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

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

Disclosure and Help-Seeking Experiences of Sexual and Gender Minority Victims of Intimate Partner Violence: A Mixed-Methods Study

Sexual and gender minorities assigned female at birth (SGM-AFAB) experience high rates of intimate partner violence (IPV), with negative effects on health and well-being. Disclosure of and help-seeking for IPV can support the well-being of IPV survivors, yet are understudied among SGM-AFAB people. To better understand the IPV disclosure and help-seeking experiences in this population, we conducted semi-structured interviews with 41 SGM-AFAB young adults who experienced physical, sexual, or severe psychological IPV. Qualitative analyses explored to whom SGM-AFAB disclosed IPV, barriers to disclosure/help-seeking, the types of responses received, and perceived helpfulness of responses. Exploratory mixed methods analyses assessed frequency of code endorsement, demographic differences, and associations among codes. Three-quarters of participants disclosed IPV, though rates were lower for sexual and physical than psychological IPV and very few sought help from formal sources. The most common barriers to disclosure were not viewing the IPV as abuse and anticipation of negative responses, often due to stigma; other participants described inability to access formal help and concerns about SGM incompetence in those services. Most actual responses received were considered helpful, including emotional support, labeling the IPV as unhealthy, nonjudgmental listening, actions to stop the IPV, and practical support. Minimizing IPV or criticizing the victim was common unhelpful response; advice to end the relationship was considered helpful and unhelpful. Whereas 92% of friend responses were described as helpful, around half of family (56%) and therapist (62%) responses were helpful. Findings suggest that efforts to increase access to culturally affirmative services and educate SGM youth to recognize IPV in their relationships may help promote help-seeking and well-being among SGM-AFAB IPV survivors.

Relationship risk factors for intimate partner violence among sexual and gender minorities: A multilevel analysis

Intimate partner violence (IPV) is alarmingly prevalent among sexual and gender minority youth assigned female at birth (SGM-AFAB), making it important to identify risk factors that can be targeted in prevention efforts for this population. Although several relationship-level risk factors for IPV have been identified in different-sex couples, research on SGM-AFAB is sparse and predominantly cross-sectional. The present study used seven waves of data from a longitudinal cohort study of SGM-AFAB youth (n = 463) to explore relationship factors (relationship quality, destructive conflict, and self- and partner-jealousy) as risk factors for perpetration and victimization of three types of IPV (physical, psychological, and coercive control). At each wave, participants reported on relationship factors and IPV for up to three romantic partners in the past 6 months. Multilevel models tested for associations between the relationship factors and IPV at three levels: between-persons, within-persons across time (wave), and within-persons across relationships. Relationship quality was associated with IPV mostly at the between-persons and within-persons (wave) levels. Couple conflict was associated with all IPV outcomes at all levels. Partner jealousy was more consistently associated with IPV victimization; participant jealousy was more consistently linked with IPV perpetration. These novel findings suggest that, within SGM individuals, IPV may be influenced by relationship quality, destructive conflict, and jealousy as they fluctuate within individuals from relationship to relationship and within individuals over time. As such, these relationship factors represent promising potential targets for interventions to reduce IPV among SGM-AFAB youth.

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

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

Biomedical and behavioral outcomes of 2GETHER: A randomized controlled trial of a telehealth HIV prevention program for young male couples

OBJECTIVE

This study evaluated the efficacy of the 2GETHER relationship education and HIV prevention program for young male couples in reducing risk for HIV.

METHOD

We conducted a comparative effectiveness randomized controlled trial of 2GETHER, a five-session hybrid group- and couple-based intervention delivered via videoconference, relative to a single-session HIV testing and risk reduction counseling protocol delivered to couples. We randomized 200 young male couples (N = 400) to 2GETHER or control from 2018 to 2020. Primary biomedical (i.e., rectal Chlamydia and Gonorrhea infection) and behavioral outcomes (i.e., condomless anal sex [CAS]) were measured at 12-months postintervention. Secondary outcomes were other HIV prevention and risk behaviors, relationship quality, and substance use. Multilevel regression was used to model intervention outcomes to account for clustering within couples. Postintervention change over time was modeled as a latent linear growth curve at the within-persons level.

RESULTS

We observed significant intervention effects on primary biomedical and behavioral HIV risk outcomes. Participants in 2GETHER had significantly lower odds of rectal STIs at 12-months relative to control. We also observed significantly steeper declines in the number of CAS partners and acts from baseline to 12-month follow-up in 2GETHER relative to control. Few differences were observed for secondary relationship and HIV-related outcomes.

CONCLUSIONS

2GETHER is an efficacious intervention that has a significant impact on both biomedical and behavioral HIV prevention outcomes among male couples. Couple-based HIV prevention programs enhanced with evidence-based relationship education may effectively reduce the most proximal predictors of HIV infection. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Violence and Related Health Outcomes in Sexual and Gender Minority Communities: Introduction to the Special Issue

Violence affects every community but is particularly prevalent among sexual and gender minority (SGM) people. Although research on violence within SGM populations is increasing, knowledge gaps remain that limit development of evidence-based policy, prevention, and intervention efforts to reduce the violence disparities the SGM community faces. In 2021, the National Institutes of Health (NIH) hosted a multiphase scientific workshop to identify and prioritize key research needs to further our understanding of violence affecting SGM communities and its health outcomes. In this perspective, we summarize the research needs identified. NIH supports this special issue as an outcome of the scientific workshop.

The Sexual Orientation Microaggression Inventory Short Form (SOMI-SF): Validation in Three Samples of Racially/Ethnically Diverse Sexual Minority Youth

Introduction

The Sexual Orientation Microaggression Inventory (SOMI) has been used to measure sexual orientation-based microaggression experiences. However, at 19 items, the SOMI may be difficult to fit into survey batteries where microaggressions are not the primary predictor or the time researchers have with each participant is very limited.

Methods

We sought to identify an eight-item short form of the SOMI (SOMI-SF) in a sample of sexual minority (SM) youth (N = 879) and confirm the validity and reliability of the SOMI-SF by administering both versions to separate cohorts of male-assigned (N = 533) and female-assigned (N = 430) at birth SM youth. Data was collected from April 2018 to May 2020.

Results

We found high reliability (α > 0.80) and validity (significant association with SM victimization, depression symptoms, anxiety symptoms, and internalized stigma) in all three samples for the SOMI-SF.

Conclusions

For researchers looking to conserve time and limit burden, the SOMI-SF is a high quality option for measuring sexual orientation microaggressions.

Policy Implications

The greater ease of administering the SOMI-SF means that sexual orientation microaggressions can be measured in a greater number of contexts. With a growing literature linking these experiences to poorer health outcomes for SM populations, measuring these experiences quickly and accurately can improve our understanding of the mechanisms creating those links and impact policy necessary to alleviate them.

Associations between Drinking Contexts, Minority Stress, and Problematic Alcohol Use among Sexual Minority Individuals Assigned Female at Birth

Sexual minority individuals assigned female at birth (SM-AFAB) are at increased risk for problematic alcohol use compared to heterosexual women. Despite evidence that drinking locations and companions play an important role in problematic alcohol use among heterosexuals, few studies have examined these social contexts of alcohol use among SM-AFAB. To address this gap, the current study examined two aspects of social contexts in which SM-AFAB drink (locations and companions). We utilized two waves of data (six-months between waves) from an analytic sample of 392 SM-AFAB ages 17-33 from a larger longitudinal study. The goals were: (1) to identify classes of SM-AFAB based on the contexts in which they drank; (2) to examine the associations between drinking contexts, minority stressors, and problematic alcohol use; and (3) to examine changes in drinking contexts over time. Using latent class analysis, we identified four classes based on drinking locations and companions (private settings, social settings, social and private settings, multiple settings). These classes did not differ in minority stress. Drinking in multiple settings was associated with more problematic alcohol use within the same timepoint and these differences were maintained six months later. However, drinking in multiple settings did not predict subsequent changes in problematic alcohol use when problematic alcohol use at the prior wave was controlled for. Based on these findings, SM-AFAB who drink in multiple settings may be an important subpopulation for interventions to target. Interventions could focus on teaching SM-AFAB strategies to limit alcohol consumption and/or minimize alcohol-related consequences.

Minority Stress and Intimate Partner Violence among Sexual and Gender Minorities assigned Female at Birth

Objective

Sexual and gender minorities assigned female at birth (SGM-AFAB) experience high rates of intimate partner violence (IPV). Using multiwave longitudinal data, the present study tested the following associations of minority stress and IPV among SGM-AFAB: concurrent within-person (i.e., whether changes in minority stress co-occur with changes in IPV), prospective within-person (i.e., whether changes in minority stressors precede changes in IPV), and between-persons (i.e., whether individuals who experience more minority stress, on average, experience more IPV).

Method

Data were from Waves 1-7 (spanning 3.5 years) of a longitudinal cohort study of 488 young SGM-AFAB. At each wave, participants reported on SGM victimization, sexual orientation microaggressions, internalized heterosexism, and five types of IPV for up to three partners in the past six months.

Results

Controlling for other minority stress experiences, microaggressions showed concurrent within-person associations with two types of IPV victimization (psychological and coercive control) and three types of IPV perpetration (psychological, physical, and sexual), and between-persons associations with psychological IPV victimization and coercive control victimization and perpetration. Microaggressions also had a significant prospective within-persons association with SGM-specific IPV perpetration. SGM victimization showed no unique within-person associations with IPV but, between-persons, was associated with all types of IPV victimization (except coercive control), and psychological and sexual IPV perpetration. Internalized heterosexism was not associated with any IPV outcome.

Conclusions

Minority stress, particularly distal stressors, appear to contribute to risk for IPV among SGM-AFAB. Clinicians working with SGM-AFAB individuals in relationships may benefit from screening for experiences of minority stress.

Help-Seeking for Severe Intimate Partner Violence Among Sexual and Gender Minority Adolescents and Young Adults Assigned Female at birth: A Latent Class Analysis

Sexual and gender minority adolescents and young adults assigned female at birth (SGM-AFAB) report high rates of intimate partner violence (IPV) victimization. Despite adverse health outcomes of IPV, many survivors, particularly SGM-AFAB, do not seek help. This study (1) examined the proportion of SGM-AFAB who reported severe IPV victimization who sought help; (2) elucidated patterns of help-seeking facilitators and barriers; and (3) identified associations between sociodemographic characteristics, IPV victimization types, and minority stressors and latent classes of help-seeking facilitators and barriers. Participants included 193 SGM-AFAB (Mage = 20.6, SD = 3.4; 65.8% non-monosexual; 73.1% cisgender; 72.5% racial/ethnic minority; 16.6% annual household income $20,000 or less). Most participants who experienced severe IPV did not seek help (62.2%). Having a person or provider who was aware of the participant's abusive relationship was the most common reason for seeking help (50; 68.5%). Minimizing IPV was the most common reason for not seeking help (103; 87.3%). Fewer than 5% of SGM-AFAB who experienced severe IPV and who did not seek help reported SGM-specific help-seeking barriers, including not wanting to contribute to negative perceptions of the LGBTQ community, not disclosing their SGM status, and perceiving a lack of tailored services. Help-seeking facilitators and barriers varied by sociodemographic characteristics. Three classes of help-seeking facilitators and two classes of help-seeking barriers emerged. SGM-AFAB subgroups based on sexual and gender identity, recent coercive control, and identity as IPV victims differed in latent classes. This study's findings confirm SGM-AFAB IPV survivors' low likelihood of seeking help. Our results also underscore the importance of continuing to bolster SGM-AFAB survivors' access to trauma-informed, culturally sensitive, and affirming support. Further, multilevel prevention and intervention efforts are needed to reduce minimization of abuse and anticipatory judgment and blame among SGM-AFAB who hold multiple marginalized identities, experience coercive control, and identify as IPV victims.

Intersectional stigma and mental health: Interactions with identity authenticity and SGM community in sexual and gender minoritized young adults of color

OBJECTIVES

Sexual and gender minoritized people (SGM) of color experience stigma unique to their intersection of identities, such as racism from SGM and heterosexism from people of color (POC) in their same racial/ethnic group. SGM POC who experience enacted stigma, like microaggressions, have been found to have poorer mental health outcomes. SGM identity authenticity and connections to the SGM community have been associated with better mental health. We sought to test if intersectional enacted stigma, identity authenticity, community connectedness, and the interactions between enacted stigma and authenticity and community were associated with mental health in assigned female at birth (AFAB) SGM young adults of color.

METHOD

Data come from 341 racial/ethnic minoritized SGM-AFAB (Mage = 21.23, SD = 3.80). Multivariate linear regressions tested main effects of intersectional enacted stigma (heterosexism from POC and racism from SGM) and authenticity and community on mental health, as well as interaction effects on mental health.

RESULTS

SGM-AFAB POC who experienced more heterosexism from POC reported more anxiety and depression symptoms. Greater connection to the SGM community was associated with fewer anxiety and depression symptoms. Heterosexism from POC and community connection interacted such that SGM-AFAB who experienced less heterosexism from POC reported fewer mental health symptoms if they were more connected to the SGM community, but SGM-AFAB who experienced more heterosexism did not benefit from stronger community connection.

CONCLUSIONS

Heterosexism from other POC may put SGM POC at higher exposure for negative mental health outcomes and reduce the mental health benefits of a stronger connection to the SGM community. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Minority stressors and suicidal ideation in sexual and gender minority youth assigned female at birth: Prospective associations and racial differences

INTRODUCTION

Suicidal ideation (SI) disproportionately affects sexual and gender minority (SGM) versus cisgender/heterosexual youth, likely due to the minority stressors (MS) they face. Research has shown cross-sectional associations between SGM MS and suicidality; however, few studies have used longitudinal data or examined racial differences in the effects of MS on SI. The current study tested whether MS prospectively predict next-year SI and whether race moderates these prospective associations.

METHOD

Three hundred and sixty-nine Black, Latinx, and White SGM youth completed baseline measures of MS, SI, and demographics, and SI 6 and 12 months later.

RESULTS

Internalized stigma, microaggressions, and low support from family and from significant others demonstrated associations with next-year SI. When controlling for baseline SI, however, only low significant other support predicted next-year SI. Moderation analyses indicated that internalized stigma predicted SI for White, but not Black or Latinx, individuals and that lower friend support was associated with SI for Latinx, but not White or Black, individuals.

CONCLUSIONS

Though minority stressors appear to raise risk for SI among SGM, effects may differ by race. Internalized stigma may be particularly influential for SI among White SGM whereas lack of support from friends may be most influential for SI among Latinx SGM youth.

Relationship, marriage, and parenthood aspirations among sexual and gender minority youth assigned female at birth

This study examined aspirations for future long-term committed relationships, marriage, and parenthood in a sample of 392 racially diverse sexual and gender minority (SGM) youth assigned female at birth (AFAB) aged 16-20. Differences by gender identity, sexual identity, and race/ethnicity were assessed, as were associations with contextual variables including minority stressors, SGM community involvement, perceived partner availability, and relationship experiences. Results showed that the majority of SGM-AFAB youth viewed long-term committed relationships as important and likely, whereas only about half of participants had high aspirations to get married and have children someday. Those who did view marriage and parenthood as important perceived that it is feasible for them to achieve these outcomes someday. These constructs did not differ by race/ethnicity. There were differences by gender identity and sexual identity, such that cisgender women reported higher aspirations for marriage and parenthood than did gender minorities, and those with binary sexual identities reported higher aspirations for marriage than did those with nonbinary sexual identities. Examination of the contextual variables revealed that relationship experience variables were the most consistently associated with aspirations for committed relationships, marriage, and parenthood. In contrast, victimization and perceived partner availability were not associated with any of the family formation aspirations. As SGM individuals are increasingly granted legal rights affecting their ability to marry and form families, research is needed to help inform efforts to promote their relationship health while considering that they may have unique aspirations for relationships, marriage, and parenthood compared to the general public. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Relationship quality and mental health among sexual and gender minorities

Sexual and gender minorities assigned female at birth (i.e., sexual minority women, transgender men, and gender diverse [SMW TGD] individuals) experience disproportionately high rates of anxiety, depression, and substance use problems. Romantic relationship involvement has been shown to be beneficial to mental health and substance use among sexual and gender minorities. However, few studies have explored the impact of relationship quality on mental health, or if high relationship quality can reduce the negative impact of minority stress on well-being in this population. The present study examined within-persons associations of romantic relationship quality with symptoms of anxiety and depression, and alcohol and cannabis use problems among SMW TGD individuals in romantic relationships, and tested relationship quality as a moderator of associations of minority stress with mental health and substance use. Participants were 213 SMW TGD individuals (mean age: 20.63; 70.9% cisgender women, 7.5% transgender men, and 19.2% gender diverse). Within-persons, higher relationship quality was associated with better mental health and substance use outcomes. Relationship quality at the between-persons level moderated the within-persons association of internalized heterosexism with depression, and of microaggressions with cannabis use problems. No other interaction effects were significant. The within-persons associations found in this study lend important support to relationship interventions based on theories that improvements in romantic relationship quality will result in improved well-being over time. Results can inform relationship education interventions to reduce mental health and substance use disparities in SMW TGD communities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Protocol for an attention-matched randomized controlled trial of 2GETHER: a relationship education and HIV prevention program for young male couples

BACKGROUND

Young men who have sex with men (YMSM) are disproportionately impacted by the HIV epidemic in the USA, and a large number of new infections among YMSM occur in the context of main or primary partnerships. At the same time, healthy romantic relationships promote health and wellbeing by improving social support and encouraging healthy behaviors. Thus, we created 2GETHER: a relationship education and HIV prevention program for young male couples. 2GETHER is delivered face-to-face in a university setting and is composed of two group sessions and two individualized skills coaching sessions. We observed strong support of the feasibility, acceptability, and preliminary efficacy of 2GETHER in a pilot trial.

METHODS

We are conducting an attention-matched randomized controlled trial (RCT) to test the efficacy of 2GETHER relative to a control condition based on a well-validated positive affect enhancement program. Enrollment occurred between August 2017 and March 2021 in Chicago and surrounding areas, and we enrolled and randomized 128 dyads (N = 256 individuals). Follow-up is ongoing and we will examine primary and secondary behavioral outcomes at 12 months post-intervention, with interim follow-up at 3, 6, and 9 months post-intervention. The primary biomedical outcome is sexually transmitted infection incidence at a 12-month follow-up.

DISCUSSION

2GETHER is innovative in that it places an equal emphasis on relationship skill building and HIV prevention. Thus, the program has the potential to impact numerous health-related outcomes. Despite challenges related to the recruitment of couples and the COVID-19 pandemic, we were able to enroll a robust sample of young male couples with sufficient power to detect effects on study outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03186534 .

A dyadic analysis of relationship satisfaction and depressive symptoms among same-sex couples

Sexual minority individuals experience depression at a disproportionately higher rate than their heterosexual peers. One predictor of depression is low romantic relationship satisfaction, and research on different-sex couples demonstrates that one's own and one's partner's levels of relationship satisfaction are negatively associated with one's own level of depressive symptoms (i.e., actor and partner effects, respectively). However, little research has explored partner effects of relationship satisfaction on depression in same-sex couples. Furthermore, little is known regarding the degree to which relationship satisfaction is associated with depression in same-sex couples, over and above their shared association with demographic characteristics and internalized heterosexism, a known correlate of both relationship satisfaction and depression. This study examined cross-sectional actor and partner effects of relationship satisfaction on depressive symptoms in a sample of 102 same-sex couples (68 female), and evaluated whether these effects were significant when adjusting for sex, relationship length, and internalized heterosexism. Multilevel analyses were conducted to estimate actor-partner interdependence model (APIM) effects for indistinguishable dyads. Results indicated that (a) there were statistically significant actor and partner effects for relationship satisfaction on depressive symptoms, such that higher levels of relationship satisfaction were associated with lower levels of depressive symptoms and (b) actor and partner effects for relationship satisfaction remained statistically significant when adjusting for sex, relationship length, and actor and partner effects for internalized heterosexism. Furthermore, there were statistically significant actor (but not partner) effects for internalized heterosexism on depressive symptoms, such that higher levels of internalized heterosexism were associated with higher levels of depressive symptoms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Longitudinal Transitions in Intimate Partner Violence among Female Assigned at Birth Sexual and Gender Minority Youth

Female-assigned at birth sexual and gender minorities (FAB SGM) are at elevated risk of experiencing intimate partner violence (IPV), yet little longitudinal research has been conducted with this population. In the current study, we attempted to understand how patterns of IPV victimization and perpetration, measured across a wide range of IPV behaviors (psychological, physical, sexual, cyber, and SGM-specific), changed over time for FAB SGM youth. Participants came from a longitudinal cohort study of FAB SGM late adolescents and young adults (FAB400; N = 488) and included anyone who reported a romantic partner at one of the first three waves (six months apart; N = 433). Latent class analysis (LCA) was run at each wave to determine the best-fitting class structure across IPV experiences. These were followed up with latent transition analyses (LTAs) to determine patterns of movement between classes over the course of the three waves. Lastly, we looked at the effects of staying with the same romantic partner on transitions. We found that the same three-class structure replicated across all three waves of the study. That class structure identified no/low, psychological, and high IPV classes at each wave. In the LTA, when transitions occurred for FAB SGM, they were much more likely to transition to a class defined by lower likelihoods of experiencing IPV (i.e., psychological to no/low) than they were to a class defined by higher likelihoods of IPV (i.e., psychological to high). However, we found that FAB SGM youth were less likely to transition to a less severe IPV class if they maintained the same serious romantic partner across waves. This finding, in particular, suggests that IPV is often relationship specific for FAB SGM and that efforts to reduce IPV in SGM communities must consider intervening at the relationship level to effect meaningful change.

Intersectional Minority Stress and Intimate Partner Violence: The Effects of Enacted Stigma on Racial Minority Youth Assigned Female at Birth

Many sexual minority youth of color experience enacted stigma based on each of their minority identities. We examined whether experiences of racist discrimination and heterosexist microaggressions were associated with intimate partner violence (IPV) among female-assigned at birth (FAB) sexual minority youth of color. Data were drawn from a larger study of FAB sexual and gender minority youth (FAB400; N = 488). We selected racial/ethnic minority participants who reported a sexual minority identity and reported a romantic relationship in the previous 6 months (N = 249). Negative binomial models were used to test for associations between enacted stigma (racial discrimination and heterosexist microaggressions) and IPV (psychological, physical, sexual, and sexual minority-specific) perpetration and victimization. When considered separately, both forms of enacted stigma was positively associated with perpetration and victimization across all four types of IPV. In multivariate models, racial discrimination and heterosexist microaggressions both had unique, additive effects on psychological IPV perpetration and physical- and sexual minority-specific IPV victimization. Only racial discrimination was uniquely associated with physical perpetration and psychological victimization. Only heterosexist microaggression was uniquely associated with sexual minority-specific perpetration and sexual IPV perpetration and victimization. Findings illustrate how enacted stigma based on each minority identity intersect to raise risk for IPV among sexual minority youth of color.

The Association Between Bi+ Stigma and Problematic Cannabis Use: Testing Coping Motives as an Underlying Mechanism

OBJECTIVE

Bi+ individuals (i.e., people with attractions to more than one gender) are at heightened risk for cannabis use disorders compared with heterosexual and lesbian/gay individuals, and their heightened risk has been attributed to the unique stressors that they experience as bi+ individuals. Limited research has quantitatively examined the association between enacted bi+ stigma (i.e., biased treatment by others based on one's bi+ identity/attractions) and cannabis use problems among bi+ individuals. Existing studies have been limited by their cross-sectional designs and their lack of attention to potential mechanisms underlying this association.

METHOD

We used four waves of data (6 months between waves) from 317 bi+ individuals assigned female at birth who reported cannabis use. The goals of our analyses were to examine (a) the prospective association between enacted bi+ stigma and problematic cannabis use; and (b) coping motives (i.e., motivations to use cannabis to cope with negative emotions) as a mediator of this association.

RESULTS

At the within-person level, when participants experienced more enacted bi+ stigma than usual at a given wave (time t-2), they experienced a subsequent increase in their motivation to use cannabis to cope (time t-1), which in turn, predicted a subsequent increase in problematic cannabis use (time t). This within-person indirect effect was significant.

CONCLUSIONS

These findings suggest that enacted bi+ stigma contributes to problematic cannabis use by increasing motivations to use cannabis to cope with negative emotions. As such, coping motives may be an important treatment target to reduce problematic cannabis use among bi+ individuals.

The Association Between Bi+ Stigma and Problematic Cannabis Use: Testing Coping Motives as an Underlying Mechanism

OBJECTIVE

Bi+ individuals (i.e., people with attractions to more than one gender) are at heightened risk for cannabis use disorders compared with heterosexual and lesbian/gay individuals, and their heightened risk has been attributed to the unique stressors that they experience as bi+ individuals. Limited research has quantitatively examined the association between enacted bi+ stigma (i.e., biased treatment by others based on one's bi+ identity/attractions) and cannabis use problems among bi+ individuals. Existing studies have been limited by their cross-sectional designs and their lack of attention to potential mechanisms underlying this association.

METHOD

We used four waves of data (6 months between waves) from 317 bi+ individuals assigned female at birth who reported cannabis use. The goals of our analyses were to examine (a) the prospective association between enacted bi+ stigma and problematic cannabis use; and (b) coping motives (i.e., motivations to use cannabis to cope with negative emotions) as a mediator of this association.

RESULTS

At the within-person level, when participants experienced more enacted bi+ stigma than usual at a given wave (time t-2), they experienced a subsequent increase in their motivation to use cannabis to cope (time t-1), which in turn, predicted a subsequent increase in problematic cannabis use (time t). This within-person indirect effect was significant.

CONCLUSIONS

These findings suggest that enacted bi+ stigma contributes to problematic cannabis use by increasing motivations to use cannabis to cope with negative emotions. As such, coping motives may be an important treatment target to reduce problematic cannabis use among bi+ individuals.

Exploring mechanisms of racial disparities in intimate partner violence among sexual and gender minorities assigned female at birth

OBJECTIVE

Sexual and gender minority people of color (SGM-POC) report higher rates of intimate partner violence (IPV) than White SGM, adding to growing evidence that people holding multiple stigmatized social identities are at particular risk for adverse experiences. We aimed to identify mechanisms underlying the racial/ethnic disparities in IPV among SGM, focusing on childhood experiences of violence, structural inequalities, and sexual minority stress.

METHOD

308 SGM assigned female-at-birth (AFAB; 82 White, 133 Black, 93 Latinx; age 16-31) self-reported on minor psychological, severe psychological, physical, and sexual IPV victimization and perpetration, and three proposed mechanisms: childhood violence (child abuse, witnessing interparental violence), structural inequalities (economic stress, racial discrimination), and sexual minority stressors (internalized heterosexism, anti-SGM victimization, low social support). Indirect effects of race on IPV victimization via hypothesized mechanisms were estimated using logistic regression with 5,000 bootstrapped samples.

RESULTS

Compared to White participants, Black participants were 2.5-7.03 times more likely to report all eight IPV types; Latinx participants were 2.5-4.8 times more likely to experience four IPV types. Univariate indirect effects analyses indicated that these racial/ethnic disparities were partially explained by higher economic stress, racial/ethnic discrimination, and childhood violence experiences (for Black and Latinx participants) and lower social support (Black participants). In multivariate models, the most robust indirect effects were through racial/ethnic discrimination and childhood violence.

CONCLUSIONS

Findings underscore the need for policy and interventions aimed at preventing IPV among SGM-POC by targeting factors that contribute to IPV disparities in this group, particularly racial/ethnic discrimination and family violence. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Prospective associations between bi+ minority stressors and internalizing symptoms: The mediating roles of general and group-specific processes

Objective: The prevalence of anxiety and depressive (i.e., internalizing) disorders is higher among bi+ individuals (i.e., individuals with attractions to more than one gender and/or who identify as bisexual or pansexual) compared to both heterosexual and lesbian/gay individuals. Cross-sectional research has demonstrated that stressors unique to bi+ individuals are associated with internalizing symptoms. However, longitudinal research examining these associations and underlying mechanisms is extremely limited. Method: We utilized five waves of data (6 months between waves) from a diverse sample of bi+ individuals assigned female at birth (age 16-32; 29% gender minority; 72.9% racial/ethnic minority) to examine: (a) prospective associations between three bi+ stressors (enacted, internalized, anticipated bi+ stigma) and internalizing symptoms; (b) potential mediating role of rumination in these associations; and (c) potential mediating roles of internalized and anticipated bi+ stigma in associations between enacted bi+ stigma and internalizing symptoms. Results: At the within-person level, when participants experienced more bi+ stressors than usual during a particular wave, they experienced subsequent increases in internalizing symptoms. Increases in rumination mediated these associations. Associations between enacted bi+ stigma and internalizing symptoms were mediated by increases in internalized and anticipated bi+ stigma. Conclusions: Findings indicate that bi+ stressors prospectively predict increases in internalizing symptoms and rumination may play a mechanistic role. Further, findings suggest that internalized and anticipated bi+ stigma may play mechanistic roles in the associations between enacted bi+ stigma and internalizing symptoms. Interventions targeting rumination, internalized stigma, and anticipated bi+ stigma may help to reduce internalizing symptoms among bi+ individuals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Sexual and Gender Minority Intimate Partner Violence and Childhood Violence Exposure

Limited research on female-assigned-at-birth sexual and gender minorities (FAB SGM) suggests that their risk of psychological, physical, and sexual intimate partner violence (IPV) victimization and perpetration may be linked to childhood violence exposure (CVE), such as experiencing child abuse, or witnessing sibling or interparental abuse. That said, there is a dearth of research in this population examining whether there is typically a violence type match between CVE and IPV (e.g., physical CVE predicting physical IPV), a gender match between those involved in CVE and later IPV (e.g., witnessing the abuse of female parents predicting IPV among women), or an increase in IPV risk commensurate with the number of different CVE types experienced. Addressing these gaps, this article draws on the baseline survey data of FAB400, a merged cohort accelerated longitudinal study of 488 FAB SGM adolescents and young adults. Analyses focused on the subsample of 457 participants with prior intimate relationship experience. Findings revealed that each assessed form of CVE-parental verbal abuse victimization, parental physical maltreatment victimization, childhood sexual abuse victimization, witnessing sibling abuse, and witnessing interparental violence-predicted risk of IPV perpetration and victimization, without evidence of violence type match. Witnessing interparental violence was associated with IPV irrespective of the abused parent's gender. In addition, exposure to a greater number of forms of CVE was associated with an increased risk of all types of IPV victimization and perpetration. Results offer preliminary evidence that the intergenerational transmission of violence is an applicable framework for FAB SGM, and as such this should be considered when screening and intervening for childhood, family, and partner violence in this population. Suggestions for future directions are discussed.

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

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

Development and Initial Validation of Three Culturally Sensitive Measures of Intimate Partner Violence for Sexual and Gender Minority Populations

Measures of intimate partner violence (IPV) have largely been developed and validated in heterosexual, cisgender samples, with little attention to whether these measures are culturally appropriate for sexual and gender minority (SGM) populations. However, rates of IPV are two to three times higher among SGM than heterosexual populations, highlighting the importance of culturally appropriate measures of IPV for SGM populations. In this article, after reviewing key problems with the use of existing IPV measures with SGM samples, we describe the development of a toolkit of new and adapted measures of IPV for use with SGM assigned female at birth (SGM-AFAB) populations, including an adapted version of the Conflict Tactics Scale-Revised, an adapted measure of coercive control, and the newly developed SGM-Specific IPV Tactics Measure. Using data from a sample of 352 SGM-AFAB individuals, we then test the psychometric properties of these three measures, including their factor structures, internal reliability, and convergent/divergent validity. Results provide initial evidence of the reliability and validity of each measure. Together, these three measures comprise a culturally appropriate and psychometrically validated measurement toolkit for studying a broad range of IPV tactics among SGM-AFAB that will help build a foundation for more in-depth research into IPV in SGM populations.

Intersectional minority stress and identity conflict among sexual and gender minority people of color assigned female at birth

Objective: Sexual and gender minority people of color (SGM-POC) experience intersectional forms of minority stress, including heterosexism within racial/ethnic minority communities, which can contribute to feelings of conflict between SGM and racial/ethnic identities. Internalized stigma may be a consequence of sexual orientation-based discrimination but has not been tested as a mechanism linking intersectional minority stress to identity conflict among SGM-POC. We hypothesized that the association between experiences of heterosexism in racial/ethnic minority communities and identity conflict would be mediated by internalized stigma among SGM assigned female at birth (SGM-AFAB). Method: Participants were 316 SGM-AFAB who identified as POC. Data were collected as a part of an ongoing longitudinal cohort study of young SGM-AFAB. We tested the longitudinal mediation using data from baseline, 6-month follow-up, and 1-year follow-up assessments. Results: Internalized stigma at 6-month follow-up partially mediated the association between experiences of heterosexism in racial/ethnic minority communities at baseline and identity conflict at 1-year follow-up. Conclusions: For SGM-POC, experiences of heterosexism within their racial/ethnic communities may lead to internalization of those negative attitudes. A consequence of internalizing heterosexist attitudes from one's racial/ethnic group could be a feeling that one's sexual orientation and racial/ethnic identities must remain separate, perhaps to maintain connection to one's racial/ethnic community. Identifying internalized stigma as a mediating process is critical to better understand identity development for SGM-POC, and has important clinical implications for working with this population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Predicting suicidality using a computer adaptive test: Two longitudinal studies of sexual and gender minority youth

OBJECTIVE

Over the past decade, rates of death by suicide have increased among youth. Efficient and effective screening approaches are needed for suicide prevention. Sexual and gender minority youth (SGMY) experience profound disparities, but little is known about subgroups and risk assessments need to be validated. This study tested the psychometric properties and predictive value of a highly efficient computerized adaptive test for suicide risk (CAT-SS) among SGMY.

METHODS

Participants in two cohort studies of SGMY completed the CAT-SS and validated measures of suicidality in 2018 (n = 1,073) and at their follow-up visit 6 months later (n = 936). Tests of psychometrics and predictive validity were performed.

RESULTS

Younger, assigned female at birth, nonmonosexual (e.g., bisexual; relative to monosexual), and gender nonconforming or nongender binary (relative to cisgender and transgender) participants had significantly higher CAT-SS scores. None of the CAT-SS items met the threshold for differential item functioning. In longitudinal analyses, prediction of suicidality moved from poor to good accuracy once CAT-SS was included in the model. CAT-SS significantly improved prediction of suicidality over-and-above reported suicidality at a prior wave.

CONCLUSIONS

The current study validated CAT-SS as a brief predictor of suicide risk in the disproportionately affected population of SGMY. Screening of SGMY in clinical and community settings using CAT-SS could allow for the identification of participants that need services to reduce their risk of future suicide. Results support the need for particular attention to suicide prevention among SGMY who are teenagers, assigned female at birth, nonmonosexual, and gender nonconforming or nongender binary. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Perceptions of Marijuana Decriminalization Among Young Sexual and Gender Minorities in Chicago: An Initial Measure Validation and Test of Longitudinal Associations with Use

Background: There is a high rate of marijuana use among young sexual and gender minorities (SGM) and, as a result of recent state-level, fragmented marijuana laws, there is also likely high variability in their perceptions of marijuana decriminalization (PMD). Methods: Data came from two cohorts of young SGM (aged 16-29) in Chicago, RADAR and FAB400, recruited from 2015 to 2017 (N=1,114). We developed a measure to assess PMD among this population, performed initial validation, and assessed its relationship to longitudinal changes in patterns of marijuana use and geographic distribution. Results: In multivariable models, mean PMD score was prospectively associated with general (adjusted odds ratio [aOR]=2.00; 95% confidence interval [CI]: 1.46-2.77), but not problematic marijuana use. An increase in perceived decriminalization also predicted a significant increase in odds of general (aOR=1.67; 95% CI: 1.18-2.39) marijuana use. Significant concentrations of high PMD scores existed in across the city. Conclusion: These results suggest further study of longitudinal changes in marijuana use as decriminalization or legalization increases in the U.S. to better understand shifting trends in use.

Sexual Agreements Among Young Sexual and Gender Minorities Assigned Male at Birth: Associations with Relationship Quality and Break-Up

Previous studies have shown that sexual non-monogamy is not associated with lower relationship satisfaction among adult male same-sex couples and may therefore be a viable alternative to monogamy. However, sexual minority men with non-monogamous agreements have reported lower commitment and trust in their relationships than those with monogamous agreements-potentially raising their risk of break-up. In this study, we investigated whether sexual agreements (monogamous, non-monogamous, or no sexual agreement) were associated with relationship quality and rates of break-up over 1 year in a sample of 338 young sexual and gender minorities assigned male at birth (SGM-AMAB). Participants reported their sexual agreement and indices of relationship quality (satisfaction, trust, and commitment) at baseline, as well as their relationship status (intact or broken up) at 6- and 12-month follow-up. Results showed no significant differences by sexual agreement in concurrent trust, but participants with monogamous agreements reported higher satisfaction and commitment than those with non-monogamous agreements or no sexual agreement. Despite these significant differences in relationship quality, there were no significant differences in rates of break-up at 6- or 12-month follow-up across the sexual agreement types. However, having a monogamous agreement was indirectly associated with lower rates of break-up through relationship commitment. Although results were mixed, findings provide some preliminary support that young SGM-AMAB in relationships with monogamous agreements may have higher satisfaction and commitment at early relationship stages, and that monogamous agreements may be a protective factor against break-up over 1 year through the mechanism of relationship commitment.

Interpersonal and Intrapersonal Influences on Sexual Satisfaction in Young Male Couples: Analyses of Actor-Partner Interdependence Models

Very little research has examined sexual satisfaction in young gay, bisexual, queer, and other men who have sex with men (YMSM). Sexual satisfaction has important implications for individual wellbeing and is a central component of romantic relationship functioning and satisfaction. In order to fill this gap, this study examined interpersonal and intrapersonal factors associated with sexual satisfaction in a large sample of young male couples. Data for these analyses came from the baseline visits of two ongoing randomized controlled trials of 2GETHER, a relationship education and HIV prevention program for young male couples. Participants for the current analytic sample were 419 couples (individual N = 838) from across the United States who were diverse in terms of race/ethnicity, HIV status, and geographic region. Analyses found that relationship functioning (i.e., relationship satisfaction, communication) was positively associated with sexual satisfaction, while not having a specified relationship agreement (i.e., monogamy/non-monogamy agreement) was associated with less sexual satisfaction. Intrapersonal factors (i.e., depression, substance use) were associated with sexual satisfaction, but most of these effects became non-significant in a full multivariate model. Relationship functioning plays a central role in sexual satisfaction and should be addressed in couple-based programs to optimize relationship functioning and sexual health.

Social Context of Cannabis Use: Associations with Problematic Use, Motives for Use, and Protective Behavioral Strategies among Sexual Minorities Assigned Female at Birth

Sexual and gender minorities assigned female at birth (SGM-AFAB) are at heightened risk for problematic cannabis use compared to heterosexual cisgender women. Despite evidence that social context influences patterns of substance use, no known studies have examined context of cannabis use among SGM-AFAB. The current study examined two aspects of social contexts of cannabis use (locations and companions) and their associations with problematic use, motives for use, and protective behavioral strategies among SGM-AFAB. We utilized three waves of data from 358 SGM-AFAB from a larger study. We aimed to: (1) identify subgroups of SGM-AFAB based on contexts in which they used cannabis; (2) examine changes in contexts over time; and (3) examine associations between contexts, problematic use, motives for use, and protective behavioral strategies. Using latent class analysis, we identified four classes: those who used cannabis at home; those who used with friends; those who used alone and with friends; and those who used in all contexts. Those who used in all contexts reported more problematic use, higher coping motives, and used fewer protective behavioral strategies compared to other classes. Transitioning to using cannabis in fewer contexts was associated with a subsequent decrease in problematic use. Classes that were most stable over time (using in all contexts or alone and with friends) were also those that were associated with more problematic use. Social context has important implications for problematic cannabis use among SGM-AFAB. As such, interventions may benefit from attending to social context to reduce problematic use in this population.

Engagement with LGBTQ community moderates the association between victimization and substance use among a cohort of sexual and gender minority individuals assigned female at birth

BACKGROUND

Research has documented higher levels of substance use among sexual and gender minority (SGM) individuals - particularly sexual minority women (SMW) and transgender people - than among their heterosexual and cisgender peers. Because SGM substance use is linked to stigma-based victimization, it is crucial to identify social contexts that may buffer the association between victimization and substance use among SGM.

METHODS

We explored how engagement with LGBTQ-specific community influences victimization experiences and substance use among 488 SGM individuals assigned female at birth (FAB-SGM; ages 16-32; 26% White) in a large Midwestern city. We tested whether participants who used LGBTQ community spaces differed from those who do not in levels of victimization and substance use, and whether use of LGBTQ spaces buffered SGM from the negative effects of victimization on substance use.

RESULTS

Results demonstrated significant associations between victimization and alcohol and use of specific drugs. Contrary to expectations, participants who used LGBTQ spaces reported more victimization and more use of certain substances; however, when controlling for being out about non-heterosexual identity, this association remained only for LGBTQ community centers and school groups. Evidence was mixed for community engagement as a moderator of the association between victimization and substance use.

CONCLUSIONS

Overall, results indicated that LGBTQ spaces may be associated with adaptive and maladaptive coping functions and should be considered a potential target for health interventions. Findings emphasize the need for increased research on FAB-SGM, including SMW and transgender individuals, and provide actionable recommendations to reduce incidence of victimization and substance use.

Dimensions of Sexual Orientation and Rates of Intimate Partner Violence among Young Sexual Minority Individuals Assigned Female at Birth: The Role of Perceived Partner Jealousy

OBJECTIVE

Sexual minorities assigned female at birth are at increased risk for experiencing intimate partner violence (IPV) compared to heterosexual individuals, and bisexual individuals assigned female at birth appear to be at greatest risk. However, few studies have examined potential explanatory factors. Partner jealousy may contribute to bisexual individuals' increased risk for experiencing IPV, given stereotypes that they are promiscuous and evidence that people anticipate being jealous of a bisexual partner.

METHODS

This study examined the role of perceived partner jealousy in cross-sectional associations between self-reported dimensions of sexual orientation (identity, attractions, behavior) and IPV victimization among 368 young sexual minorities assigned female at birth (77.4% cisgender women).

RESULTS

Sexual behavior was associated with IPV, but sexual identity and attractions were not. Those with both male and female sexual partners in their lifetime were at increased risk for many forms of IPV compared to those with only male partners and those who never had sex, and these associations were partially explained by their higher perceived partner jealousy. Those with male and female partners were only at increased risk for two types of IPV compared to those with only female partners and these differences were not explained by perceived partner jealousy.

CONCLUSIONS

Jealousy may contribute to behaviorally bisexual individuals' increased risk for many forms of IPV compared to those with only male partners or never had sex. This highlights the importance of considering multiple dimensions of sexual orientation and has implications for the development of interventions to reduce IPV in this population.

Romantic Involvement and Mental Health in Sexual and Gender Minority Emerging Adults Assigned Female at Birth

We examined whether romantic relationship involvement, a well-established protective factor against mental health problems among heterosexual adults, is also protective for sexual and gender minority emerging adults assigned female at birth (SGM-AFAB), a group at high risk for mental health issues. Using cross-sectional data from a community sample of 222 SGM-AFAB ages 18-20 years, we assessed associations between current relationship involvement and five mental health variables: depressive symptoms, anxiety symptoms, alcohol use problems, cannabis use problems, and illicit drug use. There were no differences by romantic involvement in problematic cannabis use or other illicit drug use. Overall, participants in a relationship reported fewer depressive symptoms, fewer anxiety symptoms, and less problematic alcohol use than participants who were single. Some associations differed, however, by participant gender identity, sexual orientation identity, and partner gender. Specifically, relationship involvement was associated with fewer depressive and anxiety symptoms for cisgender female participants (n=154) but not for gender minority participants (n=68), and for lesbian participants (n=38) but not for bisexual/pansexual participants (n=134) or those with other sexual orientation identities (n=50). Participants romantically involved with a cisgender female partner (n=43) had fewer depressive and anxiety symptoms than single participants (n=100), those with a cisgender male partner (n=56), and those with a gender minority partner (n=23). Together, these findings suggest that romantic involvement may promote mental health for many, but not all, SGM young adults, highlighting the importance of attending to differences among SGM subgroups in research and efforts to reduce mental health and substance use disparities.

Effects of sexual/gender minority- and race-based enacted stigma on mental health and substance use in female assigned at birth sexual minority youth

OBJECTIVE

People of color who are also sexual and gender minorities (SGM) experience forms of enacted stigma based on both their racial/ethnic identity and their SGM status. We set out to test the effects of enacted stigma specific to race/ethnicity and SGM identity on mental health and substance use problems among female assigned at birth (FAB) SGM of color.

METHOD

Data come from a community-based sample of FAB SGM who also identified as racial/ethnic minorities (N = 352). The effects of racial discrimination, SGM victimization, and sexual orientation microaggressions on depression symptoms, anxiety symptoms, alcohol-related problems, and marijuana-related problems were tested using linear regression and negative binomial models.

RESULTS

Enacted stigma based on both race/ethnicity and SGM status were significant predictors of mental health outcomes and alcohol-related problems within the same model, which suggested that both uniquely contributed to poorer health. There was little support for interactive effects between the multiple forms of enacted stigma. Marijuana-related problems were best explained by enacted stigma based on race/ethnicity only.

CONCLUSIONS

Racially diverse FAB SGM are at unique risk of experiencing multiple forms of discrimination and aggression based on their minority identities that each contribute negatively to their wellbeing. Consideration of the multiple forms of enacted stigma they face is necessary for understanding health disparities in these populations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Nonmonosexual Stress and Dimensions of Health: Within-Group Variation by Sexual, Gender, and Racial/Ethnic Identities

Non-monosexual individuals (i.e., people with attractions to more than one gender) are at heightened risk for numerous negative health outcomes compared to individuals with exclusive attractions to either same-gender or different-gender individuals. This increased risk has been linked to the unique stress non-monosexual individuals experience due to the stigmatization of non-monosexuality (i.e., monosexism). However, research with this population has rarely considered multiple intersecting stigmatized identities (e.g., gender, race/ethnicity) and has focused predominately on internalizing symptoms (i.e., anxiety/depression). The current study aimed to expand this research by taking an intersectional approach to examining a) associations between three non-monosexual stressors (enacted, internalized, and anticipated monosexism) and three dimensions of health (i.e., physical health, internalizing symptoms, substance use and problems) and b) differences in these associations and rates of non-monosexual stressors and health problems by sexual, gender, and racial/ethnic identities among a diverse sample of 360 non-monosexual individuals assigned female at birth. Results indicated that all three non-monosexual stressors were associated with the three dimensions of health for the sample as a whole. There were several notable moderators of these associations. First, enacted monosexism was more strongly associated with physical health and substance use/problems for gender minorities compared to cisgender women. Second, several interactions indicated that non-monosexual stressors were associated with poorer health for White, but not Black or Latinx, individuals. These findings highlight the importance of attending to within-group heterogeneity to understand and address the range of health disparities affecting non-monosexual individuals.

A Structural Equation Model of Sexual Satisfaction and Relationship Functioning Among Sexual and Gender Minority Individuals Assigned Female at Birth in Diverse Relationships

While there is a sizeable literature on sexual satisfaction among male-female mixed-sex couples, research examining other types of relationships (e.g., same-sex) is limited. The current study aimed to broaden our understanding of sexual satisfaction across the diverse relationships of sexual and gender minority individuals assigned female at birth (SGM-AFAB) and inform models of sexual satisfaction for this population. We examined: (1) differences in sexual satisfaction and characteristics of sexual activity (frequency of sex, frequency of orgasm, duration of sex) by relationship type (same-sex, mixed-sex, gender-diverse) among SGM-AFAB; (2) a model of sexual satisfaction and its correlates; and (3) differences in this model by relationship type. Results indicated cisgender women in relationships with cisgender women (same-sex) reported higher duration of sex, frequency of orgasm, and sexual satisfaction compared to cisgender women in relationships with cisgender men (mixed-sex). There were few differences in characteristics of sexual activity between SGM-AFAB in gender-diverse relationships (involving one or more gender minority partners) and those in same- or mixed-sex relationships. Results indicated similarities across relationship types in a model of sexual satisfaction and its correlates. For all relationship types, more frequent and longer duration of sexual activity predicted higher orgasm frequency, more frequent orgasm predicted higher sexual satisfaction, and higher sexual satisfaction predicted better relationship functioning. Only the association between orgasm frequency and sexual satisfaction varied by relationship type. As one of the first studies examining sexual satisfaction among SGM-AFAB in mixed-sex and gender-diverse relationships, findings substantially further our understanding of sexual satisfaction in this population.

High Burden of Mental Health Problems, Substance Use, Violence, and Related Psychosocial Factors in Transgender, Non-Binary, and Gender Diverse Youth and Young Adults

Transgender and gender diverse (TGD) people are disproportionately impacted by various health issues and associated risk factors, but little is known about differences in these outcomes between gender identities within the TGD population. This study characterized the health of a diverse sample of TGD youth and young adults. Data were taken from the baseline visit of two longitudinal studies in the Chicago area, RADAR (N = 1079, M age = 20.8 years) and FAB 400 (N = 488, M age = 19.57 years), which are cohorts of young sexual and gender minorities assigned male at birth (AMAB) and assigned female at birth (AFAB), respectively. There was a combined sample of 214 TGD (128 AFAB, 86 AMAB) individuals across cohorts. We examined differences between gender identities in self-reported health and related psychosocial variables, and compared TGD youth and their cisgender sexual minority peers from their cohort of origin on all variables. Among TGD youth, we found high rates of depression and suicidality (ideation, plan, attempt), violence (trauma, victimization, childhood sexual abuse), and substance use (cigarette, alcohol, illicit drug use). With the exception of depression, transgender women and non-binary AMAB youth reported worse health outcomes than transgender men and non-binary AFAB youth. Non-binary AMAB youth reported the highest rates of certain outcomes, including traumatic experiences and suicidal ideation. TGD youth generally reported worse outcomes than cisgender sexual minority youth; these differences were less pronounced among AFAB youth. Findings point to the diversity of experiences within the TGD population and critical needs for intervention approaches to mitigate health disparities.

Relationship Education and HIV Prevention for Young Male Couples Administered Online via Videoconference: Protocol for a National Randomized Controlled Trial of 2GETHER

Background

Young men who have sex with men have a high HIV incidence, and a substantial proportion of incident infections occur in the context of main partnerships. However, romantic relationships also provide numerous benefits to individual health and wellbeing. 2GETHER is a relationship education and HIV prevention program for young male couples, and the 2GETHER USA randomized controlled trial (RCT) was launched to establish the efficacy of an online version of 2GETHER.

Objective

The objective of 2GETHER is to optimize relationship functioning in young male couples as a method to improve communication about sexual risk behaviors and reduce HIV transmission. In the 2GETHER USA study, 2GETHER was adapted for online administration to couples across the United States via videoconferencing. The intervention in question aims to address the unique needs of couples from varied racial/ethnic backgrounds and geographic regions.

Methods

This is a comparative effectiveness RCT of 2GETHER USA relative to existing public health practice (control). 2GETHER USA is a hybrid group- and individual-level intervention that delivers three weekly online group discussion sessions for skills delivery, followed by two individualized couple sessions that focus on skills implementation in each couple. The control condition differs by participant HIV status: (1) the Testing Together protocol for concordant HIV-negative couples; (2) medication adherence and risk reduction counseling for concordant HIV-positive couples; or (3) both protocols for serodiscordant couples. Follow-up assessments are delivered at 3-, 6-, 9-, and 12-months post-intervention in both conditions. Testing for rectal and urethral Chlamydia and Gonorrhea occurs at baseline and 12-month follow-up. The primary behavioral outcome is condomless anal sex with serodiscordant serious partners or any casual partners. The primary biomedical outcome is sexually transmitted infection incidence at a 12-month follow-up.

Results

As of October 11, 2019, the trial has enrolled and randomized 140 dyads (Individual N=280). Enrollment will continue until we randomize 200 dyads (N=400). Assessment of intervention outcomes at 3-, 6-, 9-, and 12-months is ongoing.

Conclusions

2GETHER is innovative in that it integrates relationship education and HIV prevention for optimizing the health and wellbeing of young male couples. The 2GETHER USA online adaptation has the potential to reach couples across the United States and reduce barriers to accessing health care services that are affirming of sexual minority identities for those who live in rural or under-resourced areas.

Trial Registration

ClinicalTrials.gov NCT03284541; https://clinicaltrials.gov/ct2/show/NCT03284541

International Registered Report Identifier (IRRID)

DERR1-10.2196/15883

Longitudinal associations between minority stress, internalizing symptoms, and substance use among sexual and gender minority individuals assigned female at birth

OBJECTIVE

Sexual and gender minority individuals assigned female at birth (SGM-AFAB) are at increased risk for anxiety, depression, and substance use and problems compared with heterosexual cisgender women. Cross-sectional research has demonstrated that minority stressors are associated with anxiety, depression, and substance use. However, longitudinal research is limited and the examination of prospective associations between minority stressors, mental health, and substance use is even more sparse.

METHOD

We utilized 4 waves of data (6 months between waves) from a diverse (26.0% non-Latinx White; 26.2% gender minorities) longitudinal cohort of 488 SGM-AFAB (16- to 32-years-old at Wave 1) to examine concurrent and prospective associations between 3 minority stressors (internalized stigma, microaggressions, victimization) and anxiety, depression, and alcohol and cannabis use and problems.

RESULTS

At the within-person level, results indicated that when SGM-AFAB experienced more minority stressors than usual, they reported more concurrent and prospective anxiety and depression. Additionally, when SGM-AFAB experienced more microaggressions than usual, they were more likely to use alcohol and cannabis, and when they experienced more victimization than usual, they reported more concurrent alcohol and cannabis use problems. No prospective associations between minority stressors and substance use were significant.

CONCLUSIONS

Findings indicate that minority stressors were consistently associated with internalizing symptoms, both concurrently and prospectively, while evidence for associations between minority stressors and substance use/problems was less consistent. These findings highlight the need for interventions that that teach SGM-AFAB skills for effectively coping with minority stress. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Intimate Partner Violence Experiences of Sexual and Gender Minority Adolescents and Young Adults Assigned Female at Birth

Sexual and gender minority youth, especially those assigned female at birth, are at risk for intimate partner violence (IPV) due to minority stressors. With a sample of 352 sexual and gender minority youth assigned female at birth (age 16-32), we aimed to describe IPV in this population, including the prevalence, directionality, frequency, co-occurrence, and demographic correlates of various IPV types. Rates of past-6-month IPV were high, with victimization and perpetration of minor psychological IPV most common (64-70%); followed by severe psychological, minor physical, and coercive control (20-33%); and severe physical and sexual IPV (10-15%). For cyber abuse and IPV tactics leveraging anti-sexual minority stigma, victimization (12.5% and 15%, respectively) was more common than perpetration (8% and 6%, respectively). Most IPV was bidirectional and occurred 1-2 times in 6 months, although frequency varied considerably. Latent class analyses revealed that half of participants reported no or minimal IPV; one-third experienced multiple forms of psychological IPV (including coercive control); and 10-15% reported psychological, physical, sexual, and cyber abuse. Racial minority youth had higher rates of most IPV types than White participants. We hope study findings will inform policies and interventions to prevent IPV among gender and sexual minority youth assigned female at birth.

The Longitudinal Associations Between Outness and Health Outcomes Among Gay/Lesbian Versus Bisexual Emerging Adults

Sexual minorities are at increased risk for substance use and mental health problems. Although previous studies have examined the associations between outness and health outcomes, few have used longitudinal designs or examined differences across subgroups of sexual minorities. To address these gaps, the current study examined sexual orientation and gender as moderators of the longitudinal associations between outness and substance use (cigarettes, marijuana, illicit drugs, and alcohol) and mental health (depression and anxiety). Data were from a sample of 169 sexual minority emerging adults (98 women and 71 men) who provided self-report data at four times over 3.5 years. Results indicated that sexual orientation moderated the within-person associations between outness and changes in health. For bisexual individuals, being more out was associated with increases in marijuana use, illicit drug use, and depression. In contrast, for gay/lesbian individuals, being more out was associated with decreases in illicit drug use and it was not significantly associated with changes in marijuana use or depression. Additionally, outness was not significantly associated with changes in cigarette use, alcohol use, or anxiety for gay/lesbian or bisexual individuals, and gender did not moderate any of the associations. In sum, being more open about one's sexual orientation had negative consequences for bisexual individuals but not for gay/lesbian individuals. Professionals who work with sexual minorities need to be aware of the potential risks of being open about one's sexual orientation for bisexual individuals. Interventions are needed to facilitate disclosure decisions and to promote the health of sexual minorities.

A Longitudinal Study of IPV Victimization Among Sexual Minority Youth

Although intimate partner violence (IPV) is highly prevalent among lesbian, gay, bisexual, and transgender (LGBT) youth, little is known regarding its developmental patterns, risk factors, or health-related consequences. We examined IPV victimization in an ethnically diverse community-based convenience sample of 248 LGBT youth (aged 16-20 at study outset) who provided six waves of data across a 5-year period. Results from multilevel models indicated high, stable rates of IPV victimization across this developmental period (ages 16-25 years) that differed between demographic groups. Overall, 45.2% of LGBT youth were physically abused and 16.9% were sexually victimized by a dating partner during the study. Odds of physical victimization were 76% higher for female than for male LGBT youth, 2.46 times higher for transgender than for cisgender youth, and 2 to 4 times higher for racial-ethnic minorities than for White youth. The prevalence of physical IPV declined with age for White youth but remained stable for racial-ethnic minorities. Odds of sexual victimization were 3.42 times higher for transgender than for cisgender youth, 75% higher for bisexual or questioning than for gay or lesbian youth, and increased more with age for male than female participants. Within-person analyses indicated that odds of physical IPV were higher at times when youth reported more sexual partners, more marijuana use, and lower social support; odds of sexual IPV were higher at times when youth reported more sexual partners and more LGBT-related victimization. In prospective analyses, sexual IPV predicted increased psychological distress; both IPV types marginally predicted increased marijuana use.

Effects of romantic involvement on substance use among young sexual and gender minorities

BACKGROUND

Sexual and gender minority (SGM) adolescents and young adults experience elevated rates of alcohol and drug use; it is, therefore, important to identify protective factors that decrease risk for substance use in this population. This study examined whether involvement in a romantic relationship, a well-established protective factor against heavy drinking and drug use among heterosexual adults, is also protective for SGM youth.

METHODS

This study used eight waves of data provided by a community sample of 248 racially diverse SGM youth (ages 16-20 years at baseline). Multilevel structural equation models were used to assess within-person associations between relationship involvement and use of alcohol, cigarettes, marijuana, and other illicit drugs. Age, gender, and sexual identity were tested as moderators.

RESULTS

Romantic involvement was associated with less drinking for all participants (Rate Ratio = 0.64) and decreased likelihood of illicit drug use for gay and lesbian participants (Odds Ratio = 0.56). However, participants reported smoking 26% more cigarettes when romantically involved. Further, among bisexuals, romantic involvement was associated with increased marijuana (Rate Ratio = 2.31) and other illicit drug use (Odds Ratio = 2.39).

CONCLUSIONS

Study findings indicate some protective effects of relationship involvement against substance use among SGM youth, particularly with respect to alcohol and illicit drugs other than marijuana. However, dating may promote smoking in all SGM youth and drug use in bisexual youth. The demographic differences observed in the effects of romantic involvement highlight the importance of attending to differences among SGM youth in research, theory, and substance use reduction efforts.

Romantic involvement: A protective factor for psychological health in racially-diverse young sexual minorities

Sexual minority youth experience elevated rates of internalizing disorders; it is, therefore, important to identify protective factors that decrease risk for psychological distress in this population. In this study, we examined whether involvement in a romantic relationship, a well-established protective factor for mental health among heterosexual adults, is also protective for young sexual minorities. Using eight waves of data provided by a community sample of 248 racially diverse sexual minority youth (ages 16-20 years at baseline), we assessed within-person associations between relationship involvement and psychological distress. Results from multilevel structural equation models indicated that, overall, participants reported less psychological distress at waves when they were in a relationship than when they were not. However, findings differed as a function of race/ethnicity and sexual orientation. Specifically, although relationship involvement predicted lower psychological distress for Black and gay/lesbian participants, the association was not present for White participants and, for bisexuals, relationship involvement predicted higher distress. In addition, relationship involvement reduced the negative association between victimization based on sexual minority status and psychological distress, suggesting a stress-buffering effect that did not differ based on demographic factors. Together, these findings suggest that being in a romantic relationship may promote mental health for many, but not all, young sexual minorities, highlighting the importance of attending to differences among subgroups of sexual minorities in research, theory, and efforts to reduce mental health disparities. (PsycINFO Database Record

Piloting relationship education for female same-sex couples: Results of a small randomized waitlist-control trial

Relationship education represents a promising, nonstigmatizing approach to promoting the health and stability of same-sex couples. A new culturally sensitive adaptation of relationship education was developed specifically for female same-sex couples (The Strengthening Same-Sex Relationships Program, Female version; SSSR-F). SSSR-F includes adaptations of evidence-based strategies to build core relationship skills (e.g., communication skills training) as well as new content to address unique challenges faced by this population (e.g., discrimination; low social support). A small randomized waitlist-control trial (N = 37 couples) was conducted to evaluate program feasibility, acceptability, and efficacy. Three proximal outcomes targeted by SSSR-F (communication, perceived stress, social support) and 3 distal outcomes (global relationship satisfaction, instability, and confidence) were assessed at pre- and posttreatment and 3-month follow-up. Results of multilevel models accounting for nonindependence in dyadic data indicated statistically significant program effects on positive and negative couple communication, relationship satisfaction, and relationship confidence and small, nonsignificant program effects on stress, social support, and relationship instability. Analyses of follow-up data suggest maintenance of effects on the proximal but not the distal outcomes. Ratings of program satisfaction were high. Overall, findings support the feasibility, acceptability, and initial efficacy of SSSR-F, highlighting the potential value of culturally sensitive relationship education for same-sex couples. Continued efforts are needed to increase sustainability of program effects on global relationship quality over time. (PsycINFO Database Record

Integrating HIV Prevention and Relationship Education for Young Same-Sex Male Couples: A Pilot Trial of the 2GETHER Intervention

Young men who have sex with men are at high risk for HIV, and most new HIV infections occur in serious relationships. This pilot study assessed the feasibility, acceptability and preliminary efficacy of the 2GETHER couples-based HIV prevention and relationship education intervention for young same-sex male couples. We enrolled 57 young male couples (N = 114) into a four-session hybrid group and individual intervention. We assessed acceptability via post-session surveys and exit interviews, and we examined preliminary efficacy at a two week posttest. The vast majority of participants (93%) reported exclusively positive impressions of 2GETHER, and all components received high mean ratings. We observed decreases in HIV risk behavior, increases in information, motivation and behavioral skills related to HIV prevention, and improvement in relationship investment between pretest and posttest. Integrating relationship education and sexual health programming may be an effective way to reduce HIV transmissions in young male couples.

Intimate Partner Violence Victimization in LGBT Young Adults: Demographic Differences and Associations with Health Behaviors

OBJECTIVE

Intimate partner violence (IPV) is an important public health problem with high prevalence and serious costs. Although literature has largely focused on IPV among heterosexuals, studies have recently begun examining IPV in LGBT samples, with mounting evidence suggesting IPV may be more common among LGBT individuals than heterosexuals. Less research has examined the specific health consequences of IPV in this population, particularly across time and among young people, and it remains unclear whether experiences of IPV differ between subgroups within the LGBT population (e.g. race, gender identity, and sexual orientation).

METHOD

An ethnically diverse sample of 172 LGBT young adults completed self-report measures of IPV, sexual behavior, mental health, and substance abuse at two time points (4- and 5-year follow-up) of an ongoing longitudinal study of LGBT youth.

RESULTS

IPV was experienced non-uniformly across demographic groups. Specifically, female, male-to-female transgender, and Black/African-American young adults were at higher risk compared to those who identified as male, female-to-male transgender, and other races. Being a victim of IPV was associated with concurrent sexual risk taking and prospective mental health outcomes but was not associated with substance abuse.

CONCLUSIONS

Demographic differences in IPV found in heterosexuals were replicated in this LGBT sample, though additional research is needed to clarify why traditional risk factors found in heterosexual young people may not translate to LGBT individuals. Studies examining the impact of IPV on negative outcomes and revictimization over time may guide our understanding of the immediate and delayed consequences of IPV for LGBT young people.