Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations.

Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice.

Sexual identity and tobacco use in a venue-based sample of adolescents and young adults.

BACKGROUND: Tobacco use has been found to be more prevalent among lesbian, gay, bisexual, and transgender (LGBT) adults than among the general population, but there is little information about LGBT youth. This study examined tobacco use in relation to sexual identity in a community venue-based sample of youth. METHODS: Time-space sampling was used to select individuals aged 13-24 years visiting venues frequented by both LGBT and non-LGBT youth, including drop-in and recreational centers, cafes, bars, and a park. ORs for the association between LGBT identity and tobacco use were estimated using logistic regression models with adjustment for demographic covariates and venue selection. The two main outcomes were lifetime and last-30-day cigarette smoking. Sixteen secondary outcomes pertained to the type, initiation, frequency, and quantity of tobacco use; symptoms of dependence; and cessation. RESULTS: Seventy-seven percent (500/653) of eligible participants completed surveys by interview in 2005-2006. Sixty-three percent smoked in the last 30 days, 22% smoked more than 30 days ago, and 17% reported no prior cigarette smoking. LGBT identity predicted any prior cigarette use (OR 2.2, 95% CI=1.7, 3.2), but not recent use. Compared to non-LGBT youth, LGBT participants were less likely to use smokeless tobacco (OR 0.6, 95% CI=0.5, 0.7) and to want to quit smoking cigarettes (OR 0.6, 95% CI=0.5, 0.8). Other tobacco-related attitudes and behaviors were similar. CONCLUSIONS: Few meaningful differences in tobacco use were related to sexual identity. The remarkably high levels of cigarette smoking in the sample highlights the need for prevention and cessation resources.

Sexual risk taking among young internet-using men who have sex with men.

OBJECTIVES: We examined the characteristics of young Internet-using men who have sex with men (MSM) and risks associated with seeking sex online, offline, or through both strategies. METHODS: Data were obtained from MSM aged 18 to 24 years who completed a 45-minute online survey regarding sex and Internet use in the preceding 3 months. RESULTS: Significantly more Internet-using MSM who had met sexual partners both online and offline (43%) reported unprotected anal intercourse than did those who had met sexual partners exclusively online (29%) or offline (34%). MSM who met sexual partners exclusively offline reported the fewest partners but the greatest proportion of partnerships involving unprotected anal intercourse (49%). Meeting sexual partners both online and offline (odds ratio [OR]=3.38-58.42) and being drunk (OR=1.57) or high (OR=2.24) increased the odds of having more sexual partners. The same factors increased the odds of having unprotected anal intercourse (online and offline sexual partners, OR=1.60; being drunk, OR=1.43; being high, OR=1.61). CONCLUSIONS: Risky sexual behavior was prevalent among all of the study subgroups. Our findings suggest that online sex seeking is associated with greater numbers of sexual partners but neither promotes nor discourages unprotected anal intercourse. Regardless of where sexual partners met, being drunk and high were significant risks for unprotected anal intercourse.

Lesbian, gay, bisexual, and transgender youths: who smokes, and why?

Existing research indicates the rate of smoking among lesbian, gay, bisexual, and transgender (LGBT) youths exceeds the general population's, possibly due to stress, habitual substance abuse, socializing in smoky venues, and tobacco marketing. The study's overall aim was to conduct qualitative research regarding tobacco use and avoidance by LGBT youths. This report focuses on identifying priority subpopulations and corresponding risk and resiliency factors. Purposive and maximum variation sampling were used to select 30 LGBT youths and 30 interactors for face-to-face interviews. Almost a third of participants said that all LGBT youths are at risk for smoking. Other respondents specified a range of high-risk groups, encompassing many subpopulations. Contributing factors for smoking included personal characteristics, interpersonal issues, environmental conditions, and structural issues. More than a third of young smokers were not acquainted with LGBT nonsmokers and could not imagine how they avoid using tobacco. Half of the interactors and four youths ascribed favorable qualities to nonsmokers--such as self-esteem, will power, and concern for personal health, appearance, and well-being. In conclusion, smoking is a pervasive problem among LGBT youths. The findings corroborate prior explanations and implicate new ones. Some risks (e.g., limited opportunities to socialize with LGBT peers outside of smoking venues, the desire to appear more masculine, and sexuality-related stress) and resiliency factors (e.g., positive sexual identity) are unique to LGBT populations, reinforcing the need for culturally specific approaches to prevention and cessation. Highlighting the positive attributes of nonsmokers and nonsmoking might prove useful in prevention campaigns.

Trends in sexual risk-taking among urban young men who have sex with men, 1999-2002.

As part of an HIV prevention study, 15-25 year-old young men who have sex with men (YMSM) were surveyed in community settings annually from 1999 to 2002. Data are presented from six comparison communities in the study; these communities recruited Latinos (Jackson Heights, NYC; San Gabriel Valley, CA), African Americans (Atlanta, GA); Asians/Pacific Islanders (San Diego, CA); and primarily white men (Detroit, MI and Twin Cities, MN). Men were asked about unprotected anal intercourse (UAI) in the past three months with male partners. The prevalence of UAI reported in these six communities ranged 27-35% in 1999, compared with 14% to 39% in 2002. Significant reductions in UAI over time were observed in Jackson Heights and San Gabriel Valley. A quadratic trend was noted in Detroit, with a significant increase in UAI from 1999 to 2000 followed by a significant decrease in UAI from 2000 to 2002. There was a nonsignificant increase in UAI in the Twin Cities, and no significant trends in UAI in Atlanta or San Diego. Behavioral trends among YMSM vary considerably across subpopulations and highlight the necessity of local behavioral surveillance and culturally tailored prevention efforts for specific racial and ethnic groups.

Preventing tobacco use among lesbian, gay, bisexual, and transgender youths.

A paucity of information regarding tobacco use among lesbian, gay, bisexual, and transgender (LGBT) youths impedes prevention programs. The aim of the present study was to conduct formative qualitative research regarding subpopulations at risk for tobacco use, protective factors, patterns of use, and approaches to prevention. This report focuses on participants' recommendations for the development of preventive intervention. Purposive sampling and maximum variation sampling were used to select 30 LGBT youths and 30 interactors for face-to-face interviews. NUD*IST6 text software was used for the indexing and thematic analysis of qualitative data, based on a grounded theory approach. All participants offered suggestions for tobacco prevention pertaining to the optimal process of prevention and cessation programs, specific strategies to promote tobacco prevention and cessation, and general strategies to foster nonsmoking. Several key themes regarding prevention emerged: LGBT youth should be involved in the design and implementation of interventions; prevention programs should support positive identity formation as well as nonsmoking; the general approach to prevention should be entertaining, supportive, and interactive; and the public might not distinguish primary prevention from cessation activities. All but one young smoker had attempted to quit at least once; but only one individual had succeeded. By way of implications, prevention programs should involve young people in enjoyable and engaging activities, address the psychosocial and cultural underpinnings of tobacco use, support healthy psychosocial development, and consider offering pharmacological smoking cessation aids.

Suicidality in a venue-based sample of young men who have sex with men.

PURPOSE: To examine the incidence, prevalence, and characteristics of suicide attempts in a unique, venue-based sample of young men who have sex with men (YMSM). Eligible participants were 15-25-year-old men who were living in a major metropolitan area (Minneapolis/St. Paul, Minnesota) and had sex with men within 12 months of the interview. A total of 255 subjects were randomly sampled from popular venues for a structured, 20-min interview (1999) that included four items regarding suicide intentions and attempts. Data were analyzed using bivariate and multivariate tests of statistical significance. Eighty-six percent of eligible individuals completed the survey. One-third of all respondents reported at least one suicide attempt, and 4.7% attempted suicide in the past year. Although suicide attempts were more prevalent among African-Americans and urban residents; only school enrollment was significantly associated with attempts in the multivariate analysis (odds ratio = .55, 95% confidence interval = .31,.97). This study corroborates the findings of prior studies of high rates of suicide attempts among YMSM. In addition, it demonstrates that attempts are more prevalent among out-of-school youths.