Identifying sexual orientation health disparities in adolescents: analysis of pooled data from the Youth Risk Behavior Survey, 2005 and 2007

State-level population estimates of sexual minority adolescents in the United States: A predictive modeling study

PURPOSE

The Youth Risk Behavior Survey (YRBS) among high school students includes standard questions about sexual identity and sex of sexual contacts, but these questions are not consistently included in every state that conducts the survey. This study aimed to develop and apply a method to predict state-level proportions of high school students identifying as lesbian, gay, or bisexual (LGB) or reporting any same-sex sexual contacts in those states that did not include these questions in their 2017 YRBS.

METHODS

We used state-level high school YRBS data from 2013, 2015, and 2017. We defined two primary outcomes relating to self-reported LGB identity and reported same-sex sexual contacts. We developed machine learning models to predict the two outcomes based on other YRBS variables, and comparing different modeling approaches. We used a leave-one-out cross-validation approach and report results from best-performing models.

RESULTS

Modern ensemble models outperformed traditional linear models at predicting state-level proportions for the two outcomes, and we identified prediction methods that performed well across different years and prediction tasks. Predicted proportions of respondents reporting LGB identity in states that did not include direct measurement ranged between 9.4% and 12.9%. Predicted proportions of respondents reporting any same-sex contacts, where not directly observed, ranged between 7.0% and 10.4%.

CONCLUSION

Comparable population estimates of sexual minority adolescents can raise awareness among state policy makers and the public about what proportion of youth may be exposed to disparate health risks and outcomes associated with sexual minority status. This information can help decision makers in public health and education agencies design, implement and evaluate community and school interventions to improve the health of LGB youth.

Protection and Connection: Negating Depression and Suicidality among Bullied, LGBTQ Youth

Lesbian, gay, bisexual, transgender, queer and/or questioning (LGBTQ) youth are particularly at risk of bullying and other forms of violence, and the myriad of risk factors associated with instances of victimization. Interdisciplinary research finds that certain protective factors-biological, psychological, familial, or community-level characteristics that reduce the impact of risk and problematic outcomes-mitigate the effects of victimization. Using data from the 2019 Nashville Youth Risk Behavioral Surveillance System (YRBSS), this study examines the effects of bullying and electronic bullying on LGBTQ (n = 303) and heterosexual/cisgender (n = 1104) 9th to 12th-grade students' depression and suicidality, and the role that protective factors play in mitigating these effects. Logistic regression results show that students who feel safe at school, feel valued by their community, and seek help are less likely to report depression and suicidality overall, when they are LGBTQ, and when they are bullied. These findings point to the importance of solidifying personal, school, and community-level support systems for youth, especially LGBTQ youth.

Protective Environmental Factors and Opioid Use Among Sexual Minority Youth

Objectives: Nonmedical use of prescription opioids (NMUPO) is a pressing public health concern and affects sexual minority youth (SMY) at greater rates than heterosexual youth. We investigated whether protective environmental factors-(1) Human Rights Campaign's state equality index (SEI) and (2) supportive school environments for LGBTQ youth, influenced NMUPO among SMY and non-SMY students. Methods: We combined data from the 2017-2019 Youth Risk Behavior Survey, 2016-2018 School Health Profiles, state-level socio-demographic and SEI data across 24 states (N=156,149). Generalized linear mixed models examined associations between (1) SEI and (2) supportive school environments for LGBTQ youth, with NMUPO, accounting for clustering at the school-and state-level. Results: Before adjustment, we found that youth in states with higher SEI were significantly less likely to engage in NMUPO compared to students in states with lower SEI, a relationship that became non-significant after adjustment. After adjusting for individual-and state-level indicators, SMY in states with supportive school environments for LGBTQ youth were less likely to engage in NMUPO. Conclusions: Supportive school environments for LGBTQ youth may play an important role in the health of SMY. Establishing more inclusive policies and supportive environments within schools may reduce NMUPO among SMY.

Measurement Invariance of Psychological Distress, Substance Use, and Adult Social Support across Race/Ethnicity and Sex among Sexual Minority Youth

Research on intersectional differences among sexual minority youth (SMY) relies on population-level datasets to ensure sufficiently large samples to explore between-group differences and assess the influence of axes of oppression/privilege. I argue that a structural equation modeling framework for investigating intersectional differences among SMY increases the nuance with which we understand heterogeneity and provides tools for ensuring that variables measure comparable constructs across diverse populations - an assumption of traditional univariate methods that is rarely empirically verified. Using a subset of SMY that identified as either White or Hispanic/Latino and male or female from the New Mexico Youth Risk and Resiliency Survey (N = 3,654), this study tested invariance of three latent constructs: psychological distress, substance use, and adult support across sexual orientation, race/ethnicity, sex, and three-way intersections of those identities. Analyses established invariance across race/ethnicity and sex of all constructs among gay/lesbian youth. Partial invariance models were required to account for intersectional differences in substance use among bisexual youth and in psychological distress among questioning youth. This study models a novel strategy for examining how social location at the intersection of multiple axes of oppression/privilege shape behavioral health and social support and paves the way for significant advances in research on SMY.

Accelerating UN Sustainable Development Goals with AI-Driven Technologies: A Systematic Literature Review of Women's Healthcare

In this paper, we critically examine if the contributions of artificial intelligence (AI) in healthcare adequately represent the realm of women's healthcare. This would be relevant for achieving and accelerating the gender equality and health sustainability goals (SDGs) defined by the United Nations. Following a systematic literature review (SLR), we examine if AI applications in health and biomedicine adequately represent women's health in the larger scheme of healthcare provision. Our findings are divided into clusters based on thematic markers for women's health that are commensurate with the hypotheses that AI-driven technologies in women's health still remain underrepresented, but that emphasis on its future deployment can increase efficiency in informed health choices and be particularly accessible to women in small or underrepresented communities. Contemporaneously, these findings can assist and influence the shape of governmental policies, accessibility, and the regulatory environment in achieving the SDGs. On a larger scale, in the near future, we will extend the extant literature on applications of AI-driven technologies in health SDGs and set the agenda for future research.

Suicidality, Sexual Orientation, and Race/Ethnicity: Results from a U.S. Representative Adolescent Sample

Objective: We examined sadness/hopelessness and suicide among racial/ethnic and sexual minority youth (SMY).Methods: 2017 Youth Risk Behavior Survey (YRBS) data on sadness/hopelessness and suicide were analyzed among White, Black, and Hispanic/Latino youth.Results: A main effect of sexual minority (SM) identity emerged for sadness/hopelessness, suicidal ideation, suicide plan, suicide attempts, and injurious attempts; SMY reported increased risk compared to their heterosexual peers. An interaction between Black race and SM identity emerged for sadness/hopelessness, suicidal ideation, and suicide plan; White SMY were at greater risk than Black SMY. A main effect of Black race on suicide attempts was found; Black youth reported increased risk of suicide attempts compared to White youth.Conclusions: Black SMY exhibited lower risk of sadness/hopelessness, suicide ideation, and suicide plans than their White SMY peers, whereas Black youth overall were more likely to report suicide attempts than their White peers.HIGHLIGHTSThere was an interaction of sexual minority identity and race (Black or White) for three outcomes.SM and Black identities were associated with higher risk for suicide attempts.Only SM identity was associated with increased risk of injurious suicide attempts.

A Quality Improvement Approach to Enhance LGBTQ+ Inclusivity in Pediatric Primary Care

BACKGROUND

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) teens are at higher risk of illness as a result of bias but are less likely than peers to attend well visits. Medical organizations recommend improving care through staff education, visual cues, and routine inquiry of sexual orientation and gender identity (SO/GI) and pronouns. It is unknown how to do this confidentially in pediatrics. This quality improvement (QI) project aimed to confidentially collect and document SO/GI and pronouns early in at least 90% of teen acute care visits.

METHODS

A diverse, representative QI team in a resident primary care clinic conducted a series of staff and clinician trainings to improve knowledge, then displayed welcoming signage and offered staff pronoun and rainbow pins. Multiple Plan-Do-Study-Act cycles developed methods of routine and private collection of SO/GI and pronouns. Outcome measures included proportion of teen acute visits with such documentation collected via weekly chart reviews. Process measures included staff/clinician preparedness, assessed by surveys.

RESULTS

SO/GI and pronouns were documented in 0% of teen acute visits at baseline, 70% after 6 months, and 90% during the 20-week sustainment measurement phase. The proportion of staff and clinicians who felt prepared to provide care for LGB and transgender patients increased (53% to 68% for LGB, P = .07; and 30% to 57% for transgender, P = .002).

CONCLUSIONS

QI methods can create protocols for confidential, sustainable SO/GI and pronoun collection from teens early in acute visits. This allows clinicians and staff to address patients appropriately and for clinicians to better meet their needs.

Constructing a web-based health directory for adolescent men who have sex with men: Strategies for development and resource verification

Online health directories are increasingly used to locate health services and community resources, providing contact and service information that assists users in identifying resources that may meet their health and wellness needs. However, service locations require additional vetting when directories plan to refer vulnerable populations. As a tool included as part of a trial of a mobile life skills intervention for cisgender adolescent men who have sex with men (AMSM; ages 13-18), we constructed and verified resources for an online resource directory focused on linking young people to LGBTQ+ friendly and affirming local health and community social services resources. We collected information for 2301 individual directory listings through database and internet searches. To ensure the listings aligned with the project's focus of supporting young sexual minority men, we developed multiple data verification assessments to ensure community appropriateness resulting in verification of 1833 resources suitable for inclusion in our locator tool at project launch (March 2018). We offer lessons learned and future directions for researchers and practitioners who may benefit from adapting our processes and strategies for building culturally-tailored resource directories for vulnerable populations.

Analysis of Reported Health Care Use by Sexual Orientation Among Youth

IMPORTANCE

In the United States, adolescents who are lesbian, gay, or bisexual (LGB) face disparities across physical and mental health outcomes compared with non-LGB youth, yet few studies have looked at patterns of health care utilization by sexual orientation.

OBJECTIVE

To compare health care utilization indicators for LGB and non-LGB youth.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study analyzed wave 3 data from Healthy Passages, a longitudinal observational study of diverse public school students in Birmingham, Alabama; Houston, Texas; and Los Angeles County, California. Multivariable logistic regression models tested sexual-orientation differences in the past 12-month health care utilization measures, controlling for youth age, gender, race and ethnicity, household education, income, and marital status. Data collection began in 2010 when students were in the 5th grade (mean [SE] age, 11.13 [0.01] years) (wave 1) and continued 2 years later (wave 2, 7th grade) and 5 years later (wave 3, 10th grade). Permission to be contacted was provided for 6663 children, and 5147 (77%) participated in audio computer-assisted self-administered interviews. This study included 4256 youth (640 LGB, 3616 non-LGB) who completed interviews at wave 1 and wave 3 and answered key items used in this analysis. Analyses were completed in June 2021.

EXPOSURES

Sexual orientation (LGB vs non-LGB).

MAIN OUTCOMES AND MEASURES

Health care utilization and communication difficulty with a physician in the past 12 months.

RESULTS

Among 4256 youths included in the study at baseline in 5th grade (wave 1), 2171 (48.9%) were female; 1502 (44.5%) were Hispanic or Latino; 1479 (28.9%) were Black; the mean (SE) age was 11.19 (0.03) years; and 640 (14.5%) were LGB at wave 3. Compared with non-LGB youth, a higher proportion of LGB youth reported not receiving needed medical care in the last 12 months (adjusted odds ratio [aOR], 1.68; 95% CI,1.38-2.05), most commonly for sexually transmitted infections, contraception, and substance use. LGB youth more frequently reported difficulty communicating with their physician (aOR, 1.71; 95% CI, 1.27-2.30) than non-LGB youth.

CONCLUSIONS AND RELEVANCE

This study's results found that health care utilization differs by sexual orientation for youth. These findings suggest that clinician training is needed to address the health care needs of LGB youth. Routinely capturing sexual orientation data might enable tracking of health care utilization indicators for LGB youth.

Sexual Minority Status and Age of Onset of Adolescent Suicide Ideation and Behavior

OBJECTIVES

To determine if sexual minority adolescents have earlier onset of suicidality and faster progressions from ideation to plan and attempt than heterosexual adolescents.

METHODS

A population-based longitudinal cohort of 1771 adolescents participated in the NEXT Generation Health Study. Participants reported sexual minority status (defined by sexual attraction) in 2010-2011 and retrospectively reported age at onset of suicidality in 2015-2016.

RESULTS

Sexual minority adolescents (5.8% of weighted sample) had higher lifetime risk of suicide ideation (26.1% vs 13.0%), plan (16.6% vs 5.4%), and attempt (12.0% vs 5.4%) than heterosexual adolescents. Survival analyses adjusted for demographic characteristics and depressive symptoms revealed positive associations of sexual minority status with time to first onset of suicide ideation (hazard ratio [HR] = 1.77; 95% confidence interval [CI] 1.03-3.06) and plan (HR = 2.69; 95% CI 1.30-5.56). The association between sexual minority status and age at onset of suicide attempt was stronger at age <15 (HR = 3.26; 95% CI 1.25-8.47) than age ≥15 (HR = 0.59; 95% CI 0.21-1.66). The association between sexual minority status and progression from ideation to plan was stronger in the same year of first ideation (HR = 2.01; 95% CI 1.07-3.77) than ≥1 year after first ideation (HR = 1.33; 95% CI 0.26-6.77).

CONCLUSIONS

Sexual minority adolescents had earlier onset of suicidality and faster progression from suicide ideation to plan than heterosexual adolescents. The assessment of sexual minority status in routine pediatric care has the potential to inform suicide risk screening, management, and intervention efforts among early sexual minority adolescents.

The New Genetic Evidence on Same-Gender Sexuality: Implications for Sexual Fluidity and Multiple Forms of Sexual Diversity

In September of 2019, the largest-ever (N = 477,522) genome-wide-association study of same-gender sexuality was published in Science. The primary finding was that multiple genes are significantly associated with ever engaging in same-gender sexual behavior, accounting for between 8-25% of variance in this outcome. Yet an additional finding of this study, which received less attention, has more potential to transform our current understanding of same-gender sexuality: Specifically, the genes associated with ever engaging in same-gender sexual behavior differed from the genes associated with one's relative proportion of same-gender to other-gender behavior. I review recent research on sexual orientation and sexual fluidity to illustrate how these findings speak to longstanding questions regarding distinctions among subtypes of same-gender sexuality (such as mostly-heterosexuality, bisexuality, and exclusive same-gender experience). I conclude by outlining directions for future research on the multiple causes and correlates of same-gender expression.

Victimization, Substance Use, Depression, and Sexual Risk in Adolescent Males Who Have Sex with Males: A Syndemic Latent Profile Analysis

Adolescent males who have sex with males (AMSM) are at increased risk of HIV/STI acquisition compared to other adolescents, making sexual risk behaviors in this population a priority public health focus. AMSM experience more victimization (including sexual/partner violence), depression, and substance abuse than their heterosexual counterparts; these may form a syndemic associated with risky sexual behavior. We pooled data from the 2015 and 2017 Youth Risk Behavior Survey, restricted to male students who reported a previous male sexual partner (n = 448). Latent profile analysis was used to identify syndemic profiles, with log-binomial and cumulative complementary log-log models used to test associations with substance use at last intercourse, condomless sex at last intercourse, and the number of sexual partners. Nearly all measures of victimization, depression, and substance use had bivariate associations with greater substance use during sex and more sexual partners. We identified three profiles of AMSM: The profile (n = 55) with the greatest risk factors (evident of a syndemic) had substantially higher prevalence of substance use during sex (aPR = 4.74, 95% CI 3.02, 7.43) and more sexual partners (aPR = 2.45, 95% CI 1.39, 4.31) than the profile with the lowest risk factors (n = 326) after adjusting for confounders. This profile was not associated with condomless sex. We identified a syndemic characterized by victimization, depression, and substance use associated with risky sexual behaviors in a nationally representative sample of AMSM. Comprehensive sexual risk reduction interventions incorporating mental health and substance use are critically important in this population.

Religious and Spiritual Development from Adolescence to Early Adulthood in the U.S.: Changes over Time and Sexual Orientation Differences

Adolescence is a critical time in the U.S. for religious development in that many young people eschew their religious identity as they enter adulthood. In general, religion is associated with a number of positive health outcomes including decreased substance use and depression. The current study compared the developmental patterns of religiosity and spirituality in heterosexual and sexual minority youth. The design was a secondary data analysis of the first five waves of the Longitudinal Study of Adolescent Health and Wellness (N = 337, 71.8% female). Using multilevel linear (for spirituality) and quadratic (for religiosity) growth models, the initial level and change over time in religiosity and spirituality, as well as the correlations between growth processes, were compared between heterosexual and sexual minority individuals. The heterosexual group had significantly higher initial religiosity levels than the sexual minority group. Religiosity decreased over time at a similar rate for the heterosexual and sexual minority groups. Spirituality significantly increased over time for the sexual minority group but not for the heterosexual youth. The change over time in religiosity and spirituality were significantly and positively correlated for heterosexual individuals but were uncorrelated for sexual minority individuals. Results indicate there are differences in religious development based on sexual minority status. Future research should take into account how these differential religious and spiritual developmental patterns seen in heterosexual and sexual minority youth might predict various health outcomes.

Tobacco Use at the Intersection of Sex and Sexual Identity in the U.S., 2007-2020: A Meta-Analysis

CONTEXT

A 2009 systematic review synthesized data between 1987 and 2007 and revealed a higher prevalence of smoking among sexual minority populations than among heterosexuals. Subsequently, growing attention to tobacco use among sexual minority populations has spurred more literature on this issue because higher tobacco use prevalence has been found in certain sexual minority subgroups relative to others. However, a population-level synthesis of tobacco use prevalence by sexual minority subgroup has not been done for the past decade.

EVIDENCE ACQUISITION

Investigators conducted a meta-analysis by searching MEDLINE, Web of Science, EMBASE, and PsycINFO for U.S.-based studies published between 2007 and 2020 that specifically reported tobacco use prevalence among adults and separated the sexes and gays/lesbians versus bisexuals. Using random-effects models, meta-prevalence estimates, 95% CIs, and heterogeneity (I²) were calculated for each sexual minority subgroup.

EVIDENCE SYNTHESIS

A total of 30 studies were included in the meta-analysis. The highest current cigarette use prevalence estimates were found among bisexual women (37.7%), followed by lesbians (31.7%), gay men (30.5%), and bisexual men (30.1%). Heterosexual men (21.0%) and women (16.6%) had the lowest prevalence.

CONCLUSIONS

Tobacco use prevalence among sexual minorities during 2007-2020 remained at similarly high levels as those during 1987-2007, and tobacco use disparity between sexual minorities and heterosexuals persisted in the past decade. Significant heterogeneity existed in tobacco use across sexual minority subgroups, with bisexual women having the highest prevalence. These findings are critical for increasing decision maker's awareness and action to address sexual minorities' persistent high prevalence of tobacco use, particularly among bisexual women.

The Role of Sexual Orientation in the Associations Between Religiousness and Hypertension

This study assessed the cross-sectional associations between organizational religious activity (ORA), intrinsic religiosity (IR), and hypertension in a US nationally representative sample. Data were from Wave IV of the National Longitudinal Study of Adolescent to Adult Health, collected in 2008. The sample (N = 5115, M_age = 28.96 years, 54% female) was divided into three sexual orientation categories: heterosexual, mostly heterosexual, and sexual minority. Dependent variables were systolic and diastolic blood pressure and binary cut-scores of clinical hypertension. ORA and IR were independent variables, with sexual orientation as the moderator. Multivariable analyses revealed greater ORA was associated with increased blood pressure (BP)/hypertension for the sexual minority group. There was a trend in the heterosexual group where ORA was associated with decreased BP. Generally, ORA was not associated with BP/hypertension in the mostly heterosexual group. There were no significant effects for IR. Future research should continue to examine the complex ways ORA and IR are associated with health based on sexual orientation and use longitudinal methodology to examine how ORA may impact BP/hypertension across the lifespan.

Sexual Orientation-Based Alcohol, Tobacco, and Other Drug Use Disparities: The Protective Role of School-Based Health Centers

This study investigated whether the presence of school-based health centers (SBHCs) was associated with six substance use behaviors among sexual minority youth (SMY) and their heterosexual peers. Data from the 2015 Oregon Healthy Teens Survey, including 13,608 11th graders in 137 schools (26 with SBHCs) were used in the current study. Multilevel logistic regression analyses were performed. Results revealed significant SBHC by SMY status interactions indicating a relatively lower likelihood of past 30-day alcohol use (23%), binge drinking (43%), use of e-cigarettes (22%), marijuana (44%), and unprescribed prescription drugs (28%) among SMY in SBHC schools compared with non-SMY at SBHC schools. Furthermore, SMY in SBHC schools reported lower likelihood of aforementioned substance use behaviors than SMY attending non-SBHC schools. Conversely, no differences in these outcomes were observed for non-SMY in SBHC and non-SBHC schools. Findings from this study suggest SBHCs may help to mitigate substance use disparities among marginalized populations, such as SMY.

Innovation and Integration of Sexuality in Family Life Education

As a fundamental aspect of the human experience, sexuality is experienced at every stage in the lifespan. Sexual values, behaviors, and health are important components of individual and family well-being. Educating about such a fundamental aspect of life is both obvious and crucial. In this article, we consider the potential of sexuality education in the field and profession of family life education (FLE). We critique sexuality education in the United States, and we critique the marginal place of human sexuality in the FLE field. We then offer recommendations for incorporating lifespan, socio-ecological, family systems and intersectionality into sexuality education, and recommendations for FLE and sexuality education research and practice. We argue that educating about sexuality in the context of FLE-and activating the profession of FLE for sexuality education-will strategically advance sexuality education, sexual health, and the field of FLE.

Sexual Experimentation in Heterosexual, Bisexual, Lesbian/Gay, and Questioning Adolescents From Ages 11 to 15

To examine adolescent sexuality development, we analyzed data from a British cohort study (N = 5,070), which assessed the same 12-14 sexual activities at ages 11, 12, 13, and 15, and sexual orientation identity at age 15. The sexual activities ranged from low (e.g., cuddling), moderate (e.g., kissing), to high (e.g., sexual intercourse) intensity. We found that most adolescents having sexual activities of low-to-moderate intensity with same-sex individuals also had them with other-sex individuals, and adolescents having other-sex contacts of low intensity often reported them nonexclusively. Furthermore, other-sex and same-sex sexual activities did not reliably distinguish between sexual orientation identities. Sex differences in these phenomena were absent or small. These findings suggest that many adolescents have low-intensity nonexclusive sexual behaviors.

Victimization, depression, and the suicide cascade in sexual minority youth

Background: Suicidality remains disproportionately prevalent among sexual minority youth, necessitating novel methods of understanding suicide risk in this population. Victimization and depression are especially salient suicide risk factors.Aims: We aimed to test if victimization and depression were associated with suicidality at each step of a suicide cascade: Ideation, planning, and suicide attempts.Method: In sample of sexual minorities from the 2015 and 2017 Youth Risk Behavior Survey, we tested nine measures of victimization and depression associated with three outcomes in succession: Suicidal ideation among the full sample (n = 3357), suicide planning among those with ideation (n = 1475), and suicide attempts among those who planned suicide (n = 1073).Results: Depression was associated with suicidal ideation (aPR = 3.93, 95% CI 3.36-4.60), planning (aPR = 1.38, 95% CI 1.12-1.69), and attempts (aPR = 1.78, 95% CI 1.32-2.41) in successive subsamples. Victimization measures had different associations with suicidality at each successive stage, with the strongest associations observed with suicidal ideation in the general sample and suicide attempts among those who planned suicide.Conclusions: This may have implications for anti-victimization intervention effectiveness at each stage of suicidality. Additional research into this association among transgender and gender non-conforming youth is recommended.

Mental-health disparities between heterosexual and sexual-minority adolescents: Examining the role of informant discrepancies

INTRODUCTION

An emerging literature documents substantial mental-health disparities by sexual orientation amongst adolescents, with sexual-minority youth exhibiting poorer mental health than heterosexual youth. This brief report provides the first empirical account of how the association between sexual-minority status and adolescent mental health differs depending on who assesses adolescents' mental health (child/mother/father/teacher), and how informant discrepancies in assessments of adolescent mental health differ by adolescents' sexual orientation.

METHODS

Data come from an Australian national sample of 14-/15-year-old adolescents (Longitudinal Study of Australian Children; n~3,000). Adolescent mental health is measured using multiple measures from the Strengths and Difficulties Questionnaire, and modelled using multivariable linear regression models.

RESULTS

Mental-health disparities between sexual-minority and heterosexual adolescents emerged irrespective of who assessed the child's mental health. However, their magnitude varied substantially by informant, being largest when mental-health was reported by adolescents (~0.7 standard deviations) and smallest when reported by teachers (~0.2 standard deviations). Discrepancies between mental-health scores collected from the child and other informants were largest for internalising than externalising behaviours, and in child-father than child-mother comparisons.

CONCLUSIONS

Understanding informant discrepancies and their meaning is pivotal to designing surveys that generate robust insights into the health of sexual-minority adolescents, as well as appropriate policy interventions.

Sexual Orientation-Based Depression and Suicidality Health Disparities: The Protective Role of School-Based Health Centers

This study's purpose was to examine whether school-based health centers (SBHCs) support mental health indicators among sexual minority youth (SMY). Data came from the 2015 Oregon Healthy Teens Survey with 13,608 11th graders in 137 public high schools in Oregon. Regression results revealed significant SBHC by SMY status interactions indicating relative reductions in likelihood of depressive episodes (30%), suicidal ideation (34%), and suicide attempts (43%) among SMY in schools with SBHCs. SMY students in SBHC schools reported lower likelihood of a past-year depressive episode, suicidal ideation, and suicide attempt versus those attending non-SBHC schools. Conversely, no differences in these outcomes were observed for non-SMY by SBHC status. SBHCs may help reduce mental health disparities among SMY, a marginalized, underserved population.

Mental health, social adversity, and health-related outcomes in sexual minority adolescents: a contemporary national cohort study

BACKGROUND

Sexual minority adolescents are more likely to have mental health problems, adverse social environments, and negative health outcomes compared with their heterosexual counterparts. There is a paucity of up-to-date population-level estimates of the extent of risk across these domains in the UK. We analysed outcomes across mental health, social environment, and health-related domains in sexual minority adolescents compared with their heterosexual counterparts in a large, contemporary national cohort.

METHODS

The Millennium Cohort Study (MCS) is a birth cohort study in the UK following up children born between Sept 1, 2000, and Jan 11, 2002 across England, Wales, Scotland, and Northern Ireland. Children recruited from the MCS have been followed up over six recruitment sweeps to date at ages 9 months, 3 years, 5 years, 7 years, 11 years, and 14 years. We analysed mental health, social, and health-related outcomes in sexual minority versus heterosexual adolescents at age 14 years. Additionally, we estimated the accumulation of multiple adverse outcomes in both groups. The primary aim of the study was to assess whether sexual minority adolescents experienced more adverse outcomes than heterosexual adolescents.

FINDINGS

Between January, 2015, and April, 2016, 9885 adolescents provided a response about their sexual attraction. 629 (6%) of 9885 adolescents (481 female participants and 148 male participants) were identified as sexual minorities. 9256 (94%) of 9885 participants (4431 female and 4825 male) were attracted to the opposite sex or not attracted to the same sex and identified as heterosexual. Sexual minority adolescents were more likely to experience high depressive symptoms (odds ratio [OR] 5·43, 95% CI 4·32-6·83; p<0·0001), self-harm (5·80, 4·55-7·41; p<0·0001), lower life satisfaction (3·66, 2·92-4·58; p<0·0001), lower self-esteem (β 1·83, 95% CI 1·47-2·19; p<0·0001), and all forms of bullying and victimisation. Sexual minorities were more likely to have tried alcohol (OR 1·85, 95% CI 1·47-2·33; p<0·0001), smoking (2·41, 1·92 -3·03; p<0·0001), and cannabis (3·22, 2·24-4·61; p<0·0001), and also had increased odds of being less physically active (β 0·36, 95% CI 0·25-0·46; p<0·0001), perceiving themselves as overweight (OR 1·73, 95% CI 1·40-2·14; p<0·0001), and dieting to lose weight (1·98, 1·58-2·48; p<0·0001). Sexual minority adolescents had more co-occurring mental health outcomes (mean 1·43 of 3 outcomes, 95% CI 1·34-1·52) compared with heterosexual adolescents (0·40 of 3 outcomes, 0·38-0·41), and more total cumulative difficulties (mean 9·43 of 28 outcomes, 95% CI 9·09-9·76 in sexual minority adolescents vs 6·16 of 28 outcomes, 6·08-6·23 in heterosexual adolescents).

INTERPRETATION

Sexual minority adolescents in the UK experience disparities in mental health, social, and health-related outcomes despite living in a time of substantial progress in rights for sexual minorities. These adverse outcomes co-occur, with implications for lifelong health and social outcomes. Health and educational practitioners should be aware of the increased risk for adverse outcomes in sexual minority adolescents.

FUNDING

None.

Organizational Religious Activity, Hypertension, and Sexual Orientation: Results From a Nationally Representative Sample

Background

Hypertension is a major public health concern, given prevalence and morbidity. Among the general population, greater religious attendance is associated with lower blood pressure (BP). However, no known studies have examined the association between religious attendance and BP among sexual minorities.

Purpose

To examine the association between BP/hypertension and organizational religious activity as a function of sexual orientation.

Methods

Data were utilized from Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health), a publicly available, U.S. nationally representative data set. Of the 4,874 individuals included in analyses, 366 participants were identified as a sexual minority. An organizational religious activity variable was created by summing responses of two separate items. BP was measured as systolic blood pressure (SBP) and diastolic blood pressure (DBP). Increasing levels of clinical severity of hypertension were also examined. Relevant covariates were controlled for in two separate models. Significant interactions between religious attendance and sexual orientation were explored in simple slope analyses.

Results

Overall, results indicated that sexual orientation moderated the association between organizational religious activity, and BP/hypertension. Crossover interactions were present for the dependent variables SBP, DBP, and prehypertension and higher (prehypertension, and hypertension 1 and 2). Generally, a negative association between organizational religious activity and hypertension was revealed among the heterosexual group, whereas a positive association was found among the sexual minority group.

Conclusions

Organizational religious activity is differentially associated with BP/hypertension among sexual minority versus heterosexual individuals. Organizational religious activity may represent a risk factor for hypertension among sexual minority individuals.

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.

Comparing Relationship Quality Across Different Types of Romantic Partners in Polyamorous and Monogamous Relationships

Polyamory is the practice of having multiple emotionally close relationships that may or may not be sexual. Research concerning polyamory has just begun to determine how relationships among partners in polyamorous arrangements may vary. Most of the research assessing perceptions of polyamorous partners has focused on primary-secondary configurations; however, non-hierarchical configurations exist and can involve having multiple primary partners or having only non-primary partners. The current research is the first to examine perceptions of partners and relationship quality in various polyamorous configurations and compares results for each configuration to monogamous partners. Results from online convenience samples suggest that co-primary and non-primary configurations are common among polyamorous participants, with approximately 38% identifying with one of these configurations in 2013 and 55% in 2017. Furthermore, our results suggest that while relationships with partners in co-primary and non-primary structures still differ in some ways (e.g., investment, acceptance, secrecy, time spent having sex), they are closer to their ideals on several psychologically meaningful indicators of relationship quality (e.g., commitment and satisfaction). In other words, despite rejecting hierarchical primary-secondary labels, many of the same relationship qualities differ systematically among partners in non-hierarchical relationships. Furthermore, pseudo-primary partners and primary partners in these relationships are more comparable to monogamous partners than they are to secondary partners. We discuss how these results inform our understanding of polyamorous and monogamous relationships and suggest future directions based on these findings.

Sexual minority children: Mood disorders and suicidality disparities

BACKGROUND

Sexual minority (gay, lesbian, and bisexual) individuals experience elevated mood disorders and suicidality compared to their heterosexual counterparts. However, to date, these sexual orientation disparities have yet to be examined among middle childhood-aged participants.

METHODS

Data were employed from the baseline wave of the Adolescent Brain Cognitive Development (ABCD) study, a U.S. representative sample. Population-level weighting was utilized, resulting in an analytic sample of N = 8,204,013 (n_unweighted = 4519) children between the ages of 9 and 10 years: with 70,952 (n_unweighted= 43) identifying as sexual minories (0.9% of the population). Structured clinical interviews were used to assess mood disorders (i.e., depressive and bipolar disorders) and suicidality. Sexual orientation (sexual minority vs. heterosexual) was examined as the focal independent variable.

RESULTS

The overall prevalence of mood disorders was 7.1%. Sexual minority children (22.5%) possessed a higher rate than heterosexual children (6.9%). The overall prevalence of suicidality was 4.8%; sexual minority children (19.1%) possessed a higher rate than heterosexual children (4.6%).

LIMITATIONS

Sexual orientation assessment did not include attraction, and thus, results may represent a lower bound estimate of sexual minorities.

CONCLUSIONS

Sexual orientation disparities in mood disorders and suicidality appear to develop as early as middle childhood. Clinicians are encouraged to assess sexual orientation among children as young as 9-10 years old, and provide appropriate normalization of sexual orientation, and referrals for mental health treatment, as indicated.

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.

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.

Prospective health associations of drive for muscularity in young adult males

OBJECTIVE

The objective of the study was to estimate prospective associations of drive for muscularity measured in 2013 and related health outcomes (depressive symptoms, overeating, binge eating, purging, binge drinking, and use of muscle-building products [e.g., creatine and steroids]) measured in 2014.

METHOD

The data come from a U.S. national large prospective cohort study, the Growing Up Today Study (GUTS) and included 2,460 males aged 18-32 years. Muscularity concerns were assessed with The Drive for Muscularity Scale (item responses ranging from 1 = Never to 6 = Always), which measures the degree of the respondents' preoccupation with increasing their muscularity.

RESULTS

Gay and bisexual males presented with higher drive for muscularity compared to heterosexual males (β = 0.30, 95% CI = 0.17, 0.43, p < .0001). Prospective analysis using generalized estimating equations indicated that each unit increase in drive for muscularity was associated with increased odds of exhibiting significant depressive symptoms (OR = 1.23, 95% CI = 1.05-1.44, p = .01), binge drinking (OR = 1.21, 95% CI = 1.02-1.45, p = .03), dieting (OR = 1.17, 95% CI = 1.01, 1.35, p = .04), and use of muscle-building products (OR = 4.49, 95% CI = 3.74, 5.40, p < .0001).

DISCUSSION

The drive for muscularity appears to be relatively prevalent across adolescence and early adulthood in males and is associated with broad and substantial health consequences. Muscularity-oriented concerns should be carefully considered when assessing and treating males with body image dissatisfaction.

Expanding the Scope of Universal Design: Implications for Gender Identity and Sexual Orientation

This article encourages postsecondary educators to expand the scope of applications of universal design and universal instructional design by exploring how principles of UD and UID can be applied to other social identities, and specifically to gender identity and sexual orientation. There are many parallels that can be drawn between students who are excluded because of their disability and students who are marginalized on the basis of nonconforming gender identity or sexual orientation. It is important that faculty and staff understand intersectionality and interdependence among social identities and consider what steps they can take to apply UID principles in ways that consider multiple aspects of identity in order to provide inclusive educational experiences for all students. Scenarios for further discussion are provided.

Trajectories of Sexual Orientation from Adolescence to Young Adulthood: Results from a Community-Based Urban Sample of Girls

PURPOSE

To examine the longitudinal cohesion and stability of sexual minority status indicators.

METHODS

The sample comprised 2,450 girls recruited from the city of Pittsburgh at ages 5-8 years. Sexual attraction, sexual partnering, romantic partnering, and sexual orientation identity were assessed between 14 and 22 years.

RESULTS

Repeated measures latent class analysis identified three sexual minority trajectories: primarily other-sex oriented (n = 716), primarily same-sex oriented (n = 90), and bisexually oriented (n = 235). Sexual minority status indicators displayed fluidity over time but cohered within latent classes.

CONCLUSIONS

Within this large sample of girls, several distinct sexuality trajectories emerged. Trajectories are relatively stable from adolescence to young adulthood.

Have Mischievous Responders Misidentified Sexual Minority Youth Disparities in the National Longitudinal Study of Adolescent to Adult Health?

The National Longitudinal Study of Adolescent to Adult Health (Add Health) has been instrumental in identifying sexual minority youth health disparities. Recent commentary suggested that some Wave 1 youth responders, especially males, intentionally mismarked same-sex attraction and, as a result, published reports of health disparities from these data may be suspect. We use two recently developed approaches to identify "jokesters" and mischievous responding and apply them to the Add Health data. First, we show that Wave 1 same-sex attracted youth, including those who later reported completely heterosexual identities in adulthood, were no more likely than different-sex attracted youth and consistently heterosexual participants to be "jokesters." Second, after accounting for mischievous responses, we replicated six previously established disparities: depressive symptoms, suicidal ideation and behaviors, alcohol use, cocaine use, parental satisfaction, and school connectedness. Accounting for mischievousness resulted in the elimination of one observed disparity between heterosexual and sexual minority youth: suicidal ideation for males who reported romantic attraction to both sexes. Results also showed that accounting for mischievous responding may underestimate disparities for sexual minority youth, particularly females. Overall, results presented here support previous studies that identified health disparities among sexual minority youth using these data.

Estimates of Non-Heterosexual Prevalence: The Roles of Anonymity and Privacy in Survey Methodology

When do people feel comfortable enough to provide honest answers to sensitive questions? Focusing specifically on sexual orientation prevalence-a measure that is sensitive to the pressures of heteronormativity-the present study was conducted to examine the variability in U.S. estimates of non-heterosexual identity prevalence and to determine how comfortable people are with answering questions about their sexual orientation when asked through commonly used survey modes. We found that estimates of non-heterosexual prevalence in the U.S. increased as the privacy and anonymity of the survey increased. Utilizing an online questionnaire, we rank-ordered 16 survey modes by asking people to rate their level of comfort with each mode in the context of being asked questions about their sexual orientation. A demographically diverse sample of 652 individuals in the U.S. rated each mode on a scale from -5 (very uncomfortable) to +5 (very comfortable). Modes included anonymous (name not required) and non-anonymous (name required) versions of questions, as well as self-administered and interviewer-administered versions. Subjects reported significantly higher mean comfort levels with anonymous modes than with non-anonymous modes and significantly higher mean comfort levels with self-administered modes than with interviewer-administered modes. Subjects reported the highest mean comfort level with anonymous online surveys and the lowest with non-anonymous personal interviews that included a video recording. Compared with the estimate produced by an online survey with a nationally representative sample, surveys utilizing more intrusive methodologies may have underestimated non-heterosexual prevalence in the U.S. by between 50 and 414%. Implications for public policy are discussed.

An integrated model of skin cancer risk in sexual minority males

Sexual minority males are an at-risk group for developing skin cancer. Elevated rates of skin cancer among this population are thought to be driven by excess indoor tanning; however, motivations to indoor tan among this population are unknown. Theoretically, appearance-based and affect regulation motives may be proximal predictors of increased indoor tanning in this population. The current study tests an integrated biopsychosocial model of indoor tanning behaviors and future intentions among a sample of sexual minority males. Participants were 231 sexual minority males, between the age of 14 and 35 years, residing in San Diego County, California, who completed a battery of self-report questionnaires online. Constructs assessed included skin tone, perceived susceptibility to skin cancer, sociocultural pressures to tan, appearance-based motives to tan, affect regulation in regard to indoor tanning, indoor tanning behaviors over the previous 3 months, and future intentions to indoor tan. The three proposed proximal predictors of indoor tanning all displayed significant pathways; however, results varied depending upon the specific outcome measure modeled. Affect regulation was significantly associated with increased odds of indoor tanning, and future intentions to indoor tan. Increased appearance reasons to tan were significantly associated with future intentions to indoor tan, while increased appearance reasons not to tan were significantly associated with fewer number of indoor tanning sessions. Results underscore the unique pathways of affect regulation and appearance-based motives in indoor tanning behaviors. Skin cancer prevention programs focusing on sexual minority males may wish to address affect and appearance concerns.

Identity, Victimization, and Support: Facebook Experiences and Mental Health Among LGBTQ Youth

The rise of social networking sites (SNSs) has created new contexts within which lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth and young adults manage their social identities and relationships. On one hand, SNSs provide important social support; on the other, they comprise another realm for victimization and discrimination. Context collapse refers to the ways diverse subgroups (e.g., family, co-workers) are often united in Facebook networks, which presents unique challenges related to outness. In this study, we examine the Facebook contexts of a cohort of LGBTQ youth and young adults with regard to outness, victimization, social support, and psychological distress by first examining descriptive statistics and correlations, and then testing a series of multiple regressions in an analytic sample of 175 (M_age = 24.02 years) LGBTQ youth. Participants reported levels of daily Facebook use comparable to other samples of non-LGBTQ youth; however, they reported greater use of security controls, which may function as a tool for managing outness. Participants reported slightly lower outness across relational subgroups on Facebook, and associations between outness to relational subgroups were slightly stronger on Facebook, illustrating the potential impact of context collapse. Regression results showed that great victimization, cyberbullying, and the offering of support online were positively associated with psychological distress. Study findings illuminate how LGBTQ youth use and manage their identities on Facebook and highlight the importance of online contexts in shaping wellbeing for LGBtQ outh and young adults.

Measuring Sexual Orientation: A Review and Critique of U.S. Data Collection Efforts and Implications for Health Policy

The U.S. Department of Health and Human Services' (HHS) Healthy People 2020 goals sought to improve health outcomes among sexual minorities; HHS acknowledged that a dearth of sexual orientation items in federal and state health surveys obscured a broad understanding of sexual minority-related health disparities. The HHS 2011 data progression plan aimed to advance sexual orientation data collection efforts at the national level. Sexual orientation is a complex, multidimensional construct often composed of sexual identity, sexual attraction, and sexual behavior, thus posing challenges to its quantitative and practical measurement and analysis. In this review, we (a) present existing sexual orientation constructs; (b) evaluate current HHS sexual orientation data collection efforts; (c) review post-2011 data progression plan research on sexual minority health disparities, drawing on HHS survey data; (d) highlight the importance of and (e) identify obstacles to multidimensional sexual orientation measurement and analysis; and (f) discuss methods for multidimensional sexual orientation analysis and propose a matrix for addressing discordance/branchedness within these analyses. Multidimensional sexual orientation data collection and analysis would elucidate sexual minority-related health disparities, guide related health policies, and enhance population-based estimates of sexual minority individuals to steer health care practices.

Generational status and social factors predicting initiation of partnered sexual activity among Latino/a youth

OBJECTIVE

Examine the longitudinal association of generational status (first = child and parent born outside the United States; second = child born in the United States, parent born outside the United States; third = child and parent born in the United States) and parent and peer social factors considered in 5th grade with subsequent oral, vaginal, and anal intercourse initiation by 7th and 10th grade among Latino/a youth.

METHOD

Using data from Latino/a participants (N = 1,790) in the Healthy Passages™ study, the authors measured generational status (first = 18.4%, second = 57.3%, third-generation = 24.3%) and parental (i.e., monitoring, involvement, nurturance) and peer (i.e., friendship quality, social interaction, peer norms) influences in 5th grade and oral, vaginal, and anal intercourse initiation by 7th and 10th (retention = 89%) grade.

RESULTS

Among girls, parental monitoring, social interaction, friendship quality, and peer norms predicted sexual initiation. Among boys, parental involvement, social interaction, and peer norms predicted sexual initiation (ps < .05). When ≥1 friend was perceived to have initiated sexual intercourse, third-generation Latinas were more than twice as likely as first- and second-generation Latinas (ps < .05) to initiate vaginal intercourse by 10th grade and almost 5 times as likely as first-generation Latinas to initiate oral intercourse by 7th grade.

CONCLUSIONS

Among Latina youth, generational status plays a role in social influences on vaginal and oral intercourse initiation. Moreover, Latinas and Latinos differ in which social influences predict sexual intercourse initiation. Preventive efforts for Latino/a youth may need to differ by gender and generational status. (PsycINFO Database Record

Anabolic Steroid Misuse Among US Adolescent Boys: Disparities by Sexual Orientation and Race/Ethnicity

OBJECTIVES

To examine the prevalence of anabolic steroid misuse among US adolescent boys as a function of sexual orientation and race/ethnicity.

METHODS

We analyzed boys from the 2015 Youth Risk Behavior Survey (n = 6248; mean age = 16), a representative sample of US high school students. Lifetime prevalence of anabolic steroid misuse was dichotomized as never versus 1 or more times.

RESULTS

Sexual minority boys reported elevated misuse compared with heterosexual boys, within each level of race/ethnicity. Black, Hispanic, and White sexual minority boys reported misuse at approximately 25%, 20%, and 9%, respectively.

CONCLUSIONS

Sexual orientation health disparities in anabolic steroid misuse disproportionally affect Black and Hispanic sexual minority adolescent boys, but more research is needed to understand the mechanisms driving these disparities.

Families Matter: Social Support and Mental Health Trajectories Among Lesbian, Gay, Bisexual, and Transgender Youth

PURPOSE

Lesbian, gay, bisexual, and transgender (LGBT) adolescents are at greater risk for mental health problems than their heterosexual peers, in part due to victimization. Social support, particularly from families, has been identified as an important promotive factor. However, little is known about how LGBT youth experience multiple forms of support or how early support predicts mental health across adolescence and into young adulthood.

METHODS

In an analytic sample of 232 LGBT youth aged 16-20 years at baseline across 5.5 years, we compared developmental trajectories of psychological distress between three empirically derived social support cluster types at baseline: those who reported uniformly low support, those who reported uniformly high support, and those who reported nonfamily support (i.e., high peer and significant other but low family support).

RESULTS

Longitudinal multilevel modeling, controlling for age, victimization, and social support at each wave, indicated key differences between cluster types. Youth in the low and nonfamily support clusters reported greater distress across all time points relative to youth in the high support cluster; however, they also showed a sharper decline in distress. Youth in the nonfamily cluster gained family support across adolescence, such that they resembled youth in the high support cluster by early adulthood.

CONCLUSIONS

Findings underscore the importance of family support for LGBT youth. Youth who lack family support, but who have other forms of support, report a decrease in psychological distress and an increase in family support across adolescence. Youth who are low in all forms of support continue to exhibit high distress.

Human Immunodeficiency Virus, Other Sexually Transmitted Infections, and Sexual and Reproductive Health in Lesbian, Gay, Bisexual, Transgender Youth

Lesbian, gay, bisexual, transgender (LGBT), and questioning youth represent a diverse population who are affected by many sexual health inequities, including increased risk for human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). To provide comprehensive sexual health care for LGBT youth, providers should set the stage with a nonjudgmental, respectful tone. Providers should be competent in recognizing symptoms of STIs and HIV and aware of the most up-to-date screening guidelines for LGBT youth. Sexual health visits should also focus on prevention, including safer sex practices, HIV pre-exposure and post-exposure prophylaxis, family planning, and immunization for hepatitis and human papillomavirus.

Scrutinizing Immutability: Research on Sexual Orientation and U.S. Legal Advocacy for Sexual Minorities

We review scientific research and legal authorities to argue that the immutability of sexual orientation should no longer be invoked as a foundation for the rights of individuals with same-sex attractions and relationships (i.e., sexual minorities). On the basis of scientific research as well as U.S. legal rulings regarding lesbian, gay, and bisexual (LGB) rights, we make three claims: First, arguments based on the immutability of sexual orientation are unscientific, given what we now know from longitudinal, population-based studies of naturally occurring changes in the same-sex attractions of some individuals over time. Second, arguments based on the immutability of sexual orientation are unnecessary, in light of U.S. legal decisions in which courts have used grounds other than immutability to protect the rights of sexual minorities. Third, arguments about the immutability of sexual orientation are unjust, because they imply that same-sex attractions are inferior to other-sex attractions, and because they privilege sexual minorities who experience their sexuality as fixed over those who experience their sexuality as fluid. We conclude that the legal rights of individuals with same-sex attractions and relationships should not be framed as if they depend on a certain pattern of scientific findings regarding sexual orientation.

Associations between LGBTQ-affirmative school climate and adolescent drinking behaviors

BACKGROUND

We investigated whether adolescents drank alcohol less frequently if they lived in jurisdictions with school climates that were more affirmative of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) individuals.

METHODS

Data from the 2010 School Health Profile survey, which measured LGBTQ school climate (e.g., percentage of schools with safe spaces and gay-straight alliances), were linked with pooled data from the 2005 and 2007 Youth Risk Behavior Survey, which measured sexual orientation identity, demographics, and alcohol use (number of drinking days, drinking days at school, and heavy episodic drinking days) in 8 jurisdictions. Two-level Poisson models tested the associations between school climate and alcohol use for each sexual-orientation subgroup.

RESULTS

Living in jurisdictions with more (versus less) affirmative LGBTQ school climates was significantly associated with: fewer heavy episodic drinking days for gay/lesbian (incidence-rate ratio [IRR]=0.70; 95% confidence interval [CI]: 0.56, 0.87; p=0.001) and heterosexual (IRR=0.80; 95% CI: 0.76, 0.83; p<0.001) adolescents; and fewer drinking days at school for adolescents unsure of their sexual orientation (IRR=0.57; 95% CI: 0.35, 0.93; p=0.024).

CONCLUSIONS

Fostering LGBTQ-affirmative school climates may reduce certain drinking behaviors for gay/lesbian adolescents, heterosexual adolescents, and adolescents unsure of their sexual orientation.

Self-perceived vs. actual physical attractiveness: Associations with depression as a function of sexual orientation

OBJECTIVE

A commonly held belief about physical attractiveness is that attractive individuals are psychologically healthier than less attractive individuals (i.e., the "beauty is good" stereotype). To date, the data on this stereotype and its relationship with depression is limited, with a paucity of literature comparing subjective and objective appearance evaluations and depressive symptoms. Additionally, there is no known research on this relationship among sexual minorities (i.e., gay and bisexual individuals), a highly vulnerable population. The primary aims of the study were to assess the prediction of depression symptoms by subjective and objective appearance evaluation, and secondary aims were to assess the interaction of subjective and objective appearance with sexual orientation.

METHOD

Participants were 4882 American emerging adults (M age=22 years; 2253 males, 2629 females) taken from a U.S. nationally representative dataset (Add Health)

RESULTS

Increased negative subjective appearance evaluation was associated with elevated rates of depressive symptoms (B=-.27, p<.001), while objective appearance evaluation was not significantly related to depressive symptoms. Sexual orientation significantly moderated the relationship between subjective appearance and depression (B=.19, p=.009), with a stronger positive association between negative appearance evaluation and depressive symptoms noted among sexual minority vs. heterosexual participants.

LIMITATIONS

Limitations include cross-sectional design and self-report nature of questionnaires.

CONCLUSIONS

Findings suggest that the 'beauty is good' stereotype may not be valid in regard to depressive symptoms, and that subjective appearance evaluation is a robust predictor of depression, particularly for sexual minority individuals.

Health Risk Behaviors in a Representative Sample of Bisexual and Heterosexual Female High School Students in Massachusetts

BACKGROUND

Differences in sexual health-related outcomes by sexual behavior and identity remain underinvestigated among bisexual female adolescents.

METHODS

Data from girls (N = 875) who participated in the Massachusetts Youth Risk Behavior Surveillance survey were analyzed. Weighted logistic regression models were fit to examine sexual and psychosocial health by lifetime sexual behavior (behaviorally bisexual vs behaviorally heterosexual) and sexual identity (bisexual vs heterosexual) adjusting for grade and race/ethnicity.

RESULTS

Overall, 10.5% of girls reported lifetime bisexual behavior and 8.1% reported a bisexual identity. Behavior and identity were discordant for bisexual young women as 53.2% of behaviorally bisexual students had a bisexual identity and 46.8% had a heterosexual identity. Bisexual identity and behavior were associated with unprotected intercourse at last sexual encounter, early sexual debut, 4 or more lifetime partners, history of forced/unwanted sex, sexually transmitted infection testing history, past-year depression, and past-month drug use (all ps < .05).

CONCLUSION

Bisexuality, whether defined by identity or behavior, is associated with adverse sexual and psychosocial health outcomes in adolescent girls. Studies that explore wellness across the life span, and are designed to recognize developmental differences burgeoning in adolescence, may provide insights into the differential sexual risk outcomes observed among bisexual girls.

Sexual risk behaviors and steroid use among sexual minority adolescent boys

BACKGROUND

Previous research has extensively examined the relationship between the use of alcohol and illicit substances with sexual risk behaviors among sexual minority (i.e., gay and bisexual) male youth; however, no known studies have assessed the association of steroid use to risk behaviors among this population.

METHODS

Participants were 556 sexually active sexual minority adolescent boys (M age=16.2, SD=1.3), taken from a pooled dataset of the 14 jurisdictions from the 2005 and 2007 Youth Risk Behavior Surveys that assessed sexual orientation. The association between lifetime use of steroids and sexual risk behaviors were examined.

RESULTS

Controlling for number of sexual partners, depression, victimization, and race, boys who reported increased steroid use were at increased odds of engaging in condomless sex, OR=1.55, p=.003, and use of alcohol/drugs during sex, OR=1.48, p=.002.

CONCLUSIONS

Steroid use among sexual minority adolescent boys is prevalent and associated with HIV/STI sexual transmission risk behaviors.

Sexual Minority Health Disparities in Adult Men and Women in the United States: National Health and Nutrition Examination Survey, 2001-2010

OBJECTIVES

We used nationally representative data to investigate health disparities associated with sexual minority status among adults in the United States.

METHODS

We analyzed data from 11,114 adults who participated in the 2001 to 2010 waves of the National Health and Nutrition Examination Survey. Using multiple logistic regressions, we examined the prevalence of HIV, sexually transmitted infections, mental health problems, cigarette smoking, and alcohol and illicit drug use in sexual minorities and heterosexual adults.

RESULTS

After adjusting for sociodemographic characteristics, sexual minority men had greater odds of mental health problems, testing positive for HIV and herpes simplex virus type 2 and self-reported gonorrhea and chlamydia. Sexual minority women had greater odds of mental health problems, testing positive for hepatitis C, smoking, heavy drinking, and illicit drug use.

CONCLUSIONS

Numerous health disparities continue to face sexual minority men and women in the United States. Notably, health disparities persisted beyond the role of sociodemographic factors, including access to insurance and primary care, suggesting that further research is warranted to identify the determinants of health inequity for sexual minorities.

Sexual (Minority) Trajectories, Mental Health, and Alcohol Use: A Longitudinal Study of Youth as They Transition to Adulthood

Lesbian, gay, bisexual, and queer/questioning youth health disparities are well documented; however, study limitations restrict our understanding of how the temporal interplay among domains of sexuality (attraction, behavior, and identity) situate individuals to be more or less at risk for poor mental health and alcohol use across the transition to adulthood. Four waves of data from the National Longitudinal Study of Adolescent to Adult Health (n = 12,679; 51.29 % female) were used with repeated measures latent class analysis to estimate sexual trajectory groups designated by prospective reports of romantic attraction, sexual/romantic behavior, and sexual identity from adolescence to adulthood. Five unique trajectories emerged: two heterosexual groups (heterosexual early daters [58.37 %] and heterosexual later daters [29.83 %]) and three sexual minority groups (heteroflexible [6.44 %], later bisexually identified [3.32 %], and LG[B] identified [2.03 %]). These sexual trajectories differentiate risk for depressive symptomology, suicidal thoughts and behaviors, and alcohol use during adolescence and early adulthood. Groups where individuals first reported same-sex attraction and sexual minority identities in adulthood (heteroflexible and later bisexually identified) had similar levels of depression, suicidality, and greater substance use than those who largely reported same-sex attraction and behavior during adolescence (the LG[B] identified group). These later recognition groups showed greater risk for poor outcomes in waves where they also first reported these changes in attraction, behaviors, and identities. The emergence of three sexual minority groups reveal within-group differences in sexuality and sexual trajectories and how these experiences relate to risk and timing of risk across the transition to adulthood.

Suicide ideation and bullying among US adolescents: examining the intersections of sexual orientation, gender, and race/ethnicity

OBJECTIVES

We examined how race/ethnicity, gender, and sexual orientation shape adolescents' likelihood of being bullied and vulnerability to suicide ideation.

METHODS

We analyzed pooled data from the 2009 and 2011 Youth Risk Behavior Surveys (n = 75 344) to assess race/ethnicity, gender, and sexual orientation variation in being bullied and suicide ideation.

RESULTS

White and Hispanic gay and bisexual males, White lesbian and bisexual females, and Hispanic bisexual females were more likely to be bullied than were White heterosexual adolescents. Black lesbian, gay, and bisexual youths' vulnerability to being bullied was not significantly different from that of White heterosexual youths. Black and Hispanic heterosexual youths were less likely to be bullied than were White heterosexual youths. Despite differences in the likelihood of being bullied, sexual minority youths were more likely to report suicide ideation, regardless of their race/ethnicity, their gender, or whether they have been bullied.

CONCLUSIONS

Future research should examine how adolescents' intersecting identities shape their experience of victimization and suicidality. School personnel should develop antibullying and antihomophobia policies in response to the disproportionate risk of being bullied and reporting suicidality among sexual minority youths.

Typologies of Social Support and Associations with Mental Health Outcomes Among LGBT Youth

PURPOSE

Lesbian, gay, bisexual, and transgender (LGBT) youth show increased risk for a number of negative mental health outcomes, which research has linked to minority stressors such as victimization. Further, social support promotes positive mental health outcomes for LGBT youth, and different sources of social support show differential relationships with mental health outcomes. However, little is known about how combinations of different sources of support impact mental health.

METHODS

In the present study, we identify clusters of family, peer, and significant other social support and then examine demographic and mental health differences by cluster in an analytic sample of 232 LGBT youth between the ages of 16 and 20 years.

RESULTS

Using k-means cluster analysis, three social support cluster types were identified: high support (44.0% of participants), low support (21.6%), and non-family support (34.5%). A series of chi-square tests were used to examine demographic differences between these clusters, which were found for socio-economic status (SES). Regression analyses indicated that, while controlling for victimization, individuals within the three clusters showed different relationships with multiple mental health outcomes: loneliness, hopelessness, depression, anxiety, somatization, general symptom severity, and symptoms of major depressive disorder (MDD).

CONCLUSION

Findings suggest the combinations of sources of support LGBT youth receive are related to their mental health. Higher SES youth are more likely to receive support from family, peers, and significant others. For most mental health outcomes, family support appears to be an especially relevant and important source of support to target for LGBT youth.