Protective Factors Among Transgender and Gender Variant Youth: A Systematic Review by Socioecological Level.

Transgender and gender variant (GV) youth experience elevated risk for poor health and academic outcomes due mainly to social experiences of stigma and discrimination. To supplement the growing evidence on health risks encountered by transgender/GV youth, we identified factors theorized to be protective for these youth across all four levels of Bronfenbrenner's socioecological model (individual, relationship, community, societal). We conducted a systematic search of peer-reviewed research. The articles included in this review were published in peer-reviewed journals in English or Spanish between 1999 and 2014, analyzed data from a sample or subsample of transgender or GV participants with a mean age between 10 and 24 years, and examined the relationship of at least one theorized protective factor to a health or behavioral outcome. Twenty-one articles met inclusion criteria. Transgender/GV youth in included articles ranged from 11 to 26 years of age, were racially/ethnically diverse, and represented varied gender identities. Within these articles, 27 unique protective factors across four levels of the ecological model were identified as related to positive health and well-being. Self-esteem at the individual level, healthy relationships with parents and peers at the relationship-level, and gay-straight alliances at the community level emerged as protective factors across multiple studies. Our findings underscore the relative lack of research on transgender/GV youth and protective factors. Novel recruitment strategies for transgender/GV youth and better measurement of transgender identities are needed to confirm these protective relationships and identify others. Growth in these areas will contribute to building a body of evidence to inform interventions.

Body mass index, body esteem, and unprotected receptive anal intercourse among young men who have sex with men who seek partners online.

Research examining the relationship between body mass index (BMI) and sexual risk outcomes among men who have sex with men (MSM) has yielded inconsistent results. Using a web-based survey, single-identified (e.g., not in a relationship) young MSM (N = 431) between the ages of 18 and 24 years who sought romantic partners online were asked to respond to items regarding their BMI, body image (e.g., attribution, dissatisfaction, and pride), and sexual risk behaviors. We used Poisson regressions to examine the relationships between BMI, body image, and the number of unprotected receptive anal intercourse (URAI) occasions and partners in the past 2 months. We found a curvilinear relationship between BMI and URAI occasions, and a linear relationship between BMI and URAI partners. These relationships persisted after accounting for body image. Further, we found that body attribution served as a protective factor whereas body pride served as a risk factor. We discuss the implications of our findings for sexual health education and HIV prevention.

LGBT community, social network characteristics, and smoking behaviors in young sexual minority women.

Smoking rates among young sexual minority women (YSMW) are disproportionately high as compared to heterosexual populations. While this disparity has commonly been attributed to the sexual minority stress process, little empirical work has explored what may protect YSMW from high rates of smoking. Using data (N = 471) from a cross-sectional study designed to investigate YSMW's (age 18-24) smoking behaviors and correlates; we explore the relationship of LGBT community connections, YSMW's social network characteristics, and stress to smoking behaviors (i.e., status, frequency, amount). Through this analysis, we find support for LGBT community connection as well as friendships with other sexual minorities as protective in relation to YSMW's smoking behaviors. We discuss the implications of our results, highlighting the need for future longitudinal research and interventions designed to bolster YSMW's connections to the LGBT community and their social networks.

Sexual attraction, sexual identity, and psychosocial wellbeing in a national sample of young women during emerging adulthood.

Identity-based conceptualizations of sexual orientation may not account adequately for variation in young women's sexuality. Sexual minorities fare worse in psychosocial markers of wellbeing (i.e., depressive symptoms, anxiety, self esteem, social support) than heterosexual youth; however, it remains unclear whether these health disparities exclusively affect individuals who adopt a sexual minority identity or if they also may be present among heterosexually-identified youth who report same-sex attractions. We examined the relationship between sexual attraction, sexual identity, and psychosocial wellbeing in the female only subsample (weighted, n = 391) of a national sample of emerging adults (age 18-24). Women in this study rated on a scale from 1 (not at all) to 5 (extremely) their degree of sexual attraction to males and females, respectively. From these scores, women were divided into 4 groups (low female/low male attraction, low female/high male attraction, high female/low male attraction, or high female/high male attraction). We explored the relationship between experiences of attraction, reported sexual identity, and psychosocial outcomes using ordinary least squares regression. The results indicated sexual attraction to be predictive of women's psychosocial wellbeing as much as or more than sexual identity measures. We discuss these findings in terms of the diversity found in young women's sexuality, and how sexual minority status may be experienced by this group.

Mr. Right and Mr. Right Now: romantic and casual partner-seeking online among young men who have sex with men.

Dating is a normative behavior for youth, yet few studies have examined the relationship between romantic partner-seeking and sexual behavior among young men who have sex with men (YMSM). This omission is most notable across studies examining YMSM's partner-seeking behaviors online. In this study, we examined the relationship between sexual behaviors and online partner-seeking behaviors for casual and romantic partners in a sample of YMSM (N = 431; M = 21.49 years old, SD = 1.94) who reported using the Internet to meet other men. Using analysis of covariance (ANCOVA), we found YMSM in the High Romantic/High Casual group had more unprotected partners than YMSM in other categories. YMSM in the High Romantic/Low Casual group had fewer unprotected partners than the High Romantic/High Casual group. We discuss the implications of our findings and conclude that there is a need to further examine romantic partner-seeking among YMSM.

Achieving Safety: Safer Sex, Communication, and Desire among Young Gay Men.

Conceptualizations of safer sex practices among young gay men (YGM) are frequently structured around communication between partners and the subsequent utilization or absence of condoms in a sexual encounter. Drawing on a sample of 34 in-depth interviews with YGM, ages 18 to 24, we explore the ways in which conceptualizations and definitions of safer sex are discussed and enacted. Placing attention on their safer sex practices, we analyze the conversations that do and do not occur among YGM and their partners, including the strategies (e.g., negotiated safety, condom communication and negotiation) that are commonly perceived as most useful by YGM. We provide recommendations regarding how to craft safer sex messages for YGM by considering their competing demands.

Relationship trajectories and psychological well-being among sexual minority youth.

Dating in adolescence plays an integral part in the development of sexual and social identities. This process is particularly salient for sexual minority youth who face additional obstacles to their identity formation due to their marginalized status. We investigated the influence of participating in a same-sex relationship (SSR) or an opposite-sex relationship (OSR) on sexual minority youths' psychological well-being (i.e., symptoms of depression, anxiety and internalized homophobia, and self-esteem) in an ethnically-diverse sample of 350 youth (55% male) between the ages of 15-19 years, recruited from three GLBT drop-in centers in the New York City area. Using longitudinal data, we examined youths' SSR and OSR over time. Multivariate regression analyses suggest that involvement in a SSR was positively associated with changes in self-esteem in males, and negatively correlated with changes in internalized homophobia in females. We discuss the implications for positive development in sexual minority adolescent populations.

Harassment and Mental Distress Among Adolescent Female Students by Sexual Identity and BMI or Perceived Weight Status.

OBJECTIVE: Sexual minority girls (lesbian/bisexual) and girls with overweight/obesity experience high rates of discrimination and mental distress. This study explored whether BMI or perceived weight status might compound sexual minority girls' risk for harassment and mental distress. METHODS: Data on female students from the national 2015 Youth Risk Behavior Survey (n = 7,006) were analyzed. Logistic regression was used to examine differences in bullying, harassment, and mental distress across sexual identity/BMI groups: heterosexual/normal-weight, heterosexual/overweight, sexual minority/normal-weight, and sexual minority/overweight. Procedures were repeated with four analogous groups created from sexual identity and perceived weight. RESULTS: Across sexual identity/BMI groups, being overweight increased heterosexual females' odds of being bullied or experiencing suicidal thoughts and behaviors. Regardless of weight status, sexual minority females had greater odds for each outcome than heterosexual females. Sexual minority females who perceived themselves as overweight had greater odds of suicidality than all other sexual minority/perceived weight groups. CONCLUSIONS: Double jeopardy may exist for sexual minority female students who perceive themselves as overweight. Professional development with school staff on how to create a positive climate for sexual minorities and those with overweight/obesity and addressing positive identity and body image within school-based suicide prevention efforts may be important to the well-being of adolescent girls.

Butch tops and femme bottoms? Sexual positioning, sexual decision making, and gender roles among young gay men.

Gender and power are theoretical constructs linked to discussions of sexual transmission of HIV/AIDS among heterosexual couples. Despite the fact that HIV rates are rising among young men who have sex with men in the United States, work examining the role of gender in sexual decision making of young men who have sex with men remains in its infancy. Through qualitative interviews with 34 young gay men (YGM), the authors seek to contribute to the literature in this area by focusing on the ways that YGM understand and enact sexual positions during anal sex. The authors' results highlight the diversity of YGM's sexual preferences, as well as the high degree of sexual fluidity. Ideas of gender appear to inform part of this process; however, YGM critiqued conventional gender norms and emphasized the centrality of relationships (i.e., casual vs. romantic) in their sexual decision making. The authors discuss the importance of considering gender and interpersonal factors when designing HIV/AIDS prevention messages for YGM.

Individual and Neighborhood Correlates of HIV testing among african american youth transitioning from adolescence into young adulthood.

Disparities in HIV testing rates exist among socially disadvantaged communities. Using a longitudinal sample of urban African American youth followed from adolescence into young adulthood (n = 396; 51% female), we examined whether HIV testing was associated with individual (e.g., gender, socioeconomic status [SES], education, and history of sexually transmitted infections [STIs]) and area (i.e., neighborhood disadvantage and HIV prevalence) characteristics. In our multilevel regressions, we found females were more likely to have tested for HIV, with the magnitude of this association increasing if they lived in areas of greater disadvantage yet decreasing in higher HIV prevalence areas. Those without a high school degree, with a lower SES, or with a history of STIs in adolescence were less likely to test if they lived in greater disadvantage and HIV prevalence areas. We discuss the implications of these findings from an ecological perspective and propose recommendations for increasing testing among African American youth.