Physical Activity Mediates Associations Between Sexual Orientation And Mental Health

PURPOSE: Adolescents identifying as a sexual minority frequently experience mental health issues. Physical activity (PA) has numerous benefits for physical and emotional development. The purpose of this study was to examine the mediating effect of PA on the association between sexual minority status and mental health among adolescents during COVID-19. METHODS: A sample of adolescents (grades 9-12) completed the online Adolescent Behaviors and Experiences Survey (ABES; N = 7,705; 49.6% male) during the spring of 2021 and were recruited as the participants. The ABES is structured with 81 questions. ABES was completed within out-of-school settings using a secure web-based platform. The ABES protocol was approved by Institutional Review Boards at CDC and the survey contractor. RESULTS: The independent variable in this study was a recorded binary response item asking about sexual orientation. The dependent variable was a mental health latent variable constructed using indicator items of self-reported ratings of mental health and the presence of sadness or hopelessness. The PA mediator variable was a latent variable with indicator items asking about PA frequency, sports participation, and muscle-strengthening activities. Weighted structural equation models tested the direct effects of sexual minority status, mental health, and adolescent PA, controlling for age, sex, race/ethnicity, and BMI %tile. Monte Carlo simulations obtained indirect effects on mental health through PA. The indirect effect (IE) between sexual minority status and mental health through PA was statistically significant (IE -0.03, 95% CI: -0.04 - -0.02, p < 0.001) with 9% of the total effect being mediated through lower levels of PA. The direct effect of sexual minority status on mental health was also significant and stronger in magnitude (b = -0.32, 95%CI: -0.34--0.29, p < 0.001). These results suggest that identifying as a sexual minority is associated with poorer mental health, an association partially mediated by lower levels of PA. CONCLUSIONS: PA only partially mediated the association between adolescents’ sexual minority status and their mental health during the COVID-19 pandemic. Improving PA in adolescents of a sexual minority has the potential to mildly alleviate mental health issues during pandemics.