Family dynamics may be strained after youth disclose a sexual minority identity, 20 and peers may bully youth with actual or perceived minority identities. 19 These processes can affect the relationships of SMY. Adolescence is a time of rapid sexual development, during which SMY may become aware of same-sex attraction, engage in same-sex sexual activity, and adopt or disclose a sexual minority identity. The unique developmental experiences of SMY may have implications for their interpersonal relationships and how these relationships influence their sexual health. However, previous research has considered relationship-level protective factors specifically among SMY less frequently. Identifying protective factors relevant to specific relationships has facilitated intervention development, such as parent-based interventions that increase parent–adolescent communication and reduce sexual risk. For example, connection to and communication with parents, 14–17 behavioral norms and strength of connection to peers, 10, 16 and communication with partners about safer sex 18 have all been associated with positive adolescent sexual health outcomes. Relationship-level factors that promote sexual health can be conceptualized as attributes of specific types of relationships, such as family, peers, or romantic/sexual partners.
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The broader literature on protective factors for adolescent sexual health highlights the importance of relationship-level factors. 8 In the case of SMY, promoting protective factors may be particularly important given that an overemphasis on risk may reinforce stigma inadvertently by framing these youth as inherently risky. 7–12 Identifying protective factors is critical, as they provide useful targets for developing health programs or interventions to improve outcomes. However, literature about adolescent populations also emphasizes the importance of protective factors, which are characteristics, conditions, and behaviors that improve positive health outcomes for individuals or reduce the negative effects of risks or hazards on individual health. 4 These disparities are attributed largely to risk factors associated with the social marginalization of SMY, specifically stigma, violence, and discrimination, 4–6 and research with this population has focused traditionally on identifying how these risks drive sexual health disparities. S exual minority youth (i.e., adolescents/young adults who experience same-sex attraction, engage in same-sex sexual behavior, or identify as gay, lesbian, or bisexual SMY) experience elevated risk for adverse sexual health outcomes, including HIV, 1 sexually transmitted infections (STIs), 2 and unplanned pregnancies, 3 compared to heterosexual peers, and may engage in more sexual risk behaviors than heterosexual youth. Doing so will move the field toward development of empirically sound interventions for SMY that promote protective factors and improve sexual health. Future work should expand the types of relationship-level factors investigated, strengthen the measurement of relationship-level factors, include young sexual minority women in samples, and use longitudinal designs. Generally, we found some limits to this literature: few types of relationship-level factors were tested, most articles focused on young sexual minority men, and the bulk of the data was cross-sectional. Peer norms about safer sex and behaviorally specific communication with regular romantic/sexual partners were repeatedly protective in cross-sectional analyses, suggesting that these factors may be promising intervention targets. Included articles examined characteristics of relationships with peers, parents, romantic/sexual partners, and medical providers. A total of 36 articles reporting findings from 27 data sources met inclusion criteria. Articles examining at least one association between a relationship-level protective factor and a sexual health outcome in a sample or subsample of SMY were eligible for inclusion.
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We sought to systematically map the current evidence base of relationship-level protective factors specifically for the sexual health of SMY through a systematic mapping of peer-reviewed observational research. Many factors within interpersonal relationships have been identified as protective for the sexual health of adolescents generally. Although risk factors driving these outcomes are well studied, less attention has been paid to protective factors that potentially promote health and/or reduce negative effects of risk. Sexual minority youth (SMY) experience elevated rates of adverse sexual health outcomes.