Peer Victimization, Bullying, and Sexual Orientation-Related Health Disparities: Conceptual and Methodological Distinctions and Considerations.

Sexual minority youth (SMY) scholarship has lagged in its attention to the conceptual and practical distinctions between peer victimization and bullying. The current study includes five population-based samples from the Youth Risk Behavior Survey (n = 68,285). We used the Karlson, Holm, and Breen (KHB) method to test whether school-based victimization and bullying differentially account for sexual identity differences in substance use and mental health. Results showed that school-based victimization and bullying were weakly correlated; each was a robust independent factor in the association between sexual orientation and health outcomes. Victimization emerged as a robust factor that attenuated sexual identity differences in substance use among SM girls, but not for SM boys, accounting for 40-96% of the indirect effect (IE). In contrast, bullying was associated with larger proportions of the indirect effect for sexual orientation differences in mental health for both SM girls (IE = 47-72%) and SM boys (IE =  ≥ 72%). Findings underscore the importance of intentional and justified analytic decisions regarding investigating victimization and/or bullying as mechanisms of sexual identity differences in mental and behavioral health. Implications highlight the need for school policies and practices that distinctly target school victimization and bullying as they are independently related to outcomes and differential risk for substance use and mental health for SMY, particularly among SM girls. Research is necessary to better understand how unique forms of peer aggression relate to indicators of health and well-being for SM (and all) youth.