Disordered eating in transgender and gender non-conforming youth: A comparison to community-based and clinical samples.

OBJECTIVE: This study investigates eating pathology in transgender and gender non-conforming (TGNC) youth compared to a community-based sample and individuals with eating disorders (EDs). METHOD: Participants (ages 13-21 years) included TGNC youth from a paediatric gender clinic (N = 97), a demographically matched community-based sample of cisgender males (N = 97) and cisgender females (N = 97), and treatment-seeking patients with EDs (N = 112). The Eating Disorder Examination Questionnaire (EDE-Q) was used to assess ED cognitions and behaviours. RESULTS: Transgender and gender non-conforming participants reported significantly higher EDE-Q global scores compared to the cisgender samples, but significantly lower than the ED sample. Transgender and gender non-conforming individuals reported a higher likelihood of objective binge episodes (OBEs) than the cisgender groups, albeit lower than youth with EDs. A substantial proportion of TGNC participants scored in elevated ranges on the EDE-Q global score (35% ≥ score of 3, 17% ≥ score of 4), significantly higher than cisgender males (0% ≥ score of 3, 0% ≥ score of 4) and females (9% ≥ score of 3, 3% ≥ score of 4). CONCLUSIONS: Findings indicate that TGNC youth exhibit increased ED cognitions and OBEs compared to cisgender samples, highlighting the need for screening and addressing ED symptoms in this population.

A Content Analysis of Transgender Health and Wellness Themes Shared Through Social Media.

Transgender and gender-diverse (TGD) adolescents experience limited access to gender-affirming care (GAC) and information and use social media platforms for informational and social support. We conducted conventional content analysis of posts on the platform, Tumblr and applied univariate statistics to characterize health and wellness themes represented by this content. Content was predominantly transmasculine-relevant. Posts addressing the trans health care paradigm often co-occurred with content referencing affirmation logs, the physical and emotional impact of affirmation, surgery, and unspecified medical interventions. Gender-affirming hormone therapy was the most prevalent intervention referenced in posts related to non-professional/non-licensed medical care and advice requests. Transgender and gender-diverse youth-serving individuals can use this information to mitigate harm, enhance patient education, and improve the overall well-being of TGD youth. Further research is needed to characterize the effect of content encountered on social media on pediatric patient experiences and on outcomes of GAC.

Effect of Technology and Digital Media Use on Adolescent Health and Development: Protocol for a Multimethod Longitudinal Study.

BACKGROUND: Technology and digital media (TDM) use is integral to modern adolescence; adolescents have been labeled as "digital natives," since they have had exposure to digital technology for their entire lives. Previous evidence has illustrated TDM's connections with adolescent risk behaviors such as increased alcohol use and social media exposure, as well as relationships with adolescent well-being such as improved socioemotional health and social media connections with peers. Although several recent review articles have described both the benefits and risks of technology use, most individual studies adopt a singular risk-centered approach. In addition, reviews suggest that little evidence exists on the potential mediating and moderating factors between TDM use and well-being and health outcomes, which limits our understanding of what influences the outcomes of interest. Therefore, there is an urgent need to fill these gaps. OBJECTIVE: This protocol addresses the need to understand how TDM exposure and use affect multiple developmental domains and health outcomes. We address the fragmented nature of previous research, the common focus on single behaviors or conditions, and the typical narrow lens on risks. Our approach further aligns with reviews that called for studies identifying and investigating the factors that moderate the relationships between social media and health behaviors and outcomes. METHODS: We will address our objective by longitudinally examining over a 2-year period a common set of adolescent participants (N=400, aged 13-15 years) across 3 studies that adopt a multimethodological approach. Study 1 will use TDM to understand the mechanisms behind adolescent health and risk behaviors. Study 2 will use functional magnetic resonance imaging to understand how positive and negative TDM experiences relate to mental and behavioral health in a subsample of 150 adolescents. Study 3 will use a mixed methods design to evaluate self- and other-generated TDM content as the predictors of socioemotional well-being in sexual and gender minority and non-sexual and gender minority adolescents. RESULTS: Recruitment is ongoing, and the initial results from the first wave of recruitment are expected in 2024. CONCLUSIONS: This integrated approach to longitudinal data collection from a shared adolescent participant pool will lead to novel analyses and findings, allowing for the examination of the health and well-being risks and benefits associated with TDM use and factors that moderate these relationships. The findings from this study will advance conceptual models and inform new interventions to improve adolescent health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/50984.

Youth Perspectives on the Recommended Age of Mobile Phone Adoption: Survey Study.

BACKGROUND: Despite increasing prevalence of phone ownership in early adolescence, there is a deficit of evidence-based guidance on the appropriate time to provide youth their first phone. OBJECTIVE: This survey study explored age recommendations for phone ownership among a diverse panel of youths, as their experiences are an important contribution to the development of ownership guidelines. METHODS: Participants were recruited from MyVoice, a national panel of over 765 youth (14 to 24 years old) who respond to weekly SMS text message-based surveys. Questions were distributed between January 24 2018, and March 20, 2018. Inductive qualitative analysis was used to identify major themes among youths' open-ended responses. RESULTS: In all, 469 youth (mean age 18.8 years; female: 299/469, 63.8%; White race: 332/468, 70.8%) responded. On average, respondents obtained their first phone at 12.2 years of age. Most participants (325/459, 71.1%) stated they received their first phone out of necessity rather than for entertainment or social reasons. Youth recommended that early adolescents receive their first phone between 12 and 13 years of age primarily for reasons of necessity (146/448, 32.6%). CONCLUSIONS: According to the participants, phones supported safety and independence by allowing communication with parents and participation in activities. Youth-serving professionals and parents can incorporate these youth perspectives into shared decision-making about phone ownership among families. This can include discussions about essential features, safety, or phone use, as well as maturity and responsibility milestones, which were all key considerations reported by participants in the survey.

Gender identity and transition: relationships with sleep disorders in US youth.

STUDY OBJECTIVES: Transgender or gender-nonconforming (TGNC) identity is associated with higher burden of sleep disorders relative to cisgender identity. However, the role of gender-affirming therapy (GAT) in sleep disorders is poorly understood. This study examined relationships between TGNC identity, transition, and sleep disorders among TGNC and cisgender youth. METHODS: This retrospective cross-sectional study utilized a large US-based administrative claims database (deidentified Optum Clinformatics Data Mart Database) to identify youth aged 12-25 years who obtained a diagnosis of TGNC identity and those who pursued GAT. Descriptive statistics estimated distributions of demographic and health characteristics by gender identity. Unadjusted and age-adjusted logistic regression models were used to examine associations between TGNC identity, GAT, and sleep disorders. RESULTS: This study included 1,216,044 youth, of which 2,603 (0.2%) were identified as TGNC. Among the 1,387 TGNC who pursued GAT, 868 and 519 were identified as transmasculine and transfeminine, respectively. Adjusted analysis showed increased odds of insomnia (odds ratio = 5.4, 95% confidence interval 4.7, 6.2), sleep apnea (odds ratio = 3.0, 95% confidence interval 2.3, 4.0), and other sleep disorders (odds ratio = 3.1, 95% confidence interval 2.5, 3.9) in TGNC relative to cisgender youth. Decreased odds of any sleep disorder were observed in the TGNC youth on GAT (odds ratio = 0.5, 95% confidence interval 0.4, 0.7) relative to those not on GAT. CONCLUSIONS: This study demonstrated a high burden of sleep disorders in TGNC youth in comparison to cisgender. However, GAT may confer a protective effect on sleep disorders among TGNC youth. Longitudinal assessments of sleep disorders prior to and post-GAT are needed to uncover their temporal relationships. CITATION: Gavidia R, Whitney DG, Hershner S, Selkie EM, Tauman R, Dunietz GL. Gender identity and transition: relationships with sleep disorders in US youth. J Clin Sleep Med. 2022;18(11):2553-2559.

Youth Insight About Social Media Effects on Well/Ill-Being and Self-Modulating Efforts.

PURPOSE: We aim to investigate youth insight about how their social media use affects them. We hope to understand if and how they self-modulate their use. METHODS: Using a text message-based platform, codable survey responses were returned by a minimum of 871 of 1,144 youth aged 14-24 in November, 2020. Youth were asked the following three questions: (1) What advice would you give to young people who are new to social media? (2) Have you ever felt like you need to change your social media use (what you view, time spent, etc.)? Why? (3) Have you ever deleted or thought about deleting your social media account(s)? Why? A codebook was created from the data and two coders independently coded the entirety of the data set using the 18-code codebook. Coders resolved discrepancies in coding patterns together and the frequency of each code was recorded. RESULTS: Youth showed insight about negative impacts of social media and were especially concerned about safety on social media. A majority of respondents deleted or thought about deleting their social media account or app. Youth were more likely to report wanting to change the amount of time spent on their social media compared to the content they view. DISCUSSION: Youth are aware of ways in which social media could be negatively impacting them and they have employed methods to modulate their use because of this awareness.

Transgender Youths' Sexual Health and Education: A Qualitative Analysis.

STUDY OBJECTIVE: To characterize transgender adolescents' sexual behaviors, identities, and their perceived experiences with sex education. DESIGN: Semi-structured interviews were conducted and addressed sexual experiences and perceptions of sex education received from family, school educators, and healthcare providers. Interviews were audio recorded, transcribed, and analyzed utilizing NVivo 12 software for thematic analysis. SETTING: Child and adolescent gender services clinic at a Midwestern university-based medical center in the United States. PARTICIPANTS: 30 transgender adolescents between the ages of 15 to 20. INTERVENTIONS AND MAIN OUTCOME MEASURES: Themes generated during semi-structured interviews. RESULTS: Sexual orientations were inclusive of attractions to a spectrum of gender identities. Libido was perceived to be impacted by gender-affirming hormone therapy, which was unanticipated for some adolescents. Family and school-based sex education was perceived to be relevant only for heterosexual and cisgender adolescents. Inclusive education for transgender adolescents was desired. Counseling provided by gender-affirming providers on sexual health was trusted and other healthcare providers were perceived to lack training on gender-inclusive care. CONCLUSION: This study demonstrated that families and school educators did not provide sex education perceived to be applicable to transgender adolescents. Similarly, healthcare providers of transgender adolescents were perceived to not provide inclusive or comprehensive medical care in comparison to physicians who routinely provide gender-affirming care. Gaps in education and healthcare could be improved with sex education outreach or training for families and school educators as well as the development and implementation of professional competencies for pediatricians on transgender adolescent healthcare.

Romantic Relationships in Transgender Adolescents: A Qualitative Study.

BACKGROUND: Identity formation and exploration of interpersonal relationships are important tasks that occur during adolescence. Transgender, gender diverse, and gender-nonconforming (TGNC) individuals must face these developmental milestones in the context of their transgender identity. Our aim with this article is to describe adolescents' history and experiences with romantic partners. METHODS: We conducted phenomenological, qualitative semistructured interviews with transgender adolescents. Questions were focused on romantic experiences, thoughts, and perceptions. All interviews were coded by 2 members of the research team, with disagreements resolved by discussion and, if needed, with a third member of the research team. Thematic analysis was used to analyze the data, as well as descriptive categorization. RESULTS: In total, 30 adolescents (18 transmasculine and 12 transfeminine) between the ages of 15 and 20 years were interviewed. Themes included (1) engagement in romantic relationships, (2) disclosure of gender identity and romantic relationships, (3) experience with abusive relationships, and (4) perceived impact of gender-affirming hormone care on romantic experiences. CONCLUSIONS: TGNC adolescents are engaged in romantic experiences before and during social and/or medical transitioning and are cultivating relationships through both proximal peers and online connections. There is perceived benefit of gender-affirming hormone care on romantic experiences. Risk of transphobia in romantic relationships impacts the approach that transgender adolescents take toward romance and influences decisions of identity disclosure. TGNC adolescents have experience with relationship abuse in different forms. Providers can incorporate these findings in their approach to counseling and screening when caring for TGNC youth.

Transgender Adolescents' Uses of Social Media for Social Support.

PURPOSE: Transgender adolescents are at higher risk for negative mental health outcomes, such as depression, anxiety, and suicidality, compared with cisgender adolescents. Social media may be an effective venue for addressing these health disparities because most adolescents have access to online information and socialization. This study used qualitative inquiry to explore transgender adolescents' uses of social media for social support. METHODS: Transgender adolescents between the ages of 15 and 18 years with a social media profile were recruited from a pediatric gender clinic in the Midwestern U.S. A 30- to 60-minute semistructured interview assessed ways participants used social media to access transgender-related support. Thematic analysis was used to develop categories and code the transcripts. Coding discrepancies were resolved by two researchers following initial coding. RESULTS: Results represent data from 25 interviews comprising 13 transmasculine, 11 transfeminine, and one nonbinary participant(s), with 68% of the sample identifying as white, non-Hispanic. Categories emerged regarding forms of support participants received from transgender-related online communities including emotional support through peers and role models, appraisal support for validating their experiences, and informational support for navigating health decisions and educating family and friends. Participants also referenced negative experiences, including harassment and exclusionary behavior online. CONCLUSIONS: Social media platforms represent hubs of community for transgender adolescents. These communities provide emotional, appraisal, and informational support that transgender youth may not otherwise be able to access. Future research should use the affordances of social media to identify approaches to addressing health disparities and improving the well-being of transgender adolescents.

Ideas for addressing electronic harassment among adolescents attending a video blogging convention.

BACKGROUND: Electronic harassment affects 20-40% of adolescents and has been associated with significant negative outcomes including physical (ex. headache, abdominal pain), psychological (ex. depression, anxiety), and psychosocial (ex. school avoidance) problems. Evidence-based strategies to address electronic harassment are lacking, and few studies have incorporated adolescent input into intervention design. The purpose of this study was to use a novel data collection approach to determine perspectives on electronic harassment intervention and prevention from a targeted group of highly engaged adolescent technology users. METHODS: We conducted a qualitative survey of a purposeful sample of adolescents age 14 to 18 who were attending a video blogger convention in Seattle, Washington. Participants were approached by research staff and asked to read a vignette about an adolescent target of electronic harassment, then write down ideas for helping the target and/or preventing the scenario. Written responses were analyzed using a thematic analysis approach with an iterative comparative method to resolve any code discrepancies. We subsequently categorized codes into thematic code families to reach consensus about significant themes. RESULTS: 67 eligible adolescents completed the survey. 91% of participants were female with a mean age of 15.3 years (SD = 1.3). Code families emerged regarding people who could be involved in responses to electronic harassment: (1) Individuals targeted by electronic harassment, (2) Friends and bystanders, (3) Adults, and (4) Social media websites and policymakers. CONCLUSIONS: Findings demonstrate adolescent technology users' views on several creative strategies to prevent or intervene with electronic harassment. These strategies can be categorized using a socioecological framework, demonstrating potential to address electronic harassment on multiple levels. Many suggested responses involved the target of electronic harassment, rather than the perpetrator; future education efforts may require additional focus on perpetrators for more upstream prevention.

Stakeholder Perceptions of Cyberbullying Cases: Application of the Uniform Definition of Bullying.

PURPOSE: The Uniform Definition of Bullying was developed to address bullying and cyberbullying, and to promote consistency in measurement and policy. The purpose of this study was to understand community stakeholder perceptions of typical cyberbullying cases, and to evaluate how these case descriptions align with the Uniform Definition. METHODS: In this qualitative case analysis we recruited stakeholders commonly involved in cyberbullying. We used purposeful sampling to identify and recruit adolescents and young adults, parents, and professionals representing education and health care. Participants were asked to write a typical case of cyberbullying and descriptors in the context of a group discussion. We applied content analysis to case excerpts using inductive and deductive approaches, and chi-squared tests for mixed methods analyses. RESULTS: A total of 68 participants contributed; participants included 73% adults and 27% adolescents and young adults. A total of 650 excerpts were coded from participants' example cases and 362 (55.6%) were consistent with components of the Uniform Definition. The most frequently mentioned component of the Uniform Definition was Aggressive Behavior (n = 218 excerpts), whereas Repeated was mentioned infrequently (n = 19). Most participants included two to three components of the Uniform Definition within an example case; none of the example cases included all components of the Uniform Definition. CONCLUSIONS: We found that most participants described cyberbullying cases using few components of the Uniform Definition. Findings can be applied toward considering refinement of the Uniform Definition to ensure stakeholders find it applicable to cyberbullying.

Internet addiction, sleep and health-related life quality among obese individuals: a comparison study of the growing problems in adolescent health.

BACKGROUND: The rapid rise in the global prevalence of obesity suggests that environmental factors may be responsible. The increased use of technology is associated with increased rates of obesity due to declines in physical activity and significant sedentary life style. Internet addiction is also a growing health issue associated with diminished physical activity and poor sleep quality as well as various health problems. The purpose of this study was to determine associations between Internet addiction and adolescent obesity-related problems. DESIGN AND METHODS: In this case-control study, 71 adolescents with obesity were recruited from the outpatient clinic at Tepecik Teaching Hospital and Katip Celebi University Hospital, Department of Pediatric Endocrinology in Izmir, Turkey. The control group consisted of 64 non-obese adolescents that were matched with patients in the study group by age and gender. All subjects completed socio-demographic forms, an Internet addiction scale, the Pediatric Quality of Life Inventory, the Pittsburgh Sleep Quality Index, and the Epworth Sleepiness Scale. RESULTS: Adolescents with obesity were significantly more likely to have Internet addiction (p = 0.002), lower quality of life (p < 0.001), and higher daytime sleepiness (p = 0.008). Moreover, binary regression analysis showed that Internet addiction and less physical activity were associated with increased odds of obesity. CONCLUSION: The results indicated a significant association between Internet addiction and obesity. Health practitioners should take possible Internet addiction, online activities, and physical activities into consideration in follow-up of obese adolescents. In addition to pharmacologic therapies and dietary interventions, providing behavioral therapy targeting healthy Internet use may be promising to reduce the effects of obesity in adolescence.

Development and Testing of a 3-Item Screening Tool for Problematic Internet Use.

OBJECTIVE: To develop and validate the Problematic and Risky Internet Use Screening Scale (PRIUSS)-3 screening scale, a short scale to screen for Problematic Internet Use. STUDY DESIGN: This scale development study applied standard processes using separate samples for training and testing datasets. We recruited participants from schools and colleges in 6 states and 2 countries. We selected 3 initial versions of a PRIUSS-3 using correlation to the PRIUSS-18 score. We evaluated these 3 potential screening scales for conceptual coherence, factor loading, sensitivity, and specificity. We selected a 3-item screening tool and evaluated it in 2 separate testing sets using receiver operating curves. RESULTS: Our study sample included 1079 adolescents and young adults. The PRIUSS-3 included items addressing anxiety when away from the Internet, loss of motivation when on the Internet, and feelings of withdrawal when away from the Internet. This screening scale had a sensitivity of 100% and specificity of 69%. A score of ≥3 on the PRIUSS-3 was the threshold to follow up with the PRIUSS-18. DISCUSSION: Similar to other clinical screening tools, the PRIUSS-3 can be administered quickly in a clinical or research setting. Positive screens should be followed by administering the full PRIUSS-18. Given the pervasive presence of the Internet in youth's lives, screening and counseling for Problematic Internet Use can be facilitated by use of this validated screening tool.