Disparities in Mortality by Sexual Orientation in a Large, Prospective Cohort of Female Nurses.

Importance: Extensive evidence documents health disparities for lesbian, gay, and bisexual (LGB) women, including worse physical, mental, and behavioral health than heterosexual women. These factors have been linked to premature mortality, yet few studies have investigated premature mortality disparities among LGB women and whether they differ by lesbian or bisexual identity. Objective: To examine differences in mortality by sexual orientation. Design, Setting, and Participants: This prospective cohort study examined differences in time to mortality across sexual orientation, adjusting for birth cohort. Participants were female nurses born between 1945 and 1964, initially recruited in the US in 1989 for the Nurses' Health Study II, and followed up through April 2022. Exposures: Sexual orientation (lesbian, bisexual, or heterosexual) assessed in 1995. Main Outcome and Measure: Time to all-cause mortality from assessment of exposure analyzed using accelerated failure time models. Results: Among 116 149 eligible participants, 90 833 (78%) had valid sexual orientation data. Of these 90 833 participants, 89 821 (98.9%) identified as heterosexual, 694 (0.8%) identified as lesbian, and 318 (0.4%) identified as bisexual. Of the 4227 deaths reported, the majority were among heterosexual participants (n = 4146; cumulative mortality of 4.6%), followed by lesbian participants (n = 49; cumulative mortality of 7.0%) and bisexual participants (n = 32; cumulative mortality of 10.1%). Compared with heterosexual participants, LGB participants had earlier mortality (adjusted acceleration factor, 0.74 [95% CI, 0.64-0.84]). These differences were greatest among bisexual participants (adjusted acceleration factor, 0.63 [95% CI, 0.51-0.78]) followed by lesbian participants (adjusted acceleration factor, 0.80 [95% CI, 0.68-0.95]). Conclusions and Relevance: In an otherwise largely homogeneous sample of female nurses, participants identifying as lesbian or bisexual had markedly earlier mortality during the study period compared with heterosexual women. These differences in mortality timing highlight the urgency of addressing modifiable risks and upstream social forces that propagate and perpetuate disparities.

Health disparities in one of the world's most progressive countries: a scoping review of mental health and substance use among sexual and gender minority people in the Netherlands.

BACKGROUND: Evidence from many parts of the world shows that sexual and gender minority (SGM) people have poorer health than their cisgender heterosexual counterparts. Minority stressors, particularly stigma and discrimination, have been identified as major contributors to sexual orientation- and gender identity-related health disparities, particularly negative mental health and behavioral health outcomes. To better understand factors that contribute to these disparities, we conducted a scoping review of SGM mental health and substance use research in the Netherlands-a country with a long-standing reputation as a pioneer in SGM equality. METHODS: Using Joanna Briggs Institute guidelines and the PRISMA-ScR protocol, we searched seven databases to identify studies published between 2010 and 2022 that focused on substance use and/or mental health of SGM youth and adults in the Netherlands. RESULTS: Although there was some evidence that SGM people in the Netherlands report fewer substance use and mental health concerns than those in less progressive countries, with very few exceptions studies found poorer outcomes among SGM participants than cisgender, heterosexual participants. However, this observation must be considered cautiously given major gaps in the literature. For example, only one study focused exclusively on adult sexual minority women, two focused on older SGM adults, and very little attention was given to nonbinary individuals. Most studies used non-probability samples that were quite homogenous. Many studies, especially those with youth, assessed sexual orientation based on sexual attraction; some studies of adults operationalized SGM status as having a same-sex partner. Importantly, we found no studies that directly assessed associations between structural-level stigma and health outcomes. Studies were mostly focused at the individual level and on health problems; very little attention was given to strengths or resilience. CONCLUSIONS: Findings of persistent health disparities-despite the relatively long history of SGM supportive policies in the Netherlands-highlight the need for more research and greater attention to population groups that have been underrepresented. Such research would not only provide guidance on strategies to improve the health of SGM people in the Netherlands, but also in other countries that are seeking to reduce health inequities. Addressing SGM health disparities in the Netherlands and elsewhere is complex and requires a multifaceted approach that addresses individual, interpersonal and structural factors.

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

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

Experiences of and recommendations for LGBTQ+-affirming substance use services: an exploratory qualitative descriptive study with LGBTQ+ people who use opioids and other drugs.

BACKGROUND: Lesbian, gay, bisexual, transgender, queer, and other LGBTQ populations (LGBTQ+; e.g., asexual individuals) have higher rates of substance use (SU) and disorders (SUD) compared to heterosexual and cisgender populations. Such disparities can be attributed to minority stress, including stigma and discrimination in healthcare settings. LGBTQ+-affirming SU treatment and related services remain limited. The purpose of this exploratory qualitative descriptive study was to characterize LGBTQ+ people's experiences in SU services and recommendations for LGBTQ+- affirming care. METHODS: We conducted demographic surveys (characterized using descriptive statistics) and individual qualitative interviews with N = 23 LGBTQ+ people. We employed flexible coding and a thematic analysis approach to describe participants' experiences with stigma, discrimination, and support within SU services at the patient-, staff-, and organizational-level; and participant recommendations for how to make such services LGBTQ+-affirming. We highlighted components of minority stress and mitigators of adverse stress responses throughout our thematic analysis. RESULTS: Patient-level experiences included bullying, name-calling, sexual harassment, and physical distancing from peers; and support via community-building with LGBTQ+ peers. Staff-level experiences included name-calling, denial of services, misgendering, lack of intervention in peer bullying, and assumptions about participants' sexuality; and support via staff advocacy for LGBTQ+ patients, holistic treatment models, and openly LGBTQ+ staff. Organizational-level experiences included stigma in binary gendered program structures; and support from programs with gender-affirming groups and housing, and in visual cues (e.g., rainbow flags) of affirming care. Stigma and discrimination led to minority stress processes like identity concealment and stress coping responses like SU relapse; support facilitated SU treatment engagement and retention. Recommendations for LGBTQ+-affirming care included non-discrimination policies, LGBTQ+-specific programming, hiring LGBTQ+ staff, routine staff sensitivity training, and gender-inclusive program structures. CONCLUSIONS: LGBTQ+ people experience stigma and discrimination within SU services; supportive and affirming care is vital to reducing treatment barriers and promoting positive health outcomes. The current study offers concrete recommendations for how to deliver LGBTQ+-affirming care, which could reduce SU disparities and drug overdose mortality overall.

Childhood sexual abuse, adult sexual assault, revictimization, and coping among sexual minority women.

BACKGROUND: Compared with heterosexual women, sexual minority women experience higher rates and greater severity of sexual victimization. Little is known about how childhood sexual abuse (CSA), adult sexual assault (ASA), and revictimization impact coping in this population. Few studies have examined the effects of recency, developmental stage, and revictimization on coping. OBJECTIVE: To improve psychosocial outcomes following sexual victimization, it is important to understand whether different patterns of exposure differentially impact coping over time. To do so, we investigated associations between CSA, ASA, and revictimization (both CSA and ASA) and adult sexual minority women's coping strategies. PARTICIPANTS AND SETTING: Data are from a longitudinal community-based sample of 513 sexual minority women of diverse ages and races/ethnicities. METHODS: Participants reported CSA (

Resilience Through Social Support: An Intersectional Analysis of Sexual Minority Women's Social Resources for Wellbeing.

Sexual minority women (SMW) are at higher risk for a range of health conditions (e.g. depression, anxiety, and alcohol use disorder) than heterosexual women. However, poor health outcomes do not occur for all SMW. Resilience provides a lens for understanding why some SMW maintain good mental and behavioral health despite the presence of multiple risk factors. Few studies have examined the resilience-promoting factor of social support in relation to depression, anxiety, and alcohol use disorder in SMW. There is a need for further research clarifying sources of social support (e.g. family, significant others, friends, LGBTQ+ community) associated with resilient outcomes for SMW. This study used data from a telephone-based survey of 520 SMW to examine the relationships between resilience and social support. We used multiple regression and tested for interactions with ethnoracial identity and sexual identity. Greater levels of overall social support were associated with greater resilience, as was social support from the LGBTQ+ community in particular. There were few differences in these relationships by ethnoracial identity, sexual identity, or their intersections. Interventions that increase social support across any of four support sources appear to have the potential to increase resilience and decrease mental and behavioral health risks for SMW.

Testing whether the combination of victimization and minority stressors exacerbate PTSD risks in a diverse community sample of sexual minority women.

Informed by minority stress and intersectionality frameworks, we examined: 1) associations of sexual identity and race/ethnicity with probable diagnosis of post-traumatic stress disorder (PTSD-PD) among sexual minority women (SMW; e.g., lesbian, bisexual); and 2) potential additive and interactive associations of minority stressors (discrimination, stigma consciousness, and internalized homonegativity) and potentially traumatic childhood and adulthood events (PTEs) with PTSD-PD. Data come from a large and diverse community sample of SMW (N = 662; age range: 18-82; M = 40.0, SD = 14.0). The sample included 35.8% Black, 23.4% Latinx, and 37.2% White participants. Logistic regressions tested associations of sexual identity and race/ethnicity, minority stressors, and PTEs with PTSD-PD. More than one-third of SMW (37.2%) had PTSD-PD with significantly higher prevalence among bisexual, particularly White bisexual women, than lesbian women. Discrimination, stigma consciousness, and internalized homonegativity were each associated with higher odds of PTSD-PD, but only internalized homonegativity was additively associated with PTSD-PD in mutually adjusted models above and beyond effects of PTEs. No evidence for interactive effects between PTEs and minority stressors was found. In a diverse community sample of sexual minority women, PTSD is strongly associated with potentially traumatic childhood events and with minority stressors above and beyond the associations with other potentially traumatic events and stressors in adulthood. Our findings suggest a strong need for therapists to address the effects of stigma and homophobia in treatment for PTSD, as these minority stressors likely maintain and exacerbate the effects of past traumas.

How deep is the cut? The influence of daily microaggressions on bisexual women's health.

Bisexual women experience disproportionately poorer health outcomes in comparison to lesbian and gay groups, and the general population, including inequities related to mental and physical health. Although bisexual-specific health inequities are increasingly well-documented, research examining putative causes of such inequities, as well as research that accounts for differences within bisexual populations - particularly among racial minorities- remains limited. To address these gaps, this paper reports findings from the Women's Daily Experiences Study (WoDES), a multi-method study that explored the relationship between microaggressions and health outcomes among racially/ethnically diverse cisgender, bisexual women in Chicago. Data from 28-day daily e-diaries (N = 2,104 observations; 99 participants, 57% women of color) were analyzed using multilevel modeling to (1) measure the frequency of microaggressions among bisexual women; (2) examine the influence of sexual orientation, racial, and gender microaggressions on mental and physical health; and (3) investigate how race influences relationships between microaggressions and health. Participants reported an average of 8.1 microaggressions in the previous 28 days, and at least one microaggression was reported for more than 42% of days (n = 802). Microaggressions of any type were associated with increased same-day negative affect and somatic complaints. Latina bisexual women experienced worse health outcomes in comparison to Black bisexual women. This study demonstrated the detrimental impact of microaggressions on the health of bisexual women and highlights the critical need for strategies on broader structural changes that could improve the health and well-being of bisexual women.

Challenges of virtual RDS for recruitment of sexual minority women for a behavioral health study.

Respondent driven sampling (RDS) is an approach commonly used to recruit nonprobability samples of rare and hard-to-find populations. The purpose of this study was to explore the utility of phone and web-based RDS methodology to sample sexual minority women (SMW) for participation in a telephone survey. Key features included 1) utilizing a national probability survey sample to select seeds; 2) web-based recruitment with emailed coupons; and 3) virtual processes for orienting, screening and scheduling potential participants for computer-assisted telephone interviews. Rather than resulting in a large diverse sample of SMW, only a small group of randomly selected women completed the survey and agreed to recruit their peers, and very few women recruited even one participant. Only seeds from the most recent of two waves of the probability study generated new SMW recruits. Three RDS attempts to recruit SMW over several years and findings from brief qualitative interviews revealed four key challenges to successful phone and web-based RDS with this population. First, population-based sampling precludes sampling based on participant characteristics that are often used in RDS. Second, methods that distance prospective participants from the research team may impede development of relationships, investment in the study, and motivation to participate. Third, recruitment for telephone surveys may be impeded by multiple burdens on seeds and recruits (e.g., survey length, understanding the study and RDS process). Finally, many seeds from a population-based sample may be needed, which is not generally feasible when working with a limited pool of potential seeds. This method may yield short recruitment chains, which would not meet key RDS assumptions for approximation of a probability sample. In conclusion, potential challenges to using RDS in studies with SMW, particularly those using virtual approaches, should be considered.

Sexual and gender minority health in Chile: findings from the 2016-2017 Health Survey

ABSTRACT OBJECTIVE To expose visibility of the health concerns of sexual and gender minority groups in Chile, as well as to provide a platform to advocate for policies that support the health and well-being of sexual and gender minority people in the country. METHODS The health conditions and risk factors of participants identified as sexual and gender minority were compared to those identified as cisgender heterosexual using data from the 2016-2017 National Health Survey. RESULTS Despite reporting higher self-rated health than heterosexual men, gay men had a higher risk of lifetime diagnosis of sexually transmitted infections. Compared to heterosexual women, the prevalence of depression was higher among bisexual women, who were also less likely to have been tested for HIV. Moreover, transgender participants were more likely to report depression and worse self-rated health than cisgender heterosexual participants. CONCLUSION Small sample sizes of sexual and gender minority subgroups might have obscured some differences that would have been observable in larger samples. Despite this, we found statistically significant sexual and/or gender identity differences in several health areas, especially mental, sexual, and overall health.