Validation of an inclusive model of sexual minority identity formation on a sample of gay men

Sexual Identity Development and Social Ecological Facilitators and Barriers of PrEP Uptake and Adherence Among Latinx Men Who Have Sex with Men

Latinx gay, bisexual, and other men who have sex with men (LMSM) report lower pre-exposure prophylaxis (PrEP) use than their white, non-Latinx counterparts. We hypothesize that this disparity is partially attributable to social ecological factors that can be addressed via prevention interventions. In this retrospective study, we first examined data from 253 LMSM to determine whether theorized associations existed between acquisition of a PrEP prescription (uptake) in relation to several social ecological factors based on a conceptual framework of determinants of access to and uptake of PrEP for LMSM. We also explored relations between frequency of PrEP use (adherence) and social ecological factors with a subsample of 33 LMSM who had initiated PrEP 12 months prior to assessment. In this study, individual-level factors from this framework included age and socioeconomic status. Perceived access to medical care represented both individual- and community-level determinants of PrEP uptake and adherence. Interpersonal-level factors were social support and relationship status. Structural/cultural-level factors were sexual identity development status, the masculinity norm of heterosexual self-presentation, traditional Latinx masculine gender role beliefs of machismo and caballerismo, racial identity, and immigration status. Results indicated that older men and those who endorsed the synthesis/integration status of sexual identity development were more likely to acquire a PrEP prescription during their lifetime in comparison to peers. PrEP adherence was linked with being older, reporting higher socioeconomic status, reporting more appraisal social support, self-identifying as white-Latinx, being U.S.-born, and endorsing less sexual identity uncertainty and more heterosexual self-presentation. Results specify modifiable factors that may inform tailored, community-based prevention efforts to increase PrEP use and decrease existing HIV/AIDS disparities among LMSM.

Definitions and Measurement Tools for Assessing Parental Reactions to LGB People Coming Out: A Critical Review

Parental responses to young people's coming out as lesbian, gay or bisexual (LGB) are a crucial experience in identity formation and subsequent mental health outcomes. However, how parents react to coming out varies and remains relatively imprecise in the literature. The aim of the present critical review was to explore and discuss the different definitions and measurement tools used in studies assessing perceived parental reactions to the coming out of LGB people aged 18 years and over. Following PRISMA guidelines, a review of 14 selected articles was carried out to examine the different tools used. Then, based on this selection of articles, a review of the different proposed definitions of parental reactions was carried out. Analysis revealed that the Perceived Parental Reactions Scale emerged as the most widely used and most appropriate international scale for capturing the diversity of perceived parental reactions. Then, parental responses were often addressed in a dichotomous manner, focusing primarily on acceptance or rejection. Future studies will need to consider a more nuanced approach to understanding parental reactions to coming out.

Association of internalised homonegativity with partner notification after diagnosis of syphilis or gonorrhoea among men having sex with men in 49 countries across four continents

BACKGROUND

Partner notification (PN) after a sexually transmitted infection (STI) diagnosis is being promoted as a means to interrupt transmission chains. We investigated whether Internalised Homonegativity (IH) is associated with PN among men having sex with men (MSM).

METHODS

PN, defined as notifying at least one partner after diagnosis of syphilis and gonorrhoea, was queried in two internet-based self-completion surveys conducted between Oct 2017 and May 2018 in 68 countries in Europe, Latin America, Canada, and the Philippines. IH is defined by a man's level of agreement or disagreement with negative social beliefs about male homosexuality. Covariates included in a multivariate regression model with a random intercept at country level were age, HIV diagnosis, partnership status, sexual self-efficacy, HIV serostatus communication during last sex with a non-steady partner, place where this partner was met, and PN-related socio-historical background of the country of residence. We grouped countries in three areas: North- and Central-Western European countries plus Canada, former socialist countries, and Latin-American/Mediterranean countries plus the Philippines. In each of the three areas individuals were assigned to 4 subgroups based on IH quartiles and PN rates were determined for each subgroup.

RESULTS

PN rates were calculated for 49 countries (excluding countries with less than 10 diagnoses). Mean proportions of MSM notifying their partners were 68.1% and 72.9% after syphilis and gonorrhoea diagnoses, respectively. PN rates were lower in Latin American countries and the Philippines compared to European countries. Within Europe, a North-South divide with lower PN rates in Mediterranean countries was observed. In each of the three regions we mostly observed a stepwise increase of PN rates with decreasing IH. Regression analysis showed lower IH scores associated with higher PN rates. Higher perceived self-efficacy, living in a partnership, and HIV status communication were positively associated with PN. Men who had met their last partner in a gay social venue were more likely to have notified their partners of a syphilis diagnosis compared to men who had met this partner online. Men with diagnosed HIV were less likely to report PN.

CONCLUSIONS

We could demonstrate that IH was associated with PN among MSM across all countries included in our analysis. Reducing cultural homophobia and ensuring inclusive policies may contribute to STI prevention and control.

The process of contemporary gay identity development in China: The influence of internet use

Background

Adolescence and emerging adulthood are critical periods for an individual's sexual identity development. The internet has become a primary avenue for gay identity exploration. The purpose of this study was to examine the role of the internet in Chinese young gay male's sexual identity development.

Methods

Qualitative interviews were conducted with 37 gay males aged 16 to 29. Data were analyzed using grounded theory methods.

Results

Three categories of identity development in relation to use of the internet were identified: (1) Gay identity confirming, which includes verifying same-sex attraction and connecting the attraction feeling to gay identity through consumption of pornography, Tanbi (boy's love) materials, and searching for information online. (2) Gay identity practicing, includes interacting with the gay community to gain understandings of gay subcultures and make close gay friends, engaging in same-sex sexual and romantic relationship development through online group and interpersonal interactions. The internet practice impact on an individual's cognition and behavior by presenting same-sex sexual contact is normal and common, facilitating longing for a romantic relationship, and facilitating relationship development; and (3) Gay identity coping, includes increasing self-acceptance of gay identity, gaining a sense of belonging in the gay community, increasing autonomy in sexual and romantic relationship development, and growing consideration of coming out to parents. Young gay males' coping efficacy was gained through the lessons learned from identity practice.

Conclusion

The findings indicate that an individual's internet practice facilitates gay identity confirmation, enriches identity practice, and promotes the transition from self-identification to identity disclosure and integration. Internet practice also threatens to young gay males' sexual risk behavior, emotional hurts from failed romantic relationships. Interventions including sexual identity education and healthy internet use strategies need to be developed tailored to the developmental characteristics.

Switching to Non-daily Pre-exposure Prophylaxis Among Gay and Bisexual Men in Australia: Implications for Improving Knowledge, Safety, and Uptake

INTRODUCTION

Preexposure prophylaxis (PrEP) dosing options such as event-driven PrEP hold promise to increase PrEP uptake among gay, bisexual, and queer men (GBQM), but their impacts have not yet been realized and uptake by GBQM suitable for PrEP remains slow in countries where it is only considered an alternative option to daily PrEP.

METHODS

We conducted semi-structured interviews between June 2020 and February 2021 with 40 GBQM in Australia to understand PrEP dosing behaviors, knowledge, and preferences.

RESULTS

All participants commenced PrEP daily; 35% had ever switched to non-daily PrEP, mostly taking it event-driven. GBQM who preferred non-daily PrEP had infrequent or predictable sex, were concerned about cost given infrequency of sex, and/or wanted to minimize unnecessary drug exposure. Accurate knowledge of event-driven PrEP was poor. However, reflecting concepts underpinning critical pedagogy, having accurate knowledge was supported by access to consistent messaging across clinical, social, community, and public settings. Several participants who switched to event-driven PrEP had condomless sex events in which they were unable to adhere to pills due to unanticipated sex.

CONCLUSIONS AND POLICY IMPLICATIONS

Implementation of comprehensive and consistent education about correct dosing for event-driven PrEP across multiple settings is needed to ensure increased uptake and safe use. GBQM require messaging about non-condom based HIV prevention strategies when they cannot access daily or event-driven PrEP.

Toward the Complexity of Identity: "Being and Not Being Lesbian" in Contemporary Thailand

This paper uncovers the ways Thai lesbians negotiate and construct their sense of self as "lesbian," particularly, in the process of "coming out." It incorporates concepts such as perception and communication of self, as well as their relationships with partners and their families. The analysis is based on in-depth interviews with a sample of 13 self-identified lesbians, all of whom come from a middle-class background and engage in several professions. The results indicated that they constructed their lesbian identities while attempting to negotiate around established conformist and heteronormative structures. Respondents placed considerable emphasis on "not being different" with the notions of loving companionship, faithful relationships, and daughter obligations indicated the sameness. Conventional gender roles stemming from a dominant patriarchal culture continue to bind reported aspects of female same-sex practices. Thai lesbians continue to struggle, continuing to re-construct and deconstruct their identities even within the seemingly inclusive outlook of contemporary Thailand.

Same-Sex Attracted, Not LGBQ: The Associations of Sexual Identity Labeling on Religiousness, Sexuality, and Health Among Mormons

In the Church of Jesus Christ of Latter-Day Saints (LDS church), beliefs about same-sex sexual attraction are carefully differentiated from beliefs about same-sex sexual behavior and identity, leading some to reject a lesbian, gay, bisexual, or queer (LGBQ) identity label in favor of declining a sexual identity or describing themselves as experiencing same-sex attraction (SSA). Using data from 1,128 sexual minority Mormons recruited from both politically conservative and liberal circles, we examined the relationship between rejecting an LGBQ identity and religiousness, attitudes toward sexuality, and health outcomes. We found that Mormons who reject an LGBQ identity were significantly more religious and less content with their sexuality but had similar health outcomes relative to LGBQ Mormons. We posit that these differences are best understood by differences in group affiliation and support, intersectional experiences with minority stressors, and the lack of generalizability of LGBQ constructs to those who reject an LGBQ identity.

Psychosocial and Behavioral Correlates of Internalized Homonegativity in Midlife and Older Gay and Bisexual Men

This study investigated psychosocial and demographic variables that might influence internalized homonegativity (IH) in midlife and older gay and bisexual men (GBM). Data were collected from 802 community-dwelling GBM aged 40 to 94 years ( M = 54.8) through an anonymous questionnaire that assessed levels of IH, coping self-efficacy, self-silencing, and other characteristics. Multivariate logistic regression analysis successfully explained 22% of the variance in predicting IH, which was significantly related to coping self-efficacy, self-silencing, gay community volunteering, partnership status, and race, F = 59.74, p < .001. IH scores were highest in participants who were single, had lower education levels, were non-White, were less involved in gay community volunteering, experienced less coping self-efficacy, and reported higher levels of self-silencing behaviors. These data underscore the need for more tailored programming approaches for midlife and older GBM, focusing on underlying factors contributing to IH that include skill-building to increase coping self-efficacy, community involvement, and decrease self-silencing behaviors in this overlooked population.

LGBT Identity and Its Influence on Perceived Effectiveness of Advertisements from a LGBT Tobacco Public Education Campaign

Lesbian, gay, bisexual, and transgender (LGBT) individuals are at increased risk for tobacco use compared to those who are not LGBT. The Food and Drug Administration's Center for Tobacco Products launched the first U.S. large-scale tobacco public education campaign for LGBT young adults aged 18-24, This Free Life. The current study, using data from the evaluation of the This Free Life campaign, investigated the role of LGBT Identity Affirmation (i.e., the development of positive feelings or attachment to being LGBT), LGBT Identity Centrality (i.e., the degree to which an aspect of a person's identity shapes their overall identity), and Identification with the LGBT Community (i.e., an individual's relationship with the LGBT community) on perceived effectiveness of four This Free Life advertisements. The current study sample included 2,788 LGBT young adults. For the "Our Story" and "Flawless" advertisements, all three identity constructs were statistically significant positive predictors of perceived advertisement effectiveness. For female-centric and male-centric "Tip the Scale" advertisements, LGBT Identity Centrality and Identification with the LGBT Community were significant positive predictors. An additional secondary analysis found differences in identity constructs between sexual and gender minority subgroups. These results support that identity constructs may be leveraged in health interventions.

Heterosexual Self-Presentation and Other Individual- and Community-Based Correlates of HIV testing among Latino Men Who Have Sex With Men

From 2010 to 2014, HIV diagnoses among Latino men who have sex with other men (LMSM) have increased by 14%, while diagnoses declined by 11% among white, non-Latino MSM. This health disparity is in part due to exposure to other LMSM with undiagnosed HIV infections. To effectively engage LMSM who are unaware of their serostatus, profiles of men differing in theorized determinants of HIV testing must be considered. In this retrospective study, we examined data from 546 LMSM to investigate whether hypothesized individual- (traditional masculine gender role conformity; sexual identity development status; alcohol and illicit drug use; sexual risk behaviors; perceived HIV susceptibility; and HIV stigma) and community-based (HIV prevention programming, access to health care, social support, neighborhood collective efficacy) factors were associated with differences in HIV testing. Latent profile analysis was used to identify profiles of men, and subsequent analyses examined whether profiles exhibited differential proportions of HIV testing. Four latent profiles were observed. One profile (50.3% tested) differed markedly from all other profiles (5.1 to 11% tested) in HIV testing. Characteristics of participants in this unique profile included reporting lower levels of heterosexual self-presentation, sexual identity uncertainty (and high levels of sexual identity commitment), condom use, HIV stigma, education, and perceived HIV susceptibility than all other profiles. Findings could improve HIV testing rates among LMSM by specifying ways in which public health advertisements/campaigns and community-based testing outreach efforts could be tailored to men most at-risk for transmitting HIV due to unknown serostatus.

Birth Cohort Differences in Sexual Identity Development Milestones Among HIV-Negative Gay and Bisexual Men in the United States

The coming-out process for gay and bisexual men (GBM) involves crossing sexual identity development (SID) milestones: (1) self-awareness of sexual attraction to the same sex, (2) self-acceptance of an identity as gay or bisexual, (3) disclosure of this sexual identity to others, and (4) having sex with someone of the same sex. We examined trends in SID milestones by birth cohort in a 2015 U.S. national sample of GBM (n = 1,023). Birth cohort was independent of when men first felt sexually attracted to someone of the same sex (median age 11 to 12). However, with the exception of age of first same-sex attraction, older cohorts tended to pass other milestones at later ages than younger cohorts. Latent class analysis (LCA) of SID milestone patterns identified three subgroups. The majority (84%) began sexual identity development with same-sex attraction around the onset of puberty (i.e., around age 10) and progressed to self-identification, same-sex sexual activity, and coming out-in that order. The other two classes felt same-sex attraction during teen years (ages 12.5 to 18.0) but achieved the remaining SID milestones later in life. For 13% of men, this was during early adulthood; for 3% of men, this was in middle adulthood. Findings highlight the need to monitor ongoing generational differences in passing SID milestones.

Navigating identity: Experiences of binary and non-binary transgender and gender non-conforming (TGNC) adults

Background: Emerging research and colloquial dialogues increasingly point to an uptick in non-binary gender identity endorsement, however research has failed to parallel this increase. For example, existing literature often conflates gender identity with sexual orientation, lumping TGNC people under the LGBTQ umbrella, thus rendering the "T" silent in the process. Further, extant research adheres to a binary (i.e., dichotomous male/female) conceptualization of gender, thus excluding individuals who identify as genderqueer, gender non-conforming, or otherwise non-binary as well as those who do not identify with the construct of gender at all (e.g., agender). Method: This qualitative investigation utilized individual interviews with 15 TGNC adults. Data analysis employed two data-driven phases, first identifying themes consistent across the 15 transcripts to identify nuances in TGNC identity formation often missed by theory-driven models and second, establishing similarities and differences between binary and non-binary narratives. Results: Results indicated that various helpful and challenging factors played a stronger role than chronology, physical transition, or activism across all participants which contrasts findings in extant literature. Further, while binary and non-binary narratives were similar in many regards, several noteworthy distinctions emerged. For example, the concepts of "passing or blending", intersections of gender identity with sexual orientation, and navigating identity presentation and disclosure were described differently for binary and non-binary participants. Conclusions: Historically, the "T" in "LGBTQ" has often been rendered silent. These results indicate that non-binary narratives have been rendered doubly silent. Given the increasing preponderance of non-binary identifications and the unique needs and experiences of non-binary participants, it is crucial that professional and lay communities alike begin to take two steps moving forward: 1) explicitly acknowledge the existence of non-binary TGNC identities and 2) work to achieve fluency regarding the unique needs and experiences of this population.

Methodological and Content Review of Lesbian-, Gay-, and Bisexual-Related Articles in Counseling Journals: 1990-1999

Despite the reduction of overt heterosexist biases in the psychological literature, questions exist about the content and methodology of articles on lesbian, gay, and bisexual (LGB) issues in the counseling literature. This study provides a content and methodological analysis of 119 LGB-related articles that were published in eight major counseling journals from 1990-1999 and extends past reviews by examining issues related to bisexuality. Increasing integration of LGB issues in the counseling literature was apparent, as were methodological improvements in empirical research. Various limitations also emerged, such as the need for more theory-based research, instrument development, and attention to within-group differences (e.g., bisexual people and LGB people of color). Findings are discussed against the backdrop of the sociopolitical context of American psychology, with an emphasis on implications for future LGB-related research, practice, and training.

Heterosexual Identity Development

This article builds on earlier conceptual models of identity development to propose a model of heterosexual identity development. A review of the existing literature on majority and minority group identity development, heterosexuality, and other relevant foundational literature is provided as a rationale for the proposed model. Based on an analysis of the strengths and limitations of the existing literature, the authors propose a preliminary model of heterosexual identity development. The article concludes with implications for research, practice, training, and measurement in counseling psychology.

Why Do Individuals Seek Conversion Therapy?

This study examined the potential influence of religiosity, sexual orientation identity development, and internalized homonegativity on the propensity to seek conversion therapy to change one’s sexual orientation. An Internet sample of 76 women and 130 men who were gay-identified, lesbian-identified, same-sex attracted, and “questioning” was studied. Results indicated that two types of religious orientations, intrinsic and quest, predicted a propensity to seek conversion therapy, although in different directions. Further more, internalized homonegativity fully mediated the relationships between religious orientation and propensity to seek conversion therapy. Additionally, there was a significant inverse relationship between sexual orientation identity development and propensity to seek conversion therapy. Implications for practice and research are discussed.

Muslim and gay: seeking identity coherence in New Zealand

The process of accepting oneself as gay and of 'coming out' to family and friends is well documented. For Muslim men, this is complicated by the tension between their emerging sexual identity and their religious and cultural birth identity, which labels homosexuality as sinful. This paper explores this process in a sample of five gay Muslim men living in New Zealand, a liberal secular society where homosexuality is widely accepted and gay rights are endorsed in legislation. Identity Process Theory drives the analysis, which identifies five themes encapsulating the process of striving for psychological coherence: resistance, acceptance, tension, renegotiation and pretence. Initial phases of denial and anger at their emerging sexuality are strongly linked to the conflict with their religious identity. Later, acceptance of their sexuality as natural and even God-given protects them from blame for their 'sins'. In contrast to earlier work in the UK, for most men, renegotiation of their Muslim identity is adopted as the key strategy for achieving intrapsychic coherence. However, at an interpersonal level, families remain a source of conflict, temporarily resolved through pretence. Renegotiating religious identity leaves men having to pretend not just to be straight, but also to be strongly religious.

Outcomes of sexual behaviors among sexual minority youth

Very little is known about outcomes of sexual behavior for sexual minority youth. In this chapter, I review relevant literature and draw on findings from my own research to initiate an inquiry into this important topic. I begin with a brief overview of the range of sexual behaviors of sexual minority adolescents and young adults. Next, I describe what we know about positive and negative outcomes of sexual behavior among sexual minority youth. This discussion takes into account physical outcomes, psychological and emotional outcomes, and outcomes related to identity development. Lastly, I discuss the limitations of prior research and propose several goals for future research to expand our understanding of this topic.

MINORITY STRESS, POSITIVE IDENTITY DEVELOPMENT, AND DEPRESSIVE SYMPTOMS: IMPLICATIONS FOR RESILIENCE AMONG SEXUAL MINORITY MALE YOUTH

INTRODUCTION

Minority stress processes have been shown to have significant associations with negative mental health outcomes among sexual minority populations. Given that adversity may be experienced growing up as a sexual minority in heteronormative, if not heterosexist, environments, our research on resilience among sexual minority male youth proposes that positive identity development may buffer the effects of a range of minority stress processes.

METHODS

An ethnically diverse sample of 200 sexual minority males ages 16-24 (mean age, 20.9 years) was recruited using mixed recruitment methods. We developed and tested two new measures: concealment stress during adolescence and sexual minority-related positive identity development. We then tested a path model that assessed the effects of minority stressors, positive identity development, and social support on major depressive symptoms.

RESULTS

Experience of stigma was associated with internalized homophobia (β=.138, p<.05) and major depressive symptoms (β=1.076, OR=2.933, p<.001), and internalized homophobia partially mediated experience's effects on major depression (β=.773, OR=2.167, p<.001). Concealment stress was associated with positive identity development (β=.155, p<.05) and internalized homophobia (β=.418, p<.001), and positive identity development partially mediated concealment stress's effects on internalized homophobia (β=-.527, p<.001). Concealment stress demonstrated a direct effect on major depression (β=1.400, OR=4.056, p<.001), and indirect paths to social support through positive identity development.

CONCLUSIONS

With these results, we offer an exploratory model that empirically identifies significant paths among minority stress dimensions, positive identity development, and major depressive symptoms. This study helps further our understanding of minority stress, identity development, and resources of resilience among sexual minority male youth.

Inhabiting the sexual landscape: toward an interpretive theory of the development of sexual orientation and identity

Building on Paula Rust's (1996) concept of a sexual landscape, we propose an interpretive theory of the development of both sexual orientation and sexual identity. We seek to reconcile human agency with active and shifting influences in social context and to recognize the inherent complexity of environmental factors while acknowledging the role that biological potential plays. We ground our model in the insights of three compatible and related theoretical perspectives: social constructionism, symbolic interactionism, and scripting theory. Within this framework, we explain how sexual orientation and sexual identities develop and potentially change.

Not all one and the same: Sexual identity, activism, and collective self-esteem

This study examines important distinctions in sexual orientation identities by exploring the relationships among sexual identity, activism, and collective self-esteem. Past research has revealed that individuals who label themselves as belonging to certain minority sexual identities may experience different types of outcomes; for instance, bisexual individuals have been shown to experience more psychological hardships (Brewster & Moradi, 2010; Browne & Lim, 2010), whereas Queer individuals' politicization may buffer against some of these negative experiences and increase their psychological well-being (Galinsky et al., 2013; Klar and Kasser, 2009; Riggs, 2010). We explored whether these important differences could be attributed to a person's choice of a sexual identity description. An online survey was distributed to Facebook groups affiliated with 33 universities across Canada, which yielded responses from 265 participants. Four distinct sexual identity categories were created and compared in two multiple regression models that controlled for measures of personal and social identity. In the first model, we tested group differences in collective self-esteem and, in the second model, we assessed group differences in political activism. As predicted, collective self-esteem was significantly lower for those who identified as bisexual, and activism was most likely among those who identified as Queer. Our research highlights the need for caution when either measuring or studying aspects of sexual orientation, since these identity categories reflect different personal and political points of reference.

Gay- and Lesbian-Identified Law Enforcement Officers

This qualitative exploration examined how 14 gay- and lesbian-identified law enforcement officers managed career choice, satisfaction, and their intersecting sexual/vocational identities. Participants reported choosing the vocation for much the same reasons as others already mentioned in the literature, including service/duty to community, financial benefits, and family influences. Constraining and facilitating factors were discovered, shedding light on how participants managed their intersecting identities, and their influence on career satisfaction. These factors deepen the understanding of when participants shared their sexual identity with colleagues and to what impact within the career environment. The presence of homophobic microaggressions without institutional support to address the hostile environment significantly hampered job satisfaction and willingness to risk being out at work for some. Implications and suggestions for future research are discussed, including the findings’ usefulness for other quasimilitary vocational settings in the aftermath of the repeal of “Don’t ask, don’t tell” legislation in the military.

Lesbian, Gay, and Bisexual Identity Scale (LGBIS): Construct Validation, Sensitivity Analyses and other Psychometric Properties

According to Mohr and Fassinger (2006), identity is seen as both self-identification and collective identification with values, beliefs, traits or behaviours and attachments. Their Lesbian, Gay, and Bisexual (LGB) multidimensional identity model accounts for important variables regarding the constitution of identities. This model not only accesses numerous dimensions of the lives of LGB individuals, but is also based on a body of research that recognizes how LGB difficulties are caused by societal intolerance and marginalization (Mohr & Fassinger, 2000). The Lesbian, Gay, and Bisexual Identity Scale (LGBIS; Kendra & Mohr, 2008) constitutes an operationalization of this multidimensional model, and the aim of this article is to present its construct validity by analysing its factor structure using a sample of Portuguese lesbian, gay and bisexual participants. Results from exploratory and confirmatory factor analyses, as well as from factor invariance analysis across sub-samples are presented. In a general way, the factor structure obtained in this study follows the original proposal of Kendra and Mohr's (2008) LGBIS. Moreover, scale sensitivity analyses are presented in order to check for eventual differences in the factor structure and/or factor intercorrelations regarding participant gender and sexual orientation. These results are then discussed in the light of LGB identity models.

Chasing sexual orientation: a comparison of commonly used single-indicator measures of sexual orientation

This research investigated the utility of single-indicator measures of sexual orientation in examining group differences. Adolescents and young adults reported their sexual orientations, preferences, and partners. Results indicate that, (a) depending on the measure of sexual orientation, 10% to 22% cannot be categorized into a sexual orientation group using a single-indicator measure; (b) self-identified sexual orientation is often incongruent with preference and behavior; (c) incongruity differs by gender and self-identified sexual orientation; and (d) detected differences in gay/lesbian, bisexual, and straight individuals vary by measure of sexual orientation. These results indicate that classification of sexual orientation by single-indicator measures can lead to inconsistent conclusions across studies.

A systematic review of instruments that measure attitudes toward homosexual men

Scientific interest in the measurement of homophobia and internalized homophobia has grown over the past 30 years, and new instruments and terms have emerged. To help researchers with the challenging task of identifying appropriate measures for studies in sexual-minority health, we reviewed measures of homophobia published in the academic literature from 1970 to 2012. Instruments that measured attitudes toward male homosexuals/homosexuality or measured homosexuals' internalized attitudes toward homosexuality were identified using measurement manuals and a systematic review. A total of 23 instruments met criteria for inclusion, and their features were summarized and compared. All 23 instruments met minimal criteria for adequate scale construction, including scale development, sampling, reliability, and evidence of validity. Validity evidence was diverse and was categorized as interaction with gay men, HIV/AIDS variables, mental health, and conservative religious or political beliefs. Homophobia was additionally correlated with authoritarianism and bias, gender ideology, gender differences, and reactions to homosexual stimuli. Internalized homophobia was validated by examining relationships with disclosing one's homosexuality and level of homosexual identity development. We hope this review will make the process of instrument selection more efficient by allowing researchers to easily locate, evaluate, and choose the proper measure based on their research question and population of interest.

The role of multiple identities in adherence to medical appointments among gay/bisexual male adolescents living with HIV

Adolescents living with HIV require engagement with care providers in order to access the critical medical and psychosocial services they need. The current study sought to explore developmental determinants of adherence to medical appointments as one aspect of engagement in care among a geographically diverse sample of 200 gay/bisexual male adolescents (16-24 years) living with HIV, with a specific focus on ethnic identity, sexual orientation identity, and identity as a young man living with HIV. Ethnic identity affirmation (OR = 0.6; 95% CI: 0.3, 0.9), morality of homosexuality (OR = 1.7; 95% CI: 1.2, 2.5), and HIV-positive identity salience (OR = 1.5; 95% CI: 0.9, 2.4) were associated with significantly higher risk for missed appointments in the past 3 months. These findings highlight the importance of attending to developmental factors, such as the development of multiple identities, when attempting to increase engagement in care for gay/bisexual male adolescents living with HIV.

Rethinking sexual initiation: pathways to identity formation among gay and bisexual Mexican male youth

The topic of same-sex sexual initiation has generally remained understudied in the literature on sexual identity formation among sexual minority youth. This article analyzes the narratives of same-sex sexual initiation provided by 76 gay and bisexual Mexican immigrant men who participated in interviews for the Trayectos Study, an ethnographic study of sexuality and HIV risk. These participants were raised in a variety of locations throughout Mexico, where they also realized their same-sex attraction and initiated their sexual lives with men. We argue that Mexican male same-sex sexuality is characterized by three distinct patterns of sexual initiation--one heavily-based on gender roles, one based on homosociality, and one based on object choice--which inform the men's interpretations regarding sexual roles, partner preferences, and sexual behaviors. We analyzed the social factors and forms of cultural/sexual socialization that lead sexual minority youth specifically to each of these three patterns of sexual initiation. Our findings confirm the importance of studying same-sex sexual initiation as a topic in its own right, particularly as a tool to gain a greater understanding of the diversity of same-sex sexual experiences and sexual identities within and among ethnic/cultural groups.

Mental health among Israeli homosexual adolescents and young adults

This study examines the mental health status of Israeli homosexuals in adolescence and early adulthood in comparison to heterosexual controls. We compared 219 homosexuals (136 gay men and 83 lesbian women) with 219 individually matched heterosexuals on indices of depression and subjective well being. In line with the study hypothesis, the results indicated that the homosexual participants reported more depressive symptoms and more negative affect than matched heterosexuals. However, the homosexuals were also found to report a higher level of positive affect. This study suggests that co-activated systems of negative and positive emotions facilitate adaptation among young homosexuals.

Different patterns of sexual identity development over time: implications for the psychological adjustment of lesbian, gay, and bisexual youths

Despite research documenting variability in the sexual identity development of lesbian, gay, and bisexual (LGB) youths, it remains unclear whether different developmental patterns have implications for the psychological adjustment of LGB youths. This report longitudinally examines whether different patterns of LGB identity formation and integration are associated with indicators of psychological adjustment among an ethnically diverse sample of 156 LGB youths (ages 14-21) in New York City. Although differences in the timing of identity formation were not associated with psychological adjustment, greater identity integration was related to less depressive and anxious symptoms, fewer conduct problems, and higher self-esteem both cross-sectionally and longitudinally. Individual changes in identity integration over time were associated with all four aspects of psychological adjustment, even after controlling for rival hypotheses concerning family and friend support, gay-related stress, negative social relationships, and other covariates. These findings suggest that difficulties in developing an integrated LGB identity may have negative implications for the psychological adjustment of LGB youths and that efforts to reduce distress among LGB youths should address the youths' identity integration.

Processes of sexual orientation questioning among heterosexual women

Because very little is known about heterosexual identity development, this study assesses and describes sexual orientation questioning processes of heterosexual-identified women and offers a comparison of these processes with those employed by their sexual-minority counterparts. Participants included 333 female college students (ages 18-23; M = 19.2): 228 participants primarily identified as "exclusively straight/heterosexual," and 105 participants indicated a sexual-minority identity. Sixty-seven percent of exclusively heterosexual respondents (n = 154) indicated having thought about or questioned their sexual orientation. The processes by which heterosexual participants described questioning their sexual orientation were coded for the presence of five emergent categories using an inductive thematic coding methodology. These five categories included unelaborated questioning (19%), other-sex experiences (16%), exposure to sexual minorities (26%), assessment of same-sex attraction (48%), and evaluations of same-sex behavior (26%). Several unifying and differentiating themes emerged between sexual orientation groups. Results from this study suggest that contemporary young women's heterosexuality is not necessarily an unexamined identity; indeed, the large majority of young women in this sample were deliberately identifying as heterosexual after contemplating alternative possibilities.

Sexual identity and sexual well-being in female heterosexual university students

Sexual identity has generally been studied with a focus on sexual orientation and has not incorporated a general identity framework. Low levels of identity exploration and commitment have been shown to predict poor well-being in adolescents, but the relationship between sexual identity and sexual well-being has not been examined. The current cross-sectional survey was administered to 293 heterosexual female undergraduate students from a mid-sized university in Ontario, Canada. Participants completed the Measure of Sexual Identity Exploration and Commitment (Worthington, Navarro, Savoy, & Hampton, 2008), as well as several measures to assess sexual well-being. These included the Sexuality Scale (Snell & Papini, 1989), the Sexual Awareness Questionnaire (Snell, Fisher, & Miller, 1991), the Body Esteem Scale for Adolescents and Adults (Mendelson, Mendelson, & White, 2001; Mendelson, White, & Mendelson, 1997), and four individual items assessing sexual satisfaction (Laumann et al., 2006). Confirmatory factor analysis was used to test the measurement models of sexual identity and sexual well-being, and structural equation modeling was used to examine the relationship between sexual identity and sexual well-being. Results indicated that higher levels of sexual identity exploration and commitment predicted sexual well-being. However, other aspects of sexual identity, such as synthesis and sexual orientation identity, were not predictive of sexual well-being. The implications of using an identity framework for measuring sexual identity are discussed.

Multicultural Personality: An Evolving Theory of Optimal Functioning in Culturally Heterogeneous Societies

The present article provides an update of the author’s evolving theory of the “multicultural personality” (MP). The MP is conceptualized as a narrow matrix of personality traits or dispositions (characteristic adaptations) that can be subsumed under broad trait models of personality (e.g., Big Five). MP theory posits that its constituent factors will demonstrate incremental validity over broad personality traits in predicting adaptive human behavior in increasingly culturally heterogeneous societies. The present theory of the MP is anchored across the disciplines of evolutionary biology, human ecology, personality and developmental psychology, and counseling and positive psychology. The specific definition of the MP is based on an integration of leading theories and constructs in multicultural psychology. Limitations of MP theory are highlighted, future directions for research presented, and tentative implications for counseling training and practice noted.

The coming-out process of young lesbian and bisexual women: are there butch/femme differences in sexual identity development?

Research on lesbian and bisexual women has documented various biological and behavioral differences between butch and femme women. However, little research has examined whether differences exist in sexual identity development (i.e., the coming-out process). The present study examined longitudinally potential butch/femme differences in sexual identity formation and integration among an ethnically diverse sample of 76 self-identified lesbian and bisexual young women (ages 14-21 years). A composite measure of butch/femme identity classified 43% as butch and 51% as femme. Initial comparisons found butch/femme differences in sexual identity (i.e., nearly all butches identified as lesbian, but about half of femmes identified as bisexual), suggesting the need to examine this confound. Comparisons of lesbian butches, lesbian femmes, and bisexual femmes found that lesbian butches and femmes generally did not differ on sexual identity formation, but they differed from bisexual femmes. Lesbian butches and femmes had sexual behaviors and a cognitive sexual orientation that were more centered on women than those of bisexual femmes. With respect to sexual identity integration, lesbian butches were involved in more gay social activities, were more comfortable with others knowing about their homosexuality, and were more certain, comfortable, and accepting of their sexual identity than were bisexual femmes. Fewer differences were found between lesbian femmes and bisexual femmes or between lesbian butches and lesbian femmes. The findings suggest that sexual identity formation does not differ between butch or femme women, but differences are linked to sexual identity as lesbian or bisexual. Further, the findings that lesbian femmes sometimes differed from lesbian butches and at other times from bisexual femmes on sexual identity integration suggest that neither sexual identity nor butch/femme alone may explain sexual identity integration. Research examining the intersection between sexual identity and butch/ femme is needed.