Young Adult Sexual Minority Women Research Articles

Come for the Tobacco, Stay for the Flavor: Flavored Cigarillo-Use Trajectories Among Young Adult Sexual Gender Minority Women.

The purpose of this research was to identify how young adult sexual gender minority (SGM) women who use cigarillos may respond to cigar flavor restrictions. Young adults aged 21-28 years in the United States who currently use cigarillos were recruited between October 2020 and April 2021 to participate in an online survey. Due to high prevalence of cigarillo use among individuals who identify as sexual and/or gender minority (SGM) women, their (n = 192) flavored tobacco-use behaviors and anticipated responses to cigarillo flavor restrictions were compared to cisgender heterosexual (CisHet) women (n = 110). Logistic regression was used to model cigarillo cessation and product-switching behaviors (flavored and unflavored). SGM women were significantly less likely to report the use of flavor at the initiation of cigarillo use (61.7% vs. 86.1%) but were no different in current flavor use compared to CisHet women, with more than 80% of all women using any flavor. SGM women were 2.36 times as likely to say they would discontinue using cigarillos if flavors were unavailable. Among those who would continue using cigarillos, SGM women were 4.53 times as likely to endorse switching to an unflavored tobacco product but had the same likelihood of saying they would switch to flavored product compared to CisHet women. Flavor restriction policies may not reduce the initiation of cigarillos among SGM women and may elicit differential cigarillo use and tobacco product substitution by SGM identity. Flavor restriction policies should be coupled with targeted cessation resources to address potential remaining disparities. SGM US women have a unique cigarillo-use trajectory. These women are more likely to initiate cigarillos without flavor and then later integrate it into their behavior. National cigar flavor restrictions are expected to have a greater impact decreasing cigarillo initiation among CisHet women and decreasing current cigarillo use among SGM women. However, for those who would continue using unflavored cigarillos, SGM women may remain at risk for nicotine dependence due to increased product substitution. SGM women should be prioritized for cessation resources to reduce tobacco-use disparities leading up to and following the implementation of cigar flavor restrictions.

Associations of past-year overall trauma, sexual assault and PTSD with social support for young adult sexual minority women.

Background: Young adult sexual minority women (SMW) are at elevated risk for sexual assault (SA), posttraumatic stress disorder (PTSD), and inadequate social support. While SA and PTSD can lead to reductions in social support from close significant others, the impact of SA and PTSD on SMWs' social support has not previously been assessed.Objective: This study examined the associations of past year SA and PTSD with SMW's social support from intimate partners, family, and friends. It was hypothesized that SA and PTSD would be negatively associated with support from partners, family and friends, and that PTSD would moderate the effect of SA on support in early adulthood.Method: Young adult SMW in the United States (N = 235) who were M = 23.93 (SD = 2.15) years old, primarily lesbian or bisexual (n = 186, 79.1%) and White (n = 176, 74.9%) completed measures on past year exposure to SA and non-SA trauma, PTSD, and social support from intimate partners, family and friends.Results: PTSD was associated with less social support from partners, ( = -0.06, SE = 0.02, p = .010, R2change = .02), family, ( = -0.06, SE = 0.03, p = .025, R2change = .02), and friends, ( = -0.07, SE = 0.02, p = .008, R2change = .02). There was a significant interaction between PTSD and SA on social support from partners ( = -0.01, SE = 0.01, p = .047, R2change = .01). Neither non-SA nor SA trauma was associated with support from family or friends.Conclusions: Results underscore the potential impact of recent SA on intimate partnerships for young adult SMW with more severe PTSD. Future work should explore how addressing PTSD and improving social support quality may help SMW recover from traumatic experiences and ameliorate the effects of SA on intimate partnerships.

44. Perceptions of Safety: Characterizing Activity Spaces among Black Adolescent Young Adult Sexual Minority Women with Intimate Partner Violence Histories in Baltimore, MD

44. Perceptions of Safety: Characterizing Activity Spaces among Black Adolescent Young Adult Sexual Minority Women with Intimate Partner Violence Histories in Baltimore, MD

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 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).

Prevalence and Factor Structure of PTSD in DSM-5 Versus DSM-IV in a National Sample of Sexual Minority Women.

The impact of changes to posttraumatic stress disorder (PTSD) diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) to Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) within diverse communities is unclear. Young adult sexual minority women are at high risk for interpersonal violence and other forms of trauma exposure compared with heterosexual populations and sexual minority men. They are also at heightened risk of PTSD. As a result, young adult sexual minority women are a key population of interest when examining the impact of diagnostic criteria changes. The goal of the current study was to evaluate the impact of changes to PTSD diagnostic criteria in sexual minority women. Using an online survey, we administered both the original PTSD Symptom Checklist-S (based on DSM-IV criteria) and a version adapted to assess DSM-5 criteria to a national, nonclinical sample of young adult sexual minority women (N = 767). The DSM-5 symptom criteria fit the data well in confirmatory factor analysis. Current PTSD prevalence was higher under the DSM-5 diagnostic algorithm compared with DSM-IV (18.6% vs. 22.9%; d = 0.15). Compared with DSM-IV, associations between PTSD and depression were stronger using DSM-5 criteria, whereas associations between PTSD and high-risk drinking were reduced. Findings suggest that changes to PTSD diagnostic criteria do not have a major impact on prevalence of PTSD among sexual minority women but may have some impact on observed comorbidities.

Changes in Sexual Identity and Associations With Alcohol Use and Depression Among Young Adult Sexual Minority Women

Sexual minority women report more problematic alcohol use and depression than heterosexual women. Despite evidence that sexual identity can change over time, most studies treat it as a static construct. As a result, little is known about the extent to which changes in sexual identity influence alcohol use and depression. The current study examined (a) changes in sexual identity over 36 months, (b) the associations between the number of changes in sexual identity and measures of alcohol use (typical weekly alcohol consumption, peak drinking, and alcohol-related consequences) and depression at the final assessment, and (c) baseline sexual identity as a moderator of the associations. The analyses used four waves of data from a national U.S. sample of sexual minority women ages 18-25 (n = 1,057). One third (34%) of participants reported at least one change in sexual identity over the course of the study. The number of changes in sexual identity was positively associated with typical weekly alcohol consumption and depression but was not significantly associated with peak drinking or alcohol-related consequences. None of the associations were moderated by baseline sexual identity. These findings provide additional evidence that sexual identity continues to change over time for a sizeable proportion of young adult sexual minority women and these changes are relevant to their health and well-being.

Patient-Provider Sexually Transmitted Infection Prevention Communication among Young Adult Sexual Minority Cisgender Women and Nonbinary Assigned Female at Birth Individuals.

Health care providers are an important source of sexually transmitted infection (STI) prevention information for young adult sexual minority women (SMW). However, very few studies have described patient-provider STI communication in this understudied and underserved population. We explore sexual minority women's experiences communicating with health care providers about sexual health, with particular attention to STI prevention, to inform programs and practices that address their unique needs and concerns. We conducted 29 in-depth interviews with sexual minority cisgender women and nonbinary assigned female at birth (AFAB) individuals aged 18-36years. The sample included White (55%), Asian (31%), Black (17.2%), and Latina (3.4%) participants. We used thematic analysis with deductive and inductive coding to identify themes related to patient-provider STI prevention communication. Heteronormative health care provider assumptions inhibited participants' willingness to disclose their sexual orientation and discuss sexual health issues with providers. Most sexual health conversations focused on pregnancy and contraception, which many felt was irrelevant to them, and limited STI prevention recommendations to condom use. Participants reported that some providers lacked medical knowledge on AFAB-to-AFAB STI transmission and were not able to provide relevant STI prevention information. Providers' bias related to gender identity and race/ethnicity furthered some participants' mistrust generated from providers' heteronormative assumptions. Our study describes several barriers that AFAB sexual minorities felt inhibited their patient-provider sexual health communication. Interventions are needed to improve patient-provider STI prevention conversations with AFAB sexual minorities so they can access the sexual health information they need to effectively protect themselves from STIs.

Effects of sexual assault on alcohol use and consequences among young adult sexual minority women.

The purpose of this study was to examine effects of sexual assault victimization on later typical alcohol use and alcohol-related consequences among young sexual minority women (SMW). Data were collected over 4 annual assessments from a national sample of 1,057 women who identified as lesbian or bisexual and were 18- to 25-years-old at baseline. Marginal structural modeling, an analytic approach that accounts for time-varying confounding through the use of inverse probability weighting, was used to examine effects of sexual assault and its severity (none, moderate, severe) on typical weekly number of drinks consumed and number of alcohol-related consequences 1-year later as well as 2-year cumulative sexual assault severity on alcohol outcomes at 36-month follow-up. Findings showed that compared with not experiencing any sexual assault, severe sexual assault at the prior assessment was associated with a 71% higher number of typical weekly drinks (count ratio [CR] = 1.71; 95% confidence interval [CI] [1.27, 2.31]) and 63% higher number of alcohol-related consequences (CR = 1.63; 95% CI [1.21, 2.20]). Effects were attenuated when comparing moderate to no sexual assault; however, the linear trend across sexual assault categories was statistically significant for both outcomes. There were also effects of cumulative levels of sexual assault severity over 2 years on increased typical drinking and alcohol-related consequences at end of follow-up. Sexual assault may be an important cause of alcohol misuse among SMW. These findings further highlight the need for strategies to reduce the risk of sexual assault among SMW. (PsycINFO Database Record

Sexual Health Care Services among Young Adult Sexual Minority Women.

Young adult sexual minority women (YSMW) are at elevated risk for negative reproductive health outcomes, yet are less likely than heterosexual peers to utilize preventive health care. Medical and public health policy organizations advocate sexual orientation disclosure ("coming out") to health care providers as a strategy for increasing service utilization among YSMW. Limited research explores relationships between disclosure and receipt of sexual health services. YSMW (N=285) ages 21-24 participated in an online survey assessing their health behaviors and care utilization. We employed multivariable logistic regression models to examine the association between receipt of sexual health services and sexual orientation disclosure to provider, after adjusting for sociodemographic covariates. Thirty-five percent of YSMW were out to their provider. Less than half the sample had received Pap screening or STI testing in the previous year; approximately 15% had received at least one dose of the HPV vaccination. Disclosure was associated with increased likelihood of Pap screening (OR=2.66, p<.001) and HPV vaccination (OR=4.30, p<.001), but was not significantly associated with STI testing. Promoting coming out to providers may be a promising approach to increase sexual health care use among YSMW. Future research should explore causal relationships between these factors.

Alcohol and binge eating as mediators between posttraumatic stress disorder symptom severity and body mass index.

ObjectiveSexual minority women are at elevated risk for obesity, as well as of exposure to traumatic events. Rates of obesity are elevated in individuals with PTSD, but we know little about why this relationship exists. Behavioral mechanisms, such as eating patterns and alcohol use, are possible explanations that would be clinically useful to identify.MethodsWe longitudinally investigated binge eating and alcohol use as mediators of the relationship between PTSD symptom severity and body mass index (BMI) in a large sample of young adult sexual minority women (N = 425). We assessed PTSD symptom severity at baseline, binge eating and alcohol use 12-months later, and BMI 24-months after baseline.ResultsUsing a multiple mediator model, we found that higher baseline PTSD symptom severity was significantly associated with higher BMI 2 years later, operating through binge eating behavior, but not through alcohol use. Exploratory moderator analyses found that this effect was higher for those with lower baseline BMI.ConclusionsResults suggest that higher PTSD symptoms are longitudinally associated with increased BMI, and that binge eating behavior is one factor that explains this relationship.

Psychosocial Obstacles to Smoking Cessation Attempts Among Young Adult Sexual Minority Women Who Smoke

ABSTRACTSexual minority women (SMW; i.e., women who identify their sexuality as lesbian, bisexual, or something other than heterosexual) report greater smoking behaviors than their heterosexual counterparts across all ages. We conducted a multivariable regression to examine the correlates of prior smoking cessation attempts and smoking cessation intentions in a sample of young SMW who smoke (N = 338; aged 18–24 years). Covariates included sociodemographic characteristics (i.e., race/ethnicity, sexual identity, age, urbanity), general (i.e., perceived stress), and sexuality-specific (i.e., internalized homophobia) stressors, as well as smoking attitudes and subjective norms. Bisexual women (OR = 1.92, 95% CI: 1.11, 3.31) were more likely than lesbian counterparts to report a prior smoking cessation attempt. Prior cessation attempts were associated with less internalized homophobia (OR = 0.44, 95% CI: 0.27, 0.69) and positive attitudes toward smoking (OR = 2.17, 95% CI: 1.27, 3.70). Smoking cessation intentions in the next month were negatively associated with being a daily smoker (β = –0.14) and attitudes toward smoking (β = –0.19). Based on these findings, we underscore the need to address the risk correlates associated with SMW's quit attempts and include these in cessation interventions.

Reciprocal relationships over time between descriptive norms and alcohol use in young adult sexual minority women.

Young adulthood, roughly ages 18-25, is a period of great risk for excessive consumption of alcohol, especially among sexual minority women (SMW). Despite the substantial literature examining the relationships between social norms and behavior in general, little attention has been given to the role of descriptive norms on the drinking behaviors of sexual minorities. The present study had 3 aims: to compare both typical woman descriptive norms and sexual minority-specific descriptive normative perceptions among a sample of SMW, to examine reciprocal associations between sexual minority-specific descriptive norms and alcohol consumption over time, and to examine whether these reciprocal associations were moderated by sexual orientation (i.e., whether 1 identifies as lesbian or bisexual). A national sample of 1,057 lesbian and bisexual women between the ages of 18 and 25 was enrolled in this study. Participants completed an online survey at 4 time points that assessed the constructs of interest. Results indicated that SMW consistently perceived that SMW drank more than their nonsexual minority peers; that SMW-specific descriptive drinking norms and alcohol consumption influenced 1 another over time in a reciprocal, feed-forward fashion; and that these associations were not moderated by sexual orientation. These findings highlight the importance of considering SMW-specific norms as an important factor in predicting alcohol consumption in SMW. Results further support the development and testing of normative interventions for high-risk drinking among SMW.

Receipt of sexual health services among young adult sexual minority women

Receipt of sexual health services among young adult sexual minority women

Exploring Young Adult Sexual Minority Women's Perspectives on LGBTQ Smoking

Smoking rates are higher among lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals than among heterosexuals. These disparities are exacerbated during the transition from youth to young adulthood. The current study uses in-depth qualitative interviews to understand perceptions of LGBTQ smoking among LBQ-identified women (N = 30, ages 18 to 24). Major themes identified include the belief that smoking was a way of overcoming stressors faced by heterosexual and LGBTQ young adults alike, a mechanism to relieve sexuality-related stressors, and an ingrained part of LGBTQ culture. Results may suggest unique stressors influence LGBTQ smokers. Implications for smoking cessation interventions for LGBTQ youth are discussed.

Racial/ethnic differences in identity and mental health outcomes among young sexual minority women.

Previous research suggests that sexual minorities are at greater risk for trauma exposure, mental health problems, and substance use. To date, few studies have examined racial/ethnic differences among sexual minorities in relation to health-related behaviors and outcomes. Furthermore, studies of racial/ethnic differences among young adult sexual minority women (SMW) are virtually nonexistent. The current study adds to the previous literature by exploring differences in trauma exposure, sexual identity, mental health, and substance use in a nonprobability national sample of young adult SMW. A total of 967 self- identified lesbian and bisexual women were recruited via the Internet using social networking sites to participate in a larger longitudinal study on young women's health behaviors. The present study included 730 (76%) White, 108 (10%) African American, 91 (9%) Latina, and 38 (4%) Asian women ages 18 to 25 years. Results revealed differences in socioeconomic variables, degree of outness to family, childhood sexual assault, and forcible rape, but not overall lifetime trauma exposure. Among mental health and health-related behavior variables, few differences between groups emerged. Our findings indicate that both researchers and clinicians should turn their attention to processes of resilience among young SMW, particularly young SMW of color.

Resilience in Community: A Social Ecological Development Model for Young Adult Sexual Minority Women

Family support and rejection are associated with health outcomes among sexual minority women (SMW). We examined a social ecological development model among young adult SMW, testing whether identity risk factors or outness to family interacted with family rejection to predict community connectedness and collective self-esteem. Lesbian and bisexual women (N = 843; 57% bisexual) between the ages of 18-25 (M = 21.4; SD = 2.1) completed baseline and 12-month online surveys. The sample identified as White (54.2%), multiple racial backgrounds (16.6%), African American (9.6%) and Asian/Asian American (3.1%); 10.2% endorsed a Hispanic/Latina ethnicity. Rejection ranged from 18 to 41% across family relationships. Longitudinal regression indicated that when outness to family increased, SMW in highly rejecting families demonstrated resilience by finding connections and esteem in sexual minority communities to a greater extent than did non-rejected peers. But, when stigma concerns, concealment motivation, and other identity risk factors increased over the year, high family rejection did not impact community connectedness and SMW reported lower collective self-esteem. Racial minority SMW reported lower community connectedness, but not lower collective self-esteem. Families likely buffer or exacerbate societal risks for ill health. Findings highlight the protective role of LGBTQ communities and normative resilience among SMW and their families.

COPING AS A MEDIATOR OF INTERNALIZED HOMOPHOBIA AND PSYCHOLOGICAL DISTRESS AMONG YOUNG ADULT SEXUAL MINORITY WOMEN.

Sexual minorities have higher rates of depression and anxiety than their heterosexual counterparts. This elevated risk of psychological distress has generally been hypothesized to be a result of the effects of discrimination including internalized negative beliefs about sexual minorities. However, little research has examined the role of various types of coping in mediating between internalized homophobia and mental health. We tested the direct relationship between internalized homophobia and psychological distress and evaluated general and sexual minority-specific coping strategies as potential mediators using structural equation modeling. Data are from a national sample of 1,099 young adult sexual minority women who were on average 20.86 (SD= 2.12) years old, participating in a study on mental health and substance use. The model demonstrated acceptable fit, χ2 (83) = 402.9, p <.001, CFI=.94, TLI=.92, SRMR= .07, and RMSEA=.06, accounting for 73% of variance in psychological distress. Greater use of maladaptive coping and less use of sexual minority-specific coping were associated with higher psychological distress. Although maladaptive coping mediated the relationship between internalized homophobia and psychological distress, sexual minority-specific coping did not. Our findings support previous studies that have demonstrated the impact of internalized homophobia on psychological distress as well as the role of coping as a protective/risk factor in this relationship.

Invisible and at Risk: STDs Among Young Adult Sexual Minority Women in the United States

Sexual minority women are not adequately assessed by national STD surveillance systems, and research regarding STD burden in nationally representative samples of such women is rare. Moreover, few studies have assessed STD risk exclusively among young adult women. Wave 4 (2007-2008) data from the National Longitudinal Study of Adolescent Health on 7,296 females aged 24-32 were used to examine the relationship between sexual orientation and receipt of an STD diagnosis in the past year. Multivariate logistic regression analyses used two measures of sexual orientation: sexual identity and gender of sex partners. Eighty percent of women considered themselves straight; 16% mostly straight; and 4% bisexual, mostly gay or gay. Eighty-five percent had had only male partners, while 7% had had one female partner, and 8% two or more female partners. In unadjusted models, women who identified themselves as mostly straight were more likely than straight women to have had an STD (odds ratio, 1.4); mostly gay or gay women were at lower risk (0.4). Women who had had two or more female partners had a higher STD risk than did women who had had only male partners (1.7). Adjusting for social and demographic characteristics did not substantially alter these results; however, the associations between sexual identity, gender of sex partners and STD diagnosis were eliminated after adjustment for sexual behaviors (e.g., having had anal sex). Sexual identity, gender of sex partners and sexual behaviors should be taken into account in assessments of women's STD risk.

“Having a Girlfriend Without Knowing It”

This article provides a qualitative analysis of the intimate friendships of 80 adolescent and young adult sexual-minority women who were interviewed as part of an ongoing longitudinal study. Many reported having participated in a same-sex best friendship that they considered as committed, intimate, passionate, and intense as a romantic relationship. These “passionate friendships” typically combined components of the normative heterosexual friendship script with components of the normative romantic relationship script. For example, although passionate friendships rarely involved sexual contact, they frequently involved forms of physical intimacy (such as cuddling and hand-holding) that are usually considered exclusive to romantic relationships. Although such intense friendships are typically interpreted as unrequited love affairs, this misrepresents the unique nature of these bonds. Because such relationships challenge conventional notions about the distinctions between friendship and romance, as well as distinctions between heterosexual and sexual-minority women, they have important implications for understanding the interplay between emotional and sexual feelings in the close relationships of all women.