Association of HIV Education with HIV Testing and Sexual Risk Behaviors Among US Youth, 2009-2017: Disparities Between Sexual Minority and Sexual Majority Youth.
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SUBMITTER: Phillips G
PROVIDER: S-EPMC7470599 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:PurposeThe aim of this study was to identify sex-stratified trends in victimization risk specific to heterosexual, lesbian, gay, bisexual, and questioning youth while considering changes in sexual orientation-disparities from 2009 to 2017.MethodsYouth Risk Behavior Survey (YRBS) data collected biennially (five waves; 2009-2017) were pooled across 56 jurisdictions and 454,715 students for one of the most nationally representative samples of heterosexual and sexual minority youth to date. We analyzed a seven-item victimization risk assessment using the Centers for Disease Control and Prevention's recommended trend analysis approach. We used logistic regression with year-by-identity interactions to test whether sexual orientation-based disparities widened, narrowed, or were maintained over time.ResultsVictimization risk declined significantly for male and female bisexual and questioning youth, lesbian, gay, and heterosexual youth. Disparities narrowed between bisexual, questioning, and lesbian females and heterosexual females and between bisexual and heterosexual males. Nevertheless, sexual orientation-based disparities remained significant for all sexual minority youth in 2017.ConclusionsDistinct patterns of change in victimization risk for specific groups of sexual minority youth underscore the need to consider variability within sexual minority youth communities; treating them as a singular group could mask nuanced disparities. Some of the relatively small decreases in victimization risk also suggest the need for interventions to address a more comprehensive set of victimization-related risks beyond bullying and needed efforts that are not limited to the immediate school context.
| S-EPMC6980438 | biostudies-literature
Project description:Purpose: Sexual minority youth (SMY), particularly bisexual youth and youth unsure of their sexual identity, are at greater risk of poor mental and sexual health outcomes than heterosexual youth. The purpose of this study was to examine disparities in intimate partner violence (IPV) and mental and sexual health for Black and Latino/a bisexual and unsure youth compared with their White bisexual and unsure and Black and Latino/a heterosexual peers. Methods: We used aggregated state and school district 2015 Youth Risk Behavior Survey data to demonstrate differences in mental health (e.g., depressive symptoms and suicidality), sexual health (e.g., number of sexual partners and contraceptive use), and physical and sexual IPV between Black and Latino/a bisexual and unsure youth, and their White bisexual and unsure and Black and Latino/a heterosexual peers. Results: Bisexual and unsure youth had higher odds of depressive symptoms, suicidal ideation and plans, and physical IPV than their same-race heterosexual peers. Black and Latina bisexual and unsure females were more likely to report sexual health risk behaviors than Black and Latina heterosexual females. There were few differences between bisexual and unsure youth of color and White youth. Conclusion: We add to a growing body of literature showing disparities in IPV and mental and sexual health among bisexual and unsure youth of color. Pronounced risk for poor health outcomes among bisexual and unsure females of color needs to be especially addressed by prevention and intervention efforts. We encourage further research on the health of SMY with multiple marginalized identities.
| S-EPMC8213006 | biostudies-literature
Project description:IntroductionAlcohol use and suicidality remain serious risks for U.S. youth. Research has established that disparities exist in these outcomes between heterosexual and sexual minority youth. However, research into the associations between alcohol use and suicidality has yet to consider the differential role of sexual orientation.MethodsUsing a pooled, diverse sample from the 2009-2017 Youth Risk Behavior Survey, associations of alcohol use and suicidality by sex and sexual orientation, and changes in these outcomes over time, were investigated. Analyses were conducted in 2019.ResultsSuicidality was highest among nonheterosexuals, who ranged from twofold to sevenfold higher odds to report suicidality across all time points, with the most striking disparities among male sexual minority youth. Rates among all students remained stable or increased over time; notable exceptions included a decrease in suicide attempts among bisexual students. Among all students, current alcohol use was associated with elevated levels of suicidality. For female students, the association between drinking and suicidality did not significantly differ by sexual identity; for male students, it was significant regardless of sexual identity and most pronounced among not sure youth.ConclusionsThese results emphasize the need for additional research into the relationship between contemporaneous alcohol use and suicidality, with attention to differences based on sex, sexual orientation, and other factors that may impact these relationships. There is a particular need for research to examine the temporal nature of the association such that evidence-informed, high-impact interventions can be developed to improve suicidality outcomes among sexual minority youth.
| S-EPMC7483808 | biostudies-literature
Project description:BackgroundRisky sexual behaviors are associated with the transmission of sexually transmitted infections (STIs) and unwanted pregnancies, both major health concerns for youth worldwide. This review studies the effectiveness of narrated mass media programs in promoting safer sexual practices among youth in developed and developing countries.MethodsElectronic and manual searches were conducted to identify experimental and quasi-experimental studies with robust counterfactual designs published between 1985 and the first quarter of 2017. Effect sizes were meta-analyzed using mixed-effects models.ResultsEight experimental and two quasi-experimental studies met our inclusion criteria. The aggregated sample size was 23,476 participants, with a median of 902 participants per study. Entertainment education narratives had small but significant effects for three sexual behaviors. It reduced the number of sexual partners [standardized mean difference, (SMD) = 0.17, 95% confidence interval (CI) = 0.02-0.33, three effect sizes], reduced unprotected sex (SMD = 0.08, 95% CI = 0.03-0.12, nine effect sizes), and increased testing and management for STIs (SMD = 0.29, 95% CI = 0.11-0.46, two effect sizes). The interventions were not effective in reducing inter-generational sex, measured through the age-gap with sexual partners (SMD = 0.06, 95% CI = -0.06-0.19, four effect sizes). Entertainment education had medium-size effects on knowledge outcomes (SMD = 0.67, 95% CI = 0.32-1.02, seven effect sizes), where a time-decay relationship is observed. No effects were found on attitudes.ConclusionAlthough mass media entertainment had small effects in promoting safer sexual practices, its economies of scales over face-to-face interventions suggest its potential to be a cost-effective tool above an audience threshold. The use of study participants from the general youth population and the use of mostly effectiveness trials mitigate concerns regarding its scalability. The overall paucity of high-quality studies affirms the need for strengthening the evidence base of entertainment education. Future research should be undertaken to understand the moderator effects for different subgroups and intervention characteristics.
| S-EPMC6372167 | biostudies-literature
Project description:This study examined the longitudinal effects of co-occurring psychosocial concerns, or syndemics, on HIV-positive sexual minority men's likelihood of engaging in serodiscordant condomless anal sex (CAS), a health behavior with implications for personal and public health. Participants included 390 HIV-positive sexual minority men from two prior secondary prevention trials. Over the course of the 1-year data collection period (up to 5 observations per participant), participants completed self-report measures of CAS, as well as six syndemic factors: post-traumatic stress disorder, childhood sexual abuse, depression, anxiety, alcohol abuse, and polysubstance/stimulant use. We employed multilevel modeling to examine the longitudinal additive effect of syndemics on serodiscordant CAS (binary) over the 1-year period. The number of syndemic conditions was a significant predictor of CAS, with each additional syndemic associated with 1.41 greater odds of CAS (p?=?.0004; 95% CI [1.16, 1.70]). Both the between-person (p?=?.0121, 95% CI [1.07, 1.69]) and within-person (p?=?.01, 95% CI [1.11, 2.10]) effects of syndemics were significant predictors, showing that an increase in the number of syndemic conditions across person and time both increased odds of CAS. Interventions addressing HIV-positive sexual minority men's sexual health behaviors should address the potential impact of co-occurring psychosocial concerns that affect these behaviors. This will benefit this population's personal sexual health and reduce transmission of HIV and STIs among sexual minority men.
| S-EPMC6586562 | biostudies-literature
Project description:This study investigated whether lesbian, gay, and bisexual (LGB) adolescents were at higher risk for persistent victimization of bullying compared to heterosexual adolescents, and how victimization trajectories were associated with internalizing symptom development across LGB and heterosexual adolescents. Data came from a five-wave study (Mage T1 = 11.1 to Mage T5 = 22.3; n = 151 LGB; n = 1,275 heterosexual) and informants were adolescents and their parents. Adolescents were classified in three victimization trajectories: persistent (5.6%), decreasing (28.1%) or low (66.3%) victimization. LGB adolescents reported more persistent victimization, relative to no (OR = 6.79, 95% CI [3.52, 13.13]) or decreasing victimization (OR = 3.09, 95% CI [1.53, 6.24]), compared to heterosexual peers. Further, persistent victimization was more strongly associated with anxiety among LGB than among heterosexual adolescents.
| S-EPMC7064905 | biostudies-literature
Project description:Body image disturbance is a common experience for sexual minority men living with HIV, and is associated with poor self-care behaviors. However, to date, no known cohesive theoretical model has been advanced to understand the possible antecedents and outcomes of body image disturbance in this population. Thus, the goal of the current study was to test a biopsychosocial model of body image and self-care behaviors among sexual minority men living with HIV.Participants were 106 gay and bisexual men living with HIV who completed a battery of self-report measures, including assessment of body image disturbance, depression, lipodystrophy, appearance orientation, condom use self-efficacy, antiretroviral therapy (ART) adherence, and HIV sexual transmission risk behaviors. Bayesian estimation was employed to assess model fit and direct and indirect pathways within the model.The data fit the model well, with all theorized pathways being significant. Lipodystrophy severity and appearance orientation were associated with elevated body image disturbance. In turn, body image disturbance was related to poorer ART adherence and increased HIV sexual transmission risk behaviors, through the mechanisms of elevated depressive symptoms and poor condom use self-efficacy.Elevated body image disturbance among sexual minority men living with HIV is associated with important biopsychosocial variables, which in turn are related to poorer ART adherence and increased HIV sexual transmission risk behaviors. Integrative psychosocial interventions addressing co-occurring body image disturbance, depression, and HIV self-care behaviors may be a fruitful area for future clinical practice and research.
| S-EPMC4094355 | biostudies-literature
Project description:Sexual minority (SM) young adults, such as those who identify as lesbian, gay, or bisexual (LGB), have well documented smoking disparities compared to heterosexual young adults. However, no studies have simultaneously tested the role of three risk factors (depressive symptoms, recalling tobacco marketing in bars, and cigarette-related social norms) to explain SM tobacco use disparities. Longitudinal structural equation modeling was used to explore if the association between SM identity and past 30-day cigarette smoking one year later was mediated by these three risk factors. Starting in fall 2015, three surveys were administered every 6 months to 3,972 young adult college students. Surveys assessed SM identity, depressive symptoms, tobacco marketing in bars, normative perceptions of cigarettes, and tobacco use behaviors. Greater depressive symptoms, recalling more tobacco marketing in bars, and more accepting cigarette-related social norms were each hypothesized to explain a unique portion of the association between SM identity and subsequent cigarette use. SM young adults reported higher prevalence of cigarette use, depressive symptom scores reflecting elevated risk for major depressive disorder, and more accepting cigarette-related social norms than their heterosexual peers. Results indicated that only cigarette-related social norms mediated the association between SM identity and subsequent past 30-day smoking, while controlling for depressive symptoms, recalling tobacco marketing in bars, sociodemographic factors, and previous tobacco use. Findings reflect a need for tailored tobacco control messaging that shift the more accepting cigarette-related norms of SM young adults, as doing so may ultimately lead to decreased smoking for this high-risk subgroup. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
| S-EPMC6584955 | biostudies-literature
Project description:BackgroundSexual minority (gay, lesbian, and bisexual) individuals experience elevated mood disorders and suicidality compared to their heterosexual counterparts. However, to date, these sexual orientation disparities have yet to be examined among middle childhood-aged participants.MethodsData were employed from the baseline wave of the Adolescent Brain Cognitive Development (ABCD) study, a U.S. representative sample. Population-level weighting was utilized, resulting in an analytic sample of N = 8,204,013 (nunweighted = 4519) children between the ages of 9 and 10 years: with 70,952 (nunweighted = 43) identifying as sexual minories (0.9% of the population). Structured clinical interviews were used to assess mood disorders (i.e., depressive and bipolar disorders) and suicidality. Sexual orientation (sexual minority vs. heterosexual) was examined as the focal independent variable.ResultsThe overall prevalence of mood disorders was 7.1%. Sexual minority children (22.5%) possessed a higher rate than heterosexual children (6.9%). The overall prevalence of suicidality was 4.8%; sexual minority children (19.1%) possessed a higher rate than heterosexual children (4.6%).LimitationsSexual orientation assessment did not include attraction, and thus, results may represent a lower bound estimate of sexual minorities.ConclusionsSexual orientation disparities in mood disorders and suicidality appear to develop as early as middle childhood. Clinicians are encouraged to assess sexual orientation among children as young as 9-10 years old, and provide appropriate normalization of sexual orientation, and referrals for mental health treatment, as indicated.
| S-EPMC6450073 | biostudies-literature
Project description:Introduction:Expert recommendations state that all physicians caring for youth should be trained in providing competent and nonjudgmental care for sexual and gender minority (SGM) youth. Despite those recommendations, there is insufficient training to prepare clinicians to provide culturally competent care for SGM youth. We created a 2-hour session to address communication skills critical to caring for SGM youth. The goals of the session were for third- and fourth-year medical learners to affirm, validate, and assess the mental health status of their patient, collaborate with a school counselor, support families in acceptance of SGM children, and provide them with relevant resources. Methods:The session utilized multiple active learning modalities including flipped classroom, small-group learning, and peer-to-peer instruction. Learners completed anonymous pre- and postsurveys that aimed to measure their comfort, self-efficacy, and self-reported preparedness in counseling adolescents questioning their sexual orientation. Results:Of the 42 learners who participated in the course over two academic terms, 40 (95%) completed the presurvey, and 39 (93%) completed the postsurvey. Learners demonstrated a significant improvement in self-reported knowledge, comfort, and sense of preparedness on all skill-based objectives and reported growth in their comfort and sense of preparedness for counseling adolescents questioning their sexual orientation after participating in the session (p < .001). Discussion:This session supports the development of key communication skills needed to provide competent and nonjudgmental care for SGM youth. It can be easily replicated at other health professional schools looking to improve the cultural competency of future clinicians around care for SGM patients.
| S-EPMC6464565 | biostudies-other