For some, the results of the Center for Disease Control and Preventions’s landmark study on lesbian, gay and bisexual youth were not surprising. “It reminded me a lot of my experiences in school,” Joshua Deese, a University of Maryland student and volunteer with the Trevor Project, a national suicide intervention and prevention organization, said. Growing up in a small Florida town, Deese was verbally and physically bullied in high school, both before and after he came out as gay.

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The CDC’s report, published last Thursday, was the first nationally representative study to ask high school students about their sexuality. The data showed that lesbian, gay and bisexual (LGB) teens face higher levels of physical and sexual violence and bullying than other students and have an increased risk of suicidal thoughts and other serious health outcomes.

There are approximately 1.3 million LGB high school students in the country, according to the CDC. LGB students were three times more likely than their heterosexual peers to be forced into sexual intercourse and more than two times as likely to have experienced physical or sexual dating violence. They were more than two times as likely to feel sad or hopeless. Of LGB students, 12.5% had skipped school because they felt unsafe, compared to 4.6% of heterosexual students. They were about two times as likely to have been bullied at school or electronically. The likelihood of drug use by LGB students was up to five times that of their heterosexual peers. They were about three times as likely to have seriously considered suicide and more than four times as likely to have attempted suicide.

The data came from the 2015 National Youth Risk Behavior Survey (YRBS), a biennial survey of teen health conducted by the CDC. This was the first year that it included two questions on sexual orientation and sex of sexual contacts, making the analysis of data specific to LGB teens possible. The CDC analyzed data from more than 15,000 high school students, in addition to 25 state surveys and 19 large urban school district surveys.

The findings did not include data on students who identified as trans or a non-binary gender. They also did not include dropouts, which the CDC said may be composed of a disproportionate amount of lesbian, gay or bisexual youth. According to the New York Times, a question on gender identity “might be ready for a pilot test in 2017” for eventual inclusion on the YRBS.

The CDC’s report wasn’t designed to look at what might be causing the high risks for LGB teens. Emily Greytak, the director of research with the Gay, Lesbian and Straight Education Network (GLSEN), said that a feeling of trauma or discrimination could lead to high risk behaviors. But she also said that a “small percentage of the students that you go to school with can make your life hell even if you have a majority who are neutral or don’t care or are supportive”.

For Mia Healy, a recent high school graduate from New Jersey, many of her classmates were supportive when she came out as a lesbian, but others called her an “attention whore” for her sexuality or told her that “gay people are equivalent to shit” in response to her art project exploring gender.

David W Bond, the vice-president of programs for the Trevor Project, said victimization was one of the risk factors for suicide. When it came to dating violence, he said it could go unreported by teens who are afraid to be outed.

Greytak also theorized that there was a harsh backlash to efforts like marriage equality or recent anti-discrimination bills, creating a negative environment for students. Since the CDC’s data was collected throughout 2015, it didn’t take into account recent events – such as North Carolina’s bathroom law or the backlash to Barack Obama’s order for trans students be allowed to use the bathroom of their choosing. “It’ll be interesting to see the 2017 [study] after all of the anti-trans legislation, which is just kicking back up more homophobia in the school systems and legitimizing discrimination against gender nonconforming and transgender students,” said Geoffrey Winder, the co-executive director of the Genders & Sexualities Alliance (GSA) Network (formerly the Gay-Straight Alliance Network).

The CDC made recommendations in its report for public health action, including bolstering existing anti-bullying and harassment policies, safe spaces for students and educating staff on forging inclusive environments.

The GSA Network receives funding from the CDC’s division of adolescent and school health. One of its programs in conjunction with the CDC, called Out For Safe Schools, distributes badges to educators to show that they’re supportive of LGB students. The sight of the badges at a San Diego high school brought Christopher White, the director of safe and supportive school project at the GSA network, to tears. “A student saw a teacher wearing one and she thought, ‘Oh cool, she’s part of the club. She’s someone I can talk to,’” he recalled.

The organization also supports students in forming their own GSA clubs. Winder started his own GSA back in the beginning of the movement in 1998. Deese said his last two years of high school were improved by starting a GSA, as it helped non-LGBT students to become more understanding.

For the past six years, Deese has been volunteering with the Trevor Project and is now part of the organization’s Washington DC ambassador’s council. He found the organization when he was searching for gay resources online and said it saved his life. The organization has a 24/7 crisis hotline, as well as texting and chatting services and a social networking site for LGBT teens, which can sometimes be the only supportive resource for teens living in more hostile environments.

In addition to their own programs, these organizations had recommendations for additional reforms to improve school climate, centered around inclusivity and changes in bullying policies. Winder warned in particular against bullying policies which could make a student feel like their sexuality is at fault.

Greytak had four key recommendations for schools: anti-bullying and anti-discrimination policies that are actively implemented and well-known; supportive and trained educators; clubs and organizations; and inclusive curriculums that are “reflective of the world”. “LGB youth need to see themselves reflected in the curriculum and non-LGB youth really need to see other people reflected in the curriculum as well to break down prejudice and barriers,” she said.

Bond said schools needed to adopt suicide prevention programs that were LGBTQ inclusive and promote prevention education in a way that wouldn’t create a “suicide contagion” or cause students to think suicide was part of their identity.

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“Do not be afraid to ask someone: are you thinking of killing yourself? It is a striking question to say out loud and there’s a myth that it will get someone who wasn’t thinking about it to start thinking about it,” Bond said. “You give someone an opportunity to say, ‘Yes, I am.’”

These reforms can be difficult to implement, especially in states which have restrictive laws against discussions of homosexuality in education, which Greytak and Bond called “no promo homo” laws. Greytak said eight states – Alabama, Arizona, Lousiana, Mississippi, Oklahoma, South Carolina, Texas and Utah – had laws which “forbid educators from talking about LGBT issues in a positive light or at all”.

“Can you imagine? The only time you’re allowed to speak about homosexual people or homosexuality is talking about Aids, and that’s about it,” Greytak said. “What kind of message does that send?”

While advocates were frustrated that the CDC only recently required questions on sexuality on its survey, they applauded the step forward. “You don’t count until someone counts you,” Bond said, though he regretted that trans and non-binary genders were left out.

“I stood in the face of vitriol and bullying because of who I am and I’ve seen what this does to other people’s lives, as it’s done to mine,” Deese said. “It makes me hopeful for the future that we will continue to make things better not just for the LGBTQ community but for Americans all over.”

• In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In the UK, the Samaritans can be contacted on 116 123. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.