Middle and High School LGBTQ Students Report What Makes School LGBTQ-Affirming Across Race/Ethnicity and Gender Identity, a Topic Modeling Method.

BACKGROUND: Affirming spaces have been associated with improved mental health outcomes for lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) adolescents. METHODS: With data from adolescents currently enrolled in middle or high school across the United States, this study used topic modeling methods to examine students' reports of what they were looking for in LGBTQ-affirming schools and, separately, the association of LGBTQ-affirming schools with suicide risk reduction. RESULTS: Topic models demonstrated consistent themes in how students determined that their school was affirming, such as LGBTQ clubs, teachers requesting pronouns, pride flags, and accepting peers. Students of color uniquely looked for actionable responses in addressing LGBTQ issues. Transgender and nonbinary students required explicit mention of support for transgender issues. Quantitatively, LGBTQ students who reported that their school was LGBTQ-affirming had 20% lower odds of attempting suicide in the past year (adjusted odds ratio = 0.80). CONCLUSIONS: These findings suggest that schools must be safe for all youth and implementing policies that make LGBTQ students feel seen and supported in their identities is a protective factor for mental health. IMPLICATIONS: School policies must ensure that youth have access to supportive people, symbols of support, and LGBTQ clubs and that they are also salient to LGBTQ students of color and transgender and nonbinary students.

"I Get Treated Poorly in Regular School-Why Add To It?": Transgender Girls' Experiences Choosing to Play or Not Play Sports.

Purpose: Transgender girls' right to participate in high school sports has been attacked by legislation banning them from doing so. This study uses open-ended survey responses among transgender high school girls to examine reasons that they choose to participate or not participate in sports. Methods: Data come from 294 transgender girls currently in high school who answered one of two open-ended questions about sports participation as part of a larger survey on lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ) youth mental health. An inductive approach with exploratory and descriptive codes was used, resulting in a codebook with 14 codes about high school girls' choices to participate or not participate in sports. Results: Among respondents' answers about why they participate in sports, six codes were identified: physical health benefits, mental health benefits, fun, social connections, family expectations, and gender affirmation. Among respondents' answers about why they do not participate in sports, eight codes were identified: not interested in sports, gendered teams or spaces, not athletic, physical or mental health limitations, social discomfort around peer athletes, worsened gender dysphoria, bullying or harassment, and lack of resources or access. These codes were not mutually exclusive and many responses were tagged with multiple codes. Conclusion: This study highlights the need for inclusive sports environments for transgender athletes. Providing LGBTQ cultural competence training for coaches, administrators, and parents may decrease barriers and increase comfort for transgender athletes, allowing them to benefit from the skills and education that sports provide.

Losing a Close Friend or Family Member Due to COVID-19 and Mental Health among LGBTQ Youth.

This study examines the association between having lost a close friend or family member to COVID-19 and mental health outcomes among lesbian, gay, bisexual, transgender, or queer (LGBTQ) youth. Data come from 33,993 respondents in the United States, ages 13 to 24, who completed an online survey of LGBTQ youth mental health. Multivariate logistic regression was used to determine the adjusted odds of recent anxiety, depression, considering, or attempting suicide in the past year based on whether or not the youth reported having lost a close friend or family member to COVID-19. Among the full sample, experiences of COVID-19 loss were associated with recent anxiety (adjusted odds ratio (aOR) = 1.29, 95% confidence interval (CI) = 1.20-1.40), recent depression (aOR = 1.23, 95% CI [1.15, 1.32]), seriously considering suicide in the past year (aOR = 1.22, 95% CI (1.14, 1.30)), and attempting suicide in the past year (aOR = 1.55, 95% CI (1.41, 1.69)). These findings highlight the urgent need for investment in low-barrier, affirming mental health services for LGBTQ youth who have experienced COVID-19 loss to support their grief, overall mental health, and healthy development.

Physical Dating Violence Victimization among LGBTQ Youth: Disclosure and Association with Mental Health.

Youth dating violence and youth suicide are both major public health concerns. However, little research examines the intersection of these issues among lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth. The current study examined the association between physical dating violence victimization and mental health using online survey data collected from 39,126 LGBTQ youth of ages 13 to 24 in the United States. Overall, 11% of LGBTQ youth who were in a relationship in the past year experienced physical dating violence victimization, with 4% having experienced it once and 7% having experienced it multiple times. Rates of experiencing physical dating violence victimization varied based on a number of youth characteristics and environmental factors. Past-year physical dating violence victimization was associated with nearly four times the odds of attempting suicide in the past year. Given the intersection of suicide risk and dating violence among LGBTQ youth, dating violence prevention organizations must be LGBTQ-inclusive, and suicide prevention must be equipped to address dating violence victimization. The higher rates of physical dating violence victimization among multiple marginalized and socioeconomically disadvantaged LGBTQ youth suggest the need for an intersectional approach that addresses the structural factors that place LGBTQ youth at risk for physical dating violence.

Identity Matters: Religious Experiences of US based Transgender Young People.

Research centered on the socioemotional benefits of religion and religious congregations for young people has highlighted largely positive outcomes for both young people and religious congregations. However, fewer studies have explored whether transgender young people receive those same socioemotional benefits from being religiously affiliated. Using secondary quantitative data from the 2015 US Transgender Survey, this study examined the religious experiences of transgender young people (aged 18-24). The data indicate that individual demographics (e.g., race, gender identity, sexual orientation, religious affiliation) affected the religious experiences of transgender young people, including leaving their congregations due to the fear of being rejected. More research is needed on the socioemotional benefits of religious affiliation for transgender young people.

Association of Updating Identification Documents with Suicidal Ideation and Attempts among Transgender and Nonbinary Youth.

This study examines the association of access to concordant identity documents with attempting suicide in the last year among transgender and nonbinary youth. Data came from 6581 transgender and nonbinary youth who completed an online survey of lesbian, gay, bisexual, transgender, or queer (LGBTQ) youth ages 13−24 residing in the United States. Multivariate logistic regression was used to determine the adjusted odds of attempting suicide in the past year based on whether or not youth were able to change their identification documents. Both wanting to update one's documents but not being able to (aOR = 2.04, CI = 1.412−2.95; p < 0.001) and being able to update one's documents but not having done so (aOR = 1.74, CI = 1.22−2.50; p < 0.001) were associated with greater odds of attempting suicide in the last year, compared to youth who had changed their documents. Revising the way gender is captured on legal documents may be an efficacious public health intervention to reduce suicide risk among transgender and nonbinary youth.

Association of Gender-Affirming Hormone Therapy With Depression, Thoughts of Suicide, and Attempted Suicide Among Transgender and Nonbinary Youth.

PURPOSE: There are no large-scale studies examining mental health among transgender and nonbinary youth who receive gender-affirming hormone therapy (GAHT). The purpose of this study is to examine associations among access to GAHT with depression, thoughts of suicide, and attempted suicide among a large sample of transgender and nonbinary youth. METHODS: Data were collected as part of a 2020 survey of 34,759 lesbian, gay, bisexual, transgender, queer, and questioning youth aged 13-24, including 11,914 transgender or nonbinary youth. Adjusted logistic regression assessed whether receipt of GAHT was associated with lower levels of depression, thoughts of suicide, and attempted suicide among those who wanted to receive GAHT. RESULTS: Half of transgender and nonbinary youth said they were not using GAHT but would like to, 36% were not interested in receiving GAHT, and 14% were receiving GAHT. Parent support for their child's gender identity had a strong relationship with receipt of GAHT, with nearly 80% of those who received GAHT reporting they had at least one parent who supported their gender identity. Use of GAHT was associated with lower odds of recent depression (adjusted odds ratio [aOR] = .73, p < .001) and seriously considering suicide (aOR = .74, p < .001) compared to those who wanted GAHT but did not receive it. For youth under age 18, GAHT was associated with lower odds of recent depression (aOR = .61, p < .01) and of a past-year suicide attempt (aOR = .62, p < .05). CONCLUSIONS: Findings support a relationship between access to GAHT and lower rates of depression and suicidality among transgender and nonbinary youth.

More than Data Collectors: A Systematic Review of the Environmental Outcomes of Youth Inquiry Approaches in the United States.

Over the last twenty years, research on the impact of engaging children and adolescents in the generation of new knowledge about their lives, schools, and communities, has grown tremendously. This systematic review summarizes the findings from empirical studies of youth inquiry approaches in the United States, with a focus on their environmental outcomes. Searches of four interdisciplinary databases retrieved a total of 3,724 relevant articles published between 1995 and 2015. Sixty-three distinct studies met the systematic review inclusion criteria, of which, 36 (57.1%) reported that the youth inquiry approach contributed to positive changes among adults, peers, organizations, and/or institutions. These environmental outcomes were qualitatively recorded, inductively categorized, and then organized into Bronfenbrenner's ecological framework. Youth inquiry approaches led to practitioner growth and changes in peer group norms at the micro-system level, program development or improvement and research benefits at the meso-system level, and school, city, and state level policy adoption at the exo-system level. Qualitative methods, especially case studies, were most commonly used to evaluate the impact of youth inquiry approaches on environmental outcomes. Studies of approaches that utilized advocacy to create change, targeted decision-makers as the audience for the youth's work and convened for a longer duration were more likely to report improved environmental outcomes. This systematic review suggests that youth inquiry approaches are a promising strategy for ecological systems change.

On the fringes: How youth experiencing homelessness conceptualize social and economic inequality-A Photovoice study.

This study used Photovoice methods with young adults experiencing homelessness to collaboratively identify issues that are of greatest importance in an open-ended, exploratory, and inductive manner. Participants selected two concepts to focus their inquiry: freedom and prosperity. Within these concepts, participants discussed nature as a source of inspiration, a desire to better themselves and to change their situations, and passion for contributing to social change by exposing economic inequality and raising awareness about homelessness. These findings demonstrate that young people are keenly aware of the structural and macro-level factors that have contributed to their risks of social exclusion and marginalization.

Reconciling Adaptation and Fidelity: Implications for Scaling Up High Quality Youth Programs.

In the field of prevention science, some consider fidelity to manualized protocols to be a hallmark of successful implementation. A growing number of scholars agree that high-quality implementation should also include some adaptations to local context, particularly as prevention programs are scaled up, in order to strengthen their relevance and increase participant engagement. From this perspective, fidelity and adaptation can both be seen as necessary, albeit mutually exclusive, dimensions of implementation quality. In this article, we propose that the relationship between these two constructs may be more complex, particularly when adaptations are consistent with the key principles underlying the program model. Our argument draws on examples from the implementation of a manualized youth voice program (YVP) in two different organizations serving six distinct communities. Through a series of retreats, implementers identified examples of modifications made and grouped them into themes. Results suggest that some adaptations were actually indicators of fidelity to the key principles of YVPs: power-sharing, youth ownership, and engagement in social change. We therefore offer suggestions for re-conceptualizing the fidelity-adaptation debate, highlight implications for measurement and assessment, and illustrate that the de facto treatment of adaptation and fidelity as opposing constructs may limit the diffusion or scaling up of these types of youth programs.

A Systematic Review of Youth Participatory Action Research (YPAR) in the United States: Methodologies, Youth Outcomes, and Future Directions.

OBJECTIVES: To use a systematic review methodology to describe the state of the youth participatory action research (YPAR) literature and synthesize findings about the youth outcomes reported in these studies. METHODS: We screened and coded studies using a process consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Of the 3,724 articles found in the database search, 67 reports of 63 distinct studies were included in the final sample. These reports were coded for reports of YPAR principles and project characteristics, study methods, and reported youth outcomes. RESULTS: The YPAR literature comprises predominantly qualitative studies, with only two randomized trials. The most common outcomes associated with participation in YPAR were those related to agency and leadership (75.0%), followed by academic or career (55.8%), social (36.5%), interpersonal (34.6%), and cognitive (23.1%) outcomes. CONCLUSIONS: This systematic review provides emerging evidence of the skills and competencies youth may develop through YPAR and offers methodological recommendations for future research that can provide greater evidence of causality.