Lifetime victimization and physical health outcomes among lesbian and heterosexual women

Lifetime Abuse Victimization and Prospective Health Outcomes in Older Adults

Objectives: The current study examined the associations between lifetime abuse victimization and prospective health outcomes in late adulthood. Methods: Data from 4907 older adults (mean age = 80) from the Wisconsin Longitudinal Study were analyzed. Multivariate analyses examined the associations of lifetime abuse victimization with depression, physical health status, and memory. Results: Greater exposure to lifetime abuse was associated with a significantly higher risk of depression (OR = 1.13, CI: [1.08, 1.19], p < .001) and a greater number of limitations in physical functioning (b = .08, SE = .02, p < .001), but not with memory performance (b = .01, SE = .14, p > .05). Discussion: Our results support the interrelations of interpersonal violence across the life course and the lasting health effects of exposure to lifetime abuse. Findings highlight the need for a life course-based, trauma-informed approach in prevention and intervention programs for older adults.

Neurological Health in Sexual and Gender Minority Individuals

Despite representing a significant proportion of the U.S. population, there is a paucity of population-based research on the health status and health needs of sexual and gender minority (SGM) individuals in neurology. Compared with heterosexual peers, some SGM populations have a higher burden of chronic health conditions. In parallel, SGM individuals are more likely to experience stigma and discrimination producing psychological distress, which may contribute to and be compounded by reduced health care access and utilization. In this narrative review, we summarize the existing literature on common neurological health conditions such as stroke, headache, epilepsy, movement disorders, and traumatic brain injury through the lens of intersection of SGM identity. Special focus is attuned to social determinants of health and gender-affirming hormonal therapy. Given the limitations in the available literature, there is an urgent unmet need for datasets that include sexual orientation and gender identity information, as well as funding for research that will characterize the prevalence of neurological conditions, unique risk factors, and health outcomes in SGM populations. In the health care community, providers should address deficiencies in their professional training and integrate inclusive language into their clinical skillset to build trust with SGM patients. There is an opportunity in neurology to proactively engage SGM communities, collaborate to remove barriers to care, promote resilience, and develop targeted interventions to ensure high-quality, culturally competent care for SGM populations to improve neurological health for all.

Health Outcomes of Sexual Minority Women Who Have Experienced Adverse Childhood Experiences: A Scoping Review

Sexual minority women (SMW; e.g., lesbian, bisexual) report higher rates of almost every negative physical health (e.g., asthma, arthritis, cardiovascular disease), mental health (e.g., depression, anxiety), and substance use outcome compared to heterosexual women. Adverse Childhood Experiences (ACEs) have been identified as risk factors for negative health outcomes. Despite this, no study to date has synthesized existing literature examining ACEs and health outcomes among SMW. This gap is important because SMW are significantly more likely than heterosexual women to report every type of ACE and a higher total number of ACEs. Therefore, using a scoping review methodology, we sought to expand understanding of the relationship between ACEs and health outcomes among SMW. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for. Scoping Reviews protocol, we searched five databases: Web of Science, PsycInfo, CINAHL, PubMed, and Embase for studies published between January 2000 and June 2021 that examined mental health, physical health, and/or substance use risk factors and outcomes among adult cisgender SMW who report ACEs. Our search yielded 840 unique results. Studies were screened independently by two authors to determine eligibility, and 42 met full inclusion criteria. Our findings provide strong evidence that ACEs are an important risk factor for multiple negative mental health and substance use outcomes among SMW. However, findings were mixed with respect to some health risk behaviors and physical health outcomes among SMW, highlighting the need for future research to clarify these relationships.

Mental Health and Recovery Needs Among Women Substance Use Disorder Treatment Clients With Stalking Victimization Experiences

This study examined mental health and recovery needs at substance use disorder (SUD) program entry and at follow-up ( n = 2064) among: (1) women with no stalking victimization; (2) women with lifetime stalking victimization experiences; and (3) women with recent stalking victimization experiences (within 12 months of program entry). Stalking can be defined as a repeated pattern of behavior that creates fear or concern for safety or extreme emotional distress in the target. Women who experienced any stalking victimization, and particularly recent stalking victimization at program entry, had more recovery needs and increased mental health symptoms. At follow-up, women with any stalking victimization experiences continued to have more recovery needs with few differences between the lifetime and recent stalking victimization groups. Stalking victimization experiences were significantly associated with depression and anxiety symptoms in the multivariate analysis. Addressing stalking victimization during SUD treatment may be important to facilitate recovery.

An Overview of Transcriptional Responses of Schistosome-Susceptible (M line) or -Resistant (BS-90) Biomphalaria glabrata Exposed or Not to Schistosoma mansoni Infection

Background

We seek to provide a comprehensive overview of transcriptomics responses of immune-related features of the gastropod Biomphalaria glabrata (Bg) following exposure to Schistosoma mansoni (Sm), a trematode causing human schistosomiasis. Responses of schistosome-susceptible (M line, or SUS) and -resistant (BS-90, or RES) Bg strains were characterized following exposure to Sm for 0.5, 2, 8 or 40 days post-exposure (dpe).

Methods

RNA-Seq and differential expression analysis were undertaken on 56 snails from 14 groups. We considered 7 response categories: 1) constitutive resistance factors; 2) constitutive susceptibility factors; 3) generalized stress responses; 4) induced resistance factors; 5) resistance factors suppressed in SUS snails; 6) suppressed/manipulated factors in SUS snails; and 7) tolerance responses in SUS snails. We also undertook a gene co-expression network analysis. Results from prior studies identifying schistosome resistance/susceptibility factors were examined relative to our findings.

Results

A total of 792 million paired-end reads representing 91.2% of the estimated 31,985 genes in the Bg genome were detected and results for the 7 categories compiled and highlighted. For both RES and SUS snails, a single most supported network of genes with highly correlated expression was found.

Conclusions

1) Several constitutive differences in gene expression between SUS and RES snails were noted, the majority over-represented in RES; 2) There was little indication of a generalized stress response shared by SUS and RES snails at 0.5 or 2 dpe; 3) RES snails mounted a strong, multi-faceted response by 0.5 dpe that carried over to 2 dpe; 4) The most notable SUS responses were at 40 dpe, in snails shedding cercariae, when numerous features were either strongly down-regulated indicative of physiological distress or parasite manipulation, or up-regulated, suggestive of tolerance or survival-promoting effects; 5) Of 55 genes previously identified in genome wide mapping studies, 29 (52.7%) were responsive to Sm, as were many familiar resistance-associated genes (41.0%) identified by other means; 6) Both network analysis and remarkably specific patterns of expression of lectins and G protein-coupled receptors in categories 4, 6 and 7 were indicative of orchestrated responses of different suites of genes in SUS or RES snails following exposure to Sm.

Examining the associations of sexual minority stressors and past-year depression with overeating and binge eating in a diverse community sample of sexual minority women

Sexual minority stressors (e.g., stigma consciousness, internalized homophobia, discrimination) are posited to contribute to higher prevalence of overeating and binge eating among sexual minority women (SMW) relative to heterosexual women. Few studies have examined psychosocial mediators of the associations of minority stressors with overeating and binge eating in SMW. Using data from a diverse, community-based sample of SMW, we examined these associations, including the potential mediating effects of past-year depression. We also conducted exploratory analyses to determine if the associations of sexual minority stressors with overeating and binge eating differed by sexual identity or by race and ethnicity. The sample included 607 SMW (38.2% White, 37.1% African American, 24.7% Latina) with a mean age of 39.7 years. Approximately 17% and 9% of SMW reported overeating and binge eating, respectively, in the past 3 months. Greater stigma consciousness was associated with higher odds of overeating (AOR 1.31, 95% CI = 1.03-1.66). We found no significant associations between minority stressors and binge eating. Past-year depression did not mediate associations between minority stressors and overeating or binge eating. Although we found no sexual identity differences, stigma consciousness among Latina SMW was associated with higher odds of overeating relative to White SMW (AOR 1.95, 95% CI = 1.21-3.12) and African American SMW (AOR 1.99, 95% CI = 1.19-3.31). Findings highlight the importance of screening SMW for stigma consciousness as a correlate of overeating and considering racial and ethnic differences in overeating and binge eating in this population.

Chronic Diseases, Health Conditions, and Other Impacts Associated With Rape Victimization of U.S. Women

Sexual violence (SV) is an urgent public health issue that is common and has lifelong effects on health. Previous scholarship has documented the association of SV victimization with numerous health conditions and impacts, but much of this past work has focused on negative health outcomes associated with child sexual abuse using non-nationally representative samples. This article used a nationally representative female sample to examine health conditions associated with any lifetime experience of rape. We also examined injury and health outcomes (e.g., fear, injury) resulting from any violence by a perpetrator of rape. About two in five rape victims (39.1%) reported injury (e.g., bruises, vaginal tears), and 12.3% reported a sexually transmitted disease as a result of the rape victimization. Approximately 71.3% of rape victims (an estimated 16.4 million women) experienced some form of impact as a result of violence by a rape perpetrator. Among U.S. women, the adjusted odds of experiencing asthma, irritable bowel syndrome, frequent headaches, chronic pain, difficulty sleeping, activity limitations, poor physical or mental health, and use of special equipment (e.g., wheelchair) were significantly higher for lifetime rape victims compared with non-victims. This article fills gaps in our understanding of health impacts associated with rape of women and is the only nationally representative source of this information to our knowledge. Primary prevention efforts in youth that seek to prevent the first occurrence of rape and other forms of SV may be most effective for reducing the long-term health effects of this violence.

Differences in Lesbian, Bisexual, and Heterosexual Women's Experiences of Sexual Assault and Rape in a National U.S. Sample

Lesbian and bisexual women experience significantly higher rates of sexual assault and rape compared with heterosexual women. Despite this, researchers have yet to distinguish whether sexual orientation itself or some other related social characteristics explain these higher rates. The objective of this study was to analyze women's rates of sexual assault and rape across sexual orientation status while accounting for other social characteristics (e.g., race, education, income, outness). Women (N = 1,366), who identified as lesbian (31%), bisexual (32%), and heterosexual (31%), completed a nationally distributed, cross-sectional online survey in 2016. Victimization and repeat victimization were assessed using a modified version of Sexual Experience Survey-Short Form Victimization. Overall, 63% of bisexual, 49% of lesbian, and 35% of heterosexual women reported experiencing rape in their lifetime. When holding all other social characteristics constant, sexual orientation remained a significant predictor in the model. Compared with the odds of heterosexual women experiencing sexual assault or rape, bisexual women (3.7 odds of victimization; 7.3 odds of repeat victimization) and lesbian women (3.2 odds of repeat victimization) were disproportionately victimized. Sexual orientation clearly plays a role in sexual victimization risk, independent of other measured sociodemographic indicators. Continued research is needed to explore possible mechanisms behind sexual assault and rape prevalence, as well as the influence of contextual factors of victimization risk among sexual minority men.

The Prevalence and Psychological Cost of Interpersonal Violence in Graduate and Law School

There is a rich research literature linking interpersonal violence to mental health disorders among undergraduate students. However, scholars know less about the prevalence and consequences of victimization among students enrolled in postbaccalaureate programs. Graduate and law students are uniquely vulnerable in their dependence on programs for financial support and career advancement, and they are more isolated than undergraduates. We explore the experiences of sexual harassment, sexual assault, and stalking in a sample of 1,149 male and female master's, doctoral, and law students at a southeastern public university. First, the current study estimates prevalence rates of sexual harassment, sexual assault, and stalking across participant characteristics such as gender, race, sexual orientation, and degree program. We find higher rates of sexual harassment among lesbian, gay, bisexual, transgender, queer, intersex, or asexual (LGBTQ+) women and multiracial students and higher rates of coercion and stalking among women. Second, following a longstanding literature on experiences with violence among undergraduate women, we demonstrate the effects of interpersonal violence on depression and anxiety. A series of multivariate analysis of covariance (MANCOVA) suggests a heightened risk of mental health disturbances among law students, women, and LGBTQ+ students. Importantly, interpersonal violence partially explains these heightened levels of depression and anxiety in these groups. Given increasing rates of enrollment in postbaccalaureate programs, our findings suggest an unfulfilled need for the assessment, prevention, and treatment of individuals regarding the experiences of interpersonal violence and mental illness among graduate and law students. Student services should develop education and prevention programming for students and faculty to alleviate the occurrence and consequences of victimization while being mindful of the unique experiences of sexually and racially minoritized students.

The views and experiences of lesbians regarding their mental health needs and concerns: Qualitative findings from a mixed-methods study

PURPOSE

The aim of this paper is to report the specific views and experiences of lesbians and identify their distinct mental health issues and concerns.

DESIGN AND METHODS

A mixed-methods design with surveys and individual interviews was utilized. The data were thematically analyzed.

FINDINGS

The key themes were (a) enabling service access, (b) person-centered support, (c) models of care, (d) community presence and participation, and (e) future aspirations for mental health services.

PRACTICE IMPLICATIONS

The study results inform and develops the understanding of the issues that impact upon the mental health and well-being of lesbians. The implications for mental health practice are discussed.

Sexual Identity, Adverse Life Experiences, and Cardiovascular Health in Women

BACKGROUND

Adverse life experiences (ALE; eg, discrimination and sexual abuse) may contribute to cardiovascular disease (CVD) risk in sexual minority women (SMW), but few studies have tested whether ALE explain the association of sexual identity with cardiovascular health (CVH) markers in women.

OBJECTIVE

The aim of this study was to examine sexual identity differences in CVH among women and the role of ALE.

METHODS

In the Epidemiologic Study of Risk in Women, we used multinomial logistic regression to assess sexual identity differences (SMW vs heterosexual women [reference group]) in CVH markers (ideal vs poor, intermediate vs poor) using the American Heart Association's Life's Simple 7 metric and the total score. Next, we tested whether the association of sexual identity with the total CVH score was attenuated by traditional CVD risk factors or ALE.

RESULTS

The sample consisted of 867 women (395 heterosexual, 472 SMW). Sexual minority women were more likely to have experienced discrimination (P < .001) and lifetime sexual abuse (P < .001) than heterosexual women. Sexual minority women were also less likely to meet ideal CVH criteria for current tobacco use (adjusted odds ratio, 0.43; 95% confidence interval, 0.24-0.73) or intermediate CVH criteria for body mass index (adjusted odds ratio, 0.60; 95% confidence interval, 0.40-0.92). Sexual minority women had a lower cumulative CVH score (B [SE] = -0.35 [0.14], P < .01) than heterosexual women. This difference was not explained by traditional CVD risk factors or ALE.

CONCLUSIONS

Smoking, body mass index, and fasting glucose accounted for much of the CVH disparity due to sexual identity, but those differences were not explained by ALE. Health behavior interventions tailored to SMW should be considered.

Females have more complex patterns of childhood adversity: implications for mental, social, and emotional outcomes in adulthood

Background: Adverse childhood experiences (ACEs) have been identified as an important public health problem with serious implications. Less well understood is how distinct configurations of childhood adversities carry differential risks for mental health, emotional, and social outcomes later in life. Objective: To determine if distinct profiles of childhood adversities exist for males and females and to examine if unique associations exist between the resultant latent profiles of childhood adversities and multiple indicators of mental health and social and emotional wellbeing in adulthood. Method: Participants (N = 1,839) were a nationally representative household sample of adults currently residing in the USA and the data were collected via online self-report questionnaires. Latent class analysis was used to identify the optimal number of classes to explain ACE co-occurrence among males and females, separately. ANOVAs, chi-square tests, and t-tests were used to compare male and female classes across multiple mental health, emotional, and social wellbeing variables in adulthood. Results: Females were significantly more likely than males to report a range of ACEs and mental health, social, and emotional difficulties in adulthood. Two- and four-class models were identified as the best fit for males and females, respectively, indicating more complexity and variation in ACE exposures among females. For males and female, ACEs were strongly associated with poorer mental health, emotional, and social outcomes in adulthood. Among females, growing up in a dysfunctional home environment was a significant risk factor for adverse social outcomes in adulthood. Conclusions: Males and females have distinct patterns of childhood adversities, with females experiencing more complex and varied patterns of childhood adversity. These patterns of ACEs were associated with numerous negative mental, emotional, and social outcomes among both sexes.

Health Disparities Among Exclusively Lesbian, Mostly Lesbian, and Bisexual Young Women

Purpose: Health disparities have been identified between groups of diverse young sexual minority women (SMW) and heterosexual women. This approach may generate sufficient group sizes for statistical analyses but obscures important differences. Moreover, some young women may not identify as "lesbian" or "bisexual" but somewhere in between. This study examined health and sexual minority identity-specific outcomes among three groups of SMW-women who identify as "exclusively lesbian," "mostly lesbian," and "bisexual." Methods: Participants were 990 young (18-30 years old) SMW (exclusively lesbian: n = 305, mostly lesbian: n = 133, bisexual: n = 552) who completed an online survey, including information about mental and physical health symptoms, hazardous drinking, and identity uncertainty. Those who reported alcohol use in the past 30 days responded to questions about their alcohol use and alcohol-related negative consequences. Results: Controlling for demographic differences, health outcomes varied significantly by identity. Mostly lesbian and bisexual women reported the most depression, anxiety, and physical health symptoms; mostly lesbian women reported the highest levels of hazardous drinking. Among those who reported drinking, mostly lesbian women drank the most frequently and reported the most alcohol-related consequences. Mostly lesbian women reported the most identity uncertainty. Conclusion: Mostly lesbian women were similar to bisexual women on several health outcomes. They appear unique, however, in drinking behavior and identity uncertainty. Collapsing across identities in health research may affect outcomes.

Racial/Ethnic Differences in Cardiometabolic Risk in a Community Sample of Sexual Minority Women

Purpose: To examine the intersection of sexual identity and race/ethnicity on self-reported cardiometabolic risk in sexual minority women (SMW). Methods: Data from the Chicago Health and Life Experiences of Women study were analyzed. Logistic regression models examined racial/ethnic differences in cardiometabolic risk (including obesity, hypertension, and diabetes) in SMW, accounting for psychosocial and behavioral factors. A variable accounting for the intersection of sexual identity and race/ethnicity was added to regression models (White lesbian women were the reference group). Results: The analytic sample included 601 SMW (237 White, 219 Black, 145 Latina). Black (adjusted odds ratio [AOR] 2.96, 95% confidence interval [CI]=1.48-5.94) and Latina (AOR 2.30, 95% CI=1.18-4.48) SMW had higher rates of lifetime trauma than White SMW. Black SMW reported higher rates of obesity (AOR 3.05, 95% CI=1.91-4.88), hypertension (AOR 1.99, 95% CI=1.08-3.66), and diabetes (AOR 3.77, 95% CI=1.46-9.74) relative to White SMW. Intersectional analyses revealed that Black lesbian (AOR 2.94, 95% CI=1.74-4.97) and Black bisexual (AOR 3.43, 95% CI=1.69-6.96) women were more likely to be obese than White lesbian women. Black lesbian women also reported higher rates of hypertension (AOR 2.09, 95% CI=1.08-4.04) and diabetes (AOR 3.31, 95% CI=1.26-8.67) than White lesbian women. No differences in cardiometabolic risk were found between Latina and White SMW. Conclusion: This study extends previous research on racial/ethnic differences in cardiometabolic risk among SMW. Prevention strategies are needed to reduce cardiometabolic risk in Black SMW. Findings highlight the need for cardiovascular disease research in SMW that incorporates longitudinal designs and objective measures.

Lifetime Trauma and Cardiometabolic Risk in Sexual Minority Women

Background: Sexual minority women (SMW; such as lesbian, bisexual, and mostly lesbian) exhibit excess cardiometabolic risk, yet factors that contribute to cardiometabolic risk in this population are poorly understood. Trauma exposure has been posited as a contributor to cardiometabolic risk in SMW. Materials and Methods: An analysis of data from Wave 3 of the Chicago Health and Life Experiences of Women Study was conducted. Multinomial logistic regression was used to examine correlates of trauma. Next, multiple logistic regression was used to examine the associations of different forms of trauma throughout the life course (childhood, adulthood, and lifetime), with psychosocial and behavioral risk factors and self-reported cardiometabolic risk (obesity, hypertension, and diabetes) in SMW adjusted for relevant covariates. Results: A total of 547 participants were included. Older age was associated with higher rates of childhood and adulthood trauma. SMW of color reported higher rates of childhood trauma than white participants. Higher education was associated with lower rates of adulthood trauma. All forms of trauma were associated with probable diagnosis of post-traumatic stress disorder and lower perceived social support. Adult trauma was associated with anxiety, whereas childhood and lifetime trauma were associated with higher odds of depression. No significant associations between forms of trauma and behavioral risk factors were noted, except that childhood trauma was associated with higher odds of past-3-month overeating. Logistic regression models examining the association of trauma and cardiometabolic risk revealed that childhood trauma was an independent risk factor for diabetes. Adulthood and lifetime trauma were significantly associated with obesity and hypertension. Conclusions: Trauma emerged as an independent risk factor for cardiometabolic risk in SMW. These findings suggest that clinicians should screen for trauma as a cardiovascular risk factor in SMW, with special attention to SMW most at risk.

Adverse childhood experiences (ACEs) are associated with forced and very early sexual initiation among Black women accessing publicly funded STD clinics in Baltimore, MD

PURPOSE

To examine the association between adverse childhood experiences (ACEs) and early sexual initiation.

METHODS

We analyzed retrospective data of (n = 241) Black women recruited from public STD clinics in Baltimore, MD. Multinomial logistic and linear regression models estimated associations between ACEs and early sexual initiation; contextual variables at initiation were examined as mediators.

RESULTS

Twelve percent of our sample reported very early sexual initiation (11-12 years) and 29% reported early sexual initiation (13-14 years). Each additional ACE reported was associated with greater risk of very early sexual initiation (RRR = 1.49; 95%CI:1.23,1.80). Specifically, emotional abuse (RRR = 3.71; 95%CI:1.55,8.89), physical abuse (RRR = 9.45; 95%CI:3.56,25.12), sexual abuse (RRR = 8.60; 95%CI:3.29,22.51), witnessing maternal abuse (RRR = 5.56; 95%CI:2.13,14.52), and household substance misuse (RRR = 3.21; 95%CI:1.38,7.47) at or before the age of 18 were associated with very early sexual initiation. As for context of initiation, age at sexual initiation was younger if the man at initiation was a non-partner (ß = -0.88; 95%CI:-1.36,-0.40), was ≥3 years older (ß = -1.30; 95%CI:-1.82,-0.77), had pressured or forced sexual intitiation (ß = -1.09; 95%CI:-1.58,-0.59), and was under the influence of drugs/alcohol (ß = -0.97; 95%CI:-1.62,-0.32). Contextual variables at first sex, including being pressured or forced, and the man being ≥3 years older fully mediated the association between ACEs and early sexual initiation.

CONCLUSIONS

This study highlights the critical need to develop interventions that reduce the impact of ACEs on women's health and delay age at sexual initiation. Health education efforts are needed for clinicians and parents to identify and prevent childhood abuse and to identify and report sexual coercion and abuse for girls and adolescents.

Trauma-Informed Care Education in Baccalaureate Nursing Curricula in the United States: Applying the American Association of Colleges of Nursing Essentials

The practice of trauma-informed care (TIC) allows nurses in any setting to identify and intervene with traumatized individuals and to create a continuum of care when forensic nursing services are needed. The purpose of this article is to suggest ways to incorporate TIC content into baccalaureate nursing programs. We begin with an overview of baccalaureate nursing curricula and common types of traumatic experience important for students to understand. We then propose specific strategies for inclusion of TIC content in baccalaureate nursing education, using the American Association of Colleges of Nursing Essentials of Baccalaureate Education for Professional Nursing Practice. With a solid foundation in TIC, baccalaureate-prepared nursing students can provide effective patient care and better support forensic nursing practice. This will increase the capacity of the nursing profession in general to meet the needs of those affected by trauma, violence, and abuse.

Polyvictimization in childhood and its adverse impacts across the lifespan: Introduction to the special issue

Although much empirical work has focused on the adverse impact of specific types of childhood victimization (e.g., sexual, physical, or emotional abuse), researchers and clinicians increasingly are recognizing the prevalence of polyvictimization, or exposure to multiple types of victimization. Polyvictimization during formative developmental periods may have detrimental and potentially lifelong biopsychosocial impacts over and above the effects of exposure to specific types of adversity. In this guest editorial, we summarize the key questions and findings for six empirical studies on polyvictimization included in this Special Issue of the Journal of Trauma & Dissociation. These empirical studies further our understanding of the nature, consequences, and assessment of polyvictimization. We conclude with recommendations for continued scientific research and clinical inquiry on polyvictimization.

Childhood Abuse Experiences and the COMT and MTHFR Genetic Variants Associated With Male Sexual Orientation in the Han Chinese Populations: A Case-Control Study

BACKGROUND

Although it is widely acknowledged that genetic and environmental factors are involved in the development of male homosexuality, the causes are not fully understood.

AIM

To explore the association and interaction of childhood abuse experiences and genetic variants of the catechol-O-methyltransferase (COMT) and methylenetetrahydrofolate reductase (MTHFR) genes with the development of male homosexuality.

METHODS

A case-control study of 537 exclusively homosexual men and 583 exclusively heterosexual men was conducted, with data collected from March 2013 to August 2015. Data were analyzed using χ² tests and logistic regression models.

OUTCOMES

Sociodemographic characteristics, childhood abuse experiences, and polymorphisms of COMT at rs4680, rs4818, and rs6267 and MTHFR at rs1801133.

RESULTS

More frequent occurrence of physical (adjusted odds ratio [aOR] = 1.78), emotional (aOR = 2.07), and sexual (aOR = 2.53) abuse during childhood was significantly associated with the development of male homosexuality. The polymorphisms of MTHFR at rs1801133 and COMT at rs4818 also were significantly associated with the development of male homosexuality in the homozygote comparisons (T/T vs C/C at rs1801133, aOR = 1.68; G/G vs C/C at rs4818, aOR = 1.75). In addition, significant interaction effects between childhood abuse experiences and the COMT and MTHFR genetic variants on the development of male homosexuality were found.

CLINICAL TRANSLATION

This is the first time that an association of childhood abuse, COMT and MTHFR genetic variants, and their interactions with development of male homosexuality was exhaustively explored, which could help provide new insight into the etiology of male homosexuality.

STRENGTHS AND LIMITATIONS

Because homosexual men are a relatively obscure population, it was impossible to select the study participants by random sampling, which could lead to selection bias. In addition, because this was a case-control study, recall bias was inevitable, and we could not verify causality.

CONCLUSIONS

Childhood abuse and the COMT and MTHFR genetic variants could be positively associated with the development of homosexuality. However, it remains unknown how these factors jointly play a role in the development of homosexuality, and more studies in different ethnic populations and with a larger sample and a prospective design are required to confirm our findings. Qin J-B, Zhao G-L, Wang F, et al. Childhood Abuse Experiences and the COMT and MTHFR Genetic Variants Associated With Male Sexual Orientation in the Han Chinese Populations: A Case-Control Study. J Sex Med 2018;15:29-42.

A Systematic Review of Cardiovascular Disease in Sexual Minorities

BACKGROUND

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

OBJECTIVES

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

SEARCH METHODS

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

SELECTION CRITERIA

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

DATA COLLECTION AND ANALYSIS

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

MAIN RESULTS

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

AUTHORS' CONCLUSIONS

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

The Cascading Effects of Marginalization and Pathways of Resilience in Attaining Good Health Among LGBT Older Adults

PURPOSE OF THE STUDY

Lesbian, gay, bisexual, and transgender (LGBT) older adults comprise a diverse and growing health disparate population. In the present study, using the Health Equity Promotion Model, we investigated pathways by which LGBT older adults experience resilience, risk, and marginalization and their relationship to attaining positive health outcomes.

DESIGN AND METHODS

Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS) is the first longitudinal research project designed to examine the health, aging, and well-being of LGBT adults aged 50 and older. Using data from 2014 (N = 2,415), we tested a structural equation model linking lifetime marginalization, identity affirmation and management, social and psychological resources, and health behaviors to positive health outcomes.

RESULTS

Identity affirmation positively predicted social resources and mental health, and social resources positively predicted mental health. Marginalization was associated with fewer social resources for LGBT older adults with an open identity management style, lower identity affirmation for LGBT older adults who strategically concealed their sexual identity, and poorer mental health. Mental health was associated with better health behaviors, which in turn predicted positive physical health outcomes.

IMPLICATIONS

Although a health disparate population, good health among LGBT older adults appears to be attained via multiple resilience and risk pathways. Providers must remain aware of the historical contexts in which LGBT older adults lived and the strengths they developed in order to understand their health and to develop tailored and targeted prevention and intervention services.

Recommendations for cardiovascular disease research with lesbian, gay and bisexual adults

AIMS AND OBJECTIVES

The purpose of this paper is to provide recommendations to strengthen cardiovascular disease research with lesbian, gay and bisexual adults, and highlight implications for practice.

BACKGROUND

Lesbian, gay and bisexual individuals face significant discrimination that negatively impacts their health. Health disparities research in lesbian, gay and bisexual adults have focused on mental health, sexually transmitted infections and substance use. Although cardiovascular disease is the leading cause of death and many lesbian, gay and bisexual adults report increased risk factors for cardiovascular disease, there has been limited research in this area.

DESIGN

This paper is a critical review.

METHODS

A literature search was conducted that compared cardiovascular disease risk and/or prevalence between lesbian, gay and bisexual and heterosexual adults.

RESULTS

Measures to assess cardiovascular disease risk factors and diagnoses varied widely across the 31 included studies. There was a lack of standardisation in definitions used for alcohol consumption, illicit drug use, mental health and self-rated physical health. Most studies that reported body mass index relied on participant self-report. Few studies included measures of physical activity and diet and those that did lacked standardisation. Only seven studies used laboratory data to establish diagnosis of cardiovascular disease.

CONCLUSIONS

This study is the first comprehensive review on this topic. In cardiovascular disease research with lesbian, gay and bisexual adults, there is a need for: (1) inclusion of stress as a risk factor for cardiovascular disease, (2) standardised measures, (3) objective measures for determining the presence of cardiovascular disease, (4) data from electronic health records to strengthen the study of cardiovascular disease in this population.

RELEVANCE TO CLINICAL PRACTICE

Strengthening cardiovascular disease research in lesbian, gay and bisexual adults is an important step in addressing health disparities in this population. Nurses and other healthcare professionals should assess sexual orientation in routine health assessments.

Comparing the Rates of Early Childhood Victimization across Sexual Orientations: Heterosexual, Lesbian, Gay, Bisexual, and Mostly Heterosexual

Few studies have examined the rates of childhood victimization among individuals who identify as "mostly heterosexual" (MH) in comparison to other sexual orientation groups. For the present study, we utilized a more comprehensive assessment of adverse childhood experiences to extend prior literature by examining if MH individuals' experience of victimization more closely mirrors that of sexual minority individuals or heterosexuals. Heterosexual (n = 422) and LGB (n = 561) and MH (n = 120) participants were recruited online. Respondents completed surveys about their adverse childhood experiences, both maltreatment by adults (e.g., childhood physical, emotional, and sexual abuse and childhood household dysfunction) and peer victimization (i.e., verbal and physical bullying). Specifically, MH individuals were 1.47 times more likely than heterosexuals to report childhood victimization experiences perpetrated by adults. These elevated rates were similar to LGB individuals. Results suggest that rates of victimization of MH groups are more similar to the rates found among LGBs, and are significantly higher than heterosexual groups. Our results support prior research that indicates that an MH identity falls within the umbrella of a sexual minority, yet little is known about unique challenges that this group may face in comparison to other sexual minority groups.

Sex and sexual orientation disparities in adverse childhood experiences and early age at sexual debut in the United States: results from a nationally representative sample

Adverse childhood experiences (ACEs) have been linked to early sexual debut, which has been found to be associated with multiple adverse health outcomes. Sexual minorities and men tend to have earlier sexual debut compared to heterosexual populations and women, respectively. However, studies examining the association between ACEs and early sexual debut among men and sexual minorities are lacking. The aim of this study was to examine the sex and sexual orientation disparities in the association between ACEs and age at sexual debut. Data were obtained from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic and linear regression models were used to obtain crude and adjusted estimates and 95% confidence intervals adjusting for age, race/ethnicity, income, education, insurance and marital status for the association between ACEs (neglect, physical/psychological abuse, sexual abuse, parental violence, and parental incarceration and psychopathology) and early sexual debut. Analyses were stratified by sex and sexual orientation. Larger effect estimates depicting the association between ACEs and sexual debut were seen for women compared to men, and among sexual minorities, particularly among men who have sex with men (MSM) and women who have sex with women (WSW), compared to heterosexuals. Sexual health education programs with a focus on delaying sexual debut among children and adolescents should also consider addressing ACEs, such as neglect, physical, psychological and sexual abuse, witnessing parental violence, and parental incarceration and psychopathology. Public health practitioners, researchers and sexual health education curriculum coordinators should consider these differences by sex and sexual orientation when designing these programs.