Use of Primary Care and Emergency Departments for Substance Use Treatment: The Rural and Urban Divide.

Background: Alcohol and illicit substance use remain significant public health issues in the United States. In this analysis, we assessed differences in the use of primary care and emergency departments (EDs) for treatment of substance use among rural and urban sexual minorities (SMs).Methods: Data come from the National Survey on Drug Use and Health (NSDUH, 2015-2019). Survey-weighted multivariable linear and logistic regression analyses were used to assess the relationship between sexual identity and the use of primary care settings or EDs for treatment of substance use, stratified by urbanicity of residence.Results: Among the entire sample, 7.9% reported residing in rural environments with slightly more SMs living in urban (7.3%) relative to rural (5.4%) locales. Both rural (ß=-0.20; 95% CI: -0.29, -0.10) and urban SMs (ß=-0.13; 95% CI: -0.16, -0.11) self-reported worse overall health. Urban SMs, but not rural SMs, had significantly higher odds of reporting use of primary care treatment for substance use (aOR 2.80; 95% CI: 2.13, 3.68). ED treatment for substance use was greater among both rural (aOR = 2.99; 95% CI: 1.01, 8.87) and urban SMs (aOR = 3.02; 95% CI: 2.12, 4.30) as was overall number of ED visits among both rural (ß = 0.48; 95% CI: 0.24, 0.72) and urban SMs (ß = 0.23; 95% CI: 0.19, 0.28) .Conclusion: These findings suggest increased reliance on EDs for treatment of alcohol or substance use among rural SMs. Future research should examine whether increasing culturally competent primary care services for SMs in rural areas may be a key intervention point for reducing health disparities.

Sexual minorities are not a homogeneous population: health disparity differences based on residence in rural versus urban settings.

INTRODUCTION: Past research has demonstrated that, separately, sexual minorities (SMs) and rural-dwelling populations are each at elevated risk for chronic diseases relative to heterosexuals and urban-dwelling populations, respectively. Little research, however, has assessed whether rural SM populations may experience even further chronic disease risk. METHODS: Data come from the US National Survey on Drug Use and Health, 2015-2019. Survey-weighted logistic regression analyses were used to assess the relationship between sexual identity and various health-associated outcomes, stratified by rural/urban status and adjusted for demographic and other risk factors. RESULTS: Urban bisexual and rural lesbian females had significantly decreased odds of having any health insurance and increased odds of asthma, chronic obstructive pulmonary disease, hepatitis, any heart disease, and STIs relative to their heterosexual counterparts, with disparities affecting bisexual women living in rural areas being largest. Urban gay males had increased odds of having health insurance relative to urban heterosexuals. Both urban gay and bisexual males also experienced increased odds for several chronic diseases, however, among rural residents increased risk was only observed for bisexual males with regards to high blood pressure. CONCLUSION: Rural-dwelling bisexual women experience elevated likelihood for physical health conditions compared to urban-dwelling bisexual women, but few other rural populations experience elevated risk. Urban gay men, meanwhile, are more likely to possess insurance but simultaneously experience worse health outcomes across several domains of diseases, suggesting lower utilization of healthcare services. Future research should strive to avoid pooling all SMs into a single risk group as we have clearly demonstrated that strong differences exist based on both sex and rural/urban status.

Substance use treatment partially mitigates association between methamphetamine use and STI risk: findings from the NSDUH cohort.

BACKGROUND: In recent years, both methamphetamine use and STIs have been on the rise in the USA. In this analysis, we sought to ascertain whether the risk of STIs and HIV among methamphetamine users was moderated on the basis of participation in substance use treatment programmes. METHODS: Data came from the National Survey on Drug Use and Health, 2015-2019. Among adult participants, survey-weighted logistic regression analyses were used to assess the relationship between past year methamphetamine use and risk of HIV and STIs, stratified by methamphetamine treatment utilisation and adjusted for demographic and other risk factors. RESULTS: Among participants in the analytic sample (n=210 392), 1862 (0.9%) reported past year methamphetamine use, 566 (0.3%) reported receiving treatment for its use, 5471 (2.6%) tested positive for any STI in the past year and 395 (0.2%) for HIV ever in their lifetime. Past year methamphetamine use was associated with increased risk of STIs among those who did not receive treatment (adjusted OR=3.628; 95% CI 2.75 to 4.92). Significant moderation was also present between past-year methamphetamine use, risk of STI, and substance use treatment. CONCLUSION: In this analysis, we demonstrated a strong relationship between methamphetamine use and risk of STIs that differed based on receipt of substance use treatment. These findings suggested that integrated STI and substance use treatment programmes may yield substantial public health benefits.

Predictors of Re-Initiation of Daily Oral Preexposure Prophylaxis Regimen After Discontinuation.

Daily oral preexposure prophylaxis (PrEP) for reducing HIV transmission is recommended for those at elevated risk, including sexual gender and minorities assigned male at birth (SGM-AMAB). Few studies have examined re-initiation among PrEP discontinuers, which is critical to ensuring optimization of PrEP's protection. The current study examined predictors of re-initiation in a longitudinal sample of SGM-AMAB PrEP discontinuers (n = 253) from 10 waves of an ongoing cohort study (analytic n = 1,129). Multilevel structural equation models were used to examine the effects of psycho-social variables on re-initiation. In adjusted models, health insurance, and partner HIV positive status were significantly positively associated with PrEP re-initation. Being bisexual was significantly negatively associated with re-initiation relative to gay participants. Single status and open relationship agreements were associated with higher odds of re-initiation relative to monogamous relationships. Findings suggest that demographic, partnership characteristics and structural factors influence decisions to re-initiate PrEP after discontinuation.

RESUMEN: Se recomienda la profilaxis previa a la exposición al VIH (PrEP) en una formulación diaria para reducir la transmisión del VIH para las personas con un riesgo elevado, incluido las minorías de género y sexualidade que se les asignó el sexo masculino al nacer (SGM-AMAB). Pocos estudios han examinado el reinicio entre los que suspenden la PrEP, lo cual es fundamental para garantizar la optimización de la protección de la PrEP. El estudio actual examinó los predictores de reinicio en una muestra longitudinal de personas que interrumpieron el uso de SGM-AMAB (n = 253) de 10 oleadas de un estudio de cohorte en curso (muestra analítico n = 1129). Se utilizaron modelos de ecuaciones estructurales multinivel para examinar los efectos de las variables psicosociales en el reinicio. En los modelos ajustados, el seguro de salud y el estado VIH positivo de la pareja principal se asociaron significativamente de manera positiva con el reinicio de la PrEP. Ser bisexual se asoció significativamente de manera negativa con la reiniciación en relación con los participantes homosexuales. El estatus de soltero y los acuerdos de relación abierta se asociaron con mayores probabilidades de reinicio en relación con las relaciones monógamas. Los hallazgos sugieren que las características demográficas, de asociación y los factores estructurales influyen en las decisiones de reiniciar la PrEP después de haber suspendido el uso.

Intersectional Minority Stress and Intimate Partner Violence: The Effects of Enacted Stigma on Racial Minority Youth Assigned Female at Birth.

Many sexual minority youth of color experience enacted stigma based on each of their minority identities. We examined whether experiences of racist discrimination and heterosexist microaggressions were associated with intimate partner violence (IPV) among female-assigned at birth (FAB) sexual minority youth of color. Data were drawn from a larger study of FAB sexual and gender minority youth (FAB400; N = 488). We selected racial/ethnic minority participants who reported a sexual minority identity and reported a romantic relationship in the previous 6 months (N = 249). Negative binomial models were used to test for associations between enacted stigma (racial discrimination and heterosexist microaggressions) and IPV (psychological, physical, sexual, and sexual minority-specific) perpetration and victimization. When considered separately, both forms of enacted stigma was positively associated with perpetration and victimization across all four types of IPV. In multivariate models, racial discrimination and heterosexist microaggressions both had unique, additive effects on psychological IPV perpetration and physical- and sexual minority-specific IPV victimization. Only racial discrimination was uniquely associated with physical perpetration and psychological victimization. Only heterosexist microaggression was uniquely associated with sexual minority-specific perpetration and sexual IPV perpetration and victimization. Findings illustrate how enacted stigma based on each minority identity intersect to raise risk for IPV among sexual minority youth of color.

Sexual minorities are at elevated risk of cardiovascular disease from a younger age than heterosexuals.

Cardiovascular disease is the leading cause of death worldwide. In this study, we assessed factors related to cardiovascular disease risk and outcomes among sexual minorities (SM). Data from multiple waves of the PATH study were used in this analysis. Multivariable regression models were used to assess the association between sexual identity and: tobacco or e-cigarette use, adverse cardiovascular events, and age at first diagnosis of adverse cardiovascular disease events. In our sample (N = 23,205), 1,660 (7.15%) participants identified as SM. SM men, relative to heterosexual men, are more likely to be diagnosed with high blood pressure (aRR = 1.27; 95% CI 1.10, 1.47), high cholesterol (aRR = 1.32; 95% CI: 1.12, 1.55), congestive heart failure (aRR = 2.29; 95% CI 1.13, 4.65), stroke (aRR = 2.39; 95% CI: 1.14, 5.04), heart attack (aRR = 2.40; 95% CI 1.42, 4.04), and other heart conditions (aRR = 1.52; 95% CI: 1.06, 2.18). Although no simple differences were observed among SM women compared to heterosexual women, SM women were more likely to be diagnosed at a younger age for high blood pressure (aRR = -0.69; 95% CI - 1.08, - 0.29), high cholesterol (aRR = -0.77; 95% CI - 1.15, - 0.38), stroke (aRR = - 1.04; 95% CI - 1.94, - 0.13), and heart attack (aRR = - 1.26; 95% CI - 2.42, - 0.10). SM men were only diagnosed at a younger age for stroke (aRR = - 1.18; 95% CI - 2.06, - 0.30). Compared to heterosexuals, sexual minorities are at higher risk for cardiovascular disease, more likely to develop cardiovascular disease at an earlier age, and more likely to use tobacco products. Future research should focus on decreasing cardiovascular risk among sexual minorities including reducing tobacco use and stress. Screening recommendations for sexual minority populations should also be reviewed in light of a growing body of literature suggesting elevated risk from a young age.

Sexual Agreements Among Young Sexual and Gender Minorities Assigned Male at Birth: Associations with Relationship Quality and Break-Up.

Previous studies have shown that sexual non-monogamy is not associated with lower relationship satisfaction among adult male same-sex couples and may therefore be a viable alternative to monogamy. However, sexual minority men with non-monogamous agreements have reported lower commitment and trust in their relationships than those with monogamous agreements-potentially raising their risk of break-up. In this study, we investigated whether sexual agreements (monogamous, non-monogamous, or no sexual agreement) were associated with relationship quality and rates of break-up over 1 year in a sample of 338 young sexual and gender minorities assigned male at birth (SGM-AMAB). Participants reported their sexual agreement and indices of relationship quality (satisfaction, trust, and commitment) at baseline, as well as their relationship status (intact or broken up) at 6- and 12-month follow-up. Results showed no significant differences by sexual agreement in concurrent trust, but participants with monogamous agreements reported higher satisfaction and commitment than those with non-monogamous agreements or no sexual agreement. Despite these significant differences in relationship quality, there were no significant differences in rates of break-up at 6- or 12-month follow-up across the sexual agreement types. However, having a monogamous agreement was indirectly associated with lower rates of break-up through relationship commitment. Although results were mixed, findings provide some preliminary support that young SGM-AMAB in relationships with monogamous agreements may have higher satisfaction and commitment at early relationship stages, and that monogamous agreements may be a protective factor against break-up over 1 year through the mechanism of relationship commitment.

Examining minority stress, dyadic coping, and internalizing symptoms among male same-sex couples using actor-partner interdependence models.

Minority stress processes have been consistently linked to increased internalizing symptoms among sexual minority individuals. However, very little research has studied the impact of minority stress on the mental health of same-sex couples. The present study examined associations of actor and partner heterosexist microaggressions and internalized heterosexism with internalizing symptoms, moderated by dyadic coping, among male same-sex couples. Participants were 774 men who have sex with men (387 dyads). Results of actor-partner interdependence models showed that actor, but not partner, minority stress was positively associated with internalizing symptoms. Dyadic coping moderated the association of actor heterosexist microaggressions on internalizing symptoms such that for those who engaged in more dyadic coping, the association of heterosexist microaggressions with internalizing symptoms was weaker. Dyadic coping also moderated the association of partner internalized heterosexism on internalizing symptoms. For those who engaged in more dyadic coping, their partner's internalized heterosexism was associated with greater internalizing symptoms. Although dyadic coping may buffer the effects of minority stress on internalizing symptoms, if partners rely too heavily on one another to cope with stress, it may be detrimental to their mental health. Implications for relationship education interventions for same-sex couples are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Exploring mechanisms of racial disparities in intimate partner violence among sexual and gender minorities assigned female at birth.

OBJECTIVE: Sexual and gender minority people of color (SGM-POC) report higher rates of intimate partner violence (IPV) than White SGM, adding to growing evidence that people holding multiple stigmatized social identities are at particular risk for adverse experiences. We aimed to identify mechanisms underlying the racial/ethnic disparities in IPV among SGM, focusing on childhood experiences of violence, structural inequalities, and sexual minority stress. METHOD: 308 SGM assigned female-at-birth (AFAB; 82 White, 133 Black, 93 Latinx; age 16-31) self-reported on minor psychological, severe psychological, physical, and sexual IPV victimization and perpetration, and three proposed mechanisms: childhood violence (child abuse, witnessing interparental violence), structural inequalities (economic stress, racial discrimination), and sexual minority stressors (internalized heterosexism, anti-SGM victimization, low social support). Indirect effects of race on IPV victimization via hypothesized mechanisms were estimated using logistic regression with 5,000 bootstrapped samples. RESULTS: Compared to White participants, Black participants were 2.5-7.03 times more likely to report all eight IPV types; Latinx participants were 2.5-4.8 times more likely to experience four IPV types. Univariate indirect effects analyses indicated that these racial/ethnic disparities were partially explained by higher economic stress, racial/ethnic discrimination, and childhood violence experiences (for Black and Latinx participants) and lower social support (Black participants). In multivariate models, the most robust indirect effects were through racial/ethnic discrimination and childhood violence. CONCLUSIONS: Findings underscore the need for policy and interventions aimed at preventing IPV among SGM-POC by targeting factors that contribute to IPV disparities in this group, particularly racial/ethnic discrimination and family violence. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

PrEP Use and Sexually Transmitted Infections Are Not Associated Longitudinally in a Cohort Study of Young Men Who Have Sex with Men and Transgender Women in Chicago.

Our goal was to understand whether PrEP users are at increased risk for STIs, a key target in prevention efforts aimed at disrupting the spread of STIs and likely downstream HIV infection risk. Data were collected as part of RADAR, a cohort study of young men who have sex with men and transgender women (YMSM/TW) (aged 16-29) in Chicago. Longitudinal lagged regression models were utilized to assess the relationship between PrEP use and odds of rectal STI acquisition. Mediation models were also utilized to consider the potential pathway between PrEP use, condomless anal sex (CAS), and rectal STI. One hundred eighty-seven (16.2%) participants had a rectal STI at baseline. In both cross-sectional and longitudinal models, no significant association was observed between PrEP use and STI. In mediation models, PrEP use was significantly associated with increased CAS, however, CAS was not associated with STI status. We demonstrated that, overall, PrEP use was not associated with STIs among YMSM/TW but did observe that PrEP users were more likely to report increased participation in CAS at the subsequent study visit.

A Structural Equation Model of Sexual Satisfaction and Relationship Functioning Among Sexual and Gender Minority Individuals Assigned Female at Birth in Diverse Relationships.

While there is a sizeable literature on sexual satisfaction among male-female mixed-sex couples, research examining other types of relationships (e.g., same-sex) is limited. The current study aimed to broaden our understanding of sexual satisfaction across the diverse relationships of sexual and gender minority individuals assigned female at birth (SGM-AFAB) and inform models of sexual satisfaction for this population. We examined: (1) differences in sexual satisfaction and characteristics of sexual activity (frequency of sex, frequency of orgasm, duration of sex) by relationship type (same-sex, mixed-sex, gender-diverse) among SGM-AFAB; (2) a model of sexual satisfaction and its correlates; and (3) differences in this model by relationship type. Results indicated cisgender women in relationships with cisgender women (same-sex) reported higher duration of sex, frequency of orgasm, and sexual satisfaction compared to cisgender women in relationships with cisgender men (mixed-sex). There were few differences in characteristics of sexual activity between SGM-AFAB in gender-diverse relationships (involving one or more gender minority partners) and those in same- or mixed-sex relationships. Results indicated similarities across relationship types in a model of sexual satisfaction and its correlates. For all relationship types, more frequent and longer duration of sexual activity predicted higher orgasm frequency, more frequent orgasm predicted higher sexual satisfaction, and higher sexual satisfaction predicted better relationship functioning. Only the association between orgasm frequency and sexual satisfaction varied by relationship type. As one of the first studies examining sexual satisfaction among SGM-AFAB in mixed-sex and gender-diverse relationships, findings substantially further our understanding of sexual satisfaction in this population.

Motivations for sexual identity concealment and their associations with mental health among bisexual, pansexual, queer, and fluid (bi+) individuals.

Bisexual and other non-monosexual (bi+) people are at increased risk for depression and anxiety compared to both heterosexual and gay/lesbian people. Bi+ people are also more likely to conceal their sexual orientation than gay/lesbian people are, and concealment is generally associated with negative mental health outcomes. Despite evidence that concealment is a particularly salient stressor for bi+ people, there has been a lack of attention to their motivations for concealment. As such, the goal of the current study was to examine the associations among concealment, motivations for concealment, and depression and generalized anxiety symptoms in a sample of 715 bi+ people who completed an online survey. Nearly half of participants endorsed purposely trying to conceal their bi+ identity in their day-to-day life, and concealment was significantly associated with higher levels of depression and generalized anxiety. Using exploratory factor analysis, we identified two motivations for concealment: intrapersonal motivations (e.g., one's bi+ identity not being a central part of one's overall identity, not being comfortable with being bi+) and interpersonal motivations (e.g., concern about being judged or treated negatively, concern about putting oneself at risk of physical harm). Interpersonal motivations were significantly associated with higher levels of depression and generalized anxiety, whereas intrapersonal motivations were not. In sum, while concealment may generally be associated with negative mental health outcomes, this may only be the case for those who conceal out of concern for discrimination and victimization. These findings highlight the importance of examining bi+ people's motivations for concealing their sexual orientation in order to understand the extent to which they experience negative mental health outcomes.

Development and Validation of a Brief Version of the Anti-Bisexual Experiences Scale.

Experiencing anti-bisexual discrimination has been linked with numerous negative consequences, such as internalized stigma and symptoms of anxiety and depression. A commonly used measure of anti-bisexual discrimination in research is the Anti-Bisexual Experiences Scale (ABES). While this scale has been instrumental in advancing knowledge about discrimination against bisexual individuals, its length presents challenges to widespread use and it remains unknown if its psychometric properties are consistent across diverse genders and non-monosexual identities. To address these limitations, the current study developed and validated a brief version of the ABES. Using confirmatory factor analysis, we reduced the number of items by more than half, while retaining the full measure's associations with other stigma- and identity-related constructs as well as mental health. Invariance testing indicated that the Brief ABES functioned similarly across diverse genders (i.e., cisgender men, cisgender women, and gender minorities) and sexual identities (i.e., bisexual and other non-monosexual identities). These findings provide initial validation of the Brief ABES and demonstrate that it can be used with bisexual and other non-monosexual (e.g., pansexual, queer) individuals, including cisgender and gender minority individuals.

Bi+ Visibility: Characteristics of Those Who Attempt to Make Their Bisexual+ Identity Visible and the Strategies They Use.

There are numerous forms of stigma that contribute to the de-legitimization and erasure of bisexual and other non-monosexual identities (collectively referred to as bisexual+ or bi+ identities). To reduce such stigma, efforts are needed to increase bi+ visibility. Little is known, however, about whether bisexual+ individuals attempt to attain greater bi+ visibility (i.e., make their bisexual+ identity visible to others) and, if so, how they do this. Using data from a mixed-method (quantitative and qualitative) internet survey study of 397 individuals reporting attractions to more than one gender, we examined the proportion who attempted to attain greater bi+ visibility, the strategies they used to do so, and factors that distinguished those who made bi+ visibility attempts from those who did not. Results indicated that 58% made bi+ visibility attempts, with the most common being direct verbal communication (e.g., telling others) and visual displays (e.g., wearing bi/pride clothing, jewelry, tattoos). Less common attempts included indirect forms of communication, engagement in LGBT-related activities, and public behavioral displays. Those who made bi+ visibility attempts differed from those who did not on variables related to identity (e.g., centrality, self-affirmation, community connection) and internalized binegativity. Implications for understanding the reasons for and for not making bi+ visibility attempts, as well as the potential consequences of doing so, are discussed.

Physical Health Disparities Across Dimensions of Sexual Orientation, Race/Ethnicity, and Sex: Evidence for Increased Risk Among Bisexual Adults.

Accumulating evidence suggests that sexual minority individuals are at increased risk for physical health conditions compared to heterosexual individuals. However, we know little about physical health disparities affecting bisexual individuals, a population at increased risk for psychiatric and substance use conditions compared to both heterosexual and lesbian/gay populations. Using a large, nationally representative sample, we examined physical health disparities for bisexual individuals. To advance research on sexual minority health disparities, we further: (1) compared prevalence rates of physical health conditions across three dimensions of sexual orientation (i.e., identity, attractions, behavior) and (2) examined whether disparities differed by sex and race/ethnicity. Results indicated that sexual minority individuals were at increased risk for many physical health conditions. Notably, individuals with bisexual identity, attractions, and/or behavior were at increased risk for more physical health conditions than other sexual minority groups. The number and types of physical health disparities affecting bisexually identified individuals and individuals with same- and opposite-sex attractions and/or sexual partners varied across sex and race/ethnicity, with the most consistent disparities emerging for individuals who reported same- and opposite-sex sexual partners. Our findings highlight the substantial physical health disparities affecting sexual minorities and the heightened risk conferred by all facets of bisexuality.

The Longitudinal Associations Between Outness and Health Outcomes Among Gay/Lesbian Versus Bisexual Emerging Adults.

Sexual minorities are at increased risk for substance use and mental health problems. Although previous studies have examined the associations between outness and health outcomes, few have used longitudinal designs or examined differences across subgroups of sexual minorities. To address these gaps, the current study examined sexual orientation and gender as moderators of the longitudinal associations between outness and substance use (cigarettes, marijuana, illicit drugs, and alcohol) and mental health (depression and anxiety). Data were from a sample of 169 sexual minority emerging adults (98 women and 71 men) who provided self-report data at four times over 3.5 years. Results indicated that sexual orientation moderated the within-person associations between outness and changes in health. For bisexual individuals, being more out was associated with increases in marijuana use, illicit drug use, and depression. In contrast, for gay/lesbian individuals, being more out was associated with decreases in illicit drug use and it was not significantly associated with changes in marijuana use or depression. Additionally, outness was not significantly associated with changes in cigarette use, alcohol use, or anxiety for gay/lesbian or bisexual individuals, and gender did not moderate any of the associations. In sum, being more open about one's sexual orientation had negative consequences for bisexual individuals but not for gay/lesbian individuals. Professionals who work with sexual minorities need to be aware of the potential risks of being open about one's sexual orientation for bisexual individuals. Interventions are needed to facilitate disclosure decisions and to promote the health of sexual minorities.

A Multilevel Approach for Reducing Mental Health and Substance Use Disparities Affecting Bisexual Individuals.

Despite bisexual individuals being at increased risk for mental health and substance use problems, clinicians' ability to provide affirmative and competent care to bisexual clients is limited by their lack of bisexual-specific training. To address this common gap in training, this article provides a brief review of bisexual health disparities and the factors that influence them. Then, we describe a multi-level approach for improving the health and well-being of bisexual individuals. This approach addresses factors that influence health at the micro-level (e.g., strategies that clinicians can use to help bisexual clients cope with stigma-related stressors), mezzo-level (e.g., adaptations to clinical environments and training programs that promote bisexual-affirmative care), and macro-level (e.g., advocating for political change and implementing strategies to reduce prejudice against bisexual individuals at the population-level). Specifically, we describe how clinicians can adapt evidence-based interventions to tailor them to the needs of their bisexual clients. Additionally, we discuss the need for bisexual-affirmative clinical training and provide recommendations for how clinical training can be adapted to prepare clinicians to work effectively with bisexual clients. Finally, we describe how population-level interventions can be used to reduce prejudice against bisexual individuals in order to reduce bisexual health disparities. Given the striking health disparities affecting bisexual individuals, there is a critical need to develop, test, and disseminate interventions to improve the health of this population and to prepare clinicians to provide bisexual-affirmative care.

The Mediating Roles of Rejection Sensitivity and Proximal Stress in the Association Between Discrimination and Internalizing Symptoms Among Sexual Minority Women.

The negative impact of discrimination on mental health among lesbian, gay, and bisexual populations has been well documented. However, the possible mediating roles of sexual orientation rejection sensitivity and rejection-based proximal stress in the association between discrimination and internalizing symptoms remain unclear. Rejection-based proximal stress is a subset of proximal stressors that are theorized to arise from concerns about and expectations of sexual orientation-based rejection and discrimination. Drawing on minority stress theory, we tested potential mediating effects using indirect effects structural equation modeling in a sample of 300 sexual minority women. Results indicated that the indirect effect of discrimination on internalizing symptoms (a latent variable indicated by depression and anxiety symptoms) through sexual orientation rejection sensitivity and rejection-based proximal stress (a latent variable indicated by preoccupation with stigma, concealment motivation, and difficulty developing a positive sexual identity) was significant. Additionally, the indirect effects of discrimination on rejection-based proximal stress through sexual orientation rejection sensitivity and of sexual orientation rejection sensitivity on internalizing symptoms through rejection-based proximal stress were also significant. These findings indicate that sexual orientation rejection sensitivity plays an important role in contributing to rejection-based proximal stress and internalizing symptoms among sexual minority women.

Are Outness and Community Involvement Risk or Protective Factors for Alcohol and Drug Abuse Among Sexual Minority Women?

Sexual minority women (SMW) are at increased risk for substance abuse compared to heterosexual women. Two psychosocial factors that have been implicated in SMW's substance abuse are outness and LGBT community involvement, but findings have been mixed as to whether these are risk or protective factors. One possible explanation is that they may have different consequences for subgroups of SMW (lesbians, bisexual women, and queer women). While being open about one's sexual orientation and involved in the community may be protective for lesbians, discrimination against bisexual women may lead these same factors to contribute to substance abuse for bisexual women. It is unclear how these associations will operate for queer women, given limited research on this subpopulation. The current study examined whether sexual identity moderated the associations between outness and community involvement with alcohol and drug abuse. We also examined whether perceived discrimination would help explain why these associations may be different for subgroups of SMW. A sample of 288 self-identified SMW (113 lesbians, 106 bisexual women, and 69 queer women) completed an online survey. Higher outness was associated with higher alcohol and drug abuse for bisexual women, but not for lesbians or queer women. Similarly, higher community involvement was associated with higher drug abuse for bisexual women, but not for lesbians or queer women. Among bisexual women, the association between community involvement and drug abuse was mediated by perceived discrimination. Further, the association between outness and drug abuse was mediated by both community involvement and perceived discrimination. Findings demonstrate that outness and community involvement function as risk factors for substance abuse for bisexual women, in part due to their associations with discrimination.

Conservative Beliefs, Attitudes Toward Bisexuality, and Willingness to Engage in Romantic and Sexual Activities With a Bisexual Partner.

Negative attitudes toward bisexuals have been documented among heterosexuals as well as lesbians/gay men, and a common theme is that bisexuals would not be suitable romantic or sexual partners. While gender, sexual orientation, and attitudes toward bisexuality influence people's willingness to engage in romantic or sexual activities with a bisexual partner, there are other individual differences that may contribute. The current study examined the associations between four types of conservative beliefs and willingness to engage in romantic/sexual activities with a bisexual partner in a sample of heterosexuals and lesbians/gay men (N = 438). Attitudes toward bisexuality were examined as a mediator of these associations. In general, results indicated that higher social dominance orientation, political conservatism, and essentialist beliefs about the discreteness of homosexuality were associated with lower willingness to engage in romantic/sexual activities with a bisexual partner. Further, more negative attitudes toward bisexuality mediated these associations. There were several meaningful differences in these associations between heterosexual women, heterosexual men, lesbian women, and gay men, suggesting that influences on people's willingness to be romantically or sexually involved with a bisexual partner may differ for different gender and sexual orientation groups. Implications for reducing stigma and discrimination against bisexual individuals are addressed.