Identifying protective factors for gender diverse adolescents' mental health.

Few studies have disentangled differences in victimization exposures and mental health symptoms among gender diverse subgroups, nor considered the role of potential protective factors in ameliorating the impact of victimization on gender diverse youths' mental health. Here we report findings from a secondary data analysis, in which we address this gap by analyzing cross-sectional survey data (N = 11,264 in the final analytic sample) from a population-based survey of youth in participating school districts in a large Midwestern U.S. county. Relative to cisgender youth with gender conforming expression, transgender youth and cisgender youth with nonconforming gender expression are more likely to experience victimization and severe mental health concerns. Additionally, school-connectedness moderates the association between bias-based harassment and depression for cisgender youth with gender nonconforming expression, and family support/monitoring buffers the association of peer victimization with suicide attempts among transgender youth. Findings highlight the need to better understand factors which may confer protection among gender diverse adolescents, so that in turn appropriate supports across key contexts can be implemented.

Time trends and disparities in anxiety among adolescents, 2012-2018.

PURPOSE: Prior studies have been inconclusive in documenting whether the prevalence of adolescent anxiety is increasing, given sampling and measurement limitations. This study adds new information on recent time trends in anxiety prevalence, specifically investigating trends among previously unexamined sociodemographic subgroups. METHODS: Weighted data of 37,360 youth respondents (51.1% female, 71.8% White, 91.3% heterosexual, 99.2% cisgender) from the 2012-2018 Dane County Youth Assessment, a county-wide survey administered to youth in participating school districts, were analyzed to estimate time trends in anxiety prevalence among the whole sample and by sociodemographic subgroups. RESULTS: The prevalence of youth meeting anxiety-screening criteria increased from 34.1% (95% CI 33.4-34.9) in 2012 to 44% (95% CI 43.2-44.7) in 2018 (OR for trend = 1.07, P for trend < 0.001). The trend remained significant after adjusting for known confounds (AOR for trend = 1.07, P for trend < 0.001). Anxiety increased significantly for several subgroups and widening disparities were documented among females relative to males (P < 0.001), and sexual minority youth relative to heterosexual youth (P = 0.003). In addition, Black youth did not increase at the same swift rate as White youth over the study period (P < 0.001). CONCLUSION: This study reports recent data on anxiety time trends and finds that among a geographically representative sample of adolescents, anxiety prevalence is rising. Findings provide new evidence documenting increased anxiety prevalence among sexual minority youth relative to their peers. Results highlight the need to bolster public health interventions focused on adolescent mental health, with tailored interventions for vulnerable groups.

All Things in Moderation? Threshold Effects in Adolescent Extracurricular Participation Intensity and Behavioral Problems.

BACKGROUND: School-based extracurricular activity participation is one of the primary avenues for prosocial activity engagement during adolescence. In this study, we test the "overscheduling hypothesis" or whether the negative relationship between structured activity intensity (ie, hours) and adolescent bullying and fighting levels off or declines at moderate to high intensity (ie, threshold effects). METHODS: This study uses the Dane County Youth Survey (N = 14,124) to investigate the relationship between school-based extracurricular activity participation intensity and bullying perpetration and physical fighting and whether there are threshold effects of activity participation intensity. RESULTS: The results indicate that there is a negative relationship between extracurricular activity participation intensity and bullying perpetration and physical fighting and that there are threshold effects in these relationships at 3 to 4 hours per week. Results also suggest that low-income adolescents engage in more fighting than other youth and the negative relationship between activity participation intensity and physical fighting was mainly concentrated among low-income adolescents. CONCLUSIONS: School-based extracurricular activity participation-in moderation (ie, up to 3-4 hours per week)-may provide a positive, supportive context that could be a promising prevention strategy for bullying and fighting. Implications for future research on how school-based extracurricular activity participation intensity benefits adolescent functioning are discussed.

Cyberbullying victimization and mental health in adolescents and the moderating role of family dinners.

IMPORTANCE: This study presents evidence that cyberbullying victimization relates to internalizing, externalizing, and substance use problems in adolescents and that the frequency of family dinners attenuate these associations. OBJECTIVES: To examine the unique association between cyberbullying victimization and adolescent mental health (after controlling differences in involvement in traditional, face-to-face bullying) and to explore the potential moderating role of family contact in this association. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional, observational study used survey data on 18,834 students (aged 12-18 years) from 49 schools in a Midwestern US state. Logistic regression analysis tested associations between cyberbullying victimization and the likelihood of mental health and substance use problems. Negative binomial regression analysis tested direct and synergistic contributions of cyberbullying victimization and family dinners on the rates of mental health and substance use problems. EXPOSURES: Frequency of cyberbullying victimization during the previous 12 months; victimization by traditional (face-to-face) bullying; and perpetration of traditional bullying. MAIN OUTCOMES AND MEASURES: Five internalizing mental health problems (anxiety, depression, self-harm, suicide ideation, and suicide attempt), 2 externalizing problems (fighting and vandalism), and 4 substance use problems (frequent alcohol use, frequent binge drinking, prescription drug misuse, and over-the-counter drug misuse). RESULTS: About one-fifth (18.6%) of the sample experienced cyberbullying during the previous 12 months. The frequency of cyberbullying positively related to all 11 internalizing, externalizing, and substance use problems (odds ratios from 2.6 [95% CI, 1.7-3.8] to 4.5 [95% CI, 3.0-6.6]). However, victimization related more closely to rates of problems in adolescents that had fewer family dinners. CONCLUSIONS AND RELEVANCE: Cyberbullying relates to mental health and substance use problems in adolescents, even after their involvement in face-to-face bullying is taken into account. Although correlational, these results suggest that family dinners (ie, family contact and communication) are beneficial to adolescent mental health and may help protect adolescents from the harmful consequences of cyberbullying.

Sexual risk taking and bullying among adolescents.

BACKGROUND: Psychological and educational correlates of bullying have been explored extensively. However, little information is available about the link between bullying and sexual risk-taking behaviors among adolescents, though for some youth it may be that sexual risk taking emerges in response to bullying involvement. Associations for both heterosexual youth and those who identify as gay, lesbian, bisexual, transgender, or questioning (GLBTQ) should be considered, as should the influence of victimization exposures in other domains. Accordingly, associations among bullying, other victimization forms, and sexual risk-taking behaviors were examined among adolescents with particular consideration to sexual orientation. METHODS: A sample of 8687 high school students completed the Dane County Youth Survey, a countywide survey administered high school students from 24 schools. Participants were asked questions about their bullying involvement and sexual risk-taking behaviors (ie, engaging in casual sex and having sex while under the influence of alcohol or drugs). RESULTS: Results indicated that bullies and bully-victims were more likely to engage in casual sex and sex under the influence. In multivariate analyses, these findings held even after controlling for demographic characteristics and victimization exposures in other domains, but primarily for heterosexual youth. CONCLUSIONS: Bullies and bully-victims engaged in more sexual risk-taking behaviors, although patterns of association varied by sexual orientation. Bullying prevention programs and programs aimed at reducing unhealthy sexual practices should consider a broader stress and coping perspective and address the possible link between the stress of bullying involvement and maladaptive coping responses.

Cyber and bias-based harassment: associations with academic, substance use, and mental health problems.

PURPOSE: To examine how two forms of interstudent harassment, cyber and bias-based harassment, are associated with academic, substance use, and mental health problems. METHODS: We used a population-based survey of 17,366 middle and high school students that assessed harassment due to race/ethnicity or sexual orientation, and harassment through the Internet or text messaging along with other forms of interstudent harassment. RESULTS: Odds ratios indicated that students experiencing both cyber and bias-based harassment were at the greatest risk for adjustment problems across all indicators, with suicidal ideation and attempts having the largest risk differences. CONCLUSIONS: Assessments of adolescent health and adjustment should include questions regarding both cyber and bias-based harassment.

Adolescent health and harassment based on discriminatory bias.

Is harassment based on personal characteristics such as race/ethnicity, sexual orientation, religion, or disability more detrimental than general harassment? In 2 large population-based studies of adolescents, more than one third of those harassed reported bias-based school harassment. Both studies show that bias-based harassment is more strongly associated with compromised health than general harassment. Research on harassment among youths rarely examines the underlying cause. Attention to bias or prejudice in harassment and bullying should be incorporated into programs and policies for young people.

The effects of general and homophobic victimization on adolescents' psychosocial and educational concerns: the importance of intersecting identities and parent support.

Many adolescents experience peer victimization, which often can be homophobic. Applying the minority stress model with attention to intersecting social identities, this study tested the effects of general and homophobic victimization on several educational outcomes through suicidality and school belonging among 15,923 adolescents in Grades 7 through 12 on account of their sexual orientation and race/ethnicity. Parent support also was tested as a moderator of these effects. Homophobic victimization had different effects on suicidality across groups, indicating the importance of considering individuals' multiple social identities. However, homophobic victimization had universal negative effects on school belonging for all groups. Nearly all indirect effects of general and homophobic victimization on reported grades, truancy, and importance of graduating were significant through suicidality and school belonging across groups. Parent support was most consistent in moderating the effects of general and homophobic victimization on suicidality for heterosexual White and racial/ethnic minority youth. In nearly all cases, it did not moderate the effects of general or homophobic victimization for lesbian, gay, bisexual, transgender, and questioning youth. Furthermore, in most cases, parent support did not moderate the effects of general or homophobic victimization on school belonging. Findings underscore the need for counseling psychologists to work with parents of all youth on ways to provide support to those who experience homophobic victimization. Furthermore, they highlight the need for counseling psychologists to be involved as social justice advocates in the passage and implementation of school policies that address homophobic bullying and other forms of bias-based bullying and harassment.

Willingness to remain friends and attend school with lesbian and gay peers: relational expressions of prejudice among heterosexual youth.

In this study, heterosexual students' willingness to remain friends with peers who disclose that they are gay or lesbian and their willingness to attend schools that include gay and lesbian students were examined among two large middle school and high school samples (Sample 1: n = 20,509; 50.7% girls; Sample 2: n = 16,917; 50.2% girls). Boys were less willing than girls to remain friends or attend schools with gay and lesbian peers, as were students in earlier grades than were students in later grades. Further, there was small, yet significant, variability in these scores across schools. Greater racial diversity within the school partially accounted for this school-level variability; students in more racially diverse schools reported greater willingness to remain friends and attend school with gay and lesbian peers. Findings suggest that while intervention programs must continue to address blatant and overt physical aggression against sexual minority youth, there is also a significant need for programming to address the more subtle expressions of sexual prejudice that contribute to unwelcoming and unsafe school climates.

LGB and questioning students in schools: the moderating effects of homophobic bullying and school climate on negative outcomes.

Lesbian, gay, and bisexual students (LGB) and those questioning their sexual orientation are often at great risk for negative outcomes like depression, suicidality, drug use, and school difficulties (Elliot and Kilpatrick, How to Stop Bullying, A KIDSCAPE Guide to Training, 1994; Mufoz-Plaza et al., High Sch J 85:52-63, 2002; Treadway and Yoakam, J School Health 62(7):352-357, 1992). This study examined how school contextual factors such as homophobic victimization and school climate influence negative outcomes in LGB and questioning middle school students. Participants were 7,376 7th and 8th grade students from a large Midwestern county (50.7% Female, 72.7% White, 7.7% Biracial, 6.9% Black, 5.2% Asian, 3.7% Hispanic, and 2.2% reported "other"). LGB and sexually questioning youth were more likely to report high levels of bullying, homophobic victimization, and various negative outcomes than heterosexual youth. Students who were questioning their sexual orientation reported the most bullying, the most homophobic victimization, the most drug use, the most feelings of depression and suicidality, and more truancy than either heterosexual or LGB students. A positive school climate and a lack of homophobic victimization moderated the differences among sexual orientation status and outcomes. Results indicate that schools have the ability to lessen negative outcomes for LGB and sexually questioning students through creating positive climates and reducing homophobic teasing.

Multilevel modeling of direct effects and interactions of peers, parents, school, and community influences on adolescent substance use.

This study tested a social-ecological model of adolescent substance use. Multilevel modeling was used to investigate how systems, such as parents, peers, schools, and communities, directly influence and interact together to influence adolescent substance use. Participants included 14,548 (50.3% female) middle school students who were 78.6% White, 5.4% Biracial, 4.8% Asian, 4.8% Black, and 3.6% Hispanic. Participants completed a survey with scales assessing substance use, peer influences, parental influences, and characteristics of their school and community. Hierarchical linear modeling (HLM) was used to consider the variation of parental and peer influences on substance use and how schools and communities relate to both substance use and the relationship between substance use and peer and parental factors. Results indicated that a positive school climate and a positive sense of community were associated with less adolescent substance use and that a positive sense of community moderated the relation between peer and parental influence on adolescent substance use, thereby acting as a protective factor.

Psychosocial concerns of sexual minority youth: complexity and caution in group differences.

This investigation tested a large adolescent sample (n = 14,439) for significant group differences on psychosocial concerns on the basis of intersecting identities of sexual orientation (lesbian, gay, bisexual, questioning/less certain, heterosexual), race (Whites, racial minorities), and gender (boys, girls). A significant 2-way interaction between sexual orientation and gender was identified on victimization. Boys reported higher victimization than did girls among heterosexual and questioning/less certain students. Furthermore, significant 3-way interactions between sexual orientation, race, and gender were identified for substance use and depressed/suicidal thoughts. Questioning/less certain youth generally reported the highest levels of victimization, substance abuse, and suicidal thoughts. However, results suggest that, on the basis of small effect sizes for most comparisons, significant differences should be interpreted with caution. Results indicate the need to consider the diversity of subgroups within the sexual minority youth community and that intervention efforts might be more effective if tailored to the unique needs of specific subgroups.