Sexual Orientation Trajectories Based on Sexual Attractions,Partners, and Identity: A Longitudinal Investigation From Adolescence Through Young Adulthood Using a U.S. Representative Sample

Defining sexual minority status longitudinally over critical developmental periods is essential for understanding the roots of health disparities. Theory supports multidimensional continuums, but current research often examines single measures of sexual activity, sexual attractions, or self-labeled identity separately. Here, a new typology of longitudinal latent classes describes dynamic multidimensional processes continuing from late adolescence (ages 16 to 18) through the late 20s. Using Add Health data (N = 6,864), longitudinal latent class analysis (LLCA), a person-centered approach, showed significant differences between the orientation experiences of males and females (invariance tests led to stratification by sex). The male LLCA model predicted four classes: straight males (87.4%), minimal sexual expression males (6.5%), mostly straight and bi males (3.8%), and emerging gay males (2.4%). The female LLCA model predicted five classes: straight females (73.8%), minimal sexual expression females (7%), mostly straight discontinuous females (10.2%), emerging bi females (7.5%), and emerging lesbian females (1.5%). Some classes represent generally consistent indicators across dimensions over time, while other classes describe more emerging or discontinuous trajectories. Substantial changes were common not only from late adolescence to the early 20s but also from the early 20s to the late 20s, indicating that sexual orientation development continues throughout emerging adulthood.     

Understanding Sexual Minority Health Disparities in Rural Areas

This article reviews research from several disciplines including sociology, psychology, and public health to examine recent inconsistencies in findings of rural/urban health disparities among sexual minority populations. Previous work has found that sexual minorities (lesbian, gay, and bisexual individuals) report worse health than their heterosexual counterparts on many physical and mental health measures. To understand this occurrence, scholars have situated these findings most often within either minority stress or fundamental cause frameworks. These theories attribute health differences to unique stressors and stigmatization experienced by sexual minorities within a heteronormative social climate. This review provides an overview of specific health disparities by gender and sexual orientation, critically examines research on rural/urban health differences among sexual minorities, and offers three avenues for future research to help remedy the inconsistent results of previous rural/urban sexual minority health disparities research. Discussions of the ‘rural effect,’ rural social support resources, and the importance of geographic region for health are included as opportunities to further social scientific research on sexual minority health disparities.     

An Analysis of Health Care Disparities and Subsequent Public Policy Initiatives

Racial and ethnic health disparities are a major clinical, public health, and societal problem in the United States. This article provides a historical analysis of the identification and progression of health disparities between Whites and minorities from 1989 to 2011. Key causes of health disparities are addressed, including the lack of culturally competent care, health insurance, and medical homes. Federal legislation that mandated federal health agencies to implement a plan to eliminate disparities is discussed.     

Stress,Stigma, and Sexual Minority Status: The Intersectional Ecology Model of LGBTQ Health

One of the four overarching goals of Healthy People 2020 is to achieve health equity, eliminate health disparities, and improve the health of all groups, including the health of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) populations. In 2011, the Institute of Medicine (IOM) released a report that drew attention to the unique health disparities experienced by sexual minorities and underscored the need for a comprehensive approach to sexual minority health research. This article proposes a new model of LGBTQ health to help measure, explore, explain, and predict the impact of sexual minority status on health outcomes. The Intersectional Ecology Model of LGBTQ Health (IEM) demonstrates how the relentless hypervigilance of LGBTQ individuals in a heteronormative society impacts health outcomes through the primary vehicles of stigma and chronic, elevated stress. The purpose of the IEM is to guide future research and enhance public health practice for LGBTQ populations.     

Mental health and substance use of sexual minority college athletes

ABSTRACT

Objective: Assess the mental health and substance use of sexual minority collegiate student-athletes in the United States, as compared with heterosexual college students and heterosexual student-athletes. Participants: Undergraduate students (N = 196,872) who completed the American College Health Association's National College Health Assessment (Fall 2008–Fall 2012 administrations). Methods: Written cross-sectional survey. Results: Sexual minority student-athletes had a higher risk of experiencing mental health difficulties than their heterosexual athlete peers. There were no significant differences in mental health between sexual minority male athletes and nonathletes. Sexual minority female athletes appeared to fare better than nonathlete peers. Substance use was greater among sexual minority students (athlete and nonathlete) and was mediated by mental health. Conclusions: Participation in athletics does not appear to be associated with an elevated risk of negative mental health outcomes for sexual minority participants; however, there are disparities in mental health outcomes by sexual orientation regardless of athletics participation.     

Drinking Motives,Alcohol Use,and Sexual Attraction in Youth

Sexual minority youth were found to be more likely to drink alcohol during weekdays compared to heterosexual youth. Drinking during weekdays was associated with consuming alcohol as a coping strategy. Sexual minority youth also more frequently consumed alcohol to eliminate personal worries (coping) and to not be excluded by their peers (conformity). Sexual orientation–related alcohol problems should be addressed at an early stage. Such efforts are likely to be effective if insecurities and stress related to sexual orientation are addressed as well.     

Distressing Sexual Difficulties in Heterosexual and Non-Heterosexual Croatian Men: Assessing the Role of Minority Stress

Although research has shown a connection between minority stressors and internalizing mental health problems, the role of minority stress has mainly been neglected in the assessment of sexual problems among non-heterosexual men. Using online samples of heterosexual (n = 933) and non-heterosexual participants (n = 561) aged 18 to 50 years, this study aimed to comparatively assess sexual difficulties and problems and explore the role of minority stress in non-heterosexual men's sexual problems. Although the age-adjusted odds of reporting rapid ejaculation, delayed ejaculation, and sex-related anxiousness significantly differed between the two groups, the overall prevalence of sexual difficulties and the associated levels of distress did not significantly differ between the samples. In multivariate assessment, anxiety and depression significantly increased the odds of reporting distressing sexual difficulties among both heterosexual and non-heterosexual participants. In the non-heterosexual sample, positive body image significantly decreased the odds of experiencing sexual problems. Pointing to a role of minority stress, highest levels of victimization related to sexual orientation increased the risk of sexual problems. This association was partially mediated by negative emotions. Our findings offer some support for a recent call to include sexual orientation among the social determinants of health recognized by the World Health Organization.     

Missing from the Conversation: Sexual Risk Factors Across Young People by Gender Identity and Sexual Orientation

Abstract

Objectives: Lesbian, gay, bisexual, and queer/questioning (LGBQ), and transgender/nonbinary (trans/NB) youth experience health disparities. Much research combines gender identity with sexual orientation or siloes them, ignoring intersections. Methods: Logistic regressions with representative data from 2015 Healthy Kids Colorado Survey (n?=?15,970) explores sexual risk. Results: Findings indicate LGBQ and trans/NB youth have differential levels of sexual risk (drugs during sexual interactions, not using condoms) compared to cisgender heterosexual peers. Other identities, mental health, and bullying are also related. Conclusions: There is a need for culturally responsive bullying prevention, mental health support, education, and sexual health services for marginalized populations.     

Associations of Bisexual-Specific Minority Stress and Health Among Cisgender and Transgender Adults with Bisexual Orientation

Among sexual minorities, bisexuals are at the greatest risk for poor health due in part to prejudice and stigma. This research examined associations of bisexual-specific minority stress and health among cisgender (non-transgender) and transgender adults with bisexual orientation. Participants were 488 adults (378 cisgender women, 49 cisgender men, 61 transgender individuals), age 18 to 66 years, with bisexual orientation based on identity and/or attractions to multiple genders. Participants completed an online survey. Hierarchical linear regression analyses were conducted with sexual minority stress and bisexual-specific minority stress as the predictors and physical health, measured by the 36-Item Short Form Survey (SF-36), as the outcome. Models controlled for demographic variables. Moderation analyses were conducted to test for gender differences. Greater bisexual-specific minority stress significantly predicted poorer overall physical health (β = ?0.16), greater pain (β = ?0.16), and poorer general health (β = ?0.25) above and beyond the effects of sexual minority stress. Gender moderated the association between bisexual-specific minority stress and health, such that bisexual-specific minority stress predicted overall physical health and role limitations for transgender individuals but not for cisgender women. Addressing bisexual-specific minority stress is necessary to improve the health and well-being of bisexual individuals.     

Schools,Bullying, and Inequality: Intersecting Factors and Complexities with the Stratification of Youth Victimization at School

Bullying within United States (US) schools is a growing concern among parents, school officials and policymakers. In early 2011, the first‐ever White House Conference on Bullying Prevention was held in hope of addressing bullying within US schools. Although the social, political, and media attention is increasing, it is important to consider the complexities and disparities associated with school bullying. In this article, four of the wide array of influences that increase the vulnerabilities of youth to be a victim of bullying at school are reviewed: (i) race and ethnicity, (ii) being and immigrant, (iii) gender, and; (iv) sexual orientation. Understanding and acknowledging the inequalities associated with school bullying, as well as the policies implemented in response, is instrumental for the US’ efforts towards providing safe, healthy, and democratic learning environments.     

Traumatic Experiences and Drug Use by LGB Adolescents: A Critical Review of Minority Stress

High rates of illicit drug use found among lesbian, gay, and bisexual (LGB) adolescents are often attributed to unique and chronic traumatic events tied to sexual minority identity. Although initiation of drug use is relatively common within adolescence, little research contributes to our understanding of the disparities found among LGB adolescents. This review synthesized existing literature to determine if the minority stress model is applicable to LGB drug use disparities and fits within a trauma framework. Findings indicate that minority stress experiences have been inconsistently related to drug use among LGB adolescents. Implications for future research and practice are described.     

Well-Being Among Spanish Lesbian,Gay, Bisexual and Heterosexual Adults: Disclosure of Sexual Orientation to Family and Friends

Relevance of disclosure of minority sexual orientation on subjective (SWB) and psychological well-being (PWB) was analyzed. Participants were 236 men and 238 women self-identified as lesbian, gay, and bisexual (LGB) or heterosexual. No differences in SWB were found between heterosexuals and LGBs. Heterosexual women showed greater environmental mastery than bisexual men and greater purpose in life than lesbian and bisexual women. Outcomes showed greater well-being among LGBs who disclosed their minority sexual orientation to parents later in life. Disclosing minority sexual orientation to parents was related with greater PWB. Further research that takes a differential approach to improve well-being for LGBs is needed.     

Brief Report: Sexual Wellbeing in Heterosexual,Mostly Heterosexual,and Bisexually Attracted Men and Women

Abstract

Objective: To assess differences in sexual wellbeing among men and women with exclusively heterosexual, mostly heterosexual, and bisexual attractions. Method: An anonymous online survey in a convenience sample of 597 young adults (394 women, 203 men; average age = 20.04) assessed patterns of sexual attraction, desire, sexual functioning, and sexual satisfaction using validated questionnaires. Results: Individuals with mostly heterosexual attractions reported significantly higher solitary sexual desire than exclusively heterosexual individuals (women: d?=?0.64; men: d?=?0.68). Partnered sexual desire did not differ between groups. Women with exclusively heterosexual attractions reported significantly higher sexual functioning and satisfaction than either mostly heterosexual or bisexually attracted women (functioning: d?=?0.29; satisfaction: d?=?0.47). Men with mostly heterosexual attractions reported significantly lower sexual functioning than either exclusively heterosexual or bisexually attracted men (d?=?0.40). Conclusions: There were significant differences between exclusively vs. mostly heterosexual individuals in several aspects of sexual wellbeing, supporting the assertion that mostly heterosexual may constitute a distinct orientation. Taken together with prior research showing higher rates of sexual dysfunction in bisexual women, these findings highlight sexual health disparities among nonmonosexual women. Efforts to support the sexual wellbeing of sexual minority individuals should include consideration of mostly heterosexual individuals, as this population may have unique sexual health needs.     

Older Hispanic Women and Breast Cancer Screening: Do Cultural Factors Matter?

High morbidity and mortality cancer rates among older minority adults underscores the importance of identifying and addressing health disparities related to age and cultural factors that may influence participation in cancer screening and early detection of disease. Disparities for Hispanic women exist in part due to behavior, including lower participation in cancer screenings. Using data from the 2008 wave of the Health and Retirement Study, this study investigated the relationships among cultural factors, time orientation, and uncertainty avoidance among Hispanic women. Results indicate that time orientation and uncertainty avoidance predicted older Hispanic women’s participation in breast cancer screening services.     

Bisexual Stigma,Sexual Violence,and Sexual Health Among Bisexual and Other Plurisexual Women: A Cross-Sectional Survey Study

Bisexual women experience higher rates of sexual victimization relative to heterosexual and lesbian women, and worse sexual health outcomes. Though these health disparities are well documented in the literature, few empirical data have been published on what factors are driving these disparities. Further, research documenting sexual victimization and health of plurisexual (i.e., attracted to more than one gender) women group all participants as bisexual. We do not know whether these experiences are similar across subgroups of plurisexual women. The current study reports on data from a cross-sectional survey, analyzing the relationships between bisexual-specific stigma and sexual violence, as well as other sexual health outcomes, across a sexually diverse group of plurisexual participants. Findings indicate that bisexual stigma is a significant predictor of lifetime sexual violence (odds ratio [OR] = 1.99, p = .015) and verbal coercion (OR = 2.60, p = .004), but not other outcomes. There are differences across sexual identity categories, with bisexual participants being less likely to report sexual violence and verbal coercion, and less likely to access sexually transmitted infection/human immunodeficiency syndrome testing, compared to other plurisexual groups. Our findings support that bisexual stigma is an important factor to consider in understanding sexual violence disparities experienced by bisexual and other plurisexual women.     

Patterns of Sexual Behaviors in Young Men Who Have Sex With Men in Mexico

Recent research has documented the importance of understanding the multidimensional nature of sexual risk behavior. However, little is known about patterns of sexual behavior among men who have sex with men (MSM) in Mexico, men who are at greatest risk for HIV and sexually transmitted infections compared to other subpopulations in the country. This study applied latent class analysis to data from a large, HIV-negative sample of 18- to 25-year-old Mexican MSM recruited from a social and sexual networking website (N = 3,722) to uncover multidimensional patterns of sexual behaviors, partner factors, and protective behaviors, and examine how these were associated with health and well-being correlates. We selected a model with seven classes. The most common class included those who reported both insertive and receptive behaviors with more than one partner, but smaller groups of individuals were in classes marked by only insertive or receptive anal sex, romantic relationships, or sexual inactivity. Class membership differed by sexual orientation, age, depressive symptoms, alcohol problems, and self-acceptance, with individuals in a class marked by same-sex relationships generally reporting more positive outcomes. Findings suggest heterogeneity of behaviors among Mexican MSM and the possible efficacy of prevention messages tailored to individuals’ specific patterns of sexual behavior.     

Development and Bicultural Validation of the New Sexual Satisfaction Scale

The development and bicultural validation of the New Sexual Satisfaction Scale (NSSS)—a 20 item, multidimensional, composite measure of sexual satisfaction—is presented. The development of the scale was based on a five-dimension, conceptual model that emphasized the importance of multiple domains of sexual behavior including sexual sensations, sexual awareness and focus, sexual exchange, emotional closeness, and sexual activity. Scale construction and validation were carried out using seven independent samples with over 2,000 participants aged 18 to 55 in Croatia and the United States. Primary data collection was completed using online survey tools. Analyses did not confirm the proposed conceptual framework but suggested a two-dimensional structure focusing on self (“ego-centered”) and the other (a “partner- and sexual activity-centered” factor) domains, each containing items representing all five conceptual dimensions. Scale reliability (k = 20) was satisfactory for all samples, and construct validity was confirmed in both cultures. The NSSS was also found to have acceptable one-month stability. It is suggested that the NSSS may be a useful tool for assessing sexual satisfaction regardless of a person's gender, sexual orientation, and relationship status.     

Bullying Victimization Trajectories for Sexual Minority Adolescents: Stable Victims,Desisters, and Late‐Onset Victims

Sexual minority adolescents are bullied more frequently than heterosexual peers. Research is lacking on their rates of general and sexual orientation bullying victimization. The present study identified (1) the rate, onset, and desistance of general and sexual orientation bullying victimization, (2) the rate of bullying victimization trajectories, and (3) risk and protective factors across trajectories. A life history calendar method and thematic analysis were employed with a sexual minority adolescent sample (N = 52, 14–20 y/o). General bullying began at age 5 and declined after age 12, with sexual orientation bullying increasing throughout adolescence. Late‐onset victim (34.6%) was the most common trajectory, followed by stable victim (28.9%), desister (23.1%), and nonvictim (13.5%). Differences in risk and protective factors were found across trajectories.     

The Sell Assessment of Sexual Orientation: Background and Scoring

The measurement of sexual orientations in research studies is becoming increasingly prevalent despite little critical examination of how this should be done. This paper reviews how sexual orientations have been measured historically, and provides a review of the strengths and limitations of each measure. Measures of sexual orientation are categorized as: 1) dichotomous, 2) bipolar (such as the Kinsey Scale), 3) multidimensional (such as the Klein Scale), and/or 4) orthogonal (such as the scale proposed by Shively and DeCecco). A new measure of sexual orientation, the Sell Assessment of Sexual Orientation, is proposed based upon this review. Finally, methods of scoring and summarizing the proposed measure are discussed.     

Access barriers to mental health services for older adults from diverse populations: perspectives of leaders in mental health and aging

This project is based on the results of telephone surveys with 52 local, state, and national informed respondents including policymakers, county leaders, planners, and advocates in mental health and aging with a particular focus on the states of California and Florida. This article addresses challenges to access to mental health services for diverse older adults including barriers related to race and ethnicity, socioeconomic status, location, age, gender, immigrant status, language, sexual orientation, and diagnosis. The article also highlights broad themes that emerged including (1) the importance of outreach and transportation tailored to diverse elders, and (2) recruitment of diverse staff and training related to diversity. The article concludes with policy and practice recommendations to reduce these disparities in access to mental health services for diverse populations of older adults.