Adverse Childhood Experiences Among LGBTQ+ High School Students: National Evidence From the 2023 Youth Risk Behavior Survey

<b>Objectives.</b> To provide population-representative estimates of US high school students' exposure to adverse childhood experiences (ACEs), separately by sexual orientation, gender identity, and 3 demographic moderators: sex assigned at birth, race/ethnicity, and age. <b>Methods.</b> Using data from the 2023 US National Youth Risk Behavior Survey (n = 12 131), this cross-sectional study calculated descriptive statistics, estimated multivariable regressions, and screened for mischievous respondents. <b>Results.</b> Lesbian, gay, bisexual, transgender, and questioning (LGBTQ+) students reported elevated exposure to 8 separate ACEs, with a cumulative ACE score of 3.0 (95% confidence interval [CI] = 2.9, 3.1), compared with 1.8 (95% CI = 1.7, 1.9) among cisgender-heterosexual (cishet) students. This pattern held across all demographic subgroups and could not be explained by mischievous responders. Nearly half (46.1%; 95% CI = 39.7, 52.5) of all gender minorities reported 4 or more ACEs, compared with 34.5% (95% CI = 30.9, 38.0) of cisgender sexual minorities and 15.4% (95% CI = 14.2, 16.7) of cishet students. <b>Conclusions.</b> The first national ACE prevalence data for US high school students show that LGBTQ+ youths-particularly transgender youths-face far greater levels of abuse, neglect, and other adversities than cishet youths. (<i>Am J Public Health</i>. 2025;115(7):1137-1145. https://doi.org/10.2105/AJPH.2025.308094).