Still stressful after all these years: a review of lesbians' and bisexual women's minority stress

Associations Among Plurisexual Identity, Intimate Partner Violence, Reproductive Coercion, and Parental Monitoring in a Sample of Adolescent and Young Adult Pregnant People

Purpose: The goal of this study was to examine plurisexual identity, intimate partner violence (IPV), reproductive coercion, and parental monitoring among pregnant 13-21-year-olds. Methods: We conducted a cross-sectional analysis of data collected from a cohort of pregnant adolescents and young adults between October 2019 and May 2023 (n = 398). Logistic regression was completed to assess IPV and reproductive coercion as a function of plurisexual identity. Next, we assessed potential interactions between parental monitoring and plurisexual identity and examined IPV and reproductive coercion as a function of parental monitoring for the full sample and stratified by plurisexuality. Results: Plurisexual identity was associated with IPV (adjusted odds ratio [aOR] = 2.3; confidence interval [CI]: 1.4-4.0). IPV was inversely related to parental monitoring among plurisexual participants (aOR: 0.51; CI: 0.32-0.82), but this association was not significant for heterosexual participants (aOR: 1.1; CI: 0.75-1.6). Conclusions: This work demonstrates the importance of parental monitoring in supporting young plurisexual pregnant people.

Minority Stress, Mental Health, and Mindfulness and Self-Compassion as Moderators among Young Sexual Minority Men: A Moderated Structural Equation Analysis

Young adult sexual minority men are at heightened risk for psychological distress (i.e., depression and anxiety). Mounting evidence suggests the adverse consequences of distal stigma, and existing frameworks (the Minority Stress Theory and Psychological Mediation Framework) posit that distal minority stress may impact psychological distress through minority stress-specific processes, such as internalized homonegativity, as well as general psychological vulnerability factors, such as emotion dysregulation. There is a lack of research examining this process integrating both frameworks and understanding potential resilience factors such as mindfulness and self-compassion and where they may assert impact. Using structural equation modeling, the current study investigated the relationship between distal minority stress, measured by heterosexist discrimination, and psychological distress (i.e., depression and anxiety) through a serial indirect effect via internalized homonegativity and emotion dysregulation, while including internalized homonegativity and emotion dysregulation for their unique indirect effects separately, among young adult sexual minority men (n = 307). Further, the study explored mindfulness and self-compassion as potential moderators in subsequent models. Results indicate that two significant paths explain the association between heterosexist discrimination and psychological distress, including through internalized homonegativity and emotion dysregulation as a serial indirect path, as well as through internalized homonegativity alone. Both mindfulness and self-compassion emerged as protective factors in the "upstream" part of the model, particularly in the effect of heterosexist discrimination on internalized homonegativity. Contrary to expectation, both mindfulness and self-compassion had a strengthening impact on the positive association between internalized homonegativity and emotion dysregulation. Findings support the conceptualization of emotion dysregulation as a "downstream" effect of minority stress, as well as adapting and utilizing mindfulness and self-compassion to alleviate the impact of distal minority stress. Additional longitudinal research, particularly rigorously designed clinical trials, is needed to further evaluate such intervention programs.

Greater lifetime stressor exposure is associated with poorer mental health among sexual minority people of color

BACKGROUND

Research has shown that sexual minority people of color experience pervasive and sometimes severe life stressors that increase their risk of experiencing mental health problems, and that can contribute to lifelong health disparities. However, no studies in this population have investigated stressor exposure occurring over the entire lifespan. Moreover, it remains unknown whether these stressor-health effects differ based on the timing or types of stressors experienced.

PURPOSE

The purpose of this study is to examine how cumulative lifetime stressor exposure is associated with mental health among Black, Latinx, and biracial Black-Latinx sexual minority persons.

METHOD

Participants were 285 ethnic/racial minority young adults (Mage  = 25.18 years old, SD = 1.94, age range = 19-29 years), who completed the Stress and Adversity Inventory for Adults to assess for retrospective reports of lifetime stressor count and severity. The Brief Symptom Inventory was used to assess participants' symptoms of anxiety, depression, and somatization, which were the main outcomes. Most participants identified as cisgender male (94.7%) and gay (74.2%), with the remaining participants identifying as transgender or genderqueer/nonbinary for gender and bisexual/pansexual, queer, or another sexual orientation.

RESULTS

Multiple regression analyses indicated that experiencing more-and more severe-stressors across the lifespan was related to greater anxiety, depressive, and somatization symptoms. These effects were robust while controlling for race/ethnicity, sexual orientation, education, and employment status, and they differed based on stressor exposure timing, type, primary life domain, and core social-psychological characteristic.

CONCLUSION

Greater cumulative lifetime stressor exposure is related to poorer mental health among sexual minority people of color. Screening for lifetime stressors may thus help identify at-risk persons and provide an opportunity to intervene to help mitigate or prevent mental health disparities in multiply stigmatized adults.

Feeling safe and content: Relationship to internalized sexual stigma, self-awareness, and identity uncertainty in Italian lesbian and bisexual women

Research has linked feelings of safety and contentment to lower adverse mental health outcomes (e.g., stress, anxiety, depression) in the general population. The current study aimed at exploring the relationship between safe/content positive affect and minority stress (e.g., internalized sexual stigma) in lesbian and bisexual women, considering the effect of potential mediators such as identity self-awareness and identity uncertainty. An online survey was administered to 400 Italian women (220 lesbian and 180 bisexual women), aged 18-40 years (M = 25.98, SD = 6.07). The results showed that lesbian women reported lower internalized sexual stigma and identity uncertainty and higher safe/content positive affect and identity self-awareness, relative to bisexual women. Higher internalized sexual stigma predicted lower safe/content positive affect, regardless of sexual orientation. Furthermore, identity self-awareness and identity uncertainty significantly mediated the relationship between internalized sexual stigma and safe/content feelings, thus confirming the protective role of sexual identity variables on lesbian and bisexual women's positive affectivity. Finally, univariate analyses suggested that lesbian women were more resilient than bisexual women in the face of minority stressors. The results contribute to the understanding of the differences between lesbian and bisexual women in their perception of salient identity categories. In addition, the findings highlight the relevance of protective factors (e.g., identity certainty, lesbian and bisexual positive identity) in ameliorating the adverse effects of minority stress and promoting positive affect and social adjustment in lesbian and bisexual women. Research and clinical implications and directions are discussed.

Resilience in the lives of sexual minority women dealing with twofold peril in India

Using a model of transactional resilience, this study examined the development of resilience in relation to stressors experienced by sexual minority women throughout the life course. Twenty-five urban women were interviewed about their experiences related to gender and sexuality in Indian society. Thematic analysis was used to analyse the data. Findings showed that women experienced implicit and explicit forms of sexism and heterosexism, making it difficult to survive in a patriarchal and heteronormative society. Several resilience factors were identified reflected in women's efforts to deal with stressors to maintain and create support. Positive characteristics and smart strategies helped participants survive stressful events and maintain healthy relations with others. They also helped them by creating a safe and positive social environment. Findings point to the need to better understand the resilience process among similar populations of women in societies like India, where patriarchy and unequal opportunities affect wellbeing and quality of life.

Do relationships provide the same levels of protection against heavy drinking for lesbian and bisexual women? An intersectional approach

PURPOSE

Sexual minority women (SMW; e.g., lesbian, bisexual) are more likely than heterosexual women to be heavy drinkers, with bisexual women showing the highest risk. There is ample literature demonstrating that intimate relationships protect against stress-related health risk behaviors in the general population. However, very little research has focused on SMW's relationships and far less is known about the relationships of SMW of color. Using intersectionality theory as our framework, we tested two competing models to determine whether the effects of minority sexual identity (lesbian, bisexual) and race/ethnicity (African American, Latinx, White) are: 1) additive, or 2) multiplicative in the associations between relationship status and heavy drinking.

METHODS

Data are from a diverse sample of cisgender sexual minority women (N = 641) interviewed in Wave 3 of the CHLEW study, a 20-year longitudinal study of SMW's health.

RESULTS

Findings from two- and three-way interactions provide mixed evidence for both the additive and multiplicative hypotheses; support for each varied by sexual identity and race/ethnicity. Overall, we found that Latinx SMW, particularly single and bisexual Latinx SMW report the highest rates of heavy drinking compared to their cohabiting and lesbian counterparts, respectively. African American single SMW reported significantly higher rates of heavy drinking compared to their cohabiting counterparts.

CONCLUSION

Our findings suggest that the protective qualities of SMW's intimate relationships vary based on sexual identity and race/ethnicity-and the intersections between them. These results highlight that research among SMW that does not take into account multiple marginalized identities may obscure differences.

PUBLIC SIGNIFICANCE

Little research has focused on health within sexual minority women's relationships, particularly among sexual minority women of color. Given the potential additive or multiplicative effects of multiple sources of oppression such as heterosexism, racism, and sexism, understanding the potential protective effects of relationships is important. Our findings demonstrate that the protective qualities of intimate relationships among SMW vary based on sexual identity and race/ethnicity - and the intersections between them.

Apoio Social, Resiliência, Estresse de Minorias e Saúde Mental de Mulheres Lésbicas e Bissexuais

Resumo Este estudo buscou avaliar os efeitos de moderação do apoio social e da resiliência na relação entre o Estresse de Minorias (EM) e desfechos de saúde mental. Participaram desse estudo 337 mulheres, sendo 42,43% lésbicas (n = 143) e 57,57% bissexuais (n = 194), maiores de 18 anos (M = 26 anos; DP = 17,3). As participantes responderam escalas de homofobia internalizada, vitimização, revelação da orientação sexual, felicidade subjetiva, satisfação com a vida, depressão, ansiedade e estresse, apoio social e resiliência. Foi realizada uma modelagem por equações estruturais para verificar o impacto dos estressores de minorias nas variáveis de bem-estar (BES) e psicopatologia (PSP), além de testar se apoio social e resiliência moderavam essas relações. Os resultados demonstraram que a resiliência moderou a relação entre vitimização e psicopatologia. Implicações clínicas são apontadas ao longo do artigo.

Multidimensional Understanding of Homosexuality: A Qualitative Integration of Perspectives

Background:

Though DSM no longer considers homosexuality as a clinical condition, it still remains a contentious issue across social, legal, and religious paradigms. Collectivistic and traditional societies (eg, India) are more reticent in accepting the multifaceted nature of sexuality. This study thereby tries to arrive at a collective understanding about homosexuality.

Methods:

The study was conducted in the following 3 parts: Focus group discussion (FDG) to unravel the collective understanding of homosexuality in heterosexual young adults. In-depth personal interviews with 3 homosexual persons. In-depth personal interview with 3 heterosexual peers of homosexual persons.

Results:

Qualitative analysis of the FGDs revealed that the participants share a collective opinion that “lack of acceptance and negative stereotyping of homosexuality” to be a predominant social phenomenon in India. Interpretative phenomenological analysis (IPA) of the personal interviews of the homosexual persons revealed experience of social ostracization and unique personal journey toward self-acceptance and adaptation. IPA of the personal interviews of the heterosexual peers disseminate that these people have the agonizing vicarious experience of seeing their friends being discriminated against and also personal experiences of social rejection on account of having a homosexual friend.

Conclusion:

This study is unique in that it tried to recognize homosexuality from multiple perspectives. Findings suggest that heteronormative hegemony operates insidiously and pervades the boundary of the self-generating “self-doubt.” Understanding these dimensions might help address their unmet needs and identities as well as mitigate stigma surrounding the same.

Minority Stress and Mental Health in Italian Bisexual People

Bisexual people are a strongly stigmatized population experiencing health disparities caused by social stigmatization. The predominant framework helping to understand these health disparities and the impact of stigma on mental health of social groups belonging to a sexual minority identity constitutes the minority stress theory. In Italy, studies assessing this model in bisexual populations are very limited. Within this framework, the current study aimed at assessing in 381 Italian bisexual individuals (62 men and 319 women) the effects of anti-bisexual discrimination, proximal stressors (i.e., anticipated binegativity, internalized binegativity, and outness), and resilience on psychological distress. The results suggested that only anti-bisexual discrimination and internalized binegativity were positively associated with psychological distress, and that resilience was negatively associated with mental health issues. Furthermore, the results suggested that internalized binegativity mediated the relationship between anti-bisexual discrimination and mental health problems. No moderating effect of resilience was found. This is the first study to have thoroughly applied minority stress in Italian bisexual people, providing Italian clinicians and researchers with an outline of the associations between minority stress, stigma, resilience, and psychological distress within this population.

Sexual orientation-related stigma and relationship functioning among female same-sex couples

This article discusses how sexual orientation-based stigma serves to undermine functioning in female same-sex relationships. We particularly focus on the unique roles of interpersonal stigma (e.g., victimization, microaggressions) and structural stigma (e.g., institutional forms of discrimination), highlighting critical limitations and gaps in this literature and offering suggestions for future studies. We also discuss the need for future work on sexual orientation-related stigma and relationship functioning to consider the unique experiences of bisexual women, intersecting identities, and couple-level perspectives on stigma.

Human Papillomavirus Vaccine Predictors Among U.S. Adults Aged 18 to 45 by Sexual Orientation

Despite increased incidence rates of human papillomavirus (HPV)-associated cancers among sexual minorities, their HPV vaccine uptake remains suboptimal. This cross-sectional, correlational study aimed to investigate factors associated with HPV vaccination among a nationally representative sample of U.S. young adults by sexual orientation. We used the 2014 to 2017 Behavioral Risk Factor Surveillance System data for adults aged 18 to 45 years. HPV vaccination initiation was associated with being female and Hispanic, having higher educational attainment, and having ever been tested for HIV, whereas completion was associated with being female and non-Hispanic White and having higher educational attainment. Compared with those who reported identifying as straight, the lesbian or gay respondents were found to have been less likely not to complete the series. Providers should play a crucial part in addressing missed opportunities for HPV vaccination by implementing culturally competent communication strategies to empower sexual minorities to make informed HPV vaccine decisions.

Relationship Status and Drinking-Related Outcomes in a Community Sample of Lesbian and Bisexual Women

Although marriage tends to be protective against hazardous drinking among women in the general population, few studies have compared drinking rates, levels, or problems based on relationship status among sexual minority women (SMW; lesbian, bisexual). We examined associations between relationship status (committed relationship/cohabiting; committed/not cohabiting; single) and past-year drinking outcomes using data from a diverse sample of 696 SMW interviewed in wave 3 of the 17-year longitudinal Chicago Health and Life Experiences of Women study. The mean age of SMW in the sample was 40.01 (SD = 14.15; range 18-82). A little more than one-third (37%) of the sample was white, 36% was African American, and 23% Latina; 4% reported another or multi- race/ethnicity. Compared to SMW in committed cohabiting relationships, single SMW were significantly more likely to be heavy drinkers. SMW in committed non-cohabiting relationships were more likely to report alcohol-related problem consequences, and both single SMW and those in committed non-cohabiting relationships were more likely to report one or more symptoms of potential alcohol dependence. Findings underscore the importance of exploring relationship factors that may influence drinking and drinking-related problems among SMW.

Development of an LGB-specific health literacy scale

No studies to date have examined health literacy among lesbian, gay, and bisexual (LGB) individuals, nor considered whether LGB-specific health literacy might be a contributing factor to well-documented health disparities in LGB populations. This pilot study gathered online survey data from a national convenience sample of 232 LGB adults age 40 and older. A scale developed specifically for this study had 10 items related to general health literacy and 10 items related to LGB-specific health information and skills. Factor analysis revealed that the two subscales were distinct and internally consistent, and accounted for 66% of the variance. Higher LGB health literacy was associated with greater likelihood of coming out to the healthcare provider, reporting better overall health, and having healthcare providers who were knowledgeable about LGBT issues. Greater age was associated with lower general health literacy, but was not associated with LGB literacy. Respondents who had worked in healthcare settings had higher levels of both LGB and general health literacy. Potential differences by gender on sociodemographic and health variables were identified that need to be examined in larger, more diverse samples.

Sex and sexual orientation in relation to tobacco use among young adult college students in the US: a cross-sectional study

BACKGROUND

Sexual minority young adults represent a high-risk population for tobacco use. This study examined cigarette and alternative tobacco product (ATP) use prevalence across sexual orientation (heterosexual, gay/lesbian, and bisexual) among college-attending young adult men and women, respectively.

METHODS

Baseline data from a two-year longitudinal study of 3386 young adult college students aged 18-25 in Georgia were analyzed. Correlates examined included sociodemographics (age, sex, sexual orientation, race/ethnicity, college type, and parental education). Outcomes included past 30-day use of tobacco (cigarette, little cigars/cigarillos [LCCs], e-cigarettes, hookah, any tobacco product used, and number of tobacco products used, respectively). Two-group, multivariate multiple regression models were used to examine predictors of tobacco use among men and women, respectively.

RESULTS

Among men (N = 1207), 34.7% used any tobacco product; 18.6% cigarettes; 12.3% LCCs; 16.8% e-cigarettes; and 14.7% hookah. Controlling for sociodemographics, gay sexual orientation (OR = 1.62, p = 0.012) was associated with higher odds of cigarette use; no other significant associations were found between sexual orientation and tobacco use. Among women (N = 2179), 25.3% used any tobacco product; 10.4% cigarettes; 10.6% LCCs; 7.6% e-cigarettes; and 10.8% hookah. Being bisexual was associated with cigarette (p < 0.001), LCC (p < 0.001), and e-cigarette use (p = 0.006). Lesbian sexual orientation was associated with cigarette (p = 0.032) and LCC use (p < 0.001). Being bisexual predicted any tobacco product used (p = 0.002), as well as number of tobacco products used (p = 0.004). Group comparisons showed that the effect of sexual minority status on LCC use was significantly different for men versus women.

CONCLUSION

Sexual minority women, especially bisexual women, are at higher risk for using specific tobacco products compared to heterosexual women; homosexual men are at increased risk of cigarette use compared to heterosexual men. These nuances in tobacco use should inform interventions targeting sexual minorities.

Mining for Posttraumatic Growth (PTG) in Sexual Minority Women Who Survive Intimate Partner Violence: A Conceptual Perspective

This theoretical paper explores the need to use posttraumatic growth (PTG) as a framework when studying sexual minority women (SMW) who are survivors of intimate partner violence (IPV) to examine the relationship between risk factors such as stress, anxiety and alcohol use and to understand the role of protective factors through mining for the presence of posttraumatic growth (PTG). Despite a call for continued research in this highly vulnerable population, representative studies of SMW and PTG remain extremely limited. Research that examines the relationship between IPV, behavioral health issues, and posttraumatic growth would provide the opportunity to develop tailored intervention models and opportunities for program development to decrease isolation and increase factors of posttraumatic growth. In particular, the impact of how interpersonal relationships as potential mediators and/or outcomes of posttraumatic growth (PTG) needs to be explored more thoroughly. PTG is a valuable framework for vulnerable populations such as sexual minority women because it focuses on how transformative change may result from traumatic experiences such as surviving IPV.

Prevalence of Obesity, Prediabetes, and Diabetes in Sexual Minority Women of Diverse Races/Ethnicities: Findings From the 2014-2015 BRFSS Surveys

Purpose

The purpose of this study is to assess the weighted prevalence and odds ratios of obesity, prediabetes, and diabetes by (1) female sexual orientation (lesbian, bisexual, and straight) with racial/ethnic (Hispanic, non-Hispanic black, and non-Hispanic white) groups combined and (2) across and within racial/ethnic groups by sexual orientation.

Methods

A secondary analysis of pooled 2014-2015 Behavioral Risk Factor Surveillance System data from 28 states (N = 136 878) was conducted. Rao-Scott chi-square test statistics were computed and logistic regression models were developed to assess weighted prevalence and odds ratios of obesity, prediabetes, and diabetes with adjustments for demographics (age, income, and education), depression, and health care access factors.

Results

With racial/ethnic groups combined, lesbian and bisexual women, relative to straight women, had a significantly increased likelihood for obesity when controlling for demographics. Bisexual women were found to have significantly reduced odds for diabetes, compared with straight women, with adjustments for demographics, depression, and health care access factors. Compared with their non-Hispanic white counterparts, Hispanic lesbian women had significantly increased odds for obesity and diabetes, while non-Hispanic black bisexual women had a significantly greater likelihood for obesity, holding demographics, depression, and health care access factors constant. Non-Hispanic white lesbian women had an increased likelihood for obesity relative to their straight, ethnic/racial counterparts. Prediabetes subsample analysis revealed the prevalence was low across all female sexual orientation groups.

Conclusion

Sexual minority women, particularly those of color, may be at increased risk for obesity and diabetes. Research is needed to confirm the findings.

Queer narratives and minority stress: Stories from lesbian, gay and bisexual individuals in Norway

AIMS

This study aims to explore how minority stress related to sexual orientation is reflected in narratives from lesbian, gay and bisexual (LGB) individuals in Norway, with an impact for national public health policy.

METHODS

Arthur Frank's dialogical narrative analysis was applied to personal stories from 65 persons self-referring to different categories of queer identities, submitted online anonymously to a Norwegian national archive for queer history. A purposive sample of three different stories were selected due to their capacity to illuminate how various aspects of minority stress are narrated in diverse interplays between individual voices and resources, and cultural scripts and societal influences.

RESULTS

Our analysis highlighted how stories may offer significant glimpses into the dynamic and complex fashioning of sexual identities, giving precious clues to the vulnerabilities and strengths of the narrator. Contemporary queer narratives from Norway reflect meaning-making related to sexual orientation that are influenced by, and expand upon, the classical scripts dominated by tragedy and tristesse, personal progress or simply no particular tension. LGB individuals of different ages and backgrounds had experienced aspects of minority stress related to their sexual orientation, with a substantial impact on identity, even when significant others were encouraging.

CONCLUSIONS

The stories indicate that positive proximal processes, such as personal resilience and sympathetic environments, can support mental health and counteract negative effects of distal processes contributing to minority stress, such as heteronormativity and subtle microaggression. Public health strategies addressing attitudes to sexual orientation among the general population may contribute to diverse affirmative cultural scripts about queer lives, thereby enhancing queer mental health.

Psychosocial Obstacles to Smoking Cessation Attempts Among Young Adult Sexual Minority Women Who Smoke

Sexual minority women (SMW; i.e., women who identify their sexuality as lesbian, bisexual, or something other than heterosexual) report greater smoking behaviors than their heterosexual counterparts across all ages. We conducted a multivariable regression to examine the correlates of prior smoking cessation attempts and smoking cessation intentions in a sample of young SMW who smoke (N = 338; aged 18-24 years). Covariates included sociodemographic characteristics (i.e., race/ethnicity, sexual identity, age, urbanity), general (i.e., perceived stress), and sexuality-specific (i.e., internalized homophobia) stressors, as well as smoking attitudes and subjective norms. Bisexual women (OR = 1.92, 95% CI: 1.11, 3.31) were more likely than lesbian counterparts to report a prior smoking cessation attempt. Prior cessation attempts were associated with less internalized homophobia (OR = 0.44, 95% CI: 0.27, 0.69) and positive attitudes toward smoking (OR = 2.17, 95% CI: 1.27, 3.70). Smoking cessation intentions in the next month were negatively associated with being a daily smoker (β = -0.14) and attitudes toward smoking (β = -0.19). Based on these findings, we underscore the need to address the risk correlates associated with SMW's quit attempts and include these in cessation interventions.

Sociodemographic Characteristics and Health Outcomes Among Lesbian, Gay, and Bisexual U.S. Adults Using Healthy People 2020 Leading Health Indicators

PURPOSE

This study aimed to characterize the sociodemographic characteristics of sexual minority (i.e., gay, lesbian, bisexual) adults and compare sexual minority and heterosexual populations on nine Healthy People 2020 leading health indicators (LHIs).

METHODS

Using a nationally representative, cross-sectional survey (National Health Interview Survey 2013-2015) of the civilian, noninstitutionalized population (228,893,944 adults), nine Healthy People 2020 LHIs addressing health behaviors and access to care, stratified using a composite variable of sex (female, male) and sexual orientation (gay or lesbian, bisexual, heterosexual), were analyzed individually and in aggregate.

RESULTS

In 2013-2015, sexual minority adults represented 2.4% of the U.S.

POPULATION

Compared to heterosexuals, sexual minorities were more likely to be younger and to have never married. Gays and lesbians were more likely to have earned a graduate degree. Gay males were more likely to have a usual primary care provider, but gay/lesbian females were less likely than heterosexuals to have a usual primary care provider and health insurance. Gay males received more colorectal cancer screening than heterosexual males. Gay males, gay/lesbian females, and bisexual females were more likely to be current smokers than their sex-matched, heterosexual counterparts. Binge drinking was more common in bisexuals compared to heterosexuals. Sexual minority females were more likely to be obese than heterosexual females; the converse was true for gay males. Sexual minorities underwent more HIV testing than their heterosexual peers, but bisexual males were less likely than gay males to be tested. Gay males were more likely to meet all eligible LHIs than heterosexual males. Overall, more sexual minority adults met all eligible LHIs compared to heterosexual adults. Similar results were found regardless of HIV testing LHI inclusion.

CONCLUSION

Differences between sexual minorities and heterosexuals suggest the need for targeted health assessments and public health interventions aimed at reducing specific negative health behaviors.

The Role of Minority Stressors in Lesbian Relationship Commitment and Persistence over Time

The Investment Model of relationship commitment uses interpersonal investment, relationship satisfaction, quality of alternatives, and commitment to predict relationship longevity (Rusbult, 1980, 1983). Although ample support for the Investment Model has been found in heterosexual couples, it appears to be less powerful in predicting stability in same-sex relationships (Beals, Impett, & Peplau, 2002), potentially because the model does not account for factors unique to same-sex relationships, such as anti-gay discrimination. However, no research has tested the nature and power of sexual minority stress factors in predicting same-sex relationship stability over time. Using secondary, longitudinal data collected from a diverse sample of lesbian women in relationships (N = 211), we examined how internalized homonegativity, sexual identity disclosure, and workplace discrimination affected the Investment Model antecedents of relationship persistence: satisfaction, quality of alternatives, and investment. We tested the influence of sexual minority stressors on Investment Model processes using structural equations modeling and found that sexual identity disclosure was positively associated with satisfaction and investment, internalized homonegativity was only negatively associated with satisfaction and investment, while workplace discrimination was negatively associated with alternatives. Moreover, both relationship satisfaction and investment influenced commitment which predicted persistence in these relationships over about seven years' time, demonstrating support for the Investment Model. Our findings support the addition of sexual minority stress variables to the Investment Model when examining same-sex relationships and implications are discussed.

A Systematic Review of Cardiovascular Disease in Sexual Minorities

BACKGROUND

Mental health and HIV disparities are well documented among sexual minorities, but there is a dearth of research on other chronic conditions. Cardiovascular disease remains the leading cause of death worldwide. Although sexual minorities have high rates of several modifiable risk factors for cardiovascular disease (including stress, tobacco use, and alcohol consumption), there is a paucity of research in this area.

OBJECTIVES

In this systematic review, we synthesized and critiqued the existing evidence on cardiovascular disease among sexual minority adults.

SEARCH METHODS

We conducted a thorough literature search of 6 electronic databases for studies published between January 1985 and December 2015 that compared cardiovascular disease risk or prevalence between sexual minority and heterosexual adults.

SELECTION CRITERIA

We included peer-reviewed English-language studies that compared cardiovascular disease risk or diagnoses between sexual minority and heterosexual individuals older than 18 years. We excluded reviews, case studies, and gray literature. A total of 31 studies met inclusion criteria.

DATA COLLECTION AND ANALYSIS

At least 2 authors independently abstracted data from each study. We performed quality assessment of retrieved studies using the Crowe Critical Appraisal Tool.

MAIN RESULTS

Sexual minority women exhibited greater cardiovascular disease risk related to tobacco use, alcohol consumption, illicit drug use, poor mental health, and body mass index, whereas sexual minority men experienced excess risk related to tobacco use, illicit drug use, and poor mental health. We identified several limitations in the extant literature. The majority of included studies were cross-sectional analyses that used self-reported measures of cardiovascular disease. Even though we observed elevated cardiovascular disease risk, we found few differences in cardiovascular disease diagnoses (including hypertension, diabetes, and high cholesterol). Overall, 23 of the 26 studies that examined cardiovascular disease diagnoses used subjective measures. Only 7 studies used a combination of biomarkers and self-report measures to establish cardiovascular disease risk and diagnoses.

AUTHORS' CONCLUSIONS

Social conditions appear to exert a negative effect on cardiovascular disease risk among sexual minorities. Although we found few differences in cardiovascular disease diagnoses, we identified an elevated risk for cardiovascular disease in both sexual minority men and women. There is a need for research that incorporates subjective and objective measures of cardiovascular disease risk. Public Health Implications: Cardiovascular disease is a major health concern for clinicians, public health practitioners, and policymakers. This systematic review supports the need for culturally appropriate interventions that address cardiovascular disease risk in sexual minority adults.

Coping with workplace minority stress: Associations between dyadic coping and anxiety among women in same-sex relationships

Sexual minorities are exposed to stressors in the workplace (workplace minority stress), which can be detrimental for well-being (e.g., levels of anxiety). The present study examined whether a particular set of relationship processes, dyadic coping, served to moderate the association between workplace minority stress and symptoms of anxiety. Using a dyadic sample of 64 female same-sex couples, we found that partner problem-focused supportive dyadic coping (DC) and emotion-focused supportive DC (marginally) buffered, whereas partner delegated DC and negative DC did not moderate, the association between workplace minority stress and symptoms of anxiety. Implications for relationship researchers and mental health practitioners are discussed.

Racial/ethnic differences in unmet needs for mental health and substance use treatment in a community-based sample of sexual minority women

AIMS AND OBJECTIVES

To examine the unmet needs for mental health and substance use treatment among a diverse sample of sexual minority women (lesbian, bisexual).

BACKGROUND

Sexual minority women are more likely than heterosexual women to report depression and hazardous drinking. However, relatively little is known about sexual minority women's use of mental health or substance use treatment services, particularly about whether use varies by race/ethnicity.

DESIGN

Cross-sectional analysis of existing data.

METHODS

Analyses included data from 699 Latina, African American and white sexual minority women interviewed in wave 3 of the 17-year Chicago Health and Life Experiences of Women study. Using logistic regression, we examined the associations among sexual identity, race/ethnicity, use of mental health and substance use treatment, as well as potential unmet need for treatment.

RESULTS

Overall, women in the study reported high levels of depression and alcohol dependence, and these varied by sexual identity and race/ethnicity. Use of mental health and substance use treatment also varied by race/ethnicity, as did potential unmet need for both mental health and substance use treatment.

CONCLUSIONS

Our findings that suggest although use of treatment among sexual minority women is high overall, there is a potentially sizable unmet need for mental health and substance use treatment that varies by race/ethnicity, with Latina women showing the greatest unmet need for treatment.

RELEVANCE TO CLINICAL PRACTICE

Nurses and other healthcare providers should be aware of the high rates of depression and hazardous drinking among sexual minority women, understand the factors that may increase the risk of these conditions among sexual minority women, the potentially high unmet need for mental health and substance use treatment - perhaps particularly among Latina women and be equipped to provide culturally sensitive care or refer to appropriate treatment services as needed.

Gonads and strife: Sex hormones vary according to sexual orientation for women and stress indices for both sexes

This study assessed sexual orientation and psychobiological stress indices in relation to salivary sex hormones as part of a well-validated laboratory-based stress paradigm. Participants included 87 healthy adults that were on average 25 years old who self-identified as lesbian/bisexual women (n=20), heterosexual women (n=21), gay/bisexual men (n=26), and heterosexual men (n=20). Two saliva samples were collected fifteen minutes before and fifteen minutes after exposure to a modified Trier Social Stress Test to determine testosterone, estradiol, and progesterone concentrations via enzyme-immune assaying. Mean sex hormones were further tested in association to stress indices related to cortisol systemic output (area under the curve with respect to ground) based on ten measures throughout the two-hour visit, allostatic load indexed using 21 biomarkers, and perceived stress assessed using a well-validated questionnaire. Results revealed that lesbian/bisexual women had higher overall testosterone and progesterone concentrations than heterosexual women, while no differences were found among gay/bisexual men in comparison to heterosexual men. Lesbian/bisexual women and heterosexual men showed positive associations between mean estradiol concentrations and allostatic load, while gay/bisexual men and heterosexual women showed positive associations between mean testosterone and cortisol systemic output. In summary, sex hormone variations appear to vary according to sexual orientation among women, but also as a function of cortisol systemic output, allostatic load, and perceived stress for both sexes.

Comparing Heterosexuals' and Gay Men/Lesbians' Responses to Relationship Problems and the Effects of Internalized Homophobia on Gay Men/Lesbians' Responses to Relationship Problems in Turkey

The purpose of the present study was twofold: (1) to investigate the effects of sexual orientation (heterosexuals and gay men/lesbians) and gender difference on responses to romantic relationship problems (Exit, Voice, Loyalty, and Neglect [EVLN] responses) and of perceived partner's EVLN responses in Turkey, and (2) to examine whether internalized homophobia was associated with EVLN responses and perceived partner's EVLN responses for gay men and lesbians. Responses to Dissatisfaction Scale-Accommodation Instrument, Internalized Homophobia, and Demographics Information were administered to 187 participants (44 lesbians, 44 gay men, 53 heterosexual women, 46 heterosexual men).The MANCOVA results showed that men reported higher loyalty than women, whereas women presented more exit responses than men. Further, the interactions between gender and sexual orientation on the participants' EVLN responses and on the perceived partner's EVLN responses were significant. With respect to heterosexual women, heterosexual men displayed more loyalty responses. Lesbians had higher scores on loyalty than did heterosexual women. Lesbians also had higher scores on perceived partner's exit response than did heterosexual women and gay men. On the contrary, heterosexual women reported more perceived partner's voice response than lesbians. In addition, lesbians reported higher perceived partner's neglect responses than heterosexual women. Compared to heterosexual women, heterosexual men reported higher perceived partner's exit response. Finally, internalized homophobia was associated with destructive responses for both lesbians and gay men.

"The Wisdom of Age": Perspectives on Aging and Growth among Lesbian Older Adults

Older lesbian-identified women are a health disparate yet resilient population about whom knowledge is limited and emerging. Among the areas in need of research are older lesbians' experiences of later life and stress-related growth. This article presents the findings from a qualitative study that investigated older lesbians' experiences of adversity and adaptation as they age. In-depth, exploratory interviews were conducted with 12 lesbian-identified women who were between the ages of 65-80. This study applied grounded theory methodology to identify respondents sources of stress and fear, their strengths and coping strategies and how those relate to each other and to their growth in later life. We advance a model of adaptive change that shows how spirituality, social support, and resistance to cultural norms help older lesbian adults cope with loss, illness, and discrimination and develop wisdom in later life. Knowledgeable practitioners can help older lesbian women identify and maintain sources of social support, explore spirituality, and facilitate continuous growth through the end of life. Social workers can advocate for services that are welcoming and affirmative so as to reduce fears of isolation and dependence associated with health decline.

An ecological framework for sexual minority women's health: factors associated with greater body mass

In recent years, many studies have focused on the body of sexual minority women, particularly emphasizing their larger size. These studies rarely offer theoretically based explanations for the increased weight, nor study the potential consequences (or lack thereof) of being heavier. This article provides a brief overview of the multitude of factors that might cause or contribute to larger size of sexual minority women, using an ecological framework that elucidates upstream social determinants of health as well as individual risk factors. This model is infused with a minority stress model, which hypothesizes excess strain resulting from the stigma associated with oppressed minority identities such as woman, lesbian, bisexual, woman of color, and others. We argue that lack of attention to the upstream social determinants of health may result in individual-level victim blaming and interventions that do not address the root causes of minority stress or increased weight.

Health disparities among young adult sexual minorities in the U.S

BACKGROUND

Emerging research suggests that young adult sexual minorities (identifying as lesbian, gay, or bisexual or engaging in same-sex attractions or behaviors) experience poorer health than their majority counterparts, but many measures of health inequity remain unexamined in population-based research.

PURPOSE

To describe a wide range of health status and healthcare access characteristics of sexual minorities in comparison with those of the majority population in a national sample of U.S. young adults.

METHODS

Binary and multinomial logistic regression analyses of Wave IV data (2008) from the National Longitudinal Study of Adolescent Health (participants aged 24-32 years, n=13,088) were conducted. Health measures were self-rated health; diagnosis of any of several physical or mental illnesses or sexually transmitted infections; measured BMI; depression classified from self-reported symptoms; use of antidepressant and anxiolytic medication; uninsured; forgone care; and receipt of physical, dental, and psychological services. Analyses were conducted in 2012-2013.

RESULTS

Sexual minority women had elevated odds of most adverse health conditions and lower odds of receiving a physical or dental examination. Sexual minority men had elevated odds of fewer adverse health conditions.

CONCLUSIONS

Young adult sexual minorities are at higher risk of poor physical and mental health. The results highlight the multidimensionality of sexual minority status and respond to calls for greater understanding of the health of this population.