Promoting the Sexual Self-efficacy of Sexual and Gender Minority Youth through a Group Intervention


  • Shelley L Craig University of Toronto
  • Wook Yang University of Toronto
  • Ashley Austin Barry University



The current study examined the efficacy of an affirmative group cognitive behavioral intervention on the sexual self-efficacy level of sexual and gender minority youths (SGMY). SGMY (n=30) between the age of 15 and 18 participated in a series of eight cognitive behavioral-focused groups. They also completed measures on sexual self-efficacy before and after the intervention. Paired sample t-test was chosen as method of analysis. The results indicated a statistically significant increase in protection sexual self-efficacy but not in abstinence sexual self-efficacy post intervention.The current study concluded that affirmative groups that utilize cognitive behavioral therapy show promise for SGMY. Group content and process is detailed, and key components of groups designed to improve the sexual health of SGMY are discussed.

Author Biographies

Shelley L Craig, University of Toronto

Professor and Canada Research Chair of Sexual and Gender Minority Youth, Factor-Inwentash Faculty of Social Work, University of Toronto

Wook Yang, University of Toronto

Dalla Lana School of Public Health

Ashley Austin, Barry University

Associate Professor

School of Social Work




Austin, A., Craig, S.L. and D’Souza, S. (2018) An AFFIRMative cognitive behavioral intervention for transgender youth: Preliminary effectiveness. Professional Psychology: Research and Practice, 49, 1, 1-8

Bandura, A. (1977) Social learning theory. Englewood Cliffs, NJ: Prentice Hall

Bandura, A. (1998) Health promotion from the perspective of social cognitive theory. Psychology and Health, 13, 623–649

Bangi, A, Dolcini, M. M., Harper, G. W., Boyer, C. B. and Pollack, L. M. (2013) Psychosocial outcomes of sexual risk reduction in a brief intervention for urban African-American female adolescents. Journal of HIV/AIDS & Social Services, 12, 2, 146-159

Bauer, G. R. and Hammond, R. (2015) Toward a broader conceptualization of trans women’s sexual health. The Canadian Journal of Human Sexuality, 24, 1, 1-11

Bauer, G. R., Redman, N., Bradley, K. and Scheim, A. I. (2013) Sexual health of trans men who are gay, bisexual, or who have sex with men: results from Ontario, Canada. International Journal of Transgenderism, 14, 2, 66-74

Bauermeister, J., Pingel, E., Jadwin-Cakmak, L., Harper, G., Horvath, K., Weiss, G. and Dittus, P. (2015) Acceptability and preliminary efficacy of a tailored online HIV/STI testing intervention for young men who have sex with men: The Get Connected! Program. AIDS and Behavior, 19, 10, 1860-1874

Beck, A. T. (1993) Cognitive therapy: Nature and relation to behavior therapy. The Journal of Psychotherapy Practice and Research, 2, 4, 342-356

Berg, M. B., Mimiaga, M. J. and Safren, S. A. (2008) Mental health concerns of gay and bisexual men seeking mental health services. Journal of Homosexuality, 54, 3, 293-306

Berlan, E. D., Corliss, H. L., Field, A. E., Goodman, E. and Austin, S. B. (2010) Sexual orientation and bullying among adolescents in the growing up today study. Journal of Adolescent Health, 46, 4, 366–371

Birkett, M., Espelage, D. L. and Koenig, B. (2009) LGB and questioning students in schools: the moderating effects of homophobic bullying and school climate on negative outcomes. Journal of Youth and Adolescence, 38, 7, 989-1000

Blake, S. M., Ledsky, R., Lehman, T., Goodenow, C., Sawyer, R. and Hack, T. (2001) Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: The benefits of gay-sensitive HIV instruction in schools. American Journal of Public Health, 91, 6, 940-946

Buzwell, S. and Rosenthal, D. (1996) Constructing a sexual self: Adolescents’ sexual self-perceptions and sexual risk-taking. Journal of Research on Adolescence, 6, 4, 489-513

Cahill, S., Valadéz, R. and Ibarrola, S. (2013) Community-based HIV prevention interventions that combat anti-gay stigma for men who have sex with men and for transgender women. Journal of Public Health Policy, 34, 1, 69-81

Centers for Disease Control and Prevention (2017) HIV Surveillance Report, 2016. [Accessed 21 November 2018 at]

Centers for Disease Control and Prevention (2018) Sexually Transmitted Disease Surveillance 2017. [Accessed 21 November 2018 at]

Craig, S. L. (2013) Affirmative Supportive Safe and Empowering Talk [ASSET]: Leveraging the strengths and resiliencies of sexual minority youth in school-based groups. Journal of LGBT Issues in Counseling, 7, 1 – 15

Craig, S. L. and Austin, A. (2016) The AFFIRM open pilot feasibility study: A brief affirmative cognitive behavioral coping skills group intervention for sexual and gender minority youth. Children and Youth Services Review, 64, 136 – 144

Craig, S. L., Austin, A. and Alessi, E. (2013) Gay affirmative cognitive behavioral therapy for sexual minority youth: A clinical adaptation. Clinical Social Work, 41, 3, 25 – 35

Craig, S. L., Austin, A. and McInroy, L. (2014) School-based groups to support multiethnic sexual minority youth resiliency: Preliminary effectiveness. Child and Adolescent Social Work, 30, 4, 87 – 106

Craig, S. L., McInroy, L. B., Eaton, A. D., Iacono, G., Leung, V. W. Y., Austin, A. and Dobinson, C. (2019) Project Youth AFFIRM: Protocol for Implementation of an Affirmative Coping Skills Intervention to Improve the Mental and Sexual Health of Sexual and Gender Minority Youth. JMIR Research Protocols. 8, 6, e13462 [Accessed 11 August 2019 at]

Detrie, P. M. and Lease, S. H. (2008) The relation of social support, connectedness, and collective selfesteem to the psychological well-being of lesbian, gay, and bisexual youth. Journal of Homosexuality, 53, 4, 173–199

Doty, N. D., Willoughby, B. L. B., Lindahl, K. M. and Malik, N. M. (2010) Sexuality related social support among lesbian, gay, and bisexual youth. Journal of Youth and Adolescence. 39, 10, 1134-1147

Egbochuku, E. O. and Aihie, N. O. (2009) Peer group counselling and school influence on adolescents’ self-concept. Journal of Instructional Psychology, 36, 1, 3–12

Ferlatte, O., Hottes, T.S., Trussler, T. and Marchand, R. (2014) Evidence of a syndemic among young Canadian gay and bisexual men: Uncovering the associations between anti-gay experiences, psychosocial issues, and HIV risk. AIDS and Behavior, 18, 7, 1256–1263

Fethers, K., Marks, C., Mindel, A. and Estcourt, C, S. (2000) Sexually transmitted infections and risk behaviors in women who have sex with women. Sexually Transmitted Infections, 76, 5, 345-349

Golin, C., Marks, G., Wright, J., Gerkovich, M., Tien, H., Patel, S., Quinlivan, E. (2009) Psychosocial characteristics and sexual behaviors of people in care for HIV infection: An examination of men who have sex with men, heterosexual men and women. AIDS and Behavior, 13, 6, 1129-1142

Goodenow, C., Szalacha, L. and Westheimer, K. (2006) School support groups, other school factors, and the safety of sexual minority adolescents. Psychology in the Schools, 43, 573–589

Greaves, J. and Salloum, A. (2015) Evaluation of a youth with sexual behavior problems (YSBP) outpatient treatment program. Child and Adolescent Social Work Journal, 32, 2, 177-185

Heck, N. C., Croot, L. C. and Robohm, J. S. (2015) Piloting a psychotherapy group for transgender clients: Description and clinical considerations for practitioners. Professional Psychology: Research and Practice, 46, 1, 30-36

Hops, H., Ozechowski, T., Waldron, H., Davis, B., Turner, C., Brody, J. and Barrera, M. (2011) Adolescent health-risk sexual behaviors: Effects of a drug abuse intervention. AIDS and Behavior, 15, 8, 1664-1676

Hyun, M. S., Chung, H. I. and Lee, Y. J. (2005) The effect of cognitive-behavioral group therapy on the self-esteem, depression, and self-efficacy of runaway adolescents in a shelter in South Korea. Applied Nursing Research, 18, 3, 160- 166

Jafar, H., Salabifard, S., Mousavi, S. M. and Sobhani, Z. (2016) The effectiveness of group training of CBT-based stress management on anxiety, psychological hardiness and general self-efficacy among university students. Global Journal of Health Science, 8, 6, 47

Jenkins, M. (2015) A concept analysis of self-efficacy and adolescent sexual risk-taking behavior. Nursing Forum, 50, 1, 31-36

Kamen, C., Flores, S., Etter, D., Lazar, R., Patrick, R., Lee, S., Gore-Felton, C. (2013) General self-efficacy in relation to unprotected sexual encounters among persons living with HIV. Journal of Health Psychology, 18, 5, 658-666

Kennard, B., Brown, L., Hawkins, L., Risi, A., Radcliffe, J., Graham J., Emslie, T., Mayes, J., King,D., Foxwell, A., Buyukdura, J., Bethel, J., Naar-King, S., Xu, J., Lee, S., Garvie, P., London, C., Tanney, M., & Thornton, S. (2014) Using evidence-based cognitive and behavioral principles to improve HIV-related psychosocial interventions. Cognitive and Behavioral Practice, 21, 2, 237–246

Kessler, L. (2016) Respect detectors: A support and educational group engaging LGBTQ activists to prevent violence in their community. Groupwork, 26, 1, 34-48

King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osborn, D., Popelyuk, D. and Nazareth, I. (2008) A systematic review of mental disorder, suicide, and deliberate self-harm in lesbian, gay and bisexual people. BMC Psychiatry, 8, 70,

Kirby, D. (2008). The impact of abstinence and comprehensive sex and STD/HIV education programs on adolescent sexual behavior. Sexuality Research & Social Policy, 5, 3, 18-27

Langille, D., Asbridge, M., Kisely, S. and Wilson, K. (2012) Risk of depression and multiple sexual risk-taking behaviors in adolescents in Nova Scotia, Canada. Sexual Health, 9, 3, 254-260

Lee, Y., Salman, A. and Fitzpatrick, J. J. (2009) HIV/AIDS preventive self-efficacy, depressive symptoms, and risky sexual behavior in adolescents: A cross-sectional questionnaire survey. International Journal of Nursing Studies, 46, 5, 653-660

Little, R. and Rubin, D. (1989) The analysis of social science data with missing values. Sociological Methods Research, 18, 2/3, 292-326

Logie, C. H., Lacombe-Duncan, A., Weaver, J., Navia, D. and Este, D. (2015) A pilot study of a group-based HIV and STI prevention intervention for lesbian, bisexual, queer, and other women who have sex with women. AIDS Patient Care and STDs, 29, 6, 321-328

Marshal, M., Dietz, L., Friedman, M., Stall, R., Smith, H., McGinley, J., Thoma, B., Murray, P. and D’Augelli, A. (2011) Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review. The Journal of Adolescent Health, 49, 2, 115-23

Martin-Storey, A. and Crosnoe, R. (2012) Sexual minority status, peer harassment, and adolescent depression. Journal of Adolescence, 35, 4, 1001-1011

Mayer, K. H., Bradford, J. B., Makadon, H. J., Stall, R., Goldhammer, H. and Landers, S. (2008) Sexual and gender minority health: What we know and what needs to be done. American Journal of Public Health, 98, 6, 989-995

McDermott, E., Roen, K. and Scourfield, J. (2008) Avoiding shame: young LGBT people, homophobia and self-destructive behaviors. Culture, Health & Sexuality, 10, 8, 815-829

Melendez-Torres, G. and Bonell, C. (2014) Systematic review of cognitive behavioral interventions for HIV risk reduction in substance-using men who have sex with men. International Journal of STD & AIDS, 25, 9, 627-635

Mereish, E. H. and Poteat, V. P. (2015) A relational model of sexual minority mental and physical health: The negative effects of shame on relationships, loneliness, and health. Journal of Counseling Psychology, 62, 3, 425-437

Meyer, I. H. (2003) Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin, 129, 5, 674-97

Mojola, S. A. and Everett, B. (2012) STD and HIV risk factors among U.S. young adults: Variations by gender, race, ethnicity and sexual orientation. Perspectives on Sexual and Reproductive Health, 44, 2, 125-133

Molaie, A., Shahidi, S., Vazifeh, S. and Bagherian, S. (2010) Comparing the effectiveness of cognitive behavioral therapy and movie therapy on improving abstinence self-efficacy in Iranian substance dependent adolescents. Procedia - Social and Behavioral Sciences, 5, 1180-1184

Morrison, D. M., Casey, E. A., Beadnell, B. A., Hoppe, M. J., Gillmore, M. R., Wilsdon, A., Wells, E. A. (2007) Effects of friendship closeness in an adolescent group HIV prevention intervention. Prevention Science, 8, 4, 274-284

Mueller, M. (1997) Social barriers to recognizing HIV/AIDS in older adults. Journal of Gerontological Nursing, 23, 11, 17–21

Mustanski, B., Andrews, R., Herrick, A., Stall, R. and Schnarrs, P. W. (2014) A syndemic of psychosocial health disparities and associations with risk for attempting suicide among young sexual minority men. American Journal of Public Health, 104, 2, 287–294

Mustanski, B., Greene, G., Ryan, D. and Whitton, S (2015) Feasibility, acceptability, and initial efficacy of an online sexual health promotion program for LGBT youth: The queer sex ed intervention. The Journal of Sex Research, 52, 2, 220-230

Mustanski, B., Garofalo, R., Herrick, A. and Donenberg, G. (2007) Psychosocial health problems increase risk for HIV among urban young men who have sex with men: preliminary evidence of a syndemic in need of attention. Annals Behavioral Medicine, 34, 1, 37-45

Needham, B. L. and Austin, E. L. (2010) Sexual orientation, parental support, and health during the transition to young adulthood. Journal of Youth and Adolescence, 39, 10, 1189-98

Pachankis, J. E., Hatzenbuehler, M. L., Rendina, H. J., Safren, S. A. and Parsons, J. T. (2015) LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: A randomized controlled trial of a transdiagnostic minority stress approach. Journal of Consulting and Clinical Psychology, 83, 5, 875-889

Parsons, J. T., Grov, C. and Golub, S. A. (2012) Sexual compulsivity, co-occurring psychosocial health problems, and HIV risk among gay and bisexual men: further evidence of a syndemic. American Journal of Public Health, 102, 1, 156-162

Plöderl, M., Faistauer, G. and Fartacek, R. (2010) The contribution of school to the feeling of acceptance and the risk of suicide attempts among Austrian gay and bisexual males. Journal of Homosexuality, 57, 7, 819–841

Potoczniak, D., Crosbie-Burnett, M. and Saltzburg, N. (2009) Experiences regarding coming out to parents among African-American, Hispanic, and white gay, lesbian, bisexual, transgender, and questioning adolescents. Journal of Gay & Lesbian Social Services: Issues in Practice, Policy and Research. Special Issue: GLBTQ of color, 21, 2/3, 189-205

Robinson, J. P. and Espelage, D. L. (2013) Peer victimization and sexual risk differences between lesbian, gay, bisexual, transgender, or questioning and nontransgender heterosexual youths in grades 7-12. American Journal of Public Health, 103, 10, 1810-1819

Roe, S. L. (2015) Examining the role of peer relationships in the lives of gay and bisexual adolescents. Children & Schools, 37, 2, 117-124

Rosario, M., Mahler, K., Hunter, J. and Gwadz, M. (1999) Understanding the unprotected sexual behaviors of gay, lesbian, and bisexual youths: An empirical test of the cognitive-environmental model. Health Psychology, 18, 3, 272-280

Rosen, D. and Neinstein, L. (2009) Preventive health care for adolescents. in L. Neinstein, C. Gordon, D. Katzman, D. Rosen, & E. Woods (Eds.). Handbook of Adolescent Health Care: A Practical Guide. Philadelphia, Pennsylvania: Wolters Kluwer Health/Lippincott Williams & Wilkins (pp. 26-46)

Ross, L. E., Doctor, F., Dimito, A., Kuehl, D. and Armstrong, M. S. (2008) Can talking about oppression reduce depression? Journal of Gay & Lesbian Social Services, 19, 1, 1-15

Rosselló, J., Bernal, G. and Rivera-Medina, C. (2008) Individual and group CBT and IPT for Puerto Rican adolescents with depressive symptoms. Cultural Diversity and Ethnic Minority Psychology, 14, 234- 245

Rostosky, S. S., Dekhtyar, O., Cupp, P. K. and Anderman, E. M. (2008) Sexual self-concept and sexual self-efficacy in adolescents: A possible clue to promoting sexual health? Journal of Sex Research, 45, 3, 277-286

Senyonyi, R. M., Underwood, L. A., Suarez, E. and Musisi, S. (2012) Cognitive behavioral therapy group intervention for HIV transmission risk behavior in perinatally infected adolescents. Health, 4, 12, 1334-1345

Shoptaw, S., Reback, C. J., Peck, J. A., Yang, X., Rotheram-Fuller, E., Larkins, S., Hucks-Ortiz, C. (2005) Behavioral treatment approaches for methamphetamine dependence and HIV-related sexual risk behaviors among urban gay and bisexual men. Drug and Alcohol Dependence, 78, 2, 125-134

Singer, M. (2009) Introduction to syndemics: a system approach to public and community health. San Francisco, CA: Jossey-Bass

Tao, G. (2008) Sexual Orientation and Related Viral Sexually Transmitted Disease Rates Among US Women Aged 15 to 44. American Journal of Public Health. 98, 6, 1007- 1009

Thoma, B. C., Huebner, D. M. and Rullo, J. E. (2013) Unseen risks: HIV-related risk behaviors among ethnically diverse sexual minority adolescent females. AIDS Education and Prevention, 25, 6, 535–41

Van Campen, K. S., & Romero, A. J. (2012) How are self-efficacy and family involvement associated with less sexual risk taking among ethnic minority adolescents? Family Relations, 61, 4, 548-558

Wagner, K.,Unger, J., Bluthenthal, R.,Andreeva, V. and Pentz, M. (2010) Cognitive Behavioral Theories Used to Explain Injection Risk Behavior among injection drug users: A review and suggestions for the integration of cognitive and environmental models. Health Education Behavior. 37, 4, 504–532

Ybarra, M. L., DuBois, L. Z., Parsons, J. T., Prescott, T. L. and Mustanski, B. (2014) Online focus groups as an HIV prevention program for gay, bisexual, and queer adolescent males. AIDS Education and Prevention, 26, 6, 554-64



How to Cite

Craig, S. L., Yang, W., & Austin, A. (2020). Promoting the Sexual Self-efficacy of Sexual and Gender Minority Youth through a Group Intervention. Groupwork, 29(2), 35-57.