Firearm Access and Socio-Structural Factors Related to Suicidality Among Youth With Diverse Sexual, Gender, and Racial Identities.

OBJECTIVE: Elevated rates of suicidal ideation (SI) and suicide attempts (SA) among youth, particularly multiply marginalized youth, are occurring in the context of youths' access to household firearms. Research examining how perceived access to firearms is related to SI and SA among youth with marginalized identities is limited and often neglects to consider intersectionality. This study explored how intersecting social identities and positions, access to firearms, and socio-structural factors were associated with SI and SA for youth. METHOD: The analytic sample (N = 17,794) included 7-12th grade students who participated in the 2021 Dane County Youth Assessment. Exhaustive CHAID - a decision tree matrix approach - examined all possible combinations of self-reported sociodemographic characteristics (gender identity, sexual identity, racial identity, grade, and firearm access) and socio-structural variables (bias-based bullying, school belongingness, and social pressure) to predict mutually exclusive groups of youth based on past-year SI and SA. RESULTS: SI and SA was most prevalent among intersectional groups with multiply marginalized identities and access to firearms. Socio-structural factors, including bias-based bullying victimization, lack of school belongingness, and social pressure, were characteristic of groups with higher prevalence of SI and SA. CONCLUSIONS: While the marginalized youth in this sample have lower access to firearms, the prevalence of SI and SA was highest among multiply marginalized youth who reported access to firearms in the context of bias-based bullying, social pressure, and a lack of school belongingness. Youth suicide prevention efforts would be strengthened by policies that address firearm access and improve the school environment.

There was a higher prevalence of suicidality among marginalized youth, particularly those with firearm access.Bullying, belonging, and social pressure informed patterns in youth suicidality.Youth suicide prevention should address firearm access and school environment.

Interpersonal protective factors for LGBTQ+ youth at multiple intersecting social identities and positions.

Interpersonal supports are protective against multiple negative health outcomes for youth such as emotional distress and substance use. However, finding interpersonal support may be difficult for youth exposed to intersecting racism, heterosexism, and cisgenderism, who may feel they are "outsiders within" their multiple communities. This study explores disparities in interpersonal supports for youth at different sociodemographic intersections. The 2019 Minnesota Student Survey includes data from 80,456 high school students, including measures of four interpersonal supports: feeling cared about by parents, other adult relatives, friends, and community adults. Exhaustive Chi-square Automatic Interaction Detection analysis was used to examine all interactions among four social identities/positions (racialized/ethnic identity, sexual identity, gender identity, sex assigned at birth) to identify groups who report different rates of caring from each source (Bonferroni adjusted p<.05). In the overall sample, 69.24% perceived the highest level of caring ("very much") from parents, 50.09% from other adult relatives, 39.94% from friends, and 15.03% from community adults. Models identified considerable differences in each source of support. For example, more than 72% of straight, cisgender youth reported their parents cared about them very much, but youth who identified as LGBQ and TGD or gender-questioning were much less likely to report high parent caring (less than 36%) across multiple racialized/ethnic identities and regardless of sex assigned at birth. Findings highlight the importance of better understanding the ways interpersonal support might differ across groups, and underscore a need for intersectionality-tailored interventions to develop protective interpersonal supports for LGBTQ+ youth, rather than one-size-fits-all approaches.

Emotional Distress Disparities Across Multiple Intersecting Social Positions: The Role of Bias-Based Bullying.

OBJECTIVES: To apply an intersectional lens to disparities in emotional distress among youth, including multiple social positions and experiences with bias-based bullying. METHODS: Data are from the 2019 Minnesota Student Survey (n = 80 456). Social positions (race and ethnicity, sexual orientation, gender) and 2 forms of bias-based bullying (racist, homophobic or transphobic) were entered into decision tree models for depression, anxiety, self-injury, suicidal ideation, and suicide attempts. Groups with the highest prevalence are described. Rates of emotional distress among youth with matching social positions but no bias-based bullying are described for comparison. RESULTS: LGBQ identities (90%) and transgender, gender diverse, and questioning identities (54%) were common among the highest-prevalence groups for emotional distress, often concurrently; racial and ethnic identities rarely emerged. Bias-based bullying characterized 82% of the highest-prevalence groups. In comparable groups without bias-based bullying, emotional distress rates were 20% to 60% lower (average 38.8%). CONCLUSIONS: Findings highlight bias-based bullying as an important point for the intervention and mitigation of mental health disparities, particularly among lesbian, gay, bisexual, transgender, gender-diverse, queer, and questioning adolescents. Results point to the importance of addressing bias-based bullying in schools and supporting lesbian, gay, bisexual, transgender, gender-diverse, queer, and questioning students at the systemic level as a way of preventing emotional distress.

Unaccompanied unstable housing among racially, ethnically, sexually, and gender diverse youth: Intersecting identities bearing the greatest burden.

Disparities in youth homelessness by racial/ethnic, sexual, and gender identities are well documented, though this literature lacks specificity regarding intersectional social identities of youth who are most likely to experience homelessness. Population-based cross-sectional data on youth from the 2019 Minnesota Student Survey (N = 80,456) were used to examine the relationship between parent caring and intersections of minoritized identities that experience the highest prevalence of two distinct types of unaccompanied unstable housing with expanded categories of sexual and gender identities. Exhaustive chi-square automatic interaction detection models revealed that low parent caring was the most common predictor of unaccompanied homelessness and running away, but there was important variation among youth of color at the intersection of sexual and gender identities. The findings reveal a more complex story of disparities in unaccompanied unstable housing among youth with multiple marginalized social identities and highlight the need to create culturally informed prevention and intervention strategies for parents of LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and questioning) youth of color. The implications for prevention and intervention among subgroups with the highest prevalence are discussed in the context of interlocking systems of power and oppression. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Predictors of Adolescent Intimate Partner Sexual Violence Victimization: Patterns of Intersectional Social Positions in a Statewide, School-based Sample.

Intimate partner sexual violence (IPSV) is a substantial public health issue faced by youth, with disparities along lines of race, gender, and sexual orientation. Using an intersectional framework, the current study describes the prevalence of self-reported IPSV victimization across intersecting social positions among adolescents. High school students who completed the 2019 Minnesota Student Survey were asked whether they had ever experienced IPSV. Using exhaustive Chi-Square Automatic Interaction Detection (eCHAID), responses were modeled using five indicators: racial/ethnic identity, transgender/genderqueer/genderfluid identity, sex assigned at birth, sexual orientation, and school location. The prevalence of IPSV victimization within each end group identified by the eCHAID varied from 2.6% to 32.0%. The highest prevalence of IPSV among all students was observed in subgroups defined by multiple marginalized social positions; for example, 32.0% among lesbian, gay, bisexual, queer, pansexual, or questioning (LGBQ+) students of color who were transgender, genderqueer, genderfluid or unsure of their gender, and assigned male at birth; 22.8% among LGBQ+ students assigned female at birth and enrolled in a Greater Minnesota (outside of the Twin Cities) school; and 22.2% among Native+ or missing race LGBQ+ students assigned female at birth and enrolled in a metropolitan school. Within the eCHAID decision tree, several subsamples of students were split into two more subsamples with a twofold or greater statistically significant difference in IPSV victimization prevalence between them. Findings from this study highlight notable disparities in the prevalence of IPSV victimization among Minnesota youth and demonstrate the importance of detailing the distribution of interpersonal violence outcomes across youth with multiple marginalized identities. Findings suggest that disparities reported along one categorical axis only may miss important nuances in how risk for IPSV is distributed. Population health researchers should utilize methods that allow for the explication of complex intersections that characterize individuals' social positions in estimating the prevalence of sexual violence.

Differences in the Prevalence of Adolescent Sexual Identity: Results of Expanding Survey Response Options.

PURPOSE: To describe the prevalence of sexual identity by grade, racial and ethnic identities, and sex assigned at birth. METHODS: Data came from the statewide 2022 Minnesota Student Survey of eighth, ninth, and 11th grade students (N = 99,688). Chi-square tests compared the prevalence of sexual identity across grades, racial/ethnic groups, and sex assigned at birth. RESULTS: Over a fifth (22.2%) of students self-reported a minoritized sexual identity. Bisexual and pansexual were most common among Native+ (12.3%, 5.7%, respectively), multiracial (11.6%, 4.4%, respectively), and Latina/x/o (10.4%, 4.1%, respectively) youth. Asexuality was consistently reported across grades, and eighth graders reported gay/lesbian, bisexual, and queer identities less than 11th graders. Youth assigned female at birth were more likely to report gay/lesbian, bisexual, asexual, pansexual, queer, and questioning than youth assigned male at birth. DISCUSSION: Results support the continued use of further expanded sexual identities in epidemiologic surveys.

Are HIV Prevention Services Reaching all LGBTQ+ Youth? An Intersectional Analysis in a National Sample.

Although research has examined disparities in HIV prevention behaviors, intersectional research is needed to understand who may be underserved. This study examines disparities in consistent condom use, HIV testing, and PrEP awareness and use across assigned sex, gender identity, sexual orientation, and racial/ethnic identity in a large sample of sexually active LGBTQ+ youth (mean age = 16.5) who completed the 2022 LGBTQ National Teen Survey. Four social identities were included as indicators in Chi-Square Automated Interaction Detection models to uncover disparate rates of HIV preventive behaviors. Generally, HIV testing and PrEP services were higher among gay/lesbian and queer youth assigned male, and lower among those assigned female. Certain LGBTQ+ youth may be systematically missed by these services, (e.g., those assigned female; those assigned male who also identify as bisexual, pansexual, asexual, questioning, or straight (and trans/gender diverse)). Providers should strive to serve populations who are not being reached by HIV prevention services.

RESUMEN: Aunque las investigaciones han examinado disparidades en los comportamientos de prevención del VIH, la aplicación de un esquema interseccional es necesario para entender quienes tienen menos acceso a los cuidados de la salud. Este estudio examina disparidides en el uso del condón, las pruebas de VIH y el conocimiento y el uso de profilaxis preexposición (PrEP) entre el sexo asignado, la identidad del género, la orientación sexual, la identidad racial/étnica) en una muestra nacional de jovenes (edad promedia = 16.5), LGBTQ+. Cuatro identidades sociales estuvieron incluidas como indicadores en el modelo de la Detección de la Interacción Automática de Chi-Square para detectar diferencias de comportamientos de prevención. Generalmente, el uso de las pruebas de VIH y los servicios de PrEP estaban mas alto entre los jovenes gay/lesbiana y queer asignados masculinos y mas bajo entre jóvenes asignadas femeninas. Es posible que ciertos jovenes LGBTQ+ estén omitidos de los servicios de las pruebas de VIH y PrEP, incluyendo jóvenes que fueron asignadas feminidas, ovenes bisexuales, pansexuales, asexuales, cuestionando, o heterosexuales (transgénero/a/e o de diversos géneros) que fueron asignados masculinos. Los profesionales de salud deben luchar para servir a las poblaciones que están fuera del alcance de los servicios preventivos del VIH.

Gender-inclusive clinical screeners: Using CBCLs and YSRs in a clinic-based sample of transgender/gender-diverse youth.

This study examines differences in score profiles on the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) for transgender and gender-diverse (TGD) youth in a clinical setting. Data were collected from youth receiving services at a gender care clinic in the Midwestern United States. Inclusion criteria were youth that identify as transgender, nonbinary, or another gender-diverse identity label between the ages of 6 and 18 and received services between October 2017 and November 2021. The analytic sample (N = 177) included 51.4% transmasculine, 17.5% transfeminine, 22.6% nonbinary/gender-expansive, and 8.5% questioning youth. 88.1% of youth were White. Wilcoxon signed-rank tests compared differences in mean T scores when using male versus female scoring templates for YSR and CBCL separately. Statistically significant differences were found on the majority of scales, particularly for TGD adolescents. For example, significant differences were found on the YSR for 10 of 11 scales for transmasculine and transfeminine youth ages 11-18 and 9 of 11 scales for nonbinary/gender-expansive youth. McNemar's test revealed significant differences in the number of clinical range scores for transmasculine YSR respondents on Anxious/Depressed, Somatic Complaints, Thought Problems, and Internalizing scales. For CBCL comparison of clinical significance, significant differences were found for Anxious/Depressed, Attention Problems, and Total Problems scales for transmasculine youth ages 12-18. Selecting a scoring template is contextually relevant; however, template selection appears to matter less when examining clinical relevance. Results suggest that clinicians using the CBCL and YSR with TGD youth have flexibility in scoring template selection. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Application of an intersectional lens to bias-based bullying among LGBTQ+ youth of color in the United States.

Bias-based bullying influences health, academic success, and social wellbeing. However, little quantitative work takes an intersectional perspective to understand bias-based bullying among youth with marginalized social positions, which is critical to prevention. This paper describes the application of exhaustive chi-square automatic interaction detection (CHAID) to understand how prevalence of race-, gender-, and sexual orientation-based bullying varies for youth with different intersecting social positions. We used two datasets - the 2019 Minnesota Student Survey (MSS; N=80,456) and the 2017-2019 California Healthy Kids Survey (CHKS; N=512,067). Students self-reported sex assigned at birth, sexual orientation, gender identity, race/ethnicity, and presence of any race-, gender-, and sexual orientation-based bullying (MSS: past 30 days, CHKS: past 12 months). Exhaustive CHAID with a Bonferroni correction, a recommended approach for large, quantitative intersectionality research, was used for analyses. Exhaustive CHAID analyses identified a number of nodes of intersecting social positions with particularly high prevalences of bias-based bullying. Across both datasets, with varying timeframes and question wording, and all three forms of bias-based bullying, youth who identified as transgender, gender diverse, or were questioning their gender and also held other marginalized social positions were frequent targets of all forms of bias-based bullying. More work is needed to understand how systems of oppression work together to influence school-based bullying experiences. Effective prevention programs to improve the health of youth with marginalized social positions must acknowledge the complex and overlapping ways bias and stigma interact.

Assessment of Gender Diverse Children: Incorporating the Standard of Care 8th Edition.

This article provides an overview of the World Professional Association of Transgender Health (WPATH) Standard of Care 8th edition (SOC8) chapter on transgender and gender diverse (TGD) prepubescent children (see Scott Leibowitz's article, "Assessment of Transgender and Gender Diverse Adolescents: Incorporating the Standard of Care 8th Edition," in this issue). This is the first WPATH SOC chapter in history, specifically devoted to children, acknowledging that the developmental needs and experiences of these youth can be distinguished from those of TGD adolescents. The child standards are based on the consensus of a range of expert authors and a broader consensus derived from a Delphi process involving the entire international interdisciplinary SOC8 authorship. The child SOC draw upon general developmental literature and employ an ecological framework to establish practice recommendations, including an assessment framework which engages family members and community outreach as warranted. The primary authors of the Child chapter of the SOC 8 include the following: Amy Tishelman, Ph.D. (lead author); Dianne Berg, Ph.D., Laura Edwards-Leeper, Ph.D., Diane Ehrensaft, Ph.D.; Susie Green, Aron Janssen, M.D., Jiska Ristori, Psy.D., Thomas Steensma, Ph.D., and John Strang, Psy.

Bias-Based Bullying and Elevated Depressive Symptoms Among Sexual and Gender-Diverse Asian American, Native Hawaiian, and Pacific Islander Adolescents.

This cross-sectional study analyzes data from 2 statewide school surveys to document the experiences of sexual and gender minoritized Asian American, Native Hawaiian, and Pacific Islander students in grades 9 through 12 who reported bullying related to their identity.

Adverse Childhood Experiences, Household Income, and Mentorship Among Interns Who Are Underrepresented in Medicine.

Background: Underrepresented in medicine (UIM) interns have unique lived experiences that affect their paths to medicine, and more information is needed for medical residency and fellowship programs to better support them. Objective: We describe self-reported differences between UIM and White physician interns in key demographic areas, including household income growing up, physician mentorship, and adverse childhood experiences (ACEs). Methods: Between 2019 and 2021, we administered a diversity survey to incoming medical interns at the University of Minnesota-Twin Cities. Response rates across the 3 years were 51.2% (167 of 326), 93.9% (310 of 330), and 98.9% (354 of 358), respectively. We conducted analyses to compare UIM and White groups across demographic variables of interest. Results: A total of 831 of 1014 interns (81.9%) completed the survey. Relative to White interns, UIM interns had lower household incomes growing up, lower rates of mentorship, and higher rates of experiencing 4 or more ACEs. The odds of experiencing the cumulative burden of having a childhood household income of $29,999 or less, no physician mentor, and 4 or more ACEs was approximately 10 times higher among UIM (6.41%) than White (0.66%) interns (OR=10.38, 95% CI 1.97-54.55). Conclusions: Childhood household income, prior mentorship experiences, and number of ACEs differed between UIM and White interns.

Sex Trading Among Adolescent Cisgender Boys.

OBJECTIVES: Cisgender girls and boys report trading sex for something of value at roughly equal proportions; yet, boys are understudied and underserved. We compare boys who reported trading sex to those who never traded sex to address this gap in knowledge and practice. METHODS: The study is a secondary analysis of the Minnesota Student Survey, a triannual, census-style survey. The sample included 32 311 cisgender boy students in ninth and 11th grades who answered a question about sex trading. Bivariate descriptive statistics and multivariate logistic models were used to identify associated factors and determine the odds of trading sex on the basis of specific experiences. RESULTS: We found that 1.2% of boys reported trading sex. In bivariate analyses, boys who reported trading sex were more likely than those who did not to: identify as Black or Indigenous; report a marginalized gender identity or sexual expression; have had sexual intercourse; have experienced sexual harassment and harassment on the basis of sexual identity and race, ethnicity, and national origin; and to have experienced homelessness, food insecurity, foster care, and substance treatment (P < .001). In multivariate models, we found increased odds of trading sex for some variables, including a marginalized sexual identity, identifying as Black, and experiences of unstable housing, foster care, substance treatment, sexual harassment, and harassment based on gender (P < .001). CONCLUSIONS: These findings contribute new knowledge about boys who trade sex using a large, population-based sample and counter false assumptions and stereotypes. These data suggest new avenues of research, intervention, and prevention.

Adolescent substance use at the intersections of foster care, sexual orientation and gender identity, racial/ethnic identity, and sex assigned at birth.

BACKGROUND: Lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) youth are overrepresented in foster care and report greater substance use during adolescence. OBJECTIVE: Using an intersectional lens, the current study investigates differences in foster care placement and variation in substance use at the intersections of foster care and sexual orientation, gender identity, racial/ethnic identities, and sex assigned at birth. PARTICIPANTS AND SETTINGS: A sample of 121,910 LGBTQ youth (grades 6-12) completed either the Minnesota Student Survey in 2019, the California Healthy Kids Survey from 2017 to 2019, or the 2017 LGBTQ National Teen Study. METHODS: Youth reported their substance use in the past 30 days (alcohol, binge drinking, cigarette, marijuana), social positions (sexual orientation, gender identity, racial/ethnic identities, sex assigned at birth), living arrangement (foster care or not), and grade in school. Logistic regression was used to examine the main and interaction effects of foster care and social positions on youth substance use. RESULTS: Results indicated significant differences in substance use at the intersection of foster care placement and youth social positions. Significant two-way interactions for foster care placement and social positions emerged predicting alcohol, binge drinking, and marijuana use. CONCLUSIONS: Findings show that LGBTQ youth in foster care are at higher risk for substance use than those not in foster care. Particular support is needed for lesbian, gay, and questioning youth, transgender youth, LGBTQ youth assigned male at birth, and Asian or Pacific Islander LGBTQ youth in foster care.

Sport and Physical Activity Among Transgender, Gender Diverse, and Questioning Adolescents.

PURPOSE: We compared rates of sport and physical activity (PA) of transgender and gender diverse adolescents and adolescents questioning their gender (TGDQ) with those of cisgender adolescents. Additionally, we tested for differences in sport and PA among TGDQ youth. METHODS: We used 2019 Minnesota Student Survey data (N = 125,375). We calculated descriptive statistics, then used chi-squares and one-way analyses of variance to test for differences in involvement in sports, PA lessons, and PA between TGDQ and cisgender adolescents. Then, we used the same tests to compare participation among all TGDQ adolescents, considering their gender identity and sex assigned at birth. RESULTS: Overall, TGDQ adolescents participated in sport and PA less than cisgender adolescents; TGD youth participated less than questioning youth. Within sex assigned at birth, participation varied by gender identity. DISCUSSION: TGDQ adolescents need support to participate in sport and PA. Adults should remain cognizant that sport restrictions could impair TGDQ adolescents' health.

Substance Use Behaviors Among LGBTQ+ Youth of Color: Identification of the Populations Bearing the Greatest Burden in Three Large Samples.

PURPOSE: Research has identified persistent disparities in alcohol, e-cigarette, and marijuana use, by sexual orientation, gender identity, and race/ethnicity. Using an intersectionality framework, the present study analyzes three large datasets to identify intersecting social positions bearing the highest burden of substance use. METHODS: Data from adolescents in grades 9-12 in three samples (2019 Minnesota Student Survey, 2017-2019 California Healthy Kids Survey, and 2017 National Teen Survey) were harmonized for an analysis (N = 602,470). A Chi-squared Automatic Interaction Detection analysis compared the prevalence of four types of substance use across all combinations of four social positions (six racial/ethnic identities, five sexual orientations, three gender identities, and two sexes assigned at birth). For each substance, 10 intersectional groups with the highest prevalence of use were examined. RESULTS: In the full sample, 12%-14% of participants reported past 30-day alcohol, e-cigarette, or marijuana use and 7% reported past 30-day binge drinking. Several intersecting marginalized social positions were consistently found to bear a high burden of substance use. For example, transgender and gender diverse (TGD) Latina/x/o young people, particularly those assigned male at birth, were in the high prevalence groups for alcohol use, binge drinking, and marijuana use. Black TGD or gender-questioning youth were commonly in the high prevalence groups. DISCUSSION: Findings suggest that support, resources, and structural changes specifically tailored to youth with multiple marginalized identities (especially TGD) may be needed. The results argue for intersectional efforts that explicitly address racial/ethnic and cultural differences, while also integrating awareness and understanding of sexual and gender diversity.

Diverse Sexual and Gender Identity, Bullying, and Depression Among Adolescents.

Surveillance data indicate youth have many sexual and gender identities that should be included in clinical forms and surveys to document and improve health equity.