Sexual and racial identity are associated with unintended pregnancy; method of contraception is a factor that warrants further exploration in addressing this trend. We test associations between sexual and racial identity on contraceptive use among young women across ages 15–21 years. Participants were enrolled in the longitudinal, community based Pittsburgh Girls Study. The number of participants reporting sexual intercourse with a male and contraception use in the past year ranged from 226 (9.8

OBJECTIVE:To examine the relationships between gender minority stressors and mental health outcomes among transgender and gender diverse (TGD) youth and explore the moderating role of positive affect. METHOD:Baseline data of 315 TGD youth (ages 12-20 years old) from the Trans Youth Care-United States study comprised the analytic sample. Youth completed three subscales of the Gender Minority Stress and Resilience Measure for Adolescents (GMSR-A; nondisclosure of gender identity/gender history, negative future expectations, and internalized transphobia), Beck Depression Inventory-II (BDI-II), Revised Children's Manifest Anxiety Scale, Second Edition (RCMAS-2), Alcohol, Smoking and Substance Involvement Screen Test (ASSIST), and the NIH Toolbox Positive Affect survey. Regression analyses using the Hayes PROCESS macro assessed moderation effects. RESULTS:Gender minority stressors were associated with more symptoms of depression (r = 0.29 to 0.42) and anxiety (r = 0.32 to 0.42) and were not significantly associated with substance use (r = -0.01 to 0.10). Positive affect was negatively associated with gender minority stressors (r = -0.19 to -0.24) and mental health/substance use outcomes (r = -0.16 to -0.63). Positive affect significantly buffered the association between nondisclosure of gender identity and depressive symptoms (ΔR2 = 0.02) and protected against the impact of internalized transphobia on anxiety symptoms (ΔR2 = 0.01). CONCLUSIONS:Positive affect is a promising modifiable protective factor that buffers the negative impact of gender minority stress on the mental well-being of TGD youth. Adapting existing positive emotion interventions for TGD youth is an indicated future direction for research and clinical practice.

OBJECTIVE:Suicide is a leading cause of death in adolescents and young adults and has increased substantially in the past 15 years. Accurate suicide risk stratification based on rapid screening can help reverse these trends. This study aimed to assess the ability of the Kiddie Computerized Adaptive Test Suicide Scale (K-CAT-SS), a brief computerized adaptive test of suicidality, to predict suicide attempts (SAs) in high-risk youth. METHOD:A total of 652 participants (age range, 12-24 years), 78% of whom presented with suicidal ideation or behavior, were recruited within 1 month of mental health care contact. The K-CAT-SS, scaled from 0 to 100, was administered at baseline, and participants were assessed at about 1, 3, and 6 months after intake. Weekly incidence of SAs was assessed using the Adolescent Longitudinal Interval Follow-up Evaluation and Columbia-Suicide Severity Rating Scale. A secondary outcome was suicidal behavior, including aborted, interrupted, and actual SAs. RESULTS:The K-CAT-SS showed a 4.91-fold increase in SAs for every 25-point increase in the baseline score (95% CI 2.83-8.52) and a 3.51-fold increase in suicidal behaviors (95% CI 2.32-5.30). These relations persisted following adjustment for prior attempts; demographic variables including age, sex, gender identity, sexual orientation, and race/ethnicity; and other measures of psychopathology. No moderating effects were identified. At 3 months, area under the receiver operating characteristic curve was 0.83 (95% CI 0.72-0.93) for 1 or more SAs. CONCLUSION:The K-CAT-SS is an excellent tool for suicide risk stratification, particularly in higher-risk populations where other measures have shown lower predictive validity. PLAIN LANGUAGE SUMMARY:We studied the ability of the Kiddie Computerized Adaptive Test Suicide Scale (K-CAT-SS), a brief computerized adaptive test of suicidality, to predict suicide attempts (SA) in high-risk youth. At total of 652 participants aged 12 to 24, 78% of whom presented with suicidal ideation or behavior, were recruited within one month of mental health contact. In follow-up that averaged 7 months following baseline, there was a 5-fold increase in suicide attempts and 3.5-fold increase in suicidal behaviors for every 25-point change in the baseline K-CAT-SS score (100-point scale), which persisted after adjusting for demographic covariates. The K-CAT-SS is an excellent tool for suicide risk stratification, particularly in higher-risk populations where other measures have shown lower predictive validity.

A retrospective cross-sectional study of nearly 3 years of emergency department (ED) encounters was performed with the goal of developing an electronic medical record (EMR) search strategy to identify transgender and gender diverse (TGD) youth. A search of nine keywords to identify TGD youth was conducted in the EMR, and text from clinician notes was extracted and reviewed. Among 15,413 ED encounters, 1126 keywords were identified, and 91.2% were classified as TGD. The final dataset classified 605 ED encounters (428 unique youth) as TGD. The study offers a feasible technique to identify and prioritize TGD youth in health research using EMR data.

Methamphetamine use and HIV disproportionately affect sexual and gender minority (SGM) people assigned male at birth. Identifying risk factors for methamphetamine use is crucial to inform preventive interventions. In this cohort study with 1,296 SGM people assigned male at birth, ages 16 to 29, and who resided in Chicago, Poisson regression analyses indicated the prevalence of methamphetamine use increased from 2015 to 2023 [Incidence Rate Ratio (IRR) = 1.07; 95% CI = 1.01 to 1.13; P = 0.02]. This increase was most pronounced among those ages 25 or older at baseline (IRR = 2.20; 95% CI = 1.33 to 3.63; P = 0.002), and 23.9 [Interquartile Range (IQR) = 22.1 to 26.9] was the median age of first-time methamphetamine use. In 826 participants with a prior HIV diagnosis or previous inflammatory measurements, Cox proportional-hazards models examined risk factors for incident, first-time methamphetamine use. Adjusting for other substance use, the rate of incident, first-time methamphetamine use was two-fold greater after HIV diagnosis [adjusted hazard ratio (aHR) = 2.02; 95% CI = 1.27 to 3.23; P = 0.003]. For each SD higher C-reactive protein, the rate of incident, first-time methamphetamine use was 18% greater (aHR = 1.18; 95% CI, 1.05 to 1.34; P = 0.008). HIV seroconversion and inflammation could increase the risk of initiating methamphetamine use in SGM people assigned male at birth.

Introduction: The Outness Inventory (OI) is the most commonly used measure for assessing an individual's level of outness, or openness about sexual identity. However, data on the validity of the OI factor structure across diverse populations is limited. The present study aimed to test the factor structure of the OI in a population-based sample of Black and White young adult women. Method: Participants included 319 lesbian and bisexual women drawn from the Pittsburgh Girls Study (PGS), a large longitudinal study of 5- to 8-year-old girls (53% Black) oversampled from low-income neighborhoods and followed through adulthood. Participants completed the 11-item OI at ages 20-23 years. Confirmatory factor analyses evaluated measurement invariance of the OI across race and suggested significant differences in factor structure between Black and White sexual minority women. Exploratory factor analyses (EFA) were conducted separately by race. Results: An EFA revealed three factors for the Black subsample: Family, Straight Friends, and Work/Strangers. Three factors also emerged for the White subsample, representing Familiar Acquaintances, Less Familiar Acquaintances, and Work. Conclusion: Additional research is needed to investigate potential culturally-based differences in domains of disclosure, which may help to better understand how specific contexts of outness relate to mental health.

Transgender and nonbinary (TNB) youth are at disproportionately high risk for poor mental health outcomes, but less is known about diverse mental health trajectories within this population. Past research suggests that gender-affirming hormone therapy (GAHT; testosterone/estrogen) is associated with improvement in internalizing symptoms (depression, anxiety). However, there is substantial variability upon starting GAHT, and little research has examined whether GAHT is also associated with improvements in externalizing symptoms (disruptive/risk-taking behaviors).

Regulation of negative emotions is a core competency of child development. Parental emotion socialization profoundly influences later capacity to regulate negative affect in childhood and adolescence. The present study examined the effects of maternal emotion socialization on the development of emotion regulation in the context of a longitudinal study of 210 mother-daughter dyads. Dyads completed a conflict resolution task when the child was age 11 years during which maternal warmth and hostility were coded. At ages 11 to 13 years, mothers completed self-report measures of supportive and nonsupportive responses to child negative emotion, and children completed self-reports of inhibition and adaptive regulation of sadness and anger. We used latent growth curve modeling to estimate changes in inhibition and adaptive regulation of sadness and anger over time; observed maternal warmth and hostility were included as time-invariant covariates and maternal self-report of supportive and nonsupportive responses were included as time-varying covariates. Observed maternal warmth was positively associated with girls' adaptive regulation of anger and sadness at age 11 years. Maternal self-reported supportive responses to girls' negative affect were positively associated with girls' adaptive regulation of anger, and nonsupportive responses were negatively associated with adaptive regulation of anger and sadness. These findings support the role of maternal emotion socialization and indicate specific effects of maternal warmth and supportive responses in the development of girls' capacity to modulate negative emotions during early adolescence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

BACKGROUND:Limited prospective outcome data exist regarding transgender and nonbinary youth receiving gender-affirming hormones (GAH; testosterone or estradiol).METHODS:We characterized the longitudinal course of psychosocial functioning during the 2 years after GAH initiation in a prospective cohort of transgender and nonbinary youth in the United States. Participants were enrolled in a four-site prospective, observational study of physical and psychosocial outcomes. Participants completed the Transgender Congruence Scale, the Beck Depression Inventory-II, the Revised Children's Manifest Anxiety Scale (Second Edition), and the Positive Affect and Life Satisfaction measures from the NIH (National Institutes of Health) Toolbox Emotion Battery at baseline and at 6, 12, 18, and 24 months after GAH initiation. We used latent growth curve modeling to examine individual trajectories of appearance congruence, depression, anxiety, positive affect, and life satisfaction over a period of 2 years. We also examined how initial levels of and rates of change in appearance congruence correlated with those of each psychosocial outcome.RESULTS:A total of 315 transgender and nonbinary participants 12 to 20 years of age (mean [±SD], 16±1.9) were enrolled in the study. A total of 190 participants (60.3%) were transmasculine (i.e., persons designated female at birth who identify along the masculine spectrum), 185 (58.7%) were non-Latinx or non-Latine White, and 25 (7.9%) had received previous pubertal suppression treatment. During the study period, appearance congruence, positive affect, and life satisfaction increased, and depression and anxiety symptoms decreased. Increases in appearance congruence were associated with concurrent increases in positive affect and life satisfaction and decreases in depression and anxiety symptoms. The most common adverse event was suicidal ideation (in 11 participants [3.5%]); death by suicide occurred in 2 participants.CONCLUSIONS:In this 2-year study involving transgender and nonbinary youth, GAH improved appearance congruence and psychosocial functioning. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.).

To test the validity of a modified Trier Social Stress Test (TSST) for studying stress reactivity in sexual minority women. Two hundred seventy-four female participants (66.4% Black American), half of whom identified as lesbian/gay or bisexual and half as heterosexual, completed the TSST with instructions to describe an experience of discrimination. Cortisol levels and negative emotion scores increased, and heart rate variability decreased in response to the TSST, and the magnitude of these responses varied as a function of sexual orientation and race. Women who discussed sexual orientation as a source of discrimination had greater increases in cortisol and negative mood following the TSST. The modified instructions did not compromise the validity of the TSST. Prompting participants to discuss specific sources of discrimination may be a useful adaptation of the TSST in studying minority stress reactivity.SUMMARYThe goal of the present study was to adapt a widely used measure of stress reactivity to study the impact of experiences with discrimination on biological systems involved in regulating the stress response. The modification included asking women to discuss a time when they had been treated unfairly and to describe how they responded to that experience. The magnitude of response to the task varied as a function of sexual orientation and race, and the topics discussed, demonstrating usefulness of the modification for studying the impact of discrimination stress of physical health.

Background: Differences in risk and protective factors (e.g., victimization, abuse, social support) have been used to explain elevated rates of suicidal ideation and suicide attempts in sexual minority youth (SMY) relative to heterosexual peers. However, little is known regarding how risk and protective factors may explain suicide risk differences among subgroups of SMY. The aims of this study were to 1) examine differences in prevalence and severity for suicide risk and protective factors among SMY, and 2) explore whether risk and protective factors are differentially associated with suicidal ideation and suicide attempts for SMY subgroups. Methods: Participants were 6,423 adolescents (ages 12-17) recruited from 14 Emergency Departments across the United States who completed an assessment of suicide risk and protective factors. SMY were 20% of the sample (n = 1,275) and categorized as bisexual (8%), gay/lesbian (2%), mostly straight (5%), or other sexual minority (5%). Results: Bisexual youth had elevated rates of suicidal ideation and attempts, more risk factors (e.g., bullying victimization, depression), and fewer protective factors (e.g., parent-family connectedness, positive affect) relative to mostly straight and other sexual minority youth. Bisexual and gay/lesbian youth only differed in parent-family connectedness (lower among bisexual youth). Depression and parent-family connectedness had weaker associations with suicidal ideation for bisexual youth. Limitations: Emergency departments were not nationally representative. Study design was cross-sectional, preventing causal inferences. Conclusions: Interventions seeking to mitigate risk factors and promote protective factors are greatly needed for SMY and may benefit from tailoring to address unique stressors for sexual minority subgroups.

Background The science of stress exposure and health in humans has been hampered by differences in operational definitions of exposures and approaches to defining timing, leading to results that lack consistency and specificity. In the present study we aim to empirically derive variability in type, timing and chronicity of stress exposure for Black and White females using prospectively collected data in the Pittsburgh Girls Study (PGS). Methods The PGS is an ongoing 20-year longitudinal, community-based study. In this paper we focused on annual caregiver reports of three domains of stress: subsistence (e.g., resource strain, overcrowding); safety (e.g., community violence, inter-adult aggression), and caregiving (e.g., separation, maternal depression) from early childhood through adolescence. Z-scores were used to conduct a finite mixture model-based latent class trajectory analysis. Model fit was compared using the Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC). We examined differences in timing and chronicity of stress exposure between Black and White girls. Results Distinct trajectory groups characterized by differential timing and chronicity of stress exposure were observed across all stress domains. Six trajectories characterized subsistence and safety stress, and five characterized caregiving stress. Variability in initial level, chronicity, and magnitude and timing of change was observed within and across domains of stressors. Race differences also varied across the domains: race differences in timing and chronicity were most pronounced for the subsistence and safety domains, whereas Black and White girls had similar levels of exposure to caregiving stress. Conclusions Substantial variability in timing and chronicity was observed within and across stress domains. Modeling specific domains and dimensions of stress exposure is likely important in testing associations between exposure and health; such specificity may lead to more effective deployment of preventive interventions based on stress exposure.

Purpose: Adolescent suicidal ideation (SI) and nonsuicidal self-injury (NSSI) are associated with depression, but few studies adequately represent sexual minorities. This study investigated whether the association between SI/NSSI and depression varies by sexual orientation. Method: SI, NSSI, sexual orientation, and depressive symptoms were measured in a community sample of adolescent girls (n = 1,803). Results: Sexual orientation and depression accounted for unique risk for SI and NSSI in logistic regressions. Sexual orientation moderated the association between depression and NSSI. Conclusions: Results indicate that depression is a less specific predictor of NSSI among sexual minority adolescents compared to their heterosexual peers and indicate a need for future research to delineate which psychosocial factors better account for NSSI risk.

OBJECTIVE Sexual and gender minority youths are more likely to consider, attempt, and die by suicide than are heterosexual and cisgender youths, yet little is known about how to predict future attempts or transitions from suicidal thoughts to behaviors. Additionally, adaptive measurement of psychopathology is a promising approach that may help characterize risk in this population. This study examined the validity of the Computerized Adaptive Test for Suicide Scale (CAT-SS) in predicting suicide attempts and the transition from suicidal ideation to attempt. METHODS The CAT-SS was administered to participants of two ongoing cohort studies of sexual and gender minority adolescents and young adults (N=1,006). Survival analyses examined longitudinal associations between CAT-SS scores and time to suicide attempt. Analyses were conducted for the full sample and stratified by those with and without a history of suicidal ideation, with comparisons between adaptive and static measures of depressive symptoms. RESULTS The CAT-SS predicted future suicide attempts in the overall sample (hazard ratio [HR]=1.34, 95% confidence interval [CI]=1.03-1.74). Among youths without a history of suicidal ideation, social support reduced the risk for attempts (HR=0.66, 95% CI=0.45-0.96). Among youths with a history of ideation, predictors of the transition from suicidal thoughts to attempts included baseline CAT-SS score (HR=1.51, 95% CI=1.06-2.15) and victimization (HR=2.48, 95% CI=1.10-5.59). CONCLUSIONS Risk and protective factors for suicide attempts differed between youths with and without a history of suicidal thoughts. The CAT-SS had validity in predicting future risk of the sample overall and of youths with suicidal ideation.

Parental warmth and control are consistent and persistent correlates of adolescent health and may be particularly important for sexual minority girls, who experience higher rates of adverse health outcomes than their heterosexual peers. Differences in perceptions of parental trust, positivity, supervision, and discipline from ages 11-17 years were examined between sexual minority and heterosexual girls using data from the Pittsburgh Girls Study, a longitudinal, community-based study. Results indicated that sexual minority girls reported lower levels of parental trust and positivity compared to heterosexual girls beginning in mid-adolescence; differences in supervision were present at age 11 years and persisted over time. Further investigation of this perceived difference is warranted given the importance of familial support for health promotion.

Objective: Sexual minority young women endorse higher rates of suicidal thoughts and behaviors than heterosexual women, but the reasons for these disparities remain unclear. One hypothesis is that the two groups of women share peer-related risk factors, but the magnitude of effect is stronger for sexual minority women. Method: We utilized 6 years of data drawn from a community sample of women (N = 2078; 26% sexual minority) to examine rates of suicidality in early adulthood, adolescent peer influences on later suicidal ideation and behavior, and whether sexual minority status moderated the impact of peer influences on suicidality. Results: Across the study period, rates of suicidality were higher among sexual minority women compared to heterosexual women. In prospective analyses, peer victimization increased risk for future suicidality whereas peer connectedness attenuated risk for the entire sample. Additionally, sexual minority status moderated the magnitude of these relationships for suicidal ideation and behavior. Specifically, the effect of peer connectedness on suicidal ideation was stronger for heterosexual women than sexual minority women, whereas the effect of peer connectedness on suicidal attempts was stronger for sexual minority than for heterosexual women. In addition, peer victimization increased risk for suicide attempts among sexual minority women. Conclusions: This study highlights the importance of peer experiences in late adolescence for suicidality during the transition to young adulthood, and how such relations vary by sexual minority status.

OBJECTIVE:Sexual and gender minorities are at elevated risk for suicide, yet few studies have examined differences in risk within many sexual and gender minority subgroups. The purpose of this study was to examine differences in prevalence for suicide risk factors among a wide range of sexual orientations and gender identities.METHOD:Forty-one thousand four hundred and twelve college students (62% cis-female, 37% cis-male, 1% transgender/genderqueer) completed a wellness screen that included four suicide risk factors (depression, heavy alcohol use, suicide ideation, suicide attempt).RESULTS:Gender minority students (i.e., transgender, genderqueer/non-binary) had significantly higher rates of depression, suicide ideation, and suicide attempts relative to cisgender peers, although there were no within-group differences among gender minority students. Adjusted odds ratios for endorsing two or more (2+) suicide risk factors were substantially higher for all sexual minority subgroups relative to heterosexuals. Among sexual minorities, those identifying as pansexual, bisexual, queer, or mostly gay/lesbian had greater odds of endorsing 2+ suicide risk factors relative to students identifying as mostly heterosexual, gay/lesbian, asexual, or 'other sexual minority'. Pansexual students had 33% greater odds of endorsing 2+ suicide risk factors relative to bisexual students.CONCLUSIONS:These findings highlight significant variation in suicide risk among sexual minority subgroups and the need for targeted interventions for subgroups at highest risk.

Lesbian, gay, bisexual, and transgender (LGBT) youth are at elevated risk for self-injurious thoughts and behaviors (SITBs). However, few studies have comprehensively examined SITBs and their longitudinal course in LGBT youth at high risk for suicide. The aims of the present study were to characterize histories of SITBs among high-risk LGBT youth and to examine prospective associations with suicidal behavior. Participants were 285 youth (41.8% LGBT) ages 13-25 years receiving psychiatric emergency department (ED) services. Post-discharge suicidal behavior was assessed via 4-month phone interviews and 12 month chart reviews. The sample was 42.1% male, 57.9% female, 2.5% gender minority, 41.8% sexual minority. LGBT participants were more likely to have prior psychiatric ED visits and hospitalizations, more frequent past week suicide ideation, and more severe nonsuicidal self-injury (NSSI). We conducted stratified survival analyses to identify predictors of time to suicidal behavior post discharge. The final model for LGBT youth included past week suicide ideation and past month NSSI episodes. Among non-LGBT youth, the final model included number of lifetime NSSI methods and use of a highly lethal suicide attempt method. Within this sample of youth receiving psychiatric emergency services, LGBT youth were overrepresented and had more severe histories of SITBs. Results suggest the importance of assessing both lifetime and recent factors (i.e., past week and month), particularly for LGBT youth. Future research should replicate these findings in larger samples to explore whether there are unique risk factors that can aid in predicting and preventing suicide among LGBT youth.

ObjectiveEating pathology is more prevalent among women compared to men, but prevalence and correlates associated with eating pathology likely vary among subgroups of women. This study examines prevalence and correlates of restrictive and weight control-related eating pathology in sexual minority women. MethodData were collected from the Pittsburgh Girls Study (PGS). Participants reported on sexual orientation, and race, and body mass index (BMI) was derived from interviewer collected height and weight. Participants completed the Body Image Measure and the Eating Attitudes Test-26. ResultsSexual minority women reported higher BMIs [F (1, 862)=14.69, p<.001], higher levels of body dissatisfaction [F (1, 960)=3.12, p<.01], and higher levels of eating pathology [F (1, 950)=14.21, p<.001] than heterosexual women. Body dissatisfaction mediated the relationship between BMI and eating pathology, and levels of associations were not attenuated by sexual minority status. Race moderated the association between sexual orientation and eating pathology; compared to all other groups, White sexual minority women had the highest level of eating pathology. Results indicate that White sexual minority women have higher levels of eating pathology than Black sexual minority women and both Black and White heterosexual women. Future studies that draw from larger and more diverse, community-based samples are needed. Discussion