Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations.

This article provides an overview of the current literature on seven cancer sites that may disproportionately affect lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. For each cancer site, the authors present and discuss the descriptive statistics, primary prevention, secondary prevention and preclinical disease, tertiary prevention and late-stage disease, and clinical implications. Finally, an overview of psychosocial factors related to cancer survivorship is offered as well as strategies for improving access to care.

Links between sexuality, impulsivity, compulsivity, and addiction in a large sample of university students.

OBJECTIVE: Non-heterosexual populations experience poorer mental health outcomes than their heterosexual counterparts. Few studies, however, have examined how mental health varies across the continuum of sexual orientation. Nor has any study examined possible links between sexual orientation and traits of impulsivity and compulsivity, which contribute to functional impairment across a broad spectrum of psychiatric disorders. To address these limitations, the present study sought to identify addictive and impulsive/compulsive problems associated with sexuality in a university sample. METHODS: A 156-item anonymous survey was distributed via email to 9449 students at a public university in the United States. Sexual orientation was assessed using the Klein Sexual Orientation Grid, a modification of the Kinsey scale. Current use of alcohol and drugs, mental health status, and academic performance were also assessed, along with valid trait measures of impulsivity and compulsivity. RESULTS: Same-sex attractions were significantly correlated with a range of mental health problems and substance use. Additionally, same-sex attraction was significantly correlated with certain behavioral addictions (compulsive sexual behavior and binge eating disorder) as well as impulsive/compulsive traits. There was no relationship between academic performance and sexual attraction. CONCLUSION: Same-sex sexuality is associated with impulsive/compulsive behavior and addiction. These health disparities may be related to stable individual differences in self-control.

Same-Sex Couples' Shared Time in the United States.

This study examines and compares shared time for same-sex and different-sex coresident couples using large, nationally representative data from the 2003-2016 American Time Use Survey (ATUS). We compare the total time that same-sex couples and different-sex couples spend together; for parents, the time they spend together with children; and for both parents and nonparents, the time they spend together with no one else present and the time they spend with others (excluding children). After we control for demographic and socioeconomic characteristics of the couples, women in same-sex couples spend more time together, both alone and in total, than individuals in different-sex arrangements and men in same-sex couples, regardless of parenthood status. Women in same-sex relationships also spend a larger percentage of their total available time together than other couples, and the difference in time is not limited to any specific activity.

Mapping out a spectrum of the Chinese public's discrimination toward the LGBT community: results from a national survey.

BACKGROUND: China has the world's largest lesbian, gay, bisexual, and transgender (LGBT) population. This study assessed the discrimination experienced by LGBT individuals in China in a comprehensive way, covering discrimination perpetrated by family, media, medical services, religious communities, schools, social services, and in the workplace. METHODS: The current study involved a national survey of 31 provinces and autonomous regions. Discrimination was measured both in terms of heterosexual participants' attitudes towards LGBT individuals, and LGBT participants' self-perceived discrimination. Pearson correlation analysis was performed to examine the difference between heterosexual participants' attitudes towards LGBT individuals and LGBT participants' self-perceived discrimination. Linear regression was used to investigate the association between gross domestic product per capita and discrimination. RESULTS: Among 29,125 participants, 2066 (7.1%) identified as lesbian, 9491 (32.6%) as gay, 3441 (11.8%) as bisexual, 3195 (11.0%) as transgender, and 10,932 (37.5%) as heterosexual. Heterosexual people were generally friendly towards the LGBT community with a mean score of 21.9 (SD = 2.7, total scale score = 100) and the grand averaged score of self-perceived discrimination by LGBT participants was 49.9 (SD = 2.5). Self-perceived discrimination from family and social services is particularly severe. We created a series of provincial level choropleth maps showing heterosexual participants' acceptance towards the LGBT community, and self-perceived discrimination reported by members of the LGBT community. We found that a higher level of economic development in provinces was associated with a decrease in discrimination, and we identified that every 100 thousand RMB increase in per capita GDP lead to a 6.4% decrease in discriminatory events perpetrated by heterosexuals. CONCLUSIONS: Chinese LGBT groups consistently experience discrimination in various aspects of their daily lives. The prevalence of this discrimination is associated with the economic development of the province in which it occurs. In order to reduce discrimination, it is important for future studies to discover the underlying reasons for discrimination against LGBT individuals in China.

Late Presentation and Missed Opportunities for HIV Diagnosis in Guatemala.

Early HIV diagnosis remains a challenge in many regions with delayed diagnosis resulting in increased morbidity and mortality. We conducted a retrospective cohort study of people living with HIV receiving outpatient care at a large tertiary referral center in Guatemala to describe the proportion of late presenters (LP) and missed opportunities for HIV diagnosis. Of 3686 patients, 2990 (81.1%) were LP who were more likely to be male (60.2% vs. 48.0%, p < 0.0001), heterosexual (88.0% vs. 78.0%, p < 0.0001) and rural dwellers (43.7% vs. 33.8%. p < 0.0001). The proportions of patients who presented late or with AIDS at diagnosis decreased over time. Only 665 patients (18.2%) sought care in the 2 years prior to HIV diagnosis. This study, the first of its kind in Central America to focus on late presenters and missed opportunities for HIV diagnosis, demonstrates extremely high rates of LP in Guatemala. Although in recent years rates of LP have improved somewhat, the need for screening outside of traditional healthcare settings is apparent.

Victimization Disparities Between Heterosexual and Sexual Minority Youth From Ages 9 to 15.

Mental health disparities between heterosexual and sexual minority youth are partly explained by the higher rates of victimization experienced by sexual minority youth. The onset and progression of these victimization disparities, however, are poorly understood. Using multirater longitudinal data, trajectories of victimization starting at age 9 were compared among youth who did and did not report same-sex attraction at age 15 (N = 310). Self and teacher, but not primary caregivers, reported victimization was significantly higher among sexual minority youth starting at age 9, but did not vary across time. The findings underscore the importance of understanding homophobic experiences of sexual minority youth during late childhood and early adolescence in order to inform prevention programs.

Messaging Lesbian, Gay, Bisexual, and Transgender Health Inequities: A Qualitative Exploration.

BACKGROUND: There are substantial health inequities for lesbian, gay, bisexual, and transgender (LGBT) people compared to their straight/cisgendered counterparts. As evidence of these inequities has become unequivocal, better strategies to address them are needed. One approach is to leverage communications and media advocacy efforts to raise awareness about inequities. However, some research suggests that highlighting health inequities can have negative consequences. This study aimed to explore how LGBT leaders view communication about health inequities. METHOD: We used an inductive qualitative approach and conducted 12 semistructured phone interviews with LGBT community leaders in North Carolina between September and October 2017. RESULTS: Four themes emerged in the data. There was support for reporting health differences between LGBT and straight/cisgendered people to raise awareness of health issues facing LGBT communities. However, participants were concerned about the stigmatizing effects of messages and worried about their effectiveness. CONCLUSION: Emphasizing health differences between LGBT and straight people can be problematic; our findings suggest that health educators (1) must be cautious, (2) must be aware of the audience, and (3) should consider focusing messages on finding a solution to the identified problem. Future work should explore how to best craft messages that address health inequities for LGBT communities.

Bias From Potentially Mischievous Responders on Large-Scale Estimates of Lesbian, Gay, Bisexual, or Questioning (LGBQ)-Heterosexual Youth Health Disparities.

OBJECTIVES: To determine how sensitive estimates of lesbian, gay, bisexual, or questioning (LGBQ)-heterosexual youth health disparities are to the presence of potentially mischievous responders. METHODS: We used US data from the 2015 Youth Risk Behavior Survey, pooled across jurisdictions that included a question about sexual identity for a total sample of 148 960 students. We used boosted regressions (a machine-learning technique) to identify unusual patterns of responses to 7 screener items presumably unrelated to LGBQ identification, which generated an index of suspected mischievousness. We estimated LGBQ-heterosexual youth disparities on 20 health outcomes; then we removed 1% of suspected mischievous responders at a time and re-estimated disparities to assess the robustness of original estimates. RESULTS: Accounting for suspected mischievousness reduced estimates of the average LGBQ-heterosexual youth health disparity by up to 46% for boys and 23% for girls; however, screening did not affect all outcomes equally. Drug- and alcohol-related disparities were most affected, particularly among boys, but bullying and suicidal ideation were unaffected. CONCLUSIONS: Including screener items in public health data sets and performing rigorous sensitivity analyses can support the validity of youth health estimates.

An Exploration of the Relations Between Self-Reported Gender Identity and Sexual Orientation in an Online Sample of Cisgender Individuals.

The present study explored the relations between self-reported aspects of gender identity and sexual orientation in an online sample of 4756 cisgender English-speaking participants (1129 men) using the Multi-Gender Identity Questionnaire and a sexual orientation questionnaire. Participants also labeled their sexual orientation. We found a wide range of gender experiences in the sample, with 38% of the participants feeling also as the "other" gender, 39% wishing they were the "other" gender, and 35% wishing they had the body of the "other" sex. Variability in these measures was very weakly related to sexual orientation, and these relations were gender-specific, being mostly U shaped (or inverted-U shaped) in men and mostly linear asymptotic in women. Thus, in women, feeling-as-a-woman was highest in the exclusively heterosexual group, somewhat lower in the mostly heterosexual group, and lowest in the bisexual, mostly homosexual, and exclusively homosexual groups, which did not differ, and the reverse was true for feeling-as-a-man (i.e., lowest in the exclusively heterosexual group and highest in the bisexual, mostly homosexual, and exclusively homosexual groups). In men, feeling-as-a-man was highest at both ends of the sexual orientation continuum and lowest at its center, and the reverse was true for feeling-as-a-woman. Similar relations were evident also for the other aspects of gender identity. This study adds to a growing body of literature that questions dichotomous conventions within the science of gender and sexuality. Moreover, our results undermine the tight link assumed to exist between sexual and gender identities, and instead posit them as weakly correlated constructs.

Heterosexual College Students Who Hookup with Same-Sex Partners.

Individuals who identify as heterosexual but engage in same-sex sexual behavior fascinate both researchers and the media. We analyzed the Online College Social Life Survey dataset of over 24,000 undergraduate students to examine students whose last hookup was with a same-sex partner (N = 383 men and 312 women). The characteristics of a significant minority of these students (12% of men and 25% of women) who labelled their sexual orientation "heterosexual" differed from those who self-identified as "homosexual," "bisexual," or "uncertain." Differences among those who identified as heterosexual included more conservative attitudes, less prior homosexual and more prior heterosexual sexual experience, features of the hookups, and sentiments about the encounter after the fact. Latent class analysis revealed six distinctive "types" of heterosexually identified students whose last hookup was with a same-sex partner. Three types, comprising 60% of students, could be classified as mostly private sexual experimentation among those with little prior same-sex experience, including some who did not enjoy the encounter; the other two types in this group enjoyed the encounter, but differed on drunkenness and desire for a future relationship with their partner. Roughly, 12% could be classified as conforming to a "performative bisexuality" script of women publicly engaging in same-sex hookups at college parties, and the remaining 28% had strong religious practices and/or beliefs that may preclude a non-heterosexual identity, including 7% who exhibited "internalized heterosexism." Results indicate several distinctive motivations for a heterosexual identity among those who hooked up with same-sex partners; previous research focusing on selective "types" excludes many exhibiting this discordance.

Same-Sex Married Tax Filers After Windsor and Obergefell.

This article provides new estimates of the number and characteristics of same-sex married couples after U.S. Supreme Court rulings in 2013 and 2015 established rights to same-sex marriage. The U.S. Department of the Treasury and the Internal Revenue Service subsequently ruled that same-sex spouses would be treated as married for federal tax purposes. Because almost all married taxpayers file joint tax returns, administrative tax records provide new information on the demographic characteristics of married same-sex couples. This study provides estimates of the population of same-sex tax filers drawn from returns filed in 2013, 2014, and 2015, using methods developed by the U.S. Census Bureau to address measurement error in gender classification. We estimate that approximately 0.48 % of all joint filers in 2015 were same-sex couples, or approximately 250,450 couples.

School Progress Among Children of Same-Sex Couples.

This study uses logit regressions on a pooled sample of children from the 2012, 2013, and 2014 American Community Survey to perform a nationally representative analysis of school progress for a large sample of 4,430 children who reside with same-sex couples. Odds ratios from regressions that compare children between different-sex married couples and same-sex couples fail to show significant differences in normal school progress between households across a variety of sample compositions. Likewise, marginal effects from regressions that compare children with similar family dynamics between different-sex married couples and same-sex couples fail to predict significantly higher probabilities of grade retention for children of same-sex couples. Significantly lower grade retention rates are sometimes predicted for children of same-sex couples than for different-sex married couples, but these differences are sensitive to sample exclusions and do not indicate causal benefits to same-sex parenting.

Victimisation and life satisfaction of gay and bisexual individuals in 44 European countries: the moderating role of country-level and person-level attitudes towards homosexuality.

We examined the link between victimisation and life satisfaction for 85,301 gay and bisexual individuals across 44 European countries. We expected this negative link to be stronger when the internalised homonegativity of the victim was high (e.g. because the victim is more vulnerable) and weaker when victimisation occurs in countries that express intolerance towards homosexuality (e.g. because in such contexts victims expect victimisation more and they attribute it to their external environment). Additionally, we expected internalised homonegativity to relate negatively to life satisfaction. Multilevel analyses revealed that victimisation (i.e. verbal insults, threats of violence, minor or major physical assaults) and internalised homonegativity were negatively related to life satisfaction. Furthermore, as we expected, the negative link between victimisation and life satisfaction was stronger when high internalised homonegativity was reported (and the interaction effect occurred for verbal insults and major assaults as outcome variables), while it was weaker when there was low national tolerance of homosexuality (and the interaction effect occurred for verbal insults and for minor assaults). Future research and social policy should consider how the consequences of victimisation are dependent on personal as well as national attitudes towards homosexuality.

Love and Dating Patterns for Same- and Both-Gender Attracted Adolescents Across Europe.

Sexual orientation is a multidimensional phenomenon, which includes identity, behavior, and attraction. The attraction component, however, is less studied than the other two. In this article, we present the development of a two-item measure to identify adolescents who prefer same- and both-gender partners for love and dating. The questions were administered to nationally representative samples of 15-year-old adolescents in eight European countries and regions participating in the Health Behaviour in School-aged Children (HBSC) cross-national study. The distribution of attraction, as operationalized by preference for the gender of love and dating partners, was similar across countries. These questions offer an alternative or supplementary approach to identify same- and both-gender attracted youth, without administering questions related to sexual identity.

Support for family diversity: a three-country study.

OBJECTIVE: To understand levels of support for differences between families in terms of sexuality and mode of family formation across three countries. BACKGROUND: Previous research has found that attitudes towards family diversity continue to improve over time, although differences remain. METHODS: Subjects were 1605 people living in Australia, the United Kingdom or the United States who completed a questionnaire which sought to explore levels of support for a diverse range of family forms and modes of family formation. RESULTS: Religiosity, political leanings and beliefs about the importance of genetic relatedness were all correlated with level of support. Gender of participant was a predictor of level of support. Cluster analysis indicated three clusters (unsupportive, neutral and supportive) for level of support, for which both sexuality and parent status were predictors. CONCLUSION: Findings highlight the normative status of reproductive heterosex, and demonstrate the considerable value accorded to genetic relatedness.

Acceptance of homosexuality through education? Investigating the role of education, family background and individual characteristics in the United Kingdom.

Higher educated people tend to be more accepting of homosexuality than lower educated people. This has inspired claims that education leads to a higher acceptance of homosexuality. Alternatively, the association between education and acceptance of homosexuality could be confounded by (un)observed family background and stable individual characteristics. This study investigated the association between education and acceptance of homosexuality and the role of potential confounders in a unique longitudinal sample of British siblings. Multilevel and fixed effects analyses show that both perspectives apply. A large part of the association between education and acceptance of homosexuality could be attributed to family background and observed individual characteristics (one third), as well as unobserved individual characteristics (an additional third), but the positive association remains. Findings are discussed in light of existing explanations regarding the effect of education on the acceptance of homosexuality.

Same-sex-attracted adolescents in rural Australia: stressors, depression and suicidality, and barriers to seeking mental health support.

INTRODUCTION: To address the lack of Australian data examining mental health in same-sex attracted rural adolescents compared with their rural heterosexual peers, this study examined experiences of stressors, symptoms of depression and suicidality, and perceptions of barriers to seeking mental health support, comparing same-sex attracted adolescents with heterosexual adolescents living in rural Australia. METHODS: Respondents were recruited through high schools in rural South Australia and completed a questionnaire that included demographic questions, the Kutcher Adolescent Depression Scale (KADS-6) and measures of stressors and perceptions of barriers to seeking mental health support. Participants were 531 adolescents (55% female, 43% male), aged 13 to 18, 31 of whom identified as same-sex attracted. RESULTS: Same-sex attracted adolescents reported significantly more depression symptoms (mean=6.1, standard deviation (SD)=3.9) compared to other adolescents (mean=2.9, SD=3.2, U=2867, p<0.001, r=0 .16). More adolescents who were same-sex attracted screened positive for depression (54.8% vs 15.9%) and there was a significant difference in responses to the item assessing suicidality between same-sex attracted and other adolescents (mean=1.1, SD=1.1; mean=0.3, SD=0.7, χ2 (1, N=531)=27.10, p<0.001, phi=0.24). Same-sex attracted adolescents reported more experiences of stressors relating to relationships, bullying and physical assault than heterosexual adolescents but, contrary to expectations, did not report perceiving more barriers to seeking mental health support (total barriers: same-sex attracted adolescents mean=2.5 (1.8), other adolescents mean=2.5 (1.9), t(527)=0.06, p=0.95, d=0.00). CONCLUSIONS: Adolescents who identified as being same-sex attracted are at much greater risk of depression and suicidality than other adolescents in rural South Australia. The finding that same-sex attracted adolescents experienced a higher number of relationship stressors, bullying and assault underscores the need for more focus on addressing these issues for this group of vulnerable adolescents. While same-sex attracted adolescents did not perceive more barriers to seeking mental health support, greater understanding of same-sex attracted adolescents' access to appropriate services in rural areas is needed to be able to improve mental health functioning in this population. In addition, addressing the wider issues (eg stigma) contributing to the greater number of stressors, including victimisation, faced by same-sex attracted adolescents should be a priority.

Prevalence of Experiences With Consensual Nonmonogamous Relationships: Findings From Two National Samples of Single Americans.

Although academic and popular interest in consensual nonmonogamy (CNM) is increasing, little is known about the prevalence of CNM. Using two separate U.S. Census based quota samples of single adults in the United States (Study 1: n = 3,905; Study 2: n = 4,813), the present studies show that more than one in five (21.9% in Study 1; 21.2% in Study 2) participants report engaging in CNM at some point in their lifetime. This proportion remained constant across age, education level, income, religion, region, political affiliation, and race, but varied with gender and sexual orientation. Specifically, men (compared to women) and people who identify as gay, lesbian, or bisexual (compared to those who identify as heterosexual) were more likely to report previous engagement in CNM. These findings suggest that a sizable and diverse proportion of U.S. adults have experienced CNM, highlighting the need to incorporate CNM into theoretical and empirical therapy and family science work.

Category Specificity of Self-Reported Sexual Attraction and Viewing Times to Male and Female Models in a Large U.S. Sample: Sex, Sexual Orientation, and Demographic Effects.

Recent research has documented large and robust sex differences in the category specificity of self-reported sexual attraction and viewing times to men and women, with men showing more polarized responses to the two sexes than women. However, this research has been limited by the use of small and restricted samples. To address this, the current study assessed a representative sample of more than 2800 U.S. adults on demographic and attitudinal variables and on two measures of category specificity: one based on self-reported sexual attraction and the other based on viewing times to male and female swimsuit models. Key findings were replicated. On average, men were considerably more category specific in self-reported sexual attraction and viewing times than women, and this was true for both heterosexual and homosexual participants. Self-identified bisexual and asexual participants tended to be lower on category specificity than other groups. Although demographic and attitudinal factors such as age, ethnicity, state and region of residence, social class, political liberalism-conservatism, and religiousness were sometimes weakly related to category specificity, sex differences in category specificity remained robust despite demographic and attitudinal variation.

Pubertal Stress and Nutrition and their Association with Sexual Orientation and Height in the Add Health Data.

A number of studies have indicated that gay men tend to be shorter, on average, than heterosexual men. Less evidence exists that lesbian women are taller, on average, than heterosexual women. The most popular explanation of the association between sexual orientation and height involves prenatal factors, such that, for example, gay men may have been exposed to lower than typical androgens during fetal development, which impacts their height and sexual orientation as adults. An alternative explanation involves stress, given that stress has been associated with sexual minority identification and with lower height. Another alternative explanation involves nutrition, although its relationship is less clear with sexual minority identification. Using the Add Health data, which is a large, nationally representative and longitudinal sample of American adolescents (n = 14,786), we tested a mediation model, such that sexual orientation → pubertal stress/nutrition → height. Within men, we found that gay men (n = 126) were shorter, on average, than heterosexual men (n = 6412). None of the 24 pubertal stress-related and 15 pubertal nutrition-related variables assessed in the Add Health data mediated the relationship between sexual orientation and height in men. Within women, lesbians (n = 75) did not differ significantly in stature compared to heterosexual women (n = 6267). Thus, prenatal mechanisms (e.g., hormones, maternal immune response) are likely better candidates for explaining the height difference between gay men and heterosexual men.