Homelessness among lesbian, gay, and bisexual youth: implications for subsequent internalizing and externalizing symptoms

Prevalence, severity and risk factors for mental disorders among sexual and gender minority young people: a systematic review of systematic reviews and meta-analyses

Evidence suggests heightened prevalence and severity of mental disorders among sexual minority (SM) and gender minority (GM) young people. Several risk factors have been associated with these disparities. A systematic review of systematic reviews and meta-analysis was conducted to provide a comprehensive overview of the literature and to determine the field's current position. MEDLINE, PsycInfo, Scopus and Web of Science were searched in March 2022 and updated January 2024. Eligibility criteria were systematic reviews or meta-analyses assessing contemporaneous prevalence, severity and/or risk factors of mental disorders among SM or GM young people aged 25 and under. 42 reviews were included, all of which were low quality. The prevalence of depression among SM was 26% (95% CI 21-32%), and among GM was 46% (95% CI 36-56%). Greater depression severity was found among SM compared to heterosexual young people, with a significant albeit small effect size (Hedges' g = 0.38, 95% CI = 0.25 to 0.50); effect sizes were similar when separating by gender. GM also reported greater symptom severity compared to cisgender young people. Other mental disorders were more prevalent compared to those reported in the general population, and of greater severity compared to heterosexual/cisgender young people. Several proximal and distal risk factors were focused upon within the systematic reviews identified. Past systematic reviews consistently indicate a heightened risk of mental disorders among SM and GM young people. Services need to be aware of these disparities and adapt their care accordingly.

Homelessness and Food Insecurity During Emerging Adulthood: Associations With Changes in Behavioral and Physical Health Over a Two-Year Period

PURPOSE

For emerging adults in the United States, economic instability is a widespread problem with implications for the successful transition to adulthood. This study examines how two indicators of economic instability, homelessness and food insecurity, are associated with changes in health-related outcomes over a two-year period.

METHODS

The analytic sample (N = 2,182) completed online surveys in 2019-2020 (mean age 23 years) and 2021-2022 (mean age 25 years). Regression analyses were conducted for the full sample, as well as by sexual or gender diverse (SGD) identity (17.8% of sample identified as SGD) and race/ethnicity (76.3% identified as non-White).

RESULTS

At age 23, 8.2% of participants reported homelessness and 31.2% reported food insecurity. In the full sample, homelessness and food insecurity were associated with increased depression, anxiety, physical ailments, and drug problems two years later. A similar pattern emerged for those identifying as non-SGD. The only associations for SGD-identifying participants were food insecurity with increased anxiety, depression, and physical ailments. Racial/ethnic differences indicated that homelessness was associated with increased depression and anxiety among Hispanics, and physical ailments and drug consequences among Asians, but fewer drug problems among Whites. Food insecurity was associated with increased depression in all racial/ethnic groups, anxiety among Hispanics and Asians, physical ailments among Whites and Asians, and drug problems among Asians.

DISCUSSION

Homelessness and food insecurity predicted worse health outcomes during the transition to adulthood, with varying results across SGD and racial/ethnic subgroups. It is important for future research to continue examining long-term effects of economic instability on health disparities during this important developmental period.

Prevalence of youth experiencing homelessness and its association with suicidal thoughts and behaviors: Findings from a population-based study

Although various studies have examined factors associated with suicidal behaviors among youth, few studies have investigated the association between youth experiencing homelessness (YEH) and suicidal thoughts and behaviors (STBs) using a large nationally representative sample. The objectives of this study were to investigate prevalence of YEH and its association with STBs. Data for this study came from the 2021 Youth Risk Behavior Survey. An analytic sample of 17,033 youth aged 14-18 (51.7 % male) was analyzed using binary logistic regression. Of the 17,033 youth examined, 3 % experienced homelessness during the past 30 days, 21.3 % experienced suicidal ideation, 17.3 % made a suicide plan, and 10.9 % attempted suicide during the past 12 months. Controlling for demographic characteristics and feeling sad or hopeless, YEH was associated with 2.48 times higher odds of experiencing suicidal ideation (AOR=2.48, p<.001), 2.46 times higher odds of making a suicide plan (AOR=2.46, p<.001), and 4.38 times higher odds of making a suicide attempt (AOR=4.38, p<.001). The findings of this study highlight the importance of identifying youth who are at risk of experiencing homelessness to ensure early interventions are put in place to prevent suicidal behaviors.

Residential Instability and Suicidal Ideation Among Persons on Parole

Parolees experience numerous barriers that may impact successful reintegration into society. Residential instability may further add to these obstacles, as there may be limited opportunities for housing given their criminal history. The present study aimed to examine the impact of residential instability on suicidal ideation among parolees. Results indicated that residentially stable and unstable individuals had similar risk factors which were significantly associated with suicidality, such as age and having perceived unmet mental health needs. Other risk factors differed among the two groups, highlighting the importance of treatment and preparation for re-entry into society while in the prison setting.

Health, Homelessness Severity, and Substance Use among Sexual Minority Youth Experiencing Homelessness: A Comparison of Bisexual Versus Gay and Lesbian Youth

Lesbian, gay, bisexual, and questioning (LGBQ) youth are overrepresented among youth experiencing homelessness (YEH), and health disparities among LGBQ youth are well-documented. LGBQ youth are typically aggregated as a single sexual minority group; however, research suggests that bisexual youth may have greater mental health, substance use, and physical health risks relative to their gay and lesbian peers. In a probability sample of LGBQ YEH in Los Angeles County (n = 183), we examined subgroup differences in homelessness severity, depression, physical health, and substance use, focusing on differences between bisexual and gay/lesbian youth due to the small subsample of questioning youth. Indicators of homelessness severity were standalone outcomes, and also were integrated as control variables with gender, age, race/ethnicity, and education in multivariable models. Bisexual youth were more likely to have become unaccompanied homeless persons as minors (OR = 4.35, 95% CI 1.85-10.23), and to have not recently utilized emergency shelters or transitional housing at least once in the past month (OR = 6.41; 95% CI 2.41-17.03). Bisexual youth were more likely to have probable depression (OR = 4.06, 95% CI 1.41-11.68). Among sexual minority YEH, bisexual youth may be at elevated risk for depression, in addition to more severe homelessness.

Adolescent Homelessness and Associated Features: Prevalence and Risk Across Eight States

This study utilizes data from the Youth Risk Behavior Survey to estimate the prevalence of adolescent homelessness and relations to five indicators of poor functioning among students attending public high school in eight states. About 3.27% of students experienced homelessness, and nearly 7% of teens who identified as lesbian, gay, or bisexual (LGB) experienced homelessness. Homelessness was related to higher rates of sexual/dating violence as well as having been bullied and feeling unsafe at school. Homelessness and LGB identification predicted higher rates of more-severe problems with alcohol, hard drug use, poor grades, suicidality, and risky sexual behavior, controlling for other factors. There was no interaction effect between homelessness and LGB status, suggesting that these risks are additive.

The Confluence of Housing Instability and Psychosocial, Mental, and Physical Health in Sexual Minority Young Adults: The P18 Cohort Study

Sexual and gender minority (SGM) youth experience housing instability, including homelessness, at higher rates than heterosexuals. Few studies have examined differences within SGM populations and intersections of housing and health. Data were drawn from a study of SGM young adults who were assigned male at birth. Nearly one-quarter of the sample reported homelessness, unstable housing, or both in the six months prior to assessment. Housing instability was higher among those of lower income and educational attainment. Additionally, those who experienced any housing instability reported higher levels of depression, poorer self-rated health, and greater gay-related stigma; in multivariable models, only self-rated health was related to housing status. Stigma and discrimination may lead to poorer mental health; housing instability and homelessness may be a manifestation of stigma perpetuated by social conditions and mental health burdens directed by familial rejection. Findings indicate the importance of a biopsychosocial perspective in addressing housing instability in SGM youth.

Millennial Consumers’ Responses to Cause-Related Marketing in Support of LGBTQ Homeless Youth

This study explored Millennial consumers’ responses to a cause-related marketing (CRM) initiative for a sensitive social cause—lesbian, gay, bisexual, transgender and queer (LGBTQ) homeless youth. Qualitative and quantitative research methods were employed to examine the effectiveness of CRM in generating financial support for LGBTQ homeless youth. Findings revealed that self-cause congruence may be an important factor in determining Millennial consumers’ responses to a CRM initiative for LGBTQ homeless youth; whereas, message frame/appeal may be less important for generating response to such an initiative. Findings also indicated that gender, information processing, guilt, and skepticism influenced Millennial consumers’ attitudes toward brand, attitudes toward cause, and behavioral intentions toward the CRM initiative. These findings offer implications for brands/companies that may wish to engage in CRM initiative in support of sensitive social causes. By addressing a sensitive social cause—LGBTQ homeless youth—findings provide an original contribution to the CRM literature. Findings reveal that self-cause congruence is an important predictor of behavioral intention toward the LGBTQ social cause. This provides an implication for marketers who want to target their relationship-building efforts toward individuals who have demonstrated prior engagement with a social cause. Findings also have implications for brands/companies that wish to develop CRM initiatives for controversial causes.

Text-Messaging, Online Peer Support Group, and Coaching Strategies to Optimize the HIV Prevention Continuum for Youth: Protocol for a Randomized Controlled Trial

BACKGROUND

America's increasing HIV epidemic among youth suggests the need to identify novel strategies to leverage services and settings where youth at high risk (YAHR) for HIV can be engaged in prevention. Scalable, efficacious, and cost-effective strategies are needed, which support youth during developmental transitions when risks arise. Evidence-based behavioral interventions (EBIs) have typically relied on time-limited, scripted, and manualized protocols that were often delivered with low fidelity and lacked evidence for effectiveness.

OBJECTIVE

This study aims to examine efficacy, implementation, and cost-effectiveness of easily mountable and adaptable, technology-based behavioral interventions in the context of an enhanced standard of care and study assessments that implement the guidelines of Centers for Disease Control and Prevention (CDC) for routine, repeat HIV, and sexually transmitted infection (STI) testing for high-risk youth.

METHODS

Youth aged between 12 and 24 years (n=1500) are being recruited from community-based organizations and clinics serving gay, bisexual, and transgender youth, homeless youth, and postincarcerated youth, with eligibility algorithms weighting African American and Latino youth to reflect disparities in HIV incidence. At baseline and 4-month intervals over 24 months (12 months for lower-risk youth), interviewers monitor uptake of HIV prevention continuum steps (linkage to health care, use of pre- or postexposure prophylaxis, condoms, and prevention services) and secondary outcomes of substance use, mental health, and housing security. Assessments include rapid diagnostic tests for HIV, STIs, drugs, and alcohol. The study is powered to detect modest intervention effects among gay or bisexual male and transgender youth with 70% retention. Youth are randomized to 4 conditions: (1) enhanced standard of care of automated text-messaging and monitoring (AMM) and repeat HIV/STI testing assessment procedures (n=690); (2) online group peer support via private social media plus AMM (n=270); (3) coaching that is strengths-based, youth-centered, unscripted, based on common practice elements of EBI, available over 24 months, and delivered by near-peer paraprofessionals via text, phone, and in-person, plus AMM (n=270); and (4) online group peer support plus coaching and AMM (n=270).

RESULTS

The project was funded in September 2016 and enrollment began in May 2017. Enrollment will be completed between June and August 2019. Data analysis is currently underway, and the first results are expected to be submitted for publication in 2019.

CONCLUSIONS

This hybrid implementation-effectiveness study examines alternative models for implementing the CDC guidelines for routine HIV/STI testing for YAHR of acquiring HIV and for delivering evidence-based behavioral intervention content in modular elements instead of scripted manuals and available over 24 months of follow-up, while also monitoring implementation, costs, and effectiveness. The greatest impacts are expected for coaching, whereas online group peer support is expected to have lower impact but may be more cost-effective.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03134833; https://clinicaltrials.gov/ct2/show/NCT03134833 (Archived by WebCite at http://www.webcitation.org/76el0Viw9).

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/11165.

Smoking behaviours among heterosexual and sexual minority youth? Findings from 15 years of provincially representative data

INTRODUCTION AND AIMS

Sexual identity disparities in smoking behaviours are well established; however, there is limited research on whether these disparities have diminished as the social and political landscape has changed for lesbian, gay and bisexual people. Thus, we examined changes in prevalence and sexual identity disparities in three smoking behaviours among Canadian adolescents from 1998 to 2013.

DESIGN AND METHODS

Data are from the provincially representative British Columbia Adolescent Health Survey (N = 99 373). Using sex-stratified, age-adjusted logistic regression models, we estimated: (i) trends in lifetime cigarette use, early onset, and past 30-day use for heterosexual and three subgroups of sexual minority (i.e. mostly heterosexual, bisexual and gay/lesbian) youth; (ii) sexual identity disparities in these cigarette-related behaviours within each survey year (1998, 2003, 2008, 2013); and (iii) whether the size of the disparity has changed from 1998 to 2013.

RESULTS

Smoking has declined for all youth from 1998 to 2013, although less consistently for sexual minority youth. Within-year disparity estimates indicated elevated prevalence of cigarette use for sexual minority compared to heterosexual youth, particularly among females. Trends in sexual identity and smoking behaviours indicated that the degree of differences between heterosexual and sexual minority youth have remained stable or, in some cases, widened. Heterosexual and sexual minority youth differences widened for early onset among sexual minority boys and lifetime and past 30-day use for sexual minority girls.

DISCUSSION AND CONCLUSIONS

Efforts to prevent smoking behaviours among youth should continue. Tailored preventive strategies for sexual minority youth might help address existing disparities.

The Significance of Parenting and Parent-Child Relationships for Sexual and Gender Minority Adolescents

Adolescents in 21st century America are experiencing the emergence of their sexual and gender identities in a heteronormative society that is steadily adopting more progressive views and policies related to sexual orientation and gender. However, despite these sociocultural changes, parent-child relationships remain as one of the strongest predictors of LGBT adolescent adjustment. This article reviews the extant literature on this topic from family systems and attachment perspectives while highlighting the significance of family experiences within a minority stress framework. The presentation is oriented around the coming out process, including factors influencing this experience and how postdisclosure parenting affects the health and well-being of LGBT adolescents. We end by discussing future directions and the challenges inherent to this research.

The Association between Intentional Overdose and Same-Sex Sexual Intercourse in a Cohort of People who Inject Drugs in Melbourne, Australia

BACKGROUND

People who inject drugs (PWID) are at disproportionately high risk of suicidal behaviors, as are individuals who report same-sex attraction or experience. However, there is little evidence of compounded risk of suicide for individuals who report same-sex sexual intercourse (SSI) and are PWID.

OBJECTIVES

To explore the associations of lifetime intentional overdose amongst a cohort of PWID, with particular attention to those reporting SSI.

METHODS

The sample included 529 participants, from an ongoing cohort of 757 PWID. An "ever" SSI variable was created for participants who reported sexual intercourse with a same-sex partner at any longitudinal interview. We explored the adjusted associations between SSI and lifetime intentional overdose using logistic regression.

RESULTS

Ninety-one (17%) participants reported ever experiencing an intentional overdose. Forty-one (8%) participants reported SSI at any interview. Three hundred and sixty (68%) participants reported diagnosis of a mental health condition. Diagnosis of a mental health condition (AOR = 2.02, 95% CIs: 1.14, 3.59) and SSI (AOR = 2.58, 95% CIs: 1.22, 5.48) significantly increased the odds of lifetime intentional overdose. Conclusions/Importance: We found a heightened risk of intentional overdose amongst PWID reporting SSI, after controlling for diagnosis of a mental health condition. Services need to be aware of this heightened risk and target interventions appropriately.

Social Support and Mental Health in LGBTQ Adolescents: A review of the literature

LGBTQ adolescents experience higher rates of mental health disorders than their heterosexual peers. The purpose of this systematic review of the literature was to examine studies evaluating social support and its effects on mental health in the LGBTQ adolescent population. Higher levels of social support were associated with positive self-esteem. Lack of social support (or low social support) was associated with higher levels of depression, anxiety, alcohol or drug misuse, risky sexual behaviors, shame, and low self-esteem. Interdisciplinary research teams from multiple and diverse professions could provide valuable insight supporting the development of inclusive and comprehensive interventions programs for this population.

Are alcohol-related disparities between sexual minority and heterosexual youth decreasing?

BACKGROUND AND AIMS

Although sexual orientation-related alcohol use disparities are well established, researchers have not identified whether disparities are diminishing as societal attitudes towards lesbian/gay and bisexual (LGB) people become more accepting. We examined changes in four alcohol-related disparities between heterosexual and LGB youth from 1998 to 2013 by (1) estimating the prevalence of these behaviors; (2) estimating disparities in alcohol-related outcomes between heterosexual and LGB youth within each wave year; and (3) testing whether the degree of difference in alcohol-related disparities between heterosexual and LGB youth has changed.

DESIGN

Logistic regression models and year × sexual orientation interactions with repeated, cross-sectional, provincially representative data.

SETTING

British Columbia, Canada.

PARTICIPANTS

Students (ages 12-19) from the 1998 (n = 22 858), 2003 (n = 29 323), 2008 (n = 25 254) and 2013 (n = 21 938) British Columbia Adolescent Health Survey (total n = 99 373, 48.7% male, mean age = 14.84).

MEASUREMENTS

We modeled age-adjusted differences in life-time alcohol use, age of onset, past 30-day drinking and past 30-day heavy episodic drinking between heterosexual and three subgroups of sexual minority youth (i.e. mostly heterosexual, bisexual and lesbian/gay).

FINDINGS

Generally, alcohol use declined for all youth, although less so among LGB youth [average adjusted odds ratio (aOR) = 0.58 and aOR = 0.53 for heterosexual males and females and aOR = 0.71 and aOR = 0.57 for sexual minority males and females, respectively). Within-year comparisons demonstrated elevated rates of alcohol use among LGB compared with heterosexual youth for each of the four survey years, especially among females. Findings indicate few changes over time; however, results show an increase in risky alcohol use from 1998 to 2013 among mostly heterosexual (aOR = 1.58 for life-time alcohol use, aOR = 1.58 for 30-day alcohol use and aOR = 1.34 for 30-day heavy episodic drinking), and bisexual (aOR = 1.95 for life-time alcohol use) females.

CONCLUSION

Despite the general decline in the prevalence of alcohol use among young people in Canada since 1998, lesbian/gay and bisexual youth in Canada continue to show elevated rates of alcohol use compared with heterosexual youth.

Psychosocial Risk and Protective Factors for Depression Among Lesbian, Gay, Bisexual, and Queer Youth: A Systematic Review

Many lesbian, gay, bisexual, or queer (LGBQ) youth suffer from depression. Identifying modifiable risk and protective factors for depression can inform the development of psychosocial interventions. The aim of this review is to evaluate the methodological characteristics and summarize the substantive findings of studies examining psychosocial risk and protective factors for depression among LGBQ youth. Eight bibliographic databases were searched, and 35 studies that met all inclusion criteria were included for review. Results show that prominent risk factors for depression include internalized LGBQ-related oppression, stress from hiding and managing a socially stigmatized identity, maladaptive coping, parental rejection, abuse and other traumatic events, negative interpersonal interactions, negative religious experiences, school bullying victimization, and violence victimization in community settings. Prominent protective factors include a positive LGBQ identity, self-esteem, social support from friends, and family support. LGBQ youth may face an array of threats to their mental health originating from multiple socioecological levels.

LGBTQ+ Young Adults on the Street and on Campus: Identity as a Product of Social Context

Lesbian, gay, bisexual, queer, and other sexual and gender minority (LGBTQ+) young adults face unique identity-related experiences based on their immersion in distinctive social contexts. The predominant framework of performing separate analyses on samples of LGBTQ+ young people by their primary social status obfuscates more holistic understandings of the role of social context. Using 46 in-depth interviews with LGBTQ+ college students and LGBTQ+ homeless young adults, we ask: How are LGBTQ+ young adults' capacities for "doing" their gender and sexual identities shaped by their distinctive social contexts? In developing their identities, both groups of LGBTQ+ young adults navigated their social environments to seek out resources and support. Most college students described their educational contexts as conducive to helping them develop their identities, or "undo" rigid norms of gender and sexuality. Homeless young adults' social environments, meanwhile, imposed complex barriers to self-expression that reinforced more normative expectations of "doing" gender and sexual identities.

Promising Pedagogy: Advancing the Educational Experience of Queer Students Through Transformative Leadership

The school experience for queer youth is often quite different from that of their heterosexual and gender-conforming peers; yet it is often the c ase that little attention is given to the disparate and inequitable educational and social conditions under which lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth must learn. In fact, the entirety of pedagogical structures in many schools creates milieus where queer youth, those who have loved ones who are queer, and those who are merely perceived to be queer are systematically marginalized and deprived of their right to a safe, supportive, and equitable educational experience. Transformative leadership theory (TLT) inspires educational leaders to create inclusive and excellent schools for all youth. Neither a prescriptive model nor a process-oriented theory, TLT offers eight tenets that operate in concert to form an authentic way of being informing and guiding leaders' decisions and actions toward the goal of individual, organizational, and societal change.

Women Who Use Drugs and Have Sex with Women in a Canadian Setting: Barriers to Treatment Enrollment and Exposure to Violence and Homelessness

Individuals who use illicit drugs and belong to a sexual minority group often contend with elevated risks for adverse health outcomes. However, little is known about women who use drugs and have sex with women. We therefore sought to identify sociodemographic, substance use patterns, and exposures to social-structural factors associated with reporting sexual activity among women participating in three open prospective cohort studies of individuals who use illicit drugs in Vancouver, Canada. Generalized estimating equations were used to identify substance use patterns, violence, and other social and structural drivers of health-related harm among women who reported having sex with women (WSW) between December 2005 and May 2012. In multivariate analyses, younger age (adjusted odds ratio [AOR] 2.89; 95 % confidence interval [CI] 1.81, 4.60), violence (AOR 1.78; 95 % CI 1.22, 2.59), and homelessness (AOR 1.42; 95 % CI 1.00, 2.02) were associated with WSW. WSW were also less likely to report enrollment in addiction treatment (AOR 0.68; 95 % CI 0.46, 0.99). In a second model, sexual violence (AOR 3.47; 95 % CI 2.08, 5.78) in the previous 6 months was also found to be positively associated with WSW. These findings indicate a critical need for more thorough understandings of the intersections between sexual relationships, exposure to violence, and enrollment in addiction treatment among women who use illicit drugs, as well as the development of programs to address the unique needs of this population.

Strategies employed by sexual minority adolescents to cope with minority stress

Sexual minority adolescents (SMA) experience disparities in health and behavioral health outcomes, including high rates of depression, anxiety, self-harm, substance use, HIV risk behavior, suicidal ideation, and suicide attempts. These outcomes are commonly attributed to minority stress. Stress experiences are different for SMA than their adult counterparts. For example, disclosing their sexual orientation may be more likely to result in homelessness because these youth more often live with parents or other family members. Although stress in this population has been explored in previous research, very little is known about how SMA cope. Relying upon an adolescent coping model, this study examined the coping strategies, responses, and resources of SMA related to stress. Forty-eight racially and ethnically diverse SMA (age 14-19) were recruited for 90-minute tape-recorded interviews. The semi-structured interviews were guided by a life history calendar. Recordings were transcribed verbatim and entered into QSR NVivo. All transcripts were coded by two members of the research team and went through a consensus process. Forty-three unique coping statements emerged that fit with the Compas model of adolescent coping. SMA cope with minority stress in similar ways to heterosexual youth coping with general stress, but findings suggest that SMA may also use different kinds of coping resources. Although further research is needed, the present study identified a variety of ways SMA cope with stress and can inform future research on the development interventions.

Psychosocial Implications of Homophobia and HIV Stigma in Social Support Networks: Insights for High-Impact HIV Prevention Among Black Men Who Have Sex With Men

Black men who have sex with men (BMSM) bear an increasingly disproportionate burden of HIV in the United States. The Centers for Disease Control and Prevention recommends high-impact combination prevention for populations at high risk for HIV infection, such as BMSM. However, few scholars have considered the types of behavioral interventions that combined with biomedical prevention could prove effective for mitigating the epidemic among BMSM. Between June 2013 and May 2014, we conducted three in-depth interviews each with 31 BMSM, interviews with 17 community stakeholders, and participant observation in New York City to understand the sociocultural and structural factors that may affect the acceptance of and adherence to oral preexposure prophylaxis among BMSM and to inform an adherence clinical trial. BMSM and community leaders frequently described condomless sex as a consequence of psychosocial factors and economic circumstances stemming from internalized homophobia resulting from rejection by families and religious groups. BMSM revealed that internalized homophobia and HIV stigma resulted in perceived lack of self- and community efficacy in accepting and adhering to preexposure prophylaxis. Our results indicate that addressing internalized homophobia and fostering emotional social support in peer networks are key elements to improve the effectiveness of combination prevention among BMSM.

Mental health and support among young key populations: an ecological approach to understanding and intervention

INTRODUCTION

The patterning of the HIV epidemic within young key populations (YKPs) highlights disproportionate burden by mental disorders in these populations. The mental wellbeing of YKPs is closely associated with biological predispositions and psychosocial factors related to YKPs' sexual and gender identities and socio-economic status. The purpose of this paper is to highlight sources of risk and resilience, as well as identify treatment and supports for mental health disorders (MHDs) among YKPs.

DISCUSSION

This paper utilizes Bronfenbrenner's Bioecological Systems Theory and the Social Stress Model to explore the risk and protective factors for MHDs across YKPs' ecological systems, and identify current gaps in treatment and support for MHDs among these youth. We emphasize the fluidity and intersections across these categorizations which reinforce the vulnerability of these populations, the lack of concrete data to inform mental health interventions among YKPs, and the need to ground YKP interventions and programmes with human rights principles stipulated in the convention on the rights of a child.

CONCLUSIONS

We put forth recommendations for future research and strategies to address the mental wellbeing of YKPs, including the need for integrated interventions that address the multiplicity of risk factors inherent in the multiple group membership, rather than single-focus interventions whilst addressing the unique needs or challenges of YKPs.

Out on the street: a public health and policy agenda for lesbian, gay, bisexual, and transgender youth who are homeless

A disproportionate number of lesbian, gay, bisexual, and transgender (LGBT) youth experience homelessness each year in the United States. LGBT youth who are homeless have particularly high rates of mental health and substance use problems, suicidal acts, violent victimization, and a range of HIV risk behaviors. Given the intense needs of LGBT youth experiencing homelessness, it is imperative to understand their unique experiences and develop responsive practices and policies. The range and severity of health risks vary across subgroups of all homeless LGBT youth, and because the population is nonhomogeneous, their particular needs must be identified and addressed. Thus, the purpose of this article is to review the causes of homelessness among LGBT youth, discuss the mental health and victimization risks faced by this population, address differences among homeless LGBT subgoups, and recommend effective interventions and best practices. The authors conclude by discussing promising future research and public policy directions.

Prevalence of HIV infection and the correlates among homeless in Tehran, Iran

OBJECTIVE

To determine the prevalence of HIV infection among homeless men and women and the related risk behaviors in Tehran, Iran.

METHODS

In 2007-2008, Tehran municipality stacked up 10672 homeless men and women for assessment of HIV and began collaboration with Iranian Research Center for HIV/AIDS (IRCHA) departments to conduct HIV infection prevalence surveys in homeless populations. The results were analyzed for associations with demographic information, family support, status of drug abuse and relation with family and friends.

RESULTS

Overall HIV prevalence was 1.7% (95% confidence interval 1.4-1.9). Factors independently associated with HIV infection included history of using drugs [AOR 8.15 (4.86-13.67)], older age [AOR 1.80 (1.08-2.99) for 40-55 yr], occupation [AOR 1.64 (1.19-2.24) for unemployed], and no relation with family [AOR 1.82 (1.30-2.54)].

CONCLUSIONS

This study supports the idea that injection drug use is contributing to the increased spread of HIV among Iranian homeless. Harm reduction programs should be expanded, particularly among homeless injection drug users.

Modeling minority stress effects on homelessness and health disparities among young men who have sex with men

Sexual minority youth are more likely to experience homelessness, and homeless sexual minority youth report greater risk for mental health and substance abuse symptoms than homeless heterosexual youth, yet few studies have assessed determinants that help explain the disparities. Minority stress theory proposes that physical and mental health disparities among sexual minority populations may be explained by the stress produced by living in heterosexist social environments characterized by stigma and discrimination directed toward sexual minority persons. We used data from a sample of 200 young men who have sex with men (YMSM) (38 % African American, 26.5 % Latino/Hispanic, 23.5 % White, 12 % multiracial/other) to develop an exploratory path model measuring the effects of experience and internalization of sexual orientation stigma on depression and substance use via being kicked out of home due to sexual orientation and current homelessness. Direct significant paths were found from experience of sexual orientation-related stigma to internalization of sexual orientation-related stigma, having been kicked out of one's home, experiencing homelessness during the past year, and major depressive symptoms during the past week. Having been kicked out of one's home had a direct significant effect on experiencing homelessness during the past 12 months and on daily marijuana use. Internalization of sexual orientation-related stigma and experiencing homelessness during the past 12 months partially mediated the direct effect of experience of sexual orientation-related stigma on major depressive symptoms. Our empirical testing of the effects of minority stress on health of YMSM advances minority stress theory as a framework for investigating health disparities among this population.

Psychopathology in young people experiencing homelessness: a systematic review

Understanding mental health issues faced by young homeless persons is instrumental to the development of successful targeted interventions. No systematic review of recent published literature on psychopathology in this group has been completed. We conducted a systematic review of published research examining the prevalence of psychiatric problems among young homeless people. We examined the temporal relationship between homelessness and psychopathology. We collated 46 articles according to the PRISMA Statement. All studies that used a full psychiatric assessment consistently reported a prevalence of any psychiatric disorder from 48% to 98%. Although there was a lack of longitudinal studies of the temporal relationship between psychiatric disorders and homelessness, findings suggested a reciprocal link. Supporting young people at risk for homelessness could reduce homelessness incidence and improve mental health.

An Ecological Systems Comparison Between Homeless Sexual Minority Youths and Homeless Heterosexual Youths

This study examined risk and protective outcomes by comparing homeless sexual minority youths to heterosexual homeless youths regarding family, peer behaviors, school, mental health (suicide risk and depression), stigma, discrimination, substance use, and sexual risk behaviors. Structured interviews (N = 147) were conducted with individuals ages 16-24 at three drop-in programs serving homeless youths in Toronto. Bivariate analyses indicated statistically significant differences between homeless sexual minorities (n=66) and their heterosexual counterparts (n=81) regarding all variables: family, peer behaviors, stigma, discrimination, mental health, substance use and sexual risk behaviors with the exception of school belonging. Specifically, homeless sexual minority youths fared more poorly (e.g. lower satisfaction with family communication, experienced more stigma, used more drugs and alcohol) than their heterosexual counterparts. Improving family communication may be a worthwhile intervention if the youths are still in contact with their families. Future research should focus on victimization in the context of multiple systems.

The mediating roles of stress and maladaptive behaviors on self-harm and suicide attempts among runaway and homeless youth

Runaway and homeless youth often have a constellation of background behavioral, emotional, and familial problems that contribute to stress and maladaptive behaviors, which, in turn, can lead to self-harming and suicidal behaviors. The current study examined the roles of stress and maladaptive behaviors as mediators between demographic and psychosocial background characteristics and self-injurious outcomes through the lens of the stress process paradigm. The model was tested in a sample of runaway and homeless youth from Los Angeles County (N = 474, age 12-24, 41 % female, 17 % White, 32.5 % African American, 21.5 % Hispanic/Latino). Background variables (gender, age, sexual minority status, parental drug use history, and emotional distress) predicted hypothesized mediators of maladaptive behaviors and recent stress. In turn, it was hypothesized that the mediators would predict self-harming behaviors and suicide attempts in the last 3 months. Females and LGBT (lesbian, gay, bisexual, transgender) youth were more likely to have self-harmed and attempted suicide; younger participants reported more self-harming. The mediating constructs were associated more highly with self-harming than suicide attempts bivariately, although differences were modest. Maladaptive behaviors and recent stress were significant predictors of self-harm, whereas only recent stress was a significant predictor of suicide attempts. All background factors were significant predictors of recent stress. Older age, a history of parental drug use, and greater emotional distress predicted problem drug use. Males, younger participants, and participants with emotional distress reported more delinquent behaviors. Significant indirect effects on self-harming behaviors were mediated through stress and maladaptive behaviors. The hypothesized paradigm was useful in explaining the associations among background factors and self-injurious outcomes and the influence of mediating factors on these associations.

Risk Factors for Homelessness Among Lesbian, Gay, and Bisexual Youths: A Developmental Milestone Approach

Lesbian, gay, and bisexual (LGB) youths are over-represented in the homeless population. To examine why some LGB youths become homeless, this report compares homeless and non-homeless LGB youths. Of the 156 LGB youths, 48% reported ever being homeless (i.e., running away or being evicted from home). Results indicate that sexual orientation awareness and the initiation of sexual behavior occurred earlier in homeless than in non-homeless LGB youths and predated the first homeless episode. Substance use was more frequent and first occurred at an earlier age in homeless as compared to non-homeless LGB youths; however, substance use occurred subsequent to first homelessness. Childhood sexual abuse was associated with homelessness; and, early sexual orientation development was related to homelessness among youths without a history of sexual abuse. Findings suggest that interventions should help youths cope with their unfolding sexual orientation and work to prevent or address the consequences of sexual abuse.