The role of social cohesion in explaining rural/urban differences in healthcare access and health status among older adults in the mid-Atlantic United States.

Social cohesion can influence health. It is higher among rural versus urban residents, but the burden of chronic disease is higher in rural communities. We examined the role of social cohesion in explaining rural/urban differences in healthcare access and health status. Rural (n = 1080) and urban (n = 1846) adults (ages 50+) from seven mid-Atlantic U.S. states completed an online, cross-sectional survey on social cohesion and health. We conducted bivariate and multivariable analyses to evaluate the relationships of rurality and social cohesion with healthcare access and health status. Rural participants had higher social cohesion scores than did urban participants (rural: mean = 61.7, standard error[SE] = 0.40; urban: mean = 60.6, SE = 0.35; adjusted beta = 1.45, SE = 0.54, p < .01). Higher social cohesion was associated with greater healthcare access: last-year check-up: adjusted odds ratio[aOR] = 1.25, 95% confidence interval[CI] = 1.17-1.33; having a personal provider: aOR = 1.11, 95% CI = 1.03-1.18; and being up-to-date with CRC screening: aOR = 1.17, 95% CI = 1.10-1.25. In addition, higher social cohesion was associated with improved health status: higher mental health scores (adjusted beta = 1.03, SE = 0.15, p < .001) and lower body mass index (BMI; beta = -0.26, SE = 0.10, p = .01). Compared to urban participants, rural participants were less likely to have a personal provider, had lower physical and mental health scores, and had higher BMI. Paradoxically, rural residents had higher social cohesion but generally poorer health outcomes than did urban residents, even though higher social cohesion is associated with better health. These findings have implications for research and policy to promote social cohesion and health, particularly for health promotion interventions to reduce disparities experienced by rural residents.

Relationship Support and Strain among Sexual Minority Women: Changes across Cohorts from 1995 to 2013.

Sexual minority women are granted more rights today than ever before. However, it is unclear how the relationships of sexual minority women have changed compared to previous decades. Additionally, a large body of work has focused on women's same-sex (e.g., lesbian) relationships without accounting for the unique experiences of bisexual women in their relationships. The current study utilizes two national samples of heterosexual, lesbian, and bisexual women to address these gaps, one cohort from 1995 and a second from 2013. We performed analyses of variance (ANOVAs) to examine the effects of sexual orientation, cohort, and their interaction on relationship support and strain. On average, relationships exhibited higher quality in 2013 than in 1995. When considered together, lesbian and bisexual women exhibited higher relationship support than heterosexual women in 1995, but not 2013. Importantly, examining lesbian and bisexual women as separate groups revealed that bisexual women's relationships were on average characterized by lower support and higher strain than lesbian women. Simple effects indicated that bisexual women in 2013 were at the highest risk for diminished relationship quality, while lesbian and heterosexual women's relationships were either stable or improved in this more recent cohort. Implications for clinical practice as well as future research on sexual minority women is discussed.

Sexual Orientation and Gender Identity-Related State-Level Policies and Perceived Health Among Lesbian, Gay, Bisexual, and Transgender (LGBT) Older Adults in the United States.

ObjectivesWe examined the associations between state-level policies and the health of lesbian, gay, bisexual, and transgender (LGBT) older adults. Methods: Using data from the 2018-2020 Behavioral Risk Factor Surveillance System surveys, we assessed physical and mental health by the tally of points for enacted LGBT-related policies (Low= <0-49.9% of possible points, High= 50-100% of possible points) in 10,032 sexual minority (i.e., lesbian, gay, and bisexual) and 1,072 transgender (non-sexual minority) adults aged 50 and older from 41 states. Results: Sexual minority adults in low tally states had greater odds of reporting fair or poor general health and 14 or more days of poor physical health in the past 30 days. Transgender participants in low tally states also had greater odds of reporting fair or poor general health. Discussion: Lesbian, gay, bisexual, and transgender adults have significantly greater risk of poor health if they live in a state with fewer LGBT anti-discriminatory policies enacted.

Daily Stressor Exposure and Daily Well-Being Among Sexual Minority and Heterosexual Adults in the United States: Results from the National Study of Daily Experiences (NSDE).

BACKGROUND: Daily stress plays a significant role in mental and physical health. Negative mood (e.g., hopelessness) and physical symptoms (e.g., headaches) are responses often associated with daily stressors. It is theorized that some people or populations are more vulnerable or reactive to daily stressors. We propose sexual orientation as one factor that is associated with daily stress exposure and reactivity. PURPOSE: To understand whether sexual minorities (SMs) differ from heterosexuals in their exposure and reactivity to general, non-sexual minority-specific stressors (e.g., arguments/disagreements, job concerns). METHODS: We used daily diary data (n = 3,323 heterosexuals [52% identified as female and 85% identified as White]; n = 98 SMs [50% identified as female and 93% identified as White]) from the National Study of Daily Experiences (NSDE). Participants completed eight consecutive evening daily diary interviews (n days = 24,773; mean days completed = 7.24) and reported daily stress exposure and daily well-being. We used multilevel modeling as an approach to examine whether sexual orientation interacted with daily stressors to predict daily negative affect and physical health. RESULTS: SMs tended to experience more daily stressors compared to heterosexuals; specifically, SMs reported at least one stressor on nearly half (48%) of the study days they completed, and heterosexuals reported at least one stressor on about two-fifths (41%) of the study days they completed. SMs also tended to experience more negative mood when they experienced a daily stressor compared to heterosexuals when they experienced a daily stressor. CONCLUSION: We emphasize the importance of SMs' exposure and reactivity to general daily stressors and the implications of our results for the day-to-day lives and health of SMs.

Femininity Concerns and Feelings About Menstruation Cessation Among Lesbian, Bisexual, and Heterosexual Women: Implications for Menopause.

Background: Women differ in how they psychologically respond to the end of menstruation and onset of menopause; however, little empirical evidence exists for understanding how sexual orientation and gendered dynamics contribute to menstrual experiences in middle-to-late adulthood. We investigated if women's attitudes toward the cessation of menstruation vary by their sexual orientation. Methods: Using data from the Midlife in the United States Study (MIDUS, N = 3471), we examined the relationship between women's sexual orientation and attitudes toward menstruation cessation. We also assessed their femininity concerns, such as their worries about attractiveness and fertility in the context of aging. Results: Sexual minority (SM) women, compared with their heterosexual counterparts, expressed less regret of their menstrual periods ending. SM women also expressed lower concerns about femininity compared with heterosexual women, and concerns about femininity mediated the relationship between sexual orientation and regret. That is, SM women felt less regret about menstrual periods ending than heterosexual women, and this finding was partially explained through SM women's lower concerns about femininity (attractiveness and fertility). Conclusions: Our results contribute to a growing body of research on the psychological strengths of sexual minorities by highlighting SM women's potential strengths in an aging context. We propose implications for understanding aging stigma and women's health, and we discuss how menopause may be differently experienced by women based on sexual orientation.

Revictimization Is Associated With Higher Cardiometabolic Risk in Sexual Minority Women.

OBJECTIVES: Although there is evidence that interpersonal trauma is associated with cardiometabolic risk in women, previous studies have not assessed the potential role of revictimization (victimization in both childhood and adulthood) among sexual minority women. METHODS: We used data from the Chicago Health and Life Experiences of Women study to examine the associations of revictimization (including physical, sexual, and any revictimization) with self-reported psychosocial factors, health behaviors, and cardiometabolic risk factors (e.g., obesity, hypertension, and diabetes). We tested multiple logistic regression models, adjusted for covariates, to estimate odds ratios of the associations between revictimization and cardiometabolic risk. RESULTS: The sample included 615 sexual minority women with a mean age of 40.0 years; 38.7% White. Eighty-three (13.5%) and 101 (16.4%) participants reported experiencing sexual revictimization and physical revictimization, respectively. Each form of revictimization was associated with higher odds of reporting lifetime depression and recent binge eating, but lower odds of having high social support. Physical revictimization was associated with higher odds of obesity (adjusted odds ratio [AOR], 2.38; 95% confidence interval [CI], 1.38-4.10) and hypertension (AOR, 3.31; 95% CI, 1.70-6.46). Similarly, participants who reported any revictimization were more likely to have obesity (AOR, 2.36; 95% CI, 1.42-3.92) and hypertension (AOR, 2.60; 95% CI, 1.31-5.26). No form of revictimization was associated with a higher odds of diabetes. CONCLUSIONS: The higher odds of obesity and hypertension observed among sexual minority women who reported revictimization reinforce the need for early interventions to reduce cardiometabolic risk in this vulnerable population.

Perceived discrimination predicts elevated biological markers of inflammation among sexual minority adults.

Sexual minority (SM) adults (those who are lesbian, gay, or bisexual) consistently report more health problems compared to heterosexuals, and they tend to experience excess social stress. Although numerous studies have established links between social stress and clinical outcomes in SM adults, few studies have examined biological factors that may help explain how social stress leads to health disparities among SM adults. We used data from the Midlife in the United States Study (MIDUS) to examine whether two inflammatory markers that have been commonly associated with social stress-C-reactive protein (CRP) and interleukin-6 (IL-6)-differed by sexual orientation and whether any differences were explained by perceptions of discrimination. Participants self-identified as heterosexual (n = 1956) or lesbian, gay, or bisexual (n = 81). After controlling for age, gender, race, and education, SM individuals had higher CRP and IL-6 than heterosexuals on average and these differences were partially explained by perceptions of discrimination. Implications for inflammatory pathways as mechanisms related to SM health disparities and discrimination are discussed.

Changes in prenatal testosterone and sexual desire in expectant couples.

During the transition to parenthood (TTP), both women and men report declines in sexual desire, which are thought to reflect an evolutionarily adaptive focus on parenting over mating. New parents also show changes in testosterone, a steroid hormone implicated in both parenting and mating, suggesting that changes in sexual desire may be associated with changes in testosterone. To test these associations, we followed a sample of heterosexual couples expecting their first child across the prenatal period. We examined prenatal changes in testosterone and two forms of sexual desire (solitary, dyadic). Expectant mothers showed prenatal increases in testosterone, and women's higher testosterone was associated with lower dyadic desire. Expectant fathers showed prenatal decreases in testosterone, and declines in men's testosterone were associated with lower dyadic desire. Testosterone was unrelated to men's or women's solitary desire. Our findings provide support for the idea that prenatal changes in testosterone contribute to an evolutionarily adaptive focus on parenting over mating during the TTP.

Longitudinal associations between prenatal testosterone and postpartum outcomes in a sample of first-time expectant lesbian couples.

Although increasing numbers of gay and lesbian individuals ultimately become parents, the vast majority of research on the transition to parenthood focuses exclusively on heterosexual samples. Even less is known about the physiological implications of this major life transition among those who identify as sexual minorities. The present study begins to redress these gaps in the literature by assessing prospective links between prenatal testosterone, a steroid hormone that is negatively associated with nurturance and caregiving, and postpartum outcomes in a sample of 25 first-time expectant lesbian couples (N = 50 individuals). Consistent with prior work in heterosexual samples, which suggests that lower testosterone promotes both partnering and parenting, we found that, in both partners, lower testosterone during the prenatal period predicted better romantic relationship and parenting outcomes at three-months postpartum (e.g., higher relationship quality, more time spent doing baby care). There was also evidence for dyadic associations; for instance, birth mothers reported more overprotective behavior, and non-birth mothers reported greater commitment, when their female partners had lower testosterone. Together, our findings contribute important new knowledge about the functionality of testosterone in close relationships contexts, including some of the first evidence among sexual minorities.

Life Satisfaction Across Adulthood in Bisexual Men and Women: Findings from the Midlife in the United States (MIDUS) Study.

The number of lesbian, gay, and bisexual (LGB) adults aged 50 and older is projected to reach 5 million in the U.S. by 2030 (Fredriksen-Goldsen, Kim, Shiu, Goldsen, & Emlet, 2015). Older bisexuals experience more negative mental and physical health outcomes when compared to both heterosexuals and other sexual minorities (Fredriksen-Goldsen, Shiu, Bryan, Goldsen, & Kim, 2017). As bisexuals are the numeric majority of sexual minorities in the U.S. (Herbenick et al., 2010), bisexual aging processes are critical to understand if researchers wish to reduce sexual minority health disparities and promote healthy aging. In the current study, we use a national probability sample of adults from the Midlife in the United States (MIDUS) study to assess life satisfaction across an 18-year period. We aimed to identify whether life satisfaction-an indicator of psychological health and well-being-is similar for same-age bisexual, lesbian and gay, and heterosexual midlife individuals, and whether sexual orientation predicts change in life satisfaction across adulthood. Further, we tested whether life satisfaction among bisexuals changes at the same rate and in the same pattern as for lesbian, gay, and heterosexual individuals. Overall, we found a linear pattern of increase in life satisfaction across adulthood. However, when we accounted for sexual orientation, a different pattern emerged for bisexuals. Whereas heterosexuals and lesbian and gay individuals experienced increases in life satisfaction across adulthood, bisexuals' life satisfaction did not increase over this period. Implications for bisexual health and well-being are discussed.

Out of the Mouths of Babes: Links Between Linguistic Structure of Loss Narratives and Psychosocial Functioning in Parentally Bereaved Children.

This study examined links between the language bereaved children use to describe the death of their caregiver and children's psychological/behavioral functioning and coping strategies. Participants included 44 children (54.5% male) aged 7 to 12 (M = 9.05) years who were bereaved by the death of a caregiver. Children were assessed via self- and caregiver-report measures and an in-person interview regarding the loss of their caregiver. Children's loss narratives gathered through in-person interviews were transcribed and subjected to textual analysis. Linguistic categories included pronouns and verb tense. Drawing from linguistic and self-distancing theories, we hypothesized that children's use of language reflecting self-distancing (third-person pronouns and past tense) or social connectedness (first-person plural pronouns) would be negatively associated with psychological/behavioral distress and avoidant coping. Similarly, we expected that children's use of self-focused language (first-person singular pronouns and present tense) would be positively associated with psychological/behavioral distress and avoidant coping. As hypothesized, preliminary findings suggest that children who employed more self-distancing language and used more social connectedness words reported less avoidant coping, rs = .40-.42. Also as hypothesized, children who employed more self-focused language had higher levels of self-reported posttraumatic stress symptoms, r = .54, and avoidant coping, r = .54, and higher parent-reported psychological/behavioral distress, r = .43. Implications for theory-building, risk screening, and directions for future research with bereaved youth are discussed.

Caregivers' positive emotional expression and children's psychological functioning after parental loss.

The death of a loved one, particularly a parent, has been identified as not only the most common, but also the most distressing form of adversity youth may experience in their lifetime. Surviving caregivers' communication with their children may play a critical role in shaping bereaved children's psychological functioning. However, few studies have examined the specific content (e.g., word usage) of caregivers' verbal communication as a predictor of psychological functioning in bereaved youth. In a sample of 39 parentally-bereaved children and their surviving caregivers, we investigated whether the frequency of caregivers' use of positive emotion words (e.g., "love", "happy", "hope") during a reminiscing task about the deceased was associated with children's psychological functioning and coping. In a cross-sectional analysis, we specifically examined whether these associations were moderated by the amount of time passed since children lost their parents. The Linguistic Inquiry and Word Count Program (LIWC) was used to code and evaluate the percentage of positive emotion words caregivers used during the discussion. When caregivers used more positive emotion words, children were less likely to experience depression, anxiety, and avoidant coping. Those associations were present for children who had experienced parental loss at least 105 days prior to the study. Our findings have implications for how caregivers can support their children and help to alleviate psychological distress in the aftermath of parental loss.

Emotion Language in Trauma Narratives is Associated with Better Psychological Adjustment among Survivors of Childhood Sexual Abuse.

Traumatized individuals are often encouraged to confront their experiences by talking or writing about them. However, survivors of childhood sexual abuse (CSA) might find it especially difficult to process abuse experiences, particularly when the abuse is more severe, which could put them at greater risk for mental health problems. The current study examined whether CSA survivors who use emotion language when describing their abuse experiences exhibit better mental health. We analyzed the trauma narratives of 55 adults who, as children, were part of a larger study of the long-term emotional effects of criminal prosecutions on CSA survivors. Abuse narratives were analyzed using the Linguistic Inquiry and Word Count (LIWC) program. We examined whether positive and negative emotion language in participants' abuse narratives were associated with self- and caregiver-reported mental health symptoms and whether these associations differed according to the severity of the abuse. As hypothesized, participants who used more positive and negative emotion language had better psychological outcomes, especially when the abuse was severe. Our findings suggest that survivors of more severe abuse might benefit from including emotion language, whether positive or negative in valence, when describing the abuse.

Fathers' decline in testosterone and synchrony with partner testosterone during pregnancy predicts greater postpartum relationship investment.

The transition to parenthood has been associated with declines in testosterone among partnered fathers, which may reflect males' motivation to invest in the family. Moreover, preliminary evidence has found that couples show correlations in hormone levels across pregnancy that may also be linked to fathers' preparation for parenthood. The current study used repeated-measures sampling of testosterone across pregnancy to explore whether fathers' change in T, and correlations with mothers' T, were associated with fathers' and mothers' postpartum investment. In a sample of 27 couples (54 individuals) expecting their first child, both parents' salivary testosterone was measured multiple times across pregnancy. At approximately 3.5months postpartum, participants rated their investment, commitment, and satisfaction with their partner. A multilevel model was used to measure change in testosterone over time and associations between mother and father testosterone. Fathers who showed stronger declines in T across pregnancy, and stronger correlations with mothers' testosterone, reported higher postpartum investment, commitment, and satisfaction. Mothers reported more postpartum investment and satisfaction if fathers showed greater prenatal declines in T. These results held even after controlling for paternal investment, commitment, and satisfaction measured prenatally at study entry. Our results suggest that changes in paternal testosterone across pregnancy, and hormonal linkage with the pregnant partner, may underlie fathers' dedication to the partner relationship across the transition to parenthood.

Prospective and dyadic associations between expectant parents' prenatal hormone changes and postpartum parenting outcomes.

During the transition to parenthood, both men and women experience hormone changes that are thought to promote parental care. Yet very few studies have explicitly tested the hypothesis that prenatal hormone changes are associated with postpartum parenting behavior. In a longitudinal study of 27 first-time expectant couples, we assessed whether prenatal hormone changes were moderated by self- and partner-reported parenting outcomes at 3 months postpartum. Expectant fathers showed prenatal declines in testosterone and estradiol, and larger declines in these hormones were associated with greater contributions to household and infant care tasks postpartum. Women whose partners showed larger testosterone declines also reported receiving more support and more help with household tasks. Expectant mothers showed prenatal increases in testosterone and estradiol, and larger increases in these hormones were associated with lower partner-rated support. Together, our findings provide some of the first evidence that prenatal hormone changes may indeed be functional and that the implications of these changes may be detectable by co-parents.

Prenatal hormones in first-time expectant parents: Longitudinal changes and within-couple correlations.

OBJECTIVES: Expectant mothers experience marked hormone changes throughout the transition to parenthood. Although similar neuroendocrine pathways are thought to support maternal and paternal behavior, much less is known about prenatal hormone changes in expectant fathers, especially in humans. METHODS: We examined longitudinal changes in salivary testosterone, cortisol, estradiol, and progesterone in 29 first-time expectant couples (N = 58). Couples were assessed up to four times throughout the prenatal period, at approximately weeks 12, 20, 28, and 36 of pregnancy. We also examined within-couple correlations in hormones. Data were analyzed using dyadic growth curve modeling. RESULTS: As expected, women showed large prenatal increases in all four hormones. Men showed significant prenatal declines in testosterone and estradiol, but there were no detectable changes in men's cortisol or progesterone. Average levels of cortisol and progesterone were significantly positively correlated within couples. CONCLUSIONS: The current study represents one of the most extensive investigations to date of prenatal hormones in expectant couples. It is also the first study to demonstrate prenatal testosterone changes in expectant fathers and within-couple correlations in progesterone. We discuss implications of these findings for parental behavior and adjustment.

Dyadic associations between testosterone and relationship quality in couples.

Testosterone is thought to be positively associated with "mating effort", or the initiation and establishment of sexual relationships (Wingfield et al., 1990). Yet, because testosterone is negatively associated with nurturance (van Anders et al., 2011), high levels of testosterone may be incompatible with relationship maintenance. For instance, partnered men with high testosterone report lower relationship quality compared to partnered men with low testosterone (e.g., Booth and Dabbs, 1993). Findings for women are inconsistent, however, and even less is known about potential dyadic associations between testosterone and relationship quality in couples. In the current report, we assessed relationship satisfaction, commitment, and investment in heterosexual couples and tested the hypothesis that these aspects of relationship quality would be negatively associated with an individual's own and his/her partner's testosterone levels. We found that testosterone was in fact negatively associated with relationship satisfaction and commitment in both men and women. There was also evidence for dyadic associations: Participants' satisfaction and commitment were negatively related to their partners' levels of testosterone, and these associations were larger for women's than men's testosterone. Our findings are consistent with the idea that high testosterone may be incompatible with the maintenance of nurturant relationships. The current findings also provide some of the first evidence for dyadic associations between testosterone and relationship quality in couples, highlighting the interdependent nature of close relationship processes and the importance of considering this interdependence in social neuroendocrine research.

Psychological and environmental correlates of HPA axis functioning in parentally bereaved children: preliminary findings.

This study examined bereaved children's HPA-axis functioning (cortisol awakening response; CAR) in relation to psychological distress, coping, and surviving parents' grief reactions. Participants included 38 children (20 girls) with recent parental loss (previous 6 months) and 28 of their surviving caregivers (23 women) who were assessed using self-report instruments and in-person, semistructured interviews. Interviews involved discussions about the child's thoughts and feelings related to the loss. Participants provided 3 saliva samples at home (awakening, 30 minutes later, and evening) over 3 successive days, beginning on the day following the interview. Results show a significant relation between dampening of the child's Day 1 CAR and more symptoms of anxiety (r = -.45), depression (r = -.40), posttraumatic stress (r = -.45), and maladaptive grief (r = -.43), as well as higher levels of avoidant coping (r = -.53). Higher levels of parental maladaptive grief were also associated (r = -.47) with a dampening of the child's Day 1 CAR. Our results raise the possibility that blunted CAR may be a result of accumulating allostatic load and/or a result of emotionally challenging events (discussions regarding the deceased) and their subsequent processing (or lack thereof) within the family, which may be particularly stressful for those bereaved children experiencing high levels of psychological distress, avoidant coping, and parental maladaptive grief.