The Integrated Attachment and Sexual Minority Stress Model: Understanding the Role of Adult Attachment in the Health and Well-Being of Sexual Minority Men

The Role of Attachment Anxiety and Avoidance in Predicting Proximal Minority Stressors among Gay and Lesbian People in Italy

As has been widely documented, minority stress affects the psychosocial well-being of gay and lesbian people. Recently, researchers have turned their attention to psychological factors that may influence the level of minority stress experienced, in order to explain individual differences in perceptions of proximal minority stressors. The present research aimed at assessing the effect of attachment avoidance and anxiety on levels of perceived stigma and internalized homonegativity. A total of 163 participants who self-identified as lesbian or gay (Mage = 32.56, SD = 10.87) were recruited and responded to the self-report questionnaires. Two multiple regression models were applied to assess the association between adult attachment and perceived stigma and internalized homonegativity. Results showed a positive association between attachment anxiety and avoidance and internalized homonegativity, as well as between attachment avoidance and perceived stigma. The emerging results demonstrate the impact of attachment anxiety and avoidance on proximal minority stressors and provide useful data for interventions addressing lesbian and gay people aimed at promoting security-based strategies of affect regulation and positive representations of self and others, which in turn may reduce the level of proximal minority stressors experienced and promote psychosocial well-being.

Adult Attachment Anxiety Is Protective Against the Effects of Internalized Homophobia on Condomless Sex Among Young Sexual Minority Men: The P18 Cohort Study

Internalized homophobia, or the internalization of negative attitudes toward one's sexual minority identity, is associated with sexual risk behaviors among young sexual minority men (YSMM). However, the formation and maintenance of secure or insecure socio-emotional bonds with friends, family members, and intimate partners (i.e., adult attachment) may mitigate or exacerbate the negative effects of exposure to internalized homophobia. Nevertheless, little is known about how adult attachment influences the association between internalized homophobia and sexual risk behaviors (e.g., condomless anal sex) among YSMM. Thus, this study examined the potential moderating effect of adult attachment on the association between internalized homophobia and condomless anal sex (CAS) behaviors (i.e., insertive CAS and receptive CAS) among a sample of N = 268 YSMM who participated in the study between June 2015-March 2017 using zero-inflated Poisson regression models. We found that adult attachment anxiety, but not adult attachment avoidance, significantly moderated the association between internalized homophobia and receptive CAS behaviors such that those higher on adult attachment anxiety and internalized homophobia had fewer receptive CAS events over the preceding 30 days as compared to those lower on adult attachment anxiety and internalized homophobia. Research efforts should focus on unpacking the complex associations between adult attachment, internalized homophobia, and sexual risk behaviors among YSMM.

Associations Between Trauma and Health Behaviors and Outcomes Among Sexual Minoritized Adults: A Scoping Review

Sexual minoritized (SM) adults experience health disparities and report higher rates of trauma history compared to heterosexual adults. This scoping review synthesizes the extant literature that investigates associations between trauma and physical health among SM adults. It also describes research instruments utilized to assess trauma in relation to health outcomes among SM adults. We searched CINAHL, LGBT+ Life, PsycINFO, and PubMed to identify studies meeting inclusion criteria: peer-reviewed, English, assessed trauma as an independent variable, and assessed health behaviors or outcomes among SM adults. From 587 nonduplicate articles, 69 full texts were reviewed; 18 met criteria and were included in this review. To enhance rigor, we utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Scoping Reviews checklist. Most (n = 12) of the included studies were cross-sectional. Trauma was assessed 16 different ways, including 9 validated measures, in relation to 5 health behaviors and 17 health conditions. Trauma was operationalized by history of childhood sexual abuse, adverse childhood experiences, lifetime rape, current symptoms of post-traumatic stress disorder, and lifetime victimization among SM adults. All but one study found associations between trauma and one or more unfavorable health behaviors or outcomes. Studies used widely heterogeneous instruments to assess trauma, health, and SM identity. Greater specification and standardization of measurement is needed, along with contextualized assessments of trauma and its impact on health such as sexual minority stress-related victimization and resilience, and post-traumatic growth and recovery processes.

Attachment, Minority Stress, and Health Outcomes Among Conservatively Religious Sexual Minorities

Sexual minority (SM) members of the Church of Jesus Christ of Latter-day Saints (LDS) face increased exposure to minority stressors as well as concerns of attachment injuries relative to their heterosexual counterparts. The Integrated Attachment and Sexual Minority Stress Model outlines the mutually reinforcing associations between adult attachment and sexual minority stress, positing that adult attachment is both influenced by experiences of minority stress and simultaneously capable of shaping minority stress experiences in adulthood. The present study explored how adult attachment style directly and indirectly affects minority stressors and health outcomes for LDS SMs. A sample of 602 LDS SMs completed a quantitative survey assessing attachment, minority stress, and health. Results indicated that an insecure attachment style related to increased minority stressors and depression, whereas a secure attachment style related to decreased minority stressors and increased life satisfaction. Further, attachment moderated the relationship between minority stressors and health outcomes, such that experiences of minority stress were related to a decrease in life satisfaction only for securely attached LDS SMs. However, securely attached LDS SMs still reported better health than insecurely attached LDS SMs, even when reporting high degrees of minority stressors. These findings add to the growing body of literature suggesting that attachment style has direct and indirect effects on health outcomes for SMs, including those from conservative religious backgrounds.

The Mediating Role of Insecure Attachment in the Gap in Parenthood Desire between Lesbian and Gay Individuals and Their Heterosexual Counterparts

Previous studies have shown that lesbian and gay (LG) individuals, in comparison to their heterosexual counterparts, tend to report lower levels of parenthood desire. While numerous variables have been suggested to explain this gap in parenthood aspirations, no study has investigated the mediating role of avoidant attachment in the association between sexual orientation and parenthood desire. For that purpose, a sample of 790 cisgender Israelis aged 18-49 years (M = 28.27, SD = 4.76) was recruited using convenience sampling. Among the participants, 345 self-reported as predominantly or exclusively lesbian or gay and 445 self-reported as exclusively heterosexual. Participants completed online questionnaires assessing their sociodemographic characteristics, parenthood desire, and avoidant and anxious attachment styles. Mediation analyses were performed using the PROCESS macro, and the results revealed that LG individuals reported lower parenthood desire, higher avoidant attachment, and higher anxious attachment compared to heterosexual individuals. Moreover, avoidant attachment had a significant mediation effect in the association between sexual orientation and parenthood desire. The findings suggest that LG individuals are more likely to report higher avoidant attachment due to possible rejection and discrimination from family members and peers, and this may be associated with lower parenthood desire. The results contribute to the growing body of research on family formation and parenthood aspirations among LG individuals, and specifically studies aimed at delineating the factors that contribute to the gap in parenthood aspirations between sexual minority individuals and their heterosexual counterparts.

The descriptive analysis of depressive symptoms and White Blood Cell (WBC) count between the sexual minorities and heterosexual identifying individuals in a nationally representative sample: 2005-2014

BACKGROUND

Sexual minorities are at a higher risk of suffering from depressive symptoms compared with heterosexual individuals. Only a few studies have examined the conditions of having depressive symptoms within different sexual minority groups, especially people with sexual orientation uncertainty in a nationally representative sample. Furthermore, few studies have explored whether the mean white blood count (WBC) is different between people with and without depressive symptoms among different sexual minority groups in a nationally representative sample.

METHODS

We analyzed the National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2014 with a sample of 14,090 subjects. We compared the prevalence of depressive symptoms in subpopulations stratified by sex, sexual minority status, and race. We also examined the difference in mean WBC count between depressed and non-depressed people among heterosexual individuals and different sexual minority groups. Additionally, two multivariable logistic regression models were used to explore the association between sexual minority status and depressive symptoms, treating sexual minority status as both a binary and categorical variable.

RESULTS

Female sex (OR: 1.96, 95% CI: 1.72-2.22) and sexual minority status (OR: 1.79, 95% CI: 1.47-2.17) were both independently associated with depressive symptoms. Within the sexual minority population, subjects who were unsure about their sexual identities had the highest odds of having depressive symptoms (OR: 2.56, 95% CI: 1.40-4.68). In the subgroup analysis considering intersectionality, black sexual minority females had the highest rate of depressive symptoms (19.4%, 95% CI: 7.72-40.98). Finally, the mean WBC count differed significantly between people with and without depressive symptoms among male heterosexual individuals, female heterosexual individuals, and female sexual minorities, but not among male sexual minorities.

CONCLUSIONS

Based on sex, race, and sexual minority status, black females of sexual minority status had the highest rate of depressive symptoms. Within sexual minority groups, participants who were unsure about their sexual identities had the highest odds of having depressive symptoms. Finally, the mean WBC count was significantly higher among people with depressive symptoms than those without depressive symptoms only among male heterosexuals, female heterosexuals, and female sexual minorities, but not among male sexual minorities. Future research should investigate the social and biological mechanisms of the differences.

Race moderates the association between adult attachment avoidance and the cortisol awakening response among young sexual minority men

Adult attachment, or the ways in which individuals develop and maintain trusting and loving relationships with peers and romantic partners, has been demonstrated to influence hypothalamic-pituitary-adrenal (HPA) axis functioning among young sexual minority men (YSMM). Theory and preliminary evidence suggest that differences in the lived experiences of White and Black sexual minority young adults may influence the way in which adult attachment influences the HPA-axis functioning. We sought to further this field of inquiry by examining if race moderates the association between adult attachment insecurity (i.e., avoidance and anxiety) and HPA-axis functioning among YSMM. Sixty-three YSMM participated in a 5-day daily diary study in which they completed a baseline survey to assess adult attachment orientation and provided saliva samples 4 times per day over a 5-day period in order to measure cortisol across the day. Three-level hierarchical linear modeling was used to examine the association between adult attachment, the cortisol awakening response (CAR), diurnal cortisol, and the moderating effect of race. We found no main effect of attachment anxiety or avoidance on HPA-axis functioning. However, we found that race moderated the association between adult attachment avoidance and the CAR such that Black YSMM with higher attachment avoidance had a lower CAR as compared to White YSMM. Results suggest that there may be key differences between White and Black YSMM men's lived experiences that should be explored in future research.

Minority Stress and Positive Identity Aspects in Members of LGBTQ+ Parent Families: Literature Review and a Study Protocol for a Mixed-Methods Evidence Synthesis

BACKGROUND

Parents and children in LGBTQ+ parent families face unique stressors (i.e., minority stress), but also possess unique resources (i.e., positive identity aspects) related to their family identity. Empirical evidence and theory suggest that these minority stressors and positive identity aspects are situated on the individual, couple, and family level and may be associated with key outcomes, including parent and child health, family functioning, and school-related outcomes. A systematic evidence synthesis and a theoretical placement are currently lacking. The aims of the systematic review outlined in this protocol are thus to (1) map minority stressors and positive identity aspects according to multiple levels in the family system, and (2) to synthesize evidence on their associations with key outcomes.

METHODS

We will conduct a PRISMA-conform mixed-methods systematic review. Studies will be retrieved using a multi-tiered search strategy, including database searches (PsycInfo, PubMed, Scopus, Web of Science), cited literature searches, authors' publication lists, and study requests. The mixed-methods synthesis will follow a parallel-results convergent synthesis design, where quantitative results will be synthesized via meta-analysis and qualitative results via thematic synthesis.

CONCLUSIONS

Our proposed systematic review may add to the theoretical understanding of LGBTQ+ parent family functioning and advance social inclusion of LGBTQ+ parent families.

Young men of color lower on adult attachment anxiety have higher carotid-intima media thickness compared to white young men: The exploration of an unexpected finding

Cardiovascular disease (CVD) remains the number one cause of death among men in the United States. Emerging research demonstrates that socioemotional mechanisms such as adult attachment, or the ways in which individuals are able to form and maintain socioemotional bonds, may impact physical health via alterations in physiological stress functioning. However, there may be key differences in the relation between attachment and physical health by race and sexual orientation. Thus, this study sought to examine the potential moderating effect of race and sexual orientation on the association between adult attachment and carotid-intima media thickness (cIMT), a measure of subclinical cardiovascular disease, among young men. The sample consisted of 72 young men (mean [SD] age = 22.92 [3.23]: 30.6 % identified as White, 30.6 % as Black, and 38.8 % as Other), each of which were surveyed and underwent an ultrasound to measure cIMT. Ordinary Least Squares (OLS) regression was used in order to examine our study hypotheses. We first ran a main effects model to examine adult attachment's (i.e., anxiety and avoidance) association with mean cIMT. We then ran two interaction models with an interaction between race/ethnicity and adult-related attachment and sexual orientation and adult attachment. We found that race significantly moderated the association between attachment-related anxiety and mean cIMT in our study sample. However, we did not find evidence to suggest that race moderated the association between attachment-related avoidance and mean cIMT in our study sample. In comparison to White individuals, Black individuals and those who identified as "Other" race with lower scores on attachment-related anxiety had higher mean cIMT. Additionally, higher scores on attachment-related anxiety were associated with lower mean cIMT among Black and "Other" respondents, but not among White respondents. We did not find evidence to suggest that sexual orientation moderated the association between adult attachment and mean cIMT in our study sample. Our findings suggest that adult attachment anxiety may be protective for young men of color but not for White young men. Future research should utilize longitudinal study designs in order to better understand how adult attachment influences CVD risk among racially/ethnically diverse young men.

Discrimination is associated with C-reactive protein among young sexual minority men

This report examines associations between everyday discrimination, microaggressions, and CRP to gain insight on potential mechanisms that may underlie increased CVD risk among sexual minority male young adults. The sample consisted of 60 participants taken from the P18 cohort between the ages of 24 and 28 years. Multinomial logistic regression models were used to examine the association between perceived everyday discrimination and LGBQ microaggressions with C-reactive protein cardiovascular risk categories of low-, average-, and high-risk, as defined by the American Heart Association and Centers for Disease Control. Adjustments were made for BMI. Individuals who experienced more everyday discrimination had a higher risk of being classified in the high-risk CRP group compared to the low-risk CRP group (RRR = 3.35, p = 0.02). Interpersonal LGBQ microaggressions were not associated with CRP risk category. Everyday discrimination, but not specific microaggressions based on sexual orientation, were associated with elevated levels of CRP among young sexual minority men (YSMM). Thus, to implement culturally and age-appropriate interventions, further researcher is needed to critically examine the specific types of discrimination and the resultant impact on YSMM's health.

Romantic Attachment, Internalized Homonegativity, and Same-Sex Intimate Partner Violence Perpetration Among Lesbian Women in Italy

Same-Sex Intimate Partner Violence (SSIPV) among lesbian women has been underestimated until few decades ago. While the association between romantic attachment and SSIPV has been widely demonstrated, mechanisms that mediate this association and the complex relationships between romantic attachment, SSIPV, and SSIPV-specific risk factors have not been adequately investigated to date. The current study assessed the influence of romantic attachment on SSIPV perpetration among lesbian women, exploring the mediating role of internalized homonegativity within this association. Three hundred and twenty-five Italian lesbian women with a mean age of 30 years were recruited and completed the following self-report measures: the Experiences in Close Relationships-Revised (ECR-R), the Measure of Internalized Sexual Stigma, and the Revised Conflict Tactics Scale Short Form. The results showed a positive association between attachment anxiety, and general and psychological SSIPV perpetration. Similarly, attachment avoidance was positively related with general, psychological, and physical SSIPV perpetration. The association between romantic attachment, and general and psychological SSIPV was partially mediated by internalized homonegativity. These findings have theoretical implications and provide valuable information to implement services and interventions tailored for SSIPV, to date scarce and not effective.

Perceived Social Support Mediates the Negative Impact of Insecure Attachment Orientations on Internalized Homophobia in Gay Men

The mediating effect of perceived social support on the influence of insecure attachment orientations on internalized homophobia was assessed in a group of 70 Italian gay men (mean age = 28.8, SD = 6.2, range: 19-46 years). Participants completed self-report measures of adult attachment (Experiences in Close Relationships-Revised), perceived social support (Multidimensional Scale of Perceived Social Support), and internalized homophobia (Measure of Internalized Sexual Stigma for Lesbians and Gay). Higher levels of attachment anxiety and avoidance, and perceptions of lower social support were correlated with higher levels of internalized homophobia. The mediation analyses showed that only attachment anxiety, but not avoidance, may have a direct link with internalized homophobia, while both anxiety and avoidance may have an indirect influence on internalized homophobia mediated by perceived social support. Improving social support can reduce the negative effects of homophobia on gay men, thus mitigating the detrimental fallout of any insecure attachment orientations.

The Effect of Early Traumatic Experiences on Attachment Styles in Sexual Gender Minority Individuals

PURPOSE

This study was carried out to specify the attachment characteristics of sexual gender minority individuals and to determine the effects of childhood traumatic experiences on attachment styles.

DESIGN AND METHODS

A descriptive cross-sectional study was conducted on 141 sexual gender minority individuals from 2016 to 2017.

FINDINGS

The number of childhood physical and sexual trauma episodes was found to be high in sexual minorities; in particular, the traumatized narratives were found to be associated with an avoidant attachment style (p > 0.05).

PRACTICE IMPLICATIONS

The study results may contribute to healthcare professionals' understanding of childhood trauma as it relates to sexual identity development and attachment disorders sexual identity development and attachment disorders.

The Mediating Role of Attachment Avoidance in the Association between Sexual Orientation and Mental Health

The current study examined whether attachment avoidance mediates the association between being a sexual minority (gay men or lesbian women) and poorer mental health outcomes. For this purpose a community-dwelling sample of 350 gay men and lesbian women (M = 30.39, SD = 6.82) and 445 heterosexual men and women (M = 26.95, SD = 3.11) completed measures of attachment avoidance, depressive symptoms, anxiety symptoms and life satisfaction. Results showed that gay men and lesbians reported poorer mental health. Moreover, attachment avoidance had a mediating effect on the association between being a sexual minority and depressive symptoms, anxiety symptoms and life satisfaction. These findings are some of the first to suggest empirical support for the role of attachment avoidance in accounting for the mental health vulnerability of gay men and lesbians. The results contribute to a better understanding of the minority stress model and should be addressed by practitioners.

Adult Attachment, Differentiation of Self, and Relationship Satisfaction in Lesbians and Gay Men

We examined adult attachment styles, differentiation of self, and relationship satisfaction in a sample of 298 Italian lesbians (48%) and gay men (52%), all of whom were ages 19–71 years (M = 36.1; SD = 11.8) and in a couple relationship for at least six months. Participants were recruited via the Internet and completed a web-based survey. We tested the hypotheses that attachment insecurity and differentiation of self would predict relationship satisfaction, as well as that differentiation of self would mediate the relationship between adult attachment and relationship satisfaction. Results supported the hypotheses, thus indicating that attachment insecurity and differentiation of self were correlated with and predicted relationship satisfaction. Furthermore, results supported the hypothesized mediating role of differentiation of self. Finally, results indicated that younger participants, lesbians, and participants in civil unions reported higher levels of relationship satisfaction. Implications for counselors and therapists working with LG populations are discussed.

LGBTQ+ based discrimination is associated with ptsd symptoms, dissociation, emotion dysregulation, and attachment insecurity among LGBTQ+ adults who have experienced Trauma

Objectives: LGBTQ+ based discrimination is a form of insidious trauma and minority stress, and is associated with poor mental health. However, there is a dearth of research on the impact of discrimination on the psychological functioning of LGBTQ+ individuals who have experienced trauma. The current study seeks to remedy this gap. It was hypothesized that: (1) LGBTQ+ adults who perceived their experience of trauma as related to LGBTQ+ based discrimination would have greater attachment insecurity, emotion dysregulation, PTSD symptoms, and dissociative symptoms; (2) experiences of LGBTQ+ based discrimination would be associated with greater attachment insecurity, emotion dysregulation, PTSD symptoms, and dissociative symptoms; (3) transgender congruence (i.e., the extent to which one feels authentic and comfortable with their gender identity and appearance) would be negatively associated with attachment insecurity, emotion dysregulation, PTSD symptoms, and dissociative symptoms. Methods: Participants were 157 LGBTQ+ adults who had experienced trauma, and who completed questionnaires on discrimination and psychological functioning. Results: Compared to participants who did not experience their trauma as related to discrimination, those who did were higher in attachment anxiety, attachment avoidance, emotion dysregulation, PTSD, and dissociative symptoms. Biphobia was positively associated with attachment anxiety, emotion dysregulation, PTSD, and dissociative symptoms. Homophobia was positively associated with emotion dysregulation, PTSD, and dissociative symptoms. Transphobia was positively associated with PTSD and dissociative symptoms. Appearance congruence was negatively associated with emotion dysregulation, PTSD, and dissociative symptoms. Conclusions: When working with LGBTQ+ clients who have experienced trauma, clinicians should be mindful of the effects of discrimination on wellbeing.

Father support is protective against the negative effects of perceived discrimination on CRP among sexual minorities but not heterosexuals

BACKGROUND

Exposure to sexual orientation-related discrimination among sexual minorities may lead to elevated levels of C-reactive protein (CRP) as compared to their heterosexual counterparts. However, little is known about factors that may buffer the association between discrimination and CRP among sexual minorities versus heterosexuals. The current study examined if the association between discrimination, sexual orientation, and CRP differed across levels of social support from one's father/father-figure or mother/mother-figure between sexual minorities and heterosexuals.

METHODS

Data came from Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health). The sample sizes for father support and mother support was 3167 and 3575, respectively. Participants ranged in age from 24 to 33 years. Stratified linear regression models examined if father and mother support moderated the association between discrimination and CRP among sexual minorities and heterosexuals.

RESULTS

Father support significantly moderated the association between discrimination and CRP among sexual minorities but not heterosexuals. Sexual minorities with higher father support and who experienced discrimination had lower CRP as compared to those with lower father support and who experienced discrimination. Mother support did not moderate the association between discrimination and CRP among either sexual minorities or heterosexuals.

CONCLUSION

Father support may mitigate the negative effects of stress from discrimination on CRP among sexual minorities. Future research should further examine the potential differential role that father support may play in reducing cardiovascular risk among sexual minorities versus heterosexuals who experience discrimination.

Attachment as a Predictor of Psychological and Sexual Wellbeing Among Transgender Women in New York City

Transgender women are disproportionately affected by HIV and experience high rates of depression and anxiety. The importance of secure attachment in buffering against negative sexual and mental health outcomes is well established. However, few studies have examined attachment among transgender women. We recruited a community-based convenience sample of 213 transgender women in New York City (M_age =34.3; SD = 11.7). The majority were women of color (75.6%), almost half identified as heterosexual (47.4%), and 34.7% were HIV-positive. Preliminary analyses examined the sample distribution across attachment categories using the Revised Experiences in Close Relationships scale. Specifically, Brennan, Clark and Shaver's guidelines were used for categorization (43.19% fearful, 22.5% preoccupied, 21.6% dismissive, and 12.7% secure). Regression analyses examined the association of dimensional attachment anxiety, attachment avoidance, and their interaction with depression, anxiety, self-efficacy for condom use, temptations for condomless sex, and condomless sex acts. Results indicated a positive association between attachment anxiety and depression, anxiety, temptations and probability for condomless sex; and also between attachment avoidance and condomless sex probability. A significant interaction indicated that individuals with low attachment anxiety and attachment avoidance (i.e., secure) had the greatest condom use self-efficacy and the lowest probability of engaging in condomless sex.

Understanding Attachment Transitions Through the Lived Experiences of Young Black Gay and Bisexual Men

We conducted a mixed-methods study to identify factors that influence transitions in attachment style between childhood and adulthood among 28 young Black gay and bisexual men (YBGBM) in the United States. We used a phenomenological approach to data integration, with the major component to the results being garnered from the qualitative interviews. We organized our results by four attachment transition groups: stable secure (secure attachment in childhood and young adulthood), stable insecure (insecure attachment in childhood and young adulthood), secure to insecure (secure in childhood and insecure in adulthood) and insecure to secure (insecure in childhood and secure in adulthood). Within each of the typologies, two major themes emerged: social support and religion. Generally, transitions from secure to insecure attachment were related to experiences of perceived rejection by a parental figure during adolescence that corresponded with sexual orientation disclosure. Transitions from insecure to secure attachment appeared to be related to the absence of an attachment figure early in life, but with the acquisition of an attachment figure during early to late adolescence. The findings from our study suggest a need for attachment-based approaches to social support interventions, as well as for an increased understanding of social and cultural factors that impact attachment changes among practitioners who use attachment-based therapy models for YBGBM.

Gay and Bisexual Adolescent Boys' Perspectives on Parent-Adolescent Relationships and Parenting Practices Related to Teen Sex and Dating

Close parent-adolescent relationships and specific parenting practices (e.g., communication about sex, monitoring) are associated with reduced sexual risk behavior among heterosexual youth. Despite gay/bisexual male youth being at increased risk of HIV, little is known about parental influences on their sexual behavior. As such, the goal of the current study was to examine parent-adolescent relationships and parenting practices related to teen sex and dating from the perspective of gay/bisexual adolescent boys. Online focus groups were conducted with 52 gay/bisexual male youth ages 14-17 years. Most gay/bisexual adolescent boys felt that their sexual orientation had an influence on their relationships with their parents and discussions about sex/dating. Although some felt that their relationships improved after coming out, a larger percentage reported that it put strain on their relationships. Discussions about sex/dating generally decreased after coming out, but some youth described positive conversations with their parents. Many reported that their parents struggled with whether or not to adapt parenting practices (e.g., rules about dating) after they came out. Youth consistently noted that parent-adolescent relationships and parenting practices depended on the adolescent's level of outness. Findings have important implications for refining HIV prevention programs for gay/bisexual adolescent boys, especially interventions that include parents.

Breakup-related appraisals and the psychological well-being of young adult gay and bisexual men

Participation in romantic relationships during adolescence and young adulthood provides opportunities to explore one's sexuality, yet may also cause distress once these relationships dissolve. Although researchers have asserted that participation in same-sex relationships may be beneficial for young gay and bisexual men's (YGBM) psychosocial well-being, less is known about YGBM appraisals of breakups after participating in same-sex relationships. We examined the association between self-reported psychological well-being (e.g., symptoms of depression and anxiety; self-esteem, sense of personal competency) and YGBM's negative and positive appraisals of breakups within a sample of single YGBM (N=1,040; ages 18-24) who reported prior serious same-sex relationships. Negative appraisals were associated with lower psychological well-being. Positive appraisals were associated with greater anxiety symptoms, self-esteem and sense of personal competency. Our findings highlight the need to acknowledge how YGBM's differential responses to breakups may be associated with their psychological well-being.

Cortisol profiles differ by race/ethnicity among young sexual minority men

Much of the extant scientific research examining hypothalamic-pituitary-adrenal (HPA)-axis functioning is conducted among White heterosexuals. Very little research examines HPA-axis functioning between different minority groups. Individuals who identify as both sexual and racial minorities may experience increased stigma and discrimination that can affect HPA-axis functioning. In the current study, we examined diurnal cortisol rhythm in young White gay men (WGM) compared to young Black gay men (BGM). The sample consisted of 70 healthy gay men (mean [SD] age=22.9 [3.2]: 68% White and 38% Black) who collected four saliva samples daily for five days. Repeated measures analysis of covariance and post-hoc tests revealed that BGM had higher cortisol levels than WGM in the evening. Secondary analyses revealed no significant group differences for the cortisol awakening response or systemic output throughout the day. However, BGM compared to WGM had a lower drop from peak (morning) to lowest (evening) cortisol concentrations. Taken together, these findings reveal a flatter diurnal cortisol rhythm among BGM compared to WGB. The functional significance of these preliminary findings must be explored further with assessment of psychosocial factors among sexual minorities at the intersection of multiple identities. In summary, we expand health disparities research aimed at delineating sexual minority and race/ethnic variation in stress physiology.

Associations of Perceived Parental Psychopathology with Mental Health Burden and Lifetime Drug Use in Gay, Bisexual, and other YMSM: The P18 Cohort Study

Parental mental health may be a critical component in understanding the overlapping health burdens of mental health symptomatology and drug use in young men who have sex with men (YMSM), yet studies of YMSM have not fully examined these associations. To understand these relationships, data drawn from a study of gay, bisexual, and other YMSM were used to examine associations between perceived parental psychopathology and the health of YMSM. Findings suggest that YMSM reporting at least one parent with perceived depression, manic depression, schizophrenia, or antisocial behavior anytime during their childhoods were more likely to report higher levels of both depressive symptomatology and post-traumatic stress disorder (PTSD) than those reporting no perception of any of these psychopathologies in their parents. Number of different drugs used in one's life were higher among participants who perceived at least one parent as depressed. Mediation analyses indicated that the relationship between perceived parental depression and lifetime drug use of YMSM was mediated both by YMSM depression and YMSM PTSD. These results suggest that parental psychopathology plays an important role in the health of sexual minority men, a population with elevated levels of mental health burden and drug use across the lifespan.

Relationship cognitions and longitudinal trajectories of sexual risk behavior among young gay and bisexual men: The P18 cohort study

This study examines how romantic relationship cognitions are associated with changes of condomless anal sex among emerging adult gay and bisexual men. The sample was drawn from four waves of a prospective cohort study ( N = 598; M_age = 18.2). Results suggest that condomless anal sex increased over the emerging adulthood period. Romantic relationship fear was associated with increased receptive condomless anal sex. Perceptions of greater romantic relationship control increased the likelihood of having insertive and receptive condomless anal sex. Findings suggest that romantic relationship cognitions are important to consider when understanding longitudinal changes in condomless anal sex in this population.