Smoking cessation among sexual minority women: Differences in cigarette quit ratios across age, race/ethnicity, and sexual orientation.

OBJECTIVE: Sexual minority (SM) women experience tobacco-related disparities and report a higher prevalence of cigarette use, as well as subgroup differences in use, but little is known about their quitting behavior. This study used data from a national sample of United States SM women to examine cigarette quit ratios overall and by age, race/ethnicity, and sexual orientation. METHODS: Using baseline survey data from the Generations Study (2016-2017, N = 812), we calculated quit ratios among SM women reporting lifetime smoking (100+ cigarettes) who reported currently smoking "not at all" relative to those reporting smoking "every day or some days." Quitting was compared across cohort, race/ethnicity, and sexual orientation, controlling for household income. RESULTS: SM women reporting lifetime smoking in the older cohort were significantly more likely to report quitting than those in the younger cohort. Bisexual women also reported a greater likelihood of quitting than gay/lesbian women. There was no association between race/ethnicity and the probability of quitting smoking. CONCLUSIONS: SM women remain a priority for tobacco prevention and cessation efforts. There is evidence that the probability of quitting cigarettes differs across sexual orientation and age cohorts, which has implications for tailoring of interventions and tobacco communications.

Associations of adverse and protective childhood experiences with thwarted belongingness, perceived burdensomeness, and suicide risk among sexual minority men.

BACKGROUND: Sexual minority men (SMM) experience higher suicidal ideation and suicide attempts than the general population. We examined the associations of adverse childhood experiences (ACES) and protective and compensatory childhood experiences (PACES) with suicidal ideation and suicide attempts in adulthood via thwarted belongingness and perceived burdensomeness among SMM. METHODS: Data are from the UNITE study, a national longitudinal cohort study of HIV-negative SMM from the 50 U.S. states and Puerto Rico. Between 2017 and 2019, participants (N = 6303) completed web-based assessments at baseline and 12-month follow-up. ACES and PACES occurring before the age of 18, and current symptoms of thwarted belongingness and perceived burdensomeness were assessed at baseline. Past-week suicidal ideation and past-year suicide attempt were assessed at follow-up. RESULTS: 424 (6.7%) participants reported past-week suicidal ideation and 123 (2.0%) reported a past-year suicide attempt. The results of our multivariate model suggest that each additional adverse childhood experience was prospectively associated with 14% higher odds of past-week suicidal ideation (AOR = 1.14, 95% CI 1.09-1.19) and 19% higher odds of past-year suicide attempt (AOR = 1.19, 95% CI 1.11-1.29). Each additional protective childhood experience was prospectively associated with 15% lower odds of past-week suicidal ideation (AOR = 0.85, 95% CI 0.81-0.90) and 11% lower odds of past-year suicide attempt (AOR = 0.89, 95% CI 0.82-0.98). Perceived burdensomeness partially mediated these prospective associations. CONCLUSION: To reduce suicide, screening and treating perceived burdensomeness among SMM with high ACES may be warranted. PACES may decrease perceived burdensomeness and associated suicide risk.

Perceived parental social support and psychological control predict depressive symptoms for lesbian, gay, bisexual, transgender, queer, or questioning youth in the United States.

Salient practices in the parenting literature-support and control-have seldom been applied to understanding lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ) youth mental health. We examine associations among perceived parental social support, psychological control, and depressive symptoms for LGBTQ youth in the United States (n = 536; Mage  = 18.98; 48.1% women; 25.2% Black or African American; 37.1% Hispanic or Latino/a/x). Data were collected in 2011-2012. Results indicated joint effects of social support and psychological control predicting youth depressive symptoms. Multiple group analysis yielded a significant interaction of parenting practices for youth whose parent(s) did not know their LGBTQ identity. Findings support further consideration of parental support and control in relation to LGBTQ youth well-being.

Sexual minority youth in romantic relationships: Associations with youth well-being.

This study investigated differences in depressive symptoms, loneliness, and self-esteem for monosexual (lesbian, gay) and plurisexual (bisexual, pansexual, queer) sexual minority youth (SMY) by relationship status (single, partnered) and relationship configuration (same-gender partner, different-gender partner). Participants included 338 SMY (Mage = 19.10 years) who reported on their relationship status, partner's gender identity, well-being, and ability to confide in partner about LGBTQ issues. Results indicated that for plurisexual youth, single status was associated with greater loneliness; plurisexual youth with same-gender partners reported fewer depressive symptoms and marginally greater ability to confide in their partner about LGBTQ issues than those with different-gender partners. Findings reveal similarities across SMY while also highlighting some unique challenges among plurisexual youth with different-gender partners.

Age Trends in Bias-Based Bullying and Mental Health by Sexual Orientation and Gender Identity.

Disparities in mental health and bullying between SGM youth and their heterosexual, cisgender peers are well-established. There remain questions about whether the onset and progression of these disparities differ across adolescence-knowledge critical for screening, prevention, and intervention. To address this, the current study estimates age-based patterns of homophobic bullying, gender-based bullying, and mental health across groups of adolescents defined by sexual orientation and gender identity (SOGI). Data are from the 2013-2015 cycle of the California Healthy Kids Survey (n = 728,204). We estimated the age-specific prevalence rates of past-year homophobic bullying, gender-based bullying, and depressive symptoms using three- and two-way interactions by (1) age, sex, and sexual identity and (2) age and gender identity, respectively. We also tested how adjustments for bias-based bullying alter predicted prevalence rates of past-year mental health symptoms. Results showed that SOGI differences in homophobic bullying, gender-based bullying, and mental health were already present among youth aged 11 and younger. SOGI differences by age were attenuated when adjusting models for homophobic and gender-based bullying, particularly among transgender youth. SOGI-related bias-based bullying and mental health disparities were present early and generally persisted throughout adolescence. Strategies that prevent exposure to homophobic and gender-based bullying would significantly reduce SOGI-related disparities in mental health across adolescence.

Examination of the "model minority" stereotype through ethnicity and sexual orientation heterogeneity among Asian American youth.

INTRODUCTION: The "model minority" stereotype disguises heterogeneity among Asian American youth, many of whom are harmed by policies and attitudes that assume this population to be uniformly high achieving and "problem free." The current study uses an intersectional lens to disaggregate this population by ethnicity and sexual orientation subgroups to demonstrate differences in academic performance and substance use behavior among Asian American youth. This study also investigates the extent to which racial/ethnicity and sexual orientation-based bullying may explain such links. METHODS: Participants included 65,091 Asian American youth (46.41% Southeast Asian; 37.01% East Asian; 16.58% South Asian) in grades 6-12, who were part of the California Healthy Kids Survey (2015-2017). Participants were 49.4% female and about a third each were in grades 6-8, grades 9-10, and grades 11-12. School-based surveys were administered. Youth reported on substance use, grades, and bias-based bullying experiences in the past 12 months. RESULTS: Generalized linear mixed-effects model results showed that outcomes varied widely across youth ethnicity and sexual orientation subgroups. Inclusion of racial/ethnic and sexual orientation bullying in these models attenuated the direct effects between ethnic and sexual identities and academic performance and substance use outcomes. CONCLUSIONS: Implications of this work suggest that research and policy should not treat Asian American students as uniformly high-performing and low-risk, because the experiences of those who deviate from these assumptions will be left undetected. Interventions targeting bias-based bullying may be able to reduce disparities in academic and substance use outcomes among Asian American youth.

Interpersonal- and Community-Level Risk Factors for Adolescent Obesity: An Examination of Sexual Identity, School Violence, and School Climate in a Large Sample of Urban Adolescents.

Sexual minority adolescents are more likely to have obesity compared to their heterosexual peers, but little is known about potential contributors to this disparity that lie outside of individual-level health behaviors, such as diet and exercise. One possible contributor is school violence victimization, a factor associated with overweight/obesity in adolescence. Another possible contributor is school climate, which is associated with feelings of safety and connectedness that can lower the likelihood of school violence victimization. Moreover, even less is known about relationships among all these factors among sexual minority adolescents. This gap in the literature was addressed by analyzing CDC's district-level data from the Youth Risk Behavior Survey and School Health Profiles (N = 60,625; 50.9% female, Mage = 16 years, 84.7% heterosexual, 15.3% sexual minority). Using multilevel mixed effects logistic regression models and controlling for covariates, it was found that among females and males, those with 2+ counts of last 12-month school violence victimization had higher odds of obesity than those with no school violence victimization (AOR = 1.33; AOR = 1.24). Furthermore, females and males in more positive LGBTQ school climates had lower odds of obesity than those in less positive school climates (AOR = 0.84; AOR = 0.85). There were no sexual identity differences in these models. Findings support the careful consideration of school violence victimization and LGBTQ school climate in future obesity prevention initiatives.

Sexual minority youth's mental health and substance use: The roles of victimization, cybervictimization, and non-parental adult support.

Victimization is a well-established driver of sexual minority youth's (SMY) mental health and substance use risk. The current study examined and extended this research by exploring how victimization, cybervictimization, and non-parental supportive adults contribute to SMY's vulnerability to poor mental health and substance use. Using data from the first representative sample of Texas youth that measures sexual identity, we analyzed sex-stratified models of the association between sexual identity, mental health, and substance use, and the confounding effects of victimization, cybervictimization, and non-parental adult support. Victimization was more common among SMY and accounted for a greater proportion of sexual identity disparities on mental health and substance use, especially for males. Sexual minority females were more likely to report cybervictimization than heterosexual youth, and cybervictimization was associated with mental health risk. SMY reported fewer available non-parental supportive adults, which was associated with more sadness, suicidality, and polysubstance use. Our study adds to extant evidence that victimization drives SMY's increased susceptibility to mental health and substance use risk. Schools should implement inclusive policies that prohibit bullying based on sexual minority identity and offer professional development opportunities for supporting SMY.

Social Change and the Health of Sexual Minority Individuals: Do the Effects of Minority Stress and Community Connectedness Vary by Age Cohort?

This study examined the extent to which social stress stemming from a stigmatized social status (i.e., minority stress) was associated with three domains of health in younger as compared with older age cohorts of sexual minority individuals. Data were analyzed from the Generations Study, a longitudinal study using a probability sample (N = 1518) of age cohorts of sexual minority individuals in the USA. Exposure to a variety of minority stressors was associated with poorer health for all age cohorts. We hypothesized that because of improved social and legal environments in recent years, the associations between minority stress and health would be diminished in the younger cohort. As expected, we found that the associations between some minority stressors and health outcomes were diminished in the younger cohort compared to older cohorts. Positive associations between community connectedness and mental health and social well-being were observed for all participants but were attenuated in the younger cohort. Findings demonstrate the continuing negative association between minority stress and health among sexual minorities, which, despite some attenuation, persists even for young cohorts of sexual minority individuals in a more equal and accepting social climate.

School climate perceptions at the intersection of sex, grade, sexual, and gender identity.

School climate is an important construct in research on adolescents. Yet, no known studies have evaluated whether the measured school climate constructs are equivalent across lesbian, gay, bisexual, transgender, questioning (LGBTQ), and heterosexual students as well as sex and grade levels. This study assessed measurement equivalence of a second-order school climate construct across 1) sexual identity and sex among cisgender adolescents and 2) sexual and gender identity and grade level among cisgender and transgender adolescents. Data come from a California statewide survey of middle and high school students. Measurement equivalence was supported. This study reinforces prior findings on sexual and gender minority disparities and sheds light on an interesting pattern of school experiences across grades that deserves further investigation.

School Pushout: The Role of Supportive Strategies Versus Punitive Practices for LGBT Youth of Color.

Recently, schools have focused on supportive (e.g., behavioral supports) rather than punitive (e.g., suspension) strategies to reduce school pushout among marginalized youth. We examined the association between suspension and discipline practices for students with intersecting identities (e.g., LGBT youth of color). We used teacher and student data from 1,091 schools that participated in the California School Climate and California Healthy Kids Surveys. Relative to White LGBT youth, LGBT youth of color were at higher risk of being suspended, and youth were differentially affected by punitive policies depending on their race, sexual orientation, and/or gender identity. While supportive strategies were associated with lower risk of suspension, punitive practices were associated with higher risk of suspension, especially for LGBT youth of color.

Does a Decade of School Administrator Support for Educator Training on Students' Sexual and Gender Identity Make a Difference for Students' Victimization and Perceptions of School Climate?

Professional development training for school personnel on issues related to sexual and gender identity (i.e., SOGI training) is a school strategy designed to prevent health and educational disparities for lesbian, gay, bisexual, and transgender (LGBT) youth at school. Yet we know surprisingly little about how the presence of this practice at school affects students' experience. This study explores whether students' experiences of victimization and school climate vary as a function of school administrator support for SOGI training at two time points (2004 and 2014). We combined multiple independent databases: students' reports on victimization and school climate in 2013-2015 (n = 55,158), and school (n = 152) and school district data (n = 67) on support for SOGI training in 2004 and 2014. More positive school climates were found in schools with support for SOGI training in 2004 only and both 2004 and 2014 compared to schools with SOGI training support in 2014 only. In schools with support for SOGI training in both 2004 and 2014, LGBT students reported the lowest rates of victimization. Findings from this study provide evidence that support for SOGI training by school administration is an effective way to improve school contexts for LGBT and all students. School administrators who aim to reduce victimization disparities for LGBT students and improve school climates should support the implementation of SOGI training, and sustain such training over time.

Everyday Discrimination and Alcohol use among Sexual Minority Adults in a U.S. National Probability Sample.

Objective: Limited research assesses how sexual orientation and gender identity and expression (SOGIE)-based discrimination affects alcohol use above and beyond non-SOGIE-related discrimination and how this may differ for sexual minority subgroups. We examined if SOGIE-related discrimination is additive in affecting alcohol use above and beyond non-SOGIE-related discrimination and examined differences in alcohol use, everyday discrimination, and the attribution of discrimination by sex and sexual identity. Methods: A national probability sample of sexual minority adults in the United States was used (N = 1311, female = 56.4%). Bivariate sexual identity and sex-based differences in drinking frequency, heavy episodic drinking (HED), everyday discrimination, and the attribution of discrimination were assessed. Sexual identity and sex-stratified logistic regression models were estimated, where everyday discrimination and the attribution of discrimination predicted drinking frequency and HED. Results: Several differences by sex assigned at birth and sexual identity in drinking frequency, HED, everyday discrimination, and the attribution of discrimination were found in bivariate analyses. In logistic regression models, experiencing SOGIE-related in addition to other types of discrimination was associated with higher odds of HED only for gay males. No other associations were found for everyday discrimination or the attribution of discrimination with drinking frequency or HED. Conclusions: Findings suggest sex and sexual identity-based differences in everyday discrimination and the attribution of discrimination.

Cigarette Smoking and Minority Stress Across Age Cohorts in a National Sample of Sexual Minorities: Results From the Generations Study.

BACKGROUND: Sexual minority populations in the United States have persistently higher rates of cigarette use than heterosexuals, partially driven by exposure to minority stressors (e.g., discrimination and victimization). Little is known about cigarette use across cohorts of sexual minority adults who came of age in distinctly different sociopolitical environments. PURPOSE: To examine cigarette use and minority stressors across three age cohorts of U.S. sexual minority adults. METHODS: We used data from the Generations Study, a nationally representative sample (N = 1,500) of White, Black, and Latino/a sexual minority adults in three age cohorts (younger: 18-25 years; middle: 34-41 years; and older: 52-59 years). Survey data were collected from March 2016 to March 2017. We used sex-stratified logistic regression models to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between age cohort, minority stressors (discrimination and victimization), and two indicators of cigarette smoking (lifetime use and current use). RESULTS: Prevalence of current cigarette use in each age cohort was high (younger: 20%; middle: 33%; and older: 29%). Relative to the younger cohort, men and women in the middle- and older-age cohorts had significantly higher odds of lifetime and current smoking (e.g., men, current, aOR [95% CI]: middle = 2.47 [1.34, 4.52], older = 2.85 [1.66, 4.93]). Minority stressors were independently associated with higher odds of current smoking; when victimization was included, the magnitude of the association between age cohort and current smoking was diminished but remained significant. CONCLUSIONS: Smoking cessation interventions must consider the role of minority stress and the unique needs of sexual minority people across the life course.

Homophobic Bullying in Positive and Negative School Climates: The Moderating Role of Gender Sexuality Alliances.

The presence of Gay-Straight Alliances (GSAs) in schools has been linked to low rates of bullying for lesbian, gay, bisexual, questioning (LGBQ), transgender, and all students. However, little is known about how the heterogeneity in GSA functioning and school climates may affect these rates. This study examines whether a well-functioning GSA would limit the effect of a negative school climate as a risk factor for homophobic victimization experiences. The sample included 38,872 students (3401 LGBQ and 453 transgender) from 58 California high schools. Several independent databases were combined. Students reported on homophobic victimization, the school climate, and demographic information. At the school level, reports from all students were aggregated for school climate; reports from GSA members were aggregated on their perceptions of GSA functioning; publicly-available data were used for school characteristics. The results suggest that greater GSA functioning may be beneficial for all students in schools that have a negative school climate, and particularly protective for transgender students.

Intersections of Racial Discrimination and LGB Victimization for Mental Health: A Prospective Study of Sexual Minority Youth of Color.

Sexual minority youth (i.e., lesbian, gay, and bisexual youth; LGB) of color have multiple minoritized identities, and few studies examine the implications of intersectional minority stressors for their prospective mental health. The current study tested three intersectional hypotheses: the additive hypothesis-racial discrimination and LGB victimization are independently associated with mental health; the multiplicative hypothesis-racial discrimination and LGB victimization interact in to exacerbate their negative association with mental health, and the inuring hypothesis-only racial discrimination or LGB victimization is associated with mental health. Data come from a sample of lesbian, gay, and bisexual youth of color (36% Black, 30% Latino, 26% Multi-racial, 4% Native American, and 3% Asian, Hawaiian, and Pacific Islander) from two U.S. cities, one in the Northeast (77%) and one in the Southwest, who were between ages 15-24 (M = 19) and surveyed four times over three years spaced nine months apart (N = 476; 38% bisexual; 67% free and reduced lunch; and 49% assigned female at birth). The multiplicative hypothesis was supported for depression symptoms, and the additive hypothesis was supported for suicidal ideation. Intersectional minority stressors undermine the mental health of sexual minority youth of color and warrant further investigation.

Comparing National Probability and Community-Based Samples of Sexual Minority Adults: Implications and Recommendations for Sampling and Measurement.

Scientific evidence regarding sexual minority populations has generally come from studies based on two types of samples: community-derived samples and probability samples. Probability samples are lauded as the gold standard of population research for their ability to represent the population of interest. However, while studies using community samples lack generalizability, they are often better able to assess population-specific concerns (e.g., minority stress) and are collected more rapidly, allowing them to be more responsive to changing population dynamics. Given these advantages, many sexual minority population studies rely on community samples. To identify how probability and community samples of sexual minorities are similar and different, we compared participant characteristics from two companion samples from the Generations Study, each designed with the same demographic profile of U.S. sexual minority adults in mind. The first sample was recruited for a national probability survey, whereas the second was recruited for a multicommunity sample from four U.S. cities. We examined sociodemographic differences between the samples. Although there were several statistical differences between samples, the effect sizes were small for sociodemographic characteristics that defined the sample inclusion criteria: sex assigned at birth, race/ethnicity, and age cohort. The samples differed across other characteristics: bisexual respondents, respondents with less education, and those living in non-urban areas were underrepresented in the community sample. Our findings offer insights for recruiting community samples of sexual minority populations and for measuring sexual identity on probability surveys. They also bolster confidence in well-designed community samples as sources for data on sexual minority populations.

Gay-Straight Alliances, Inclusive Policy, and School Climate: LGBTQ Youths' Experiences of Social Support and Bullying.

Gay-Straight Alliances (GSA) and school policies focused on support for lesbian, gay, bisexual, transgender, and queer/questioning youth may reduce bias-based bullying and enhance social supports in schools. Using multivariate regression, we tested the relationship between youth reports of the presence of GSAs and LGBTQ-focused policies, independently and mutually, with experiences bullying and perceived support (n = 1,061). Youth reported higher classmate support in the presence of GSAs and higher teacher support in the presence of LGBTQ-focused policies; the presence of both GSAs and LGBTQ-focused policies was associated with less bullying and higher perceived classmate and teacher support. The findings indicate that GSAs and LGBTQ-focused policies are distinctly and mutually important for fostering safer and more supportive school climates for youth.

Person-Environment Fit and Positive Youth Development in the Context of High School Gay-Straight Alliances.

Drawing from a person-environment fit framework, we identified profiles of youth in gay-straight alliances (GSAs) based on the extent to which they received information/resources, socializing/support, and advocacy opportunities in their GSAs and the extent to which this matched what they desired from their GSA along these three functions. Further, we examined profile differences in positive developmental competencies while accounting for community-contextual factors. In a sample of 290 youth from 42 Massachusetts GSAs, latent profile analyses identified five subgroups. Overall, youth receiving less from their GSAs than they desired, particularly regarding opportunities for advocacy, reported lower levels of self-reflection, bravery, civic engagement, and agency than youth who received information, socializing/support, and advocacy that matched or exceeded what they desired.

The contribution of school safety to weight-related health behaviors for transgender youth.

INTRODUCTION: The aim of the present study is to examine gender identity disparities in different kinds of weight-related health behaviors, including physical activity, participation in physical education at school, and healthy and unhealthy eating habits, and to investigate the relationship between school safety and such behaviors in a sample of transgender and non-transgender students. METHOD: We analyzed a statewide sample of 31,609 students (Mage = 14.04, SD = 1.70; 1.1% transgender). We used multilevel regression models to examine the interactive effects of gender identity and perceptions of school safety on the 4 different outcome variables (physical activity, physical education, healthy and unhealthy eating habits). All models included student- and school-level characteristics as controls. RESULTS: Findings indicated that transgender students, when compared to non-transgender students, reported (a) feeling less safe at school; (b) more physical activity, but less participation in physical education at school; and (c) both more healthy as well as unhealthy eating behaviors. Adjusted regression models showed a significant interaction between gender identity and perceived school safety on healthy eating behaviors; simple slopes indicated that transgender students have healthier eating behaviors when the school context is perceived as safe compared to those who perceived the school as less safe. CONCLUSIONS: School interventions are needed to improve school safety for transgender youth and to reduce gender identity-related disparities in healthy eating and physical activity. Research implications and limitations are discussed.