Disproportionate exposure to early-life adversity and sexual orientation disparities in psychiatric morbidity

Sexual Orientation, Adverse Childhood Experiences, and Comorbid DSM-5 Substance Use and Mental Health Disorders

OBJECTIVE

To assess the relationships between adverse childhood experiences (ACEs) and comorbid Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) substance use and mental health disorders across 5 sexual orientation subgroups: lesbian/gay, bisexual, unsure, discordant heterosexual (ie, heterosexual-identified with same-sex attraction or behavior), and concordant heterosexual.

METHODS

Data were from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, a cross-sectional, nationally representative survey of non-institutionalized US adults. Data were collected in households via structured diagnostic face-to-face interviews; the overall response rate was 60.1%. The sample included 36,309 US adults aged 18 years and older.

RESULTS

Sexual minorities (gay, lesbian, bisexual), especially bisexual women, reported the highest prevalence of ACEs and comorbid substance use and mental health disorders. Approximately 43.8% of bisexual women reported 4 or more ACEs, and 38.0% of bisexual women reported comorbid substance use and mental health disorders. Multivariable regression analyses indicated a curvilinear relationship between ACEs and comorbid substance use and mental health disorders, and sexual minorities consistently had a higher ACE mean than concordant heterosexual respondents. The majority of sexual minorities with high levels of ACEs had comorbid substance use and mental health disorders.

CONCLUSIONS

Sexual minorities are exposed to more ACEs than their heterosexual counterparts in the US. We found evidence that US sexual minorities are at higher risk of comorbid substance use and mental health disorders. These findings reinforce the importance of identifying exposure to ACEs and developing trauma-informed interventions to treat comorbidities in those exposed to multiple ACEs, especially sexual minorities.​.

HIV and Sexual Health Services Available to Sexual and Gender Minority Youth Seeking Care at Outpatient Public Mental Health Programs in Two California Counties

Purpose: Sexual and gender minority youth (SGMY, ages 16-24 years) face disparities in sexually transmitted infections (STIs) and HIV, in part, due to exposure to settings and behaviors that may harm youth's physical and mental health. This study examines the scope of sexual health and HIV services available to youth living with serious mental illness (SMI), including SGMY, seeking care at publicly funded outpatient mental health programs. Methods: Between 2018 and 2019, we surveyed 183 managers of mental health programs serving youth living with SMI of ages 16-24 years, including SGMY, in San Diego and Los Angeles counties. Participants reported on programs' target populations, sexual health/HIV service provision, and the use of peer providers. Descriptive statistics and Pearson chi-square tests were used to describe sexual health/HIV services and identify programmatic characteristics associated with providing these services. Results: Overall, 46% of all programs surveyed provided sexual health/HIV services. Of these, 62% provided HIV education, 81% provided sexual/reproductive health education, and 69% provided sexual/reproductive health education tailored for lesbian, gay, bisexual, queer, intersex (LGBQI) youth. Peers often provided these services. Chi-squared tests showed that programs employing peer specialists (p=0.009) and targeting LGBQI youth (p=0.045) were significantly more likely to provide sexual health/HIV services. Conclusion: The use of peer providers may reduce stigma around sexual/HIV service utilization and promote SGMY's trust. Publicly funded outpatient mental health programs serving youth and especially those actively engaging SGMY may consider also offering onsite HIV, STI, and sexual health services, creating a one-stop-shop approach.

Adverse childhood experiences and sexual health outcomes and risk behaviors among a nationwide sample of men who have sex with men

BACKGROUND

Adverse Childhood Experiences (ACEs) are associated with a wide range of increased risk behaviors and health consequences, they have not been extensively described in all subpopulations.

OBJECTIVE

The specific objectives of the study were to describe the prevalence of predefined ACEs among a nationwide sample of men who have sex with men (MSM) and determine associated HIV or sexually transmitted infection (STI) related health outcomes, testing practices, and risk behaviors.

PARTICIPANTS AND SETTING

Eligible participants were MSM aged 18 years or older who reported male-male sex in the past 12 months.

METHODS

Data were obtained from the 2015 cycle of the American Men's Internet Survey, these data were collected between September 2015 and April 2016, and contained questions related to 8 ACE exposure categories. During analyses conducted between September 2017 and April 2018, multiple log-binomial models were fit to assess associations.

RESULTS

Among 2590 participants, 79.7 % reported exposure to one or more ACE category. Participants exposed to any ACE were more likely to report STI testing (adjusted prevalence ratio [aPR]: 1.07; 95 % confidence interval [95 %-CI]: 1.00, 1.15), illicit substance use (aPR: 1.23, 95 %-CI: 1.05, 1.46), and condomless anal intercourse with another man (aPR: 1.13, 95 %-CI: 1.03, 1.21).

CONCLUSIONS

There is a high overall ACE burden among MSM nationally, with potential influences on key HIV/STI behaviors in later life. ACE exposure should be routinely assessed, prevention is ideal but appropriate measures such as trauma informed care should also be considered for adult MSM accessing HIV and STI-related services.

A phenomenological exploration of transgender people's experiences of mental health services in Ireland

AIM

This study sought to explore the personal experiences of transgender people with Irish mental health services.

BACKGROUND

The transgender community have been identified as an underserved, under-researched community in Ireland and abroad. While there has been a surge in research carried out with the community in recent years, there is little known about the personal experiences of Irish transgender people with mental health services.

METHOD

Interpretative phenomenological analysis was used to inform data collection and analysis of semi-structured interviews carried out with four research participants all identifying as transgender and having experienced accessing Irish mental health services.

RESULTS

Three themes emerged: affirmative experiences, non-affirmative experiences and clinician relationship.

CONCLUSION

Lack of information and non-affirmative experiences are contributing to poor clinician-patient relationships with transgender populations and impacting attrition.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers have a central role in supporting a transgender-positive organisational approach to care by ensuring policies, care practices and the environment are supportive of sexual and gender expression by role modelling attitudes of respect and inclusivity. In order to provide appropriate and responsive services to transgender people, there needs to be in place strategies to enable the development of confident, competent and knowledgeable staff.

Evaluation of sexual minority identity as a moderator of the association between intimate partner violence and suicidal ideation and attempts among a national sample of youth

Sexual minority (SM) youth are at high risk for intimate partner violence (IPV) and suicidal ideation/attempts compared to their heterosexual peers. We examined whether SM identity enhanced the relationship between experiences of IPV and suicidal ideation/attempts. Weighted logistic regression models were run using the 2017 Youth Risk Behavior Survey. All main effects were significant; each SM identity and both physical and sexual IPV were significantly associated with suicidal ideation and suicide attempts. The interaction between bisexual identity and physical IPV was significant for suicidal ideation; as physical IPV experiences increased, the difference between bisexual identity and heterosexual youth was non-significant. Findings suggest exploring trauma and suicidal ideation by aggregate groups and increasing support for SM youth in schools and communities.

Prevalence of Social Determinants of Health Among Sexual Minority Women and Men in 2017

INTRODUCTION

Inequities in social determinants of health are plausible contributors to worse health of sexual minorities relative to heterosexuals. Sexual minorities may have higher rates of housing, food, and financial insecurity as adults owing to adverse childhood experiences or policies that induce social disadvantage. This study compares the prevalence of 3 types of social determinants of health among sexual minority and heterosexual adults.

METHODS

Data were from the Behavioral Risk Factor Surveillance System 2017 survey of U.S. states that administered the optional Social Determinants of Health module and Sexual Orientation and Gender Identity modules. In August 2019, authors estimated the odds of food, housing, and financial insecurity among sexual minority men and women, compared with heterosexuals.

RESULTS

Sexual minority women and men had higher odds of housing insecurity, housing instability, and food insecurity, but no differences were observed for perceived neighborhood safety. Sexual minority women had higher odds of financial insecurity than their heterosexual peers.

CONCLUSIONS

Sexual minorities have more housing and food insecurity than heterosexuals, which may contribute to their risk for poorer health. Future research should address the causes and consequences of these differences.

Dimensions of Sexual Orientation and Rates of Intimate Partner Violence among Young Sexual Minority Individuals Assigned Female at Birth: The Role of Perceived Partner Jealousy

OBJECTIVE

Sexual minorities assigned female at birth are at increased risk for experiencing intimate partner violence (IPV) compared to heterosexual individuals, and bisexual individuals assigned female at birth appear to be at greatest risk. However, few studies have examined potential explanatory factors. Partner jealousy may contribute to bisexual individuals' increased risk for experiencing IPV, given stereotypes that they are promiscuous and evidence that people anticipate being jealous of a bisexual partner.

METHODS

This study examined the role of perceived partner jealousy in cross-sectional associations between self-reported dimensions of sexual orientation (identity, attractions, behavior) and IPV victimization among 368 young sexual minorities assigned female at birth (77.4% cisgender women).

RESULTS

Sexual behavior was associated with IPV, but sexual identity and attractions were not. Those with both male and female sexual partners in their lifetime were at increased risk for many forms of IPV compared to those with only male partners and those who never had sex, and these associations were partially explained by their higher perceived partner jealousy. Those with male and female partners were only at increased risk for two types of IPV compared to those with only female partners and these differences were not explained by perceived partner jealousy.

CONCLUSIONS

Jealousy may contribute to behaviorally bisexual individuals' increased risk for many forms of IPV compared to those with only male partners or never had sex. This highlights the importance of considering multiple dimensions of sexual orientation and has implications for the development of interventions to reduce IPV in this population.

Women's Cortisol Stress Responsivity, Sexual Arousability, and Sexual History

Life history theory and the adaptive calibration model state that characteristics of one's early environment influence individual differences in both neuroendocrine reactivity to stress and sexual risk-taking behavior. However, few studies have directly examined the relationship between neuroendocrine reactivity to stress and risky sexual behavior. This study used multilevel modeling to test whether cortisol reactivity and recovery in response to laboratory stress were associated with women's history of sexual behavior and their sexual arousability in response to laboratory sexual stimuli. Participants were 65 women (35% heterosexual, 44% bisexual, and 21% lesbian) who completed two laboratory sessions, two weeks apart. Women's self-reported sexual arousability to sexual stimuli interacted with their sexual abuse history to predict their trajectories of cortisol stress reactivity and recovery. Cortisol reactivity and recovery were not associated with women's sexual risk taking, such as the age of sexual debut, sociosexuality, or lifetime number of sexual partners.

Effects of victimization on mental health and substance use trajectories in young sexual minority men

Young sexual minority men (YSMM) experience more victimization and are at higher risk for mental health and substance use problems compared with heterosexual youth. We attempt to understand change over time in the experience of these constructs among YSMM. Data were taken from a diverse community-based sample of YSMM (N = 450, baseline mean age 18.93) surveyed every 6 months for 2.5 years. Multilevel modeling was used to model within-person change in victimization, internalizing symptoms, externalizing symptoms, alcohol frequency, marijuana use, and illicit drug use. We tested the indirect effect of concurrent and time-lagged victimization on the association between age and mental health and substance use. Victimization, internalizing symptoms, and externalizing symptoms decreased over time. Concurrent victimization was associated with higher internalizing symptoms, externalizing symptoms, alcohol use, marijuana use, and illicit drug use. Analysis of indirect effects suggested that the association between victimization and mental health and substance use outcomes decreased as participants transitioned from adolescence into adulthood. This study found that the reduction in victimization that YSMM experience as they grow older is associated with a reduction in negative mental health and substance use outcomes. Prevention efforts to limit victimization exposure may reduce health disparities for YSMM.

A Systematic Review of Family Victimization Experiences Among Sexual Minority Youth

Sexual minority youth experience substantially higher rates of family victimization than their heterosexual peers. No systematic review has yet identified the predictors and consequences in this vulnerable population of childhood abuse, exposure to sibling abuse and domestic violence, and sibling aggression. This systematic review aims to (a) describe differences in these family victimization rates by sexual orientation, gender, and race/ethnicity; (b) identify potential sexual minority and non-sexual minority-specific risk factors; and (c) identify physical, mental, and behavioral health and extrafamilial victimization correlates. The systematic review, which followed PRISMA guidelines, yielded 32 articles that met study inclusion criteria. Rates of childhood physical, sexual, and emotional abuse were consistently higher for sexual minority youth than for their heterosexual peers. Bisexual youth appear to be at greater risk for physical abuse than their gay and lesbian peers. Younger age at sexual minority milestones (first awareness, disclosure, and same-sex sexual contact) and higher levels of sexual minority-specific (sexuality disclosure, gender non-conformity) and non-sexual minority-specific (delinquent behaviors, parental drinking) risk factors were associated with higher rates of family victimization. Sexual minorities who experienced some form of childhood abuse reported more frequent physical (higher rates of HIV, higher BMIs, lower levels of perceived health), mental (higher rates of depression, PTSD symptoms, experiential avoidance, internalized homophobia), and behavioral (higher rates of suicidality, substance misuse, earlier sexual debut, unprotected anal sex) health problems relative to heterosexual or non-abused sexual minority peers. Sexual minority females who experienced childhood physical or sexual abuse were at greater risk than abused sexual minority males for sexual assault later in life. We conclude this systematic review with recommendations for future research, including the necessity for longitudinal research that utilizes a poly-victimization conceptual framework to identify the developmental pathways connecting risk factors, different types of family victimization, and health and extrafamilial victimization consequences.

Overweight and obesity in sexual and gender minority adolescents: A systematic review

Population data indicate that sexual and gender minority adolescents may be at increased risk for excess weight gain compared with cisgender, heterosexual youth. However, no studies, to our knowledge, have systematically reviewed the literature on weight disparities in this population nor explored risk for overweight and obesity by sexual and gender minority subgroup across studies. The current systematic review, therefore, identified 21 studies that assessed the relationship between sexual and gender minority status and weight among adolescents. Results indicated an overall greater prevalence of overweight and obesity among sexual and gender minority adolescents compared with cisgender, heterosexual youth. However, cisgender sexual minority males demonstrated lower or no added risk for overweight and obesity, whereas cisgender sexual minority females demonstrated greater risk for overweight and obesity. Findings were mixed among gender minority adolescents. This study highlights weight disparities in sexual and gender minority youth, although important subgroup differences exist. Additional research is needed to elucidate the mechanisms that may contribute to differential weight trajectories in this population and to develop tailored approaches for prevention and treatment.

National Study of Childhood Traumatic Events and Adolescent and Adult Criminal Justice Involvement Risk: Evaluating the Protective Role of Social Support From Mentors During Adolescence

OBJECTIVE

With nearly 11 million people in the United States arrested in 2015, the need to identify antecedent risk factors driving criminal justice involvement (CJI) and possible mitigating factors is crucial. This study examines the relation between childhood trauma and CJI in adolescence and adulthood and assesses how this relation is moderated by mentoring during young adulthood.

METHODS

The analysis included 3 waves of data-adolescents, young adults, and adults-collected from 1995 to 2008 from 12,288 adolescents who participated in the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study of adolescents in grades 7 to 12. Logistic regression was used to examine how having a close mentor in adolescence moderated the relation between criminal justice involvement and 9 childhood traumatic events: (1) neglect, (2) emotional abuse, (3) physical abuse, (4) sexual abuse, (5) parental incarceration, (6) parental binge drinking, (7) witnessed violence, (8) threatened with violence, and (9) experienced violence.

RESULTS

Cumulative exposure to childhood trauma was associated with CJI in adolescence (adjusted odds ratios [AORs] ranging from 2.24 to 25.98) and adulthood (AOR range, 1.82-6.69), and parental incarceration was consistently one of the, if not the, most strongly associated with each form of CJI; the strength of these associations was weakened for those who reported a close mentor compared to those who did not.

CONCLUSIONS

This study advances the literature regarding trauma and CJI, highlighting the role of social support and mentorship as protective factors for youth who experience childhood trauma. Interventions aimed at protecting vulnerable children from the harms of trauma should be the next priority.

Self-identified sexual orientations and high-risk sexual behaviours among Chinese youth

PURPOSE

High-risk sexual behaviour is a factor affecting the health of sexual minority students, yet few related studies have been completed among Chinese students. This article explores the distribution of sexual minority groups and its association with high-risk sexual behaviours and symptoms of sexually transmitted infections(STIs) among Chinese college students.

METHODS

An internet-based questionnaire was applied, and a sample of 17 966 surveys from 130 Chinese colleges was collected. Based on their self-reports, participants were classified into the following groups: homosexual male or female, heterosexual, bisexual, and sexual orientation unknown. High-risk sexual behaviours were defined as having sexual intercourse before the age of 18 years, having one's sexual debut with a non-regular partner, having had more than four sexual partners before investigation, and having mostly had sexual intercourse without using condoms. Logistic regression models were constructed to analyse the associations.

RESULTS

The proportions of the homosexual males and females, and the bisexual groups were 1.62%, 0.88% and 5.07%, respectively. Homosexual males were more likely to have their sexual debut with a non-regular partner (OR 4.79, 95% CI 3.38 to 6.78), having more than four sexual partners (OR 5.81, 95% CI 4.06 to 8.32), having their sexual debut before the age of 18 years (OR 1.92, 95% CI 1.34 to 2.76), and not using condoms for most episodes of sexual intercourse (OR 1.47, 95% CI 1.00 to 2.17). Similar associations also existed among homosexual females. A positive association between sexual orientation and having symptoms of STIs (OR 1.49, 95% CI 1.02 to 2.18) was found among homosexual males.

CONCLUSIONS

Sexual minority groups among Chinese college students had a greater risk of engaging in high-risk sexual behaviours and having STI symptoms. Future studies and interventions should focus on this population.

Young people's health and risk behaviours in relation to their sexual orientation: A cross-sectional study of Thailand and Sweden

OBJECTIVES

This study examined the associations between sexual orientation of young people and their health and risk behaviours in Thailand and Sweden, and to explore similarities and differences between the countries.

STUDY DESIGN

A cross-sectional study using data from the Life and Health - Young surveys in Thailand and Sweden. Three different statistical analyses were used to examine the associations of the variables.

RESULTS

In total, 3869 students aged 16-18 years old were included: 1488 Thai students and 2381 Swedish students. Significantly more Thai (20%) than Swedish (9%) students identified themselves as bisexual, homosexual or unsure (p < .001). Bivariate analysis showed that, in Thailand, self-harm was more often reported by the homosexual, unsure, and bisexual groups than by the heterosexual group (p = .005). In Sweden, early sexual debut was more often reported by the unsure, bisexual, and homosexual groups than by the heterosexual group (p = .033). Multiple logistic regression analysis showed that homosexual and unsure sexual orientations were significantly associated with self-harm (p < .05) among Thai students. Unsure sexual orientation was significantly associated with early sexual debut (p = .04) among Swedish students. Multiple correspondence analysis indicated that sexual orientation was associated with health and risk behaviours, and varied by different subcategories of students' backgrounds such as country, sexual orientation, family structure and adult support.

CONCLUSIONS

Sexual minority young people reported more risk behaviours and poorer health than their heterosexual counterparts. The findings are useful for policy programmes on sexual and reproductive health and rights of young people.

Developmental Trends in Sexual Attraction Among Puerto Rican Early Adolescents in Two Contexts

Sexual attraction (SA), the earliest stage of sexual orientation, is scarcely studied. This prospective study examined, over 3 years, prevalence, changes in SA, and the role of context, among 946 Puerto Rican youth, aged 11-13 years at initial assessment in the South Bronx (SBx), New York City, and Puerto Rico (PR). Overall, 98.1% of boys and 95.3% of girls reported opposite-sex only SA at some point, whereas 13.8% of girls and 12.0% of boys reported any-same SA. Opposite-sex only SA increased over time, whereas other SAs decreased except for any same-sex SA among SBx girls. Girls in the SBx and younger youth in PR reported more any same-sex SA. Context and culture may play a role in the developmental trajectories of adolescents' SA.

Factor analysis of the heterosexist harassment, rejection, and discrimination scale in lesbian, gay, bisexual, transgender, and queer people of colour

The factor structure of the Heterosexist Harassment, Rejection, and Discrimination Scale (HHRDS) was examined in lesbian, gay, bisexual, transgender, and queer (LGBTQ) people of colour. Two hundred participants completed a survey with the HHRDS and several mental health scales. A confirmatory factor analysis suggested the original HHRDS structure fit the data poorly. Exploratory factor analyses found a different 2-factor structure, consisting of harassment/rejection and family discrimination. Convergent validity analyses demonstrated that family discrimination had the largest association with depression and anxiety, indicating that family discrimination may be particularly salient among LGBTQ people of colour. This study supports the use of the HHRDS in racially/ethnically diverse samples, but with a slightly different factor structure. Examining discriminatory experiences from family members is an important direction for future research in LGBTQ people of colour.

Intimate Partner Violence Experiences of Sexual and Gender Minority Adolescents and Young Adults Assigned Female at Birth

Sexual and gender minority youth, especially those assigned female at birth, are at risk for intimate partner violence (IPV) due to minority stressors. With a sample of 352 sexual and gender minority youth assigned female at birth (age 16-32), we aimed to describe IPV in this population, including the prevalence, directionality, frequency, co-occurrence, and demographic correlates of various IPV types. Rates of past-6-month IPV were high, with victimization and perpetration of minor psychological IPV most common (64-70%); followed by severe psychological, minor physical, and coercive control (20-33%); and severe physical and sexual IPV (10-15%). For cyber abuse and IPV tactics leveraging anti-sexual minority stigma, victimization (12.5% and 15%, respectively) was more common than perpetration (8% and 6%, respectively). Most IPV was bidirectional and occurred 1-2 times in 6 months, although frequency varied considerably. Latent class analyses revealed that half of participants reported no or minimal IPV; one-third experienced multiple forms of psychological IPV (including coercive control); and 10-15% reported psychological, physical, sexual, and cyber abuse. Racial minority youth had higher rates of most IPV types than White participants. We hope study findings will inform policies and interventions to prevent IPV among gender and sexual minority youth assigned female at birth.

Does it Get Better? Change in Depressive Symptoms from Late-Adolescence to Early-Adulthood, Disordered Eating Behaviors, and Sexual Identity

Sexual minority youth are often described as at-risk for mental health comorbidities, including disordered eating behavior (DEB) and depression. This study assesses differences in late-adolescent DEB and depressive symptoms among gay/lesbian, bisexual, or mostly-heterosexual individuals, and how their symptoms change across early-adulthood. While sexual minority youth were more likely to report DEB and elevated depressive symptoms in late-adolescence relative to exclusively heterosexual peers, gay/lesbian individuals experienced improvement in early-adulthood depressive symptoms. Conversely, bisexual individuals maintained elevated depressive symptoms into early-adulthood, and additional depressive symptoms associated with DEB. DEB may be a unique risk-factor shaping the mental health of bisexual youth.

Patterns of childhood maltreatment and intimate partner violence, emotion dysregulation, and mental health symptoms among lesbian, gay, and bisexual emerging adults: A three-step latent class approach

BACKGROUND

Childhood abuse and neglect (CAN) and intimate partner violence victimization (IPV) is prevalent among lesbian, gay, and bisexual individuals (LGB). Identification of distinct patterns of childhood and adult victimization, including technology-mediated and face-to-face IPV, and their cumulative relations to mental/behavioral health challenges, among LGB people is needed to facilitate identification of at-risk individuals.

OBJECTIVE

Using latent class analysis, we first sought to identify patterns of lifetime interpersonal victimization, primarily five types of CAN and IPV in LGB emerging adults. Second, we examined if LGB-status and race/ethnicity predicted class-membership; third, we assessed differences between the latent classes on emotion dysregulation, depressive and anxiety symptoms, and alcohol use.

PARTICIPANTS

Participants were 288 LGB adults between 18-29 years (M = 25.35, SD = 2.76; 41.7% gay/lesbian) recruited via Amazon MTurk.

METHODS AND RESULTS

The 3-step LCA identified five-latent classes: high victimization, childhood emotional abuse and neglect, cybervictimization, adult face-to-face IPV, and lower victimization. People of color (including Hispanics) were more likely to be in the high victimization class, and bisexual individuals, especially bisexual women, in the childhood emotional abuse and neglect class. High victimization and childhood emotional abuse and neglect classes had elevated emotion dysregulation levels and depression and anxiety symptoms, and the high victimization class reported the highest levels of alcohol use.

CONCLUSION

Findings suggest a detrimental effect of cumulative interpersonal victimization on emotion dysregulation and the mental/behavioral health of LGB emerging adults, with bisexuals and LGB-people of color at heightened risk of cumulative victimization and of related mental/behavioral health challenges.

A Longitudinal Study of IPV Victimization Among Sexual Minority Youth

Although intimate partner violence (IPV) is highly prevalent among lesbian, gay, bisexual, and transgender (LGBT) youth, little is known regarding its developmental patterns, risk factors, or health-related consequences. We examined IPV victimization in an ethnically diverse community-based convenience sample of 248 LGBT youth (aged 16-20 at study outset) who provided six waves of data across a 5-year period. Results from multilevel models indicated high, stable rates of IPV victimization across this developmental period (ages 16-25 years) that differed between demographic groups. Overall, 45.2% of LGBT youth were physically abused and 16.9% were sexually victimized by a dating partner during the study. Odds of physical victimization were 76% higher for female than for male LGBT youth, 2.46 times higher for transgender than for cisgender youth, and 2 to 4 times higher for racial-ethnic minorities than for White youth. The prevalence of physical IPV declined with age for White youth but remained stable for racial-ethnic minorities. Odds of sexual victimization were 3.42 times higher for transgender than for cisgender youth, 75% higher for bisexual or questioning than for gay or lesbian youth, and increased more with age for male than female participants. Within-person analyses indicated that odds of physical IPV were higher at times when youth reported more sexual partners, more marijuana use, and lower social support; odds of sexual IPV were higher at times when youth reported more sexual partners and more LGBT-related victimization. In prospective analyses, sexual IPV predicted increased psychological distress; both IPV types marginally predicted increased marijuana use.

LGBT+ Individuals' Perceptions of Healthcare Services in Turkey: A Cross-sectional Qualitative Study

When accessing healthcare services, LGBT+ individuals are often exposed to segregating and marginalizing discourses. Knowledge about how such experiences are reflected in the moral world of LGBT+ individuals living in Turkey is limited. This study examined LGBT+ individuals' lived experiences when utilizing healthcare services. The findings are discussed in terms of moral discourses related to LGBT+ individuals' gender identity and sexual orientation. A qualitative field study was conducted using semi-structured interviews with fifty-five LGBT+ individuals from Turkish cities who were in contact with various non-governmental organizations that conduct studies on gender identity and sexual orientation. A questionnaire was administered with items on participants' demographic information, experiences, behavioural patterns, and knowledge regarding healthcare services. The data were analysed thematically. The findings were evaluated within the framework of "access to healthcare service" theme related to "healthcare service demand" context. Additionally, the "interaction with physicians" theme was addressed in the context of "physician-patient/counselee relationship." LGBT+ individuals state that they are exposed to stigmatizing and segregating discourses by healthcare professionals, which might pose an obstacle for adaptive health-seeking behaviours. These results suggest that physicians' professional approach has a considerable influence on LGBT+ individuals' capacity for utilizing healthcare services.

Hearing "That's So Gay" and "No Homo" on Campus and Substance Use Among Sexual Minority College Students

Sexual orientation microaggressions are common on college campuses and can contribute to negative outcomes; yet little is known about their relationship with substance use outcomes. Among a convenience sample of cisgender sexual minority college students (n= 574; 57.0% female, 24.9% people of color, 50.7% gay/lesbian; 72.4% public school) from 37 states (67.8% Midwest), this analysis investigates the association between hearing "that's so gay" and "no homo" on campus and hazardous alcohol use and the frequency of illicit drug use. Using multivariable regression analyses, the commonly heard phrases "that's so gay" and "no homo" were each found to significantly increase the risk for hazardous drinking and the frequency of drug use among students. Efforts should be made to create more welcoming campus climates for sexual minority students by reducing the use of these microaggressions and, in the meantime, offering supports to mitigate their harmful effects.

Sexual orientation disparities in eating disorder symptoms among adolescent boys and girls in the UK

Much of the research on sexual orientation disparities in eating disorder behaviors has been conducted in the USA, Canada, and Australia. Data on the associations of sexual orientation and eating disorder symptoms among adolescents in the UK are lacking. Participants were children from the Avon Longitudinal Study of Parents and Children, a youth cohort born 1991-1992 (n = 5048; 53% female; 12% sexual minority). Sexual orientation was assessed at 16 years. Eating disorder symptoms were assessed at 14 and 16 years. Multivariable regression models (adjusting for BMI, ethnicity, socioeconomic status) examined associations between sexual orientation and (1) odds of past-year purging and binge eating, and (2) mean differences in body dissatisfaction, pressure to increase muscularity (boys only), and Dutch Eating Behavior Questionnaire subscales. At age 14, gay and bisexual boys and mostly heterosexual girls reported greater body dissatisfaction than their same-gender heterosexual peers. All sexual minority boys and mostly heterosexual girls reported greater mean dysfunctional eating behaviors than their same-gender heterosexual peers. At age 16, gay and bisexual boys had 12.5 times the odds of heterosexual boys of binge eating; mostly heterosexual boys had over three times the odds of reporting binge eating. Sexual minority girls had over twice the odds of heterosexual girls of purging and binge eating. By mid-adolescence, sexual minority youth in the UK had elevated risk for eating disorder symptoms, suggesting the need for early prevention efforts.

Sexual orientation among Icelandic year 10 adolescents: Changes in health and life satisfaction from 2006 to 2014

Minority sexual orientation may add additional stresses to the period of adolescence thus affecting mental health and wellbeing. The whole population of year 10 students in 2006, 2010, and 2014 in Iceland were surveyed as part of the Health Behaviour in School-aged Children Survey. Sexual orientation could be identified in 1,994 participants from 2006 (43.8% of population; 988 girls), 3,777 from 2010 (78.6%; 1,863 girls) and 3,526 in 2014 (80.1%; 1,731 girls). About 3.1%, 3.6%, and 4.4% were identified as lesbian, gay, or bisexual (LGB) in 2006, 2010, and 2014, respectively. Given the sampling proportions, the results reflect parameters (population values) rather than statistics (sample values). LGB adolescents were worse off across most of the psychosocial measures across the three surveys as compared with adolescents of unknown sexual orientation (USO). However, the gap between LGB and USO adolescents appears to be closing, at least for the 2010 to 2014 change, suggesting that outcomes for LGB adolescents have improved compared to four years earlier. Social support, liking school and one's classmates, being bullied, and physical and mental health all seem to play an important part in life satisfaction and general wellbeing. While advances have been made for LGB adolescents, gaps between LGB and USO adolescents still exist and need to be closed through evidence-based school and society-wide programs.

Sexual and gender minority cigarette smoking disparities: An analysis of 2016 Behavioral Risk Factor Surveillance System data

We examined the association between lesbian, gay, bisexual, and transgender (LGBT) identity, cigarette and e-cigarette use, and potential risk factors in the United States. Using data from 198,057 adults in 26 states in the 2016 Behavioral Risk Factor Surveillance System (BRFSS), we estimated the prevalence of cigarette use, e-cigarette use, and potential risk factors by gender identity and sexual identity. Overall and sex-stratified bivariate and multivariate logistic regressions examined whether the relationship between sexual and gender identity and cigarette and e-cigarette use persisted after adjusting for demographics, socio-economic status, and other unhealthy behaviors. After adjusting for covariates, gender minority identity was no longer associated with increased likelihood of currently smoking cigarettes and ever use of e-cigarettes. Sexual minority identity continued to be significant after adjusting for covariates, indicating that sexual identity disparities in cigarette and e-cigarette use are not fully explained by these factors. Findings varied by identity. Compared to their straight peers, likelihood of tobacco product use among LGB individuals varied between sexes, by product, and by sexual identity (gay/lesbian versus bisexual). More research is needed to understand the mechanisms that influence diverse patterns of cigarette and e-cigarette use among sexual and gender minority adults.

Recruiting Hard-to-Reach Populations for Survey Research: Using Facebook and Instagram Advertisements and In-Person Intercept in LGBT Bars and Nightclubs to Recruit LGBT Young Adults

Background

Tobacco public education campaigns focus increasingly on hard-to-reach populations at higher risk for smoking, prompting campaign creators and evaluators to develop strategies to reach hard-to-reach populations in virtual and physical spaces where they spend time.

Objective

The aim of this study was to describe two novel recruitment strategies (in-person intercept interviews in lesbian, gay, bisexual, and transgender [LGBT] social venues and targeted social media ads) and compares characteristics of participants recruited via these strategies for the US Food and Drug Administration’s This Free Life campaign evaluation targeting LGBT young adults who smoke cigarettes occasionally.

Methods

We recruited LGBT adults aged 18-24 years in the United States via Facebook and Instagram ads (N=1709, mean age 20.94, SD 1.94) or intercept in LGBT social venues (N=2348, mean age 21.98, SD 1.69) for the baseline evaluation survey. Covariates related to recruitment strategy were age; race or ethnicity; LGBT identity; education; pride event attendance; and alcohol, cigarette, and social media use.

Results

Lesbian or gay women (adjusted odds ratio, AOR 1.88, 95% CI 1.54-2.29, P<.001), bisexual men and women (AOR 1.46, 95% CI 1.17-1.82, P=.001), gender minorities (AOR 1.68, 95% CI 1.26-2.25, P<.001), and other sexual minorities (AOR 2.48, 95% CI 1.62-3.80, P<.001) were more likely than gay men to be recruited via social media (than intercept). Hispanic (AOR 0.73, 95% CI 0.61-0.89, P=.001) and other or multiracial, non-Hispanic participants (AOR 0.70, 95% CI 0.54-0.90, P=.006) were less likely than white, non-Hispanic participants to be recruited via social media. As age increased, odds of recruitment via social media decreased (AOR 0.76, 95% CI 0.72-0.80, P<.001). Participants with some college education (AOR 1.27, 95% CI 1.03-1.56, P=.03) were more likely than those with a college degree to be recruited via social media. Participants reporting past 30-day alcohol use were less likely to be recruited via social media (AOR 0.33, 95% CI 0.24-0.44, P<.001). Participants who reported past-year pride event attendance were more likely to be recruited via social media (AOR 1.31, 95% CI 1.06-1.64, P=.02), as well as those who used Facebook at least once daily (AOR 1.43, 95% CI 1.14-1.80, P=.002). Participants who reported using Instagram at least once daily were less likely to be recruited via social media (AOR 0.73, 95% CI 0.62-0.86, P<.001). Social media recruitment was faster (incidence rate ratio, IRR=3.31, 95% CI 3.11-3.52, P<.001) and less expensive (2.2% of combined social media and intercept recruitment cost) but had greater data quality issues—a larger percentage of social media respondents were lost because of duplicate and low-quality responses (374/4446, 8.41%) compared with intercept respondents lost to interviewer misrepresentation (15/4446, 0.34%; P<.001).

Conclusions

Social media combined with intercept provided access to important LGBT subpopulations (eg, gender and other sexual minorities) and a more diverse sample. Social media methods have more data quality issues but are faster and less expensive than intercept. Recruiting hard-to-reach populations via audience-tailored strategies enabled recruitment of one of the largest LGBT young adult samples, suggesting these methods’ promise for accessing hard-to-reach populations.

Sexual Orientation Group Differences in Perceived Stress and Depressive Symptoms Among Young Adults in the United States

PURPOSE

Overall, sexual minorities have poorer mental health than heterosexual individuals, and stress is thought to underlie such disparities. However, sexual minorities include both those identifying as lesbian, gay, or bisexual (LGB) and many who do not (e.g., individuals identifying as mostly heterosexual, or as heterosexual but with discordant same-sex attractions or behaviors), and little is known about the mental health or stress experiences of non-LGB identified sexual minorities. This study assessed perceived stress and depressive symptom differences between concordant heterosexual individuals and three groups of sexual minority young adults (LGB, mostly heterosexual, and discordant heterosexual individuals).

METHODS

Data were from the National Longitudinal Study of Adolescent to Adult Health, Wave IV (2008-2009). Descriptive and bivariate statistics were estimated. Path analyses assessed whether perceived stress mediated differences in depressive symptomatology. Analyses were weighted and gender-stratified.

RESULTS

Mostly heterosexual individuals comprised the largest sexual minority group, for both men (3.58%) and women (15.88%). All sexual minority groups reported significantly more depressive symptoms than concordant heterosexual individuals, for both men and women (all P < 0.05). Among women, all sexual minority groups reported significantly higher perceived stress than concordant heterosexual individuals (all P < 0.05), which partially mediated elevations in depressive symptomatology (all P < 0.05). Mostly-heterosexual-identified men reported significantly higher perceived stress than concordant heterosexual men (P < 0.01), which partially mediated elevations in depressive symptomatology (P < 0.01).

CONCLUSIONS

Our results underscore the importance of assessing sexual orientation comprehensively to fully understand sexual minority health disparities. Additional research should examine the stressors specific to different sexual minority groups.

Disparities for LGBTQ and Gender Nonconforming Adolescents

OBJECTIVES

To identify patterns of childhood adversity in a sample of adolescents and assess disparities in these experiences for lesbian, gay, bisexual, transgender, and questioning adolescents and by level of gender nonconformity.

METHOD

By using the cross-sectional, statewide, anonymous 2016 Minnesota Student Survey, 81 885 students were included in the current study (50.59% male; mean age = 15.51). Participants were enrolled in grades 9 and 11 in a total of 348 schools.

RESULTS

Four patterns of childhood adversity were identified with sex-stratified latent class analyses (entropy = 0.833 males; 0.833 females), ranging from relatively low levels of abuse (85.3% males; 80.1% females) to polyvictimization (0.84% males; 1.98% females). A regression analysis showed that compared with heterosexual adolescents, gay, lesbian, bisexual, and questioning adolescents were more likely to be classified into profiles characterized by polyvictimization (odds ratio [OR] 1.81-7.53) and psychological and/or physical abuse (OR 1.29-3.12), than no or low adversity. Similarly, compared with nontransgender adolescents, transgender adolescents were more likely to be classified into profiles characterized by patterns of polyvictimization (OR 1.49-2.91) and psychological and/or physical abuse (OR 1.23-1.96). A higher level of gender nonconformity predicted a higher likelihood of being classified into each adversity profile compared with the no or low adversity profile (OR 1.14-1.45).

CONCLUSIONS

Sexual minority adolescents and adolescents with high levels of gender nonconformity are vulnerable to experience adversity. The disparities for lesbian, gay, bisexual, transgender, and questioning adolescents and adolescents with high gender nonconformity highlight the variation in patterns of childhood adversity that these youth are at risk of experiencing. The findings reveal the need for further research on the benefits and harm of screening for childhood adversity by physicians and pediatricians.

Annual Research Review: Suicide among youth - epidemiology, (potential) etiology, and treatment

BACKGROUND

Suicide is a leading cause of death and a complex clinical outcome. Here, we summarize the current state of research pertaining to suicidal thoughts and behaviors in youth. We review their definitions/measurement and phenomenology, epidemiology, potential etiological mechanisms, and psychological treatment and prevention efforts.

RESULTS

We identify key patterns and gaps in knowledge that should guide future work. Regarding epidemiology, the prevalence of suicidal thoughts and behaviors among youth varies across countries and sociodemographic populations. Despite this, studies are rarely conducted cross-nationally and do not uniformly account for high-risk populations. Regarding etiology, the majority of risk factors have been identified within the realm of environmental and psychological factors (notably negative affect-related processes), and most frequently using self-report measures. Little research has spanned across additional units of analyses including behavior, physiology, molecules, cells, and genes. Finally, there has been growing evidence in support of select psychotherapeutic treatment and prevention strategies, and preliminary evidence for technology-based interventions.

CONCLUSIONS

There is much work to be done to better understand suicidal thoughts and behaviors among youth. We strongly encourage future research to: (1) continue improving the conceptualization and operationalization of suicidal thoughts and behaviors; (2) improve etiological understanding by focusing on individual (preferably malleable) mechanisms; (3) improve etiological understanding also by integrating findings across multiple units of analyses and developing short-term prediction models; (4) demonstrate greater developmental sensitivity overall; and (5) account for diverse high-risk populations via sampling and reporting of sample characteristics. These serve as initial steps to improve the scientific approach, knowledge base, and ultimately prevention of suicidal thoughts and behaviors among youth.

Sexual orientation disparities in prescription drug misuse among a nationally representative sample of adolescents: Prevalence and correlates

OBJECTIVE

Sexual minority adolescents (SMA) may be at disproportionate risk for misusing prescription psychotropic medications compared to their heterosexual peers. However, generalizable studies specific to this age group are lacking. The current study aimed to describe the prevalence of sexual orientation disparities in prescription drug misuse among a nationally representative sample of adolescents as well as to examine key correlates of misuse.

METHOD

Using data from the National Youth Risk Behavior Survey, we conducted stepwise multivariable weighted logistic regressions, sequentially controlling for demographics, experiences of victimization, mental health, and other illicit substance use.

RESULTS

Adjusting for grade and race/ethnicity, female SMA and gay and unsure males had significantly elevated odds of ever misusing a prescription drug compared to heterosexual adolescents (ORs from 1.7-2.5). Most sexual orientation disparities among females remained significant with the addition of victimization and mental health covariates but attenuated completely after controlling for other illicit drug use. The effect for unsure males attenuated when victimization variables were included, but the effect for gay males remained significant through the final model. Controlling for other illicit drug use, mental health variables remained significant correlates for females whereas only forced sex was significant for males.

CONCLUSION

These results suggest experiences of victimization and mental health partially account for the disparities in prescription drug misuse between SMA and heterosexual adolescents, and their effects may differ by sex. A combination of structural, individual coping, and universal drug prevention approaches should be used to make the largest impact on reducing these disparities.

Sexual Identity, Adverse Childhood Experiences, and Suicidal Behaviors

PURPOSE

The objective of this study was to examine the influence of sexual identity and adverse childhood experiences (ACEs) on suicidal behaviors in a population-based sample of high school students.

METHODS

A two-stage cluster random sampling design was used to recruit 5,108 students from 97 high schools. A total of 4,955 students (97%) provided information that allowed for classification of sexual identity into three groups: (1) lesbian, gay, or bisexual (LGB) (10%); (2) not sure (4.6%); and (3) heterosexual (85.4%). Five measures of childhood abuse and household dysfunction were summed, and the ACE score was categorized as 0, 1, 2, and 3-5 ACEs. Weighted logistic regression was used to assess the influence of sexual identity, ACEs, and their interaction on suicide ideation and attempts in the past 12 months.

RESULTS

Compared with heterosexual students, those who were LGB and were not sure had higher odds of suicide ideation and attempts. There was also a graded relationship between cumulative ACE exposure and suicidal behaviors. Although sexual identity/ACE interaction was not observed, LGB/not sure students who experienced a high number of ACEs were disproportionately affected. Compared with heterosexual students with 0 ACE, LGB/not sure students with 0 ACE (adjusted odds ratio [AOR] = 3.32, 95% confidence interval [CI] = 1.96-5.61), 1 ACE (AOR = 6.58, 95% CI = 4.05-10.71), 2 ACEs (AOR 13.50, 95% CI = 8.45-21.58), and 3-5 ACEs (AOR = 14.04, 95% CI = 8.72, 22.62) had higher odds of suicide ideation. A similar pattern was observed for suicide attempts.

CONCLUSIONS

LGB and students not sure of their sexual identity with greater exposure to ACEs have disproportionately high levels of suicide ideation and attempts. Trauma-informed interventions for these populations are warranted.

Identifying diverse life transition patterns from adolescence to young adulthood: The influence of early socioeconomic context

The purposes of the present study are to investigate: (1) the heterogeneity in life transition patterns of youth from adolescence to young adulthood (ages 18-30) involving the timing and sequence of four transition events (college graduation, full-time employment, marriage, and parenthood), (2) the influence of early socioeconomic adversity on life transition patterns from adolescence to young adulthood, and (3) the influence of gender and race/ethnicity on these transition patterns. Using a multivariate discrete-time mixture survival model with a sample of 14,503 adolescents from the National Longitudinal Study of Adolescent to Adult Health (Add Health), the study identified four life transition patterns and found that early socioeconomic adversity shapes disrupted life transition patterns from adolescence to young adulthood. Gender and race/ethnicity differences are discussed. These results highlight the need for prevention and intervention programs that selectively target at-risk youth beginning in adolescence and continuing through subsequent transition periods.

Adult attachment as a moderator of the association between childhood traumatic experiences and depression symptoms among young Black gay and bisexual men

OBJECTIVE

The present study examined the moderating effect of adult attachment on the association between childhood traumatic experiences, (i.e., physical abuse, emotional abuse, emotional neglect, and being bullied), age of childhood traumatic experience, and young adult depression symptoms among young Black gay and bisexual men (YBGBM).

METHOD

Self-report measures of attachment, childhood traumatic experiences, and depression symptoms were collected from a community-based sample of YBGBM living in New York City (n = 228). Regression analyses were conducted to address the study goals.

RESULTS

Findings indicated that YBGBM who were more anxious in their adult attachment style and experienced being bullied or physically abused by a non-family member during childhood experienced greater depression in young adulthood than YBGBM who were less anxious in their adult attachment style. In addition, we found that being bullied later in childhood was associated with greater depression symptoms than being bullied earlier. Lastly, we found that YBGBM who were more avoidant and bullied later in adolescence reported more depression symptoms in young adulthood than YBGBM who were less avoidant in their attachment style.

DISCUSSION

The findings suggest that it may be important to utilize an attachment perspective that is sensitive to age of traumatic experience when creating mental health and trauma interventions for YBGBM. (PsycINFO Database Record

How Do Discrepancies between Victimization and Rejection Expectations in Gay and Bisexual Men Relate to Mental Health Problems?

Introduction: Victimization and rejection expectations predict mental health problems in gay and bisexual men. Furthermore, it was shown that victimization predicts rejection expectations. Nevertheless, the levels of these two variables do not necessarily correspond as indicated by low inter-correlations, resulting in the question “How do discrepancies in the two variables relate to mental health problems?” This study tests if non-corresponding levels of victimization and rejection expectations in gay and bisexual men relate to mental health problems differently than corresponding levels of victimization and rejection expectations. It furthermore tests for linear and curvilinear relationships between victimization, rejection expectations, and mental health problems.

Methods: Data from N = 1423 gay and bisexual men were obtained online. Victimization and rejection expectations were tested for discrepant values (differing 0.5 SD or more) and those that were in agreement (differing less than 0.5): 33.7% of participants were in agreement, 33.0% reported higher rejection expectations than victimization, and 33.3% v.v. Then, a polynomial regression and a surface analysis were conducted.

Results: Discrepant values in victimization and rejection expectations or the direction of the discrepancy did not relevantly predict mental health problems. Findings indicate that victimization and rejection expectations predict mental health problems linearly as well as convexly (upward curving) in gay and bisexual men.

Discussion: This study replicates findings that gay and bisexual men with more experiences of victimization and rejection expectations demonstrated more mental health problems. Furthermore, this study is the first one to find a convex relationship between these predictors and mental health problems, implicating that disproportionally high mental health problems exist in those gay and bisexual men with high levels of victimization and rejection expectations. On the other hand, discrepancies between these two variables do not predict mental health problems. Future studies are needed to test for replication of our findings.

Adverse Childhood Experiences and Health and Wellness Outcomes among Black Men Who Have Sex with Men

Black men who have sex with men (BMSM) are a population at the intersection of two minority statuses-racial minority and sexual minority. Membership in either group, compared to white or heterosexual group membership, may increase one's risk of negative childhood and adult experiences. Baseline data from an HIV intervention efficacy trial (the Black Men Evolving Study) were used to explore the prevalence of adverse childhood experiences (ACEs) among 536 BMSM and associations between ACEs and adult mental and physical health outcomes. Overall, the prevalence of ACEs was high among this sample of BMSM with almost 90% experiencing at least one ACE. Findings revealed that ACE score was significantly associated with adult mental health (AOR = 1.21, 95% CI [1.12, 1.30]), but not with adult physical health. All ACEs were significantly associated with mental health, but only physical neglect and household substance abuse were significantly associated with physical health (AOR = 1.69, 95% CI [1.02, 2.74] and AOR = 1.57, 95% CI [1.03, 2.40], respectively). The findings support the need for interventions targeting improved adult health outcomes, particularly for minority groups, to consider the impact of early adversity on health and wellness.

Internalized Homophobia and Perceived Stigma: A Validation Study of Stigma Measures in a Sample of Young Men who Have Sex with Men

Young men who have sex with men (YMSM) experience minority stressors that impact their mental health, substance use, and sexual risk behaviors. Internalized homophobia (IH) and perceived stigma represent two of these minority stressors, and there has been limited research empirically validating measures of these constructs. We validated measures of IH and perceived stigma with a sample of 450 YMSM (mean age=18.9) and a sample of 370 YMSM (mean age=22.9). Results from exploratory and confirmatory factor analyses supported modifications to the IH and perceived stigma scales, ultimately revealing a three factor and one factor structure, respectively. Convergent and discriminant validity were examined utilizing correlations between IH, perceived stigma, and other variables related to minority stress (e.g., victimization). We evaluated predictive validity by examining relations with mental health, substance use, and risky sexual behaviors measured 12-months from baseline. There were mixed findings for IH, with subscales varying in their relations to mental health, drinking, and sexual risk variables. Perceived stigma was not related to mental health or substance use, but was associated with greater prevalence of STIs. Findings supported the use of these modified scales with YMSM and highlight the need for further measurement studies.

Lesbian and bisexual women's gynaecological conditions: a systematic review and exploratory meta-analysis

BACKGROUND

Little is known about the gynaecological health of lesbian and bisexual (LB) women.

OBJECTIVES

To examine differences in incidence and/or prevalence of gynaecological conditions in LB compared with heterosexual women.

SEARCH STRATEGY

The systematic review protocol was prospectively registered (PROSPERO-CRD42015027091) and searches conducted in seven databases.

SELECTION CRITERIA

Comparative studies published 2000-2015, reporting any benign (non-infectious) and/or malignant gynaecological conditions with no language or setting restrictions.

DATA COLLECTION AND ANALYSIS

Inclusions, data extraction and quality assessment were conducted in duplicate. Meta-analyses of condition prevalence rates were conducted where ≥3 studies reported results.

MAIN RESULTS

From 567 records, 47 full papers were examined and 11 studies of mixed designs included. No studies directly addressing the question were found. Two chronic pelvic pain studies reported higher rates in bisexual compared with heterosexual women (38.5 versus 28.2% and 18.6 versus 6.4%). Meta-analyses showed no statistically significant differences in polycystic ovarian syndrome, endometriosis and fibroids. There was a higher rate of cervical cancer in bisexual than heterosexual women [odds ratio (OR) = 1.94; 95% CI 1.46-2.59] but no difference overall (OR = 0.76; 95% CI 0.15-3.92). There was a lower rate of uterine cancer in lesbian than heterosexual women (OR = 0.28; 95% CI 0.11-0.73) and overall (OR = 0.36; 95% CI 0.13-0.97), but no difference in bisexual women (OR = 0.43; 95% CI 0.06-3.07).

CONCLUSIONS

More bisexual women may experience chronic pelvic pain and cervical cancer than heterosexual women. There is no information on potential confounders. Better evidence is required, preferably monitoring sexual orientation in research using the existing validated measure and fully reporting results.

TWEETABLE ABSTRACT

Lesbians have less uterine cancer than heterosexual women; bisexuals have more pelvic pain and cervical cancer.

Integrating male sexual diversity into violence prevention efforts with men and boys: evidence from the Asia-Pacific Region

Men's perpetration of gender-based violence remains a global public health issue. Violence prevention experts call for engagement of boys and men to change social norms around masculinity in order to prevent gender-based violence. Yet, men do not comprise a homogenous category. Drawing on probability estimates of men who report same-sex practices and preferences captured in a multi-country gender-based violence prevention survey in the Asia-Pacific region, we test the effects of sexuality-related factors on men's adverse life experiences. We find that sexual minority men face statistically higher risk of lifetime adversity related to gender-based violence, stemming from gender inequitable norms in society. Sexuality is thus a key axis of differentiation among men in the Asia-Pacific region, influencing health and wellbeing and reflecting men's differential engagement with dominant norms of masculinity. Integrating awareness of male sexual diversity into gender-based violence prevention interventions, particularly those that work with boys and men, and bridging violence prevention programming between sexual minority communities and women, are essential to tackle the root drivers of violence.

Three critical questions for future research on lesbian relationships

In this article I discuss three questions that should be priorities for future research on lesbian love and relationships. The first question concerns the very definition of "lesbian relationship," given how many women may be engaged in same-sex relationships without identifying as lesbian. The second question concerns the potential influence of childhood neglect and abuse on adult women's same-sex relationships, a topic that has important implications for both psychological well-being and relationship functioning. The third question concerns the potential downsides of legal marriage for women's same-sex relationships, a topic that is particularly important in light of the newfound legal recognition of same-sex marriage in all 50 states. Although there are many understudied questions in the domain of women's same-sex relationships, research on these three questions has particularly strong potential to advance our understanding of lesbian love and relationships in important ways.

Lesbian, Gay, Bisexual, and Transgender Youth and Family Acceptance

In this article, we address theories of attachment and parental acceptance and rejection, and their implications for lesbian, gay, bisexual, and transgender (LGBT) youths' identity and health. We also provide 2 clinical cases to illustrate the process of family acceptance of a transgender youth and a gender nonconforming youth who was neither a sexual minority nor transgender. Clinical implications of family acceptance and rejection of LGBT youth are discussed.

Persecution Experiences and Mental Health of LGBT Asylum Seekers

Asylum seekers are a unique population, particularly those who have endured persecution for their sexual orientation or gender identity. Little data exist about the specific experiences and needs of asylum seekers persecuted due to lesbian, gay, bisexual, or transgender (LGBT) identity. Quantitative data were gathered regarding demographics, persecution histories, and mental health of 61 clients from a torture survivors program in New York City who reported persecution due to LGBT identity. Thirty-five clients persecuted due to their LGBT identity were matched by country of origin and sex with clients persecuted for other reasons to explore how persecution and symptoms may differ for LGBT clients. LGBT asylum seekers have a higher incidence of sexual violence, persecution occurring during childhood, persecution by family members, and suicidal ideation. Understanding the type of persecution experiences and how these influence mental health outcomes is an essential step toward designing and delivering effective treatments.

Sexual Identity Mobility and Depressive Symptoms: A Longitudinal Analysis of Moderating Factors Among Sexual Minority Women

Sexual minority identity (bisexual, lesbian) is a known risk factor for depression in women. This study examined a facet of minority stress prevalent among women-sexual identity mobility-as an identity-related contributor to higher levels of depressive symptoms. We used three waves of data from the Chicago Health and Life Experiences of Women study, a longitudinal study of sexual minority women (N = 306). Random effects OLS regression models were constructed to examine the effect of sexual identity changes on depressive symptoms. We found that 25.6 % of the sample reported a sexual identity change between Wave I and Wave II, and 24.9 % reported a sexual identity change between Waves II and III. Women who reported a change in sexual identity also reported more depressive symptoms subsequent to identity change. This effect was moderated by the number of years participants had reported their baseline identity and by whether the participant had initiated a romantic relationship with a male partner.

Parent Perspectives About Sexual Minority Adolescent Participation in Research and Requirements of Parental Permission

PURPOSE

Lesbian, gay, bisexual, transgender, and other sexual and gender minority (LGBTQ) adolescents and young adults experience health inequities relative to heterosexuals but may be reluctant to participate in research that requires guardian permission. Institutional review boards are often reluctant to approve studies without parental permission because of concerns about parent reactions. There is little to no data from the parent's perspective on these issues. We aimed to understand parent perspectives on parental permission requirements for minimal risk studies of LGBTQ health inequities.

METHODS

We conducted semistructured interviews with 31 parents of LGBTQ individuals. We presented a vignette describing an HIV behavioral surveillance protocol and assessed beliefs about whether parental permission should be required under various conditions (i.e., varying adolescent demographics, study procedures).

RESULTS

Most parents (74.2%) believed that parental permission should not be required, and this percent increased when considering adolescent participants for whom permission would be less feasible or potentially more dangerous (e.g., homeless adolescents). Qualitative analyses revealed that many parents were concerned about research quality and negative consequences for adolescents if permission was required. Others wanted to help support their child in making decisions about research and health care.

CONCLUSIONS

Most parents believed that parental permission should not be required for a minimal risk study, and the reasons for their beliefs fell squarely in line with federal regulations regarding adolescent self-consent to research. Studies of LGBTQ adolescent health inequities should receive waivers of parental permission to obtain representative samples and minimize risk of harm to the adolescent.

Mental health of sexual minorities. A systematic review

Many studies, reviews, and meta-analyses have reported elevated mental health problems for sexual minority (SM) individuals. This systematic review provides an update by including numerous recent studies, and explores whether SM individuals are at increased risk across selected mental health problems as per dimensions of sexual orientation (SO), genders, life-stages, geographic regions, and in higher quality studies. A systematic search in PubMed produced 199 studies appropriate for review. A clear majority of studies reported elevated risks for depression, anxiety, suicide attempts or suicides, and substance-related problems for SM men and women, as adolescents or adults from many geographic regions, and with varied SO dimensions (behaviour, attraction, identity), especially in more recent and higher quality studies. One notable exception is alcohol-related problems, where many studies reported zero or reversed effects, especially for SM men. All SM subgroups were at increased risk, but bisexual individuals were at highest risk in the majority of studies. Other subgroup and gender differences are more complex and are discussed. The review supports the long-standing mental health risk proposition for SM individuals, overall and as subgroups.

The Impact of Victimization and Neuroticism on Mental Health in Young Men who have Sex with Men: Internalized Homophobia as an Underlying Mechanism

Sexual minorities experience greater mental health issues compared to heterosexuals due to minority stressors. This study focused on the impact of victimization and neuroticism on mental health in young men who have sex with men (YMSM), and the mediating role of internalized homophobia (IH). IH refers to when a sexual minority person internalizes social bias and develops a negative view of themselves, which is a likely process through which victimization and neuroticism impact mental health. Data were collected over three time points across 12 months, with 450 YMSM (mean age = 18.9) and an 80.7% retention rate. Two mediation analyses with bias-corrected bootstrapping using 1000 samples were conducted, controlling for age, race, and sexual orientation. Results revealed that victimization [F (9, 440) = 4.83, p < .001, R² = .09] and neuroticism [F (9, 440) = 12.23, p < .001, R² = .20] had a significant indirect effect on mental health via increased levels of IH. These findings show how external experiences of stigma and personality level characteristics may impact YMSM in terms of their sense of self. Furthermore, these results support addressing social conditions that marginalize YMSM in order to promote better mental health through decreasing IH.

Differences Across Contexts

Minority stressors encountered by lesbian, gay, and bisexual (LGB) women are inherently connected to contextual experiences. Although there is a growing body of research on the benefits of gaining political rights and the costs of their denial, little research has focused on the effects of access to LGB-affirmative resources. In the current study with 1,017 women in same-sex relationships, we created profiles using latent class analysis to characterize the contexts in which participants were raised and the contexts in which they lived at the time of the study. We examined differences in interpersonal relationships, internalized heterosexism (IH), and outness across these profiles. Class 1 (28%) included participants who always lived in affirmative contexts with LGB-supportive resources. Class 2 participants (28%) always lived in more heterosexist contexts with few resources. Class 3 participants (44%) originally lived in more heterosexist contexts with few resources but shifted to more affirmative contexts. Class 3 individuals had greater social support and lower IH than Class 2 participants. Classes 1 and 3 had greater outness than Class 2. This study provides evidence linking IH to the lack of contextual supports. Our data also suggest that the quality of relationships for LGB women may remain strong even in heterosexist contexts. Actions that increase affirming resources will provide avenues for more positive identity development and interpersonal relationships for LGB individuals. Online slides for instructors who want to use this article for teaching are available on PWQ's website at http://journals.sagepub.com/page/pwq/suppl/index .