Sexual orientation and mental health in a US cohort of children: a longitudinal mediation study.

BACKGROUND: Sexual minorities, including children, are at increased risk for adverse mental health outcomes compared to their heterosexual peers, but longitudinal studies are needed to determine the factors that explain the associations between sexual minority identification and adverse mental health outcomes during this developmental period. We examined longitudinal associations between sexual orientation and mental health over 2 years in a US cohort of children (aged 9-10 at baseline) and two explanatory factors (increased social problems such as getting teased and decreased perceived school safety). We hypothesized that beginning to identify as gay/bisexual and consistently identifying as gay/bisexual would be associated with increases in internalizing (e.g. depression, anxiety) and externalizing (e.g. aggression) problems compared to consistently identifying as heterosexual, and these associations would be partially explained by increased social problems and decreased perceived school safety. METHODS: We used data from Waves 1-3 of the Adolescent Brain Cognitive Development study. The analytic sample included 5,574 children (46.0% female; 55.1% non-Hispanic White). RESULTS: Beginning to identify as gay/bisexual was associated with increased internalizing/externalizing problems, and consistently identifying as gay/bisexual was associated with increased internalizing problems, compared to consistently identifying as heterosexual. For those who consistently identified as gay/bisexual, increased disparities in internalizing problems were partially explained by increased social problems and decreased perceived school safety, and increased disparities in externalizing problems were partially explained by increased social problems. CONCLUSIONS: These findings suggest the health disparities affecting sexual minority children include both internalizing and externalizing problems, and social problems and feeling unsafe at school may be contributing factors.

Interpersonal and Community-Level Influences Across the PrEP Cascade Among Young Adult Latinx Men who Have Sex with Men Living in a US-Mexico Border Region: A Qualitative Study.

Latinx men who have sex with men (MSM) are an at-risk population for new HIV diagnoses. Pre-exposure prophylaxis (PrEP) is a suite of biomedical approaches to prevent HIV infection. Latinx MSM are less likely to take PrEP compared to non-Latinx White MSM. This qualitative study identified interpersonal- and community-level barriers and facilitators of PrEP among young adult Latinx MSM. Using stratified purposeful sampling, 27 Latinx men, ages 19-29 years and living in a US-Mexico border region, completed self-report demographic surveys and participated in semi-structured in-depth interviews assessing barriers and facilitators to PrEP. Directed content analysis was used to identify both a priori and emerging themes. Most participants reported that other people, including peers, friends, partners, and health care providers were both supportive and discouraging of PrEP use. Participants' intersectional identities as members of both Latinx and LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer) communities both hindered and facilitated PrEP use.

The association between gender-affirming care and disordered eating in transgender and gender diverse individuals: Exploring appearance congruence and gender-related motivating factors for weight loss.

OBJECTIVE: The objective of this study is to explore between-group differences across different stages of gender-affirming care, and associations between appearance congruence, gender-related motivations for weight loss, and disordered eating in transgender and gender expansive (TGE) individuals. METHOD: A total of 160 TGE adults (aged 18-30) were recruited across the United States. Participants completed a comprehensive online survey. Data were analyzed using generalized linear models and bivariate correlations. RESULTS: Significant differences in appearance congruence among participants at different transition stages were revealed, with the group that achieved their desired transition reporting the highest appearance congruence compared to all other groups. Furthermore, gender-related motivations for weight loss were significantly lower in individuals who achieved their desired transition compared to those with no plans to transition. DISCUSSION: Findings suggest significantly higher appearance congruence in those who achieved their desired transition compared to other groups, and individuals who attained their desired transition exhibited significantly reduced gender-related motivations for weight loss compared to those with no plans to transition. These findings underscore the potential psychological benefits associated with successful gender-affirming care, highlighting its role not only in fostering appearance congruence but also in mitigating gender-related motivations for weight loss among TGE individuals. Future research should include larger and more diverse samples, longitudinal designs, and considerations of other factors influencing body image outcomes in this population. PUBLIC SIGNIFICANCE: This study sheds light on the crucial relationship between gender-affirming care and body image outcomes in TGE individuals. Understanding how appearance congruence and gender-related motivations for weight loss are associated with disordered eating can inform tailored support and interventions. By recognizing the association of gender affirming care and well-being, healthcare providers can enhance care for TGE individuals.

Dissonance-Based Eating Disorder Prevention for Body-Dissatisfied Brazilian Cisgender Gay and Bisexual Men: A Randomized Controlled Trial With a 1-Year Follow-Up.

OBJECTIVE: Gay and bisexual men are at an increased risk for eating disorders (EDs) and muscle dysmorphia (MD) compared with their heterosexual counterparts. Existing dissonance-based (DB) EDs prevention programs for this population have been evaluated in the United States; however, these programs have not been evaluated in the Brazilian context. Thus, we investigated the feasibility, acceptability, and efficacy of a DB ED prevention program (i.e., the PRIDE Body Project) among Brazilian cisgender gay and bisexual men. METHOD: Eligible men were randomly assigned to either a DB intervention (n = 74) condition or an assessment-only control (AOC) condition (n = 75). Participants completed measures assessing ED and MD risk and protective factors at baseline, post-intervention, 1-month, 6-month, and 1-year follow-up. Those in the intervention condition also completed acceptability measures. RESULTS: Feasibility and acceptability ratings were highly favorable. Regarding efficacy, post-intervention results were not significant, except for self-objectification, which showed a significantly greater decrease in the DB condition compared with the AOC condition at all time-points of follow-ups (Cohen's d = -0.31 to -0.76). At follow-up, the DB condition showed significantly greater decreases in appearance-ideal internalization, drive for muscularity, self-objectification, ED and MD symptoms at 1-month, 6-month, and 1-year follow-ups (d = -0.33 to -0.92) compared with the AOC condition. Significant increases were observed in the DB compared with the AOC condition for body appreciation at 1-month, 6-month, and 1-year follow-ups (d = 0.31-0.81). DISCUSSION: Results support the feasibility, acceptability, and efficacy of the PRIDE Body Project up to 1-year in Brazilian cisgender gay and bisexual men. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC; available at http://www.ensaiosclinicos.gov.br/) number of registration: RBR-62fctqz.

Promoting Resilience to Improve Disordered Eating (PRIDE): A case series of an eating disorder treatment for sexual minority individuals.

OBJECTIVE: Despite the increased risk for eating disorders (EDs) among sexual minority (SM) individuals, no ED treatments exist specifically for this population. SM stress and appearance-based pressures may initiate and/or maintain ED symptoms in SM individuals; thus, incorporating strategies to reduce SM stressors into existing treatments may help address SM individuals' increased ED risk. This mixed-methods study evaluated the feasibility, acceptability, and preliminary efficacy of Promoting Resilience to Improve Disordered Eating (PRIDE)-a novel ED treatment for SM individuals. METHODS: N = 14 SM individuals with an ED diagnosis received 14 weekly sessions integrating Enhanced Cognitive Behavioral Therapy for EDs (CBT-E) with techniques and principles of SM-affirmative CBT developed to address SM stressors. Participants completed qualitative interviews and assessments of ED symptoms and SM stress reactions at baseline (pretreatment), posttreatment, and 1-month follow-up. RESULTS: Supporting feasibility, 12 of the 14 (85.7%) enrolled participants completed treatment, and qualitative and quantitative data supported PRIDE's acceptability (quantitative rating = 3.73/4). By 1-month follow-up, 75% of the sample was fully remitted from an ED diagnosis. Preliminary efficacy results suggested large and significant improvements in ED symptoms, clinical impairment, and body dissatisfaction, significant medium-large improvements in internalized stigma and nonsignificant small-medium effects of sexual orientation concealment. DISCUSSION: Initial results support the feasibility, acceptability, and initial efficacy of PRIDE, an ED treatment developed to address SM stressors. Future research should evaluate PRIDE in a larger sample, compare it to an active control condition, and explore whether reductions in SM stress reactions explain reductions in ED symptoms. PUBLIC SIGNIFICANCE: This study evaluated a treatment for SM individuals with EDs that integrated empirically supported ED treatment with SM-affirmative treatment in a case series. Results support that this treatment was well-accepted by participants and was associated with improvements in ED symptoms and minority stress outcomes.

A longitudinal study of potentially traumatic events and binge-purge eating disorder onset in children.

Although the association between childhood trauma and subsequent binge-purge spectrum eating disorders (BP-EDs) is established in adult samples, little is known about the temporal association between potentially traumatic life events and BP-ED onset in children. Using longitudinal data from the U.S.-nationwide Adolescent Brain Cognitive Development (ABCD) study with children aged 9-10 at baseline, logistic regression with complex sampling assessed the longitudinal association of exposure to potentially traumatic events (PTEs) at baseline and meeting BP-ED criteria one year later. Children exposed to PTEs prior to baseline had 1.91 times greater odds of being diagnosed with a BP-ED one year later (95% CI: 1.26 - 2.90; p = .004), compared to those who had not experienced a PTE. The current study extends previous cross-sectional research to show a significant temporal association between childhood PTEs before ages 9-10 and the subsequent onset of BP-EDs one year later. Future research should consider specific timing of PTE exposure as well as examining children diagnosed with restrictive eating disorders.

A qualitative analysis of relationship advice from the perspective of people living with and recovering from eating disorders while in diverse romantic relationships.

Eating disorders (EDs) have adverse consequences across life domains, ranging from physical health to interpersonal relationships. While research suggests that romantic partners have the potential to support ED recovery, partners to those with EDs often report feeling confused and helpless in the face of the condition. The extant literature on EDs in relationships centers on the experiences of cisgender, heterosexual women. The present study aimed to garner a more comprehensive understanding of the types of support people with EDs believe are most helpful from romantic partners by analyzing relationship advice from a diverse group of individuals with EDs who were in romantic relationships. As part of a larger study on romantic relationships in ED recovery, we analyzed responses to the question, "If you had to give one piece of advice to someone who learns that their partner has an ED, what would it be?" Through Consensual Qualitative Research-Modified, we identified 29 themes, which we grouped into 7 domains: Foster Open Communication, Create an Environment of Emotional Intimacy, Let Your Partner Guide You, Educate Yourself, Be Compassionate with Yourself, Use Caution when Discussing Food and Bodies, and a Miscellaneous domain. These findings highlight the importance of patience, flexibility, psychoeducation, and self-compassion for individuals working to support their partner's ED recovery, and can inform future couples-based treatments and interventions for EDs.

Psychiatric comorbidity of eating disorders in children between the ages of 9 and 10.

BACKGROUND: Eating disorders exhibit high comorbidity with other psychiatric disorders, most notably mood, substance use, and anxiety disorders. However, most studies examining psychiatric comorbidity are conducted in adolescents and adults. Therefore, the comorbidity among children living with eating disorders is unknown. The aim of this study was to characterize co-occurring psychiatric disorders with eating disorders in a US sample of children aged 9-10 years old utilizing the Adolescent Brain Cognitive Development study. METHODS: The analytic sample included 11,718 children aged 9-10 years. Anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding and eating disorder subtype diagnoses were examined. Statistical analyses were conducted using complex sampling. Odds ratios and 95% confidence intervals were calculated comparing the likelihood of being diagnosed for a psychiatric disorder when having an eating disorder, as compared to children without an eating disorder, children diagnosed with major depressive disorder, and children diagnosed with posttraumatic stress disorder using binary logistic regression. RESULTS: Co-occurring psychiatric disorders were substantially higher in children with eating disorders as compared to children without eating disorders, but not as compared to children diagnosed with major depressive disorder or posttraumatic stress disorder. The most common comorbidities for the eating disorder group were anxiety disorders (71.4%), attention deficit/hyperactivity disorder (47.9%), disruptive/impulse control disorders (45.0%), mood disorders (29.6%), and obsessive-compulsive disorder (28.8%), largely in line with previous research. CONCLUSIONS: This study extends prior research finding high rates of comorbidity in eating disorders, specifically with anxiety, mood, and disruptive/impulse control disorders. Clinicians assessing for psychiatric disorders should be aware that eating disorders can occur in children 9 and 10 years old and are associated with severe comorbidity. Referrals for specialty mental health care should be considered.

Trauma exposure and eating disorders: Results from a United States nationally representative sample.

OBJECTIVE: Sexual assault, child abuse, and combat have been linked to eating disorders (EDs). However, noninterpersonal trauma is relatively understudied, and therefore it is unknown whether noninterpersonal trauma is associated with EDs. Furthermore, most previous studies do not account for multiple trauma exposures, or the relative association of traumatic events with EDs in the same statistical model. METHOD: Multinomial regression was used to examine the association of lifetime ED diagnosis (anorexia nervosa [AN], bulimia nervosa [BN], binge eating disorder [BED]) with trauma type (sexual interpersonal, other interpersonal, war/combat, and noninterpersonal) in a nationally representative dataset of US adults in bivariate and multivariable (i.e., with all trauma types) models. RESULTS: Sexual interpersonal trauma was significantly positively associated with AN and BED in bivariate and multivariable models. In the multivariable model, only BED was found to be equally associated with sexual interpersonal, other interpersonal, and noninterpersonal trauma. DISCUSSION: These results indicate a strong positive association between sexual trauma and EDs, even when controlling for experiences of other trauma events. Future research should examine longitudinal mediators between trauma and EDs, especially sexual trauma, to identify what factors may explain this relationship. PUBLIC SIGNIFICANCE STATEMENT: Individuals with eating disorders often experience traumatic events but it is unclear whether specific trauma types are more or less common in this population. This study found that only events such as rape and sexual assault are associated with anorexia nervosa, but that most trauma types are associated with binge eating disorder. Therefore, the relationship between trauma and binge eating disorder may function differently than other eating disorders.

Internalization of muscularity and thinness ideals: Associations with body dissatisfaction, eating disorder symptoms, and muscle dysmorphic symptoms in at risk sexual minority men.

OBJECTIVE: In the tripartite influence model, appearance-ideal internalization is identified as a prominent risk factor for the development of body dissatisfaction and subsequent eating disorder (ED) behaviors. For men, prior research has emphasized the importance of both thin-ideal internalization and muscular-ideal internalization in explaining later ED behaviors and muscle dysmorphia (MD) symptoms. Previous research in heterosexual men has shown that the associations between muscular-ideal internalization and ED or MD symptoms may depend on whether the individual has also internalized the thin ideal. However, this interaction has not been examined in research with sexual minority men (SMM). METHOD: The current study collected self-report data from 452 at risk SMM (i.e., endorsed body dissatisfaction), with ages ranging from 18 to 35 years. Linear regression models were conducted to test the interaction effects between thinness and muscularity internalization on ED symptoms, MD behaviors, and general body dissatisfaction. Simple slopes and the Johnson-Neyman technique were used to investigate significant interaction terms. RESULTS: Thin- and muscular-ideal internalization were positively associated with muscular appearance intolerance and dietary restriction with no significant interaction. Muscular drive for size was highest when both muscularity internalization and thinness internalization were high. Muscular-ideal internalization was positively associated with both cognitive restraint and general body dissatisfaction, but only at lower levels of thinness internalization. DISCUSSION: Given the interacting association between thinness and muscularity internalization and aspects of body dissatisfaction, attitudes, and behavior, prevention and intervention programs for EDs and MDs in SMM should seek to dismantle both thinness and muscularity internalization. PUBLIC SIGNIFICANCE STATEMENT: Internalizing-or adopting as one's own-the ideal of a body with low body fat and high muscularity has been shown to lead to muscle dysmorphia and eating disorder symptoms in men. The current study examines whether the combination of thin-ideal and muscular-ideal internalization is associated with worse symptoms than either facet alone in sexual minority men. Treatment efforts in sexual minority men should address both types of internalization.

Gay Community Involvement and Condomless Anal Sex Among Sexual Minority Men in the USA.

Sexual minority men (SMM) remain disproportionately burdened by sexually transmitted infections. Although gay community involvement has been theorized to be protective against many negative health outcomes, research examining the association between community involvement and condomless anal sex (CAS) has yielded conflicting results. The current study, conducted between 2018-2020, examined whether the importance one places on various aspects of community involvement was associated with CAS among a sample of young adult SMM aged 18-34 years with body image concerns (N = 180). Gay community involvement was measured using the Importance of Gay Community Scale, and the results of an exploratory factor analysis indicated the presence of two factors: "social activism" and "going out/nightlife." A zero-inflated Poisson regression was conducted to examine the association between gay "social activism," "going out/nightlife," and their interaction with the number of CAS partners. Upon examining a significant interaction, "social activism" had a protective effect against CAS at low levels of "going out/nightlife," but this effect was non-significant at higher levels. These results suggest that encouraging gay community involvement through activism could be effective at reducing CAS and addressing the health disparity that exists within this population.

Exploring moderators of mirror exposure on pre- to post changes in body image outcomes: Systematic review and meta-analysis.

PURPOSE: Mirror exposure (ME) is embedded within cognitive behavioral treatment of body image concern (BIC), and existing literature demonstrates its potential value as a BIC intervention. The purpose of the study is to provide a meta-analytic review of ME effects on attitudinal and behavioral BIC. METHODS: Twelve studies met inclusion criteria, yielding six between-group and 18 within-group comparisons. RESULTS: Random effects models demonstrated a medium effect of ME versus control conditions, on attitudinal BIC, from pre- to immediate posttreatment, small effect at follow-up (1 to 4 weeks posttreatment), and large effect on behavioral BIC pre- to immediate posttreatment. However, small sample sizes yielded nonsignificant findings and significant heterogeneity. Exploratory moderator analyses-ME type, ME dosage (session frequency, duration), and diagnosis-demonstrated that, among single group pre-post designs, higher ME dosage may be instrumental to pre-posttreatment improvements. Consistent with this finding, individual studies with high dosages of ME demonstrated the largest effect sizes. Conclusion: Results may suggest a strong ME effect on BIC at high dosages (>120 minutes). The current review highlights gaps in ME literature and the need for future clinical trials assessing ME, using a priori, high-quality research designs that further the understanding of ME's mechanisms of change.

Motivation for Physical Activity among U.S. Adolescents: A Self-Determination Theory Perspective.

BACKGROUND: Promoting adolescent physical activity is crucial as this marks a time when physical activity rates decline. PURPOSE: This study examined motivation for physical activity from a self-determination theory (SDT) perspective in a large sample of adolescents in the USA across three settings: in school, out of school, and on weekends. METHODS: Participants (N = 1,661) were adolescents from the National Cancer Institute's Family Life, Activity, Sun, Health, and Eating study. Participants had a mean age of 14.47 (standard deviation = 1.61) and were 50.2% female. In this national sample balanced to match the U.S. population on several key demographics, 64.2% were non-Hispanic White. Analyses included three linear regression models in which estimated weekly minutes of moderate-to-vigorous physical activity (MVPA) in school, out of school, and on weekends were entered as dependent variables. Five forms of motivation (intrinsic, integrated, identified, introjected, and external) were entered simultaneously as independent variables. Age, body mass index, gender, and race/ethnicity were also included as covariates. RESULTS: All models were significant. For MVPA in school, external regulation, introjected regulation, identified regulation, and intrinsic motivation were positively associated with MVPA. For MVPA out of school, external regulation, introjected regulation, identified regulation, integrated regulation, and intrinsic motivation were positively associated with MVPA. For MVPA on weekends, integrated regulation, and intrinsic motivation were positively associated with MVPA. CONCLUSIONS: The relationship between motivation and MVPA varies across settings. These findings have important implications for motivating adolescents to engage in physical activity and may inform future interventions aimed at increasing physical activity.

Confirmatory factor and measurement invariance analyses of the Eating Disorder Examination Questionnaire in sexual minority men and women.

OBJECTIVE: The present study aimed to investigate the factor structure of the Eating Disorder Examination Questionnaire (EDE-Q) in a large sample of cisgender sexual minority men and women, and subsequently, to evaluate measurement invariance by gender. METHOD: The sample consisted of 962 sexual minority adult men (n = 479) and women (n = 483) who completed online self-report surveys. Confirmatory factor analysis was conducted using two previously supported factor structures (Friborg et al.'s four-factor model and Grilo et al.'s brief three-factor model) as well as the original four-factor structure of the EDE-Q. RESULTS: Results indicated that the best fitting models were Friborg et al.'s four-factor model (CFI = .974, RMSEA = .098, SRMR = .0 70) and Grilo et al.'s brief three-factor model (CFI = .999, RMSEA = .049, SRMR = .017). The model fit of both factor structures were nearly identical when examined separately for men and women. The original four-factor structure could not be supported in this sample. Measurement invariance analyses further indicated that the best fitting models were invariant by gender in sexual minority individuals. Internal consistency was adequate for all subscales of Friborg et al.'s and Grilo et al.'s models. DISCUSSION: The present study provides support for the use of the EDE-Q in sexual minority men and women. Additionally, findings demonstrate that the EDE-Q performs similarly in sexual minority men and women. Future research is needed to further evaluate measurement invariance of the EDE-Q by sexual orientation, gender identity, and race.

Integrating minority stress theory and the tripartite influence model: A model of eating disordered behavior in sexual minority young adults.

Eating disorders are serious mental illnesses associated with high mortality rates and health complications. Prior research has found increased rates of eating pathology in sexual minority (SM; e.g., lesbian, gay, bisexual) individuals compared to sexual majority (i.e., heterosexual) individuals. Two prominent models have potential to explain these differences: the tripartite influence model and minority stress theory. While both models separately have promise for explaining the pathway of eating disordered behavior in SM individuals, research has indicated that both models have unexplained variance. Therefore, a comprehensive, integrative model could further explain unique variance. 479 men and 483 women between 18 and 30 years old were recruited through Qualtrics; all participants endorsed attraction to same-gender partners. Two models were estimated by gender using structural equation modeling. For men and women, community involvement accelerated the positive association of heterosexist discrimination with internalized homophobia. Minority stressors were associated with dissatisfaction and muscularity behavior, indicating the importance of incorporating minority stress. For women, community involvement accelerated both the association of pressures with muscularity internalization and the association of muscularity-based dissatisfaction with muscle building behaviors. If confirmed by prospective studies, this model could help refine prevention and intervention efforts with this vulnerable population.

Appearance discrimination and binge eating among sexual minority men.

Sexual minority men (SMM) face substantial disparities in rates of binge eating compared to heterosexual individuals, underscoring the need to study risk factors for the development of binge eating amongst SMM. One potential explanation for this disparity in binge eating is minority stress theory, which posits that minority groups face stressors, such as discrimination, due to their stigmatized position in society. Additionally, specific domains of discrimination may confer different levels of risk for binge eating. Therefore, the current study examined the association of various forms of discrimination, including appearance-based discrimination, and binge eating in a sample of SMM. A sample of 200 SMM (analytic sample of N = 187) from the greater Boston area completed self-report questionnaires assessing frequency of different forms of perceived discrimination (appearance, sexual orientation, race, etc.) and binge eating. A hierarchical binary logistic regression model was used to examine the association of different forms of discrimination with binge eating. 9% of the sample reported binge eating. Appearance-based discrimination was the most common form of discrimination (47%), and was significantly associated with binge eating, over and above all other forms of discrimination and sociodemographic variables, OR = 1.71, 95% CI = [1.24, 2.35], Wald χ2 (1) = 10.65, p = .001. Findings suggest that appearance-based discrimination may be related to binge eating in SMM. Clinicians may consider assessing appearance-based discrimination among SMM patients.

Intimate partner violence and muscularity-building behavior in latino sexual minority men.

Intimate partner violence (IPV) has been associated with increased prevalence of eating disorders. In men, disordered eating is often related to the muscularized ideal. Sexual minority men (SMM; e.g., gay, bisexual, etc.) are at higher risk for eating disorders and Latino SMM may be at particularly high risk; however, IPV and eating pathology has yet to be examined in this population. Therefore, the aim of this study is to elucidate the association between IPV and muscularity-related dissatisfaction and muscularity-oriented behavior in Latino SMM. Participants were 81 Latino SMM. Thirty participants (37% of the sample) met the cutoff score for experiencing IPV in the past month. In bivariate analyses, IPV was associated with muscularity-oriented behavior, but not muscularity-related dissatisfaction. In multivariable analyses, IPV was negatively associated with muscularity-related dissatisfaction with a small effect size and positively associated with muscularity-oriented behavior with a large effect size. It may be that SMM engage in muscle building behavior to increase self-esteem, regulate affect, or better physically protect themselves from their abusive partner. Future research should investigate motivation for muscle building behavior in individuals experiencing IPV.

Medical Mistrust and the PrEP Cascade Among Latino Sexual Minority Men.

Latino sexual minority men (SMM) have high HIV incidence rates but report low pre-exposure prophylaxis (PrEP) use. Medical mistrust predicts lower medical care use and could contribute to decreased PrEP engagement. This study examines how medical mistrust relates to the PrEP cascade among 151 Latino SMM aged 18-29. Logistic regressions were employed with medical mistrust predicting PrEP awareness, willingness, current use, and adherence. Greater medical mistrust was associated with decreased odds of all outcomes and may represent a barrier to PrEP engagement for Latino SMM. Further research should explore whether reducing medical mistrust among Latino SMM could increase PrEP engagement.

Syndemics and the PrEP Cascade: Results from a Sample of Young Latino Men Who Have Sex with Men.

Young Latino men who have sex with men (MSM) are a highly vulnerable population for HIV infection. Pre-exposure prophylaxis (PrEP) is a novel biomedical HIV prevention tool that may aid in reducing the disparity in HIV incidence among Latino MSM. However, PrEP use is disproportionally low among Latino MSM and, therefore, identifying barriers along the PrEP continuum of care (the "PrEP cascade") would provide insight into how to best deploy PrEP interventions. Syndemics theory is a prominent framework employed in HIV prevention; however, to date, no known studies have applied this theory to PrEP. Thus, the aim of the current study was to explore the association between syndemics and the PrEP cascade, including the degree to which psychosocial and structural syndemic constructs are related to the PrEP cascade. Participants were 151 young Latino MSM (M age = 24 years; SD = 3) residing in San Diego, California, who completed a battery of online self-report measures. Results indicated high levels of syndemic indicators and varying levels of engagement across the PrEP cascade. As syndemic indicators increased, the odds of engagement across the PrEP cascade were significantly lowered. Psychosocial and structural syndemic factors accounted for unique variance in the PrEP cascade. Results highlight the need for combination interventions that address both psychosocial and structural barriers to PrEP use and persistence among young Latino MSM.

Examining a Syndemics Network Among Young Latino Men Who Have Sex with Men.

BACKGROUND: Although studies consistently find that syndemic indicators are additively associated with increased HIV/STI risk behavior (e.g., condomless anal sex; CAS) among men who have sex with men (MSM), information is lacking about how syndemic indicators are associated with each other. Young Latino MSM are one of the most at-risk groups for acquiring HIV in the U.S. Understanding the associations of syndemic indicators with each other and with CAS may improve understanding of how to enhance sexual and behavioral health in this population. METHOD: Network analysis using the graphical LASSO (glasso) algorithm was employed to explore associations between CAS and syndemic indicators among 139 young Latino MSM. Structural and psychosocial syndemic indicators were assessed via self-report. CAS was defined as the number of partners in the past 3 months with whom one engaged in CAS. RESULTS: Results of the network analysis suggested the variables with the highest centrality were unstable housing, prison history, childhood sexual abuse, and CAS. Specific significant associations included links between CAS and alcohol use (b = 0.40), childhood sexual abuse and unstable housing (b = - 0.75), alcohol use and childhood sexual abuse (b = 0.40), and substance use and intimate partner violence (b = 0.43). CONCLUSION: This pattern of interconnectedness demonstrates the potential for network analysis to examine nuanced interrelationships of syndemic indicators. The specific associations in this sample raise the question whether a primary focus of interventions should address the more central syndemic indicators for this population, such as alcohol use and unstable housing, and whether this would, via downstream effects, affect other aspects of behavioral health in this population.