Physical Activity as a Mediator for Health Outcomes Among Sexual Minority Adults

Where's the Joy in That? Sexual Minority College Students Report Lower Physical Activity Engagement and Enjoyment Compared to Heterosexual Students

Sexual minority (e.g. non-heterosexual) individuals are at greater risk for negative health outcomes, often linked to inadequate physical activity (PA). The purpose of this study was to assess PA levels and PA enjoyment among college students, by sexual orientation. Data were collected from a volunteer sample of college students enrolled in general health and wellness courses offered at a large, Northeastern U.S. university via an online survey. Participants self-reported demographic information, PA levels using the Global Physical Activity Questionnaire (GPAQ), and PA enjoyment using a 7-item Physical Activity Enjoyment scale (PACES). Among participants (n = 1471), independent sample t-tests showed that sexual minority (SM) students reported significantly lower mean MET-mins/week of MPA (MHeterosexual = 568.09 ± 488.12 vs. MSexual minority = 469.95 ± 471.51; p = .006) and VPA (MHeterosexual = 1089.54 ± 1110.64 vs. MSexual Minority = 628.93 ± 942.78; p < .001), ST days/week (MHeterosexual = 1.93 ± 1.90 vs. MSexual Minority = 1.00 ± 1.60; p < .001), and reported lower total PACES score (MHeterosexual = 7.80 ± 1.92 vs. MSexual Minority = 6.87 ± 2.14; p < .001) compared to heterosexual students. Bootstrap mediation analyses with 5000 samples revealed that PACES has direct and indirect mediation effects on the association between sexual orientation status and MET-mins/week of MPA and VPA, and ST days/week. The current findings provide evidence of the underlying mechanisms linked to the physical activity disparities experienced by SM college students compared to heterosexual students. Additionally, PACES can serve as a facilitator to promote PA engagement among SM students. These findings can inform future intervention work to target PA enjoyment for meaningful behavior change.

Contextual Influences on Nonresponse to Health Survey Questions About Sexual Orientation and Gender Identity

Purpose: We examined the relationship between state context and survey nonresponse to sexual orientation (SO) and gender identity (GI) questions. Methods: We obtained data from the 2014-2020 Behavioral Risk Factor Surveillance System (BRFSS) surveys. Item nonresponse was defined as selecting "don't know/not sure" or "refused" for each of two questions about SO and GI. Nonresponse patterns included responding to both SO and GI questions; responding only to the SO question (nonresponse to GI); responding only to the GI question (nonresponse to SO); and responding to neither question. State-level contextual measures included legal protections for lesbian, gay, bisexual, transgender, or other sexual or gender minority (LGBT+) people, LGBT+ social movement strength, and public opinion regarding LGBT+ issues. Results: The analysis included 1,459,525 respondents from 44 states (190 state-years). On weighted analysis, 96.5% of adults answered both SO/GI questions, 2.4% responded only to GI, 0.4% responded only to SO, and 0.7% responded to neither. The demographic profile of individuals with GI-only nonresponse differed markedly from the profile of adults with SO-only nonresponse. An increasingly favorable legal climate for LGBT+ people was associated with greater rates of response to SO and GI questions. However, a more LGBT+ friendly state climate measured by social movement strength or public opinion was not consistently associated with reduced SO and GI question nonresponse. Conclusion: Contextual factors have mixed association with nonresponse to SO and GI question on BRFSS surveys. Our results warrant continued development of health survey questionnaires to elicit accurate information on respondents' SO and GI.

Differences in Ideal Cardiovascular Health Between Sexual Minority and Heterosexual Adults

Importance

Research on the cardiovascular health (CVH) of sexual minority adults has primarily examined differences in the prevalence of individual CVH metrics rather than comprehensive measures, which has limited development of behavioral interventions.

Objective

To investigate sexual identity differences in CVH, measured using the American Heart Association's revised measure of ideal CVH, among adults in the US.

Design, Setting, and Participants

This cross-sectional study analyzed population-based data from the National Health and Nutrition Examination Survey (NHANES; 2007-2016) in June 2022. Participants included noninstitutional adults aged 18 to 59 years. We excluded individuals who were pregnant at the time of their interview and those with a history of atherosclerotic cardiovascular disease or heart failure.

Exposures

Self-identified sexual identity categorized as heterosexual, gay/lesbian, bisexual, or something else.

Main Outcomes and Measures

The main outcome was ideal CVH (assessed using questionnaire, dietary, and physical examination data). Participants received a score from 0 to 100 for each CVH metric, with higher scores indicating a more favorable CVH profile. An unweighted average was calculated to determine cumulative CVH (range, 0-100), which was recoded as low, moderate, or high. Sex-stratified regression models were performed to examine sexual identity differences in CVH metrics, disease awareness, and medication use.

Results

The sample included 12 180 participants (mean [SD] age, 39.6 [11.7] years; 6147 male individuals [50.5%]). Lesbian (B = -17.21; 95% CI, -31.98 to -2.44) and bisexual (B = -13.76; 95% CI, -20.54 to -6.99) female individuals had less favorable nicotine scores than heterosexual female individuals. Bisexual female individuals had less favorable body mass index scores (B = -7.47; 95% CI, -12.89 to -1.97) and lower cumulative ideal CVH scores (B = -2.59; 95% CI, -4.84 to -0.33) than heterosexual female individuals. Compared with heterosexual male individuals, gay male individuals had less favorable nicotine scores (B = -11.43; 95% CI, -21.87 to -0.99) but more favorable diet (B = 9.65; 95% CI, 2.38-16.92), body mass index (B = 9.75; 95% CI, 1.25-18.25), and glycemic status scores (B = 5.28; 95% CI, 0.59-9.97). Bisexual male individuals were twice as likely as heterosexual male individuals to report a diagnosis of hypertension (adjusted odds ratio [aOR], 1.98; 95% CI, 1.10-3.56) and use of antihypertensive medication (aOR, 2.20; 95% CI, 1.12-4.32). No differences in CVH were found between participants who reported their sexual identity as something else and heterosexual participants.

Conclusion and Relevance

Results of this cross-sectional study suggest that bisexual female individuals had worse cumulative CVH scores than heterosexual female individuals, whereas gay male individuals generally had better CVH than heterosexual male individuals. There is a need for tailored interventions to improve the CVH of sexual minority adults, particularly bisexual female individuals. Future longitudinal research is needed to examine factors that might contribute to CVH disparities among bisexual female individuals.