Race-specific associations between psychological distress and obesity: the role of social cohesion.

OBJECTIVE: Nearly two-thirds of Black women in the US are obese. Studies have focused more on lifestyle and behavioral factors to explain racial disparities; less research has examined psychosocial factors such as psychological distress and social cohesion. While research suggests that social cohesion may confer benefits for health, no studies have assessed how social cohesion is related to both mental health and obesity, and potential racial differences. Our study examined associations between psychological distress, social cohesion, and obesity among Black and White adult women. DESIGN: Data are from the 2014-2018 National Health Interview Survey (n = 66,743). Participants self-reported psychological distress (Kessler K6 scale), obesity (body mass index≥30 kg/m2), and social cohesion. We fit logistic regression models of obesity with likelihood ratio tests for effect modification by social cohesion and by race. RESULTS: Psychological distress was associated with a 1.19 and 1.31 higher odds of obesity for Black (95% confidence interval: 1.05, 1.36) and White women (1.24, 1.39), respectively. Social cohesion was associated with a 0.75 lower odds of obesity among White (0.69, 0.81) but not Black women (odds ratio 0.94; 0.80, 1.10). Tests of interaction indicated no differences by social cohesion or race in the association between psychological distress and obesity. CONCLUSION: Findings highlight complex relationships between psychological distress, obesity, and social cohesion in Black and White women. Public health efforts should focus on understanding mechanisms relating social factors to health.

Diet, Food Insecurity, and CVD Risk in Sexual and Gender Minority Adults.

PURPOSE OF REVIEW: Sexual and gender minority (SGM) adults experience significant cardiovascular health disparities, yet little is known about diet and food insecurity in this population. This review summarizes recent literature on diet and food insecurity in SGM adults and their contribution to cardiovascular disease (CVD) risk in this population. RECENT FINDINGS: Existing evidence on diet and food insecurity disparities among SGM adults is inconclusive and research examining their link with CVD risk in SGM adults is limited. The majority of existing studies lack standardized and validated assessments of diet and food insecurity. Correlates of unhealthy diet and food insecurity among SGM adults are poorly understood. Research examining the associations between diet and food insecurity with CVD risk in SGM adults is limited. Longitudinal studies are needed to investigate whether diet and food insecurity contribute to the cardiovascular health disparities observed in SGM adults.

A Quantitative Intersectional Exploration of Sexual Violence and Mental Health among Bi + People: Looking within and across Race and Gender.

Young bisexual people report disparities related to mental health and sexual violence compared to their heterosexual and gay/lesbian peers. However, the majority of research in these areas does not employ an intersectional design, despite evidence that health outcomes vary by race and gender within bi + populations. The goal of this paper is to provide an intersectionally-informed exploration of the prevalence of sexual violence among a diverse sample of 112 bi + people age 18-26, as well as descriptive data on stigma, mental health, and social support. Most (82%) of participants reported at least once experience of sexual violence since the age of 16. Sexual violence was positively associated with sexual stigma, anxiety, depression, and suicidality. Nonbinary participants reported greater prevalence of violence, exposure to stigma, and worse mental health outcomes relative to cisgender participants. Nonbinary BIPOC participants reported higher levels of anxiety and depression than cisgender BIPOC participants.

Variation in diet quality across sexual orientation in a cohort of U.S. women.

PURPOSE: Extensive prior research has shown that sexual minority women are more likely to have a number of cancer risk factors, thereby putting them at higher risk for cancer than heterosexual women. However, there has been little research evaluating the association between sexual orientation and diet quality. METHOD: Data come from participants (aged 24-54 years) enrolled in Nurses' Health Study 3, an ongoing, U.S.-based cohort study (N = 15,941). We measured diet using recommendations from the Dietary Approach to Stop Hypertension (DASH) and American Health Association (AHA) 2020 Strategic Impact Goals. RESULTS: We found limited evidence of differences across diet quality by sexual orientation. When examining predicted DASH scores, mostly heterosexual [predicted mean score (95% confidence interval), 24.0 (23.8, 24.3)] and lesbian [24.3 (23.8, 24.9)] women had healthier predicted DASH scores than the reference group of completely heterosexual women with no same-sex partners [23.6 (23.5, 23.7)]. Even though certain sexual minority women had overall healthier predict DASH scores, their consumption of certain food groups-low-fat dairy and fruit-was lower than completely heterosexual women with no same-sex partners. When measuring AHA scores, most sexual minority groups (completely heterosexual women with same-sex partners, mostly heterosexual women, and lesbian women) had higher diet quality compared to the reference group of completely heterosexual women with no same-sex partners. CONCLUSION: Sexual minority women, particularly mostly heterosexual women and lesbian women, had healthier diet quality than completely heterosexual women with no same-sex partners. These data suggest that cancer risk factors (e.g., smoking, drinking, and inactivity) other than diet would drive higher cancer rates among sexual minority compared to heterosexual women. Nonetheless, it is critical for all women to improve their diet quality since diet quality was poor among participants of all sexual orientations.

Depression, Anxiety, and Alcohol Use Among LGBTQ+ People During the COVID-19 Pandemic.

Objectives. To describe disparities in depression, anxiety, and problem drinking by sexual orientation, sexual behavior, and gender identity during the COVID-19 pandemic. Methods. Data were collected May 21 to July 15, 2020, from 3245 adults living in 5 major US metropolitan areas (Atlanta, Georgia; Chicago, Illinois; New Orleans, Louisiana; New York, New York; and Los Angeles, California). Participants were characterized as cisgender straight or LGBTQ+ (i.e., lesbian, gay, bisexual, and transgender people, and men who have sex with men, and women who have sex with women not identifying as lesbian, gay, bisexual, or transgender). Results. Cisgender straight participants had the lowest levels of depression, anxiety, and problem drinking compared with all other sexual orientation, sexual behavior, and gender identity groups, and, in general, LGBTQ+ participants were more likely to report that these health problems were "more than usual" during the COVID-19 pandemic. Conclusions. LGBTQ+ communities experienced worse mental health and problem drinking than their cisgender straight counterparts during the COVID-19 pandemic. Future research should assess the impact of the pandemic on health inequities. Policymakers should consider resources to support LGBTQ+ mental health and substance use prevention in COVID-19 recovery efforts.

Sexual orientation and benign breast disease in a cohort of U.S. women.

PURPOSE: Several studies indicate that sexual minority (e.g., bisexual, lesbian) women may be at an increased risk for breast cancer. However, we know little about how risk factors, such as benign breast disease (BBD)-which can confer nearly a fourfold breast cancer risk increase-may vary across sexual orientation groups. METHODS: Among Nurses' Health Study II participants followed from 1989 to 2013 (n = 99,656), we investigated whether bisexual and lesbian women were more likely than heterosexual women to have breast cancer risk factors including a BBD diagnosis (self-reported biopsy or aspiration confirmed, n = 11,021). Cox proportional hazard models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: Compared to heterosexuals, sexual minority participants more commonly reported certain breast cancer risk factors including increased alcohol intake and nulliparity. However, sexual minority participants were more likely than heterosexuals to have certain protective factors including higher body mass index and less oral contraceptive use. When evaluating age- and family history-adjusted rates of BBD diagnoses across sexual orientation groups, bisexual (HR 1.04, 95% CI [0.78, 1.38]) and lesbian (0.99 [0.81, 1.21]) women were just as likely as heterosexuals to have a BBD diagnosis. Results were similar after adjusting for other known breast cancer risk factors. CONCLUSIONS: In this cohort of women across the U.S., sexual minorities were more likely than heterosexuals to have some breast cancer risk factors-including modifiable risk factors such as alcohol intake. Heterosexual, bisexual, and lesbian women were equally as likely to have a BBD diagnosis.

College Climate and Sexual Orientation Differences in Weight Status.

Previous research has identified significant sexual orientation disparities in obesity. Contextual factors, like lack of anti-discrimination policies and gay-straight alliances, have been shown to be associated with health outcomes like poor mental health and substance use for lesbian, gay, and bisexual (LGB) individuals moreso than their heterosexual counterparts; however, little work to date has explored the role of contextual factors on sexual orientation disparities in obesity. Individual-level, serial cross-sectional data from the 2009-2013 College Student Health Survey, which includes 2- and 4-year college students (n = 29,118) attending 46 Minnesota colleges, were used. College-level data on LGB context were primarily collected through college websites. Multinomial logistic regression models were fit to examine associations between LGB college climate scores (including non-discrimination policies, presence of LGB or diversity-related student groups, LGB courses offered, LGB housing accommodations, and prevalence of LGB students) and students' weight status (underweight, healthy weight, overweight, and obese), based on self-reported height and weight. Higher LGB climate scores (i.e., more supportive environments) were associated with lower risk of overweight and obesity among all students. Sexual orientation-stratified findings among female students suggested that the association between LGB climate scores and weight status was similar to the overall female sample. Sexual orientation-stratified findings among male students showed a more complex relationship between LGB climate scores and weight status. More work is needed to disentangle the observed associations, and to investigate other contextual factors, like state- and city-level policies, social networks and norms, and individual resiliency within these contexts to better understand the contextual influences on sexual orientation disparities in obesity.

Unhealthy weight control behaviors among youth: Sex of sexual partner is linked to important differences.

Unhealthy weight control behaviors (UWCBs) have been decreasing for most youth over time, yet little is known whether these behaviors have changed for sexual minority (e.g., non-heterosexual) youth. This is important because many studies have found that sexual minorities report some of the highest rates of UWCBs. To determine whether or not these behaviors have changed over time, given the extreme changes in social contexts over the past two decades, we utilised three waves of the Minnesota Student Survey (N = 55,597, Mage = 17). In doing so, we report trends, disparities, and changes in disparities of UWCBs. Overall, the prevalence of UWCBs has declined from 1999 to 2010 for all youth, but there are alarming disparities by sex of sexual partner. We found that both- and same-sex partnered male youth were more likely to fast, use diet pills, and vomit on purpose to lose weight compared to their opposite-sex partnered counterparts in all three survey years; specifically, both-sex partnered boys were up to 5.5× as likely to vomit on purpose compared to their opposite-sex partnered counterparts. Likewise, both-sex partnered girls were more likely to use diet pills and vomit on purpose to lose weight compared to opposite-sex partnered girls in all three survey years. Additionally, the disparity in fasting to lose weight widened for the same-sex partnered females compared to the opposite-sex partnered females from 1998 to 2004. This has implications for UWCB interventions and preventions targeted specifically towards sexual minorities.

Lesbian, gay and bisexual college student perspectives on disparities in weight-related behaviours and body image: a qualitative analysis.

AIMS AND OBJECTIVES: To (1) explore college students' perceived sexual orientation-related barriers to engaging in physical activity, eating healthfully and maintaining healthy body images and (2) identify types of campus resources on physical activity, healthy eating and body image available to lesbian, gay and bisexual college students. BACKGROUND: Previous research has highlighted sexual orientation disparities in weight status, physical activity, healthy eating and body image. Despite this, little is known about the context surrounding these disparities. DESIGN: Cross-sectional study using individual interviews. METHODS: Thirty (15 males, 15 females) lesbian, gay, bisexual, queer and pansexual-identified college students, aged 18-30 years participated in the study. Quasi-inductive coding was used to analyse transcribed interview data and an iterative coding process was used to organise data into themes. RESULTS: Many felt their sexual orientation helped them be physically active, engage in healthful eating habits and have a positive body image. However, sexual orientation was also identified as a stressor that adversely impacted physical activity and eating habits. CONCLUSIONS: Lesbian, gay and bisexual students may have to negotiate their sexuality in ways that could adversely influence their physical activity, eating habits and body image. Both clinical and institutional interventions should be inclusive of all people, including lesbian, gay and bisexual, queer, and pansexual students. Further, tailored interventions to meet the specific health needs of sexual minority populations are needed. RELEVANCE TO CLINICAL PRACTICE: Clinicians need to understand the context in which sexual minority young adults experience health promotion messaging and programming. Clinic-based tailored interventions are critical as part of a multi-faceted approach in promoting physical activity and healthier eating habits for all young people, including lesbian, gay, bisexual, queer and pansexual, to more effectively address the prevention of chronic diseases.

Disparities in Weight and Weight Behaviors by Sexual Orientation in College Students.

Objectives. We assessed disparities in weight and weight-related behaviors among college students by sexual orientation and gender. Methods. We performed cross-sectional analyses of pooled annual data (2007-2011; n = 33 907) from students participating in a Minnesota state-based survey of 40 two- and four-year colleges and universities. Sexual orientation included heterosexual, gay or lesbian, bisexual, unsure, and discordant heterosexual (heterosexuals engaging in same-sex sexual experiences). Dependent variables included weight status (derived from self-reported weight and height), diet (fruits, vegetables, soda, fast food, restaurant meals, breakfast), physical activity, screen time, unhealthy weight control, and body satisfaction. Results. Bisexual and lesbian women were more likely to be obese than heterosexual and discordant heterosexual women. Bisexual women were at high risk for unhealthy weight, diet, physical activity, and weight control behaviors. Gay and bisexual men exhibited poor activity patterns, though gay men consumed significantly less regular soda (and significantly more diet soda) than heterosexual men. Conclusions. We observed disparities in weight-, diet-, and physical activity-related factors across sexual orientation among college youths. Additional research is needed to better understand these disparities and the most appropriate intervention strategies to address them.

Health and health risks among sexual minority women: an examination of 3 subgroups.

We used 2001-2010 National Health and Nutrition Examination Survey data to examine insurance status, source of routine care, cigarette and alcohol use, and self-rated health among lesbian, bisexual, and heterosexual women who have sex with women, compared with heterosexual women who do not have sex with women. We found higher risks of being uninsured among lesbian and bisexual women, worse self-rated health among bisexual women, higher alcohol use among bisexual and heterosexual women who have sex with women, and higher smoking across all subgroups.

Sexual Identity Differences in Chronic Pain: Results from the 2019 to 2021 National Health Interview Survey.

INTRODUCTION: Chronic pain has been highlighted as an important public health and clinical health issue. The prevalence of chronic pain has been increasing, with notable disparities for many minoritized populations. However, evidence regarding sexual minoritized populations and chronic pain is lacking. Therefore, the purpose of this study is to compare the prevalence of chronic pain among men and women by sexual identity. METHODS: Data from the 2019 to 2021 National Health Interview Survey (n=78,686), a population-based public health surveillance system were analyzed in 2023-2024. This included 592 lesbian/gay and 952 bisexual women as well as 868 gay and 317 bisexual men. Chronic pain measures included frequency, amount of pain, pain limiting activities, and pain affecting family and others. Covariates included age, race/ethnicity, relationship status, education attainment, income, and employment status. RESULTS: After adjusting for covariates, significantly (p<0.05) more gay/lesbian (26.7%) and bisexual (31.6%) women reported experiencing chronic pain "most days or everyday" than straight women (21.7%). More bisexual women reported chronic pain as well as negative impacts in their life due to chronic pain than straight women. More bisexual men also reported experiencing chronic pain "most days or everyday" compared to straight men (26.1% versus 19.6%), although no differences were found for other aspects of pain. CONCLUSIONS: Sexual minoritized populations have a greater burden of chronic pain that should be considered in moving forward in pain work. Future work in this area is needed to understand why these disparities exist and how best to provide care and treatment to those affected.

A Latent Class Analysis of Family Eating Behaviors and Home Environment Habits on Preschool-Aged Children's Body Mass Index.

Background: The etiology of obesity is multifaceted, with multiple risk factors occurring during early childhood (e.g., fast food frequency, eating dinner as a family, TV in the bedroom). Many past studies have largely considered obesity risk factors in isolation, when in reality, the risk factors likely cluster together. A latent class analysis can be used to identify patterns in child eating behaviors, parent feeding behaviors, and household habits among preschool-aged children and their families to identify distinct, heterogenous classes and to determine if classes are associated with overweight and obesity. Methods: We used data from a community-based study of 624 three- to five-year-old children and a parent in New Hampshire, from March 2014 to October 2015. Parent-reported data were used to determine frequency of eating behaviors and household habits. Height and weight were objectively measured. Results: Four classes were identified; Class 1: "Healthy/Mildly accommodating," Class 2: "Healthy/Accommodating," Class 3: "Moderately healthy/Moderately accommodating," and Class 4: "Least healthy/Least accommodating." Compared with Class 1, children in Class 4 had increased odds of being overweight or obese [adjusted odds ratio (aOR): 1.64, 95% confidence interval (CI): 1.13-2.15], whereas Classes 2 and 3 were not associated with BMI (Class 2: aOR: 1.24, 95% CI: 0.62-1.86; Class 3: aOR: 1.31, 95% CI: 0.81-1.81). Conclusion: Study findings highlight that child-parent interactions around meals differentially relate to children's weight status given the context of children's eating habits. Most important, our study findings confirm the importance of adapting multiple healthy habits within the home social and physical environment to offset obesity risk in young children.

Children's Perception of Food Marketing Across Digital Media Platforms.

Introduction: Exposure to food marketing increases the risk of poor diet. Children's perception and interpretation of food marketing across digital media platforms is understudied. Children aged 9-11 years are uniquely susceptible to food marketing because children may watch content alone, and it is unclear whether embedded ads are decipherable by children (e.g., social media influencers) and if children are receptive to advertisements. Methods: The authors collected data from 21 child-parent dyads in 2022 to fill this gap. Children were interviewed about their food marketing exposure and media use and were asked to share their perspectives on food advertisements. Parents completed a survey for household digital devices, demographics, and perception of their child's food advertising knowledge. Results: This study found that all children generally recognized direct food advertisements, could describe them with varying levels of confidence, and shared examples. Despite self-identifying ads and understanding the intent of advertising, many children are still receptive to advertisements on the basis of engaging content (e.g., liking the ads as entertainment, watching ads even when given the chance to skip the ad) and the food items marketed (e.g., liking the taste of foods). Conclusions: These findings suggest that knowledge of advertisement exposure and intent of advertising are not sufficient to reduce receptiveness of unhealthy food ad exposure. Additional research on the potential impacts of embedded ads, such as through social media influencers, is needed to understand children's interaction with the current digital media landscape.

Factors Correlated With Ultra-Processed Food (UPF) Intake in Preschool-Aged Children and Association With Weight.

OBJECTIVE: Understand the correlates of ultra-processed food (UPF) intake and examine the association of UPF on body mass index in children aged 3-5 years. DESIGN: Secondary analysis of a prospective cohort of 3-5-year-olds/parent, followed 1-year between March 2014 and October 2016. Usual UPF intake from 2 3-day food records completed 1 year apart, a standardized nutrient database customized with child-specific foods, and a NOVA food classification system was used. Child/parent characteristics and media use were measured via parent-reported surveys. Child weight/height objectively measured. SETTING: New Hampshire community. PARTICIPANTS: Six hundred and sixty-seven parent-child dyads were screened, and 624 were enrolled with 90% follow-up. MAIN OUTCOME MEASURE(S): Primary outcome: identify correlates of UPF intake. SECONDARY OUTCOME: determine if UPF intake is associated with body mass index change. ANALYSIS: Adjusted ß linear regression, linear regression, P <0.05. RESULTS: Ultra-processed food accounted for 67.6% of total caloric intake. In adjusted models, children's UPF intake was positively associated with increasing child age, greater hours watching television, and more frequent parent soda/fast-food intake. Ultra-processed food intake was negatively associated with higher parent education and reported race/ethnicity other than non-Hispanic White. There was no association between UPF intake and weight. CONCLUSIONS AND IMPLICATIONS: There are several predictors of UPF intake in young children. Family-level interventions could be implemented to encourage the intake of minimally processed foods before and during preschool years.

Sexual Violence and Mental Health among Young Bi+ and Lesbian Women and Gender Minoritized People.

Introduction: Sexual minoritized people report worse mental health and are at risk of sexual violence compared to their heterosexual peers. Method: We conducted a survey to explore sexual stigma, sexual violence, and mental health among 326 bi+ and lesbian women and gender minoritized people age 18-25. Results: Mental health did not differ by sexual identity; sexual stigma and violence were associated with negative mental health symptoms, as were identifying as BIPOC, as trans or nonbinary, or having less formal education. Conclusion: Sexual stigma and violence are related to mental health among young bi+ and lesbian women and gender minoritized people.

Racism-Related Experiences and Adiposity: Findings From the Black Women's Experiences Living With Lupus (BeWELL) Study.

INTRODUCTION: Studies suggest that higher rates of excess adiposity in Black women may in part be driven by experiences of racism. Racial microaggressions, which include unintentional and subtle slights and insults, and responses to racism such as racism-related vigilance, may contribute to adiposity in this population. This study examined these understudied racism-related facets as well as interpersonal racial discrimination in relation to adiposity in a cohort of Black women with systemic lupus erythematosus. METHODS: Data are from the Black Women's Experiences Living with Lupus (BeWELL) Study (2015-2017; n = 432). Linear regression was used to examine adiposity measures (body mass index [BMI], percent body fat, and waist-to-hip ratio), measured during a physical examination, in relation to self-reported measures of racial microaggressions, racism-related vigilance, and interpersonal racial discrimination. RESULTS: Compared with infrequent microaggressions, very frequent experiences of microaggressions were associated with 2.9 kg/m2 higher BMI (95% confidence [CI], 0.63-5.21) and 2.6% higher body fat (95% CI, 0.32-4.80) after adjusting for covariates. Racism-related vigilance, measured continuously, was positively associated with BMI (b = 0.84; 95% CI-0.08, 1.61) and percent body fat (b = 0.89; 95% CI, 0.14-1.64). Very frequent experiences of everyday discrimination were associated with a higher BMI (b = 2.70; 95% CI, 0.58-4.83) and waist-to-hip ratio (b = 0.32; 95% CI, 0.09-0.55) compared with less frequent everyday discrimination. CONCLUSIONS: Our results suggest that various dimensions of racism are associated with excess adiposity. Efforts to address obesity among Black women with systemic lupus erythematosus should consider these multiple aspects to decrease racial inequities in adiposity.

Mental health disorders among Middle Eastern immigrant women living in the United States: A scoping review.

PURPOSE: This review aims to describe the up-to-date knowledge of the prevalence of mental health disorders among Middle Eastern immigrants women living in the United States (U.S.) and the factors affecting mental health status. CONCLUSION: High prevalence of mental health disorders and low utilization of mental health services among Middle Eastern immigrants were reported. The factors affecting mental health disorders included socio-demographics, immigration-related factors, and previous mental and physical health problems. PRACTICE IMPLICATIONS: Further research is needed to understand the factors affecting mental health disorders and attitudes associated with the utilization of mental health services among Middle Eastern women in the U.S.

Sexual Orientation and Obesity: What Do We Know?

PURPOSE OF REVIEW: This review describes research addressing sexual orientation disparities in obesity and their sequelae, with a focus on new findings from the past year and areas for future work. RECENT FINDINGS: Sexual minority people of color experience important health disparities related to obesity. Sexual minority women may be at greater risk of developing type 2 diabetes than their heterosexual counterparts, potentially because of obesity-related disparities. Bisexual men also appear to experience more obesity and potential greater risk for type 2 diabetes than heterosexual men. Stigma and discrimination are important emerging areas for additional research to better understand sexual orientation disparities in obesity-related health. There is a need for intersectional research and longitudinal research that connects existing sexual orientation disparities in obesity with subsequent chronic disease development. Additionally, upstream efforts to understand the impact of stigma and discrimination on the weight-related health of sexual minority groups are needed.

Differences in Rape Acknowledgment and Mental Health Outcomes Across Transgender, Nonbinary, and Cisgender Bisexual Youth.

The purpose of this study was to document the rates of rape acknowledgment (labeling rape as rape rather than using a minimizing label) and the corresponding mental health correlates using the minority stress framework in a unique and vulnerable sample: racially diverse sexual and gender minority young adults. Participants were 245 young adults who identified their sexual orientation as under the bisexual umbrella. A total of 159 of these participants (65.2%) identified their gender identity as nonbinary. All participants completed a series of online questionnaires regarding their sexual victimization history, mental health outcomes (depression, anxiety, and posttraumatic stress disorder [PTSD]), and constructs relevant to minority stress theory (level of outness, internalized bisexual negativity, connection to LGBTQ [lesbian, gay, bisexual, transgender, questioning] community). Rape acknowledgment was significantly greater among gender nonbinary participants (79.9%) than among trans and cisgender male participants (17.9%). Lack of rape acknowledgment was associated with increased anxiety, depression, and PTSD. Outness was significantly associated with greater rape acknowledgment. Despite the highly increased vulnerability for sexual violence among sexual and gender minorities, very little is understood about the mechanisms of this increased vulnerability or their unique needs for recovery. The results of this study strongly suggest the importance of a minority stress framework for understanding this increased vulnerability and for designing sexual violence prevention and recovery interventions for sexual and gender minority populations.