Disclosing and Reporting of Consent Violations Among Kink Practitioners in the United States

Kink practitioners are marginalized and experience adverse health and social outcomes, which are exacerbated by consent violations. This study aims to understand experiences of reporting consent violations within a kink context. Kink practitioners (N = 2,888) completed a survey focused on consent violations, reporting, and recommendations, with 767 (25.56%) of them reporting consent violations in the kink context. The type of consent violation (sexual assault or kink-related behaviors), disclosure, and reporting significantly differed based on gender, sexual orientation, and injury status, but not age. Additionally, recommended steps included avoidance of police and others in positions of power and increased accountability.

Bystander intervention for problematic alcohol use among graduate and international students: opportunities and challenges

OBJECTIVES

Bystander intervention (BI) is a prevention approach commonly used for interpersonal violence, but is less studied for problematic alcohol use (PAU). Domestic graduate and international students' life experiences bring a unique context for the potential application of BI to PAU.

METHODS AND MEASURES

We conducted a mixed methods study that consisted of a needs assessment and focus groups at a southeastern university in the U.S. The aims of this study were to understand (1) differences in PAU BI opportunities for domestic graduate versus international students, (2) reasons for differences in PAU BI use, and (3) barriers/facilitators in use of PAU BI.

RESULTS

Overall, participants had few opportunities to use BI. Domestic graduate students had slightly more opportunities compared to international students. Most prominent reasons for lack of opportunities included not wanting to drive, the cost of drinking, and holding a graduate student identity (e.g. not interested in heavy drinking). Trusting others to be responsible for themselves was a common barrier noted for not using BI for PAU.

CONCLUSION

PAU BI programs should contextualize experiences of domestic graduate and international students to provide appropriate skill development that considers unique barriers and facilitators to intervention use.

Entrapment and Defeat Scales: Factor Structure Assessment and Variation by Gender and Sexual Identity among Adults in the United Kingdom

Entrapment and defeat are empirically-supported suicide risk factors. Their measurement is the subject of some debate, however. Also, limited work exists examining sexual and gender minority (SGM) differences in these suicide risk factors despite overall elevated rates of suicidal thoughts and behaviors (STBs) for SGM persons. The present study examined (1) entrapment and defeat differences by sexual orientation and gender identity, (2) factor structure and criterion validity of the Entrapment Scale (E-Scale) and the Defeat Scale (D-Scale), and (3) measurement invariance by sexual orientation (subsamples were too small for gender identity). A sample of 1,027 adults living in the United Kingdom completed a cross-sectional online questionnaire assessing mental health. Analysis of Variance and Kruskal-Wallis testing revealed: (1) all sexual minority (i.e., gay/lesbian, bisexual, and other SM) persons reported higher internal and external entrapment, defeat, and suicidal ideation compared to their heterosexual counterparts, and; (2) gender minority (i.e., transgender and gender diverse) persons reported higher internal and external entrapment, defeat, and suicidal ideation compared to cisgender persons. Supported by suicide theory, confirmatory factor analysis showed modest support for a two-factor E-Scale (internal and external), and a one-factor D-Scale. All entrapment and defeat scores displayed significant moderate positive correlations with suicidal ideation. E- and D-scale scores displayed high intercorrelation, tempering confidence in conclusions regarding the facture structure findings. Item threshold-level responding varied by sexual orientation for the D-Scale but not the E-Scale. Results are discussed with respect to suicide theory and measurement, public health, and clinical practice.

Social Reactions to Disclosure of Sexual Violence Experienced by Sexual and Gender Minority Young Adults: Comparisons of Sexual and Gender Minority Recipients Versus Cisgender/Heterosexual Recipients

Sexual and gender minority (SGM) individuals are at an increased risk of experiencing sexual violence (SV). Social reactions received upon disclosure of SV impact survivors' mental health, and this may be more extreme when social reactions are provided by other SGM individuals. The purpose of the current study was to understand the SV disclosure experiences of SGM young adults, including the identity of disclosure recipients and the quality of the social reactions received by SGM and cisgender/heterosexual disclosure recipients. Additionally, the current study sought to examine how the SGM identity of the disclosure recipient and the quality of the social reactions received were associated with mental health outcomes (depression, post-traumatic stress disorder [PTSD], and alcohol use) among SGM SV survivors. SGM-identifying participants (N = 110) completed a 10-min survey on Qualtrics that was distributed through Prime Panels. Results revealed that 83% of participants (SGM survivors of SV) disclosed their SV experience to other SGM individuals. SGM disclosure recipients provided more positive social reactions and fewer negative social reactions than cisgender/heterosexual disclosure recipients. Regression models indicated that positive social reactions from cisgender/heterosexual recipients were associated with a decrease in depression scores. Negative social reactions from SGM recipients were associated with an increase in depression scores. Unexpectedly, positive social reactions from SGM recipients, while negative social reactions from cisgender/heterosexual recipients, were associated with an increase in PTSD scores. No associations were found between social reactions and alcohol use. Findings highlight the importance of social reactions and disclosure experiences on SGM survivors' mental health and mitigation opportunities to improve these disclosure experiences.

Collectives for Care: Perspectives of Providers and Community Members in Transgender Health Care in a Southern U.S. City

Affirming and accessible health care may improve health outcomes for trans individuals in the U.S. We explored strategies to improve affirming care for trans individuals from the perspectives of providers and transgender and non-binary community members. Forty members of a collective group of gender-affirming providers (GAP) in the southern U.S. were recruited to participate in a brief online survey. A graphical LASSO undirected network analysis approach visualized associations across outcomes and explanatory variables. Multinomial ordered (or logistic, for binary outcomes) models explored associations between a common set of explanatory variables and outcomes. Strong partial correlations (network) and statistically significant explanatory variables (ordinal and logistic models) were identified. Additionally, we conducted three focus groups (FGs) audio-recorded over Zoom with 11 community members. Four study team members analyzed the transcripts using content analyses. Survey results indicated that higher frequency of attendance at monthly provider meetings, additional training, and provision of training and consultation were associated with greater perceived competence among GAP members. To improve services, FG participants suggested treating patients as experts, increasing diversity and representation among providers, and expanding the GAP group. These results highlight the critical need to design and implement community-identified interventions to improve gender-affirming services and enhance provider training.

Sexual Behaviors and Aggression in Gay Pornography

Previous studies have suggested a substantial number of men who have sex with men (MSM) have consumed and used pornography to learn about same-sex sexual behaviors. Yet, past research has focused almost exclusively on condom-use in the category of Gay pornography and ignored the types of sexual behaviors and aggression depicted within the content. This study examined aggression and sexual behaviors depicted in Gay online pornography (N = 415). We found fellatio and anal sex were the most common behaviors, occurring in roughly two-thirds of scenes, while kissing occurred in less than a third of scenes. Additionally, sexual aggression occurred in 31% of scenes, with spanking being the most common, occurring in 20% of scenes. Anal sex and forced fellatio were found to be predictors of physical aggression. These findings point to normalization of aggression and narrow sexual behaviors in Gay pornography, which may have implications for MSM's norm perceptions related to sexuality.

A Systematic Review of Validated Measures of U.S.-Based Bystander Intervention-Related Constructs

This review aimed to identify U.S.-based, construct-validated measures of bystander intervention. Following PRISMA-P guidelines, electronic databases were searched, and emails were solicited identifying 8,559 articles for title screening. Abstracts and full texts were double screened, resulting in 24 scales meeting inclusion criteria: (a) measured a bystander-related construct in a situation where there was a potential for actual or perceived imminent physical or emotional harm, (b) written in English, and (c) statistically validated on U.S. samples. Most scales addressed the domain of interpersonal violence (67%), with fewer relating to bias/bullying (8.2%), mental health crises (12.5%), and substance use (12.5%). Most scales (71%) assessed the "take action" step of the situational model. The modal construct represented was intent/willingness/likelihood to intervene (50%). The average number of items on a scale was 14, and most (79%) provided Likert-style response options. None of the validated scales assessing behavior first accounted for an opportunity. Sample sizes ranged from 163 to 3,397, with the modal setting from colleges. Overall, samples were young (21.8 years old), White (75%), women (64%), and heterosexual (89%). Results indicate the need to validate additional measures that capture the "interpreting the situation as problematic" step of the situational model. Scales also need to be validated using diverse samples, particularly within the mental health crisis domain. Across all domains, validated measures need to be developed that first account for an opportunity when measuring actual bystander behavior. The information gleaned can be used to assist researchers in selecting measures and guide future measure development.

Psychometric Properties of the Brief Resilience Scale Among Alternative Sexuality Community Members

Assessing resilience among alternative sexuality (alt-sex; e.g., kink, polyamory) community members is imperative as alt-sex individuals often face discrimination and possess intersecting marginalized identities. The Brief Resilience Scale (BRS) has extensive psychometric support; however, prior research indicates both a one- and two-factor (i.e., succumbing and resilience) structure. Further, the psychometric properties of the BRS have not been examined among alt-sex community members. As such, the current study examined the BRS factor structure among alt-sex individuals and measurement invariance across demographic groups (i.e., sexual orientation, gender identity, and sexual assault history). Confirmatory factor analyses and multi-groups invariance analyses were conducted. The two-factor BRS model demonstrated better fit to the data. Model fit did not differ by sexual orientation or gender identity. Measurement invariance was observed by lifetime sexual assault history, with higher factor loadings on succumbing items among alt-sex community members with a lifetime history of sexual assault. Our findings support use of the BRS to measure resilience among alt-sex individuals. Succumbing, or weakened resilience, is a salient factor for alt-sex community members who are sexual assault survivors, warranting further attention.

A qualitative assessment and short-term mediation analysis of defeat, entrapment, and suicide

OBJECTIVES

The Integrated Motivational-Volitional Model (IMV) of Suicide is growing in empirical support. The present study advances IMV research through two aims: (1) to qualitatively probe the subjective experiences of defeat, internal entrapment, and external entrapment, and (2) conducting a 3-month prospective mediation analysis using quantitative and qualitative metrics of defeat and entrapment.

METHODS

The study featured an online two-point survey separated by 3 months. Participants were 255 adults living in the United Kingdom.

RESULTS

Persons endorsing qualitative defeat and internal entrapment in their narratives also showed higher quantitative scores on corresponding IMV and suicide-related self-report scales. Internal entrapment mediated the effect of baseline defeat on 3-month suicidal ideation, whereas external entrapment mediated the association of baseline defeat on 3-month suicide attempt likelihood. Quantitative assessment of entrapment was more significantly associated with suicide attempts and ideation within mediation tests compared to corresponding qualitative variables.

CONCLUSIONS

IMV model principles are largely supported by findings. Mediation results support further consideration of entrapment and defeat within clinical practice and public health-focused suicide research. Understanding the complexity of entrapment narratives represents an important next step for conducting qualitative IMV-focused research with minoritized and high-risk suicide populations.

The bystander intervention for problematic alcohol use model (BIPAUM)

Objective: The study aimed to identify phases of bystander intervention (BI) for problematic alcohol use (PAU) among college students. Participants: Twenty focus groups and nine interviews were conducted. Methods: Transcripts were thematically analyzed. Results: The phases of the Bystander Intervention for Problematic Alcohol Use Model (BIPAUM) include: (1) plan in advance, (2) notice and interpret a sign, (3) decide (i.e., assume responsibility, assess support/feasibility to intervene, and identify intervention strategy), (4) intervene, and (5) assess outcomes. Assessing outcomes loops to influence future behavior and each phase is influenced by barriers and facilitators. Conclusions: These unique phases should be considered when designing and evaluating intervention programs for PAU to meet students' needs and better reduce PAU. Future research should empirically test the BIPAUM. The results of the current study demonstrate a promising opportunity for applying BI to PAU, with the goal of reducing risky drinking among college students.

A pilot study of the adverse childhood experiences-dimensions questionnaire (ACE-DQ): Associations with depression

BACKGROUND

Recent ACE research proposed items to assess ACE dimensions, such as the frequency or timing of adverse events, that can be added to the original ACE-Study Questionnaire.

OBJECTIVE

The goal of our study was to pilot-test the refined ACE-Dimensions Questionnaire (ACE-DQ) to determine its predictive validity and compare scoring approaches.

PARTICIPANTS AND SETTING

Cross-sectional online survey via MTurk with U.S. adults to collect data on the ACE-Study Questionnaire and the newly developed ACE dimension items, and mental health outcomes.

METHODS

We compared ACE exposure by assessment approach and their associations with depression outcomes. We used logistic regression to compare the predictive validity of different ACE scoring approaches for depression outcomes.

RESULTS

Participants (n = 450) were on average 36 years old, half were female, and the majority was White. Almost half reported depressive symptoms; approximately two-thirds had experienced ACEs. Participants reporting depression had significantly higher ACE scores. Using the ACE index, participants with ACEs were 45 % more likely to report depression symptoms than participants without ACEs (OR 1.45, 95%CI 1.33-1.58). When using perception-weighted scores, participants had smaller, yet significant odds of reporting depression outcomes.

CONCLUSIONS

Our results suggest that the ACE index may overestimate the impact of ACEs and the effects of ACEs on depression. Adding the comprehensive set of conceptual dimensions to more fully weigh participants' experience of adverse events can increase the accuracy of ACE measurement but will also increase participant burden considerably. We recommend including items to assess a person's perception of each adverse event for improved screening efforts and in research focused on cumulative adversity.

Gender, sexual orientation, and mental health in the kink community: an application of coping self-efficacy theory

OBJECTIVE

This paper advances understanding of the kink community by examining mental health and coping-self efficacy (CSE) variation by gender and sexual orientation.

DESIGN

Adult members of the National Coalition for Sexual Freedom (N = 332) completed an online cross-sectional health assessment.

MAIN OUTCOME MEASURES

The assessment included the Coping Self-Efficacy (CSE) Scale; Depression and Anxiety Stress Scale-21; and Alcohol Use Disorders Identification Test.

RESULTS

Transgender and non-binary persons reported consistently low coping beliefs and poor mental health. Queer sexual minority persons reported low CSE thought stopping and high anxiety. Several CSE thought stopping moderation effects on mental health were observed.

CONCLUSIONS

Findings may inform clinical implications, as bolstering coping-related beliefs and skills via cognitive-behavioral therapy may offer mental health benefit to kink practitioners.

Coming together in a digital age: Community twitter responses in the wake of a campus shooting

Campus mass shootings have become a pressing policy and public health matter. Twitter is a platform used for processing events among interested community members. Examining the responses of invested community members to a mass shooting on a college campus provides evidence for how this type of violence affects the immediate community and the larger public. These responses may reflect either content (e.g. context-specific) or emotions (e.g. humor). Aims Using Twitter data, we analyzed the emotional responses as well as the nature of non-affective short-term reactions, in response to the April 2019 shooting at UNC Charlotte. Methods Drawn from a pool of tweets between 4/30/19-5/7/19, we analyzed 16,749 tweets using keywords related to the mass shooting (e.g. "shooting," "gun violence," "UNC Charlotte"). A coding team manually coded the tweets using content and sentiment analyses. Results Overall, 7,148 (42.67%) tweets contained negative emotions (e.g. anger, sadness, disgust, anxiety), 5,088 (30.38%) contained positive emotions (e.g. humor, hope, appreciation), 14,892 (88.91%) were communal responses to the shooting (e.g. prayers, healing, victim remembrance), 8,329 (49.73%) were action-oriented (e.g. action taken, policy advocacy), and 15,498 (92.53%) included information (e.g. death/injury, news). All tweets except positive emotions peaked one day following the incident. Conclusions Our findings point to peaks in most emotions in the 24 hours following the event, with the exception of positive emotions which peaked one day later. Social media responses to a campus shooting suggest college preparedness for immediate deployment of supportive responses in the case of campus violence is needed.

Sexual Violence and Nonconsensual Experiences Among Alt-Sex Communities' Members

BACKGROUND

As behaviors, alternative sexual (alt-sex) (i.e., kink, bondage, discipline, dominance, submission, sadism, and masochism , consensual non-monogamy, swinging, leather, and fetish practices) practitioners often emphasize that consent and boundaries are key elements of alt-sex activities. Despite these emphases, individuals experience consent violations and sexual assault both prior to engaging and during their involvement in alt-sex activities.

PURPOSE

This study examines alt-sex practitioners' sexual assault and nonconsensual experiences in order to highlight potential means of intervention and prevention, as well as inform clinical and legal professionals.

METHODS

In collaboration with the National Coalition for Sexual Freedom, this study uses an international survey of adults in alt-sex communities (N = 2996) to examine sexual assault and nonconsensual experiences both within and outside of alt-sex contexts.

RESULTS

We found a lower rate of consent violations in the alt-sex community (26%) compared to sexual assault as an adult outside of alt-sex contexts (34%) and sexual assault as a minor (40%). We found significant differences by groups in sexual assault as a minor (gender, sexual orientation, age, and live in the US or not), sexual assault outside of alt-sex contexts (gender, sexual orientation, and age), nonconsensual experiences in alt-sex contexts (gender, sexual orientation, age, and race), receiving nonconsensual touch in alt-sex contexts (gender, sexual orientation, and age), giving nonconsensual touch in alt-sex contexts (sexual orientation, age, living in the US or not, and race), and being falsely accused of nonconsensual touching in alt-sex contexts (gender, age, and living in the US or not). Within the most recent consent violation, the most common behaviors were non-kink related, except for lack of aftercare. Nearly 40% of participants reported the reasons for their most recent consent violation in alt-sex contexts were being selfish or caught up in the moment.

IMPLICATIONS

Focused interventions are needed to address how different populations are experiencing assault and violations in alt-sex contexts.

A simultaneous concept analysis of resilience, coping, posttraumatic growth, and thriving

BACKGROUND

Research has shifted in recent decades from a focus on negative effects of adversity, trauma, and stress to protective factors and positive outcomes. Resilience and related concepts (coping, posttraumatic growth, thriving, and preparedness) reflect this shift. However, the current state of literature reflects conceptualization challenges in relation to these terms, which blur their differentiation.

AIM

We aim to examine how resilience and related terms are conceptualized in health-related literature.

DESIGN

We used a simultaneous concept analysis to independently explore and further inform the conceptual development of resilience, coping, PTG, and thriving.

DATA SOURCE

We searched PsycINFO and PubMed for literature between 1999 and 2019 for each of our concepts.

REVIEW METHODS

For each of these concepts, we propose a definition, antecedents, attributes, an example, consequences, and related concepts. Next, we concurrently examined the concepts, compared and contrasted findings across them, and clarified similarities as well as differences between them.

RESULTS

Many concepts' definitions lack specificity, clear boundaries, and consistency across the literature. Resilience literature fails to differentiate between attributes and antecedents of resilience. There was overlap regarding conceptualization between resilience and coping, and resilience and thriving.

CONCLUSIONS

Several concepts' definitional literature diverged between a return to baseline functioning and surpassing baseline.

Disclosure to friends or family and consequences after interpersonal violence: intersections of sexual identity and race

Objective: This study's purpose was to examine whether disclosures to friends or family post-victimization was associated with emotional and academic consequences (e.g. feeling detached from others, getting worse grades) among students grouped by sexual identity and race intersections. Participants and Methods: We analyzed data from an online survey that was distributed to students (n = 6,331) at a university in the Southeast. Results: Path analyses indicated disclosure to friends and family partially mediated the relationship between victimization and consequences, such that an increase in the number of disclosures was associated with an increase in the number of consequences. These paths were significant among White sexual minority victims, sexual minority victims of color, White heterosexual students, and heterosexual students of color. Conclusions: These findings indicate that disclosure to informal sources is associated with amplified consequences, which may be ameliorated by training friends and family to respond to disclosures in a supportive manner.

“Sex as a way to gain some control”: Sexual subjectivity during the COVID-19 pandemic

The COVID-19 pandemic has shifted dynamics of sexual health, including sexual subjectivity, or the way in which someone thinks of themself as a sexual being and feels entitled to pleasure. This study examines how adults in the US perceive changes in their sexual subjectivity related to the pandemic. We conducted an online survey ( N = 326), and included thematic analyses related to open-ended questions. The following themes emerged: intentional self-reflection, control of change, control of perspective, control of relationships, control of communication, and control of sexual behavior. Our findings have implications for psychological and public health approaches. We find large overlap of “capacity and engagement in self-reflection” across other themes. The implications and durability of these changes are unknown.

Human Papillomavirus Vaccination Initiation and Completion Among Heterosexual and Sexual Minority U.S. Adults

Purpose: The current study examined the relationship between sexual orientation and human papillomavirus (HPV) vaccination status (no vaccination vs. vaccination initiation [one to two doses] or completion [three or more doses]) among a nationally representative sample of U.S. adults. Methods: Pooled Integrated Public Use Microdata Series-National Health Interview Survey data from 2013 to 2017 were used. The analysis sample (N = 35,266) reported on HPV vaccination status, sexual orientation, and demographic covariates. Multinomial logistic regression, stratified by sex, was conducted to assess the relationship between sexual orientation and HPV vaccination status. Results: Most of the sample (80.37%) had not received any HPV vaccination dose, and only ∼10% reported vaccine completion (three or more doses). After adjusting for demographic covariates, gay and bisexual males were more likely than heterosexual males to initiate (gay: adjusted odds ratio [AOR] = 2.46, 95% confidence interval [CI] = 1.67-3.62; bisexual: AOR = 2.30, 95% CI = 1.28-4.12) and complete (gay: AOR = 2.59, 95% CI = 1.45-4.65; bisexual: AOR = 3.20, 95% CI = 1.56-6.55) HPV vaccination. Bisexual females were more likely than heterosexual females to initiate (AOR = 1.99, 95% CI = 1.55-2.54) and complete (AOR = 1.45, 95% CI = 1.23-1.86) HPV vaccination. Females of another sexual orientation were less likely than heterosexual females to complete HPV vaccination (AOR = 0.49, 95% CI = 0.26-0.92). Conclusions: HPV vaccination remains low across sexual orientation groups. Sexual minority status may be a promotive factor in HPV vaccination for specific subgroups.

The dimensionality of adverse childhood experiences: A scoping review of ACE dimensions measurement

OBJECTIVE

Despite extensive research, the concept of adverse childhood experiences (ACEs) is not fully developed and there is low agreement on how the concept should be defined and measured. The purpose of this study was to 1) identify different conceptual dimensions associated with ACEs, such as timing or frequency; and 2) determine how these dimensions have been operationalized and analyzed to this point, in order to advance the conceptual understanding of ACEs.

METHODS

We conducted a scoping review of empirical journal articles on ACEs published after the original ACE-Study in 1998 to summarize the use of dimensions for the 10 conventional ACE domains. We used a PRISMA methodology to identify articles that assessed at least two of the 10 conventional ACE domains and at least two ACE dimensions. A standardized data extraction spreadsheet was used to record basic article information and specifics on ACE domains and dimensions.

RESULTS

Of 15,417 initial search results, 61 articles met all selection criteria. We identified four primary dimensions used for most ACE domains: frequency, timing, perception, and the role of the perpetrator. Additionally, we found several secondary and domain-specific dimensions, which relate to the intensity of the adverse event.

DISCUSSION

We identified the most commonly used ACE dimensions, but these lack standardized phrasing of items and response options. The inclusion of ACE dimensions may increase the accuracy of the association between ACEs and health outcomes and provide for more tailored treatment plans for people who have experienced ACEs. Future research should include a more comprehensive list of ACE domains and aim to develop a clearly articulated, standardized approach to assessing and analyzing ACE dimensions.

Facilitators and Barriers of HPV Vaccine Acceptance, Initiation, and Completion among LGBTQ Community in the U.S.: A Systematic Review

Objective: This study aims to identify facilitators and barriers of Human Papillomavirus (HPV) vaccine acceptance, initiation, and completion among LGBTQ (lesbian, gay, bisexual, trans, and queer) individuals. Method: A systematic review of qualitative and quantitative studies on HPV vaccine acceptance, initiation, and completion from 2006 to June 15, 2020 was performed in each database. Results: Twenty-six studies focusing on HPV vaccination among LGBTQ individuals were reviewed. Conclusions: Knowledge of HPV vaccine and healthcare providers' recommendations were identified as facilitators to receive HPV vaccinate, while high co-pay cost and concerns of the effectiveness and safety were identified as barriers.

“It’s a walk of shame”: Experiences of unintended pregnancy and abortion among sexual- and gender-minoritized females in urban India

Background:

Unintended pregnancy and safe abortion access in India remain critical public health concerns. The health of sexual- and gender-minoritized females (SGMF; those assigned female at birth and identify as other than heterosexual and/or as other than cisgender women) in India is understudied.

Aim:

We examined experiences of unintended pregnancy and abortion among SGMF individuals in urban India.

Methods:

We used focus group discussions (n = 8 individuals in two groups) and interviews (n = 20) with SGMF individuals. Data were collected in December 2017. Transcripts were analyzed using a priori thematic analysis and then open thematic analysis in Dedoose online software.

Results:

Nine participants experienced or suspected they had unintended pregnancies. Pregnancy circumstances were mostly due to sex without using a barrier method. Participants discussed using traditional methods to induce abortion or changing their approach to contraception. Social support was often lacking, though partners were supportive of abortion choices. Participants reported stigma and surveillance from family, friends, providers, and community members.

Conclusion:

These findings highlight the effects of stigma in relation to abortion and unintended pregnancy on health and relationships.

"Everything feels risky now": Perceived "risky" sexual behavior during COVID-19 pandemic

Social distancing through the COVID-19 pandemic has impacted sexuality and relationships, which may also change risk perceptions beyond traditional definitions (e.g. sexually transmitted infections). This study examines risk perceptions related to sexuality during the pandemic. We present qualitative analyses of a survey of adults in the United States (N = 333) to identify impacts of COVID-19 on individuals’ risk perceptions. Risky sexual behavior definitions included: (1) COVID-19-related, (2) STI/pregnancy, (3) relationship-related, (4) physical boundaries, (5) drug or alcohol, and (6) multiple risks. Conventional public health messaging may need to incorporate changing risk definitions to address sexual health during the pandemic.

Suicidal self-directed violence among gender minority individuals: A systematic review

OBJECTIVE

Gender minority individuals represent a population at increased risk for suicidal self-directed violence (SDV). However, traditional models of suicidal SDV fail to consider gender minority population-specific factors that may buffer or exacerbate risk; further, while sexual and gender minority (SGM) health disparity frameworks may be extended suicidal SDV outcomes among gender minority individuals, little research exists bridging the gap between suicidal SDV research and SGM health disparity research. Thus, the current study sought to identify factors from SGM health disparity models related to suicidal SDV among gender minority individuals.

METHOD

The current study presents a synthesis of peer-reviewed publications (n = 11) that were informed by an SGM health framework and specifically examined suicidal SDV among adult gender minority individuals within the United States.

RESULTS

Factors from SGM health disparity models related to suicidal SDV outcomes included the following: 1) gender minority identity-related factors; 2) gender minority-related rejection, discrimination, harassment, and victimization; 3) structural stigma; and 4) resilience factors.

CONCLUSIONS

Findings support the applicability of SGM health disparity concepts to suicidal SDV outcomes among gender minority individuals. Future longitudinal research with more diverse participants examining the impact of intersectionality of identity and predictive model fit is warranted.

Perceived reproductive health needs among Muslim women in the southern US

Despite growing rates of Muslims in the United States, we know little about the health of Muslim women in this country. Due to the stigma surrounding sex, sexuality, and the cultural beliefs of this population, there may be unique and unknown challenges regarding access to reproductive health care for Muslims in the US. Purpose: This study aims to examine variables that promote and impede access to reproductive health care for Muslim women in the southern US. Methods: This multi-method study included in-person semi-structured interviews (n=15) and an anonymous online survey (n=76). Findings: Participants generally had low rates of gynecological care and cervical cancer screening. The cultural (e.g. waiting for marriage to receive gynecological care) and contextual aspects (e.g. gender) that increased or restricted access to care in terms of screening, providers and education are discussed. We also identified some misconceptions related to screening and contraception. Conclusions: Influences on reproductive health care experienced by participants in this study have similarities yet are distinct from Muslim populations in other countries as well as other groups of women in the US. This study points to a need for more population-focused education of providers, as well as awareness about reproductive health and health care recommendations and access for Muslim women.

"It just feels right": Perceptions of the effects of community connectedness among trans individuals

Trans individuals (e.g. trans men and women, non-binary, gender fluid) are at higher risk for mental health concerns, in part due to marginalization. Previous work has documented the effects of social support and community engagement on health outcomes. However, individuals’ perceptions of community engagement effects may point to opportunities for intervention. This mixed methods study examines trans individuals’ perceived effects of participating in trans communities on health outcomes. Semi-structured in-person interviews were conducted with 20 individuals, and 60 individuals participated in cross-sectional online surveys. Perceived discrimination had a strong negative association with self-assessed mental health. Effects of participation included a) positive: contextualization and normalization of experience, self-appraisal, safety, and relief; and b) neutral/negative: energy drain and stigmatization. Effects of not participating included loneliness, depression, isolation, hiding identity, and losing resources. Both discrimination and non-participation in trans communities had negative effects on mental health. Though community participation is often discussed as positive for marginalized populations, it may be important to include possible negative effects (such as energy drain) in research.

"It's the nature of the beast": Community resilience among gender diverse individuals

Marginalization causes gender diverse individuals to experience increased stress compared with cisgender individuals, such as social stigma and discrimination, which can lead to poor physical and mental health outcomes. This population uses various resources to cope with these challenges, including community social support. This qualitative research aimed to understand how gender diverse individuals perceive their community resilience. Supported by a community partner organization, we recruited N = 20 gender diverse participants for semi-structured interviews analyzed through inductive thematic qualitative analysis. The data revealed similarities with community resilience factors observed among other minority groups as well as novelty. Themes emerged on both individual and group levels and include strengths (e.g., opening to the group, role modeling for resilience, and group resources) and threats to community resilience (e.g., social anxiety, physical health conditions, and stigma). This paper informs the development of community resilience interventions in the context of gender diversity.

Examining the Role of Childhood Adversity on Excess Alcohol Intake and Tobacco Exposure among US College Students

BACKGROUND

Adverse childhood experiences (ACEs) are often associated with substance use behaviors such as drinking excess alcohol and tobacco use. Resilience may protect individuals from engaging in these maladaptive behaviors following ACEs. Objectives: We examined the associations between ACEs and excessive alcohol consumption, and ACEs and tobacco intake and exposure among diverse college students, and whether resilience buffered this relationship. Methods: We conducted a cross-sectional online survey in October 2018 with students at a large Southern university to assess ACEs, levels of resilience, and students' health behaviors. We used the Adverse Childhood Experiences - International Questionnaire (ACE-IQ) and the Brief Resilience Scale. Logistic regression modeled the relationship between ACEs and students' substance use behaviors. We adjusted for demographics, other health behaviors, and emotional health and we tested resilience as a possible buffer. Results: Participants (n = 568) were in their early twenties, almost three-fourths were female. We had a racially/ethnically diverse sample. Over two-thirds had experienced 1-4 ACEs. ACE exposure was not associated with excess alcohol consumption but exhibited a consistent dose-response relationship in unadjusted and adjusted models. Moderate ACEs increased the odds of tobacco exposure by 227% (OR: 3.27, 95% CI: 1.17-9.11) in adjusted models. Resilience was unrelated to either behavior. Black respondents had significantly reduced odds for both substance use outcomes. Tobacco exposure and excess alcohol intake were comorbid behaviors. Conclusion: Childhood adversity was a significant predictor for tobacco exposure among diverse US college students. Resilience did not buffer this relationship. Age, gender, and race/ethnicity were differentially associated with substance use.

The Association Between Childhood Adversity and Self-Rated Physical Health in US College Students

Purpose:

Adverse childhood experiences (ACEs) are related to unhealthy behaviors and poor self-rated health. Poor self-rated physical health (SRPH) is negatively associated with college students’ grades and overall academic achievement. This study examined the effects of ACEs on SRPH among undergraduate and graduate students (n = 568; 18-30 years) from a public university in the southeast.

Methods:

Students completed a cross-sectional online survey in October 2018. We conducted unadjusted and adjusted logistic regressions to examine the relationship between ACEs and SRPH among US college students.

Results:

Most participants reported 1 to 4 ACEs; one-fourth reported poor SRPH. Higher ACE exposure increased the odds for poor SRPH in a curvilinear relationship. Unadjusted results indicate ACE exposure increased risk between 82% and 228%, and that higher levels of resilience and adherence to diet and physical activity guidelines reduced risk for poor SRPH. In adjusted models, moderate ACE exposure was associated with 2.46 times greater odds (95% CI = 1.28-9.34) of reporting poor SRPH. Graduate students (odds ratio [OR] = .52, 95% CI = .27-.99) and those who met healthy diet (OR = .12, 95% CI = .02-.93) and physical activity recommendations (OR = .36, 95% CI = .23-.58) had reduced odds of poor SRPH.

Conclusions:

Students who have experienced ACEs are at a greater risk for poor health. Student health programs on campus should take a holistic approach by screening students for childhood adversity and promoting healthy behaviors to improve physical health.

Definitions of sex and intimacy among gender and sexual minoritised groups in urban India

Understandings of sex and intimacy carry important implications for individuals' behaviours and health. In many research studies, sex is narrowly defined as penile-vaginal intercourse, which may exclude the experiences of sexual and gender minoritised individuals. Likewise, sexual intimacy, or intimacy related to sexual experience between two or more people, is under-researched. Even less is known about how sexual and gender minoritised individuals in countries such as India understand these concepts. This qualitative study included focus group discussions and interviews conducted in three urban areas in India - Chennai, Bangalore and Kolkata. Data were analysed thematically. Participants described sex as a context-dependent experience, acknowledging that their definitions might not capture others' characterisations. Participants reported numerous barriers to intimacy, especially for transgender and other gender minority individuals. We discuss the implications of simplistic definitions related to gender and sexuality for future sexuality research and public health in settings such as those discussed here.

Factors Associated With and Barriers to Disclosure of a Sexual Assault to Formal On-Campus Resources Among College Students

Sexual assault on college campuses occurs at high rates, but disclosure to formal on-campus resources remains low. This study used a mixed methodological survey to explore demographic and social characteristics of students who formally reported their assaults and those who did not and examined barriers to formal disclosure. Responses revealed that students who disclosed to formal on-campus resources suffered frequent polyvictimization, had high rates of physical and emotional consequences, and were mostly White women involved in campus organizations. Barriers to formal resource utilization were identified at the individual, interpersonal, organizational, and community levels.

Family Formation Goals Among Sexual and Gender Minority Individuals in Urban India

Sexual and Gender Minority (SGM) individuals' (nonheterosexual or noncisgender) desires and intentions to form families have been under-researched. Further, research on family formation among SGM individuals is even more scant in India. Family formation, a significant milestone for many individuals, has important implications for overall health. Using data from interviews (n=25) and focus group discussions (8 participants) with SGM individuals in Bangalore, Chennai, and Kolkata, we explore desires and intentions related to parenting. Pressure to have children was ubiquitous, though participants' parenting-related desires varied. Participants considering parenting noted many priorities including their financial stability, relationships with partners, and the legality and legitimacy of their partnerships. Adoption and assisted biological reproduction (e.g., IVF) were the preferred methods of family formation. Experiences and expectations of stigma for themselves and their children shaped participants' limited control over parenting-related decisions. However, they exerted agency as they navigated achieving their ideals for family formation.

Adopting Social Media for Improving Health: Opportunities and Challenges

Social media's ubiquitous influence is changing the landscape of health-related practices. Health organizations and individuals continue to utilize social media for health with mixed results. We discuss current perspectives and challenges of using social media for improving health outcomes. We conclude this paper by highlighting five specific areas that warrant further investigation to better harness social media for health.

Perceptions of Resilience and Coping Among Gender-Diverse Individuals Using Photography

Gender-diverse individuals (those whose gender and/or sex differ from societal expectations, such as trans or genderqueer) face stigma and discrimination, which can translate into negative health outcomes. Resilience describes the process of overcoming adversity that can mitigate these negative effects. Previous work has focused on trans individuals only or measured resilience without first exploring subjective understandings. Purpose: We sought to explore subjective perceptions of resilience among gender-diverse individuals. Methods: This qualitative study uses longitudinal photo-elicited interviews (in which participants' photos prompt interview discussion) with 21 gender diverse individuals (35 total interviews or a 66% retention rate). Interviews were separated by 6 months and transcripts were analyzed using Dedoose software, with each coded twice by separate coders. Results: Participants' strategies to foster resilience included proactive approaches at both the internal and external levels and distracting/temporary approaches. Two themes, flexibility and awareness, emerged as central facets of resilience trajectories. Flexibility took several forms and was intrinsic to cognitive processes, as well as coping choices, and sought through mental training techniques, such as meditation. Participants demonstrated high levels of awareness by incorporating trauma and health outcomes in gender-diverse populations within their narratives, and through the recognition of the unhelpful aspect of avoidant strategies in building resilience. Conclusions: The diverse ways that individuals perceive their own resilience have implications for resilience research in this group and have the potential to inform the development of strength-based interventions tailored to gender-diverse individuals. Public health interventions targeting resilience have the potential to break the pathway linking adversity to ill health among gender-diverse individuals, thereby reducing health disparities in this group.

Influences of health care access on resilience building among transgender and gender non-binary individuals

Background: Health care disparities between transgender/gender non-binary individuals and the general population are well-documented and related to both interpersonal and institutional discrimination. Resilience has been found to buffer the negative health effects of discrimination among gender diverse individuals as well as other stigmatized populations. Aims : The purpose of this study was to identify and understand resilience related to health and health care among a community sample of transgender and gender non-binary individuals in the southern United States. Methods: We conducted 35 longitudinal photo elicitation interviews with 21 participants among a community sample of transgender and gender non-binary individuals in the Southern US. Interview transcripts were coded using thematic analysis and themes were organized according to the Resilience Activation Framework. Results: Overall, individual and community-level resources within the domains of social and human capital were frequently activated to navigate challenges related to seeking and receiving health care. Lack of access to resources in economic and political capital domains constrained resilience. Discussion: This work demonstrates how stakeholders can identify target areas for interventions and policy change aimed at improving resilience in transgender and gender non-binary communities by utilizing the Resilience Activation Framework. In our sample, we found that resources should be directed toward building economic and political capital at the community level so participants have the ability and opportunity to marshal such resources.

Humanizing an Invisible Population in India: Voices from Bisexual Men Concerning Identity, Life Experiences, and Sexual Health

Research examining the sexual identities, behaviors, and experiences of bisexual men outside of Western contexts (including in India) is limited. Individuals who self-identify as bisexual due to their orientation toward partners of more than one gender face distinct psychosocial challenges relative to exclusively heterosexual, gay/lesbian, or other individuals. We conducted four focus group discussions (n = 22) and in-depth interviews (n = 50) with self-identified bisexual men (age 18 years and older) who were recruited from the metropolitan area of Mumbai, India, between June and August 2013. We triangulated and analyzed focus group and interview data using standard qualitative research techniques. Findings from our study suggest that multiple factors influence the sexual experiences of self-identified bisexual men in Mumbai, including contexts of sexual interactions, sexual positioning, and the gender of sexual partners. Participants described cultural meaning systems and psychosocial dynamics that regulate bisexual identity development, disclosure, and sexual decision making with male, female, and other partners. Secrecy, discretion, and sexual pleasure also influenced sexual behaviors and relationships. Although Western sexual identity categories are not necessarily equivalent in the Indian context, it is interesting and important to note that a number of individuals in India continue to use the identity label of "bisexual." Before developing interventions to meet unique sexual health needs of bisexual men, it is crucial to understand how these men perceive themselves, reconcile the ordinary aspects of their lives with their sexuality, and structure their relationships with partners.

Paths to Parenthood Among Self-Identified Bisexual Individuals in the United States

Bisexual parents have been notably absent from prior research on parenting, despite comprising the largest proportion of parents among "lesbian, gay, and bisexual" (LGB) individuals. Indeed, recent national probability data indicate that young bisexual women are more likely than their heterosexual counterparts to report having at least one child. Intentions to have children, patterns of family planning and contraception use, and related issues have important implications for health and healthcare-related decisions and priorities among bisexual parents. We conducted in-depth interviews with a sample of 33 bisexual parents from across the U.S. who reported having at least one child (genetic, adopted, step or foster child, guardian, and/or warden of the state). In cases of intentional pregnancies, participants considered relationship and financial stability, job security and their ideal family size. Unintentional pregnancies, as well as pregnancy terminations, were often reframed as positive experiences. After deciding not to have more children, participants reported using contraceptive methods, including sterilization or long-acting reversible contraceptive methods (e.g., intrauterine devices). Instances of deception, in which partners deceived participants with false beliefs regarding their contraceptive use, were recalled negatively for the relatively small number of participants who reported such experiences. Overall, our findings point to a diversity in the intentions and ways bisexual individuals become parents, similar to parents of other sexual identities. Acknowledgements of the diverse experiences and concerns faced by bisexual parents may be beneficial in improving efforts related to providing appropriate and relevant health- and healthcare-related services.

Social support relationships for sexual minority women in Mumbai, India: a photo elicitation interview study

Little research exists on women who do not identify as heterosexual in India. Social support for sexual minority women may protect against the effects of discrimination. An examination of significant social relationships may point to both strengths and weaknesses in this support. We aimed to understand relationship prioritisation and communication patterns associated with the social support of sexual minority women in Mumbai. In partnership with the Humsafar Trust, India's oldest and largest sexual and gender minority-advocacy organisation, we conducted photo-elicitation interviews with 18 sexual minority women, using participants' photographs to prompt dialogue about their social support. Intimate partners were a source of dependable support and many of those without relationships were seeking them. Participants' extended networks included friends and family as well as less formal relationships of social support. Participants mediated their communication with particular social network members, which involved filtering information sexual identity, romantic interests, and personal aspirations, among others. The diverse relationships that sexual minority women have in their social support networks may be used to guide programmes to improve health outcomes.

Female condom acceptability in urban India: Examining the role of sexual pleasure

This qualitative study examined the acceptability of female condoms in urban India, with a focus on sexual pleasure. We conducted focus group discussions with 50 women and 19 men, as well as a small number of individual interviews with women ( n = 3), in Chennai and New Delhi. Perceived benefits of female condoms included protection against unintended pregnancy and sexually transmitted infections, increased sense of empowerment for women, and simple clean up. The most common drawback was reduced sensation. Participants suggested structural changes to the female condom to ease insertion and use. Consent and privacy were discussed as increasing sexual pleasure. Pleasure should be acknowledged in design and education efforts to increase female condom use.

A multi-method study of health behaviours and perceived concerns of sexual minority females in Mumbai, India

BACKGROUND

This multi-method study explores the perceived health status and health behaviours of sexual minority (i.e. self-identifying with a sexual identity label other than heterosexual) females (i.e. those assigned female at birth who may or may not identify as women) in Mumbai, India, a population whose health has been generally absent in scientific literature.

METHODS

Using community-based participatory research approaches, this study is a partnership with The Humsafar Trust (HST). HST is India's oldest and largest LGBT-advocacy organisation. An online survey targeted towards sexual minority females was conducted (n=49), with questions about sexual identity, perceived health and wellbeing, physical and mental healthcare access and experiences, and health behaviours (including substance use). Additionally, photo-elicitation interviews in which participants' photos prompt interview discussion were conducted with 18 sexual minority females.

RESULTS

Sexual minority females face obstacles in health care, mostly related to acceptability and quality of care. Their use of preventative health screenings is low. Perceived mental health and experiences with care were less positive than that for physical health. Participants in photo-elicitation interviews described bodyweight issues and caretaking of family members in relation to physical health. Substance use functioned as both a protective and a risk factor for their health.

CONCLUSION

Our findings point to a need for more resources for sexual minority females. Education on screening guidelines and screening access for sexual minority females would also assist these individuals in increasing their rates of preventative health.

Sexual diversity in the United States: Results from a nationally representative probability sample of adult women and men

In 2015, we conducted a cross-sectional, Internet-based, U.S. nationally representative probability survey of 2,021 adults (975 men, 1,046 women) focused on a broad range of sexual behaviors. Individuals invited to participate were from the GfK KnowledgePanel^®. The survey was titled the 2015 Sexual Exploration in America Study and survey completion took about 12 to 15 minutes. The survey was confidential and the researchers never had access to respondents’ identifiers. Respondents reported on demographic items, lifetime and recent sexual behaviors, and the appeal of 50+ sexual behaviors. Most (>80%) reported lifetime masturbation, vaginal sex, and oral sex. Lifetime anal sex was reported by 43% of men (insertive) and 37% of women (receptive). Common lifetime sexual behaviors included wearing sexy lingerie/underwear (75% women, 26% men), sending/receiving digital nude/semi-nude photos (54% women, 65% men), reading erotic stories (57% of participants), public sex (≥43%), role-playing (≥22%), tying/being tied up (≥20%), spanking (≥30%), and watching sexually explicit videos/DVDs (60% women, 82% men). Having engaged in threesomes (10% women, 18% men) and playful whipping (≥13%) were less common. Lifetime group sex, sex parties, taking a sexuality class/workshop, and going to BDSM parties were uncommon (each <8%). More Americans identified behaviors as “appealing” than had engaged in them. Romantic/affectionate behaviors were among those most commonly identified as appealing for both men and women. The appeal of particular behaviors was associated with greater odds that the individual had ever engaged in the behavior. This study contributes to our understanding of more diverse adult sexual behaviors than has previously been captured in U.S. nationally representative probability surveys. Implications for sexuality educators, clinicians, and individuals in the general population are discussed.

Perceived health concerns among sexual minority women in Mumbai, India: an exploratory qualitative study

The experiences of sexual minority women (i.e., women who do not identify as 'heterosexual') in India have largely been absent in scientific literature. In partnership with India's oldest and largest sexual and gender minority-advocacy organisation, the Humsafar Trust, our study used community-based participatory research principles to explore the lived experiences and health concerns of sexual minority women in Mumbai. Study methodologies included interviews with key informants, a focus group comprised of six women, and an additional 12 in-person interviews with sexual minority women to identify important physical, mental, social and other health priorities from these women's perspectives. Thematic data are organised within the framework offered by the social ecological model, including individual, interpersonal, micro and macro levels. Findings from this study are important in providing the groundwork for future research and intervention involving sexual minority women in India, a dramatically underserved population.

Sexual Relationships, Behaviors, and Experiences among Bisexual Men in Mumbai, India

This exploratory study aimed to assess a range of sexual behaviors, relationships and related factors among a sample of bisexual men in Mumbai, India. Data collection occurred in two separate phases: 1. focus group discussions were facilitated with local community members in order to finalize an interviewer-administered questionnaire, and 2. structured interviews were conducted with a sample of 50 bisexual men using this questionnaire. Participants self-reported a wide range of sexual behaviors and relationships. Findings have implications for future research and practice focusing on bisexual men in India, as well as their partners of all genders.

Sexual self-identification among behaviorally bisexual men in the midwestern United States

Previous social and behavioral research on identity among bisexual men, when not subsumed within the category of men who have sex with men (MSM), has primarily focused on samples of self-identified bisexual men. Little is known about sexual self-identification among men who are behaviorally bisexual, regardless of sexual identity. Using qualitative data from 77 in-depth interviews with a diverse sample of behaviorally bisexual men (i.e., men who have had sex with at least one woman and at least one man in the past six months) from a large city in the Midwestern United States, we analyzed responses from a domain focusing on sexual self-identity and related issues. Overall, participants' sexual self-identification was exceptionally diverse. Three primary themes emerged: (1) a resistance to, or rejection of, using sexual self-identity labels; (2) concurrent use of multiple identity categories and the strategic deployment of multiple sexual identity labels; and (3) a variety of trajectories to current sexual self-identification. Based on our findings, we offer insights into the unique lived experiences of behaviorally bisexual men, as well as broader considerations for the study of men's sexuality. We also explore identity-related information useful for the design of HIV/STI prevention and other sexual health programs directed toward behaviorally bisexual men, which will ideally be variable and flexible in accordance with the wide range of diversity found in this population.

FROM BIAS TO BISEXUAL HEALTH DISPARITIES: ATTITUDES TOWARD BISEXUAL MEN AND WOMEN IN THE UNITED STATES

PUROPSE

A newly emergent literature suggest that bisexual men and women face profound health disparities in comparison to both heterosexual and homosexual individuals. Additionally, bisexual individuals often experience prejudice, stigma, and discrimination from both gay/lesbian and straight communities, termed "biphobia." However, only limited research exists that empirically tests the extent and predictors of this double discrimination. The Bisexualities: Indiana Attitudes Survey (BIAS) was developed to test associations between biphobia and sexual identity.

METHODS

Using standard techniques, we developed and administered a scale to a purposive online sample of adults from a wide range of social networking websites. We conducted exploratory factor analysis to refine scales assessing attitudes toward bisexual men and bisexual women, respectively. Using generalized linear modeling, we assessed relationships between BIAS scores and sexual identity, adjusting for covariates.

RESULTS

Two separately gendered scales were developed, administered, and refined: BIAS-m (n=645), focusing on attitudes toward bisexual men; and BIAS-f (n=631), focusing on attitudes toward bisexual women. Across scales, sexual identity significantly predicted response variance. Lesbian/gay respondents had lower levels of bi-negative attitudes than their heterosexual counterparts (all p-values <.05); bisexual respondents had lower levels of bi-negative attitudes than their straight counterparts (all p-values <.001); and bisexual respondents had lower levels of bi-negative attitudes than their lesbian/gay counterparts (all p-values <.05). Within racial/ethnic minority respondents, biracial/multiracial status was associated with lower bi-negativity scores (all p-values <.05).

CONCLUSION

This study provides important quantitative support for theories related to biphobia and double discrimination. Our findings provide strong evidence for understanding how stereotypes and stigma may lead to dramatic disparities in depression, anxiety, stress, and other health outcomes among bisexual individuals in comparison to their heterosexual and homosexual counterparts. Our results yield valuable data for informing social awareness and intervention efforts that aim to decrease bi-negative attitudes within both straight and gay/lesbian communities, with the ultimate goal of alleviating health disparities among bisexual men and women.