Sexual Minority Adolescents Research Articles

Sexual attraction-based disparities in adolescent mental health: The role of school norms

Abstract Purpose Few researchers have explained disparities in mental health between sexual minority and heterosexual adolescents by focusing on structural forms of stigma as, for instance, heterosexist school or classroom norms. Addressing this gap, our paper aimed to study disparities in life satisfaction, psychosomatic complaints, and emotional problems between sexual minority and heterosexual adolescents and examine the moderating role of heterosexist norms in the classroom and school. Methods We used data from the 2013 and 2017 Dutch Health and Behaviour in School-Aged Children (HBSC) study (N = 12,756; M age = 14.02; SD = 1.54). Separate multi-level analyses for life satisfaction, psychosomatic complaints, and emotional problems were conducted in which cross-level interaction effects between sexual attraction and school and classroom-level heterosexist norms were estimated. Results Same-sex attracted, both-sex attracted, and adolescents unsure about their sexual attraction reported lower life satisfaction, more psychosomatic complaints (not for unsure adolescents), and more emotional problems than their other-sex attracted peers. Stronger school-level heterosexist norms were associated with higher life satisfaction and fewer psychosomatic complaints and fewer emotional problems. Stronger classroom-level heterosexist norms were associated with less emotional problems. Few moderating effects of classroom and school-level heterosexist norms were found. Contrary to expectations, disparities in life satisfaction between same-sex attracted and other-sex attracted adolescents decreased when classroom-level heterosexist norms were stronger. Conclusions Although our findings suggest pressing health disparities between heterosexual and sexual minority adolescents, heterosexist norms at the school- and classroom-level hardly contributed to these health disparities.

10.O. Workshop: Developmental and School-Based Factors Shaping Sexual and Gender Minority Youth Mental Health

Abstract Research from across the globe has consistently shown that young sexual and gender minority individuals (e.g., those identifying as lesbian, gay, bisexual, and/or transgender [LGBT+]) are at a higher risk for depression, anxiety, and suicidal thoughts and behaviors when compared to heterosexual youth, including during early childhood and later adolescence. A sizeable body of research has attributed the elevated risk to increased exposure to specific social stressors related to navigating a stigmatized minority identity, including stressors such as victimization and other interpersonal and social difficulties in, for example, the school environment. Yet, relatively less is known about the early developmental timing of such disparities in childhood and how LGBT+ youth navigate school climates. As a sensitive developmental period, childhood and adolescence may be a particularly challenging time for sexual and gender minority youth to navigate cisnormative and heteronormative school contexts. Exposure to oppressive norms, particularly in school environments, has only recently become the subject of research. Additionally, research has been limited on how supportive school climates may be protective but stigmatizing school environments may drive LGBT+ trajectories towards suicidal behaviors and shape how they may navigate self-disclosure of cooccurring identities and mental health status in school settings, particularly when such stigmas may prevalently intersect. This workshop aims to further explore these novel aspects around developmental and school-based risk and protective factors shaping the mental health of sexual and gender minority children and adolescents. This workshop includes five empirical presentations that span from examining the developmental timing of mental health disparities, the role school-based experiences play in shaping and driving these disparities, to how sexual and gender minority youth may navigate their school context and how supportive climates may be protective for mental health. First, Arjan van der Star will present longitudinal evidence on how sexual identity formation precedes the onset of sexual orientation-based mental health disparities and the role that peer difficulties play in driving these as early as pre-teen years. Next, Niolyne Jasmin Bomolo will present findings from a qualitative study that unravel how school-based experiences shape individual trajectories toward suicidal attempts among LGBT+ adolescents. Third, Wouter Kiekens will explore how normative cultures in school environments may drive sexual attraction-based mental health disparities among a large sample of adolescents. Fourth, Lourdes Cantarero Arévalo will present findings on how LGBT+ adolescents living with mental conditions navigate self-disclosure in school environments. Finally, Sandra Sevic will present results on how supportive school environments may be protective for gender minority mental health. Key messages • Negative school-based experiences put sexual and gender minority youth at elevated risk for adverse mental health as early as middle childhood. • Intersecting stigmas around minority identities and mental health problems may further complicate how sexual and gender minority children and adolescents navigate their school environments.

State Marijuana Laws and Marijuana Use Among Sexual and Gender Minority Youth in the United States.

Purpose: The purpose of this study was to explore the association between state-level marijuana policies and marijuana use among sexual and gender minority (SGM) adolescents. Methods: A secondary analysis was conducted using a nonprobability sample, the 2017 LGBTQ National Teen Survey, based on 10,027 youth who reported their marijuana use behaviors and state of residence. Random intercept multilevel models were estimated to account for between- and within-state variability. Results: State marijuana possession laws were not associated with lifetime use; however, the odds of current marijuana use were 50% greater among youth living in states with legalized marijuana possession for recreational use (adjusted odds ratio [aOR] = 1.50; 95% confidence interval [CI]: 1.21-1.86) compared with states that prohibit any possession. Lesbian, gay, bisexual, transgender, and queer victimization was associated with greater odds of lifetime (aOR = 1.98; 95% CI: 1.78-2.20) and current (aOR = 1.99; 95% CI: 1.74-2.27) marijuana use. Conclusions: State-level policies governing recreational marijuana possession are associated with current marijuana use among SGM youth. Public health approaches to control underage access to legal marijuana and mitigate substance use-related health disparities are needed.

Oral healthcare visits among sexual minority adolescents ages 14-18, 2019, USA.

Health disparities persist among sexual minority (SM) adolescents (i.e., bisexual, lesbian/gay) compared to heterosexual adolescents, however, research is limited on oral health. The purpose of this study was to examine reported recency of dental visits by sexual orientation among a national sample of adolescents. Data from the 2019 Youth Risk Behavior Surveillance Survey (n=12,673 adolescents, 14-18 years old) were analyzed. We assessed dental care in the past 12 months or more based on sexual orientation ("lesbian/gay," "bisexual," "not sure"). Adjusted, sex-stratified, multinomial logistic regression analyses were used to determine conditional associations. Bisexual boys (aRR:2.50), "not sure" boys (aRR:3.55), and "not sure" girls (aRR:2.32) were at increased relative risk for not going to the dentist compared to heterosexual adolescents. Findings indicate gaps in oral healthcare access among SM adolescents, specifically bisexual and not sure youth. Results can be used to increase access to preventive dental care among SM adolescents.

Validation of the Body Appreciation Scale-2 in cisgender, heterosexual and sexual and gender minority adolescents and sexuality-related correlates

Body dissatisfaction has received considerable scientific attention, while research about positive body image has been neglected, particularly among adolescents. The aims of the present study were to examine (1) the factor structure of the Body Appreciation Scale-2 (BAS-2) in a large sample of cisgender, heterosexual and sexual and gender minority adolescents, (2) measurement invariance across language, gender and sexual orientation-based groups, (3) convergent validity with sexuality-related outcomes and (4) one-year temporal stability. Results of a confirmatory analysis among 2419 adolescents (Mage=14.6 years, SD=0.62; 52.6% girls) corroborated the proposed one-dimensional factor structure of the scale. The BAS-2 demonstrated adequate reliability and one-year temporal stability. The scale was partially invariant across gender and fully invariant across language and cisgender heterosexual and sexual and gender minority adolescents. Boys (cis and trans) had higher levels of body appreciation than girls (cis and trans), while no significant differences were observed between heterosexual and sexual minority adolescents. The BAS-2 correlated positively with sexual satisfaction and sexual body-esteem as well as negatively with sexual distress. Our findings support the validity and reliability of the BAS-2 in French and English for measuring body appreciation in adolescents.

Homonegative Victimization and Perceived Stress among Adolescent Sexual Minority Males: The Attenuating Role of Peer and Family Support

Purpose: Research suggests social support may protect sexual minorities from the harmful effects of victimization that undermine mental and sexual health wellness; however, this relationship has been underexplored among a diverse youth population. We examined the association between lifetime homonegative victimization, perceived stress in the last month, and resilience factors among a diverse sample of adolescent sexual minority males. Methods: Data were collected between June 2018 and April 2020 as part of the MyPEEPS Mobile study, a multi-site randomized controlled trial evaluating the effectiveness of a mobile behavioral HIV prevention intervention for adolescents living in the U.S. We analyzed baseline survey data from 542 sexual minority males, aged 13–18 years. We used bivariate analyses to examine relationships among variables and multivariable linear regression models to determine if resilience factors attenuated the association between homonegative victimization and perceived stress. Results: Perceived stress was positively associated with younger age, internalized homophobia, experiencing verbal victimization, threats of being outed, and threats of physical violence. Relying on online friends for support and having good family relations both attenuated the relationship between verbal victimization and perceived stress. However, neither of these resilience factors significantly weakened the associations between perceived stress, threats of physical violence, and being outed. Conclusion: Resilience factors, including peer and family support, may play an attenuating role in the relationship between homonegative victimization and perceived stress among adolescent sexual minority males. ClinicalTrials.gov Identifier: NCT03167606

The Association Between Family Physical Abuse and Suicide Attempts Among Gender Minority Adolescents: A Comparison Study.

Purpose: This study examines the prevalence of reported family physical abuse and the concurrent association between abuse and suicide attempts by adolescent gender identity. Methods: This study used the Profiles of Student Life: Attitudes and Behaviors dataset (N = 121,150 adolescents aged 11-19 [mean = 14.74, standard deviation = 1.78]) collected from 61 participating school districts and programs across the United States by Search Institute from 2012 to 2015. Multigroup logistic regression was used to examine the association between family abuse and suicide attempts by gender identity. Correlates included race/ethnicity, age, parent education, rurality, binge drinking, and tobacco use. Results: Results indicated that cisgender adolescents (i.e., participants who did not select a transgender identity) reported significantly less family abuse compared to gender minority adolescents. Family physical abuse was associated with higher odds of suicide attempts among all adolescents. The association was stronger for female adolescents compared to male adolescents but not significantly different across gender minority adolescents, including those who identify as transgender female to male, transgender male to female, and transgender without identifying or being unsure of their gender identity. The association between family physical abuse and suicide attempts was stronger among heterosexual female adolescents compared to sexual minority female, heterosexual male, sexual minority male, heterosexual gender minority, or sexual and gender minority adolescents. Conclusions: Findings highlight the importance of identifying and treating family abuse to prevent suicide attempts, particularly among gender and sexual minority adolescents.

Explaining behavioral health differences in urban and rural sexual minority adolescents: A longitudinal investigation of minority stress in a diverse national sample of sexual minority adolescents: A longitudinal investigation of minority stress in a diverse national sample of sexual minority adolescents.

Experiences of sexuality-based discrimination (ie, minority stressors) against youth who identify as nonheterosexual (ie, sexual minority) have been associated with increased symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD) for sexual minority adolescents (SMA; ages 14-17). However, little is known about the experiences of SMA living in rural communities across the United States. Thus, the present study sought to examine differences in mental health patterns between urban and rural dwelling SMA, and to see whether these differences are, at least in part, explained by experiences of lifetime minority stress. A nationwide sample of SMA residing in the United States (N = 2,558; aged 14-17, M = 15.90 years, SD = 0.98) was recruited through purposive social media and respondent-driven sampling methods to complete a cross-sectional survey online. Measures included those of minority stress, urbanicity, and symptoms of anxiety, depression, and PTSD. Parallel multiple mediation (PMM) analysis was employed to test whether urbanicity was associated with anxiety, depressive, and PTSD symptoms through reported lifetime minority stress. On average, SMA living in rural areas significantly reported more lifetime minority stress, depressive, and PTSD symptoms than SMA living in urban settings. Results from our PMM analysis indicated that heightened experiences of lifetime minority stress indirectly linked the effects of living in rural areas on anxiety (b = -0.288, 95% CI = [-0.491, -0.085]), depressive (b = -0.158, 95% CI = [-0.270, -0.047), and PTSD symptoms PTSD (b = -0.349, 95% CI = [-0.596, -0.105]). The model accounted for 16.8%, 18%, and 24.1% of the variability in anxiety symptoms, depressive symptoms, and PTSD symptoms, respectively. SMA in our study who reside in rural areas reported elevated minority stress, depressive, and PTSD symptoms as compared to their urban dwelling peers. Our study found that lifetime experiences of minority stress fully mediated the relationship between urbanicity and both depressive and PTSD symptoms, and partially mediated the relationship between urbanicity and anxiety. These findings highlight the need to increase support for rural youth who are growing into adulthood and may find continuing challenges in their family, peer, and community relationships.

Using the Implementation Research Logic Model as a Lens to View Experiences of Implementing HIV Prevention and Care Interventions with Adolescent Sexual Minority Men—A Global Perspective

Adolescents and sexual minority men (SMM) are high priority groups in the United Nations’ 2021 − 2016 goals for HIV prevention and viral load suppression. Interventions aimed at optimizing HIV prevention, testing and viral load suppression for adolescents must also attend to the intersectional realities influencing key sub-populations of SMM. Consequently, there is not a robust evidence-base to guide researchers and program partners on optimal approaches to implementing interventions with adolescent SMM. Using a multiple case study design, we integrated the Implementation Research Logic Model with components of the Consolidated Framework for Implementation Research and applied it as a framework for a comparative description of ten HIV related interventions implemented across five countries (Ghana, Kenya, Nigeria, Tanzania and United States). Using self-reported qualitative survey data of project principal investigators, we identified 17 of the most influential implementation determinants as well as a range of 17 strategies that were used in 90 instances to support intervention implementation. We highlight lessons learned in the implementation research process and provide recommendations for researchers considering future HIV implementation science studies with adolescent SMM.

Digital Sexual Violence and Suicide Risk in a National Sample of Sexual Minority Adolescents.

This paper aimed to examine the association between digital sexual violence (threat to post or nonconsensual posting of sexually explicit media) and suicidal (ideation, planning, and attempt) and non-suicidal self-harm behavior. The data for the current analysis come from an online sample of sexual minority adolescents (aged 14-17) recruited from across the United States (n = 970). Multivariate logistic regressions were used to examine the association between digital sexual violence with suicide (ideation, planning, and attempt) and self-harm. In the sample, 9.1% of participants reported being threatened to have their sexually explicit media posted without their consent, while 6.5% reported their sexually explicit media had been posted without their consent. Threat to post sexually explicit media without consent was associated with higher odds of reporting suicidal ideation (odds ratio [OR] = 1.88), suicide plan (OR = 2.12), suicide attempt (OR = 3.56), and self-harm (OR = 1.96). While nonconsensual posting of sexually explicit media was associated with higher odds of reporting suicidal ideation (OR = 1.82) and suicide attempt (OR = 2.20). All models controlled for age, assigned sex at birth, sexual identity, and race and ethnicity. These findings underscore important considerations and future research directions. Given the associations between digital sexual violence and suicide risk among sexual minority adolescents, suicide prevention efforts with adolescents must be responsive to the needs of sexual minority adolescents and the changing landscape of sexual violence in digital spaces. Future research should examine the trajectories of digital sexual violence among adolescents and comparative analyses by demographic subgroups to better understand changes in these processes over time.

Intersectional Minority Stress and Alcohol, Tobacco, and Cannabis Use Among Sexual and Gender Minority Adolescents of Color: Moderating Role of Family Support.

Purpose: We examined the associations between intersectional minority stress and substance use among sexual and gender minority (SGM) adolescents of color and the moderating role of family support on these associations. Methods: Data were from a national U.S. sample of SGM adolescents of color (N = 3423). Intersectional minority stress was assessed with the LGBT People of Color Microaggressions Scale. Results: Intersectional minority stress was associated with greater odds of recent and heavy alcohol and recent cannabis use, but not tobacco use. When examining specific domains of intersectional minority stress, racism from SGM communities was associated with greater odds of recent and heavy alcohol, and recent cannabis use, whereas heterosexism from same racial/ethnic communities was associated with greater odds of recent cigarette and cigar use. Family support was associated with lower substance use. Family support was not a significant moderator. Conclusions: Findings underscore the need to examine intersectional stressors that SGM adolescents of color experience and to bolster family supports to prevent substance use. Family support did not buffer the effects of intersectional minority stress on substance use outcomes, suggesting that other strategies, such as other forms of family support (e.g., identity-specific support) and community-level and structural changes that target reducing and dismantling oppression are needed to reduce the deleterious impact of intersectional minority stress.

Sexual Orientation-Based Victimization and Internalized Homonegativity Among Latinx Sexual Minority Youth: The Moderating Effects of Social Support and School Level

ABSTRACTLatinx sexual minority adolescents and young adults experience sexual orientation-based victimization at school and may internalize these heterosexist experiences. However, social support may buffer the deleterious contributions of sexual orientation-based victimization. The current study explored associations between sexual orientation-based victimization and internalized homonegativity in different social contexts (family, peer, school adult) and across development (high school versus college) among 238 Latinx sexual minority adolescents and young adults (M = 19.03, SD = 2.28). Results indicated that sexual orientation-based victimization was positively associated with internalized homonegativity among Latinx sexual minority adolescents and young adults. Such associations were moderated by family support and the school level in the family context, such that in high school, family support exacerbated the association between sexual orientation-based victimization and internalized homonegativity. Yet, in college, family support mitigated that association. Findings also indicated that peer support exacerbated the association between sexual orientation-based victimization and internalized homonegativity in high school and college. No moderation of school adult support emerged in the context of school adults. Findings support the application of the minority stress model in Latinx sexual minority adolescents and young adults and highlight the complex moderating effect of social support across social contexts and development.

Familial understanding and self‐esteem development: Comparing sexual minority and heterosexual individuals

AbstractObjectiveThe present study sought to explore how support from one's family of origin predicts the development of self‐esteem across the transition to adulthood for sexual minority individuals compared with their heterosexual peers.BackgroundFamilial relationships have an influence on the development of self‐esteem. Additionally, lesbian, gay, and bisexual emerging adults may perceive less support from their families than heterosexual peers.MethodsThe present study used secondary data from the National Longitudinal Study of Adolescent and Adult Health study. The study conducted a multiple group latent growth curve following the development of self‐esteem.ResultsResults indicated that feeling as though one's family understood them in adolescence was significantly associated with self‐esteem during adolescence for both sexual minority and majority individuals. Additionally, this sense of feeling understood by one's family was also associated with the rate of change of the developmental trajectory of self‐esteem across four time points.DiscussionThe study illustrates the lasting influence one's family of origin has during this important developmental moment. Results illustrated how familial understanding in adolescence was significantly associated with the development of self‐esteem for both sexual minority and sexual majority individuals.ImplicationsThe relationship with the family of origin has a lasting impact into emerging adulthood, and practitioners working with families can help ensure support for sexual minority adolescents. This includes, but is not limited to, encouraging communication within the family to build a sense of understanding.

Perspectives on Cigarette Use, Vaping, and Antitobacco Campaigns Among Adolescent Sexual Minority Males and Gender Diverse Youth.

Purpose: This qualitative study examined perceived benefits and drawbacks of smoking/vaping and attitudes toward antitobacco campaigns among adolescent sexual minority males and gender-diverse (ASMM/GD) youth. Methods: In July 2019, 215 U.S. ASMM/GD youth (meanage 16.78, 95.3% cisgender male, 60.0% racial/ethnic minority) answered questions about smoking/vaping behaviors, motivations for smoking/vaping, and attitudes toward antitobacco campaigns via an online survey. Data were analyzed with thematic analysis. Results: Overall, 17.2% of participants had smoked cigarettes, and 34.9% had vaped. Teens described psychological (e.g., stress relief), chemical (e.g., nicotine buzz), and social incentives (e.g., fitting in with peers) for smoking/vaping. Teens also reported concerns about physical health, costs, and self-image as drawbacks of smoking/vaping. Most considered antitobacco campaigns unrelatable and uninteresting, while others reported that campaigns reinforced their decisions to not smoke/vape. Most participants wanted antitobacco campaigns to be tailored to the sexual and gender minority (SGM) community. Conclusions: These findings shed light on ASMM/GD youth's perspectives of smoking/vaping and antitobacco campaigns. Results suggest that equipping teens with skills to cope with minority stress and resisting peer pressure could indirectly reduce smoking/vaping, and that SGM-inclusive campaigns may better reach SGM adolescents.

Mental Health Problems and Bullying Victimization Among Sexual Minority Adolescents in Greek Secondary Schools

This study provides the first empirical account of mental health issues among sexual minority adolescents in Greece and the effects on mental health of both bullying and victimization in relation to adolescents’ sexual orientation. A sample of 757 adolescents (M age = 15.98, SD = 0.84) completed self-reported scales measuring school bullying victimization experiences, levels of depression, feelings of loneliness, hopelessness, feeling of belonging in school, self-esteem, and sense of wellbeing. Statistically significant differences were observed between heterosexuals and gay adolescents in depression, loneliness, bullying behavior and school belongingness. Gay adolescents are more likely to present higher levels of depression. Furthermore, sexual orientation was also found to be significant moderator of the effect of bullying victimization on loneliness. Bullying was associated with low sense of school belonging and victimization with depressive symptomatology, loneliness and low sense of school belonging and self-esteem. Students’ self-esteem and school belongingness were found to have a protective role against loneliness, depression and hopelessness. The findings of the current study provide valuable information to school psychologists, teachers, policy makers, and other professionals whose goals are to enhance adolescent functioning and adaptation. It is suggested that intervention strategies designed to promote resilience should incorporate sexual orientation issues.

Future Orientation as a Moderator of Bullying Victimization and School Outcomes: Comparing Heterosexual and Sexual Minority Urban African American Adolescents

Bullying victimization remains to be a public health concern in the United States, especially among sexual and ethnic minority youth. However, few studies have examined how school outcomes might be associated with bullying victimization among heterosexual and sexual minority African American youth and the factors that may attenuate that relationship. To address this gap, this study surveyed 462 heterosexual and 102 sexual minority African American youth residing in Chicago’s Southside neighborhoods, who participated in the Resiliency Project. Study variables included bullying victimization, school outcomes (i.e., school connectedness, and academic grades), and future orientation. Bullying victimization was associated with a significant increase in feeling disconnected from school among both heterosexual and sexual minority adolescents; however, there was no significant association observed between bullying victimization and receiving low grades among either group. Future orientation did not moderate the association between bullying victimization and school outcomes among heterosexual adolescents; however, positive future orientation did attenuate the association between bullying victimization and feeling disconnected from school among sexual minority adolescents. Prevention programs that focus on promoting school connectedness need to consider the role of future orientation for sexual minority youth.

HIV and Sexually Transmitted Infection Testing Among Substance-Using Sexual and Gender Minority Adolescents and Young Adults: Baseline Survey of a Randomized Controlled Trial.

BackgroundGay, bisexual, and other men who have sex with men and transgender individuals are more heavily affected by HIV and other sexually transmitted infections (STIs) than their cisgender, heterosexual peers. In addition, sexual and gender minorities who use substances are often at a further increased risk of HIV and other STIs. Increasing testing for HIV and other STIs allows this hardly reached population to receive early intervention, prevention, and education.ObjectiveWe explored HIV and STI testing patterns among 414 sexual and gender minority adolescents and young adults aged 15 to 29 years who self-reported substance use and lived in southeastern Michigan.MethodsWe analyzed data from the baseline survey of a 4-arm randomized controlled trial that aimed to examine the efficacy of a brief substance use intervention for creating gains in engagement in HIV prevention. We fit multinomial logistic regression models to 2 categorical HIV and STI testing variables (lifetime and previous 12 months) based on self-reports of testing (never, STIs only, HIV only, or both). In addition, we compared HIV and STI testing behaviors across demographic characteristics, structural factors, psychosocial barriers, substance use, and sexual behaviors.ResultsOur findings showed that 35.5% (147/414) of adolescents and young adults reported not being tested for either HIV or STIs in the previous year, and less than half (168/414, 40.6%) of the sample achieved the Centers for Disease Control and Prevention recommendation of HIV and STI testing once per year. We observed HIV and STI testing disparities across sociodemographic (eg, sexual identity, education, and income) and health (eg, substance use) correlates. Specifically, cisgender gay men who have sex with men were more likely to report being tested for HIV compared with bisexual men and transgender individuals, who were more likely to be tested for STIs.ConclusionsThis study illustrates the results of an HIV prevention intervention in southeastern Michigan showing the need for HIV prevention interventions that leverage structural factors, psychosocial barriers, and substance use as key drivers to achieve HIV and STI testing rates to meet the Centers for Disease Control and Prevention guidelines.Trial RegistrationClinicalTrials.gov NCT02945436; http://clinicaltrials.gov/ct2/show/NCT02945436International Registered Report Identifier (IRRID)RR2-10.2196/resprot.9414

Heterosexist Bullying Victimization and Perpetration and Substance Use Among Heterosexual Adolescents.

Although heterosexist bullying mainly affects sexual minority adolescents, heterosexual adolescents may also be targets. Research is needed to understand the impact of heterosexist bullying victimization on heterosexual adolescents' behavioral health. Moreover, there is a dearth of research examining the negative consequences of perpetrating heterosexist bullying among heterosexual adolescents. The purpose of this study was to examine the associations between heterosexist bullying victimization and perpetration and substance use in a racially diverse sample of heterosexual adolescents. A probability sample of middle and high school heterosexual students (N = 2,337; aged 11-19; 52.7% female; 35.9% Black or African American and 31.9% White) using random cluster methods was obtained from a southeastern US school district. Multiple logistic regression models were used to test the relationships between experiencing and perpetrating heterosexist bullying and substance use while accounting for sociodemographics. Of the participants, 7.1% reported heterosexist bullying victimization and 7.8% reported perpetration of heterosexist bullying. Of those engaging in heterosexist bullying, 29.5% also experienced it as a victim. Perpetrating heterosexist bullying was associated with greater odds of recent and lifetime alcohol, cigarette, e-cigarette, cannabis, and prescription drug use. Heterosexist bullying victimization was only associated with recent and lifetime cigarette use and lifetime e-cigarette use. The results demonstrate the negative correlates of heterosexist bullying victimization and perpetration on heterosexual adolescents' substance use. The findings underscore the need to address sexual stigma, such as heterosexist bullying, among not only adolescents experiencing it but also its perpetrators to help reduce substance use among all adolescents.

Suicidality among sexual minority and transgender adolescents: a nationally representative population-based study of youth in Canada.

Background:Very little research has described risk of suicidal ideation and suicide attempt among transgender youth using high-quality, nationally representative data. We aimed to assess risk of suicidality among transgender and sexual minority adolescents in Canada.Methods:We analyzed a subsample of adolescents aged 15–17 years from the 2019 Canadian Health Survey on Children and Youth, a nationally representative, cross-sectional survey. We defined participants’ transgender identity (self-reported gender different from sex assigned at birth) and sexual minority status (self-reported attraction to people of the same gender) as exposures, and their self-reported previous-year suicidal ideation and lifetime suicide attempt as outcomes.Results:We included 6800 adolescents aged 15–17 years, including 1130 (16.5%) who indicated some degree of same-gender attraction, 265 (4.3%) who were unsure of their attraction and 50 (0.6%) who reported a transgender identity. Compared with cisgender, heterosexual adolescents, transgender adolescents showed 5 times the risk of suicidal ideation (95% confidence interval [CI] 3.63 to 6.75; 58% v. 10%) and 7.6 times the risk of suicide attempt (95% CI 4.76 to 12.10; 40% v. 5%). Among cisgender adolescents, girls attracted to girls had 3.6 times the risk of previous-year suicidal ideation (95% CI 2.59 to 5.08) and 3.3 times the risk of having ever attempted suicide (95% CI 1.81 to 6.06), compared with their heterosexual peers. Adolescents attracted to multiple genders had 2.5 times the risk of suicidal ideation (95% CI 2.12 to 2.98) and 2.8 times the risk of suicide attempt (95% CI 2.18 to 3.68). Youth questioning their sexual orientation had twice the risk of having attempted suicide in their lifetime (95% CI 1.23 to 3.36).Interpretation:We observed that transgender and sexual minority adolescents were at increased risk of suicidal ideation and attempt compared with their cisgender and heterosexual peers. These findings highlight the need for inclusive prevention approaches to address suicidality among Canada’s diverse youth population.

"Queer Insights": Considerations and Challenges for Assessing Sex, Gender Identity, and Sexual Orientation in Oncofertility Research.

This article addresses issues related to clinical and research approaches to oncofertility for adolescent and young adult (AYA) sexual and gender minority (SGM) cancer patients. Limited attention has been dedicated to understanding the extent to which oncofertility services are appropriately and equitably delivered to AYAs with diverse orientations toward sexual orientation, gender identity, and future family. Unresolved challenges to conducting research with this vulnerable population perpetuate a lack of adequate knowledge about SGM AYA oncofertility needs. Therefore, the purpose of this paper is to inform considerations of sex, gender identity, and sexual orientation for investigations that include SGM AYAs. In order to improve the knowledge base and clinical services for this population, we discuss (1) challenges to sampling this population; (2) categorization and survey logic (e.g., skip patterns) in light of fluid sexual orientation and gender identities; and (3) clinical implications of accurately assessing sex and gender for oncofertility research and practice. We also recommend strategies for producing inclusive and accurate assessments of sexual and gender identity categories in both research and clinical encounters with SGM AYAs. Incorporating "queer insights" into empirical research - that is, positioning queer theory at the center of oncofertility study design - is suggested as a future direction for oncofertility research and practice.