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...     

Gender Dysphoria and Sexual Well-Being Among Trans Masculine and Nonbinary Individuals

Archives of Sexual Behavior - Prior qualitative research has noted that gender dysphoria impacts sexual engagement and satisfaction for many trans masculine and nonbinary individuals. As such, the...     

Correction to: Risk and Protective Factors for Social Anxiety Among Sexual Minority Individuals

Archives of Sexual Behavior - The figure given in Row 7, Column 9 in Table 2 in this article as originally published was incorrect.     

A Systematic Review of Family Victimization Experiences Among Sexual Minority Youth

Sexual minority youth experience substantially higher rates of family victimization than their heterosexual peers. No systematic review has yet identified the predictors and consequences in this vulnerable population of childhood abuse, exposure to sibling abuse and domestic violence, and sibling aggression. This systematic review aims to (a) describe differences in these family victimization rates by sexual orientation, gender, and race/ethnicity; (b) identify potential sexual minority and non-sexual minority-specific risk factors; and (c) identify physical, mental, and behavioral health and extrafamilial victimization correlates. The systematic review, which followed PRISMA guidelines, yielded 32 articles that met study inclusion criteria. Rates of childhood physical, sexual, and emotional abuse were consistently higher for sexual minority youth than for their heterosexual peers. Bisexual youth appear to be at greater risk for physical abuse than their gay and lesbian peers. Younger age at sexual minority milestones (first awareness, disclosure, and same-sex sexual contact) and higher levels of sexual minority-specific (sexuality disclosure, gender non-conformity) and non-sexual minority-specific (delinquent behaviors, parental drinking) risk factors were associated with higher rates of family victimization. Sexual minorities who experienced some form of childhood abuse reported more frequent physical (higher rates of HIV, higher BMIs, lower levels of perceived health), mental (higher rates of depression, PTSD symptoms, experiential avoidance, internalized homophobia), and behavioral (higher rates of suicidality, substance misuse, earlier sexual debut, unprotected anal sex) health problems relative to heterosexual or non-abused sexual minority peers. Sexual minority females who experienced childhood physical or sexual abuse were at greater risk than abused sexual minority males for sexual assault later in life. We conclude this systematic review with recommendations for future research, including the necessity for longitudinal research that utilizes a poly-victimization conceptual framework to identify the developmental pathways connecting risk factors, different types of family victimization, and health and extrafamilial victimization consequences.     

Depression and Sexual Orientation During Young Adulthood: Diversity Among Sexual Minority Subgroups and the Role of Gender Nonconformity

Sexual minority individuals are at an elevated risk for depression compared to their heterosexual counterparts, yet less is known about how depression status varies across sexual minority subgroups (i.e., mostly heterosexuals, bisexuals, and lesbians and gay men). Moreover, studies on the role of young adult gender nonconformity in the relation between sexual orientation and depression are scarce and have yielded mixed findings. The current study examined the disparities between sexual minorities and heterosexuals during young adulthood in concurrent depression near the beginning of young adulthood and prospective depression 6 years later, paying attention to the diversity within sexual minority subgroups and the role of gender nonconformity. Drawn from the National Longitudinal Study of Adolescent Health (N = 9421), we found that after accounting for demographics, sampling weight, and sampling design, self-identified mostly heterosexual and bisexual young adults, but not lesbians and gay men, reported significantly higher concurrent depression compared to heterosexuals; moreover, only mostly heterosexual young adults were more depressed than heterosexuals 6 years later. Furthermore, while young adult gender nonconforming behavior was associated with more concurrent depression regardless of sexual orientation, its negative impact on mental health decreased over time. Surprisingly, previous gender nonconformity predicted decreased prospective depression among lesbians and gay men whereas, among heterosexual individuals, increased gender nonconformity was not associated with prospective depression. Together, the results suggested the importance of investigating diversity and the influence of young adult gender nonconformity in future research on the mental health of sexual minorities.     

Patterns of Union Formation Among Urban Minority Youth in the United States

Since 1990, several large surveys of sexual behavior have been conducted. In addition to collecting general information on sexual histories, such as number of partners in the previous year and whether subjects ever used condoms, these studies collected information on sexual behavior with specific partners, or partnerships. The data are useful both for testing of substantive hypotheses about the determinants of behavior as well as for disease transition modeling. The objective of this paper is to use partnership histories to describe the union formation patterns of low-income youth living in Detroit. Data from the partnership histories will be used to illustrate the types of statistics that can be generated from these histories. Data will be presented on the number and types of unions (married/cohabiting, knew well, casual), the frequency and duration of these unions, the types of intercourse reported in each type of union, the patterns of mixing by age and ethnic group in each type of union, concurrency in unions, and condom use in unions.     

Sexual Minority Identity and Mental Health Among Individuals on the Asexuality Spectrum in China: A Longitudinal Study

Archives of Sexual Behavior - This study examined the association between sexual minority identity and mental health among Chinese asexual individuals. Data were collected in two waves at 12-months...     

Sexual Orientation Among Gender Diverse Youth

PurposeMany youth are gender diverse, but our understanding of sexual orientation among gender diverse youth (GDY) is limited. We sought to compare sexual identity, attraction, and contact between cisgender youth and GDY and to describe these characteristics across GDY subgroups.MethodsWe analyzed cross-sectional data from school-based surveys of 4,207 adolescents. Two-sample t-tests or chi-squared tests compared characteristics between GDY and cisgender youth. Sexual attraction/contact was summarized with frequencies/proportions and stratified by transmasculine, transfeminine, and nonbinary identities.ResultsTwo hundred eighty-one (9.1%) youth were GDY. Compared to cisgender peers, GDY were more likely to identify as sexual minority youth. In total, 29.9% of GDY were transmasculine, 36.7% transfeminine, and 33.5% nonbinary. Many transmasculine (45%) and transfeminine (58%) youth identified as heterosexual; most nonbinary youth (91%) identified as sexual minority youth. For transgender youth identifying as heterosexual, sexual attraction/contact varied.DiscussionAspects of sexuality among GDY remain complex, warranting individualized approaches to sexual/reproductive healthcare.     

Sexual Coercion and Behavior Among a Sample of Sexual Minority Women

Sexual coercion may affect the sexual experiences of sexual minority women differently. Women (n = 445) aged 18 to 71 years (Mean = 30.38) answered an online survey on sexual orientation, lifetime coercion, and sexual history. Sexual minority women (45.8%, n = 204) were more likely to report having been coerced into unwanted sexual behavior (56.5%) than heterosexual women (44.8 %; p = 0.010). Coerced sexual minority women reported earlier ages of initiation into performing oral sex (p = 0.016), penile-vaginal (p = 0.024), and penile-anal (p = 0.027) intercourse. In multiple logistic regression models, currently being in a partnered relationship was the sole factor related to lifetime engagement in penile-vaginal intercourse and receiving oral sex from partners. Having at least a graduate degree was the only characteristic related to engagement in lifetime penile-anal intercourse. Sexual coercion was not related to any lifetime sexual behavior outcomes. The nature of sexual initiation and coercion should be explored further among sexual minority women, with the goal of incorporating their experiences into prevention and treatment initiatives.     

Breastfeeding Initiation and Continuation Among Sexual Minority Women

Maternal and Child Health Journal - Identify disparities in breastfeeding initiation and continuation among sexual minority women (SMW) and determine if known risk factors explain any observed...     

Correlates of Sexual Risk Among Sexual Minority and Heterosexual South African Youths

We explored psychosocial correlates of sexual risk among heterosexual and sexual minority youths (SMYs) in Johannesburg, South Africa. Young people 16 to 18 years old (n = 822) were administered surveys assessing demographic characteristics, sexual behaviors, mental health, and parent–child communication. Adjusted multivariate regressions examining correlates of sexual risk revealed that SMYs had more sexual partners than heterosexual youths (B = 3.90; SE = 0.95; P < .001) and were more likely to engage in sex trading (OR = 3.11; CI = 1.12-8.62; P < .05). South African SMYs are at increased risk relative to their heterosexual peers.South Africa has the highest burden of HIV in the world; 9.2% of young persons aged 15 to 19 years living in the country are infected with HIV.1,2 Few studies have examined multilevel sexual risk factors (e.g., individual, partner, family) among sexual minority youths (SMYs)3 in South Africa, despite their increased vulnerability.4–8 Research has shown that rates of sexual risk behavior are high among adult men who have sex with men (MSM) in sub-Saharan Africa,5,9 and South African SMYs may be especially vulnerable given the transitional nature of adolescence, fear of discrimination, and lack of cultural acceptance of homosexuality.4,7,10Our analyses were guided by theories of syndemics (i.e., collective risk or co-occurring epidemics)11–13 and minority group stress.14 These theories posit that young MSM experience psychosocial disparities in numerous areas (substance use, abuse and victimization, mental health problems, risk taking)15–18 and that SMYs are at increased risk for poor mental health, sexual vulnerability, substance use, and violence.19,20 Moreover, stigma creates stressful environments, another cause of mental health problems among SMYs.14 This situation is especially salient in South Africa, where same-sex behavior is so highly stigmatized that even normative adolescent sexual exploration would likely be denounced.7We hypothesized that South African SMYs would be at increased sexual risk relative to heterosexual youths. To our knowledge, this is one of the first investigations to examine risk and protective factors associated with sexual risk in this population.     

Physical Dating Violence Victimization Among Sexual Minority Youth

Objectives. We examined (1) whether sexual minority youths (SMYs) are at increased risk for physical dating violence victimization (PDVV) compared with non-SMYs, (2) whether bisexual youths have greater risk of PDVV than lesbian or gay youths, (3) whether youths who have had sexual contact with both sexes are more susceptible to PDVV than youths with same sex–only sexual contact, and (4) patterns of PDVV among SMYs across demographic groups.Methods. Using 2 measures of sexual orientation, sexual identity and sexual behavior, and compiling data from 9 urban areas that administered the Youth Risk Behavior Surveys from 2001 to 2011, we conducted logistic regression analyses to calculate odds of PDVV among SMYs across demographic sub-samples.Results. SMYs have significantly increased odds of PDVV compared with non-SMYs. Bisexual youths do not have significantly higher odds of PDVV than gay or lesbian youths, but youths who had sexual contact with both-sexes possess significantly higher odds of PDVV than youths with same sex–only sexual contact. These patterns hold for most gender, grade, and racial/ethnic subgroups.Conclusions. Overall, SMYs have greater odds of PDVV versus non-SMYs. Among SMYs, youths who had sexual contact with both sexes have greater odds of PDVV than youths with same sex–only sexual contact. Prevention programs that consider sexual orientation, support tolerance, and teach coping and conflict resolution skills could reduce PDVV among SMYs.Dating violence refers to any stalking behaviors, psychological, physical or sexual violence perpetrated by a partner toward a current or former dating partner; violence may be perpetrated in-person or electronically (e.g., repeated unwanted texts, cyberstalking).1 The prevalence of dating violence victimization reported across studies varies by definition, measure, and population.2 In general, between 10% and 30% of adolescent samples reported experiencing some form of dating violence.2 There are few studies on dating violence among sexual minorities, defined either by sexual identity (e.g., gay or lesbian, bisexual) or by sexual contact (e.g., sexual contact with same sex–only or contact with both sexes), and they suggested that prevalence may vary from 11% to upwards of 40%.3–6 In a convenience sample of adolescents, Freedner et al. found that bisexual boys had 3.6 times the odds of experiencing any form of dating violence compared with heterosexual boys and lesbians had 2.4 times the odds of reporting fear for their safety in the context of a dating relationship compared with heterosexual girls.4 In a sample of 10 schools in New York, researchers found that 42% of lesbian, gay, and bisexual students reported experiencing physical dating violence compared with 29% of heterosexual students.3 Using data from 8 states, an analysis of the Youth Risk Behavior Surveys found that physical dating violence victimization (PDVV) in the past 12 months ranged from 6.1% to 13.8% among heterosexual students, from 19.1% to 29.2% among gay or lesbian students, and from 17.7% to 28.0% among bisexual students.6 Based on sex of sexual contact, the prevalence of dating violence victimization ranged from 11.5% to 17.1% among students who only had sexual contact with the opposite sex, from 16.3% to 26.2% among students who only had sexual contact with the same sex, and from 26.3% to 39.6% among students who engaged with both sexes.6 Only 1 study showed relatively low prevalence of PDVV―among 117 youths in the National Longitudinal Study of Adolescent Health who reported same-sex romantic or sexual relationships, 11% reported experiencing any physical violence in the past 18 months.5Many reasons exist for a higher prevalence of dating violence among sexual minority youths (SMYs). Although many youths face stressors in adolescence as they develop their social and sexual identities, this pressure may be more intense for SMYs who often grow up amidst individual and institutional stigma, prejudice, and discrimination toward sexual minorities. This hostile social environment may lead to feelings of shame and isolation, denying one’s sexuality, internalized homophobia, depression, negative health behaviors, less favorable perceptions of the quality of one’s relationships, and relationship violence.7–10 Other related reasons for increased relationship violence may include difficulties among some SMYs in navigating their gender identity and gender expression which may play a role among some SMYs and create tensions in relationships.11 SMYs, like their heterosexual peers are also influenced by strict gender roles and social norms of behaving depicted in the “mainstream” culture.12,13 For example, a partner may take on a more dominant role and expect the other partner to conform. Without visible role models, issues of dominance and submissiveness may become destructive.11 Other stressors within heterosexual couples also play out in sexual minority relationships such as power imbalances attributed to social class differences, jealousy, incompatibility, and a lack of recognition of unhealthy relationships stemming from absent role models.11 When SMYs do recognize violence in their relationships, they may be less likely to seek help for fear of reprisal or rejection upon coming out.14 Additionally, services and education received may lack cultural appropriateness.15 These factors may keep youths feeling stuck in violent relationships. SMYs may also be afraid to leave a violent relationship because they don’t see other relationship options for themselves given low visibility of sexual minorities in the community.11The short- and long-term consequences of dating violence have been well documented and include variety of negative physical, social, and mental health outcomes including injury, fear, depression, substance abuse, sexual risk behaviors, suicidal ideation, school failure, and eating disorders.12,16–19 Findings from 2 studies suggested that the consequences of dating violence among sexual minorities may be even more severe with increased risk of HIV infection in populations experiencing intimate partner violence.20,21 Numerous risk factors have been associated with dating violence in past research. These factors include having multiple sexual partners, depression, anxiety, substance use, or aggression, holding traditional gender views, having antisocial friends or friends who perpetrate dating violence, witnessing or experiencing family violence, having a poor relationship with parents, and low parental monitoring.22More research on the prevalence of dating violence among SMY youths is needed to guide research on etiology and prevention of such violence. According to Wolfe et al., adolescent dating violence may be a stepping-stone to adult intimate partner violence,23 so prevention is imperative. Specifically, understanding which sexual minorities are at increased risk is essential as sexual minorities are not a single homogenous group. Examining results within sexual minority groups (e.g., lesbian or gay or bisexual) requires large sample sizes. To date, most studies have employed relatively small convenience samples and have often grouped all sexual minorities together.4,5 Additionally, stratified analyses by race/ethnicity remain absent in the literature of dating violence among SMYs, perhaps because of sample size limitations.To address these gaps, we combined data from large population-based local Youth Risk Behavior Surveys from 2001 to 2011 to examine PDVV experienced by SMY groups and stratified analyses by demographic characteristics (e.g., gender or race/ethnicity). We used 2 measures of sexual orientation, sexual identity and sexual behavior, which allowed for the inclusion of more SMYs in the analyses, because not all youths who engage in same-sex behavior identify as a sexual minority and similarly not all youths who identify as a sexual minority engage in sexual behavior. We sought to examine the following: (1) whether SMYs (based on both definitions) are at increased risk for PDVV compared with non-SMYs, (2) whether bisexual youths have a higher risk of PDVV than do lesbian or gay youths, (3) whether youths with sexual contact with both-sexes have a higher risk of PDVV than do youths with same sex–only engagement, and (4) patterns of PDVV among SMYs in different demographic groups.     

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.     

Awareness and Knowledge of Pre-exposure Prophylaxis Among Sexual and Gender Minority Adolescents Assigned Male at Birth in the United States

Archives of Sexual Behavior - Sexual and gender minority (SGM) adolescents assigned male at birth are at increased risk for HIV infection. Pre-exposure prophylaxis (PrEP) is a daily pill taken to...