Discussion | In this study, which is to our knowledge the first to longitudinally examine sexual identity and sexual contact in a nationally representative sample of high school students, an increase was noted for nonheterosexual identity but not same-sex sexual contact. However, it is unclear to what extent this increase reflects a change in the true prevalence of nonheterosexual sexual identities or whether the observed increase was in part because of increased comfort with selfdisclosure.In terms of additional limitations, the YRBS questionnaire never explicitly defined the term sexual contact 4 and failed to adequately distinguish between same-sex and samegender sexual contact. 5 Moreover, some participants may have responded to the question assessing sex with their gender identity, leading to the incorrect classification of same-sex sexual contact. Furthermore, some youths in sexual minority groups may have felt their identity was not represented by the available responses to the question regarding sexual identity. Additionally, adolescents may have underreported nonheterosexual sexual identities and same-sex sexual contact because of persistent stigma associated with sensitive topics such as sexual identity. 6 Although the YRBS measures are imperfect, the apparent increase in nonheterosexual identity among youth in the US calls for greater vigilance among health care professionals regarding the heightened risks faced by these youths, such as bullying and mental health challenges.

BACKGROUND AND OBJECTIVES: Hospitalized children with medical complexity (CMC) are at high risk of medical errors. Their families are an underutilized source of hospital safety data. We evaluated safety concerns from families of hospitalized CMC and patient/parent characteristics associated with family safety concerns. METHODS: We conducted a 12-month prospective cohort study of English- and Spanish-speaking parents/staff of hospitalized CMC on 5 units caring for complex care patients at a tertiary care children’s hospital. Parents completed safety and experience surveys predischarge. Staff completed surveys during meetings and shifts. Mixed-effects logistic regression with random intercepts controlling for clustering and other patient/parent factors evaluated associations between family safety concerns and patient/parent characteristics. RESULTS: A total of 155 parents and 214 staff completed surveys (>89% response rates). 43% (n = 66) had ≥1 hospital safety concerns, totaling 115 concerns (1–6 concerns each). On physician review, 69% of concerns were medical errors and 22% nonsafety-related quality issues. Most parents (68%) reported concerns to staff, particularly bedside nurses. Only 32% of parents recalled being told how to report safety concerns. Higher education (adjusted odds ratio 2.94, 95% confidence interval [1.21–7.14], P = .02) and longer length of stay (3.08 [1.29–7.38], P = .01) were associated with family safety concerns. CONCLUSIONS: Although parents of CMC were infrequently advised about how to report safety concerns, they frequently identified medical errors during hospitalization. Hospitals should provide clear mechanisms for families, particularly of CMC and those from disadvantaged backgrounds, to share safety concerns. Actively engaging patients/families in reporting will allow hospitals to develop a more comprehensive, patient-centered view of safety.

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