whenever possi-
ble as this will considerably strengthen the research
base.
A second limitation addresses the dearth of
prospective research with LGB youth. Of the 31
articles, only three presented longitudinal findings,
and all of these were based on Add Health data.
Future research should continue to maximize Add
Health. As a nationally representative dataset, it is
one of the few probability samples of LGB young
people that enables researchers to explore parental
influences in both adolescence and adulthood. At the
same time, Add Health is unable to answer key
questions, such as how responses to a childs sexual
orientation are related to LGB youths health (such
questions were not included in the survey). Thus,
additional prospective studies that can clarify the
temporal relationships observed in cross-sectional
research as well as the precise pathways of influence
through which parents shape LGB youth health
would be a welcome addition to the literature.
Our results suggest that research needs to better
attend to the diversity among LGB youth. Although
many articles included ethnic minority youth, the
majority of sampled youth were White, with Native
American, Asian American/Pacific Islander, and bi
and multiracial youth being particularly understudied.
This area of research is particularly important as
studies suggest that race/ethnicity and cultural and
familial values can influence the extent to which
young people come out to their parents (Grov et al.
2006) and important others (Rosario et al. 2004),
parents responses to their childs sexual orientation
(Garofalo et al. 2008), and youths responses to
dynamics within the parentchild relationship (Parke
et al. 2004). For example, families who embody more
traditional values, such as speaking a language other
than English in the home, valuing religion, and
valuing the importance of marriage and having
children, may be less accepting of their childs sexual
orientation (Newman and Muzzonigro 1993). Some
123
J Primary Prevent (2010) 31:273309
research also has found that White youth are more
likely to disclose their sexual orientation to their
parents than are Latino and African American youth
(Garofalo et al. 2008; Grov et al. 2006). At the same
time, there were no differences in parental/caregiver
rejection between Whites and Latinos observed by
Ryan et al. (2009). Clearly, this is an area that
deserves more focused attention and is likely to be
particularly important in the context of developing
tailored interventions for diverse groups of LGB
youth.
Two other underexplored areas were the extent to
which parental influences differed as a function of
youth sexual orientation and area of geographical
residence. In the present review, rural youth were
underrepresented in most health areas. In one of the
only studies exploring this potential difference,
Savin-Williams (1989a) found that maternal knowl-
edge and contact had different associations for youth
living in rural versus urban areas. This is an important
area of research to address as access to supportive
services and resources for LGB youth and their
families are likely to differ for youth residing in rural,
suburban, and urban areas, with urban areas likely
having a higher concentration of LGB-focused social
venues, neighborhoods, and community-based orga-
nizations. In addition, empirical support for attending
to the importance of sexual orientation was offered
by Needham and Austin (2010), who observed
significant mean differences in substance use and
suicidal thoughts between gays, lesbians, and bisex-
uals, and that parental support operated as a mediator
for some groups of LGB youth but not others. Similar
findings have been observed in previous research (for
a review, see Elze 2005; Volpp 2010). Currently, the
reasons underlying these differences are not well
understood, making this a particularly fruitful area for
additional research.
Across the five health areas, the majority focused
on mental health and suicide, with limited attention to
parental influences on sexual behavior, substance use,
and experiences with violence and victimization
among LGB youth. The focus on these two health
outcomes may reflect concern over existing epidemi-
ological data (Hershberger and DAugelli 1995;
Silenzio et al. 2007). However, the lack of research
on substance abuse and sexual behavior is particu-
larly notable because LGB youth experience health
disparities in each area (Garofalo et al. 1998; Hall
J Primary Prevent (2010) 31:273309
et al. 2008; Marshall et al. 2008) and because a large
and strong body of evidence suggests that parents are
important in both of these domains (Hill et al. 2005;
Miller et al. 2001). The lack of parent-based research
and interventions in the domains of sexual behavior
and substance use is particularly troubling given that
young MSM of color are more likely to be infected
with HIV during adolescence and to have higher rates
of undiagnosed HIV infection than their White MSM
peers (Campsmith et al. 2010; Hall et al. 2008).
Our review also indicates that we know relatively
little about the perspectives of parents of LGB youth.
In order to protect LGB youth from potential harm,
the majority of articles in the review sought waivers
of parental consent. However, there is evidence to
suggest that many LGB youth disclose their sexual
orientation to at least one parent and that a cohort
effect is occurring, such that more contemporary
groups of LGB youth are coming out to their parents
at younger ages (Savin-Williams 1998; Grov et al.
2006). Although youth reports are more consistent
correlates of health behaviors, parent perspectives
remain important. Indeed, effective intervention
programs cannot be designed without a better
understanding of parents needs. Because protecting
youths safety is of utmost concern, researchers can
adopt methods that seek to involve parents and
protect youth. These include asking youth to nomi-
nate parents to whom they have disclosed their sexual
orientation and documenting the characteristics of
youth who agree to nominate and those who refuse.
In a recent study, 48% of LGB youth under age 18
agreed to have a parent contacted to provide parental
consent (Elze 2003). Notably, no parent/legal guard-
ian refused consent (Elze 2003).
In addition, future research should explore how
specific characteristics of parents may be related to
youths health. For example, Savin-Williams (1989a)
observed that both maternal knowledge and self-
esteem were higher among LGB youth with younger
mothers, and previous studies have suggested that
younger parents are more accepting than are older
parents. While we focused our review on parenting
style and goal-directed parenting practices, there are
other parenting characteristics and behaviors that
deserve additional attention. These include factors
such as parental mental health and substance use,
which have implications for parenting, the parent
child relationship, and LGB young peoples health
305
and well-being (Corliss et al. 2010; Schneider et al.
1989).
Despite the existing limitations in the research,
there were some key trends with respect to the
potential influence of parents on the health and well-
being of LGB youth. Although the cross-sectional
study designs and dearth of research in certain health
areas make it difficult to draw firm conclusions, the
overall pattern of results suggested that two dimen-
sions of parenting are important: (a) parents knowl-
edge of and responses to their childs sexual
orientation and (b) emotional qualities of the par-
entchild relationship, such as support, caring, and
parentchild connectedness. Across separate articles
with diverse samples of youth, parental rejection was
found to have a negative association with all five
targeted health areas. In contrast, numerous studies
indicated that a parentchild relationship character-
ized by support, acceptance, and connectedness was
generally associated with less risky behavior and
improved health outcomes. Although most of the
research examined direct relationships, a smaller
number investigated parental support as a potential
moderator or mediator. Overall, the findings lend
support to the idea that parents can serve as a source
of stress and a source of support, and future research
is needed to better understand how these two
dimensions of parenting operate with diverse groups
of LGB youth.
At the same time, it is premature to conclude that
these two dimensions of parenting are what matter
most. Currently, they are important because they are
the two dimensions of parenting that have been most
studied. A notable gap in the extant literature is the
lack of research on how parental influences identified
in the broader empirical literature, such as parental
monitoring or parentchild communication, shape
LGB youths health. None of the included articles
examined these aspects of parenting, which is a stark
contrast to the larger body of research. In addition, no
studies conducted a simultaneous analysis of how
these two dimensions of parenting work together to
influence youth health or if these dimensions of
parenting remain significant when controlling for
other parenting practices and behaviors. As a result, a
number of important questions remain unanswered.
For example, two of the most commonly studied and
robust parental influences are parental monitoring and
parentchild communication. Research suggests that
123
306
both practices are most effective when there is an
open and mutual exchange of information between
parents and youth (Kerr et al. 1999; Stattin and Kerr
2000) and when young people perceive that their
parents are trustworthy and looking out for their best
interests (Guilamo-Ramos et al. 2006). Given these
factors, how then does parental monitoring operate in
families where parents express ambivalence or
rejection of their childs sexual orientation? Can
parents be effective monitors and communicators in
these situations? These questions are not trivial and
have important theoretical and applied implications.
Future research should explore these areas, which
will help to bring LGB research in line with the rigor,
breadth, and complexity of scholarship on parental
influences among the general youth population.
Across the articles, there was a trend to focus on
negative parental influences as opposed to the mech-
anisms through which parents might be able to
positively influence youths health. In some ways, this
trend is consistent with the broader research on LGB
youth, which has tended to focus on risk and pathology
(Savin-Williams 2001). However, there is a clear need
to identify protective mechanisms in the family that
can buffer LGB youth from negative responses to their
sexual orientation. Although strained parentchild
relationships exist for many LGB youth, there is a
strong public health imperative to identify mecha-
nisms that can enable parents to support their childs
health, even in families where parents struggle to
accept their childs sexual orientation.
As with any study, the findings must be interpreted
within the context of existing limitations. Because
we focused specifically on parental influences, we
excluded studies that examined the broader family
system. Parents are one part of families and future
research should examine how the influence of siblings,
grandparents, or extended family members can be
utilized to support LGB youth. In addition, we were
not able to examine if parental influences differed
between different types of parents, e.g., biological,
stepparents, or legal guardians. Future research should
examine the extent to which different types of family
configurations are important for understanding paren-
tal influences on LGB youth. Our focus on parents also
meant that we excluded other important ecological
contexts, such as schools. Recent studies indicate
that schools with LGB support groups, supportive
and caring adults, and other supportive services are
123
J Primary Prevent (2010) 31:273309
associated with lower rates of victimization and
suicidality among LGB youth (Goodenow et al.
2006). Given that schools and families are two of the
most important developmental contexts for young
people, future research should explore how schools
can support parents in their own efforts to keep their
child safe from harm or potentially buffer youth
from negative parental influences. Finally, although
we excluded transgender youth from the review, we
believe that parents are important for transgender
youth and encourage researchers to better explore
parental influences for this group of young people.
Although we did not identify any existing inter-
ventions, the overall pattern of results suggests that
parent-based interventions are not necessarily con-
traindicated by the extant data. That is, among LGB
youth who have disclosed their sexual orientation
to their parents, there are important research and
practice opportunities. Here, we join a growing
chorus of prevention scientists who are calling for
greater attention to the protective role of parents in
the lives of LGB young people (DAugelli 2005;
Garofalo et al. 2008; Horn et al. 2009; Ryan et al.
2009; Savin-Williams 1998). Given that the majority
of parents want their children to develop into healthy
and productive adults, a careful consideration of the
protective role of parents among LGB youth is
warranted and represents a significant conceptual
shift in the current public health literature.
Acknowledgments This review was supported through funds
from the Centers for Disease Control and Prevention, Division
of Adolescent and School Health. The support was made
possible through the Parenting Synthesis Project at CDC,
DASH. The findings and conclusions in this report are those of
the authors and do not necessarily represent the official
position of the CDC.
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