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Latino sexual minority men (LSMM) are affected by HIV and behavioral health disparities. Evidence-based HIV-prevention and behavioral health (BH) services are not sufficiently scaled up to LSMM. The current study identified multilevel barriers and facilitators to LSMM's use of HIV-prevention and BH services. LSMM (N = 290) in South Florida, a US HIV epicenter, completed a battery of measures potentially associated with pre-exposure prophylaxis (PrEP) and BH treatment use. Stochastic search variable selection (SSVS) followed by multiple linear regression analyses identified variables associated with engagement in PrEP and BH treatment. Multilevel determinants of PrEP and BH treatment engagement were identified, with most identified determinants being at the relational level (e.g., stigma, discrimination based on income and immigration status, personal recommendation for treatment). Individual (e.g., knowledge, self-efficacy) and structural (e.g., financial stress) determinants were also identified. Accordingly, modifiable leverage points to enhance the reach of PrEP and BH treatment to LSMM include educating and enhancing the perceived relevance of services, de-stigmatizing and normalizing via peer examples, bolstering self-efficacy, and building trust., Author(s): Audrey Harkness [sup.1] , Alyssa Lozano [sup.2] , Sierra Bainter [sup.3] , Daniel Mayo [sup.3] , Daniel Hernandez Altamirano [sup.1] , Brooke G. Rogers [sup.4] , Guillermo Prado [sup.1] [...]

Sexual minorities report poorer mental health relative to heterosexual counterparts, but this is underexplored in Latinx youth. This study compares internalizing symptoms and externalizing behaviors in Latinx adolescents with Same Sex Behaviors (LASSB) to their Latinx adolescent peers who did not report same sex behaviors (non-LASSB). It also explores the moderating role of biculturalism on the relationship between internalizing symptoms and externalizing behaviors, and same-sex behaviors. Individual-level baseline data (Total N = 1,634; LASSB n = 195) from five trials of a preventive intervention for Latinx adolescents were synthesized. Normal and clinical levels of internalizing symptoms and externalizing behaviors were determined, and logistic regression models were conducted to determine the odds of LASSB reporting these behaviors relative to non-LASSB. Additional adjusted models tested for the moderating effect of biculturalism. LASSB reported significantly higher odds of normal levels of all externalizing behaviors and clinical levels of anxious/depressed compared to non-LASSB. Biculturalism significantly moderated the association between same-sex behavior and clinical levels of internalizing behaviors; however, in subgroup analyses among LASSB, biculturalism did not significantly predict any of these behaviors. Latinx adolescents exhibited mental health disparities by same-sex behavior. Biculturalism may be an important indicator for describing these disparities in LASSB and should be further explored.

Youth internalizing symptoms (i.e. depression and anxiety), suicide ideation and attempts have been rising in recent years, including among Hispanics. Disparities in mental healthcare are concerning and require intervention, ideally prevention or early intervention. Familias Unidas is a culturally-syntonic, family-centered intervention effective in reducing youth drug use and sexual risk, with evidence of unanticipated effects on internalizing symptoms. This paper describes the systematic process used to adapt the eHealth version of the Familias Unidas intervention to more directly address internalizing symptoms and suicide risk in preparation for an effectiveness-implementation hybrid trial for youth with elevated internalizing symptoms, a history of suicide ideation/attempts, or poor parent-youth communication. The resulting eHealth Familias Unidas Mental Health intervention is described. Guided by a 4-phase framework, the steps in the adaptation process involved: assessment of the community and intervention delivery setting (pediatric primary care clinics); integration of previous intervention research, including intervention mechanisms of action; and expert and community consultation via focus groups. Focus group analyses showed that youth and parents perceived that the intervention was helpful. Their feedback was categorized into themes that were used to directly target mental health by addressing technology use, parent mental health, and social support. Effective and scalable preventive interventions are needed to address mental health disparities. The systematic adaptation process described in this paper is an efficient approach to expanding interventions while maintaining known, empirical and theoretical mechanisms of action. Findings from the ongoing effectiveness-implementation trial will be critical. [ABSTRACT FROM AUTHOR]

Background: There is an established link between depression and drug use among adolescents. This relationship holds true for Hispanic youth, for whom familial relationships are especially impactful toward health outcomes. Purpose: Our purpose was to examine the relationships between family functioning and adolescent and parent depressive symptoms, and the indirect effects of depressive symptoms on the relationship between family functioning and adolescent drug use. Methods: Participants were 231 Hispanic adolescents (52.9% female, Mage = 13.90 ± 1.37) and their parents (93.0% female, Mage = 43.24 ± 6.64) enrolled in an RCT. Data on depressive symptoms, drug use, and family functioning were collected and a latent variable was specified using four indicators of family functioning (positive parenting, monitoring, communication, and involvement). A structural equation model approach was utilized. Results: Youth family functioning predicted youths' depressive symptoms which predicted their own drug use. Youths' depressive symptoms mediated the relationship between youth family functioning and drug use. Discussion: Findings suggest that adolescents' perceptions of family functioning plays a role in preventing depressive symptoms and drug use among Hispanic youth. Translation to Health Education Practice: Teaching students of the role that family support and depressive symptoms play in the manifestation of drug use may be an effective approach to preventing drug use. [ABSTRACT FROM AUTHOR]

AbstractMeasuring sexual orientation involves assessing multiple domains to account for the various conceptualizations adolescents may have. The purpose of this study was to examine: (1) the factor structure and reliability of the Klein Sexual Orientation Grid (KSOG) and (2) measurement invariance across age and nativity groups. Participants included 454 Latina/o/x adolescents [25.3% Latina/o/x sexual minority youth (LSMY) and 74.7% Latina/o/x non-SMY]. We examined the hypothesized factor structure of the KSOG using confirmatory factor analysis and the configural, metric, and scalar invariance of the identified factor structure was examined between age (12–14 and 15–17) and nativity (U.S. born and foreign-born) groups. A single factor captured: identity, attraction, emotional connection, and fantasies (CFI/RMSEA = 1.00/.000). We found evidence for metric noninvariance suggesting that sexual orientation as a latent construct does not perform equivalently among Hispanic adolescents who are younger versus older (Δχ2(3) = 106.01, p < 0.001, ΔCFI = 0.041, ΔTLI = 0.064, and ΔRMSEA = 0.154) or adolescents who are U.S. born versus foreign-born (Δχ2(3) = 10.34, p < 0.05, ΔCFI = 0.003, ΔTLI = 0.002, and ΔRMSEA = 0.011). The KSOG may not be used equivalently among older and younger Latina/o/x adolescents and Latina/o/x adolescents who are U.S. born and foreign-born. [ABSTRACT FROM AUTHOR]

Mental health disparities among Latino sexual minority men (LSMM) are exacerbated by un(der)treated mental health needs. This study sought to establish the factor structure of the Cultural Attitudes Toward Healthcare and Mental Illness Questionnaire (CAHMIQ) and examine measurement invariance across nativity (born in vs. outside the continental U.S.). Participants included 290 LSMM in South Florida. Confirmatory factor analysis examined the factor structure of CAHMIQ and measurement invariance examined equivalence across LSMM born outside (51.4%) and inside (48.3%) the continental U.S. The second-order factor model showed an acceptable fit (CFI/RMSEA =.91/.03) and consisted of first-ordered factors representing manifest indicators of causes and supports for mental health. Measurement invariance results suggest that the CAHMIQ performs equivalently across nativity groups (∆χ2(18) = 16.941, p =.5272). The CAHMIQ may be used among both nativity groups to understand attitudes toward healthcare and mental illness and inform LSMMs' engagement in mental health treatment. [ABSTRACT FROM AUTHOR]

Mental health professionals can support LGBT youth in schools by applying affirmative-counseling practices to prevent stressors that affect mental health. Little is known about the use of affirmative practices in schools among school social workers and psychologists. A modified version of the Lesbian, Gay, and Bisexual Affirmative Counseling Self-Efficacy Inventory—Short Form (LGB-CSI-SF) was administered to school mental health professionals [i.e., school social workers (n = 62) and school psychologists (n = 39)] in South Florida. The modified LGB-CSI-SF is reliable and may be used in schools with mental health professionals. The modified LGB-CSI-SF can assess the need for affirmative counseling trainings. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to refine and establish measures of multilevel barriers and facilitators to HIV testing and PrEP for Latino sexual minority men (LSMM). Design: Cross-sectional measure validation. Setting: Participants from Miami, FL. Subjects: 290 LSMM from the DÍMELO study. Measures: Based on prior qualitative work, we developed two measures that evaluated multiple determinants (i.e., barriers and facilitators) to (1) HIV testing and (2) PrEP use. Analysis: All measures included in this analysis assessed a set of theoretically distinct barriers and facilitators. We performed 11 exploratory factor analyses (EFA) to assess the dimensionality of theoretical groupings of items informed by prior qualitative work, including: knowledge, perceived need and benefit, mistrust and concerns, stigma and normalization, cultural competence, navigation support, provider demeanor, clinic and medical system issues, privacy concerns, cost, and language and immigration barriers. Based on EFA results, we conducted two confirmatory factor analyses (CFA), one for each measure. Results: Within each measure, the 11 EFAs extracted 10 barrier factors and 7 facilitator factors. The CFAs for HIV testing and PrEP measures were consistent, such that all models retained the structures identified in the EFAs. Conclusion: Findings support the use of these measures with LSMM. These measures can inform multilevel implementation strategies for health promotion professionals to scale up and disseminate HIV prevention services to LSMM. [ABSTRACT FROM AUTHOR]

Objective: This study examined associations of family cohesion and acculturation gap conflicts with depressive symptoms, as well as the moderation effect of family cohesion on the association between acculturation gap conflicts and depressive symptoms among Latinx emerging adults. Background: In addition to normative developmental stressors (e.g., making long‐term career decisions), many Latinx emerging adults face additional sociocultural stressors (acculturative stress, ethnic discrimination) that put them at risk of experiencing adverse psychological outcomes. However, acculturation gap conflicts have not been examined much in this population. Method: Data from a cross‐sectional survey were collected from 200 participants from Arizona (n = 99) and Florida (n = 101). Hierarchical multiple regression and moderation analyses were conducted to examine the association between acculturation gap conflicts and depressive symptoms and the moderating effects of family cohesion of that respective association. Results: Higher family cohesion was associated with lower depressive symptoms. Conversely, higher acculturation gap conflicts were associated with higher depressive symptoms. Moderation analyses indicated that family cohesion moderated the association between acculturation gap conflicts and depressive symptoms. Conclusion: This study adds to the limited literature on acculturation gap conflicts among Latinx emerging adults and advances our understanding of the role of family cohesion as a modifiable moderator. Implications: It is critical to identify culturally relevant and modifiable determinants that can have beneficial or adverse associations with the mental health of Latinx emerging adults. Findings from this study have the potential to inform intervention for mental health targeting Latinx emerging adults. [ABSTRACT FROM AUTHOR]

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool available in several modalities (e.g., daily oral, injectable, implants, rectal douching). The Ending the HIV Epidemic (EHE) initiative, a national initiative that began in 2019 as a partnership among the Department of Health and Human Services and other federal agencies (e.g., the Centers for Disease Control and Prevention, National Institute of Health), seeks to increase PrEP engagement for groups experiencing HIV inequities, including Latino sexual minority men (LSMM). Given the limited research on PrEP modality preferences among LSMM, this study aimed to explore and characterize these preferences. LSMM ( n = 214) not using PrEP and living in South Florida participated in the DÍMELO study, which examined PrEP engagement among LSMM in South Florida. Authors employed latent class analysis (LCA) to identify groups of LSMM based on their PrEP modality preferences and examined predictors of class membership. LCA results led to a three-class solution with participants who were: (1) reluctant to use most PrEP modalities (30.5%), (2) PrEP willing, with constraints (36.0%), and (3) enthusiastically accepting of all PrEP modalities (33.5%). LSMM in the reluctant class (Class 1) showed minimal interest in most PrEP modalities. The constrained class (Class 2) displayed interest in daily oral, on-demand, and quarterly injectable PrEP while the enthusiastic class (Class 3) demonstrated high interest in all modalities except rectal douching. Key predictors of PrEP modality preferences were altruism, community normalization of PrEP, and migration history. Understanding LSMM's PrEP modality preferences can enhance the reach of PrEP to LSMM, a group the EHE initiative prioritizes. The current findings suggest the need to tailor PrEP outreach efforts to promote various PrEP modalities based on LSMM's preferences.

Purpose: Sexual orientation is multidimensional, yet existing studies often only assess one dimension. This study examines multiple dimensions of sexual orientation in a sample of Hispanic adolescents using a latent profile analysis. The study also examines differences in levels of adolescent family functioning (i.e., parent-adolescent communication, parental involvement, family communication) and depressive symptoms by latent profile or subgroup., Methods: The study sample consisted of 456 Hispanic adolescents (M = 13.90 years; SD = 1.37). Adolescents self-reported their sexual orientation by responding to the Klein Sexual Orientation Grid (KSOG), family functioning (parent-adolescent communication, parental involvement, family communication), and depressive symptoms (Center for Epidemiologic Studies Depression (CESD) Scale). Latent profile analysis was used to identify heterogeneous groups of adolescents based on their response to the KSOG. A Welch test was used to examine mean levels of depressive symptoms and family functioning across profile membership., Results: We found that a three-class solution (heterosexual: 90%, mostly bisexual: 6.05%, mostly LGBQ: 3.95%) fit the data best. Results from the Welch test indicated significant differences for parent-adolescent communication and depressive symptoms across latent profiles., Conclusion: Existing research indicates that sexual minorities are at a disproportionate risk for adverse health outcomes. These findings corroborate best practice recommendations encouraging researchers to assess multiple dimensions of sexual orientation., Competing Interests: Compliance with Ethical Standards Author Disclosure Statement All authors have no potential conflicts of interest and no competing financial interests exist.

Positive family functioning is negatively associated with drug use, sexual risk behaviors, and depression; however, existing measures of family functioning were not specifically developed for Latina/o/x sexual minority youth (LSMY). This study examined the factor structure of family functioning and whether it is invariant across sexual orientation (i.e., LSMY and heterosexual Latina/o/x youth). Participants included 454 Latina/o/x youth (LSMY: n = 115, 25.3%). Results yielded a higher-order family functioning factor consisting of parental involvement, positive parenting, parent-adolescent communication, and parental monitoring. The model fit for the sample was acceptable (CFI/RMSEA = .91/.04) and configural invariance indicated that the model fit the data adequately in both groups (CFI/RMSEA = .87/.05). Fit of the metric invariance model (∆χ 2 (42) = 54.83, p = .09, ΔCFI, ΔRMSEA, ΔTLI < .001) was not significantly worse than the configural model, however, the scalar invariance model (∆χ 2 (42) = 80.18, p < .001, ΔCFI = .01, ΔRMSEA, ΔTLI < .001) was significantly worse than the less constrained models, suggesting that family functioning was noninvariant with regard to sexual orientation. Noninvariance may be related to the unique experiences of LSMY related to sexual orientation that are not captured in existing measures of family functioning.