Sexual Identity Disclosure and Alcohol Experiences Among LGBTQ+ Adolescents.

Sexual and gender minority youth (SGMY) report greater alcohol use in comparison to their heterosexual counterparts. Prior research has found that elevated alcohol use among SGMY can be explained by minority stress experiences. Sexual identity outness may be another factor that drives alcohol use among SGMY, given that outness is associated with alcohol use among older sexual and gender minority samples. We examined how patterns of sexual identity outness were associated with lifetime alcohol use, past-30-day alcohol use, and past-30-day heavy episodic drinking. Data were drawn from the LGBTQ National Teen Survey (N = 8884). Participants were SGMY aged 13 to 17 (mean age = 15.59) years living in the US. Latent class analysis was used to identify sexual identity outness patterns. Multinomial regressions were used to examine the probability of class membership by alcohol use. Six outness classes were identified: out to all but teachers (n = 1033), out to siblings and peers (n = 1808), out to siblings and LGBTQ+ peers (n = 1707), out to LGBTQ+ peers (n = 1376), mostly not out (n = 1653), and very much not out (n = 1307). SGMY in classes characterized by greater outness to peers, friends, and family had greater odds of lifetime alcohol use compared with SGMY in classes characterized by lower outness. These findings suggest that SGMY with greater sexual identity outness may be a target for alcohol use prevention programming. Differences in sexual identity outness may be explained by minority stress factors.

Complex Outness Patterns Among Sexual Minority Youth: A Latent Class Analysis.

Prior scholarship has documented health-relevant consequences of sexual minority youth (SMY) sexual identity disclosure (i.e., "outness"), yet most of the extant work focuses on one social context at a time and/or measures outness as dichotomous: out or not out. However, SMY are out in some contexts (e.g., family, friends) and not in others, and to varying degrees (e.g., to some friends, but not to all). Using a national sample of 8884 SMY ages 13-17 (45% cisgender female, 67% White, 38% gay/lesbian and 34% bisexual, and 36% from the U.S. South), this study used latent class analysis to identify complex patterns of outness among SMY, as well differences in class membership by demographics, depression, family rejection, and bullying. The results indicated six distinct classes: out to all but teachers (n = 1033), out to siblings and peers (n = 1808), out to siblings and LGBTQ peers (n = 1707), out to LGBTQ peers (n = 1376), mostly not out (n = 1653), and very much not out (n = 1307). The findings reveal significant differences in class membership by age, sexual identity, gender identity, race and ethnicity, geography, and well-being outcomes. Moreover, these findings underscore the complex role of outness across social contexts in shaping health and well-being.

Intersections of Racial Discrimination and LGB Victimization for Mental Health: A Prospective Study of Sexual Minority Youth of Color.

Sexual minority youth (i.e., lesbian, gay, and bisexual youth; LGB) of color have multiple minoritized identities, and few studies examine the implications of intersectional minority stressors for their prospective mental health. The current study tested three intersectional hypotheses: the additive hypothesis-racial discrimination and LGB victimization are independently associated with mental health; the multiplicative hypothesis-racial discrimination and LGB victimization interact in to exacerbate their negative association with mental health, and the inuring hypothesis-only racial discrimination or LGB victimization is associated with mental health. Data come from a sample of lesbian, gay, and bisexual youth of color (36% Black, 30% Latino, 26% Multi-racial, 4% Native American, and 3% Asian, Hawaiian, and Pacific Islander) from two U.S. cities, one in the Northeast (77%) and one in the Southwest, who were between ages 15-24 (M = 19) and surveyed four times over three years spaced nine months apart (N = 476; 38% bisexual; 67% free and reduced lunch; and 49% assigned female at birth). The multiplicative hypothesis was supported for depression symptoms, and the additive hypothesis was supported for suicidal ideation. Intersectional minority stressors undermine the mental health of sexual minority youth of color and warrant further investigation.

Sexual Identity Continuity and Change in a U.S. National Probability Sample of Sexual Minority Adults: Associations With Mental Health and Problematic Substance Use.

OBJECTIVE: Sexual minority disparities in behavioral health (e.g., mental health and substance use) are well-established. However, sexual identity is dynamic, and changes are common across the life course (e.g., identifying with a monosexual [lesbian or gay] label and later with a plurisexual [queer, pansexual, etc.] label). This study assessed whether behavioral health risks coincide with sexual identity change among sexual minority people. METHODS: Associations in a 3-year U.S. national probability sample of sexual minority adults were assessed between sexual minority identity change (consistently monosexual [N=400; 44.3% weighted], consistently plurisexual [N=239; 46.7% weighted], monosexual to plurisexual [N=19; 4.2% weighted], and plurisexual to monosexual [N=25; 4.8% weighted]) and five behavioral health indicators (psychological distress, social well-being, number of poor mental health days in the past month, problematic alcohol use, and problematic use of other drugs), controlling for demographic characteristics and baseline behavioral health. RESULTS: Among female participants, monosexual-to-plurisexual identity change (vs. consistently monosexual identity) was associated with greater psychological distress (B=3.41, SE=1.13), lower social well-being (B=-0.61, SE=0.25), and more days of poor mental health in the past month (B=0.69 [Bexp=1.99], SE=0.23). Among male participants, plurisexual-to-monosexual identity change (vs. consistently plurisexual identity) was associated with lower social well-being (B=-0.56, SE=0.25), and identity change (regardless of type) was generally associated with increased problematic use of alcohol and other drugs. CONCLUSIONS: Sexual identity change is an important consideration for sexual minority behavioral health research, with changes (vs. consistency) in identity being an important risk factor for compromised behavioral health. Prevention and treatment interventions may need to tailor messaging to sexual minority men and women differently.

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.

Sociodemographic Factors Associated with Suicide Outcomes in Transgender and Gender Diverse Young Adults.

OBJECTIVE: Transgender and gender diverse (TGD) populations have a higher prevalence of suicide outcomes compared to cisgender peers. Further, among TGD groups, young adults frequently demonstrate a higher risk compared to other age cohorts. While evidence supports sociodemographic differences in suicide risk, these relationships are not well-established for TGD young adults. METHOD: A secondary data analysis of the young adult (18-24 years) subpopulation of the 2015 U.S. Transgender Survey was conducted. Predicted probabilities of 12-month and lifetime suicide outcomes by gender identity, sexual orientation, race/ethnicity, homelessness, and poverty were estimated comparing fully adjusted models. RESULTS: Gender identity, race/ethnicity, and homelessness were significantly associated with all suicide outcomes. Comparisons of gender identities were significant for all outcomes and varied based on the outcome. American Indian/Alaska Native TGD young adults had the highest predicted probabilities compared to other race/ethnicity groups. Further, having a heterosexual/straight sexual identity was among the lowest predicted probabilities for suicide outcomes and significantly differed from several of the other sexual identities. CONCLUSIONS: Findings underscore the importance of heterogeneity among TGD young adults and the need for intersectional research within this population. Elucidating sociodemographic characteristics that contribute to differential suicide risk is necessary for effective intervention strategies and policy advocacy.

Sexual Minority Identity Development: Latent Profiles of Developmental Milestones in a National Probability Sample.

Sexual identity development milestones mark the ages at which sexual minority people first experience key developmental events including same-sex attraction, self-realization of a sexual minority identity, same-sex sexual behavior and romantic relationships, and sexual identity disclosure. Most studies of milestones use variable-centered, rather than person-centered approaches, potentially obscuring diversity in patterns across milestones. Using data from The Generations Study, the first national probability sample of White, Black, and Latinx sexual minority adults in the United States (n = 1,492), we examined variability in milestone timing and patterning using a latent profile analysis approach. We identified four distinct profiles, characterized by variability in milestone mean ages, pacing, and sequences: an early adolescence profile (22.9%), a middle adolescence profile (33.6%), a late adolescence profile (27.6%), and an adulthood profile (15.9%). Profiles were demographically distinct, varying by birth cohort, sexual identity, race/ethnicity, gender identity, and childhood gender nonconformity. Results suggest developmental and demographic diversity in the emergence of sexual identity development across the life course, with implications for sexual minority health and thriving.

Dimensions of couples' sexual communication, relationship satisfaction, and sexual satisfaction: A meta-analysis.

Despite consistent evidence that sexual communication positively correlates with relationship and sexual satisfaction, there has been empirical murkiness regarding which aspects of sexual communication matter more or less for relationship and sexual satisfaction. A systematic meta-analysis was conducted to investigate if the strength of the association between sexual communication and relationship and sexual satisfaction varied by dimensions of sexual communication and individual, interpersonal, and cultural factors. The meta-analysis included 93 studies with 209 unique effect sizes, which represented 38,499 unique individuals in a current relationship. The multilevel meta-analysis evidenced a positive association between sexual communication and both relationship (r = .37) and sexual satisfaction (r = .43). For relationship satisfaction and sexual satisfaction, the effect size for quality of sexual communication (r = .43; .52) was larger compared to the frequency of sexual communication (r = .31; .31) and sexual self-disclosure (r = .28; .39). After controlling for the average age and relationship length of the sample, samples with married participants (r = .49) had larger effect sizes compared to samples with mixed relationship statuses (r = .35). Higher levels of individualism (b = .003) strengthened, and higher levels of gender inequality (b = -.06) weakened, the association between sexual communication and sexual satisfaction. Finally, when sociosexuality was low, sexual communication had a large association with relationship satisfaction for men (r = .69) and a small association for women (r = .16). Measurement, sample characteristics, and cultural factors have an important role in understanding the link between partners' sexual communication and their relationship and sexual satisfaction. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Distribution and Prevalence of Health in a National Probability Sample of Three Cohorts of Sexual Minority Adults in the United States.

Purpose: This study examined the health profile of a national probability sample of three cohorts of sexual minority people, and the ways that indicators of health vary among sexual minority people across age cohorts and other defining sociodemographic characteristics, including sexual identity, gender identity, and race/ethnicity. Methods: The Generations Study, the first national probability sample of three age cohorts of sexual minority people (n = 1507) in the United States collected in 2016-2017, was used to examine general health profiles across several broad domains: alcohol and drug abuse; general health, physical health, and health disability; mental health and psychological distress; and positive well-being, including general happiness, social well-being, and life satisfaction. Results: There were no cohort differences in substance abuse or positive well-being. The younger cohort was physically healthier, but had worse psychological health than both the middle and older cohorts. Conclusions: Cohort differences in physical health were consistent with patterns of aging, whereas for mental health, there were distinct cohort differences among sexual minority people. Given that compromised mental health in the early life course creates trajectories of vulnerability, these results point to the need for mental health prevention and intervention for younger cohorts of sexual minority people.

The effect of racial discrimination on mental and physical health: A propensity score weighting approach.

RATIONALE: The preponderance of research documents the negative consequences of racial discrimination for the mental and physical well-being across several racial/ethnic groups including Black Americans, Hispanic Americans, and Asian Americans. Despite this large body of research, few studies have attempted to evaluate racial discrimination as a casual factor of worse health among racial minority groups. The current study utilized nationally representative data to estimate the causal effect of racial discrimination on cardiovascular disease (CVD), self-rated physical health (SRH), body mass index (BMI), depression disorder, and substance use disorder. In addition, we examined whether the effect of racial discrimination on health was moderated by socio-demographic characteristics (i.e., age, race/ethnicity, sex, socioeconomic status, marital status, geographic location, and health insurance coverage). METHODS: Data were from the combined National Survey of American Life and the National Latino and Asian American Study. We applied a propensity score weighting approach to estimate the differences between individuals who reported ever (N = 4358) or never (N = 1836) experiencing racial discrimination on a list of health outcomes (e.g., CVD, SRH, BMI, depression disorder, and substance use disorder). RESULTS: Participants who reported ever experiencing racial discrimination were about 5 % higher CVD risk, had 0.12 points lower SRH, a 3 % higher probability of a depression disorder, and a 2 % higher probability of a substance use disorder. Moderation effects by race/ethnicity, sex, socioeconomic status, geographic region, and health insurance coverage were found. CONCLUSION: Our study represents one of the first attempts to apply a propensity score weighting approach to causally link racial discrimination to worse health for racial minority individuals. This study adds to a larger body of research documenting the negative association between racial discrimination and health.

Mental and Sexual Health Disparities Among Bisexual and Unsure Latino/a and Black Sexual Minority Youth.

Purpose: Sexual minority youth (SMY), particularly bisexual youth and youth unsure of their sexual identity, are at greater risk of poor mental and sexual health outcomes than heterosexual youth. The purpose of this study was to examine disparities in intimate partner violence (IPV) and mental and sexual health for Black and Latino/a bisexual and unsure youth compared with their White bisexual and unsure and Black and Latino/a heterosexual peers. Methods: We used aggregated state and school district 2015 Youth Risk Behavior Survey data to demonstrate differences in mental health (e.g., depressive symptoms and suicidality), sexual health (e.g., number of sexual partners and contraceptive use), and physical and sexual IPV between Black and Latino/a bisexual and unsure youth, and their White bisexual and unsure and Black and Latino/a heterosexual peers. Results: Bisexual and unsure youth had higher odds of depressive symptoms, suicidal ideation and plans, and physical IPV than their same-race heterosexual peers. Black and Latina bisexual and unsure females were more likely to report sexual health risk behaviors than Black and Latina heterosexual females. There were few differences between bisexual and unsure youth of color and White youth. Conclusion: We add to a growing body of literature showing disparities in IPV and mental and sexual health among bisexual and unsure youth of color. Pronounced risk for poor health outcomes among bisexual and unsure females of color needs to be especially addressed by prevention and intervention efforts. We encourage further research on the health of SMY with multiple marginalized identities.

Changes in disclosure stress and depression symptoms in a sample of lesbian, gay, and bisexual youth.

Disclosing a sexual minority (e.g., lesbian, gay, or bisexual) identity to others is an ongoing process throughout life. Research shows that disclosure is stressful, and this stress is related to poorer mental health for sexual minority youth. However, there are few theoretically grounded studies examining disclosure stress and its prospective association with mental health. The current study utilizes two conceptualizations of sexual identity development-stage models and milestone models-to contextualize how changes in disclosure-related stress are associated with depression symptoms from adolescence into young adulthood. Data come from a sample of lesbian, gay, and bisexual youth between ages 15-24 surveyed over three years (N=555; 82% youth of color; 40% bisexual; 63% free and reduced lunch; and 49% assigned female at birth). We estimated (1) parallel process models and (2) growth curve models with disclosure stress as a time-varying covariate, which were respectively informed by stage and milestone conceptualizations of sexual identity development. Results indicated that depression symptoms declined while disclosure stress increased. In the parallel process model, higher baseline disclosure stress correlated with higher baseline levels and steeper declines in depression symptoms. When disclosure stress was modeled as a time-varying covariate, it was most strongly associated with higher depression symptoms at earlier ages. Disclosure is a developmental process that confers differential risk for depression symptoms earlier in the life course, which can hinder the typical decline of depression symptoms in young adulthood. Supporting sexual minority youth when they disclose their sexual identity throughout adolescence can have long-term benefits for mental health.

School-based Sexuality Education Experiences across Three Generations of Sexual Minority People.

Sexual minority people face greater risk for compromised sexual health than their heterosexual peers, yet school-based sexuality education often excludes them. Little is known about whether or how sexual minority people's sexuality education experiences have varied across sociohistorical contexts of rapid social change in both sexuality education and sexual minority visibility. Semi-structured qualitative interviews were conducted among 191 sexual minority people from three distinct sociohistorical generations (ages 18-25, 34-41, and 52-59, respectively) and four geographic regions of the United States. Data were analyzed using thematic content analysis following a consensual qualitative protocol. Fifty-one participants (i.e., 27%) discussed school-based sexuality education experiences despite the lack of an explicit question in the interview protocol prompting them to do so. Four distinct yet overlapping themes emerged in participants' experiences of sexuality education: 1) Silence; 2) The profound influence of HIV/AIDS; 3) Stigma manifest through fear, shame, and prejudice; and, 4) Comparing school-based experiences to sexuality education outside of school. The presence of themes varied across groups defined by sociohistorical generation. The implications of sexuality education experiences for the wellbeing of sexual minority people are discussed.

Sexual and Gender Minority Youth and Sexual Health Education: A Systematic Mapping Review of the Literature.

PURPOSE: To synthesize the diverse body of literature on sexual and gender minority youth (SGMY) and sexual health education. METHODS: We conducted a systematic search of the literature on SGMY and sexual health education, including SGMY perspectives on sexual health education, the acceptability or effectiveness of programs designed for SGMY, and SGMY-specific results of sexual health education programs delivered to general youth populations. RESULTS: A total of 32 articles were included. Sixteen qualitative studies with SGMY highlight key perspectives underscoring how youth gained inadequate knowledge from sexual health education experiences and received content that excluded their identities and behaviors. Thirteen studies examined the acceptability or effectiveness of sexual health interventions designed for SGMY from which key characteristics of inclusive sexual health education relating to development, content, and delivery emerged. One study found a sexual health education program delivered to a general population of youth was also acceptable for a subsample of sexual minority girls. CONCLUSIONS: Future research on SGMY experiences should incorporate populations understudied, including younger adolescents, sexual minority girls, and transgender persons. Further, the effectiveness of inclusive sexual health education in general population settings requires further study.

Suicide Attempt Rates and Associations with Discrimination Are Greatest in Early Adulthood for Sexual Minority Adults Across Diverse Racial and Ethnic Groups.

Purpose: The study purpose was to investigate differences in past 5-year suicide attempts among racially/ethnically diverse sexual minority (SM) and heterosexual adults across the life course and examine the association of discrimination with past 5-year suicide attempts among SM adults. Methods: Using nationally representative data collected from 2012 to 2013, we assessed differences in age-varying prevalence of past 5-year suicide attempts among Black, Hispanic, and White SM and heterosexual adults (ages 18-60). We tested whether the association between discrimination and suicide attempts differed by race/ethnicity among SM adults. All secondary data analyses were approved by the Institutional Review Boards of The Pennsylvania State University and University of Maryland. Results: Compared with heterosexual adults of any race/ethnicity, SM adults exhibited elevated suicide attempt rates until the late twenties when prevalence for Black and Hispanic SM adults declined. Disparities persisted into the mid-40s for White SM adults. Among SM adults of all races/ethnicities, the relationship between SM discrimination and suicide attempts was strongest between ages 18 and 25. For SM adults reporting SM discrimination, odds of suicide attempts were 3.6 times higher for White SM adults and 4.5 times higher for Black and Hispanic SM adults, relative to same-race/ethnicity SM adults who did not report SM discrimination. The effect of SM discrimination was robust among Black and Hispanic SM young adults even when accounting for racial/ethnic discrimination. Conclusions: SM adults of all racial/ethnic groups demonstrated disparities when contrasted with heterosexual adults of any race/ethnicity, although ages characterized by heightened prevalence rates of suicide attempts differed by race/ethnicity. Early adulthood is a critical period for intervention seeking to disrupt the association between SM discrimination and suicide attempts.

Racial, Socioeconomic, and Attitudinal Disparities in Trajectories of Young Women's Willingness to Refuse Unwanted Sex.

PURPOSE: We identify trajectories of young women's willingness to refuse unwanted sex, assess racial, socioeconomic, and attitudinal variation across trajectory groups, and describe the sexual and relationship behaviors of different trajectory groups. METHODS: Panel data from the Relationship Dynamics and Social Life study facilitate a latent class analysis identifying trajectories of women's willingness to refuse unwanted sex, followed by bivariate analyses illuminating demographic, attitudinal, experiential, and behavioral correlates of each trajectory. RESULTS: Three trajectories emerge confident (stable high), moderate (slightly declining moderate), and reluctant (low-U). Socially advantaged women were most likely to follow a confident trajectory. Black women, socially disadvantaged women, women with early sexual debut, women with early births, and women who adhere to rape myths were most likely to follow a reluctant trajectory. Women whose trajectory was moderate spent the most time in relationships and had sex most often. CONCLUSIONS: How much young women are willing to refuse unwanted sex and how this willingness changes during the transition to adulthood vary with key characteristics of their demographic background, earlier sexual experiences, and perceptions of rape. The trajectories by which this willingness evolves further correspond with sexual and relationship behaviors during the transition to adulthood. Greater research on whether willingness to refuse unwanted sex affects behavior and/or vice versa is needed to more fully understand the diversity of women's sexual experiences and to develop effective interventions for improving women's willingness to refuse unwanted sex.

Couples' Sexual Communication and Dimensions of Sexual Function: A Meta-Analysis.

Research and clinical data have shown that couples with sexual problems report a lack of sexual communication. However, no published meta-analyses have evaluated the relationship between sexual communication and sexual function. This meta-analysis examines the correlation between couples' sexual communication and dimension of sexual function across 48 studies. Sexual communication was positively associated with sexual desire (r = .16), sexual arousal (r = .21), lubrication (r = .17), orgasm (r = .23), erectile function (r = .19), less pain (r = .12), and overall sexual function (r = .35). The effect sizes for sexual desire (r = .21; r = .12) and orgasm (r = .26; r = .16) were higher for women than for men. For overall sexual function, studies with married participants (r = .47) had a larger effect size than studies with participants with multiple relationship types (r = .31) or than studies with dating participants (r = .11). Effect sizes were larger for studies conducted outside of the United States (r = .39) compared to studies conducted in the United States (r = .12). We discuss the importance of addressing the relationship between sexual communication and sexual function, as well as future directions for research in this area.

A Meta-Analysis of Risk Markers for Intimate Partner Violence in Same-Sex Relationships.

Research on intimate partner violence (IPV) has largely focused on heterosexual relationships, but, in recent years, researchers have expanded their focus to include same-sex relationships. Using meta-analytic techniques, this study was conducted to examine the relative strength of various risk markers for men and women being perpetrators and victims of physical IPV in same-sex relationships. Articles were identified through research search engines and screened to identify articles fitting the inclusion criteria, a process that resulted in 24 studies and 114 effect sizes for the meta-analysis. The strongest risk marker among those with at least two effect sizes for both male and female perpetration was psychological abuse perpetration. The strongest risk marker among those with at least two effect sizes for IPV victimization was also perpetration of psychological abuse for males and psychological abuse victimization for females. Among same-sex-specific risk markers, internalized homophobia and fusion were the strongest predictors for being perpetrators of IPV for men and women, respectively. HIV status and internalized homophobia were the strongest risk markers for IPV victimization for men and women, respectively. Of 10 comparisons between men and women in risk markers for IPV perpetration and victimization, only 1 significant difference was found. The results suggest that although same-sex and heterosexual relationships may share a number of risk markers for IPV, there are risk markers for physical IPV unique to same-sex relationships. Further research and increased specificity in measurement are needed to better study and understand the influence of same-sex-specific risk markers for IPV.

Homophobic Bullying and Sexual Minority Youth Alcohol Use: Do Sex and Race/Ethnicity Matter?

PURPOSE: Sexual minority youth (SMY) are more likely to use alcohol than their heterosexual peers, yet a lack of research on within-group differences and modifiable mechanisms has hindered efforts to address alcohol use disparities. The purpose of the current study was to examine differences in the mediating role of homophobic bullying on the association between sexual orientation identity and drinking frequency and heavy episodic drinking frequency by sex and race/ethnicity. METHODS: We used data from a subsample of 20,744 youth in seven states from the 2015 Youth Risk Behavior Survey, a population-based data set of 9-12th grade high school students in the United States. We included youth who self-identified as male or female; heterosexual, lesbian/gay, bisexual, or unsure of their sexual orientation identity; and White, Black, or Latino. RESULTS: Within-group comparisons demonstrated that SMY alcohol use disparities were concentrated among Latino bisexual and unsure youth. All subgroups of SMY at the intersection of race/ethnicity and sex were more likely than their heterosexual counterparts to report homophobic bullying. Homophobic bullying mediated alcohol use disparities for some, but not all, subgroups of SMY. CONCLUSION: Homophobic bullying is a serious risk factor for SMY alcohol use, although youths' multiple identities may differentiate degrees of risk. Sexual orientation identity-related disparities in alcohol use among Latino, bisexual, and unsure youth were not fully attenuated when adjusted for homophobic bullying, which suggests that there may be additional factors that contribute to rates of alcohol use among these specific subgroups of SMY.

Public Perspectives Toward the Sexual Behavior of an Individual With Dementia Residing in Long-Term Care.

OBJECTIVE: This study examines public perspectives toward sexual behavior within a heterosexually married couple in which one individual has dementia and resides in a long-term care facility. METHOD: Respondents included 318 adults in the Southern United States. Paired sample t tests were used to understand how the diagnosis of dementia statistically influenced participants' responses, and a logistic regression model was used to understand how a vignette character's sex and respondent characteristics influenced attitudes. RESULTS: Fifty-eight percent of respondents believed that a sexual relationship should be permitted for an adult with dementia, and t tests revealed that dementia had a statistical effect on participants' responses. Sex of the vignette character was not a predictor of attitudes. Participant's qualitative rationales are offered for additional insight. DISCUSSION: Respondents who felt that a couple should not engage in a sexual relationship commonly cited consent-related issues as their primary concern. Implications for policy development are discussed.