Homeless lesbian, gay, bisexual and transgender (LGBT) youth in New York City: Insights from the field

$is article reviews existing information about homeless lesbian, gay, bisexual, and transgender (LGBT) youth in New York City. It describes how the frequently heard narrative about them—“kicked out” of familial homes to the streets for being LGBT, heavy involvement with hard drugs and sex work, broad prevalence of HIV and suicidality—misrepresents the majority. It foregrounds issues that really are faced by most homeless LGBT youth, such as trauma, discrimination in foster care and shelters, structural barriers to exiting homelessness, and emerging adult development

Playing Video Games While Using or Feeling the Effects of Substances: Associations with Substance Use Problems

This study tested the hypothesis that playing video games while using or feeling the effects of a substance—referred to herein as “concurrent use”—is related to substance use problems after controlling for substance use frequency, video gaming as an enthusiastic hobby, and demographic factors. Data were drawn from a nationally representative online survey of adult video gamers conducted by Knowledge Networks, valid n = 2,885. Problem video game playing behavior was operationalized using Tejeiro Salguero and Bersabé Morán’s 2002 problem video game play (PVP) measure, and measures for substance use problems were taken from the National Survey of Drug Use and Health (NSDUH). Separate structural equation modeling analyses were conducted for users of caffeine, tobacco, alcohol, and marijuana. In all four models, concurrent use was directly associated with substance use problems, but not with PVP. Video gaming as an enthusiastic hobby was associated with substance use problems via two indirect paths: through PVP for all substances, and through concurrent use for caffeine, tobacco, and alcohol only. Results illustrate the potential for “drug interaction” between self-reinforcing behaviors and addictive substances, with implications for the development of problem use

Decision Processes about Condom Use among Shelter-Homeless LGBT Youth in Manhattan

Health behavior interventions based on Theory of Planned Behavior address participants' personally-held beliefs, perceived social norms, and control over the behavior. New data are always needed to “member check” participants' decision processes and inform interventions. This qualitative study investigates decision processes around condom use among 81 homeless LGBT youth ages 18–26. Findings indicated considerable endorsement of the conventional policy of always using condoms, promulgated in HIV prevention education targeting this population. Although some participants reported risk behavior in contexts of sex work, survival sex, casual encounters, open relationships, and substance use, most were aware of these risks and consistently safe in those situations. Condoms use boundaries became vulnerable in states of emotional need and negative mood. The only effect participants acknowledged of homelessness on condom use was indirect, through negative mood states. The most prevalent context of condom non-use was with long-term primary partners, a potential area of vulnerability because, of 13 participants for HIV or HCV, nine mentioned how they had been infected, and all nine believed they had acquired it from a primary partner. Findings imply programs should emphasize HIV risk potential within long-term romantic partnerships and mental health services to remediate negative mood states

Contextual Mediators between Adolescent Sexuality and Negative Outcomes

These three papers form an argument that youths? sexual behavior and sexual-minority orientation are associated with negative outcomes of alcohol use, depression, and suicide via negative changes in perceived contextual support. They employ data from the first two waves of the National Longitudinal Survey of Adolescent Health (collected 1995 & 1996, Wave I N = 18,924, Wave II N = 13,570, http://www.cpc.unc.edu/projects/addhealth). The first paper demonstrates reciprocal effects over one year between adolescent sexual activity and shared activities with opposite-sex parents, closeness with same-sex parents, and more problem-focused interactions with both parents. The second paper finds that initiating or continuing sexual activity predicts reduced integration with the school environment, increased number of close friends who use alcohol, and increased problem-focused interactions with parents. It is additionally associated with lower personal religiousness for young women only. The second paper finds further that ceasing sexual activity did not forestall negative changes in contextual supports, as the first paper?s results implied, but rather that negative changes continued. The second paper also finds that levels of context factors significantly mediate the relationship between sexual activity and each of depression, suicidality, and alcohol use. The third paper, using only Wave I data, applies the first two papers? contextual mediation concept to explain mental health risks associated with same-sex, both sex, and opposite-sex romantic attraction, dating, and sexual behavior. After testing every combination of subject?s gender, object?s gender, and domain of expression for associations with depression and suicidality, the third paper finds several patterns ? sexually/romantically active female, sexual-minority, and non-virgin ? consistently associated with depression and suicidality. These patterns are suggested to be associated with risk because they impart stigmatized status to youth that impedes their access to needed social supports. A theoretical model is advanced asserting that stigmatization of youth sexuality leads to both mental health risk and greater likelihood of risk behavior, the latter of which leads to even greater stigmatization and even greater likelihood of risk behavior. This model suggests that increasing support for non-virgin and sexual-minority youth and decreasing stigmatization of them would be most helpful approach for their health

The Provider Perception Inventory: Psychometrics of a Scale Designed to Measure Provider Stigma about HIV, Substance Abuse, and MSM Behavior

Nongay identified men who have sex with men and women (NGI MSMW) and who use alcohol and other drugs are a vulnerable, understudied, and undertreated population. Little is known about the stigma faced by this population or about the way that health service providers view and serve these stigmatized clients. The provider perception inventory (PPI) is a 39-item scale that measures health services providers stigma about HIV/AIDS, substance use, and MSM behavior. The PPI is unique in that it was developed to include service provider stigma targeted at NGI MSMW individuals. PPI was developed through a mixed methods approach. Items were developed based on existing measures and findings from focus groups with 18 HIV and substance abuse treatment providers. Exploratory factor analysis using data from 212 health service providers yielded a two dimensional scale: (1) individual attitudes (19 items) and (2) agency environment (11 items). Structural equation modeling analysis supported the scale\u27s predictive validity (N=190 sufficiently complete cases). Overall findings indicate initial support for the psychometrics of the PPI as a measure of service provider stigma pertaining to the intersection of HIV/AIDS, substance use, and MSM behavior. Limitations and implications to future research are discussed