Exploring Discrimination and Mental Health Disparities Faced By Black Sexual Minority Women Using a Minority Stress Framework

Microaggression and discrimination exposure on young adult anxiety, depression, and sleep

BACKGROUND

Increasing research examines social determinants of health, including structural oppression and discrimination. Microaggression - subtle/ambiguous slights against one's marginalized identity - is distinct from discrimination, which typically presents as overt and hostile. The current study investigated the comparative effects of each exposure on young adult anxiety, depression, and sleep. Race-stratified analyses investigated patterns across groups.

METHODS

Young adults (N = 48,606) completed the Spring 2022 American College Health Association-National College Health Assessment III. Logistic regressions tested odds of anxiety symptoms, depressive symptoms, and sleep disturbance in association with microaggression and discrimination exposure.

RESULTS

Microaggression and discrimination equally predicted increased likelihood of anxiety symptoms (ORMicro = 1.42, ORDiscrim = 1.46). Discrimination more strongly predicted depressive symptoms (OR = 1.59) and sleep disturbance (OR = 1.54) than did microaggression (ORDepress = 1.24, ORSleep = 1.27). Race-stratified analyses indicated stronger associations between the each exposure and poor mental health in Whites than Asian American, Black/African American, and Hispanic or Latino/a/x respondents.

LIMITATIONS

Microaggression and discrimination exposure were each assessed using a single item. The outcome measures were not assessed using validated measures of anxiety, depression, and sleep (e.g., GAD-7, MOS-SS); thus results should be interpreted with caution. Analyses were cross-sectional hindering our ability to make causal inferences.

CONCLUSIONS

The findings provide preliminary evidence that microaggression and discrimination exposure operate on health in distinct ways. Racially marginalized individuals may demonstrate a blunted stress response relative to Whites. Treatment approaches must be tailored to the particular exposures facing affected individuals to maximize benefits.

Understanding the Social Drivers for LGBTQIA+ Youth Suicide

LGBTQIA+ youth are disproportionately affected by mental health issues including suicidal ideation and suicide attempts. Minoritized youth have numerous social and structural factors influencing their health, including a lack of access to care and resources. However, these youth and their caregivers also have many unique and individual cultural strengths. Awareness of special considerations and work toward dismantling structural drivers is essential in improving the health of these youth. Additionally, it is important to support minoritized youth and their caregivers through tailored evidence-based treatments in addressing social and structural drivers to influence individual, community, educational, institutional, and policy levels and prevent suicide in achieving mental health equity.

Examining Factors Associated with Cannabis Use Among Sexual and Gender Minority and Cisgender Heterosexual Emerging Adults in California

Purpose: We explored correlates of cannabis risk and examined differences between sexual and gender minority (SGM) and cisgender heterosexual emerging adults (ages 18-29) in California. Methods: We recruited 1491 participants aged 18-29 years for a cross-sectional online survey. Ordinal logistic regressions assessed associations between minority stress (discrimination and internalized homophobia [IH]), social support (perceived social support and lesbian, gay, bisexual, transgender, and queer+ [LGBTQ+] community connectedness), and cannabis risk scores (low, medium, and high risk of developing problems related to their cannabis use). We also explored differences in cannabis risk scores by sexual orientation and gender identity (SOGI). Results: Higher everyday discrimination scores were associated with increased odds of self-scoring in a higher cannabis risk range (adjusted odds ratio = 1.53, 95% confidence interval [CI] = 1.31-1.79). We found no significant associations for IH, LGBTQ+ community connectedness, or social support on cannabis risk scores. There were also no statistically significant differences by SOGI groups; however, SOGI did moderate the relationship between IH and cannabis risk score such that the slope for IH was 0.43 units higher for cisgender sexual minority women compared to cisgender sexual minority men (95% CI = 0.05-0.81). Conclusion: Our findings suggest that experiences of everyday discrimination are important contributors to developing cannabis-related problems and IH may have more pronounced effects for sexual minority women compared to sexual minority men. More research is needed to better understand risk and protective factors of cannabis risk to inform the development of culturally tailored interventions for SGM emerging adults.

Exploring pathways to successful aging among older black lesbians and sexual minority women: A focus on life satisfaction and intersectional factors

PURPOSE

Satisfaction with life is a core aspect of successful aging, which is influenced by a broad range of factors, including health, socioeconomic status, and social relationships. Black lesbians experience various social challenges, including racism, sexism, ageism, and heterosexualism, that may present as deterrents to aging successfully. To develop better policies and programs in support of successful aging among all adults, an understanding of the unique components associated with their intersecting identities must be explored. This study was carried out to gain a better understanding of how Black lesbians and other Black sexual minority women (BSMW) view successful aging within the context of life satisfaction.

METHODS

Inferential statistics were used to determine relationships between satisfaction with life (SWLS-3) and selected independent variables. Backward stepwise regression was conducted to ascertain significant relationships of the study outcome variable.

RESULTS

The respondents were 118 Black lesbians and other BSMW aged 50 and above. Independent t-tests showed that those living with a partner had a significantly higher SWLS-3. Backwards stepwise regression indicated the predictor variables for higher rates of SWLS-3 to be harmony in life, annual household income, and provider sensitivity/cultural competence to their patient being Black.

CONCLUSION

This study provides insight on factors increasing and diminishing satisfaction with life for aging Black lesbians and other BSMW. Future research should replicate this study with a more diverse and nationally representative sample, especially given the study limitations of having recruited a highly educated sample during a global pandemic.

Sexual and Reproductive Justice and Health Equity for LGBTQ+ Women

LGBTQ+ women have long been overlooked in sexual and reproductive health research. However, recent research has established that LGBTQ+ women have unique and specific needs that need to be addressed in order to improve effectiveness of sexual health education and practice with this historically and presently underserved population. Informed by a reproductive justice framework coupled with liberation psychology theory, this review discusses the current state of sexual and reproductive health and technologies among LGBTQ+ women. In particular, we focus on a range of HIV prevention and reproductive technologies and their use and promotion, including the internal condom, abortion, oral contraceptives, dapivirine ring, HIV pre-exposure prophylaxis, intrauterine device, and other less studied options, such as the contraceptive sponge. Grounded in an intersectional framing, this review acknowledges the intersecting systems of oppression that affect multiply marginalized women inequitably and disproportionately. A sociohistorical, critical lens is applied to acknowledge the well-documented racist origins of reproductive health technologies and ongoing coercive practices that have led to medical mistrust among marginalized and stigmatized communities, particularly racialized LGBTQ+ women, women with disabilities, and women who are poor or incarcerated. Moreover, we discuss the urgent need to center LGBTQ+ women in research and clinical care, community-engaged health promotion efforts, affirming non-heteronormative sexual health education, and health policies that prioritize autonomy and dismantle structural barriers for this population. We conclude with recommendations and future directions in this area to remedy entrenched disparities in health.

Attitudes and behaviours of mental health professionals in the care of transgender people: A qualitative study

WHAT IS KNOWN ON THE SUBJECT?: Mental health professionals' beliefs about transgender individuals vary, often influenced by stereotypes. There's recognition of healthcare needs, but limited knowledge impacts decision-making. Stereotypes persist regarding why transgender individuals seek mental health care. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Professionals' attitudes show both positive support and negative, discriminatory views. Lack of training and knowledge gaps hinder effective care for transgender individuals. Pathologising attitudes exist, associating gender diversity with mental health conditions. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Addressing training gaps is crucial for equitable care for transgender individuals. Challenging stereotypes and beliefs is necessary to reduce stigma and improve understanding. Enhancing knowledge and evidence-based tools will ensure safe and equal healthcare access.

ABSTRACT

INTRODUCTION: Transgender people face against significant barriers in accessing mental health services due to, among other reasons, discrimination and a lack of expertise among professionals.

AIM

To explore the beliefs and attitudes of professionals in the mental health network of the region of Murcia towards transgender people, focusing on aspects such as knowledge, perceptions, and prejudices about gender identity.

METHOD

We carried out a qualitative study involving 14 participants, conducting semi-structured interviews based on prior knowledge of the topic. We asked the professionals about their experiences and challenges in their clinical interaction with transgender users and followed an inductive-deductive process to analyse the data.

RESULTS

Two main themes were identified from the interviews, which were sub-categorised into different sub-themes: (a) beliefs about transgender people: underlying factors and origins of gender diversity, health needs, and stereotypes about the demand for health care; (b) attitudes and behaviours of professionals towards transgender people: pathologization and attitudes towards decision-making.

DISCUSSION/IMPLICATIONS FOR PRACTICE

Our findings suggest that mental health professionals tend to oversimplify the factors underlying gender diversity and hold certain stereotypical beliefs about these users that oversimplify the complexity of their experiences.

Resilience Through Social Support: An Intersectional Analysis of Sexual Minority Women's Social Resources for Wellbeing

Sexual minority women (SMW) are at higher risk for a range of health conditions (e.g. depression, anxiety, and alcohol use disorder) than heterosexual women. However, poor health outcomes do not occur for all SMW. Resilience provides a lens for understanding why some SMW maintain good mental and behavioral health despite the presence of multiple risk factors. Few studies have examined the resilience-promoting factor of social support in relation to depression, anxiety, and alcohol use disorder in SMW. There is a need for further research clarifying sources of social support (e.g. family, significant others, friends, LGBTQ+ community) associated with resilient outcomes for SMW. This study used data from a telephone-based survey of 520 SMW to examine the relationships between resilience and social support. We used multiple regression and tested for interactions with ethnoracial identity and sexual identity. Greater levels of overall social support were associated with greater resilience, as was social support from the LGBTQ+ community in particular. There were few differences in these relationships by ethnoracial identity, sexual identity, or their intersections. Interventions that increase social support across any of four support sources appear to have the potential to increase resilience and decrease mental and behavioral health risks for SMW.

Factors Influencing Shared Decision-Making Between Healthcare Providers and Lesbian, Gay, Bisexual, Transgender, and Queer People of Color About Intimate Partner Violence

Within the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community, people of color (POC) disproportionately experience intimate partner violence (IPV). While shared decision-making (SDM)-a model of patient-provider communication-about IPV could benefit LGBTQ POC, its unique challenges merit consideration. This study identifies key factors affecting SDM between LGBTQ POC and healthcare providers surrounding IPV. LGBTQ POC participants (n = 217) in Chicago and San Francisco completed surveys about demographic information, healthcare utilization, and IPV history. Individual interviews and focus groups were then conducted with a Chicago-based subset of participants (n = 46) who identified as LGBTQ IPV survivors of color. Descriptive analyses were conducted of survey responses while focus group and interview transcripts were analyzed and thematically coded. Although 71% of survey participants experienced IPV, only 35% were asked about IPV in healthcare interactions within the previous year. Focus group and interview participants endorsed encounter-, patient-, and provider-centered factors affecting SDM around IPV. When IPV was discussed, patient-provider trust was essential while concordance of identities could either encourage or discourage IPV disclosure. Patients were hesitant to disclose IPV if they had never discussed their LGBTQ identity with their provider or thought providers would ignore their preferences for addressing IPV. Deterrents to SDM included providers denying the prevalence of IPV among LGBTQ individuals or lacking resources to support LGBTQ IPV survivors of color. This study highlights the identity-driven barriers that LGBTQ POC face in discussing IPV with providers. Utilizing SDM to discuss IPV with LGBTQ POC can better address the diverse health needs of this community. However, its success requires that providers acknowledge the diversity of experiences among this population, promote LGBTQ-inclusive practices, and identify resources welcome to LGBTQ POC.

Racism and access to maternal health care among garo indigenous women in Bangladesh: A qualitative descriptive study

Racism as social determinant of health significantly affects Indigenous women's maternal healthcare access. This study uses Jones' 'Three Levels of Racism' theory and an intersectional lens to explore how racism shapes the experience of maternal health care access among Garo Indigenous women in Bangladesh. Semi-structured interviews were conducted with 24 women of diverse backgrounds and pregnancy statuses using snowball sampling. Thematic analysis, incorporating inductive and deductive approaches, was employed for data analysis. The findings reveal a significant deviation from Jones' theory regarding the level of internalized racism within the specific context of Garo Indigenous women's experiences. Jones' theory usually focuses on how racism is internalized due to institutional and personally-mediated factors. On the contrary, this study uncovers a unique theme: 'women agency.' This theme emerges as a robust response among the Garo Indigenous women to their encounters with institutional and personally-mediated racism, highlighting their cultural resistance and resilience. The findings suggest that the complex relationship between these two forms of racism contributes to the strengthening of agency among Garo Indigenous women. Their agency stems from avoiding hospitals that disrespect their culture, manifesting their cultural resistance practice against the encountered racism at the institutional and relational levels. To increase biomedical healthcare access among Garo Indigenous women, it is recommended to address racism through intercultural competency training with the 'cultural safety' 'cultural humility' approach. This approach would foster inclusivity and empowerment, recognizing the agency of Garo women in healthcare decisions. Additionally, it would facilitate constructive dialogues between clinicians and Garo Indigenous women, acknowledging the shared experiences of racism within the latter group.

The impact of perceived everyday discrimination and income on racial and ethnic disparities in PTSD, depression, and anxiety among veterans

OBJECTIVES

Black and Hispanic/Latinx individuals experience a greater burden of mental health symptoms as compared to White individuals in the general population. Examination of ethnoracial disparities and mechanisms explaining these disparities among veterans is still in its nascence. The current study examined perceived everyday discrimination and income as parallel mediators of the association between race/ethnicity and PTSD, depression, and general anxiety symptoms in a sample of White, Black, and Hispanic/Latinx veterans stratified by gender.

METHODS

A random sample of 3,060 veterans living across the U.S. (oversampled for veterans living in high crime communities) completed a mail-based survey. Veterans completed self-report measures of perceived discrimination via the Everyday Discrimination Scale, PTSD symptoms via the Posttraumatic Stress Disorder Checklist-5, depressive symptoms via the Patient Health Questionnaire, and anxiety symptoms via the Generalized Anxiety Disorder Questionnaire.

RESULTS

Models comparing Black vs. White veterans found that the significant effect of race on PTSD, depression, and anxiety symptoms was mediated by both perceived discrimination and income for both male and female veterans. Results were less consistent in models comparing Hispanic/Latinx vs. White veterans. Income, but not perceived discrimination, mediated the relationship between ethnicity/race and depression and anxiety symptoms, but only among women.

CONCLUSIONS

Results suggest that discrimination and socioeconomic status are important mechanisms through which marginalized social status negatively impacts mental health.

The continuum of violence against women: Gynecological violence within the Medical Model in Chile

OBJECTIVE

This study aims to investigate the presence of gynecological violence within the health system in Chile, quantify the magnitude of this problem, define its general contours, and shed light on a phenomenon that has long been silenced. Additionally, we are interested in detecting differences between public and private health services, as well as exploring the role played by variables such as sexual orientation, ethnicity, age, and educational level in contributing to the prevalence of gynecological violence.

METHODS

This study employed a cross-sectional and not probabilistic sampling approach. It included a sample of 1503 women from all regions of Chile, who were of legal age and who had attended gynecological services. A questionnaire was applied between January 2021 and April 2022 using the online platform SurveyMonkey®. Data were collected through the second national survey on obstetric and gynecological violence (GinObs 2021). The study adheres to activist research methodologies and was conducted in collaboration with activists and academic researchers.

RESULTS

57.9% of the women participants reported having experienced violence. Such violence appears to occur most frequently in the public health system, although not exclusively, and the victims are often people who belong to native ethnic groups, who identify as of African descent, whose sexual orientation is lesbian, who are elderly, and who have a lower level of education.

CONCLUSION

Gynecological violence is an integral part of the continuum of violence against women and is consistently reported in both public and private health services. This form of violence has serious consequences for women's health and constitutes a significant public health problem.

Utilizing Latent Class Analysis to Assess the Association of Intersectional Stigma on Mental Health Outcomes Among Young Adult Black, Indigenous, and Sexual Minority Women of Color

Purpose: Discrimination has detrimental effects on mental health, particularly among Black, Indigenous, and people of color who are also sexual minority women (BIPOC SMW); however, measurement of multiple intersecting forms of discrimination (e.g., race, gender, and sexual identity discrimination among BIPOC SMW) poses methodological challenges. This analysis uses latent class analysis (LCA) to examine the influences of discrimination on mental health in a convenience sample of BIPOC SMW. Methods: Online survey data from BIPOC SMW aged 18-29 years (n = 324) were used to estimate latent classes for discrimination type (race, gender, and sexual identity). Data for this study were collected from July to October 2018. Adjusted linear regressions examined the influences of discrimination profiles on perceived stress and depressive symptoms. Results: Utilizing LCA, the following four classes emerged: (1) low discrimination; (2) mid-level discrimination; (3) high racial, medium gender, and low sexual identity discrimination; (4) high discrimination. Classes 3 and 4 were positively associated with perceived stress and depressive symptoms relative to Class 1 in adjusted models. Conclusion: This analysis highlights the importance of intersectionality and the adverse impact of multiple forms of discrimination on mental health outcomes for BIPOC SMW. Respondents reporting higher levels of racial or multiple forms of discrimination had poorer mental health outcomes. LCA is a promising analytical tool for investigating intersectional stigma and discrimination. There is an urgent need to develop tailored, culturally appropriate intersectional mental health interventions to address the multiple identities and oppressions faced by BIPOC SMW.

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 (Mage = 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.

Testing the minority stress model across gender identity, race, and ethnicity among U.S. gender minority adolescents

Gender minority (GM) youth are at heightened risk for psychopathology, purportedly due to their experiences of GM stressors. However, few studies have examined how GM stressors are associated with depression and anxiety among GM youth. Furthermore, no prior studies have investigated how experiences of GM stressors differ across gender identity and race/ethnicity within a diverse sample of GM youth. A nationwide online cross-sectional survey of 1,943 fourteen- to 18-year-old GM adolescents (66.91% White, 11.73% multiracial, 8.49% Latinx, 7.10% Black, 3.09% Asian, 1.49% American Indian/Alaskan Native) in the United States assessed GM stressors (prejudice events, expectations of rejection, internalized transnegativity, and concealment) and mental health. Structural equation modeling was used to examine how GM stressors and depressive and anxiety symptoms differ across gender identity and race/ethnicity. Higher levels of each GM stressor were related to higher depressive symptoms. Prejudice events, expectations of rejection, and concealment were related to higher anxiety symptoms. Transmasculine and transfeminine youth reported higher levels of GM prejudice events and expectations of rejection, and higher mental health symptoms, than nonbinary youth. Findings were relatively consistent across racial/ethnic identities, with the exception that Black GM adolescents reported fewer GM prejudice events and expectations of rejection and indirectly exhibited lower mental health symptoms as compared to White GM youth. Researchers and clinicians should be attuned to how intersectional identities are related to stress and mental health among diverse GM youth. Recommendations for individual and structural-level interventions are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Associations of adult roles and minority stressors with trajectories of alcohol dependence symptoms throughout adulthood among sexual minority women

OBJECTIVE

In the present study, we sought to identify trajectories of symptoms of potential alcohol dependence (AD) among adult sexual minority women (SMW). Theoretical correlates were examined in relation to the empirically identified trajectories.

METHOD

Data were collected at three time points between 2000 and 2012 from SMW drinkers (n = 434) enrolled in a longitudinal study (M Age = 37.49 at baseline, SD = 11.55). Using an accelerated-cohort longitudinal design, latent growth curve mixture models identified homogeneous patterns of any past-year symptoms of potential AD. Correlates of trajectories included alcohol-related developmental risk factors, adult roles, and exposure to minority stressors.

RESULTS

Three trajectories were identified that captured risk of symptoms of potential AD over time, reflecting: (a) relatively consistent, low risk over time; (b) deceleration in risk throughout adulthood; (c) relatively persistent, high risk over time. Consistent with prior work, SMW drinkers who reported higher levels of perceived stigma or masculinity showed persistently high risk of reporting at least one past-year symptom of potential AD.

CONCLUSIONS

Most SMW drinkers report deceleration in risk of AD symptoms over time. Findings have implications for prevention and intervention efforts tailored to SMW drinkers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A conceptual framework for queer, black womxn sexual assault survivors: an adaptation of the minoritised stress model

Queer, Black womxn experience sexual assault at an alarming rate in the USA leading to adverse mental and physical health outcomes in survivors. A synthesis of the literature was conducted to understand their unique lived experiences and needs. This article proposes an adapted Meyer's Minoritised Stress framework to understand salient clinical factors impacting Queer, Black womxn sexual assault survivors, including those associated with multiple minoritised identities: Queer-based trauma, race-based trauma, cultural betrayal trauma, and misogynoir. Given the high rates of victimisation, marginalisation and discrimination, psychologists and others working with members of this population should engage with and address these factors to provide culturally responsive, sexually affirming and effective mental health treatment and care.

Healthcare Access and Health-Related Cultural Norms in a Community Sample of Black and Latinx Sexual Minority Gender Expansive Women

Major strides have been made in understanding the impact of intersectionality in everyday life. However, there is a significant gap in the research literature on how individuals with multiple minority statuses must uniquely interact and navigate health services. We carried out an exploratory qualitative study with twenty sexual minority gender expansive women of Latinx and African American descent to explore participants' access to health services and the impact of cultural factors on their health decisions and behaviors. Participants described long-term challenges with accessing health services that were primarily tied to income and discriminatory treatment on the part of health providers. Participants also shared regular discouragement from family members to engage with U.S./Western medicine and health traditions. Together, participants' early life experiences and the continued messages from family members, influenced their health behaviors (e.g., delaying care). Implications for future research and health services are discussed.

PTSD Symptoms and Hazardous Drinking Indicators among Trauma-Exposed Sexual Minority Women during Heightened Societal Stress

Trauma-exposed sexual minority women (SMW) are at elevated risk of posttraumatic stress disorder (PTSD) and hazardous drinking compared to trauma-exposed heterosexual women. To understand whether these problems might be exacerbated during times of elevated societal stress, we collected data from a New York-based sample of trauma-exposed SMW between April 2020 and August 2020, a period of notable, compounding societal stressors, including: (a) living in or near one of the first epicenters of the coronavirus disease 2019 (COVID-19) epidemic in the United States and (b) living through multiple high-profile occurrences of racism-related police violence and subsequent racial unrest. SMW (n = 68) completed online self-report questionnaires related to trauma, PTSD symptoms, and alcohol use, and a subset (n = 29) completed semi-structured qualitative interviews. PsycINFO was searched with terms related to SMW, PTSD, and alcohol use to identify studies with samples of SMW from articles published within the last 10 years to which we could compare our sample; this produced nine studies. Welch's t-tests and Chi-square analyses revealed that SMW within our sample reported significantly higher PTSD symptom severity, probable PTSD, and hazardous drinking indicators (i.e., alcohol use disorder and heavy episodic drinking) between April 2020 and August 2020 compared to similar samples (i.e., trauma-exposed SMW and general samples of SMW) assessed previously. Qualitative reports also indicated that the societal stressors of 2020 contributed to mental and behavioral health concerns. These results underscore the need for integrated PTSD and alcohol use prevention and intervention efforts for trauma-exposed SMW during times of heightened societal stress.Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.2006132 .

Sexual Minority Women and Discriminatory Health Care Experiences: An Intersectional Evaluation Across Race and Ethnicity

OBJECTIVE

Health care discrimination contributes to medical mistrust among marginalized communities. Sexual minority women of color (SM-WOC) are marginalized because of the intersection of their sexual orientation, gender, and race/ethnicity and regularly report poor health care experiences at the intersection of these identities. However, research has yet to quantify differences in the prevalence of reported health care discrimination across SM women of various racial/ethnic backgrounds. As such, this study compared the rates of discriminatory treatment during the most recent medical appointment between SM-WOC (Black, Hispanic, Asian American, Native American) and White SM women.

METHODS

We used nationally representative data from the Association of American Medical Colleges survey of health care services. Data were collected from 2010 to 2019 from N = 1,499 SM women (n = 458 SM-WOC). Binary logistic regressions compared frequencies of reported identity-based discrimination between each minoritized racial/ethnic group to White SM women.

RESULTS

Across the sample, 33% of SM-WOC reported discrimination during their last medical appointment compared with 19% of White SM women. Discriminatory treatment was more common among every minoritized racial/ethnic group of SM women compared with White SM women, with variability in frequency of specific forms of identity-based discrimination across minoritized racial/ethnic groups.

CONCLUSIONS

Although discriminatory treatment during the last medical appointment was common for all SM women, prevalence was higher for SM-WOC compared with White SM women. Findings have important implications for policy and practice to reduce health disparities, such as targeted interventions for SM-WOC and provider trainings in cultural humility, implicit bias, and common microaggressions.

Testing the Reserve Capacity Model: Does Race Moderate the Relationship Between Negative Emotions and Neurocognition?

OBJECTIVE

To test whether race moderates the relationship between negative emotions and neurocognition by applying the reserve capacity model within a large sample that spans adulthood.

METHOD

The study sample (N = 1,020) consisted of community-dwelling adults between 18 and 84 years of age who were drawn from the Virginia Cognitive Aging Project. Demographic variables were used to match a sample of Black participants to a sample of White participants. Race was examined as a moderator of the relationship between negative emotions (i.e., depressive symptoms, trait anxiety, and the negative affect subscale from the Positive and Negative Affect Schedule) and neurocognitive variables (episodic memory, reasoning, spatial visualization, and processing speed) with multiple-group structural equation modeling.

RESULTS

After accounting for sociodemographic variables, depressive symptoms were negatively associated with processing speed in both groups, and with worse reasoning in the White subsample. Negative affect was associated with lower reasoning performance in both groups and with lower spatial visualization in the White subsample. Trait anxiety was not significantly associated with the neurocognitive constructs in either group. Multigroup structural equation models showed that the magnitudes of the associations were not different between the Black and White subsamples. Thus, race did not moderate the relationships between depressive symptoms, trait anxiety, and negative affect with neurocognition.

CONCLUSIONS

Negative emotions are associated with lower performance on different neurocognitive tasks, but race does not moderate these relationships. Future research should examine perceived discrimination or other psychosocial variables when examining the relationships among negative emotions and neurocognition.

An Intersectional Approach to Understanding Barriers to Healthcare for Women

Access to health care depends on multiple sociodemographic factors such as race/ethnicity, marital status, education, income, and insurance status. However, a paucity of research has examined access to healthcare disparities as they uniquely affect women, specifically women of color. National data were analyzed from the Medical Expenditure Panel Survey (MEPS) utilizing an 11-year sample (2005-2015) of women ages 18-74 (N = 128,355). More recent data were not included due to changes in how sampling was conducted after 2015. Predictor variables included race/ethnicity cross-classified with marital status, education, income, or insurance status, controlling for age. A dichotomous outcome variable called "any barriers to healthcare" was created based on usual source of care, delayed medical care, delayed dental care and delayed prescription care. Multivariate logistic regression models were used to identify associations with barriers to care. The foundation of this methodology is intersectionality and how it impacts access to care for women across social identities. Hispanic women (OR 1.08, 95% CI 1.02-1.14) had higher odds of having a barrier to care compared to White women. However, Black women (OR 0.92, 95% CI 0.87-0.97) had lower odds of having a barrier to care compared to White women. Race/ethnicity also significantly moderated the relationship between socioeconomic variables (marital status, income, education and insurance status) and having a barrier to care. To achieve a healthy community, addressing these racial/ethnic and socioeconomic inequalities helps to support the people who live and work within these communities.

A conditional embrace-Swedish LGBTQ+ spaces through the eyes of ethnic minority non-heterosexual individuals

Introduction

In research on sexuality, marginalized sub-groups within sexual minorities have often been overlooked. From the vantage point of Sweden, internationally ranked as an exemplary progressive nation in equality issues and LGBTQ+ rights, and with an increasingly diversified population, the lived experiences of ethnic minority non-heterosexual people are still very much lacking in voice and visibility. The present study aimed to examine experiences within Swedish non-heterosexual spaces, held by ethnic minority non-heterosexual individuals.

Method

A thematic analysis of in-depth interviews with 22 Swedish non-heterosexual individuals, 13 cis-men and nine cis-women, with diverse first- and second-generation immigration backgrounds, was conducted.

Results

Two main themes were identified. The first theme, "Constantly contested identities," is composed of the sub-themes "Ingrained, intersecting ideals" and "Prejudiced spaces," and the second theme, "Effects and counteractions," of the sub-themes "Never fully human" and "Representation and separatism." The results, presented starting from a more theoretical level, moving to situated knowledge, and finally to psychological and practical implications, demonstrate that ethnic minority non-heterosexual people experience problematic and intersecting ideals, with related discrimination, in various Swedish non-heterosexual settings. Experiences of alienation, exotification, and tokenism were common among the participants and had negative psychological effects, including multiple-minority stress and a constant outsider feeling. Representation and participation in separatist forums were utilized as primary strategies to counteract the negative effects.

Discussion

The findings shed light on previously under-researched ideals and actions within Swedish LGBTQ+ spaces, and raises questions about how positive belonging can be achieved for multiple-minorities. Further research and continued critical discussions about ethnic minority non-heterosexual people's plight within non-heterosexual settings in Sweden, and beyond, is advocated.

The Initial Response to COVID-19 Disruptions for Older People with HIV in Ukraine

Ukraine imposed a COVID-19 lockdown in March 2020. From April to June 2020, we surveyed 123 older people with HIV (OPWH) by phone to assess their mental health, engagement in HIV and other healthcare, and substance use using standardised scales. Variables of key interest were symptoms of depression and symptoms of anxiety. Univariate and multivariable Firth logistic regression models were built to assess factors associated with: (1) symptoms of depression, and (2) symptoms of anxiety. Findings indicated high suicidal ideation (10.6%); 45.5% met the screening criteria for moderate to severe depression; and 35.0% met the criteria for generalised anxiety disorder (GAD). Independent correlates of having moderate to severe depression included being female (AOR: 2.83, 95%CI = 1.19-7.05), having concerns about potential barriers to HIV treatment (AOR: 8.90, 95%CI = 1.31-104.94), and active drug use (AOR: 34.53, 95%CI = 3.02-4885.85). Being female (AOR: 5.30, 95%CI = 2.16-14.30) and having concerns about potential barriers to HIV treatment (AOR: 5.33, 95%CI = 1.22-28.45) were independently correlated with GAD, and over half (58.5%) were willing to provide peer support to other OPWH. These results highlight the impact of the COVID-19 restrictions in Ukraine on mental health for OPWH and support the need to screen for psychiatric and substance use disorders, potentially using telehealth strategies.

Disparities in the implementation of the Health Extension Program in Ethiopia: Doing more and better towards universal health coverage

Introduction

Large-scale implementation of the Health Extension Program (HEP) has enabled Ethiopia to make significant progress in health services coverage and health outcomes. However, evidence on equity and disparities in the implementation of the HEP is limited. The aim of this study was to examine disparities in the implementation of the HEP in Ethiopia.

Methods

We used data from the 2019 National HEP assessment which was conducted between Oct 2018 and Sept 2019 in nine regions in the country. Data were collected from 62 districts, 343 Health posts, 179 Health centres, 584 Health Extension Workers (HEWs), and 7043 women from 7122 Households. This study focused on selected input, service delivery, and coverage indicators. We used rate differences, rate ratios and index of disparity to assess disparities in HEP implementation across regions.

Results

We found wide inter-regional disparities in HEP implementation. Developing regional states (DRS) had significantly lower availability of qualified HEWs (Rate Ratio (RR) = 0.54), proportion of households visited by Health Extension workers (RR = 0.40), and proportion of mothers who received education on child nutrition (RR = 0.45) as compared national average. There were also significant disparities in HEP implementation among DRS in the proportion of households visited by HEWs in the past 12 months (Index of disparity = 1.58) and proportion of adolescents who interacted with HEWs (Index of disparity = 1.43). Despite low overall coverage of health services in DRS, the contribution of the HEP for maternal health services was relatively high.

Conclusion

There were significant inter-regional disparities in the implementation HEP in Ethiopia. The level of disparity among DRS was also remarkable. To achieve Universal Health Coverage, it is important that these disparities are addressed systematically and strategically. We recommend a tailored approach in HEP implementation in DRS.

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.

Analysis of the social consequences and value implications of the Everyday Discrimination Scale (EDS): implications for measurement of discrimination in health research

The Everyday Discrimination Scale (EDS) is one of the most widely used measures of discrimination in health research, and has been useful for capturing the impact of discrimination on health. However, psychometric analysis of this measure has been predominantly among Black Americans, with limited examination of its effectiveness in capturing discrimination against other social groups. This paper explores the theoretical and historical foundations of the EDS, and draws on the analytic framework of Messick's theory of unified validity to examine the effectiveness of the EDS in capturing diverse experiences of discrimination. Encompassing both social consequences and value implications, Messick's unified validity contends that psychometric evaluation alone is insufficient to justify instrument use or ensure social resonance of findings. We argue that despite the robust psychometric properties and utility in addressing anti-Black race-related discrimination, the theoretical foundations and research use of the EDS have yet to respond to current discrimination theory, particularly intersectionality. This paper concludes with guidance for researchers in using the EDS in health research across diverse populations, including in data collection, analysis, and presentation of findings.

Hearing loss and risk of depressive symptoms in older adults in the Health ABC study

Objective

Hearing loss (HL) is highly prevalent among older adults and may lead to increased risk of depressive symptoms. In both cross-sectional and longitudinal analysis, we quantified the association between HL and depressive symptoms, incorporating the variable nature of depressive symptoms and characterizing by race and gender.

Methods

Data were from the Health, Aging, and Body Composition study. Depressive symptoms were measured using the Center for Epidemiologic Study Depression Scale short form (CES-D 10), defined as CES-D 10 score ≥10 or treatment for depression. Hearing was defined via four-frequency pure-tone average (PTA) decibel hearing level (dB HL), categorized as normal hearing (PTA ≤25 dB HL), mild HL (PTA26-40 dB HL), and ≥moderate HL (PTA > 40 dB HL). Associations at baseline were quantified using logistic regression, incident depressive symptoms using Cox proportional hazard models, and change in depressive symptoms over time using growth mixture models and multinomial logistic regression.

Results

Among 2,089 older adults (1,082 women, 793 Black; mean age 74.0 SD: 2.8), moderate or greater HL was associated with greater odds of concurrent [Odds Ratio (OR):2.45, 95% CI:1.33, 4.51] and incident depressive symptoms [Hazard Ratio (HR):1.26, 95% CI:1.00, 1.58]. Three depressive symptom trajectory patterns were identified from growth mixture models: low, moderate increasing, and borderline high depressive symptom levels. Those with moderate or greater HL were more likely to be in the borderline high depressive-symptom trajectory class than the low trajectory class [Relative Risk Ratio (RRR):1.16, 95% CI:1.01, 1.32].

Conclusions

HL was associated with greater depressive symptoms. Although findings were not statistically significantly different by gender and race, estimates were generally stronger for women and Black participants. Investigation of psychosocial factors and amelioration by hearing aid use could have significant benefit for older adults' quality of life.

Minority stress and academic outcomes among ethnic minority college students: Anxiety as a mediating mechanism

Objective: The present study examines the relationship between minority stress and academic outcomes for ethnic minority college students in the U.S. We explore to what extent anxiety functions as a potential mediating mechanism for these relationships. Participants: Data were obtained from 347 undergraduate ethnic minority college students attending a public university in West Texas. Results: Results revealed that minority stress was significantly related to anxiety symptoms when controlling for ethnic minority group membership. Additionally, it was found that anxiety symptoms significantly mediated the relationship between minority stress and major satisfaction, controlling for ethnic minority group membership. Conclusions: This study contributes to the existing psychological literature on ethnic minority college students by highlighting the extent that minority stress is related to certain academic outcomes, taking a step further to investigate anxiety as a mechanism that may explain these relationships.

The Social Determinants of Perinatal Maternal Distress

This pilot study examined associations between prenatal individual and socioenvironmental determinants of health and symptoms of perinatal maternal distress (PMD) in women enrolled in midwifery practice and living in a rural state. Pearson's correlations between prenatal predictors and PMD scores were calculated. Having experienced emotional abuse in one's lifetime, total number of past year stressors, and everyday discrimination score were all statistically significant predictors of PMD at study enrollment and follow-up. Result suggest shifting to a multi-symptom, life course assessment and intervention paradigm, tailored to the context of specific populations, may improve perinatal care and reduce disparities.

Testing whether the combination of victimization and minority stressors exacerbate PTSD risks in a diverse community sample of sexual minority women

Informed by minority stress and intersectionality frameworks, we examined: 1) associations of sexual identity and race/ethnicity with probable diagnosis of post-traumatic stress disorder (PTSD-PD) among sexual minority women (SMW; e.g., lesbian, bisexual); and 2) potential additive and interactive associations of minority stressors (discrimination, stigma consciousness, and internalized homonegativity) and potentially traumatic childhood and adulthood events (PTEs) with PTSD-PD. Data come from a large and diverse community sample of SMW (N = 662; age range: 18-82; M = 40.0, SD = 14.0). The sample included 35.8% Black, 23.4% Latinx, and 37.2% White participants. Logistic regressions tested associations of sexual identity and race/ethnicity, minority stressors, and PTEs with PTSD-PD. More than one-third of SMW (37.2%) had PTSD-PD with significantly higher prevalence among bisexual, particularly White bisexual women, than lesbian women. Discrimination, stigma consciousness, and internalized homonegativity were each associated with higher odds of PTSD-PD, but only internalized homonegativity was additively associated with PTSD-PD in mutually adjusted models above and beyond effects of PTEs. No evidence for interactive effects between PTEs and minority stressors was found. In a diverse community sample of sexual minority women, PTSD is strongly associated with potentially traumatic childhood events and with minority stressors above and beyond the associations with other potentially traumatic events and stressors in adulthood. Our findings suggest a strong need for therapists to address the effects of stigma and homophobia in treatment for PTSD, as these minority stressors likely maintain and exacerbate the effects of past traumas.

Relationship Quality and Health Among Black Same-Sex Male Couples: Protocol for a Symbolic Netnography Study

BACKGROUND

Across a range of studies, health scientists have found that being in a romantic relationship can have positive and negative influences on one's health. A couple's health outcomes are often influenced by relationship quality-or how they perceive the positive or negative character of their relationship. These findings have important implications for how scientists and interventionists may leverage romantic relationships facilitating good health among couples. However, in general, couples research has not included Black same-sex male couples in large enough numbers to make previous studies' findings relevant to them. This represents a gap in the scientific literature and, more importantly, a missed opportunity to understand how romantic relationships influence health for a group that must navigate distinct, multilevel health and social inequities.

OBJECTIVE

This study aims to (1) decode and understand the ways in which Black same-sex male couples express their romantic relationships in virtual contexts via symbolic indicators, (2) determine how Black same-sex male couples describe the quality of their romantic relationships, and (3) explore how Black same-sex male couples make meaning of their relationship quality and its impact on their relational and individual health.

METHODS

We will use joint dyadic interviews embedded within a symbolic netnography research design to accomplish our aims. We will use grounded theory to analyze our qualitative data. We will then triangulate our findings to determine how well they answer our research questions.

RESULTS

This study received ethical approval on October 8, 2020 and we began data collection in November 2020. Results are expected to be available no later than December 31, 2022.

CONCLUSIONS

This study will apply novel symbolic netnographic qualitative methods to further our understanding of Black same-sex male couples' romantic relationships and how they contribute to their health. The findings will be used to develop programs to improve Black same-sex male couples' health in community and virtual settings.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/29589.

Discrimination experienced by Aboriginal and Torres Strait Islander males in Australia: Associations with suicidal thoughts and depressive symptoms

INTRODUCTION

Globally, Indigenous populations have higher rates of suicidal behavior and psychological distress compared to non-Indigenous populations. Indigenous populations also report high rates of exposure to discrimination, which could potentially contribute to poor mental health outcomes. The objectives of this paper were to estimate the prevalence of discrimination among Aboriginal and Torres Strait Islander males in Australia and to examine the role of discrimination in the association between Aboriginal and Torres Strait Islander status and suicidal thoughts and depressive symptoms.

METHODS

We used cross-sectional data on 13,697 males aged 18-55 years from the Australian Longitudinal Study on Male Health. We undertook a Poisson regression with robust standard error analyses to examine Aboriginal and Torres Strait Islander status and self-perceived exposure to discrimination in the past 2 years as correlates of recent suicidal ideation. We used zero-inflated negative binomial regression to assess Aboriginal and Torres Strait Islander status and self-perceived exposure to discrimination as correlates of recent depressive symptoms.

RESULTS

Aboriginal and Torres Strait Islander males have a twofold higher prevalence of self-perceived discrimination (39.2% vs 19.3%, p < 0.001), suicidal ideation (21.8% vs 9.4%, p < 0.001) and moderate or worse depressive symptoms (24.0% vs 12.2%, p < 0.001) as compared to their non-Indigenous counterparts. After adjusting for sociodemographics and substance use, Aboriginal and Torres Strait Islander status was significantly associated with suicidal thoughts (odds ratio = 1.49, p = 0.019) and depressive symptoms (prevalence rate ratio = 1.19, p = 0.018). About 15.3% and 28.7% of the association between Aboriginal and Torres Strait Islander status and suicidal thoughts and depressive symptoms, respectively, was explained by discrimination.

CONCLUSION

Our analyses add to evidence that discrimination is a contributor to mental health disparities between Aboriginal and Torres Strait Islander and non-Indigenous populations in Australia. Reducing discrimination ought to be considered as part of strategies to improve the social and emotional well-being of Aboriginal and Torres Strait Islander people.

Black women's experiences of gendered racial sexual objectification, body image, and depressive symptoms

Black women navigate unique sexual objectification experiences and concerns about their bodies as a consequence of the race- and gender-based marginalization that they face. However, less is known about the influence of gendered racial sexual objectification experiences on Black women's mental health (i.e., depressive symptoms) or the contributions of key body image indicators (i.e., body surveillance and current-ideal body image discrepancy) that reflect Black women's engagement in monitoring and managing their bodies. We surveyed 1595 Black women to test our hypotheses that experiences of gendered racial sexual objectification (i.e., frequency and stress appraisal) would be positively associated with depressive symptoms and that body surveillance and current-ideal body image discrepancy would moderate this association. Analyses showed that more frequent experiences of gendered racial sexual objectification and higher stress appraisal of these experiences were significantly associated with more depressive symptoms. Furthermore, body surveillance and current-ideal body image discrepancy moderated the relation between gendered racial sexual objectification and depressive symptoms. Findings highlight how Black women's objectification and increased engagement in body monitoring and management practices are associated with their experiences of depressive symptoms, and thus, may negatively influence their mental health.

Discrimination experienced by sexual minority males in Australia: Associations with suicidal ideation and depressive symptoms

INTRODUCTION

Discrimination has been under-examined as a social determinant of the higher rates of poor mental health experienced by sexual minorities. The objectives of our study were to: 1) assess whether discrimination was independently associated with poor mental health among sexual minority males, and 2) assess the potential mediation role of discrimination in the associations between sexual minority status and poor mental health.

METHODS

We used cross-sectional data on 13,230 males aged 18-55 years from the Australian Longitudinal Study on Male Health; bisexual and homosexual males comprised 1.5% and 1.6% of the sample, respectively. We fit Poisson regression and zero-inflated negative binomial regression models to examine suicidality, depressive symptoms and perceived discrimination in the past two years as correlates of suicidality and depressive symptoms.

RESULTS

Statistically significant differences were observed in the prevalence of perceived discrimination by sexual orientation (p < 0.001), with the highest prevalence among bisexual (29.3%) and homosexual (40.4%) males, and the lowest prevalence among heterosexual males (18.6%). After adjusting for confounding, bisexual/homosexual males had higher rates of perceived discrimination (IRR = 1.88, p < 0.001), recent suicidal ideation (IRR = 1.51, p = 0.008), lifetime suicide attempt (IRR = 2.09, p < 0.001) and recent depressive symptoms (IRR = 1.34, p < 0.001) than heterosexual males. Analysis of β-coefficients suggested that discrimination may mediate a small to moderate proportion of the association between sexual minority status and poor mental health.

LIMITATIONS

Use of cross-sectional data.

CONCLUSION

Poor mental health is more common among sexual minority males, and discrimination may be a contributor to these mental health disparities. Reducing discrimination should be considered as part of a strategy to improve the mental wellbeing of sexual minority males.

Black sexual minority women's social well-being and psychological distress

Black sexual minority women (SMW), the largest racial group among the sexual minority community, often report high psychological distress and decreased psychological health and social well-being. Strong, positive, social relationships positive within group identities, and support networks are a key component in coping with minority stressors and promoting overall well-being. This study explored the association between minority stressors, social support, and Black SMW's social well-being and psychological distress. Participants consisted of individuals identifying as Black (including biracial identities, n = 48) cisgender women (N = 149) who responded to the Generations Study's initial round of surveys collected in 2016-2017. Participants were between the ages of 18-60, with a mean of 29.3 years old. Descriptive and bivariate correlations were conducted for lesbian, gay, and bisexual (LGB) stigma, internalized homophobia, gender presentation, ethnic identity affiliation, LGB community connectedness, and social support. Multiple regression models were conducted to analyze correlates of social well-being and psychological distress, controlling for age and education level. LGB stigma and internalized homophobia were significant predictors of social well-being and psychological distress. Low internalized homophobia, distress, and stigma were associated with higher social well-being as were high connection to LGB and ethnic communities. Implications for therapy are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Systematic Review of Black American Same-Sex Couples Research: Laying the Groundwork for Culturally-Specific Research and Interventions

ABSTRACTThis article presents the findings of a systematic review of the empirical literature related to Black American same-sex couples (BASCs). We found 16 articles that met inclusion criteria. Most articles were published in journals that focused on interdisciplinary studies, HIV/AIDS, and couples and families' studies. Approximately 63% of the articles reported external funding support. However, only one of these grants was awarded to a Black investigator. Articles predominately focused on BASCs composed of Black sexual minority men residing in major U.S. cities. Only 25% of the articles focused on couples where both partners were Black. Most studies were cross-sectional, used convenience samples, and were reported without mention of a theoretical framework that explicated the philosophical assumptions that guided the research. The articles focused on a range of topics such as resilience, relationship dynamics, couple-level social support, rituals with extended families, and partner-health associations. The implications of these findings for advancing culturally-specific behavioral and social science health research and interventions with BASCs are presented.

Intersectional Activism Among Black Lesbian, Gay, Bisexual, Transgender, and Queer or Questioning Young Adults: The Roles of Intragroup Marginalization, Identity, and Community

Research around the importance of activism for positive development has been primarily focused on a single identity, missing the ways in which race and sexual orientation intersect to influence the communities young adults advocate for. The current study assesses how Black lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) young adults’ experiences of discrimination, identity, and community predict involvement in intersectional activism (e.g., activism for LGBTQ communities of color). With a sample of 216 Black LGBTQ young adults from the Social Justice Sexuality project, we used hierarchical linear regression to examine relationships between intragroup marginalization, identity, community involvement, and intersectional activism. While all three constructs explained a significant variance in intersectional activism, only racial marginalization within the LGBTQ community and involvement in LGBTQ communities of color were positively associated with intersectional activism. These findings demonstrate that experiences of intragroup marginalization and connection to communities that center both race and sexual orientation may be important in fostering activism among Black LGBTQ young adults.

Psychosocial stress and neuroendocrine biomarker concentrations among women living with or without HIV

OBJECTIVE

Women living with HIV (WLWH) experience psychosocial stress related to social-structural vulnerabilities. To investigate neuroendocrine pathways linking stress and increased cardiovascular disease risk among WLWH, we evaluated associations between psychosocial stress (i.e., perceived stress, posttraumatic stress, and experiences of race- and gender-based harassment) and a composite neuroendocrine biomarker index among WLWH and women without HIV.

METHODS

In 2019-2020, Women's Interagency HIV Study participants in Washington, DC completed a questionnaire and provided blood and 12-hour overnight urine samples for testing of serum dehydroepiandrosterone sulfate (DHEA-S) and urinary free cortisol, epinephrine, and norepinephrine. Psychosocial stress was measured using the Perceived Stress Scale, PTSD Checklist-Civilian Version, and Racialized Sexual Harassment Scale. Latent profile analysis was used to classify participants into low (38%), moderate (44%), and high (18%) stress groups. Composite biomarker index scores between 0-4 were assigned based on participants' number of neuroendocrine biomarkers in high-risk quartiles (≥75th percentile for cortisol, epinephrine, and norepinephrine and ≤25th percentile for DHEA-S). We evaluated associations between latent profile and composite biomarker index values using multivariable linear regression, adjusting for socio-demographic, behavioral, metabolic, and HIV-related factors.

RESULTS

Among 90 women, 62% were WLWH, 53% were non-Hispanic Black, and median age was 55 years. In full multivariable models, there was no statistically significant association between psychosocial stress and composite biomarker index values among all women independent of HIV status. High (vs. low) psychosocial stress was positively associated with higher mean composite biomarker index values among all monoracial Black women (adjusted β = 1.32; 95% CI: 0.20-2.43), Black WLWH (adjusted β = 1.93; 95% CI: 0.02-3.83) and Black HIV-negative women (adjusted β = 2.54; 95% CI: 0.41-4.67).

CONCLUSIONS

Despite a null association in the overall sample, greater psychosocial stress was positively associated with higher neuroendocrine biomarker concentrations among Black women, highlighting a plausible mechanism by which psychosocial stress could contribute to cardiovascular disease risk.

Optimizing a mindfulness-based intervention to alleviate stress from discrimination among young sexual and gender minorities of color: A study protocol

Background

Young sexual and gender minorities (SGMs) of color may face unique experiences of discrimination based on their intersectional positions (eg, discrimination based on both racial or ethnic identity and sexual identity). Emerging evidence suggests that mindfulness practices may reduce stress from discrimination and improve overall well-being among young SGM. Moreover, the omnipresence of smartphone access among racial or ethnic and sexual minority communities provides a method through which to administer mindfulness-based interventions among young SGMs of color.

Objective

This paper outlines the protocol of the Optimizing a Daily Mindfulness Intervention to Reduce Stress from Discrimination among Young Sexual and Gender Minorities of Color (REDUCE) study, a pilot optimization trial of a smartphone-based mindfulness intervention that was developed in conjunction with the Healthy Minds Program (HMP) with the aim of reducing stress from discrimination among young SGMs.

Methods

In total, 80 young (ages 18-29 years) SGMs of color will be enrolled in the study. The HMP is a self-guided meditation practice, and participants will be randomized to either a control condition or an intervention that uses a neuroscience-based approach to mindfulness. We will use the multiphase optimization strategy to assess which combination of mindfulness interventions is the most effective at reducing stress from discrimination among young SGMs of color. A combination of mindfulness-based meditation intervention components will be examined, comprising mindfulness-based practices of awareness, connection, and purpose. Awareness refers to the practice of self-awareness, which reduces the mind’s ability to be distracted and instead be present in the moment. Connection refers to the practice of connection with oneself and others and emphasizes on empathy and compassion with oneself and others. Purpose encourages goal-making in accordance with one’s values and management of behavior in accordance with these goals. In addition, we will assess the feasibility and acceptability of the HMP application among young SGMs of color.

Results

The REDUCE study was approved by the Institutional Review Board of New York University, and recruitment and enrollment began in the winter of 2021. We expect to complete enrollment by the summer of 2022. The results will be disseminated via social media, journal articles, abstracts, or presentations, as well as to participants, who will be given the opportunity to provide feedback to the researchers.

Conclusions

This optimization trial is designed to test the efficacy, feasibility, and acceptability of implementing an application-based, mindfulness-based intervention to reduce stress from discrimination and improve well-being among young SGMs of color. Evidence from this study will assist in the creation of a sustainable, culturally relevant mobile app–based mindfulness intervention to reduce stress from discrimination among young SGMs of color.

Trial Registration

Clinicaltrials.gov NCT05131360; https://clinicaltrials.gov/ct2/show/NCT05131360

International Registered Report Identifier (IRRID)

DERR1-10.2196/35593

Differences in Perinatal Outcomes of Birthing People in Same-Sex and Different-Sex Marriages

It is unknown whether people in same-sex relationships who give birth have different perinatal outcomes than people in different-sex relationships, despite differences in risk factors such as use of assisted reproductive technologies, obesity, smoking, and poor mental health. Marriage equality has established birth certificates as a promising new source of population-based data on births to same-sex married parents. We used birth certificate data from Massachusetts for 201,873 singletons born to married parents from 2012 to 2016. We estimated the associations of several birth outcomes with having a birth parent in a same-sex marriage using propensity score-matched and -unmatched samples. We also tested whether these associations were modified by the use of assisted reproductive technologies. People in same-sex marriages who gave birth had perinatal outcomes related to decreased fetal growth and preterm birth that were similar to those of their peers in different-sex marriages. Use of assisted reproductive technology was associated with decreased fetal growth and increased risk of preterm birth for infants with different-sex parents but not for infants with same-sex parents. More research is needed across other states and to understand why use of assisted reproductive technology is not a risk factor for poor birth outcomes for those in same-sex marriages.

Exploring the Relation between Adolescents' Number of Perceived Reasons for Discrimination and Depressive Symptoms

Methodological impediments have presented challenges in identifying which individuals are at the highest risk of experiencing discrimination and its detrimental corollaries. In the current study, we examined whether adolescents' number of perceived reasons for everyday discriminations (i.e., number of identities and/or characteristics adolescents identify as the reasons(s) they are discriminated against) is associated with frequency of perceived everyday discriminations (PED) and depressive symptoms. Further, we evaluated indirect associations between number of perceived reasons for PEDs and depressive symptoms through frequency of PED, brooding, and reflection. The sample for this cross-sectional study consisted of 328 9th grade students between the ages of 13 and 16 (M = 14.19, SD = 0.56). Around 60% of the sample identified as male, and a majority of the adolescents identified their race as either Black (46%) or White (35%). Adolescents provided data on perceived reasons for PEDs, frequency of PED, brooding, reflection, and depressive symptoms using self-report measures. Adolescents' number of perceived reasons for PEDs was associated with frequency of PED and depressive symptoms. There were also multiple indirect associations between adolescents' number of perceived reasons for PEDs and depressive symptoms through frequency of PED, brooding, and reflection. Our results indicate that accounting for adolescents' number of perceived reasons for PEDs may be useful to both researchers and clinicians in identifying which individuals are at the greatest risk of experiencing PED and associated outcomes. Additional implications and future directions for research are discussed.

Racial and Language Microaggressions in the School Ecology

The growth trajectory of ethnically and linguistically diverse individuals in the United States, particularly for youth, compels the education system to have urgent awareness of how diverse aspects of culture (e.g., Spanish-speaking, Black Latina student) are implicated in outcomes in American school systems. Students spend a significant amount of time in the school ecology, and this experience plays an important role in their well-being. Diverse ethnic, racial, and linguistic students face significant challenges and are placed at considerable risk by long-observed structural inequities evidenced in society and schools. Teachers must develop the capacity to be culturally sensitive, provide culturally responsive pedagogy, and regularly self-assess for biases implicated in positive academic outcomes for students in kindergarten through Grade 12. Research and practice have suggested that racism and discrimination in the form of racial microaggressions are observed daily in schools and classrooms. This article provides an overview of racial microaggressions in the school context and their damaging effects on students. We provide specific examples of microaggressions that may be observed in the U.S. classroom environment and how schools can serve as a positive intervention point to ameliorate racism, discrimination, and racial and language microaggressions. This comprehensive approach blends theory with practice to support the continued development of cultural humility, culturally sustaining pedagogy, and an equity-responsive climate.

History of Physical Teen Dating Violence and Its Association With Suicidal Behaviors Among Adolescent High School Students: Results From the 2015 Youth Risk Behavior Survey

Although studies have investigated and found physical teen dating violence (TDV) has a significant negative impact on mental health outcomes, few studies are yet to investigate the effect of physical TDV on suicidal behaviors among adolescents. The objectives of this study are to examine the prevalence of physical TDV, suicidal ideation, suicide plan, and suicide attempt among adolescents aged 14 to 18 years and the association between physical TDV and these suicidal behaviors. Data for this study were obtained from the 2015 Youth Risk Behavior Survey. A sample of 9,693 adolescents aged 14 to 18 years (50.4% males) was analyzed using logistic regression with suicidal ideation, suicide plan, and suicide attempt as outcome variables and physical TDV as the main explanatory variable. About 17% of the adolescent students experienced suicidal ideation, 13.7% made a suicide plan, and 7.6% attempted suicide during the past 12 months. Among those who were dating, 9.9% experienced physical TDV. In the multivariate logistic regression, adolescent students who experienced physical TDV were 1.92 times more likely to have experienced suicidal ideation, 1.67 times more likely to have made a suicide plan, and 2.42 times more likely to have attempted suicide during the past 12 months when compared with their counterparts who were dating but experienced no physical TDV. Other significant predictors of suicidal behaviors include being a sexual minority, experiencing forced sex, bullying, feeling sad or hopeless, and binge drinking. Having sufficient sleep lowered the odds of suicidal ideation and suicide plan. The topic of physical TDV and its association with suicidal behaviors among adolescents is such an important issue for researchers, policymakers, and practitioners in the United States and around the world. Prevention and intervention efforts should be culturally tailored to reflect the unique experiences with physical TDV and suicide among minority populations such as sexual minority adolescents.