Harmony Rhoades

Sexually and racially diverse (SD) adolescents experience elevated proximal and distal minority stressors that vary across school, community, and policy contexts. Limited research has examined how access to and use of LGBTQIA+ supportive structures, such as Gender and Sexualities Alliances (GSAs), LGBTQIA+ community centers, and affirming school staff, shape distal minority stress for racially and sexually diverse youth across geographic settings. Using cross‐sectional national sample data of SD adolescents from the Adolescent Stress Experiences Over Time Study (ASETS; N = 1076), this study applied binary logistic regression and linear regression to assess how racial identity, urbanicity, and structural access to and use of LGBTQ community centers and school affirmative SD groups are associated with distal sexual minority stress domains (homonegative climate, social marginalization, and intersectional stress), friend social support, and coping skills. Results indicated that GSA presence, regardless of individual participation, was associated with reduced odds of minority stress across all domains, while attending a GSA was further associated with increased use of engagement‐oriented coping strategies. Conversely, community center attendance was associated with higher odds of social marginalization, suggesting contextual variability in the protective impacts of community‐based supports. Geographic differences in distal minority stress were evident in only one domain, homonegative climate, and rurality was not significantly associated with differences in peer social support or coping. Findings underscore the importance of school‐embedded, structurally inclusive supports for reducing minority stress and bolstering resilience among sexually and racially diverse adolescents, and highlight ongoing gaps in support for youth outside urban areas or in restrictive community climates. Future research should examine culturally grounded mechanisms that enhance the effectiveness of supportive structures and ensure inclusivity across racial and geographic contexts.

Background: Web-based recruitment for research studies is becoming increasingly popular and necessary. When compared with the traditional methods of recruitment, these methods may enable researchers to reach more diverse participants in less time. Social media use is highly prevalent among adolescents, and the unique context of social media may be particularly important for the recruitment of sexual minority young people who would not be captured by traditional methods. Objective: This paper described the details of a national web-based study recruitment approach aimed at sexual minority adolescents across the United States, focusing on important details of this relatively novel approach, including cost, time efficiency, and retention outcomes. Methods: This study recruited sexual minority adolescents aged 14-17 years living in the United States through targeted advertisements on Facebook, Instagram, and YouTube and through respondent-driven sampling (RDS). Potential participants completed eligibility screening surveys and were automatically directed to a baseline survey if they were eligible. After baseline survey completion, additional data checks were implemented, and the remaining participants were contacted for recruitment into a longitudinal study (surveys every 6 months for 3 years). Results: Recruitment lasted 44 weeks, and 9843 participants accessed the initial screening survey, with 2732 (27.76%) meeting the eligibility criteria and completing the baseline survey. Of those, 2558 (93.63%) were determined to have provided nonfraudulent, usable study data and 1076 (39.39%) subsequently enrolled in the longitudinal study. Of the baseline sample, 79.05% (2022/2558) was recruited through Facebook and Instagram, 3.05% (78/2558) through YouTube, and 17.9% (458/2558) through RDS. The average cost of recruiting a participant into the study was US $12.98, but the recruitment cost varied by method or platform, with a realized cost of US $13 per participant on Facebook and Instagram, US $24 on YouTube, and US $10 through RDS. Participant differences (sex assigned at birth, race and ethnicity, sexual orientation, region, and urbanicity) were identified between platforms and methods both in terms of overall number of participants and cost per participant. Facebook and Instagram were the most time efficient (approximately 15 days to recruit 100 participants), whereas RDS was the least time efficient (approximately 70 days to recruit 100 participants). Participants recruited through YouTube were the most likely to be longitudinally retained, followed by Facebook and Instagram, and then RDS. Conclusions: Large differences exist in study recruitment cost and efficiency when using social media and RDS. Demographic, region, and urbanicity differences in recruitment methods highlight the need for attention to demographic diversity when planning and implementing recruitment across platforms. Finally, it is more cost-effective to retain than recruit samples, and this study provided evidence that with thorough screening and data quality practices, social media recruitment can result in diverse, highly involved study populations.

Background: Sexual minority youth are at more than twice the risk of experiencing homelessness than their peers and both sexual minority youth and youth experiencing homelessness have disproportionate risk for mental health disorder symptoms. Couch-surfing is a common form of homelessness experienced by youth, but research on the relationship between couch-surfing and mental health outcomes, especially among sexual minority adolescents (SMA), is limited. Methods: Utilizing a sample of 2,558 SMA (14–17 years old) recruited via social media and respondent-driven sampling, this study explores the relationship between different forms of homelessness (exclusive couch-surfing vs. multiple types of homelessness) and symptoms of depression, anxiety, suicidal ideation, and suicide attempt. Results: Nearly 21% of participants experienced any homelessness in their lifetime, with 14% reporting exclusive couch-surfing. All forms of homelessness were associated with large increases in symptoms of anxiety, depression, suicidal ideation and suicide attempt. Conclusion: Homelessness – primarily couch-surfing – is a common experience for SMA in this sample. All forms of homelessness – including exclusive couch-surfing – were associated with large increases in depression, anxiety, suicidal ideation, and suicide attempt, emphasizing the importance of services that are available to couch-surfing young people and responsive to the needs of sexual minority adolescents.

IntroductionLittle is known about the momentary patterns and predictors of substance use among young adults who experience homelessness. To enhance understanding of substance use patterns, smartphone-based ecological momentary assessment (EMA) was utilized to examine the real-time association between affect and substance use. Methods: 251 young adults (aged 18–27) with history of homelessness were recruited from supportive housing programs and drop-in facilities in Los Angeles. Exploratory factor analysis was used to examine the latent structure of positive and negative affective states and mixed-effects logistic regression models were completed separately for both the full remaining sample (n = 227) and a subsample of alcohol or cannabis users (n = 145) to evaluate whether positive or negative affect predicted lead, recent, or lagged substance use. Results: Greater positive affect within-person was associated with greater odds of alcohol or cannabis use within the past two hours, and participants who reported feeling more negative than their peers experienced greater odds of reporting use within the past 4 h and the following two hours. Conclusion: Results suggest that individuals experience a heightened positive mood compared to their own average mood, concurrently or immediately after engaging in alcohol or cannabis use. Heightened positive mood might be an anticipatory effect of drinking or cannabis use. Future research should consider a longer study period to capture multiple drinking or drug use events over a longer period and consider more environmental exposures that may influence the frequency or intensity of substance use.

BACKGROUND Online recruitment for research studies is increasingly popular and necessary. When compared to traditional methods of recruitment, these methods may enable researchers to reach more diverse participants in less time. Social media use is highly prevalent among adolescents, and the unique context of social media may be particularly important for the recruitment of sexual minority young people who would not be captured by traditional methods. OBJECTIVE This paper describes the details of a national online study recruitment approach aimed at sexual minority adolescents across the United States, focusing on important details of this relatively novel approach, including cost, time efficiency, and retention outcomes. METHODS This study recruited sexual minority adolescents aged 14–17 years living in the United States through targeted advertisements on Facebook, Instagram, and YouTube and through respondent-driven sampling (RDS). Potential participants completed eligibility screening surveys and were automatically directed to a baseline survey if eligible. After baseline survey completion, additional data checks were implemented and remaining participants were contacted for recruitment into a longitudinal study (surveys every 6 months for 3 years). RESULTS Recruitment lasted 44 weeks, And 9,843 participants accessed the initial screening survey, with 2,732 meeting eligibility criteria and completing the baseline survey. Of those, 2,558 were determined to have provided nonfraudulent, useable study data and 1,076 subsequently enrolled in the longitudinal study. Of the baseline sample, 79% was recruited through Facebook and Instagram, 3% through YouTube, and 18% through RDS. The average cost of recruiting a participant into the study was $12.98, but varied by method or platform, with a realized cost of $13 per participant on Facebook and Instagram, $24 on YouTube, and $10 through RDS. Participant differences (sex assigned at birth, race and ethnicity, sexual orientation, region, and urbanicity) were identified between platforms and methods both in terms of overall number of participants and cost per participant. Facebook and Instagram was the most time efficient (approximately 15 days to recruit 100 participants), whereas RDS was the least (approximately 70 days for 100 participants). Participants recruited through YouTube were the most likely to be longitudinally retained, followed by Facebook and Instagram and then RDS. CONCLUSIONS Overall, large differences exist in study recruitment cost and efficiency when using social media and RDS. In this study, RDS was the most cost-efficient but least time-efficient method, whereas Facebook and Instagram was the most time efficient and YouTube resulted in the highest rate of longitudinal retention. Demographic, region, and urbanicity differences in recruitment methods highlight the need for attention to demographic diversity when planning and implementing recruitment across platforms. Finally, it is more cost effective to retain than recruit samples, and this study provided evidence that with thorough screening and data-quality practices, social media recruitment can result in diverse, highly involved study populations.

Sexual and gender minority adolescents (SGMA) experience higher rates of internalizing psychopathology, including depression, anxiety, self-harm, and posttraumatic stress disorder. The primary explanation for these mental health disparities is minority stress theory, which suggests that discrimination, violence, and victimization are key drivers of chronic minority stress and place SGMA at higher risk of mental health concerns. To help address these concerns, the authors undertook a nearly 8-year process of developing Proud & Empowered, a school-based intervention to help SGMA cope with minority stress experiences. This manuscript details the intervention development process, including: (a) identifying the mechanisms of change (Stage 0), (b) building the intervention (Stage 1A, Part 1), (c) acceptability testing and program revision (Stage 1A, Part 2), (d) feasibility and pilot testing (Stage 1B, Part 1), (e) modification of the intervention to improve implementability (Stage 1B, Part 2), and (f) the final intervention.

This study examines whether routine, low-cost service use changes in the transition from homelessness to permanent supportive housing (PSH) and explores whether housing model, neighbourhood and level of case management engagement affect utilisation of routine services. Data come from a prospective longitudinal study of adults experiencing homelessness who entered PSH in Los Angeles between 2014 and 2016 and participated in four interviews: pre-housing (i.e., while experiencing homelessness), and 3, 6 and 12 months after move-in. Mixed effects logistic regression assessed the effects of demographics, case management, housing model and neighbourhood location on service utilisation at each time point across five domains: basic needs, financial, educational, mental health and physical health. Longitudinal unmet need for services and onsite service use contextualised findings. Service utilisation significantly decreased at each time point in the domains of basic needs, financial and mental health. Neighbourhood was significantly associated with basic needs and mental health service use, while housing model was associated with financial service utilisation. Case management was associated with all service use outcomes with all relationships demonstrating more case management visits was associated with greater odds of routine service utilisation. Unmet service needs were consistent over time. Onsite service utilisation was low across all residents. Results indicate that routine service use declines with length of tenancy while unmet need for services remain prevalent. Case management appears to be critical in facilitating routine service use, while the housing environment should be considered to ensure residents have accessible and proximal routine care.

Background: Adults experiencing homelessness have a high burden of sleep disturbance, which may be reduced by accessing permanent supportive housing. Objectives: To assess sleep disturbances and their correlates, including demographics, activity level, health status, age-related health issues (eg, functionality and cognitive impairment), substance use, and homelessness history in a sample of permanent supportive housing (PSH) tenants. Research Design: Cross-sectional survey design. Subjects: A total of 237 formerly homeless adults between 45 and 80 years old. Measures: The Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance short form was used to measure sleep disturbance. Results: Twenty-eight percent of our sample had PROMIS scores indicative of a moderate or severe sleep disturbance. Functional impairment, pain, and mental health comorbidities were associated with increased sleep disturbance in multivariable linear regression analyses. The number of years a person experienced homelessness was inversely associated with sleep disturbance. Conclusions: This study supports the need to screen for sleep disturbances among PSH tenants. The findings suggest that supportive services in PSH may need to include integrated physical and behavioral health care, pain management, and interventions designed to address activities of daily livings to improve tenant sleep. They also suggest that improved sleep may help reduce PSH tenant pain, impairment, and mental health symptoms among PSH tenants.

Approximately one in 10 people experiencing homelessness have pets. Despite the psychosocial benefits derived from pet ownership, systemic and structural barriers can prevent this group from meeting their basic needs and exiting homelessness. A multilevel framework is proposed for improving the health and well-being of pet owners experiencing homelessness. Informed by a One Health approach, the framework identifies interventions at the policy, public, and direct service delivery levels. Policy interventions are proposed to increase the supply of pet-friendly emergency shelters, access to market rental housing and veterinary medicine, and the use of a Housing First approach. At the public level, educational interventions are needed to improve knowledge and reduce stigma about the relationship between homelessness and pet ownership. Direct service providers can support pet owners experiencing homelessness by recognizing their strengths, connecting them to community services, being aware of the risks associated with pet loss, providing harm reduction strategies, documenting animals as emotional support animals, and engaging in advocacy. By targeting policies and service approaches that exacerbate the hardships faced by pet owners experiencing homelessness, the framework is a set of deliberate actions to better support a group that is often overlooked or unaccommodated in efforts to end homelessness.