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Eisenberg ME, Wood BA, Erickson DJ, Gower AL, Schneider SK, Corliss HL. Associations between LGBTQ+-supportive school and community resources and suicide attempts among adolescents in Massachusetts. AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2021; 91:800-811. [PMID: 34516147 PMCID: PMC9972362 DOI: 10.1037/ort0000574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Supportive school and community resources are associated with reduced risk of suicidality among lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ +) adolescents as well as their cisgender, heterosexual peers. This study examined whether adolescents attending schools and living in communities with more versus fewer LGBTQ +-supportive resources were at lower risk of a past-year suicide attempt. Data on sexual orientation and past-year suicide attempt were obtained from student surveys administered in 30 Massachusetts public high schools between 2014 and 2017 (N = 20,790). Data on school resources were obtained from a questionnaire administered to school officials, and community resources were assessed through internet searching. Modified Poisson generalized estimating equations tested associations between school and community LGBTQ +-supports and suicide attempt separately by sex/gender, adjusting for student, school, and community covariates. Several school resources and the availability of community-wide LGBTQ +-supportive resources were associated with lower risk of a suicide attempt among several subgroups of students, even after controlling for the presence of multiple school and community resources and covariates. For example, the risk of a suicide attempt among gay, bisexual and questioning boys in schools with a gender-neutral restroom was approximately half compared to gay, bisexual and questioning boys in schools without this resource. Past year suicide attempts were also significantly lower among questioning, RR = 0.56, CI [0.37-0.86], and heterosexual, RR = 0.59, CI [0.50-0.68], girls living in communities with more supportive resources compared to those in communities with fewer resources. LGBTQ +-supportive resources in schools and communities may be beneficial for all adolescents regardless of sexual orientation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Marla E. Eisenberg
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota
| | - Brittany A. Wood
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California, San Diego
| | - Darin J. Erickson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota
| | - Amy L. Gower
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota
| | | | - Heather L. Corliss
- San Diego State University, School of Public Health,Institute for Behavioral and Community Health, San Diego State University
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Hatchel T, Polanin JR, Espelage DL. Suicidal Thoughts and Behaviors Among LGBTQ Youth: Meta-Analyses and a Systematic Review. Arch Suicide Res 2021; 25:1-37. [PMID: 31597541 DOI: 10.1080/13811118.2019.1663329] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Suicide continues to be the second-leading cause of death for all youths aged 15-24. Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are at a significantly higher risk for suicidal thoughts or behaviors (STB). Establishing and understanding correlates of STB among LGBTQ youth is one important step toward enhancing prevention, intervention, and research efforts. To synthesize current knowledge on suicide among LGBTQ youth, the present meta-analyses offer results from 44 studies over the past 20 years. Two-hundred and thirty-four correlation coefficient effect sizes were calculated and categorized. To be included, the study had to quantitatively examine correlates of STB among LGBTQ youth. A number of social-science databases were used to examine the existing published research. Results illustrated the variability among correlates of STB as well as substantial limitations in the extant literature. There was a heterogeneity of effect sizes, a lack of novel correlates, a focus on risk, a dearth of theoretically driven designs, moderate publication bias, a paucity of developmentally driven analyses, and a dearth of research with transgender youth.
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53
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Associations Between LGBTQ-Affirming School Climate and Intimate Partner Violence Victimization Among Adolescents. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 22:227-236. [PMID: 33219902 DOI: 10.1007/s11121-020-01192-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
Intimate partner violence (IPV) impacts sexual minority adolescents at rates equal to or greater than the rate it impacts heterosexual adolescents. We investigated whether reports of physical and sexual IPV were less frequent in school jurisdictions with more affirming climates for lesbian, gay, bisexual, transgender, and queer (LGBTQ) students; and whether these associations varied for sexual orientation subgroups. We combined student-level data from the 2015 Youth Risk Behavior Surveys on demographics and experiences with physical and sexual IPV with jurisdiction-level data from the 2014 School Health Profiles on LGBTQ-affirming school climate. Multilevel logistic regression models examined associations between LGBTQ-affirming school climates and IPV. We stratified our data by sex and examined whether these associations differed by sexual orientation subgroups using cross-level interaction terms between school climate and sexual orientation (assessed via sexual identity and behavior). Sexual minority youth were more likely to report experiencing past-year physical and sexual IPV than their heterosexual counterparts. Attending schools with more LGBTQ-affirming climates reduced the likelihood of reporting physical IPV, but not sexual IPV, for female students. More LGBTQ-affirming school climates increased risk for sexual IPV among gay male students. Establishing LGBTQ-affirming school climates may reduce physical IPV for female students, but may have unintended consequences on sexual IPV prevalence for gay male students. More work is necessary to ensure that these climates are affirming for all sexual minority students and to address sexual violence prevention.
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54
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Greenfield B, Alessi EJ, Manning D, Dato C, Dank M. Learning to endure: A qualitative examination of the protective factors of homeless transgender and gender expansive youth engaged in survival sex. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 22:316-329. [PMID: 34240074 PMCID: PMC8118232 DOI: 10.1080/26895269.2020.1838387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Background: Transgender and gender expansive (TGE) youth face a number of adversities that are associated with deleterious consequences, including mental health problems, substance misuse, suicide, and homelessness. However, there is evidence that TGE youth still demonstrate resilience under extraordinary conditions. Aims: Therefore, this study examined how TGE youth who are homeless and engaging in survival sex describe and understand the protective factors present in their lives. Methods: In-depth qualitative interviews were conducted with 57 TGE youth living in a large U.S. city. Participants were 17-26 years old (M = 19.88, SD = 1.55), and identified as transgender woman (53%), transgender man (16%), and other (32%; gender-queer, gender-fluid, androgynous, or non-binary). Youth identified as Black (40%), multiracial (35%), Latinx (16%), White (5%), and as another race (3%). Researchers conducted a secondary analysis of qualitative data using thematic analysis. Results: We identified three themes to capture youth's understanding of their protective factors: relying on oneself and others to avoid violence, accessing gender-affirming health and mental health care, and proactively maintaining sexual health. Participants described strategies for mitigating risk of harm while attempting to meet their basic needs. Additionally, they discussed the importance of having gender-affirming health and mental health services. Participants also expressed keen awareness of their sexual health risks and making calculated, often proactive decisions about their sexual health. Conclusion: The protective factors described by TGE youth reflect the unique ways in which hyper-marginalized youth must navigate their own survival and well-being, and align with literature suggesting resilience is not mutually exclusive from risk. By focusing on TGE youth, this research privileges the experiences of individuals historically underrepresented in research and encourages future research to incorporate these perspectives into policies and programs.
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Affiliation(s)
- Brett Greenfield
- Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Edward J. Alessi
- Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Dean Manning
- Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Caroline Dato
- Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Meredith Dank
- John Jay College of Criminal Justice, City University of New York, New York, New York, USA
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Fish JN. Future Directions in Understanding and Addressing Mental Health among LGBTQ Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2020; 49:943-956. [PMID: 33074740 PMCID: PMC7736182 DOI: 10.1080/15374416.2020.1815207] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Today's LGBTQ youth come of age at a time of dynamic social and political change with regard to LGBTQ rights and visibility, yet remain vulnerable to compromised mental health. Despite advances in individual-level treatment strategies, school-based programs, and state-level policies that address LGBTQ mental health, there remains a critical gap in large-scale evidence-based prevention and intervention programs designed to support the positive development and mental health of LGBTQ youth. To spur advances in research and translation, I pose six considerations for future scholarship and practice. I begin by framing LGBTQ (mental) health disparities in a life course perspective and discuss how research focused on the timing of events could offer insight into the optimum targets and timing of prevention and intervention strategies. Next, I argue the importance of expanding notions of "mental health" to include perspectives of wellbeing, positive youth development, and resilience. I then consider how research might attend to the complexity of LGBTQ youths' lived experience within and across the various contexts they traverse in their day-to-day lives. Similarly, I discuss the importance of exploring heterogeneity in LGBTQ youth experiences and mental health. I also offer suggestions for how community partnerships may be a key resource for developing and evaluating evidence-informed programs and tools designed to foster the positive development and mental health of LGBTQ youth. Finally, I acknowledge the potentials of team science for advancing research and practice for LGBTQ youth health and wellbeing. Throughout, these future directions center the urgent needs of LGBTQ youth.
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Affiliation(s)
- Jessica N. Fish
- Department of Family Science, School of Public Health, University of Maryland, College Park, 4200 Valley Drive, Suite 1142, College Park, MD, 20742
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56
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The link between LGBTQ-supportive communities, progressive political climate, and suicidality among sexual minority adolescents in Canada. Prev Med 2020; 139:106191. [PMID: 32653353 PMCID: PMC8474062 DOI: 10.1016/j.ypmed.2020.106191] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 01/09/2023]
Abstract
Despite supportive structural changes to reduce stigma towards lesbian, gay, and bisexual, transgender, queer, and questioning (LGBTQ) Canadian residents, sexual minority youth still face disparities compared to heterosexual peers. We aimed to characterize LGBTQ-supportive environments and political climates, and examine their links to suicidal behavior among sexual minority adolescents in western Canada. Data were from the 2013 British Columbia Adolescent Health Survey, a cluster-stratified random cross-sectional survey of public school students in BC, Canada; We sampled 2678 self-identified LGB and mostly heterosexual students (69% girls) from 274 schools, representing an estimated provincial population of 24,624 sexual minority students in weighted models. Student reports of past-year suicidal ideation, suicidal attempts, and self-harm behaviors were merged with community-level data assessing diverse aspects of LGBTQ-supportive resources and progressive political climates in communities surrounding the schools. Adjusted multilevel models showed that for sexual minority adolescent girls, higher community LGBTQ-supportiveness predicted marginally significant lower suicidal ideation (aOR = 0.94, 95% CI [0.88, 1.01]) and suicidal attempts (aOR = 0.91, 95% CI [0.83, 1.00]) and significantly lower self-harm behaviors (aOR = 0.91, 95% CI [0.85, 0.98]). Further, progressive political climates predicted marginally significant lower suicidal ideation (aOR = 0.89, 95% CI [0.78, 1.02]) and significantly lower self-harm behaviors (aOR = 0.87, 95% CI [0.77, 0.99]). For sexual minority adolescent boys, no community-level variables were associated with suicidal behavior in adjusted models. Thus, LGBTQ-supportive communities and progressive political climates appear to be protective against suicidal behavior among sexual minority adolescent girls, but not sexual minority adolescent boys.
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57
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Feldman S, Watson RJ, Gallik C. College Aspirations, Gender Sexuality Alliances, and Teacher Support among Diverse LGBTQ Youth. EDUCATIONAL REVIEW 2020; 74:281-297. [PMID: 35280598 PMCID: PMC8916710 DOI: 10.1080/00131911.2020.1816907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 08/21/2020] [Indexed: 06/14/2023]
Abstract
Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth report hostile school climates and sexuality-based harassment, but scholarship has not clearly documented how these climates might be associated with college aspirations among this population. Given college has become a common aspiration for many high school youths, we sought to explore subgroup differences in college aspirations among LGBTQ youth, and whether or not LGBTQ-specific community factors, such as Gender Sexuality Alliances (GSA) presence and teacher support, were related to college aspirations. To do this, we analyzed a large sample (N = 11,327, Mage = 15.57) of LGBTQ youth from across the United States. We compared college aspirations across subgroups of youth via bivariate and multivariable logistic regression models to explore how school factors (i.e., presence of GSAs and LGBTQ-specific teacher supportiveness) were associated with college aspirations among LGBTQ youth. We found that transgender youth were less likely to aspire to go to college compared to cisgender counterparts. Additionally, more common sexual minority subgroups (e.g., gay/lesbian) were less likely to aspire to go to college compared to their counterparts with more emergent identity labels (e.g., asexual, queer). The presence of GSAs and higher reports of LGBTQ-supportive teachers were associated with increased odds of aspiring to go to college across all LGBTQ youth in our sample. These findings have implications for how schools and teachers prepare sexual and gender minorities for college. The findings imply that LGBTQ populations should not be treated as monolithic in their college readiness, preparation, and aspirations.
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Affiliation(s)
- Steven Feldman
- Department of Higher Education & Student Affairs, University of Connecticut, Storrs, CT
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT
| | - Connor Gallik
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
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58
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Bertolino DF, Sanchez TH, Zlotorzynska M, Sullivan PS. Adverse childhood experiences and sexual health outcomes and risk behaviors among a nationwide sample of men who have sex with men. CHILD ABUSE & NEGLECT 2020; 107:104627. [PMID: 32683201 PMCID: PMC7494627 DOI: 10.1016/j.chiabu.2020.104627] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/13/2020] [Accepted: 07/06/2020] [Indexed: 06/02/2023]
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) are associated with a wide range of increased risk behaviors and health consequences, they have not been extensively described in all subpopulations. OBJECTIVE The specific objectives of the study were to describe the prevalence of predefined ACEs among a nationwide sample of men who have sex with men (MSM) and determine associated HIV or sexually transmitted infection (STI) related health outcomes, testing practices, and risk behaviors. PARTICIPANTS AND SETTING Eligible participants were MSM aged 18 years or older who reported male-male sex in the past 12 months. METHODS Data were obtained from the 2015 cycle of the American Men's Internet Survey, these data were collected between September 2015 and April 2016, and contained questions related to 8 ACE exposure categories. During analyses conducted between September 2017 and April 2018, multiple log-binomial models were fit to assess associations. RESULTS Among 2590 participants, 79.7 % reported exposure to one or more ACE category. Participants exposed to any ACE were more likely to report STI testing (adjusted prevalence ratio [aPR]: 1.07; 95 % confidence interval [95 %-CI]: 1.00, 1.15), illicit substance use (aPR: 1.23, 95 %-CI: 1.05, 1.46), and condomless anal intercourse with another man (aPR: 1.13, 95 %-CI: 1.03, 1.21). CONCLUSIONS There is a high overall ACE burden among MSM nationally, with potential influences on key HIV/STI behaviors in later life. ACE exposure should be routinely assessed, prevention is ideal but appropriate measures such as trauma informed care should also be considered for adult MSM accessing HIV and STI-related services.
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Affiliation(s)
- Daniel F Bertolino
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, United States.
| | - Travis H Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, United States
| | - Maria Zlotorzynska
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, United States
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Alcohol Use and Suicidality by Sexual Orientation Among U.S. Youth, 2009-2017. Am J Prev Med 2020; 59:394-403. [PMID: 32446749 PMCID: PMC7483808 DOI: 10.1016/j.amepre.2020.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/07/2020] [Accepted: 03/06/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Alcohol use and suicidality remain serious risks for U.S. youth. Research has established that disparities exist in these outcomes between heterosexual and sexual minority youth. However, research into the associations between alcohol use and suicidality has yet to consider the differential role of sexual orientation. METHODS Using a pooled, diverse sample from the 2009-2017 Youth Risk Behavior Survey, associations of alcohol use and suicidality by sex and sexual orientation, and changes in these outcomes over time, were investigated. Analyses were conducted in 2019. RESULTS Suicidality was highest among nonheterosexuals, who ranged from twofold to sevenfold higher odds to report suicidality across all time points, with the most striking disparities among male sexual minority youth. Rates among all students remained stable or increased over time; notable exceptions included a decrease in suicide attempts among bisexual students. Among all students, current alcohol use was associated with elevated levels of suicidality. For female students, the association between drinking and suicidality did not significantly differ by sexual identity; for male students, it was significant regardless of sexual identity and most pronounced among not sure youth. CONCLUSIONS These results emphasize the need for additional research into the relationship between contemporaneous alcohol use and suicidality, with attention to differences based on sex, sexual orientation, and other factors that may impact these relationships. There is a particular need for research to examine the temporal nature of the association such that evidence-informed, high-impact interventions can be developed to improve suicidality outcomes among sexual minority youth.
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60
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Gonzales G, Gavulic KA. The Equality Act Is Needed to Advance Health Equity for Lesbian, Gay, Bisexual, and Transgender Populations. Am J Public Health 2020; 110:801-802. [PMID: 32374685 DOI: 10.2105/ajph.2020.305614] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Gilbert Gonzales
- Gilbert Gonzales is with the Center for Medicine, Health & Society, the Program for Public Policy Studies, and the Department of Health Policy at Vanderbilt University, Nashville, TN. At the time of this writing, Kyle A. Gavulic was a graduating senior majoring in Medicine, Health & Society at Vanderbilt University
| | - Kyle A Gavulic
- Gilbert Gonzales is with the Center for Medicine, Health & Society, the Program for Public Policy Studies, and the Department of Health Policy at Vanderbilt University, Nashville, TN. At the time of this writing, Kyle A. Gavulic was a graduating senior majoring in Medicine, Health & Society at Vanderbilt University
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61
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Understanding the Linkages Between Parental Monitoring, School Academic Engagement, Substance Use, and Suicide Among Adolescents in U.S. CHILD & YOUTH CARE FORUM 2020. [DOI: 10.1007/s10566-020-09570-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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62
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Lessard LM, Puhl RM, Watson RJ. Gay-Straight Alliances: A Mechanism of Health Risk Reduction Among Lesbian, Gay, Bisexual, Transgender, and Questioning Adolescents. Am J Prev Med 2020; 59:196-203. [PMID: 32553898 PMCID: PMC7375916 DOI: 10.1016/j.amepre.2020.02.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/21/2020] [Accepted: 02/28/2020] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Adolescents who identify as a sexual or gender minority are vulnerable to multiple health disparities because of stigma-based peer harassment. Given that sexual and gender minority adolescents may be bullied for several stigmatized identities that may exacerbate health risk, it is important to examine factors that can simultaneously reduce multiple forms of targeted victimization among sexual and gender minority adolescents. This study examines whether variation in health risk across sexual and gender minority adolescents who attend schools with versus without a gay-straight alliance can be explained by lessened bias-based bullying across a broad scope of stigmatized identities and attributes. METHODS Data on school-based gay-straight alliances, bias-based bullying, and health risk indicators were collected from the LGBTQ National Teen Survey (n=17,112; mean age=15.57 [SD=1.27] years) and analyzed in 2019. Multiple mediation analysis was conducted using latent variable structural equation modeling. RESULTS The majority (73%) of sexual and gender minority adolescents were bullied for stigmatized identities other than those related to their gender or sexual orientation. Compared to schools without a gay-straight alliance, student reports of multiple forms of bias-based bullying (based on body weight, gender, religion, disability, gender typicality, sexual orientation) were lower at schools with gay-straight alliances, which in turn attenuated adverse health outcomes (i.e., stress, sleep problems, depression, and unhealthy weight control behaviors). CONCLUSIONS Sexual and gender minority adolescents experience multiple forms of bias-based bullying, which independently heighten health risk, and this study extends previous work on gay-straight alliances to highlight a wider range of potential positive contributions to adolescent health.
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Affiliation(s)
- Leah M Lessard
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut.
| | - Rebecca M Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut; Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut
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63
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Dai H, Ingram DG, Taylor JB. Hierarchical and Mediation Analysis of Disparities in Very Short Sleep among Sexual Minority Youth in the U.S., 2015. Behav Sleep Med 2020; 18:433-446. [PMID: 31068017 DOI: 10.1080/15402002.2019.1607738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Insufficient sleep is associated with increased risk of chronic diseases, substance use, and unintentional injuries. Little is known about the disparities in short sleep among sexual minority youth. METHODS A nationally representative sample of U.S. students in grades 9-12 (n = 14,703) from the 2015 Youth Risk Behavior Survey was analyzed to examine the prevalence and risk factors of short sleep. Self-reported sleep duration (very short: ≤5 h, short: 6-7 h, normal: ≥8 h per day) were compared by sex group (male vs. female) and sexual orientation (heterosexual, gay, lesbian, bisexual, and unsure). RESULTS Of all respondents, 88.8% were heterosexual/straight, 2.0% were lesbian or gay, 6.0% were bisexual, and 3.2% were unsure about their sexual identity. Bisexual and unsure girls (36.2%, 95% CI [31.3-41.0] and 33.7%, CI [25.6-41.8], respectively) had a higher prevalence of very short sleep duration than straight girls (19.8%, CI [18.3-21.4]). Gay and unsure boys (38.5%, CI [25.6-51.5] and 33.3%, CI [23.5-32.1], respectively) had a higher prevalence of very short sleep duration than straight boys (16.5%, CI [15.1-17.9]). The effects of sexual minority status on very short sleep duration attenuated when incrementally adjusting for influencing factors, and further analysis identified that feeling sad/hopeless had the largest standardized mediation effect. CONCLUSIONS AND RELEVANCE Sexual minority adolescents had a higher prevalence of reporting very short sleep duration as compared to their straight peers, and the effects were mediated by influencing variables including demographic factors, substance use, excessive media use, and experiences of victimization/mental health problems.
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Affiliation(s)
- Hongying Dai
- College of Public Health, University of Nebraska Medical Center , Omaha, Nebraska
| | - David G Ingram
- Department of Pediatrics, University of Missouri-Kansas City , Kansas City.,Sleep Center, Children's Mercy Hospital , Kansas City, Missouri
| | - Jane B Taylor
- Department of Pediatrics, University of Missouri-Kansas City , Kansas City.,Pulmonology, Children's Mercy Hospital , Kansas City, Missouri
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64
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Fulginiti A, Goldbach JT, Mamey MR, Rusow J, Srivastava A, Rhoades H, Schrager SM, Bond DW, Marshal MP. Integrating Minority Stress Theory and the Interpersonal Theory of Suicide among Sexual Minority Youth Who Engage Crisis Services. Suicide Life Threat Behav 2020; 50:601-616. [PMID: 32048340 DOI: 10.1111/sltb.12623] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 10/28/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The present study sought to integrate minority stress theory (MST) and the interpersonal theory of suicide (ITS) to better understand high rates of suicide among sexual minority youth (SMY). To date, the ITS and MST have largely advanced independently from one another even though the research base for each theory contains gaps that the other theory may help fill. METHOD Using data from a national sample of 564 SMY (aged 12-24) recruited from an LGBTQ youth-focused suicide crisis prevention provider, we examined structural equation models to understand how perceived burdensomeness and thwarted belongingness mediate the relationship between minority stress and suicidal ideation and attempt. RESULTS Sexual minority stress was significantly associated with both perceived burdensomeness and thwarted belongingness in models predicting suicidal ideation and attempt. Moreover, minority stress had a direct effect on suicide attempt and an indirect effect on both suicidal ideation and suicide attempt through burdensomeness. CONCLUSIONS Given that minority stress is associated with greater thwarted belongingness, perceived burdensomeness, and suicide attempts, there should be greater demand for continuing education centered on sexual minority populations and population-specific services. Identifying burdensomeness as a minority stress-suicide mechanism highlights the potential gains of piloting recently developed burdensomeness interventions among SMY.
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Affiliation(s)
- Anthony Fulginiti
- Graduate School of Social Work, University of Denver, Denver, CO, USA
| | - Jeremy T Goldbach
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Mary Rose Mamey
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Joshua Rusow
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Ankur Srivastava
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Harmony Rhoades
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Sheree M Schrager
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA.,California State University, Northridge, Los Angeles, CA, USA
| | - David W Bond
- Blue Shield of California, San Francisco, CA, USA
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65
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Stargell NA, Jones SJ, Akers WP, Parker MM. Training School Teachers and Administrators to Support LGBTQ+ Students: A Quantitative Analysis of Change in Beliefs and Behaviors. JOURNAL OF LGBT ISSUES IN COUNSELING 2020. [DOI: 10.1080/15538605.2020.1753624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Allen BJ, Andert B, Botsford J, Budge SL, Rehm JL. At the Margins: Comparing School Experiences of Nonbinary and Binary-Identified Transgender Youth. THE JOURNAL OF SCHOOL HEALTH 2020; 90:358-367. [PMID: 32105347 PMCID: PMC7771707 DOI: 10.1111/josh.12882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/21/2019] [Accepted: 08/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Transgender, nonbinary, and gender nonconforming (TNG) young people are a diverse group, including young people with gender identities beyond the gender binary. Whereas nonbinary youth experience disparities in victimization and mental health, school belonging, support, and resources have not been well described. METHODS We conducted an online survey of TNG young people (ages 12-22) in Wisconsin to assess school belonging, safety, support, and resources. We compared responses among participants with nonbinary versus binary identities using mulvariate analysis of variance, multivariate analysis of covariance, chi-square and logistic regression analysis. RESULTS A total of 287 TNG young people met inclusion criteria (average age 18.2 ± 2.5 years). More than 40% of participants identified as nonbinary. Nonbinary participants were less likely to be out to teachers, but more likely to utilize supportive staff as a resource compared to binary-identified TNG peers. There were no significant differences in school safety and belonging. CONCLUSIONS Most school experiences do not vary significantly between TNG young people with binary versus nonbinary gender identities, though nonbinary young people are less likely to be out at school. Future research should examine factors that impact whether nonbinary young people share their gender identity and access school support services.
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Affiliation(s)
- Brittany J Allen
- University of Wisconsin School of Medicine and Public Health, 2870 University Avenue, Mail Code 9010, Madison, WI, 53705
| | - Ben Andert
- University of Wisconsin School of Medicine and Public Health, Program & Development Assistant, Fair Wisconsin, 122 E. Olin Ave, Suite 100, Madison, WI, 53713
| | - Jay Botsford
- Transgender Youth Resource Network, University of Wisconsin School of Medicine and Public Health, 749 University Row, Madison, WI, 53705
| | - Stephanie L Budge
- University of Wisconsin-Madison, Department of Counseling Psychology, School of Education, 305 Education Building, 1000 Bascom Mall, Madison, WI, 53706
| | - Jennifer L Rehm
- University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Mail code 4108, Madison, WI, 53792
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Richardson SC, Hales T, Meehan E, Waters A. Sexual minorities and teen suicide attempts in a southeastern state with prominent exclusionary policies. DEATH STUDIES 2020; 46:495-500. [PMID: 32207637 DOI: 10.1080/07481187.2020.1744202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study examines differences in suicide-related behaviors between heterosexual and sexual minority youth in a southeastern state with exclusionary policies. Furthermore, it seeks to further knowledge regarding risk factors for suicide attempts among sexual minority high school students. Utilizing the 2017 Youth Risk Behavior Survey data, descriptive analysis tests, and logistic regression tests were conducted. Findings indicate that sexual minorities were three times as likely to experience suicidal thoughts and plans but four times as likely to attempt suicide. Risk factors were noted for sexual minority youth. Policy advocacy is recommended to decrease suicide-related behaviors among this population.
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Affiliation(s)
| | - Travis Hales
- School of Social Work, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Erin Meehan
- School of Social Work, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Abby Waters
- School of Social Work, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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68
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Day JK, Fish JN, Grossman AH, Russell ST. Gay-Straight Alliances, Inclusive Policy, and School Climate: LGBTQ Youths' Experiences of Social Support and Bullying. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2020; 30 Suppl 2:418-430. [PMID: 30861243 PMCID: PMC8063225 DOI: 10.1111/jora.12487] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Gay-Straight Alliances (GSA) and school policies focused on support for lesbian, gay, bisexual, transgender, and queer/questioning youth may reduce bias-based bullying and enhance social supports in schools. Using multivariate regression, we tested the relationship between youth reports of the presence of GSAs and LGBTQ-focused policies, independently and mutually, with experiences bullying and perceived support (n = 1,061). Youth reported higher classmate support in the presence of GSAs and higher teacher support in the presence of LGBTQ-focused policies; the presence of both GSAs and LGBTQ-focused policies was associated with less bullying and higher perceived classmate and teacher support. The findings indicate that GSAs and LGBTQ-focused policies are distinctly and mutually important for fostering safer and more supportive school climates for youth.
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69
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Watson RJ, Park M, Taylor AB, Fish JN, Corliss HL, Eisenberg ME, Saewyc EM. Associations Between Community-Level LGBTQ-Supportive Factors and Substance Use Among Sexual Minority Adolescents. LGBT Health 2020; 7:82-89. [PMID: 31985327 DOI: 10.1089/lgbt.2019.0205] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose: Using representative school-based data and community-level primary data, we investigated how environmental factors (e.g., school and community climate) might be protective against substance use behaviors among a vulnerable population of adolescents. Methods: We analyzed a sample of 2678 sexual minority adolescents using a combination of student-level data (British Columbia Adolescent Health Survey) and primary community-level data (assessing lesbian, gay, bisexual, transgender, and queer [LGBTQ]-specific community and school environments). Using multilevel logistic regression models, we examined associations between lifetime substance use (alcohol, illegal drugs, marijuana, nonmedical use of prescription drugs, and smoking) and community-level predictors (community and school LGBTQ supportiveness). Results: Above and beyond student characteristics (e.g., age and years living in Canada), sexual minority adolescents residing in communities with more LGBTQ supports (i.e., more supportive climates) had lower odds of lifetime illegal drug use (for boys and girls), marijuana use (for girls), and smoking (for girls). Specifically, in communities with more frequent LGBTQ events (such as Pride events), the odds of substance use among sexual minority adolescents living in those communities was lower compared with their counterparts living in communities with fewer LGBTQ supports. Conclusions: The availability of LGBTQ community-level organizations, events, and programs may serve as protective factors for substance use among sexual minority adolescents. In particular, LGBTQ-supportive community factors were negatively associated with substance use, which has important implications for our investment in community programs, laws, and organizations that advance the visibility and rights of LGBTQ people.
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Affiliation(s)
- Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut
| | - Minjeong Park
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, The University of British Columbia, Vancouver, Canada
| | - Ashley B Taylor
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, The University of British Columbia, Vancouver, Canada
| | - Jessica N Fish
- Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland
| | - Heather L Corliss
- School of Public Health and Institute for Behavioral and Community Health, San Diego State University, San Diego, California
| | - Marla E Eisenberg
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, School of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Elizabeth M Saewyc
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, The University of British Columbia, Vancouver, Canada
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Family and School Contexts as Predictors of Suicidal Behavior among Adolescents: The Role of Depression and Anxiety. J Clin Med 2019; 8:jcm8122066. [PMID: 31771287 PMCID: PMC6947333 DOI: 10.3390/jcm8122066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/08/2019] [Accepted: 11/20/2019] [Indexed: 11/17/2022] Open
Abstract
Suicide is the highest external cause of death in the majority of developed countries. In adolescents, the prevalence of suicide has increased significantly in recent years, becoming a serious public health concern. The main aim of the present study is to characterize suicidal behavior, and to evaluate the relationship between family and school contexts and suicidal behavior through the possible mediating effects of depression and anxiety. The design of the study is cross-sectional. The sample was composed of 1386 Spanish adolescents from 14 high-schools. Suicidal behavior, anxiety, depression, family function, and school climate were evaluated through self-reported questionnaires. The results obtained show a significant association between adaptive family function and a positive school climate with low levels of depression, anxiety, and suicidal behavior. Mediation analyses revealed a significant full mediating effect of depression on family function and school climate with suicidal behavior. No significant mediating effects were found for anxiety. The results obtained underline the importance of family and school as protective factors for the prevention of suicidal behavior in adolescents, through the main mediating role of depression. Future studies should evaluate the mechanisms underlying the effects of family function and school climate on depression, and therefore, on suicidal behavior in adolescents.
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71
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Higgins Tejera C, Horner-Johnson W, Andresen EM. Application of an intersectional framework to understanding the association of disability and sexual orientation with suicidal ideation among Oregon Teens. Disabil Health J 2019; 12:557-563. [DOI: 10.1016/j.dhjo.2019.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/07/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
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Supportive Community Resources Are Associated with Lower Risk of Substance Use among Lesbian, Gay, Bisexual, and Questioning Adolescents in Minnesota. J Youth Adolesc 2019; 49:836-848. [PMID: 31446582 DOI: 10.1007/s10964-019-01100-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/30/2019] [Indexed: 12/28/2022]
Abstract
Research has indicated that lesbian, gay, bisexual, and queer/questioning (LGBQ) adolescents have disproportionately high rates of substance use compared to heterosexual peers; yet certain features of schools and communities have been associated with lower substance use rates in this population. To advance this field, research examining multiple levels of influence using measures developed with youth input is needed. With community, school, and student data, this study tested hypotheses that LGBQ students attending high schools and living in communities with more LGBQ-supportive environments (assessed with a novel inventory tool) have lower odds of substance use behaviors (cigarette smoking, alcohol use, marijuana use, prescription drug misuse, and other drug use) than their peers in less supportive LGBQ environments. Multilevel models using data from 2454 LGBQ students (54.0% female, 63.9% non-Hispanic white) in 81 communities and adjusting for student and school covariates found that LGBQ adolescents who lived in areas with more community support had lower odds of frequent substance use, particularly among females. Expanding and strengthening community resources (e.g., LGBQ youth-serving organizations, LGBQ events such as a Pride parade, and LGBQ-friendly services) is recommended to further support LGBQ adolescents and reduce substance use disparities.
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73
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Johnson B, Leibowitz S, Chavez A, Herbert SE. Risk Versus Resiliency: Addressing Depression in Lesbian, Gay, Bisexual, and Transgender Youth. Child Adolesc Psychiatr Clin N Am 2019; 28:509-521. [PMID: 31076124 DOI: 10.1016/j.chc.2019.02.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Lesbian, gay, bisexual, and transgender (LGBT) youth have unique risk factors that predispose them to depression at higher rates than their non-LGBT peers. Family rejection, bullying, and lack of societal acceptance can contribute to negative health outcomes. Additionally, youth with gender dysphoria may need or benefit from medical interventions. LGBT youth also have the same risk factors as non-LGBT youth, requiring clinicians to decipher risk factors associated with sexual and gender minority identity status, general risk factors, and relationships among them. Assessment of these risk factors and implementation of targeted interventions are important when treating depression in LGBT youth.
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Affiliation(s)
- Brandon Johnson
- Mount Sinai St. Luke's Hospital, Icahn School of Medicine at Mount Sinai, 411 West 114th Street, 2nd Floor, New York, NY 10025, USA.
| | - Scott Leibowitz
- THRIVE Gender Development Program, Nationwide Children's Hospital, The Ohio State University College of Medicine, 555 South 18th Street, Columbus, OH 43205, USA
| | - Alexis Chavez
- Department of Psychiatry, University of Colorado, Anschutz, 13001 East 17th Place, Building 500, 2E, Aurora, CO 80045, USA
| | - Sarah E Herbert
- Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta, GA, USA
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School environment, physical activity, and sleep as predictors of suicidal ideation in adolescents: Evidence from a national survey. J Adolesc 2019; 74:83-90. [PMID: 31176240 DOI: 10.1016/j.adolescence.2019.05.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/14/2019] [Accepted: 05/28/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Suicide is the second leading cause of death among individuals between 10 and 34 years of age and suicidal ideation substantially increases during adolescence. The purpose of this study was to examine the associations among physical activity, sleep, and factors relating to the school environment with adolescent self-reported rates of suicidal ideation on the 2017 National Risk Behavior Survey (YRBS). METHODS A multi-stage cluster sampling procedure was employed to yield a representative sample of US adolescents recruited from the 9th through 12th grade. The number of sampled adolescents was 18,324 with 10,125 students submitting questionnaires with useable data for this study. Weighted logistic regression models were employed to examine the predictive utility of physical activity, sleep, and factors related to the school environment with suicidal ideation, adjusting for age, sex, and BMI percentile. RESULTS Meeting physical activity guidelines every day of the week (OR 0.62, 95% CI: 0.51-0.76), hours of sleep (OR 5.46, 95% CI: 4.21-7.09), and factors relating to the school environment including bringing weapons to school (OR 2.06, 95% CI: 1.24-3.41), perceived school safety (OR 1.59, 95% CI: 1.27-2.00), and being bullied (OR 3.23, 95% CI: 2.71-3.87) and buying illegal drugs at school (OR 1.92, 95% CI: 1.63-2.27) all significantly independently predicted suicidal ideation. CONCLUSIONS Physical activity, sleep, and the school environment significantly predict suicidal ideation among this national sample of adolescents. These factors should be considered when designing interventions or programs to reduce the risk of suicidal ideation among adolescents.
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75
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Day JK, Ioverno S, Russell ST. Safe and supportive schools for LGBT youth: Addressing educational inequities through inclusive policies and practices. J Sch Psychol 2019; 74:29-43. [PMID: 31213230 PMCID: PMC10409610 DOI: 10.1016/j.jsp.2019.05.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 01/15/2019] [Accepted: 05/10/2019] [Indexed: 11/22/2022]
Abstract
Inclusive policies that attend to sexual orientation and gender identity (SOGI) are associated with more supportive school environments for lesbian, gay, bisexual, and transgender (LGBT) youth. We use the 2013-2015 California Healthy Kids Survey (n = 113,148) matched with principal reports of school policies from the 2014 California School Health Profiles to examine differential effects of SOGI-focused policies for LGB and transgender youth. SOGI-focused policies had a direct association with less truancy, and moderated the association between sexual orientation/gender identity and other school outcomes. SOGI-focused policies were associated with more positive experiences and perceptions of school climate for LGB youth and, to a lesser extent, transgender youth. Findings underscore the importance of inclusive policies, especially those that address the unique needs of transgender students.
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Affiliation(s)
- Jack K Day
- Department of Human Ecology, SUNY Oneonta, 108 Ravine Parkway, Oneonta, NY 13820, United States of America.
| | - Salvatore Ioverno
- Department of Human Development and Family Sciences, Population Research Center, University of Texas at Austin, 116 Inner Campus Dr Stop G6000, Austin, TX 78712, United States of America.
| | - Stephen T Russell
- Department of Human Ecology, SUNY Oneonta, 108 Ravine Parkway, Oneonta, NY 13820, United States of America; Department of Human Development and Family Sciences, Population Research Center, University of Texas at Austin, 116 Inner Campus Dr Stop G6000, Austin, TX 78712, United States of America.
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76
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Building Resilience, Reducing Risk: Four Pillars to Creating Safer, More Supportive Schools for LGBTQ+ Youth. Dela J Public Health 2019; 5:46-52. [PMID: 34467040 PMCID: PMC8389759 DOI: 10.32481/djph.2019.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In 2017 Delaware, LGBTQ+ Youth reported that almost 1 out of 3 were bullied on school grounds. Additionally, over 50% reported feeling sad/hopeless; and almost as many seriously considered suicide as an option, while 32% planned for suicide with almost 1 in 4 reporting having acted on their suicide plan at least once. Of all the students who reported a suicide attempt, 10% required medical treatment as a result of their attempt.1 The Delaware Department of Education does not have comprehensive statewide protections in place to support some of our most vulnerable youth, yet school districts can make a positive difference in implementing policy/practices to build resilience and reduce risk. This article will focus on four key areas where schools and school districts may implement changes toward creating safer, more supportive schools: (1) policy/procedures that protect LGBTQ+ students at the administrative level; (2) comprehensive cultural sensitivity training for serving LGBTQ+ students and their families; (3) incorporating inclusive curriculum on LGBTQ+ history into the classroom; (4) and creating, supporting, and sustaining gender sexuality alliances in both the middle and high schools.
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77
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Coulter RWS, Miller E. Professional Development and Research to Improve School Practices and LGBTQ Health in US Schools. Am J Public Health 2019. [PMID: 29513599 DOI: 10.2105/ajph.2018.304331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Robert W S Coulter
- Robert W.S. Coulter is with the Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center (UPMC), the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh; and the Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Elizabeth Miller is with the Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, and the Department of Pediatrics, School of Medicine, University of Pittsburgh
| | - Elizabeth Miller
- Robert W.S. Coulter is with the Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center (UPMC), the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh; and the Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Elizabeth Miller is with the Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, and the Department of Pediatrics, School of Medicine, University of Pittsburgh
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78
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Proulx CN, Coulter RW, Egan JE, Matthews DD, Mair C. Associations of Lesbian, Gay, Bisexual, Transgender, and Questioning-Inclusive Sex Education With Mental Health Outcomes and School-Based Victimization in U.S. High School Students. J Adolesc Health 2019; 64:608-614. [PMID: 30691941 PMCID: PMC6478545 DOI: 10.1016/j.jadohealth.2018.11.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE Homophobic school climates are related to increased victimization for sexual minority youth (SMY), leading to increased risk of adverse mental health outcomes. Interventions that promote positive school climate may reduce the risk of victimization and adverse mental health outcomes in SMY. This study explored whether lesbian, gay, bisexual, transgender, and questioning (LGBTQ)-inclusive sex education is associated with adverse mental health and school-based victimization in U.S. youth. METHODS Data analysis of representative data from the 2015 Youth Risk Behavior Survey and the 2014 School Health Profiles was conducted using multilevel logistic models testing whether youth in states with higher proportions of schools teaching LGBTQ-inclusive sex education had lower odds of reporting being bullied in school and experiencing adverse mental health outcomes, including depressive symptoms and suicidality. RESULTS After controlling for covariates, protective effects for all youth were found for suicidal thoughts (adjusted odds ratio [AOR]: .91, 95% confidence interval [CI]: .89-.93) and making a suicide plan (AOR: .79; 95% CI: .77-.80). Lesbian and gay youth had lower odds of experiencing bullying in school as the proportion of schools within a state teaching LGBTQ-inclusive sex education increased (AOR: .83; CI: .71-.97). Bisexual youth had significantly lower odds of reporting depressive symptoms (AOR: .92; 95% CI: .87-.98). CONCLUSIONS Students in states with a greater proportion of LGBTQ-inclusive sex education have lower odds of experiencing school-based victimization and adverse mental health. These findings can be used to guide intervention development at the school and state levels.
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Affiliation(s)
- Chelsea N. Proulx
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania, United States 15261,Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania, United States 15261
| | - Robert W.S. Coulter
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania, United States 15261,Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania, United States 15261
| | - Jamie E. Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania, United States 15261,Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania, United States 15261
| | - Derrick D. Matthews
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania, United States 15261,Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania, United States 15261
| | - Christina Mair
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania, United States 15261
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Ream GL. What's Unique About Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth and Young Adult Suicides? Findings From the National Violent Death Reporting System. J Adolesc Health 2019; 64:602-607. [PMID: 30711364 DOI: 10.1016/j.jadohealth.2018.10.303] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/23/2018] [Accepted: 10/26/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of the study was to explore variability in circumstances around suicide deaths among youth and young adults by sexual/gender identity category (gay male, lesbian/gay female, bisexual male, bisexual female, transgender male, transgender female, non-LGBT [lesbian, gay, bisexual, and transgender] male, and non-LGBT female). METHODS Secondary analysis of National Violent Death Reporting System (NVDRS) data for all 12- to 29-year-olds who died by suicide in NVDRS participating states. Coverage begins in 2013, the year that NVDRS began coding for sexual orientation and transgender status, and ends in 2015, the latest year of NVDRS data available. The valid sample was limited to cases in which sexual orientation or transgender status could be determined postmortem, n = 2,209. RESULTS Almost one quarter (24%) of 12- to 14-year-olds who died by suicide were LGBT, whereas only 8% of 25- to 29-year-olds who died by suicide were LGBT. Most non-LGBT males and bisexual males died by firearm and had intimate partner problems contribute to their deaths. Non-LGBT females and LGBT persons other than bisexual males were generally less likely to use firearms. They were also more likely to have psychiatric diagnoses, prior suicidality, and family problems contributing to their deaths. Rates of many circumstances varied widely among LGBT subgroups. CONCLUSIONS The LGBT versus non-LGBT suicide disparity is greatest at younger ages, and each LGBT subgroup has its own specific risk profile for suicide. Suicide prevention and intervention efforts targeted at LGBT youth may increase their effectiveness by attending to these distinct risk profiles.
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Affiliation(s)
- Geoffrey L Ream
- School of Social Work, Adelphi University, Garden City, New York.
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Goldbach JT, Rhoades H, Green D, Fulginiti A, Marshal MP. Is There a Need for LGBT-Specific Suicide Crisis Services? CRISIS 2019; 40:203-208. [DOI: 10.1027/0227-5910/a000542] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: Lesbian, gay, bisexual, and transgender (LGBT) youth are more than twice as likely to attempt suicide than their peers. Although LGBT-specific crisis services have been developed, little is known about the need for these services beyond that of general lifeline services. Aims: The present study sought to (a) describe the primary reasons for calling a specialized provider as opposed to another and (b) examine sociodemographic differences in the primary reason by race, ethnicity, gender, age, and sexual orientation. Method: Data from 657 youth who sought crisis services from an LGBT-specific national service provider in the United States were assessed. Logistic regression models assessed demographic differences. Thematic analysis of open-ended responses regarding reasons for choosing this LGBT-specific crisis service provider followed a consensus model. Results: Most respondents indicated they either would not have contacted another helpline (26%) or were not sure (48%). Nearly half (42%) indicated they called specifically because of LGBT-affirming counselors, a reason more commonly reported by gender minority (transgender and gender nonbinary) and queer or pansexual youth than cisgender, gay, or lesbian youth. Conclusion: LGBT-specific crisis services appear to play an important role in suicide prevention. Further research is needed to understand the use of culturally tailored suicide prevention approaches.
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Affiliation(s)
- Jeremy T. Goldbach
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Harmony Rhoades
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Daniel Green
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | | | - Michael P. Marshal
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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81
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Toomey RB, Syvertsen AK, Flores M. Are Developmental Assets Protective Against Suicidal Behavior? Differential Associations by Sexual Orientation. J Youth Adolesc 2019; 48:788-801. [PMID: 30417268 PMCID: PMC6441614 DOI: 10.1007/s10964-018-0954-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022]
Abstract
Sexual orientation disparities in suicide behavior are well-documented. Yet, few studies have examined how developmental assets - key values, self-perceptions, skills, relationships, and opportunities that have been identified as the building blocks of positive youth development - are associated with suicide behaviors, particularly among sexual minority youth. This study examined concurrent associations between young people's developmental assets and suicidal behavior by sexual orientation using a large sample of 116,925 in-school U.S. adolescents (ages 11 to 19, M = 14.74, SD = 1.78). Most of the sample identified as only heterosexual (90.2%); 5% identified as mostly heterosexual, 3.5% as bisexual, 0.6% as mostly lesbian/gay, and 0.7% as only lesbian/gay. Most participants identified as White, non-Latina/o (62.6%) and as cisgender female (50.3%) or cisgender male (47.8%). Compared to only heterosexual adolescents, youth with all other sexual orientations reported lower levels of internal and external developmental assets except for non-sports extracurricular activity participation and social justice values. Identifying as a racial/ethnic minority, particularly for only heterosexual adolescents, and specifically as Latina/o for sexual minority adolescents was associated with greater risk for suicidal behavior. Further, identifying as a gender minority exacerbated risk for suicidal behavior. Relatedly, when youth reported feeling unsafe with their family, or in their school or neighborhood, they were at greater risk for suicidal behavior, regardless of sexual orientation. Feeling hopeful was associated with lower risk for suicidal behavior for all youth. Regardless of sexual orientation, planning and decision-making skills were associated with lower risk and social-emotional skills were associated with heightened risk for suicidal behavior. School boundaries and social justice values were associated with lower risk for suicidal behavior among bisexual adolescents; there were no additional protective assets for mostly/only lesbian/gay adolescents. In conclusion, sexual orientation disparities exist in the lives of adolescents for several internal and external developmental assets. Disparities in suicidal behavior by sexual orientation, however, were largely unexplained by differential associations between developmental assets and suicidal behavior.
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Affiliation(s)
- Russell B. Toomey
- The University of Arizona, Family Studies and Human Development, Tucson, AZ, USA;
| | | | - Melissa Flores
- The University of Arizona, Family Studies and Human Development, Tucson, AZ, USA;
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82
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Taliaferro LA, McMorris BJ, Rider GN, Eisenberg ME. Risk and Protective Factors for Self-Harm in a Population-Based Sample of Transgender Youth. Arch Suicide Res 2019; 23:203-221. [PMID: 29461934 PMCID: PMC6102088 DOI: 10.1080/13811118.2018.1430639] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study sought to identify factors distinguishing transgender/gender non-conforming (GNC) adolescents across three groups: no self-harm, non-suicidal self-injury (NSSI) only, and NSSI and suicide attempt (NSSI + SA). Data were from the 2016 Minnesota Student Survey. The final analytic sample included 1,635 transgender/GNC students in grades 9 and 11. Logistic regression analyses determined factors that best distinguished transgender/GNC students who reported self-harm (NSSI only or NSSI + SA) from those who reported no self-harm, and transgender/GNC adolescents who reported NSSI + SA from those who reported NSSI only. Final models were developed over 3 stages of analysis that tested associations of variables within risk factor, protective factor, and health-risk behavior domains to self-harm. Over half (51.6%) of transgender/GNC adolescents reported past-year self-harm behavior. Factors that consistently distinguished transgender/GNC youth who reported self-harm from those who reported no self-harm included reports of a mental health problem, depression, running away from home, and substance use (alcohol or marijuana use). Factors that distinguished the NSSI + SA group from the NSSI only group were reports of a mental health problem, physical or sexual abuse, relationship violence, bullying victimization, less parent connectedness, lower grades, lower levels of perceived school safety, and running away from home. Clinicians and school personnel need to be prepared to address risk factors and enhance protective factors that may reduce the likelihood this population of vulnerable youth will engage in NSSI and/or attempt suicide.
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83
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Suicidal behaviour among sexual-minority youth: a review of the role of acceptance and support. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:190-198. [DOI: 10.1016/s2352-4642(18)30400-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/27/2018] [Accepted: 12/04/2018] [Indexed: 11/20/2022]
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84
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Sellers CM, Iriarte ADV, Battalen AW, O’Brien KHM. Alcohol and marijuana use as daily predictors of suicide ideation and attempts among adolescents prior to psychiatric hospitalization. Psychiatry Res 2019; 273:672-677. [PMID: 31207851 PMCID: PMC9262037 DOI: 10.1016/j.psychres.2019.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Little research has been conducted on alcohol use, marijuana use, and suicide ideation and attempts on a daily level, and specifically among adolescents prior to inpatient hospitalization. The purpose of this study was to examine the within (over time) and between (between adolescents) effects of alcohol use and marijuana use on suicide ideation and attempts. METHODS Participants included 50 adolescents (80% female; Mage = 15.8). All participants reported drinking alcohol in the prior three months and were receiving treatment in an inpatient psychiatric hospital. Random and mixed-effect models were used to test study hypotheses. RESULTS Results from the random effect model indicated that alcohol use, marijuana use, hospitalization and sexual orientation were significant predictors of suicide attempts. Results from the mixed-effect model indicated that marijuana use, hospitalization, and sexual orientation were significant predictors of suicide ideation. CONCLUSIONS Study findings extend current knowledge about the longitudinal and day-to-day relationship between alcohol and marijuana use and suicide ideation and attempts. Results underscore the importance of addressing alcohol and marijuana use in interventions with suicidal adolescents, recognizing that sexual minority youth may be at elevated risk for suicide ideation.
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Affiliation(s)
- Christina M. Sellers
- Boston Children’s Hospital, Department of Psychiatry, 300 Longwood Ave Boston, MA 02115, USA,Corresponding author at: Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, USA. (C.M. Sellers)
| | - Antonia Diaz-Valdes Iriarte
- Boston College, School of Social Work, 140 Commonwealth Ave Chestnut Hill, MA 02467, USA,Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Badajoz 130, Oficina 1305, Las Condes, Santiago 750000 Chile
| | - Adeline Wyman Battalen
- Boston Children’s Hospital, Department of Psychiatry, 300 Longwood Ave Boston, MA 02115, USA
| | - Kimberly H. McManama O’Brien
- Boston Children’s Hospital, Department of Psychiatry, 300 Longwood Ave Boston, MA 02115, USA,Education Development Center, Department of Innovation in Practice and Technology, 43 Foundry Ave Waltham, MA 02453, USA,Harvard Medical School, Department of Psychiatry, 25 Shattuck St Boston, MA 02115, USA
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85
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Barnett AP, Molock SD, Nieves-Lugo K, Zea MC. Anti-LGBT Victimization, Fear of Violence at School, and Suicide Risk Among Adolescents. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2019; 6:88-95. [PMID: 37383950 PMCID: PMC10306240 DOI: 10.1037/sgd0000309] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
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.
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86
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Implementation of a Socio-structural Demonstration Project to Improve HIV Outcomes Among Young Black Men in the Deep South. J Racial Ethn Health Disparities 2019; 6:775-789. [PMID: 30793253 DOI: 10.1007/s40615-019-00576-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/31/2019] [Accepted: 02/12/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND We describe the background, rationale, intervention components, and formative results of a demonstration project aimed to ameliorate five socio-structural barriers to HIV services for young Black men aged 18-29 living with and at risk for HIV in Louisiana. METHODS The interventions and activities consisted of (1) five person-centered approaches to enhance linkage to HIV services and improve socio-economic outcomes; (2) the implementation of systematic mystery shopping tests to document instances of housing discrimination; (3) the development and implementation of a multi-prong communications campaign to increase knowledge about the signs of housing discrimination and community resources among young Black men who have sex with men (YBMSM); (4) the integration of HIV/STI services and lesbian, gay, bisexual, and trans (LGBT)-inclusive events on Historically Black Colleges and Universities (HBCUs); and (5) the development of a safe space for YBMSM. A multi-method approach was used to evaluate the outcomes of the different interventions. RESULTS The majority (62%) of participants living with HIV were linked to HIV care and 49% had achieved viral suppression. More than 40% of participants were employed during the project. Thirty-seven percent (37%) of the mystery shopping tests showed definite or possible signs of housing discrimination. The housing campaign's duration was limited with unknown long-term impact among YBMSM. Fifteen cases of syphilis were identified during two HBCU events. A safe space was specifically created for YBMSM at a community-based organization. CONCLUSION Multi-component holistic health interventions are needed to improve HIV outcomes and curb the high HIV rates among young Black men, particularly YBMSM in the United States and the Deep South.
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87
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Coulter RW, Sang JM, Louth-Marquez W, Henderson ER, Espelage D, Hunter SC, DeLucas M, Abebe KZ, Miller E, Morrill BA, Hieftje K, Friedman MS, Egan JE. 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. JMIR Res Protoc 2019; 8:e12164. [PMID: 30767903 PMCID: PMC6416896 DOI: 10.2196/12164] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/10/2018] [Indexed: 01/19/2023] Open
Abstract
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
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Affiliation(s)
| | - Jordan M Sang
- University of Pittsburgh, Pittsburgh, PA, United States
| | | | | | - Dorothy Espelage
- College of Health and Human Performance, University of Florida, Gainesville, FL, United States
| | - Simon C Hunter
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | | | | | | | | | | | | | - James E Egan
- University of Pittsburgh, Pittsburgh, PA, United States
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88
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Salway T, Ross LE, Fehr CP, Burley J, Asadi S, Hawkins B, Tarasoff LA. A Systematic Review and Meta-Analysis of Disparities in the Prevalence of Suicide Ideation and Attempt Among Bisexual Populations. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:89-111. [PMID: 29492768 DOI: 10.1007/s10508-018-1150-6] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/24/2017] [Accepted: 01/07/2018] [Indexed: 05/12/2023]
Abstract
Sexual minorities are at increased risk of suicide; however, it is unclear whether there are within-sexual minority differences in risk across specific sexual identities-notably between bisexual and lesbian/gay subgroups. We therefore conducted a systematic review and meta-analysis to quantify associations between bisexual identity and self-reported suicide ideation and attempt and the moderation of these associations by gender/sex, age, sampling strategy, and measurement of sexuality. Abstracts and full texts were independently screened by two reviewers, resulting in a total of 46 studies that met inclusion criteria and reported 12-month or lifetime prevalence estimates for suicide ideation or attempt. A consistent gradient was observed across all four outcomes, whereby bisexual respondents reported the highest proportion of suicide ideation or attempt, lesbian/gay respondents the next highest proportion, and heterosexual respondents the lowest proportion. Random-effects meta-analysis comparing bisexual individuals with lesbian/gay individuals yielded odds ratios (ORs) ranging between 1.22-1.52 across the four outcomes examined. Between-study variability in ORs was large. Thirty-one percent of heterogeneity was explained by sample type (e.g., probability vs. non-probability) and 17% by gender/sex. ORs were consistently larger for women (range: 1.48-1.95, all statistically significant at p < .05) than for men (range: 1.00-1.48, all p > .05), suggesting that gender/sex moderates the association between bisexual identity and suicide risk. Within-sexual minority differences in suicide risk may be attributed to structural and interpersonal experiences of monosexism, bisexual erasure and invisibility, or lack of bisexual-affirming social support, each of which may be experienced differently across gender/sex identities.
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Affiliation(s)
- Travis Salway
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
- Clinical Prevention Services, BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
| | - Lori E Ross
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Charles P Fehr
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Joseph Burley
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Shayan Asadi
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Blake Hawkins
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Lesley A Tarasoff
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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89
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di Giacomo E, Krausz M, Colmegna F, Aspesi F, Clerici M. Estimating the Risk of Attempted Suicide Among Sexual Minority Youths: A Systematic Review and Meta-analysis. JAMA Pediatr 2018; 172:1145-1152. [PMID: 30304350 PMCID: PMC6583682 DOI: 10.1001/jamapediatrics.2018.2731] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Suicide is the second-leading cause of death among adolescents. Sexual minority individuals are at a higher risk of suicide and attempted suicide, but a precise and systematic evaluation of this risk among sexual minority youths has not been documented to our knowledge. OBJECTIVE To examine the risk of attempted suicide among sexual minority adolescents, differentiating for each sexual minority group. DATA SOURCES Electronic databases (PubMed, Embase, and PsycINFO) were searched for articles published through April 30, 2017, with the following search terms: heterosexual, homosexual, bisexual, transgender, adolescents, teens, and attempted suicide. STUDY SELECTION Studies that reported attempted suicide in sexual minority adolescents compared with heterosexual peers were included. Thirty-five studies satisfied criteria for inclusion of 764 records identified. DATA EXTRACTION AND SYNTHESIS Pooled analyses were based on odds ratios (ORs), with relevant 95% CIs, weighting each study with inverse variance models with random effects. Risk of publication bias and analysis of heterogeneity through univariable and multivariable meta-regressions were also rated. MAIN OUTCOMES AND MEASURES The evaluation of increased odds of attempted suicide among sexual minority youths compared with heterosexual peers. RESULTS Thirty-five studies reported in 22 articles that involved a total of 2 378 987 heterosexual and 113 468 sexual minority adolescents (age range, 12-20 years) were included in the analysis. Sexual minority youths were generally at higher risk of attempted suicide (OR, 3.50; 95% CI, 2.98-4.12; c2 = 3074.01; P < .001; I2 = 99%). If estimated in each sexual minority group, the OR was 3.71 in the homosexual group (95% CI, 3.15-4.37; c2 = 825.20; P < .001; I2 = 97%) and 4.87 in the bisexual group (95% CI, 4.76-4.98; c2 = 980.02; P < .001; I2 = 98%); transgender youths were described as an individual group in only 1 study, which reported an OR of 5.87 (95% CI, 3.51-9.82). Meta-regressions weighted for the study weight highlighted that the presence of young participants (12 years old) was associated with heterogeneity in the bisexual group, whereas the year of sampling was associated with heterogeneity in the whole group when combined with other covariates. CONCLUSIONS AND RELEVANCE Our findings suggest that youths with nonheterosexual identity have a significantly higher risk of life-threatening behavior compared with their heterosexual peers. Public awareness is important, and a careful evaluation of supportive strategies (eg, support programs, counseling, and destigmatizing efforts) should be part of education and public health planning.
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Affiliation(s)
- Ester di Giacomo
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy,Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy,Department of Neuroscience, Doctorate School of the University of Milano-Bicocca, Monza, Italy
| | - Micheal Krausz
- Institute of Mental Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fabrizia Colmegna
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Flora Aspesi
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Massimo Clerici
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy,Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
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90
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Green AE, Willging CE, Ramos MM, Shattuck D, Gunderson L. Factors Impacting Implementation of Evidence-Based Strategies to Create Safe and Supportive Schools for Sexual and Gender Minority Students. J Adolesc Health 2018; 63:643-648. [PMID: 30205932 PMCID: PMC6289584 DOI: 10.1016/j.jadohealth.2018.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 10/28/2022]
Abstract
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.
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Affiliation(s)
- Amy E Green
- Department of Psychiatry, University of California, La Jolla, California; Child and Adolescent Services Research Center, San Diego, California.
| | - Cathleen E Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - Mary M Ramos
- Division of Adolescent Medicine, Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico, USA
| | - Daniel Shattuck
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - Lara Gunderson
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
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91
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Watson RJ, VanKim NA, Rose HA, Porta CM, Gahagan J, Eisenberg ME. Unhealthy weight control behaviors among youth: Sex of sexual partner is linked to important differences. Eat Disord 2018; 26:448-463. [PMID: 29601272 DOI: 10.1080/10640266.2018.1453633] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Unhealthy weight control behaviors (UWCBs) have been decreasing for most youth over time, yet little is known whether these behaviors have changed for sexual minority (e.g., non-heterosexual) youth. This is important because many studies have found that sexual minorities report some of the highest rates of UWCBs. To determine whether or not these behaviors have changed over time, given the extreme changes in social contexts over the past two decades, we utilised three waves of the Minnesota Student Survey (N = 55,597, Mage = 17). In doing so, we report trends, disparities, and changes in disparities of UWCBs. Overall, the prevalence of UWCBs has declined from 1999 to 2010 for all youth, but there are alarming disparities by sex of sexual partner. We found that both- and same-sex partnered male youth were more likely to fast, use diet pills, and vomit on purpose to lose weight compared to their opposite-sex partnered counterparts in all three survey years; specifically, both-sex partnered boys were up to 5.5× as likely to vomit on purpose compared to their opposite-sex partnered counterparts. Likewise, both-sex partnered girls were more likely to use diet pills and vomit on purpose to lose weight compared to opposite-sex partnered girls in all three survey years. Additionally, the disparity in fasting to lose weight widened for the same-sex partnered females compared to the opposite-sex partnered females from 1998 to 2004. This has implications for UWCB interventions and preventions targeted specifically towards sexual minorities.
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Affiliation(s)
- Ryan J Watson
- a Department of Human Development and Family Studies, University of Connecticut, Storrs, CT, USA
| | - Nicole A VanKim
- b University of Massachusetts - Amherst, School of Public Health and Health Sciences, Amherst, MA, USA
| | - Hilary A Rose
- c Applied Human Sciences, Concordia University, Montreal, QC, Canada
| | - Carolyn M Porta
- d School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Jacqueline Gahagan
- e School of Health and Human Performance, Dalhousie University, Halifax, NS, Canad
| | - Marla E Eisenberg
- f Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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92
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Porta CM, Watson RJ, Doull M, Eisenberg ME, Grumdahl N, Saewyc E. Trend Disparities in Emotional Distress and Suicidality Among Sexual Minority and Heterosexual Minnesota Adolescents From 1998 to 2010. THE JOURNAL OF SCHOOL HEALTH 2018; 88:605-614. [PMID: 29992605 DOI: 10.1111/josh.12650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 10/10/2017] [Accepted: 10/18/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Sexual minority young people have demonstrated higher rates of emotional distress and suicidality in comparison to heterosexual peers. Research to date has not examined trends in these disparities, specifically, whether there have been disparity reductions or increases and how outcomes have differed over time by sex and sexual orientation group. METHODS Minnesota Student Survey data, collected from 9th and 12th graders in 3 cohorts (1998, 2004, 2010) were used to examine emotional distress and suicidality rates. Logistic regression analyses were completed to examine outcome changes over time within and across sexual orientation/sex groups. RESULTS With few exceptions, sexual minority youth are at increased risk of endorsing emotional distress and suicidality indicators in each surveyed year between 1998 and 2010. Young people with both-sex partners reported more emotional distress across all health indicators compared to their opposite-sex partnered peers. With a few exceptions, gaps in disparities between heterosexual and sexual minority have not changed from 2004 to 2010. CONCLUSIONS Disparities in emotional health persist among youth. Research is needed to advance understanding of mental health disparities, with consideration of sexual orientation differences and contextualized to sociocultural status and changes over time. Personalized prevention strategies are needed to promote adolescent mental health.
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Affiliation(s)
- Carolyn M Porta
- School of Nursing, University of Minnesota, 5-160 Weaver Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455
| | - Ryan J Watson
- Department of Human Development and Family Studies, University of Connecticut, 348 Mansfield Road U1058, Storrs, CT, 06269, USA
| | - Marion Doull
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, T222-2211 Wesbrook Mall, Vancouver, British Columbia V6T 2B5, Canada
| | - Marla E Eisenberg
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, 717 Delaware St. SE, Minneapolis, MN 55414
| | - Nathan Grumdahl
- School of Nursing, University of Minnesota, 5-160 Weaver Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455
| | - Elizabeth Saewyc
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, T222-2211 Wesbrook Mall, Vancouver, British Columbia V6T 2B5, Canada
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93
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Wilkinson L, Pearson J, Liu H. Educational attainment of transgender adults: Does the timing of transgender identity milestones matter? SOCIAL SCIENCE RESEARCH 2018; 74:146-160. [PMID: 29961481 PMCID: PMC6234844 DOI: 10.1016/j.ssresearch.2018.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/17/2018] [Accepted: 04/30/2018] [Indexed: 06/08/2023]
Abstract
Adolescence is a difficult life stage in which to navigate a transgender identity, yet adolescence plays a key role in shaping educational trajectories. While transgender-related stigma and victimization within secondary schools persists, the social climate in which transgender adolescents navigate their identity has changed over time. Analyzing data from the National Transgender Discrimination Survey, a national, non-probability sample of U.S. transgender adults, we address the following research questions: 1) Is experiencing transgender identity milestones in adolescence associated with educational attainment?; 2) Does this association vary by birth cohort? We find that those who first experienced transgender identity milestones in adolescence attained less education than those who first experienced milestones in other life stages. This association is larger among younger birth cohorts, pointing to the adolescent years as a particularly difficult time to navigate a transgender identity, even in the midst of increased transgender awareness and resources within schools and society.
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Affiliation(s)
- Lindsey Wilkinson
- Department of Sociology, Portland State University, PO Box 751, Portland, OR, 97207, USA.
| | - Jennifer Pearson
- Department of Sociology, Wichita State University, 1845 Fairmount, Box 25, Wichita, KS, 67260, USA
| | - Hui Liu
- Department of Sociology, Michigan State University, 317 Berkey Hall, 509 East Circle Hall, East Lansing, MI, 48824, USA
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Raifman J, Moscoe E, Austin SB, Hatzenbuehler ML, Galea S. Association of State Laws Permitting Denial of Services to Same-Sex Couples With Mental Distress in Sexual Minority Adults: A Difference-in-Difference-in-Differences Analysis. JAMA Psychiatry 2018; 75:671-677. [PMID: 29799924 PMCID: PMC6129969 DOI: 10.1001/jamapsychiatry.2018.0757] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Recent evidence suggests that state policies affecting sexual minorities are associated with health disparities. Twelve states have laws permitting the denial of services to same-sex couples, and the US Supreme Court is considering whether states can prohibit the denial of services to same-sex couples. OBJECTIVE We investigated whether state laws permitting individuals to refuse services to sexual minorities were associated with changes in the proportion of sexual minority adults reporting mental distress. DESIGN, SETTING, AND PARTICIPANTS This difference-in-difference-in-differences linear regression analysis with state fixed effects used Behavioral Risk Factor Surveillance System (BRFSS) data from 2014 through 2016 from adults aged 18 to 64 years in 3 states that implemented laws permitting the denial of services to same-sex couples (Utah, Michigan, and North Carolina) and 6 nearby control states (Idaho and Nevada, Ohio and Indiana, and Virginia and Delaware, respectively). Sexual minority adults were defined as those who identified as gay, lesbian, bisexual, or not sure of their sexual orientation under a module on sexual orientation that BRFSS implemented in 2014 and each state could opt to include. Analysis controlled for year and individual-level sex, race, ethnicity, age group, educational attainment, income, employment, and marital status. A permutation test was conducted to precisely estimate statistical significance. EXPOSURES An interaction term indicating whether individuals identified as a sexual minority and lived in a state with a law permitting denial of services to same-sex couples in 2015. MAIN OUTCOMES AND MEASURES Mental distress, defined as poor mental health on 14 or more of the past 30 days. RESULTS Of 109 089 participants, 4656 (4.8%; all percentages incorporate survey weights) identified as sexual minorities, 86141 (72.1%) were non-Hispanic white, and ages were uniformly distributed between 18 and 64 years. In 2014, 2038 of 16637 heterosexual adults (12.6%) and 156 of 815 sexual minority adults (21.9%) in the 3 same-sex denial states reported mental distress. The proportion of sexual minority adults reporting mental distress increased by 10.1 percentage points (95% CI, 1.8 to 18.5 percentage points, permutation-adjusted P value = .046) between 2014 and 2016 in states that passed laws permitting denial of services to same-sex couples compared with control states, a 46% relative increase in sexual minority adults experiencing mental distress. Laws permitting denial of services to same-sex couples were not associated with significant changes in heterosexual adults experiencing mental distress (-0.36 percentage points, 95% CI, -1.73 to 1.01 percentage points). CONCLUSIONS AND RELEVANCE Laws permitting denial of services to same-sex couples, which exist in 12 states and are under consideration by the US Supreme Court, are associated with a 46% increase in sexual minority adults experiencing mental distress.
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Affiliation(s)
- Julia Raifman
- Boston University School of Public Health, Boston, Massachusetts
| | | | | | | | - Sandro Galea
- Boston University School of Public Health, Boston, Massachusetts
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95
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Eisenberg ME, Gower AL, McMorris BJ, Rider GN, Coleman E. Emotional Distress, Bullying Victimization, and Protective Factors Among Transgender and Gender Diverse Adolescents in City, Suburban, Town, and Rural Locations. J Rural Health 2018; 35:270-281. [PMID: 29940070 DOI: 10.1111/jrh.12311] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Marla E Eisenberg
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Amy L Gower
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | | | - G Nicole Rider
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Eli Coleman
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota
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96
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Gallagher ML, Miller AB. Suicidal Thoughts and Behavior in Children and Adolescents: An Ecological Model of Resilience. ADOLESCENT RESEARCH REVIEW 2018; 3:123-154. [PMID: 29904718 PMCID: PMC5995470 DOI: 10.1007/s40894-017-0066-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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97
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Salway T, Gesink D, Ibrahim S, Ferlatte O, Rhodes AE, Brennan DJ, Marchand R, Trussler T. Evidence of Multiple Mediating Pathways in Associations Between Constructs of Stigma and Self-Reported Suicide Attempts in a Cross-Sectional Study of Gay and Bisexual Men. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1145-1161. [PMID: 28821997 DOI: 10.1007/s10508-017-1019-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 03/11/2017] [Accepted: 06/17/2017] [Indexed: 06/07/2023]
Abstract
Gay and bisexual men (GBM) are more likely to attempt suicide than heterosexual men. This disparity is commonly interpreted using minority stress theory; however, specific pathways from antigay stigma to suicidal behavior are poorly understood. We aimed to estimate associations between multiple constructs of stigma and suicide attempts among adult GBM, and to measure the proportion of these associations mediated by distinct suicide risk factors, thus identifying proximal points of intervention. Data were drawn from a Canadian community-based survey of adult GBM. Structural equation modeling was used to compare associations between three latent constructs-enacted stigma (e.g., discrimination, harassment), anticipated prejudice (worry about encountering antigay/bisexual prejudice), and sexuality concealment-and self-reported suicide attempts (last 12 months). Coefficients were estimated for direct, indirect, and total pathways and evaluated based on magnitude and statistical significance. The proportion of associations mediated by depression, drug/alcohol use, and social isolation was calculated using indirect paths. Among 7872 respondents, 3.4% reported a suicide attempt in the past 12 months. The largest total association was observed for enacted stigma, and this association was partially mediated by depression and drug/alcohol use. The total association of anticipated prejudice was relatively smaller and mediated by depression and social isolation. Concealment had an inverse association with suicide attempts as mediated by depression but was also positively associated with suicide attempts when mediated through social isolation. Multiple constructs of antigay stigma were associated with suicide attempts; however, mediating pathways differed by construct, suggesting that a combination of strategies is required to prevent suicide in adult GBM.
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Affiliation(s)
- Travis Salway
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
- Community-Based Research Centre for Gay Men's Health, Suite 234 - 970 Burrard Street, Vancouver, BC, V6Z 2R4, Canada.
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Selahadin Ibrahim
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
- Institute for Work & Health, 481 University Avenue, Toronto, ON, M5G 2E9, Canada
| | - Olivier Ferlatte
- School of Nursing, University of British Columbia, Room 107 - Med Block C, 2176 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Anne E Rhodes
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
- Department of Psychiatry, University of Toronto, 585 University Avenue, Toronto, ON, M5G 2N2, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, St. Joseph's Healthcare Hamilton, West 5th Campus, Administration - B3, 100 West 5th, Hamilton, ON, L8N 3K7, Canada
- Offord Centre for Child Studies, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Rick Marchand
- Community-Based Research Centre for Gay Men's Health, Suite 234 - 970 Burrard Street, Vancouver, BC, V6Z 2R4, Canada
| | - Terry Trussler
- Community-Based Research Centre for Gay Men's Health, Suite 234 - 970 Burrard Street, Vancouver, BC, V6Z 2R4, Canada
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98
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Demissie Z, Rasberry CN, Steiner RJ, Brener N, McManus T. Trends in Secondary Schools' Practices to Support Lesbian, Gay, Bisexual, Transgender, and Questioning Students, 2008-2014. Am J Public Health 2018; 108:557-564. [PMID: 29470123 DOI: 10.2105/ajph.2017.304296] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine trends in the percentage of US secondary schools that implemented practices related to the support of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) students. METHODS This analysis used data from 4 cycles (2008-2014) of School Health Profiles, a surveillance system that provides results representative of secondary schools in each state. Each school completed 2 self-administered questionnaires (principal and teacher) per cycle. We used logistic regression models to examine linear trends. RESULTS Of 8 examined practices to support LGBTQ youths, only 1-identifying safe spaces for LGBTQ youths-increased in most states (72%) from 2010 to 2014. Among the remaining 7, only 1-prohibiting harassment based on a student's perceived or actual sexual orientation or gender identity-had relatively high rates of adoption (a median of 90.3% of schools in 2014) across states. CONCLUSIONS Many states have seen no change in the implementation of school practices associated with LGBTQ students' health and well-being.
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Affiliation(s)
- Zewditu Demissie
- Zewditu Demissie, Catherine N. Rasberry, Riley J. Steiner, Nancy Brener, and Tim McManus are with the Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Zewditu Demissie is also with the US Public Health Service Commissioned Corps, Rockville, MD
| | - Catherine N Rasberry
- Zewditu Demissie, Catherine N. Rasberry, Riley J. Steiner, Nancy Brener, and Tim McManus are with the Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Zewditu Demissie is also with the US Public Health Service Commissioned Corps, Rockville, MD
| | - Riley J Steiner
- Zewditu Demissie, Catherine N. Rasberry, Riley J. Steiner, Nancy Brener, and Tim McManus are with the Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Zewditu Demissie is also with the US Public Health Service Commissioned Corps, Rockville, MD
| | - Nancy Brener
- Zewditu Demissie, Catherine N. Rasberry, Riley J. Steiner, Nancy Brener, and Tim McManus are with the Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Zewditu Demissie is also with the US Public Health Service Commissioned Corps, Rockville, MD
| | - Tim McManus
- Zewditu Demissie, Catherine N. Rasberry, Riley J. Steiner, Nancy Brener, and Tim McManus are with the Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Zewditu Demissie is also with the US Public Health Service Commissioned Corps, Rockville, MD
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Valdiserri RO, Holtgrave DR, Poteat TC, Beyrer C. Unraveling Health Disparities Among Sexual and Gender Minorities: A Commentary on the Persistent Impact of Stigma. JOURNAL OF HOMOSEXUALITY 2018; 66:571-589. [PMID: 29297774 DOI: 10.1080/00918369.2017.1422944] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
LGBT (lesbian, gay, bisexual, and transgender) populations experience disparities in health outcomes, both physical and mental, compared to their heterosexual and cisgender peers. This commentary confronts the view held by some researchers that the disparate rates of mental health problems reported among LGBT populations are the consequences of pursuing a particular life trajectory, rather than resulting from the corrosive and persistent impact of stigma. Suggesting that mental health disparities among LGBT populations arise internally, de novo, when individuals express non-heterosexual and non-conforming gender identities ignores the vast body of evidence documenting the destructive impact of socially mediated stigma and systemic discrimination on health outcomes for a number of minorities, including sexual and gender minorities. Furthermore, such thinking is antithetical to widely accepted standards of health and wellbeing because it implies that LGBT persons should adopt and live out identities that contradict or deny their innermost feelings of self.
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Affiliation(s)
- Ronald O Valdiserri
- a Department of Health, Behavior, and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - David R Holtgrave
- a Department of Health, Behavior, and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Tonia C Poteat
- b Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Chris Beyrer
- b Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
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