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Although perception of stigma (PS) has been dubbed as a key barrier to the optimal uptake of PrEP, research on PS is sparse. More specifically, no scholarly work has explored factors associated with the expression of PS toward PrEP use. This study addresses the literature gap by investigating factors associated with PS toward PrEP use. Data were drawn from the baseline survey (2017–2019) of the "Keeping It LITE Study", involving a large cohort (n = 3330) of young sexual minority men, transgender men and women, and non-binary individuals in the US. Participants' ages ranged from 13 to 34 years, with the majority (87%) assigned male at birth. The racial composition of the sample was diverse, with 53.9% identifying as white, 19.8% as Latinx, 10.7% as Black or African American, and smaller proportions as Asian, American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and another race/ethnicity. Logistic regression models were utilized to examine two common measures of PS in PrEP use: (1) the perception that PrEP users are seen as promiscuous and (2) the perception that PrEP users are assumed to be HIV-positive. Two sets of models were developed to account for the correlation between gender identity and sex assigned at birth. The results suggest strong PS among current PrEP users, which can explain the weak PrEP adherence reported among this group. The findings underscore the need for targeted interventions to mitigate PS and enhance PrEP uptake and adherence in vulnerable populations. Social and practical implications of the results and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Youth and young adults (YYA) have been uniquely affected by COVID-19. Behavioral models have not yet been applied to understand YYA's preventive behavior, though the Information–Motivation–Behavior (IMB) model may be appropriate. We used data from a national, diverse survey of COVID-19 effects and prevention behaviors in YYA ages 14–24 (n = 1026) and conducted an exploratory factor analysis and bivariate linear regressions to assess the association between demographics and IMB measures. Significant differences by sexual identity were identified, with bisexual/pansexual, gay/lesbian, and queer populations reporting significantly lower prevention stigma, in comparison to their straight respondents. Non-binary respondents (vs. women/girls) and transgender and gender diverse individuals (vs. cisgender) had significantly higher intentions to social distance. Racial/ethnicity differences were also found in lower prevention efficacy beliefs (Latinx and multiracial vs. white), and lower motivation norms (Black and Latinx vs. white). Our findings about critical disparities in IMB measures provide recommendations for future prevention research, practice, and policy development in response to the pandemic, particularly related to highly marginalized communities. [ABSTRACT FROM AUTHOR]

Objectives. To comprehensively assess asthma disparities and identify correlates in youths at the intersections of sex, sexual identity, and race/ethnicity in the United States. Methods. We obtained a diverse sample of youths (n = 307 073) from the Centers for Disease Control and Prevention's Youth Risk Behavior Survey. We pooled data across 107 jurisdiction-years (2009–2017). We calculated lifetime asthma prevalence by sexual identity, race/ethnicity, and their intersections—stratified by sex. We developed multivariable weighted logistic regression models to examine the impact of selected correlates on lifetime asthma prevalence. Results. Lesbian, gay, and bisexual youths have significant disparities in asthma prevalence compared with heterosexual peers. Moreover, across sex, higher prevalence of lifetime asthma was seen for most sexual identity and race/ethnicity subpopulations (27 of 30) when compared with White heterosexual sex-matched participants. Selected traditional risk factors (overweight, obese, and smoking) and bullying tended to attenuate odds among groups, especially those with a minority sexual identity. Conclusions. Asthma inequities at the intersection of sexual identity and race/ethnicity are substantive. Future studies should investigate the mechanisms contributing to these disparities to promote health equity among vulnerable youth populations. [ABSTRACT FROM AUTHOR]

Objectives. To determine how sensitive estimates of lesbian, gay, bisexual, or questioning (LGBQ)-heterosexual youth health disparities are to the presence of potentially mischievous responders. Methods. We used US data from the 2015 Youth Risk Behavior Survey, pooled across jurisdictions that included a question about sexual identity for a total sample of 148 960 students. We used boosted regressions (a machine-learning technique) to identify unusual patterns of responses to 7 screener items presumably unrelated to LGBQ identification, which generated an index of suspected mischievousness.WeestimatedLGBQ- heterosexual youth disparities on 20 health outcomes; then we removed 1% of suspected mischievous responders at a time and re-estimated disparities to assess the robustness of original estimates. Results. Accounting for suspected mischievousness reduced estimates of the average LGBQ-heterosexual youth health disparity by up to 46% for boys and 23% for girls; however, screening did not affect all outcomes equally. Drug- and alcohol-related disparities were most affected, particularly among boys, but bullying and suicidal ideation were unaffected. Conclusions. Including screener items in public health data sets and performing rigorous sensitivity analyses can support the validity of youth health estimates. [ABSTRACT FROM AUTHOR]

Background: Young men who have sex with men and young transgender women (YMSM-YTW) use online spaces to meet sexual partners with increasing regularity, and research shows that experiences of racism online mimics the real world., Objective: We analyzed differences by race and ethnicity in web-based and mobile apps used to meet sexual partners as reported by Chicago-based YMSM-YTW in 2016-2017., Methods: A racially and ethnically diverse sample of 643 YMSM-YTW aged 16-29 years were asked to name websites or mobile apps used to seek a sexual partner in the prior 6 months, as well as provide information about sexual partnerships from the same period. We used logistic regression to assess the adjusted association of race and ethnicity with (1) use of any website or mobile apps to find a sexual partner, (2) use of a "social network" to find a sexual partner compared to websites or mobile apps predominantly used for dating or hookups, (3) use of specific websites or mobile apps, and (4) reporting successfully meeting a sexual partner online among website or mobile app users., Results: While most YMSM-YTW (454/643, 70.6%) used websites or mobile apps to find sexual partners, we found that Black non-Hispanic YMSM-YTW were significantly less likely to report doing so (comparing White non-Hispanic to Black non-Hispanic: adjusted odds ratio [aOR] 1.74, 95% CI 1.10-2.76). Black non-Hispanic YMSM-YTW were more likely to have used a social network site to find a sexual partner (comparing White non-Hispanic to Black non-Hispanic: aOR 0.20, 95% CI 0.11-0.37), though this was only reported by one-third (149/454, 32.8%) of all app-using participants. Individual apps used varied by race and ethnicity, with Grindr, Tinder, and Scruff being more common among White non-Hispanic YMSM-YTW (93/123, 75.6%; 72/123, 58.5%; and 30/123, 24.4%, respectively) than among Black non-Hispanic YMSM-YTW (65/178, 36.5%; 25/178, 14%; and 4/178, 2.2%, respectively) and Jack'd and Facebook being more common among Black non-Hispanic YMSM-YTW (105/178, 59% and 64/178, 36%, respectively) than among White non-Hispanic YMSM-YTW (6/123, 4.9% and 8/123, 6.5%, respectively). Finally, we found that while half (230/454, 50.7%) of YMSM-YTW app users reported successfully meeting a new sexual partner on an app, Black non-Hispanic YMSM-YTW app users were less likely to have done so than White non-Hispanic app users (comparing White non-Hispanic to Black non-Hispanic: aOR 2.46, 95% CI 1.50-4.05)., Conclusions: We found that Black non-Hispanic YMSM-YTW engaged with websites or mobile apps and found sexual partners systematically differently than White non-Hispanic YMSM-YTW. Our findings give a deeper understanding of how racial and ethnic sexual mixing patterns arise and have implications for the spread of sexually transmitted infections among Chicago's YMSM-YTW., (© Kathryn Risher, Patrick Janulis, Elizabeth McConnell, Darnell Motley, Pedro Alonso Serrano, Joel D Jackson, Alonzo Brown, Meghan Williams, Daniel Mendez, Gregory Phillips II, Joshua Melville, Michelle Birkett. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org).)

Background: Latino, Latina, and Latinx (Latino/a/x) individuals remain disproportionately impacted by HIV, particularly sexual minority men and transgender women. Pre-exposure prophylaxis (PrEP) is an effective means of biomedical HIV prevention, but awareness and uptake remain low among marginalized Latino/a/x populations. Social marketing campaigns have demonstrated promise in promoting PrEP in other populations but are poorly studied in Latino/a/x sexual minority men and transgender women., Objective: This study aims to (1) adapt and pilot a PrEP social marketing campaign tailored to Latino/a/x populations with a focus on sexual minority men and transgender women through community-based participatory research (CBPR) and (2) evaluate the reach and ad performance of the adapted PrEP social marketing campaign., Methods: We used the ADAPT-ITT (assessment, decision, adaptation, production, topical experts-integration, training, and testing) framework for adapting evidence-based interventions for new settings or populations. This paper presents how each phase of the ADAPT-ITT framework was applied via CBPR to create the PrEPárate ("Be PrEPared") campaign. Key community engagement strategies included shared ownership with community partners, focus groups to guide content, crowdsourcing to name the campaign, design by local Latino/a/x artists, and featuring local influencers as the faces of PrEPárate. We evaluated campaign reach and advertisement performance using social media platform metrics (paid and organic reach, impressions, unique clicks, and click-through rates [CTR]) and website use statistics from Google Analytics., Results: The PrEPárate campaign ran in Cook County, Illinois, from April to September 2022. The campaign reached over 118,750 people on social media (55,750 on Facebook and Instagram [Meta Platforms Inc] and 63,000 on TikTok [ByteDance Ltd]). The Meta ads performed over the industry benchmark with ads featuring local transgender women (2% CTR) and cisgender sexual minority men (1.4% CTR). Of the different Grindr (Grindr Inc) ad formats piloted, the interstitial Grindr ads were the highest performing (1183/55,479, 2.13% CTR). YouTube (Google) ads were low performing at 0.11% (153/138,337) CTR and were stopped prematurely, given limits on sexual education-related content. In the first year, there were 5006 visitors to the website., Conclusions: Adaptation of an existing evidence-based intervention served as an effective method for developing a PrEP social marketing campaign for Latino/a/x audiences. CBPR and strong community partnerships were essential to tailor materials and provide avenues to systematically address barriers to PrEP access. Social marketing is a promising strategy to promote PrEP among underserved Latino/a/x populations., (©Harita S Shah, Pedro Alonso Serrano, Gregory Phillips II. Originally published in JMIR Formative Research (https://formative.jmir.org), 17.07.2024.)

Aims: Sexual minority youth (SMY) use alcohol at disproportionate rates compared to their heterosexual peers. However, sexual orientation is multidimensional. Analyzing alcohol use disparities only by one dimension of sexual orientation may result in critical disparities being obscured., Methods: Data from state and local versions of the Youth Risk Behavior Survey were pooled (2009-2017), resulting in a large, diverse sample (n = 201,671). Multivariable logistic regression models were used to analyze associations between sexual identity/sexual behavior and three alcohol use outcomes among sexually active youth: age at first drink, binge drinking and current drinking., Results: SMY, when categorized by sexual identity and sexual behavior, reported greater alcohol use than their heterosexual peers, though the magnitude of these disparities varied by subgroup. Both those who identified as bisexual and those who reported sexual behavior with both males and females reported the greatest levels of alcohol use. Decomposition analysis revealed that youth whose reported sexual behavior was not aligned with stereotypical behavioral expectations based on their sexual identity had higher odds of current drinking and drinking before 13 years as compared to other youth., Conclusions: Results highlight the need to incorporate multiple methods of sexual orientation measurement into substance use research. Interventions based solely on identity, rather than both identity and behavior, may not be sufficient; targeted research into the causes of alcohol use disparities is needed, especially for bisexual youth, youth whose sexual behavior and sexual identity are not stereotypically aligned, and youth who report a sexual identity of 'not sure.', (© The Author(s) 2020. Medical Council on Alcohol and Oxford University Press. All rights reserved.)