Sexual Identity Research Articles

Critical femininities: exploring young women’s digital sexual cultures

ABSTRACT This study adopts a Critical Femininities approach to examine the under-theorised domain of sexual norms on dating apps, with a focus on the self-representations of Spanish heterosexual women on Tinder. Through an analysis of three hundred profiles, this research investigates the gendered dynamics influencing these women’s portrayals of themselves in the digital dating context. Combining quantitative and qualitative methodologies, the findings reveal patterns in women’s online-mediated intimacies and sexual subjectivities, highlighting the pervasive influence of femmephobia in this space. Empirical data underscore how these dynamics operate, providing insight into the extent to which hegemonic gender beliefs and regulatory norms shape digital femininities. Moreover, a discursive examination of the ways these Spanish women construct their gendered and sexual identities on Tinder offers a critical view of the constraints and possibilities they face within this specific socio-cultural framework. This study’s focus on linguistic and representational strategies in digital self-presentation deepens our understanding of how normative gender expectations continue to shape social and sexual interactions in contemporary online spaces. In so doing, this research contributes to broader discussions in Gender Studies and linguistics, illustrating how femininity is performed, policed, and navigated in digital dating environments.

Population trends and demographic disparities in sexual identity in Stockholm County, 2010 to 2021

Abstract Background Sexual identity, linked to experiences of disadvantage and discrimination, is crucial in equality monitoring. Sweden’s gender-neutral marriage laws, introduced in 2009, provide a unique context. This study examines the population trends and demographic disparities in sexual identity over time. Methods We analyzed three population surveys (2010, 2014, 2021) from the Stockholm Public Health Cohort, including around 50,000 individuals per survey. Sexual identity was assessed via self-administered questionnaires. Demographic data were sourced from Swedish national registers. Weighted multivariate Poisson regression with robust variance estimators was used to identify demographic disparities in sexual identity. Results were presented as proportion ratio (PR) with 95% confidence interval (CI). Results Overall, 29,607 (2010), 20,249 (2014), and 22,558 (2021) individuals reported sexual identity. Heterosexual identity decreased from 95.7% (95% CI 95.4-96.0%) in 2010 to 89.0% (88.5-89.4%) in 2021, while bisexual identity increased from 1.4% (1.2-1.6%) in 2010 to 2.0% (1.8-2.3%) in 2014, and further up to 2.7% (2.4-2.9%) in 2021. Homosexual identity increased slightly from 1.5% (1.4-1.7%) in 2010 to 1.8% (1.6-2.0%) in 2021. Multivariate analyses showed that female, older age, and lower education were inversely associated, while never-married status and living alone were positively associated, with homosexual identity. In contrast, female, younger age, lower income (100 SEK/year) ( < =2,500 vs > 4,500: 2010: PR 3.32 [95% CI 1.92-5.75]; 2014: 1.83 [1.28-2.60]; 2021: 1.51 [1.14-2.01]), and never-married status (never vs currently married: 2010: 2.03 [1.47-2.80]; 2014: 1.92 [1.39-2.65]; 2021: 1.50 [1.15-1.95]) were positively associated with bisexual identity. Conclusions Heterosexual identity decreased while homosexual/bisexual identities increased in Stockholm County during 2010-2021. Socioeconomic disparities persist in sexual minorities and vary by sexual identity. Key messages • Marked socioeconomic disparities persist in sexual minorities and vary by sexual identity in Stockholm County, although income and marital status disparities in bisexual group seem narrowing. • Future studies are warranted to investigate the social dynamics that continue to produce sexual minority disadvantages.

Individual fluidity of sexual identity in Stockholm County, 2010 to 2021

Abstract Background Sexual fluidity is key to understanding the size of sexual minority populations and analyzing the socioeconomic disparities these populations face. This study explores the stability and changes in sexual identity over time, and identifies key demographic factors that predict shifts in sexual identity. Methods We analyzed longitudinal data from the Stockholm Public Health Cohort, following 36,398 participants from 2010 to 2021. Sexual identity was measured using a self-administered questionnaire in 2010, 2014, and 2021. Demographic data from 2010 were collected from the Swedish national registers. Multivariate Poisson regression with robust variance estimators was used to identify demographic factors that predicted identity changes. Results were presented as proportion or risk ratio (RR) with 95% confidence interval (CI). Results Overall, 12.1% (95% CI 11.8%-12.5%) changed sexual identity at least once in 2010-2021, including 10.4% (10.0%-10.7%) among those initially identifying as heterosexual in 2010, 41.3% (37.1%-45.6%) as homosexual, 59.6% (55.0%-64.0%) as bisexual, and 65.0% (59.4%-70.3%) as uncertain. Multivariate analyses showed that sexual minorities (homosexual: RR 5.00, 95% CI 4.45-5.61; bisexual: 6.68, 6.04-7.38; uncertain: 3.88, 3.30-4.55), females (1.28, 1.21-1.35), younger (18-29 years: 1.49, 1.30-1.70) and older ( > =60 years: 2.07, 1.92-2.22) ages, born outside Sweden (Europe: 1.21, 1.11-1.32; Outside Europe: 2.90, 2.62-3.21), and lower education ( < =9 years: 2.14, 1.98-2.31; 10-12 years: 1.43, 1.34-1.53) and income (100 SEK/year) ( < =2,500: 1.83, 1.66-2.02; (2,500, 3,500]: 1.32, 1.19-1.46) independently predicted a higher probability of identity changes. Conclusions This study provides the first insights into sexual identity fluidity in a large general population sample in Sweden, highlighting its fluid nature. Future research is needed to unravel the intricate mechanisms underlying the demographic disparities in sexual identity fluidity. Key messages • This study provides the first insights into sexual identity fluidity in Sweden, highlighting its fluid nature. • Future research is needed to unravel the intricate mechanisms underlying the demographic disparities in sexual identity fluidity.

Prevalence of Adverse Childhood Experiences Among Adolescents.

Adverse childhood experiences (ACEs) are preventable, potentially traumatic events with lifelong negative impacts. Population-level data on ACEs among adolescents have historically relied on parent reports and excluded abuse-related ACEs. We present the self-reported prevalence of ACEs among a large population-based sample of US high school students. Using cross-sectional, state-representative data from 16 states that included core ACE questions on their 2021 Youth Risk Behavior Survey, we estimate the prevalence of 8 individual (lifetime emotional, physical, or sexual abuse, physical neglect, witnessed intimate partner violence, household substance use, household poor mental health, incarcerated parent or guardian) and cumulative ACEs (0, 1, 2-3, ≥4) among a large population-based sample of adolescents, overall and by demographic characteristics (sex, race and ethnicity, age, sexual orientation). Emotional abuse (65.8%), household poor mental health (36.1%), and physical abuse (32.5%) had the highest prevalence. ACEs were very common, with 80.5% of adolescents experiencing at least 1 ACE and 22.4% experiencing ≥4 ACEs. Experiencing ≥4 ACEs was highest among adolescents who were female (27.7%), non-Hispanic multiracial (33.7%), non-Hispanic American Indian or Alaska Native (27.1%), gay or lesbian (36.5%), bisexual (42.1%), or who described their sexual identity some other way or were not sure of their sexual identity (questioning) (36.5%). Self-reported ACE estimates among adolescents exceed previously published parent-reported estimates. ACEs are not equally distributed, with important differences in individual and cumulative ACEs by demographic characteristics. Collecting ACE data directly from adolescents at the state level provides actionable data for prevention and mitigation.

Closing the gap: introducing the EQUALS MAP framework for equity-focused evidence synthesis

Abstract Background Equity-focused analysis is vital to understanding how interventions affect disadvantaged groups and prevent widening inequalities via intervention-generated inequalities. We reviewed PROGRESS-Plus usage - a commonly used framework in equity-focused reviews and proposed a novel framework. Methods First, we re-analysed articles from the EQUALISE study, a review of interventions that increase or decrease inequalities in general practice, to explore the various domains of disadvantage examined in the included studies. We then compared these domains of disadvantage with the existing PROGRESS-Plus framework. Finally, we propose a new framework to support equity-focused evidence synthesis. Results From the 325 studies included, the PROGRESS-Plus dimensions most assessed were sex(52%), ethnicity/race(49%), and age(44%). The PROGRESS-Plus framework missed context-specific groups, those with multiple intersecting disadvantage, and people who experience disability. Our new framework EQUALS MAP includes: Ethnicity (and culture and race); Qualifications (and other socioeconomic factors of household or individual); Underprivileged areas; Age; Lesbian, gay and other sexual identities; Sex and gender; Multiple disadvantages; Additional groups experiencing significant disadvantage; and Physical and mental disability. Conclusions EQUALS MAP encapsulates the key dimensions of health inequities whilst for allowing context-specific flexibility. Examining the effectiveness of policy and practice interventions by disadvantaged groups is paramount to prioritise actions. Key messages • PROGRESS-Plus - a commonly used framework for equity-focuses evidence synthesis - misses context-specific groups, those with multiple intersecting disadvantage, and people who experience disability. • EQUALS MAP is a novel framework which encapsulates the key dimensions of health inequalities whilst allowing for context-specific flexibility.

Sexual health education in Italian schools: preliminary results of EduForIST3 national project

Abstract Background School-based comprehensive sexuality education (CSE) is the best approach to disseminate scientific evidence and promote healthier sexual behaviours among young people. However, in Italy, CSE is not included in schools curricula. This study, funded by the Ministry of Health, seeks to investigate information uptake and attitudes towards sexuality among adolescents included in a pilot CSE intervention in 6 Italian regions, from December 2023 to June 2024. Methods A 10-hours education intervention was implemented in a convenient sample of 26 upper and lower secondary schools (U/LSS), covering topics such as changes in adolescence, relationships and consent, sexual identity, sexually transmitted infections (STIs), contraception and sexual health services. Students’ evaluation comprised pre/post tests assessing knowledge, attitudes towards sexuality and satisfaction. A Solomon 4-group design study was used to compare intervention and control classes. A follow-up test will be conducted 4-6 months post-intervention. Results Preliminary analysis of available data as of 30 April, 510 pre-tests and 266 post-tests, showed incremented correct answers in all items. A significant increase (p<.05) was found in 12/21 items for USS and in 9/19 items for LSS, especially in the domain STIs symptoms and prevention, among those mostly appreciated. Over 90% of students considered schools as suitable setting to receive CSE, preferably by external experts. Ongoing qualitative and long-term analysis will provide further insights of the overall impact of the activity. Conclusions The pilot CSE intervention increased the knowledge and attitudes of the students involved. Additional insights will be available after study completion. Findings from this study will contribute to evaluate the effects of CSE initiatives on sexual health knowledge and attitudes among Italian secondary schools students, as well as the effectiveness of such programs in fostering healthier behaviours. Key messages • Providing evidence-based, relevant information and education on sexual health to young people in secondary schools increases their knowledge and improves attitudes towards sexuality. • CSE should be included in Italian school curricula in order to promote an incremental uptake of information and to improve young people’s sexual health.

Quitting with pride: Differences in smoking behaviour across sexual identity groups in Ireland

Abstract Background As smoking prevalence reduces, smoking inequalities across population groups is emerging as a key challenge. Despite recognition of specific needs among members of the Lesbian, Gay, Bisexual, Transexual Plus (LGBT+) community, differences in smoking across sexual identity groups is uncharted in Ireland and the community is not represented in tobacco policy agenda setting. This study aimed to measure and compare the prevalence of smoking, quitting intention and quitting behaviour across sexual identify groups in Ireland. Methods Secondary analysis of the 2023 “Healthy Ireland” cross sectional survey of health status was conducted (n = 7,411). For the first time, this survey included a question on self-reported sexual identify, along with standard questions on smoking prevalence, quitting intention and quitting behaviour. Prevalence of smoking, quitting intention and quitting behaviour were calculated with 95% Confidence Intervals (CI) and compared across groups with Chi Square tests. Results In total, 2.3% (95% CI 2.0-2.7%) of respondents reported an LGB+ identity. Compared to those reporting straight identity, LGB+ respondents reported higher smoking prevalence (17.6% versus 21.4% respectively); intention to quit was similar across groups, however, LBG+ respondents also reported a higher prevalence of making at least one quit attempt in the previous 12 months (51.3% versus 78.0% respectively, p < 0.0001). Conclusions While this study highlighted tobacco-use as a health challenge for the LGB+ community in Ireland, it also identified an opportunity for tailored stop smoking approaches to support quit success. As a consequence, an innovative Fulbright-sponsored policy dialogue was convened between leaders in tobacco control, LGBT+ community leaders, health services and academia across Ireland and the USA to explore solutions, underlining the important role equity stratifiers and population surveillance play in agenda setting for public health. Key messages • Including sexual identity in the national population health survey enabled tobacco-use needs across sexual identity groups in Ireland delineated for the first time. • Equity-stratified population health surveillance informed a policy dialogue to better represent needs of LGBT+ community in public health agenda setting.

Sexuality and Gender Diversity Among Adolescents in Australia, 2019-2021.

Sexuality- and gender-diverse (SGD) young people experience substantial health disparities relative to cisgender heterosexual peers. Little is known about SGD adolescents younger than 15 years. To describe SGD prevalence and associated factors in a population-representative cohort of younger adolescents in Australia. This prospective cohort study was part of the Future Proofing Study, with enrollment of year 8 students at 134 Australian secondary schools from 2019 to 2021 and annual follow-ups for 5 years. Data were analyzed from June 20, 2023, to June 6, 2024. Outcomes of interest were baseline self-reported gender and sexuality identities, individual characteristics, and mental health and disability diagnoses, as well as school characteristics. Among 6388 participants, median (IQR) age was 13.9 (13.6-15.8), with a range of 10.7 to 17.5 years. Most participants attended school in a major city (76.0%), were born in Australia (91.4%), and spoke English at home (93.7%). Approximately half (3122 participants; 48.9% [95% CI, 45.2%-59.0%]) identified as female or girls, and 46.5% (2973 participants; 95% CI, 39.8%-53.4%) identified as male or boys. The overall proportion of transgender identity was 3.3% (95% CI, 2.7%-3.9%), with 23 participants (0.4%) identifying as transgender boys, 10 participants (0.2%) identifying as transgender girls, 117 participants (1.8%) identifying as transgender nonbinary, and 59 participants (0.9%) identifying as another transgender identity. The overall proportion of sexuality diversity was 12.0% (95% CI, 10.4%-13.8%). The proportion of cisgender participants who were sexuality-diverse (13.0% [95% CI, 11.4%-14.8%] of girls and 4.7% [95% CI, 3.7%-5.9%] of boys) was lower than the proportion among gender-diverse participants, which ranged from 30.0% (95% CI, 9.3%-64.1%) of transgender girls to 91.5% (95% CI, 81.3%-96.4%) of those with another diverse gender identity. Gender diversity and sexuality diversity were strongly associated (odds ratio [OR], 66.24; 95% CI, 38.23-114.80), and both were negatively associated with age (gender diversity: OR per 1-year older, 0.61; 95% CI, 0.49-0.76; sexuality diversity: OR per 1-year older, 0.78; 95% CI, 0.65-0.93) and positively with mental health diagnosis (gender diversity: OR, 2.41; 95% CI, 1.79-3.24; sexuality diversity: OR, 2.50; 95% CI, 2.10-2.98), and disability diagnosis (gender diversity: OR, 2.39; 95% CI, 1.68-3.40; sexuality diversity: OR, 1.96; 95% CI, 1.64-2.36). While there were significant associations between individual and school characteristics and responses to gender and sexuality identity items, patterns of association differed, with no consistent association with economic disadvantage. This cohort study of young adolescents found higher rates of SGD than among samples of older adolescents. The significant associations with younger age, poorer mental health, and disability underscored the urgent need for inclusive programs to promote a safe and welcoming environment in schools, health care settings, and communities.

The “noise” of suicide attempts – relating LGBTQ+-specific vs. non-specific factors

Abstract Background Despite the numerous research on the determinants and risk factors of suicide attempts, an understanding of suicide attempts as a process that holistically captures the perspectives of the actors involved is still lacking. Our study, therefore, aimed to better understand, from different perspectives, how (process) and why (subjective meaning, patterns of interpretation) (a) suicide attempt(s) among LGBTQ+ youth happen and to relate LGBTQ+-specific vs. non-specific factors. Methods From 2021 to 2024, we interviewed LGBTQ+ youth in Switzerland who had attempted suicide between the ages of 14 and 25. As part of a multi-perspective approach, we also interviewed people from their social environment where possible. Data were collected and analysed using Grounded Theory Methodology, including theoretical sampling. The final sample consisted of 41 people: 7 bisexual/lesbian cis women, 4 bisexual/gay cis men, 15 trans/non-binary people of different sexual orientations, 3 heterosexual cis people, and 12 people from their social environment. Results Sexual orientation and gender identity (SOGI) emerged as either background or foreground “music” of the suicidal processes. In some LGBTQ+ youth, SOGI were key factors influencing their suicidality, e.g. experiencing a major lack of acceptance and barriers to accessing gender-affirming transition (foreground music type). In others, suicidality was mainly related to other aspects than SOGI, especially fundamental ones such as unsafe familial circumstances or sexualised violence, which were accentuated by SOGI-related factors e.g. feeling a lack of belonging (background music type). Further, a mixed type was identified, with SOGI and non-SOGI-related factors being equally important for suicide attempt(s). Conclusions Our study implies the need to adapt health promotion, suicide prevention, and early detection and intervention strategies according to the identified types of suicidal processes.

Stressors and symptoms explaining sexual orientation inequalities in mental health services usage: A longitudinal study with young adults

Abstract Background Sexual minority (i.e., lesbian, gay, and bisexual [LGB], and other non-heterosexual) individuals are more likely to use mental health services than heterosexuals; however, evidence is scarce about factors contributing to this difference. Methods This study uses longitudinal data from a population-based sample of young adults (aged 18- 36) in Sweden (N = 1,137). We use mediation analysis to examine whether common mental health symptoms (i.e., depressive, anxiety and social anxiety symptoms, suicidality, and alcohol use) mediate sexual orientation differences in mental health services use; and to understand whether adding general stressors (i.e., low social support, loneliness, and perceived stress) to these models increases the total effect explained. Afterwards, we use logistic regression models to understand how minority-specific stressors (e.g., family reaction and dimensions of sexual minority identity) predict mental health service use among sexual minority individuals (N = 498), adjusting for common mental health symptoms. Results Common mental health symptoms only partially mediate the associations and the direct effect for sexual orientation remain significant (β = 0.11, p < 0.01). Adding general stressors to these models only slightly increase the total effect explained and the direct effect remained significant (β = 0.11, p < 0.01). Among sexual minority individuals, after adjusting for common mental health symptoms, a difficult process of coming out (β = 0.12, p < 0.05) and negative family reaction towards one’s sexual orientation (β = 0.15, p < 0.05) predicted use of mental health services. Conclusions Overall, these results show that minority-specific stressors contribute to help-seeking behaviours among sexual minority individuals, regardless of psychiatric morbidity, highlighting the potential role of mental health services empowering sexual minority individuals to cope with minority stress.

11.O. Scientific session: Mental Health Among Sexual and Gender Minority Populations in Diverse Structural Stigma Environments

Abstract Research conducted across numerous countries finds that sexual minority (e.g., lesbian, gay, and bisexual [LGB]) and gender minority (e.g., transgender [T]) individuals represent high-risk populations for poor mental health and suicidality. These disparities are believed to be a consequence of a stigmatizing environment and sexual and gender minority individuals’ disproportionate exposure to stigma-based stress compared to cisgender (i.e., non-transgender) heterosexuals. Stigma occurs at multiple levels to compromise LGBT individuals’ health. At the structural level, stigma manifests as unjust laws, policies, and cultural norms that deny, or fail to protect, the equal rights of LGBT individuals. At the interpersonal level, stigma manifests as discrimination in social interactions, social exclusion, and outright victimization. At the individual level, stigma can tax LGBT individuals’ coping resources by requiring costly behavioral strategies such as concealment of one’s LGBT identity. In this workshop, four studies from different regional environment with varying degree of structural stigma will be presented, i.e., the USA, Switzerland, Rwanda, and Kenya. They resent novel findings on the processes and mechanism underlying LGBT populations increased risk of mental health and links between stigma experiences at different levels. Dr. Clark will present a study of how negative news media coverage influence suicidality among LGBT young adults in the USA using intensive longitudinal assessments. Dr. Pfister will present findings from in-depth interviews concerning suicidality with individuals representing a wide variety of sexual and gender minority identities in Switzerland. Dr. van der Star will present a study exploring how structural stigma environments are linked to interpersonal and individuals level stigma experiences in sexual minorities representing different generations of LGBT populations. Dr. Stojanovski will present data from surveys and interviews of LGBT populations in Kenya and Rwanda focusing on experiences of discrimination and mental health. Key messages • Negative media reporting, discrimination, and barriers to health care can influence mental health and suicidality among LGBT individuals. • Identity concealment may represent a mechanism through which sexual minorities navigate structurally stigmatizing climates.

Changes in Sexual, Romantic, and Gender Identities Across the COVID-19 Pandemic: A Mixed Methods Study

Changes in Sexual, Romantic, and Gender Identities Across the COVID-19 Pandemic: A Mixed Methods Study

Addressing vulnerable groups in (public) health and humanitarian crises using RCCE-IM strategies

Abstract Background Vulnerable groups, including older people, infants and children, women, people with disabilities, migrant populations, individuals with marginalized sexual and gender identities, etc., become more fragile in public health and humanitarian crises. These groups’ vulnerability limits their access to health care and other services. Labeling, stigmatization, stereotyping, and other negative consequences contribute to the burden. Concurrent with the motto of the World Health Organization, “Leaving no one behind,’ it reminds us of the need for equality and equity-based models to reach these vulnerable groups in such crises. Methods Existing scientific literature and perspectives were synthesized. Results Novel Coronavirus Disease (COVID-19) contains various experiences. Since the pandemic, the need for interdisciplinary approaches and strategies has become more apparent based on the complexity and intersectionality of the determinants of the crisis. In this regard, Risk Communication (RC), Community Engagement (CE) and Infodemic Management (IM) strategies before, during, and after crises might be used to respond to and mitigate the hazards. Preparation plans before the crisis are almost the most effective intervention. However, “during” and “after” crises need considerable steps of RCCE-IM as well. Listening to the concerns of the vulnerable populations, avoiding discriminatory language, providing correct and timely information, using effective communication strategies, using tools to build resilience, and engaging with the community should be built and/or strengthened among the vulnerable groups. Conclusions Addressing structural vulnerabilities with public and global health perspective might provide us with more sustainable and efficient solutions. In this presentation, answers will be provided on how to use RCCE-IM strategies in structural vulnerability and the strengths and weaknesses of the system with the proposed solutions based on the global situation.

Genital Stigma and Sexual Satisfaction Among Queer Women and Gender Expansive Individuals: The Roles of Sexual Communication and Identity Positivity

Under cisheteropatriarchy, women's and gender expansive individuals’ bodies are highly stigmatized. Research finds internalizing stigma about the genitals has negative implications for sexual satisfaction, but this work has predominantly focused on heterosexual cisgender women. We examined associations between genital stigma and partnered sexual satisfaction among Queer (including any minoritized sexual identity) women (cisgender and transgender) and gender expansive people. We also examined whether comfort communicating with a sexual partner mediated the relation between genital stigma and sexual satisfaction, and whether positive LGBTQ+ identity may buffer against internalized genital stigma (i.e., moderate relations between stigma, communication, and sexual satisfaction). We analyzed survey data from 452 Queer women and gender expansive people. We tested a moderated mediation model. Mediation was supported—greater genital stigma was associated with less comfort communicating with a sexual partner, and greater discomfort communicating was associated with lower sexual satisfaction. Moderated mediation was supported, as the negative association between genital stigma and comfort communicating with a partner increased as participants’ LGBTQ+ identity positivity decreased. Our findings offer novel insights into genital stigma and factors that may facilitate and hinder Queer women's and gender expansive individuals’ sexual satisfaction.

Bullying of LGBTQ+ children and adolescents in schools: understanding the phenomenon, consequences, and international standards with a focus on the polish context

Bullying refers to repetitive, aggressive behavior intended to harm or intimidate others. Cyberbullying extends this aggression to digital platforms, involving harassment via social media, texts, or emails. These forms of bullying are particularly damaging to LGBTQ+ youth, who often face discrimination based on their sexual orientation or gender identity. In the context of LGBTQ+ individuals, bullying and cyberbullying can lead to severe emotional and psychological harm, contributing to higher rates of depression, anxiety, and suicidal ideation. Despite extensive global efforts and campaigns to combat homophobia, LGBTQ+ students continue to face significant challenges, with the situation in Poland being notably severe. The review highlights various forms of bullying, including physical, verbal, and social aggression, and underscores the alarming involvement of school personnel in perpetuating such behaviors. The focus on the Polish context enriches the global discourse on LGBTQ+ rights and highlights the critical need for targeted interventions to support vulnerable youth in regions with prevalent conservative and religious sentiments.

Sexual identity differences in the association between psychological distress and cardiometabolic health among women: 2013-2018 National Health Interview Survey.

Poor psychological health has been consistently documented for sexually minoritized women. However, little is known about the association between poor psychological health and physical health. This study examined associations between psychological distress and cardiometabolic health, including cardiovascular disease risk conditions (hypertension, high cholesterol, and diabetes) and diagnoses (stroke, coronary heart disease, myocardial infarction, and angina), by sexual identity among women. Data are from the 2013-2018 National Health Interview Survey and included 102,279 women, who were straight (n = 97,909), lesbian/gay (n = 1,424), bisexual (n = 1,235), something else (n = 360), did not know (n = 712), and refused to disclose (n = 639). Multivariable multinomial logistic regression models were fit to estimate associations between psychological distress (measured with Kessler-6) and cardiometabolic health (self-reported diagnosis) and to examine sexual-identity differences in these associations. Covariates included sociodemographic characteristics. Overall, severe psychological distress was associated with significantly higher odds of having a cardiometabolic health condition (OR = 2.66). These associations generally did not statistically significantly differ based on sexual identity. However, potential substantive differences in the magnitude of the association existed among lesbian/gay (OR = 4.00) compared to straight women (OR = 2.73). Moreover, women who identified as gay/lesbian, bisexual, "something else," or "I don't know" all reported significantly higher prevalence of severe psychological distress than straight women. Given the overall positive association between psychological distress and cardiometabolic health as well as the higher prevalence of severe psychological distress among sexual minority women, more work is needed to longitudinally examine the effects of psychological distress on health among sexually minoritized women. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

LGBTQ+ Supportive and Inclusive Care Practices: Survey Data From the T1D Exchange Quality Improvement Collaborative

OBJECTIVE Living with type 1 diabetes is challenging, but more barriers exist when one also identifies as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, or other gender-expansive identities). Acknowledging the importance of identifying this population and providing personalized care, the Health Resources and Services Administration mandated institutions to document sexual orientation and gender identity (SOGI) data. To understand the current state of SOGI documentation in the T1D Exchange Quality Improvement Collaborative, a survey assessing LGBTQ+ supportive and inclusive care practices was given to affiliated sites. RESEARCH DESIGN AND METHODS Thirty-three pediatric and 21 adult care centers were surveyed via Qualtrics. The survey included questions about their electronic health record documentation of patient-identified gender, pronouns, sexual orientation, and sex assigned at birth (SAAB). Care centers also reported on the legality of gender-affirming care in their municipalities, as well as their willingness to change SAAB after patients meet requirements. Fisher’s exact tests were used to evaluate response frequencies. RESULTS All 33 of the pediatric centers and 81% (17 of 21) of the adult centers responded to the survey. Sixty-four percent of pediatric centers had established strategies to support SOGI documentation, whereas only 50% of adult centers had implemented strategies. Some adult centers could not confirm whether they documented SOGI. Differences were seen between the pediatric and adult endocrinology centers in their documentation of gender identity (P = 0.04) and pronouns (P = 0.02). CONCLUSION Although most endocrinology centers documented gender identity and pronouns, fewer documented sexual orientation. Further work is needed to improve SOGI documentation and assess its impact on LGBTQ+ patients with diabetes.

Interventions addressing care staff views of older LGBTQ+ people in residential and homecare settings: a scoping review protocol

IntroductionPrevious research has identified that lesbian, gay, bisexual, trans and queer (LGBTQ+) social care service users have concerns and/or negative experiences of their care due to staff views and attitudes...

Brain Health Outcomes in Sexual and Gender Minority Groups: Results From the All of Us Research Program.

Sexual and gender minority (SGM) groups have been historically underrepresented in neurologic research, and their brain health disparities are unknown. We aim to evaluate whether SGM persons are at higher risk of adverse brain health outcomes compared with cisgender straight (non-SGM) individuals. We conducted a cross-sectional study in the All of Us Research Program, a US population-based study, including all participants with information on gender identity and sexual orientation. We used baseline questionnaires to identify sexual minority (lesbian, gay, bisexual, diverse sexual orientation; nonstraight sexual orientation) and gender minority (gender diverse and transgender; gender identity different from sex assigned at birth) participants. The primary outcome was a composite of stroke, dementia, and late-life depression, assessed using electronic health record data and self-report. Secondarily, we evaluated each disease separately. Furthermore, we evaluated all subgroups of gender and sexual minorities stratified by sex assigned at birth. We used multivariable logistic regression (adjusted for age, sex assigned at birth, race/ethnicity, cardiovascular risk factors, other relevant comorbidities, and neighborhood deprivation index) to assess the relationship between SGM groups and the outcomes. Of 413,457 US adults enrolled between May 31, 2017, and June 30, 2022, we included 393,041 participants with available information on sexual orientation and gender identity (mean age 51 [SD 17] years), of whom 39,632 (10%) belonged to SGM groups. Of them, 38,528 (97%) belonged to a sexual minority and 4,431 (11%) to a gender minority. Compared with non-SGM, SGM persons had 15% higher odds of the brain health composite outcome (odds ratio [OR] 1.15, 95% CI 1.08-1.22). In secondary analyses, these results persisted across sexual and gender minorities separately (all 95% CIs > 1). Assessing individual diseases, all SGM groups had higher odds of dementia (SGM vs non-SGM: OR 1.14, 95% CI 1.00-1.29) and late-life depression (SGM vs non-SGM: OR 1.27, 95% CI 1.17-1.38) and transgender women had higher odds of stroke (OR 1.68, 95% CI 1.04-2.70). In a large US population study, SGM persons had higher odds of adverse brain health outcomes. Further research should explore structural causes of inequity to advance inclusive and diverse neurologic care.

When employees matter: How employee resource groups and workforce liberalism jointly spur firms to support Pro-LGBTQ legislation

Employees are increasingly vocal about and attentive toward their organizations’ social policies and practices. Scholars have identified two main channels through which employees influence responsible business conduct: (1) employee activists proactively shaping corporate decisions and (2) the prevailing worldviews and attitudes of the workforce, which create normative pressure on appropriate corporate behavior. We propose that these two channels interact to produce high levels of employee influence. To assess this hypothesis, we examined corporate support for the Equality Act, a US congressional bill prohibiting discrimination based on sexual orientation and gender identity. Our quantitative analysis shows that firms with both LGBTQ employee resource groups and liberal workforces were more likely to endorse the Equality Act. Qualitative methods then allowed us to pinpoint the underlying mechanisms. Thus, our study expands our understanding of what enables employees to advance responsible business conduct and why firms engage in sociopolitical issues.