Bisexual Adults Research Articles

An evaluation of measurement invariance of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition borderline personality disorder criteria across heterosexual, lesbian, gay, and bisexual adults.

There is a robust, yet poorly understood relationship between nonheterosexual orientation and borderline personality disorder (BPD), with lesbian, gay, and bisexual individuals evidencing greater BPD symptoms compared to heterosexual individuals. Recent evidence suggests possible psychometric bias in BPD diagnostic criteria leading to greater endorsement among sexual minority individuals, which hinders researchers' ability to make valid group comparisons. The present study utilized an epidemiological sample of 35,995 men and women to evaluate the extent of differential item functioning (DIF) among BPD criteria across sexual orientation groups using a multiple indicators multiple causes approach. All criteria except affective instability and emptiness indicated DIF for at least one sexual minority focal group, although both demonstrated DIF in sensitivity analyses. DIF was most consistently indicated for suicidality, efforts to avoid abandonment, and impulsivity. Contrary to predictions, DIF was mostly nonuniform with greater item discrimination for sexual minority groups compared to their heterosexual counterparts. Finally, all estimated effect sizes were small, suggesting that DIF was not practically meaningful and unlikely to impact the validity of group comparisons for BPD criteria across heterosexual and nonheterosexual men and women. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Substance Use and Adverse Mental Health Disparities Between Heterosexual and Sexual Minority Service Members in the U.S. Military.

Nationally representative studies have shown that lesbian, gay, and bisexual adults have higher levels of substance use than heterosexual adults. In the military, substance use is often associated with adverse mental health outcomes and is often comorbid with other mental health conditions and adverse or harmful behaviors. Few military studies to date have comprehensively examined the relationship between sexual orientation, mental health, and substance use. Data from the 2018 Health-Related Behaviors Survey (n = 17,166) were used. Univariate and multivariable logistic regression models were used to examine the association between sexual orientation and substance use. Regression models were also used to examine whether measures of mental health moderate the relationship between sexual orientation and substance use. Compared to heterosexual individuals, lesbian and gay individuals were more likely to engage in illicit drug use (adjusted odds ratio = 3.27; 95% CI, 1.45 to 7.36). Bisexual individuals were more likely to binge drink (adjusted odds ratio = 1.37; 95% CI, 1.08 to 1.74). Individuals with moderate or serious psychological distress were more likely to report binge drinking or smoking tobacco. Individuals with serious psychological distress were more likely to use illicit drugs. None of the interactions tested in this study were statistically significant. Substance use in the military was more likely among sexual minority individuals compared to heterosexual individuals. These findings reflect the patterns of substance use seen in the general population. Increased levels of psychological distress were associated with both the lesbian, gay, and bisexual population in this study and self-reported substance use behaviors. Further investigation of health disparities by sexual orientation may inform more efficacious treatment and prevention programs.

Supplemental Material for An Evaluation of Measurement Invariance of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Borderline Personality Disorder Criteria Across Heterosexual, Lesbian, Gay, and Bisexual Adults

Supplemental Material for An Evaluation of Measurement Invariance of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Borderline Personality Disorder Criteria Across Heterosexual, Lesbian, Gay, and Bisexual Adults

Cancer in people who identify as lesbian, gay, bisexual, transgender, queer, or gender-nonconforming.

Individuals who identify as lesbian, gay, bisexual, transgender, queer, intersex, or gender-nonconforming (LGBTQ+) experience discrimination and minority stress that may lead to elevated cancer risk. In the absence of population-based cancer occurrence information for this population, this article comprehensively examines contemporary, age-adjusted cancer risk factor and screening prevalence using data from the National Health Interview Survey, Behavioral Risk Factor Surveillance System, and National Youth Tobacco Survey, and provides a literature review of cancer incidence and barriers to care. Lesbian, gay, and bisexual adults are more likely to smoke cigarettes than heterosexual adults (16% compared to 12% in 2021-2022), with the largest disparity among bisexual women. For example, 34% of bisexual women aged 40-49 years and 24% of those 50 and older smoke compared to 12% and 11%, respectively, of heterosexual women. Smoking is also elevated among youth who identify as lesbian, gay, or bisexual (4%) or transgender (5%) compared to heterosexual or cisgender (1%). Excess body weight is elevated among lesbian and bisexual women (68% vs. 61% among heterosexual women), largely due to higher obesity prevalence among bisexual women (43% vs. 38% among lesbian women and 33% among heterosexual women). Bisexual women also have a higher prevalence of no leisure-time physical activity (35% vs. 28% among heterosexual women), as do transgender individuals (30%-31% vs. 21%-25% among cisgender individuals). Heavier alcohol intake among lesbian, gay, and bisexual individuals is confined to bisexual women, with 14% consuming more than 7 drinks/week versus 6% of heterosexual women. Incontrast, prevalence of cancer screening and risk reducing vaccinations in LGBTQ+ individuals is similar to or higher than their heterosexual/cisgender counterparts except for lower cervical and colorectal cancer screening among transgender men. People within the LGBTQ+ population have a higher prevalence of smoking, obesity, and alcohol consumption compared to heterosexual and cisgender people, suggesting a higher cancer burden. Health systems have an opportunity to help inform these disparities through the routine collection of information on sexual orientation and gender identity to facilitate cancer surveillance and to mitigate them through education to increase awareness of LGBTQ+ health needs.

Therapist cultural humility, Black lesbian, gay, or bisexual centrality, client satisfaction with therapist, and future utilization of counseling services among Black lesbian, gay, or bisexual adults.

Therapist cultural humility, Black lesbian, gay, or bisexual centrality, client satisfaction with therapist, and future utilization of counseling services among Black lesbian, gay, or bisexual adults.

The intersection of bisexuality and gender modality: exploring differences in sexual interest and satisfaction

Background Sexual well-being is crucial for overall health, but research on bisexual individuals’ sexual experiences across gender modalities is limited. This study aims to address this gap by examining differences in sexual interest and satisfaction among bisexual adults of various gender modalities. Objectives To investigate whether there are differences in sexual interest and satisfaction levels among bisexual adults across gender modalities (cisgender men, cisgender women, and transgender/gender diverse individuals). Methods A cross-sectional online survey was conducted with 475 self-identified bisexual adults (161 cisgender men, 228 cisgender women, 86 transgender/gender diverse). Participants completed demographic questionnaires and standardized measures of sexual interest and satisfaction from the PROMIS Sexual Function and Satisfaction Version 2.0. One-way ANOVAs were used to compare scores across gender modality groups. Results Significant differences were found in sexual interest across gender modalities (F(2, 472) = 10.131, p < .001). Cisgender men reported higher sexual interest (M = 52.958) compared to cisgender women (M = 48.563, p < .001) and transgender/gender diverse individuals (M = 50.566, p = .170). No significant differences were found in sexual satisfaction across gender modalities (i(2, 387) = 2.102, p = .124). Conclusions While cisgender bisexual men reported higher levels of sexual interest, sexual satisfaction was comparable across all gender modalities. These findings highlight the need for nuanced understanding of sexual experiences among bisexual individuals and underscore the importance of considering gender modality in research and clinical practice related to sexual health. Implications This study contributes to the limited research on bisexual individuals’ sexual experiences across gender modalities. The findings can inform more inclusive and tailored approaches to sexual health care and support for bisexual individuals of all gender modalities.

Investigating the Interrelationships Among Mental Health, Substance Use Disorders, and Suicidal Ideation Among Lesbian, Gay, and Bisexual Adults in the United States: Population-Based Statewide Survey Study.

Mental health disparities have been documented among lesbian, gay, and bisexual (LGB) adults in the United States. Substance use disorders and suicidal ideation have been identified as important health concerns for this population. However, the interrelationships among these factors are not well understood. This study aims to investigate the interrelationships among mental health, substance use disorders, and suicidal ideation among LGB adults in the United States using a population-based statewide survey. Our study was an observational cross-sectional analysis, and the data for this study were collected from a sample of LGB adults who participated in the statewide survey. The survey collected information on mental health, substance use disorders, and suicidal ideation using validated measures. Descriptive statistics and inferential data analysis were conducted to explore the interrelationships among these factors. The results showed that LGB adults who reported higher levels of depression and drug abuse and dependence also reported higher levels of suicidal tendency and mental illness. Inferential data analysis using χ2 tests revealed significant differences in depression score (χ22=458.241; P<.001), drug abuse and dependence score (χ22=226.946; P<.001), suicidal tendency score (χ22=67.795; P<.001), and mental illness score (χ22=363.722; P<.001) among the 3 sexual identity groups. Inferential data analysis showed significant associations between sexual identity and mental health outcomes, with bisexual individuals reporting the highest levels of depression, drug abuse and dependence, suicidal tendency, and mental illness. This study provides important insights into the interrelationships among mental health, substance use disorders, and suicidal ideation among LGB adults in the United States. The findings underscore the need for targeted interventions and research aimed at addressing the mental health needs of sexual minority populations. Future research should aim to better understand the underlying mechanisms driving these disparities and develop culturally sensitive and tailored interventions that meet the unique needs of LGB individuals. Reducing stigma and discrimination against sexual minority populations is also crucial to improving their mental health outcomes.

Aging well in an aging society: physical health in older lesbian, gay, and bisexual adults.

Older sexual minority people meet a double stigma in our society related to their sexual identity and chronological age. The present study explores how experiences of discrimination and prejudice, coming out, and personal resiliency influence physical health of older lesbian, gay, and bisexual (LGB) adults. Respondents were recruited through online advertisements and an online-based survey. The sample included 82 Italian cisgender LGB adults over 65 years: young older adults (65-70 years; 78%) and old-old adults (over 71 years; 22%). Regarding sexual orientation, the sample was composed of sexual minority women (n = 30; 37%) and sexual minority men (n = 52; 63%). ANOVAs' findings showed that sexual minority women described lower levels of physical health compared to sexual minority men. At the same time, old-old adults reported higher experiences of discrimination and prejudice compared to young older adults. Moreover, findings from hierarchical multiple regression analysis described that coming out, higher levels of personal resiliency, and fewer experiences of discrimination were predictors of physical health, regardless of age and sexual minority categories. These findings seem to align with previous studies that underline the relevance of investigating aging well in sexual minority people. Knowledge and awareness of LGBTQ+ issues are necessary for recognizing the unique needs and resources of older LGB people for promoting a healthy aging process.

Patterns and Reasons for Being Uninsured Among Sexual Minority Adults Before and After the Affordable Care Act Implementation.

Purpose: We aimed to identify the self-reported reasons for being uninsured and sociodemographic factors associated with uninsurance among lesbian, gay, or bisexual (LGB) adults before and after the Affordable Care Act (ACA). Methods: We analyzed the 2013-2018 National Health Interview Survey data using multivariable logistic regression models to estimate the odds of being uninsured and the prevalence of self-reported reasons for not having insurance among LGB adults aged 18-64 years. Results: The study included 2124 LGB adults. The weighted uninsured rate decreased significantly from 19.6% in 2013 to 13.2% in 2017-2018 (odds ratio 0.61; 95% confidence interval 0.47-0.78). The primary reason cited for not having insurance post-ACA was similar to pre-ACA, with cost-related factors being the most commonly reported (31.5%). Conclusion: The overall uninsured rate decreased among LGB adults from 2013 to 2018, whereas disparities across subpopulations remained. Cost-related factors remained significant barriers to obtaining insurance coverage.

Self-Warmth, Self-Coldness, and Depressive Symptoms Among Sexual Minority Adults

Depression is more prevalent among sexual minority adults than heterosexual adults. Whilst research has shown self-compassion is related to lower levels of depressive symptoms, few studies have focused on sexual minority adults. Furthermore, few studies have examined the relationship between the positive (self-warmth) and negative (self-coldness) components of self-compassion and depressive symptoms. This study aimed to investigate whether self-warmth and self-coldness were associated with depressive symptoms among sexual minority adults and whether these relations were moderated by gender and sexual orientation. An international sample of 439 sexual minority women aged 18 to 69 years (M = 30.21, SD = 10.70) and 391 sexual minority men aged 18 to 71 years (M = 32.20, SD = 11.74) completed the Center for Epidemiology-Depression Scale and the Self-Compassion Scale. Results indicated both self-warmth and self-coldness were significantly associated with depressive symptoms, however, self-coldness explained more unique variance (12%) than self-warmth (1%). Higher levels of self-warmth were significantly associated with lower levels of depressive symptoms and the association was not conditional on gender or sexual orientation. Higher levels of self-coldness were associated with higher levels of depressive symptoms. This association was conditional on sexual orientation but not gender. The association was stronger for bisexual adults than monosexual adults. Interventions such as compassion-focused therapy that target self-coldness among sexual minority adults may be beneficial for reducing depressive symptoms, particularly bisexual adults.

Intimate Partner Violence Among Lesbian, Gay, and Bisexual Adults: A Cross-Sectional Survey in Hong Kong.

Purpose: This study investigated the prevalence rates of various types of intimate partner violence (IPV) among lesbian, gay, and bisexual (LGB) adults in Hong Kong and examined the associations between IPV and different addictive behavior and mental health problems. Methods: A total of 759 LGB adults completed an online cross-sectional survey between November 2021 and February 2022. Data on past-year IPV and LGB-specific tactics (whether perpetrated or experienced by participants), addictive behavior, anxiety, depression, and demographics were collected and analyzed with descriptive statistics and logistic regressions. Results: Psychological aggression was the most common type of IPV within an LGB relationship (22.1%), followed by physical assault (10.8%) and IPV-related injury (4.1%). LGB-specific tactics were experienced by 39.0% of the LGB adults. Depression, anxiety, and frequent gambling were significantly associated with specific types of IPV and LGB-specific tactics. Conclusion: IPV was prevalent in the LGB population. Findings on correlates provided insights for future development of IPV detection and intervention.

Abstract P172: Potential Contribution of Social Factors in Reducing Population Disparities in Cardioprotective Health Behavior Between Bisexual, Gay/Lesbian, and Straight Adults

Background: Studies have demonstrated disparities in cardioprotective behavior by sexual orientation. Social factors have been associated with individual outcomes, but their impact on population disparities is unclear. We assessed if hypothetically intervening on social factors may reduce health behavior disparities by sexual orientation. Methods: We analyzed the intake survey data from the 2015-2023 Kaiser Permanente Research Bank. We compared unadjusted and demographics-standardized prevalence of selected health behaviors by sexual orientation (gay/lesbian or bisexual (LGB) vs straight adults (reference)). We then assessed the potential impact of hypothetically intervening on a single social factor (neighborhood safety, discrimination, education, income) on population disparities using a gap-closing estimand approach (i.e., modified inverse propensity weighting with g-computation). Results: We included 166,479 adults (mean age = 59 years), with 4.5% (7,476) gay/lesbian and 3% (4,936) bisexual. A higher proportion of LGB adults had documented current smoking, binge drinking, and low fruit intake compared to straight adults. Also, a higher proportion of bisexual adults had a high fast-food diet and inadequate sleep. Standardized prevalence of smoking, binge drinking, and inadequate sleep (bi only) remained higher in LGB adults. In gap-closing analysis, no change in gay/lesbian-straight disparities were observed. Reduction in bi-straight disparities in smoking (-2.5%, 95%CI: -3.5, -1.7) and sleep (-2.4%, 95%CI: -3.6, -1.1) may occur with higher college education rates. The sleep disparity (-2.4, 95%CI: -4.0, -0.93) may also decrease by reducing discrimination rates. None of the factors reduced the binge drinking disparity. (Table) Conclusion: LGB adults had higher prevalence of smoking, drinking, and inadequate sleep (bi only). Addressing single factors could reduce some LGB health behavior disparities but multi-factor interventions may be necessary to attain equity across orientations.

Multiple risk factors of substance use among lesbian, gay, bisexual (LGB) adults: A comparison study

ABSTRACT The aim of this study was to identify and compare risk factors of substance use between heterosexual and LGB adults. Using data from the 2020 National Survey on Drug Use and Health (NSDUH), Chi-square, t-test, and standard multiple regressions were employed to analyze the data. The findings showed that LGB participants had significantly higher experiences with substances and initiated substance use earlier than heterosexual participants. Some risk factors were related to experiences with substance use for both groups (i.e. depression, emotional distress, age of first alcohol and marijuana use), but these factors accounted for more of the variance for LGB participants. Additionally, overall health was uniquely associated with experiences with substance use for LGB participants. These results have important implications for the design of culturally appropriate substance use prevention and intervention services for LGB individuals.

The trauma-suicide connection among racial and ethnically diverse lesbian, gay, and bisexual adults: Examining the roles of intersectional discrimination and complex posttraumatic stress disorder

Aim We sought: (a) to explore the roles of complex posttraumatic stress disorder (CPTSD), racism, and heterosexist discrimination in linking exposure to traumatic events and lifetime suicide attempt among sexually diverse racial and ethnic minority adults; and (b) to explore differences by race/ethnicity. Methods We used structural equation modeling methods (moderated mediation analysis) to analyze a sample of sexually diverse racial and ethnic minority adults from the National Epidemiological Study of Alcohol and Related Conditions (NESARC-III) dataset (n = 632). Descriptive results are included for underpowered subgroups. Results We found significant differences by racial/ethnic identity, with CPTSD mediating associations between trauma exposure and suicide attempt status among Hispanic respondents, but not Black respondents. Furthermore, racism and heterosexist discrimination amplified the effects of trauma exposure on CPTSD symptoms among Hispanic respondents. Conclusion CPTSD may be an important mechanism in the trauma-suicide connection among some sexually diverse racial and ethnic minority people. These findings have important implications for suicide prevention work among sexually diverse populations, including the need for interventions that integrate traumatic stress treatment and employ an intersectional approach, addressing the influence of racism and heterosexism, particularly for Latinx and Hispanic groups.

Substance use and sexual identity: health disparities in NYC sexual health clinics

ABSTRACT Background The prevalence of alcohol and other drug (AOD) use among lesbian, gay, and bisexual (LGB) adults is well documented; less is known about rates of unhealthy AOD use that could escalate into substance use disorders. Methods In a retrospective sample of 11,278 patients seen in New York City Sexual Health clinics, rates of unhealthy AOD use were compared by sexual identity (i.e., gay/lesbian, bisexual, and heterosexual). Results Patients who identified as LGB reported higher rates of unhealthy AOD use than patients who identified as heterosexual. Patients who identified as bisexual reported the highest rates of AOD use. Conclusion Findings are consistent with existing research on LGB health disparities. Healthcare providers can use non-judgmental approaches to elicit information from clients about sexual orientation, sexual health, and substance use. Implementing SBIRT in school and community settings addresses these behaviors without contributing to stigma.

Cigarette smoking behaviors and nicotine dependence at the intersection of sexual identity and sex in the United States: Findings from the National Survey on Drug Use and Health

Introduction: Cigarette smoking is disproportionately high among lesbian, gay, and bisexual (LGB) adults. Yet, collapsing these identities into a monolith can disguise important within group disparities (e.g., lesbian/gay versus bisexual female). The purpose of this study is to report recent national prevalence estimates and trends of cigarette smoking behaviors and nicotine dependence by sexual identity and sex. Methods: Data were from the 2015–2019 National Survey on Drug Use and Health (n = 210,392; adults 18+), a nationally representative, repeated cross-sectional study of substance use and mental health in the U.S. We examined bivariate and multivariable associations between sexual identity and cigarette smoking measures (i.e., former smoking, lifetime smoking, current smoking, current daily smoking, nicotine dependence) by sex. We also examined linear time trends in current and former smoking. Covariates included age, race/ethnicity, education, annual household income, and survey year. Results: Bisexual women had the highest unadjusted prevalence of current smoking (31 %) and lowest of former smoking (25 %). LGB females and males had higher adjusted prevalence of current smoking, daily smoking, and nicotine dependence than heterosexual adults. Bisexual females and gay and bisexual males had lower adjusted prevalence of former smoking (adjusted prevalence ratio range: 0.78–0.85) than heterosexual counterparts. Discussion: This is the first study to identify disproportionately low prevalence of former smoking among bisexual females. Paired with findings of high prevalence of current cigarette smoking and nicotine dependence, these data suggest that tobacco control interventions targeted toward bisexual females are urgently needed to reduce the burden of cigarette smoking among these individuals.

Telehealth use among cancer survivors: Results from the 2022 Health Information National Trends Survey.

520 Background: Telehealth availability and use expanded rapidly at the start of the COVID-19 pandemic and continues to be a care delivery option for both cancer patients and their providers. Methods: Using data from the 2022 Health Information National Trends Survey (HINTS 6), we characterized telehealth use among U.S. adults with a history of cancer (n=842). Survey-weighted proportions were calculated to describe reasons for telehealth use, non-use, and patient experiences with telehealth. Survey-weighted bivariate logistic regressions were used to further identify sociodemographic and health-related factors associated with telehealth use. Results: Among the 842 cancer survivors, 50% reported no telehealth use in the last 12 months and 50% reported a telehealth encounter. Among survivors that reported no telehealth use, 77% indicated they were not offered telehealth. Among non-users given a telehealth option, most (91%) chose not to participate because they preferred an in-person visit, though some reported concerns about the difficulty of using telehealth technology (28%) or the privacy of telehealth visits (13%). Among survivors reporting telehealth use, 44% used video, 30% phone, and 26% phone and video. The most common reason for choosing telehealth was a provider recommendation (79%), followed by convenience (59%), avoiding possible infection (40%), and inclusion of caregivers (26%). Most survivors who used telehealth reported that the care they received was as good as an in-person visit (77%), though some reported technical difficulties (25%) and privacy concerns (11%). Odds of reporting telehealth use were significantly lower among cancer survivors aged 65+ (vs. &lt;65, OR=0.55, 95% CI 0.34-0.88) and higher among gay and bisexual adults (vs. heterosexual; OR=1.29, 95% CI 1.10-7.09) and those reporting worse health (fair/poor vs. excellent, OR=3.49, 95% CI 1.63-7.49). Telehealth use was not associated with sex, race/ethnicity, education, geographic residence, medical comorbidity, time since diagnosis, or use of high-speed internet. Conclusions: Lack of provider recommendation to use telehealth may be a barrier to greater adoption among cancer survivors. Conversely, provider recommendation was associated with higher telehealth uptake, highlighting the need for provider engagement and support of telehealth options. Lower odds of telehealth use among older survivors supports prior digital divide research, though other commonly reported disparities were not significant. In contrast, gay and bisexual survivors as well as survivors with self-perceived poor health reported the highest rates of telehealth use, demonstrating a unique opportunity for telehealth use to meet care needs among these cancer survivor populations.

Adverse Childhood Experiences and Sexual Orientation: An Intersectional Analysis of Nationally Representative Data

This study compared the prevalence of adverse childhood experiences across intersections of sexual orientation, gender, race/ethnicity, and economic status. Data collected between 1994 and 2018 from 12,519 participants in the National Longitudinal Study of Adolescent to Adult Health were analyzed in 2023 to generate adverse childhood experience prevalence estimates. Unadjusted 1-way ANOVAs and multivariate regressions were performed to compare differences in independent and cumulative adversity measures by sexual orientation, gender, race/ethnicity, and poverty status. A multilevel analysis of individual heterogeneity and discriminatory accuracy was conducted to estimate adversity scores across 24 groups that were stratified by sexual orientation, gender, race/ethnicity, and poverty status. Adolescents with same-sex attractions and adults who identified with a sexual minority group reported more adverse childhood experiences overall than straight participants, although associations varied by type of adversity. Strikingly, adversity scores were higher among White youth with same-sex attractions than among Black youth with same-sex attractions, among more economically advantaged bisexual adults than among poorer ones, and among poor White participants than among poor Black and Hispanic participants, suggesting that the combination of disadvantaged and marginalized statuses does not necessarily correspond with greater childhood adversity. A multilevel analysis of individual heterogeneity and discriminatory accuracy interaction model showed that sexual orientation and poverty status contributed significant variance to cumulative adversity scores, whereas gender and race/ethnicity did not. The results show that disparities in adverse experiences can be more fully and accurately represented when sexual orientation and other social identities are modeled as intersectional configurations. Given that adverse childhood experiences are linked to morbidity and mortality, the findings have salient implications for understanding health disparities that affect population subgroups.

Polysubstance use by sexual identity among US adults, 2021

ObjectiveUnderstanding polysubstance use among US sexual minority adults is important to serve as a population-level baseline to promote health equity around substance use prevention and public health strategies. This study quantifies the number of substances used by sexual identity among US adults. MethodsWe used the 2021 National Survey on Drug Use and Health and included adults (aged ≥18) (unweighted n = 47,291). We conducted multivariable Poisson regression models to examine the number of substances used in the past year (count variable; range: 0–18) by sexual identity (“heterosexual”, “gay/lesbian”, “bisexual”, “unknown” [don't know, refused, blank]), after adjusting for covariates (i.e., age, sex, race/ethnicity, income level, education level, having insurance status, living in urban area, past-year distress level (Kessler-6), any drug or alcohol use disorder in the past year, and sexual attraction). ResultsOf the total sample (51.4% were female, 12.1% were non-Hispanic Black and 17.0% were Hispanic adults), 88.3% were heterosexual, 2.4% were gay/lesbian, 5.0% were bisexual adults, and 4.3% reported “unknown” sexual identity. After adjusting for covariates, a greater number of substances were used in the past year among gay/lesbian individuals (aIRR = 1.44, 95% CI = 1.09, 1.75), bisexual individuals (aIRR =1.34, 95% CI = 1.26, 1.41), and individuals reporting an “unknown” sexual identity (aIRR = 1.22, 95% CI = 1.09, 1.36) (vs. heterosexual adults). ConclusionsTailored substance use prevention and public health strategies specializing in sexual minority populations are warranted.

Intersections of race, gender, and sexual identity attributions toward discrimination and mental health across three cohorts of lesbian, gay, and bisexual adults.

Intersections of race, gender, and sexual identity attributions toward discrimination and mental health across three cohorts of lesbian, gay, and bisexual adults.