Weight-based discrimination and disordered eating behaviors in a cohort of U.S. sexual minority young adults.

OBJECTIVE: Though prevalent, weight-based discrimination is understudied and has been linked to disordered eating behaviors (DEB) among adolescents and adults. Sexual minority populations experience elevated risk of DEB, but little is known about the role of weight discrimination in this elevated risk. METHODS: Participants were 1257 sexual minority women and men (ages 18-31 years) in the US Growing Up Today Study cohort. We examined cross-sectional associations between weight discrimination victimization and three DEB in the past year: unhealthy weight control behaviors, overeating, and binge eating. Generalized estimating equations, adjusted for potential confounders, were used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS: Three in 10 participants (31%) reported weight-based discrimination victimization. Sexual minority young adults who reported weight-based discrimination had greater relative prevalence of unhealthy weight control behaviors (PR [95% CI]: 1.92 [1.35, 2.74]), overeating (3.15 [2.24, 4.44]), and binge eating (3.92 [2.51, 6.13]), compared with those who reported no weight-based discrimination. Associations with overeating and binge eating remained significant after adjusting for BMI. DISCUSSION: The role of weight-based discrimination, and its intersections with other forms of stressors for sexual minority young adults, must be included in efforts to advance eating disorder prevention for this underserved population. PUBLIC SIGNIFICANCE: Three in 10 sexual minority young adults in this study had experienced weight-based discrimination, a common but understudied form of discrimination. Sexual minority young adults who experienced weight-based discrimination were at greater risk of disordered eating behaviors than those who had not experienced weight-based discrimination. These findings suggest that weight-based discrimination may be an important-and preventable-risk factor for disordered eating behaviors among sexual minority young adults.

Subgroup Analyses of Girl2Girl, a Text Messaging-Based Teen Pregnancy Prevention Program for Sexual Minority Girls: Results from a National RCT.

This study aims to investigate whether Girl2Girl, a text messaging-based pregnancy prevention program for cisgender LGB+ girls, had different effects on subgroups based on age, sexual identity, and experience with penile-vaginal sex. A total of 948 girls, 14-18 years old, were recruited nationally via social media and enrolled over the telephone. Once they completed the baseline, they were randomized to either Girl2Girl or an attention-matched control program that discussed "healthy lifestyle" topics (e.g., self-esteem). Both programs were 5 months long: Girls received daily messages for 8 weeks, and then went through a "latent" period of 3 months, and finished with a 1-week review. Outcome measures included condom-protected sex, uptake of other types of birth control, abstinence, and pregnancy. Measures were collected at baseline; 3-month, 6-month, 9-month, and 12-month post-intervention end, which was 17 months after enrollment. Effect modification was examined using longitudinal mixed effects models. Overall, results suggested significant moderating effects of age, (f2 = .12), sexual identity (f2 < .14), and sexual experience (f2 = .11) on rates of condom use and use of other contraception. Although there were no significant moderating effects on pregnancy, abstinence, or intentions to use condoms, use birth control, or be abstinent, (p's > .16), patterns of effects were in the same direction as for significant findings. For example, at 9-month post-intervention, among those who identified as bisexual, the incidence rate of protected sex events was 39% higher for intervention vs. control (IRR = 1.39, 95% CI: 1.06-2.70), adjusting for baseline rate of condom use and sexual experience. Similarly, at 12 months, among bisexual participants, intervention participants had a significantly higher IRR of condom-protected sexual events (IRR = 2.65, 95% CI: 1.31-5.34). There were also higher odds of uptake of birth control use other than condoms for intervention vs. control at 6- (OR = 1.10, 95% CI: 1.01-1.77), 9 m (OR = 1.11, 95% CI: 1.07-1.89), and 12-month (OR = 1.13, 95% CI: 1.07-1.78) follow-up. Girl2Girl appears to be particularly effective for older adolescents, bisexual girls, and those who have already had penile-vaginal sex. No one single approach is going to affect teen pregnancy. Instead, it is more likely that different intervention content and delivery methods will be more accessible and salient to some but not other youth. Understanding for whom the intervention works is just as important as understanding for whom the intervention does not, as this can inform opportunities for future intervention development.Clinical Trial Registration: ClinicalTrials.gov ID# NCT03029962.

Incorporating LC-MS/MS Analysis and the Dereplication of Natural Product Samples into an Upper-Division Undergraduate Laboratory Course.

Growth in the biomedical and biotechnology sectors requires a highly trained and highly skilled workforce to answer the next great scientific questions. Undergraduate laboratory courses incorporating hands-on training based in authentic research position soon-to-be graduates to learn in environments that mirror that of academic, industrial, and government laboratories. Mass spectrometry is one of the most broadly applied analyses carried out in the biomedical and pharmaceutical sciences and thus it is essential that upper-division students gain hands-on experience in techniques and analytical workflows in mass spectrometry. Our pre-course assessments identified weaknesses in student experience and knowledge in the fundamentals of mass spectrometry, supporting that it was a necessary area for improvement. We incorporated a laboratory experiment focused on tandem mass spectrometry and database searching into a preexisting mini-semester project devoted to identifying metabolites from medicinal plants. Implementation of the experiment allowed students to make more confident metabolite identifications, introduced them to a cutting-edge database analysis platform (GNPS: Global Natural Products Social Molecular Networking), and increased student experience and knowledge of mass spectrometry in addition to the principle of dereplication of samples derived from nature.

A National, Qualitative Study of Sexual Decision Making by Teenage Girls who are Lesbian, Gay, Bisexual, or who have Another Nonheterosexual Identity.

OBJECTIVE: To address the significant dearth of literature that examines how girls who are lesbian, gay, bisexual, or who have another nonheterosexual identity (LGB+) decide when and with whom to have sex; and to explore why inexperienced LGB+ girls might have sex with girls or boys. STUDY DESIGN: We conducted 8 online, asynchronous, bulletin board-style focus groups with 160 adolescent girls 14-18 years of age. The transcripts were analyzed using a thematic analysis of each girls' responses to the questions. Analyses were focused on increasing our understanding of sexual health decision making among LGB+ teenage girls (eg, "What was the reason you had sex for the first time?"). Participants' responses reflected their day-to-day experiences and roles of cisgender LGB+ girls inside a dominant heteronormative social structure. RESULTS: Some LGB+ girls talked about the perception that LGB+ girls were presumed or expected to be hypersexual, and that they did not feel they could be accepted as LGB+ without being sexually active. Developmental aspects of identity were also salient: Girls considered or engaged in sexual encounters as a way of figuring out to whom they were attracted as well as confirming or disconfirming the identity labels they used for themselves. Same-sex encounters could be offered as "proof" that one really was LGB+. Similarly, unsatisfying experiences with guys could serve as evidence that they were not attracted to guys. CONCLUSION: Sexual decision making among LGB+ girls is often driven by aspects of their sexual minority identity.

Girl2Girl: How to develop a salient pregnancy prevention program for cisgender sexual minority adolescent girls.

INTRODUCTION: Although sexual minority girls are more likely than heterosexual girls to be pregnant during adolescence, programs tailored to their needs are non-existent. Here we describe the iterative development of Girl2Girl, a text messaging-based pregnancy prevention program for cisgender lesbian, gay, bisexual and other sexual minority (LGB+) girls across the United States. METHODS: Four activities are described: 1) 8 online focus groups to gain feedback about intended program components (n = 160), 2) writing the intervention content, 3) 4 online Content Advisory Teams that reviewed and provided feedback on the salience of drafted intervention content (n = 82), and 4) a beta test to confirm program functionality, the feasibility of assessments, and the enrollment protocol (n = 27). Participants were 14-18-year-old cisgender LGB+ girls recruited nationally on social media. Across study activities, between 52% and 70% of participants were 14-16 years of age, 10-22% were Hispanic ethnicity, and 30-44% were minority race. RESULTS: Focus group participants were positive about receiving text messages about sexual health, although privacy was of concern. Thus, better safeguards were built into the enrollment process. Teens in the Content Advisory Teams found the content to be approachable and compelling, although many wanted more gender-inclusive messaging. Messages were updated to not assume people with penises were boys. Between 71 and 86% of participants in the beta test provided weekly feedback, most of which was positive; no one withdrew during the seven-week study period. CONCLUSIONS: This careful step-by-step iterative approach appears to have resulted in a high level of intervention feasibility and acceptability.

The Relational and Bodily Experiences Theory of Sexual Desire in Women.

We review the theory and research on women's sexual desire and present a theory that incorporates internalized representations of relational and bodily experiences into our understanding of the full range of desire in women. To this end, we move away from the current tendency to focus on low sexual desire in women and instead consider desire on a spectrum or continuum from absent or diminished to high desire across multiple sexual orientations, including heterosexual, bisexual, and lesbian. We review definitions of sexual desire, as well as the epidemiology and etiology of hypoactive sexual desire, the most prevalent sexual complaint in women, including the biological, psychological, and relationship correlates of inhibited sexual desire. Subsequently, we examine the research on highly sexual women, who tend to experience high levels of sexual desire, sexual agency, and sexual esteem, and distinguish between high sexual desire and hypersexuality. We introduce two important constructs that are integrated into the Relational and Bodily Experiences Theory (RBET) of sexual desire in women: attachment and sexual body self-representations, suggesting that women's internalized representations of self and other that stem from childhood and their capacity to embody their sexual bodies are integral to our understanding of the phenomenology of sexual desire in women. RBET calls for further research into the links between attachment, sexual body self-representations, and desire, and suggests that clinical interventions for sexual desire difficulties in women should emphasize internalized working models of relationships (i.e., attachment) and integrate bodily based approaches.

A Model of Female Sexual Desire: Internalized Working Models of Parent-Child Relationships and Sexual Body Self-Representations.

The etiology of low female sexual desire, the most prevalent sexual complaint in women, is multi-determined, implicating biological and psychological factors, including women's early parent-child relationships and bodily self-representations. The current study evaluated a model that hypothesized that sexual body self-representations (sexual subjectivity, self-objectification, genital self-image) explain (i.e., mediate) the relation between internalized working models of parent-child relationships (attachment, separation-individuation, parental identification) and sexual desire in heterosexual women. We recruited 614 young, heterosexual women (M = 25.5 years, SD = 4.63) through social media. The women completed an online survey. Structural equation modeling was used. The hypotheses were supported in that the relation between internalized working models of parent-child relationships (attachment and separation-individuation) and sexual desire was mediated by sexual body self-representations (sexual body esteem, self-objectification, genital self-image). However, parental identification was not related significantly to sexual body self-representations or sexual desire in the model. Current findings demonstrated that understanding female sexual desire necessitates considering women's internalized working models of early parent-child relationships and their experiences of their bodies in a sexual context. Treatment of low or absent desire in women would benefit from modalities that emphasize early parent-child relationships as well as interventions that foster mind-body integration.

Associations of Timing of Sexual Orientation Developmental Milestones and Other Sexual Minority Stressors with Internalizing Mental Health Symptoms Among Sexual Minority Young Adults.

Sexual minorities (mostly heterosexual, bisexual, lesbian/gay) are more likely than heterosexuals to have adverse mental health, which may be related to minority stress. We used longitudinal data from 1461 sexual minority women and men, aged 22-30 years, from Wave 2010 of the Growing Up Today Study, to examine associations between sexual minority stressors and mental health. We hypothesized that sexual minority stressors (earlier timing of sexual orientation developmental milestones categorized into early adolescence, middle adolescence, late adolescence/young adulthood; greater sexual orientation mobility; more bullying victimization) would be positively associated with mental health outcomes (depressive and anxious symptoms). Linear regression models stratified by gender and sexual orientation were fit via generalized estimating equations and controlled for age and race/ethnicity. Models were fit for each stressor predicting each mental health outcome. Reaching sexual minority milestones in early versus middle adolescence was associated with greater depressive and anxious symptoms among lesbians and gay men. Reaching sexual minority milestones in late adolescence/young adulthood versus middle adolescence was associated with greater depressive symptoms among lesbians, but fewer depressive and anxious symptoms among gay men. Greater sexual orientation mobility was associated with greater depressive symptoms among mostly heterosexual women. More bullying victimization was associated with greater depressive symptoms among bisexual women and with greater anxious symptoms among mostly heterosexual women. Sexual minority stressors are associated with adverse mental health among some sexual minority young adults. More research is needed to understand what may be protecting some subgroups from the mental health effects of sexual minority stressors.

Disparities by Sexual Orientation in Frequent Engagement in Cancer-Related Risk Behaviors: A 12-Year Follow-Up.

OBJECTIVES: We examined sexual-orientation disparities in frequent engagement in cancer-related risk indicators of tobacco, alcohol, diet and physical activity, ultraviolet radiation, and sexually transmitted infections (STIs). METHODS: We used longitudinal data from the national Growing Up Today Study (1999-2010). Of the analytic sample (n = 9958), 1.8% were lesbian or gay (LG), 1.6% bisexual (BI), 12.1% mostly heterosexual (MH), and 84.5% completely heterosexual (CH). RESULTS: More sexual minorities (LGs, BIs, and MHs) than CHs frequently engaged in multiple cancer-related risk behaviors (33%, 29%, 28%, and 19%, respectively). Sexual-minority young women, especially BI and MH, more frequently engaged over time in substance use and diet and physical activity risk than CH women. More young gay than CH men frequently engaged over time in vomiting for weight control (odds ratio [OR] = 3.2; 95% confidence interval [CI] = 1.1, 9.4), being physically inactive (OR = 1.7; 95% CI = 1.2, 2.4), and using tanning booths (OR = 4.7; 95% CI = 3.0, 7.4), and had a higher prevalence of ever having an STI (OR = 3.5; 95% CI = 2.0, 6.4). Individual analyses were generally comparable to the group-level analyses. CONCLUSIONS: Young sexual minorities are at risk for cancer through frequent exposure to cancer-related risk behaviors over time. Long-term, longitudinal studies and surveillance data are essential and warranted to track frequent engagement in the risk behaviors and cancer-related morbidity and mortality.

Polybrominated Diphenyl Ethers: Structure Determination and Trends in Antibacterial Activity.

Antibacterial-guided fractionation of the Dictyoceratid sponges Lamellodysidea sp. and two samples of Dysidea granulosa yielded 14 polybrominated, diphenyl ethers including one new methoxy-containing compound (8). Their structures were elucidated by interpretation of spectroscopic data of the natural product and their methoxy derivatives. Most of the compounds showed strong antimicrobial activity with low- to sub-microgram mL(-1) minimum inhibitory concentrations against drug-susceptible and drug-resistant strains of Staphylococcus aureus and Enterococcus faecium, and two compounds inhibited Escherichia coli in a structure-dependent manner.

Indicators of victimization and sexual orientation among adolescents: analyses from Youth Risk Behavior Surveys.

OBJECTIVES: We used nuanced measures of sexual minority status to examine disparities in victimization and their variations by gender, age, and race/ethnicity. METHODS: We conducted multivariate analyses of pooled data from the 2005 and 2007 Youth Risk Behavior Surveys. RESULTS: Although all sexual minorities reported more fighting, skipping school because they felt unsafe, and having property stolen or damaged at school than did heterosexuals, rates were highest among youths who identified as bisexual or who reported both male and female sexual partners. Gender differences among sexual minorities appeared to be concentrated among bisexuals and respondents who reported sexual partners of both genders. Sexual minority youths reported more fighting than heterosexual youths, especially at younger ages, and more nonphysical school victimization that persisted through adolescence. White and Hispanic sexual minority youths reported more indicators of victimization than did heterosexuals; we found few sexual minority differences among African American and Asian American youths. CONCLUSIONS: Victimization carries health consequences, and sexual minorities are at increased risk. Surveys should include measures that allow tracking of disparities in victimization by sexual minority status.

Sexual orientation disparities in sexually transmitted infection risk behaviors and risk determinants among sexually active adolescent males: results from a school-based sample.

OBJECTIVES: We examined disparities in risk determinants and risk behaviors for sexually transmitted infections (STIs) between gay-identified, bisexual-identified, and heterosexual-identified young men who have sex with men (YMSM) and heterosexual-identified young men who have sex with women (YMSW) using a school-based sample of US sexually active adolescent males. METHODS: We analyzed a pooled data set of Youth Risk Behavior Surveys from 2005 and 2007 that included information on sexual orientation identity, sexual behaviors, and multiple STI risk factors. RESULTS: Bisexual-identified adolescents were more likely to report multiple STI risk behaviors (number of sex partners, concurrent sex partners, and age of sexual debut) compared with heterosexual YMSW as well as heterosexual YMSM and gay-identified respondents. Gay, bisexual, and heterosexual YMSM were significantly more likely to report forced sex compared with heterosexual YMSW. CONCLUSIONS: Our results provide evidence that sexual health disparities emerge early in the life course and vary by both sexual orientation identity and sexual behaviors. In particular, they show that bisexual-identified adolescent males exhibit a unique risk profile that warrants targeted sexual health interventions.

The association between sexual orientation identity and behavior across race/ethnicity, sex, and age in a probability sample of high school students.

OBJECTIVES: We examined the prevalence and associations between behavioral and identity dimensions of sexual orientation among adolescents in the United States, with consideration of differences associated with race/ethnicity, sex, and age. METHODS: We used pooled data from 2005 and 2007 Youth Risk Behavior Surveys to estimate prevalence of sexual orientation variables within demographic sub-groups. We used multilevel logistic regression models to test differences in the association between sexual orientation identity and sexual behavior across groups. RESULTS: There was substantial incongruence between behavioral and identity dimensions of sexual orientation, which varied across sex and race/ethnicity. Whereas girls were more likely to identify as bisexual, boys showed a stronger association between same-sex behavior and a bisexual identity. The pattern of association of age with sexual orientation differed between boys and girls. CONCLUSIONS: Our results highlight demographic differences between 2 sexual orientation dimensions, and their congruence, among 13- to 18-year-old adolescents. Future research is needed to better understand the implications of such differences, particularly in the realm of health and health disparities.

Mediation by peer violence victimization of sexual orientation disparities in cancer-related tobacco, alcohol, and sexual risk behaviors: pooled youth risk behavior surveys.

OBJECTIVES: We examined the role of adolescent peer violence victimization (PVV) in sexual orientation disparities in cancer-related tobacco, alcohol, and sexual risk behaviors. METHODS: We pooled data from the 2005 and 2007 Youth Risk Behavior Surveys. We classified youths with any same-sex sexual attraction, partners, or identity as sexual minority and the remainder as heterosexual. We had 4 indicators of tobacco and alcohol use and 4 of sexual risk and 2 PVV factors: victimization at school and carrying weapons. We stratified associations by gender and race/ethnicity. RESULTS: PVV was related to disparities in cancer-related risk behaviors of substance use and sexual risk, with odds ratios (ORs) of 1.3 (95% confidence interval [CI] = 1.03, 1.6) to 11.3 (95% CI = 6.2, 20.8), and to being a sexual minority, with ORs of 1.4 (95% CI = 1.1, 1.9) to 5.6 (95% CI = 3.5, 8.9). PVV mediated sexual orientation disparities in substance use and sexual risk behaviors. Findings were pronounced for adolescent girls and Asian/Pacific Islanders. CONCLUSIONS: Interventions are needed to reduce PVV in schools as a way to reduce sexual orientation disparities in cancer risk across the life span.

Sexual orientation disparities in adolescent cigarette smoking: intersections with race/ethnicity, gender, and age.

OBJECTIVES: We examined sexual orientation differences in adolescent smoking and intersections with race/ethnicity, gender, and age. METHODS: We pooled Youth Risk Behavior Survey data collected in 2005 and 2007 from 14 jurisdictions; the analytic sample comprised observations from 13 of those jurisdictions (n = 64,397). We compared smoking behaviors of sexual minorities and heterosexuals on 2 dimensions of sexual orientation: identity (heterosexual, gay-lesbian, bisexual, unsure) and gender of lifetime sexual partners (only opposite sex, only same sex, or both sexes). Multivariable regressions examined whether race/ethnicity, gender, and age modified sexual orientation differences in smoking. RESULTS: Sexual minorities smoked more than heterosexuals. Disparities varied by sexual orientation dimension: they were larger when we compared adolescents by identity rather than gender of sexual partners. In some instances race/ethnicity, gender, and age modified smoking disparities: Black lesbians-gays, Asian American and Pacific Islander lesbians-gays and bisexuals, younger bisexuals, and bisexual girls had greater risk. CONCLUSIONS: Sexual orientation, race/ethnicity, gender, and age should be considered in research and practice to better understand and reduce disparities in adolescent smoking.

Sexual orientation disparities in cancer-related risk behaviors of tobacco, alcohol, sexual behaviors, and diet and physical activity: pooled Youth Risk Behavior Surveys.

OBJECTIVES: We examined sexual orientation disparities in cancer-related risk behaviors among adolescents. METHODS: We pooled data from the 2005 and 2007 Youth Risk Behavior Surveys. We classified youths with any same-sex orientation as sexual minority and the remainder as heterosexual. We compared the groups on risk behaviors and stratified by gender, age (< 15 years and > 14 years), and race/ethnicity. RESULTS: Sexual minorities (7.6% of the sample) reported more risk behaviors than heterosexuals for all 12 behaviors (mean = 5.3 vs 3.8; P < .001) and for each risk behavior: odds ratios (ORs) ranged from 1.3 (95% confidence interval [CI] = 1.2, 1.4) to 4.0 (95% CI = 3.6, 4.7), except for a diet low in fruit and vegetables (OR = 0.7; 95% CI = 0.5, 0.8). We found sexual orientation disparities in analyses by gender, followed by age, and then race/ethnicity; they persisted in analyses by gender, age, and race/ethnicity, although findings were nuanced. CONCLUSIONS: Data on cancer risk, morbidity, and mortality by sexual orientation are needed to track the potential but unknown burden of cancer among sexual minorities.

Influence of hormonal contraceptive use and health beliefs on sexual orientation disparities in Papanicolaou test use.

OBJECTIVES: Reproductive health screenings are a necessary part of quality health care. However, sexual minorities underutilize Papanicolaou (Pap) tests more than heterosexuals do, and the reasons are not known. Our objective was to examine if less hormonal contraceptive use or less positive health beliefs about Pap tests explain sexual orientation disparities in Pap test intention and utilization. METHODS: We used multivariable regression with prospective data gathered from 3821 females aged 18 to 25 years in the Growing Up Today Study (GUTS). RESULTS: Among lesbians, less hormonal contraceptive use explained 8.6% of the disparities in Pap test intention and 36.1% of the disparities in Pap test utilization. Less positive health beliefs associated with Pap testing explained 19.1% of the disparities in Pap test intention. Together, less hormonal contraceptive use and less positive health beliefs explained 29.3% of the disparities in Pap test intention and 42.2% of the disparities in Pap test utilization. CONCLUSIONS: Hormonal contraceptive use and health beliefs, to a lesser extent, help to explain sexual orientation disparities in intention and receipt of a Pap test, especially among lesbians.

Sexual orientation and gender differences in markers of inflammation and immune functioning.

BACKGROUND: Sexual minorities have documented elevated risk factors that can lead to inflammation and poor immune functioning. PURPOSE: This study aims to investigate disparities in C-reactive protein (CRP) and Epstein-Barr virus (EBV) by gender and sexual orientation. METHODS: We used the National Longitudinal Study of Adolescent Health to examine disparities in CRP (N = 11,462) and EBV (N = 11,812). RESULTS: Among heterosexuals, women had higher levels of CRP and EBV than men. However, sexual minority men had higher levels of CRP and EBV than heterosexual men and sexual minority women. Lesbians had lower levels of CRP than heterosexual women. CONCLUSIONS: Gender differences in CRP and EBV found between men and women who identify as 100 % heterosexual were reversed among sexual minorities and not explained by known risk factors (e.g., victimization, alcohol and tobacco use, and body mass index). More nuanced approaches to addressing gender differences in sexual orientation health disparities that include measures of gender nonconformity and minority stress are needed.