Sexual Identity Differences Research Articles

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).

Driving Under the Influence of Alcohol and Cannabis by Sexual Identity, Race, Ethnicity, and Gender: A Nationwide Analysis Using the 2016 to 2019 National Survey on Drug Use and Health.

Sexual minority populations experience higher rates of substance use and related problems, but little is known about their specific involvement in driving under the influence (DUI) of alcohol (DUIA) and cannabis (DUIC) incidents. Using data from the 2016 to 2019 National Survey on Drug Use and Health, we used logistic regression models to estimate the interactive effects of sexual identity, race/ethnicity, and gender on past-year DUIA among adults who used alcohol and DUIC among adults who used cannabis, accounting for covariates. Using model estimates and linear combinations, we calculated the predicted probabilities of each outcome and compared sexual identity differences within and across race/ethnicity and gender. With few exceptions, the predicted probabilities of DUIA and DUIC were significantly higher among sexual minority women than heterosexual women of similar race/ethnicity. The results were more variable among men with the probabilities of DUIA and DUIC being significantly higher for some groups of sexual minority men and some groups having probabilities equal to or lower than similar heterosexual men. Some of the largest sexual minority gaps in DUIA and DUIC were observed among Hispanic and Other lesbian women and Black gay men. Sexual minority individuals are more likely to report DUI than their heterosexual counterparts; however, the risk of DUI among sexual minority populations varies by racial/ethnic and gender subgroup. Our findings indicate the importance of applying an intersectional framework when addressing substance-use-related disparities and when designing effective DUI prevention interventions for sexual minority populations.

Sexual Identity Differences in Chronic Pain: Results from the 2019 to 2021 National Health Interview Survey

IntroductionChronic pain has been highlighted as an important public health and clinical health issue. The prevalence of chronic pain has been increasing, with notable disparities for many minoritized populations. However, evidence regarding sexual minoritized populations and chronic pain is lacking. Therefore, the purpose of this study is to compare the prevalence of chronic pain among men and women by sexual identity. MethodsData from the 2019-2021 National Health Interview Survey (n=78,686), a population-based public health surveillance system were analyzed in 2023-2024. This included 592 lesbian/gay and 952 bisexual women as well as 868 gay and 317 bisexual men. Chronic pain measures included frequency, amount of pain, pain limiting activities, and pain affecting family and others. Covariates included age, race/ethnicity, relationship status, education attainment, income, and employment status. ResultsAfter adjusting for covariates, significantly (p<0.05) more gay/lesbian (26.7%) and bisexual (31.6%) women reported experiencing chronic pain “most days or everyday” than straight women (21.7%). More bisexual women reported chronic pain as well as negative impacts in their life due to chronic pain than straight women. More bisexual men also reported experiencing chronic pain “most days or everyday” compared to straight men (26.1% vs. 19.6%), although no differences were found for other aspects of pain. ConclusionsSexual minoritized populations have a greater burden of chronic pain that should be considered in moving forward in pain work. Future work in this area is needed to understand why these disparities exist and how best to provide care and treatment to those affected.

Does the approach used to measure sexual identity affect estimates of health disparities differently by race? A randomized experiment from the National Survey of Family Growth

The inclusion of “something else” as a response option for survey questions about sexual identity has been shown to significantly moderate estimated differences between sexual identity subgroups in the distributions of various health outcomes in national health surveys, specifically for substance use/misuse and reproductive health. This moderation effect may be larger depending on the respondent's race, possibly due to the intersectionality of multiple minority identities and compounding minority stressors. To test this hypothesis, we conducted secondary analyses of data from five consecutive years of the National Survey of Family Growth (2015–2019) [n = 18,903 (8510 males, 10,393 females)] in the United States, where respondents were randomly assigned to receive either a four-category version of the sexual identity question that included “something else” as a response option along with lesbian/gay, bisexual, and heterosexual, or a three-category version that omitted “something else.” We focused on model-based estimates of distributions of health outcomes across subgroups defined by both race and sexual identity and tested the race moderation hypothesis using three-way interactions involving sexual identity, question type received (four-category vs. three-category), and race (Black, White, and other). Based on this randomized experiment, we found evidence of significant differences between the four-category and three-category question versions of sexual identity, in terms of the associations between sexual identity and several health outcomes, along with moderation of these differences by the respondent's race. For some outcomes, such as wanting a child or another child, the magnitudes of the estimated sexual identity differences among racial minority individuals, specifically between bisexual and heterosexual women, were sensitive to the measurement of sexual identity. These results further suggest a need for improved sexual minority measurement, especially among racial minorities. These differences were also mostly found among women, suggesting further intersectionality of groups exposed to specific stressors.

Examining COVID-19 pandemic-related economic and household stress and its association with mental health, alcohol, and substance use in a national sample of Latinx sexual minority and heterosexual adults.

Sexual minority adults of Latinx descent faced compounded intersectional stressors during the COVID-19 pandemic across socioeconomic and health domains. Latinx people have experienced some of the highest COVID-19 infection, hospitalization, and mortality rates in the United States in addition to significant economic challenges. Yet, current data have not observed the unique pandemic-related experiences of sexual minority Latinx (SML) adults. We examined sexual identity differences in economic and household stress, social support, mental health symptomatology (depression, anxiety), alcohol, and substance use among sexual minority and nonsexual minority Latinx adults in the United States. Primary data were collected via the AmeriSpeak panel, a national probability sample of U.S.-based 2,286 Latinx adults [sexual minority = .34% (n = 465)]. Data were collected from November 2020 to January 2021, during the third wave of the COVID-19 pandemic. SML adults endorsed higher levels of economic and household stress, mental health symptomatology, and alcohol and substance use than nonsexual minority Latinx adults. Economic stress was associated with increased mental health symptomatology, alcohol, and substance use among SML adults. Social support moderated the association between economic stress and mental health symptomatology and substance use, but not alcohol use. Findings highlighted unique intersectional considerations among SML adults during the COVID-19 pandemic, including the importance of social support and the negative toll of economic stress on mental health and substance use. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Abstract P173: Examining Sexual Identity Differences in Ideal Cardiovascular Health

Introduction: Recent evidence suggests that sexual minority (e.g., gay, lesbian, bisexual, queer) adults in the United States are at increased risk of cardiovascular disease compared to heterosexual adults. However, the majority of cardiovascular health (CVH) research among sexual minority adults has focused on investigating differences in individual CVH metrics rather than comprehensive measures of CVH. Methods: We analyzed nationally representative data from the National Longitudinal Study of Adolescent to Adult Health to examine sexual identity differences in ideal CVH (i.e., individual CVH metrics and cumulative ideal CVH score) among adults. Participants received a score of 0 (poor), 1 (intermediate), or 2 (ideal) for each CVH metric, and scores were summed to calculate cumulative ideal CVH scores (continuous; range 0-12). We ran sex-stratified multiple logistic and linear regression models to examine sexual identity differences in ideal CVH. Models were adjusted for demographics, health insurance coverage, and adverse childhood experiences. Results: The final sample included 3,492 participants with a mean age of 21.8 (+/- 1.76) years. Approximately 60% were female, over 76% were White and around 90% were non-Hispanic. Compared to exclusively heterosexual women, mostly heterosexual (AOR 0.89, 95% CI = 0.79-0.99) and lesbian (AOR 0.73, 95% CI = 0.55-0.91) women had lower odds of meeting ideal criteria for tobacco use. In contrast, lesbian women had higher odds of meeting ideal criteria for glycosylated hemoglobin (AOR 1.22, 95% CI = 1.09-1.35). Among men, compared to exclusively heterosexual men, mostly heterosexual (AOR 0.87, 95% CI = 0.76-0.97) and bisexual (AOR 0.86, 95% CI = 0.74-0.97) men had lower odds of meeting ideal criteria for tobacco use and blood pressure, respectively. Gay (AOR 0.79, 95% CI = 0.67-0.90) and bisexual (AOR 0.75, 95% CI = 0.54-0.96) men had lower odds of meeting ideal criteria for physical activity, but gay men had higher odds of meeting ideal criteria for body mass index (AOR 1.25, 95% CI = 1.00-1.55). No sexual identity differences were observed for cumulative ideal CVH scores among women and men. Conclusions: As one of the first studies to use nationally representative longitudinal data to examine sexual identity differences in ideal CVH, this study makes an important contribution to the literature on CVH among sexual minority adults. Findings highlight significant CVH disparities in sexual minority adults and suggest there is a need to develop interventions that focus on improving their CVH. Future research is needed to investigate factors that may contribute to the CVH disparities observed among sexual minority adults in this study.

Initial Development and Validation of the Brief Internalized Heterosexist Racism Scale for Gay and Bisexual Black Men: A Measure of Internalized Heterosexist Racism.

We introduce internalized heterosexist racism (IHR), or the internalization of damaging stereotypes, harmful beliefs, and negative attitudes about being a sexual minority person of color. We also present the initial development and validation of the Brief Internalized Heterosexist Racism Scale for gay and bisexual Black men (IHR-GBBM), a unidimensional, 10-item measure of IHR. Exploratory factor analyses on an internet-obtained sample of gay and bisexual Black men (N = 312; Mean age = 30.36 years) show that the IHR-GBBM had evidence of good internal consistency, and good convergent, discriminant, concurrent, and incremental validity. The IHR-GBBM was positively correlated with internalized racism, internalized heterosexism, and discrimination (racist, heterosexist). IHR was also negatively correlated with race stigma consciousness, weakly positively correlated with sexual identity stigma consciousness, but not correlated with either race identity, sexual identity, or social desirability. Hierarchical regressions showed that the IHR-GBBM explained an additional variance of 2.8% and 3.1% in anxiety symptoms and substance use coping, respectively, after accounting for (1) sociodemographics, (2) internalized racism and internalized heterosexism, and (3) an interaction of internalized racism and internalized heterosexism. Older participants and those who were "out" about their sexual identity reported lower IHR. Those who did not know/want to report their HIV status reported greater IHR. Results revealed no sexual identity, sexual position, relationship status, income, education, or employment status differences in IHR. We hope the development of the IHR-GBBM spurs future research on predictors and consequences of IHR. We discuss limitations and implications for the future study of internalized heterosexist racism.

Abstract 11548: An Examination of Differences in Ideal Cardiovascular Health Between Sexual Minority and Heterosexual Adults in the All of Us Research Program

Introduction: Although cardiovascular health (CVH) disparities have been documented among sexual minority (e.g., gay/lesbian, bisexual) adults, research has been limited by a focus on sexual identity differences in individual, rather than composite, measures of CVH. Composite measures of CVH provide more comprehensive assessments of future cardiovascular disease risk. Methods: We analyzed data from the All of Us Research Program to examine sexual identity differences in CVH using the American Heart Association’s Life's Essential 8 measure of ideal CVH. Participants received a score from 0-100 for each CVH metric. We calculated an unweighted average to determine cumulative ideal CVH (range 0-100). Higher scores indicated a more favorable CVH profile. We used sex-stratified multiple linear regression models to estimate differences in individual CVH metrics and cumulative ideal CVH between sexual minority and heterosexual adults. All models were adjusted for age, race, ethnicity, household income, education, and insurance status Results: The sample included 6,597 participants with a mean age of 63.3 years (±13.89) of which 57% were female and 79% were Non-Hispanic White. Lesbian women (B = -7.43, 95% CI = -13.20, -1.65), gay men (B = -6.39, 95% CI = -10.17, -2.61), and bisexual men (B = -7.41, 95% CI = -14.71, -0.10) had less favorable nicotine exposure scores than their heterosexual counterparts of the same sex. Gay (B = -9.65, 95% CI = -16.60, -2.71) and bisexual men (B = -14.12, 95% CI = -27.53, -0.72) had less favorable physical activity scores than heterosexual men. Bisexual men also had lower cumulative ideal CVH scores than heterosexual men (B = -5.22, 95% CI = -9.16, -1.29). In contrast, gay men had more favorable body mass index scores (B = 6.23, 95% CI = 2.24, 10.22) than heterosexual men. Conclusions: This is the first study to examine ideal CVH in sexual minority adults in the All of Us Research Program. Findings have important implications for the development of interventions to promote optimal CVH among middle-aged and older sexual minority adults. Interventions to reduce nicotine exposure are needed for lesbian women and sexual minority men. Efforts to improve the CVH of sexual minority men should also focus on increasing physical activity.

Abstract 18650: Differences in Hypertension Prevalence, Awareness, and Treatment Between Sexual Minority and Heterosexual Adults in the All of Us Research Program

Introduction: Hypertension accounts for approximately half of cardiovascular disease morbidity and mortality globally. There is growing evidence that younger sexual minority (e.g., gay and bisexual) men and bisexual women report a higher prevalence of hypertension than their heterosexual counterparts. However, there is limited evidence on differences in hypertension prevalence, awareness, and treatment among sexual minority middle-aged and older adults. Therefore, we sought to examine differences in hypertension prevalence, awareness and treatment between sexual minority and heterosexual middle-aged and older adults. Hypothesis: Compared to heterosexual adults, sexual minority participants will: 1) have a higher prevalence of hypertension, 2) be less likely to be aware of their hypertension, and 3) be less likely to obtain hypertension treatment. Methods: We analyzed questionnaire, physical examination, and diagnostic data from the All of Us Research Program. We used sex-stratified multivariate logistic regression models to examine sexual identity differences in objective hypertension (i.e., a systolic blood pressure ≥ 130 and/or a diastolic blood pressure ≥ 80), hypertension awareness, and hypertension treatment among adults. Results: The sample included 53,582 participants with a mean age of 56.3 years (±16.4); 66% were female and 78% were non-Hispanic White. Among men who met objective criteria for hypertension, bisexual men were less likely to report they were unaware they had hypertension compared to heterosexual men (AOR = 0.67, 95% CI = 0.52-0.88). There were no differences in hypertension prevalence or hypertension treatment between sexual minority and heterosexual adults. Conclusions: This is the first study to use data from the All of Us Research Program to examine disparities in hypertension prevalence, treatment, and awareness among sexual minority middle-aged and older adults. We found few differences between sexual minority and heterosexual participants, which contradicts prior work that has largely focused on younger adults. Findings suggest that researchers should investigate factors that contribute to the narrowing of hypertension disparities among sexual minority adults as they age.

Trends in Cannabis and Alcohol Use by Sexual Identity in the 2015-2019 National Survey on Drug Use and Health.

Sexual minority individuals are at substantially elevated risk for both cannabis use disorder (CUD) and alcohol use disorder (AUD). Although recent increases in the legalization of cannabis have been linked to increases in cannabis use among the general population, few studies have examined if changes in cannabis use and CUD vary by sexual identity. The purpose of the current study was to examine sexual identity differences in trends for CUD and compare them to trends for AUD. We used data from 2015-2019 National Survey on Drug Use and Health to examine annual prevalence and year-specific disparities in cannabis use, CUD, heavy episodic drinking, and AUD. We also examined sex-specific sexual identity differences in linear trends for these substance use outcomes over this 5-year period. All groups except lesbian females experienced significant increases in cannabis use rates from 2015 to 2019. Heterosexual males, heterosexual females, and bisexual females also experienced significant increases in CUD rates. In contrast, no group exhibited significant increases in heavy episodic drinking or AUD rates. Bisexual women exhibited some of the largest year-specific disparities in cannabis use and CUD as well as the largest growth in disparities across time. The few changes in heavy episodic drinking and AUD alongside numerous changes in cannabis use and CUD suggest that changes in cannabis use may be attributable to legalization of cannabis use in many states during this period. Given profound disparities and increasing rates of CUD affecting bisexual females, further research is needed to identify factors that may explain their disproportionate burden.

Interpersonal- and Community-Level Risk Factors for Adolescent Obesity: An Examination of Sexual Identity, School Violence, and School Climate in a Large Sample of Urban Adolescents.

Sexual minority adolescents are more likely to have obesity compared to their heterosexual peers, but little is known about potential contributors to this disparity that lie outside of individual-level health behaviors, such as diet and exercise. One possible contributor is school violence victimization, a factor associated with overweight/obesity in adolescence. Another possible contributor is school climate, which is associated with feelings of safety and connectedness that can lower the likelihood of school violence victimization. Moreover, even less is known about relationships among all these factors among sexual minority adolescents. This gap in the literature was addressed by analyzing CDC's district-level data from the Youth Risk Behavior Survey and School Health Profiles (N = 60,625; 50.9% female, Mage = 16 years, 84.7% heterosexual, 15.3% sexual minority). Using multilevel mixed effects logistic regression models and controlling for covariates, it was found that among females and males, those with 2+ counts of last 12-month school violence victimization had higher odds of obesity than those with no school violence victimization (AOR = 1.33; AOR = 1.24). Furthermore, females and males in more positive LGBTQ school climates had lower odds of obesity than those in less positive school climates (AOR = 0.84; AOR = 0.85). There were no sexual identity differences in these models. Findings support the careful consideration of school violence victimization and LGBTQ school climate in future obesity prevention initiatives.

Correction to: Examination of Sexual Identity Differences in the Prevalence of Hypertension and Antihypertensive Medication Use Among US Adults: Findings From the Behavioral Risk Factor Surveillance System.

HomeCirculation: Cardiovascular Quality and OutcomesVol. 16, No. 4Correction to: Examination of Sexual Identity Differences in the Prevalence of Hypertension and Antihypertensive Medication Use Among US Adults: Findings From the Behavioral Risk Factor Surveillance System Free AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCorrectionPDF/EPUBCorrection to: Examination of Sexual Identity Differences in the Prevalence of Hypertension and Antihypertensive Medication Use Among US Adults: Findings From the Behavioral Risk Factor Surveillance System Originally published18 Apr 2023https://doi.org/10.1161/HCQ.0000000000000116Circulation: Cardiovascular Quality and Outcomes. 2023;16This article corrects the followingExamination of Sexual Identity Differences in the Prevalence of Hypertension and Antihypertensive Medication Use Among US Adults: Findings From the Behavioral Risk Factor Surveillance SystemIn the article by Caceres et al, “Examination of Sexual Identity Differences in the Prevalence of Hypertension and Antihypertensive Medication Use Among US Adults: Findings From the Behavioral Risk Factor Surveillance System”, which initially published online December 21, 2022 (Circulation: Cardiovascular Quality and Outcomes. 2022;15: e00899. DOI: 10.1161/CIRCOUTCOMES.122.008999), corrections are needed.On page 954 the sentence “In 2014, an optional sexual orientation and sex identity module was introduced to the BRFSS” should read “In 2014, an optional sexual orientation and gender identity module was introduced to the BRFSS.”On page 954 the sentence “Given that this analysis focused on sexual identity differences in the prevalence of hypertension and antihypertensive medication use among cisgender (ie, individuals whose sex identity aligns with their sex assigned at birth) adults, we next excluded participants with missing data for the sex identity item (n=1635) as well as those who self-identified as gender minorities (ie, transgender or gender non-binary nonbinary; n=1636)” should read “Given that this analysis focused on sexual identity differences in the prevalence of hypertension and antihypertensive medication use among cisgender (ie, individuals whose gender identity aligns with their sex assigned at birth) adults, we next excluded participants with missing data for the gender identity item (n=1635) as well as those who self-identified as gender minorities (ie, transgender or gender nonbinary; n=1636).”.On page 961 the sentence “Findings are not nationally representative as the optional sexual orientation and sex identity module in the BRFSS was only used by 22 states in 2015, 27 states in 2017, and 31 states in 2019” should read “Findings are not nationally representative as the optional sexual orientation and gender identity module in the BRFSS was only used by 22 states in 2015, 27 states in 2017, and 31 states in 2019.”On page 961 the sentence “Thus, findings may not be generalizable to sexual minority adults living in states that did not include the BRFSS optional sexual orientation and sex identity module during these years” should read “Thus, findings may not be generalizable to sexual minority adults living in states that did not include the BRFSS optional sexual orientation and gender identity module during these years.”The publisher regrets these errors.This correction has been made to the current version of the article, which is available at https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.122.008999. Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesExamination of Sexual Identity Differences in the Prevalence of Hypertension and Antihypertensive Medication Use Among US Adults: Findings From the Behavioral Risk Factor Surveillance SystemYashika Sharma, et al. Circulation: Cardiovascular Quality and Outcomes. 2022;15 April 2023Vol 16, Issue 4 Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/HCQ.0000000000000116PMID: 37071724 Originally publishedApril 18, 2023 PDF download Advertisement

Highlights From the Circulation Family of Journals.

Highlights From the Circulation Family of Journals.

Abstract P355: Examining Sexual Identity Differences in Self-Measured Blood Pressure Monitoring Among Adults in the Behavioral Risk Factor Surveillance System

Background: Hypertension is a leading risk factor for cardiovascular disease. Self-measured blood pressure (SMBP) monitoring has been identified as an effective strategy to achieve BP control among adults with hypertension. Although there is growing evidence that sexual minority (e.g., gay/lesbian, bisexual) adults are at higher risk of hypertension than heterosexual adults, there is no data on hypertension self-management among sexual minority people with hypertension. Methods: We used data from the 2019 Behavioral Risk Factor Surveillance System to examine differences in SMBP monitoring between sexual minority and heterosexual participants with hypertension. Participants were asked questions regarding SMBP monitoring at home, including whether they were advised by a healthcare professional to check their BP at home, regularly checked their BP at home, and if they shared their home BP readings with a healthcare professional. We ran sex-stratified logistic regression models, adjusted for demographic factors and healthcare utilization, to estimate differences in SMBP monitoring between sexual minority and heterosexual participants. Results: The sample included 25,461 participants with a mean age of 54.1 ( ± 16.8) of which 95.1% were heterosexual, 1.7% were gay/lesbian, and 2.2% were bisexual. Although there were no differences in the odds of being advised by a healthcare professional to check their BP at home, lesbian women were more likely than heterosexual women to report taking their BP at home (AOR 1.23, 95% CI = 1.03-4.85) and sharing their home BP readings with a healthcare professional (AOR 2.31, 95% CI = 1.04-5.17). In contrast, bisexual women were less likely than heterosexual women to report taking their BP at home (AOR 0.59, 95% CI = 0.43-0.81) and sharing their home BP readings with a healthcare professional (AOR 0.56, 95% CI = 0.40-0.78). No differences in SMBP monitoring were found between sexual minority and heterosexual men. Conclusions: As the first examination of sexual identity differences in SMBP monitoring among adults with hypertension, this study addresses important knowledge gaps within cardiovascular and sexual minority health research. Lesbian women with hypertension exhibited more favorable self-management behaviors compared to heterosexual women. However, bisexual women with hypertension were less likely than heterosexual women to engage in SMBP monitoring. Findings suggest there is a need for clinical interventions to improve hypertension self-management among bisexual women.

Co-occurring suicidal ideation and alcohol-related problems: An intersectional analysis of Native American and White adults with minoritized sexual identities

BackgroundDisparities in suicidal ideation (SI) and alcohol use disorder (AUD) are evident in both Native American and minoritized sexual identity groups, relative to non-Hispanic White and heterosexual groups. However, Native Americans report lower drinking and binge drinking rates than White adults. Persons with intersecting identities, specifically Native Americans with minoritized sexual identities, may be at greater risk for SI and drinking, binge drinking, and AUD than White and Native American heterosexual adults. MethodsFive years (2015–2019) of National Survey of Drug Use and Health data were combined (N = 130,157). Multinomial logistic regressions tested racial (Native American vs White) and sexual identity (lesbian/gay/bisexual vs heterosexual) differences in odds of SI, drinking, and co-occurring SI + drinking, versus neither SI/drinking. Subsequent analyses examined SI + binge drinking, and SI + AUD. ResultsCompared to White heterosexual adults, Native American heterosexual adults reported lower co-occurring SI + drinking odds, whereas Native American sexual minoritized adults reported higher odds. Native American sexual minoritized groups showed greater co-occurring SI + binge drinking odds and greater co-occurring SI + AUD odds compared to White heterosexual adults. Native American sexual minoritized adults showed greater SI only compared to White sexual minoritized adults. Sexual minoritized Native Americans showed higher odds of co-occurring SI + drinking, binge drinking, and AUD than White heterosexual adults. ConclusionsNative American sexual minoritized groups showed higher likelihood of co-occurring SI + drinking, binge drinking, and AUD relative to both White and Native American heterosexual adults. Disparities warrant outreach for suicide and AUD prevention for Native American sexual minoritized adults.

Differences in Ideal Cardiovascular Health Between Sexual Minority and Heterosexual Adults

Research on the cardiovascular health (CVH) of sexual minority adults has primarily examined differences in the prevalence of individual CVH metrics rather than comprehensive measures, which has limited development of behavioral interventions. To investigate sexual identity differences in CVH, measured using the American Heart Association's revised measure of ideal CVH, among adults in the US. This cross-sectional study analyzed population-based data from the National Health and Nutrition Examination Survey (NHANES; 2007-2016) in June 2022. Participants included noninstitutional adults aged 18 to 59 years. We excluded individuals who were pregnant at the time of their interview and those with a history of atherosclerotic cardiovascular disease or heart failure. Self-identified sexual identity categorized as heterosexual, gay/lesbian, bisexual, or something else. The main outcome was ideal CVH (assessed using questionnaire, dietary, and physical examination data). Participants received a score from 0 to 100 for each CVH metric, with higher scores indicating a more favorable CVH profile. An unweighted average was calculated to determine cumulative CVH (range, 0-100), which was recoded as low, moderate, or high. Sex-stratified regression models were performed to examine sexual identity differences in CVH metrics, disease awareness, and medication use. The sample included 12 180 participants (mean [SD] age, 39.6 [11.7] years; 6147 male individuals [50.5%]). Lesbian (B = -17.21; 95% CI, -31.98 to -2.44) and bisexual (B = -13.76; 95% CI, -20.54 to -6.99) female individuals had less favorable nicotine scores than heterosexual female individuals. Bisexual female individuals had less favorable body mass index scores (B = -7.47; 95% CI, -12.89 to -1.97) and lower cumulative ideal CVH scores (B = -2.59; 95% CI, -4.84 to -0.33) than heterosexual female individuals. Compared with heterosexual male individuals, gay male individuals had less favorable nicotine scores (B = -11.43; 95% CI, -21.87 to -0.99) but more favorable diet (B = 9.65; 95% CI, 2.38-16.92), body mass index (B = 9.75; 95% CI, 1.25-18.25), and glycemic status scores (B = 5.28; 95% CI, 0.59-9.97). Bisexual male individuals were twice as likely as heterosexual male individuals to report a diagnosis of hypertension (adjusted odds ratio [aOR], 1.98; 95% CI, 1.10-3.56) and use of antihypertensive medication (aOR, 2.20; 95% CI, 1.12-4.32). No differences in CVH were found between participants who reported their sexual identity as something else and heterosexual participants. Results of this cross-sectional study suggest that bisexual female individuals had worse cumulative CVH scores than heterosexual female individuals, whereas gay male individuals generally had better CVH than heterosexual male individuals. There is a need for tailored interventions to improve the CVH of sexual minority adults, particularly bisexual female individuals. Future longitudinal research is needed to examine factors that might contribute to CVH disparities among bisexual female individuals.

Sexual Identity Differences in Tobacco (Re)Uptake: Testing Mediation by Internalizing and Externalizing Symptoms

Tobacco use among gay, lesbian, and bisexual individuals is disproportionately higher than among heterosexual individuals. Identifying the mechanisms behind these differences can inform prevention and cessation efforts aimed at advancing health equity. Internalizing and externalizing symptoms as mediators of tobacco (re)uptake among sexual minority individuals was examined. Waves 4 and 5 of the Population Assessment of Tobacco and Health (2016-2019) study were analyzed in 2022. Adolescents aged ≥14 and adults years not using tobacco at Wave 4 (n=21,676) were included. Wave 4 sexual identity was categorized as heterosexual, gay/lesbian, bisexual, or something else. Associations of sexual identity with (re)uptake of cigarette use, E-cigarette use, and polytobacco use at Wave 5 were assessed, along with possible mediation of these associations by Wave 4‒internalizing and ‒externalizing symptoms. Internalizing and externalizing symptoms predicted tobacco (re)uptake regardless of sexual identity, particularly for female individuals. Gay/lesbian females (AOR=2.26; 95% CI=1.14, 4.48) and bisexual females (AOR=1.36; 95% CI=1.06, 1.74) had greater odds of E-cigarette (re)uptake than heterosexual females. High internalizing and externalizing symptoms accounted for over one third of the difference in E-cigarette (re)uptake among bisexual compared with that among heterosexual females. Males who reported sexual identity as something-else had lower odds of cigarette (re)uptake than heterosexual males (AOR=0.19; 95% CI=0.06, 0.66); this association was not mediated by internalizing and externalizing symptoms. Internalizing and externalizing symptoms uniquely contribute to E-cigarette (re)uptake among bisexual females. Strategies that reduce sexual minority stressors and resulting psychological distress may help to reduce tobacco use disparities.

Examination of Sexual Identity Differences in the Prevalence of Hypertension and Antihypertensive Medication Use Among US Adults: Findings From the Behavioral Risk Factor Surveillance System.

Recent evidence suggests that sexual minority (eg, gay/lesbian, bisexual) adults might be at increased risk of hypertension compared with heterosexual adults. However, disparities by sexual identity in antihypertensive medication use among adults with hypertension have not been comprehensively examined. We analyzed data from the Behavioral Risk Factor Surveillance System (2015-2019), to examine sexual identity differences in the prevalence of hypertension and antihypertensive medication use among adults. We ran sex-stratified logistic regression models to estimate the odds ratios of diagnosis of hypertension and antihypertensive medication use among sexual minority (ie, gay/lesbian, bisexual, and other) and heterosexual adults (reference group). The sample included 420 340 participants with a mean age of 49.7 (±17.0) years, of which 66.7% were Non-Hispanic White. Compared with heterosexual participants of the same sex, bisexual women (adjusted odds ratio, 1.19 [95% CI, 1.03-1.37]) and gay men (adjusted odds ratio, 1.18 [95% CI, 1.03-1.35]) were more likely to report having been diagnosed with hypertension. Among women with diagnosed hypertension, bisexual women had lower odds of current antihypertensive medication use (adjusted odds ratio, 0.71 [95% CI, 0.56-0.90]). Among men with diagnosed hypertension, gay men were more likely than heterosexual men to report current antihypertensive medication use (adjusted odds ratio, 1.39 [95% CI, 1.10-1.78]). Compared with heterosexual participants of the same sex, there were no differences in hypertension or antihypertensive medication use among lesbian women, bisexual men, and participants who reported their sexual identity as other. Clinical and public health interventions are needed to reduce the risk of hypertension among bisexual women and gay men. Bisexual women were at higher risk of untreated hypertension, which may be attributed to lower health care utilization due to fear of discrimination from health care providers and socioeconomic disadvantage. Future research is needed to better understand factors that may contribute to untreated hypertension among bisexual women with hypertension.

Sexual and gender minority health in Chile: findings from the 2016-2017 Health Survey.

To expose visibility of the health concerns of sexual and gender minority groups in Chile, as well as to provide a platform to advocate for policies that support the health and well-being of sexual and gender minority people in the country. The health conditions and risk factors of participants identified as sexual and gender minority were compared to those identified as cisgender heterosexual using data from the 2016-2017 National Health Survey. Despite reporting higher self-rated health than heterosexual men, gay men had a higher risk of lifetime diagnosis of sexually transmitted infections. Compared to heterosexual women, the prevalence of depression was higher among bisexual women, who were also less likely to have been tested for HIV. Moreover, transgender participants were more likely to report depression and worse self-rated health than cisgender heterosexual participants. Small sample sizes of sexual and gender minority subgroups might have obscured some differences that would have been observable in larger samples. Despite this, we found statistically significant sexual and/or gender identity differences in several health areas, especially mental, sexual, and overall health.

Abstract 9596: An Investigation of Differences in Ideal Cardiovascular Health Between Sexual Minority and Heterosexual Adults: Findings From the National Health and Nutrition Examination Survey (2007-2016)

Introduction: There is growing evidence that sexual minority (e.g., lesbian, gay, bisexual) adults are at higher risk of cardiovascular disease (CVD) than heterosexual adults. Research on the cardiovascular health (CVH) of sexual minority adults has primarily examined differences in the prevalence of individual CVH metrics rather than comprehensive measures. Therefore, we investigated sexual identity differences in ideal CVH among adults (ages 18-59) in the United States using the American Heart Association’s (AHA) Life’s Simple 7; a composite measure of ideal CVH. Methods: We analyzed cross-sectional data from the National Health and Nutrition Examination Survey (2007-2016). Questionnaire, dietary, and physical examination data were used to assess the seven metrics included in the Life's Simple 7 measure. Participants received a score of 0 (poor), 1 (intermediate), or 2 (ideal) for each CVH metric and scores were summed to calculate ideal CVH scores (continuous; range 0-14). We ran sex-stratified regression models adjusted for demographic characteristics and survey year to examine sexual identity differences in ideal CVH scores and ideal CVH (i.e., odds of meeting ideal criteria for ≥5 CVH metrics). Results: The sample included 12,832 participants with a mean age of 39.2 (±11.95) of which 5.7% were sexual minority. Compared to heterosexual women, bisexual women had lower ideal CVH scores ( B = -0.65, 95% CI = -1.02, -0.27) and they were also less likely to meet criteria for ideal CVH (AOR = 0.66, 95% CI = 0.47-0.93). Gay men had higher ideal CVH scores than heterosexual men ( B = 0.61 95% CI = 0.01, 1.21). Gay (AOR = 2.05, 95% CI = 1.16-3.62) and bisexual (AOR = 2.15, 95% CI = 1.16-3.99) men were more likely than heterosexual men to meet criteria for ideal CVH. Conclusions: This is the first representative study to investigate sexual identity differences in ideal CVH. Bisexual women were at higher risk of CVD than heterosexual women, which was attributed to higher odds of current tobacco use and obesity. Gay and bisexual men were at lower risk of CVD than heterosexual men. Future longitudinal research is needed to examine factors that might contribute to CVH disparities among bisexual women. Clinical interventions to reduce CVD risk among bisexual women are needed.