Minority Youth Research Articles

Factors Associated with Mental Health Care among Adolescents in Southern California.

Mental health care is critical to improving mental health but factors associated with student utilization are poorly understood. Data were from high school students (N = 2933; mean age = 15.7 ± .6) enrolled in a California cohort. We examined associations of sociodemographic factors, substance use, and mental health symptoms at baseline (Fall 2021) with mental health care at follow-up (Spring 2022). At follow-up, 7.7% of students reported out-of-school therapy, and 16.0% reported in-school counseling. Generally, therapy was more common for female and gender minority (vs male), some sexual minority youth (vs heterosexual), black, non-Hispanic white, and multi-ethnic (vs Asian), and English language speakers. Higher socioeconomic status was associated with greater use of out-of-school therapy, but not in-school counseling. Students with clinical levels of mental health symptoms, or alcohol or e-cigarette use had greater odds of mental health care (ORs = 1.42-2.61;ps <.05), though utilization was less than 20% for out-of-school therapy and less than 30% for in-school counseling among these students. Mental health care is underutilized, and disproportionately used by certain student sub-groups. Findings indicate a need to increase mental health care utilization in- and out-of-school.

Prepared, Protected, EmPowered (P3): Primary Results of a Randomized Controlled Trial Using a Social Networking, Gamification, and Coaching App to Promote Pre-exposure Prophylaxis (PrEP) Adherence for Sexual and Gender Minority (SGM) Youth Living in the United States.

The population-level reductions in HIV incidence attributed to pre-exposure prophylaxis (PrEP) have not been fully realized among sexual, gender, and racial/ethnic minority youth. P3 (Prepared, Protected, emPowered) is a comprehensive mobile application (app) intervention developed to support PrEP adherence through gamification, medication tracking, and social engagement. A randomized controlled trial was conducted with 246 young men who have sex with men (YMSM) and young transgender women who have sex with men (YTWMSM) currently on or planning to begin PrEP. Participants were randomized in a 1:1:1 ratio to: standard of care (SOC), P3 app (P3), or P3 app plus in-app adherence coaching (P3+). Adherence was measured at 3- and 6- months post enrollment by emtricitabine-triphosphate (FTC-TP) and tenofovir-diphosphate (TFV-DP) levels in dried blood spots consistent with PrEP use > 4 days/week. The primary outcome was the difference in the proportion adherent comparing P3/P3+ to SOC. P3/P3+ was associated with a higher proportion adherent compared to SOC for both outcome measures. At 3 months, the estimated increase in the proportion adherent was 0.13 (95% CI: 0.00, 0.27, p: 0.05) and 0.12 (95% CI: -0.03, 0.26, p: 0.11) for TFV-DP and FTC-TP, respectively. Estimated adherence was higher, but not statistically different, in P3+ compared to P3, for both TFV-DP and FTC-TP. Receipt of P3 (P3 or P3+) is associated with an increase in PrEP adherence among YMSM and YTWSM at 3 months. Additional analyses to discern the role of app usage and sociodemographic and behavioral factors on intervention effects are warranted.

Associations Between Alcohol Delivery Policy and Pandemic Alcohol Use Among Sexual and Gender Minority Youth and Young Adults

Associations Between Alcohol Delivery Policy and Pandemic Alcohol Use Among Sexual and Gender Minority Youth and Young Adults

Online commercial sexual exploitation of children in a national victim survey.

To describe the characteristics and consequences of online commercial sexual exploitation of children using a nationally representative sample. The online survey sample comprised 2,639 respondents aged 18-28 from the KnowledgePanel maintained by the survey research firm Ipsos. Fifty-eight respondents or a weighted 1.7% of the sample described childhood experiences in which they used technology to exchange sexual talks, sexual images, or other sexual activities for money, drugs, or other valuable items. The episodes were very diverse. Sixty-three percent were girls, 30% boys, 7% gender fluid, and 42% sexual minorities. Half were ages 16 or 17, and half were younger at the time of the activity. Many (44%) were involved in offline sexual activity. The purchasers were not exclusively anonymous internet contacts; 19% were current or former intimate partners and another 10% friends or acquaintances. Most of the exchanges (92%) were self-negotiated, and only 8% involved a facilitator. Nonetheless, most reported negative reactions involving embarrassment, anxiety, and feeling afraid. Sexual minority youth reported more exchanging sexual talk, having a facilitator involved, feeling afraid and falling behind in school or work than heterosexual youth. This national survey reveals a high frequency of childhood commercial sex that diverges from descriptions of dynamics based on police and social agency data. Such dynamics suggest the need for alternative approaches to prevention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Social and institutional inclusion in multi-ethnic schools enable better intergroup relations for majority youth and higher school achievement for minority youth

Inclusive school climates have been related to more friendly and equal intergroup relations among majority and ethnic minority youth. Yet, comprehensive research distinguishing majority and ethnic minority group perspectives on both social and institutional inclusion, and looking beyond individual perceptions of inclusion is missing. Taking a multi-group and multi-level approach, we assessed the actual social climate (aggregating majority intergroup attitudes within schools) and institutional climate (coding school diversity policies); and we tested associations with intergroup relations (i.e., individual intergroup bias and contact) and school performance (i.e., self-reported Dutch language grades) as individual outcomes for both majority and minority youth. To this end, we draw on a large-scale survey of 1814 native-origin majority and 1068 Turkish- and Moroccan-origin minority youth in the same 65 Flemish-Belgian middle schools. As expected for majority youth, a more inclusive ingroup social climate predicts less intergroup bias; and more social and institutional inclusion jointly predict more intergroup contact with minority peers. For minority youth, an inclusive outgroup social climate predicts higher Dutch grades; yet social and institutional inclusion were unrelated to their intergroup attitudes or contact.

Legal protections for sexual and gender minority youth in foster care: A review of Preventing Sex Trafficking and Strengthening Families Act (Normalcy Standards)

The aim of this study was to investigate legal protections for sexual and gender minority (SGM) youth population who identify as lesbian, gay, bisexual, transgender, queer, intersex (LGBTQ+), or any nonheterosexual orientation, gender identity, or expression (SOGIE) within the context of the United States (US) publicly administered state child welfare foster care system through federal Public Law 113–183 (Preventing Sex Trafficking and Strengthening Families Act – Prudent Parenting for short). SGM youth are identified in foster care 2.5 times higher than their heterosexual peers and often report worse outcomes. There are some federal recommendations for SGM youth, but it does not include normalcy or other activities that are federally supported. A state-by-state analysis of legislation, policy, implementation policy and youth bill of rights was conducted. While there was significant variance across the USA, many states provided levels of support in their legislation, policy implementation and youth bill of rights that could assist SGM youth impact normalcy efforts. More research is needed to investigate if SGM youth in foster care experience protections in the states that have legal protections.

Differential patterns of emotion regulation in sexual minority adolescents in residential treatment

ObjectiveSexual minority adolescents experience disproportionate mental health problems, including increased anxiety, depression, and suicidal thoughts and behaviors. Minority Stress Theory posits that sexual minority people experience significantly more stress (e.g., via discrimination or prejudice) in their everyday lives, which can underlie these mental health disparities. Though group differences in mental health symptoms are well-documented, there has been less focus on symptom trajectories, which is critical for identifying effective mental health interventions. MethodSeventy adolescents ages 13–19 years enrolled in a short-term, acute residential psychiatric treatment program provided self-report measures of depressive symptoms, anxiety, and emotion regulation difficulties at baseline, discharge (~2 weeks), and one-month post-treatment follow-up. Adolescents self-reported sexual orientation and were stratified into sexual minority (SM, n = 37) or heterosexual (n = 33) groups. ResultsDepressive and anxiety symptoms and emotion dysregulation scores were significantly reduced at follow-up, compared to baseline. While there were no significant group x time interactions for depressive and anxiety symptoms, the SM group entered the program with worse emotion dysregulation scores, which improved more over time compared to the heterosexual group. ConclusionThese findings show that although sexual minority individuals can make substantial gains during residential treatment, emotion regulation difficulties are a particularly relevant treatment target. Emotion regulation, a transdiagnostic construct that typically develops substantially during adolescence, might be of critical importance when identifying effective treatment interventions for sexual minority youth. LimitationsAdolescents in this sample demonstrated limited racial diversity and likely displayed a higher degree of psychopathology than the general population.

“I have some people who actually really care:” Young sexual minority women’s lived experiences of non-suicidal self-injury disclosure

Sexual minority youth are more likely to engage in Non-Suicidal Self-Injury (NSSI) than their heterosexual peers, and sexual minority women demonstrate greater risk of NSSI than their sexual minority male counterparts. However, a lack of research exists on NSSI among young sexual minority women, particularly their NSSI disclosure experiences. We used a descriptive-interpretive, qualitative design with semi-structured interviews to examine young sexual minority women’s lived experiences disclosing NSSI and of others’ responses to these disclosures. The sample included 65 sexual minority women aged 14-30 recruited via paid social media advertising from across the U.S. We performed an inductive thematic analysis of transcripts from 58 participants (89%) who reported a history of NSSI. Participants shared reasons for disclosure (wanting help, communicating distress) or nondisclosure (cultural stigmas), types of disclosure (accidental/involuntary, and direct/voluntary), and recipients of a disclosure (friends, partners, mental health providers, and parents). They also described responses to, and feelings after, NSSI disclosure, revealing two themes: i) Unhelpful/stigmatizing responses (based on fear, anger, and apathy) and ii) Helpful/destigmatizing responses (expressions of concern, emotional support, and alternative coping strategies). Overall, young sexual minority women’s disclosure experiences were consistent with those of other populations, highlighting the need to further reduce stigma about NSSI, as well as sexual minority identities, and provide universal education promoting helpful responses to NSSI disclosure.

Strategies to promote safety for sexual and gender minority youth in secondary schools: A longitudinal analysis.

In order to promote school safety for sexual and gender minority youth (SGMY), many schools implement strategies such as SGM-focused policies and gender-sexuality alliances (GSAs). Little is known about the effects such strategies have over time on feelings of safety at school for SGMY. Hierarchical Linear Models were conducted using longitudinal data from 417 SGMY attending secondary schools to examine trajectories of feelings of safety and the effects of SGM-focused policies, GSA presence, or GSA membership on feelings of safety. Findings indicate that SGM-focused policies and GSAs had direct benefits for safety at school SGMY, both independently and in combination; however, GSA membership was not. Schools should implement a combination of school strategies to promote safer environments for SGMY.

Battle Against Effects of Discrimination with Belonging and Support: Mental Health Risk and Protective Factors Among Sexual and Gender Minority Youth

Battle Against Effects of Discrimination with Belonging and Support: Mental Health Risk and Protective Factors Among Sexual and Gender Minority Youth

Telehealth Outreach Program for Child Traumatic Stress: Strategies for Long-Term Sustainability.

There are high documented rates of exposure to traumatic events and mental health disorders among youths yet existing disparities in access to care for racial and ethnic minority youths and youths in rural communities. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based behavioral health therapy for children. The delivery of TF-CBT via telehealth can decrease access to care barriers. An interdisciplinary clinical team developed a training program to guide clinicians to effectively provide TF-CBT via telehealth. The goal of this study was to describe variation in implementation processes of the telehealth TF-CBT program and identify barriers and facilitators to program implementation post-training, which were utilized to develop implementation strategies for intervention sustainability. Using a mixed-methods approach, data were collected on telehealth implementation processes and facilitators and barriers to the delivery of telehealth TF-CBT. This study was guided by an adapted implementation science framework, namely the Exploration, Preparation, Implementation, Sustainment model. Interviews and surveys were completed with clinical site leaders who had participated in the telehealth TF-CBT training. Throughout clinical sites, there was varied adoption and penetration of the telehealth TF-CBT program. Facilitators to implementation included leadership and site staff buy in, community needs, and training resources, while barriers included funding, available logistical resources, and child and family involvement. The feedback gained from this project assisted in the development of implementation strategies for increased adoption and sustainment of TF-CBT delivered via telehealth. Strategies include ongoing interactive assistance and resource support, enhanced training for stakeholders, and program adaptations, with the goal to increase access to quality mental health care for underserved populations.

Through the eyes of my peers: Sharing perceptions of unequal treatment in ethno-racially diverse classrooms.

Perceptions of unequal treatment, especially when shared, can challenge the status-quo. Starting from the social grounding of shared perceptions, we ask when perceptions of inequality align and converge in ethno-racially diverse peer groups. We are especially interested when perceptions are shared among peers across ethno-racial group boundaries. Social-psychological research suggests asymmetric sharing: Ethno-racial minority group members often see less inequality with more majority contact, while in some cases ethno-racial majority members perceive more inequality with more minority contact. Therefore, we ask if perceptions of inequality are shared across minority and majority groups within time and if perceptions of inequality converge over time. We focus on schools as sites of inequality and cross-group interactions. First, we tested our predictions with 290 minority and 468 majority youth in 53 classes in the United States using multilevel modelling. Next, we implemented follow-up studies in Belgium with 1,800 minority and 1,700 majority adolescents in 433 classes using longitudinal multilevel models. In line with intragroup sharing, minority and majority youth shared their minority and majority peers' perceptions of inequality, respectively. Furthermore, we documented cross-group sharing: Majority youth also shared their minority peers' perceptions, especially in contexts with higher minority proportions. We found consistent evidence of sharing minority perceptions, so that both majority and minority youth would see inequality through their minority peers' eyes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Depressive symptoms and suicidal ideation in sexual minority adolescents: An examination of social reward responsiveness and support as moderators

Sexual minority (SM) youth are at increased risk of depression and suicidal ideation (SI), due in part to discrimination and other stressors. This raises questions about social factors that may increase risk or resilience to stressors commonly faced by SM youth. The goal of this multimethod study was to examine both neural processing of social feedback and perceived social support as potential moderators of the association between SM identity, depressive symptoms, and endorsement of SI in adolescents. For this study, 165 adolescents aged 14–17 (22.42 % identifying as SM) were oversampled for current depression. Participants self-reported social support, depressive symptoms, and SI. Electroencephalogram (EEG) was recorded while participants completed a computerized peer interaction task in which the reward positivity (RewP) component was measured in response to social acceptance vs. rejection feedback. We tested social RewP and social support as moderators of associations between SM identity, depressive symptoms, and whether SI was reported. SM youth reported lower social support and elevated depressive symptoms and were more likely to endorse SI compared to non-SM youth. Social RewP moderated the associations between SM identity, depressive symptoms, and SI such that SM youth with blunted neural responses to social acceptance had higher depression and were more likely to endorse SI. Lower social support was associated with greater depressive symptoms and SI, but social support was not a significant moderator of the association between SM identity and symptoms. This is among the first studies to use affective neuroscience methods to examine social processes in SGM youth and our findings underscore the role of social factors in SGM youth mental health.

Raised by White People. Conceptualisations of ‘Culture’ in the Foster Placement of African Minority Youth in Norway

AbstractThis paper examines the intricate dynamics of transethnic foster placement in Norway, focusing on African minority youth and how ‘culture’ and ‘identity’ is conceptualised within this context. Through semi-structured interviews, the study builds on the lived experiences of a set of 15 families (including 60 children), alongside insights from fostered individuals, foster parents, and a placement official. The discussion delves into the profound effects of cultural dislocation and identity crisis experienced by minority youth, problematising how foster placement often leads to adverse life trajectories, including issues with uprootedness, substance abuse, psychiatric illness, and loss of ethnic identity. At the core of the discussion is the contention that while the child protection system in Norway is mandated to safeguard children, it inadvertently neglects the cultural rights and identity development of African minority youth. Employing insight from Franz Fanon and Jean-Paul Sartre to articulate the psychological impact and moral implications of such transethnic placements, the paper argues for re-evaluating assimilation practices and cultural rights within the child protection framework, highlighting the need for a culturally sensitive and rights-based approach to foster care. This research contributes to the broader discourse on human rights and social work, emphasising the ethical and legal dimensions of fostering minority children.

Differences in Mental Health Between Female Sexual Minority and Heterosexual Youth with a Substance Use Disorder Who Are Experiencing Homelessness.

Purpose: The purpose of this study was to examine differences in mental health outcomes of two groups within youth experiencing homelessness (YEH) and who have a substance use disorder (SUD): sexual minority (SM) and heterosexual females. Methods: This study used baseline data from four randomized clinical trials of substance use interventions for YEH with a SUD to examine differences in depression and suicidality between SM and heterosexual female youth. Participants were between 12 and 24 years of age. Meta-analytic methods were used to aggregate data across studies to estimate differences in mental health. Results: Results indicated that female SM-YEH had higher depression symptoms (Hedge's g [g]=0.20; 95% confidence interval [CI] 0.01-0.39), higher risk of a history of suicide behavior (risk ratio = 1.63; 95% CI: 1.17-2.27), and a greater number of suicide behaviors (g = 0.31; 95% CI: 0.09-0.54) compared to their heterosexual peers. These effect sizes were not moderated by age. Conclusion: Female SM-YEH had elevated levels of depression and suicidality compared to their heterosexual peers. The findings of this study align with research on mental health disparities between SM and heterosexual youth generally, which underscores the unique struggles and risks associated with identifying as a female SM-YEH with a SUD.

Neighborhood ethnoracial diversity and positive psychotic symptoms among youth at high-risk and healthy comparisons

Neighborhood ethnoracial composition has been associated with schizophrenia, but mechanisms are unclear. This study investigates the moderators and mediators of the association between neighborhood ethnoracial diversity and positive symptoms among youth at clinical high-risk for psychosis (CHR-P) and healthy comparisons (HC). Data were collected as part of The North American Prodrome Longitudinal Study and included 492 youth at CHR-P and 136 HCs. Neighborhood ethnoracial diversity measures the probability that two people chosen at random will be from different ethnoracial groups. Attenuated positive symptoms were derived from the Scale of Prodromal Symptoms. Peer victimization and discriminatory experiences were constructed as latent variables. Using structural equation modeling, this study tested the relationship of these variables and included the following covariates: age, sex, neighborhood poverty, and depressive symptoms. Greater neighborhood ethnoracial diversity was associated with reduced positive symptoms among ethnoracial minorities at CHR-P (β=-3.78; 95 % CI [-6.61, -0.84]). Fewer life events of peer victimization (β=-0.13; 95 % CI [-0.24, -0.03]) leading to perceived ethnoracial discrimination (β=0.56; 95 % CI [0.45, 0.67]) mediated 15.06 % of this association. These findings deepen our understanding of the social determinants of psychosis and may help develop effective interventions to prevent psychosis, especially among ethnoracial minority youth at high risk.

Queering Critical Consciousness: Measurement and Implications of Critical Consciousness Among Sexual and Gender Minority Youth

We consider critical consciousness among sexual and gender minority (SGM) youth. Factor analytic and measurement invariance analyses were conducted across straight Black and Latinx youth (N = 254), SGM Black and Latinx youth (N = 111), and SGM white youth (N = 458). Factors of critical reflection and political efficacy emerged in all groups. Configural and partial metric invariance, but not scalar or residual invariance, were established. Correlations between political efficacy and wellbeing and grades replicated across groups. Critical reflection was associated with grades only for white youth, while critical action was associated with grades only for non-white youth. Implications for measurement and generalizable application of CC with an intersectional lens are discussed.

Associations Between PrEP Stigma, PrEP Confidence, and PrEP Adherence: Conditional Indirect Effects of Anticipated HIV Stigma.

Research has linked stigma surrounding preexposure prophylaxis (PrEP) to poor HIV prevention outcomes, including PrEP adherence. However, there remains a limited understanding of the mechanisms through which PrEP stigma affects PrEP adherence, specifically among sexual and gender minority (SGM) youth. In this study, we aimed to investigate the indirect effect of PrEP stigma on PrEP adherence through PrEP confidence and the moderating role of anticipated HIV stigma. Participants included 235 SGM youth, assigned male sex at birth, aged 16-24, and self-reported HIV-negative, with an active PrEP prescription from the Prepared, Protected, emPowered randomized controlled trial. Participants were recruited from 9 clinics in the United States between 2019 and 2021. Using baseline data, we tested cross-sectional indirect and conditional indirect effects using the Statistical Package for the Social Sciences Process with confidence intervals and 2000 resamples. We found significant indirect effects, suggesting that PrEP stigma was negatively associated with PrEP confidence, which in turn resulted in both monthly and weekly optimal PrEP adherence (Indirect effects: B = -0.11, Standard Error [SE] = 0.05, CI: [-0.244 to -0.032]; B = -0.09, SE = 0.04, CI: [-0.191 to -0.014], respectively). Anticipated HIV stigma moderated these indirect effects (B = -0.11, SE = 0.08, CI: [-0.315 to -0.001]; B = -0.09, SE = 0.06, CI: [-0.245 to -0.001], respectively), suggesting that the conditional indirect effects were significant at high but not low levels of anticipated HIV stigma. Results suggest that SGM youth who are on PrEP anticipating HIV stigma experience a compounding effect of PrEP stigma on PrEP confidence, consequently leading to suboptimal adherence. Interventions addressing the intersectionality of PrEP and HIV stigmas and enhancing confidence could improve PrEP adherence, particularly among SGM youth.

Familias con Orgullo: Pilot Study of a Family Intervention for Latinx Sexual Minority Youth to Prevent Drug Use, Sexual Risk Behavior, and Depressive Symptoms.

Families are key in the healthy development of Latinx sexual minority youth (Latinx SMY), a group that experiences behavioral, mental, and sexual health disparities. Despite this, there are no family-based interventions for Latinx SMY and their families to prevent drug use, sexual risk behaviors, and depressive symptoms. The purpose of this pilot study was to evaluate the preliminary impact (i.e., estimated effect sizes) of Familias con Orgullo (FcO) and examine its feasibility and acceptability among 30 Latinx SMY and their parents. Parents and adolescents were randomized to FcO or a control condition and assessed pre/post-intervention. Feasibility was measured based on session completion and effect sizes. Focus groups were conducted to evaluate intervention acceptability. Findings showed promising effects favoring FcO on parent-adolescent communication (d = 0.46) and parental involvement (d = 0.34). There were also promising effects favoring FcO on suicidal thoughts (OR = 0.75) and depression symptoms (OR = 0.69). Finally, 100% of the adolescents in FcO either continued to remain drug-free or transitioned from current use to no use (from baseline to post-intervention) compared to 74% in the control. Effect sizes for condomless sex, parental monitoring, and positive parenting were small. Session completion (above 80%) and focus group findings indicated strong feasibility and acceptability. FcO holds promise for reducing drug use and depressive symptoms and improving family functioning among Latinx SMY.

Influence of trauma on longitudinal association between depressive symptoms and use of alcohol and cannabis among young people.

Trauma, depressive symptoms, and the use of alcohol and drugs are common among youth, especially those with marginalized racial/ethnic identities, sexual and gender minority youth (SGMY), and those with low socioeconomic status, homelessness, and HIV-positive status. However, most research on trauma, depression, and substance use among such youth is cross-sectional. This article examines these patterns over time. Participants were youth with multiple life challenges (N = 1,728) recruited from 13 community-based agencies and health centers in Los Angeles, CA, and New Orleans, LA, and reassessed twice at 4-month intervals over 8 months (follow-up > 70%). Youth were predominantly Black, Latiné, and SGMY, with an average age of 21 years (range 12-24). We analyzed the association between trauma, depression, and substance use using a Bayesian approach to latent growth curve modeling. Trauma had a robust, positive association with depressive symptoms and substance use, although this association differed depending on whether alcohol or cannabis use was examined. Higher levels of trauma were also associated with a slower decline in depressive symptoms over time. Study findings highlight the longitudinal association between trauma and both depression and substance use. This suggests the potential utility of trauma-focused interventions among vulnerable youth with one or both of these issues. (PsycInfo Database Record (c) 2024 APA, all rights reserved).