Adult stakeholders' perspectives on supporting or undermining the mental health of sexual and gender minoritised adolescents.

OBJECTIVES: To explore adult stakeholders' perspectives on what supports or undermines the mental health of sexual and gender minoritised adolescents (SGMA) in everyday life in order to better understand how to foster supportive psychosocial environments for SGMA. DESIGN: Descriptive qualitative study design, using framework analysis. METHODS: Semi-structured interviews were conducted remotely with 16 UK-based adult stakeholders which included parents of SGMA, health and social care professionals, community-based professionals, and professionals who commission services related to adolescent health and well-being. RESULTS: Nine themes were identified that represented barriers and enablers of fostering psychosocial environments that are supportive of SGMA mental health. Example barrier themes include SGMA 'facing chronic and acute safety threats and stress', 'psychological responses to social connection losses and navigating alienation', 'digital exposure and online risk and vulnerability' and 'conflicting messages, resulting divisions and adult distancing'. Example enablers include 'exploring, owning, and changing (personal) identities', 'advocating alongside adolescents whilst containing oneself as the adult in the situation' and 'personally fostering adolescents' psychological safety and inclusion'. CONCLUSIONS: Adult stakeholders report that SGMA are often exposed to environments hostile to key aspects of their identity which then by extension undermines their mental health. These experiences can threaten their sense of safety and evolving identity. Practitioners in particular should be aware of the stressors relating to SGMA identity and minoritisation experiences in order to develop the psychological safety and sense of inclusion needed for SGMA to trust in the relationship and the support offered.

Understanding risk of chronic pain development and related mental health disparities among transgender people: A review of current literature and future directions.

Biomedical and clinical research has traditionally focused on binary sex assignments as opposed to gender identity. This oversight has resulted in other gender minority populations being understudied. As a result, there is limited literature on chronic pain and mental health in transgender populations. These socially vulnerable individuals may be at increased risk for chronic pain development and related mental health disorders. Transgender individuals experience higher rates of social stigma and discrimination than their cisgender counterparts, and these factors have been linked to an increased prevalence of chronic pain, depression, and stress. Beyond chronic pain and mental health research, large overall health disparities and differences exist for transgender people compared to their cisgender peers. Therefore, it is crucial to include transgender individuals, as well as other gender minority people, in research in order to fully understand the impact of gender minority status on pain and quality of life. PERSPECTIVE: This review explores the intersectional impact of stress and mental health on chronic pain development and the unequal risk for transgender individuals. Promoting inclusion of gender minority individuals in research is a critical step to understanding the factors contributing to minority stress.

Oppression-Based Stress and Alcohol Inequities Among Sexual and Gender Minority People: An Intersectional Multilevel Framework.

PURPOSE: Sexual and gender minority (SGM) people are at heightened risk for alcohol use, hazardous drinking, and alcohol use disorder compared to heterosexual and cisgender individuals. This paper: (a) presents an oppression framework that integrates intersectionality, stress, stigma, and addiction-based theories to examine the complex and nuanced ways oppression-based stress (e.g., minority stress) leads to sexual orientation and gender identity inequities in alcohol use; (b) conducts a narrative review that summarizes recent and novel advancements in the literature on the impact of oppression-based stressors on alcohol use outcomes across structural, interpersonal, and intrapersonal domains among SGM people; and (c) provides future research and intervention directions for the alcohol field. SEARCH METHODS: A select review of the literature was conducted on July 10, 2023, using multiple electronic databases (i.e., PsycInfo, PubMed, Web of Science) and focusing on studies that had examined the associations between oppression-based stressors and alcohol use outcomes across structural, interpersonal, and intrapersonal levels. Search terms focused on alcohol consumption; SGM people, particularly SGM people of color; and oppression-based stress. Cross-sectional studies that focused on heterosexism-based and anti-bisexual oppression-based stressors at the interpersonal or intrapersonal levels and alcohol use outcomes were excluded as they have been included in prior reviews of the literature. SEARCH RESULTS: The initial and combined search across the databases resulted in 3,205 articles. Of those, the narrative review included 50 peer-reviewed articles that focused on the following four areas of the literature on the associations between oppression-based stressors and alcohol use outcomes: (1) experimental, longitudinal, and experience sampling studies of heterosexism- and anti-bisexual oppression-based stressors (22 articles); (2) any studies of cissexism-based stressors (12 articles); (3) any studies of intersectional oppression among SGM people of color (seven articles, one article overlapped with the first category and another overlapped with the fourth category); and (4) any studies of structural oppression (11 articles). DISCUSSION AND CONCLUSIONS: Results of this narrative review indicate that mounting evidence implicates oppression-based stress in inequities in alcohol use, hazardous drinking, and alcohol use disorder in SGM populations. This reflects SGM people's embodiment of oppression and injustice at the structural, interpersonal, and intrapersonal levels. Given some inconsistent and mixed patterns of findings, future research needs greater specificity in drinking inclusion criteria, robust and well-validated measures, more attention to culturally and developmentally relevant moderating and mediating mechanisms across the lifespan, application of sophisticated methodologies, and integration of intersectional and addiction frameworks.

Gender Identity Disparities in Early Adolescent Sleep: Findings from the Adolescent Brain Cognitive Development Study.

Purpose: Our aim was to examine associations between transgender identity and sleep disturbance in a demographically diverse, national sample of U.S. early adolescents. Methods: We conducted a cross-sectional analysis of the Adolescent Brain Cognitive Development Study from Year 3 (2019-2021, n = 10,277, 12-13 years) to investigate the association between transgender identity and caregiver-reported measures of their adolescent's sleep, assessed by the Sleep Disturbance Scale for Children. Results: Transgender adolescents had a higher risk of overall sleep disturbance and symptoms of insomnia and excessive sleepiness. Furthermore, per caregiver report, transgender adolescents were more likely to have shorter sleep duration categories; particularly concerning is the significant risk of <5 hours of sleep for transgender adolescents compared with their cisgender peers. Conclusion: These findings indicate that transgender adolescents had worse caregiver-reported sleep outcomes compared to cisgender peers. This study highlights the need for screenings and interventions targeted at improving sleep among transgender adolescents.

Comparing and Predicting Rape Acknowledgment Between Sexual Orientation and Gender Identity Categories.

It is well known that sexual violence is a prevalent social problem that often results in numerous deleterious outcomes for victims and these outcomes are often influenced by rape acknowledgment (i.e., whether the rape victim acknowledges their experience as rape). Most research on rape acknowledgment examines acknowledgment as a dichotomous variable and comprises heterosexual cisgender women, revealing two gaps in the literature. To fill these gaps, this study used quantitative data that oversampled LGBTQ+ populations to examine three categories of rape acknowledgment (yes, no, uncertain) among a gender and sexually diverse sample (N = 817). Results indicate that 20% of the sample were uncertain as to whether they had been raped, 33% were unacknowledged victims, and 44% acknowledged their rape. Sexual minority transgender/nonbinary people had the highest prevalence of rape acknowledgment (56%), compared with four other groupings: heterosexual cis men and women as well as sexual minority cis men and women (28%-49%). Multivariate analysis revealed that when controlling for other factors, gender identity, but not sexual orientation, significantly predicts rape acknowledgment. Namely, sexual minority transgender/nonbinary people and cis women were more likely than cis men to acknowledge their rape. This study offers evidence to suggest that acknowledgment differs significantly by gender identity and is worth further inquiry. Limitations and suggestions for future research are discussed.

Socioecological Predictors of Resilience in Sexual and Gender Minority Individuals.

Many factors affect an individual's resilience. Low resilience has been attributed to increased stress, anxiety, depression, and suicidality within the LGBTQIA + population, which is heightened compared to different populations. This study identifies predictors of resilience in the LGBTQIA + population and aims to identify predicting factors at all levels of the socioecological model. This was a cross-sectional study of data from a web-based survey that was conducted from January to February 2022. A national sample of 1033 LGBTQIA + adults was utilized for hierarchical regression analysis. Hierarchical regression analyses were performed for total resilience, which had an average score of 143.66 (SD = 33.88) and accounted for 53.4% of resiliency variance. Factors that were found to decrease an individuals resiliency score were depression, stress, suicidality, and isolation discrimination distress. Factors found to increase an individuals resiliency scores are college graduate 4 years+, married, outness, personal comfortability with being SGM, gender expression discrimination distress, and vicarious discrimination distress. Understanding the factors that influence resilience is vital to improving the resilience of the LGBTQIA + communities. Interventions that focus on decreasing depression, stress, and suicidality may be particularly impactful for all types of resilience.

Beyond stigma: Clinician bias in contraceptive counseling to sexual and gender minority youth.

OBJECTIVES: Sexual and gender minority (SGM) youth experience disparities in sexual and reproductive health; however, little is known about how clinicians engage in contraceptive counseling with this patient population. This study describes pediatric clinician patterns and biases in contraceptive counseling with SGM youth. STUDY DESIGN: We conducted 16 in-depth interviews with a convenience sample of clinicians who counsel adolescents on contraception. Participants were recruited and interviewed in-person at the American Academy of Pediatrics National Conference in October 2022. We used codebook thematic analysis. RESULTS: When discussing contraceptive counseling among SGM youth, three major themes emerged: (1) participants' acceptance of SGM youth identities varied from support to suspicion and rejection; (2) participants' conceptualizations of their SGM youth patients' identities circumscribed the scope of the contraceptive care they provided; and (3) participants described using a universal approach to contraceptive counseling that disregarded the relevance of SGM youth identities. For transgender patients, many clinicians focused on menstrual regulation and overlooked potential pregnancy risk. When discussing sexual minority patients, clinicians overemphasized pregnancy prevention and encouraged the use of highly effective contraceptive methods rather than taking a shared decision-making approach to contraceptive care. CONCLUSION: Many clinicians demonstrated bias in approaches to contraceptive care provision to SGM youth patients by holding patients accountable to normative assumptions in transgender medicine and family planning. Training and support for adolescent-facing clinicians in bias recognition and comprehensive contraceptive care are necessary to provide person-centered reproductive health care to SGM youth.

Gender Minority Stressors and Psychological Distress Among Chinese Transgender and Gender Diverse People: Variable-Centered, Person-Centered, and Psychological Network Approaches.

Mental health disparities in transgender and gender diverse (TGD) populations call for more research examining gender minority stressors (GMS) as antecedents to their psychological distress, especially for the long-underrepresented groups living in conservative societies towards gender minorities. Furthermore, some questions remain underexamined, including the relative, independent influences of various GMS on TGD people's mental well-being (i.e., uniqueness of each stressor); how these stressors would configurate with each other in distinctive patterns to characterize subgroups of TGD people (i.e., beyond-average heterogeneity); and how these stressors would constitute a psychological network and vary in their centrality in that network (i.e., holistic complexity). To narrow such gaps, we examined the links between GMS and TGD people's psychological distress, using survey data collected in 2023 from 410 Chinese TGD people (Meanage = 22.33 years, SD = 4.27; 306 transgender, 70 non-binary/gender-queer/gender-fluid, 26 agender/gender-neutral, 3 intersex, and 5 others). We approached such links from three perspectives. First, variable-centered analyses indicated that while different GMS were considered simultaneously, internalized transphobia, preoccupation with gender dysphoria, and gender-related victimization were uniquely associated with psychological distress. Second, person-centered analyses yielded a 3-profile solution. Psychological distress varied systematically across profiles. Last, network analyses revealed a 3-cluster structure: Distal, Proximal Internal, and TGD-Specific Stressors. Preoccupation with gender dysphoria was the most central node. These findings contribute to a more nuanced understanding of the implications of GMS for TGD people's mental well-being. GMS related to internal struggles with gender identity might be among the central intervention targets to prevent/reduce TGD people's psychological distress.

Advancing Refugee Health Data Management: The Implementation of ICD-11 in UNRWA's Primary Care System.

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) was one of the earliest healthcare systems globally to implement the International Classification of Diseases, Eleventh Revision (ICD-11) across its 140 clinics serving 5.9 million Palestine refugees. This paper discusses the integration of ICD-11 into UNRWA's cloud-based electronic medical record (EMR) system, identifying both the barriers and facilitators involved and analyzing trends in clinical documentation and healthcare utilization. The key challenges included data privacy provisions, integration into a coordinated care model, complex classification schema for primary care settings, frequent staff turnover, and limited data analysis capabilities. Conversely, facilitators included physician-tailored training and on-site support, system compatibility, a multidisciplinary team approach, policy support from UNRWA and the World Health Organization (WHO), and leadership commitment and effective change management. Medical officers (MOs) using ICD-11 reported greater satisfaction with the system's capabilities in managing and visualizing health information. This article contributes to the discourse on health data management in complex humanitarian settings, offering insights into the benefits and challenges of implementing advanced classification systems like ICD-11. Future research should explore longitudinal impacts and further integration with global health systems, ensuring that the advancements in classification continue to support the overarching goal of health equity and access in vulnerable and hard-to-reach populations.

Contraceptive use among transgender men and gender diverse individuals in the United States: reasons for use, non-use, and methods used for pregnancy prevention.

OBJECTIVES: To describe contraceptive use for pregnancy prevention among transgender men and gender diverse (TGD) individuals assigned female or intersex at birth (AFIAB) and explore whether contraceptive use differs by testosterone use. STUDY DESIGN: We analyzed data from a cross-sectional, online survey of N=1,694 TGD individuals AFIAB recruited in 2019 through a community-facing website and a national community-engaged cohort study of sexual and/or gender minority (SGM) adults in the US. Descriptive and regression analyses characterized the current and ever use of contraceptive methods for pregnancy prevention, stratified by testosterone use, and described reasons for contraceptive use/non-use. RESULTS: Most respondents (71.0%) had used contraception before with 49.4% using it for pregnancy prevention. The methods for pregnancy prevention that were most frequently ever used for pregnancy prevention included: external condoms (91.8%), combined hormonal contraceptive pills (63.0%), and withdrawal (45.9%). The methods most frequently currently used for pregnancy prevention included: external condoms (35.4%), hormonal IUD (24.8%), and abstinence (19.2%). Some reported formerly (n=55, 6.6%) or currently (n=30, 3.6%) relying on testosterone for pregnancy prevention. Only 4 of the 33 reasons for contraceptive use and non-use differed by testosterone use group. The most reported reasons for never using contraception were not engaging in penis-in-vagina sex (5.7%) or no sex with individuals who produce sperm (4.8%). CONCLUSIONS: Most TGD individuals AFIAB have used contraception, and almost half for pregnancy prevention. The most used methods require minimal and/or non-invasive healthcare system interaction. Some respondents relied on testosterone as birth control, despite a lack of efficacy evidence.

COVID-19 Knowledge Among Sexual and Gender Minority Adults in New York City.

Purpose: This study describes sources of COVID-19 vaccine information and COVID-19 knowledge among sexual and gender minority (SGM) adults in New York City (NYC). Methods: A sample of 986 SGM adults in NYC completed an online survey between June 25 and December 1, 2021. Participants indicated their top three sources of COVID-19 vaccine information from a list of 10 options. Participants were also categorized into low or high COVID-19 knowledge using a 14-item questionnaire. We described knowledge sources, then conducted bivariate and multivariable logistic regression to identify characteristics associated with greater knowledge. Results: The mean age of participants was 29 years (range 18-68 years). Only 12.5% identified their health care provider as a main COVID-19 vaccine information source. Social media (54.9%) and TV news channels (51.4%) were most reported as a main COVID-19 vaccine information source. COVID-19 vaccine knowledge was moderate, with four of eight questions showing correct responses in approximately 70% or more participants. In the multivariable logistic regression model, having at least some college education (adjusted odds ratio [aOR]: 2.34, 95% confidence interval [CI]: 1.55-3.52), attaining a master's degree (aOR: 3.28, 95% CI: 1.93-5.57), reporting a household income of $25,000-$49,999 per year (aOR: 1.68, 95% CI: 1.14-2.46), and having health insurance (aOR: 2.12, 95% CI: 1.51-2.96) were significantly associated with high COVID-19 knowledge. Conclusion: Our sample demonstrated high levels of COVID-19 knowledge, particularly among educated individuals and those with health insurance. Primary access to health information was through social media and TV news channels.

Medical student clinical cultural awareness in cancer care of sexual gender minority patients.

OBJECTIVE: Health disparities in lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+), or sexual and gender minority (SGM) people are known. SGM people have higher cancer risk, but lower rates of screenings, resulting in a higher likelihood of late-stage disease. This study evaluates medical students' clinical cultural awareness in cancer care of SGM patients to identify gaps in education. METHODS: This was a cross-sectional survey distributed to medical students at a academic center. There were 38 questions on demographics, attitudes, and knowledge of SGM topics. Descriptive statistics were used for demographic information and stratified analyses assessed responses by demographic subgroups. RESULTS: There were 238 responses from 1145 students (response rate = 20.7 %). Of the responders, 91.2 % and 79 % were comfortable treating lesbian, gay, bisexual (LGB) and transgender patients respectively. Only 28.6 % and 21.8 % were confident treating LGB and transgender patients respectively after taking the survey. 91.2 % of students were interested receiving education regarding SGM health needs. CONCLUSION: While most medical students are comfortable treating LGBTQ+ patients, most are not confident in their knowledge. This difference is most profound in knowledge of transgender patients. PRACTICE IMPLICATIONS: Schools must provide more education in SGM topics to improve student knowledge to produce competent providers.

Are social supports always protective? A seven-city study on heavy drinking among sexual and gender minority young adults experiencing homelessness.

PURPOSE: Sexual and gender minority (SGM) young adults are disproportionately impacted by homelessness and heavy drinking (i.e., having five or more drinks of alcohol in a row within a couple of hours). Social support, in general, is protective in reducing individuals' risk of heavy drinking. However, whether and how support from different sources may have different implications on heavy drinking among SGM young adults experiencing homelessness (SGM-YAEH) remains unclear. Informed by the risk amplification and abatement model (RAAM), this study examined the associations between support sources and heavy drinking among SGM-YAEH. METHODS: A purposive sample of SGM-YAEH (N=425) recruited in homeless service agencies from seven major cities in the U.S. completed a self-administered computer-assisted anonymous survey. This survey covered heavy drinking behaviors and social network properties. Logistic regression models were conducted to identify social support sources associated with SGM-YAEH's heavy drinking. RESULTS: Over 40 % of SGM-YAEH were involved in heavy drinking in the past 30 days. Receiving support from street-based peers (OR=1.9; 95 % CI=1.1, 3.2) and home-based peers (OR=1.7; 95 % CI=1.0, 2.8) were each positively associated with SGMYAEH heavy drinking risks. CONCLUSION: This study was not able to identify the protective role social supports may play in reducing SGM-YAEH's heavy drinking. Furthermore, receiving support from network members was correlated with elevated heavy drinking risks among this population. As heavy drinking prevention programs develop interventions: they should use affirming and trauma approaches to promote protective social ties, as research points to its association in reducing alcohol use disparities among SGM-YAEH.

A compassion microintervention targeting stress reactivity among sexual minority women and transgender/nonbinary people: Study protocol for a randomized controlled trial.

OBJECTIVE: Sexual minority women (SMW) and transgender and/or nonbinary (TNB) people report more adverse health outcomes (e.g., depression, anxiety, posttraumatic stress, substance use) relative to heterosexual, cisgender people, often due to the additional stress burden from experiencing stigma. Physiological and emotional stress reactivity are mechanisms through which high cumulative stress contributes to adverse health outcomes. The randomized controlled trial (RCT) described in this study protocol examines whether a single-session compassion microintervention may attenuate physiological and emotional stress reactivity to the minority stress Trier Social Stress Test (MS-TSST) among SMW/TNB people. This study will also examine whether the compassion microintervention reduces depression, anxiety, posttraumatic stress symptoms, and substance use from baseline to one-month follow-up, and assess microintervention acceptability. METHODS: This protocol describes a two-arm parallel RCT. Participants are recruited online and at in-person events (e.g., Pride events). Participants complete baseline measures online (e.g., demographics, anxiety symptoms) and then complete an in-person lab visit that includes the compassion microintervention (or no training control). Immediately after the intervention period, participants complete the MS-TSST. Measures of physiological (i.e., blood pressure, cortisol) and emotional (i.e., negative affect, state anxiety) reactivity are collected throughout the lab visit. Participants also complete a one-month follow-up survey. Participants randomized to the microintervention are invited to complete a semi-structured virtual interview about their experiences to assess acceptability. CONCLUSION: Findings from this study could provide initial evidence that compassion microinterventions show promise in addressing stigma-related stress reactivity among SMW/TNB people. CLINICALTRIALS: govregistration:NCT05949060.

Novel Machine Learning HIV Intervention for Sexual and Gender Minority Young People Who Have Sex With Men (uTECH): Protocol for a Randomized Comparison Trial.

BACKGROUND: Sexual and gender minority (SGM) young people are disproportionately affected by HIV in the United States, and substance use is a major driver of new infections. People who use web-based venues to meet sex partners are more likely to report substance use, sexual risk behaviors, and sexually transmitted infections. To our knowledge, no machine learning (ML) interventions have been developed that use web-based and digital technologies to inform and personalize HIV and substance use prevention efforts for SGM young people. OBJECTIVE: This study aims to test the acceptability, appropriateness, and feasibility of the uTECH intervention, a SMS text messaging intervention using an ML algorithm to promote HIV prevention and substance use harm reduction among SGM people aged 18 to 29 years who have sex with men. This intervention will be compared to the Young Men's Health Project (YMHP) alone, an existing Centers for Disease Control and Prevention best evidence intervention for young SGM people, which consists of 4 motivational interviewing-based counseling sessions. The YMHP condition will receive YMHP sessions and will be compared to the uTECH+YMHP condition, which includes YMHP sessions as well as uTECH SMS text messages. METHODS: In a study funded by the National Institutes of Health, we will recruit and enroll SGM participants (aged 18-29 years) in the United States (N=330) to participate in a 12-month, 2-arm randomized comparison trial. All participants will receive 4 counseling sessions conducted over Zoom (Zoom Video Communications, Inc) with a master's-level social worker. Participants in the uTECH+YMHP condition will receive curated SMS text messages informed by an ML algorithm that seek to promote HIV and substance use risk reduction strategies as well as undergoing YMHP counseling. We hypothesize that the uTECH+YMHP intervention will be considered acceptable, appropriate, and feasible to most participants. We also hypothesize that participants in the combined condition will experience enhanced and more durable reductions in substance use and sexual risk behaviors compared to participants receiving YMHP alone. Appropriate statistical methods, models, and procedures will be selected to evaluate primary hypotheses and behavioral health outcomes in both intervention conditions using an α<.05 significance level, including comparison tests, tests of fixed effects, and growth curve modeling. RESULTS: This study was funded in August 2019. As of June 2024, all participants have been enrolled. Data analysis has commenced, and expected results will be published in the fall of 2025. CONCLUSIONS: This study aims to develop and test the acceptability, appropriateness, and feasibility of uTECH, a novel approach to reduce HIV risk and substance use among SGM young adults. TRIAL REGISTRATION: ClinicalTrials.gov NCT04710901; https://clinicaltrials.gov/study/NCT04710901. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/58448.

Sociocultural Implications in the Development of Early Maladaptive Schemas in Adolescents Belonging to Sexual and Gender Minorities.

Culture is a central theme across various theories and disciplines, influencing behavior and self-perception through interactions within social groups, families, and legal systems. This influence extends to the general population and particularly impacts sexual and gender minorities (SGMs), resulting in minority stress that contributes to mental health issues and the development of Early Maladaptive Schemas (EMSs). Adolescents within these groups face typical developmental stressors-such as hormonal changes and societal pressures-compounded by prejudice, increasing their vulnerability to depression, anxiety, stress, substance abuse, and eating disorders. Despite these challenges, Schema Therapy (ST) lacks comprehensive studies on the sociocultural aspects influencing EMS acquisition in SGM adolescents. This theoretical review aims to fill this gap by exploring the impact of society and culture on EMS development within SGM adolescents. We recognize the broad spectrum of cultural influences and emphasize the importance of cultural sensitivity and diversity. This review specifically addresses how societal and cultural dynamics impact SGM individuals, acknowledging that while ethnic or other cultural factors are not the focus of this paper, they merit future research. This manuscript will discuss central topics and their impact on LGBTQIA+ youth, including (1) the background (definition of culture, lack of studies on ST focusing on culture, and studies on adverse psychological outcomes), (2) minority stress theory and prejudice against sexual and gender diversity (distal and proximal stressors and sociocultural aspects), (3) EMSs and unmet emotional needs, (4) ST affirmative strategies (working with schema modes, imagery rescripting, chair work, and photo techniques), and (5) final considerations (limitations and research agenda).

Community-Based Participatory Research with Sexual and Gender Minority Trauma Survivors: Challenges, Solutions, and Recommendations for Future Research.

Research on sexual and gender minority (SGM) and domestic violence/sexual assault (DV/SA) is needed given that SGM people are at elevated risk of experiencing DV/SA and accessing inclusive and affirming services from DV/SA community agencies poses challenges for SGM survivors. Community-based participatory research (CBPR) is emerging as a valuable methodological tool in this area, yet few CBPR studies focus on DV/SA among SGM people. In the current paper, we present a case study of a CBPR study conducted in collaboration with SGM survivors of DV/SA, as well as community stakeholders (i.e., DV/SA agency staff and providers). More specifically, we make six recommendations to address CBPR study challenges specifically focused on SGM DV/SA, including (a) integrating positionality throughout every step of the research process, (b) establishing rapport with community partners early in the process, (c) engaging external experts in conducting research related to SGM DV/SA to enhance community-research partnerships, (d) ensuring diverse identities are represented within the study team, (e) developing clear, co-defined feedback and communication guidelines with a Survivor Advisory Board (SAB), and (f) implementing an SAB engagement/retention plan. We also provide concrete examples from our CBPR case study to illustrate each recommendation. These recommendations may enhance the impact of conducting CBPR that seeks to promote recovery from DV/SA among SGM via practices for sustainable community partnerships and linkage-to-care efforts for SGM survivors.

Attitudes Toward Using and Willingness to Use a Hypothetical Online Sex Communication Intervention for Parents of Sexual and Gender Minority Adolescents.

Although parents of sexual and gender minority (SGM) adolescents play a critical role in communicating about sexual health to their children, most parents have reported that they are unknowledgeable and uncomfortable talking about sexual health to their SGM adolescent. Because of the limited availability of sex education programs for parents of SGM adolescents, the study aimed to (1) describe the attitudes toward using and willingness to use a hypothetical online sex communication intervention for parents of SGM adolescents and (2) examine factors associated with willingness to use such an intervention. Parents of SGM adolescents from across the United States (N = 385) completed an online survey from March 10-16, 2023. Most participants were open to participating in a hypothetical online sex communication program and had positive attitudes toward it. Logistic regression results showed that participants who overall agreed a hypothetical online parent-based sex education intervention would be helpful and of interest had higher odds of being overall willing to participate in such a hypothetical intervention. Additionally, participants with higher income levels were also more likely to be willing to participate in a hypothetical program. Results from this exploratory study suggest that most parents of SGM adolescents have positive attitudes toward a hypothetical online parent-based sex education program and are willing to participate in it, highlighting a need to develop sex education programs tailored to the needs and preferences of parents of SGM adolescents. Additionally, equitable access to such programs is necessary especially regarding income level.

State LGBTQ policy environments and the cancer burden in sexual and gender minoritized communities in the United States.

PURPOSE: Our objective was to assess the association between state policies related to sexual orientation and gender identity (SOGI) and cancer prevalence and survivorship indicators in a sexual and gender minoritized (SGM) population in the United States. METHODS: Data from the 2017-2021 Behavioral Risk Factor Surveillance System were used to measure cancer diagnosis, physical and mental health, and substance use for SGM adult cancer survivors. A state policy Z-score, ranging from most restrictive to most protective state policies related to SOGI, was computed from data available from the Movement Advancement Project. Survey-weighted logistic regression was used to test the relationship between state policies and cancer-related outcomes for SGM people. RESULTS: More protective state policies were associated with lower odds of a cancer diagnosis (adjusted odds ratio [AOR]: 0.92; 95% confidence interval [CI]: 0.87-0.97). Among SGM cancer survivors, increasing protective state policies were associated with lower odds of poor physical health (AOR: 0.83; 95% CI: 0.74-0.94), lower odds of difficulty walking or climbing stairs (AOR: 0.90; 95% CI: 0.80-1.00), and lower odds of difficulty concentrating or remembering (AOR: 0.87; 95% CI: 0.78-0.98). No significant associations were found between state policies and mental health, depression, substance use, diabetes, or cardiovascular disease among SGM cancer survivors. CONCLUSION: SGM people diagnosed with cancer are more likely to live in restrictive policy states, and survivors in those states have worse physical health and cognitive disability. Additional research should investigate potential causal relationships between state policies and SGM cancer outcomes.

Equity and Inclusion for LGBTQ+ Residents: Lessons Learned from the Initial Long-Term Care Equality Index (LEI).

OBJECTIVES: Most older adults with lesbian, gay, bisexual, queer, questioning, transgender, and related identities (LGBTQ+) are concerned about receiving lower-quality care and/or being mistreated in nursing homes. Older LGBTQ+ veterans may have additional reservations about care in Department of Veterans Affairs (VA) nursing homes (Community Living Centers [CLCs]) because of experience with past discriminatory military policies (eg, bans on participating in military service, Don't Ask Don't Tell). This article describes one of the first VA CLCs to participate in the Human Rights Campaign-developed Long-Term Care Equality Index (LEI). DESIGN: A single-site formative evaluation was completed to support quality improvement and identify opportunities for growth using the LEI. The LEI is a facility benchmarking tool to support more inclusive environments for LGBTQ+ residents and employees. The LEI offers 4 evaluation criteria: (1) Non-Discrimination and Staff Training; (2) LGBTQ+ Resident Services and Support; (3) Employee Benefits and Policies; and (4) Resident and Community Engagement. Facilities receive ratings based on the number of requirements achieved in each category. PARTICIPANTS AND METHODS: Older LGBTQ+ veterans, current CLC residents, interdisciplinary CLC providers and leadership, and national Geriatrics and Extended Care program managers collaborated to pilot the LEI and develop tools and materials to support other VA facilities' participation in the LEI. RESULTS: Qualitative interviews with veterans and CLC residents supported inclusion of gender identity and sexual orientation in resident handbooks, discussions about person-centered care, and opportunities for additional staff training and community engagement (eg, observing Pride Month in June). Resources to support VA long-term care facilities' participation in the LEI were developed. CONCLUSIONS AND IMPLICATIONS: The LEI offers a structured approach to identifying areas for improvement in providing high-quality and equitable care in long-term care settings. Practical suggestions for CLCs and other nursing home settings considering the LEI for the first time are discussed.