Trajectories of procrastination among Swedish University students over one academic year: a cohort study.

BACKGROUND: Procrastination is common among university students and associated with adverse outcomes such as physical and mental health problems. According to the Temporal motivation theory procrastination may vary over time depending on the temporal proximity to goals and deadlines. AIMS: To determine if mean procrastination levels among university students varies over an academic year, and if trajectories of procrastination are moderated by gender identity, perfectionistic strivings, and/or perfectionistic concerns. SAMPLE: Swedish university students (n = 1410). METHODS: The cohort was followed with web-surveys at four time-points over one academic year (Late semester, Mid semester, After semester, and Early semester). Generalized Estimating Equations were used to estimate mean levels of self-rated procrastination at the different time-points. RESULTS: We found only small fluctuations in mean procrastination levels over the academic year. Participants with high perfectionistic concerns demonstrated higher mean procrastination levels at all time-points, but neither gender identity, perfectionistic concerns nor perfectionistic strivings affected the slope of the mean procrastination trajectories. CONCLUSIONS: In this cohort of Swedish university students, self-rated procrastination levels were stable over the academic year. Perfectionistic concerns, but not gender identity or perfectionistic strivings, was associated with higher levels of procrastination.

Conversion practice recall and mental health symptoms in sexual and gender minority adults in the USA: a cross-sectional study.

BACKGROUND: Conversion practices are associated with psychological morbidity, yet few studies have evaluated differences between efforts to change gender identity, sexual orientation, or both. We aimed to examine the individual and joint association of conversion practice recall targeted at gender identity or sexual orientation, or both, with current mental health symptoms among sexual and gender minority people. METHODS: This cross-sectional study used data from The PRIDE Study, a US-based, online, prospective cohort study of sexual and gender minority adults who were recruited through social media, digital advertisements, and sexual and gender minority community-based events and organisations. For this analysis, we included participants who completed a lifetime questionnaire in 2019-20 and a subsequent annual questionnaire in 2020-21 without missing outcome data. All questionnaires were in English. The exposure was lifetime recall of conversion practice targeting gender identity alone, sexual orientation alone, or both (versus no conversion practice). Mental health outcomes were continuous measures: Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire 9-item (depression) scale, Post-Traumatic Stress Disorder Checklist 6-item scale, and Suicide Behaviors Questionnaire-Revised scale. We used linear regression to analyse the associations of conversion practice recall and mental health symptoms, controlling for demographic and childhood factors and stratified between cisgender and transgender and gender diverse groups. Sensitivity analyses evaluated the potential impact of unmeasured confounding. Analyses were conducted in R. We included people with related lived experience in the design and implementation of this study. FINDINGS: Of 6601 participants who completed the lifetime questionnaire in 2019-20, 4440 completed the subsequent annual questionnaire in 2020 or 2021, and 4426 did not have missing outcome data. Of the 4426 included participants, 4073 (92·0%) identified as White (either alone or in combination with other ethnoracial options), 460 (10·4%) identified with multiple ethnoracial identities, and 1923 (43·4%) were transgender and gender diverse. Participants' age ranged from 18 years to 84 years (median 31·7 years, IQR 25·5-44·1). 149 (3·4%) participants reported sexual orientation-related conversion practice alone, 43 (1·0%) reported gender identity-related conversion practice alone, and 42 (1·0%) reported both. Recalling both forms of conversion practice was most strongly associated with greater post-traumatic stress disorder (PTSD; ß 2·84, 95% CI 0·94-4·74) and suicidality (2·14, 0·95-3·32) symptoms. Recall of only sexual orientation-related conversion practice was associated with greater symptoms of PTSD (1·10, 0·22-1·98). Recall of gender identity-related conversion practice alone was most strongly associated with greater depressive symptoms (3·24, 1·03-5·46). Only associations for suicidality differed between cisgender and transgender and gender diverse participants, although the latter showed higher mental health symptoms overall. Findings were moderately robust to potential sources of unmeasured confounding in sensitivity analysis. INTERPRETATION: Recall of conversion practice exposure was associated with a range of mental health symptoms among sexual and gender minority people. These findings support calls to ban conversion practices because of their effects as a structural determinant of mental health. FUNDING: Gill Foundation, Dona Rockstad, and Patient-Centered Outcomes Research Institute.

Gender identity in Klinefelter Syndrome: a patient-centered approach to treatment.

INTRODUCTION: There is increasing evidence that gender dysphoria (GD) is more prevalent in the Klinefelter Syndrome (KS) population than in males in the general population; however, the exact incidence is uncertain. The aim of this study was to further explore the prevalence of gender-related issues, the role that physical characteristics play in gender identity, and the issues surrounding Hormone Replacement Therapy (HRT) in KS. METHODS: As part of a registered Quality Improvement Project (QIP), one online 23-point questionnaire on KS patient attitudes toward gender identity was shared with members of the Klinefelter Syndrome Association (KSA). In total, 139 anonymous responses were collected between December 2021 and January 2023. The questionnaire was developed with the guidance of multiple clinicians (including gender psychiatrists, urologists, psychosexual medicine specialists, and endocrinologists) and patient Delphi rounds. Data was reviewed and analyzed by 4 independent researchers within the QIP team. RESULTS: Only 53% of KS patients responding to this survey fully identified as male and 19% stated that they did not enjoy living as the sex on their birth certificate, with 43% considering changing aspects of their physical appearance to better match their gender. Regarding HRT, 67% of respondents were receiving Testosterone Replacement Therapy (TRT). 63% wanted TRT and 17% wanted estrogen, including 6% of TRT users who would prefer estrogen instead. 36% that were currently receiving TRT did not identify as male, and 3 participants stated that they have GD. CONCLUSION: These results indicate that a significant proportion of KS patients do not fully identify with the male gender and are unhappy living as the sex on their birth certificate. Although TRT worked for most, its use should be discussed carefully with those with gender identity concerns.

The interplay of sex/gender and migration: implications for health and healthcare access.

This intervention explores the intricate relationship among sex, gender, migratory status, and health outcomes in migrant populations. It emphasizes the distinction between sex (biological characteristics) and gender (socially constructed roles), highlighting how they intersect throughout the migration journey. The impact of gender dynamics on migration decisions, experiences, and outcomes is examined, with specific attention to sex/gender differences in the health and lifestyles of immigrant populations. Furthermore, it underscores how sex and gender disparities may affect access to healthcare. The importance of sex- and gender-inclusive healthcare services and cultural sensitivity in addressing these disparities is emphasized. Additionally, the intervention calls for research that considers diverse gender identities and country-specific factors. Ultimately, it asserts the need for sex- and gender-sensitive policies, collaborative efforts, and tailored interventions to promote health equity, gender equality, and human rights in migrant populations, aligning with global policy goals.

"It's been a Process": A Multiple Case Study of Biology Instructor Efforts to Reform their Sex and Gender Curriculum to be More Inclusive of Students with Queer Genders and Intersex Students.

Inaccurate sex and gender narratives have saturated the political landscape, resulting in legal restrictions for people with queer genders. Biology educators can correct these false narratives by teaching scientifically accurate and queer gender and intersex inclusive sex and gender curriculum. Here, we interviewed four undergraduate biology instructors who were working to reform their sex and gender curriculum. Using their reformed curriculum to promote conversation in the interviews, we asked participants about their curriculum, their reform process, and the obstacles they faced in implementing their reformed curriculum. We noticed the instructors' journeys to reforming involved intense personal work and education, both at the beginning and iteratively throughout implementation. We found instructors focused on changing language and using a variety of inclusive activities in their undergraduate biology classroom, ranging from highlighting scientists with queer genders to assigning students to research the experiences of people with queer genders with adolescent hormone therapy. Instructors mentioned obstacles to implementing reformed curriculum, including fear of potentially isolating students and concern about the instructor's own positionality. Removing obstacles and supporting the process of unlearning exclusive ways of teaching sex and gender topics may bolster instructor efforts to provide more accurate and inclusive biology education.

Group differences in gender expression discrimination and depressive and anxiety symptoms among transgender and gender-expansive adults: The role of gender identity pride.

Despite established associations between discrimination and mental health, little research has focused on gender expression discrimination and integrated individual strengths such as transgender and gender-expansive (TGE) identity pride. This study examined the roles of gender expression discrimination and pride in mental health among TGE adults across gender identity, race, and class. A national sample of TGE adults (N = 212) completed online measures assessing gender identity, race, income, gender expression-related discrimination, TGE identity pride, and depression and anxiety symptoms. Gender expression discrimination was positively associated with depressive and anxiety symptoms. Black, Indigenous, People of Color (BIPOC), higher income, transfeminine participants reported more gender expression discrimination. High TGE identity pride buffered the association between gender expression discrimination and depression-most robustly for BIPOC, lower income, transfeminine participants. TGE identity pride may buffer the effects of gender expression discrimination on depression. Intersectionality in case formulation and treatment planning with TGE individuals is vital.

Gender socialization and adolescent pregnancies in Togo.

The aim of this article is to understand the significance of the gender socialisation of adolescents and its impact on sexuality. This socio-anthropological study is based on qualitative surveys conducted as part of two action-research programmes implemented between 2018 and 2022 in Togo. The empirical data comes from individual semi-directed interviews, group interviews and life stories relating to the themes of sexuality, early pregnancy and gender-based violence. The results show that in these patriarchal societies, the socialisation of adolescents is structured around gender relations. The social construction of masculinity is based on a position of decision-making power for young boys, while that of femininity inculcates submissive behaviour in young girls. In these contexts, many young girls, even if they do attend school, find it difficult to express their opinions on matters of love and sex.

L'objectif de cet article consiste à appréhender la prégnance de la socialisation des adolescents.es et son impact sur la sexualité. Cette étude socio-anthropologique s'appuie sur des enquêtes qualitatives conduites dans le cadre de deux programmes de recherche action mis en œuvre entre 2018 à 2022 au Togo. Les données empiriques sont issues d'entretiens individuels semi-directifs, d'entretiens de groupes et de récits de vie relatifs aux thèmes de la sexualité, des grossesses précoces et des violences basées sur le genre. Les résultats indiquent que dans ces sociétés patriarcales, la socialisation des adolescents.es est structurée sur des rapports de genre. La construction sociale de la masculinité s'établit sur une position de pouvoir de décision des jeunes garçons tandis que celle de la féminité inculque aux jeunes filles des conduites de soumission. Dans ces contextes, de nombreuses jeunes filles, bien que scolarisées éprouvent des difficultés à exprimer leurs avis sur les questions amoureuses et sexuelles.

Affirming Everyone in the Rainbow: Is Gender-Affirming Healthcare "Gay Conversion Therapy?"

Many young people today embrace gender-diverse identities, with adolescents and young adults comprising the largest and fastest-growing demographic of gender-affirming healthcare seekers. Simultaneously, gender-affirming healthcare for this demographic has been debated, and restrictions have been introduced in many jurisdictions. Within this politically charged climate, some journalists, cultural commentators, gender clinicians and politicians have leveraged rhetorical claims that gender-affirming healthcare comprises a new form of "gay conversion therapy." In this commentary, we explore the extent to which empirical evidence supports or contradicts this discourse as a real phenomenon. While we conclude that gender-affirming healthcare is not gay conversion therapy, we also draw attention to opportunities to enrich gender-affirming healthcare by embracing the complexity of sexuality and gender.

Inequities in Self-Reported Social Risk Factors by Sexual Orientation and Gender Identity.

Importance: Sexual minority (ie, people who self-identify as gay, lesbian, bisexual, and other nonheterosexual identities) and gender minority (ie, people who self-identify as transgender, nonbinary, or other noncisgender identities) adults report worse health outcomes compared with heterosexual and cisgender adults, respectively. Although social risk factors (SRFs; eg, housing instability) are associated with health outcomes, little is known about the prevalence of SRFs among sexual and gender minority adults. Objective: To examine differences in the prevalence of SRFs by sexual orientation and gender identity among adults. Design, Setting, and Participants: This cross-sectional study used Behavioral Risk Factor Surveillance System data collected from January 2022 to February 2023 for adults aged 18 years or older residing in 22 US states. Exposure: Self-reported sexual orientation and gender identity. Main Outcomes and Measures: Outcome measures were dissatisfaction with life, lack of emotional support, social isolation, employment loss in the past 12 months, Supplementary Nutrition Assistance Program participation in the past 12 months, insufficient food, inability to pay bills, inability to pay utilities, lack of transportation, and stress. Survey weights were applied. Multivariable linear regression models were used to measure the association between sexual orientation and gender identity for each outcome. Results: The study sample comparing outcomes by sexual orientation included 178 803 individuals: 84 881 men (48.5%; 92.9% heterosexual; 7.1% sexual minority) and 93 922 women (51.5%; 89.4% heterosexual; 10.6% sexual minority). The study sample comparing outcomes by gender identity included 182 690 adults (99.2% cisgender; 0.8% gender minority). Of sexual minority women, 58.1% reported at least 1 SRF compared with 36.5% of heterosexual women. Sexual minority women were significantly more likely to report social isolation (difference, 7.4 percentage points [PP]; 95% CI, 4.9-10.0 PP) and stress (difference, 12.2 PP; 95% CI, 9.8-14.7 PP) compared with heterosexual women. A greater proportion of sexual minority men (51.1%) reported at least 1 SRF than heterosexual men (34.0%); the largest magnitudes of inequity were in dissatisfaction with life (difference, 7.9 PP; 95% CI, 5.8-10.1 PP) and stress (difference, 6.7 PP; 95% CI, 4.5-8.9 PP). Of gender minority adults, 64.1% reported at least 1 SRF compared with cisgender adults (37.1%). Gender minority adults were significantly more likely to report social isolation (difference, 14.8 PP; 95% CI, 9.9-19.7 PP) and stress (difference, 17.0 PP; 95% CI, 11.9-22.1 PP). Conclusions and Relevance: In this cross-sectional study, sexual and gender minority adults were significantly more likely to report multiple SRFs. These findings suggest that policies and community-based systems to advance socioeconomic equity among sexual and gender minority adults are critical.

Positive masculinity programmes and attitudes towards nonconforming gender identities among young males in urban Democratic Republic of Congo, Nigeria, and Rwanda.

Implementing programmes on sexual and reproductive health and rights (SRHR) in sub-Saharan Africa often involves promoting inclusive sexual identity/orientation. However, whether and how the programmes are changing gender norms in the target populations have not been established. This study was designed to determine whether participation in Positive Masculinity (PM) programmes can change attitudes associated with prevailing gender norms. We explored attitudes towards nonconforming sexual identity/orientation among young males in selected informal settlements in Democratic Republic of the Congo (DRC), Nigeria and Rwanda. The key variables we tested included "country of participation" and other socio-demographics such as "education", "marital status" and "prior residential location" (rural or urban). We found no significant association between participation in PM programmes with attitudes towards nonconforming sexual identities/orientations across our target populations irrespective of educational qualification, marital status, and previous location of residence. By contrast, religious teachings showed up in the qualitative responses as a significant factor influencing young people's resistance to PM programmes' advocating for inclusive sexuality. Additionally, negative masculinity attributes had significant negative association with attitudes towards nonconforming sexual identity, while respondents with violent tendencies showed significant positive attitudes. We conclude that current PM interventions do not significantly contribute to positive attitudes towards inclusive sexuality in DRC, Nigeria, and Rwanda.

La mise en œuvre de programmes sur la santé et les droits sexuels et reproductifs (SDSR) en Afrique subsaharienne implique souvent la promotion d'une identité/orientation sexuelle inclusive. Cependant, il n'a pas été établi si et comment les programmes modifient les normes de genre dans les populations cibles. Cette étude a été conçue pour déterminer si la participation à des programmes de masculinité positive (PM) peut changer les attitudes associées aux normes de genre dominantes. Nous avons exploré les attitudes à l'égard de l'identité/orientation sexuelle non conforme chez les jeunes hommes dans des quartiers informels sélectionnés en République démocratique du Congo (RDC), au Nigeria et au Rwanda. Les variables clés que nous avons testées comprenaient le « pays de participation ¼ et d'autres données sociodémographiques telles que « l'éducation ¼, « l'état civil ¼ et « le lieu de résidence antérieur ¼ (rural ou urbain). Nous n'avons trouvé aucune association significative entre la participation à des programmes de PM et les attitudes à l'égard des identités/orientations sexuelles non conformes au sein de nos populations cibles, indépendamment du diplôme, de l'état civil et du lieu de résidence précédent. En revanche, les enseignements religieux sont apparus dans les réponses qualitatives comme un facteur important influençant la résistance des jeunes aux programmes PM prônant une sexualité inclusive. De plus, les attributs négatifs de la masculinité présentaient une association négative significative avec les attitudes à l'égard d'une identité sexuelle non conforme, tandis que les répondants ayant des tendances violentes montraient des attitudes positives significatives. Nous concluons que les interventions actuelles de PM ne contribuent pas de manière significative à des attitudes positives envers une sexualité inclusive en RDC, au Nigeria et au Rwanda.

Social cure model: testing the link between identity centrality and body appreciation in diverse sexual orientation and gender identity groups.

BACKGROUND: The level of experienced sociocultural pressure to have an idealized body can vary depending on a person's gender identity and sexual orientation. The current study explored whether differences in levels of body appreciation among people with different sexual orientations and gender identities vary because of differing levels of experienced pressure by in-group members and varying levels of experienced hostile behaviors because of their looks or body. Thereby, the study tests the social cure model, according to which high levels of identity centrality are associated with better mental health. METHODS: An online cross-sectional questionnaire study was conducted with 1,587 people (51.3% cisgender women, 39.3% cisgender men, 9.5% non-binary; 52.9% identified as heterosexual, 27.7% identified as bisexual/pansexual, 11.2% identified as gay/lesbian, 8.2% identified as asexual/demi/queer; Mage = 32.9, SD = 12.6) from German-speaking countries. Variables were assessed with German-language versions of the Multidimensional and Multicomponent Measure of Social Identification, Body Appreciation Scale-2, the Perceived Stigmatization Questionnaire, and the Sociocultural Attitudes Towards Appearance Questionnaire-4, revised. A manifest-path model was calculated. RESULTS: Non-binary persons reported lower levels of body appreciation than did cisgender men and sexual minority persons reported lower levels of body appreciation than did heterosexual persons. Furthermore, sexual minority persons experienced more hostile behaviors directed towards them because of their looks or body than did heterosexual persons. Similarly, non-binary persons experienced more hostile behaviors than did men. Non-binary persons were subjected to lower levels of in-group pressure than were men. Gay/lesbian persons and asexual persons were subjected to lower levels of in-group pressure than were heterosexual persons. More hostile behaviors and stronger in-group pressure were related to lower body appreciation. In cisgender women and men indirect links revealed associations between strong identity centrality and low levels of body appreciation through the mediator of high in-group pressure. CONCLUSIONS: Data in sexual minority individuals or non-binary persons supported the social cure model, according to which persons can find support and validation for their looks and body from in-group members. In cisgender women and men, strong identification as a woman or man can be related to stronger in-group pressure and in turn to lower body appreciation.

Sexual and gender identities and alcohol use during the COVID-19 pandemic.

This study examined differences in alcohol use by sexual and gender identities during the COVID-19 pandemic, and assessed whether variation between groups was explained by pandemic-related stressors and minority stress. Data from 2,429 partnered adults in the National Couples' Health and Time Use Study (n = 3,593) collected from September 2020 to April 2021 were used to model drinking patterns (frequency, amount, and drinking to cope) by sexual and gender identities, COVID-19 stress and disruption, microaggressions, and supportive climate. Regression models indicated differences in drinking by gender and sexual identities, even controlling for demographic and socioeconomic factors. Gay, lesbian, and bisexual people had higher odds of drinking to cope with the pandemic than did heterosexual people, and cisgender men had higher odds than did cisgender women. Gay and lesbian people drank more regularly than did heterosexual people, as did cisgender men in relation to cisgender women. Exclusively bisexual people drank significantly more drinks than exclusively heterosexual people, and cisgender men drank significantly more drinks than did cisgender women and those who identified as trans/another gender identity. COVID-19 stress and minority stress were associated with greater alcohol consumption, but they did not account for these differentials. Moving forward, researchers will need to continuously assess these associations, as sources of discrimination and stress will persist beyond the pandemic. Although LGBTQ+ people have disproportionate sources of stress, they varied in how they used alcohol to cope. Potential sources of resilience among sexual and gender diverse individuals should be explored.

Educating gender: The economic and spiritual battles over land and Mapuche children in Araucanía, Chile, 1897-1922.

This article examines the role of gender as an embodied site of political control and resistance within Mapuche-Capuchin relations in the early period of Bavarian Capuchin mission-building in Chile (1897-1922). The study frames agricultural science education as a civilizing method employed in the Capuchin mission schools, targeting Mapuche children. The aim was to educate Mapuche children in Christian and Western gender roles, moral behavior, and rural economic occupations. Amid the overarching conflict over land rights and privatization between Mapuche communities and the Chilean government, the state's support for the Capuchin order's evangelizing mission was perceived as a long-term strategy to appropriate Indigenous lands and assimilate the Mapuche into the rural and urban workforce. The article illustrates how the conflict over embodied gender roles disrupted Mapuche socioeconomic relations.

A Data Portrait of Cisgender, Transgender, and Gender-Nonconforming Populations in the United States: A Research Note.

The transgender population is a critically underresearched population in the United States, owing to rare measures on national and state-level surveys that ask about sex and gender or transgender identification. Consequently, we know relatively less about the sociodemographic, socioeconomic, family, and health lives of gender minorities. In this research note, I use population-level data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System to provide a data portrait of cisgender, transgender, and gender-nonconforming populations on a range of sociodemographic (e.g., sexual identity, race and ethnicity), socioeconomic (e.g., education, homeownership), family (e.g., union status), and health (e.g., number of poor mental health days) characteristics. Results reveal that gender minorities are younger than cisgender men and cisgender women and are disproportionately sexual minorities and people of color. Gender minority groups also experience lower socioeconomic status, report drastically different family lives, and bear the burden of worse health compared with cisgender people. I conclude by contending that descriptive research of this nature can illuminate compositional differences between cisgender and gender minority populations, provide rationales for adjusting for certain characteristics, and highlight potential explanatory mechanisms to make better sense of well-established findings (e.g., the transgender health disadvantage).

Supporting parents and caregivers: mapping and scoping review of experiences in Europe and central Asia

This report provides an overview of parenting support programmes in Europe and central Asia, based on a mapping and scoping review of parenting programmes that was conducted in 2023. The report provides an analysis of the scale, scope and target groups of parenting support interventions, the trends and features of parenting approaches, and a selection of case studies highlighting parenting programmes with a strong evidence base and emerging programmes that offer unique or specialized approaches.