Associations between Sexual Minority Identities, Heterosexism, Identity Concealment, and Depression in Lesbian, Gay, and Bisexual Emerging Adults: Adjusting for the Effects of General Stressors.

OBJECTIVES: Lesbian, gay, and bisexual (LGB) individuals experience stressors distinctively tied to their sexual identities, such as externalized and internalized heterosexism and identity concealment, which are correlated with increased psychological distress, including depression. The present study examined the variance in depression scores resulting from heterosexism, LGB identity concealment, and minority sexual identities, after adjusting for race/ethnicity and interpersonal violence victimization experiences. METHODS: Participants were 277 LGB emerging adults 18 to 29 years old (mean 25.39, standard deviation 2.77; 46 lesbian women, 71 gay men) recruited from an online platform. RESULTS: Nearly 41% reported moderate to severe depression symptoms. A two-step hierarchical regression model examining the effect of sexual minority stressors, heterosexism, LGB identity concealment, and minority sexual identity on depression after controlling for childhood maltreatment and face-to-face intimate partner violence types was significant. Bisexual women (vs gay men), those with greater exposure to heterosexism, and those with a greater degree of identity concealment experienced significantly higher scores on depression. In addition, being a person of color (including identifying as Hispanic), exposure to childhood maltreatment, and experiencing psychological intimate partner violence significantly predicted increases in depression scores. CONCLUSIONS: Findings emphasize the importance of assessing minority stressors and taking them into account when providing clinical interventions to LGB individuals.

Forgone Care among LGBTQ and Non-LGBTQ Americans during the COVID-19 Pandemic: The Role of Health, Social Support, and Pandemic-Related Stress.

OBJECTIVES: In this study, we explore the role of Coronavirus Disease 2019 pandemic-related stress, social support, and health on unmet healthcare needs during the Coronavirus Disease 2019 pandemic, particularly among lesbian, gay, bisexual, transgender, and queer plus (LGBTQ+) adults. METHODS: We collected data using a self-administered online survey of US adults. Using logistic regression, we modeled potential risk and protective factors for not receiving needed care during the pandemic (forgone care) among LGBTQ+ individuals (n = 121), cisgender and heterosexual-identifying women (n = 235), and cisgender and heterosexual-identifying men (n = 62). Limiting analyses to the LGBTQ+ subsample, we also assessed the unique role of LGBTQ+ discrimination and depressive symptoms. RESULTS: Logistic regression results suggested that social support was associated with lower odds of forgone care (odds ratio [OR] 0.95, P < 0.01). Furthermore, better self-rated health and higher levels of income were associated with lower odds of forgone care (OR 0.56, P < 0.001, and OR 0.92, P < 0.05, respectively). Finally, LGBTQ+ individuals experienced uniquely high levels of forgone care, and LGBTQ+ discrimination (OR 1.03, P < 0.05) and depressive symptoms (OR 1.09, P < 0.01) were associated with higher odds of forgone care among LGBTQ+ participants. CONCLUSIONS: Future research should examine the unique factors shaping the access to health care of LGBTQ+ adults in the United States, and healthcare practitioners should consider strategies to screen for discrimination and leverage the protective benefits of social support.

LGBTQ+ People's Mental Health and Pets: Novel Strategies of Coping and Resilience.

Health disparities persist for lesbian, gay, bisexual, transgender, and/or queer (LGBTQ+)-identified people, often shaped by minority stress through anti-LGBTQ+ stigma. Resilience and coping are important for LGBTQ+ people widely, especially through social supports, but further examination is needed into more diverse, expansive mental health assets. Companion animals, or pets, have significant positive mental health benefits in the general population, but more understanding is needed to validate LGBTQ+ people's lived experiences of minority stress, mental health challenges, and pet-based sources of resilience. We employ the minority resilience framework to ask: What role do pets play in how LGBTQ+ people navigate and cope with stress? This U.S.-based study centers the voices of 45 LGBTQ+ people's qualitative interview narratives characterizing the diverse coping and resilience-building processes they develop through pet relationships. Findings demonstrate diverse processes surrounding pets as contributing to resilience, as participants emphasized the unique beneficial emotional connections pets provided. Second, pet family members were conceptualized as vital sources of support that promoted thriving. Finally, pet relationships fostered happiness and life enjoyment that augmented participants' life satisfaction. This study delineates more diverse understandings of how LGBTQ+ people manage stress through their pet relationships, which can provide vital information to service providers and policymakers in more holistically attending to marginalized communities' health needs.

Childhood Disadvantage, Social and Psychological Stress, and Substance Use Among Homeless Youth: A Life Stress Framework.

We used a life stress framework to examine linkages between distal or primary stressors (e.g., child abuse) and proximal or secondary stressors (e.g., street victimization) and their association with substance use among 150 youth experiencing homelessness in the Midwestern United States. Results revealed that numerous primary stressors such as number of times youth ran from home and number of foster care placements were associated with secondary stressors, such as anxiety, total duration of homelessness, and street victimization. Only street physical victimization (e.g., been beaten up since leaving home) was associated with greater substance use. Our findings provide a more holistic picture of both distal and proximal life stressors that these young people experience and reveal the complexity of issues that service providers must acknowledge when working with this population.

Social Determinants of Sexual Behavior and Awareness of Sexually Transmitted Infections (STI) Among Low-Income HIV+ or STI At-Risk Hispanic Residents Receiving Care at the U.S.-Mexico Border.

U.S.-Mexico border communities are uniquely vulnerable to sexually transmitted infection (STI) transmission given the economic and social challenges these communities face. This study examines how marginalized statuses of U.S. border residents are associated with STI awareness and sexual behaviors. We surveyed low-income residents receiving STI testing and/or HIV/AIDS care in the lower Rio Grande Valley of southernmost Texas. Respondents aged 18+ took a self-administered survey available in English or Spanish in a clinic waiting room (N = 282). Approximately 52% of respondents reported being HIV+, and 32% of respondents reported having a prior STI other than HIV. Although most respondents had heard of HPV (72%), awareness of the HPV vaccine was low across all subgroups (28%), including women (< 35%), reflecting previous findings that border residents are less knowledgeable about the HPV vaccine. Almost half of respondents reported always using a condom (45%), which is higher than elsewhere in the U.S. Male and non-Hispanic respondents had higher estimated prevalence ratios (PR) of lifetime partners [PR 1.39 (95% confidence interval 1.43-3.68), PR 1.88 (1.04-3.41), respectively] and sexual partners met online [PR 3.73 (1.00-14.06), PR 19.98 (5.70-70.10), respectively]. Sexual minority, non-Hispanic, and male respondents had higher adjusted odds ratios (AOR) of utilizing the internet to find sexual partners than their peers [AOR 2.45 (1.60-3.87), AOR 1.52 (1.11-2.07), AOR 1.97 (1.20-3.24), respectively], placing them at greater STI-transmission risk. We found diversity in dimensions of STI awareness and sexual behaviors in our sample. Results can help tailor public health interventions to the unique STI risks of marginalized groups in border communities.

LGBTQ+ Latinx young adults' health autonomy in resisting cultural stigma.

Lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ+) young people of colour are exposed to intersecting dynamics of social prejudice and discrimination related to sexuality and gender as well as race/ethnicity. In particular, Latinx-identifying LGBTQ+ young people face unique challenges in their lives, due to cultural stressors that stigmatise expansive gender and sexual identities. While it is crucial to examine the effects of multiple stressors on the well-being of LGBTQ+ young people of colour, this risk-based focus can overshadow the resilient capacities of multiply marginalised groups. Guided by an intersectional minority stress resilience framework, we asked: how do self-identified LGBTQ+ Latinx young adults manage cultural messages of prejudice and discrimination in relation to their health? Findings underscore how LGBTQ+ Latinx young adults established a strong sense of health autonomy to resist cultural stigma related to their intersecting identities. Young people actively educated themselves on health-related concerns, engaged in health-promoting tactics, and practised cultural negativity management to effectively navigate exposure to prejudice and discrimination.

The Complexity of Family Reactions to Identity among Homeless and College Lesbian, Gay, Bisexual, Transgender, and Queer Young Adults.

Familial responses to lesbian, gay, bisexual, transgender, and queer (LGBTQ) young people's identities range on a spectrum from rejection to acceptance and these reactions strongly impact family relationships and young adult well-being. Less is known, however, about how family members' reactions may differ based on young people's contexts of socioeconomic status. Through a qualitative, life course analysis of in-depth interview data from 46 LGBTQ college students and LGBTQ homeless young adults, our study highlights the diverse, contextual nuances of young people's "linked lives" within their families. We find that the context of socioeconomic status influenced how a young person managed family rejection. Conversely, processes of familial acceptance were also connected to life course transitions that worked in some cases to enhance LGBTQ young adults' family relationships. Finally, the intricacy of familial reactions to a young person's LGBTQ identity transcended socioeconomic contexts as many respondents shared similar experiences of rejection and acceptance. These findings have implications for understanding how young people manage family relationships across different contexts of socioeconomic status and how these experiences can shape their life course trajectories. Results from this study can inform LGBTQ youth service providers by tailoring intervention programs that account for contextual social diversity.

Role of Social Environmental Protective Factors on Anxiety and Depressive Symptoms Among Midwestern Homeless Youth.

We employ a social stress framework, which examines the influence of multiple stressors (e.g., physical abuse, foster care placement) on an individual's ability to function (e.g., mental well-being), to longitudinally examine the effects of stressful life events on mental health and the role of the social environment in this process among 150 homeless youth. Results revealed that numerous stressors, such as physical abuse and running away from home more frequently, were associated with greater depressive symptoms and elevated anxiety. Having mentors and family and friends from home that youth can rely on resulted in more positive social support, which subsequently lowered the risk for depressive symptoms and anxiety at wave 2.

The Role of Protective Behavioral Strategies, Social Environment, and Housing Type on Heavy Drinking among College Students.

BACKGROUND: Though research has examined heavy drinking by housing type, the link between type of college student housing and protective behavioral strategies (PBS) has rarely been examined comparing different college campuses. OBJECTIVES: The purpose of this study is to examine the role of housing type, perceptions of peer drinking, and PBS with respondent heavy drinking among undergraduate college students from one Southeastern and one Midwestern university in the United States. METHODS: 1,448 college students enrolled in undergraduate courses at two public universities completed a paper and pencil survey of attitudes and experiences about dating, sexuality, and substance use. Data were analyzed using multiple group path analysis. RESULTS: Students living in Greek housing perceived their close friends as engaging in more risky drinking, and had higher rates of heavy drinking compared to those living in other housing types. The effect of perceptions of peer drinking on PBS was significantly different between campuses as were several other indirect pathways to heavy drinking. Conclusion/Importance: Understanding more about the differing roles of college residential environments can help inform effective drinking interventions, and reduce heavy drinking among college students.

A comparison of risk factors for various forms of trauma in the lives of lesbian, gay, bisexual and heterosexual homeless youth.

Numerous homeless youth experience trauma prior to leaving home and while on the street. Bullying and trading sex (i.e. exchanging sexual favors for survival items such as food) are additional forms of trauma experienced by many homeless youth. Although lesbian, gay, and bisexual (LGB) homeless youth experience higher rates of child abuse compared to their heterosexual counterparts, there is a paucity of research comparing these two groups. As such, we compare whether difficulties finding items of necessity (e.g. food) and different forms of trauma including child sexual abuse, being bullied, trading sex, and street sexual victimization significantly differ for LGB and heterosexual homeless youth. Bivariate results reveal that LGB youth have more trouble finding shelter and are more likely to trade sex compared to heterosexual youth. Logistic regression results show that trading sex is correlated with street sexual victimization. In the second model, we find that being female, experiencing more child sexual abuse, and ever having traded sex are all positively linked with street sexual victimization. LGB youth are over-represented among homeless youth populations and are also more likely to trade sex; therefore, these young people need services that are widely accessible and specific to their needs.

Child Abuse, Mental Health and Sleeping Arrangements among Homeless Youth: Links to Physical and Sexual Street Victimization.

Physical safety is a primary concern among homeless youth because they struggle to secure basic necessities and a permanent place to live. Despite this, studies have not fully examined the numerous linkages that might explain risk for victimization within the context of material insecurity. In this study, we examine multiple levels of both proximal and distal risk factors at the individual (e.g. mental health), family (e.g. child abuse), and environmental levels (e.g. finding necessities) and their associations with physical and sexual street victimization among 150 Midwestern homeless youth. Results from path analyses show that child physical abuse is positively associated with anxiety, depressive symptoms, locating necessities, and street physical victimization. Having difficulties finding basic necessities is positively correlated with street physical victimization. Experiencing child sexual abuse is positively associated with street sexual victimization. Additionally, sleeping at certain locations (e.g. violence shelter, in a car) is associated with less sexual street victimization compared to temporarily staying with a family member. These findings have implications for service providers working to improve the safety and well-being of homeless youth.

The Role of Entitlement, Self-Control, and Risk Behaviors on Dating Violence Perpetration.

Dating violence continues to be pervasive among college students (Stappenbeck & Fromme, 2010). Given the paucity of research investigating the various pathways through which risk factors are linked to dating violence among different college campuses, we use multiple group path analysis to examine the role of child abuse, self-control, entitlement, and risky behaviors on dating violence perpetration among college students from one Southeastern and one Midwestern university. There were 1,482 college students (51% female) enrolled in undergraduate courses at 2 large public universities who completed paper and pencil surveys. Dating violence perpetration was directly associated with gender, child physical abuse, and sexual and drug risk behaviors and indirectly associated with college Greek letter fraternity affiliation, self-control, and entitlement. Moreover, significant differences in the pathways to dating violence were found between the Southeast and Midwest campuses.

Using Cell Phones for Data Collection: Benefits, Outcomes, and Intervention Possibilities with Homeless Youth.

While many homeless youth use cell phones to stay socially connected, and maintaining positive social ties can contribute to pathways out of homelessness, little is known about how using cell phones for data collection can improve these young people's lives. We conducted baseline and follow-up interviews with 150 homeless youth as well as provided them with a cell phone for 30 days to gather daily data using short message service (SMS) surveying. This paper examines youths' opinions about study participation and how they used the cell phone. Results revealed that youth liked participating in the study because the SMS texting portion, for example, made them feel that someone still cared about them, prompted them to self-reflect on their life, and allowed them to make a difference (e.g. educating the public about homelessness). Despite numerous benefits of study participation, improvements that youth discussed for future studies included changing the format of our text questions to allow for explanations and the use of higher quality phones. In terms of study phone usage, youth reported using the phone to schedule appointments, contact employers, and to keep in touch with family and friends. Finally, we highlight ways in which cell phones via SMS could be used with homeless youth to provide informational resources along with educational and employment opportunities, all of which are important intervention strategies in improving life situations for this population.

Multi-Level Risk and Protective Factors for Substance Use Among Zambian Street Youth.

BACKGROUND: High rates of substance use have been reported among youth in Zambia. This is particularly concerning given that substance use is one of the biggest risk factors placing young people at risk for HIV infection. OBJECTIVES: The purpose of the current study is to examine how multi-level risk and protective factors (i.e., community, family, peers, individual) influence alcohol and marijuana use. METHODS: A total of 250 street youth in Lusaka, Zambia were interviewed in the summer of 2014 about their alcohol and marijuana use and reasons for usage. Data were analyzed using descriptive and multivariate methods. RESULTS: Youth reported high rates of alcohol use. At the multivariate level, peer and individual level variables (e.g., using alcohol or drugs for coping or for fun) explained the most variance, followed by family level factors. Community level variables explained the least variance in all models. Conclusion/Importance: A better understanding of multi-level risk and protective factors for young people's alcohol and marijuana use could lead to the development of better intervention strategies to reduce this behavior among Zambian street youth.

An Inside Look at Homeless Youths' Social Networks: Perceptions of Substance Use Norms.

Substance use among homeless young people is a pervasive problem, and there have been many efforts to understand more about the dynamics of this health compromising behavior. The current study examined perceived substance use norms within homeless youths' social networks utilizing in-depth interviews. The sample included 19 homeless individuals aged 16 to 21. Four elements of substance use within networks emerged: substance use choices, drug use safety issues, encouragement and/or discouragement, and appropriate situations in which substance use is condoned. These findings provide unique insight into the norms associated with drug and alcohol use within homeless youths' social networks.

Family Histories and Multiple Transitions Among Homeless Young Adults: Pathways to Homelessness.

This study explored the early family histories of homeless young adults, the types and number of transitions they experienced, and their pathways to the street. Intensive qualitative interviews were audio taped and transcribed with 40 homeless young adults 19 to 21 years of age in the Midwest. Findings show that family backgrounds were generally characterized by substance use, child maltreatment, and witnessing violence, all of which provide social context for understanding why so many of these young people opted to leave home in search of an alternative living situation. The current findings also reveal that while some young adults ran away from home as adolescents, others were "pushed out" (i.e., told to leave), or removed by state agencies. Current study findings illustrate that young adults' trajectories are marked by multiple living arrangements such as home, foster care, detention facility, and drug rehabilitation. Overall, study results show that young adults' family histories place them on trajectories for early independence marked by multiple transitions and numerous living situations, culminating in a lack of a permanent residence to call home.

"'I am a Man. How Could I Possibly Have Been Raped?' Men Making Sense of Their Experiences With Sexual Violence".

Sexual violence among college students is an enduring issue that can shape adverse outcomes for victim survivors. The gender dynamics of college sexual assault and rape include rates of women overrepresented as victims and men as perpetrators. Dominant cultural frames reinforcing the (hetero)normative gendered sexual scripts of masculinity often preclude men from being considered as legitimate victims of sexual violence, despite evidence documenting their victimization. The present study contributes to knowledge of men's experiences of sexual violence by sharing the narratives of 29 college men survivors and how they make sense of their experiences. Through open and focused thematic qualitative coding, findings revealed how men struggled to understand their victimization experiences within cultural frameworks that exclude men as victims. Participants engaged in complex linguistic processes (i.e., "epiphanies") to process their unwanted sexual encounter, in addition to altering their sexual behavior after experiencing sexual violence. Findings can inform programing and interventions to be more inclusive of supporting men as victims.

Queer Politics of a Pandemic: LGBTQ + People's Conceptions of COVID-19's Politicization.

Introduction: Lesbian, gay, bisexual, transgender, and/or queer (LGBTQ+) people have historically been at the center of contentious political debates in the United States. The pandemic's divisive politicization has created societal stress in both hindering mitigation efforts and exacerbating social marginalization. Research has examined relatively privileged groups' COVID beliefs; however, explorations are needed into ideological processes among those marginalized by COVID, such as LGBTQ+ people, to provide a holistic framework of queer politics. Methods: Data come from in-depth interviews conducted with 43 LGBTQ+ people collected between October 2020 and January 2021. Purposive sampling was used to recruit participants from a larger survey on pandemic experiences. Results: Through the "underdog" framework," LGBTQ+ people held strong convictions to science-informed political beliefs, which informed their critiques of inadequate government leadership. Participants also engaged in ideological resistance to harmful individualistic rhetoric through an emphasis on collectivism. The divisive politicization of the pandemic shaped numerous social stressors that LGBTQ+ people adapted to using various strategies to maintain their mental health. Conclusions: Participants viewed American individualism and Christian nationalism as a public health threat that led to resistance to health and safety measures putting other people at risk. Findings support the underdog theory, with LGBTQ+ people elevating evidence-based science and disadvantaged groups' wellbeing by emphasizing social empathy as a collective good that supports community health. Policy Implications: Findings can inform policies and community programming that promotes equity across all social identities through the depoliticization of public health and centering LGBTQ+ people's capacity for resistance and resilience.

Embracing Complexity: Variation in Faculty's Attitudes Toward Inclusive Measures of Gender and Sexuality in Social and Health Sciences Research.

In the absence of adequate measurement efforts, expansive gender and sexual identities will remain underexplored in quantitative social science and health research. We use primary survey data (N = 309) to identify factors associated with U.S.based social and health science faculty's attitudes toward inclusive gender and sexuality measures in participant-based research. Results suggest that political science faculty rated expansive gender and sexuality measures as less important to their own research, relative to psychology, sociology, and health sciences faculty. In addition, cisgender/heterosexual women and LGBTQ+ identifying faculty rate and apply these measures more positively compared to faculy who identify as cisgender/heterosexual men. Finally, faculty engaging in predominantly quantitative research, or in teaching-focused positions, had lower ratings of the importance of gender expansive measurement. Results suggest that while individual characteristics shape faculty's attitudes toward and use of inclusive gender and sexuality measures, disciplinary and academic contexts also matter.

LGBTQ+ identity-related abuse during childhood and associations with depression and suicide behavior: Role of adulthood cisheterosexism and expressive suppression.

BACKGROUND: Exposure to minority stressors specific to LGBTQ+ individuals, such as heterosexism and cissexism (or cisheterosexism) is not covered under the traditional adverse childhood experiences framework. This is important because childhood identity-related abuse by a parent/caregiver can lead to mental health challenges in later life through the adoption of maladaptive coping mechanisms. OBJECTIVE: The present study aimed to examine the role of cisheterosexism and expressive suppression as serial mediators in the associations between identity-related abuse and depressive symptoms and suicide behavior. PARTICIPANTS AND SETTING: Participants included 563 LGBTQ+ identifying adults between 18 and 64 years (M = 30.02, SD = 9.05) from different regions of Spain and were recruited through social media (e.g., Twitter, Facebook, and Instagram). METHOD: A serial mediation model was conducted with cisheterosexism and expressive suppression as the mediators in the associations between LGBTQ+ identity-related childhood abuse and depressive symptoms and suicide behavior. RESULTS: Findings indicated a positive indirect effect of identity-related abuse on depressive symptoms through cumulative cisheterosexism (B = 0.628, p < .01), and via cumulative cisheterosexism and suppression (B = 0.146, p < .05). No significant indirect effect was found for identity-related abuse on depressive symptoms via suppression (B = 0.086). An indirect effect was found for identity-related abuse on suicide behavior via cumulative cisheterosexism (B = 0.250, p < .01). CONCLUSIONS: Findings reveal that LGBTQ+ identity-related cisheterosexist experiences perpetrated by parents or caregivers are associated with harmful, long-term impacts on symptoms of depression and suicide behavior via experiences of cisheterosexism and expressive suppression.