Negative Associations between Minority Stressors and Self-Reported Health Status among Sexual Minority Adults Living in Colombia.

Colombia has extensive laws prohibiting discrimination against sexual minority people. However, violence and discrimination toward sexual minorities are still frequent. While a growing body of research shows that sexual minority people experience elevated rates of discrimination and domestic abuse globally, little research has been conducted on these issues affecting sexual minorities in Colombia specifically. Using minority stress theory as a conceptual framework, this paper aims to fill this gap by examining the prevalence of experiencing intimate partner violence (IPV) and witnessed discrimination and the relationship of these stressors to self-reported health among a national sample of sexual minority Colombians. We found that bisexual individuals experienced higher rates of physical and sexual IPV, compared to lesbian and gay individuals. Additionally, sexual minority Colombians who experienced IPV and witnessed discrimination were more likely to report having poorer health, compared to those who had not. We discuss the implications of our findings for future research and clinicians working with sexual minority clients.

'My safety depends on everyone else feeling safe and good': emotion work among transgender and gender diverse Texans.

Emotion work is a regulatory method used to change the degree or quality of one's own or another's emotions. Among sexual minority people, emotion work is a regulatory method utilised to maximise identity expression while maintaining harmony in interpersonal connections. However, little is known about the utilisation of emotion work among transgender and gender diverse (TGD) people. We sought to address this gap by qualitatively exploring emotion work among members of this population. We conducted semi-structured focus groups and interviews with 11 TGD adults. Eligibility criteria included (1) English speaking, (2) at least 18 years old, (3) currently living in Texas, and (4) identifying as TGD. Interviews explored identity-related experiences of discrimination and affirmation in different social environments, and emotional, physiological and behavioural responses. Interview transcripts were analysed by four researchers using thematic analysis. Four superordinate themes were developed: 1) feeling rules, 2) intrapersonal processes, 3) identity management strategies, and 4) psychophysiological strain. We found transgender and gender diverse participants feel responsible for emotion work to maintain comfort in social interactions often at the expense of authentic identity expression and psychosocial wellbeing. Findings are interpreted using the existing literature on identity management and emotion regulation. Implications for clinical practice are also provided.

Reproductive Coercion in Heterosexual and Sexual Minority Emerging Adults: Prevalence and Behavioral Health Impact.

Reproductive coercion (RC) is a type of intimate partner violence (IPV) characterized by partner interference with contraception or reproductive decision-making. Despite sexual minority people's vulnerability to other forms of IPV, limited research has examined reproductive coercion in this population. Research on behavioral health impacts of reproductive coercion is also lacking, especially for sexual minorities. This study addressed these gaps by examining the occurrence and behavioral health impact of reproductive coercion among emerging adults, including both heterosexual and sexual minority people. In 2020, survey data were collected with emerging adults (aged 18-24 years) at a university in the southeastern United States (N = 387). We conducted bivariate analyses to explore associates of reproductive coercion and logistic regression to identify risk factors. We then conducted linear regression to investigate relationships between reproductive coercion and behavioral health outcomes, in the full sample and in separate models based on sexual attraction. One in 15 sampled students (6.3%) had experienced reproductive coercion. Sexual attraction was a significant risk factor for reproductive coercion, with increased rates among plurisexual (i.e., attracted to people of multiple genders) compared to monosexual students, in both bivariate (χ2(2) = 7.57, p = .023) and regression analyses (B = 1.25, p = .012). Reproductive coercion was associated with worse behavioral health outcomes in bivariate and regression analyses (anxiety: B = 3.77, p = .001; depression: B = 3.26, p = .010; alcohol use: B = 2.32, p < .001). In separate linear regression models based on sexual attraction, RC was significantly associated with behavioral health indicators for participants who were attracted only to men and those attracted to people of multiple genders but not for participants who were attracted only to women. Findings indicated increased RC risk for plurisexual students compared to monosexuals and showed significant associations between RC and behavioral health outcomes, with differential effects based on sexual attraction. These novel findings support the need for continued research on RC, inclusive of nuanced conceptualizations of sexuality.

"It's the Environment, Not Me": Experiences shared by transgender and gender diverse adults living in Texas.

Transgender and gender diverse people (TGD) experience elevated rates of behavioral health problems, including depression, anxiety, substance misuse, and suicidality. Minority stressors (e.g., discrimination and victimization) contribute to these poor health outcomes. A salient form of discrimination is the use of gender nonaffirming language, such as using incorrect pronouns or names, yet less is known about other environmental stimuli that may be reined as affirming or nonaffirming. A recent study uncovered the impact symbols (e.g., flags, stickers) may have on invoking positive or negative feelings among TGD youth in the Midwest. Our study further investigates this phenomenon with TGD adults in Texas. During Summer 2021, 3 researchers conducted audio-recorded semistructured focus groups and interviews with 11 participants who identified as transgender, gender nonconforming, or nonbinary. Interview topics included gender-affirming and nonaffirming language, positive and negative experiences, nonsupportive and supportive symbolism, and coping mechanisms. In this manuscript, we present findings regarding symbolism. Within our two primary themes, supportive and nonsupportive symbolism, subthemes emerged. Supportive symbolism includes flags and signage, written and oral language and communication, and representation of diversity. Nonsupportive symbolism includes extreme patriotism and religious symbols and highly gendered settings. Further, Texas-specific culture and a meter of safety were identified as being related to interacting with and observing an array of symbols. Symbolism can have a profound impact on someone's identity development, expression, emotions, coping mechanisms, and access to and engagement with social environments, exemplifying the importance of understanding geographic and cultural-specific mechanisms within environments TGD people occupy.

Linking critical consciousness and health: The utility of the critical reflection about social determinants of health scale (CR_SDH).

INTRODUCTION: Critical consciousness (CC) theory has been proposed as a framework to inform health interventions targeting a wide variety of health conditions. Unfortunately, methodological limitations have made it difficult to test CC as a mediator of health outcomes. Specifically, standardized and widely accepted measures of health-related CC are needed. The goal of this study was to develop and test a measure of critical reflection on social determinants of health (SDH). This measure focused on critical reflection, an essential dimension of CC. METHODS: Community-based participatory research principles and a mixed methods design were used with three samples: (1) experts in SDH and CC, (2) 502 individuals completing online surveys, and (3) 602 men with histories of substance use disorder and incarceration. All participants were over 18 years of age. Analysis included descriptive frequencies, exploratory factor analyses (EFA), confirmatory factor analysis (CFA), generalized linear regression models, correlations, and Cronbach's alpha calculations. RESULTS: The Critical Reflection about SDH scale (CR_SDH) is a short, unidimensional, and reliable scale (α = 0.914). Construct validity was supported and known-groups validity showed that the scale discriminated different levels of CR_SDH based on political views, educational level, knowledge of health inequities, and gender. CONCLUSION: The CR_SDH is a standardized measure that can assess critical reflection about the impact of SDH on health among providers and consumers of health care. The CR_SDH can be used to identify critical reflection related training needs and inform decisions about development and testing of critical reflection related health interventions and health care policy.

Between cornfields and Kinfolk: Identity management among transgender youth in Midwestern families and communities.

Transgender and gender diverse (TGD) youth face high rates of discrimination and victimization in their communities and families that contribute to elevated rates of behavioral health concerns. While the individual links between community and family environments and well-being for this population are clear, how these environments work in unison remains unclear. Furthermore, the methods TGD youth use to manage their identities in these environments are not well understood. We address this gap by exploring the overlap between community climate and familial treatment of TGD identities and the methods TGD youth use to manage their identities in these environments. Semi-structured qualitative interviews were conducted with TGD youth (n = 19) in two Midwestern U.S. states. Thematic analysis was used to develop categories that represent the phenomena being investigated and to understand relationships between categories. Findings depict overlap about TGD people between three components of community climate and family members that shaped the treatment of TGD youth. Furthermore, community climate toward TGD people influenced identity management through the availability of proximal resources. Four methods of identity management emerged from the data: emotion work, educating, connections, and generativity. Findings are discussed in the context of current literature, and recommendations are made for future research and practice with TGD youth.

"Sometimes You Get Married on Facebook": The Use of Social Media Among Nonmetropolitan Sexual and Gender Minority Youth.

Sexual and gender minority (SGM) youth experience risks due to their stigmatized SGM identities; however, supportive resources and people can mitigate these risks. In nonmetropolitan areas, SGM-affirming support may not be readily available. The internet and social media may be a way for SGM youth to access support and resources pertaining to their SGM identities, yet little research has been conducted in this area. This qualitative, exploratory study utilized in-depth interviews (N = 34) with nonmetropolitan SGM youth in one Midwestern state to better understand how they utilized the internet and social media related to their SGM identities. Grounded theory analysis revealed three categories of social media and internet usage among participants. Participants utilized the internet to establish a sense of community (access others, form relationships), express themselves (come out, vent), and access resources and information. These findings suggest important implications for practice and research.

Suicidal Ideation Among Transgender and Gender Expansive Youth: Mechanisms of Risk.

Purpose: Suicide is a leading public health concern among transgender and gender expansive adolescents, although little research has examined mechanisms through which gender identity is associated with suicidal ideation. This study examined the indirect effects of peer victimization, dating violence, substance use (SU), SU problems, and depressive symptoms in the relationship between gender identity and suicidal ideation. Methods: Secondary data analysis was conducted from a 2018 statewide survey, including 4464 adolescents who identified as male, female, transgender, or gender expansive (n=1116 per gender). The sample was frequency matched on grade, race, geographic region, and free/reduced lunch status. Mediation analyses were performed. Results: Reports of suicidal ideation were highest among transgender (49.29%) and gender expansive (41.31%) adolescents compared with male (10.82%) and female adolescents (19.08%). Using the Karlson, Holm, and Breen approach, 50.45% of the effect of being transgender on suicidal ideation was mediated through peer victimization, dating violence, and depressive symptoms, and 39.29% through SU, SU problems, and depressive symptoms. The mediation through the same pathways for being gender expansive was 46.37% and 39.89%, respectively. Across both models, depressive symptoms predominately accounted for the mediating effect. Conclusion: Transgender and gender expansive youth are at alarming risk for suicidal ideation, which illustrates the critical need for suicide prevention within this population. Programs that promote mental health and work to prevent bullying, dating violence, SU, and SU problems are crucial; although longitudinal research is needed, targeting these mechanisms may play a critical role in reducing suicidal ideation and risk.

Dating Violence and Peer Victimization Among Male, Female, Transgender, and Gender-Expansive Youth.

BACKGROUND AND OBJECTIVES: Transgender adolescents experience disproportionately high rates of dating violence and peer victimization. However, research has relied on small samples of transgender youth and has not captured victimization experiences of gender-expansive youth (who do not identify as male, female, or transgender). In the current study, we address these limitations, comparing victimization by gender. METHODS: We examined a subsample of 4464 male, female, transgender, and gender-expansive youth (1116 per group) from the 2018 Illinois Youth Survey who were frequency matched on grade, race, geographic region, and free or reduced lunch status. Prevalence of self-reported verbal, physical, and cyber peer victimization and physical and psychological dating violence was calculated. Adjusted prevalence ratios were obtained by using log-binomial regression. RESULTS: The highest rates across all forms of victimization were reported among transgender (15.6%-51.6%) and gender-expansive (13.2%-41.4%) youth. Transgender youth had a 2.09 to 2.96 times higher frequency of victimization than male youth and a 1.34 to 2.65 times higher frequency of victimization than female youth. Transgender youth also had higher frequencies of specific forms of victimization than gender-expansive youth. Gender-expansive youth had a 1.83 to 2.61 times higher frequency of victimization than male youth and 1.18 to 2.35 times higher frequencies of most forms of victimization than female youth. CONCLUSIONS: Disparities in dating violence and peer victimization rates exist among transgender and gender-expansive adolescents compared with male and female youth. The distinct experiences of transgender and gender-expansive youth should be considered in school policies and violence prevention programs.

"It feels like home": Transgender youth in the Midwest and conceptualizations of community climate.

Community climate toward sexual and gender minority (SGM) youth is associated with higher rates of victimization and poorer health and wellbeing-related outcomes such as depression and suicidal ideation. However, this field of research has underemphasized the experiences of transgender youth, particularly within the Midwestern context which is marked by vast rurality and characterized as sociopolitically conservative. Using qualitative and community-based methods, this study identified factors that impact community climate from the perspective of transgender youth (n = 19) in the Midwest and situated them within the Ecological Systems Theory (EST). Thematic analysis of interviews revealed four themes: resources, visibility, policies, and ideologies. Themes often crossed levels within the EST, indicating the complexity and interrelated nature of climate across local, regional, and national contexts. Implications for theory, research, and practice are discussed.

Young Transgender Women Survivors of Intimate Partner Violence: A Latent Class Analysis of Protective Processes.

Research is critically needed to understand protective processes that may lessen the impact of intimate partner violence (IPV) on negative outcomes for transgender individuals. The current study utilized a latent class analysis to identify combinations of protective processes (i.e., collective self-esteem and social support) in relation to internalizing mental health symptoms among young transgender women (YTW) survivors of IPV. Data from Project LifeSkills (2012-2015), a multisite trial for HIV sexual risk reduction intervention, were used for the present study. A subsample of 78 YTW (ages 16 to 29) who were IPV survivors (i.e., indicated lifetime IPV) were included in the analyses. Participants completed measures of general social support, perceived social support from their mother and friends, and collective self-esteem, as well as mental health symptoms. Three latent classes emerged: 1) YTW who perceived high levels of social support and collective self-esteem (48%), 2) YTW who perceived low levels of collective self-esteem, but average to high levels of social support from mother and friends (23%), and 3) YTW who perceived low levels of collective self-esteem and low to average levels of social support from mother and friends (29%). YTW in the overall low class had significantly higher levels of depressive, anxiety, and somatization symptoms, compared to the other two classes. These findings highlight how low levels of social support and collective self-esteem can place YTW survivors of IPV at significant risk for experiencing negative internalizing mental health symptoms.

The Impact of Community Size, Community Climate, and Victimization on the Physical and Mental Health of SGM Youth.

Sexual and gender minority (SGM) youth experience high rates of victimization leading to health disparities. Community size and community climate are associated with health outcomes among SGM youth; however, we lack studies that include them as covariates alongside victimization to understand their collective impact on health. This study utilized minority stress theory to understand how community context shapes experiences of victimization and health among SGM youth. SGM youth in one Midwestern U.S. state completed an online survey (n = 201) with measures of physical health, mental health, community context, and victimization. Data were analyzed via multiple regression using a path analysis framework. Results indicate that perceived climate was associated with mental, but not physical, health; Community size was unrelated to health outcomes. Victimization mediated the association between community climate and mental health.