Sexual identity distress, social support, and the health of gay, lesbian, and bisexual youth

LGBTQ+ Grassroots Activism: An Opportunity for Resilience

Lesbian, gay, bisexual, transgender, queer, and other gender and sexual minority (LGBTQ+) individuals have a long history of mobilizing to raise awareness and initiate social and political change for LGBTQ+ related issues. The present study explored how grassroots activism impacted resilience among LGBTQ+ people. In-depth and semi-structured interviews were conducted with 15 LGBTQ+ activists from one statewide grassroots organization aiming to ban conversion therapy. Grounded theory analysis was used to identify a central theme and six interrelated subthemes. The central theme was that outness, activism, and resilience have cyclical relationships. Subthemes were related to identity exploration, affirmation, and synthesis; responsibility and humility; psychological skills; coping; social support; and negative experiences. These data may be helpful for LGBTQ+ grassroots activism and community leaders aiming to boost the resilience and strengthen well-being of their organization members.

Conditions for Social Exclusion Leading to Distress Change in Chinese Lesbian, Gay, and Bisexual (LGB) People

Lesbian, gay, and bisexual (LGB) people are likely to be at risk of distress because of social exclusion, including the feelings of resentment, resistance, and rejection they might experience from society. Nevertheless, the conditions for social exclusion leading to changes in distress are empirically unclear, especially in Chinese LGB people. To examine these conditions, this study surveyed 303 Chinese LGB people in Taiwan, Hong Kong, and various places in Mainland China. For comparability with other LGB studies, the study did not explicitly identify asexual, demisexual, or pansexual people in the LGB group. Results show that the retrospective reporting of social exclusion in 2016 did not significantly and unconditionally predict levels of distress in 2017. However, the reporting of exclusion significantly predicted current distress when the retrospective report of distress in 2016 was high. These results from the stress-vulnerability model indicate that prior distress is a vulnerability condition that allows social exclusion to exert its stressful effect. This study implies the need to prevent the social exclusion of highly distressed LGB people.

Measurement Invariance of Psychological Distress, Substance Use, and Adult Social Support across Race/Ethnicity and Sex among Sexual Minority Youth

Research on intersectional differences among sexual minority youth (SMY) relies on population-level datasets to ensure sufficiently large samples to explore between-group differences and assess the influence of axes of oppression/privilege. I argue that a structural equation modeling framework for investigating intersectional differences among SMY increases the nuance with which we understand heterogeneity and provides tools for ensuring that variables measure comparable constructs across diverse populations - an assumption of traditional univariate methods that is rarely empirically verified. Using a subset of SMY that identified as either White or Hispanic/Latino and male or female from the New Mexico Youth Risk and Resiliency Survey (N = 3,654), this study tested invariance of three latent constructs: psychological distress, substance use, and adult support across sexual orientation, race/ethnicity, sex, and three-way intersections of those identities. Analyses established invariance across race/ethnicity and sex of all constructs among gay/lesbian youth. Partial invariance models were required to account for intersectional differences in substance use among bisexual youth and in psychological distress among questioning youth. This study models a novel strategy for examining how social location at the intersection of multiple axes of oppression/privilege shape behavioral health and social support and paves the way for significant advances in research on SMY.

Loneliness in Sexual Minority Individuals in the Southeastern United States: The Role of Minority Stress and Resilience

Health disparities in the sexual minority population may be exacerbated by the loneliness experienced due to minority stress. Using a minority stress framework, this study examined minority stress, protective variables, and mental health as correlates of loneliness in sexual minority individuals in a small metropolitan area in the southeastern United States. Participants (n = 273) were a subsample of sexual minority individuals from a broader sample of LGBTQ adults in the Central Savannah River area who completed a health needs assessment. Bivariate correlations were calculated to assess for degree of significant relationships between loneliness and barriers to health care, minority stress, and mental health. Hierarchical linear regression was conducted to examine the relative importance of the study variables' associations with loneliness. A multiple regression model found household income, assault victimization, depressive symptoms, and sense of community to be significant correlates of loneliness. Interventions to decrease loneliness in this population will need to consider these interconnected, multi-level influences.

Illicit drug use among lesbian, gay, bisexual, pansexual, trans and gender diverse, queer and asexual young people in Australia: Intersections and associated outcomes

INTRODUCTION

High rates of illicit drug use have been reported among gay and bisexual young men, however limited research has examined patterns of drug use among the broader population of lesbian, pansexual, trans and gender diverse, asexual and queer (LGBTQA) young people. We examined factors associated with illicit drug use in the past 6 months and lifetime experiences of self-reported concern with drug use among LGBTQA youth in Australia.

METHODS

A cross-sectional survey was conducted involving 6418 LGBTQA participants aged 14-21 years, 5914 of whom provided information relating to their use of illicit drugs. Multivariable logistic regressions examined demographic factors and life experiences associated with drug use in the past 6 months and lifetime experiences of self-reported concern with drug use.

RESULTS

Overall, 26.4% of participants aged 14-17 and 41.9% aged 18-21 reported any drug use in the past 6 months, of whom 23.5% had ever been concerned about their drug use. Cannabis use was most commonly reported (28.3%), followed by ecstasy/MDMA (7.1%), antidepressants (5.6%) and LSD (3.5%). Higher odds of drug use were reported among cisgender men and those who had experienced homelessness or sexual harassment in the past 12 months. Higher odds of self-identified concern about drug use were observed among participants reporting challenging life experiences.

DISCUSSION AND CONCLUSIONS

Rates of illicit drug use among LGBTQA young people in this study were considerably higher than those observed in general population youth studies in Australia and were further elevated among those who had experienced LGBTQA-related prejudice or harassment, or homelessness.

Comparing sexual orientation identity development in plurisexual versus monosexual latinx sexual minority youth

INTRODUCTION

Plurisexual individuals represent 50% of sexual minority adolescent communities. However, most studies of sexual minority adolescents analyze this population as a homogeneous group rather than attending to plausible differences between plurisexual and monosexual sexual minority youth. This study examined whether plurisexual Latinx youth differed from monosexual youth on three facets of sexual orientation identity (SOI) development (exploration, resolution, and affirmation). Further, we examined whether plurisexual (vs. monosexual) identity moderated the relationship between SOI development and depressive symptoms and self-esteem.

METHODS

The sample included 365 Latinx sexual minority youth (14-24 years) living in the United States or US Territory. The majority of participants identified as monosexual (84.1%); 15.9% were plurisexual. The sample was 75.6% male, 19.5% female, and 2.0% transgender. Participants were asked to complete an online, cross-sectional survey that asked questions pertaining to ethnicity and sexual orientation. This data was collected in the fall of 2014.

RESULTS

Latinx plurisexual youth had higher levels of SOI affirmation, exploration, and resolution than monosexual youth. SOI affirmation and exploration and were positively associated with self-esteem for all youth. SOI affirmation was significantly negatively associated with depressive symptoms for monosexual youth but not for plurisexual youth. SOI exploration and resolution were not significantly associated with depressive symptoms.

CONCLUSIONS

This study demonstrates that there are significant differences between plurisexual and monosexual Latinx adolescent populations in reference to identity affirmation, exploration, and resolution, and that these sexual orientations should be treated distinctly in future research. In addition, all three aspects of identity development were significantly related to higher self-esteem for all youth regardless of identity, providing evidence for the importance of developing these three factors.

Identifying Coping Strategies Used by Transgender Individuals in Response to Stressors during and after Gender-Affirming Treatments-An Explorative Study

BACKGROUND

Gender-affirming treatments are reported to improve mental health significantly. However, a substantial number of transgender individuals report a relapse in, or persistence of, mental health problems following gender-affirming treatments. This is due to multiple stressors occurring during this period, and in general as a consequence of widespread stigma and minority stress.

AIM

The aim of this pilot study was to identify different coping strategies that transgender individuals use in response to stressors prior to and following gender-affirming treatments, as mediator of mental health.

METHODS

Qualitative interviews were conducted to better understand the treatment outcomes and healthcare experiences of Dutch transgender individuals who had received gender-affirming treatments. Nineteen participants were included, of which 12 identified as (transgender) male, six as (transgender) female and one as transgender.

OUTCOMES

Inductive coding and theory-informed thematic analysis were used to assess stressors (n_codes = 335) and coping strategies (n_codes = 869).

RESULTS

Four stressor domains were identified, including lack of support system, stressors related to transition, and physical and psychosocial stressors post-transition. We identified six adaptive coping strategies of which acceptance, help seeking and adaptive cognitions concerning gender and transition were reported most frequently. Of the seven maladaptive strategies that we identified, social isolation and maladaptive cognitions concerning gender and transition were the most-reported maladaptive coping strategies Clinical implications: The results indicated that transgender individuals may experience significant stress, both transgender-specific and non-specific, prior to and following gender-affirming treatments and, as a result, use many coping strategies to adapt. Increased awareness of stressors and (mal)adaptive coping strategies may help to improve mental healthcare and overall support for transgender individuals. Strengths and Limitations: This is the first (pilot) study to provide insight into the range of stressors that transgender individuals experience during and after gender-affirming treatments, as well as the variety of coping strategies that are used to adapt. However, since this was a pilot study assumptions and generalizations of the evidence should be made cautiously.

CONCLUSION

Results of this pilot study showed that transgender individuals may undergo significant stress during and after gender-affirming medical treatment related to the treatments and the social experiences that occur during this period, and as a result, use a range of coping strategies to adapt to the stress.

Effects of Friendship among Same-Sex Attracted Youth on Sexual Minority Identity Development in Young Adulthood

Using data from Waves 1 and 3 of the National Longitudinal Study of Adolescent to Adult Health, this study investigated the interactive impact of adolescent friendship network characteristics and same-sex attraction (SSA) on the development of sexual minority (SM) identity in young adulthood. Results indicate that SSA youth who identified a best friend that also identified them as their best friend were 5.3 times more likely to identify as a SM compared to those who did not experience reciprocity. For each additional classmate who listed them as a friend, SSA youth were 1.2 times more likely to identify as a SM. Increased centrality in friendship network increased the likelihood that SSA youth would identify as a SM by 1.8 times. Sex-stratified results reveal that particular network characteristics impact boys and girls differently. These findings point to the importance of further investigating relationships between friendship characteristics and identity formation among adolescents.

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.

Sexual Complexity: A Comparison between Men and Women in a Sexual Minority Sample of Members of the Church of Jesus Christ of Latter-day Saints

We report here some of the results from an online survey of 1612 LGBTQ members and former members of the Church of Jesus Christ of Latter-day Saints (CJCLDS, Mormon). The data permitted an exploration of diversity—individual similarities and differences within and between the sexes. Men and women were compared with respect to sexual identity self-labeling and behavior (i.e., identity development, disclosure, activity), orientation change efforts, marital relationships, and psychosocial health—these variables in the context of their religious lives. More women than men self-identified in the bisexual range of the sexual attraction continuum. Both men and women had engaged in extensive effort to change their sexual orientation. Only about 4% of the respondents claimed that those efforts had been successful, and the claims were for outcomes other than an alteration in erotic feeling. In general, only those who identified as bisexual reported success in maintaining a mixed-orientation marriage and continuing activity in the church. For both men and women, measures of psychosocial and sexual health were higher for those in same-sex relationships and those disaffiliated from the church.

Validation of the Brief Sense of Community Scale in a lesbian, gay, and bisexual sample

Sense of community can buffer against negative mental health outcomes in lesbian, gay, and bisexual (LGB) individuals. Valid measurement of this construct can better inform research, assessment, and intervention designed to promote well-being in this population. The present study aims to evaluate the validity of the Brief Sense of Community Scale (BSCS) among sexual minority individuals. The scale was administered to 219 LGB participants within a larger assessment of health needs in a southern lesbian, gay, bisexual, and transgender (LGBT) population. Validity evidence was evaluated using the Downing model. Confirmatory factor analyses revealed good fit for a second-order model, supporting internal structure validity. Acceptable to excellent internal validity was demonstrated. Correlational analyses revealed negative relations with loneliness, internalized homophobia, and poor mental health. This study provides evidence for the use of the BSCS in an LGB population and demonstrates the utility in measuring the sense of community in sexual minority individuals.

Examining the Relationship between Gender Contentedness and Sex-Related Experiences among Taiwanese Youth

Little is known about how gender contentedness is related to sex-related experiences among Taiwanese adolescents. Secondary analysis of data (n = 2624, Mage = 13.3 ± 0.47 years and 51% males) on a longitudinal youth cohort was used to track the evolving development of sex-related experiences such as exposure to sexually explicit media, romantic experiences, and sexual behaviors. Hierarchical multinomial logistic regression analyses were applied to study the effects of gender contentedness on sex-related outcome variables. The results showed that nearly 10% of the subjects were not contented with their gender. As compared to peers, gender-discontented adolescents had a higher likelihood of exposures to sexually explicit media (odds ratio [OR]. = 1.70, 95% confidence interval [CI]. = 1.18–2.46) and risky sex behaviors (OR = 2.22, 95% CI = 1.03–4.81). These results shed light on the impact of self-perceived gender contentedness on sex-related experiences in Taiwanese adolescents. Our findings are helpful for the development of practical guidance on sexual health issues, particularly for those who are discontented with their gender.

Gender stigma awareness is associated with adolescent risky health behaviors

Objectives

Although racial stigma in school is associated with adolescent risky health behaviors, there are no studies investigating how gender stigma relates to adolescent risky health behaviors among low-income, minority youth. We sought to determine whether gender stigma awareness is associated with adolescent risky health behaviors (delinquency, fighting, and substance use) and whether this association is mediated by school disengagement (low perceived teacher support, low school engagement, cutting classes, and breaking school rules) among low-income, minority students.

Methods

We analyzed cross-sectional survey data, collected from 2017 to 2019, from 412 high school students. Multi-level logistic regressions tested whether gender stigma awareness was associated with delinquency, fighting, and substance use, controlling for covariates, baseline behaviors, and clustering within schools. Mediation analyses tested whether school disengagement (low school engagement, perceived teacher support, cutting class, and breaking school rules) mediated these associations. Secondary analyses explored whether associations differed for male versus female, high-performing versus low-performing, and Latinx versus non-Latinx students.

Results

In this predominantly Latinx (83%) sample, gender stigma awareness was associated with delinquency (AOR = 1.48, P< 0.001) and fighting (AOR = 1.15, P< 0.001). School engagement, perceived teacher support, breaking school rules, and cutting classes mediated 42.7% of the association between gender stigma awareness and delinquency and 65.42% of the association between gender stigma awareness and fighting. Gender stigma awareness was also associated with substance use for low-performing (AOR = 1.68, P = 0.003) and non-Latinx adolescents (AOR = 3.80, P = 0.03). School disengagement did not mediate the association between gender stigma awareness and substance use for non-Latinx students but mediated 50% of this association for low-performing students.

Conclusions

Gender stigma awareness is associated with adolescent risky health behaviors. A decreased sense of acceptance in the school community and increased school misbehavior may mediate these associations. School environments that value and accept all students may better support adolescent health.

Exploring Minority Stress and Resilience in a Polyamorous Sample

Polyamory is a type of consensual non-monogamy (CNM) in which participants engage in multiple simultaneous romantic and often sexual relationships with the knowledge and consent of all involved. CNM practitioners in general, and polyamorous people in specific, appear to be highly stigmatized due to their relational practices, and to experience acts of CNM-related discrimination, harassment, and violence. Conceptualizing this dynamic via minority stress theory predicts that this stigma and discrimination will lead to negative mental health effects for polyamorous individuals. However, recent research has begun to identify possible sources of resilience within polyamorous populations that may ameliorate these negative effects. This study investigated these hypotheses in a sample of 1176 polyamorous American adults utilizing structural equation modeling. Four constructs were assessed as potential resilience factors: mindfulness, cognitive flexibility, a positive CNM identity, and connection to a supportive CNM community. Results indicate that CNM-related minority stress was positively related to increased psychological distress, such as higher self-reported depression and anxiety symptoms. Mindfulness was found to have both direct and moderating effects on the relationship between minority stress and psychological distress, such that higher mindfulness attenuated the negative impact of minority stress. Cognitive flexibility also displayed direct and moderating effects, but in the opposite than predicted direction. Clinical and research implications of these findings are discussed, with an emphasis on expanding understanding of how anti-CNM stigma affects practitioners and improving clinical cultural competence with this unique and under-served population.

Correlates of Transactional Sex and Violent Victimization among Men Who Inject Drugs in Los Angeles and San Francisco, California

Men who inject drugs (MWID) and engage in transactional sex (i.e., receive money or drugs in exchange for sex) are vulnerable to HIV and violence. However, MWID who engage in transactional sex have been less studied than women. We examine factors associated with transactional sex among MWID in Los Angeles and San Francisco and whether transactional sex is associated with violent victimization. MWID were recruited using targeted sampling methods in 2011-2013 and completed surveys that covered demographics, drug use, HIV risk, violence, transactional sex, and other items. Multivariable logistic regression was used to (1) determine factors independently associated with transactional sex and (2) determine if transactional sex was independently associated with violence victimization in the last 6 months among MWID. An interaction term between income source and sexual identity was included in the transactional sex model. Of the 572 male PWID in the sample, 47 (8%) reported transactional sex in the past 6 months. Self-reported HIV infection was 7% for MWID who did not report transactional sex, 17% for MWID who reported transactional sex, and 24% for MWID who reported transactional sex and reported gay or bisexual identity. In multivariable analysis, transactional sex was positively associated with gay or bisexual identity (GB without illegal income adjusted odds ratio [AOR] = 5.16; 95% confidence interval [CI] = 1.86-14.27; GB with illegal income AOR = 13.55, CI = 4.57-40.13), coerced sex in the last 12 months (AOR = 11.66, CI = 1.94-70.12), and violent victimization in the last 12 months (AOR = 2.31, CI = 1.13-4.75). Transactional sex was negatively associated with heroin injection (last 30 days) (AOR = 0.37; 95% CI = 0.18-0.78). Transactional sex was independently associated with violent victimization in the last 12 months (AOR = 2.04; 95% CI = 1.00-4.14) while controlling for confounders. MWID who engaged in transactional sex are at elevated risk for HIV and multiple forms of violent victimization. Interventions focused on this at-risk subpopulation are urgently needed and should include access to substance use disorder treatment, victimization services, and harm reduction services across the HIV care continuum.

A Qualitative Analysis of Adolescent Responses to YouTube Videos Portraying Sexual and Gender Minority Experiences: Belonging, Community, and Information Seeking

Sexual and gender minority youth are at risk for negative mental health outcomes, such as depression and suicide, due to stigma. Fortunately, sense of community, connection, and social support can ameliorate these deleterious effects. Youth express that most of their social support comes from peers and in-school organizations, but these sources require in-person interaction. Past research has identified social media sites as virtual and anonymous sources of support for these youth, but the role of YouTube specifically in this process has not been thoroughly explored. This study explores YouTube as a possible virtual source of support for sexual and gender minority youth by examining the ecological comments left on YouTube videos. A qualitative thematic analysis of YouTube comments resulted in six common themes in self-identified adolescents' YouTube comments: sharing, relating, information-seeking, gratitude, realization, and validation. Most commonly, adolescents shared feelings and experiences related to their identity, especially when they could relate to the experiences discussed in the videos. These young people also used their comments to ask for identity-related advice or information, treating the platform as a source of education. Results suggest that sexual minority youth's use of YouTube can be advantageous for social support and community, identity-related information, identity development, and overall well-being.

Maternal Comfort with Lesbian, Gay, and Bisexual People and Their Children's Drinking, Smoking, and Disordered Weight Control Behaviors as Adults

Purpose: We investigated associations between maternal comfort with lesbian, gay, and bisexual (LGB) people during the participant's adolescence and their health indicators in adulthood. Methods: Data came from a prospective cohort, Growing Up Today Study (N = 7476), limited to men and women who provided information during their adulthood about recent binge drinking, cigarette smoking, or disordered weight control behaviors (DWCB) and whose mothers provided information during the participant's adolescence about her comfort with LGB people. Results: Increased maternal comfort with LGB people was associated with increased engagement in health indicators for heterosexual but not sexual minority adults (binge drinking, cigarette smoking, and DWCB for women; binge drinking for men). No association existed between maternal comfort with LGB people and binge drinking or cigarette smoking for sexual minority women, and binge drinking for sexual minority men. This resulted in statistically smaller differences across sexual orientation in cigarette smoking for women when their mothers were highly comfortable with LGB people compared with those whose mothers were uncomfortable with LGB people. There were no differences in binge drinking (women and men) and DWCB (women only) across sexual orientation when mothers were highly comfortable with LGB people. Conclusion: Maternal comfort with LGB people is associated with certain sexual orientation-related disparities in health indicators through adulthood, due to increased engagement in health indicators by heterosexual adults. Exposure to sexual orientation stigma in adolescence, measured as maternal comfort with LGB people, possibly drives well-known differences in drinking, smoking, and DWCB during adulthood between heterosexual and sexual minority adults.

Menstrual Cup Use Intention and the Moderating Effects of Sexual Orientation and Gender Characteristic Among Female University Students in Taiwan: A Theory-Driven Exploration

Menstruation plays an important role in women's lives as it accompanies about half of their living years. However, little is known about women's intention to use menstrual cups, a relatively new menstrual product in Taiwan. Therefore, this study aimed to systematically explore the factors associated with menstrual cup use (MCU) intention among female university students in Taiwan, using the Theory of Planned Behavior (TPB). Data from 1245 female university students in Taiwan were collected using an anonymous online survey based on the TPB from December 2016 through January 2017. Multivariate logistic regression found the following TPB factors associated with high MCU intention: positive attitudes about positive (adjusted odds ratio [AOR] = 4.35, 95% confidence interval [CI] 2.87-6.60) and negative (AOR = 2.32, 95% CI 1.54-3.49) outcomes of MCU, supportive subjective norms (AOR = 1.88, 95% CI 1.33-2.65), and high perceived control over MCU under constraining conditions (AOR = 3.40, 95% CI 2.24-5.16). Sexual orientation and gender characteristic were also found to have moderating effects. For example, bisexual college girls with masculine characteristic who perceived high control over MCU under constraining conditions had elevated MCU intention (AOR = 2.45, 95% CI 1.04-5.76). Therefore, to improve women's menstrual health, future health education could focus more on introducing the different features of various menstrual products, including menstrual cups, and help users make informed decisions about which menstrual products could best suit their needs.

Health and socio-economic inequalities by sexual orientation among older women in the United Kingdom: findings from the UK Household Longitudinal Study

Lesbian, gay, bisexual and queer (LGBQ) women living in the United Kingdom (UK) experience worse health than their heterosexual peers throughout their lives, but less is known about health inequalities in older age. This study uses population-level data to examine inequalities among LGBQ older women and women who prefer not to disclose their sexuality, compared to heterosexual women. Analyses use data from women aged 50 and older who were active in Waves 3 and 7 of the UK Household Longitudinal Study (also known as Understanding Society) (N = 8,209) to examine inequalities in socio-economic conditions, health and alcohol consumption across sexual orientation groups. LGBQ older women are on average younger and have higher socio-economic resources than their heterosexual peers. In contrast, women who prefer not to disclose their sexual orientation are older and have the lowest income and educational qualifications. Results of the health inequalities analyses show that LGBQ older women are almost twice as likely as heterosexual older women to engage in harmful alcohol consumption. Older women who prefer not to disclose their sexuality have worse physical and mental health than heterosexual older women. The health of LGBQ older women and women who prefer not to disclose their sexual orientation is one of the most neglected research areas in UK gerontology. Findings of this study contribute to our understanding of their social and health circumstances, and illuminate methodological limitations in existing data.

Utilizing Mixed Methodology to Increase Cultural Competency in Research with Transgender and Gender Nonconforming Individuals

Transgender and gender nonconforming (TGNC) individuals experience increased risk to mental and physical health concerns based on minority stress variables, including discrimination, internalized stigma, and expectations of violence. Research in this area displays a disconnect between provider and TGNC individuals seeking care. This study sought to improve cultural competency in research with TGNC individuals, with the ultimate goal to further explore cultural competency factors in work with TGNC individuals in research and clinically. Mixed methods research was conducted with trans masculine, trans feminine, and nonbinary identifying individuals to pilot survey measures before administration in a larger study.

The role of syringe exchange programs and sexual identity in awareness of pre-exposure prophylaxis (PrEP) for male persons who inject drugs

BACKGROUND

Male persons who inject drugs (male PWID) are at heightened risk for HIV, particularly if they also have sex with men. Pre-exposure prophylaxis (PrEP) could aid in HIV prevention for this population, but PrEP awareness within different sexual identities among male PWID is not well-understood. We report factors associated with greater awareness among male PWID to identify efficient means of awareness dissemination.

METHODS

Data from the 2015 National HIV Behavioral Surveillance (NHBS) system cycle on injection drug use collected in New York City (NYC) were used. Bivariable analyses, using chi-squared statistics, were conducted to examine correlates of awareness of PrEP with socio-demographic, behavioral, and health care variables. Log-linked Poisson regression with robust standard errors was used to estimate adjusted prevalence ratios and determine differences in awareness of PrEP.

RESULTS

Among a sample of 332 male PWID (i.e., PWID who identified as male, not transgender) we find awareness of PrEP to be low (23%) among male PWID despite 68% reporting condomless vaginal/anal sex and 32% reporting injection equipment sharing in the last twelve months. Multivariable analysis found greater PrEP awareness associated with gay or bisexual identity (aPR: 2.77, 95% CI: 1.81-4.24) and having a conversation about HIV prevention at a syringe exchange program (SEP) (aPR: 2.71, 95% CI: 1.87-3.94) to be associated with increased PrEP awareness.

CONCLUSION

We found low rates of PrEP awareness among male PWID. However, our findings provide insight into information diffusion that can be utilized to increase PrEP awareness among male PWID and among all PWID. We suggest that gay and bisexual social networks and syringe exchange programs are diffusing PrEP awareness among male PWID and can be harnessed to increase PrEP awareness among male PWID.

Gender and Generational Differences in the Internalized Homophobia Questionnaire: An Alignment IRT Analysis

Internalized homophobia (IH) refers to negative attitudes and stereotypes that a lesbian, gay, or bisexual (LGB) person may hold regarding their own sexual identity. Recent sociocultural changes in attitudes and policies affecting LGB people generally reflect broader acceptance of sexual minorities, and may influence the manner in which LGB people experience IH. These experiences should be reflected in the measurement properties of instruments designed to assess IH. This study utilized data from three different samples ( N = 3,522) of LGB individuals residing in the United States to examine the invariance of a common self-report IH measure by gender identity (Female, Male) and age cohort (Boomers, Generation X, and Millennials). Multigroup item response theory–differential item functioning analysis using the alignment method revealed that 6 of the 9 Internalized Homophobia Scale items exhibited differential functioning across gender and generation. Latent scores based on the invariant items suggested that Male and Female Boomers exhibited the lowest level of latent IH, relative to the other cohorts.

Multi-Dimensional Factors Associated with Illegal Substance Use Among Gay and Bisexual Men in Taiwan

Illegal substance use in sexual minorities is an important health issue worldwide. The present cross-sectional study aimed to investigate the multi-dimensional factors associated with illegal substance use among gay and bisexual men in Taiwan. This questionnaire-survey study recruited 500 gay or bisexual men aged between 20 and 25 years. Their experiences of using eight kinds of illegal substances in the preceding month were collected. Their previous experiences of homophobic bullying, satisfaction with academic performance, truancy, perceived family and peer support in childhood and adolescence, and social-demographic characteristics, were also collected. Potential factors associated with illegal substance use were identified using univariate logistic regression, and further selected into a forward stepwise logistic regression model to identify the factors most significantly related to illegal substance use. A total of 22 (4.4%) participants reported illegal substance use in the preceding month, and mean age was 22.9 ± 1.6. Forward stepwise logistic regression revealed that being victims of homophobic cyberbullying in childhood and adolescence (odds ratio (OR) = 1.26; p = 0.011), disclosure of sexual orientation at junior high school (OR = 4.67; p = 0.001), and missing classes or truancy in senior high school (OR = 2.52; p = 0.041) were significantly associated with illegal substance use in early adulthood. Multi-dimensional factors in childhood and adolescence that were significantly associated with illegal substance use in early adulthood among gay and bisexual men were identified. Besides traditional bullying, the effect of cyberbullying and school performance on illegal substance use should not be ignored. This study is limited to the cross-sectional design and possible recall bias. Mental health professionals must routinely assess these significant factors to prevent and intervene in illegal substance use among gay and bisexual men.

Frequent Experience of LGBQ Microaggression on Campus Associated With Smoking Among Sexual Minority College Students

Introduction

Lesbian, gay, bisexual, or queer/questioning (LGBQ) microaggressions refer to often-unintentional insults, assaults, and invalidations that denigrate sexual minorities. While experiencing hostile discrimination and violence has previously been associated with elevated rates of smoking cigarettes for LGBQ college students, the relationship between LGBQ microaggressions and smoking is unknown.

Methods

Data from a national anonymous online survey of sexual and gender minority college students were used to examine the relationship between past month cigarette smoking and interpersonal LGBQ microaggressions. Multivariable logistic regression assessed the relationship between smoking and frequent (chronic) experiences of microaggressions, using a hierarchical procedure to control for demographics, predictors of smoking, and academic factors.

Results

Past year frequent LGBQ microaggression was reported by 48% of respondents and was more common among students who smoked in past 30 days. Experiencing past year physical violence was reported by 15% and did not differ by smoking status. Past year frequent experience of microaggressions was associated with increased odds of 1.72 (95% CI 1.03-2.87) for past 30-day smoking after adjusting for age, gender, race, socioeconomic indicators, alcohol misuse, physical violence, as well as academic stress and engagement.

Conclusions

The results indicate that frequently experiencing LGBQ microaggressions is a risk factor for LGBQ college students smoking cigarettes. The mechanisms underlying this relationship require additional research, as does identifying positive coping strategies and institutional strategies to address LGBQ microaggressions on campuses. Tobacco control efforts should consider the impact of microaggression on the social environment for the prevention and treatment of tobacco use among LGBQ individuals.

Implications

Microaggressions related to sexual minority identity include subtle forms of discrimination experienced during daily interactions that can create hostile and stressful social environments for a socially disadvantaged group. Prior research has demonstrated that LGBQ college students have higher rates of cigarette smoking, and that experiencing identity-based violence is a risk factor. This study revealed that experiencing frequent LGBQ microaggressions on college campus is associated with increased likelihood of current smoking among LGBQ college students.

Minority Stress, Activism, and Health in the Context of Economic Precarity: Results from a National Participatory Action Survey of Lesbian, Gay, Bisexual, Transgender, Queer, and Gender Non-Conforming Youth

Lesbian, gay, bisexual, transgender, queer, and gender non-conforming (LGBTQ & GNC) youth experience more economic hardship and social stress than their heterosexual and cisgender peers. However, the ways that LGBTQ & GNC youth resist these damaging social factors and the corresponding implications for their health have not been addressed. Data were analyzed from a national participatory survey of LGBTQ & GNC youth ages 14-24 (N = 5,860) living in the United States. Structural equation models indicated that economic precarity was associated with experiences of health problems. This association was mediated by the negative influence of minority stress on health as well as by activism, which had a positive association with health. Findings suggest that minority stress explanations of health inequalities among LGBTQ & GNC youth can benefit from including a focus on economic precarity; both in terms of its deleterious impact on health and its potential to provoke resistance to structural oppression in the form of activism.

Breast health, risk factors, and cancer screening among lesbian, bisexual, and queer/questioning women in China

In this study, we examine the health disparities of sexual minority women by surveying 310 lesbian, bisexual, and queer/questioning women (LBQW) in China about their breast health and cancer screening practices. We found that Chinese LBQW, particularly those identified with a masculine gender role and practice chest binding, are vulnerable to breast cancer given their high rates of behavioral risk factors (e.g., cigarette smoking) and symptoms (e.g., breast lumps) but low rates of self and clinical breast examinations. Salient barrier (stigma) and facilitators (social support availability, self-efficacy, and breast cancer information exposure) of breast cancer screening were also identified.

LGBT communities and substance use in Queensland, Australia: Perceptions of young people and community stakeholders

Sexual minority young people use licit and illicit substances at disproportionate levels. However, little is known about the perceptions of substance use among members of LGBT communities. This paper reports the results of a content analysis of 45 semi-structured interviews about substance use in LGBT communities with sexual minority young people (n = 31) and community stakeholders (n = 14). Results indicated both sexual minority youth and community stakeholders perceived the use and acceptance of substances to be higher in LGBT communities compared to the general population. Participants identified a range of characteristics potentially leading to higher levels of substance use including peer pressure, high exposure to substance use, and the high concentrations of licensed venues in LGBT communities. Marginalisation, discrimination and mental health were also perceived as important reasons for these disparities. Community stakeholders identified a range of potential interventions including legislation to address discrimination and substance use, increased services and activities, advertising in commercial LGBT venues and social media, and reinvigorating community cohesion.

Non-Suicidal Self-Injury, Sexuality Concerns, and Emotion Regulation among Sexually Diverse Adolescents: A Multiple Mediation Analysis

Despite increasing interest in the prevalence and correlates of Non-Suicidal Self-Injury (NSSI) in adolescent populations, relatively few studies have examined NSSI among lesbian, gay and bisexual (LGB) adolescents. The current study explored sexuality concerns and elevated emotion dysregulation as potential mechanisms underlying the relationship between sexual orientation and elevated non-suicidal self-injury (NSSI). A community sample of 1,799 adolescents completed a questionnaire assessing NSSI, sexual orientation, sexuality concerns, and emotion regulation. Across the study, 20.6% of adolescents reported a history of NSSI. Adolescents who identify as "mostly heterosexual," "bisexual," and "mostly homosexual" were more likely to engage in NSSI than gay/lesbian, heterosexual, and asexual adolescents. Multiple mediation analysis showed that emotion regulation, but not sexuality concerns, mediated the relationship between sexual orientation and NSSI. The current study tested two theoretical pathways by which sexual orientation could predict NSSI engagement. Findings suggest that literature on general psychological processes, as well as group-specific minority stressors, can shed light on high rates of NSSI among LGB populations. Specifically, the challenges faced by LGB adolescents may undermine the development of emotion regulation. As such, this should be a key target of intervention with LGB adolescents engaging in NSSI.

School Progress Among Children of Same-Sex Couples

This study uses logit regressions on a pooled sample of children from the 2012, 2013, and 2014 American Community Survey to perform a nationally representative analysis of school progress for a large sample of 4,430 children who reside with same-sex couples. Odds ratios from regressions that compare children between different-sex married couples and same-sex couples fail to show significant differences in normal school progress between households across a variety of sample compositions. Likewise, marginal effects from regressions that compare children with similar family dynamics between different-sex married couples and same-sex couples fail to predict significantly higher probabilities of grade retention for children of same-sex couples. Significantly lower grade retention rates are sometimes predicted for children of same-sex couples than for different-sex married couples, but these differences are sensitive to sample exclusions and do not indicate causal benefits to same-sex parenting.

Teen Pregnancy Risk Factors Among Young Women of Diverse Sexual Orientations

OBJECTIVES

Young women who are sexual minorities (eg, bisexual and lesbian) are approximately twice as likely as those who are heterosexual to have a teen pregnancy. Therefore, we hypothesized that risk factors for teen pregnancy would vary across sexual orientation groups and that other potential risk factors exist that are unique to sexual minorities.

METHODS

We used multivariable log-binomial models gathered from 7120 young women in the longitudinal cohort known as the Growing Up Today Study to examine the following potential teen pregnancy risk factors: childhood maltreatment, bullying victimization and perpetration, and gender nonconformity. Among sexual minorities, we also examined the following: sexual minority developmental milestones, sexual orientation-related stress, sexual minority outness, and lesbian, gay, and bisexual social activity involvement.

RESULTS

Childhood maltreatment and bullying were significant teen pregnancy risk factors among all participants. After adjusting for childhood maltreatment and bullying, the sexual orientation-related teen pregnancy disparities were attenuated; these risk factors explained 45% of the disparity. Among sexual minorities, reaching sexual minority developmental milestones earlier was also associated with an increased teen pregnancy risk.

CONCLUSIONS

The higher teen pregnancy prevalence among sexual minorities compared with heterosexuals in this cohort was partially explained by childhood maltreatment and bullying, which may, in part, stem from sexual orientation-related discrimination. Teen pregnancy prevention efforts that are focused on risk factors more common among young women who are sexual minorities (eg, childhood maltreatment, bullying) can help to reduce the existing sexual orientation-related teen pregnancy disparity.

Social Support and Mental Health in LGBTQ Adolescents: A review of the literature

LGBTQ adolescents experience higher rates of mental health disorders than their heterosexual peers. The purpose of this systematic review of the literature was to examine studies evaluating social support and its effects on mental health in the LGBTQ adolescent population. Higher levels of social support were associated with positive self-esteem. Lack of social support (or low social support) was associated with higher levels of depression, anxiety, alcohol or drug misuse, risky sexual behaviors, shame, and low self-esteem. Interdisciplinary research teams from multiple and diverse professions could provide valuable insight supporting the development of inclusive and comprehensive interventions programs for this population.

It's Complicated: Sociocultural factors and the Disclosure Decision of Transgender Individuals in Pakistan

The literature on the disclosure decision of transsexual individuals is sparse, and that which does exist either uses empirical quantitative methods or aggregates transsexuals with other non-heterosexual individuals. The current study focuses this underresearched group and examines the disclosure decision of transsexual people in Pakistan, a developing Muslim country with a unique amalgam of social, cultural, and religious ground realities. Drawing on thematic analysis technique using in-depth interviews with 16 transsexuals, we show how sociocultural factors that are inherently embedded in the environment influence the disclosure decision in work and non-work settings. In particular, our respondents illustrate that their disclosure decision, which ranges from total disclosure on one end to nondisclosure on the other end, is influenced by the complexities of family honor, tightly integrated family network, social obligation to get married, and prevalent religious beliefs in the society. This study advances understanding of identity and disclosure decision of transsexual individuals by explicating the ways in which sociocultural factors are intricate part of their decision of coming out.

Trajectories of alcohol, marijuana, and illicit drug use in a diverse sample of young men who have sex with men

INTRODUCTION

Cross-sectional research has found that young men who have sex with men (YMSM) are more likely to engage in heavy drinking and to have higher rates of marijuana and other illicit drug use compared to their heterosexual peers, but considerably less is known about their patterns of substance use over time.

METHODS

In this study, we combined two longitudinal samples of racially diverse YMSM (N=552) and modeled their substance use trajectories from late-adolescence to young adulthood, including their frequency of alcohol use, frequency of marijuana use, and poly-drug use, using piecewise latent curve growth modeling to model change from ages 17-21 and change from ages 22-24.

RESULTS

We found that all three substance use behaviors increased linearly over the adolescent-to-adult transition. The trajectories for all three substance use behaviors were significantly correlated from ages 17-21. Black YMSM had significantly lower growth from ages 17-21 in alcohol, marijuana, and poly-drug use compared to White YMSM. Hispanic/Latino YMSM had significantly higher growth from ages 22-24 in alcohol use but significantly lower growth in poly-drug use compared to White YMSM. YMSM with higher alcohol frequency slopes and YMSM with higher marijuana use slopes were more likely to have alcohol-related and marijuana-related problems, respectively, at the last wave of the study.

CONCLUSIONS

The results of the present study suggest that the transition from adolescence to adulthood for YMSM is a time of increasing and co-varying substance use and may be a critical period for substance use behaviors to grow into substance use problems.

Are Outness and Community Involvement Risk or Protective Factors for Alcohol and Drug Abuse Among Sexual Minority Women?

Sexual minority women (SMW) are at increased risk for substance abuse compared to heterosexual women. Two psychosocial factors that have been implicated in SMW's substance abuse are outness and LGBT community involvement, but findings have been mixed as to whether these are risk or protective factors. One possible explanation is that they may have different consequences for subgroups of SMW (lesbians, bisexual women, and queer women). While being open about one's sexual orientation and involved in the community may be protective for lesbians, discrimination against bisexual women may lead these same factors to contribute to substance abuse for bisexual women. It is unclear how these associations will operate for queer women, given limited research on this subpopulation. The current study examined whether sexual identity moderated the associations between outness and community involvement with alcohol and drug abuse. We also examined whether perceived discrimination would help explain why these associations may be different for subgroups of SMW. A sample of 288 self-identified SMW (113 lesbians, 106 bisexual women, and 69 queer women) completed an online survey. Higher outness was associated with higher alcohol and drug abuse for bisexual women, but not for lesbians or queer women. Similarly, higher community involvement was associated with higher drug abuse for bisexual women, but not for lesbians or queer women. Among bisexual women, the association between community involvement and drug abuse was mediated by perceived discrimination. Further, the association between outness and drug abuse was mediated by both community involvement and perceived discrimination. Findings demonstrate that outness and community involvement function as risk factors for substance abuse for bisexual women, in part due to their associations with discrimination.

Explaining sexual minorities’ disclosure: The role of trust embedded in organizational practices

This paper reports on an empirical study that demonstrated how organizational inclusion practices and employees’ trust in their organization and supervisors affect their willingness to share personal information that could potentially lead to workplace discrimination. The findings are based on data obtained from 431 sexual- and gender-minority employees using an anonymous online survey. The results reveal that trust in the organization and the supervisor fully mediates the relationship between organizational policies and practices and workplace disclosure. In other words, in organizations where policies and practices generate trust, employees are more willing to disclose their minority identity. Our analysis also reveals how trust in the organization and the supervisor interacts with psychological variables associated with the workplace disclosure decision.

A developmentally informed adaptation of minority stress for sexual minority adolescents

Sexual minority adolescents (lesbian, gay, bisexual) experience disparities in behavioral health outcomes compared to their heterosexual peers, generally attributed to minority stress. Although evidence of the applicability of the minority stress model among adolescents exists, it is based on a primarily adult literature. Developmental and generational differences demand further examination of minority stress to confirm its applicability. Forty-eight life history interviews with sexual minority adolescents in California (age 14-19; M = 19.27 SD = 1.38; 39.6% cismale, 35.4% cisfemale, 25% other gender) were completed, recorded, transcribed, and analyzed using thematic analysis in QSR NVivo. Following a consensus model, all transcripts were double coded. Results suggest that minority stress is appropriate for use with adolescents; however, further emphasis should be placed on social context, coping resources, and developmental processes regarding identity development. A conceptual model is provided, as are implications for research and practice.

Sexual Orientation Disclosure in Primary Care Settings by Gay, Bisexual, and Other Men Who Have Sex with Men in a Canadian City

PURPOSE

Sexual orientation affects individuals' health histories and is fundamental to providers' understanding of patients as a whole. Gay, bisexual, and other men who have sex with men (GB-MSM) are vulnerable to certain health conditions, including HIV. The aim of this exploratory analysis was to examine factors associated with sexual orientation disclosure and communication with providers about GB-MSM health issues and to discuss implications.

METHODS

We conducted a cross-sectional internet survey of GB-MSM (n = 202) in London-Middlesex, Ontario, Canada; analyses were limited to those with a regular primary care provider (n = 173). Blockwise regression models explored demographic, psychosocial, and healthcare-related factors associated with sexual orientation disclosure and physician-patient communication about GB-MSM-related health.

RESULTS

Just over seventy-one percent (71.1%) of participants reported that their primary care provider (PCP) knew their sexual orientation, and 44.5% had talked to them about GB-MSM health. Overt negative comments or being refused care based on sexual orientation occurred infrequently, although 26.6% reported their provider had assumed they were heterosexual. Being married to or living common-law with another man, more frequent experiences of homosexual prejudice, and higher quality assessment of provider's communication skills were associated with the PCP knowing respondents' sexual orientation. Greater internalized homonegativity was associated with not talking to a PCP about GB-MSM-related health issues. More frequent experiences of homosexual prejudice, higher assessment of provider communication, and having prior negative experiences with a PCP were significantly associated with talking to a PCP about GB-MSM health.

CONCLUSION

The majority of our sample disclosed their sexual orientation; however, not all patients voluntarily disclose. Medical training and education in Canada, where specific rights protections exist for sexual orientation minority populations, should emphasize awareness of essential patient health information. Training should include information about GB-MSM health and building a foundation on how to speak with GB-MSM patients nonjudgmentally.

Individual-level protective factors for sexual health outcomes among sexual minority youth: a systematic review of the literature

Although factors associated with negative sexual health outcomes among sexual minority youth (SMY) have been well documented, protective factors have been less studied. This review summarises the current state of science on individual-level protective factors for SMY and identifies gaps to inform future research. A systematic search of non-intervention, empirical peer-reviewed research was conducted. Articles that examined an a priori-identified individual-level protective factor and at least one sexual health outcome in a sample or subsample of SMY aged 10-24 years in Western, industrialised countries were eligible for inclusion. A total of 21 articles that reported data from 13 unique studies met inclusion criteria. Only two studies described findings for young sexual minority women and thus the literature synthesis was limited to studies reporting on young men who have sex with men (YMSM) in the USA. A total of 11 individual-level protective factors were examined. Subjective peer norms and attitudes about condom use were repeatedly protective in cross-sectional analyses. Findings related to self-efficacy, self-esteem and clear and positive identity were more mixed. The findings of this review suggest that attitudes and subjective peer norms related to condom use are promising intervention targets for YMSM. There is a need, however, for longitudinal research to confirm these protective effects and to consider them among other SMY. Moreover, protective factors related to skills and competencies have been insufficiently studied among SMY. Addressing these gaps will help develop a robust body of evidence to inform interventions.

Associations of Health-Risk Behaviors and Health Cognition With Sexual Orientation Among Adolescents in School: Analysis of Pooled Data From Korean Nationwide Survey From 2008 to 2012

Homosexual adolescents may face significant health disparities. We examined health-risk behaviors and health cognition related to homosexual behavior in a representative sample of adolescents.Data were obtained from 129,900 adolescents between 2008 and 2012 over 5 cycles of the Korean Youth Risk Behavior Survey, a national survey of students in grades 7 to 12. Various health-risk behaviors and aspects of health cognition were compared between homosexual and heterosexual adolescents and analyzed with multiple logistic regression models.Compared with heterosexual adolescents (n = 127,594), homosexual adolescents (n = 2306) were more likely to engage in various health-risk behaviors and to have poor health cognition. In multiple logistic regression analysis, not living with parents, alcohol experience (adjusted odds ratio, 1.50; 95% confidence interval, 1.26-1.78 for males and 1.66; 1.33-2.07 for females), smoking experience (1.80; 1.54-2.10 for males and 3.15; 2.61-3.79 for females), and drug experience (3.65; 2.81-4.80 for males and 3.23; 2.35-4.46 for females) were associated with homosexual behavior. Homosexual adolescents were more likely to use adult internet content (2.82; 2.27-3.50 for males and 7.42; 4.19-13.15 for females), and to be depressed (1.21; 1.03-1.43 for males and 1.32; 1.06-1.64 for females). In addition, suicide ideation (1.51; 1.26-1.81 for males and 1.47; 1.16-1.86 for females) and attempts (1.67; 1.37-2.05 for males and 1.65; 1.34-2.03 for females) were significantly more prevalent among homosexual adolescents.Homosexual adolescents report disparities in various aspects of health-risk behavior and health cognition, including use of multiple substances, adult internet content and inappropriate weight loss methods, suicide ideation and attempts, and depressive mood. These factors should be addressed relevantly to develop specific interventions regarding sexual minorities.

An Examination of the Validity and Reliability of a Measure of Sexual Orientation Identity Exploration, Resolution, and Affirmation

The processes of identity exploration and resolution are salient during adolescence and young adulthood, and awareness of sexual orientation identity, in particular, is heightened in early adolescence. Much of the research on sexual orientation identity development has focused on identity milestones (e.g., age of awareness and disclosure) or internalized homonegativity, rather than the developmental processes of exploration and resolution. Psychometric properties of the Sexual Orientation Identity Development Scale, which was adapted from a developmentally-informed measure of ethnic-racial identity, were evaluated in a sample of 382 Latina/o sexual minority adolescents and young adults. Results supported the reliability and validity of the adapted measure, as well as measurement equivalence across language (Spanish and English) and development (adolescence and young adulthood).

Harassment Due to Gender Nonconformity Mediates the Association Between Sexual Minority Identity and Depressive Symptoms

The visibility of a stigmatized identity is central in determining how individuals experience that identity. Sexual minority status (e.g., identifying as gay, lesbian, or bisexual) has traditionally been identified as a concealable stigma, compared with race/ethnicity or physical disability status. This conceptualization fails to recognize, however, the strong link between sexual minority status and a visible stigma: gender nonconformity. Gender nonconformity, or the perception that an individual fails to conform to gendered norms of behavior and appearance, is strongly stigmatized, and is popularly associated with sexual minority status. The hypothesis that harassment due to gender nonconformity mediates the association between sexual minority status and depressive symptoms was tested. Heterosexual and sexual minority-identified college and university students (N = 251) completed questionnaires regarding their sexual minority identity, experiences of harassment due to gender nonconformity, harassment due to sexual minority status, and depressive symptoms. A mediational model was supported, in which the association between sexual minority identity and depressive symptoms occurred via harassment due to gender nonconformity. Findings highlight harassment due to gender nonconformity as a possible mechanism for exploring variability in depressive symptoms among sexual minorities.

A social network typology and sexual risk-taking among men who have sex with men in Cape Town and Port Elizabeth, South Africa

Despite the high prevalence of HIV among men who have sex with men in South Africa, very little is known about their lived realities, including their social and sexual networks. Given the influence of social network structure on sexual risk behaviours, a better understanding of the social contexts of men who have sex with men is essential for informing the design of HIV programming and messaging. This study explored social network connectivity, an understudied network attribute, examining self-reported connectivity between friends, family and sex partners. Data were collected in Cape Town and Port Elizabeth, South Africa, from 78 men who have sex with men who participated in in-depth interviews that included a social network mapping component. Five social network types emerged from the content analysis of these social network maps based on the level of connectivity between family, friends and sex partners, and ranged from disconnected to densely connected networks. The ways in which participants reported sexual risk-taking differed across the five network types, revealing diversity in social network profiles. HIV programming and messaging for this population can greatly benefit from recognising the diversity in lived realities and social connections between men who have sex with men.

Reflecting resiliency: openness about sexual orientation and/or gender identity and its relationship to well-being and educational outcomes for LGBT students

For lesbian, gay, bisexual, and transgender (LGBT) youth, coming out (i.e., disclosure of LGBT identity to others) can be a key developmental milestone, one that is associated with better psychological well-being. However, this greater visibility may come with increased risk of peer victimization. Being out, therefore, may reflect resilience and may unfold differently depending on ecological context as some spaces may be more or less supportive of LGBT youth than others. This article explores a model of risk and resilience for outness among LGBT youth, including whether it varies by community context. We tested our hypothesized model with a national dataset of 7,816 LGBT secondary school students using multi-group structural equation modeling. Consistent with our hypotheses, outness was related to higher victimization but also to higher self-esteem and lower depression. Greater victimization was related to negative academic outcomes directly and indirectly via diminished well-being. The increases in victimization associated with outness were larger for rural youth, and benefits to well-being partly compensated for their lower well-being overall. This article suggests that being out reflects resilience in the face of higher risk of victimization, in addition to promoting well-being in other ways. Nonetheless, contextual factors influence how this model operates among LGBT youth.

Mental health and support among young key populations: an ecological approach to understanding and intervention

INTRODUCTION

The patterning of the HIV epidemic within young key populations (YKPs) highlights disproportionate burden by mental disorders in these populations. The mental wellbeing of YKPs is closely associated with biological predispositions and psychosocial factors related to YKPs' sexual and gender identities and socio-economic status. The purpose of this paper is to highlight sources of risk and resilience, as well as identify treatment and supports for mental health disorders (MHDs) among YKPs.

DISCUSSION

This paper utilizes Bronfenbrenner's Bioecological Systems Theory and the Social Stress Model to explore the risk and protective factors for MHDs across YKPs' ecological systems, and identify current gaps in treatment and support for MHDs among these youth. We emphasize the fluidity and intersections across these categorizations which reinforce the vulnerability of these populations, the lack of concrete data to inform mental health interventions among YKPs, and the need to ground YKP interventions and programmes with human rights principles stipulated in the convention on the rights of a child.

CONCLUSIONS

We put forth recommendations for future research and strategies to address the mental wellbeing of YKPs, including the need for integrated interventions that address the multiplicity of risk factors inherent in the multiple group membership, rather than single-focus interventions whilst addressing the unique needs or challenges of YKPs.