Coming Out to Dad: Young Gay and Bisexual Men's Experiences Disclosing Same-Sex Attraction to Their Fathers

Definitions and Measurement Tools for Assessing Parental Reactions to LGB People Coming Out: A Critical Review

Parental responses to young people's coming out as lesbian, gay or bisexual (LGB) are a crucial experience in identity formation and subsequent mental health outcomes. However, how parents react to coming out varies and remains relatively imprecise in the literature. The aim of the present critical review was to explore and discuss the different definitions and measurement tools used in studies assessing perceived parental reactions to the coming out of LGB people aged 18 years and over. Following PRISMA guidelines, a review of 14 selected articles was carried out to examine the different tools used. Then, based on this selection of articles, a review of the different proposed definitions of parental reactions was carried out. Analysis revealed that the Perceived Parental Reactions Scale emerged as the most widely used and most appropriate international scale for capturing the diversity of perceived parental reactions. Then, parental responses were often addressed in a dichotomous manner, focusing primarily on acceptance or rejection. Future studies will need to consider a more nuanced approach to understanding parental reactions to coming out.

Measurement equivalence of family acceptance/rejection among sexual and gender minority youth by disclosure status

Family acceptance is a crucial component of healthy development during adolescence, especially for sexual and gender minority youth (SGMY) who often fear rejection from family members. Studies focused on SGMY family environments often utilize broad measures that fail to capture SGMY-specific aspects of family acceptance and rejection. Less research has considered how the measurement of family acceptance and rejection might differ depending on whether SGMY have disclosed their sexual and/or gender identities to their parents. We used data from a national nonprobability sample of 9,127 SGMY in the United States who had either disclosed (n = 6,683) or not disclosed (n = 2,444) their sexual and/or gender identities to parents to test the factor structure of an eight-item measure of family acceptance and rejection and differences by disclosure status. A two-factor, negatively correlated model reflecting constructs of family acceptance and family rejection was equivalent across disclosure groups. Youth who had disclosed their identity reported greater acceptance and less rejection and showed a stronger negative association between the two constructs than nondisclosed youth. Family acceptance, but not rejection, had higher variability among disclosed youth than nondisclosed youth. Results suggest that the family environments of SGMY are simultaneously characterized by accepting and rejecting behaviors. Though families of disclosed youth appear to be more accepting and less rejecting, the experiences of these youth are complex. Findings suggest that research on SGMY family environment must consider both supportive and undermining behaviors and that the measures assessed here operate similarly for youth based on disclosure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Impacts of psychological wellbeing with HIV/AIDS and cancer among sexual and gender minorities: A systematic review and meta-analysis

Background

The agony and economic strain of cancer and HIV/AIDS therapies severely impact patients' psychological wellbeing. Meanwhile, sexual minorities experience discrimination and mental illness. LGBT individuals with cancer and HIV/AIDS play two roles. It is important to understand and examine this groups mental wellbeing.

Objective

The purpose of this study is to synthesize current studies on the impact of HIV/AIDS and cancer on LGBT patients' psychological wellbeing.

Methods

This research uses a systematic literature review at first and later stage a meta-analysis was run on the same review. In this study, data from Google academic and Web of Science has been used to filter literature. PRISMA 2020 Flow Diagram seeks research on LGBT cancer and HIV/AIDS patients. The above sites yielded 370 related papers, some of which were removed due to age or inaccuracy. Finally, meta-analyses was done on 27 HIV/AIDS and 33 cancer patients's analyse.

Results

The research included 9,898 LGBT cancer sufferers with AIDS and 14,465 cancer sufferers with HIV/AIDS. Using meta-analysis, we discovered the gap in psychological wellbeing scores between HIV/AIDS LGBT and non-LGBT groups ranged from -10.86 to 15.63. The overall score disparity between the HIV/AIDS LGBT and non-LGBT groups was 1.270 (95% CI = 0.990-1.560, Z = 86.58, P < 0.1). The disparity in psychological wellbeing scores between cancer LGBT group and general group varies from -8.77 to 20.94 in the 34 papers examined in this study. Overall, the psychological wellbeing score disparity between the cancer LGBT subset and the general group was 12.48 (95% CI was 10.05-14.92, Test Z-value was 268.40, P-value was <0.1).

Conclusion

Inflammation and fibrosis in HIV/AIDS and cancer sufferers adversely affect their psychological wellbeing.

Investigating Protective Factors Associated With Mental Health Outcomes in Sexual Minority Youth

PURPOSE

The aim of this study is to identify and evaluate the efficacy of adolescent protective factors against mental health (MH) outcomes in young adulthood of sexual minority identifying youth (SMY).

METHODS

Using data from the National Longitudinal Study of Adolescent to Adult Health, we identified potential protective factors (e.g., individual factors like self-esteem, family factors like family communication, and community factors like caring teachers) at baseline (1994) when the sample was school-aged for SMY. SMY included those who identified their sexual identity as mostly heterosexual, bisexual, mostly homosexual, or 100% homosexual. MH outcomes (depression, anxiety, or suicidality) were assessed at 14-year follow-up.

RESULTS

Approximately 14,800 youth completed baseline and follow-up surveys, where 13.5% identified as SMY. Of SMY, 57% had a MH outcome compared to 37% of non-SMY (p < .05). Not all factors were protective for SMY. At the individual level, emotional well-being (adjusted odds ratio [AOR] .56, 95% confidence interval [CI] .41-.78) and self-esteem (AOR .79, 95% CI .66-.95) were found to be protective for MH outcomes in regression models. At the family level, family connectedness (AOR .82, 95% CI .71-.95) was found to be protective. At the community level, school connectedness (AOR .78, 95% CI .66-.92) and caring teachers (AOR .76, 95% CI .58-.99) were found to be protective for SMY.

CONCLUSION

Factors at the individual, family, and community (e.g., caring teachers) levels appear to be protective against MH outcomes unique to SMY. Developing interventions focused on protective factors have potential to prevent health disparities.

“Here in the Bible Belt, It’s Predominantly Negative”: Sexual Identity Stigma in the American South, 50 Years After Stonewall

Lesbian, gay, bisexual, and pansexual (LGB+) individuals have disproportionate rates of mental illness. Minority stress and sexual identity stigma are posited as the primary social determinants of LGB+ mental health disparities. Discussions in the literature have questioned the impact of sexual identity stigma in a world increasingly accepting of sexual minorities. Additionally, the LGB+ population in the United States South is often overlooked in American research. This article details a qualitative study exploring experiences related to sexual identity stigma among adults who identify as LGB+ in the United States South. Semi-structured interviews with 16 individuals were analyzed using content analysis. Six thematic categories of stigma emerged from participants’ experiences: (a) navigating an LGB+ identity, (b) social acceptability of an LGB+ identity, (c) expectation of LGB+ stigma, (d) interpersonal discrimination and harassment, (e) structural stigma, and (f) relationship with the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community. Findings suggest that sexual identity stigma remains a common experience among these Southern United States participants. Further, thematic categories and subcategories primarily aligned with extant theory with one exception: Intracommunity stigma, a form of stigma emanating from the LGBTQ community, emerged as a stigma type not currently accounted for in theoretical foundations underpinning mental health disparities in this population.

Associations Between Fathers' Masculinity Orientation and Anticipated Reaction Toward Their Child's Coming Out

The present study examined associations between fathers' masculinity orientation and their anticipated reaction toward their child's coming out as lesbian or gay (LG). Participants were 134 German fathers (28 to 60years) of a minor child. They were asked how they would personally react if, one day, their child disclosed their LG identity to them. As hypothesized, fathers with a stronger masculinity orientation (i.e., adherence to traditional male gender norms, such as independence, assertiveness, and physical strength) reported that they would be more likely to reject their LG child. This association was serially mediated by two factors: fathers' general anti-LG attitudes (i.e., level of homophobia) and their emotional distress due to their child's coming out (e.g., feelings of anger, shame, or sadness). The result pattern was independent of the child's gender or age. The discussion centers on the problematic role of traditional masculinity when it comes to fathers' acceptance of their non-heterosexual child.

The interplay of familial warmth and LGBTQ+ specific family rejection on LGBTQ+ adolescents' self-esteem

INTRODUCTION

Our study sought to assess the interplay of family dynamics, namely familial warmth and LGBTQ+ specific rejection, and its association to self-esteem in a non-probabilistic sample of LGBTQ+ adolescents in the United States.

METHODS

Stratified by (1) cisgender and (2) transgender and non-binary LGBTQ+ adolescents (N = 8774), we tested multivariable regression analyses to assess the association between familial warmth and LGBTQ+ specific family rejection, adjusted for sociodemographic characteristics. We then conducted a sub-analysis with LGBTQ+ adolescents who reported being out to any family member about their LGBTQ+ identity; specifically, we tested a series of multivariable regression models to assess whether levels of LGBTQ+ specific family rejection attenuated the association between familial warmth and self-esteem.

RESULTS

Full sample models indicated a positive association between familial warmth and self-esteem. Findings from our sub-analysis indicated that familial warmth remained positively linked to self-esteem and family rejection was negatively associated with self-esteem. Family rejection was a statistically significant moderator, attenuating the association between familial warmth and self-esteem. With respect to being out about one's sexual orientation, these findings were robust across gender stratification groups.

CONCLUSIONS

Families of origin serve as sources of stress and resilience for LGBTQ+ adolescents. Our findings contribute support to arguments that familial warmth and LGBTQ+ specific rejection are not mutually-exclusive experiences among LGBTQ+ adolescents. We provide recommendations for multilevel interventions to leverage activities that support positive family dynamics and self-esteem among LGBTQ+ adolescents.

Same-Sex Attraction Disclosure and Sexual Communication Topics within Families

Few studies compare family communication about sex and relationships for sexual minority youth versus hetero-sexual teenagers. Further, existing studies often focus on mothers, overlooking fathers and extended family. Our survey of 952 adolescents aged 14-21 included 115 adolescents disclosing non-heterosexual attraction. Mothers offered more sexual protection methods messages to their non-SM teens, whereas fathers talked less with SM teens about risks of sex and relational sex. Most participants identified mothers, sisters, and female cousins, with male SMs having the highest number of disclosures to family members, whereas female and non-binary SMs confided in fewer family members or no one.

Evaluation of a Stepped-Care eHealth HIV Prevention Program for Diverse Adolescent Men Who Have Sex With Men: Protocol for a Hybrid Type 1 Effectiveness Implementation Trial of SMART

BACKGROUND

Adolescent men who have sex with men (AMSM), aged 13 to 18 years, account for more than 80% of teen HIV occurrences. Despite this disproportionate burden, there is a conspicuous lack of evidence-based HIV prevention programs. Implementation issues are critical as traditional HIV prevention delivery channels (eg, community-based organizations, schools) have significant access limitations for AMSM. As such, eHealth interventions, such as our proposed SMART program, represent an excellent modality for delivering AMSM-specific intervention material where youth are.

OBJECTIVE

This randomized trial aimed to test the effectiveness of the SMART program in reducing condom-less anal sex and increasing condom self-efficacy, condom use intentions, and HIV testing for AMSM. We also plan to test whether SMART has differential effectiveness across important subgroups of AMSM based on race and ethnicity, urban versus rural residence, age, socioeconomic status, and participation in an English versus a Spanish version of SMART.

METHODS

Using a sequential multiple assignment randomized trial design, we will evaluate the impact of a stepped-care package of increasingly intensive eHealth interventions (ie, the universal, information-based SMART Sex Ed; the more intensive, selective SMART Squad; and a higher cost, indicated SMART Sessions). All intervention content is available in English and Spanish. Participants are recruited primarily from social media sources using paid and unpaid advertisements.

RESULTS

The trial has enrolled 1285 AMSM aged 13 to 18 years, with a target enrollment of 1878. Recruitment concluded in June 2020. Participants were recruited from 49 US states as well as Puerto Rico and the District of Columbia. Assessments of intervention outcomes at 3, 6, 9, and 12 months are ongoing.

CONCLUSIONS

SMART is the first web-based program for AMSM to take a stepped-care approach to sexual education and HIV prevention. This design indicates that SMART delivers resources to all adolescents, but more costly treatments (eg, video chat counseling in SMART Sessions) are conserved for individuals who need them the most. SMART has the potential to reach AMSM to provide them with a sex-positive curriculum that empowers them with the information, motivation, and skills to make better health choices.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT03511131; https://clinicaltrials.gov/ct2/show/NCT03511131.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/19701.

Family Characteristics in Sex Communication and Social Support: Implications for Emerging Adult Men Who Have Sex with Men's PrEP Engagement

While emerging adulthood (ages 18-25) is marked by increased independence from parents, parental support remains a strong correlate of positive sexual health outcomes for heterosexual youth. With the emergence of pre-exposure prophylaxis (PrEP), few studies have examined the potential for parent-child sex communication and PrEP adoption among emerging adult men who have sex with men (MSM). We aimed to describe the extent to which parents/family characteristics play supportive roles in emerging adult MSM's current PrEP use. PrEP-indicated participants (N = 222) were recruited via social media to complete an online survey. Multivariable logistic regression assessed associations between emerging adult MSM's current PrEP use and comfort with parent-child sex communication, family social support, family outness, and family prioritization, adjusted for sociodemographic variables. Thirty percent of participants reported current PrEP use. Only 20% reported moderate/high comfort with parent sex communication, 80% reported any family sexual identity disclosure, 70% reported moderate/high family social support, and 70% ranked family as a high/very high priority. Our multivariable model demonstrated an association between comfort with parent-child sex communication with current PrEP use only (AOR= 1.55, 95% CI 1.04-2.32). Our findings support that parents of emerging adult MSM possess a critical potential to reduce their sons' risk of HIV and promote PrEP uptake. Interventions that facilitate parents' efficacy to foster affirming, non-judgmental environments and discussions about their child's sexual behaviors, attractions/relationships, and health (e.g., PrEP) may be impactful in reducing the high HIV incidence rate that burdens emerging adult MSM.

Minority Stress, Parenting Styles, and Mental Health in Brazilian Homosexual Men

Homosexual men are constantly exposed to prejudice and violence in Brazil. The aim of this study was to investigate the relationship between minority stress, parenting styles, and indicators of mental health problems in a sample of homosexual men.

METHOD

quantitative, cross-sectional, correlational, and retrospective design. Participants were 101 Brazilian men who selfidentified as homosexuals, aged between 18 and 55 years.

RESULTS

concealing sexual identity was a predictor of depression and stress. Parental responsiveness was associated with a lower incidence of enacted stigma and depression.

CONCLUSIONS

the mental health of homosexual men can be negatively affected by the need to conceal their sexual orientation. Parental responsiveness is a protective factor in terms of experiencing enacted stigma and depression. The results found in the study may be useful for counselors and social workers who are working with LGBT people and their families.

Policing Heteronormativity and Sexual Risk-Taking Among Young Adult Men Who Have Sex with Men in the Detroit Metro Area

Policing gender and sexuality can have enduring health implications for the well-being of young men who have sex with men (YMSM). Using data from a community-based sample of YMSM in the Detroit Metro Area (N = 364), we examined the prevalence of lifetime heteronormative policing by gender (e.g., punished/restricted for femininity) and sexuality (e.g., attempts to alter same-sex attractions). We examined the associations of heteronormative policing attempts and the number of condomless insertive and receptive anal intercourse partners, respectively. We also tested whether internalized homophobia moderated the association between sexuality policing and sexual risk. Multivariable models demonstrated that policing sexuality, but not gender, was associated with a greater number of partners in which participants engaged in condomless intercourse as the receptive partner. We observed no interaction between policing sexuality and internalized homophobia. Multilevel efforts are needed to reduce the contribution of heteronormative policing on YMSM's HIV risk.

The theory of masculinity in studies on HIV. A systematic review

This study aimed to describe the methodological characteristics of publications on HIV and masculinity, to identify possible information gaps and determine the main thematic areas. A systematic review was conducted of gender, masculinity, HIV infection and other sexually-transmitted infections in original articles published between 1992 and 2015. Original studies published from Pubmed and Scopus were included. A total of 303 articles were identified, of which 187 were selected. Most of the studies were qualitative and the most widely used technique was the interview. Twenty-nine-point five percent of studies were performed in South Africa, 20.8% in the USA, and 3.2% in Europe. Fifteen percent of the studies were performed in heterosexuals, 12.8% in men who have sex with men, and 60% did not specify the sexual orientation of the population. Eight thematic areas were defined, the most frequent being sexuality and risk behaviours, defined by men's need to demonstrate they were sexually active and a breadwinner. Most studies on HIV and masculinity show a gender bias by not specifying the sexual identity of the population. Studies should consider diversity in sexual and cultural identity in different contexts, including in Europe, to carry out more effective HIV interventions from a masculinity perspective.

Who counts as family? Family typologies, family support, and family undermining among young adult gay and bisexual men

Gay and bisexual men may form chosen families in addition to or in place of families of origin. However, the characteristics of these diverse families remain largely unexamined in the quantitative literature. The purpose of this study was to develop a family typology based on responses from a racially and ethnically diverse sample of young adult gay and bisexual men (YGBM) recruited from the Detroit Metropolitan Area (N=350; 18-29 years old). To explore the role of family, we then examined family social support and social undermining in relation to YGBM psychological distress within different family types. A series of multivariate regressions were used to examine associations between family social support and social undermining with depression and anxiety outcomes. The majority (88%) of YGBM included family of origin in their definitions of family and 63% indicated having chosen families. Associations between family social processes and psychological outcomes varied by type of family, suggesting that family composition shapes how perceptions of support and undermining relate to experiencing symptoms of depression and anxiety. Chosen families play a prominent role in the lives of YGBM and should not be overlooked in family research. Findings also highlight the importance of examining co-occurring family social support and social stress processes to further address psychological distress symptoms among YGBM.

Prevalence and Correlates of Prescription Drug Misuse Among a Racially Diverse Sample of Young Sexual Minority Men

PURPOSE

Sexual minority men (SMM) are at greater risk than heterosexual men for misusing prescription psychotropic medications. However, community prevalence estimates of prescription drug misuse among young SMM are lacking. The current study described lifetime and past-6-month stimulant, painkiller, and depressant/tranquilizer misuse in a large, racially diverse sample of 967 SMM aged 16-29 in Chicago, Illinois, and investigated demographic and other substance use associations.

METHODS

Data came from the baseline visit of the RADAR longitudinal cohort study. Associations were examined using bivariate and multivariable logistic regression.

RESULTS

A quarter of the sample reported ever misusing any prescription drug, and 14.2% reported recent misuse. Lifetime class-specific misuse was 16.9% for stimulants, 11.0% for painkillers, and 11.4% for depressants/tranquilizers; recent misuse was 8.0%, 5.7%, and 6.2%, respectively. In multivariable analysis, Non-Hispanic black participants had lower odds of lifetime stimulant and depressant/tranquilizer misuse and recent stimulant misuse than non-Hispanic white participants, and bisexual participants had greater odds of lifetime and recent painkiller and depressant/tranquilizer misuse than gay participants. Generally, using other substances was associated with greater odds of prescription drug misuse. Having ever been prescribed a psychotropic medication was associated with higher odds of lifetime painkiller misuse after controlling for covariates.

CONCLUSION

These results provide critical information on a growing public health problem among young SMM. Future research should explore why differential rates of misuse exist across subgroups. New interventions emphasizing the risk of prescription drugs, discouraging drug sharing, and bolstering refusal and coping skills should be developed and evaluated.

Trends in Parental Monitoring and Knowledge Over Time Between Sexual Minority and Heterosexual Girls

This study assessed whether trajectories of parental monitoring components were different for sexual minority girls (SMGs) compared to heterosexual girls. We recruited 14-19-year-old girls from two adolescent medicine clinics. We estimated growth curve models to compare how components of parental monitoring-adolescent disclosure, parental solicitation, and parental knowledge-changed over 2 years for SMGs and heterosexual girls. SMGs and heterosexual girls had similar trajectory slopes and quadratic forms of adolescent disclosure, but SMGs had consistently lower adolescent disclosure scores. Parental knowledge trajectories indicated differential intercepts and slopes for SMGs compared to heterosexual girls, suggesting potential higher risk for maladaptive behaviors. Results of this study suggest that parental monitoring may operate differently over time for SMGs compared to heterosexual girls.

Effects of Parental Monitoring and Knowledge on Substance Use and HIV Risk Behaviors Among Young Men Who have Sex with Men: Results from Three Studies

Young men who have sex with men (YMSM) are disproportionately impacted by HIV/AIDS and have elevated rates of substance use. Parenting practices, such as knowledge of child whereabouts and monitoring of behavioral rules, protect against these outcomes among heterosexual youth. This article examined the relationship between these parenting practices and substance use and HIV risk behaviors among YMSM. Data are reported from three similar studies of YMSM: ChiGuys (ages 14-18), Crew 450 (ages 16-22), and RADAR (ages 16-29). The ChiGuys and RADAR studies report cross-sectional analyses, whereas Crew 450 reports latent growth curve analyses. In ChiGuys and Crew 450, participants reported significantly higher scores for parental knowledge of general activities than parental knowledge of gay-specific activities. Parental knowledge of general activities was significantly associated with less binge drinking in both samples and with condomless sex in the ChiGuys sample. Parental monitoring was significantly associated with less marijuana use and condomless sex in younger RADAR participants (16-18 years) and with less drug use in older participants (>18 years). Findings support the need for further research on the influences of parents on YMSM health risk behaviors and the value of exploring family- and parent-interventions to address YMSM health.

HIV Testing Preferences Among MSM Members of an LGBT Community Organization in Los Angeles

Lack of regular HIV testing puts African American, Asian, and Latino men who have sex with men (MSM) at high risk for HIV infection. Rapid self-testing may be an effective option for these men. We explored acceptability, preferences, and usability of HIV self-test kits with MSM of color using semi-structured focus groups to discuss HIV testing history, reasons for testing, and self-testing preferences. Participants (n = 21) lived in Los Angeles, identified as MSM of color, and were 18-35 years of age. Discussions were audio-recorded, transcribed, and analyzed using grounded theory. Participants expressed needs for (a) accessibility, (b) privacy, (c) local support, and (d) access to testing professionals. Self-testing for HIV infection may be an effective method for high-risk MSM. Effective self-testing programs need to consider accessibility, confidentiality, and support to increase routine testing. Community-based organizations have an opportunity to increase HIV testing for MSM of color.

Differences in Parental Monitoring Components and Their Associated Health Indicators Between Sexual-Minority and Heterosexual Girls

Our study sought to assess whether parental monitoring and their associations with health behaviors differed for heterosexual girls compared to sexual minority girls (girls who identified as lesbian or bisexual, endorsed same-sex attraction, or had same-sex romantic or sexualpartners). We analyzed three components of parental monitoring-adolescent disclosure, parental solicitation, and parental knowledge-between heterosexual and sexual minority girls.We also tested if the associations between these three constructs and adolescent relationship abuse, suicidality, heavy drinking, binge drinking, anxiety symptoms, and depressive symptoms were different for heterosexual girls compared to sexual minority girls. Sexual minority girls were less likely to disclose accurately to their parents their location and activities and perceived their parents asked less and knew less about their location and activities than did heterosexual girls. Heterosexual girls who reported higher levels of adolescent disclosure were less likely than were sexual minority girls to report suicidality and anxiety symptoms. Additionally, heterosexual girls who reported higher levels of parental knowledge were also less likely than were sexual minority girls to report anxiety and depressive symptoms. These findings suggest that parental monitoring may not be as protective forsexual minority girls as it is for heterosexual girls.

MINORITY STRESS, POSITIVE IDENTITY DEVELOPMENT, AND DEPRESSIVE SYMPTOMS: IMPLICATIONS FOR RESILIENCE AMONG SEXUAL MINORITY MALE YOUTH

INTRODUCTION

Minority stress processes have been shown to have significant associations with negative mental health outcomes among sexual minority populations. Given that adversity may be experienced growing up as a sexual minority in heteronormative, if not heterosexist, environments, our research on resilience among sexual minority male youth proposes that positive identity development may buffer the effects of a range of minority stress processes.

METHODS

An ethnically diverse sample of 200 sexual minority males ages 16-24 (mean age, 20.9 years) was recruited using mixed recruitment methods. We developed and tested two new measures: concealment stress during adolescence and sexual minority-related positive identity development. We then tested a path model that assessed the effects of minority stressors, positive identity development, and social support on major depressive symptoms.

RESULTS

Experience of stigma was associated with internalized homophobia (β=.138, p<.05) and major depressive symptoms (β=1.076, OR=2.933, p<.001), and internalized homophobia partially mediated experience's effects on major depression (β=.773, OR=2.167, p<.001). Concealment stress was associated with positive identity development (β=.155, p<.05) and internalized homophobia (β=.418, p<.001), and positive identity development partially mediated concealment stress's effects on internalized homophobia (β=-.527, p<.001). Concealment stress demonstrated a direct effect on major depression (β=1.400, OR=4.056, p<.001), and indirect paths to social support through positive identity development.

CONCLUSIONS

With these results, we offer an exploratory model that empirically identifies significant paths among minority stress dimensions, positive identity development, and major depressive symptoms. This study helps further our understanding of minority stress, identity development, and resources of resilience among sexual minority male youth.

Future directions in research on sexual minority adolescent mental, behavioral, and sexual health

This article describes current knowledge on sexual, mental, and behavioral health of sexual minority (SM) youth and identifies gaps that would benefit from future research. A translational sciences framework is used to conceptualize the article, discussing findings and gaps along the spectrum from basic research on prevalence and mechanisms, to intervention development and testing, to implementation. Relative to adults, there has been much less research on adolescents and very few studies that had longitudinal follow-up beyond 1 year. Due to historical changes in the social acceptance of the SM community, new cohorts are needed to represent contemporary life experiences and associated health consequences. Important theoretical developments have occurred in conceptualizing mechanisms that drive SM health disparities and mechanistic research is underway, including studies that identify individual and structural risk/protective factors. Research opportunities exist in the utilization of sibling-comparison designs, inclusion of parents, and studying romantic relationships. Methodological innovation is needed in sampling SM populations. There has been less intervention research and approaches should consider natural resiliencies, life-course frameworks, prevention science, multiple levels of influence, and the importance of implementation. Regulatory obstacles are created when ethics boards elect to require parental permission and ethics research is needed. There has been inconsistent inclusion of SM populations in the definition of "health disparity population," which impacts funding and training opportunities. There are incredible opportunities for scholars to make substantial and foundational contributions to help address the health of SM youth, and new funding opportunities to do so.