Self-Reported Sexual Behavior of Transgender Youth.

INTRODUCTION: Research indicates that transgender/gender diverse (TGD) youth are more likely to engage in sexual behavior, have more sexual partners, and initiate sexual behavior earlier than their cisgender peers. However, no gender-inclusive self-report survey questionnaires (ie, those that do not assume the gender of sexual partners or body parts used for sex) exist to assess the sexual behavior of TGD youth. The current study illustrates a questionnaire with nuanced wording to more accurately portray the sexual behavior of TGD youth presenting for gender-affirming medical care compared with national adolescent norms. METHODS: A retrospective chart review was conducted of 323 youth, ages 13-18, presenting to a pediatric gender clinic between 2015 and 2021. The youth self-reported their gender identity (ie, masculine, feminine, gender queer, questioning/unsure), sexual behaviors, and partners via a REDCAP survey. RESULTS: Rates of dating among TGD youth were significantly lower than national norms (33.7% vs 68.3%; χ2= 172.644, P < .0001), as was sexual behavior (14.9% vs. 39.5% χ2= 80.419, P < .0001). Rates of self-reported involuntary sexual activity among TGD youth did not differ significantly from national norms (7.1% vs. 6.9%, ns). The body parts used for sex, the number of sexual partners, and the gender identity of sexual partners are reported. DISCUSSION: The results suggest that rates of dating and sexual behavior among TGD youth are significantly lower than national norms, supporting a need for screening of sexual health among TGD youth utilizing gender-inclusive measures. A standardized gender-inclusive questionnaire of sexual behavior is needed to improve data accuracy and help develop inclusive programs to address the sexual health needs of TGD youth.

Body Mass Index Categories of Transgender and Gender Diverse Youth: Clinical Associations and Predictors.

Background: Transgender/gender diverse (TGD) youth are at risk for weight-related problems. We describe factors associated with their body mass index (BMI) category. Methods: Chart review of 228 TGD patients, 12-20 years (u = 15.7, standard deviation 1.3), 72% female assigned at birth. BMI percentile was calculated using CDC growth charts. We examined bivariate relationships of 18 clinically derived factors, utilizing analysis of variance (ANOVA) for continuous variables and chi-squared/Fisher's exact test for categorical variables. Nonparametric Classification and Regression Tree (CART) analyses were used to predict BMI category. Results: Almost half (49.6%) of TGD youth presenting for their initial visit for pediatric gender-affirming care fell in the healthy weight range, 4.4% in the underweight range, 16.7% in the overweight range, and 29.4% in the obese range. Self-described weight, weight management intentions, unhealthy weight management, prescription of psychiatric medications, and medications associated with weight gain were associated with BMI category. Use of psychiatric medications (54.8%) and medications associated with weight gain (39.5%) was associated with BMI in the overweight/obese categories. Youth with obesity most often reported unhealthy weight management. In CART models, self-described weight was the strongest predictor of BMI category. Conclusion: TGD youth have high rates of underweight and overweight/obesity. Unhealthy BMI should be treated as part of gender-affirming care. Self-described body weight is associated with weight category. More than half of TGD youth were prescribed psychiatric medications; those with overweight and obesity were more likely prescribed psychiatric and medications with associated weight gain. Youth with obesity were most likely to use unhealthy weight management.

Weight Status, Medication Use, and Recreational Activities of Treatment-Naïve Transgender Youth.

Background: Studies of transgender/gender diverse (TGD) youth indicate a high prevalence of overweight/obesity and concern for unhealthy weight management behavior. This study describes the association of weight status with medication use and recreational activities among treatment-naïve, pediatric TGD patients. Methods: This study is a chart review of 277 patients [aged 9-18 years, 79.1% female sex assigned at birth (SAB), and 86.3% white] seen at a medical center from 2017 to 2020. BMI was calculated by age and SAB using CDC growth charts. BMI percentile (BMI%) and BMI z-score (BMIz) were used to define weight status. Results: By BMI% category, 3.6% patients were in the underweight range (BMI <5%); 50.5% had BMI >85%; and 30.3% had BMI >95%. Overweight and obesity rates were higher than national norms (χ2 = 15.152, p < 0.01). Female SAB participants had higher BMIz values than male SAB participants. Youth who reported watching/listening to media (t = 3.50, p < 0.01) and parent-reported creative arts involvement (t = 1.97, p = 0.05) were associated with higher BMIz values. Conversely, spending time with friends and family was associated with a lower BMIz. Over half of the patients were prescribed medications, and those patients taking medications had higher BMIz values than those not taking medications (t = -1.96, p < 0.05). Female SAB, involvement in sedentary recreational activities, and taking medications to treat gastrointestinal conditions were associated with elevated BMIz. Conclusions: Overweight/obesity is a common problem among TGD youth. TGD youth should be considered a high-risk group and targeted in obesity prevention and treatment efforts. Interventions to decrease sedentary activities and improve connections with friends and family are promising strategies to address overweight and obesity among TGD youth.

Family rules, routines, and caregiver distress during the first year of pediatric cancer treatment.

OBJECTIVE: A new diagnosis of pediatric cancer may disrupt family functioning. The current study aimed to describe changes in family rules and routines during the first year of pediatric cancer treatment, and to explore associations with demographics, illness factors, and caregiver distress. METHODS: This exploratory mixed-methods, cross-sectional study examined 44 primary caregivers of youth in treatment for a new cancer diagnosis in 2019 and 2020, before the onset of the COVID-19 pandemic. Caregivers completed validated questionnaires assessing demographic and child illness characteristics, psychosocial distress, and cancer-related stressors, and participated in a semi-structured interview about family rules and routines. RESULTS: Caregivers reported changes in bedtime, mealtime, and school routines, relaxed behavioral expectations and rules around screen time, and new rules and routines around treatment, medications, and infection control. Caregivers with elevated levels of psychosocial distress reported more changed routines than caregivers with low levels of psychosocial distress. Caregivers who endorsed more cancer-related stressors reported more new rules and routines than those who reported fewer cancer-related stressors. Demographic and illness factors were not significantly associated with the number of changed, new, or stable family rules and routines. CONCLUSIONS: Families may relax rules and routines during the first several months of diagnosis, and this may be related to side effects of treatment and limited caregiver capacity. The long-term impact of changes in family rules and routines during cancer treatment warrants further study given that accommodating parenting strategies have been associated with adverse short- and long-term child health and behavior outcomes.

Reconciling Contemporary Approaches to School Attendance and School Absenteeism: Toward Promotion and Nimble Response, Global Policy Review and Implementation, and Future Adaptability (Part 2).

As noted in Part 1 of this two-part review, school attendance is an important foundational competency for children and adolescents, and school absenteeism has been linked to myriad short- and long-term negative consequences, even into adulthood. Categorical and dimensional approaches for this population have been developed. This article (Part 2 of a two-part review) discusses compatibilities of categorical and dimensional approaches for school attendance and school absenteeism and how these approaches can inform one another. The article also poses a multidimensional multi-tiered system of supports pyramid model as a mechanism for reconciling these approaches, promoting school attendance (and/or prevention of school absenteeism), establishing early warning systems for nimble response to school attendance problems, assisting with global policy review and dissemination and implementation, and adapting to future changes in education and technology.

Reconciling Contemporary Approaches to School Attendance and School Absenteeism: Toward Promotion and Nimble Response, Global Policy Review and Implementation, and Future Adaptability (Part 1).

School attendance is an important foundational competency for children and adolescents, and school absenteeism has been linked to myriad short- and long-term negative consequences, even into adulthood. Many efforts have been made to conceptualize and address this population across various categories and dimensions of functioning and across multiple disciplines, resulting in both a rich literature base and a splintered view regarding this population. This article (Part 1 of 2) reviews and critiques key categorical and dimensional approaches to conceptualizing school attendance and school absenteeism, with an eye toward reconciling these approaches (Part 2 of 2) to develop a roadmap for preventative and intervention strategies, early warning systems and nimble response, global policy review, dissemination and implementation, and adaptations to future changes in education and technology. This article sets the stage for a discussion of a multidimensional, multi-tiered system of supports pyramid model as a heuristic framework for conceptualizing the manifold aspects of school attendance and school absenteeism.

Family Environment Variables as Predictors of School Absenteeism Severity at Multiple Levels: Ensemble and Classification and Regression Tree Analysis.

School attendance problems, including school absenteeism, are common to many students worldwide, and frameworks to better understand these heterogeneous students include multiple classes or tiers of intertwined risk factors as well as interventions. Recent studies have thus examined risk factors at varying levels of absenteeism severity to demarcate distinctions among these tiers. Prior studies in this regard have focused more on demographic and academic variables and less on family environment risk factors that are endemic to this population. The present study utilized ensemble and classification and regression tree analysis to identify potential family environment risk factors among youth (i.e., children and adolescents) at different levels of school absenteeism severity (i.e., 1 + %, 3 + %, 5 + %, 10 + %). Higher levels of absenteeism were also examined on an exploratory basis. Participants included 341 youth aged 5-17 years (M = 12.2; SD = 3.3) and their families from an outpatient therapy clinic (68.3%) and community (31.7%) setting, the latter from a family court and truancy diversion program cohort. Family environment risk factors tended to be more circumscribed and informative at higher levels of absenteeism, with greater diversity at lower levels. Higher levels of absenteeism appear more closely related to lower achievement orientation, active-recreational orientation, cohesion, and expressiveness, though several nuanced results were found as well. Absenteeism severity levels of 10-15% may be associated more with qualitative changes in family functioning. These data may support a Tier 2-Tier 3 distinction in this regard and may indicate the need for specific family-based intervention goals at higher levels of absenteeism severity.

Internalizing Symptoms as Predictors of School Absenteeism Severity at Multiple Levels: Ensemble and Classification and Regression Tree Analysis.

School attendance problems are highly prevalent worldwide, leading researchers to investigate many different risk factors for this population. Of considerable controversy is how internalizing behavior problems might help to distinguish different types of youth with school attendance problems. In addition, efforts are ongoing to identify the point at which children and adolescents move from appropriate school attendance to problematic school absenteeism. The present study utilized ensemble and classification and regression tree analysis to identify potential internalizing behavior risk factors among youth at different levels of school absenteeism severity (i.e., 1+%, 3+%, 5+%, 10+%). Higher levels of absenteeism were also examined on an exploratory basis. Participants included 160 youth aged 6-19 years (M = 13.7; SD = 2.9) and their families from an outpatient therapy clinic (39.4%) and community (60.6%) setting, the latter from a family court and truancy diversion program cohort. One particular item relating to lack of enjoyment was most predictive of absenteeism severity at different levels, though not among the highest levels. Other internalizing items were also predictive of various levels of absenteeism severity, but only in a negatively endorsed fashion. Internalizing symptoms of worry and fatigue tended to be endorsed higher across less severe and more severe absenteeism severity levels. A general expectation that predictors would tend to be more homogeneous at higher than lower levels of absenteeism severity was not generally supported. The results help confirm the difficulty of conceptualizing this population based on forms of behavior but may support the need for early warning sign screening for youth at risk for school attendance problems.