The application of minority stress theory to marijuana use among sexual minority adolescents.

Previous research indicates that lesbian, gay, and bisexual (LGB) adolescents are at increased risk for substance use, including heightened rates of marijuana use. Minority stress theory suggests that difficult social situations create a state of chronic stress that leads to poor health outcomes for LGB adults; however, the applicability of this model has not been well explored in relation to substance use among LGB adolescents. The current study is a secondary analysis of the OutProud survey, conducted in 2000. The original study used purposive sampling to collect data from 1,911 LGB adolescents (age 12-17) across the United States, and represents the largest known study to explore experiences specific to identifying as LGB, such as homophobia and gay-related victimization. We used structural equation modeling (SEM) to explore the feasibility of applying a minority stress framework to understand marijuana use in this population. The final structural model for marijuana use in the LGB adolescent sample displayed excellent fit and modest explanatory power for marijuana use. Two of the five factors, community connectedness and internalized homophobia, were significantly (p < .05) associated with marijuana use. Findings suggest that minority stress theory may be appropriately applied to marijuana use in this population; however, better measurement of minority stress concepts for LGB adolescents is needed.

Network correlates of sexual health advice seeking and substance use among members of the Los Angeles House and Ball communities.

House and Ball communities (HBCs), represent a prime context for human immunodeficiency virus prevention with African American young men who have sex with men and transgender persons. This study sought to understand the composition and function of social support and sexual networks of HBC members in Los Angeles, California (N = 263). Participants were recruited using venue-based sampling and asked to report on sexual health advice seeking, alcohol use and illicit substance use. Participants were more likely to seek sexual health advice from social support network members compared with sexual network members [odds ratio (OR): 2.50, P < 0.001]. HBC members were more likely to get drunk (OR: 1.57; P < 0.05) and use illicit substances (OR: 1.87; P < 0.10) with House members and sexual network members compared with non-House members and social support network members. Health promotion programs tailored for the HBC should encourage open communication regarding sexual health; these interventions must include information about the role of substance use in sexual risk taking.

Support for Transgender Military Service from Active Duty United States Military Personnel.

INTRODUCTION: Most transgender individuals are banned from serving in and joining the U.S. military. Historically, exclusions and limits have been placed on women, people of color, and sexual minority people seeking to serve and advance within the U.S. military. However, both history and prior research demonstrate that diversity contributes to social and institutional advancement within both U.S. and international militaries. METHODS: We used an adapted respondent-driven sampling (RDS) approach to recruit transgender and cisgender heterosexual and LGB active duty military members in a first-of-its-kind study funded by the Department of Defense. We recruited 540 active duty service members serving one of the four major branches of the U.S. military between August 2017 and March 2018. We examined data from 486 heterosexual cisgender and LGB cisgender service members to understand their support for transgender people serving in the U.S. military. RESULTS: Findings indicate broad support for transgender military service across all four branches of the military and military ranks, with some statistically significant differences in support emerging by gender, sexual orientation, and race/ethnicity. DISCUSSION: Results suggest that the ban, in part, based on a belief that transgender service members degrade unit readiness, contradicts our findings of broad support for transgender service among active duty service members. POLICY IMPLICATIONS: Policies limiting transgender service in the U.S. military should be lifted given these data.

Leveraging Social Networks and Technology for HIV Prevention and Treatment With Transgender Women.

Transgender women ("trans women") are disproportionately impacted by HIV; yet there are few interventions tailored for trans women. This study employed qualitative methods to better understand how trans women's social networks and technology-based networking platforms may be leveraged in developing health promotion strategies for this high-priority population. Qualitative data from five focus groups (N = 39) revealed three key themes: (1) Social network structure and composition; (2) Technology use patterns; and (3) Accessing transgender health resources online. Participants used technology to establish affiliation with other trans women, build networks of support, and exchange health information and advice. Policymakers and practitioners can invest in the knowledge and expertise of trans women in using technology to organize health resources and support the development of peer-led, technology-based HIV prevention and care interventions.

Sexual Health Transformation Among College Student Educators in an Arts-Based HIV Prevention Intervention: A Qualitative Cross-Site Analysis.

We examined the sexual health change process experienced by 26 college student sexual health educators from three geographic regions of the United States who participated in a multisite arts-based sexual health prevention program. We conducted eight focus groups and used a phenomenological approach to analyze data. We drew from social cognitive theory (SCT) to examine how sexual health knowledge, attitudes, self-efficacy, and communication shifted across the duration of participation. Findings suggest that the college student sexual health educators (a) developed enhanced sexual health awareness and critical consciousness, (b) questioned their own sexual health education and challenged previous beliefs, and (c) demonstrated self-efficacy related to intended behavior change and their perceived role as social justice advocates. We present both similarities and differences regarding the sexual health change process among the college student sexual health educators across the three sites.

Subcutaneous Testosterone: An Effective Delivery Mechanism for Masculinizing Young Transgender Men.

PURPOSE: Testosterone is the recommended treatment for transgender youth who desire the development of male secondary sexual characteristics. While intramuscular injection remains the most common means of delivering injectable testosterone, subcutaneous (SC) delivery has been used with clinical success. No data reporting serum levels and feasibility are available. We aimed to determine both if subcutaneous delivery of testosterone resulted in menstrual cessation, and the normal male ranges of serum testosterone in this subpopulation of female-to-male transgender youth. METHODS: Within an urban hospital-affiliated Adolescent Medicine clinic, thirty-six youth aged 13 to 24 years transitioning from female to male received testosterone cypionate via subcutaneous injections for masculinization. Participants were a subpopulation of those enrolled in a longitudinal, prospective study examining the impact of treatment for transgender youth. A titrated dose of testosterone cypionate (average dose 46.4 mg per week) via subcutaneous injection was delivered over 6 months. The main outcomes included menstrual cessation as well as raised free and total testosterone levels. RESULTS: Eighty-five percent of participants had ceased menstrual bleeding within 6 months after initiating testosterone. The average time to menstrual cessation was 2.9 months. Most participants (91.4%) reached total testosterone levels within the normal male range after 6 months of subcutaneous delivery (49-1138 ng/dL, 521.4 ng/dL total test). Few adverse effects were reported. CONCLUSION: Subcutaneous delivery of testosterone for masculinization of transgender youth seems to be effective and well tolerated over short treatment times. Additional studies are needed to determine whether long term use of subcutaneous testosterone delivery yield similar results.