This project examined the attitudes of sexual and gender minority youth (SGMY) toward guardian permission for a pre-exposure prophylaxis (PrEP) adherence trial and their preparedness to provide informed, rational and voluntary self-consent. Sixty sexually active SGMY (ages 14–17) participated in online survey and asynchronous focus group questions after watching a video describing a PrEP adherence study. Youth responses highlighted guardian permission as a significant barrier to research participation, especially for those not “out” to families. Youth demonstrated understanding of research benefits, medical side effects, confidentiality risks, and random assignment and felt comfortable asking questions and declining participation. Reasoning about participation indicated consideration of health risks and benefits, personal sexual behavior, ability to take pills everyday, logistics, and post-trial access to PrEP. Results demonstrate youth’s ability to self-consent to age- and population- appropriate procedures, and underscore the value of empirical studies for informing IRB protections of SGMY research participants.

No abstract

Sexual and gender minority (SGM) adolescents under age 18 are underrepresented in sexual health research. Exclusion of SGM minors from these studies has resulted in a lack of knowledge about the risks and benefits youth experience from sexual health research participation. Institutional Review Boards’ (IRB) overprotective stances toward research risks and requirements for guardian consent for SGM research are significant barriers to participation, though few have investigated SGM youth’s perspectives on these topics. This study aimed to empirically inform decisions about guardian consent for sexuality survey studies involving SGM youth. Seventy-four SGM youth aged 14–17 completed an online survey of sexual behavior and SGM identity, and a new measure that compared the discomfort of sexual health survey completion to everyday events and exemplars of “minimal risk” research (e.g., behavioral observation). Youth described survey benefits and drawbacks and perspectives on guardian permission during an online focus group. Participants felt about the same as or more comfortable completing the survey compared to other research procedures, and indicated that direct and indirect participation benefits outweighed concerns about privacy and emotional discomfort. Most would not have participated if guardian permission were required, citing negative parental attitudes about adolescent sexuality and SGM issues and not being “out” about their SGM identity. Findings suggest that sexual health survey studies meet minimal risk criteria, are appropriate for SGM youth, and that recruitment would not be possible without waivers of guardian consent. Decreasing barriers to research participation would dramatically improve our understanding of sexual health among SGM youth.

The present study was designed to examine the effects of school engagement on risky behavior in adolescence. Using data from the 4‐H Study of Positive Youth Development (PYD), a longitudinal study of U.S. adolescents, discrete‐time survival analyses were conducted to assess the effect of behavioral and emotional school engagement on the initiation of drug use and delinquency. The current analyses used seven years of longitudinal data collected from youth and their parents. Results of discrete‐time survival analysis indicated that, controlling for demographic variables, higher degrees of behavioral and emotional school engagement predicted a significantly lower risk of substance use and involvement in delinquency. Substance use prevention programs and other health‐risk reduction programs should include components (i.e., adolescents' participation in and emotional attachment to school) to capitalize on the protective role of the school context against youth risk behavior.

We recommend that practitioners integrate nonjudgmental questions regarding bisexuality into standard contraceptive and sexual health practices involving female youth, including discussion of HIV and STI risk reduction methods. Further support for bisexual health among adolescent girls can come through addressing stigmas of female bisexuality, increasing sensitivity to privacy while engaging parents, and expanding the reach of school-based sexual health education.