A Web 2.0 and Epidemiology Mash-Up: Using Respondent-Driven Sampling in Combination with Social Network Site Recruitment to Reach Young Transwomen

The rising tide of HIV among young men who have sex with men in Brazil: insights from the Conectad@s study

Background

Young gay, bisexual, and other men who have sex with men (YMSM) in Latin America experience disproportionately high rates of HIV. While new case numbers have stabilised in other demographics, the incidence of HIV in this particular group continues to rise. We estimated the prevalence of HIV and sexually transmitted infections (STI) and identified correlates of new HIV diagnoses among YMSM in Brazil.

Methods

Conectad@s was a respondent-driven sampling-based study to recruit and engage YMSM in HIV prevention and treatment services in Rio de Janeiro, Brazil (November 2021-October 2022). Eligibility criteria were age 18-24 years and self-identification as MSM (cis/trans) or non-binary person who have sex with men. Participants underwent HIV/STI testing and completed a socio-behavioural questionnaire. We described baseline characteristics by HIV status and used logistic regression models to identify correlates of new HIV diagnoses. Trial ID: DERR1-10.2196/34885.

Findings

Among 409 participants, 370 (90.5%) self-identified as cisgender men, nine (2.2%) transgender men, and 30 (7.3%) non-binary. Median age was 21 years (IQR: 20-23), with 80 (19.6%) aged 18-19 years. Most self-identified as Black or Pardo (70.6%); 109 (26.7%) never tested for HIV. HIV prevalence was 9.8%; 50% (n = 20/40) were newly diagnosed with HIV. Only nine participants ever used PrEP and three were currently using it. Overall, 133 (32.5%) reported sexual violence in their lifetime and 102 (24.9%) reported a suicide attempt. Prevalence of active syphilis, chlamydia, and gonorrhoea were 14.4%, 15.9%, and 14.7%, respectively. New HIV diagnoses were positively associated with engaging in high-risk behaviour (aOR 4.88 [95% CI: 1.88-13.40]) and anxiety (aOR 2.67 [95% CI: 1.01-7.70]), and negatively associated with ever disclosing sexual orientation (aOR 0.19 [95% CI: 0.04-0.92]) and HIV knowledge (aOR 0.77 [95% CI: 0.59-1.01]).

Interpretation

High prevalence of HIV coupled with a high proportion of new HIV diagnoses underscore a potentially growing HIV epidemic among YMSM in Brazil.

Funding

National Institutes of Health (NIH), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Ministry of Health of Brazil.

The Usefulness of Web-Based Communication Data for Social Network Health Interventions: Agent-Based Modeling Study

BACKGROUND

Social network interventions are an effective approach to promote physical activity. These interventions are traditionally designed using self-reported peer nomination network data to represent social connections. However, there is unexplored potential in communication data exchanged through web-based messaging apps or social platforms, given the availability of these data, the developments in artificial intelligence to analyze these data, and the shift of personal communication to the web sphere. The implications of using web-based versus offline social networks on the effectiveness of social network interventions remain largely unexplored.

OBJECTIVE

This study aims to investigate the differences in the impact of social network interventions on physical activity levels (PALs) between networks derived from web-based communication and peer nomination data.

METHODS

We used the data on sociometric questionnaires, messages from a web-based communication app, and PAL (number of steps per day) of 408 participants in 21 school classes. We applied social network analysis to identify influential peers and agent-based modeling to simulate the diffusion of PAL and explore the impact of social network interventions on PAL among adolescents in school classes. Influential peers (n=63) were selected based on centrality measures (ie, in-degree, closeness, and betweenness) to spread the intervention. They received health education, which increased their PAL by 17%. In sensitivity analyses, we tested the impact of a 5%, 10%, and 20% increase in PAL among influential peers.

RESULTS

There was a 24%-27% overlap in selected influential peers between the 2 network representations. In general, the simulations showed that interventions could increase PAL by 5.0%-5.8% within 2 months. However, the predicted median impact on PAL was slightly higher in networks based on web-based communication data than peer nomination data for in-degree (5.7%, IQR 5.5%-6.1% vs 5.5%, IQR 5.2%-5.8%; P=.002), betweenness (5.6%, IQR 5.4%-5.9% vs 5.0%, IQR 4.7%-5.3%; P<.001), and closeness centrality (5.8%, IQR 5.6%-6.1% vs 5.3%, IQR 5.0%-5.6%; P<.001). A large variation in impact was observed between school classes (range 1.5%-17.5%). Lowering the effectiveness of health education from 17% to 5% would reduce the overall impact of the social network intervention by 3-fold in both networks.

CONCLUSIONS

Our findings showed that network interventions based on web-based communication data could increase PAL. Web-based communication data may therefore be a valuable addition to peer nomination data for future social network intervention design. Artificial intelligence methods, including agent-based modeling, can help to design these network interventions and provide insights into the role of network characteristics in their effectiveness.

The association between religiosity and resilience among young trans women

INTRODUCTION

Young transgender women (trans women) experience poor health in part due to discrimination. Factors that promote resilience may help young trans women positively adapt to discrimination, resulting in attenuation of poor health outcomes. While religion is sometimes a source of stigma and transphobia, qualitative studies have identified religiosity as an important resilience resource for young trans women. The goals of this study were to quantitatively measure religiosity and resilience among young trans women and to assess whether they are associated.

METHODS

From 2012-2013, 300 young trans women between the ages of 16-24 years were enrolled in a longitudinal study; we examined the cross-sectional baseline data on demographics, religiosity, and resilience. Bivariate and multivariable logistic regression analysis examined the correlation between demographics (age, gender, race/ethnicity, education, income) and religiosity among young trans women. Additionally, bivariate and multivariable logistic regression analysis examined the association between religiosity and resilience among young trans women, controlling for age, gender, race/ethnicity, education, and income.

RESULTS

Participants who reported high religiosity had significantly greater odds (aOR 1.78, 95% CI 1.05-3.01, p = .03) of reporting high resilience compared to those reporting low religiosity. Black/African American participants had significantly higher odds (aOR 6.16, 95% CI 2.34-16.20, p = < .001) of reporting high religiosity compared to those who identified as White.

CONCLUSION

Religiosity may be an important resilience resource for young trans women. Gender affirming religious and spiritual interventions may promote resilience among some young trans women.

Through a Different Lens: Occupational Health of Sex-Working Young Trans Women

Purpose

Sex work is a common form of work among young trans women (YTW).

Methods

Using an occupational health frame, we measured associations between demographics, sex work, and vocational outcomes in 18-month visit data from the SHINE study (n=263, San Francisco).

Results

Overall, 41.8% reported lifetime sex work, primarily escorting/paid sex. Motivations included "better pay" and "can't get a job due to gender discrimination." Occupational injuries included anxiety (53.6%) and depression (50%), with significantly higher relative risk for YTW doing multiple types of sex work. Criminalization experiences (i.e., incarceration, arrests, and police interaction) were common.

Conclusion

Results echo calls for sex worker-affirming mental health care for YTW.

Addressing Health Inequities in Digital Clinical Trials: A Review of Challenges and Solutions From the Field of HIV Research

Clinical trials are considered the gold standard for establishing efficacy of health interventions, thus determining which interventions are brought to scale in health care and public health programs. Digital clinical trials, broadly defined as trials that have partial to full integration of technology across implementation, interventions, and/or data collection, are valued for increased efficiencies as well as testing of digitally delivered interventions. Although recent reviews have described the advantages and disadvantages of and provided recommendations for improving scientific rigor in the conduct of digital clinical trials, few to none have investigated how digital clinical trials address the digital divide, whether they are equitably accessible, and if trial outcomes are potentially beneficial only to those with optimal and consistent access to technology. Human immunodeficiency virus (HIV), among other health conditions, disproportionately affects socially and economically marginalized populations, raising questions of whether interventions found to be efficacious in digital clinical trials and subsequently brought to scale will sufficiently and consistently reach and provide benefit to these populations. We reviewed examples from HIV research from across geographic settings to describe how digital clinical trials can either reproduce or mitigate health inequities via the design and implementation of the digital clinical trials and, ultimately, the programs that result. We discuss how digital clinical trials can be intentionally designed to prevent inequities, monitor ongoing access and utilization, and assess for differential impacts among subgroups with diverse technology access and use. These findings can be generalized to many other health fields and are practical considerations for donors, investigators, reviewers, and ethics committees engaged in digital clinical trials.

Synthesizing Adaptive Digital Bioethics to Guide the Use of Interactive Communication Technologies in Adolescent Behavioral Medicine: A Systematic Configurative Review

Despite the continuing integration of digital outreach tools into adolescent preventive services, adaptive guidance for their ethical use remains limited. In this configurative review, we synthesize the ad hoc, applied digital bioethics developed in adolescent human immunodeficiency virus prevention science. By focusing on generalizable technological affordances, while balancing privacy and autonomy, we offer strategies for identifying potential technologically mediated harms that can transcend specific platforms, tools, or the knowledge levels of individual clinicians. Clinical vignettes illustrate the application of these strategies.

A Technology-Based Intervention Among Young Men Who Have Sex With Men and Nonbinary People (The Conectad@s Project): Protocol for A Vanguard Mixed Methods Study

BACKGROUND

In many parts of the world, including Brazil, uptake for biomedical interventions has been insufficient to reverse the HIV epidemic among key populations at high risk for HIV, including men who have sex with men. Young MSM (YMSM), particularly Black YMSM, have high HIV incidence, low viral suppression, and low preexposure prophylaxis (PrEP) uptake and adherence. Therefore, novel approaches to increase the HIV biomedical interventions uptake by YMSM are urgently needed.

OBJECTIVE

We describe the Conectad@s Project, which aims to: (1) estimate the prevalence and incidence of HIV and other sexually transmitted infections, the onset of sexual risk behavior, and barriers to biomedical interventions among YMSM aged 18 to 24 years in Rio de Janeiro, Brazil; and (2) conduct a technology-based adherence intervention study to promote a rapid linkage of YMSM to HIV care or prevention, and support and sustain adherence.

METHODS

A cross-sectional survey will be conducted with 400 YMSM recruited using respondent-driven sampling (RDS) adapted for social media-based sampling, preceded by a formative phase. HIV and sexually transmitted infections testing will be conducted, including early HIV infection biomarker detection. Behavioral, partnership, network, and structural measures will be collected through structured questionnaires. All individuals recruited for the survey will have access to HIV risk assessment, antiretroviral therapy (ART), PrEP, prevention counseling, and a technology-based adherence intervention. Those who accept the adherence intervention will receive weekly text messages via a social networking app (WhatsApp) for 24 weeks, with follow-up data collected over 48 weeks.

RESULTS

The Conectad@s project has been approved by our local institutional review board (#CAAE 26086719.0.0000.4262) in accordance with all applicable regulations. Questionnaires for the RDS survey and intervention were developed and tested in 2020, formative interviews were conducted in January and February 2021 to guide the development of the RDS, and enrollment is planned to begin in early 2022.

CONCLUSIONS

The Conectad@s Project is a vanguard study that, for the first time, will apply digital RDS to sample and recruit YMSM in Brazil and rapidly connect them to ART, PrEP, or prevention counseling through a technology-based adherence intervention. RDS will allow us to estimate HIV prevalence among YMSM and measure HIV infection biomarkers in the context of the onset of risky behavior. The data will lay the groundwork to adapt and implement HIV prevention strategies, identify barriers to the earliest HIV infection diagnosis, immediate ART or PrEP initiation, and detect new clusters of HIV transmission.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/34885.

Recruiting young women of color into a pilot RCT targeting sexual health: Lessons learned and implications for applied health technology research

Objective To evaluate different recruitment methods to enroll participants into a mHealth pilot RCT: banner ads on Facebook and OkCupid, and targeted electronic outreach (e.g., emails to community-based organizations and to professors at local colleges). Participants: Between October 2015 and May 2016, 114 college-aged Black and Latina women 18 to 24 participated in the study. Methods: Recruitment methods compared online banner ads on social media to targeted electronic outreach. Individual banner ad images were compared by impressions, clicks, and cost by enrolled participants. Results: More targeted electronic recruited participants enrolled than via banner advertisements. Banner ads with images of women yielded a higher click-through-rate and was more cost effective versus the logo alone. Conclusions: Recruiting young women of color may be facilitated through known and trusted adults, such as college professors, rather than through anonymous banner advertisements on social media.

An evaluation of assumptions underlying respondent-driven sampling and the social contexts of sexual and gender minority youth participating in HIV clinical trials in the United States

INTRODUCTION

Respondent-driven sampling (RDS) has been an effective sampling strategy for HIV research in many settings, but has had limited success among some youth in the United States. We evaluated a modified RDS approach for sampling Black and Latinx sexual and gender minority youth (BLSGMY) and explored how lived experiences and social contexts of BLSGMY youth may impact traditional RDS assumptions.

METHODS

RDS was implemented in three US cities, Baltimore, Philadelphia and Washington DC, to engage BLSGMY aged 15 to 24 years in HIV prevention or care intervention trials. RDS was modified to include targeted seed recruitment from venues, Internet and health clinics, and provided options for electronic or paper coupons. Qualitative interviews were conducted among a sub-sample of RDS participants to explore their experiences with RDS. Interviews were coded using RDS assumptions as an analytic framework.

RESULTS

Between August 2017 and October 2019, 405 participants were enrolled, 1670 coupons were distributed, with 133 returned, yielding a 0.079 return rate. The maximum recruitment depth was four waves among seeds that propagated. Self-reported median network size was 5 (IQR 2 to 10) and reduced to 3 (IQR 1 to 5) when asked how many peers were seen in the past 30 days. Qualitative interviews (n = 27) revealed that small social networks, peer trust and targeted referral of peers with certain characteristics challenged network, random recruitment, and reciprocity assumptions of RDS. HIV stigma and research hesitancy were barriers to participation and peer referral. Other situational factors, such as phone ownership and access to reliable transportation, reportedly created challenges for referred peers to participate in research.

CONCLUSIONS

Small social networks and varying relationships with peers among BLSGMY challenge assumptions that underlie traditional RDS. Modified RDS approaches, including those that incorporate social media, may support recruitment for community-based research but may challenge assumptions of reciprocal relationships. Research hesitancy and situational barriers are relevant and must be addressed across any sampling method and study design that includes BLSGMY in the United States.

An evaluation of assumptions underlying respondent-driven sampling and the social contexts of sexual and gender minority youth participating in HIV clinical trials in the United States

Introduction:

Respondent-driven sampling has been an effective sampling strategy for HIV research in many settings, but has had limited success among some youth in the United States. We evaluated a modified RDS approach for sampling Black and Latinx sexual and gender minority youth (BLSGMY) and evaluates how lived experiences and social contexts of BLSGMY youth may impact traditional RDS assumptions.

Methods:

RDS was implemented in three cities to engage BLSGMY in HIV prevention or care intervention trials. RDS was modified to include targeted seed recruitment from venues, internet, and health clinics, and provided options for electronic or paper coupons. Qualitative interviews were conducted among a sub-sample of RDS participants to explore their experiences with RDS. Interviews were coded using RDS assumptions as an analytic framework.

Results:

Between August 2017 and October 2019, 405 participants were enrolled, 1,670 coupons were distributed, with 133 returned, yielding a 0.079 return rate. The maximum recruitment depth was 4 waves among seeds that propagated. Self-reported median network size was 5 (IQR 2–10) and reduced to 3 (IQR 1–5) when asked how many peers were seen in the past 30 days. Qualitative interviews (n=27) revealed that small social networks, peer trust, and targeted referral of peers with certain characteristics challenged network, random recruitment, and reciprocity assumptions of RDS. HIV stigma and research hesitancy were barriers to participation and peer referral.

Conclusions:

Small social networks and varying relationships with peers among BLSGMY challenge assumptions that underlie traditional RDS. Modified RDS approaches, including those that incorporate social media, may support recruitment for community-based research but may challenge assumptions of reciprocal relationships. Research hesitancy and situational barriers must be addressed in recruitment and study designs.

Social media recruitment for mental health research: A systematic review

BACKGROUND

Social media holds exciting promise for advancing mental health research recruitment, however, the extent and efficacy to which these platforms are currently in use are underexplored.

OBJECTIVE

A systematic review was conducted to characterize the current use and efficacy of social media in recruiting participants for mental health research.

METHOD

A literature review was performed using MEDLINE, EMBASE, and PsychINFO. Only non-duplicative manuscripts written in the English language and published between 1/1/2004-3/31/2019 were selected for further screening. Data extracted included study type and design, participant inclusion criteria, social media platform, advertising strategy, final recruited sample size, recruitment location, year, monetary incentives, comparison to other recruitment methods if performed, and final cost per participant.

RESULTS

A total of 176 unique studies that used social media for mental health research recruitment were reviewed. The majority of studies were cross-sectional (62.5%) in design and recruited adults. Facebook was overwhelmingly the recruitment platform of choice (92.6%), with the use of paid advertisements being the predominant strategy (60.8%). Of the reviewed studies, substance abuse (43.8%) and mood disorders (15.3%) were the primary subjects of investigation. In 68.3% of studies, social media recruitment performed as well as or better than traditional recruitment methods in the number and cost of final enrolled participants. The majority of studies used Facebook for recruitment at a median cost per final recruited study participant of $19.47. In 55.6% of the studies, social media recruitment was the more cost-effective recruitment method when compared to traditional methods (e.g., referrals, mailing).

CONCLUSION

Social media appears to be an effective and economical recruitment tool for mental health research. The platform raises methodological and privacy concerns not covered in current research regulations that warrant additional consideration.

The CAN-DO-IT Model: a Process for Developing and Refining Online Recruitment in HIV/AIDS and Sexual Health Research

PURPOSE OF REVIEW

HIV/AIDS and sexual health research has increasingly relied on online recruitment in recent years. However, as potential online recruitment avenues (e.g., dating and sexual networking applications, websites, social media) have proliferated, navigating this process has become increasingly complex. This paper presents a practical model to guide researchers through online recruitment irrespective of platform.

RECENT FINDINGS

The CAN-DO-IT model reflects 7 iterative steps based on work by the authors and other investigators: conceptualize scope of recruitment campaign, acquire necessary expertise, navigate online platforms, develop advertisements, optimize recruitment-to-enrollment workflow, implement advertising campaign, and track performance of campaigns and respond accordingly. Online recruitment can accelerate HIV/AIDS research, yet relatively limited guidance exists to facilitate this process across platforms. The CAN-DO-IT model presents one approach to demystify online recruitment and reduce enrollment barriers.

Parent/Caregiver Responses to Gender Identity Associated With HIV-Related Sexual Risk Behavior Among Young Trans Women in San Francisco

PURPOSE

Young trans women (YTW) carry a disproportionate burden of HIV. The developmental context of HIV risk for YTW is underexamined. The aim of this analysis was to examine whether parent/caregiver responses to gender identity were associated with engagement in HIV-related sexual risk behavior for YTW and whether these associations varied by racial/ethnic identity or age.

METHODS

Baseline data from the SHINE study (n = 300) at San Francisco Department of Public Health (2012-2014) were analyzed. Multivariable Poisson binomial regression models characterized relationships between parent/caregiver responses to gender identity and HIV-related sexual risk behaviors, adjusting for select participant demographics. Statistically significant interactions (by race/ethnicity or age) were plotted using marginal predicted probabilities of sexual risk behaviors.

RESULTS

Thirty-seven percent of YTW engaged in any condomless anal intercourse; 12% reported income from sex work in the last month. Ever moving away from family and friends because of gender identity was associated with condomless anal intercourse (adjusted prevalence ratio [PR] = 1.44, 95% confidence interval [CI] = 1.08-1.92, p = .01) and sex work (PR = 2.07, 95% CI = 1.14-3.75, p=.02). Ever receiving poor treatment from parents/caregivers because of gender identity was associated with sex work (PR = 3.47, 95% CI = 1.52-7.95, p < .01). Greater parent/caregiver acceptance of gender identity was associated with lower adjusted prevalence of condomless anal intercourse for Hispanic/Latinx YTW.

CONCLUSIONS

Negative parent/caregiver exposures related to YTW's gender identities were associated with increased HIV-related sexual risk behaviors, whereas parent/caregiver acceptance of gender identity was protective against condomless anal intercourse for Hispanic/Latinx YTW. There is a need for additional studies that inform interventions for YTW focusing on parent/caregiver relationships to prevent HIV-related risk behavior.

Effects of mobile health on HIV risk reduction for men who have sex with men

Mobile health (M-Health) has become a novel method for HIV prevention and the effects need to be promoted. The study purpose was to exam how a smartphone application (app) reduces HIV risky behaviour in men who have sex with men (MSM). The Safe Behaviour and Screening (SBS) app was developed, and included five features: record, output, and resources connection; information provision; testing services; interaction; and online statistics. A random assignment was used. The experimental group used the SBS app for six months. The control group did not use any intervention. There were 130 participants in the experimental group, and 135 in the control group. The average age of all subjects was 27.38 (SD = 5.56). Compared to the control group, the experimental group had significantly higher mean score of safe behaviour knowledge, motivation, and skills; percentage of condom use during anal intercourse; frequency of searching for testing resources and getting HIV and syphilis tests. The frequency of anal intercourse and recreational drug usage were significantly lower in the experimental group. The SBS app could decrease the HIV risky behaviour among MSM and be applied to HIV prevention and nursing intervention.

Assessing mental health signals among sexual and gender minorities using Twitter data

Sexual and gender minorities face extreme challenges that breed stigma with alarming consequences damaging their mental health. Nevertheless, sexual and gender minority people and their mental health needs remain little understood. Because of stigma, sexual and gender minorities are often unwilling to self-identify themselves as sexual and gender minorities when asked. However, social media have become popular platforms for health-related researches. We first explored methods to find sexual and gender minorities through their self-identifying tweets, and further classified them into 11 sexual and gender minority subgroups. We then analyzed mental health signals extracted from these sexual and gender minorities' Twitter timelines using a lexicon-based analysis method. We found that (1) sexual and gender minorities expressed more negative feelings, (2) the difference between sexual and gender minority and non-sexual and gender minority people is shrinking after 2015, (3) there are differences among sexual and gender minorities lived in different geographic regions, (4) sexual and gender minorities lived in states with sexual and gender minority-related protection laws and policies expressed more positive emotions, and (5) sexual and gender minorities expressed different levels of mental health signals across different sexual and gender minority subgroups.

Recruiting Hard-to-Reach Populations for Survey Research: Using Facebook and Instagram Advertisements and In-Person Intercept in LGBT Bars and Nightclubs to Recruit LGBT Young Adults

Background

Tobacco public education campaigns focus increasingly on hard-to-reach populations at higher risk for smoking, prompting campaign creators and evaluators to develop strategies to reach hard-to-reach populations in virtual and physical spaces where they spend time.

Objective

The aim of this study was to describe two novel recruitment strategies (in-person intercept interviews in lesbian, gay, bisexual, and transgender [LGBT] social venues and targeted social media ads) and compares characteristics of participants recruited via these strategies for the US Food and Drug Administration’s This Free Life campaign evaluation targeting LGBT young adults who smoke cigarettes occasionally.

Methods

We recruited LGBT adults aged 18-24 years in the United States via Facebook and Instagram ads (N=1709, mean age 20.94, SD 1.94) or intercept in LGBT social venues (N=2348, mean age 21.98, SD 1.69) for the baseline evaluation survey. Covariates related to recruitment strategy were age; race or ethnicity; LGBT identity; education; pride event attendance; and alcohol, cigarette, and social media use.

Results

Lesbian or gay women (adjusted odds ratio, AOR 1.88, 95% CI 1.54-2.29, P<.001), bisexual men and women (AOR 1.46, 95% CI 1.17-1.82, P=.001), gender minorities (AOR 1.68, 95% CI 1.26-2.25, P<.001), and other sexual minorities (AOR 2.48, 95% CI 1.62-3.80, P<.001) were more likely than gay men to be recruited via social media (than intercept). Hispanic (AOR 0.73, 95% CI 0.61-0.89, P=.001) and other or multiracial, non-Hispanic participants (AOR 0.70, 95% CI 0.54-0.90, P=.006) were less likely than white, non-Hispanic participants to be recruited via social media. As age increased, odds of recruitment via social media decreased (AOR 0.76, 95% CI 0.72-0.80, P<.001). Participants with some college education (AOR 1.27, 95% CI 1.03-1.56, P=.03) were more likely than those with a college degree to be recruited via social media. Participants reporting past 30-day alcohol use were less likely to be recruited via social media (AOR 0.33, 95% CI 0.24-0.44, P<.001). Participants who reported past-year pride event attendance were more likely to be recruited via social media (AOR 1.31, 95% CI 1.06-1.64, P=.02), as well as those who used Facebook at least once daily (AOR 1.43, 95% CI 1.14-1.80, P=.002). Participants who reported using Instagram at least once daily were less likely to be recruited via social media (AOR 0.73, 95% CI 0.62-0.86, P<.001). Social media recruitment was faster (incidence rate ratio, IRR=3.31, 95% CI 3.11-3.52, P<.001) and less expensive (2.2% of combined social media and intercept recruitment cost) but had greater data quality issues—a larger percentage of social media respondents were lost because of duplicate and low-quality responses (374/4446, 8.41%) compared with intercept respondents lost to interviewer misrepresentation (15/4446, 0.34%; P<.001).

Conclusions

Social media combined with intercept provided access to important LGBT subpopulations (eg, gender and other sexual minorities) and a more diverse sample. Social media methods have more data quality issues but are faster and less expensive than intercept. Recruiting hard-to-reach populations via audience-tailored strategies enabled recruitment of one of the largest LGBT young adult samples, suggesting these methods’ promise for accessing hard-to-reach populations.

LGBTQ Youth and Young Adult Perspectives on a Culturally Tailored Group Smoking Cessation Program

Introduction

The prevalence of smoking among LGBTQ youth and young adults (YYAs) is much higher than that of non-LGBTQ young people. The current study explored LGBTQ YYA perceptions of a culturally tailored group smoking cessation counselling program, along with how the intervention could be improved.

Methods

We conducted focus groups (n = 24) with 204 LGBTQ YYAs in Toronto and Ottawa, Canada. Open-ended questions focused on their feelings, likes and dislikes, concerns and additional ideas for a culturally tailored group cessation counselling intervention. Focus group transcripts were coded thematically and analyzed.

Results

Overall, YYAs were ambivalent towards the concept of a culturally tailored, group cessation counselling program. Although several participants were attracted to the LGBTQ friendly and social benefits of such a program (eg, good support system), many also had concerns. Particularly, the possibility that other group members might trigger them to smoke was a frequently stated issue. Focus group members also noted lack of motivation to attend the group, and that the group program may be inaccessible depending on where and when the program was offered. Several suggestions were made as to how to ameliorate the expressed issues related to inaccessibility or lack of attractiveness.

Conclusions

This study is among the first to gain the perspectives of LGBTQ YYAs on culturally tailored group cessation strategies in Canada. We identified components of group cessation programs that are both favored and not favored among LGBTQ YYAs, as well as suggestions as to how to make group cessation programs more appealing.

Implications

This study is particularly relevant as smoking cessation programs are one of the most commonly offered and published cessation interventions for the LGBTQ community, yet little is understood in terms of preferences of LGBTQ YYA smokers. Given the disparity in the prevalence of smoking among LGBTQ young people compared to their non-LGBTQ peers, research on effective intervention strategies for this population is needed. Findings from this study can assist practitioners and researchers in designing interventions.

Mixed-Method Evaluation of Social Media-Based Tools and Traditional Strategies to Recruit High-Risk and Hard-to-Reach Populations into an HIV Prevention Intervention Study

Men who have sex with men and transgender women are hard-to-reach populations for research. Social media-based tools may overcome certain barriers in accessing these groups and are being tested in an ongoing study exploring HIV home-test kit use to reduce risk behavior. We analyzed pre-screening responses about how volunteers learned about the study (n = 896) and demographic data from eligible participants who came for an initial study visit (n = 216) to determine the strengths and weaknesses of recruitment strategies. Social media-based strategies resulted in the highest number of individuals screened (n = 444, 26% eligible). Dating sites/apps reached large numbers of eligible participants. White-Hispanics and African-Americans were more likely to be recruited through personal contacts; community events successfully reached Hispanic volunteers. Incorporating recruitment queries into pre-screening forms can help modify recruitment strategies for greater efficacy and efficiency. Findings suggest that recruitment strategies need to be tailored to reach specific target populations.

Unevenness in Health at the Intersection of Gender and Sexuality: Sexual Minority Disparities in Alcohol and Drug Use Among Transwomen in the San Francisco Bay Area

Research on the health of transwomen is largely focused on heterosexual HIV risk. Little is known about the health of sexual minority transwomen. We conducted a secondary cross-sectional analysis of data from a HIV risk and resilience study of transwomen aged 16 to 24 years in the San Francisco Bay Area (N = 259). Prevalence and demographic characteristics of sexual minority transwomen was assessed and logistic regression models were used to examine the relationship between sexual minority status and alcohol and drug use. In logistic regression models, sexual minority transwomen had greater fold odds of heavy episodic drinking and illicit prescription drug use compared to their heterosexual counterparts, controlling for race/ethnicity, age, income, nativity, hormone status, and history of feminization procedures. These results suggest that sexual minority status may be an important social determinant of health among gender minorities. Populations of transwomen are heterogeneous; effective interventions must consider sexual minority status.

Sociodemographic Factors Associated With Trans*female Youth's Access to Health Care in the San Francisco Bay Area

PURPOSE

Trans*female youth (TFY) are an underserved population at risk for a variety of poor health outcomes, in part related to barriers to accessing health and mental health care.

METHODS

We conducted a secondary analysis of data collected with 250 TFY aged 16-24 years in the San Francisco Bay Area from 2012 to 2014. Logistic regression was used to test associations between sociodemographic variables and barriers to gender identity-based medical and mental health care.

RESULTS

Having a history of unstable housing was associated with significantly higher odds of problems accessing both medical care (odds ratio: 2.16, 95% confidence interval: 1.12-4.13) and mental health care due to gender identity (odds ratio 2.65, 95% confidence interval: 1.08-6.45). Conversely, identifying as genderqueer/genderfluid, Latina, or living in dependent housing was associated with access to either medical or mental health care.

CONCLUSIONS

Interventions are needed to address housing and discrimination barring access to health care among TFY.

Brief Report: Psychosocial Predictors of Engagement in Sexual Risk Behavior Among Trans*female Youth Aged 16-24 Years in San Francisco

BACKGROUND

Trans*female youth (TFY) carry a disproportionate burden of HIV. Few longitudinal studies have analyzed both proximal and upstream predictors of changes in HIV-related risk behaviors for TFY. The aim of the present analysis was to identify psychosocial predictors of changes in sexual risk behavior over time for TFY in the San Francisco Bay Area.

METHODS

Data come from the SHINE cohort study conducted at the San Francisco Department of Public Health from 2012 to 2014 (n = 263). The relationship between hypothesized psychosocial factors and changes in engagement in condomless receptive anal intercourse over 12-month follow-up was modeled using generalized estimating equations, after adjusting for participant age, race/ethnicity, and education level.

RESULTS

TFY who were ever in a serious relationship since identifying as trans* [adjusted odds ratio (aOR) = 1.89, 95% confidence interval (CI): 1.16 to 3.08], those who reported recent crack/cocaine use (aOR = 2.01, 95% CI: 1.05 to 3.85), and those with a monthly income of more than $500 (aOR = 0.55, 95% CI: 0.35 to 0.85) had significantly higher odds of condomless receptive anal intercourse over the 12-month study period compared to TFY without these exposures. Those who reported high exposure to gender-based discrimination had increased adjusted odds of engagement in condomless receptive anal intercourse compared to those who had low exposure over the study period (aOR = 1.70, 95% CI: 1.10 to 2.63).

CONCLUSIONS

Both proximal and structural factors predicted increased engagement in sexual risk behavior among TFY. Results demonstrate the need for a multilevel approach to HIV prevention strategies for this population.

The Impact of Discrimination on the Mental Health of Trans*Female Youth and the Protective Effect of Parental Support

Significant health disparities exist for transgender female (trans*female) youth. We assessed differences in mental health outcomes based on exposure to discrimination among transgender female youth in the San Francisco Bay Area aged 16-24 years. Youth were recruited using a combination of respondent driven sampling with online and social media methods. Logistic regression models were used to estimate odds ratios for the mental health outcomes, comparing levels of discrimination and levels of resiliency promoting protective factors among sexually active youth in the sample (N = 216). High transgender-based discrimination was significantly associated with greater odds of PTSD (AOR, 2.6; 95 % CI 1.4-5.0), depression (AOR, 2.6; 95 % CI 1.2-5.9), and stress related to suicidal thoughts (AOR 7.7, 95 % CI 2.3-35.2). High racial discrimination was significantly associated with greater odds of psychological stress (AOR 3.6; 95 % CI 1.2-10.8), PTSD (AOR 2.1; 95 % CI 1.1-4.2) and stress related to suicidal thoughts (AOR 4.3, 95 % CI 1.5-13.3). Parental closeness was related to significantly lower odds of all four mental health outcomes measured, and intrinsic resiliency positively reduced risk for psychological stress, PTSD, and stress related to suicidal thoughts. Transgender and racial discrimination may have deleterious effects on the mental health of trans*female youth. Interventions that address individual and intersectional discrimination and build resources for resiliency and parental closeness may have success in preventing mental health disorders in this underserved population.

Types of social support and parental acceptance among transfemale youth and their impact on mental health, sexual debut, history of sex work and condomless anal intercourse

INTRODUCTION

Transfemale youth (TFY) are an underserved and understudied population at risk for numerous poor physical and mental health outcomes, most notably HIV. Research suggests that parental acceptance and social support may serve as protective factors against HIV and other risks for TFY; however, it is unclear whether TFY receive primary social support from parents with or without parental acceptance of their gender identity. This study examines differences in parental acceptance, mental health and the HIV risk factors of history of sex work, age at sexual debut and engagement in condomless anal intercourse between TFY with two types of primary social support - non-parental primary social support (NPPSS) and parental primary social support (PPSS).

METHODS

Cross-sectional data collected from 301 TFY from 2012 to 2014 in the San Francisco Bay Area were analyzed to determine differences in parental acceptance, mental health and HIV risk factors between youth with and without PPSS. Univariate statistics and chi-squared tests were conducted to determine if parental acceptance and health outcomes were correlated with type of social support.

RESULTS

Two-hundred fifty-one participants (83.7%) reported having NPPSS, and 49 (16.3%) reported PPSS. Significantly more youth with PPSS reported affirmative responses on parental acceptance items than their NPPSS counterparts. For example, 87.8% of youth with PPSS reported that their parents believed they could have a happy future as a trans adult, compared with 51.6% of youth with NPPSS (p<0.001). Fewer participants with PPSS reported symptoms of psychological distress (2.0% vs. 12.5%, p=0.057), though this finding was not statistically significant; no significant associations were found between primary social support type and HIV risk factors.

CONCLUSIONS

These results suggest that TFY with parental acceptance of their gender identity may be more likely to reach out to their parents as their primary source of social support. Interventions focused on parental acceptance of their child's gender identity may have the most promise for creating parental social support systems in the lives of TFY.

Types of social support and parental acceptance among transfemale youth and their impact on mental health, sexual debut, history of sex work and condomless anal intercourse

INTRODUCTION

Transfemale youth (TFY) are an underserved and understudied population at risk for numerous poor physical and mental health outcomes, most notably HIV. Research suggests that parental acceptance and social support may serve as protective factors against HIV and other risks for TFY; however, it is unclear whether TFY receive primary social support from parents with or without parental acceptance of their gender identity. This study examines differences in parental acceptance, mental health and the HIV risk factors of history of sex work, age at sexual debut and engagement in condomless anal intercourse between TFY with two types of primary social support - non-parental primary social support (NPPSS) and parental primary social support (PPSS).

METHODS

Cross-sectional data collected from 301 TFY from 2012 to 2014 in the San Francisco Bay Area were analyzed to determine differences in parental acceptance, mental health and HIV risk factors between youth with and without PPSS. Univariate statistics and chi-squared tests were conducted to determine if parental acceptance and health outcomes were correlated with type of social support.

RESULTS

Two-hundred fifty-one participants (83.7%) reported having NPPSS, and 49 (16.3%) reported PPSS. Significantly more youth with PPSS reported affirmative responses on parental acceptance items than their NPPSS counterparts. For example, 87.8% of youth with PPSS reported that their parents believed they could have a happy future as a trans adult, compared with 51.6% of youth with NPPSS (p<0.001). Fewer participants with PPSS reported symptoms of psychological distress (2.0% vs. 12.5%, p=0.057), though this finding was not statistically significant; no significant associations were found between primary social support type and HIV risk factors.

CONCLUSIONS

These results suggest that TFY with parental acceptance of their gender identity may be more likely to reach out to their parents as their primary source of social support. Interventions focused on parental acceptance of their child's gender identity may have the most promise for creating parental social support systems in the lives of TFY.