The Developmental Collision Hypothesis: An Empirical Test With Three Generations of Sexual Minority Youth.

Sexual minority youth experience disproportionate rates of mental health symptomatology relative to their heterosexual peers. Less is known about why these disparities have persisted despite growing public awareness of sexual diversity. The developmental collision hypothesis states that increased cultural visibility of sexual diversity has accelerated the developmental timing of sexual minority identity formation processes such that they collide with early adolescence, a uniquely sensitive period for experiencing identity-based stigma and associated mental health vulnerability. To test this hypothesis, levels and relations between ages of sexual minority identity development milestones, frequency of LGBT-related victimization, and depressive symptoms were examined across three age-matched but cohort-distinct samples of sexual minority adolescents. Data come from three secondary datasets of sexual minority youth who were adolescents in the 1990s, 2000s, and 2010s, respectively: the Challenges and Coping Study, the Victimization and Mental Health among High Risk Youths Study, and the Risk and Protective Factors for Suicide among Sexual Minority Youth Study (n = 1312; Mage = 17.34, SD = 1.30; 52% female). Adolescents from more recent cohorts reported earlier mean ages of several milestones but similar frequencies of LGBT-related victimization relative to those from less recent cohorts. Path analysis models showed that earlier milestones were associated indirectly with more depressive symptoms through LGBT-related victimization. Notably, earlier ages of self-identification and disclosure of a sexual minority identity were also directly related to less depressive symptoms. Few generational differences in relations between constructs emerged. Findings garner initial support for the developmental collision hypothesis and suggest that LGBT-related victimization, rather than earlier milestones themselves, increases mental health vulnerability.

The onset of mental health disparities in sexual minority and majority youth: evidence from the UK Millennium Cohort Study.

Decades of research shows that sexual minority youth (SMY) display heightened risk for mental health problems, although the onset of such disparities remains unclear. The Millennium Cohort Study is the largest nationally representative longitudinal study of adolescents in the United Kingdom. In this study, participants (N = 10,047, 50% female) self-reported their sexual identity at age 17 and had parent-reported mental health data, from the Strengths and Difficulties Questionnaire, reported across five waves at ages 5, 7, 11, 14, and 17. Multilevel linear spline models, stratified by sex, were used to examine mental health trajectories between sexual identity groups (completely heterosexual, mostly heterosexual, SMY). SMY showed heightened peer problems from the baseline assessment at age five, increasing over time, and heightened emotional problems from age 11, increasing over time. Mostly heterosexual youth showed heightened emotional problems at age 11 in males, and at age 17 in females. Findings are discussed in light of the literature on minority stress and gender conformity in youth. The use of parent-reported mental health data means that estimates are likely to be conservative. We conclude that interventions supporting SMY should start early and be available throughout adolescence.

From the Margins to the Mainstream: Explicating and Validating Queer Readings Among Sexual Minority Youth.

Scholars posit that media texts are polysemic (i.e., open to multiple interpretations) with popular media representing a social institution within Western cultures that spreads dominant societal values, norms, and expectations. Due to their marginalized position within society, sexual minority individuals (i.e., LGBQ+) are frequently underrepresented by mainstream media messages. One way in which marginalized individuals can challenge the dominant, heteronormative discourse is through subversive in which individuals interpret messages against heteronormative ideals (i.e., queer readings). Across two studies, a reliable and valid measure of the uses and gratifications of queer readings was explicated; revealing a four-factor, 20-item scale. Results contribute to the entertainment media and fan studies literatures by providing an understanding of the utility of queer readings in the experiences and development of sexual minority individuals, as well as presents numerous future avenues for inquiry.

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

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

Substance use in sexual minority youth: prevalence in an urban cohort.

BACKGROUND: Little comparative data on substance use (SU) between sexual minority youth (SMY) and heterosexual youth (HET) is available. This study compares the prevalence of SU in an urban cohort between SMY and HET and evaluates demographic and psychosocial predictors of SU. METHODS: Data came from a prospective-longitudinal cohort study in an urban setting (N = 1297). SU and psychosocial variables such as internalizing symptoms, self-control, sensation-seeking, bullying-victimization, subjective stress, leisure activities, and peer influences were assessed with self-reports at age 17 and 20. SU was stratified by sex and sexual attraction, and the groups were compared using regression models, with demographic and psychosocial variables included as covariates. RESULTS: SMY- and HET-youth displayed differences in a number of psychosocial variables. Overall, SMY- and HET-youth differed in their 12-months prevalence of SU: At age 17, SMY-females had significantly higher rates of SU than HET-females for cannabis (aOR = 2.14, p = 0.04), ecstasy/MDMA (aOR = 4.29, p = 0.01), and hallucinogens (aOR = 5.59, p = 0.02). At age 20, SMY-females had significantly higher rates of SU than HET-females for tobacco (aOR = 2.06, p = 0.03), cannabis (aOR = 2.24, p = 0.004), ecstasy/MDMA (aOR = 3.93, p < 0.001), stimulants (aOR = 3.45, p = 0.002), and hallucinogens (aOR = 6.65, p < 0.001). SMY-males reported significantly lower rates for tobacco and cannabis than HET-males at age 17. At age 20, they reported significantly higher rates for the use of ecstasy/MDMA (aOR = 2.30, p = 0.04) and hallucinogens (aOR = 2.43, p = 0.03). CONCLUSIONS: Given that psychosocial variables were significant covariates of SMY-status and SU, our results underline the importance of accounting for these when explaining differences in SU between adolescents. While differentiation by sex is established in most studies, such standardized comparisons are lacking with regards to sexual identities. But knowledge about SU of SMY is critical for designing effective interventions. This is especially true for SMY-females: Thus, SU in SMY-females early in life needs to be explored more thoroughly and addressed with adequate prevention measures.

Table 2 Fallacy in Descriptive Epidemiology: Bringing Machine Learning to the Table.

There is a lack of rigorous methodological development for descriptive epidemiology, where the goal is to describe and identify the most important associations with an outcome given a large set of potential predictors. This has often led to the Table 2 fallacy, where one presents the coefficient estimates for all covariates from a single multivariable regression model, which are often uninterpretable in a descriptive analysis. We argue that machine learning (ML) is a potential solution to this problem. We illustrate the power of ML with an example analysis identifying the most important predictors of alcohol abuse among sexual minority youth. The framework we propose for this analysis is as follows: (1) Identify a few ML methods for the analysis, (2) optimize the parameters using the whole data with a nested cross-validation approach, (3) rank the variables using variable importance scores, (4) present partial dependence plots (PDP) to illustrate the association between the important variables and the outcome, (5) and identify the strength of the interaction terms using the PDPs. We discuss the potential strengths and weaknesses of using ML methods for descriptive analysis and future directions for research. R codes to reproduce these analyses are provided, which we invite other researchers to use.

Differential resilience effects of everyday political engagement against heterosexist victimization among sexual minority youth: The importance of identity-based action.

Everyday forms of political engagement, such as civic participation and collective action, have been recognized as a crucial factor for positive youth development, but less is known about their resilience effects on youth from marginalized populations, especially in less democratic societies. The present study investigated experiences of everyday political engagement among sexual minority youth in China and examined their compensatory and protective effects against heterosexist victimization. A sample of 793 Chinese sexual minority youth was included in the study. The results showed that collective action operated as a protective factor in buffering the effect of heterosexist victimization, such that its association with academic engagement was not significant among those with higher levels of collective action. In contrast, civic participation served the compensatory function and was associated with greater academic engagement, a stronger sense of school belonging, and fewer depression symptoms, but it did not protect against the negative effects of heterosexist victimization. The findings highlight the importance of identity-based action among sexual minority youth and provide insight into the differential resilience effects of everyday political engagement. The study has implications for fostering resilience among sexual minority youth with victimization experiences in school and counseling settings.

Trajectories of Drug Use and Depressive Symptoms among Latinx Youth and Sexual Minority Youth.

Drug use and depression co-occur and disproportionately affect Latinx sexual minority youth relative to their heterosexual Latinx peers. However, heterogeneity in co-occurring patterns of drug use and depressive symptoms is unknown. The objective of the current study was to identify patterns of drug use and depressive symptom trajectories and examine how these patterns varied between Latinx sexual minority youth and Latinx non-sexual minority youth. Latent class trajectory analysis identified distinct patterns of drug use and depressive symptom trajectories among 231 Latinx adolescents (Latinx sexual minority youth: n = 46, 21.4%; Latinx non-sexual minority youth: n = 169, 78.6%). After identifying class mean trajectories, we examined differences in mean trajectories across groups. A 3-class model was selected as the optimal class trajectory model for both groups, yet classes and trajectories differed. There were differences in initial levels of depression and drug use trajectories between both groups, as well as differences in patterns of drug use trajectories between both groups in two of the three classes. Given the variation in trajectory patterns, there is a need for practitioners to consider the unique needs of both groups to inform the development of preventive interventions for these two populations.

Dating and friendships in adolescence: Variation across same-sex and other-sex romantic partners.

This research examined associations between dating and number of friends for rural adolescents with same-sex and other-sex dating partners using longitudinal sociometric data (N = 2826; 55% female, 87% White, mean age = 14 at baseline). In multilevel models assessing within-person change, boys gained female friends when they were in same-sex romantic relationships, compared to when they were single. In contrast, girls in same-sex relationships lost female friends and gained male friends. Adolescents in other-sex romantic relationships gained same-sex friends compared to when they were single. Results advance understanding of adolescent social and sexual development, suggesting that sexual minority adolescents find allies when dating but may struggle to maintain same-sex friendships.

Increasing Participation in a TelePrEP Program for Sexual and Gender Minority Adolescents and Young Adults in Louisiana: Protocol for an SMS Text Messaging-Based Chatbot.

BACKGROUND: Sexual and gender minority (SGM) adolescents and young adults (AYAs) are at increased risk of HIV infection, particularly in the Southern United States. Despite the availability of effective biomedical prevention strategies, such as pre-exposure prophylaxis (PrEP), access and uptake remain low among SGM AYAs. In response, the Louisiana Department of Health initiated the LA TelePrEP Program, which leverages the power of telemedicine to connect Louisiana residents to PrEP. A virtual TelePrEP Navigator guides users through the enrollment process, answers questions, schedules appointments, and facilitates lab testing and medication delivery. To increase the participation of SGM AYAs in the program, the TelePrEP program partnered with researchers to develop a chatbot that would facilitate access to the program and support navigator functions. Chatbots are capable of carrying out many functions that reduce employee workload, and despite their successful use in health care and public health, they are relatively new to HIV prevention. OBJECTIVE: In this paper, we describe the iterative and community-engaged process that we used to develop an SMS text messaging-based chatbot tailored to SGM AYAs that would support navigator functions and disseminate PrEP-related information. METHODS: Our process was comprised of 2 phases: conceptualization and development. In the conceptualization phase, aspects of navigator responsibilities, program logistics, and user interactions to prioritize in chatbot programming (eg, scheduling appointments and answering questions) were identified. We also selected a commercially available chatbot platform that could execute these functions and could be programmed with minimal coding experience. In the development phase, we engaged Department of Health staff and SGM AYAs within our professional and personal networks. Five different rounds of testing were conducted with various groups to evaluate each iteration of the chatbot. After each iteration of the testing process, the research team met to discuss feedback, guide the programmer on incorporating modifications, and re-evaluate the chatbot's functionality. RESULTS: Through our highly collaborative and community-engaged process, a rule-based chatbot with artificial intelligence components was successfully created. We gained important knowledge that could advance future chatbot development efforts for HIV prevention. Key to the PrEPBot's success was resolving issues that hampered the user experience, like asking unnecessary questions, responding too quickly, and misunderstanding user input. CONCLUSIONS: HIV prevention researchers can feasibly and efficiently program a rule-based chatbot with the assistance of commercially available tools. Our iterative process of engaging researchers, program personnel, and different subgroups of SGM AYAs to obtain input was key to successful chatbot development. If the results of this pilot trial show that the chatbot is feasible and acceptable to SGM AYAs, future HIV researchers and practitioners could consider incorporating chatbots as part of their programs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/42983.

Looking Within: An Analysis of Intimate Partner Violence Victimization Among Sexual Minority Youth.

Sexual minority youth are at increased risk of intimate partner violence (IPV) victimization compared to their heterosexual peers. However, the sexual minority population is not a homogenous group and risk of IPV victimization varies by LGB+ subgroup (e.g., gay/lesbian, bisexual, and unsure). Using two waves of data (2017, 2019) from the National Youth Risk Behavior Survey (YRBS), this study analyzes (a) differences in physical and sexual IPV victimization between heterosexual and sexual minority youth, (b) within group differences among sexual minority youth, and (c) if the relationship between IPV victimization and sexual identity is attenuated after controlling for sociodemographic characteristics and theoretically relevant risk factors. Results indicate that sexual minority youth are at elevated risk of IPV victimization compared to their heterosexual peers. Within-LGB+ analyses show that bisexual youth are more likely than gay/lesbian youth to be victims of sexual IPV. The association between physical and sexual IPV victimization and sexual identity is partially attenuated by sociodemographic variables and observed risk factors. Findings indicate that intervention and prevention programming should be tailored to identify, and treat, the risks and needs of unique, at-risk populations.

Sampling Sexual and Gender Minority Youth With UnACoRN (Understanding Affirming Communities, Relationships, and Networks): Lessons From a Web-Based Survey.

BACKGROUND: Periodic surveys of sexual and gender minority (SGM) populations are essential for monitoring and investigating health inequities. Recent legislative efforts to ban so-called conversion therapy make it necessary to adapt youth surveys to reach a wider range of SGM populations, including those <18 years of age and those who may not adopt an explicit two-spirit, lesbian, gay, bisexual, transgender, and queer (2S/LGBTQ) identity. OBJECTIVE: We aimed to share our experiences in recruiting SGM youth through multiple in-person and online channels and to share lessons learned for future researchers. METHODS: The Understanding Affirming Communities, Relationships, and Networks (UnACoRN) web-based survey collected anonymous data in English and French from 9679 mostly SGM respondents in the United States and Canada. Respondents were recruited from March 2022 to August 2022 using word-of-mouth referrals, leaflet distribution, bus advertisements, and paid and unpaid campaigns on social media and a pornography website. We analyzed the metadata provided by these and other online resources we used for recruitment (eg, Bitly and Qualtrics) and describe the campaign's effectiveness by recruitment venue based on calculating the cost per completed survey and other secondary metrics. RESULTS: Most participants were recruited through Meta (13,741/16,533, 83.1%), mainly through Instagram; 88.96% (visitors: 14,888/18,179) of our sample reached the survey through paid advertisements. Overall, the cost per survey was lower for Meta than Pornhub or the bus advertisements. Similarly, the proportion of visitors who started the survey was higher for Meta (8492/18,179, 46.7%) than Pornhub (58/18,179, 1.02%). Our subsample of 7037 residents of Canada had a similar geographic distribution to the general population, with an average absolute difference in proportion by province or territory of 1.4% compared to the Canadian census. Our US subsample included 2521 participants from all US states and the District of Columbia. A total of CAD $8571.58 (the currency exchange rate was US $1=CAD $1.25) was spent across 4 paid recruitment channels (Facebook, Instagram, PornHub, and bus advertisements). The most cost-effective tool of recruitment was Instagram, with an average cost per completed survey of CAD $1.48. CONCLUSIONS: UnACoRN recruited nearly 10,000 SGM youth in the United States and Canada, and the cost per survey was CAD $1.48. Researchers using online recruitment strategies should be aware of the differences in campaign management each website or social media platform offers and be prepared to engage with their framing (content selection and delivery) to correct any imbalances derived from it. Those who focus on SGM populations should consider how 2S/LGBTQ-oriented campaigns might deter participation from cisgender or heterosexual people or SGM people not identifying as 2S/LGBTQ, if relevant to their research design. Finally, those with limited resources may select fewer venues with lower cost per completed survey or that appeal more to their specific audience, if needed.

Inclusive State Legislation and Reduced Risk of Past-Year Suicide Attempts Among Lesbian, Gay, Bisexual, and Questioning Adolescents in the United States.

OBJECTIVE: This study examines the relationship between state legislation relevant to equality for sexual minorities and past-year suicide attempts among lesbian, gay, bisexual, and questioning (LGBQ) adolescents in the United States. METHODS: Data were aggregated from 24 states that participated in the 2017 Youth Risk Behavior Surveillance System (N = 70,599). We utilized multilevel logistic regression to determine whether observed positive associations between sexual minority identity and past-year suicide attempts differ as a function of 2016 State Equality Index (SEI), an objective measure of state laws and policies affecting equality for sexual minorities. RESULTS: LGBQ adolescents were significantly more likely to report having made a suicide attempt in the past year than heterosexual youth (adjusted odds ratio [AOR]: 3.82; 95% confidence interval [CI]: 3.29-4.44). The 2016 SEI moderated the positive association between sexual minority identity and suicide attempts, with odds of past-year suicide attempts significantly reduced in states with more inclusive legislation (AOR: 0.91; CI: 0.85-0.97). Among sexual minority subgroups, significant effect modifications were found for bisexual (AOR: 0.88; CI: 0.77-0.99) and questioning (AOR: 0.87; CI: 0.78-0.96) - but not gay or lesbian (AOR: 1.10; CI: 0.97-1.24) - adolescents. The effect modification was strongest for bisexual males (AOR: 0.68; CI: 0.47-0.99). CONCLUSIONS: State legislation relevant to equality for sexual minorities differentially affected associations between sexual minority identity and suicide attempts, such that past-year suicide attempts were substantially lower in states with more inclusive legislation. Inclusive state legislation may exert a protective effect on risk for suicide attempts among sexual minority youth.

Examining Racial/Ethnic Differences in the Association of Victimization and Suicidal Thoughts and Behaviors with Alcohol Use Among Sexual Minority Youth.

Purpose: Integrating Minority Stress Theory and Bagge and Sher's Theoretical Framework of the Alcohol-Suicide Attempt Relation, this study aimed to test whether experiencing both minority stress and suicidal thoughts and behaviors (STBs) had a greater strength of association with Latinx and Black sexual minority youth (SMY)'s alcohol use compared with that of White SMY. Methods: Using data on 2341 non-Latinx Black, Latinx, and non-Latinx White SMY from the 2015 and 2017 Youth Risk Behavior Surveys, we tested the prevalence of STBs, victimization, and alcohol use for Black and Latinx participants compared with White participants. Multivariate logistic regression analyses tested the main effects of STBs, victimization, and race/ethnicity on alcohol use. Finally, interaction terms assessed the interaction among STBs, victimization, and race/ethnicity on alcohol use. Results: The results supported our hypothesis, based on Minority Stress Theory, that experiencing victimization would be associated with greater alcohol use. Results also supported Bagge and Sher's theoretical framework showing that suicide plan and attempts were associated with greater alcohol use. When taking all of these stressors into account, results showed that Latinx SMY who experienced victimization had greater current prevalence of alcohol use than their White counterparts. However, Latinx SMY who were victimized and experienced suicidal ideation reported lower alcohol use than White SMY. Conclusion: These findings support the double jeopardy and resiliency hypotheses, which suggest that minority stressors have differing associations for each racial/ethnic SMY group's alcohol use. More research is needed that helps to disentangle the protective and risk factors for alcohol use among Black and Latinx SMY.

LGBTQ+ Youth-Generated Intervention Concepts for Reducing Teen Dating Violence Inequities.

Lesbian, gay, bisexual, transgender, queer, nonbinary, and other sexual and gender minority (LGBTQ+) youth are at substantially greater risk than cisgender heterosexual youth for experiencing teen dating violence (TDV) victimization, including emotional, physical, and sexual abuse within dating/romantic relationships. Despite these inequities, there are no evidence-based interventions designed specifically to address TDV among LGBTQ+ youth. To redress this dearth of interventions, we utilized a youth-centric approach, wherein 46 LGBTQ+ youth co-developed intervention concepts for reducing TDV. Participants engaged in a process of generating, prioritizing, and refining intervention concepts for reducing TDV inequities using human-centered design activities. LGBTQ+ youth generated eight intervention concepts, including the name, description, audience, problem focus, goals, and process for each. Their interventions focused on strategies for enhancing education, support systems, and advocacy. The intervention concepts had a wide variety of intended audiences, including LGBTQ+ and non-LGBTQ+ youth, teachers, school administrators, and policymakers. Overall, LGBTQ+ youth sought to improve education and skills pertaining to violence, sexual health, and healthy relationships; enhance support systems and resources for students' basic, mental health, and safety needs; and build advocacy channels related to "outing" and LGBTQ+ students' needs. These LGBTQ+ youth-generated programmatic and policy intervention concepts, in addition to our human-centered design approach, can be directly leveraged by health promotion practitioners and prevention experts into future intervention development, implementation, and evaluation efforts to improve LGBTQ+ youth health, well-being, resilience, and advocacy.

Measurement Invariance of Family Functioning Among Latina/o/x Sexual Minority Youth and Heterosexual Latina/o/x Youth.

Positive family functioning is negatively associated with drug use, sexual risk behaviors, and depression; however, existing measures of family functioning were not specifically developed for Latina/o/x sexual minority youth (LSMY). This study examined the factor structure of family functioning and whether it is invariant across sexual orientation (i.e., LSMY and heterosexual Latina/o/x youth). Participants included 454 Latina/o/x youth (LSMY: n = 115, 25.3%). Results yielded a higher-order family functioning factor consisting of parental involvement, positive parenting, parent-adolescent communication, and parental monitoring. The model fit for the sample was acceptable (CFI/RMSEA = .91/.04) and configural invariance indicated that the model fit the data adequately in both groups (CFI/RMSEA = .87/.05). Fit of the metric invariance model (∆χ2 (42) = 54.83, p = .09, ΔCFI, ΔRMSEA, ΔTLI < .001) was not significantly worse than the configural model, however, the scalar invariance model (∆χ2 (42) = 80.18, p < .001, ΔCFI = .01, ΔRMSEA, ΔTLI < .001) was significantly worse than the less constrained models, suggesting that family functioning was noninvariant with regard to sexual orientation. Noninvariance may be related to the unique experiences of LSMY related to sexual orientation that are not captured in existing measures of family functioning.

Supporting and Establishing Gender and Sexuality Alliances in Chicago Public Schools.

School nurses are uniquely positioned to support lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) students. One approach is involvement in Gender and Sexuality Alliances (GSAs). GSAs have been found to improve outcomes for LGBTQ students. The purposes of this quality improvement project were to build infrastructure for GSAs by implementing a GSA Support Plan including a digital resource binder, GSA advisor trainings, and establishment of an Advisor Leadership Committee and increase the number of schools with a GSA. The binder was distributed electronically to 95 advisors. Forty-nine participants attending virtual trainings. A statistically significant increase in all measures of participant confidence occurred between the pre- and post-training surveys. The Advisor Leadership Committee was established. This paper adds to the literature by showing that support for GSAs is important to aiding LGBTQ students. Further, authors suggest ways in which school nurses can harness their expertise to be involved with GSAs.

Associations of a Multilevel School Health Program and Health Outcomes Among Lesbian, Gay, and Bisexual Youth.

Lesbian, gay, and bisexual (LGB) adolescents are often at higher risk than their heterosexual peers for adverse sexual health, violence, mental health, and substance use outcomes. Schools are a vital resource for enhancing protective behaviors and reducing risk behaviors. Sixteen school districts selected schools to implement a sexual health program (exposed) or usual programming (unexposed). We analyzed LGB student health outcomes using 2015 and 2017 Youth Risk Behavior Surveys. Analyses compared LGB student health outcomes by exposure status across time points using a multilevel approach. Program exposure was associated with decreased odds of ever having sex, ever testing for HIV, and using effective hormonal birth control, and an increased odds of condom use. There were no significant findings among secondary violence, mental health, and substance use outcomes. This evaluation highlights the potential for schools to reduce sexual risk behaviors among LGB youth, and opportunities to improve access to health services.

Mental health condition indicators and e-cigarette use among sexual minority youth.

BACKGROUND: Sexual minorities face mental health disparities compared to heterosexual people. There is limited research on the possible connections between mental health and e-cigarette use among sexual minority youth. This study examines anxiety, depression, and e-cigarette use for sexual minority youth only and between sexual minorities versus straight youth. METHODS: Study data were drawn from the 2021 National Youth Tobacco Survey (n = 16,065). Prevalence of self-reported anxiety and depression by sexual minority status was calculated, and the univariate analysis was assessed using Rao-Scott Chi-Square tests. Multivariable logistic regression models were used to evaluate the association of current e-cigarette use with self-reported anxiety and depression among sexual minority youth. The study also examined current e-cigarette use between sexual minorities versus straight students for those with or without anxiety and depression, and stratified analyses were performed by sex. RESULTS: Analysis showed a substantially higher prevalence of all self-reported mental health problems among sexual minorities than straight students. Sexual minority males with anxiety (aOR 1.91, 95 % CI, 1.22-3.00), depression (aOR 2.08, 95 % CI, 1.27-3.40), moderate depression and anxiety (aOR 1.85, 95 % CI, 1.16-2.97), and severe depression and anxiety (aOR 2.03, 95 % CI, 1.16-3.56) were more likely to be current e-cigarette users than their straight peers with similar mental health conditions. LIMITATIONS: Self-reported measures and the analysis design precludes making causal inferences. CONCLUSIONS: Sexual minority males with mental health conditions may be particularly vulnerable to e-cigarette use and may require special efforts toward prevention and cessation.

Medial Prefrontal Cortex Activity to Reward Outcome Moderates the Association Between Victimization Due to Sexual Orientation and Depression in Youth.

BACKGROUND: Sexual minority youth (SMY) are 3 times more likely to experience depression than heterosexual peers. Minority stress theory posits that this association is explained by sexual orientation victimization, which acts as a stressor to impact depression. For those vulnerable to the effects of stress, victimization may worsen depression by altering activity in neural reward systems. This study examines whether neural reward systems moderate the influence of sexual orientation victimization, a common and distressing experience in SMY, on depression. METHODS: A total of 81 participants ages 15 to 22 years (41% SMY, 52% marginalized race) reported sexual orientation victimization, depression severity, and anhedonia severity, and underwent a monetary reward functional magnetic resonance imaging task. Significant activation to reward > neutral outcome (pfamilywise error < .05) was determined within a meta-analytically derived Neurosynth reward mask. A univariate linear model examined the impact of reward activation and identity on victimization-depression relationships. RESULTS: SMY reported higher depression (p < .001), anhedonia (p = .03), and orientation victimization (p < .001) than heterosexual youth. The bilateral ventral striatum, medial prefrontal cortex (mPFC), anterior cingulate cortex, and right orbitofrontal cortex were significantly active to reward. mPFC activation moderated associations between sexual orientation victimization and depression (p = .03), with higher depression severity observed in those with a combination of higher mPFC activation and greater orientation victimization. CONCLUSIONS: Sexual orientation victimization was related to depression but only in the context of higher mPFC activation, a pattern observed in depressed youth. These novel results provide evidence for neural reward sensitivity as a vulnerability factor for depression in SMY, suggesting mechanisms for disparities, and are a first step toward a clinical neuroscience understanding of minority stress in SMY.