Poppies in a wheat field: exploring the lives of rural lesbians

Explaining behavioral health differences in urban and rural sexual minority adolescents: A longitudinal investigation of minority stress in a diverse national sample of sexual minority adolescents: A longitudinal investigation of minority stress in a diverse national sample of sexual minority adolescents

PURPOSE

Experiences of sexuality-based discrimination (ie, minority stressors) against youth who identify as nonheterosexual (ie, sexual minority) have been associated with increased symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD) for sexual minority adolescents (SMA; ages 14-17). However, little is known about the experiences of SMA living in rural communities across the United States. Thus, the present study sought to examine differences in mental health patterns between urban and rural dwelling SMA, and to see whether these differences are, at least in part, explained by experiences of lifetime minority stress.

METHODS

A nationwide sample of SMA residing in the United States (N = 2,558; aged 14-17, M = 15.90 years, SD = 0.98) was recruited through purposive social media and respondent-driven sampling methods to complete a cross-sectional survey online. Measures included those of minority stress, urbanicity, and symptoms of anxiety, depression, and PTSD. Parallel multiple mediation (PMM) analysis was employed to test whether urbanicity was associated with anxiety, depressive, and PTSD symptoms through reported lifetime minority stress.

FINDINGS

On average, SMA living in rural areas significantly reported more lifetime minority stress, depressive, and PTSD symptoms than SMA living in urban settings. Results from our PMM analysis indicated that heightened experiences of lifetime minority stress indirectly linked the effects of living in rural areas on anxiety (b = -0.288, 95% CI = [-0.491, -0.085]), depressive (b = -0.158, 95% CI = [-0.270, -0.047), and PTSD symptoms PTSD (b = -0.349, 95% CI = [-0.596, -0.105]). The model accounted for 16.8%, 18%, and 24.1% of the variability in anxiety symptoms, depressive symptoms, and PTSD symptoms, respectively.

CONCLUSIONS

SMA in our study who reside in rural areas reported elevated minority stress, depressive, and PTSD symptoms as compared to their urban dwelling peers. Our study found that lifetime experiences of minority stress fully mediated the relationship between urbanicity and both depressive and PTSD symptoms, and partially mediated the relationship between urbanicity and anxiety. These findings highlight the need to increase support for rural youth who are growing into adulthood and may find continuing challenges in their family, peer, and community relationships.

Social resource patterns and health outcomes among Canadian LGBTQ2+ adults: A latent class analysis

BACKGROUND

Decades of research have shown a strong association between wellbeing, health, and social resources. LGBTQ2+ communities are among those who historically have been excluded from accessing quality social resources. However, little is known about how access to different types of resources influences mental health and wellbeing.

METHOD

Data were drawn from an online sample of 3890 LGBTQ2+ people aged 18 years and older in Quebec, Canada. We identified key social resource patterns (from family of origin, friends, partner, neighbourhood, and LGBTQ2+ community) and investigated differences in socio-demographic and health outcomes across classes.

RESULTS

A five-class solution best fitted the data, highlighting distinctive patterns in access to five key social resources: moderate friend support access (42.14%), overall high support access (23.51%), high friend support access (18.06%), only close ties support access (10.90%) and overall low support access (5.39%). Marginalized groups (trans and non-binary people, racialized or disabled people, immigrants) were less likely to access diverse, high-quality social resources. Accessing diverse social resources, particularly close ties (e.g., family of origin), was associated with better health outcomes. In the absence of close ties, having at least one other social resource was associated with better health outcomes compared to having limited access to all resources.

CONCLUSIONS

We found a major imbalance in social resource access among LGBTQ2+ people. Creating safe spaces for LGBTQ2+ people and ensuring access to high-quality social resources is important in sustaining their health and wellbeing.

Rural Incarcerated Women: HIV/HCV Knowledge and Correlates of Risky Behavior

Rural incarcerated women have an increased risk of acquiring the human immunodeficiency virus (HIV) and the hepatitis C virus (HCV) due to prevalent engagement in drug use and sexual behaviors. Limited research has investigated HIV and HCV knowledge in this high-risk population. Furthermore, the interplay of sociodemographic factors (i.e., education, age, income, and sexual orientation) and risky behavior is understudied in this population. The present study evaluated a sample of adult, predominately White women from rural Kentucky ( n = 387) who were recruited from local jails. The sample had high HIV and HCV knowledge but also reported extensive risk behaviors including 44% engaging in sex work and 75.5% reporting a history of drug injection. The results of multiple regression analysis for risky sexual behavior indicated that sexual minority women and those with less HIV knowledge were more likely to engage in high-risk sexual behaviors. The regression model identifying the significant correlates of risky drug behavior indicated that HIV knowledge, age, and income were negative correlates and that sexual minority women were more likely to engage in high-risk drug use. When HCV knowledge was added to the regression models already including HIV knowledge, the interaction was significant for drug risk. Interventions for rural imprisoned women should consider the varied impact of sociodemographic background and prioritize HIV education to more effectively deter risky sexual and drug behaviors.

A Mixed-Method Assessment of a Pilot Peer Advocate Intervention for Rural Gender and Sexual Minorities

Mental health disparities affect lesbian, gay, bisexual, transgender, and queer (LGBTQ) people in rural America. There are few empirically-based mental health interventions for this population. This exploratory study uses a mixed-method approach to assess implementation issues related to the feasibility, acceptability, appropriateness, and preliminary impacts of a novel peer-based intervention designed to enhance support and treatment engagement among rural LGBTQ people with mental distress and/or addiction issues. Quantitative and qualitative results illuminate intervention strengths and areas for improvement. Strengths centered on enhancing social support, advocacy behaviors, and engagement in treatment. Implementation challenges and recommendations to advance the intervention model are discussed.

Violent Victimization and Substance Dependency: Comparing Rural Incarcerated Heterosexual and Sexual Minority Women

This exploratory study examines the relationship between sexual identity and violent victimization experiences as predictors of differences in illicit substance and alcohol use and substance use problems among a sample of incarcerated women in rural Appalachia (N = 400). Results indicated that, compared to heterosexual women, sexual minority women were more likely to have a lifetime history of weapon, physical, and sexual assault, and were younger at the time of their first violent victimization. Sexual minority women were younger than heterosexual women at the age of onset for intravenous drug use and at the time they first got drunk, and were more likely to report having overdosed. Multivariate analysis found violent victimization to be the strongest predictor of a history of overdose and substance use problems.

Development and Evaluation of Training for Rural LGBTQ Mental Health Peer Advocates

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) people in rural areas experience negative mental health consequences of minority stress, and encounter multiple barriers to accessing mental health and substance use treatment services. As part of a larger intervention study, we developed and piloted a unique training program to prepare peer advocates for roles as paraprofessionals who assist rural LGBTQ people with mental health needs. Thirty-seven people in New Mexico took part in either the initial training or a second revised training to improve their knowledge and skills to address LGBTQ mental health needs. Evaluation of this training consisted of self-administered structured assessments, focus groups, and open-ended interviews. Results for the initial training showed no significant increases from pre- and post-test scores on knowledge about LGBTQ people and their mental health issues, whereas significant increases were detected for the revised training. There also were significant increases in self-efficacy to perform tasks associated with the peer advocate role for all but a subset of tasks for the revised training. Qualitative data reveal that participants appreciated the opportunity to increase information and skills, especially concerning bisexual and transgender persons, and the opportunity to connect with others in the community who want to support LGBTQ people.

An Examination of Past and Current Influences of Rurality on Lesbians' Overweight/Obesity Risks

PURPOSE

The purpose of our study was to separately examine past (i.e., rural or non-rural background) and present (i.e., current rural or urban location) influences of rurality on the weight status and diet/exercise behaviors of lesbians.

METHODS

A total of 895 lesbians participated in the online study. Participants were surveyed regarding their rurality status, weight/height, and diet/exercise patterns. A 2×2 (location×background) ANCOVA was conducted to explore influences of rurality on body mass index (BMI), while controlling for age, race, and education. Chi-square analyses were used to examine the relationship between dimensions of rurality and diet/exercise behaviors.

RESULTS

There was a significant main effect of current location on BMI. No significant interaction between location and background on BMI was found nor was there a significant main effect of background. Lesbians currently living in rural areas were on average obese (M=30.61), with significantly higher BMIs than urban-residing lesbians (M=28.53). The only significant differences that emerged for lesbians' diet/exercise patterns were for current location-more rural-residing lesbians reported they never engage in exercise in comparison to their urban-residing counterparts, with a greater percentage of urban-residing lesbians reporting frequent exercise. Rural lesbians were also more likely to report a diet high in protein.

CONCLUSION

Findings suggest that current rather than past influences of rurality may have a significant impact on lesbians' weight and diet/exercise behaviors and highlight significant obesity-related health disparities for rural-residing lesbians. These findings offer support for the development of culturally-appropriate healthy diet/exercise and weight promotion efforts that are accessible to rural lesbians.

Sexual orientation, internal migration, and mental health during the transition to adulthood

Previous research has suggested that sexual minorities may have higher rates of migration than heterosexuals, indicating their effort to escape stigma in the currently residing areas. However, direct evidence for the migration pattern has been lacking, and mental health implications of such coping effort have been unclear. This study seeks to fill these gaps in the literature by analyzing the Add Health data, which include longitudinal measures of residential locations, sexual orientation, and mental health. The analysis focuses on the transition to adulthood, when the rate of internal migration peaks. Among women, sexual minorities have a higher rate of migration than heterosexuals, but men do not show such a difference. Sexual minorities show better mental health when they migrate to counties with higher proportions of people living in urban areas whereas heterosexuals do not show such an association. Among sexual minority men, migration to counties with higher population density and higher proportions of college-educated residents is also linked to better mental health.

The only gay in the village? Everyday life of gays and lesbians in rural Slovenia

The article deals with the comparison of the characteristics, experiences, and perceptions of everyday life of gays and lesbians living in rural and urban areas of Slovenia. We focus on the following thematic aspects: (1) coming out; (2) intimate partnerships; (3) the access and the use of gay infrastructure; and (4) violence against gays and lesbians. The article also addresses and discusses the urban/rural divide as a Western construct that might not be completely applicable to other social and cultural contexts. Taking Slovenia as an example, this article questions the self-evidence of rural/urban divide as an analytical concept. On the basis of our research, we conclude that this concept requires continuous revisions and reinterpretations in a concrete social and cultural context(s). The characteristics of gay and lesbian everyday life either in rural or in urban context in Slovenia lead to the conclusion that even within a specific social and cultural context, the concept of urban/rural divide should be used carefully, taking into account complexities of everyday lives and various factors that influence them.

Status homophily, sexual identity, and lesbian social ties

The literature on friendship and social networks finds that individuals form social ties with people who are like them--a much studied concept called homophily. However, few studies have explicitly examined sexual identity as a point of homophily. Scholars from multiple disciplines have long argued that sexuality influences the organization of our social worlds, yet most studies of friendship and social networks under-examine or overlook the influence of sexual identity. This study addresses that gap by looking at status homophily among lesbian social ties to examine the influence of sexual identity, as well as gender, race, class, and family, on their personal networks. Using survey data from 544 U.S. lesbian respondents, the findings make visible some of the factors and forces that shape social ties for lesbians. The results point to the importance of sexuality as an organizing element of social life, and suggest that studies that examine social networks or friendships more often make sexual identity, gender, and intersecting social locations a central focus.

Does place of residence matter? Rural-urban differences and the wellbeing of gay men and lesbians

Does place of residence matter for gay men and lesbians? Both conventional wisdom and scholarly literature suggests that it does, and that those living in rural areas are disadvantaged relative to their urban peers. This study explores this issue by comparing gay people's wellbeing in rural and urban areas. Results from a large probability sample show that rural gay people fare no worse than their urban peers. If anything, results suggest living in the largest cities may be detrimental to gay people's wellbeing, although more so for lesbians than for gay men. Results are discussed in light of 4 competing perspectives on rural-urban differences.

Grief and loss of religion: the experiences of four rural lesbians

The purpose of this four-person study was to discover the grief and loss experiences of rural lesbians using a phenomenological approach. A prominent theme that emerged from the interview data was grief and loss related to religion and a lesbian identity. Participants identified the need to modify their beliefs, the experience of rejection by church members or the church itself, and seeking acceptance.

Effective support for lesbians in rural communities: the role of psychotherapy

Most research involving lesbians has been conducted using urban or suburban samples. However, the challenges lesbians face in their rural communities differ from those encountered by lesbians in urban areas. Lesbians in rural areas face potential isolation due to the lack of a visible gay community, an overall lack of services and resources, and an often heightened experience of stigma. Rural areas tend to have a more conservative political climate with an emphasis on fundamentalist religious beliefs. Due to such strong heteronormist pressures, lesbians who decide to come out to their rural communities often face justifiable fears surrounding possible discrimination from employers, religious organizations, schools, and even their friends and family members. Therapists who work with lesbians in rural areas should be prepared to help their clients face and successfully deal with many unique challenges.

Narrating rural lesbian lives: body image and lesbian community in central Pennsylvania

Research on women's body image has focused on the sexual objectification that women experience in society. The present study explored how rural lesbian women experience their bodies and how lesbian communities, as safe havens from the dominant heterosexual culture, contribute to their body image. Ten lesbians living in central Pennsylvania were interviewed for this study. Interviews were analyzed using interpretative phenomenological analysis, which aims to explore individuals' experiences and examine how they make sense of their world. The resulting themes focus on participants' descriptions of their feelings about their bodies, the role that lesbian, gay, bisexual, and transgender (LGBT) communities played in their sense of body image, and the difficulties of finding these communities in the central Pennsylvania area.

"Abomination"--life as a Bible belt gay

Drawing on observation, autoethnography, and audio-taped interviews, this article explores the religious backgrounds and experiences of Bible Belt gays. In the Bible Belt, Christianity is not confined to Sunday worship. Christian crosses, messages, paraphernalia, music, news, and attitudes permeate everyday settings. Consequently, Christian fundamentalist dogma about homosexuality-that homosexuals are bad, diseased, perverse, sinful, other, and inferior-is cumulatively bolstered within a variety of other social institutions and environments in the Bible Belt. Of the 46 lesbians and gay men interviewed for this study (age 18-74 years), most describe living through spirit-crushing experiences of isolation, abuse, and self-loathing. This article argues that the geographic region of the Bible Belt intersects with religious-based homophobia. Informants explained that negative social attitudes about homosexuality caused a range of harmful consequences in their lives including the fear of going to hell, depression, low self-esteem, and feelings of worthlessness.

The health, social care and housing needs of lesbian, gay, bisexual and transgender older people: a review of the literature

This paper reports the findings of a literature review of the health, social care and housing needs of older lesbian, gay, bisexual and transgender (LGBT) adults undertaken in 2006 for the Welsh Assembly Government. Peer-reviewed literature was identified through database searches of BNI, PubMed, CINAHL, DARE, ASSIA and PsychInfo. Follow-up searches were conducted using references to key papers and journals as well as specific authors who had published key papers. A total of 187 papers or chapters were retrieved, of which 66 were included in the study; major themes were identified and the findings synthesised using a meta-narrative approach. The main themes that emerged from the review were isolation, health behaviours, mental health and sexual health behaviours. The literature indicates that the health, social care and housing needs of LGBT older people is influenced by a number of forms of discrimination which may impact upon the provision of, access to and take up of health, social care and housing services. Understanding of the health, social care and housing needs of older LGBT people is limited and research in this area is scarce. The research which exists has been criticised for using small samples and for tending to exclude participants from less affluent backgrounds. The focus of research tends to be on gay men and lesbians; consequently, the needs of bisexual and transgender people remain largely unknown. Additionally, research which does exist tends to focus on a narrow range of health issues, often related to the health needs of younger LGBT people. Discrimination in various forms has a major impact on needs and experiences, leading to marginalisation of LGBT people both in the provision of health and social care services and neglect of these groups in public health research.

Out yonder: sexual-minority adolescents in rural communities in British Columbia

OBJECTIVES

We compared sexual-minority adolescents living in rural communities with their peers in urban areas in British Columbia, exploring differences in emotional health, victimization experiences, sexual behaviors, and substance use.

METHODS

We analyzed a population-based sample of self-identified lesbian, gay, or bisexual respondents from the British Columbia Adolescent Health Survey of 2003 (weighted n=6905). We tested rural-urban differences separately by gender with the chi2 test and logistic regressions.

RESULTS

We found many similarities and several differences. Rural sexual-minority adolescent boys were more likely than were their urban peers to report suicidal behaviors and pregnancy involvement. Rural sexual-minority adolescents, especially girls, were more likely to report various types of substance use. Rural status was associated with a lower risk of dating violence and higher risk of early sexual debut for sexual-minority girls and a higher risk of dating violence and lower risk of early sexual debut for sexual-minority boys.

CONCLUSIONS

Location should be a demographic consideration in monitoring the health of sexual-minority adolescents. Lesbian, gay, and bisexual adolescents in rural communities may need additional support and services as they navigate adolescence.

Is the rural idyll bad for your health? Stigma and exclusion in the English countryside

The aim of this paper is to challenge assumptions that life in the English countryside is a healthy existence. This paper proposes that public health practitioners should consider the problems of stigma and social exclusion sometimes faced by individuals in rural areas. Using ethnographic research from a village in South East England the experiences of several individuals are examined to illustrate how stigma impacts on the health and well-being of those supposedly living in the rural idyll. It also argues for more ethnographic research to be conducted in health studies, particularly in rural areas, to gain deeper insight into health experiences.

Explaining comfort with homosexuality in rural america

While recent research has explored the determinants of homophobia in urban settings, few have looked at the perception of homosexuals in rural communities. This research fills this gap by exploring the ways in which Central Appalachians feel about homosexuality. In doing so, the impact of interpersonal contact with a homosexual as well as the factors of gender, age, religious beliefs, gender role prescriptions and fear of AIDS are identified through a multivariate analysis of 123 college students. In the end, the role of homosexual peers is emphasized, as are the effects of the perceived cause of homosexuality, and the anxieties over AIDS. Finally after some stipulations about methodological limitations, this work offers some suggestions as to how practitioners and social work educators can use this study to counter the homophobic ideas that are prevalent in rural Americans.