Psychosocial characteristics and quality of life among sexual and gender minority patients with cancer.

BACKGROUND: Underserved and minoritized patients with cancer often experience more psychosocial concerns and inferior quality of life (QOL) compared with majority populations. This study compared patient-reported psychosocial characteristics and QOL among self-identified sexual and gender minority patients with cancer vs cisgender-heterosexual patients with cancer treated at a National Cancer Institute-designated comprehensive cancer center in the United States. METHODS: Self-report data from 51 503 patients were obtained from an institutional standard-of-care electronic patient questionnaire that was completed prior to, or on the day of, the patient's initial visit. The electronic patient questionnaire collects demographic information, including sexual orientation and gender identity, psychosocial variables, and QOL using the validated Short Form Health Survey-12. Sexual orientation and gender identity information was used to identify self-identified sexual and gender minority and cisgender-heterosexual persons (ie, non-self-identified sexual and gender minority). Using parametric analyses, psychosocial variables and QOL measures were compared for self-identified sexual and gender minority vs non-self-identified sexual and gender minority patients with cancer. RESULTS: Compared with non-self-identified sexual and gender minority patients (n = 50 116), self-identified sexual and gender minority patients (n = 1387, 2.7%) reported statistically significantly greater concerns regarding getting help during treatment (2.6% vs 4.3%, respectively; P = .001) and concerns with ability to seek care (16.7% vs 21.6%, respectively, P < .001). Self-identified sexual and gender minority patients reported statistically significantly elevated mental health concerns and daily emotional and pain interference (all P < .001), whereas there was no statistically significant difference in daily interference due to physical functioning. CONCLUSION: These data reveal real-world disparities among self-identified sexual and gender minority patients with cancer, which can be used to develop psychosocial interventions tailored to address the unique psychosocial and QOL needs of this underserved and minoritized population and to ultimately improve cancer care.

Dispositional Mindfulness in Heterosexual and Lesbian/Bisexual Women: Associations with Sexual Prejudice and Internalized Sexual Stigma.

This research investigated the effect of dispositional mindfulness on the reduction of sexual prejudice and internalized sexual stigma in heterosexual and lesbian/bisexual women, who still represent a population that is under-represented in the scientific literature. Participants were 203 Italian women, both heterosexual (N = 104, 51.2%) and lesbian/bisexual (N= 99, 48.8%), ranging between 18 and 68 years old. They responded to a questionnaire containing demographic information and measures of dispositional mindfulness, need for cognitive closure, and adherence to traditional gender roles. Dominance analyses were run to test the predictive power of mindfulness' dimensions on internalized sexual stigma and on sexual prejudice over and above the other predictors. Results showed that having a mindful nonjudging attitude toward one's inner experience is associated with less internalized sexual stigma in lesbian and bisexual women. On the contrary, dispositional mindfulness was not associated with heterosexual women's sexual prejudice against gay and lesbian individuals.

Sexuality and Gender Identity Inequities in Substance Use Disorder and Its Treatment among American Indian, Alaska Native, and Native Hawaiian College Students.

BACKGROUND: The aim of this study was to investigate inequities in substance use disorder (SUD) diagnosis, opioid misuse, marijuana misuse, SUD treatment utilization, and utilization of university mental health services among sexual and gender minority (SGM) American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) college students. METHODS: Data consisting of 8,103 AI/AN/NH students' responses to the American College Health Association's National College Health Assessment survey from fall 2015 through spring 2019 were utilized for this study. Multivariable logistic regression models were used to compare the odds of SUD diagnosis, opioid misuse, and marijuana misuse in SGM AI/AN/NH students to cisgender, heterosexual peers. Unadjusted odds of SUD treatment utilization and utilization of university mental health services were also evaluated. RESULTS: Compared to cisgender females, transgender (aOR = 4.43, 95% CI = 2.67-7.34) and gender diverse (aOR = 2.86, 95% CI = 1.61-5.07) students had significantly higher odds of SUD diagnosis. Similarly, significantly higher odds of SUD diagnosis were observed among sexual minorities, including gay/lesbian (aOR = 2.95, 95% CI = 1.71-5.09) and bisexual (aOR = 1.97, 95% CI = 1.30-2.99) students compared to heterosexual peers. Sexual minority students had significantly higher odds of utilizing university mental health services (uOR = 2.43, 95% CI = 1.22-4.84) than heterosexual peers. Odds of opioid misuse and marijuana misuse were also significantly increased among sexual minority students. CONCLUSIONS: AI/AN/NH college students who identify as SGM have higher odds of SUD diagnosis, opioid misuse, and marijuana misuse than their cisgender, heterosexual peers. These findings highlight the need to consider tailored programming for SGM AI/AN/NH students in substance use prevention and intervention efforts in U.S. college settings.

Sexual Minority Status, Affect Lability, and Suicide Ideation: Buffering Role of Trait Mindfulness.

OBJECTIVE: Emotion regulation has been proposed as a mechanism driving sexual orientation disparities in suicide ideation (SI), but little research has examined the role of affect lability in the association of sexual minority identity and SI. As prior research has found trait mindfulness to be associated with lower SI, the objective of the present study was to examine the buffering role of mindfulness in the associations of sexual orientation, affect lability, and SI. METHOD: The present study used a moderated mediation model to examine a cross-sectional dataset consisting of heterosexual (n = 1511) and sexual minority (n = 355) U.S. college students (N = 1866), to examine whether five facets of mindfulness moderated the indirect association of sexual minority identity on SI via affect lability. RESULTS: As predicted, sexual minority identity was associated with higher affect lability, which in turn was associated with higher SI. Acting with awareness (i.e., attending to the present activities), describing (i.e., the ability to verbalize inner experiences), and non-judging (i.e., refraining from judging inner experiences) buffered the indirect association of sexual minority identity on SI via affect lability, such that the indirect association weakened at higher levels of those mindfulness facets. CONCLUSIONS: Our results provide a better understanding of the emotion regulation mechanisms underlying the higher risk of SI among sexual minorities. Future research is needed to examine mindfulness facets as buffers against SI among other communities, and to examine the efficacy of emotion regulation and mindfulness interventions in reducing suicide ideation and other aspects of suicidality (i.e., plans/attempts).HighlightsSexual orientation disparities in suicide ideation (SI) and affect lability.Sexual minority identity linked to higher SI via higher affect lability.Three mindfulness facets attenuated indirect association of identity on SI.

Affective responses to non-sexual imagery depicting gay men and lesbian women.

When examining negative attitudes and behaviors directed toward gay men and lesbian women (i.e., homonegativity), researchers tend to use measures that require participants to respond to belief statements. This methodology is problematic for two reasons: 1) it focuses on the social categories "gay men" and "lesbian women" and ignores the practices of relational intimacy engaged in by gay and lesbian persons (practices that, arguably, are at the crux of homonegativity); and 2) it overlooks the affective responses that sexual minorities evoke in heterosexual people. These issues were tackled in the current study. Specifically, heterosexual participants (N = 241) were asked to report their affective state using six basic emotions while viewing photos depicting male-male, female-female, and heterosexual couples. Findings demonstrated that participants, regardless of gender, reacted most negatively to images of female-female couples engaging in everyday intimacies. Theoretical explanations for these findings are explored.

The role of sexual mindfulness in sexual wellbeing, Relational wellbeing, and self-esteem.

In this study we examine the role of sexual mindfulness in individuals' sexual satisfaction, relational satisfaction, and self-esteem. Midlife U.S. men and women (N = 194 married, heterosexual individuals; 50.7% female; 94% Caucasian, age range 35-60 years) completed an online survey. More sexually mindful individuals tended to have better self-esteem, be more satisfied with their relationships and, particularly for women, be more satisfied with their sex lives. Some of these associations occurred even after controlling for trait mindfulness. These findings may also allow researchers and therapists to better address an individual's sexual wellbeing, relational wellbeing, and self-esteem by teaching sexual mindfulness skills.

The Longitudinal Effects of Non-injection Substance Use on Sustained HIV Viral Load Undetectability Among MSM and Heterosexual Men in Brazil and Thailand: The Role of ART Adherence and Depressive Symptoms (HPTN 063).

The effect of non-injection substance use on HIV viral load (VL) is understudied in international settings. Data are from HPTN063, a longitudinal observational study of HIV-infected individuals in Brazil, Thailand, and Zambia, with focus on men with VL data (Brazil = 146; Thailand = 159). Generalized linear mixed models (GLMM) assessed whether non-injection substance use (stimulants, cannabis, alcohol, polysubstance) was associated with VL undetectability. ART adherence and depressive symptoms were examined as mediators of the association. In Thailand, substance use was not significantly associated with VL undetectability or ART adherence, but alcohol misuse among MSM was associated with increased odds of depression (AOR = 2.75; 95% CI 1.20, 6.32, p = 0.02). In Brazil, alcohol misuse by MSM was associated with decreased odds of undetectable VL (AOR = 0.34; 95% CI 0.13, 0.92, p = 0.03). Polysubstance use by heterosexual men in Brazil was associated with decreased odds of ART adherence (AOR = 0.25; 95% CI 0.08, 0.78, p = 0.02). VL suppression appears attainable among non-injection substance users. Substance use interventions among HIV-positive men should address depression, adherence, and VL undetectability.

HIV Stigma and Older Men's Psychological Well-Being: Do Coping Resources Differ for Gay/Bisexual and Straight Men?

OBJECTIVES: This study investigated whether sexual orientation moderated the mediation effects of coping resources (i.e., spirituality and complementary and integrative health [CIH] use) in the relationship between HIV stigma and psychological well-being (PWB) among older men with HIV (MWH). METHOD: Data from the Research of Older Adults with HIV (ROAH) study was used (N = 640, Age 50+). Structural equation modeling (SEM) was employed to examine a coping resource mediation model. We used a multiple-group procedure to test moderation effects by sexual orientation. RESULTS: HIV stigma was negatively associated with spirituality and PWB. HIV stigma accounted for a significant amount of variance in PWB, with significant indirect effects via spirituality, indicating a partial mediation. Chi-square difference tests supported the hypothesis that this mediation effect was moderated by sexual orientation. CIH use was not statistically significant. DISCUSSION: HIV stigma's negative relationship with PWB was salient in both groups. Spirituality's buffer between HIV stigma and PWB was stronger in older gay/bisexual MWH compared to their heterosexual counterparts. With respect to HIV stigma, older gay/bisexual MWH exhibited a "crisis competence" in coping with stigma, perhaps through overcoming past homophobia related to their sexual minority status (i.e., homophobia).

Factors Associated with Mood Disorder Diagnosis Among a Population Based Cohort of Men and Women Living With and Without HIV in British Columbia Between 1998 and 2012.

Using data from the Comparison of Outcomes and Service Utilization Trends (COAST) study we examined factors associated with mood disorder diagnosis (MDD) among people living with HIV (PLHIV) and HIV-negative individuals in British Columbia, Canada. MDD cases were identified between 1998 and 2012 using International Classification of Disease 9 and 10 codes. A total of 491,796 individuals were included and 1552 (23.7%) and 60,097 (12.4%) cases of MDD were identified among the HIV-positive and HIV-negative populations, respectively. Results showed HIV status was associated with greater odds of MDD among men and lower odds among women. Among PLHIV, MDD was significantly associated with: identifying as gay, bisexual or other men who have sex with men compared to heterosexuals; higher viral load; history of injection drug use; and concurrent anxiety, dysthymia, and substance use disorders. Findings highlight the need for comprehensive and holistic HIV and mental health care.

Religiosity as a protective factor for hazardous drinking and drug use among sexual minority and heterosexual women: Findings from the National Alcohol Survey.

OBJECTIVE: Despite research documenting disparities in risk for alcohol-related problems among sexual minority women, few studies explore potential protective factors within this population. This study examines how religiosity may function as a protective or risk factor for alcohol-problems or other substance use among sexual minorities compared to heterosexuals. METHOD: Data from 11,169 women who responded to sexual identity and sexual behavior questions from three population-based National Alcohol Survey waves (2000, 2005, 2010) were utilized for analyses of religiosity in relation to lifetime drinking, past year hazardous drinking, and past year drug use. RESULTS: Religiosity was significantly greater among exclusively heterosexual women compared to all sexual minority groups (lesbian, bisexual and heterosexual women who report same sex partners). Lesbians reported the lowest rates of affiliation with religions/denominations discouraging alcohol use. Past year hazardous drinking and use of any illicit drugs were significantly lower among exclusively heterosexual women compared to all sexual minority groups. High religiosity was associated with lifetime alcohol abstention and was found to be protective against hazardous drinking and drug use among both sexual minority and heterosexual women. Reporting religious norms unfavorable to drinking was protective against hazardous drinking among exclusively heterosexual women but not sexual minority women. CONCLUSIONS: Findings reveal the importance of considering sexual minority status in evaluation of religion or spirituality as protective among women. Future studies should explore religiosity in the context of other individual and environmental factors, such as positive identity development and community-level acceptance, which may be salient to resiliency among sexual minorities.

Emotional reactions of heterosexual men to gay imagery.

Studies of homonegativity in the general population typically use scales to examine the attitudes of a heterosexual sample toward gay men and lesbian women. However, these scales fail to address that accepting gay and lesbian people in theory is not tantamount to accepting the sexual practices engaged in by gay and lesbian people. As a result, relying on homonegativity scales and hypothetical scenarios (i.e., asking a participant to imagine a gay man or lesbian woman from personality characteristics provided) may not offer a complete view of the complexities of homonegativity. To explore this possibility, 83 men self-identifying as either largely or exclusively heterosexual rated one of three groups of images (romantic gay, erotic gay, and control) on the basis of five questions related to their emotional responses. A psychometrically sound homonegativity scale was also completed. Results indicated that homonegativity was a significant predictor of decreased happiness, anger, disgust, task enjoyment, and reported liking of the imagery. Furthermore, homonegativity was found to moderate the association between exposure to the romantic images and four of the five emotional responses (happiness, anger, disgust, and liking). Exposure to the set of erotic gay images, however, was associated with negative emotional responses, regardless of participants' self-reported level of homonegativity (i.e., overt homonegativity possessed less moderational power for this type of imagery). These findings suggest that standard scales of homonegative attitudes may be unable to capture the affective negativity that heterosexual men experience when viewing gay male intimacy.

Testing the sexual imagination hypothesis for gender differences in response to infidelity.

BACKGROUND: Evolutionary psychologists hypothesized that men are more upset by sexual infidelity than women are, whereas women are more upset by emotional infidelity than men are. On the other hand, the sexual imagination hypothesis states that gender differences in infidelity responses are derived from explicit men's sexual imagery. Based on the latter hypothesis, we hypothesized that although men would report being more distressed by sexual infidelity than women who were not in a committed relationship (NCR), no gender difference would be reported in a committed relationship (CR). FINDINGS: These two hypotheses were tested with 598 participants in a CR and 1,643 participants in a NCR. No significant gender difference was found sexual infidelity response in the CR group (d=0.008, a power of .956), whereas men were more upset than women about sexual infidelity in the NCR group. Moreover, a significant interaction between gender and infidelity type was found in the NCR, whereas no significant interaction between gender and infidelity type was observed in the CR group (partial η2=0.005, a power of .943). CONCLUSIONS: Our findings supported the sexual imagination hypothesis but were inconsistent with the EJM hypothesis.

Views of hospice and palliative care among younger and older sexually diverse women.

The aim of the present study was to explore end-of-life health care attitudes among younger and older sexually diverse women. Self-identified lesbian and heterosexual older women as well as lesbian and heterosexual middle-aged women were recruited. Results indicated that lesbian women held significantly more positive beliefs about hospice services and the role of alternative medicines in health care. No differences among sexual orientation were found for comfort discussing pain management but heterosexual women reported a significantly greater desire for life-sustaining treatments in the event of an incurable disease and severe life-limiting conditions (eg, feeding tube, life support, no brain response). Additionally, as expected, older women in this study held more positive beliefs about hospice and more comfort discussing pain management than middle-aged women.

Teen magazines as educational texts on dating violence: the $2.99 approach.

This study analyzed the portrayal of dating violence in teen magazines published in the United States. Such an investigation is important because previous research indicates that dating violence is a serious problem facing adolescents, teen magazines overemphasize the importance of romantic relationships, and teens who read this genre frequently or for education/advice are especially susceptible to its messages. Results indicated that although teen magazines do frame dating violence as a cultural problem, they are much more likely to utilize an individual frame that emphasizes the victim. Results were discussed as they apply to the responsibilities of professionals working with adolescents.

The politics of heterosexuality--a missing discourse in cancer nursing literature on sexuality: a discussion paper.

In this article, a critique of cancer nursing literature on the issue of sexuality is presented, with particular reference to literature on cancers common to women. The paper begins with an account of two competing perspectives on sexuality. The first is a version of sexuality rooted in sexology, underpinned by biomedical science that makes a claim to having identified 'normal' sexuality. The second is a version of sexuality developed within feminist scholarship that tends to reject biological determinism as a basis for understanding sexuality, instead favouring constructionist perspectives, with the socio-political context of sexual relations problematised. The focus of the article then shifts to cancer nursing literature on sexuality that deals primarily with cancers common to women, to appraise the extent to which either of the above perspectives on sexuality is invoked. Within this body of nursing knowledge, I argue that there has largely been an uncritical endorsement of biomedical constructions of sexuality, rooted in orthodox sexology, with a dominant focus on sexual functioning and on sexual rehabilitation for women with cancer. Moreover, in this knowledge base, phallocentric heterosexuality over and above other forms of sexual expression is privileged, and the socio-political context of unequal gender power relations is largely excluded. References to the social sphere as a dimension of nursing care are focused almost exclusively on maintaining normality, and reflect the emphasis on functional restoration. The largely individualistic, uncritical and biocentric emphasis in this literature may serve inadvertently to reinforce and maintain existing gender inequalities in heterosexual relationships. Finally, I consider the difficulties for oncology nurses in dealing with contradictory truth claims or conventional wisdoms about sexuality from the disparate disciplines of which holism is comprised.

Lack of differences between males with or without perceived same sex attraction.

Adolescent males are often concerned that they may be homosexual because of a sense of sexual attraction to other males. This not uncommon concern is often expressed to pediatric endocrinologists who come into contact with these boys because of concerns with abnormal pubertal development. To explore the character and prevalence of these types of homosexual concerns we assessed the perceptions of a group of healthy adolescent males using a structured questionnaire. The aim of this study was to determine whether males concerned about homosexual tendencies manifest a unique self-perception profile or interact differently with others. A multi-item questionnaire regarding demographic, behavioral, psychological and sexual characteristics was administered to 52 18-24 year-old males. Overall, there were few differences between males admitting to an adolescent homosexual attraction to males and males without this attraction. Differences between these two groups included more exposure to some kinds of pornography (including male to male imagery), noticeable psychosexual responses to male pornography, internal questioning over homosexual tendencies, comparisons of genitalia and perceptions of body build. There were no differences in demographics, family structure, religious beliefs, socio-economic status, knowledge of puberty, inter-personal relationships or sources of information about sexuality.

Complementary medicine practices in a community-based sample of lesbian and heterosexual women.

While researchers have examined the established the foundation for understanding the correlates of complementary and alternative medicine (CAM) use among some medical populations, less is known about the correlates of CAM use in nonclinical samples of women, and particularly according to sexual orientation. Information on CAM modalities was collected as part of a survey of lesbian and heterosexual women's health. Eighty-two percent of the sample reported CAM use. Predictors of CAM use included a lesbian sexual orientation, less health-related worry, and perceived discrimination in health care settings. Additional research is warranted to better understand how sexual orientation relates to use of CAM. Future studies should also examine the relationships between and experiences with discrimination in traditional medical settings and increased use of complementary and alternative medicine.

A qualitative exploration of the experiences of lesbian and heterosexual patients with breast cancer.

PURPOSE/OBJECTIVES: To explore similarities and differences between lesbian and heterosexual survivors of breast cancer regarding cancer experiences, medical interactions related to cancer treatment, and quality of life (QOL). DESIGN: Qualitative study using focus groups. SETTING: Urban, community-based health center. SAMPLE: A convenience sample of lesbians (n = 13) and heterosexual women (n = 28) with a diagnosis of breast cancer within the past five years. Participants were recruited via posted advertisements. METHODS: Focus groups were conducted as part of a larger study exploring coping and adjustment in lesbian survivors of breast cancer. Transcribed focus group data were analyzed through thematic and representative case study methods. MAIN RESEARCH VARIABLES: Broad aspects of medical interactions and the patient-provider relationship that may be associated with improved QOL of lesbian and heterosexual patients with cancer. FINDINGS: Data suggested similarities between lesbians and heterosexual women in their overall QOL. However, differences did emerge between the groups. Lesbians reported higher stress associated with diagnosis, lower satisfaction with care received from physicians, and a trend toward lower satisfaction with the availability of emotional support. CONCLUSIONS: Study findings have important implications for future research on adjustment and coping among lesbian patients with breast cancer and for the improvement of their mental and physical healthcare services. IMPLICATIONS FOR NURSING: Study findings may help improve healthcare services for lesbians with cancer.

Comparison of stress and stress management strategies between lesbian and heterosexual women.

Stress is said to be part of life, but stress may be uniquely experienced by different groups of women. We conducted this study to compare the experiences of stress and the methods of stress management used by lesbian and heterosexual women. A convenience sample of 215 (136 lesbian and 79 heterosexual) urban women was used. All women reported generally good mental health; however, more than 80% of the women reported moderate or severe stress. There were more similarities than differences between the groups, but lesbians reported more stress due to sexual identity, being female, and mental problems, and heterosexual women reported more stress due to parents and children. Both groups used a wide range of stress management strategies, although lesbians more frequently used meditation and therapy.