Is HIV/AIDS stigma dividing the gay community? Perceptions of HIV-positive men who have sex with men - Courtenay-Quirk, C.; Wolitski, R.J.; Parsons, J.T.; Gómez, C.A. (AIDS Education and Prevention, 2006)
Stigma surrounding HIV/AIDS has existed since the beginning of the epidemic, but little is known about HIV/AIDS stigma within the gay community and how it affects men who have sex with men (MSM) living with HIV. A better understanding of the effects of stigma on this population is needed to reduce it and its harmful effects. Our study used quantitative data from 206 HIV-positive MSM and qualitative data from 250 to document beliefs about HIV/AIDS stigma within the gay community and to measure its effects on sexual risk behaviors, substance use behaviors, serostatus disclosure, and mental health. Stigma was associated with increased levels of anxiety, loneliness, depressive symptoms, engaging in avoidant coping strategies, and history of suicidal ideation. HIV/AIDS stigma exists within the gay community and has a negative effect on the mental health of people living with HIV. HIV/AIDS stigma should be monitored closely so that we may better understand how to address it. © 2006 The Guilford Press.

The relationship between self-reported sexual orientation and behavior in a sample of middle-aged male injection drug users - Washington, T.A.; Galai, N.; Cohn, S.; Celentano, D.D.; Vlahov, D.; Strathdee, S.A. (Archives of Sexual Behavior, 2006)
Data are sparse on injection drug using (IDU) men who have sex with men (MSM). Previous literature suggests perceived taboos can result in an underreporting of atypical sexual orientation (i.e., bisexuality, homosexuality). As a result, HIV prevention programs have been difficult to mount, particularly programs for IDU-MSM. The association between self-reported sexual orientation and sexual behavior at semi-annual study visits was longitudinally assessed in a population of 1300 male IDUs in Baltimore during the period 1993 to 1998. Overall, a small minority (5%) of the male IDUs inconsistently reported their sexual orientation over time. Logistic regression analyses were performed, which yielded five significant predictors. These men tended to be older, to have been incarcerated, to have attended shooting galleries during follow-up, and were more than twice as likely to be HIV-seropositive (OR, 2.66; 95% CI, 1.62-4.36) compared with those who consistently reported their sexual orientation. Furthermore, men reporting inconsistent sexual orientation tended to engage in higher risk behaviors, suggesting that these men should be especially targeted for interventions. © 2006 Springer Science+Business Media, Inc.
Keywords: Human immunodeficiency virus; Injection drug users; Sex behavior; Sexual orientation; Substance abuse

Who's gay? Does it matter? - Savin-Williams, R.C. (Current Directions in Psychological Science, 2006)
To answer the question "Who's gay?" - and its logical follow-up, "Does it matter?" - researchers usually define homosexuality with reference to one of three components or expressions of sexual orientation: sexual/romantic attraction or arousal, sexual behavior, and sexual identity. Yet, the three components are imperfectly correlated and inconsistently predictive of each other, resulting in dissimilar conclusions regarding the number and nature of homosexual populations. Depending on which component is assessed, the prevalence rate of homosexuality in the general population ranges from 1 to 21%. When investigators define the homosexual population based on same-sex behavior or identity, they enhance the possibility of finding a biological basis for homosexuality and a compromised mental health (suicidality). Copyright © 2006 Association for Psychological Science.
Keywords: Gay; Sexual behavior; Sexual identity; Sexual orientation; Sexual/romantic attraction

Prevalence and correlates of suicidal ideation among young injection vs. noninjection drug users - Havens, J.R.; Sherman, S.G.; Sapun, M.; Strathdee, S.A. (Substance Use and Misuse, 2006)
The objective of this study was to identify correlates of suicidal ideation and to examine the hypothesis that injection drug users (IDUs) were more likely to report suicidal ideation than noninjection drug users (NIDUs). Participants included IDUs (n = 244) and NIDUs (n = 73) from Baltimore, Maryland, aged 15-30 who began snorting or smoking heroin or cocaine/crack (NIDUs) or injecting drugs (IDUs) within the past 5 years who were recruited between August 2000 and March 2002. Among the 317 participants, 42% were female, 59% were white, and median age was 24. The prevalence of suicidal ideation was 27%. IDUs were more likely to report suicidal ideation than NIDUs (31% vs. 14%, p = 0.003). Adjusting for age, gender, and race, IDUs were 2.4 times more likely than NIDUs to report suicidal ideation [95% Confidence Interval (CI): 1.1-5.2]. However, on further adjustment for homelessness, depressive symptoms, and gay/lesbian/bisexual identity, IDU status was no longer independently associated with suicidal ideation. These results suggest that factors associated with injection drug users' lifestyles and mental health status may account for the higher prevalence of suicidal ideation in IDUs vs. NIDUs. Further study into these associations is warranted in identifying avenues for suicide prevention among these populations. Copyright © 2006 Taylor & Francis Inc.
Keywords: Depression; Drug use; Homeless; Injection; Risk behaviors; Sexual orientation; Suicidal ideation

Sexual minority youth perspectives on the school environment and suicide risk interventions: A qualitative study - Rutter, P.A.; Leech, N. (Journal of Gay and Lesbian Issues in Education, 2006)
This qualitative study explored the experiences of five gay, lesbian, and bisexual adolescents' perspectives on their schools' acceptance of their sexual orientation, and perceptions of these schools' approach to suicide risk intervention. Focus groups were tape recorded, transcribed, and analyzed through constant comparative analysis. Themes that emerged from the data included participants feeling judged by school counselors and teachers, feeling unsafe at school, and concerned about school staff's response to suicide risk and interventions. Implications for school counselors, teachers and administrators are discussed. Copyright © by The Haworth Press, Inc. All rights reserved.
Keywords: Curriculum; Homophobia; LGBT youth; School; School climate; School counselors; School safety; Suicide; Suicide prevention

Sexualities equality in schools: Why every lesbian, gay, bisexual or transgender (LGBT) child matters - Biddulph, M. (Pastoral Care in Education, 2006)
In an increasingly complex global society, schools frequently have to re-examine their understanding of the social and cultural dimensions that constitute ‘community. One such dimension is the sexual orientation of individuals who make up this group. Historically, this has been a difficult task, given the tension that exists between sexuality and education and the heteronormative practices within schools. Consequently, individuals who identify as Lesbian, Gay, Bisexual or Transgender (LGBT), are thought to be LGBT or who are connected with the LGBT community, have frequently found themselves in a marginalized and vulnerable position. In the case of young people, the consequences of this include lowered self-esteem, absenteeism, underachievement and, in some cases, suicide. Given the mantra that Every Child Matters, schools now have a strategic opportunity to formulate new responses in supporting this group. A key question in this article relates to the ways in which the dimensions of strategy can be integrated into ‘joined-up’, effective action. © 2006 NAPCE.
Keywords: Ethos; Homophobia; Schools; Sexuality; Support

Depression and suicide attempt as risk factors for incident unprovoked seizures - Hesdorffer, D.C.; Allen Hauser, W.; Olafsson, E.; Ludvigsson, P.; Kjartansson, O. (Annals of Neurology, 2006)
Major depression has been shown to increase the risk for development of epilepsy, but prior studies have not evaluated whether this is due to specific symptoms of depression. We conducted a population-based case-control study of all newly diagnosed unprovoked seizures among Icelandic children and adults aged 10 years and older to test the hypothesis that major depression is a risk factor for developing unprovoked seizure and epilepsy, and to address whether specific symptoms of depression account for this increased risk. Cases were matched to the next two same sex births from the population registry. Using standardized interviews, we ascertained symptoms of major depression to make a Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) diagnosis. A history of major depression was 1.7-fold more common among cases than among controls (95% confidence interval, 1.1-2.7). A history of attempted suicide was 5.1-fold more common among cases than among controls (95% confidence interval, 2.2-11.5). Attempted suicide increased seizure risk even after adjusting for age, sex, cumulative alcohol intake, and major depression or number of symptoms of depression. Major depression and attempted suicide independently increase the risk for unprovoked seizure. These data suggest that depression and suicide attempt may be due to different underlying neurochemical pathways, each of which is important in the development of epilepsy. © 2005 American Neurological Association.

Clinical problem solving: The case of John, part III - Drell, M.J.; Josephson, A.; Pleak, R.; Riggs, P.; Rosenfeld, A. (Journal of the American Academy of Child and Adolescent Psychiatry, 2006)

Advanced optical fuzing technology - Von Der Lippe, C.M.; Liu, J.J. (Proceedings of SPIE - The International Society for Optical Engineering, 2005)
We are developing a robust and compact photonic proximity sensor for munition applications. Successful implementation of this sensor will provide a new capability for direct fire applications. The photonic component development exploits pioneering work and unique expertise at ARDEC, ARL, and Sandia National Laboratories by combining key optoelectronic technologies to design and demonstrate components for this fuzing application. The technologies employed in the optical fuze design are vertical cavity surface-emitting lasers (VCSELs), the p-i-n or metal-semiconductor-metal (MSM) photodetectors, and miniature lenses optics. This work will culminate in a robust, fully integrated, g-hardened component design suitable for proximity fuzing applications. This compact sensor will replace costly assemblies that are based on discrete lasers, photodetectors, and bulk optics. It will be mass manufacturable and impart huge savings for such applications. The specific application under investigation is for gun-fired munitions. Nevertheless, numerous civilian uses exist for this proximity sensor in automotive, robotics and aerospace applications. This technology is also applicable to robotic ladar and short-range 3-D imaging.
Keywords: MSM photodetector; Optical fuze; Optoelectronic processing; Ranging; VCSEL

Are transgender persons at higher risk for HIV than other sexual minorities? A comparison of HIV prevalence and risks - Bockting, W.; Huang, C.-Y.; Ding, H.; Robinson, B.; Rosser, B.R.S. (International Journal of Transgenderism, 2005)
Recent studies have shown that transgender people are at high risk for HIV. Few studies, however, have directly compared the HIV risks and sexual health of transgender persons with that of other sexual minority populations. This study used baseline data of intervention studies targeting transgender persons, men who have sex with men, and women who have sex with women and men to compare their HIV risk behavior and sexual health. No significant differences were found between transgender persons and nontransgender men or women in consistent condom use or attitudes toward condom use. Transgender persons were less likely to have multiple partners and more likely to be monogamous than men who have sex with men; no differences were found between transgender persons and the women in this respect. When combining data on condom use, monogamy, and multiple partners, transgender persons did not differ from either nontransgender group in their overall risk for HIV. Transgender persons were less likely than the men or the women to have been tested for HIV. With regard to HIV prevalence, 17% of the men compared to only one transgender person and none of the women reported being HIV-positive. Transgender persons were also less likely than men who have sex with men to use drugs; no differences were found in the use of alcohol. However, with regard to mental health, transgender persons were more likely than the men to have experienced depression and more likely than men or women to have considered or attempted suicide. Finally, transgender persons reported the lowest levels of support from family and peers. Thus, in our sample, transgender persons appear to be at lower risk for HIV but at higher risk for mental health concerns than men who have sex with men. Remarkably few differences were found between transgender persons and women who have sex with women and men-a finding which might reflect the impact of social stigma on sexual health and have implications for the design of future HIV/STI prevention efforts. © 2005 by The Haworth Press, Inc. All rights reserved.
Keywords: Bisexual women; HIV risk; MSM; Sexual health; Transgender

Suicidality and associated risk factors among lesbian, gay, and bisexual compared to heterosexual Austrian adults - Plöderl, M.; Fartacek, R. (Suicide and Life-Threatening Behavior, 2005)
This is the first study in German-speaking countries to compare the suicidality of lesbian, gay, and bisexual adults (n = 358) with matched heterosexual adults (n = 267). The former had significantly elevated incidences of current suicide ideation (28% vs. 13%) and lifetime suicide attempts defined in three ways (14% vs. 1% to 10% vs. 2%), including higher incidences for most suicidality-related risk factors. Increased psychosocial stress and vulnerability is indicated, especially with respect to a lack of family support. Controlling for risk factors in multivariate analysis diminished the association of sexual orientation with current suicide ideation. © 2005 The American Association of Suicidology.

Predicting the suicide attempts of lesbian, gay, and bisexual youth - D'Augelli, A.R.; Grossman, A.H.; Salter, N.P.; Vasey, J.J.; Starks, M.T.; Sinclair, K.O. (Suicide and Life-Threatening Behavior, 2005)
In this study predictors of serious suicide attempts among lesbian, gay, and bisexual (LGB) youth were examined. Three groups were compared: youth who reported no attempts, youth who reported attempts unrelated to their sexual orientation, and youth whose attempts were considered related to their sexual orientation. About one third of respondents reported at least one suicide attempt; however, only half of the attempts were judged serious based on potential lethality. About half of all attempts were related to youths' sexual orientation. Factors that differentiated youth reporting suicide attempts and those not reporting attempts were greater childhood parental psychological abuse and more childhood gender-atypical behavior. Gay-related suicide attempts were associated with identifiability as LGB, especially by parents. Early openness about sexual orientation, being considered gender atypical in childhood by parents, and parental efforts to discourage gender atypical behavior were associated with gay-related suicide attempts, especially for males. Assessment of past parental psychological abuse, parental reactions to childhood gender atypical behavior, youths' openness about sexual orientation with family members, and lifetime gay-related verbal abuse can assist in the prediction of suicide attempts in this population. © 2005 The American Association of Suicidology.

God, guns and gays: Supply and demand of religion in the US and western Europe - Norris, P.; Inglehart, R. (Public Policy Research, 2005)

Health and social service needs of transgender people in Chicago - Kenagy, G.P.; Bostwick, W.B. (International Journal of Transgenderism, 2005)
A needs assessment of transgender people was conducted in Chicago in 2001 to assess their HIV risks, health and social service needs, and barriers to care. One hundred and eleven transgender individuals, 78 male-to-females (MTFs) and 33 female-to-males (FTMs), participated in the study. Fourteen percent of respondents reported being HIV-positive; they were all male-to-female and the majority was of color. Risk factors for HIV included unprotected sex and willingness to have high-risk sex in the future. Respondents experienced high levels of violence. Two-thirds of respondents had thought of attempting suicide. Respondents reported a high need for health and social services, particularly MTFs and people of color. © 2005 by The Haworth Press, Inc. All rights reserved.
Keywords: Barriers; Health; Services; Transgender

Sex, drugs, violence, and HIV status among male-to-female transgender persons in Houston, Texas - Risser, J.M.H.; Shelton, A.; McCurdy, S.; Atkinson, J.; Padgett, P.; Useche, B.; Thomas, B.; Williams, M. (International Journal of Transgenderism, 2005)
To inform the Community Planning Group (Houston, Texas) in setting HIV-prevention priorities, risk behavior surveys were completed by 67 male-to-female (MtF) transgender persons. By self-identification, 58% were preoperative and 48% were self-described heterosexual women. We found this small sample of male-to-female transgender individuals to have high rates of HIV infection, and high prevalence of risky behaviors, intimate partner violence, and suicidal ideation. Twenty-seven percent were infected with HIV. Barriers were seldom used during oral sex and used less than half the time for anal sex with either primary or casual partners. Nearly one-third of the sample reported use of methamphetamines, amyl nitrite or LSD and 40% reported crack or cocaine use. Intimate partner violence and forced sex were reported by 50% and 25%, respectively. Suicidal ideation was reported by 16% in the last 30 days; lifetime suicidal ideation was 60%. © 2005 by The Haworth Press, Inc. All rights reserved.
Keywords: Drug use; HIV prevention; HIV risk; Transgender; Violence

Death rather than disclosure: Struggling to be a real man - Cleary, A. (Irish Journal of Sociology, 2005)
Non-disclosure of distress emerged as a key issue in examining pathways to suicidal action for a group of men. Disclosure of difficulties was viewed as un-masculine, as implying weakness and this was associated with feminine or homosexual type behaviour. Constant performative work, including hyper-performances, was required to project an image of strength and to conceal growing levels of distress. When extreme, this challenged their sense of a coherent self-identity. Performances were directed at family, friends and work colleagues and this inhibited others from identifying and responding to the distress. © Irish Journal of Sociology.

Advanced high-bandwidth optical fuzing technology - Liu, J.J.; Von Der Lippe, C.M. (Proceedings of SPIE - The International Society for Optical Engineering, 2005)
A robust and compact photonic proximity sensor is developed for optical fuze in munitions applications. The design of the optical fuze employed advanced optoelectronic technologies including high-power vertical-cavity surface-emitting lasers (VCSELs), the p-i-n or metal-semiconductor-metal (MSM) photodetectors, SiGe ASIC driver, and miniature optics. The development combines pioneering work and unique expertise at ARDEC, ARL, and Sandia National Laboratories and synergizes the key optoelectronic technologies in components and system designs. This compact sensor will replace conventional costly assemblies based on discrete lasers, photodetectors, and bulky optics and provide a new capability for direct fire applications. It will be mass manufacturable in low cost and simplicity. In addition to the specific applications for gun-fired munitions, numerous civilian uses can be realized by this proximity sensor in automotive, robotics, and aerospace applications. This technology is also applicable to robotic ladar and short-range 3-D imaging.
Keywords: MSM photodetector; Optical Fuze; Optoelectronic processing; Ranging; VCSEL

Self-harm - Skegg, K. (Lancet, 2005)
The term self-harm is commonly used to describe a wide range of behaviours and intentions including attempted hanging, impulsive self-poisoning, and superficial cutting in response to intolerable tension. As with suicide, rates of self-harm vary greatly between countries. 5-9% of adolescents in western countries report having self-harmed within the previous year. Risk factors include socioeconomic disadvantage, and psychiatric illness - particularly depression, substance abuse, and anxiety disorders. Cultural aspects of some societies may protect against suicide and self-harm and explain some of the international variation in rates of these events. Risk of repetition of self-harm and of later suicide is high. More than 5% of people who have been seen at a hospital after self-harm will have committed suicide within 9 years. Assessment after self-harm includes careful consideration of the patient's intent and beliefs about the lethality of the method used. Strong suicidal intent, high lethality, precautions against being discovered, and psychiatric illness are indicators of high suicide risk. Management after self-harm includes forming a trusting relationship with the patient, jointly identifying problems, ensuring support is available in a crisis, and treating psychiatric illness vigorously. Family and friends may also provide support. Large-scale studies of treatments for specific subgroups of people who self-harm might help to identify more effective treatments than are currently available. Although risk factors for self-harm are well established, aspects that protect people from engaging in self-harm need to be further explored.

Sexual risk behavior and substance use among a sample of Asian Pacific Islander transgendered women - Operario, D.; Nemoto, T. (AIDS Education and Prevention, 2005)
We examined the prevalence and correlates of HIV-related sexual risk and substance use behaviors among Asian Pacific Islander (API) male-to-female (MTF) transgendered individuals, referred to here as API transgendered women. As part of a larger study on HIV risk among transgendered women of color (Nemoto, Operario, Keatley, Han, & Soma, 2004), a sample of 110 API transgendered women in San Francisco completed individual interviews, of which 13% reported being HIV-positive. In the past 30 days, one fifth of the sample engaged in unprotected receptive anal intercourse (URAI) with any male partner, nearly one half had sex while under the influence of substances, and over half used illicit drugs. In multivariate models, URAI was associated with commercial sex work (odds ratio [OR] = 4.23, 95% confidence interval [CI] = 1.10, 16.25) and previous attempted suicide (OR = 5.83, 95% CI = 1.02, 33.44). Sex under the influence of substances was associated with commercial sex work (OR = 3.35, 95% CI = 1.11, 10.13) and having a college degree (OR = 5.32, 95% CI = 1.34, 21.18). Illicit drug use was associated with commercial sex work (OR = 7.15, 95% = 2.26, 22.63). Findings suggest that API MTF transgenders are on the front line of HIV risk for the API community, and provide insight into factors within this group that might contribute to unsafe sex and substance use. © 2005 The Guilford Press.

Gender role, sexual orientation and suicide risk - Fitzpatrick, K.K.; Euton, S.J.; Jones, J.N.; Schmidt, N.B. (Journal of Affective Disorders, 2005)
Background: There has been interest in the relationship between homosexuality, gender role and suicide risk. Though homosexuals are more likely to identify as cross-gender, research has not simultaneously examined sexual orientation and gender role in assessing suicide risk. In the current study, the unique and interactive effects of sexual orientation and gender role were assessed in regard to suicidal ideation, related psychopathology and measures of coping. Methods: 77 participants were recruited from an undergraduate psychology subject pool (n = 47) or from gay, lesbian and transgender student organizations (n = 30) and assessed on measures of gender role, homosexuality, and psychopathology. Results: Consistent with expectations, cross-gender role (i.e., personality traits associated with the opposite sex) is a unique predictor of suicidal symptoms. Moreover, gender role accounted for more of the overall variance in suicidal symptoms, positive problem orientation, peer acceptance and support, than sexual orientation. After accounting for gender role, sexual orientation contributed little to the variance in suicidal symptoms, associated pathology and problem-solving deficits. There was no support for gender role by sexual orientation interaction effects. Limitations: The cross-sectional nature of the data limits statements regarding causality. Conclusions: Cross-gendered individuals, regardless of sexual orientation, appear to have higher risk for suicidal symptoms. Researchers and clinicians should assess gender role in evaluations of youth samples. © 2005 Elsevier B.V. All rights reserved.
Keywords: Gender role; Mood; Sexual orientation; Suicide

Sexual orientation and mental health in a birth cohort of young adults - Fergusson, D.M.; Horwood, L.J.; Ridder, E.M.; Beautrais, A.L. (Psychological Medicine, 2005)
Background. This paper sought to examine the relationship between sexual orientation and mental health in a New Zealand birth cohort studied to age 25 years. Method. The analysis is based on a sample of 967 participants (469 males; 498 females) in the Christchurch Health and Development Study. As part of this study information was gathered on: (a) measures of sexual orientation, same-sex behaviour and sexual attraction obtained at ages 21 and 25 years; (b) measures of mental disorders and suicidal behaviours over the interval 21-25 years; (c) measures of childhood and family background. Results. Latent class analysis was used to combine indicators of sexual orientation, same sex behaviour and attraction to form an empirically based classification of sexual orientation. The best-fitting model classified the sample into three groups: exclusively heterosexual orientation (87.6%); predominantly heterosexual but with same-sex inclinations or experience (9.6%); predominantly homosexual (2.8%). Proportionately more women than men were classified as predominantly heterosexual (14.2% v. 4.8% respectively) or predominantly homosexual (3.9% v. 1.5% respectively). Cohort members with a predominantly homosexual orientation had rates of mental disorder and suicidal behaviours that were between 1.5 and 12 times higher than for those with an exclusively heterosexual orientation. These associations persisted after adjustment for confounding. The associations between sexual orientation and mental health were more marked for males than females. Conclusions. The findings suggest a continuum of sexual preferences amongst young adults. Variations in sexual orientation were clearly associated with mental health. These associations tended to be stronger for males. © 2005 Cambridge University Press.

Restraining orders in California : A look at statewide data - Sorenson, S.B.; Shen, H. (Violence Against Women, 2005)
The authors tabulated statewide administrative data for all types of restraining orders. On June 6, 2003, there were 227,941 active restraining orders against adults in California; most were for domestic violence. Rates of restraining orders (i.e., restrained persons) were highest for men, African Americans, and 25- to 34-year-olds. In 72.2% of the orders, a woman was to be protected and a man was to be restrained; in 19.3%, the restrained and protected persons were of the same sex. Although state law prohibits the purchase or possession of a firearm by persons against whom a restraining order is issued, 9.2% of the orders documented no firearm restrictions. © 2005 Sage Publications.
Keywords: Domestic violence; Firearms; Restraining orders; Women's health

Suicidal masculinities - Scourfield, J. (Sociological Research Online, 2005)
Across the West, suicide rates in young men have been rising for some time. This trend has attracted considerable media attention and is often cited within media discourse as evidence of a 'crisis of masculinity'. The field of suicide research (or suicidology) is dominated by quantitative methodology, and although there has been research attention to the gendered character of suicidal behaviour, studies tend to compare 'men' as a group with 'women' as a group. There is also relatively little consideration within this literature of power relations and the social-political dimension of masculinities. This paper argues the case for a qualitative sociological approach to the study of gendered suicide and begins to outline a framework for understanding the diversity of suicidal masculinities. Connell's theoretical work on masculinities is used to analyse evidence from the suicidology literature. The framework includes consideration of when hegemonic masculinity fails; the subordinated masculinities of gay sexuality and mental illness; and control in intimate relationships.
Keywords: Autopsy; Crisis; Gender; Hegemonic; Masculinity; Men; Mental Health; Qualitative; Subordinated; Suicide

Beyond risk: Resilience in the lives of sexual minority youth - Russell, S.T. (Journal of Gay and Lesbian Issues in Education, 2005)
Several decades of research tell us that sexual minority youth are among those most at risk for the negative outcomes of frequent concern in the lives of young people: academic failure, emotional distress, compromised relationships, risk behavior, and suicidality. We know much less about resilience, the characteristics and factors that explain or predict the healthy adolescent and adult lives of most sexual minorities. How can we move,“beyond risk” to understanding resilience? I outline a context for the focus on risk in studies of sexual minority youth and then discuss the conceptual distinctions between risk, risk factors, risk outcomes, protective factors, and resilience. I argue that an important area for further research will be to identify risk and protective factors that are unique to sexual minority youth. Recent research on school-based harassment and victimization is used as an example of research on LGBT issues in education that is grounded in the history of risk while offering the potential for significant advances in thinking about resilience. © 2005, by The Haworth Press, Inc. All rights reserved.
Keywords: Adolescence; Education; Gay-straight alliances; Harassment; Mental health; Resilience; Risk; Schools; Sexual minority youth; Victimization

Psychological distress following suicidality among gay, lesbian, and bisexual youths: Role of social relationships - Rosario, M.; Schrimshaw, E.W.; Hunter, J. (Journal of Youth and Adolescence, 2005)
Longitudinal relations between past suicidality and subsequent changes in psychological distress at follow-up were examined among gay, lesbian, and bisexual (GLB) youths, as were psychosocial factors (e.g., self-esteem, social support, negative social relationships) that might mediate or moderate this relation. Past suicide attempters were found to have higher levels of depressive symptoms, anxious symptoms, and conduct problems at a later time than youths who neither attempted nor ideated. Psychosocial factors failed to mediate this relation. The interaction among past suicidality, social support, and negative relationships was associated with subsequent changes in all 3 psychological distress indicators 6 months later. Specifically, high levels of support (either from family or friends) or negative relationships were found to predict increased psychological distress among those with a history of suicide attempts, but not among youths without a history of suicidality. The findings suggest that GLB youths who attempt suicide continue to have elevated levels of psychological distress long after their attempt and they highlight the importance of social relationships in the youths' psychological distress at follow-up. © 2005 Springer Science + Business Media, Inc.
Keywords: Adolescents; Bisexual; Conduct problems; Gay; Lesbian; Longitudinal research; Negative social relationships; Psychological distress; Self-esteem; Social support; Suicidal ideation; Suicide attempts

Same-sex sexual orientation, childhood sexual abuse, and suicidal behavior in university students in Turkey - Eskin, M.; Kaynak-Demir, H.; Demir, S. (Archives of Sexual Behavior, 2005)
This questionnaire study investigated the prevalence of, and interrelationships among, self-reported same-sex sexual orientation, childhood sexual abuse, and suicidal behavior in 1262 university students in Turkey. Approximately 7% of the sample reported lifetime or current same-sex sexual attractions, 5% reported that they engaged in same-sex sexual behavior, and almost 2% self-identified as either homosexual or bisexual. Overall, almost 10% of the sample acknowledged some form of a same-sex sexual orientation. Twenty-eight percent of the participants reported at least one instance of sexual abuse during their childhood. Almost 42% of the students reported suicidal ideation during the past 12 months or lifetime, and 7% reported that they attempted to kill themselves during their lifetime or in the past 12 months. Five hypotheses about the interrelationships among same-sex sexual orientation, childhood sexual abuse, and suicidal behavior were developed and tested in the study. Self-reported childhood sexual abuse was associated with same-sex sexual behavior. Participants who engaged in same-sex sexual behavior and those who identified themselves as homosexual or bisexual perceived more distance between themselves and their fathers than those who did not. Being sexually abused by someone of one's own sex was related to same-sex sexual orientation in male participants but not in female participants. Childhood sexual abuse was found to be an independent predictor of both suicidal ideation and attempts during the past 12 months. Only identifying oneself as homosexual or bisexual was associated with an increased risk for suicidal ideation during the past 12 months. © 2005 Springer Science+Business Media, Inc.
Keywords: Childhood sexual abuse; Same-sex sexual orientation; Suicidal behavior; Turkey

Evaluation of a sexual health approach to reducing HIV/STD risk in the transgender community - Bockting, W.O.; Robinson, B.E.; Forberg, J.; Scheltema, K. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2005)
Despite reports of high prevalence of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) among the transgender community, very little prevention education has targeted this population. To fill this gap, we developed and evaluated a transgender-specific intervention, All Gender Health, which incorporates prevention strategies into comprehensive sexuality education. Transgender participants (N=181) attended the two-day seminar in community-based venues. The curriculum was delivered via lectures, panel discussions, videos, music, exercises and small group discussions. Attitudes toward condom use, safer sex self-efficacy and sexual risk behaviour were evaluated before participation in the intervention (pre-test), immediately after participation (post-test) and at three-month follow-up. Compared to pre-test values, significant improvements were seen in attitudes toward condom use and in safer sex self-efficacy at post-test, and in attitudes toward condom use, increased monogamy and decreased sexual risk behaviour at three-month follow-up. Pre-test data identified unprotected anal, vaginal and oral sex as the most commonly reported risk behaviours. Many respondents also indicated problems with social discrimination, depression, suicidal ideation and sexual functioning. Future interventions should address these risk co-factors. Alternative interventions need to be developed to target those who, as a result of social marginalization, are less likely to be reached with an intensive seminar-based intervention.

Affirmative, evidence-based, and ethically sound psychotherapy with lesbian, gay and bisexual clients - Safren, S.A. (Clinical Psychology: Science and Practice, 2005)
Writing from the perspective of heterosexual therapists treating lesbian, gay, and bisexual (LGB) individuals, Eubanks-Carter, Burckell, and Goldfried (this issue) provide important information on how to enhance therapeutic effectiveness with this population. Their manuscript is an example of a refreshing departure from historical views of homosexuality as a pathological psychological condition and from work that supports using therapy to change sexual orientation. Eubanks-Carter et al. document significant improvements both in the provision of psychotherapy, the view of LGB individuals from the mental health field, and the view of LGB individuals from the community. Despite these improvements, continued progress is still needed. The present commentary points to several areas where the science and practice of clinical psychology can further progress regarding the care of LGB clients. This includes improving systems in training and institutions that employ psychologists where bias or discrimination may exist and reducing biased language in psychological research that implies pathology towards homosexual sexual orientations when homosexuality is not a pathological condition. It also includes reducing or eliminating psychological harm that can be caused by psychological interventions that attempt to change sexual orientation by further restricting these practices. © American Psychological Association D12 2005; all rights reserved.
Keywords: Gay, lesbian and bisexual issues; Psychotherapy

Sertraline treatment caused elevated plasma prolactin concentrations in a transsexual patient with major depression - Wang, T.-S.; Chou, Y.-H. (Journal of Medical Sciences, 2005)
We report a depressive 20-year-old male-to-female transsexual whose plasma prolactin concentrations became elevated after receiving sertraline treatment (50 mg/day) for major depression. A dechallenge-rechallenge protocol demonstrated a sertraline-related endocrine effect. Thus, transsexual patients with major depression might develop increased prolactin secretion following sertraline treatment. Copyright © 2005 JMS.
Keywords: Depression; Prolactin; Sertraline; Transsexualism

Mental health of lesbian, gay, bisexual, and heterosexual siblings: Effects of gender, sexual orientation, and family - Balsam, K.F.; Beauchaine, T.P.; Mickey, R.M.; Rothblum, E.D. (Journal of Abnormal Psychology, 2005)
Self-identified lesbian, gay male, and bisexual (LGB) individuals were recruited via convenience sampling, and they in turn recruited their siblings (79% heterosexual, 19% LGB). The resulting sample of 533 heterosexual, 558 lesbian or gay male, and 163 bisexual participants was compared on mental health variables and their use of mental health services. Multilevel modeling analyses revealed that sexual orientation predicted suicidal ideation, suicide attempts, self-injurious behavior, use of psychotherapy, and use of psychiatric medications over and above the effects of family adjustment. Sexual orientation was unrelated to current psychological distress, psychiatric hospitalizations, and self-esteem. This is the 1st study to model family effects on the mental health of LGB participants and their siblings. Copyright 2005 by the American Psychological Association.
Keywords: Bisexual; Gay; Lesbian; Mental health; Sexual orientation

Homelessness and drug abuse among young men who have sex with men in New York city: A preliminary epidemiological trajectory - Clatts, M.C.; Goldsamt, L.; Yi, H.; Gwadz, M.V. (Journal of Adolescence, 2005)
The objective of this paper is to profile the role of homelessness in drug and sexual risk in a population of young men who have sex with men (YMSM). Data are from a cross-sectional survey collected between 2000 and 2001 in New York City (N = 569). With the goal of examining the import of homelessness in increased risk for the onset of drug and sexual risk, we compare and contrast three subgroups: (1) YMSM with no history of homelessness, (2) YMSM with a past history of homelessness but who were not homeless at the time of the interview, and (3) YMSM who were currently homeless. For each group, we describe the prevalence of a broad range of stressful life events (including foster care and runaway episodes, involvement in the criminal justice system, etc.), as well as selected mental health problems (including past suicide attempts, current depression, and selected help-seeking variables). Additionally, we examine the prevalence of selected drug and sexual risk, including exposure to a broad range of illegal substances, current use of illegal drugs, and prevalence of lifetime exposure to sex work. Finally, we use an event history analysis approach (time-event displays and paired t-test analysis) to examine the timing of negative life experiences and homelessness relative to the onset of drug and sexual risk. High levels of background negative life experiences and manifest mental health distress are seen in all three groups. Both a prior experience of homelessness and currently being homeless are both strongly associated with both higher levels of lifetime exposure to drug and sexual risk as well as higher levels of current drug and sexual risk. Onset of these risks occur earlier in both groups that have had an experience of housing instability (e.g., runaway, foster care, etc.) but are delayed or not present among YMSM with no history of housing instability. Few YMSM had used drug prior to becoming homeless. While causal inferences are subject to the limitations of a cross-sectional design, the findings pose an empirical challenge to the prevailing assumption that prior drug use is a dominant causal factor in YMSM becoming homeless. More broadly, the data illustrate the complexity of factors that must be accounted for, both in advancing our epidemiological understanding of the complexity of homelessness and its relationship to the onset of drug and sexual risk among high risk youth populations. © The Association for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Acting (to) out: Approaching homosexuality in a 15-year-old boy with anxiety and depression - Jackson, J.A.; Telingator, C.J.; Pleak, R.R.; Pollack, W.S. (Harvard Review of Psychiatry, 2005)
Keywords: Adolescence; Child psychiatry evaluation; Gay; Gender identity; Homosexuality; Internet

Bullying and peer victimization: Position paper of the Society for Adolescent Medicine - Eisenberg, M.E.; Aalsma, M.C. (Journal of Adolescent Health, 2005)

Transgender health: Findings from two needs assessment studies in Philadelphia - Kenagy, G.P. (Health and Social Work, 2005)
HIV/AIDS, suicide, violence, and barriers to health care access among transgender people were explored using two needs assessment surveys conducted in Philadelphia in 1997. A total of 182 people responded to a face-to-face interview or self-administered mail survey: 113 male-to-female individuals and 69 female-to-male individuals. About three-fifths of respondents had engaged in unprotected sexual activity during the past 12 months. The risk for HIV infection from unprotected sex was significantly higher among respondents of color than among white respondents. About one-third (30.1 percent) of respondents had attempted suicide. More than half of respondents had been forced to have sex, 56.3 percent had experienced violence in their homes, and 51.3 percent had been physically abused. Twenty-six percent of respondents had been denied medical care because they were transgender. These findings suggest that prevention services that specifically address HIV/AIDS, suicide, and violence among transgender people are urgently needed. © 2005 National Association of Social Workers.
Keywords: Health barriers; HIV/AIDS; Suicide; Transgender; Violence

A needs assessment of transgendered people of color living in Washington, DC - Xavier, J.M.; Bobbin, M.; Singer, B.; Budd, E. (International Journal of Transgenderism, 2005)
A needs assessment (N = 248) conducted in Washington, DC, revealed that transgendered people of color are at high risk for HIV/AIDS, substance abuse, suicide and violence/crime victimization. Overall HIV prevalence was 25%, with 32% in natal males (MTFs, i.e., male-to-females). Four predictors for HIV positive status were identified through logistic regression-male sex at birth, a history of substance abuse, sexual assault, and unemployment. Substance abuse was found in nearly half the sample (48%) but only half of those (51%) had sought treatment for it. Thirty-eight percent reported experiencing suicidal ideation, with 63% of those attributing it to their gender issues. Of those with suicidal ideation, nearly half (49%, or 16% of the entire sample), went on to make attempt(s) to kill themselves. Forty-three percent had been victims of violence or crime, including 13% who had been sexually assaulted. Knowledge of the Standards of Care of the Harry Benjamin International Gender Dysphoria Association was quite low (9%) and associated with white race, any higher education beyond high school, and access to sex reassignment surgery (SRS). Access to SRS, defined as obtaining vaginoplasties for natal males and chest surgeries for natal females, was just 4%. White race (versus all other races, p < .001) and female at birth (versus male, p < .01) were significantly associated with access to SRS. Use of hormones at some point during their lives was reported by 51% of participants. Thirty-five percent were currently taking hormones, with 72% acquiring their hormones from friends or on the street. Among natal males, 25% had injected silicone. Nineteen percent did not have their own living space, and employment, housing and job training were the most commonly-reported immediate needs of the sample. The results of this needs assessment provide evidence of an urgent need for increased medical and social services specific to transgendered people of color living in the District of Columbia. © 2005 by The Haworth Press, Inc. All rights reserved.
Keywords: African American; Health and social services; Hispanic; HIV/AIDS; Transgender people of color

Young People, Gender and Suicide: A Review of Research on the Social Context - Smalley, N.; Scourfield, J.; Greenland, K. (Journal of Social Work, 2005)
Summary: The paper reviews some recent research on the social context of suicide in young people, with particular reference to evidence about the gendered character of suicidal behaviour. Some implications for social work and social policy are discussed. Findings: Key messages from the research reviewed are presented in relation to some specific social domains. These are employment, social cohesion and social comparison, mental illness, family and relationships, sexual orientation and help-seeking. Applications: This review is especially of use to those in the social work field who are not familiar with the large body of research on the social context of youth suicide in the medical and psychological literature. There is some discussion in the article of the implications of this research for suicide prevention, both in terms of policy and in terms of the practices of individual social workers. © 2005, Sage Publications. All rights reserved.
Keywords: gender; review; suicide; youth

HIV Prevalence and correlates of receptive needle sharing among injection drug users inthe mexican-U.S. Border city of tijuana - Magis-Rodríguez, C.; Brouwer, K.C.; Morales, S.; Gayet, C.; Lozada, R.; Ortiz-Mondragón, R.; Ricketts, E.P.; Strathdee, S.A. (Journal of Psychoactive Drugs, 2005)
Injection drug use is a growing but understudied problem in Tijuana, a city situated on the northwestern Mexico-U.S border. The authors studied factors associated with receptive needle sharing in an effort to inform prevention activities. In 2003, street-recruited injection drug users (IDUs) in Tijuana underwent interviews on injection risk behaviors and rapid HIV antibody tests. Logistic regression was used to identify correlates of receptive needle sharing at the last injection episode. Of 402 IDUs, 87.6% were male; the median age was 34. HIV prevalence was 4.01% (95%CI: 2.29–6.51). One third reported receptive needle sharing at last injection. Factors independently associated with receptive needle sharing were years living in Tijuana (Adjusted Odds Ratio [AdjOR]= 0.97 per year, 95% CI: 0.96–0.99), being bisexual/homosexual (AdjOR=2.12; 95% CI: 1.30 – 3.44), unemployed (AdjOR=2.5; 95% CI: 1.52–4.10), never having an HIV test (AOR: 4.02; 95% CI: 2.44–6.60), having friends who placed importance on avoiding HIV (AdjOR: 0.36; 95% CI: 0.19–0.68) and last injecting in a shooting gallery (AdjOR=l.98; 95% CI: 1.21–3.24). These results underscore the need to increase access to voluntary HIVtesting and counseling to IDUs and migrants in Tijuana, as wellas expand access to sterile syringes in an effort to avert widespread HIV transmission. © 2005 Taylor and Francis Group, LLC.
Keywords: Border; HIV testing; HIV/AIDS; Injection drug use; Mexico; Needle sharing

Youth risk behavior survey: Bangkok, Thailand - Ruangkanchanasetr, S.; Plitponkarnpim, A.; Hetrakul, P.; Kongsakon, R. (Journal of Adolescent Health, 2005)
Purpose: To identify the prevalence of risk behaviors and related risk factors in adolescents in Bangkok, Thailand. Methods: Youth risk behavior survey questionnaires were collected from 2311 adolescents in 8 schools, 13 communities and 2 Juvenile Home Institutions from January to February 2001. Their mean age was 15.5 ± 1.8 years, and 59% were female. Risk factors of interest were gender, parental marital status, socioeconomic status, family relationship, parental drug addiction, peer group, loneliness, self-esteem, and school performance. Multiple logistic regression was used to identify significant risk factors associated with each risk behavior. Results: The risk behaviors leading to traffic accidents were rarely or never having worn a seat belt (30.6%) or helmet while bicycling (66.9%) and while motorcycling (50.1%), riding with drivers who had consumed alcohol (18.8%), and driving after consuming alcohol (12.1%). The studied group carried weapons (8.5%) and has been involved in a violent event (31.5%). Among 13.9% who were assaulted, 6.7% needed hospitalization; rape was reported by 2.4%. Depression was reported by 19.9%, with 12% having suicidal tendencies and 8% attempting suicide. The lifetime use vs. heavy use prevalence of substance abuse, respectively, was: 15.4% and 3.5% for smoking, 37.3% and 1.7% for alcohol, 37.8% and 4.6% for amphetamine use, and 37.9% and 0.1% for other drugs. Among the 10% who have had sexual intercourse, 1% were homosexual, 7.1% have never used a condom, and 2.1% resulted in pregnancy. Being male was a risk factor for every untoward behavior except depression. Other risk factors included poor self-esteem, poor school performance, and early school leaving. Factors relating to the family included a low socioeconomic status, poor relationships, broken families, and parental substance abuse. Socioenvironmental factors included being in a gang and loneliness. Some risk behaviors started at younger than 8 years old. Schools and media were given as the sources of information regarding sex, human immunodeficiency virus infection, and substance abuse. Conclusions: The prevalence of six major-risk behaviors in adolescents in Bangkok was significantly high. Several risk factors were identified, the knowledge from which may help to form preventive measures in this population. © 2005 Society for Adolescent Medicine. All rights reserved.
Keywords: Adolescents; Bangkok; Risk behaviors; Risk factors; Thailand

The structure of conventional morality - Devine, P. (International Philosophical Quarterly, 2005)
In recent years, analytically trained philosophers have given extensive attention to various issues involved in the "culture wars," including abortion, same-sex marriage, stem-cell research, and assisted suicide. There are, however, moral judgments that virtually no one questions. Defenses of adult-child sex, for example, are rare. There is also "conventional immorality" - the breach of conventional moral standards within roughly defined limits that at least limit the resulting damage to third parties and social institutions. These phenomena frame moral discussion even when, as often happens, conventional people are in serious moral disagreement. In this essay I try to make sense of the phenomenon; in a subsequent essay I will show how conventional morality contains within itself the seeds of its collapse, and hence requires support from human nature, either rationally discovered or understood through revelation accepted in faith.

Drowning in early Dickens - Cregan-Reid, V. (Textual Practice, 2005)
Drowning was a Victorian obsession, and Charles Dickens' use of it as a trope was both paradigmatic and extraordinary. Like many other novelists of the Victorian period, Dickens repeatedly drowned his characters, but his use of death by water was different to that of his contemporaries because of the sheer frequency with which he employed the trope. Moreover, the most-common trope of drowning was usually that of the suicidal woman, but of the thirty-something characters that drown in the Dickensian canon, none are women. This article addresses why Dickens' texts seem to be out of step with the Victorian metaphorical economy while also exploring the ways in which nineteenth-century water has been simplistically gendered in recent criticism. The work of Helen V. Emmit, Mary Jane Lupton, and others has historically situated water as unproblematically feminine, and drowning as a return to the womb. However, the Dickensian canon throws up a number of examples which imply that the gender status of water was much more mutable than previous studies have suggested; consequently, there is nothing epistemologically or phenomenologically clear about Dickensian waters. The article concludes by suggesting that, for the mid- to late Victorians, drowning was metonymically linked with coitus, and consequently had developed an active role and fluctuating sexual identity in the drowning of its victims by selecting, luring, clasping, and violating; and finally transforming, assimilating and obliterating its drownees. © 2005 Taylor & Francis Ltd.
Keywords: Dickens; Drowning; Queer; Quilp; Thames; Water

The health and psycho-social consequences of ketamine use - Copeland, J.; Dillon, P. (International Journal of Drug Policy, 2005)
Ketamine is a non-competitive NMDA receptor antagonist that acts as a dissociative anaesthetic with analgesic and amnestic properties. Ketamine has broad areas of application and is a rapidly acting, relatively safe analgesic and anaesthetic agent, particularly for children and is widely used in veterinary practice. Ketamine can induce schizophrenic-like symptoms in healthy adults and schizophrenic patients. It has a wide margin of safety and there are very few cases of pure ketamine overdose recorded, with the majority of deaths due to the dangerous activities or contexts of its use. Information on ketamine is not routinely collected in population surveys and morbidity and mortality data collections. Levels of use in the general population, however, appear to be very low with higher levels in groups with access to the drug, medical and veterinarian professionals, and party drug users. There are a number of potential ketamine effects that may be seen as adverse or harmful, with growing evidence of the physical and psychological symptoms of ketamine dependence among recreational ketamine users. A withdrawal syndrome, including psychotic features, is beginning to be described. The use of ketamine with other neurotoxic drugs, such as alcohol, should be avoided. Increased rates of high risk sexual and injecting behaviours in association with ketamine use, however, have been reported by gay men and marginalised youth in the US. In conclusion, ketamine does not appear to currently pose a significant public health risk, however, at the individual level the usual harm minimisation strategies should be observed. © 2005 Elsevier B.V. All rights reserved.
Keywords: Anaesthetic; Club drug; Dependence; Harms; Ketamine

Recollections of bullying at school and their long-term implications for lesbians, gay men, and bisexuals - Rivers, I. (Crisis, 2004)
This study explores the relationship between experiences of bullying at school, adult mental health status, and symptoms of posttraumatic stress among a sample of 119 UK residents who identified as lesbian, gay, or bisexual. Participants completed a series of questionnaires that focused upon school experiences, suicide ideation at school, sexual history, relationship status and negative affect, recent positive and negative life-events, internalized homophobia, and symptoms associated with posttraumatic stress. The results suggested that posttraumatic stress was a potential issue for 17% of participants who also scored significantly higher for depression, and reported having had more casual sexual partners than their peers. However, those who were found to exhibit symptoms of posttraumatic stress were also more accepting of their sexual orientation. A small number of participants used prescription or nonprescription drugs, or alcohol to help them cope with memories of bullying. It is suggested that posttraumatic stress may be a feature of the adult lives of men and women who experienced frequent and prolonged bullying at school as a result of their actual or perceived sexual orientation.
Keywords: Bisexual; Bullying; Gay; Homophobia; Lesbian; Memories

Differences between matched heterosexual and non-heterosexual college students on defense mechanisms and psychopathological symptoms - Biernbaum, M.A.; Ruscio, M. (Journal of Homosexuality, 2004)
Differences between heterosexual and non-heterosexual college students on measures of defense mechanisms and psychopathological symptoms were examined. Fifty-six (28 heterosexual, 28 non-heterosexual) subjects were drawn from a larger study of college student adjustment. Non-heterosexual subjects were matched to a heterosexual peer on several demographic variables as well as on attachment security/insecurity. Differences between the two groups on the Defense Mechanism Inventory and the Brief Symptom Inventory were tested. Contrary to traditional psychoanalytic conceptions of homosexuality, no differences were found between the two groups on any subscale of the Defense Mechanism Inventory, thereby repudiating one important aspect of traditional psychoanalytic theories on the development of homosexuality. Non-heterosexual students reported significantly higher levels of anxiety, depression, somaticization, paranoid ideation, general symptom severity, and suicidal ideation. These students appear to be at increased risk for psychopathology and suicidal ideation, despite similar defense profiles, when compared to matched heterosexual peers. Additional research is needed to determine the origins of this increased risk, and comprehensive and targeted prevention and intervention programs must be established to ameliorate such risks. © 2004 by The Haworth Press, Inc. All rights reserved.
Keywords: College students; Defense mechanisms; Homosexuality; Psychoanalytic theory; Psychopathology; Suicide

Rates and predictors of mental illness in gay men, lesbians and bisexual men and women: Results from a survey based in England and Wales - Warner, J.; McKeown, É.; Griffin, M.; Johnson, K.; Ramsay, A.; Cort, C.; King, M. (British Journal of Psychiatry, 2004)
Background: There is a dearth of research into the mental health of gay men, lesbians and bisexual men and women in the UK. Aims: To assess rates and possible predictors of mental illness in these groups. Method: A comprehensive assessment was made of the psychological and social well-being of a sample of gay men, lesbians and bisexual men and women, identified using 'snowball' sampling. Results: Of the 1285 gay, lesbian and bisexual respondents who took part, 556 (43%) had mental disorder as defined by the revised Clinical Interview Schedule (CIS-R). Out of the whole sample, 361 (31%) had attempted suicide. This was associated with markers of discrimination such as recent physical attack (OR=1.7, 95% CI 1.3-2.3) and school bullying (OR=1.4, 95% CI 1.1-2.0), but not with higher scores on the CIS-R. Conclusions: Gay, lesbian and bisexual men and women have high levels of mental disorder, possibly linked with discrimination.

Lesbian use and abuse of alcohol: Results of the Boston Lesbian Health Project II - Roberts, S.J.; Grindel, C.G.; Patsdaughter, C.A.; DeMarco, R.; Tarmina, M.S. (Substance Abuse, 2004)
The Boston Lesbian Health Project II, a national survey of 1139 self-identified lesbian women, found higher rates of drinking alcohol, heavy alcohol intake and self reported alcoholism than in national studies of women in general. Several known risk factors for alcoholism were higher in lesbians who self defined as alcoholic in this sample: family history of alcoholism and drug abuse, rape and childhood sexual abuse and report of having made a suicide attempt. These findings are consistent with other studies that found a high rate of drinking alcohol, alcohol abuse and problem drinking among lesbians. The reasons for these findings are not clear and further research is needed to continue to explore the reasons. © 2004 by The Haworth Press, Inc. All rights reserved.
Keywords: Alcohol; Alcohol abuse; Lesbian

Covert cultural sexual abuse of gay male teenagers contributing to etiology of sexual addiction - Kort, J. (Sexual Addiction and Compulsivity, 2004)
Gay male teenagers are at high risk for the development of sexual addiction. There exists a regular assault on the sexuality of gay males. This covert cultural sexual abuse suffered by these gay adolescents predisposes them to reenact this trauma through sexual acting out. The trauma model is useful in conceptualizing how to treat this population and address the post traumatic stress disorder suffered from the cultural victimization of homophobia and heterosexism. Copyright © Taylor & Francis, Inc.

The attitudes of australian heterosexual university students toward the suicide of gay, lesbian and heterosexual peers - Molloy, M.; McLaren, S. (Journal of Gay and Lesbian Issues in Education, 2004)
This study sought to examine the attitudes of heterosexual university students to peer suicide when that peer was gay, lesbian, or heterosexual. University students (n = 206) completed several questionnaires, including The Suicide Attitude Vignette Experience. Results indicated that the suicide act was seen as more justified, acceptable, and necessary when the adolescent was gay or lesbian. Further, gay and lesbian youth suicide victims were shown significantly less empathy than heterosexual suicide victims. Participants' level of homophobia was found to be a significant predictor of attitudes toward gay and lesbian youth suicide. Results indicate that the peer group of gay and lesbian youth is unsupportive of their sexual orientation, and these attitudes may be an additional risk factor for gay and lesbian youth suicide. © 2004, by The Haworth Press, Inc. All rights reserved.
Keywords: Attitudes; Australia; Homophobia; Suicide; Undergraduate students

The effects of sexual orientation, gender identity, and gender role on the mental health of women in taiwan's t-po lesbian community - Kuang, M.-F.; Mathy, R.M.; Carol, H.M.; Nojima, K. (Journal of Psychology and Human Sexuality, 2004)
We obtained via the Internet a convenience sample of Taiwanese heterosexual (n = 287) and sexual minority females (n = 260). A significantly greater percentage of sexual minorities (lesbian and bisexual females) than heterosexuals reported they had used tobacco or alcohol. Relative to heterosexuals, sexual minorities were significantly more likely to report a serious suicide attempt. Overall, gender identity (masculine, feminine, and androgynous) and gender role (butch, femme, and pure or undifferentiated) were poor discriminators of lesbian mental health. Differences between sexual minorities and heterosexuals were more robust than were the variations in gender identities and gender roles among lesbian and bisexual women. We discuss the implications of these findings for further clinical research. © 2003 Taylor & Francis Group, LLC.
Keywords: Gender; Lesbian; Mental health; Suicide attempt; Taiwan

The impact of religiosity on lesbian and bisexual women's psychosexual development: Child maltreatment, suicide attempts, and self-disclosure - Mathy, R.M. (Journal of Psychology and Human Sexuality, 2004)
We examined the relation between religiosity (importance of religion) and child maltreatment, psychosexual development, self-disclosure of homosexuality and reactions to same with two samples of sexual minority women (Internet n = 84, Coffee House n = 92) obtained with block sampling designs. Extremely important religiosity currently was associated with precocious psychosexual development and self-disclosure in the Internet sample only. Very important religiosity currently was associated with psychosexual development and self-disclosure of minority sexual orientation at significantly older ages. We discuss these results in the context of arguments that religiosity may be a risk factor for sexual minorities. Although not a risk factor in our samples, religiosity appeared to have lost the protective influence observed in studies of the general population. © 2003 Taylor & Francis Group, LLC.
Keywords: Child abuse; Lesbian; Psychosexual development; Religiosity; Suicide attempt

The impact of community size on lesbian and bisexual women's psychosexual development: Child maltreatment, suicide attempts, and self-disclosure - Mathy, R.M.; Schillace, M.; Carol, H.M. (Journal of Psychology and Human Sexuality, 2004)
We tested competing hypotheses about the impact of rural-urban gradients on sexual minorities with a public Internet chat room sample (n = 82) and a community-owned coffee house sample (n = 92). We found associations between rural-urban gradient and reports of paternal maltreatment as a child as well as self-disclosure of sexual orientation to a family member. In the coffee house sample, rural-urban gradient mediated the mean age at which participants self-disclosed their sexual orientation to another person, close friend, family member, and parent, though it was associated in the Internet sample only with disclosure of sexual orientation to a family member. Rural-urban gradient was not associated with suicidal intent or victimization. © 2003 Taylor & Francis Group, LLC.
Keywords: Child abuse; Lesbian; Psychosexual development; Religiosity; Suicide

Mental health implications of same-sex marriage: Influences of sexual orientation and relationship status in canada and the united states - Mathy, R.M.; Kerr, S.K.; Lehmann, B.A. (Journal of Psychology and Human Sexuality, 2004)
Marriage is a mental health protective factor and homosexuality is sometimes a risk factor. The combined effect of these factors on mental health was examined in this study. We conducted a secondary analysis of an international, cross-sectional survey completed in 2000 (N = 7,616). We examined risks of suicide ideations and attempts, behavioral problems, and treatment histories for male and female participants from Canada and the United States. We found significant relations between sexual orientation and suicidality in all four gender-country groups. We found significant associations between relationship status and suicidality for men but not women in both countries. Behavioral problems and treatment histories were equivocal. We discuss the mental health implications of these findings for same-sex marriage. © 2003 Taylor & Francis Group, LLC.
Keywords: Attempted suicide; Bisexual; Homosexual; Marriage; Service utilization

A review of lesbian depression and anxiety - Kerr, S.K.; Emerson, A.M. (Journal of Psychology and Human Sexuality, 2004)
The Surgeon General's first report on mental health identified depression and anxiety as significant mental health issues that disproportionately affect women. Research indicates that lesbians experience depression at rates that parallel those of the general female population, suggesting that depression is an important mental health issue for lesbians. Given the high rate of comorbidity between depression and anxiety disorders, it is likely that many depressed lesbians have struggled with problems related to anxiety as well. This paper reviews literature pertaining to lesbians and depression including incidence rates, risk factors, suicidality and treatment approaches, and stress and anxiety that may also contribute to the experience of depression among lesbians. © 2003 Taylor & Francis Group, LLC.
Keywords: Anxiety; Depression; Lesbian; Review

The saga of untreated congenital adrenal hyperplasia - Jones Jr., H.W. (Journal of Pediatric Endocrinology and Metabolism, 2004)
Keywords: Female pseudohermaphroditism; Genital ambiguity; Intersex

Goodbye note to my lover - Gibson, M. (Journal of Lesbian Studies, 2004)
Imagining the aftermath of her own suicide, the speaker says goodbye to her lover, apologizing for leaving and for the aggressive nature of the act. Before the apology, the speaker reminds herself of the way her own demons inserted themselves into the relationship, interfering with the sexual and emotional passion she shares with her lover. © 2004 by The Haworth Press, Inc. All rights reserved.
Keywords: Depression; Lesbian; Lovers; Sadness; Suicide

Major depressive disorder, suicidal ideation, and suicide attempt in twins discordant for cannabis dependence and early-onset cannabis use - Lynskey, M.T.; Glowinski, A.L.; Todorov, A.A.; Bucholz, K.K.; Madden, P.A.F.; Nelson, E.C.; Statham, D.J.; Martin, N.G.; Heath, A.C. (Archives of General Psychiatry, 2004)
Background: Previous research has reported both a moderate degree of comorbidity between cannabis dependence and major depressive disorder (MDD) and that early-onset cannabis use is associated with increased risks for MDD. Objective: To examine whether associations between both lifetime cannabis dependence and early cannabis use and measures of MDD, suicidal ideation, and suicide attempt persist after controlling for genetic and/or shared environmental influences. Design: Cross-sectional survey of twin pairs discordant for lifetime cannabis dependence and those discordant for early cannabis use. Setting: General population sample of twins (median age, 30 years). Participants: Two hundred seventy-seven same-sex twin pairs discordant for cannabis dependence and 311 pairs discordant for early-onset cannabis use (before age 17 years). Main Outcome Measures: Self-report measures of DSM-IV-defined lifetime MDD, suicidal ideation, and suicide attempt. Results: Individuals who were cannabis dependent had odds of suicidal ideation and suicide attempt that were 2.5 to 2.9 times higher than those of their non-cannabis-dependent co-twin. Additionally, cannabis dependence was associated with elevated risks of MDD in dizygotic but not in monozygotic twins. Those who initiated cannabis use before age 17 years had elevated rates of subsequent suicide attempt (odds ratio, 3.5 [95% confidence interval, 1.4-8.6]) but not of MDD or suicidal ideation. Early MDD and suicidal ideation were significantly associated with subsequent risks of cannabis dependence in discordant dizygotic pairs but not in discordant monozygotic pairs. Conclusions: Comorbidity between cannabis dependence and MDD likely arises through shared genetic and environmental vulnerabilities predisposing to both outcomes. In contrast, associations between cannabis dependence and suicidal behaviors cannot be entirely explained by common predisposing genetic and/or shared environmental predispositions: Previously reported associations between early-onset cannabis use and subsequent MDD likely reflect shared genetic and environmental vulnerabilities, although it remains possible that early-onset cannabis use may predispose to suicide attempt.

Ethics and the proposed treatment for a 13-year-old with atypical gender identity - Spriggs, M.P. (Medical Journal of Australia, 2004)

Who are the kids who self-harm? An Australian self-report school survey - De Leo, D.; Heller, T.S. (Medical Journal of Australia, 2004)
Objective: To determine the prevalence and types of deliberate self-harm (DSH) in adolescents, and associated factors. Design: A cross-sectional questionnaire study. Participants and setting: 3757 of 4097 Year 10 and Year 11 students (91.7%) from 14 high schools on the Gold Coast, Queensland, during September 2002. Main outcome measures: DSH behaviour, including descriptions of the last act, psychological symptoms, recent stressors, coping styles, help-seeking behaviour, lifestyle choices, and self-prescribing of medications. Results: 233 students (6.2%) met the criteria for DSH in the previous 12 months, with DSH more prevalent in females than males (OR, 7.5; 95% CI, 5.1-10.9). The main methods were self-cutting (138 respondents; 59.2%) and overdosing with medication (69 respondents; 29.6%). Factors associated with DSH included similar behaviours in friends or family, coping by self-blame, and self-prescribing of medications. Most self-harmers did not seek help before or after their most recent action, with those who did primarily consulting friends. Conclusions: DSH is common in Australian youth, especially in females. Preventive programs should encourage young people to consult health professionals in stressful situations.

Sex race/ethnicity, and romantic attractions: Multiple minority status adolescents and mental health - Consolacion, T.B.; Russell, S.T.; Sue, S. (Cultural Diversity and Ethnic Minority Psychology, 2004)
This study examined the association between multiple minority statuses and reports of suicidal thoughts, depression, and self-esteem among adolescents. Data from the National Longitudinal Study of Adolescent Health were used to examine mental health outcomes across racial/ethnic groups for same-sex-attracted youths and female youths. Hispanic/Latino, African American, and White female adolescents reported more suicidal thoughts, higher depression, and lower self-esteem compared with male adolescents in their racial/ethnic group. Same-sex-attracted youths did not consistently demonstrate compromised mental health across racial/ethnic groups. Follow-up analyses show that White same-sex-attracted female adolescents reported the most compromised mental health compared with other White adolescents. However, similar trends were not found for racial/ethnic minority female youths with same-sex attractions.
Keywords: Adolescent mental health; Adolescents; Multiple minority status; Racial/ethnic minority youths; Sexual minority youths

In vitro multiplication in Kaempferia galanga Linn - Swapna, T.S.; Binitha, M.; Manju, T.S. (Applied Biochemistry and Biotechnology - Part A Enzyme Engineering and Biotechnology, 2004)
Kaempferia galanga is an important medicinal plant that is facing threat of extinction owing to indiscriminate and unsustainable harvesting in the wild. Conventional breeding is difficult in this plant, and in vitro multiplication is important to conservation and propagation. Leaf and rhizome explants of Kaempferia were aseptically cultured on MS medium with various combinations of indole-3-acetic acid (IAA), benzyl amino purine (BAP), napthalene acetic acid (NAA), 2-4-dichlorophenoxy acetic acid (2,4-D) and kinetin at concentrations ranging from 0.5 to 2.5 mg/L. High-frequency organogenesis and multiple shoot regeneration was induced from rhizome explants on MS medium supplemented with 0.5 mg/L of IAA and 2.5 mg/L of BAP. Rooting was induced in MS medium with 0.5 mg/L of IAA and 2 mg/L of BAP.
Keywords: In vitro propagation; Kaempferia galanga; Medicinal plants; Multiple shooting; Organogenesis

Bisexual and transgender identities in a nonclinical sample of north americans:Sucidal intent, behavioral difficulties, and mental health treatment - Mathy, R.M.; Lehmann, B.A.; Kerr, D.L. (Journal of Bisexuality, 2004)
We hypothesized that a higher proportion of bisexual females (n = 792) and transgender individuals (n = 73) than bisexual males (n = 1,457) would self-report suicidal intent, behavioral difficulties, and mental health treatment. Relative to bisexual males, bisexual females and transgender individuals had significantly higher prevalence rates of suicidal intent, mental health difficulties, and mental health services. Prevalence rates among transgender participants did not vary by sexual orientation. The findings suggest that sexism and heterosexism have an interactive effect that compounds the social weight of oppression and increases risks for overwhelming sexual minorities’ adaptive functioning. © 2004, Taylor & Francis Group, LLC. All rights reserved.
Keywords: Bisexual; Discrimination; Mental health; Suicide; Transgender

Distress and Depression in Men Who Have Sex with Men: The Urban Men's Health Study - Mills, T.C.; Paul, J.; Stall, R.; Pollack, L.; Canchola, J.; Chang, Y.J.; Moskowitz, J.T.; Catania, J.A. (American Journal of Psychiatry, 2004)
Objective: This study estimates the prevalence of depression and describes the correlates and independent associations of distress and depression among U.S. men who have sex with men. Method: A household-based probability sample of men who have sex with men (N=2,881) was interviewed between 1996 and 1998 in four large American cities. With cutoff points of 15 and 22 for the Center for Epidemiological Studies Depression Scale, individual correlates and predictors of distress and depression were examined, and multinomial logistic regression was performed. Results: The 7-day prevalence of depression in men who have sex with men was 17.2%, higher than in adult U.S. men in general. Both distress and depression were associated with lack of a domestic partner; not identifying as gay, queer, or homosexual; experiencing multiple episodes of antigay violence in the previous 5 years; and very high levels of community alienation. Distress was also associated with being of other than Asian/Pacific Islander ethnicity and experiencing early antigay harassment. Depression was also associated with histories of attempted suicide, child abuse, and recent sexual dysfunction. Being HIV positive was correlated with distress and depression but not significantly when demographic characteristics, developmental history, substance use, sexual behavior, and current social context were controlled by logistic regression. Conclusions: Rates of distress and depression are high in men who have sex with men. These high rates have important public health ramifications. The predictors of distress and depression suggest prevention efforts that might be effective when aimed at men who have sex with men.

Risk factors of gay, lesbian, and bisexual adolescents: Review of empirical literature and practice implications - Thompson, S.J.; Johnston, L. (Journal of Human Behavior in the Social Environment, 2004)
Many researchers of gay, lesbian, and bisexual adolescents describe them as an “invisible” minority. These youth are alsoone of the most “at risk” youth populations, as they often experience a range of problems related to society’s stigmatization of same-sex orientation. Although sexual orientationis not necessarily related to heightened difficulties, lack of social support, infrequentpositive interactions, and chronic stress may lead to increased problem behaviors for these youth. To further understand the risk and protectivefactors experienced by sexual minority adolescents, this article explores a number of these factors and reviews the current empirical research on specific topics, including: family, peer and school, substance use, suicide, and HIV/AIDS issues. Finally, practice implications are discussedto guide clinicians in working more effectively with this youth population. © 2003 Taylorand Francis Group, LLC.
Keywords: Adolescents; Bisexual; Gay; Lesbian; Lesbian; Sexual minority youth

Asian/Pacific Islander adolescent sexual orientation and suicide risk in Guam - Pinhey, T.K.; Millman, S.R. (American Journal of Public Health, 2004)
Objectives. We examined the effects of same-sex orientation on suicide risks for Guam's Asian/Pacific Islander adolescents. Methods. We used a probability sample and logistic regression analysis to identify suicide risk factors. Results. Same-sex orientation was associated with a greater risk of suicide attempt, especially for boys. Adolescents who reported suffering physical abuse in the context of a romantic relationship, engaging in binge drinking, and experiencing feelings of hopelessness were at greater risk for suicidal ideation and attempts. Race/ethnicity was associated with suicide risk for both boys and girls, and patterns suggest that membership in the same racial/ethnic group decreased suicide risk for girls and increased risk of suicide for boys. Conclusions. Gay, lesbian, and bisexual Asian/Pacific Islander adolescents in Guam deserve intervention and counseling programs to reduce suicide risk.

Mental disorder, subsistence strategies, and victimization among gay, lesbian, and bisexual homeless and runaway adolescents - Whitbeck, L.B.; Chen, X.; Hoyt, D.R.; Tyler, K.A.; Johnson, K.D. (Journal of Sex Research, 2004)
This study compares participation in deviant subsistence strategies, street victimization, and lifetime prevalence of five mental disorders (conduct disorder, major depressive disorder, post-traumatic stress disorder, alcohol abuse, and drug abuse) among heterosexual males and females (n = 366) and gay, lesbian, and bisexual (n = 63) homeless and runaway adolescents from the first wave of a longitudinal study of homeless youth in four Midwestern states. The results indicate that gay, lesbian, and bisexual adolescents were more likely to have been physically and sexually abused by caretakers, were more likely to engage in risky survival strategies when on their own (including survival sex), were more likely to be physically and sexually victimized when on the streets, and were more likely to meet criteria for mental disorder than were their heterosexual counterparts.

Mental health concerns of HIV-infected gay and bisexual men seeking mental health services: An observational study - Berg, M.B.; Mimiaga, M.J.; Safren, S.A. (AIDS Patient Care and STDs, 2004)
Addressing mental health concerns of HIV-positive individuals is an important component of providing quality HIV care. Mental health intake information from patients with HIV can be an important source of data to complement existing research on HIV and mental health because the intake information contains concerns that are both from the perspective of the patients and are significant enough to bring them into treatment. The current study describes the mental health intake information of HIV-positive men who have sex with men (MSM) at an urban community health clinic over a 1-year period. This information included presenting problems, current symptoms from a symptom checklist, ratings of impairments in functioning, and client histories (e.g., substance abuse, emotional, physical, and sexual abuse, previous treatment). It also included clinicians' Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnoses of the participants, and recommended treatments. Depression was the most prevalent presenting problem (58.1% of clients), followed by anxiety (38.2%). Consistently, depression (96.3%) and low energy (78.2%) were the most frequently endorsed symptoms on a symptom checklist, followed by anxiety (69.2%). HIV-specific problems also played a large role both directly, as a presenting problem, and indirectly as they related to such concerns as relationship issues. Axis I diagnoses included adjustment disorders (50.0%), major depressive disorder (21.4%), and dysthymia (a less severe but more chronic depression) (8.9%). This review highlights the mental health issues that HIV-positive MSM feel are significant enough to require treatment. Because mental health is a key component of overall quality of life, HIV providers who work with MSM can use these data to increase awareness of the types of mental concerns that are most distressing to this population.

Experiences of harassment, discrimination, and physical violence among young gay and bisexual men - Huebner, D.M.; Rebchook, G.M.; Kegeles, S.M. (American Journal of Public Health, 2004)
Objectives. We examined the 6-month cumulative incidence of anti-gay harassment, discrimination, and violence among young gay/bisexual men and documented their associations with mental health. Methods. Gay/bisexual men from 3 cities in the southwestern United States completed self-administered questionnaires. Results. Thirty-seven percent of men reported experiencing anti-gay verbal harassment in the previous 6 months; 11.2% reported discrimination, and 4.8% reported physical violence. Men were more likely to report these experiences if they were younger, were more open in disclosing their sexual orientation to others, and were HIV positive. Reports of mistreatment were associated with lower self-esteem and increased suicidal ideation. Conclusions. Absent policies preventing anti-gay mistreatment, empowerment and community-building programs are needed for young gay/bisexual men to both create safe social settings and help them cope with the psychological effects of these events.

2. Suicide by a transvestite or sexual asphyxia? A case report - Bhardwaj, D.N.; Rautji, R.; Sharma, R.K.; Dogra, T.D. (Medicine, Science and the Law, 2004)
Autoerotic asphyxiai activity may at times result in unexpected death. Although the majority of deaths that occur during autoerotic asphyxiai episodes are accidental, the possibility of suicide must always be entertained. In the case presented here, a 22-year-old married male was found hanging by his neck in his bedroom, which was locked from the inside. He was suspended by a 'lungi' (male wrap-around cloth) from the ceiling fan hook in his room, with his feet touching the ground. He was dressed in a brassière, panties, and silver anklets. There was no evidence of previous perverse behaviour, and investigation disclosed no evidence of previous autoerotic sexual activity, homosexual behaviour, drug abuse or suicidal ideation.

Telling truths: Wounded truths and the activity of truth telling - Harwood, V. (Discourse, 2004)
It appears that being young and queer seems to be all about woundedness: it means experiencing suffering, including the risk of suicide, increased drug use, homelessness and violence. Yet how are these wounded truths told, and further, why is it that people in education seem to tell them "unproblematically"? This paper considers these questions by analysing wounded truth telling in the recent debate over the Western Australia Lesbian and Gay Law Reform Bill. Using <citeref rid="b7">Foucault's (2001)</citeref> discussion of Greek parrhesia (truth telling), the Western Australian debate is analysed in terms of its problematisation of wounded truth telling. Questions are raised regarding the implications of unproblematised educational practices that engage in the telling of wounded truths. © 2004, Taylor & Francis Group, LLC.

Substance use and misuse: Are bisexual women at greater risk? - McCabe, S.E.; Hughes, T.L.; Boyd, C.J. (Journal of Psychoactive Drugs, 2004)
The objective of this study was to compare the prevalence of substance use and alcohol-related consequences among bisexual and heterosexual women. A cross-sectional survey was self-administered to a random sample of undergraduate women. The final sample consisted of 49 self-identified bisexual women and 2,042 self-identified heterosexual women. Bivariate and multivariate results indicated that bisexual women were more likely than heterosexual women to report cigarette smoking, illicit drug use and medically prescribed use of antidepressant prescription medication. Although their drinking behaviors were similar, bisexual women were more likely than heterosexual women to experience adverse alcohol-related consequences. These findings suggest that traditional-age undergraduate women who self-identify as bisexual may be at heightened risk for substance use. However, additional research is needed to replicate these findings with larger samples of bisexual women. © 2004 Taylor and Francis Group, LLC.
Keywords: Bisexual; College students; Consequences; Sexual identity; Substance use; Women

in terrorem: “with their tanks and their bombs, and their bombs and their guns, in your head” - Asquith, N. (Journal of Sociology, 2004)
While terrorism has become a major topic of discussion and analysis in the academy and in the policy making of Australian institutions, it rarely affects the everyday life of Australian citizens. Yet for some groups, in terroremis a way of life - particularly for those whose lives are performed under social and political spotlights. At the core of the limitations imposed on certain groups in Australia is the use of language to police the behaviours of these groups, and to create a social environment that makes hiding one's identity the most effective mechanism to avoid terror. In this article, I analyse the linguistic themes and forms used in hate violence as a way to illustrate the impact of in terrorem on gay men, lesbians and Jews, and suggest alternative means by which to regulate the harm caused by vilification. © 2004, Sage Publications. All rights reserved.

New, Fast Numerical Method for Solving Two-Point Boundary-Value Problems - Holsapple, R.; Venkataraman, R.; Doman, D. (Journal of Guidance, Control, and Dynamics, 2004)
A numerical method, modified simple-shooting method (MSSM), to solve two-point boundary-value problem (TPBVP) was presented. The method include favourable aspects of the short-shooting method (SSM) and multiple-shooting method (MSM). A comparison of computation time of MSSM, MSM, collocation methods (CM), and finite difference methods (FDM) was illustrated. It was observed that the convergence of the MSSM was proved under mild conditions on the TPBVP. The solutions of MSSM were resulted in a trajectory which satisfied the system differential equations.

Homophobia and the production of shame: Young people and same sex attraction - Hillier, L.; Harrison, L. (Culture, Health and Sexuality, 2004)
Research among same-sex attracted young people in Western cultures has described a minority group of adolescents whose sexuality is negated by the significant institutions and people in their lives. Very often, there is a silence in the family and at school about same-sex sexuality and when a young person's homosexuality is suspected or disclosed s/he suffers from denial, discrimination and abuse. Not surprisingly, living in hostile environments leaves such young people at high-risk of drug abuse, depression and suicide. This paper describes some of the ways young people resist being positioned in these negative ways. Using autobiographical stories from 200 same-sex attracted young Australians, we document the discursive field of sexuality in which these young people struggle to construct positive identities. Young people were well aware of dominant discourses which characterized homosexuality as 'evil, diseased and unnatural'. Yet they use different strategies to fault, deflect and discount these negative understandings and to highlight other discourse which positions them positively.

Victimisation and psychosocial difficulties associated with sexual orientation concerns: A school-based study of adolescents - Cotter, P.; Corcoran, P.; McCarthy, J.; O'suilleabhin, F.; Carli, V.; Wasserman, D.; Hoven, C.; Wasserman, C.; Sarchiapone, M.; Keeley, H. (Irish Medical Journal, 2004)
This study examined victimisation, substance misuse, relationships, sexual activity, mental health difficulties and suicidal behaviour among adolescents with sexual orientation concerns in comparison to those without such concerns. 1112 Irish students (mean age 14yrs) in 17 mixed-gender secondary schools completed a self-report questionnaire with standardised scales and measures of psychosocial difficulties. 58 students (5%) reported having concerns regarding their sexual orientation. Compared with their peers, they had higher levels of mental health difficulties and a markedly-increased prevalence of attempted suicide (29% vs. 2%), physical assault (40% vs. 8%), sexual assault (16% vs. 1%) and substance misuse. Almost all those (90%) with sexual orientation concerns reported having had sex compared to just 4% of their peers. These results highlight the significant difficulties associated with sexual orientation concerns in adolescents in Ireland. Early and targeted interventions are essential to address their needs. © Copyright 2004 - 2009 Irish Medical Journal.

Factors associated with suicidal phenomena in adolescents: A systematic review of population-based studies - Evans, E.; Hawton, K.; Rodham, K. (Clinical Psychology Review, 2004)
Suicidal phenomena (suicide attempts, deliberate self-harm, and suicidal plans, threats and thoughts) are common in adolescents. Identification of factors associated with these phenomena could play an important role in the development of school or community-based prevention and intervention programs. In this article, we report the results of a systematic review of the international literature on population-based studies of factors associated with suicidal phenomena in adolescents. These factors encompass psychiatric, psychological, physical, personal, familial and social domains. The quantity of evidence in support of associations between suicidal phenomena and specific factors is compared with the quantity of evidence against such associations. We conclude with a summary of the findings, including identification of new or neglected areas, which require further investigation. Methodological considerations are highlighted and implications of the findings for clinicians and other professionals concerned with prevention of suicidal behavior by adolescents are discussed. © 2004 Elsevier Ltd. All rights reserved.
Keywords: Adolescence; Review; Suicidal ideation; Suicide attempt

Measuring sexual orientation in adolescent health surveys: Evaluation of eight school-based surveys - Saewyc, E.M.; Bauer, G.R.; Skay, C.L.; Bearinger, L.H.; Resnick, M.D.; Reis, E.; Murphy, A. (Journal of Adolescent Health, 2004)
To examine the performance of various items measuring sexual orientation within 8 school-based adolescent health surveys in the United States and Canada from 1986 through 1999. Analyses examined nonresponse and unsure responses to sexual orientation items compared with other survey items, demographic differences in responses, tests for response set bias, and congruence of responses to multiple orientation items; analytical methods included frequencies, contingency tables with Chi-square, and ANOVA with least significant differences (LSD)post hoc tests; all analyses were conducted separately by gender. In all surveys, nonresponse rates for orientation questions were similar to other sexual questions, but not higher; younger students, immigrants, and students with learning disabilities were more likely to skip items or select "unsure." Sexual behavior items had the lowest nonresponse, but fewer than half of all students reported sexual behavior, limiting its usefulness for indicating orientation. Item placement in the survey, wording, and response set bias all appeared to influence nonresponse and unsure rates. Specific recommendations include standardizing wording across future surveys, and pilot testing items with diverse ages and ethnic groups of teens before use. All three dimensions of orientation should be assessed where possible; when limited to single items, sexual attraction may be the best choice. Specific wording suggestions are offered for future surveys. © Society for Adolescent Medicine, 2004.
Keywords: Adolescent; Bisexuality; Health surveys; Homosexuality; Sexual orientation

A 46-year-old man with recurrent mood disturbances and suicidal ideation - Thase, M. (Psychiatric Annals, 2004)

Precarious conditions: A note on counter-insurgency in Africa after 1945 - White, L. (Gender and History, 2004)
This paper looks at the politics of surfaces, and the practices of veiling (and unveiling) and of white men wearing blackface in counter-insurgency efforts in post-war Africa. The sten gun beneath the veil, the unveiled woman with a bomb in her handbag and the countergangs masquerading as African guerillas all embody specific kinds of violence; they also embody a political imaginary in which racial and cultural lines are more fluid than previous studies of these periods suggest; indeed, they raise questions about what makes a race, a gender or a regiment: are racial and national categories learned, mimicked, or are they literally skin deep? My question, however, is not why do people dress up as guerillas or as Western women to wreak havoc on their enemies, but how historians of post-war Africa might understand such actions. To this end I want to read accounts of counter-insurgency, Fanon's famous essay, the memoirs of British soldiers in Kenya and Rhodesian soldiers in Rhodesia and some of the volumes of Rhodesian wartime fiction through the lens of transgender literature, looking at how various crossings, and the multiple markers thereof, shed light on broader issues of hierarchy, race and gender at the time of decolonisation. © Blackwell Publishing Ltd. 2004.

Commentary: Social-ethical values issues in the political public square: Principles vs. packages - Somerville, M. (Journal of Law, Medicine and Ethics, 2004)
The use of social-ethical values issues for political ends is now a major election strategy in countries such as Canada and the United States. Such issues include same-sex marriage, abortion, human embryo stem cell research, capital punishment, engaging in armed conflict, euthanasia, legalizing marihuana and access to health care. This article explores the role these issues, and their manipulation by politicians and the media, played in influencing Canadians' voting decisions in the recent Federal election.

Alan's wife: Mother love and theatrical sociability in London of the 1890s - Kelly, K.E. (Modernism - Modernity, 2004)
What appeared to some critics as gloomy, fin-de-siècle decadence preaching "race suicide" grew out of a vibrant set of flexible associations, including erotic love, fierce competition for rights to Ibsen's plays, loyal same-sex and other-sex friendships, maternal solicitude, and professional sponsorship. The modern mother, positioned between the forces of heredity, the subconscious, and a hostile industrial workplace, provided Robins and Bell with a set of references to their private lives and public postures on issues related to women's roles in a changing world that resonated with their Independent Theatre audiences and readers. Alan's Wife occupied a brief moment in the arrival of the London-based new drama, but its delivery offers striking evidence that theatre and paratheatre functioned as vehicles for modernist sociability.

Sexual minorities seeking services: A retrospective study of the mental health concerns of lesbian and bisexual women - Rogers, T.L.; Emanuel, K.; Bradford, J. (Journal of Lesbian Studies, 2003)
Understanding the mental health needs of lesbian and bisexual (sexual minority) women is an integral part of designing and providing appropriate mental health services and treatment for them. In an effort to understand the mental health needs of sexual minority women who seek community treatment, a chart review was conducted of the 223 lesbian and bisexual women who presented for services between July 1, 1997 and December 31, 2000 at Fenway Community Health in Boston, MA. Data are based on clients' self-reports and clinician assessments of clients' presenting problem, relevant developmental history, prior mental health and substance abuse treatment, current reports of emotional/psychological symptoms, and areas of impaired functioning. Although substance abuse and suicidal ideation were commonly reported problems, other concerns were more frequently reported. High percentages of lesbians and bisexual women reported relationship concerns and lack of adequate social networks; rates of depression and anxiety based on clinicians' assessments were also high. Overall, lesbians and bisexual women did not differ in the issues they brought to treatment or level or types of impairment. Compared with previous community survey samples, however, study participants appeared to be healthier than general, non-clinical samples of self-identified lesbians, possibly reflecting the special characteristics of sexual minority women who seek treatment in specialized community sites such as the Fenway. Although patients who come to these sites may not represent the more general population of sexual minority women, community health centers known to serve lesbian, gay, bisexual and transgender (LGBT) individuals may be fruitful access points for studying the mental health status and treatment needs of sexual minority women. © 2003 by The Haworth Press, Inc. All rights reserved.
Keywords: Anxiety; Bisexual women; Depression; Lesbians; Mental health services

A modified simple shooting method for solving two-point boundary-value problems - Holsapple, R.; Venkataraman, R.; Doman, D. (IEEE Aerospace Conference Proceedings, 2003)
In the study of mechanics and optimal control, one often encounters what is called a two-point boundary-value problem (TPBVP). A couple of methods exist for solving these problems, such as the Simple Shooting Method (SSM) and its variation, the Multiple Shooting Method (MSM). In this paper a new method is proposed that was designed from the favorable aspects of both the SSM and the MSM. The Modified Simple Shooting Method (MSSM) sheds undesirable aspects of both previously mentioned methods to yield a superior, faster method for solving TPBVPs. The convergence of the MSSM is proven under mild conditions on the TPBVP. A comparison of the MSM and the MSSM is made for a problem where both methods converge. We also provide a second example where the MSM fails to converge while the MSSM converges rapidly. © 2003 IEEE.

The death of a patient with AIDS in Turkey: Thoughts on the ethical dimensions - Namal, A. (Nursing Ethics, 2003)
A Turkish patient with AIDS attempted to commit suicide. Turkey is one of the countries where AIDS education in society and for health personnel has started rather late. This article documents what this patient, his sister and his friends, who helped him to survive for a short while, experienced in the hospital environment. This is a real case history and should be considered from various aspects because suicide was attempted by a person with AIDS who was near the terminal stage. The patient's friends made a remarkable effort to help him to survive. They were unsure about what to do because they had not respected his wishes and they experienced deep alienation because of the extremely negative attitude of the medical staff. © 2003 Arnold.
Keywords: Ethics; Suicide of a patient with AIDS; Turkey

Suicide Attempts Among Sexual-Minority Male Youth - Savin-Williams, R.C.; Ream, G.L. (Journal of Clinical Child and Adolescent Psychology, 2003)
The purpose of this study was to provide data addressing Diamond's (this issue) 4 problem areas in sexual orientation research by comparing gay, bisexual, and questioning male youth who report attempting suicide with those who do not. Secondary analyses were conducted with 2 datasets, 1 with a gay support group (n = 51) and the other with online youth (n = 681). Reported suicide attempts ranged from 39% among support-group youth, to 25% among Internet gay support group youth, to 9% among Internet non-support group youth. Sexual orientation, behavior, and identity did not predict suicidal attempt status, but suicide attempters experienced higher levels of both generic life Stressors (low self-esteem, substance use, victimization) and gay-related Stressors, particularly those directly related to visible (femininity) and behavioral (gay sex) aspects of their sexual identity. Support-group attendance was related to higher levels of suicidality and life Stressors, as well as certain resiliency factors. Results suggest that there exists a minority of sexual-minority youth who are at risk but that it would be inappropriate to characterize the entire population as such.

Life on the seesaw: A qualitative study of suicide resiliency factors for young gay men - Fenaughty, J.; Harré, N. (Journal of Homosexuality, 2003)
While considerable research has highlighted the factors that increase gay youth suicide risk, there has been much less emphasis on protective factors. Using grounded theory methodology, we explored the suicide resiliency in eight young gay men in Aotearoa/New Zealand. Common themes emerged, including positive social norms and conditions, high levels of support, identification with role models and high self-esteem. These were integrated with "known" risk factors to form the Seesaw Model of Gay Male Suicide. This model demonstrates that the balance between risk and resiliency may be the key to gay suicide. Depending on the balance of these factors, youth might either be resilient, attempt suicide, or teeter somewhere in between. The current findings indicate that gay youth suicide prevention requires efforts to increase resiliency factors for this group. © 2003 by The Haworth Press, Inc. All rights reserved.
Keywords: Gay men; Gay youth; Protective factors; Qualitative; Resiliency; Risk factors; Suicide; Suicide prevention

A late sex reassignment in 5-α reductase deficiency: Case report - Yücel, B.; Polat, A. (International Journal of Psychiatry in Medicine, 2003)
The syndrome of male pseudohermaphroditism, caused by a deficiency of the enzyme 5-α reductase, results in a selective decrease in dihyrotestosterone. Culture is an important part of the context in which decisions are made on sex assignment of patients with abnormalities of the external genitalia. In Turkey, patients with ambiguious genitalia are diagnosed very late and corrective surgery is usually performed during or after puberty. Here we present a case with 5-α reductase deficiency who was diagnosed at puberty and followed-up for 10 years.
Keywords: 5-α reductase deficiency; Culture; Intersexuality; Sex reassignment

Predictors of suicide in the old elderly - Waern, M.; Rubenowitz, E.; Wilhelmson, K. (Gerontology, 2003)
Background: Seniors aged 75 and above have the highest suicide rates of all age groups in most industrialized countries. However, research concerning risk factors for suicide in the old elderly is sparse. Objective: The purpose was to determine predictors for suicide among the old elderly (75+). Data concerning the young elderly (65-74 years) are shown for comparison. Methods: 85 consecutive cases of suicide that occurred in western Sweden and 153 control persons with the same sex, birth year, and zip code as the suicide cases were randomly selected from the tax register. The old elderly group included 38 cases and 71 controls; the young elderly group included 47 cases and 82 controls. Data concerning the suicide cases were collected through interviews with close informants; controls were interviewed in person. The interview included questions on past-year life events and mental and physical health. Medical records were reviewed for cases and controls. The Cumulative Illness Rating Scale - Geriatrics was used to rate illness burden. Results: Family conflict, serious physical illness, loneliness, and both major and minor depressions were associated with suicide in the 75+ group. Economic problems predicted suicide in the younger but not in the older elderly. Old elderly suicide victims with depression (major or minor) were less likely to have received depression treatment than their younger counterparts. Conclusions: Better recognition and treatment of both major and minor depression should constitute an important target for the prevention of suicide in the old elderly. Intervention studies with large numbers of senior participants are sorely needed. Copyright © 2003 S. Karger AG, Basel.
Keywords: Depression; Elderly; Suicide

Violent Video Games and Aggressive Behavior in Young Women - Anderson, C.A.; Murphy, C.R. (Aggressive Behavior, 2003)
The increasing availability of violent video games and their implication in recent school shootings has raised the volume of public debate on the effects of such games on aggressive behavior and related variables. This article reports an experiment designed to test key hypotheses concerning the short term impact of exposure to violent video games on young women, a population that has received relatively little attention in this research literature. Results were that brief exposure to a violent video game increased aggressive behavior. Mediational analyses suggested that the violent video game effect on aggression was not mediated by instrumental aggressive motivation, but was partially mediated by revenge motivation. Other results suggested that the violent video game effect on aggression might be greater when the game player controls a same-sex violent game character. © 2003 Wiley-Liss, Inc.
Keywords: Aggression; Aggressive behavior; Electronic games; Video games; Violence

Transgender identity and suicidality in a nonclinical sample: Sexual orientation, psychiatric history, and compulsive behaviors - Mathy, R.M. (Journal of Psychology and Human Sexuality, 2003)
This study examined the relation between sexual orientation and suicidality among 73 transgender respondents, who were compared to heterosexual females (n = 1,083) and males (n = 1,077), psychosocially matched females (n = 73) and males (n = 73), and homosexual females (n = 256) and males (n = 356). Significantly more (p < .05)transgender respondents reported suicide ideation and attempts than any group except homosexual females. Sexual orientation did not differentiate transgender ideators or attempters from non-ideators or non-attempters. Attempters were more likely than non-attempters to report psychotherapy and psychiatric medications currently and previously as well as difficulties with both alcohol and drugs (attempters and ideators) or alcohol only (attempters). Implications for gender studies as well as research regarding suicide and sexual orientation are discussed. © 2002 Taylor & Francis Group, LLC.
Keywords: Oppression; Sexual orientation; Suicide attempt; Suicide ideation; Transgenderism

Young adults' reactions to gay and lesbian peers who became suicidal following "coming out" to their parents - Cato, J.E.; Cantetto, S.S. (Suicide and Life-Threatening Behavior, 2003)
Rates of nonfatal suicidal behavior among gay and lesbian youth surpass those recorded among their heterosexual peers. A frequently cited precipitant of gay and lesbian nonfatal suicidal behavior is the turmoil associated with coming out to one's family. This study investigated young adults' attitudes toward peers who engaged in suicidal behavior after coming out and being rejected by their parents, and compared them with attitudes toward persons who had become suicidal in response to other stressors (a physical illness, a relationship loss, or an academic failure). Our goal was to explore whether young persons hold beliefs that may encourage lesbian and gay suicidal behavior. We found that gays and lesbians who engaged in suicidal behavior following coming out were not viewed in particularly forgiving or empathic ways, as was the case for persons who became suicidal following an incurable illness. All suicidal persons were perceived as relatively feminine. At the same time, suicidal males were rated as more masculine if they engaged in suicidal behavior because of an academic failure or a physical illness, while suicidal females were viewed as more masculine only if their suicidal behavior followed an academic failure. Finally, we found that both respondent sex and respondent gender-identity influenced evaluations of suicidal persons. Building on these findings, future research should explore attitudes toward the permissibility of a suicidal decision by lesbian and gay persons.

The characteristics of different transparent electrodes on GaN photodetectors - Chiou, Y.-Z.; Chiou, J.-R.; Su, Y.-K.; Chang, S.-J.; Huang, B.-R.; Chang, C.-S.; Lin, Y.-C. (Materials Chemistry and Physics, 2003)
The sputter ITO, TiN and E-gun ITO films deposited onto GaN as the transparent electrodes in the application of metal-semiconductor-metal (MSM) photodetectors were first fabricated and reported. The transmittance of sputter ITO, TiN and E-gun ITO films for thickness of 1000 Å was 94, 62 and 85%, respectively, at a wavelength of 400 nm. Unlike TiN films, the variation of transmittance of sputter ITO films was not sensitive to the thickness. Also, the effective barrier height of sputter ITO, TiN and E-gun ITO films to GaN was 0.46, 0.59 and 0.95 eV, respectively. Furthermore, the photo/dark contrast of sputter ITO, TiN and E-gun ITO MSM photodetectors was 0.36, 3 and 4.25 orders, at 5 V bias, respectively. © 2002 Elsevier Science B.V. All rights reserved.
Keywords: BST; GaN; ITO; Photodetector; TiN; UV

Sexual orientation and self-harm in men and women - Skegg, K.; Nada-Raja, S.; Dickson, N.; Paul, C.; Williams, S. (American Journal of Psychiatry, 2003)
Objective: Recent studies of homosexual people have found higher rates of nonfatal suicidal behavior than among heterosexuals. The purpose of this study was to determine associations between self-harm and sexual orientation for men and women separately, defining sexual orientation by sexual attraction rather than by behavior. Method: In a birth cohort of 1,019 New Zealand young adults eligible to be interviewed at age 26 years, 946 participated in assessments of both sexual attraction and self-harm. Results: Both women and men who had experienced same-sex attraction had higher risks of self-harm. The odds ratios for suicidal ideation in the past year were 3.1 for men and 2.9 for women. Odds ratios for ever having deliberately self-harmed were 5.5 for men and 1.9 for women. Men with same-sex attraction were also significantly more likely to report having attempted suicide. In both sexes, a greater degree of same-sex attraction predicted increasing likelihood of self-harm, with over one-third of men and women with persistent major same-sex attraction reporting this. Men with even a minor degree of same-sex attraction had high rates of self-harm and resulting physical injury. One-quarter of deliberate self-harm among men and one-sixth among women was potentially attributable to same-sex attraction. Conclusions: This study provides evidence of a link between increasing degrees of same-sex attraction and self-harm in both men and women, with the possibility of some difference between the sexes that needs to be explored further.

Sexual orientation and suicide attempt: A longitudinal study of the general Norwegian adolescent population - Wichstrøm, L.; Hegna, K. (Journal of Abnormal Psychology, 2003)
Past and future suicide attempt rates among gay, lesbian, and bisexual (GLB) young people were compared with those of heterosexual young people. A sample of Norwegian students (N = 2,924; grades 7-12) was followed in 3 data collection waves. Risk factors included previous suicide attempt, depressed mood, eating problems, conduct problems, early sexual debut, number of sexual partners, pubertal timing, self-concept, alcohol and drug use, atypical gender roles, loneliness, peer relations, social support, parental attachment, parental monitoring, and suicidal behavior among family and friends. When homosexual attraction, homosexual identity, and same-sex sexual behavior were entered to predict suicide attempt, only same-sex sexual behavior was significantly predictive. The increased odds could not be attributed to GLB students' greater exposure to risk factors for suicide attempt.

Childhood sexual abuse and sexual transmission risk behaviour among HIV-positive men who have sex with men - O'Leary, A.; Purcell, D.; Remien, R.H.; Gomez, C. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2003)
Previous studies have indicated an association between childhood sexual abuse (CSA,) and adult sexual risk behaviour among women and among men who have sex with men (MSM). However, no studies to date have tested the hypothesis that a history of CSA predicts sexual behaviour carrying risk of transmission of HIV to others, i.e. in a known HIV-positive cohort. The present study tested this hypothesis among a sample of 456 HIV-positive MSM recruited from community venues in New York and San Francisco. CSA history was found to be significantly associated with past (in the last 90 days) unprotected anal sex acts, both insertive (33% versus 20%, p < 0.05) and receptive (43% versus 27%, p < 0.02), with partners of HIV-negative or unknown serostatus. Further, several potential mediators of this effect were tested, and three found to be predicted by CSA history. Each of these potential mediators was associated with sexual risk behaviour, but differentially: anxiety and hostility were significantly associated with insertive acts, while anxiety, hostility and suicidality were associated with receptive acts. Mediation analyses supported the hypothesis that these factors significantly (albeit partially) accounted for the association of CSA with receptive anal intercourse. Nonsignificant mediation effects were found for insertive sex, suggesting the operation of unmeasured mediating variables. These results highlight the importance of mental health services for individuals who have been sexually abused, both for personal and for public health benefit, and also indicate a need for further research into mediators of CSA effects on transmission-related behaviour.

Non-consensual sex experienced by men who have sex with men: Prevalence and association with mental health - Ratner, P.A.; Johnson, J.L.; Shoveller, J.A.; Chan, K.; Martindale, S.L.; Schilder, A.J.; Botnick, M.R.; Hogg, R.S. (Patient Education and Counseling, 2003)
Little is known about the psychosocial factors associated with sexual assault experienced by males. Men (N=358), 19-35 years of age, recruited by community outreach, completed questionnaires. Eligibility criteria included: being HIV-negative and self-identifying as gay or bisexual. Lifetime prevalence rates of childhood sexual abuse, juvenile prostitution, and adult sexual assault were determined. The mental health of this population was explored including associations between sexual victimization and mental health disorders (alcohol abuse, suicidal ideation and attempts, mood disorders, and poor self-esteem). Almost 1 in 10 of the men had engaged in juvenile prostitution, 14% were forced into sexual activity before 14 years of age, and 14% were sexually victimized after the age of 14. Those exposed to non-consensual sex were 2.9 (95% CI: 1.8-4.7) times more likely to abuse alcohol than those free of victimization. Those who reported childhood sexual abuse were 3.3 (95% CI: 1.7-6.4) times more likely to have attempted suicide. Juvenile prostitution was associated with current depression (OR=6.4; 95% CI: 2.8-14.9). Health professionals have the responsibility to respond competently and sensitively to victims of sexual violence. To do this, many need to recognize the prevalence of male sexual trauma, to deconstruct their personal beliefs about same-sex sexual violence, and to learn to ask sensitive questions in their assessment interviews. © 2002 Elsevier Science Ireland Ltd. All rights reserved.
Keywords: Child abuse (sexual); Homosexuality (male); Mental disorders; Prostitution; Rape

Recognizing gay, lesbian, and transgender teens in a child and adolescent psychiatry practice - Rosenberg, M. (Journal of the American Academy of Child and Adolescent Psychiatry, 2003)

Internalized homophobia: A factor in depression, anxiety, and suicide in the gay and lesbian population - Igartua, K.J.; Gill, K.; Montoro, R. (Canadian Journal of Community Mental Health, 2003)
Two-hundred and twenty participants recruited through multiple sampling strategies completed a self-report questionnaire examining: (a) whether internalized homophobia predicts depressive and anxious symptoms, suicide, and substance abuse; and (b) the periods of gay-identity development which were particularly risky for suicide. Results indicate that internalized homophobia, particularly negative feelings towards one's own homosexuality (as measured by the Self subscale of the Nungesser Homosexual Attitudes Inventory), accounts for 18% of the variance in depressive scores and 13% of anxiety scores (using the Beck inventories). Internalized homophobia did not predict suicide independently from depression. The period of greatest risk for both suicidal ideation and suicide attempts was the period of disclosure of one's homosexuality to one's immediate family.

Lesbians' drinking patterns: Beyond the data - Hughes, T.L. (Substance Use and Misuse, 2003)
Early studies report very high rates of "alcohol abuse" and alcoholism among lesbians. However, serious methodological problems, including nonrepresentative samples that were often recruited in lesbian or gay lesbian bars, limit the validity of findings from these studies. In this article, I briefly review the literature on lesbians' use of alcohol and present findings from a recent study conducted in Chicago (USA). This study recruited a race- and age-diverse sample of lesbians and a demographically matched group of heterosexual women. Rates of "heavy" alcohol use and alcohol-use-related problems among lesbians were much lower in this study than in early studies. However, lesbians were more likely than their heterosexual counterparts to be in recovery and to have been in treatment for alcohol-use-related problems. Further, high rates of childhood sexual abuse, depression, and suicidal ideation reported by lesbians suggest that at least some groups may be at heightened risk for "heavy" drinking and drinking-related problems. Nevertheless, results of this and other studies suggest that reports of heavy drinking and drinking-related problems among lesbians may have been inflated in earlier studies, or that heavy drinking and drinking-related problems may have declined among lesbians.
Keywords: Alcohol use; Homosexuality; Lesbian; Mental health risks; Sexual orientation; Substance use

Our offices: Safe and tolerant places - Danforth, N.; Schlozman, S.C. (Journal of the American Academy of Child and Adolescent Psychiatry, 2003)

Mechanical properties of weak locust bean gum (LBG) gels under controlled rapid freeze-thawing - Zeira, A.; Nussinovitch, A. (Journal of Texture Studies, 2003)
Locust bean gum (LBG) solutions and gels were studied in compression, and stress-relaxation was monitored by an Instron universal testing machine (UTM). The strength of the formed gels under freeze-thaw treatment was dependent upon the freezing and thawing rates and the temperature of freezing. LBG solution which froze at a rate of 50C/min was stiffer than those samples which froze at a rate of 1C/min. LBG solution thawed at a rate of 1C/min was stiffer than those samples which were thawed at 10C/min. Very high freezing rates may reduce the size of the formed ice crystals (less disturbance to network formation), while slow thawing may induce the favored gelation. LBG solutions frozen to -60C were stiffer than those frozen to -20C. A short holding time (up to 90 min) at the freezing temperature did not influence the strength of the cryogels. These parameters are important in building products which require a priori knowledge of their texture.

Staff knowledge and attitudes towards deliberate self-harm in adolescents - Crawford, T.; Geraghty, W.; Street, K.; Simonoff, E. (Journal of Adolescence, 2003)
This study investigates knowledge, attitudes and training needs concerning deliberate self-harm (DSH) in adolescents, amongst a variety of professionals involved in the assessment and management of adolescence who self-harm. A questionnaire survey was completed by 126 health professionals working with adolescents who harm themselves. The main outcome measures were a knowledge measure and three attitude measures (generated using factor analysis). The mean percentage of correctly answered knowledge questions, across all professional groups, was 60%. With regard to knowlege, over three-quarters of participants were unaware that homosexual young men and those who had been sexually abused are at greater risk of DSH, whilst one third of staff were unaware that adolescents who self-harm are at increased risk of suicide. Staff who felt more effective felt less negative towards this group of patients (B=-0.21, p=0.03). Forty-two per cent of the participants wanted further training in DSH amongst adolescents. © 2003 The Association for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Sexual transmission of hepatitis C and early intervention - Fletcher, S. (Journal of the Association of Nurses in AIDS Care, 2003)
The major risk factors for the transmission of hepatitis C virus (HCV) have been sharing needles for intravenous drug use (IDU) and receiving blood and blood products; however, recent findings suggest that HCV is being increasingly sexually transmitted, particularly among HIV-positive men who engage in high-risk, unprotected sexual behaviors with other men. Sixteen HIV-positive patients were diagnosed with sexually acquired HCV infection at a leading London HIV outpatient treatment center during 2002. All 16 patients were homosexual males with no history of IDU who had been involved in high-risk, unprotected sexual behaviors, which included active and passive anal intercourse, fisting, rimming, and oral sex. Six patients (37.5%) in the cohort spontaneously cleared HCV infection and consequently tested negative for HCV RNA. The remaining 10 patients were all started on HCV treatment, which consisted of pegylated interferon alpha-2b in combination with ribavirin. Three patients (43%) have achieved a significant reduction in HCV RNA after 12 to 24 weeks of HCV treatment. The earlier HCV seroconversion is detected and treated, the better the chance of achieving viral eradication.
Keywords: Coinfection; Combination therapy; Hepatitis C virus (HCV); HIV; Sexual transmission

Anaesthesia or psychotherapy: Eradicating thoughts or working them through - Hinz, H. (International Journal of Psycho-Analysis, 2003)
The author presents two sessions from the analysis of a depressive narcissistic doctor, which are characterised by a mixture of co-operation and pseudo-co-operation. The dialogue is in parts intellectualised, complicated, lifeless and schizoid. Points at which the patient shows surprising insights are then partly denigrated by him, on the basis that change is not to be expected. Semi-lifeless contact assists the defensive claustrophobia that he experiences in meaningful contact. It becomes very clear that he is then afraid of entering into an openly aggressive conflict that entails the existential threat of object loss. However, this has so far been avoided. The secret pleasure in an anal-narcissistic, sadomasochistic addiction to doubt persists in the partial denigration. The patient's artificially maintained self-doubt and doubt of the object reinforce a genuine confusion that consists in never knowing exactly what lies behind the helpful and needed object.
Keywords: Claustro-agoraphobic dilemma; Confusion caused by doubt; Existential fear; Expelling thoughts; Faecalising thoughts; Genuine confusion; Homosexual panic; Intellectualised; Lifeless; Narcissistically dependent; Narcissistically detached; Nightmare; Panic about object loss; Paranoid fear; Schizoid contact; Secret sado-masohistic pleasure; Total identification; Working through thoughts

Gay youth and gay adults: Bridging the generation gap - Bohan, J.S.; Russell, G.M.; Montgomery, S. (Journal of Homosexuality, 2002)
Recent discussion of lesbian, gay, bisexual, and trans (LGBT) youth has included two emphases: the burgeoning trend toward youth-supportive organizations and focus on risk factors experienced by these Youth. In practice, the two are intertwined: the need for youth-supportive endeavors is typically demonstrated by appeals to the risks LGBT youth face. Relatively little attention has been given to relationships between youth and adults in LGBT communities. This article employs data from a long-term qualitative study with LGBT youth, supported by information from numerous other settings to suggest that a failure on the part of both groups fully to comprehend the experience of the other hampers the optimal functioning of everyone involved. In particular, we suggest that the discourse about the dangers faced by LGBT youth, despite its being thoroughly well-intentioned, may actually place these teens at greater risk. © 2002 by The Haworth Press. Inc. All rights re reserved.
Keywords: Adolescence; At-risk youth; Communication; Community (LGBT community); Generation gap; Homosexuality; Narrative; Suicide; Youth

Prevention of HIV/AIDS in Native American communities: Promising interventions - Vernon, I.S.; Jumper-Thurman, P. (Public Health Reports, 2002)
Objective: This article presents the latest data on trends in AIDS prevalence among Native American men and women and discusses problems of classification, data collection, factors that contribute to high risk, and factors that affect prevention and intervention. It presents a model for building effective prevention and intervention strategies. Observations: The number of people in the United States diagnosed with AIDS has risen by less than 5% per year since 1992, and the slowdown is estimated to continue in coming years. Among Native Americans, however, the number of people diagnosed with AIDS rose 8% in 1997, and nonwhites accounted for more than one-half of all reported AIDS cases through December 2000. For Native Americans, the rate of growth in AIDS prevalence has been steadily increasing since the early 1980s, and AIDS is now the ninth leading killer of Native Americans between the ages of 15 and 44. Factors that contribute to high risk include poverty, homophobia, denial, and mistrust. Conclusions: Effective strategies must include efforts to reduce the risk factors for AIDS. Future research should honor and celebrate diversity among people as an empowering force that facilitates collaboration and shared learning with tribes.

Sexual orientation and gender identity: An administrative approach to diversity - Quinn, T.L. (Child Welfare, 2002)
Research indicates that gay, lesbian, bisexual, transgender, and questioning (GLBTQ) teens in the care of a northeastern child welfare department do not receive adequate services due to the workers' homophobic attitudes. These teens are at high risk for alcohol and drug abuse, homelessness, prostitution, and suicide. A training module was developed for administrators. Pretest and posttest instruments measured their education and support of GLBTQ issues before and after the training.

Suicidality in a venue-based sample of young men who have sex with men - Remafedi, G. (Journal of Adolescent Health, 2002)
Purpose: To examine the incidence, prevalence, and characteristics of suicide attempts in a unique, venue-based sample of young men who have sex with men (YMSM). Methods: Eligible participants were 15-25-year-old men who were living in a major metropolitan area (Minneapolis/St. Paul, Minnesota) and had sex with men within 12 months of the interview. A total of 255 subjects were randomly sampled from popular venues for a structured, 20-min interview (1999) that included four items regarding suicide intentions and attempts. Data were analyzed using bivariate and multivariate tests of statistical significance. Results: Eighty-six percent of eligible individuals completed the survey. One-third of all respondents reported at least one suicide attempt, and 4.7% attempted suicide in the past year. Although suicide attempts were more prevalent among African-Americans and urban residents; only school enrollment was significantly associated with attempts in the multivariate analysis (odds ratio =.55, 95% confidence interval =.31,.97). Conclusions: This study corroborates the findings of prior studies of high rates of suicide attempts among YMSM. In addition, it demonstrates that attempts are more prevalent among out-of-school youths. © Society for Adolescent Medicine, 2002.
Keywords: Adolescence; Homosexuality; Sexuality; Suicide

Temporal trends in the incidence of human immunodeficiency virus infection and risk behavior among injection drug users in Baltimore, Maryland, 1988-1998 - Nelson, K.E.; Galai, N.; Safaeian, M.; Strathdee, S.A.; Celentano, D.D.; Vlahov, D. (American Journal of Epidemiology, 2002)
Although the incidence of and mortality from acquired immunodeficiency syndrome have declined recently in the United States, data are needed on the incidence of human immunodeficiency virus (HIV) and risk behaviors among injection drug users (IDUs). The authors studied the temporal trends of HIV incidence and risk behavior, ascertained through semiannual confidential interviews, between 1988 and 1998 in a cohort of 1,532 HIV-seronegative IDUs in Baltimore, Maryland. An additional 338 HIV-negative drug users were recruited in 1994 and were studied by using the same methods. Overall, 277 persons seroconverted to HIV during 8,826.45 person-years of follow-up, an incidence of 3.14 per 100 person-years. The incidence per 100 person-years declined over time from 4.45 in 1988-1990 to 3.35 in 1991-1994 to 1.84 in 1995-1998, a decline of 12% per year. HIV infections were associated with injection of cocaine, more frequent injection, needle sharing, and injection in a shooting galley. Sexual behavior variables associated with HIV incidence included a sexually transmitted infection, male homosexual behavior, and sex with another IDU. These data suggest that high-risk behavior and HIV incidence among IDUs have decreased recently in Baltimore. Nevertheless, additional prevention strategies are needed in these populations.
Keywords: Acquired immunodeficiency syndrome; HIV; Incidence; Needle sharing; Needle-exchange programs; Sex behavior; Sexually transmitted diseases; Substance abuse, intravenous

Suicide among homosexual youth - Lebson, M. (Journal of Homosexuality, 2002)
The contemporary literature on homosexual youth and suicide risk are reviewed in order to delineate the incidence, development, causes/risk factors, and effects of suicidality among homosexual youth. In comparison to heterosexual youth, homosexual youths are more likely to attempt and complete suicide. They confront more challenges in identity development and face more risk factors for suicidality. In some cases, homosexual youths might use suicidal ideation as a means of rediscovering a will to live. © 2002 by The Haworth Press, Inc. All rights reserved.
Keywords: Adolescent; Depression; Heterosexual; Homosexual; Sexual orientation; Suicidal; Suicide; Teenage; Youth

Lesbian, gay, and bisexual suicidal behavior: Testing a constructivist model - Mcbee-Strayer, S.M.; Rogers, J.R. (Suicide and Life-Threatening Behavior, 2002)
The present investigation surveyed 162 self-identified lesbian, gay, and bisexual individuals recruited from LGB-related social organizations or contacted through networking procedures with regard to suicidal behaviors, suicide risk factors, and reasons for living. Approximately 41% of the respondents indicated a serious consideration of suicide including the identification of a specific suicide plan (23%) or a past suicide attempt (36%) with significant intent to die (13%). Forty-six percent of the sample indicated at least some degree of chance of attempting suicide in the future. Grounded in the existential-constructivist theory of suicide (Rogers, 2001), empirically and theoretically identified suicide risk factors were found as a group to predict suicidal ideation (R2 = .16) and attempts (R2 = .17), with abuse-related items independently predicting both suicidal ideation (R2 = .03) and attempts (R2 = .08). Items related to self-identity issues and social acceptance were predictive of suicidal ideation (R2 = .04), while substance abuse was predictive of suicidal ideation (R2 = .05) and attempts (R2 = .13) for males only. The established factor structure of the Reasons for Living Inventory (Linehan et al., 1983) was not supported in the current data, suggesting that it may not be an appropriate measure of reasons for living with LGB individuals.

Changes in the cause of death among HIV positive subjects across Europe: Results from the EuroSIDA study - Mocroft, A.; Brettle, R.; Kirk, O.; Blaxhult, A.; Parkin, J.M.; Antunes, F.; Francioli, P.; D'Arminio Monforte, A.; Fox, Z.; Lundgren, J.D. (AIDS, 2002)
Objectives: The causes of death among HIV-positive patients may have changed since the introduction of highly active antiretroviral therapy (HAART). We investigated these changes, patients who died without an AIDS diagnosis and factors relating to pre-AIDS deaths. Methods: Analyses of 1826 deaths among EuroSIDA patients, an observational study of 8556 patients. Incidence rates of pre-AIDS deaths were compared to overall rates. Factors relating to pre-AIDS deaths were identified using Cox regression. Results: Death rates declined from 15.6 to 2.7 per 100 person-years of follow-up (PYFU) between 1994 and 2001. Pre-AIDS incidence declined from 2.4 to 1.1 per 100 PYFU. The ratio of overall to pre-AIDS deaths peaked in 1996 at 8.4 and dropped to < 3 after 1998. The adjusted odds of dying following one AIDS defining event (ADE) increased yearly (odds ratio, 1.53; P < 0.001), conversely the odds of dying following three or more ADE decreased yearly (odds ratio, 0.79; P < 0.001). The proportion of deaths that followed an HIV-related disease decreased by 23% annually; in contrast there was a 32% yearly increase in the proportion of deaths due to known causes other than HIV-related or suicides. Injecting drug users (IDU) were significantly more likely to die before an ADE than homosexuals (relative hazard, 2.97; P < 0.0001) and patients from northern/eastern Europe (relative hazard, 2.01; P < 0.0001) were more likely to die pre-AIDS than southern patients. Conclusions: The proportion of pre-AIDS deaths increased from 1994 to 2001; however, the incidence of pre-AIDS deaths and deaths overall declined. IDU and subjects from northern/eastern Europe had an increased risk of pre-AIDS death. HIV-positive patients live longer therefore it is essential to continue to monitor all causes of mortality to identify changes. © 2002 Lippincott Williams & Wilkins.
Keywords: AIDS; Cause of death; HAART; Pre-AIDS mortality

Risk assessment of adolescents with same-sex relationships - Udry, J.Richard; Chantala, K. (Journal of Adolescent Health, 2002)
Purpose: To compare the risk status on health and behavior for those with same-sex partners and those without. Methods: Add Health data provide a sample of 20,745 adolescents in grades 7 through 12 interviewed at home. The risk statuses of respondents with no partners, same-sex-only partners, and partners of both sexes were compared to respondents with opposite-sex partners only. Respondents were evaluated on selected personal and social attributes (verbal IQ, family structure, masculinity, popularity), and risk status (substance use, depression, suicidal thoughts, anal sex, general delinquency, being physically attacked, perceived risk of being killed or getting AIDS). Data were analyzed by logistic and linear regression using STATA to adjust for clustering and sampling weights. Results: Compared to boys with opposite-sex-only partners, boys with same-sex-only partners were at high risk for emotional problems, but not delinquency or substance use. Boys with partners of both sexes were at high risk for delinquency and substance use, but not for emotional problems. Neither group of boys with same-sex partners is at high risk of being attacked compared to those with opposite-sex partners only. Girls with only same-sex partners are never a high-risk group, while girls with partners of both sexes are the high-risk category in every case. Conclusions: Adolescents with same-sex-only partners do not resemble those with partners of both sexes in risk status. Combining the two categories obscures the unique risk profile of those with both-sex partners, and obscures the low risk on most variables but the high emotional risk of boys with only same-sex partners. © Society for Adolescent Medicine, 2002.
Keywords: Add Health; Homosexual; Risk behavior; Same-sex partners

Youth suicide risk and sexual orientation - Rutter, P.A.; Soucar, E. (Adolescence, 2002)
Using a broad suicide risk assessment (suicidal ideation, hopelessness, hostility) with 100 youth ages 17 to 19, this study examined the relationship between sexual orientation and youth suicide risk. Participants were compared across sexual orientation, as well as level of perceived external support, which may be a mitigating variable in suicide risk. The suicide risk demonstrated by sexual minorities in this study was no greater than that of their heterosexual peers. Youth who reported more external support demonstrated lower overall suicide risk and, specifically, lower levels of hostility, hopelessness, and suicidal ideation. The results indicated that suicide risk is not determined by demographic criteria alone, and may be influenced by psychosocial variables, such as support.

Suicidal behavior among gay male youth - Halpert, S.C. (Journal of Gay and Lesbian Psychotherapy, 2002)
Suicide has been purported to be a major problem among gays and lesbians in general, and rates of suicidal behavior (suicide attempts and ideation) are said to be even higher among adolescent samples. While most studies have consistently found rates of suicide attempts among gay and lesbian adolescent populations to be two to three times higher than their heterosexual peers, these findings have not been supported by all studies, particularly those which have relied upon the findings of psychological autopsies. In a comprehensive review of the literature, over 100 sources are examined to determine: (a) whether suicidal behaviors are greater among gay male youths than among heterosexuals, (b) if, in fact, homosexuality is nonpathological, can the higher rates of purported suicide be explained if supported by the literature, and (c) can findings contradicting the higher rates of suicidal behavior among gay male youth be explained? It is hypothesized that the higher rates of suicidal behavior among gay male youth are not due to a homosexual orientation per se, but to the societal hatred and prejudice inflicted upon gay youth. © 2002, Copyright Taylor & Francis Group, LLC.
Keywords: Adolescence; Gay youth; Homosexuality; Lesbian youth; Suicide

Enactment of Gay Rights Laws in U.S. States and Trends in Adolescent Suicide: An Investigation of Non-Hispanic White Boys - Jesdale, B.M.; Zierler, S. (Journal of the Gay and Lesbian Medical Association, 2002)
Objective: To estimate the decline in adolescent suicide rates in temporal relation to enactment of state laws offering protection from discrimination against sexual minorities. Methods: From 1990 to 1999,9,639 non-Hispanic White boys aged 11-18 years committed suicide in the United States. We compared rates before and after enactment of laws prohibiting discrimination on sexual orientation. Results: States that enacted antidiscrimination laws had a reduction of 29.1 suicides per million non-Hispanic White boys per year relative to states that have never enacted these laws. Relative to the same states before enactment of protective laws, the rate reduction was 19.7 suicides per million boy-years. Conclusions: Efforts to reduce heterosexual societal prejudice may affect a severe health outcome. Validation of the ecologic assumptions in this analysis is necessary. Complementary approaches are needed to enhance our understanding of this finding.
Keywords: Civil rights; Ecologic study; Heterosexism; Homosexuality-male; Suicide

Sexual orientation and mental health: Results from a community survey of young and middle-aged adults - Jorm, A.F.; Korten, A.E.; Rodgers, B.; Jacomb, P.A.; Christensen, H. (British Journal of Psychiatry, 2002)
Background: Community surveys have reported a higher rate of mental health problems in combined groups of homosexual and bisexual participants, but have not separated these two groups. Aims: To assess separately the mental health of homosexual and bisexual groups compared with heterosexuals. Method: A community survey of 4824 adults was carried out in Canberra, Australia. Measures covered anxiety, depression, suicidality, alcohol misuse, positive and negative affect and a range of risk factors for poorer mental health. Results: The bisexual group was highest on measures of anxiety, depression and negative affect, with the homosexual group falling between the other two groups. Both the bisexual and homosexual groups were high on suicidality. Bisexuals also had more current adverse life events, greater childhood adversity, less positive support from family, more negative support from friends and a higher frequency of financial problems. Homosexuals reported greater childhood adversity and less positive support from family. Conclusions: The bisexual group had the worst mental health, although homosexual participants also tended to report more distress.

Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths' health risk behavior - Bontempo, D.E.; D'Augelli, A.R. (Journal of Adolescent Health, 2002)
Purpose: To examine the link between victimization at school and health risk behaviors using representative data comparing lesbian, gay, and bisexual (LGB) youths and heterosexual youths. Methods: Data from the 1995 Youth Risk Behavior Survey taken in Massachusetts and Vermont were examined. This sample included 9188 9th through 12th grade students; 315 of these students were identified as LGB. Analyses of variance were used to examine health risk behaviors by sexual orientation by gender by victimization level. Results: The combined effect of LGB status and high levels of at-school victimization was associated with the highest levels of health risk behaviors. LGB youths reporting high levels of at-school victimization reported higher levels of substance use, suicidality, and sexual risk behaviors than heterosexual peers reporting high levels of at-school victimization. Also, LGB youths reporting low levels of at-school victimization reported levels of substance use, suicidality, and sexual-risk behaviors that were similar to heterosexual peers who reported low at-school victimization. Conclusions: The findings provide evidence that differences in health risks among LGB youth are mediated by victimization at school. Such victimization of LGB youth is associated with health risk behaviors. © Society for Adolescent Medicine, 2002.
Keywords: Adolescents; Gay; Gender differences; Health risk factors; Lesbian; Sexual orientation; Victimization; Youth

Use of anabolic steroids and associated health risks among gay men attending London gyms - Bolding, G.; Sherr, L.; Elford, J. (Addiction, 2002)
Aim. To examine, by HIV status, the use of anabolic steroids among London gay men and their effect on physical and mental health. Design. Cross-sectional survey using self-administered questionnaire. Setting. Six gyms in central London. Participants. 772 gay men using the gyms in January-February 2000. Measurements. Proportion of gay men who reported (i) using steroids, (ii) sharing injecting equipment. (iii) experiencing side-effects and (iv) having suicidal thoughts or feeling depressed. Findings. Of 772 gay men. 117 (15.2%) had used and 90 (11.7%) had injected steroids in the previous 12 months: HIV positive men (steroid use) 31.7% (40/126), HIV negative men 14.5% (69/477), never-tested for HIV 4.7% (8/169) (p < 0.001). No one reported sharing needles or syringes. HIV positive men were more likely to have used steroids for medical reasons than other men (24.3% versus 5.9%, p = 0.01). Nearly all steroid users (96.4%) reported side effects including testicular atrophy (51.0%), insomnia (47.7%), depression between cycles (25.2%) and hypertension (19.0%). Steroid users were more likely to have had suicidal thoughts in the previous 6 months than non-users (22.6% versus 11.2%. adjusted odds ratio after controlling for HIV status 1.84; 95% CI 1.10-3.12, p = 0.02) or to have felt depressed (49.1% versus 38.5%. adjusted OR 1.52, 95% CI 1.01-2.30, p = 0.047) Conclusion. One in seven gay men surveyed in central London gyms in 2000 said they had used steroids in the previous 12 months. HIV positive men were more likely to have used steroids than other men. some therapeutically. Side effects were reported widely and steroid use was associated with having had suicidal thoughts and feeling depressed, although cause and effect could not be established. Our findings suggest that steroid use among gay men may have serious consequences for both physical and mental health.
Keywords: Gay men; Side effects; Steroids

Suicide attempts among gay and bisexual men: Lifetime prevalence and antecedents - Paul, J.P.; Catania, J.; Pollack, L.; Moskowitz, J.; Canchola, J.; Mills, T.; Binson, D.; Stall, R. (American Journal of Public Health, 2002)
Objectives. We examined lifetime prevalence of suicide attempts and psychosocial correlates in a large population-based sample of men who have sex with men (MSM). Methods. A telephone probability sample of US urban MSM (n=2881) were interviewed between November 1996 and February 1998. Results. Twenty-one percent had made a suicide plan; 12% had attempted suicide (almost half of those 12% were multiple attempters). Most who attempted suicide made their first attempt before age 25. Although prevalence of parasuicide (i.e., attempted suicide) has remained constant across birth cohorts, mean age at initial attempts has declined. Conclusions. MSM are at elevated risk for suicide attempts, with such risk clustered earlier in life. Some risk factors were specific to being gay or bisexual in a hostile environment.

Violence and sexual minority youth - Lock, J. (Journal of School Violence, 2002)
Among the most maligned and harassed students in high schools are those who are perceived not to fit the norms for sexual behavior. These include gay and lesbian students, bisexual students, transgendered students, effeminate heterosexual males, and masculine-acting heterosexual females. Together these students are the targets of a wide range of negative behaviors from subtle exclusion to physical assault. In addition, many develop negative attitudes towards themselves which put them at increased risk for self-harm and suicide. The origin of these attitudes and behaviors is societal homophobia that fuels social aggression against this stigmatized group. Although challenging, educators can assist in undermining the effects of homophobia on sexual minorities through teaching tolerance, sponsoring support groups that address these issues, and providing educational opportunities about sexual minority youth. © 2002 by The Haworth Press, Inc. All rights reserved.
Keywords: Gay; High school; Lesbian; Violence

Correlates of suicide attempts in an open cohort of young men who have sex with men - Botnick, M.R.; Heath, K.V.; Cornelisse, P.G.A.; Strathdee, S.A.; Martindale, S.L.; Hogg, R.S. (Canadian Journal of Public Health, 2002)
Objective: To investigate baseline correlates of attempted suicide in a large cohort of young gay and bisexual men. Methods: Participants completed annual questionnaires asking demographic information, sexual behaviours, history of forced and paid sex, comfort with sexual orientation, use of illicit drugs, and validated measures of depression, social support, alcohol dependency, self-esteem and suicide ideation and attempts. Contingency table analysis and step-wise logistic regression were used to identify potential predictors of self-reported suicide attempts. Results: Of 345 gay and bisexual men eligible for this cross-sectional analysis, 150 (43.5%) reported that they had ever considered suicide and 67 (19.4%) that they had attempted suicide at least once. After adjustment for multiple explanatory variables, the use of nitrite inhalants (poppers) (AOR=2.37; 95%Cl 1.30, 4.33), social support scores below the 75th percentile of all scores (AOR=2.19; 95%Cl 1.18, 4.09) and low or moderate self-esteem (AOR=3.73; 95%Cl 2.03, 6.86) were independently associated with elevated risk of attempted suicide. Conclusion: Our data indicate that men in this analysis who ideate or attempt suicide earlier in life are more likely to report lower social support and self-esteem, and high popper use.

Mental health problems among lesbian, gay, and bisexual youths ages 14 to 21 - D'Augelli, A.R. (Clinical Child Psychology and Psychiatry, 2002)
The mental health problems of lesbian, gay, and bisexual (Igb) youths were studied using a sample of 542 youths from community settings. Information about the development of sexual orientation, problems related to sexual orientation, parents' reactions, and victimization based on sexual orientation was related to mental health symptoms and suicidality. Lesbian, gay, and bisexual youths were found to demonstrate more symptoms than a comparison group of adolescents. Over one-third of the sample reported a past suicide attempt. More symptoms were related to parents not knowing about youths' sexual orientation or with both parents having negative reactions to youths' sexual orientation. More than three-quarters had been verbally abused because of their sexual orientation, and 15 percent reported physical attacks. More than one-third said they had lost friends because of their sexual orientation. Youths who had experienced more victimization and who had lost friends reported more mental health symptoms. Mental health professionals are urged to attend to the distinct problems of these youths, especially dealing with conflicts with families and peers.
Keywords: Adolescence; Homosexuality; Mental health; Victimization

Trying to hide: A cross-national study of growing up for non-identified gay and bisexual male youth - Carragher, D.J.; Rivers, I. (Clinical Child Psychology and Psychiatry, 2002)
Research shows that 'out' lesbian, gay and bisexual youth often experience long-term and repeated abuse when they are growing up. Currently, very little is known about the experiences of those youth who do not disclose their sexual orientation at school, but also face discrimination because of their perceived sexual orientation. A cross-cultural comparison of two groups of gay and bisexual men from the US and UK who were non-identified at school was conducted by the authors. Quantitative and qualitative data were analysed focusing upon recollections of sexual orientation developmental milestones, the nature of the victimization experienced in adolescence, alternative behaviours adopted for self-preservation and suicidal ideation. In addition, current functioning in adulthood was also assessed, and measures relating to personal homonegativity and sexual behaviour were compared. The results suggested that there were variations in the nature and correlates of the victimization experienced by US and UK gay and bisexual males during adolescence, including the alternative behaviours adopted for self-preservation. As adults, UK males were more likely to report feelings of internalized homonegativity, however, US males were proportionally more likely to engage in transient sexual encounters. The implications of these findings are discussed.
Keywords: Gay; Non-identified; Sexual orientation; Suicide; Victimization

Links between past abuse, suicide ideation, and sexual orientation among san diego college students - Garcia, J.; Adams, J.; Friedman, L.; East, P. (Journal of the American College Health Association, 2002)
The authors explored relationships among childhood abuse, suicidal ideation, and sexual orientation of 18- to 30-year-old students enrolled in 2 San Diego area colleges, using responses from anonymous questionnaires. Sixty percent of the 138 eligible respondents were women, and 22% were self-identified gay/bisexual individuals. Women were more likely than men to report at least 1 form of emotional abuse (odds ratio [OR] = 2.3; p =.02) and unwanted sexual touching (OR = 4.3; p =.0004). Lesbian/bisexual women were significantly more likely to report past suicidal ideation than were heterosexual women (OR = 3.7, p =.03). Gay/bisexual men were more likely to report unwanted sexual touching than were heterosexual men (OR = 5.1, p =.04), but the men did not report significantly higher rates of past suicide ideation or suicide attempts. Sexual orientation and a past history of child sexual, physical, and emotional abuse could be compounding risk factors for suicidal ideation among college students. © 2002 Taylor & Francis Group, LLC.
Keywords: Adolescent suicide; Emotional abuse; Physical abuse; Sexual abuse; Sexual orientation

Being lesbian, gay, bisexual, and 60 or older in north america - Grossman, A.H.; D’augelli, A.R.; O’connell, T.S. (Journal of Gay and Lesbian Social Services, 2002)
This study examined mental and physical health, perceived social support, and experiences with HIV/AIDS of 416 lesbian, gay, and bisexual adults aged 60 to 91. Most participants reported fairly high levels of self-esteem; however, many experienced loneliness. Most also reported low levels of internalized homophobia, but men reported significantly higher levels than women did. Ten percent of respondents sometimes or often considered suicide, with men reporting significantly more suicidal thoughts related to their sexual orientation. Men also had significantly higher drinking scores than women, and more men could be classified as problem drinkers. Only 11% of the respondents said that their health status interfered with the things they wanted to do. Although 93% of the participants knew people diagnosed with HIV/AIDS, 90% said that they were unlikely to be HIV-infected. Participants averaged six people in their support networks, most of whom were close friends. Most support network members knew about the participants’ sexual orientation, and the respondents were more satisfied with support from those who knew. Those living with domestic partners were less lonely and rated their physical and mental health more positively than those living alone. © 2002 by The Haworth Press, Inc. All rights reserved.
Keywords: Homosexuality; Internalized homophobia; Loneliness; Mental health; Physical health; Social support; Support network

Homosexuality and risk for psychiatric disorders - Alexander, C.J. (Journal of Gay and Lesbian Social Services, 2002)
Social science researchers have traditionally found it difficult to obtain representative samples of gay men and lesbians. Still, this has not prevented some from making broad conclusions about the lives and mental status of homosexuals as a group. In recent months, two separate national studies have examined sexual attitudes and behaviors of adults and adolescents. Collectively, the sample size of males and females surveyed in these studies is in the thousands. Because the subjects in both studies were randomly selected, the findings were based on persons with a wide spectrum of sexual attitudes and behaviors. In many respects, these studies confirm some of the data from smaller studies. That is, homosexual orientation can be a risk factor for psychiatric disturbance for some men and women. In addition, adolescents struggling with issues related to sexual orientation are two times more likely than their peers to consider or attempt suicide. © 2002 by The Haworth Press, Inc. All rights reserved.
Keywords: Depression; Mental illness; Substance abuse; Suicide

Patient characteristics, HIV serostatus, and risk behaviors among gay and bisexual males seeking treatment for methamphetamine abuse and dependence in Los Angeles - Freese, T.E.; Obert, J.; Dickow, A.; Cohen, J.; Lord, R.H. (Journal of Addictive Diseases, 2002)
Methamphetamine, a drug used at alarming rates among gay/bisexual males in the West, is often combined with sexual activities, thereby increasing HIV-related risks in an already high-risk group. Findings from 68 gay/bisexual men seeking treatment for methamphetamine dependence in Hollywood, California were analyzed to predict HIV serostatus based on demographic, drug use, or sexual behavior variables. Results showed that more HIV-infected participants than non-infected men reported medical problems (97.6% versus 46.2%; X2 = 24.7, df = 1, p <. 0001), histories of genital gonorrhea (59.5% versus 26.9%; X2 = 6.9, df = 1, p <. 01), use of injection methods (45.2% versus 19.2%; X2 = 4.8, df = 1, p <. 03), and more sexual partners with unprotected receptive anal intercourse in the 30 days prior to intake (5.9 versus 0.7; separate t = 3.5, df = 43.7, p <. 001). More non-infected participants (19.2%) reported suicidal thoughts than HIV-infected men (0%; X2 = 4.8, df = 1, p <. 03). Discriminant function analysis correctly classified 74.6% of cases into serostatus groupings based on presence of suicidal thoughts, history of gonorrhea, number of sexual partners with unprotected receptive anal intercourse and prior methamphetamine treatment. Findings provide information that may prove helpful in tailoring culturally relevant treatment and prevention messages. © 2002 by The Haworth Press, Inc. All rights reserved.
Keywords: Gay men; Medical consequences; Methamphetamine

Social alienation in gay youth - Sullivan, M.; Wodarski, J.S. (Journal of Human Behavior in the Social Environment, 2002)
The focus of this article is twofold; first, to review known risk factors for gay youth including: substance abuse, depression, suicide, and HIV risks, secondly, to determine the impact of social support factors; specifically parental, peer and religious support factors for this population. Evidence suggests that gay and lesbian youth are at high risk for isolation and subsequent psychological damage that results from social alienation. Insight into the problems faced by gay youth, along with some helpful intervention strategies for professionals working with a gay adolescent population is discussed. © 2002 by The Haworth Press, Inc. All rights reserved.
Keywords: Gay youth; Identity formation; Risk factors; Social alienation; Social supports

Prediction of depressive distress in a community sample of women: The role of sexual orientation - Matthews, A.K.; Hughes, T.L.; Johnson, T.; Razano, L.A.; Cassidy, R. (American Journal of Public Health, 2002)
Objectives. This study compared factors known or hypothesized to influence depressive symptomatology in a community sample of lesbians and heterosexual women. Methods. Data were collected in a multisite survey of lesbians' physical and mental health. Results. Findings confirmed earlier reports suggesting that traumatic life events such as physical and sexual abuse, and individual traits and coping styles are risk factors for depressive distress. However, findings of higher rates of suicidal behavior and of several risk factors for depressive distress among lesbians suggest that risk for depression may differ among lesbians and heterosexual women. Conclusions. Sexual orientation may represent an important but poorly understood risk factor for depressive distress as well as suicidal ideation and behavior.

Sex-Specific Predictors of Suicidality Among Runaway Youth - Leslie, M.B.; Stein, J.A.; Rotheram-Borus, M.J. (Journal of Clinical Child and Adolescent Psychology, 2002)
Examined predictors of suicidality (ideation and attempts) among 348 adolescent runways (197 boys; 56% African American; M age =16) using sex-specific models that tested the impact of the three domains of the Social Action Model: individual characteristics, interpersonal influences, and life events. Twenty-five percent of the girls and 14% of the boys had attempted suicide at least once. Male suicidality was mainly predicted by individual characteristics: identifying as gay, emotional distress, fewer conduct problems, and avoidant reasons for drug use. The interpersonal influence of suicidal friends also predicted suicidality. Variables from all three domains influenced girls: individual characteristics of lower age, lower self-esteem, and emotional distress; interpersonal influence of suicidal friends; and life events of having lived on the streets and assaults. Findings suggest some sex-specific interventions, but decreasing emotional distress and lessening the influence of suicidal friends may be useful for both boys and girls.

The transsexual: What about the future? - Michel, A.; Ansseau, M.; Legros, J.J.; Pitchot, W.; Mormont, C. (European Psychiatry, 2002)
Since the 1950s, sexual surgical reassignments have been frequently carried out. As this surgical therapeutic procedure is controversial, it seems important to explore the actual consequences of such an intervention and objectively evaluate its relevance. In this context, we have carried out a review of the literature. After looking at the methodological limitations of follow-up studies, the psychological, sexual, social, and professional futures of the individuals subject to a transsexual operation are presented. Finally, prognostic aspects are considered. In the literature, follow-up studies tend to show that surgical transformations have positive consequences for the subjects. In the majority of cases, transsexuals are very satisfied with their intervention and any difficulties experienced are often temporary and disappear within a year after the surgical transformation. Studies show that there is less than 1% of regrets, and a little more than 1% of suicides among operated subjects. The empirical research does not confirm the opinion that suicide is strongly associated with surgical transformation. © 2002 Éditions scientifiques et médicales Elsevier SAS.
Keywords: Follow-up; Literature review; Transsexualism

Associations between health risk behaviors and opposite-, same-, and both-sex sexual partners in representative samples of Vermont and Massachusetts high school students - Robin, L.; Brener, N.D.; Donahue, S.F.; Hack, T.; Hale, K.; Goodenow, C. (Archives of Pediatrics and Adolescent Medicine, 2002)
Objective: To examine associations between health risk behaviors and sexual experience with opposite-, same-, or both-sex partners in representative samples of high school students. Design: We used 1995 and 1997 data from the Vermont and Massachusetts Youth Risk Behavior Surveys. Logistic regression and multiple regression analyses were used to compare health risk behaviors among students who reported sex with opposite-sex partners only (opposite-sex students), with same-sex partners only (same-sex students), and with both male and female sexual partners (both-sex students). Setting: Public high schools in Vermont and Massachusetts. Participants: Representative, population-based samples of high school students. The combined samples had 14623 Vermont students and 8141 Massachusetts students. Main Outcome Measure: Violence, harassment, suicidal behavior, alcohol and other drug use, and unhealthy weight control practices. Results. In both states, both-sex students were significantly more likely to report health risk behaviors than were opposite-sex students. For example, both-sex students had odds 3 to 6 times greater than opposite-sex students of being threatened or injured with a weapon at school, making a suicide attempt requiring medical attention, using cocaine, or vomiting or using laxatives to control their weight. In both states, same-sex students were as likely as opposite-sex students to report most health risk behaviors. Conclusion: Relative to opposite- and same-sex students, both-sex students may be at elevated risk of injury, disease, and death by experiencing serious harassment and engaging in violence, suicidal behavior, alcohol and other drug use, and unhealthy weight control practices.

Response to "Clone Alone" by Carson Strong and "Are There Limits to the Use of Reproductive Cloning" by Timothy Murphy (CQ Vol 11, No 1): Equal access to cloning? - Chambers, J.E. (Cambridge Quarterly of Healthcare Ethics, 2002)

Sexual orientation of adolescent girls. - Frankowski, B.L. (Current women's health reports, 2002)
It is important for healthcare providers to have a clear understanding of sexual orientation and other components of sexual identity (genetic gender, anatomic gender, gender identity, gender role, and sexual behavior). Knowledge of how a lesbian identity is formed will aide providers in guiding these girls through adolescence. Societal stigma often forces isolation that leads to many risky behaviors that affect health (alcohol and drug use; risky sexual behaviors; truancy and dropping out; running away and homelessness; and depression and suicide). Health providers need to ensure a safe and understanding environment for these girls, to enhance their physical, emotional, and social development to healthy adulthood.

After a suicide: trying to make sense of the senseless. - Von Ornsteiner, J.B. (The Body positive, 2002)

Issue evolution, political parties, and the culture wars - Lindaman, K.; Haider-Markel, D.P. (Political Research Quarterly, 2002)
Using the issue evolution framework, our research examines partisan polarization on several culture war issues, including pornography, environment, gun control, and gay civil rights. We look for evidence of partisan polarization among political elites and citizens, as well as examine top-down versus bottom-up paths of influence among Republicans and Democrats. Data from the General Social Survey and congressional roll-call votes between 1970-1999 are analyzed. Our results suggest that although partisan elites have become increasingly polarized on culture war issues, mass partisans have not followed suit across all issues. Only on environmental and gun control issues do we find significant evidence of issue evolution, including a linkage between elite and mass opinion. We conclude that culture war issues may not be as prone to issue evolution as previous research has indicated, in part because these issues are not all equally salient to the mass public.

Erotic deaths - Eke, N. (Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology, 2002)
Background. Accidental deaths associated with sexual activities occur but are often unreported in the medical literature. Aim. To review reported cases of such deaths to determine the characteristics. Method. A Medline search from 1966 to June 2001 using such terms as 'coital deaths' was done to obtain publications and relevant references on accidental deaths from sexual intercourse. The data extracted included the gender and age of the victim, the sexual act involved, the marital relationships or status of the participants, the location and immediate cause of death. Results. Deaths from sexual activities affect males and females. The victims were often adolescents. The age correlated with the type of erotic act. Some deaths occurred in consensual heterosexual and homosexual activities as well as autoerotic acts. Often, the consensual sexual act was 'illicit' and took place outside the home of either partner, while autoerotic deaths often occurred in the homes of the victims. The commonest causes of death were myocardial infarction and air embolism in consensual heterosexual intercourse and asphyxia in autoerotic acts. Predisposing factors include older age in myocardial infarction, pregnancy in air embolism and paraphilia in autoerotic deaths. Autoerotic deaths predominantly occurred around the third decade. Psychiatric counseling can prevent autoerotic deaths. Psychological and psychiatric counseling are indicated for relations of victims. Conclusion. It is essential to identify the circumstances of each case to exclude suicide or homicide. Deaths at sexual acts may be merely coincidental and are probably underreported. Legal and social implications demand careful forensic evaluation in each case.
Keywords: Aetiology; Erotic deaths; Prevention

Association between self-reported childhood sexual abuse and adverse psychosocial outcomes: Results from a twin study - Nelson, E.C.; Heath, A.C.; Madden, P.A.F.; Cooper, M.L.; Dinwiddie, S.H.; Bucholz, K.K.; Glowinski, A.; McLaughlin, T.; Dunne, M.P.; Statham, D.J.; Martin, N.G. (Archives of General Psychiatry, 2002)
Background: Increased risk for serious adverse outcomes has been associated with a history of childhood sexual abuse (CSA). Whether these risks are directly attributable to CSA rather than family background remains controversial. Methods: Structured psychiatric telephone interviews were conducted from February 1996 to September 2000 with both members of 1991 same-sex pairs (1159 female and 832 male pairs) from a young adult Australian volunteer twin panel (mean [SD] age, 29.9 [2.5] years). A binary composite CSA variable was constructed from responses to 5 component questions. The association between CSA and adverse psychosocial outcomes was examined, controlling for family background. Results: A history of CSA, reported by 16.7% of the women and 5.4% of the men, was more common among those reporting parental alcohol-related problems. Significantly increased risk was observed in women reporting a history of CSA for subsequently occurring major depression, suicide attempt, conduct disorder, alcohol dependence, nicotine dependence, social anxiety, rape after the age of 18 years, and divorce; most similar risks reached statistical significance in men. The greatest risks were associated with CSA involving intercourse. Childhood sexual abuse-negative twins (ie, those who denied having experienced CSA) from CSA-discordant pairs compared with other CSA-negative individuals had increased risk for many adverse outcomes suggesting correlated family background risk factors. Childhood sexual abuse - positive members (ie, those who reported having experienced CSA) of CSA-discordant pairs had significantly greater risk for all 8 examined adverse outcomes than their co-twins. Conclusions: Self-reported CSA was associated with increased risk for adverse outcomes, controlling for family background. Family background risk factors also were associated with adverse outcome risk. Discordant pair analysis seems to provide an effective means of controlling for family background risk factors.

Suicidal behaviour in people with HIV/AIDS: A review - Komiti, A.; Judd, F.; Grech, P.; Mijch, A.; Hoy, J.; Lloyd, J.H.; Street, A. (Australian and New Zealand Journal of Psychiatry, 2001)
Objective: To review the existing literature on suicidal behaviour in people with HIV/AIDS infection. Method: A search on the Index Medicus/MEDLINE database was performed, for articles that investigated and/or reviewed suicidal behaviour in people with HIV at any stage of the illness. Only articles written in English were used in this review. Results: Most studies have been done on homosexual/bisexual groups, with little data available for heterosexual populations or women. Studies show an increased rate of suicidal ideation, suicide attempts and completed suicide in individuals with HIV/AIDS. Of note, there is a high prevalence of psychiatric illness and substance abuse in those with suicidal behaviour. Conclusions: The increased rate of suicidal behaviour in HIV-infected persons is consistent with findings in other medically ill groups with chronic, life-threatening disorders. However, assessment of any possible direct effect of HIV/AIDS on suicidal behaviour is confounded by methodological limitations of many of the studies. More longitudinal studies encompassing other affected groups including heterosexual populations and women are needed to elucidate the relationship between suicidal behaviour and HIV/AIDS.
Keywords: AIDS; HIV; Prevalence; Risk; Suicide

Sexual and drug risk-related behaviours after initiating highly active antiretroviral therapy among injection drug users - Vlahov, D.; Safaien, M.; Lai, S.; Strathdee, S.A.; Johnson, L.; Sterling, T.; Celentano, D.D. (AIDS, 2001)
Objective: To assess whether initiation of highly active antiretroviral therapy (HAART) is associated with a subsequent resumption of sexual and drug use risk behaviors. Methods: Within an ongoing prospective study of HIV-seropositive injection drug users (IDUs), a subsample with at least one CD4 cell count < 500 × 106 cells/l after 1996 (when HAART became available) and three consecutive visits were selected for analysis. Patients underwent semi-annual interviews for risk behaviors and reports of medication use. Data from visits immediately prior to and following initiation of HAART for the treated group, and from consecutive visits for the eligible but untreated group were compared using linear growth curve analysis. Results: Of 316 eligible HIV-seropositive IDUs, 133 reported HAART use during the study period; 95% were African American, 76% were male, and median age at enrollment was 34 years. The proportion who reported any sexual activity increased over time from 55 to 61% for the HAART-treated group, but decreased from 67 to 63% in the untreated group (P = 0.03); the respective values for unprotected sex were 18 versus 20% and 36 versus 28% (P = 0.06). In both treated and untreated groups, the proportion injecting drugs declined (P = 0.04), whereas the proportion reporting needle sharing decreased marginally (P = 0.11). However, trends in use of shooting galleries between the groups differed (P = 0.04) increasing slightly from 2.3 to 3% in the treated group while decreasing from 12 to 5% in the untreated group. Conclusion: In persons treated with HAART, self-report of high-risk behaviors remained stable or showed some increase. Persons initiating HAART should be counselled to refrain from high-risk behaviors. © 2001 Lippincott Williams & Wilkins.
Keywords: AIDS; HIV; Sexual risk; Substance abuse; Treatment

Religious conflicts experienced by Lesbian, Gay, and Bisexual individuals - Schuck, K.D.; Liddle, B.J. (Journal of Gay and Lesbian Psychotherapy, 2001)
A qualitative and quantitative study of 66 lesbian, gay, and bisexual (LGB) respondents examined perceived conflicts between religion and sexual orientation. Nearly two-thirds reported having experienced such conflicts. Sources of conflict included denominational teachings, scriptural passages, and congregational prejudice. Reactions included shame, depression, and suicidal ideation. Resolutions included identifying as spiritual rather than religious, reinterpreting religious teachings, changing affiliations, remaining religious but not attending, and abandoning religion altogether. Respondents listed resources that helped them achieve positive resolutions. The experience of conflict was associated with greater difficulty in coming out and with greater diversity in age at coming out, suggesting that religious conflicts can affect LGB identity formation. Implications for practice with religious LGB clients are discussed. © 2001, Copyright Taylor & Francis Group, LLC.
Keywords: Coming out; Homosexuality; Identity formation; Psychotherapy; Religion; Religious conflict; Spirituality

Psychoanalytic treatment of an asymptomatic HIV-positive gay man - Leli, U. (Journal of Gay and Lesbian Psychotherapy, 2001)
This paper describes the psychoanalytic treatment of an asymptomatic HIV-positive gay man. At present, the analysis is in its fifth year, and termination themes are apparent and central to the analysis, although a termination date has not yet been set. This patient presented a formidable challenge to psychoanalytic treatment, independently of his serological status. The patient's history of alcoholism, suicide attempts, depression requiring pharmacological maintenance, and his general proclivity to acting out, coupled with the restricted nature of his object relations, made the decision of whether to treat him with psychoanalysis versus psychoanalytic psychotherapy a very difficult one. © 2001, Copyright Taylor & Francis Group, LLC.
Keywords: Aids; Countertransference; Enactment; Hiv; Psychoanalysis; Psychotherapy; Transference

Attitudes on end-of-life care and advance care planning in the lesbian and gay community - Stein, G.L.; Bonuck, K.A. (Journal of Palliative Medicine, 2001)
Gay men and lesbians have special interests in documenting their preferences regarding advance care planning and end-of-life care. A 64-item survey instrument was developed to ascertain the preferences of this community regarding approaches to end-of-life care, viewpoints on physician-assisted suicide (PAS) and euthanasia, and practices regarding advance care planning. The survey was completed by 575 participants recruited through community-based health care and social service organizations serving the lesbian and gay community, primarily in the New York metropolitan area. Respondents represent a diverse group of women (36%) and men (63%) from various age, racial/ethnic, and religious/spiritual backgrounds; 10% were human immunodeficiency virus (HIV)-positive. Respondents' perspectives on end-of-life care are generally consistent with findings from other attitudinal studies of U.S. adults: a majority supported legalization of PAS and preferred a palliative approach to end-of-life care. However, the gay community sample revealed even stronger support for assisted suicide and palliative care. Although respondents completed advance directives at a higher rate than adults generally, the legal importance for gay men and lesbians to execute directives should encourage health care providers and community organizations to assume a larger educational role on advance care planning. Results confirm other reports on the need to address provider communication skills. It is speculated that the HIV epidemic was a major influence behind these results because of the overwhelming personal impact of the epidemic on most gay men and lesbians during the past two decades.

Relationship of sexual orientation to substance use, suicidal ideation, suicide attempts, and other factors in a population of homeless adolescents - Noell, J.W.; Ochs, L.M. (Journal of Adolescent Health, 2001)
Purpose: To explore the relationship of sexual orientation and gender to four sets of factors: (a) family history, (b) incarceration, (c) substance use, and (d) depression and suicide, in a population of homeless adolescents. Methods: A sample of homeless adolescents was recruited in Portland, Oregon and assessed using semi-structured interviews at baseline, three months and six months. A total of 532 youths (216 females and 316 males) provided data on sexual orientation and other variables. Heterosexual (n = 391) and non-heterosexual youths (n = 141) were compared on all sets of factors, primarily using logistic regressions. Results: 44.9% of females identified as lesbian or bisexual, while only 13.9% of males identified as gay or bisexual. Gay, lesbian, bisexual, and 'unsure' (GLBU) youths were less likely to have been in foster care or arrested, but were more likely to have spent time in a locked mental health treatment facility. More than one-third of all participants reported use of injection drugs. GLBU youths were more likely to have recently used amphetamines and to have injected drugs, however, gay-bisexual males were less likely to have recently used marijuana. GLBU status was associated with recent measures of depression and suicidal ideation, but not with lifetime measures. Associations of sexual orientation with several lifetime measures were different than with prospective measures, demonstrating the limitations of using lifetime measures rather than recent or prospective measures. Conclusions: This population of homeless adolescents appears to be higher in its high rate of injection drug use and the large proportion of females who identify as lesbian or bisexual than found in other studies. The high rates of depression and suicidal ideation, especially among GLBU youth, are of great concern. Copyright © 2001 Society for Adolescent Medicine.
Keywords: Adolescents; Gay; Gender differences; Homeless; Lesbian; Sexual orientation; Substance abuse; Suicide

Sex-specific determinants of HIV infection among injection drug users in Montreal - Bruneau, J.; Lamothe, F.; Soto, J.; Lachance, N.; Vincelette, J.; Vassal, A.; Franco, E.L. (CMAJ, 2001)
Background: Sex-specific issues have not been extensively addressed in studies of HIV prevalence, despite the strong implications of differences between men and women in the risk of HIV transmission. The objective of this study was to examine sex-specific behaviours associated with HIV infection among injection drug users in Montreal. Methods: A total of 2741 active drug users (2209 [80.6%] men) were recruited between 1988 and 1998. Information was sought on sociodemographic characteristics, drug-related behaviour and sexual behaviour, and participants were tested for HIV antibodies. Sex-specific independent predictors of HIV prevalence were assessed by stepwise logistic regression. Results: The overall prevalence of HIV among study subjects was 11.1%; the prevalence was 12.0% among men and 7.5% among women. In multivariate models, a history of sharing syringes with a known seropositive partner (odds ratio [OR] for men 2.44, 95% confidence interval [CI] 1.72-3.46; OR for women 3.03, 95% CI 1.29-7.13) and of sharing syringes in the past 6 months (OR for men 0.61, 95% CI 0.44-0.85; OR for women 0.32, 95% CI 0.14-0.73) were independently associated with HIV infection. Other variables associated with HIV infection were homosexual or bisexual orientation, cocaine rather than heroin as drug of choice, frequency of injection drug use, and obtaining needles at a pharmacy or through needle exchange programs (for men only) and obtaining needles at shooting galleries and being out of treatment (for women only). Interpretation: These results support the hypothesis that risk factors for HIV seropositivity differ between men and women. These sex-related differences should be taken into account in the development of preventive and clinical interventions.

Parallel processing of steady-state analysis for a power electronic system by PVM3 - Sasada, I.; Tomonari, T.; Noda, T. (Electrical Engineering in Japan (English translation of Denki Gakkai Ronbunshi), 2001)
It is important to get a steady-state operation of a power electronic circuit for its design. The shooting method, which is one of the steady-state analysis methods, solves a boundary value condition which equates initial values to final values after one-period transient. This paper proposes how to process the analysis in parallel by using a Parallel Virtual Machine (PVM3) system. In particular, the multiple shooting method (MSM) which divides the shooting time into subsections is suitable because it can parallel numerical processes for the divided shooting times by using multiple CPU units independently. This parallel method is applied to converter examples which are processes by PVM3. The computed results are investigated for their convergence and CPU times to check their parallel effects. According to the MSM algorithm, CPU times are reduced almost to one-fifth by using five computer units from a PVM3 system example. © 2001 Scripta Technica.
Keywords: Converter circuit; Multiple shooting method; Parallel processing; Periodic steady-state analysis

Gay, lesbian, and bisexual college students: The relationship between sexual orientation and depression, loneliness, and suicide - Westefeld, J.S.; Maples, M.R.; Buford, B.; Taylor, S. (Journal of College Student Psychotherapy, 2001)
This study compared 70 gay male/lesbian/bisexual (lesbigay) college students with a control group of 154 college students on measures of loneliness, depression, and suicidal risk. Results indicated significant differences in several important areas. Issues concerning a variety of attitudes/feelings of the gay male/lesbian/bisexual group are discussed as are implications for college mental health and student development professionals. © 2001 by The Haworth Press, Inc. All rights reserved.
Keywords: Bisexual; Depression; Gay; Lesbian; Loneliness; Sexual orientation; Suicide

Adolescent suicide attempts: Risks and protectors - Borowsky, I.W.; Ireland, M.; Resnick, M.D. (Pediatrics, 2001)
Objective. In 1997, suicide was the third leading cause of death among 10- to 19-year-olds in the United States, with the greatest increases in suicide rates in the previous decade experienced by black and other minority youth. The purpose of this study was to identify risk and protective factors for suicide attempts among black, Hispanic, and white male and female adolescents. Methods. We used data from the National Longitudinal Study of Adolescent Health, conducted in 1995 and 1996. A nationally representative sample of 13 110 students in grades 7 through 12 completed 2 in-home interviews, an average of 11 months apart. We examined Time 1 factors at the individual, family, and community level that predicted or protected against Time 2 suicide attempts. Results. Perceived parent and family connectedness was protective against suicide attempts for black, Hispanic, and white girls and boys, with odds ratios ranging from 0.06 to 0.32. For girls, emotional well-being was also protective for ali of the racial/ethnic groups studied, while a high grade point average was an additional protective factor for all of the boys. Cross-cutting risk factors included previous suicide attempt, violence victimization, violence perpetration, alcohol use, marijuana use, and school problems. Additionally, somatic symptoms, friend suicide attempt or completion, other illicit drug use, and a history of mental health treatment predicted suicide attempts among black, Hispanic, and white females. Weapon-carrying at school and same-sex romantic attraction were predictive for all groups of boys. Calculating the estimated probabilities of attempting suicide for adolescents with increasing numbers of risk and protective factors revealed that the presence of 3 protective factors reduced the risk of a suicide attempt by 70% to 85% for each of the gender and racial/ethnic groups, including those with and without identified risk factors. Conclusions. In these national samples of black, Hispanic, and white youth, unique and cross-cutting factors derived from a resiliency framework predicted or protected against attempting suicide. In addition to risk reduction, promotion of protective factors may offer an effective approach to primary as well as secondary prevention of adolescent suicidal behavior.

Depression does not influence basal ganglia-mediated psychomotor speed in HIV-1 infection - Giesen, H.-J.V.; Bäcker, R.; Hefter, H.; Arendt, G. (Journal of Neuropsychiatry and Clinical Neurosciences, 2001)
The authors examined the effects of depressive mood (Hamilton Rating Scale for Depression [Ham-D]) on basal ganglia-mediated psychomotor speed (motor test battery) in 202 HIV-1 seropositive homosexual males with no prior history of antiretroviral treatment. HIV-1 seropositive patients showed a significant slowing of most rapid alternating movements (MRAM) and significantly prolonged contraction times (CT) compared with 66 HIV-1 seronegative male control subjects. Factor analysis of Ham-D scores isolated a factor containing the items depressed mood, suicide, and psychic and somatic anxiety. This factor did not correlate with MRAM or CT. Depression and psychomotor speed are independent in HIV-1 infection.

Improving adolescent preventive care in community health centers - Klein, J.D.; Allan, M.J.; Elster, A.B.; Stevens, D.; Cox, C.; Hedberg, V.A.; Goodman, R.A. (Pediatrics, 2001)
Objective. To evaluate implementation of the Guidelines for Adolescent Preventive Services (GAPS) in Community and Migrant Health Centers (CMHCs). Design. Before and after comparison of health center policy, clinician and adolescent self-report, and chart reviews in 5 CMHCs. Participants. Eighty-one preintervention and 80 one-year postintervention providers and 318 preintervention and 331 postintervention 14- to 19- year-old adolescent patients being seen for well visits at 5 CMHCs. Intervention. Health center staff were trained to implement GAPS and were provided resource materials, patient questionnaires, and clinician manuals. Main Outcome Measures. Delivery of and receipt of preventive services and perceived access to care. Results. CMHC systems changes were related to stronger leadership commitment to adolescent care. Providers reported high levels of preventive services delivery before and after guideline implementation. After guideline implementation, adolescents reported increases in having discussed prevention content with providers in 19 of 31 content areas, including increased discussion of physical or sexual abuse (10% before to 22% after), sexual orientation (13% to 27%), fighting (6% to 21%), peer relations (37% to 52%), suicide (7% to 22%), eating disorders (11% to 28%), weapons (5% to 22%), depression (16% to 34%), smokeless tobacco (10% to 29%), and immunizations (19% to 48%). Adolescents were also more likely to report knowing where to get reproductive or mental health services and were more likely to have received health education materials. Implementation also increased documentation of recommended screening and counseling in 51 of 79 specific content areas assessed in chart reviews. Conclusion. Implementing GAPS increased the receipt of preventive services at these health centers. Adolescents received more comprehensive screening and counseling, more health education materials, and had greater access to care after implementation. GAPS implementation may help improve the quality of care for adolescents.
Keywords: Adolescents; Community health centers; Preventive services

Documented prevalence of HIV and hepatitis C infection in patients with penetrating trauma - Chambers, A.J.; Lord, R.S.A. (Australian and New Zealand Journal of Surgery, 2001)
Background: Trauma patients infected with human immunodeficiency virus (HIV) or hepatitis C (HCV) pose specific problems to health-care workers due to the risk of exposure to these agents in blood and other body fluids. Studies of patients with penetrating trauma in the USA have shown a higher prevalence of HIV and HCV infection than the general population. No studies have examined the prevalence of these infections in Australian trauma patients. Methods: The medical records of all patients presenting to St Vincent's Hospital, Sydney, from January 1994 to December 1998, with a stab wound to the neck, chest or abdomen, or with a gunshot wound to any anatomical site, were retrospectively reviewed. The number of patients with a history of HIV or HCV infection, or with risk factors for these such as male-to-male sexual intercourse and intravenous drug use, were recorded. Results: The medical records of 148 patients with stab wounds to the neck, chest or abdomen, or with gunshot wounds were examined. Risk factors for HIV or HCV infection were recorded in 31 patients (21%). Two patients (1.3%) had a history of HIV infection and a further eight patients (5.4%) were known to have HCV. Conclusions: Them was a high prevalence of risk factors for HIV and HCV in patients with major penetrating wounds at St Vincent's Hospital. The prevalence of documented HIV and HCV infection was subsequently greater than that expected in the general population, highlighting the risks to health-care workers managing these patients.
Keywords: Firearms; Gunshot wounds; Hepatitis C virus; Human immunodeficiency virus; Penetrating wounds; Retrospective study; Stab wounds; Trauma; Violence; Wounds

A critique of research on sexual-minority youths - Savin-Williams, R.C. (Journal of Adolescence, 2001)
Developmental scientists should seriously reconsider traditional empirical and theoretical paradigms that narrowly define sexual-minority adolescents in terms of those who adopt a culturally defined sexual identity label. A broader consideration of youth populations who have same-sex desires but who might not necessarily identify as gay, lesbian or bisexual, lead one to a very different understanding of sexual-minority youths than is apparent in most published studies. First, they are in most regards just like all other adolescents with similar developmental needs and concerns. Second, they are not a homogeneous group but vary among themselves in predictable ways. Third, this expanded definition allows us to conclude that same-sex attraction per se does not lead to pathology or to problematic behavior such as drug abuse, suicide, prostitution or HIV infection. Indeed, researchers and clinicians should focus on the resiliency that often characterizes sexual-minority youths. © 2001 The Association for Professionals in Services for Adolescents.

Suicidality patterns and sexual orientation-related factors among lesbian, gay, and bisexual youths - D'Augelli, A.R.; Hershberger, S.L.; Pilkington, N.W. (Suicide and Life-Threatening Behavior, 2001)
Three hundred fifty lesbian, gay, and bisexual youths aged 14 to 21 years were questioned about suicidal thoughts and behaviors, families' reactions to youths' sexual orientation, and suicidality among relatives and friends. Results confirmed an association between sexual orientation and suicidality. Nearly half (42%) had sometimes or often thought of suicide; one third (33%) reported at least one suicide attempt. Many related suicidal ideation and suicide attempts to their sexual orientation. Most attempts followed awareness of same-sex feelings and preceded disclosure of sexual orientation to others. One quarter said a family member had made a suicide attempt, and nearly three quarters said a close friend had attempted suicide.

The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: Findings from 3 US cities - Díaz, R.M.; Ayala, G.; Bein, E.; Henne, J.; Marin, B.V. (American Journal of Public Health, 2001)
Objectives. This study assessed the relation between experiences of social discrimination (homophobia, racism, and financial hardship) and symptoms of psychologic distress (anxiety, depression, and suicidal ideation) among self-identified gay and bisexual Latino men in the United States. Methods. Data were collected from a probability sample of 912 men (self-identified as both Latino and non-heterosexual) recruited from the venues and public social spaces identified as both Latino and gay in the cities of Miami, Los Angeles, and New York. Results. The study showed high prevalence rates of psychologic symptoms of distress in the population of gay Latino men during the 6 months before the interview, including suicidal ideation (17% prevalence), anxiety (44%), and depressed mood (80%). In both univariate and multivariate analyses, experiences of social discrimination were strong predictors of psychologic symptoms. Conclusions. The mental health difficulties experienced by many gay and bisexual Latino men in the United States are directly related to a social context of oppression that leads to social alienation, low self-esteem, and symptoms of psychologic distress.

Suicide attempts among sexual-minority youths: Population and measurement issues - Savin-Williams, R.C. (Journal of Consulting and Clinical Psychology, 2001)
Two questions were addressed regarding suicide attempts among sexual-minority youths: Who should be classified as a sexual minority, and what constitutes a suicide attempt? Results from 2 studies indicated that sexual-minority youths, broadly defined in terms of sexual orientation and recruitment venue, were slightly more likely than heterosexual youths to report a suicide attempt. To afford a more accurate assessment of suicide attempts, a detailed measure distinguished true from false attempts. This method eliminated over half of suicide attempt reports among sexual minorities because they were false attempts-ideation rather than a concrete act to end life. Furthermore, many true attempts were not life threatening, suggesting that the reports were attempts to communicate the hardships of lives or to identify with a gay community.

The bullying of sexual minorities at school: Its nature and long-term correlates - Rivers, I. (Educational and Child Psychology, 2001)
Over the past 10 years, there has been a great deal of research activity exploring the nature and frequency of peer victimisation and bullying behaviour. This paper reports on a three-year study focusing upon the experiences of a sample of lesbians, gay men and bisexual men and women who were bullied at school, and the long-term impact it has had upon their lives. Data collection consisted of three elements: A survey of lesbian, gay, bisexual and transgendered adults' experiences of bullying at school (N = 190); a survey of the psycho-social correlates and long-term effects of bullying with a sub-sample of 119 participants; and, finally, a small number of in-depth interviews with 16 participants. Participants' experiences of bullying in school were long-term (mean: 5 years) systematic, and were perpetrated by groups of peers rather than by individuals. Participants were unlikely to report incidents of bullying either to teachers or to someone at home. In the survey of psychosocial correlates and long-term effects over 50 per cent of participants reported contemplating self-harming behaviour or suicide with 40 per cent making one or more attempts. As adults, they were found to exhibit some symptoms associated with negative affect when compared to controls. However, participants did not suffer from low self-esteem and had a positive attitude towards their own homosexuality/bisexuality and homosexuality/bisexuality generally.

Aspects of mental health among older lesbian, gay, and bisexual adults - D'Augelli, A.R.; Grossman, A.H.; Hershberger, S.L.; O'Connell, T.S. (Aging and Mental Health, 2001)
This study examined aspects of mental health among 416 lesbian, gay, and bisexual adults aged 60 to 91 years old, attending social and recreational programs. Mental health indicators were perceived mental health status; self-esteem; internalized homophobia; loneliness; alcohol and drug abuse; and suicidality. Better mental health was correlated with higher self-esteem, less loneliness, and lower internalized homophobia. Compared to women, men reported significantly more internalized homophobia, alcohol abuse, and suicidality related to their sexual orientation. Less lifetime suicidal ideation was associated with lower internalized homophobia, less loneliness, and more people knowing about participants' sexual orientation.

Suicide and gay/lesbian/bisexual youth: Implications for clinicians - Morrison, L.L.; L'Heureux, J. (Journal of Adolescence, 2001)
The research indicating the incidence rates and specific risks for suicide in the gay, lesbian, bisexual, and questioning (GLBQ) adolescent population is reviewed. An ecological model of suicide risk assessment for GLBQ youth is presented based on Bronfenbrenner's model of human development. The model argues for individual, micro, and macro levels of assessment to increase clinical judgement and accuracy in determining high risk GLBQ adolescents. The model also delineates both primary and secondary intervention strategies which could be utilized to prevent GLBQ youth suicide. © 2001 The Association for Professionals in Services for Adolescents.

Adolescent sexual orientation and suicide risk: Evidence from a national study - Russell, S.T.; Joyner, K. (American Journal of Public Health, 2001)
Objectives. Sexual orientation has been a debated risk factor for adolescent suicidality over the past 20 years. This study examined the link between sexual orientation and suicidality, using data that are nationally representative and that include other critical youth suicide risk factors. Methods. Data from the National Longitudinal Study of Adolescent Health were examined. Survey logistic regression was used to control for sample design effects. Results. There is a strong link between adolescent sexual orientation and suicidal thoughts and behaviors. The strong effect of sexual orientation on suicidal thoughts is mediated by critical youth suicide risk factors, including depression, hopelessness, alcohol abuse, recent suicide attempts by a peer or a family member, and experiences of victimization. Conclusions. The findings provide strong evidence that sexual minority youths are more likely than their peers to think about and attempt suicide.

A model of predictors and outcomes of outness among lesbian and bisexual women - Morris, J.F.; Waldo, C.R.; Rothblum, E.D. (American Journal of Orthopsychiatry, 2001)
In a structural equation model of 2,401 lesbian and bisexual women, three variables of lesbian sexual identity were found to predict outness, which predicted lower psychological distress, which, in turn, predicted lower suicidality. The model held true for the subsamples of European-American and African-American women, and to a lesser extent for those of Latina, Asian-American, Native-American, and Jewish women.

Integrating Gay, Lesbian, and Bisexual IssuesInto Mainstream Psychology - Goldfried, M.R. (American Psychologist, 2001)
Despite the growing clinical and research literature dealing with gay, lesbian, and bisexual (GLB) issues, mainstream psychology has tended to ignore much of the work that has been done in this area. This article illustrates how clinical and research writings on GLB issues continue to remain invisible to mainstream psychology in such areas as life span development and aging, teenage suicide, substance abuse, victimization and abuse, and family and couple relationships. It also deals with some of the determinants of well-being among GLB individuals, such as family support, and notes the benefits accruing to mainstream psychology from studying GLB issues. A network of family members within psychology having GLB relatives has been formed - AFFIRM: Psychologist Affirming Their Gay, Lesbian, and Bisexual Family - and is dedicated to supporting its own family members, encouraging other family members to do likewise, supporting research and clinical work on GLB issues, and closing the gap between GLB clinical and research work and mainstream psychology.

Depression, suicidal ideation and STD-related risk in homeless older adolescents - Rohde, P.; Noell, J.; Ochs, L.; Seeley, J.R. (Journal of Adolescence, 2001)
Goals of this study were to examine the frequency of depression and related constructs of suicidal ideation and hopelessness in a sample of homeless older adolescents and their associations with behaviors that may increase the risk of sexually transmitted disease (STD). Diagnostic interviews and blood/urine samples were obtained from 523 homeless adolescents (mean age = 17.8). Overall, 12.2 per cent had a current DSM-IV diagnosis of major depression and 6.5 per cent had dysthymia, with higher rates for female and older participants. Depression appeared to precede rather than follow homelessness and was associated with biologically verified STDs (in older participants), infrequent condom use, a non-heterosexual orientation (in older participants), and lifetime homosexual experience. Unlike depression, suicidal ideation and hopelessness were associated with higher rates of intravenous drug use but lower rates of multiple sex partners and, in young homeless women, less sexual coercion. Depression is frequent in homeless older adolescents and has a complex association with STD-related behaviors. © 2001 The Association for Professionals in Services for Adolescents.

Homosexuality and suicide: A case report - Tamam, L.; Özpoyraz, N.; Diler, R.S. (Annals of Medical Sciences, 2001)
Despite the inconsistency in data concerning the higher prevalence of mental disorders among homosexuals than heterosexuals, suicidality in homosexuals, particularly among adolescents and young adults have been consistently reported to be higher over the past 25 years. It has been recently stated that gay youth are 2 to 3 times more likely to attempt suicide than other young people which may comprise up to 30% of completed youth suicides annually. In this case report, we presented a young gay patient who attempted suicide and discussed the major causes of this attempt, primarily sexual prejudice of the society and possible therapeutic approaches.
Keywords: Homophobia; Homosexuality; Sexual prejudice; Suicide

Disclosure of Sexual Orientation, Victimization, and Mental Health Among Lesbian, Gay, and Bisexual Older Adults - D'augelli, A.R.; Grossman, A.H. (Journal of Interpersonal Violence, 2001)
This study examined the lifetime victimization based on sexual orientation of 416 lesbian, gay, or bisexual (LGB) older adults aged 60 or older. Participants reported the ages at which they were aware of their sexual orientation, self-identified as LGB, and first disclosed their sexual orientation to anyone. Frequencies of nine kinds of verbal and physical victimization were obtained. Nearly three quarters reported some kind of sexual orientation victimization. Men reported more overall victimization than women. The more open participants were about their sexual orientation and the less time they spent before disclosing their sexual orientation, the more victimization they reported. Physical victimization was associated with earlier achievement of sexual orientation milestones and more time being open about one's sexual orientation. Participants who had been physically attacked reported lower self-esteem, more loneliness, and poorer mental health than others. More suicide attempts were reported among those older adults who were physically attacked. © 2001, Sage Publications. All rights reserved.

Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: The benefits of gay-sensitive HIV instruction in schools - Blake, S.M.; Ledsky, R.; Lehman, T.; Goodenow, C.; Sawyer, R.; Hack, T. (American Journal of Public Health, 2001)
Objectives. This study compared sexual risk behaviors of gay, lesbian, and bisexual (GLB) and heterosexual adolescents and evaluated associations between gay-sensitive HIV instruction and risk behaviors of GLB youths. Methods. A random sample of high school students and HIV education teachers completed surveys. Self-reported risk behaviors of heterosexual and GLB adolescents were compared, with control for student and community demographic characteristics. Sexual risk behaviors of GLB youths in schools with and without gay-sensitive instruction were compared. Results. GLB youths reported more substance use, high-risk sexual behaviors, suicidal thoughts or attempts, and personal safety issues than did heterosexual youths (P<.001). Among those who were sexually active. GLB youths reported more lifetime and recent sexual partners than did heterosexuals (P<.001), and more of them reported alcohol use before last sex (P<.01) and a history of pregnancy (P<.001). GLB youths in schools with gay-sensitive instruction reported fewer sexual partners, less recent sex, and less substance use before last sex than did GLB youths in other schools (P<.05). Conclusions. The findings document increased risk behaviors among GLB youths and demonstrate the potential benefits of providing gay-sensitive HIV instruction in schools.

Sexual identity, psychological well-being and suicide risk among lesbian and gay young people - Walker, P.H. (Educational and Child Psychology, 2001)
Five lesbians and nine gay men participated in a semi-structured interview study looking at psychological well-being within the context of developing a lesbian or gay identity. Particular attention was paid to suicidal ideas and parasuicide. Data were analysed using Interpretative Phenomenological Analysis (Smith, 1996a) which revealed 10 main themes, of which two are highlighted as being relevant to providers of services for young lesbians and gay men, namely, coping strategies for dealing with negative reactions to disclosure and feelings of isolation. Recommendations are made regarding the provision of services to support and develop the psychological well-being of lesbian and gay young people.

Playing it safe: Addressing the emotional and physical health of lesbian and gay pupils in the U.K. - Warwick, I.; Aggleton, P.; Douglas, N. (Journal of Adolescence, 2001)
Compared to young people in general, young lesbians and gay men can face specific challenges to their physical and emotional well-being. These include discrimination, victimization, homophobic bullying and an elevated suicide risk. Relative to initiatives which attempt to address bullying in general, little has been done in schools in the U.K. to address physical and verbal homophobic bullying. This paper reports on an exploratory study to examine teachers' perceptions of homophobic bullying, the responses made to this form of bullying, and the factors which impact on the provision of education and support to lesbian and gay pupils. Findings suggested that teachers were aware of homophobic bullying but were confused, unable or unwilling to address the needs of lesbian and gay pupils. Implications for policy, practice and research are discussed. While current U.K. Government policy promoting Healthy Schools and Citizenship education offers hope for the future, much remains to be done to ensure that such initiatives are inclusive of all pupils. © 2001 The Association for Professionals in Services for Adolescents.

HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: Implications for public health intervention - Clements-Nolle, K.; Marx, R.; Guzman, R.; Katz, M. (American Journal of Public Health, 2001)
Objectives. This study described HIV prevalence, risk behaviors, health care use, and mental health status of male-to-female and female-to male transgender persons and determined factors associated with HIV. Methods. We recruited transgender persons through targeted sampling, respondent-driven sampling, and agency referrals; 392 male-to-female and 123 female-to-male transgender persons were interviewed and tested for HIV. Results. HIV prevalence among male-to-female transgender persons was 35%. African American race (adjusted odds ratio [OR] = 5.81; 95% confidence interval [CI] = 2.82, 11.96), a history of injection drug use (OR - 2.69; 95% CI = 1.50, 4.62), and low education (adjusted OR = 2.08; 95% CI =1.17, 3.68) were independently associated with HIV. Among female-to-male transgender persons, HIV prevalence (2%) and risk behaviors were much lower. Most male-to-female (78%) and female-to-male (83%) transgender persons had seen a medical provider in the past 6 months. Sixty-two percent of the male-to-female and 55% of the female-to-male transgender persons were depressed; 32% of each population had attempted suicide. Conclusion. High HIV prevalence suggests an urgent need for risk reduction interventions for male-to-female transgender persons. Recent contact with medical providers was observed, suggesting that medical providers could provide an important link to needed prevention, health, and social services.

Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the national comorbidity survey - Gilman, S.E.; Cochran, S.D.; Mays, V.M.; Hughes, M.; Ostrow, D.; Kessler, R.C. (American Journal of Public Health, 2001)
Objectives. This study examined the risk of psychiatric disorders among individuals with same-sex sexual partners. Methods. Data are from the National Comorbidity Survey, a nationally representative household survey. Respondents were asked the number of women and men with whom they had sexual intercourse in the past 5 years. Psychiatric disorders according to Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria were assessed with a modified version of the Composite International Diagnostic Interview. Results. A total of 2.1% of men and 1.5% of women reported 1 or more same-sex sexual partners in the past 5 years. These respondents had higher 12-month prevalences of anxiety, mood, and substance use disorders and of suicidal thoughts and plans than did respondents with opposite-sex partners only. Decomposition showed that the elevated same-sex 12-month prevalences were largely due to higher lifetime prevalences. Ages at onset and persistence of disorders did not differ between the same-sex and opposite-sex subsamples. Conclusions. Homosexual orientation, defined as having same-sex sexual partners, is associated with a general elevation of risk for anxiety, mood, and substance use disorders and for suicidal thoughts and plans. Further research is needed to replicate and explore the causal mechanisms underlying this association.

Suicide & homosexual teens: What can biology teachers do to help? - Smith, M.U.; Drake, M.A. (American Biology Teacher, 2001)

Phallic narcissism, anal sadism, and oral discord: The case of yukio mishima, part I - Piven, J. (Psychoanalytic Review, 2001)

Beyond personhood and autonomy: moral theory and the premises of privacy. - Rappaport, A.J. (Utah law review, 2001)

Sex differences in risk factors for HIV seroconversion among injection drug users: A 10-year perspective - Strathdee, S.A.; Galai, N.; Safaiean, M.; Celentano, D.D.; Vlahov, D.; Johnson, L.; Nelson, K.E. (Archives of Internal Medicine, 2001)
Background: Injection drug use directly or indirectly accounts for nearly half the annual human immunodeficiency virus (HIV) infections in the United States. Prospective studies that investigate both sexual and parenteral HIV risks among injection drug users (IDUs) are needed. We studied factors for HIV seroconversion among male and female IDUs in Baltimore, Md. Methods: The HIV-negative IDUs (1447 male and 427 female) were recruited into a prospective study from 1988 to 1989 or in 1994. Participants underwent semiannual HIV tests and surveys through December 1998. Poisson regression was used to identify risk factors for HIV seroconversion, stratified by sex. Behaviors were treated as time-dependent covariates that varied at each semiannual period. Results: Subjects were primarily African American (91%), and median age at enrollment was 35 years. Incidence of HIV was 3.14 per 100 person years (95% confidence interval, 2.78-3.53) and did not significantly differ by sex. Younger age independently predicted HIV seroconversion for both men and women. Among men, factors that independently predicted HIV seroconversion were the following: less than a high school education, recent needle sharing with multiple partners, daily injection, and shooting-gallery attendance. The incidence of HIV was double for men recently engaging in homosexual activity and cocaine injection. Among women, the incidence of HIV was more than double for those recently reporting sexually transmitted diseases. Conclusions: The incidence of HIV remained high among IDUs in Baltimore over the past decade. Risk factors for HIV seroconversion differed markedly by sex. Predominant risks among men included needle sharing and homosexual activity; among women, factors consistent with high-risk heterosexual activity were more significant than drug-related risks. Human immunodeficiency virus interventions aimed at IDUs should be sex-specific and incorporate sexual risks.

Effects of perceived consensus on selective reinforcement of other people's stated opinions - Wallace, D.S.; Desforges, D.M.; Thomas, J.C.; Lord, C.G.; Sia, T.L. (Basic and Applied Social Psychology, 2001)
Three studies tested whether perceived consensus affects selective reinforcement of other people's stated opinions on important social issues. Participants who perceived relatively high consensus for their opinions were more likely than participants who perceived low consensus to reward another person's agreeing statements more than the person's disagreeing statements about gun control (Study 1) and to prolong interrogating another student about abortion (Study 2). In Study 3, participants who were told they were in a two-thirds majority regarding gay scout troop leaders were more likely than participants who were told they were in a one-third minority to practice selective reinforcement. The results have implications for settings in which interrogators believe they can exercise power over the person who is being questioned.

Scent marking in meadow voles and prairie voles: A test of three hypotheses - Ferkin, M.H.; Mech, S.G.; Paz-Y-Miño, G.C. (Behaviour, 2001)
Most terrestrial mammals deposit scent marks to communicate with conspecifics. We examined the scent marking behaviour of meadow voles and prairie voles, species with different mating systems and social organizations, to determine whether voles scent mark according to the 'targeting' response, the 'avoidance' response, or the 'shotgun' response. The targeting response occurs when the second scent donor deposits more of its scent marks in an area marked by the first scent donor than in an unscented area. The avoidance response occurs when the second scent donor deposits more of its scent marks in an unscented area than in an area marked by the first scent donor. The shotgun response occurs when the second scent donor deposits a similar number of its scent marks in an area containing scent marks of a conspecific and in an area containing no conspecific scent marks. We allowed voles simultaneous access to an arena containing two arms: one of the arms was scented by a conspecific and the other arm was unscented. We recorded the number of marks deposited by the voles in each arm and the amount of time they spent investigating marks deposited previously in the scented arm. Our data provide no support for the avoidance response, but provide support for the shotgun response and the target response. Species and sex differences in the scent marking behaviours of voles when they encounter the scent marks of conspecifics are discussed within the framework that scent marking responses depend on the voles' social organization and mating system, and that these responses may reflect the tactics males and females use to attract mates and compete with same-sex conspecifics.

Autoerotic asphyxia (a case report). - Doychinov, I.D.; Markova, I.M.; Staneva, Y.A. (Folia medica, 2001)
The authors report the case of a young man, 18 years of age, who died as a result of autoerotic asphyxia. In the practice of forensic medicine such cases are presented as deaths from mechanic asphyxia in which, using various means and devices, the neck is constricted or the external respiratory orifices are obstructed with the purpose of achieving sexual gratification as a result of the induced hypoxia. These cases pose serious difficulties to the forensic medicine expert and the coroner because of the difficulties of distinguishing it as homicide, suicide or accident. The young man was found hanging by the neck, suspended on a leather belt attached on the door of his room. A mirror was placed in front of the door, reflecting him in full height. He was dressed in women's clothing (a skirt, a blouse, bikini) and a brassiere padded to resemble female breasts. Pornographic pictures from newspapers and magazines were spread on the floor. The young man had no known history of mental disorders, but there was evidence for bisexual tendencies and behaviour. On the basis of a comprehensive evaluation of the data it was accepted that the death was accidental and was attributed to autoerotic asphyxia. All the characteristic features for an act of autoerotic asphyxia, described in the forensic medicine literature, were found in this case. Autoerotic asphyxia is almost unknown as a distinctive psychopathological entity in this country's forensic medicine practice. The deficiency of theoretical knowledge in this field, as well as the lack of personal practical experience in most of the legal physicians and pathologists could result in erroneous interpretation of such case.

Whither hunter's culture war? Shifts in evangelical morality, 1988-1998 - McConkey, D. (Sociology of Religion: A Quarterly Review, 2001)
Ten years have passed since the events of the late 1980s spurred James Davison Hunter to write his book Culture wars, which was published in 1991. Since then, the political world has witnessed several shifts that call into question the durability of this conflict. This paper examines both the current state of the culture war ana its precipitating trends over the past decade. In doing so, it is necessary to determine whether evangelicals have been softening their traditionalist moral positions on issues like men's roles, homosexuality, nonmarital sexuality, birth control, abortion, suicide, and euthanasia. It is also necessary to determine the nature of any fluctuations in evangelical morality relative to that of religious progressives and moderates. Specifically, three questions are addressed. First, are evangelicals leaving the socioeconomic margins of society? Second, is evangelical morality becoming more liberal? And finally, is the culture war dissipating? Using data from the 1988 and 1998 General Social Surveys, results indicate that evangelicals are capitulating on some -though not all -arenas of moral conct, but that the cultural tension between evangelicals and religious progressives remains strong. The evidence suggests that, consistent with Christian Smith's subcultural identity theory, evangelicals will likely continue to experience a cultural tension with the larger culture, tut this tension is not likely to result in anything resembling warfare.

Suicidal acts and ideation in homosexual and bisexual young people: A study of prevalence and risk factors - Van Heeringen, C.; Vincke, J.; Van Heeringen, C. (Social Psychiatry and Psychiatric Epidemiology, 2000)
Background: Suicide attempts are the most robust clinical predictor of suicide, which is now the second cause of death among young people in many countries. Previous research has shown an increased risk of attempted suicide associated with a homosexual orientation. However, the mechanisms underlying this increased risk are not yet clear. This study therefore aimed to determine the risk of attempted suicide and the effect of potential risk factors on the occurrence of suicidal ideation and behaviour among homosexual youngsters. Methods: The association between suicidal ideation and behaviour and potential risk factors was assessed by means of a questionnaire in a general population sample of homosexual or bisexual young people and a control sample consisting of school pupils. Results: A twofold increased risk of suicidal ideation was found associated with a homosexual or bisexual orientation. A significantly increased risk of attempted suicide associated with homosexuality or bisexuality was found in females. Independent of sexual orientation, depression was identified as a significant risk factor for suicidal ideation, while suicidal behaviour was associated with low self-esteem, higher levels of hopelessness and suicidal behaviour in someone close. Among homosexual or bisexual young people, less satisfying homosexual friendships were an additional risk factor for suicidal behaviour. Conclusions: The identified increased risk of suicidal ideation among homosexual or bisexual young people is associated with depression and may lead to suicidal behaviour, independent of sexual orientation, especially in the presence of a role model of suicidal behaviour, and among those with unsatisfying friendships.

Female-to-male transsexual with 47,XXX karyotype - Turan, M.T.; Eşel, E.; Dündar, M.; Candemir, Z.; Baştürk, M.; Sofuǒlu, S.; Özkul, Y. (Biological Psychiatry, 2000)
Background: There are few reports describing chromosomal abnormalities in transsexuals. In rare cases, transsexualism and sexual chromosomal multiplicity coexist. Six cases of male-to-female transsexuals with 47,XYY chromosomal pattern have been previously reported. We have not encountered any female transsexual cases with 47,XXX karyotype in the literature. Methods: A 21-year-old female patient came to our outpatient department with depressive symptoms and suicidal thoughts. On psychiatric interview, she reported that she had feelings of discomfort with her gender identity and had desired to be male since her childhood. Then, we performed cytogenetic investigation using blood culture and G chromosome banding. Results: Histology and DNA histograms of the patient revealed a chromosomal pattern of 47,XXX. Conclusions: We conclude that sexual chromosomal abnormalities in some transsexuals may cause a vulnerability to development of a gender identity disorder. (C) 2000 Society of Biological Psychiatry.
Keywords: Gender identity disorder; Sex chromosomal abnormality; Transsexualism

Sexuality as compromise formation - Hoffman, L.; Lager, E.; Rosenbaum, A.L. (Journal of Clinical Psychoanalysis, 2000)

Fuzzy techniques in the aircraft engineering - Pokorádi, L. (Proceedings of the Mini Conference on Vehicle System Dynamics, Identification and Anomalies, 2000)
The fuzzy logic is a relatively new mathematical tool to model the real world's behavior especially in a contradictory reality and when the modeler has to cope with missing data. LOFTI ZADEH, at the BERKELEY UNIVERSITY, issued first publications in the middle of 60's about the fuzzy logic. He was the first researcher who successfully applied non-binary logic in his work and called this part of the mathematics as "fuzzy logic". In the aircraft engineering and in the technical management, the fuzzy logic is - can be or should be - used as a fuzzy control, decision making and expert system. The very great experience of engineers and technicians is similar to the real world's characteristics mentioned above. This experience can be analyzed and utilized statistically applying the fuzzy logic. The fuzzy logic based methods can be used to trouble-shoot and to make management-decision. This paper will show basis of the fuzzy logic and its possibilities of use in the aircraft engineering. The overview of international research and potential challenges in Hungary will be shown too.
Keywords: Decision-making; Fuzzy logic; Mathematical modeling; System diagnostics; Trouble-shooting

Factors associated with willingness to participate in HIV vaccine trials among HIV-negative injection drug users and young gay and bisexual men - Strathdee, S.A.; Hogg, R.S.; Cornelisse, P.G.A.; Martindale, S.L.; Currie, S.L.; O'shaughnessy, M.V.; Schechter, M.T. (AIDS and Behavior, 2000)
We identified factors associated with willingness to participate in HIV vaccine trials among HIV-negative injection drug users (IDU) and young men having sex with men (MSM) enrolled in prospective cohort studies in Vancouver. Of 435 IDU and 330 MSM, 83% and 63% were willing to participate in HIV vaccine trials, respectively. In both samples, greater willingness was associated with high perceived HIV threat, and with initiating injection or first having sex with men at younger ages. Among IDU, frequent needle exchange programs attenders were more willing to participate than infrequent attenders (p = .004). Among MSM, those with a higher depression score were more willing to participate (p < .001). In logistic regression models, independent predictors of willingness to participate included frequent needle exchange attendance among IDU, and high depression score and high perceived HIV threat among MSM. This suggests that needle exchange programs are ideal venues for recruiting high-risk IDU into HIV vaccine trials. Since MSM reporting more depressive symptoms were more willing to participate, HIV vaccine trials should provide appropriate counseling to safeguard participants' psychological and physical health.
Keywords: HIV vaccine trials; Homosexual men; Injecting drug users; Needle exchange programs; Risk behavior

Eating disorders in males: A comparison with female patients - Bramon-Bosch, E.; Troop, N.A.; Treasure, J.L. (European Eating Disorders Review, 2000)
It is controversial whether males and females with eating disorders differ in a relevant way. We present a comparison of 30 male and 30 female patients assessed at The Maudsley Hospital in 2.5 years. Of the male group 33 per cent were anorexic, 50 per cent were bulimic, and 17 per cent met criteria for an eating disorder not otherwise specified. The female sample was matched to the males by diagnosis. Male and female patients are essentially similar, in particular there are no differences in severity of eating disorder. However, homosexuality appears to be more frequent among males. Moreover, males with an eating disorder show a stronger psychiatric co-morbidity and a higher rate of suicide attempts. Copyright (C) 2000 John Wiley and Sons, Ltd and Eating Disorders Association.
Keywords: Eating disorders; Homosexuality; Males; Psychiatric co-morbidity; Suicide

Theoretical perspectives on suicide in gay men with AIDS - McNaught, A.; Spicer, J. (Social Science and Medicine, 2000)
Suicide among gay men with AIDS constitutes a significant theoretical and practical problem. In order to understand this problem it is necessary to consider the specific circumstances that surround these individuals. Whilst there are many theories of suicide with which to address the problem, few are able to capture the special context within which gay men with AIDS live. This article explores three broad concepts from the theoretical literature on suicide that have explanatory potential in this unique context. The three concepts are: the search for meaning in the midst of suffering, Shneidman's [Shneidman, E., 1985. Definition of Suicide. John Wiley, New York] notion of unendurable psychological pain, and hopelessness. This article attempts to demonstrate how these three concepts can incorporate the experiences of gay men with AIDS and contribute to understanding the problem of suicide in this population. Copyright (C) 2000 Elsevier Science Ltd.
Keywords: AIDS; Gay men; Suicide; Theory

Plans to hasten death among gay men with HIV/AIDS: Relationship to psychological adjustment - Goggin, K.; Sewell, M.; Ferrando, S.; Evans, S.; Fishman, B.; Rabkin, J. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2000)
This study assessed the prevalence and nature of thoughts and future plans to end one's life in a group of gay men with HIV/AIDS over an 18-month period. HIV-positive men (n = 167) participated in a series of clinical interviews which measured current health status, current and past psychiatric disorders, current levels of distress, and thoughts and plans about ending their lives currently or at some future point. A small number of HIV-positive men (17%) reported serious thoughts or plans to end their lives at some point in the future which were stable over an 18-month period. No differences in psychiatric or medical measures were observed among men with and without thoughts/plans at either assessment point. In the absence of current psychiatric disorders, such thoughts or plans about the future may represent one way to maintain control and independence in the face of the uncertainty of life with HIV illness.

Lesbians in New Zealand: Their mental health and satisfaction with mental health services - Welch, S.; Collings, S.C.D.; Howden-Chapman, P. (Australian and New Zealand Journal of Psychiatry, 2000)
Objectives: To describe the mental health of lesbians in New Zealand, and to document their accounts of their experience of mental health services. Method: This is a descriptive cross-sectional study. A postal questionnaire, the Lesbian Mental Health Survey, was distributed via lesbian newsletters to 1222 women throughout New Zealand. Mental health measures included the General Health Questionnaire (GHQ-28), Interview Schedule for Social Interaction (ISSI), and respondents' histories of sexual abuse and psychiatric histories. Experiences of mental health services were sought. Results: The estimated response rate was 50.8%. The respondent group were predominantly New Zealand European, highly educated, urban women between 25 and 50 years of age. Three-quarters had identified as lesbian for more than 5 years. Recent self-identification as lesbian was associated with higher GHQ score, as was being younger than 35, having a history of sexual abuse, and not living with a partner. Eighty percent of respondents had used mental health services sometime in their lives and nearly 30 percent of users had received 'lesbian-unfriendly' treatment at some point. One-sixth of respondents had experienced discrimination from service providers in the previous 5 years. Conclusion: While the mental health of lesbians is influenced by factors similar to those influencing women's mental health in general, because of social factors, such as stigma and isolation, lesbians may be more vulnerable to common mental illnesses. Health professionals, mental health professionals in particular, need to raise their awareness of the issues lesbians face in dealing with their sexuality, therapeutic relationships and mental health services. Increased training about sexuality for health professionals, as well as further research into areas such as stress and stigma, sexual abuse and attempted suicide among lesbian women, is recommended.
Keywords: Lesbian; Mental health; Service satisfaction; Women

Early sexual abuse and lifetime psychopathology: A co-twin-control study - Dinwiddie, S.H.; Heath, A.C.; Dunne, M.P.; Bucholz, K.K.; Madden, P.A.F.; Slutske, W.S.; Bierut, L.J.; Statham, D.B.; Martin, N.G. (Psychological Medicine, 2000)
Background. This study was designed to determine lifetime prevalence of psychiatric disorders among twins who reported childhood sexual abuse (CSA), and to compare these rates with those among non-abused co-twins. The contribution of familial and individual-specific factors to reported sexual abuse was also examined. Method. Information about lifetime psychopathology and substance use was obtained by structured telephone interviews with 5995 Australian twins. Twins who reported a history of childhood sexual abuse (CSA) were contrasted on lifetime psychopathology with subjects without such a history; in addition, comparisons were made between same-sex twin pairs discordant for CSA. Results. A history of CSA was reported by 5.9% of the women and 2.5% of the men. In the sample as a whole, those reporting CSA were more likely to receive lifetime diagnoses of major depression, conduct disorder, panic disorder and alcoholism, and were more likely to report suicidal ideation and a history of suicide attempt. Abused women, but not men, were also more likely to report social phobia. When comparisons were restricted to non-abused co-twins, no differences in psychopathology were seen. However, rates of major depression, conduct disorder and suicidal ideation were higher if both co-twins were abused than if the respondent alone reported CSA. Model-fitting indicated that shared environmental factors influenced risk for reported CSA in women, but not in men. Conclusion. The association between CSA and psychopathology arises at least in part through the influence of shared familial factors on both risk of victimization and risk of psychopathology.

Social exclusion, absenteeism and sexual minority youth - Rivers, I. (Support for Learning, 2000)
In this article, on a topic not previously explored in this journal, Ian Rivers compares two groups of lesbian, gay and bisexual adults (mean age, 28 years) who reported having been subjected to anti-lesbian/gay abuse at school. The first group recalled a history of absenteeism at school while the second group, although experiencing similar levels of harassment, reported attending school on a regular basis. The findings suggest an association between the experience of harassment and a history of absenteeism and an ideation of self-harm and suicide while at school. Rivers proposes that anti-harassment initiatives be set up to ensure a safe environment in which sexual minority youth can learn. © 2000 NASEN.

Generating stories of resilience: Helping gay and lesbian youth and their families - Sanders, G.L.; Kroll, I.T. (Journal of Marital and Family Therapy, 2000)
Lesbian, gay, and bisexual youth have often been forgotten in the provision of care to families. Not only are 10%-12% of all youth lesbian, gay, or bisexual, they all have families of origin and many also have "families of choice" that are dramatically increasing the numbers of persons who are directly affected. These youth can suffer disqualification ranging from internalized poor esteem and suicidality to physical danger, often at the hands of those very persons who are expected to care for them - families, educators, and health care providers. This article examines both how homophobia and heterosexism are both manifest and recovered from using case examples and offering therapeutic suggestions to clinicians.

Gifted and gay: A study of the adolescent experience - Peterson, J.S.; Rischar, H. (Gifted Child Quarterly, 2000)
A retrospective study of the adolescent experience of 18 gay, lesbian, or bisexual young adults with high ability (12 males, 6 females) using a postpositivistic mode of inquiry found significant themes of danger, isolation, depression, and suicidal ideation, together with high achievement and extreme involvement in activities, in their narrative responses to an extended questionnaire. Participants described personal responses to wondering about sexual orientation, being convinced, and eventually coming out, and the effects on school and family relationships. Half reported awareness by the end of elementary school, and almost all were convinced by grade 11. Most participants offered suggestions for educators in general and for those involved in gifted programs, and many of the suggestions have implications for staff development.

Lifetime prevalence of suicide symptoms and affective disorders among men reporting same-sex sexual partners: Results from NHANES III - Cochran, S.D.; Mays, V.M. (American Journal of Public Health, 2000)
Objectives. This study examined lifetime prevalence of suicide symptoms and affective disorders among men reporting a history of same-sex sexual partners. Methods. In the third National Health and Nutrition Examination Survey, men aged 17 to 39 years were assessed for lifetime history of affective disorders and sexual behavior patterns. The study classified this subset of men into 3 groups: those reporting same-sex sexual partners, those reporting only female sexual partners, and those reporting no sexual partners. Groups were compared for histories of suicide symptoms and affective disorders. Results. A total of 2.2% (95% confidence interval [CI]=1.3%, 3.1%) of men reported same-sex sexual partners. These men evidenced greater lifetime prevalence rates of suicide symptoms than men reporting only female partners. However, homosexually/bisexually experienced men were no more likely than exclusively heterosexual men to meet criteria for lifetime diagnosis of other affective disorders. Conclusions. These data provide further evidence of an increased risk for suicide symptoms among homosexually experienced men. Results also hint at a small, increased risk of recurrent depression among gay men, with symptom onset occurring, on average, during early adolescence.

Gay Youth: More visible but fewer problems? - Alexander, C.J. (Journal of Gay and Lesbian Social Services, 2000)
In recent years there has been a growing awareness among parents and social service professionals of the complex sexual identity development of adolescents. Despite this, adolescents continue to struggle to define their sexual identity. Gay and lesbian adolescents in particular are at risk for a host of problems, including substance abuse and suicide. In this context it is important for social service researchers to study adolescent sexual identity and to report their findings in such a way as to be accessible to professionals and to the public. © 2000 by The Haworth Press, Inc. All rights reserved.
Keywords: Adolescent sexuality; Gay and lesbian youth; Sexual identity development

Preventive services in a health maintenance organization: How well do pediatricians screen and educate adolescent patients? - Halpern-Felsher, B.L.; Ozer, E.M.; Millstein, S.G.; Wibbelsman, C.J.; Fusler, C.D.; Elster, A.B.; Irwin Jr., C.E. (Archives of Pediatrics and Adolescent Medicine, 2000)
Objective: To determine whether pediatricians in managed care settings adhere to national guidelines concerning the provision of clinical preventive services. Design: Surveys were mailed between September 1996 and April 1997 to all pediatricians practicing in a California group-model health maintenance organization. The survey asked pediatricians about their screening and education practices on 34 recommended services and the actions taken with adolescent patients who have engaged in risk behavior. Results: The response rate was 66.2% (N = 366). Pediatricians, on average, screened 92% of their adolescent patients for immunization status and blood pressure; 85% for school performance; 60% to 80% for obesity, sexual intercourse, cigarette use, alcohol use, drug use, and seat belt and helmet use; 30% to 47% for access to handguns, suicide, eating disorders, depression, and driving after drinking alcohol; fewer than 20% for use of smokeless tobacco, sexual orientation, sexual and physical abuse, and riding a bike or swimming after drinking alcohol; and 26% to 41% for close friends' engagement in risk behavior. Pediatricians' assessment and education with adolescent patients who screened positive for risk behavior was particularly low. Female physicians, physicians who saw a greater proportion of older adolescents, and recent medical school graduates were more likely to provide preventive services. Conclusions: Pediatricians in this health maintenance organization provide preventive services to adolescent patients at rates below recommendations but at rates greater than physicians in other practice settings. Improvement is especially needed in the areas that contribute most to adolescent mortality and for patients who screen positive for a risk behavior.

Sex reassignment surgery in france: Analysis of the legal framework and current procedures and its consequences for transsexuals - Meningaud, J.-P. (Medicine and Law, 2000)
Main objectives: In France there is no specific law that recognizes either sex reassignment surgery (SRS) or changes in civil status. This practice is based on a set of rules that have been devised by those practitioners in the disciplines involved. This study has been directed to evaluate the perceptions of French surgeons regarding their own activity in the area of the SRS with the implications that these perceptions may have on the management of patients and to contribute to a useful international collection of material on this difficult topic in terms both of report and interpretation. Methods: Personal interviews with 10 surgeons representing almost all of teams involved in transsexualism in France. The data were collected during 1998. Findings: Surgeons alone cannot evaluate the motivation of each patient's request. Their decision whether or not to operate is made in consultation with both a psychiatrist and an endocrinologist. They never urge patients to undergo SRS. An assessment lasting at least two years before making a recommendation for surgery is routine. The rate of postoperative suicides is very low. Among surgeons, postoperative regrets are minimal (postoperative regrets by patients were not directly evaluated in the framework of this study). The diagnosis seems to be made with satisfactory reliability, but at the cost of a tedious process for the patient. As a consequence some decide to be operated on abroad. However not all are true transsexuals. Conclusion: SRS represents a good example of the collaboration of certain disciplines as surgery, medicine, psychiatry and law to reaffirm the meaning that society gives to the status of the individual while protecting the respect of some unusual situations. © YOZMOT 2000.
Keywords: Ethics; France; Law; Sex reassignment surgery; Transsexualism

Neurochemical variables in subjects with adjustment disorder after suicide attempts - Tripodianakis, J.; Markianos, M.; Sarantidis, D.; Leotsakou, C. (European Psychiatry, 2000)
The investigation of biological correlates of suicidal behavior is important for identifying high-risk subjects. The objective of this study was to examine the neurochemical variables' platelet MAO activity and urinary MHPG, 5HIAA and HVA, the main metabolites of noradrenaline, serotonin and dopamine, neurotransmitters that are considered to be involved in the pathophysiology of suicidal behavior, as well as plasma cortisol, in a group of subjects with adjustment disorder after a suicide attempt. Fifty-three patients, 42 females and 11 males, were included in the study and were compared to a group of 50 healthy controls, 25 females and 25 males. Platelet MAO activity was found to be significantly lower in both male and female patients compared to controls of the same sex (P < 0.001 for both comparisons). 5HIAA and HVA were not different between patients and controls, but MHPG was significantly higher in the patients group (P = 0.008). Moreover, plasma levels of cortisol were significantly higher in the patients compared to the controls (P < 0.001). Our results confirm the hypothesis of low platelet MAO activity as a biological characteristic of patients who attempt suicide. They also point to a possible parallel activation of the noradrenergic system. (C) 2000 Editions scientifiques et medicales Elsevier SAS.
Keywords: Adjustment disorder; Cortisol; MAO; MHPG; Suicide attempt

Sexual attitudes and associated psychiatric features among youths in a community sample - Feldman, M.J.; Bird, H.R.; Hoven, C.; Moore, R.E.; Bin, F. (Journal of the American Academy of Child and Adolescent Psychiatry, 2000)
Objective: Using an epidemiological sample of adolescents, this study examined associations between the acceptability of potential sex partners and psychiatric status. Method: Subjects aged 14 to 17 years (N = 161) from the Columbia site of the National Institute of Mental Health (NIMH) Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study were grouped according to their responses about the acceptability of youths their age having sex with partners of (1) the opposite sex, (2) neither sex, and (3) either sex. Youths endorsing either sex were compared with youths endorsing the other two types of partners according to psychiatric indicators obtained from the Diagnostic Interview Schedule for Children Version 2.3. Results: Higher-than-expected proportions of male and female youths endorsed sex partners of either sex as potentially acceptable for peers. Youths who did so abused substances and used mental health services more than peers but did not differ in rates of suicidal ideation or attempts. Males endorsing either sex also had higher rates of mood disorders and, compared with males endorsing only the opposite sex, a higher intelligence level. Conclusions: Attitudes about the potential acceptability of sex partners for peers are associated with psychiatric morbidity and mental health service use in the respondent as well as with intelligence level in males. Youths who endorsed potential sex partners of either sex, especially males, appear to be at higher risk for multiple psychiatric problems.
Keywords: Adolescent suicide; Psychopathology; Sexual attitudes; Sexual orientation

Prognosis of penetrating trauma in elderly patients: A comparison with younger patients - Nagy, K.K.; Smith, R.F.; Roberts, R.R.; Joseph, K.T.; An, G.C.; Bokhari, F.; Barrett, J.; Kauder, D.R.; McGonigal, M.D.; Brotman, S.; Scalea, T.M. (Journal of Trauma - Injury, Infection and Critical Care, 2000)
Background: It has previously been shown that elderly patients have a worse prognosis than their younger counterparts after sustaining blunt trauma. This is due in part to a higher incidence of comorbid conditions as well as less physiologic reserve in an elderly population sustaining largely blunt trauma. We compared the outcome after penetrating trauma in elderly patients to matched 'younger' patients to determine whether they had a similarly poor prognosis. Methods: Elderly patients (≥65 years) were identified from our trauma registry. Sex, mechanism of injury, and Abbreviated Injury Score/Injury Severity Score were determined from the registry. Patients presenting with traumatic arrest were excluded. The registry was then searched for patients aged 15 to 40 years with the same sex, mechanism of injury, and Abbreviated Injury Score in each region. A chart review was then performed to determine additional details of their hospital stay. The two groups were then compared using Student's t test and Fisher's exact χ2 test, as appropriate. Results: Eighty-five elderly patients (OLD group) were admitted with penetrating trauma between 1983 and 1998. They were compared with 85 matched young patients (YOUNG group). Each group included 66 male and 19 female patients. In each group, gunshot wounds occurred in 45.9%, stab wounds in 52.9%, and shotgun wounds in 1.2% of patients. The average Injury Severity Score in each group was 5.5 ± 5.6 (range, 1-29) and the regional Abbreviated Injury Scores were likewise equal in both groups. The OLD patients had an average hospital stay of 6.9 ± 9.1 days compared with 4.3 ± 5.7 days in the YOUNG patients (p < 0.05). Twenty-seven OLD patients spent 7.3 ± 9.2 days in the intensive care unit compared with 19 YOUNG patients who stayed 3.4 ± 3.2 days (p < .05). A total of 91 comorbidities were identified in 58 OLD patients compared with 18 in 15 YOUNG patients (p < .0001). Eighty-six invasive procedures were performed in the OLD group compared with 96 in the YOUNG group (p = not significant). Nineteen OLD patients (22.3%) and 15 YOUNG patients (17.6%) suffered one or more complications, including death (p = not significant). A total of 91% of surviving OLD patients were discharged to home compared with 100% of surviving YOUNG patients (p < .01). Conclusion: Elderly patients who sustain penetrating trauma have more comorbidities than their younger counterparts. This may account for their longer hospital stay and lesser ability to be discharged home. These patients do not have an increased complication rate and should continue to be managed aggressively.

Eradication of Feral Cats (Felis catus) from Gabo Island, south-east Victoria - Twyford, K.L.; Humphrey, P.G.; Nunn, R.P.; Willoughby, L. (Ecological Management and Restoration, 2000)
Summary Concerns about the effects of predation by Feral Cats (Felis catus) on native fauna, particularly breeding seabirds, precipitated a decision in 1987 to control and eventually eradicate cats from Gabo Island. The size of the population prior to control was at least 30 animals. A control programme, undertaken between 1987 and 1991, centred on shooting, trapping and an extensive 1080 poison-baiting programme. Trapping and shooting were ineffectual. Poisoning was the most successful and effective technique for the rapid and widespread reduction in the Feral Cat population on Gabo Island. The effectiveness of dead 1-day-old chickens as a poison carrier was demonstrated. Effective poison baiting was attributed to bait selection and strategic timing of baiting to periods when prey was at low levels. Outcomes from the trapping programme and post-control monitoring strongly suggested that the cat population had been reduced to only two or three animals, possibly of the same sex. Monitoring between 1992 and 1998 failed to record any evidence of cats, indicating that the cats remaining after poison baiting had been unable to sustain a viable population. On the basis of the available evidence, Feral Cats appear to have been successfully eradicated from Gabo Island.
Keywords: 1080 poison; Feral animal control; Seabirds

The mysterious magnum bonum: Fighting to read Charlotte Yonge - Schaffer, T. (Nineteenth-Century Literature, 2000)
This essay argues that Charlotte Yongc has presented a particular challenge to critics because she depicts rebellious youths only to subsume them within an overriding (and unpalatable) ideological nexus. She encourages readers to identify with these dissident characters in order to share their inevitable conversions to a Yongian world-view. A close examination of Magnum Bonum; or, Mother Carey's Brood (1879) reveals the mechanisms by which Yonge manipulates her readers. This novel centers on a mysterious legacy, a medical discovery named the "Magnum Bonum," left by a dying father to his most deserving son. Magnum Bonum exerts a normalizing force on the younger generation, suppressing daughter Janet's lesbian desires and feminist activism, and disciplining son Jock's iconoclastic and anticapitalist performances. The only person empowered by the Magnum Bonum is Mother Carey, who becomes its guardian, exalts it into a near-religious icon, and finally acquires a voice of her own through being ventriloquized by her dead husband's wishes. Through the Magnum Bonum, the patriarch's disembodied, omnipotent authority transforms his unruly offspring into docile (if suicidal) replicas of himself. Magnum Bonum reveals that the mixture of realist observation and pious oppression in Yonge's novels is a sophisticated literary strategy and suggests that monitoring this technique might be the most useful way into Yonge's fiction. © 2000 by The Regents of the University of California/Society. All rights reserved.

Is sexual orientation related to mental health problems and suicidality in young people? - Fergusson, D.M.; Horwood, L.J.; Beautrais, A.L. (Archives of General Psychiatry, 1999)
Background: This study examines the extent to which gay, lesbian, and bisexual young people are at increased risk of psychiatric disorder and suicidal behaviors using data gathered on a New Zealand birth cohort studied to age 21 years. Methods: Data were gathered during the course of the Christchurch Health and Development Study, a 21-year longitudinal study of a birth cohort of 1265 children born in Christchurch, New Zealand. At 21 years of age, 1007 sample members were questioned about their sexual orientation and relationships with same-sex partners since the age of 16 years. Twenty- eight subjects (2.8%) were classified as being of gay, lesbian, or bisexual sexual orientation. Over the period from age 14 to 21 years, data were gathered on a range of psychiatric disorders that included major depression, generalized anxiety disorder, conduct disorder, and substance use disorders. Data were also gathered on suicidal ideation and suicide attempts. Results: Gay, lesbian, and bisexual young people were at increased risks of major depression (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.8-9.3), generalized anxiety disorder (OR, 2.8; 95% CI, 1.2-6.5), conduct disorder (OR, 3.8; 95% CI, 1.7-8.7), nicotine dependence (OR, 5.0; 95% CI, 2.3-10.9), other substance abuse and/or dependence (OR, 1.9; 95% CI, 0.9-4.2), multiple disorders (OR, 5.9; 95% CI, 2.4-14.8), suicidal ideation (OR, 5.4; 95% CI, 2.4-12.2), and suicide attempts (OR, 6.2; 95% CI, 2.7-14.3). Conclusions: Findings support recent evidence suggesting that gay, lesbian, and bisexual young people are at increased risk of mental health problems, with these associations being particularly evident for measures of suicidal behavior and multiple disorder.

Sexual orientation and suicidality: A co-twin control study in adult men - Herrell, R.; Goldberg, J.; True, W.R.; Ramakrishnan, V.; Lyons, M.; Eisen, S.; Tsuang, M.T. (Archives of General Psychiatry, 1999)
Background: Several recent studies have found a higher lifetime prevalence of suicide attempts in homosexual males compared with heterosexual control subjects or population rates. These studies used either convenience samples, most without controls, or population-based samples in which confounding factors such as depression and substance abuse were not measured. Methods: This study used twins from the population-based Vietnam Era Twin Registry, Hines, Ill. An analytic sample of 103 middle-aged male-male twin pairs from the registry was identified in which one member of the pair reported male sex partners after age 18 years while the other did not. Four lifetime symptoms of suicidality as measured by the Diagnostic Interview Schedule were analyzed: thoughts about death, wanting to die, thoughts about committing suicide, and attempted suicide. A composite measure of reporting at least one suicidality symptom was also assessed. Results: Same-gender sexual orientation is significantly associated with each of the suicidality measures. Unadjusted matched-pair odds ratios follow: 2.4 (95% confidence interval [CI], 1.2 - 4.6) for thoughts about death; 4.4 (95% CI, 1.7 - 11.6) for wanted to die; 4.1 (95% CI, 2.1 - 8.2) for suicidal ideation; 6.5 (95% CI, 1.5 - 28.8) for attempted suicide; and 5.1 (95% CI, 2.4 - 10.9) for any of the suicidal symptoms. After adjustment for substance abuse and depressive symptoms (other than suicidality), all of the suicidality measures remain significantly associated with same-gender sexual orientation except for wanting to die (odds ratio, 2.5 [95% CI, 0.7 - 8.8]). Conclusions: The substantially increased lifetime risk of suicidal behaviors in homosexual men is unlikely to be due solely to substance abuse or other psychiatric comorbidity. While the underlying causes of the suicidal behaviors remain unclear, future research needs to address the inadequacies in the measurement of both sexual orientation and suicidality in population-based samples.