Lesbian and bisexual couples experiencing dual motherhood: (dis)encounters in the provision of healthcare. / Casais de mulheres lésbicas e bissexuais que vivenciam a dupla maternidade: (des)encontros na produção do cuidado em saúde.

The bond with healthcare services is a crucial dimension in facilitating the maternal journey of lesbian and bisexual women couples. This study aimed to analyze the culturally constructed meanings regarding the bond with healthcare services and professionals by lesbian and bisexual women who experienced dual motherhood. It is a qualitative investigation grounded in interpretative anthropology. The research corpus was built based on in-depth interviews with 10 lesbian and bisexual women, aged 30 to 39 years. The results indicate that access to parenthood, until its realization, involved a journey permeated by satisfactions and sufferings triggered by failed attempts and gestational losses. Challenges experienced in healthcare provision were also reported due to prejudices, lack of empathy, and unpreparedness of professionals in dealing with prenatal care for lesbian and bisexual women couples. Manifestations of discrimination were more pronounced concerning non-gestational mothers. The findings offer insights into implementing policies that prioritize humanization and planning programs and healthcare services based on culturally sensitive care for lesbian and bisexual women couples as they transition into dual motherhood.

O vínculo com os serviços de saúde é uma dimensão crucial para viabilizar o projeto materno de casais de mulheres lésbicas e bissexuais. Este estudo teve como objetivo analisar os significados culturalmente construídos sobre o vínculo com os serviços e profissionais de saúde por mulheres lésbicas e bissexuais que vivenciaram a dupla maternidade. Investigação qualitativa fundamentada na antropologia interpretativa. O corpus de pesquisa foi construído com base em entrevista em profundidade com 10 mulheres de 30 a 39 anos. Os resultados mostram que o acesso à parentalidade implicou um itinerário permeado por satisfações e sofrimentos devido a tentativas frustradas e perdas gestacionais. Também foram relatados percalços vivenciados na produção do cuidado em saúde devido a preconceitos, falta de empatia e despreparo de profissionais para lidarem com acompanhamento de pré-natal aos casais de mulheres lésbicas/bissexuais. As manifestações de discriminação foram mais contundentes em relação às mães não gestantes. Os resultados oferecem subsídios para implementação de políticas de humanização e planejamento de programas e serviços de saúde baseados em cuidados culturalmente sensíveis à diversidade para casais de mulheres lésbicas/bissexuais que vivenciam a transição para a maternidade.

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.

Promoting equitable sexual health communication among patients with minoritized racial/ethnic, sexual orientation, and gender identities: Strategies, challenges, and opportunities.

People assigned female at birth (AFAB) with minoritized racial/ethnic, sexual orientation, and gender identities experience notable barriers to high-quality sexual healthcare. In confronting these barriers, patient-provider communication can be a crucial factor, influencing patients' experiences and access to relevant sexual health information and services by determining the quality of care. However, research that investigates this communication among AFAB patients with minoritized social positions is scarce, indicating a research gap regarding the perspectives and roles of healthcare providers in addressing such barriers to care for minoritized patients. Thus, we conducted a qualitative research study, using individual in-depth interviews, to explore the multi-level factors that influence providers' attitudes, knowledge, and skills regarding sexual health communication with AFAB patients with minoritized racial/ethnic, sexual orientation, and gender identities. Interpreting study findings within frameworks of person-centered care, intersectionality, and structural competency, we identified three cross-cutting themes. We found that providers frequently drew on their prior professional training, personal lived experiences, and population-level health disparities data when engaging in sexual health communication with minoritized AFAB patients. Participants reported minimal explicit training in anti-racist and lesbian, gay, bisexual, transgender, and queer (LGBTQ+)-competent care as a significant barrier to engaging in equitable sexual health communication with minoritized AFAB patients, which was exacerbated by many providers' lack of shared social positions and lived experiences with these patients. Providers also frequently applied population-level data to individual patients when formulating counseling and recommendations, which may undermine person-centered sexual health communication. Our findings suggest that critical anti-racist and LGBTQ+-competent provider training is urgently needed, and that health professional education and institutions must be transformed to better reflect and consider the experiences of patients with minoritized racial/ethnic, sexual orientation, and gender identities.

Sexual orientation based health disparities in Chile.

Numerous studies from Europe and North America have documented sexual orientation-based health disparities, but due to data limitations, very little is known about the health of sexual minorities (i.e., lesbians, gay men, bisexual individuals, and other non-heterosexual populations) in developing countries. This research note uses newly available nationally representative data from the Chilean Socio-Economic Characterization Survey (CASEN) to explore sexual orientation-based disparities in self-rated health, health insurance coverage, and healthcare utilization in Chile. Our findings indicate that sexual minority respondents report worse self-rated health and greater health care utilization, and that sexual minority men are more likely to have private health insurance relative to heterosexual men. These findings are important in facilitating continued efforts to reduce health disparities in Latin America.

We are complex beings: comparison of statistical methods to capture and account for intersectionality.

OBJECTIVES: Intersectionality conceptualises how different parts of our identity compound, creating unique and multifaceted experiences of oppression. Our objective was to explore and compare several quantitative analytical approaches to measure interactions among four sociodemographic variables and interpret the relative impact of axes of marginalisation on self-reported health, to visualise the potential elevated impact of intersectionality on health outcomes. DESIGN: Secondary analysis of National Epidemiologic Survey on Alcohol and Related Conditions-III, a nationally representative cross-sectional study of 36 309 non-institutionalised US citizens aged 18 years or older. PRIMARY OUTCOME MEASURES: We assessed the effect of interactions among race/ethnicity, disability status, sexual orientation and income level on a self-reported health outcome with three approaches: non-intersectional multivariate regression, intersectional multivariate regression with a single multicategorical predictor variable and intersectional multivariate regression with two-way interactions. RESULTS: Multivariate regression with a single multicategorical predictor variable allows for more flexibility in a logistic regression problem. In the fully fitted model, compared with individuals who were white, above the poverty level, had no disability and were heterosexual (referent), only those who were white, above the poverty level, had no disability and were gay/lesbian/bisexual/not sure (LGBQ+) demonstrated no significant difference in the odds of reporting excellent/very good health (aOR=0.90, 95% CI=0.71 to 1.13, p=0.36). Multivariate regression with two-way interactions modelled the extent that the relationship between each predictor and outcome depended on the value of a third predictor variable, allowing social position variation at several intersections. For example, compared with heterosexual individuals, LGBQ+ individuals had lower odds of reporting better health among whites (aOR=0.94, 95% CI=0.93 to 0.95) but higher odds of reporting better health among Black Indigenous People of Color (BIPOC) individuals (aOR=1.13, 95% CI=1.11 to 1.15). CONCLUSION: These quantitative approaches help us to understand compounding intersectional experiences within healthcare, to plan interventions and policies that address multiple needs simultaneously.

The Unique Lived Experiences of LGBQ Athletes: A Collegiate Women's Rugby Club Team as an Inclusive & Empowering Community.

There is ongoing debate regarding the culture of competitive women's sports. On one hand, women who participate in sports are viewed as adhering to and reinforcing heteronormative stereotypes and hegemonic masculinity. Conversely, women's sports are viewed as an inherently supportive environment for those involved. The current study explored the latter phenomena, specifically related to factors that promote an inclusive and empowering community for LGBTQ+ women. Eleven individual semi-structured interviews and one follow-up focus group with six participants were conducted with women from a collegiate women's rugby club team. All participants described their sexual identities as Lesbian, Gay, Bisexual, and/or Queer (LGBQ). A reflexive thematic analysis was used to analyze the data collectively. Participants described their collegiate rugby team as being one of their first encounters with a safe and inclusive LGBTQ+ environment. Membership on the team also was viewed as an important experience that helped participants come to terms with their sexual identity. Specifically, findings indicate the supportive actions of teammates, an inclusive team culture, and unique factors related to the sport of rugby helped promote an inclusive and empowering community for LGBTQ+ women. Indeed, from a critical positive youth development perspective, social justice life skills (e.g., allyship) provided actionable behaviors that promote an inclusive and empowering community for LGBTQ+ women. However, future research must seek to understand the lived experiences of all women's rugby participants, particularly transgender and athletes of color.

Implicit Bias Toward Lesbian and Gay Persons Among Nursing Students: A Correlation Study.

AIM: The purpose of this study was to measure implicit bias among nursing students toward lesbian and gay (LG) persons. BACKGROUND: Implicit bias is identified as a contributor to the health disparities experienced by LG persons. This bias has not been studied among nursing students. METHOD: This descriptive, correlation study used the Implicit Association Test to measure implicit bias in a convenience sample of baccalaureate nursing students. Demographic information was collected to identify relevant predictor variables. RESULTS: Implicit bias in this sample ( n = 1,348) favored straight persons over LG persons ( D -score = 0.22). Participants identifying as male ( B = 0.19), straight ( B = 0.65), other sexuality ( B = 0.33), somewhat ( B = 0.09) or very religious ( B = 0.14), or enrollment in an RN-BSN program ( B = 0.11) predicted stronger bias favoring straight persons. CONCLUSION: Implicit bias toward LG persons among nursing students remains a challenge for educators.

Implementing LGBTQ Culturally Appropriate Affirmation Training in the Southern United States: An Evidence-Based Practice Project.

BACKGROUND: The lesbian, gay, bisexual, transgender, or queer (LGBTQ) community is diverse, and members have a shared need for culturally competent health care (CCH). Best practices show that culturally appropriate affirmation training (CAAT) bridges the sociocultural knowledge gap between patient and provider, resulting in increased access to CCH. METHOD: The pre-/posttest project design used validated tools to measure group changes in knowledge, attitude, and skills before and after delivery of LGBTQ CAAT. The sample included staff interacting with or making decisions on behalf of patients (n = 11) at a nonprofit clinic in the southern United States. RESULTS: A Wilcoxon signed-rank test showed an increase in health care team scores for knowledge, attitude, and skills (knowledge, p = .006, r = -.59; attitude, p = .123, r = -.33; skills, p = .005, r = -.60). Qualitative analysis (thematic analysis) (a) showed that participants explored sensitive subjects in a nonjudgmental way; (b) connected the dots between minority stress, bias, and patient-provider trust; and (c) showed increased staff confidence in providing care to LGBTQ patients. CONCLUSION: As staff undergo LGBTQ CAAT, access to CCH will increase, health outcomes will improve, and LGBTQ health disparities will decrease. [J Contin Educ Nurs. 2024;55(3):121-129.].

The Society of General Internal Medicine's Recommendations to Improve LGBTQ + Health.

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ +) individuals experience bias in healthcare with 1 in 6 LGBTQ + adults avoiding healthcare due to anticipated discrimination and overall report poorer health status compared to heterosexual and cisgendered peers. The Society of General Internal Medicine (SGIM) is a leading organization representing academic physicians and recognizes that significant physical and mental health inequities exist among LGBTQ + communities. As such, SGIM sees its role in improving LGBTQ + patient health through structural change, starting at the national policy level all the way to encouraging change in individual provider bias and personal actions. SGIM endorses a series of recommendations for policy priorities, research and data collection standards, and institutional policy changes as well as community engagement and individual practices to reduce bias and improve the well-being and health of LGBTQ + patients.

Health, Economic, and Social Disparities among Lesbian, Gay, Bisexual, and Sexually Diverse Adults: Results from a Population-Based Study.

We investigated health, economic, and social disparities among lesbian, gay, bisexual, and sexually diverse adults, 18 years and older. Analyzing 2011-2019 Washington State Behavioral Risk Factor Surveillance System (N = 109,527), we estimated and compared the prevalence rates of background characteristics, economic and social indicators, health outcomes, chronic conditions, health care access, health behaviors, and preventive care by gender and sexual identity. Sexual minority adults reported heightened risks of poor general health, physical and mental health, disability, subjective cognitive decline, and financial barriers to health care, compared with their straight counterparts. Economic disparities and disability were evident for lesbians and both bisexual adult women and men. We found higher rates of smoking and excessive drinking among lesbians and bisexual women, and higher rates of smoking and living alone among gay men. Sexually diverse adults experience disparities in health care access. This study is one of the first to identify disparities among sexually diverse populations, in addition to lesbian, gay, and bisexual adults. More research is required to understand the mechanisms of disparities within these groups to address their distinct intervention needs.

Long-term care planning and the influencing factors among sexual minority older women: A qualitative study.

AIMS: The aim of the study was to explore plans, considerations and factors influencing long-term care among older sexual minority (SM) women. DESIGN: Qualitative interview study. METHODS: Semi-structured in-depth interviews were conducted with 37 older Taiwanese SM women between May and September 2019. This study analysed interview data using a socio-ecological model and constant comparative analysis. RESULTS: The most frequently reported long-term care plans were housing and institutions, private medical or long-term care insurance, financial planning and medical decisions. Factors associated with women's long-term care plans were categorized using the socio-ecological model level: (1) intrapersonal factors: current physical and mental health status, ageing signs and women's attitudes towards ageing; (2) interpersonal-level factors: receiving support from partners, child(ren), siblings or significant others, concerns about being a caregiver for parents and worries regarding social isolation; (3) community-level factors: receiving support from lesbian, gay, bisexual and transgender (LGBT) organizations; private lesbian online groups; or religious groups; (4) societal-level factors: concerns about negative social environments, concerns about the healthcare system and healthcare providers, inappropriate policies and insufficient resources. CONCLUSION: This study identified multi-level factors related to long-term care plans and concerns among older Taiwanese SM women. Recommendations for nurses, managers of long-term care and healthcare settings, policymakers, and governments have been provided to diminish health disparities and reduce anxiety among older SM women. IMPACT: This study assists nurses in understanding older SM women's long-term care concerns and worries when accessing long-term care and healthcare services and helps nurses provide SM-sensitive services and care for women. PATIENT OR PUBLIC CONTRIBUTION: SM older women were recruited from LGBT organizations, LGBT-friendly bookstores, restaurants, coffee shops and LGBT online chatrooms using purposive and snowball sampling.

TERFs aren't feminists: lesbians stand against trans exclusion.

In this article, I examine lesbians' solidarity with trans people in the United States. Trans exclusionary radical feminists (TERFs) are feminists who believe that there is a stark difference between the biological reality of sex and the socially constructed nature of gender. They argue that sex is essential and innate. This leads some feminists to the argument that trans people are trying to infiltrate sex exclusive spaces. While TERFs are not always lesbians, lesbians are assumed to make up a large proportion of TERFs. As Thomsen and Essig argue that current ideologies within the media are allowing for the slippage between the terms "lesbian," "feminist," and "TERFs." Some scholars are suggesting that equating lesbian identities with transphobia and trans exclusion is but a new form of lesbian marginalization. I utilize 49 in-depth, qualitative interviews with lesbians across the United States to interrogate the stereotype that lesbians are largely TERFs. Through the voices of lesbians across the United States, I illustrate how many lesbians despise TERF ideology and argue that lesbians must stand in solidarity with trans people in the fight for social justice.

Evidence-Based Education on Care of LGBTQ Patients: Improving Knowledge and Attitudes Among Pediatric Nurses.

BACKGROUND: Due to stigma and mistreatment, lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients and their families often face barriers to accessing and receiving equitable health care. Pediatric settings are not immune to this health inequity, yet there is limited literature to address it with pediatric nurses. METHOD: An evidence-based education program on the care of LGBTQ patients was delivered electronically to pediatric nurses. Using a pre- and posttest design, knowledge and attitudes regarding care of LGBTQ patients were collected via online questionnaires. RESULTS: Knowledge significantly increased from pre- to posttest (p = .02). Attitudes related to LGBTQ concepts either remained consistently positive or shifted in the positive direction. CONCLUSION: Providing education regarding LGBTQ patients to pediatric nurses can improve related knowledge and attitudes. Expansion of evidence-based LGBTQ education to pediatric nurses is likely to contribute to lessening the health care barriers and inequities faced by these patients and their families. [J Contin Educ Nurs. 2024;55(4):181-186.].

Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Education in Healthcare Professional Graduate Programs: A Comparison of Medical, Nursing, and Pharmacy Students.

Relative to cisgender heterosexual persons, lesbian, gay, bisexual, and transgender (LGBT) people experience greater health inequities, thereby affecting their engagement in care. One strategy to address these disparities is to educate future healthcare professionals to provide nondiscriminatory care to LGBT people. The goal of this study was to explore the perceived coverage of LGBT health education topics in graduate-level medical (MD), pharmacy (PharmD) and nursing (DNP) curricula. Cross-sectional data were collected from web-based surveys (N = 733) completed by healthcare professional students enrolled at two universities in New York State. Of those who responded, 50.5% were MD, 38.9% were PharmD, and 10.6% were DNP students. Overall, mean scores indicated a dearth of perceived LGBT health coverage. Results demonstrated variations in coverage by degree program. Findings highlight the need to develop educational curricula inclusive of topics concerning LGBT patient health. Adequately educating the next generation of healthcare professionals can further promote healthcare engagement among LGBT persons and improve pedagogical practices in healthcare professional education programs.

Gender and sexual identity-based inequalities in adolescent wellbeing: findings from the #BeeWell Study.

BACKGROUND: Gender and sexual minority adolescents experience greater symptoms of psychological distress than their peers, but little is known about broader aspects of their wellbeing. This study examines wellbeing inequalities relating to gender and sexual identity among adolescents from Greater Manchester in the United Kingdom. METHOD: 37,978 adolescents (aged 12-15, attending 165 secondary schools) completed surveys of life satisfaction, positive and negative affect (hedonic framework); autonomy, self-esteem, optimism, and positive relationships (eudaimonic framework); and, symptoms of distress and mental wellbeing (complete state framework). Structural correlated factors models were used to assess gender and sexual identity wellbeing inequalities. RESULTS: The magnitude of wellbeing inequalities pertaining to gender and sexual identity were routinely substantially greater than those concerning other characteristics (e.g., socio-economic disadvantage). Gender identity wellbeing inequalities followed a consistent pattern, with the largest disparities evident between gender diverse adolescents and boys. Sexual identity wellbeing inequalities also followed a consistent pattern, with the largest disparities evident between sexual minority youth (both gay/lesbian and bi/pansexual) and their heterosexual peers. Finally, variation was evident across wellbeing domains. For example, observed gender identity (boys vs. girls) and sexual identity (heterosexual vs. sexual minority) disparities were substantially greater for symptoms of distress than for mental wellbeing in the complete state model. CONCLUSIONS: LGBTQ + adolescents experience lower wellbeing than their peers, and this is evident across a range of wellbeing domains. Accordingly, there is an urgent need for the prioritisation of improved prevention and intervention efforts that can better meet the needs of gender diverse and sexual minority youth, and future research should be conducted to improve understanding of the mechanisms underpinning the wellbeing inequalities observed.

Polysubstance use by sexual identity among US adults, 2021.

OBJECTIVE: Understanding polysubstance use among US sexual minority adults is important to serve as a population-level baseline to promote health equity around substance use prevention and public health strategies. This study quantifies the number of substances used by sexual identity among US adults. METHODS: We used the 2021 National Survey on Drug Use and Health and included adults (aged ≥18) (unweighted n = 47,291). We conducted multivariable Poisson regression models to examine the number of substances used in the past year (count variable; range: 0-18) by sexual identity ("heterosexual", "gay/lesbian", "bisexual", "unknown" [don't know, refused, blank]), after adjusting for covariates (i.e., age, sex, race/ethnicity, income level, education level, having insurance status, living in urban area, past-year distress level (Kessler-6), any drug or alcohol use disorder in the past year, and sexual attraction). RESULTS: Of the total sample (51.4% were female, 12.1% were non-Hispanic Black and 17.0% were Hispanic adults), 88.3% were heterosexual, 2.4% were gay/lesbian, 5.0% were bisexual adults, and 4.3% reported "unknown" sexual identity. After adjusting for covariates, a greater number of substances were used in the past year among gay/lesbian individuals (aIRR = 1.44, 95% CI = 1.09, 1.75), bisexual individuals (aIRR =1.34, 95% CI = 1.26, 1.41), and individuals reporting an "unknown" sexual identity (aIRR = 1.22, 95% CI = 1.09, 1.36) (vs. heterosexual adults). CONCLUSIONS: Tailored substance use prevention and public health strategies specializing in sexual minority populations are warranted.

Sexual orientation disparities in developmental assets among youth: The mediating role of bullying victimization.

BACKGROUND: Navigating the developmental transition from adolescence to young adulthood while simultaneously integrating the emergence of a sexual minority identity can be overwhelming for lesbian, gay, bisexual, and questioning youth as the developmental tasks pose tremendous challenges to the cultivation of developmental assets, which are the building blocks necessary for fostering positive youth development and thriving. OBJECTIVES: The present study aimed to estimate the sexual orientation disparities in bullying victimization and developmental assets, investigate whether these sexual orientation differences varied by sex assigned at birth, and examine the mediating role of bullying victimization in the association between sexual orientation and developmental assets. METHODS: This study included a national sample of 3020 Chinese youth (51.5 % assigned male at birth; 48.5 % assigned female at birth) with a mean age of 15.71 years. They completed a self-report questionnaire on experiences of bullying victimization and developmental assets. RESULTS: Sexual minority and questioning youth showed significantly lower levels of developmental assets than heterosexual youth. The sexual orientation differences in developmental assets did not significantly differ by sex assigned at birth. In addition, sexual minority youth were at heightened risk of relational bullying than heterosexual youth. The results obtained from the structural equation modeling indicated that bullying victimization mediated the association of sexual orientation with developmental assets. Compared to heterosexual youth, sexual minority youth were more likely to be subjected to bullying, which was linked to lower levels of developmental assets. CONCLUSIONS: The study shows sexual orientation disparities in developmental assets among youth in China and reveals that the positive development of sexual minority youth may be hindered by their experiences of bullying victimization. The implications for positive psychological interventions and anti-bullying policies in Chinese educational settings are discussed.

Mitigating invalid and mischievous survey responses: A registered report examining risk disparities between heterosexual and lesbian, gay, bisexual, or questioning youth.

In a Registered Report, the authors propose a new survey-bias-mitigation method-incorporating inverse probability weighting via boosted regression-to better understand lesbian, gay, bisexual, or questioning (LGBQ)-heterosexual youth risk disparities. This method is tested using the 2019 US Centers for Disease Control and Prevention-collected Youth Risk Behavior Survey (YRBS) national data, which contain 12,847 observations (ages 12-18 [M = 16, SD = 1.25]; 49.1% male [8.7% LGBQ] and 50.9% female [22.4% LGBQ]; nationally representative regarding race and ethnicity). Looking across 44 outcomes, the authors found that the YRBS contains responses that are potentially biased against LGBQ youth in systematic ways, inflating perceived risk for this group in some outcomes. This potential bias is more pronounced among reported males than among reported females, and it is more pronounced for low-incidence outcomes. For example, the steroid-use disparity estimate among reported males reduced by 67%, while the reduction in bullying victimization was small and not statistically significant. The authors discuss robustness of results, the new method, and data policy implications.

Rolling out PRIDE in All Who Served: Barriers and Facilitators for Sites Implementing an LGBTQ+ Health Education Group for Military Veterans.

BACKGROUND/OBJECTIVE: The Veterans Health Administration (VHA) PRIDE in All Who Served health education group (PRIDE) was developed to improve health equity and access to care for military veterans who are lesbian, gay, bisexual, transgender, queer, and/or other sexual/gender-diverse identities (LGBTQ+). This 10-week program rapidly spread to over 30 VHA facilities in 4 years. Veterans receiving PRIDE experience improved LGBTQ+ identity-related resilience and reductions in suicide attempt likelihood. Despite PRIDE's rapid spread across facilities, information is lacking on implementation determinants. The current study's goal was to clarify determinants of PRIDE group implementation and sustainment. METHODS: A purposive sample of VHA staff (N = 19) with experience delivering or implementing PRIDE completed teleconference interviews January-April 2021. The interview guide was informed by the Consolidated Framework for Implementation Research. Rapid qualitative matrix analysis was completed with methods to ensure rigor (e.g., triangulation and investigator reflexivity). RESULTS: Key barriers and facilitators of PRIDE implementation were heavily related to facility inner setting (what is happening inside the facility), including implementation readiness (e.g., leadership support for LGBTQ+-affirming programming, access to LGBTQ+-affirming care training) and facility culture (e.g., systemic anti-LGBTQ+ stigma). Several implementation process facilitators enhanced engagement at sites, such as a centrally facilitated PRIDE learning collaborative and a formal process of contracting/training for new PRIDE sites. DISCUSSION/CONCLUSION: Although aspects of the outer setting and larger societal influences were mentioned, the majority of factors impacting implementation success were at the VHA facility level and therefore may be more readily addressable through tailored implementation support. The importance of LGBTQ+ equity at the facility level indicates that implementation facilitation should ideally address institutional equity in addition to implementation logistics. Combining effective interventions with attention to local implementation needs will be required before LGBTQ+ veterans in all areas will benefit from PRIDE and other health equity-focused interventions.

Associations Between Childhood Victimization, Adult Victimization, and Physical Health Among Sexually Diverse Adults at Different Stages of Life.

Purpose: Research examining health disparities in sexually diverse populations is quite variable. The purpose of the present article was to shed light on the conflicting findings pertaining to minority stress and health by examining the potential impact of age, childhood victimization, and different measurements of health. Methods: The present research used data from the Generations Study, a questionnaire study of sexually diverse adults (ages 18-60) surveyed between 2016 and 2019. We modeled direct and indirect links among (1) childhood exposure to physical or sexual abuse, (2) adult exposure to victimization or harassment, and (3) adult physical health status, assessed both subjectively and objectively. Participants were 1398 sexually diverse adults (e.g., lesbian, gay, bisexual); the present work only utilizes wave one of the data collected in 2016. Results: We found that both childhood abuse and adult harassment/victimization predicted sexually diverse adults' health status, but these associations only manifested as diagnosable disease outcomes among adults over 50. Associations between childhood abuse and adult health were partly attributable to the fact that abuse-exposed children were disproportionately exposed to harassment and victimization as adults. Conclusion: Our research makes a novel contribution to our understanding of the health effects of stigma by pinpointing the multiple, cascading pathways through which adversity relates to health.