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Objectives: Examine very short sleep among adolescents across multiple intersecting social positions and experiences of sexual orientation-based bullying and cyberbullying in two statewide samples., Methods: A harmonization of two large statewide school-based datasets from grades 9-12 (2019 Minnesota Student Survey, and 2018-2019 California Healthy Kids Survey) was utilized for the analysis (N = 379,710). Exhaustive chi-square automatic interaction detection (an approach for quantitative intersectionality research) explored variability in very short sleep (≤5 hours/night) among adolescents from multiple intersecting social positions (race/ethnicity, gender identity, sexual orientation, and sex assigned at birth), grade, state, and two types of bullying experiences (sexual orientation-based bullying and cyberbullying). Intersectional groups reporting the highest prevalence of very short sleep were identified. We compared very short sleep rates among adolescents from the same social positions who experienced bullying with those who did not experience bullying., Results: Very short sleep was common among this sample of adolescents (19.2%), especially among those holding multiple marginalized social positions (36.9%-51.4%). Adolescents who were transgender or gender diverse or questioning gender identity, and with minoritized sexual and racial/ethnic identities were overrepresented among high prevalence groups of very short sleep. Bullying experiences were reported by all highest prevalence groups. Adolescents who were bullied had 24.9%-51.3% higher rates of very short sleep than adolescents from the same intersecting social positions who were not bullied., Conclusions: Very short sleep is pervasive among marginalized adolescents. Findings suggest that victimization contributes to adolescents' very short sleep rates. Individual-level interventions may fall short of promoting better sleep among adolescents; systemic interventions addressing bullying are needed., Clinical Trial Registration: N/A., Competing Interests: Declaration of conflicts of interest The authors have no conflicts of interest to disclose., (Copyright © 2024 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: This study aimed to examine asthma disparities at the intersection of four sociodemographic characteristics, inhaled substance use, and bias-based bullying as metrics of stigma. We hypothesized that high prevalence groups for asthma would be those with marginalized social positions and those reporting bullying experiences, independent of inhaled substance use., Method: The analytic sample ( N = 90,367) included eighth, ninth, and 11th grade students who participated in the 2022 Minnesota Student Survey. Exhaustive Chi-square Automatic Interaction Detection tested all combinations of sociodemographic characteristics (gender identity, sexual orientation, racial/ethnic identity, and access to resources), inhaled substance use (none vs. any), and bias-based bullying about sexuality, gender identity/expression, racial identity, and weight/size to predict mutually exclusive groups of youth based on self-reported asthma diagnosis., Results: Approximately 15% of the sample reported asthma. Sexually, gender, and racially/ethnically diverse youth reported higher rates of asthma relative to their heterosexual, cisgender, and White counterparts. High prevalence groups for asthma (rates between 24% and 41%) were characterized by having multiple marginalized identities, experiencing bias-based bullying, and engaging in inhaled substance use. Three of the 10 intersectional groups with a high prevalence of asthma were not inhaled substance users., Conclusions: These findings suggest that stigma may help explain the asthma disparities among marginalized youth. Efforts to reduce asthma disparities in marginalized youth should move beyond pathologizing the individual through overfocusing on health behaviors and attend to root causes, like experiences of stigma. Future studies should examine systemic inflammation as the potential connection between stigma and asthma. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Purpose: To determine how beliefs about various disease outcomes caused by human papillomavirus (HPV) infection differ among young gay, bisexual, and other men who have sex with men (YGBMSM)., Methods: From 2019 to 2021, we recruited cisgender YGBMSM ages 18-25 in the United States who were unvaccinated against HPV ( n  = 1,227). Survey items examined three disease outcomes (genital warts, anal cancer, and oropharyngeal cancer) for each of three different beliefs (perceived vulnerability, perceived severity, and worry)., Results: Participants reported lower perceived vulnerability to and worry about anal cancer and oropharyngeal cancer compared to genital warts (all p  < 0.001). Participants also reported greater perceived severity of anal cancer and oropharyngeal cancer compared to genital warts (all p  < 0.001). Some patterns of beliefs differed by participant characteristics., Conclusions: The beliefs of YGBMSM varied by HPV-related disease outcome. Findings can guide future HPV vaccination communication efforts for YGBMSM by informing how to better frame messages and increase relevance., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Although research has examined disparities in HIV prevention behaviors, intersectional research is needed to understand who may be underserved. This study examines disparities in consistent condom use, HIV testing, and PrEP awareness and use across assigned sex, gender identity, sexual orientation, and racial/ethnic identity in a large sample of sexually active LGBTQ+ youth (mean age = 16.5) who completed the 2022 LGBTQ National Teen Survey. Four social identities were included as indicators in Chi-Square Automated Interaction Detection models to uncover disparate rates of HIV preventive behaviors. Generally, HIV testing and PrEP services were higher among gay/lesbian and queer youth assigned male, and lower among those assigned female. Certain LGBTQ+ youth may be systematically missed by these services, (e.g., those assigned female; those assigned male who also identify as bisexual, pansexual, asexual, questioning, or straight (and trans/gender diverse)). Providers should strive to serve populations who are not being reached by HIV prevention services., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Interpersonal supports are protective against multiple negative health outcomes for youth such as emotional distress and substance use. However, finding interpersonal support may be difficult for youth exposed to intersecting racism, heterosexism, and cisgenderism, who may feel they are "outsiders within" their multiple communities. This study explores disparities in interpersonal supports for youth at different sociodemographic intersections. The 2019 Minnesota Student Survey includes data from 80,456 high school students, including measures of four interpersonal supports: feeling cared about by parents, other adult relatives, friends, and community adults. Exhaustive Chi-square Automatic Interaction Detection analysis was used to examine all interactions among four social identities/positions (racialized/ethnic identity, sexual identity, gender identity, sex assigned at birth) to identify groups who report different rates of caring from each source (Bonferroni adjusted p<.05). In the overall sample, 69.24% perceived the highest level of caring ("very much") from parents, 50.09% from other adult relatives, 39.94% from friends, and 15.03% from community adults. Models identified considerable differences in each source of support. For example, more than 72% of straight, cisgender youth reported their parents cared about them very much, but youth who identified as LGBQ and TGD or gender-questioning were much less likely to report high parent caring (less than 36%) across multiple racialized/ethnic identities and regardless of sex assigned at birth. Findings highlight the importance of better understanding the ways interpersonal support might differ across groups, and underscore a need for intersectionality-tailored interventions to develop protective interpersonal supports for LGBTQ+ youth, rather than one-size-fits-all approaches.

Purpose: To describe the prevalence of sexual identity by grade, racial and ethnic identities, and sex assigned at birth., Methods: Data came from the statewide 2022 Minnesota Student Survey of eighth, ninth, and 11th grade students (N = 99,688). Chi-square tests compared the prevalence of sexual identity across grades, racial/ethnic groups, and sex assigned at birth., Results: Over a fifth (22.2%) of students self-reported a minoritized sexual identity. Bisexual and pansexual were most common among Native+ (12.3%, 5.7%, respectively), multiracial (11.6%, 4.4%, respectively), and Latina/x/o (10.4%, 4.1%, respectively) youth. Asexuality was consistently reported across grades, and eighth graders reported gay/lesbian, bisexual, and queer identities less than 11th graders. Youth assigned female at birth were more likely to report gay/lesbian, bisexual, asexual, pansexual, queer, and questioning than youth assigned male at birth., Discussion: Results support the continued use of further expanded sexual identities in epidemiologic surveys., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: To apply an intersectional lens to disparities in emotional distress among youth, including multiple social positions and experiences with bias-based bullying., Methods: Data are from the 2019 Minnesota Student Survey (n = 80 456). Social positions (race and ethnicity, sexual orientation, gender) and 2 forms of bias-based bullying (racist, homophobic or transphobic) were entered into decision tree models for depression, anxiety, self-injury, suicidal ideation, and suicide attempts. Groups with the highest prevalence are described. Rates of emotional distress among youth with matching social positions but no bias-based bullying are described for comparison., Results: LGBQ identities (90%) and transgender, gender diverse, and questioning identities (54%) were common among the highest-prevalence groups for emotional distress, often concurrently; racial and ethnic identities rarely emerged. Bias-based bullying characterized 82% of the highest-prevalence groups. In comparable groups without bias-based bullying, emotional distress rates were 20% to 60% lower (average 38.8%)., Conclusions: Findings highlight bias-based bullying as an important point for the intervention and mitigation of mental health disparities, particularly among lesbian, gay, bisexual, transgender, gender-diverse, queer, and questioning adolescents. Results point to the importance of addressing bias-based bullying in schools and supporting lesbian, gay, bisexual, transgender, gender-diverse, queer, and questioning students at the systemic level as a way of preventing emotional distress., (Copyright © 2024 by the American Academy of Pediatrics.)

Disparities in youth homelessness by racial/ethnic, sexual, and gender identities are well documented, though this literature lacks specificity regarding intersectional social identities of youth who are most likely to experience homelessness. Population-based cross-sectional data on youth from the 2019 Minnesota Student Survey ( N = 80,456) were used to examine the relationship between parent caring and intersections of minoritized identities that experience the highest prevalence of two distinct types of unaccompanied unstable housing with expanded categories of sexual and gender identities. Exhaustive chi-square automatic interaction detection models revealed that low parent caring was the most common predictor of unaccompanied homelessness and running away, but there was important variation among youth of color at the intersection of sexual and gender identities. The findings reveal a more complex story of disparities in unaccompanied unstable housing among youth with multiple marginalized social identities and highlight the need to create culturally informed prevention and intervention strategies for parents of LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and questioning) youth of color. The implications for prevention and intervention among subgroups with the highest prevalence are discussed in the context of interlocking systems of power and oppression. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

We examined perceptions of vaccines and changes during the coronavirus disease 2019 (COVID-19) pandemic. From 2019 to 2021, a national sample of young gay, bisexual, and other men who have sex with men completed an open-ended survey item about vaccine perceptions. Analyses identified themes and polarity (negative, neutral, or positive) within responses and determined temporal changes across phases of the pandemic ("pre-pandemic," "pandemic," "initial vaccine availability," or "widespread vaccine availability"). Themes included health benefits of vaccines (53.9%), fear of shots (23.7%), COVID-19 (10.3%), vaccines being safe (5.6%), and vaccine hesitancy/misinformation (5.5%). Temporal changes existed for multiple themes ( p  < .05). Overall, 53.0% of responses were positive, 31.2% were negative, and 15.8% were neutral. Compared to the pre-pandemic phase, polarity was less positive for the widespread vaccine availability phase (odds ratio = 0.64, 95% confidence interval: 0.42-0.96). The findings provide insight into how vaccine perceptions change in concert with a public health emergency.

Purpose: The current study extends the limited body of intersectional research on adolescents' sexual health by examining experiences of bias-based bullying and multiple intersecting social positions associated with engagement in sexual risk behaviors. Methods: Participants were 14,968 sexually active 9th and 11th grade students surveyed as part of the 2019 Minnesota Student Survey (15% lesbian/gay/bisexual/queer/pansexual/questioning [LGBQ] and/or transgender/gender diverse [TGD] or gender questioning). Exhaustive Chi-square Automatic Interaction Detection analysis was used to identify experiences (i.e., bias-based bullying victimization) and intersecting social positions (i.e., sexual orientation identity; gender identity/modality; race/ethnicity; physical disabilities/chronic illness; mental health/behavioral/emotional problems) associated with the highest prevalence of three sexual risk behaviors. Results: Overall, 18% of adolescents reported 3+ sex partners in the last year, 14% reported drug/alcohol use before last sex, and 36% reported not discussing protection from sexually transmitted infections with new sexual partners. Adolescents with 2+ marginalized social positions, some of whom also experienced bias-based bullying, were part of 53% of the highest prevalence risk groups. For example, 42% of Multiracial or Latina/x/o gender questioning adolescents who identified as LGBQ reported 3+ sex partners in the last year-twice the sample average. Adolescents who were Black, American Indian/Alaska Native, Latina/x/o, Multiracial, TGD, or gender questioning were in the highest prevalence nodes across all outcomes. Conclusion: Adolescents with multiple marginalized social positions and who experience bias-based bullying engage in high-risk sexual behaviors at higher-than-average rates. Findings underscore the importance of addressing intersecting experiences of stigma to reduce high-risk sex behaviors and promote health equity among adolescents.

Purpose: This study examines adolescents' self-reported school-based developmental assets and four intersecting social positions as they relate to prevalence of bullying involvement. Methods: Participants were 80,456 ninth and 11th grade students who participated in the 2019 Minnesota Student Survey (30.2% youth of color; 11% lesbian/gay/bisexual/pansexual/queer/questioning; 2.9% transgender/gender diverse [TGD] or gender questioning). Exhaustive Chi-square Automatic Interaction Detection analysis was used to identify school-based developmental assets (i.e., school safety, school adult support) and intersecting social positions (i.e., sexual identity; gender identity/modality; racial/ethnic identity; physical disabilities/chronic illness; and/or mental health/behavioral/emotional problems) associated with the highest prevalence of involvement as physical and relational bullies, victims, and bully-victims. Results: Adolescents with 2+ marginalized social positions who often lacked school-based developmental assets were part of nearly all the highest prevalence bullying involvement groups. TGD and gender questioning adolescents, Native American youth, and youth living with both physical disabilities/chronic illness and mental health/emotional/behavioral problems-most of whom had additional marginalized social positions and lacked school-based assets-were particularly overrepresented in high prevalence groups. For example, 31.1% of TGD or gender questioning youth of color living with both types of disabilities/health problems who did not feel strongly that school was safe reported involvement as physical bully-victims-nearly six times the sample average rate. Conclusion: Adolescents with multiple marginalized social positions and those lacking certain school-based assets-often overlapping categories-were involved in bullying at higher-than-average rates. Findings underscore the need for schools to address intersecting experiences of stigma and structural oppression that may perpetuate bullying involvement disparities.

Bias-based bullying influences health, academic success, and social wellbeing. However, little quantitative work takes an intersectional perspective to understand bias-based bullying among youth with marginalized social positions, which is critical to prevention. This paper describes the application of exhaustive chi-square automatic interaction detection (CHAID) to understand how prevalence of race-, gender-, and sexual orientation-based bullying varies for youth with different intersecting social positions. We used two datasets - the 2019 Minnesota Student Survey (MSS; N=80,456) and the 2017-2019 California Healthy Kids Survey (CHKS; N=512,067). Students self-reported sex assigned at birth, sexual orientation, gender identity, race/ethnicity, and presence of any race-, gender-, and sexual orientation-based bullying (MSS: past 30 days, CHKS: past 12 months). Exhaustive CHAID with a Bonferroni correction, a recommended approach for large, quantitative intersectionality research, was used for analyses. Exhaustive CHAID analyses identified a number of nodes of intersecting social positions with particularly high prevalences of bias-based bullying. Across both datasets, with varying timeframes and question wording, and all three forms of bias-based bullying, youth who identified as transgender, gender diverse, or were questioning their gender and also held other marginalized social positions were frequent targets of all forms of bias-based bullying. More work is needed to understand how systems of oppression work together to influence school-based bullying experiences. Effective prevention programs to improve the health of youth with marginalized social positions must acknowledge the complex and overlapping ways bias and stigma interact.

Primary care providers are well positioned to address the sexual and reproductive health (SRH) needs of adolescents; however, gaps often exist in the delivery of quality SRH services in primary care. Our objective was to identify specific opportunities to improve the delivery of adolescent SRH services in primary care. We conducted in-depth interviews with 25 primary care providers from various disciplines across rural and urban areas of Minnesota and conducted thematic analysis of transcribed data. Participants identified salient opportunities in three areas: (1) training and resources for providers (e.g., related to minor consent laws or addressing sensitive subjects), (2) practices and procedures (e.g., time-alone procedures and policies for confidential screening and sharing test results), and (3) education for adolescents (e.g., knowing their rights and accessing confidential SRH services). Study findings provide actionable opportunities to improve delivery of adolescent SRH services in primary care.

Purpose: Time alone between health care providers and adolescent patients is a core element of quality adolescent primary care, yet not all adolescents receive this care. Clinicians' apprehension about how best to introduce time alone may contribute to lower levels of time alone. This study aims to understand how adolescent patients and their parents or guardians experience the introduction of time alone during adolescent preventive visits., Method: We conducted semistructured interviews with adolescents, aged 11-17 years (n = 35) and a parent or guardian of the adolescent (n = 35) across metropolitan and nonmetropolitan areas of Minnesota. We used thematic analysis to describe (1) parent and adolescent experiences learning about time alone for the first time and (2) parent and adolescent reactions to this experience., Results: Key findings from this study suggest that adolescents prefer a universal application of time alone with an option to opt out (e.g., "At this age, I always ask parents to step out for a few minutes, are you okay with that?"), rather than opt in (e.g., "Would you like your parent to step out?"). Parents noted that time alone should not be a surprise but rather should be presented as routine, so they are not left to wonder if time alone was offered to their adolescent for a particular reason., Discussion: Findings suggest universal presentation of time alone with the option for adolescents to opt out may improve acceptability of time alone and support delivery of highquality care., (Copyright © 2023 Society for Adolescent Health and Medicine. All rights reserved.)

Background: Routine human papillomavirus (HPV) vaccination is recommended for young adults, yet many young gay, bisexual, and other men who have sex with men (YGBMSM) remain unvaccinated. We report the efficacy of Outsmart HPV, a web-based HPV vaccination intervention for YGBMSM., Methods: From 2019 to 2021, we recruited YGBMSM in the United States who were ages 18-25 and unvaccinated against HPV (n = 1,227). Participants were randomized to receive either: (i) Outsmart HPV content online and monthly interactive text reminders (interactive group); (ii) Outsmart HPV content online and monthly unidirectional text reminders (unidirectional group); or (iii) standard information online about HPV vaccine (control group). Regression models compared study groups on HPV vaccination outcomes., Results: Overall, 33% of participants reported initiating the HPV vaccine series and 7% reported series completion. Initiation was more common among participants in the interactive group compared with the control group [odds ratio (OR) = 1.47, 98.3% confidence interval (CI): 1.03-2.11]. Completion was more common among participants in both the interactive group (OR = 3.70, 98.3% CI: 1.75-7.83) and unidirectional group (OR = 2.26, 98.3% CI: 1.02-5.00) compared with the control group. Participants who received Outsmart HPV content reported higher levels of satisfaction with online content compared with the control group., Conclusions: Outsmart HPV is an efficacious and acceptable HPV vaccination intervention for YGBMSM. Future efforts are needed to determine how to optimize the intervention and disseminate it to settings that provide services to YGBMSM., Impact: Outsmart HPV is a promising tool for increasing HPV vaccination among YGBMSM with the potential for wide dissemination., (©2023 American Association for Cancer Research.)

Extensive media coverage and potential controversy about COVID-19 vaccination during the pandemic may have affected people's general attitudes towards vaccination. We sought to describe key psychological antecedents related to vaccination and assess how these vary temporally in relationship to the pandemic and availability of COVID-19 vaccination. As part of an ongoing online study, we recruited a national (U.S.) sample of young gay, bisexual and other men who have sex with men (N = 1,227) between October 2019 and June 2021, and assessed the "4Cs" (antecedents of vaccination; range = 1-5). Overall, men had high levels of confidence (trust in vaccines; M = 4.13), calculation (deliberation; M = 3.97) and collective responsibility (protecting others; M = 4.05) and low levels of complacency (not perceiving disease risk; M = 1.72). In multivariable analyses, confidence and collective responsibility varied relative to the pandemic phase/vaccine availability, reflecting greater hesitancy during later stages of the pandemic. Antecedents also varied by demographic characteristics. Findings suggest negative effects of the COVID-19 pandemic on key antecedents of general vaccination and identify potential targets for interventions., (© 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

Mechanical stresses across different length scales play a fundamental role in understanding biological systems' functions and engineering soft machines and devices. However, it is challenging to noninvasively probe local mechanical stresses in situ, particularly when the mechanical properties are unknown. We propose an acoustoelastic imaging-based method to infer the local stresses in soft materials by measuring the speeds of shear waves induced by custom-programmed acoustic radiation force. Using an ultrasound transducer to excite and track the shear waves remotely, we demonstrate the application of the method by imaging uniaxial and bending stresses in an isotropic hydrogel and the passive uniaxial stress in a skeletal muscle. These measurements were all done without the knowledge of the constitutive parameters of the materials. The experiments indicate that our method will find broad applications, ranging from health monitoring of soft structures and machines to diagnosing diseases that alter stresses in soft tissues.

Background: Lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) youth are overrepresented in foster care and report greater substance use during adolescence., Objective: Using an intersectional lens, the current study investigates differences in foster care placement and variation in substance use at the intersections of foster care and sexual orientation, gender identity, racial/ethnic identities, and sex assigned at birth., Participants and Settings: A sample of 121,910 LGBTQ youth (grades 6-12) completed either the Minnesota Student Survey in 2019, the California Healthy Kids Survey from 2017 to 2019, or the 2017 LGBTQ National Teen Study., Methods: Youth reported their substance use in the past 30 days (alcohol, binge drinking, cigarette, marijuana), social positions (sexual orientation, gender identity, racial/ethnic identities, sex assigned at birth), living arrangement (foster care or not), and grade in school. Logistic regression was used to examine the main and interaction effects of foster care and social positions on youth substance use., Results: Results indicated significant differences in substance use at the intersection of foster care placement and youth social positions. Significant two-way interactions for foster care placement and social positions emerged predicting alcohol, binge drinking, and marijuana use., Conclusions: Findings show that LGBTQ youth in foster care are at higher risk for substance use than those not in foster care. Particular support is needed for lesbian, gay, and questioning youth, transgender youth, LGBTQ youth assigned male at birth, and Asian or Pacific Islander LGBTQ youth in foster care., Competing Interests: Declaration of competing interest The authors have no conflicts of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: Human papillomavirus vaccination coverage is suboptimal, especially among males. Social networks influence young adults' health behaviors and could be leveraged to promote vaccination. We sought to describe how young sexual minority men communicate about human papillomavirus (HPV) vaccination with their sexual partners. Participants: National (U.S.) sample of sexual minority men ages 18-26 ( n  = 42) from January 2019. Methods: We conducted four online focus groups and identified salient themes using inductive content analysis. Results: Across groups, participants described that HPV vaccination is not a focus of their conversations with sexual partners. Other key themes related to HPV vaccine communication included: varying discissions based on relationship type, and valuing conversations with partners about safer sex. Conclusions: Findings provide novel insight into how young sexual minority men communicate with their sexual partners about HPV vaccination and identify potential areas for interventions to promote communication. Future research is needed to investigate associations between partner communication and HPV vaccine uptake.

Purpose: We compared rates of sport and physical activity (PA) of transgender and gender diverse adolescents and adolescents questioning their gender (TGDQ) with those of cisgender adolescents. Additionally, we tested for differences in sport and PA among TGDQ youth., Methods: We used 2019 Minnesota Student Survey data (N = 125,375). We calculated descriptive statistics, then used chi-squares and one-way analyses of variance to test for differences in involvement in sports, PA lessons, and PA between TGDQ and cisgender adolescents. Then, we used the same tests to compare participation among all TGDQ adolescents, considering their gender identity and sex assigned at birth., Results: Overall, TGDQ adolescents participated in sport and PA less than cisgender adolescents; TGD youth participated less than questioning youth. Within sex assigned at birth, participation varied by gender identity., Discussion: TGDQ adolescents need support to participate in sport and PA. Adults should remain cognizant that sport restrictions could impair TGDQ adolescents' health., (Copyright © 2022 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Knowledge, attitudes, and beliefs are important antecedents to HPV vaccination, yet remain suboptimal among young gay, bisexual, and other men who have sex with men (YGBMSM). We report the effects of a theoretically-informed, web-based HPV vaccination intervention on these cognitive outcomes. From 2019-2021, we recruited a national sample of YGBMSM ages 18-25 in the United States who were unvaccinated against HPV ( n  = 1,227). Participants received either standard HPV vaccination information online (control) or population-targeted, individually-tailored content online ( Outsmart HPV intervention). Mixed effects models determined if pre-post changes in cognitive outcomes differed between study groups. For five of seven knowledge items about HPV, there were larger pre-post increases among the intervention group than the control group in the percentage of participants who provided correct responses (all statistically significant at p  = .05 after Holm's correction). There were also larger pre-post improvements among the intervention group than the control group for most attitudes and beliefs examined, including response efficacy of HPV vaccine (pre-post increases in means: 0.57 vs. 0.38); self-efficacy for the HPV vaccination process (pre-post increases in means: 0.23 vs. 0.10); and intention to get HPV vaccine (pre-post increases in means: 0.70 vs. 0.28) (all statistically significant at p  = .05 after Holm's correction). Outsmart HPV is a promising tool for improving key cognitive antecedents to HPV vaccination among YGBMSM, supporting the use of theoretically-informed interventions to affect such outcomes. If efficacious in increasing HPV vaccine uptake in future analyses, this intervention could be utilized in clinical and other healthcare settings that provide services to YGBMSM.

Bias-based bullying (e.g., bullying related to race, weight, sexual orientation) is a common experience among youth, yet few school-based prevention programs explicitly address this type of bullying. This study explores whether schools that offer diversity education activities have lower rates of bias-based bullying among students compared to schools that do not offer these activities. Data came from two sources: the 2018 CDC School Profiles Survey ( N = 216 schools) and the 2019 Minnesota Student Survey ( N = 64,510 students). Multilevel logistic regression tested associations between diversity education activities (diversity clubs, lessons, or special events) and eight types of bias-based bullying among students, with attention to effect modification by relevant demographic characteristics. Students attending schools that offer a wider variety of diversity education opportunities had significantly lower odds of bullying about race, ethnicity, or national origin among boys of color ( OR = 0.89, CI: 0.80, 1.00), about sexual orientation for gay, bisexual, and questioning boys ( OR = 0.81, CI: 0.67, 0.97), and about disability for boys with a physical health problem ( OR = 0.86, CI: 0.76, 0.99). Attending a school with more types of diversity education activities may protect vulnerable students against specific types of bias-based bullying and advance health equity. A diversity education is recommended as a key component of antibullying efforts and policy.

Purpose: Research has identified persistent disparities in alcohol, e-cigarette, and marijuana use, by sexual orientation, gender identity, and race/ethnicity. Using an intersectionality framework, the present study analyzes three large datasets to identify intersecting social positions bearing the highest burden of substance use., Methods: Data from adolescents in grades 9-12 in three samples (2019 Minnesota Student Survey, 2017-2019 California Healthy Kids Survey, and 2017 National Teen Survey) were harmonized for an analysis (N = 602,470). A Chi-squared Automatic Interaction Detection analysis compared the prevalence of four types of substance use across all combinations of four social positions (six racial/ethnic identities, five sexual orientations, three gender identities, and two sexes assigned at birth). For each substance, 10 intersectional groups with the highest prevalence of use were examined., Results: In the full sample, 12%-14% of participants reported past 30-day alcohol, e-cigarette, or marijuana use and 7% reported past 30-day binge drinking. Several intersecting marginalized social positions were consistently found to bear a high burden of substance use. For example, transgender and gender diverse (TGD) Latina/x/o young people, particularly those assigned male at birth, were in the high prevalence groups for alcohol use, binge drinking, and marijuana use. Black TGD or gender-questioning youth were commonly in the high prevalence groups., Discussion: Findings suggest that support, resources, and structural changes specifically tailored to youth with multiple marginalized identities (especially TGD) may be needed. The results argue for intersectional efforts that explicitly address racial/ethnic and cultural differences, while also integrating awareness and understanding of sexual and gender diversity., (Copyright © 2022 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Surveillance data indicate youth have many sexual and gender identities that should be included in clinical forms and surveys to document and improve health equity., Competing Interests: CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no conflicts of interest relevant to this article to disclose., (Copyright © 2022 by the American Academy of Pediatrics.)

Objectives. To describe the prevalence of sex trading by gender and by associations with mental health concerns and protective factors. Methods. We used data from 9th and 11th graders who completed the 2019 Minnesota Student Survey. The analytic sample (n = 67 806) included transgender and gender-diverse (TGD) youths and cisgender youths who reported trading sex. Data on 7 mental health measures and 4 school-related and health care-related protective factors were collected. Results. The prevalence of sex trading (5.9%) was 5 times higher among TGD students than cisgender students (1.2%). In addition, the prevalence of all mental health concerns was high among TGD students who traded sex (e.g., 75.9% reported a lifetime suicide attempt, as compared with 45.9% of cisgender students who traded sex). Fewer statistical differences were found across protective factors. When TGD students who traded sex were compared according to sex assigned at birth, no statistically significant differences were found. Conclusions. Our findings support strong calls for increased competence regarding gender and sex trading or exploitation in clinical and school-based settings to decrease health disparities among TGD youths. Public Health Implications. In this study, we have presented unique prevalence estimates of mental health disparities among TGD students in the United States who trade sex. Our results indicate that TGD students who trade sex are at risk for mental health symptoms and that sensitivity to both gender and sex trading or exploitation will be critical to meeting the needs of this group in clinical as well as school-based settings.

Measuring the in-plane mechanical stress in a taut membrane is challenging, especially if its material parameters are unknown or altered by the stress. Yet being able to measure the stress is of fundamental interest to basic research and practical applications that use soft membranes, from engineering to tissues. Here we present a robust non-destructive technique to measure directly in-situ stress and strain in soft thin films without the need to calibrate material parameters. Our method relies on measuring the speed of elastic waves propagating in the film. Using optical coherence tomography, we verify our method experimentally for a stretched rubber membrane, a piece of cling film (about 10 μ m thick), and the leather skin of a traditional Irish frame drum. We find that our stress predictions are highly accurate and anticipate that our technique could be useful in applications ranging from soft matter devices to biomaterial engineering and medical diagnosis., Competing Interests: Competing interests The authors declare no competing interests.

Purpose: Youth face similar rates of homelessness across rural and urban areas, yet little is known about how the health of unstably housed youth varies by location. We assessed differences in health by location (city, suburb, town, and rural) and housing status among youth facing a range of unstable housing experiences., Methods: This secondary data analysis from 8th, 9th, and 11th graders completing the 2019 Minnesota Student Survey examined youth who had experienced housing instability in the prior year (n = 10,757), including running away (48%) or experiencing homelessness (staying in shelter, couch-surfing, or rough sleeping) with (42%) or without (10%) an adult family member. We conducted multifactor analysis of variance to assess differences by location (urban, suburban, town, and rural) and housing experience for each of five health indicators: suboptimal health, depressive symptoms, suicide attempts, ≥2 sexual partners, and e-cigarette use., Results: In main effects models, all health indicators varied based on housing status; suboptimal health, ≥2 sexual partners, and e-cigarette use also varied by location. Interaction models showed that unaccompanied homeless youth in suburbs reported poorer health compared with those in cities. Compared with suburbs, youth in towns were more likely to report ≥2 sexual partners (19.9%, 24.1%) and e-cigarette use (39.5%, 43.3%)., Conclusions: Our findings suggest that unstably housed youth face a similar burden of poor health across locations, with only subtle differences in health indicators, yet most research focuses on urban youth. Future research is needed to identify how to best meet the health needs of unstably housed youth across locations., (Copyright © 2020 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Research on enacted stigma, or stigma- and bias-based victimization, including bullying and harassment, among lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth often focuses on one context (e.g., school) or one form (e.g., bullying or microaggressions), which limits our understanding of these experiences. We conducted qualitative go-along interviews with 66 LGBTQ adolescents (14-19 years) in urban, suburban, town, and rural locations in the United States and Canada identified through purposive and snowball sampling. Forty-six participants (70%) described at least one instance of enacted stigma. Three primary themes emerged: (1) enacted stigma occurred in many contexts; (2) enacted stigma restricted movement; and (3) second-hand accounts of enacted stigma shaped perceptions of safety. Efforts to improve well-being among LGBTQ youth must address the diverse forms and contexts of enacted stigma that youth experience, which limit freedom of movement and potential access to opportunities that encourage positive youth development. School nurses can play a critical role in reducing enacted stigma in schools and in collaboration with community partners.

Background: Homelessness is associated with health problems and with adverse childhood experiences (ACEs). The risk of chronic health conditions for homeless compared to housed youth, and how this risk interacts with ACEs remains unclear. This study investigated the relationship between ACEs, housing, and child health, and whether: 1) ACEs and health vary by housing context; 2) ACEs and homelessness confer independent health risks; and 3) ACEs interact with housing with regard to adolescent health., Methods: Using data from 119,254 8th-11th graders, we tested independent and joint effects of ACEs and past-year housing status (housed, family homelessness, unaccompanied homelessness) on overall health and chronic health conditions, controlling for sociodemographic covariates., Results: The prevalence of ACEs varied by housing status, with 34.1% of housed youth experiencing ≥1 ACE vs. 56.3% of family-homeless and 85.5% of unaccompanied-homeless youth. Health status varied similarly. Homelessness and ACEs were independently associated with low overall health and chronic health conditions, after adjusting for covariates. Compared to housed youth, both family-homeless youth and unaccompanied-homeless youth had increased odds of low overall health and chronic physical and/or mental health conditions. All ACE x housing-status interactions were significant (all p < 0.001), such that ACE-related health risks were moderated by housing status., Conclusions: ACEs and housing status independently predict health status during adolescence beyond other sociodemographic risks. Experiencing homelessness, whether unaccomapnied or with family, is associated with increased health risk, and every additional ACE increases this risk. Clinicians and health systems should advocate for policies that include stable housing as a protective factor.

Supportive school and community resources are associated with reduced risk of suicidality among lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ +) adolescents as well as their cisgender, heterosexual peers. This study examined whether adolescents attending schools and living in communities with more versus fewer LGBTQ +-supportive resources were at lower risk of a past-year suicide attempt. Data on sexual orientation and past-year suicide attempt were obtained from student surveys administered in 30 Massachusetts public high schools between 2014 and 2017 ( N = 20,790). Data on school resources were obtained from a questionnaire administered to school officials, and community resources were assessed through internet searching. Modified Poisson generalized estimating equations tested associations between school and community LGBTQ +-supports and suicide attempt separately by sex/gender, adjusting for student, school, and community covariates. Several school resources and the availability of community-wide LGBTQ +-supportive resources were associated with lower risk of a suicide attempt among several subgroups of students, even after controlling for the presence of multiple school and community resources and covariates. For example, the risk of a suicide attempt among gay, bisexual and questioning boys in schools with a gender-neutral restroom was approximately half compared to gay, bisexual and questioning boys in schools without this resource. Past year suicide attempts were also significantly lower among questioning, RR = 0.56, CI [0.37-0.86], and heterosexual, RR = 0.59, CI [0.50-0.68], girls living in communities with more supportive resources compared to those in communities with fewer resources. LGBTQ +-supportive resources in schools and communities may be beneficial for all adolescents regardless of sexual orientation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Measuring stress levels in loaded structures is crucial to assess and monitor structure health and to predict the length of remaining structural life. Many ultrasonic methods are able to accurately predict in-plane stresses inside a controlled laboratory environment but struggle to be robust outside, in a real-world setting. That is because these methods rely either on knowing beforehand the material constants (which are difficult to acquire) or require significant calibration for each specimen. This paper presents an ultrasonic method to evaluate the in-plane stress in situ directly, without knowing any material constants. The method is simple in principle, as it only requires measuring the speed of two angled shear waves. It is based on a formula that is exact for incompressible solids, such as soft gels or tissues, and is approximately true for compressible "hard" solids, such as steel and other metals. The formula is validated by finite element simulations, showing that it displays excellent accuracy, with a small error on the order of 1%.

Despite supportive structural changes to reduce stigma towards lesbian, gay, and bisexual, transgender, queer, and questioning (LGBTQ) Canadian residents, sexual minority youth still face disparities compared to heterosexual peers. We aimed to characterize LGBTQ-supportive environments and political climates, and examine their links to suicidal behavior among sexual minority adolescents in western Canada. Data were from the 2013 British Columbia Adolescent Health Survey, a cluster-stratified random cross-sectional survey of public school students in BC, Canada; We sampled 2678 self-identified LGB and mostly heterosexual students (69% girls) from 274 schools, representing an estimated provincial population of 24,624 sexual minority students in weighted models. Student reports of past-year suicidal ideation, suicidal attempts, and self-harm behaviors were merged with community-level data assessing diverse aspects of LGBTQ-supportive resources and progressive political climates in communities surrounding the schools. Adjusted multilevel models showed that for sexual minority adolescent girls, higher community LGBTQ-supportiveness predicted marginally significant lower suicidal ideation (aOR = 0.94, 95% CI [0.88, 1.01]) and suicidal attempts (aOR = 0.91, 95% CI [0.83, 1.00]) and significantly lower self-harm behaviors (aOR = 0.91, 95% CI [0.85, 0.98]). Further, progressive political climates predicted marginally significant lower suicidal ideation (aOR = 0.89, 95% CI [0.78, 1.02]) and significantly lower self-harm behaviors (aOR = 0.87, 95% CI [0.77, 0.99]). For sexual minority adolescent boys, no community-level variables were associated with suicidal behavior in adjusted models. Thus, LGBTQ-supportive communities and progressive political climates appear to be protective against suicidal behavior among sexual minority adolescent girls, but not sexual minority adolescent boys., (Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: Research indicates that natural features surrounding schools are associated with better academic achievement, enhanced focus, and reduced stress in students. However, few studies have examined the associations between school landscape elements and anxiety, depression, and behavioral concerns in students. The purpose of this study was to determine whether greenery and impervious surfaces surrounding schools are associated with student internalizing and externalizing problems., Method: Fifth-grade students (n = 21,378) reported internalizing and externalizing behaviors on the 2016 Minnesota Student Survey, an anonymous school-based survey administered statewide. Geographic information system landscape data were available for 268 schools in metropolitan areas. We calculated the percentages of tree canopy, grass and shrub cover, and impervious surfaces within 300- and 500-m radius areas around each school building. Multilevel regression models evaluated the associations between student-level internalizing and externalizing behaviors and school-level landscape percentages, controlling for sex, race, and free/reduced-price lunch., Results: Students attending metropolitan schools with a higher percentage of impervious surfaces were more likely to report externalizing behaviors and marginally more internalizing symptoms than students in schools with a lower percentage of impervious surfaces. Higher percentages of tree canopy and grass and shrub cover surrounding schools were not associated with internalizing or externalizing behaviors., Conclusion: Increased impervious surfaces around schools in metropolitan areas were related to increased student externalizing behaviors. Further studies are necessary to understand the significance of the built environment, types of greenery, impact of greenery on student adjustment in nonmetropolitan settings, and varying areas surrounding schools. These results could inform initiatives to improve school landscapes.

Extensive literature documents that adverse childhood experiences increase risk for non-suicidal self-injury (NSSI) and suicide behaviors among adolescents. However, few studies have examined patterns of co-occurring family based adversities, whether distinct patterns of adversity are differentially associated with NSSI and suicide behaviors, and if social support can offset the impact of adversity for these behaviors. This study used a statewide school-based sample that was 50.1% female, 71% non-Hispanic White, and evenly divided by grade (9th grade N = 39,682; 11th grade N = 33,966). Latent class analysis identified three mutually exclusive, homogeneous subgroups of co-occurring familial adversities; low or no family based adversity, parental dysfunction but low maltreatment, and parental dysfunction plus maltreatment. The relationships between membership in the identified subgroups and past year NSSI, suicidal ideation, and suicide attempt were assessed separately for 9th graders (average age = 14) and 11th graders (average age = 17). Although membership in the parent dysfunction plus maltreatment class was associated with the highest odds of NSSI, suicidal ideation, and suicide attempt, membership in either class of familial adversity elevated risk for these behaviors compared to membership in the low or no adversity class. Whether the protective effects of perceived peer and teacher social support moderated these associations and varied across age groups was also explored. The findings suggest that peer and teacher social support can promote positive outcomes even for youth living in stressful family conditions and that the protective effects of social support increase as the number of sources of support expands.

Research has identified discrimination and a lack of knowledgeable providers as major barriers for transgender and gender diverse (TGD) individuals seeking care, which contributes to greater stress and significant health disparities affecting this population. However, research involving TGD youth is limited. The aim of this study, therefore, was to describe TGD adolescents' experiences, concerns and needs in healthcare settings, including their feedback on themes previously identified by healthcare providers (i.e. discomfort with gender-related topics, reasons for not asking patients about gender and previous training regarding gender diversity). The authors conducted semi-structured interviews with 12 TGD-identified adolescents aged 14-17, living in Minnesota, USA in 2017-2018. Inductive thematic analysis was used to summarise participant comments into themes and subthemes. Two main themes were directly relevant to concerns and needs of TGD youth in healthcare settings and their views on healthcare providers' concerns: (a) asking about gender and pronouns and (b) training for healthcare providers. Findings suggest the need for revisions to clinic materials, infrastructure and protocols. Adding training to all general medical and nursing education to increase knowledge, comfort and competence around gender identity would further improve care and ultimately reduce healthcare disparities affecting TGD youth., (© 2020 John Wiley & Sons Ltd.)

Research has indicated that lesbian, gay, bisexual, and queer/questioning (LGBQ) adolescents have disproportionately high rates of substance use compared to heterosexual peers; yet certain features of schools and communities have been associated with lower substance use rates in this population. To advance this field, research examining multiple levels of influence using measures developed with youth input is needed. With community, school, and student data, this study tested hypotheses that LGBQ students attending high schools and living in communities with more LGBQ-supportive environments (assessed with a novel inventory tool) have lower odds of substance use behaviors (cigarette smoking, alcohol use, marijuana use, prescription drug misuse, and other drug use) than their peers in less supportive LGBQ environments. Multilevel models using data from 2454 LGBQ students (54.0% female, 63.9% non-Hispanic white) in 81 communities and adjusting for student and school covariates found that LGBQ adolescents who lived in areas with more community support had lower odds of frequent substance use, particularly among females. Expanding and strengthening community resources (e.g., LGBQ youth-serving organizations, LGBQ events such as a Pride parade, and LGBQ-friendly services) is recommended to further support LGBQ adolescents and reduce substance use disparities.

Background: Violence and bullying perpetration among boys are major public health problems. We address gaps in the literature by examining: (1) how risk and protective factors co-occur, and (2) how different risk/protection profiles are associated with violence and bullying perpetration among adolescent boys., Methods: Data came from the population-based 2016 Minnesota Student Survey. The analytic sample included boys in grades 8, 9, and 11 (N = 63,818). Latent profile analyses identified patterns of 22 behavioral, intrapersonal, family, and school and community risk/protective factors. Logistic regression analyses examined how these patterns related to violence and bullying perpetration., Results: We identified 5 groups: Class 1: Low risk, high safety, high connectedness; Class 2: Low risk, moderate safety, moderate connectedness; Class 3: Moderate risk, high safety, moderate connectedness; Class 4: High risk, moderate safety, low connectedness; and Class 5: High risk, low safety, low connectedness. Compared to Class 1, Class 5 students had the highest odds of all for violence and bullying perpetration. Class 4 students also demonstrated high odds of violence and bullying, compared to Class 1. Though not as high as Classes 4 or 5, Class 2 and 3 students showed higher odds for both outcomes, compared to Class 1., Conclusions: Substantive variations exist in boys who engage in violence and bullying. We highlight cumulative, co-occurring risk factors, connectedness to parents and other prosocial adults (eg, teachers), and school and neighborhood safety as important factors to address in school health programs seeking to prevent violence and bullying perpetration among boys., (© 2020, American School Health Association.)

Background: Gay, bisexual, and other men who have sex with men experience several disparities related to human papillomavirus (HPV) infection, including high incidence rates of anal cancer. Although the HPV vaccine is currently recommended for young adults, HPV vaccine coverage is modest among young gay, bisexual, and other men who have sex with men (YGBMSM)., Objective: We describe the design and methods for a randomized controlled trial (RCT) to rigorously evaluate Outsmart HPV, a population-targeted, individually tailored, Web-based HPV vaccination intervention for YGBMSM. The RCT is designed to determine the efficacy of the intervention, the mechanism by which the intervention has an effect (ie, mediation), and whether efficacy varies by participant characteristics (ie, moderation)., Methods: Outsmart HPV was previously developed and pilot-tested. This study is a 3-arm prospective RCT that will enroll a projected 1995 YGBMSM who are aged 18 to 25 years, live in the United States, and have not received any doses of the HPV vaccine. Participants will be recruited by means of paid advertisements on social media sites and randomized to receive (1) standard information on the Web about HPV vaccine (control group), (2) Outsmart HPV content on the Web with monthly unidirectional vaccination reminders sent via text messages, or (3) Outsmart HPV content on the Web with monthly interactive vaccination reminders sent via text messages. Participants will complete Web-based surveys at 4 time points during the study: baseline, immediately after engaging with Web-based content, 3 months after randomization, and 9 months after randomization. Primary outcomes will include both HPV vaccine initiation (ie, receipt of 1 or more doses of the HPV vaccine) and completion (receipt of all 3 doses recommended for this age range). We will examine constructs from the intervention's theoretical framework as potential mediators and demographic and health-related characteristics as potential moderators of intervention effects., Results: The institutional review board at The Ohio State University has approved the study. Materials have been developed and finalized for all study groups. Recruitment for the RCT began in fall 2019., Conclusions: If shown to be efficacious, Outsmart HPV has the potential to fill an important gap by promoting HPV vaccination among a population at increased risk of HPV infection and HPV-related disease., Trial Registration: ClinicalTrials.gov NCT04032106; http://clinicaltrials.gov/show/NCT04032106., International Registered Report Identifier (irrid): PRR1-10.2196/16294., (©Paul L L Reiter, Amy L Gower, Dale E Kiss, Molly A Malone, Mira L Katz, Jose A Bauermeister, Abigail B Shoben, Electra D Paskett, Annie-Laurie McRee. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 24.02.2020.)

Young peoples' acceptance and use of nontraditional, descriptive identity labels (e.g., pansexual, genderqueer) require nurses to consider moving beyond use of traditional terms (e.g., gay, transgender). This mixed methods study explores (a) labels used by sexual orientation and gender identity (SOGI) minority youth, (b) their expressed importance and meaning of these labels, and (c) differences in label usage. Sixty-six SOGI minority adolescents in British Columbia, Minnesota, and Massachusetts (mean age = 16.6) participated in "go-along" interviews; during interviews, 42 (63.6%) commented on labels. Chi-square and t tests were used to compare traditional versus nontraditional labels across participant demographic categories. Inductive thematic analysis was used to identify representative themes. Approximately, 1/3 of participants used nontraditional sexual orientation identity labels; this finding was associated with a trans identity and nontraditional gender labels. Using terminology that is meaningful and representative to the youth themselves has potential to facilitate representative research and welcoming environments in practice.

Retrospective studies using adult self-report data have demonstrated that adverse childhood experiences (ACEs) increase risk of violence perpetration and victimization. However, research examining the associations between adolescent reports of ACE and school violence involvement is sparse. The present study examines the relationship between adolescent reported ACE and multiple types of on-campus violence (bringing a weapon to campus, being threatened with a weapon, bullying, fighting, vandalism) for boys and girls as well as the risk of membership in victim, perpetrator, and victim-perpetrator groups. The analytic sample was comprised of ninth graders who participated in the 2013 Minnesota Student Survey ( n ~ 37,000). Multinomial logistic regression models calculated the risk of membership for victim only, perpetrator only, and victim-perpetrator subgroups, relative to no violence involvement, for students with ACE as compared with those with no ACE. Separate logistic regression models assessed the association between cumulative ACE and school-based violence, adjusting for age, ethnicity, family structure, poverty status, internalizing symptoms, and school district size. Nearly 30% of students were exposed to at least one ACE. Students with ACE represent 19% of no violence, 38% of victim only, 40% of perpetrator only, and 63% of victim-perpetrator groups. There was a strong, graded relationship between ACE and the probability of school-based victimization: physical bullying for boys but not girls, being threatened with a weapon, and theft or property destruction ( p s < .001) and perpetration: bullying and bringing a weapon to campus ( p s < .001), with boys especially vulnerable to the negative effects of cumulative ACE. We recommend that schools systematically screen for ACE, particularly among younger adolescents involved in victimization and perpetration, and develop the infrastructure to increase access to trauma-informed intervention services. Future research priorities and implications are discussed.

Background: Adolescents are in a unique developmental stage, ideal for initiating healthy behaviors and benefiting from health promotion interventions. In this study, we used positive youth development and resilience frameworks, to investigate the role of internal assets as a protective factor for bullying and emotional distress among early adolescents, with attention to whether those associations vary by sex., Methods: This is a secondary analysis of the 2013 Minnesota Student Survey, a cross-sectional, population-based survey of Minnesota youth. Participating eighth grade students (N = 42,841) reported on internal assets, physical, relational and cyberbullying involvement, and emotional distress., Results: Logistic regression analyses, stratified by sex and controlling for sociodemographic characteristics, revealed that students with higher internal assets had lower odds of all forms of bullying victimization and perpetration than those with lower internal assets. Higher levels of internal assets were also associated with lower odds of emotional distress. All associations were significant for boys and girls, but appeared stronger for girls., Conclusions: Findings indicate that internal assets may buffer young teens from bullying and from the emotional distress that may result from bullying involvement. Approaches bolstering internal assets may be beneficial for combating bullying and emotional distress during early adolescence., (© 2019, American School Health Association.)

Effective medium theory aims to describe a complex inhomogeneous material in terms of a few important macroscopic parameters. To characterize wave propagation through an inhomogeneous material, the most crucial parameter is the effective wavenumber . For this reason, there are many published studies on how to calculate a single effective wavenumber. Here, we present a proof that there does not exist a unique effective wavenumber; instead, there are an infinite number of such (complex) wavenumbers. We show that in most parameter regimes only a small number of these effective wavenumbers make a significant contribution to the wave field. However, to accurately calculate the reflection and transmission coefficients, a large number of the (highly attenuating) effective waves is required. For clarity, we present results for scalar (acoustic) waves for a two-dimensional material filled (over a half-space) with randomly distributed circular cylindrical inclusions. We calculate the effective medium by ensemble averaging over all possible inhomogeneities. The proof is based on the application of the Wiener-Hopf technique and makes no assumption on the wavelength, particle boundary conditions/size or volume fraction. This technique provides a simple formula for the reflection coefficient, which can be explicitly evaluated for monopole scatterers. We compare results with an alternative numerical matching method., Competing Interests: We have no competing interests., (© 2019 The Authors.)

Introduction: Nurses and physicians receive minimal training about providing competent care to transgender and gender-diverse (TGD) patients, and training specific to TGD youth is particularly lacking. This qualitative study examined health care providers' experiences and attitudes about working with TGD youth to identify specific training needs., Method: Semistructured interviews were conducted with 14 nurses and physicians who work with adolescents. Thematic analysis was used to characterize participants' responses., Results: Five themes summarized participants' responses to interview questions: Training Regarding Gender Diversity, Discomfort With Gender-Related Topics, Reasons for Not Asking About Gender, Talking About Gender With Patients, and Need for Resources., Discussion: Findings highlight multiple opportunities to improve provider education and care experiences of TGD youth. Specific training is needed to help providers manage discomfort with gender-related topics and simultaneously develop their knowledge of and skills for discussing gender issues., (Copyright © 2018 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

Most gambling research utilizes general youth samples and focuses on binary gender categories; few studies examine and compare gambling behaviors between transgender and gender diverse (TGD) youth and their cisgender peers. The current study used population-based data from the 2016 Minnesota Student Survey to compare the prevalence of gambling behaviors and problem gambling among TGD versus cisgender adolescents, in addition to examining differences by birth-assigned sex. The analytic sample consisted of 80,929 students (including, n = 2168 [2.7%] TGD) in 9th and 11th grades. Chi-square tests and Cohen's d effect sizes were used for all comparisons. TGD youth reported greater involvement in most gambling behaviors and problem gambling compared to cisgender youth. In comparisons by birth-assigned sex, TGD youth assigned male at birth were particularly at risk for gambling involvement and problem gambling. TGD youth assigned female at birth also reported higher rates of problem gambling than both cisgender youth assigned male and female at birth. Results suggest that examining rates of gambling behavior and problem gambling as well as identifying disparities in vulnerable youth populations is crucial in order to develop culturally responsive and gender inclusive prevention, intervention, and outreach programs.

Purpose: Understanding the root causes of the substantial disparities in risk and protective factors among transgender and gender diverse (TGD) adolescents is essential to the development and expansion of resources and supports for this vulnerable population. This study examines differences in emotional distress, bullying victimization, and protective factors among TGD high school students in city, suburban, town, and rural locations., Methods: Data come from a statewide school-based survey conducted in Minnesota in 2016 (n = 2,168 TGD youth). Analysis of covariance models were used to predict the prevalence of multiple indicators of emotional distress, bullying victimization, and protective factors across the 4 location categories, with multiple adjustments., Findings: Significant linear trends were observed for 2 emotional distress outcomes and 2 bullying victimization outcomes, with urban TGD students having the lowest rates and rural having the highest prevalences. Additional significant differences in emotional distress were noted, with unexpectedly high rates of depressive symptoms and suicidal ideation among suburban students., Conclusions: Helping TGD adolescents in all types of locations identify resources and supportive professionals is critical to supporting this population., (© 2018 National Rural Health Association.)

The social environment in which lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth live influences health and wellbeing. We describe the development of the LGBTQ Supportive Environments Inventory (LGBTQ SEI), designed to quantify the LGBTQ-inclusiveness of social environments in the US and Canada. We quantify aspects of the social environment: 1) Presence/quality of LGBTQ youth-serving organizations; 2) LGBTQ-inclusive Community Resources; 3) Socioeconomic and Political environment. Using GIS tools, we aggregated data to buffers around 397 schools in 3 regions. The LGBTQ SEI can be used to assess the role of the social environment in reducing health disparities for LGBTQ youth., Competing Interests: Disclosure Statement The authors have no conflicts of interest to disclose.

This study examines the intersection of sexual and gender identities among adolescents, including the prevalence of these groups and rates of emotional distress and bullying victimization. Data come from a large population-based sample; two measures of sexual orientation and gender identity create eight identity groups. Youth who report identifying both as lesbian, gay, bisexual, or queer/questioning (LGBQ) and as transgender/gender diverse (TGD) had significantly higher levels of two measures of emotional distress and four measures of bullying victimization than those who report only identifying as LGBQ non-TGD or straight TGD. Implications for research and practice are discussed.

Purpose of Review: This paper examines recent research on bullying victimization among lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth to identify critical issues and advocate for future research priorities., Recent Findings: Recent studies have begun to document the importance of bullying in general, and bias-based bullying (rooted in stigma) in particular, on the health and wellbeing of this vulnerable subgroup of adolescents, as well as drivers of disparities. Current research demonstrates the role of multiple identities for and important differences among LGBTQ youth and has begun to identify protective factors for youth who are the targets of bullying., Summary: Researchers, clinicians, and those working with and on behalf of LGBTQ youth must measure and acknowledge the multiple reasons for which LGBTQ youth are the targets of bullying. Intervention and prevention efforts should focus on improving the supportiveness of the climates within which LGBTQ youth live.