"Sometimes You Get Married on Facebook": The Use of Social Media Among Nonmetropolitan Sexual and Gender Minority Youth

How social is social media for transgender and gender-diverse youth? Association of online social experiences with internalizing mental health problems

Adolescents spend a critical amount of their free time on the Internet and social media. Transgender and gender-diverse (TGD) adolescents, who report elevated rates of mental health issues, especially internalizing problems, have both positive and negative online social experiences (e.g., support and cyberbullying). This can have both beneficial and/or harmful effects on their mental health. Given the lack of research, the present study examined TGD adolescents' online (social) experiences and the association of positive and negative online social experiences with internalizing problems. The sample consisted of n = 165 TGD adolescents (11-18 years) diagnosed with gender dysphoria who attended a Gender Identity Service for children and adolescents (Hamburg GIS) in Germany between January 2020 and December 2022 during the COVID-19 pandemic. Positive (use of online support networks) and negative online social experiences (cyberbullying or other adverse online interactions) were assessed using study-specific items and internalizing problems using the Youth Self-Report. Frequencies of various online (social) experiences were analyzed, and a multiple linear regression analysis was performed to test their association with internalizing problems. In total, 42% of participants reported positive online social experiences (use of online support networks) and 51% of participants reported negative online social experiences (cyberbullying or other adverse online interactions). There was no significant association between negative online social experiences and internalizing problems but between positive online social experiences and more internalizing problems (adjusted R2 = .01). TGD adolescents may seek online support, especially when struggling with mental health problems. Therefore, it is crucial to support youth navigating these online spaces more safely and positively and to empower them to buffer against potentially harmful experiences. Furthermore, strengthening offline relations with peers and family members is pivotal, given their importance for TGD adolescents' mental health.

Rural-Urban Differences in HIV Sexual Risk Behaviors and HIV Service Utilization Among Adolescent Sexual Minority Males in the United States

In the United States, HIV prevalence is increasing in rural areas, specifically among rural adolescent sexual minority males (ASMM). However, it is unclear what HIV sexual risk behaviors rural ASMM engage in and what HIV preventative services they utilize. This study aimed to (1) document the lifetime HIV sexual risk behaviors and service utilization of rural ASMM and (2) compare rural-urban differences in the prevalence of HIV sexual risk behaviors and service utilization. We analyzed data collected from 1615 ASMM who participated in a baseline survey for an online HIV prevention program from April 2018 to June 2020. We compared the prevalence of lifetime HIV sexual risk behaviors and HIV healthcare utilization among rural and urban participants via descriptive statistics, chi-square tests, linear and logistic regressions, and zero-inflated Poisson regressions. These analyses indicated that rural ASMM were more likely than urban ASMM to engage in condomless sex when they had anal sex. Rural ASMM could benefit from offline and online evidence-based HIV prevention interventions, especially interventions that increase condom use.

A Latent Profile Analysis of Social Support, Online Contacts, and Preference for Online Communication Among Same- and Both-Sex Attracted and Other-Sex Attracted Adolescents

This study aimed to assess differences between other-sex attracted and same- and both-sex attracted adolescents in profiles of peer and family social support, online contacts, and preferences for online communication. Data stem from the 2017 Dutch "Health and Behavior in School-Aged Children" (HBSC) survey (N = 6,823; 4.0% same- and both-sex attracted; M age=14.73, SD = 1.59, range = 12-18). We conducted latent profile analyses to estimate profiles in peer and family social support, online contacts, and preferences for online communication. Then we assessed the association between sexual attraction and profile membership. A five-profile solution fitted the data best. Profiles were characterized as high support, online contact, and average online communication preference (35.6%); high support, low online contact, and weak online communication preference (42.9%); average support, high online contact, and strong online communication preference (9.9%); low support, low online contact, and average online communication preference (6.9%); and low support, average online contact, and average online communication preference (5.0%). Same- and both-sex attracted adolescents had higher odds than other-sex attracted adolescents of being in the latter three profiles than in the first profile. Thus, same- and both-sex attracted adolescents were more likely to report average to low rates of peer and family social support, high to low frequency of online contact, and an average to strong preference for online communication than other-sex attracted adolescents. The average to low levels of support especially influenced these sexual orientation-based differences in profile membership.

Age Moderates the Association of Community Connectedness and Psychological Distress Among LGBTQ+ Youth and Adults

High levels of psychological distress present a major public health issue among LGBTQ+ youth and adults; however, research has repeatedly identified community connectedness as an important protective factor for mental health in LGBTQ+ populations. The aim of the present study was to examine whether age moderates the association of community connectedness on psychological distress in a community sample of LGBTQ+ people. In the present exploratory study, we analyzed secondary cross-sectional data from a sample of LGBTQ+ youth and adults (n = 292) in a semi-rural community in the Western United States. Participants completed a measure of community connectedness, the K6, and the PHQ-4. The results of two moderation models showed that the negative association of community connectedness on psychological distress was strongest among youth, weaker among young adults, and nonsignificant among older middle-aged adults and older adults. These results provide further evidence for the potential buffering role of community connectedness on psychological distress for LGBTQ+ youth and young adults.

A chatbot-delivered intervention for optimizing social media use and reducing perceived isolation among rural-living LGBTQ+ youth: Development, acceptability, usability, satisfaction, and utility

Background

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) youth are at higher risk of isolation and depression than their heterosexual peers. Having access to tailored mental health resources is a documented concern for rural living LGBTQ+ youth. Social media provides access to connections to a broader and like-minded community of peers, but it also is a vehicle for negative interactions. We developed REALbot, an automated, social media-based educational intervention to improve social media efficacy, reduce perceived isolation, and bolster connections for rural living LGBTQ+ youth. This report presents data on the acceptability, feasibility, and utility of REALbot among its target audience of rural living LGBTQ+ youth.

Methods

We conducted a week-long exploratory study with a single non-comparison group of 20 rural-living LGBTQ+ youth aged 14-19 recruited from social media to test our Facebook- and Instagram-delivered chatbot. We assessed pre- and post-test scores of social media self-efficacy, social isolation (4-item Patient-Reported Outcomes Measurement System - PROMIS), and depressive symptoms (Patient Health Questionnaire, Adolescent Version - PHQ-A). At post-test, we assessed acceptability (User Experience Questionnaire - UEQ-S), usability (Chatbot Usability Questionnaire -CUQ and Post-Study Satisfaction and Usability Questionnaire -PSSUQ), and satisfaction with the chatbot (Client Satisfaction Questionnaire - CSQ), along with two open-ended questions on 'likes' and 'dislikes' about the intervention. We compared pre- and post-test scores with standard univariate statistics. Means and standard deviations were calculated for usability, acceptability, and satisfaction. To analyze the responses to post-test open-end questions, we used a content analysis approach.

Results

Acceptability of REALbot was high with UEQ-S 5.3 out of 7 (SD = 1.1) and received high usability scores with CUQ and PSSUQ (mean score (M) = 78.0, SD = 14.5 and M = 86.9, SD = 25.2, respectively), as well as high user satisfaction with CSQ (M = 24.9, SD = 5.4). Themes related to user 'likes' and 'dislikes' were organized in two main categories: usability and content provided. Participants were engaged with the chatbot, sending an average of 49.3 messages (SD = 43.6, median = 30). Pre-/post- changes in scores of perceived isolation, depressive symptoms and social media self-efficacy were not significant (p's > 0.08).

Conclusion

REALbot deployment was found to be feasible and acceptable, with good usability and user satisfaction scores. Participants reported changes from pre- to post-test in most outcomes of interest and effect sizes were small to medium. Additional development and a formal evaluation of feasibility and engagement with behavioral targets is warranted.

Examining Social Media Experiences and Attitudes Toward Technology-Based Interventions for Reducing Social Isolation Among LGBTQ Youth Living in Rural United States: An Online Qualitative Study

Purpose

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth living in rural areas who feel isolated are at high risk of depression and suicidality. Given the lack of support in their offline communities, many rural-living LGBTQ youth turn to social media for social support. In this qualitative study, we examined rural LGBTQ youth's social media experiences and attitudes toward technology-based interventions for reducing perceived isolation.

Method

In Spring 2020, we conducted online interviews with LGBTQ youth aged 14-19, living in rural areas of the United States, who screened positive for perceived social isolation (n = 20; 11 cisgender sexual minority, 9 transgender). Interviews examined (1) supportive social media experiences, (2) personal strategies to improve social media experiences, and (3) perspective on potential digital intervention delivery modalities. Data were analyzed using thematic analysis.

Findings

Related to supportive content and interactions, themes included (1) positive representation of and connecting with LGBTQ groups on social media are important; (2) content from people with shared experience feels supportive, and (3) lack of feedback to one's experiences is isolating. Regarding personal strategies to improve social media experiences, themes were (1) selecting platforms to connect with different audiences helps make for a more enjoyable social media experience, and (2) several social media platform features can help make for a safer social media experience. Youth discussed advantages and disadvantages of intervention delivery via a mobile app, social media pages or groups, conversational agents (chatbots), and a dedicated website.

Conclusion

Viewing positive representation of and connecting with LGBTQ groups, content from people shared experiences, and utilizing a wide array of platform features to increase the likelihood of positive connections are key to a positive social media experience among this group. Combining delivery modalities is key to engaging rural-living LGBTQ youth in digitally delivered support interventions to reduce perceived isolation. Our results inform future intervention research and conversations about social determinants of health between providers and rural LGBTQ patients.

Impact of News Overload on Social Media News Curation: Mediating Role of News Avoidance

In this global village, easy access to news has resulted in many changes in the preferences and patterns of people for accessing news. Therefore, the present study has attempted to investigate the effects of news relevance, perceived quality, and news overloading on people's news curation preferences. This study has also examined the mediating role of news avoidance between the news relevance, perceived quality, and news overloading on the news curation. A quantitative technique has been employed to check the relationships proposed in the study. A sample size of 217 has been analyzed to check these hypotheses. The findings of the study revealed that news relevance has a negative impact while news overload positively and significantly impact the news curation. However, the news avoidance only mediated the relationship of news quality and news curation. Theoretically, the study has contributed to the literature of journalism and social media by finding that relevance of news has a negative significant impact on the news curation behavior of people, such that if they do not find the news relevant, they happily curate it. Practically, the study implies that the people are more prone to the quality of news rather than quantity; therefore, it is important for the news agencies to ensure that they produce and deliver the quality based news considering the accuracy to penetrate the Theoretic lass level.

Social media use and health and wellbeing of LGBTQ youth: A systematic review (Preprint)

Background

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals are at higher risk of poor mental health and well-being. Social media platforms can provide LGBTQ youths with a space that counters heteronormative environments and potentially supports mental health and well-being. Mental health includes an individual’s state of psychological and emotional well-being and not merely the absence of mental disorders.

Objective

We sought to identify how LGBTQ youths and adolescents use social media for connection with other LGBTQ peers and groups, identity development, and social support and how these affect mental health and well-being.

Methods

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) procedures were used to guide this review. Searches were conducted in ACM Digital Library, CINAHL, Ovid Embase, Ovid MEDLINE, and Web of Science in March 2021. This review focused on LGBTQ youths aged 10 to 24 years. Included peer-reviewed studies must comprise social media; explore peer connection, identity development, or social support; and be published from 2012 onward. In total, 2 researchers extracted data and performed quality assessments independently using the Newcastle-Ottawa Scale for quantitative articles and the Critical Appraisal Skills Programme for qualitative articles. Qualitative synthesis was performed on articles that satisfied the eligibility criteria.

Results

A total of 26 studies (n=15, 58% qualitative; n=8, 31% quantitative; n=3, 12% mixed methods) met the inclusion criteria. Of the 8 quantitative studies, 6 (75%) were cross-sectional, and 2 (25%) were cohort studies. All studies ranged from moderate to high quality. Social media was a popular tool used by LGBTQ youths to connect with LGBTQ communities. In qualitative data, we found that LGBTQ youths negotiated and explored identity and obtained support from peers on social media. Instagram, Tumblr, and Twitter were commonly used to access LGBTQ content owing to ease of anonymity. Identity management was the most studied social media affordance, important to LGBTQ youths for strategic disclosure. Key strategies for managing identities included being anonymous, censoring locations or content, restricting audiences, and using multiple accounts. Quantitative studies (3/8, 38%) showed that social media was associated with reduced mental health concerns and increased well-being among LGBTQ youths. Mental health concerns arising from social media use were attributed to discrimination, victimization, and policies that did not accommodate changed identities.

Conclusions

We found that social media may support the mental health and well-being of LGBTQ youths through peer connection, identity management, and social support, but findings were limited by weaknesses in the evidence. More robust and longitudinal studies are needed to determine the relationship between social media use and LGBTQ mental health, particularly among adolescents. The findings may inform interventions to promote social media health literacy and the mental health and well-being of this vulnerable group.

Trial Registration

PROSPERO CRD42020222535; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=222535

Protective Factors for LGBTI+ Youth Wellbeing: A Scoping Review Underpinned by Recognition Theory

Considerable research has been undertaken regarding the mental health inequalities experienced by lesbian, gay, bisexual, transgender and intersex (LGBTI+) youth as a consequence of societal and individual prejudice, stigma and discrimination. Far less research has focussed on protective factors that promote wellbeing for this population. A scoping review was conducted using a six-stage methodological framework, and is reported in accordance with the PRISMA-ScR statement. This explored the extent, range and nature of the peer-reviewed, published, academic literature on what is known about the protective factors that promote LGBTI+ youth wellbeing. Six databases were systematically searched applying Population–Concept–Context key inclusion criteria, complemented by contact with authors to identify additional sources, reference checks and hand searches. Ninety-six individual research records were identified and analysed, drawing from Honneth’s Recognition Theory. Interpersonal relations with parents (n = 40), peers (n = 32) and providers (n = 22) were associated with indicators of enhanced wellbeing, as were LGBTI+ community relations (n = 32). Importantly, online (n = 10), faith (n = 10) and cultural (n = 5) communities were potentially protective. Content and thematic analysis highlighted the importance of Gay–Straight Alliances (GSAs) (n = 23) offering powerful protective opportunities through intersecting interpersonal, community and legal forms of recognition. GSAs enhance allyship by peers and providers (n = 21), facilitate access to LGBTI+ community networks (n = 11) and co-exist alongside inclusive policies (n = 12), curricular (n = 5) and extracurricular activities (n = 1). This scoping review underscores the need to move beyond the predominant focus on risk factors for LGBTI+ youth, which subsequently inform protectionist approaches. It concludes with an appeal to develop mechanisms to apply recognitive justice to policy, practice and, importantly, future research directions. This emphasises the salience of enhanced understandings of inclusion, which is rights-based, universally available and of potential benefit to all.

Q Chat Space: Assessing the Feasibility and Acceptability of an Internet-Based Support Program for LGBTQ Youth

There are few psychosocial support programs specifically designed to meet the unique developmental and health needs of LGBTQ youth. Even when available, many youth face significant barriers to accessing LGBTQ-specific services for fear of being “outed” to parents, peers, and community members. The current study assessed the utility, feasibility, and acceptability of a synchronous, adult-facilitated, chat-based Internet community support program for LGBTQ youth aged 13–19. Chat transcripts were analyzed to examine how LGBTQ youth used the chat-based platform to connect with peers and trusted adults. A separate user satisfaction survey was collected to assess the personal (e.g., sexual orientation, gender identity, age) and contextual (e.g., geography, family environment) characteristics of youth engaging in the platform, their preferred topics of discussion, and their satisfaction with the program focus and facilitators. Qualitative data analysis demonstrated the degree to which LGBTQ youth were comfortable disclosing difficult and challenging situations with family, friends, and in their community and in seeking support from peers and facilitators online. Youth also used the platform to explore facets of sexual and gender identity/expression and self-acceptance. Overall, users were very satisfied with the platform, and participants accurately reflect the program’s desired populations for engagement (e.g., LGBTQ youth of color, LGBTQ youth in the South). Together, findings support the feasibility and acceptability of synchronous, adult-facilitated, chat-based Internet programs to connect and support LGBTQ youth, which encourage future research and innovation in service delivery.

LGBTQ+ Inclusion and Support: An Analysis of Challenges and Opportunities Within 4-H

LGBTQ+ youth experience health disparities compared with heterosexual and cisgender youth. Community-based, positive youth development organizations are an important resource to support and affirm LGBTQ+ youth. This study aimed to identify the opportunities and challenges in supporting LGBTQ+ youth within 4-H. The study took place in one state in the United States within a 4-H program and employed qualitative, community-based methods using SWOT (strengths, weaknesses, opportunities, threats) analyses and focus groups of 4-H staff, support staff, volunteers, and youth participants. The majority of participants were White and middle class with direct connections to the 4-H program. Thematic analyses were conducted by multiple analysts until consensus was reached. Challenges and opportunities emerged in 3 themes: (a) organizational climate; (b) policies and procedures; and (c) training, education, and resources. Two additional themes included opportunities only: (a) community engagement and (b) youth-specific resources. This study has important implications for the 4-H program, rural community practice, and research, including strategies to improve LGBTQ+ inclusivity through education, programs and policies, hiring, and community partnerships. Additionally, this study highlights the opportunity and unique positionality of the 4-H program to amplify youth voices in the creation of youth-specific resources.

A Qualitative Analysis of Adolescent Responses to YouTube Videos Portraying Sexual and Gender Minority Experiences: Belonging, Community, and Information Seeking

Sexual and gender minority youth are at risk for negative mental health outcomes, such as depression and suicide, due to stigma. Fortunately, sense of community, connection, and social support can ameliorate these deleterious effects. Youth express that most of their social support comes from peers and in-school organizations, but these sources require in-person interaction. Past research has identified social media sites as virtual and anonymous sources of support for these youth, but the role of YouTube specifically in this process has not been thoroughly explored. This study explores YouTube as a possible virtual source of support for sexual and gender minority youth by examining the ecological comments left on YouTube videos. A qualitative thematic analysis of YouTube comments resulted in six common themes in self-identified adolescents' YouTube comments: sharing, relating, information-seeking, gratitude, realization, and validation. Most commonly, adolescents shared feelings and experiences related to their identity, especially when they could relate to the experiences discussed in the videos. These young people also used their comments to ask for identity-related advice or information, treating the platform as a source of education. Results suggest that sexual minority youth's use of YouTube can be advantageous for social support and community, identity-related information, identity development, and overall well-being.