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BACKGROUND: Although lesbian, gay, bisexual and other sexual minority (LGB+) girls are more likely than heterosexual girls to be pregnant during adolescence, relevant pregnancy prevention programming is lacking. METHODS: A national randomized controlled trial was conducted with 948 14- to 18-year-old cisgender LGB+ girls assigned to either Girl2Girl or an attention-matched control group. Participants were recruited on social media between January 2017 and January 2018 and enrolled over the telephone. Between 5 and 10 text messages were sent daily for 7 weeks. Both experimental arms ended with a 1-week booster delivered 12 weeks subsequently. RESULTS: A total of 799 (84%) participants completed the intervention end survey. Participants were, on average, 16.1 years of age (SD: 1.2 years). Forty-three percent were minority race; 24% were Hispanic ethnicity. Fifteen percent lived in a rural area and 29% came from a low-income household. Girl2Girl was associated with significantly higher rates of condom-protected sex (adjusted odds ratio [aOR] = 1.48, P < .001), current use of birth control other than condoms (aOR = 1.60, P = .02), and intentions to use birth control among those not currently on birth control (aOR = 1.93, P = .001). Differences in pregnancy were clinically but not statistically significant (aOR = 0.43, P = .23). Abstinence (aOR = 0.82, P = .34), intentions to be abstinent (aOR = 0.95, P = .77), and intentions to use condoms (aOR = 1.09, P = .59) were similar by study arm. CONCLUSIONS: Girl2Girl appears to be associated with increases in pregnancy preventive behaviors for LGB+ girls, at least in the short-term. Comprehensive text messaging–based interventions could be used more widely to promote adolescent sexual health behaviors across the United States.

Objective To address the significant dearth of literature that examines how girls who are lesbian, gay, bisexual, or who have another nonheterosexual identity (LGB+) decide when and with whom to have sex; and to explore why inexperienced LGB+ girls might have sex with girls or boys. Study design We conducted 8 online, asynchronous, bulletin board-style focus groups with 160 adolescent girls 14-18 years of age. The transcripts were analyzed using a thematic analysis of each girls' responses to the questions. Analyses were focused on increasing our understanding of sexual health decision making among LGB+ teenage girls (eg, “What was the reason you had sex for the first time?”). Participants' responses reflected their day-to-day experiences and roles of cisgender LGB+ girls inside a dominant heteronormative social structure. Results Some LGB+ girls talked about the perception that LGB+ girls were presumed or expected to be hypersexual, and that they did not feel they could be accepted as LGB+ without being sexually active. Developmental aspects of identity were also salient: Girls considered or engaged in sexual encounters as a way of figuring out to whom they were attracted as well as confirming or disconfirming the identity labels they used for themselves. Same-sex encounters could be offered as “proof” that one really was LGB+. Similarly, unsatisfying experiences with guys could serve as evidence that they were not attracted to guys. Conclusion Sexual decision making among LGB+ girls is often driven by aspects of their sexual minority identity.

Objective Disordered eating has decreased for all youth over time, but studies have not focused specifically on lesbian, gay, and bisexual (LGB) youth. Research has found that LGB youth report disordered eating behaviors more often compared to their heterosexual counterparts, but no studies have documented trends over time for LGB youth and considered whether these disparities are narrowing or widening across sexual orientation groups. Method We use pooled data from the 1999 to 2013 Massachusetts Youth Risk Behavior Surveys (N = 26,002) to investigate trends in purging, fasting, and using diet pills to lose or control weight for heterosexual and sexual minority youth. We used crosstabs, logistic regression, and interactions in regression models, stratified by sex. Results The prevalence of disordered eating has decreased on all three measures across nearly all groups of heterosexual and sexual minority youth. However, we found disparities in reported disordered eating behaviors for LGB youth persisted across all survey years, with LGB students reporting significantly higher prevalence of disordered eating than heterosexuals. The disparities in fasting to control weight widened between the first and last survey waves between lesbian adolescents and heterosexual females. Discussion The significant reductions over time in prevalence of disordered eating among some youth are encouraging, but the disparities remain. Indeed, the increasing prevalence of fasting, diet pill use, and purging to control weight among lesbians may warrant targeted prevention and intervention programs. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:22–31)

Purpose Data suggest that lesbian and bisexual adolescents engage in risky sexual behaviors at higher rates than heterosexual girls. Whether these findings also apply to girls of other sexual identities is less well understood. Potential differences in risky sexual behaviors reported by lesbian versus bisexual adolescents are also underreported in the literature. Methods Data were collected online in 2010–2011 among 2,823 girls, aged 13–18 years, in the United States. Multinomial logistic regression was used to quantify comparisons of sexual behaviors between (1) lesbian; (2) bisexual; and (3) questioning, unsure, or other (QUO) identity; and (0) heterosexual girls. Logistic regression compared lesbian and bisexual adolescents. Results Lesbian and bisexual adolescents reported significantly more lifetime and past-year sexual partners than heterosexual girls. Bisexual girls were also more likely to report penile-anal and penile-vaginal sex, whereas lesbians were more likely to report earlier sexual debut for almost all types of sex, as compared to heterosexual girls. Lesbians also were more likely to report infrequent condom use and less likely to have conversations with partners about the use of barriers (e.g., dental dams) before first sex. Relative to lesbians, bisexual girls reported older age at first sex for almost all sexual behaviors and higher lifetime prevalence of recent male partners, penile-vaginal, and penile-anal sex. Few differences were noted between QUO and heterosexual girls. Conclusions Sexual minority adolescents are not identical in terms of sexual risk. Providers need to be sensitive to these differences and their implications for health and counseling of patients.

Disordered eating has decreased for all youth over time, but studies have not focused specifically on lesbian, gay, and bisexual (LGB) youth. Research has found that LGB youth report disordered eating behaviors more often compared to their heterosexual counterparts, but no studies have documented trends over time for LGB youth and considered whether these disparities are narrowing or widening across sexual orientation groups.We use pooled data from the 1999 to 2013 Massachusetts Youth Risk Behavior Surveys (N = 26,002) to investigate trends in purging, fasting, and using diet pills to lose or control weight for heterosexual and sexual minority youth. We used crosstabs, logistic regression, and interactions in regression models, stratified by sex.The prevalence of disordered eating has decreased on all three measures across nearly all groups of heterosexual and sexual minority youth. However, we found disparities in reported disordered eating behaviors for LGB youth persisted across all survey years, with LGB students reporting significantly higher prevalence of disordered eating than heterosexuals. The disparities in fasting to control weight widened between the first and last survey waves between lesbian adolescents and heterosexual females.The significant reductions over time in prevalence of disordered eating among some youth are encouraging, but the disparities remain. Indeed, the increasing prevalence of fasting, diet pill use, and purging to control weight among lesbians may warrant targeted prevention and intervention programs. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:22-31).

Objectives. This study examined the prevalence of AIDS-related risk behaviors among adolescent males with female, male, and both-sex sexual partners and explored factors related to these behaviors. Methods. Three waves of a population-based survey provided data on male high school students: 3065 with only female sexual partners, 94 with only male partners, and 108 with both. Logistic regression analyses were used to examine AIDS-related outcomes. Results. Youths with any same-sex experience reported less school AIDS education. Bisexual experience predicted multiple sexual partners, unprotected intercourse, sexually transmitted disease, and injection drug use. School AIDS education and condom instruction predicted less AIDS-related risk. Conclusions. Bisexually active adolescent males report especially high levels of AIDS risk behavior. School-based AIDS prevention should address the needs of all sexually active youths.

Objectives. This study compared sexual risk behavioi-s of gay, lesbian, and bisexual (GLB) and heterosexual adolescents and evaluated associations between gay-sensitive HIV instruction and risk behaviors of GLB youths. Methods. A random sample of high school students and HIV education teachers completed surveys. Self-reported risk behaviors of heterosexual and GLB adolescents were compared, with control for stiident and community demographic characteristics. Sexual risk behaviors of GLB youths in schools with and without gay-sensitive instruction were compared. Results. GLB youths reported more substance use, high-risk sexual behaviors, suicidal thoughts or attempts, and personal safety issues than did heterosexual youths (P

Purpose Gay, lesbian, and bisexual youth may experience significant body dissatisfaction. We examined sexual orientation differences in self-perceived weight status and the prevalence of potentially dangerous weight control behaviors in a representative sample of adolescents. Methods Data were obtained from 12,984 youth between 2003 and 2009 over four cycles of the Massachusetts Youth Risk Behavior Survey, a statewide survey of ninth- through 12th-grade students. Self-perceived weight status and past-month unhealthy weight control behaviors (fasting >24 hours, using diet pills, and vomiting or using laxatives) were compared among gay/lesbian, bisexual, or self-identified heterosexual youth with same-sex partners, unsure youth, and exclusively heterosexual youth using logistic regression, adjusting for age and race/ethnicity. Results Compared with exclusively heterosexual males, heterosexual males with prior same-sex partners and bisexual males were more likely to self-perceive as overweight despite being of healthy weight or underweight (respectively, adjusted odds ratio [AOR], 2.61; 95% confidence interval [CI], 1.68–4.05; and AOR, 2.56; 95% CI, 1.64–4.00). Compared with exclusively heterosexual females, lesbians and bisexual females were more likely to self-perceive as being of healthy weight or underweight despite being overweight or obese (respectively, AOR, 3.17; 95% CI, 1.15–8.71; and AOR, 2.00; 95% CI, 1.20–3.33). Unhealthy weight control behaviors were significantly more prevalent among sexual minority males (32.5%; AOR, 4.38; 95% CI, 3.38–5.67) and females (34.7%; AOR, 2.27; 95% CI, 1.85–2.78) when considered together relative to exclusively heterosexual males (9.7%) and females (18.8%). Conclusions One third of sexual minority youth engage in hazardous weight control behaviors. Future research should investigate underlying mechanisms and determine whether clinicians should routinely screen for these behaviors.

Students' subjective sense of school belonging recently has been identified as a potentially important influence on academic motivation, engagement, and participation, especially among students from groups at risk of school dropout. Students' friends also influence their academic motivation, sometimes negatively. In this study, the relationship among early adolescent students' sense of school belonging, perceptions of their friends' academic values, and academic motivation was investigated among 301 African-American, White/Anglo, and Hispanic students in two urban junior high schools. School belonging was significantly associated with several motivation-related measures—expectancy of success, valuing schoolwork, general school motivation, and self-reported effort. Students' beliefs about their friends' academic values were more weakly related to these outcomes. The correlations between school belonging and the motivation-related measures remained positive and statistically significant even after ...

Objectives. We examined the relationship of 2 dimensions of sexual orientation—sexual identity and sex of partners—with self-reported behaviors and experiences to identify factors that may place adolescent females at risk of HIV/AIDS. Methods. We gathered data on sexually experienced female high school students from 4 waves of a population-based survey. We used logistic regression analyses to investigate the association between their sexual identity (3666 heterosexual; 184 lesbian, gay, or bisexual; 113 not sure) and sex of partners (3714 male only, 79 female only, and 180 both males and females) with HIV-related risk behaviors. Results. Self-defined sexual identity was often inconsistent with sex of sexual partners. Sexual identities other than heterosexual and having same-sex partners (either exclusively or in addition to male partners) were associated with high rates of several HIV-related risk behaviors. Coerced sexual contact was significantly associated with every risk outcome. AIDS education in school predicted lower HIV risk on 4 of 6 indicators. Conclusions. Programs to prevent HIV infection among adolescent females should take into account the complexity of sexual orientation and should address the needs and behaviors of sexual-minority youths.

Objectives. This study assessed relationships between condom availability programs accompanied by community discussion and involvement and adolescent sexual practices. Methods. Sexual practice and condom use differences were assessed in a representative sample of 4166 adolescents enrolled in high schools with and without condom availability programs. Results. Adolescents in schools where condoms were available were more likely to receive condom use instruction and less likely to report lifetime or recent sexual intercourse. Sexually active adolescents in those schools were twice as likely to use condoms, but less likely to use other contraceptive methods, during their most recent sexual encounter. Conclusions. The strategy of making condoms available, an indication of socioenvironmental support for condom use, may improve HIV prevention practices.

OBJECTIVES: This study examined the relationships between recency of immigration, substance use, and sexual behavior. METHODS: Surveys were conducted with 2635 Massachusetts 8th and 10th graders that allowed comparisons of health behaviors and risk and protective factors among students living in the United States "always," more than 6 years, or 6 years or less. RESULTS: Compared with lifetime residents, immigrant youths (particularly those living in the United States 6 years or less) reported lower lifetime and recent alcohol and marijuana use (P < .001); sexual intercourse rates were similar across groups. However, recent immigrants were most likely to report peer pressures to engage in, and less parental support to avoid, risk behaviors (P < .001). CONCLUSIONS: A window of opportunity exists to provide primary prevention programs in schools to immigrant youths that may reduce adolescent health risk behaviors.

The letter by Rice et al. provides further evidence that sexual-minority adolescents are at greater risk for homelessness than adolescents in general. To understand the scope of the problem nationally, we strongly urge surveillance mechanisms, such as the Youth Risk Behavior Surveillance System (YRBSS), to collect standardized data on sexual orientation and homelessness. In addition to Massachusetts, a number of other state and regional YRBSSs collect sexual orientation data. Standardizing sexual orientation questions across surveys and increasing the number of surveys that collect these data will improve our ability to quantify the scope of the problem. Additionally, we suggest using a homeless question like the one in the Massachusetts YRBSS1 because it is based on the McKinney-Vento2 federal definition of homelessness (i.e., lacking a fixed, regular, and adequate nighttime residence) and provides detailed information on type of living situation and unaccompanied status. As Rice et al. note, there is great variation in homelessness by region. There are also regional differences in attitudes toward homosexuality and gender-role norms.3,4 Systematic data collection will allow us to examine how risk for homelessness in sexual-minority teens may vary by region and other sociodemographic characteristics such as race/ethnicity and gender. The 2005 Massachusetts YRBSS estimated that 4.2% of Massachusetts public high school students were homeless, yet only 0.6% of Massachusetts high school students were identified by schools as homeless during the 2004–2005 academic year.5 Health and social service professionals need to do a better job working with schools to identify homeless students and to link them with services to find stable housing, to assist them with their educational needs, and to support their health and well-being. In public health, these efforts are known as secondary (i.e., intervening early to end homelessness) and tertiary (i.e., providing services to those currently homeless such as temporary shelter, food, and other social and medical services) prevention efforts. Equally important are primary prevention efforts that focus on preventing homelessness in the first place. Efforts to identify effective primary, secondary, and tertiary prevention strategies for sexual-minority youth at risk for homelessness are clearly needed. What strategies help families overcome challenges leading to sexual-minority teen homelessness? Are programs in schools and communities for homeless youth effective at reaching sexual minorities and addressing their specific needs? Because homeless sexual-minority teens are likely to be unaccompanied by their parents/guardians, does this influence their access to shelter-based and other services? Answers to these and other questions will help us eliminate the unconscionable sexual orientation disparities in youth homelessness.

Based on a behavioral analysis of compliance with breast self-examination (BSE), this study replicates a previously successful stimulus control intervention and tests the effectiveness of two types of reward for increasing compliance: external reward and self-reward. Patient volunteers (N = 153) were randomly assigned to experimental conditions and followed for 1 year, equally divided into experimental and postexperimental periods. Compliance was measured by the monthly return of BSE records, with self-reports used as a secondary measure. The results indicate that external reward was most effective; self-reward was used by only half the participants but was effective when used. In the postexperimental period, all rates of record return declined, especially in the external reward group. A cycle-by-cycle analysis indicates that the decline was gradual except for a sharp drop when the external reward was withdrawn. The results are discussed in terms of the acceptability of both interventions and contingencies.