Sexual Minority Young Adults Research Articles

Reactions to targeted tobacco control messaging: Transgender and gender diverse young adult perspectives

IntroductionTobacco interventions specifically created for transgender and gender diverse young adults appear almost non-existent. The Food and Drug Administration’s This Free Life is the first large scale campaign specifically designed to address the smoking disparities of sexual and gender minority (SGM) young adults. The purpose of this study was to gauge the reactions and receptivity to This Free Life from a gender diverse young adult sample using interviews conducted in spring and summer 2018. MethodsParticipants were 25 young adults recruited in Austin, Texas (M age = 23.2, 64.0 % non-Hispanic White, 70 % assigned female at birth) for semi-structured one-on-one interviews as part of a larger project focusing on the reasons and settings for tobacco use. Data in the current study pertain to attitudes and reactions to online video content from This Free Life. ResultsPositive reactions to video content related to visible queer representation and depictions of gender non-conformity in videos that were positive and affirming in tone. Negative reactions related to what was perceived as sexist stereotypes perpetuated in videos, and an over-reliance on cisgender gay bar culture. Some participants felt that messaging discouraging social/occasional smoking did not take into account their own important reasons for smoking. ConclusionsTransgender and gender diverse young adults have been overlooked in many efforts to address SGM smoking disparities. Targeted efforts such as This Free Life have the potential to help curb the disproportionate tobacco burden of gender diverse young adults by including diverse gender representation in affirming messages that emphasize freedom and autonomy.

A Preliminary Experimental Study of Minority Stress, Startle Reactivity, and Alcohol Use among Heavy Drinking Sexual Minority Young Adults

Background: Sexual minorities (e.g. lesbian, gay, bisexual) are at increased risk for alcohol use disorder (AUD) compared to heterosexuals. The minority stress model postulates that disparities in AUD stem, in part, from stress specific to sexual minorities (e.g. heterosexism). However, little research has examined psychophysiological markers of minority stress reactivity and how psychophysiological stress reactivity is associated with lifetime minority stress and alcohol use among sexual minorities. Emotion modulation of the startle response is a well-established paradigm for capturing psychophysiological stress reactivity under controlled laboratory conditions. Purpose: This preliminary study is the first to use the startle experimental paradigm to examine psychophysiological reactivity to stigma among sexual minorities. Procedures: Sexual minority participants (N = 20; 55% female), aged 18 to 27 years (M = 21.80, SD = 2.65), were recruited from the community. We compared startle reactivity in response to three types of stimuli (stigma, negative, and neutral) among heavy drinking sexual minority young adults. Although statistically underpowered, we also explored the associations between startle reactivity and self-reported drinking behaviors and lifetime minority stress. Results: Both stigma and general unpleasant stimuli produced more psychophysiological stress reactivity than neutral stimuli among sexual minorities. Psychophysiological stress reactivity was correlated with greater quantity of drinks reported on drinking days in the past month, but not greater frequency. Additionally, lifetime exposure to minority stress was associated with a blunted reactivity to stigma stimuli. Conclusions: These findings provide methodological advances and important implications for minority stress theory and alcohol use among sexual minorities.

The Role of Perceived Parental Acceptance-Rejection on Personality Psychopathology in Sexual Orientation Minority Young Adults

The construct of Parental Acceptance-Rejection (PAR) impacts a person’s mental health and well-being well into adulthood and has many adverse outcomes. Sexual orientation minorities are at particular risk for parental rejection. Sexual orientation minorities who experience parental rejection are at risk for substance use, internalized homophobia, and a disrupted sense of identity. Furthermore, regardless of PAR, the sexual orientation minority population already has an increased risk of mental health issues, notably higher personality psychopathology rates. However, no research has examined the role of PAR on personality psychopathology in sexual orientation minority populations. This study examined the association between PAR and personality psychopathology and impairment in a sample of 79 people whoself-identify as sexual minorities. Significant correlations were found between parental rejection and rates of pathological personality traits and impairment. Identity-related moderators were examined, and multiple interaction effects were identified. Implications and future directions are discussed.

Those who believe they can, do: The relationship between smoking avoidance beliefs, perceived risks of smoking, and behavior in a sexual and gender minority young adult sample

An individual’s beliefs in their perceived risk and ability to resist smoking have been found to be associated with smoking behavior. The current study explores the effects of confidence in one’s ability to avoid smoking, measured by avoidance beliefs, on the relationship between perceived risks of smoking and behavior. This analysis was done using 2016 baseline data collected among 4057 participants aged 18–24 for the evaluation of a large-scale public education campaign in the U.S. aimed at reducing tobacco use among sexual and gender minority young adults. The analytic sample included roughly 3493 participants per analysis. Analyses used the following measures: (1) perceived risks of smoking (e.g., smoking cigarettes will shorten my life); (2) confidence to avoid smoking in various situations (i.e., avoidance beliefs), and (3) past 30-day cigarette smoking. Binary logistic regression models with interaction analyses assessed the relationship between perceived risks of smoking and past 30-day smoking behavior using the interaction term of avoidance beliefs. An interaction between perceived risks of smoking and avoidance behaviors interaction emerged, such that the negative relationship between perceived risks of smoking and smoking behavior was stronger for those who believed that they could avoid smoking in various situations. This suggests that the relationship between perceived risk and smoking behavior can be bolstered if one’s beliefs about their ability to avoid smoking are strong. Campaigns that build smoking avoidance confidence may enhance the effects of tobacco outcome expectations-related messaging on smoking.

Sexual Health Information Sources, Needs, and Preferences of Young Adult Sexual Minority Cisgender Women and Non-Binary Individuals Assigned Female at Birth.

Young adult sexual minority women (SMW) have unique sexual health needs and higher rates of some poor sexual health outcomes compared to their heterosexual peers. Unequal access to relevant sexual health information may contribute to sexual orientation disparities in sexual health among women, but research on sexual health communication among SMW is sparse. In-depth interviews conducted in 2016-2017 investigated sexual health communication in a sample of 29 racially/ethnically diverse cisgender women and non-binary individuals assigned female at birth who were between 19 and 36 years of age and identified as a sexual minority. Data were analyzed using a thematic analysis approach that involved inductive and deductive coding to identify themes. Three broad themes were identified: 1) sources of sexual health information; 2) sexual health information needs; and 3) preferences for sexual health information delivery. Participants discussed and critiqued the Internet, other mass media, health care providers, school-based sex education, family, and peers/partners as sources of sexual health information. Participants expressed a need for customized, non-heteronormative information pertaining to sexually transmitted infection risk and prevention. They preferred receiving information from health care providers, the Internet, and other mass media, and some also suggested school-based sex education and peer education as methods for delivering information. Participants expressed clear desires for relevant, high-quality sexual health information delivered through a variety of channels, especially the Internet, other mass media, and health care providers. Findings call for policies that improve provision of sexual health information through health care providers, online resources, and school-based sex education.

A Qualitative Community Assessment of Racial/Ethnic Sexual Gender Minority Young Adults: Principles for Strategies to Motivate Action(s) for Realistic Tasks (SMART Thinking) Addressing HIV/AIDS, Viral Hepatitis, Mental Health, and Substance Abuse.

HIV/STI, substance use, and mental health issues disproportionately affect racial/ethnic sexual minority young adults. These health vulnerabilities intensify across the life course, most notably when young adults are independent college students. To identify the perspectives of racial/ethnic sexual gender minorities living on or near an urban university, we implemented an intersectionality-informed SWOT (strengths, weakness, opportunities, and threats) analysis, as a qualitative community assessment situated within in a campus-community setting. The community needs assessment was the first step in the strategic prevention framework (SPF) to co-locate substance abuse, mental health, viral hepatitis, and HIV prevention care services for Latinx and Black/African American sexual gender minority young adults at a minority-serving institution. The SWOT analysis identified principles for selecting, adapting, and implementing an evidence-based intervention. The significance of these principles demonstrates the value of intersectionality in evidence-based interventions to influence health education and behavior among racial/ethnic sexual gender minorities.

How Many and Which Sexual Minorities Will Be Impacted by The New “Tobacco 21” Law? Evidence from the National Health Interview Survey

The objective of this study was to identify and describe the number of sexual minority and heterosexual young adults who will be impacted by the new “Tobacco 21” law signed by President Trump in December 2019. Data came from the 2015 to 2018 National Health Interview Survey. We used descriptive statistics and multivariable logistic regression to identify key risk factors for tobacco use among adults aged 18–20 years by sexual orientation. Sexual minority tobacco users were more likely to be women, have a high school degree or less, and not living with a parent. Sexual minority tobacco users share similarities with heterosexual tobacco users, but they may remain a hard-to-reach population for tobacco cessation interventions.

Questions of faith: Religious affiliations and suicidal ideation among sexual minority young adults.

To examine how the associations of specific religious affiliations with recent suicidal ideation vary by sexual orientation among young adults. This project was a cross-sectional secondary analysis of data from the 2006 and 2011 surveys of the National Research Consortium of Counseling Centers in Higher Education. The analytic sample was restricted to persons between the ages of 18-29 (n=40,150). Multiple logistic regression analyses were used to examine associations of religious affiliations with recent suicidal ideation between heterosexual and sexual minority (e.g., gay, lesbian, bisexual, questioning) young adults. Approximately 6.7% of the sample self-identified as sexual minority. Compared to heterosexuals, sexual minorities were more likely to report recent suicidal ideation (aOR=4.52, 95% CI=3.97-5.16). Among heterosexuals, Unspecified Christian and Catholic denominations were associated with 24% and 37% reduced odds of recent suicidal ideation compared to agnostic/atheist heterosexuals. However, among sexual minorities, Unspecified Christian and Catholic denominations were associated with 68% and 77% increased odds of recent suicidal ideation compared to agnostic/atheist sexual minorities. Unspecified Christian and Catholic sexual minorities had 184% and 198% increased odds of recent suicidal ideation compared to Unitarian/Universalist sexual minorities. Although protective for heterosexuals, religious affiliation may not be globally protective against suicidal ideation among sexual minorities.

Evidence for the Confluence of Cigarette Smoking, Other Substance Use, and Psychosocial and Mental Health in a Sample of Urban Sexual Minority Young Adults: The P18 Cohort Study.

Sexual minority men (SMM) and transgender women (TW) are more likely to smoke cigarettes than heterosexual and cisgender peers, which may exacerbate existing disparities in mental and psychosocial health and substance use. As few existing studies have examined the confluence of these factors, we sought to examine tobacco use in a diverse sample of SMM and TW and describe its relationship with other substance use and health. Data were drawn from a study of syndemic conditions among SMM and TW, which included measures assessing tobacco use, substance use, and mental, psychosocial, and general health. A majority of the racially/ethnically and socioeconomically diverse sample (n = 665) reported ever smoking a cigarette, and more than half of them were current smokers. Current smoking was associated with more frequent recent substance use and poorer mental, psychosocial, and general health. In multivariable analyses, current smoking was predicted by more frequent substance use and more severe anxiety, when adjusting for demographic, substance use, and health factors. A syndemic approach to health conditions such as substance use, mental health, and psychosocial burden dictates a framework of interrelation and mutual exacerbation. In doing so, we found that current cigarette use was associated with more frequent alcohol and marijuana use and more severe anxiety, suggesting a confluence of cigarette smoking, other substance use, and mental health burden. We recommend a holistic approach to treating tobacco use in sexual and gender minority populations that addresses both substance use and the myriad psychosocial burdens that sexual and gender minority communities experience.

A transdiagnostic minority stress intervention for gender diverse sexual minority women's depression, anxiety, and unhealthy alcohol use: A randomized controlled trial.

To remedy the notable gap in evidence-based treatments for sexual minority women, this study tested the efficacy of a minority-stress-focused cognitive-behavioral treatment intended to improve this population's mental and behavioral health. The intervention, EQuIP (Empowering Queer Identities in Psychotherapy), was adapted from a transdiagnostic cognitive-behavioral treatment as also recently adapted for sexual minority men. Sexual minority women at risk of mental and behavioral health problems (n = 19) and expert providers with this population (n = 12) shaped the treatment's development, including by supporting its primary focus on universal and minority-stress-focused processes underlying this population's disproportionately poor mental and behavioral health. The resulting treatment was then delivered to young adult sexual minority women (n = 60; M age = 25.58; 41.67% racial/ethnic minority; 43.33% transgender/nonbinary) experiencing depression/anxiety and past 90-day heavy alcohol use. Compared to waitlist (n = 30), participants randomized to immediately receive EQuIP (n = 30) experienced significantly reduced depression and anxiety (d = 0.85, 0.86, respectively); effects for alcohol use problems were smaller (d = 0.29) and marginally significant. In pre- to post-intervention pooled analyses, effect sizes for minority stress processes (mean d = .25) and universal risk factors (mean d = .48), through which the treatment was expected to work, were small and moderate, respectively, and in the expected direction. This study provides initial support for a minority-stress-focused transdiagnostic cognitive-behavioral treatment for sexual minority women. These first results can launch exploration of other mechanisms and modalities through which to equip this population with evidence-based support. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Characterizing the polytobacco behaviors of sexual minority young adult college students

IntroductionPolytobacco use is a growing concern; users are exposed to cumulatively more nicotine, increasing their risk for dependence and long-term use. More sexual minority (SM) young adults report polytobacco use than their heterosexual peers, yet no studies explore how their tobacco patterns vary across the diverse product landscape. The purpose of this study was to characterize SM young adults’ patterns of tobacco use and nicotine dependence, and explore co-occurring risk factors for polytobacco use. MethodsParticipants were 609 SM Texas college students. Latent class analysis identified subgroups of tobacco users based on their tobacco use behaviors and an indicator of nicotine dependence. Multinomial logistic regression identified associations between individual-level variables and the probability of membership in various user classes. ResultsTobacco use clustered in four classes: non-users, non-addicted cigarette users, non-addicted e-cigarette users, and addicted polytobacco users. Polytobacco users had an increased probability of depressive symptoms and cannabis use relative to non-users, and more binge alcohol use than all other groups. Non-addicted cigarette users had an increased probability of binge alcohol use, cannabis use, and being non-Hispanic White relative to non-users, and an increased likelihood of cannabis use relative to non-addicted e-cigarette users. Non-addicted e-cigarette users had an increased probability of binge alcohol use relative to non-users. ConclusionsSM young adults’ tobacco use varies across the diverse product landscape. Failing to account for a range of tobacco behaviors and nicotine dependence prevents tailoring interventions that should also address concerns such as depressive symptoms, cannabis use, and binge alcohol use.

Differences in Substance Use and Sexual Risk by Sexual Orientation and Gender Identity Among University and Community Young Adults in a U.S.-Mexico Border City.

Ethnic and sexual minority young adults in El Paso, Texas, are at high risk for substance use, human immunodeficiency virus (HIV), and hepatitis C virus (HCV). In 2014, a Hispanic-serving higher education institution partnered with two community-based organizations to implement integrated substance use interventions and HIV and HCV prevention among young adults on campus and in surrounding communities. Among the 95 young adults, aged 18-24 years, who responded to a needs assessment survey, 91.5% were Hispanic, 53.7% were female, and 27.4% were sexual or gender minorities (SGMs) as defined by behavior and identity. SGMs had significantly higher rates of current smoking, drinking when bored, and of being told they had a drinking problem. Compared with the other young adult survey respondents, SGMs had lower health risk perceptions for tobacco, alcohol, and marijuana use and reported similar or higher rates of lifetime drug use during sex and higher rates of HIV risk behaviors. Study findings have implications for including measures for sexual orientation and gender identity in substance use studies, examining regional and cultural norms that may intersect to shape substance use among SGMs, and incorporating unique risk contexts for SGMs in interventions for substance use.

“It Takes a Lot of Planning”: Sexual Minority Young Adult Perceptions of Gay and Lesbian Parenthood

Lesbian and gay parents are becoming more prevalent, visible, and accepted in the United States. Despite these shifts, legal and social obstacles continue to shape pathways to parenthood. For many lesbians and gay men, access to parenthood is difficult, uncertain, and varies geographically. Using focus group interviews, this study explores how 36 Midwestern gay, lesbian, and bisexual young adults without children perceive gay and lesbian parenting and their own parenthood prospects. Themes included perceptions of legal and social barriers to parenthood, assumptions of the mounting economic obstacles and constraints surrounding parenthood, and concerns with navigating legal relatedness when establishing their families. This research provides insight into how emerging adulthood is experienced by sexual minority young adults in a shifting legal and social climate full of uncertainty regarding LGBTQ rights and parenthood. Policy implications and future research are discussed surrounding sexually diverse people’s accessibility in pursuing parenthood.

Intimate Partner Violence Perpetration and Victimization Among Young Adult Sexual Minorities.

Intimate partner violence (IPV) among sexual minority young adults has been understudied, and victimization and perpetration estimates are needed. Data on 13,653 women and men aged 24-32 who participated in Wave 4 of the National Longitudinal Study of Adolescent to Adult Health were used to examine associations between sexual orientation and IPV perpetration and victimization in respondents' current or most recent relationship. Logistic regression analyses were used to identify associations between respondent characteristics and three IPV categories (physical violence, threatened violence and forced sex). Some 94% of males and 80% of females identified as 100% heterosexual; 4% of males and 16% of females as mostly heterosexual; 1% of males and 2% of females as bisexual; and 2% of males and females as either mostly homosexual or 100% homosexual. Compared with their heterosexual counterparts, mostly heterosexual women were more likely to report having perpetrated or been a victim of physical IPV (odds ratios, 1.9 and 1.6, respectively), having threatened violence (2.0) and having been a victim of threatened violence and forced sex (1.6 for each); mostly heterosexual males were more likely to have been a perpetrator or victim of physical IPV (3.1 and 1.8, respectively) and a perpetrator of forced sex and threatened violence (2.0 and 1.8, respectively). Bisexual males had elevated odds of physical violence victimization (3.3) and forced sex victimization (4.9) and perpetration (5.0). Some sexual minority groups are disproportionately affected by IPV, indicating a need for increased prevention efforts and for studies exploring the mechanisms underlying these differences.

The Role of Adolescent Sex Education in Sexual Satisfaction among LGB+ and Heterosexual Young Adults

Comprehensive sex education from schools and parents can reduce adolescent sexual risk. Little is known about the associations between adolescent sex education and sexual satisfaction among young adults—particularly lesbian, gay, bisexual, and other sexual minority (LGB+) young adults. We examined how adolescent sex education (comprehensive versus abstinence-only) was associated with young adult sexual satisfaction (sexual contentment and sexual communication satisfaction). More comprehensive school-based sex education had a stronger association with sexual contentment and communication satisfaction in young adulthood for heterosexual participants than LGB+ participants. More comprehensive family-based sex education was associated with higher communication satisfaction for all participants.

Brief online interventions for LGBTQ young adult mental and behavioral health: A randomized controlled trial in a high-stigma, low-resource context.

To identify scalable interventions for improving sexual minority mental health and health-risk behavior, this study tested the efficacy of two self-guided online writing interventions-expressive writing and self-affirmation. To reach sexual minority young adults living in high-stigma, low-resource settings, we developed and tested these interventions in Appalachian Tennessee. In consultation with sexual minority young adults (n = 10) and stakeholders (n = 10) living in Appalachian Tennessee, we adapted these two writing interventions that we then delivered to 108 local sexual minority young adults (Mage = 23.68, SD = 3.11). Participants, representing diverse sexual and gender identities and socioeconomic backgrounds, were randomly assigned to participate in a 3-session expressive writing intervention, self-affirmation intervention, or neutral control. Participants completed mental health and health-risk behavior measures at baseline, postintervention, and 3-month follow-up. Compared to the neutral control, expressive writing exerted 3-month improvements in depressive symptoms (d = 0.48) and general psychological distress (d = 0.36) whereas self-affirmation exerted improvement in suicidal ideation (d = 0.62) and drug abuse (d = 0.59). Participants who were exposed to greater contextual minority stressors common in rural regions (i.e., discrimination and victimization) experienced significantly greater 3-month reductions in depression from expressive writing and self-affirmation compared to control. Those who experienced greater discrimination also experienced significantly greater 3-month reductions in suicidality from self-affirmation compared to control. Brief writing interventions exert significant impact on the mental health of young adult sexual minorities, especially those exposed to minority stress. Future research can consider strategies for population-level implementation, especially in high-stigma, low-resource settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Sexuality Disclosure, Trust, and Satisfaction With Primary Care Among Urban Young Adult Sexual Minority Men

Young adult sexual minority men may be receiving inadequate care from the health care system in the United States. A brief street intercept survey was conducted in a large urban center with 800 gay men 18 to 29 years old to assess access to and experiences with health care. Disclosure of sexual orientation was also found to be a critical factor in explaining comfort discussing sexual behavior with providers. These findings suggest that health care providers must be more effectively prepared to help facilitate disclosure of sexual orientation to address the health care needs of young adult sexual minority men more effectively.

Effects of the Affordable Care Act Dependent Coverage Mandate on Health Insurance Coverage for Individuals in Same-Sex Couples

A large body of research documents that the 2010 dependent coverage mandate of the Affordable Care Act was responsible for significantly increasing health insurance coverage among young adults. No prior research has examined whether sexual minority young adults also benefitted from the dependent coverage mandate, despite previous studies showing lower health insurance coverage among sexual minorities and the fact that their higher likelihood of strained relationships with their parents might predict a lower ability to use parental coverage. Our estimates from the American Community Surveys using difference-in-differences and event study models show that men in same-sex couples age 21-25 were significantly more likely to have any health insurance after 2010 compared to the associated change for slightly older 27 to 31-year-old men in same-sex couples. This increase is concentrated among employer-sponsored insurance, and it is robust to permutations of time periods and age groups. Effects for women in same-sex couples and men in different-sex couples are smaller than the associated effects for men in same-sex couples. These findings confirm the broad effects of expanded dependent coverage and suggest that eliminating the federal dependent mandate could reduce health insurance coverage among young adult sexual minorities in same-sex couples.

The Confluence of Housing Instability and Psychosocial, Mental, and Physical Health in Sexual Minority Young Adults: The P18 Cohort Study.

Sexual and gender minority (SGM) youth experience housing instability, including homelessness, at higher rates than heterosexuals. Few studies have examined differences within SGM populations and intersections of housing and health. Data were drawn from a study of SGM young adults who were assigned male at birth. Nearly one-quarter of the sample reported homelessness, unstable housing, or both in the six months prior to assessment. Housing instability was higher among those of lower income and educational attainment. Additionally, those who experienced any housing instability reported higher levels of depression, poorer self-rated health, and greater gay-related stigma; in multivariable models, only self-rated health was related to housing status. Stigma and discrimination may lead to poorer mental health; housing instability and homelessness may be a manifestation of stigma perpetuated by social conditions and mental health burdens directed by familial rejection. Findings indicate the importance of a biopsychosocial perspective in addressing housing instability in SGM youth.

Inequities in tobacco advertising exposure among young adult sexual, racial and ethnic minorities: examining intersectionality of sexual orientation with race and ethnicity

ObjectiveThis study examined sexual orientation differences in encoded exposure to tobacco product ads and intersections with race and ethnicity.MethodsWe analysed data from young adults (18–24) from the US Population Assessment...