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Gender minority (GM) youth are more likely to engage in sexual behaviors that increase risk of exposure to sexually transmitted infections, including HIV. However, family functioning may be protective against sexual risk taking. We characterized longitudinal associations between family functioning (family communication and family satisfaction) and sexual risk behaviors across two years in a community sample of 30 GM adolescents, ages 13-17 years. Participants were purposively recruited from community-based venues, through social media, and peer referrals throughout the New England area and completed surveys every 6 months, with measures of family functioning, sexual risk behaviors, risk factors (depressive and anxious symptoms, perceived stress related to parents), and protective factors (social support, gender-related pride, and community connectedness). Results indicated that higher levels of family communication, improved family satisfaction, and increased social support were protective for sexual risk taking, in general, and specifically for condom use for anal/vaginal sex. In contrast, increased depressive symptoms were associated with lower likelihood of anal/vaginal condom use. Associations between family functioning and sexual risk taking were not attenuated by adding risk and protective factors to the model; thus, these factors did not explain the observed associations between family functioning and sexual risk taking. These findings suggest improved family functioning, greater social support, and lower depressive symptoms are associated with reduced sexual risk taking among gender minority youth, thus making these factors an important target for future prevention efforts., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: Gender minority (GM) adolescents, who have a different gender identity than their sex assigned at birth, may use substances as a coping strategy in response to GM-related stressors. This study examined longitudinal effects of gender minority stressors on substance use in GM adolescents, and related risk factors (internalized transphobia, depressive symptoms, anxious symptoms) and protective factors (resilience, gender-related pride, family functioning, social support, gender-related community connectedness)., Methods: Participants were 30 GM adolescents, ages 13-17 years, from the U.S. community-based longitudinal Trans Teen and Family Narratives Project. Participants completed an online survey every 6 months across 2 years (5 waves; data collected 2015-2019)., Results: Exposure to gender minority stressors was associated with higher odds of alcohol use. Across models, internalized transphobia (risk factor), resilience (protective factor), and gender-related pride (protective factor) were the most significant mediators of associations between gender minority stressors and substance use. Family functioning and social support (protective factors) significantly moderated the association between gender minority stressors and alcohol use, such that family functioning and social support were protective for alcohol use at lower levels of gender minority stress, but not at higher levels., Conclusion: Results suggest that GM adolescents engage in substance use as a coping strategy in response to gender minority stressors. A number of hypothesized risk and protective factors mediated or moderated these associations. Future interventions with GM adolescents should focus efforts on addressing internalized transphobia as a risk factor and strengthening resilience, gender-related pride, and family functioning as protective factors for substance use., Competing Interests: The authors have declared that no competing interests exist.

Objectives: To examine contraceptive methods used by adolescent/young adult women of diverse sexual orientations., Study Design: We collected data from 12,902 females, born 1982-1995, from the longitudinal Growing Up Today Study., Results: Compared to heterosexuals, lesbians were half as likely to use contraceptives; other sexual minority subgroups (e.g., bisexuals) were more likely to use contraceptives, particularly long-acting reversible contraceptives., Conclusions: Many sexual minority women use contraception throughout adolescence/young adulthood, though use is low among lesbians., Implications: With limited contraception use, lesbians miss opportunities for care and need to be brought into the healthcare system in other ways., (Copyright © 2020. Published by Elsevier Inc.)

Purpose: Several studies indicate that sexual minority (e.g., bisexual, lesbian) women may be at an increased risk for breast cancer. However, we know little about how risk factors, such as benign breast disease (BBD)-which can confer nearly a fourfold breast cancer risk increase-may vary across sexual orientation groups., Methods: Among Nurses' Health Study II participants followed from 1989 to 2013 (n = 99,656), we investigated whether bisexual and lesbian women were more likely than heterosexual women to have breast cancer risk factors including a BBD diagnosis (self-reported biopsy or aspiration confirmed, n = 11,021). Cox proportional hazard models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI)., Results: Compared to heterosexuals, sexual minority participants more commonly reported certain breast cancer risk factors including increased alcohol intake and nulliparity. However, sexual minority participants were more likely than heterosexuals to have certain protective factors including higher body mass index and less oral contraceptive use. When evaluating age- and family history-adjusted rates of BBD diagnoses across sexual orientation groups, bisexual (HR 1.04, 95% CI [0.78, 1.38]) and lesbian (0.99 [0.81, 1.21]) women were just as likely as heterosexuals to have a BBD diagnosis. Results were similar after adjusting for other known breast cancer risk factors., Conclusions: In this cohort of women across the U.S., sexual minorities were more likely than heterosexuals to have some breast cancer risk factors-including modifiable risk factors such as alcohol intake. Heterosexual, bisexual, and lesbian women were equally as likely to have a BBD diagnosis.

Objectives: To examine contraceptive methods used across sexual orientation groups., Study Design: We collected data from 118,462 female participants in two longitudinal cohorts-the Nurses' Health Study (NHS) 2 (founded in 1989, participants born 1947-1964) and NHS3 (founded in 2010, born 1965-1995). We used log-binomial models to estimate contraceptive methods ever used across sexual orientation groups and cohorts, adjusting for age and race., Results: Lesbians were the least likely of all sexual orientation groups to use any contraceptive method. Lesbians in NHS2 were 90% less likely than heterosexuals to use long-acting reversible contraceptives (LARCs; adjusted risk ratio [aRR]; 95% confidence interval [CI]: 0.10 [0.04, 0.26]) and results were similar for other contraceptive methods and in the NHS3 cohort. Compared to the reference group of completely heterosexual participants with no same-sex partners, those who identified as completely heterosexual with same-sex partners, mostly heterosexual, or bisexual were generally more likely to use any method of contraception. Use of LARCs was especially striking across sexual minority groups, and, with the exception of lesbians, they were more likely to use LARCs; as one illustration, NHS3 bisexuals were more than twice as likely to use LARCs (aRR [95% CI]: 2.01 [1.67, 2.42])., Conclusions: While certain sexual minority subgroups (e.g., bisexuals) were more likely than heterosexuals to use contraceptive methods such as LARCs, lesbians were less likely to use any method., Implications: Many sexual minority patients need contraceptive counseling and providers should ensure to offer this counseling to patients in need, regardless of sexual orientation., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction: Sexual minority female adolescents have worse reproductive health than heterosexual peers; research into the origins of these disparities is limited. Our objective was to examine whether exposure to structural stigma (e.g., societal-level conditions, cultural norms, institutional policies/practices that constrain the lives of the stigmatized) is associated with sexually transmitted infections (STIs) and teen pregnancy in sexual minority female adolescents., Methods: Longitudinal data were utilized from 6581 female adolescents aged 9-14 years at baseline (1996) in the U.S.-based Growing Up Today Study and followed through 2007. We used a previously-validated structural stigma scale composed of four state-level items (e.g., employment non-discrimination policies) with one item added relevant to reproductive health. Risk ratios were generated from multivariate models., Results: Sexual minority female adolescents were significantly more likely than heterosexual peers to have an STI diagnosis and teen pregnancy. Sexual minority female adolescents living in states with lower, compared to higher, levels of structural stigma were significantly less likely to have an STI diagnosis, after adjustment for individual- and state-level covariates (relative risk [RR] = 0.70, 95% confidence interval [CI]: 0.51, 0.97). In contrast, among completely heterosexual adolescents, structural stigma was not associated with STI diagnosis. Teen pregnancy risk-a rare outcome-did not vary by level of structural stigma for sexual minority or heterosexual adolescents., Conclusions: Structural stigma is a potential risk factor for adverse reproductive health among sexual minority female adolescents. Changing laws and policies to be inclusive of all people, regardless of sexual orientation, can help alleviate entrenched reproductive health disparities., (Copyright © 2019 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

Sexual minorities in the United States are at elevated risk of prejudice, discrimination, and violence victimization due to stigma associated with their sexual orientation. These stressors may contribute to physiological stress responses and changes in the regulation of the sympathetic nervous system (SNS). To date, no studies have examined the associations among minority sexual orientation, recent stressful events, and diurnal salivary alpha-amylase (sAA) patterns. The present study included 1663 young adults ages 18-32 years (31% men, 69% women) from the Growing Up Today Study, a prospective cohort of U.S. youth. Participants provided five saliva samples over the course of one day to estimate diurnal sAA patterns. Sexual orientation groups included completely heterosexual with no same-sex partners (CH; referent), mostly heterosexual/completely heterosexual with same-sex partners, and gay/lesbian/bisexual (LB or GB). Sex-stratified multilevel models were fit to evaluate the association of sexual orientation with diurnal patterns of log sAA. The association of recent stressful events was also evaluated. Among women, sexual minorities scored significantly higher than CH on perceived stress and number of stressful events in the past month (p < 0.05). Among men, sexual minorities scored higher than CH on perceived stress but not recent stressful events. In multivariable models, recent stressful events were not associated with sAA patterns, but significant sexual orientation group differences in sAA diurnal rhythm were observed among women though not among men. Compared to CH women, LB showed a blunted awakening response and elevated sAA levels across the day, both indicators consistent with SNS dysregulation. Findings suggest dysregulation of stress physiology in LB women, but not other sexual minority women or men, relative to same-sex heterosexuals. Observed dysregulation may relate to exposure among LB women to chronic stressors associated with sexual orientation stigma, although these relations and differences by sex warrant further study., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Purpose: This study sought to examine how human papillomavirus (HPV) vaccination may differ across sexual orientation groups (e.g., bisexuals compared to heterosexuals)-particularly in boys and men, about whom little is known., Methods: Data were from a prospective cohort of 10,663 U.S. females and males enrolled in the Growing Up Today Study followed from 1996 to 2014. Participants were aged 11-24 years when the vaccine was approved for females in 2006 and 14-27 years when approved for males in 2009. In addition to reporting sexual orientation identity/attractions, participants reported sex of lifetime sexual partners. Log-binominal models were used to examine HPV vaccination across sexual orientation groups., Results: Among females, 56% received ≥1 dose. In contrast, 8% of males obtained ≥1 dose; HPV vaccination initiation was especially low among completely heterosexual males. After adjusting for potential confounders, completely heterosexual (risk ratio [RR]; 95% confidence interval [CI]: 0.45 [0.30-0.68]) and mostly heterosexual (RR; 95% CI: 0.44 [0.25-0.78]) males were half as likely to have received even a single dose compared to gay males. Compared to lesbians, no differences were observed for completely heterosexual or bisexual females, but mostly heterosexual females were 20% more likely to have received at least one dose., Conclusions: HPV vaccination rates in the U.S. are strikingly low and special attention is needed for boys and men, especially those who do not identify as gay. Vaccinating everyone, regardless of sex/gender and/or sexual orientation, will not only lower that individual's susceptibility but also decrease transmission to partners, females and/or males, to help eradicate HPV through herd immunity.

This research examined endorsement and timing of sexual orientation developmental milestones. Participants were 1,235 females and 398 males from the Growing Up Today Study, ages 22 to 29 years, who endorsed a sexual minority orientation (lesbian/gay, bisexual, mostly heterosexual) or reported same-gender sexual behavior (heterosexual with same-gender sexual experience). An online survey measured current sexual orientation and endorsement and timing (age first experienced) of five sexual orientation developmental milestones: same-gender attractions, other-gender attractions, same-gender sexual experience, other-gender sexual experience, and sexual minority identification. Descriptive analyses and analyses to test for gender and sexual orientation group differences were conducted. Results indicated that women were more likely than men to endorse same-gender attraction, other-gender attraction, and other-gender sexual experience, with the most gender differences in endorsement among mostly heterosexuals and heterosexuals with same-gender sexual experience. In general, men reached milestones earlier than women, with the most gender differences in timing among lesbian and gay individuals and heterosexuals with same-gender sexual experience. Results suggest that the three sexual minority developmental milestones may best characterize the experiences of lesbians, gay males, and female and male bisexuals. More research is needed to understand sexual orientation development among mostly heterosexuals and heterosexuals with same-gender sexual experience.