Confirming the Reliability and Validity of the Sexual Minority Adolescent Stress Inventory in a National Sample of Sexual Minority Adolescents

Objective: Sexual minority adolescents (SMA) experience numerous behavioral health disparities, including depression, anxiety, substance use, non-suicidal self-injury, and suicidality. The primary framework to understand these disparities is minority stress theory, which frames this disproportionate burden as the result of discrimination, violence, and victimization in a homophobic culture. Empirical examinations of minority stress among SMA have been limited by lack of diverse samples or validated measures. This study engaged a national community sample of SMA to confirm reliability and validity of the Sexual Minority Adolescent Stress Inventory (SMASI).Method: A national sample of 2,310 SMA aged 14–17 was recruited in the United States through a hybrid social media and respondent-driven sampling approach. Item response theory and confirmatory factor analysis established the psychometric properties of the SMASI in this sample; minority stress was modeled as a latent variable in several regression models to verify criterion and divergent validity.Results: In this national sample (M age = 15.9; 64% female and 60% White), the factor structure of the SMASI and its 11 subscales was confirmed and shown to be invariant by demographic characteristics. Minority stress as measured by the SMASI was significantly associated with all mental and behavioral health outcomes.Conclusions: This study provides evidence that SMASI is a reliable, valid, and important tool for better understanding minority stress and subsequent health and mental health consequences among SMA.

Barriers and Facilitators for Mental Health Service Use Among Racial/Ethnic Minority Adolescents: A Systematic Review of Literature

Introduction: Mental disorders represent serious public health concerns in the U.S. Compared with Whites, racial/ethnic minority adolescents are more likely to be affected by mental disorders but less likely to use mental health services. This systematic review aimed to summarize factors related to mental health service use among minority adolescents in the U.S. as identified in previous research.Methodology: Following the PRISMA guideline, we systematically searched seven databases for peer reviewed articles related to barriers and facilitators of mental health service use among racial/ethnic minority adolescents.Results: Thirty-two quantitative studies met our inclusion criteria, among which 12 studies (37.5%) sampled mostly Blacks or African Americans, 6 studies (18.7%) focused primarily on Hispanics or Latin/a/x, including Mexican Americans and Puerto Ricans, and 4 studies (12.5%) were mostly Asian Americans (e.g., Chinese, Vietnamese). Based on the socio-ecological framework, 21 studies (65.6%) identified adolescent-related barriers and facilitators of mental health service use, including biological (e.g., age, gender), clinical (e.g., symptom severity), behavioral (e.g., drug/alcohol use), and psychological characteristics (e.g., internal asset) of minority youth. Ten studies (31.3%) identified parents-related factors that influenced minority adolescent mental health service use, including parental perceptions and beliefs, family and parenting issues, and demographic characteristics. Primary factors at the therapist level included ethnic match between patient and practitioner, relationship with healthcare practitioners, and patient-therapist co-endorsement of etiological beliefs. Fifteen studies (46.9%) identified factors influencing minority adolescent mental health service use at the contextual/structural level, including household income, insurance status, and family structure. Lastly, acculturation and school experiences were major factors at the social/cultural level that influence minority adolescent service use.Conclusion: More empirical studies are needed to understand the mechanism underlying minority adolescents' unmet mental health service needs. Culturally competent interventions are warranted to engage minority adolescents with mental disorders into treatment.

Girl2Girl: How do develop a salient pregnancy prevention program for sexual minority adolescent girls (Preprint)

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