PURPOSE:To address the gap in interventions for improving sexual and gender minority youth (SGMY; e.g., lesbian, gay, bisexual, and transgender youth) health, we tested the feasibility of a game-based intervention for increasing help-seeking, productive coping skills, resource knowledge/use, and well-being. METHODS:We conducted a 2-arm randomized controlled trial testing a theory-based, community-informed, Web-accessible computer role-playing game intervention. Control condition received a list of resources. Primary hypotheses were high levels of implementation success, game demand, and game acceptability. RESULTS:We randomized 240 SGMYs aged 14-18 years into the intervention (n = 120) or control (n = 120) conditions. Participants completed baseline (100%), 1-month follow-up (T2; 73.3%), and 2-month follow-up (T3; 64.4%) surveys. Among intervention participants, 55.8% downloaded and played the game. Of those who played, 46.2% reported a desire to play it again, and 50.8% would recommend it. Game acceptability exceeded hypothesized benchmarks, wherein participants reported high positive affect (M = 2.36; 95% confidence interval [CI]: 2.13, 2.58), low negative affect (M = 2.75; 95% CI: 2.55, 2.95), low tension/annoyance (M = 3.18; 95% CI: 2.98, 3.39), and high competence (M = 2.23; 95% CI: 2.04, 2.43) while playing the game. In multivariable intent-to-treat analyses of 38 secondary/tertiary outcomes, intervention participants reported significantly larger reductions than control participants in cyberbullying victimization (T2 b = -.28; 95% CI: -.56, -.01), binge drinking frequency (T2 b = -.39; 95% CI: -.71, -.06), and marijuana use frequency (T3 b = -2.78; 95% CI: -4.49, -1.08). CONCLUSIONS:We successfully implemented a Web-accessible game trial with SGMY. The game-based intervention was feasible and acceptable to SGMY, and preliminary results show it improved several health-related behaviors. A larger scale trial is needed to test whether the game-based intervention can reduce health inequities for SGMY.

Sexual minority girls (SMGs), compared with heterosexual females, are more likely to report negative sexual outcomes including earlier age of sexual intercourse debut, more lifetime and recent sexual partners, pregnancy involvement, and sex while intoxicated. Data describing the mechanisms related to these health disparities are limited. The purpose of this study was therefore to longitudinally assess the roles of sexual minority–related peer victimization and heavy episodic drinking (HED) as mediators of the relation between sexual minority status and sexual outcomes. The girls examined in this study were recruited into a longitudinal study of adolescent health from two large, urban adolescent medicine clinics affiliated with academic medical centers. The final sample for this analysis included 79 SMGs and a comparison group of 127 heterosexual girls aged between 14 and 19 years. Mediation models were run in the structural equation modeling framework. Our results provided evidence to support a serial multiple mediation pathway. SMGs were more likely to report sexual minority–related victimization, and sexual minority–related victimization predicted increased HED, which was subsequently found to prospectively predict increased sexual risk behaviors. Taken together, these novel findings indicate that both sexual minority–related victimization and HED may play important roles in explaining disparities in risky sexual behavior among SMGs.

Sexual and gender minority youth (SGMY) have higher rates of bullying than their heterosexual peers and must disproportionately cope with bullying victimization. The purpose of this research is to highlight various coping strategies employed by SGMY. We conducted 20 cross-sectional, semi-structured online interviews with SGMY about their bullying experiences and coping strategies. We coded interviews with descriptive qualitative research to illustrate a comprehensive summary of bullying-related coping methods. We found SGMY engage in multiple coping strategies that include (1) emotion-focused coping-rumination; self-harm and considering or attempting suicide; seeking social and emotional support; engaging in creative endeavors; self-acceptance and community connectedness-and (2) problem-focused coping-reporting the bully; confronting the bully; conceal orientation; ignoring the bullying; and changing environment. Additionally, most SGMY reported using multiple coping techniques or changing how they coped over time (i.e., coping flexibility). These findings can inform future interventions to promote positive coping mechanisms among SGMY.

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.

Sexual and gender minority youth (SGMY; eg, lesbian, gay, bisexual, and transgender youth) experience myriad substance use and mental health disparities compared with their cisgender (nontransgender) heterosexual peers. Despite much research showing these disparities are driven by experiences of bullying and cyberbullying victimization, few interventions have aimed to improve the health of bullied SGMY. One possible way to improve the health of bullied SGMY is via a Web-accessible game intervention. Nevertheless, little research has examined the feasibility of using a Web-accessible game intervention with SGMY. This study aimed to describe the protocol for a randomized controlled trial (RCT) pilot, testing the feasibility and limited efficacy of a game-based intervention for increasing help-seeking–related knowledge, intentions, self-efficacy, behaviors, productive coping skills use, and coping flexibility and reducing health risk factors and behaviors among SGMY. We enrolled 240 SGMY aged 14 to 18 years residing in the United States into a 2-arm prospective RCT. The intervention is a theory-based, community-informed, computer-based, role playing game with 3 primary components: encouraging help-seeking behaviors, encouraging use of productive coping, and raising awareness of Web-based resources. SGMY randomized to both the intervention and control conditions will receive a list of SGMY-inclusive resources, covering a variety of health-related topics. Control condition participants received only the list of resources. Notably, all study procedures are conducted via the internet. We conveniently sampled SGMY using Web-based advertisements. Study assessments occur at enrollment, 1 month after enrollment, and 2 months after enrollment. The primary outcomes of this feasibility study include implementation procedures, game demand, and game acceptability. Secondary outcomes include help-seeking intentions, self-efficacy, and behaviors; productive coping strategies and coping flexibility; and knowledge and use of Web-based resources. Tertiary outcomes include bullying and cyberbullying victimization, loneliness, mental health issues, substance use, and internalized sexual and gender minority stigma. From April to July 2018, 240 participants were enrolled and randomized. Half of the enrolled participants (n=120) were randomized into the intervention condition and half (n=120) into the control condition. At baseline, 52.1% (125/240) of the participants identified as gay or lesbian, 26.7% (64/240) as bisexual, 24.2% (58/240) as queer, and 11.7% (28/240) as another nonheterosexual identity. Nearly half (113/240) of participants were a gender minority: 36.7% (88/240) were cisgender boys, and 16.3% (39/240) were cisgender girls. There were no differences in demographic characteristics between intervention and control condition participants. Web-accessible game interventions overcome common impediments of face-to-face interventions and present a unique opportunity to reach SGMY and improve their health. This trial will provide data on feasibility and limited efficacy that can inform future Web-based studies and a larger RCT aimed at improving health equity for SGMY. ClinicalTrials.gov NCT03501264; https://clinicaltrials.gov/ct2/show/NCT03501264 (Archived by WebCite at http://www.webcitation.org/72HpafarW) DERR1-10.2196/12164

This article reports the findings of a 2-day public health social work (PHSW) summit that brought together PHSW educators, practitioners, and administrators to generate ideas for preparing the next generation of PHSW leaders. Data from focus groups revealed four themes: the importance of PHSW in our healthcare delivery system, the need for public health social workers to develop their professional identity, the significance of branding/promoting PHSW, and the favorable consequences of infusing PHSW content into social work curricula. Attendees generated ideas for bringing PHSW forward and provided recommendations to accrediting bodies for highlighting the importance of PHSW.

Individuals, including youth, often participate in online research without understanding the characteristics of studies they have agreed to be part of. We assessed the impact of including questions as part of the assent process by randomizing 568 youth to one of three groups: (a) asking youth to only read study information and then indicate their willingness to participate, (b) requiring youth to answer two questions about the study's risks and voluntary nature as part of the assent process, and (c) requiring youth to answer seven questions. Participants in the two- and seven-question groups, compared with the no-question group, were less likely to complete the assent process but, among those who did complete it, were more likely to read and understand study information.

Sexual minority youth (youth who are attracted to the same sex or endorse a gay/lesbian/bisexual identity) report significantly higher rates of depression and suicidality than heterosexual youth. The minority stress hypothesis contends that the stigma and discrimination experienced by sexual minority youth create a hostile social environment that can lead to chronic stress and mental health problems. The present study used longitudinal mediation models to directly test sexual minority-specific victimization as a potential explanatory mechanism of the mental health disparities of sexual minority youth. One hundred ninety-seven adolescents (14-19 years old; 70 % female; 29 % sexual minority) completed measures of sexual minority-specific victimization, depressive symptoms, and suicidality at two time points 6 months apart. Compared to heterosexual youth, sexual minority youth reported higher levels of sexual minority-specific victimization, depressive symptoms, and suicidality. Sexual minority-specific victimization significantly mediated the effect of sexual minority status on depressive symptoms and suicidality. The results support the minority stress hypothesis that targeted harassment and victimization are partly responsible for the higher levels of depressive symptoms and suicidality found in sexual minority youth. This research lends support to public policy initiatives that reduce bullying and hate crimes because reducing victimization can have a significant impact on the health and well-being of sexual minority youth.

Sexual minority girls (SMGs) are four times more likely to engage in substance use than are heterosexual girls. A better understanding of the explanatory mechanisms of this disparity is needed to inform prevention and intervention programs. The goal of this study was to conduct a preliminary test of a stress-negative affect pathway by examining gay-related victimization and depression as mediators of substance use among SMGs. Adolescent girls (N = 156, 41% SMGs) were recruited from two urban adolescent medicine clinics to participate in an NIH-funded study of adolescent substance use. The average age was 17.0 years old and 57% were nonwhite. Mediation analyses were conducted in a multiple regression framework using SPSS and a mediation macro utilizing bias-corrected bootstrapping. Four models were estimated to test mediated pathways from sexual orientation to gay-related victimization (Mediator 1), to depression symptoms (Mediator 2), and then to each of four substance use variables: cigarettes, marijuana, alcohol, and heavy alcohol use. Significant mediated pathways (mediation tests with 95% CIs) were found for cigarette, alcohol and heavy alcohol use outcome variables. Results provide preliminary support for the minority stress hypothesis and the stress-negative affect pathway, and may inform the development of future prevention and intervention programs.

Sexual minority youth report higher rates of depression and suicidality than do heterosexual youth. Little is known, however, about whether these disparities continue as youth transition into young adulthood. The primary goals of this study were to describe and compare trajectories of adolescent depressive symptoms and suicidality among sexual minority and heterosexual youth, examine differences in depressive symptoms and suicidality trajectories across sexual orientation subgroups, and determine whether there are gender differences in these longitudinal disparities. Four waves of data from the National Longitudinal Study of Adolescent Health were analyzed using latent curve modeling (N = 12,379; 53 % female). Results showed that the rates of depressive symptoms and suicidality in early adolescence were higher among sexual minority youth than among heterosexual youth, and that these disparities persisted over time as participants transitioned into young adulthood. Consistent with previous cross-sectional studies, the observed longitudinal disparities were largest for females and for bisexually-identified youth. Sexual minority youth may benefit from childhood and early adolescent prevention and intervention programs.

Sexual minority (lesbian and gay, bisexual, mostly heterosexual) individuals are at an increased risk for hazardous drinking than heterosexual individuals, but little is known about the nature of the disparities as adolescents reach adulthood. We used four waves of a nationally representative data set, the National Longitudinal Study of Adolescent Health (Add Health), to examine disparities of hazardous drinking outcomes between sexual minority and heterosexual men and women from adolescence to young adulthood. Participants were 14–18 years old at the first assessment (N = 12,379; 53 % female) and 27–31 years old at the fourth assessment. At the fourth assessment, 13 % self-identified as sexual minority individuals, 16 % were Hispanic, and 36 % were of minority race, including primarily African Americans (60 %) and Asian Americans (18 %). There were clear hazardous drinking disparities between sexual minority individuals and heterosexual individuals over time. During adolescence, sexual minority individuals, particularly females, reported higher levels of hazardous drinking. As study participants reached adulthood, the magnitude of the hazardous drinking disparities increased among sexual minorities, sexual minority men in particular. Additional research is needed to better understand the developmental mechanisms that underlie the emerging sexual orientation related disparities of hazardous drinking in young adulthood.

Purpose: To examine substance use and mental health disparities between sexual minority girls and heterosexual girls.Methods: Data from the Pittsburgh Girls Study were analyzed. All girls were 17 years old. Girls were included if they were not missing self-reported sexual orientation and mental health data (N = 527). Thirty-one girls (6%) endorsed same-sex romantic orientation/identity or current same-sex attraction. Bivariate analyses were conducted to test group differences in the prevalence of substance use and suicidal behavior, and group differences in depression, anxiety, borderline personality disorder (BPD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms.Results: Compared with heterosexual girls, sexual minority girls reported higher past-year rates of cigarette, alcohol, and heavy alcohol use, higher rates of suicidal ideation and self-harm, and higher average depression, anxiety, BPD. ODD, and CD symptoms.Conclusions: Sexual minority girls are an underrepresented group in the health disparities literature, and compared with heterosexual girls, they are at higher risk for mental health problems, most likely because of minority stress experiences such as discrimination and victimization. The disparities found in this report highlight the importance of discussing sexual orientation as part of a comprehensive preventive care visit.

Men who have sex with men experience high rates of psychosocial health problems such as depression, substance use, and victimization that may be in part the result of adverse life experiences related to cultural marginalization and homophobia. These psychosocial health conditions interact to form a syndemic which may be driving HIV risk within this population. However, MSM also evidence great resilience to both the effects of adversity and the effects of syndemics. Investigating and harnessing these natural strengths and resiliencies may enhance HIV prevention and intervention programs thereby providing the additional effectiveness needed to reverse the trends in HIV infection among MSM.

While there have been attempts to explore the association of obesity and risky sexual behaviors among gay men, findings have been conflicting. Using a prospective cohort of gay and bisexual men residing in Pittsburgh, we performed a semi-parametric, group-based analysis to identify distinct groups of trajectories in body mass index slopes over time from 1999 to 2007 and then correlated these trajectories with a number of psychosocial and behavioral factors, including sexual behaviors. We found many men were either overweight (41.2%) or obese (10.9%) in 1999 and remained stable at these levels over time, in contrast to recent increasing trends in the general population. Correlates of obesity in our study replicated findings from the general population. However, we found no significant association between obesity and sexual risk-taking behaviors, as suggested from several cross-sectional studies of gay men. While there was not a significant association between obesity and sexual risk-taking behaviors, we found high prevalence of overweight and obesity in this population. Gay and bisexual men's health researchers and practitioners need to look beyond HIV and STI prevention and also address a broader range of health concerns important to this population.

We conducted a critical literature review for possible reasons that may explain the lower HIV prevalence observed among API MSM compared to MSM of other races/ethnicities. Trends emerging from the literature suggest that traditional individual-level factors-unprotected anal intercourse, substance use, STD prevalence, rates and frequency of HIV testing, and utilization of HIV prevention services-do not appear to be related to the lower HIV prevalence among API MSM. Some evidence suggests that socio-cultural and structural factors might be the more critical forces in determining racial/ethnic disparities of HIV among MSM. For API MSM, these factors include structures of sexual networks, access to and reception of medical care and treatment among HIV-positive MSM, and influences of different levels and types of acculturation. Moreover, emerging risk reduction strategies, such as seroadaptive behaviors, could play a role. Future research should address these factors in intervention design. In addition, better theories of resilience and measurement of strengths and protective factors are needed to enhance the efficacy of HIV interventions.