Mapping a psychosocial syndemic among methamphetamine-using sexual minority men living with HIV.

INTRODUCTION: While research with sexual minority men (SMM) has focused on disparities related to HIV, substance use and mental health, synergistic psychosocial pathways driving these epidemics remain underexplored. We used syndemic theory to assess how psychosocial factors sustain methamphetamine use and hinder recovery efforts for SMM living with HIV. METHODS: A triangulation of network analyses and constructivist grounded theory approaches is utilised to elucidate pathways through which psychosocial factors influence methamphetamine use among this population. Survey data (N = 129) are used for quantitative analyses and a purposive sub-sample (n = 24) was recruited for semi-structured interviews for qualitative analyses. FINDINGS: The network analysis revealed two statistically significant bivariate associations: between post-traumatic stress disorder and depression symptoms (b = 0.37, SD = 0.07, 95% confidence interval [0.23, 0.49]) and between depression symptoms and negative affect (b = 0.26, SD = 0.07, 95% confidence interval [0.12, 0.38]). Findings from the constructivist grounded theory analysis supplement the network analysis by offering a nuanced take on how negative affect, post-traumatic stress disorder, and depression symptoms operate synergistically to promote methamphetamine use and impede recovery efforts. DISCUSSION AND CONCLUSIONS: Participants relay experiences of using methamphetamine to cope with these psychosocial factors through avoidance, escapism, mood elevation, and numbing of emotions. Findings suggest that centring these psychosocial factors may inform more effective, holistic interventions for this high-priority population.

Outness, Acceptance, and Victimization: A Longitudinal Study of Depressive Symptoms and Suicidality of Lesbian, Gay, and Bisexual and Transgender and Gender Diverse Youth.

PURPOSE: LGBTQ+ youth are at higher risk for poorer mental health. Studies are typically cross-sectional and categorize cisgender lesbian, gay, and bisexual (LGB) and transgender and gender diverse (TGD) youth as a combined group (i.e., LGBTQ+). There is a need for longitudinal studies that examine differences between LGB and TGD youth for a better understanding of their mental health needs. METHODS: Data come from a 4-wave longitudinal community-based study collected between 2011 and 2015. Hierarchical Linear Models examined trajectories of depressive symptoms and suicidality, comparing LGB and TGD youth. Between-person and within-person associations were examined, accounting for cumulative experiences of victimization, outness to family, and family acceptance in association with depressive symptoms and suicidality. RESULTS: The study included a diverse sample of 543 LGB and 118 TGD youth. Although TGD youth had, overall, higher levels of depression and suicidality, both LGB and TGD youth experienced improvement in mental health. Youth who were more out and accepted in family were less depressed and suicidal than youth who were less out and accepted in family. Within individuals, when youth become more out and accepted in family, they concurrently reported less depressive symptoms. The accumulation of victimization experiences was associated with higher levels of depression and suicidality, and more depression for youth across time. DISCUSSION: TGD youth face higher stigmatization than LGB youth, contributing to poorer mental health and disparities. Findings suggest that both LGB and TGD youth develop resilience despite victimization, and many find support within their families to cope with stigma.

Perceived risks and benefits of telePrEP interventions: An interview study with rural sexual minority men in Texas.

PURPOSE: Many rural areas lack brick-and-mortar HIV prevention resources despite the increasing rates of HIV. Although online HIV pre-exposure prophylaxis (PrEP) programs can potentially increase uptake among rural sexual minority men (SMM), their attitudes and preferences regarding telehealth-based PrEP (telePrEP) programming are uncertain. This qualitative study examined rural SMM's perceived risks and benefits of participating in a hypothetical telePrEP program. METHODS: Twenty rural SMM living in Texas completed a semi-structured online videoconferencing interview between April 12 and June 14, 2023. Data were analyzed with reflexive thematic analysis. FINDINGS: Four themes were constructed: (1) telePrEP interventions increase accessibility but completely online services might be inadequate; (2) telePrEP and mail-order interventions are convenient but face challenges; (3) telePrEP interventions need to address confidentiality and privacy within the context of the sociopolitical climate; and (4) telePrEP interventions need to address trustworthiness and transparency. CONCLUSIONS: Overall, our results indicate that rural SMM perceive telePrEP interventions that provide at-home and telehealth PrEP, HIV testing, and HIV care services as beneficial. However, overall utility and acceptability depend on perceptions of privacy, confidentiality, trustworthiness, and transparency. Given the HIV prevention and treatment service deserts in which many rural SMM live, telePrEP interventions must purposefully demonstrate how their operations and data will remain safe and secure. Further work should explore contextual or situational factors that influence the willingness and acceptability of rural SMM to participate in online HIV prevention intervention research studies.

Adult stakeholders' perspectives on supporting or undermining the mental health of sexual and gender minoritised adolescents.

OBJECTIVES: To explore adult stakeholders' perspectives on what supports or undermines the mental health of sexual and gender minoritised adolescents (SGMA) in everyday life in order to better understand how to foster supportive psychosocial environments for SGMA. DESIGN: Descriptive qualitative study design, using framework analysis. METHODS: Semi-structured interviews were conducted remotely with 16 UK-based adult stakeholders which included parents of SGMA, health and social care professionals, community-based professionals, and professionals who commission services related to adolescent health and well-being. RESULTS: Nine themes were identified that represented barriers and enablers of fostering psychosocial environments that are supportive of SGMA mental health. Example barrier themes include SGMA 'facing chronic and acute safety threats and stress', 'psychological responses to social connection losses and navigating alienation', 'digital exposure and online risk and vulnerability' and 'conflicting messages, resulting divisions and adult distancing'. Example enablers include 'exploring, owning, and changing (personal) identities', 'advocating alongside adolescents whilst containing oneself as the adult in the situation' and 'personally fostering adolescents' psychological safety and inclusion'. CONCLUSIONS: Adult stakeholders report that SGMA are often exposed to environments hostile to key aspects of their identity which then by extension undermines their mental health. These experiences can threaten their sense of safety and evolving identity. Practitioners in particular should be aware of the stressors relating to SGMA identity and minoritisation experiences in order to develop the psychological safety and sense of inclusion needed for SGMA to trust in the relationship and the support offered.

Assessing a Couples-Based, Digital HIV Serostatus-Neutral Intervention (Para Ti, Para Mí, Para Nosotros) for Adult Cisgender Sexual Minority Male Couples in Lima, Peru: Protocol for a 6-Month Pilot Randomized Controlled Trial.

BACKGROUND: HIV disproportionately affects sexual minority men (SMM; eg, gay, bisexual, and other men who have sex with men) in Lima, Peru; epidemiological data estimate that 32% to 39% of new HIV infections occur among adult cisgender SMM within primary partnerships (ie, male couples). Most HIV prevention-care research in Lima, Peru, has focused on SMM as individuals and not couples. To help address this critical gap in prevention care, we developed Para Ti, Para Mí, Para Nosotros (P3): a couples-based, digital HIV serostatus-neutral intervention (DHI) for adult cisgender SMM couples in Lima, Peru. The P3 DHI is designed to facilitate couples with skill-building, communication, decision-making, and working together to form and adhere to a detailed prevention care plan that aligns with their explicit sexual agreement. The P3 DHI is theoretically informed, self-guided, directed, sequential, and fully automated. OBJECTIVE: This pilot randomized controlled trial (RCT) aims to examine the preliminary effects of P3 on couples' formation and adherence to a detailed prevention care plan containing evidence-based strategies that also aligns with their explicit sexual agreement over time. In addition, the feasibility of enrollment and retention and couples' acceptability of P3 will be assessed. METHODS: The research implements a prospective, 6-month pilot RCT with a 3-month delayed control condition. After baseline, 60 enrolled SMM couples will be randomized to 1 of 2 conditions. Couples randomized to the unmatched, delayed control condition will receive access to the P3 DHI to use during the last 3 months of the trial after the 3-month assessment. Couples randomized to the immediate intervention condition will immediately receive access to the P3 DHI for 6 months. Study assessments will occur at baseline and months 3 and 6. Descriptive, comparative, qualitative, and longitudinal analyses using generalized linear mixed-effect, multilevel, and actor-partner interdependence models will be conducted to address the specific aims. RESULTS: The 6-month pilot RCT is ongoing. Recruitment, enrollment, and data collection began in January 2023 and ended in April 2024. A total of 74 adult cisgender SMM couples met all inclusion criteria, provided consent, and were enrolled in the pilot RCT. Retention was 92% (68/74) at month 6. Data are currently being analyzed to address the 3 specific aims regarding feasibility, acceptability, and preliminary efficacy. CONCLUSIONS: Findings from this research will reveal whether couples deemed the P3 DHI to be acceptable. Findings will also highlight the preliminary efficacy of the P3 DHI on couples managing their vulnerability to HIV and other sexually transmitted infections (STIs) over time via alignment of their prevention-care plan and sexual agreement. Trial findings will help shape the future direction of the P3 DHI while addressing the existing gap in prevention and care services for couples in the local context. TRIAL REGISTRATION: ClinicalTrials.gov NCT05873855; https://clinicaltrials.gov/study/NCT05873855. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63106.

Minority Stress, Mental Health, and Mindfulness and Self-Compassion as Moderators among Young Sexual Minority Men: A Moderated Structural Equation Analysis.

Young adult sexual minority men are at heightened risk for psychological distress (i.e., depression and anxiety). Mounting evidence suggests the adverse consequences of distal stigma, and existing frameworks (the Minority Stress Theory and Psychological Mediation Framework) posit that distal minority stress may impact psychological distress through minority stress-specific processes, such as internalized homonegativity, as well as general psychological vulnerability factors, such as emotion dysregulation. There is a lack of research examining this process integrating both frameworks and understanding potential resilience factors such as mindfulness and self-compassion and where they may assert impact. Using structural equation modeling, the current study investigated the relationship between distal minority stress, measured by heterosexist discrimination, and psychological distress (i.e., depression and anxiety) through a serial indirect effect via internalized homonegativity and emotion dysregulation, while including internalized homonegativity and emotion dysregulation for their unique indirect effects separately, among young adult sexual minority men (n = 307). Further, the study explored mindfulness and self-compassion as potential moderators in subsequent models. Results indicate that two significant paths explain the association between heterosexist discrimination and psychological distress, including through internalized homonegativity and emotion dysregulation as a serial indirect path, as well as through internalized homonegativity alone. Both mindfulness and self-compassion emerged as protective factors in the "upstream" part of the model, particularly in the effect of heterosexist discrimination on internalized homonegativity. Contrary to expectation, both mindfulness and self-compassion had a strengthening impact on the positive association between internalized homonegativity and emotion dysregulation. Findings support the conceptualization of emotion dysregulation as a "downstream" effect of minority stress, as well as adapting and utilizing mindfulness and self-compassion to alleviate the impact of distal minority stress. Additional longitudinal research, particularly rigorously designed clinical trials, is needed to further evaluate such intervention programs.

Gender Nonconformity, Minority Stress, and Psychological Distress Among Sexual Minority Adolescents.

Purpose: Sexual minority adolescents (SMAs) have disproportionate experiences of mental health symptoms during adolescence, and minority stress contributes to mental health inequities among SMAs. Gender nonconformity (GNC) could place SMAs at higher risk for minority stress and subsequent mental health symptoms. The current study was designed to examine associations between GNC, minority stress, and psychological distress among SMAs. Method: SMAs ages 12-17 years (n = 455; mean age = 15.52 years) in the United States completed a cross-sectional online survey from February to July 2022, including measures of GNC, peer victimization, family rejection, negative expectations, negative disclosure experiences, internalized homonegativity, and psychological distress. We conducted path analysis to examine associations between GNC, minority stressors, and psychological distress, including indirect effects of GNC on psychological distress via minority stress. Results: In multivariable path analysis adjusted for demographic characteristics, GNC was associated with higher levels of peer victimization and negative expectations and lower internalized homonegativity among SMAs. Higher levels of peer victimization and negative expectations were associated with higher psychological distress. GNC was indirectly related to higher levels of psychological distress via higher peer victimization. Conclusions: The current study is the first to document associations between GNC and multiple minority stress experiences among SMAs, and GNC was indirectly related to psychological distress among SMAs via peer victimization. Although all SMAs would benefit from interventions designed to reduce peer victimization and increase their capacity to cope with minority stress, such interventions may be particularly beneficial for SMAs who are gender nonconforming.

Disordered Eating in Early Adolescence: Disparities Among Minoritised Youth.

BACKGROUND: Disordered eating in early adolescence impacts development, with long-term health implications. Minoritised adolescents might be at higher risk of disordered eating due to minority stress, but most research has focused on White, heterosexual, cisgender individuals; less is known about disordered eating among minoritised adolescents. We examined sexual, gender, racial, and ethnic identities in relation to disordered eating in early adolescence. METHOD: Using 2-year follow-up data from adolescents ages 10-14 in the Adolescent Brain Cognitive Development Study (N = 9385), we examined associations between sexual, gender, racial, and ethnic identities and past-2 week disordered eating (preoccupation with weight, weight control behaviors, and binge eating). RESULTS: Compared to heterosexual peers, gay/bisexual adolescents had higher odds of all three outcomes (AOR 1.90-3.32); those "questioning" their sexual identity had higher odds of preoccupation with weight (AOR 1.82) and binge eating (AOR 2.53). Compared to cisgender adolescents, transgender adolescents had higher odds of binge eating (AOR 2.62); those "questioning" their gender identity had higher odds of preoccupation with weight (AOR 2.45). Adolescents whose racial identity was categorised as "Another" had higher odds of preoccupation with weight (AOR 1.46) and weight control behaviors (AOR 1.58) compared to White adolescents. Finally, Hispanic adolescents had higher odds of all disordered eating outcomes than non-Hispanic adolescents (AOR 1.25-1.59). DISCUSSION: This study is among the first to reveal disparities in disordered eating among minoritised early adolescents. Further examination of these disparities can inform future interventions. Healthcare providers are encouraged to screen for disordered eating, recognising that minoritised early adolescents may be at risk.

A systematic review of the prevalence and associated factors of mental health conditions among lesbian, bisexual, and other sexual minority women in Southeast Asia.

The present review explored the prevalence and factors of mental health conditions among lesbian, bisexual, and other sexual minority women (LBSW) in Southeast Asia. It found that the rates of significant depression and depressive symptoms range from 10% to 93.2%, with a median of 27.7%. This wide range can be due to a study conducted during the COVID-19 pandemic, which found elevated depression, stress, and anxiety rates. Studies also highlight high levels of sadness, hopelessness, sleep and eating problems, fatigue, and suicidal thoughts among LBSW. Suicide rates indicate that LBSW have higher odds of suicidal ideations and attempts than their heterosexual peers in the region. Additionally, bisexual and polysexual women report higher rates of depressive symptoms and suicidal behaviors than lesbian women, necessitating tailored mental health interventions. Substance use among LBSW is also notable, including smoking and heavy drinking, though some rates are below the global average. Factors influencing mental health include openness about sexuality, coping styles, and discrimination. Discrimination is linked to various mental health issues, supporting the minority stress model's applicability in the region. Aging-related factors also affect mental health among LBSW, with older age being possibly protective against depression. Overall, this review highlights the urgent need for more inclusive mental health research and interventions in the region. Recommendations include training healthcare providers, developing tailored mental health programs, adopting suicide prevention initiatives, enacting anti-discrimination laws, and addressing substance use. Future research should focus on underrepresented regions and older LBSW.

Clients' perceptions of motivational interviewing with couples: A qualitative examination of male couples' statements to counselors in session.

The past two decades have seen expanding interest in the application of Motivational Interviewing (MI) with couples. Thus far, literature detailing the development of MI with couples has focused primarily on elucidating counseling processes and techniques or on evaluating intervention effects. To date no published studies have examined client-perceptions of the counseling process in MI with couples. This study involved qualitative analysis of 55 sessions from 24 couple (48 individuals) who received short (3-session) courses of MI with couples in the context of a randomized controlled trial. All participants identified as cisgender male and were 18 or older. In each couple, at least one partner was aged 18 to 29, HIV negative, and reported drug use in the past 30 days. Analysis revealed that client couples attributed the benefits of MI with couples to the expectancy-related effects s (merely structuring time to talk) and common factors (the presence of the counsellor as a non-judgmental observer). Clients also conveyed appreciation for techniques and activities that enhanced dyadic functioning through communication skill building and the identification of shared values. Finally, clients appreciated the opportunity to discuss drug use and sexual behavior in an integrated way. Findings indicate the utility of counselor-delivered behavioral interventions. They also align with recent formulations of the counselor's role in MI with couples as well as the introduction of facilitating dyadic functioning as a distinct process. Finally, they highlight the potential value of training counselors to address the intersection of drug use, sexual risk, and sexual pleasure in sessions. These dimensions of practice receive inconsistent attention across counseling training program curricula.

Lifetime and Daily Weight Stigma among Higher Weight Sexual Minority Women: Links to Daily Weight-based Concerns, Avoidance, and Negative Affect.

Background: Weight stigma is associated with a range of adverse health outcomes (e.g., disordered eating). Women, sexual minorities, and higher-weight individuals are at increased risk of experiencing weight stigma, but little is known about its influence on emotions, cognitions, and behaviors in real-world contexts, particularly among multiply marginalized individuals such as higher-weight sexual minority women (SMW). The current study examined how lifetime and daily weight stigma experiences relate to momentary weight/shape concerns, size-based avoidance, and negative affect in this population. Methods: Fifty-five higher-weight (BMI > 25 kg/m2) SMW completed a baseline survey and a five-day Ecological Momentary Assessment protocol (five prompts per day) assessing weight stigma events, weight/shape concerns, size-based avoidance, and negative affect. Results: Greater frequency of lifetime weight stigma experiences was significantly associated with greater odds of engaging in size-based avoidance at least once during the 5-day period. Reporting momentary weight stigma events at any given prompt was significantly associated with greater odds of reporting momentary weight/shape concerns, but not negative affect, at the same prompt. Greater frequency of lifetime weight stigma experiences was also marginally associated with greater odds of reporting momentary weight/shape concerns at any given prompt. Conclusions: Both lifetime and momentary experiences of weight stigma are linked to negative consequences (e.g., weight/shape concerns, size-based avoidance) among higher-weight SMW. Although structural interventions are needed to reduce weight stigma at its source, individual interventions can help higher-weight SMW to cope with weight stigma in ways that may reduce its negative consequences.

Prevalence and sociodemographic associations with weight discrimination in early adolescents.

Objectives: To evaluate the prevalence of weight discrimination (the perception of being treated unfairly based on weight) and its sociodemographic associations among early adolescents aged 10 to 13 in the United States. Methods: We analyzed cross-sectional data from the Adolescent Brain Cognitive Development (ABCD) Study in Year Two (2018-2020). Multivariable logistic regression analyses were conducted, with perceived weight discrimination as the dependent variable and age, sex, sexual orientation, race and ethnicity, body mass index (BMI) category, household income, and highest parental education level as adjusted independent variables. Interaction with BMI category and weight discrimination by sex, sexual orientation, race and ethnicity, and household income was tested for. Results: In our analytical sample (N = 7129), we found that 5.46 % of early adolescents reported experiencing weight discrimination. Adolescents with BMI percentile ≥95th (adjusted odds ratio [AOR], 6.41; 95 % confidence interval [CI], 4.71-8.70), <5th (AOR, 3.85; 95 % CI, 2.10-7.07), and ≥85th to <95th (AOR, 2.22; 95 % CI, 1.51-3.25) had higher odds of experiencing weight discrimination compared to adolescents with BMI percentile 5th to <85th. Sex and race and ethnicity modified the relationship between BMI category and weight discrimination. Adolescents who identified as gay/bisexual (AOR, 3.46; 95 % CI, 2.19-5.45) had higher odds of experiencing weight discrimination compared with heterosexual adolescents. Conclusions: Our results underscore the need for anti-bullying campaigns and positive media representation of all body types. Clinicians should recognize that sexual minority youth disproportionately experience weight discrimination, emphasizing the need for affirmative healthcare and early intervention to prevent the mental health impacts of such discrimination.

Cultural humility training interventions for healthcare students to improve care for gender and sexual minority groups: Protocol for a systematic review and a proposed meta-analysis.

Introduction: To deliver comprehensive and efficient care, it is crucial to understand and address the unique healthcare needs of gender and sexual minority (GSM) groups. Implementing cultural humility training may enhance healthcare students' sensitivity, awareness, and proficiency in serving patients. However, there's a necessity to thoroughly evaluate the impact and effectiveness of these interventions, especially in relation to addressing the distinct healthcare requirements of GSM groups. This protocol describes the steps in conducting a systematic review (SR) to investigate if cultural humility training interventions for medical students enhance care of GSM groups. This SR aims to guide the creation of focused interventions and instructional plans to support fair healthcare delivery for GSM populations. Methods and Analysis: The objective of this SR encompass a comprehensive examination across multiple databases such as PubMed (NCBI), Scopus (Elsevier), Cochrane (Wiley), Web of Science (Clarivate). Using keywords and MeSH phrases, the search method will find relevant research from each database's launch from January 1, 2000, until August 30, 2024, emphasizing English-language publications. To ensure comprehensiveness, reference lists of qualifying papers will be thoroughly reviewed. We shall extract the data and use the appropriate Joanna Briggs Institute (JBI) checklist to evaluate the quality of the included study. By synthesizing the data, the findings will illuminate the value and efficacy of cultural humility training interventions for medical students in enhancing GSM group care. This synthesis will incorporate quantitative studies, to ensure a comprehensive understanding of the interventions' impacts. Ethics and dissemination: Ethics approval is not sought as the review will only synthesize data from published studies. The findings will be presented at conferences and published in peer-reviewed journals. PROSPERO registration number: CRD42024533825 Strengths and limitations of this study:•Our study examines cultural humility training, emphasizing self-reflection and power dynamics, specifically relevant for gender and sexual minority (GSM) groups.•We focus on healthcare students, exploring how early cultural humility training can impact future practice and GSM care.•This is the first systematic review and meta-analysis of cultural humility training for GSM groups, addressing a gap in existing literature.•Our findings aim to inform curriculum and educational policies, addressing a significant need in medical training.•Limiting the review to English-language studies may exclude important research conducted in other languages, potentially missing valuable perspectives and findings that could enhance the understanding of cultural humility training's global applicability.•The review may face challenges in measuring the long-term impact of cultural humility training interventions on healthcare students' competency and attitudes, as existing studies might have a limited follow-up period.

Sexual and Gender Identity-Associated Disparities in University Students' Experiences with Inappropriate, Disrespectful, and Coercive Health Care.

Purpose: Inappropriate, disrespectful, or coercive health care (IDCH) is associated with patient age and sexual orientation and gender identity (SOGI) and can impact healthcare engagement and outcomes. Emerging adulthood is a critical period for establishing trust in health care, yet little is known about university students' IDCH experiences. This study assessed the IDCH prevalence and identified IDCH-SOGI associations in a university student sample. Methods: Using data from the cross-sectional IDC Survey (2021), we quantified the lifetime prevalence of 18 IDCH items in a sample of 3403 university students. Chi-squared and Kruskal-Wallis tests were used to assess bivariate associations between IDCH items and SOGI. We modeled associations between demographic characteristics and two types of provider-sexual misconduct using logistic regression. Results: Statistically significant associations between SOGI and 17 of the analyzed IDCH items were identified. Self-reported IDCH experiences were more prevalent among minoritized SOGI students than heterosexual cisgender students, including receiving inappropriate/harmful treatment and dismissive or biased provider communication. Gender minority and sexual minority cisgender male and female students had significantly higher odds of ever being touched inappropriately during an exam, compared with heterosexual cisgender males (adjusted odds ratios [95% confidence interval]: 3.07 [1.59-5.93], 2.34 [1.24-4.41], and 1.85 [1.16-2.90], respectively). SOGI was not significantly associated with experiencing a provider's sexual advances. Conclusion: University students with historically minoritized SOGIs may be particularly vulnerable to IDCH experiences; research is needed to understand differential experiences within minoritized sexual and gender subpopulations. Patient and provider education about healthcare norms and trauma-centered care could potentially reduce IDCH and its harms.

Sexual and reproductive health guidelines for Black girls: a call to action.

OBJECTIVE: Black girls disproportionately face adverse sexual and reproductive health outcomes in their lifetime. In healthcare, Black girls experience racism and misogyny, which manifest as a combination of discriminatory practices and biases that result in their symptoms being dismissed or neglected, their voices silenced, inadequate treatment, and higher mortality rates. Pediatric providers are in an ideal position to influence, advocate, and strengthen Black girls' sexual and reproductive health. The purpose of this topical review is to discuss current guidelines and provide recommendations to improve pediatric sexual and reproductive care for Black girls. METHODS: We examine current pediatric guidelines and recommendations for adolescent sexual and reproductive health. RESULTS: Current guidelines recommended by organizations and professional societies such as the Centers for Disease Control and Prevention, World Health Organization, Society of Adolescent Health Medicine, and American Academy of Pediatrics are inconsistent and insufficient for the unique needs of Black girls. CONCLUSIONS: We offer three recommendations for pediatric providers to ensure the optimal sexual and reproductive health care for Black girls. These provider recommendations will aid in the protection of Black girls' sexual and reproductive health.

Sexual Function in Women With Pelvic Floor Disorders Who Have Sex with Women: A Qualitative Study.

BACKGROUND: Urogynecologic literature confirms that pelvic floor disorders are detrimental to sexual function in heterosexual women and that sexual function improves following treatment. Few data exist regarding these issues in women who have sex with women, potentially affecting patient-provider interactions, treatment choices and outcomes. OBJECTIVE: To describe sexual function concerns of women with pelvic floor disorders among women who have sex with women. STUDY DESIGN: This was a multi-center qualitative study conducted to explore the sexual function of women who have sex with women and to investigate how pelvic floor dysfunction affected their sexual function. A semi-structured interview guide was created to conduct one-on-one interviews via digital conferencing. The audio interviews were transcribed and deidentified. Transcripts were then analyzed with line-by-line coding by at least two independent researchers and organized into themes using a team-based approach. Interviews were conducted until thematic saturation was reached. Domains investigated included: knowledge and beliefs regarding pelvic floor disorders, impact of pelvic floor disorders on sexual function, and sexual function in general. RESULTS: Eighteen women who have sex with women participated in cognitive interviews. Thematic saturation was reached. Participants' average age was 49.0 (+/-16.6) years, the majority self-identified as Non-Hispanic White, were healthy with minimal chronic medical conditions, and were married or living with a partner. Four major concepts emerged from the focus groups: (1) pelvic floor disorders resulted in fear and embarrassment and negatively affected sexual function, (2) women adapted their sexual lives to accommodate PFDs, (3) partner choice & communication with that partner could ameliorate PFD effects on sexual function, and (4) women shared impressions potentially affecting future sexual function research and clinical care of women who have sex with women; a need for broader interpretation of sexual activity, the importance of non-judgment and recognition of potential history of sexual trauma. CONCLUSION: A major theme reported by women with pelvic floor disorders who have sex with women mirrored those of heterosexual women; fear and embarrassment regarding their pelvic floor disorders and their effect on sexual function. These women also voiced novel viewpoints regarding sexual function and amelioration of pelvic floor disorder effects on sexual activity by partner choice and partner communication. Novel issues that could affect future sexual function research and clinical care of women who have sex with women include broadening the definition of sexual activity and emphasizing the importance of non-judgmental and trauma-informed care.

Exploring Latino cultural factors from the perspective of sexual minority men in the USA.

Existing research on Latino cultural factors mainly focuses on gender and nationality, often overlooking sexual orientation and giving limited attention to the experiences of Latino sexual minority men in the United States of America (USA). This study addressed this gap by exploring how sexual minority men identify, describe and experience Latino cultural factors. Between April and December 2019, semi-structured interviews were conducted with 28 men (ages 18-40, 43% non-US-born) in the greater Miami, Florida area to explore their engagement in HIV prevention and behavioural health services. Secondary qualitative analysis examined five Latino cultural factors (personalismo, machismo, familismo, fatalismo and curanderismo), informed by the existing literature for initial coding and supplemented by the use of an inductive approach, yielding 14 subthemes. Findings revealed that although participants often described cultural factors in their traditional interpretations within the Latino community at large, they also highlighted unique experiences, particularly for relationship-oriented factors like personalismo, machismo and familismo. Sexual orientation stigma shaped participants' experiences of these cultural factors. Study findings enhance knowledge about Latino sexual minority men's lived experiences in the USA, underscoring how cultural factors are perceived both traditionally and uniquely, and emphasises the need for nuanced, culturally tailored assessments in future research.

Interaction between nutrition-related parameters and sexual orientation on depression.

OBJECTIVES: Sexual minorities may be more vulnerable to mental disorders. Previous studies have found associations between diet and depression, but no studies have focused on the interaction between nutrition-related parameters and sexual orientation regarding depression. This study aims to explore the interaction between nutrition-related parameters and sexual orientation regarding depression. STUDY DESIGN: Cross-sectional analysis using NHANES 2007-2016 data. METHODS: This study utilized data from NHANES 2007-2016, with 11,065 participants involved. Nutrition-related parameters were evaluated using the healthy eating index-2015 (HEI-2015) and the dietary inflammation index (DII), while depression was obtained through Patient Health Questionnaire (PHQ-9). Logistic regression and stratified analysis of subgroups were used in this study. RESULTS: Compared to those who consumed healthy and anti-inflammatory diets, the ORs for depression in groups consuming unhealthy and pro-inflammatory diets were 1.366 (95%CI:1.073,1.738) and 1.652 (95%CI:1.345,2.028), respectively. Sexual minorities have a higher risk of depression than heterosexuals. There is an interaction effect (P = 0.037) between HEI-2015 and sexual orientation on depression, while it was not found in DII. Subgroup analysis indicated that the interaction between sexual orientation and HEI-2015 persisted in males (P = 0.024), but not in females. CONCLUSION: Both diet and sexual orientation had impacts on depression. There was an interaction between HEI-2015 and sexual orientation on depression, and this association was different by gender. Sexual minorities who are Gay/lesbian, Bisexual, and Something else are at higher risk for depression, and adopting healthy eating patterns and anti-inflammatory diets that are consistent with the recommendations of the USDA may appropriately reduce the risk of depression.

Psychosis risk for lesbian, gay, and bisexual individuals: systematic review and meta-analysis.

The social defeat hypothesis posits that low status and repeated humiliation increase the risk for psychotic disorders (PDs) and psychotic experiences (PEs). The purpose of this paper was to provide a systematic review of studies on risk of PDs and PEs among lesbian, gay, or bisexual (LGB) people and a quantitative synthesis of any difference in risk. PubMed, PsycINFO, Embase, and Web of Science were searched from database inception until January 30, 2024. Two independent reviewers assessed the eligibility and quality of studies, extracted effect sizes, and noted the results of mediation analyses. Using a random effects model we computed pooled odds ratios (ORs). Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The search identified seven studies of PDs and six of PEs. As for PDs, the unadjusted (2.13; 95% confidence interval 0.72-6.34) and covariate-adjusted pooled OR (2.24; 1.72-3.53) were not significantly increased for LGB individuals. After exclusion of a study of limited quality, both the unadjusted pooled OR (2.77; 1.21-6.32) and the covariate-adjusted pooled OR (2.67; 1.53-4.66) were significantly increased. The pooled ORs were increased for PEs: unadjusted, pooled OR = 1.97 (1.47-2.63), covariate-adjusted, pooled OR = 1.85 (1.50-2.28). Studies of PE that examined the mediating role of several variables reported that the contribution of drug abuse was small compared to that of psychosocial stressors. The results of a study in adolescents suggested a protective effect of parental support. These findings suggest an increased psychosis risk for LGB people and support the social defeat hypothesis.