Bisexual Adults Research Articles

Supplemental Material for Intersections of Race, Gender, and Sexual Identity Attributions Toward Discrimination and Mental Health Across Three Cohorts of Lesbian, Gay, and Bisexual Adults

Supplemental Material for Intersections of Race, Gender, and Sexual Identity Attributions Toward Discrimination and Mental Health Across Three Cohorts of Lesbian, Gay, and Bisexual Adults

Intersectional microaggressions, mental health outcomes, and the role of social support among Black LGB adults.

The present study explored the relationship between intersectional microaggressions (racism and heterosexism) and psychological distress outcomes among a sample of 370 Black lesbian, gay, and bisexual (LGB) adults. Additionally, social support from family, friends, and significant others was examined as potential moderators. Results showed that intersectional microaggressions were associated with greater depression, anxiety, and stress. Also, a significant moderating effect for family social support was found, suggesting that Black LGB adults with higher family social support reported greater levels of depression and stress as their microaggression experiences increased compared to those with less family social support. These results highlight the deleterious effects of intersectional microaggressions on the health of Black LGB adults and important clinical considerations pertaining to the role of social support. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sexual Orientation, High-Deductible Health Plans, And Financial Barriers To Care.

Among US adults in 2013-18, we found high-deductible health plan enrollment to be the lowest among heterosexual and gay/lesbian adults in families with incomes below 200percent of the federal poverty level and the highest among bisexual adults in families with incomes at or above 400percent of poverty. Gay/lesbian and bisexual adults in these plans experienced greater financial barriers to health care than heterosexual adults.

SAMHSA finds sexual minority adults more likely to use substances

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), data shows that lesbian, gay, and bisexual adults are more likely than straight adults to use substances, as well as to experience mental health conditions.

Investigating the Joint Effect of Allostatic Load among Lesbian, Gay, and Bisexual Adults with Risk of Cancer Mortality.

Sexual minorities (SM) have higher chronic physiologic stress as indicated by allostatic load (AL), which may be explained in part by consistent experiences of discriminatory practices. This is one of the first studies to examine the joint effects of SM status and AL on the association with long-term risk for cancer death. Retrospective analyses were conducted on 12,470 participants using National Health and Nutrition Examination Survey (NHANES) from years 2001 through 2010 linked with the National Death Index through December 31, 2019. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) of cancer deaths between groups of SM (those reporting as gay, lesbian, bisexual, or having same-sex sexual partners) status and AL. SM adults living with high AL (n = 326) had a 2-fold increased risk of cancer death (aHR: 2.55, 95% CI: 1.40-4.65) when compared to straight/heterosexual adults living with low AL (n = 6674). Among those living with high AL, SM (n = 326) had a 2-fold increased risk of cancer death (aHR: 2.26, 95% CI: 1.33-3.84) when compared to straight/heterosexual adults with high AL (n = 4957). SM with high AL have an increased risk of cancer mortality. These findings highlight important implications for promoting a focused agenda on cancer prevention with strategies that reduce chronic stress for SM adults.

Suicidal thoughts, suicide attempt and non-suicidal self-harm amongst lesbian, gay and bisexual adults compared with heterosexual adults: analysis of data from two nationally representative English household surveys

PurposeWe aimed to compare differences in suicidality and self-harm between specific lesbian, gay and bisexual (LGB) groups, and investigate whether minority stress factors might contribute to any associations, addressing methodological limitations of previous research.MethodsWe analysed data combined from two population-based representative household surveys of English adults (N = 10,443) sampled in 2007 and 2014. Using multivariable logistic regression models adjusted for age, gender, educational attainment, area-level deprivation, and common mental disorder, we tested the association between sexuality and three suicide-related outcomes: past-year suicidal thoughts, past-year suicide attempt, and lifetime non-suicidal self-harm (NSSH). We added bullying and discrimination (separately) to final models to explore whether these variables might mediate the associations. We tested for interactions with gender and survey year.ResultsLesbian/gay people were more likely to report past-year suicidal thoughts [adjusted odds ratio (AOR) = 2.20; 95% CI 1.08–4.50] than heterosexuals. No minority group had an increased probability of suicide attempt. Bisexual (AOR = 3.02; 95% CI = 1.78–5.11) and lesbian/gay (AOR = 3.19; 95% CI = 1.73–5.88) individuals were more likely to report lifetime NSSH than heterosexuals. There was some evidence to support a contribution of bullying in the association between lesbian/gay identity and past-year suicidal thoughts, and of each minority stress variable in the associations with NSSH. There was no interaction with gender or survey year.ConclusionSpecific LGB groups are at elevated risk of suicidal thoughts and NSSH, with a possible contribution of lifetime bullying and homophobic discrimination. These disparities show no temporal shift despite apparent increasing societal tolerance towards sexual minorities.

Differences in HIV testing among sexual orientation subgroups in the United States: A national cross-sectional study

Understanding differences in HIV testing among US adults is a crucial step for HIV prevention. This study used cross-sectional data to assess whether HIV testing varies across sexual orientation subgroups and by important psychosocial factors. Data were from the National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III; n = 36 309, response rate = 60.1%), a nationally representative survey of the US non-institutionalized adult population. Using logistic regression, we examined HIV testing among heterosexual concordant, heterosexual discordant, gay/lesbian, and bisexual adults. Psychosocial correlates included adverse childhood experiences (ACEs), discrimination, educational attainment, social support, and substance use disorders (SUDs). Bisexual (77.0%) and gay/lesbian (65.4%) women had a greater prevalence of HIV testing than concordant heterosexual women (51.6%), and bisexual women had a significantly higher testing prevalence than discordant heterosexual women (54.8%). Gay (84.0%) and bisexual (72.1%) men also had a significantly higher testing prevalence than discordant (48.2%) and concordant (49.4%) heterosexual men. In multivariable models, bisexual men and women (AOR = 1.8; 95% CI = 1.3–2.4) and gay men (AOR = 4.7; 95% CI = 3.2–7.1) had significantly greater odds of HIV testing than heterosexual concordant adults. A higher number of ACEs, greater social support, history of SUDs, and higher educational attainment were positively associated with HIV testing. HIV testing prevalence varied across sexual orientation subgroups; discordant heterosexual men had the lowest prevalence. Health care providers should consider a person’s sexual orientation, ACEs, educational attainment, social support, and history of SUDs when evaluating HIV testing needs in the US.

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

41 Prevalence of Diabetes Among Veterans by Sexual Orientation

OBJECTIVES/GOALS: There is evidence that lesbian, gay, and bisexual (LGB) adults have poorer cardiovascular health than their heterosexual peers, but studies of the association between sexual orientation (SO) and diabetes mellitus (DM) have been few with mixed findings. To further investigate this association, large cohorts with objective data capture are needed. METHODS/STUDY POPULATION: We used data from the Veterans Healthcare Administration Lesbian, Gay, Bisexual, Transgender EHR cohort which includes veterans with at least 2 encounters October 1, 2009-September 30, 2019. The first clinic visit in this window was the index date with the baseline date one year later; the intervening year served as a baseline period for observation of prevalent disease and comorbidities. We did not include transgender veterans in this analysis in order to focus on SO rather than on the intersection of SO with gender identity. The SO of 1,108,990 veterans was identified using a natural language processing tool; 185,788 veterans were classified as LGB. We first examined sample characteristics by sex and SO and then used logistic regression to assess the association between SO and prevalent DM. RESULTS/ANTICIPATED RESULTS: DM was present among 193,330 veterans (32,986 LGB). Mean age was similar across SO in women (41) and men (53). Distribution of race was similar across groups, but LGB veterans were more likely to be Hispanic (11%, both sexes) than non-LGB men (6%) and women (8%). Current smoking was more prevalent among LGB (44% men, 39% women) than non-LGB veterans (40% men, 30% women). Adjusting for age, sex, race, Hispanic ethnicity, BMI, smoking status, health insurance, marital status, and enrollment priority, LGB veterans had 1.12 [1.10, 1.13] times the odds of DM vs. non-LGB veterans. Bisexual (0.87 [0.74, 1.01]) or lesbian (1.03 [0.97, 1.10]) women did not have significantly different DM odds than non-LGB women. Bisexual men had lower DM odds (0.86 [0.80, 0.93]) while gay men had higher odds (1.04 [1.01, 1.06]) than non-LGB men. DISCUSSION/SIGNIFICANCE: This is one of the first studies to report DM in a veteran cohort stratified by SO. Our findings highlight the importance of examining SO groups separately and jointly, as to further elucidate the association between SO, cardiovascular risk factors, and general cardiovascular health. Future work will examine the intersection of SO and gender identity.

Queer Aging: Older Lesbian, Gay, and Bisexual Adults' Visions of Late Life.

Diversity in aging has received increased attention in recent years in the field of gerontology. However, older lesbian, gay, and bisexual (LGB) people have largely been missing from these conversations. In this study, I examine older LGB people's subjective views on the aging process, focusing specifically on visions of late life. Life story interviews were conducted with 60 LGB individuals over the age of 55 who reside in the Southeastern and Midwestern portions of the United States. Inductive coding (e.g., line-by-line, focused) and analyses were conducted. Four major themes emerged from the data: (1) financial distress linked to past events of homophobic discrimination, (2) anxieties regarding staying in paid care settings, (3) desires to age in place or "in community" with other lesbian, gay, bisexual, transgender, and queer people, and (4) a prioritization of quality of life over longevity via plans to pursue assisted suicide. The findings of this study suggest that views of aging and visions of late life are tied to social group membership, highlighting the need for gerontologists to further consider cumulative inequality processes. The study also offers evidence of queer aging, wherein queer culture, history, and experience produce distinct meanings of aging.

Manipulating minority stress: Validation of a novel film-based minority stress induction with lesbian, gay, and bisexual adults.

Manipulating minority stress: Validation of a novel film-based minority stress induction with lesbian, gay, and bisexual adults.

Abstract P188: Diabetes Prevalence and its Risk Factors Among Veterans by Sexual Orientation

Introduction: There is evidence that lesbian, gay, and bisexual (LGB) adults have poorer cardiovascular health than their heterosexual peers, but studies of the association between sexual orientation (SO) and diabetes mellitus (DM) have been few. Prior studies have largely been cross-sectional, rely on self-reported data, and have small sample size; findings have been mixed. To further investigate this association, large nationwide cohorts with objective data capture are needed. Methods and Results: We used data from the Veterans Healthcare Administration Lesbian, Gay, Bisexual, Transgender EHR cohort which includes veterans with ≥2 encounters October 1, 2009-September 30, 2019. The first clinic visit in this window was the index date with the baseline date one year later; the subsequent year served as a baseline period for observation of prevalent disease and comorbidities. We did not include transgender veterans in this analysis in order to focus on SO rather than on the intersection of SO with gender identity. The SO of 1,108,990 veterans was identified using a natural language processing tool; 185,788 veterans were classified as LGB. Prevalent DM (ICD-9/10 codes or HbA1c≥6.5%) was present among 193,330 veterans (32,986 LGB). We first examined sample characteristics by sex and SO. Mean age (years) and BMI (kg/m 2 ) were similar across SO in women (age: 41, BMI: 29) and men (age: 53, BMI: 30). Although the distribution of race was similar across groups, LGB men and women were more likely to be of Hispanic ethnicity (11%, both sexes) than non-LGB men and women (6% and 8%, respectively). Current smoking was more prevalent among LGB (44% men, 39% women) than among non-LGB veterans (40% men, 30% women). We used logistic regression to assess the association between SO and DM. Adjusting for age, sex, race, Hispanic ethnicity, BMI, smoking status, health insurance, marital status, and enrollment priority group (based on military service history, disability and income), LGB veterans had 1.12 [1.10, 1.13] times the odds of DM versus non-LGB veterans. Among women, those classified as bisexual (0.87 [0.74, 1.01]) or lesbian (1.03 [0.97, 1.10]) did not have significantly different odds of DM than non-LGB women. Among men, bisexual men had lower odds of DM (0.86 [0.80, 0.93]) while gay men had higher odds (1.04 [1.01, 1.06]) than non-LGB men. In both men and women, sexual minority individuals whose SO could not be classified had greater odds of DM than their non-LGB peers (women: 1.15 [1.08, 1.23]; men: 1.25 [1.22, 1.28]). Conclusion: This is one of the first studies to examine DM in a veteran population stratified by SO. Our sex-specific findings highlight the importance of examining each SO group separately, in addition to jointly, as to further elucidate the association between SO, cardiovascular risk factors, and general cardiovascular health. Future work will examine the intersection of SO with gender identity.

Health Status and Health Care Access Among Lesbian, Gay, and Bisexual Adults in the US, 2013 to 2018

This cross-sectional study evaluated data from a large US survey (2013-2018) to determine how health status and access have changed among lesbian, gay, and bisexual adults compared with heterosexual counterparts.

Associations between Relationship Status, Anxiety, Sexual Function, and Sexual Satisfaction in Lesbian, Gay, and Bisexual People

Objectives The purpose of this study was to describe associations between relationship status, anxiety, and sexual function and satisfaction in lesbian, gay, and bisexual (LGB) adults. Methods Linear regression determined associations between sexual function, relationship characteristics and anxiety in 979 LGB participants. Results Relationship status was not related to sexual interest in gay men. Partnered relationship status was associated with higher sexual satisfaction for gay men, lesbians, and bisexual women. Anxiety symptoms were negatively associated with sexual interest, satisfaction, and orgasm pleasure for gay men but not associated with sexual outcomes in lesbian women. Conclusion Using a nationally representative sample of LGB adults, differences were found in factors related to sexual function and satisfaction by gender and sexual orientation.

Risk and Danger among the “Invisible”: Bisexual IPV Victimization, Lifestyle Factors, and Feelings of Marginalization

ABSTRACT This paper examines intimate partner violence (IPV) victimization risk of bisexual individuals compared with their straight and gay peers, highlighting the ways in which risky lifestyle factors and feelings of marginalization operate to increase risk. We theorize that both behavioral and stigma-related risk factors identified in previous work may be systematically different in the bisexual population compared to their straight peers, thus increasing IPV risk. Using data from the National Longitudinal Study of Adolescent to Adult Health (Wave 4, N = 14,415), we examine the extent to which risky behaviors and feelings of marginalization mediate the impact of bisexual identity on IPV risk. Findings suggest bisexual individuals are significantly more at risk for IPV (OR = 1.60) than their straight and gay peers. Their increased risk is explained by risky behaviors (e.g., drug use and number of partners), and feeling unloved. Adjusting for these mediators, the effect of being bisexual on IPV is reduced substantially (OR = 1.27) but remains significant. Understanding the unique stigmatization experiences and vulnerability of this population is critical for designing effective victimization prevention strategies. It is important to consider risk reduction strategies that may be uniquely important for bisexual adults and mitigating the burdens of stigma.

INTERNALIZED HOMOPHOBIA MEDIATING THE RELATIONSHIP OF SELF-CONCEALMENT ON DEPRESSION IN LGB OLDER ADULTS

Abstract Previous research has demonstrated that self-concealment of sexual orientation may negatively affect the wellbeing of lesbian, gay, and bisexual (LGB) adults (Hu, Wang, & Wu, 2013). Additionally, studies have indicated that internalized homophobia significantly predicts depressive symptoms in LGB older adults (Sharma & Subramanyam, 2020). The present study examined how internalized homophobia may mediate the predictive relationship between self-concealment on depression symptoms in LGB older adults. As part of a larger study, participants (Nf301) responded to several questions and measures including the Sexual Orientation Self-Concealment Scale, The Internalized Homophobia Scale, and the Center for Epidemiological Studies Depression Scale. Using the Baron and Kenny’s Method for Mediation (1986), the data analysis indicated that internalized homophobia fully mediates the relationship between self-concealment and depression severity (ps < .05). These results suggest that older adults who self-conceal their sexual orientation may experience an increase in depressive symptoms because of internalized homophobias. These findings may help clinicians better understand the mechanisms contributing to the high rates of depressive symptoms within the older LGB population. Furthermore, the findings suggest that cognitive restructuring of thoughts related to internalized homophobia and self-concealment may improve depressive severity in older LGB adults.

Health, Economic, and Social Disparities among Lesbian, Gay, Bisexual, and Sexually Diverse Adults: Results from a Population-Based Study

We investigated health, economic, and social disparities among lesbian, gay, bisexual, and sexually diverse adults, 18 years and older. Analyzing 2011–2019 Washington State Behavioral Risk Factor Surveillance System (N = 109,527), we estimated and compared the prevalence rates of background characteristics, economic and social indicators, health outcomes, chronic conditions, health care access, health behaviors, and preventive care by gender and sexual identity. Sexual minority adults reported heightened risks of poor general health, physical and mental health, disability, subjective cognitive decline, and financial barriers to health care, compared with their straight counterparts. Economic disparities and disability were evident for lesbians and both bisexual adult women and men. We found higher rates of smoking and excessive drinking among lesbians and bisexual women, and higher rates of smoking and living alone among gay men. Sexually diverse adults experience disparities in health care access. This study is one of the first to identify disparities among sexually diverse populations, in addition to lesbian, gay, and bisexual adults. More research is required to understand the mechanisms of disparities within these groups to address their distinct intervention needs.

Abstract 10145: Cardiovascular Disease Risk and Outcomes Among Veterans by Sexual Orientation

Introduction: Lesbian, gay, and bisexual (LGB) adults have CVD risk and outcome inequities compared to heterosexual peers. With upwards of 7 million sexual minority adults aged >50 by 2030, assessing and addressing their cardiovascular health is critical for clinicians and public health practitioners. However, few electronic health record (EHR) cohorts have been used to study this association. Methods and Results: In this analysis, we used the Veterans Healthcare Administration Lesbian, Gay, Bisexual, Transgender EHR cohort, excluding transgender individuals to avoid conflating sexual orientation with gender identity. The baseline date was the first primary care appointment on or after October 1, 2009. Sexual orientation of 1,108,990 veterans was identified via a natural language processing tool with 88.2% sensitivity, 91.5% specificity, and 85.9% PPV; 185,788 veterans were classified as LGB. Prevalent CVD (history of AMI, ischemic stroke, or revascularization in the year preceding the baseline date) was present among 19,887 veterans (4,684 LGB). We calculated sample statistics stratified by sex and sexual minority status; results are displayed in the Table . We used logistic regression analyses to assess the association between sexual minority status and prevalent CVD. Adjusting for age, sex, race, and Hispanic ethnicity, LGB veterans had 1.12 [1.16, 1.24] times the odds of prevalent CVD compared to non-sexual minority veterans. Upon additional adjustment for BMI, diabetes, hypertension, lipids, substance use, anxiety, and depression, this association remained significant (OR [95% CI]: 1.08 [1.04, 1.12]). Conclusion: This is one of the first studies to examine cardiovascular health within a veteran population stratified by sexual orientation. Addressing the cardiovascular health of marginalized populations requires further exploring the mechanisms by which stress results in CVD risk and outcomes and the inequitable distribution of both.

Age-related patterns of cocaine and methamphetamine use across the life course in the United States: Disparities by gender and sexual identity among adults

PurposeResearch showing substance use decreases over the life course has focused primarily on heterosexual adults. We examined how age-related patterns of cocaine and methamphetamine use vary by sexual identity and gender among a national sample. MethodsWe included 191,954 adults aged 18–64 from the 2015–2019 National Survey on Drug Use and Health. We described the weighted prevalence of past-year cocaine and methamphetamine use and used logistic regressions to estimate relative odds of past-year cocaine and methamphetamine use by age, stratified by gender and sexual identity (heterosexual, gay/lesbian, bisexual). ResultsCocaine and methamphetamine use was highest among lesbian, gay, and bisexual (LGB) adults compared to their heterosexual counterparts. Gay/lesbian men and women and bisexual men were also more likely to use cocaine at later ages. Heterosexual adults ages 26–34 (adjusted odds ratio [aOR] = 0.73; confidence interval [CI] = 0.65–0.83) were less likely than those 21–25 to report past-year cocaine use, but there were no differences between those ages 26–34 and 21–25 among any LGB sub-group. Heterosexual (aOR = 1.62; CI = 1.28–2.04) and gay (aOR = 2.93; CI = 1.26–6.80), men ages 26–34 were more likely to report past-year methamphetamine use than their counterparts ages 21–25. There were no age-related differences in past-year methamphetamine use between bisexual men and gay/lesbian women. ConclusionsPatterns of cocaine and methamphetamine use across the life course for LGB individuals differ from those of heterosexuals. This has implications for targeted prevention efforts to address stimulant use among minoritized populations.

Establishment of a dermatology clinic serving both patients living with HIV/AIDS and transgender individuals (PRIDE clinic) in an urban academic setting: Demographics, evolution, and lessons learned

To the Editor: Given structural barriers, marginalized populations, including LGBTQ+ individuals and people living with HIV, deserve improved care access. 1 Gonzales G. Przedworski J. Henning-Smith C. Comparison of health and health risk factors between lesbian, gay, and bisexual adults and heterosexual adults in the United States: results from the National Health Interview Survey. JAMA Intern Med. 2016; 176: 1344-1351https://doi.org/10.1001/jamainternmed.2016.3432 Crossref PubMed Scopus (224) Google Scholar , 2 Reisner S.L. Poteat T. Keatley J. et al. Global health burden and needs of transgender populations: a review. Lancet. 2016; 388: 412-436https://doi.org/10.1016/S0140-6736(16)00684-X Abstract Full Text Full Text PDF PubMed Scopus (558) Google Scholar , 3 Geter A. Herron A.R. Sutton M.Y. HIV-related stigma by healthcare providers in the United States: a systematic review. AIDS Patient Care STDS. 2018; 32: 418-424https://doi.org/10.1089/apc.2018.0114 Crossref PubMed Scopus (85) Google Scholar , 4 Yeung H. Luk K.M. Chen S.C. Ginsberg B.A. Katz K.A. Dermatologic care for lesbian, gay, bisexual, and transgender persons: epidemiology, screening, and disease prevention. J Am Acad Dermatol. 2019; 80: 591-602https://doi.org/10.1016/j.jaad.2018.02.045 Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar In 2014, we started monthly clinics within normal operations and clinic hours to serve patients living with HIV and associated dermatologic manifestations. These sessions were established as entry points to the system, to expedite access for new patients within 1 month of request, referred by partner clinic providers. Over time, a second population emerged from the same partner clinics: transgender and non-binary patients. The clinic slowly pivoted and rebranded to serve both communities: those living with HIV and transgender and non-binary patients. Importantly, these communities are distinct but show overlap in both population and resources used. 5 Becasen J.S. Denard C.L. Mullins et al. Estimating the prevalence of HIV and sexual behaviors among the US transgender population: a systematic review and meta-analysis, 2006–2017. Am J Public Health. 2019; 109: e1-e8https://doi.org/10.2105/ajph.2018.304727 Crossref PubMed Scopus (0) Google Scholar In 2020, the clinic was officially named PRoviding Integrated Dermatology for Everyone (PRIDE).