The association between health risk behaviors and sexual orientation among a school-based sample of adolescents

Online Human-Centered Design Methods are Acceptable, Appropriate, and Feasible for Generating Adolescent Relationship Abuse Intervention Ideas With Sexual and Gender Diverse Youth

PURPOSE

Sexual and gender diverse youth (SGDY) are at greater risk for adolescent relationship abuse (ARA) than cisgender heterosexual youth, but there are not enough evidence-based interventions for reducing ARA among SGDY. We piloted online human-centered design (HCD) methodology to engage SGDY in generating ARA intervention ideas. This study evaluated the acceptability, appropriateness, and feasibility of the online methods and identified SGDY-derived intervention ideas for reducing ARA.

METHODS

From August 2020 through March 2021, we conducted a longitudinal online HCD study with 46 SGDY (aged 14-18 years) recruited via social media from across the United States. SGDY completed HCD activities using MURAL (collaborative digital whiteboard) in four group-based sessions (1.5 hours each) and a follow-up survey with validated measures of acceptability, appropriateness, and feasibility (a priori success benchmarks: means > 3.75 on each five-point scale).

RESULTS

SGDY in the sample were 41% racial/ethnic minorities. SGDY rated the online HCD methods as highly acceptable, appropriate, and feasible (means ≥ 4.29). SGDY co-created a breadth of ARA intervention concepts across all social-ecological levels, including commonplace ideas (e.g., curriculum for schools) and novel ideas, such as social media-based interventions to foster healthy relationships, incentivization interventions for performing social justice work, and school plays with SGDY storylines.

DISCUSSION

Online HCD methods are acceptable, appropriate, and feasible for designing ARA intervention ideas. The intervention ideas generated in this study can help catalyze ARA intervention research for SGDY. Our method can be transported to other populations and health topics to help advance adolescent health and equity.

Going the Extra Mile: How High School Staff Use Informal Strategies to Support, Protect, and Care for LGBTQ+ Students

BACKGROUND

High school staff can play a key role in supporting students with LGBTQ+ identities through informal strategies; however, more research is needed to understand how staff are employing these strategies.

METHODS

We conducted semi-structured interviews, collecting information on informal strategies used to support students identifying as LGBTQ+ from a diverse sample of 23 school staff from high schools across the United States.

RESULTS

Staff employed informal support strategies across social ecological levels: within the school community, staff interacted with parents/guardians of students and advocated for more inclusive policies. Within the classroom, staff created inclusive physical environments, implemented inclusive curricula, and employed bullying prevention strategies. Interpersonally, staff listened to and affirmed students and collaborated to employ support strategies. Intrapersonal qualities, including having a personal connection to the LGBTQ+ community and demonstrating open-mindedness, facilitated staff efforts to support students.

CONCLUSIONS

Supporting staff in the implementation of the strategies we identified could foster more inclusive school environments, advancing equity for students identifying as LGBTQ+.

Providing Lesbian, Gay, Bisexual, Transgender, Nonbinary, and Queer Adolescents With Nurturance, Trustworthiness, and Safety: Protocol for Pilot Cluster Randomized Controlled Trial Design

BACKGROUND

Sexual and gender minority youths (lesbian, gay, bisexual, transgender, nonbinary, and queer individuals) face elevated risks of substance use (eg, alcohol and tobacco) and mental health issues (eg, depressive symptoms and suicidality) compared to their cisgender heterosexual peers. These inequities are hypothesized to be reduced by building supportive high school environments via the training of school staff. An intervention that trains school staff to better understand and support sexual and gender minority youths and engage in positive bystander behaviors that protect them from bullying exposure may reduce disparities in drug and alcohol use among them. Experts, school staff, and sexual and gender minority youths developed Providing LGBTQ+ Adolescents with Nurturance, Trustworthiness, and Safety (PLANTS), a web-based intervention to train school staff on how to support, affirm, and protect sexual and gender minority youths.

OBJECTIVE

This paper describes the design of the PLANTS pilot trial primarily aimed at assessing its acceptability, usability, appropriateness, and feasibility. We hypothesize PLANTS will have high acceptability, usability, appropriateness, and feasibility as rated by the school staff. Secondary objectives focus on implementation, safety, and pre-post changes in high school staff outcomes, including self-efficacy and skills (eg, active-empathic listening and bullying intervention). Exploratory objectives focus on the impact of PLANTS on student health outcomes.

METHODS

In a 2-arm cluster randomized controlled trial, high schools in Massachusetts are allocated to PLANTS or an active comparator group (publicly available sexual and gender minority youths resources or training). High school staff complete pretest and posttest surveys containing validated scales. Primary outcomes are validated measures of acceptability, usability, appropriateness, and feasibility of the intervention completed by staff during posttest surveys. To test our primary hypotheses for each outcome, we will calculate means and 95% CIs and P values using 1-sample 2-sided t tests against a priori thresholds or benchmarks of success. Secondary outcomes include staff's active-empathetic listening skills, self-efficacy for working with sexual and gender minority youths, bystander intervention behaviors for bullying and cyberbullying, and self-efficacy for PLANTS' change objectives completed during pretest and posttest staff surveys. Staff can also complete a posttest interview guided by the Information-Motivation-Behavior model and Consolidated Framework for Implementation Research. Exploratory outcomes include student-level data collected via the 2021 and 2023 MetroWest Adolescent Health Surveys, a health behavior surveillance system in 30 Massachusetts schools.

RESULTS

School enrollment began in May 2023 and participant enrollment began in June 2023. Data collection is expected to be completed by February 2024.

CONCLUSIONS

This pilot trial will yield important information about the PLANTS intervention and provide necessary information to conduct a fully powered trial of the efficacy of PLANTS for reducing the deleterious health inequities experienced by sexual and gender minority youths.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05897827; https://clinicaltrials.gov/study/NCT05897827.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55210.

Mitigating invalid and mischievous survey responses: A registered report examining risk disparities between heterosexual and lesbian, gay, bisexual, or questioning youth

In a Registered Report, the authors propose a new survey-bias-mitigation method-incorporating inverse probability weighting via boosted regression-to better understand lesbian, gay, bisexual, or questioning (LGBQ)-heterosexual youth risk disparities. This method is tested using the 2019 US Centers for Disease Control and Prevention-collected Youth Risk Behavior Survey (YRBS) national data, which contain 12,847 observations (ages 12-18 [M = 16, SD = 1.25]; 49.1% male [8.7% LGBQ] and 50.9% female [22.4% LGBQ]; nationally representative regarding race and ethnicity). Looking across 44 outcomes, the authors found that the YRBS contains responses that are potentially biased against LGBQ youth in systematic ways, inflating perceived risk for this group in some outcomes. This potential bias is more pronounced among reported males than among reported females, and it is more pronounced for low-incidence outcomes. For example, the steroid-use disparity estimate among reported males reduced by 67%, while the reduction in bullying victimization was small and not statistically significant. The authors discuss robustness of results, the new method, and data policy implications.

The relationship between school bullying victimization and mental health among high school sexual minority students in China: A cross-sectional study

BACKGROUND

School bullying has become a matter of global concern for the general public. Sexual minority youth (SMY) may experience minority stress and victimization which are known to adversely affect mental health and happiness. However, a few scholars explored and linked sexual orientation with campus bullying, depression, and anxiety symptoms under the specific cultural background of China.

OBJECTIVE

This study was to examine the effect of traditional and cyber bullying victimization on depression and anxiety among Chinese sexual minority adolescents.

METHODS

This is a cross-sectional survey with a total of 3841 subjects among senior high school students in Hunan Province, China. Related information was collected through a series of self-reported questionnaires. The association between variables was examined via a set of logistic regressions.

RESULTS

Homosexuality (OR: 6.398; 95 % CI: 3.321 to 12.325), bisexuality (OR: 3.146; 95 % CI: 1.499 to 6.603) and uncertainty of sexual orientation (OR: 2.341; 95 % CI: 1.516 to 3.615) were significantly associated with a combination of traditional and cyber bullying victimization. Compared to the heterosexual group, the sexual minority students, especially the bisexual students has a higher risk of depressive mood (OR: 2.349; 95 % CI: 1.664 to 3.316) and anxiety mood (OR: 3.049; 95 % CI: 2.150 to 4.324). Further multivariate binary hierarchical regression showed that the effects of sexual orientation and mental health were statistically significant only among those who are not involved in bullying victimization, OR values are from 1.929 (95 % CI: 1.061 to 3.507) to 3.209 (95 % CI: 2.090 to 4.927).

CONCLUSIONS

Homosexuals are most likely to be victims of a combination of traditional and cyber bullying victims. Bisexuals are most at risk for emotional problems. Sexual minorities in particular, showed differences in mental health risks between bullied and non-bullied groups. More attention needs to be paid to bullying and mental health among sexual minority students in China.

Safety and Predictors of Sexual Minority Youth Carrying Weapons

Prior research has revealed sexual minority youth are more likely to carry weapons both outside of and within school. However, to date, no study has examined the degree to which bullying and harassment is associated with weapon carrying among sexual minority youth. We utilized the Youth Risk Behavior Survey to examine the prevalence and likelihood of carrying weapons by sexual identity, adjusting for adverse experiences. From the Youth Risk Behavior Survey 2009-2015, we examined self-report of adverse experiences (e.g., being bullied, skipping school due to fear for personal safety) and performed Logistic regressions to estimate the odds of carrying a weapon and were adjusted to include demographics and adverse experiences. When surveyed by sexual identity, 14.0% of heterosexual, 21.8% of gay/lesbian, 18.5% of bisexual, and 17.4% of "not sure" students reported carrying a weapon in the past 30 days. Odds of carrying a weapon were significantly increased for youth who skipped school due to feeling unsafe at school, had ever been threatened with a weapon in the past year, and had ever been in a physical fight. Compared to heterosexual female peers, sexual minority women had increased odds of carrying a weapon. Pediatricians should recognize that experiencing bullying and feeling unsafe are associated with weapon carrying, particularly among sexual minorities. Pediatricians and professionals who work with youth should recognize that reported experiences of bullying may not be the most salient indicator of risk for weapon carrying among all youth, and that other fears of or experiences with bullying are crucial to screen for among sexual minorities in particular.

Sexual and Gender Minorities: Reporting Sexual Assault to the Police

Sexual assault is defined as any type of forced or coerced sexual contact or behavior that happens without consent. Victims seeking justice and personal safety must report their assaults to police, however few survivors report their victimization. Sexual and gender minorities, inclusive of the LGBTQI2-S population, are at an increased risk for experiencing sexual assault yet the vast majority of empirical research on sexual victimization has been conducted through a hetero-cisnormative lens. Sexual and gender minorities likely have a unique experience of sexual assault compared to heterosexual, cisgender survivors, especially as it relates to their help-seeking behaviors post-assault. Through the use of Sexual and Gender Script Theory, this review explores barriers that sexual and gender minorities may experience when reporting sexual assault to the police, thereby impeding their access to equitable justice. Opportunities for future policy, practice, and research among sexual and gender minorities are presented.

Sexual minority disparities in opioid and benzodiazepine misuse among adults with opioid use disorder

BACKGROUND AND OBJECTIVES

Sexual minority individuals demonstrate disparate rates of substance use. Research suggests that bisexual women are vulnerable to substance use disorders when compared to other sexual minority groups. This study explored differences in prevalence of past-year alcohol use disorder (AUD) with and without concurrent past-year opioid and/or benzodiazepine misuse.

METHODS

The present study utilized responses from the National Survey on Drug Use and Health (NSDUH) public dataset between the years 2015-2019 (N = 16,002) to examine the association between sexual orientation and concurrent misuse of opioids and/or benzodiazepines among individuals with past-year AUD, stratified by sex.

RESULTS

Bisexual females demonstrated higher rates of concurrent opioid and benzodiazepine use compared to all other groups. Although there was no association between sexual orientation and concurrent substance use patterns among males, female respondents with past-year AUD endorsing past-year misuse of opioids and benzodiazepines, both alone and in combination, were more likely to be bisexual compared to heterosexual. Lesbians were less likely to endorse concurrent misuse of opioids and benzodiazepines compared to bisexual females.

DISCUSSION AND CONCLUSIONS

In a national sample, bisexual females demonstrated higher odds of risky concurrent substance use patterns. Identifying sexual minority individuals who exhibit elevated risk of co-occurring alcohol, opioid, and/or benzodiazepine misuse is an important step to targeted prevention efforts and allocation of resources to combat rising overdose deaths.

SCIENTIFIC SIGNIFICANCE

For the first time, this study explored risky concurrent alcohol, opioid, and benzodiazepine misuse patterns among individuals of different sexual orientations.

Gaming Preferences and Motivations Among Bullied Sexual and Gender Minority Youth: An Interview Study

Objective: Game-based interventions can easily disseminate health information to hard-to-reach populations, such as sexual and gender minority youth (SGMY; e.g., gay/lesbian, bisexual, and transgender youth). SGMY disproportionately experience health problems, which have been attributed to greater violence victimization, such as bullying. Nevertheless, few interventions exist to improve health outcomes for bullied SGMY. Since game-based interventions offer economically viable and easily scalable solutions, we explored why bullied SGMY play games, the gaming characteristics they enjoy, and their preferences for future game-based interventions. Materials and Methods: We conducted semistructured qualitative interviews with 20 14- to 18-year-old U.S.-residing bullied SGMY recruited from social media. We asked participants about their current gaming experiences, preferences, and suggestions for future games and then conducted thematic analysis. Results: The majority of SGMY reported playing games to experience positive feelings associated with higher degrees of agency. Through controlling in-game storyline and character customization settings, SGMY described feeling safe and engaged in game play. In addition, SGMY reported playing games as a distraction from the real world. Coping with stress and other negative emotions was a commonly reported motivation for playing games, as was gleaning happiness independent from stress management. Furthermore, SGMY mentioned using games to connect with people, both in-person and virtually, to develop and maintain friendships. Conclusion: This study highlights specific methods of tailoring games to the interests of bullied SGMY. In addition, our findings are preliminary indicators that SGMY may use games to achieve healthy psychosocial developmental milestones. This study may be integral in informing the development of future game-based interventions for SGMY.

Associations between having been threatened or injured with a weapon and substance use and mental health among high school students in the United States

Being threatened or injured with a weapon is a serious form of physical bullying. Little is known about the effects of being threatened or injured with a weapon on substance use and mental health among adolescents. A secondary analysis of 2017 Youth Risk Behavior Survey data assessed the associations between having been threatened or injured with a weapon and substance use (binge drinking, marijuana, tobacco use, prescription medication misuse) and mental health (feeling sad or hopeless, considering suicide). Multiple logistic regression models with complex survey weights were used, controlling for potential confounders. Approximately 6.0% of students reported having been threatened/injured with a weapon. After adjusting for covariates, having been threatened/injured with a weapon was associated with binge drinking (AOR = 2.5; 95% CI: 1.9-3.4), marijuana (AOR = 2.1; 95% CI: 1.6-2.7), tobacco use (AOR = 2.6; 95% CI: 2.0-3.5), and misuse of prescription medication (AOR = 2.2; 95% CI: 1.6-3.0) compared with students who have not been threatened/injured. Having been threatened/injured with a weapon was associated with 1.6 times the odds (95% CI: 1.2-2.2) of feeling sad/hopeless and 1.7 times the odds (95% CI: 1.3-2.3) of considering suicide. Having been threatened or injured with a weapon is an important public health issue associated with negative mental health and substance use.

Risk-taking behaviors in adolescent men who have sex with men (MSM): An association between homophobic victimization and alcohol consumption

Objective

The aim of this study was to determine whether homophobic victimization was associated with alcohol consumption and riding with an intoxicated driver or driving a car while under the influence of alcohol or drugs among adolescent men who have sex with men (MSM).

Methods

Cross-sectional analysis used baseline data from a national HIV prevention trial (NCT03167606) for adolescent MSM aged 13–18 years (N = 747). Multivariable logistic regression models assessed associations between homophobic victimization (independent variable) and alcohol-related outcomes (dependent variables), controlling for age, parents’ education level, sexual orientation, health literacy, race, and ethnicity.

Results

Most participants (87%) reported at least one form of homophobic victimization in their lifetime, with verbal insults being the most frequently reported (82%). In the bivariate analysis, alcohol consumption and riding with an intoxicated driver or driving a car while under the influence were associated with many forms of victimization. Exposure to at least one form of victimization was associated with increased odds of alcohol consumption (OR: 2.31; 95% CI: 1.38–3.87) and riding with an intoxicated driver or driving a car while under the influence (OR: 2.25; 95% CI: 1.26–4.00), after controlling for covariates.

Conclusion

Increased risk of alcohol consumption and risky alcohol-related behaviors were found among adolescent MSM who experienced homophobic victimization. Interventions should address homophobic victimization and its impact on adolescent MSM, as well as disentangling motivations for underage drinking, riding with an intoxicated driver or driving a car while under the influence.

A randomized controlled trial of an mHealth intervention for increasing access to HIV testing and care among young cisgender men and transgender women: the mLab App study protocol

BACKGROUND

The number of youth living with HIV in the United States (US) continues to rise, and racial, ethnic, and sexual minority youth including young men who have sex with men (YMSM) and young transgender women (YTGW) bear a disproportionate burden of the HIV epidemic. Due to social and healthcare system factors, many YMSM and YTGW do not seek HIV testing services and are therefore less likely to be aware that they are infected. Mobile health technology (mHealth) has the ability to increase uptake of HIV testing among these populations. Thus, the mLab App-which combines HIV prevention information with a mobile phone imaging feature for interpreting at-home HIV test results-was developed to improve testing rates and linkage to care among Black, Latino, and other YMSM and YTGW living in New York City and Chicago and their surrounding areas.

METHODS

This study is a three-arm randomized controlled trial among YMSM and YTGW aged 18-29 years. Participants are randomized to either the mLab App intervention including HIV home test kits and standard of preventive care, standard of preventive care only, or HIV home test kits and standard of preventive care only.

DISCUSSION

mHealth technology used for HIV prevention is capable of delivering interventions in real-time, which creates an opportunity to remotely reach users across the country to strengthen their HIV care continuum engagement and treatment outcomes. Specifically during the COVID-19 pandemic, mHealth technology combined with at-home testing may prove to be essential in increasing HIV testing rates, especially among populations at high-risk or without regular access to HIV testing.

TRIAL REGISTRATION

This trial was registered with Clinicaltrials.gov ( NCT03803683 ) on January 14, 2019.

Feasibility of a Web-Accessible Game-Based Intervention Aimed at Improving Help Seeking and Coping Among Sexual and Gender Minority Youth: Results From a Randomized Controlled Trial

PURPOSE

To address the gap in interventions for improving sexual and gender minority youth (SGMY; e.g., lesbian, gay, bisexual, and transgender youth) health, we tested the feasibility of a game-based intervention for increasing help-seeking, productive coping skills, resource knowledge/use, and well-being.

METHODS

We conducted a 2-arm randomized controlled trial testing a theory-based, community-informed, Web-accessible computer role-playing game intervention. Control condition received a list of resources. Primary hypotheses were high levels of implementation success, game demand, and game acceptability.

RESULTS

We randomized 240 SGMYs aged 14-18 years into the intervention (n = 120) or control (n = 120) conditions. Participants completed baseline (100%), 1-month follow-up (T2; 73.3%), and 2-month follow-up (T3; 64.4%) surveys. Among intervention participants, 55.8% downloaded and played the game. Of those who played, 46.2% reported a desire to play it again, and 50.8% would recommend it. Game acceptability exceeded hypothesized benchmarks, wherein participants reported high positive affect (M = 2.36; 95% confidence interval [CI]: 2.13, 2.58), low negative affect (M = 2.75; 95% CI: 2.55, 2.95), low tension/annoyance (M = 3.18; 95% CI: 2.98, 3.39), and high competence (M = 2.23; 95% CI: 2.04, 2.43) while playing the game. In multivariable intent-to-treat analyses of 38 secondary/tertiary outcomes, intervention participants reported significantly larger reductions than control participants in cyberbullying victimization (T2 b = -.28; 95% CI: -.56, -.01), binge drinking frequency (T2 b = -.39; 95% CI: -.71, -.06), and marijuana use frequency (T3 b = -2.78; 95% CI: -4.49, -1.08).

CONCLUSIONS

We successfully implemented a Web-accessible game trial with SGMY. The game-based intervention was feasible and acceptable to SGMY, and preliminary results show it improved several health-related behaviors. A larger scale trial is needed to test whether the game-based intervention can reduce health inequities for SGMY.

Delineating patterns of sexualized substance use and its association with sexual and mental health outcomes among young gay, bisexual and other men who have sex with men in Singapore: a latent class analysis

BACKGROUND

Young gay, bisexual, and other men who have sex with men (YMSM) are vulnerable to the risks associated with sexualized substance use. This is a novel study in Singapore that aims to classify patterns of sexualized substance use among YMSM, and investigate its association with sexual and mental health outcomes.

METHODS

In this cross-sectional study among 570 YMSM aged 18 to 25 years old, latent class analysis (LCA) conducted to identify classes with similar patterns of sexualized substance use, across which measures of inconsistent condom use, recent STI diagnoses, past suicide ideation and depression severity were compared.

RESULTS

LCA revealed three classes of YMSM based on types of substances ever used in sexualized contexts, which we labelled as 'substance-naive', 'substance-novice', and 'chemsex'. Substance-naive participants (n = 404) had only ever used alcohol, while substance-novice participants (n = 143) were primarily amyl nitrite users with a small proportion who reported using chemsex-related drugs. Chemsex participants (n = 23) comprised individuals who had mostly used such drugs. Those in the chemsex group were more likely to report recent unprotected anal sex with casual partners (aPR = 3.28, 95%CI [1.85, 5.79]), depression severity (aβ = 3.69, 95%CI [0.87, 6.51]) and a history of suicide ideation (aPR = 1.64, 95%CI [1.33, 2.03]).

CONCLUSIONS

Findings of this study highlight how the use of varying substances in sexualized contexts may be classified and characterized by different sexual and mental health outcomes. Health promotion efforts should be differentiated accordingly to address the risks associated with sexualized substance use among YMSM.

Association between sexual orientation acceptance and suicidal ideation, substance use, and internalised homophobia amongst the pink carpet Y cohort study of young gay, bisexual, and queer men in Singapore

Background

Gay, bisexual and queer (GBQ) men are frequently subjected to minority stressors that have negative impacts on their health. Milestones that include the acceptance and disclosure of sexual identity amongst GBQ men are hence key instruments in understanding the prevalence of internalised homophobia and predicting health outcomes. As such, this work takes a novel approach to deduce the correlates of delayed acceptance of sexual orientation in young GBQ men as a measure of internalised homophobia through retrospective self-reporting and age-based analysis.

Methods

Participants were recruited as part of a cohort study exploring the syndemic risks associated with HIV acquisition among young GBQ men in Singapore. We examined their levels of internalised, perceived, experienced homophobia, as well as their health behaviours and suicidal tendencies. Two separate variables were also self-reported by the participants – the age of questioning of sexual orientation and the age of acceptance of sexual orientation. We subsequently recoded a new variable, delayed acceptance of sexual orientation, by taking the difference between these two variables, regressing it as an independent and dependent variable to deduce its psychosocial correlates, as well as its association with other measured instruments of health.

Results

As a dependent variable, delayed acceptance of sexual orientation is positively associated with an increase of age and internalised homophobia, while being negatively associated with reporting as being gay, compared to being bisexual or queer. As an independent variable, delayed acceptance of sexual orientation was associated with a delayed age of coming out to siblings and parents, suicide ideation, historical use of substances including smoking tobacco cigarettes and consuming marijuana, as well as reporting higher levels of experienced, internalised and perceived homophobia.

Conclusion

Greater levels of early intervention and efforts are required to reduce the heightened experience of minority stress resulting from communal and institutional hostilities. Areas of improvement may include community-based counselling and psychological support for GBQ men, while not forsaking greater education of the social and healthcare sectors. Most importantly, disrupting the stigma narrative of a GBQ ‘lifestyle’ is paramount in establishing an accepting social environment that reduces the health disparity faced by GBQ men.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10992-6.

A Minority Stress Response Model of Health Behaviors in Gay and Bisexual Men: Results from a Taiwanese Sample

Purpose: Health disparities among sexual minority men remain and continue to demand novel interventions. Other than risk reduction, a promising approach is to identify pathways to health-promoting behaviors. In this study, depressive symptoms, internalized homophobia, and sense of community connectedness were hypothesized to result from the experience of harassment and rejection, and in turn either promote or inhibit an individual's tendency toward health-promoting behaviors. We accounted for subgroup differences by examining the hypothesized model in gay and bisexual men separately. Methods: This was a cross-sectional survey study. One thousand three hundred eighty-one gay (81.5%) and bisexual (18.5%) Taiwanese men 18-49 years of age (mean = 26.56, standard deviation = 6) were recruited through a social media advertisement and completed an online survey. Structural equation modeling was employed to simultaneously examine multiple hypothesized paths. Results: Harassment and rejection were associated with greater depressive symptoms, internalized homophobia, and sense of community connectedness, which in turn yielded direct or indirect associations with health-promoting behavior among gay men. For bisexual men, depressive symptoms remained an important mechanism linking harassment and rejection and health-promoting behavior, whereas the roles of internalized homophobia and sense of community connectedness appeared less obvious. Conclusion: These findings cast new light on the behavioral implications of minority stress and elucidate the possible underlying mechanisms. The study suggests that more effort should be invested to understand and promote the drivers of health-promoting behavior to reduce health disparities in this population.

Social capital and chemsex initiation in young gay, bisexual, and other men who have sex with men: the pink carpet Y cohort study

Background

Young gay, bisexual, and other men who have sex with men (YMSM) are especially vulnerable to the risks associated with sexualized substance use, or ‘chemsex’. Engaging in chemsex established as a major risk factor for Human Immunodeficiency Virus (HIV) acquisition, and is thus a public health issue of increasing urgency. This paper attempts to explore the association between measures of social capital and patterns of sexualized substance use among a sample of YMSM in Singapore.

Methods

Results of this study were derived from baseline data of the Pink Carpet Y Cohort Study in Singapore, comprising a sample of 570 HIV-negative YMSM aged 18 to 25 years old. Latent class analysis was employed to identify classes with similar patterns of sexualized substance use, and multinomial logistic regression was employed to examine associations between class membership and proxy measures of social capital, including age of sexual debut, bonding and bridging social capital, connectedness to the lesbian, gay, bisexual and transgender community, and outness.

Results

Latent class analysis revealed three classes of YMSM based on their histories of sexualized substance use, which we labelled as ‘alcohol’, ‘poppers’, and ‘chemsex’. Multivariable analyses revealed that participants who were older (aOR = 1.19, p = 0.002) and who identified as gay (aOR = 2.43, p = 0.002) were more likely to be in the poppers class compared to the alcohol class. Participants with a later age of sexual debut were increasingly less likely to be in the poppers (aOR = 0.93, p = 0.039) and chemsex classes (aOR = 0.85, p = 0.018), compared to the alcohol class.

Conclusions

Varying measures of social capital such as an earlier age of exposure to sexual networks may predispose YMSM to greater opportunities for sexualized substance use. Future interventions should target YMSM who become sexually active at an earlier age to reduce the risks associated with sexualized substance use.

Substance Use and Sexual Risk Behavior Among Black Men Who Have Sex With Men in New York City: Evidence for Increased Risk During Young Adulthood

This study evaluated whether the association between substance use and sexual risk behavior varies as a function of age among 1,009 Black men who have sex with men (BMSM) in New York City. Hierarchical linear regression was used to examine the relationship between age (18-26 vs. 27+), substance use, and number of sexual partners and acts of condomless anal sex (CAS) in the past 90 days. Age moderated the relationship between substance use and sexual risk behavior, such that positive associations among binge drinking, marijuana, cocaine, and party drug use and number of male sexual partners and cocaine use and acts of CAS were significantly stronger among young adults than adults. BMSM may engage in more sexual risk behavior during young adulthood, and those who use substances may be at increased risk for HIV transmission-particularly through multiple sex partners. HIV prevention interventions targeting BMSM may benefit from being tailored to age and addressing sexual risk behavior and substance use concurrently.

Electronic and School Bullying Victimization by Race/Ethnicity and Sexual Minority Status in a Nationally Representative Adolescent Sample

PURPOSE

The purpose of the study was to examine the prevalence of electronic and school bullying victimization in sexual and racial/ethnic minorities in a nationally representative U.S. sample of high school students.

METHODS

Cross-sectional data from the 2015 and 2017 National Youth Risk Behavior Survey (2015, n = 15,624; 2017, n = 14,765) were analyzed using logistic regression.

RESULTS

Approximately 15% of the sample reported electronic bullying victimization and 20% reported school bullying victimization. Sexual minority youth were significantly more likely to report both types of bullying than their heterosexual peers, whereas black and Latinx students were significantly less likely to report both types. White students who identified as gay/lesbian or bisexual were more likely to report both types of bullying than white, heterosexual youth. Very few changes were observed in electronic or school bullying victimization from 2015 to 2017, although there was a statistically significant decrease in school bullying among white, heterosexual youth.

CONCLUSIONS

A sizeable number of adolescents experience electronic and school bullying. Sexual minority and white adolescents report a higher prevalence of these phenomena. This may have implications for designing bullying prevention strategies that target sexual minority adolescents to reduce their risk for victimization both online and in school.

Suicidal Thoughts and Behaviors Among LGBTQ Youth: Meta-Analyses and a Systematic Review

Suicide continues to be the second-leading cause of death for all youths aged 15-24. Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are at a significantly higher risk for suicidal thoughts or behaviors (STB). Establishing and understanding correlates of STB among LGBTQ youth is one important step toward enhancing prevention, intervention, and research efforts. To synthesize current knowledge on suicide among LGBTQ youth, the present meta-analyses offer results from 44 studies over the past 20 years. Two-hundred and thirty-four correlation coefficient effect sizes were calculated and categorized. To be included, the study had to quantitatively examine correlates of STB among LGBTQ youth. A number of social-science databases were used to examine the existing published research. Results illustrated the variability among correlates of STB as well as substantial limitations in the extant literature. There was a heterogeneity of effect sizes, a lack of novel correlates, a focus on risk, a dearth of theoretically driven designs, moderate publication bias, a paucity of developmentally driven analyses, and a dearth of research with transgender youth.

The Epidemiology of Cocaine Use Among Hispanic Individuals: Findings From the 2015-2018 National Survey of Drug Use and Health

Cocaine use disproportionately affects several social groups, including ethnic and sexual minorities. The present study sought to identify the epidemiology of cocaine use among a national sample of Hispanic young adults using pooled data from the 2015-2018 National Survey of Drug Use and Health. Weighted analyses were used to identify correlates to past-year cocaine use. Results revealed that 4.11% (n = 729) of individuals used cocaine in the past year. Individuals who identified as gay/lesbian or bisexual, who drove under the influence of alcohol in the past year, and who reported prior drug use were at risk of cocaine use. Of concern, nearly 10% of gay/lesbian Hispanic individuals report having used cocaine in the past year. Furthermore, cocaine use was associated with other risky behaviors; 41.1% of LSD (Lysergic acid diethylamide) users also reported cocaine use, and 18.2% of cocaine users reported having driven under the influence of alcohol within the past year. Findings from the present study may inform harm reduction efforts and health prevention messages.

Are Sexual Minorities More at Risk? Bullying Victimization Among Lesbian, Gay, Bisexual, and Questioning Youth

Bullying has garnered the attention of researchers and policy makers alike, because of various negative physical, mental, and educational outcomes that stem from these experiences. Certain youth are more at risk for bullying victimization (ASPA, 2012). Thus, research highlighting and addressing these experiences is crucial to provide safer environments for youth. This study utilizes the 2013 Youth Risk Behavior Surveillance System (YRBSS) data to investigate whether or not experiences of victimization differ for lesbian, gay, bisexual, and questioning (LGBQ) youth. Drawing from a sample of 12,642 9th through 12th grade youth, this study investigates two primary areas: (a) the prevalence of traditional bullying, electronic bullying, and homophobic bullying victimizations among LGBQ youth, and (b) the interaction of sexual orientation and gender with traditional bullying, electronic bullying, and homophobic bullying victimizations. Results suggest that LGBQ youth experience all types of bullying victimization at higher rates than heterosexual youth. Results also highlight the importance of the interaction of sexual orientation and gender in bullying victimization. Findings reveal that LGBQ females, LGBQ males, and heterosexual females experience each type of victimization at higher rates than heterosexual males. Findings confirm that disparities exist in bullying victimization among LGBQ youth, and thus cannot be ignored in schools. School policies must explicitly acknowledge and address how sexual orientation and gender matter within the constructs of youth violence if they wish to create safer learning environments for youth.

Providing Unique Support for Health Study Among Young Black and Latinx Men Who Have Sex With Men and Young Black and Latinx Transgender Women Living in 3 Urban Cities in the United States: Protocol for a Coach-Based Mobile-Enhanced Randomized Control Trial

BACKGROUND

The US National HIV/AIDS Strategy 2020 calls for increasing access to care, improving outcomes of people living with HIV, and targeting biomedical prevention efforts, including access to pre-exposure prophylaxis (PrEP) in communities where HIV is most heavily concentrated. The cities of Baltimore, Maryland (MD); Washington, DC; and Philadelphia, Pennsylvania (PA) are disproportionately burdened by high rates of new cases of HIV infection, with high prevalence among young Black and Latinx men who have sex with men (YBLMSM) and young Black and Latinx transgender women (YBLTW) aged 15-24 years.

OBJECTIVE

This study aims (1) to identify and recruit YBLMSM and YBLTW who are at risk or living with HIV in Baltimore, MD; Philadelphia, PA; and Washington, DC, using respondent-driven sampling (RDS) with targeted seed selection, and (2) to assess the efficacy of a coach-based mobile-enhanced intervention (MEI) compared with standard of care (SOC) to increase successful engagement and retention into HIV, PrEP, and substance use treatment care across the HIV care and prevention continua in 3 Mid-Atlantic cities. This paper describes the protocol and progress as of October 20, 2019.

METHODS

This study uses a multiphase mixed methods design. The first phase is a formative, qualitative research with focus group discussions and key informant interviews. The second phase consists of evaluating the ability of RDS with targeted seed selection. The third phase includes 2 embedded randomized controlled trials (RCTs), where participants complete a baseline sociobehavioral survey, rapid HIV testing, and eligible youth enroll in parallel status-dependent RCTs that randomize the participant to 1 of 2 study arms: MEI with coach or SOC. Participants are asked to complete a web-based survey and provide biologic specimens-HIV-1 RNA (viral load) or HIV-1 antibody test and urine drug screen-at baseline and at 3, 6, and 12 months, and an exit interview at 18 months.

RESULTS

A formative qualitative research was conducted in February 2017 and May 2018, and this led to further refinement of recruitment and study methods. Aim 1 recruitment began in September 2017 with subsequent enrollment into the RCTs. Recruitment is ongoing with 520 participants screened and 402 (77.3%) enrolled in aim 1 by October 2020. Of these, 159 are enrolled in the 2 randomized trials: 36 (22.6%) HIV-positive not virally suppressed (aim 2) and 123 (77.4%) high-risk HIV-negative (aim 3).

CONCLUSIONS

This study has the potential to significantly impact the medical and substance use services provided to YBLMSM and YBLTW in the United States by providing rigorous scientific evidence outlining approaches and strategies that improve the uptake and engagement of YBLMSM and YBLTW in the HIV treatment and prevention continuum.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03194477; https://clinicaltrials.gov/ct2/show/NCT03194477.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/17269.

Engagement with LGBTQ community moderates the association between victimization and substance use among a cohort of sexual and gender minority individuals assigned female at birth

BACKGROUND

Research has documented higher levels of substance use among sexual and gender minority (SGM) individuals - particularly sexual minority women (SMW) and transgender people - than among their heterosexual and cisgender peers. Because SGM substance use is linked to stigma-based victimization, it is crucial to identify social contexts that may buffer the association between victimization and substance use among SGM.

METHODS

We explored how engagement with LGBTQ-specific community influences victimization experiences and substance use among 488 SGM individuals assigned female at birth (FAB-SGM; ages 16-32; 26% White) in a large Midwestern city. We tested whether participants who used LGBTQ community spaces differed from those who do not in levels of victimization and substance use, and whether use of LGBTQ spaces buffered SGM from the negative effects of victimization on substance use.

RESULTS

Results demonstrated significant associations between victimization and alcohol and use of specific drugs. Contrary to expectations, participants who used LGBTQ spaces reported more victimization and more use of certain substances; however, when controlling for being out about non-heterosexual identity, this association remained only for LGBTQ community centers and school groups. Evidence was mixed for community engagement as a moderator of the association between victimization and substance use.

CONCLUSIONS

Overall, results indicated that LGBTQ spaces may be associated with adaptive and maladaptive coping functions and should be considered a potential target for health interventions. Findings emphasize the need for increased research on FAB-SGM, including SMW and transgender individuals, and provide actionable recommendations to reduce incidence of victimization and substance use.

Experience of sexual and gender minority youth when accessing health care in Turkey

OBJECTIVES

Lesbian, gay, bisexual, transgender and questioning (LGBTQ) patients report alarming rates of identity-based discrimination in healthcare settings. Despite the health risks and challenges impacting LGBTQ young adults, little is known about their healthcare experience, especially in Turkey. This study aimed to increase the knowledge base on LGBTQ young individuals' experiences when accessing health care in an attempt to address the myriad of health disparities they might face.

METHODS

Participants were recruited from the division of Adolescent Medicine at Hacettepe University, and also from an LGBTQ support group. Participants' responded to open-ended items asking about their experiences in the healthcare setting, in particular to any case of discrimination and reasons for non-disclosure of gender identity/orientation.

RESULTS

A total of 24 LGBTQ youth completed the interview, mean age 21.1 years. Overall participants reported alarming rates of identity-discrimination and non-disclosure when accessing health care. Additionally, participants reported high rates of postponing care as they felt they would be subjected to LGBTQ-based discrimination. Furthermore results suggest that transgender individuals face additional healthcare challenges compared with their LGB and cisgender counterparts.

CONCLUSIONS

To the best of our knowledge this is the first study in Turkey to evaluate the experiences of LGBTQ youth accessing medical care. This study shows that similar to barriers observed in previous studies on LGBTQ individuals, discrimination when accessing healthcare is a serious problem. Increasing knowledge concerning the discrimination LGBTQ people face when accessing healthcare is essential to decreasing healthcare disparities.

Elevated Risky Sexual Behaviors Among Sexual Minority Girls: Indirect Risk Pathways Through Peer Victimization and Heavy Drinking

Sexual minority girls (SMGs), compared with heterosexual females, are more likely to report negative sexual outcomes including earlier age of sexual intercourse debut, more lifetime and recent sexual partners, pregnancy involvement, and sex while intoxicated. Data describing the mechanisms related to these health disparities are limited. The purpose of this study was therefore to longitudinally assess the roles of sexual minority-related peer victimization and heavy episodic drinking (HED) as mediators of the relation between sexual minority status and sexual outcomes. The girls examined in this study were recruited into a longitudinal study of adolescent health from two large, urban adolescent medicine clinics affiliated with academic medical centers. The final sample for this analysis included 79 SMGs and a comparison group of 127 heterosexual girls aged between 14 and 19 years. Mediation models were run in the structural equation modeling framework. Our results provided evidence to support a serial multiple mediation pathway. SMGs were more likely to report sexual minority-related victimization, and sexual minority-related victimization predicted increased HED, which was subsequently found to prospectively predict increased sexual risk behaviors. Taken together, these novel findings indicate that both sexual minority-related victimization and HED may play important roles in explaining disparities in risky sexual behavior among SMGs.

Cyberphysical Human Sexual Behavior Acquisition System (SeBA): Development and Implementation Study in China

Background

Sexual health is one of the principal components of human well-being. Traditional methods for observing human sexual behavior typically adopt manual intervention approaches (eg, interviews). However, the data obtained by such traditional approaches suffer from intrinsic bias and limited sample sizes. Sexual behavioral data that are more reflective of the actual situation can be collected by equipping sex toys with sensors.

Objective

To address the limitations of traditional human sexual behavior data observation methods, a novel cyberphysical system is proposed to capture natural human sexual behavior data in China at the nationwide level.

Methods

A cyberphysical human sexual behavior acquisition system (SeBA) was designed and implemented. SeBA jointly utilizes state of the art information and communication technologies such as smart sex toys, smartphones, and mobile social networks. Smart sex toys enable objective collection of data on human sexual behavior, while the mobile social network provides the possibility of partnered sex in a cyberphysical manner. The objectives and function settings are discussed, and the overall framework of the system architecture is presented.

Results

Operation and privacy policies are proposed and the technical solution of SeBA is described. The effectiveness of SeBA was verified based on analysis of users’ human sexual behavior data collected from January 2016 to June 2017. A total of 103,424 solo sexual behaviors were recorded involving 13,047 users, and 61,007 partnered sexual behaviors from 7,140 users were observed. The proportions of males and females in the solo and partnered sex groups were fairly consistent with recent statistics on unmarried individuals in China. We also found that only a small portion of individuals provided information on at least one other attribute besides the required input of gender, such as age, height, location, job, sex preferences, purposes, and interests.

Conclusions

To the best of our knowledge, this is the first study to analyze objective human sexual behavior data at the nationwide level. Although the data are restricted to China, this study can provide insight for further research on human sexual behavior based on the huge amount of data available from wireless smart sex toys worldwide. It is anticipated that findings from such objective big data analyses can help deepen our understanding of sexual behavior, as well as improve sexual health and sexual wellness.

Sexual Orientation in Individuals With Congenital Adrenal Hyperplasia: A Systematic Review

Congenital adrenal hyperplasia (CAH) is a genetic condition of the steroidogenic enzymes in the adrenal cortex normally leading to variable degrees of cortisol and aldosterone deficiency as well as androgen excess. Exposure to androgens prenatally might lead to ambiguous genitalia. The fetal brain develops in traditional male direction through a direct action of androgens on the developing nerve cells, or in the traditional female direction in the absence of androgens. This may indicate that sexual development, including sexual orientation, are programmed into our brain structures prenatally. The objective of this study was to perform a systematic review of the literature, investigating sexual orientation in individuals with CAH. The study also aimed at identifying which measures are used to define sexual orientation across studies. The review is based on articles identified through a comprehensive search of the OVIDMedline, PsycINFO, CINAHL, and Web of Science databases published up to May 2019. All peer-reviewed articles investigating sexual orientation in people with CAH were included. Quantitative, qualitative, and mixed methods were considered, as well as self-, parent-, and third-party reports, and no age or language restrictions were enforced on publications. The present review included 30 studies investigating sexual orientation in patients with CAH assigned female at birth (46, XX) (n = 927) or assigned male at birth (46, XY and 46, XX) (n = 274). Results indicate that assigned females at birth (46, XX) with CAH had a greater likelihood to not have an exclusively heterosexual orientation than females from the general population, whereas no assigned males at birth (46, XY or 46, XX) with CAH identified themselves as non-heterosexual. There was a wide diversity in measures used and a preference for unvalidated and self-constructed interviews. Hence, the results need to be interpreted with caution. Methodological weaknesses might have led to non-heterosexual orientation being overestimated or underestimated. The methodological challenges identified by this review should be further investigated in future studies.

Stigma, Anxiety, and Depression Among Gay and Bisexual Men in Mixed-Orientation Marriages

The mental health of gay and bisexual men in mixed-orientation marriages is poorly understood. In this article, the authors explore the development of anxiety and depression among gay and bisexual men in heterosexual marriages. Sixteen men, living in the Australian states of New South Wales, Queensland, Victoria, and Tasmania were interviewed throughout 2016 and 2017. An analysis of interviews identified four main themes, namely, compulsory heterosexuality, existential distress, compartmentalization, and integration and resolution. Participants reported experiencing anxiety and depression, which were exacerbated by the stigmatization of same-sex attraction and by an overwhelming distress from feelings of shame and guilt regarding their marital infidelity. Findings indicate that gay and bisexual men in mixed-orientation marriages develop anxiety and depression in response to the exigencies of compulsory heterosexuality and the compartmentalizing of same-sex attraction and identity during heterosexual marriage. Coming-out as same-sex attracted resolved men's distress by facilitating an integrative self-structure.

The Nature and Extent of Sexting Among a National Sample of Middle and High School Students in the U.S

Sexting is the sending or receiving of sexually explicit or sexually suggestive images or video, usually via mobile devices. Despite widespread public concern about these behaviors as they occur among adolescents, including potentially serious legal consequences, relatively little research has been done to estimate the frequency of sexting among middle and high school students. The current study contributes to this scant body of knowledge by reporting prevalence rates for sending and receiving sexually explicit images or video among a nationally representative sample of 5593 American middle and high school students. Overall, approximately 13% of students reported that they had sent a sext, while 18.5% had received a sext. About one-third of those who sext had done it just one time. Rates of asking for, being asked for, and sharing of sexts are also presented, and are broken down further by gender, sexual orientation, race, and age. Implications for preventing sexting behaviors with these results in mind are also discussed.

Mental Health, Drug, and Violence Interventions for Sexual/Gender Minorities: A Systematic Review

CONTEXT

Compared with cisgender (nontransgender), heterosexual youth, sexual and gender minority youth (SGMY) experience great inequities in substance use, mental health problems, and violence victimization, thereby making them a priority population for interventions.

OBJECTIVE

To systematically review interventions and their effectiveness in preventing or reducing substance use, mental health problems, and violence victimization among SGMY.

DATA SOURCES

PubMed, PsycINFO, and Education Resources Information Center.

STUDY SELECTION

Selected studies were published from January 2000 to 2019, included randomized and nonrandomized designs with pretest and posttest data, and assessed substance use, mental health problems, or violence victimization outcomes among SGMY.

DATA EXTRACTION

Data extracted were intervention descriptions, sample details, measurements, results, and methodologic rigor.

RESULTS

With this review, we identified 9 interventions for mental health, 2 for substance use, and 1 for violence victimization. One SGMY-inclusive intervention examined coordinated mental health services. Five sexual minority-specific interventions included multiple state-level policy interventions, a therapist-administered family-based intervention, a computer-based intervention, and an online intervention. Three gender minority-specific interventions included transition-related gender-affirming care interventions. All interventions improved mental health outcomes, 2 reduced substance use, and 1 reduced bullying victimization. One study had strong methodologic quality, but the remaining studies' results must be interpreted cautiously because of suboptimal methodologic quality.

LIMITATIONS

There exists a small collection of diverse interventions for reducing substance use, mental health problems, and violence victimization among SGMY.

CONCLUSIONS

The dearth of interventions identified in this review is likely insufficient to mitigate the substantial inequities in substance use, mental health problems, and violence among SGMY.

Romantic Attraction and Substance Use in 15-Year-Old Adolescents from Eight European Countries

Sexual minority youth are at higher risk of substance use than heterosexual youth. However, most evidence in this area is from North America, and it is unclear whether the findings can be generalized to other cultures and countries. In this investigation, we used data from the 2014 Health Behaviour in School-aged Children (HBSC) study to compare substance use in same- and both-gender attracted 15-year-old adolescents from eight European countries (n = 14,545) to that of their peers who reported opposite-gender attraction or have not been romantically attracted to anyone. Both-gender attracted, and to a lesser extent, same-gender attracted adolescents were significantly more likely to smoke cigarettes, consume alcohol, get drunk and use cannabis, or be involved in multiple substance use in the last 30 days compared to their opposite-gender attracted peers. Those adolescents who have not been in love had significantly lower odds for substance use than all other youth. The pattern of results remained the same after adjusting for country, gender and family affluence. These findings are compatible with the minority stress and romantic stress theories. They suggest that sexual minority stigma (and love on its own) may contribute to higher substance use among adolescents in European countries.

The impact of sexual self-concept ambiguity on alcohol approach bias and consumption

The current work sought to examine both intra-individual and situational features that can predict heightened alcohol misuse among individuals who report sexual-orientation self-concept ambiguity (SSA). It was hypothesized that situations that evoke the salience of individuals' sexuality will contribute to alcohol misuse among individuals who report heightened SSA. In the first experiment, fifty-nine students were recruited from psychology subject pools at two large state universities. Following a writing manipulation, used to evoke a state of heightened self-focus on an individual's sexuality, participants completed the Alcohol Approach-Avoidance Task, which served as a marker of implicit bias toward alcohol-related cues. In the second experiment, ninety-four women between the ages of 21 and 35 were recruited into a lab-based study. Utilizing procedures similar to the first experiment, we attempted to test our research questions in an ad lib drinking study. Among young adults with greater SSA, situations that induced heightened self-focus were predictive of increased approach bias toward alcohol-related cues and increased consumption of an ostensibly alcoholic beverage. Evidence supported a causal link between the situational salience of sexuality and acute risk of alcohol-approach bias and consumption behavior among those with heightened SSA. Preventive interventions may highlight variation in risk of alcohol misuse based on identity-related risk factors, such as sexual self-concept ambiguity, and drinking motivations.

Pilot feasibility trial of the MyPEEPS mobile app to reduce sexual risk among young men in 4 cities

Objectives

Our study team adapted the MyPEEPS (Male Youth Pursuing Empowerment, Education, and Prevention around Sexuality) curriculum, an evidence-based human immunodeficiency virus (HIV) prevention intervention, from a face-to-face, group-based intervention to an individual-level mobile responsive web-based intervention to improve HIV risk behaviors in very young men, aged 13–18 years.

Materials and methods

In adapting the MyPEEPS intervention to mobile app, we used a series of methodologies, including expert panel reviews, weekly team meetings with the software development company, and conducted in-depth interviews with very young men. Following the iterative process, we conducted a 6-week pre–post feasibility pilot trial with 40 young men in Birmingham, AL; Chicago, IL; New York City, NY; and Seattle, WA. Primary outcomes of interest were uptake of the app, accessibility and satisfaction.

Results

Across all 4 sites, 62.5% (25/40) of participants completed all modules in the app in an average of 28.85 (SD 21.69) days. Participants who did not attend to the follow-up visit did not complete any of the app modules. Overall participants reported that the app was easy to use, useful and has the potential to improve their sexual health knowledge and behavior and awareness in risky contexts. Participants also highly rated the app, information and interface quality of the app.

Discussion

Lessons learned from the pilot included the need for reminder systems and providing anticipatory guidance about Internet connectivity when using the app. These changes will be incorporated into study procedures for our multisite trial.

Conclusion

Overall, participants found the app to be highly usable and have the potential to positively improve their sexual risk behavior.

Latent Classes of Polysubstance Use Among Adolescents in the United States: Intersections of Sexual Identity with Sex, Age, and Race/Ethnicity

PURPOSE

We aimed to estimate latent classes of concurrent polysubstance use and test for sexual orientation differences in latent class memberships with representative data from adolescents living in 19 U.S. states. We also tested whether sex, race/ethnicity, and age moderated the sexual identity differences in polysubstance use class memberships.

METHODS

We analyzed data from 119,437 adolescents from 19 states who participated in the 2015 Youth Risk Behavior Survey. Latent class analysis characterized polysubstance use patterns based on self-reported frequency of lifetime and past-month use of alcohol (including heavy episodic drinking), tobacco (cigarettes, cigars, and smokeless tobacco), and marijuana. Multinomial logistic regression models tested differences in latent class memberships by sexual identity. Interaction terms tested whether sex, race/ethnicity, and age moderated the sexual identity differences in polysubstance use class memberships.

RESULTS

A six-class model of polysubstance use fit the data best and included nonusers (61.5%), experimental users (12.2%), marijuana-alcohol users (14.8%), tobacco-alcohol users (3.8%), medium-frequency three-substance users (3.6%), and high-frequency three-substance users (4.1%). Gay/lesbian- and bisexual-identified adolescents had significantly higher odds than heterosexual-identified adolescents of being in all of the user classes compared with the nonuser class. These sexual identity differences in latent polysubstance use class memberships were generally larger for females than for males, varied occasionally by race/ethnicity, and were sometimes larger for younger ages.

CONCLUSION

Compared with their heterosexual peers, gay/lesbian and bisexual adolescents-especially females-are at heightened risk of engaging in multiple types of polysubstance use. Designing, implementing, and evaluating interventions will likely reduce these sexual orientation disparities.

Pilot Testing the Feasibility of a Game Intervention Aimed at Improving Help Seeking and Coping Among Sexual and Gender Minority Youth: Protocol for a Randomized Controlled Trial

Background

Sexual and gender minority youth (SGMY; eg, lesbian, gay, bisexual, and transgender youth) experience myriad substance use and mental health disparities compared with their cisgender (nontransgender) heterosexual peers. Despite much research showing these disparities are driven by experiences of bullying and cyberbullying victimization, few interventions have aimed to improve the health of bullied SGMY. One possible way to improve the health of bullied SGMY is via a Web-accessible game intervention. Nevertheless, little research has examined the feasibility of using a Web-accessible game intervention with SGMY.

Objective

This study aimed to describe the protocol for a randomized controlled trial (RCT) pilot, testing the feasibility and limited efficacy of a game-based intervention for increasing help-seeking–related knowledge, intentions, self-efficacy, behaviors, productive coping skills use, and coping flexibility and reducing health risk factors and behaviors among SGMY.

Methods

We enrolled 240 SGMY aged 14 to 18 years residing in the United States into a 2-arm prospective RCT. The intervention is a theory-based, community-informed, computer-based, role playing game with 3 primary components: encouraging help-seeking behaviors, encouraging use of productive coping, and raising awareness of Web-based resources. SGMY randomized to both the intervention and control conditions will receive a list of SGMY-inclusive resources, covering a variety of health-related topics. Control condition participants received only the list of resources. Notably, all study procedures are conducted via the internet. We conveniently sampled SGMY using Web-based advertisements. Study assessments occur at enrollment, 1 month after enrollment, and 2 months after enrollment. The primary outcomes of this feasibility study include implementation procedures, game demand, and game acceptability. Secondary outcomes include help-seeking intentions, self-efficacy, and behaviors; productive coping strategies and coping flexibility; and knowledge and use of Web-based resources. Tertiary outcomes include bullying and cyberbullying victimization, loneliness, mental health issues, substance use, and internalized sexual and gender minority stigma.

Results

From April to July 2018, 240 participants were enrolled and randomized. Half of the enrolled participants (n=120) were randomized into the intervention condition and half (n=120) into the control condition. At baseline, 52.1% (125/240) of the participants identified as gay or lesbian, 26.7% (64/240) as bisexual, 24.2% (58/240) as queer, and 11.7% (28/240) as another nonheterosexual identity. Nearly half (113/240) of participants were a gender minority: 36.7% (88/240) were cisgender boys, and 16.3% (39/240) were cisgender girls. There were no differences in demographic characteristics between intervention and control condition participants.

Conclusions

Web-accessible game interventions overcome common impediments of face-to-face interventions and present a unique opportunity to reach SGMY and improve their health. This trial will provide data on feasibility and limited efficacy that can inform future Web-based studies and a larger RCT aimed at improving health equity for SGMY.

Trial Registration

ClinicalTrials.gov NCT03501264; https://clinicaltrials.gov/ct2/show/NCT03501264 (Archived by WebCite at http://www.webcitation.org/72HpafarW)

International Registered Report Identifier (IRRID)

DERR1-10.2196/12164

Reproductive Health Considerations in Sexual and/or Gender Minority Adolescents

Disparities exist in the area of reproductive health for lesbian, gay, bisexual (LGB), and transgender and gender nonconforming (TGNC) adolescents compared with cisgender, heterosexual adolescents, particularly related to pregnancy and pregnancy risk factors. Review of the literature indicates an estimated increased risk of adolescent pregnancy involvement between 2 and 10 times higher for LGB youth compared with heterosexual youth. This might be explained by a broad spectrum of sexual health risks experienced, including an earlier age of sexual debut, exposure to sexual abuse, and a higher number of sexual partners. TGNC youth face conflict with their gender identity and potentially their sexual orientation. It is likely that their experience is similar to cisgender LGB adolescents as it pertains to reproductive health considerations. TGNC adolescents additionally confront the added challenge of fertility preservation. Health care providers play an important role in identifying and addressing these risk factors to improve the health of LGB and TGNC adolescents. Unfortunately, whether implicit or explicit, bias among health care providers exists and affects patient care. We believe it is the responsibility of health care providers to be informed about the increased needs of these patients and to provide appropriate risk-reducing management while using inclusive and sensitive history-taking and language.

A National Survey on Depression, Internalized Homophobia, College Religiosity, and Climate of Acceptance on College Campuses for Sexual Minority Adults

Sexual minority persons have an increased risk for negative mental health outcomes in adulthood. This seems to largely be due to experiences of stigma in social settings. This study sought to understand the relationship between attending a religiously conservative college, internalized homophobia (a measure of sexual stigma), and depressive symptoms for sexual minority adults. Sexual minority adult participants (n = 384) from across the U.S. were recruited and completed a Web-based, anonymous survey. A mediation model predicting depression through college religious conservatism, college acceptance of sexual minority identities, and internalized homophobia was tested using path analysis. Results revealed an indirect effect of increased religious conservatism of a college predicted higher depression through lower college acceptance and higher internalized homophobia. Implications for the mental health of sexual minority adults and future research are examined.

Sexual Identity Disclosure and Awareness of HIV Prevention Methods Among Black Men Who Have Sex With Men

Black men who have sex with men (BMSM) are disproportionately affected by the human immunodeficiency virus (HIV) epidemic, yet we know little about how HIV-negative BMSM of different sexual orientations access HIV prevention strategies. Identity development, minority stress, and disclosure theories suggest that for people of different sexual orientations, disclosure of sexual identity may be related to health behaviors. We performed a latent class analysis on a sample of 650 BMSM (Mage = 33.78, SD = 11.44) from Atlanta, Georgia, to explore whether sexual orientation, disclosure of sexual identity, and relationship status were related to HIV prevention strategies, including awareness of PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) and frequency of HIV testing. We found three distinct BMSM classes referred to as (1) closeted bisexuals, (2) sexual identity managers, and (3) gay, out, and open; all classes primarily engaged in casual sex. Classes differed in their awareness and access to HIV prevention strategies. The closeted bisexual class was least aware of and least likely to access HIV prevention. Findings have important implications for future research, namely the consideration of sexual identity and disclosure among BMSM. With this knowledge, we may be able to engage BMSM in HIV/sexually transmitted infection (STI) prevention services.

Biological origins of sexual orientation and gender identity: Impact on health

Gynecologic Oncologists are sometimes consulted to care for patients who present with diverse gender identities or sexual orientations. Clinicians can create more helpful relationships with their patients if they understand the etiologies of these diverse expressions of sexual humanity. Multidisciplinary evidence reveals that a sexually dimorphic spectrum of somatic and neurologic anatomy, traits and abilities, including sexual orientation and gender identity, are conferred together during the first half of pregnancy due to genetics, epigenetics and the diversity of timing and function of sex chromosomes, sex-determining protein secretion, gonadal hormone secretion, receptor levels, adrenal function, maternally ingested dietary hormones, fetal health, and many other factors. Multiple layers of evidence confirm that sexual orientation and gender identity are as biological, innate and immutable as the other traits conferred during that critical time in gestation. Negative social responses to diverse orientations or gender identities have caused marginalization of these individuals with resultant alienation from medical care, reduced self-care and reduced access to medical care. The increased risks for many diseases, including gynecologic cancers are reviewed. Gynecologic Oncologists can potentially create more effective healthcare relationships with their patients if they have this information.

Early Initiation of Substance Use as an Indicator of Problematic Substance Use Among Young Men Who Have Sex with Men (YMSM)

BACKGROUND AND OBJECTIVES

Much research has documented that young men who have sex with men (YMSM) are at higher risk for substance use-related problems. This study examined the age of substance use initiation and it's relationship to current substance use-related problems among substance-using YMSM.

DESIGN AND METHODS

A cross-sectional survey of 191 YMSM (aged 18 to 29) with recent histories of prescription drug misuse was conducted in Philadelphia in 2012-13. Participants were surveyed about age of initiation of cigarette smoking, alcohol use to the point of intoxication, marijuana, prescription, and illicit drugs, and about alternate modes of prescription drug administration. The severity of participants' current substance use related problems was measured using the Drug Abuse Screening Test (DAST-10).

RESULTS

Mean age of initiation was 14.6 years for cigarette smoking, 15.3 years for alcohol use to the point of intoxication, 15.2 years for marijuana, 16.8 years for prescription drugs, and 17.9 years for illicit drugs. Use of 2 or more substances by the age of 15 was reported by 56% of the participants. Odds of substance-related problems were significantly greater among those who reported earlier initiation of alcohol, prescription drugs, or polysubstance use. Odds of prescription drug misuse via altered routes of administration were significantly greater among participants with earlier onset of alcohol, marijuana, prescription, illicit drugs, or polysubstance use.

DISCUSSION AND CONCLUSIONS

This study demonstrates that earlier initiation of substance use is associated with higher risk of substance-related problems among substance-using YMSM. Early interventions addressing substance use initiation could benefit this population.

Health Concerns of Transgender and Gender Nonconforming Youth and Their Parents Upon Presentation to a Transgender Clinic

PURPOSE

The purpose of the study was to determine the frequency of specific health concerns identified by transgender and gender nonconforming patients and their parents at initial clinic visit.

METHODS

Checklists were developed in an iterative process and distributed to both patients and parents at their initial visit to a transgender clinic. Retrospective chart review and secondary data analyses were performed to determine the number of items endorsed, frequency with which each item was endorsed, and provider domain of each item endorsed: physician, social work, or both physician and social work.

RESULTS

Checklists were collected from 118 patients and 103 parents. Patients endorsed a mean of 8.4 concerns (range 0-22) and parents 7.9 concerns (range 0-20). The most commonly endorsed patient concerns included use of gender-affirming hormones, steps for transition, gender-affirming surgery, restroom/dressing room use, and legal issues. Common parent concerns included general resources, child safety at school, acute mental health concerns, restroom/dressing room use, and steps for transition. Of the concerns endorsed by patients, 44% were in the social work domain, 37% in the physician domain, and 19% in both the social work and physician domain. Of the concerns endorsed by parents, 40% were in the social work domain, 31% in the physician domain, and 29% in the social work and physician domain.

CONCLUSIONS

Although patients and parents had similar numbers of concerns, they primarily focused on different topics. Youth were more interested in hormones and transition, while parents were more interested with transition and acceptance. Many concerns for both patients and parents fell within the social work domain.