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We explored gender diverse youth’s experiences seeking and receiving gender-affirming care in various health system locations. Results provide evidence for system-, clinic-, and provider-level improvements to promote the development of affirming environments and to improve health outcomes for gender diverse youth.

PURPOSE: To examine the lifetime and pre-18 sexual partnering patterns of populations with physical disabilities from adolescence to early adulthood, and how these patterns further vary by biological sex, race/ethnicity, and sexual orientation. METHODS: Data were from 13,458 respondents to Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health. Poisson regression models were used to assess differences in pre-18 and lifetime sexual partner counts among populations with physical disabilities compared to those without disabilities. Moderation analyses by biological sex, race/ethnicity, and sexual orientation were used to consider further differences among minority subgroups. RESULTS: Results indicated more similarities than differences in sexual partnering patterns across disability severity groups. Specifically, populations with disabilities had just as many pre-18 and lifetime sexual partners as peers without disabilities. There was variation by biological sex, race/ethnicity, and sexual orientation, though this was not tied to disability status. CONCLUSIONS: These results fill an important gap in the literature by considering the sexual partnering behaviors of populations with physical disabilities in the United States over the life course. Future research should continue to include populations with disabilities and other minority groups to ensure that their experiences are represented in sexual health policies and programs. IMPLICATIONS AND CONTRIBUTION: Findings show that the sexual partnering behaviors of populations with and without disabilities are more similar than they are different, providing valuable evidence for the provision of age- and developmentally-appropriate sex education to populations with physical disabilities.

CONTEXT: Despite health risks associated with minority stress, few studies have examined intimate partner violence (IPV) among sexual minorities; those that do have significant limitations. This study addresses key limitations to generate victimization and perpetration estimates in a national sample of young adults (ages 24–32). METHODS: Data are from Wave IV of the National Longitudinal Study of Adolescent to Adult Health (n=13,668). Sexual identity categories were: 100% heterosexual (94% of males, 80% of females), mostly heterosexual (4% males, 16% females), bisexual (1% males, 2% females), mostly homosexual, and 100% homosexual (2% males, 2% females – mostly and 100% combined). IPV outcomes included physical violence (slapping, hitting, or kicking); threatened or mild violence (threats, pushing or shoving); and forced sex. Multivariate logistic regression, stratified by biological sex, was used to estimate odds of IPV victimization and perpetration. RESULTS: Compared to same-sex heterosexual peers, adjusted odds of perpetrating (1.9) and experiencing (1.6) physical IPV were higher for mostly heterosexual females and mostly heterosexual males (3.1, 1.8 respectively). Mostly heterosexual females also had higher odds of experiencing threatened violence (1.6) and forced sex (1.6), and threatening violence (2.0). Mostly heterosexual males had higher odds of perpetrating forced sex (2.0) and threatening violence (1.8). Bisexual males had higher odds of forced sex victimization (4.9) and perpetration (5.0), and physical violence victimization (3.3). CONCLUSIONS. National prevalence estimates indicate heterogeneity in IPV perpetration and victimization by sexual identity and biological sex. Heterogeneity has important policy and prevention implications that require further study of stressor mechanisms.

BACKGROUND Access to gender-affirming care services for transgender and gender diverse (TGD) youth is limited, in part because it is currently provided primarily by specialists. Telehealth platforms that facilitate specialist to primary care provider (PCP) education and consultation may help improve access, however little is known about PCPs preferences regarding receiving this support. OBJECTIVE The purpose of this study was to explore pediatric PCPs’ perspectives regarding optimal ways to provide telehealth-based support to facilitate gender-affirming care provision in the primary care setting. METHODS PCPs who had previously requested support from the Seattle Children’s Gender Clinic were recruited to participate in a semi-structured, one-hour interviews over Zoom. Three different PCP-to-specialist telehealth modalities (tele-education, electronic consultation, telephonic consultation) were described and participants were invited to share their perspectives on 1) the benefits and drawbacks of each modality, 2) which modality would be most effective, and 3) the most important characteristics or outcomes of a successful platform. Interviews were transcribed and analyzed using Dedoose qualitative analysis software using an inductive thematic analysis framework. RESULTS Interviews were completed with 15 pediatric PCPs. Benefits of the tele-education platform included developing a network with other PCPs to facilitate shared learning, receiving comprehensive didactic and case-based education, occurring at a scheduled time and increasing provider confidence. Drawbacks included requiring a significant time commitment and not allowing for real-time, patient-specific consultation. Benefits of the electronic consultation platform included convenient and efficient communication, documentation in the electronic health record (EHR), ability to bill for provider time and sufficient time to synthesize information. Drawbacks of this platform included EHR-related difficulties, text-based communication challenges, not receiving an answer in real time, forced conversations with patients about billing and limitations for providers who lack baseline knowledge. With respect to telephonic consultation, benefits included having a dialogue with a specialist, compensation for PCP time and helping with high acuity or complex cases. Drawbacks included challenges associate with using the phone for communication, the limited expertise of responding providers, and lack of utility for non-emergent issues. Regarding the most effective platform, responses were mixed with 27% preferring the electronic consultation, 27% tele-education, 20% telephonic consultation, and the remaining 27% suggesting a hybrid of the three models. The ten factors important to the development of a successful PCP-to-specialist telehealth platform included: reliable, timely, engaging, non-judgmental, scalable, practical, adaptable, comprehensive, integrated and accessible. CONCLUSIONS We must develop a diverse suite of telehealth-based training and consultation services to meet the needs of PCPs with different levels of experience and training in gender-affirming care. Beyond the widely used telephonic consultation model, electronic consultation and tele-education may provide important alternative training and consultation opportunities to facilitate greater PCP independence promote more widespread access. CLINICALTRIAL n/a

ImportanceStudies linking the quality of parent-adolescent relationships with young adult health outcomes could inform investments to support these complex relationships.ObjectiveTo evaluate whether consistently measured, modifiable characteristics of parent-adolescent relationships are associated with young adult health across multiple domains.Design, Setting, and ParticipantsThis cohort study used data from waves I (1994-1995; ages 12-17 years) and IV (2008-2009; ages 24-32 years) of the US National Longitudinal Study of Adolescent to Adult Health. Of 20 745 adolescents enrolled in wave I, 15 701 of 19 560 who were eligible completed wave IV (response rate, 80.3%). Data analyses were conducted from February 2019 to November 2020.ExposuresParental warmth, parent-adolescent communication, time together, relationship and communication satisfaction, academic expectations, and maternal inductive discipline as reported at wave I by adolescent participants.Main Outcomes and MeasuresWave IV participant-reported self-rated health, depression, stress, optimism, nicotine dependence, substance abuse symptoms (alcohol, cannabis, or other drugs), unintended pregnancy, romantic relationship quality, physical violence, and alcohol-related injury. Separate regression models were run for mother-adolescent and father-adolescent relationships while controlling for age, biological sex, race and ethnicity, parental educational level, family structure, and child maltreatment experiences.ResultsA total of 10 744 participants (mean [SD] age at wave IV, 28.2 [1.8] years; 52.0% female; 67.3% non-Hispanic White) and 8214 participants (mean [SD] age at wave IV, 28.2 [1.8] years; 50.8% female; 71.9% non-Hispanic White) had valid sampling weights and complete data for mother-adolescent and father-adolescent relationship characteristics, respectively. Adolescents who reported higher levels of mother-adolescent warmth (β = 0.11 [95% CI, 0.06-0.15]), communication (β = 0.02 [95% CI, 0.00-0.04]), time together (β = 0.07 [95% CI, 0.05-0.09]), academic expectations (β = 0.05 [95% CI, 0.02-0.08]), relationship or communication satisfaction (β = 0.07 [95% CI, 0.04-0.10]), and inductive discipline (β = 0.03 [95% CI, 0.01-0.05]) reported significantly higher levels of self-rated general health in young adulthood. Adolescents who reported higher levels of father-adolescent warmth (β = 0.07 [95% CI, 0.03-0.11]), communication (β = 0.03 [95% CI, 0.01-0.05]), time together (β = 0.06 [95% CI, 0.03-0.08]), academic expectations (β = 0.04 [95% CI, 0.01-0.06]), and relationship satisfaction (β = 0.07 [95% CI, 0.04-0.10]) also reported significantly higher levels of self-rated general health in young adulthood. Adolescents reporting higher levels of all exposures also reported significantly higher levels of optimism and romantic relationship quality in young adulthood (β coefficient range, 0.02 [95% CI, 0.00-0.04] to 0.24 [95% CI, 0.15-0.34]) and lower levels of stress and depressive symptoms (β coefficient range, −0.07 [95% CI, –0.12 to –0.02] to −0.48 [95% CI, –0.61 to –0.35]). Higher levels of parental warmth, time together, and relationship or communication satisfaction were significantly associated with lower levels of nicotine dependence (odds ratio range, 0.78 [95% CI, 0.72-0.85] to 0.89 [95% CI, 0.81-0.98]) and substance abuse symptoms (incidence rate ratio range, 0.60 [95% CI, 0.50-0.73] to 0.94 [95% CI, 0.89-0.99]), as well as lower odds of unintended pregnancy (odds ratio range, 0.81 [95% CI, 0.74-0.88] to 0.93 [95% CI, 0.86-0.99]). Patterns were less consistent for physical violence and alcohol-related injury. Characteristics of mother-adolescent and father-adolescent relationships were similarly associated with young adult outcomes.Conclusions and RelevanceThe findings of this cohort study suggest that adolescents’ positive perceptions of their relationships with their mothers and fathers are associated with a wide range of favorable outcomes in young adulthood. Investments in improving parent-adolescent relationships may have substantial benefits for young adult population health.

To examine associations between reports of sensitive health behaviors and the provision of time alone by a clinician during adolescent well visits.Data were collected from 547 adolescents who completed a well visit at one of eight clinics. Adjusted mixed logistic regression was used to examine whether reports of sexual behavior, substance use, disordered eating, mental health concerns, and demographic characteristics were associated with time alone.Sexual behavior was found to be significantly associated with time alone, while substance use, disordered eating, a positive depression screen, and suicidal ideation were not. Older adolescents and males were more likely to report time alone, while race/ethnicity had no association with time alone.Clinicians may be prioritizing time alone for behavioral concerns differently than for other sensitive behaviors.

PurposeThe purpose of this paper is to investigate the associations between minor women’ (girls’) disability status and victimization via minor sex trafficking.Design/methodology/approachThis investigation used data from the National Longitudinal Study of Adolescent to Adult Health, a large, nationally-representative sample of in-school adolescents in the USA that began in 1994. The analysis included bivariate associations between physical disability status or low cognitive ability and minor sex trafficking among female survey respondents (n = 5,430).FindingsGirls with any disability had a higher prevalence of minor sex trafficking than their peers without disabilities. Odds of minor sex trafficking were significantly higher for those with severe physical disabilities (5.83) and for those with low cognitive abilities (4.86) compared to the odds of their peers without their respective disabilities. Results for girls with mild or moderate physical disabilities were not statistically significant compared to peers without disabilities.Social implicationsThese nationally-representative survey data reinforce the trends present in smaller populations and case study research: female adolescents with disabilities are at a heightened risk for sex trafficking. On both a national and global scale, the human rights gaps in policy and practice must be addressed to adequately reach, intervene and protect this vulnerable population.Originality/valueResearch about minor sex trafficking typically relies on small-scale surveys and/or convenience samples. This study used a nationally-representative survey to demonstrate the link between disability status and women’s experiences with minor sex trafficking.

Peer delivered, family-to-family (F2F) support-defined as the provision of outreach, engagement, knowledge, care coordination, and support to family members of children and youth with mental health challenges-is a rapidly growing and needed component of the service array. Progress is occurring toward greater specification of program models and core competencies for the parent support providers (PSPs) with lived experience providing these services; however, strategies to inform quality improvement and ensure accountability are lacking. The Family Journey Assessment (FJA), completed by PSPs and family members, fills this gap by tracking caregiver progress toward self-advocacy and self-efficacy. Analyses of 436 FJAs showed a reliable 3-component structure, reflecting progress in the recognition of needs, collaboration to access help from formal and natural supports, and activation of skills to cope with stress, enhance resilience, and develop and carry out plans of care. PSP feedback provided strong evidence for relevance and usability. Examination of FJAs at baseline and follow-up provides one of the first reports showing significant improvement in key indicators of benefit of F2F for participating families. The FJA holds promise as a measure of the impact of F2F services on key goals and as a way to identify benchmarks for focused and individualized peer-to-peer support depending on the family's level of need. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The goal of this article was to examine gender-typed behavior longitudinally and to consider its relationship with sexual orientation in adulthood. Data were from 10,624 respondents who completed Wave 1 (adolescence), Wave 3 (emerging adulthood), and Wave 4 (early adulthood) of the National Longitudinal Study of Adolescent to Adult Health. First, we described the distributions of gender-typed behavior by adult sexual orientation at each of the three developmental stages. Next, we performed multilevel mixed regression models to assess longitudinal variation in gender-typed behavior from adolescence to adulthood within sexual orientation groups. Results showed that gender-typed behavior varied both within and between sexual orientation groups, as well as over time. For males, the differences in gender-typed behavior among the sexual orientation groups were relatively consistent at each stage, whereas differences in gender-typed behavior among sexual orientation groups varied more at each stage among females. Longitudinal models exhibited curvilinear patterns, such that gender-typed behavior strengthened from adolescence to early adulthood but peaked in emerging adulthood. To our knowledge, this is the first study to use population representative data to study gender-typed behavior both prospectively and at multiple time points from adolescence to adulthood, and to consider how such behavior is related to adult sexual orientation. This research contributes to a growing body of prospective literature on the link between gendered behavior and sexual orientation and provides further justification for more age- and cohort-specific measures of gender-typed behavior in future research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background Timing of first sex has important implications for later sexual health, but little research has considered this in populations with physical disabilities. Objective The purpose of this paper was to examine timing of sexual experiences among populations with physical disabilities in the United States from adolescence to early adulthood, and how timing varies by biological sex, race/ethnicity, and sexual orientation. We hypothesized that those with physical disabilities would exhibit earlier initiation of each type of sexual activity compared to those without disabilities, but the degree of differences would depend on disability severity. We further hypothesized that these associations would be moderated by biological sex, race/ethnicity, and sexual orientation. Methods Data were from 13,458 respondents to Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health. Cox proportional hazards models assessed differences in timing of vaginal, oral, anal, and first sex by disability severity. Results Populations with the most severe physical disabilities had a significantly slower progression to first vaginal sex, oral sex, and their first sexual experience compared to those without disabilities (aHR: 0.74–0.77). Timing also differed by biological sex, race/ethnicity, and sexual orientation, though the direction and degree of these differences varied by disability severity. Conclusions Results fill an important gap in the literature by considering variations in sexual timing among populations with physical disabilities using a longitudinal, nationally representative sample. Future research should continue to promote inclusion of populations with disabilities to inform future policies and programs for healthy sexual development.

Purpose Few studies have sought to understand the typical sexual development of populations with physical disabilities in the United States, and those that do are often based on convenience samples or cross-sectional data. The purpose of this paper is to examine relationships between physical disability and experiences of vaginal, oral, and anal sex in a nationally representative sample of individuals in the United States who have been followed from adolescence through early adulthood. Methods We used data from 13,456 respondents who completed Waves I (1994–1995) and IV (2008–2009) of the National Longitudinal Study of Adolescent to Adult Health (Add Health). Physical disabilities were identified and grouped by severity using information regarding limb difficulties, blindness, and deafness during adolescence. Analyses included bivariate statistics and adjusted logistic regression models relating physical disability and experiences of each type of sex. Results Respondents with the most severe physical disabilities had significantly lower odds of experiencing vaginal sex, oral sex, and having any sexual experience compared with the odds of those without disabilities. After stratifying by biological sex, we found that males with the most severe physical disabilities had significantly lower odds of experiencing any type of sex compared with the odds of males without disabilities, whereas females with moderate and severe physical disabilities had significantly lower odds of experiencing vaginal sex compared with the odds of females without disabilities. Conclusions Our findings build on past research often conducted with convenience samples or cross-sectional data, indicating variation in sexual experiences among populations with disabilities.

The goal of this study was to examine, in a nationally representative sample, relationships between various sexual initiation patterns, subsequent sexual partnerships, and related health outcomes from adolescence through early adulthood. Data were from a subset of 6,587 respondents from the National Longitudinal Study of Adolescent to Adult Health. Bivariate analyses and adjusted logistic and ordinary least squares regression models were used to determine associations between membership in three sexual initiation classes, lifetime sexual partner counts, and multiple health outcomes, including lifetime sexually transmitted infection or disease (STI/STD) diagnosis, lifetime unintended pregnancy, and romantic relationship quality. Broadly, having fewer lifetime sexual partners was associated with lower odds rates of STI/STD diagnosis and unintended pregnancy, and better relationship quality; however, findings also indicated both within and between sexual initiation class differences in the relationship between lifetime sexual partners and all three health outcomes. In particular, results showed little variation in health outcomes by sexual partnering among those who postponed sexual activity, but members of the class characterized by early and atypical sexual initiation patterns who had fewer lifetime partners exhibited better health outcomes than most other initiation groups. These results show that while both sexual initiation and partnering patterns add important information for understanding sexual health from adolescence to early adulthood, partnering may be more relevant to these sexual health outcomes. Findings indicate a need for more comprehensive sexual education focused on sexual risk reduction and promotion of relationship skills among adolescents and adults.

Few studies have investigated the sexual development of populations with low cognitive abilities in the United States. This article examines the relationship between cognitive ability and various sexual experiences from adolescence (ages 12 to 18) to early adulthood (ages 28 to 34). Data were from 13,845 respondents interviewed at Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health), a probability sample of adolescents in the United States followed from adolescence to adulthood. Adjusted logistic regression models were used to study relationships between cognitive ability, approximated by the Add Health Picture Vocabulary Test (AHPVT), and experiences of vaginal, oral, and anal sex. After controlling for biological sex, age, race/ethnicity, and socioeconomic status (SES), individuals in the lowest cognitive ability group had significantly lower odds of experiencing each type of sex than those in the average ability group. Although individuals in the highest cognitive ability group had significantly lower odds of experiencing vaginal intercourse than those in the average ability group, this association did not remain significant when analyses were stratified by biological sex. These differences in experiences have implications for future health and warrant further study to understand policy implications for sexual health services and education.

Low-income and ethnic minority families continue to face critical disparities in access to diagnostic and treatment services for neurodevelopmental conditions, such as autism spectrum disorder and attention deficit hyperactivity disorder. Despite the growing cultural diversity of the United States, ethnic minority children and families continue to be substantially underrepresented across research on neurodevelopmental disorders, and there is a particularly concerning lack of research on the treatment of these conditions in low-income and ethnic minority communities. Of note, there are currently no published studies on adapting autism spectrum disorder treatment for low-income Latino communities and relatively few studies documenting adapted treatments for children with attention deficit hyperactivity disorder in these communities. This article describes methodological considerations and adaptations made to research procedures using a Diffusion of Innovation framework in order to effectively recruit and engage low-income, ethnic minority, particularly Latino, families of children with neurodevelopmental disorders, in a comparative effectiveness trial of two school-based interventions for executive dysfunction.

Previous identity research has explored the presence and patterning of racial centrality and regard among African American, Latino, Asian, and multiracial Americans and their connection with important life outcomes. Extending that work, this study used cluster analysis to explore the unique combinations of centrality and regard among 174 Jewish American emerging adults (48 men, 125 women, 1 undifferentiated). Results parallel identity profiles observed among African American adolescents and adults, yet suggest potential age-related differences in profile content.

Objective This study used the Strengths and Difficulties Questionnaire (SDQ) to describe the prevalence of parent-reported mental health (MH) concerns in youth presenting for primary care appointments and to examine relationships between children's MH issues and functional impairment. We hypothesized that increased MH symptomology would be associated with increased impairment and family burden. Methods Parents of 4- to 17-year-old children were approached at routine visits in 13 primary care sites. Chi-square tests, independent sample t tests, and a 1-way analysis of variance (ANOVA) were used to make comparisons between demographic groups. Age-, sex-, and race-adjusted ordered logistic regression models and ANOVAs examined relationships between impact and SDQ scales. Results Boys had higher total Hyperactivity and Peer Problems. Adolescents showed higher Emotional Symptoms, while younger children showed more Hyperactivity. Latinos reported more Conduct Problems, Hyperactivity, and Peer Problems. Latinos also indicated less distress on the child, impairment at home and school, and family burden. Regression analyses indicated increased odds of impairment with higher scale scores. MH symptoms identified with the SDQ in pediatric primary care settings were associated with parent-reported impairment affecting youth and their families. Conclusions The presence of significant impairment suggests that parents' concerns identified by screening are likely to be clinically important and worthy of practice strategies designed to promote assessment, treatment, and referral for these common problems. Identifying and exploring parents' concerns with strategic use of screening tools may allow primary care providers to directly engage families around the MH issues that affect them most.