Disparities in positive mental health of sexual and gender minority adults in Canada. / Disparités dans la santé mentale positive des adultes faisant partie d'une minorité sexuelle ou de genre au Canada.

INTRODUCTION: The goal of this study was to examine potential disparities in positive mental health (PMH) among adults in Canada by sexual orientation and gender modality. METHODS: Using 2019 Canadian Community Health Survey (CCHS) Annual Component data (N = 57 034), we compared mean life satisfaction and the prevalence of high self-rated mental health (SRMH), happiness and community belonging between heterosexual and sexual minority adults, and between cisgender and gender minority adults. We used 2019 CCHS Rapid Response on PMH data (N = 11 486) to compare the prevalence of high psychological well-being between heterosexual and sexual minority adults. Linear and logistic regression analyses examined the between-group differences in mean life satisfaction and the other PMH outcomes, respectively. RESULTS: Sexual minority (vs. heterosexual) adults reported lower mean life satisfaction (B = -0.7, 95% CI: -0.8, -0.5) and were less likely to report high SRMH (OR = 0.4, 95% CI: 0.3, 0.5), happiness (OR = 0.4, 95% CI: 0.3, 0.5), community belonging (OR = 0.6, 95% CI: 0.5, 0.7) and psychological well-being (OR = 0.4, 95% CI: 0.3, 0.6). Differences were not always significant for specific sexual minority groups in sexstratified analyses. Gender minority adults reported lower mean life satisfaction and were less likely to report high SRMH and happiness than cisgender adults. CONCLUSION: Future research could investigate how these PMH disparities arise, risk and protective factors in these populations, how other sociodemographic factors interact with sexual orientation and gender identity to influence PMH and changes in disparities over time.

Trajectories of Mental Distress Among US Women by Sexual Orientation and Racialized Group During the First Year of the COVID-19 Pandemic.

Objectives. To describe longitudinal trends in the prevalence of mental distress across the first year of the COVID-19 pandemic (April 2020‒April 2021) among US women at the intersection of sexual orientation and racialized group. Methods. Participants included 49 805 cisgender women and female-identified people from the COVID-19 Sub-Study, a cohort of US adults embedded within the Nurses' Health Studies 2 and 3 and the Growing Up Today Study. We fit generalized estimating equation Poisson models to estimate trends in depressive and anxiety symptoms by sexual orientation (gay or lesbian, bisexual, mostly heterosexual, completely heterosexual); subsequent models explored further differences by racialized group (Asian, Black, Latine, White, other or unlisted). Results. Relative to completely heterosexual peers, gay or lesbian, bisexual, and mostly heterosexual women had a higher prevalence of depressive and anxiety symptoms at each study wave and experienced widening inequities over time. Inequities were largest for sexual minority women of color, although confidence intervals were wide. Conclusions. The COVID-19 pandemic may have exacerbated already-glaring mental health inequities affecting sexual minority women, especially those belonging to marginalized racialized groups. Future research should investigate structural drivers of these patterns to inform policy-oriented interventions. (Am J Public Health. 2024;114(5):511-522. https://doi.org/10.2105/AJPH.2024.307601).

Sexual Sanctification and Relationship Satisfaction in Black Heterosexual Couples.

This study examines dyadic data from 299 married and 242 cohabiting Black heterosexual couples in the United States (an understudied cross-section of the population) and assesses individual (actor) effects as well as couple (partner) effects of sexual sanctification and relationship satisfaction. Higher levels of sexual sanctification were associated with higher levels of relationship satisfaction for women and men in the actor effects, but no significant associations were found in the partner effects for couples. Additionally, initial findings suggest that sexual sanctification may act as a relational protective factor for Black married and cohabiting couples. Implications for further research as well as practical applications for clergy, therapists, and practitioners working with Black heterosexual couples in sexual relationships are also discussed.

The role of loneliness in the association between sexual orientation and depressive symptoms among older adults: A prospective cohort study.

BACKGROUND: This study aims to understand the mechanisms contributing to the elevated risk of depression among sexual minority older adults compared to heterosexuals. Specifically, the role of loneliness as a potential mediator is investigated to inform targeted interventions for preventing depression in sexual minority populations. METHODS: Data from the English Longitudinal Study of Ageing, focusing on adults aged over 50, were analysed. Sexual orientation (sexual minority or heterosexual) and loneliness scores (UCLA scale) were assessed at wave six (2010-2011), while depressive symptoms (CESD) were assessed at wave seven (2013-14). Linear regression models and mediation analyses, using g-computation formula and adjusted for confounders, were conducted. RESULTS: The sample included 6794 participants, with 478 (7.0 %) identifying as sexual minorities. After adjustments, sexual minorities scored higher on depressive symptoms at wave seven (mean difference): 0.23, 95 % CI 0.07 to 0.39) and loneliness at wave six (MD: 0.27, 95 % CI 0.08 to 0.46). Loneliness was positively associated with depressive symptoms (coefficient: 0.27, 95 % CI 0.26 to 0.29). In mediation analyses, loneliness explained 15 % of the association between sexual orientation and subsequent depressive symptoms. LIMITATIONS: The dataset used sexual behaviour rather than desire and identity, potentially skewing representation of sexual minorities. Additionally, transgender older adults were not included due to limited gender diversity reported within the ELSA dataset. CONCLUSIONS: Loneliness appears to be a significant modifiable mechanism contributing to the heightened risk of depressive symptoms in sexual minority older adults compared with their heterosexual counterparts.

Examining sexual minority engagement in recovery community centers.

INTRODUCTION: Research indicates that sexual minority (SM) individuals with alcohol and other drug use disorders may underutilize recovery resources generally but be more likely to use recovery community centers (RCCs). To inform recovery supports, this study characterized SM and heterosexual RCC members by demographics and clinical and recovery support service utilization. METHODS: Cross-sectional secondary analyses compared SM and heterosexual RCC members in the northeastern U.S. (n = 337). Qualitative analyses coded the top three recovery facilitators. RESULTS: Of the 337 participants (Meanage[SD] = 40.98[12.38], 51.8 % female), SM RCC members were more likely than heterosexuals to endorse lifetime psychiatric diagnoses and emergency department mental health treatment (p < .01). RCC service utilization and qualitatively derived recovery facilitators were mostly consistent across groups. CONCLUSIONS: RCCs engaged SM individuals in recovery in ways consistent with heterosexuals. Despite otherwise vastly similar demographic characteristics across sexual identity, findings suggest a need for additional mental health resources for SM individuals in recovery.

Fertility of Czech Gay and Straight Men, Women, and Their Relatives: Testing the Sexually Antagonistic Gene Hypothesis.

One proposal for the persistence of homosexuality in the human population is the sexually antagonistic gene hypothesis, which suggests that the lower fertility of homosexual individuals, especially men, may be compensated by higher fertility of their relatives of the opposite sex. To test this hypothesis, we have collected data from 7,312 heterosexual men, 459 gay men, 3,352 heterosexual women, and 79 lesbian women mainly from Czechia. In an online survey, participants answered questions regarding their own as well as their parents' and grandparents' fertility. For men, we obtained no significant results except for higher fertility of gay men's paternal grandmothers, but the magnitude of this effect was very small. For the female sample, we recorded lower fertility of lesbian women's mothers and fathers. In line with our expectations, both gay men and lesbian women had lower fertility rates than their heterosexual counterparts. Our results are consistent with recent studies which likewise do not support the sexually antagonistic gene hypothesis.

Characterizing the hierarchical depression phenotype in sexually diverse individuals.

INTRODUCTION: Sexual diverse individuals are at high risk for internalizing psychopathologies, such as depression. Understanding how symptom profiles of heterogeneous psychiatric disorders such as depression differ for sexually diverse vs. heterosexual individuals is thus critical to advance precision psychiatry and maximize our ability to effectively treat members of this population. Research has failed to consider the possibility of hierarchical phenotypes, wherein sexual orientation status may be uniquely and simultaneously associated with both depression broadly and with individual symptoms. METHOD: To address these issues, we conducted a moderated nonlinear factor analysis in Wave IV of the Add Health study, using sexual diversity status as a predictor of (a) latent depression, (b) factor loadings, and (c) individual symptoms, with and without controlling for race. RESULTS: Sexual diversity status was positively and simultaneously associated with latent depression, concentration difficulties, and happiness. DISCUSSION: These findings suggest that sexually diverse populations not only face greater depression, broadly defined, but are disproportionately more likely to experience concentration difficulties and be happier compared to heterosexual counterparts. Methodologically, these models indicate that the CES-D is scalar noninvariant as a function of sexual diversity status (i.e., identical scores on the CES-D may represent different manifestations of depression for sexually diverse and heterosexual participants). Studies examining disparities in depression across heterosexual and sexually diverse samples should thus consider depression broadly as well as specific symptoms. Further, it is critical to examine whether these relations function via different mechanisms.

Subtypes of Alcohol Expectancies Are Differentially Associated With Alcohol Use for Bisexual and Heterosexual Women.

Background: Bisexual women, compared to heterosexual women, report greater amounts of alcohol use and heavy drinking. Alcohol expectancies (i.e., beliefs about alcohol outcomes) are a strong predictor of alcohol use, but few studies have examined the importance of alcohol expectancies in relation to alcohol use among bisexual women specifically or in comparison to heterosexual women. Objectives: The current study examined 262 heterosexual and 225 bisexual women using an online survey about alcohol use, sexual risk-taking, and alcohol expectancy subtypes (sexuality, tension reduction, and aggression). Results: Compared to heterosexual women, bisexual women reported greater sexuality and tension reduction expectancies after accounting for their level of drinking, but groups did not differ on aggression expectancies. Moreover, sexual identity status moderated the associations between sexuality and tension reduction expectancies and alcohol use, respectively. Specifically, our study findings suggested that sexuality and tension reduction alcohol expectancies were more strongly tied to alcohol use among bisexual women than heterosexual women. Conclusions: Taken together, in our study, bisexual women held stronger sexuality and tension reduction expectancies, as compared to heterosexual women. Interventions targeting alcohol expectancies may be considered when tailoring intervention content for this population.

Differential Evaluation of Straight and Gay Men for Nonverbal Effeminate Behavior.

The purpose of this study was to determine how violation of gender-based expectancies might influence straight men's attitudes toward men who differ by sexual orientation (i.e., straight or gay). This study was specifically designed to avoid methodological issues that may have been present in similar research. Hypotheses were informed by Expectancy-Violation Theory (EVT) and the Black Sheep Effect (BSE), which together suggest that an effeminate straight man should be evaluated by other straight men more negatively than an effeminate gay man because the former target negatively violated expectations. Additionally, EVT suggests that a masculine gay man should be evaluated more positively than a masculine straight man because the former positively violates expectations, while the BSE instead suggests the latter should be evaluated more positively than the former due to ingroup bias. Self-identified straight men evaluated a male target whose sexual orientation and gender conformity were manipulated through a photo and vignette. A moderated mediation analysis was performed to determine if perceived expectancy violation mediated the relationship between sexual orientation and evaluations for both effeminate and masculine men. Straight effeminate targets were evaluated more negatively than gay effeminate targets; however, straight masculine targets were evaluated more favorably than gay masculine targets, a finding more consistent with the BSE. In addition, perceived expectancy violation did not mediate the relationship between sexual orientation and evaluations regardless of gender expression. More research should be conducted to identify the mechanisms through which evaluations of straight and gay targets differ based on gender expression.

What Do Different People Look for in a Partner? Effects of Sex, Sexual Orientation, and Mating Strategies on Partner Preferences.

Partner preferences are an important differential in relationship formation and evolutionary fitness, and vary according to individual, ecological, and social factors. In this study, we evaluated the variation in preference for intelligence, kindness, physical attractiveness, health, and socioeconomic level among individuals of different sexes and sexual orientations in a Brazilian sample. We analyzed the preference scores of 778 heterosexual, bisexual, and homosexual men and women in three budgeted mate design tasks (low vs. medium vs. high budget) and their association with sociosexuality, attachment styles, homogamy, and willingness to engage in short- and long-term relationships. Results indicated a global trait preference order, with intelligence ranking first, followed by kindness, physical attractiveness, health, and lastly by socioeconomic status. Typical sex differences were observed mostly within the heterosexual group, and specific combinations of sex and sexual orientation were linked to variation in preference for physical attractiveness, kindness, and socioeconomic status. We also found unique associations of the other variables with partner preferences and with willingness to engage in short- or long-term relationships. By exploring the partner preferences of non-heterosexual individuals from a Latin American country, an underrepresented group in evolutionary psychology research, our results help understand the universal and specific factors that guide partner preferences and human sexual behavior.

The Desirable Dad Hypothesis: Male Same-Sex Attraction as the Product of Selection for Paternal Care via Antagonistic Pleiotropy.

Same-sex attraction, a heritable trait with a reproductive cost, lacks a comprehensive evolutionary explanation. Here we build on a hypothesis invoking antagonistic pleiotropy, which suggests that genes linked to male same-sex attraction remain in the gene pool because they have conferred some fitness advantage to heterosexual men possessing them. We posit the "desirable dad hypothesis," which proposes that alleles linked to male non-heterosexual orientations increase traits conducive to childcare; heterosexual men possessing same-sex attracted alleles are more desirable mating partners as a function of possessing superior paternal qualities. We conducted three studies to test predictions from this hypothesis. Results were consistent with all three predictions. Study 1 (N = 1632) showed that heterosexual men with same-sex attracted relatives were more feminine than men without, as indicated by self-report measures of femininity (η2 = .007), warmth (η2 = .002), and nurturance (η2 = .004 - .006). In Study 2 (N = 152), women rated feminine male profiles as more romantically appealing than masculine ones (d = 0.83)-but less so than profiles possessing a combination of feminine and masculine traits. In Study 3 (N = 153), women perceived feminine male profiles as depicting the best fathers and masculine profiles the worst (d = 1.56): consistent with the idea that femininity is attractive for childcare reasons. Together, these findings are consistent with the idea that sexual selection for male parental care may be involved in the evolution of male same-sex attraction.

Sexual orientation and mental health in a US cohort of children: a longitudinal mediation study.

BACKGROUND: Sexual minorities, including children, are at increased risk for adverse mental health outcomes compared to their heterosexual peers, but longitudinal studies are needed to determine the factors that explain the associations between sexual minority identification and adverse mental health outcomes during this developmental period. We examined longitudinal associations between sexual orientation and mental health over 2 years in a US cohort of children (aged 9-10 at baseline) and two explanatory factors (increased social problems such as getting teased and decreased perceived school safety). We hypothesized that beginning to identify as gay/bisexual and consistently identifying as gay/bisexual would be associated with increases in internalizing (e.g. depression, anxiety) and externalizing (e.g. aggression) problems compared to consistently identifying as heterosexual, and these associations would be partially explained by increased social problems and decreased perceived school safety. METHODS: We used data from Waves 1-3 of the Adolescent Brain Cognitive Development study. The analytic sample included 5,574 children (46.0% female; 55.1% non-Hispanic White). RESULTS: Beginning to identify as gay/bisexual was associated with increased internalizing/externalizing problems, and consistently identifying as gay/bisexual was associated with increased internalizing problems, compared to consistently identifying as heterosexual. For those who consistently identified as gay/bisexual, increased disparities in internalizing problems were partially explained by increased social problems and decreased perceived school safety, and increased disparities in externalizing problems were partially explained by increased social problems. CONCLUSIONS: These findings suggest the health disparities affecting sexual minority children include both internalizing and externalizing problems, and social problems and feeling unsafe at school may be contributing factors.

Associations Between Verbal and Physical Abuse in the Home and Mental Health Indicators Among Heterosexual and Lesbian, Gay, Bisexual, and Questioning High School Students in the US-Adolescent Behaviors and Experiences Survey, 2021.

PURPOSE: A number of factors may contribute to disparities in mental health and suicidality for lesbian, gay, bisexual, and questioning (LGBQ) students, including parental abuse. METHODS: The Centers for Disease Control and Prevention's (CDC) Adolescent Behaviors and Experiences Survey included a nationally representative sample of US high school students during the COVID-19 pandemic. The current analyses examined experiences of verbal and physical abuse in the home with mental health and suicidality among LGBQ students compared to heterosexual students. RESULTS: The relationship between abuse and mental health and suicidality was significant for all students; however, LGBQ students experienced substantially more abuse and had significantly poorer mental health and greater suicidality than heterosexual students. DISCUSSION: Experiencing verbal or physical abuse in the home is strongly associated with poor mental health and suicidality among youth, regardless of sexual identity; however, among LGBQ students who experienced abuse, the prevalence of poor mental health and suicidality reached crisis levels.

Sexual Attraction Disparities in Adolescent Mental Health: The Role of School Norms.

Purpose: Few studies examine whether and how heterosexist norms in schools might influence disparities in mental health between sexual minority and heterosexual adolescents. Addressing this gap, we study disparities in life satisfaction, psychosomatic complaints, and emotional problems between same/both-sex attracted and other-sex attracted adolescents and examine the moderating role of heterosexist norms on the classroom- and school-level. Methods: We used data from the 2013 and 2017 Dutch Health and Behavior in School-Aged Children study (N = 12,756; mean age = 14.02; standard deviation = 1.54). Separate multi-level analyses for life satisfaction, psychosomatic complaints, and emotional problems were conducted in which cross-level interaction effects between sexual attraction and school and classroom-level heterosexist norms were estimated. Results: Same-sex attracted, both-sex attracted, and adolescents unsure about their sexual attraction reported lower life satisfaction, more psychosomatic complaints, and more emotional problems than their other-sex attracted peers. On average, stronger school-level heterosexist norms were associated with higher life satisfaction, fewer psychosomatic complaints, and fewer emotional problems. Stronger classroom-level heterosexist norms were associated with fewer emotional problems. One moderating effect of sexual attraction and school-level heterosexist norms was found. Contrary to expectations, disparities in life satisfaction between same-sex attracted and other-sex attracted adolescents were smaller when classroom-level heterosexist norms were stronger. Standardized regression coefficients showed that the associations were small. Conclusion: Although our findings suggest pressing health disparities between heterosexual and sexual minority adolescents, heterosexist norms at the school and classroom level were weakly associated with these health disparities.

Minority stressors, traumatic events, and associations with mental health and school climate among gender and sexuality diverse young people in Australia: Findings from a nationally representative cohort study.

INTRODUCTION: Population-level, nationally representative data on the prevalence of minority stressors and traumatic events, mental ill-health effects, and the preventative utility of school climate, among gender and sexuality diverse young people in Australia, is significantly lacking. In this study, we estimated the prevalence and distribution of minority stressors and traumatic events among young people by sexuality identity (gay/lesbian, bisexual, other sexuality, heterosexual), sexuality diversity (sexuality diverse, not sexuality diverse), and gender identity (transgender, cisgender) and assessed associations with mental ill-health and the moderating role of school climate factors. METHODS: Using Wave 8 (2018) follow-up data from a population-level, nationally representative longitudinal cohort study, the sample comprised 3037 young people aged 17-19 years in Australia. Prevalence ratios for minority stressors and traumatic events were calculated for gender and sexuality diverse categories using logistic regression models. Linear regression models were used to test associations between traumatic events and minority stressors, and mental ill-health. Multivariate linear regression tested school climate factors as effect modifier between minority stressors and mental ill-health among sexuality diverse young people. RESULTS: Rates of traumatic events and minority stressors were highest among bisexual and gay/lesbian young people and were significantly associated with mental ill-health among all gender and sexuality diverse young people. Highest mental ill-health effects were observed among trans young people. Among sexuality diverse young people, positive and negative feelings toward school climate were associated with decreased and increased mental ill-health, respectively. After accounting for sexuality diversity, positive overall school climate appeared protective of mental ill-health effects of sexuality-based discrimination. DISCUSSION: Minority stressors, traumatic events, and associated mental ill-health are prevalent among gender and sexuality diverse young people in Australia, especially trans, bisexual, and gay/lesbian young people. Promotion of affirmative, safe, and inclusive school climate demonstrates significant promise for the prevention and early intervention of mental ill-health among gender and sexuality diverse young people.

Category intersections as conceptual combinations: Combining male categories of age and sexual orientation.

We reconcile interactive and additive models of category intersection by recasting these theoretical efforts within the conceptual combination framework. In three studies (Ntot = 364), we showed that, in line with an interactive approach, combining 'elderly men' with 'gay men' generated an atypical subtype with unique attributes that could not be reduced to the sum of the attributes of the constituent categories (Studies 1-3). Moreover, consistent with the additive models, combining 'heterosexual men' with age categories (i.e. young/elderly men, Study 1) made their age typicality particularly salient, and 'young men' with sexual orientation categories (i.e. gay/heterosexual men, Study 2) emphasized their sexual orientation typicality. Also, participants not only appraised 'gay men' and 'young gay men' in part as redundant categories, but they also judged 'elderly men' and 'elderly heterosexual men' to be largely overlapping. These findings take advantage of a multi-method assessment, spanning from measures of perceived typicality to the analysis of attributes freely generated in reaction to the target categories. Our results inform cognitive models of multiple category combinations and shed light on the cognitive 'invisibility' of elderly gay men and its social implications.

Self-Rated Masculinity and Femininity and Reported Number of Lifetime Sexual Partners Among Cisgender Heterosexual and LGBQ Men and Women.

Prior research has quantitatively examined why heterosexual men and women report different numbers of lifetime different-sex sexual partners, whereas qualitative work has analyzed how men's masculinity-and to a lesser extent, women's femininity-is tied to gender norms about sexual activity. Less research, however, has quantitatively examined the associations between self-rated masculinity and femininity and reported number of lifetime sexual partners. This brief report uses a large sample of Canadians (n = 2117) to examine how self-rated masculinity and femininity relate to reported numbers of sexual partners among four groups of cisgender people: (1) heterosexual men (n = 972), (2) heterosexual women (n = 979), (3) gay and bisexual/pansexual men (n = 99), and (4) lesbian and bisexual/pansexual women (n = 67). Results demonstrate that self-rated femininity was negatively, and masculinity positively, associated with reported numbers of lifetime different-sex sexual partners among heterosexual women. No significant associations emerged for other groups. The lack of significant associations among heterosexual men may be attributable to the fact that most rated themselves as very masculine and not very feminine, whereas there was more variation among heterosexual women. In contrast, the non-significance among LGBQ women and men could reflect that subcultural norms and practices more strongly shape the number of sexual partners individuals report having in these communities. These results demonstrate that it would be beneficial for researchers to measure self-rated masculinity and femininity in future studies about sexual partnering practices, especially among heterosexual cisgender women.

Emotion regulation and OCD among sexual minority people: Identifying treatment targets.

Sexual minority individuals experience higher rates of psychopathology, such that sexual minority people are nine times more likely to receive a diagnosis or treatment for obsessive-compulsive disorder (OCD) compared to heterosexual people. Poor emotion regulation capacity is a risk factor for OCD, but little is known about sexual orientation differences in dimensions of emotion regulation and how dimensions of emotion regulation relate to OCD severity among sexual minority people. The aims of the current study include 1) comparing sexual minority to heterosexual people on OCD severity and emotion regulation capacity upon admission to treatment for OCD, and 2) examining emotion regulation in relation to OCD severity among sexual minority people. Participants (N = 470) were adults in partial hospital/residential treatment with an average stay of 59.7 days (SD = 25.3), including 22 % sexual minority people. Sexual minority people reported a lower emotion regulation capacity. Among the largest three subgroups (heterosexual, bi+, and gay/lesbian), bi+ individuals reported a lower emotion regulation capacity compared to heterosexual but not gay/lesbian people. Results suggest there are sexual orientation differences in emotion regulation capacity, and that bi+ people have the most difficulty with ER. There is a need for OCD treatment to directly target emotion regulation strategies and be affirming of sexual minority identities.

Comprehensive systematic review and meta-analysis on physical health conditions in lesbian- and bisexual-identified women compared with heterosexual-identified women.

BACKGROUND: Sexual minority individuals experience discrimination, leading to mental health disparities. Physical health disparities have not been examined to the same extent in systematic reviews so far. OBJECTIVES: To provide a systematic review and, where possible, meta-analyses on the prevalence of physical health conditions in sexual minority women (i.e. lesbian- and bisexual-identified women) compared to heterosexual-identified women. DESIGN: The study design is a systematic review with meta-analyses. DATA SOURCES AND METHODS: A systematic literature search in MEDLINE, EMBASE, CENTRAL, CINAHL, and Web of Science databases was conducted on epidemiologic studies on physical health conditions, classified in the Global Burden of Disease project, published between 2000 and 2021. Meta-analyses pooling odds ratios were calculated. RESULTS: In total, 23,649 abstracts were screened and 44 studies were included in the systematic review. Meta-analyses were run for arthritis, asthma, back pain, cancer, chronic kidney diseases, diabetes, headache disorders, heart attacks, hepatitis, hypertension, and stroke. Most significant differences in prevalence by sexual identity were found for chronic respiratory conditions, especially asthma. Overall, sexual minority women were significantly 1.5-2 times more likely to have asthma than heterosexual women. Furthermore, evidence of higher prevalence in sexual minority compared to heterosexual women was found for back pain, headaches/migraines, hepatitis B/C, periodontitis, urinary tract infections, and acne. In contrast, bisexual women had lower cancer rates. Overall, sexual minority women had lower odds of heart attacks, diabetes, and hypertension than heterosexual women (in terms of diabetes and hypertension possibly due to non-consideration of pregnancy-related conditions). CONCLUSION: We found evidence for physical health disparities by sexual identity. Since some of these findings rely on few comparisons only, this review emphasizes the need for routinely including sexual identity assessment in health research and clinical practice. Providing a more detailed picture of the prevalence of physical health conditions in sexual minority women may ultimately contribute to reducing health disparities.

Identity development, attraction, and behaviour of heterosexually identified men who have sex with men: scoping review protocol.

BACKGROUND: Heterosexually identified men who have sex with men (H-MSM) are distinct from other heterosexual men and from gay, bisexual, and other sexual minority men. Specifically, H-MSM experience discordance between their sexual identity (i.e., heterosexual) and behaviours (i.e., sexual encounters with other men). This sexual identity-behaviour discordance can create barriers to obtaining healthcare and social support. Understanding and accepting H-MSM as they self-identify may be necessary to implement effective public health and psychosocial interventions. The aim of the present study is to provide an overview of research on H-MSM. METHODS: A scoping review will be conducted to identify and describe the identity development, attraction, and behaviour of H-MSM. This scoping review will also identify and describe current trends related to the recruitment of H-MSM and recommend directions for future research. Searches will be conducted in Academic Search Complete, APA PsychInfo, CINAHL Plus with full text, Education Research Complete, Gender Studies Database, GenderWatch, Health Source: Nursing/Academic Edition, LGBTQ + Source, MEDLINE, Psychology and Behavioral Sciences Collection, SocINDEX with full text, Sociological Collection, Social Work Abstracts, ProQuest Dissertations and Theses, and ResearchGate. Primary research studies published in peer-reviewed journals will be included. Dissertations and theses that include primary research on H-MSM will also be included. Reference lists, experts in the field, preprint servers, and relevant conferences will also be consulted for extant and in-progress literature. Two reviewers will independently pilot the data extraction form and conduct the title and abstract screening, with consultation from a research librarian. Seven reviewers will then conduct the full-text article screening. Thematic content analysis will guide the review; through independent review and reviewer meetings, themes and subthemes will be identified and reported from the extracted literature. DISCUSSION: This is the first known knowledge synthesis on H-MSM, seeking to better understand sexual identity-behaviour discordance amongst cisgender men. We anticipate that a theoretical framework of H-MSM's sexuality, internal processes, and behaviours will be constructed from this review. Alongside implications for further research with H-MSM, this review may be relevant to sexually transmitted infection public health and to clinicians working in the field of male sexuality. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework: https://doi.org/10.17605/OSF.IO/MVY9H.