Acad Pediatr. 2026 Apr 2:103315. doi: 10.1016/j.acap.2026.103315. Online ahead of print.
ABSTRACT
OBJECTIVE: To estimate the prevalence of parent-reported sexual orientation and gender identity (SOGI) discrimination among U.S. children and adolescents and examine associated demographic, health, and adversity-related characteristics.
METHODS: We analyzed 2021-2023 National Survey of Children’s Health (NSCH) data, a cross-sectional, caregiver-reported survey of U.S. children. We compared sociodemographic characteristics, health conditions, adverse childhood experiences (ACEs), co-occurring discrimination, and family context by SOGI discrimination status among children ages 6-17. Multivariable logistic regression identified characteristics independently associated with SOGI discrimination. Analyses incorporated survey weights and were stratified by age group.
RESULTS: Among 93,982 children ages 6-17, 2.2% were reported to have experienced SOGI-based discrimination. Relative to those without reported discrimination, they were more frequently female, older, and less likely to live in two-parent households. They had significantly higher rates of co-occurring discrimination based on race or health status, bullying, depression, anxiety, ADHD, and learning disabilities, and their caregivers reported greater stress. ACEs – including economic hardship, parental divorce, parental incarceration, and household violence – were significantly more prevalent among those with SOGI-based discrimination. In multivariable regression, co-occurring race- and health-based discrimination, female sex, and older age showed the strongest independent associations; most ACEs and neurodevelopmental conditions did not remain significant after adjustment. Adolescents had higher rates of SOGI-based discrimination (3.5%) compared to children ages 6-11 (0.7%).
CONCLUSIONS: SOGI-based discrimination is strongly associated with co-occurring adversity and mental health concerns beginning in childhood. These findings highlight the importance of early, trauma-informed, and affirming approaches within pediatric settings.
PMID:41935714 | DOI:10.1016/j.acap.2026.103315
