Correlates of Sexual Risk Among Sexual Minority and Heterosexual South African Youths

We explored psychosocial correlates of sexual risk among heterosexual and sexual minority youths (SMYs) in Johannesburg, South Africa. Young people 16 to 18 years old (n = 822) were administered surveys assessing demographic characteristics, sexual behaviors, mental health, and parent–child communication. Adjusted multivariate regressions examining correlates of sexual risk revealed that SMYs had more sexual partners than heterosexual youths (B = 3.90; SE = 0.95; P < .001) and were more likely to engage in sex trading (OR = 3.11; CI = 1.12-8.62; P < .05). South African SMYs are at increased risk relative to their heterosexual peers.South Africa has the highest burden of HIV in the world; 9.2% of young persons aged 15 to 19 years living in the country are infected with HIV.1,2 Few studies have examined multilevel sexual risk factors (e.g., individual, partner, family) among sexual minority youths (SMYs)3 in South Africa, despite their increased vulnerability.4–8 Research has shown that rates of sexual risk behavior are high among adult men who have sex with men (MSM) in sub-Saharan Africa,5,9 and South African SMYs may be especially vulnerable given the transitional nature of adolescence, fear of discrimination, and lack of cultural acceptance of homosexuality.4,7,10Our analyses were guided by theories of syndemics (i.e., collective risk or co-occurring epidemics)11–13 and minority group stress.14 These theories posit that young MSM experience psychosocial disparities in numerous areas (substance use, abuse and victimization, mental health problems, risk taking)15–18 and that SMYs are at increased risk for poor mental health, sexual vulnerability, substance use, and violence.19,20 Moreover, stigma creates stressful environments, another cause of mental health problems among SMYs.14 This situation is especially salient in South Africa, where same-sex behavior is so highly stigmatized that even normative adolescent sexual exploration would likely be denounced.7We hypothesized that South African SMYs would be at increased sexual risk relative to heterosexual youths. To our knowledge, this is one of the first investigations to examine risk and protective factors associated with sexual risk in this population.     

Risk and Protective Factors for Social Anxiety Among Sexual Minority Individuals

Archives of Sexual Behavior - Minority stress processes represent clear determinants of social anxiety among sexual minority populations. Yet sources of resilience to social anxiety are less...     

Explaining the Suicide Risk of Sexual Minority Individuals by Contrasting the Minority Stress Model with Suicide Models

Many studies have found elevated levels of suicide ideation and attempts among sexual minority (homosexual and bisexual) individuals as compared to heterosexual individuals. The suicide risk difference has mainly been explained by minority stress models (MSTM), but the application of established suicidological models and testing their interrelations with the MSTM has been lacking so far. Therefore, we have contrasted two established models explaining suicide risk, the Interpersonal Psychological Theory (IPT) (Joiner, 2005) and the Clinical Model (CM) (Mann et al., 1999), with the MSTM (Meyer, 2003) in a Bavarian online-sample of 255 adult sexual minority participants and 183 heterosexual participants. The results suggested that the CM and the IPT model can well explain suicide ideation among sexual minorities according to the factors depression, hopelessness, perceived burdensomeness, and failed belongingness. The CM and the IPT were intertwined with the MSTM via internalized homophobia, social support, and early age of coming out. Early coming out was associated with an increased suicide attempt risk, perhaps through violent experiences that enhanced the capability for suicide; however, coming out likely changed to a protective factor for suicide ideation by enhanced social support and reduced internalized homophobia. These results give more insight into the development of suicide risk among sexual minority individuals and may be helpful to tailor minority-specific suicide prevention strategies.     

Religious Climate and Health Risk Behaviors in Sexual Minority Youths: A Population-Based Study

Objectives. We examined whether the health risk behaviors of lesbian, gay, and bisexual (LGB) youths are determined in part by the religious composition of the communities in which they live.Methods. Data were collected from 31 852 high school students, including 1413 LGB students, who participated in the Oregon Healthy Teens survey in 2006 through 2008. Supportive religious climate was operationalized according to the proportion of individuals (of the total number of religious adherents) who adhere to a religion supporting homosexuality. Comprehensive data on religious climate were derived from 85 denominational groups in 34 Oregon counties.Results. Among LGB youths, living in a county with a religious climate that was supportive of homosexuality was associated with significantly fewer alcohol abuse symptoms (odds ratio [OR] = 0.58; 95% confidence interval [CI] = 0.40, 0.85) and fewer sexual partners (OR = 0.77; 95% CI = 0.60, 0.99). The effect of religious climate on health behaviors was stronger among LGB than heterosexual youths. Results remained robust after adjustment for multiple confounding factors.Conclusions. The religious climate surrounding LGB youths may serve as a determinant of their health risk behaviors.Stigma operates through both discrete events and pervasive environments in threatening the health of its targets.1 Explanations of lesbian, gay, and bisexual (LGB) youths’ higher level of engagement in health risk behaviors relative to their heterosexual peers have largely relied on reports of encounters with discrete stigmatizing events, such as parental rejection and peer victimization.2 Yet, when social structures, institutions, and norms transmit disapproval or invalidation of LGB identities and life experiences, they have the potential to threaten LGB youths’ health independent of individual-level events.1,3,4The social climate surrounding LGB individuals both worldwide5 and in the United States6 is shaped by the moral debate regarding the legitimacy of homosexuality. Given that social ideology is closely intertwined with religious ideology in the United States, expressed attitudes toward homosexuality are largely aligned with degree and type of religious affiliation.6,7 A majority of US residents report that advancement of LGB rights, such as the legal recognition of same-sex marriage, clashes with their religious beliefs.8 Approximately 85% of individuals in the United States identify as religious, and more than half of the US population in 2003 believed that homosexuality is sinful.9Although condemnation of homosexuality has long been a part of many religious doctrines, not all religions hold similar beliefs toward homosexuality.10 Indeed, a 2011 survey of the US population showed that about half of religious adherents believe that society should accept homosexuality,11 highlighting a shift from the results of earlier studies and mirroring the changing attitudes toward same-sex marriage that also exist across some religious groups.12 In all, the US public''s view of homosexuality is changing and varies as a function of several characteristics, including religious affiliation.LGB youths construct their sexual identities within social climates shaped by these religious influences, with some LGB youths encountering more threatening climates than others given that religious demography varies widely by geographical region.13 The health risk behaviors of LGB youths may thus vary according to the religious composition of the communities in which they live, in that encountered stigma influences health-impairing coping behaviors.14 However, existing research has focused almost exclusively on associations between personal religiosity and health behaviors among LGB youths.15–17 Thus, research on the intersection of religious climate and the health behaviors of LGB youths remains limited.To address this gap in the literature, we used an objective index of community religiosity to predict tobacco use, alcohol abuse, and sexual behaviors in a sample of LGB and heterosexual youths. We hypothesized that religious climate would be associated with these health outcomes over and above the influence of other environmental factors surrounding LGB youths (e.g., school bullying policies, presence of Gay-Straight Alliances) and that the association would be stronger for LGB youths than for heterosexual youths. We also expected that religious climate would exert these health effects independent of established individual-level psychosocial predictors of health risk behaviors.     

Internalized Homophobia and Suicide Ideation Among Sexual Minority Adults: The Serial Mediation of Core Self-Evaluations and Depression

Archives of Sexual Behavior - Internalized homophobia (IH) is the endorsement of negative attitudes and stereotypes about sexual minority individuals among those who are LGBQ?+?....     

Sexual Orientation and Risk Factors for Suicidal Ideation and Suicide Attempts: a Multi-centre Cross-Sectional Study in Three Asian Cities

Purpose

Despite robust empirical and theoretical evidence for higher rates of suicide among lesbian, gay, and bisexual (LGB) youths, little is known about the relationship between suicide and sexual orientation among Asian youths. This study examined differences in prevalence of suicidal ideation and suicide attempts between LGB and heterosexual youths in the cities of Hanoi, Shanghai, and Taipei, China.

Methods

The data are from a community-based multi-centre cross-sectional study conducted from 2006 to 2007, with a sample of 17 016 youths aged 15–24 years from Hanoi, Shanghai, and Taipei. Chi-square test and logistic regression were used to evaluate correlates of suicidal ideation and suicide attempts.

Results

The overall prevalence of suicidal ideation and suicide attempts in the preceding 12 months in LGB youths were both higher than in heterosexual youth (12.8% vs. 8.1% and 4.0% vs. 2.4%, respectively). Stratified by city, the prevalence of suicidal ideation was lowest in Hanoi (2.2%), followed by Shanghai (8.0%) and Taipei (17.0%). Similar trends were observed in the prevalence of suicide attempts, which was lowest in Hanoi (0.3%), followed by Shanghai (1.2%) and Taipei (2.5%). Of note, however, multivariate logistic regression results revealed that LGB youth were at a higher risk for suicidal ideation than heterosexual youth only in Taipei (odds ratio 1.65).

Conclusions

Suicidality is common among Asian youth, with higher prevalence observed in urbanized cities. LGB youths are at greater risk of suicidal ideation than their heterosexual counterparts in Taipei than in the other two examined cities.Key words: suicide, China, Vietnam, Taiwan, sexual orientation, youth     

Promoting the Successful Development of Sexual and Gender Minority Youths

Because of societal discomfort with atypical expressions of sexual orientation and gender identity, lesbian, gay, bisexual and transgender (LGBT) youths have experienced enhanced developmental challenges compared with their heterosexual peers.A recent special issue of the American Journal of Public Health delineated how social stigma affecting LGBT youths has resulted in a wide range of health disparities, ranging from increased prevalence of depression and substance use to downstream effects, such as an increased risk for cancer and cardiovascular disease when older.We review the clinical significance of these findings for health care professionals, who need to become informed about these associations to provide better care for their sexual and gender minority youth patients, and to be able to educate their parents and other caregivers.Homosexual and gender nonconforming behaviors have been variably expressed in different cultures since the beginning of recorded history. However, only in recent years has there been sufficient scholarship about sexual and gender minority youths to enable clinicians to learn more about the unique health needs of these populations.1 For most of the 20th century and previous centuries, sexual and gender minority people were not recognized as discrete populations that required specific, culturally responsive attention from health care professionals and public health programs. However, awareness increased after the emergence of the gay liberation movement in the late 1970s, and was exponentially enhanced as clinicians began to recognize an increasingly varied panoply of sexually transmitted infections, culminating with the AIDS epidemic. These observations were only the tip of the iceberg, because many health issues faced by sexual and gender minorities were not exclusively related to their sexual behavior, but were often a response to the stigma and discrimination they experienced.2 Societal understanding of these issues has been informed by the emerging awareness of health disparities that are not only prevalent among racial and ethnic minority populations, but are common among sexual and gender minority populations.3 This emerging awareness has also led to the recognition that health systems must become responsive to the reality of a diverse array of minority health disparities, to enhance access to appropriate health care for disenfranchised populations.4 An understanding of the reasons why specific populations may not fully engage in care is critical to creating more culturally responsive systems for health care, as well as the specific clinical conditions that may be more prevalent in subpopulations. It is also important that clinicians learn how to improve the ways that sexual and gender minority youths experience their clinical care, including evaluating how provider attitudes may affect physicians’ ability to provide nonjudgmental care.For sexual and gender minority populations, the recognition of the importance of addressing their unique health needs is a recent development.5 Historically, many key professional documents, such as the early versions of the Diagnostic Management System (DSM) of the American Psychiatric Association, presumed that individuals who were homosexual or who displayed gender nonconformity were ipso facto experiencing a mental health illness. Only in recent decades have health professionals recognized that past dogma and professional bias caused much harm, and prevented development of ways for providers to help their sexual and gender minority patients to optimize their resilience to lead confident, healthy, productive lives.6,7 Health care professionals’ understanding of sexual and gender minority subcultures is particularly important to ensure the successful growth and development of lesbian, gay, bisexual and transgender (LGBT) youths, given young people’s developmental vulnerabilities, and the normative role that trusted health professionals can play. The February 2014 issue of the American Journal of Public Health has provided a wide array of studies based on recent data from the Youth Risk Behavioral Survey (YRBS) system, which provides data that can inform and improve the clinical care of sexual and gender minority youths.Careful analyses of the life experiences of sexual and gender minority populations suggest that proximate causes of psychological distress and risk-taking behavior for some stem from early childhood experiences, including physical and emotional abuse by family or peers, as well as general societal stigma and discrimination (Institute of Medicine5 [IOM]), resulting in dysfunctional behavior.8,9 Similar health disparities (e.g., increased risk for HIV or sexually transmitted infection), depression, and substance use are now being recognized among sexual and gender minorities in developing countries.10 These findings suggest that successful responses to the global HIV/AIDS epidemic will require the development of culturally sensitive programs that address concomitant clinical concerns and root causes, such as societal and institutional homophobia. Research is needed to understand how the majority of sexual and gender minority people lead resilient and productive lives in the face of discrimination and to develop assets-based interventions that build on the community supports that they have created.     

Elevated Risk of Posttraumatic Stress in Sexual Minority Youths: Mediation by Childhood Abuse and Gender Nonconformity

Objectives. We examined whether lifetime risk of posttraumatic stress disorder (PTSD) was elevated in sexual minority versus heterosexual youths, whether childhood abuse accounted for disparities in PTSD, and whether childhood gender nonconformity explained sexual-orientation disparities in abuse and subsequent PTSD.Methods. We used data from a population-based study (n = 9369, mean age = 22.7 years) to estimate risk ratios for PTSD. We calculated the percentage of PTSD disparities by sexual orientation accounted for by childhood abuse and gender nonconformity, and the percentage of abuse disparities by sexual orientation accounted for by gender nonconformity.Results. Sexual minorities had between 1.6 and 3.9 times greater risk of probable PTSD than heterosexuals. Child abuse victimization disparities accounted for one third to one half of PTSD disparities by sexual orientation. Higher prevalence of gender nonconformity before age 11 years partly accounted for higher prevalence of abuse exposure before age 11 years and PTSD by early adulthood in sexual minorities (range = 5.2%–33.2%).Conclusions. Clinicians, teachers, and others who work with youths should consider abuse prevention and treatment measures for gender-nonconforming children and sexual minority youths.Posttraumatic stress disorder (PTSD) has severe sequelae that can particularly affect youths by disrupting the achievement of adulthood milestones. PTSD negatively affects career prospects through elevated risk of substance abuse1 and unemployment,2 reduces educational attainment by increasing the risk of school dropout,2 and affects family formation by increasing the risk of relationship instability and adolescent pregnancy.2 Studies have also indicated that the course of PTSD is chronic in one third of cases2; identifying risk factors in children and early adulthood is therefore particularly important for public health because PTSD in adolescence or early adulthood may affect health and well-being throughout adulthood. Research indicates that lesbian, gay, and bisexual youths have higher prevalence of mental health problems than heterosexuals, including anxiety, depression, and suicidality3–6; to our knowledge, however, no studies of youths have examined the association between sexual orientation and probable PTSD in samples including both sexual minorities and heterosexuals.Childhood abuse greatly increases risk of developing PTSD.7–9 Child abuse can directly trigger PTSD,10 increase the risk of exposure to subsequent stressful events,8 and increase the conditional risk of developing PTSD following exposure to subsequent stressful events.11,12 Sexual minorities—lesbians, gay men, bisexuals, and “mostly heterosexuals”—experience higher rates of childhood abuse than do heterosexuals.13–18 Thus, disparities in childhood abuse may be a cause of higher prevalence of PTSD among sexual minority youths compared with heterosexuals.Additionally, gender-nonconforming appearance and behavior in childhood is more common among persons who will later have a minority sexual orientation.19–21 Differences in gender nonconformity may contribute to sexual-orientation disparities in maltreatment in early and middle childhood, before sexual identity has developed, as childhood gender nonconformity has been associated with parental rejection, harassment, and physical and verbal victimization related to sexual orientation.22–26We examine whether there are disparities in lifetime probable PTSD in youths by sexual orientation and whether greater exposure to child abuse may account for differences in PTSD. Additionally, we examine whether gender nonconformity accounts for higher prevalence of abuse before age 11 years and possible increased risk of PTSD among sexual minorities compared with heterosexuals. Because gender nonconformity has been associated with psychosocial stressors other than childhood abuse—namely, harassment and bullying—nonconformity may increase the risk of PTSD above and beyond its possible effects on childhood abuse. Given the high population prevalence of PTSD, its chronicity, and its associated impairment,2 identifying factors that put children and youths at risk for PTSD is vital.Although several studies have separately noted elevated prevalence of both child maltreatment and adulthood PTSD in sexual minorities,17,22 to date, only 1 study in adults has shown that higher rates of childhood abuse may partially account for higher prevalence of PTSD in sexual minorities.15 Very few studies have examined whether childhood gender nonconformity might explain elevated exposure to child abuse before adolescence24,27 or probable PTSD among sexual minorities. We examine possible sexual-orientation disparities in childhood abuse and PTSD separately by gender because studies have found gender differences in PTSD and childhood abuse.28,29 We further examine possible gender-by-sexual-orientation interactions in risk of PTSD and abuse.     

Correction to: Risk and Protective Factors for Social Anxiety Among Sexual Minority Individuals

Archives of Sexual Behavior - The figure given in Row 7, Column 9 in Table&nbsp;2 in this article as originally published was incorrect.     

School Environment and the Mental Health of Sexual Minority Youths: A Study Among Dutch Young Adolescents

Objectives. We examined whether structural elements of the school environment, in particular cultural pluralism and consistency and clarity of school rules and expectations of students, could mitigate the risk for mental health problems among young sexual minority adolescents.Methods. Data were collected in 2008 by means of a computer-based questionnaire completed at school by 513 young Dutch adolescents (12–15 years old) during regular class times. Eleven percent of these students, who were enrolled in 8 different schools, reported having at least some feelings of same-sex attraction.Results. Adolescents with same-sex attractions in schools where rules and expectations were experienced as less consistent and clear reported significantly more mental health problems than their peers with no same-sex attractions in the same schools. Such differences were absent in schools where rules and expectations were experienced as more consistent and clear. There were no such effects of cultural pluralism.Conclusions. Our results suggest that schools with consistent and clear rules and expectations mitigate the risk for mental health problems among students with same-sex attractions and underscore the importance of structural measures for the health of sexual minority youth.Shocking reports appear in the press with some regularity about the bullying of adolescents who are gay or lesbian or who are perceived as such, sometimes resulting in suicide attempts and even actual suicides.^1–3 Such reports draw attention to the role of schools: what can schools do to protect sexual minority youths?Studies conducted in various countries have shown that sexual minority youths are at disproportionate risk for several negative health outcomes, including victimization, witnessing and perpetrating violence, substance use, sexual risk behaviors, and suicide ideation and attempts.^4–9 A recent Dutch study of younger adolescents (13- to 15-year-olds) showed that those experiencing same-sex attractions had significantly higher levels of depression and lower self-esteem than did their peers not experiencing same-sex attractions.¹⁰Sexual minority youths come of age in a society that is often hostile to their interests and needs. Increased health problems in these youths are usually understood as a consequence of discrimination by peers and family. Victimization in high school has been shown to be positively associated with mental health and traumatic stress symptoms in sexual minority youths.¹¹ In a survey of Illinois middle school students, being the target of homophobic verbal harassment was associated with higher levels of anxiety and depression, personal distress, and a lower sense of school belonging among boys and higher levels of withdrawal among girls.¹²Homophobic bullying by classmates can start at an early age, as suggested by the April 2009 suicides of 2 boys, both 11 years old, in Massachusetts and Georgia, each bullied at school for being perceived as gay.^1,2 In a study involving a community-based sample of self-identified lesbian, gay, and bisexual youths (aged 15–19 years) who were interviewed about their lifetime experiences of sexual orientation victimization, the mean ages at which verbal victimization began were 11.4 years for male participants and 14.4 years for female participants.¹³ The corresponding mean ages at which physical victimization began were 13.1 years and 14.2 years.¹³ School was reported as the setting for 72% of first experiences with verbal victimization and 56% of first experiences with physical victimization.¹³A few studies suggest that structural factors may affect how young people feel at school. In one investigation, students who reported having a Gay–Straight Alliance (GSA) at school, knowing where to go for information and support related to sexual orientation and gender identity, and having lesbian, gay, bisexual, and transgender (LGBT) issues included in their school curriculum were more likely to report feeling safe at school than were those who did not have these resources.¹⁴Another study showed that sexual minority students in schools that have a comprehensive harassment policy (i.e., specifying sexual orientation or gender identity and expression) are less frequently verbally harassed and hear fewer homophobic remarks than students in schools with no policy or a policy not specifically inclusive of LGBT people; students reported that school personnel were also more likely to intervene upon hearing homophobic remarks in these schools.¹⁵ Feeling safe at school seems to be a protective factor for sexual minority youths. In one study, feeling safe at school attenuated the association between sexual orientation and suicidal ideation and attempts.¹⁶Further support for the importance of structural factors comes from a cross-sectional study that compared rates of victimization and suicidality among sexual minority adolescents in schools with and without GSAs and other school programs.¹⁷ Using data from the Massachusetts Youth Risk Behavior Survey and controlling for student demographic characteristics and school characteristics, Goodenow et al. showed that sexual minority youths in Massachusetts schools with GSAs were less than half as likely as those in other schools to report dating violence, being threatened or injured at school, or skipping school as a result of fear; in addition, they were less than one third as likely to report multiple suicide attempts in the past year.Goodenow et al. also found that peer support groups other than GSAs, nonacademic counseling, school antibullying policies, a student judiciary, staff training on sexual harassment, and peer tutoring systems were associated with lower rates of victimization and suicidality among sexual minority students. Sexual minority youths from schools where there was a perception that school staff could be approached about a problem were less likely to report multiple suicide attempts, and those from schools where antibullying policies were in place were less likely to report single or multiple suicide attempts.Building on existing knowledge, we explored whether a protective school climate offsets negative health outcomes among young adolescents. In particular, we hypothesized that when schools support cultural pluralism and have consistent and clear rules and expectations, the relationship between same-sex attraction and mental health will be attenuated.     

A Syndemic of Psychosocial Health Disparities and Associations With Risk for Attempting Suicide Among Young Sexual Minority Men

Objectives. We examined a syndemic of psychosocial health issues among young men who have sex with men (MSM), with men and women (MSMW), and with women (MSW). We examined hypothesized drivers of syndemic production and effects on suicide attempts.Methods. Using a pooled data set of 2005 and 2007 Youth Risk Behavior Surveys from 11 jurisdictions, we used structural equation modeling to model a latent syndemic factor of depression symptoms, substance use, risky sex, and intimate partner violence. Multigroup models examined relations between victimization and bullying experiences, syndemic health issues, and serious suicide attempts.Results. We found experiences of victimization to increase syndemic burden among all male youths, especially MSMW and MSM compared with MSW (variance explained = 44%, 38%, and 10%, respectively). The syndemic factor was shown to increase the odds of reporting a serious suicide attempt, particularly for MSM (odds ratio [OR] = 5.75; 95% confidence interval [CI] = 1.36, 24.39; P < .001) and MSMW (OR = 5.08; 95% CI = 2.14, 12.28; P < .001) compared with MSW (OR = 3.47; 95% CI = 2.50, 4.83; P < .001).Conclusions. Interventions addressing multiple psychosocial health outcomes should be developed and tested to better meet the needs of young MSM and MSMW.Substantial evidence has been accumulating over the past several decades to suggest that men who have sex with men (MSM) experience substantial disparities in many facets of health.1 An important characteristic of these disparities is that they tend to arise early in the life course. For example, meta-analyses have shown that by adolescence and young adulthood MSM experience significantly higher rates of depression,2 substance use,3 HIV sexual risk behaviors,4 and suicidality2 than do their heterosexual peers. Little research has been conducted on the health of young men who have sex with men and women (MSMW). The few empirical studies separating adolescent MSM from adolescent MSMW have shown that adolescent MSMW report significantly higher rates of substance use, including tobacco use, than do their heterosexual3 and MSM5–9 counterparts. Additionally, MSMW have been found to be more likely to report HIV sexual risk behaviors than are their heterosexual peers.9One theoretical explanation for these disparities is syndemics.10–12 Syndemic theory posits that as individuals are confronted with adversity across the life course, particularly in the forms of social marginalization and victimization, they develop psychosocial health problems such as low self-image, depression, and substance use.13 These conditions tend to co-occur, which has a snowballing effect on overall health. In fact, several studies have demonstrated that as the number of psychosocial conditions within an individual increases, so does their risk of major negative health outcomes.10–12,14 It follows from this argument that young MSM, who experience far greater levels of adversity than do heterosexual youths,15–18 would also experience greater rates of syndemics and higher rates of the resulting negative health outcomes.We examined syndemic production in a population-based sample of young men and its association with serious suicide attempts. By looking at syndemics in a large enough sample that could be broken into MSM, MSMW, and men who have sex with women (MSW), we sought to determine whether syndemics are a general human phenomenon or whether they exist and are associated with negative health outcomes only for certain socially marginalized populations.10,11,19 We also examined the structure of the syndemic construct by testing for measurement invariance using multigroup confirmatory factor analysis (CFA),20 which, essentially, asks whether the meaning of the syndemic construct is the same across groups. Next we examined the relation between experienced adversity and syndemic production to see whether this association exists for all groups of young men, and if so, to what degree. Finally, we tested the relationship between syndemics and a serious adverse health outcome—making a life-threatening suicide attempt—and whether the negative effects were the same across groups.     

Mental Health and Suicidality Among Racially/Ethnically Diverse Sexual Minority Youths

Objectives. We examined the relationships among sexual minority status, sex, and mental health and suicidality, in a racially/ethnically diverse sample of adolescents.Methods. Using pooled data from 2005 and 2007 Youth Risk Behavior Surveys within 14 jurisdictions, we used hierarchical linear modeling to examine 6 mental health outcomes across 6 racial/ethnic groups, intersecting with sexual minority status and sex. Based on an omnibus measure of sexual minority status, there were 6245 sexual minority adolescents in the current study. The total sample was n = 72 691.Results. Compared with heterosexual peers, sexual minorities reported higher odds of feeling sad; suicidal ideation, planning and attempts; suicide attempt treated by a doctor or nurse, and self-harm. Among sexual minorities, compared with White youths, Asian and Black youths had lower odds of many outcomes, whereas American Native/Pacific Islander, Latino, and Multiracial youths had higher odds.Conclusions. Although in general, sexual minority youths were at heightened risk for suicidal outcomes, risk varied based on sex and on race/ethnicity. More research is needed to better understand the manner in which sex and race/ethnicity intersect among sexual minorities to influence risk and protective factors, and ultimately, mental health outcomes.Over the past 20 years, research has documented elevated suicidality1—defined as behavior related to contemplating, attempting, or completing suicide2—among sexual minority youths (an umbrella term, generally including those who identify as lesbian, gay, bisexual, or transgender [LGBT]; engage in same-sex sexual behavior; or have same-sex attractions). This research has consistently demonstrated substantial sexual orientation disparities in suicidality, with sexual minority youths having higher prevalence of suicidality than their heterosexual peers.3–6 A recent review of the literature indicated that sexual minority youths are at least twice as likely as heterosexual youths to contemplate suicide, and 2 to 7 times as likely to attempt suicide.7 A meta-analysis found that 28% of sexual minority youths had a history of suicidality, compared with 12% of their heterosexual peers.8Despite the development of knowledge about suicidality among sexual minority youths, little is known about suicidality in sexual minority youths of color. To the extent that existing researchers have explored racial/ethnic differences, analyses have rarely gone beyond dichotomous (White vs “youths of color”) or trichotomous (White vs Black vs Latino) comparisons. As a result, there exists scant literature exploring the full spectrum of racial/ethnic differences in suicidality among sexual minority youths.The literature on suicide in the general adolescent population demonstrates racial/ethnic differences in suicide ideation and attempts. For example, prevalence of suicide among Native American and Alaska Native youths is twice that of other youths,9 and Latino youths are more likely than either Black or White youths to have considered and attempted suicide.10 Differences are further moderated by participants’ gender: girls are more likely to consider suicide and attempt suicide than boys,10 although boys are more likely to complete suicide.11Studies that have considered racial/ethnic differences in suicidality among sexual minority youths have found differences, though the patterns have been inconsistent. A study based on Youth Risk Behavior Survey (YRBS) data from Massachusetts, reported that among self-identified lesbian, gay, or bisexual (LGB) youths3 Latinos were significantly more likely than Whites to report past-year suicide attempt. Another study found that same-sex–attracted Black and White youths were more likely than their other-sex–attracted peers to report suicidal ideation, whereas same-sex–attracted Latino and Asian/Pacific Islander youths did not differ from other-sex–attracted peers.12 In a nonprobability sample of urban LGBT youths,13 Black and White youths were more likely to report suicidal ideation than Latinos; however, Latinos reported the highest frequency of suicide attempts. A study of New York City adults found that Latino and Black LGB participants were more likely to report serious suicide attempts than were White LGB participants, with most reported attempts occurring during adolescence and young adulthood.14 These conflicting results suggest that there are important differences in suicidality at the intersections of sexual minority status and race/ethnicity, yet further study requires data of sufficient scale and scope to enable analyses of low-prevalence behaviors across small subgroups of youths.To address the need for information about suicidality among racially/ethnically diverse sexual minority populations, we assess suicidality patterns among youths based on sexual orientation, race/ethnicity, and sex. With this, we respond to calls for public health to utilize minority stress and intersectional frameworks as potential lenses through which to understand health and health disparities among sexual minority populations.15,16 Rather than treating social identities as separate and discrete phenomena, our inquiry allows that co-occurring minority identities operate together. An intersectional approach suggests that sexual identity–race–sex intersections are informed by unique cultural, historical, social, and political factors that differentially influence life experiences, including discrimination based on such identities.17–19 In turn, minority stress theory posits that discriminatory experiences predispose populations to stress and adverse mental health outcomes, including suicidality.20The focus on health differences among sexual minority youths across race/ethnicity and sex is vital to creating effective health interventions and programs. Such a focus is particularly relevant within the context of youth suicide, as risk and protective factors associated with suicidality vary across both racial/ethnic and sexual minority groups, and there is a need to better integrate these bodies of research.21     

Suicide Risk and Sexual Orientation: A Critical Review

Many studies have reported higher rates of suicide attempts among sexual minority individuals compared with their heterosexual counterparts. For suicides, however, it has been argued that there is no sexual orientation risk difference, based on the results of psychological autopsy studies. The purpose of this article was to clarify the reasons for the seemingly discrepant findings for suicide attempts and suicides. First, we reviewed studies that investigated if the increased suicide attempt risk of sexual minorities resulted from biased self-reports or less rigorous assessments of suicide attempts. Second, we reanalyzed the only two available case–control autopsy studies and challenge their original “no difference” conclusion by pointing out problems with the interpretation of significance tests and by applying Bayesian statistics and meta-analytical procedures. Third, we reviewed register based and clinical studies on the association of suicides and sexual orientation. We conclude that studies of both suicide attempts and suicides do, in fact, point to an increased suicide risk among sexual minorities, thus solving the discrepancy. We also discuss methodological challenges inherent in research on sexual minorities and potential ethical issues. The arguments in this article are necessary to judge the weight of the evidence and how the evidence might be translated into practice.     

Sexual Values and Risky Sexual Behaviors Among Latino Youths

CONTEXT: Understanding Latino youths' sexual values is key to informing HIV prevention efforts. Few studies have examined associations between culturally based sexual values and behaviors among Latinos.
METHODS: A sample of 839 sexually active Latinos aged 16–22 residing in San Francisco were interviewed in 2003–2006. Multiple regression and multinomial logistic regression analyses were conducted to examine associations between sexual values and behaviors, while adjusting for language use (a proxy for acculturation) and other covariates.
RESULTS: The importance attached to female virginity was negatively associated with the number of sexual partners women had had in their lifetime (odds ratio, 0.8) and in the past year (0.9), and was positively associated with women's nonuse of condoms, rather than consistent use, during the first month of their current relationships (1.8). For men, the importance of satisfying sexual needs increased with the numbers of lifetime and recent sexual partners (1.4 and 1.1, respectively), and with inconsistent condom use in the first month of their relationships (1.9). Comfort with sexual communication was positively associated with inconsistent use or nonuse of condoms in the last month of both men's and women's current relationships (2.0–2.2). For women, considering satisfaction of sexual needs important was associated with more sexual partners only among those who attached little value to female virginity.
CONCLUSIONS: It is important to integrate themes of virginity and sexual desire into intervention curricula so youth can better understand how these sexual norms influence their developing sexual identities and behaviors.     

Sexual Risk Behaviors in Adolescent Sexual Minority Males: A Systematic Review and Meta-Analysis

Although adolescent sexual minority males (ASMM) are at increased risk for human immunodeficiency virus (HIV) in the United States (US), studies that estimate sexual risk behaviors that contribute to HIV risk in ASMM are limited. We completed a systematic review and meta-analysis to compile available data and estimate the prevalence of risk behaviors in this population. We searched four databases for key terms related to ASMM, defined as males aged 14 through 19 who identified as gay or bisexual, reported sex with a male in their lifetime, and/or were considered sexual minority by the study. Articles eligible for inclusion were in English, from US studies, and reported quantitative data on sexual risk behaviors among ASMM. We extracted data from eligible articles and meta-analyzed outcomes reported in three or more articles using random effects. Of 3864 articles identified, 21 were eligible for data extraction. We meta-analyzed nine outcomes. Sixty-two percent of adolescent males self-identifying as gay or bisexual ever had sex with a male, and 67% of participants from ASMM studies recently had sex. Among ASMM who had sex in the last 6 months or were described as sexually active, 44% had condomless anal intercourse in the past 6 months, 50% did not use a condom at last sex, and 32% used alcohol or drugs at their last sexual experience. Available data indicate that sexual risk behaviors are prevalent among ASMM. We need more data to obtain estimates with better precision and generalizability. Understanding HIV risk in ASMM will assist in intervention development and evaluation, and inform behavioral mathematical models.     

广州市大学生自杀倾向现状研究

目的了解大学生自杀倾向发生状况及其影响因素,为制定干预措施提供依据。方法对广州市2所高校1 245名大学生进行问卷调查。结果20.8%的学生曾感到非常悲伤和无望持续2周以上,9.0%的学生曾想过自杀,4.6%的学生曾经为如何自杀制定过计划,2.5%的学生曾有自杀行为。不同性别、不同年级、不同来源地学生自杀倾向发生率差异有统计学意义,来自城镇、男生、低年级学生自杀倾向发生率较高。自杀倾向与吸烟、物质滥用等危险行为关系密切。结论大学生自杀倾向状况值得关注,应在教育系统内引入促进精神健康和预防自杀的策略。