Indicators of victimization and sexual orientation among adolescents: analyses from Youth Risk Behavior Surveys

Differing gender diverse children have differing experiences with same- and other-gender peers

How gender diversity is exhibited varies: some individuals feel similar to the other gender; others experience little similarity to either gender, and some feel similar to both genders. For children, do these variations relate to differing relationships with peers? The goal was to assess whether a community sample of children (884, Mage = 9.04, SD = .90, 51% boys/1 transgender boy; 57% non-Latinx) with differing types of gender diversity have differing relationship experiences and beliefs about same- and other-gender peers. Gender diversity was determined by gender self-concepts (Both-Gender Similar, Cross-Gender Similar, Low-Gender Similar); these were compared among themselves and to gender-typical children (Own-Gender Similar). Results confirmed that children who exhibited differing gender diversity patterns varied in their peer experiences such that gender self-concept matching was found: Children who felt more similar to other-gender peers reported more contact and felt included and efficacious with other-gender peers; children who felt more similar to same-gender peers reported more contact and felt included and efficacious with same-gender peers. These findings suggest that children with two of the atypical patterns (i.e., Cross-Gender and Both-Gender) may experience social benefits that gender typical children do not. These findings illustrate the variability and strengths among gender diverse children.

A Call to Disrupt Heteronormativity and Cisnormativity in Physical Therapy: Perspectives of 2SLGBTQIPA+ Participants on Future Directions for PT Curricula

Purpose

To explore the perspectives of individuals with self-reported expertise and/or lived experiences regarding aspects of 2SLGBTQIPA+ health that should be included in pre-licensure physical therapy (PT) curricula across Canada, including how, when, and by whom this content should be delivered.

Method

We conducted a critical qualitative, cross-sectional study with semi-structured virtual interviews. We analyzed participants' perspectives thematically using the DEPICT method.

Results

Thirteen participants across Canada with a variety of gender identities and sexual orientations were interviewed. Participants described how transformative change on 2SLGBTQIPA+ issues in PT requires an approach that is based on interrupting heteronormativity and cisnormativity in PT curricula. Participants explained how this could be achieved by (1) emphasizing both historical inequities and present-day considerations for safe and inclusive practice, (2) introducing the content early and integrating it throughout the programme using a variety of large- and small-group sessions, and (3) including 2SLGBTQIPA+ individuals in content delivery and creation.

Conclusions

This study brings attention to the need for the PT profession to understand how the pervasive social structures of heteronormativity and cisnormativity shape education and practice, and offer strategies for disrupting complicity with these systems of inequality.

Providing Lesbian, Gay, Bisexual, Transgender, Nonbinary, and Queer Adolescents With Nurturance, Trustworthiness, and Safety: Protocol for Pilot Cluster Randomized Controlled Trial Design

BACKGROUND

Sexual and gender minority youths (lesbian, gay, bisexual, transgender, nonbinary, and queer individuals) face elevated risks of substance use (eg, alcohol and tobacco) and mental health issues (eg, depressive symptoms and suicidality) compared to their cisgender heterosexual peers. These inequities are hypothesized to be reduced by building supportive high school environments via the training of school staff. An intervention that trains school staff to better understand and support sexual and gender minority youths and engage in positive bystander behaviors that protect them from bullying exposure may reduce disparities in drug and alcohol use among them. Experts, school staff, and sexual and gender minority youths developed Providing LGBTQ+ Adolescents with Nurturance, Trustworthiness, and Safety (PLANTS), a web-based intervention to train school staff on how to support, affirm, and protect sexual and gender minority youths.

OBJECTIVE

This paper describes the design of the PLANTS pilot trial primarily aimed at assessing its acceptability, usability, appropriateness, and feasibility. We hypothesize PLANTS will have high acceptability, usability, appropriateness, and feasibility as rated by the school staff. Secondary objectives focus on implementation, safety, and pre-post changes in high school staff outcomes, including self-efficacy and skills (eg, active-empathic listening and bullying intervention). Exploratory objectives focus on the impact of PLANTS on student health outcomes.

METHODS

In a 2-arm cluster randomized controlled trial, high schools in Massachusetts are allocated to PLANTS or an active comparator group (publicly available sexual and gender minority youths resources or training). High school staff complete pretest and posttest surveys containing validated scales. Primary outcomes are validated measures of acceptability, usability, appropriateness, and feasibility of the intervention completed by staff during posttest surveys. To test our primary hypotheses for each outcome, we will calculate means and 95% CIs and P values using 1-sample 2-sided t tests against a priori thresholds or benchmarks of success. Secondary outcomes include staff's active-empathetic listening skills, self-efficacy for working with sexual and gender minority youths, bystander intervention behaviors for bullying and cyberbullying, and self-efficacy for PLANTS' change objectives completed during pretest and posttest staff surveys. Staff can also complete a posttest interview guided by the Information-Motivation-Behavior model and Consolidated Framework for Implementation Research. Exploratory outcomes include student-level data collected via the 2021 and 2023 MetroWest Adolescent Health Surveys, a health behavior surveillance system in 30 Massachusetts schools.

RESULTS

School enrollment began in May 2023 and participant enrollment began in June 2023. Data collection is expected to be completed by February 2024.

CONCLUSIONS

This pilot trial will yield important information about the PLANTS intervention and provide necessary information to conduct a fully powered trial of the efficacy of PLANTS for reducing the deleterious health inequities experienced by sexual and gender minority youths.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05897827; https://clinicaltrials.gov/study/NCT05897827.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55210.

Examining Mental Health and Bullying Concerns at the Intersection of Sexuality, Gender, Race, and Ethnicity Among a National Sample of Sexual and Gender Diverse Youth

Purpose: Most extant scholarship that examines the health experiences of sexual and gender diverse youth (SGDY) is limited in the ability to apply an intersectional framework due to small sample sizes and limitations in analytic methods that only analyze the independent contribution of social identities. To address this gap, this study explored the well-being of youth at the intersection of ethnic, racial, sexual, and gender identities in relation to mental health and bullying. Methods: Data were from a U.S. national survey of SGDY aged 13-18 years, collected in 2022 (N = 12,822). Exhaustive Chi-square Automatic Interaction Detection analysis identified intersectional social positions bearing the greatest burden of negative health-related experiences (depression, anxiety, and past 30-day in-person victimization). Results: Transgender boys were among those at the highest prevalence for compromised mental health and peer-based in-person victimization. Although the primary distinguishing factor was transgender identity for depression and anxiety, there were no racial/ethnic distinctions, corroborating some previous scholarship. Asian cisgender and transgender girl SGDY shared the lowest burden of peer-based in-person victimization in school. Conclusion: Our findings suggest a need for scholars, health professionals, and other stakeholders to better understand the mechanisms that drive negative health experiences and in-person victimization experiences at the intersections of sexual, gender, racial, and ethnic identities.

Sexual orientations in association between childhood maltreatment and depression among undergraduates in mainland of China

BACKGROUND

There is growing evidence that sexual minorities including lesbian, gay, bisexual and questioning individuals (LGBQ) have significantly higher rates of childhood maltreatment than heterosexuals. However, few studies focused on the association between different type of childhood maltreatment and depression in LGBQs.

METHODS

Cross-sectional study by random sampling was conducted among the undergraduates in mainland of China. A total of 1920 undergraduates from different majors and colleges completed self-report questionnaires to record depression, childhood maltreatment, sexual orientation and other related information. The associations were examined via a set of logistic regression analysis.

RESULTS

Compared to the participants who had never experienced childhood maltreatment, the participants who reported emotional abuse (p < 0.001) and sexual abuse (p < 0.05) had higher odds of depression. The LGBQs have higher risk of being the victims of childhood maltreatment. The prevalence of depression was much higher in the LGBQ than that in the heterosexuals (33.9 % vs 16.1 %, χ2 = 43.627, p < 0.001). Compared to heterosexual adolescents, LGBQs had significantly higher odds of depression (p < 0.001).

LIMITATIONS

Cross-sectional design, self-reported information, and unable to examine underlying protective factors.

CONCLUSIONS

Emotional abuse, emotional neglect and sexual abuse have stronger association with LGBQ than other kind of childhood maltreatment. Emotional abuse and sexual abuse have stronger association with depression. Sexual abuse has stronger association with depression in LGBQs than heterosexuals. More attention to the mental health should be paid especially in LGBQs to reduce the risk of depression.

Bullying Involvement at the Intersection of Gender Identity/Modality, Sexual Identity, Race, Ethnicity, and Disability: Prevalence Disparities and the Role of School-Related Developmental Assets

Purpose: This study examines adolescents' self-reported school-based developmental assets and four intersecting social positions as they relate to prevalence of bullying involvement. Methods: Participants were 80,456 ninth and 11th grade students who participated in the 2019 Minnesota Student Survey (30.2% youth of color; 11% lesbian/gay/bisexual/pansexual/queer/questioning; 2.9% transgender/gender diverse [TGD] or gender questioning). Exhaustive Chi-square Automatic Interaction Detection analysis was used to identify school-based developmental assets (i.e., school safety, school adult support) and intersecting social positions (i.e., sexual identity; gender identity/modality; racial/ethnic identity; physical disabilities/chronic illness; and/or mental health/behavioral/emotional problems) associated with the highest prevalence of involvement as physical and relational bullies, victims, and bully-victims. Results: Adolescents with 2+ marginalized social positions who often lacked school-based developmental assets were part of nearly all the highest prevalence bullying involvement groups. TGD and gender questioning adolescents, Native American youth, and youth living with both physical disabilities/chronic illness and mental health/emotional/behavioral problems-most of whom had additional marginalized social positions and lacked school-based assets-were particularly overrepresented in high prevalence groups. For example, 31.1% of TGD or gender questioning youth of color living with both types of disabilities/health problems who did not feel strongly that school was safe reported involvement as physical bully-victims-nearly six times the sample average rate. Conclusion: Adolescents with multiple marginalized social positions and those lacking certain school-based assets-often overlapping categories-were involved in bullying at higher-than-average rates. Findings underscore the need for schools to address intersecting experiences of stigma and structural oppression that may perpetuate bullying involvement disparities.

Protocol for a systematic review of substance use and misuse prevalence and associated factors among transgender and non-binary youth living in the USA

BACKGROUND

Transgender and gender non-binary (TNB) youth living in the USA report elevated levels of substance use compared with their cisgender counterparts, with previous literature pointing to minority stressors as some of the factors that could facilitate such elevated levels. Yet, substance use and misuse prevalence and associated modifiable factors among TNB youth are not fully known. The current paper details the protocol for a systematic review aimed at (1) identifying substance use and misuse prevalence among TNB youth (ages <25) and related demographic disparities (based on racial, ethnic and gender identity, and sexual orientation), (2) examining factors associated with substance use and misuse among TNB youth and (3) examining protective factors against substance use and misuse among TNB youth.

METHODS AND ANALYSIS

Systematic searches will be conducted across four databases: PubMed, LGBTQ+ Source, CINAHL and PsycInfo to identify quantitative, qualitative and mixed-methods peer-reviewed research publications. An exhaustive list of keywords and corresponding MeSH (Medical Subject Headings) terms representing the concepts of 'TNB' (the population of interest) and 'substance use and misuse' (outcome) will be employed. Identified records will be initially screened via a review of titles and abstracts. Full text of the remaining records will be reviewed corresponding to the inclusion and exclusion criteria. Extracted data will be synthesised in table and narrative format. A meta-analysis will be considered contingent on the existence of sufficient data. Methodological quality and risk of bias of studies will be assessed.

ETHICS AND DISSEMINATION

This review does not require approval from the Institutional Review Board as it involves no interactions with human subjects. We will disseminate our findings via peer-reviewed manuscripts and academic conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42023394985.

Application of an intersectional lens to bias-based bullying among LGBTQ+ youth of color in the United States

Bias-based bullying influences health, academic success, and social wellbeing. However, little quantitative work takes an intersectional perspective to understand bias-based bullying among youth with marginalized social positions, which is critical to prevention. This paper describes the application of exhaustive chi-square automatic interaction detection (CHAID) to understand how prevalence of race-, gender-, and sexual orientation-based bullying varies for youth with different intersecting social positions. We used two datasets - the 2019 Minnesota Student Survey (MSS; N=80,456) and the 2017-2019 California Healthy Kids Survey (CHKS; N=512,067). Students self-reported sex assigned at birth, sexual orientation, gender identity, race/ethnicity, and presence of any race-, gender-, and sexual orientation-based bullying (MSS: past 30 days, CHKS: past 12 months). Exhaustive CHAID with a Bonferroni correction, a recommended approach for large, quantitative intersectionality research, was used for analyses. Exhaustive CHAID analyses identified a number of nodes of intersecting social positions with particularly high prevalences of bias-based bullying. Across both datasets, with varying timeframes and question wording, and all three forms of bias-based bullying, youth who identified as transgender, gender diverse, or were questioning their gender and also held other marginalized social positions were frequent targets of all forms of bias-based bullying. More work is needed to understand how systems of oppression work together to influence school-based bullying experiences. Effective prevention programs to improve the health of youth with marginalized social positions must acknowledge the complex and overlapping ways bias and stigma interact.

Looking Within: An Analysis of Intimate Partner Violence Victimization Among Sexual Minority Youth

Sexual minority youth are at increased risk of intimate partner violence (IPV) victimization compared to their heterosexual peers. However, the sexual minority population is not a homogenous group and risk of IPV victimization varies by LGB+ subgroup (e.g., gay/lesbian, bisexual, and unsure). Using two waves of data (2017, 2019) from the National Youth Risk Behavior Survey (YRBS), this study analyzes (a) differences in physical and sexual IPV victimization between heterosexual and sexual minority youth, (b) within group differences among sexual minority youth, and (c) if the relationship between IPV victimization and sexual identity is attenuated after controlling for sociodemographic characteristics and theoretically relevant risk factors. Results indicate that sexual minority youth are at elevated risk of IPV victimization compared to their heterosexual peers. Within-LGB+ analyses show that bisexual youth are more likely than gay/lesbian youth to be victims of sexual IPV. The association between physical and sexual IPV victimization and sexual identity is partially attenuated by sociodemographic variables and observed risk factors. Findings indicate that intervention and prevention programming should be tailored to identify, and treat, the risks and needs of unique, at-risk populations.

Ethnoracial Differences in Past Year Victimization Rates for a National Sample of Gender and Sexual Minority Adolescents

Little research exists on victimization for gender and sexual minority adolescents (GSMA) of color. This study identifies differences in past year rates across six victimization types for GSMA by ethnoracial identification. Descriptive analyses were conducted on 1,177 GSMA (14-19 years old), with victimization types stratified by ethnoracial identification and multiple logit regression was used to identify differences. Compared to White (non-Hispanic) peers, Black (non-Hispanic) GSMA reported lower victimization rates across multiple categories with two exceptions. Higher rates of racially biased physical assault were noted among Black (non-Hispanic) and bi/multi-ethnoracial GSMA. Higher rates of witnessing community violence were reported by Black (non-Hispanic), bi/multi-ethnoracial, and Latinx GSMA. To address GSMA's needs, we need to understand the differential risk so that our interventions are responsive to the diversity within this community.

Sexual minority youth's mental health and substance use: The roles of victimization, cybervictimization, and non-parental adult support

Victimization is a well-established driver of sexual minority youth's (SMY) mental health and substance use risk. The current study examined and extended this research by exploring how victimization, cybervictimization, and non-parental supportive adults contribute to SMY's vulnerability to poor mental health and substance use. Using data from the first representative sample of Texas youth that measures sexual identity, we analyzed sex-stratified models of the association between sexual identity, mental health, and substance use, and the confounding effects of victimization, cybervictimization, and non-parental adult support. Victimization was more common among SMY and accounted for a greater proportion of sexual identity disparities on mental health and substance use, especially for males. Sexual minority females were more likely to report cybervictimization than heterosexual youth, and cybervictimization was associated with mental health risk. SMY reported fewer available non-parental supportive adults, which was associated with more sadness, suicidality, and polysubstance use. Our study adds to extant evidence that victimization drives SMY's increased susceptibility to mental health and substance use risk. Schools should implement inclusive policies that prohibit bullying based on sexual minority identity and offer professional development opportunities for supporting SMY.

At-School Victimization and Alcohol Use Among Minoritized U.S. Youth, 2009-2017

INTRODUCTION

Sexual minority and/or racial/ethnic minority youth may use alcohol at school as a form of minority stress-based coping. Polyvictimization is particularly prevalent among sexual minority and/or racial/ethnic minority youth and may be a useful proxy measure for minority stressors.

METHODS

Data from local administrations of the Youth Risk Behavior Survey were pooled across 42 jurisdiction years (biennially, 2009-2017) and analyzed in 2022, resulting in a sample of 118,052 U.S. youth. The prevalence of alcohol use at school was examined by sexual identity, race/ethnicity, and their intersections, stratified by sex. Multivariable logistic regression models were built to examine the disparities in alcohol use at school and the impact of school-based polyvictimization.

RESULTS

At the intersections of race/ethnicity and sexual identity, 25 of 30 sexual minority and/or racial/ethnic minority subpopulations had greater odds of alcohol use at school than their White heterosexual same-sex peers. Hispanic/Latinx not-sure males (AOR=9.15; 95% CI=5.97, 14.03) and Hispanic/Latinx lesbian females (AOR=11.24; 95% CI=6.40, 19.77) were most likely to report alcohol use at school. After adjusting for polyvictimization, the magnitude of association was attenuated for most sexual minority and/or racial/ethnic minority subpopulations; however, all but 2 significant associations remained.

CONCLUSIONS

Sexual minority and/or racial/ethnic minority youth were more likely than White heterosexual peers to use alcohol at school, with the greatest odds among multiply marginalized and polyvictimized youth. Interventions should consider addressing more than school-based victimization alone because disparities persisted, although at a lower magnitude, after accounting for polyvictimization. Future longitudinal studies are warranted to further explore the associations between multiply marginalized identities, school-based polyvictimization, and alcohol use at school.

Intersectionality of Sexual Orientation With Race and Ethnicity and Associations With E-Cigarette Use Status Among U.S. Youth

INTRODUCTION

Although structural discrimination against sexual and racial/ethnicity minorities is a putative risk factor for youth tobacco use, understanding health disparities in youth E-cigarette use at the intersection of sexual orientation, race, and ethnicity is still lacking. This study aims to examine the differences in E-cigarette use prevalence among U.S. youth at the intersections of sexual orientation with race and ethnicity.

METHODS

E-cigarette use status (never, experimental, or current use) was analyzed among 38,510 U.S. youth using a pooled data set from the Youth Risk Behavior Surveillance System 2015-2019. The weighted E-cigarette use status between youth at the intersections of sexual orientation with race and ethnicity was reported, stratified by sex. Multivariable multinomial regression adjusting for relevant covariates was further conducted. Data analyses were performed in April 2022.

RESULTS

After controlling for other covariates, the RRR of current E-cigarette use compared with never use between lesbian Black girls (and heterosexual Black girls) was higher than between lesbian White girls (and heterosexual White girls) (adjusted RRR=6.99; 95% CI=2.21, 22.14). The RRR of current E-cigarette use compared with never use between lesbian other race/multiracial girls (and heterosexual other race/multi-racial girls) was higher than between lesbian White girls (and heterosexual White girls) (adjusted RRR=3.60; 95% CI=1.06, 12.26).

CONCLUSIONS

This study has shown that sexual minority Black girls were more likely to currently use E-cigarettes than heterosexual Black girls. Future studies should examine the underlying reasons for current E-cigarette use among girls with intersectional identities, including race and sexual orientation.

The Association Between Bullying Victimization and Fighting in School Among US High School Students

In-school fighting often results in severe punishment and compromised learning outcomes, without adequate consideration of contextual factors or student vulnerabilities. In this study, using a large, nationally representative data sample from the 2019 Youth Risk Behavior Survey (N = 13677), we assessed associations between a history of bullying victimization (at school and online) and past year fighting at school among U.S. high school students. Multiple regression models were used, adjusting first for demographics, and then for demographics and emotional-behavioral risks (depressive symptoms, alcohol consumption, and sexual violence victimization), for the total sample and then stratified by gender/sex. Both cyberbullying and in-school bullying were significantly associated with past year in-school fighting for the total sample, with associations retained, but marginally attenuated in fully adjusted models (cyberbullying: AOR: 1.30; 95% CI: 1.01-1.66 and in-school bullying: AOR: 1.96, 95% CI: 1.57-2.45). Gender/sex-stratified models demonstrated retained associations for males (cyberbullying: AOR: 1.93; 1.51-2.46 and in-school bullying: AOR: 2.70, 95% CI: 2.18-3.34) and females (cyberbullying: AOR: 1.89; 1.33-2.68 and in-school bullying: AOR: 1.66, 95% CI: 1.19-2.33) after adjusting for demographics, but only for males after adjusting for demographics and emotional-behavior risk factors (cyberbullying: AOR: 1.43; 95% CI: 1.07-1.93 and in-school bullying: AOR: 2.25; 95% CI: 1.73-2.92). These results demonstrate a significant association between bullying victimization and fighting, which was amplified for male students, and partially explained by social and emotional risks. This suggests that punitive approaches to fighting in school may be resulting in compounded harms for already vulnerable adolescents and that support-oriented approaches emphasizing conflict resolution, social-emotional well-being, positive gender identity development, and bullying prevention may be more appropriate.

Development of Narratives and Belief in a Just World in Victims of Bullying Due to Sexual and Gender Diversity Issues

Students belonging to a sexual and gender minority go through experiences of injustice in their educational centers and are victims of school bullying. This research analyzes the relationship between these experiences and their influence on the development of the Belief in a Just World, as well as the impact of their experiences on the development of their narratives. Participants are students who have suffered from bullying due to sexual and gender diversity issues during their primary and secondary education stages (ages 15-40 years). Starting from a constructivist qualitative methodological approach, a semi-structured interview was developed as an instrument for collecting data on these aspects. The information extracted was contrasted with the results of the Personal and General Belief in a Just Word Scales. The results of the first interviews provide us with prior information on current identities and narratives and their representations of justice.

Associations of nonconforming gender expression and gender identity with bullying victimization: an analysis of the 2017 youth risk behavior survey

PURPOSE

Although gender nonconformity (GNC) and transgender identity are both linked to bullying victimization, few studies have examined them with bullying victimization simultaneously. Using a sample of Youth Risk Behavior Survey, we investigated the associations of GNC and transgender identity with bullying victimization within the same study.

METHODS

We analyzed data from the cross-sectional school-based Youth Risk Behavior Survey in 2017 (n = 25,378). The exposures were GNC and transgender identity. The main outcomes were traditional victimization, cyber victimization, and combined victimization. We calculated adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) using Poisson regression models.

RESULTS

There were 22.15% of high school students with GNC, and 1.61% identified themselves as transgender. GNC is associated with traditional (APR,1.45;95%CI, 1.21-1.73), cyber (APR,2.00; 95%CI, 1.66-2.40) and combined victimization (APR,1.61;95%CI, 1.42-1.83) respectively among assigned male at birth (AMAB) students only. Transgender male and female students are both at higher risk of bullying victimization for all the three outcomes than cisgender peers.

CONCLUSIONS

AMAB GNC and transgender identity are associated with a higher risk of bullying victimization. Providing support systems and celebrating gender diversity within and outside schools are important.

The perks of being bi+: Positive sexual orientation-related experiences among bisexual, pansexual, and queer male youth

Previous research on sexual minority health has largely focused on negative experiences related to one's sexual orientation with limited attention to the ways in which being a sexual minority can contribute to positive experiences. This is especially true of bisexual, pansexual, and queer (bi+) male youth, whose experiences have not been represented in the literature. To address these gaps, the goal of the current study was to characterize positive experiences related to one's sexual orientation in a sample of 46 bi+ male youth (ages 14-17) who were interviewed as part of a larger study. Interviews were transcribed and thematically analyzed. Almost all of the participants described at least one positive experience related to their bi+ identity. The positive experiences fell into six categories: (1) experiences with LGBTQ+ people in general; (2) experiences with other bi+ people; (3) experiences in LGBTQ+ environments; (4) experiences disclosing bi+ identities; (5) romantic and sexual experiences; and (6) experiences with allies. Participants described eight reasons for these experiences being positive: (1) feeling a sense of belonging in a community; (2) the normalization, acceptance, and visibility of one's identity or community; (3) providing or receiving support; (4) discussing shared experiences; (5) the promotion of authenticity; (6) celebrating one's identity or community; (7) experiencing personal growth; and (8) not feeling limited by gender when it came to romantic and sexual experiences. In sum, bi+ male youth report a range of positive experiences related to their sexual orientation, which may have important implications for promoting resilience and wellbeing.

Differences in Tobacco Product Use by Sexual Orientation and Violence Factors Among United States Youth

OBJECTIVE

To assess differences in the relationship between violence factor exposure and tobacco product pattern use (exclusive and poly), we hypothesized that compared with heterosexuals, sexual minority youth would be more likely to report exclusive-tobacco and poly-tobacco use patterns, and controlling for violence factors would attenuate these associations.

STUDY DESIGN

Data from 27 513 US high-school youth were analyzed from the Centers for Disease Control and Prevention's Youth Risk Factor Surveillance System from 2015 and 2017. We fit sex-stratified, weighted, adjusted log-Poisson models to compare past 30-day exclusive combustible, exclusive e-cigarette, and poly-tobacco use in across sexual orientation. Then, models were adjusted for past-year experiences of physical fighting, bullying, attempting suicide, and physical and sexual dating violence.

RESULTS

Compared with heterosexual girls with other-sex partners, sexual minority girls were more likely to use exclusive combustible, exclusive e-cigarette, or poly-tobacco products. When adjusting for violence factors, most tobacco use associations were partially attenuated for all sexual minority girls, and completely attenuated for exclusive e-cigarette use among all sexual minority girls.

CONCLUSIONS

Sexual minority girls have greater exclusive- and poly-tobacco use compared with heterosexual girls. Tobacco interventions for sexual minority youth should address the risks of poly-tobacco use as well as violence-based risk factors.

Factors Associated With Violence Against Children in Low- and Middle-Income Countries: A Systematic Review and Meta-Regression of Nationally Representative Data

BACKGROUND

This systematic review and meta-regression sought to identify the relative importance of factors associated with physical, emotional, and sexual violence against children in low- and middle-income countries. Understanding of factors associated with violence is important for targeted programming and prevention on the population level.

METHODS

We searched 17 electronic databases from 1989 to 2018 and reports from child violence surveys. Nationally representative studies that described evidence on potential factors associated with violence against children under 18 years old were included. The search was restricted to the English language. Factors were synthesized quantitatively using robust variance estimation, with 95% confidence intervals, for each violence type.

RESULTS

We identified 8,346 unduplicated studies, and 103 publications met our eligibility criteria. The data distribution was uneven across region, country income status, factors, and violence types. Of the 94 eligible studies quantitatively synthesized, no specific factors were significant for physical violence. Lower household socioeconomic status, being a girl, and primary education of mothers and adults in the household were associated with emotional violence, and being a girl was associated with sexual violence.

CONCLUSION

A broad spectrum of factors merit consideration for physical violence policy and prevention among the general population of children in low- and middle-income countries. Conversely, a tailored approach may be warranted for preventing emotional and sexual violence. Information is unequally distributed across countries, factors, and violence types. Greater emphasis should be placed on collecting representative data on the general population and vulnerable subgroups to achieve national reductions in violence against children.

Are Sexual Minorities More at Risk? Bullying Victimization Among Lesbian, Gay, Bisexual, and Questioning Youth

Bullying has garnered the attention of researchers and policy makers alike, because of various negative physical, mental, and educational outcomes that stem from these experiences. Certain youth are more at risk for bullying victimization (ASPA, 2012). Thus, research highlighting and addressing these experiences is crucial to provide safer environments for youth. This study utilizes the 2013 Youth Risk Behavior Surveillance System (YRBSS) data to investigate whether or not experiences of victimization differ for lesbian, gay, bisexual, and questioning (LGBQ) youth. Drawing from a sample of 12,642 9th through 12th grade youth, this study investigates two primary areas: (a) the prevalence of traditional bullying, electronic bullying, and homophobic bullying victimizations among LGBQ youth, and (b) the interaction of sexual orientation and gender with traditional bullying, electronic bullying, and homophobic bullying victimizations. Results suggest that LGBQ youth experience all types of bullying victimization at higher rates than heterosexual youth. Results also highlight the importance of the interaction of sexual orientation and gender in bullying victimization. Findings reveal that LGBQ females, LGBQ males, and heterosexual females experience each type of victimization at higher rates than heterosexual males. Findings confirm that disparities exist in bullying victimization among LGBQ youth, and thus cannot be ignored in schools. School policies must explicitly acknowledge and address how sexual orientation and gender matter within the constructs of youth violence if they wish to create safer learning environments for youth.

Bullying and Peer Victimization of Minority Youth: Intersections of Sexual Identity and Race/Ethnicity

BACKGROUND

Youth with multiple minority identities, such as those who are both sexual minority (eg, lesbian, gay, bisexual) and racial/ethnic minority (eg, Black, Latino) may be at increased risk for bullying and peer victimization.

METHODS

Youth Risk Behavior Surveillance data (2011-2017) were analyzed (N = 114,881; 50.8% girls; mean age = 15.7 years, SD = 0.03). We used chi-square tests and sex-stratified multiple linear regression models to examine sexual identity and racial/ethnic differences and the intersection between sexual identity and race/ethnicity across 3 forms of bullying and peer victimization, co-occurrence of traditional and electronic bullying, and any type of bullying or peer victimization.

RESULTS

Sexual minority youth reported higher odds of bullying and peer victimization than heterosexual youth. White youth reported higher odds of bullying than racial/ethnic minority youth. In intersectional analyses, all sexual minority and racial/ethnic minority boys, and bisexual racial/ethnic minority girls were at higher risk for bullying and peer victimization compared to heterosexual peers of the same race/ethnicity.

CONCLUSIONS

This study of a large diverse sample of youth advances our understanding of vulnerability to bullying and peer victimization among youth with multiple minority identities. This research can inform policy initiatives and interventions to prevent peer victimization of vulnerable youth.

Changes in Victimization Risk and Disparities for Heterosexual and Sexual Minority Youth: Trends From 2009 to 2017

PURPOSE

The aim of this study was to identify sex-stratified trends in victimization risk specific to heterosexual, lesbian, gay, bisexual, and questioning youth while considering changes in sexual orientation-disparities from 2009 to 2017.

METHODS

Youth Risk Behavior Survey (YRBS) data collected biennially (five waves; 2009-2017) were pooled across 56 jurisdictions and 454,715 students for one of the most nationally representative samples of heterosexual and sexual minority youth to date. We analyzed a seven-item victimization risk assessment using the Centers for Disease Control and Prevention's recommended trend analysis approach. We used logistic regression with year-by-identity interactions to test whether sexual orientation-based disparities widened, narrowed, or were maintained over time.

RESULTS

Victimization risk declined significantly for male and female bisexual and questioning youth, lesbian, gay, and heterosexual youth. Disparities narrowed between bisexual, questioning, and lesbian females and heterosexual females and between bisexual and heterosexual males. Nevertheless, sexual orientation-based disparities remained significant for all sexual minority youth in 2017.

CONCLUSIONS

Distinct patterns of change in victimization risk for specific groups of sexual minority youth underscore the need to consider variability within sexual minority youth communities; treating them as a singular group could mask nuanced disparities. Some of the relatively small decreases in victimization risk also suggest the need for interventions to address a more comprehensive set of victimization-related risks beyond bullying and needed efforts that are not limited to the immediate school context.

Understanding (and Acting On) 20 Years of Research on Violence and LGBTQ + Communities

Questions related to violence, vulnerability, and sexual and gender minorities continuing to occupy a focal place in U.S. public discourse. We reviewed findings from 20 years of research on that topic to make recommendations for policy, practice, and future research. This article synthesizes findings from 102 peer-reviewed articles as well as a small number of unpublished studies and grey literature. We found no data to support the idea (widespread in popular discourse) that those in the sexual or gender majority require protection from sexual or gender minority individuals. Instead, this wide body of research indicates that sexual and gender minorities are themselves at elevated risk for physical and sexual assault, harassment, bullying, and hate crime victimization throughout childhood, adolescence, and adulthood. Contradicting the image of hate crimes as perpetrated by strangers or acquaintances, we find that bias-related verbal abuse, physical, and sexual assault by close family members contribute heavily to observed victimization rates. Further, despite the perception that society is becoming more welcoming, victimization disparities appear to be stable or widening since the 1990s. More studies with probabilistic sampling approaches, standardized measures, and larger samples of gender minorities are needed. However, widespread victimization of sexual and gender minorities is clearly an urgent issue, demanding attention from clinicians, program developers, and policy makers.

School-Based Interventions for Reducing Youths’ Racial and Ethnic Prejudice

Minoritized youth encounter racial and ethnic prejudice and discrimination in a variety of settings, including schools. Prejudice refers to harboring negative attitudes and beliefs toward targeted social groups; discrimination reflects translating those attitudes into actions that marginalize targeted groups. Exposure to racial and ethnic discrimination has been associated with numerous detrimental outcomes for youth, including poorer mental health outcomes and lower levels of academic performance. This article describes the nature of racial and ethnic discrimination encountered by minoritized youth as well as its impact on these populations. It also reviews research on prejudice reduction interventions for youth, with a focus on those interventions designed for school settings. In light of existing research, several policy recommendations support high-quality, evidence-based programming in schools.

Social and Non-social Reward Processing and Depressive Symptoms Among Sexual Minority Adolescents

Sexual minority adolescents (SMA) are more likely to suffer from depression, putatively through experiences of social stress and victimization interfering with processing of social reward. Alterations in neural reward networks, which develop during adolescence, confer risk for the development of depression. Employing both social and monetary reward fMRI tasks, this is the first neuroimaging study to examine function in reward circuitry as a potential mechanism of mental health disparities between SMA and heterosexual adolescents. Eight SMA and 38 heterosexual typically developing adolescents completed self-report measures of depression and victimization, and underwent fMRI during monetary and peer social reward tasks in which they received positive monetary or social feedback, respectively. Compared with heterosexual adolescents, SMA had greater interpersonal depressive symptoms and exhibited blunted neural responses to social, but not monetary, reward in socioaffective processing regions that are associated with depressive symptoms. Specifically, compared with heterosexual adolescents, SMA exhibited decreased activation in the right medial prefrontal cortex, left anterior insula (AI), and right temporoparietal junction (TPJ) in response to being liked. Lower response in the right TPJ was associated with greater interpersonal depressive symptoms. These results suggest that interpersonal difficulties and the underlying substrates of response to social reward (perhaps more so than response to monetary reward) may confer risk for development of depressive symptoms in SMA.

Early roots of sexual-orientation health disparities: associations between sexual attraction, health and well-being in a national sample of Australian adolescents

Background

Research documents substantial adolescent health disparities by sexual orientation, but studies are confined to a small number of countries—chiefly the USA. We provide first-time evidence of associations between sexual orientation and adolescent health/well-being in a new country—Australia. We also add to knowledge by examining health/well-being outcomes not previously analysed in national samples, considering adolescents reporting no sexual attractions, and rank-ordering sexual-orientation health disparities by magnitude.

Methods

Data from an Australian national probability sample of 14/15 years old (Longitudinal Study of Australian Children, n=3318) and regression models adjusted for confounding and for multiple comparisons were used to examine the associations between sexual attraction and 30 outcomes spanning multiple domains of health/well-being—including socio-emotional functioning, health-related quality of life, depressive symptoms, health-related behaviours, social support, self-harm, suicidality, victimisation, self-concept, school belonging and global health/well-being assessments.

Results

Lesbian, gay, bisexual and questioning adolescents displayed significantly worse health/well-being than their heterosexual peers in all outcomes (p<0.05). The magnitude of the disparities ranged between 0.13 and 0.75 SD, and was largest in the domains of self-harm, suicidality, peer problems and emotional problems. There were fewer differences between the heterosexual and no-attraction groups. Worse outcomes were observed among both-sex-attracted adolescents compared with same-sex-attracted adolescents, and sexual-minority girls compared with sexual-minority boys.

Conclusions

Consistent with the minority stress model and recent international scholarship, sexual-minority status is an important risk factor for poor adolescent health/well-being across domains in Australia. Interventions aimed at addressing sexual-orientation health disparities within Australian adolescent populations are urgently required.

Positive Youth Development Programs in Low- and Middle-Income Countries: A Conceptual Framework and Systematic Review of Efficacy

PURPOSE

Positive youth development (PYD) has served as a framework for youth programs in high-income countries since the 1990s and has demonstrated broad behavioral health and developmental benefits. PYD programs build skills, assets, and competencies; foster youth agency; build healthy relationships; strengthen the environment; and transform systems to prepare youth for successful adulthood. The goal of this article was to systematically review the impact of PYD programs in low- and middle-income countries (LMICs).

METHODS

Targeted searches of knowledge repository Web sites and keyword searches of Scopus and PubMed identified over 21,500 articles and over 3,700 evaluation reports published between 1990 and mid-2016. Ninety-four PYD programs with evaluations in LMICs were identified, of which 35 had at least one experimental or rigorous quasi-experimental evaluation.

RESULTS

Sixty percent of the 35 programs with rigorous evaluations demonstrated positive effects on behaviors, including substance use and risky sexual activity, and/or more distal developmental outcomes, such as employment and health indicators.

CONCLUSIONS

There is promising evidence that PYD programs can be effective in LMICs; however, more rigorous examination with long-term follow-up is required to establish if these programs offer benefits similar to those seen in higher income countries.

Sexual minority youth, social change, and health: A developmental collision

Few societal attitudes and opinions have changed as quickly as those regarding sexual minority people and rights. In the context of dramatic social change in the space of a single generation, there have been multiple policy changes toward social inclusion and rights for lesbian, gay, and bisexual (LGB) people, and perceptions that the sociocultural context for LGB people - perhaps particularly for youth - has improved. Yet recent evidence from the developmental sciences points to paradoxical findings: in many cases there have been growing rather than shrinking health disparities. In light of swift sociocultural changes, combined with emergent findings regarding the health and wellbeing of sexual minority youth, we suggest that there is a developmental collision between normative adolescent developmental processes and sexual minority youth identities and visibility. The result is a new reality for sexual minority youth health and disparities.

Anti-LGBT Victimization, Fear of Violence at School, and Suicide Risk Among Adolescents

We investigated whether strengths of the relationships between anti-lesbian, gay, bisexual, and transgender (LGBT) victimization, fear of violence at school, and suicide risk differ by sexual orientation among a predominantly ethnic minority sample of adolescents. Using the 2012 District of Columbia Youth Risk Behavior Survey high school data set, we performed a 4-stage, stepwise logistic regression for suicide attempts, suicidal ideation, and suicide planning. First, we tested the independent variables, sexual orientation and anti-LGBT victimization. Second, we added an anti-LGBT victimization by sexual orientation interaction term. Third, we tested the independent variable, fear of violence at school, in an additive model. Fourth, we added a fear of violence at school by sexual orientation interaction term. In Model 1, sexual orientation and anti-LGBT victimization were both significantly associated with each suicide risk behavior. In Model 2, the anti-LGBT victimization by sexual orientation interaction term was not significant for any of the dependent variables. In Model 3, fear of violence at school was significantly associated with each suicide risk behavior. In Model 4, the fear of violence at school by sexual orientation interaction term was not significant for suicide attempts or suicidal ideation but was significant for suicide planning in the direction opposite to our hypotheses. Anti-LGBT victimization, sexual orientation, and fear of violence at school were associated with suicidal ideation, suicide planning, and suicide attempts. The strength of the association between fear of violence at school and suicide planning was weaker for sexual minority adolescents than for heterosexual adolescents.

Pilot Testing the Feasibility of a Game Intervention Aimed at Improving Help Seeking and Coping Among Sexual and Gender Minority Youth: Protocol for a Randomized Controlled Trial

Background

Sexual and gender minority youth (SGMY; eg, lesbian, gay, bisexual, and transgender youth) experience myriad substance use and mental health disparities compared with their cisgender (nontransgender) heterosexual peers. Despite much research showing these disparities are driven by experiences of bullying and cyberbullying victimization, few interventions have aimed to improve the health of bullied SGMY. One possible way to improve the health of bullied SGMY is via a Web-accessible game intervention. Nevertheless, little research has examined the feasibility of using a Web-accessible game intervention with SGMY.

Objective

This study aimed to describe the protocol for a randomized controlled trial (RCT) pilot, testing the feasibility and limited efficacy of a game-based intervention for increasing help-seeking–related knowledge, intentions, self-efficacy, behaviors, productive coping skills use, and coping flexibility and reducing health risk factors and behaviors among SGMY.

Methods

We enrolled 240 SGMY aged 14 to 18 years residing in the United States into a 2-arm prospective RCT. The intervention is a theory-based, community-informed, computer-based, role playing game with 3 primary components: encouraging help-seeking behaviors, encouraging use of productive coping, and raising awareness of Web-based resources. SGMY randomized to both the intervention and control conditions will receive a list of SGMY-inclusive resources, covering a variety of health-related topics. Control condition participants received only the list of resources. Notably, all study procedures are conducted via the internet. We conveniently sampled SGMY using Web-based advertisements. Study assessments occur at enrollment, 1 month after enrollment, and 2 months after enrollment. The primary outcomes of this feasibility study include implementation procedures, game demand, and game acceptability. Secondary outcomes include help-seeking intentions, self-efficacy, and behaviors; productive coping strategies and coping flexibility; and knowledge and use of Web-based resources. Tertiary outcomes include bullying and cyberbullying victimization, loneliness, mental health issues, substance use, and internalized sexual and gender minority stigma.

Results

From April to July 2018, 240 participants were enrolled and randomized. Half of the enrolled participants (n=120) were randomized into the intervention condition and half (n=120) into the control condition. At baseline, 52.1% (125/240) of the participants identified as gay or lesbian, 26.7% (64/240) as bisexual, 24.2% (58/240) as queer, and 11.7% (28/240) as another nonheterosexual identity. Nearly half (113/240) of participants were a gender minority: 36.7% (88/240) were cisgender boys, and 16.3% (39/240) were cisgender girls. There were no differences in demographic characteristics between intervention and control condition participants.

Conclusions

Web-accessible game interventions overcome common impediments of face-to-face interventions and present a unique opportunity to reach SGMY and improve their health. This trial will provide data on feasibility and limited efficacy that can inform future Web-based studies and a larger RCT aimed at improving health equity for SGMY.

Trial Registration

ClinicalTrials.gov NCT03501264; https://clinicaltrials.gov/ct2/show/NCT03501264 (Archived by WebCite at http://www.webcitation.org/72HpafarW)

International Registered Report Identifier (IRRID)

DERR1-10.2196/12164

Victimization Disparities Between Heterosexual and Sexual Minority Youth From Ages 9 to 15

Mental health disparities between heterosexual and sexual minority youth are partly explained by the higher rates of victimization experienced by sexual minority youth. The onset and progression of these victimization disparities, however, are poorly understood. Using multirater longitudinal data, trajectories of victimization starting at age 9 were compared among youth who did and did not report same-sex attraction at age 15 (N = 310). Self and teacher, but not primary caregivers, reported victimization was significantly higher among sexual minority youth starting at age 9, but did not vary across time. The findings underscore the importance of understanding homophobic experiences of sexual minority youth during late childhood and early adolescence in order to inform prevention programs.

Sexual Orientation and Gender Identity Victimization Among Young Adults in the New York City Metropolitan Area: The P18 Cohort Study

Sexual and gender minority populations are significantly more likely to experience verbal and physical victimization in young adulthood. These analyses examine the types, contexts, and sources of lifetime sexual orientation and gender identity victimization (SGV) in a diverse sample of sexual minority men (SMM) and transgender women as well as the extent to which experiences of SGV vary between subgroups of the population. Cross-sectional data were collected as part of a study of sexual health, mental health, and HIV examined through the lens of syndemic production in young SMM. Measures assessed sociodemographic characteristics as well as the types, sources, and contexts of physical assault and verbal harassment due to actual or perceived gender or sexuality. Verbal harassment was more prevalent in the sample than physical assault (44.5% vs. 11.6%). Schools or sports teams and neighborhoods were the most common contexts for verbal and physical SGV. Strangers were the most frequent perpetrators of SGV, followed by family and peers. Bivariate analyses showed significant differences in SGV based on race, education, perceived familial SES, sexual identity, and borough of residence. In multivariate analyses, race, SES, sexual identity, and borough of residence were significant predictors of verbal SGV. Findings suggest that SGV experiences are not uniform in sexual minority young adults, and thus prevention and care must be targeted. Understanding the multiple identities of sexual minority young adults who experience greater levels of victimization can allow for policy and interventions to best support those at risk.

The scientific pursuit of sexual and gender minority mental health treatments: Toward evidence-based affirmative practice

The time has arrived for psychological science to translate the accumulating empirical research regarding sexual and gender minority (SGM) mental health into evidence-based affirmative treatments for this population. Far from the unscientific, homophobic theories of the early 20th century, several recent efforts in psychological science are starting to pave the way for evidence-based SGM-affirmative mental health treatments. These efforts include (a) identifying clear treatment targets for SGM, (b) conducting treatment studies that test the efficacy of therapy for SGM populations, (c) increased reporting of sexual orientation and gender diversity in existing randomized controlled trials conducted with the general population, and (d) reducing stigma itself, which has heretofore impeded the resources necessary to produce scientific evidence about SGM-affirmative treatments. This article reviews this progress and outlines future research directions needed to advance evidence-based practice for SGM, including determining whether and how existing evidence-based treatments need to be adapted to address SGM-specific concerns, why SGM-affirmative treatments work, and for whom and under what conditions SGM-affirmative treatments work best. A program of research is described that attempts to address these questions through randomized controlled trials with strong comparison conditions, psychotherapy process research of current SGM-affirmative practice, and tests of treatment moderators. To the extent that the mental health profession continues to pursue these solutions, it can ensure the continued flourishing of this population, whose visibility and vibrancy likely represent the surest route toward improving public acceptance and therefore its future mental health. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Factors Impacting Implementation of Evidence-Based Strategies to Create Safe and Supportive Schools for Sexual and Gender Minority Students

PURPOSE

The Centers for Disease Control and Prevention recommends six evidence-based strategies to improve safety and support for sexual and gender minority (SGM) youth in U.S. schools. However, only a small minority of schools implement all strategies. This study draws on implementation science to assess contextual challenges to strategy implementation.

METHODS

Semistructured interviews were conducted with at least two stakeholders at each of 42 high schools in New Mexico. Interviews consisted of open-ended questions centered on attitudes toward, access to, and availability of school and community supports for SGM youth, school policies, and practices, and organizational factors believed to impact implementation. Transcripts were imported into NVivo 11 for iterative coding and qualitative analysis.

RESULTS

We identified eleven overarching sets of factors related to the preparedness of schools to implement the evidence-based strategies: (1) political climate; (2) community context; (3) community resources; (4) policies and practices; (5) staff knowledge and exposure to SGM issues; (6) training deficits; (7) prevalence of neutrality discourses suggesting SGM students should not be singled out for "special treatment" or intervention; (8) student attitudes and support; (9) de facto safe spaces; (10) health education curricula; and (11) pragmatic considerations, such as time, staff turnover, and workloads. Key factors believed to hinder implementation included lack of resources, staffing concerns, and knowledge deficits.

CONCLUSIONS

These results can be used to inform the development of implementation strategies to modify school health systems from within to best support evidence-based practices for SGM youth and other stigmatized populations.

Disparities in Health Risk Behaviors and Health Conditions Among Rhode Island Sexual Minority and Unsure High School Students

BACKGROUND

Sexual minority students have higher risk for health-related behaviors. We examined 5 domains including 34 health risk behaviors and health conditions among sexual minorities and unsure students in Rhode Island. We also included sexual contact of heterosexually identified students to capture heterosexually identified students who may be considered sexual minorities by their behavior.

METHODS

We used the 2007-2015 Rhode Island Youth Risk Behavior Survey data (N = 14,264). We categorized students into 4 groups: students self-identified as heterosexual and reported no sexual contact with same sex only or both sexes (group 1); self-identified as heterosexual and reported sexual contact with same sex only or both sexes (group 2); self-identified as lesbian, gay, bisexual (group 3); and responded as unsure (group 4). We used multivariable adjusted logistic regression analyses to evaluate associations of sexual minority and unsure students with 34 health risk behaviors and health conditions accounting for complex sampling design.

RESULTS

Students in groups 2-4 were more likely to engage in health-risk behaviors including violent behaviors, attempted suicide, substance use, and no physical activity than their peers.

CONCLUSIONS

As sexual minority youth continue to report higher rates of health-related risk behaviors, targeted evidence-based prevention approaches must focus on reducing these risk behaviors among those youth.

Homophobic Bullying and Sexual Minority Youth Alcohol Use: Do Sex and Race/Ethnicity Matter?

PURPOSE

Sexual minority youth (SMY) are more likely to use alcohol than their heterosexual peers, yet a lack of research on within-group differences and modifiable mechanisms has hindered efforts to address alcohol use disparities. The purpose of the current study was to examine differences in the mediating role of homophobic bullying on the association between sexual orientation identity and drinking frequency and heavy episodic drinking frequency by sex and race/ethnicity.

METHODS

We used data from a subsample of 20,744 youth in seven states from the 2015 Youth Risk Behavior Survey, a population-based data set of 9-12th grade high school students in the United States. We included youth who self-identified as male or female; heterosexual, lesbian/gay, bisexual, or unsure of their sexual orientation identity; and White, Black, or Latino.

RESULTS

Within-group comparisons demonstrated that SMY alcohol use disparities were concentrated among Latino bisexual and unsure youth. All subgroups of SMY at the intersection of race/ethnicity and sex were more likely than their heterosexual counterparts to report homophobic bullying. Homophobic bullying mediated alcohol use disparities for some, but not all, subgroups of SMY.

CONCLUSION

Homophobic bullying is a serious risk factor for SMY alcohol use, although youths' multiple identities may differentiate degrees of risk. Sexual orientation identity-related disparities in alcohol use among Latino, bisexual, and unsure youth were not fully attenuated when adjusted for homophobic bullying, which suggests that there may be additional factors that contribute to rates of alcohol use among these specific subgroups of SMY.

Emotional Distress, Bullying Victimization, and Protective Factors Among Transgender and Gender Diverse Adolescents in City, Suburban, Town, and Rural Locations

PURPOSE

Understanding the root causes of the substantial disparities in risk and protective factors among transgender and gender diverse (TGD) adolescents is essential to the development and expansion of resources and supports for this vulnerable population. This study examines differences in emotional distress, bullying victimization, and protective factors among TGD high school students in city, suburban, town, and rural locations.

METHODS

Data come from a statewide school-based survey conducted in Minnesota in 2016 (n = 2,168 TGD youth). Analysis of covariance models were used to predict the prevalence of multiple indicators of emotional distress, bullying victimization, and protective factors across the 4 location categories, with multiple adjustments.

FINDINGS

Significant linear trends were observed for 2 emotional distress outcomes and 2 bullying victimization outcomes, with urban TGD students having the lowest rates and rural having the highest prevalences. Additional significant differences in emotional distress were noted, with unexpectedly high rates of depressive symptoms and suicidal ideation among suburban students.

CONCLUSIONS

Helping TGD adolescents in all types of locations identify resources and supportive professionals is critical to supporting this population.

The Effects of Gender- and Sexuality-Based Harassment on Lesbian, Gay, Bisexual, and Transgender Substance Use Disparities

PURPOSE

We tested three competing models about whether gender- and sexuality-based harassment at school have nonindependent, additive, or interactive effects on adolescents' electronic cigarette use (i.e., vaping), cigarette smoking, alcohol use, and heavy episodic drinking (HED). We also tested whether harassment mediated substance use disparities between lesbian, gay, bisexual, transgender (LGBT) adolescents and their cisgender heterosexual peers.

METHODS

We analyzed cross-sectional data from the 2013-2014 California Healthy Kids Survey, including 316,766 students in grades 7, 9, and 11 from more than 1,500 middle and high schools. We used logistic regression models and interaction terms to estimate associations of past-year gender- and sexuality-based harassment at school on past-month substance use, and the Karlson-Holm-Breen method to test whether harassment mediated LGBT disparities in substance use.

RESULTS

Vaping, smoking, drinking, HED, and gender- and sexuality-based harassment were higher for transgender adolescents than for cisgender males and females, and for adolescents who were lesbian, gay, or bisexual only versus heterosexual only. Gender- and sexuality-based harassments were independently associated with greater odds of using each substance in every grade. These two types of harassment had positive interactions with each other for vaping in grade 11, smoking in grade 11, and HED in grades 9 and 11. Gender- and sexuality-based harassment significantly mediated many of the LGBT disparities in substance use.

CONCLUSIONS

Gender- and sexuality-based harassment at school independently or interactively produced LGBT disparities in substance use. Reducing these types of discrimination in schools will likely mitigate these disparities.

Gay-Straight Alliance Involvement and Youths' Participation in Civic Engagement, Advocacy, and Awareness-Raising

Civic engagement among lesbian, gay, bisexual, transgender, or questioning (LGBTQ) youth and heterosexual cisgender allies can challenge oppressive systems. Among 295 youth in 33 Gay-Straight Alliances (GSAs; 69% LGBQ, 68% cisgender female, 68% white, M_age = 16.07), we examined whether greater GSA involvement was associated with greater general civic engagement, as well as participation in greater LGBTQ-specific advocacy and awareness-raising efforts. Further, we tested whether these associations were partly mediated through members' sense of agency. Greater GSA involvement was associated with greater civic engagement, advocacy, and awareness-raising; associations did not differ based on sexual orientation or gender identity. Finally, the association between GSA involvement and civic engagement was partially mediated through youths' greater sense of agency. Agency did not mediate the association between GSA involvement and engagement in advocacy or awareness-raising efforts. The results suggest GSAs are settings with potential to foster students' capacity to be active and engaged citizens.

Childhood Abuse Experiences and the COMT and MTHFR Genetic Variants Associated With Male Sexual Orientation in the Han Chinese Populations: A Case-Control Study

BACKGROUND

Although it is widely acknowledged that genetic and environmental factors are involved in the development of male homosexuality, the causes are not fully understood.

AIM

To explore the association and interaction of childhood abuse experiences and genetic variants of the catechol-O-methyltransferase (COMT) and methylenetetrahydrofolate reductase (MTHFR) genes with the development of male homosexuality.

METHODS

A case-control study of 537 exclusively homosexual men and 583 exclusively heterosexual men was conducted, with data collected from March 2013 to August 2015. Data were analyzed using χ² tests and logistic regression models.

OUTCOMES

Sociodemographic characteristics, childhood abuse experiences, and polymorphisms of COMT at rs4680, rs4818, and rs6267 and MTHFR at rs1801133.

RESULTS

More frequent occurrence of physical (adjusted odds ratio [aOR] = 1.78), emotional (aOR = 2.07), and sexual (aOR = 2.53) abuse during childhood was significantly associated with the development of male homosexuality. The polymorphisms of MTHFR at rs1801133 and COMT at rs4818 also were significantly associated with the development of male homosexuality in the homozygote comparisons (T/T vs C/C at rs1801133, aOR = 1.68; G/G vs C/C at rs4818, aOR = 1.75). In addition, significant interaction effects between childhood abuse experiences and the COMT and MTHFR genetic variants on the development of male homosexuality were found.

CLINICAL TRANSLATION

This is the first time that an association of childhood abuse, COMT and MTHFR genetic variants, and their interactions with development of male homosexuality was exhaustively explored, which could help provide new insight into the etiology of male homosexuality.

STRENGTHS AND LIMITATIONS

Because homosexual men are a relatively obscure population, it was impossible to select the study participants by random sampling, which could lead to selection bias. In addition, because this was a case-control study, recall bias was inevitable, and we could not verify causality.

CONCLUSIONS

Childhood abuse and the COMT and MTHFR genetic variants could be positively associated with the development of homosexuality. However, it remains unknown how these factors jointly play a role in the development of homosexuality, and more studies in different ethnic populations and with a larger sample and a prospective design are required to confirm our findings. Qin J-B, Zhao G-L, Wang F, et al. Childhood Abuse Experiences and the COMT and MTHFR Genetic Variants Associated With Male Sexual Orientation in the Han Chinese Populations: A Case-Control Study. J Sex Med 2018;15:29-42.

LGBTQ Bullying: Translating Research to Action in Pediatrics

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth experience significant bullying that undermines their mental and physical health. National health organizations have called for the development of innovative strategies to address LGBTQ bullying. Pediatricians and other clinicians, medical and public health students, interdisciplinary researchers, government officials, school leaders, community members, parents, and youth from around the country came together at a national symposium entitled "LGBTQ Bullying: Translating Research to Action to Improve the Health of All Youth" in May 2016 to generate strategies to prevent LGBTQ bullying and meet the needs of LGBTQ youth experiencing bullying. This article describes key scientific findings on bullying, LGBTQ stigma, and LGBTQ bullying interventions that were shared at the symposium and provides recommendations for pediatricians to address LGBTQ bullying via clinical care, research, interventions, and policy. Symposium participants recommended that pediatricians engage in efforts to foster inclusive and affirming health care environments wherein LGBTQ youth feel comfortable discussing their identities and experiences, identify youth experiencing LGBTQ bullying, and prevent the negative health consequences of bullying among youth. Moreover, pediatricians can attend to how multiple identities (eg, sexual orientation, gender identity, race and/or ethnicity, disability, and others) shape youth experiences of bullying and expand intervention efforts to address LGBTQ bullying in health care settings. Pediatricians can further advocate for evidence-based, antibullying policies prohibiting bullying on the basis of sexual orientation and gender identity. Collaboration between pediatricians and diverse stakeholders can contribute to the development and implementation of lasting change in all forms of bullying, including LGBTQ bullying.

Resilience to Discrimination and Rejection Among Young Sexual Minority Males and Transgender Females: A Qualitative Study on Coping With Minority Stress

Sexual minority and transgender status is associated with mental health disparities, which have been empirically and theoretically linked to stressors related to social stigma. Despite exposure to these unique stressors, many sexual minority and transgender individuals will not experience mental health disorders in their lifetime. Little is known about the specific processes that sexual minority and transgender youth use to maintain their wellbeing in the presence of discrimination and rejection. Semistructured interviews were conducted with 10 sexual minority males and transgender females aged 18-22 years, who currently met criteria for an operationalized definition of resilience to depression and anxiety. Data were analyzed qualitatively, yielding information related to a wide variety of problem-solving, support-seeking, and accommodative coping strategies employed by youth in the face of social stigma. Results are discussed in light of their clinical implications.

Health Care Disparities Among Lesbian, Gay, Bisexual, and Transgender Youth: A Literature Review

About 3.5% Americans identify themselves as lesbian, gay, or bisexual while 0.3% identify themselves as transgender. The LGBT (lesbian, gay, bisexual, and transgender) community belongs to almost every race, ethnicity, religion, age, and socioeconomic group. The LGBT youth are at a higher risk for substance use, sexually transmitted diseases (STDs), cancers, cardiovascular diseases, obesity, bullying, isolation, rejection, anxiety, depression, and suicide as compared to the general population. LGBT youth receive poor quality of care due to stigma, lack of healthcare providers' awareness, and insensitivity to the unique needs of this community. The main objective of this literature review is to highlight the challenges faced by the LGBT youth and to enhance the awareness among physicians about the existing disparities in order to provide a more comprehensive, evidence-based, and humane medical care to this community.

Bullying Among Lesbian, Gay, Bisexual, and Transgender Youth

Bullying of lesbian, gay, bisexual, and transgender (LGBT) youth is prevalent in the United States, and represents LGBT stigma when tied to sexual orientation and/or gender identity or expression. LGBT youth commonly report verbal, relational, and physical bullying, and damage to property. Bullying undermines the well-being of LGBT youth, with implications for risky health behaviors, poor mental health, and poor physical health that may last into adulthood. Pediatricians can play a vital role in preventing and identifying bullying, providing counseling to youth and their parents, and advocating for programs and policies to address LGBT bullying.

Greater Engagement Among Members of Gay-Straight Alliances: Individual and Structural Contributors

Using youth program models to frame the study of Gay-Straight Alliances (GSAs), we identified individual and structural predictors of greater engagement in these settings with a cross-sectional sample of 295 youth in 33 GSAs from the 2014 Massachusetts GSA Network Survey (69% LGBQ, 68% cisgen-der female, 68% White, M_age = 16.07). Multilevel modeling results indicated that members who perceived more support/socializing from their GSA, had more LGB friends, were longer serving members, and were in GSAs with more open and respectful climates reported greater engagement. Further, there was a curvilinear association between organizational structure in the GSA and engagement: Perceptions of more structure were associated with greater engagement to a point, after which greater structure was related to less engagement.