Young Men Who Have Sex With Men and Substance Use: A Comparison of Venue-Based Sampling and Geosocial Networking Application Sampling.

To compare the demographics, sexual risk behaviors, and substance use characteristics of two probability samples of young men who have sex with men (YMSM): one recruited using a geosocial networking application (GSNA) and one recruited using venues. In 2017 and 2018, a cross-sectional online survey was utilized with a sample of 122 YMSM recruited in Los Angeles, CA. Recruitment procedures included both venue-based (n = 68) and GSNA-based probability sampling (n = 54). Sample substance use, sexual risk behaviors (e.g., unprotected sex at last encounter), and demographics were compared using chi-square tests and t-tests. The samples significantly differed in demographics characteristics (e.g., race, education, employment, outness). Samples did not significantly differ in sexual risk variables. Regressions indicated significant differences (higher in the venue sample) in substance use (marijuana, prescription drugs, alcohol, and poppers) between the two samples. Results indicate that recruitment method impacts demographics and substance use prevalence levels for YMSM. GSNA- based recruitment appears to recruit samples from a broader range of social demographics. GSNA-based methods may be especially applicable to areas in which venues are not readily accessible (e.g., rural areas), allowing social research with the most marginalized sexual minority populations.

Relationships between internalized stigma and depression and suicide risk among queer youth in the United States: a systematic review and meta-analysis.

Background: Queer youth experience high rates of depression and suicidality. These disparities stem from stigma-based stressors, including internalized stigma (i.e., negative social views that minoritized individuals internalize about their own identity). Given the importance of this factor in understanding mental health disparities among queer youth, we completed a systematic review and meta-analysis examining the relationships between internalized stigma and outcomes of depression and suicide risk (i.e., suicidal ideation, non-suicidal self-injury, and suicidal behavior). Methods: We followed the PRISMA standards. Six bibliographic databases were searched for studies in the United States from September 2008 to March 2022. Dual independent screening of search results was performed based on a priori inclusion criteria. Results: A total of 22 studies were included for data extraction and review. Most studies examined general internalized homophobia, with few examining internalized biphobia or transphobia. Many studies examined depression as an outcome, few studies examined suicidal ideation or behavior, and no studies examined non-suicidal self-injury. Meta-analyses model results show the association between general internalized queer stigma and depressive symptoms ranged r = 0.19, 95% CI [0.14, 0.25] to r = 0.24, 95% CI [0.19, 0.29], the latter reflecting more uniform measures of depression. The association between internalized transphobia and depressive outcomes was small and positive (r = 0.21, 95% CI [-0.24, 0.67]). General internalized queer stigma and suicidal ideation had a very weak positive association (r = 0.07, 95% CI [-0.27, 0.41]) and an even smaller, weaker positive association with suicide attempt (r = 0.02, 95% CI [0.01, 0.03]). Conclusion: Implications for clinical practice, policy, and future research are discussed.

Sexual Identity Fluidity and Depressive Symptoms: Findings From a National Longitudinal Study of Sexual Minority Adolescents.

PURPOSE: Sexual minority adolescents (SMAs) consistently report elevated risk of mental health symptoms, including depression. Sexual identities may change over time (referred as sexual identity fluidity), particularly during adolescence. This study examined the effect of sexual identity fluidity on depressive symptoms over time. METHODS: National longitudinal data were analyzed from SMAs aged 14-17 years (N = 1,077) in the adolescent stress experiences over time study during an 18-month period. Multigroup time-varying covariate latent growth models were employed to examine the effect of sexual identity fluidity on depressive symptoms. RESULTS: In the sample, 40% of SMAs reported at least 1 change in sexual identity during an 18-month period. Cisgender females reported sexual identity fluidity at a higher rate than their male counterparts (46.9% vs. 26.6%, respectively). In our first model (total sample), a change in sexual identity was associated with reporting fewer depressive symptoms (b = -0.591, p = .004). In our multigroup model (by sex assigned at birth), a change in sexual identity was significantly associated with reporting fewer depressive symptoms among cisgender females (b = -0.591, p < .01). However, there was no significant effect found among cisgender males. The models controlled for age and race or ethnicity. DISCUSSION: The results add to the limited knowledge on the complex relationship between sexual identity fluidity and mental health risks over time among adolescents. Our results indicate that sexual identity development and change processes differ between cisgender females and males. The nuances associated with these sexual identity processes need further investigation.

Development and Validation of the Military Minority Stress Scale.

Despite affecting nearly 3% of active-duty service members, little is known about how LGBT-related stress experiences may relate to health outcomes. Thus, the present study sought to create a Military Minority Stress Scale and assess its initial reliability and construct validity in a cross-sectional study of active-duty LGBT service members (N = 248). Associations between 47 candidate items and health outcomes of interest were analyzed to retain those with substantial betas. Item response theory analyzes, reliability testing, invariance testing, and exploratory factor analysis were performed. Construct validity of the final measure was assessed through associations between the sum score of the final measure and the health outcomes. The final 13-item measure demonstrated an excellent reliability (ω = 0.95). Bivariate linear regressions showed significant associations between the sum score of the measure and overall health (ß = -0.26, p < 0.001), overall mental health (ß = -0.34, p < 0.001), physical health (ß = 0.45, p < 0.001), life satisfaction (ß = -0.24, p < 0.001), anxiety (ß = 0.34, p < 0.001), depressive symptoms (ß = 0.37, p < 0.001), suicidality (ß = 0.26, p < 0.001), and PTSD (ß = 0.42, p < 0.001), respectively. This study provides the first evidence that minority stressors in the military setting can be operationalized and measured. They appear to have a role in the health of LGBT service members and may explain the continued health disparities experienced by this population. Little is known regarding the experiences of LGBT active-duty service members, including experiences of discrimination. Understanding these experiences and their associated health outcomes during military service may therefore help and guide further etiological studies and intervention development.

"That's kind of like the big struggle right now is can we get PrEP?": Facilitators and Barriers to PrEP Uptake Among Active Duty Gay and Bisexual Men.

Introduction: The US Military is experiencing a rise in HIV infections among gay and bisexual men (GBM) serving on active duty, yet little is known about this population's uptake of pre-exposure prophylaxis (PrEP), an evidence-based intervention for HIV prevention. This mixed methods study examines the facilitators and barriers to PrEP access and uptake among active duty GBM. Methods: Active duty GBM were recruited using respondent-driven sampling (2017 and 2018). Participants (n = 93) answered quantitative survey questions on PrEP interest and accessibility. Another set of participants (n = 10) discussed their PrEP experiences in qualitative interviews. We conducted descriptive and bivariate analyses of quantitative data, while qualitative data were analyzed using structural and descriptive coding techniques. Results: Approximately 71% of active duty GBM indicated interest in accessing PrEP. A greater proportion of those who disclosed (vs. did not disclose) their sexual orientation to their military doctor discussed (p < 0.001) or accessed (p = 0.017) PrEP. The following qualitative themes emerged: (1) providers' negative views and knowledge gaps related to PrEP; (2) lack of a systems approach to PrEP access; (3) confidentiality concerns; and (4) reliance on peer networks for PrEP guidance and support. Conclusions: Study results indicate that active duty GBM are interested in and want to discuss PrEP with their military doctors, but gaps in providers' PrEP-related knowledge and skills, as well as mistrust in the military health care system, remain. Policy Implications: A system-wide approach that addresses confidentiality concerns and removes procedural barriers to PrEP access is recommended to improve PrEP uptake in this population.

Longitudinal association of homonegative school climate with body dysmorphic disorder among cisgender sexual minority adolescents: Testing mediation through proximal minority stressors.

In a US national cohort study of cisgender sexual minority adolescents (SMAs), we prospectively (1) assessed whether within-person changes in homonegative school climate (i.e., school contextual factors that lead SMAs to feel unsafe or threatened) were associated with risk of probable body dysmorphic disorder (BDD) and (2) tested whether internalized homonegativity and negative expectancies mediated this association. Data came from consecutive time points (18-month, 24-month, 30-month) of the Adolescent Stress Experiences over Time Study (ASETS; N = 758). The Body Dysmorphic Disorder Questionnaire measured probable BDD. Sexual Minority Adolescent Stress Inventory subscales measured past 30-day minority stress experiences. Multilevel models were specified with person mean-centered predictor variables to capture within-person effects. Across one year of follow-up, 26.86% screened positive for probable BDD at least once. Model results indicated significant total (risk ratio [RR]=1.43, 95% credible interval [CI]=1.35-1.52) and direct effects (RR=1.18, 95% CI=1.05-1.34) of homonegative school climate. Internalized homonegativity was independently associated with probable BDD (RR=1.28, 95% CI=1.12-1.46) and mediated 49.7% (95% CI=12.4-82.0) of the total effect. There was limited evidence of mediation via negative expectancies. Implementing SMA-protective school policies and targeting internalized homonegativity in clinical practice may reduce the prevalence and incidence of probable BDD among cisgender SMAs.

Nominal Versus Realized Costs of Recruiting and Retaining a National Sample of Sexual Minority Adolescents in the United States: Longitudinal Study.

BACKGROUND: Web-based recruitment for research studies is becoming increasingly popular and necessary. When compared with the traditional methods of recruitment, these methods may enable researchers to reach more diverse participants in less time. Social media use is highly prevalent among adolescents, and the unique context of social media may be particularly important for the recruitment of sexual minority young people who would not be captured by traditional methods. OBJECTIVE: This paper described the details of a national web-based study recruitment approach aimed at sexual minority adolescents across the United States, focusing on important details of this relatively novel approach, including cost, time efficiency, and retention outcomes. METHODS: This study recruited sexual minority adolescents aged 14-17 years living in the United States through targeted advertisements on Facebook, Instagram, and YouTube and through respondent-driven sampling (RDS). Potential participants completed eligibility screening surveys and were automatically directed to a baseline survey if they were eligible. After baseline survey completion, additional data checks were implemented, and the remaining participants were contacted for recruitment into a longitudinal study (surveys every 6 months for 3 years). RESULTS: Recruitment lasted 44 weeks, and 9843 participants accessed the initial screening survey, with 2732 (27.76%) meeting the eligibility criteria and completing the baseline survey. Of those, 2558 (93.63%) were determined to have provided nonfraudulent, usable study data and 1076 (39.39%) subsequently enrolled in the longitudinal study. Of the baseline sample, 79.05% (2022/2558) was recruited through Facebook and Instagram, 3.05% (78/2558) through YouTube, and 17.9% (458/2558) through RDS. The average cost of recruiting a participant into the study was US $12.98, but the recruitment cost varied by method or platform, with a realized cost of US $13 per participant on Facebook and Instagram, US $24 on YouTube, and US $10 through RDS. Participant differences (sex assigned at birth, race and ethnicity, sexual orientation, region, and urbanicity) were identified between platforms and methods both in terms of overall number of participants and cost per participant. Facebook and Instagram were the most time efficient (approximately 15 days to recruit 100 participants), whereas RDS was the least time efficient (approximately 70 days to recruit 100 participants). Participants recruited through YouTube were the most likely to be longitudinally retained, followed by Facebook and Instagram, and then RDS. CONCLUSIONS: Large differences exist in study recruitment cost and efficiency when using social media and RDS. Demographic, region, and urbanicity differences in recruitment methods highlight the need for attention to demographic diversity when planning and implementing recruitment across platforms. Finally, it is more cost-effective to retain than recruit samples, and this study provided evidence that with thorough screening and data quality practices, social media recruitment can result in diverse, highly involved study populations.

Digital Sexual Violence and Suicide Risk in a National Sample of Sexual Minority Adolescents.

This paper aimed to examine the association between digital sexual violence (threat to post or nonconsensual posting of sexually explicit media) and suicidal (ideation, planning, and attempt) and non-suicidal self-harm behavior. The data for the current analysis come from an online sample of sexual minority adolescents (aged 14-17) recruited from across the United States (n = 970). Multivariate logistic regressions were used to examine the association between digital sexual violence with suicide (ideation, planning, and attempt) and self-harm. In the sample, 9.1% of participants reported being threatened to have their sexually explicit media posted without their consent, while 6.5% reported their sexually explicit media had been posted without their consent. Threat to post sexually explicit media without consent was associated with higher odds of reporting suicidal ideation (odds ratio [OR] = 1.88), suicide plan (OR = 2.12), suicide attempt (OR = 3.56), and self-harm (OR = 1.96). While nonconsensual posting of sexually explicit media was associated with higher odds of reporting suicidal ideation (OR = 1.82) and suicide attempt (OR = 2.20). All models controlled for age, assigned sex at birth, sexual identity, and race and ethnicity. These findings underscore important considerations and future research directions. Given the associations between digital sexual violence and suicide risk among sexual minority adolescents, suicide prevention efforts with adolescents must be responsive to the needs of sexual minority adolescents and the changing landscape of sexual violence in digital spaces. Future research should examine the trajectories of digital sexual violence among adolescents and comparative analyses by demographic subgroups to better understand changes in these processes over time.

Greater lifetime stressor exposure is associated with poorer mental health among sexual minority people of color.

BACKGROUND: Research has shown that sexual minority people of color experience pervasive and sometimes severe life stressors that increase their risk of experiencing mental health problems, and that can contribute to lifelong health disparities. However, no studies in this population have investigated stressor exposure occurring over the entire lifespan. Moreover, it remains unknown whether these stressor-health effects differ based on the timing or types of stressors experienced. PURPOSE: The purpose of this study is to examine how cumulative lifetime stressor exposure is associated with mental health among Black, Latinx, and biracial Black-Latinx sexual minority persons. METHOD: Participants were 285 ethnic/racial minority young adults (Mage = 25.18 years old, SD = 1.94, age range = 19-29 years), who completed the Stress and Adversity Inventory for Adults to assess for retrospective reports of lifetime stressor count and severity. The Brief Symptom Inventory was used to assess participants' symptoms of anxiety, depression, and somatization, which were the main outcomes. Most participants identified as cisgender male (94.7%) and gay (74.2%), with the remaining participants identifying as transgender or genderqueer/nonbinary for gender and bisexual/pansexual, queer, or another sexual orientation. RESULTS: Multiple regression analyses indicated that experiencing more-and more severe-stressors across the lifespan was related to greater anxiety, depressive, and somatization symptoms. These effects were robust while controlling for race/ethnicity, sexual orientation, education, and employment status, and they differed based on stressor exposure timing, type, primary life domain, and core social-psychological characteristic. CONCLUSION: Greater cumulative lifetime stressor exposure is related to poorer mental health among sexual minority people of color. Screening for lifetime stressors may thus help identify at-risk persons and provide an opportunity to intervene to help mitigate or prevent mental health disparities in multiply stigmatized adults.

The Development of Proud & Empowered: An Intervention for Promoting LGBTQ Adolescent Mental Health.

Sexual and gender minority adolescents (SGMA) experience higher rates of internalizing psychopathology, including depression, anxiety, self-harm, and posttraumatic stress disorder. The primary explanation for these mental health disparities is minority stress theory, which suggests that discrimination, violence, and victimization are key drivers of chronic minority stress and place SGMA at higher risk of mental health concerns. To help address these concerns, the authors undertook a nearly 8-year process of developing Proud & Empowered, a school-based intervention to help SGMA cope with minority stress experiences. This manuscript details the intervention development process, including: (a) identifying the mechanisms of change (Stage 0), (b) building the intervention (Stage 1A, Part 1), (c) acceptability testing and program revision (Stage 1A, Part 2), (d) feasibility and pilot testing (Stage 1B, Part 1), (e) modification of the intervention to improve implementability (Stage 1B, Part 2), and (f) the final intervention.

Heterosexist Bullying Victimization and Perpetration and Substance Use Among Heterosexual Adolescents.

BACKGROUND: Although heterosexist bullying mainly affects sexual minority adolescents, heterosexual adolescents may also be targets. Research is needed to understand the impact of heterosexist bullying victimization on heterosexual adolescents' behavioral health. Moreover, there is a dearth of research examining the negative consequences of perpetrating heterosexist bullying among heterosexual adolescents. The purpose of this study was to examine the associations between heterosexist bullying victimization and perpetration and substance use in a racially diverse sample of heterosexual adolescents. METHODS: A probability sample of middle and high school heterosexual students (N = 2,337; aged 11-19; 52.7% female; 35.9% Black or African American and 31.9% White) using random cluster methods was obtained from a southeastern US school district. Multiple logistic regression models were used to test the relationships between experiencing and perpetrating heterosexist bullying and substance use while accounting for sociodemographics. RESULTS: Of the participants, 7.1% reported heterosexist bullying victimization and 7.8% reported perpetration of heterosexist bullying. Of those engaging in heterosexist bullying, 29.5% also experienced it as a victim. Perpetrating heterosexist bullying was associated with greater odds of recent and lifetime alcohol, cigarette, e-cigarette, cannabis, and prescription drug use. Heterosexist bullying victimization was only associated with recent and lifetime cigarette use and lifetime e-cigarette use. CONCLUSIONS: The results demonstrate the negative correlates of heterosexist bullying victimization and perpetration on heterosexual adolescents' substance use. The findings underscore the need to address sexual stigma, such as heterosexist bullying, among not only adolescents experiencing it but also its perpetrators to help reduce substance use among all adolescents.

Age Differences in the Associations Between Outness and Suicidality Among LGBTQ+ Youth.

OBJECTIVE: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth are at increased risk for suicidality compared to their heterosexual and cisgender peers, and outness (the extent to which an individual is open about their LGBTQ+ identity to others) is an important correlate of suicidality. However, previous research has led to mixed findings regarding whether outness functions as a risk or protective factor for suicidality, and the available evidence suggests that age may play an important role. As such, the goal of the current study was to examine whether the associations between outness and suicidality differed between LGBTQ+ adolescents (ages 12-17) and emerging adults (ages 18-24). METHOD: The analytic sample included 475 LGBTQ+ youth who completed an online survey after contacting a national, LGBTQ+ crisis service provider. RESULTS: Results indicated that age significantly moderated the association between outness and suicidal ideation, such that greater outness was significantly associated with greater suicidal ideation for adolescents, but not for emerging adults. In contrast, age did not significantly moderate the associations between outness and likelihood of a past suicide attempt or perceived likelihood of a future suicide attempt. However, the main effect of outness was significant in both models, such that greater outness was significantly associated with a greater likelihood of a past suicide attempt and a greater perceived likelihood of a future suicide attempt. CONCLUSIONS: These findings suggest that the associations between outness and suicidality among LGBTQ+ youth may depend on age as well as the dimension of suicidality (ideation versus attempt). HighlightsBeing more open about one's LGBTQ+ identity may confer risk for suicidality.The influence of outness on suicidal ideation may be strongest during adolescence.There is a need for LGBTQ+ affirming policies and laws to reduce suicidality.

Explaining behavioral health differences in urban and rural sexual minority adolescents: A longitudinal investigation of minority stress in a diverse national sample of sexual minority adolescents: A longitudinal investigation of minority stress in a diverse national sample of sexual minority adolescents.

PURPOSE: Experiences of sexuality-based discrimination (ie, minority stressors) against youth who identify as nonheterosexual (ie, sexual minority) have been associated with increased symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD) for sexual minority adolescents (SMA; ages 14-17). However, little is known about the experiences of SMA living in rural communities across the United States. Thus, the present study sought to examine differences in mental health patterns between urban and rural dwelling SMA, and to see whether these differences are, at least in part, explained by experiences of lifetime minority stress. METHODS: A nationwide sample of SMA residing in the United States (N = 2,558; aged 14-17, M = 15.90 years, SD = 0.98) was recruited through purposive social media and respondent-driven sampling methods to complete a cross-sectional survey online. Measures included those of minority stress, urbanicity, and symptoms of anxiety, depression, and PTSD. Parallel multiple mediation (PMM) analysis was employed to test whether urbanicity was associated with anxiety, depressive, and PTSD symptoms through reported lifetime minority stress. FINDINGS: On average, SMA living in rural areas significantly reported more lifetime minority stress, depressive, and PTSD symptoms than SMA living in urban settings. Results from our PMM analysis indicated that heightened experiences of lifetime minority stress indirectly linked the effects of living in rural areas on anxiety (b = -0.288, 95% CI = [-0.491, -0.085]), depressive (b = -0.158, 95% CI = [-0.270, -0.047), and PTSD symptoms PTSD (b = -0.349, 95% CI = [-0.596, -0.105]). The model accounted for 16.8%, 18%, and 24.1% of the variability in anxiety symptoms, depressive symptoms, and PTSD symptoms, respectively. CONCLUSIONS: SMA in our study who reside in rural areas reported elevated minority stress, depressive, and PTSD symptoms as compared to their urban dwelling peers. Our study found that lifetime experiences of minority stress fully mediated the relationship between urbanicity and both depressive and PTSD symptoms, and partially mediated the relationship between urbanicity and anxiety. These findings highlight the need to increase support for rural youth who are growing into adulthood and may find continuing challenges in their family, peer, and community relationships.

A Trans Youth of Color Study to Measure Health and Wellness: Protocol for a Longitudinal Observation Study.

BACKGROUND: Growing research on transgender youth is accounting for the variety of ways in which young people define their genders and sexualities. Because of this growing representation, more research is needed to understand how intersectional identities and stigma affect risk for HIV acquisition along the HIV care continuum and engagement in mental and physical health care. Little is known about accessibility to HIV-related prevention services of nonbinary and transmasculine youth, and further understanding of the impacts on transfeminine people-those who have historically faced the highest prevalence of HIV positivity-is crucial. OBJECTIVE: The overarching aims of the Trans Youth of Color Study are to conduct longitudinal research with a cohort of transgender minority youth (TGMY), explore factors that aid in the prevention of new HIV infection and transmission, and reduce HIV- and AIDS-related disparities by focusing on successful engagement in care. Findings from this research will be used to inform the development of new interventions designed to engage TGMY in the HIV prevention and care continua. METHODS: Longitudinal research (baseline and follow-up assessments every 6 months for 3 waves of data collection) followed a cohort (N=108) of transgender youth of color recruited in Los Angeles, California, United States. Participants were recruited using multiple community-informed strategies, such as from local venues, social media, and participant referral. In addition to self-report surveys, urine was collected to assess recent use of illicit drugs, and blood, rectal, and throat swabs were collected to test for current sexually transmitted infection and HIV infection. Additional blood and plasma samples (10 mL for 4 aliquots and 1 pellet) were collected and stored for future research. RESULTS: Participants in the Trans Youth of Color Study were recruited between May 25, 2018, and December 7, 2018. Baseline and longitudinal data are being analyzed as of August 2022. CONCLUSIONS: The findings from this research will inform adaptations to existing evidence-based HIV prevention interventions and help to guide new interventions designed to engage TGMY, especially those who are Black, Indigenous, or people of color, in the HIV prevention and care continua. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/39207.

Combining the HYM (Healthy Young Men's) Cohort Study and the TRUTH (A Trans Youth of Color Study): Protocol for an Expanded Mixed Methods Study Renewal.

BACKGROUND: As we enter the fifth decade of the AIDS epidemic, health researchers and AIDS activists reflect both on the progress that has been made and the importance of continued prevention efforts for those most at risk. As HIV infection rates continue to fluctuate across communities, a trend has emerged with new HIV infections becoming increasingly concentrated-with cascading effects-among people aged <30 years, from marginalized racial and ethnic groups, and who are sexual or gender minorities. OBJECTIVE: In this paper, we discuss the renewal of the Healthy Young Men's (HYM) Cohort Study and the addition of a subcohort-TRUTH: A Transgender Youth of Color Study. The overarching aim of our renewed study was to inform new intervention strategies; understand linkage to care; and examine changes over time with respect to minority-related stress and intersectional identities and their relationship with substance use, mental health, and HIV risk. Findings from this study will help to inform the development of new interventions designed to engage African American and Black and Latino young men who have sex with men (YMSM) and transgender and gender minority youth in the HIV prevention and care continua and to reduce risk by addressing pathways of minority-related stress and intersectional stigma. METHODS: Longitudinal study (baseline and follow-up assessments every 6 months for a total of 8 waves of data collection) is ongoing with reconsented cohort from the last iteration of HYM Cohort Study. This study protocol includes self-report survey, collection of urine to assess recent use of illicit drugs, and collection of blood and rectal and throat swabs to test for current sexually transmitted infection and HIV infection. An additional sample of blood and plasma (10 mL for 4 aliquots and 1 pellet) is also collected and stored in the HYM Cohort Study biorepository for future studies. This mixed methods study design includes collection of triangulated analysis of quantitative, qualitative, and biological measures (ie, drug use, sexually transmitted infection and HIV testing, and adherence to antiretroviral therapy among participants who are HIV+) at baseline and every 6 months. RESULTS: As of February 2022, participants from the past 4 years of the HYM Cohort Study and TRUTH: A Transgender Youth of Color Study Cohort have been reconsented and enrolled into the renewal period of longitudinal data collection, which is projected from summer of 2020 until summer of 2025. Recruitment is ongoing to reach our target enrollment goal of YMSM and transgender minority youth. CONCLUSIONS: The findings from this study are being used to inform the development of new, and adaptation of existing, evidence-based HIV prevention interventions designed to engage populations of transgender and gender minority youth and YMSM in the HIV prevention and care continua. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/39232.

Sexual Orientation Change among Adolescents and Young Adults: A Systematic Review.

This article reviews research on changes in self-reported sexual orientation labels and associated health outcomes among adolescents and young adults. Using seven electronic databases and supplementary methods, we identified 30 studies for inclusion in the review, published between 2000 and 2020. This review aimed to summarize the approaches to measuring sexual orientation change; the prevalence, patterns, and directionality of changes in sexual identity; and how changes in sexual orientation relate to health outcomes among adolescents and youth adults. The reviewed studies lacked agreement in operationalization and assessment of sexual orientation changes. Prevalence of change in self-reported sexual orientation differed by birth sex, whereby cisgender female participants were more likely to report a change than male participants. In addition, adolescents and youth identifying with a nonheterosexual orientation or sexual minority at baseline were more likely to report a change in sexual orientation. Few studies reported on the impact of changes in sexual orientation on behavioral health outcomes. Adolescents who reported either nonheterosexual orientation at baseline or a shift toward nonheterosexual orientation had a greater likelihood of reporting depressive symptomology, suicidality, and substance use compared to those who did not report a change or reported consistent heterosexuality. Recommendations for future research and implications for practice are discussed.

What affects timely linkage to HIV Care for Young Men of Color who have sex with Men? Young Men's Experiences Accessing HIV Care after Seroconverting.

The HIV care continuum provides intervention points that should be addressed to optimally identify, engage, and retain populations in HIV care. This study addressed the lack of research into barriers and facilitators of linkage to care for HIV-positive young men who have sex with men (YMSM) of color. Data were collected using a qualitative timeline follow-back interview approach with YMSM who had seroconverted in the last 6 months. Interviews were conducted with 15 YMSM from April 2017 to April 2018. This study provides important information about what can delay linkage to care for YMSM of color. These delays include fractured referrals to care providers via mobile HIV testing vans, adapting to an HIV diagnosis and integrating it into their lives, and finding caring and competent providers that offer wraparound services, specifically mental health services, as soon as possible after an HIV diagnosis. Addressing these issues is imperative to optimize YMSM's engagement in the HIV care continuum and work toward ending the epidemic.

Access to health services among sexual minority people in the United States.

Sexual minority people in the United States are less likely to have access to health services when compared to their heterosexual counterparts. Less is known about the within-group sociodemographic memberships among sexual minority people regarding access to health services. Using data from a nationally representative sample, a series of univariate and bivariate analyses were used to determine associations between sociodemographic group membership and access to health services. Results suggest there are significant differences in access to health services within the sexual minority population. Differences in access to health services when considering sex-at-birth, sexual identity, age, race/ethnicity, urbanicity, education level and income status were found. These findings offer insight into the role sociodemographic group membership has on the equity of access to health services. Specifically, results indicated that disproportionate access to health services among sexual minority people were more pronounced among those with group membership who experience social marginalisation. This was particularly true for sexual minority people who were bisexual, younger, Black and Latinx, lower-income earners and sexual minority people with less education attainment. Results from this study may be used to inform policies and practices aimed at improving access to health services including, but not limited to, the expansion of the Affordable Care Act and continued development of Federally Qualified Health Centers, while acknowledging the role of within-group differences among sexual minority people.

Adolescent stress experiences over time study (ASETS) protocol: design and methods of a prospective longitudinal study of sexual minority adolescents in the USA.

INTRODUCTION: Sexual minority adolescents (SMA) report higher rates of anxiety, self-harm, depression and suicide than heterosexual peers. These disparities appear to persist into adulthood and may worsen for certain subgroups, yet the mechanisms that drive these concerns remain poorly understood. Minority stress theory, the predominant model for understanding these disparities, posits that poorer outcomes are due to the stress of living in a violently homophobic and discriminatory culture. Although numerous studies report associations between minority stress and behavioural health in adolescence, no study has comprehensively examined how minority stress may change throughout the course of adolescence, nor how stress trajectories may predict health outcomes during this critical developmental period. METHODS AND ANALYSIS: Between 15 May 2018 and 1 April 2019, we recruited a US national sample of diverse SMA (n=2558) age 14-17 through social media and respondent-driven sampling strategies. A subset of participants (n=1076) enrolled in the longitudinal component and will be followed each 6 months until 1 July 2022. Primary outcomes include symptoms of depression, anxiety and post-traumatic stress disorder; suicidality and self-harm and substance use. The key predictor is minority stress, operationalised as the Sexual Minority Adolescent Stress Inventory. We will use parallel cohort-sequential latent growth curve models to test study hypotheses within a developmental framework. ETHICS AND DISSEMINATION: All participants provided assent to participate, and longitudinal participants provided informed consent at the first follow-up survey after reaching age 18. All study procedures were reviewed and approved by the University of Southern California Social-Behavioral Institutional Review Board, including a waiver of parental permission given the potential for harm due to unintentional 'outing' to a parent during the consent process. The final anonymous data set will be available on request, and research findings will be disseminated through academic channels and products tailored for the lay community.