HIV Risk Among Homosexual, Bisexual, and Heterosexual Male and Female Youths

Variations in sexual risk acts and thesocial-cognitive mediators of sexual acts were examinedamong young homosexual, bisexual, and heterosexual malesand females (N = 478; 13-21 Years of age) from four community-based agencies in New York City, SanFrancisco, and Los Angeles (29% African American, 36%Latino, 36% White/other). The prevalence and frequencyof sexual risk acts varied by gender but were similar across youth of different sexualorientations, ethnicities, and ages. Condom use and thesocial-cognitive mediators of risk varied by sexualorientation and gender. Homosexual youths reported a gap between their positive attitudes toward HIVprevention and their skills to implement safer sex acts,particularly under social pressure. Bisexual youthsappeared at greatest risk; their reports of sexual risk were the highest, yet their perceived riskfor HIV was relatively low and skills and knowledge weremoderate (relative to their peers). Heterosexual youthsappear at high risk for HIV based on reports of low rates of condom use and HIV-relatedbeliefs and attitudes. However, heterosexual youthsdemonstrated the highestlevelofcondom skills. The numberofsexual partners was not associated with anyHIV-related social cognitive mediator, suggesting thatalternative theoretical models must be proposed forpartner selection. Longitudinal research with similarsubgroups of youths is needed.     

Mental Health and Suicidality Among Racially/Ethnically Diverse Sexual Minority Youths

Objectives. We examined the relationships among sexual minority status, sex, and mental health and suicidality, in a racially/ethnically diverse sample of adolescents.Methods. Using pooled data from 2005 and 2007 Youth Risk Behavior Surveys within 14 jurisdictions, we used hierarchical linear modeling to examine 6 mental health outcomes across 6 racial/ethnic groups, intersecting with sexual minority status and sex. Based on an omnibus measure of sexual minority status, there were 6245 sexual minority adolescents in the current study. The total sample was n = 72 691.Results. Compared with heterosexual peers, sexual minorities reported higher odds of feeling sad; suicidal ideation, planning and attempts; suicide attempt treated by a doctor or nurse, and self-harm. Among sexual minorities, compared with White youths, Asian and Black youths had lower odds of many outcomes, whereas American Native/Pacific Islander, Latino, and Multiracial youths had higher odds.Conclusions. Although in general, sexual minority youths were at heightened risk for suicidal outcomes, risk varied based on sex and on race/ethnicity. More research is needed to better understand the manner in which sex and race/ethnicity intersect among sexual minorities to influence risk and protective factors, and ultimately, mental health outcomes.Over the past 20 years, research has documented elevated suicidality1—defined as behavior related to contemplating, attempting, or completing suicide2—among sexual minority youths (an umbrella term, generally including those who identify as lesbian, gay, bisexual, or transgender [LGBT]; engage in same-sex sexual behavior; or have same-sex attractions). This research has consistently demonstrated substantial sexual orientation disparities in suicidality, with sexual minority youths having higher prevalence of suicidality than their heterosexual peers.3–6 A recent review of the literature indicated that sexual minority youths are at least twice as likely as heterosexual youths to contemplate suicide, and 2 to 7 times as likely to attempt suicide.7 A meta-analysis found that 28% of sexual minority youths had a history of suicidality, compared with 12% of their heterosexual peers.8Despite the development of knowledge about suicidality among sexual minority youths, little is known about suicidality in sexual minority youths of color. To the extent that existing researchers have explored racial/ethnic differences, analyses have rarely gone beyond dichotomous (White vs “youths of color”) or trichotomous (White vs Black vs Latino) comparisons. As a result, there exists scant literature exploring the full spectrum of racial/ethnic differences in suicidality among sexual minority youths.The literature on suicide in the general adolescent population demonstrates racial/ethnic differences in suicide ideation and attempts. For example, prevalence of suicide among Native American and Alaska Native youths is twice that of other youths,9 and Latino youths are more likely than either Black or White youths to have considered and attempted suicide.10 Differences are further moderated by participants’ gender: girls are more likely to consider suicide and attempt suicide than boys,10 although boys are more likely to complete suicide.11Studies that have considered racial/ethnic differences in suicidality among sexual minority youths have found differences, though the patterns have been inconsistent. A study based on Youth Risk Behavior Survey (YRBS) data from Massachusetts, reported that among self-identified lesbian, gay, or bisexual (LGB) youths3 Latinos were significantly more likely than Whites to report past-year suicide attempt. Another study found that same-sex–attracted Black and White youths were more likely than their other-sex–attracted peers to report suicidal ideation, whereas same-sex–attracted Latino and Asian/Pacific Islander youths did not differ from other-sex–attracted peers.12 In a nonprobability sample of urban LGBT youths,13 Black and White youths were more likely to report suicidal ideation than Latinos; however, Latinos reported the highest frequency of suicide attempts. A study of New York City adults found that Latino and Black LGB participants were more likely to report serious suicide attempts than were White LGB participants, with most reported attempts occurring during adolescence and young adulthood.14 These conflicting results suggest that there are important differences in suicidality at the intersections of sexual minority status and race/ethnicity, yet further study requires data of sufficient scale and scope to enable analyses of low-prevalence behaviors across small subgroups of youths.To address the need for information about suicidality among racially/ethnically diverse sexual minority populations, we assess suicidality patterns among youths based on sexual orientation, race/ethnicity, and sex. With this, we respond to calls for public health to utilize minority stress and intersectional frameworks as potential lenses through which to understand health and health disparities among sexual minority populations.15,16 Rather than treating social identities as separate and discrete phenomena, our inquiry allows that co-occurring minority identities operate together. An intersectional approach suggests that sexual identity–race–sex intersections are informed by unique cultural, historical, social, and political factors that differentially influence life experiences, including discrimination based on such identities.17–19 In turn, minority stress theory posits that discriminatory experiences predispose populations to stress and adverse mental health outcomes, including suicidality.20The focus on health differences among sexual minority youths across race/ethnicity and sex is vital to creating effective health interventions and programs. Such a focus is particularly relevant within the context of youth suicide, as risk and protective factors associated with suicidality vary across both racial/ethnic and sexual minority groups, and there is a need to better integrate these bodies of research.21     

Correlates of Sexual HIV Risk Among African American Men Who Have Sex With Men

Objectives. We examined correlates of condomless anal intercourse with nonmain sexual partners among African American men who have sex with men (MSM).Methods. We recruited social networks composed of 445 Black MSM from 2012 to 2014 in Milwaukee, Wisconsin; Cleveland, Ohio; and Miami Beach, Florida. Participants reported past-3-month sexual behavior, substance use, and background, psychosocial, and HIV-related characteristics.Results. Condomless anal intercourse outside main concordant partnerships, reported by 34.4% of MSM, was less likely in the case of no alcohol and marijuana use in the past 30 days, and higher risk-reduction behavioral intentions. High frequency of condomless anal intercourse acts with nonmain partners was associated with high gay community participation, weak risk-reduction intentions, safer sex not being perceived as a peer norm, low condom-use self-efficacy, and longer time since most recent HIV testing.Conclusions. Condomless anal intercourse with nonmain partners among Black MSM was primarily associated with gay community participation, alcohol and marijuana use, and risk-reduction behavioral intentions.HIV infection in the United States falls along sharp lines of disparity related to sexual orientation and race. Every year since HIV surveillance began, men who have sex with men (MSM) have accounted for the majority of the country’s HIV cases.1 The disease also disproportionately affects African Americans, who constitute 12% of the American population but carry 44% of its HIV infection burden.1 Yet, the starkest disparity emerges from the combined impact of race and sexual orientation. Black MSM represent only a fraction of a percent of the American population but accounted for more than 25% of the country’s new HIV infections in 2010,1 with HIV rates much higher among Black than White MSM.2 HIV incidence among racial-minority MSM in some cities ranges from 24% to 29%.3,4 Considerable attention is being given to biomedical strategies such as early initiation of antiretroviral therapy (ART) and preexposure ART prophylaxis for HIV prevention.5,6 However, the impact of these promising strategies will depend upon ART coverage and adherence, neither of which is likely to be quickly attained or complete. For this reason, integrated HIV prevention approaches are needed, including improved interventions to reduce risk behavior among racial-minority MSM.Previous research has examined but has generally failed to establish differences in individual-level risk practices between Black and White MSM.7–10 However, sexual network characteristics, high rates of undiagnosed and untreated HIV infection, high sexually transmitted infection (STI) prevalence, and unsuppressed viral load among HIV-positive African American MSM are believed to contribute to HIV disparities.9–16Black MSM are not a monolithic population,17–20 and multiple factors may influence extent of HIV vulnerability within the community of racial-minority MSM. These include risk-related sexual behavior norms, attitudes, and intentions21–25; substance use12,26–30; poverty and disadvantage19,20; and psychosocial domains including internalized homonegativity or homophobia,31–34 self-perceived masculinity,35,36 HIV conspiracy beliefs or mistrust,37,38 religiosity,39 and resilience.40,41 It is important to ascertain the relative importance of these and other factors to properly tailor HIV prevention interventions for racial-minority MSM.In this study, we recruited social networks of African American MSM and sought to determine the relationships of 4 types of factors with the riskiness of men’s sexual behavior practices: (1) social, economic, and demographic background characteristics; (2) substance use; (3) HIV risk–specific knowledge, attitudes, beliefs, and intentions; and (4) psychosocial domains including internalized homonegativity, self-ascribed masculinity, AIDS conspiracy beliefs, resilience, religiosity, and gay community participation. We examined HIV risk–specific characteristics because they are proximal to adopting protective actions according to many behavioral science theories.42–44 We examined psychosocial domains because broader personal and contextual life experiences may also potentiate risk. We sought to identify characteristics related not only to some men’s high-risk behavior but also the adoption of very safe behavior by other African American MSM, a strengths-based question that has been insufficiently explored.     

Sexual Partnerships, Risk Behaviors, and Condom Use Among Low-Income Heterosexual African Americans: A Qualitative Study

The purpose of the current investigation was to contextualize the sexual relationships and risk behaviors of heterosexually active African Americans. A total of 38 participants (20 females and 18 males) aged 18–44 years were recruited in a large city in the southeastern U.S. to participate in focus group discussions exploring sexual partnerships, general condom perceptions, and condom negotiation. Results indicated that participants distinguished among at least three partner types—one-night stand, “regular” casual partner, and main partner. Partner types were found to shape and influence types of sexual behaviors, perceptions of risk and condom use, and condom negotiation. Participants also shared general perceptions about condoms and elucidated situations in which intentions to use condoms were not realized. Gender differences emerged in many of these areas. Implications of these findings are discussed and directions for future research on sexual partnerships and risk behavior are offered.     

Sexual Values and Risky Sexual Behaviors Among Latino Youths

CONTEXT: Understanding Latino youths' sexual values is key to informing HIV prevention efforts. Few studies have examined associations between culturally based sexual values and behaviors among Latinos.
METHODS: A sample of 839 sexually active Latinos aged 16–22 residing in San Francisco were interviewed in 2003–2006. Multiple regression and multinomial logistic regression analyses were conducted to examine associations between sexual values and behaviors, while adjusting for language use (a proxy for acculturation) and other covariates.
RESULTS: The importance attached to female virginity was negatively associated with the number of sexual partners women had had in their lifetime (odds ratio, 0.8) and in the past year (0.9), and was positively associated with women's nonuse of condoms, rather than consistent use, during the first month of their current relationships (1.8). For men, the importance of satisfying sexual needs increased with the numbers of lifetime and recent sexual partners (1.4 and 1.1, respectively), and with inconsistent condom use in the first month of their relationships (1.9). Comfort with sexual communication was positively associated with inconsistent use or nonuse of condoms in the last month of both men's and women's current relationships (2.0–2.2). For women, considering satisfaction of sexual needs important was associated with more sexual partners only among those who attached little value to female virginity.
CONCLUSIONS: It is important to integrate themes of virginity and sexual desire into intervention curricula so youth can better understand how these sexual norms influence their developing sexual identities and behaviors.     

Protective School Climates and Reduced Risk for Suicide Ideation in Sexual Minority Youths

Objectives. We examined whether sexual minority students living in states and cities with more protective school climates were at lower risk of suicidal thoughts, plans, and attempts.Methods. Data on sexual orientation and past-year suicidal thoughts, plans, and attempts were from the pooled 2005 and 2007 Youth Risk Behavior Surveillance Surveys from 8 states and cities. We derived data on school climates that protected sexual minority students (e.g., percentage of schools with safe spaces and Gay–Straight Alliances) from the 2010 School Health Profile Survey, compiled by the Centers for Disease Control and Prevention.Results. Lesbian, gay, and bisexual students living in states and cities with more protective school climates reported fewer past-year suicidal thoughts than those living in states and cities with less protective climates (lesbians and gays: odds ratio [OR] = 0.68; 95% confidence interval [CI] = 0.47, 0.99; bisexuals: OR = 0.81; 95% CI = 0.66, 0.99). Results were robust to adjustment for potential state-level confounders. Sexual orientation disparities in suicidal thoughts were nearly eliminated in states and cities with the most protective school climates.Conclusions. School climates that protect sexual minority students may reduce their risk of suicidal thoughts.Suicide is the third leading cause of death among youths aged 15 to 24 years.1 Decades of research have identified multiple risk factors for adolescent suicide ideation and attempts.2 One of the most consistent findings is that lesbian, gay, and bisexual (LGB, or sexual minority) adolescents are more likely than heterosexual adolescents to endorse suicidal thoughts3,4 and to report having a suicide plan.5 Additionally, a recent review of the epidemiological literature found that LGB youths are between 2 and 7 times more likely to attempt suicide than their heterosexual peers.6Given the elevated risk of suicidal ideation, plans, and attempts among sexual minority youths, researchers have focused on identifying factors that explain these marked disparities. Theories of minority stress7 and stigma8 have highlighted the important roles that social-structural contexts as well as institutional practices and policies play in contributing to mental health disparities. Consistent with these theories, LGB adults who live in states with fewer protective social policies have higher rates of psychiatric and substance use disorders than LGB adults living in states with more protective policies.9,10 For instance, LGB adults in states that passed constitutional amendments banning same-sex marriage experienced a 37% increase in mood disorders, a 40% increase in alcohol use disorders, and nearly a 250% increase in generalized anxiety disorders in the year following the enactment of the amendments.10 These and other studies11 have shown that the broader social contexts surrounding LGB adults shape their mental health.Among adolescents, schools are an important social context that contributes to developmental and health outcomes.12 For sexual and gender minority youths in particular, the social context of schools can promote both vulnerability and resilience.13–16 A variety of methodological approaches have been used to evaluate the mental health consequences of school climates for LGB students. The predominant approach is to ask LGB adolescents to report on the supportiveness of their schools.17–19 Studies using this approach have indicated that LGB youths who report greater school connectedness and school safety also report lower suicidal ideation and fewer suicide attempts.18 Although informative, this research may introduce bias because information is self-reported for both the exposure and the outcome.20 Studies using alternative methodologies may therefore improve the validity of the inferences on the relationship between the social environment and individual health outcomes.An alternative methodological approach has been to develop indicators of school climate that do not rely on self-report, such as geographic location of the school (i.e., urban vs rural)21 and the presence of Gay–Straight Alliances in the school.22 Although this approach has received comparatively less attention in the literature, recent studies have documented associations between these more objective measures of school climate and sexual minority mental health. For example, lesbian and gay adolescents are at lower risk for attempting suicide if they live in counties where a greater proportion of school districts have antibullying policies that include sexual orientation.23 Although they provide important initial insights, existing studies have been limited by examining only 1 aspect of school climate (e.g., antibullying policies or presence of Gay–Straight Alliances),16,22,23 relying on nonprobability samples,16,22 and using a single location,16,22,23 all of which can restrict generalizability.We built on this previous research by using data on multiple school climate variables relevant to LGB students that we obtained from the 2010 School Health Profile Survey, compiled by the Centers for Disease Control and Prevention (CDC).24 We then linked this information on school climate to population-based data of adolescents living in 8 states and cities across the United States. We hypothesized that LGB adolescents living in states and cities with school climates that are more protective of sexual minority youths would be less likely to report past-year suicidal thoughts, plans, and attempts than LGB youths living in areas with less protective school climates.     

Contraceptive Use Effectiveness and Pregnancy Prevention Information Preferences Among Heterosexual and Sexual Minority College Women

Background

Previous research shows that sexual minority women have higher rates of unintended pregnancy than heterosexual women, but has not considered the wide range of contraceptive method effectiveness when exploring this disparity. We examine contraceptive use effectiveness and desire for pregnancy prevention information among college women across sexual orientation identity as a risk factor for unintended pregnancy.

Religious Climate and Health Risk Behaviors in Sexual Minority Youths: A Population-Based Study

Objectives. We examined whether the health risk behaviors of lesbian, gay, and bisexual (LGB) youths are determined in part by the religious composition of the communities in which they live.Methods. Data were collected from 31 852 high school students, including 1413 LGB students, who participated in the Oregon Healthy Teens survey in 2006 through 2008. Supportive religious climate was operationalized according to the proportion of individuals (of the total number of religious adherents) who adhere to a religion supporting homosexuality. Comprehensive data on religious climate were derived from 85 denominational groups in 34 Oregon counties.Results. Among LGB youths, living in a county with a religious climate that was supportive of homosexuality was associated with significantly fewer alcohol abuse symptoms (odds ratio [OR] = 0.58; 95% confidence interval [CI] = 0.40, 0.85) and fewer sexual partners (OR = 0.77; 95% CI = 0.60, 0.99). The effect of religious climate on health behaviors was stronger among LGB than heterosexual youths. Results remained robust after adjustment for multiple confounding factors.Conclusions. The religious climate surrounding LGB youths may serve as a determinant of their health risk behaviors.Stigma operates through both discrete events and pervasive environments in threatening the health of its targets.1 Explanations of lesbian, gay, and bisexual (LGB) youths’ higher level of engagement in health risk behaviors relative to their heterosexual peers have largely relied on reports of encounters with discrete stigmatizing events, such as parental rejection and peer victimization.2 Yet, when social structures, institutions, and norms transmit disapproval or invalidation of LGB identities and life experiences, they have the potential to threaten LGB youths’ health independent of individual-level events.1,3,4The social climate surrounding LGB individuals both worldwide5 and in the United States6 is shaped by the moral debate regarding the legitimacy of homosexuality. Given that social ideology is closely intertwined with religious ideology in the United States, expressed attitudes toward homosexuality are largely aligned with degree and type of religious affiliation.6,7 A majority of US residents report that advancement of LGB rights, such as the legal recognition of same-sex marriage, clashes with their religious beliefs.8 Approximately 85% of individuals in the United States identify as religious, and more than half of the US population in 2003 believed that homosexuality is sinful.9Although condemnation of homosexuality has long been a part of many religious doctrines, not all religions hold similar beliefs toward homosexuality.10 Indeed, a 2011 survey of the US population showed that about half of religious adherents believe that society should accept homosexuality,11 highlighting a shift from the results of earlier studies and mirroring the changing attitudes toward same-sex marriage that also exist across some religious groups.12 In all, the US public''s view of homosexuality is changing and varies as a function of several characteristics, including religious affiliation.LGB youths construct their sexual identities within social climates shaped by these religious influences, with some LGB youths encountering more threatening climates than others given that religious demography varies widely by geographical region.13 The health risk behaviors of LGB youths may thus vary according to the religious composition of the communities in which they live, in that encountered stigma influences health-impairing coping behaviors.14 However, existing research has focused almost exclusively on associations between personal religiosity and health behaviors among LGB youths.15–17 Thus, research on the intersection of religious climate and the health behaviors of LGB youths remains limited.To address this gap in the literature, we used an objective index of community religiosity to predict tobacco use, alcohol abuse, and sexual behaviors in a sample of LGB and heterosexual youths. We hypothesized that religious climate would be associated with these health outcomes over and above the influence of other environmental factors surrounding LGB youths (e.g., school bullying policies, presence of Gay-Straight Alliances) and that the association would be stronger for LGB youths than for heterosexual youths. We also expected that religious climate would exert these health effects independent of established individual-level psychosocial predictors of health risk behaviors.     

Correlates of Concurrent Sexual Partnerships Among Young,Rural African American Men

ObjectiveWe investigated the social, behavioral, and psychological factors associated with concurrent (i.e., overlapping in time) sexual partnerships among rural African American young men with a primary female partner.MethodsWe recruited 505 men in rural areas of southern Georgia from January 2012 to August 2013 using respondent-driven sampling; 361 reported having a primary female partner and participating only in heterosexual sexual activity. Men provided data on their demographic characteristics and HIV-related risk behaviors, as well as social, behavioral, and psychological risk factors.ResultsOf the 361 men with a primary female partner, 164 (45.4%) reported concurrent sexual partners during the past three months. Among the 164 men with a concurrent sexual partner, 144 (92.9%) reported inconsistent condom use with their primary partners, and 68 (41.5%) reported using condoms inconsistently with their concurrent partners. Having concurrent sexual partnerships was associated with inconsistent condom use, substance use before sex, and self-reported sexually transmitted infections (STIs). Bivariate correlates of concurrent sexual partnerships included incarceration, substance use, early onset of sexual activity, impulsive decision-making, and masculinity attitudes (i.e., men''s adherence to culturally defined standards for male behavior). In a multivariate model, both masculinity ideology and impulsive decision-making independently predicted concurrent sexual partnerships independent of other risk factors.ConclusionMasculinity attitudes and impulsive decision-making are independent predictors of concurrent sexual partnerships among rural African American men and, consequently, the spread of HIV and other STIs. Developing programs that target masculinity attitudes and self-regulatory skills may help to reduce concurrent sexual partnerships.African American men who have sex with women (hereinafter referred to as heterosexual) are an understudied group that has experienced rising rates of human immunodeficiency virus (HIV) infection and high rates of other sexually transmitted infections (STIs).¹ Since 2004, HIV diagnoses among African American men who report heterosexual contact have been increasing by more than 9% annually,² and approximately 25% of African American men currently living with HIV/acquired immunodeficiency syndrome (AIDS) reported contracting the disease through heterosexual contact.³ Heterosexual transmission of HIV is facilitated by non-HIV STIs, both inflammatory and ulcerative, which increase HIV infectivity and susceptibility in both women and men.⁴ Thus, risk conferred by STIs acquired in heterosexual relationships affects the spread of HIV in a community and highlights the importance of investigating heterosexual men''s behavior.Engaging in concurrent sexual partnerships has been identified as a potential influence on the HIV/STI epidemics in African American communities.^5–7 Concurrent sexual partnerships describe situations in which an individual has overlapping sexual relationships with more than one person. They can be contrasted with serial monogamy, in which an individual has a sexual relationship with only one partner, with no overlap in time with subsequent partners. Population-based studies have linked concurrent sexual partnerships to male sex, younger age, and African American race.⁷ Structural drivers, such as community poverty and gender ratios, appear to play a key role in the prevalence of African American men''s concurrent sexual partnerships.^8,9 In multiethnic samples, associations also have emerged between concurrent sexual partnerships and a range of personal risk factors, including unemployment and economic distress, substance use, history of incarceration, early onset of sexual activity, and perception of partner infidelity.^5,10–12 Less is known, however, about individual differences in the social, behavioral, and psychological factors that predict concurrent sexual partnerships, specifically among African American men.The African American men in the present study live in small towns and rural communities in southern Georgia. In these communities, interconnected sexual networks increase the risks that concurrent sexual partnerships pose. In addition, this study focused on men with a primary sexual partner. Compared with men without a primary partner, men with a primary partner report more frequent intercourse and less consistency in condom use with their primary partners.^13,14 In the context of concurrent sexual partnerships, these factors amplify exposure to pathogens for men and their sexual partners. Little research, however, focuses on correlates of concurrent sexual partnerships specifically among African American men with a primary partner.We investigated previously identified personal risk factors, including incarceration history, early onset of sexual activity, and substance use.^6,10,15 We also considered two psychological processes, masculinity attitudes (i.e., men''s adherence to culturally defined standards for male behavior) and impulsive decision-making, that have been suggested as targets of study.^15–17 Little research addresses the influence of psychological processes associated with African American men''s concurrent sexual partnerships despite the important role psychological factors play in designing individual-, group-, and community-level interventions.The first psychological risk mechanism is masculinity attitudes. In his anthropological work with African American and Caribbean men, Whitehead¹⁸ described a set of reputation-based attributes that men may adopt to maintain masculine self-esteem. These attributes include sexual prowess, masculine “gamesmanship” skills (e.g., toughness and ability to seduce women), fathering numerous children, and street smarts. In contrast, masculine respectability attributes include marriage, economic provision for one''s family, and satisfactory possessions and accomplishments (e.g., a home, higher education, and economic independence). When men from economically disadvantaged backgrounds experience barriers to respect-based pathways to masculinity, they become more likely to express and identify with reputation-based attributes to achieve a sense of masculine self-esteem.^18,19 Masculinity attitudes characterized by endorsement of reputation-based assets are hypothesized to place men at risk for concurrent sexual partnerships.The second psychological risk mechanism is impulsive decision-making, which has been implicated in a range of sexual risk behaviors, including inconsistent condom use, casual sex, multiple sexual partners, and sex while intoxicated.^20–24 Impulsive behavior has been thought to result from personality factors that include sensation seeking, urgency, and a lack of premeditation and perseverance.²⁵ A number of possible pathways support the link between impulsive decision-making and concurrent sexual partnerships. Impulsive individuals lack the self-regulatory capacity needed to resist hedonistic impulses when opportunities for concurrent sexual activity arise.²² Impulsive decision-making also reduces men''s ability to deal with stresses in committed relationships that can undermine sexual fidelity.^24,26,27     

Risk and Protective Factors for Social Anxiety Among Sexual Minority Individuals

Archives of Sexual Behavior - Minority stress processes represent clear determinants of social anxiety among sexual minority populations. Yet sources of resilience to social anxiety are less...     

Heterosexual Marital Intention: The Influences of Confucianism and Stigma Among Chinese Sexual Minority Women and Men

Archives of Sexual Behavior - In traditional Confucianist culture in China, marriage and offspring are highly valued, placing sexual minority adults under tremendous pressure to marry an opposite...     

School Environment and the Mental Health of Sexual Minority Youths: A Study Among Dutch Young Adolescents

Objectives. We examined whether structural elements of the school environment, in particular cultural pluralism and consistency and clarity of school rules and expectations of students, could mitigate the risk for mental health problems among young sexual minority adolescents.Methods. Data were collected in 2008 by means of a computer-based questionnaire completed at school by 513 young Dutch adolescents (12–15 years old) during regular class times. Eleven percent of these students, who were enrolled in 8 different schools, reported having at least some feelings of same-sex attraction.Results. Adolescents with same-sex attractions in schools where rules and expectations were experienced as less consistent and clear reported significantly more mental health problems than their peers with no same-sex attractions in the same schools. Such differences were absent in schools where rules and expectations were experienced as more consistent and clear. There were no such effects of cultural pluralism.Conclusions. Our results suggest that schools with consistent and clear rules and expectations mitigate the risk for mental health problems among students with same-sex attractions and underscore the importance of structural measures for the health of sexual minority youth.Shocking reports appear in the press with some regularity about the bullying of adolescents who are gay or lesbian or who are perceived as such, sometimes resulting in suicide attempts and even actual suicides.^1–3 Such reports draw attention to the role of schools: what can schools do to protect sexual minority youths?Studies conducted in various countries have shown that sexual minority youths are at disproportionate risk for several negative health outcomes, including victimization, witnessing and perpetrating violence, substance use, sexual risk behaviors, and suicide ideation and attempts.^4–9 A recent Dutch study of younger adolescents (13- to 15-year-olds) showed that those experiencing same-sex attractions had significantly higher levels of depression and lower self-esteem than did their peers not experiencing same-sex attractions.¹⁰Sexual minority youths come of age in a society that is often hostile to their interests and needs. Increased health problems in these youths are usually understood as a consequence of discrimination by peers and family. Victimization in high school has been shown to be positively associated with mental health and traumatic stress symptoms in sexual minority youths.¹¹ In a survey of Illinois middle school students, being the target of homophobic verbal harassment was associated with higher levels of anxiety and depression, personal distress, and a lower sense of school belonging among boys and higher levels of withdrawal among girls.¹²Homophobic bullying by classmates can start at an early age, as suggested by the April 2009 suicides of 2 boys, both 11 years old, in Massachusetts and Georgia, each bullied at school for being perceived as gay.^1,2 In a study involving a community-based sample of self-identified lesbian, gay, and bisexual youths (aged 15–19 years) who were interviewed about their lifetime experiences of sexual orientation victimization, the mean ages at which verbal victimization began were 11.4 years for male participants and 14.4 years for female participants.¹³ The corresponding mean ages at which physical victimization began were 13.1 years and 14.2 years.¹³ School was reported as the setting for 72% of first experiences with verbal victimization and 56% of first experiences with physical victimization.¹³A few studies suggest that structural factors may affect how young people feel at school. In one investigation, students who reported having a Gay–Straight Alliance (GSA) at school, knowing where to go for information and support related to sexual orientation and gender identity, and having lesbian, gay, bisexual, and transgender (LGBT) issues included in their school curriculum were more likely to report feeling safe at school than were those who did not have these resources.¹⁴Another study showed that sexual minority students in schools that have a comprehensive harassment policy (i.e., specifying sexual orientation or gender identity and expression) are less frequently verbally harassed and hear fewer homophobic remarks than students in schools with no policy or a policy not specifically inclusive of LGBT people; students reported that school personnel were also more likely to intervene upon hearing homophobic remarks in these schools.¹⁵ Feeling safe at school seems to be a protective factor for sexual minority youths. In one study, feeling safe at school attenuated the association between sexual orientation and suicidal ideation and attempts.¹⁶Further support for the importance of structural factors comes from a cross-sectional study that compared rates of victimization and suicidality among sexual minority adolescents in schools with and without GSAs and other school programs.¹⁷ Using data from the Massachusetts Youth Risk Behavior Survey and controlling for student demographic characteristics and school characteristics, Goodenow et al. showed that sexual minority youths in Massachusetts schools with GSAs were less than half as likely as those in other schools to report dating violence, being threatened or injured at school, or skipping school as a result of fear; in addition, they were less than one third as likely to report multiple suicide attempts in the past year.Goodenow et al. also found that peer support groups other than GSAs, nonacademic counseling, school antibullying policies, a student judiciary, staff training on sexual harassment, and peer tutoring systems were associated with lower rates of victimization and suicidality among sexual minority students. Sexual minority youths from schools where there was a perception that school staff could be approached about a problem were less likely to report multiple suicide attempts, and those from schools where antibullying policies were in place were less likely to report single or multiple suicide attempts.Building on existing knowledge, we explored whether a protective school climate offsets negative health outcomes among young adolescents. In particular, we hypothesized that when schools support cultural pluralism and have consistent and clear rules and expectations, the relationship between same-sex attraction and mental health will be attenuated.     

Promoting the Successful Development of Sexual and Gender Minority Youths

Because of societal discomfort with atypical expressions of sexual orientation and gender identity, lesbian, gay, bisexual and transgender (LGBT) youths have experienced enhanced developmental challenges compared with their heterosexual peers.A recent special issue of the American Journal of Public Health delineated how social stigma affecting LGBT youths has resulted in a wide range of health disparities, ranging from increased prevalence of depression and substance use to downstream effects, such as an increased risk for cancer and cardiovascular disease when older.We review the clinical significance of these findings for health care professionals, who need to become informed about these associations to provide better care for their sexual and gender minority youth patients, and to be able to educate their parents and other caregivers.Homosexual and gender nonconforming behaviors have been variably expressed in different cultures since the beginning of recorded history. However, only in recent years has there been sufficient scholarship about sexual and gender minority youths to enable clinicians to learn more about the unique health needs of these populations.1 For most of the 20th century and previous centuries, sexual and gender minority people were not recognized as discrete populations that required specific, culturally responsive attention from health care professionals and public health programs. However, awareness increased after the emergence of the gay liberation movement in the late 1970s, and was exponentially enhanced as clinicians began to recognize an increasingly varied panoply of sexually transmitted infections, culminating with the AIDS epidemic. These observations were only the tip of the iceberg, because many health issues faced by sexual and gender minorities were not exclusively related to their sexual behavior, but were often a response to the stigma and discrimination they experienced.2 Societal understanding of these issues has been informed by the emerging awareness of health disparities that are not only prevalent among racial and ethnic minority populations, but are common among sexual and gender minority populations.3 This emerging awareness has also led to the recognition that health systems must become responsive to the reality of a diverse array of minority health disparities, to enhance access to appropriate health care for disenfranchised populations.4 An understanding of the reasons why specific populations may not fully engage in care is critical to creating more culturally responsive systems for health care, as well as the specific clinical conditions that may be more prevalent in subpopulations. It is also important that clinicians learn how to improve the ways that sexual and gender minority youths experience their clinical care, including evaluating how provider attitudes may affect physicians’ ability to provide nonjudgmental care.For sexual and gender minority populations, the recognition of the importance of addressing their unique health needs is a recent development.5 Historically, many key professional documents, such as the early versions of the Diagnostic Management System (DSM) of the American Psychiatric Association, presumed that individuals who were homosexual or who displayed gender nonconformity were ipso facto experiencing a mental health illness. Only in recent decades have health professionals recognized that past dogma and professional bias caused much harm, and prevented development of ways for providers to help their sexual and gender minority patients to optimize their resilience to lead confident, healthy, productive lives.6,7 Health care professionals’ understanding of sexual and gender minority subcultures is particularly important to ensure the successful growth and development of lesbian, gay, bisexual and transgender (LGBT) youths, given young people’s developmental vulnerabilities, and the normative role that trusted health professionals can play. The February 2014 issue of the American Journal of Public Health has provided a wide array of studies based on recent data from the Youth Risk Behavioral Survey (YRBS) system, which provides data that can inform and improve the clinical care of sexual and gender minority youths.Careful analyses of the life experiences of sexual and gender minority populations suggest that proximate causes of psychological distress and risk-taking behavior for some stem from early childhood experiences, including physical and emotional abuse by family or peers, as well as general societal stigma and discrimination (Institute of Medicine5 [IOM]), resulting in dysfunctional behavior.8,9 Similar health disparities (e.g., increased risk for HIV or sexually transmitted infection), depression, and substance use are now being recognized among sexual and gender minorities in developing countries.10 These findings suggest that successful responses to the global HIV/AIDS epidemic will require the development of culturally sensitive programs that address concomitant clinical concerns and root causes, such as societal and institutional homophobia. Research is needed to understand how the majority of sexual and gender minority people lead resilient and productive lives in the face of discrimination and to develop assets-based interventions that build on the community supports that they have created.