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Byer L, Orozco-Poore C, Rosendale N. Limitations and Future Directions in Sex, Sexuality, and Gender Diverse Research in Neurology. Ann Neurol 2024; 95:421-431. [PMID: 38112171 DOI: 10.1002/ana.26863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/16/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023]
Abstract
Sex, sexuality, and gender diversity is understudied and underserved in neurology. Neurology research inclusive of LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual) people is limited. Existing research struggles with a paucity of neurology studies collecting sex, sexuality, and gender diverse (SSGD) data, conflation of sex and gender, lack of precision in measures, neglect of younger and older populations, nebulous benefit to community, and absent intersectionality. Future directions in SSGD neurology research include precise and community-based measurements, respect for LGBTQIA+ colleagues, and the application of minority stress models. All patients stand to benefit from research that elucidates how SSGD variables influence neurological health. ANN NEUROL 2024;95:421-431.
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Affiliation(s)
- Lennox Byer
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Casey Orozco-Poore
- Department of Child Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Nicole Rosendale
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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2
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Silva T. Heterosexual Identification and Same-Sex Partnering: Prevalence and Attitudinal Characteristics in the USA. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2231-2239. [PMID: 35505221 DOI: 10.1007/s10508-022-02293-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 01/03/2022] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
This paper used the 2011-2017 National Survey of Family Growth to estimate population sizes and attitudinal characteristics of heterosexual-identified men who have sex with men (MSM) and women who have sex with women (WSW) aged 15-44 years. Analyses estimated population sizes in stages: after excluding respondents who reported only one lifetime same-sex partner, which happened before the age of 15; after excluding males who reported nonconsensual male-male sex; after excluding respondents who reported only one lifetime same-sex partner, regardless of the age at which that experience occurred; after excluding respondents who reported only two lifetime same-sex partners, the first of which occurred before age 15; and after excluding males who reported male-male sex work. The broadest criteria included many individuals with limited same-sex sexual histories or those who experienced nonconsensual sex or potentially coerced sex in youth. After excluding those respondents, analyses showed that heterosexual-identified MSM and WSW had a diversity of attitudes about gender and LGB rights; only a distinct minority were overtly homophobic and conservative. Researchers should carefully consider whether to include respondents who report unwanted sexual contact or sex at very young ages when they analyze sexual identity-behavior discordance or define sexual minority populations on the basis of behavior.
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Affiliation(s)
- Tony Silva
- Department of Sociology, University of British Columbia, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada.
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Pham VT, Adjei Boakye E, Simpson MC, Van Phu Bui Q, Olomukoro SI, Zand DH, Halloran DR, Osazuwa-Peters N. Human Papillomavirus-Associated Sexual Risks Among High School Students in the U.S.: Does Sexual Orientation Play a Role? ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3093-3101. [PMID: 34590221 DOI: 10.1007/s10508-021-02083-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
We examined the association between sexual orientation and human papillomavirus (HPV)-related risky sexual behaviors among high school students in the U.S. We used the 2015 Youth Risk Behavior Survey, a three-stage cluster sample, nationally representative, cross-sectional study. Participants were sexually active students (Grades 9-12) in public, private, and Catholic schools in 50 states and the District of Columbia (n = 5,958). Sexual orientation dimensions were: sexual self-identity (heterosexual, gay, lesbian, bisexual, and not sure) and sex of sexual contacts. HPV-associated risky sexual risk behaviors selected a priori were early sexual debut (≤ 12 or ≥ 13 years old) and number of lifetime partners (≥ 2 or ≥ 4). Separate multiple logistic regression analyses estimated association between sexual orientation and sex of sexual contacts, and HPV-associated risky sexual behaviors. Among the 5,958 high school students, a quarter had ≥ 4, and two-thirds had ≥ 2 sexual partners. Students who self-identified as bisexual (aOR = 2.43, 99% CI 1.19-4.98) or "not sure" (aOR = 4.56, 99% CI 2.54-8.17) were more likely to have sexual debut before 13 years. Similarly, students whose sexual contacts were adolescent females who had sex with females and males were more likely to have sexual debut before they turned 13 years of age (aOR = 3.46, 99% CI 1.83-6.48), or had ≥ 4 sexual partners (aOR = 2.66, 99% CI 1.74-4.08), or had ≥ 2 sexual partners (aOR = 3.09, 99% CI 1.91-5.00). In conclusion, HPV-associated risky sexual behavior is prevalent among high school students, especially sexual minorities. Interventions tailored to this population could increase HPV vaccine uptake and prevent future HPV-associated cancers and other negative outcomes.
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Affiliation(s)
- Vy T Pham
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, 201 E. Madison Street, 19664, Springfield, IL, 62794-9664, USA.
- Simmons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL, USA.
| | - Matthew C Simpson
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Quoc Van Phu Bui
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Stephanie I Olomukoro
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Debra H Zand
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Donna R Halloran
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Nosayaba Osazuwa-Peters
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
- Saint Louis University Cancer Center, St. Louis, MO, USA
- Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
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Romanelli M, Xiao Y, Lindsey MA. Sexual Identity-Behavior Profiles and Suicide Outcomes Among Heterosexual, Lesbian, and Gay Sexually Active Adolescents. Suicide Life Threat Behav 2020; 50:921-933. [PMID: 32190929 DOI: 10.1111/sltb.12634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 01/17/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Adolescents' sexual behaviors can be incongruent with those assumed to align with their sexual identity. Identity-behavior profiles permit the characterization of youth who might remain undetected using a single-dimensional assessment of sexual orientation. This study examined suicide risks among four distinct sexual identity-behavior profiles of youth: heterosexual with other-sex partners only, heterosexual with any same-sex partners, lesbian or gay (LG) with same-sex partners only, and LG with any other-sex partners. METHOD Data were analyzed from the 2017 National Youth Risk Behavior Survey. Participants' reported sex, sexual identity, and the sex of their sexual contacts were used to construct the identity-behavior profiles. Multivariate logistic regression was used to examine the relationship between identity-behavior profiles and suicide outcomes. RESULTS Compared to heterosexual respondents with other-sex partners only, heterosexual respondents with any same-sex partners and LG respondents with same-sex partners only had greater odds of having a suicide plan; LG respondents with any other-sex partners were over seven times more likely to have suicidal thoughts and attempt suicide and 14 times more likely to have a suicide plan. CONCLUSIONS Health and mental health providers can expand the identification of youth at risk for suicide by assessing both sexual identity and behavior.
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Affiliation(s)
- Meghan Romanelli
- Silver School of Social Work, New York University, New York, NY, USA.,McSilver Institute for Poverty Policy and Research, New York, NY, USA
| | - Yunyu Xiao
- Silver School of Social Work, New York University, New York, NY, USA.,McSilver Institute for Poverty Policy and Research, New York, NY, USA
| | - Michael A Lindsey
- Silver School of Social Work, New York University, New York, NY, USA.,McSilver Institute for Poverty Policy and Research, New York, NY, USA
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Mallory AB, Stanton AM, Handy AB. Couples' Sexual Communication and Dimensions of Sexual Function: A Meta-Analysis. JOURNAL OF SEX RESEARCH 2019; 56:882-898. [PMID: 30777780 PMCID: PMC6699928 DOI: 10.1080/00224499.2019.1568375] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Research and clinical data have shown that couples with sexual problems report a lack of sexual communication. However, no published meta-analyses have evaluated the relationship between sexual communication and sexual function. This meta-analysis examines the correlation between couples' sexual communication and dimension of sexual function across 48 studies. Sexual communication was positively associated with sexual desire (r = .16), sexual arousal (r = .21), lubrication (r = .17), orgasm (r = .23), erectile function (r = .19), less pain (r = .12), and overall sexual function (r = .35). The effect sizes for sexual desire (r = .21; r = .12) and orgasm (r = .26; r = .16) were higher for women than for men. For overall sexual function, studies with married participants (r = .47) had a larger effect size than studies with participants with multiple relationship types (r = .31) or than studies with dating participants (r = .11). Effect sizes were larger for studies conducted outside of the United States (r = .39) compared to studies conducted in the United States (r = .12). We discuss the importance of addressing the relationship between sexual communication and sexual function, as well as future directions for research in this area.
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Affiliation(s)
- Allen B Mallory
- Department of Human Development and Family Sciences, The University of Texas at Austin
- The Population Research Center, The University of Texas at Austin
| | | | - Ariel B Handy
- Department of Psychology, The University of Texas at Austin
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Fu TC, Herbenick D, Dodge B, Owens C, Sanders SA, Reece M, Fortenberry JD. Relationships Among Sexual Identity, Sexual Attraction, and Sexual Behavior: Results from a Nationally Representative Probability Sample of Adults in the United States. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1483-1493. [PMID: 30523472 DOI: 10.1007/s10508-018-1319-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 03/17/2018] [Accepted: 09/26/2018] [Indexed: 05/25/2023]
Abstract
Sexual orientation is a multi-dimensional concept, at a minimum comprised of sexual identity, sexual attraction, and sexual behavior. Our study aimed to assess relationships among self-identified sexual identity, sexual attraction, and sexual behaviors in a probability sample of adults in the U.S. and to identify associated factors with diverse patterns. We collected data from adults in the 2015 National Survey of Sexual Health and Behavior, an Internet-based nationally representative probability survey of the general U.S. population. Concordance between sexual identity versus sexual attraction and sexual behaviors was assessed using percent agreement. We identified correlates of discordance using logistic regression. Concordance between sexual identity versus sexual attraction and past-year sexual behaviors was 94% and 96%, respectively, though our sample was predominately composed of heterosexual individuals. Women and sexual minority individuals reported greater discordance across sexuality-related measures than men and heterosexual individuals. Younger adults (aged 18-24 years) were more likely to report sexual behaviors discordant with sexual identity compared with older adults (including those ages 25-34 years). Higher levels of educational attainment were significantly associated with less discordance of reported recent sexual activity and sexual identity. Measures of sexual identity, attraction, and behaviors are not interchangeable. Future research should consider multiple sexuality-related measures in order to capture the complexity and variability of sexualities.
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Affiliation(s)
- Tsung-Chieh Fu
- Center for Sexual Health Promotion, Indiana University, 1025 E 7th St., SPH 116, Bloomington, IN, 47405, USA.
| | - Debby Herbenick
- Center for Sexual Health Promotion, Indiana University, 1025 E 7th St., SPH 116, Bloomington, IN, 47405, USA
| | - Brian Dodge
- Center for Sexual Health Promotion, Indiana University, 1025 E 7th St., SPH 116, Bloomington, IN, 47405, USA
| | - Christopher Owens
- Center for Sexual Health Promotion, Indiana University, 1025 E 7th St., SPH 116, Bloomington, IN, 47405, USA
| | - Stephanie A Sanders
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, USA
- Department of Gender Studies, Indiana University, Bloomington, IN, USA
| | - Michael Reece
- Center for Sexual Health Promotion, Indiana University, 1025 E 7th St., SPH 116, Bloomington, IN, 47405, USA
| | - J Dennis Fortenberry
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Luoto S, Krams I, Rantala MJ. A Life History Approach to the Female Sexual Orientation Spectrum: Evolution, Development, Causal Mechanisms, and Health. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1273-1308. [PMID: 30229521 DOI: 10.1007/s10508-018-1261-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 05/29/2018] [Accepted: 06/14/2018] [Indexed: 05/12/2023]
Abstract
Women's capacity for sexual fluidity is at least as interesting a phenomenon from the point of view of evolutionary biology and behavioral endocrinology as exclusively homosexual orientation. Evolutionary hypotheses for female nonheterosexuality have failed to fully account for the existence of these different categories of nonheterosexual women, while also overlooking broader data on the causal mechanisms, physiology, ontogeny, and phylogeny of female nonheterosexuality. We review the evolutionary-developmental origins of various phenotypes in the female sexual orientation spectrum using the synergistic approach of Tinbergen's four questions. We also present femme-specific and butch-specific hypotheses at proximate and ultimate levels of analysis. This review article indicates that various nonheterosexual female phenotypes emerge from and contribute to hormonally mediated fast life history strategies. Life history theory provides a biobehavioral explanatory framework for nonheterosexual women's masculinized body morphology, psychological dispositions, and their elevated likelihood of experiencing violence, substance use, obesity, teenage pregnancy, and lower general health. This pattern of life outcomes can create a feedback loop of environmental unpredictability and harshness which destabilizes intrauterine hormonal conditions in mothers, leading to a greater likelihood of fast life history strategies, global health problems, and nonheterosexual preferences in female offspring. We further explore the potential of female nonheterosexuality to function as an alloparental buffer that enables masculinizing alleles to execute their characteristic fast life history strategies as they appear in the female and the male phenotype. Synthesizing life history theory with the female sexual orientation spectrum enriches existing scientific knowledge on the evolutionary-developmental mechanisms of human sex differences.
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Affiliation(s)
- Severi Luoto
- English, Drama and Writing Studies, University of Auckland, Arts 1, Building 206, Room 616, 14A Symonds St., Auckland, 1010, New Zealand.
- School of Psychology, University of Auckland, Auckland, New Zealand.
| | - Indrikis Krams
- Department of Zoology and Animal Ecology, University of Latvia, Riga, Latvia
- Institute of Ecology and Earth Sciences, University of Tartu, Tartu, Estonia
| | - Markus J Rantala
- Department of Biology & Turku Brain and Mind Center, University of Turku, Turku, Finland
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8
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Dyar C, Taggart TC, Rodriguez-Seijas C, Thompson RG, Elliott JC, Hasin DS, Eaton NR. Physical Health Disparities Across Dimensions of Sexual Orientation, Race/Ethnicity, and Sex: Evidence for Increased Risk Among Bisexual Adults. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:225-242. [PMID: 29633061 PMCID: PMC6382069 DOI: 10.1007/s10508-018-1169-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 12/16/2017] [Accepted: 01/31/2018] [Indexed: 05/18/2023]
Abstract
Accumulating evidence suggests that sexual minority individuals are at increased risk for physical health conditions compared to heterosexual individuals. However, we know little about physical health disparities affecting bisexual individuals, a population at increased risk for psychiatric and substance use conditions compared to both heterosexual and lesbian/gay populations. Using a large, nationally representative sample, we examined physical health disparities for bisexual individuals. To advance research on sexual minority health disparities, we further: (1) compared prevalence rates of physical health conditions across three dimensions of sexual orientation (i.e., identity, attractions, behavior) and (2) examined whether disparities differed by sex and race/ethnicity. Results indicated that sexual minority individuals were at increased risk for many physical health conditions. Notably, individuals with bisexual identity, attractions, and/or behavior were at increased risk for more physical health conditions than other sexual minority groups. The number and types of physical health disparities affecting bisexually identified individuals and individuals with same- and opposite-sex attractions and/or sexual partners varied across sex and race/ethnicity, with the most consistent disparities emerging for individuals who reported same- and opposite-sex sexual partners. Our findings highlight the substantial physical health disparities affecting sexual minorities and the heightened risk conferred by all facets of bisexuality.
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Affiliation(s)
- Christina Dyar
- Department of Psychology, University of Cincinnati, Cincinnati, OH, 45221, USA.
| | - Tenille C Taggart
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | | | - Ronald G Thompson
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jennifer C Elliott
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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Staples JM, Bird ER, Masters TN, George WH. Considerations for Culturally Sensitive Research With Transgender Adults: A Qualitative Analysis. JOURNAL OF SEX RESEARCH 2018; 55:1065-1076. [PMID: 28276930 PMCID: PMC7064308 DOI: 10.1080/00224499.2017.1292419] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Transgender (trans) individuals have historically been left out of research, and previous work has often conflated gender identity with sexual orientation. Furthermore, language used in psychology measures is often heteronormative and uses binary gendered language (e.g., "him"/"her"). The aim of the current study was to provide empirically derived guidance on conducting culturally sensitive research with transgender participants using qualitative data. We recruited trans individuals, ages 18 to 44, to participate in an anonymous, qualitative, national online survey as part of a quantitative study on the relationships among minority stress, sexual behavior, and mental health. The qualitative portion included four open-ended feedback questions. We identified four overarching themes regarding experiences with our survey: (a) emotional reaction; (b) insight gained; (c) being outside the box; and (d) value of the work. Research with trans adults should be more inclusive of diverse gender identities, sexual identities, and sexual behaviors. Steps in this direction may include soliciting feedback from community members regarding survey language and response options, allowing participants to contextualize their responses using open-ended questions, and clarifying language to distinguish between sexual behavior and sexual identity. A list of seven preliminary guidelines was proposed to aid scientists in conducting culturally sensitive research with trans individuals.
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10
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Health service use by same-sex attracted Australian women for alcohol and mental health issues: a cross-sectional study. BJGP Open 2018; 2:bjgpopen18X101565. [PMID: 30564720 PMCID: PMC6184099 DOI: 10.3399/bjgpopen18x101565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/20/2018] [Indexed: 12/05/2022] Open
Abstract
Background Same-sex attracted women (SSAW) have higher rates of alcohol and mental health problems than heterosexual women, but utilisation of and satisfaction with treatment is limited. Aim This study investigated the influences on health service use for alcohol and mental health problems among SSAW. Design & setting The Gelberg-Andersen behavioural model of health service utilisation was used to generate outcome variables. Method A convenience sample of 521 community-connected Australian SSAW completed an online survey. Health service use according to sexual identity was compared using χ2 analysis. Binary logistic regression examined associations between the independent variables with treatment utilisation. Results Reports of alcohol treatment were very low. Only 41.1% of participants with service need had utilised mental health and alcohol treatment. Bisexual women (adjusted odds ratio [AOR] = 2.76) and those with ‘other’ identities (AOR = 2.38) were more likely to use services than lesbian women. Enablers to service use were having a regular GP (AOR = 3.02); disclosure of sexuality to the GP (AOR = 2.42); lesbian, gay, bisexual and transgender (LGBT) community-connectedness (AOR = 1.11); and intimate partner violence ([IPV] AOR = 2.51). Social support was associated with a reduction in treatment use (AOR = 0.97). Significant access barriers included not feeling ready for help, and previous negative experiences related to sexual identity. Conclusion Disclosing sexual identity to a regular, trusted GP correlated with improved utilisation of alcohol and mental health treatment for SSAW. The benefits of seeking help for alcohol use, and of accessing LGBT-inclusive GPs to do so, should be promoted to SSAW.
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Annor FB, Clayton HB, Gilbert LK, Ivey-Stephenson AZ, Irving SM, David-Ferdon C, Kann LK. Sexual Orientation Discordance and Nonfatal Suicidal Behaviors in U.S. High School Students. Am J Prev Med 2018; 54:530-538. [PMID: 29449136 PMCID: PMC5860993 DOI: 10.1016/j.amepre.2018.01.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 12/08/2017] [Accepted: 01/11/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Studies among adults have documented association between sexual orientation discordance and some suicide risk factors. However, studies examining sexual orientation discordance and nonfatal suicidal behaviors in youth are rare. This study examines the association between sexual orientation discordance and suicidal ideation/suicide attempts among a nationally representative sample of U.S. high school students. METHODS Using sexual identity and sex of sexual contact measures from the 2015 national Youth Risk Behavior Survey (n=6,790), a sexual orientation discordance variable was constructed describing concordance and discordance (agreement and disagreement, respectively, between sexual identity and sex of sexual contacts). Three suicide-related questions (seriously considered attempting suicide, making a plan about how they would attempt suicide, and attempting suicide) were combined to create a two-level nonfatal suicide risk variable. Analyses were restricted to students who identified as heterosexual or gay/lesbian, who had sexual contact, and who had no missing data for sex or suicide variables. The association between sexual orientation discordance and nonfatal suicide risk was assessed using logistic regression. Analyses were performed in 2017. RESULTS Approximately 4.0% of students experienced sexual orientation discordance. High suicide risk was significantly more common among discordant students compared with concordant students (46.3% vs 22.4%, p<0.0001). In adjusted models, discordant students were 70% more likely to have had suicidal ideation/suicide attempts compared with concordant students (adjusted prevalence ratio=1.7, 95% CI=1.4, 2.0). CONCLUSIONS Sexual orientation discordance was associated with increased likelihood of nonfatal suicidal behaviors. Discordant adolescents may experience unique stressors that should be considered when developing and implementing suicide prevention programs.
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Affiliation(s)
- Francis B Annor
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Heather B Clayton
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leah K Gilbert
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Asha Z Ivey-Stephenson
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shalon M Irving
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Corinne David-Ferdon
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laura K Kann
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Abstract
The current article describes the adaptation of a measure of sexual orientation self-concept ambiguity (SSA) from an existing measure of general self-concept clarity. Latent "trait" scores of SSA reflect the extent to which a person's beliefs about their own sexual orientation are perceived as inconsistent, unreliable, or incongruent. Sexual minority and heterosexual women ( n = 348), ages 18 to 30, completed a cross-sectional survey. Categorical confirmatory factor analysis guided the selection of items to form a 10-item, self-report measure of SSA. In the current report, we also examine (a) reliability of the 10-item scale score, (b) measurement invariance based on respondents' sexual identity status and age group, and (c) correlations with preexisting surveys that purport to measure similar constructs and theoretical correlates. Evidence for internal reliability, measurement invariance (based on respondent sex), and convergent validity was also investigated in an independent, validation sample. The lowest SSA scores were reported by women who self-ascribed an exclusively heterosexual or exclusively lesbian/gay sexual identity, whereas those who reported a bisexual, mostly lesbian/gay, or mostly heterosexual identity, reported relatively higher SSA scores.
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Branstetter AJ, McRee AL, Reiter PL. Correlates of Human Papillomavirus Infection Among a National Sample of Sexual Minority Women. J Womens Health (Larchmt) 2017; 26:1004-1011. [PMID: 28486052 DOI: 10.1089/jwh.2016.6177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Many sexual minority women are infected with human papillomavirus (HPV), yet little is known about correlates of HPV infection among this population. MATERIALS AND METHODS We analyzed data from a national sample of sexual minority women (i.e., women who either reported a history of female sexual partners or identified as nonheterosexual) aged 20-59 from the 2003 to 2012 National Health and Nutrition Examination Survey (n = 830). Weighted logistic regression identified correlates of infection with any HPV type and infection with a high-risk HPV type. RESULTS About 53% of women were infected with any HPV type, and about 37% were infected with a high-risk HPV type. Women who reported five or more sexual partners during their lifetime (adjusted odds ratio [aOR] = 5.07, 95% confidence interval [CI]: 2.26-11.42) were more likely to be infected with a high-risk HPV type. Compared to women aged 20-29, women aged 40-49 (aOR = 0.51, 95% CI: 0.32-0.81) or 50-59 (aOR = 0.27, 95% CI: 0.14-0.53) were less likely to be infected with a high-risk HPV type, as were women who were married or living with a partner (aOR = 0.62, 95% CI: 0.44-0.89). Mostly similar correlates were identified for infection with any HPV type, although infection with any HPV type was also less common among women who identified as lesbian compared to those who identified as heterosexual (aOR = 0.38, 95% CI: 0.21-0.68). CONCLUSIONS Demographic and health-related characteristics were associated with HPV infection outcomes. Findings can inform HPV prevention efforts for sexual minority women by providing information about risk factors and subgroups at particular risk for infection.
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Mor Z, Davidovich U. Sexual Orientation and Behavior of Adult Jews in Israel and the Association With Risk Behavior. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1563-1571. [PMID: 26754157 DOI: 10.1007/s10508-015-0631-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 09/05/2015] [Accepted: 09/15/2015] [Indexed: 06/05/2023]
Abstract
Estimating the size of key risk groups susceptible to HIV/sexually transmitted diseases (STI) is necessary for establishment of interventions and budget allocation. This study aimed to identify various dimensions of sexual orientation and practices in Israel, and correlate the findings with sexual risk behavior (SRB). It used a random representative sample of the Jewish population aged 18-44 years who completed online questionnaires regarding their self-identified sexual orientation, attraction and practices, and SRB. Concordant heterosexuals were those who self-reported heterosexual identity, were attracted and had sex only with the opposite gender. National estimates regarding prevalence of gay, lesbian, and bisexual men and women were based on the civil census. The sample included 997 men and 1005 women, of whom 11.3 and 15.2 % were attracted to the same-gender, 10.2 and 8.7 % reported lifetime same-gender encounters, while 8.2 and 4.8 % self-identified as gay or bisexual men and lesbian or bisexual women, respectively. The estimated population of self-identified Jewish gay or bisexual men and lesbian or bisexual women aged 18-44 in Israel was 94,176, and 57,671, respectively. SRB was more common among self-identified gays or bisexual men and among discordant heterosexual men and women. Those who reported same-gender sexual practices reported greater SRB than those who only had opposite-gender encounters. Interestingly, SRB among discordant heterosexuals was associated with same-sex behavior rather than attraction. Health practitioners should increase their awareness of sexual diversity among their clientele, and should recognize that risk for HIV/STI may exist among self-identified heterosexuals, who may not disclose their actual sexual attraction or practices.
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Affiliation(s)
- Zohar Mor
- Ramla Department of Health, Ministry of Health, 3 Danny Mass St., 72100, Ramla, Israel.
| | - Udi Davidovich
- Geneeskundige en Gezondheidsdienst, Amsterdam, The Netherlands
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15
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Intimate Partner Violence and Correlates With Risk Behaviors and HIV/STI Diagnoses Among Men Who Have Sex With Men and Men Who Have Sex With Men and Women in China: A Hidden Epidemic. Sex Transm Dis 2016. [PMID: 26222752 DOI: 10.1097/olq.0000000000000302] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) research has primarily focused on heterosexual couples but has largely ignored IPV among men who have sex with men (MSM). We examined IPV prevalence among MSM and men who have sex with men and women (MSMW) in China. METHODS Men who have sex with men older than 16 years were recruited through 3 MSM-focused Web sites in China. An online survey containing items on sociodemographics, risk behaviors, IPV, and self-reported HIV or sexually transmitted infection diagnosis was completed. Multivariate regression was used to examine associations between IPV and risk behaviors and an HIV or sexually transmitted infection diagnosis. RESULTS Among 610 participants, 182 (29.8%) reported experiencing at least 1 type of IPV. Men who have sex with both men and women were at significantly greater risk for IPV (adjusted odds ratio [AOR], 1.65; 95% confidence interval [CI], 1.08-2.53) compared with MSM. Men who had experienced IPV were more likely to have participated in group sex (AOR, 1.86; 95% CI, 1.08-3.21), to have had sex in exchange for gifts or money (AOR, 5.06; 95% CI, 2.47-10.35), and to report a positive HIV diagnosis (AOR, 2.59; 95% CI, 1.22-5.51). CONCLUSIONS There is a hidden epidemic of IPV among MSM in China, especially among MSMW. The hidden nature of MSM and MSMW suggests the need for a clinical environment more conducive to disclosure. Research is needed to understand the pathways linking IPV and HIV risk among MSM to optimize the design of effective interventions.
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16
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Currin JM, Hubach RD, Brown C, Farley S. Impact of non-heterosexual impulses on heterosexuals’ attitudes towards monogamy and casual sex. PSYCHOLOGY & SEXUALITY 2016. [DOI: 10.1080/19419899.2016.1168313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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Mor Z, Davidovich U. Same-sex sexual attraction, behavior, and practices of Jewish men in Israel and the association with HIV prevalence. AIDS Care 2016; 28 Suppl 1:64-7. [PMID: 26883581 PMCID: PMC4828613 DOI: 10.1080/09540121.2016.1146400] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/20/2016] [Indexed: 11/02/2022]
Abstract
In order to efficiently direct efforts and resources required for the prevention of HIV and other sexually transmitted infection among men who have sex with men (MSM) in Israel, it is necessary to define their particular behaviors, estimate their size, and asses the HIV-burden. This cross-sectional study included a sub-sample from a random representative National study performed in Israel, which included Jewish males aged 18-44 who completed online anonymous questionnaires regarding their sexual attraction and practices, commercial sex-work, as well as condom and substances' use. Additionally, participants were asked to identify themselves as gay, bisexual, or heterosexual. National estimates regarding prevalence of risk-behaviors and HIV-infection among MSM were based on the Statistical Abstract of Israel and the National HIV Registry, respectively. Of the total sample of 997 men, 11.9% reported lifetime male sex encounters, while 4.5% and 3.7% self-identified as gay or bisexual, respectively. The estimated population of self-identified Jewish gays/bisexuals aged 18-44 in Israel was 94,176, and in Tel-Aviv 33,839. HIV prevalence among MSM was estimated at 0.7% in Israel and 1.0% in Tel-Aviv. MSM were more likely to live in Tel-Aviv, had higher levels of education, and were scored higher on several determinants of sexual risk in comparison to those attracted to women, including early sexual debut, greater number of sexual partners, ever paid/been paid for sex, sexually coerced, and substance use. In conclusion, MSM were involved in greater risk behaviors than those who only had female sex partners. Most MSM were living in Tel-Aviv and their estimated HIV prevalence was 1.0%.
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Affiliation(s)
- Zohar Mor
- Ramla Department of Health, Ministry of Health, Ramla, Israel
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18
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Davis A, Best J, Wei C, Luo J, Van Der Pol B, Meyerson B, Dodge B, Aalsma M, Tucker J. Intimate Partner Violence and Correlates With Risk Behaviors and HIV/STI Diagnoses Among Men Who Have Sex With Men and Men Who Have Sex With Men and Women in China: A Hidden Epidemic. Sex Transm Dis 2015. [PMID: 26222752 DOI: 10.1097/olq.00000000000003022017.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
BACKGROUND Intimate partner violence (IPV) research has primarily focused on heterosexual couples but has largely ignored IPV among men who have sex with men (MSM). We examined IPV prevalence among MSM and men who have sex with men and women (MSMW) in China. METHODS Men who have sex with men older than 16 years were recruited through 3 MSM-focused Web sites in China. An online survey containing items on sociodemographics, risk behaviors, IPV, and self-reported HIV or sexually transmitted infection diagnosis was completed. Multivariate regression was used to examine associations between IPV and risk behaviors and an HIV or sexually transmitted infection diagnosis. RESULTS Among 610 participants, 182 (29.8%) reported experiencing at least 1 type of IPV. Men who have sex with both men and women were at significantly greater risk for IPV (adjusted odds ratio [AOR], 1.65; 95% confidence interval [CI], 1.08-2.53) compared with MSM. Men who had experienced IPV were more likely to have participated in group sex (AOR, 1.86; 95% CI, 1.08-3.21), to have had sex in exchange for gifts or money (AOR, 5.06; 95% CI, 2.47-10.35), and to report a positive HIV diagnosis (AOR, 2.59; 95% CI, 1.22-5.51). CONCLUSIONS There is a hidden epidemic of IPV among MSM in China, especially among MSMW. The hidden nature of MSM and MSMW suggests the need for a clinical environment more conducive to disclosure. Research is needed to understand the pathways linking IPV and HIV risk among MSM to optimize the design of effective interventions.
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Affiliation(s)
- Alissa Davis
- From the *Department of Epidemiology & Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN; †UNC-Project China, Guangzhou, China; ‡Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, Bloomington, IN; §School of Medicine and ¶Department of Epidemiology & Biostatistics and Global Health Sciences, University of California-San Francisco, San Francisco, CA; ∥School of Medicine, University of Alabama-Birmingham, Birmingham, AL; **Department of Applied Health Science and ††Center for Sexual Health Promotion, Indiana University School of Public Health-Bloomington, Bloomington, IN; ‡‡Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN; §§School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, CA; and ¶¶Social Entrepreneurship for Sexual Health Research Group, University of North Carolina and Guangdong Provincial Center for Skin Diseases & STI Control, Guangzhou, China
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