Sexual Orientation Research Articles

Sexual Orientation Disparities in Subjective Cognitive Decline in a Large Cohort of Female Nurses.

Purpose: Sexual minority (SM) women have more dementia risk factors than heterosexual women, but it remains unknown whether they experience increased symptoms of subjective cognitive decline (SCD)-a key predictor of dementia. Methods: We investigated sexual orientation-related disparities in SCD in Nurses' Health Study II (N = 70,772). Sexual orientation subgroups included completely heterosexual (n = 62,884); participants identifying as heterosexual with same-sex experience ("heterosexual-SM", n = 5017); and participants identifying as mostly heterosexual (n = 1825), bisexual (n = 287), or lesbian/gay (n = 759). SCD was measured using seven symptoms from the Structured Telephone Interview for Dementia Assessment, controlling for demographics with Poisson regression models. Results: Relative to completely heterosexual participants, SM participants had 29% more SCD symptoms (95% confidence interval [CI] = 1.26-1.32). Symptoms were elevated in every SM subgroup; the largest disparities were among bisexual and mostly heterosexual subgroups (adjusted risk ratios for 1-unit increment in symptoms [aRR]: 1.60, 95% CI = 1.45-1.77; 1.48, 95% CI = 1.42-1.54, respectively) followed by lesbian/gay (aRR: 1.22, 95% CI = 1.14-1.31) and heterosexual-SM participants (aRR: 1.21, 95% CI = 1.18-1.25). Conclusion: SM women-particularly bisexual and mostly heterosexual women-had more symptoms of SCD than completely heterosexual women. These findings align with known sexual orientation-related disparities in dementia risk factors (e.g., mental health, substance use), and indicate that better understanding and closer monitoring of cognitive health in SM groups remains important for prevention efforts as an increasing proportion of aging Americans identifies as SM.

Sexual Assertiveness Across Cultures, Genders, and Sexual Orientations: Validation of the Short Sexual Assertiveness Questionnaire (SAQ-9).

Sexual assertiveness (SA) is an important concept in understanding sexual well-being and decision-making. However, psychometric evaluation of existing measures of SA in diverse populations is largely lacking, hindering cross-cultural and comparative studies. This study validated the short version of the Sexual Assertiveness Questionnaire (SAQ-9) and examined its measurement invariance across several languages, countries, genders, sexual orientations, and relationship statuses among 65,448 sexually-active adults (Mage = 32.98 years, SD = 12.08, 58% women, 2.74% gender-diverse individuals) taking part in the International Sex Survey. The scale demonstrated adequate psychometric properties. Measurement invariance tests indicated that the SAQ-9 is suitable for comparing individuals from different cultures, genders, sexual orientations, and relationship statuses, and significant group differences were also noted (e.g., gender-diverse individuals reported the highest levels of SA). Findings suggest that the SAQ-9 is a reliable and valid measure of SA and appropriate for use in diverse populations, with specific populations exhibiting varying levels of SA.

Women of Color and Intersectionality Initiative: A Workgroup Report on the Continued Need to Support and Retain Women of Color.

Background: Unprecedented stressors have significantly impacted our nation. These occurrences compounded the prepandemic structural factors that disproportionately affect historically, economically, and socially marginalized communities of color and women as highlighted by the National Academies of Sciences, Engineering, and Medicine. In response, health care organizations and regulatory bodies have shifted from the quadruple aim to the quintuple aim to conceptualize health care improvement by adding to the prioritizing of the health workforce's well-being and advancing health equity (Nundy, Cooper, & Mate, 2022). The literature presents limited and conflicting information regarding workforce well-being based on demographic background. A 2021 report by the National Academies of Sciences, Engineering, and Medicine described the potential for race, ethnicity, gender identity, sexual orientation, age, and disability status to alter or amplify the career impacts of COVID-19 (National Academies of Sciences, Engineering, and Medicine, 2021). Methods: In 2020, the Association of American Medical Colleges (AAMC) convened a Women of Color and Intersectionality Initiative ("Initiative") to understand better and address factors contributing to the well-being challenges encountered in health systems by women of color (WOC). Results: Based on a rigorous review of existing data and national trends, the group concluded that WOC continue to exist and work at the margins and that the threat of "not belonging" is a key factor impacting their well-being. The authors, who are members of this AAMC WOC Intersectionality Initiative, identified key strategies in the domains of intersectionality and equity, work-life boundaries, gendered divisions of labor, and mental health and well-being for implementation and evaluation in future studies. Conclusion: Over the last 4 years, the health and scientific workforces have encountered staffing shortages, increased attrition rates, and an overall decline of wellness. Authors and thought leaders in this space have postulated the need to refine tools and methodologies to capture intersectional differences to inform strategy. This article presents recommendations from the Initiative that include solutions that prioritize intersectionality, which can be adopted by academic health systems to support the well-being of WOC.

Healthcare Providers' Perspectives on Anoreceptive Intercourse in Sexual and Gender Minorities with Ileal Pouch Anal Anastomosis.

Evidence-based recommendations for sexual practices regarding anal receptive intercourse (ARI) do not exist in patients with inflammatory bowel diseases (IBD) undergoing restorative proctocolectomy with ileal-pouch anal anastomosis (IPAA). This study surveys providers on perspectives and attitudes related to sexual practices post-IPAA. We developed a 23-item survey and distributed it to providers caring for patients with IBD. 95% of providers think that it is important to discuss sexual orientation or practices before IPAA, but only 27% routinely discuss this. 50% did not feel comfortable and 74% did not feel confident discussing ARI recommendations with patients who underwent or will undergo IPAA. Future interventions should aim to standardize recommendations regarding feasibility and timeline to safe ARI after IPAA.

Prevalence and correlates of muscle dysmorphia in a sample of boys and men in Canada and the United States

BackgroundMuscle dysmorphia is a significant mental health condition that has been under-researched in epidemiological, community-based studies. Therefore, this study aimed to identify the prevalence and correlates of probable muscle dysmorphia among a sample of Canadian (n = 784) and American (n = 563) boys and men ages 15–35 years.MethodsThe sample comprised 1,488 boys and men who completed a variety of measures and items to capture sociodemographic characteristics and muscle dysmorphia symptoms. Diagnostic criteria were applied to identify probable muscle dysmorphia among the sample. Unadjusted (e.g., chi-square tests, independent samples t-tests) and adjusted (e.g., logistic regression) analyses were used to determine the sociodemographic factors (e.g., age, body mass index, gender, race/ethnicity, sexual orientation, education, relationship status, and country) associated with cases of probable muscle dysmorphia.ResultsThe prevalence of probable muscle dysmorphia was 2.8% (95% confidence interval 2.0-3.7%). Aside from lower body mass index among those with probable muscle dysmorphia, there were no significant demographic differences between those with and without probable muscle dysmorphia across ages, genders, races/ethnicities, and sexual orientations. Those with probable muscle dysmorphia had significantly higher scores on standardized measures of muscle dysmorphia symptomatology and muscularity-oriented attitudes and behaviors compared to those without probable muscle dysmorphia.ConclusionsFindings underscore that muscle dysmorphia may be more prevalent among boys and men in Canada and the United States than previously thought, highlighting the need for more research, prevention, assessment, and intervention efforts. The minimal differences across sociodemographic factors are notable, highlighting the need for an inclusive understanding of muscle dysmorphia.

Moving Toward a More Comprehensive Standard for Sex Education: A Latent Class Analysis and Examination of Young Adult Sexual Health

ABSTRACT While sex education has been linked to adolescent health, few studies have examined how comprehensiveness of school-based sex education may promote young adult sexual wellbeing. The current study used latent class analysis to examine patterns in the comprehensiveness of topics included in sex education among a national sample of young adults (N = 676). Many participants had not received sex education (40%) or had received sex education that was focused on abstinence (20%) or sexual risks (25%). Only 15% had received comprehensive sex education (likely to cover a range of topics, including condoms/contraception, sexual communication, gender, sexual orientation, pleasure, consent, etc.). Analyses examined how class membership related to sexual health. Compared to all other groups, young adults that had received the most comprehensive sex education were more likely to use condoms and communicate with their partners about STIs. They were also more likely to have had an STI test (compared to those who received other types of sex education) and reported greater sexual satisfaction (compared to those who received no sex education). Those that received the most comprehensive sex education reported their sex education to be more inclusive, preparative, and empowering but less comfortable. Implications for research and practice are discussed.

Anti‐Stigma Potentials of Mobile Methods

ABSTRACTThe article refers to the problem of stigmatisation, generally understood as discrediting dignity and refusing to respect individuals and groups due to their attributes, such as appearance, race, nationality, gender, age, social status, sexual orientation or religion. The article aims to determine the extent to which the use of mobile methods in social education can contribute to preventing, reducing, and overcoming the phenomenon of stigmatisation. The article has both a theoretical, methodological and empirical dimension. On the theoretical level, it proposes a transformative approach as adequate in terms of searching for anti‐stigma potentials. Methodologically, it contains a description of mobile methods, a relatively new set of ways of conducting social research, and, at the same time, a potential way of preventing and overcoming stigma within educational practices. On the empirical level, it presents a case study to illustrate the described methods and their anti‐stigma potentials.

Check your data before you wreck your model: The impact of careless responding on substance use data quality

AbstractBackgroundThe accuracy of survey responses is a concern in research data quality, especially in college student samples. However, examination of the impact of removing participants from analyses who respond inaccurately or carelessly is warranted given the potential for loss of information or sample diversity. This study aimed to understand if careless responding varies across a number of demographic indices, substance use behaviors, and the timing of survey completion.MethodCollege students (N = 5809; 70.7% female; 75.7% White, non‐Hispanic) enrolled in psychology classes from six universities completed an online survey assessing a variety of demographic and substance use‐related information, which included four attention check questions dispersed throughout the hour‐long survey. Differences in careless responding were assessed across multiple demographic groups, and we examined the impact of careless responding on data quality via a confirmatory factor analysis of a validated substance use measure, the Drinking Motives Questionnaire‐Revised Short Form.ResultsCareless responding varied significantly by participant race, sex, gender, sexual orientation, and socioeconomic status. Substance use was generally unassociated with careless responding, though careless responding was associated with experiencing more alcohol‐related problems. Careless responding was more prevalent when the survey was completed near the end of the semester. Finally, the factor structure of the drinking motives measure was affected by the inclusion of those who failed two or more attention check questions.ConclusionsIncluding attention checks in surveys is an effective method to detect and address careless responding. However, omitting participants from analyses who evidence any careless responding may bias the sample demographics. We discuss recommendations for the use of attention check questions in undergraduate substance use cross‐sectional surveys, including retaining participants who fail only one attention check, as this has a minimal impact on data quality while preserving sample diversity.

Violence Against Lesbian, Gay, and Bisexual Older Adults: Findings From the Brazilian Health System.

The primary objective of this research was to describe the prevalence of violence against older adults according to sexual orientation as documented in the Notifiable Diseases Information System (SINAN) in Brazil. SINAN is a national database that compiles violence-related notifications reported by healthcare services. This ecological study analyzed aggregated data at the population level, focusing on violence notifications involving individuals aged 50 and above from 2017 to 2021. The data underwent descriptive and bivariate statistical analyses, adhering to a significance level of 5%. The completeness percentage of the sexual orientation variable ranged from 70% to 72%. Our analysis detected noteworthy disparities in the distribution of violence notifications based on sexual orientation. Specifically, lesbians had the highest incidence rates of physical violence compared to heterosexual and bisexual women. In a broader context, women demonstrated a higher susceptibility to psychological violence, with bisexual women experiencing a notably elevated prevalence (41.67%). Reports of physical and psychological violence differed based on contextual variables, such as race, education level, and geographic region. We hereby conclude that the disparities found in violence notifications underscore a troubling situation faced by older adults within the LGB community, with a particular emphasis on the challenges encountered by bisexual individuals. Improving cultural competence in health systems is essential to enhancing data collection and understanding the complexities of violence against this population.

Capturing sexual orientation and gender identity information in electronic medical records to inform the person-centred care of sexual and gender minority people

BackgroundThe healthcare disparities of sexual and gender minority (SGM) people are globally recognised. Research from the United States has advocated for sexual orientation and gender identity (SOGI) information capture via the electronic medical record (EMR) to support the generation of knowledge regarding SGM people’s healthcare needs and the appropriate care for this population. In November 2022, The Royal Melbourne Hospital (RMH) enabled the SOGI capture EMR functionality. The purpose of this study is to understand how SOGI capture can inform the person-centred care of SGM people by way of interviews with SGM patients and RMH staff. It quantitatively describes RMH SOGI capture throughout the study period to provide additional insights.MethodsThis study uses an embedded mixed-methods design: qualitative data are primary and quantitative data are supplementary. SOGI capture uptake at RMH informed the recruitment of SGM patients (n = 11) and RMH staff (n = 13). Participants were engaged in in-depth semi-structured interviews that were then reflexively thematically analysed. SOGI capture throughout the study period (8th November 2022 to 23rd September 2024) was quantitatively described via frequency and percentage and then analysed in relation to the qualitative results to provide additional insights.ResultsInterviewed participants considered SOGI capture a significant step toward providing person-centred care for SGM people. However, participants shared problems in SGM healthcare and expressed that for SOGI capture to benefit SGM patients, staff must be aware of not only SOGI capture but also SGM healthcare issues. Other recommendations for SOGI capture included patient informed consent; patient preferences accurately captured; and mandatory SOGI questions to normalise this process. During the study period 272,672 patients were admitted to RMH, of which there were 2,174 (0.8%) SGM SOGI captures; 2,000 (0.7%) captured a gender identity that was not ‘male’ or ‘female’ and 1,113 captured a sexual orientation that was not ‘straight’ or ‘not reported’ (0.4%). These numbers demonstrate SGM patients’ minority status and signal the need for more staff and patient awareness of SOGI capture and mandatory SOGI questions to increase the representation and knowledge of this population and ultimately improve its care provision. A diversity of identifiers for this population was captured (10 sexual orientation identifiers and 14 gender identity identifiers) which demonstrate the significance of recognising SGM patient preferences.ConclusionThis study presented an in-depth exploration of how SOGI capture can inform the person-centred care of SGM people if staff are aware of SGM healthcare issues, and if SOGI capture is done according to patient preference and consent and is normalised through mandatory questions. Insights and recommendations generated from this study can inform local and international policies and processes in the implementation of SOGI capture such that it can inform person-centred care for SGM people.

Are Stereotypes About Minorities More Negative?

ABSTRACTVarious theories on intergroup bias predict that stereotypes about minorities are more negative than those about majorities. Although there is clear evidence that specific minorities are often subject to negative stereotypes, a systematic test of the relationship between group size and stereotype valence across various social groups is lacking. We conducted a multinational study across seven Western European countries to examine this relationship. We retrieved objective data on group sizes for 196 political, social, religious, ethnic and sexual orientation groups and assessed people's stereotypes about these groups. With 19,958 stereotype ratings from 1397 individuals (∼200 per country), our findings reveal that stereotypes about minorities are indeed more negative. This pattern persisted when controlling for respondents’ group membership and several robustness checks (e.g., which country is studied). Our study provides a systematic test of a central claim in stereotype research within WEIRD (Western, Educated, Industrialized, Rich and Democratic) countries.

Stress, Psychological Distress, Suicide Ideation, and Physical Health by Sexual Orientation*

ABSTRACT The COVID-19 pandemic created a mental and physical health crisis. Certain social groups—such as sexual minorities—were predicted to be disproportionately affected by the pandemic due to prior evidence of multiple health disparities. Using data from the 2021 Crime, Health, and Politics Survey (CHAPS) sampled from the National Opinion Research Center’s AmeriSpeak© panel, we explore how stress, psychological distress, physical health, and suicide ideation varied by sexual orientation. Responses were collected mid-2021—when vaccines were becoming widely available, rates of COVID-19 infections were declining, lockdown and mask restrictions were being lifted, and the delta variant was emerging—providing insight into a unique time of the pandemic. Controlling for demographic and socioeconomic factors, results show associations between sexual orientation identity and suicide ideation and physical health, but not with stress or psychological distress. A year into the pandemic, stress and psychological distress did not differ by sexual orientation, though sexual minorities did report lower odds of good physical health and higher odds of suicide ideation than those identifying as heterosexual.

Navigating Surgical Societies as Minority Women: The Intersectionality of Race and Gender.

Navigating Surgical Societies as Minority Women: The Intersectionality of Race and Gender.

Is it Necessary to Design a “Bivalent Genital Wart Vaccine” for Young Men?—— A Cross-Sectional Survey on Male College Students with Different Sexual Orientations

Is it Necessary to Design a “Bivalent Genital Wart Vaccine” for Young Men?—— A Cross-Sectional Survey on Male College Students with Different Sexual Orientations

Vaccination coverage against three viral sexually transmitted diseases, among 18-to-30-year-olds seen between May 2023 and May 2024 in the Martinique University Hospital CeGIDD.

We retrospectively assessed protection against HBV (defined by HBs Ab>10 UI/L), HAV (defined by positive IgG), and HPV (defined by at least one shot) in 1161 patients aged 18---30years old who consulted at an HIV and STI screening center (CeGIDD) between May 2023 and May 2024. Results are presented by gender, sexual orientation and PrEP use. All in all, 59% (621/1051) of the population was HBV-immune. Among MSM, bisexual men and transgender people, 17% (18/105) were HAV-immune, a proportion rising to 40% (42/105) at the end of the study period. Among PrEP patients, 18% (13/78) were HAV-immune and 64% (50/78) were HBV-immune. HPV vaccination was given to 12% (68/569) of women, 13% (72/583) of men, 37% (54/147) of MSM, bisexual men and transgender patients, and to 41% (32/78) of PrEP users. All health workers should be fully aware of the relevant recommendations and actively involved in enhancing patient protection.

Sports Team Participation, Bias-Based Bullying, and Mental Health Among Transgender and Gender Diverse Adolescents

ABSTRACT Purpose: We investigated associations between sport participation and depressive and anxiety symptoms among transgender and gender diverse (TGD) adolescents, considering social positions and experiences of bias-based bullying specific to sexual orientation, gender identity, and/or gender expression (SOGIE-BB). Method: TGD adolescents (n = 10,454) completed a school survey. Adolescents in eighth, ninth, or 11th grade self-reported sports team participation, elevated depressive and anxiety symptoms, experiencing past-month SOGIE-BB, specific gender identity, race/ethnicity, and access to resources. We identified groups with highest prevalences of elevated depressive and anxiety symptoms by sports team participation (any/none), experiences of SOGIE-BB (any/none), and social positions using Exhaustive Chi-square Automatic Interaction Detections. Via post-hoc tests, we determined whether prevalences differed between adolescents with the same social positions 1) without SOGIE-BB, 2) with sports participation, and 3) without SOGIE-BB and with sports participation. Results: Experiencing SOGIE-BB comprised each of the highest prevalence elevated depressive and anxiety groups. Four of 7 groups with elevated depressive symptoms and 3 of 4 groups with elevated anxiety symptoms reported no sports participation. Among adolescents sharing social positions, experiencing no SOGIE-BB was significantly associated with lower prevalences of elevated depressive and anxiety symptoms. Sports participation was also significantly associated with lower prevalences of elevated depressive and anxiety symptoms, including when experiencing SOGIE-BB. This was true for all but two high prevalence groups. Conclusion: Sports team participation is associated with better mental health among TGD adolescents. Experiencing SOGIE-BB is associated with higher mental health risks. Promoting sports participation and preventing SOGIE-BB could each enhance TGD adolescents’ well-being.

Do drug and opioid use vary by spousal sexual orientation and military status.

Do drug and opioid use vary by spousal sexual orientation and military status.

Viral Storytelling: COVID-19 Comes to Albany, Georgia.

Early in the COVID-19 pandemic, when the novel coronavirus SARS-CoV-2 spilled into the United States and spawned devastating outbreaks in Albany, Georgia, and multiple other cities, news media organizations served an important public health function. Journalists gathered and reported information about a new infectious disease peril, and they used increasing tolls of cases, hospitalizations, and deaths as a shorthand form of risk communication. However, there were ample reasons from the start to question the completeness, accuracy, and fairness of the information that local news sources provided, and reporters repeated in numerous accounts of the Albany hotspot from March to July 2020. The story that went viral adhered to and supported a standard but strikingly deficient explanation of how novel infectious diseases wreak widespread havoc. The conventional outbreak narrative, exemplified by the Albany news coverage, frames causality, spread, and repercussions in ways that implicate personal behaviors while diminishing or disregarding population-level drivers of epidemics and the contribution of institutional lapses in healthcare safety. A second, closely related ramification of this responsibility framing is stigmatization of specific individuals or groups when they are singled out on the basis of an attribute, such as their race/ethnicity, religion, or sexual orientation, and identified as bearers and spreaders of a communicable disease. As the COVID-19 pandemic once again demonstrated, and the Albany story epitomizes, the conventional outbreak narrative sends strong stigma cues while leaving large gaps in the information needed to contend more equitably and effectively with emerging infectious diseases.

Promoting Gender Inclusive Language in Radiology: Next Steps?

Promoting Gender Inclusive Language in Radiology: Next Steps?

Sexual orientation differences in mental health service use and unmet mental health care needs: a cross-sectional population-based study of young adults.

This study aims to examine sexual orientation differences in mental health services use and unmet mental health care needs, and to explore associated sociodemographic factors in a populational-based sample of Swedish young adults (aged 18-34). Data from the Pathways to Longitudinally Understanding Stress (PLUS) study were used (2019, N = 2,126, participation rate of 37.8%). We performed logistic regressions to model mental health services use and unmet mental health service needs, followed by a subgroup analysis among those with perceived need for mental health services. We also examined if associations between sociodemographic factors (gender, age, educational level, income, employment status, household composition, urbanicity and country of birth) and these outcomes varied by sexual orientation. Around one-third (35.0%) of sexual minority individuals had used mental health services the previous year, versus 20.2% of heterosexuals (OR = 1.52, 95%CI = 1.17-1.96, p = 0.002). Unmet needs were more likely among sexual minority individuals (17.6%) than heterosexuals (11.8%, OR = 1.47, 95%CI = 1.09-2.00, p = 0.013), with no significant sexual orientation differences among participants perceiving a need for mental health services. Among those with perceived need for mental health services, it was estimated that 56% of sexual minority males had unmet needs (vs. 37% of heterosexual); no such difference existed among women. Other than gender, there were not significant interactions between sociodemographic factors and sexual orientation. Sexual minority individuals' higher mental health services use highlights the need for high-quality, culturally sensitive services. Future research should identify reasons for the greater proportion of unmet mental health service needs among sexual minority men.