BULLYING EXPERIENCES AMONG SEXUAL MINORITY YOUTHS IN ENGLAND: THE NATURE, PREVALENCE AND ASSOCIATION WITH LIFE SATISFACTION

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

Most research regarding sexual and gender minority (SGM) populations is limited to examination of cigarette or general tobacco use or does not examine heterogeneity across SGM groups other than lesbian or gay and bisexual individuals. This study examined differences in the odds of current use and age of initiation of five tobacco/nicotine products among three groups of SGM young adults who self-identified as (1) gay or lesbian, (2) bisexual, and (3) queer, transgender, or "other," compared to their heterosexual peers. Participants were 4252 college students aged 18-29 years from 24 colleges in Texas who completed an online tobacco use survey. Multilevel logistic regression models were used to examine the odds of SGM participants currently using each tobacco product. Multilevel linear regression models were used to examine the association of current product users' SGM status with self-reported age of each product's initiation. All models were adjusted for sociodemographic factors and accounted for students clustered within each college. At least one SGM group had significantly greater odds of currently using every tobacco product type compared to heterosexual participants, except hookah. There were few differences across groups in age of initiation. However, queer, transgender, and "other-" identified participants initiated e-cigarettes 1.34 years younger than heterosexual participants, and bisexual participants initiated smokeless tobacco 3.66 years younger than heterosexual participants. Findings highlight some significant tobacco use disparities among SGM young adults compared to their heterosexual peers. Longitudinal studies with larger group sizes will identify prospective predictors of sustained SGM-related tobacco use disparities. This study extends the current literature by including the sexual and gender minority identity options of queer, transgender, and "other," highlighting disparities in tobacco use between young adults in these subgroups compared to their heterosexual peers, particularly in noncigarette tobacco product use. Findings underscore the need for the Food and Drug Association and other health agencies to tailor health communication efforts specific to sexual and gender minority populations pertaining to the risks and harms surrounding tobacco product use.

Lesbian, gay, bisexual, transgender, and other minority sexual orientation and gender minority(LGBT+) individuals in the United States use tobacco products more than their heterosexual and cisgender peers. Although existing literature identifies this relationship, more research using recent, national data from a large sample is needed to better examine trends over time. A repeat cross-sectional survey of approximately n = 300 youth and young adults aged 15-24 was fielded weekly from October 2022 to June 2024, resulting in a total sample of N = 25 675. This sample was used to examine cigarette and e-cigarette use over time among LGBT+ and non-LGBT+ youth and young adults. Cigarette and e-cigarette use was also examined by specific sexual orientation and gender identity, using the aggregated sample. From October 2022 to June 2024, cigarette and e-cigarette use were consistently higher among LGBT+ youth and young adults, compared to their cisgender and heterosexual peers. Compared to heterosexual young people, gay/lesbian and bisexual young people reported higher cigarette and e-cigarette use. Male-identifying individuals reported the highest cigarette use, while female young people reported the highest e-cigarette use. Transgender and gender-diverse individuals reported lower cigarette and e-cigarette use than cisgender young people. Tobacco use disparities persist among LGBT+ youth and young adults. Sexual minority respondents sawelevated risk of tobacco use, while gender minority youth saw lower rates of tobacco use, although prevalence remains high. Future research should continue to investigate LGBT+ tobacco use using national surveillance methods. Effective programs for tobacco prevention and cessation are necessary to advance health equity among LGBT+ youth and young adults. This study finds persistently elevated tobacco use among LGBT+ youth and young adults over a 2-year period, highlighting the importance of continued tobacco use surveillance, as well as the development of programmatic interventions to reduce LGBT+ tobacco use. These analyses also inform future work further investigating differences in tobacco use by sexual orientation and gender identity among young people. This work provides a call to action to focus efforts on reducing tobacco use among LGBT+ youth, improving the long-term health of this population, and increasing health equity.

Background: Adolescent and young adults (AYA) with cancer have distinct psychosocial needs, with reproductive health being a chief concern. Reproductive health includes fertility, contraception, romantic relationships, body image, sexuality and disease prevention. Along with the unique needs of AYAs with cancer, health disparities exist among sexual and gender minority (SGM) AYAs, and there is a gap in clinician training. Our NCI-funded R25 Enriching Communication skills for Health professionals in Oncofertility (ECHO) provides reproductive health communication training to psychologists, social workers, nurses, and physician assistants who provide care for AYA people diagnosed with cancer. To refine our curriculum to address the unique needs of SGM AYAs with cancer, we conducted a survey of prior ECHO trainees to evaluate knowledge and comfort in obtaining sexual orientation and gender identity (SOGI) information from patients and providing reproductive health counseling. Methods: A 28-item electronic survey was distributed to 601 prior ECHO trainees. Quantitative items assessed: SOGI data collection at their institution; SGM AYA cancer-related health knowledge; adequacy of ECHO training for SGM AYAs; desire for additional training; comfort discussing reproductive health with SGMs; and confidence in knowledge of SGM health needs (pre- and post-survey). Response options ranged from 1=strongly agree to 5=strongly disagree, or ‘prefer not to answer. Total knowledge score was computed and ranged from 0=no correct responses to 7=all correct. Self-perceived comfort and confidence were assessed with regard to specific patient subgroups (i.e., gay/lesbian; bisexual/queer; and trans/nonbinary patients). Four open-ended items invited respondents to describe personal experiences, reservations, and suggestions for improving SGM AYA cancer care. Quantitative responses were summarized with descriptive statistics. Paired t- tests were used to analyze changes in confidence. Content analysis was applied to qualitative responses. Results: Of the 346 who completed the survey (58% response rate), only 7.4% correctly answered all knowledge questions (M=3.76, SD=1.72). One- third thought ECHO training adequately addresses SGM needs, and the majority (89%) wanted additional training in SGM reproductive health. Confidence in knowledge of SGM health was neutral in all subgroups prior to survey completion (M=3.05, SD=1.02), but reduced significantly for bisexual/queer (M=-0.21 t(307)=4.70, p<.001) and transgender/nonbinary health(M=-0.12 t(307)=2.66, p=.008). Open-ended responses focused on experiences caring for SGM AYAs with cancer; training needs; and appreciation for the survey. Conclusions: Our findings demonstrate a need to expand our ECHO curriculum to include SGM reproductive health concerns and strong desire for SGM content among trainees. We are developing a module to improve reproductive health communication for the care of SGM AYAs with cancer and survivors. Citation Format: Rhyan J. Toldeo, Amani Sampson, Paige W. Lake, Megan E. Sutter, Ash B. Alpert, Matthew B. Schabath, Susan T. Vadaparampil, Gwendolyn P. Quinn. Assessment of training needs for clinicians who provide reproductive health counseling for sexual and gender minority adolescents and young adults with cancer [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-014.

Alcohol Use Disorders and the Use of Treatment Services Among College-Age Young Adults

Minority stressors and tobacco use among a US sample of sexual and gender minority young adults

Tobacco use is disproportionately high among sexual minorities (i.e., lesbian/gay and bisexual [LGB] individuals). Receptivity to tobacco advertising is an established risk factor for tobacco use among the general population, yet little research has assessed how receptivity to tobacco advertising differs based on sexual identity and sex. Additionally, studies often fail to distinguish between LGB identities, creating a monolith of sexual identity that ignores different underlying risk factors and behaviors. This study examined differences in receptivity to advertising of five tobacco product categories (any tobacco, cigarettes, cigars, e-cigarettes, and smokeless tobacco) between straight/heterosexual and lesbian/gay, and bisexual (LGB) young adults by sex. We used data from Wave 1 of the Population Assessment of Tobacco and Health Study Restricted Use File. Analyses were limited to young adults (aged 18-24) with complete data on sexual identity (n = 8,839). Multivariable logistic regressions examined the association between receptivity and sexual identity, controlling for demographics, past 30-day tobacco use, and media use, stratified by sex. In the multivariable models, gay males had higher odds of receptivity to cigar advertising and gay and bisexual males had higher odds of receptivity to e-cigarette advertising, compared with straight/heterosexual males. Compared with straight/heterosexual females, bisexual females had higher odds of receptivity to advertising for all products; lesbian/gay females had higher odds of receptivity to any tobacco advertising. In conclusion, our study identified elevated receptivity to tobacco marketing among sexual minorities-particularly sexual minority women. More research is needed to understand the sources of exposure to tobacco advertising and the reasons for elevated receptivity among LGB individuals.

Examining the relationship between mental health and e-cigarette initiation among sexual and gender minority youth and young adults in the United States compared to their cisgender, heterosexual peers, 2021-2023.

BackgroundResearch suggests that lesbian, gay and bisexual (LGB) adolescents have a higher risk of suicidal behaviours than their heterosexual peers, but little is known about specific risk factors.AimsTo assess sexual orientation as a risk factor for suicidal behaviours, and to identify other risk factors among LGB adolescents and young adults.MethodA systematic search was made of six databases up to June 2015, including a grey literature search. Population-based longitudinal studies considering non-clinical populations aged 12-26 years and assessing being LGB as a risk factor for suicidal behaviour compared with being heterosexual, or evaluating risk factors for suicidal behaviour within LGB populations, were included. Random effect models were used in meta-analysis.ResultsSexual orientation was significantly associated with suicide attempts in adolescents and youths (OR = 2.26, 95% CI 1.60-3.20). Gay or bisexual men were more likely to report suicide attempts compared with heterosexual men (OR = 2.21, 95% CI 1.21-4.04). Based on two studies, a non-significant positive association was found between depression and suicide attempts in LGB groups.ConclusionsSexual orientation is associated with a higher risk of suicide attempt in young people. Further research is needed to assess completed suicide, and specific risk factors affecting the LGB population.

Sexual and gender minority (SGM) young adults spend more time on social media than their heterosexual peers. However, the link between social media and mental health is mixed. This study employed a mixed methods approach to explore the links between social media, social connectedness, and mental health symptoms among SGM young adults between 18 to 26 years old. Focus groups ( N = 14) revealed how SGM emerging adults perceive social media as a place for socialization, building identity, and connecting to the larger SGM community. However, using social media as a primary way to seek social connections had drawbacks, such as consistent exposure to negative content. A series of multiple regressions ( N = 238) further corroborated these findings, indicating that social connection played a role in reducing symptoms of depression for SGM young adults. Implications for social media development and clinicians working with SGM young adults are provided.

Background Research showing that sexual and gender minority (SGM) young adults are at increased risk of substance use and mental health symptoms have insufficiently accounted for SGM identity diversity. This study examined differences in substance use and mental health symptoms among young adults with diverse sexual (heterosexual, lesbian/gay, asexual, bisexual, pansexual, and queer) and gender (cisgender, transgender, and on-binary) identities. Methods Five longitudinal survey waves (2019–2023) of young adults (n = 2724; mean age = 21.7) from Southern California were used to estimate time-varying contemporaneous associations of SGM identities with eight outcomes. Outcomes were: past 30-d alcohol, combustible cigarette, e-cigarette, or other drug (e.g., prescription painkillers, stimulants) use and binge drinking, and depression and anxiety symptoms. Results Young adults with transgender and non-binary identities (vs. cisgender female) reported higher cigarette, e-cigarette, and other drug use, and greater depression. Bisexual identities showed higher use in all six substance outcomes, gay/lesbian identities reported increased alcohol and combustible cigarette use, and pansexual identities reported higher e-cigarette and other drug use (vs. heterosexual). All sexual minority identities displayed higher depression and anxiety levels, except asexual identities, who showed positive associations with depression symptoms only. Associations did not vary by time, stable vs. dynamic identity status, or sexual identity-gender identity intersections. Conclusion Young adults with SGM identities report significantly higher levels of substance use and mental health problems compared to cisgender and heterosexual identities, with heterogeneity in associations across diverse SGM identities. Inclusive SGM assessment could inform precise and tailored young adult behavioral health prevention and treatment.

Evaluation of sexual behaviors is essential to better understand the epidemiology of sexually transmitted infections and their sequelae. The National Health and Nutrition Examination Surveys (NHANES) is an ongoing probability sample survey of the US population. Using NHANES sexual behavior data from 1999 to 2012, we performed the following: (1) trend analyses among adults aged 25 to 59 years by 10-year birth cohorts and (2) descriptive analyses among participants aged 14 to 24 years. Sex was defined as vaginal, anal, or oral sex. Among adults aged 25 to 59 years, median age at sexual initiation decreased between the 1940-1949 and 1980-1989 cohorts from 17.9 to 16.2 among females (P trend < 0.001) and from 17.1 to 16.1 among males (P trend < 0.001). Median lifetime partners increased between the 1940-1949 and 1970-1979 cohorts, from 2.6 to 5.3 among females (P trend < 0.001) and from 6.7 to 8.8 among males (P trend < 0.001). The percentage of females reporting ever having a same-sex partner increased from 5.2% to 9.3% between the 1940-1949 and 1970-1979 cohorts (P trend < 0.001). Among participants aged 14 to 24 years, the percentage having had sex increased with age, from 12.5% among females and 13.1% among males at age 14 years to more than 75% at age 19 years for both sexes. Among sexually experienced 14- to 19-year-olds, 45.2% of females and 55.0% of males had at least 3 lifetime partners; 39.4% of females and 48.6% of males had at least 2 partners in the past year. The proportion of females aged 20 to 24 years who reported ever having a same-sex partner was 14.9%. The proportion of participants aged 14-19 or 20-24 years reporting ever having sex did not differ by survey year from 1999 to 2012 for either males or females. Sexual behaviors changed with successive birth cohorts, with more pronounced changes among females. A substantial proportion of adolescents are sexually active and have multiple partners. These data reinforce existing recommendations for sexual health education and sexually transmitted infection prevention targeting adolescents before sexual debut.

This pilot open trial examined the efficacy of attachment‐based family therapy (ABFT) for Israeli sexual and gender minority (SGM) young adults and their persistently nonaccepting parents. Thirty families received up to 26 weeks of treatment, with parental rejection, parental acceptance, and young adults' attachment avoidance and attachment anxiety assessed at baseline, 8, 16, 24, and 36 weeks (three months post‐treatment). Analyses using multilevel growth models revealed that both young adults and their mothers independently reported increases in mothers’ acceptance of their young adult's same‐sex orientation or noncisgender identity. In addition, young adults reported decreases in both parents’ levels of rejection. Also, mothers, but not fathers, reported decreases in their own level of rejection. Finally, young adults reported a decrease in attachment avoidance in their relationships with both mothers and fathers, but not a decrease in attachment anxiety. Importantly, these treatment gains were maintained three months after the end of treatment. Together, these results suggest that ABFT‐SGM, a manualized, affirmative, experiential, family‐based treatment, may be effective in reducing long‐standing parental rejection, promoting parental acceptance, and improving the quality of LGBTQ+ young adults’ relationships with their parents. These findings are encouraging in light of the urgent need for efficacious interventions to reduce family generated minority stress and promote safer, more supportive environments for sexual and gender minority people.

This study examined associations between sexual identity and both substance use and mental health outcomes via nationally representative data from adolescents and young adults, using a six-response sexual identity assessment. Data were from 11,328 adolescents (12-17 years) and 13,131 young adults (18-25 years) completing the 2023 National Survey on Drug Use and Health. Sexual identity had six-response options: heterosexual, lesbian/gay, bisexual, using a different term, unsure/don't know, and do not understand the question. Substance use variables included alcohol, cannabis, nicotine, prescription drug misuse, polysubstance use, and substance use disorder (SUD). Mental health variables included major depressive episodes, suicidal ideation, and serious psychological distress (measured only among young adults). Multivariable logistic regression models were fitted to examine whether substance use and mental health differed by sexual identity. Analyses adjusted for sociodemographics, occurred separately by age group and sex, and heterosexual individuals were the reference category. Youth identifying as lesbian, gay, bisexual, unsure/don't know, or using a different term had significantly higher rates of all mental health concerns than their heterosexual peers, with 80% of adjusted odds ratios above 3.0. Substance use-sexual identity links were less consistent, although lesbian and bisexual females were more likely than heterosexual females to have past-year SUD. Individuals not understanding the sexual identity question had lower rates than their heterosexual peers on 15 of 36 outcomes (41.7%). Screening and indicated prevention for mental health concerns and SUD are needed for sexual minority youth, along with the development of culturally sensitive interventions.

Tobacco harm perceptions and use among sexual and gender minorities: findings from a national sample of young adults in the United States