Search

BACKGROUND Lesbian, gay, bisexual, and other sexual minority (LGB+) girls are more likely than heterosexual girls to be pregnant during adolescence. Nonetheless, LGB+ inclusive pregnancy prevention programming is lacking. METHODS Between January 2017 and January 2018, 948, 14 to 18 year-old cisgender LGB+ girls were enrolled in a national randomized controlled trial. Girls were assigned either to Girl2Girl or an attention-matched control group. They were recruited via social media and enrolled over the telephone. The 5-month intervention consisted of a 7-week program (4–12 text messages sent daily) and a 1-week booster delivered 12 weeks later. Longitudinal models of protected sex events had a negative binomial distribution and a log link function. Longitudinal models examining use of birth control assumed a Bernoulli distribution of the outcome variable and a logit link function. Models adjusted for baseline rate of the outcome, age, and a time-varying indicator of sexual experience. RESULTS Girl2Girl participants had higher rates of protected penile-vaginal sex events over time compared with controls. Girl2Girl participants also were more likely than control participants to report use of birth control other than condoms. Models of abstinence and pregnancy rates did not suggest statistically significant group differences across time. However, effect sizes were in the small to medium range and point estimates favored Girl2Girl versus control in both cases. CONCLUSIONS Girl2Girl is associated with sustained pregnancy preventive behaviors for LGB+ girls through 12 months postintervention. Text messaging could be considered as a viable method to increase access to sexual health programming to adolescents nationally.

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.

We examined reasons lesbian and bisexual adolescent girls have sex or, if sexually inexperienced, might have sex with girls or boys, and the role of internalized homonegativity in these relations and among lesbians. Girls were recruited online and classified as lesbian (

Introduction Although sexual minority girls are more likely than heterosexual girls to be pregnant during adolescence, programs tailored to their needs are non-existent. Here we describe the iterative development of Girl2Girl, a text messaging-based pregnancy prevention program for cisgender lesbian, gay, bisexual and other sexual minority (LGB+) girls across the United States. Methods Four activities are described: 1) 8 online focus groups to gain feedback about intended program components (n = 160), 2) writing the intervention content, 3) 4 online Content Advisory Teams that reviewed and provided feedback on the salience of drafted intervention content (n = 82), and 4) a beta test to confirm program functionality, the feasibility of assessments, and the enrollment protocol (n = 27). Participants were 14–18-year-old cisgender LGB+ girls recruited nationally on social media. Across study activities, between 52% and 70% of participants were 14–16 years of age, 10–22% were Hispanic ethnicity, and 30–44% were minority race. Results Focus group participants were positive about receiving text messages about sexual health, although privacy was of concern. Thus, better safeguards were built into the enrollment process. Teens in the Content Advisory Teams found the content to be approachable and compelling, although many wanted more gender-inclusive messaging. Messages were updated to not assume people with penises were boys. Between 71 and 86% of participants in the beta test provided weekly feedback, most of which was positive; no one withdrew during the seven-week study period. Conclusions This careful step-by-step iterative approach appears to have resulted in a high level of intervention feasibility and acceptability.

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.

BACKGROUND Research suggests that lesbian and bisexual girls are between two and four times more likely to report having been pregnant than girls who identify as exclusively heterosexual. Despite this compelling evidence that sexual minority adolescent girls are at risk for teen pregnancy, programs tailored to the unique needs of LGB adolescents are nonexistent. OBJECTIVE Research suggests that lesbian and bisexual girls are between two and four times more likely to report having been pregnant than girls who identify as exclusively heterosexual. Despite this compelling evidence that sexual minority adolescent girls are at risk for teen pregnancy, programs tailored to the unique needs of LGB adolescents are nonexistent. METHODS Over a 12-month period between 2015 and 2016, three different formative activities were implemented to develop and refine the prevention program. Participants were 14-18 year-old cisgender females recruited nationally on Facebook and Instagram. First, focus groups (FGs) were conducted to gain teens’ ‘voice’ about how they talked about sexual situations (n=160). Next, content advisory teams (CATs) were convened to iteratively review a draft of the intervention messages and provide feedback on their tone, saliency, and understandability (n=82). Finally, once the content and assessments were finalized, a beta test was conducted to confirm the program functionality, the feasibility of the assessments, and the enrollment protocol (n=27). RESULTS Girls in the FGs were overwhelmingly positive about the idea of receiving text messages about sexual health, although privacy was a noteworthy concern. As such, important safe guards were built into the enrollment process (e.g., the provision of how-to guides to safe-guard one’s phone). Teens in the CATs found the content to be approachable, salient, and educational although many wanted the messages to be more gender inclusive. Messages were thusly updated to not assume people with penises were boys. Once the messages and study protocol were finalized, a beta test was conducted. None of the participants withdrew during the six-week intervention and between 71-86% provided weekly feedback, suggesting both the protocol and content were feasible to test at the national level in a subsequent RCT. CONCLUSIONS This careful step-by-step iterative approach resulted in a high level of feasibility and acceptability, with all randomized beta test participants successfully completing the program. Developed and refined with the input of diverse sexual minority adolescent girls from across the United States, Girl2Girl program is a promising approach to addressing sexual health and pregnancy prevention in this underserved but vulnerable population. CLINICALTRIAL NCT03029962

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.

Despite efforts to decrease substance use, rates among sexual minority youth (SMY) remain higher than among heterosexuals. Substance use is a leading contributor to morbidity and mortality in adulthood, and SMY's use of substances is related to poorer mental and emotional health.We sought to document the trends in substance use for a large sample of youth over 14 years with special attention to SMY. In addition, we tested whether there were disparities in substance use behaviors between SMY and heterosexual youth. Last, we examined changes in disparities over time in substance use among SMY.We analyzed data from 8 waves of the Massachusetts YRBS (N = 26,002, MIn absolute terms, substance use rates decreased for nearly all youth between 1999 and 2013. There were striking disparities in substance use between heterosexual youth and all sexual minority subgroups. These disparities in substance use narrowed among males but remained unchanged or worsened among females. Conclusions/Importance: Trends in substance use are changing over time, but not in the same ways for all sexual minority subgroups. Patterns are worsening for females. These findings suggest that we need to address the needs of LGB populations in novel ways.

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).

Sexual minority adolescents—those self-identifying as lesbian, gay, or bisexual (LGB) or with same-sex desires or sexual experiences—report higher rates of victimization and suicidality than their heterosexual peers, yet little empirical research has examined school factors associated with these risks. This study used data from the Massachusetts Youth Risk Behavior Survey (Massachusetts Department of Education, 2000), matched with school-level data from state records and school principals, to compare the safety of 202 sexual minority adolescents in 52 schools with and without support groups for LGB students, to investigate the relationship between perceived staff support and safety, and to explore other school factors associated with victimization and suicidality among these youth. As hypothesized, sexual minority adolescents in schools with LGB support groups reported lower rates of victimization and suicide attempts than those in other schools. Victimization and perceived staff support predicted suicidality. Several additional school factors were associated with the safety of sexual minority students. © 2006 Wiley Periodicals, Inc. Psychol Schs 43: 573–589, 2006.

This study identified substantial training and resource needs for special education (SPED), transitional bilingual education/ English as a Second Language (TBE/ESL), and general education (GENED) HIV education teachers relative to providing appropriate, effective HIV education to students with disabilities (SWD) and language minority/Limited English Proficient (LEP) students. Samples of school district administrators of special education (n = 287), bilingual education directors (n = 51), and high school HIV education teachers (n = 174) in Massachusetts reported substantial gaps in the training and preparation of teachers to provide instruction on key HIV education topics, lack of availability of instructional materials and inadequacy of available materials, and need for more adaptations of instructional materials to meet students' unique learning needs. Study findings provided HIV prevention program staff with data to improve staff development efforts and classroom-based instruction. Implications...

Background. This study evaluated the extent to which school districts in Massachusetts adopted HIV education policies consistent with state education agency recommendations, and whether adoption of state-recommended policy language was associated with other core components of school-based HIV prevention programs such as staff development, curriculum, and implementation characteristics. Methods. A census of health coordinators (n = 251) and high school HIV teachers (n = 174) in randomly selected schools in Massachusetts were surveyed. Chi-squares and analysis of variance (ANOVAs) were used to analyze data. Results. Most districts' policies fully incorporated state-recommended language for training HIV teachers (62%), providing HIV education within comprehensive sexuality education (62%), and providing skills-based instruction (57%). Districts adopting state-recommended policies were significantly more likely to have trained more HIV teachers (82% vs. 59% of teachers trained; P < 0.001), provided HIV education to a greater percentage of students (90% vs. 50% of students educated; P < 0.001), and adopted research-based curricula (44% vs. 27%; P < 0.01). High school teachers who received training and those using research-based curricula covered more HIV prevention topics and used more skills-based instructional methods than those who did not receive training or did not use research-based curricula (P < 0.01). Conclusions. Results suggest that strong, state-level HIV prevention education policy recommendations can help shape local school health policy and, when adopted locally, can positively influence the reach and quality of HIV education.

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

Unhealthy weight control behaviors may be precursors to clinical eating disorders; therefore, it is important to identify these actions, and what may trigger them, as early as possible. We used 2009 and 2011 Massachusetts Youth Health Survey data for middle and high school students. We studied age, sex, and race disparities related to unhealthy weight control behaviors in conjunction with other risk factors such as body mass index (BMI), body weight perception, involvement in bullying, and depressive symptoms. The surveys were completed in public schools. Bivariate and multinomial regression analyses were conducted to assess associations between weight control behaviors and BMI categories, body weight perception, bullying involvement, and depressive symptoms. Poor body weight perception, bullying involvement, and depressive symptoms were associated with significantly elevated odds of reporting unhealthy weight control behaviors in both middle and high school students. Most patterns were consistent for middle and high school students, with obesity and bullying involvement being prevailing risks for high school students. Though females were more likely to report unhealthy weight control behaviors we also showed the rarely presented prevalence of male involvement in disordered eating behaviors including those who perceived themselves to be underweight. Health education classes and school-based interventions may be two strategies to help prevent the development of unhealthy weight control behaviors. Continuation of youth surveys that gather data on weight control behaviors and known risk factors is essential for observing changes in behaviors over time.

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 ...

Este articulo analiza el desarrollo y la validacion de una medida de la pertenencia percibida o la pertenencia psicologica de los estudiantes adolescentes al entorno escolar.

Maslach and Jackson's (1986) three dimensions of burnout, emotional exhaustion, lack of personal accomplishment and depersonalization, were investigated among 78 counselors at a short-term, residential treatment facility for emotionally disturbed children and adolescents. Two waves of data were collected so that possible changes in burnout over time could be assessed. Measures of co-worker support (team cohesion and perceived quality of friendships) were better predictors of burnout than supervisor support. High levels of co-worker support were consistently and positively related to greater personal accomplishment. Levels of personal accomplishment increased and emotional exhaustion decreased as staff accumulated more counseling experience. Women residential counselors experienced higher levels of emotional exhaustion than did their male counterparts. Initial levels of burnout were powerful predictors of later levels of burnout. Theoretical and practical implications of these findings for human services providers are discussed.

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.

Objective To examine associations between health risk behaviors and sexual experience with opposite-, same-, or both-sex partners in representative samples of high school students. Design We used 1995 and 1997 data from the Vermont and Massachusetts Youth Risk Behavior Surveys. Logistic regression and multiple regression analyses were used to compare health risk behaviors among students who reported sex with opposite-sex partners only (opposite-sex students), with same-sex partners only (same-sex students), and with both male and female sexual partners (both-sex students). Setting Public high schools in Vermont and Massachusetts. Participants Representative, population-based samples of high school students. The combined samples had 14 623 Vermont students and 8141 Massachusetts students. Main Outcome Measure Violence, harassment, suicidal behavior, alcohol and other drug use, and unhealthy weight control practices. Results In both states, both-sex students were significantly more likely to report health risk behaviors than were opposite-sex students. For example, both-sex students had odds 3 to 6 times greater than opposite-sex students of being threatened or injured with a weapon at school, making a suicide attempt requiring medical attention, using cocaine, or vomiting or using laxatives to control their weight. In both states, same-sex students were as likely as opposite-sex students to report most health risk behaviors. Conclusion Relative to opposite- and same-sex students, both-sex students may be at elevated risk of injury, disease, and death by experiencing serious harassment and engaging in violence, suicidal behavior, alcohol and other drug use, and unhealthy weight control practices.

Few current studies of the effects of chronic conditions on social functioning examine the effects of disease on the role of homemaker. A major problem confronting researchers in this area is the difficulty in operationalizing dysfunction in social roles other than work roles. In this study we have developed a measure of homemaker functioning based on conceptualizing the homemaker role on two dimensions: the instrumental functions associated with meeting the physical needs of the household and the nurturant dimension concerned with meeting the expressive needs of the household. We used our measure of homemaker functioning to study the effects of rheumatoid arthritis on 142 women, whether employed outside the home or not, between the ages of 21 and 65, all living with husband and/or children at the time of disease onset. The disease significantly limited both instrumental and nurturing functions associated with managing a household. The more strenuous instrumental functions were more likely to be limited, although women in our study experienced serious limitations in nurturant role functions, as well. Limitations in functioning along the nurturant dimension were surprisingly high and previously undocumented. Comparisons between women employed outside the home and those not employed found few differences between the groups in social functioning on either dimension of the homemaker role. Employed women were somewhat less physically disabled than the unemployed, but both groups of homemakers continued to assume major responsibility for homemaking. Assessing functioning in social roles other than work, and functioning in nurturant as well as instrumental areas, is especially important in evaluating the effects on women of a chronic disease such as rheumatoid arthritis.

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.