Protocol for a scoping review on technology use and sexual and gender minority youth and mental health

INTRODUCTION

Research indicates that sexual and gender minority youth [SGMY] may engage more with information communication technologies [ICTs] more than their non-SGMY counterparts Craig SL et al. 2020. While scholarship generally explores youth's use of ICTs, there are gaps in scholarship that connect SGMY, their ICT engagement and influences to mental health. This scoping review will synthesize the literature that connects these core concepts in order to better understand the influence ITCs have on the mental health of SGMY and to develop a more fulsome understanding of this emerging area of literature.

METHODS AND ANALYSIS

Following the scoping review framework of Arksey and O'Malley, the search will be conducted in the PsycINFO [Ovid interface, 1980-], MEDLINE [Ovid interface, 1948-], CINAHL [EBSCO interface, 1937-], Sociological Abstracts [ProQuest interface, 1952-], Social Services Abstracts [ProQuest interface, 1979-], and Scopus. Descriptive summaries and thematic analysis will summarize the articles that meet the inclusion criteria using an extraction table.

ETHICS AND DISSEMINATION

The review outlined in this paper provides an overview of information that exists on the technology use of SGMY, ICTs and the interconnection with mental health. Results will be disseminated through peer reviewed journals and national and international conferences. As information collected for this paper as is retrieved from publicly available sources, ethics approval is not required.

The politics of LGBT+ suicide and suicide prevention in the UK: risk, responsibility and rhetoric

Suicide is a major public health concern, patterned by systematic inequalities, with lesbian, gay, bisexual and trans (LGBT+) people being one example of a minoritised group that is more likely to think about and attempt suicide worldwide. To address this, UK national suicide prevention policies have suggested that LGBT+ people should be prioritised in prevention activities. However, there is little research seeking to understand how LGBT+ suicide is re/presented in political and policy spheres. In this article, we critically analyse all mentions of LGBT+ suicide in UK parliamentary debates between 2009 and 2019 and in the eight suicide prevention policies in use during this period. We argue that LGBT+ suicide is understood in two contrasting ways: firstly, as a pathological 'problem', positioning LGBT+ people either as risks or as at risk and in need of mental health support. Alternatively, suicide can be seen as externally attributable to perpetrators of homophobic, biphobic and transphobic hate, requiring anti-hate activities as part of suicide prevention. In response, we argue that although these explanations may appear oppositional; they both draw on reductive explanations of LGBT+ suicide, failing to consider the complexity of suicidal distress, thus constraining understandings of suicide and suicide prevention.

Experiences of COVID‐19 pandemic‐related stress among sexual and gender minority emerging adult migrants in the United States

There is a dearth of research that examines COVID-19-related stress among multiply marginalised individuals who are in the developmental phase of emerging adulthood. This qualitative study investigated how the intersection of emerging adulthood, sexual and gender minority (SGM) identity, and migrant status were reflected in the experiences of SGM individuals (n = 37; ages 20-25 years old) who migrated to various parts of the United States in the last 5 years. Data were collected online using semi-structured interviews. Thematic analysis revealed that participants' developmental processes (e.g., identity exploration, building financial independence) were shaped by pandemic-related stressors, especially unemployment and financial instability. Participants who were able to maintain employment did so but at the risk of their health and safety. Findings also showed that participants experienced feelings of anxiety and depression due to social isolation, but online communication played an important role in combatting loneliness. Findings highlight the potential for trauma-informed and intersectional approaches to practice with SGM emerging adult migrants and expanded health services and temporary entitlement programs to mitigate the pandemic's effects on this population's psychosocial and financial well-being.

Sexual orientation, social support, and mental health resilience in a U.S. national sample of adults

Sexual minority mental health disparities can be attributed, in large part, to chronic exposure to stress. There is growing interest in understanding the factors associated with psychological resilience, or the ability to positively cope with life's stressors. Using nationally representative data (2012-2013; N = 14,470), this study compared differences in resilience status (operationalized empirically using SF-12 mental health score among respondents reporting 2+ past-year stressful life events; respondents were categorized as "flourishing," "average," or "languishing") by sexual orientation and assessed whether social support mediated sexual minority disparities in resilience. Comparisons were made across four sexual orientation groups: heterosexuals and three sexual minority subgroups (lesbians/gay men, bisexual, heterosexual-identified sexual minorities [HSM]). Generally, heterosexual respondents were more likely to be flourishing, less likely to be languishing, and reported more social support, compared to sexual minority respondents. In multivariable analysis, bisexual women, HSM women, and gay men had lower odds of resilience than heterosexual women and men, respectively. In mediation models, lower social support was associated with reduced resilience for all sexual minority subgroups except lesbian/gay women. This study demonstrated that sexual orientation is an important determinant of resilience, and further, that social support contributes to sexual minority peoples' abilities to flourish when faced with stress.

Resilience among LGBTQIA+ youth in out-of-home care: A scoping review

BACKGROUND

Research on the experiences of LGBTQIA+ youth in out-of-home care has mainly focused on these youth's adversities and the resulting negative impact on their wellbeing. Little is known about the ways through which LGBTQIA+ youth in out-of-home care are resilient to these adversities. To date, a review study on resilience in this population is lacking.

OBJECTIVE

To map and synthesize the existing research on resilience among LGBTQIA+ children and youth in out-of-home care. Specific goals were to summarize and analyze 1) the general characteristics of the existing studies, and 2) the resilience resources found at the individual, relational, sociocultural, and ecological levels.

METHODS

We carried out a scoping review examining empirical published academic literature.

RESULTS

The 14 studies included in this scoping review indicated that resilience studies among LGBTQIA+ youth in out-of-home care are mainly qualitative, cross-sectional, US-based, and were centered on gay youth. Studies suggested that resilience resources were mostly focused at the socio/relational level (e.g., foster family acceptance) with fewer studies at the individual (e.g., LGBTQ positive identity), and community levels (e.g., LGBTQ centers). Importantly, no studies explored the interaction of resilience resources across these different domains.

CONCLUSIONS

Resilience among LGBTQIA+ youth in out-of-home care remains understudied and the results of this scoping review point to specific research gaps. Recommendations are provided for research, practice, and policy.

Embracing Complexity: Variation in Faculty's Attitudes toward Inclusive Measures of Gender and Sexuality in Social and Health Sciences Research

In the absence of adequate measurement efforts, expansive gender and sexual identities will remain underexplored in quantitative social science and health research. We use primary survey data (N = 309) to identify factors associated with U.S.based social and health science faculty's attitudes toward inclusive gender and sexuality measures in participant-based research. Results suggest that political science faculty rated expansive gender and sexuality measures as less important to their own research, relative to psychology, sociology, and health sciences faculty. In addition, cisgender/heterosexual women and LGBTQ+ identifying faculty rate and apply these measures more positively compared to faculy who identify as cisgender/heterosexual men. Finally, faculty engaging in predominantly quantitative research, or in teaching-focused positions, had lower ratings of the importance of gender expansive measurement. Results suggest that while individual characteristics shape faculty's attitudes toward and use of inclusive gender and sexuality measures, disciplinary and academic contexts also matter.

Resiliencia y personalidad en adultos de identidad cisgénero heteronormativos y de identidades disidentes en Argentina

Esta investigación tuvo como objetivo describir y comparar la resiliencia y personalidad en personas con identidades disidentes (ID) e  Identidades Cisgénero heteronormativos (ICH) en una muestra incidental de Argentina. Previamente se presentó una síntesis del estado legal de las identidades disidentes (ID) en los países, su epidemiología, el desarrollo de la orientación sexual y estudios previos sobre personalidad y resiliencia.  A 92 adultos (43 de ID y 49 ICH) se les administraron la Escala de Resiliencia (ER), el Cuestionario Personalidad de Eysenck, y un cuestionario sociodemográfico que indagó la existencia de grupos de apoyo. Los dos grupos fueron homogéneos en los datos sociodemográficos y en la presencia de grupos de apoyo, aunque en los ICH predominaron los familiares y en los ID, los amigos. En resiliencia se obtuvieron valores más bajos en las personas de ID; la única diferencia significativa fue en autoeficacia (Z= -1,979, p<,048, r=.02). En personalidad, los ID obtuvieron mayor neuroticismo que los ICH (Z= -3,473, p<.001, r=.04). Hubo una correlación significativa entre neuroticismo y resiliencia con independencia de cada grupo (r= -.58, p<.0001). En conjunto los valores de resiliencia y de personalidad de los dos grupos estuvieron alrededor de los percentiles 50 de muestras generales de Argentina. Estos resultados apoyan las teorías que indican que la orientación sexual no son indicadores válidos de existencia de cuadros psicopatológicos, tal como lo determinó la OMS en 1990, y como consecuencia, el DSM-IV y DSM-V modificaron las clasificaciones previas.

Associations between anti-bisexual minority stress and body esteem and emotional eating among bi+ individuals: The protective role of individual- and community-level factors

Bisexual individuals experience prejudice specifically related to their bisexual identity, and these experiences may compound extant risk for disordered eating behaviors and body esteem concerns. However, little is known about how sexual minority stress related to bisexual orientation is associated with emotional eating and body esteem. The current study examined the associations between bisexual-specific minority stress and emotional eating and body esteem in a sample of bisexual plus (bi+) adults (including bisexual, pansexual, queer, and those with attractions to more than one gender regardless of identity), and tested the moderating effects of identity centrality, affirmation, and community connectedness as potential protective factors. This study leveraged data from an online survey of 498 adults (77.46% cisgender women; 79.7% White), ages 18 to 64 years (M = 28.5; SD = 9.59). Bisexual-specific minority stress was associated with more emotional eating (β = 0.15, p = .013) and lower body esteem (β = -0.16, p = .005), while controlling for sociodemographic characteristics, body mass index, and heterosexist minority stress. This finding remained the same when sensitivity analyses were conducted with participants who identified specifically as bisexual. Identity centrality and affirmation and community connectedness did not demonstrate moderating effects but they had main effects, such that they were positively associated with body esteem (β = 0.16, p = .001; β = 0.21, p < .001; β = 0.13, p = .004, respectively). Results suggest that anti-bisexual minority stress has a unique association with bi+ individuals' emotional eating and body esteem, and identified potential individual- and community-level protective factors for body esteem. These findings inform future research and interventions for this understudied population.

The Effect of Frames on Personal Narratives of Bullying Memories

Research demonstrates the malleability of memory; a dynamic process that occurs across development and can be influenced by internal and external frames. Narratives of past experiences represent one modality of understanding how memories are influenced by these frames. The present experimental study examines how memories of bullying are affected by two distinct yet common cultural frames. College students (n = 92) were randomly assigned to one of two groups; one with a definition of bullying framing the experience in terms of resilience and one framing it in terms of negative psychosocial effects. Participants then wrote about a remembered experience with bullying. The researchers coded the narratives for coping strategies used in response to bullying as well as for positive or negative emotion words and story endings. The results demonstrated statistically significant differences between groups in the ways bullying experiences were remembered and described. Participants in the Resiliency Group more often had positive endings to their bullying narratives and used more coping skills and positive emotion words overall. The implications of a subtle frame influencing memories of bullying and its relation to development, identity, social order, peer relationships, and resilience are discussed.

Educator interaction with sexual minority youth

Sexual minority youth experience a variety of challenges that are further exacerbated by intersectionality and interactions with various educators. Using a directed form of empirical, qualitative research, the authors explored the retrospective school experiences (as part of life stories) of three cohorts of sexual minorities (Stonewall Generation, HIV/AIDS Generation, and Marriage Equality Generation). The aim was to learn how they experienced K-12 education, including interactions with educators. Four major categories were identified from the interview data: (a) unsupportive educators, (b) role of school counselors, (c) supportive educators, and (d) sexual minority teachers. Interactions with educators were either supportive or unsupportive and occurred at either the individual or school (institutional) level. Interactions at either of these levels were (a) explicit-intentional behavior(s) or implicit-chance behavior(s) and (b) related to academic and personal concerns.

Multidimensional Understanding of Homosexuality: A Qualitative Integration of Perspectives

Background:

Though DSM no longer considers homosexuality as a clinical condition, it still remains a contentious issue across social, legal, and religious paradigms. Collectivistic and traditional societies (eg, India) are more reticent in accepting the multifaceted nature of sexuality. This study thereby tries to arrive at a collective understanding about homosexuality.

Methods:

The study was conducted in the following 3 parts: Focus group discussion (FDG) to unravel the collective understanding of homosexuality in heterosexual young adults. In-depth personal interviews with 3 homosexual persons. In-depth personal interview with 3 heterosexual peers of homosexual persons.

Results:

Qualitative analysis of the FGDs revealed that the participants share a collective opinion that “lack of acceptance and negative stereotyping of homosexuality” to be a predominant social phenomenon in India. Interpretative phenomenological analysis (IPA) of the personal interviews of the homosexual persons revealed experience of social ostracization and unique personal journey toward self-acceptance and adaptation. IPA of the personal interviews of the heterosexual peers disseminate that these people have the agonizing vicarious experience of seeing their friends being discriminated against and also personal experiences of social rejection on account of having a homosexual friend.

Conclusion:

This study is unique in that it tried to recognize homosexuality from multiple perspectives. Findings suggest that heteronormative hegemony operates insidiously and pervades the boundary of the self-generating “self-doubt.” Understanding these dimensions might help address their unmet needs and identities as well as mitigate stigma surrounding the same.

"It Truly Does Get Better:" Young Sexual Minority Men's Resilient Responses to Sexual Minority Stress

Due to minority stress, sexual minority men experience mental health disparities. Sexual minority men who engaged in cognitive-behavioral therapy to address the minority stress underlying their distress completed an exercise eliciting their own resilience. This exercise involved writing an advice letter to a hypothetical peer about coping with minority stress. Qualitative analysis of these letters yielded 18 codes grouped into three categories reflecting resilience to minority stress. Categories included (1) cultivating internal affirmation strategies, (2) building supportive relationships and community, and (3) using cognitive and behavioral skills to cope with minority stress. Findings highlight this population's resilience and suggest building resilience through treatment.

Staff and Parent Perspectives on a Therapeutic Recreation-Based Bereavement Camp for Families Whose Child Has Died From Serious Illness

This study explores the nature of a therapeutic recreation-based bereavement camp for families whose child has died from serious illness. Open-ended surveys and interviews were conducted with parents attending a three-camp cycle over a 12-month period or a reunion camp. Thirteen parents completed open-ended surveys before and after each camp and six of these also completed interviews after the final camp. Six additional parents completed interviews after the reunion camp. Six staff working with families during the camps were also interviewed. Content analysis of surveys and thematic analysis of interviews revealed the aims, structure, and content of the camp. The findings suggest a model whereby shared experience allows for normalization and offers a nonjudgmental place to share stories, discuss difficulties come together as a family, and create a support network. These findings highlight the value of therapeutic recreation-based bereavement interventions for families whose child has died from serious illness.

Gender-Based Effects of Frames on Bullying Outcomes

The study extends research on the effect of frames. It is the first study to examine how framing affects the impact of being bullied. College students were randomly assigned to one of two groups: one framing bullying in terms of resilience and the other framing bullying with negative psychosocial consequences. Participants were asked to engage in a brief writing task aimed to actively create a frame and then completed both implicit and explicit measures. There was a significant main effect by gender and several significant interaction effects between frame and gender. These results suggest that framing impacts an individual's conceptualization of emotionally salient personal memories and should be considered when developing bullying interventions. The impact of framing bullying may vary by gender.

Trajectories of Suicidal Ideation from Adolescence to Adulthood: Does the History of Same-Sex Experience Matter?

The fluidity of same-sex experience (SSE) can be conceptualized as both a risk and a resource that impacts suicidal ideation over time. Considering whether SSE occurs in adolescence, adulthood, or both, this study suggests that SSE in both adolescence and adulthood is associated with depression and low self-esteem throughout the life course, resulting in chronic susceptibility to suicidal ideation. Yet due to variation in both accumulation of risk and resources over time, trajectories of suicidal ideation during the transition to adulthood likely vary by timing of SSE. To test these hypotheses, we fit latent growth curve models to a gender-stratified sample taken from the National Longitudinal Study of Adolescent to Adult Health (7608 men, 8070 women). We created four groups of SSE: no SSE (6322 men, 5981 women), SSE in adolescence only (634 men, 480 women), SSE in adulthood only (372 men, 1081 women), and SSE in adolescence and adulthood (280 men, 528 women). Men and women with SSE in both life stages had the greatest risk of suicidal ideation in adolescence and in adulthood. Yet women with first SSE in adulthood had less of a decline in suicidal ideation over time, relative to those with no SSE and those with SSE in adolescence only, and this was partially due to higher depression and lower self-esteem. Results suggest greater support is needed for adolescents expressing non-normative sexualities and for those with first SSE in adulthood, a group that is more difficult to identify in schools.

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

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

Young men's rationales for non-exclusive gay sexualities

Recent evidence suggests it is useful to distinguish sexual identities among young men at the gay end of the spectrum because of group differences between primarily gay, mostly gay and gay orientations on several assessed physiological, behavioural and self-report measures. However, little is known about individuals' rationales for choosing sexuality labels beyond traditional gay or bisexual categories. We addressed this issue by interviewing 24 young men with a non-exclusive gay orientation about their sexual desires and histories, drawing on both qualitative and numeric data. Undertaking an inductive analysis, we found four distinct rationales for identification with a sexual orientation label: sexual, romantic, intellectual and internalised homophobia. By examining what young men mean when they classify themselves as primarily gay, mostly gay or bisexual-leaning gay, this article provides data to understand these issues and proposes that greater focus should be placed on sexual identity for non-exclusive gay men. Although the sexual and affectional components of sexual orientation are meaningful, previous research has not sufficiently accounted for the importance of intellectual, cultural and romantic factors in non-exclusive sexual orientations. To address these issues, the use of in-depth interviews should be incorporated in future studies.

Educational attainment of transgender adults: Does the timing of transgender identity milestones matter?

Adolescence is a difficult life stage in which to navigate a transgender identity, yet adolescence plays a key role in shaping educational trajectories. While transgender-related stigma and victimization within secondary schools persists, the social climate in which transgender adolescents navigate their identity has changed over time. Analyzing data from the National Transgender Discrimination Survey, a national, non-probability sample of U.S. transgender adults, we address the following research questions: 1) Is experiencing transgender identity milestones in adolescence associated with educational attainment?; 2) Does this association vary by birth cohort? We find that those who first experienced transgender identity milestones in adolescence attained less education than those who first experienced milestones in other life stages. This association is larger among younger birth cohorts, pointing to the adolescent years as a particularly difficult time to navigate a transgender identity, even in the midst of increased transgender awareness and resources within schools and society.

Coping With Sexual Orientation-Related Minority Stress

Little is known about how adolescents cope with minority stressors related to sexual orientation. This study examined 245 lesbian, gay, and bisexual (LGB) young adult's (ages 21-25) retrospective reports of coping in response to LGB minority stress during adolescence (ages 13-19) to test the reliability and validity of a measure of minority stress coping. Further, the study examined associations between LGB minority stress coping and young adult psychosocial adjustment and high school attainment. Validation and reliability was found for three minority stress coping strategies: LGB-specific strategies (e.g., involvement with LGBT organizations), alternative-seeking strategies (e.g., finding new friends), and cognitive strategies (e.g., imagining a better future). LGB-specific strategies were associated with better psychosocial adjustment and greater likelihood of high school attainment in young adulthood, whereas alternative-seeking and cognitive-based strategies were associated with poorer adjustment and less likelihood of high school attainment.

Paving Pathways Through the Pain: A Grounded Theory of Resilience Among Lesbian, Gay, Bisexual, Trans, and Queer Youth

This grounded theory study utilized interviews with 16 service providers and 19 lesbian, gay, bisexual, trans, and queer (LGBTQ) youth to develop a substantive theory of resilience processes among LGBTQ youth. The core category, paving pathways through the pain, suggests that LGBTQ youth build on emotional pain inflicted by external adversities to carve out pathways to resilience. Youth employed the following resilience processes: (1) navigating safety across contexts, (2) asserting personal agency, (3) seeking and cultivating meaningful relationships, (4) un-silencing marginalized identities, and (5) engaging in collective healing and action. Youth focused on particularly painful adversities and engaged intentionally in one or more of the resilience processes related to the origins of their pain.

Sex, Sexual Orientation, Gender Atypicality, and Indicators of Depression and Anxiety in Childhood and Adulthood

The current study evaluated the possibility that greater negative mental health outcomes reported among gay, lesbian, and gender-atypical individuals, compared to gender-typical individuals, are present in childhood and persist into adulthood. Sex and sexual orientation differences in self-reported adulthood and recalled childhood indicators of depression and anxiety and their association with current and retrospectively reported gender (a)typicality were examined in a non-clinically recruited community sample of Canadian heterosexual men (n = 98), heterosexual women (n = 142), gay men (n = 289), and lesbian women (n = 69). Indicators of depression and anxiety were constructed based on diagnostic criteria for generalized anxiety disorder, major depression, agoraphobia, social anxiety disorder, panic disorder, obsessive-compulsive disorder, and specific phobias. Factor reduction analyses yielded three factors: (1) indicators of childhood separation anxiety, (2) indicators of childhood depression and anxiety, and (3) indicators of adulthood depression and anxiety. Lesbian women scored higher on childhood separation anxiety than all other groups. Heterosexual men scored lower on indicators of childhood separation anxiety than gay men and lower on indicators of childhood and adulthood depression and anxiety than all other groups. No other significant group differences were observed. Correlational analysis suggested that for men, but not for women, gender-atypical behavior was associated with negative mental health. The current study indicated that childhood should be considered a critical time period during which the noted sexual orientation-related mental health discrepancies manifest and that childhood gender atypicality is a key factor for understanding the emergence of such discrepancies.

Disordered eating behaviors among transgender youth: Probability profiles from risk and protective factors

PURPOSE

Research has documented high rates of disordered eating for lesbian, gay, and bisexual youth, but prevalence and patterns of disordered eating among transgender youth remain unexplored. This is despite unique challenges faced by this group, including gender-related body image and the use of hormones. We explore the relationship between disordered eating and risk and protective factors for transgender youth.

METHODS

An online survey of 923 transgender youth (aged 14-25) across Canada was conducted, primarily using measures from existing youth health surveys. Analyses were stratified by gender identity and included logistic regressions with probability profiles to illustrate combinations of risk and protective factors for eating disordered behaviors.

RESULTS

Enacted stigma (the higher rates of harassment and discrimination sexual minority youth experience) was linked to higher odds of reported past year binge eating and fasting or vomiting to lose weight, while protective factors, including family connectedness, school connectedness, caring friends, and social support, were linked to lower odds of past year disordered eating. Youth with the highest levels of enacted stigma and no protective factors had high probabilities of past year eating disordered behaviors.

DISCUSSION

Our study found high prevalence of disorders. Risk for these behaviors was linked to stigma and violence exposure, but offset by social supports. Health professionals should assess transgender youth for disordered eating behaviors and supportive resources. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:515-522).

Differences in Mental Health Symptoms Across Lesbian, Gay, Bisexual, and Questioning Youth in Primary Care Settings

PURPOSE

Lesbian, gay, bisexual, and questioning (LGBQ) youth exhibit significantly higher rates of mental health problems, including anxiety, depression, suicidal ideation, and nonsuicidal self-injury than their heterosexual peers. Past studies tend to group LGBQ youth together; however, more recent studies suggest subtle differences in risk between sexual minority groups. This study examined differences in mental health symptoms across male and female youth who are attracted to the same sex (gay and lesbian), opposite sex (heterosexual), both sexes (bisexual), or are unsure of whom they were attracted to (questioning) in a sample of 2,513 youth (ages 14-24 years).

METHODS

Data were collected using the Behavioral Health Screen-a Web-based screening tool that assesses psychiatric symptoms and risk behaviors-during routine well visits.

RESULTS

Bisexual and questioning females endorsed significantly higher scores on the depression, anxiety, and traumatic distress subscales than did heterosexual females. Lesbians, bisexual females, and questioning females all exhibited significantly higher lifetime suicide scores than heterosexual females. Interestingly, bisexual females exhibited the highest current suicide scores. Gay and bisexual males endorsed significantly higher scores on the depression and traumatic distress subscales than did heterosexual males. Gay males also exhibited higher scores on the anxiety subscale than heterosexual males, with bisexual males exhibiting a nonsignificant trend toward higher scores as well.

CONCLUSIONS

Findings highlight varying level of risk across subgroups of LGBQ youth and suggest the importance of considering LGBQ groups separately in the context of a behavioral health assessment, especially for females.

Promoting Youth Agency Through Dimensions of Gay-Straight Alliance Involvement and Conditions that Maximize Associations

Gay-Straight Alliances (GSAs) may promote wellbeing for sexual minority youth (e.g., lesbian, gay, bisexual, or questioning youth) and heterosexual youth. We considered this potential benefit of GSAs in the current study by examining whether three GSA functions-support/socializing, information/resource provision, and advocacy-contributed to sense of agency among GSA members while controlling for two major covariates, family support and the broader school LGBT climate. The sample included 295 youth in 33 Massachusetts GSAs (69 % LGBQ, 68 % cisgender female, 68 % white; M age = 16.06 years). Based on multilevel models, as hypothesized, youth who received more support/socializing, information/resources, and did more advocacy in their GSA reported greater agency. Support/socializing and advocacy distinctly contributed to agency even while accounting for the contribution of family support and positive LGBT school climate. Further, advocacy was associated with agency for sexual minority youth but not heterosexual youth. Greater organizational structure enhanced the association between support/socializing and agency; it also enhanced the association between advocacy and agency for sexual minority youth. These findings begin to provide empirical support for specific functions of GSAs that could promote wellbeing and suggest conditions under which their effects may be enhanced.

Reactions to Participating in Intimate Partner Violence and Minority Stress Research: A Mixed Methodological Study of Self-Identified Lesbian and Gay Emerging Adults

The purpose of this study was to examine lesbian and gay (LG) young adults' reactions to participating in intimate partner violence (IPV) and minority stress research using a mixed methodological design. Participants were 277 U.S. college students currently involved in same-sex relationships and self-identified cisgender LG who completed an online questionnaire that included closed- and open-ended questions. Results suggested that IPV research was well tolerated by the vast majority of participants; close to one in 10 participants reported being upset by the study questions, yet 75% of upset individuals reported some level of personal benefit. Reasons for upset as identified in the open-ended responses included thinking about personal experiences with IPV, as the perpetrator or friend of a victim, as well as thinking about the uncertainty of their future with their current partner. The correlates of emotional reactions and personal benefits to research participation were also examined, and these varied among gay men and lesbian women. Implications of these findings underscore the importance of accurate reflection of risk and benefits in informed consent documents as well as systematic evaluation of sexual minority participants' reactions to research participation in an effort to conduct ethically sound sexual science research.

Minority Stress and HERoic Coping Among Ethnoracial Sexual Minority Girls: Intersections of Resilience

This study used a focus group methodology to explore the experiences of stress and coping among 40 Hispanic, Caribbean Black, Haitian, and African American cisgender sexual minority girls living in the southeastern United States. An analysis of the data using grounded theory strategies revealed that participants were part of a cultural context in which few boundaries existed between family, religion, and culture, and that they tended to believe that they were betraying family and culture because of their sexual minority identities. Participants described (a) real or perceived transgressions of gender expectations and roles, (b) violating religious doctrine, and (c) emotional exclusion and taunting by family members. In the same context, the theme of HERoic Coping described participants’ resilience that manifested as (a) serving as the family educator, (b) being “out” in the open with family, and (c) creating safety. This study found that the negotiation of complex family, religious, and community environments is critical to understanding resilience in ethnoracial sexual minority girls.

Individual-level protective factors for sexual health outcomes among sexual minority youth: a systematic review of the literature

Although factors associated with negative sexual health outcomes among sexual minority youth (SMY) have been well documented, protective factors have been less studied. This review summarises the current state of science on individual-level protective factors for SMY and identifies gaps to inform future research. A systematic search of non-intervention, empirical peer-reviewed research was conducted. Articles that examined an a priori-identified individual-level protective factor and at least one sexual health outcome in a sample or subsample of SMY aged 10-24 years in Western, industrialised countries were eligible for inclusion. A total of 21 articles that reported data from 13 unique studies met inclusion criteria. Only two studies described findings for young sexual minority women and thus the literature synthesis was limited to studies reporting on young men who have sex with men (YMSM) in the USA. A total of 11 individual-level protective factors were examined. Subjective peer norms and attitudes about condom use were repeatedly protective in cross-sectional analyses. Findings related to self-efficacy, self-esteem and clear and positive identity were more mixed. The findings of this review suggest that attitudes and subjective peer norms related to condom use are promising intervention targets for YMSM. There is a need, however, for longitudinal research to confirm these protective effects and to consider them among other SMY. Moreover, protective factors related to skills and competencies have been insufficiently studied among SMY. Addressing these gaps will help develop a robust body of evidence to inform interventions.

Same-Sex Sexuality and Educational Attainment: The Pathway to College

Research finds lower levels of academic performance among sexual minority high school students, but some studies suggest sexual minorities have higher levels of educational attainment in adulthood. To further our understanding of how and why sexual orientation is associated with educational success, this study turns attention to the pathways to college completion, examining points along educational trajectories in which sexual minorities fall behind or surpass their heterosexual peers. Using data from the National Longitudinal Study of Adolescent to Adult Health, we find that sexual minority women are less likely than women with no same-sex sexuality to complete college, in part due to their high school performance and transition into college. Men who experience same-sex sexuality only in adolescence struggle in high school, but men who experience same-sex sexuality for the first time in adulthood are more likely to earn a college degree than men who do not experience same-sex sexuality.

The utility of resilience as a conceptual framework for understanding and measuring LGBTQ health

BACKGROUND

Historically, lesbian, gay, bisexual, transgender and queer (LGBTQ) health research has focused heavily on the risks for poor health outcomes, obscuring the ways in which LGBTQ populations maintain and improve their health across the life course. In this paper we argue that informing culturally competent health policy and systems requires shifting the LGBTQ health research evidence base away from deficit-focused approaches toward strengths-based approaches to understanding and measuring LGBTQ health.

METHODS

We recently conducted a scoping review with the aim of exploring strengths-based approaches to LGBTQ health research. Our team found that the concept of resilience emerged as a key conceptual framework. This paper discusses a subset of our scoping review findings on the utility of resilience as a conceptual framework in understanding and measuring LGBTQ health.

RESULTS

The findings of our scoping review suggest that the ways in which resilience is defined and measured in relation to LGBTQ populations remains contested. Given that LGBTQ populations have unique lived experiences of adversity and discrimination, and may also have unique factors that contribute to their resilience, the utility of heteronormative and cis-normative models of resilience is questionable. Our findings suggest that there is a need to consider further exploration and development of LGBTQ-specific models and measures of resilience that take into account structural, social, and individual determinants of health and incorporate an intersectional lens.

CONCLUSIONS

While we fully acknowledge that the resilience of LGBTQ populations is central to advancing LGBTQ health, there remains much work to be done before the concept of resilience can be truly useful in measuring LGBTQ health.

Mental Health in Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth

Today's lesbian, gay, bisexual, and transgender (LGBT) youth come out at younger ages, and public support for LGBT issues has dramatically increased, so why do LGBT youth continue to be at high risk for compromised mental health? We provide an overview of the contemporary context for LGBT youth, followed by a review of current science on LGBT youth mental health. Research in the past decade has identified risk and protective factors for mental health, which point to promising directions for prevention, intervention, and treatment. Legal and policy successes have set the stage for advances in programs and practices that may foster LGBT youth mental health. Implications for clinical care are discussed, and important areas for new research and practice are identified.

The Schooling Experience of Lesbian, Gay, and Bisexual Youth in lsrael: Falling Below and Rising Above as a Matter of Social Ecology

Research on the schooling experience of lesbian, gay, and bisexual (LGB) youth in Israel and in other Western countries has been largely risk-focused, whereas extrinsic and intrinsic protective factors, which enable LGB adolescent students to cope with school homophobic bullying, are often overlooked. To address this shortcoming, the researchers conducted a qualitative study based on semistructured interviews with 20 LGB-identified secondary school students. The findings and implications emphasized the key role of adequate ecological protective factors for LGB youth in enhancing effective coping mechanisms in response to school homophobic bullying.

Understanding the Educational Attainment of Sexual Minority Women and Men

National studies have not analyzed sexual identity disparities in high school completion, college enrollment, or college completion in the United States. Using Add Health data, we document the relationship between adult sexual orientation and each of these outcomes. Many sexual minority respondents experienced disadvantages in adolescent academic achievement, school experiences, and social environments. This translates into educational attainment in complex, gendered ways. We find that the socially privileged completely heterosexual identity predicts higher educational attainment for women, while for men it is often a liability. Mostly heterosexual and gay identities are educationally beneficial for men but not women. There are college completion disparities between gay and mostly heterosexual women and their completely heterosexual counterparts. Bisexual respondents, especially women, have particularly problematic outcomes. Adolescent experiences, attitudes, and social contexts explain some of these differences. From adolescence through college, sexual minority groups, but especially females, need intervention to reduce substantial educational disparities.

Individual and community resilience factors among lesbian, gay, bisexual, queer and questioning youth and adults in Israel

Drawing on resilience theories, this study examined the individual and community factors of Israeli lesbians, gays, bisexuals, queers, and questioning (LGBQs) that contribute to positive mental health and the degree to which individual and community protective factors mitigate the adverse effect of risk factors for poor mental health. Differences in resilience factors between LGBQ youth and adults were explored. Data were collected on 890 LGBQ youth and adults. Findings emphasize the role of community-level resilience factors in the lives of LGBQs, and that these support systems differ slightly between the two age groups. Among youth, family support was both a strong predictor for well-being and a protective factor for mental distress. Although family support was found as a resilience factor among adults as well, other community-level factors (friends' support, LGBT connectedness and having steady partner) were found as protective factors for poorer mental health. These findings suggest for efforts on fostering familial support for LGBQ youth and a multi-level system that offers support at the familial, peer, relationship and community levels for both LGBQ youth and adults.

Discrimination and depressive symptoms among sexual minority youth: is gay-affirming religious affiliation a protective factor?

Researchers have examined perceived discrimination as a risk factor for depression among sexual minorities; however, the role of religion as a protective factor is under-investigated, especially among sexual minority youth. Drawing on a cross-sectional study investigating campus climate at a large public university in the U.S. midwest, we examined the role of affiliation with a gay-affirming denomination (i.e., endorsing same-sex marriage) as a moderating factor in the discrimination-depression relationship among self-identified sexual minority (n = 393) and heterosexual youth (n = 1,727). Using multivariate linear regression analysis, religious affiliation was found to moderate the discrimination-depression relationship among sexual minorities. Specifically, the results indicated that the harmful effects of discrimination among sexual minority youth affiliated with denominations that endorsed same-sex marriage were significantly less than those among peers who affiliated with denominations opposing same-sex marriage or who identified as secular. In contrast, religious affiliation with gay-affirming denominations did not moderate the discrimination-depression relationship among heterosexual participants. The findings suggest that, although religion and same-sex sexuality are often seen as incompatible topics, it is important when working with sexual minority clients for clinicians to assess religious affiliation, as it could be either a risk or a protective factor, depending on the religious group's stance toward same-sex sexuality. To promote the well-being of sexual minority youth affiliated with denominations opposed to same-sex marriage, the results suggest these faith communities may be encouraged to reconsider their position and/or identify ways to foster youth's resilience to interpersonal discrimination.

Negative and Positive Factors Associated With the Well-Being of Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning (LGBTQ) Youth

Factors associated with the well-being of lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth were qualitatively examined to better understand how these factors are experienced from the youths' perspectives. Largely recruited from LGBTQ youth groups, 68 youth participated in focus groups (n = 63) or individual interviews (n = 5). The sample included 50% male, 47% female, and 3% transgender participants. Researchers used a consensual methods approach to identify negative and positive factors across 8 domains. Negative factors were associated with families, schools, religious institutions, and community or neighborhood; positive factors were associated with the youth's own identity development, peer networks, and involvement in the LGBTQ community. These findings suggest a pervasiveness of negative experiences in multiple contexts, and the importance of fostering a positive LGBTQ identity and supportive peer/community networks. Efforts should work towards reducing and eliminating the prejudicial sentiments often present in the institutions and situations that LGBTQ youth encounter.

Male clients' behaviours with and perspectives about their last male escort encounter: comparing repeat versus first-time hires

Research on men who have sex with men suggests that condomless anal intercourse occurs more frequently in established sexual relationships. While comparable data regarding male-for-male escorting is unavailable, research implies that many clients seek emotional as well as physical connections with the men they hire. In 2012, 495 male clients, recruited via daddysreviews.com completed an online survey about their last hiring experience. Most participants were from the USA (85.7%), the UK and Canada (3.2% each). In total, 75% of encounters involved an escort hired for the first time; 25% were with a previously hired escort ('repeat encounter'). The client's age, lifetime number of escorts hired and number hired in the past year were positively associated with the last encounter being a repeat encounter. Cuddling, sharing a meal, drinking alcohol, taking a walk, watching a show and shopping were also positively associated with repeat encounters. Conversely, none of the sexual behaviours were significantly associated with repeat encounters. Repeat encounters were significantly more likely to include non-sexual behaviours alongside sexual activities, but no more likely to involve condomless anal intercourse. Moreover, clients' knowledge of escorts' HIV status was not significantly associated with engaging in condomless anal intercourse with repeat encounters.

Extracting dirt from water: a strengths-based approach to religion for African American same-gender-loving men

Religion is one of the most powerful and ubiquitous forces in African American same-gender-loving (SGL) men's lives. Research indicates that it has both positive and negative influences on the health behaviors and outcomes of this population. This paper presents a review of the literature that examines religion as a risk and protective factor for African American SGL men. A strengths-based approach to religion that aims to utilize its protective qualities and weaken its relation to risk is proposed. Finally, recommendations are presented for the use of a strengths-based approach to religion in clinical work and research.

Changes in neighborhood characteristics and depression among sexual minority young adults

Using the National Longitudinal Study of Adolescent Health, this study examined the relationship between changes in neighborhood characteristics during the transition from adolescence to young adulthood and depression among sexual minority young adults. Previous research has found that neighborhood characteristics influence sexual minority mental health and that sexual minorities are more likely to move to more urban and politically liberal locations. No study to date, however, has examined the impact of changes in neighborhood characteristics on sexual minority depression. The results from this study show that decreases in the percent urban was associated with increased risk of depression and decreases in the percent Republican voters in sexual minority's neighborhood was associated with decreases in risk of depression. The results suggest that clinicians may want to screen sexual minority youth for recent changes in their neighborhoods to assess if these changes may be related to the onset or exacerbation of depressive episodes.

An Initial Investigation of Sexual Minority Youth Involvement in School-Based Extracurricular Activities

Sexual minority youth are at risk for negative school-based experiences and poor academic outcomes. Yet, little is known about their experiences in positive school-based contexts. Using the National Longitudinal Study of Adolescent Health (1,214 sexual minority and 11,427 heterosexual participants), this study compared participation rates in, predictors of, and outcomes associated with three types of school-based extracurricular activities - sports, arts, and school clubs - by sexual orientation and gender. Findings revealed several significant sexual orientation and gender differences in participation rates in school-based sports, clubs, and arts activities. Further, findings suggested that the outcomes associated with extracurricular activity involvement do not differ by sexual orientation and gender; however, predictors of participation in these domains varied across groups.

Gender nonconformity, sexual orientation, and psychological well-being

Both a same-sex sexual orientation and gender nonconformity have been linked with poorer well-being; however, sexual orientation and gender nonconformity are also correlated. It is, therefore, critical to investigate their independent contributions to well-being. Based on survey responses of 230 female and 245 male high school seniors, the present study is one of the first to provide empirical data on this topic. Both childhood and adolescent gender nonconformity were negatively related to well-being. In the same analyses, neither sexual orientation nor biological sex was a significant predictor of well-being. These results suggest that gender-atypical traits may be more relevant for psychological health than a same-sex sexual orientation. Both environmental and biological influences may account for these findings.

A critique of neoliberalism with fierceness: queer youth of color creating dialogues of resistance

As a form of deregulated capitalism that has run amok, commodifying all that is in its path, and as a cultural means of commodifying Black and brown bodies, neoliberalism has taken a serious toll on the lives of working-class queer youth of color. Although it has hijacked spaces of cultural representation and material production, neoliberal capitalism is far from transparent. Through resistance, activism and performance queer youth of color have now started to shape a critique of oppressive structures, neoliberal policies, and pedagogical practices that are critical of their intersecting identities. This article examines neoliberalism's impact on education, focusing on educational policy and how these policies have affected queer youth of color in the urban centers of our major cities. This article also considers the contributions made by educators writing from the perspective of critical pedagogy in addressing the plight of queer youth of color in U.S. schools while employing the example of the dance group, Innovation, as way of addressing the havoc of neoliberalism in the lives of queer youth of color through performance and activism. This group has not only transformed notions of gender, race, class and sexuality that challenge major tenants of neoliberalism, but has also served as potent sites for the development of a critical pedagogy for working-class queer youth of color. Through sites of resistance rooted in progressive struggle, queer youth of color must be enabled by critical transformative intellectuals committed to encouraging youth to critically evaluate and challenge ideologies while displaying an allegiance to egalitarianism.