The Effects of Sexual Orientation on the Relationship Between Victimization Experiences and Smoking Status Among US Women

Introduction

This study examined the relationships between experiences of childhood and adulthood victimization and current smoking among heterosexual and sexual minority women. The main hypothesis was that victimization experiences would predict current smoking status. Further, we hypothesized that the effect of childhood victimization on self-reported smoker status would be mediated by adult victimization.

Methods

Data are from two studies conducted in the United States that used similar methods and questionnaires in order to conduct a comparative analysis of women based on sexual orientation. Data from Wave 1 (2000-2001) of the Chicago Health and Life Experiences of Women (CHLEW) study and from Wave 5 (2001) of the National Study of Health and Life Experiences of Women (NSHLEW) study were used in these analyses.

Results

Twenty-eight percent of the sample reported current smoking. Victimization experiences were common, with 63.4% of participants reporting at least one type of victimization in childhood and 40.2% reporting at least one type in adulthood. Women who identified as heterosexual were less likely to be victimized during childhood than were women who identified as lesbian or bisexual. Adult victimization had a significant effect on current smoker status, and the effect of childhood victimization on smoker status was mediated by adult victimization. When examined by sexual orientation, this indirect relationship remained significant only among bisexual women in the sample.

Conclusions

Study findings make a valuable contribution to the literature on victimization and health risk behaviors such as smoking. Given the negative and long-term impact of victimization on women, strategies are needed that reduce the likelihood of victimization and subsequent engagement in health risk behaviors such as smoking.

Implications

The study findings make a valuable contribution to the literature on sexual minority women's health on the influence of victimization on health risk behaviors. With the goal of reducing the likelihood of adult victimization and subsequent engagement in health risk behaviors, programs and policies aimed at preventing victimization of women are warranted. Providers and community health agencies should assess and target physically and sexually abused sexual minority youth for mental health intervention with the goal of interrupting the progression from childhood victimization to adult victimization and subsequent engagement in health risk behaviors.

Exploring the lived experience of gay men with prostate cancer: A phenomenological study

PURPOSE

Gay men with prostate cancer are an 'invisible species' in the research literature despite concerns that the impact of treatment may be more profound and in some ways unique compared to heterosexual men. The aim of this research is to explore the lived experience of gay men with prostate cancer.

METHOD

In-depth interviews were recorded and transcribed verbatim from a purposive sample of eight gay men treated for prostate cancer in Ireland. A qualitative methodological approach employing Giorgi's descriptive phenomenological method was used to collect and analyse data.

FINDINGS

Three key aspects emerged representing the essence of the participants lived experience; The experience of diagnosis, treatment decision making, and the impact of treatment, with sub-themes of shock of diagnosis, the generalist nature of information, sexual side effects and incontinence, and masculinity and gay identity. Secondly, the experience of the healthcare service with sub-themes of sexual orientation disclosure and communication with the healthcare team; and thirdly, sources of support and means of coping which included significant others, family & friends, cancer support groups, and gay resources and support services.

CONCLUSION

Gay men with prostate cancer have unmet information and supportive care needs throughout their prostate cancer journey, especially related to the impact of sexual dysfunction and associated rehabilitation, negatively impacting their quality of life. Issues associated with heteronormativity, minority stress, and stigma may influence how gay men interact with the health service, or how they perceive the delivery of care. Healthcare education providers should update prostate cancer education programmes accordingly.

Risk Behaviors Among Young Men Who Have Sex With Men in Bangkok: A Qualitative Study to Understand and Contextualize High HIV Incidence

The Bangkok Men Who Have Sex With Men (MSM) Cohort Study has shown high HIV incidence (8-12/100 person-years) among 18-21-year-old MSM. These data led to a further study using qualitative methods among young (18-24 years old) MSM in order to understand the factors driving the HIV epidemic among YMSM. We conducted eight focus group discussions and 10 key informant interviews among YMSM in Bangkok, Thailand. Sociodemographic and behavioral data were collected using a questionnaire. We audio-recorded, transcribed, and analyzed qualitative and questionnaire data using computer software. The categories relating to risk behavior were (1) the use of social networks for seeking sexual partners and the marketing promotions of MSM entertainment venues, (2) social influence by peers and older MSM, (3) easy access to high parties and group sex, (4) easy access to club drugs, (5) conceptions related to HIV risk, and (6) sexual preferences of YMSM. Increased HIV testing, same-sex education, and YMSM-specific HIV prevention efforts are urgently needed for YMSM in Bangkok.

Social support relationships for sexual minority women in Mumbai, India: a photo elicitation interview study

Little research exists on women who do not identify as heterosexual in India. Social support for sexual minority women may protect against the effects of discrimination. An examination of significant social relationships may point to both strengths and weaknesses in this support. We aimed to understand relationship prioritisation and communication patterns associated with the social support of sexual minority women in Mumbai. In partnership with the Humsafar Trust, India's oldest and largest sexual and gender minority-advocacy organisation, we conducted photo-elicitation interviews with 18 sexual minority women, using participants' photographs to prompt dialogue about their social support. Intimate partners were a source of dependable support and many of those without relationships were seeking them. Participants' extended networks included friends and family as well as less formal relationships of social support. Participants mediated their communication with particular social network members, which involved filtering information sexual identity, romantic interests, and personal aspirations, among others. The diverse relationships that sexual minority women have in their social support networks may be used to guide programmes to improve health outcomes.

'You have to bow right here': heteronormative scripts and intimate partner violence in women's same-sex relationships

Intimate partner violence is increasingly recognised as occurring not only between heterosexual partners but also in same-sex relationships. Heterogendered relationship norms have been identified as intersecting with other social inequalities to create and sustain power differentials between partners - and fuel violence - yet remain largely unexplored in relation to women's same-sex relationships. Building on existing feminist research we explore the use of gendered scripts in South African lesbian and bisexual women's accounts of relationship norms and practices. We apply a feminist poststructuralist lens to focus-group discussion data to investigate how such scripts are drawn on to either uphold or challenge violent and coercive relationship practices. The findings illustrate the salience of heterogendered norms and demonstrate how violent practices become possible in contexts of deepening socioeconomic impoverishment - such as in post-apartheid South Africa - where race, space, gender and sexuality are tied to attempts at reclaiming respectable personhood. Efforts to dismantle inequitable gendered power relations and attendant violent practices require both macro-interventions aimed at shifting structural constraints on lesbian and bisexual women's agency, as well as micro-processes aimed at scripting equal power relations between partners as desirable.

School Environment Is Related to Lower Health and Safety Risks Among Sexual Minority Middle and High School Students

PURPOSE

The objective of this study was to examine the relationship between school involvement and connectedness with measures of sexual risk, substance use, and experience of violence among students who had sexual contact with the same sex or with both sexes.

METHODS

A sample of middle school and high school students who participated in a study conducted in a large urban school district were selected based on their reported experience of having initiated sexual activity with same-sex partners. In classroom-based surveys, we assessed self-reported involvement in school-based activities and feelings of school connectedness, as well as self-reported sexual risk, substance use, and experience of violence.

RESULTS

Significant protective associations were found between school involvement and lifetime alcohol and marijuana use, and between school connectedness and ever having been in a fight, feeling safe at school, and drug use other than marijuana (all p < .05).

CONCLUSIONS

Findings suggest that efforts to increase school involvement and connectedness provide a starting point for addressing significant health and safety concerns among students with same-sex sexual activity.

Frequency, Nature, and Correlates of Hate Crime Victimization Experiences in an Urban Sample of Lesbian, Gay, and Bisexual Community Members

The present study examines two central research questions. First, we sought to add to current knowledge on the frequency and types of hate crime experiences in an urban sample. Also, drawing on existing frameworks for sexual minority specific (SMS) stress, we examined internalized SMS stress (defined by internalized homophobia and acceptance concerns regarding one's minority status) as a mediator of the association between hate crime victimization (i.e., objective or social SMS stress) and mental health symptoms (i.e., symptoms of depression, anxiety, and general stress). Participants were 336 self-identified lesbian, gay, and bisexual (LGB) community members who elected to participate in research at a community health agency in an urban southwestern United States jurisdiction. Results suggested (a) approximately one third of the sample reported lifetime hate crime victimization, with the most common types characterized by interpersonal, as opposed to property, crimes; (b) approximately half of participants reported their most recent victimization to law enforcement; and (c) internalized SMS stress mediated the relation between hate crime victimization and overall mental health symptoms. Findings are discussed with respect to implications of the unique nature of hate crimes in an urban setting, as well as theoretical and practical implications of SMS stress findings.

The Impact of Attachment Style on Sexual Satisfaction and Sexual Desire in a Sexually Diverse Sample

Research has indicated that adult romantic attachment is influential and important to sexual and relationship satisfaction. Sexual desire, although not a direct focus of attachment literature, is highly related to sexual and relationship satisfaction, suggesting it may also be impacted by attachment style in romantic couples. However, the research conducted on sexual desire, sexual satisfaction, and attachment has been largely heterocentric, making it difficult to determine whether the findings documented in the literature thus far are relevant in a sexually diverse group of individuals. The current study aimed to better understand the way that attachment style may impact sexual desire, sexual satisfaction, and relationship satisfaction in a sample of sexually diverse men and women. In total, 955 individuals (63.4% cisgender women, 30.7% cisgender men, 6.0% genderqueer, 54.8% straight, 20.4% bisexual, 18.4% gay) participated in a web-based study examining relationship dynamics. Three multivariate regression models indicated that attachment style significantly predicted relationship satisfaction (29% of variance accounted for), sexual satisfaction (19% of variance accounted for), and sexual desire (4% of variance accounted for). Attachment style appears to be a more important contributing factor to satisfaction than desire among diverse sexual orientations. Clinical implications and future directions are discussed.

Sexual Norms for Lesbian and Bisexual Women in a Culture Where Lesbianism Is Not Acceptable Enough: The Japanese Survey About Sexual Behaviors, STIs Preventive Behaviors, and the Value of Sexual Relations

This study aimed to identify key factors preventing STIs among women who have sex with women in Japan. This description is based on survey and open-ended responses from participants. The questionnaire contained participants' background, sexual behavior, STI prevention behavior, experience and knowledge of STIs, and the value of sex with women. 104 responded, and 92 (88.5 %) reported having sexual experience with women. A variety of sexual behaviors were reported. Regarding STIs, 14.4% of participants had an STI in past. Almost half of the participants cited measures to prevent STIs included hygienic activities. Participants believed that sexual relations accompany partnership with females.

Ambivalently post-lesbian: LBQ friendships in the rural Midwest

Using data from friendship interviews with lesbian, bisexual, and queer women in a small Midwestern city, I argue that non-urban communities might be characterized as ambivalently post-lesbian, as participants explain that shared identities "don't matter" in their friendships, while continuing to insist on the relevance of lesbian identity in their community. This research highlights three sets of concerns about lesbian communities, identities, and friendships. First, given the theoretical purchase of the concept of "post-gay" communities, there is a parallel need to develop the concept of "post-lesbian" as uniquely ambivalent and distinct from post-gay discourses, as the case of LBQ friendship demonstrates. Second, the appearance of post-lesbian narratives beyond major cities suggests a need to reassess the presumably progressive post-gay narrative that gay identities are becoming less central to gay lives. Finally, a focus on close lesbian friendships highlights the central role such relationships continue to play in constituting, and perhaps dismantling, lesbian identities and communities.

Fried Green Tomatoes and The Color Purple: A case study in lesbian friendship and cultural controversy

Published in the 1980s, Fannie Flagg's Fried Green Tomatoes at the Whistle Stop Café and Alice Walker's The Color Purple are lesbian coming-of-age narratives that share a great deal in common in terms of their thematic content, publication histories, and cultural afterlives. In both novels, female friendships are shaped by patriarchal violence and develop in the context of the rural, segregated, early twentieth-century U.S. South. But the two novels also diverge in significant ways, as differences in race, gender, class, and sexuality shape their protagonists' experiences of love and friendship. As filmmakers Steven Spielberg and Jon Avnet adapted these novels for the screen, they made decisions about how to portray the texts' representations of homoerotic friendship and same-sex love. Both films generated significant cultural controversy as a result, particularly as some viewers claimed that the films elided the novels' representations of lesbian sexuality. Building upon recent scholarship in critical race theory, queer theory, and friendship studies, I argue that Walker's and Flagg's representations of queer friendship, a term that I describe in more detail throughout the essay, subvert dominant classifications of romantic, familial, and platonic love. By comparatively analyzing the American public's reception of the two film adaptations in conjunction with close readings of scenes from the novels and films, I reveal how representations of queer friendship not only catalyze cultural controversy, but also serve as a vehicle of social criticism.

Sexual Minority Disparities in Substance Use Willingness Among Youth

BACKGROUND

Disparities in substance use have been observed in sexual minority youth, but less is known about willingness to use substances, an important precursor to actual use.

OBJECTIVE

The goal of this study was to examine willingness to use cigarettes, alcohol, and marijuana among sexual minority youth compared to their non-sexual minority counterparts using both cross-sectional and longitudinal data.

METHODS

The present study drew on two waves (Times 1 and 2; 6 months apart) of data collected during high school as part of a prospective study of substance use initiation and progression in Rhode Island. At Time 1, participants (N = 443) ranged in age from 15 to 20 years (M age = 16.7 years, 26.6% sexual minority, 59.5% female, 72.0% White). Participants self-reported their sexual identity and attraction, lifetime use of alcohol, cigarettes and marijuana, and cigarette, alcohol, and marijuana use willingness (i.e., if offered by a best friend or group of friends).

RESULTS

In cross-sectional multivariate regression models, sexual minority youth were more likely to report willingness to use cigarettes (p <.05) and marijuana (p <.01) compared to their non-sexual minority counterparts. Longitudinal multivariate regression models revealed that sexual minorities were only significantly more likely to report cigarette willingness at Time 2 compared to their non-sexual minority counterparts (p <.01). There were no significant differences in alcohol use willingness in multivariable cross-sectional or longitudinal models by sexual minority status.

CONCLUSIONS

Sexual minority youth reported more willingness than non-sexual minority youth to use substances offered by peers; however, longitudinal analyses revealed that peers appear to play a role only in willingness to smoke cigarettes for these youth, and thus peer influence may be a contributing factor in explaining tobacco-related disparities among sexual minority youth. Given that stigma and peer groups may a particular risk factor for tobacco among sexual minority youth, our findings highlight the importance of prevention programs such as social marketing approaches that correct social norms, reduce stigma, and provide refusal-skills training to reduce tobacco-related disparities among sexual minorities.

The caregiver and her friends

This article is a personal essay about the lesbian friendship networks called upon when a dyke has to take on caregiving responsibilities for her dying mother and, especially, her partner who develops dementia and dies. The primary areas of concern are how friendships form a community's ethical base, the navigation of overlapping friendship networks, the different ways women come through, and the role our institutions play in creating "friendliness." Underpinning these concerns is the way that lesbians create informal groups to investigate, inform, and affirm difficult decisions.

Coping With Sexual Orientation-Related Minority Stress

Little is known about how adolescents cope with minority stressors related to sexual orientation. This study examined 245 lesbian, gay, and bisexual (LGB) young adult's (ages 21-25) retrospective reports of coping in response to LGB minority stress during adolescence (ages 13-19) to test the reliability and validity of a measure of minority stress coping. Further, the study examined associations between LGB minority stress coping and young adult psychosocial adjustment and high school attainment. Validation and reliability was found for three minority stress coping strategies: LGB-specific strategies (e.g., involvement with LGBT organizations), alternative-seeking strategies (e.g., finding new friends), and cognitive strategies (e.g., imagining a better future). LGB-specific strategies were associated with better psychosocial adjustment and greater likelihood of high school attainment in young adulthood, whereas alternative-seeking and cognitive-based strategies were associated with poorer adjustment and less likelihood of high school attainment.

Reasons for Non-Disclosure of Sexual Orientation Among Behaviorally Bisexual Men: Non-Disclosure as Stigma Management

Although bisexual men are known to be less likely to disclose their sexual orientation to others than gay men, the reasons why bisexual men choose or feel unable to disclose have received minimal research attention. To examine the reasons behaviorally bisexual men offer for not disclosing to their friends, family, and female partners, in-depth interviews were conducted with an ethnically diverse sample of 203 men who had not disclosed their same-sex behavior to their female sexual partners in New York City. Men were recruited from multiple venues and online sources using a targeted sampling approach. Transcripts were thematically analyzed using Atlas.ti software. Contrary to the theory that non-disclosure is due to uncertainty about one's sexual identity, the reasons offered for non-disclosure revealed that it was largely a method to avoid stigmatizing reactions from others. Men reported a number of specific reasons for non-disclosure, including (1) anticipation of negative emotional reactions; (2) anticipation of negative changes in relationships; (3) belief that others held stigmatizing attitudes toward homosexuality; (4) prior experience with negative reactions to disclosure; (5) wanting to maintain others' perceptions of him; (6) fear that those told would disclose to additional people; and (7) fear of rejection due to culture or religion. These findings provide insights into the reasons why many behaviorally bisexual men choose not to disclose, potential reasons why bisexual and gay men differ in the extent to which they disclose, and potential reasons why some bisexual men report greater emotional distress than gay men. Further, they suggest that greater attention needs to be placed on addressing the stigmatizing contexts that confront bisexual men and providing them with strategies to manage stigma.

The Mediating Roles of Rejection Sensitivity and Proximal Stress in the Association Between Discrimination and Internalizing Symptoms Among Sexual Minority Women

The negative impact of discrimination on mental health among lesbian, gay, and bisexual populations has been well documented. However, the possible mediating roles of sexual orientation rejection sensitivity and rejection-based proximal stress in the association between discrimination and internalizing symptoms remain unclear. Rejection-based proximal stress is a subset of proximal stressors that are theorized to arise from concerns about and expectations of sexual orientation-based rejection and discrimination. Drawing on minority stress theory, we tested potential mediating effects using indirect effects structural equation modeling in a sample of 300 sexual minority women. Results indicated that the indirect effect of discrimination on internalizing symptoms (a latent variable indicated by depression and anxiety symptoms) through sexual orientation rejection sensitivity and rejection-based proximal stress (a latent variable indicated by preoccupation with stigma, concealment motivation, and difficulty developing a positive sexual identity) was significant. Additionally, the indirect effects of discrimination on rejection-based proximal stress through sexual orientation rejection sensitivity and of sexual orientation rejection sensitivity on internalizing symptoms through rejection-based proximal stress were also significant. These findings indicate that sexual orientation rejection sensitivity plays an important role in contributing to rejection-based proximal stress and internalizing symptoms among sexual minority women.

Beyond 'invisibility': queer intelligibility and symbolic annihilation in healthcare

Sexual minority health is increasingly receiving attention by health sciences education and healthcare, with the core argument being that health can be improved by challenging sexual minority invisibility. Invisibility as a concept, however, does not allow for a deeper theoretical engagement with the reasons and consequences of the lack of representation of queerness in healthcare. Drawing on empirical research with queer healthcare users in South Africa, I argue that 'invisibility' actually encompasses two distinct, though related, concepts: queer symbolic annihilation as the reason for the exclusion of queer identities in health professions education and, by consequence, in healthcare; and queer (un)intelligibility as the consequence of this systemic erasure. By simply attributing discriminatory healthcare experiences of queer people to 'invisibility' we are missing opportunities to address underlying issues of queer symbolic annihilation and unintelligibility.

Scenes as Micro-Cultures: Examining Heterogeneity of HIV Risk Behavior Among Gay, Bisexual, and Other Men Who Have Sex with Men in Toronto, Canada

Using latent class analysis (LCA), we examined patterns of participation in multiple scenes, how sexual risk practices vary by scene, and psychosocial factors associated with these patterns among 470 gay, bisexual, and other men who have sex with men (GBM) recruited from Toronto. We calculated posterior probability of being in a class from participation in nine separate scenes. We used Entropy, the Bayesian information criterion and the Lo-Mendel-Rubin likelihood ratio test to identify the best fit model. Fit indices suggested a four-class solution. Half (50%) of the GBM reported no or minimal participation in any scene, 28% reported participating in the dance club scene, 16% reported participating in the BDSM, bear, and leather scenes, and 6% reported participating in circuit, party and play, and sex party scenes. Compared to GBM who did not participate in scenes, GBM participating in the BDSM-Bear-Leather scene were more likely to be older, white, to report higher sexual self-esteem, and to engage in condomless anal sex; Party and Play scene members were more likely to be of Asian origin, and to use drugs before and during sex, whereas Dance Club scene members were more likely to be younger and to report lower self-esteem but higher hope. LCA allowed us to identify distinct social niches or micro-cultures and factors characterizing these micro-cultures. GBM differ in their risk for HIV and STIs according to characteristics associated with participation in distinct micro-cultures associated with scenes. Tailored interventions may be needed that focus on reducing HIV risk and promoting sexual health in specific contexts such as the BDSM-Bear-Leather and Party and Play.

Discrete Effects of Religiosity and Spirituality on Gay Identity and Self-Esteem

Previous research has indicated that although spirituality may bolster development of a positive gay identity, religiosity may prove detrimental. Because the majority of this research confounds these constructs, there is little evidence as to the discrete roles religiosity and spirituality may play in LGB identity development. The present study endeavored to tease apart the unique effects of religion and spirituality on positive and negative gay identity and self-esteem. A sample of 376 self-identified sexual minority adults were given measures of religiosity, spirituality, LGB identity, and self-esteem. Models were built to evaluate the effects of religiosity (independent of spirituality) and spirituality (independent of religiosity), understanding that the constructs are greatly overlapped, on identity and self-esteem. Results included a positive association between spirituality and identity affirmation, identity superiority, and self-esteem. Religiosity was negatively associated with identity affirmation and self-esteem and positively associated with internalized homonegativity and heteronormativity. Limitations and implications are discussed.

Americans' Gender Attitudes at the Intersection of Sexual Orientation and Gender

Extensive research on differences in women's and men's gender attitudes and more recent work on sexual orientation differences in these and other social attitudes have overlooked the potential intersection between gender and sexual orientation in predicting Americans' gender attitudes. I use data from the 2012 American National Election Survey 2012 to investigate differences in views on gender roles, gender discrimination and inequality, and abortion among lesbian and bisexual women, gay and bisexual men, heterosexual women, and heterosexual men. The results suggest that heterosexual men hold the most conservative views on gender, while lesbian and bisexual women are most conscious of gender discrimination and inequality. These differences are partially explained by LGB Americans' liberal political ideology and heightened awareness of homophobic discrimination-two mechanisms that are also gendered. I conclude by arguing that the intersection between sexual orientation and gender produces unique lived experiences that, in turn, produce gendered sexual orientation gaps in worldviews.

Is sexual minority status associated with poor sleep quality among adolescents? Analysis of a national cross-sectional survey in Chinese adolescents

OBJECTIVES

Recent studies have suggested that sexual minorities are more likely to have poor sleep quality. This study aims to explore sleep quality among sexual minority adolescents and examines the association between sexual minority status and sleep quality.

DESIGN

Cross-sectional survey.

SETTING

A total of 506 high schools in seven Chinese provinces.

PARTICIPANTS

A total of 150 822 students in grades 7-12 completed the questionnaires, and 123 459 students who reported being aware of their sexual orientation were included in analyses.

MAIN OUTCOME MEASURES

The Pittsburgh Sleep Quality Index, sexual attraction and school bullying victimisation.

RESULTS

Of the 123 459 students who were analysed, 5.00% self-reported as sexual minorities. Only 26.67% of sexual minority students slept 8 or more hours/day, which is less than their heterosexual peers (35.70%; χ²=130.04, P<0.001). Of the total sample, 22.41% of the students reported poor sleep quality, and this prevalence was significantly higher in sexual minority students than in heterosexual students (32.56% vs 21.87%; χ²=281.70, P<0.001). After controlling for social demographics, lifestyle and depressive symptoms, sexual minority students had higher odds of poor sleep quality (adjusted OR=1.41, 95% CI 1.31 to 1.51) than their heterosexual peers. The indirect effect of school bullying victimisation (standardised β estimate=0.007, 95% CI 0.006 to 0.009) was significant, indicating that school bullying victimisation partially mediated the association between sexual minority status and sleep quality.

CONCLUSIONS

Our study suggested that poor sleep quality was common in sexual minority adolescents, and more attention should be paid to sleep problems in this population. Conducting interventions to reduce school bullying behaviours is an important step to improving sleep quality in sexual minority adolescents. Further, studies are warranted that focus on the risk factors and mechanisms of and interventions for sleep problems in sexual minority adolescents.

The Impact of Marriage Equality on Sexual Minority Women's Relationships With Their Families of Origin

Support from family of origin is important to the health and wellbeing of sexual minority women (SMW) and structural stigma may impact that support. The recent extension of marriage rights to same-sex couples in all U.S. states provided an opportunity to examine whether this change in law would impact the relationship of SMW with their families of origin regarding their same-sex relationships, including marriage. Interviews with 20 SMW were conducted to learn about their perceptions of how support from families of origin had been impacted by or changed since the U.S. Supreme Court decision (Obergefell v. Hodges, 135 S. Ct. 2584, 2015). Thematic analysis of the narrative responses revealed stories of continued family support; increases in acceptance or support; mixed support/rejection or unclear messages; "don't ask, don't tell" or silence; and continued or increased family rejection. Most participant narratives included more than one theme. Implications for SMW's health and relationships are discussed.

Cost-effective way to reduce stimulant-abuse among gay/bisexual men and transgender women: a randomized clinical trial with a cost comparison

OBJECTIVES

A randomized controlled study was conducted with 422 homeless, stimulant-using gay/bisexual (G/B) men and 29 transgender women (n = 451) to assess two community-based interventions to reduce substance abuse and improve health: (a) a nurse case-managed program combined with contingency management (NCM + CM) versus (b) standard education plus contingency management (SE + CM).

STUDY DESIGN

Hypotheses tested included: a) completion of hepatitis A/B vaccination series; b) reduction in stimulant use; and c) reduction in number of sexual partners.

METHODS

A deconstructive cost analysis approach was utilized to capture direct costs associated with the delivery of both interventions. Based on an analysis of activity logs and staff interviews, specific activities and the time required to complete each were analyzed as follows: a) NCM + CM only; b) SE + CM only; c) time to administer/record vaccines; and d) time to receive and record CM visits. Cost comparison of the interventions included only staffing costs and direct cash expenditures.

RESULTS

The study outcomes showed significant over time reductions in all measures of drug use and multiple sex partners, compared to baseline, although no significant between-group differences were detected. Cost analysis favored the simpler SE + CM intervention over the more labor-intensive NCM + CM approach. Because of the high levels of staffing required for the NCM relative to SE, costs associated with it were significantly higher.

CONCLUSIONS

Findings suggest that while both intervention strategies were equally effective in achieving desired health outcomes, the brief SE + CM appeared less expensive to deliver.

A Critical Analysis and Applied Intersectionality Framework with Intercultural Queer Couples

Intercultural queer couples are growing at an extensive rate in the United States, exemplifying diversity across multiple dimensions (e.g., race, ethnicity, sexuality, affectional identity, gender identity) while experiencing multiple converging forms of oppression (e.g., racism, heterosexism, genderism). Given the dearth of conceptual and empirical literature that unifies both dimensions related to intercultural and queer, applied practices and research contend with a unilateral approach focusing exclusively on either intercultural or queer couples. Intersectionality theory has revolutionized critical scholarship to determine overlapping forms of oppression, decenter hegemonic structures of power relations and social contexts, and enact a social justice agenda. This article addresses the following aims: (1) an overview of the gaps eliciting unilateral approaches to intercultural queer couples; (2) an illustration of intersectionality's theoretical underpinnings as a critical approach; and (3) applications for insights in practices and research with intercultural queer couples.

Suicide Risk Behaviors Among Sexual Minority Adolescents in the United States, 2015

This survey study estimates suicide risk behaviors of sexual minority adolescents using National Youth Risk Behavior Survey data from 2015.

Same-Sex Parenting: Identification of Social Representations in a Sample of Portuguese Professionals

Although international scientific research and the position of professional associations reiterate that the parents' sexual orientation is not a criterion of parenting quality, the social recognition of same-sex parenting remains difficult in Portugal. Given the importance of forensic issues in this field, this study aims to identify the representations of psychologists, social workers, lawyers/attorneys, and judges regarding same-sex parenting. The study involves five homogeneous focus groups with a total of 19 professionals. Content analysis reveals reservations regarding same-sex couples' access to parenting, in particular among lawyers/attorneys. There also emerged narratives that highlight specific competencies in these families and that argue that sexual orientation does not define the quality of parenting. Social narratives are more expressive than scientific knowledge in support of professional representations. These findings have critical implications for professional practice and formation.

Discrimination, Subjective Wellbeing, and the Role of Gender: A Mediation Model of LGB Minority Stress

The present study examined the link between discrimination and the three components of subjective wellbeing (positive and negative affect and life satisfaction) among a cisgender sample of lesbian, gay, and bisexual (LGB) adults. Specifically, we investigated internalized homonegativity and expectations of rejection as potential mediators of the links between discrimination and subjective wellbeing among a sample of 215 participants. Results from our structural equation model demonstrated a strong, positive direct link between discrimination and negative affect. Discrimination also had small, negative indirect effects on life satisfaction through our two mediators. Interestingly, neither discrimination nor our two mediators were related with positive affect, demonstrating the need for future research to uncover potential buffers of this link. Finally, our model evidenced configural, metric, and scalar invariance, suggesting that our model applies well for both women and men. Practical implications and future directions for research are discussed.

Testing the Cross-Cultural Robustness of the Minority Stress Model in Gay and Bisexual Men

The study tests the cross-cultural robustness of the minority stress model using a most different systems approach. Data from Western European, Eastern European (including Russian), Indian, Philippine, and Thai gay and bisexual men was obtained online. The final sample consisted of N = 90,467 participants who reported their level of satisfaction with life, victimization, felt stigma, and internalized homonegativity, as well as their disclosure status and sociodemographic details. Stepwise linear regressions were conducted on reported levels of satisfaction with life. Higher levels of victimization, felt stigma, and internalized homonegativity predicted lower satisfaction with life in all groups. Disclosure was associated with higher satisfaction with life in Western Europe as well as the Philippines and Thailand. Minority stressors explained far more variance in participants' satisfaction with life (13% to 24%) than sociodemographics alone (1% to 3%). The findings suggest that the minority stress theory is a useful cross-cultural explanatory model for satisfaction with life.

Out in the Open: The Consequences of Intimate Partner Violence for Victims in Same-Sex and Opposite-Sex Relationships

Intimate partner violence (IPV) is a major public health problem in the United States. While our understanding of this form of violence has grown substantially over the past several decades, the majority of research involving victims of IPV has focused almost exclusively on female heterosexual victims. Unfortunately, little attention has been paid to how this form of violence affects specific populations, such as gay and lesbian victims. It is possible that gay and lesbian victims may experience more maladaptive outcomes as a result of unique components of same-sex IPV, their sexual minority status in American society, and the lack of appropriate services tailored to victims of this violence. Using data from the second wave of the National Longitudinal Study of Adolescent to Adult Health, this study contributes to the research on gay and lesbian victims of IPV by investigating same-sex and opposite-sex adolescent victims' experiences with depression, alcohol-related problems, marijuana use, violent delinquency, and property delinquency. Results indicate that opposite-sex victims experienced more depressive symptoms, alcohol problems, and marijuana use than non-victims and engaged in higher levels of violent and property delinquency than non-victims. IPV within the context of same-sex relationships led to more depressive symptoms and greater involvement in violent delinquency, with the impact of IPV on violent delinquency being greater for victims of same-sex IPV compared with opposite-sex IPV. The implications of this study could inform interventions for victims of same-sex IPV and lead to more comprehensive services to address the needs of gay and lesbian victims of this violence.

Disparities in Body Mass Index Trajectories From Adolescence to Early Adulthood for Sexual Minority Women

PURPOSE

We aimed to estimate group-based trajectories of body mass index (BMI) in a longitudinal cohort of young women and determine the association between sexual identity and BMI trajectory group, adjusting for obesity risk factors.

METHODS

We analyzed data from females in waves I-IV of the National Longitudinal Study of Adolescent to Adult Health. Sexual identity was categorized as heterosexual, mostly heterosexual, bisexual, or lesbian (homosexual/mostly homosexual). We conducted group-based trajectory modeling of BMI with a censored normal distribution and a cubic relationship with age to identify three BMI trajectory groups. Multinomial logit regressions predicted the risk of trajectory membership associated with sexual identity, adjusting for background characteristics.

RESULTS

At wave I, the mean (n = 7,801) age was 15.9 years (95% confidence interval: 15.6-16.1). Subjects were 16.3% African-American; and 80.0% heterosexual, 15.9% mostly heterosexual, 2.5% bisexual, and 1.7% lesbian. Group-based trajectory modeling identified three BMI trajectory groups characterized as (1) minimal obesity (62.2%), (2) developing obesity (29.9%), and (3) progressive obesity (8.0%). In multinomial logit regressions adjusted for age, race, parental obesity and education, sexual abuse, household income, screen time, depressive symptoms, and rural residence, lesbian women had a nearly two-fold higher relative risk of being in the developing obesity trajectory group (relative risk ratio = 1.91, 95% confidence interval: 1.10-3.32) relative to the minimal obesity group, compared with heterosexual women.

CONCLUSIONS

Lesbian women were at increased risk of membership in the developing obesity trajectory group compared with heterosexual women. Adjusting for obesity risk factors had minimal impact on the point estimates for this association.

A weekly diary study of minority stress, coping, and internalizing symptoms among gay men

OBJECTIVE

Research has demonstrated that gay men are at increased risk for internalizing disorders compared with heterosexual men and that minority stressors are risk factors. However, the mechanisms underlying the associations between minority stressors and internalizing symptoms remain unclear. The current study examined coping strategies (active and disengaged coping) as mediators of the associations between minority stressors (internalized homonegativity [IH] and rejection sensitivity [RS]) and internalizing symptoms.

METHOD

A sample of 147 gay men completed a baseline questionnaire and weekly questionnaires for seven consecutive weeks.

RESULTS

At the between-person level, higher IH and RS were associated with higher disengaged coping, but not active coping. In turn, higher disengaged coping was associated with higher internalizing symptoms. Disengaged coping mediated the between-person association between IH and internalizing symptoms. At the within-person level, higher IH and RS were associated with higher disengaged coping, which, in turn, was associated with higher internalizing symptoms. Higher RS was also associated with higher active coping. Disengaged coping mediated the within-person associations between both minority stressors and internalizing symptoms. Of note, some associations with IH became nonsignificant controlling for RS, suggesting that the latter has a stronger influence on coping and internalizing symptoms.

CONCLUSIONS

Findings demonstrate that gay men's negative thoughts and feelings about their sexual orientation and anxious expectations of rejection vary from week to week and this weekly fluctuation has an impact on mental health. Further, findings implicate disengaged coping as a mechanism through which minority stressors influence internalizing symptoms. (PsycINFO Database Record

Trends in Parental Monitoring and Knowledge Over Time Between Sexual Minority and Heterosexual Girls

This study assessed whether trajectories of parental monitoring components were different for sexual minority girls (SMGs) compared to heterosexual girls. We recruited 14-19-year-old girls from two adolescent medicine clinics. We estimated growth curve models to compare how components of parental monitoring-adolescent disclosure, parental solicitation, and parental knowledge-changed over 2 years for SMGs and heterosexual girls. SMGs and heterosexual girls had similar trajectory slopes and quadratic forms of adolescent disclosure, but SMGs had consistently lower adolescent disclosure scores. Parental knowledge trajectories indicated differential intercepts and slopes for SMGs compared to heterosexual girls, suggesting potential higher risk for maladaptive behaviors. Results of this study suggest that parental monitoring may operate differently over time for SMGs compared to heterosexual girls.

Couple-level Minority Stress: An Examination of Same-sex Couples' Unique Experiences

Social stress resulting from stigma, prejudice, and discrimination-"minority stress"-negatively impacts sexual minority individuals' health and relational well-being. The present study examined how being in a same-sex couple can result in exposure to unique minority stressors not accounted for at the individual level. Relationship timeline interviews were conducted with 120 same-sex couples equally distributed across two study sites (Atlanta and San Francisco), gender (male and female), and relationship duration (at least six months but less than three years, at least three years but less than seven years, and seven or more years). Directed content analyses identified 17 unique couple-level minority stressors experienced within nine distinct social contexts. Analyses also revealed experiences of dyadic minority stress processes (stress discrepancies and stress contagion). These findings can be useful in future efforts to better understand and address the cumulative impact of minority stress on relational well-being and individual health.

Ecological momentary assessment of daily discrimination experiences and nicotine, alcohol, and drug use among sexual and gender minority individuals

OBJECTIVE

Sexual and gender minority (SGM) individuals experience elevated rates of minority stress, which has been linked to higher rates of nicotine and substance use. Research on this disparity to date is largely predicated on methodology that is insensitive to within day SGM-based discrimination experiences, or their relation to momentary nicotine and substance use risk. We address this knowledge gap in the current study using ecological momentary assessment (EMA).

METHOD

Fifty SGM individuals, between 18 and 45 years of age, were recruited from an inland northwestern university, regardless of their nicotine or substance use history, and invited to participate in an EMA study. Each were prompted to provide data, six times daily (between 10:00 a.m. and 10:00 p.m.) for 14 days, regarding SGM-based discrimination, other forms of mistreatment, and nicotine, drug, and alcohol use since their last prompt.

RESULTS

Discrimination experiences that occurred since individuals' last measurement prompt were associated with greater odds of nicotine and substance use during the same measurement window. Substance use was also more likely to occur in relation to discrimination reported two measurements prior in lagged models. Relative to other forms of mistreatment, discrimination effects were consistently larger in magnitude and became stronger throughout the day/evening.

CONCLUSION

This study adds to existing minority stress research by highlighting the both immediate and delayed correlates of daily SGM-based discrimination experiences. These results also contribute to our understanding of daily stress processes and provide insight into ways we might mitigate these effects using real-time monitoring and intervention technology. (PsycINFO Database Record

The Masculine Vaginal: Working With Queer Men's Embodiment at the Transgender Edge

Turning away from the conspicuous phenomena of transgender experience, with an eye toward locating and illuminating the transgender edge in cisgender, this paper explores the relationship between men and the Vaginal, both material and fantasized. Positing the Vaginal as a counterpart to the Phallic allows a delinkage of vaginal psychic and embodied states from the strictly female so that, like the Phallic, they can be accessed by people of all genders and sexes. This concept goes beyond the conceptual to the fleshy, embodied experience of many transgender men, who live in whole, partial, and/or temporary "female" bodies. It can also be applied to the physio-psychic reality of many cisgender men. Included is a discussion of a case in which a gay cisgender male patient experiences and fantasizes his anus as a vagina.

"Where Is the Love?" Expanding and Theorizing With LGBTQ Memorable Messages of Sex and Sexuality

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) women exist as a population with an increased complexity in the relationship between themselves and their sexuality. For the LGBTQ community, sexual behaviors are often silenced or erased. This exploratory qualitative research examines 186 memorable messages that emerged from 91 LGBTQ women and gender minorities who participated in a national study. Each participant was asked to share memorable messages they received about sex, sexuality, and sexual health. Consistent with past research, "advice" was a common memorable messages form; however, negative attributes and media-derived messages emerged. The results contribute to understanding the messages that LGTBQ individuals confront on topics of sex and sexuality.

Sexual assault incidents among college undergraduates: Prevalence and factors associated with risk

Sexual assault on college campuses is a public health issue. However varying research methodologies (e.g., different sexual assault definitions, measures, assessment timeframes) and low response rates hamper efforts to define the scope of the problem. To illuminate the complexity of campus sexual assault, we collected survey data from a large population-based random sample of undergraduate students from Columbia University and Barnard College in New York City, using evidence based methods to maximize response rates and sample representativeness, and behaviorally specific measures of sexual assault to accurately capture victimization rates. This paper focuses on student experiences of different types of sexual assault victimization, as well as sociodemographic, social, and risk environment correlates. Descriptive statistics, chi-square tests, and logistic regression were used to estimate prevalences and test associations. Since college entry, 22% of students reported experiencing at least one incident of sexual assault (defined as sexualized touching, attempted penetration [oral, anal, vaginal, other], or completed penetration). Women and gender nonconforming students reported the highest rates (28% and 38%, respectively), although men also reported sexual assault (12.5%). Across types of assault and gender groups, incapacitation due to alcohol and drug use and/or other factors was the perpetration method reported most frequently (> 50%); physical force (particularly for completed penetration in women) and verbal coercion were also commonly reported. Factors associated with increased risk for sexual assault included non-heterosexual identity, difficulty paying for basic necessities, fraternity/sorority membership, participation in more casual sexual encounters (“hook ups”) vs. exclusive/monogamous or no sexual relationships, binge drinking, and experiencing sexual assault before college. High rates of re-victimization during college were reported across gender groups. Our study is consistent with prevalence findings previously reported. Variation in types of assault and methods of perpetration experienced across gender groups highlight the need to develop prevention strategies tailored to specific risk groups.

Suicidal and Help-Seeking Behaviors Among Youth in an Online Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Social Network

LGBTQ youth have a great burden for suicidal ideation/behavior compared to their non-LGBTQ peers. While scholars have explored risk factors for suicidal behaviors, little is known about protective factors among LGBTQ youth, let alone within group differences in terms of help-seeking. Data were collected from 203 TrevorSpace (e.g., a social network for LGBTQ youth) users via online survey to examine suicidal and help-seeking behaviors among LGBTQ individuals. Among participants who reported suicidal ideation/behavior, a large proportion did not seek help (73.1% of gay men, 33.3% of bisexual men, 42.9% of bisexual women, 14.3% of lesbian women, 41.2% of queer individuals) when they considered or attempted suicide. Among those who sought support, reaching out to a friend was most common. However, family support was associated with fewer suicidal behaviors. Our findings underscore the need to examine the effectiveness of specific sources of help and the impact of exposure to social connectedness.

Differences in Risky Sexual Behavior According to Sexual Orientation in Korean Adolescents

Adolescents in sexual minority groups are known to be at risk of contracting sexually transmitted diseases through risky sexual behavior. However, few studies have examined associations between sexual orientation and risky sexual behavior and sexually transmitted diseases in Korean adolescents. Therefore, this cross-sectional study used raw data from the Tenth Korea Youth Risk Behavior Web-Based Survey to explore these relationships. Logistic regression analyses were performed to examine the associations between risky sexual behavior and sexual orientation in adolescents. The participants were 6,884 adolescents who provided data regarding demographic characteristics, sexual orientation, and risky sexual behavior. The proportions of homosexual and bisexual subjects who used condoms, engaged in sexual intercourse after drinking alcohol, and experienced sexually transmitted diseases were higher relative to those of heterosexual subjects. Associations between homosexuality and bisexuality and sexually transmitted diseases and engagement in sexual intercourse after drinking remained after multivariate adjustment. Interventions to prevent risky sexual behavior should target sexual orientation, to improve sexual health and prevent sexually transmitted disease in homosexual and bisexual adolescents.

Shaping LGBTQ Identities: Western Media Representations and LGBTQ People's Perceptions in Rural Spain

A growing academic discussion has focused on how, in a globalized world, LGBTQ identities are shaped and influenced by different and international actors, such as the media. This article analyzes how LGBTQ people from a rural region of a Western country-Spain-feel toward their representations on TV series from English-speaking countries. Employing a qualitative approach, this research aims to depict whether the academic conceptualizations to analyze these identity conformation processes are accurate. In addition, it explores how dominating media representations are being adapted in a region that, although within the West, can serve a context of a very different nature. The results found that a major rejection of the TV series representations among participants can suggest both an inaccuracy of the conceptualizations used by some scholars to understand LGBTQ flows and a problematic LGBTQ representation in media products that goes beyond regions and spaces.

Australian Queer Science Fiction Fans

Science fiction (sf) does more than provide a fleeting moment of entertainment; it has many personal and social functions. In addition to offering audiences "romantic escapism" (Gerrold, 1996, pp. 5-6), sf also enables the "postulation of an alternative reality from which to contemplate this one" (Gerrold, 1996, pp. 5-6); as such, it is especially important "for groups which have had limited stakes in the status quo" (Jenkins, 1995, p. 242). To date, no research has been undertaken on the relationship between Australian queers and sf fandom. This article reports the findings of an online survey and explores the psycho-social features of Australian queer sf fans and why they like the genre. While the characteristics of this sample mirror those of Australian queers generally, they also have slightly higher rates of mental illness and are far more likely to state they have "no religion." Furthermore, while enjoying the "sciency" (P10, bisexual woman) aspects of sf, Australian queers also like the "poignant metaphors for our own civilization" (P45, asexual man).

Social Network Types and Mental Health Among LGBT Older Adults

PURPOSE OF THE STUDY

This study was designed to identify social network types among lesbian, gay, bisexual, and transgender (LGBT) older adults and examine the relationship between social network type and mental health.

DESIGN AND METHODS

We analyzed the 2014 survey data of LGBT adults aged 50 and older (N = 2,450) from Aging with Pride: National Health, Aging, and Sexuality/Gender Study. Latent profile analyses were conducted to identify clusters of social network ties based on 11 indicators. Multiple regression analysis was performed to examine the association between social network types and mental health.

RESULTS

We found five social network types. Ordered from greatest to least access to family, friend, and other non-family network ties, they were diverse, diverse/no children, immediate family-focused, friend-centered/restricted, and fully restricted. The friend-centered/restricted (33%) and diverse/no children network types (31%) were the most prevalent. Among individuals with the friend-centered/restricted type, access to social networks was limited to friends, and across both types children were not present. The least prevalent type was the fully restricted network type (6%). Social network type was significantly associated with mental health, after controlling for background characteristics and total social network size; those with the fully restricted type showed the poorest mental health.

IMPLICATIONS

Unique social network types (diverse/no children and friend-centered/restricted) emerge among LGBT older adults. Moreover, individuals with fully restricted social networks are at particular risk due to heightened health needs and limited social resources. This study highlights the importance of understanding heterogeneous social relations and developing tailored interventions to promote social connectedness and mental health in LGBT older adults.

The Relationship Between Sexual History, Bullying Victimization, and Poor Mental Health Outcomes Among Heterosexual and Sexual Minority High School Students: A Feminist Perspective

This study uses a feminist theoretical framework to extend the literature on the relationship between sexual history, bullying victimization, and poor mental health outcomes. First, we examined whether an association between the sexual double standard and bullying victimization would apply to sexual minority youth the same way it applies to heterosexual youth. A second aim was to assess whether sexual minority boys, typically stereotyped as effeminate, would report the highest odds of bullying victimization. A third and final aim of our study was to look at the joint effect of sex and sexual intercourse on depression and suicidal ideation. Our analytic sample ( N = 9,300) was from the 2009, 2011, and 2013 Rhode Island Youth Risk Behavior Surveys. Findings demonstrated that heterosexual girls who engaged in sexual intercourse had significantly higher adjusted odds of bullying victimization than heterosexual boys who engaged in the same behavior. Similar results were not found for sexual minority adolescents, suggesting the sexual double standard may not apply to sexual minority adolescents in the same way it applies to heterosexual adolescents. Consistent with our second hypothesis, sexual minority boys reported the highest odds of being recently bullied compared with heterosexual boys. Among students who were recently bullied, sexual minority girls displayed the highest adjusted odds of recent depression and suicidal ideation. Our study demonstrated that using a feminist theoretical framework broadens our understanding of why girls and sexual minority boys are particularly vulnerable to bullying victimization and the sequel of depression and suicidal ideation.

Daily-level associations between PTSD and cannabis use among young sexual minority women

INTRODUCTION

Sexual minority women have elevated trauma exposure and prevalence of posttraumatic stress disorder (PTSD) compared to heterosexual women and they are also more likely to use cannabis, although no research has examined relationships between PTSD and cannabis use in this population. Daily-level methodologies are necessary to examine proximal associations between PTSD and use.

METHODS

This study included 90 trauma-exposed young adult women who identified as sexual minorities (34.4% identified as lesbian and 48.9% identified as bisexual) and evaluated daily-level associations between their PTSD symptoms and cannabis use. Participants were assessed at two measurement waves, one year apart, each consisting of 14 consecutive daily assessments.

RESULTS

Cannabis use occurred on 22.8% of the days. Results from generalized linear mixed effects models showed that a person's mean level of PTSD symptom severity across days was strongly associated with same-day likelihood of cannabis use (OR=2.67 for 1 SD increase in PTSD score; p<0.001). However, daily deviation from one's average PTSD score was not associated with cannabis use on the same day.

CONCLUSIONS

Findings suggest that PTSD severity may confer general risk for cannabis use, rather than being a state-dependent risk factor.

The role of alcohol in identity construction among LGBT people: a qualitative study

Research suggests that alcohol use and misuse are higher among lesbian, gay and bisexual than heterosexual populations, yet the social context of drinking in sexual minority communities has rarely been examined. To explore lesbian, gay, bisexual and transgender (LGBT) people's relationship with alcohol, we conducted seven focus groups (N = 33) with pre-existing groups of friends and work colleagues (18 to 52 years) in Scotland, UK. We identified and analysed patterns in our data using thematic analysis. Respondents perceived heavy drinking as central to the commercial gay scene. Choice of drink and drinking vessel was an important part of identity construction. Respondents discussed the perception that gay men would drink alcopops and cocktails while lesbians would drink pints of beer. Even when stereotypes were dismissed as inaccurate, they were still thought to pressure people to drink 'appropriately'. Respondents who did not identify as male or female, and those who used drag, were particularly aware of their choice of drink as a means to express identity or to challenge people's preconceptions about gender. Researchers developing interventions to reduce alcohol-related harm in sexual minority populations need to take account of the central role of identity construction in LGBT drinking practices.

The gas that fuels the engine: Individuals' motivations for medicalisation

It is well established that the drivers of medicalisation have shifted alongside changes in the institution of medicine. The process of medicalisation is no longer incited by macro processes of institutional prestige or control; rather, individual patients/consumers are pushing the process forward. The present study complicates this neat transition and examines the relationship between structure and agency using the case of assisted reproductive technology (ART), specifically the medicalisation of lesbian reproduction in the US. I explore individuals' influence on and motivations towards medicalisation through 24 in-depth interviews with women in same-sex relationships who had ever attempted to become pregnant. In centring on their experiences, I find that while individual consumers may now propel medicalisation forward, oftentimes consumers' motivations for doing so reside in the prestige and control of medicine. In other words, consumers now seek medicalisation precisely because of the process's previous institutional drivers. In exploring what fuels the engine of medicalisation, the findings reveal its nuance and complexity.

Medical School Factors Associated with Changes in Implicit and Explicit Bias Against Gay and Lesbian People among 3492 Graduating Medical Students

BACKGROUND

Implicit and explicit bias among providers can influence the quality of healthcare. Efforts to address sexual orientation bias in new physicians are hampered by a lack of knowledge of school factors that influence bias among students.

OBJECTIVE

To determine whether medical school curriculum, role modeling, diversity climate, and contact with sexual minorities predict bias among graduating students against gay and lesbian people.

DESIGN

Prospective cohort study.

PARTICIPANTS

A sample of 4732 first-year medical students was recruited from a stratified random sample of 49 US medical schools in the fall of 2010 (81% response; 55% of eligible), of which 94.5% (4473) identified as heterosexual. Seventy-eight percent of baseline respondents (3492) completed a follow-up survey in their final semester (spring 2014).

MAIN MEASURES

Medical school predictors included formal curriculum, role modeling, diversity climate, and contact with sexual minorities. Outcomes were year 4 implicit and explicit bias against gay men and lesbian women, adjusted for bias at year 1.

KEY RESULTS

In multivariate models, lower explicit bias against gay men and lesbian women was associated with more favorable contact with LGBT faculty, residents, students, and patients, and perceived skill and preparedness for providing care to LGBT patients. Greater explicit bias against lesbian women was associated with discrimination reported by sexual minority students (b = 1.43 [0.16, 2.71]; p = 0.03). Lower implicit sexual orientation bias was associated with more frequent contact with LGBT faculty, residents, students, and patients (b = -0.04 [-0.07, -0.01); p = 0.008). Greater implicit bias was associated with more faculty role modeling of discriminatory behavior (b = 0.34 [0.11, 0.57); p = 0.004).

CONCLUSIONS

Medical schools may reduce bias against sexual minority patients by reducing negative role modeling, improving the diversity climate, and improving student preparedness to care for this population.

Health and identity-related interactions between lesbian, bisexual, queer and pansexual women and their healthcare providers

Disclosure of sexual identity among sexual minority women is related to better outcomes and improved quality of care. The existing literature on sexual minority women's experiences of identity disclosure and related interactions with healthcare providers draws little distinction between different groups of sexual minority women, despite the different barriers, stigma and health outcomes that exist between them. This paper presents factors influencing identity disclosure and describes the characteristics of interactions that sexual minority women have with their healthcare providers around sexual identity and health. Using a mixed-methods approach, both qualitative and quantitative data were gathered using an online survey. The sample included lesbian, bisexual, queer and pansexual women from across the USA. Qualitative and quantitative data were analysed concurrently, and qualitative themes were quantified and integrated into quantitative analyses. Identity disclosure, reasons for disclosing identity and characteristics of interactions with providers varied by identity, but often overlapped. Bisexual and pansexual participants were significantly less likely to disclose identity than lesbian participants. There were no significant differences related to age or ethnicity. Findings from this study have the potential to inform ethical medical practices and improve healthcare quality among sexual minority women.

Crossing the gender boundaries: The gender experiences of male nursing students in initial nursing clinical practice in Taiwan

BACKGROUND

The initial nursing clinical practice is the necessary practicum required for nursing students. Because of the changing learning style, many of them are under great pressure for environmental change and therefore their daily routine is severe affected. Interacting directly with patients in a female-dominated occupation, along with the general gender stereotypes, the impact is especially significant to male nursing students than to female nursing students.

PURPOSE

The purpose of this preliminary qualitative study is to explore the gendered experiences of male nursing students during their first initial nursing clinical practice.

METHODS

Both focus group interviews and individual interviews are conducted with twenty-two sophomore nursing students from a university of technology in northern Taiwan, with ten male students and twelve female students.

RESULTS

Two main themes emerge from the gendered experiences shared by the nursing students: Gender consciousness awakening and thus maintaining masculinity, and male advantage in the learning environments.

CONCLUSIONS

The results identify the specific gendered experiences of nursing students, providing implications for future nursing education and counseling service. Further, this study may serve to promote an active yet gender-sensitive nursing education for training nursing professionals.