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Article Reference Troff document (with manpage macros)Are sexual minority youth overrepresented in foster care, child welfare, and out-of-home placement? Findings from nationally representative data
BACKGROUND: Preliminary evidence suggests that sexual minority (e.g. lesbian, gay, bisexual, and same-sex attracted) youth are overrepresented in child welfare services. Yet, no study to date has been able to test this hypothesis with national data. OBJECTIVE: Using a two-study design, we test whether sexual minority youth are overrepresented in child welfare, foster care, and out-of-home placement using nationally representative data from the United States. PARTICIPANTS AND SETTING: Study 1 data are from the National Longitudinal Study of Adolescent to Adult Health (n = 14,154; Mean age = 15.4). Study 2 data are from wave three of the National Survey of Child and Adolescent Well-Being II (n = 1309; Mean age = 15.0). METHODS: For Study 1, we use adjusted logistic regression models to test differences in lifetime foster care involvement between sexual minority and heterosexual youth. In Study 2, we calculate a Disproportionality Representation Index (DRI) - a ratio of sample prevalence relative to the general population - to estimate whether sexual minority youth were overrepresented in child welfare and out-of-home care. RESULTS: Study 1 results indicate that sexual minority youth are nearly 2.5 times as likely as heterosexual youth to experience foster care placement (aOR = 2.43, 95% CI 1.40, 4.21, p = .002). Results from Study 2 show that sexual minority youth were largely overrepresented in child welfare services (DRI = 1.95-2.48) and out-of-home placement (DRI = 3.69-4.68). CONCLUSIONS: Findings are the first to demonstrate sexual minority youth's overrepresentation in child welfare, foster care, and out-of-home placement using nationally representative data and emphasizes the need for focused research on sexual minority youth involved in the child welfare system.
Located in MPRC People / Jessica N Fish, Ph.D. / Jessica N Fish Publications
Article Reference Troff document (with manpage macros)Gay‐Straight Alliances, Inclusive Policy, and School Climate: LGBTQ Youths’ Experiences of Social Support and Bullying
Gay‐Straight Alliances (GSA) and school policies focused on support for lesbian, gay, bisexual, transgender, and queer/questioning youth may reduce bias‐based bullying and enhance social supports in schools. Using multivariate regression, we tested the relationship between youth reports of the presence of GSAs and LGBTQ‐focused policies, independently and mutually, with experiences bullying and perceived support ( n  =   1,061). Youth reported higher classmate support in the presence of GSAs and higher teacher support in the presence of LGBTQ‐focused policies; the presence of both GSAs and LGBTQ‐focused policies was associated with less bullying and higher perceived classmate and teacher support. The findings indicate that GSAs and LGBTQ‐focused policies are distinctly and mutually important for fostering safer and more supportive school climates for youth.
Located in MPRC People / Jessica N Fish, Ph.D. / Jessica N Fish Publications
Jessica Fish, UMD Family Science
Sexual minority population health inequities across the life course: Where do we go from here?
Located in Coming Up
Fish editorial published in AJPH
So-called “conversion therapy” efforts create serious harm for youth that are LGBTQ
Located in News
Article ReferenceLGBTQ Youth-Serving Community-Based Organizations: Who Participates and What Difference Does it Make?
LGBTQ youth are at greater risk for compromised health, yet large-scale health promotion programs for LGBTQ young people have been slow to develop. LGBTQ community-based organizations—which provide LGBTQ-focused support and services—have existed for decades, but have not been a focus of the LGBTQ youth health literature. The current study used a contemporary sample of LGBTQ youth (age 15–21;  M  = 18.81;  n  = 1045) to examine who participates in LGBTQ community-based organizations, and the association between participation and self-reported mental health and substance use. Youth who participated in LGBTQ community-based organizations were more likely to be assigned male at birth, transgender, youth of color, and accessing free-or-reduced lunch. Participation was associated with concurrent and longitudinal reports of mental health and substance use. LGBTQ community-based organizations may be an underutilized resource for promoting LGBTQ youth health.
Located in MPRC People / Jessica N Fish, Ph.D. / Jessica N Fish Publications
Article Reference Troff document (with manpage macros)Sexual and Gender Minority Youth Alcohol Use: Within-Group Differences in Associations with Internalized Stigma and Victimization
Sexual and gender minority (SGM) youth are more likely to use alcohol than their heterosexual cisgender peers. At the same time, SGM youth experience sexuality- and gender identity-specific stressors known to exacerbate negative health outcomes. Though scholars have established a link between minority stressors (e.g., internalized stigma and victimization) and increased alcohol use for SGM youth as a whole, there is little indication of whether internalized stigma and victimization are more strongly associated with alcohol use for specific groups of SGM youth. A United States sample of 11,811 racially and geographically diverse 13–17 year old SGM youth was used to employ a series of gender-stratified multivariable regression models to examine the association among internalized stigma, victimization, and alcohol-related behaviors, and whether they differed for specific groups of sexual minority youth. Sexual orientation moderated several associations between sexual minority stressors (i.e., victimization and stigma) and youth’s alcohol use (i.e., recent use and heavy episodic drinking) across models stratified by gender (i.e., male, female, and non-binary). For example, bisexual boys had stronger associations between SGM-specific victimization and alcohol use frequency and heavy episodic drinking relative to gay boys; conversely, victimization and alcohol use frequency were more weakly associated among bisexual girls relative to lesbian/gay girls. Pansexual girls showed weaker associations between internalized stigma and alcohol use frequency compared to lesbian/gay girls. This paper demonstrates who among SGM youth are more likely to engage in alcohol-related behaviors as a function of differential forms of SGM-related victimization and stigma. These findings can inform substance use interventions that are tailored to youth of diverse sexual orientations and gender identities.
Located in MPRC People / Jessica N Fish, Ph.D. / Jessica N Fish Publications
Article ReferenceGenetic Clustering Analysis for HIV Infection among Men Who Have Sex with Men in Nigeria
Background:  The  HIV  epidemic continues to grow among  MSM  in countries across sub-Saharan Africa including  Nigeria . To inform prevention efforts, we used a  phylogenetic cluster  method to characterize  HIV  genetic clusters and factors associated with cluster formation among  MSM  living with  HIV  in  Nigeria . Methods:  We analyzed  HIV -1 pol sequences from 417  MSM  living with  HIV  enrolled in the TRUST/RV368 cohort between 2013 and 2017 in Abuja and Lagos,  Nigeria . A genetically linked cluster was defined among participants whose sequences had pairwise genetic distance of 1.5% or less. Binary and multinomial logistic regressions were used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for factors associated with  HIV  genetic cluster membership and size. Results:  Among 417  MSM  living with  HIV , 153 (36.7%) were genetically linked. Participants with higher viral load (AOR = 1.72 95% CI: 1.04–2.86), no female partners (AOR = 3.66; 95% CI: 1.97–6.08), and self-identified as male sex (compared with self-identified as bigender) (AOR = 3.42; 95% CI: 1.08–10.78) had higher odds of being in a genetic cluster. Compared with unlinked participants,  MSM  who had high school education (AOR = 23.84; 95% CI: 2.66–213.49), were employed (AOR = 3.41; 95% CI: 1.89–10.70), had bacterial sexually transmitted infections (AOR = 3.98; 95% CI: 0.89–17.22) and were not taking antiretroviral therapy (AOR = 6.61; 95% CI: 2.25–19.37) had higher odds of being in a large cluster (size > 4). Conclusion:  Comprehensive  HIV  prevention packages should include behavioral and biological components, including early diagnosis and treatment of both  HIV  and bacterial sexually transmitted infections to optimally reduce the risk of  HIV  transmission and acquisition.
Located in MPRC People / Hongjie Liu, Ph.D. / Hongjie Liu Publications
Article Reference Troff document (with manpage macros)Sexual Minority-related Discrimination across the Life Course: Findings from a National Sample of Adults in the United States
In the United States, sexual minority (SM) status is associated with a number of health disparities. Based on mounting evidence, stigma and discrimination have been cited as key barriers to health equity for this population. We estimated the prevalence of three types of discrimination as a function of age among SM adults from the National Epidemiological Study of Alcohol Use and Related Conditions III (NESARC-III) (2012–2013). Among SM adults, reports of past-year general discrimination, victimization, and healthcare discrimination varied by age, with peaks in early adulthood and again in midlife. Age trends varied by biological sex, with males experiencing significantly more general discrimination, victimization, and healthcare discrimination at specific ages. Age trends also varied by sexual identity, as LGB-identifying SMs were significantly more likely to experience all forms of discrimination across all ages. Policies preventing homophobic discrimination and victimization are necessary given the pervasiveness of these experiences across adulthood.
Located in MPRC People / Jessica N Fish, Ph.D. / Jessica N Fish Publications
Article Reference Troff document (with manpage macros)Cigarette Smoking Among Youth at the Intersection of Sexual Orientation and Gender Identity
Abstract Purpose: The purpose of this study was to identify subgroups of sexual and gender minority (SGM) youth who are most vulnerable to tobacco use. Methods: We analyzed data from a national nonprobability sample of 11,192 SGM youth (ages 13–17). Age of cigarette initiation and current use were modeled using Cox proportional hazard and binomial regression. Sexual and gender identities were explanatory variables and the models were adjusted for ethnoracial identity and age. Results: Approximately 7\% of the sample reported current smoking. Cisgender and transgender boys had higher odds of current smoking compared with cisgender and transgender girls (adjusted odds ratio [AOR] = 1.86; 95\% confidence interval [CI]: 1.56–2.21). Pansexual-identified youth had higher odds of smoking (AOR = 1.33; 95\% CI: 1.05–1.70) compared with gay/lesbian youth independent of gender identity. Pansexual-identified cisgender boys had the highest smoking prevalence (21.6\%). Predicted probabilities were higher among transgender boys across all sexual identities, except asexual. The hazard of smoking at a younger age was greater for transgender boys compared with cisgender boys (adjusted hazard ratio [AHR] = 1.67; 95\% CI: 1.43–1.94) as well as for bisexual (AHR = 1.12; 95\% CI: 1.01–1.24) and pansexual (AHR = 1.17; 95\% CI: 1.03–1.33) youth compared with those who identified as gay or lesbian. Conclusions: These findings suggest that transgender boys may be at higher risk for early and current cigarette use regardless of their sexual identity, whereas smoking varied more widely for youth across different sexual identities. The findings suggest that specific subgroups of SGM youth require focused attention in tobacco control research and practice.
Located in MPRC People / Jessica N Fish, Ph.D. / Jessica N Fish Publications
Article Reference Troff document (with manpage macros)Sexual Minority Youth, Social Change, and Health: A Developmental Collision
Few societal attitudes and opinions have changed as quickly as those regarding sexual minority people and rights. In the context of dramatic social change, there have been multiple policy changes toward social inclusion and rights for lesbian, gay, and bisexual (LGB) people, and perceptions that the sociocultural context for LGB people—perhaps particularly for youth—has improved. Yet recent evidence from the developmental sciences points to paradoxical findings: in many cases there have been growing rather than shrinking health disparities. The authors suggest that there is a developmental collision between normative adolescent developmental processes and sexual minority youth identities and visibility.
Located in MPRC People / Jessica N Fish, Ph.D. / Jessica N Fish Publications