Mental Health and Substance Misuse Indicators Associated with First-Time Homelessness among a Community Sample of Sexual and Gender Minority Adults.

Homelessness is a priority public health issue in the United States (U.S.) given its strong associations with multiple adverse health outcomes. While overall rates of homelessness have decreased over the last decade, some populations-such as sexual and gender minorities-have not seen equitable decreases. The present study explores the relationship between experiences of first-time homelessness with substance misuse (assessed via the DAST-10) and depression and anxiety (assessed via the PHQ-4) in an adult sample of SGM individuals in South Central Texas. The analytic sample (n = 907) was majority gay/lesbian or same-gender loving (55.8%) followed by bisexual or pansexual (34.7%) or another sexual identity (9.5%) and 12.5% were transgender. First-time homelessness was more common in childhood than adulthood. Multivariate logistic regression models were used to evaluate relationships between first-time homelessness and outcomes of interest. The odds of substance misuse (DAST > 3) were marginally higher for those experiencing first-time homelessness in childhood and significantly higher for those reporting first-time homelessness in adulthood. The odds of experiencing past 2-week depression were significantly greater for those reporting homelessness in childhood or adulthood. However, only first-time homelessness in adulthood was significantly associated with past two-week anxiety. These findings underscore the need to consider intersectionality when exploring solutions to existing health disparities, as this work suggests that both sexual and gender identity and homelessness are important factors in shaping mental and behavioral health outcomes.

The Relationship Between Adverse Childhood Experiences and Utilization of Different HIV Testing Strategies Among Young Men Who Have Sex with Men in Texas.

Adverse childhood experiences (ACEs) are a well-documented HIV-risk factor, but less is known about the relationship between ACEs and different HIV testing strategies. This study used data from an LGBTQ + community health assessment, that was part of a multi-staged community-based participatory research project in San Antonio, Texas. Overall, 464 young men who have sex with men (YMSM; < 36-years-old) completed an online, cross-sectional survey that included questions about ACEs and HIV testing behavior. An association between increased ACEs exposure and the odds of clinic-based testing and HIVST HIV significantly decreased relative to never testing for HIV. Additionally, greater ACEs exposure was significantly associated with increased odds of reporting community-based testing (AOR = 1.09, 95% CI = 1.00, 1.20) and significantly reduced odds of HIV self-testing (AOR = 0.72, 95% CI = 0.63, 0.82) compared to clinic-based testing. Cumulative ACEs exposure is important in understanding HIV testing behaviors in YMSM and should be considered when developing HIV testing programs.

The Moderating Effect of Resilience on the Relationship between Adverse Childhood Experiences (ACEs) and Quality of Physical and Mental Health among Adult Sexual and Gender Minorities.

Sexual and gender minority (SGM) individuals experience a greater burden of poor mental health compared to heterosexual individuals. One factor that helps to explain this disparity is trauma experienced during childhood. SGM are more likely to report traumatic experiences during childhood contributing to this disparity. Previous research has shown that resilience moderates the relationship between childhood trauma and adults mental health outcomes. As part of the Strengthening Colors of Pride project, data on 463 SGM adults living in San Antonio were collected using surveys. A diverse recruitment strategy was used in conjunction with a community advisory board. The brief resilience scale (BRS) was used to assess intrapersonal level resilience to determine if there was an effect on the relationship between ACEs and quality of mental and physical health. Differences were noted for some items across low, normal, and high levels of resilience. Both ACEs and BRS significantly predicted quality of mental and physical health. We also noted a significant interaction between ACEs and BRS with regard to quality of mental health. Findings suggest there is a relationship between intrapersonal level resilience, ACEs, and quality of mental health.

"You out-gayed the gays": Gay aesthetic power and lesbian, bisexual, and queer women in LGBTQ spaces.

In lesbian, gay, bisexual, transgender, and queer (LGBTQ) spaces, gay male practices, sexualities, and priorities often dominate. I argue that in mixed-gender LGBTQ festival spaces in the South, gay aesthetics are normative, which often minimizes the contributions of lesbian, bisexual, and queer (LBQ) women. I compare two festival events run by the LGBTQ community-Cornyation, a mock debutante pageant that is part of Fiesta in San Antonio, Texas, and Osiris Ball, a formal Carnival ball during Mardi Gras in Mobile, Alabama. This research is based on participant observation data collected at both events over several years and 38 interviews conducted with event participants. I argue that at these events, gay aesthetic power is exerted through the expectation that LBQ women should master these aesthetics, a dynamic that often relies on gay men as arbiters of successful mastery. These processes were more dramatic in organizations and spaces where men were a numerical majority. This marginalization fits within a pattern of androcentric bias in both the arts and the workplace.

Adverse Childhood Experiences, Perceived Discrimination, and Mental Health in Sexual and Gender Minoritized Adults: Comparing Stress Accumulation and Stress Sensitization Models.

Purpose: The purpose of this study was to assess the relationship between adverse childhood experiences (ACEs) exposure, perceived discrimination, and anxiety and depressive symptoms in sexual and gender minoritized (SGM) adults in the United States. Methods: Respondents (n = 4445) from a national Qualtrics research panel completed a web-based survey. Guided by the stress proliferation (mediation model) and stress sensitization (moderation model) models, we examined the relationships between ACEs and perceived discrimination and the severity of anxiety and depressive symptoms in adulthood. Results: Cumulative ACEs exposure was positively associated with everyday discrimination scale (EDS) scores. ACEs and EDS scores had a significant direct association with anxiety and depressive symptoms. We found support for EDS as a mediator for anxiety (ß = 0.12, p < 0.001) and depressive symptoms (ß = 0.14, p < 0.001) and for ACEs as a moderator of the relationship between EDS and anxiety (ß = -0.04, p = 0.004) and depressive (ß = -0.05, p = 0.001) symptoms. Conclusions: These findings suggest that both stress proliferation and stress sensitization likely contribute to disparities in anxiety and depressive symptoms in SGM adults. This finding supports the integration of social safety and minority stress perspectives regarding health disparities in SGM populations. Exposure to early life adversity likely alters neurodevelopment, which in turn increases awareness of the lack of social safety in adulthood, reduces capacity to cope with minority stress exposure, and ultimately contributes to increased anxiety and depressive symptoms. Prevention efforts should focus on building positive and compensatory childhood experiences.

Sexual and gender minority adverse childhood experiences (SGM-ACEs), perceived social support, and adult mental health.

BACKGROUND: Building on decades of research into the long-term developmental impacts of adverse childhood experiences (ACEs), researchers have called for expanding the ACEs framework to include experiences specific to minoritized identities. Recent empirical research has led to the development of a measure of sexual and gender minority adverse childhood experiences (SGM-ACEs). Within the SGM-specific ACEs framework, research on the long-term impact to adult mental health and the role of perceived social support are not well studied. OBJECTIVE: The purpose of this paper was two-fold. First, examine whether SGM-ACEs adversely impact mental health in SGM adults. Second, examine the role of perceived social support in the association between SGM-ACEs and adult mental health. PARTICIPANTS AND SETTING: Data were collected using a multifaceted sampling strategy. In total, 1819 self-identified SGM Texans completed an online survey inquiring about ACEs, SGM-ACEs, mental health, and demographic characteristics. RESULTS: We estimated two competing structural equation models (SEM) examining the associations between SGM-ACEs and anxiety and depressive symptoms, and whether perceived social support may moderate or mediate his association. While both models demonstrated that SGM-ACEs were significantly associated with higher anxiety and depressive symptoms. However, we found more support for the mediation model such that SGM-ACEs had direct effects on anxiety and depressive symptoms, and an indirect effect on anxiety symptoms through family support. CONCLUSIONS: Our findings confirmed that exposure to SGM-ACE is associated with poorer adult mental health. Additionally, SGM-ACEs exposure undermines SGM individuals' perceptions of family support, which increases symptoms of anxiety.

The Sexual and Gender Minority Adverse Childhood Experiences Scale.

INTRODUCTION: Sexual and gender minority (SGM) adverse childhood experiences (ACEs) are identity-based forms of early life adversity. Exposure to SGM ACEs is associated with increased odds of depression, anxiety, and post-traumatic stress disorder in SGM adults. The purpose of this study was to further test a revised version of the measure in a U.S. sample with more robust and clinically relevant mental health outcomes. METHODS: In May and June 2022, a national sample of SGM adults (N=4,445) was recruited from a Qualtrics Panel to complete a 20-minute online survey that included questions regarding ACEs, SGM ACEs, depression, anxiety, and post-traumatic stress disorder. Exploratory factor analysis and confirmatory factor analysis were used to examine factor structure. Multivariable regression was used to assess criterion validity, and a sensitivity analysis was conducted. Data were analyzed in February 2023. RESULTS: Respondents indicate that vicarious trauma (81%) and school bullying (67%) were the most common experiences and that all SGM ACEs were frequently occurring before adulthood. Confirmatory factor analysis determined a 1-factor solution. Participants with more SGM adverse childhood experiences exposure had worse anxiety, depression, and post-traumatic stress disorder symptoms (ß=0.16, ß=0.18, ß=0.26, respectively, p<0.0001) after controlling for ACEs exposure and demographic factors. A sensitivity analysis indicated that estimates were similar in terms of magnitude and direction. CONCLUSIONS: SGM ACEs commonly and frequently occur before adulthood and impact adult SGM mental health. Overall, the measure had good-to-excellent psychometric properties. Future research should consider integrating SGM ACEs and Minority Stress Theory.

High-risk polysubstance use among LGBTQ+ people who use drugs in the United States: An application of syndemic theory.

BACKGROUND: Compared to heterosexual and cisgender people, lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) people are more likely to develop problems with high-risk polysubstance use. According to syndemic theory, this disparity in high-risk polysubstance use is produced by the LGBTQ+ community's increased vulnerability to experiencing psychosocial (e.g., discrimination, unwanted sex) and structural (e.g., food insecurity, homelessness) conditions, greater likelihood of coping with concurrent health problems (e.g., human immunodeficiency virus [HIV]), and decreased opportunities to develop protective factors (e.g., social support, resilience). METHODS: Data from 306 LGBTQ+ participants living in the United States (U.S.) with a lifetime history of alcohol and drug use were analyzed; 21.2% reported lifetime problems with 10 different drugs. Bootstrapped hierarchical multiple regression was used to test demographic correlates and syndemic predictors of high-risk polysubstance use. One-way ANOVA and post-hoc comparison tests were used to test subgroup differences by gender. RESULTS: Results indicated that income, food insecurity, sexual orientation-based discrimination, and social support were associated with high-risk polysubstance use, explaining 43.9% of the variance of high-risk polysubstance use. Age, race, unwanted sex, gender identity-based discrimination, and resilience were not significant. Group comparison tests revealed that, compared to nonbinary people and cisgender sexual minority men and women, transgender individuals experienced significantly higher levels of high-risk polysubstance use and sexual orientation-based discrimination but significantly lower levels of homelessness and social support. CONCLUSION: This study provided further evidence for conceptualizing polysubstance use as an adverse outcome of syndemic conditions. Harm reduction strategies, anti-discrimination laws, and gender-affirming residential treatment options should be considered in U.S. drug policy. Clinical implications include targeting syndemic conditions to reduce high-risk polysubstance use among LGBTQ+ people who use drugs.

Adverse Childhood Experiences, Substance Use, and Self-Reported Substance Use Problems Among Sexual and Gender Diverse Individuals: Moderation by History of Mental Illness.

Recent research has highlighted the alarmingly high rates at which sexual and gender diverse (SGD) individuals experience Adverse Childhood Experiences (ACE). ACE, in turn, are strongly related to mental illness-an important correlate of substance use. The present study explores whether mental illness moderates the relationship between ACE and substance use outcomes among SGD adults. As part of a larger community-based participatory research study, we assessed ACE, self-reported mental illness, and past-year substance use and misuse among a large and diverse sample of SGD community members in South Central Texas (n = 1,282). Multivariate logistic regression models were used to assess relationships between ACE, mental illness, substance use, and substance misuse (DAST > 3). Interaction terms between ACE and history of mental illness were created to assess moderation effects. Cumulative ACE scores were associated with a significantly higher odds of self-reported past year substance use (AOR = 1.43, 95% CI = 1.34-1.54) and substance misuse (AOR = 1.21, 95% CI = 1.11-1.32). History of mental illness was associated with an increased odds of self-reported substance misuse (AOR = 2.07, 95% CI = 1.20-3.55), but not past year substance use. There was a significant interaction of ACE and history of mental illness on the odds of past year substance use (AOR = 0.78, 95% CI = 0.69-0.89), but not for substance misuse. These results provide support for theoretical models linking ACE, mental illness, and substance use among SGD adults. Longitudinal research designs are needed to address temporality of outcomes and test mediation models of trauma, mental illness, and substance use. Future directions for prevention and intervention are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s40653-023-00560-y.

Understanding the Experiences of Latinx LGBTQ Texans at the Beginning of the COVID-19 Pandemic.

Marginalized communities have been disproportionately affected by COVID-19, including both racial/ethnic minority and sexual minority populations. To date, there has been little research examining the impact of the COVID-19 pandemic at the intersections of marginalized identities. Furthermore, available national data on COVID-19 outcomes may obscure our understanding of region-specific outcomes, particularly in the U.S. South. Using an intersectional approach, we explore differences in worries over COVID-19, preventative behaviors, and COVID-19 outcomes in the early months of the pandemic in a diverse sample of LGBTQ people (N = 1076) living in Texas. Our findings indicated that LGBTQ Latinx people in Texas reported more COVID-19 related worries and adverse outcomes than non-Latinx LGBTQ people. These findings are in line with previous research that found that the increased risk to Latinx and LGBTQ populations in public health crises is often overlooked and can be attributed to many factors such as socioeconomic status, occupational propensity, disparities in physical health, and barriers to healthcare access. Furthermore, our findings suggest the necessity of utilizing an intersectional approach when examining the disproportionate burden marginalized communities face in public health crises.

Development and psychometric properties of the sexual and gender minority adverse childhood experiences (SGM-ACEs): Effect on sexual and gender minority adult mental health.

BACKGROUND: Research has consistently shown a relationship between adverse childhood experiences (ACEs) and poor mental health outcomes, and recent research shows that sexual and gender minority (SGM) individuals are at increased risk for ACEs. Moreover, SGM individuals may experience unique ACEs. Increased risk for exposure to traditional and SGM-specific ACEs are related to heterosexism. OBJECTIVE: The purpose of this paper is two-fold. First, establish the need for an SGM specific ACEs framework that accounts for exposure to heterosexism. Second, assess the psychometric properties of the SGM-ACEs scale. PARTICIPANTS AND SETTING: Data were collected using a multifaceted sampling strategy. In total, 1725 self-identified SGM Texans completed an online survey about ACEs, SGM-ACEs, mental health diagnoses, and demographic characteristics. RESULTS: The most commonly reported SGM-ACEs were seeing or hearing of other SGM being physical harmed (71.2%), being bullied in school for being SGM (67.9%), and hearing religious leaders say homophobic, biphobic, or transphobic things (60.8%). The EFA showed that 7-items loaded onto a single factor and the CFA indicated a good model fit, with items showing a significant factor loading higher than 0.60. SGM-ACE showed adequate to good psychometric properties and predicted depression (AOR = 1.49, CI = 1.20, 1.86), anxiety (AOR = 1.61, CI = 1.25, 2.00), and PTSD (AOR = 1.97, CI = 1.47, 2.66), when controlling for ACEs and demographic factors. CONCLUSIONS: The 7-item SGM-ACEs measure is a psychometrically sound and unidimensional measure that can be quickly used to assess common adverse childhood experiences related to heterosexism.

How often were you traumatized? Reconceptualizing adverse childhood experiences for sexual and gender minorities.

INTRODUCTION: The manifold consequences of adverse childhood experiences (ACEs) are well-documented. Recent research has demonstrated that sexual and gender minorities (SGMs) typically encounter ACEs more often than cisgender heterosexual individuals. Given the higher exposure rate, the measurement of frequency of exposure to traumatic events may be relevant for SGMs. METHODS: We changed the response options of the ACEs index from dichotomous to a five-point Likert scale that described frequency of exposure. As part of a larger community-based participatory research study, the Likert ACEs measure was distributed to a large and diverse sample of SGM participants in San Antonio. RESULTS: A cross-validation design demonstrated that the Likert ACEs scores outperformed the traditional ACEs index in predicting self-reported anxiety and post-traumatic stress disorder. Half of the SGMs in this sample experienced 3 or more ACEs, compared to only 10% of Americans in a nationally representative sample. LIMITATIONS: These analyses were based on retrospective self-report data instead of structured clinical interviews. Since only the Likert ACEs was administered, we had to assume that any response other than "never" on Likert ACEs corresponded to "yes" on the ACEs Index. CONCLUSIONS: Future research may assess the utility of the Likert ACEs approach with other minoritized or intersectional populations. For clinical practitioners, these results suggest that a better way to measure ACEs for SGMs is to ask them how often they were exposed, rather than asking whether they were exposed.

"My meemaw is a Cool Ass Person": Family Members as Role Models of Resilience for Sexual and Gender Diverse People of Color.

The families of people of Color and indigenous people (POCI) are often analyzed as hostile institutions for sexual and gender diverse (SGD) adults. Using 58 interviews with SGD POCI from the Strengthening Colors of Pride 2018 Interview Study, we argue that Black and Latinx SGD adults gain resilience from family role models, mostly resilient mothers and othermothers. These resilient family members model three things: 1) how to overcome adversity and trauma, 2) being providers, and 3) emotional strength. This resilient modeling facilitates the adult resilience of SGD POCI who are navigating the complexity of intersections of race, sexuality, gender, poverty, and childhood trauma.

"Multiplicity, Race, and Resilience: Transgender and Non-Binary People Building Community".

Scholars theorize that the development of community is an important part of resilience. In this mixed-methods study, we argue that race informs the experiences that transgender and non-binary (TNB) people have in seeking community. Using the Strengthening Colors of Pride Phase I and Phase II research, we argue that in a Latinomajority city, Latinx and Anglo TNB people connected with the transgender and broader lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community, although Anglo TNB people reported more transphobia in the LGBTQ+ community. Black and American Indian TNB people connected with LGBTQ+ communities of color specifically and struggled more to find in-person community. Anglo TNB people used their own White racial networks to connect with supportive hobby and interest groups. In general, TNB people connected more with communities that resonated with the multiplicities of their own lives, such as commonalities of economic precarity and immigration status. This research is an important contribution to understanding the development of community for resilience, and the way race and gender identity inform community experiences for TNB people.

Differences in adverse childhood experiences (ACEs) and quality of physical and mental health between transgender and cisgender sexual minorities.

Adverse childhood experiences (ACEs) have been shown to increase risk for negative health outcomes. Recent work has shown that lesbian, gay, and bisexual (LGB) individuals, on average, have higher ACEs scores compared to heterosexual individuals. However, past ACEs research involving LGB people did not assess the influence of experiencing childhood neglect and risk for poor health among this population. Further, this previous work has been limited to LGB people, excluding transgender and gender nonconforming experiences. The purpose of this project was to assess the relationship between ACEs, gender-identity, and physical and mental health status. As part of a larger community-based participatory research study, we surveyed 477 sexual and gender minority individuals about mental and physical health, ACEs, and sociodemographic characteristics. Transgender participants reported emotional abuse, physical neglect, and emotional neglect more frequently compared to cisgender LGB people. Two logistic regression models were run to assess the influence of ACE on quality of physical and mental health. The model adjusted for ACE scores showed that ACEs explained 17.6% of the variance in mental health. Our findings show that neglect is a common experience among LGB/TGN and needs to be assessed along with other ACE domains. Further, there may exist unique adverse experiences among this population during childhood resulting from social stigma. Future research should identify and quantify these experiences as well as assess the role of adversity during adulthood on mental health.

Accessory muscle activity contributes to the variation in time to task failure for different arm postures and loads.

Time to failure and electromyogram activity were measured during two types of sustained submaximal contractions with the elbow flexors that required each subject to exert the same net muscle torque with the forearm in two different postures. Twenty men performed the tasks, either by maintaining a constant force while pushing against a force transducer (force task), or by supporting an equivalent load while maintaining a constant elbow angle (position task). The time to failure for the position task with the elbow flexed at 1.57 rad and the forearm horizontal was less than that for the force task (5.2 +/- 2.6 and 8.8 +/- 3.6 min, P = 0.003), whereas it was similar when the forearm was vertical (7.9 +/- 4.1 and 7.8 +/- 4.5 min, P = 0.995). The activity of the rotator cuff muscles was greater during the position tasks (25.1 +/- 10.1% maximal voluntary contraction) compared with the force tasks (15.2 +/- 5.4% maximal voluntary contraction, P < 0.001) in both forearm postures. However, the rates of increase in electromyogram of the accessory muscles and mean arterial pressure were greater for the position task only when the forearm was horizontal (P < 0.05), whereas it was similar for the elbow flexors. These findings indicate that forearm posture influences the difference in the time to failure for the two fatiguing contractions. When there was a difference between the two tasks, the task with the briefer time to failure involved greater rates of increase in accessory muscle activity and mean arterial pressure.

Flexible queers, serious bodies: transgender inclusion in queer spaces.

Queer spaces are significant for understanding transgender inclusion as "queer spaces were places where individuals were expected to be attentive to or aware of alternative possibilities for being, including non-normative formulations of bodies, genders, desires and practices" ( Nash, 2011 , p. 203). Indeed, in this interview study of members of a queer leather group called the Club, members described a flexible "sexual landscape" that easily includes transgender members. However, these same queer spaces have been criticized for the way they regulate queer bodies and organize queer subjectivities. In this study, queer members of the Club also contrasted playful queer flexibility with serious transgender bodies. This article argues that, although there is a reiterative relation between transgender inclusion and queer spaces, the idealization of flexibility within queer spaces can also serve to marginalize and regulate transgender bodies.