Sexual orientation disparities in physical health: age and gender effects in a population-based study

Relative Adiposity and Body Dissatisfaction in Young Adult Sexual Minority Women

The purpose of this study was to examine potential differences in body mass index (BMI), relative adiposity (%Fat), and body dissatisfaction (BD) between heterosexual (HSW) and sexual minority women (SMW). Young adult women (n = 84; 23.8% SMW; 21.9 ± 3.8 years) were included in our analysis. %Fat was assessed using a four-compartment model. BD was assessed using the Body Shape Questionnaire (BSQ), the BD subscale of the Eating Disorders Inventory Questionnaire (EDI-BD), the appearance evaluation subscale of the Multidimensional Body Self-Relations Questionnaire (MBSRQ-AE), and the Photographic Figure Rating Scale (PFRS). Potential differences in BMI, %Fat, and BD between sexual orientation groups were assessed using independent samples t-tests. Bivariate correlations were assessed using Pearson's r. No differences in BMI or BD were observed between groups (all p > .05). Higher %Fat was observed in SMW when compared to HSW (p = .046), and higher %Fat was associated with higher BSQ (r = .364), EDI-BD (r = .388), lower MBSRQ-AE (r = .388), and PFRS (r = .521), collectively indicating greater BD. %Fat was higher in SMW, and higher %Fat was associated with greater BD, regardless of sexual orientation. These results suggest that SMW tend to have higher %Fat than heterosexual counterparts which would increase their risk of negative health outcomes.

Toward an understanding of sexual minority women's social stressors and health in post-communist countries in Europe: a scoping review

BACKGROUND

While significant evidence demonstrates disproportionate burden of poor health among sexual minority men and transgender women, there is a dearth of research on the health of sexual minority women (SMW). We conducted a review to examine social stressors, physical and mental health, and health behaviors of SMW in post-communist countries in Europe.

METHODS

In September 2023, August 2024, and January 2025, we used the Joanna Briggs Institute guidelines and PRISMA-ScR protocol to conduct a scoping review of empirical quantitative or qualitative studies published in English, Romanian, Czech, and/or Russian that focused on the health of adult SMW living in Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Czechia, Estonia, Georgia, Hungary, Kosovo, Latvia, Lithuania, Moldova, Montenegro, North Macedonia, Poland, Romania, Serbia, Slovakia, Slovenia, and Ukraine. Seven databases were searched.

RESULTS

We found few research articles (N = 21) that met full inclusion criteria. Existing evidence documented poor mental health, discrimination in the workplace, reproductive health problems, coming out and relationship challenges, and heightened risk of substance use. Most studies were conducted in Poland; the earliest report was published in 2011. Only one quarter of the studies focused exclusively on SMW, and most study samples included few SMW.

CONCLUSION

This first review of literature on SMW's health in post-communist countries in Europe indicates a dearth of research on and under-prioritization of the health and needs of SMW, signaling a pressing need for related health equity research. Longitudinal and interventional studies with large samples are warranted to document SMW's health needs as well as intervention studies on the stigma-driven mechanisms and sources that perpetuate SMW's marginalization to improve health outcomes of this underrepresented population group.

Leveraging Electronic Health Record Data to Identify Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Veteran Participants in the Pride in All Who Served Program

BACKGROUND

Pride in All Who Served (PRIDE) is an intervention in the Veterans Health Administration (VHA) focused on enhancing Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) veterans' access to affirmative care services, social support, and engagement with VHA. Evaluation of PRIDE to date has focused on self-report data, missing critical opportunities to examine the impact of this program on health outcomes and utilization indicators detectable in the electronic health record (EHR).

OBJECTIVE

This study is the first to: (1) comprehensively identify a sample of LGBTQ+ veterans who attended PRIDE; and (2) describe the sample demographics, health conditions, and health care utilization.

RESEARCH DESIGN

A retrospective cross-sectional study was conducted using EHR data and staff-reported PRIDE information (eg, site name, facilitator names, dates of delivery). PRIDE-related keywords and chart reviews were used to validate participation and determine the final sample.

SUBJECTS

We identified 588 PRIDE participants at 34 VHA sites from 2016 to 2022.

MEASURES

Demographics (eg, age), health conditions (eg, depression), and health care utilization (eg, mental/behavioral health care visits).

RESULTS

Nearly half of the PRIDE participants (47%) were women, 75% were transgender and gender diverse, and 37% identified as lesbian or gay. A high proportion of the sample had stress-related health conditions, including depression (63%), hypertension (22%), and posttraumatic stress disorder (48%).

CONCLUSIONS

PRIDE serves a disproportionate number of women and transgender and gender diverse veterans compared with general VHA users. In the absence of standardized EHR fields, time-intensive methods are required to leverage EHRs to evaluate programs addressing health equity for LGBTQ+ people.

Disparities in self-reported mental health, physical health, and substance use across sexual orientations in Canada

BACKGROUND

While prior studies have shown LGB individuals have elevated risk of poor mental health, poor physical health, and substance use, existing study designs may be improved by using representative samples, wider ranges of health outcomes, heterosexual comparison groups, and disaggregated data. The goal of this study is to provide estimates of multiple health disparities across sexual orientations in Canada based on these principles.

METHODS

Using data from 2009-2014 Canadian Community Health Surveys, a sample of 19,980,000 weighted individuals was created. Outcomes included mental health, physical health, binge drinking, illicit drug use, and cannabis use. The study used logistic regression models adjusted by covariates, stratified by sex, to estimate health disparities across sexual orientations over time.

RESULTS

Among LGB individuals, there was evidence for elevated risk of poor mental health (i.e. gay men, bisexual men, bisexual women), poor physical health (i.e. bisexual men, bisexual women), binge drinking (i.e. lesbians, bisexual women), illicit drug use (i.e. lesbians, bisexual women), and cannabis use (i.e. lesbians, bisexual women) relative to their heterosexual counterparts. Those identifying as 'don't know' or 'refuse' showed reduced odds of substance use. Bisexual women exhibited highest disparities in health outcomes, e.g. OR=3.3, 95% 2.58 to 4.22 for poor mental health. Trends over time showed worsening mental health among bisexual women (relative to changes in heterosexual women), and decreasing substance use in gay and bisexual men, and lesbians.

CONCLUSION

This study highlights health disparities across sexual orientations in Canada, especially bisexual women, calling for targeted interventions (e.g. increased training of service providers in working with bisexual women and community outreach against biphobia). Future research should aim to explore these disparities longitudinally while also including the use of administrative-linked health data to reduce potential bias in self-reported data.

A scoping review of sense of coherence and salutogenesis among LGBTQ+ populations

Salutogenesis and sense of coherence can buffer the effects of external threats such as stigma, discrimination, and emergencies. Lesbian, gay, bisexual, trans, and queer (LGBTQ+) communities globally face discrimination, prejudice, and victimization. Understanding salutogenesis and sense of coherence among LGBTQ+ people could improve policy and health promotion responses and reduce the impact of these stressors on LGBTQ+ people's health. This scoping review addressed the following question: To what extent has salutogenesis, either qualitatively or through measurement of sense of coherence, been explored among LGBTQ+ populations globally? Systematic searches of five databases identified 448 unique sources: 413 were excluded through title and abstract screening, and 18 by full-text screening. Of the 17 included studies, 14 were quantitative, two qualitative, and one mixed methods. Studies recruited participants from 11 high-income countries. Two-thirds (11) recruited participants only from within the LGBTQ+ community and six had more broadly based samples. The studies sampled a diverse range of subpopulations and subgroups from a variety of contexts limiting generalizability. The quantitative measure of sense of coherence most often used was the SoC-13 (n = 7), however, heterogeneity in the results reporting prevented quantitative synthesis. The limited evidence suggests that sense of coherence may be lower in LGBTQ+ populations than in comparison groups of cisgender heterosexuals, at least in some contexts, and is related to measures of wellbeing and discrimination. Further research is needed to understand how sense of coherence and its dimensions influence, and is influenced by, LGBTQ + people's life experiences and resources and their responses to external stressors.

Somatization Patterns and Minority Stress Among LGBTQ+ Individuals in Hungary

This research aims to explore the relationship between somatization and minority stress in the LGBTQ+ community in Hungary, building on the biopsychosocial model, addressing the unique health challenges of the community and expanding the currently limited literature on the subject. The study involved adult, LGBTQ+, Hungarian individuals, and it assessed somatic symptom severity using the Patient Health Questionnaire-15. Ordinal logistic regressions were carried out, using multiple covariates and factors. Our findings shows that women reported higher somatic symptoms and stress levels, however, these effects are moderate among those living in the capital. The influence of residence type on the individual's psychosomatic health was proven to depend on their sexual orientations and gender identities. Additionally, older respondents, regardless of their gender or sexual orientation, seem to experience less somatic symptoms and stress. The gender respondents identify with, their type of residency, and age have been demonstrated as the most significant factors influencing somatic symptoms and perceived stress. As one of the pioneering studies on psychosomatic symptoms in sexual and gender minorities in Hungary, this research underscores the imperative to academically and practically address the health concerns of the LGBTQ+ community.

Prevalence of Neurologic Disease Among Those in Same-Sex Relationships: Evidence from the Medical Expenditure Panel Survey

Background and Objectives

Prior research has shown several health disparities affecting sexual minority people. Research on the neurologic health of sexual minority people has been limited. Our objective was to characterize the prevalence of neurologic disease and utilization of a neurologist among a population of sexual minority people.

Methods

We conducted a cross-sectional analysis of sexual minority people, using people in same-sex relationships as a proxy for sexual minority status, from the Medical Expenditure Panel Survey (MEPS) from 2016 to 2020. The MEPS is a government-run survey that uses complex sampling to obtain a nationally representative sample. Our primary outcome was a diagnosis of any neurologic disease. We also completed stratified analyses by sex, race, and ethnicity. Our secondary outcome was visit to a neurologist within the past year. Logistic regression was used to compare the odds of both outcomes in those in same-sex relationships and those in different-sex relationships.

Results

Among 153,313 MEPS participants, there were 61,645 (40.2%) participants in relationships who were included in our sample. Of those, 822 (1.33%) participants were in same-sex relationships. Participants were, on average, aged 51 years (median 50 years, IQR 38-63); nearly 50% reported female sex and mostly non-Hispanic White (67.81%). Among those in same-sex relationships, 22.7% reported a neurologic diagnosis compared with 18.1% of those in different-sex relationships (OR 1.33; 95% CI 1.04-1.71). This difference was maintained with adjustment for age, sex, education, and insurance (OR 1.48; 95% CI 1.15-1.91). There was no significant difference in visit to a neurologist (adjusted OR 1.38; 95% CI 0.91-2.10).

Discussion

In this nationally representative sample, neurologic disease was more prevalent among those in same-sex relationships compared with those in different-sex relationships. Limited sample size and absent measurements of minority stress limited the etiologic search for factors driving this disparity. There was no significant difference in visit to a neurologist, and both groups reported their overall health as being similar. There is a need for more routine measurement of sexual orientation in neurologic research. This will allow us to detail differences in neurologic disease risk factors, prevalence, and outcomes. The end goal is the identification of opportunities for intervention and advancement of neurologic health equity.

Mixed evidence for the relationship between HIV stigma and Pain in two studies of people with HIV in Florida

Previous work suggests that HIV stigma is associated with greater pain severity. We sought to characterize this relationship by examining intersectional identities that tend to be stigmatized (i.e., gender; sexual orientation) in two cross-sectional studies of people with HIV (PWH). In Study 1 (N = 840), participants responded to the Enacted Stigma Scale and the Brief Pain Inventory. We found a significant positive association between HIV stigma and pain severity (and between sexual orientation and pain severity), but no interaction effects. In Study 2 (N = 309), participants responded to Internalized Stigma Scale and the Brief Pain Inventory. We did not find a relationship between HIV stigma and pain severity but conceptually replicated the relationship between sexual orientation and pain severity. Results may be due to a small sample size in Study 2, or because the relationship between HIV stigma and pain is specific to enacted stigma (i.e., overt acts of stigma; Study 1) rather than internalized stigma (i.e., an intrapersonal aspect of stigma; Study 2). PERSPECTIVE: Among people with HIV (PWH), there is a positive relationship between enacted stigma and pain. This relationship between stigma and pain should be studied among other intersectional groups including gay men and women of color. PWH should be provided with supportive care for both physical and psychosocial symptoms.

Etiology Beliefs About Sexual and Gender Minority Youth (EB-SGM): Validation with College Students, Community Adults, and Pediatric Healthcare Providers

Sexual and gender minority (SGM) youth are at risk for adverse health outcomes because of stigma and discrimination exposure. Individuals' beliefs about the biological origin of SGM identity are linked to their negative attitudes and biases against SGM populations, which can also apply to pediatric healthcare providers. The current study outlines validation of the Etiology Beliefs about Sexual and Gender Minority Youth (EB-SGM) scale, a 12-item measure designed to assess adults' beliefs about youths' biological versus environmental SGM etiology. College students (N = 285; study 1), community adults (N = 258; study 2), and pediatric providers (N = 104; study 3) completed the EB-SGM and other self-report measures. Exploratory factor analysis (EFA) in study 1 revealed a three-factor structure: beliefs about gender nonconforming behavior, beliefs about gender identity, and beliefs about sexual attraction/behavior. Confirmatory factor analysis (CFA) in study 2 suggested a bi-factor structure, which was replicated in study 3. The EB-SGM demonstrated adequate concurrent and discriminant validity. We also examined bivariate correlations between etiology beliefs and sociodemographic characteristics across samples. Findings indicate that EB-SGM is a psychometrically sound instrument to measure adults' etiology beliefs. The EB-SGM has the potential to be used as a screening measure to enhance pediatric healthcare providers' SGM training.

Associations Between Sexual Orientation Dimensions and Cardiometabolic Diseases: Data From the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III)

OBJECTIVE

Sexual orientation can be measured across identity, attraction, and behavior. Sexual minorities are at increased risk of cardiovascular disease (CVD) and diabetes; however, it is not known whether cardiometabolic disease risk varies across these dimensions.

METHODS

We analyzed cross-sectional data from 36,309 adults who participated in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III; 2012-2013). Participants were categorized as heterosexual (reference), lesbian/gay, or bisexual across identity, attraction, and behavior using structured clinical interview data. Prevalent CVD (myocardial infarction, stroke, angina, or arteriosclerosis) and diabetes were assessed by self-report.

RESULTS

Demographics (age, sex, race/ethnicity, education, and income) adjusted logistic regression models revealed bisexual behavior (i.e., people reporting sexual activity with both man- and woman-identifying individuals), but not lesbian/gay behavior (i.e., people reporting sexual activity exclusively with same-sex individuals), was associated with an increased odds of prevalent CVD (OR = 1.44, 95% CI = 1.08-1.91, p = .013) and prevalent diabetes (OR = 1.39, 95% CI = 1.09-1.77, p = .007). Contrastingly, sexual minority identity (i.e., self-concept) and attraction (i.e., one's sexual/romantic feelings) were not associated with prevalent CVD or diabetes.

CONCLUSIONS

Our results in a nationally representative sample indicate that the sexual orientation dimension of behavior is linked with prevalent CVD and diabetes. This finding suggests that assessing multiple sexual orientation dimensions may aid in identifying sexual minority subgroups in greatest need of cardiometabolic disease prevention efforts. Although mechanisms such as stigma and minority stress have been proposed, future studies are required to elucidate mechanisms underlying the bisexual behavior-cardiometabolic disease relationship.

Structural Stigma and Disparities in Long-Term Health Conditions Among Australians in Same-Sex Relationships: 2021 Australian Census

Objectives.  To explore the extent to which structural stigma (sociocultural and institutional constraining factors) is associated with sexual orientation disparities in long-term health conditions. Methods.  We measured structural stigma using the regional percentage of votes against same-sex marriage from Australia's 2017 Marriage Equality Survey and mapped this to the 2021 Census survey of 10 093 399 and 136 988 individuals in different-sex and same-sex relationships, respectively. Controlling for individual and area-level confounders, we used logistic regression analyses to examine the association between quartiles of structural stigma and sexual orientation disparities in long-term health conditions (e.g., any, mental health, asthma, cardiovascular). Results.  In the lowest stigma quartile, individuals in same-sex relationships had 56% higher odds of reporting any long-term health condition (odds ratio [OR] = 1.56; 95% confidence interval [CI] = 1.53, 1.59) and this increased to 63% in the highest stigma quartile (OR = 1.63; 95% CI = 1.58, 1.68). Effects were particularly pronounced for cardiovascular, respiratory, and mental health conditions as well as for men, younger populations, and those living in socioeconomically deprived regions. Conclusions.  Living in stigmatizing environments may have deleterious health effects for sexual minorities in Australia. Policy action and enhanced protections for sexual minorities are urgently required. (Am J Public Health. 2024;114(10):1110-1122. https://doi.org/10.2105/AJPH.2024.307759).

Sexual Orientation/Gender Identity Discrimination and Chronic Pain in Children: A National Study

INTRODUCTION

This study provides national estimates of parental perceived child sexual orientation or gender minority (SGM) discrimination and examines associations between SGM discrimination and chronic pain in children.

METHODS

Cross-sectional analysis of the 2020 and 2021 National Survey of Children's Health (N=47,213). Caregivers of children ages 6-17 years old reported whether their child had ever been treated or judged unfairly (i.e., discrimination) because of their SGM identity. Chronic pain in children was defined as frequent or chronic difficulty with repeated or chronic physical pain during the past 12 months, as reported by caregivers. Weighted prevalence estimates for discrimination were calculated for the whole sample and sociodemographic subgroups. Associations between SGM discrimination and chronic pain were estimated using multivariable Poisson regression models adjusting for sociodemographic factors. Analyses were conducted 2022-2023.

RESULTS

Within this nationally representative sample, parents reported 1.4% (95% CI 1.2%-1.6%) of children have experienced SGM-related discrimination. The prevalence was higher among adolescents, females at birth, and those living in suburban areas. Children who experienced discrimination had a higher prevalence of chronic pain (20.2%) compared to those who did not (7.0%, p<0.0001), with an adjusted prevalence rate ratio of 2.0 (95% CI 1.5-2.5, p<0.0001).

CONCLUSIONS

Based on parent report, about 0.6 million children in the U.S. have experienced SGM-based discrimination; these children are twice as likely to have chronic pain. Findings highlight the importance of assessment and intervention for chronic pain in children who may experience marginalization and discrimination due to their sexual orientation and gender identity.

The association between gender-affirming care and disordered eating in transgender and gender diverse individuals: Exploring appearance congruence and gender-related motivating factors for weight loss

OBJECTIVE

The objective of this study is to explore between-group differences across different stages of gender-affirming care, and associations between appearance congruence, gender-related motivations for weight loss, and disordered eating in transgender and gender expansive (TGE) individuals.

METHOD

A total of 160 TGE adults (aged 18-30) were recruited across the United States. Participants completed a comprehensive online survey. Data were analyzed using generalized linear models and bivariate correlations.

RESULTS

Significant differences in appearance congruence among participants at different transition stages were revealed, with the group that achieved their desired transition reporting the highest appearance congruence compared to all other groups. Furthermore, gender-related motivations for weight loss were significantly lower in individuals who achieved their desired transition compared to those with no plans to transition.

DISCUSSION

Findings suggest significantly higher appearance congruence in those who achieved their desired transition compared to other groups, and individuals who attained their desired transition exhibited significantly reduced gender-related motivations for weight loss compared to those with no plans to transition. These findings underscore the potential psychological benefits associated with successful gender-affirming care, highlighting its role not only in fostering appearance congruence but also in mitigating gender-related motivations for weight loss among TGE individuals. Future research should include larger and more diverse samples, longitudinal designs, and considerations of other factors influencing body image outcomes in this population.

PUBLIC SIGNIFICANCE

This study sheds light on the crucial relationship between gender-affirming care and body image outcomes in TGE individuals. Understanding how appearance congruence and gender-related motivations for weight loss are associated with disordered eating can inform tailored support and interventions. By recognizing the association of gender affirming care and well-being, healthcare providers can enhance care for TGE individuals.

Men who have sex with men experience low anxiety and few barriers to performing anal self or companion examinations: a qualitative study of the Prevent Anal Cancer Palpation Study

While rare in the larger population, anal cancer incidence is significantly higher in groups such as sexual minority men and people living with HIV. This qualitative analysis examined participants' experiences and perceptions of barriers to anal self-examination and anal companion examination through interviews completed as a part of a larger clinical trial. Interviews were conducted online with participants (n = 131) within a week of their baseline appointment between January 2020 and October 2021. Content analysis denoted participants' thoughts and perceptions about anal self-examination and anal companion examinations. Of the 131 cisgender men interviewed (mean age 49.9 years, SD 12.7), 92.4% identified as gay, 54.9% identified as white, 22.1% identified as Black, 19.9% identified as Latino, and 44.3% of participants were living with HIV. Participants did not report feelings of excessive anxiety when an abnormality was detected. However, three salient themes emerged as to why participants may not perform an anal self-examination or anal companion examination: (1) physical limitation(s), (2) potential sexualisation of the examination, and (3) level of comfort discussing anal health. Future work must continue to explore methods that not only decrease stigma surrounding anal health but also bolster feelings of accessibility to perform self and couple examinations.

Opportunity and accessibility: an environmental scan of publicly available data repositories to address disparities in healthcare decision-making

BACKGROUND

Health disparities, starkly exposed and exacerbated by coronavirus disease 2019, pose a significant challenge to healthcare system access and health outcomes. Integrating health inequalities into health technology assessment calls for robust analytical methodologies utilizing disaggregated data to investigate and quantify the scope of these disparities. However, a comprehensive summary of population datasets that can be used for this purpose is lacking. The objective of this review was to identify publicly accessible health inequalities data repositories that are potential resources for healthcare decision-making and future health technology assessment submissions.

METHODS

An environmental scan was conducted in June of 2023 of six international organizations (World Health Organization, Organisation for Economic Co-operation and Development, Eurostat, United Nations Inter-agency Group for Child Mortality Estimation, the United Nations Sustainable Development Goals, and World Bank) and 38 Organisation for Economic Co-operation and Development countries. The official websites of 42 jurisdictions, excluding non-English websites and those lacking English translations, were reviewed. Screening and data extraction were performed by two reviewers for each data repository, including health indicators, determinants of health, and health inequality metrics. The results were narratively synthesized.

RESULTS

The search identified only a limited number of country-level health inequalities data repositories. The World Health Organization Health Inequality Data Repository emerged as the most comprehensive source of health inequality data. Some country-level data repositories, such as Canada's Health Inequality Data Tool and England's Health Inequality Dashboard, offered rich local insights into determinants of health and numerous health status indicators, including mortality. Data repositories predominantly focused on determinants of health such as age, sex, social deprivation, and geography.

CONCLUSION

Interactive interfaces featuring data exploration and visualization options across diverse patient populations can serve as valuable tools to address health disparities. The data they provide may help inform complex analytical methodologies that integrate health inequality considerations into healthcare decision-making. This may include assessing the feasibility of transporting health inequality data across borders.

Sexual Orientation, Health, and Well-Being in Spanish People

Although several studies have found disparities in health outcomes between heterosexual and lesbian, gay, and bisexual (LGB)-identifying individuals, few studies have focused on subjective well-being and protective factors for health and well-being. The purpose of this work is twofold: (1) to examine the relevance of sexual orientation to health and well-being in women and men; (2) to identify protective and risk factors for psychological distress, self-rated health, and well-being for gay men, lesbian women, bisexual women and men, and heterosexual women and men. The sample consisted of 908 women and 586 men from the general Spanish population aged 16-64, half of whom identified themselves as LGB and half as heterosexual. All were assessed using eight questionnaires and inventories. The results showed that differences varied depending on the health indicator considered. In general, bisexuals had the poorest health, with lower self-rated health and lower self-esteem. In all groups, self-esteem was a protective factor against psychological distress and was associated with better health and well-being. To a lesser extent, social support served as a protective factor against psychological distress and was associated with greater well-being in all groups. It is concluded that although sexual orientation is relevant to the health and well-being of individuals, there are differences among sexual minorities, with bisexuals having lower self-esteem than homosexuals.

Efficacy of psychosocial interventions to reduce affective symptoms in sexual and gender minorities: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals are more likely than cisgender heterosexuals to experience mental, physical, and sexual health issues. A promising contemporary strategy to address the issue of affective symptoms in sexual and gender minorities (SGM) is psychosocial intervention.

OBJECTIVE

To systematically evaluate the effect of psychosocial interventions on the improvement of affective symptoms in SGM, and to provide a reference for the implementation of effective psychological interventions for SGM with affective symptoms.

METHODS

Between the date of database construction until December 10, 2022, a computerized search of the English-language literature published both nationally and worldwide was done. 8 literature databases and 3 additional gray databases were searched. We gathered randomized controlled trials that used psychological interventions for SGM. To evaluate risk bias in included papers in accordance with Cochrane cooperation criteria, we used Review Manager 5.4 software. In conjunction with post-test and follow-up data, mean differences were standardized using Stata 12.0 software. Subgroup analysis was used to investigate the cause of heterogeneity. The study was conducted strictly in accordance with PRISMA guidelines, and it was registered on the PROSPERO platform (CRD42023408610).

RESULTS

This review covered 18 research, and 14 studies were included in the meta-analysis. A total of 1194 study cases, including 706 cases from the control group and 488 cases from the experimental group, were included in these investigations. Compared to the control group, the psychosocial intervention group had significantly lower levels of depression (standardized mean difference (SMD) = -0.17;95% CI = [-0.30, -0.04]; p = 0.012) and anxiety (SMD = -0.22; 95% CI = [-0.41, -0.04]; p = 0.01), but no significant differences were found for distress (SMD = -0.19; 95% CI = [-0.45,0.07]; p = 0.021).

CONCLUSION

According to this study, psychosocial interventions helped lessen the symptoms of depression and anxiety in SGM but had no significant effect on their psychological distress. To assess the impact of psychological intervention on SGM, more randomized controlled trials with larger sample sizes and numerous follow-up times should be done.

Bridging the Gap: Engaging Black Men in Lung Cancer Research Through Barbershop Collaboration

Health disparities persist among Black men, notably in the context of lung cancer and stress-related health outcomes. This study explores these disparities through a community-based participatory research (CBPR) approach, citizen science, and social network theory, leveraging the expertise and trust of Black barbers as community leaders. The purpose is to understand the nuanced connections between stress and lung cancer in this demographic. Engaging 161 Black men across four Chicago neighborhoods, the study successfully collected hair samples and survey data, emphasizing the importance of culturally sensitive recruitment strategies. Findings highlight the effectiveness of the collaboration, showcasing the role of barbershops as community hubs for research. The study concludes by advocating for sustained partnerships with community leaders, emphasizing transparency in research communication, and promoting culturally grounded approaches to address health disparities and enhance research participation among underrepresented populations.

Structural competency in global perspective

This special issue aims to help fill two critical gaps in the growing literature as well as in practice. First, to bring together scholars and practitioners from around the world who develop, practice, review, and question structural competency with the aim of promoting a dialogue with related approaches, such as Latin American Social Medicine, Collective Health, and others, which have been key in diverse geographical and social settings. Second, to contribute to expanding structural competency beyond clinical medicine to include other health-related areas such as social work, global health, public health practice, epidemiological research, health policy, community organisation and beyond. This conceptual expansion is currently taking place in structural competency, and we hope that this volume will help to raise awareness and reinforce what is already happening. In sum, this collection of articles puts structural competency more rigorously and actively in conversation with different geographic, political, social, and professional contexts worldwide. We hope this conversation sparks further development in scholarly, political and community movements for social and health justice.

Health disparities in one of the world's most progressive countries: a scoping review of mental health and substance use among sexual and gender minority people in the Netherlands

BACKGROUND

Evidence from many parts of the world shows that sexual and gender minority (SGM) people have poorer health than their cisgender heterosexual counterparts. Minority stressors, particularly stigma and discrimination, have been identified as major contributors to sexual orientation- and gender identity-related health disparities, particularly negative mental health and behavioral health outcomes. To better understand factors that contribute to these disparities, we conducted a scoping review of SGM mental health and substance use research in the Netherlands-a country with a long-standing reputation as a pioneer in SGM equality.

METHODS

Using Joanna Briggs Institute guidelines and the PRISMA-ScR protocol, we searched seven databases to identify studies published between 2010 and 2022 that focused on substance use and/or mental health of SGM youth and adults in the Netherlands.

RESULTS

Although there was some evidence that SGM people in the Netherlands report fewer substance use and mental health concerns than those in less progressive countries, with very few exceptions studies found poorer outcomes among SGM participants than cisgender, heterosexual participants. However, this observation must be considered cautiously given major gaps in the literature. For example, only one study focused exclusively on adult sexual minority women, two focused on older SGM adults, and very little attention was given to nonbinary individuals. Most studies used non-probability samples that were quite homogenous. Many studies, especially those with youth, assessed sexual orientation based on sexual attraction; some studies of adults operationalized SGM status as having a same-sex partner. Importantly, we found no studies that directly assessed associations between structural-level stigma and health outcomes. Studies were mostly focused at the individual level and on health problems; very little attention was given to strengths or resilience.

CONCLUSIONS

Findings of persistent health disparities-despite the relatively long history of SGM supportive policies in the Netherlands-highlight the need for more research and greater attention to population groups that have been underrepresented. Such research would not only provide guidance on strategies to improve the health of SGM people in the Netherlands, but also in other countries that are seeking to reduce health inequities. Addressing SGM health disparities in the Netherlands and elsewhere is complex and requires a multifaceted approach that addresses individual, interpersonal and structural factors.

Anxiety sensitivity in terms of mental health among a racially and ethnically diverse sample of sexual minority college students

Objective: Limited work has focused on understanding the function of individual difference factors in terms of mental health among sexual minority college students. Anxiety sensitivity is one individual difference factor which has received substantial empirical attention, but its role is presently understudied among racially/ethnically diverse sexual minority college students.Participants: Participants included a racially and ethnically diverse sample of sexual minority college students (N = 217; Mage = 20.82 years; SD = 3.06).Methods: The present investigation evaluated the role of anxiety sensitivity in relation to anxious arousal, social anxiety, depression, and suicidality.Results: Results indicated that anxiety sensitivity was significantly related to increased anxious arousal, social anxiety, depression, and suicidality after adjusting for age, sex, relationship status, subjective social status, and neuroticism.Conclusions: This investigation provides the first empirical evidence that anxiety sensitivity is related to poorer mental health outcomes for racially/ethnically diverse sexual minority college students.

Double Disparity of Sexual Minority Status and Rurality in Cardiometabolic Hospitalization Risk: A Secondary Analysis Using Linked Population-Based Data

Studies have shown separately that sexual minority populations generally experience poorer chronic health outcomes compared with those who identify as heterosexual, as do rural populations compared with urban dwellers. This Canadian national observational study explored healthcare patterns at the little-understood intersections of lesbian, gay, or bisexual (LGB) identity with residence in rural and remote communities, beyond chronic disease status. The secondary analysis applied logistic regressions on multiple linked datasets from representative health surveys, administrative hospital records, and a geocoded index of community remoteness to examine differences in the risk of potentially avoidable cardiometabolic-related hospitalization among adults of working age. Among those with an underlying cardiometabolic condition and residing in more rural and remote communities, a significantly higher hospitalization risk was found for LGB-identified persons compared with their heterosexual peers (odds ratio: 4.2; 95% confidence interval: 1.5-11.7), adjusting for sociodemographic characteristics, behavioral risk factors, and primary healthcare access. In models stratified by sex, the association remained significant among gay and bisexual men (5.6; CI: 1.3-24.4) but not among lesbian and bisexual women (3.5; CI: 0.9-13.6). More research is needed leveraging linkable datasets to better understand the complex and multiplicative influences of sexual minority status and rurality on cardiometabolic health to inform equity-enhancing preventive healthcare interventions.

Musculoskeletal health considerations for the transgender athlete

BACKGROUND

In addition to the familiar sports-related injuries and conditions experienced by cisgender athletes, transgender athletes may also face unique challenges to maintaining their musculoskeletal health. Encouraging sports medicine professionals to become familiar with accepted nomenclature and terminology related to transgender athletes will enable open communication on the field, in the athletic training facility, and office.

OBJECTIVE

Understanding contemporary medical and surgical gender-affirming treatments and the unique ways in which the musculoskeletal system might be affected by each - such as impairments in bone health, changes in ligamentous function and the potential increased risk for deep venous thromboembolism - is essential for provision of optimal musculoskeletal care to transgender athletes. Knowledge of the existing participation policies for transgender athletes is also key for enabling sports medicine professionals to effectively counsel athletes about the need for specialized protective equipment. Additionally, this knowledge is important for appropriately managing therapeutic use exemptions in the competitive sports setting.

CONCLUSION

This article provides an overview of the current accepted nomenclature, common gender-affirming medical and surgical treatments, unique musculoskeletal health considerations, and participation policies for transgender athletes.

Disparities in physical activity between sexual minority and heterosexual women: A systematic review and meta-analysis

Research examining potential differences in physical activity (PA) between sexual minority women (SMW) and heterosexual women have yielded inconsistent results.

OBJECTIVE

Therefore, the purpose of this systematic review and meta-analysis is to examine potential differences in PA between SMW and heterosexual women and to identify potential moderators that may partially explain observed differences in PA.

METHODS

All studies were peer reviewed, published in English, and included a continuous measure of PA for SMW and heterosexual women. A standardized mean difference effect size (ES) was used to compare groups, with random effects models used to estimate a mean ES and 95% CI using a 3-level meta-analysis model to adjust for the correlation between effects nested within studies.

RESULTS

The cumulative results of 24 effects gathered from 7 studies indicated there was no difference in PA between SMW (n = 1619) and heterosexual women (n = 103,295) (ES = -0.038, 95%CI -0.179 to 0.102, p = 0.576). Despite no mean differences, moderate-high heterogeneity was observed, indicating that the results were not consistent across effects (I2 = 64.8%, Q23 = 36.7, p = 0.035). The difference in PA was associated with age (β = -0.018, 95%CI -0.034 to -0.003, p = 0.022) and BMI (β = -0.145, 95%CI -0.228 to -0.061, p = 0.002), with a quadratic relationship observed for both variables.

CONCLUSIONS

Although the results of the current analysis did not indicate significant differences in PA behaviors between SMW and heterosexual women, age and BMI modify the association and are curvilinear in nature; such that smaller differences in PA were observed between SMW and heterosexual women when samples were middle-aged and overweight.

The Effects of Prostate Cancer Treatment on Role-In-Sex in Gay and Bisexual Men: Mixed Methods Results from the Restore-1 and Restore-2 Studies

Gay and bisexual men (GBM) with prostate cancer experience worse sexual and mental health outcomes following prostate cancer treatment than heterosexual men. Emerging evidence suggests that GBM may change their role-in-sex in response to treatment effects. The purpose of this study was to describe the impact of prostate cancer treatment on role-in-sex, to estimate the prevalence of such changes, and to determine the impact on quality of life and mental health. We conducted semi-structured interviews with 30 sexual minority prostate cancer patients. Then, we recruited 401 gay and bisexual prostate cancer patients into a study assessing the effects of rehabilitation. Qualitative data were analyzed using descriptive thematic analysis. Differences in quality of life and mental health outcomes were analyzed using multivariate analyses of variance. Prostate cancer treatment resulted in loss of role-in-sex for many patients. When changes in role-in-sex occurred, the shifts were predominantly from tops to bottoms. Those with a current top role-in-sex had significantly better sexual and mental health outcomes than either versatiles or bottoms. Clinical implications include the need for providers to ask about role-in-sex in order to address disparities in health outcomes by sexual orientation and to provide culturally appropriate care to sexual minority patients.

Evaluation of Survey Nonresponse in Measuring Cardiometabolic Health Risk Factors and Outcomes among Sexual Minority Populations: A National Data Linkage Analysis

Understanding cardiometabolic health among lesbian, gay, and bisexual (LGB) people is challenged by methodological constraints, as most studies are either based on nonprobability samples or assume that missing values in population-based samples occur at random. Linking multiple years of nationally representative surveys, hospital records, and geocoded data, we analyzed selection biases and health disparities by self-identified sexual orientation in Canada. The results from 202,560 survey respondents of working age identified 2.6% as LGB, 96.4% as heterosexual, and <1.0% with nonresponse to the sexual identity question. Those who did not disclose their sexual identity were older, less highly educated, less often working for pay, and less often residing in rural and remote communities; they also had a diagnosed cardiometabolic condition or experienced a cardiometabolic-related hospitalization more often. Among those reporting their sexual identity, LGB individuals were younger, more likely to smoke tobacco or drink alcohol regularly, more likely to have heart disease, and less likely to have a regular medical provider than heterosexual persons. This investigation highlighted the potential of leveraging linked population datasets to advance measurements of sexual minority health disparities. Our findings indicated that population health survey questions on sexual identity are not generally problematic, but cautioned that those who prefer not to state their sexual identity should neither be routinely omitted from analysis nor assumed to have been randomly distributed.

Sexual-orientation differences in risk of health-related impaired ability to work and to remain in the paid workforce: a prospective population-based twin study

BACKGROUND

Studies consistently show an increased risk of poor health among sexual minorities (i.e., those identifying as lesbian, gay, bisexual [LGB] or other non-heterosexuals individuals), as compared to those identifying as heterosexual. It is largely unknown whether the increased risk of mental and physical health problems among sexual minorities is also reflected in an increased risk of health-related impaired ability to work, in terms of sickness absence (SA) and disability pension (DP), or successfully remain in the paid workforce. This study made use of a large sample of Swedish twins with self-reported information about sexual behavior in young adulthood to examine sexual orientation difference in SA and DP during a 12-year follow-up period.

METHOD

Data from the Swedish Twin project of Disability pension and Sickness absence (STODS), including Swedish twins born 1959-1985 was used (N = 17,539; n = 1,238 sexual minority). Self-report survey data on sexual behavior was linked to information about SA and DP benefits from the MicroData for Analysis of the Social Insurance database (MiDAS), the National Social Insurance Agency. Sexual orientation differences in SA and DP between 2006 and 2018 was analyzed, as well as, the influence of sociodemographic, social stress exposure (i.e., victimization, discrimination), mental health treatment, and family confounding on these differences.

RESULTS

Compared to heterosexuals, sexual minorities were more likely to having experienced SA and having been granted DP. The odds were highest for DP, where sexual minorities were 58% more likely to having been granted DP compared to heterosexuals. The higher odds for SA due to any diagnosis could largely be explained by sociodemographic factors. The higher odds of SA due to mental diagnosis could partially be explained by increased risk of being exposed to discrimination and victimization, and partially by having received treatment with antidepressant medication. The higher odds of being granted DP could also partially be explain by increased risk of being exposed to social stress and treatment with antidepressant medication.

CONCLUSION

To our knowledge, this is the first study to report on sexual orientation differences in risk of SA and DP in a population-based sample. We found higher period prevalence of both SA and DP among sexual minorities as compared to heterosexuals. The higher odds of SA and DP could partially or fully be explained by sexual orientation differences in sociodemographic factors, exposure to social stress, and antidepressant treatment for depression. Future studies can extend these findings by continuing to investigate risk factors for SA and DP among sexual minorities and how such factors can be reduced.

Examining Associations Between Resilience and PrEP Use Among HIV-negative GBM in Toronto, Montreal and Vancouver

This study evaluated the association between resilience and PrEP use among a population-based sample of Canadian gay, bisexual, and other men who have sex with men (GBM). Sexually active GBM aged ≥ 16 years old were recruited via respondent-driven sampling (RDS) in Toronto, Montreal, and Vancouver from 02/2017 to 07/2019. We conducted a pooled cross-sectional analysis of HIV-negative/unknown GBM who met clinical eligibility for PrEP. We performed multivariable RDS-II-weighted logistic regression to assess the association between scores on the Connor-Davidson Resilience-2 Scale and PrEP. Mediation analyses with weighted logistic and linear regression were used to assess whether the relationship between minority stressors and PrEP use was mediated by resilience. Of 1167 PrEP-eligible GBM, 317 (27%) indicated they took PrEP in the past six months. Our multivariable model found higher resilience scores were associated with greater odds of PrEP use in the past six months (aOR = 1.13, 95%CI = 1.00, 1.28). We found that resilience reduced the effect of the association between heterosexist discrimination and PrEP use. Resilience also mediated the relationship between internalized homonegativity and PrEP use and mediated the effect of the association between LGBI acceptance concern and PrEP use. Overall, PrEP-eligible GBM with higher resilience scores had a greater odds of PrEP use in the past six months. We also found mixed results for the mediating role of resilience between minority stress and PrEP use. These findings underline the continued importance of strength-based factors in HIV prevention.

Comment l’évolution de l’opinion publique et des réformes législatives influence-t-elle la satisfaction de vie des minorités sexuelles ?

INTRODUCTION

Structural stigma in the form of legal discrimination and population acceptance of same-sex relationships vary greatly across European countries. Previous cross-sectional research has linked such county variation in stigma with life-satisfaction among sexual minorities, but the consequences of the past decade's improvement in legal recognition and social acceptance of same-sex relationships are unknown. In the current study, we, therefore, examined the change in life-satisfaction among sexual minorities between 2012 and 2019 in France, Sweden, and Poland - three countries for which the legal situation and social acceptance of sexual minorities have changed in different directions during the past decade.

METHOD

Between April and July 2012, and again between May and July 2019, the European Union Agency for Fundamental Rights conducted web-based surveys to monitor the fundamental rights situation affecting lesbian, gay, and bisexual (LGB) individuals, living in 28 European countries. For the current study, we analyzed data from all LGB respondents in France, Sweden, and Poland, with no history of migration in 2012 (n = 12,357) and 2019 (n = 21,858).

RESULTS

Regression models adjusted for age, gender, education, and relationship status, showed a strong and significant improvement in life-satisfaction among sexual minorities in France between 2012 and 2019 (β = 0.397, 95 % CI: 0.337, 0.457, p &lt; .001), a country that had experienced improvements in legal recognition (e.g., same-sex marriage legislation in 2013) and improved social acceptance during the same period. In Sweden, which had a high degree of legal recognition and social acceptance in place already in 2012, we found a small increase life-satisfaction among sexual minorities between 2012 and 2019 (β = 0.188, 95 % CI: 0.042, 0.333, p = .012). In Poland, who had experienced deteriorating social acceptance between 2012 and 2019, we found a declined in life-satisfaction among sexual minorities (β = - 0.289, 95 % CI: - 0.385, - 0.193, p &lt; .001).

CONCLUSIONS

Although life satisfaction has increased during the past decade among sexual minorities living in Europe, there are significant variations across countries largely due to the structural stigma and degree of legal recognition of same-sex relationships of those countries. The findings highlight the importance of further efforts to reduce structural stigma by improving legal recognition and social acceptance of same-sex relationships to promote equitable life satisfaction.

A Qualitative Approach to Exploring the Impact of the Gay Identity Formation Process

Background

Most gay men experience difficulty in coming to terms with their sexual orientation, with their health, wellbeing, and quality of life potentially affected by unpleasant experiences often associated with the formation of their gay identity. It is therefore important for nurses to understand the needs of gay men so that they can accompany them and provide quality care during and after the identity formation process.

Objective

The aim of the study was to explore and describe the identity formation and coming out experiences of gay men.

Methods

A qualitative design with a constructivist naturalist approach was used. Data were collected through in-depth semi-structured interviews with five gay men with experience of the gay identity formation process, and data were analyzed using a thematic analysis method.

Results

The results show that the men needed support, as they reported feeling different and alone during the identity formation and coming out process, and that their mental health was affected. Fear of rejection, negative reactions, and disappointing people were the reasons that led the men not to disclose their sexual orientation to family, while those who had come out defined a feeling of liberation.

Conclusions

The gay identity formation process has potential impacts on health, wellbeing, and quality of life. Nurses need cultural competence training to be able to understand the needs of gay men, accompany them in the identity formation process, and provide individualized and non-heteronormative care. Nurses also need to participate in dismantling a heterosexist social structure.

Health and health-related behaviours in refugees and migrants who self-identify as sexual or gender minority - A National population-based study in Sweden

BACKGROUND

To examine health and health-related behaviors in migrant and refugee individuals who identify as sexual or gender minority, and in comparison to their heterosexual peers.

METHODS

The study included 168,952 individuals (aged 16-84 years, males: 45·9%, sexual or gender minorities: 3·1%) who answered the Swedish National Public Health Survey in 2018 and 2020. Participants were grouped into Swedish-and Western-born (White) heterosexual, White sexual- or gender minority, migrant heterosexual, migrant sexual- or gender minority, refugee heterosexual, and refugee sexual- or gender minority. Outcomes included mental health (for example suicidal ideation, wellbeing), general health, risky behaviors (risk alcohol use, risk gambling, and substance use), and experiences of violence. Associations between 1) sexual- or gender -ethnic identities and 2) gender-ethnic identities and all outcomes were analyzed using logistic and linear regression adjusting for sex, age, and educational level.

FINDINGS

Being a sexual- or gender minority, regardless of ethnic minority status, was associated with worse general health and mental ill-health compared to heterosexual peers including suicidal ideation in refugee sexual- or gender minority individuals (OR 2·42, 95 % CI 1·44-4·08). Ethnic minorities (heterosexual and sexual- or gender minority migrants and refugees) had lower odds of drug and risk alcohol use compared to White heterosexual peers but higher odds of risk gambling (1·88, 1·49-2·37 for refugee heterosexuals). Transgender refugees had high odds for risk gambling (8·62, 1·94-38·40) and exposure to physical violence (7·46, 2·97-18·70).

INTERPRETATION

In this national population-based study, sexual and gender minority individuals have worse mental and general health regardless of ethnic minority status. We did not find evidence for worse health in sexual- or gender minority refugees in comparison to migrant, and White sexual- or gender minorities and their heterosexual peers. Transgender individuals (White and ethnic minority) experienced significantly higher levels of physical violence. Public health policy should emphasize preventive measures to reduce exposure to violence and discrimination in sexual- and gender minority individuals, increase access and use of mental healthcare services and sensitise healthcare professionals about higher rates of health and related issues faced by sexual- and gender minority individuals including those with multiple minority identities.

FUNDING

We received no external funding for this study and hence the funder had no role in the study design, data collection, data analysis, data interpretation, writing of the manuscript and the decision to submit.

Changes in General Health and Mental Health Outcomes in an Urban Population Over a Decade: A Population-Representative Analysis Stratified by Sexual Orientation

Purpose: We explored population-level changes in general and mental health outcomes among sexual minority and heterosexual New York City (NYC) adults. Methods: Using the NYC Health and Nutrition Examination Surveys, we analyzed data from 2931 adults surveyed between 2004 and 2014. Sexual minority (LGB+) participants included those who identified as lesbian, gay, bisexual, something else, or not sure. Prevalence estimates of general health, mental health services use, prescription use for a mental/emotional condition, and mental/emotional disability were calculated. Changes in these estimates were compared across survey iterations with two-sided t-tests. Multivariate log binomial regression modeling was also employed. Results: Across the study period, LGB+ adults reported a decrease in fair/poor general health (24%-18%). Compared to 2004, LGB+ adults in 2014 were more likely to use mental health services (15%-27%), take prescription medication for a mental/emotional condition (11%-20%), and have a mental/emotional disability limiting work (5%-10%). Point estimates showed similar changes over time among both LGB+ and heterosexual adults, but some changes were not statistically significant. We also found that bisexual adults utilized mental health services (prevalence ratio [PR] = 2.15; 95% confidence interval [CI]: 1.34-3.44) and medications (PR = 2.92; 95% CI: 1.72-4.96) more than heterosexual adults. Conclusion: Although reporting fair/poor general health decreased, the prevalence of using mental health services, using prescription medication, and having a mental/emotional disability increased for both LGB+ and heterosexual adults in NYC. These findings may be related to greater mental health literacy and awareness or to other population-wide trends.

Effects of Online Heterosexist Experiences on Physical and Mental Health in Sexual Minorities: An Examination of the Cognitive and Affective Mechanisms

Cyber violence has emerged as a new source of minority stress over the past decade. Due to the anonymous and unrestrictive nature of the internet, cyber violence is even more blatant and pervasive than in person violence for sexual minority individuals. The present study aimed to examine whether and how online and offline experiences of heterosexism are related to physical and mental health. A total of 941 sexual minority individuals participated in a community-based online survey study. The findings indicated that online heterosexist experiences explained variance in physical and mental health, beyond the contribution of offline heterosexist experiences. Among sexual minority young adults, the effect of online heterosexist experiences on mental health was stronger than that of offline heterosexist experiences, whereas the association between online heterosexist experiences and health problems was not observed in the adult sample. The results of mediation analysis showed that heterosexist experiences were related to heightened expectations of rejection, which, in turn, were related to poor physical and mental health. The association of heterosexist experiences and mental health was also mediated by negative affect. Given the detrimental effect of online heterosexist experiences, effective interventions are needed to combat cyber violence motivated by sexual orientation and enhance the coping and confrontation strategies in response to harmful online content.

Media pressure and the process of Westernization in the context of body self-assessment among young heterosexual and gay Polish men

Mass media and social networks portray a unified image of the perfect male body. The intensity and universality of this influence is an important element of the process of Westernization, especially in traditional cultures such as that of Poland. The main aim of the present study was to investigate the differences between Polish gay and heterosexual men in terms of the role played by self-esteem and the level of internalization of sociocultural standards of body appearance as predictors of the development of their body images. The research study was conducted by reference to 19- to 29-year-old Polish heterosexual (n = 287) and gay (n = 97) men. The variables were measured using Polish versions of the Sociocultural Attitudes towards Appearance Scale-3, the Self-Esteem Scale, and the Multidimensional Body–Self Relations Questionnaire. Statistical analyses identified several variables as the main predictors of body image in both heterosexual and gay young men: self-esteem, information-seeking, perceived pressure and the internalization of sociocultural standards regarding an athletic body image drawn from mass media. The only significant difference between the two groups was the fact that self-esteem, perceived pressure and the internalization of sociocultural standards from mass media did not play a predictive role with respect to Appearance Orientation among the group of gay men.

Behavior without beliefs: Profiles of heteronormativity and well-being among heterosexual and non-heterosexual university students in Chile

Heteronormativity comprises essentialist, binary beliefs about sex and gender, and normative behaviors derived from those beliefs. There is scarce literature on how heteronormative attitudes and well-being variables are concurrent among individuals who are heterosexual or gay, lesbian, bisexual, and of other queer sexual identities (LGBQ). The objective of this study was to distinguish profiles of university students based on essentialism and normative behavior, two dimensions of heteronormativity, and to characterize these groups by sexual orientation and gender, perceived social support, physical and mental health, and life satisfaction. A sample of 552 university students in Temuco, Chile, responded to an online questionnaire consisting of sociodemographic questions, the Scale of Heteronormative Attitudes and Beliefs, the Life Satisfaction Scale, the Health-Related Quality of Life Index, and the Multidimensional Scale of Perceived Social Support. We used Latent profile analysis to distinguish profiles based on significant score differences in Essentialism and Normative behavior. We identified four heteronormativity profiles: High heteronormativity (34.85%), with a significant proportion of heterosexuals and men; Low heteronormativity (25.59%), comprising a significant proportion of students who were non-binary, and LGBQ; Heteronormativity focused on normative behavior (20.42%), with a significant proportion students who were men or non-binary, and who were lesbian, gay or bisexual or preferred not to disclose their sexual orientation; and Heteronormativity focused on essentialism (19.14%), with a significant proportion of heterosexuals and women, and individuals who preferred not to disclose their sexual orientation. The four profiles differed in the proportions of students by faculty and area of residence (urban/rural), and by life satisfaction, self-perceived mental health, and perceived social support. These results show that patterns of association between heteronormativity and subjective well-being are heterogeneous among heterosexual and non-heterosexual individuals. Some of these patterns may respond to the COVID-19 pandemic, which has disrupted daily life and social dynamics. These findings expand our understanding of advantageous and disadvantageous conditions associated with maintaining heteronormativity attitudes, particularly among non-heterosexual individuals.

Risk of poor mental health and experience of violence among a young adult population with same-sex sexuality: a cross-sectional study in southern Sweden

OBJECTIVES

To assess prevalence and correlates of same-sex sexuality and its relationship to poor mental health and experiences of violence among youth and young adults in Sweden. A secondary aim was to estimate the same-sex sexuality attributable fractions.

DESIGN

A population-based cross-sectional survey.

SETTING

Southern Sweden.

PARTICIPANTS

2968 respondents out of 7000 youth and young adults between 18 and 29 years old, resident in southern Sweden, selected randomly by the Swedish Central Population Registry (final sample=2931 respondents, 318 with same-sex sexuality and 2613 without).

OUTCOME MEASURES

The outcome measures were self-reported poor mental health (depression and anxiety) and experience of violence (physical violence, sexual violence and sexual coercion).

RESULTS

Increased odd of high scores of depression (adjusted OR 1.8, 95% CI 1.39 to 2.26) and anxiety (adjusted OR 1.6, 95% CI 1.28 to 2.07) were observed among youth and young adults with same-sex sexuality. Similarly, increased odds of experience of physical violence (OR 1.8, 95% CI 1.23 to 2.51), sexual violence (OR 2.8, 95% CI 1.96 to 3.89) and sexual coercion (OR 2.5, 95% CI 1.95 to 3.30) were observed with same-sex sexuality. Within the entire young population, same-sex sexuality accounted for 4.7% and 4.1% of the self-reported experience of depression and anxiety, respectively. The estimated same-sex sexuality attributable fractions of violence within the entire population of young people were 4.5% for physical violence, 7.3% for sexual violence and 6.4% for sexual coercion.

CONCLUSIONS

This study findings suggest that same-sex sexuality is associated with poor self-rated mental health and experience of violence among youth and young adults in Sweden. Some differences were observed between males and females, indicating that the vulnerabilities and experiences vary between young males and females. Further research is needed in order to gain a deeper knowledge of the factors underlying these associations and the gender differences observed.

Austrian University Hospital Physicians' Barriers to and Reasons for Assessing Their Patients' Sexual Orientation

The current online-questionnaire study examined physicians' (N = 135; 51.9% women and 48.1% men) attitudes toward homosexuality and assessed physicians' barriers to and reasons for asking patients about their sexual orientation at an Austrian university hospital. Only 37.1% of female physicians and 27.7% of male physicians included questions about their patients' sexual orientation in everyday clinical practice. The most commonly reported barrier was the belief that sexual orientation was irrelevant for healthcare. Reported discomfort or negative attitudes toward homosexuality were low and did not play a role in the frequency of physicians' everyday assessment of patients' sexual orientation. Physicians mostly stated concerns for their patients' sexual health as reasons for assessing sexual orientation. Medical education or training programs need to include more thorough education with regard to sexual orientation, minority stress and health disparities. It is important that physicians recognize the relevance of assessing their patients' sexual orientation.

Missing Pieces: Engaging Sociology of Disability in Medical Sociology

Medical sociologists and sociologists of disability study similar topics but, because of competing or conflicting theoretical paradigms, tend to arrive at different conclusions, engage with different audiences, and pursue different directions for social change. Despite diverging trajectories over the past 20 years, however, there remains clear potential overlap between both subfields in the study of disability and untapped opportunities for cross-fertilization. Our purpose here is to place these literatures in conversation with each other. Toward this end, we identify major themes in the last 20 years of medical sociology scholarship, gaps with regard to disability in those themes, and possibilities (including methodologies) we see at the intersection of medical sociology and the sociology of disability that could address these gaps.

Access to health services for lesbian women: a literature review

This study explores access to health services for lesbians in the light of current literature. A literature search was conducted using various databases and an interpretive synthesis of the findings of the selected articles was produced anchored in the concepts of habitus and symbolic violence developed by Pierre Bourdieu. Two main themes and their respective units of meaning were identified: (a) barriers and difficulties experienced by lesbians in accessing healthcare (issues related to coming out as a lesbian and difficulties experienced by health services and professionals in dealing with lesbian women); and (b) lesbian women's experiences in health services (unequal care, invisibility, and feeling uncomfortable). We conclude that, despite advances in policy and care protocols, sexual and gender diversity needs to be widely discussed in social, educational, and health settings.

Older gay men's engagement with physical activity: A scoping review

Older gay men experience an elevated prevalence of adverse health conditions that may be compounded by age-related deterioration. Some of these conditions may be ameliorated by regular adherence to physical activity (PA). However, many gay men participate in less PA than their age-matched heterosexual counterparts. With a focus on gay men aged 60 and over, the aims of this review were to examine the evidence for older gay men's engagement with PA and the research approaches used to describe this group. A systematic search of six academic databases (Academic Search Premier, Cinahl, PubMed, Sport Discus, APA PsychInfo and APA PsychArticles) generated 23 papers from 1970 to 2020 that focused on older gay men's engagement with PA. Although surveys were well represented in the literature, further studies utilising qualitative methodological frameworks have the potential to inform targeted interventional programs aimed at reducing less health disparities. The value of PA in older adults lies principally in improved performance of activities of daily living, independent living, increased longevity, decreased cognitive decline and improved mental well-being.

A biopsychosocial framework for understanding sexual and gender minority health: A call for action

The number of US adults identifying as lesbian, gay, bisexual, transgender, or a different sexual identity has doubled since 2008, and about 40 % of the sexual and gender minority population identify as people of color. Minority stress theory posits that sexual and gender minorities are at particular risk for stress via stigma and discrimination at the structural, interpersonal, and individual levels. This stress, in turn, elevates the risk of adverse health outcomes across several domains. However, there remains a conspicuously limited amount of research on the psychoneuroimmunology of stress among sexual and gender minorities. We developed the Biopsychosocial Minority Stress Framework which posits that sexual minority status leads to unique experiences of minority stress which results in adverse health behavioral factors, elevated psychological distress and sleep disturbance, and immune dysregulation. Moderators in the model include both individual differences and intersectional identities. There is a crucial need to understand the biological-psychological axis of stress among the increasingly visible sexual and gender minority population to increase their health, longevity, and quality of life.

The Role of Interpersonal Relationships and Household Socioeconomic Status in the Association Between Sexual Orientation and Health: A Moderated Mediation Analysis

Purpose: Emerging studies indicate that sexual minority youths experience worse health than their heterosexual peers, but few studies have examined the intervening mechanisms linking sexual orientation and health status. This study hypothesizes that interpersonal relationships, moderated by household socioeconomic status (HSES), are important mediators in the association between sexual orientation and health status. Methods: A total of 49,084 youths, consisting of 9499 youths who identified as sexual minority individuals and 39,585 youths who identified as heterosexual, were sampled from a national study on sexual and reproductive health conducted in China. Logistic regression analyses were performed to estimate the association between sexual orientation and self-rated health. Causal mediation and moderated mediation analyses were performed to analyze the mediating and moderating effects of interpersonal relationships and HSES, respectively. Results: Self-rated health was significantly poorer for sexual minority youths compared with heterosexual youths (p < 0.01). From 7.90% to 25.74% of the association between sexual orientation and self-rated health was mediated through poor interpersonal relationships with both parents and peers. A poor relationship with the father accounted for the highest percentage. HSES was found to moderate the mediation effect of interpersonal relationships, with the greatest effect found for sexual minority youths with lower HSES. Conclusion: HSES moderated the indirect effects of interpersonal relationships on the association between sexual orientation and self-rated health. Interventions focused on improving interpersonal relationships for sexual minority youths, especially those with low HSES, merit attention.

Risk and Protective Factors for Adolescent Relationship Abuse across Different Sexual and Gender Identities

Little is known about the characteristics and context of adolescent relationship abuse victimization across youth of different sexual and gender minority identities. This study sought to examine this in a national sample of 14-15-year-old youth. The sample comprised 3296 youth who reported having been in a relationship, of which 36% (n = 1197) were exclusively cisgender heterosexual; 41% (n = 1, 349) cisgender sexual minority; and 23% (n = 750) gender minority, the majority of whom were also sexual minority. More than half of all youth who had been in a relationship, dated or hooked up with someone had experienced some form of adolescent relationship abuse victimization. Gender minority youth, in particular transgender boys and non-binary youth assigned female at birth, were more likely to be victims of multiple types of adolescent relationship abuse compared to cisgender youth. Perpetrator gender varied for sexual and gender minorities and was more homogenous for cisgender heterosexual youth. Several factors were associated with adolescent relationship abuse for all youth, although alcohol use, and parental trust and communication emerged as particularly important for sexual and gender minority youth. Overall, findings address multiple gaps in the literature and contribute to the understanding of adolescent relationship abuse across different sexual and gender identities.

Validation of the factor structure of the Eating Pathology Symptoms Inventory in an international sample of sexual minority men

Sexual minority individuals are at greater risk for the development of eating-disorder (ED) psychopathology. Despite the importance of understanding ED symptoms in sexual minority men, most ED measures were developed and validated in heterosexual, young adult, white women. The psychometric properties of ED measures in diverse populations remain largely unknown. The purpose of this study was to test: 1) whether the eight-factor structure of the Eating Pathology Symptoms Inventory (EPSI) replicated in sexual minority men and 2) group-level mean differences between gay and bisexual men on the eight EPSI scales. International participants (N = 722 sexual minority men from 20 countries) were recruited via the Grindr smartphone application. Confirmatory factor analysis (CFA) was completed using a weighted least square mean and variance adjusted estimator. Group differences in eating pathology between gay and bisexual men were tested using independent samples t-tests. The CFA model fit was good on all fit indices (CFI/TLI > 0.90, RMSEA < 0.06). Gay and bisexual men only differed on the EPSI Binge Eating scale. The results of this investigation suggest that the EPSI may be a useful tool for understanding eating pathology in this population. Using psychometrically sound assessment tools for sexual minority men is a vital piece of treatment planning and clinical decision making. The current study fills an important gap in the clinical and research literature by testing the validity and psychometric properties of a commonly used ED measure in sexual minority men.

Gay men's stress response to a general and a specific social stressor

Gay men show altered psychobiological stress responses and exhibit a higher prevalence of mental disorders than their heterosexual counterparts. Both of these findings are likely due to gay-specific discrimination. Since it has not yet been determined whether gay-specific stress is more noxious than general stress, we tested whether gay men react more strongly to gay-specific socially stressful stimuli than to general socially stressful stimuli. N = 33 self-identified gay men (mean = 26.12 years of age, SD = 5.89), 63.6% of whom were in a relationship with a man, participated in an experimental within-group study, in which they were exposed to the Trier Social Stress Test (TSST) as well as a gay-specific TSST in a randomized order. Salivary cortisol and testosterone were assessed at five time points during the laboratory tests and perceived stress was assessed at four time points. According to psychobiological and perceived stress indices, the participants reacted similarly to a gay-specific and general social stressor. There were no significant differences in the outcomes, either when looking at pre-post-test differences or when comparing the overall stress responses. Given that the response to a gay-specific social stressor was equally pronounced as the one to a general social stressor, programs aiming to decrease minority stress but overlooking general stress are likely to yield only partial improvements in gay men's mental health. Instead, we suggest helping gay men cope with both forms of stress through building social support, assertiveness, and mindfulness skills, as well as decreasing emotional dysregulation.

Disparities in Social and Economic Determinants of Health by Sexual Identity, Gender, and Age: Results from the 2015-2018 National Survey on Drug Use and Health

Purpose: We characterize disparities between lesbian, gay, and bisexual (LGB) adults and heterosexual adults across multiple health determinants in a nationally representative sample. Methods: Data on 153,939 adults (including 11,133 LGB adults) were from the 2015-2018 National Survey on Drug Use and Health. Separate Poisson regression models were used to estimate the relative risk (RR) that gay/lesbian and bisexual adults, respectively, experienced each health determinant, relative to heterosexual adults of the same gender and age group (ages 18-25, 26-34, 35-49, and 50-64). Statistically significant RR estimates were interpreted as a disparity. Results: Bisexual females exhibited disparities on all economic/health care access factors (no college degree, household poverty, means-tested assistance, unemployment, and lacking health insurance) across nearly all age groups; lesbian/gay females exhibited disparities in means-tested assistance and health insurance for some age groups. Notably fewer economic disparities were observed among gay and bisexual males. LGB adults (across identity, gender, and age group) were more likely to live alone, to have never been married, and to report low religious service attendance. Bisexual and lesbian/gay females, across age groups, had 1.7-2.2 times the risk of a lifetime arrest for a criminal offense, relative to same-age heterosexual females. Conclusions: Our results highlight that LGB females, particularly bisexual females, experience significant disparities in economic determinants of health, and all LGB subgroups exhibited disparities in some of the examined social determinants of health. The observed disparities, which spanned across age groups, likely contribute to disparities in physical and mental health observed among LGB adults.

Who Aren't We Reaching? Young Sexual Minority Men's Non-participation in an HIV-Prevention and Mental Health Clinical Trial

Despite many successful clinical trials to test HIV-prevention interventions for sexual minority men (SMM), not all SMM are reached by these trials. Identifying factors associated with non-participation in these trials could help to ensure the benefits of research extend to all SMM. Prospective participants in New York City and Miami were screened to determine eligibility for a baseline assessment for a mental health/HIV-prevention trial (N = 633 eligible on screen). Logistic regression and classification and regression tree (CART) analysis identified predictors of non-participation in the baseline, among those who were screened as eligible and invited to participate. Individuals who reported unknown HIV status were more likely to be non-participators than those who reported being HIV-negative (OR = 2.39; 95% CI 1.41, 4.04). In New York City, Latinx SMM were more likely to be non-participators than non-Latinx white SMM (OR = 1.81; 95% CI, 1.09, 2.98). A CART model pruned two predictors of non-participation: knowledge of HIV status and age, such that SMM with unknown HIV status and SMM ages 18-19 were less likely to participate. Young SMM who did not know their HIV status, and thus are more likely to acquire and transmit HIV, were less likely to participate. Additionally, younger SMM (18-19 years) and Latinx SMM in New York City were less likely to participate. The findings suggest the importance of tailored recruitment to ensure HIV-prevention/mental health trials reach all SMM.

Sexual orientation identity in relation to unhealthy body mass index: individual participant data meta-analysis of 93 429 individuals from 12 UK health surveys

Background

Lesbian, gay and bisexual adults are more likely than heterosexual adults to experience worse health outcomes. Despite increasing public health interest in the importance of maintaining a healthy body weight, no study has considered sexual orientation identity (SOI) and unhealthy BMI categories among adults in the UK population.

Methods

Individual participant data meta-analysis using pooled data from population health surveys reporting on 93 429 adults with data on SOI, BMI and study covariates.

Results

Adjusting for covariates and allowing for between-study variation, women identifying as lesbian (OR = 1.41, 95% CI: 1.16, 1.72) or bisexual (OR = 1.24, 95% CI: 1.03, 1.48) were at increased risk of overweight/obesity compared to heterosexual women, but men identifying as gay were at decreased risk (OR = 0.72, 95% CI: 0.61, 0.85) compared to heterosexual men. Increased risk of being underweight was seen for women identifying as ‘other’ (OR = 1.95, 95% CI: 1.07, 3.56), and men identifying as gay (OR = 3.12, 95% CI: 1.83, 5.38), bisexual (OR = 2.30, 95% CI: 1.17, 4.52), ‘other’ (OR = 3.95, 95% CI: 1.85, 8.42).

Conclusions

The emerging picture of health disparities in this population, along with well documented discrimination, indicate that sexual orientation should be considered as a social determinant of health.

Freedom and struggling openly in psychotherapy: A qualitative inquiry with LGBQ young adults from religious families

Lesbian, gay, bisexual, and queer (LGBQ) young people from religious families are at increased risk of family rejection, poor mental health outcomes, and are overrepresented in mental health services. This article describes a two-part qualitative study aimed at exploring the experiences of LGBQ young adults from religious families in psychotherapy, identifying positive and negative psychotherapy experiences, and understanding the influence of family and religion on the psychotherapy experience. Data were collected through a web-based survey (n = 77) and interviews (n = 7) with LGBQ young adults (ages 18-25) from religious families. The study followed an interpretative phenomenological approach. Integrated results found often invisible, relational therapy processes, and religious discourses as significant to LGBQ young people who seek psychotherapy. Implications for future research, effective systemic family therapy practices with LGBQ young people from religious families, and a critique on ethical and legal limits of confidentiality with policy implications are outlined.