Youth Characteristics Associated With Sexual Violence Perpetration Among Transgender Boys and Girls, Cisgender Boys and Girls, and Nonbinary Youth

Sexual Health of US Transgender Boys, Nonbinary Youth, and Cisgender Girls

Importance

Research documenting the pregnancy experiences of transgender boys and nonbinary youth assigned female at birth (AFAB) in the US is lacking.

Objective

To examine AFAB youth sexual health indicators by gender.

Design, Setting, Participants

Self-reported data were collected cross-sectionally from 2018 through 2020. Initial analyses were conducted in 2023 and analyses were finalized in September 2024. The study took place online, across the 50 US states and Washington, DC. Eligible participants were 14 to 16 years old, read English, and had internet access.

Main Outcome

Sexual health (ie, self-reported pregnancy and sexually transmitted infections [STIs] lifetime prevalence, condom use, and use of other forms of birth control at last penile-vaginal or penile-anal sex).

Results

Based on weighted data (sample sizes are unweighted), 2109 cisgender girls, 348 transgender boys, and 458 nonbinary AFAB youth were included in analyses. There were 44 transgender boys (14%; 95% CI, 9.4-20.1; P = .24), 67 AFAB nonbinary youth (14%; 95% CI, 10.8-18.8; P = .18), and 397 cisgender girls (18%; 95% CI, 16.0-19.7) who reported ever having penile-vaginal sex. Rates for penile-anal sex were also similar by gender (4% to 6%). Lifetime pregnancy rates were higher for transgender boys (5 [9%]; 95% CI, 2.7-27.1; P = .23) than cisgender (18 [4%]; 95% CI, 2.5-7.1) girls, although not statistically significantly so. Pregnancy rates were similar for AFAB nonbinary youth (5 [5%]; 95% CI, 1.9-13.3; P = .73) compared with cisgender girls. Lifetime STI rates were universally low for all AFAB youth (0.5% to 2.0%). Mean age at first penile-vaginal sex was lower for AFAB nonbinary youth (mean age, 13.6 years; SE, 0.4; P = .003) and transgender boys (mean age, 13.9 years; SE, 0.3; P = .06) compared with cisgender girls (mean age, 14.4 years; SE, 0.1). Condom use at last penile-anal or penile-vaginal sex for transgender boys (24 [16%]; 95% CI, 9.5-27.0; P < .001) and AFAB nonbinary youth (33 [24%]; 95% CI, 16.4-34.2; P < .001) was half that of cisgender girls (245 [49%]; 95% CI, 44.1-54.2). Use of birth control other than condoms at last sex was lower for AFAB nonbinary youth (18 [28%]; 95% CI, 16.2-44.5; P = .14), but similar for transgender boys (20 [42%]; 95% CI, 23.4-62.4; P = .69) compared with cisgender girls (167 [44%]; 95% CI, 38.6-50.0).

Conclusion and Relevance

In this cross-sectional study of sexual health among AFAB youth with a diversity of gender identities, transgender boys were more likely, and nonbinary youth, similarly likely, as cisgender girls to be pregnant during adolescence. Even though overall rates of penile-vaginal sex were similar for transgender boys and AFAB nonbinary youth compared with cisgender girls, half as many transgender boys and AFAB nonbinary youth who had this type of sex used a condom at last sex compared with cisgender girls. As with cisgender girls, transgender boys and AFAB nonbinary youth need to be engaged in affirming and inclusive sexual health education.

Sexual Violence Among a State Sample of High School Students: The Impact of Gender Identity and Sexual Orientation

Sexual violence is a pervasive public health issue that has a direct and disproportionate impact on U.S. adolescents. Sexual violence victimization (SVV) is strongly associated with adolescent depression, anxiety, post-traumatic stress, and suicidality, and sexual violence perpetration (SVP) with substance abuse and other health risk behaviors. Gender and sexual-orientation-diverse youth may be at greater risk of sexual violence and the associated mental health consequences. We used data from the 2021 Healthy Kids Colorado Survey, a school-based survey administered to a population sample of high school students, to examine the prevalence of SVV and SVP. We examined the prevalence by demographic characteristics and association with mental health outcomes. Among this sample of high school students, 13% reported SVV and 2.6% reported SVP. Prevalence of SVV was significantly higher for cisgender females and transgender students than cisgender males, and higher for lesbian/gay/bisexual youth than heterosexual youth. SVP was significantly lower among cisgender females than males, yet transgender students had significantly higher odds of SVP, as did lesbian/gay/bisexual and asexual/questioning youth, as compared to heterosexual youth. Future research, particularly those with state-representative samples, should ensure careful attention to include questions around sexual violence experiences (both victimization and perpetration), gender/sexual identity, and race/ethnicity, given the magnitude of differences of SVV and SVP among these subgroups of adolescents. Mental health and suicidality are further underscored as key associations with sexual violence experiences, highlighting the importance of additional research and interdisciplinary responses to these critical aspects of public health prevention and care.

Daily minority stressors, threat appraisal, and identity concealment among trauma-exposed sexual minority women and transgender and gender-diverse people

Recent calls have been made to decolonize White-dominated, Western narratives around concealment (e.g., that disclosure should be prioritized) and instead to examine psychosocial factors associated with concealment. Existing literature lacks exploration into daily variations of sexual or gender identity concealment (hereafter, "concealment") among sexual and gender minority people, especially sexual minority women (SMW) and transgender and gender-diverse (TGD) individuals who have experienced trauma. Additionally, there is little research delving into individual characteristics, such as trait-based avoidance coping, and specific contexts, including daily minority stressors and threat appraisal, prompting trauma-exposed SMW and TGD people to conceal their identities. Addressing these gaps, we aimed to develop and test an innovative model that advances stress and coping frameworks by integrating minority stress and social safety theories. We used data from a 14-day intensive longitudinal study among 57 trauma-exposed SMW and TGD people. Minority stressors and threat appraisal were associated with concealment at both the within- and between-person levels, respectively. Trait-based general avoidance coping predicted identity concealment and moderated the link between daily minority stressors and concealment. Daily minority stressors were associated with greater concealment only among those who reported lower avoidance coping. Concealment may operate as an experiential avoidance behavior among those who habitually cope by using avoidance and as a goal-directed coping response among trauma-exposed SMW and TGD people who face acute minority stressors and report less avoidance coping. Counseling psychologists exploring the function of concealment with trauma-exposed SMW and TGD people should attend to stigma exposure, threat appraisal, and avoidance coping. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Bystanders to Sexual Violence: Findings From a National Sample of Sexual and Gender Diverse Adolescents

Mobilizing bystanders to prevent sexual violence is an increasingly popular prevention strategy. While research has identified characteristics related to opportunity and actions around helping, a more nuanced understanding of how helping behavior and its modifiable levers may differ for youth of various genders is needed. The current study examined bystander-helping behaviors in sexual violence situations in a national, social media-recruited sample of adolescents 14 to 16 years of age. Measures of opportunity and self-reported actions were included in an online survey along with items assessing attitudes related to violence and helping. Given that prevention programs may work differently for cisgender, transgender, and nonbinary young people, between-group differences in amount of opportunity and helping behaviors were examined. Further, we examined correlates of opportunities to help as well as helping behaviors within each group. Overall, few attitude and personal experience characteristics consistently predicted opportunities and behaviors across groups. Group differences that emerged, such as the association between attitudes supportive of rape and lower helping for cisgender but not trans or nonbinary youth, support attending to these group differences in both basic and intervention research to inform tailoring of prevention programs.

Factors affecting the risk of gender-based violence among 2SLGBTQIA+ adolescents and youth: a scoping review of climate change-related vulnerabilities

Gender-based violence (GBV) is a pervasive and growing issue that affects diverse populations worldwide. This study aimed to synthesize the factors affecting the risk of GBV among 2SLGBTQIA+ adolescents and youth. A scoping review was conducted using international databases (Web of Science, Scopus, Proquest, PubMed, Embase, EBSCOhost) since 2009. The studies were independently appraised by two reviewers guided by the PRISMA approach. Ninety-nine articles focusing on the 2SLGBTQIA+ community, GBV, and adolescents or youth were included for the review. The factors affecting the risk of GBV among 2SLGBTQIA+ adolescents and youth were categorized into (1) Wellbeing and mental health; (2) Disparities compared to cisgender youth; (3) Perpetration and victimization; (4) Different types of violence; and (5) Differences among 2SLGBTQIA+ subgroups. The studies further showed relevance to climate-related stressors such as displacement and resource scarcity, and how those can further amplify the vulnerabilities of 2SLGBTQIA+ youth to GBV. The findings revealed the necessity for multi-level strategies that account for the compounded risks faced by 2SLGBTQIA+ adolescents and youth, including those introduced by environmental crises. These five factors related to GBV among 2SLGBTQIA+ adolescents and youth should be considered by social work professionals when working with at-risk populations. Due to limited robust evidence (from countries outside the US) and the diverse contexts of the selected studies, future research is needed to minimize GBV among 2SLGBTQIA+ adolescents and youth, especially as climate change introduces new layers of vulnerability.

Systematic review registration

10.37766/inplasy2024.4.0008.

Prevalence of Diverse Genders and Sexualities in Australia and Associations With Five Forms of Child Maltreatment and Multi-type Maltreatment

This study presents the most comprehensive national prevalence estimates of diverse gender and sexuality identities in Australians, and the associations with five separate types of child maltreatment and their overlap (multi-type maltreatment). Using Australian Child Maltreatment Study (ACMS) data (N = 8503), 9.5% of participants identified with a diverse sexuality and .9% with a diverse gender. Diverse identities were more prevalent in the youth cohort, with 17.7% of 16-24 years olds identifying with a diverse sexuality and 2.3% with a diverse gender. Gender and sexuality diversity also intersect - for example, with women (aged 16-24 and 25-44) more likely than men to identify as bisexual. The prevalence of physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence was very high for those with diverse sexuality and/or gender identities. Maltreatment was most prevalent for participants in the youth cohort with diverse gender identities (90.5% experiencing some form of child maltreatment; 77% multi-type maltreatment) or diverse sexualities (85.3% reporting any child maltreatment; 64.3% multi-type maltreatment). The strong association found between child maltreatment and diverse sexuality and gender identities is critical for understanding the social and mental health vulnerabilities of these groups, and informing services needed to support them.

Gender Identity and Aggression

Gender identity, or people's deeply felt, internal sense of their gender, plays an important role in aggression perpetration and victimization. In this article, I review and organize the psychological research literatures on gender identity-based aggression. I first discuss the need to move beyond binary, cisgender understandings of gender by embracing expansive definitions that more fully capture people's experiences and identities. Next, I summarize relevant research indicating two paths from gender identity to aggression. In one path, individuals with a more masculine (i.e., dominant, agentic) gender identity use aggression proactively, motivated by pursuit of social dominance. In another path, individuals with a more uncertain (i.e., insecure, precarious) gender identity use aggression defensively-and often toward vulnerable, gender nonconforming targets-as a means of protecting their gender identity against threats. I end by identifying important areas for future research and considering how interventions might best mitigate gender identity-based aggression.

Exploring the Influence of Romantic Relationship Communication on Adolescents' Self-Efficacy to Ask for Sexual Consent

Adolescence represents a crucial period for sexual and romantic relationship development, and acquisition of skills and confidence essential for effective sexual consent communication. However, various barriers may interfere with adolescents' belief in their ability (i.e., their self-efficacy) to negotiate consent in practice. This study aimed to investigate the state of adolescents' self-efficacy to ask for consent and explore the influence of romantic relationship communication (a construct comprised of three characteristics: relationship assertiveness skills, positive conflict resolution, and communication awkwardness). Participants were 411 adolescents who had current or past relationships (61% girls, 77% Latine, 79% heterosexual). Participants generally reported above-average levels of self-efficacy to ask for consent (M = 4.14 out of 7, SD = 1.24), with LGBQ+ adolescents exhibiting statistically significantly higher levels of self-efficacy compared to heterosexual adolescents (M = 4.51 vs. 4.09, t = -2.66, p = .008). Self-efficacy to ask for consent was positively individually related to positive conflict resolution and relationship assertiveness skills, and negatively related to communication awkwardness (all ps < .001). In a path model, romantic relationship communication displayed a statistically significant association with adolescents' self-efficacy to ask for consent, with high positive conflict resolution, low communication awkwardness, and high relationship assertiveness skills being associated with higher self-efficacy to ask for consent. Findings suggest improving adolescents' romantic communication skills may enhance their self-efficacy to ask for consent, and contribute to increased rates of sexual consent communication. Intervention strategies should target multiple levels of influence to promote positive consent cognitions, behaviors, and cultural norms.

The Psychosocial Consequences of Sexual Violence Stigma: A Scoping Review

Over the past decade, scholars have explored whether the stigma associated with sexual violence (SV) represents a risk factor for psychopathology and related comorbidities following SV. We conducted a scoping review to summarize and evaluate the state of this burgeoning literature. We included studies from Pubmed, APA PsychInfo, Embase, CINAHL Plus, Social Science Premium, and Web of Science that quantified stigma related to SV. Studies were screened and abstracted in accordance with the PRISMA-SCR guidelines for scoping reviews. Our final sample contained 62 studies. We address two key questions about SV stigma. First, is SV a stigmatized status? Articles (n = 14) provided evidence for SV stigma among potential stigmatizers (e.g., individuals who may perpetuate stigma) across a range of methods (e.g., vignettes) and outcomes (e.g., desire for social distance). Additional work (n = 20) corroborates perceptions of SV stigma among targets (i.e., SV survivors). Second, what are the psychosocial consequences of SV stigma? We reviewed studies (n = 28) demonstrating that SV stigma is correlated with a range of adverse psychosocial outcomes-including anxiety, depression, posttraumatic stress disorder, problematic drinking, and somatic symptoms-among individuals experiencing multiple types of SV (e.g., childhood sexual abuse and sexual assault). Thus, emerging evidence suggests that SV stigma may be a critical determinant of risk and recovery following SV exposure. However, a number of limitations were observed, including that SV stigma has not been consistently measured and that the literature has not fully incorporated stigma constructs, such as concealment and structural stigma. We offer several recommendations to advance this line of work.

Effectiveness of the myPlan Teen App, a Digital Healthy Relationship and Safety Planning Intervention With Adolescent Aged 15-17 Years

PURPOSE

To determine the effectiveness of myPlan Teen app compared to usual care on the use of helpful safety behaviors, dating violence victimization and perpetration, depression, and suicide behavior.

METHODS

A longitudinal randomized clinical trial with 617 adolescents randomized to myPlan Teen or usual care. Participants in both groups completed surveys using validated measures at baseline, 3, 6-, and 12-months post-baseline. The study analysis examined the difference between the intervention and control groups in change over time in outcomes.

RESULTS

myPlan Teen significantly increased the use and helpfulness of safety behaviors among adolescents compared to the control group. Intervention users also significantly reduced the perpetration of physical and sexual violence and suicide behaviors. Although both groups experienced decreases in victimization and depression over the 12 months, the differences were not significantly different by group.

DISCUSSION

myPlan Teen, a digitally delivered intervention, is one of the few interventions targeting dating violence in adolescence that has proven effective.

Barriers to Formal Help-Seeking Among Black American Young Adults: Exploring the Roles of Sexual Violence Victimization, Intersectional Oppression, and Perceived Burdensomeness

Though sexual violence can impact people across genders, sexual orientations, ages, and incomes, societal inequities can increase the risk of experiencing sexual violence. Such inequities are often intersectional in nature (e.g., racism and sexism) and may impact a person's ability to engage in help-seeking for experiences of sexual violence, especially among those who perceive themselves to be a burden on others or society as a whole. Therefore, the purpose of the current study was to examine the association between experiencing sexual violence, intersectional oppression, and perceived burdensomeness on barriers to help-seeking among Black American young adults. Participants (n = 289) completed an online questionnaire assessing constructs of interest. We found that half of our sample experienced any sexual violence and nearly three-fourths experienced more than one form of intersectional oppression (e.g., racism, sexism, and homophobia). Ultimately, we found that sexual violence and perceived burdensomeness - but not intersectional oppression - were correlates of experiencing barriers to help-seeking. Through incorporating multiple marginalized identities beyond Black race, our findings can expand our understanding of barriers to help-seeking among diverse Black sexual violence survivors, while revealing a new area for practitioners, healthcare providers, social workers, and related professionals to focus intervention strategies on: perceived burdensomeness. These findings are relevant to all who care for the health and well-being of those who have experienced sexual violence, chronic stress (due to singular and multiple forms of discrimination), and/or other traumas.

Dating Violence Victimization, Perpetration and Suicidality Among Adolescents

Few studies have focused on evaluating the relationship between dating violence (DV) and suicide during the critical period of adolescence, particularly for transgender and gender-diverse (TGD) youth. The study examined the relationship between experiencing DV victimization and perpetration in the past 6 months and suicidality (ideation and attempts) among male, female, and TGD adolescents. This study used data from a longitudinal randomized trial examining the effectiveness of myPlan, a healthy relationship and safety planning app intervention for adolescents, to a control website. Data for this study was collected virtually, in which participants completed surveys through online platforms. A convenience sample was recruited through youth organizations and posting on online platforms including social media. N = 610 adolescents age 15-17 years, who resided in the U.S. experienced DV in the past 6 months, had access to a safe device, and were able to access online surveys were included in this study. The majority were female (63.8%) with (19.5%) TGD and 16.7% male. Nearly 22% of the sample identified as Hispanic/Latino and 61.0% as white. Participants completed an online survey consisting of measures of socio demographics, DV victimization and perpetration via the Conflict of Adolescent Dating Relationships Inventory (CADRI), and suicidality. The primary outcome was the association between DV victimization and perpetration on suicidality. Different forms of DV were accounted for including emotional/relational, physical, and sexual DV. Logistic regressions determined differences in the rate of DV victimization and perpetration on suicidality between gender groups (cisgender female, cisgender male, and TGD). A stratified analysis was conducted to test if the relationship between DV and suicidality differed across gender identity. Approximately one-third (32.2%) of adolescents reported suicidality in the past 6 months. TGD adolescents were more likely to report suicidality compared to males (20.6%, p < .05) and females (32.7%, p > .05). The overall odds of suicidality increased as frequency of emotional/relational DV victimization (OR = 1.37, p < .001), physical DV victimization (OR = 1.59, p < .001) and sexual DV victimization (OR = 1.42, p < .001) increased. These relationships were not significant for DV perpetration. When stratifying findings by gender groups, all forms of DV victimization significantly increased the odds of suicidality for females as well as female perpetration of physical violence. For males, all forms of DV victimization and perpetration were associated with increased odds of suicidality, although not significant due to the smaller sample size. While DV victimization is associated with increased odds of suicidality for TGD, perpetration of DV is associated with decreased odds of suicidality, although not significant due to small sample size. The findings from this study provide further insight into experiences of DV and suicidality among gender diverse youth and can guide future interventions aimed at preventing DV and suicide among adolescents.

Preliminary Prevalence Estimates of Sexual Exploitation as Measured by the Sexual Experiences Survey-Victimization (SES-V) in a National US Sample

The new Sexual Experiences Survey-Victimization (SES-V) was designed to capture a larger range of sexual exploitation and to be applicable to more diverse populations than prior measures. This study represents the first administration of the SES-V in a national sample of adults (N = 347). Participants were recruited from a crowdsourcing platform and selected to reflect the national distribution in terms of age, sex, and race/ethnicity. Rates of sexual exploitation since age 14 were very high in this sample (90%), providing evidence that the SES-V was successful in capturing experiences on the low end of the severity continuum. Using the items corresponding to the FBI definition of rape, 60% of women and 29% of men endorsed rape on the SES-V. Compared to men, women reported higher rates of sexual exploitation overall, and higher rates of every type of sexual exploitation except technology-facilitated. The new SES-V also asks participants to estimate the number of separate instances of four types of sexual exploitation that they have experienced; results provided support for the value of these incident estimates in understanding the scope of sexual exploitation. Finally, this study evaluated new sexual acts and exploitative tactics that were added to the SES-V and found that they demonstrated utility and validity. These findings offer preliminary support for the validity and functionality of the SES-V, although the high prevalence of sexual exploitation on the SES-V is discussed as both a strength and limitation. Future research should evaluate prevalence and demographic differences in a larger national sample.

Effects of sexual assault vs. other traumatic experiences on emotional and cannabis use outcomes in regular cannabis users with trauma histories: moderation by gender?

Introduction

While sexual assault may have particularly adverse emotional effects compared with other forms of trauma, it remains unclear which emotional outcome dimensions are impacted, whether cannabis outcomes are similarly impacted, and whether gender differences exist in sexual assault's links with these outcomes.

Methods

N = 100 cannabis users with trauma histories (M age = 33.1) completed standardized measures of demographics, trauma exposure, posttraumatic stress (PTS) and depressive symptoms, hopelessness, and cannabis outcomes (frequency, medicinal prescription, motives, and craving).

Results

Sexual assault was experienced more often by women (83.9%) than men (31.8%). A series of 2 × 2 analyses of variance [gender: women (n = 56) vs. men (n = 44) × trauma type: sexual assault (n = 61) vs. other (n = 39)] and logistic regression revealed that sexual assault survivors scored higher than other trauma survivors on re-experiencing and hyperarousal PTS symptoms (DSM-5 Clusters B and E), cognitive depressive symptoms, hopelessness, cannabis use frequency, medicinal cannabis prescription, cannabis use to cope with psychological symptoms, and compulsivity craving; and lower on social and enhancement cannabis use motives. In terms of gender main effects, women scored higher than men on cannabis use to cope with negative emotions. In terms of interactions for PTS Cluster D symptoms (negative alterations in mood/cognitions), among men only, sexual assault survivors scored higher than other trauma survivors; and for cannabis enhancement motives and purposefulness cannabis craving, among sexual assault survivors only, women scored higher than men.

Discussion

Across many different trauma, women survivors' use of cannabis to cope with negative affect should be a specific therapeutic focus. Moreover, we identified specific emotional and cannabis use outcomes that should be of specific clinical concern among sexual assault survivors regardless of gender. Finally, in terms of gender differences of clinical interest among sexual assault survivors, while PTS Cluster D symptoms should be specific treatment targets in men, cannabis enhancement motives and purposefulness craving should be treatment targets in women.

Descriptive Data of Transgender and Nonbinary People's Experiences of Sexual Assault: Context, Perpetrator Characteristics, and Reporting Behaviors

Purpose: Nearly half of transgender and nonbinary (trans/NB) people will experience sexual assault in their lifetime. Beyond prevalence, little else is known about the general context in which sexual assault occurs in this community. In addition, whether and to whom trans/NB people report these experiences is also not well understood. As such, we examined these contextual factors regarding trans/NB people's sexual assault experiences. Methods: Using a cross-sectional online survey, we assessed sexual assault prevalence rates, contextual details, and reporting behaviors in a sample of 230 trans/NB adults in the United States. Data were gathered in 2016 and 2017 across two collections. Results: Eighty percent of the sample had experienced sexual assault; 62% reported experiencing completed penetrative behaviors (rape) and 37% reported repeat victimization-assault during both childhood and adulthood. Most participants indicated that their perpetrator was male (80%) and the plurality described perpetrators as dating partners (34%) or acquaintances (34%). Alcohol was involved in 26% of assaults. Approximately 8% characterized the event as a hate crime. Most trans/NB people reported their experience to a friend (64%), dating partner (50%), and/or therapist (35%). Only 6% reported their sexual assault to the police, and 20% stated that they have never told anyone. Conclusion: With the exception of substantially higher prevalence rates, many of our findings are similar to findings in the broader, typically cis-centric, sexual assault literature. We recommend that prevention and support services address both the high rates of sexual assault and the low rates of reporting to police and other support services.

Mediational pathways exploring the link between adverse childhood experiences and physical health in a transgender population

BACKGROUND

Adverse childhood experiences (ACEs) consist of instances of abuse, neglect, or household dysfunction occurring before adulthood. Prevalence rates of ACEs are higher among specific populations, including gender minorities. In addition to ACEs, transgender individuals (TG) face many personal, social, and structural factors that have the potential to negatively impact their physical health.

OBJECTIVE

This study examines exploratory mediational pathways between ACEs and two health outcomes (i.e., general health and days physically ill) in TG. Mediators include everyday discrimination, social support, gender non-affirmation, and mental distress.

METHODS

Cross-sectional data from the U.S. Transgender Population Health Survey (TransPop) was used to conduct a serial/parallel mediation analysis. The TransPop survey included a total of 274 TG.

RESULTS

For both outcome variables, the same three indirect pathways were significant. First, ACEs were associated with increased mental distress, which was associated with a decrease in general health and an increase in days physically ill. Second, ACEs were associated with increased discrimination, which was associated with increased mental distress, and this was associated with a decrease in general health and an increase in days physically ill. Finally, ACEs were associated with discrimination, which was associated with increased gender non-affirmation which was associated with increased mental distress, and this was associated with a decrease in general health and an increase in days physically ill.

CONCLUSION

Interventions focused on reducing discrimination, gender non-affirmation, and poor mental health may be vital to improving the health of TG and to mitigating the indirect role of ACEs on TG health.

Preventing sexual violence in sexual orientation and gender diverse communities: A call to action

Background: Members of the lesbian, gay, bisexual, transgender, queer, and other sexual orientation and gender diverse (SOGD) communities are at disproportionately higher risk for sexual violence compared to cisgender heterosexual people. Despite this elevated risk, relatively few sexual violence prevention efforts effectively reduce these victimization disparities based on sexual orientation or gender identity.Objective: This narrative review provides an overview of the prevalence of sexual violence in the SOGD communities, delineates risk factors for sexual victimization among SOGD community members, and reviews and evaluates existing prevention efforts for the SOGD communities. We outline specific recommendations for ensuring that prevention efforts meet the needs of the SOGD communities.Method: Drawing on ecological systems theory and public health approaches to sexual violence prevention, we outline current approaches and opportunities for preventionists and scholars to push the field forward.Results: There have been promising prevention programmes designed to be implemented within SOGD communities specifically; however, it is important that general primary prevention programmes endeavour to specifically address sexual violence perpetrated against SOGD people. While many packaged programmes that endeavour to prevent sexual violence across all gender identities and sexual orientations are inclusive of SOGD participants, more programming is needed that integrates anti-oppression training to target social norms that perpetuate SOGD-specific rape myths and normalize sexual violence against SOGD community members.Conclusion: Ecological prevention strategies in line with a public health approach for primary prevention may be particularly valuable for reducing victimization disparities based on SOGD status and identity. Comprehensive sexual education and anti-discrimination policies should be considered front-line prevention programming. To assess if these strategies are effective, the implementation of large-scale surveillance surveys that use comprehensive assessments of sexual orientation, gender identity, and sexual violence are needed. Using theoretically grounded implementation strategies for prevention programmes can ensure effective programme delivery.

Barriers to Seeking Medical Care Among Youth Victims of Sexual Violence

PURPOSE

Youth victims of sexual violence often experience physical health problems but are unlikely to receive medical care. However, victims' reasons for not accessing medical care have been understudied. We examined barriers to seeking medical care among youth victims who contacted the National Sexual Assault Online Hotline.

METHODS

We used archival data about one-on-one chat sessions with youth victims between June 2018 and February 2020. Hotline staff described victims' reasons for not accessing medical care via an online assessment. We coded and qualitatively examined these reasons using data about 520 victims with physical health concerns who had not received medical care.

RESULTS

Victims' barriers were rooted in individual beliefs and contextual realities reflected in three categories: (1) perception that medical care was not needed, (2) anticipated consequences of seeking medical care, and (3) inability to physically access medical care. Victims who perceived care as unnecessary did not understand the health implications of abuse or minimized their need for care. Anticipated consequences included privacy and control over disclosure, stigmatization, retaliation from the perpetrator, family disruptions, and retraumatizing medical treatment. Victims unable to physically access care were uncertain how to access care independently, lacked social support, or were prevented from care by the perpetrator.

DISCUSSION

Medical treatment can ameliorate acute health concerns and increase safety, but youth victims perceived numerous barriers to care. Several barriers implied unintended consequences of child maltreatment policies, including mandatory reporting. Trauma-informed policy and practice are critical for improving victims' access to medical care and other support services.

Polyvictimization Among Sexual and Gender Minority Youth

INTRODUCTION

Polyvictimization is a significant public health issue. Sexual and gender minority youth are important to include in polyvictimization research because they report higher rates of victimization than nonsexual and gender minority youth. This study examines whether polyvictimization attenuates the associations between individual types of victimization and depressed mood and substance use across gender and sexual identities.

METHODS

Data were collected cross-sectionally from 3,838 youth aged 14-15 years. Youth were recruited through social media between October 2018 and August 2019 across the U.S. Analyses were conducted in July 2022. Sexual and gender minority youth were oversampled. Depressed mood and substance use were dependent variables.

RESULTS

Transgender boys were the most likely to be polyvictims (25%). Transgender girls (14.2%) and cisgender sexual minority girls (13.4%) also reported high rates. Cisgender heterosexual boys were the least likely to be classified as polyvictims (4.7%). When adjusting for polyvictimization, existing relationships between individual types of victimization (e.g., theft) and depressed mood became nonsignificant in most cases. Of exception, witnessing violence and peer victimization remained significant predictors of the odds of depressed mood. Most associations between individual types of victimization and substance use became nonsignificant after considering polyvictimization, with the exception of cisgender heterosexual boys and girls, for whom many remained significant but attenuated (e.g., emotional interpersonal violence).

CONCLUSIONS

Sexual and gender minority youth experience a disproportionate number of victimizations across multiple domains. A comprehensive assessment of victimization exposure may be important when considering prevention and intervention approaches for depressed mood and substance use.

Recommendations to Improve the Nature and Extent of Relationships Among Organizations Within a Network to Enhance Supports for Transgender Survivors of Sexual Assault

CONTEXT

To enhance the provision of comprehensive supports to transgender (trans) survivors of sexual assault, a structurally marginalized group with complex care needs, we developed an intersectoral network of trans-positive health care and community organizations in Ontario, Canada.

OBJECTIVE

As a baseline evaluation of the network, we conducted a social network analysis to determine the extent and nature of collaboration, communication, and connection among members.

DESIGN

Relational data (eg, activities of collaboration) were collected from June to July 2021, and analyzed using a validated survey tool, Program to Analyze, Record, and Track Networks to Enhance Relationships (PARTNER). We shared findings in a virtual consultation session with key stakeholders and facilitated discussion to generate action items. Consultation data were synthesized into 12 themes through conventional content analysis.

SETTING

An intersectoral network in Ontario, Canada.

PARTICIPANTS

Of the 119 representatives of trans-positive health care and community organizations invited to participate in this study, 78 (65.5%) completed the survey.

MAIN OUTCOME MEASURES

Proportion/count of organizations collaborating with other organizations. Network scores for value and trust.

RESULTS

Almost all (97.5%) invited organizations were listed as collaborators, representing 378 unique relationships. The network achieved a value score of 70.4% and trust score of 83.4%. The most prominent themes were "Communication and knowledge exchange channels," "Clearer roles and contributions," "Indicators of success," and "Client voices at the centre."

CONCLUSION

As key antecedents of network success, high value and trust indicate that network member organizations are well positioned to further foster knowledge sharing, define their roles and contributions, prioritize the integration of trans voices in all activities, and, ultimately, achieve common goals with clearly defined outcomes. There is great potential to optimize network functioning and advance the network's mission to improve services for trans survivors by mobilizing these findings into recommendations.

Transgender Youth's Perspectives on Factors Influencing Intended and Unintended Pregnancies

Drawing on data from focus groups with 152 trans youth aged 14-18 years in the United States, this article explores the factors that the participants understood as contributing to adolescent pregnancy among trans youth. Youth posited that unintended pregnancies occur due to barriers to contraceptives; a lack of gender-affirming sexual health education; sexual assault and dating violence; and mental health-influenced sexual risk-taking. Participants suggested that intended pregnancies may be a self-development strategy; a self-directed effort to repress/change gender modality or identity; and due to the perceived incompatibility between pregnancy and transition, where pregnancy must occur prior to transitioning.