Who Adopts Queer and Pansexual Sexual Identities?

Menopause experiences in sexual minority women and non-binary people

Sexual minority women (lesbian/gay, bisexual, and queer-identified cisgender women) as well as non-binary people have unique experiences in menopause but remain underrepresented in the scientific literature as compared with cisgender, heterosexual women. This review provides an overview of their experiences with menopause, including menstrual cessation, menopause symptoms, experiences with healthcare systems, and sexual health. The end of menstruation comes with mixed emotions for many sexual minority women, including sadness, grief, relief, and a sense of freedom. Sexual and gender minority individuals often experience discrimination and bias in healthcare encounters. So, too, do sexual minority women and non-binary people report negative experiences with the healthcare system while navigating menopause. In particular, this includes challenges locating inclusive menopause resources and culturally competent clinicians who create safe, trusting healthcare environments. In contrast to heterosexual women, sexual minority women have more open communication with partners regarding sexual function during menopause, and often have greater sexual satisfaction due to more expansive definitions of sex and pleasure. Non-binary individuals can experience distress, isolation, and gender dysphoria during the menopause transition, though research on their experiences remains extremely limited. To better care for sexual and gender minorities, more inclusive menopause education resources and healthcare environments are sorely needed, as are culturally competent healthcare clinicians. Increasing representation of sexual and gender minorities in the scientific literature on menopause is also crucial to improve understanding and clinical care.

Understanding Psychological Help-Seeking: The Role of Perceived LGBTQ+ Community Support

In this cross-sectional study, we examined the relations between perceived LGBTQ+ community support for psychotherapy and both willingness to seek counseling and use of mental health services in the past year among 721 sexual minority persons. At the bivariate level, we found that LGBTQ+ community support for psychotherapy was positively correlated with both willingness to seek counseling and use of mental health services in the past year. Further, LGBTQ+ community support for psychotherapy was directly and indirectly related to willingness to seek counseling via less public stigma, less self-stigma, and more positive attitudes toward help-seeking in serial. LGBTQ+ community support for psychotherapy was indirectly related to use of mental health services in the past year via these same explanatory variables. Finally, we provide psychometric support for the LGBTQ+ Community Support for Psychotherapy Scale that we developed for this study. Our findings indicate the important role that contextual factors can have on psychological help-seeking attitudes, intentions, and behaviors for sexual minority persons.

An Intersectional Exploration of Outness, Encountered Discrimination and Violence, and Non-Suicidal Self-Injury among Asexual Youth across Gender Identities

Current research on asexual youth is limited, especially in understanding the impact of their outness and the intersection of sexual orientation with gender minority identities. This study investigates the influence of outness on experiences of harassment, discrimination, violence, and the risk of non-suicidal self-injury (NSSI) among asexual youth, with a focus on those with transgender and non-binary identities. Data for this study were obtained from the 2021 Ace Community Survey, an international online survey designed to assess the needs and health status of the Ace community, targeting respondents aged 13 and older. The analysis involved a subsample of 5574 respondents aged 13 to 24 (mean age = 19.28), including 2361 cisgender (mean age = 19.65), 1,195 transgender (mean age = 18.80), and 2,018 non-binary individuals (mean age = 19.13). The results revealed that experienceds of sexual violence, verbal aggression, and physical harassment and bullying not only correlated with but also completely mediated the relationship between outness and NSSI. Asexual transgender youth experienced heightened levels of discrimination and NSSI but demonstrated notable resilience against the negative effects of identity disclosure, highlighting complex dynamics of vulnerability and protection within these communities.

Mental health impact of multiple sexually minoritized and gender expansive stressors among LGBTQ+ young adults: a latent class analysis

AIMS

In the United States, lesbian, gay, bisexual, transgender, queer, intersex, asexual and other sexually minoritized and gender expansive (LGBTQ+) young adults are at increased risk for experiencing mental health inequities, including anxiety, depression and psychological distress-related challenges associated with their sexual and gender identities. LGBTQ+ young adults may have unique experiences of sexual and gender minority-related vulnerability because of LGBTQ+-related minority stress and stressors, such as heterosexism, family rejection, identity concealment and internalized homophobia. Identifying and understanding specific LGBTQ+-related minority stress experiences and their complex roles in contributing to mental health burden among LGBTQ+ young adults could inform public health efforts to eliminate mental health inequities experienced by LGBTQ+ young adults. Therefore, this study sought to form empirically based risk profiles (i.e., latent classes) of LGBTQ+ young adults based on their experiences with familial heterosexist experiences, LGBTQ+-related family rejection, internalized LGBTQ+-phobia and LGBTQ+ identity concealment, and then identify associations of derived classes with psychological distress.

METHODS

We recruited and enrolled participants using nonprobability, cross-sectional online survey data collected between May and August 2020 (N = 482). We used a three-step latent class analysis (LCA) approach to identify unique classes of response patterns to LGBTQ+-related minority stressor subscale items (i.e., familial heterosexist experiences, LGBTQ+-related family rejection, internalized LGBTQ+-phobia and LGBTQ+ identity concealment), and multinomial logistic regression to characterize the associations between the derived classes and psychological distress.

RESULTS

Five distinct latent classes emerged from the LCA: (1) low minority stress, (2) LGBTQ+ identity concealment, (3) family rejection, (4) moderate minority stress and (5) high minority stress. Participants who were classified in the high and moderate minority stress classes were more likely to suffer from moderate and severe psychological distress compared to those classified in the low minority stress class. Additionally, relative to those in the low minority stress class, participants who were classified in the LGBTQ+ identity concealment group were more likely to suffer from severe psychological distress.

CONCLUSION

Familial heterosexist experiences, LGBTQ+-related family rejection, internalized LGBTQ+-phobia and LGBTQ+ identity concealment are four constructs that have been extensively examined as predictors for mental health outcomes among LGBTQ+ persons, and our study is among the first to reveal nuanced gradients of these stressors. Additionally, we found that more severe endorsement of minority stress was associated with greater psychological distress. Given our study results and the previously established negative mental health impacts of minority stressors among LGBTQ+ young adults, findings from our study can inform research, practice, and policy reform and development that could prevent and reduce mental health inequities among LGBTQ+ young adults.

Differences in Minority Stress Experiences, Mental Health, and Relationship Quality Outcomes Among Bisexual, Pansexual, and Queer Women

The majority of sexual minority women in the United States today identify as bi+. Recent research suggests that "non-traditional" bi+ labels such as pansexual and queer are being adopted more frequently than ever before, making it increasingly important to evaluate whether these women have unique needs. In the current study, we explored differences in minority stress experiences, mental health, and relationship quality outcomes by sexual identity label among women who identify with the most common bi+ labels: bisexual, pansexual, and queer. Participants were 285 bi+ cisgender women in romantic relationships. They completed online measures of minority stress (antibisexual experiences, identity concealment, disconnection from the sexual and gender minority (SGM) community, and internalized stigma), mental health (depression and anxiety), and relationship quality (satisfaction and commitment). Overall, participants reported similar experiences of minority stress and few differences in their mental health outcomes. However, there were differences in antibisexual experiences by sexual identity label, such that pansexual women reported more frequent antibisexual experiences than bisexual and queer women. There were also differences in relationship quality by sexual identity label, such that bisexual women reported higher satisfaction than pansexual women and higher commitment than both pansexual and queer women. Findings suggest that pansexual and queer women may be facing their own unique challenges, even compared to bisexual women. Clinical prevention and intervention efforts can be tailored for these women to include strategies to cope with more frequent exposure to antibisexual experiences, as well as relationship education and skill-building to promote healthy romantic relationships.

Responses to Sexual and Gender Identity Measures in Population-Level Data by Birth Cohort: A Research Note

The measurement of sexual and gender identity in the United States has been evolving to generate more precise demographic estimates of the population and a better understanding of health and well-being. Younger cohorts of sexual- and gender-diverse adults are endorsing identities outside of the lesbian, gay, bisexual, and transgender (LGBT) labels. Current population-level surveys often include a category such as "something else" without providing further details, and doing so inadequately captures these diverse identities. In this research note, our analysis of the most recent federal data source to incorporate sexual and gender identity measures-the Household Pulse Survey-reveals that younger birth cohorts are more likely to select "something else" for their sexual identity and "none of these" for their gender identity. The observed sexual and gender identity response patterns across birth cohorts underscore the importance of developing and applying new strategies to directly measure sexual- and gender-diverse adults who identify with identities outside of those explicitly captured on surveys. The integration of sexual and gender identity measures in population-level surveys carries broader implications for civil rights and for addressing health inequities and therefore must be responsive to cohort differences in identification.

'Let the ladies know': queer women's perceptions of how gender and sexual orientation shape their eating and weight concerns

This exploratory study aimed to describe the lived experiences of queer women affected by eating and weight-related concerns. Qualitative data from young queer women (n = 105; Age = 23.6 ± 3.4 years) with eating and weight-related concerns in response to open-ended questions related to the influence of gender identity and body image on weight concern, behaviours, and perception were analysed using reflexive thematic analysis. Nine themes were created to describe participants' experiences: (1) compensation for other internalised stigma, (2) to suppress body parts that can be gendered or sexualised, (3) comparisons to romantic partners' bodies, (4) media representations, (5) queer signalling, (6) queerness as protective, (7) gender expression and dysphoria, (8) societal expectations of women's bodies, and (9) internalisation of body/beauty ideals. Seven sub-themes were created to represent beauty ideals for specific subcultural communities (e.g. femme, butch). Findings suggest that queer women attribute individual, interpersonal and social factors to weight concerns, behaviours and perceptions. Findings highlight how complex tensions between the beauty/body ideals experienced in cisheteronormative and queer spaces influence eating and weight concerns among queer women. Gender, sexual orientation and subcultural ideals intersect in important ways, and may be useful to consider when screening, treating and preventing eating and weight concerns among queer women.

Refining United States Sexual Minority Adult Population Estimates with the Inclusion of "Something Else" and "Don't Know" Survey Responses

Purpose: To refine estimates of the U.S. sexual minority population, we sought to characterize trends in the odds of respondents selecting "something else" or "don't know" when asked about sexual orientation on the National Health Interview Survey and to reclassify those respondents likely to be sexual minority adults. Methods: Logistic regression was conducted to test whether the odds of selecting "something else" or "don't know" increased over time. A previously established analytic approach was used to identify sexual minority adults among these respondents. Results: Between 2013 and 2018, the percentage of respondents selecting "something else" or "don't know" increased 2.7-fold, from 0.54% to 1.44%. Reclassifying respondents with >50% predicted probabilities of being sexual minorities increased sexual minority population estimates by as much as 20.2%. Conclusion: A growing proportion of adults are selecting "something else" or "don't know." Properly classifying these responses yields more accurate sexual minority population estimates.

Recruiting and retaining sexual and gender minority couples in intervention research: Lessons learned from trials of tailored relationship education programs

Relationship interventions, including healthy relationship education, couple therapy, and dyadic approaches to treating mental and physical health issues, hold promise for promoting relationship and individual health among sexual and gender minority (SGM) populations. Because SGM couples live within a context of societal stigma against their minority identities and relationships, they are likely to be best served by targeted, culturally sensitive relationship interventions that are affirming, free of hetero- and cis-normativity, and address the unique stigma-based challenges that they face. Therefore, a key goal for the field today is to conduct research evaluating and refining newly developed relationship interventions designed specifically for SGM couples. In this paper, we offer recommendations for effectively recruiting and retaining large, diverse samples of SGM couples for clinical trials of tailored relationship interventions, grounded in guidelines for psychological practice and conducting research with SGM populations. Throughout, we offer examples and lessons learned from our experiences conducting clinical trials of tailored SGM relationship education programs. We encourage the use of recruitment and retention strategies that involve members of the target SGM community from the outset, are informed by knowledge about SGM individuals and relationships, use currently preferred language for individual identities and relationships, attend to issues of confidentiality regarding sexual/gender identity or relationship involvement, and adhere to the norms of the particular community and recruitment venue.

Conditions for Social Exclusion Leading to Distress Change in Chinese Lesbian, Gay, and Bisexual (LGB) People

Lesbian, gay, and bisexual (LGB) people are likely to be at risk of distress because of social exclusion, including the feelings of resentment, resistance, and rejection they might experience from society. Nevertheless, the conditions for social exclusion leading to changes in distress are empirically unclear, especially in Chinese LGB people. To examine these conditions, this study surveyed 303 Chinese LGB people in Taiwan, Hong Kong, and various places in Mainland China. For comparability with other LGB studies, the study did not explicitly identify asexual, demisexual, or pansexual people in the LGB group. Results show that the retrospective reporting of social exclusion in 2016 did not significantly and unconditionally predict levels of distress in 2017. However, the reporting of exclusion significantly predicted current distress when the retrospective report of distress in 2016 was high. These results from the stress-vulnerability model indicate that prior distress is a vulnerability condition that allows social exclusion to exert its stressful effect. This study implies the need to prevent the social exclusion of highly distressed LGB people.

Monosexism as an Additional Dimension of Minority Stress Affecting Mental Health among Bisexual and Pansexual Individuals in Hong Kong: The Role of Gender and Sexual Identity Integration

Monosexism has been increasingly recognized as a minority stressor uniquely experienced by plurisexual individuals. The present study investigated the effects of monosexist discrimination on mental health and examined the moderating role of gender and sexual identity integration (i.e., negation, authenticity, and disclosure). In a sample of 314 bisexual and pansexual individuals in Hong Kong (73.9% women and 26.1% men), the results showed that monosexist discrimination was associated with higher levels of depression and anxiety symptoms, above and beyond heterosexist discrimination. The association between monosexist discrimination and depression symptoms was stronger among bisexual and pansexual men than women, despite there being no gender differences in vulnerability to monosexist discrimination. Moreover, sexual identity negation, authenticity, and disclosure moderated the associations of monosexist discrimination with depression and anxiety symptoms, such that the associations were not significant among those with more positive integration of sexual identity (i.e., lower levels of sexual identity negation as well as higher levels of sexual identity authenticity and disclosure). This study provides insight into the deleterious impact of monosexism and the protective role of sexual identity integration. Implications for plurisexual-affirming psychological intervention, public policy, and community practice are discussed.

Measurement Invariance of Psychological Distress, Substance Use, and Adult Social Support across Race/Ethnicity and Sex among Sexual Minority Youth

Research on intersectional differences among sexual minority youth (SMY) relies on population-level datasets to ensure sufficiently large samples to explore between-group differences and assess the influence of axes of oppression/privilege. I argue that a structural equation modeling framework for investigating intersectional differences among SMY increases the nuance with which we understand heterogeneity and provides tools for ensuring that variables measure comparable constructs across diverse populations - an assumption of traditional univariate methods that is rarely empirically verified. Using a subset of SMY that identified as either White or Hispanic/Latino and male or female from the New Mexico Youth Risk and Resiliency Survey (N = 3,654), this study tested invariance of three latent constructs: psychological distress, substance use, and adult support across sexual orientation, race/ethnicity, sex, and three-way intersections of those identities. Analyses established invariance across race/ethnicity and sex of all constructs among gay/lesbian youth. Partial invariance models were required to account for intersectional differences in substance use among bisexual youth and in psychological distress among questioning youth. This study models a novel strategy for examining how social location at the intersection of multiple axes of oppression/privilege shape behavioral health and social support and paves the way for significant advances in research on SMY.

Sexual and Gender Minority Victimization: Base Rates of Assault in College Students Across Sexual and Gender Identities

Past findings have indicated that sexual and gender minority (SGM) individuals experience disproportionate rates of emotional, physical, and sexual assault compared to their heterosexual/cisgender counterparts. While these findings are robust, many studies report homogenous groupings of SGM participants. This practice likely masks important between-group differences. We sought to address this issue by examining reported base rates of emotional, physical, and sexual assault within 12 months of data collection, split across specific sexual (heterosexual, gay/lesbian, bisexual, questioning, queer, pansexual, asexual, and demisexual) and gender (cisgender men, cisgender women, gender nonconforming female assigned at birth [FAB], and gender nonconforming male assigned at birth) identity groups. Our data came from 2020 to 2021 Healthy Minds Study, a large survey of college students living in the United States (N = 119,181). Results indicated most forms of assault were higher in SGM groups compared to heterosexual and cisgender individuals, both on univariate and multivariate (e.g., one or more type of assault) levels. Demisexual individuals reported the highest base rates for emotional assault (45.7%), whereas pansexual individuals reported highest rates of physical assault (12.5%) and sexual assault (17.3%). Demisexual individuals reported the highest multivariate base rate of experiencing at least one form of assault (49.5%), and pansexual individuals reported the highest multivariate base rate of experiencing all three forms of assault (4.7%) within the past 12 months. Gender nonconforming FAB individuals reported the highest univariate and multivariate base rates across assault types compared to all other gender identity groups. With few exceptions, compared to heterosexual and cisgender men (referents), all other sexual and gender identity groups reported significantly higher adjusted odds of experiencing each assault type. These data suggest SGM individuals experience disproportionate levels of assault.

Substance Use Experiences Among Bisexual, Pansexual, and Queer (Bi+) Male Youth: A Qualitative Study of Motivations, Consequences, and Decision Making

Sexual minority youth are at increased risk of substance use compared to their heterosexual peers, and bisexual youth appear to be at greatest risk. However, little is known about their motivations for and against using substances, how they make decisions, and what consequences they experience. We used qualitative data from a study of 54 cisgender and transgender male youth (ages 14-17 years) who reported attractions to more than one gender or regardless of gender (i.e., bisexual, pansexual, or queer; collectively referred to as bi+) to explore these aspects of substance use. Participants completed a survey and an interview, and interviews were thematically analyzed. Qualitative analyses revealed that participants described diverse motivations for using substances (e.g., to cope with stress, to experiment, to have fun) and for not using them (e.g., concern about consequences, not having access). The most common sources of stress were mental health problems, school, and family. They did not describe sexual orientation-related stress as a motivation for their use, but they acknowledged that it could influence others' use. Participants also described thinking about when, where, and with whom they were going to use prior to doing so (e.g., only using in safe places and with people who they trusted). Finally, they described a range of consequences they experienced (e.g., getting sick, getting in trouble), and a subset of transgender participants described experiencing dependence symptoms. These findings suggest that substance use prevention and harm reduction interventions for bi+ male youth should address diverse motivations for use, including general stressors, which are often overlooked compared to minority-specific stressors. Further, interventions should approach youth as capable of making decisions. Findings also highlight the particular need to address substance use among transgender youth.

Do Beliefs About Sexual Orientation Predict Sexual Identity Labeling Among Sexual Minorities?

Research has found that sexual orientation beliefs predict heterosexuals' attitudes toward sexual minorities, and important sexual identity outcomes in sexual minority populations. To this point, no studies have systematically examined how sexual orientation beliefs may be associated with sexual identity self-labeling among sexual minority individuals. The present study examined this question in a sample of 1840 same-gender attracted individuals recruited for a cross-sectional online survey. Beliefs in the naturalness and discreteness of sexual orientation categories were highest in gay/lesbian individuals, intermediate in bisexual people, and lower in queer and pansexual individuals. Beliefs in the importance of sexual orientation were highest in gay/lesbian and queer identified individuals and lower in bisexual people. Within-group analysis demonstrated that gay/lesbian individuals who reported more exclusive same-gender attraction reported higher naturalness, discreteness, and importance beliefs than those with less-exclusive same-gender attraction. However, naturalness, discreteness, and importance beliefs were not associated with sexual attraction patterns in bisexual individuals. Finally, among predominately same-gender attracted populations, the adoption of a queer identity (over a gay/lesbian identity) was predicted by lower naturalness and discreteness beliefs, and increased perceived importance in females. Among non-monosexual populations, adoption of a pansexual identity over a bisexual identity was predicted by lower naturalness beliefs in females, but not predicted by sexual orientation beliefs in males. Collectively, these findings suggest that sexual orientation beliefs differ between sexual identity groups and may partly explain the adoption of particular sexual identity labels among contemporary sexual minority populations.

Is the Grass Really Greener? The Influence of Gender Identity and Sexual Orientation on Mate Copying Behaviors

Mate copying is a sexual strategy whereby individuals attend to socially available information about their prospective mate. This allows for more accurate decision making in regard to mating. This phenomenon was originally demonstrated among nonhumans, but there is an increasing weight of evidence suggesting that humans also engage in mate copying. Research typically focuses on heterosexual cisgender women, with no previous studies having looked at those identifying outside of the traditional gender binary. The current study aimed to address this gap by examining the impact of gender identity and sexual orientation on the propensity to engage in mate copying. Participants (N = 831) completed an online survey providing desirability ratings for photographs alone (T₁) and then rated the same photographs after receiving social information about the relationship status and previous relationship history of the pictured individual (T₂). It was found that both gender identity (F(4, 713) = 3.94, η_p² = .02) and sexual orientation (F(4, 713) = 4.40, η_p² = .02) influenced an individual's overall propensity to mate copy, and that desirability patterns for individuals were very different depending on these variables. It was concluded that while mate copying certainly is evident among humans, the phenomenon is extremely nuanced and sensitive.

Terms which LGBTIQ+ individuals prefer or hate to be called by

Introduction

The evolution of the abbreviation LGBTQI+ comes on the backdrop of numerous studies that were conducted as a form of advocacy to promote the inclusion of LGBTQI+ individuals into society.

Objective

This study sought to explore the terms that LGBTQI+ individuals prefer to be called and those they hate to be called by.

Methods

The study adopted a qualitative approach underpinned by Husserl's descriptive phenomenological research design. Data was collected through WhatsApp-based semi-structured individual interviews from a 19 participants who were sampled using purposive and snowballing sampling methods. Data analysis was done using Collaizzi's phenomenological analysis method, and all ethical considerations to safeguard participants were adhered to.

Results

The analysis yielded two main themes as preferred terminologies and terms that are hated by the LGBTQI+ persons. The findings show an evolution in the terminologies used in relation to the LGBTQI+ identifying persons. Terms such as Queer, LGBTQI+ community, terms confirming gender identity, SOGI neutral, and preferred pronouns emerged as terms that LGBTQI+ people preferred to be called or addressed by. On the other side of the coin, the findings revealed terms that the LBGTQI + people hated as these were perceived to be discriminatory and derogatory, such as terms like "moffie" and "stabane".

Conclusion

LGBTQI+ terms are forever evolving and there is a need to raise community awareness and conscientisation towards moving away from the use of derogatory and hateful terms. The hated terms continue to perpetuate verbal abuse, stigmatisation and discrimination of the LGBTQI+ community. Therefore, a nuanced approach to develop and adopt inclusive language policies to promote diversity in public and private spheres.

Beyond Wokeness: Why We Should All Be Using a More "Sensitive" Measure of Self-Reported Gender Identity

Gender plays a significant role in an individual's experiences and behaviors, as well as their expectations of others. Researchers have long operationalized gender using limited, mutually exclusive categories that fail to capture the rich variability within a gender-diverse population. While open-ended responses or multi-item scales may be a socially progressive approach and necessary for some gender-based research (e.g., Bauer et al., 2017), it may be unsuitable and statistically unfeasible for quantitative researchers in other areas. We analyzed responses from over 700 gender-diverse participants in the U.S. on a series of unipolar scales (i.e., gender identity, expression, and perception by others) that granted participants the flexibility of selecting a comprehensive self-definition while still enabling quantitative analysis of group differences as well as capturing maximum within-group variability. Using a cluster analysis, we found that participants' responses were best represented by five categories: Archetypical Men (n = 169), Archetypical Women (n = 168), Intertypical Men (n = 158), Intertypical Women (n = 126), and Nonconforming (n = 85). We explore the variability of characteristics and beliefs (e.g., gender norms, sexist beliefs) within and between traditional sex and these new gender categories. In this paper, we discuss theoretical considerations for future research and how using this comprehensive operationalization of gender can expand our understanding of "gender differences'' beyond the current scientific assumptions and barriers.

Recent developments in research with bisexual women

This article is organised into sections that explore three key themes. The first is overarching and cuts across the literature, where within recent bisexuality research there has been increased inclusion of those whose identities are defined by attraction to multiple genders (e.g., pansexual, queer, and others). This has sometimes been in the form of an amalgamated bisexual+ category, but recent attention has also been given to definitions of bisexuality and pansexuality and how bisexual and pansexual identities might compare. The second theme explores mental health including substance use/abuse and sexual violence/victimisation. The third section notes that there has, to some extent, also been an interest in bipositivity and positive aspects of bisexual identification.

Mental health among sexual and gender minorities: A Finnish population-based study of anxiety and depression discrepancies between individuals of diverse sexual orientations and gender minorities and the majority population

Substantial empirical evidence suggests that individuals who belong to sexual and gender minorities experience more anxiety and depression than heterosexual and cisgender people. Many previous studies have not, however, used population-based samples. There is also a shortage of evidence about certain sexual and gender minorities (e.g., nonbinary individuals). We examined differences in levels of anxiety and depression within sexual and gender minorities, as well as compared to the heterosexual and cisgender majority in a population-based Finnish sample (N = 8,589). We also explored if individuals who belong to both a gender and a sexual minority (double minority) reported higher rates of anxiety and depression than individuals who hold either a gender or a sexual minority status (single minority). Individuals who belonged to either a sexual or a gender minority overall experienced significantly higher rates of anxiety and depression than cisgender and heterosexual individuals. Among the different sexual and gender minorities, bisexual, emerging identity, and nonbinary individuals reported the highest rates of anxiety and depression. We found no differences in anxiety and depression between single minority and double minority individuals. Our results suggest that even though Finland is a country with an inclusive social climate, sexual and gender minorities are, nevertheless, disproportionately affected by mental health issues. The present study gives further support to the claim that individuals holding a sexual or gender minority status experience higher levels of depression and anxiety compared to cisgender and heterosexual individuals and pinpoints the need to acknowledge these issues both in the context of health care and in the society at large.

Sexual Orientation Change among Adolescents and Young Adults: A Systematic Review

This article reviews research on changes in self-reported sexual orientation labels and associated health outcomes among adolescents and young adults. Using seven electronic databases and supplementary methods, we identified 30 studies for inclusion in the review, published between 2000 and 2020. This review aimed to summarize the approaches to measuring sexual orientation change; the prevalence, patterns, and directionality of changes in sexual identity; and how changes in sexual orientation relate to health outcomes among adolescents and youth adults. The reviewed studies lacked agreement in operationalization and assessment of sexual orientation changes. Prevalence of change in self-reported sexual orientation differed by birth sex, whereby cisgender female participants were more likely to report a change than male participants. In addition, adolescents and youth identifying with a nonheterosexual orientation or sexual minority at baseline were more likely to report a change in sexual orientation. Few studies reported on the impact of changes in sexual orientation on behavioral health outcomes. Adolescents who reported either nonheterosexual orientation at baseline or a shift toward nonheterosexual orientation had a greater likelihood of reporting depressive symptomology, suicidality, and substance use compared to those who did not report a change or reported consistent heterosexuality. Recommendations for future research and implications for practice are discussed.

Childhood Experiences and Mental Health of Sexual Minority Adults: Examining Three Models

Three models of recalled childhood gender nonconformity (GNC) and maltreatment are proposed to explain disparities in current psychological distress and lifetime suicidality among sexual minority individuals, using a United States probability sample of cisgender lesbian/gay (n = 701), bisexual (n = 606), and other (e.g., queer, n = 182) adults. Indirect effects indicated that lesbian/gay individuals were more likely than bisexual individuals to experience maltreatment and suicidal ideation as childhood GNC increased. Other indirect effects found that bisexual individuals reported more psychological distress and greater likelihood of lifetime suicidal ideation and attempts than lesbian/gay individuals as maltreatment increased. The direct effects of sexual orientation were stronger than the indirect effects via maltreatment or GNC, with bisexual individuals reporting more maltreatment, distress, and suicidality than lesbian/gay individuals. Significant findings for individuals with other identities were similar to those of bisexual individuals. Adjusted findings were comparable for women and men. The findings indicated that sexual minority individuals reported experiences consistent with sexual minority stress during early developmental periods, before being aware of their sexual orientation. It is necessary to understand the early lived experiences of sexual minority individuals, differences between lesbian/gay and bisexual individuals in those experiences, and their implications for adaptation.

Sexual Identity and Birth Cohort Differences in Social Support and Its Link with Well-Being among Sexual Minority Individuals

This study examined sexual identity and birth cohort differences in social support and its association with well-being, using a longitudinal national probability sample of 706 cisgender and non-binary sexual minority individuals from the USA. The data allowed for extensive descriptions of perceived social support and support networks across subgroups. Findings demonstrated that sexual identity and birth cohort differences in overall sizes of support networks and levels of perceived social support were small. Furthermore, fixed effects analyses indicated that changes in the size of respondents' social support networks were not related to well-being, with a one-person change being associated with a .04 SD change in well-being or less, depending on the indicator of well-being being tested. Moreover, changes in perceived social support were only limitedly related to changes in respondents' well-being, a 1-point change in the scale of perceived social support being associated with a .11 SD change in life-satisfaction. Associations were smaller for overall well-being or psychological distress, the other two indicators of well-being used. Together, these findings could imply that cross-sectional research has overestimated the relevance of social support for the well-being of sexual minority individuals, but also that general social support is insufficiently tailored to the support needs of the sexual minority population.

Sexual Orientation and Attraction in a Cohort of Transmasculine Adolescents and Young Adults

As part of an ongoing longitudinal study of transmasculine adolescents and young adults seeking gender-affirming surgery, this analysis examined sexual orientation and attraction in a cohort of 167 binary and nonbinary participants 15-35 years of age. Correlations were analyzed using Pearson's chi square. Binary and nonbinary transmasculine individuals had different patterns of orientation and attraction, with binary males more likely to be heterosexual and less likely to be queer (p<0.003). Nonbinary individuals were more likely to be attracted to and have history with other nonbinary people (p<0.01). Transmasculine sexual identities are variable, complex, and not well described by standard sexual orientation categories.

Diverse Sexual and Gender Identity, Bullying, and Depression Among Adolescents

Surveillance data indicate youth have many sexual and gender identities that should be included in clinical forms and surveys to document and improve health equity.

Social Support as a Mediator of Anti-Bisexual Prejudice and Posttraumatic Stress Disorder Symptoms

Among sexual minorities, bisexual individuals experience higher rates of victimization and symptoms of PTSD than their lesbian and gay peers as well as heterosexual individuals. Despite these disparities, little work has examined factors contributing to PTSD symptoms among bisexual adults. The current study examined the associations between bisexual-specific minority stress and PTSD symptoms in a sample of adults with bisexual orientation and tested social support as a potential mediator of this association. Participants were 488 adults (378 cisgender women, 49 cisgender men, 61 transgender individuals), ages 18 to 66 years, with bisexual orientation based on identity and/or attraction to multiple genders. Greater anti-bisexual prejudice was associated with greater PTSD symptoms (β = 0.16) and lower social support (β = -.16), while accounting for sociodemographics and sexual identity-based victimization. Social support was associated with lower PTSD symptoms (β = -.25), while accounting for sociodemographics, sexual identity-based victimization, and anti-bisexual prejudice. Mediation analyses indicated that anti-bisexual prejudice was indirectly associated with greater PTSD symptoms through lower social support. Addressing bisexual-specific minority stress and its role in diminishing social support for bisexual individuals represents a critical component of trauma-informed research and intervention development in the bisexual community.

Contextualizing the Well-being of Asexual Youth: Evidence of Differences in Family, Health, and School Outcomes

Despite increasing efforts to better understand sexual and gender minority youth (SGMY), asexual youth remain understudied. This study examines differences in health, family support, and school safety among asexual youth (n = 938) from a national study of SGMY (N = 17,112) ages 13-17. Compared to non-asexual youth, asexual youth were more likely to identify as transgender and report a disability, and less likely to identify as Black or Hispanic/Latino. Transgender (versus cisgender) asexual youth fared worse on most study outcomes. Cisgender asexual (versus cisgender non-asexual) youth fared worse on all study outcomes. Transgender asexual (versus transgender non-asexual) youth reported lower sexuality-related family support. These findings underscore the role of gender identity in understanding the experiences of asexual youth.

Exposure to continuous or fluid theories of sexual orientation leads some heterosexuals to embrace less-exclusive heterosexual orientations

We examined whether heterosexual individuals' self-reported sexual orientation could be influenced experimentally by manipulating their knowledge of the nature of sexual orientation. In Study 1 (180 university students, 66% female) participants read summaries describing evidence for sexual orientation existing on a continuum versus discrete categories or a control manipulation, and in Study 2 (460 participants in a nationally representative Qualtrics panel, 50% female) additionally read summaries describing sexual orientation as fluid versus stable across the life-course. After reading summaries, participants answered various questions about their sexual orientation. In Study 1, political moderates and progressives (but not conservatives) who read the continuous manipulation subsequently reported being less exclusively heterosexual, and regardless of political alignment, participants reported less certainty about their sexual orientation, relative to controls. In Study 2, after exposure to fluid or continuous manipulations heterosexual participants were up to five times more likely than controls to rate themselves as non-exclusively heterosexual. Additionally, those in the continuous condition reported less certainty about their sexual orientation and were more willing to engage in future same-sex sexual experiences, than those in the control condition. These results suggest that non-traditional theories of sexual orientation can lead heterosexuals to embrace less exclusive heterosexual orientations.

Within-person associations between romantic involvement and mental health among sexual and gender minorities assigned female-at-birth

Sexual and gender minorities assigned female at birth (SGM-AFAB) experience significant mental health disparities, making it important to identify protective factors against psychological and substance use problems in this population. We examined whether romantic relationship involvement, a well-established protective factor for mental health in heterosexual adults, is protective for SGM-AFAB young people. Using five waves of data from 488 racially diverse SGM-AFAB (ages 16-31 years at baseline), we assessed within-person associations between relationship involvement and depressive symptoms, anxiety symptoms, and problematic alcohol and cannabis use. We tested for differences in these associations by age; sexual, gender, and racial identity; relationship status; and partner gender, and whether romantic involvement buffers the negative effects of anti-SGM victimization. Multilevel models indicated that participants reported fewer depressive symptoms, alcohol use problems, and cannabis use problems when romantically involved than when single. Romantic involvement was associated with fewer anxiety symptoms for Latinx participants only. Associations did not differ by age and were generally consistent (with some exceptions) across sexual, gender, and racial identity. Effects on substance use were stronger for long-term commitments than dating relationships. Participants reported less depression and anxiety, but more alcohol or cannabis use, when romantically involved with cisgender women than with cisgender men or gender minority partners. Together, findings suggest that relationship involvement is broadly protective of mental health among SGM-AFAB, though it may not buffer the negative effects of SGM victimization. Efforts to reduce SGM-AFAB mental health disparities should consider including strategies to support healthy relationship involvement. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Is Being Queer Gay? Sexual Attraction Patterns, Minority Stressors, and Psychological Distress in Non-Traditional Categories of Sexual Orientation

This study examined characteristics of cisgender people who use non-traditional sexual orientation labels and investigated minority stress in these groups. Pansexual (n = 160), queer (n = 80), and asexual (n = 98) participants were compared with heterosexual (n = 1,021), bisexual (n = 1,518), and lesbian/gay (n = 2,730) individuals recruited from a cross-sectional survey. Participants were compared on sexual attraction, age, gender and childhood gender nonconformity. Hierarchical regression models with psychological distress as the dependent variable and outness, prejudice events, expectations of rejection, self-stigma, and rumination as independent variables were then tested in pansexual, queer, and asexual individuals. Sexual attraction, age, gender and recalled childhood gender nonconformity were significant predictors of group identity. Pansexual individuals were not significantly distinct from bisexual individuals in sexual attraction. Queer individuals fell between bisexual and lesbian/gay individuals in sexual attraction scores. Prejudice events and rumination were significantly associated with distress in all three non-traditional groups. Rumination scores attenuated the relationship between prejudice events and distress in all groups. These findings help characterize pansexual, asexual and queer individuals and suggest indirect effects of prejudice events on distress via rumination represent a worthy avenue for future minority stress research in these groups.

Family Belongingness Attenuates Entrapment and Buffers Its Association with Suicidal Ideation in a Sample of Dutch Sexual Minority Emerging Adults

Sexual minority emerging adults are more likely to engage in suicidal ideation than their heterosexual counterparts. Experiences of homophobic violence are associated with suicidal ideation. Yet, the specific mechanisms linking homophobic violence to suicidal ideation remain unclear. Entrapment and social belongingness were tested to determine their relevance for understanding the link between homophobic violence and suicidal ideation. A sample of sexual minority Dutch emerging adults (N = 675; ages 18-29, M = 21.93 years, SD = 3.20) were recruited through online platforms and flyers. Homophobic violence was expected to be positively associated with suicidal ideation and entrapment. The association between homophobic violence and suicidal ideation was expected to be indirectly linked through entrapment. We explored whether various sources of social belongingness moderated the path between entrapment and suicidal ideation and whether those sources of social belongingness moderated the indirect effect of homophobic violence on suicidal ideation through entrapment. Results showed that homophobic violence and entrapment were positively associated with suicidal ideation and that family belongingness was negatively associated with suicidal ideation. Homophobic violence and suicidal ideation were not indirectly linked through entrapment. The interaction effect between entrapment and family belongingness was significant, suggesting that, on average, the effect of entrapment on suicidal ideation decreased when family belongingness was high. These results suggest that family belongingness may reduce the association between entrapment and suicidal ideation while adjusting for homophonic violence. Reducing entrapment and improving family belongingness may be useful targets for programs aimed at preventing suicidal ideation among sexual minority emerging adults.

Gender and Sexual Identity in Adolescence: A Mixed-Methods Study of Labeling in Diverse Community Settings

Understandings of sexual and gender identity have expanded beyond traditional binaries, yet we know little about adolescents’ appropriation of identity labels across diverse communities. In a mixed-methods study of adolescents recruited from lesbian, gay, bisexual, transgender, and queer (LGBTQ+) spaces in communities differing in support of sexual and gender diversity, seven patterns emerged: (a) frequent use of nonbinary gender identity labels (23.9% of survey sample), especially in high-support communities; (b) greater comfort among adolescents assigned female at birth (AFAB) with diverse gender expression, which informants attributed to pressures to conform to compulsive masculinity for boys; (c) frequent use of plurisexual (60.8%) and asexual (9.9%) labels, especially among those AFAB, and discussion of online settings as a resource; (d) intersectional patterning of “queer” to describe sexual identity (12.4% of survey sample), with White youth in high-support communities signifying an intellectual/political stance and non-White youth in low-support communities using queer as an umbrella term; (e) resistance to labeling and ambivalence about labels due to intra-community dynamics; (f) labeling challenges among boys of color; and (g) challenges with stigma, sexualization, and violence for transgender and nonbinary youth. Findings highlight how contemporary adolescents engage with and challenge received conceptions of gender and sexuality and how this process is shaped by intersectional identities.

Sexual identity development milestones in three generations of sexual minority people: A national probability sample

Using data from the first national probability sample of Black, White, and Latinx sexual minority people in the United States, we examined whether and how sexual identity development timing and pacing differs across demographic subgroups at the intersections of cohort, sex, sexual identity, and race/ethnicity. Among a sample of 1,491 participants aged 18-60 from 3 distinct birth cohorts, we measured participants' ages of sexual identity development milestones, including first same-sex attraction, first self-realization of a sexual minority identity, first same-sex sexual behavior, first disclosure to a straight friend, and first disclosure to a family member. Participants from more recent cohorts reported earlier and accelerated pacing of milestones relative to those from older cohorts. Subgroups defined by sex and sexual identity varied in milestone timing and pacing, with gay males reporting an earlier onset of some milestones than other subgroups. Those who used newer identity labels (e.g., pansexual, queer) reported younger ages of milestones relative to bisexual participants but similar ages to lesbian and gay participants. Black and Latinx participants reported some milestones at younger ages than White participants. Race-stratified models testing groups at the intersection of cohort, sex, and sexual identity revealed subgroup differences in ages of first disclosure to family, as well as differences in the time between self-realization, same-sex sexual behavior, and disclosure to a straight friend. The results suggest substantial variation in the developmental timing and pacing of milestones across social identities and the need to further examine how milestone timing is related to identity, stress, and health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Reasons Lesbian and Bisexual Adolescent Girls Have or Might Have Sex with Females or Males: Implications for Discordance between Sexual Identity and Behaviors and for Prevention of Pregnancy and STIs

We examined reasons lesbian and bisexual adolescent girls have sex or, if sexually inexperienced, might have sex with girls or boys, and the role of internalized homonegativity in these relations and among lesbians. Girls were recruited online and classified as lesbian (n = 129) or bisexual (n = 193); the classification was validated. Love and pleasure were common reasons for having sex with girls, although more lesbian girls (LG) than bisexual girls (BG) endorsed love. BG, relative to LG, had sex with girls because they were curious or wanted to verify their sexual identity. Love and pleasure were motives for having sex with boys for BG. They were common reasons for potentially having sex with either sex among sexually inexperienced girls, but both were more likely for BG than LG for sex with boys. Internalized homonegativity did not mediate the relation between sexual identity and reasons for sex, but LG just with male partners were more homonegative than LG just with female partners. The findings indicate that LG and BG should not be combined into a single group, provide insights into the discordance between sexual identity and behaviors, and have implications for reducing risk for pregnancy and sexually transmitted infections among sexual minority girls.

Sexual Minority Stress and Social Support Explain the Association between Sexual Identity with Physical and Mental Health Problems among Young Lesbian and Bisexual Women

Bisexual women report more physical and psychological health problems than lesbian women do, which may be attributed to greater sexual minority stress and less social support. However, many studies combine lesbian and bisexual women into a single group. The current study examined if sexual minority stress and social support mediated the association between women's sexual identity (lesbian or bisexual) and health-related outcomes. A total of 650 U.S. young adult lesbian (n = 227) and bisexual (n = 423) women completed an online survey about sexual minority stress, social support, and physical and mental health problems. Bisexual women reported more physical and mental health problems. A sequential mediation model showed that bisexual women reported greater sexual minority stress than lesbian women, which in turn was associated with less social support, which was associated with more physical and mental health problems. Greater sexual minority stress and lower social support may help explain why bisexual women report more health-related problems than lesbian women. The results of the present study support the importance of examining risk and protective factors for health problems separately for lesbian and bisexual women. Health-related intervention programs that target sexual minority women may need to be tailored differently for lesbian and bisexual women.

Prospective associations among relationship abuse, sexual harassment and bullying in a community sample of sexual minority and exclusively heterosexual youth

INTRODUCTION

Sexual minority youth (SMY) are at significantly greater risk for experiencing adolescent relationship abuse (ARA) than exclusively heterosexual youth, yet little is known about the factors that elevate their risks for such abuse. Peer victimization (i.e., bullying, sexual harassment) has been associated with ARA among heterosexual youth. SMY experience higher rates of peer victimization than heterosexual youth, suggesting that it may be a risk factor for ARA among these youth. Using longitudinal data from a community sample of adolescents recruited from the northeastern US, we examined whether sexual identity was associated prospectively with ARA, and whether that relationship would be indirect, and mediated via bullying and sexual harassment at a 12-month follow-up. We expected to find higher rates of peer victimization and ARA among SMY than heterosexual youth, and we expected that sexual harassment and bullying would predict subsequent relationship abuse.

METHODS

Adolescents (N = 800; 58% female; 81% European-American; 19% SMY) between 13 and 15 years (M = 14.45, SD = 0.85) completed a web survey at baseline, 6-months and 12-months.

RESULTS

Consistent with prior studies, SMY reported higher rates of bullying, sexual harassment, and relationship abuse than heterosexual youth. SMY who reported sexual harassment at baseline were more likely to report relationship abuse over time. Contrary to our expectations, however, bully victimization did not predict subsequent relationship abuse.

CONCLUSIONS

Sexual harassment can be particularly harmful for SMY because it targets gender and sexual identity at a formative developmental period and puts youth at risk for relationship abuse.

Comparing National Probability and Community-Based Samples of Sexual Minority Adults: Implications and Recommendations for Sampling and Measurement

Scientific evidence regarding sexual minority populations has generally come from studies based on two types of samples: community-derived samples and probability samples. Probability samples are lauded as the gold standard of population research for their ability to represent the population of interest. However, while studies using community samples lack generalizability, they are often better able to assess population-specific concerns (e.g., minority stress) and are collected more rapidly, allowing them to be more responsive to changing population dynamics. Given these advantages, many sexual minority population studies rely on community samples. To identify how probability and community samples of sexual minorities are similar and different, we compared participant characteristics from two companion samples from the Generations Study, each designed with the same demographic profile of U.S. sexual minority adults in mind. The first sample was recruited for a national probability survey, whereas the second was recruited for a multicommunity sample from four U.S. cities. We examined sociodemographic differences between the samples. Although there were several statistical differences between samples, the effect sizes were small for sociodemographic characteristics that defined the sample inclusion criteria: sex assigned at birth, race/ethnicity, and age cohort. The samples differed across other characteristics: bisexual respondents, respondents with less education, and those living in non-urban areas were underrepresented in the community sample. Our findings offer insights for recruiting community samples of sexual minority populations and for measuring sexual identity on probability surveys. They also bolster confidence in well-designed community samples as sources for data on sexual minority populations.

Exploring the Q in LGBTQ: Demographic characteristic and sexuality of Queer people in a U.S. representative sample of sexual minorities

Although queer identity has been used among sexual minorities for decades, little is known about the population of queer-identified people in the U.S. We compared people who identify as queer (unweighted n = 88; weighted % = 5.8%) with those who identify as lesbian/gay (n = 833; 46.9%), bisexual (n = 493; 40.6%) or other sexual minority identities (n = 93; 6.7%), in order to describe queer-identified people as a distinct sexual minority group. The study is the first to estimate demographic characteristics and sexuality of queer-identified people using a U.S. nationally representative sample. We found that queer people are overwhelmingly cisgender women and genderqueer/ nonbinary (GQNB), younger, and more highly educated than other groups. After stratifying by gender identity (cisgender women; cisgender men; GQNB), survey-weighted descriptive differences in attraction, sexual partnering, and relationship patterns show that queer individuals are more likely to report attraction to, and sexual relationships with, transgender and GQNB people, though differences by respondent gender identity were noted: The majority of queer women are attracted to and partnered with both women and men, and were more likely than other groups to be attracted to and partnered with cisgender and transgender people. In contrast, queer men are split in their attractions-about half were attracted exclusively to men, and half to men and women-but the majority partnered with men only. Of all groups, queer men are the most likely to partner with transgender men, but none had partnered with transgender women. GQNB people are more likely than cisgender people to identify as queer (25.9%) and are attracted to both cisgender and transgender women and men, yet predominantly partnered with cisgender people. The results provide support for queer as a distinct sexual identity.

Comparing Pansexual- and Bisexual-Identified Participants on Demographics, Psychological Well-Being, and Political Ideology in a New Zealand National Sample

Pansexuality, characterized by attraction to people regardless of their gender, is an emerging sexual identity. Research has started to explore the differences between those who identify as pansexual and those who identify as bisexual, typically defined as being attracted to both men and women. This article extends past research by testing for differences between those who identify as pansexual (n = 52) and bisexual (n = 497) in a nationally representative sample. We used the New Zealand Attitudes and Values Study (NZAVS) to test for differences in demographic variables, psychological well-being, and political ideology. We found that pansexual participants were younger, more likely to be gender diverse (transgender or nonbinary), and more likely to be from the indigenous Māori ethnic group than bisexual participants. Pansexual participants also reported higher psychological distress and were more politically liberal than bisexual participants. These results suggest that people who identify as pansexual are, on average, quantifiably different from those who identify as bisexual; this study adds to a new but growing body of research on emerging plurisexual identities.

A Cross-sectional Study Examining the (In)congruency of Sexual Identity, Sexual Behavior, and Romantic Attraction among Adolescents in the US

OBJECTIVE

To examine how sexual identity, romantic attraction, and sexual behavior co-relate for cisgender adolescents.

STUDY DESIGN

The Teen Health and Technology survey was a cross-sectional, self-report online survey. More than 5000 youth between 13 and 18 years of age were randomly recruited through Harris Panel OnLine's panel as well as outreach by GLSEN to over-recruit lesbian, gay, bisexual, and other sexual minority youth. Data were collected between 2010 and 2011. Analyses were conducted in 2018 and restricted to cisgender youth.

RESULTS

Overall, romantic attraction and sexual behavior most closely mapped each other. The greatest discordance was noted between sexual identity and romantic attraction. For example, 59% of girls and 16% of boys who identified with a nonheterosexual identity reported that at least 1 of their 2 most recent sexual partners was a different gender. Nine percent of heterosexually-identified girls and 3% of heterosexually-identified boys reported romantic attraction to the same sex, and 6% and 7% of heterosexually-identified girls and boys, respectively, reported that at least 1 of their 2 most recent sexual partners was the same gender.

CONCLUSIONS

Treating romantic attraction, sexual identity, and sexual behavior as synonymous assumes a unidimensionality that is unsupported by the data. Pediatricians and others working with youth, including researchers, should be mindful not to assume identity on the basis of behavior. Researchers should be clear and purposeful about how they are operationalizing "sexual minority" and how it may affect the composition of their study population. Healthy sexuality and risk reduction programs need to acknowledge that adolescents with a particular sexual identity may have romantic attractions, and even sexual encounters, with people who fall outside of that identity.

Improving the health of cisgender men who identify as bisexual: What do they want from interventions?

Self-identified bisexual men are at increased risk for negative health outcomes, but there are no interventions tailored to their unique needs. In order to develop interventions for this population, it is first necessary to understand their preferences. As part of a larger study, 128 cisgender men who identified as bisexual reported on their preferences for different intervention components. Large proportions of participants prioritized addressing both health (e.g., mental health, HIV/STI) and psychosocial experiences (e.g., dating/relationships, discrimination/victimization). A slightly larger proportion of participants preferred an intervention for gay and bisexual men together compared to an intervention for bisexual men only. However, those who reported more discrimination and recent female sexual partners were more likely to prefer an intervention for bisexual men only. Larger proportions of participants preferred a group intervention compared to an individual intervention and an in-person intervention compared to an online intervention. These findings highlight the importance of addressing both health and psychosocial experiences in tailored interventions for self-identified bisexual men. Further, while in-person and group interventions may appeal to larger proportions of self-identified bisexual men, the appeal of an intervention for gay and bisexual men together compared to an intervention for bisexual men only may depend on individual and social/contextual factors.

Methodological Considerations for Advancing Research on the Health and Wellbeing of Sexual and Gender Minority Youth

Continued research with sexual and gender minority (SGM) youth is essential both to understand health disparities and to develop interventions targeting those disparities, but conducting rigorous, ethical research with these populations remains a substantial challenge. In addition to considerations for research with adolescents in general, such as utilizing developmentally appropriate measures and obtaining parental permission, factors unique to SGM youth must be addressed at every step of the research process. Defining the study population is complex, as is recruiting a sample once it is defined. Measurement is another challenge, given the paucity of measures developed for or validated with SGM samples. Key constructs, such as sexual orientation, gender identity, and family acceptance, are not amenable to randomization and involving minor participants' parents poses ethical concerns given the precarious home and safety situations that can arise from employing typical study procedures with youth who have a stigmatized identity. In this article, we examine some of these unique methodological challenges. Informed by theoretical and empirical literature, practical experience, and an ongoing dialogue with SGM youth themselves, we present a guide to best practices for ethical, productive research with SGM youth. By discussing existing approaches to studying SGM youth and suggesting innovative ways to approach the questions that remain, we hope to assist the research community in addressing methodological gaps to advance research on SGM youth in relation to families and schools.

Perceptions of Sexual Orientation and Gender Identity Minority Adolescents About Labels

Young peoples' acceptance and use of nontraditional, descriptive identity labels (e.g., pansexual, genderqueer) require nurses to consider moving beyond use of traditional terms (e.g., gay, transgender). This mixed methods study explores (a) labels used by sexual orientation and gender identity (SOGI) minority youth, (b) their expressed importance and meaning of these labels, and (c) differences in label usage. Sixty-six SOGI minority adolescents in British Columbia, Minnesota, and Massachusetts (mean age = 16.6) participated in "go-along" interviews; during interviews, 42 (63.6%) commented on labels. Chi-square and t tests were used to compare traditional versus nontraditional labels across participant demographic categories. Inductive thematic analysis was used to identify representative themes. Approximately, 1/3 of participants used nontraditional sexual orientation identity labels; this finding was associated with a trans identity and nontraditional gender labels. Using terminology that is meaningful and representative to the youth themselves has potential to facilitate representative research and welcoming environments in practice.

Stigma on the Streets, Dissatisfaction in the Sheets: Is Minority Stress Associated with Decreased Sexual Functioning Among Young Men Who Have Sex with Men?

INTRODUCTION

Sexual function and satisfaction are understudied aspects of adolescent and young adult sexual wellbeing, and even less is known about sexual minority youth who are vulnerable to unique lesbian, gay, bisexual, and transgender (LGBT)-related stigma.

AIM

We aimed to describe sexual functioning (sexual interest, erectile function, orgasm satisfaction, global satisfaction with one's sex life, and anal discomfort) and examine its associations with demographics, sexual and relationship behavior, and minority stressors (internalized stigma, victimization, microaggressions, and perceived LGBT acceptance within residential neighborhood) among a cohort of young men who have sex with men (YMSM) aged 16-29.

METHODS

Data for this cross-sectional analysis came from an ongoing longitudinal study of HIV and substance use among YMSM (analytic N = 678). We conducted univariate and bivariate analyses and multivariable linear regression, controlling for age, race/ethnicity, and sexual orientation as well as sexual and relationship characteristics that were significant at the bivariate level.

MAIN OUTCOME MEASURE

We assessed sexual functioning in the previous 30 days using the Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction Measures Brief Profile for Males.

RESULTS

YMSM in our sample reported high levels of sexual functioning that were significantly greater than an adult clinical reference population. However, 13.9% of the sample reported having any difficulty with erections, 6.9% reported having less than "good" satisfaction with orgasms, 20.0% reported being "somewhat" or less satisfied with their sex lives, and 9.1% reported experiencing problems during receptive anal sex at least "sometimes." Most associations between minority stressors and sexual functioning domains that were significant at the bivariate level attenuated to non-significance in multivariable analyses. Internalized stigma remained negatively associated with global satisfaction, whereas perceived neighborhood acceptance remained positively associated with orgasm satisfaction. Being sexually active was significantly associated with increased sexual interest and orgasm satisfaction. Having had a recent serious partner was significantly associated with sexual interest and global satisfaction. Negative effects were found for having had casual partners and being HIV positive.

CLINICAL IMPLICATIONS

Although most YMSM have high sexual functioning, a minority report problems and dissatisfaction that may warrant intervention.

STRENGTHS & LIMITATIONS

Our study was limited by its cross-sectional design, measurement limitations, and generalizability to other populations, but it is one of the first to examine sexual functioning among YMSM, using a large, diverse community sample.

CONCLUSION

Public health research and practice must continue to combat LGBT stigma and include sexual functioning as integral to healthy sexuality. Li DH, Remble TA, Macapagal K, et al. Stigma on the Streets, Dissatisfaction in the Sheets: Is Minority Stress Associated with Decreased Sexual Functioning Among Young Men Who Have Sex with Men? J Sex Med 2019;16:267-277.

Bisexual Women's Reports of Descriptive Drinking Norms for Heterosexual, Bisexual, and Lesbian Women

Bisexual women drink more than lesbian and heterosexual women. However, few studies have examined factors that influence drinking among bisexual women. Although descriptive drinking norms are strong predictors of drinking, little research has examined how drinking norms influence alcohol use for bisexual women. The present study examined bisexual women's reports of descriptive drinking norms for bisexual, lesbian, and heterosexual women, and associations with their own frequency of alcohol consumption, quantity, binge drinking, and hazardous alcohol use. Participants were 179 self-identified bisexual women between 18 and 30 years old who reported past 30-day drinking. Participants perceived more frequent alcohol use for bisexual and heterosexual women as compared to lesbian women. Further, participants perceived higher alcohol quantity for heterosexual as compared to lesbian women, but norms for alcohol quantity did not differ between bisexual women and other groups. Descriptive drinking norms about bisexual women were positively related to participants' frequency of alcohol consumption, binge drinking, and hazardous alcohol use. In contrast, descriptive drinking norms about heterosexual women were negatively associated with participants' binge drinking and hazardous alcohol use. Findings document the importance of assessing drinking norms separately for bisexual, lesbian, and heterosexual women. Alcohol interventions that include information about drinking norms for bisexual women specifically may be more effective at reducing hazardous drinking.