Association of Sexual Orientation Acceptance with Reduced Suicide Attempts Among Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Youth.

Purpose: This study examined the relationship between sexual orientation acceptance from others and suicide attempts among lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth. Methods: We analyzed data from a 2018 cross-sectional survey of LGBTQ youth between the ages of 13 and 24 years across the United States. Youth reported sexual orientation acceptance levels from parents, other relatives, school professionals, health care professionals, friends, and classmates to whom who they were "out." Adjusted logistic regression analyses were used to examine the association between sexual orientation acceptance and a past-year suicide attempt. Results: All forms of peer and adult acceptance were associated with reduced reports of a past-year suicide attempt, with the strongest associations found for acceptance from parents (adjusted odds ratio [aOR] = 0.52) and straight/heterosexual friends (aOR = 0.54). Youth who reported high levels of acceptance from any adult had nearly 40% (aOR = 0.61) lower odds of a past-year suicide attempt compared with LGBTQ peers with little to no acceptance. Youth with high levels of acceptance from any peer also had significantly lower odds of reporting a past-year suicide attempt (aOR = 0.55). These relationships remained significant even after controlling for the impact of each form of acceptance, suggesting unique associations with suicide risk for both peer and adult acceptance. Conclusion: Interventions aimed at increasing sexual orientation acceptance from supportive adults and peers have strong potential to address the public health burden of LGBTQ youth suicide.

Impact of Bathroom Discrimination on Mental Health Among Transgender and Nonbinary Youth.

PURPOSE: Nascent research has found that transgender and/or nonbinary (TGNB) youths experience higher rates of poor mental health outcomes than cisgender youths. The minority stress model highlights experiences of rejection and discrimination on mental health disparities for TGNB individuals. METHODS: Using data from a quantitative cross-sectional survey of TGNB youth aged 13-24 years, we examined the association between experiencing bathroom discrimination and depressive mood, seriously considering suicide, and attempting suicide. RESULTS: Overall, 58% of TGNB youths in this sample reported being prevented or discouraged from using a bathroom that corresponds to their gender identity. Among the TGNB youth who experienced bathroom discrimination, 85% reported depressive mood and 60% seriously considered suicide. Furthermore, 1 in three TGNB youths who experienced bathroom discrimination reported a past-year suicide attempt, with 1 in five reporting multiple suicide attempts. After adjusting for demographic variables and general discrimination due to one's gender identity, bathroom discrimination significantly increased the odds of reporting depressive mood (adjusted odds ratio [aOR] = 1.34), seriously considering suicide (aOR = 1.40), a suicide attempt (aOR = 1.66), and multiple suicide attempts (aOR = 1.71). CONCLUSIONS: These findings suggest that preventing TGNB youths from accessing appropriate bathrooms is associated with harmful mental health indicators. Addressing the suicide disparities for TGNB youths requires structural change. Policies and procedures need to be in place to ensure that all youths have equal access to appropriate bathrooms.

Suicidality Among Youth Who are Questioning, Unsure of, or Exploring Their Sexual Identity.

Many studies have found that lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth are disproportionately impacted by poor mental health outcomes. However, there remains a gap in understanding factors associated with the mental health of youth who are questioning, unsure of, or exploring (QUE) their sexual identity. Using data from The Trevor Project's 2019 National Survey on LGBTQ Youth Mental Health, a quantitative cross-sectional survey of LGBTQ youth between 13 and 24, we explored suicidality among 801 QUE youth. Significantly more QUE youth were younger, nonwhite, and transgender and nonbinary compared to other LGBTQ youth. QUE youth reported higher rates of suicidality compared to other LGBTQ youth; however, this increased risk was related to the overrepresentation of younger and transgender and nonbinary youth among QUE youth. In adjusted models, being transgender and nonbinary, hearing parents use religion to say negative things about being LGBTQ, and experiencing physical threat or harm based on sexual orientation or gender identity were significantly related to seriously considering suicide and attempting suicide among QUE youth. Given the intricate relationship between the two, researchers should assess both gender identity and sexual identity when determining the risk of suicidality among LGBTQ youth.

Girl2Girl: How to develop a salient pregnancy prevention program for cisgender sexual minority adolescent girls.

INTRODUCTION: Although sexual minority girls are more likely than heterosexual girls to be pregnant during adolescence, programs tailored to their needs are non-existent. Here we describe the iterative development of Girl2Girl, a text messaging-based pregnancy prevention program for cisgender lesbian, gay, bisexual and other sexual minority (LGB+) girls across the United States. METHODS: Four activities are described: 1) 8 online focus groups to gain feedback about intended program components (n = 160), 2) writing the intervention content, 3) 4 online Content Advisory Teams that reviewed and provided feedback on the salience of drafted intervention content (n = 82), and 4) a beta test to confirm program functionality, the feasibility of assessments, and the enrollment protocol (n = 27). Participants were 14-18-year-old cisgender LGB+ girls recruited nationally on social media. Across study activities, between 52% and 70% of participants were 14-16 years of age, 10-22% were Hispanic ethnicity, and 30-44% were minority race. RESULTS: Focus group participants were positive about receiving text messages about sexual health, although privacy was of concern. Thus, better safeguards were built into the enrollment process. Teens in the Content Advisory Teams found the content to be approachable and compelling, although many wanted more gender-inclusive messaging. Messages were updated to not assume people with penises were boys. Between 71 and 86% of participants in the beta test provided weekly feedback, most of which was positive; no one withdrew during the seven-week study period. CONCLUSIONS: This careful step-by-step iterative approach appears to have resulted in a high level of intervention feasibility and acceptability.

Self-Reported Conversion Efforts and Suicidality Among US LGBTQ Youths and Young Adults, 2018.

Objectives. To explore associations between undergoing sexual orientation or gender identity conversion efforts (SOGICE) and suicidality among young LGBTQ (lesbian, gay, bisexual, transgender, and queer or questioning) individuals.Methods. Data were derived from a 2018 online cross-sectional study of young LGBTQ individuals (13-24 years of age) residing in the United States. Multivariate logistic regression was used to determine the relative odds of suicidality among young LGBTQ individuals who experienced SOGICE (in comparison with those who did not) after adjustment for age, race/ethnicity, geography, parents' use of religion to say negative things about being LGBTQ, sexual orientation, gender identity, discrimination because of sexual orientation or gender identity, and physical threats or harm because of sexual orientation or gender identity.Results. Relative to young people who had not experienced SOGICE, those who reported undergoing SOGICE were more than twice as likely to report having attempted suicide and having multiple suicide attempts.Conclusions. The elevated odds of suicidality observed among young LGBTQ individuals exposed to SOGICE underscore the detrimental effects of this unethical practice in a population that already experiences significantly greater risks for suicidality.

Understanding the Mental Health of Transgender and Nonbinary Youth.

PURPOSE: Currently, there is a lack of nationwide data examining the mental health of transgender and nonbinary youth. Furthermore, relatively little is known about how the mental health of transgender and nonbinary youth compares to that of their cisgender lesbian, gay, bisexual, queer, and questioning peers or differences within subgroups of transgender and nonbinary youth. The goal of the present study was to better understand the mental health of transgender and nonbinary youth. METHODS: We analyzed responses from a national quantitative cross-sectional survey of more than 25,000 lesbian, gay, bisexual, transgender, queer, and questioning youth, aged between 13 and 24 years, in the U.S. RESULTS: Transgender and nonbinary youth were at increased risk of experiencing depressed mood, seriously considering suicide, and attempting suicide compared with cisgender lesbian, gay, bisexual, queer, and questioning youth. Controlling for sexual orientation-based or gender identity-based experiences of perceived discrimination and physical threats or harm reduced the disparities but did not fully account for them. Within-group analyses highlighted particularly increased risk for negative mental health outcomes among transgender males and nonbinary youth assigned female at birth. CONCLUSIONS: Findings point to the need to directly address the needs of transgender and nonbinary youth in prevention and intervention programs and to advance policies that reduce discrimination and victimization based on sexual orientation or gender identity.

A Cross-sectional Study Examining the (In)congruency of Sexual Identity, Sexual Behavior, and Romantic Attraction among Adolescents in the US.

OBJECTIVE: To examine how sexual identity, romantic attraction, and sexual behavior co-relate for cisgender adolescents. STUDY DESIGN: The Teen Health and Technology survey was a cross-sectional, self-report online survey. More than 5000 youth between 13 and 18 years of age were randomly recruited through Harris Panel OnLine's panel as well as outreach by GLSEN to over-recruit lesbian, gay, bisexual, and other sexual minority youth. Data were collected between 2010 and 2011. Analyses were conducted in 2018 and restricted to cisgender youth. RESULTS: Overall, romantic attraction and sexual behavior most closely mapped each other. The greatest discordance was noted between sexual identity and romantic attraction. For example, 59% of girls and 16% of boys who identified with a nonheterosexual identity reported that at least 1 of their 2 most recent sexual partners was a different gender. Nine percent of heterosexually-identified girls and 3% of heterosexually-identified boys reported romantic attraction to the same sex, and 6% and 7% of heterosexually-identified girls and boys, respectively, reported that at least 1 of their 2 most recent sexual partners was the same gender. CONCLUSIONS: Treating romantic attraction, sexual identity, and sexual behavior as synonymous assumes a unidimensionality that is unsupported by the data. Pediatricians and others working with youth, including researchers, should be mindful not to assume identity on the basis of behavior. Researchers should be clear and purposeful about how they are operationalizing "sexual minority" and how it may affect the composition of their study population. Healthy sexuality and risk reduction programs need to acknowledge that adolescents with a particular sexual identity may have romantic attractions, and even sexual encounters, with people who fall outside of that identity.

Health Indicators of Lesbian, Gay, Bisexual, and Other Sexual Minority (LGB+) Youth Living in Rural Communities.

OBJECTIVE: To investigate whether the intersectionality of being lesbian, gay, bisexual, and other sexual minority youth (LGB+) and living in a rural community may portend worse concurrent health indicators than identifying as heterosexual and/or living in a nonrural community. STUDY DESIGN: Data were collected online between 2010 and 2011 from 5100 13- to-18-year-old youth across the US. Youth were randomly recruited from within the Harris Panel Online and through targeted outreach efforts to LGBT+ youth by a youth-focused nonprofit. The survey questionnaire was self-administered and included measures used in the present study and other measures related to the goal of the Teen Health and Technology study. RESULTS: Living in a rural community was not associated with additional challenges beyond those posed by LGB+ status. Instead, most noted differences in indicators of psychosocial challenge were between LGB+ and heterosexual youth, regardless of rural vs nonrural community living status. For example, sexual minority youth, both male and female, were more likely to have used substances, have depressive symptomatology, have low self-esteem, and report being bullied in the past year compared with both rural and nonrural heterosexual youth. CONCLUSIONS: Findings suggest that LGB+ youth living in rural areas are equally likely to face psychosocial challenges as LGB+ youth living in nonrural areas. Pediatricians and other healthcare providers who work with youth should be mindful of creating LGB+ inclusive environments that can promote self-disclosure by youth who may benefit from additional health services or clinical support for psychosocial challenges.

Prevalence and correlates of anal sex among secondary school students in Cape Town, South Africa.

Research efforts have overlooked anal sex as a risk factor for adolescents' acquisition of HIV despite the high rates of HIV among South African youth. Here, we report findings from a survey conducted in 2012 among secondary school youth, ages 16-24, in Cape Town. 937 adolescents completed a pencil-and-paper survey. Eleven and 31% of female and male youth, respectively, reported ever having anal sex. By comparison, 59% and 78% of female and male youth reported ever having vaginal sex. The percentage of youth reporting lifetime rates of anal sex increased with age: 32% of 20-to-24 year olds had anal sex compared to 16% of 16-to-17-year olds. When the sample was stratified by sex, this difference appeared to be driven by older male, but not female, sexual behavior. Despite noted differences in prevalence rates by sex, both boys and girls who had anal sex were more likely than their same-sex peers who had vaginal sex to report sexual coercion victimization and perpetration experiences and inconsistent condom use. Interestingly, some differences in HIV motivation, information, and behavioral skills were noted for youth who had vaginal sex versus youth who had never had sex; scores were largely similar for youth who had anal sex versus youth who had never had sex however. Together, these findings suggest that anal sex is not uncommon and may be an important marker for other HIV risk behaviors in at least one lower income South African community. Anal sex needs to be explicitly discussed in adolescent HIV prevention and healthy sexuality programing, incorporating age-relevant scenarios about negotiating condoms and other healthy relationship behaviors (e.g., refusing sex when it is not wanted).

The relationship between bias-based peer victimization and depressive symptomatology across sexual and gender identity.

OBJECTIVE: The current study examined the prevalence of seven types of bias-based victimization (sexual orientation, gender, expression of gender, race or ethnicity, disability, religion, and physical appearance), with an emphasis on identifying similarities and differences by sexual and gender identity, and explored the association between victimization and depressive symptomatology for different subgroups. METHODS: Data from the Teen Health and Technology Study were collected nationally online between 2010 and 2011 from 5,542 13 to 18-year-old youth in the United States. RESULTS: Half of all youth reported experiencing some form of bias-based victimization. Sexual and gender minority youth were more likely than heterosexually-identified and cisgender youth to perceive that they had been targeted because of their sexual orientation, gender, gender expression, physical appearance, or religion. Cisgender girls were also more likely to experience bias-based victimization compared with cisgender boys. Being targeted because of one's appearance was associated with concurrent odds of depressive symptomatology for nearly all youth. Victimization due to one's perceived or actual sexual orientation or victimization due to one's gender expression was only associated with increased odds of depressive symptomatology for heterosexual and cisgender youth, respectively. CONCLUSIONS: Findings from the current study add to the growing body of research documenting the heightened risk for experiencing multiple types of bias-based victimization among sexual and gender minority youth. They further emphasize the importance of making distinctions within subgroups of sexual and gender minority youth. The emotional consequences of bias-based victimization for youth require that prevention should be a high priority for schools and communities.