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Youth experiencing homelessness (YEH) often engage in "couch-surfing," or frequently moving from one tenuous living arrangement to another. Understanding the characteristics and risk factors associated with couch-surfing is necessary to designing adequate responses to youth homelessness. The present study aims to investigate factors associated with youth at risk of couch-surfing or sleeping on the streets relative to staying in a shelter. The present study used Homeless Management Information System administrative data sourced from 16 communities across the U.S. between January 2015 and February 2017 (n = 9,417). Multinomial logistic regression models were used to explore correlates (e.g., demographics, homeless histories, risk and victimization, behavioral health, and self-sufficiency) of couch-surfing or sleeping on the streets relative to staying in an emergency shelter program. YEH identifying as female; Black or another non-Latinx youth of color; or as lesbian, gay, bisexual, questioning, or another sexual orientation (LGBQ+) were at greater risk of couch-surfing relative to staying in a shelter. YEH who threatened to harm themselves or others in the preceding 12 months or who attributed their homelessness to an abusive relationship were significantly more likely to either be couch-surfing or on the streets. Service providers must recognize and validate the vulnerabilities and risks experienced by couch-surfing YEH in order to help reduce barriers to accessing services faced by this population. Federal definitions of homelessness should be aligned to correct systemic biases and more accurately reflect the realities of how youth experience homelessness. [ABSTRACT FROM AUTHOR]

The aim of this study is to identify and evaluate the efficacy of adolescent protective factors against mental health (MH) outcomes in young adulthood of sexual minority identifying youth (SMY). Using data from the National Longitudinal Study of Adolescent to Adult Health, we identified potential protective factors (e.g., individual factors like self-esteem, family factors like family communication, and community factors like caring teachers) at baseline (1994) when the sample was school-aged for SMY. SMY included those who identified their sexual identity as mostly heterosexual, bisexual, mostly homosexual, or 100% homosexual. MH outcomes (depression, anxiety, or suicidality) were assessed at 14-year follow-up. Approximately 14,800 youth completed baseline and follow-up surveys, where 13.5% identified as SMY. Of SMY, 57% had a MH outcome compared to 37% of non-SMY (p <.05). Not all factors were protective for SMY. At the individual level, emotional well-being (adjusted odds ratio [AOR].56, 95% confidence interval [CI].41–.78) and self-esteem (AOR.79, 95% CI.66–.95) were found to be protective for MH outcomes in regression models. At the family level, family connectedness (AOR.82, 95% CI.71–.95) was found to be protective. At the community level, school connectedness (AOR.78, 95% CI.66–.92) and caring teachers (AOR.76, 95% CI.58–.99) were found to be protective for SMY. Factors at the individual, family, and community (e.g., caring teachers) levels appear to be protective against MH outcomes unique to SMY. Developing interventions focused on protective factors have potential to prevent health disparities. [ABSTRACT FROM AUTHOR]

To determine the prevalence of disordered eating behaviors (DEBs) and body image dissatisfaction (BID) according to sexual minority youth (SMY) status and describe healthcare utilization patterns by SMY status. Retrospective data from 107,528 adolescents, who had a Well Check in Kaiser Permanente Northern California in 2016, were used to compare DEB and BID by SMY status. Multivariate logistic models were used to examine the associations of SMY, birth-assigned sex, age, race/ethnicity, and body mass index on DEB and BID. The utilization of specialized eating disorder (ED) medical and mental health services and general mental health services was described at one Kaiser Permanente Northern California facility. BID was reported in 20,763 (19.3%) adolescents, DEB in 1,458 (1.7%) adolescents, and 5,363 (5%) adolescents identified as SMY. SMY had higher odds of having DEB and BID than non-SMY, respectively (adjusted odds ratio 2.0 95% confidence interval [1.9–2.2] and adjusted odds ratio 3.8 [3.4–4.2]). Regardless of SMY status, adolescents with older age, female sex, nonwhite race, and elevated body mass index had higher odds of ED risk factors. SMY with ED risk factors had higher ED medical utilization than non-SMY with ED risk factors (4.6% vs. 1.6%). However, SMY status was not associated with utilization of specialized ED mental health services. SMY had increased rates of DEB and BID but had underutilization of specialized ED mental health services. Future targeted efforts to prevent eating disorder-related mortality and morbidity for SMY should include targeted eating disorder screening and referral to specialized ED medical and mental health services. [ABSTRACT FROM AUTHOR]

PurposeLittle is known about adolescent relationship abuse (ARA) and related sexual and reproductive health among females who either identify as lesbian or bisexual or engage in sexual behavior with female partners (i.e., sexual minority girls [SMGs]).MethodsBaseline data were collected from 564 sexually active girls ages 14-19 years seeking care at eight California school-based health centers participating in a randomized controlled trial. Associations between ARA, sexual minority status and study outcomes (vaginal, oral, and anal sex, number and age of sex partners, contraceptive nonuse, reproductive coercion, sexually transmitted infection [STI] and pregnancy testing) were assessed via logistic regression models for clustered survey data.ResultsSMGs comprised 23% (n = 130) of the sample. Controlling for exposure to ARA, SMGs were less likely to report recent vaginal sex (adjusted odds ratio [AOR], .51; 95% confidence interval [CI], .35-.75) and more likely to report recent oral sex (AOR, 2.01; 95% CI, 1.38-2.92) and anal sex (AOR, 1.76; 95% CI, 1.26-2.46) compared with heterosexual girls. Heterosexual girls with ARA exposure (AOR, 2.85; 95% CI, 1.07-7.59) and SMGs without ARA exposure (AOR, 3.01; 95% CI, 2.01-4.50) were more likely than nonabused heterosexual girls be seeking care for STI testing or treatment than heterosexual girls without recent victimization.ConclusionsFindings suggest the need for attention to STI risk among all girls, but SMGs in particular. Clinicians should be trained to assess youth for sexual contacts and sexual identity and counsel all youth on healthy relationships, consensual sex, and safer sex practices relevant to their sexual experiences.

To estimate the association between same-sex marriage legalization and deaths by suicide among youth. The study used country-level suicide data sourced from the Global Burden of Disease Study for all 36 Organisation for Economic Co-operation and Development countries for the period 1991–2017. We analyzed the suicide rates of all youth, male youth, and female youth aged 10–24 years using multiple policy-evaluation methods—difference-in-differences, matrix completion, and generalized synthetic control via expectation-maximization—to estimate the impact of same-sex marriage legalization at the country level. Secondary analysis considered several covariate specifications, evaluated the immediacy and persistence of the estimated associations, and assessed whether any observed association was limited to early adopters of same-sex marriage. The state-of-the-art matrix completion analysis indicated that same-sex marriage legalization was associated with a decline in the youth suicide rate of 1.191 deaths per 100,000 individuals (95% CI = −1.66, −.64; p <.001), corresponding to a reduction of 17.90% compared to the youth suicide rate at the time of legalization. This decline was most pronounced in males for whom the suicide rate fell by 1.993 (CI = −2.76, −1.12; p <.001) compared to a decrease of.348 for female youth (CI = −.60, −.06; p =.02), corresponding to decreases of 19.98% and 10.90%, respectively. These associations persisted after legalization, but to differing degrees depending on model specification. Developed countries that are yet to legalize same-sex marriage have an opportunity to put downward pressure on youth suicide. [ABSTRACT FROM AUTHOR]

Misperception of body weight during adolescence is a risk factor for negative self-image, harmful eating/dietary habits (e.g., binge eating and purging), and body dysmorphia. Sexual minority youth, particularly males, may be at increased risk for misperceptions of body weight, relative to youth who do not identify as a sexual minority. This study examines the risk for misperception of body weight among sexual minority youth and explores biological sex as an effect modifier in this relationship. We pooled data from the 2015 and 2017 Youth Risk Behavior Surveillance Surveys. Participants were 18,634 high school students who were not overweight/obese. Multivariable logistic regression examined the association between sexual minority status (i.e., gay, lesbian, bisexual, and unsure) and misperceptions of body weight (i.e., self-perceived as overweight/severely overweight). Weighted multivariable logistic regression analyses, stratified by biological sex, were used to compare this relationship across males and females. Covariates included race/ethnicity, grade, bullying victimization, television/electronic screen time, and tobacco use. Overall, 16.6% of the sample self-reported misperceptions of body weight. Sexual minority youth had 1.49 (95% confidence interval [CI]: 1.28–1.73) greater odds of misperception of body weight, adjusting for covariates; this relationship was found across biological sex, but that the main effect was significantly greater among sexual minority males (adjusted odds ratio: 2.24, 95% CI: 1.65–3.03) relative to sexual minority females (adjusted odds ratio: 1.33, 95% CI: 1.11–1.59). Sexual minority youth had greater odds of overestimating their weight status. Biological sex appears to modify this relationship with sexual minority males being at particularly high risk for overestimating their weight status. [ABSTRACT FROM AUTHOR]

Homophobic school climates are related to increased victimization for sexual minority youth (SMY), leading to increased risk of adverse mental health outcomes. Interventions that promote positive school climate may reduce the risk of victimization and adverse mental health outcomes in SMY. This study explored whether lesbian, gay, bisexual, transgender, and questioning (LGBTQ)–inclusive sex education is associated with adverse mental health and school-based victimization in U.S. youth. Data analysis of representative data from the 2015 Youth Risk Behavior Survey and the 2014 School Health Profiles was conducted using multilevel logistic models testing whether youth in states with higher proportions of schools teaching LGBTQ-inclusive sex education had lower odds of reporting being bullied in school and experiencing adverse mental health outcomes, including depressive symptoms and suicidality. After controlling for covariates, protective effects for all youth were found for suicidal thoughts (adjusted odds ratio [AOR]:.91, 95% confidence interval [CI]:.89–.93) and making a suicide plan (AOR:.79; 95% CI:.77–.80). Lesbian and gay youth had lower odds of experiencing bullying in school as the proportion of schools within a state teaching LGBTQ-inclusive sex education increased (AOR:.83; CI:.71–.97). Bisexual youth had significantly lower odds of reporting depressive symptoms (AOR:.92; 95% CI:.87–.98). Students in states with a greater proportion of LGBTQ-inclusive sex education have lower odds of experiencing school-based victimization and adverse mental health. These findings can be used to guide intervention development at the school and state levels. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose There is a dearth of research to inform sexual education programs to address sexual health disparities experienced by adolescent males who are interested in sex with males (AMSM). The current study sought to determine where AMSM receive sexual health information, clarify their preferences, and explore relations with sexual behavior. Methods AMSM (N = 207; ages 14–17) in the United States completed an online sexual health survey. Bivariate associations between sexual education exposure/preferences by sexual behavior were assessed using Fisher's exact tests and one-way analyses of variance. Results Eighty-nine (43%) participants reported no sexual contact with male partners, 77 (37%) reported sexual contact without condomless anal sex, and 41 (20%) reported condomless anal sex. Participants received sexual health information from their parents/guardians (n = 122, 59%), formal sources (n = 160, 78%), and the Internet (n = 135, 65%). The most commonly covered topics by parents/guardians and formal sources were how to say no to sex, how to prevent HIV and other sexually transmitted infections, and methods of birth control. The most common online-researched topics were how to safely have anal sex, the types of sex you can have with a male partner, how to use a condom, and how to use lubrication. Participants noted preferring a sexually-explicit online sexual health program that addresses male–male sex. Conclusions Online sexual education programs that explicitly address male–male sex are needed. Tailored programs can help AMSM develop healthy sexual behaviors and decrease their HIV/STI risk. [ABSTRACT FROM AUTHOR]

The aim of the study was to estimate the prevalence of sexual minority youth (SMY) within an integrated health care system using a standardized questionnaire. This study assessed SMY status in youth aged 12.5–18 years using a previsit Well Check questionnaire at Kaiser Permanente Northern California facilities in 2016. SMY was defined as self-reported attraction to the same sex or both sexes. A total of 93,817 youth (87.3%) self-reported sexual attraction, and 5% (n = 5,329) of respondents (N = 107,532) identified as SMY: 1.7% were attracted to same sex, and 3.2% were attracted to both sexes. There were youth who responded neither (1.5%) and unsure (2.4%). Females were 2.8 times (95% confidence interval 2.6–2.94) more likely to be SMY than males. SMY status significantly increased with age. Nonwhite youth were significantly less likely to be SMY compared with white youth. This is the first study to examine SMY prevalence in pediatric primary care. Primary care providers can use previsit screening before preventive visits to identify and support sexual minority adolescents, facilitate family acceptance, and promote healthy behaviors with care coordination. [ABSTRACT FROM AUTHOR]

Purpose The objective of this study was to examine the relationship between school involvement and connectedness with measures of sexual risk, substance use, and experience of violence among students who had sexual contact with the same sex or with both sexes. Methods A sample of middle school and high school students who participated in a study conducted in a large urban school district were selected based on their reported experience of having initiated sexual activity with same-sex partners. In classroom-based surveys, we assessed self-reported involvement in school-based activities and feelings of school connectedness, as well as self-reported sexual risk, substance use, and experience of violence. Results Significant protective associations were found between school involvement and lifetime alcohol and marijuana use, and between school connectedness and ever having been in a fight, feeling safe at school, and drug use other than marijuana (all p  < .05). Conclusions Findings suggest that efforts to increase school involvement and connectedness provide a starting point for addressing significant health and safety concerns among students with same-sex sexual activity. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To examine disparities between sexual minority youth (SMY) and heterosexual youth in rates of suicidality and depression symptoms. Methods: Separate meta-analyses were conducted to examine suicidality and depression disparities. Studies were included if the average age of the participants was <18 years, and if suicidality or depression symptoms were compared across SMY and heterosexual youth. Results: SMY reported significantly higher rates of suicidality (odds ratio [OR] = 2.92) and depression symptoms (standardized mean difference, d = .33) as compared with the heterosexual youth. Disparities increased with the increase in the severity of suicidality (ideation [OR = 1.96], intent/plans [OR = 2.20], suicide attempts [OR = 3.18], suicide attempts requiring medical attention [OR = 4.17]). Effects did not vary across gender, recruitment source, and sexual orientation definition. Conclusions: Disparities in suicidality and depression may be influenced by negative experiences including discrimination and victimization. Clinicians should assess sexual orientation, analyze psychosocial histories to identify associated risk factors, and promote prevention and intervention opportunities for SMY and their families. [Copyright &y& Elsevier]