Heterosexual Youth Research Articles

Exposure to Suicidal Behavior and Social Support Among Sexual- and Gender-Minority Youth.

In this study, we examine reports of exposure to suicidal behavior by youth sexual and gender identity. We explore how exposure is related to depressed mood in the context of high social support while accounting for cumulative adversity. Data from a large national sample of youth aged 14 to 15 years in the United States (N = 3979) were collected online in 2018-2019. Sexual- and gender-minority youth were more likely to know someone close to them who attempted suicide, relative to cisgender heterosexual youth. Cisgender heterosexual youth were buffered from recent depressed mood when they endorsed having high social support in the context of exposure to suicidal behavior; less social support did not provide such a buffer. For cisgender sexual-minority male and female youth, exposure to suicidal behavior was related to recent depressed mood regardless of the level of social support. For gender-minority youth assigned female at birth, the combination of exposure and high social support was significantly associated with elevated depressed mood. Cumulative adversity accounted for some but not all of these relationships, indicating the influential role of exposure to suicidal behavior on depressed mood for some youth. These findings illustrate the complexities of social support and raise questions about its potential to magnify stress rather than serve as a buffer for some youth. Although findings need to be replicated, suicide prevention efforts should carefully consider how to promote resilience among these suicide-exposed sexual- and gender-minority youth who may themselves be at risk for suicidal ideation and behavior.

Interpersonal Violence Among Heterosexual and Sexual Minority Youth: Descriptive Findings From the 2017 Youth Risk Behavior Surveillance System

Interpersonal violence is pervasive among youth in the United States. Sexual minority youth are disproportionately impacted. Utilizing data from the 2017 Youth Risk Behavior Surveillance System (YRBS, N = 12,868), this study describes the disparities in victimization among heterosexual and sexual minority youth. Sexual minority status was operationalized to include nonheterosexual identity (e.g., bisexual) and/or behavior (e.g., reporting same- and different-sex partners). Other predictors included sex (male/female), a sexuality*sex interaction term, age, and race/ethnicity. Outcomes included lifetime forced sexual intercourse and 12-month incidence of sexual violence, physical violence in relationships, sexual violence in relationships, in-school bullying, and cyberbullying. Approximately 15% (n = 1,974) of participants were classified as sexual minority youth and 48% (n = 6,213) self-identified as female. More than half (56%, n = 7,190) identified as racial and/or ethnic minorities. In bivariate logistic regression, sexual minority youth were significantly more likely to report all outcomes (p < .001). In multivariable logistic regression, sexual minority and female youth were significantly more likely to report all outcomes (p < .001). With the exception of physical violence in dating, sexuality*sex interaction terms were significant predictors for all outcomes (p < .001), indicating that the risks associated with sexual minority status are heightened for male youth. This study concludes with a call for more attention toward violence among and against sexual minority youth. Although some prevention and response efforts address the unique needs and experiences of these youth, particularly antibullying initiatives, efforts to address sexual and dating violence often emphasize heterosexual contexts and communities.

The Moderating Role of Parenting Dimensions in the Association between Traditional or Cyberbullying Victimization and Mental Health among Adolescents of Different Sexual Orientation.

Cyberbullying victimization is associated with mental health problems and reported to occur more in nonheterosexual orientation youth (lesbian, gay, bisexual, and questioning (LGBQ)) than among heterosexual youth. Parental support may protect against mental health problems after being victimized, but nonsupportive parental influences may also exacerbate harm. This study investigated whether parenting dimensions (autonomy support, psychological control) moderated the associations between bullying victimization and mental health problems among heterosexual and LGBQ adolescents. An anonymous survey was completed by 1037 adolescents (M age = 15.2 ± 1.9, 50% female). Regression analyses examined associations between victimization, sexual orientation, and mental health problems, and investigated the moderating role of parenting. Both forms of victimization were associated with higher mental health problems. LGBQ youth experienced more depressive symptoms and suicidal ideation than heterosexual youth. Lower levels of parental psychological control and higher levels of autonomy support were related to having fewer mental health problems. However, perceived autonomy support appeared less protective when adolescents experienced more frequent victimization. Moreover, parental psychological control was related to heightened risk for suicidal plans specifically among LGBQ youth and also exacerbated the association between cyberbullying victimization and stress among LGBQ youth. These findings underscore the need to address parenting in whole-school antibullying and mental health promotion programs.

Religious and Spiritual Development from Adolescence to Early Adulthood in the U.S.: Changes over Time and Sexual Orientation Differences.

Adolescence is a critical time in the U.S. for religious development in that many young people eschew their religious identity as they enter adulthood. In general, religion is associated with a number of positive health outcomes including decreased substance use and depression. The current study compared the developmental patterns of religiosity and spirituality in heterosexual and sexual minority youth. The design was a secondary data analysis of the first five waves of the Longitudinal Study of Adolescent Health and Wellness (N = 337, 71.8% female). Using multilevel linear (for spirituality) and quadratic (for religiosity) growth models, the initial level and change over time in religiosity and spirituality, as well as the correlations between growth processes, were compared between heterosexual and sexual minority individuals. The heterosexual group had significantly higher initial religiosity levels than the sexual minority group. Religiosity decreased over time at a similar rate for the heterosexual and sexual minority groups. Spirituality significantly increased over time for the sexual minority group but not for the heterosexual youth. The change over time in religiosity and spirituality were significantly and positively correlated for heterosexual individuals but were uncorrelated for sexual minority individuals. Results indicate there are differences in religious development based on sexual minority status. Future research should take into account how these differential religious and spiritual developmental patterns seen in heterosexual and sexual minority youth might predict various health outcomes.

Teacher Support, Victimization, and Alcohol Use Among Sexual and Gender Minority Youth: Considering Ethnoracial Identity

Although scholarship continues to document higher rates of alcohol use for sexual and gender minority (SGM) youth compared with heterosexual and cisgender youth, research identifying factors that mitigate SGM youths' risk is nascent. Youth spend substantial time in schools; therefore, teachers could play significant roles in attenuating these health concerns. We used data from a nationwide survey of 11,189 SGM youth (Mage=15.52; 67.7% White) to explore whether perceived teacher social-emotional support attenuated the association between victimization and alcohol use, further conditioned by youths' specific ethnoracial identity. As expected, victimization was associated with more frequent alcohol use; however, greater perceived teacher support attenuated this association. The attenuating effect of perceived teacher support was significantly stronger for Hispanic/Latinx youth than White youth. Our findings have implications for alcohol use prevention among SGM youth, who face significant marginalization in schools and society. If we are to prevent alcohol use disparities among SGM youth, scholars and stakeholders (e.g., school administrators, teachers) should invest in building teacher efficacy to intervene in SGM-specific victimization.

Bullying and Cyberbullying among LGBQ and Heterosexual Youth from an Intersectional Perspective: Findings from the 2017 National Youth Risk Behavior Survey

ABSTRACT While LGBTQ youth may be victims of bullying at greater rates than heterosexual youth, research examining in-school bullying and cyberbullying victimization disparities through an intersectional framework is limited. Using the 2017 Youth Risk Behavior Survey, the present study examined the prevalence of in-school bullying and cyberbullying victimization across sexual orientation, gender, race, and grade (N = 13,567). Results position sexual minority youth at higher odds of experiencing in-school bullying and cyberbullying than heterosexual youth and show that bisexual youth were more likely than gay/lesbian youth to be cyberbullied. Findings from intersectional analyses show within-group variation in bullying victimization across sexual orientation based on gender, grade, and race. Specific intersectional results and implications for in-school bullying and cyberbullying prevention and intervention efforts are discussed.

Sexual Debut Among Heterosexual Men of African and Caribbean Descent: Are the Youth Initiating Sex Earlier than the Older Generation?

Although age at first sex is considered a measure of sexual risk and vulnerability for HIV infection, there is a dearth of literature on age at sexual debut in the Canadian context. This study examined time variations to first sex among heterosexual African, Caribbean, and Black (ACB) men in four Ontarian cities. A population-based retrospective survey (n = 879) on timing to first sexual intercourse was conducted between 2018 and 2019 among self-identified heterosexual ACB men 16years or older and residing in London, Ottawa, Toronto or Windsor. We used the lognormal survival analysis technique to examine variations in time to first sexual intercourse among age cohorts and between cities. The findings showed a generational shift in the pattern of sexual initiation, with younger heterosexual ACB men initiating sexual intercourse earlier compared with those currently older than 50years. We observed those between 16 and 19years, 20 and 29years, and 30 and 39years of age to have significantly higher risk ratios of TR = 0.852, TR = 0.869, and TR = 0.855, respectively. At city level, the results show marked spatial variations, with youth in cities of Toronto, Ottawa, and London at the highest risk of early sexual debut relative to those in Windsor. Early initiation of first sexual intercourse among heterosexual ACB youth was observed with those in the larger cities being at a relatively higher risk. There is the need for programs aimed at delaying sexual debut among youth in general. It is, however, important to recognize the relative risk of those in the larger cities.

Discrimination and Mental Health: Mediation Effects of Coping Strategies in LGB and Heterosexual Youth

Previous studies reveal that the negative effect of discrimination on mental health is particularly pernicious among stigmatised minorities. However, research also points out the importance of protection mechanisms that may buffer its effect. This study aimed to explore the relationships between mental health, perceived discrimination, and coping strategies of positive reframing and self-blame in LGB and heterosexual youth. Data were collected through a paper and pencil and an online survey administered to 195 Portuguese adolescents and young adults. The survey covered mental health (Mental Health Inventory-5), discrimination (Everyday Discrimination Scale), and coping strategies (Brief COPE). Of the sample, 73.3% were women and 51.8% self-identified as lesbian, gay or bisexual (LGB). Analyses of variance show that LGB participants have experienced more discrimination than their heterosexual counterparts. There was no difference in the levels of mental health and the use of self-blame or positive reframing coping strategies. Regression analyses reveal that perceived discrimination and self-blame contribute to the worsening of the mental health of LGB and heterosexual youth. Positive reframing coping was a predictor of mental health only in LGB participants, a strategy that contributed to their resilience in the face of discrimination. Additionally, only LGB participants displayed an indirect effect of discrimination on mental health, partially mediated by self-blame coping. Results corroborate previous findings that suggest that perceived discrimination has a more deleterious effect for members of a minority group and support the psychological mediation framework regarding the effect of discrimination on mental health in stigmatised groups.

LGBTQ+ Inclusion and Support: An Analysis of Challenges and Opportunities Within 4-H.

LGBTQ+ youth experience health disparities compared with heterosexual and cisgender youth. Community-based, positive youth development organizations are an important resource to support and affirm LGBTQ+ youth. This study aimed to identify the opportunities and challenges in supporting LGBTQ+ youth within 4-H. The study took place in one state in the United States within a 4-H program and employed qualitative, community-based methods using SWOT (strengths, weaknesses, opportunities, threats) analyses and focus groups of 4-H staff, support staff, volunteers, and youth participants. The majority of participants were White and middle class with direct connections to the 4-H program. Thematic analyses were conducted by multiple analysts until consensus was reached. Challenges and opportunities emerged in 3 themes: (a) organizational climate; (b) policies and procedures; and (c) training, education, and resources. Two additional themes included opportunities only: (a) community engagement and (b) youth-specific resources. This study has important implications for the 4-H program, rural community practice, and research, including strategies to improve LGBTQ+ inclusivity through education, programs and policies, hiring, and community partnerships. Additionally, this study highlights the opportunity and unique positionality of the 4-H program to amplify youth voices in the creation of youth-specific resources.

Experiences and Correlates of Violence Among American Indian and Alaska Native Youth: A Brief Report.

The purpose of this paper is to document the scope and correlates of past 6-month victimization among American Indian (AI) and Alaska Native (AN) youth. Types of victimization under investigation included sexual assault, dating violence, bullying, sharing of nude photos, sexual harassment, homophobic teasing, and racism. Participants were 400 AI and AN youth in grades 7-10 who completed a survey in school. Results documented concerning rates of all forms of victimization among AI and AN youth during the past 6 months. Although most forms of victimization were related, bullying (at school and electronically), racism, and sexual harassment occurred more often than sexual assault and dating violence. Older youth, girls, and sexual minorities were more likely to report some forms of violence than younger youth, boys, and heterosexual youth respectively. Compared to nonvictims, victim status was consistently related to depressive symptoms, suicidal ideation, and alcohol use and was less consistently correlated with feelings of school mattering. Evidence-based, culturally grounded prevention and response efforts are needed for AI and AN youth, as well as broader initiatives that seek to reduce health disparities among AI and AN youth.

Associations between tobacco use patterns and demographic characteristics of sexual minority and heterosexual youth: Results from a nationwide online survey.

INTRODUCTIONYouth are at risk for tobacco use, and previous research has pointed to increased vulnerabilities associated with sexual minority identity. For example, LGB youth have increased odds for using tobacco than their heterosexual peers, and bisexual youth have higher odds of smoking than other sexual identity groups. As new tobacco products proliferate and health risks from dual/poly use grow, increased understanding of tobacco use patterns by sexual minority youth is needed.METHODSFor 3117 youth, aged 13–18 years, who completed an online questionnaire in 2017 and identified their sexual orientation [minority (e.g. lesbian/gay, bisexual, or pansexual) vs majority (heterosexual)] and gender, we classified current tobacco use into four categories: e-cigarette only, other product only (such as cigarette, cigar, or smokeless tobacco; not an e-cigarette), dual/poly use, and no use. Analyses were conducted separately for male and female participants. Multinomial logistic regression was employed.RESULTSFemale sexual minority youth had nearly twofold odds of dual/ poly tobacco use (OR=1.95; 95% CI: 1.12–3.40), compared to their heterosexual counterparts. For male youth, sexual minority identification was not significantly associated with dual/poly use. No significant differences were found in sexual minority and heterosexual youth e-cigarette only or other tobacco only use groups. Tobacco use patterns also significantly differed by age, race, place of residence, and parental education level.CONCLUSIONSStudy findings reveal greater odds of dual/poly tobacco use for female sexual minority youth. Tailored tobacco prevention and cessation programs or interventions are needed for sexual minority youth most at risk of tobacco use, especially multiple product use.

"Words Aren't Supposed to Hurt, But They Do": Sexual and Gender Minority Youth's Bullying Experiences.

Sexual and gender minority youth (SGMY) are more likely to experience bullying and violence compared to the youth who do not identify as SGMY, leading to increased risk of poor mental and physical health outcomes, and poor academic performance. Few studies explore the entire range of bullying experienced by sexual and gender minority youth (SGMY). The purpose of this study was to qualitatively describe the ways in which SGMY experience bullying victimization. We conducted semi-structured interviews with a diverse sample of 20 SGMY aged 14-18 years (median age 16 years) recruited from online social media. The sample included 10 participants who identified as cisgender girls, 4 who identified as cisgender boys, 2 who identified as transgender, and 4 who identified as another gender identity. Ten participants identified as bisexual, six identified as lesbian, and four identified as gay. Findings indicated six common experiences of bullying among the participants: (a) verbal harassment; (b) gender policing; (c) physical violence; (d) sexual harassment; (e) treated as sexual perpetrators and deviants; and (f) and social exclusion. SGMY described how bullying victimization ranged from overt to concealed attitudes and behaviors, and they articulated how several forms of bullying are likely not experienced by heterosexual and cisgender youth. These results support findings from prior qualitative studies and suggest that efforts to address school-based bullying may benefit from a more complete awareness of the range of bullying victimization experienced by SGMY. Development of multi-item scales of bullying that reflect the six common experiences of bullying presented in this study would allow researchers to quantitatively explore the range of bullying behaviors experienced by SGMY, and would aid in the conceptualization and successful implementation of anti-bullying interventions.

Developing an inclusive Safe Dates program for sexual and gender minority adolescents: A pilot study

IntroductionDespite the prevalence and negative consequences of dating violence among sexual and gender minority (SGM) adolescents, few prevention programs address dating violence for these groups. We describe the adaptation of the evidence-based Safe Dates dating violence prevention program to be inclusive of SGM adolescents and the outcome of a pilot trial of the expanded curriculum implemented in mixed settings serving both SGM and cisgender, heterosexual youth. MethodsFollowing a published framework of curriculum adaptation, we gathered information on SGM adolescents’ needs and adapted Safe Dates materials to address SGM-specific risk factors for, and manifestations of, dating violence. We piloted the adapted program in 11 US schools and organizations serving SGM and cisgender, heterosexual youth (N = 156). The average age of participants was 15.11 years (SD = 2.76) at baseline. Participants were diverse with respect to race/ethnicity (26% Black/African American, 24% Hispanic/Latino, 21% White, 7% American Indian/Native Alaskan, 5% Asian/Pacific Islander), gender (56% female), and SGM status (35% SGM). Multi-level models measured change in scores on a written measure of dating violence knowledge from pre-test to post-test. ResultsDating violence knowledge increased significantly. Improvements did not differ by gender (female-identified versus not female-identified) or SGM status. ConclusionsResults support initial feasibility and efficacy of dating violence prevention programs that include both SGM and cisgender, heterosexual adolescents. The program normalizes diverse SGM identities and encourages participation of youth who are questioning or choosing not to disclose their gender or sexual identities. Larger-scale research should examine effects on dating violence experiences.

Self-Injurious Thoughts and Behaviors Among Sexual and Gender Minority Youth: a Systematic Review of Recent Research

Research has demonstrated that sexual and gender minority youth are at elevated risk for self-injurious thoughts and behaviors (SITBs). This systematic review aimed to synthesize and critically examine research published within the last 5 years, with a particular emphasis on (1) prevalence rates; (2) disparities over time; and (3) individual- and macro-level risk and protective factors contributing to risk for SITBs within this population. Overall, 97 peer-reviewed articles, published since 2015, were identified for inclusion. Across studies, rates of SITBs among sexual and gender minority youth were substantially elevated compared to heterosexual and/or cisgender youth and the general population. Studies identified several common risk factors, including bullying and other forms of victimization, minority-specific discrimination and harassment, and general mental health factors, as well as several common protective factors, including support from close others, school-based programs, and statewide policies. Further research is needed in numerous domains, including the examination of identity-specific factors in large, representative samples, additional protective factors, disparities across subgroups of LGBTQ youth, and intersectionality, as well as the use of longitudinal designs and randomized controlled trials examining interventions in this population. Critical areas for further research on SITBs among this high-risk population are discussed.

Suicidal as Normal - A Lesbian, Gay, and Bisexual Youth Script?

Background: Lesbian, gay, and bisexual (LGB) youth are more likely to report suicidal thoughts and/or behavior (STB) than heterosexual youth. The elevated suicidality of LGB youth is not fully accounted for by sexual-minority stress, according to a meta-analysis. A less-tested explanation is that suicidality has become an expected idiom of LGB youth distress. This explanation is consistent with suicide script theory and evidence that suicidal behavior is most likely when it is relatively acceptable. Aims: Building on suicide script theory and evidence, two studies were designed: one of LGB youth attitudes about suicidal behavior, and the other of LGB youth attitudes about suicidal individuals. Method: Surveys of LGB and heterosexual youth (total N = 300; M age = 20; 51% female) were conducted. Results: LGB youth were more accepting of and empathic toward suicidal behavior than heterosexual youth. They also viewed suicidal individuals as more emotionally adjusted. Limitations: Attitudes were not examined by sexual-minority subgroups. Conclusion: LGB youth's understanding attitudes may translate into less judgmental behavior toward suicidal peers, but also into normalizing suicidality as a way to express distress and cope with life problems. There may be utility in evaluating LGB youth suicide attitudes in suicide prevention initiatives.

Differential Decline in Illicit Drug Use by Sexual Identity Among United States High School Students, 2005-2017.

Purpose: Adolescent drug use remains a significant public health concern. Sexual minority youth (SMY) are at elevated risk for illicit drug use compared with their heterosexual peers. We investigated this pattern at the national level, exploring whether trends and disparities in drug use vary over time and by sexual identity. Methods: This study used Youth Risk Behavior Survey (YRBS) data, which were collected at seven time points from 2005 to 2017. Trends and disparities over time in the use of five drugs, as well as any drug use, were analyzed by self-reported sexual identity. Results: The results demonstrated a general decrease in drug use behaviors from 2005 to 2017. The greatest number of significant decreases was among heterosexual and bisexual students; the fewest were among gay and lesbian students. Disparities between heterosexual youth and SMY persisted across years, and were greater for gay and lesbian students in 2017 than for bisexual and not-sure youth. Conclusions: Our results represent the most comprehensive analysis of recent trends in drug use by sexual identity to date. Disparities in drug use remained significant despite overall downward trends within our sample. The significant decreases among bisexual students are not readily explained. We emphasize the need for ongoing research in this area, particularly given the currently volatile social position of sexual minority populations in the United States, and for culturally responsive and trauma-informed responses to SMY drug use.

Serious and persistent suicidality among European sexual minority youth.

BackgroundSuicide is a leading cause of death among adolescents and more knowledge from high risk groups is needed in order to develop effective preventive strategies. The aim of this study was to evaluate the association between sexual minority status and suicidality in a multinational sample of European school pupils.MethodsA self-report questionnaire was delivered to 2046 adolescents (mean age 15.34±1.01; 56.3% females) recruited from 27 randomly selected schools in 6 European countries. Suicidal ideation, measured with the Paykel Suicide Scale (PSS), and lifetime suicide attempts were compared between heterosexual and sexual minority (i.e. those with a non-heterosexual orientation) youth. Poisson regression analyses studied the longitudinal association between sexual minority status and the rate of serious suicidal ideation, measured at three time-points during a 4-month period. Several variables, including alcohol and illegal drugs use, bullying, family interaction, school-related stress, economic status, and religiosity, were included in multivariable analysis. Sex-stratified analyses evaluated the association respectively among females and males.ResultsOf 1958 pupils included in analysis (mean age 15.35±1.00; females 56.8%), 214 (10.9%) were categorized as sexual minority youth (SMY). When compared to heterosexual youth (HSY), SMY were significantly more exposed to substance abuse, bullying, school-related stress, and lower economic status. SMY pupils had significantly higher suicidal ideation scores (p<0.001; r 0.145) as well as higher prevalence of serious suicidal ideation (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.83–3.79) and previous suicide attempts (OR 2.72, 95%CI 1.77–4.18), compared to their HSY peers. The rate of serious suicidal ideation reports during the study was significantly higher among SMY compared to HSY (rate ratio [RR] 2.55, 95%CI 1.90–3.43). A significant difference was found even when controlling for the pupils’ country as well as after adjustment for alcohol and illegal drugs use, bullying, family interaction, school-related stress, economic status, and religiosity (adjusted RR 1.73, 95%CI 1.23–2.48). Stratified analyses showed significant associations between SMY status and persistent serious suicidal ideation for both sexes, with a notably strong association among male pupils (females aRR 1.51, 95%CI 1.01–2.24; males aRR 3.84, 95%CI 1.94–7.59).ConclusionsEuropean sexual minority youth are a high-risk group for suicidality, independently from objective factors such as victimization or substance abuse. There is a need to develop primary and secondary preventive measures for sexual minority youth, including the management of context vulnerabilities and related distal stressors, before the establishment of proximal stressors. Context-targeting interventions may effectively focus on social and economic factors, as well as on the potentially different risk profile of female and male sexual minority youth.

The Association of Asthma, Sexual Identity, and Inhaled Substance Use among U.S. Adolescents.

Rationale: Minority sexual identity appears to confer asthma risks. Although associations between inhaled substances and asthma are established, these have not been examined among sexual minority youths. Given sexual minority adolescents' disproportionately high rates of substance use, research is needed to fill this important gap.Objectives: Using a representative sample of adolescents from the United States, we 1) examined associations among asthma, sexual identity, and inhaled substance use and tested 2a) whether sexual identity moderates relationships between asthma and inhaled substance use and 2b) whether inhaled substance use mediates associations between sexual identity and asthma.Methods: Data are from the 2015 and 2017 Youth Risk Behavior Surveillance Survey. Adolescents (n = 30,113) reported if they were ever diagnosed with asthma, current use of cigarettes, cigars and/or cigarillos, marijuana, and electronic vapor products and if they ever used inhalants or synthetic marijuana. We used logistic regression to examine associations between asthma, sexual identity, and inhaled substance use controlling for age, race or ethnicity, and body mass index percentile, stratified by sex.Results: Lesbian, gay, and bisexual respondents had higher relative risks for asthma than heterosexual youth. Sexual minority female youths had significantly higher relative risks than heterosexual female youths for use of every inhaled substance. There were few sexual identity differences in inhaled substance use among male youths. Inhaled substance use was significantly associated with higher risks for asthma. In general, associations between each individual inhaled substance and asthma did not differ between sexual minority and heterosexual youths. However, when all inhaled substances were added into the models concurrently, inhaled substance use appeared to mediate associations with asthma among lesbian and bisexual female youths, and partially mediated these associations among sexual minority male youths.Conclusions: Sexual identity and inhaled substance use appear to play important roles in asthma risk. However, these variables do not fully explain the risk, suggesting that other unmeasured variables (e.g., stress and victimization) may be implicated in risks for both inhaled substance use and asthma. It is important that clinicians providing care to adolescents ask about sexual identity and inhaled substance use. Effective approaches to reducing inhaled substance use among adolescents, especially sexual minorities, are needed.

Health and wellbeing of sexual minority youth – the School Health Promotion study in 2019 in Finland

Abstract Background Sexual minority youth have an increased risk for depression, anxiety disorders and bullying. In addition, particularly boys have an increased risk for sexual harassment. However, information on their general health and wellbeing is scarce. The purpose of this study is to examine the general health and wellbeing of sexual minority youth compared to heterosexual youth. Methods Data from the national School Health Promotion study 2019 were used including youth from comprehensive (N = 87026), upper secondary (N = 44498) and vocational schools (N = 23366). The proportion of sexual minority youth in comprehensive school was 8.5%, in upper secondary school 10.3% and in vocational school 7.5%. Each of the following issues was asked by using one question: general health, life satisfaction, loneliness, and worry about own mental health. Anxiety was measured by GAD-7 (Generalized anxiety disorder) and depression by PHQ-2 (Patient health questionnaire). Data were analyzed by school level and sex using cross-tabulations with Chi-square tests. Results Response rate at comprehensive school was 73% and at upper secondary school 69% but at vocational schools it couldn't be estimated reliably. Sexual minority youth reported significantly more often poor or average general health (44.2% vs. 18.2%) and loneliness (26.5% vs. 8.5%) but less often life satisfaction (50.0% vs. 78.5%) compared to heterosexual youth. They had significantly more often experienced depression (40.4% vs. 14.5%) and anxiety (31.4% vs. 10.4%) and worried more often about their mental health (65.6% vs. 28.5%) than other youth. Differences remained after stratifying the data by school level and sex. Conclusions This large population-based study including both sexual minority and heterosexual youth suggests that sexual minority youth have poorer outcomes in general health and wellbeing than heterosexual youth. More detailed analyses are needed to find out associated factors. Key messages Sexual minority youth at each school level and all sexes had poorer outcomes in each studied health and wellbeing indicator compared to heterosexual youth. Low-threshold services and support as well as more accepted atmosphere in society are essential to guaranteeing better health and wellbeing for sexual minority youth.

Parent-Adolescent Sex Communication with Sexual and Gender Minority Youth: An Integrated Review.

Sexual and gender minority (SGM) youth experience adverse sexual health outcomes at higher rates than their heterosexual and cisgender peers. Although parent-adolescent sex communication (PASC) is associated with improved sexual health outcomes among heterosexual youth, less is known about PASC with SGM youth. Studies describing experiences of SGM youth and parents during PASC and/or health outcomes of PASC were reviewed. Eleven studies met inclusion criteria, and six themes emerged. These included: (1) limited communication and barriers to communication, (2) impact of SGM disclosure on communication, (3) HIV and/or sexually transmitted disease-focused communication, (4) heteronormative communication, (5) outcomes of communication, and (6) youth preferences for PASC. Parent-adolescent sex communication was complicated by barriers to communication and was limited, heteronormative, and influenced by SGM disclosure. Parent-adolescent sex communication may improve sexual health outcomes, but adequate parental education and guidance is lacking. This review identifies ways that health providers can foster positive and inclusive PASC.