Raising sexual minority youths' health levels by incorporating resiliencies into health promotion efforts

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.

Differences in Multimorbidity among Cisgender Sexual Minority and Heterosexual Adults: Investigating Differences across Age-Groups

Objectives: Despite increased risk for chronic disease, there is limited research that has examined disparities in multimorbidity among sexual minority adults and whether these disparities differ by age. Methods: Data were from the 2014-2018 Behavioral Risk Factor Surveillance System. We used sex-stratified multinomial logistic regression to examine differences in multimorbidity between sexual minority and heterosexual cisgender adults and whether hypothesized differences varied across age-groups. Results: The sample included 687,151 adults. Gay, lesbian, and bisexual adults had higher odds of meeting criteria for multimorbidity than same-sex heterosexual adults. These disparities were greater among sexual minority adults under the age of 50 years. Only other non-heterosexual men over the age of 50 years and lesbian women over the age of 80 years were less likely to have multimorbidity than their same-sex heterosexual counterparts. Discussion: Health promotion interventions to reduce adverse health outcomes among sexual minorities across the life span are needed.

Conceptualizing the Effects of Continuous Traumatic Violence on HIV Continuum of Care Outcomes for Young Black Men Who Have Sex with Men in the United States

The United States (US) is on track to achieve the 90-90-90 targets set forth by UNAIDS and the National HIV/AIDS strategy, yet significant racial disparities in HIV care outcomes remain, particularly for young Black men who have sex with men (YBMSM). Research has demonstrated that various types of violence are key aspects of syndemics that contribute to disparities in HIV risk. However, little research has looked collectively at cumulative violent experiences and how those might affect HIV treatment and care outcomes. Drawing on extant literature and theoretical underpinnings of syndemics, we provide a conceptual model that highlights how continuous traumatic violence experienced by YBMSM may affect HIV outcomes and contribute to racial disparities in HIV outcomes. The findings of this focused review suggest a need for research on how continuous exposure to various types of violence influence HIV prevention and treatment outcomes for young Black MSM.

Risk, Resilience, and Smoking in a National, Probability Sample of Sexual and Gender Minority Adults, 2017, USA

Background. There are well-documented inequities in smoking between sexual and gender minority (SGM; e.g., lesbian, gay, bisexual, and transgender [LGBT]) and straight and cisgender people. However, there is less information about risk for and resilience against smoking among SGM people. Such information is critical for understanding etiology and developing interventions. Aims. To conduct a within-group assessment of risks and resiliencies relating to smoking status. Method. In 2017, we conducted a cross-sectional telephone survey with a national, probability-based sample of SGM adults (N = 453). We assessed theory-informed risks (adverse childhood events, substance use-oriented social environment, mental distress, stigma, discrimination, social isolation, and identity concealment) and resiliencies (advertising skepticism, identity centrality, social support, and SGM community participation). We applied survey weights, standardized predictor variables, and fit logistic regression models predicting smoking status. We stratified by age and SGM identity. Results. Patterns of risk and resilience differ by age and identity. Effects were consistently in the same direction for all groups for participating in substance use-oriented social environments, pointing to a potential risk factor for all groups. Advertising skepticism and having people you can talk to about being LGBTQ were potential protective factors. Discussion. Intervention development should address risk and resilience that differs by SGM identity. Additionally, our findings suggest interventionists should consider theoretical frameworks beyond minority stress. Conclusion. While much of the literature has focused on the role of stress from stigma and discrimination in tobacco use, addressing social norms and bolstering protective factors may also be important in SGM-targeted interventions.

Effects of familial and non-familial warmth during childhood and adolescence on sexual-orientation disparities in alcohol use trajectories and disorder during emerging adulthood

BACKGROUND

We investigated sexual-orientation differences in typologies of self-reported familial and non-familial warmth in childhood (before age 11) and adolescence (ages 11-17); and tested whether warmth explained sexual minority emerging adults' (ages 18-25) heightened odds of having heavier alcohol use trajectories (AUTs) and heightened risk for past-year alcohol use disorder (AUD) compared to completely heterosexuals.

METHODS

Using self-reported data from the U.S.-based Growing Up Today Study cohort, latent class analyses identified typologies of familial and non-familial warmth during childhood and adolescence. Multivariable regression models tested our objectives.

RESULTS

Six warmth classes emerged, including: High-High (i.e., high familial and high non-familial warmth, respectively); High-Moderate; Moderate-Moderate; Moderate-Occasional; Occasional-Occasional; and Low-Low. Among women, sexual minorities had higher odds than completely heterosexuals of being in the Moderate-Moderate, Moderate-Occasional, and Occasional-Occasional versus the High-High warmth class. There were not significant associations between sexual orientation and warmth classes for men. Lower warmth classes were generally associated with greater past-year AUD, and mediated heightened disparities in AUD for sexual minority women versus completely heterosexual women (4.3% mediated), but not among men. Warmth classes were generally unassociated with AUTs, and did not mediate sexual-orientation differences in AUTs.

CONCLUSIONS

Lower warmth was associated with greater alcohol-related problems, but not alcohol use itself. Warmth explained a small proportion of AUD disparities for sexual minority women-but not for men.

Revisiting the 'Thai gay paradise': Negative attitudes toward same-sex relations despite sexuality education among Thai LGBT students

School settings are volatile and often violent for LGBT teens who are first coming to terms with their sexuality. We explored the attitudes of LGBT students in Thai secondary schools towards homosexuality. Students aged 12-19 years were surveyed in 393 public institutions providing secondary-school education in six regions of Thailand, selected by a multistage cluster sampling. Among 1088 LGBT-identified students, 378 (35%) reported negative attitudes toward homosexuality. Factors associated with homonegative attitudes in a multivariable logistic regression analysis were identifying as a transgender (Adjusted Odds Ratio [aOR] 2.5, 95% CI 1.5-4.1), having low academic performance (GPA scores of 2-3 [aOR 2.6, 95% CI 1.7-4.1] or less than 2 [aOR 2.1, 95% CI 1.5-2.]), and attending sexuality education classes covering topics such as bullying LGBT students (aOR 1.9, 95% CI 1.2-3.1) and safe homosexual practices (aOR 2.1, 95% CI 1.7-4.1). Sexuality education in its current form in Thai public schools may not be effective in reducing homonegative attitudes of LGBT-identified students. A more comprehensive sexuality education emphasising gender and rights along with strategies addressing social disparities due to sexual orientation is needed to enable Thai LGBT teens to accept their sexuality without shame and self-disrespect.

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.

Moderators of the Association Between Community Connectedness and Internalizing Symptoms Among Gay Men

Sexual minorities are exposed to various gay-related and general stressors that increase risk of mental and physical health problems. Yet, less attention has been paid to positive factors such as ameliorative coping strategies and social supports that reduce risk of mental health difficulties in this population. The current study sought to address this gap by examining the association between gay community connectedness and internalizing symptoms (i.e., general psychological distress, anxiety, and depression) in a sample of 147 self-identified gay men living in the greater New York City area, as well as the conditions under which gay community connectedness is associated with better mental health. Data were collected between 2013 and 2014. Findings indicated that gay community connectedness was associated with lower levels of internalizing symptoms among gay men, consistent with minority stress theory and other work examining the benefits of community coping resources. This association was strongest for non-White gay men, those whose gay identity was more central to their overall identity, and those with higher levels of femininity. These findings underscore the need to consider multiple aspects of gay men's identity (e.g., race/ethnicity, centrality, femininity) in order to fully understand the factors associated with mental health outcomes in this population.

The Role of Self-Conscious Emotions in the Sexual Health of Gay and Bisexual Men: Psychometric Properties and Theoretical Validation of the Sexual Shame and Pride Scale

Researchers have theorized about the role of sexual shame as a mechanism through which sexual minority stress manifests into mental health difficulties, such as sexual compulsivity for gay and bisexual men (GBM), and about the resilience-promoting effects of sexual pride. However, no validated measures to date have directly tapped into these constructs rather than using proxies for them, such as internalized homonegativity. We developed the Sexual Shame and Pride Scale (SSPS) and conducted a psychometric evaluation of it using a sample of 260 highly sexually active GBM. The scale had the expected structure in factor analysis and showed evidence of internal consistency and test-retest reliability. Correlational analyses demonstrated the convergent validity of sexual shame and sexual pride with relevant constructs. Regression analyses demonstrated the predictive validity of sexual shame in relation to sexual compulsivity, accounting for unique variability even after adjusting for previously demonstrated etiological factors, and the predictive validity of both shame and pride, which interacted to consistently predict four sexual behavior outcomes. Findings suggest the SSPS is a psychometrically valid and reliable measure that may be useful in future empirical work and highlight preliminary evidence for the role of these constructs in the sexual health of GBM.

Disparities in Health Risk Behaviors and Health Conditions Among Rhode Island Sexual Minority and Unsure High School Students

BACKGROUND

Sexual minority students have higher risk for health-related behaviors. We examined 5 domains including 34 health risk behaviors and health conditions among sexual minorities and unsure students in Rhode Island. We also included sexual contact of heterosexually identified students to capture heterosexually identified students who may be considered sexual minorities by their behavior.

METHODS

We used the 2007-2015 Rhode Island Youth Risk Behavior Survey data (N = 14,264). We categorized students into 4 groups: students self-identified as heterosexual and reported no sexual contact with same sex only or both sexes (group 1); self-identified as heterosexual and reported sexual contact with same sex only or both sexes (group 2); self-identified as lesbian, gay, bisexual (group 3); and responded as unsure (group 4). We used multivariable adjusted logistic regression analyses to evaluate associations of sexual minority and unsure students with 34 health risk behaviors and health conditions accounting for complex sampling design.

RESULTS

Students in groups 2-4 were more likely to engage in health-risk behaviors including violent behaviors, attempted suicide, substance use, and no physical activity than their peers.

CONCLUSIONS

As sexual minority youth continue to report higher rates of health-related risk behaviors, targeted evidence-based prevention approaches must focus on reducing these risk behaviors among those youth.

"All We Had Were the Streets": Lessons Learned From a Recreation-Based Community Health Space for Young Black MSM and Trans Women Across the HIV Prevention and Care Continuum

Young Black men who have sex with men (MSM) and transgender people experience disparities in HIV incidence and HIV outcomes. To effectively engage these communities in HIV-related programming, we developed a recreation-based community health space. We sought to examine the challenges and successes in implementing this program. Qualitative data were collected from federal progress reports and by a process evaluator who recorded interviews with staff, stakeholders, and participants. These data were coded for themes related to barriers and successes. We consolidated themes into four key domains: community engagement, service provision, stigma, and violence. Each of these domains was determined to significantly affect programmatic success during the implementation period. Young Black MSM and transgender people experience stigmas that pose challenges to effective engagement in HIV-related programming. These lessons learned offer strategies for community engagement and for addressing violence and stigma to maximize programmatic effectiveness.

Developing a community-level anti-HIV/AIDS stigma and homophobia intervention in new York city: The project CHHANGE model

HIV/AIDS stigma and homophobia are associated with significant negative health and social outcomes among people living with HIV/AIDS (PLWHA) and those at risk of infection. Interventions to decrease HIV stigma have focused on providing information and education, changing attitudes and values, and increasing contact with people living with HIV/AIDS (PLWHA), activities that act to reduce stereotyped beliefs and prejudice, as well as acts of discrimination. Most anti-homophobia interventions have focused on bullying reduction and have been implemented at the secondary and post-secondary education levels. Few interventions address HIV stigma and homophobia and operate at the community level. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a community-level, multi-component anti-HIV/AIDS stigma and homophobia intervention designed to reduce HIV stigma and homophobia thus increasing access to HIV prevention and treatment access. The theory-based intervention included three primary components: workshops and trainings with local residents, businesses and community-based organizations (CBO); space-based events at a CBO-partner drop-in storefront and "pop-up" street-based events and outreach; and a bus shelter ad campaign. This paper describes the intervention design process, resultant intervention and the study team's experiences working with the community. We conclude that CHHANGE was feasible and acceptable to the community. Promoting the labeling of gay and/or HIV-related "space" as a non-stigmatized, community resource, as well as providing opportunities for residents to have contact with targeted groups and to understand how HIV stigma and homophobia relate to HIV/AIDS prevalence in their neighborhood may be crucial components of successful anti-stigma and discrimination programming.

Someone to count on: social support as an effect modifier of viral load suppression in a prospective cohort study

Though functional social support has been shown to serve as a protective factor for HIV viral load suppression in other populations, scant research has examined this relationship among men who have sex with men (MSM) in the United States. We assessed characteristics of social support, effects of social support on HIV viral load, and moderation by social support of the relationship between psychosocial indicators of a synergistic epidemic (syndemic) and HIV viral load. We analyzed longitudinal data from HIV-positive MSM using antiretroviral therapy who were enrolled in the Multicenter AIDS Cohort Study between 2002 and 2009 (n = 712). First, we conducted reliability assessments of a one-item social support measure. Then, we conducted a series of generalized longitudinal mixed models to assess our research questions. Moderation was assessed using an interaction term. A three-level (low/medium/high) social support variable demonstrated high reliability (intraclass correlation coefficients  = 0.72; 95% CI: 0.70, 0.75). Black and Hispanic MSM reported lower social support than their White counterparts (p < .0001). Recent sero-conversion was associated with higher social support (p < .05). Higher numbers of concomitant syndemic indicators (depression, polysubstance use, and condomless anal sex) were associated with lower social support (p < .0001). Medium and high social support levels were associated with greater viral load suppression and lower viral load means (p < .0001). Social support moderated the relationships between syndemic and HIV viral load (p < .05). HIV-positive MSM, particularly those of color, may benefit greatly from interventions that can successfully boost functional social support. Creating strengths-based interventions may also have particularly high impact among HIV-positive MSM with the highest psychosocial burdens.

Advancing Research on Structural Stigma and Sexual Orientation Disparities in Mental Health Among Youth

Psychological research on stigma has focused largely on the perceptions of stigmatized individuals and their interpersonal interactions with the nonstigmatized. This work has been critical in documenting many of the ways in which stigma operates to harm those who are targeted. However, this research has also tended to overlook broader structural forms of stigma, which refer to societal-level conditions, cultural norms, and institutional policies and practices that constrain the lives of the stigmatized. In this article I describe the emerging field of research on structural stigma and review evidence documenting the harmful consequences of structural stigma for the mental/behavioral health of lesbian, gay, and bisexual youth. This research demonstrates that structural stigma represents an important, but thus far largely underrecognized, mechanism underlying mental health disparities related to sexual orientation among youth. I offer several suggestions to advance research in this area, including (a) adopting a life-course approach to the study of structural stigma; (b) developing novel measures of structural stigma; (c) expanding both the range of methods used for studying structural stigma and the sequelae of structural stigma that are evaluated; (d) identifying potential mediators and moderators of the structural stigma-health relationship; (e) examining intersectionalities; and (f) testing generalizability of structural stigma across other groups, with a particular focus on transgender youth. The implications of this research for preventive interventions and for public policy are also discussed.

Body image in transgender young people: Findings from a qualitative, community based study

The goal of this study was to examine the ways in which transgender youth experience their bodies with regard to gender and body size. Ninety transgender youth and young adults completed in-depth interviews in eight metropolitan areas of the United States, Canada, and Ireland. Using a queer perspective, qualitative analyses revealed two broad conceptual categories: body dissatisfaction and body satisfaction. Within these categories, participants focused on body issues related to gender characteristics and body size. Findings revealed evidence of self-criticism and social distress related to body image dissatisfaction and self-acceptance and social acceptance related to body image satisfaction. Data demonstrated how gender, body size, and the intersection of gender and body size influenced personal perceptions of body dissatisfaction and satisfaction. Developmental processes were evident: participants further along in consolidating a gender identity described gaining a sense of social awareness, self-acceptance, and body satisfaction reflecting a sense of resilience.

Life stress as a mediator and community belonging as a moderator of mood and anxiety disorders and co-occurring disorders with heavy drinking of gay, lesbian, bisexual, and heterosexual Canadians

PURPOSE

To examine the extent to which sexual identity disparities in mental health outcomes (anxiety disorder, mood disorder, anxiety-mood disorder, and co-occurring anxiety or mood disorder and heavy drinking) are mediated by life stress or moderated by a sense of community belonging.

METHODS

This study pooled data from a large, national, multi-year sample of Canadians aged 18-59 years, who self-identified as lesbian, gay, bisexual, or heterosexual (N = 222,548). A series of stratified binary mediation models were fitted. Significance of the indirect effect was determined by using bootstrapping to obtain standard errors and confidence intervals.

RESULTS

Sexual minority (versus heterosexual) respondents were significantly more likely to describe their lives as stressful, their sense of community belonging as weak, and had significantly greater odds of the negative mental health outcomes. Perceived life stress partially mediated the effects of sexual identity on the mental health outcomes. The differences between the mediated effects for the gay/lesbian and bisexual subgroups were statistically significant (all p < 0.05). When stratified by sense of community belonging, life stress mediated the relationship with mood disorders for the gay/lesbian group, where a strong sense of community belonging was associated with greater odds of mood disorders for gay/lesbian versus heterosexual respondents.

CONCLUSIONS

These mediation and moderated mediation models provide further evidence for a social patterning of the mental health disparities experienced by sexual minorities in Canada.

Social innovation for the promotion of health equity

The role of social innovations in transforming the lives of individuals and communities has been a source of popular attention in recent years. This article systematically reviews the available evidence of the relationship between social innovation and its promotion of health equity. Guided by Fair Foundations: The VicHealth framework for health equity and examining four types of social innovation--social movements, service-related social innovations, social enterprise and digital social innovations--we find a growing literature on social innovation activities, but inconsistent evaluative evidence of their impacts on health equities, particularly at the socio-economic, political and cultural level of the framework. Distinctive characteristics of social innovations related to the promotion of health equity include the mobilization of latent or unrealised value through new combinations of (social, cultural and material) resources; growing bridging social capital and purposeful approaches to linking individual knowledge and experience to institutional change. These have implications for health promotion practice and for research about social innovation and health equity.

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.

Understanding and Measuring LGBTQ Pathways to Health: A Scoping Review of Strengths-Based Health Promotion Approaches in LGBTQ Health Research

Health research traditionally has focused on the health risks and deficits of lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations, obscuring the determinants that can promote health across the life course. Recognizing, appropriately measuring, and rendering visible these determinants of health is paramount to informing appropriate and engaging health policies, services, and systems for LGBTQ populations. The overarching purpose of this article is to provide an overview of the findings of a scoping review aimed at exploring strengths-based health promotion approaches to understanding and measuring LGBTQ health. Specifically, this scoping review examined peer-reviewed, published academic literature to determine (a) existing methodological frameworks for studying LGBTQ health from a strengths-based health promotion approach, and (b) suggestions for future methodological approaches for studying LGBTQ health from a strengths-based health promotion approach. The findings of this scoping review will be used to inform the development of a study aimed at assessing the health of and improving pathways to health services among LGBTQ populations in Nova Scotia, Canada.

Prevalence and Co-Occurrence of Heavy Drinking and Anxiety and Mood Disorders Among Gay, Lesbian, Bisexual, and Heterosexual Canadians

OBJECTIVES

To investigate the prevalence and co-occurrence of heavy drinking, anxiety, and mood disorders among Canadians who self-identified as gay, lesbian, bisexual, or heterosexual.

METHODS

Pooled data from the 2007 to 2012 cycles of the Canadian Community Health Survey (n = 222 548) were used to fit logistic regression models controlling for sociodemographic characteristics.

RESULTS

In adjusted logistic regression models, gay or lesbian respondents had greater odds than heterosexual respondents of reporting anxiety disorders, mood disorders, and anxiety-mood disorders. Bisexual respondents had greater odds of reporting anxiety disorders, mood disorders, anxiety-mood disorders, and heavy drinking. Gay or lesbian and bisexual respondents had greater odds than heterosexuals of reporting co-occurring anxiety or mood disorders and heavy drinking. The highest rates of disorders were observed among bisexual respondents, with nearly quadruple the rates of anxiety, mood, and combined anxiety and mood disorders relative to heterosexuals and approximately twice the rates of gay or lesbian respondents.

CONCLUSIONS

Members of sexual minority groups in Canada, in particular those self-identifying as bisexual, experience disproportionate rates of anxiety and mood disorders, heavy drinking, and co-occurring disorders.

Sexual-Orientation Differences in Positive Youth Development: The Mediational Role of Bullying Victimization

OBJECTIVES

To examine sexual-orientation differences in positive youth development, and how bullying victimization mediated these differences in a sample of adolescents.

METHODS

In 2007 to 2008, positive youth development was measured in 1870 adolescents from US schools and after-school programs in 45 states by using the validated Five Cs model of competence, confidence, connection, character, and caring/compassion. Sexual-minority youths (6.8%) reported having same- or both-gender sexual attractions. Nonattracted youths (4.2%) reported having no sexual attractions.

RESULTS

Compared with sexual-minority youths, heterosexual and nonattracted youths had lower odds of being a victim of bullying. Heterosexual and nonattracted youths also had higher average scores in competence, confidence, and connection, but these associations between sexual orientation and positive youth development scores were partly attributable to lack of bullying victimization.

CONCLUSIONS

Designing, implementing, and evaluating interventions that reduce bullying can give sexual-minority youths access to several building blocks of health and well-being.

Predictors of Self-Reported Adherence to Antiretroviral Medication in a Multisite Study of Ethnic and Racial Minority HIV-Positive Youth

OBJECTIVE

To test social cognitive predictors of medication adherence in racial/ethnic minority youth living with HIV using a conceptual model.

METHODS

Youth were participants in two descriptive studies by the Adolescent Trials Network for HIV/AIDS Interventions. Minority youth ages 16-24 years who were prescribed antiretroviral medication were included (N = 956). Data were collected through chart extraction and/or laboratory testing and by Audio Computer-Assisted Self-Interview.

RESULTS

39% of youth reported suboptimal adherence. Path analysis was used to explore predictors of medication adherence. Higher self-efficacy predicted higher readiness and adherence. Greater social support predicted higher self-efficacy. Psychological symptoms and substance use were associated with several predictors and lower adherence.

CONCLUSIONS

The model provided a plausible framework for understanding adherence in this population. Culturally competent, but individually tailored, interventions focused on increasing self-efficacy to take medication and reducing risk behaviors (e.g., substance use) may be helpful for racial or ethnic minority youth with HIV.

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.

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

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