0. Parenting effects on SGM adolescent health
Brian Mustanski, PhD
@SexualContinuum
Michael Newcomb, PhD
Kathryn Macapagal, PhD

1. Parent reactions and their impact
Until 1990s literature primarily anecdotal reports of parents’ reactions to their children’s disclosure with shock and surprise, followed by distress.
Consistently more SGM teens told mother than father.
Some reports of mixed parental reactions.
Negative impact of family rejection across outcomes.
Mixed reactions…D’Augelli’s 1998 study of year olds residing with parents. 76% had disclosed to parent with average age of 17 at coming out. Of those who disclosed51% of mothers were accepting and 27% of fathers. 10% of mothers and 26% of fathers were rejecting, with the rest in between tolerant and intolerant.
Research by Ryan, Huebner, and colleagues with LGB youth adults in their early 20s showed effects of family rejection, with high levels reated to 8.4X suicide, 5.9X depression, 3.4X illegal drugs, and 3.4X unprotected sex compared to young adults with no or low levels of rejection.
My own research with LGBT teens showed
*Leelah Alcorn (November 15, 1997 – December 28, 2014) was an American transgender girl whose suicide attracted international attention. Alcorn had posted a suicide note to her Tumblr blog, writing about societal standards affecting transgender people and expressing the hope that her death would create a dialogue about discrimination, abuse and lack of support for transgender people.

2. Shift to studying acceptance
My own research with LGBT teens has shown a significant effect of family support on reducing the odds of being HIV positive and reduced rates of mental health problems.
While support has important promotive effects, it does not eliminate the negative effects of bullying and victimization.

3. Parental influences beyond support
Ecological Systems Theory1, highlights the importance of the family-system in adolescent health and wellbeing.
Parenting practices, such as knowledge of child whereabouts and monitoring of behavioral rules, protect against negative outcomes in sexual health and risk behavior, and drug use among (presumably) heterosexual youth.
Parent-based interventions2 can reduce adolescent sexual risk taking and substance use by:.
Improving parent-child communication around sexual health and drug use
setting strict rules against underage substance use
monitoring children’s’ activities.
1 Bronfenbrenner (1992) Six Theories of Child Development
2 Kuntsche & Kuntsche (2016) Clin Psychol Rev
Image from National Academies of Sciences on Preventing Bullying Through Science, Policy, and Practice 

4. Very little research on parental influences on SGM health, especially < 18
Most existing studies of LGB youth have focused on emotional aspects of the parent-child relationship rather than parenting practices.
Studies that have examined parenting practices have found effects different than those found with heterosexual youth3.
Qualitative research with sexual and gender minority adolescents has found that many parents enforce a code of silence about sex, which may hamper their ability to monitor their child’s risk behaviors.  
Almost all studies have focused on the youth perspective. Few studies of parents of SGM teens.
Most existing studies of LGB youth have focused on emotional aspects of the parent-child relationship such as rejection/acceptance or support, rather than parenting practices like monitoring (despite it being a primary focus in research with heterosexual youth).
Few significant associations with sexual risk taking have been reported. In one of the few studies focused on YMSM3 and parental monitoring, researchers found that among YMSM that were out to their parents, parental monitoring had no effect on condomless anal sex (CAS).
However, for those YMSM who were not out to parents, monitoring increased engagement in CAS. (The authors suggested that parental monitoring may increase risk because, in the context of YMSM trying to maintain secrecy, it might be more difficult to plan for sex and thereby obtain and use condoms consistently). 
Qualitative research with sexual and gender minority adolescents has found that many parents enforce a code of silence about sex, which may hamper their ability to monitor their child’s risk behaviors.  
Studies suggest parent rejection of LGBT youth is a risk factor for substance use, while parental support may show a protective effect.
3 Thoma & Huebner (2014) AIDS Behav

5. The elephant in the room

7. A pilot study of National HIV Behavioral Surveillance study to examine feasibility of collecting data from adolescent MSM (CDPH/CDC Grant Number: 5U1BPS003260; co-Pis Newcomb & Mustanski)
225 YMSM (ages 14-18) enrolled between Jan-2015 and Dec-2015
5-item “parental knowledge” subscale of Parenting Style Questionnaire + 3-items reworded for “gay-specific parental knowledge”
Parental knowledge of general activities was significantly higher than gay-specific knowledge (t = 8.21, p < .001)
Age was negatively associated with parental knowledge (std. beta = -0.20, p < .01)
75.4% were out to at least one parent, and reported significantly higher levels of parental knowledge of gay- specific activities (mean diff = 1.03, p < .001)
Parental rejections scores were negatively associated with both general knowledge (r = -0.26, p < .01) and gay- specific knowledge (r = -0.34, p < .001)
Controlling for age, race/ethnicity, and bisexual identity, higher parental knowledge was significantly associated with lower rates of binge drinking and condomless sex acts. No differences in marijuana use, other drug use, and number of condomless anal sex (CAS) partners.
Recruited online thru social media, and respondent-driven sampling (37% and 63%, respectively)
94.2% lived with a parent/guardian
PARENTAL KNOWLEDGE: Scale mean scores indicate that on average participants
reported telling parents about general activities slightly
more than half the time, and gay-specific events between
‘‘occasionally’’ and ‘‘about half the time.’’
CDPH (RFP# DA ); U.S. Department of Health and Human Services, Centers for Disease Control and Prevention;

8. An ongoing longitudinal cohort study of YMSM that aims to understand multilevel influences on HIV risk and substance use (NIDA U01DA036939)
1077 YMSM (ages 16-29) enrolled between Jan-2015 and Dec-2015 through hybridization of three existing cohorts + venue- and peer-based recruitment; ongoing recruitment of serious romantic and sexual partners
8-item Poor Family Management subscale of Family Risk and Protective Factors section of the Communities that Care5 study (reworded in the past tense for participants >18)
No significant differences between participants based on age (≤ 18 vs. ≥ 19)
No associations between outness to parents and parental monitoring (mean diff = -0.03, p = .70)
Parental rejection showed a small but significant negative association with monitoring (r = -0.09, p < .05)
Higher parental monitoring was significantly associated with:
Less marijuana use for the RADAR sample as a whole, regardless of age group (≤ 18 vs. ≥ 19)
Lower number of other drugs in the sample as a whole, and in the ≥ 19 group
Lower numbers of CAS acts and fewer CAS partners for the ≤ 18 group
No significant associations between parental monitoring and binge drinking
34.8% of the sample reported living with a parent/guardian (reflecting older participants compared to ChiGuys)
5 Arthur et al. (2002) Eval Rev

9. Parent and Adolescent Perspectives on Parent-Child Relationships
Conducted parallel sets of online focus groups to characterize parent- adolescent relationships for sexual and gender minority adolescents
Adolescent MSM (N=52) (Feinstein et al., under review)
Parents of LGBTQ youth (N=44) (Newcomb et al., under review)
Funding
National Institute on Minority Health and Health Disparities (R01MD009561; PIs: Mustanski & Fisher)
Third Coast Center for AIDS Research pilot award (PI: Newcomb)
Faculty collaborators
Celia B. Fisher, PhD
Kathryn Macapagal, PhD, project director & co-investigator (NIMHD)
Michael Newcomb, PhD, co-investigator (NIMHD) & PI (TC-CFAR)

10. Adolescent sexual orientation disclosure and parent-child relationships
56% of adolescent MSM reported that coming out had a negative impact on their relationships with their parents.
Because I am not straight, it puts a strain on my relationship with my father. Rather than being an active part of my life, he decides to only participate when he needs to….He favors my sister more than me which makes me upset and confused. I hope that in the future I could have a relationship with my father similar to that of when I was not out. (15 yo, White, questioning/unsure)
Some adolescents MSM reported that coming out had a positive impact on their relationship:
At first me being gay was a little awkward because they didn't really know how to act about it or how to ask about relationships but after I had a couple boyfriends it's pretty normal. (17 year-old, Latino, gay)
In contrast, 79% of parents said their child coming out had a neutral or positive impact on their relationships
I think the way that it has changed our relationship is that after he told me, we became closer. We kind of clung together to try to figure this out and keep him safe. (mother of 16 yo, gay male, White)
A different quote for the first point, depending on what point you are trying to make
…my parents are not at all supportive about my [sexual orientation]...I went ahead and told my parents I had a boyfriend. My mom like freaked the f out. [My mom and dad] immediately told me I was going to die from HIV/AIDS if I continue to be gay. (15 yo, White, gay)

11. Some parents reported a “grieving” period immediately after their child came out during which they were often less accepting
I feel like it strained our relationship for a few weeks…I was proud of her, but felt like I went through a bit of a grieving period. I think, as a parent, you visualize how your child’s life is going to be and when you realize it isn't going to look exactly like that you grieve for that loss (mother of 17 yo, lesbian, White)
Coming out sometimes had a positive impact on the relationship between the child and one parent (typically mothers) and a negative impact on the other (typically fathers) - consistent across adolescent and parent focus groups
Me and my mom are really close. I feel as though when I came out we got closer while me and my dad only grew apart. I like how I can talk to my mom about anything…My mom is always interested in if I'm dating someone but not what we do on those dates. I think being gay makes me and my mom closer because she loves gay guys (17 year-old, Black, gay)
Unfortunately, my husband and son have never been all that close, but this new chapter in my teen’s life highlighted that for him. [My son] doesn't know how to even bring it up [that he is transgender] and feels like Dad won't be supportive (mother of 15 yo, transgender male, gay, White)

12. Barriers to parent-child communication
Adolescents, regardless of outness, indicated their sexual identity created a significant barrier to communicating with their parents about sex, dating, and their lives in general
…one effect it [being gay] has would be the fact that I don't necessarily share everything with them, stuff like being in the GSA at school, crushes, etc (15 yo, American Indian/Alaska Native, gay, not out)
Being gay has made my parents act more cautious about my relationships instead of being happy for them. For this reason, I don't tell my parents about relationships because I don't want them to be overly worried for no reason. (16 yo, Black, gay, out)
Parents noted similar barriers to communication about sex and dating
My challenge around talking about sex is that I have no idea about what sex is really like for men, especially for gay men (mother of 17 yo, gay male, White)
I felt challenged that I'm straight, my daughter is dating a gal, and I didn't know anything about that. All my sex talks were about how not to get pregnant and how babies are conceived and all that (mother of 17 yo, bisexual female, White)
Another possible quote
I dislike the idea that I can’t tell them everything going on in my life (15 yo, Black, bisexual, not out)

13. FUTURE DIRECTIONS
More research involving parents of SGM teens, including research on how to recruit them across a range of levels of acceptance.
Research on other parenting practices (e.g., control, discipline) and parent engagement in various settings.
Intervention research: (1) parent-based interventions (2) family-based interventions
Studies of parents of gender minority teens.

14. Thanks to our Faculty, Staff, and Sponsors
Include those that are appropriate for the particular project

15. Parent-Based Sexual Health Interventions
Parents had various perspectives on the content and format of parent-adolescent interventions for promoting LGBTQ adolescent health.
Top two content areas
73% sexual health
68% mental health
Intervention format
52% preferred an online format
43% believe parents and teens should be separated to tailor content and avoid awkwardness
29% felt groups of parent-teen dyads would help to build community