Characteristics of childhood sexual abuse in lesbians and heterosexual women

Childhood sexual abuse, adult sexual assault, revictimization, and coping among sexual minority women

BACKGROUND

Compared with heterosexual women, sexual minority women experience higher rates and greater severity of sexual victimization. Little is known about how childhood sexual abuse (CSA), adult sexual assault (ASA), and revictimization impact coping in this population. Few studies have examined the effects of recency, developmental stage, and revictimization on coping.

OBJECTIVE

To improve psychosocial outcomes following sexual victimization, it is important to understand whether different patterns of exposure differentially impact coping over time. To do so, we investigated associations between CSA, ASA, and revictimization (both CSA and ASA) and adult sexual minority women's coping strategies.

PARTICIPANTS AND SETTING

Data are from a longitudinal community-based sample of 513 sexual minority women of diverse ages and races/ethnicities.

METHODS

Participants reported CSA (

RESULTS

High-risk (i.e., genital penetration) CSA and recent ASA were associated with more avoidant coping (compared to no CSA or no ASA). No interaction between CSA and ASA was found, but history of both CSA and ASA had a stronger effect on avoidant coping than no victimization or CSA only.

CONCLUSIONS

Although sexual revictimization had a stronger impact on coping than CSA or ASA only, we did not find a synergistic effect (i.e., CSA and ASA may have had stacked independent effects). History of ASA was more strongly associated with coping than CSA. Recency of sexual victimization appears especially salient to coping among sexual minority women.

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Key Words

• Adult sexual assault
• Childhood sexual abuse
• Coping
• Revictimization
• Sexual minority women

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MESH Headings

• Adult
• Female
• Child
• Humans
• Adolescent
• Child Abuse, Sexual/psychology
• Sexual Behavior/psychology
• Crime Victims/psychology
• Coping Skills
• Ethnicity

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Grants

• F32 AA029957 NIAAA NIH HHS
• K01 AA028239 NIAAA NIH HHS
• L60 AA029575 NIAAA NIH HHS
• R01 AA013328 NIAAA NIH HHS

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Affiliation(s)

Mariah Xu Columbia University, School of Nursing, United States of America.
Thomas Corbeil Columbia University, Department of Psychiatry, United States of America
Lauren Bochicchio Columbia University, School of Nursing, United States of America
Jillian R Scheer Syracuse University, Department of Psychology, United States of America
Melanie Wall Columbia University, Department of Psychiatry, United States of America
Tonda L Hughes Columbia University, School of Nursing, United States of America

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Health Outcomes of Sexual Minority Women Who Have Experienced Adverse Childhood Experiences: A Scoping Review

Sexual minority women (SMW; e.g., lesbian, bisexual) report higher rates of almost every negative physical health (e.g., asthma, arthritis, cardiovascular disease), mental health (e.g., depression, anxiety), and substance use outcome compared to heterosexual women. Adverse Childhood Experiences (ACEs) have been identified as risk factors for negative health outcomes. Despite this, no study to date has synthesized existing literature examining ACEs and health outcomes among SMW. This gap is important because SMW are significantly more likely than heterosexual women to report every type of ACE and a higher total number of ACEs. Therefore, using a scoping review methodology, we sought to expand understanding of the relationship between ACEs and health outcomes among SMW. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for. Scoping Reviews protocol, we searched five databases: Web of Science, PsycInfo, CINAHL, PubMed, and Embase for studies published between January 2000 and June 2021 that examined mental health, physical health, and/or substance use risk factors and outcomes among adult cisgender SMW who report ACEs. Our search yielded 840 unique results. Studies were screened independently by two authors to determine eligibility, and 42 met full inclusion criteria. Our findings provide strong evidence that ACEs are an important risk factor for multiple negative mental health and substance use outcomes among SMW. However, findings were mixed with respect to some health risk behaviors and physical health outcomes among SMW, highlighting the need for future research to clarify these relationships.

Adverse childhood experiences and depressive symptoms among lesbian and bisexual women in China

BACKGROUND

Despite the relationship between Adverse childhood experiences (ACEs) and depressive symptoms, which has been well researched in general populations, little is known about homosexual and bisexual populations, especially lesbian and bisexual women in China. This study aims to investigate the prevalence of ACEs and depressive symptoms and to analyze the relationship between them among lesbian and bisexual women in China.

METHODS

The eligible participants were aged 16 years or older who report their sexual orientation as homosexual or bisexual. The data was collected through anonymous questionnaires with the help of Lespark in Beijing from July 18 to December 29, 2018, and all participants had informed consent to this study. Univariate analysis and multiple linear regression analyses were performed to explore the relationship between ACEs and depressive symptoms among lesbian and bisexual women. All statistical analyses were conducted by the software of SPSS 22.0.

RESULTS

Among 301 lesbian and bisexual women, 81.4% were lesbian, 18.4% were bisexual women, and the majority were 21-30 years. As for ACEs, 51.5% reported at least one ACE, in which emotional neglect (22.6%) and emotional abuse (22.3%) were common ACEs. As for depressive symptoms of lesbian and bisexual women, the detection rate was 56.1%. The multiple linear regression analyses showed that abuse (β = 2.95, 95%CI:1.07-4.83) and neglect (β = 3.21, 95%CI:1.09-5.31) were positively associated with depressive symptoms and lesbian and bisexual women with three (β = 4.11, 95%CI: 0.99-7.22) or more (β = 6.02, 95%CI: 3.23-8.78) ACEs suffered from more depressive symptoms than others.

CONCLUSION

Adverse childhood experiences (ACEs) and depressive symptoms were at high prevalence among lesbian and bisexual women in China. ACEs were associated with depressive symptoms, especially childhood abuse and neglect experiences that have a significant effect on lesbian and bisexual women mental health.

COVID-19 Concerns, Coping and Perceived Peer Norms: Correlates of Increased Alcohol and Marijuana Use Among Sexual Minority Women

This study explored the impact of COVID-related concerns and other characteristics on alcohol and marijuana use among sexual minority women (SMW). Survey data from a racially/ethnically diverse sample of 338 SMW participants in the Chicago Health and Life Experiences of Women (CHLEW) study were used to examine correlates of three substance use outcomes: frequent intoxication (once a month or more), perceived increase in alcohol use, and perceived increase in marijuana use. Coping motives for alcohol use was positively associated with each of the substance use outcomes. Belief that peers (in terms of age, sexual identity, and gender) used alcohol often to cope was associated with higher odds of frequent intoxication. COVID-19 related financial concerns were positively associated with both frequent intoxication and increased marijuana use. Health and mental health concerns were associated with lower odds of frequent intoxication. Findings underscore the importance of enhancing coping skills, addressing perceived peer coping norms, and providing both economic and social support in intervention efforts.

Associations Between Latent Classes of Trauma Exposure and Minority Stressors and Substance Use Among Cisgender Sexual Minority Women

Psychosocial stressors (e.g., minority stressors, trauma exposure) profoundly impact sexual minority women's (SMW's) risk of alcohol and other drug (AOD) use. However, research has not examined whether there are distinct typologies (i.e., patterns) of psychosocial stressors and whether these vary based on sociodemographic characteristics or are differentially associated with AOD outcomes (e.g., alcohol dependence) among SMW. This study aimed to identify latent classes of SMW reporting distinct typologies of psychosocial stressors and examine predictors and outcomes of latent classes of psychosocial stressors among SMW. Participants included a community sample of 602 SMW (M_age = 39.9, SD = 14.0; 74.0% lesbian; 37.4% White, 36.6% Black, 22.3% Latinx; 26.6% annual income ≤$14,999). Latent class analysis was used to identify typologies of psychosocial stressors. Regression analyses were employed to examine sociodemographic predictors and AOD outcomes of class membership. Three classes of psychosocial stressors emerged. Participants in Class 1 were likely to report relatively low adversity. SMW in Class 2, who reported childhood physical abuse (CPA), severe childhood sexual abuse, and adult physical assault, were vulnerable to discrimination and stigma consciousness. A distinct subgroup of SMW (Class 3) was at heightened risk of CPA, adult sexual assault (ASA), and stigma consciousness. Older SMW, Black SMW, and SMW with lower social support were more likely to be in classes characterized by higher adversity. Older SMW were at disproportionate risk of CPA and ASA. Different combinations of psychosocial stressors were uniquely associated with AOD outcomes. Findings underscore the importance of considering within-group heterogeneity in SMW's differential risk of psychosocial stressors and AOD outcomes. Routine screening of psychosocial stressors across several dimensions, brief interventions targeting AOD outcomes, and policies mitigating structural drivers of SMW's increased risk of trauma and minority stressors may be especially important for older SMW, Black SMW, and SMW who lack social support.

Mental health and substance use among sexual minority women who report childhood sexual abuse: A systematic literature review

OBJECTIVE

A growing body of literature provides evidence that sexual minority women (SMW; e.g., lesbian, bisexual) are at greater risk of negative mental health and substance use outcomes than are heterosexual women. While minority stress may partially explain these disparities, it does not fully account for them. Therefore, it is necessary to identify how other risk factors (i.e., childhood sexual abuse [CSA]) contribute to SMW's increased risk of negative mental health and substance use outcomes.

METHOD

We conducted a systematic literature review to identify and synthesize the state of knowledge about CSA and mental health and substance use outcomes among SMW. Two independent reviewers screened 347 articles identified in searches of five databases (Web of Science, PsycInfo, CINAHL, PubMed, and Embase). Eligible articles were peer-reviewed, reported quantitative or mixed methods results focused on mental health or substance use outcomes among adult SMW with a history of CSA.

RESULTS

Twenty-four papers were included in the review. Findings clearly show that SMW report higher rates of CSA than heterosexual women. Findings also suggest that CSA may mediate the relationship between minority sexual identity and some negative outcomes.

CONCLUSIONS

Future studies should include minority stress factors, a broader range of mental health outcomes (apart from substance use and suicide), and more nuanced measures of CSA. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Network analysis of adverse childhood experiences and cardiovascular diseases

Significance

The findings to date indicate that adverse childhood experiences (ACEs) increase the risk of cardiovascular disease (CVD) in later life. We demonstrate how network analysis, a statistical method that estimates complex patterns of associations between variables, can be used to model ACEs and CVD. The main goal is to explore the differential impacts of ACE components on CVD outcomes, conditioned on other ACEs and important covariates using network analysis. We also sought to determine which ACEs are most synergistically correlated and subsequently cluster together to affect CVD risk.

Methods

Our analysis was based on cross-sectional data from the 2020 Behavioral Risk Factor Surveillance System, which included 31,242 adults aged 55 or older (54.6% women, 79.8% whites, mean age of 68.7 ± 7.85 years). CVD outcomes included angina/coronary heart disease (CHD) and stroke prevalence. Mixed graphical models were estimated using the R-package mgm, including all variables simultaneously to elucidate their one-to-one inter-relationships. Next, we conducted Walktrap cluster detection on the estimated networks using the R-package igraph. All analyses were stratified by gender to examine group differences.

Results

In the network for men, the variable "household incarceration" was most strongly associated with stroke. For women, the strongest connection was between "physical abuse" and stroke, followed by "sexual abuse" and angina/CHD. For men, angina/CHD and stroke were clustered with several CVD risk factors, including depressive disorder, diabetes, obesity, physical activity, and smoking, and further clustered with components of household dysfunction (household substance abuse, household incarceration, and parental separation/divorce). No clusters emerged for women.

Conclusions

Specific ACEs associated with CVDs across gender may be focal points for targeted interventions. Additionally, findings from the clustering method (especially for men) may provide researchers with valuable information on potential mechanisms linking ACEs with cardiovascular health, in which household dysfunction plays a critical role.

Sexual orientation differences in childhood sexual abuse, suicide attempts, and DSM-5 alcohol, tobacco, other drug use, and mental health disorders in the US

BACKGROUND

Childhood sexual abuse (CSA) contributes to increased risk of substance use and mental health disorders in the general population.

OBJECTIVE

To assess the prevalence and associations of CSA and suicide attempts, substance use, and mental health disorders as a function of sex (female, male) and sexual orientation (lesbian, gay, bisexual, heterosexual-identified with same-sex attraction and/or behavior, heterosexual-identified without same-sex attraction and/or behavior, and unsure).

PARTICIPANTS AND SETTING

Data were collected using structured diagnostic face-to-face interviews in a nationally representative sample of 36,309 US adults.

METHODS

We used descriptive statistics and logistic regression modeling to analyze data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III).

RESULTS

Childhood sexual abuse was most prevalent among sexual minorities, especially bisexual females. Nearly one-third of bisexual females (30.6%) reported experiencing two or more types of CSA, p < .001. Among all participants, exposure to one or more types of CSA was associated with greater odds of lifetime suicide attempts, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) alcohol, tobacco or other drug use disorder, and mental health disorders, after adjusting for other childhood adversity/maltreatment and general life stressors.

CONCLUSIONS

Sexual minority females and males in the US are more likely than their heterosexual counterparts to report CSA. Higher risk of suicide attempts and DSM-5 alcohol, tobacco, other drug use, and mental health disorders in adulthood was directly associated with CSA, particularly among bisexual females. Health professionals working with individuals who have experienced CSA should assess these risks and intervene as needed.

The Chicago Health and Life Experiences of Women Couples Study: Protocol for a Study of Stress, Hazardous Drinking, and Intimate Partner Aggression Among Sexual Minority Women and Their Partners

BACKGROUND

Large gaps exist in research on alcohol use and intimate partner aggression (IPA) among sexual minority women (SMW; eg, lesbian, bisexual). Dyadic research with SMW and their partners can illuminate how couple-level factors operate in conjunction with individual-level factors to shape well-being in this understudied and vulnerable population. Given the traditionally gendered lens with which women are primarily viewed as victims and men as perpetrators, understanding the dynamics of IPA in same-sex female couples can also advance research and practice related to IPA more generally.

OBJECTIVE

Guided by a recent extension of the minority stress model that includes relational (couple-level) sexual minority stress and the I-cubed theoretical perspective on IPA, we will collect individual and dyadic data to better characterize the links between hazardous drinking and IPA among SMW and their partners. First, this study aims to examine the associations among minority stress, hazardous drinking, and IPA in SMW and their partners. Minority stressors will be assessed as both individual and couple-level constructs, thus further extending the minority stress model. Second, we aim to examine potential mediators and moderators of the associations among minority stress, hazardous drinking, and IPA. Finally, we aim to test models guided by the I-cubed theoretical perspective that includes instigating (eg, relationship conflict), impelling (eg, negative affect and trait anger), and inhibiting (eg, relationship commitment and emotion regulation) or disinhibiting (eg, hazardous drinking) influences on IPA perpetration.

METHODS

This United States National Institutes of Health-funded project will draw from a large and diverse cohort of SMW currently enrolled in the Chicago Health and Life Experiences of Women (CHLEW) study-a 21-year longitudinal study of risk factors and consequences associated with SMW hazardous drinking. SMW currently enrolled in the CHLEW and their partners will be invited to participate in the CHLEW Couples Study. By analyzing dyadic data using actor-partner interdependence models, we will examine how each partner's minority stress, hazardous drinking, and IPA experiences are associated with both her own and her partner's minority stress, hazardous drinking, and IPA perpetration.

RESULTS

Data collection began in February 2021 and will likely continue through 2023. Initial results should be available by mid-2024.

CONCLUSIONS

The CHLEW Couples Study will fill important gaps in knowledge and provide the basis for future research aimed at clarifying the causal pathways linking hazardous drinking and IPA among SMW. This will support the development of culturally appropriate targeted individual and dyadic prevention and intervention strategies.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/28080.

Understanding Alcohol and Marijuana Use among Sexual Minority Women during the COVID-19 Pandemic: A Descriptive Phenomenological Study

Sexual minority women (SMW; e.g., lesbian, bisexual, queer) are at increased risk for heavy/hazardous drinking and marijuana use, which may be exacerbated by stress associated with the COVID-19 pandemic and efforts to mitigate its spread (e.g., sheltering at home). To explore their experiences and perceptions of alcohol and marijuana use in the context of COVID-19, qualitative in-depth interviews were conducted with a diverse sample of 16 SMW from a longitudinal study who previously reported being at least moderate drinkers to explore their experiences and perceptions of alcohol and marijuana use during the pandemic. We used descriptive phenomenological analysis to explore data from the interviews. Participants described how their alcohol/marijuana use intersected with the complex and changing context of the pandemic, revealing four themes: 1) losing and creating routine; 2) seeking recreation and relief; 3) connecting, reconnecting, and disconnecting; and 4) monitoring alcohol and marijuana use boundaries. Findings highlight the importance of fostering community supports and possible interventions informed by the experiences of SMW.

Sexual Identity, Adverse Life Experiences, and Cardiovascular Health in Women

BACKGROUND

Adverse life experiences (ALE; eg, discrimination and sexual abuse) may contribute to cardiovascular disease (CVD) risk in sexual minority women (SMW), but few studies have tested whether ALE explain the association of sexual identity with cardiovascular health (CVH) markers in women.

OBJECTIVE

The aim of this study was to examine sexual identity differences in CVH among women and the role of ALE.

METHODS

In the Epidemiologic Study of Risk in Women, we used multinomial logistic regression to assess sexual identity differences (SMW vs heterosexual women [reference group]) in CVH markers (ideal vs poor, intermediate vs poor) using the American Heart Association's Life's Simple 7 metric and the total score. Next, we tested whether the association of sexual identity with the total CVH score was attenuated by traditional CVD risk factors or ALE.

RESULTS

The sample consisted of 867 women (395 heterosexual, 472 SMW). Sexual minority women were more likely to have experienced discrimination (P < .001) and lifetime sexual abuse (P < .001) than heterosexual women. Sexual minority women were also less likely to meet ideal CVH criteria for current tobacco use (adjusted odds ratio, 0.43; 95% confidence interval, 0.24-0.73) or intermediate CVH criteria for body mass index (adjusted odds ratio, 0.60; 95% confidence interval, 0.40-0.92). Sexual minority women had a lower cumulative CVH score (B [SE] = -0.35 [0.14], P < .01) than heterosexual women. This difference was not explained by traditional CVD risk factors or ALE.

CONCLUSIONS

Smoking, body mass index, and fasting glucose accounted for much of the CVH disparity due to sexual identity, but those differences were not explained by ALE. Health behavior interventions tailored to SMW should be considered.

A Systematic Review of Family Victimization Experiences Among Sexual Minority Youth

Sexual minority youth experience substantially higher rates of family victimization than their heterosexual peers. No systematic review has yet identified the predictors and consequences in this vulnerable population of childhood abuse, exposure to sibling abuse and domestic violence, and sibling aggression. This systematic review aims to (a) describe differences in these family victimization rates by sexual orientation, gender, and race/ethnicity; (b) identify potential sexual minority and non-sexual minority-specific risk factors; and (c) identify physical, mental, and behavioral health and extrafamilial victimization correlates. The systematic review, which followed PRISMA guidelines, yielded 32 articles that met study inclusion criteria. Rates of childhood physical, sexual, and emotional abuse were consistently higher for sexual minority youth than for their heterosexual peers. Bisexual youth appear to be at greater risk for physical abuse than their gay and lesbian peers. Younger age at sexual minority milestones (first awareness, disclosure, and same-sex sexual contact) and higher levels of sexual minority-specific (sexuality disclosure, gender non-conformity) and non-sexual minority-specific (delinquent behaviors, parental drinking) risk factors were associated with higher rates of family victimization. Sexual minorities who experienced some form of childhood abuse reported more frequent physical (higher rates of HIV, higher BMIs, lower levels of perceived health), mental (higher rates of depression, PTSD symptoms, experiential avoidance, internalized homophobia), and behavioral (higher rates of suicidality, substance misuse, earlier sexual debut, unprotected anal sex) health problems relative to heterosexual or non-abused sexual minority peers. Sexual minority females who experienced childhood physical or sexual abuse were at greater risk than abused sexual minority males for sexual assault later in life. We conclude this systematic review with recommendations for future research, including the necessity for longitudinal research that utilizes a poly-victimization conceptual framework to identify the developmental pathways connecting risk factors, different types of family victimization, and health and extrafamilial victimization consequences.

Lifetime Trauma and Cardiometabolic Risk in Sexual Minority Women

Background: Sexual minority women (SMW; such as lesbian, bisexual, and mostly lesbian) exhibit excess cardiometabolic risk, yet factors that contribute to cardiometabolic risk in this population are poorly understood. Trauma exposure has been posited as a contributor to cardiometabolic risk in SMW. Materials and Methods: An analysis of data from Wave 3 of the Chicago Health and Life Experiences of Women Study was conducted. Multinomial logistic regression was used to examine correlates of trauma. Next, multiple logistic regression was used to examine the associations of different forms of trauma throughout the life course (childhood, adulthood, and lifetime), with psychosocial and behavioral risk factors and self-reported cardiometabolic risk (obesity, hypertension, and diabetes) in SMW adjusted for relevant covariates. Results: A total of 547 participants were included. Older age was associated with higher rates of childhood and adulthood trauma. SMW of color reported higher rates of childhood trauma than white participants. Higher education was associated with lower rates of adulthood trauma. All forms of trauma were associated with probable diagnosis of post-traumatic stress disorder and lower perceived social support. Adult trauma was associated with anxiety, whereas childhood and lifetime trauma were associated with higher odds of depression. No significant associations between forms of trauma and behavioral risk factors were noted, except that childhood trauma was associated with higher odds of past-3-month overeating. Logistic regression models examining the association of trauma and cardiometabolic risk revealed that childhood trauma was an independent risk factor for diabetes. Adulthood and lifetime trauma were significantly associated with obesity and hypertension. Conclusions: Trauma emerged as an independent risk factor for cardiometabolic risk in SMW. These findings suggest that clinicians should screen for trauma as a cardiovascular risk factor in SMW, with special attention to SMW most at risk.

Delivering LGBT-sensitive substance use treatment to sexual minority women

Epidemiologic studies have consistently found elevated rates of alcohol and other substance use among sexual minority women (SMW), and despite calls for "LGBT-specific" services and culturally-tailored interventions, few such services exist. This study involved qualitative interviews with directors from substance use treatment programs (N=10) about how they addressed the needs of SMW. Strategies implemented primarily focused on creating a safe and welcoming environment for sexual minority clients. Findings highlight challenges involved in meeting the treatment needs of SMW and provide guidance to researchers and service providers on how to improve the quality of care for them.

Depression and Victimization in a Community Sample of Bisexual and Lesbian Women: An Intersectional Approach

Mental health inequities among bisexual and lesbian women are well-documented. Compared to heterosexual women, both bisexual and lesbian women are more likely to report lifetime depressive disorders, with bisexual women often faring the worst on mental health outcomes. Risk factors for depression, such as victimization in childhood and adulthood, are also more prevalent among bisexual women. Less is known about the intersection of racial/ethnic and sexual minority identities, and how depression and victimization may differ across these multiple, co-occurring identities. Data were from Wave 3 of the Chicago Health and Life Experiences of Women study, an 18-year, community-based longitudinal study of sexual minority women's health. We constructed a six-category "intersection" variable based on sexual identity and race/ethnicity to examine group differences in lifetime depression and victimization. We tested childhood and adult victimization as moderators of lifetime depression (n = 600). A majority (58.2%) of the total sample met criteria for lifetime depression. When considering the intersection of race/ethnicity and sexual identity, Black bisexual and Black lesbian women had significantly lower odds of depression than White lesbian women, despite their higher reports of victimization. Latina bisexual and lesbian women did not differ from White lesbians on depression. Victimization did not moderate the association between the intersection variable and depression. More research is needed to better understand risk and protective factors for depression among racially/ethnically diverse sexual minority women (SWM). We highlight the need to deliberately oversample SWM of color to accomplish this goal.

Health Care of Sexual Minority Women

Sexual minority women may be invisible in health care settings unless practitioners ask every patient about sexual attractions/behaviors and identity. Sexual minority women need to feel comfortable and able to share information about their sexual identity, partners, and lives. No medical diagnoses are found more commonly in sexual minority women, but problems such as overweight/obesity, increased tobacco and alcohol use, increased mental health problems, and a past history of childhood sexual abuse are common. These factors intertwine when treating sexual minority women.

Violence as Mediating Variable in Mental Health Disparities Associated to Sexual Orientation Among Mexican Youths

In this study, we explored the role of sex as an effect-modifying variable in the association between sexual orientation and mental health in Mexican youth. In addition, we tested if violent experiences in the family and the school and attitudes toward homosexuality could act as mediating variables in such association. Data from three representative surveys performed in 2007, 2009, and 2013 among Mexican high school students were analyzed. Two dimensions of sexual orientation were evaluated: romantic partnership and sexual behavior. The outcomes were negative and positive mood, suicidal ideation and intent, self-concept, and self-esteem. There were differences by gender because in males, there were more disparities in mental health associated with sexual orientation (suicidal ideation and attempt, negative and positive mood, negative self-concept, and family-related self-esteem) than in females (suicidal ideation and negative mood). Experiences of school violence were mediators in the relationship between sexual orientation and most health outcomes in males.

Childhood Abuse Experiences and the COMT and MTHFR Genetic Variants Associated With Male Sexual Orientation in the Han Chinese Populations: A Case-Control Study

BACKGROUND

Although it is widely acknowledged that genetic and environmental factors are involved in the development of male homosexuality, the causes are not fully understood.

AIM

To explore the association and interaction of childhood abuse experiences and genetic variants of the catechol-O-methyltransferase (COMT) and methylenetetrahydrofolate reductase (MTHFR) genes with the development of male homosexuality.

METHODS

A case-control study of 537 exclusively homosexual men and 583 exclusively heterosexual men was conducted, with data collected from March 2013 to August 2015. Data were analyzed using χ² tests and logistic regression models.

OUTCOMES

Sociodemographic characteristics, childhood abuse experiences, and polymorphisms of COMT at rs4680, rs4818, and rs6267 and MTHFR at rs1801133.

RESULTS

More frequent occurrence of physical (adjusted odds ratio [aOR] = 1.78), emotional (aOR = 2.07), and sexual (aOR = 2.53) abuse during childhood was significantly associated with the development of male homosexuality. The polymorphisms of MTHFR at rs1801133 and COMT at rs4818 also were significantly associated with the development of male homosexuality in the homozygote comparisons (T/T vs C/C at rs1801133, aOR = 1.68; G/G vs C/C at rs4818, aOR = 1.75). In addition, significant interaction effects between childhood abuse experiences and the COMT and MTHFR genetic variants on the development of male homosexuality were found.

CLINICAL TRANSLATION

This is the first time that an association of childhood abuse, COMT and MTHFR genetic variants, and their interactions with development of male homosexuality was exhaustively explored, which could help provide new insight into the etiology of male homosexuality.

STRENGTHS AND LIMITATIONS

Because homosexual men are a relatively obscure population, it was impossible to select the study participants by random sampling, which could lead to selection bias. In addition, because this was a case-control study, recall bias was inevitable, and we could not verify causality.

CONCLUSIONS

Childhood abuse and the COMT and MTHFR genetic variants could be positively associated with the development of homosexuality. However, it remains unknown how these factors jointly play a role in the development of homosexuality, and more studies in different ethnic populations and with a larger sample and a prospective design are required to confirm our findings. Qin J-B, Zhao G-L, Wang F, et al. Childhood Abuse Experiences and the COMT and MTHFR Genetic Variants Associated With Male Sexual Orientation in the Han Chinese Populations: A Case-Control Study. J Sex Med 2018;15:29-42.

Three critical questions for future research on lesbian relationships

In this article I discuss three questions that should be priorities for future research on lesbian love and relationships. The first question concerns the very definition of "lesbian relationship," given how many women may be engaged in same-sex relationships without identifying as lesbian. The second question concerns the potential influence of childhood neglect and abuse on adult women's same-sex relationships, a topic that has important implications for both psychological well-being and relationship functioning. The third question concerns the potential downsides of legal marriage for women's same-sex relationships, a topic that is particularly important in light of the newfound legal recognition of same-sex marriage in all 50 states. Although there are many understudied questions in the domain of women's same-sex relationships, research on these three questions has particularly strong potential to advance our understanding of lesbian love and relationships in important ways.

A Review and Critique of Research on Same-Sex Parenting and Adoption

Are the outcomes for children of gay, lesbian, or bisexual parents in general the same as those for heterosexual parents? That controversial question is discussed here in a detailed review of the social science literature in three parts: (1) stability of same-sex parental relationships, (2) child outcomes, and (3) child outcomes in same-sex adoption. Relationship instability appears to be higher among gay and lesbian parent couples and may be a key mediating factor influencing outcomes for children. With respect to part 2, while parental self-reports usually present few significant differences, social desirability or self-presentation bias may be a confounding factor. While some researchers have tended to conclude that there are no differences whatsoever in terms of child outcomes as a function of parental sexual orientation, such conclusions appear premature in the light of more recent data in which some different outcomes have been observed in a few studies. Studies conducted within the past 10 years that compared child outcomes for children of same-sex and heterosexual adoptive parents were reviewed. Numerous methodological limitations were identified that make it very difficult to make an accurate assessment of the effect of parental sexual orientation across adoptive families. Because of sampling limitations, we still know very little about family functioning among same-sex adoptive families with low or moderate incomes, those with several children, or those with older children, including adolescents or how family functioning may change over time. There remains a need for high-quality research on same-sex families, especially families with gay fathers and with lower income.

The Influence of Gender and Sexual Orientation on Alcohol Use and Alcohol-Related Problems: Toward a Global Perspective

Although there are wide differences in alcohol use patterns among countries, men are consistently more likely than women to be drinkers and to drink heavily. Studies of alcohol use among sexual minorities (SMs), however, reflect a more complex picture. Such research has found higher rates of alcohol use and alcohol-related problems among SM persons than among heterosexuals and greater differences between SM and heterosexual women than between SM and heterosexual men. A variety of factors may contribute to differences in alcohol use and alcohol-related problems between men and women and between SM and heterosexual people. An improved understanding of these factors is important to guide prevention and treatment efforts. Although there is a dearth of literature on use of alcohol by SMs in many parts of the world, especially lower- and middle-income countries, we attempt to review and integrate the sparse data that are available from these lower-resourced countries. The global perspective presented in this article is the first attempt to go beyond a general review of literature in the Western world to document the gender paradox in alcohol use among heterosexuals and SMs in diverse countries worldwide.

Comparing the Rates of Early Childhood Victimization across Sexual Orientations: Heterosexual, Lesbian, Gay, Bisexual, and Mostly Heterosexual

Few studies have examined the rates of childhood victimization among individuals who identify as "mostly heterosexual" (MH) in comparison to other sexual orientation groups. For the present study, we utilized a more comprehensive assessment of adverse childhood experiences to extend prior literature by examining if MH individuals' experience of victimization more closely mirrors that of sexual minority individuals or heterosexuals. Heterosexual (n = 422) and LGB (n = 561) and MH (n = 120) participants were recruited online. Respondents completed surveys about their adverse childhood experiences, both maltreatment by adults (e.g., childhood physical, emotional, and sexual abuse and childhood household dysfunction) and peer victimization (i.e., verbal and physical bullying). Specifically, MH individuals were 1.47 times more likely than heterosexuals to report childhood victimization experiences perpetrated by adults. These elevated rates were similar to LGB individuals. Results suggest that rates of victimization of MH groups are more similar to the rates found among LGBs, and are significantly higher than heterosexual groups. Our results support prior research that indicates that an MH identity falls within the umbrella of a sexual minority, yet little is known about unique challenges that this group may face in comparison to other sexual minority groups.

Multiple early victimization experiences as a pathway to explain physical health disparities among sexual minority and heterosexual individuals

Prior research shows that health disparities exist between sexual minority and heterosexual individuals. We extend the literature by testing if the higher prevalence of childhood victimization experienced by sexual minority individuals accounts for lifetime health disparities. Heterosexual (n = 422) and sexual minority (n = 681) participants were recruited on-line in North America. Respondents completed surveys about their childhood victimization experiences (i.e., maltreatment by adults and peer victimization) and lifetime physician-diagnosed physical health conditions. Results showed that sexual minority individuals experienced higher prevalence of childhood victimization and lifetime physical health problems than heterosexuals. Mediation analyses indicated that maltreatment by adults and peer bullying explained the health disparities between sexual minority individuals and heterosexuals. This study is the first to show that multiple childhood victimization experiences may be one pathway to explain lifetime physical health disparities. Intervention programs reducing the perpetration of violence against sexual minority individuals are critical to reduce health care needs related to victimization experiences.

An ecological framework for sexual minority women's health: factors associated with greater body mass

In recent years, many studies have focused on the body of sexual minority women, particularly emphasizing their larger size. These studies rarely offer theoretically based explanations for the increased weight, nor study the potential consequences (or lack thereof) of being heavier. This article provides a brief overview of the multitude of factors that might cause or contribute to larger size of sexual minority women, using an ecological framework that elucidates upstream social determinants of health as well as individual risk factors. This model is infused with a minority stress model, which hypothesizes excess strain resulting from the stigma associated with oppressed minority identities such as woman, lesbian, bisexual, woman of color, and others. We argue that lack of attention to the upstream social determinants of health may result in individual-level victim blaming and interventions that do not address the root causes of minority stress or increased weight.

Prevalence of Childhood Sexual Abuse among Lesbian, Gay, and Bisexual People: A Meta-Analysis

In order to determine the prevalence of childhood sexual abuse among gay, lesbian, and bisexual individuals, we conducted a meta-analysis that compiled the results of 65 articles across 9 countries. The results revealed no significant difference in the prevalence of child sexual abuse between homosexual and bisexual people for both sexes. The prevalence of child sexual abuse among female sexual minorities was significantly higher than that among male sexual minorities. The lowest prevalence was found in South America, followed by Asia. The definition of child sexual abuse, dimension used to measure sexual orientation, year of data collection, and the mean age of participants at the time of assessment influenced the estimated prevalence of child sexual abuse. We conclude that many variables influence the reported prevalence of child sexual abuse among sexual minorities.

Stressful childhood experiences and health outcomes in sexual minority populations: a systematic review

PURPOSE

Stressful childhood experiences (SCE) are associated with many different health outcomes, such as psychiatric symptoms, physical illnesses, alcohol and drug abuse, and victimization experiences. Lesbian, gay, bisexual, and transgender (LGBT) people are at risk to be victims of SCE and show higher prevalence of SCE when compared with heterosexual controls.

METHODS

This review analyzed systematically 73 articles that addressed different types of SCE in sexual minority populations and included items of household dysfunction. The samples included adults who identified either their sexual orientation as non-heterosexual or their gender identity as transgender.

RESULTS

The studies reported childhood sexual abuse (CSA), childhood physical abuse (CPA), childhood emotional abuse (CEA), childhood physical neglect, and childhood emotional neglect. Items of household dysfunction were substance abuse of caregiver, parental separation, family history of mental illness, incarceration of caregiver, and witnessing violence. Prevalence of CSA showed a median of 33.5 % for studies using non-probability sampling and 20.7 % for those with probability sampling, the rates for CPA were 23.5 % (non-probability sampling) and 28.7 % (probability sampling). For CEA, the rates were 48.5 %, non-probability sampling, and 47.5 %, probability sampling. Outcomes related to SCE in LGBT populations included psychiatric symptoms, substance abuse, revictimization, dysfunctional behavioral adjustments, and others.

CONCLUSIONS

LGBT populations showed high prevalence of SCE. Outcomes related to SCE ranged from psychiatric symptoms and disorders to physical ailments. Most studies were based in the USA. Future research should aim to target culturally different LGBT population in the rest of the world.

Lifetime victimization and physical health outcomes among lesbian and heterosexual women

Background

Lifetime victimization experiences, including child sexual abuse (CSA), child physical abuse (CPA), adult sexual assault (ASA), and adult physical assault (APA), are associated with health problems.

Purpose

To examine relationships between cumulative victimization and physical health among heterosexual and lesbian women and determine whether these relationships differ by sexual identity.

Methods

Large samples of heterosexual (n = 482) and lesbian women (n = 394) were interviewed. Questions included lifetime victimization experiences and physical health problems.

Results

Compared to women who reported no childhood victimization, those who reported experiencing both CSA and CPA were 44% more likely to report health problems and women who experienced all four types of victimization (CSA, CPA, APA, ASA) were nearly 240% as likely to report physical health problems. Interaction analyses revealed the association between victimization and physical health did not differ by sexual identity.

Conclusions

Although lesbians were more likely to report all types of victimization, results suggest that victimization conferred increased physical health risks regardless of sexual identity.

Lifetime Victimization, Hazardous Drinking, and Depression Among Heterosexual and Sexual Minority Women

PURPOSE

Substantial research documents sexual-orientation-related mental health disparities, but relatively few studies have explored underlying causes of these disparities. The goals of this article were to (1) understand how differences in sexual identity and victimization experiences influence risk of hazardous drinking and depression, and (2) describe variations across sexual minority subgroups.

METHODS

We pooled data from the 2001 National Study of Health and Life Experiences of Women and the 2001 Chicago Health and Life Experiences of Women study to compare rates of victimization, hazardous drinking, and depression between heterosexual women and sexual minority women (SMW), and to test the relationship between the number of victimization experiences and the study outcomes in each of five sexual identity subgroups.

RESULTS

Rates of each of the major study variables varied substantially by sexual identity, with bisexual and mostly heterosexual women showing significantly higher risk than heterosexual women on one or both of the study outcomes. The number of victimization experiences explained some, but not all, of the risk of hazardous drinking and depression among SMW.

CONCLUSION

Although victimization plays an important role, sexual-minority-specific stressors, such as stigma and discrimination, likely also help explain substance use and mental health disparities among SMW.

The association between bullying and physical health among gay, lesbian, and bisexual individuals

BACKGROUND

Research suggests that lesbian, gay, and bisexual (LGB) populations experience higher prevalence of school bullying than heterosexuals.

OBJECTIVES

We examined if (a) verbal versus physical bullying were differentially associated with physical health among sexual minorities and (b) if sexual identity (i.e., homosexual [i.e., lesbian/gay] vs. bisexual) moderated the association of bullying on physical health.

DESIGN

LGB adults aged 18 to 66 years (n = 463) were recruited online. Participants reported high school experiences of verbal and physical bullying and physician-diagnosed health conditions.

RESULTS

Physical and verbal bullying were related to physical health conditions (ps < .01). Physical bullying had a significant negative impact on physical health for bisexual persons (p < .001) but not for gay/lesbian persons.

CONCLUSIONS

Experiencing bullying in high school was associated with physical health problems in adulthood. Bullying had a different relationship with health problems for bisexually identified individuals compared to lesbian/gay individuals. Future research should strive to disentangle potential differences in the relationship between bullying and health within sexual minority groups.

Sexual identity group differences in child abuse and neglect

Childhood abuse and neglect are pervasive problems among girls and young women that have numerous health consequences. Research suggests that sexual minority women are more likely than heterosexual women to report childhood abuse and neglect, but little is known about which sexual minority women are at greatest risk for these early adverse experiences. Using data from a pooled sample of women in a national probability study and in a large community-based study of sexual minority women designed to replicate the national study's methodology (pooled n = 953), we investigated rates and characteristics of childhood sexual abuse, physical abuse, and neglect among women from five sexual identity groups. As predicted, heterosexual women reported significantly less childhood abuse and neglect than did women who identified as mostly heterosexual, bisexual, mostly lesbian, or lesbian. We found considerable variability across the sexual minority subgroups, including severity of abuse, highlighting the need for research that distinguishes among these groups. To the extent that differences reported by women in the sample reflect the actual prevalence and severity of abuse experiences, sexual identity group differences in childhood abuse have important clinical and public health implications.

Incorporating lesbian and bisexual women into women veterans' health priorities

Relative to the general population, lesbian and bisexual (LB) women are overrepresented in the military and are significantly more likely to have a history of military service compared to all adult women. Due to institutional policies and stigma associated with a gay or lesbian identity, very little empirical research has been done on this group of women veterans. Available data suggest that compared to heterosexual women veterans, LB women veterans are likely to experience heightened levels of prejudice and discrimination, victimization, including greater incidence of rape, as well as adverse health and substance use disorders. They are also likely to encounter a host of unique issues when accessing health care, including fears of insensitive care and difficulty disclosing sexual orientation to Veterans Health Administration (VHA) providers. Training of staff and providers, education efforts, outreach activities, and research on this subpopulation are critical to ensure equitable and high quality service delivery.

Disparities in adverse childhood experiences among sexual minority and heterosexual adults: results from a multi-state probability-based sample

BACKGROUND

Adverse childhood experiences (e.g., physical, sexual and emotional abuse, neglect, exposure to domestic violence, parental discord, familial mental illness, incarceration and substance abuse) constitute a major public health problem in the United States. The Adverse Childhood Experiences (ACE) scale is a standardized measure that captures multiple developmental risk factors beyond sexual, physical and emotional abuse. Lesbian, gay, and bisexual (i.e., sexual minority) individuals may experience disproportionately higher prevalence of adverse childhood experiences.

PURPOSE

To examine, using the ACE scale, prevalence of childhood physical, emotional, and sexual abuse and childhood household dysfunction among sexual minority and heterosexual adults.

METHODS

Analyses were conducted using a probability-based sample of data pooled from three U.S. states' Behavioral Risk Factor Surveillance System (BRFSS) surveys (Maine, Washington, Wisconsin) that administered the ACE scale and collected information on sexual identity (n = 22,071).

RESULTS

Compared with heterosexual respondents, gay/lesbian and bisexual individuals experienced increased odds of six of eight and seven of eight adverse childhood experiences, respectively. Sexual minority persons had higher rates of adverse childhood experiences (IRR = 1.66 gay/lesbian; 1.58 bisexual) compared to their heterosexual peers.

CONCLUSIONS

Sexual minority individuals have increased exposure to multiple developmental risk factors beyond physical, sexual and emotional abuse. We recommend the use of the Adverse Childhood Experiences scale in future research examining health disparities among this minority population.