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.

Mental Health, Sexual Orientation, and Perceived Social Network Support in Relation to Hazardous Alcohol Consumption Among Active Duty Military Men.

Knowledge surrounding perceived network support and alcohol consumption among active duty U.S. military personnel is limited, particularly among sexual minorities.We sought to determine the correlates of hazardous alcohol consumption and whether perceived network support moderated the relationship between sexual orientation and Alcohol Use Identification Test (AUDIT-C) score.The sample comprised cisgender men currently serving in the U.S. military (N = 292). Participants were recruited through respondent-driven sampling and completed an online survey. Logistic regression analysis evaluated associations between positive AUDIT-C with sociodemographic characteristics (including sexual orientation), military service, mental health, and perceived social network support. Interaction analysis assessed the moderating effect of perceived network support on sexual orientation and AUDIT-C.Among study participants, 52.7% (154/292) had positive AUDIT-C, while 65.4% (191/292) self-identified as heterosexual/straight and 34.6% (101/292) identified as gay or bisexual. In adjusted analysis, positive AUDIT-C was associated with increased post-traumatic stress disorder symptomatology (adjusted odds ratio [adjOR] 1.03; 95% CI [1.00, 1.06]; p = .019) and high perceived network support (adjOR 1.85; 95% CI [1.04, 3.29]; p = .036), while mental health service utilization had reduced odds of positive AUDIT-C (adjOR 0.40; 95% CI [0.20, 0.78]; p = .007). In interaction analysis, high perceived network support was associated with increased odds of positive AUDIT-C among sexual minority men (adjOR 3.09; 95% CI [1.21, 7.93]; p = .019) but not heterosexual men (adjOR 1.38; 95% CI [0.68, 2.81]; p = .37).Hazardous alcohol use was prevalent among all men in our sample. Perceived social network support may influence hazardous alcohol consumption, particularly among sexual minority servicemen. These findings suggest the potential role of tailored social network-based interventions to decrease hazardous alcohol use among military personnel.

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.

Psychological distress, health protection, and sexual practices among young men who have sex with men: Using social action theory to guide HIV prevention efforts.

The present study addresses gaps in the literature related to theory development for young men who have sex with men (YMSM) sexual practices through the application and modification of Social Action Theory. Data come from the Healthy Young Men study (N = 526), which longitudinally tracked a diverse cohort of YMSM ages 18-24 to characterize risk and protective factors associated with drug use and sexual practices. Structural equation modeling examined the applicability of, and any necessary modifications to a YMSM-focused version of Social Action Theory. The final model displayed excellent fit (CFI = 0.955, TLI = 0.947, RMSEA = 0.037) and suggested concordance between social support and personal capacity for sexual health promotion. For YMSM, practicing health promotion and avoiding practices that may put them at risk for HIV was associated with both social isolation and psychological distress (ß = -0.372, t = -4.601, p<0.001); psychological distress is an internalized response to environmental and cognitive factors and sexual practices are an externalized response. Results point to the utility of Social Action Theory as a useful model for understanding sexual practices among YMSM, the application of which shows health protective sexual practices are a function of sociocognitive factors that are influenced by environmental contexts. Social Action Theory can help prevention scientists better address the needs of this vulnerable population.

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.

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.

Minority stress and substance use in sexual minority adolescents: a meta-analysis.

Lesbian, gay, and bisexual (LGB) adolescents report disparate rates of substance use, and often consume more cigarettes, alcohol, marijuana, cocaine, and ecstasy than their heterosexual peers. It is therefore crucial to understand the risk factors for substance use among LGB adolescents, particularly those unique to their minority status. In an effort to organize the current knowledge of minority-related risk factors for substance use among LGB youth, this study presents results from a systematic review and meta-analysis of the published research literature. Results from 12 unique studies of LGB youth indicated that the strongest risk factors for substance use were victimization, lack of supportive environments, psychological stress, internalizing/externalizing problem behavior, negative disclosure reactions, and housing status. Results are discussed in terms of their implications for targeted intervention programs that address minority stress risk factors for substance use among LGB youth.

Online Social Networking, Sexual Risk and Protective Behaviors: Considerations for Clinicians and Researchers.

Online social networking refers to the use of internet-based technologies that facilitate connection and communication between users. These platforms may be accessed via computer or mobile device (e.g., tablet, smartphone); communication between users may include linking of profiles, posting of text, photo and video content, instant messaging and email. This review provides an overview of recent research on the relationship between online social networking and sexual risk and protective behaviors with a focus on use of social networking sites (SNS) among young people and populations at high risk for sexually transmitted infections (STIs). While findings are mixed, the widespread use of SNS for sexual communication and partner seeking presents opportunities for the delivery and evaluation of public health interventions. Results of SNS-based interventions to reduce sexual risk are synthesized in order to offer hands-on advice for clinicians and researchers interested in engaging patients and study participants via online social networking.

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.

Acceptability of smartphone application-based HIV prevention among young men who have sex with men.

Young men who have sex with men (YMSM) are increasingly using mobile smartphone applications ("apps"), such as Grindr, to meet sex partners. A probability sample of 195 Grindr-using YMSM in Southern California were administered an anonymous online survey to assess patterns of and motivations for Grindr use in order to inform development and tailoring of smartphone-based HIV prevention for YMSM. The number one reason for using Grindr (29 %) was to meet "hook ups." Among those participants who used both Grindr and online dating sites, a statistically significantly greater percentage used online dating sites for "hook ups" (42 %) compared to Grindr (30 %). Seventy percent of YMSM expressed a willingness to participate in a smartphone app-based HIV prevention program. Development and testing of smartphone apps for HIV prevention delivery has the potential to engage YMSM in HIV prevention programming, which can be tailored based on use patterns and motivations for use.

Make your enemies your allies.

Rivalries in the workplace can be destructive to both personal career growth and group success. Many attempts to reverse rivalries fail because of the complex way emotion and reason operate in the building of trust. Using a method called the 3Rs, an effective leader can turn a rival into a collaborator, setting the stage for a healthy work life while driving fresh thinking within an organization. Step 1 of the method is redirection, shifting a rival's negative emotions away from the adversarial relationship. This creates an opening for Step 2, reciprocity, through which a relationship can be established. Here, the essential principle is to give before you ask--offering a rival something of clear benefit and "priming the pump" for a future return that requires little effort on the rival's part. Step 3, rationality, sets expectations of the new relationship so that efforts made using the previous steps don't come off as disingenuous. A rival is encouraged to see collaborative opportunities from a reasoned standpoint. A key advantage of the 3Rs is that the method can work to reverse all kinds of rivalries, including those with subordinates, peers, and superiors.

How to build your network.

Many sensational ideas have faded away into obscurity because they failed to reach the right people. A strong personal network, however, can launch a burgeoning plan into the limelight by delivering private information, access to diverse skill sets, and power. Most executives know that they need to learn about the best ideas and that, in turn, their best ideas must be heard by the rest of the world. But strong personal networks don't just happen around a watercooler or at reunions with old college friends. As Brian Uzzi and Shannon Dunlap explain, networks have to be carefully constructed through relatively high-stakes activities that bring you into contact with a diverse group of people. Most personal networks are highly clustered--that is, your friends are likely to be friends with one another as well. And, if you made those friends by introducing yourself to them, the chances are high that their experiences and perspectives echo your own. Because ideas generated within this type of network circulate among the same people with shared views, though, a potential winner can wither away and die if no one in the group has what it takes to bring that idea to fruition. But what if someone within that cluster knows someone else who belongs to a whole different group? That connection, formed by an information broker, can expose your idea to a new world, filled with fresh opportunities for success. Diversity makes the difference. Uzzi and Dunlap show you how to assess what kind of network you currently have, helping you to identify your super-connectors and demonstrating how you act as an information broker for others. They then explain how to diversify your contacts through shared activities and how to manage your new, more potent, network.