Self-Rated Health by Sexual Orientation Among Middle-Aged and Older Adults in Canada

Sexual Orientation, Health, and Well-Being in Spanish People

Although several studies have found disparities in health outcomes between heterosexual and lesbian, gay, and bisexual (LGB)-identifying individuals, few studies have focused on subjective well-being and protective factors for health and well-being. The purpose of this work is twofold: (1) to examine the relevance of sexual orientation to health and well-being in women and men; (2) to identify protective and risk factors for psychological distress, self-rated health, and well-being for gay men, lesbian women, bisexual women and men, and heterosexual women and men. The sample consisted of 908 women and 586 men from the general Spanish population aged 16-64, half of whom identified themselves as LGB and half as heterosexual. All were assessed using eight questionnaires and inventories. The results showed that differences varied depending on the health indicator considered. In general, bisexuals had the poorest health, with lower self-rated health and lower self-esteem. In all groups, self-esteem was a protective factor against psychological distress and was associated with better health and well-being. To a lesser extent, social support served as a protective factor against psychological distress and was associated with greater well-being in all groups. It is concluded that although sexual orientation is relevant to the health and well-being of individuals, there are differences among sexual minorities, with bisexuals having lower self-esteem than homosexuals.

Perceived Community Belonging as a Moderator of the Association Between Sexual Orientation and Health and Well-Being

PURPOSE

This study examines the moderating role of perceived community belonging in the association between sexual orientation and various health and well-being outcomes.

DESIGN

A national cross-sectional survey.

SETTING

Confidential microdata from the 2021 Canadian Community Health Survey.

SUBJECTS

Individuals aged 15 and older, with a sample size ranging from 43,000 to 44,100.

MEASURES

Sexual orientation, health and well-being outcomes, and sense of community belonging were all self-reported. Outcomes included self-rated general and mental health, depressive symptoms, and life satisfaction.

ANALYSIS

A series of multiple linear regression models.

RESULTS

Compared to heterosexual individuals, bisexual individuals reported poorer self-rated general health (b = .402, P < .001 for men; b = .454, P < .001 for women) and mental health (b = .520, P < .001 for men; b = .643, P < .001 for women), higher depressive symptoms (b = 2.140, P < .001 for men; b = 2.685, P < .001 for women), and lower life satisfaction (b = .383, P < .05 for men; b = .842, P < .001 for women). Few disparities were observed among gay men and lesbians. Contrary to some recent findings, no disparities were observed among individuals uncertain about their sexual orientation or those who chose not to disclose it, even without controlling for covariates. A stronger sense of community belonging mitigated the disadvantages associated with self-rated general health (b = -.276, P < .01) and depressive symptoms (b = -.983, P < .01) for gay men, and life satisfaction (b = -.621, P < .01) for lesbians.

CONCLUSION

This study is among the first to highlight the stress-buffering role of community belonging in the association between sexual orientation and health and well-being outcomes.

Impact of Neighborhood Deprivation on Aging Sexual Minority People's Depression: Results from the CANUE and CLSA data

As the aging population grows across the world, exploring the impact of social environment on minority populations' aging and well-being would be an essential step towards building an inclusive society. Using the Canadian Longitudinal Study on Aging (CLSA) and Canadian Urban Environmental Health Research Consortium (CANUE) data, the study investigated the relationship between deprivation and depression level in aging sexual minority people to examine how neighborhood level social and material deprivation influence mental health. 48,792 survey respondents were included in our analyses and the average age was 62.9. The study had 47,792 heterosexual, 760 gay/lesbian, and 240 bisexual individuals (23,977 men and 24,815 women). Regression analyses were conducted while controlling for age in each model. Results revealed that neighborhood material deprivation has a significant impact on mental health outcomes of aging lesbian women and bisexual men. The study provides an opportunity for intervention considerations for materially deprived neighborhoods to serve the aging sexual minority people residing in such areas.

Evaluation of Survey Nonresponse in Measuring Cardiometabolic Health Risk Factors and Outcomes among Sexual Minority Populations: A National Data Linkage Analysis

Understanding cardiometabolic health among lesbian, gay, and bisexual (LGB) people is challenged by methodological constraints, as most studies are either based on nonprobability samples or assume that missing values in population-based samples occur at random. Linking multiple years of nationally representative surveys, hospital records, and geocoded data, we analyzed selection biases and health disparities by self-identified sexual orientation in Canada. The results from 202,560 survey respondents of working age identified 2.6% as LGB, 96.4% as heterosexual, and <1.0% with nonresponse to the sexual identity question. Those who did not disclose their sexual identity were older, less highly educated, less often working for pay, and less often residing in rural and remote communities; they also had a diagnosed cardiometabolic condition or experienced a cardiometabolic-related hospitalization more often. Among those reporting their sexual identity, LGB individuals were younger, more likely to smoke tobacco or drink alcohol regularly, more likely to have heart disease, and less likely to have a regular medical provider than heterosexual persons. This investigation highlighted the potential of leveraging linked population datasets to advance measurements of sexual minority health disparities. Our findings indicated that population health survey questions on sexual identity are not generally problematic, but cautioned that those who prefer not to state their sexual identity should neither be routinely omitted from analysis nor assumed to have been randomly distributed.

Factors related to self-rated health of older adults in rural China: A study based on decision tree and logistic regression model

Objective

This study aimed to explore the related factors of self-rated health (SRH) by using decision tree and logistic regression models among older adults in rural China.

Methods

Convenience sampling was employed with 1,223 enrolled respondents who met the inclusion criteria from 10 randomly selected villages in M County in China. The content of the questionnaire covered demographic characteristics, physical and mental health, sleep status, and risk of falling. The Pittsburgh Sleep Quality Index (PSQI) and the Morse Falls Risk Scale (MFS) were used to evaluate sleep status and risk of falling, respectively. The decision tree and logistic regression models were employed to analyze the related factors of SRH.

Results

Notably, 817 (68.7%) subjects had good SRH. The logistic regression model showed that living standard, alcohol consumption, sleep quality, labor, hospitalization, discomfort, the number of chronic diseases, and mental health were associated with SRH (P-value < 0.05), while the decision tree model showed that the number of chronic diseases, sleep quality, mental health, hospitalization, gender, and drinking were associated with SRH. The sensitivity and specificity of the logistic regression model were 67.7 and 75.5%, respectively, and the area under the ROC curve was 0.789 (0.763, 0.816); the sensitivity and specificity of the decision tree model were 71.5, and 61.4% respectively, and the area under the ROC curve was 0.733 (0.703, 0.763).

Conclusion

Decision tree and logistic regression models complement each other and can describe the factors related to the SRH of the elderly in rural China from different aspects. Our findings indicated that mental health, hospitalization, drinking, and sleep quality were the important associated factors.

Does Religion Buffer Against the Detrimental Effect of Cyberbullying Victimization on Adults' Health and Well-Being? Evidence from the 2014 Canadian General Social Survey

While prior research has well-documented the detrimental effect of cyberbullying victimization on health and well-being among children and adolescents, less is known about whether the same adverse pattern can be observed among adults. Moreover, it is unclear about what psychosocial resources might moderate this association. The present study uses a nationally representative cross-sectional survey-2014 Canadian General Social Survey (N = 17,548)-to examine three research questions. First, is cyberbullying victimization associated with adults' self-rated health, mental health, and life satisfaction? Second, how does religiosity-religious service attendance and religious beliefs-moderate this association? Third, do any observed patterns further differ for men and women? Through a series of logistic and ordinary least squares regression models, the results show that adults who experienced cyberbullying victimization in the past 5 years are more likely to report poor self-rated health and mental health compared to those who did not experience cyberbullying victimization in the past 5 years. Likewise, cyberbullying victimization is also associated with lower levels of life satisfaction. In addition, the adverse associations of cyberbullying victimization in the past 5 years with self-rated health and life satisfaction are weaker among those who attended religious service at least once a week in the past twelve months. A similar pattern is observed for the buffering effect of viewing religious beliefs as very important in the adverse association of cyberbullying victimization in the past 5 years with self-rated life satisfaction. There is also evidence suggesting the gendered buffering effect of the importance of religious beliefs in the association between cyberbullying victimization and self-rated health. This study makes important empirical and theoretical contributions to the growing field of research on the association between cyberbullying victimization and health and well-being and to our understanding of how religion matters to individuals dealing with stressful experiences.

Resiliencia y personalidad en adultos de identidad cisgénero heteronormativos y de identidades disidentes en Argentina

Esta investigación tuvo como objetivo describir y comparar la resiliencia y personalidad en personas con identidades disidentes (ID) e  Identidades Cisgénero heteronormativos (ICH) en una muestra incidental de Argentina. Previamente se presentó una síntesis del estado legal de las identidades disidentes (ID) en los países, su epidemiología, el desarrollo de la orientación sexual y estudios previos sobre personalidad y resiliencia.  A 92 adultos (43 de ID y 49 ICH) se les administraron la Escala de Resiliencia (ER), el Cuestionario Personalidad de Eysenck, y un cuestionario sociodemográfico que indagó la existencia de grupos de apoyo. Los dos grupos fueron homogéneos en los datos sociodemográficos y en la presencia de grupos de apoyo, aunque en los ICH predominaron los familiares y en los ID, los amigos. En resiliencia se obtuvieron valores más bajos en las personas de ID; la única diferencia significativa fue en autoeficacia (Z= -1,979, p<,048, r=.02). En personalidad, los ID obtuvieron mayor neuroticismo que los ICH (Z= -3,473, p<.001, r=.04). Hubo una correlación significativa entre neuroticismo y resiliencia con independencia de cada grupo (r= -.58, p<.0001). En conjunto los valores de resiliencia y de personalidad de los dos grupos estuvieron alrededor de los percentiles 50 de muestras generales de Argentina. Estos resultados apoyan las teorías que indican que la orientación sexual no son indicadores válidos de existencia de cuadros psicopatológicos, tal como lo determinó la OMS en 1990, y como consecuencia, el DSM-IV y DSM-V modificaron las clasificaciones previas.

Systemic inflammation as a driver of health disparities among sexually-diverse and gender-diverse individuals

Sexually-diverse individuals (those who seek sexual or romantic relationships with the same and/or multiple genders) and gender-diverse individuals (those whose gender identity and/or expression differs from their birth-assigned sex/gender) have disproportionately high physical health problems, but the underlying biological causes for these health disparities remain unclear. Building on the minority stress model linking social stigmatization to health outcomes, we argue that systemic inflammation (the body's primary response to both physical and psychological threats, indicated by inflammatory markers such as C-reactive protein and proinflammatory cytokines) is a primary biobehavioral pathway linking sexual and gender stigma to physical health outcomes. Expectations and experiences of social threat (i.e., rejection, shame, and isolation) are widespread and chronic among sexually-diverse and gender-diverse individuals, and social threats are particularly potent drivers of inflammation. We review research suggesting that framing "minority stress" in terms of social safety versus threat, and attending specifically to the inflammatory consequences of these experiences, can advance our understanding of the biobehavioral consequences of sexual and gender stigma and can promote the development of health promoting interventions for this population.

Awareness of and willingness to use HIV pre-exposure prophylaxis among community residents

INTRODUCTION

Human Immunodeficiency Virus (HIV) Pre-exposure prophylaxis (PrEP) helps to decrease HIV acquisition and transmission rates. The purpose of this study was to assess awareness of HIV PrEP and willingness to use it, if available, among individuals residing in Buea, Cameroon.

METHODS

Residents in different communities throughout Buea, Cameroon participated in the study through survey completion with their responses assessed by age, marital status, highest level of education completed, profession, and health area (urban or rural).

RESULTS

421 participants completed the survey with the majority being 20-29 years of age, single, having secondary or tertiary education, residing in rural Cameroonian areas. Eighty percent of respondents had not previously heard of HIV PrEP. Ninety-five percent of the study sample expressed willingness to use HIV PrEP, if available. Participants ages 40 years old and above were less aware of HIV PrEP than those 39 years old and younger. Primary education, serving in the role of a nurse, doctor, or scientist, along with hospital affiliations were characteristics closely associated with HIV PrEP awareness. Participants younger than 20 years old were less likely to report willingness to use HIV PrEP whereas married participants found HIV PrEP to be a more favorable option.

CONCLUSIONS

Awareness of HIV PrEP was minimal with healthcare personnel having more familiarity. Willingness to use HIV PrEP decreased by age but higher among married participants. Further promotion of HIV PrEP and facilitating its accessibility can lead to less transmissions of HIV worldwide.

Co-occurring mental illness, drug use, and medical multimorbidity among lesbian, gay, and bisexual middle-aged and older adults in the United States: a nationally representative study

BACKGROUND

Older lesbian, gay, and bisexual (LGB) adults are an underserved and understudied population that experience specific health disparities. The intersection of aging and chronic medical disease with a higher risk for substance use and mental illness may place older LGB adults at risk for co-occurring conditions and resulting comorbidity. Understanding multimorbidity among older LGB adults may help inform interventions to reduce disparities in health outcomes.

METHODS

Data come from the 2015 to 2017 National Surveys on Drug Use and Health (n = 25,880). We first determined whether sexual orientation was associated with reporting: past-year drug use, mental illness, and/or 2 or more chronic medical diseases. We then determined whether sexual orientation was associated with reporting co-occurrence of these conditions. This was done using multivariable logistic regression. Analyses were stratified by gender.

RESULTS

Compared to heterosexual men, gay men were at increased odds for reporting 2 or more chronic medical diseases (adjusted odds ratio [aOR] = 2.18, 95% confidence interval [CI] = 1.48, 3.21), and gay (aOR = 1.79, 95% CI = 1.09, 2.93) and bisexual men (aOR = 3.53, 95% CI = 2.03, 6.14) were at increased odds for reporting mental illness. Gay men (aOR = 2.95, 95CI = 1.60, 5.49) and bisexual men (aOR = 2.84, 95% CI = 1.58, 5.08) were at increased odds of reporting co-occurring conditions. Compared to heterosexual women, bisexual women were at increased odds for past-year drug use (aOR = 4.20, 95% CI = 2.55, 6.93), reporting mental illness (aOR = 1.94, 95% CI = 1.03, 3.67), and reporting co-occurring conditions (aOR = 3.25, 95% = 1.60, 6.62).

CONCLUSIONS

Middle-aged and older LGB adults in the United States are at high risk for experiencing co-occurring drug use, mental illness, and/or medical multimorbidity. Interventions for older sexual minority populations are needed to reduce disparities.

Loneliness and self-rated physical health among gay, bisexual and other men who have sex with men in Vancouver, Canada

BACKGROUND

Due to stigma and discrimination, gay, bisexual and other men who have sex with men (gbMSM) potentially carry a heightened burden of loneliness. This analysis investigates loneliness among gbMSM and its relationship with self-rated physical health, along with the mediating effect of depression.

METHODS

Participants were recruited using respondent-driven sampling into the Momentum Health Study (February 2012-February 2015) with follow-up visits occurring every 6 months till February 2018. Using computer-assisted self-interviews, measures of loneliness were assessed using a 6-item Loneliness Scale for Emotional and Social Loneliness (lonely vs not lonely). Current physical health was self-assessed (poor, fair, good, very good or excellent). A multivariable generalised linear-mixed model with a logit link function was used to examine the relationship between loneliness and self-rated physical health. We further investigated the mediating effect of depressive symptomatology on this relationship via the Hospital Anxiety and Depression Scale.

RESULTS

Of the 770 participants included, we found that 61% (n=471) experienced loneliness at baseline. Of the 674 (88%) who reported good/very good/excellent physical health, 59% (n=391) reported loneliness, compared with 87% (n=80) of those in poor/fair self-rated physical health who reported feeling lonely. After adjustment for confounding, loneliness was associated with poor self-rated physical health (adjusted OR 1.71; 95% CI 1.13 to 2.60). Depressive symptomatology was found to partially mediate this relationship.

CONCLUSION

There may be a need for the integration of social, mental and physical health programming, targeted towards gbMSM, to alleviate the degree of loneliness experienced and its co-occurrence with poor self-rated physical health.