GSA Advocacy Predicts Reduced Depression Disparities Between LGBQ+ and Heterosexual Youth in Schools.

OBJECTIVE: Depression disparities between heterosexual youth and lesbian, gay, bisexual, queer, and other non-heterosexual (LGBQ+) youth are robust and linked to discrimination in schools. Advocacy by school-based Gender-Sexuality Alliances (GSAs) to raise awareness of LGBQ+ issues and to counteract discrimination may reduce these disparities within schools, yet has not been investigated schoolwide. We considered whether GSA advocacy over the school year moderated sexual orientation differences in depressive symptoms at the school year's end for students in the general school population (i.e., students who were not members of the GSA). METHOD: Participants were 1,362 students (Mage = 15.68; 89% heterosexual; 52.6% female; 72.2% White) in 23 Massachusetts secondary schools with GSAs. Participants reported depressive symptoms at the beginning and end of the school year. Separately, GSA members and advisors reported their GSA's advocacy activities during the school year and other GSA characteristics. RESULTS: LGBQ+ youth reported higher depressive symptoms than heterosexual youth at the school year's beginning. However, after adjusting for initial depressive symptoms and multiple covariates, sexual orientation was a weaker predictor of depressive symptoms at the school year's end for youth in schools whose GSAs engaged in more advocacy. Depression disparities were significant in schools whose GSAs reported lower advocacy, but were statistically non-significant in schools whose GSAs reported higher advocacy. CONCLUSION: Advocacy could be a means by which GSAs achieve school-wide impacts, benefiting LGBQ+ youth who are not GSA members. GSAs may therefore be a key resource for addressing the mental health needs of LGBQ+ youth.

Youth Advocacy Varies in Relation to Adult Advisor Characteristics and Practices in Gender-Sexuality Alliances.

With growing attention to youth's efforts to address sexual and gender diversity issues in Gender-Sexuality Alliances (GSAs), there remains limited research on adult advisors. Do advisor characteristics predict their youth members' advocacy? Among 58 advisors of 38 GSAs, we considered whether advisor attributes predicted greater advocacy by youth in these GSAs (n = 366) over the school year. GSAs varied in youth advocacy over the year. Youth in GSAs whose advisors reported longer years of service, devoted more time to GSA efforts each week, and employed more structure to meetings (to a point, with a curvilinear effect), reported greater relative increases in advocacy over the year (adjusting for initial advocacy and total meetings that year). Relative changes in advocacy were not associated with whether advisors received a stipend, training, or whether GSAs had co-advisors. Continued research should consider how advisors of GSAs and other social justice-oriented groups foster youth advocacy.

Gender-sexuality alliance membership and activities: associations with students' comfort, confidence and awareness regarding substance use resources.

Belonging to a school Gender and Sexuality Alliance (GSA) is associated with lower substance use among LGBTQ+ youth. However, it is unknown whether GSA participation facilitates access to resources for substance use concerns. Using longitudinal data from 38 Massachusetts high schools, we compared sources of support for substance use concerns listed by GSA members (n = 361) and nonmembers (n = 1539). Subsequently, we tested whether GSA membership was associated with comfort, confidence and awareness regarding substance use resources in school and the community. Finally, we assessed whether specific GSA activities and discussions (e.g. social support) were associated with these outcomes. Among students with recent substance use, GSA membership was associated with greater comfort, confidence and awareness regarding school-based substance use resources in the spring semester, adjusted for fall semester levels and non-GSA club involvement. Furthermore, students in GSAs where members reported more advocacy and social support activities reported higher levels of comfort, confidence and awareness regarding community-based substance use resources. These results indicate that among students using alcohol or nicotine products, GSA members may be more receptive to school-based substance use prevention efforts. Furthermore, GSA-based social support and activism experiences may promote access to community-based substance use resources.

Depression, Anxiety, and Interest in Mental Health Resources in School-Based Gender-Sexuality Alliances: Implications for Sexual and Gender Minority Youth Health Promotion.

Schools can be a setting to address mental health needs of sexual and gender minority (SGM) youth. Gender-Sexuality Alliances (GSAs), as extracurricular support groups, provide an existing structure that could be leveraged to reach SGM youth and deliver services. Nevertheless, limited data indicate the prevalence of depression and anxiety among GSA members, how often GSAs discuss mental health, or their receptivity to resources. Participants in the current study were 580 youth (Mage = 15.59; 79% sexual minority, 57% cisgender female; 68% White) and 58 advisors in 38 GSAs purposively sampled across Massachusetts. Youth completed established measures of depression and anxiety; advisors reported how frequently their GSAs discussed mental health; and both reported their interest in mental health materials. Among youth, 70.1% scored above the threshold indicating probable mild depression, and 34.4% scored above the threshold suggesting concerning anxiety. Adjusted odds ratios indicated that the odds of depression and anxiety were higher for SGM members relative to heterosexual and cisgender members, particularly among youth reporting SGM identities that have been underrepresented. GSAs discussed mental health with some frequency over the school year. Youth and advisors expressed strong interest in resources. Findings support the case for developing selective and indicated school-based prevention programming for youth in GSAs to address their mental health needs.

Greater Engagement in Gender-Sexuality Alliances (GSAs) and GSA Characteristics Predict Youth Empowerment and Reduced Mental Health Concerns.

Extracurricular groups can promote healthy development, yet the literature has given limited attention to indirect associations between extracurricular involvement and mental health or to sexual and gender minority youth. Among 580 youth (Mage  = 15.59, range = 10-20 years) and adult advisors in 38 Gender-Sexuality Alliances (GSAs), multilevel structural equation models showed that greater engagement in GSAs over the school year predicted increased perceived peer validation, self-efficacy to promote social justice, and hope (baseline adjusted). Through increased hope, greater engagement indirectly predicted reduced depressive and anxiety symptoms at the year's end (baseline adjusted). GSAs whose members had more mental health discussions and more meetings reported reduced mental health concerns. Findings suggest how groups addressing issues of equity and justice improve members' health.

Extracurricular Settings as a Space to Address Sociopolitical Crises: The Case of Discussing Immigration in Gender-Sexuality Alliances Following the 2016 U.S. Presidential Election.

School-based extracurricular settings could promote dialogue on sociopolitical crises. We considered immigration discussions within Gender-Sexuality Alliances (GSAs), which address multiple systems of oppression. Among 361 youth and 58 advisors in 38 GSAs (19 in 2016-2017/Year 1; 19 in 2017-2018/Year 2), youth in Year 1 reported increased discussions from baseline throughout the remaining school year; differences were non-significant in Year 2. In both years, youth reporting greater self-efficacy to promote social justice, and GSAs with advisors reporting greater self-efficacy to address culture, race, and immigration discussed immigration more over the year (adjusting for baseline). In interviews, 38 youth described circumstances promoting or inhibiting discussions: demographic representation, open climates, critical reflection, fear or consequences of misspeaking, discomfort, agenda restrictions, and advisor roles.

The national implementation of Contingency Management (CM) in the Department of Veterans Affairs: Attendance at CM sessions and substance use outcomes.

BACKGROUND: In 2011, the Department of Veterans Affairs launched an initiative to expand patients' access to contingency management (CM) for the treatment of substance use disorders, particularly stimulant use disorder. This study evaluates the uptake and effectiveness of the VA initiative by presenting data on participation in coaching, fidelity to key components of the CM protocol, and clinical outcomes (CM attendance and substance use). METHODS: Fifty-five months after the first VA stations began offering CM to patients in June 2011, 94 stations had made CM available to 2060 patients. As those 94 VA stations began delivering CM to Veterans, their staff participated in coaching calls to maintain fidelity to CM procedures. As a part of the CM coaching process, those 94 implementation sites provided data describing the setting and structure of their CM programs as well as their fidelity practices. Additional data on patients' CM attendance and urine test results also were collected from the 94 implementation sites. RESULTS: The mean number of coaching calls the 94 programs participated in was 6.5. The majority of sites implemented CM according to recommended standard guidelines and reported high fidelity with most CM practices. On average, patients attended more than half their scheduled CM sessions, and the average percent of samples that tested negative for the target substance was 91.1%. CONCLUSION: The VA's CM implementation initiative has resulted in widespread uptake of CM and produced attendance and substance use outcomes comparable to those found in controlled clinical trials.

Challenges to Practicing HIV Sex-Risk Prevention Among People in Continuing Care for Cocaine Addiction.

BACKGROUND: Intimate partnerships are discouraged during early recovery, despite research that highlights their capacity to be resources for change. OBJECTIVE: This study seeks to provide descriptions of intimate partnerships and how such partnerships challenge and/or support minimizing HIV sex-risk among participants in continuing care for cocaine addiction in order to inform substance use programming. METHODS: Forty-two recorded continuing care counseling sessions of 33 people who discussed HIV sex-risk behavior were transcribed and analyzed using thematic analysis. This sample was derived from a larger randomized controlled trial that looked at the impact of a continuing care intervention for people with cocaine use problems. RESULTS: Although participants expressed the desire for a primary intimate partnership, casual intimate partnerships that often involved HIV sex-risk behavior were more prevalent. Challenges to having a primary intimate partner included the belief that intimate partnerships do not support recovery, difficulty in developing friendships with women among heterosexual men, and the ubiquity of drug use and sex work in home environments with limited economic opportunity. Despite these challenges, some participants reported having primary intimate partners that supported their recovery through open communication. CONCLUSION: Clinicians providing substance use interventions can consider encouraging components of intimate partnerships that support recovery. In addition, the strong environmental influence on individual HIV sex-risk behavior should be considered in delivering any substance use intervention.