Lesbian, Gay, and Bisexual Adults: Childhood Gender Nonconformity, Childhood Trauma, and Sexual Victimization.

The present study examined whether the relationship between childhood gender nonconformity and sexual victimization in adulthood among lesbian, gay, and bisexual (LGB) same-sex attracted men and women is mediated by experiences with childhood trauma experiences by an adult family member. Data are based on a survey among same-sex attracted individuals ( N = 2,352; 1,396 men and 956 women; Mage= 44.97) recruited from an online research panel. Participants completed an online questionnaire consisting of existing scales. Sixteen percent of the participants reported that they had experienced sexual victimization as an adult. There were gender differences: Men reported less childhood gender nonconformity and women more often reported experiences with childhood trauma by an adult family member and sexual victimization as an adult. Bootstrapped mediation analysis and follow-up moderated mediation analyses showed that childhood trauma significantly mediated the relation between childhood gender nonconformity and experiences of sexual victimization for men but not for women. In other words, for men higher levels of childhood gender nonconformity predicted experiences with childhood trauma by an adult family member, which in turn predicted the higher prevalence of sexual victimization. Implementations of these findings are that interventions aimed at increasing the social acceptance of gender nonconformity might also lower the levels of childhood trauma and sexual victimization among gay and bisexual men. Professionals working with children (and especially with boys) should be aware of the impact of gender nonconformity on childhood trauma and experiences of sexual victimization later in life.

A Population-Based Comparison of Female and Male Same-Sex Parent and Different-Sex Parent Households.

This investigation compared Dutch same-sex parent and different-sex parent households on children's psychological well-being, parenting stress, and support in child rearing. It was also assessed whether associations among children's well-being, parenting stress, and support in child rearing were different in the two household types. Data were based on a nationally representative survey (N = 25,250). Matching was used to enhance similarity in background characteristics between both types of families. Parental and child characteristics were matched for 43 female same-sex parent, 52 male same-sex parent, and 95 different-sex parent households with offspring between 5 and 18 years old. No significant differences were found on children's well-being, problems in the parent-child relationship, being worried about the child, or the use of formal and informal support between mothers in same-sex and different-sex parent households or for fathers in same-sex and different-sex parent households. Regarding perceived confidence in child rearing, fathers in same-sex parent households and mothers in different-sex parent households felt less competent than their counterparts. Neither the associations between children's well-being and the predictors (parenting stress variables) nor those between support and the predictors (parenting stress and children's well-being) differed along household type. In this population-based study, the similarity in child outcomes regardless of household type confirms the results of prior investigations based on convenience samples. These findings are pertinent to family therapists, practitioners, court officials, and policymakers who seek information on parenting experiences and child outcomes in female and male same-sex parent families.

Gender nonconformity and mental health among lesbian, gay, and bisexual adults: Homophobic stigmatization and internalized homophobia as mediators.

We assessed among a sample of 724 Dutch lesbian, gay, and bisexual-identified adults ( Mage = 31.42) whether experiences with homophobic stigmatization and internalized homophobia simultaneously mediated the relation of gender nonconformity with mental health. Results indicated that homophobic stigmatization and internalized homophobia partially mediated the relation between gender nonconformity and mental health. Gender nonconformity was related to more mental health problems via increased experiences with homophobic stigmatization and to less mental health problems because of reduced levels of internalized homophobia. However, the mediated relation of gender nonconformity with mental health via homophobic stigmatization was only significant for men.

Growing Up With the Right to Marry: Sexual Attraction, Substance Use, and Well-Being of Dutch Adolescents.

PURPOSE: To assess the well-being and substance use of sexual minority adolescents growing up in a tolerant society, we examined differences among same-sex attracted (SSA), those who do not know their attraction yet (not yet attracted [NYA]), and heterosexual Dutch adolescents. METHODS: Unadjusted and adjusted logistic and linear multilevel analyses were performed using representative data of the 2013 Health Behaviour in School-Aged Children study (N = 5,995; 11-16 years old). The adjusted analyses controlled for sociodemographics (gender, age, education type, ethnicity, urbanicity, and religion). RESULTS: Adjusted results showed that SSA adolescents substantially more often reported alcohol use (adjusted odds ratio [AOR] = 2.01), tobacco smoking (AOR = 2.37), and cannabis smoking (AOR = 3.52) than their heterosexual peers, while NYA participants less often reported alcohol use (AOR = .57) and equal levels of tobacco (AOR = .71) and cannabis smoking (AOR = .87) compared with heterosexual adolescents. SSA adolescents reported lower levels of life satisfaction (b = -1.25) and higher levels of psychosomatic complaints (b = .61) and emotional problems (b = 1.57) than heterosexual adolescents. NYA adolescents reported equal levels of life satisfaction (b = -.18) and psychosomatic complaints (b = .06) as heterosexual adolescents, but higher levels of emotional problems (b = .51). CONCLUSIONS: In Dutch society, with over 20 years of inclusive policies for sexual minorities and generally tolerant population attitudes toward sexual minorities, SSA adolescents are still at increased risk of substance use and have lower levels of well-being compared with peers.

A Comparative Analysis of a Community and General Sample of Lesbian, Gay, and Bisexual Individuals.

Samples recruited at lesbian, gay, and bisexual (LGB) venues have certain benefits, but a major drawback is that these samples are prone to bias as they only contain LGB participants who visit such venues. Empirical data with regard to the potential differences between LGB community samples and LGB general samples may shed some light on the generalizability of research findings from convenience samples recruited through LGB venues. The current study attempted to contribute to existing knowledge by examining differences in social demographics, sexual orientation, minority stress, and mental health between a convenience sample recruited at LGB venues ("community sample," N = 3,403) and an LGB sample recruited from a general research panel in the Netherlands ("panel sample," N = 1,000). Various differences were found. In general, community participants were younger, reported a more exclusive same-sex sexual orientation, were more open about their sexual orientation, had lower levels of internalized homonegativity, and encountered more negative social reactions on their LGB status. They also reported higher levels of psychological distress and suicidality. The Nagelkerke R (2) of the analyses (which were adjusted for sociodemographic differences) ranged from .08 (suicide plans among men) to .27 (sexual attraction among women). However, while the estimates of sociodemographics, sexual orientation, minority stress, and mental well-being differed, the relationships between these constructs were comparable in both samples. Implications and suggestions for future studies are discussed.

Mostly Heterosexual and Lesbian/Gay Young Adults: Differences in Mental Health and Substance Use and the Role of Minority Stress.

Individuals mostly attracted to other-sex but also to same-sex partners are a distinct and common sexual orientation group with possibly increased levels of health problems. The current study examined whether mostly heterosexual individuals differed in mental health and substance use from lesbian/gay individuals and whether sexual minority risk and protective factors offer an explanation in a sample of 528 Dutch young adults (16 to 25 years old, M = 21.2 years). Mostly heterosexual participants reported higher levels of psychological distress, suicidality, drug use, and smoking than lesbian/gay participants and equal levels of binge drinking. They also reported higher levels of internalized negativity to same-sex attractions, less openness to family members and others, less community involvement, and lower numbers of lesbian/gay/bisexual friends. However, bootstrapped mediation analysis showed that the differences in minority stress risk and protective factors did not mediate most of the differences in mental health and substance use with one exception: higher levels of psychological distress were mediated by the higher levels of internalized negativity to same-sex attractions. The limited explanatory power of the minority stress factors combined with the elevated level of problems of mostly heterosexual individuals call for future studies examining other risk and protective factors.

Distress, need for help, and positive feelings derived from participation in sex research: findings of a population study in The Netherlands.

To inform cost-benefit analyses of potential harms and benefits for participants in sex research, the current study investigated potential effects of completing a self-report sex survey. The data stem from a sexual health study in a population sample in the Netherlands (N = 8,064; 15 to 70 years old). Three measures assessed potential effects of participation: distress, need for help, and positive feelings related to research participation. Analyses showed that levels of experienced distress and need for help resulting from participation in a self-report sex survey were low, while participants reported positive feelings to a considerable extent. Only few participants reported levels of positive experiences that were lower than the levels of distress (4.8%) or need for help (1.7%) they experienced. Although differences were found according to sociodemographic characteristics and sexual experiences, the proportion of variance explained by these variables was generally small. While the findings of this study show that the balance between potential harm and positive outcomes seems disturbed for few participants, researchers should provide participants with the details of care providers in case they experience any distress or need for help.

Gender identities and gender dysphoria in the Netherlands.

Several studies estimate the prevalence of gender dysphoria among adults by examining the number of individuals turning to health services. Since individuals might be hesitant to seek medical care related to gender dysphoria, these studies could underestimate the prevalence. The studies also lack information regarding the variance among different aspects of gender dysphoric conditions. Therefore, the current study estimated the prevalence by examining self-reported gender identity and dysphoria in a Dutch population sample (N = 8,064, aged 15-70 years old). Three measures assessed aspects of gender dysphoria: gender identity, dislike of the natal female/male body, and wish to obtain hormones/sex reassignment surgery. Results showed that 4.6 % of the natal men and 3.2 % of the natal women reported an ambivalent gender identity (equal identification with other sex as with sex assigned at birth) and 1.1 % of the natal men and 0.8 % of the natal women reported an incongruent gender identity (stronger identification with other sex as with sex assigned at birth). Lower percentages reported a dislike of their natal body and/or a wish for hormones/surgery. Combining these figures estimated the percentage of men reporting an ambivalent or incongruent gender identity combined with a dislike of their male body and a wish to obtain hormones/surgery at 0.6 %. For women, this was 0.2 %. These novel findings show that studies based on the number of individuals seeking medical care might underestimate the prevalence of gender dysphoria. Furthermore, the findings argue against a dichotomous approach to gender dysphoria.

Gender differences in patterns of experienced sexual coercion and associated vulnerability factors among young people in the Netherlands.

The development of effective policies and programs to prevent sexual coercion among young people requires thorough understanding of the diversity of coercive sexual experiences, patterns in such types of experiences, and similarities and differences between subgroups, especially by gender, in patterns of coercive sexual experiences and associations with potential vulnerability factors. The present online self-report study assessed a wide range of coercive sexual experiences and potential vulnerability factors among a sociodemographically diverse sample of 1,319 young people (16-25 years old) in The Netherlands. Findings confirm that sexual coercion comprises a diversity of experiences, with rates differing substantially across types of coercion. Latent class analysis revealed distinct patterns of coercive sexual experiences for young women and young men. Among young men, three patterns of experiences were found: no coercive sexual experiences, experience with verbal pressure, and experience with verbal pressure as well as coercion related to alcohol intoxication. Among young women, four patterns of coercive experiences were identified. In addition to the three patterns observed among young men, a fourth pattern encompassed experiences with verbal pressure as well as the use of force or violence. Higher numbers of sexual partners, lower levels of sexual refusal skills, and higher levels of token resistance were consistently associated with increased vulnerability. Findings illustrate the importance of communication skills and suggest that sexual communication training should be an integral part of sexuality education.

Does viewing explain doing? Assessing the association between sexually explicit materials use and sexual behaviors in a large sample of Dutch adolescents and young adults.

INTRODUCTION: Concerns have been voiced that the use of sexually explicit materials (SEMs) may adversely affect sexual behaviors, particularly in young people. Previous studies have generally found significant associations between SEM consumption and the sexual behaviors investigated. However, most of these studies have focused on sexual behaviors related to sexually transmitted infections or sexual aggression and/or failed to adequately control for relevant covariates. Thus, research more thoroughly investigating the association between SEM consumption and a broader range of sexual behaviors is needed. AIMS: The study aims to investigate SEM consumption patterns of young people, and to assess the strength of the association between SEM consumption and a range of sexual behaviors, controlling for a comprehensive array of variables previously shown to affect these relationships. METHODS: Online cross-sectional survey study of 4,600 young people, 15-25 years of age, in The Netherlands was performed. MAIN OUTCOMES MEASURES: The main outcome measures were self-reported SEM consumption and sexual practices. RESULTS: The study found that 88% of men and 45% of women had consumed SEM in the past 12 months. Using hierarchical multiple regression analyses to control for other factors, the association between SEM consumption and a variety of sexual behaviors was found to be significant, accounting for between 0.3% and 4% of the total explained variance in investigated sexual behaviors. CONCLUSIONS: This study suggests that, when controlling for important other factors, SEM consumption influences sexual behaviors. The small to moderate associations that emerged between SEM consumption and sexual behavior after controlling for other variables suggest that SEM is just one factor among many that may influence youth sexual behaviors. These findings contribute novel information to the ongoing debates on the role of SEM consumption in sexual behaviors and risk, and provide appropriate guidance to policy makers and program developers concerned with sexual education and sexual health promotion for young people.

Doing more good than harm? The effects of participation in sex research on young people in the Netherlands.

Ethical guidelines for research with human participants stress the importance of minimizing risks and maximizing benefits. In order to assist Institutional Review Boards (IRBs) and researchers to make more informed risk/benefit analyses with regard to sex research among adolescents, the current study examined the effects of participation in sex research among 899 young people (15-25 years old). Participants completed three questionnaires on a wide range of sexuality-related measures. They also completed scales measuring their levels of distress, need for help, and positive feelings due to their research participation. In general, negative effects of research participation seemed limited, while benefits of participation appeared substantial. Several differences with regard to sociodemographic characteristics were found (e.g., females experienced more distress then males and younger or lower educated participants experienced more positive feelings). In addition, victims of sexual coercion reported more distress and need for help due to their participation, but also experienced more positive feelings. No significant differences were found in relation to experience with sexual risk behaviors (e.g., experience with one-night-stands). Several limitations of the study were discussed, as were implications for future research. Overall, the findings caution IRBs and researchers against being overly protective regarding the inclusion of young people in sex research.

Minority stress and mental health among Dutch LGBs: examination of differences between sex and sexual orientation.

Minority stress is often cited as an explanation for greater mental health problems among lesbian, gay, and bisexual (LGB) individuals than heterosexual individuals. However, studies focusing on sex or sexual orientation differences in level of minority stress and its impact on mental health are scarce, even more so outside the United States. Performing secondary analyses on the data of a Dutch population study on sexual health, the present study examines the robustness of the minority stress model by explaining mental health problems among men and women with mostly or only same-sex sexual attraction, and men and women who are equally attracted to same-sex and opposite-sex partners in the "gay-friendly" Netherlands (N = 389; 118 gay men, 40 bisexual men, 184 lesbian women, and 54 bisexual women). Results showed that minority stress is also related to mental health of Dutch LGBs. Participants with a higher level of internalized homonegativity and those who more often encountered negative reactions from other people on their same-sex sexual attraction reported more mental health problems. Such negative reactions from others, however, had a stronger link with mental health among lesbian/gay than among bisexual participants. Openness about one's sexual orientation was related to better mental health among sexual minority women, but not among their male counterparts. Suggestions for future research, implications for counseling, and other societal interventions are discussed.

Examining sexual health differences between lesbian, gay, bisexual, and heterosexual adults: the role of sociodemographics, sexual behavior characteristics, and minority stress.

Many studies focus on the differences in mental health between lesbian, gay, bisexual (LGB), and heterosexual individuals. Less attention has been paid to the differences in various aspects of sexual health and the potential explanations for these differences. Data from a Dutch population study on sexual health (aged 19-70 years; N = 4,333) were used to examine the potential differences in sexual satisfaction, sexual victimization, sexual dysfunction, and sexual health care need. At the same time, this study examined whether the differences could be attributed to differences in general factors influencing sexual health (sociodemographic variables and sexual behavior characteristics) or to LGB-specific factors (minority stress). The results showed that bisexual women and bi- and homosexual men had more often experienced sexual coercion and reported a higher need for sexual health care than their heterosexual counterparts. Both general determinants (e.g., a higher number of sexual partners or being single) and LGB-specific factors (e.g., internalized homonegativity or negative social reactions related to sexual orientation) were associated with different aspects of sexual health. Interventions aimed at improving the sexual health of LGB individuals should focus on general risk factors, as well as on LGB-specific stressors. Methodological limitations of the study and implications for further research are discussed.

Loneliness among older lesbian, gay, and bisexual adults: the role of minority stress.

Past research has consistently found that aging lesbians, gay men, and bisexuals (LGBs) are more apt to suffer from loneliness than their heterosexual counterparts. Data from the 2002 Gay Autumn survey (N = 122) were used to find out whether minority stress relates to higher levels of loneliness among older LGB adults in the Netherlands. We examined five minority stress factors: external objective stressful events, expectations of those events, internalized homonegativity, hiding and concealment of one's LGB identity, and ameliorating processes. The results showed that greater insight into loneliness among older LGB adults was obtained when minority stress factors were considered. Older LGB adults who had experienced negative reactions, as well as aging LGBs who expected those reactions, had the highest levels of loneliness. Having an LGB social network buffered against the impact of minority stress. These minority stress processes added to the variance already explained by general factors that influenced levels of loneliness (partner relationships, general social network, physical health, and self-esteem). Interventions aimed at decreasing feelings of loneliness among older LGBs should be focused on decreasing societal homonegativity (to decrease the amount of negative and prejudiced reactions) and on the enhancement of social activities for LGB elderly.

High levels of same-sex experiences in the Netherlands: prevalences of same-sex experiences in historical and international perspective.

Some authors suggest that the public stance toward homosexuality can influence the prevalence of same-sex experiences (e.g., Butler, 2005). Since the Dutch stance toward homosexuality has become more positive during the last decades, it was hypothesized that the current Dutch prevalences of same-sex experiences are higher than in other times and countries. This hypothesis was investigated using the data of a recent Dutch population study, and comparing these results to those from previous and international studies. The current Dutch figures were indeed higher than recent figures from other countries. Among women, the recent figures were also higher than those found in previous Dutch studies. The prevalence of same-sex experiences among Dutch males stayed the same. These results and the methodological aspects of the study are discussed.

Influencing risk behavior of sexually transmitted infection clinic visitors: efficacy of a new methodology of motivational preventive counseling.

A quasi-experimental study was conducted at a Dutch sexually transmitted infection (STI) clinic to compare the effects of educational counseling and motivational interviewing (MI)-based HIV/STI counseling on determinants of condom use and partner notification at 6-month follow-up. It also examined the feasibility of MI-based counseling in a busy real-life clinic. The counseling approaches were historically compared: respondents in the control condition were recruited between April and July 2005, those in the experimental condition between September and December 2005. The study involved 428 participants. These were all high-risk clients of the STI clinic. Their mean age was 33.7 years, and 39.6% were female. The study showed that MI-based counseling had a more positive effect on self-efficacy, intentions to use condoms with casual partners, and long-term condom use with steady partners. It had no adversarial outcomes on other social cognitions or behaviors compared to educational counseling. Furthermore, MI-based counseling is experienced as a more respectful and structured way of counseling. MI-based counseling was relatively easily implemented into the current clinic procedures. In addition to the implementation of the training, neither specialized staff nor additional or longer client visits were needed. However, some nurses indicated that the new method required more personal investment and effort. Limitations of the current study are the low response rates, the high educational level of most participants, and the small sample size regarding partner notification. Nonetheless, we conclude that MI-based counseling was a more effective approach to preventive counseling compared to educational counseling and feasible in the busy real-life setting.

The relation between social embeddedness and loneliness among older lesbian, gay, and bisexual adults in the Netherlands.

Research has shown that aging lesbians, gay men, and bisexuals (LGBs) often experience feelings of loneliness. The main aim of this study was to examine whether older LGB adults in the Netherlands are lonelier than their heterosexual counterparts and, if so, whether the higher levels of loneliness can be attributed to a lower degree of social embeddedness. Using data from the Gay Autumn project and the NESTOR survey on Living Arrangements and Social Networks of Older Adults, we found that LGB elders were significantly lonelier and less socially embedded than heterosexual elders. Compared with their heterosexual peers, older LGBs were more likely to have experienced divorce, to be childless or to have less intensive contact with their children. They also had less intensive contact with other members of their families and they were less frequent churchgoers. Their weaker level of social embeddedness, however, only partially explained the stronger feelings of loneliness among older LGB adults. Nor could their higher levels of loneliness be attributed to other, non-social embeddedness factors (health, living conditions, self-esteem, and socioeconomic status). Emphasis on other aspects of social embeddedness, such as the quality of social relationships in the private domain and minority stress, is an important challenge for future research.

Condom use at first intercourse with a new partner in female adolescents and young adults: the role of cognitive planning and motives for having sex.

This study examined the extent to which cognitive planning and motives for sex can explain condom use at first intercourse with young females' most recent partner. A total of 133 female adolescents completed a questionnaire on cognitive planning (i.e., mentally preparing oneself for discussing condom use and for managing condoms), motives for having sex (i.e., having sex to express love, to experience pleasure, to enhance mood, and to please others), and condom use at this particular occasion. Logistic regression analyses showed that condom use was positively related to cognitive planning with respect to discussing condom use and negatively related to the motive for having sex to enhance mood. Cognitive planning for the management of condoms did not have a significant overall effect on condom use, but it did appear to be very effective for those adolescents who had a low score on the motive for having sex to express love. It thus appears useful to strengthen the skills of adolescents to discuss the use of condoms. Furthermore, stressing the negative affective consequences of unsafe sex may be particularly effective for those who are inclined to have sex to enhance mood, while encouraging adolescents to make plans for the management of condoms is likely to positively affect the use of condoms among those who are not primarily motivated to express love by having sex.

Need for intimacy in relationships and motives for sex as determinants of adolescent condom use.

PURPOSE: To investigate the extent to which need for intimacy in relationships and motives for sex are capable of distinguishing between adolescents who always have protected sex and adolescents who do not, with reference to both steady and casual relationships. METHODS: Seven-hundred-and-one adolescents (424 males and 277 females) aged 15 to 23 years filled out a questionnaire assessing determinants of sexual behavior and various outcome behaviors, such as having casual sex and condom use. RESULTS: Two-thirds of the participants (470) were sexually experienced. Discriminant functions using constructs of the Theory of Planned Behavior (attitude, subjective norm, self-efficacy), as well as the need for intimacy in relationships and motives for sex, were found to distinguish significantly between adolescents who always had protected sexual intercourse and adolescents who did not. This was valid both for sex within steady and within casual relationships. Besides a positive attitude and high perceived subjective norms, protected sex with a steady partner was characterized by low scores on the scale for the motive for sex to express love, and on the scale for the need for intimacy in relationships. Consistent condom use with casual partners was related to high self-efficacy, attitude, and perceived subjective norms, as well as a greater need for intimacy in relationships. Gender differences emerged with respects to determinants of (un)safe sex with casual partner(s), in that for males the variables of the Theory of Planned Behavior were most important in distinguishing those who had unsafe casual sex from those who had safe casual sex. For females, on the other hand, the variables concerning the meaning attached to having sex or to the relationship within which sex occurs seemed to be of more significance in explaining (un)safe sex with casual partner(s). However, owing to small subsamples, caution is warranted when interpreting these differences. CONCLUSIONS: In adolescence, the factors which influence the decision to have (un)protected sex depend on the kind of relationship that exists between the partners. In addition, the goals which adolescents pursue with regard to their relationships and with regard to having sex fulfill an important role in the decision-making process whether to use condoms.