Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice.

A model is proposed and explored that links the coming-out process to the psychological functioning (i.e., self-esteem and distress) and sexual behaviors of gay, lesbian, and bisexual youths recruited from gay-focused community-based and college organizations in New York City. The coming-out process is multidimensional, consisting, as defined here, of involvement in gay/lesbian activities, attitudes toward homosexuality, comfort with homosexuality, self-disclosure of sexual identity to others, and sexual identity. The coming-out dimensions were related to self-esteem, distress, and unprotected sexual behaviors. In addition, the relations between the coming-out dimensions and unprotected sexual behaviors were explained by psychological functioning. In particular, limited involvement in gay/lesbian activities was associated with more unprotected sex. Negative attitudes toward homosexuality were related directly to more unprotected sex, and they were related indirectly to more unprotected sex by means of increasing emotional distress. These and other findings have implications for designing preventive interventions to increase the youths' psychological functioning and reduce their unprotected sexual behaviors.

A longitudinal report of 156 gay, lesbian, and bisexual youths examined changes in sexual identity over time. Fifty-seven percent of the youths remained consistently self-identified as gay/lesbian, 18% transited from bisexual to gay/lesbian, and 15% consistently identified as bisexual over time. Although youths who consistently identified as gay/lesbian did not differ from other youths on time since experiencing sexual developmental milestones, they reported current sexual orientation and sexual behaviors that were more same-sex centered and they scored higher on aspects of the identity integration process (e.g., more certain, comfortable, and accepting of their same-sex sexuality, more involved in gay-related social activities, more possessing of positive attitudes toward homosexuality, and more comfortable with others knowing about their sexuality) than youths who transited to a gay/lesbian identity and youths who consistently identified as bisexual. Contrary to the hypothesis that females are more sexually fluid than males, female youths were less likely to change identities than male youths. The finding that youths who transited to a gay/lesbian identity differed from consistently gay/lesbian youths suggests that identity integration continues after the adoption of a gay/lesbian sexual identity.

This longitudinal report of 145 lesbian, gay, and bisexual (LGB) youths examined ethnic/racial differences in the coming-out process. No significant differences emerged in sexual developmental milestones, sexual orientation, sexual behavior, or sexual identity. However, Black youths reported involvement in fewer gay-related social activities, reported less comfort with others knowing their sexual identity, and disclosed that identity to fewer people than did White youths. Latino youths disclosed to fewer people than did White youths. Analyses of change indicated Black youths had greater increases in positive attitudes toward homosexuality and in certainty in their sexual identity over time than did White youths. These findings support the authors' hypothesis that cultural factors do not impede the formation of identity but may delay identity integration.

Sexual risk behaviors of young gay and bisexual men must be understood within the context of other health concerns (e.g., anxiety, substance abuse), population specific factors (i.e., the coming-out process and gay-related stress), childhood sexual abuse, and other theoretical factors (e.g., safer-sex intentions). The current report proposes and longitudinally examines a model of risk factors for subsequent sexual risk behaviors among young gay and bisexual men in New York City. As hypothesized, more negative attitudes toward homosexuality, more substance abuse symptoms, and poorer intentions for safer sex were directly associated with a greater likelihood of unprotected anal sex over the following year. Furthermore, lower self-esteem, more anxious symptoms, and childhood sexual abuse were related to more unprotected anal sex indirectly through more sexual partners, sexual encounters, and substance abuse symptoms. These findings suggest that interventions targeting sexual risk behaviors of young gay and bisexual men may be more effective if they also address mental health concerns and aspects of the coming-out process.

The longitudinal relations between gay-related stress (i.e., gay-related stressful events, negative attitudes toward homosexuality, and discomfort with homosexuality) and emotional distress (i.e., anxious symptoms, depressive symptoms, and conduct problems) were examined at 3 assessment periods (baseline, 6 months, and 12 months) among 140 gay, lesbian, and bisexual (GLB) youths. Although some findings were consistent with the hypothesis that stress would be associated with subsequent distress among GLB youths, the larger number of nonsignificant relations and the presence of relations between distress and subsequent gay-related stress indicate that the hypothesis was unsupported. The authors discuss the potential reasons for the lack of hypothesized relations and offer suggestions for future research.

This study investigated stability and change in self-reported sexual orientation identity over time in youth. We describe gender-and age-related changes in sexual orientation identity from early adolescence through emerging adulthood in 13,840 youth ages 12-25 employing mobility measure M, a measure we modified from its original application for econometrics. Using prospective data from a large, ongoing cohort of U.S. adolescents, we examined mobility in sexual orientation identity in youth with up to four waves of data. Ten percent of males and 20% of females at some point described themselves as a sexual minority, while 2% of both males and females reported ever being "unsure" of their orientation. Two novel findings emerged regarding gender and mobility: (1) Although mobility scores were quite low for the full cohort, females reported significantly higher mobility than did males. (2) As expected, for sexual minorities, mobility scores were appreciably higher than for the full cohort; however, the gender difference appeared to be eliminated, indicating that changing reported sexual orientation identity throughout adolescence occurred at a similar rate in female and male sexual minorities. In addition, we found that, of those who described themselves as "unsure" of their orientation identity at any point, 66% identified as completely heterosexual at other reports and never went on to describe themselves as a sexual minority. Age was positively associated with endorsing a sexual-minority orientation identity. We discuss substantive and methodological implications of our findings for understanding development of sexual orientation identity in young people.

Research on whether disclosure of sexual orientation promotes lower substance use among lesbian, gay, and bisexual (LGB) individuals has been inconsistent. One reason for this may be that disclosure results in accepting and rejecting reactions. The current report longitudinally examines whether the types of reactions to disclosure are associated with substance use and abuse among an ethnically diverse, urban sample of 156 LGB youths (ages 14 -21 years). Neither the number of disclosures nor the numbers of accepting or neutral disclosure reactions experienced were associated with substance use or abuse. However, the number of rejecting reactions to disclosure was associated with current and subsequent alcohol, cigarette, and marijuana use even after controlling for demographic factors, social desirability, and emotional distress. Further, high numbers of accepting reactions were found to moderate or protect youths from the negative role of rejecting reactions on alcohol use, but not other substances. This research indicates that, rather than disclosure per se, it is the number of accepting and rejecting reactions in response to disclosure that are critical to understanding substance use among LGB youths. Further, the results suggest that to be maximally effective in helping LGB youths, substance use prevention and treatment efforts should address the rejecting reactions to disclosure of sexual orientation. KeywordsAlcohol; Cigarette; Marijuana; Self-Disclosure; Rejection; Acceptance; Sexual Orientation; Sexual Identity; Longitudinal Extensive research using large representative samples has examined the potential role of sexual orientation as a risk factor for substance use and abuse among adolescents and young adults Address correspondence to Margaret Rosario, Ph.D., Department of Psychology, The City University of New York -City College and Graduate Center, NAC Building 7-120, Convent Avenue and 138 th Street, New York, NY 10031; mrosario@gc.cuny.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/journals/adb NIH Public Access e.g., Bontempo & D'Augelli, 2002;Eisenberg & Wechsler, 2003a;Russell, Driscoll, & Truong, 2002). A recent meta-analysis of this research concludes that lesbian, gay, and bisexual (LGB) youths are significantly more likely to report alcohol, tobacco, and other drug use than are heterosexual youths (Marshal et al., 2008). The meta-analysis also finds that the higher risk among LGB youths occurs among both sexes and regardless of definition of sexual orientation (e.g., self-identification as LGB...