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

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

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

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55210.

Sexual orientation disparities in developmental assets among youth: The mediating role of bullying victimization

BACKGROUND

Navigating the developmental transition from adolescence to young adulthood while simultaneously integrating the emergence of a sexual minority identity can be overwhelming for lesbian, gay, bisexual, and questioning youth as the developmental tasks pose tremendous challenges to the cultivation of developmental assets, which are the building blocks necessary for fostering positive youth development and thriving.

OBJECTIVES

The present study aimed to estimate the sexual orientation disparities in bullying victimization and developmental assets, investigate whether these sexual orientation differences varied by sex assigned at birth, and examine the mediating role of bullying victimization in the association between sexual orientation and developmental assets.

METHODS

This study included a national sample of 3020 Chinese youth (51.5 % assigned male at birth; 48.5 % assigned female at birth) with a mean age of 15.71 years. They completed a self-report questionnaire on experiences of bullying victimization and developmental assets.

RESULTS

Sexual minority and questioning youth showed significantly lower levels of developmental assets than heterosexual youth. The sexual orientation differences in developmental assets did not significantly differ by sex assigned at birth. In addition, sexual minority youth were at heightened risk of relational bullying than heterosexual youth. The results obtained from the structural equation modeling indicated that bullying victimization mediated the association of sexual orientation with developmental assets. Compared to heterosexual youth, sexual minority youth were more likely to be subjected to bullying, which was linked to lower levels of developmental assets.

CONCLUSIONS

The study shows sexual orientation disparities in developmental assets among youth in China and reveals that the positive development of sexual minority youth may be hindered by their experiences of bullying victimization. The implications for positive psychological interventions and anti-bullying policies in Chinese educational settings are discussed.

Narratives of bullying and emersion of self-compassion expressions in adolescents

Abstract This study aimed to investigate the narratives of bullying and the expression of self-compassion in statements written by adolescents as a possible coping strategy. Participated 162 adolescents from a state in northern Brazil. The data collected in written testimonials were categorized based on Bardin’s Content Analysis. The instructions provided for preparing the testimonies supported the structuring of four categories: 1) bullying experience; 2) reasons for bullying; 3) consequences of bullying; 4) coping strategies and self-compassion expressions. The results suggest 63.7% of adolescents witnessed bullying behaviors. Physical characteristics were the main motivation reported toward bullying. Negative feelings and psychosomatic symptoms were the main consequences reported. The adolescents reported forms of self-compassion as a coping resource before receiving psychoeducation about the concept. The implications of these findings and the use of psychoeducational interventions on bullying and self-compassion are discussed.

Training Pre-Service Teachers to Better Serve LGBTQ High School Students

Pre-service teachers rarely receive training on how best to serve lesbian, gay, bisexual, transgender, and queer (LGBTQ) high school students. We tested whether participating in LGBTQ-focused service-based learning or LGBTQ-focused didactic training improved pre-service teachers' knowledge, attitudes, self-efficacy, and skills for serving LGBTQ high school students more than a control group. A non-randomised pre-test-post-test design with eighty-eight participants tested these differences. At post-test, the service-based learning group had significantly higher active-empathic listening and self-efficacy for working with LGBTQ high school students than the control group. There were no differences for didactic versus control groups. Overall, service-based learning may better prepare pre-service teachers to serve LGBTQ high school students.

Emotional changes following discrimination induction in gender- and sexuality-diverse adolescents

Sexual and gender minority (SGM)-identifying adolescents are particularly vulnerable to negative psychological outcomes, including engagement in nonsuicidal self-injury (NSSI). However, little is known about why these relationships exist. We used experimental methods to test the psychological mediation framework in an online sample of 328 adolescents who reported female sex at birth and a range of sexual and gender identities. Participants reported on depressive symptoms, self-criticism (both self-report and implicit), NSSI, and discrimination. They also completed a discrimination-based mood induction to test emotional reactivity. At baseline, SGM participants reported higher levels of implicit and self-reported self-criticism, depressive symptoms, discrimination, and higher rates of NSSI compared with cisgender, heterosexual participants (ps < .03). Following the discrimination induction, SGM-identifying participants exhibited larger emotional reactivity compared with cisgender heterosexual participants, as measured by change in negative mood, F(1, 326) = 7.33, p = .01, ηp2 = .02, and state self-criticism, F(1, 326) = 4.67, p = .03, ηp2 = .014, but not implicit affect toward the self. This effect was associated with baseline depressive symptoms, self-criticism, NSSI history, and discrimination. Post hoc analyses revealed that participants who tended to reframe experiences of discrimination as opportunities for growth exhibited attenuated emotional reactivity to the induction; findings remained significant after adjusting for SGM status and event severity (ps < .001). Results indicate that adolescents identifying as SGM may experience elevated psychological distress compared with their cisgender heterosexual peers and that stigma-related stressors may increase emotion dysregulation and maladaptive cognitive styles, paralleling previously proposed psychological mediation models. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Victimization as a mediator in the relationship between sexual orientation and adolescent alcohol use

This study aimed to identify differences in Korean adolescents' alcohol use behaviors according to their sexual orientation and the mediating effect of victimization in this relationship using nationally representative data. Data from the Korea Youth Risk Behavior Web-based Surveys were analyzed using logistic regression analysis. There were significant associations between sexual orientation and alcohol use behaviors. Heterosexual adolescents were significantly more likely to have drinking experience in lifetime than their homosexual and bisexual peers in adjusted analyses. Victimization significantly mediated the relationship between sexual orientation and alcohol use behaviors. Our findings suggest that reducing the prevalence of alcohol use by sexual orientation should involve interventions to prevent victimization in schools.

Victimization of Traditional and Cyber Bullying During Childhood and Their Correlates Among Adult Gay and Bisexual Men in Taiwan: A Retrospective Study

This study examined the associations of timing of sexual orientation developmental milestones, gender role nonconformity, and family-related factors with victimization of traditional and cyber sexuality-related bullying during childhood among gay and bisexual men in Taiwan, in addition to the moderating effects of family-related factors on these associations. A total of 500 homosexual or bisexual men aged between 20 and 25 years were recruited into this study. The associations of early identification of sexual orientation, early coming out, level of masculinity, parental education levels, and perceived family support with victimization of traditional and cyber sexuality-related bullying were evaluated. Early identification of sexual orientation, low self-rated masculinity, and low family support were significantly associated with victimization of traditional bullying. Moreover, low family support, early coming out, and traditional bullying victimization were significantly associated with victimization of cyber bullying. Family support did not moderate the associations of early identification of sexual orientation and low masculinity with victimization of traditional bullying or cyberbullying. The factors associated with victimization of traditional and cyber sexuality-related bullying should be considered when mental health and educational professionals develop prevention and intervention strategies to reduce sexuality-related bullying.

Mediators of increased self-harm and suicidal ideation in sexual minority youth: a longitudinal study

BACKGROUND

Sexual minority youth have elevated suicidal ideation and self-harm compared with heterosexual young people; however, evidence for mediating mechanisms is predominantly cross-sectional. Using a longitudinal design, we investigated self-esteem and depressive symptoms as mediators of increased rates of suicidal ideation or self-harm (SISH) among sexual minority youth, and the roles of childhood gender nonconformity (CGN) and sex as moderators of these relationships.

METHOD

In total, 4274 youth from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort reported sexual orientation at age 15 years, and past-year SISH at age 20 years. Self-esteem and depressive symptoms were assessed at ages 17 and 18 years, respectively. CGN was measured at 30-57 months. Covariates included sociodemographic variables and earlier measures of mediator and outcome variables. Mediation pathways were assessed using structural equation modelling.

RESULTS

Sexual minority youth (almost 12% of the sample) were three times more likely than heterosexual youth to report past-year SISH (95% confidence interval 2.43-3.64) at 20 years. Two mediation pathways were identified: a single mediator pathway involving self-esteem and a multiple-mediated pathway involving self-esteem and depressive symptoms. Although CGN was associated with past-year SISH, it did not moderate any mediation pathways and there was no evidence for moderation by sex.

CONCLUSIONS

Lower self-esteem and increased depressive symptoms partly explain the increased risk for later suicidal ideation and self-harm in sexual minority youth. Preventive strategies could include self-esteem-enhancing or protecting interventions, especially in female sexual minority youth, and treatment of depression.

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.

Substance Use and School Characteristics in Lesbian, Gay, Bisexual, and Heterosexual High School Students

BACKGROUND

Tobacco, alcohol, and illicit drug use among lesbian, gay, and bisexual (LGB) high school students as well as related environment and school-level risk and protective factors were examined.

METHODS

Data was acquired from the 2015 CDC's Youth Behavior Risk Survey for Kentucky (N = 2577). Prevalence of substance use was calculated for all high school respondents by reported sexual orientation. Multivariate analyses estimated the relationship between school and environmental-level factors (eg, having an adult to talk to) and tobacco, alcohol, and illicit drug use via logistic regressions. Sexual orientation, gender, age, and race/ethnicity were covariates.

RESULTS

LGB students used tobacco, alcohol, and illicit drugs more frequently than their heterosexual counterparts. More LGB teens report facing school risk factors (eg, 37% LGB vs 20% heterosexual bullied at school, p ≤ .001; 17% LGB vs 5% heterosexual ever threatened or injured at school, p < .001; 13% LGB vs 7% heterosexual involved in a school fight, p = .001). Adjusting for school related risk factors, having an adult to talk to was associated with a reduced likelihood of daily smoking (adjusted odds ratio [aOR]: 0.43; 95% confidence interval [CI]: 0.26-0.73), past 30-day alcohol use (aOR: 0.71; 95% CI: 0.50-0.95), and ever marijuana use (aOR: 0.71; 95% CI: 0.50-1.00).

CONCLUSION

Innovative strategies are needed to create safe, supportive school environments. These strategies are particularly needed in predominately rural states like Kentucky.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

Trial Registration

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

International Registered Report Identifier (IRRID)

DERR1-10.2196/12164

The Effects of Gender- and Sexuality-Based Harassment on Lesbian, Gay, Bisexual, and Transgender Substance Use Disparities

PURPOSE

We tested three competing models about whether gender- and sexuality-based harassment at school have nonindependent, additive, or interactive effects on adolescents' electronic cigarette use (i.e., vaping), cigarette smoking, alcohol use, and heavy episodic drinking (HED). We also tested whether harassment mediated substance use disparities between lesbian, gay, bisexual, transgender (LGBT) adolescents and their cisgender heterosexual peers.

METHODS

We analyzed cross-sectional data from the 2013-2014 California Healthy Kids Survey, including 316,766 students in grades 7, 9, and 11 from more than 1,500 middle and high schools. We used logistic regression models and interaction terms to estimate associations of past-year gender- and sexuality-based harassment at school on past-month substance use, and the Karlson-Holm-Breen method to test whether harassment mediated LGBT disparities in substance use.

RESULTS

Vaping, smoking, drinking, HED, and gender- and sexuality-based harassment were higher for transgender adolescents than for cisgender males and females, and for adolescents who were lesbian, gay, or bisexual only versus heterosexual only. Gender- and sexuality-based harassments were independently associated with greater odds of using each substance in every grade. These two types of harassment had positive interactions with each other for vaping in grade 11, smoking in grade 11, and HED in grades 9 and 11. Gender- and sexuality-based harassment significantly mediated many of the LGBT disparities in substance use.

CONCLUSIONS

Gender- and sexuality-based harassment at school independently or interactively produced LGBT disparities in substance use. Reducing these types of discrimination in schools will likely mitigate these disparities.

Depression and Associated Factors Among Gay and Heterosexual Male University Students in Nigeria

Homosexuality is a recognized risk factor for depression in high-income countries; however, there is little research investigating the relationship between depression and sexual orientation in developing countries, especially in Africa. In this first study to investigate psychopathology in sexual minority men in Nigeria, the prevalence rates of depression in Nigerian gay and heterosexual individuals were compared as well as the explanatory power of risk and resilience factors in both groups. Eighty-one gay and 81 heterosexual male university students were, respectively, recruited from the Obafemi Awolowo University. Both groups were assessed for depression and other clinical factors, including alcohol and other substance use, suicidal ideation, and resilience. Gay students were further assessed for sexuality-related variables, including minority stress factors such as internalized homophobia and perceived stigma. The prevalence rates of depression among gay and heterosexual students were, respectively, 16 and 4.9% (OR 3.7; 95% CI 1.15-11.82), and this increased likelihood for depression was significantly attenuated by resilience. Clinical factors correlated significantly with depression in both groups, explaining 31% of the variance in depression in gay and heterosexual students, respectively. Sexuality-related variables including internalized homophobia and perceived stigma were further associated with depression in gay students-accounting for a further 14% of the variance of depression in gay students. The findings highlight the importance of minority stress factors in understanding depression among non-heterosexual individuals in a developing country, and the need for further research to investigate the mechanisms of these relationships in such settings.

HIV Acquisition and Transmission Potential Among African American Men Who Have Sex with Men and Women in Three U.S. Cities

Black men who have sex with men and women (BMSMW) are at increased HIV risk, but few efficacious interventions meet their unique needs. Three HIV prevention interventions were evaluated with a common protocol. Baseline data were pooled to describe sexual behavior involving transmission risk with male, female, and male-to-female transgender partners and identify factors associated with transmission risk. BMSMW from Los Angeles, Philadelphia, and Chicago who reported sexual risk and bisexual behavior in the past year were recruited via modified chain referral sampling and community recruitment. Baseline assessments were conducted via audio computer-assisted interview and sexual behaviors assessed over the past 3 months. From December 2010 to November 2012, 584 BMSMW were enrolled across the three cities. More than half (55%) were recruited by other participants. Overall, the mean age was 43 years. Seventy-five percent reported an annual income <$10,000 and selling sex was prevalent (31%). Three-quarters identified as bisexual. Thirty-nine percent were HIV-positive. Among HIV-positive participants, 46% reported sex without condoms with HIV-negative or unknown male partners and 45% with HIV-negative or unknown female partners. Overall, factors associated with sex without condoms included network size, education, income, sexual orientation identification, HIV status, exchange sex, homonegativity, and social support. Findings support the need for enhanced HIV prevention efforts for this population. Future studies should examine contextual factors in addition to individual risk behaviors to inform the development and implementation of promising strategies to prevent HIV and promote the overall health and wellness of BMSMW and their sexual partners.

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.

Mental Health Issues Related to Sexual Orientation in a High School Setting

High school students are maturing physically, psychosocially, and sexually. Some may be unsure of their sexual orientation. The purpose of the study was to determine whether students who self-identified as homosexual-lesbian/gay, bisexual (LGB), and unsure of sexual orientation had more stressful life events (SLEs), perceived stress, bullying victimization, and depressive symptoms as compared to heterosexual peers. Cortisol was examined to determine whether levels were within normal range for age and followed a normal diurnal rhythm. This correlational design included five surveys to assess n = 143 ninth graders. LGB and unsure students had more SLEs, perceived stress, bullying victimization, and depressive symptoms than heterosexual peers. All participants had normal cortisol levels, with the majority having normal diurnal rhythms. School nurses should consider more training about LGB and unsure students. Additional outreach, support, screening, or referrals for LGB and unsure students are warranted if the school nurse suspects depressive symptoms.

Substance use among adolescent sexual minority athletes: A secondary analysis of the youth risk behavior survey

Aims

While a robust literature exists regarding substance use patterns among adolescent athletes, no studies have examined substance use among adolescent sexual minority athletes; a subpopulation of adolescents that may experience greater rates of substance use due to their marginalized status within the context of sport.

Methods

This study uses data from the Youth Risk Behavior Survey (2009-2013). Adolescents (N = 26,940) from four states were included in the analyses that assessed past 30-day cigarette use, alcohol use, binge drinking and marijuana use among sexual minority athletes, heterosexual athletes, heterosexual non-athletes, and sexual minority non-athletes.

Results

Approximately 4% of the sample included athletes who identified as a sexual minority (3.7% males and 5.3% females). While the bivariate analyses found that sexual minority athletes had higher past 30-day prevalence rates of substance use when compared to heterosexual athletes and non-athletes, these rates were similar to sexual minority non-athletes. Moreover, when demographic characteristics and history of substance use were included in the multivariate analytic models, many of these differences were no longer statistically significant. These results were generally consistent for both males and females.

Conclusions

The results of the study suggest that the context of sport may not be an additional site for stress among adolescent athletes who identify as a sexual minority, and subsequently may have little impact on substance use behaviors. However, participating in sport may not serve as a protective context for adolescent sexual minorities given that substance use behaviors may be learned and reinforced.