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Kelly NK, Ranapurwala SI, Pence BW, Hightow-Weidman LB, Slaughter-Acey J, French AL, Hosek S, Pettifor AE. The relationship between anti-LGBTQ+ legislation and HIV prevention among sexual and gender minoritized youth. AIDS 2024; 38:1543-1552. [PMID: 38742882 PMCID: PMC11239282 DOI: 10.1097/qad.0000000000003926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The aim of this study was to estimate the longitudinal associations of state-level anti-LGBTQ+ policies and county-level politics with individual HIV prevention outcomes among sexual and gender minoritized (SGM) youth. DESIGN Keeping it LITE-1 prospectively enrolled 3330 SGM youth and young adults (ages 13-34) at increased risk of HIV throughout the United States from 2017 to 2022. METHODS Semiannual surveys collected self-reported HIV prevention measures [current preexposure prophylaxis (PrEP) use, weekly PrEP adherence, HIV/STI testing in the past 6 months]. Geolocation was linked with state-level LGBTQ+ policy data and county-level election data. Generalized linear models with GEE estimated the single and joint longitudinal associations for two exposures [state-level policy climate (more discriminatory vs. less discriminatory) and county-level political majority (Democratic/swing vs. Republican)] with each outcome. RESULTS Among participants living in a state with more discriminatory laws, those in a Democratic/swing county had a 6-percentage point increase in PrEP use (95% confidence interval: 0.02, 0.09) compared to those in a Republican county. Those living in a Republican county but a state with less discriminatory laws saw a similar increase (0.05; -0.02,0.11). Residing in both a Democratic/swing county and a state with less discriminatory laws, relative to a Republican county and a state with more discriminatory laws, was associated with a 10-percentage point increase in PrEP use (0.10; 0.06,0.14) and a 5-percentage point increase in HIV/STI testing (0.05; 0.00,0.09). CONCLUSION More progressive state and local policies were each associated with increased PrEP use, and together, doubled the magnitude of this association. PrEP is underutilized among SGM youth, and anti-LGBTQ+ policies may exacerbate this gap in coverage.
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Affiliation(s)
- Nicole K Kelly
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Shabbar I Ranapurwala
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brian W Pence
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lisa B Hightow-Weidman
- Institute on Digital Health and Innovation, Florida State University, College of Nursing, Tallahassee, Florida
| | - Jaime Slaughter-Acey
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Audrey L French
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sybil Hosek
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Audrey E Pettifor
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Wallace ER, O'Neill S, Lagdon S. Risk and protective factors for suicidality among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) young people, from countries with a high global acceptance index (GAI), within the context of the socio-ecological model: A scoping review. J Adolesc 2024; 96:897-924. [PMID: 38372179 DOI: 10.1002/jad.12308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) young people experience higher prevalence rates of suicidality than their heterosexual and/or cisgender peers. However, there is limited research that can inform suicide prevention efforts. Our aim was to synthesize quantitative, qualitative, and mixed methods research on risk and protective factors among LGBTQ+ young people, from countries with a high Global Acceptance Index. METHODS A scoping review guided by Arksey and O'Malley's five-stage framework, using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews protocol. Five databases and grey literature were searched for relevant studies. Identified factors were clustered by thematic type, according to the socio-ecological model to identify empirical trends and knowledge gaps. The mixed methods appraisal tool was used for quality assessment of studies. RESULTS Sixty-six studies met our inclusion criteria. Overall, 59 unique risk factors and 37 unique protective factors were identified. Key risk factors include past suicidality, adverse childhood experiences, internalized queerphobia, minority stress, interpersonal violence, bullying, familial conflict, and anti-LGBTQ+ policies/legislation. Key protective factors include self-affirming strategies, adult/peer support, at-school safety, access to inclusive healthcare, family connectedness, positive coming out experiences, gender-affirming services and LGBTQ+ inclusive policies and legislation. CONCLUSIONS Overall, our findings affirm that multiple risk and protective factors, at all levels of the socio-ecological model, interact in complex, unique and diverse ways upon suicidality among LGBTQ+ young people. Implications for suicide prevention are discussed. Further empirical studies are required, particularly at the communities, policies, and societal levels of the socio-ecological model, and these studies should include a focus on protective factors and significant within-group differences.
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Affiliation(s)
| | - Siobhan O'Neill
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Susan Lagdon
- School of Psychology, Ulster University, Coleraine, Northern Ireland
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Ricks JM, Montgomery CM, Nash JA. Measurement of Adolescent Dating Violence in Sexual Minority Youth: A Scoping Review. AGGRESSION AND VIOLENT BEHAVIOR 2023; 73:101870. [PMID: 37587915 PMCID: PMC10426751 DOI: 10.1016/j.avb.2023.101870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Effectively addressing adolescent dating violence rests on the quality of its measurement, as that has substantial implications for our understanding of prevalence, correlates, outcomes. Although dating violence is highly prevalent among sexual minority youth, the state of measurement in this population has scarcely been explored. This scoping review presents information on the measurement of adolescent dating violence in exiting studies conducted with sexual minority youth. Three databases were searched, and the ancestry approach was used to identify relevant literature published in the United States between 1992-2022 that included sexual minority adolescents aged 19 years or younger. Twenty-one articles were identified. Five enrolled entirely sexual minority samples. Sexual minority distribution ranged from 2.1%-100%. All studies operationalized sexual identity as an orientation (not sexual behavior, attraction). Nineteen studies focused on measuring dating violence behavior. Twelve reported on female and male victimization, 4 on female and male perpetration and victimization, 2 on female perpetration and victimization, and 2 on female victimization-only. Most commonly used items were from the Youth Risk Behavior Survey (11 studies) and the Conflict in Adolescent Dating Relationships Inventory (3 studies). Two studies assessed knowledge of and attitudes toward dating violence. Domains explored included rape myth acceptance, victim empathy, bystander opportunity, and dating abuse knowledge. Only two scales had undergone previous systematic psychometric evaluation. There was no evidence of cross-cultural validation in sexual minority populations. Rigorous research on adolescent dating violence measurement among sexual minority youth is greatly needed and should be given priority among researchers.
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Affiliation(s)
- JaNelle M. Ricks
- Ohio State University College of Public Health, Division of Health Behavior and Health Promotion, 1841 Neil Ave, Columbus OH 43210, United States
| | - Courtni M. Montgomery
- Ohio State University College of Public Health, Division of Health Behavior and Health Promotion, 1841 Neil Ave, Columbus OH 43210, United States
| | - Jimmy A. Nash
- Ohio State University College of Public Health, Division of Health Behavior and Health Promotion, 1841 Neil Ave, Columbus OH 43210, United States
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Pereira DG, Francisco LM. Loneliness, affective disorders, suicidal ideation, and the use of psychoactive substances in a sample of adolescents during the COVID-19 pandemic: A cross-sectional study. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2023; 36:327-328. [PMID: 37190923 DOI: 10.1111/jcap.12423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/07/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Diana Gomes Pereira
- Institute of Health Sciences, Universidade Católica Portuguesa, Lisbon, Portugal
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Baiden P, Onyeaka HK, Aneni K, Wood BM, LaBrenz CA, Hagedorn A, Muoghalu C, Gobodzo EC, Baiden JF, Adeku Y, Mets VE, Brown FA. Racial/ethnic differences in adolescents' non-response to suicide attempt: Findings from the Youth Risk Behavior Survey, 2015-2019. J Psychiatr Res 2023; 166:115-121. [PMID: 37757704 DOI: 10.1016/j.jpsychires.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 07/13/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023]
Abstract
Racial/ethnic minority adolescents are at greater risk of attempting suicide compared to their White counterparts. Yet, racial/ethnic minority adolescents are more likely to not respond to questions on suicidal behaviors. The objective of this study was to investigate the association between race/ethnicity and missing response to suicide attempt among adolescents in the United States. Data for this study were obtained the 2015-2019 national Youth Risk Behavior Survey (n = 40,360). The outcome variable investigated in this study was missing response to suicide attempt and the main explanatory variable was race/ethnicity. Two hierarchical binary logistic regression models were fitted to examine the association between race/ethnicity and missing response to suicide attempt. Of the 40,036 adolescents, 13.4% had missing response to suicide attempt. Controlling for the effects of demographic factors and symptoms of depression, adolescents who self-identified as non-Hispanic Black had more than threefold higher odds of having missing response to suicide attempt when compared to their non-Hispanic White counterparts (AOR = 3.62, p < .001, 95% CI = 2.45-5.34). Adolescent males and adolescents questioning their sexual identity had higher odds of having missing response to suicide attempt. Adolescents with depressive symptoms had lower odds of having missing response to suicide attempt. Missing response to suicide attempt among adolescents continues to differ by race/ethnicity and other demographic factors. The use of a single item in assessing suicide attempt history may be inadequate in capturing national estimates of adolescent suicide metrics.
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Affiliation(s)
- Philip Baiden
- The University of Texas at Arlington, School of Social Work, 501 W. Mitchell St., Box 19129, Arlington, TX, 76010, USA.
| | - Henry K Onyeaka
- Harvard Medical School, Department of Psychiatry, Boston, MA, 02115, USA; Massachusetts General Hospital, Department of Psychiatry, Boston, MA, 02115, USA; McLean Hospital, Department of Psychiatry, Boston, MA, 02478, USA
| | | | - Bethany M Wood
- The University of Texas at Arlington, School of Social Work, 501 W. Mitchell St., Box 19129, Arlington, TX, 76010, USA
| | - Catherine A LaBrenz
- The University of Texas at Arlington, School of Social Work, 501 W. Mitchell St., Box 19129, Arlington, TX, 76010, USA
| | - Aaron Hagedorn
- The University of Texas at Arlington, School of Social Work, 501 W. Mitchell St., Box 19129, Arlington, TX, 76010, USA
| | | | | | - John F Baiden
- East Airport International School, P. O. Box KAPM 57, KIA, Accra, Ghana
| | - Yvonne Adeku
- Western University, Department of Sociology, Social Science Centre, Room 5306, London, Ontario, N6A 5C2, Canada
| | - Vera E Mets
- University of Ghana, Legon, Department of Social Work, P. O. Box LG 419, Legon, Accra, Ghana
| | - Fawn A Brown
- The University of Texas at Arlington, Department of Psychology, 501 Nedderman Dr., Box 19528, Arlington, TX, 76019, USA
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Mandatori F, Paez GR, Briones Robinson R, Severson R. Comparing the Effects of Victimization, School Connectedness, and Social Support on Heterosexual and Sexual Minority Adolescent Suicidality in the United States: A Partial Test of Minority Stress Theory. JOURNAL OF INTERPERSONAL VIOLENCE 2023:8862605231168822. [PMID: 37066807 DOI: 10.1177/08862605231168822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
In the United States, sexual minority adolescents are among the subpopulations at the highest risk for suicide; yet, predictors of suicidality among this unique group remain significantly understudied. Drawing from Meyer's minority stress theory (MST), this study examines whether general stressors act as predictors of adolescent suicidality and whether differences exist in the variation of these effects between heterosexual and sexual minority adolescents. Specifically, multivariate logistic regression models were developed to examine the impact that victimization, school connectedness, and social support have on heterosexual and sexual minority adolescent suicidality using a sample of 166,176 U.S. adolescents drawn from the 2019 Minnesota Student Survey. Participants ranged from 10 to 18 years of age and identified as heterosexual, bisexual, gay or lesbian, questioning, pansexual, queer, or as none of these. Findings highlight that sexual minorities (Exp(B) = 1.870, p < .001) were roughly twice as likely to report suicidality compared to their heterosexual peers. All victimization measures were highly predictive of suicidality among heterosexual and sexual minority adolescents. Overall, adolescents who were less connected to their school setting and more socially isolated were also more likely to experience suicidality; however, such effects were not reflected uniformly in every item measuring school connectedness and social support. Findings highlight important avenues for policies implementation aimed at mitigating the effects of multiple sources of stressors on adolescents' mental health and reducing adolescents' suicide rates. Interventions tailored to the unique needs of sexual minority adolescents are needed to address their disproportionate representation among those at risk for suicide.
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DeMello AS, Peskin MF, Hill RM, Casarez RL, Santa Maria DM. The Impact of Bullying Victimization and Sexual Orientation on the Severity of Suicidal Behavior. VIOLENCE AND VICTIMS 2022; 37:641-658. [PMID: 36192122 DOI: 10.1891/vv-2021-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background: Lesbian, gay, and bisexual youth face a disproportionate risk of suicidal ideation and attempt compared to heterosexual counterparts. Escalation from ideation to attempt can occur quickly, and youth who survive suicide attempts are likely to pursue subsequent, riskier attempts. This study examines the effects of bullying and sexual orientation on suicidal outcomes. Methods: Data came from the national, school-administered 2017 Youth Risk Behavior Survey (N = 14,765). Bivariate associations, binomial logistic regressions, and ordinal logistic regressions were performed. Results: Lesbian/gay, bisexual, and unsure youth reported greater odds of ideation and attempts compared to heterosexual youth. For ideation, increased effects were inconsistent across bullying types and significant interactions were found for bisexual youth who were bullied in school, and for lesbian/gay youth who were cyberbullied. Conclusion: These results underscore the need to understand bullying victimization for lesbian, gay, and bisexual youth. Awareness of increasing cyberbullying and creating school environments of no-bullying tolerance in the post-pandemic era are among the challenges ahead.
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Affiliation(s)
- Annalyn S DeMello
- The University of Texas, Medical Branch, School of Nursing, Galveston, Texas, USA
| | - Melissa F Peskin
- The University of Texas Health Science Center, School of Public Health, Houston, Texas, USA
| | - Ryan M Hill
- Baylor College of Medicine and Texas Children's Hospital, Section of Psychology, Houston, Texas, USA
| | - Rebecca L Casarez
- The University of Texas Health Science Center, Cizik School of Nursing, Houston, Texas, USA
| | - Diane M Santa Maria
- The University of Texas Health Science Center, Cizik School of Nursing, Houston, Texas, USA
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O’Malley MD, Cerna R, Romero L, Zhang G, Furlong MJ. Reducing the Impact of Bias-Based Bullying on Suicidal Thoughts Among Sexual and Gender Minority Youth: Are Psychological Strengths Enough? SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-021-09490-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Luk JW, Goldstein RB, Yu J, Haynie DL, Gilman SE. Sexual Minority Status and Age of Onset of Adolescent Suicide Ideation and Behavior. Pediatrics 2021; 148:e2020034900. [PMID: 34580171 PMCID: PMC9446478 DOI: 10.1542/peds.2020-034900] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine if sexual minority adolescents have earlier onset of suicidality and faster progressions from ideation to plan and attempt than heterosexual adolescents. METHODS A population-based longitudinal cohort of 1771 adolescents participated in the NEXT Generation Health Study. Participants reported sexual minority status (defined by sexual attraction) in 2010-2011 and retrospectively reported age at onset of suicidality in 2015-2016. RESULTS Sexual minority adolescents (5.8% of weighted sample) had higher lifetime risk of suicide ideation (26.1% vs 13.0%), plan (16.6% vs 5.4%), and attempt (12.0% vs 5.4%) than heterosexual adolescents. Survival analyses adjusted for demographic characteristics and depressive symptoms revealed positive associations of sexual minority status with time to first onset of suicide ideation (hazard ratio [HR] = 1.77; 95% confidence interval [CI] 1.03-3.06) and plan (HR = 2.69; 95% CI 1.30-5.56). The association between sexual minority status and age at onset of suicide attempt was stronger at age <15 (HR = 3.26; 95% CI 1.25-8.47) than age ≥15 (HR = 0.59; 95% CI 0.21-1.66). The association between sexual minority status and progression from ideation to plan was stronger in the same year of first ideation (HR = 2.01; 95% CI 1.07-3.77) than ≥1 year after first ideation (HR = 1.33; 95% CI 0.26-6.77). CONCLUSIONS Sexual minority adolescents had earlier onset of suicidality and faster progression from suicide ideation to plan than heterosexual adolescents. The assessment of sexual minority status in routine pediatric care has the potential to inform suicide risk screening, management, and intervention efforts among early sexual minority adolescents.
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Affiliation(s)
- Jeremy W Luk
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Risë B Goldstein
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Jing Yu
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Denise L Haynie
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Stephen E Gilman
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Self-Injurious Thoughts and Behaviors Among Sexual and Gender Minority Youth: a Systematic Review of Recent Research. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00295-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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