Sexual Minority Identity Research Articles

Sexual Minority Identities in Autistic Adults: Diversity and Associations with Mental Health Symptoms and Subjective Quality of Life.

Although disparities in mental health and subjective quality of life (QoL) have been reported for autistic adults, reasons for these disparities are poorly understood. A potential factor in these disparities is exposure to social stressors related to minority status (i.e., minority stress), including stigma and discrimination. Autistic individuals are more likely than nonautistic individuals to be from groups with other minority identities, including sexual minorities (i.e., sexual orientations such as asexual, bisexual, gay). However, to date, few studies have examined whether sexual minority autistic adults experience diminished mental health relative to heterosexual autistic adults, and no research has examined subjective QoL for sexual minority compared with heterosexual autistic adults. Participants were 651 autistic adults aged 18.5 to 83.3 years recruited through Simons Powering Autism Research's Research Match. All participants resided in the United States. Participants completed surveys online, including measures of anxious and depressive symptomatology, perceived stress, and subjective QoL. Participants reported their sexual orientation and other sociodemographic variables. A large proportion of autistic adults reported a sexual minority identity (41.2%), and a diversity of sexual identities was reported. Sexual minority autistic adults reported poorer mental health and lower subjective QoL across all assessed domains relative to heterosexual autistic adults. Understanding factors that may be associated with poorer mental health and decreased subjective QoL in autistic adults is critical and has been identified as a research priority by autistic stakeholders. The findings reported here underscore the need to examine mental health and subjective QoL disparities among autistic individuals within a societal context, taking into consideration the potential of intersecting minority identities and increased social stressors, as these added stressors may increase risks for poorer outcomes.

Protected, but Not Included? The Role of Workplace Inclusion for Sexual and Gender Minorities in the Federal Service

The public workplace has traditionally been conceived of in heteronormative and cisnormative terms, wherein heterosexuality, the gender binary, and opposite-sex relationships are presumed and institutionalized in both word and deed. Recent policy changes and public opinion shifts regarding lesbian, gay, bisexual, and transgender individuals have placed an onus on employers to develop means to include sexual and gender minorities in the overall organizational culture and improve LGBT individuals’ workplace experiences. Using multilevel data analysis, this study focuses on how LGBT federal workers’ perceptions of inclusion at the agency, supervisory, and work unit levels affect their job satisfaction. The results indicate that LGBT employees’ inclusion perceptions play a moderating role between their sexual or gender minority identities and individual job satisfaction. The findings suggest that interventions aimed at developing an inclusive culture that reduces or eliminates traditional heteronormativity and cisnormativity, both agency-wide and at separate organizational levels, may improve job satisfaction among LGBT workers.

Sexual Orientation and Racial Bias in Relation to Medical Specialty

ABSTRACT Physician explicit and implicit biases involving race and sexual orientation (SO) affect patient and provider experiences in healthcare settings. An anonymous survey was disseminated nationally to graduating medical students, residents, and practicing physicians to evaluate SO and racial biases across medical specialties. SO explicit and implicit bias were measured with the Attitudes toward Lesbians and Gay Men Scale, short form (ATLG-S) and Gay-Straight Implicit Association Test (IAT). Racial explicit and implicit bias were measured with the Quick Discrimination Index (QDI) and the Black-White IAT. Medical specialty was associated with racial explicit bias and specialty prestige with Black-White IAT score. Medical specialty and specialty prestige were not associated with SO bias. Female sex, sexual and gender minority (SGM) identity, and decreased religiosity were associated with reduced SO and racial bias. Provider race was associated with racial implicit and explicit bias.

Identity and pregnancy in conflict?: an examination of sexual minority women using qualitative description

While there is growing documentation of pregnancy among sexual minority women, little research has focused on their perceptions and experiences of conflict between sexual minority identity and pregnancy. Because of this, this study used Social Identity Theory and qualitative descriptive analysis to explore the following questions: do sexual minority women perceive sexual minority identity and pregnancy as in conflict; and if so, from where does this conflict arise and how do sexual minority women experience it? Participants included 21 lesbian, gay, bisexual, queer and other non-heterosexual cisgender women, a third of whom had previously been pregnant. Themes captured internally located conflict, including participants who saw pregnancy as irrelevant and those who experienced pregnancy as acceptable for sexual minority women; imposed conflict from healthcare contexts, including both health provider assumptions and imposed conflict on reproductive autonomy; and ambivalence. Overall, few participants noted internalised conflict between their sexual minority identity and pregnancy. Instead, sexual minority women experienced ambivalence or imposed conflict between their sexual minority identities and pregnancy from their health providers, although this imposed conflict was not limited to sexual orientation.

Sexual orientation and mental health disparities in US pre-teens: A longitudinal mediation study

Abstract Background Sexual minority children are at increased risk for psychopathology compared to their heterosexual peers, but longitudinal studies are needed to determine whether sexual minority identification precedes (rather than co-occurs with) mental health disparities and what may drive these disparities during childhood. The current study examined the longitudinal associations between sexual orientation and mental health over two years in a cohort of U.S. pre-teens with two potential mediators (increased social problems and decreased perceived school safety). Methods We used data from Waves 1-3 (2016-2020) of the U.S. Adolescent Brain Cognitive Development study. Multiple linear regression and auto-regressive cross-lagged mediation models were used to examine longitudinal associations and mediation. Analyses accounted for customized sampling weights to correct for attrition and missing data. Results The analytic sample included 5,574 children (46.0% assigned female at birth, 55.1% non-Hispanic White). Across waves, beginning to identify as gay/bisexual (0.6-2.7% of sample) was associated with increased internalizing and externalizing problems, and consistently identifying as gay/bisexual (3.4-5.0% of sample) with increased internalizing problems, compared to consistently identifying as heterosexual. For those who consistently identified as gay/bisexual, the widening disparities in internalizing problems were partially explained by increased social problems and decreased perceived school safety. Conclusions The health disparities affecting sexual minority children include internalizing and externalizing problems, and are partially explained by increased social problems and decreased perceived school safety. These findings demonstrate that sexual minority identification precedes increases in mental health problems relative to heterosexual children, driven by peer difficulties and feelings of unsafety at school experienced by sexual minority children.

Risk factors for postpartum depression among sexual minority and heterosexual parents.

Postpartum depression (PPD), a major depressive episode with postpartum onset, develops in 15% of mothers. Although findings suggest sexual minority parents may be at risk for PPD, research among this population is scarce. We evaluated risk factors for PPD in a sample of sexual minority and heterosexual parents. Four hundred and twenty seven heterosexual and one hundred and eleven sexual minority parents responded to a questionnaire distributed via social media that included demographics, the Edinburgh Postnatal Depression Scale, and the Multidimensional Scale of Perceived Social Support. Sexual minority identity was not associated with increased risk for PPD. Pregnancy had no significant effect on the likelihood for PPD. Social support was negatively and significantly associated with probability for PPD. Our data suggest that sexual minority parents are not at increased risk for PPD, contrary to previous findings. The parental role, a psychosocial factor, is a more dominant risk factor than pregnancy itself, in the development of PPD.

The Roles of Minority Stress and Thwarted Belongingness in Suicidal Ideation among Cisgender and Transgender/Nonbinary LGBTQ+ Individuals

Rates of suicidal ideation (SI), attempts, and death by suicide are consistently elevated among persons from sexual and gender minority groups relative to the general population. Experiences of minority stress and thwarted belongingness may contribute to elevated risk, and be most pernicious among persons with multiple marginalized identities. Aim The present study sought to examine the relation between gender identity (cisgender vs. transgender and nonbinary individuals [TNB]) and recent SI among a convenience sample of lesbian, gay, bisexual, questioning, and queer adults. Methods Participants (N = 807) completed an online survey with measures of minority stress, SI, and thwarted belongingness. Results We tested a mediation model in which TNB identity was indirectly associated with SI via minority stress (β = 1.94, SE = 0.30, Bootstrap 95% CI = [1.39, 2.58]). We also investigated thwarted belongingness as a moderator between minority stress and SI, and found evidence of a two-way interaction (β = 0.01, SE = 0.001, p < .001). The conditional indirect effect of gender identity on SI through minority stress was higher for individuals with higher levels of thwarted belongingness (β = 0.07, SE = 0.02, Bootstrap 95% CI = [0.04, 0.11]). Conclusion Gender identity was indirectly associated with SI through minority stress and elevations in minority stress were associated with more frequent SI. The minority stress and SI association was strongest for participants reporting higher thwarted belongingness. Building and maintaining strong social support networks may be especially important for persons with intersecting gender and sexual minority identities who face minority stress. HIGHLIGHTS TNB gender identity was indirectly associated with SI via minority stress Thwarted belongingness moderated the relation between minority stress and SI The minority stress SI relation was strongest at higher thwarted belongingness

Constructing a 'target population': A critical analysis of public health discourse on substance use among gay and bisexual men, 2000-2020.

Gay and bisexual men (GBM) have higher substance use prevalences than general population samples - often attributed to stigmatisation of sexual minority identities. We examined how influential public health research on substance use among GBM interprets this behaviour and what GBM-specific identities emerge through the discourses employed. We searched Web of Science for publications on substance use among GBM, selecting 60 of the most cited papers published during 2000-2020. We studied the language used to describe and interpret drug-using behaviour using critical discourse analysis, focusing on interpretive repertoires and subject positions. Three distinct discursive tendencies were identified. First, in constructing a target population, GBM who use illicit drugs are positioned as deficient, socially irresponsible, and maladapted to dealing with stigmatisation and HIV risks. Second, in shifting the focus beyond the individual, the gay community is conceptualised as offering a safe space for socialisation. Nonetheless, gay community spaces are problematised as promoting substance use among vulnerable GBM through aggravating loneliness and normalising drug use as a form of maladaptive (avoidance) coping. Third, counterdiscursive movements add nuance, context, and comparisons that relativise rather than generalise substance use and focus on pleasure and self-determination. Such discourses centre the need for interventions that disrupt homophobic socio-structures instead of individualising approaches to limit non-conformity. 'Expert' assessments of substance use among GBM perpetuate pathologising understandings of this behaviour and promote abject subject positions, contributing to perpetuations of intergroup stigma and social exclusion based on drug and sexual practices. Our findings highlight the need for deliberate and critical engagement with prior research and a conscious effort to disrupt dominant discourses on GBM's substance use.

Longitudinal trajectories of marijuana use in tobacco products among young adult Texas college students from 2015 to 2019.

To measure longitudinal trajectories of marijuana use in four tobacco/nicotine products (hand-rolled cigarettes/spliffs, cigars/blunts, hookah, and e-cigarettes) among young adult Texas college students from 2015 to 2019. This study used six consecutive waves of data from the marketing and promotions across colleges in Texas project (Project M-PACT), a longitudinal study of the tobacco behaviors of young adult college students. The first four waves were collected every 6months (fall 2015-spring 2017), and the final two waves were conducted yearly (spring 2018 and 2019). Growth curve models measured trajectories of marijuana use in tobacco products across the 3.5-year period. A total of 4857 young adults from 24 colleges in the largest metropolitan areas of Texas, United States (Austin, Dallas, Houston, and San Antonio): mean age = 21.0, SD = 2.3; 64.2% assigned female; 36.1% non-Hispanic white, 31.0% Hispanic, and 33.0% other or combination race/ethnicity. Participants completed online surveys assessing their past 6-month use of marijuana in four tobacco products of interest (spliffs, blunts, hookah, and e-cigarettes) and socio-demographic variables (sex, race/ethnicity, age, 2-year/4-year college attendance, and sexual and gender minority identity). Observed vaping marijuana in e-cigarettes approximately doubled between the spring of 2015 and the spring of 2019, from 11.8% to 23.9% following a quadratic time trend (linear OR = 0.84, 95% CI = 0.73-0.97, quadratic OR = 1.18, CI = 1.13-1.22). This same time period saw a quadratic decline in using marijuana in hookah (P < 0.001) and no changes in using hand-rolled cigarettes/spliffs or cigars/blunts for marijuana delivery. The popularity of nicotine e-cigarettes appears to be expanding the avenues for marijuana delivery among young adults in Texas, United States.

Experiences of COVID-19 pandemic-related stress among sexual and gender minority emerging adult migrants in the United States.

There is a dearth of research that examines COVID‐19‐related stress among multiply marginalised individuals who are in the developmental phase of emerging adulthood. This qualitative study investigated how the intersection of emerging adulthood, sexual and gender minority (SGM) identity, and migrant status were reflected in the experiences of SGM individuals (n = 37; ages 20–25 years old) who migrated to various parts of the United States in the last 5 years. Data were collected online using semi‐structured interviews. Thematic analysis revealed that participants' developmental processes (e.g., identity exploration, building financial independence) were shaped by pandemic‐related stressors, especially unemployment and financial instability. Participants who were able to maintain employment did so but at the risk of their health and safety. Findings also showed that participants experienced feelings of anxiety and depression due to social isolation, but online communication played an important role in combatting loneliness. Findings highlight the potential for trauma‐informed and intersectional approaches to practice with SGM emerging adult migrants and expanded health services and temporary entitlement programs to mitigate the pandemic's effects on this population's psychosocial and financial well‐being.

Job‐related well‐being of sexual minorities: Evidence from the British workplace employment relations study

AbstractDespite the increasingly liberal views toward sexual orientation and the evolution of legal rights worldwide, sexual minorities have been an understudied demographic group, especially in mainstream management scholarship. Using a national representative employer and employee linked survey, this study examines the relationship between sexual minority identity and job‐related well‐being. Multi‐level regression analysis reveals that bisexual employees have higher levels of anxiety and depression at work than their heterosexual counterparts. The difference is greater in industries that are not friendly to sexual minorities. When bisexual employees believe their managers are trustworthy and supportive, that difference disappears. No differences are found in well‐being between lesbians, gay men and their heterosexual counterparts. This study provides initial evidence on the effect of sexual minority identity on job‐related well‐being. It also sheds light on the different workplace outcomes between bisexual employees, lesbian women and gay men.

Ethnic and Sexual Identity-Related Inequalities in Adolescent Health and Well-Being in a National Population-Based Study.

Purpose: This study employed an intersectional framework to examine impact of inequalities related to sexual minority (SM) and ethnic minority (EM) identities in risk for health, well-being, and health-related behaviors in a nationally representative sample. Methods: Participants included 9789 (51% female) adolescents aged 17 years from the U.K.-wide Millennium Cohort Study, with data on self-identified sexual and ethnic identities. Adolescents were grouped into White heterosexual, White-SM, EM-heterosexual, and EM-SM categories. Questionnaires assessed mental health (e.g., self-reported psychological distress, doctor-diagnosed depression, attempted suicide), general health (self-rated health, chronic illness, body mass index), and health-related behaviors (e.g., smoking, substance use). Associations were analyzed using multivariable logistic regression. Results: SM individuals (White: 18% and EM: 3%) had increased odds for mental health difficulties and attempted suicide, with higher odds for White-SM individuals than for EM-SM individuals. Compared with White heterosexual individuals, White-SM and EM-SM individuals had higher risk for psychological distress (adjusted odds ratios [OR] 3.47/2.24 for White-SM/EM-SM, respectively) and emotional symptoms (OR 3.17/1.65). They had higher odds for attempted suicide (OR 2.78/2.02), self-harm (OR 3.06/1.52), and poor sleep quality (OR 1.88/1.67). In contrast, the White heterosexual and White-SM groups had similarly high proportions reporting risky behaviors except for drug use (OR 1.45) and risky sex (OR 1.40), which were more common in White-SM individuals. EM-heterosexual and EM-SM individuals had decreased odds for health-related behaviors. Conclusion: SM (White and EM) individuals had substantially worse mental health compared with heterosexual peers. Adverse health-related behaviors were more common in White-SM individuals. Investigation into the mechanisms leading to these differences is needed.

Sexual Minority Identity and Mental Health Among Individuals on the Asexuality Spectrum in China: A Longitudinal Study.

This study examined the association between sexual minority identity and mental health among Chinese asexual individuals. Data were collected in two waves at 12-months intervals, and 156 participants (27 male and 129 female) completed measures of the Asexuality Identification Scale (AIS) and Depression Anxiety Stress Scales at Times 1 and 2. The adjusted version of the Lesbian, Gay, and Bisexual Identity Scale was assessed at Time 1. Participants self-reported as asexual/gray-sexual and pansexual/demi-sexual, and those having an AIS ≥ 40 were classified as being on the asexuality spectrum. Compared with a control sample of lesbian and gay individuals (521 gay and 216 lesbian individuals), asexual individuals reported poorer mental health. Self-reported non-asexual individuals on the asexuality spectrum had a negative minority identity and poorer mental health than self-reported asexual individuals. Participants who changed their asexual orientation scored higher on internalized asexuality-phobia and identity uncertainty than participants maintaining an asexual orientation. At Time 1, acceptance concern, difficult process, and identity uncertainty were associated with poorer mental health. A difficult process was longitudinally associated with poorer mental health. The findings indicate that minority stress was partially related to asexual people's mental health and, for this reason, more asexuality-specific factors should be explored.

A Developmental Model of the Sexual Minority Closet: Structural Sensitization, Psychological Adaptations, and Post-closet Growth.

Across the lifespan, most sexual minority individuals experience the closet-a typically prolonged period in which no significant others know their sexual identity. This paper positions the closet as distinct from stigma concealment given its typical duration in years and absolute removal from sources of support for an often-central identity typically during a developmentally sensitive period. The Developmental Model of the Closet proposed here delineates the vicarious learning that takes place before sexual orientation awareness to shape one's eventual experience of the closet; the stressors that take place after one has become aware of their sexual orientation but has not yet disclosed it, which often takes place during adolescence; and potential lifespan-persistent mental health effects of the closet, as moderated by the structural, interpersonal, cultural, and temporal context of disclosure. The paper outlines the ways in which the model both draws upon and is distinct from earlier models of sexual minority identity formation and proposes several testable hypotheses and future research directions, including tests of multilevel interventions.

Examining substance-involved sexual experiences and consent communication by sexual identity

ABSTRACT Substance use can occur prior to nonconsensual and consensual sexual activity and affect how sexual consent is communicated and felt. Yet, researchers’ understanding of how substance use relates to these sexual experiences is still developing. Few researchers examine these behaviors among the intersection of sexual minority (SM) identity and gender. The goal of this study was to assess if experiences of nonconsensual and consensual substance-involved sexual activity, consent communication and feelings varied by the intersection of SM identity and identifying as a woman. Participants were recruited from a Prolific Academic panel to complete a survey about their substance use, sexual experiences, and sexual consent. SM persons and SM women reported more nonconsensual and consensual substance involved sexual experiences than heterosexual participants and SM men. Consent communication and feelings did not differ by across groups. Prevention initiatives for substance use and sexual activity may want to take an intersectional approach that addresses why different subgroups are at elevated risk to coalesce these two behaviors. Because consent feelings and communication did not differ by SM identity and gender, consent initiatives should expand their discussion to be inclusive of SM as these initiatives are often presented within a heteronormative framework.

An Identity-Affirming Web Application to Help Sexual and Gender Minority Youth Cope With Minority Stress: Pilot Randomized Controlled Trial

BackgroundEfficacious mental health interventions for sexual and gender minority youth have had limited reach, given their delivery as time-intensive, in-person sessions. Internet-based interventions may facilitate reach to sexual and gender minority youth; however, there is little research examining their efficacy.ObjectiveThis study aims to describe the results of a pilot randomized controlled trial of imi, a web application designed to improve mental health by supporting lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority identity affirmation, coping self-efficacy, and coping skill practice.MethodsSexual and gender minority youth (N=270) aged 13 to 19 (mean 16.5, SD 1.5) years and living in the United States were recruited through Instagram advertisements. Approximately 78% (210/270) of the sample identified as racial or ethnic minorities. Participants were randomized in a 1:1 fashion to the full imi intervention web application (treatment; 135/270, 50%) or a resource page–only version of the imi site (control; 135/270, 50%). The imi application covered four topical areas: gender identity; lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority identity; stress and coping; and internalized homophobia and transphobia. Participants explored these areas by engaging with informational resources, exercises, and peer stories at a self-guided pace. Both arms were assessed via web-based surveys at baseline and 4-week follow-up for intervention satisfaction, stress appraisals (ie, challenge, threat, and resource), coping skills (ie, instrumental support, positive reframing, and planning), and mental health symptoms among other outcomes. Main intent-to-treat analyses compared the arms at week 4, controlling for baseline values on each outcome.ResultsSurvey retention was 90.4% (244/270) at week 4. Participants in the treatment arm reported greater satisfaction with the intervention than participants in the control arm (t241=–2.98; P=.003). The treatment arm showed significantly greater improvement in challenge appraisals (ie, belief in one’s coping abilities) than the control (Cohen d=0.26; P=.008). There were no differences between the arms for threat (d=0.10; P=.37) or resource (d=0.15; P=.14) appraisals. The treatment arm showed greater increases in coping skills than the control arm (instrumental support: d=0.24, P=.005; positive reframing: d=0.27, P=.02; planning: d=0.26, P=.02). Mental health symptoms improved across both the treatment and control arms; however, there were no differences between arms. Within the treatment arm, higher engagement with imi (≥5 sessions, >10 minutes, or >10 pages) predicted greater improvement in stress appraisals (all P values <.05).ConclusionsThe results provide initial evidence that asynchronous psychosocial interventions delivered via a web application to sexual and gender minority youth can support their ability to cope with minority stress. Further research is needed to examine the long-term effects of the imi application.Trial RegistrationClinicalTrials.gov NCT05061966; https://clinicaltrials.gov/ct2/show/NCT05061966

Retrospective accounts of first exposure to minoritized sexual and gender identities

AbstractAlthough there has been considerable research about attitudes towards LGBTQ+ people, there has been little research into how people first come to be aware of minoritized sexual and gender minority (SGM) identities. This study sought to address this gap. A sample of sexual minority (n = 150) and heterosexual (n = 802) young adults (N = 952; Mage = 18.88 years, SD = 1.75; 949 were cisgender, three were transgender), primarily recruited from a large southern university, were asked retrospectively to recount their first exposure to or awareness of SGM identities. Responses between SGM and heterosexual participants were compared through a variety of analytical approaches, including analyzing themes about the source from which participants first recalled encountering these identities, and whether understanding about these identities came through a personal connection to someone with these identities. SGM participants reported encountering minoritized sexual identities a year earlier than did heterosexual participants, with both groups encountering these concepts in middle childhood, on average. SGM participants were more likely than heterosexual participants to report learning about minoritized gender identities from someone with a minoritized gender identity, while heterosexual participants more often reported learning about these identities from media or celebrities. Heterosexual (vs. SGM) participants were also more likely to imply that minoritized gender identities were adopted to be popular, rather than being authentic identities in themselves. Framed by developmental intergroup theory (DIT), we discuss implications of these findings, especially potential interrelationships with the development of prejudiced attitudes about SGM identities.

Existing in the void: an interpretative phenomenological analysis of rural LGBTQ+ students

While a growing body of literature has been devoted to addressing the lived experiences of LGBTQ+ youth, specific information related to LGBTQ+ youth in rural high schools is a topic in need of more attention. Utilizing the theory of LGBTQ+ minority stress and research specific to rural LGBTQ+ experiences, we explore the experiences of LGBTQ+ identities in rural Midwestern high schools. We investigate how LGBTQ+ students understand themselves and others within the context of their rural Midwestern high school education experiences. Finally, we use minority stress theory to frame rural LGBTQ+ student experiences as distal and proximal stressors related to the location of their minority sexual and gender identity within a rural environment. Interview data from two undergraduate and two graduate students were analyzed using interpretative phenomenological analysis. Participants describe the rural LGBTQ+ student phenomenon as consisting of four major themes: (a) affirmative experiences, (b) antagonistic experiences, (c) antithetical experiences, and (d) engaging in advocacy. Implications for practice, education, and policy are further discussed.

Trends in Self-Injurious Thoughts and Behaviors Among US Adults, 2015–2019: Differential Risk According to Sexual Orientation

Background Suicide continues to be one of the leading causes of death in the United States and lesbian, gay, and bisexual (LGB) individuals are disproportionately at risk of suicide in comparison to heterosexuals. Methods We examined data from adults participating for five waves (2015–2019) of the National Survey on Drug Use and Health. We first determined whether there is differential risk of suicidal thoughts, suicide plans, and suicide attempts (self-injurious thoughts and behaviors [SITBs]) in the past year according to current sexual orientation. We then estimated linear trends in prevalence of each SITB outcome stratified by each sexual orientation category. Results We estimate that compared to heterosexual men and women, gay and bisexual men and lesbian and bisexual women are at greater odds of past-year suicidal thoughts, suicide plans, and suicide attempts, respective to their sexes. Between 2015 and 2019, suicidal thoughts increased among bisexual men (by 34.3%, p = 0.037), lesbian women (by 18.4%, p = 0.033), and bisexual women (by 15.7%, p < 0.001). Prevalence of suicide plans increased among heterosexual men (by 15.3%, p = 0.017), gay men (by 28.5%, p = 0.037), and bisexual women (by 23.2%, p < 0.001). Suicide attempts increased among bisexual women by 26.6% (p < 0.001). Conclusions Sexual minority identity is a risk factor for SITBs. Bisexual women in particular are not only at greater risk for SITBs, but estimated prevalence has increased in recent years. More attention needs to be paid to LGB populations regarding future suicide prevention efforts.

A Socioecological Mixture Model of Asthma Prevalence Among Sexual Minority Adults in the United States.

Purpose: Sexual minority (SM) identity as well as sociodemographic and socioeconomic factors are associated with asthma prevalence. A syndemics framework analyzes disease conditions in a population and the social, economic, and environmental contexts in which they are found. We used a syndemic model of individual-level socioecological factors to identify profiles of asthma prevalence among SM adults. Methods: Latent class analysis (LCA) was conducted on a subpopulation of SM adults aged 18-59 years from the 2001 to 2016 National Health and Nutrition Examination Survey. Indicators in the LCA model included current asthma, gender, sexual identity, poverty-income ratio, education, and serum cotinine level. Multinomial logistic regression analyzed the effects of covariates (race/ethnicity, nativity, age, marital status, body mass index, lifetime smoking, and mental health care seeking) on identified profiles. Results: Four classes were identified among our sample of n = 1097 SM adults. Classes 1 and 2 had 19% and 18% conditional probabilities of current asthma, respectively, and were primarily female and bisexual. Classes 3 and 4 had 5% and 2% conditional probabilities of asthma, respectively, and were primarily male and gay. Classes 1 and 3 also had conditional probabilities of high income and educational attainment. Black individuals had higher odds than White individuals of being in Class 1 (odds ratio [OR] = 4.46, 95% confidence interval [CI] = 1.43-13.93), Class 2 (OR = 21.66, 95% CI = 7.50-62.60), and Class 4 (OR = 7.41, 95% CI = 2.05-26.71), relative to Class 3. Conclusion: Findings extend past literature that suggests within-group asthma disparities among SM adults. Informational campaigns on asthma management should target this community to avoid severe disease exacerbations.