A Decade of Microaggression Research and LGBTQ Communities: An Introduction to the Special Issue

Violence Victimization and Depressive Symptoms Among a Sub-Sample of Sexual and Gender Minority Adults in a Population-Based South African Study

Sexual and gender minority (SGM) adults in South Africa face high levels of violence and poor mental health outcomes. Interventions to prevent these negative health implications are hampered by a lack of representative data among this population. This study aims to quantify the associations between three forms of violent victimization and depressive symptoms in a sub-sample of SGM drawn from a population-based cross-sectional study in Gauteng, South Africa. Data come from the sixth Quality of Life survey conducted in South Africa's Gauteng province. Brief screeners assessed childhood sexual abuse (CSA), past-year intimate partner violence (IPV), non-partner violence, and depressive symptoms. Three survey-weighted logistic regression analyses were fit to model associations between elevated depressive symptoms and CSA, past-year IPV, and past-year non-partner violence, controlling for socio-demographics (age, race, sex, area of residence, education, socioeconomic status, and recent employment). N = 1,328 SGM respondents were included. Over 40% (n = 537) reported depressive symptoms, while 17% (n = 222) reported CSA, 5% (n = 67) reported IPV, and 16% (n = 208) reported non-partner violence. CSA and non-partner violence were associated with significantly higher odds of reporting depressive symptoms (aOR: 1.51, 95% CI [1.03, 2.23]; aOR: 1.84, [1.24, 2.73], respectively). IPV was not associated with elevated depressive symptoms (aOR: 1.17, [0.64, 2.16]). In all models, employment in the past 7 days was associated with significantly lower odds of reporting depressive symptoms. Recent and childhood violence is a major burden that is associated with elevated symptoms of depression among SGM in urban South Africa. Community-tailored interventions and policy-related advocacy related to employment and violence prevention may alleviate depressive symptoms in SGM adults in Gauteng.

Lifestyle behaviors and mental health outcomes in sexual and gender minority graduate students

OBJECTIVE

There are well-documented health disparities among sexual and/or gender minority (LGBTQ+) individuals generally, but there is limited research investigating the disparities in health-related lifestyle factors and mental health among LGBTQ+ graduate students, which is a group that may be especially vulnerable.

PARTICIPANTS

This project was a secondary analysis of data from the American College Health Association's National College Health Assessment's (NCHA) Fall 2019 wave, which included 7,766 graduate students.

METHODS

Students self-reported engagement in health-related lifestyle factors and psychological distress. Welch's independent samples t-tests were used to compare differences in psychological distress and lifestyle behaviors and multiple linear regression models were used to test lifestyle factors as predictors of LGBTQ+ psychological distress.

RESULTS

LGBTQ+ graduate students reported worse lifestyle profiles compared to their peers and greater psychological distress. Sleep quality had the strongest association with psychological distress among LGBTQ+ graduate students.

CONCLUSIONS

These findings have important implications for policies and interventions to improve health and decrease suffering in LGBTQ+ graduate students.

Measurement invariance of the LGBT People of Color Microaggressions Scale among LGBTQ+ youth

The LGBT People of Color Microaggressions Scale (LGBT-PCMS) is a widely used measure of intersectional microaggression experiences among sexual and gender minority people of color. Although it is widely used-and increasingly used in adolescent and young adult samples-it is unknown whether the LGBT-PCMS demonstrates similar measurement properties across subgroups of sexual and gender minority youth of color (SGMYOC). Among 4142 SGMYOC (ages 13-17) we found evidence for either partial or full scalar invariance (item loadings and intercepts were generally equal) across sexual orientation, race-ethnicity, and gender identity groups for all three subscales. Specific patterns of invariance and noninvariance across groups, as well as implications for the use of the LGBT-PCMS and its subscales among SGMYOC are discussed.

Experiences of Microaggressions, Attributions, and Impact Among US Young Adults: An Intersectional Perspective Regarding Sexual/Gender and Racial/Ethnic Minorities

BACKGROUND

Understanding discrimination (e.g., microaggressions) toward sexual/gender minorities (SGM) and racial/ethnic minorities (REM) from an intersectional perspective is critical in informing interventions to reduce such experiences and their impacts.

PURPOSE

This study examined US young adults identifying as SGM, REM, both, or neither in relation to microaggression experiences, and these factors in relation to mental health.

METHODS

Using 2022 data from 932 US adults (Mage = 27.61) in an online survey study, we compared subgroups (SGM-only, REM-only, both, neither) in relation to microaggression experiences and mental health symptoms, stratified by sex (male, female). Multivariable linear regression examined: 1) sex and intersectional subgroup in relation to number of microaggressions experienced; and 2) sex, subgroup, and number of microaggression experiences in relation to mental health symptoms.

RESULTS

Among females (n = 612), 42.0% were SGM-only, 17.3% REM-only, 15.2% both, and 25.5% neither. Among males (n = 320), 25.0% were SGM-only, 25.0% REM-only, 8.4% both, and 41.6% neither. Females (vs. males) reported more microaggressions (M = 5.67, SD = 3.00 vs. M = 3.95, SD = 3.46, p < .001). Those with intersecting minority identities experienced the most microagressions (females: M = 6.98, SD = 2.64; males: M = 6.44, SD = 2.95, respectively). In multivariable analyses, females and those in any of the 3 minority-identifying subgroups experienced more microaggressions; those with intersecting minority identities experienced more microaggressions than SGM-only and REM-only. Identifying as SGM-only or both SGM and REM, as well as experiencing more microaggressions, was associated with greater mental health symptoms.

CONCLUSIONS

Intersecting minority identities increase risk for microaggressions and mental health consequences. Multilevel interventions must reduce minority subgroups' experiences of microaggressions and their impacts.

Microaggression and discrimination experiences among diverse youth with LGBTQ+ parents in the United States

Family-based microaggressions and discrimination experienced by youth with LGBTQ+ parents are important to understand from their perspectives. Using mixed methods, we examined such experiences among 12- to 25-year-old youth (N = 51) with at least one LGBTQ+ parent in the United States. Youth were diverse in race/ethnicity, family structure, gender and sexual identities, socioeconomic status, and geographic region. Using interviews, we explored LGBTQ+ family-based microaggressions (reported through scale items with feedback) and discrimination (assessed via thematic analysis). Microaggressions and discrimination based on having LGBTQ+ parents were common, yet there were distinctions in direct and indirect stigma across the quantitative items and qualitative themes. These results underscore the value of mixed methods research with youth and implications for future research, practice, and policy.

Law, Blood, and Custody: Sexual Minority Mothers and Heteronormativity

This article analyzes how couples made up of two mothers redefine their roles when they break up as well as how legal professionals frame the custodial arrangements of these former same-sex couples. To do so, we focus on the case of Quebec, Canada, where parentage equality between mothers was attained as early as in 2002. We rely on individual semi-structured interviews with mothers' (N = 17) and legal professionals' accounts (N = 23) as well as on court records regarding physical custody arrangements. We find that the legal recognition of both mothers favors coparenting practices, and especially joint physical custody. However, the heteronormative frame of custody arrangements lingers. Sexual minority mothers struggle with the valorization of birth motherhood and with the standard of gendered parental complementarity. Indeed, professionals can still fall back on heteronormative norms, notably by assigning to non-birth mothers a "paternal" role. In the end, the inexperience of many professionals on LGBTQ+ issues, the embeddedness of heteronormativity in day-to-day relations, as well as the permanence of heteronormative legal categories and professional practices are all factors that set these families apart.

A Conditional Process Analysis of Microaffirmations, Microaggressions, and Mental Health Among Thai Sexual Minorities

Sexual orientation (SO) microaggressions contribute to mental health issues among sexual minorities. Microaffirmations may mitigate these effects, with internalized heterosexism and SO concealment proposed as mediators. A community sample of 307 Thai sexual minorities completed measures assessing SO microaggressions, microaffirmations, internalized heterosexism, SO concealment, and mental health concerns. Serial mediation analysis using Hayes' PROCESS macro model 6 tested indirect effects through proposed mediators. Conditional process analysis using PROCESS model 85 examined the moderating role of microaffirmations. These models tested hypothesized moderated serial mediation relationships among study variables. SO microaggressions had a total effect on mental health concerns, directly and indirectly through increased SO concealment. The internalized heterosexism → SO concealment sequence mediated this relationship. Microaffirmations moderated the direct microaggressions-mental health link, reducing this association at higher levels of microaffirmations. The full model accounted for 31.6% of the variance (R2 = 0.316) in mental health concerns. The Johnson-Neyman technique identified 0.613 as the microaffirmations value above which the effect of SO microaggressions on mental health was no longer significant. Findings elucidate mechanisms linking SO microaggressions to mental health issues and microaffirmations' protective role among Thai sexual minorities. These results could inform efforts to mitigate minority stress impacts.

Born This Way: Integrating LGBTQIA+ Identities as Pharmacy Practitioners

Progression through the profession of pharmacy is filled with many milestones that can contribute to feelings of stress, rejection, and isolation. For Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual+(LGBTQIA+) students and practitioners, these feelings can be compounded by similar issues experienced by their sexual orientation or gender identity. Historically, LGBTQIA+ students, new practitioners, and seasoned professionals alike have lacked visible role models for how to intersect personal and professional identity in the pharmacy profession. In this paper, the authors describe experiences of intersecting personal queer identities with professional pharmacy identities; exploring barriers to integration and developing solutions to overcome these barriers. The authors also share how the formation of a collective of LGBTQIA+ practitioners and educators has led to a unified voice to advocate for the advancement of LGBTQIA+ healthcare in pharmacy education and practice. This manuscript will provide readers with a guide to navigate and address issues with the integration of personal and professional identity to lead to practice that validates personal identity as important, valuable, and affirmed.

The Effectiveness of Didactic and Perspective-Taking Interventions on Reducing Multiple Dimensions of Heterosexism

This study examined the effect of two interventions (didactic and perspective-taking) on five dimensions of heterosexism (hostile, aversive, amnestic, paternalistic, and positive stereotypic). Participants were 117 undergraduate students, randomly assigned to one of three groups in this posttest-only control group experiment. After the intervention, the participants completed measures of sexual prejudice, right-wing authoritarianism (RWA), gender role beliefs (GRB), and a demographic questionnaire. Results from the first step of hierarchical regression models showed that RWA and GRB were significantly predictive of all dimensions of heterosexism except for positive stereotypic, accounting for 13.8% to 56.7% of the variance. This suggests that interventions targeting sexual prejudice should examine both variables. When between-group comparisons were added during the second step, the didactic intervention in comparison with the control group was significantly predictive of lower paternalistic heterosexism; the perspective-taking intervention in comparison with the control group was significantly predictive of lower positive stereotypic heterosexism.

"Family Is the Beginning but Not the End": Intergenerational LGBTQ Chosen Family, Social Support, and Health in a Vietnamese American Community Organization

Homophobia and anti-LGBTQ (Lesbian, Gay, Bisexual, Transgender, and Queer) discrimination within ethnic communities can negatively impact the health of LGBTQ people. The formation of chosen families has been a source of social support that may have health benefits for LGBTQ people. This ethnographic study explores how participation in a LGBTQ Vietnamese American community organization reveals the salience of chosen family in informing individual members' perceptions of their health and well-being. Fifteen members were interviewed and over 30 were included in a 6-month participant-observation period. Three themes emerged: 1) queering family and kinship, 2) Vietnamese motherhood and the social reproduction of the family, 3) social ties and community connectedness as relational dimensions of health. Findings suggest that specific ethnic social support via chosen family formations for LGBTQ Vietnamese Americans can shape individuals' sense of self, sense of belonging, purpose in life, and consequently perceptions of well-being.

The impacts of adverse childhood experiences on socioeconomic disadvantage by sexual and gender identity in the U.S

BACKGROUND

Adverse childhood experiences (ACEs) predict low education and low income, but this has scarcely been examined by sexual orientation and gender identity.

OBJECTIVE

We investigated prevalence and associations between ACEs, low income, and low education in sexual and gender diverse (SGD) and cisgender heterosexual (CGH) sub-groups.

PARTICIPANTS AND SETTING

Data came from 14 states in the 2019 Behavioral Risk Factor Surveillance System survey (n = 79,303).

METHODS

Chi-square, logistic regression, and moderation analyses were implemented to examine the prevalence and associations between ACEs, low income, and low education. Sample stratification was used to examine differences between SGD and CGH sub-groups.

RESULTS

SGD participants reported higher prevalence of ACEs, low income, and low education compared to CGH participants (p < 0.0001) with the highest proportions in transgender and queer/something else groups. ACEs were associated with low income (AOR 1.084, CI 1.067-1.102) and low education (AOR 1.056, CI 1.041-1.071) in the entire sample. Transgender and queer/something else groups had higher odds of low income (AOR 3.345, CI 1.975-5.665; AOR 1.702, CI 1.096-2.643) and low education (AOR 1.702, CI 1.096-2.643; AOR 3.552, CI 2.842-4.440) and gay/lesbian identity had reduced odds of low education (AOR 0.586, CI 0.457-0.751) compared to CGH males. The strength of associations between ACEs and low income and low education were weaker among SGD compared to CGH sub-groups.

CONCLUSION

These findings highlight the importance of including categories of sexual identity cross-classified by gender identity in population-based analyses in order to facilitate a comprehensive characterization of the life course outcomes of SGD populations.

Transgender Dehumanization and Mental Health: Microaggressions, Sexual Objectification, and Shame

Using structural equation modeling in a national, nonprobabilistic sample of 292 transgender women and men, this project extends the pantheoretical dehumanization framework by testing direct and indirect relations between dehumanization (i.e., a higher-order construct from experiences of transgender microaggressions and sexual objectification), internalization processes (i.e., internalized transnegativity, self-objectification), shame, and general mental health. The model explained 55% of the variance in general mental health. Direct relations between dehumanization and all internalization processes were positive and significant. Internalized transnegativity and shame were significant, negative, direct predictors of mental health, but neither dehumanization nor self-objectification was a significant direct predictor of transgender mental health. Both self-objectification and internalized transnegativity directly predicted more feelings of shame. However, only shame yielded a significant indirect pathway from dehumanization to mental health. The indirect relations from self-objectification and internalized transnegativity to mental health through shame were significant. Research, advocacy, and clinical implications are discussed.

Hidden hurt: A qualitative study of the microaggressions experienced by disabled children in education in China

BACKGROUND

Microaggressions are brief, commonplace indignities expressed through verbal or behavioral means. In China, microaggressions have proliferated with the wide implementation of education protection policies for disabled children (including learning in regular classes (LRC), special school education (SSE), and home-delivery education (HDE)), resulting in severe consequences. However, related issues have not been discussed yet.

OBJECTIVE

This study explores concrete forms of microaggressions that disabled children have experienced under three educational policies.

METHODS

We took a qualitative phenomenological approach and used semi-structured interviews to collect data. 22 disabled children, their guardians, and eight educators from three compulsory education schools in Jinan, China, were included in this study.

RESULTS

Microaggressions are categorized into three types: microassaults, microinsults, and microinvalidations. In LRC, typical microaggressions include the microassaults of refusal, extra requirements, avoiding needs, and accusations; the microinsults of labeling, differential patronization, and over-protection; and the microinvalidation of suspicion. In SSE, typical microaggressions include the microassaults of refusal, belittling, hiding, and ignoring; the microinsults of assumptions of low intelligence, ignoring, and distancing; and the microinvalidation of suspicion. In HDE, typical microaggressions include the microassaults of denial of privacy and denial of expression; and the microinsults of infantilization and blame.

CONCLUSIONS

The microaggressions that disabled children experience under educational policies produce serious disciplinary effects. To eliminate microaggressions, it is necessary to publicize the new disability rights paradigm, engage disabled children and their families in participation in the political process, develop demand-oriented assessment criteria, and standardize educators' discretion.

Antidiscrimination Laws as Essential Tools for Achieving LGBTQ+ Health Equity

This Viewpoint discusses a pending US Supreme Court case to determine the extent to which people who identify as LGBTQ+ are protected under state antidiscrimination laws in the commercial marketplace.

"Ah, it's best not to mention that here:" Experiences of LGBTQ+ health professionals in (heteronormative) workplaces in Canada

Introduction

Despite human rights protections for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people, LGBTQ+ professionals may continue to experience discrimination working in heteronormative systems and spaces.

Methods

In this qualitative study 13 health professionals (nurses, occupational therapists, and physicians) from across Canada participated in in-depth qualitative interviews to explore their experiences with work-related microaggressions and heteronormativity.

Results

Heterosexist microaggressions from both patients/clients and colleagues were the norm, perpetuating and bolstered by heteronormative workplace and professional cultures. In turn, LGBTQ+ professionals navigated disclosure-decision-making, in power-laden contexts where all options carried potential negative consequences.

Discussion

Drawing on the notion of "heteroprofessionalism," we argue that the concept of professional carries encoded within it demands that the occupant of that category be-or present as-heterosexual, an unmarked status that can be readily desexualized. Acknowledging sex and sexuality disrupts "professionalism." We argue that such disruption, indeed dissention, is necessary to open (hetero)professional spaces to LGBTQ+ workers.

Abord de l’orientation sexuelle des patientes : représentations et pratiques des médecins généralistes

INTRODUCTION

While more and more women say they are non-heterosexual, they feel that they benefit from poorer follow-up, both quantitative and qualitative, in general medicine than heterosexual women. Few studies focus on the experience of general practitioners with this audience.

PURPOSE OF RESEARCH

To identify the medical practionners' representations and pratices in approaching the sexual orientation with female patients.

METHOD

This is a qualitative study with data from 10 interviews with general practitioners selected as part of a theoretical sampling. Grounded theory-based analysis was used.

RESULTS

General practioners deduced sexual orientation from one of its 3 components: attraction, practices and sexual identity. General practitioners described heteronormative behaviors but some operated a progressive distancing from it. In practice, this resulted in an inclusive approach of non-heterosexual people with an absence of presumption of heterosexuality. Whether or not to discuss sexual orientation depended on general practioners' perceptions of the usefulness and intrusiveness of this data. Social representations and stereotypes of the sexuality of non-heterosexual female patients could lead to discrimination in access to care.

CONCLUSION

Identifying one's social representations and questioning one's heteronormativity allows for more inclusive care of non-heterosexual female patients. Supporting students and professionals in this process is one of the keys to better support for minority people.

Validity and reliability study of the mental illness micro-aggression scale-perpetrator version

This study was conducted to determine the Turkish Validity and Reliability of the Mental Illness Micro-Aggression Scale- perpetrator version. This methodological study was conducted with 302 nursing students studying at two different universities in Turkey. The data of the study were collected via introductory information form, the Mental Illness Micro-Aggression Scale-Perpetrator Version, and Community Attitudes to Mental Illness. As a result of the exploratory factor analysis and confirmatory factor analysis, the original three-factor structure of the scale was changed and a four-factor structure emerged. The Turkish version of the Mental Illness Micro-Aggression Scale-Perpetrator Version was found to be a valid and reliable measurement tool to measure micro-aggression towards people with mental illness.

Invisible Stories: A Phenomenological Study of Bi and Trans Parent Experiences Within Elementary Schools in the Southwestern United States

Heteronormativity, family hegemony, and gender biases in K-12 education threaten child safety, parental dignity, and identity among queer families. While prior research examined the experiences of queer parents-specifically those of lesbian and gay parents-empirical attention to school-related experiences of trans and bi parents is lacking. Hence, this phenomenological study focuses on the PK-12 school-related experiences of bi and trans parents. Using queer theory as a theoretical framework, we review relevant literature on family hegemony, gender biases, and heteronormativity within school settings and its impact on children with queer families. Then, we discuss the methods and analysis used to understand the experiences of bi and trans parent participants. Analysis revealed four themes: (a) concern for the child; (b) value for diversity; (c) heteronormative nature of schools; and (d) importance of inclusivity. Finally, we provide recommendations on ways school personnel can better support trans and bi parents and their children.

Exploring the microaggression experiences of LGBTQ+ community for a culturally safe care: A descriptive qualitative study

BACKGROUND

Microaggressions, stigma and minority stress still occur among sexual and gender minorities on an individual, interpersonal, and structural level. Cultural immersion may therefore be an effective strategy in order to find potential healthcare approaches and foster more comprehensive, critical, intersectional, and inclusive care practices.

OBJECTIVE

The aim of this study was to develop insight into the experiences of LGBTQ+ community members to obtain in-depth perceptions of microaggressions and an understanding of their healthcare needs to provide a culturally safe and sensitive care.

DESIGN

A qualitative descriptive study was conducted between September to November 2021.

SETTINGS

This study was conducted at the University of Almeria with LGBTQ+ community members.

PARTICIPANTS

Twenty-one LGBTQ+ individual participated in this study, aged between 18 and 56 years old.

METHODS

Participants were recruited using a purposive sampling. Responses from semi-structured interviews were studied using a thematic analysis. Methods and findings are reported in line with Standards for Reporting Qualitative Research recommendations.

RESULTS

Three themes emerged from the qualitative analysis: (i) experiences to understand the impact of a heteronormative society, (ii) perceptions of engaging with health education and promotion, and (iii) healthcare access, use and experiences within the LGTBQ+ community.

CONCLUSIONS

This study yields findings about the difficulties that LGBTQ+ community members face in the healthcare system in order to ensure equal care for vulnerable communities and integrate a culturally safe care approach into nursing practice. Certain microaffirmation strategies against social determinants of health such as school-based nursing strategies can help to raise awareness and knowledge among heterosexual peers and reduce cultural invisibility, microaggressions, stigma and minority stress. In order to provide culturally safe care, educators might also explore the inclusion of gender and sexual minority care content in both in-faculty education and ongoing continuing education for nurse practitioners.

Digestive Health in Sexual and Gender Minority Populations

It has been over 50 years since the Stonewall Inn Riots in June 1969, a seminal event for the lesbian, gay, bisexual, transgender, queer, intersex, and other sexual and gender-diverse minorities (LGBTQI+, or lesbian, gay, bisexual, transgender, queer, intersex, and everyone else) rights movement. However, sexual and gender minority (SGM) individuals still face discrimination and harassment due to their sexual orientation or gender identity. As such, the National Institute on Minority Health and Health Disparities has identified SGM communities as a "health disparity population." Broadly, there are higher rates of sexually transmitted infections, substance use and abuse, mental health conditions, obesity and eating disorders, certain cancers (breast, cervical, and anorectal), and cardiovascular disease in SGM communities. Transgender patients, especially those of color, are more likely to be uninsured, experience discrimination, and be denied health care than cisgender patients. In addition, SGM individuals have twice the risk of lifetime exposure to emotional, physical, and sexual trauma compared with heterosexuals. It is expected all these factors would negatively affect digestive health as well. This review summarizes the effects of social determinants of health and discrimination on health care access, highlights important digestive diseases to consider in the SGM population, and offers solutions to improve and prioritize the health of these communities. We aim to draw attention to SGM-specific issues that affect gastrointestinal health and spur research that is desperately lacking.

Trajectories of depressive symptoms among young adults in Texas 2014-2018: a multilevel growth curve analysis using an intersectional lens

INTRODUCTION

Research has demonstrated disparities in depressive symptoms among people who are marginalized. However, more work should examine depressive symptoms through an intersectional lens, recognizing that multiple systems of privilege and oppression interlock to create unique struggles where multiple marginalized identities meet. Recent methodological developments have advanced quantitative intersectionality research using multilevel modeling to partition variance in depressive symptoms to person-level sociodemographic variables and intersectional-level social strata. The purpose of this study is to leverage these methods to examine trajectories of depressive symptoms among young adults in Texas through an intersectional lens.

METHODS

Multilevel modeling was used to examine the longitudinal trajectories of depressive symptoms among 3575 young adults from 24 colleges in Texas assessed seven times between Fall 2014 and Spring 2018. Intersectional identities included sex, race/ethnicity, and sexual and gender minority identities. The model examined time nested within individuals and individuals nested within intersectional social strata.

RESULTS

Young adults in Texas experienced an increase in depressive symptoms from 2014-2018. Those with female, Hispanic, AAPI, other race/ethnicity, or LGBTQ + identities experienced more depressive symptoms. After controlling for the main effects of the sociodemographic variables, 0.08% of variance in depressive symptoms remained attributed to the effects of intersectional identities.

CONCLUSION

Evaluating disparities in depressive symptoms through an intersectional lens offers a more complete description of the epidemiology of depressive symptoms. Communities and institutions that serve marginalized people should consider the elevated burden of depressive symptoms that marginalized people may carry, and integrate culturally competent psychoeducation, assessments, and therapies where possible.

Revealing the queer-spectrum in STEM through robust demographic data collection in undergraduate engineering and computer science courses at four institutions

Queer identities are often ignored in diversity initiatives, yet there is a growing body of research that describes notable heterosexist and gender-normative expectations in STEM that lead to unsupportive and discriminatory environments and to the lower persistence of queer individuals. Research on the experiences of queer-spectrum individuals is limited by current demographic practices. In surveys that are queer-inclusive there is no consensus on best practices, and individuals with queer genders and queer sexual, romantic, and related orientations are often lumped together in a general category (e.g. LGBTQ+). We developed two queer-inclusive demographics questions and administered them as part of a larger study in undergraduate engineering and computer science classes (n = 3698), to determine which of three survey types for gender (conventional, queered, open-ended) provided the most robust data and compared responses to national data to determine if students with queer genders and/or queer sexual, romantic, and related orientations were underrepresented in engineering and computer science programs. The gender survey with queer-identity options provided the most robust data, as measured by higher response rates and relatively high rates of disclosing queer identities. The conventional survey (male, female, other) had significantly fewer students disclose queer identities, and the open-ended survey had a significantly higher non-response rate. Allowing for multiple responses on the survey was important: 78% of those with queer gender identities and 9% of those with queer sexual, romantic and related orientations selected multiple identities within the same survey question. Queer students in our study were underrepresented relative to national data. Students who disclosed queer gender identities were 7/100ths of the expected number, and those with queer orientations were under-represented by one-quarter. Further work developing a research-based queered demographics instrument is needed for larger-scale changes in demographics practices, which will help others identify and address barriers that queer-spectrum individuals face in STEM.

COVID-19 Stress and Sexual Identities

The coronavirus disease 2019 pandemic has disrupted lives and resulted in high levels of stress. Although the evidence at the societal level is clear, there have been no population-based studies of pandemic-based stress focusing on individuals who identify as sexual minorities. Drawing on representative data collected during the pandemic, National Couples' Health and Time Study, the authors find that partnered (cohabiting or married) individuals who identified as sexual minorities experienced higher levels of stress than individuals who identified as heterosexual. However, variation exists observed among sexual minority adults. Although economic resources, discrimination, social and community support, and health conditions are tied to reported stress levels, they do not explain differentials according to sexual identity. These results provide evidence that sexual minority adults faced greater stress during the pandemic and the importance of recognizing that sexual minorities are not a monolithic group with varying stress responses to the pandemic.

LGBTQ+ Psychosocial Concerns in Nursing and Midwifery Education Programmes: Qualitative Findings from a Mixed-Methods Study

LGBTQ+ people experience significant physical and psychosocial health issues and concerns, and encounter barriers when accessing healthcare services. We conducted a mixed-methods research study across all Schools of Nursing and Midwifery in the United Kingdom and Ireland using a survey and qualitative interviews. This was to identify the current content within nursing and midwifery pre-registration programmes in relation to LGBTQ+ health and to identity best practice and education innovation within these programmes. The survey was completed by 29 academics, with 12 selected to participate in a follow-up in-depth qualitative interview. Analysis of the data from the survey and interviews identified five themes: there is variable programme content; academics are developing their own programmes with no clear consistency; LGBTQ+ health is being linked to equality and diversity; there are barriers to education provision; and these is some evidence of best practice examples. The findings of the study support the need to develop and implement a curriculum for LGBTQ+ health in nursing and midwifery pre-registration programmes with learning aims and outcomes. Academics need support and tools to prepare and deliver LGBTQ+ health content to nurses and midwives as they ultimately have the potential to improve the experiences of LGBTQ+ people when accessing healthcare.

"Always Thinking About Safety": African American Lesbian Mothers' Perceptions of Risk and Well-being

Although there is a growing body of knowledge focusing on lesbian families and their parenting experiences, African American lesbian mothers are often underrepresented in research. This qualitative exploratory study aims to understand the constructions and perspectives of African American lesbian mothers, from an urban East Coast area, on risk and well-being. Fifteen in-depth semi-structured interviews were conducted and analyzed at the end of 2016, coinciding with the presidential election yielding main themes that were significant for the participants pertaining to the mothers' experiences and construction of the challenges and risks to well-being. Main themes first focused on discrimination and insensitivity in everyday spaces; then moved into the effects of political climate on perceived safety and security, conditions and unintended consequences of the coming out process; and ended with strategies for reducing risk. Adoption of an intersectional framework to discuss our findings allowed us to explore the ways in which multiple identities engage to shape experiences and constructions of risk and well-being among African American lesbian parents. The results suggest the importance of context (e.g., political, historical, gender-related, racial) when working with LGBTQ+ families of color.

A Personal Perspective: Is Bullying Still a Problem in Medicine?

Bullying of whatever form should have no place in the Medical Profession. Reforms to junior doctor training and reduction in working hours have helped to control most of the individual bullying which may have existed in the past. However, the complexities of institutional bullying still exist. In the United Kingdom, centralised monitoring systems, such as Athena SWAN, are designed to reward academic and medical institutions for positive steps to introduce equality and mitigate bullying. However, the reality is that such processes may be conducted in healthcare or educational establishments that have little intention to address the problem thoroughly. We report the personal experience of both individual and institutional bullying in the medical career of a medically-qualified interviewee and reflect on ways to mitigate the problem. We also consider whether unconscious bias affects our relationships with patients. In a caring medical profession, there should be no room for intolerance, unconscious bias or bullying.

Fourteen Recommendations to Create a More Inclusive Environment for LGBTQ+ Individuals in Academic Biology

Individuals who identify as lesbian, gay, bisexual, transgender, queer, and otherwise nonstraight and/or non-cisgender (LGBTQ+) have often not felt welcome or represented in the biology community. Additionally, biology can present unique challenges for LGBTQ+ students because of the relationship between certain biology topics and their LGBTQ+ identities. Currently, there is no centralized set of guidelines to make biology learning environments more inclusive for LGBTQ+ individuals. Rooted in prior literature and the collective expertise of the authors who identify as members and allies of the LGBTQ+ community, we present a set of actionable recommendations to help biologists, biology educators, and biology education researchers be more inclusive of individuals with LGBTQ+ identities. These recommendations are intended to increase awareness of LGBTQ+ identities and spark conversations about transforming biology learning spaces and the broader academic biology community to become more inclusive of LGBTQ+ individuals.

Stigma Experiences, Mental Health, Perceived Parenting Competence, and Parent-Child Relationships Among Lesbian, Gay, and Heterosexual Adoptive Parents in the United States

Adoptive parents often face stigma related to "non-traditional" family structures. Lesbian and gay (LG) adoptive parents often face additional stigmatization based on sexual identity, which in turn may negatively affect parents' mental health. Despite controversy about LG parenting, research demonstrates that family processes are more strongly associated with individual outcomes than family structure. Thus, family systems and minority stress theories provided our conceptual foundation in examining how adoptive LG parents' stigma experiences were associated with mental health, parenting competence, and parent-child relationships. Participating families (N = 106; n = 56 LG parent families) were originally recruited from five US domestic private infant adoption agencies and completed two waves of data collection (W1, W2; 91% retention) when children were preschool-age (M age = 3.01 years) and school-age (M age = 8.36 years), respectively. Data for the current study are largely drawn from W2. Via Qualtrics, parents completed assessments of mental health symptoms, adoption stigma, and perceived childcare competence. LG parents also reported on their experiences of homonegative microaggressions, and children responded to a measure about their relationships with parents. No significant differences emerged as a function of parental sexual orientation and gender except that lesbian mothers, heterosexual mothers, and gay fathers all reported higher parenting competence than heterosexual fathers. Although parents' mental health did not significantly predict parent-child relationship quality, parents' perceived competence and LG parents' current homonegative microaggression experiences did (e.g., greater competence, greater closeness; more microaggressions, lower closeness). Consistent with our conceptual framework, our results-derived from parent and child reports-demonstrate that although adoptive and LG parent families experience stigma, family processes (rather than structure) are most associated with individual outcomes. Researchers, policy makers, and practitioners should work together to employ identity-affirming practices to reduce stigma and support adoptive family functioning and well-being.