Identity development and exploration among sexual minority adolescents: examination of a multidimensional model

Variations in Sexual Identity Milestones Among Asexual People

There is increasing interest in the interpersonal factors that shape the development of asexual individual's sexual identity, including age, gender, and romantic orientation. In this study, we examined variability in timing and pacing of asexual identity development milestones, with a focus on the diversity present in the asexual population. Among a sample of 317 participants aged 18-59 from three distinct birth cohorts, we measured participants' ages of asexual identity development milestones, including: first awareness of a lack of sexual attraction, first searching for orientation, first discovery of the term asexuality, first self-identification, and first disclosure. Participants from more recent cohorts reported earlier and accelerated pacing of milestones relative to those from middle and older cohorts. Subgroups defined by gender also varied in milestone timing, with cisgender participants experiencing asexual identity development milestones at a later age than gender non-binary cohorts. No significant difference in milestones were found among romantic orientation sub-groups, apart from the timing of identity disclosure. Romantic-identified asexual individuals disclosed their asexual identities much sooner than aromantic-identified asexual individuals following identification as asexual. By comparing differences within subpopulations, the results of this study extend upon our understanding of the various sub-identities that exist within the asexual population and attend to different experiences within the asexual community. This in turn contributes towards our understanding of how asexual people experience interpersonal relationships, their interactions with others, and how they develop a positive sense of identity.

The pride framework: a sociocultural-developmental approach for understanding LGBTQ+ adolescents' body image and disordered eating

This theoretical review paper offers a sociocultural-developmental framework for understanding LGBTQ+ adolescents' body image concerns and disordered eating risk. The Pride Framework integrates well-established sociocultural theories and extant empirical research, drawing from objectification theory, the tripartite influence model, minority stress theory, and intersectionality theory. The Pride Framework situates sociocultural appearance pressures within the adolescent developmental context, wherein biological, cognitive, and social transitions exacerbate the likelihood of body image disturbances and eating pathology. Various processes are then posited to link these sociocultural-developmental pressures to body image concerns and disordered eating. Crucially, this framework underscores that LGBTQ+ status itself does not pose a risk for body dissatisfaction and eating disorders. Instead, it is the experience of residing in a society that stigmatizes LGBTQ+ identities that increases youth's vulnerabilities. LGBTQ+ health researchers and practitioners are encouraged to engage in collaborative efforts with the aim of fostering acceptance for LGBTQ+ youth. This, in turn, could support normative adolescent identity exploration processes within sociocultural settings that are both affirming and inclusive, potentially mitigating adverse health consequences associated with body image disturbances.

Timing of a First Romantic Union Among Sexual Minority Young Adults

Cohabitation and marriage are critical milestones during the transition to adulthood; however, there is limited research on the timing of young adults' first same-sex unions. There is some evidence that same-sex unions may be delayed, particularly for men. Further, formation of both same- and different-sex dating relationships, common among sexual minority young adults, may also extend to cohabitation and marriage. We used the National Longitudinal Study of Adolescent to Adult Health to predict the timing of a first romantic union, defined as a cohabitation or marriage, among sexual minority young adults. We then distinguished between women and men and the timing of a different-sex versus a same-sex union. Compared with heterosexual young adults, lesbian and gay young adults entered a union at later ages (driven by men), whereas bisexual young adults entered a union at younger ages (driven by women). Lesbian and gay young adults who entered a first union with a same-sex partner did so at later ages than those who entered a first union with a different-sex partner. Results suggest that patterns of sexual minority dating relationship formation might extend to unions.

'I turn to my closest friends for support': queer youth navigating mental health during COVID-19

The objectives of this in-depth qualitative study were to identify how COVID-19 impacted the mental health experiences of queer youth in Vancouver, Canada. Between November 2020 and June 2021, fifteen queer youth aged 15 to 25 were enrolled in the study. They participated in semi-weekly, solicited digital diary entries and semi-structured intake and follow-up interviews about COVID-19, social distancing protocols, and mental health. Using thematic analysis, two major themes were identified. First, participants described how COVID-19 impacted social support by highlighting the limitations of their existing social networks and feelings of disconnect from others in the local queer community. Second, participants described how public health guidance and the offloading of responsibility for COVID-19 risk-management onto the individual was a significant source of anxiety and stress, and how they moralised the struggle to balance compliance with the desire to connect with others. These findings highlight the need to understand the negative mental health outcomes arising from moralising approaches to public health that offload risk-management onto the individual, isolate queer youth, and hamper their identity-development processes.

Dating and friendships in adolescence: Variation across same-sex and other-sex romantic partners

This research examined associations between dating and number of friends for rural adolescents with same-sex and other-sex dating partners using longitudinal sociometric data (N = 2826; 55% female, 87% White, mean age = 14 at baseline). In multilevel models assessing within-person change, boys gained female friends when they were in same-sex romantic relationships, compared to when they were single. In contrast, girls in same-sex relationships lost female friends and gained male friends. Adolescents in other-sex romantic relationships gained same-sex friends compared to when they were single. Results advance understanding of adolescent social and sexual development, suggesting that sexual minority adolescents find allies when dating but may struggle to maintain same-sex friendships.

Timing to a first relationship among youth: Variability by sexual orientation development

Romantic relationships are developmentally salient across the transition to adulthood, yet the timing to a first relationship for sexual minority youth is largely unknown and is complicated by the developmental timing of sexual orientation development. We use the National Longitudinal Study of Adolescent to Adult Health to predict the timing to a first relationship among heterosexual and sexual minority youth, defined as those with same-sex attraction and/or a sexual minority identity. We examine variability across subgroups of youth with a sexual minority status in adolescence only, in adulthood only, or in both developmental periods, and by gender. Participants with lesbian/gay sexual orientations emerging during adulthood delay a first relationship compared to their heterosexual peers. Those with bisexual orientations only in adulthood enter relationships earlier than their heterosexual peers, particularly women. Results suggest that patterns of dating relationship formations differ by distinct developmental contexts of sexual orientation development.

Sexual identity fluidity, identity management stress, and depression among sexual minority adolescents

Introduction

Sexual identity is mutable and evolving, particularly during adolescence. Sexual identity fluidity could be stressful for some adolescents and may differ by birth-sex. Evidence suggests chronic stress can lead to negative mental health outcomes. However, it is unknown if these two processes (stress and depression) differ by sexual identity fluidity.

Methods

This paper studied time-sequential associations between identity management stress and depression over time by sexual identity fluidity, in a national longitudinal data from sexual minority adolescents (SMA) aged 14-17 years using a multigroup autoregressive cross-lagged model (n = 1077).

Results

In the sample, 40% of SMA reported at least one change in sexual identity over 18-month period. Greater number of cisgender females reported sexual identity fluidity compared to their male counterparts (46.9% vs. 26.6%). A temporal cross-lagged effect was reported between depression and identity management stress among cisgender females who reported fluidity in sexual identity; and no cross-lagged effect was reported among those females who did not report fluidity. However, among cisgender male sample depression predicted subsequent identity management stress, irrespective of their change sexual identity fluidity status.

Conclusion

Public health programs and practice must be responsive to the sexual identity fluidity processes among adolescents, with particular attention to minority stress and depression. In addition, our results indicate that sexual identity development and fluidity processes differ between cisgender females and males; and the nuances associated with these processes of change need further investigation.

State LGBTQ policies and binge drinking among sexual minority youth in the US: a multilevel analysis

PURPOSE

Though higher rates of binge drinking have been reported among sexual minority (lesbian, gay, and bisexual) youths compared to their heterosexual peers in the United States, questions remain about which specific structural factors drive these inequities. We test whether state LGBTQ (lesbian, gay, bisexual, transgender, queer/questioning) policy climate is associated with youth binge drinking, as well as whether that association is unique to sexual minority youth.

METHODS

We use LGBTQ policy scores compiled by the Movement Advancement Project in 2017 and analyze 2017 Youth Risk Behavior Survey data (126,432 youths living in 24 states). We fit multi-level logistic regression models to estimate odds ratios for binge drinking with state-level LGBTQ policy scores.

RESULT

More progressive state-level overall LGBTQ policies were associated with lower odds of binge drinking among sexual minority youths (interaction term OR = 0.990, CI 0.984-0.996, p = 0.0009), but not among heterosexuals (OR = 1.001, CI 0.992, 1.009, p = 0.881). For sexual minorities, living in the most LGBTQ-affirming state was associated with a probability of binge drinking 27% lower than that of those living in the least LGBTQ-affirming state. In sensitivity analyses, policies specific to LGBTQ youth (opposed to general LGBTQ people) were even more strongly related to sexual minorities' binge drinking (interaction term: state-level youth policy score × individual-level sexual identity-of OR = 0.949, CI 0.927-0.971, p = 0.00001). In sex-stratified models, associations with overall LGBTQ policy scores were significant only for girls (OR = 0.986, CI 0.979-0.993, p < 0.001), not boys (OR = 0.997, CI 0.986-1.008, p = 0.551), while associations with youth-focused LGBTQ policies were significant for both sexual minority girls and boys.

CONCLUSION

Our findings point to state-level LGBTQ policy climate as a potential social determinant of binge drinking problems among sexual minority youths.

Differential Alcohol Use Disparities by Sexual Identity and Behavior Among High School Students

AIMS

Sexual minority youth (SMY) use alcohol at disproportionate rates compared to their heterosexual peers. However, sexual orientation is multidimensional. Analyzing alcohol use disparities only by one dimension of sexual orientation may result in critical disparities being obscured.

METHODS

Data from state and local versions of the Youth Risk Behavior Survey were pooled (2009-2017), resulting in a large, diverse sample (n = 201,671). Multivariable logistic regression models were used to analyze associations between sexual identity/sexual behavior and three alcohol use outcomes among sexually active youth: age at first drink, binge drinking and current drinking.

RESULTS

SMY, when categorized by sexual identity and sexual behavior, reported greater alcohol use than their heterosexual peers, though the magnitude of these disparities varied by subgroup. Both those who identified as bisexual and those who reported sexual behavior with both males and females reported the greatest levels of alcohol use. Decomposition analysis revealed that youth whose reported sexual behavior was not aligned with stereotypical behavioral expectations based on their sexual identity had higher odds of current drinking and drinking before 13 years as compared to other youth.

CONCLUSIONS

Results highlight the need to incorporate multiple methods of sexual orientation measurement into substance use research. Interventions based solely on identity, rather than both identity and behavior, may not be sufficient; targeted research into the causes of alcohol use disparities is needed, especially for bisexual youth, youth whose sexual behavior and sexual identity are not stereotypically aligned, and youth who report a sexual identity of 'not sure.'

Measurement implications associated with refinement of sexual and gender identity survey items: A case study of the National College Health Assessment

Objective: To quantitatively measure psychometric impact associated with changes to sexual and gender identity survey questions included on the National College Health Assessment (NCHA). Participants: Respondents included all iterations (31) of the NCHA between the years of 2000 and 2015 (N = 1,202,582). Methods: Secondary analysis using complete NCHA data across 15 years. Results: Scale reliability for cisgender men, cisgender women, gay and lesbian, and bisexual groups improved when transgender was moved to reflect a gender option, rather than a sexual orientation category. Scale reliability for the alcohol protective behaviors measure was consistently higher for heterosexual persons than sexual minorities. Conclusions: Less inclusive, less representative conceptualizations of sexual and gender identities on survey questionnaires can result in poorer measurement of social characteristics and behaviors. Researchers and practitioners should seek to ensure their assessments and evaluations include demographic items that capture important nuances associated with human sexual and gender identities.

Sexual Identity-Behavior Profiles and Suicide Outcomes Among Heterosexual, Lesbian, and Gay Sexually Active Adolescents

OBJECTIVE

Adolescents' sexual behaviors can be incongruent with those assumed to align with their sexual identity. Identity-behavior profiles permit the characterization of youth who might remain undetected using a single-dimensional assessment of sexual orientation. This study examined suicide risks among four distinct sexual identity-behavior profiles of youth: heterosexual with other-sex partners only, heterosexual with any same-sex partners, lesbian or gay (LG) with same-sex partners only, and LG with any other-sex partners.

METHOD

Data were analyzed from the 2017 National Youth Risk Behavior Survey. Participants' reported sex, sexual identity, and the sex of their sexual contacts were used to construct the identity-behavior profiles. Multivariate logistic regression was used to examine the relationship between identity-behavior profiles and suicide outcomes.

RESULTS

Compared to heterosexual respondents with other-sex partners only, heterosexual respondents with any same-sex partners and LG respondents with same-sex partners only had greater odds of having a suicide plan; LG respondents with any other-sex partners were over seven times more likely to have suicidal thoughts and attempt suicide and 14 times more likely to have a suicide plan.

CONCLUSIONS

Health and mental health providers can expand the identification of youth at risk for suicide by assessing both sexual identity and behavior.

Sexual Orientation and Sleep Behaviors in a National Sample of Adolescents Followed Into Young Adulthood

STUDY OBJECTIVES

Sexual minority adolescents experience mental and physical health disparities attributable to increased discrimination and minority stress. These same factors may also impair sleep health, although available literature on this topic is limited. This study examined longitudinal associations between adolescent sexual minority status and seven sleep behaviors in young adulthood and tested depressive symptoms and overweight as mediators.

METHOD

Data were drawn from Waves 2 (11th grade) to 7 (4 years after high school) of the NEXT Generation Health Study, a national longitudinal cohort study of US adolescents (n = 1946; 6.3% sexual minorities).

RESULTS

There were no significant sexual orientation disparities in sleep duration, trouble falling asleep, trouble staying asleep, or trouble waking up during young adulthood. Relative to heterosexual females, sexual minority females had higher odds of snoring/stop breathing (36.6% versus 19.2%; adjusted odds ratio = 2.57; 95% confidence interval = 1.30, 5.09) and reported more frequent daytime sleepiness (b = 0.66, 95% confidence interval = 0.05, 1.27). Mediation analyses revealed that female sexual minority status was associated with increased risk of snoring/stop breathing though overweight status (mediated 43.6% of total effect) and was also associated with increased daytime sleepiness through higher depressive symptoms (mediated 70.8% of total effect).

CONCLUSIONS

Among US youth, no sexual orientation disparities were found except for snoring/stop breathing and daytime sleepiness among females. Sexual orientation disparities in these aspects of sleep are partially due to worse mental and physical health among sexual minority females, highlighting depressive symptoms and overweight problems as potential intervention targets.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov; Title: Health Behavior in School-Aged Children: NEXT Longitudinal Study 2009-2016; Identifier: NCT01031160.

"Stepping Out of My Sexual Comfort Zone": Comparing the Sexual Possible Selves and Strategies of College-Attending and Non-College Emerging Adults

Limited attention has been devoted to examining internalized sexual expectations and fears (i.e., sexual possible selves [SPS]) during emerging adulthood, and in particular how these differ based on college attendance. The purpose of this study was to replicate and extend research on SPS and strategies using a large, diverse sample of college-attending (n = 400) and non-college (n = 400) emerging adults (ages 18-25 years). Open-ended responses on internalized sexual expectations and fears were collected through an online survey (Amazon's MTurk). Qualitative content analysis of each groups' responses revealed 11 emergent expected SPS themes, with the majority focused on abstinence, interpersonal relationships, quantity, quality, explore/experiment, and sexual health/well-being. Emergent themes of feared SPS overlapped with expected SPS on six categories (e.g., sexual health/well-being); however, we also found fears related to sexual assault/coercion, self-focus, partner focus, and increased sexual risk. Pearson chi-square analyses of themes based on college attendance showed differences in expectations for interpersonal relationships, along with subgroup differences based on gender (male versus female) and gender by college attendance status (e.g., college-attending women versus non-college women). Implications for sexual education and future SPS research are discussed.

Sexual Trajectories of Lesbian, Gay, and Bisexual Adults in the Netherlands

Studies on sexual trajectories of lesbian, gay, and bisexual (LGB) people generally focus on the first same-sex attraction and sexual experience, and their relation to self-identification and coming out as LGB. Relational and opposite-sex experiences are generally not taken into account. The aim of this study was to provide a more comprehensive overview of LGBs' sexual trajectories and to distinguish subsamples with different trajectories. A sample of same-sex attracted members of an online research panel (N = 3054) completed a sexual health questionnaire, including items about the timing of sexual and relational milestones. Results showed that the majority of gay men and lesbian women had same-sex sexual and relational experiences, whereas most bisexual men and women had had experiences with the opposite sex. Among gay men and lesbian women, two trajectories emerged, differing mainly on whether people had been sexually or romantically involved with opposite-sex partners, and on age of first same-sex attraction. Among those who were not exclusively attracted to the same sex, six patterns emerged, which differed especially with regard to the nature and comprehensiveness of their same-sex experiences. Within the exclusively same-sex attracted group, the trajectory with no heterosexual experiences related to higher levels of psychological adjustment. For non-exclusive sexually attracted people, trajectories including experience of same-sex relationships seem to be most beneficial. In conclusion, both relational and opposite-sex experiences proved to be important elements of LGB men and women's sexual trajectories.

When holistic care is not holistic enough: The role of sexual health in mental health settings

AIMS AND OBJECTIVES

To explore the preparation that mental health nurses receive to address sexual health in practice.

BACKGROUND

People who use the mental health services often have complex sexual health needs. Mental health nurses are well placed to offer support. However, this rarely happens in practice, and therefore, people's sexual health needs are not being routinely addressed. It is not known why this is the case.

DESIGN

Systematic review and meta-ethnography.

METHODS

EBSCO, PsycINFO, MEDLINE and ASSIA databases were searched using Booleans with Mesh and key terms including "mental health nurse" and "sexual health". Date range was June 2006 to June 2016. Discursive papers were excluded. Included papers (n = 7) were synthesised using a meta-ethnographic approach.

RESULTS

The search yielded seven studies. Five key themes were identified: the (not so) therapeutic relationship; personal values dictating professional ones; institutionalised fear; being human; and education: the answer but where is it?

CONCLUSIONS

The findings illustrate the complexity of supporting people with mental health and sexual health needs. They show the discomfort many nurses have about broaching sexual health. Arguably more than with most issues, personal values impacted strongly on professional practice. Understanding the depth and multifaceted nature of these themes is important, because strategies can then be developed to mitigate the barriers to best practice. For example, the findings presented here offer a framework from which structured education and support can be built.

RELEVANCE TO CLINICAL PRACTICE

There is a need for Mental health nurses to be more responsive to concerns around sexual health and it should be routinely included in their practice. This study illuminates why this is not currently the case. By understanding this, remedial action can be taken by nurse educators. Implications are also discussed in relation to policy, research and practice.

Labeling Same-Sex Sexuality in a Tolerant Society That Values Normality: The Dutch Case

Studies have pointed to a trend in Western societies toward the normalization of homosexuality and emerging "post-gayness" among young people, who no longer consider their sexual identity meaningful in defining themselves. This article takes a closer look at the Dutch case where tolerance is regarded as a national virtue, while society remains heteronormative. In 38 interviews with Dutch same-sex-attracted young people, we investigated the labels they used to describe their sexual orientation to reveal what they can tell us about normalization, tolerance, and heteronormativity. In their labeling strategies, participants de-emphasized their sexual identity, othered, and reinforced the hetero/homo binary. They preferred labels without connotations to gender expression. While post-gay rhetoric was ideologically appealing, its use was not an outcome of their sexual orientation having become insignificant; it rather enabled them to produce normality. We discuss the findings against the backdrop of "Dutch tolerance," which rests on an ideology of normality.

Dangerous girls and cheating boys: Zulu-speaking disabled young peoples' constructs of heterosexual relationships in Kwazulu-Natal, South Africa

Across South Africa there is a growing body of work that explores gender dynamics in heterosexual relationships between young people aged 15-24 years. This is mainly influenced by the high prevalence of HIV and the incidence of intimate partner violence in this age group. Most studies to date have been based upon non-disabled young people, with limited focus on young disabled people. In an attempt to address this gap, this paper describes findings from a study conducted with 22 Zulu-speaking young people with visual and physical disabilities in KwaZulu-Natal. Throughout the findings, young disabled participants appeared to downplay their disability with respect to intimate relationships and accentuated the interweaving of complementary and contentious discourses of gender and cultural identity. Taking cognisance of the intersectionality of gender and cultural discourses, the paper extend constructs of disabled sexualities beyond an exclusive gaze on disability in the South African context.

Beyond alphabet soup: helping college health professionals understand sexual fluidity

Many college students today are no longer using the terms straight, gay, lesbian, bisexual, or transgender to self-identify their sexual orientation or gender identity. This commentary explores research related to fluidity of sexual identities, emerging sexual identities used by college students, and how these identities interact with the health and well-being of the student. Additionally, the authors discuss strategies to help college health professionals provide a sensitive environment and clinical experience for students whose sexual identity is fluid.

Associations of Health-Risk Behaviors and Health Cognition With Sexual Orientation Among Adolescents in School: Analysis of Pooled Data From Korean Nationwide Survey From 2008 to 2012

Homosexual adolescents may face significant health disparities. We examined health-risk behaviors and health cognition related to homosexual behavior in a representative sample of adolescents.Data were obtained from 129,900 adolescents between 2008 and 2012 over 5 cycles of the Korean Youth Risk Behavior Survey, a national survey of students in grades 7 to 12. Various health-risk behaviors and aspects of health cognition were compared between homosexual and heterosexual adolescents and analyzed with multiple logistic regression models.Compared with heterosexual adolescents (n = 127,594), homosexual adolescents (n = 2306) were more likely to engage in various health-risk behaviors and to have poor health cognition. In multiple logistic regression analysis, not living with parents, alcohol experience (adjusted odds ratio, 1.50; 95% confidence interval, 1.26-1.78 for males and 1.66; 1.33-2.07 for females), smoking experience (1.80; 1.54-2.10 for males and 3.15; 2.61-3.79 for females), and drug experience (3.65; 2.81-4.80 for males and 3.23; 2.35-4.46 for females) were associated with homosexual behavior. Homosexual adolescents were more likely to use adult internet content (2.82; 2.27-3.50 for males and 7.42; 4.19-13.15 for females), and to be depressed (1.21; 1.03-1.43 for males and 1.32; 1.06-1.64 for females). In addition, suicide ideation (1.51; 1.26-1.81 for males and 1.47; 1.16-1.86 for females) and attempts (1.67; 1.37-2.05 for males and 1.65; 1.34-2.03 for females) were significantly more prevalent among homosexual adolescents.Homosexual adolescents report disparities in various aspects of health-risk behavior and health cognition, including use of multiple substances, adult internet content and inappropriate weight loss methods, suicide ideation and attempts, and depressive mood. These factors should be addressed relevantly to develop specific interventions regarding sexual minorities.

Emotional Health of Lesbian, Gay, Bisexual and Questioning Bullies: Does It Differ from Straight Bullies?

Research demonstrates that young people involved in bullying are at greater risk for poor emotional health outcomes, but this association may not be consistent for youth of different sexual orientations. Understanding the unique needs of lesbian, gay, bisexual and questioning (LGBQ) youth may suggest important opportunities for intervention and prevention. This study, therefore, examines whether involvement with bullying is differentially associated with emotional well-being across sexual orientation. Survey data were collected from a large statewide sample of 9th and 11th grade students in 2013 (N = 79,039, 49.8% female, 74.6% white). Logistic regression tested associations between sexual orientation, physical or relational bullying perpetration and five measures of emotional health. In the full sample, those reporting bullying perpetration had significantly elevated odds of emotional health problems. However, interaction terms and stratified models indicated that in nine out of ten physical bullying models and two out of ten relational bullying models, perpetration was not as strongly associated with poor emotional health among LGBQ adolescents as it was among heterosexual youth. Possible explanations for this finding include unhealthy coping strategies or masking one's own vulnerable status as LGBQ. Continued efforts to prevent bullying are needed for all youth.

Salience, valence, context, and integration: conceptualizing the needs of sexually and gender diverse youth in P-12 schools

A framework for conceptualizing the needs of lesbian, gay male, bisexual, transgender, questioning, and other sexually and gender diverse youth is essential for guiding service delivery throughout educational settings. Review and synthesis of the literature reveals that integrating assessment of the salience, valence, and context of issues related to sexual and gender diversity facilitates affirmative practice at the individual student, group, and school-wide levels. The authors describe the components of the salience, valence, context, and integration (SVCI) model with emphasis on practical application. The theoretical and empirical support for each component of the model is also discussed.

Initial design of culturally informed behavioral intervention technologies: developing an mHealth intervention for young sexual minority men with generalized anxiety disorder and major depression

BACKGROUND

To our knowledge, there is no well-articulated process for the design of culturally informed behavioral intervention technologies.

OBJECTIVE

This paper describes the early stages of such a process, illustrated by the methodology for the ongoing development of a behavioral intervention technology targeting generalized anxiety disorder and major depression among young sexual minority men.

METHODS

We integrated instructional design for Internet behavioral intervention technologies with greater detail on information sources that can identify user needs in understudied populations, as well as advances in the understanding of technology-specific behavioral intervention technology dimensions that may need to be culturally tailored.

RESULTS

General psychological theory describing how to effect change in the clinical target is first integrated with theory describing potentially malleable factors that help explain the clinical problem within the population. Additional information sources are then used to (1) evaluate the theory, (2) identify population-specific factors that may affect users' ability to relate to and benefit from the behavioral intervention technology, and (3) establish specific skills, attitudes, knowledge, etc, required to change malleable factors posited in the theory. User needs result from synthesis of this information. Product requirements are then generated through application of the user needs to specific behavioral intervention technology dimensions (eg, technology platform). We provide examples of considerations relevant to each stage of this process and how they were applied.

CONCLUSIONS

This process can guide the initial design of other culturally informed behavioral intervention technologies. This first attempt to create a systematic design process can spur development of guidelines for design of behavioral intervention technologies aimed to reduce health disparities.

Office-based care for lesbian, gay, bisexual, transgender, and questioning youth

The American Academy of Pediatrics issued its last statement on homosexuality and adolescents in 2004. Although most lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are quite resilient and emerge from adolescence as healthy adults, the effects of homophobia and heterosexism can contribute to health disparities in mental health with higher rates of depression and suicidal ideation, higher rates of substance abuse, and more sexually transmitted and HIV infections. Pediatricians should have offices that are teen-friendly and welcoming to sexual minority youth. Obtaining a comprehensive, confidential, developmentally appropriate adolescent psychosocial history allows for the discovery of strengths and assets as well as risks. Referrals for mental health or substance abuse may be warranted. Sexually active LGBTQ youth should have sexually transmitted infection/HIV testing according to recommendations of the Sexually Transmitted Diseases Treatment Guidelines of the Centers for Disease Control and Prevention based on sexual behaviors. With appropriate assistance and care, sexual minority youth should live healthy, productive lives while transitioning through adolescence and young adulthood.

Office-based care for lesbian, gay, bisexual, transgender, and questioning youth

The American Academy of Pediatrics issued its last statement on homosexuality and adolescents in 2004. This technical report reflects the rapidly expanding medical and psychosocial literature about sexual minority youth. Pediatricians should be aware that some youth in their care may have concerns or questions about their sexual orientation or that of siblings, friends, parents, relatives, or others and should provide factual, current, nonjudgmental information in a confidential manner. Although most lesbian, gay, bisexual, transgender, and questioning(LGBTQ) youth are quite resilient and emerge from adolescence as healthy adults, the effects of homophobia and heterosexism can contribute to increased mental health issues for sexual minority youth. LGBTQ and MSM/WSW (men having sex with men and women having sex with women) adolescents, in comparison with heterosexual adolescents,have higher rates of depression and suicidal ideation, high errates of substance abuse, and more risky sexual behaviors. Obtaining a comprehensive, confidential, developmentally appropriate adolescent psychosocial history allows for the discovery of strengths and assets as well as risks. Pediatricians should have offices that are teen-friendly and welcoming to sexual minority youth. This includes having supportive, engaging office staff members who ensure that there are no barriers to care. For transgender youth, pediatricians should provide the opportunity to acknowledge and affirm their feelings of gender dysphoria and desires to transition to the opposite gender. Referral of transgender youth to a qualified mental health professional is critical to assist with the dysphoria, to educate them,and to assess their readiness for transition. With appropriate assistance and care, sexual minority youth should live healthy, productive lives while transitioning through adolescence and young adulthood.

High School Religious Context and Reports of Same-Sex Attraction and Sexual Identity in Young Adulthood

The objectives of this study are to understand the association between high school religious context in adolescence and the reporting of same-sex attraction and sexual identity in young adulthood and how these associations vary by gender. Previous studies have considered how high school contexts shape the well-being of sexual minority youth, yet few have examined the extent to which these contexts shape sexual desire and identity. We use data from the National Longitudinal Study of Adolescent Health and find that among women, school religious context is negatively associated with the likelihood of reporting same-sex attraction in young adulthood. We also find a negative association between school religious context and reporting a bisexual or flexible sexual identity among men and women. Finally, we find a positive association between mean school religious attendance and reporting a homosexual identity among men and women.

The interplay between online and offline explorations of identity, relationships, and sex: a mixed-methods study with LGBT youth

Although the Internet is commonly used by lesbian, gay, bisexual, and transgender (LGBT) youth to explore aspects of sexual health, little is known about how this usage relates to offline explorations and experiences. This study used a mixed-methods approach to investigate the interplay between online and offline explorations of multiple dimensions of sexual health, which include sexually transmitted infections, sexual identities, romantic relationships, and sexual behaviors. A diverse community sample of 32 LGBT youth (ages 16-24) completed semi-structured interviews, which were transcribed and then qualitatively coded to identify themes. Results indicated that, although many participants evaluated online sexual health resources with caution, they frequently used the Internet to compensate for perceived limitations in offline resources and relationships. Some participants turned to the Internet to find friends and romantic partners, citing the relative difficulty of establishing offline contact with LGBT peers. Further, participants perceived the Internet as an efficient way to discover offline LGBT events and services relevant to sexual health. These results suggest that LGBT youth are motivated to fill gaps in their offline sexual health resources (e.g., books and personal communications) with online information. The Internet is a setting that can be harnessed to provide support for the successful development of sexual health.

Patterns of alcohol use and consequences among empirically derived sexual minority subgroups

OBJECTIVE

The current study develops an empirically determined classification of sexual orientation developmental patterns based on participants' annual reports of self-identifications, sexual attractions, and sexual behaviors during the first 4 years of college. A secondary aim of the current work was to examine trajectories of alcohol involvement among identified subgroups.

METHOD

Data were drawn from a subsample of a longitudinal study of incoming first-time college students at a large, public university (n = 2,068). Longitudinal latent class analysis was used to classify sexual minority participants into empirically derived subgroups based on three self-reported facets of sexual orientation. Multivariate repeated-measures analyses were conducted to examine how trajectories of alcohol involvement varied by sexual orientation class membership.

RESULTS

Four unique subclasses of sexual orientation developmental patterns were identified for males and females: one consistently exclusively heterosexual group and three sexual minority groups. Despite generally similar alcohol use patterns among subclasses, certain sexual minority subgroups reported elevated levels of alcohol-related negative consequences and maladaptive motivations for use throughout college compared with their exclusively heterosexual counterparts.

CONCLUSIONS

Elevations in coping and conformity motivations for alcohol use were seen among those subgroups that also evidenced heightened negative alcohol-related consequences. Implications and limitations of the current work are discussed.

Relationship trajectories and psychological well-being among sexual minority youth

Dating in adolescence plays an integral part in the development of sexual and social identities. This process is particularly salient for sexual minority youth who face additional obstacles to their identity formation due to their marginalized status. We investigated the influence of participating in a same-sex relationship (SSR) or an opposite-sex relationship (OSR) on sexual minority youths' psychological well-being (i.e., symptoms of depression, anxiety and internalized homophobia, and self-esteem) in an ethnically-diverse sample of 350 youth (55% male) between the ages of 15-19 years, recruited from three GLBT drop-in centers in the New York City area. Using longitudinal data, we examined youths' SSR and OSR over time. Multivariate regression analyses suggest that involvement in a SSR was positively associated with changes in self-esteem in males, and negatively correlated with changes in internalized homophobia in females. We discuss the implications for positive development in sexual minority adolescent populations.

Sexual orientation and substance use trajectories in emerging adulthood

AIMS

The current study examined developmental changes in substance use behaviors (SUBS) based upon sexual orientation. The analyses also attempted to address a number of methodological limitations in the extant longitudinal literature (i.e. distinct operationalizations of sexual orientation, timing of sexual orientation assessment with respect to reports of SUBs, non-linear growth).

PARTICIPANTS

Data were drawn from a longitudinal study of incoming first-time college students at a large public university (n = 3720).

DESIGN

After a paper-and-pencil assessment just prior to matriculation, participants completed a web-based survey every fall and spring for 4 years (sub-sample n = 2854).

FINDINGS

Latent growth models revealed that sexual minorities demonstrated significant heterogeneity with regard to substance use trajectories. Initial levels and trajectories of the frequency of substance use for sexual minority individuals were distinct, generally, from their exclusively heterosexual peers. Methodologically, the timing of the assessment of sexual orientation influenced the results, and modeling non-linear components indicated that sexual minorities are at risk for exponential increases in their frequency of certain SUBs over time (i.e. drunkenness; cannabis use).

CONCLUSIONS

Sexual minority and majority individuals exhibited differences in SUBs during emerging adulthood, especially when using self-identification to define sexual orientation. Individuals who endorsed a sexual minority self-identification at the onset of emerging adulthood, as opposed to 4 years later, evidenced exponential increases in rates of drunkenness and cannabis use. These results support that the timing of assessment is important and that some trajectories of sexual minority SUBs are non-linear during this developmental period.