Gender Minority Research Articles

Predicting Suicidal Ideation Among Native American High Schoolers in California

Introduction Suicide is the leading cause of non-accidental death for Native American young people ages 15-24. Alarmingly, suicide rates have continued to rise over the past decade despite ongoing prevention efforts. This shortcoming has urged some scholars to (re)examine dominant theoretical models to better direct suicide prevention efforts in tribal communities. Method Using Indigenous Wholistic Theory, this study used an algorithmic approach to identify a broader set of factors associated with suicidal ideation among Native American high school students in California (n = 2,609). Data were drawn from the 2019–2020 California Healthy Kids Survey, a statewide school-based dataset. Lasso penalized regression was employed to select the most predictive variables for suicidal ideation from a set of 17 candidate factors. Results Ten predictors were retained in the final model: depressive symptoms; school-based victimization; sexual and gender minority status; lifetime use of alcohol, vapes, and cannabis; breakfast consumption; access to alcohol and other drugs; and parent education level. Conclusion A combination of factors spanning individual, emotional-social, mental-political, and physical-economic domains predicted individualized risk for experiencing suicidal ideation. These findings underscore the need to move beyond psycho-centric models and toward more comprehensive understandings of suicide-related behavior among Native American youth.

Measures Assessing Barriers and Facilitators to Post-Sexual Violence Services: A Critical Review.

Sexual violence (SV) is a significant public health problem associated with poor health, social, and economic outcomes. Although services exist to support survivors of SV, many do not access these services. This critical review examines measures used to assess barriers and facilitators to post-SV services and whether these measures address the full breadth of concerns among SV survivors, particularly those who hold marginalized identities. Eligible studies had to be original and peer-reviewed, include a measure of barriers or facilitators to service-seeking, and focus on SV survivors. We reviewed 10 measures that assessed barriers and/or facilitators to mental health, medical, advocacy, and legal services among SV survivors. These measures were designed for and/or applied to survivors of intimate partner violence, human trafficking, military sexual trauma, child sexual abuse, and adult sexual assault. Populations sampled included college students, military personnel, gender and sexual minority youth, women living with HIV, and crime victims seeking legal services. Using a social-ecological model approach, we assessed barriers at the individual, interpersonal/community/provider, and structural/organizational levels. Barriers at the community level were largely absent, and only three measures addressed facilitators. Five measures provided some psychometric data with survivors, and only three incorporated survivor feedback in their development. Four measures included some cultural and/or identity-specific factors. Future research should prioritize the development of trauma- and violence-informed measures that incorporate survivor feedback and address diverse cultural and identity contexts to improve service access and utilization.

Participants' reactions to the inclusion of Sexual Orientation and Gender Identity (SOGI) measures in an established large-scale cohort: The California Teachers Study.

Sexual and gender minority (SGM) populations are more likely than non-SGM populations to experience poor health outcomes but are underrepresented in research. The California Teachers Study (CTS) is a large prospective observational cohort that, in its 2017-2019 survey, included sexual orientation and gender identity (SOGI) measures and also asked participants to provide feedback on the questionnaire. We conducted an inductive content analysis of participants' feedback responses and used these qualitative codes to a) identify which participants commented on SOGI and b) establish whether these participants had a positive, negative, or ambiguous reaction to the measures. We used Chi-square tests and multivariable logistic regression to evaluate whether demographic factors were associated with reaction type. A total of 373(2%) of 19,496 respondents commented on the SOGI questions. Of these, 41% had negative reactions, 35% had ambiguous reactions, and 25% had positive reactions. Younger age (<65 years) was positively associated with positive reaction (OR=2.30; 95%CI, 1.23-4.32). Non-white participants had lower adjusted odds of having a negative reaction to the SOGI measures compared to white participants (OR=0.38; 95%CI, 0.17-0.87). In this large established study of older adults, feedback on SOGI measures was rare but differed in frequency and content by participants' demographics.

The development and utilization of a diversity advisory board in an intervention to support social skill development for autistic transition-aged youth.

Recent discourse has identified significant issues surrounding the lack of diversity in autism-related research. However, recent efforts have called for the regular use of diversity advisory boards (DAB) in autism-related research to improve the inclusivity of underrepresented and marginalized groups included in the growing autism scholarship. This article outlines the development and implementation of a DAB to support the design and evaluation of an innovative intervention, WorkChat: A Virtual Workday. Specifically, WorkChat focuses on improving knowledge and practicing conversational skills with virtual customers, coworkers, and supervisors to support workplace interactions for autistic transition-age youth. Here, we share guidelines for developing, utilizing, and maintaining a DAB, as well as recommended practices and future implications for implementing DABs in autism services research while using the WorkChat DAB as a case study. The goal is to support the further use of DABs as a means of significantly improving the inclusion of underrepresented and marginalized identities including racial, gender, and sexual minorities, and individuals with disabilities in autism services research.Lay AbstractAutism research often does not include enough people with different identities such as different races, genders, and sexualities. Sometimes, support for autistic individuals does not help everyone equally. They often work better for white, straight autistic males. This article will talk about how we are trying to make autism research more diverse. We will share how we are using a group of diverse advisors to help with research. We will also talk about how to use these advisor groups in the future for autism research.

What Has Been Studied About Attitudes and Social Stigma Towards HIV/AIDS? A Global Bibliometric Study with Correlations on Global Health HIV-Related Indicators

Introduction: This study aimed to assess, through health metrics and bibliometric analysis, the global research on attitudes and social stigma of people living with HIV/AIDS and to identify research findings, gaps, and future directions. Methods: A cross-sectional bibliometric study was conducted through a structured search in different databases. Fifteen thousand four hundred and ninety-six documents were found between 1981 and 2024. Results: 83.5% were original articles, and international co-authorship was 30.66%. Since 2000, there has been an increase in research on HIV/AIDS attitudes and social stigma. The United States is the most prolific country worldwide (n = 7837 publications; 50.5%), with the highest number of prolific institutions (n = 4/5), as well as the greatest influence and relevance in research (h-index 170). The most studied topics worldwide are social support and social psychology concerning homosexuality, middle age, and youth in people living with HIV/AIDS. There was no significant correlation between the volume of publications, countries’ income levels, and the most prolific geographic regions with adult HIV prevalence, overall HIV incidence and prevalence, or antiretroviral therapy coverage in people living with HIV (p &gt; 0.05 for all cases). Conclusions: Over the past two decades, research has shifted from human rights, legal rights, and ethics to attitudes toward healthcare, with the recent interest in pre-exposure prophylaxis, gender minorities, and intersectional stigma. The absence of strong correlations between publications volume and global health HIV-related indicators underscores the necessity of translating evidence into actionable strategies to reduce stigma and improve health outcomes.

HIV Conspiracy Beliefs Among Black LGBQ+ People: The Roles of Public Health Sources, Social Media, Algorithmic Assistants, and Religious Leaders

ABSTRACT As Human Immunodeficiency Virus (HIV) disproportionately affects racial and gender minorities in the U.S., this study investigates the role of intersecting identities – specifically being Black and LGBQ+ – along with the sociocultural and communicative factors intertwined with these identities in shaping beliefs in HIV conspiracy theories. An online survey (N = 1,505) shows that Black LGBQ+ people display higher levels of HIV conspiracy beliefs than their non-Black heterosexual peers. Low trust in public health sources and high reliance on social media, algorithmic assistants (e.g. Alexa and ChatGPT), and religious leaders predicted greater conspiracy beliefs. The positive relationship between reliance on social media and HIV conspiracy beliefs was weakened for those who identify as Black LGBQ+. Our findings highlight the importance of targeted health communication in the HIV context and offer actionable solutions to address health disparities.

Transforming Queer Mixed Methods Research to be Trans and Nonbinary-Inclusive

This paper describes an aspect of a larger research project using mixed methods to develop a transgender resilience measure. We highlight how our approach “queers” mixed methods research. We center transgender and nonbinary (TNB) voices throughout our research process, disrupting conventional scale development methods and ultimately (trans)forming traditional conceptualizations of resilience, which emphasize individual recovery from adversity. Historically, TNB research has perpetuated marginalization and is rooted in cisnormativity. By understanding resilience from the theoretical frameworks of gender minority stress, the transgender resilience intervention model, and intersectionality, our conceptualization of TNB resilience rejects assumptions of cisnormativity, binary normativity, and ultimately transforms our understanding of resilience. This case study exemplifies one way to queer mixed methods research to reflect TNB people’s experiences.

Characteristics of non-suicidal self-injury and its associations with gender minority stressors among Hungarian transgender and gender diverse adults

BackgroundTransgender and gender diverse (TGD) individuals experience gender-related distal (i.e., discrimination, victimization, rejection, non-affirmation) and proximal (i.e., internalized transphobia, expectation of rejection, and identity nondisclosure) stressors, which increase their risk for non-suicidal self-injury (NSSI). Yet, there is a paucity of research examining the prevalence, characteristics, and correlates of NSSI in TGD populations.MethodsA convenient sample of Hungarian TGD adults (N = 202; M = 29.60, SD = 10.27; 39.6% gender diverse individuals, 35.6% trans men, 24.8% trans women) took part in an online, questionnaire-based, cross-sectional survey. Gender minority stressors and several aspects of NSSI (i.e., prevalence, frequency, number of methods, and motivations) were assessed.ResultsResults showed a high lifetime (n = 142, 70.3%) and past-month (n = 48, 33.8%) prevalence of NSSI, with trans men (n = 55, 76.4%) and gender diverse individuals (n = 59, 73.8%) reporting higher lifetime prevalence than trans women (n = 28, 56.0%). Those who engaged in NSSI previously were significantly younger compared to those without NSSI. Structural equation model (SEM), examining the associations among gender minority stressors and functions of NSSI, revealed that proximal stressors mediated the link between distal stressors and intrapersonal functions of NSSI. Regarding interpersonal functions, neither distal nor proximal stressors were significant predictors.ConclusionsFindings suggest that trans men and gender diverse individuals, and younger TGD individuals are at greater risk for NSSI. Intrapersonal functions of NSSI and their potential association with proximal stressors should be carefully considered and assessed in clinical practice. Interventions targeting these specific associations should be developed and implemented to provide culturally sensitive care to TGD population.

Within-week associations between alcohol and other substance use and interaction with naltrexone among sexual and gender minority men in San Francisco, California, USA.

To determine whether there were within-week associations between changes in alcohol use and changes in cannabis, cocaine or amphetamines use and, if so, to ascertain whether these associations varied by naltrexone use among adult sexual and gender minority men (SGMM) with mild and moderate alcohol use disorder (AUD). Secondary analyses of data from the Say When study, a double-blind placebo-controlled trial comparing targeted oral naltrexone (50 mg) to placebo for AUD over 12 weeks. Procedures were conducted at the San Francisco Department of Public Health from May 2015 to November 2020, in San Francisco, California, USA. 98 of 120 SGMM who reported substance use beyond alcohol. Mixed effects logistic regression models tested associations between alcohol exposures [ethyl-glucuronide (EtG)-positive urine screens, past-week binge drinking and past-week binge drinking frequency] and same-week use of other substances (positive urine screens for cannabis, cocaine or amphetamines), adjusting for age, race/ethnicity, income, depression score and treatment assignment. Associations by treatment assignment (naltrexone or placebo) were also evaluated. Having a positive EtG urine screen was associated with higher odds of positive urine screens for cannabis [adjusted odds ratio (aOR) = 2.93, 95% confidence interval (95% CI) = 1.37-6.30, P = 0.006) or cocaine (aOR = 3.08, 95% CI = 1.52-6.23, P = 0.002). Each additional binge drinking day was associated with higher odds of having a positive urine screen for cocaine (aOR = 1.29, 95% CI = 1.04-1.60, P = 0.018). Among those receiving naltrexone, greater binge drinking days was associated with increased odds of having a positive urine screen for cocaine (aOR = 1.64, 95% CI = 1.18-2.27, P = 0.003), while results for cannabis and amphetamines were not statistically significant. Among adult sexual and gender minority men enrolled in a clinical trial, alcohol use was positively associated with cannabis and cocaine use. Naltrexone may mitigate cocaine use in this group by moderating binge drinking or diminishing the rewarding effects of cocaethylene. Findings highlight the potential of targeted naltrexone as an intervention to address alcohol and cocaine co-use and improve treatment outcomes in this underserved group.

Health Outcomes, Discrimination, and Stigma Among Sexual and Gender Minority People With Inflammatory Bowel Disease.

Sexual and gender minority (SGM) individuals often experience more discrimination and worse health than non-SGM people. Less is known about SGM individuals with inflammatory bowel disease (IBD). We studied IBD outcomes, discrimination, illness-related stigma, and SGM status in a cross-sectional survey. In total, 1586 IBD Partners e-cohort participants self-reported sexual orientation, gender identity, and prior IBD treatment. They completed the Short Crohn's Disease Activity Index or Simple Clinical Colitis Activity Index, the Everyday Discrimination Scale, and the Paradox of Self Stigma (PASS-24) scale. We performed regression analyses controlling for age, race, disease duration, and IBD type. SGM people were 7.8% (n = 124) of the cohort. SGM participants were younger than non-SGM participants (median age 40 vs. 54 years, P < .001). Among SGM individuals, 67% (n = 74) were in remission based on disease activity scores. Among non-SGM individuals, 74% (n = 936) were in remission (P = .097). Similar proportions of SGM and non-SGM persons reported prior IBD-related hospitalization (40% vs. 37%, P = .426; adjusted odds ratio [aOR] 0.95, 95% confidence interval [CI], 0.62-1.45) and IBD-related surgery (52% vs. 54%, P = .707, aOR 1.25, 95% CI, 0.81-1.94). SGM respondents reported more discrimination (71% vs. 47%, P < .001), and 43% of SGM individuals reported healthcare-related discrimination versus 21% of non-SGM individuals (P < .001). SGM persons also endorsed more internalized stigma (median PASS-24 scores 53 vs. 47, P = .026). SGM individuals with IBD are more likely to experience discrimination, including in healthcare, and illness-related stigma. These may significantly impact the quality of life and should be considered in the care of SGM people with IBD.

PrEP Implementation with Sexual and Gender Minority Youth: a Review on Barriers and Facilitators

PrEP Implementation with Sexual and Gender Minority Youth: a Review on Barriers and Facilitators

The mental health age gradient by gender identity

Abstract Using data from the Behavioral Risk Factor Surveillance System (BRFSS) 2017–2022 we estimated adjusted and unadjusted differences in self-reported number of poor mental health days (past month) between gender minority (GM) and cisgender adults. We document that the disparity is largest among younger individuals. Among 18- to 23-year-olds, GM adults report on average 14.5 days of poor mental health, compared to 6.3 days for cisgender individuals, yielding an unadjusted disparity of 8.2 days [95% CI: 7.15, 9.24]. This disparity decreases with age – among people over the age of 73, the observed difference was 1.7 days [95% CI: 0.13, 3.27].

Gender Differences in the Prevalence of Autistic Experiences of Interpersonal Violence: A Mixed Methods Systematic Review and Meta-Analysis

Abstract Research has identified intersectional effects of autism and gender for experiences of interpersonal violence; however, findings have been mixed and vary by violence type. This systematic review and meta-analysis examined gender differences in autistic experiences of interpersonal violence prevalence. We identified 64 studies examining physical, sexual, or psychological violence, bullying, and homicide among autistic people, varying by gender, age, and support needs. We conducted a meta-analysis over 24 studies, and found increased violence experienced by autistic cis-females (d = 0.32) and gender minorities (d = 0.73) compared to cis-males. This review suggests autistic people experience disproportionate rates of violence compared to the general population, and highlights concerningly high rates of lifetime and poly-victimization, particularly among gender-marginalized groups.

Factors that influence communication between healthcare providers and sexual minority men in HIV service delivery in Zambia

ABSTRACT Studies that have investigated client–provider interactions in HIV service delivery have focused mainly on the views of sexual and gender minorities. This study explored the views of both Healthcare Providers (HCPs) and Sexual Minority Men (SMM) in Zambia about factors that influence client–provider interactions and how this could affect HIV service delivery. We conducted in-depth interviews with 20 HCPs (>25 years old) and 20 SMM (20–34 years old) purposively recruited from Lusaka with help from local partners in 2021. Interviews lasted 30–80 min, were conducted in English, and were audio-recorded. Verbatim transcripts of audio files were iteratively coded using Nvivo. Thematic analysis was performed using the inductive approach. Study findings suggest that a lack of trust in HCPs among SMM and the religious and cultural persuasions of some HCPs negatively impact communication between SMM and HCPs. The above factors will likely make establishing a good working relationship between HCPs and SMM difficult and could negatively influence HIV service delivery. Therefore, promoting an SMM-friendly environment at health facilities and promoting HCPs’ understanding of the health needs of SMM are critical to ensure the delivery of quality HIV services to SMM in Zambia.

Awakened Awareness Online: Results from an Open Trial of a Spiritual–Mind–Body Wellness Intervention for Remote Undergraduate Students

This study aimed to assess the feasibility and acceptability of the online delivery of a spiritual–mind–body (SMB) wellness intervention previously delivered and validated in person, Awakened Awareness for Adolescents (AA-A), designed for spiritual individuation among emerging-adult undergraduates. Undergraduates aged 18–25 (N = 39) participated in an open trial study. Enrollment, retention, and engagement rates were calculated to assess the feasibility of delivering AA-A online. Thematic analysis on qualitative feedback was conducted to assess acceptability. Clinical and spiritual well-being were assessed before and after AA-A delivery using self-report measures and pre-to-post-intervention changes examined. Results were compared to previous findings from AA-A delivered in person. Interactions between sexual and gender minority (SGM) status and AA-A delivery method on spiritual well-being change scores were explored. Significant improvements were seen in anxiety and post-traumatic stress symptoms and spiritual well-being. Affordances and constraints of the online format were identified across three themes. SGM students showed significantly greater improvements than non-SGM students in depression and anxiety symptoms and spiritual well-being. AA-A is feasible and acceptable in an online format and can support students’ spiritual individuation and mental health in a way that is comparable to its in-person format. Furthermore, the online format may be particularly beneficial for SGM students to actively participate and engage.

Community norms of the Eating Pathology Symptoms Inventory (EPSI) in cisgender sexual minority adults

PurposeCisgender sexual minority adults are at elevated risk for eating disorders; however, community norms for certain eating disorder measures are lacking for this population. This study aimed to establish community norms for the Eating Pathology Symptom Inventory (EPSI) among cisgender gay, lesbian, bisexual + (individuals who identify as bisexual or pansexual; bi +) adults.MethodsCross-sectional data were analyzed from 2062 cisgender participants—including 925 gay men, 573 lesbian women, 116 bi + men, and 448 bi + women—enrolled in The PRIDE Study, a national longitudinal cohort of sexual and gender minority adults in the United States. Participants completed the EPSI, and descriptive statistics were calculated for the eight EPSI scales.ResultsWe report mean scores, standard deviations, medians, interquartile ranges, and percentile ranks for the eight EPSI scales within cisgender sexual minority populations. Distinct patterns of eating-pathology symptoms were evidenced among the cisgender sexual minority groups. Cisgender bi + women exhibited the highest scores for Body Dissatisfaction, Binge Eating, and Restricting compared to other groups, whereas cisgender bi + men reported the highest scores for Excessive Exercise. Cisgender gay men had significantly higher scores for Muscle Building and Negative Attitudes Toward Obesity compared to other groups.ConclusionThese findings offer valuable benchmarks for interpreting EPSI scores in the assessment and treatment of eating disorders among cisgender sexual minority individuals.Level of evidence: Level V: based on descriptive results.

Factor Structure, Internal Consistency, and Measurement Invariance of the Eating Pathology Symptoms Inventory (EPSI) in Transgender and Gender‐Diverse Adults

ABSTRACTObjectiveThis study aimed to examine the psychometric properties, including factor structure, internal consistency, and measurement invariance of the Eating Pathology Symptoms Inventory (EPSI) in a large national sample of transgender and gender‐diverse (TGD) adults.MethodThe sample consisted of 2098 TGD adults—including transgender men (n = 599), transgender women (n = 293), and gender‐diverse individuals (n = 1206)—who completed online self‐report surveys. Using a subset of the sample, exploratory factor analysis (EFA) was conducted to identify underlying factor structures, followed by confirmatory factor analysis (CFA) to confirm the model fit within each population in the remainder of the sample. Multi‐group confirmatory factor analysis (MG‐CFA) was used to assess measurement invariance across transgender men, transgender women, and gender‐diverse individuals.ResultsThe EPSI's eight‐factor structure was supported across all three TGD groups with strong model fit: transgender men (CFI = 0.985, RMSEA = 0.047, SRMR = 0.078), transgender women (CFI = 0.948, RMSEA = 0.048, SRMR = 0.085), and gender‐diverse individuals (CFI = 0.962, RMSEA = 0.040, SRMR = 0.060). Measurement invariance analyses supported that the EPSI was invariant across the groups, facilitating meaningful group comparisons using the inventory. Internal consistency, assessed using McDonald's omega, was acceptable for all subscales (ω = 0.74–0.94).DiscussionThis study provides psychometric support for the EPSI in TGD groups. The results indicate that the EPSI performs reliably and consistently across these groups for assessing eating pathology among gender minority people.

Protection for All? Inclusion of Sexual and Gender Minority Refugees in Indonesia

This article considers whether the refugee governance system and humanitarian programs in Indonesia accommodate people with diverse sexual orientation, gender identity, and expression (SOGIE). It contributes to an area of migration research which has been under-researched, on structural processes shaping the lives of sexual and gender minorities as they seek asylum in receiving countries in the Global South. The article utilizes social integration and social inclusion concepts with intersectional analysis. The article offers rich empirical findings on social inclusion, based on Focus Group Discussions and interviews with humanitarian organizations, service providers, and refugee-led organizations. The research shows that refugees with diverse SOGIE face discrimination and threats linked to social stigma toward the LGBTIQ+ community combined with xenophobic attitudes in Indonesia. These challenges are amplified by a weak national refugee governance framework and lack of enforcement of antidiscrimination laws. The author has synthesized these findings in a system map illustrating key enablers and barriers of social inclusion to provide insights on potential levers of change. The map illuminates areas for further research and advocacy, revealing what more can be done to prioritize the agency, safety and dignity of refugees with diverse SOGIE.

The inclusion of LGBTQ + people within UK health policy: a critical discourse analysis

BackgroundHealth policymakers can leverage change to improve equity in access to care, patient experiences and clinical outcomes. Despite legal progress to reduce health inequalities, social and systemic injustices persist and lesbian, gay, bisexual, trans and queer (LGBTQ+) people have increased risk of some health conditions and poorer health outcomes linked to the discrimination they experience. In 2022, 42 regional integrated care systems were created across England to reduce health inequalities and improve the wellbeing of their local population.MethodsThis study aimed to examine the inclusion of UK Equality Act (2010) protected characteristics within the 42 publicly available integrated care system strategies, and to consider specifically how LGBTQ + communities and their needs, experiences and outcomes are framed within these strategies. A Critical Discourse Analysis was conducted positioned within a social constructivist paradigm.ResultsAlmost all strategies talked about the needs of their populations in terms of age (42/42), disability (42/42), gender (41/42), ethnicity (39/42) and maternity or pregnancy (39/32). 27/42 strategies mentioned religion. There were no references to marital status. 22/42 strategies referred to LGBTQ + people, but only around 25% of those references provided context about the specific needs of LGBTQ + people, the health inequities they face, or services for LGBTQ + people. Regarding gender minorities, there were eight mentions of trans people and no mentions of intersex people, despite some policies using the acronym LGBQTI. While there were two mentions of inequities in care delivery for trans people, the specific health or social care needs of trans people were not described in any strategies, and there were a small number of examples where trans people were presented in a problematizing frame; with no discussion of trans inclusive care, only problems associated with being trans. Across all 42 strategies there were only four references to systemic forces (e.g. homophobia, transphobia, discrimination) affecting LGBTQ + people.ConclusionsWhile the needs of some minoritized groups are well recognized within health policies, LGBTQ + people remain marginalized. Further work is needed to educate and enable policy makers to advocate for LGBTQ + people and communities, and to ensure equitable and respectful inclusion of all minoritised groups.

Out of Sight but on My Mind: Distal Stressors, Identity Concealment, Proximal Stress, and Mental Health Among Sexual or Gender Minorities

Out of Sight but on My Mind: Distal Stressors, Identity Concealment, Proximal Stress, and Mental Health Among Sexual or Gender Minorities