The Perceived Health Implications of Policies and Rhetoric Targeting Transgender and Gender Diverse Youth: A Community-Based Qualitative Study.

Purpose: In early 2021, >50 bills targeting transgender and gender diverse (TGD) youth in the United States were proposed; these policies and the rhetoric surrounding them is associated with TGD health disparities. Methods: A community-based qualitative study utilized focus groups with a TGD youth research advisory board to explore their knowledge and perceived impacts of the current policy climate and rhetoric in one Midwestern state. Results: Themes revealed (1) mental health, (2) structural impacts, and (3) messages to policymakers. Conclusions: Discriminatory policies and rhetoric harm TGD youth; health professionals should denounce the harmful disinformation perpetuated by these policies.

Training in LGBTQ-affirmative cognitive behavioral therapy: A randomized controlled trial across LGBTQ community centers.

OBJECTIVES: This randomized controlled trial examined whether an 11-week synchronous (i.e., real-time) online training in lesbian, gay, bisexual, transgender, queer, and other sexual or gender diverse (LGBTQ)-affirmative cognitive behavioral therapy (CBT) could lead to increased uptake of this practice at LGBTQ community centers across 20 U.S. states and internationally. METHOD: A total of 121 mental health providers (Mage = 37.74; 78.5% LGBTQ; 60.3% non-Hispanic/Latinx White) were randomized to receive the 11-week training either immediately (n = 61) or after a 4-month wait (n = 60). At baseline and 4 and 8 months after baseline, participants self-reported their LGBTQ-affirmative competency, cultural humility, and knowledge of the minority stress theory and practice skills underlying LGBTQ-affirmative CBT. To objectively assess uptake of LGBTQ-affirmative CBT, participants demonstrated, through simulated practice, how they would respond to two video-based clinical vignettes. RESULTS: Compared to wait-list, participants in the immediate training condition reported greater improvements in self-reported cultural competence (d = 1.24), minority stress knowledge (d = 0.78), LGBTQ-affirmative CBT knowledge (d = 0.78), and LGBTQ-affirmative CBT skills familiarity (d = 0.91) and use (d = 0.96); effects persisted 8 months postbaseline. Cultural humility showed no significant difference by condition (d = 0.07). In objectively coded assessments of simulated practice, participants in the training condition demonstrated greater uptake of LGBTQ-affirmative practice skills (d = 0.82). CONCLUSIONS: Findings preliminarily suggest that mental health providers can be trained to deliver LGBTQ-affirmative CBT using the low-cost, efficient reach of online training. This training can help disseminate evidence-based mental health care to LGBTQ individuals and support its implementation across practice settings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Q Chat Space: Assessing the Feasibility and Acceptability of an Internet-Based Support Program for LGBTQ Youth.

There are few psychosocial support programs specifically designed to meet the unique developmental and health needs of LGBTQ youth. Even when available, many youth face significant barriers to accessing LGBTQ-specific services for fear of being "outed" to parents, peers, and community members. The current study assessed the utility, feasibility, and acceptability of a synchronous, adult-facilitated, chat-based Internet community support program for LGBTQ youth aged 13-19. Chat transcripts were analyzed to examine how LGBTQ youth used the chat-based platform to connect with peers and trusted adults. A separate user satisfaction survey was collected to assess the personal (e.g., sexual orientation, gender identity, age) and contextual (e.g., geography, family environment) characteristics of youth engaging in the platform, their preferred topics of discussion, and their satisfaction with the program focus and facilitators. Qualitative data analysis demonstrated the degree to which LGBTQ youth were comfortable disclosing difficult and challenging situations with family, friends, and in their community and in seeking support from peers and facilitators online. Youth also used the platform to explore facets of sexual and gender identity/expression and self-acceptance. Overall, users were very satisfied with the platform, and participants accurately reflect the program's desired populations for engagement (e.g., LGBTQ youth of color, LGBTQ youth in the South). Together, findings support the feasibility and acceptability of synchronous, adult-facilitated, chat-based Internet programs to connect and support LGBTQ youth, which encourage future research and innovation in service delivery.

"I'm Kinda Stuck at Home With Unsupportive Parents Right Now": LGBTQ Youths' Experiences With COVID-19 and the Importance of Online Support.

PURPOSE: LGBTQ youth are a population who experience unique stressors. This study investigated their experiences with the COVID-19 pandemic via Q Chat Space-a national online chat-based support program. METHODS: Transcript data from 31 synchronous, text-based chats collected during the onset of state-based "social distancing" ordinances in Spring 2020 were analyzed. RESULTS: While encountering COVID-19-related stressors likely to be experienced by youth generally, participants' experiences were concomitantly imbued with LGBTQ-specific intrapersonal, interpersonal, and structural challenges. Difficulties included maintaining mental health, being isolated with unsupportive families, and loss of in-person identity-based socialization and support. CONCLUSIONS: Findings highlight the importance of synchronous, text-based online platforms to enable LGBTQ youth to feel safe to seek support while at home. Given the potential for long-term physical distancing, concerted efforts are required to provide necessary resources and support for LGBTQ youth during the COVID-19 pandemic.

Meeting the Needs of Sexual and Gender Minority Youth: Formative Research on Potential Digital Health Interventions.

PURPOSE: Sexual and gender minority youth (SGMY) have unique risk factors and worse health outcomes than their heterosexual and cisgender counterparts. SGMY's significant online activity represents an opportunity for digital interventions. To help meet the sex education and health needs of SGMY and to understand what they consider important, formative research was conducted to guide and inform the development of new digital health interventions. METHODS: Semistructured interviews, in-person focus groups, and online focus groups were conducted with 92 youths (aged 15-19 years) who self-identify as nonheterosexual, noncisgender, questioning, and/or have engaged in same-sex sexual behavior. Data were coded and analyzed using inductive thematic analysis. RESULTS: Thematic analysis revealed that SGMYs are often driven online by experiences of isolation, stigmatization, and lack of information and are looking for a supportive, validating community and relevant, accurate information. Gender minority youths felt that they faced a larger number of and more extreme incidences of discrimination than sexual minority youths. Most youths described interpersonal discrimination as having substantial negative effects on their mental health. CONCLUSIONS: Any digital intervention for SGMY should focus on mental health and well-being holistically rather than solely on risk behaviors, such as preventing HIV. Interventions should include opportunities for interpersonal connection, foster a sense of belonging, and provide accurate information about sexuality and gender to help facilitate positive identity development. Content and delivery of digital interventions should appeal to diverse sexualities, genders, and other intersecting identities held by SGMY to avoid further alienation.

Potential for using online and mobile education with parents and adolescents to impact sexual and reproductive health.

Research supports the central role of parents in the sexual health behaviors and outcomes of their adolescent children. Too often, parents and adolescents with the greatest sexual health disparities are difficult to reach and engage in preventative interventions. Online and mobile technologies (OMTs) represent an innovative opportunity to reach large numbers of youth and their parents. However, there is a dearth of information related to the feasibility and acceptability of OMT-delivered family interventions for reaching vulnerable youths--particularly, ethnic minority youths. The current manuscript addresses this gap in the empirical literature by examining the feasibility and acceptability of OMT-based parent-adolescent sexual health interventions for African American and Latino families. Focus groups were conducted with convenience samples of Latino and African Americans from six US cities. Fourteen focus groups (six parents and eight adolescents) with an average of 10-12 participants each provided data for the study. Researchers used inductive thematic analysis to evaluate data. The findings suggest that parents and adolescents were motivated to obtain sexual health information through OMTs due to their accessibility, widespread use, and ability to deliver large quantities of information. However, personalized and trustworthy information was viewed as less attainable through the Internet or similar digital means, presenting a potential barrier to delivering an adolescent sexual health intervention via OMTs. Sexual health interventions delivered through online and mobile mechanisms present a novel opportunity for reaching potentially at-risk ethnic minority adolescents and their parents. Feelings of discomfort surrounding OMT use with parents, generational differences, and parent-adolescent relationship quality must be considered when developing technology-based sexual health interventions for Latino and African American families.

Using chat and text technologies to answer sexual and reproductive health questions: Planned Parenthood pilot study.

BACKGROUND: Teens and young adults in the United States are in need of sexual and reproductive health information, as evidenced by elevated rates of sexually transmitted infections (STIs), pregnancy, and births among this population. In-person sexuality education programs are helpful, but they are unlikely to rapidly accommodate teens and young adults in a moment of crisis. Evidence suggests that technologies such as instant messaging (IM) and text messaging may be effective ways to provide teens and young adults with sexual and reproductive health information. In September 2010, Planned Parenthood Federation of America launched a text and IM program designed to provide immediate answers to urgent sexual and reproductive health questions from a reliable and confidential source and to link young people to sexual and reproductive health services if needed. OBJECTIVE: To assess whether this program is successful in reaching the target population, whether user characteristics vary by mode (IM vs text), and whether mode is associated with reaching individuals with high levels of worry or reducing worry postchat. METHODS: Data were collected from prechat and postchat surveys for all IM and text message conversations between September 2010 and August 2011. A bivariate analysis was conducted using chi-square tests for differences in the main covariates by mode of conversation. In the multivariable analysis, logistic regression was used to identify factors that were independently associated with prechat levels of worry and changes in worry postchat. RESULTS: A total of 32,589 conversations occurred during the program's first year. The odds of feeling very worried prechat were highest for IM users (adjusted odds ratio [AOR] 1.43, 95% CI 1.20-1.72), users 17 years and younger (AOR 1.62, 95% CI 1.50-1.74), Latino/Hispanic users (AOR 1.36, 95% CI 1.27-1.46), and black users (AOR 1.40, 95% CI 1.30-1.50). After controlling for the study covariates, there was no significant difference in the odds of feeling better (less worried) postchat between IM and text message users. Feeling better postchat was associated with being younger (≤17 years: AOR 1.42, 95% CI 1.17-1.72; 18-24 years: AOR 1.20, 95% CI 1.02-1.42), being Latino/Hispanic (AOR 1.31, 95% CI 1.10-1.55), reporting that the service was very helpful (AOR 3.47, 95% CI 3.24-4.32), and asking about emergency contraception (AOR 1.35, 95% CI 1.13-1.61). The odds of feeling better were lowest for users with questions about STIs (AOR 0.61, 95% CI 0.47-0.78). CONCLUSIONS: The results from the process evaluation suggest that the program was able to provide informational support to vulnerable groups, such as teens and racial minorities, in moments of particular worry. Differences between the IM and text message users reveal that each mode appeals to a different population and that both are necessary to reach a diverse audience.