Sexual identity development milestones in three generations of sexual minority people: A national probability sample

Using data from the first national probability sample of Black, White, and Latinx sexual minority people in the United States, we examined whether and how sexual identity development timing and pacing differs across demographic subgroups at the intersections of cohort, sex, sexual identity, and race/ethnicity. Among a sample of 1,491 participants aged 18-60 from 3 distinct birth cohorts, we measured participants' ages of sexual identity development milestones, including first same-sex attraction, first self-realization of a sexual minority identity, first same-sex sexual behavior, first disclosure to a straight friend, and first disclosure to a family member. Participants from more recent cohorts reported earlier and accelerated pacing of milestones relative to those from older cohorts. Subgroups defined by sex and sexual identity varied in milestone timing and pacing, with gay males reporting an earlier onset of some milestones than other subgroups. Those who used newer identity labels (e.g., pansexual, queer) reported younger ages of milestones relative to bisexual participants but similar ages to lesbian and gay participants. Black and Latinx participants reported some milestones at younger ages than White participants. Race-stratified models testing groups at the intersection of cohort, sex, and sexual identity revealed subgroup differences in ages of first disclosure to family, as well as differences in the time between self-realization, same-sex sexual behavior, and disclosure to a straight friend. The results suggest substantial variation in the developmental timing and pacing of milestones across social identities and the need to further examine how milestone timing is related to identity, stress, and health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Health and health care access in the US transgender population health (TransPop) survey

BACKGROUND

Probability and nonprobability-based studies of US transgender persons identify different disparities in health and health care access.

OBJECTIVES

We used TransPop, the first US national probability survey of transgender persons, to describe and compare measures of health and health access among transgender, nonbinary, and cisgender participants. We directly compared the results with 2015 US Transgender Survey (USTS) data and with previously published analyses from the Behavioral Risk Factor Surveillance System (BRFSS).

METHODS

All participants were screened by Gallup Inc., which recruited a probability sample of US adults. Transgender people were identified using a two-step screening process. Eligible participants completed self-administered questionnaires (transgender n = 274, cisgender n = 1162). We obtained weighted proportions/means, then tested for differences between gender groups. Logistic regression was performed to evaluate associations. Bivariate analyses were conducted using the weighted USTS data set for shared variables in USTS and TransPop.

RESULTS

Transgender participants were younger and more racially diverse compared to the cisgender group. Despite equally high insurance coverage, transgender people more often avoided care due to cost concerns. Nonbinary persons were less likely to access transgender-related health care providers/clinics than transgender men and women. Transgender respondents more often rated their health as fair/poor, with more frequently occuring poor physical and mental health days compared to cisgender participants. Health conditions including HIV, emphysema, and ulcer were higher among transgender people. TransPop and USTS, unlike BRFSS-based analyses, showed no differences in health or health access.

DISCUSSION

Transgender persons experience health access disparities centered on avoidance of care due to cost beyond insured status. Health disparities correspond with models of minority stress, with nonbinary persons having distinct health/health access patterns. Despite different sampling methods, USTS and TransPop appear more similar than BRFSS studies regarding health/health access.

CONCLUSION

Future research should elucidate health care costs for transgender and nonbinary people, while addressing methodology in national studies of transgender health.

HIV Testing and PrEP Use in a National Probability Sample of Sexually Active Transgender People in the United States

BACKGROUND

HIV testing and pre-exposure prophylaxis (PrEP) are effective HIV prevention strategies often underused by transgender people.

METHODS

Recruitment occurred in 2 phases to identify transgender respondents in a probability sample of adults in the United States. Transgender respondents completed a self-administered paper or web-based survey designed to assess transgender population health. Sexually active respondents (HIV-negative and had sex in the 5 years previously, N = 190) and a subsample of those at risk for sexual HIV acquisition (sex with cisgender men or transgender women, n = 120) were included in analyses.

RESULTS

Of the full sample of sexually active respondents, those who were transfeminine were less likely to be familiar with PrEP; most (72%) reported favorable attitudes toward PrEP. Of those at risk for HIV acquisition, 23% had never tested for HIV. Respondents of color were more likely than white respondents to meet Centers for Disease Control and Prevention recommendations for HIV testing. Respondents who met Centers for Disease Control and Prevention recommendations for HIV testing were more likely to report looking online for lesbian, gay, bisexual, and transgender or transgender-specific health information. Few respondents reported currently taking PrEP (3%); those who reported higher levels of nonaffirmation of their gender identity were less likely to currently use PrEP.

DISCUSSION

These findings may indicate some success of HIV testing outreach programs that prioritize people at higher risk for acquiring HIV, focusing on those who are vulnerable to structural marginalization. Ongoing public health efforts are needed to increase HIV testing and PrEP awareness among transgender adults, who are disproportionately impacted by HIV.

Gender Matters: Workplace Bullying, Gender, and Mental Health

The aim of this study was to examine the role of gender in the process of workplace bullying. In particular, we examined how gender affects reported prevalence rates and health consequences of bullying. In addition, we pay particular attention to if the measurement method – self-labelling or behavioural experience methods – affects potential gender differences. A longitudinal study, with two measurement points 18 months apart, was conducted in Sweden (n = 1854 at T1; n = 1096 at T2). It was a probability sample out of a population of all 3.3 million people in Sweden working at workplaces with ten or more employees. The results showed a slightly higher tendency for women to self-label as bullied (8% vs. 6%), while a higher proportion of men than women could be labelled as bullied based on the negative acts they had been exposed to (21% vs. 14%). Exposure to negative acts was associated with more subsequent mental health problems for both men and women, whereas self-labelling was associated with mental health problems for men only. Mental health problems at baseline also increased the risk of bullying for both men and women; however, the measurement method affected if the effect was stronger for men or women. Overall, the study advances our understanding of the role of gender in bullying, in particular highlighting the importance of the measurement method for understanding such gender differences.

Comparison of three rapid household survey sampling methods for vaccination coverage assessment in a peri-urban setting in Pakistan

BACKGROUND

Household surveys are an essential tool for vaccine coverage monitoring in developing countries, and the World Health Organization (WHO) Expanded Program on Immunization (EPI) cluster survey design has been a default choice for decades. In response to methodological limitations of the traditional EPI sampling, alternative methods have been proposed, based on modern statistical and geographical techniques. This study compared the coverage estimates and the time efficiency of the EPI sampling design and two alternative methods: the compact segment sampling and innovative grid-based geographical information system (GIS) sampling.

METHODS

We conducted a series of equal-sized concurrent prospective vaccine coverage surveys in Karachi, Pakistan, from January to December 2016, using traditional EPI, compact segment and grid-based GIS sampling methods.

RESULTS

No differences in vaccine coverage estimates were identified across sampling methods in the peri-urban setting; however, due to stronger clustering effects and correct incorporation of sampling weights, the compact segment [design effect (DEFF) = 2.03] and the grid-based GIS surveys (DEFF = 1.72) had higher design effects and, therefore, appeared to have lower statistical precision than the traditional EPI surveys (DEFF = 1.57). To achieve the same level of apparent precision, data collection activities in the compact segment surveys would require more than twice the implementation time needed compared with the traditional EPI surveys.

CONCLUSIONS

The precision of the EPI surveys appeared higher than that of the alternative methods because, under a questionable self-weighting assumption, the estimated design effect did not account for variable sampling weights. The compact segment and grid-based GIS methods were designed to improve randomness and representativeness of sampling households. Although these alternative methods did not result in coverage estimates that differed from the EPI survey results in the peri-urban setting, they have a lower risk of selection bias and therefore may be preferred.

Mental health impact of the 2010 Haiti earthquake on the Miami Haitian population: A random-sample survey

This study examined the mental health consequences of the January 2010 Haiti earthquake on Haitians living in Miami-Dade County, Florida, 2-3 years following the event. A random-sample household survey was conducted from October 2011 through December 2012 in Miami-Dade County, Florida. Haitian participants (N = 421) were assessed for their earthquake exposure and its impact on family, friends, and household finances; and for symptoms of posttraumatic stress disorder (PTSD), anxiety, and major depression; using standardized screening measures and thresholds. Exposure was considered as "direct" if the interviewee was in Haiti during the earthquake. Exposure was classified as "indirect" if the interviewee was not in Haiti during the earthquake but (1) family members or close friends were victims of the earthquake, and/or (2) family members were hosted in the respondent's household, and/or (3) assets or jobs were lost because of the earthquake. Interviewees who did not qualify for either direct or indirect exposure were designated as "lower" exposure. Eight percent of respondents qualified for direct exposure, and 63% qualified for indirect exposure. Among those with direct exposure, 19% exceeded threshold for PTSD, 36% for anxiety, and 45% for depression. Corresponding percentages were 9%, 22% and 24% for respondents with indirect exposure, and 6%, 14%, and 10% for those with lower exposure. A majority of Miami Haitians were directly or indirectly exposed to the earthquake. Mental health distress among them remains considerable two to three years post-earthquake.

"Clustering by interviewer": a source of variance that is unaccounted for in single-stage health surveys

Although the impact of interviewers on survey measurement has been studied for more than 85 years, such impacts are rarely considered in the analysis of health surveys. This issue is particularly important with single-stage surveys such as that used in the Behavioral Risk Factor Surveillance System (BRFSS), where there are no sampling clusters in which interviewer effects could be captured. The BRFSS involves an ongoing telephone survey of the health behaviors of US adults and was established in 1984 by the Centers for Disease Control and Prevention. Public-use BRFSS data files are widely used by epidemiologists and public health researchers to describe the health behaviors of adults in the United States. Since its onset, the BRFSS has provided identification codes for telephone interviewers completing BRFSS interviews in its public-use data files; however, a review of BRFSS publications shows no evidence that these codes have been used in estimating standard errors. In this paper we analyze data from the 2012 BRFSS, illustrate both design-based and model-based approaches to incorporating interviewer effects in variance estimation, and find evidence of substantial interviewer effects for 5 key estimates across states. These results suggest that BRFSS analysts should consider accounting for interviewer effects, and we provide example code enabling analysts to do so. We conclude with suggestions regarding possible directions for future research.

HIV Risk and Prevention Outcomes in a Probability-Based Sample of Gay and Bisexual Men in the United States

BACKGROUND

Although gay and bisexual men (GBM) represent the largest group of HIV-infected individuals in the United States, nearly all evidence on their HIV risk and prevention outcomes derive from nonprobability samples.

SETTING

A probability-based cohort of GBM (N = 502) from 45 states and Washington, DC.

METHODS

Cross-sectional survey.

RESULTS

Among HIV-negative/unknown/untested GBM, only 6.7% reported using pre-exposure prophylaxis (PrEP) in the past 6 months. Two-thirds (63.3%) of PrEP users reported daily adherence in the past week. Over half (54.2%) of GBM reported not using a condom during anal sex with their most recent male partner; of these men, 93.8% were not on PrEP. Most GBM had been tested for HIV (80.7%) and other sexually transmitted infections (67.1%) in their lifetime, with 45.2% having tested for HIV during the past year. Among those ever tested, 14.1% reported being HIV infected, whereas an additional 8.9% reported testing positive for at least one other sexually transmitted infection after their most recent test. All HIV-positive GBM reported being currently on antiretroviral treatment, and 94.7% reported an undetectable viral load, but nearly one-third (30.4%) reported not taking their medication every day during the past month. A majority of HIV-negative/unknown/untested GBM (64.3%) reported that they had never discussed HIV prevention with their primary health care provider.

CONCLUSIONS

Our findings present a decidedly mixed picture regarding the success of the US National HIV/AIDS Strategy in meeting its stated goals of addressing HIV risk among the general population of GBM.

Constructing a representative sample of out-of-care HIV patients from a representative sample of in-care patients

Individuals infected with HIV who are out of care are at a higher risk of HIV-related morbidity and mortality. It has been difficult to recruit a representative sample of out-of-care patients for epidemiological studies. Using a novel weighting method, we constructed a representative sample of out-of-care HIV patients from a representative sample of in-care patients. In-care patients were weighted based on the probability of receiving care during the study period and the probability of selection to participate in the study, and out-of-care patients were represented by those who were previously out of care and recently returned. The method can be used in other patient populations, if every patient in the population has a known, non-zero probability of receiving care and a known, non-zero probability of participating in the study.

Behavioral Outcomes of Children with Same-Sex Parents in The Netherlands

Same-sex parents face substantial stressors due to their sexual orientation, such as experiences of prejudice and prohibitive legal environments. This added stress is likely to lead to reduced physical and mental health in same-sex parents that, in turn, may translate into problematic behavioral outcomes in their children. To date, there are only a few nationally representative studies that investigate the well-being of children with same-sex parents. The current study takes a closer look at children’s behavioral outcomes, reported by a parent, using an adapted version of the emotional, conduct, hyperactivity, pro-social, and peer problems subscales of the Strengths and Difficulties Questionnaire (SDQ). We take advantage of unique data from the Netherlands based on a probability sample from population registers, whereby findings can be inferred to same-sex and different-sex parent households with parents between the ages of 30 and 65, and with children between the ages of 6 and 16 years (62 children with same-sex, and 72 children with different-sex parents). The findings obtained by coarsened exact matching suggest no significant disadvantages for children with same-sex parents compared to different-sex parents. We contextualize these findings in their wider cultural context, and recommend a renewed focus in future research away from deficit-driven comparisons.

Design of a population-based longitudinal cohort study of SARS-CoV-2 incidence and prevalence among adults in the San Francisco Bay Area

Purpose

We describe the design of a longitudinal cohort study to determine SARS-CoV-2 incidence and prevalence among a population-based sample of adults living in six San Francisco Bay Area counties.

Methods

Using an address-based sample, we stratified households by county and by census-tract risk. Risk strata were determined by using regression models to predict infections by geographic area using census-level sociodemographic and health characteristics. We disproportionately sampled high and medium risk strata, which had smaller population sizes, to improve precision of estimates, and calculated a desired sample size of 3400. Participants were primarily recruited by mail and were followed monthly with PCR testing of nasopharyngeal swabs, testing of venous blood samples for antibodies to SARS-CoV-2 spike and nucleocapsid antigens, and testing of the presence of neutralizing antibodies, with completion of questionnaires about socio-demographics and behavior. Estimates of incidence and prevalence will be weighted by county, risk strata and sociodemographic characteristics of non-responders, and will take into account laboratory test performance.

Results

We enrolled 3842 adults from August to December 2020, and completed follow-up March 31, 2021. We reached target sample sizes within most strata.

Conclusions

Our stratified random sampling design will allow us to recruit a robust general population cohort of adults to determine the incidence of SARS-CoV-2 infection. Identifying risk strata was unique to the design and will help ensure precise estimates, and high-performance testing for presence of virus and antibodies will enable accurate ascertainment of infections.

Mental Health Problems as a Risk Factor for Workplace Bullying: The Protective Effect of a Well-Functioning Organization

This study examined a strain-stressor association, when mental health problems may lead to subsequent workplace bullying, and a mechanism of how this can happen. I hypothesized that the association between mental health problems and bullying depends on the perceived role clarity and order in the organization, and that sickness presenteeism (SP) mediates this association. The study is based on a longitudinal probability sample drawn from the total number of employees in Sweden. Workplace bullying, mental health, SP, and role clarity and order in the organization were assessed using a questionnaire. The results showed that mental health problems are associated with an increased risk for subsequent bullying, consistent with previous findings. However, this risk depends on the level of role clarity and order in the organization. The results also show a partial indirect effect via SP. This means that if one has mental health problems and persists in coming to work although one should have stayed at home, the risk of bullying increases. The indirect effect depends also on the level of order in the organization. The findings suggest that individual deficits, such as mental health problems, are associated with subsequent bullying only if organizational deficits are also present.

Distribution and Prevalence of Health in a National Probability Sample of Three Cohorts of Sexual Minority Adults in the United States

Purpose: This study examined the health profile of a national probability sample of three cohorts of sexual minority people, and the ways that indicators of health vary among sexual minority people across age cohorts and other defining sociodemographic characteristics, including sexual identity, gender identity, and race/ethnicity. Methods: The Generations Study, the first national probability sample of three age cohorts of sexual minority people (n = 1507) in the United States collected in 2016-2017, was used to examine general health profiles across several broad domains: alcohol and drug abuse; general health, physical health, and health disability; mental health and psychological distress; and positive well-being, including general happiness, social well-being, and life satisfaction. Results: There were no cohort differences in substance abuse or positive well-being. The younger cohort was physically healthier, but had worse psychological health than both the middle and older cohorts. Conclusions: Cohort differences in physical health were consistent with patterns of aging, whereas for mental health, there were distinct cohort differences among sexual minority people. Given that compromised mental health in the early life course creates trajectories of vulnerability, these results point to the need for mental health prevention and intervention for younger cohorts of sexual minority people.

Grouping methods for estimating the prevalences of rare traits from complex survey data that preserve confidentiality of respondents

Originally, 2-stage group testing was developed for efficiently screening individuals for a disease. In response to the HIV/AIDS epidemic, 1-stage group testing was adopted for estimating prevalences of a single or multiple traits from testing groups of size q, so individuals were not tested. This paper extends the methodology of 1-stage group testing to surveys with sample weighted complex multistage-cluster designs. Sample weighted-generalized estimating equations are used to estimate the prevalences of categorical traits while accounting for the error rates inherent in the tests. Two difficulties arise when using group testing in complex samples: (1) How does one weight the results of the test on each group as the sample weights will differ among observations in the same group. Furthermore, if the sample weights are related to positivity of the diagnostic test, then group-level weighting is needed to reduce bias in the prevalence estimation; (2) How does one form groups that will allow accurate estimation of the standard errors of prevalence estimates under multistage-cluster sampling allowing for intracluster correlation of the test results. We study 5 different grouping methods to address the weighting and cluster sampling aspects of complex designed samples. Finite sample properties of the estimators of prevalences, variances, and confidence interval coverage for these grouping methods are studied using simulations. National Health and Nutrition Examination Survey data are used to illustrate the methods.

Racial and Ethnic Differences in the Associations Between COVID-19 Stigma and Mental Health in a Population-Based Study of Adults with SARS-CoV-2 Infection

Introduction

Many individuals with coronavirus disease 2019 (COVID-19) faced stigmatization, which may contribute to poor health. However, very few studies have explored the relationship between COVID-19 stigma and health, and even less is known about differences in the relationship by race and ethnicity. This article examines associations between COVID-19 stigma and mental health overall and by race and ethnicity.

Methods

We used a population-based probability sample of Michigan adults with SARS-CoV-2 infection between March 2020 and May 2022. We captured COVID-19 stigma based on perceived COVID-19 stigma, fear of COVID-19 disclosure to friends or family, and fear of COVID-19 disclosure at work. We conducted modified Poisson regression with robust standard errors to estimate associations of COVID-19 stigma with depressive and anxiety symptoms adjusting for confounding factors.

Results

Individuals who experienced perceived COVID-19 stigma had 1.44 times higher prevalence of depressive symptoms (95% confidence intervals [CIs]: 1.23-1.69) and 1.48 times higher prevalence of anxiety symptoms (95% CI: 1.30-1.69) compared with individuals who did not experience perceived stigma. Moreover, individuals who were afraid to disclose their COVID-19 diagnosis to friends or family, or who were afraid to disclose their diagnosis at work, had a higher prevalence of depressive symptoms and anxiety symptoms, compared with those who were not afraid. These associations were more pronounced among racial and ethnic minoritized individuals than non-Hispanic White individuals.

Discussion

COVID-19 stigma was associated with depressive and anxiety symptoms. There is a critical need to examine long-lasting effects of stigma, particularly among racial and ethnic minoritized individuals.

Mental health and help-seeking in Czech sexual minorities: a nationally representative cross-sectional study

AIMS

The mental health of sexual minority (SM) individuals remains overlooked and understudied in Czechia. We aimed to estimate (1) the prevalence rate and (2) the relative risk of common mental disorders and (3) the mental distress severity among the Czech SM people compared with the heterosexual population. In addition, we aimed to investigate help-seeking for mental disorders in SM people.

METHODS

We used data from a cross-sectional, nationally representative survey of Czech community-dwelling adults, consisting of 3063 respondents (response rate = 58.62%). We used the Mini-International Neuropsychiatric Interview to assess the presence of mental disorders. In individuals scoring positively, we established help-seeking in the past 12 months. We assessed symptom severity using the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder scale. We computed the prevalence of mental disorders and the treatment gap with 95% confidence intervals. To assess the risk of having a mental disorder, we used binary logistic regression.

RESULTS

We demonstrated that the prevalence of current mental disorders was 18.85% (17.43-20.28), 52.27% (36.91-67.63), 33.33% (19.5-47.17) and 25.93% (13.85-38) in heterosexual, gay or lesbian, bisexual and more sexually diverse individuals, respectively. Suicidal thoughts and behaviours were present in 5.73% (4.88-6.57), 25.00% (11.68-38.32), 22.92% (10.58-35.25) and 11.11% (2.45-19.77) of heterosexual, gay or lesbian, bisexual and more sexually diverse individuals, respectively. After confounder adjustment, gay or lesbian individuals were more likely to have at least one current mental disorder compared with heterosexual counterparts (odds ratio = 3.51; 1.83-6.76). For bisexual and sexually more diverse individuals, the results were consistent with a null effect (1.85; 0.96-3.45 and 0.89; 0.42-1.73). The mean depression symptom severity was 2.96 (2.81-3.11) in heterosexual people and 4.68 (2.95-6.42), 7.12 (5.07-9.18) and 5.17 (3.38-6.95) in gay or lesbian, bisexual and more sexually diverse individuals, respectively. The mean anxiety symptom severity was 1.97 (1.85-2.08) in heterosexual people and 3.5 (1.98-5.02), 4.63 (3.05-6.2) and 3.7 (2.29-5.11) in gay or lesbian, bisexual and more sexually diverse individuals, respectively. We demonstrated broadly consistent levels of treatment gap in heterosexual and SM individuals scoring positively for at least one current mental disorder (82.91%; 79.5-85.96 vs. 81.13%; 68.03-90.56).

CONCLUSIONS

We provide evidence that SM people in Czechia have substantially worse mental health outcomes than their heterosexual counterparts. Systemic changes are imperative to provide not only better and more sensitive care to SM individuals but also to address structural stigma contributing to these health disparities.

Being out in high school: Positive implications for well-being in three U.S. cohorts of sexual minority adults

For lesbian, gay, bisexual, or queer (i.e., sexual minority [SM]) youth, coming out is an important developmental milestone and is typically associated with positive well-being. However, coming out in high school may entail a higher risk of school-based victimization. Due to the greater risk of homophobic bullying, the implications of being out in adolescence and well-being later in adulthood remain unclear. Using data from a national probability survey (Generations Study) of three distinct age cohorts of SM adults (N = 1,474) in the United States, this study (a) examined how being out at school in adolescence affects general well-being in adulthood and (b) SM-specific well-being in adulthood, and (c) examined if these associations differ by cohort. Results from multivariate regression analyses demonstrated that being out in adolescence was not significantly associated with general well-being, but was significantly associated with SM-specific well-being: higher rates of identity centrality and community connectedness, and lower rates of internalized homophobia. There were no cohort differences in the associations between outness in high school, general well-being, and SM well-being. The findings from this national probability sample of SM adults provide novel insight into implications of being out across the life course, including the positive implications of being out at school in adolescence for SM-specific well-being in adulthood. (PsycInfo Database Record (c) 2024 APA, all rights reserved).