Differences in Mental Health Between Female Sexual Minority and Heterosexual Youth with a Substance Use Disorder Who Are Experiencing Homelessness.

Purpose: The purpose of this study was to examine differences in mental health outcomes of two groups within youth experiencing homelessness (YEH) and who have a substance use disorder (SUD): sexual minority (SM) and heterosexual females. Methods: This study used baseline data from four randomized clinical trials of substance use interventions for YEH with a SUD to examine differences in depression and suicidality between SM and heterosexual female youth. Participants were between 12 and 24 years of age. Meta-analytic methods were used to aggregate data across studies to estimate differences in mental health. Results: Results indicated that female SM-YEH had higher depression symptoms (Hedge's g [g]=0.20; 95% confidence interval [CI] 0.01-0.39), higher risk of a history of suicide behavior (risk ratio = 1.63; 95% CI: 1.17-2.27), and a greater number of suicide behaviors (g = 0.31; 95% CI: 0.09-0.54) compared to their heterosexual peers. These effect sizes were not moderated by age. Conclusion: Female SM-YEH had elevated levels of depression and suicidality compared to their heterosexual peers. The findings of this study align with research on mental health disparities between SM and heterosexual youth generally, which underscores the unique struggles and risks associated with identifying as a female SM-YEH with a SUD.

Physiotherapy students hold varying attitudes, beliefs and learning preferences regarding LGBTQIA+ healthcare: a mixed methods study.

QUESTIONS: What are physiotherapy students' attitudes and beliefs towards providing care for lesbian, gay, bisexual, transgender, queer, intersex, asexual and other related identities (LGBTQIA+) individuals? What education have students received on LGBTQIA+ healthcare needs? What are students' preferences for receiving this content? DESIGN: Mixed-methods design using a purpose-built online survey. PARTICIPANTS: Australian undergraduate and postgraduate physiotherapy students. METHODS: Participants were invited to complete an online survey. Data were collected on: personal, clinical, professional and educational exposure to LGBTQIA+ identities and topics; heteronormative attitudes and beliefs via the modified Heteronormative Attitudes and Beliefs Scale (mHABS); and perspectives about LGBTQIA+ care. Welch's t-test and analysis of variance were used to analyse differences in mHABS and subscale scores between groups based on personal, clinical, professional and educational exposure. Open text responses were analysed thematically. Quantitative and qualitative data were first analysed separately and then cross-validated for integration in the results. RESULTS: The survey was completed by 324 eligible students. Cross-comparison of data generated four key themes pertaining to students' perspectives about working with the LGBTQIA+ community and education about LGBTQIA+ health: students with closer personal relationships to the LGBTQIA+ community demonstrated more inclusive attitudes and beliefs about LGBTQIA+ care and education; there are cis/heteronormativity and negative views towards LGBTQIA+ health; students who are ambivalent about LGBTQIA+ care hold egalitarian beliefs; and integrated education on LGTBQIA+ health delivered by members of the community is important. CONCLUSION: Physiotherapy students' attitudes and beliefs about the LGBTQIA+ community were diverse, with cis/heteronormativity prevalent in respondents. Students with closer relationships to the LGBTQIA+ community demonstrated more inclusive attitudes and beliefs. The lack of understanding of LGBTQIA+ needs and relevance to physiotherapy highlights the need for improved LGBTQIA+ education in physiotherapy curricula.

Culturally-sensitive and Inclusive IBD Care.

As the prevalence of inflammatory bowel disease (IBD) increases within historically disadvantaged communities, it is imperative to better understand how intersectionality-defined as the complex, cumulative way in which the effects of multiple forms of discrimination (such as racism, sexism, and classism) - intersect and social determinants of health influence the patient's experiences within the medical system when navigating their disease. Culturally-sensitive care is characterized by the ability to deliver patient-centered care that recognizes how the intersectionality of an individual's identities impacts their disease journey. An intentional consideration and sensitivity to this impact play important roles in providing an inclusive and welcoming space for historically disadvantaged individuals living with IBD and will help address health inequity in IBD. Cultural competence implies mastery of care that understands and respects values and beliefs across cultures, while cultural humility involves recognizing the complexity of cultural identity and engaging in an ongoing learning process from individual patient experiences. Heightening our patient care goals from cultural competence to cultural sensitivity allows healthcare professionals and the systems in which they practice to lead with cultural humility as they adopt a more inclusive and humble perspective when caring for patient groups with a diverse array of identities and cultures and to avoid maintaining the status quo of implicit and explicit biases that impede the delivery of quality IBD care. In this article, we will review the literature on IBD care in historically disadvantaged communities, address culturally-sensitive care, and propose a framework to incorporating cultural humility in IBD practices and research.

Vicarious heterosexism-based stress induces alcohol, nicotine, and cannabis craving and negative affect among sexual minority young adults: An experimental study.

Purpose: Sexual minority young adults are at increased risk for hazardous drinking and alcohol use disorder compared to heterosexual adults. Heterosexism-based stressors contribute and often explain inequities in alcohol outcomes. However, the extant research primarily relies on correlational designs, and often neglects the importance of alcohol craving, despite its foundational role in addiction. Leveraging a novel experimental mood induction paradigm, this study examined the effects of exposure to vicarious heterosexism-based stress on alcohol craving and negative affect among sexual minority young adults who drink heavily. We also examined its effects on cannabis and nicotine craving among participants who used cannabis and nicotine, respectively. Lastly, we examined moderating factors that could influence the impact of exposure to heterosexism-based stress on alcohol craving. Methods: Participants were 101 heavy drinking sexual minority young adults, ages 20-35 (M = 26.46 years old; SD = 3.49), recruited from the community (51.5% female sex assigned at birth; 76.3% cisgender; 51.5% plurisexual; and 42.6% racial and ethnic minorities). They completed three mood induction trials counterbalanced over three visits on different days: heterosexism stress, general stress, and neutral. Structured interviews assessed criteria for DSM-5 alcohol use disorder (AUD) and substance use, and self-report measures assessed lifetime traumatic stressors. Results: Most participants met criteria for past-year AUD (74.7%). Exposure to heterosexism stress produced more negative affect and substance craving than the neutral mood induction, even while controlling for demographic variables and lifetime exposure to traumatic and heterosexism stressors. Exposure to heterosexism-based stress had large effects on alcohol craving among participants who had greater drinking to cope motives and heterosexism-specific rejection sensitivity, whereas the effects were small for those who had lower drinking to cope motives and heterosexism-specific rejection sensitivity. Demographic, lifetime stress, prior alcohol use, and AUD symptom severity variables were not significant moderators. Greater substance craving induced by heterosexism-based stress in the laboratory was associated with greater recent and current substance use. Conclusions: This study findings show that vicarious exposure to heterosexism elicits negative mood and alcohol, cannabis, and nicotine craving among sexual minority young adults who engaged in heavy drinking. The effects for alcohol craving were largest among those who endorse high levels of drinking to cope motives and heterosexism-based rejection sensitivity. These findings have implications for oppression-based stress and motivational models of addiction.

Does sexual rehabilitation work for gay and bisexual prostate cancer patients? Acceptability, feasibility, and efficacy results from the Restore-2 randomized controlled trial.

PURPOSE: Sexual minority prostate cancer patients have worse health-related quality of life outcomes than heterosexual patients. We conducted the first study to test whether sexual and urinary rehabilitation tailored for sexual minority patients was acceptable, feasible, and efficacious at improving their sexual and urinary function. METHODS: Restore-2 was a 24-month randomized controlled trial of an online biopsychobehavioral rehabilitation study for sexual minority men treated for prostate cancer experiencing sexual and/or urinary problems. Participants were 401 US sexual minority men treated for prostate cancer and experiencing sexual and/or urinary problems at baseline. Intervention components included phosphodiesterase-5 inhibitors, sexual aids, a pelvic floor exercise regimen and video, a guide to good gay sex following treatment, and coaching. Quality of life assessments were completed at baseline, 3, 6, 12, 18, and 24 months. RESULTS: We confirmed good acceptability and feasibility, but only minimal improvement was observed over time and no differences were found between treatment and control arms. CONCLUSIONS: We found no evidence that the intervention improved sexual or urinary outcomes for participants. However, we confirmed excellent acceptability and feasibility for a sexual rehabilitation program tailored to sexual minority participants. In addition, participants reported enduring usage and acceptability of sexual aids (including vacuum pump, anal dilators, and penile constriction rings) as well as masturbation and pelvic floor exercises to accommodate their sexual challenges. IMPLICATIONS FOR CANCER SURVIVORS: Sexual "accommodation," rather than "rehabilitation," may be a more accurate and realistic goal for this population. Patients should be provided sexual aids to help accommodate their sexual and urinary challenges. TRIAL REGISTRATION: This study was retrospectively registered with ClinicalTrials.gov, study number: NCT03923582; date: 22/04/2019.

Measurement Invariance of the Four-Item Entrapment Scale Short-Form (E-SF): A Transnational Examination Across Race/Ethnicity, Sexual Orientation, and Suicide Attempt History Among Minoritized Adults.

Feelings of entrapment-posited to arise when attempts to escape from defeating or humiliating circumstances are blocked-may confer increased risk for psychopathology and suicidal thoughts and behaviors (STB), particularly among minoritized individuals who often have more frequent exposure to such experiences. Including entrapment in empirical models may aid research efforts in further exploring its role in minority mental health. The Entrapment Scale Short-Form (E-SF), a brief version of the 16-item Entrapment Scale, is one tool that may be utilized toward this end; however, to do so meaningfully, its psychometric properties and measurement invariance must be evaluated in diverse samples. This study aimed to examine the factor structure, measurement invariance, and convergent validity of the E-SF across race/ethnicity and sexual orientation in a combined transnational sample of minoritized adults (total N = 1,194). Results supported a one-factor model of the E-SF that was invariant across samples, race/ethnicity, sexual orientation, and history of suicide attempt. Furthermore, significant positive correlations observed between theoretically relevant constructs of anxiety, depression, and posttraumatic stress disorder symptoms supported its convergent validity. Implications include disproportionate levels of entrapment experienced by minoritized individuals-particularly by sexual minorities-which likely reflect the discrimination frequently endured by these individuals.

Implementation and Evaluation of a Home-Based Pre-Exposure Prophylaxis Monitoring Option: Protocol for a Randomized Controlled Trial.

BACKGROUND: HIV prevention is a public health priority. Despite progress in recent years, pre-exposure prophylaxis (PrEP) use remains suboptimal especially among groups disproportionately impacted by new HIV diagnoses such as gender and sexual minorities of color. Multiple barriers including a lack of PrEP providers and challenges with attending quarterly monitoring visits contribute to low PrEP uptake and retention. Home-based PrEP (HB-PrEP) services could reduce stigma, increase convenience, expand health system capacity for PrEP care, and improve PrEP retention. OBJECTIVE: Home Option Testing for PrEP (HOT4PrEP) is a hybrid randomized controlled trial (RCT) that aims to examine whether HB-PrEP care is acceptable to PrEP users, feasible to implement in a sexual health clinic setting, and impacts PrEP retention. METHODS: The RCT will recruit 458 persons currently taking or soon to initiate PrEP at a sexual health clinic in Seattle, Washington, and randomize them to continue the standard of care or have the option to use HB-PrEP for 2 of 3 triannual PrEP follow-up visits. Participants in the intervention arm will be sent home kits containing gonorrhea and chlamydia swabs and Tasso devices for blood self-collection. The primary outcome is PrEP retention between groups at 20 months; secondary outcomes include user satisfaction and acceptability, feasibility, self-reported PrEP adherence, and sexually transmitted infection (STI) incidence. Interviews with PrEP users and clinic staff will elucidate barriers and facilitators of implementation. RESULTS: The HOT4PrEP RCT began enrolling in March 2022, was on hold during the height of the US mpox epidemic, then resumed enrollment in December 2022. Of the first 100 enrollees, the median age is 34 years, and most are cisgender gay men (89/100, 89%) with at least some college education (91/100, 91%). Among the 49 participants randomized to the HB-PrEP option, 33 (67%) chose to self-collect samples at home at least once, of whom 27 (82%) successfully returned test kits for HIV and STI testing. Primary PrEP retention and qualitative analyses are ongoing. CONCLUSIONS: Implementation of HB-PrEP into a high-volume sexual health clinic seems to be feasible and acceptable to early RCT enrollees. This strategy has the potential to address individual and systemic barriers associated with initiating and persisting on PrEP, such as increasing sexual health agency and expanding clinical capacity to serve greater numbers of PrEP users. TRIAL REGISTRATION: ClinicalTrials.gov NCT05856942; https://clinicaltrials.gov/study/NCT05856942. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56587.

Sexuality Minority Status, Victimization, Mental Health, and Substance Use.

Background: Prior research suggests that sexual minority status is related to victimization, mental health issues, and substance use. However, few studies have sought to connect these relationships in a way supported by theory, and fewer have utilized probability and/or nationally representative samples. Objective: The current study seeks to test the relationships among these variables, guided by general strain theory (GST). Methods: One wave of the National Longitudinal Study of Adolescent to Adult Health dataset (Add Health) (N = 14,121) and path modeling in Mplus are utilized. Results: Models run separately by race/ethnicity suggest that the relationship among these variables largely support expectations from GST, but with some notable differences by race/ethnicity. Conclusion: Results suggest a relationship among these variables that concurs with criminological theorizing. Implications and limitations are discussed.

The Relationship between Serving as a Mentor and Depressive Symptoms among Sexual Minority Men in the MACS Healthy Aging Study.

Sexual minority men (SMM) in the US are twice as likely to experience mental health challenges, including depressive symptoms, compared with their heterosexual counterparts. Having a like-mentor, or a sexual minority mentor, is associated with improved mental well-being among SMM mentees. However, few studies have explored the potential benefits to mentors. Using confirmatory factor analysis, we calculated a perceptions of mentoring score that encompasses experiences and beliefs regarding mentoring of SMM from the Healthy Aging Substudy of the Multicenter AIDS Cohort Study. We used a generalized estimating equations model to assess associations between perceptions of mentoring and clinically significant depressive symptoms adjusted for key covariates; models were also stratified by HIV serostatus. Among 1,246 men aged 40+ years, the strongest agreement was with the statement "I have encouraged people to be proud of their sexual orientation," for which 770 individuals (72%) indicated "Agree" or "Strongly Agree." Each unit increase in the mean perceptions of mentoring score was associated with 8% decreased odds of having clinically significant depressive symptoms (adjusted odds ratio: 0.92; 95% CI: 0.85-0.99). We show that SMM reported like-mentoring experiences and had positive mentoring beliefs, and that these were associated with a decreased odds of having depressive symptoms. Encouraging SMM to serve as like-mentors could be a way to counter depressive symptoms among this key population. There is a need for increased research regarding how mentoring programs can best be designed to benefit sexual minority mentees and mentors.

Women's Revenge in Sexual Behavior? An Interpretation About "The Fourth Love" in Chinese Youth Culture From the Perspective of Gender Performativity.

In the current era of exploring changing sexual behavior, promoting and supporting the diversity of pleasure, the sexual health and rights of sexual minorities are getting more public attention, among which the "Fourth Love" emerges as a distinctive group within the framework of Chinese culture. Fourth Love refers to a loving relationship between couples of the opposite sex where the woman assumes the traditional male gender role and the man assumes the traditional female gender role, and always accompanied by a special pattern of sexual behavior that women penetrate the men's anus using their fingers or a device. This theoretical article begins by introducing and discussing the historical background, core concept "Fourth Love" and its related categories. Subsequently, we start from Judith Butler's gender performativity theory and interpret the Fourth Love from the perspective of "de-naturalization" and argue that the gender performativity theory provides a reasonable explanation for the gender characteristics (female top and male bottom) of the Fourth Love. Finally, we posit a discussion and outlook on the survival and development of the Fourth Love in the fields of sexual health, sexual pleasure, sexual right, and family and marriage, and calls for more understanding and psychological support from the society for them.