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BACKGROUND Lesbian, gay, bisexual, and other sexual minority (LGB+) girls are more likely than heterosexual girls to be pregnant during adolescence. Nonetheless, LGB+ inclusive pregnancy prevention programming is lacking. METHODS Between January 2017 and January 2018, 948, 14 to 18 year-old cisgender LGB+ girls were enrolled in a national randomized controlled trial. Girls were assigned either to Girl2Girl or an attention-matched control group. They were recruited via social media and enrolled over the telephone. The 5-month intervention consisted of a 7-week program (4–12 text messages sent daily) and a 1-week booster delivered 12 weeks later. Longitudinal models of protected sex events had a negative binomial distribution and a log link function. Longitudinal models examining use of birth control assumed a Bernoulli distribution of the outcome variable and a logit link function. Models adjusted for baseline rate of the outcome, age, and a time-varying indicator of sexual experience. RESULTS Girl2Girl participants had higher rates of protected penile-vaginal sex events over time compared with controls. Girl2Girl participants also were more likely than control participants to report use of birth control other than condoms. Models of abstinence and pregnancy rates did not suggest statistically significant group differences across time. However, effect sizes were in the small to medium range and point estimates favored Girl2Girl versus control in both cases. CONCLUSIONS Girl2Girl is associated with sustained pregnancy preventive behaviors for LGB+ girls through 12 months postintervention. Text messaging could be considered as a viable method to increase access to sexual health programming to adolescents nationally.

OBJECTIVES: In this study, we examine reports of exposure to suicidal behavior by youth sexual and gender identity. We explore how exposure is related to depressed mood in the context of high social support while accounting for cumulative adversity. METHODS: Data from a large national sample of youth aged 14 to 15 years in the United States (N = 3979) were collected online in 2018–2019. RESULTS: Sexual- and gender-minority youth were more likely to know someone close to them who attempted suicide, relative to cisgender heterosexual youth. Cisgender heterosexual youth were buffered from recent depressed mood when they endorsed having high social support in the context of exposure to suicidal behavior; less social support did not provide such a buffer. For cisgender sexual-minority male and female youth, exposure to suicidal behavior was related to recent depressed mood regardless of the level of social support. For gender-minority youth assigned female at birth, the combination of exposure and high social support was significantly associated with elevated depressed mood. Cumulative adversity accounted for some but not all of these relationships, indicating the influential role of exposure to suicidal behavior on depressed mood for some youth. CONCLUSIONS: These findings illustrate the complexities of social support and raise questions about its potential to magnify stress rather than serve as a buffer for some youth. Although findings need to be replicated, suicide prevention efforts should carefully consider how to promote resilience among these suicide-exposed sexual- and gender-minority youth who may themselves be at risk for suicidal ideation and behavior.

BACKGROUND: Although lesbian, gay, bisexual and other sexual minority (LGB+) girls are more likely than heterosexual girls to be pregnant during adolescence, relevant pregnancy prevention programming is lacking. METHODS: A national randomized controlled trial was conducted with 948 14- to 18-year-old cisgender LGB+ girls assigned to either Girl2Girl or an attention-matched control group. Participants were recruited on social media between January 2017 and January 2018 and enrolled over the telephone. Between 5 and 10 text messages were sent daily for 7 weeks. Both experimental arms ended with a 1-week booster delivered 12 weeks subsequently. RESULTS: A total of 799 (84%) participants completed the intervention end survey. Participants were, on average, 16.1 years of age (SD: 1.2 years). Forty-three percent were minority race; 24% were Hispanic ethnicity. Fifteen percent lived in a rural area and 29% came from a low-income household. Girl2Girl was associated with significantly higher rates of condom-protected sex (adjusted odds ratio [aOR] = 1.48, P < .001), current use of birth control other than condoms (aOR = 1.60, P = .02), and intentions to use birth control among those not currently on birth control (aOR = 1.93, P = .001). Differences in pregnancy were clinically but not statistically significant (aOR = 0.43, P = .23). Abstinence (aOR = 0.82, P = .34), intentions to be abstinent (aOR = 0.95, P = .77), and intentions to use condoms (aOR = 1.09, P = .59) were similar by study arm. CONCLUSIONS: Girl2Girl appears to be associated with increases in pregnancy preventive behaviors for LGB+ girls, at least in the short-term. Comprehensive text messaging–based interventions could be used more widely to promote adolescent sexual health behaviors across the United States.

Transient hypothyroidism can present itself as clinically asymptomatic or with few symptoms. Early treatment with levothyroxine (L-T4) prevents complications related to this disorder. We report a case of a male infant with concomitant short bowel syndrome and transient hypothyroidism treated with rectal L-T4. A 4-month-and-10-day-old boy with previous gastroschisis underwent multiple surgical approaches for small bowel resection and developed short bowel syndrome. We suspected hypothyroidism because of jaundice (direct bilirubin up to 59 mg/dL), the absence of evacuation, oral diet intolerance, and intestinal dysmotility. Because of a thyrotropin level of 34.45 μIU/mL and a free thyroxine level of 0.64 ng/dL, the diagnosis was confirmed. Because fasting was demanding, we started the patient on rectal diluted L-T4. After 4 weeks, the patient had spontaneous peristalsis, improvement of jaundice (direct bilirubin: 4.6 mg/dL), and normalized free thyroxine and thyrotropin values. In the present case, the patient was diagnosed with hypothyroidism and was on absolute fasting. An alternative route of drug administration was warranted. We empirically prescribed rectal diluted L-T4 when intravenous and suppository L-T4 were not available. This method was proven to be safe and effective in improving the patient’s clinical and biochemical status. Rectal L-T4 is a possible alternative route of administration to treat hypothyroidism in patients who are unable to take the medication orally.

OBJECTIVE: To examine rates of technology-based violent experiences (eg, bullying, harassment, unwanted sexual experiences [USEs] perpetration, and victimization) and exposures (eg, hate sites) from 2006 to 2008 among US children. PATIENTS AND METHODS: One thousand five-hundred eighty-eight youth aged 10 to 15 years were surveyed nationally online in 2006, 2007 (76% follow-up rate), and 2008 (73% follow-up rate). RESULTS: All other things equal, rates of Internet-based violent exposures and experiences were stable. Of exception, harassment perpetration and exposure to violent cartoon sites reduced by 26% and 36% over the 2 year period (P < 0.05), respectively. In contrast, several rates of violent experiences via text messaging increased over time, specifically: harassment victimization (aOR = 1.6, p = 0.001) and perpetration (aOR = 1.4, p = 0.03), and USE victimization (aOR = 1.9, p = 0.02). Increases in bullying victimization were suggested (aOR = 1.5, p = 0.06). Text messaging USE perpetration did not significantly change, however. General technology use (i.e., intensity and frequency of Internet and text messaging) was consistently influential in explaining the odds of almost all violent experiences and exposures both online and via text messaging; as was age for many exposures and experiences online. CONCLUSIONS: Ongoing surveillance of text-messaging–based experiences is needed to understand trends as population usage rates begin to stabilize. General technology use is a predictive factor for almost all technology-based violent experiences and exposures. Age is also influential in explaining involvement in Internet-based experiences and exposures. Prevention programs should focus on reducing risk as youth age into later adolescence and to help heavy technology users manage their risk for violence involvement.

OBJECTIVE. The goal was to examine the association between violence in the media and the expression of seriously violent behavior among older children and teenagers in a national sample.METHODS. The Growing up with Media survey was a national, online survey of 1588 youths that was conducted in August and September 2006. Participants were 10- to 15-year-old youths who had used the Internet at least once in the past 6 months. The main outcome measure was self-reported seriously violent behavior, including (1) shooting or stabbing someone, (2) aggravated assault, (3) robbery, and (4) sexual assault.RESULTS. Five percent of youths reported engaging in seriously violent behavior in the past 12 months. Thirty-eight percent reported exposure to violence online. Exposures to violence in the media, both online and off-line, were associated with significantly elevated odds for concurrently reporting seriously violent behavior. Compared with otherwise similar youths, those who indicated that many, most, or all of the Web sites they visited depicted real people engaged in violent behavior were significantly more likely to report seriously violent behavior. After adjustment for underlying differences in youth characteristics, respondents' alcohol use, propensity to respond to stimuli with anger, delinquent peers, parental monitoring, and exposures to violence in the community also were associated with significantly increased odds of concurrently reporting seriously violent behavior.CONCLUSIONS. Exposure to violence in the media is associated with concurrent reports of seriously violent behavior across media (eg, games and music). Newer forms of violent media seem to be especially concerning.

OBJECTIVE. We sought to identify the characteristics of youth who are targets of Internet harassment and characteristics related to reporting distress as a result of the incident. PARTICIPANTS AND METHODS. The Second Youth Internet Safety Survey is a national telephone survey of a random sample of 1500 Internet users between the ages of 10 and 17 years conducted between March and June 2005. Participants had used the Internet at least once a month for the previous 6 months. RESULTS. Nine percent of the youth who used the Internet were targets of online harassment in the previous year. Thirty-two percent of the targets reported chronic harassment (ie, harassment ≥3 times in the previous year). In specific incidents, almost half (45%) knew the harasser in person before the incident. Half of the harassers (50%) were reportedly male, and half (51%) were adolescents. One in 4 targets reported an aggressive offline contact (eg, the harasser telephoned, came to the youth's home, or sent gifts); 2 in 3 disclosed the incident to another person. Among otherwise similar youth, the odds of being a target of Internet harassment were higher for those youth who harassed others online, reported borderline/clinically significant social problems, and were victimized in other contexts. Likewise, using the Internet for instant messaging, blogging, and chat room use each elevated the odds of being a target of Internet harassment versus those who did not engage in these online activities. All other demographic, Internet-use, and psychosocial characteristics were not related to reports of online harassment. Thirty-eight percent of the harassed youth reported distress as a result of the incident. Those who were targeted by adults, asked to send a picture of themselves, received an aggressive offline contact (eg, the harasser telephoned or came to the youth's home), and were preadolescents were each significantly more likely to report distress because of the experience. Conversely, the youth who visited chat rooms were significantly less likely to be distressed by the harassment. CONCLUSIONS. Internet harassment can be a serious event for some youth. Because there has been a significant increase in the prevalence of Internet harassment from 2000 to 2005, adolescent health professionals should continue to be vigilant about such experiences in the lives of young people with whom they interact. Social problems and online aggressive behavior are each associated with elevated odds of being the target of harassment. Thus, prevention efforts may be best aimed at improving the interpersonal skills of young people who choose to communicate with others using these online tools. Adolescent health professionals should be especially aware of events that include aggressive offline contacts by adult harassers or asking the child or adolescent to send a picture of themselves, because each of these scenarios increase the odds of reporting distress by more than threefold. Findings further support the call for the inclusion of Internet-harassment prevention in conventional antibullying programs empowering schools to address Internet bullying situations that occur between students. This will not solve all situations, however. We also must encourage Internet service providers to partner with consumers to be proactive in serious harassment episodes that violate criminal laws and service-provider codes of conduct.

BACKGROUND: Guy2Guy (G2G) is the first comprehensive HIV prevention program developed for sexual minority males as young as 14 years old and is delivered nationally via text messaging. Here, we report the results of the pilot randomized control trial. METHODS: G2G was tested against an attention-matched “healthy lifestyle” control (eg, self-esteem). Both programs lasted 5 weeks and delivered 5 to 10 text messages daily. A 1-week booster was delivered 6 weeks subsequently. Participants were cisgender males ages 14 to 18 years old who were gay, bisexual, and/or queer and had an unlimited text messaging plan. Youth were recruited across the United States via Facebook and enrolled by telephone from October 2014 to April 2015. Ninety-day postintervention outcomes were condomless sex acts (CSA) and abstinence and, secondarily, HIV testing. We also examined these outcomes at intervention end and stratified them by sexual experience. RESULTS: At 90 days postintervention, there were no significant differences in CSAs or abstinence noted. Among participants who were sexually active at baseline, intervention participants were significantly more likely to report getting an HIV test (adjusted odds ratio = 3.42, P = .001). They were also less likely than control youth to be abstinent (adjusted odds ratio = 0.48, P = .05). CSAs were significantly lower for those in the intervention versus control at intervention end (incident rate ratio = 0.39, P = .04), although significance was lost once age was added to the analysis (incident rate ratio = 0.58, P = .26). CONCLUSIONS: G2G appears promising in increasing adolescent HIV testing rates. Sex-positive intervention messages appear to have increased the participants’ comfort with having sex (ie, less abstinence) while not increasing their potential for HIV transmission (ie, more CSAs). Additional content or features may be needed to invigorate condom use.

OBJECTIVE. Recently, public attention has focused on the possibility that social networking sites such as MySpace and Facebook are being widely used to sexually solicit underage youth, consequently increasing their vulnerability to sexual victimization. Beyond anecdotal accounts, however, whether victimization is more commonly reported in social networking sites is unknown. PARTICIPANTS AND METHODS. The Growing up With Media Survey is a national cross-sectional online survey of 1588 youth. Participants were 10- to 15-year-old youth who have used the Internet at least once in the last 6 months. The main outcome measures were unwanted sexual solicitation on the Internet, defined as unwanted requests to talk about sex, provide personal sexual information, and do something sexual, and Internet harassment, defined as rude or mean comments, or spreading of rumors. RESULTS. Fifteen percent of all of the youth reported an unwanted sexual solicitation online in the last year; 4% reported an incident on a social networking site specifically. Thirty-three percent reported an online harassment in the last year; 9% reported an incident on a social networking site specifically. Among targeted youth, solicitations were more commonly reported via instant messaging (43%) and in chat rooms (32%), and harassment was more commonly reported in instant messaging (55%) than through social networking sites (27% and 28%, respectively). CONCLUSIONS. Broad claims of victimization risk, at least defined as unwanted sexual solicitation or harassment, associated with social networking sites do not seem justified. Prevention efforts may have a greater impact if they focus on the psychosocial problems of youth instead of a specific Internet application, including funding for online youth outreach programs, school antibullying programs, and online mental health services.