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Sexual and gender minorities (SGM) of colour in the United States experience heightened HIV vulnerability, but prevention interventions have not adequately met their needs. We analysed survey responses from sexually active men who have sex with men, transgender people and gender-nonconforming people of colour (N = 216), regarding barriers to participation in HIV prevention research and services. We applied Meyer's Minority Stress Theory (MST), which highlights that SGM are at increased risk for mental health disorders due to the psychosocial stress resulting from experiences of stigmatisation and discrimination. Themes regarding barriers to participation in HIV prevention research and accessing prevention services included: (1) concern regarding familial rejection; (2) decreased access to timely sexual health education; (3) financial challenges regarding study participation and continued access to antiretroviral medications; (4) concerns regarding intersectionality, race and stigma ; and (5) lived experiences of stigma, discrimination and internalised homophobia among Black respondents. Healthcare providers and researchers can utilise this information to better tailor HIV prevention interventions to the specific health needs of SGM of colour. [ABSTRACT FROM AUTHOR]

Transgender and nonbinary (TNB) people experience elevated rates of posttraumatic stress (PTS) due to transphobic violence, discrimination, microaggressions, and minority stress. Nonbinary people in particular experience unique chronic minority stressors (e.g., misgendering, interpersonal invalidation) because of the assumption that gender is inherently binary. Such examples of oppression against TNB people could contribute to complex PTS (c-PTS) symptoms, which arise due to exposure to chronic, cumulative, and interpersonal trauma. This study aimed to examine how misgendering and invalidation may be associated with PTS and c-PTS symptoms among nonbinary people and whether this association is moderated by pride and community connectedness. Cross-sectional data from 610 nonbinary people living in the United States and Canada were analyzed using hierarchical linear regressions. Misgendering and invalidation had significant positive associations with PTS and c-PTS symptoms. However, pride and community connectedness were not significant moderators of these associations. Findings from this study contribute to the conceptualizations of traumatic stress among nonbinary people and provide considerations for more affirming trauma-informed care. Public Significance Statement: The findings of this study suggest that misgendering and invalidation are associated with trauma symptoms among nonbinary people. Results can be applied to inform nonbinary-affirming clinical practice and advocacy. [ABSTRACT FROM AUTHOR]

Background: The love, joy and sense of connection between humans and animal companions can bring shared health benefits. Often this is referred to as the 'pet effect'. Previous research on the 'pet effect' suggests that living with an animal companion, and especially one who is considered part of the family, can increase human wellbeing, though to date research has rarely focused on trans people and the 'pet effect'. Aims: This article explores the 'pet effect' in the lives of trans people, given that trans people may uniquely benefit from animal companionship as a counter to the negative effects of living in cisgenderist contexts. Methods: A secondary analysis of three studies was undertaken (N = 857 participants residing in Aotearoa New Zealand, Australia, the UK or the US). Studies included measures of psychological distress, human social support, and trans-related discrimination, with all participants being asked if they lived with animals and if so, if they considered animals to be part of the family. Results: Trans-related marginalization explained the greatest amount of variance in psychological distress (β =.398, p =.001), with social support (β = −0.198, p =.001), living with animals (β =.149, p =.001), and animals being part of the family (β = 0.196, p =.001) explaining additional variance. Age (β = −0.322, p =.001) and employment status (β =.147, p =.001) were the only demographic variables that explained variance in psychological distress among participants who lived with animals considered part of the family. Discussion: The findings suggest that animal companions make a unique contribution to the wellbeing of trans people. The article concludes by exploring implications of these findings for future research and practice with regard to the 'pet effect' and trans people. [ABSTRACT FROM AUTHOR]

Objectives: To examine the associations of two measures of minority stress, non-affirmation minority stress and internalized transphobia, with subjective cognitive decline (SCD) among transgender and gender diverse (TGD) veterans. Method: We administered a cross-sectional survey from September 2022 to July 2023 to TGD veterans. The final analytic sample included 3,152 TGD veterans aged ≥45 years. We used a generalized linear model with quasi-Poisson distribution to calculate prevalence ratios (PR) and 95% confidence intervals (CIs) measuring the relationship between non-affirmation minority stress and internalized transphobia and past-year SCD. Results: The mean age was 61.3 years (SD = 9.7) and the majority (70%) identified as trans women or women. Overall, 27.2% (n = 857) reported SCD. Adjusted models revealed that TGD veterans who reported experiencing non-affirmation minority stress or internalized transphobia had greater risk of past-year SCD compared to those who did not report either stressor (aPR: 1.09, 95% CI: 1.04–1.15; aPR: 1.19, 95% CI: 1.12–1.27). Conclusion: Our findings demonstrate that proximal and distal processes of stigma are associated with SCD among TGD veterans and underscore the need for addressing multiple types of discrimination. Above all, these results indicate the lasting sequelae of transphobia and need for systemic changes to prioritize the safety and welfare of TGD people. [ABSTRACT FROM AUTHOR]

Objectives: This study explored how coping moderates the association between discrimination and health outcomes in lesbian, gay, and bisexual (LGB) and heterosexual midlife and older adults. Methods: This study analyzed longitudinal data from 163 LGB and 326 propensity-matched heterosexual midlife and older adults over approximately 20 years, using the Midlife in the United States study. Results: Discrimination was associated with slower chronic condition accumulation over time for LGB individuals. Problem-focused and avoidance coping moderated discrimination's impact on mental health in LGB participants over time, and in heterosexual participants, they moderated the association between discrimination and chronic conditions. Discussion: The results suggest a potential "steeling" effect in LGB midlife and older adults facing higher discrimination levels. Furthermore, the findings suggest that effective coping strategies for mitigating the adverse impacts of discrimination on physical and mental health may vary by sexual orientation. [ABSTRACT FROM AUTHOR]

Objective: To test whether internalized heterosexism, a form of minority stress, heightens the effect of hazardous or harmful alcohol use on frequency of intimate partner violence (IPV) perpetration among sexual minority and same-sex-attracted men. Method: We recruited participants online via Amazon Mechanical Turk (MTurk). Inclusion criteria were adult cisgender men living in the United States who identified as a sexual minority (i.e., gay, bisexual) or who endorsed being sexually attracted to men and who reported a male partner in the preceding year. Participants (N = 198) completed self-report questionnaires measuring sexual orientation and attraction, internalized heterosexism, IPV perpetration (sexual, physical, and psychological), and hazardous or harmful alcohol use. Results: Hazardous or harmful alcohol use and internalized heterosexism were associated with frequency of IPV perpetration. Internalized heterosexism moderated the effect of hazardous or harmful alcohol use on IPV perpetration, such that greater hazardous or harmful alcohol use and higher levels of internalized heterosexism were associated with the greatest rates of IPV perpetration. Results were consistent for each type of IPV (sexual, physical, and psychological). Conclusions: Our findings highlight the association between high levels of internalized heterosexism, magnified by the presence of hazardous or harmful alcohol use, and physical, sexual, and psychological IPV. Alleviating internalized heterosexism is a potential target for decreasing IPV in this at-risk population. [ABSTRACT FROM AUTHOR]

In the United States, an estimated 1.9 million youth 13 to 17 years of age (9.5%) identify as sexual and/or gender diverse (SGD), identifying as nonheterosexual and/or having a gender identity other than the assigned sex at birth.1 Up to 7% of SGD adolescents may have at least one parent currently or previously serving in the US military, an estimated 133,000 youth nationwide.1,2 SGD adolescents are highly exposed to acute and chronic stressors, including minority stress and discrimination, resulting in elevated rates of depression, anxiety, and suicidal ideation.3,4 SGD military-connected youth (ie, SGD youth with a parent or caregiver with military service experience) were found to be at even higher risk for these negative outcomes in one published report.2 While both military connection and SGD identity may foster strengths, these youth also face well-studied stressors,2,5 and the convergence of these identities and experiences is likely to produce greater challenges. Nearly half of military-connected youth are seen by civilian clinicians in local communities for primary care, and even more are seen for specialty care.6 As a result, all clinicians, both within and outside the military health system, and especially clinicians providing mental health care, must be familiar with these unique converging stressors facing SGD military-connected youth. [ABSTRACT FROM AUTHOR]

Background and Objectives Population aging has led to an increased interest in cognitive health and, in particular, the role that stress plays in cognitive disparities. This paper extends previous work by characterizing coronavirus disease 2019 (COVID-19) stress type prevalence and its association with cognitive health in metro-Detroit among Black, Middle Eastern/Arab (MENA), and White older adults. Research Design and Methods Data come from a regionally representative sample of adults aged 65+ in metro-Detroit (N = 600; MENA n = 199; Black n = 205; White n = 196). We used generalized linear models to compare groups on sociodemographic, objective stress, and social stress indicators. Multiple group structural equation models evaluated whether COVID-19 stress predicted cognitive health and whether that association varied across racial/ethnic groups. Results MENA and Black older adults reported higher levels of objective stress than Whites. There were no racial/ethnic group differences in social stress. More objective stress was associated with better cognitive health, and more social stress was associated with worse cognitive health. The positive effect of objective stress was especially apparent for White older adults. Discussion and Implications Though it appears that minority stress was not exacerbated in the context of pandemic stress, links between greater objective stress and better cognitive health apparent among White older adults were not evident among MENA or Black older adults. Broadening health disparities research by including underrepresented populations allows us to elevate scientific knowledge by clarifying what is universal and what is unique about the stress process. [ABSTRACT FROM AUTHOR]

Purpose: Gender minority (GM) stress, resulting from distal (i.e., external) and proximal (i.e., internal) stigma-based stressors, is thought to drive mental health disparities among transgender and gender diverse (TGD) youth. We tested the gender minority stress and resilience (GMSR) model hypotheses that distal GM stress effects on mental health are partially mediated by proximal GM stress and moderated by GM-specific resilience (i.e., community connectedness, identity pride) among a U.S. national sample of TGD youth. Methods: As part of an HIV prevention study (NCT03185975), 159 TGD youth (ages 15–24) completed an online survey that included the GMSR measure, assessing distal and proximal GM stress and GM resilience, and the 18-item Brief Symptom Inventory, assessing past-7-day psychological distress. Three models linking GMSR constructs to psychological distress were tested using PROCESS v4.0: (1) simple partial mediation, (2) moderated partial mediation, and (3) serial partial mediation. Results: A direct effect of distal GM stress was observed in all models. An indirect effect through proximal GM stress alone was observed in model 1, but not models 2 or 3. In model 2, resilience did not moderate the effects of distal or proximal GM stress. In model 3, indirect effects were observed through proximal GM stress and GM resilience serially as well as GM resilience alone. Conclusion: Larger prospective studies are needed to confirm the role of GM resilience as a mediator, rather than moderator, of GM stress effects on mental health and a critical, rather than supplementary, target for mental health intervention among TGD youth. [ABSTRACT FROM AUTHOR]

Background Objective Materials and methods Results Discussion and conclusions There are limited data on pelvic pain among transgender men and gender diverse people, and the impact of testosterone on pelvic pain is poorly understood.Characterize the prevalence and correlates of chronic pelvic pain (CPP) among transgender men and gender diverse people and examine the association between testosterone use and CPP.We used 2020–2022 data from The Population Research in Identity and Disparities for Equality (PRIDE) Study, an online prospective cohort study of sexual and gender minority adults in the United States, to conduct complementary cross‐sectional and longitudinal analyses. Our primary outcome was self‐reported CPP lasting 3 months or longer measured using the Michigan Body Map.Among 2579 transgender men and gender diverse people assigned female at birth included in our sample, 457 (18%) reported CPP. CPP correlates included: inflammatory bowel disease, irritable bowel syndrome (IBS), kidney stones, pelvic inflammatory disease, polycystic ovary syndrome (PCOS), uterine fibroids, current hormonal intrauterine device use, prior pregnancy, vaginal delivery, hysterectomy, and oophorectomy. Individuals with CPP reported a high prevalence of IBS (37%), PCOS (20%), uterine fibroids (9%), post‐traumatic stress disorder (51%), and severe depression and anxiety symptoms (42% and 25%, respectively). Current testosterone use was associated with a 21% lower prevalence of CPP (adjusted prevalence ratio (aPR) 0.79, 95% confidence interval [CI]: 0.65–0.96). In longitudinal analyses (N = 79), 15 (19%) participants reported any CPP after initiating testosterone: eight (56%) of whom reported CPP prior to testosterone initiation, and seven (47%) who reported new‐onset CPP.The relationship between CPP and testosterone is complex. Although testosterone use was associated with a lower prevalence of CPP, some transgender and gender diverse individuals experienced new‐onset pelvic pain after testosterone initiation. Given the significant impact that CPP can have on mental health and quality of life, future research must examine the role of testosterone in specific underlying etiologies of CPP and identify potential therapies. [ABSTRACT FROM AUTHOR]

Introduction Lesbian, gay, and bisexual (LGB) individuals and Veterans are more likely to report current smoking than the general adult population in the United States. The Minority Stress Model may explain the high prevalence of cigarette smoking among LGB individuals, who experience unique interpersonal (e.g. discrimination) and intrapersonal (e.g. identity concealment) stressors related to their minoritized sexual orientation. Aims and Methods This study assessed whether three types of stressors (interpersonal, intrapersonal, and LGB-specific military) were associated with past-year smoking among LGB Veterans. Veterans were recruited online for a prospective cohort study. We conducted secondary data analysis of baseline surveys collected from 2019 to 2020. The study sample included cisgender, LGB Veterans (n = 463). Adjusted nested multivariable logistic regression models were used to estimate the association of each stressor with past-year cigarette smoking. Results Participants were mostly male (54.0%), non-Hispanic white (82.1%), and at least a college graduate (58.5%). LGB Veterans who were younger, had lower levels of education, income, and healthcare coverage, higher general stressors, and post-traumatic stress disorder and depression symptoms were more likely to smoke in the past year (n = 98, 21.2%). The adjusted odds of past-year smoking were higher among those who reported higher levels of harassment (aOR = 1.13, 95% confidence interval [CI]: 1.01 to 1.26), victimization (aOR = 1.13, 95% CI: 1.02 to 1.43), and family rejection (aOR = 1.13, 95% CI: 1.08 to 1.36). Conclusions Multiple interpersonal stressors were associated with past-year smoking, highlighting the need to intervene on these stressors. Future interventions should aim to address policies that reduce prejudice against LGB Veterans, while helping those who smoke identify and develop positive coping skills that support cessation. Implications Our findings contribute to the growing body of literature on tobacco use disparities among LGB individuals, particularly LGB Veterans. Results of this analysis provide some evidence for the Minority Stress Model as a conceptual model for understanding and intervening in disparities in smoking prevalence among LGB Veterans. [ABSTRACT FROM AUTHOR]

Proximal minority stressors (e.g. internalised homonegativity, motivation to conceal a sexual minority identity) have severe adverse effects on sexual minority individuals’ mental health. Many sexual minorities report experiencing workplace harassment, which is linked to poorer mental health outcomes. However, the precise nature of how workplace harassment shapes the relationship between minority stress and mental health is unknown. To address this question, we tested the moderation effect of workplace harassment on the relationship between proximal minority stressors, specifically internalised homonegativity and concealment motivation, and psychological distress (i.e. depression, anxiety, somatisation) using Hayes’ PROCESS macro package in SPSS. Sexual minority employees living in the United States (N = 529) completed a survey involving measures of proximal minority stressors, workplace harassment, and psychological symptoms via Prolific. Results of the moderation analyses supported the hypothesis that workplace harassment amplifies the positive relationship between internalised homonegativity and anxiety symptoms as well as the relationship between internalised homonegativity and somatic symptoms, though a similar moderation effect was not found for depression. We did not find a significant moderation effect of workplace harassment on the link between concealment motivation and psychological symptoms. We conclude by emphasising the importance of creating safer workplace environments for sexual minorities and identifying directions for future research. [ABSTRACT FROM AUTHOR]

Internalizing symptoms associated with anxiety and depression have been correlated with harmful alcohol use among Latino/as, but little attention has been paid to assessing the association between perceived discrimination and harmful alcohol use. The present study was designed to investigate the association between perceived discrimination, internalizing symptoms associated with anxiety and depression, and harmful alcohol use among Latino/a immigrants living in the United States (US). Our sample included 426 Latino/a immigrants. Their mean age was 40.05 years (SD = 6.50), 65.50% were women, 80.00% had a partner, 54.20% lived on less than $2,000 a month, and 41.50% reported having attained a college degree. Perceived discrimination was assessed using the Perceived Discrimination Scale, anxious symptoms were assessed using the GAD-7, depressive symptoms were assessed using the CES-D short form, and harmful alcohol use was assessed using AUDIT. We estimated a linear regression model using cross-sectional, self-reported data. The model was statistically significant, R² = 0.38, F (8, 425) = 32.09, p < 0.01. Discrimination was significantly associated with AUDIT scores, (b = 0.21, p < 0.01) after accounting for covariates and for symptoms of anxiety and depression. Our results indicate that experiences of discrimination in the US are associated with increased harmful alcohol use even after controlling for other variables. These findings may be useful in designing coping interventions specifically for Latino/a immigrants to reduce the risk of alcohol use disorder. This study also has political and public health implications for acknowledging the detrimental health consequences of experiencing discrimination, providing support to the position that reducing racism and discrimination represent important public health priorities. [ABSTRACT FROM AUTHOR]

The coronavirus (COVID-19) pandemic and associated shelter-in-place ordinances rapidly limited access to in-person social interactions, raising concerns of diminishing social support and community cohesion while psychological stressors increased. For LGBTQIA+ people, connectedness to the LGBTQIA+ community buffers against the harmful effects of stressors and decreases risks for poor psychological and behavioural health outcomes. The current study uses qualitative cross-sectional (between-person) and trajectory (within-person) analysis methods to characterise how LGBTQIA+ people's perceptions of community connectedness shifted during the first year of the pandemic. A convenience sample of LGBTQIA+ people in the U.S. completed an initial online survey in September 2020 (n = 298 and a follow-up survey in September 2021; n = 129). The survey included questions about changes in connectedness to the LGBTQIA+ community since the pandemic's beginning. Eight cross-cutting themes (related to identity shifts/exploration, disconnection, online connections, and increased awareness of social justice issues) were identified and then organised within each level of the LGBTQIA+ Social-Ecological Model (i.e. the individual-, couple-, interpersonal-, organisational-, community-, and chronosystem- level). Given the importance of social support for LGBTQIA+ wellbeing, more longitudinal research is needed to determine whether these changes persist after the resolution of the acute phase of the pandemic. [ABSTRACT FROM AUTHOR]

Indian Americans now constitute the nation's second largest foreign-born population group in the United States (U.S.). Concerning Indian American youth, there is a paucity of information about their experiences in the U.S., particularly with respect to cultural stress and model minority stress, and whether these stressors have an impact on their mental health. This article describes the dual experiences of Indian American youth in the Indian and American cultures and discusses two theoretical frameworks (cultural stress and model minority stress) that illuminate dynamics influencing the lives of these youth. We illustrate three core pathways (independent, synergistic and indirect) by which cultural stress and model minority stress can influence the mental health of Indian American youth. Social workers and other behavioral health providers can assist Indian American youth by examining their own biases related to the model minority stereotype, helping school personnel assess the impact of this stereotype, and remembering that Indian American youth are not a monolith. Researchers need to disaggregate data on Asian Americans to gather accurate statistics on the Indian American population and refine model-minority-stereotype assessment instruments. [ABSTRACT FROM AUTHOR]

Objective: Sexual minority adults of Latinx descent faced compounded intersectional stressors during the COVID-19 pandemic across socioeconomic and health domains. Latinx people have experienced some of the highest COVID-19 infection, hospitalization, and mortality rates in the United States in addition to significant economic challenges. Yet, current data have not observed the unique pandemic-related experiences of sexual minority Latinx (SML) adults. We examined sexual identity differences in economic and household stress, social support, mental health symptomatology (depression, anxiety), alcohol, and substance use among sexual minority and nonsexual minority Latinx adults in the United States. Method: Primary data were collected via the AmeriSpeak panel, a national probability sample of U.S.-based 2,286 Latinx adults [sexual minority =.34% (n = 465)]. Data were collected from November 2020 to January 2021, during the third wave of the COVID-19 pandemic. Results: SML adults endorsed higher levels of economic and household stress, mental health symptomatology, and alcohol and substance use than nonsexual minority Latinx adults. Economic stress was associated with increased mental health symptomatology, alcohol, and substance use among SML adults. Social support moderated the association between economic stress and mental health symptomatology and substance use, but not alcohol use. Conclusion: Findings highlighted unique intersectional considerations among SML adults during the COVID-19 pandemic, including the importance of social support and the negative toll of economic stress on mental health and substance use. Public Significance Statement: A national sample of 2,286 U.S.-based Latinx adults [Sexual Minority = 20.34% (n = 465)] participated in an online survey between November 2020 and January 2021, commonly considered the third wave of the COVID-19 pandemic. Findings revealed that sexual minority Latinx adults endorsed higher levels of economic and household stress, mental health symptomatology, and alcohol and substance use than nonsexual minority Latinx adults. Further, sexual minority Latinx adults also reported lower levels of social support than their heterosexual counterparts. [ABSTRACT FROM AUTHOR]

Objective: There is a need for more research on minority stress theory (MST) with sexual and gender minority (SGM) adolescents of color, because of their disproportionate risk for depression. Method: We recruited 1,627 SGM adolescents of color in the United States to complete measures assessing lesbian, gay, bisexual, transgender, and queer (LGBTQ) climate, LGBTQ microaggressions within one's ethnoracial community, internalized LGBTQ stigma, stress management ability, and depressive symptoms. Using structural equation modeling, a hybrid measurement-structural model was tested, indicating good model fit. Results: Multiple significant indirect pathways linking LGBTQ climate and depressive symptoms emerged. A less positive LGBTQ climate was associated with more microaggression-related stress, more internalized LGBTQ stigma, and worse stress management ability, all of which were associated with greater depressive symptoms. A serial mediation with more microaggression-related stress being associated with greater internalized LGBTQ stigma approached significance. Conclusions: Our findings generally support MST processes in terms of depressive symptoms in SGM adolescents of color, suggesting that psychosocial interventions targeting these processes may have meaningful implications for the mental health of this vulnerable group. Public Significance Statement: The stress related to being LGBTQ can contribute to risk of depression among adolescents of color. This study showed that the stressors of an unsupportive climate, as well as anti-LGBTQ sentiments from adolescents' own ethnoracial community, are directly and indirectly linked to depressive symptoms, through the internalization of stigma about being LGBTQ and poor stress management ability. [ABSTRACT FROM AUTHOR]

Purpose: Using a minority stress paradigm, this paper examines the relationship between anti-transgender discrimination, harassment, and violence among transgender adults. Methods: Data from the 2015 U.S. National Transgender Survey were used to examine twenty types of anti-transgender experiences/problems (e.g., harassment at work, problems with police officials, verbal and physical assaults) in a sample of 27,715 transgender Americans aged 18 or older. Binge drinking during the previous month was the dependent variable, and eight control measures were examined in the multivariate analysis. Results: Experiencing any of the twenty types of anti-transgender discrimination, harassment, or violence increased the odds of binge drinking by 48%. Experiencing many such problems increased the odds of binge drinking by 104%. Multivariate analysis showed that anti-transgender discrimination, harassment, and violence remains a predictor of binge drinking even when other key measures are taken into account. Younger people, racial minority group members, and persons who were not married or "involved" were at particularly great risk. Conclusions: Consistent with the minority stress paradigm, the more different types of anti-transgender experiences people had, the more likely they were to engage in binge drinking. Targeted intervention needs to help transgender persons to avoid anti-transgender discrimination, harassment, and violence to the greatest extent possible, and to develop resiliency skills whenever they are victimized. This is particularly true for transgender persons who are younger, minority, and not "involved" in a relationship. [ABSTRACT FROM AUTHOR]

Sexual minority, individuals who are not heterosexual, college students experience high rates of intimate partner violence (IPV), which is linked to a myriad of deleterious outcomes. However, little work has evaluated whether there are differences in IPV outcomes among sexual minority college students as compared to heterosexual college students. Further, the extent to which minority stress at the institutional and individual level relates to IPV outcomes among sexual minority students is understudied. As such, the purpose of the current study was to evaluate IPV outcomes in a large sample of undergraduate students attending 18 medium- to large-sized universities across the contiguous U.S. Results supported that sexual minority victims of IPV had more anxious and depressive symptoms than heterosexual victims of IPV but were not more likely to engage in hazardous drinking. Further, analyses supported that several campus-level (but not individual-level) indicators of minority stress moderated the relation between IPV victimization and negative outcomes among sexual minority students, such that the association between IPV and negative outcomes was stronger among students embedded in campuses with higher levels of minority stressors. Results support the critical importance of interventions addressing campus-level minority stressors to reduce deleterious IPV outcomes among sexual minority college student victims. [ABSTRACT FROM AUTHOR]

Background: The lesbian, gay, bisexual, transgender, or queer (LGBTQ) community is diverse, and members have a shared need for culturally competent health care (CCH). Best practices show that culturally appropriate affirmation training (CAAT) bridges the sociocultural knowledge gap between patient and provider, resulting in increased access to CCH. Method: The pre-/posttest project design used validated tools to measure group changes in knowledge, attitude, and skills before and after delivery of LGBTQ CAAT. The sample included staff interacting with or making decisions on behalf of patients (n = 11) at a nonprofit clinic in the southern United States. Results: A Wilcoxon signed-rank test showed an increase in health care team scores for knowledge, attitude, and skills (knowledge, p =.006, r = −.59; attitude, p =.123, r = −.33; skills, p =.005, r = −.60). Qualitative analysis (thematic analysis) (a) showed that participants explored sensitive subjects in a nonjudgmental way; (b) connected the dots between minority stress, bias, and patient-provider trust; and (c) showed increased staff confidence in providing care to LGBTQ patients. Conclusion: As staff undergo LGBTQ CAAT, access to CCH will increase, health outcomes will improve, and LGBTQ health disparities will decrease. [J Contin Educ Nurs. 2024;55(3):121–129.] [ABSTRACT FROM AUTHOR]

Background: Minority stress theory views social support as a protective factor against the effects of minority-specific stressors like internalized homophobia (IH) on mental health in sexual minority populations. However, much of the empirical validation of this theory has been conducted within predominantly White samples, resulting in a limited understanding of how the theory applies to Black sexual minority individuals. Current examinations of social support fail to capture the nuances of how Black sexual minority men may access support systems differently, resulting in a need to investigate how social support, IH, and mental health operate for Black sexual minority men. This study examined relationships between IH, depression, and different types of social support (i.e., family, friends, Black community, gay community) using a mediation model. Methods: We used data from the POWER (Promoting Our Worth Equity and Resilience) Study, which recruited Black sexual minority men at Black Pride events across six cities in the United States from 2014 to 2017, to test four mediation pathways concurrently in Stata 17. Participants (N  =  4,430) completed a questionnaire assessing a variety of health and life domains, including depression symptoms, internalized homophobia, and social support. Results: IH was positively associated with depression. Lower levels of family, friend, and Black community support were all positively associated with depression symptoms. Additionally, IH was positively associated with all types of support. Finally, family, friend, and Black community support partially mediated the relationship between IH and depression. Conclusions and implications: Results suggest that the relationship between social support and depression is complex for Black sexual minority men. Findings suggest family support is an important factor for clinical intervention efforts targeting depression, and that gay community support systems should assess how their environments can better support Black sexual minority men. Overall, findings demonstrate the necessity of future examination of how social support functions differently within Black sexual minority communities. [ABSTRACT FROM AUTHOR]

The marching arts (MA) are an understudied art form involving both music and dance, which has been cited as an inclusive space for all, despite little to no work directly investigating racial-ethnic marching minority members' intergroup experiences. As such, the purpose of this study was to empirically assess racial minority members' intergroup experiences in the MA and if such experiences were related to their well-being. We conducted an online survey of 174 self-identified members of ethnic-racial minority groups in the United States who had participated in the MA. The sample was predominantly Black/African Americans (42%) and young adults (Mage = 27.54) with large numbers of Native American, Asian, and Hispanic members. Participants described their experiences of intergroup contact in the MA, feelings of belongingness, marching self-efficacy, and minority stress. When controlling for demographics and experience, we found positive intergroup contact is a more persistent predictor of stress, belongingness, and self-efficacy than negative contact. Despite positive contact being more persistent, negative contact is a significant moderator against the positive effects of positive contact, suggesting it can be particularly detrimental to the relationship between positive contact and well-being. These findings suggest MA activities may be viable avenues to explore arts engagement for people of color, and how intergroup contact symmetries and interactions of contact work in real-world contexts. [ABSTRACT FROM AUTHOR]

Purpose: The sociopolitical context in which transgender and gender-diverse (TGD) people live has significant effects on mental health. We examined whether perceptions of context (TGD people's perceptions of how TGD people were viewed) differed across four United States (U.S.) states and associations with mental health and identity pride, the mediational effects of minority stressors, and potential buffering effects of resilience. Methods: TGD individuals in Oregon, Michigan, Nebraska, and Tennessee (n=158; ages 19–70, mean=33.06) completed questionnaires assessing their perceptions of how TGD people were viewed in their local area and in the U.S., as well as scales assessing minority stressors, pride, resilience, and mental health. Data were collected during Fall 2019 to Spring 2020. Results: Oregon participants viewed perceptions in their state the most positively, with no state-level differences in terms of broader U.S. perceptions. Tennessee participants experienced more expectations of rejection; however, there were no differences across the states in other minority stress variables, identity pride, resilience, or mental health. Participants who viewed their area as having more negative views of TGD people reported higher levels of discrimination, expectations of negative events, internalized stigma, and anxiety, as well as less pride. The effects of perceptions of local context on mental health were partially explained by enacted stigma and internalized stigma. Resilience did not buffer the effects of perceptions of the local context on mental health or pride. Conclusion: Context is important to shaping exposure to minority stressors and mental health, potentially through increasing enacted and internalized stigma. [ABSTRACT FROM AUTHOR]

Background: Transgender women (TW) experience significant inequities in healthcare access and health disparities compared to cisgender populations. Access to non-transition related healthcare is understudied among TW. We aimed to assess the association between access to care and gender minority stress and resilience factors among TW living with and without HIV in eastern and southern United States. Methods: This study was a cross-sectional analysis of baseline data drawn from a cohort of 1613 adult TW from the LITE Study. The cohort permitted participation through two modes: a site-based, technology-enhanced mode and an exclusively online (remote) mode. Exploratory and confirmatory factor analyses determined measurement models for gender minority stress, resilience, and healthcare access. Structural equation modeling was used to assess the relationships between these constructs. Models were evaluated within the overall sample and separately by mode and HIV status. Results: Higher levels of gender minority stress, as measured by anticipated discrimination and non-affirmation were associated with decreased access to healthcare. Among TW living with HIV, higher levels of anticipated discrimination, non-affirmation, and social support were associated with decreased healthcare access. Among TW living without HIV in the site-based mode, resilience was positively associated with positive healthcare experiences and inversely associated with barriers to healthcare access. Among TW living without HIV in the online mode, anticipated discrimination was associated with barriers to healthcare access; resilience was positively associated with positive healthcare experiences and inversely associated with barriers to healthcare access. Conclusions: Gender minority stress was associated with increased barriers to healthcare access among TW in the US, regardless of HIV status. Resilience factors did not mediate this effect. Interventions aiming to increase healthcare access among TW can be aided by efforts to mitigate drivers of gender minority stress and improve patient experiences in healthcare facilities. [ABSTRACT FROM AUTHOR]

Guided by the Family Stress Model for minority families, the present study examined the potential buffering effect of resting respiratory sinus arrythmia (RRSA), cognitive reappraisal, and mindfulness on the association between political climate stress (PCS) and anxiety symptoms in a sample of Latina and Black mothers. Participants were 100 mothers living in the southeastern United States. Mothers reported on PCS, cognitive reappraisal, mindfulness, and symptoms of anxiety. RRSA were measured during a resting task. Moderation analyses tested the influence of these three factors (RRSA, cognitive reappraisal, mindfulness) on the relation between PCS and anxiety. Results showed that the relation between PCS and anxiety symptoms was strongest at low levels of RRSA and cognitive reappraisal. At high levels of these two factors, there was no association between PCS and anxiety symptoms. Mothers with high levels of RRSA and cognitive reappraisal may be able to interact with and evaluate environmental stimuli in such a way that allows for adaptive adjustment, buffering against the negative impact of PCS. RRSA and cognitive reappraisal may be important targets of interventions designed to address the rising rates of anxiety symptoms in Latina and Black mothers. [ABSTRACT FROM AUTHOR]

Black and Hispanic/Latino sexual and gender diverse individuals disproportionately experience overlapping health disparities, such as drug use and elevated depressive symptoms, which are often driven by minority stressors. We sought to better understand the interaction between drug use and mental health, as it may be fruitful in developing effective interventions to address co-occurring health disparities. In a longitudinal, 5-wave sample of 300 Black and Hispanic/Latino sexual and gender diverse (SGD) individuals collected between March 2020 and March 2022, we found a within-person association between greater than average levels of psychological distress (depression and anxiety) and more frequent extra-medical use of cannabis, inhalants, methamphetamines, and opioids over the span of two years. These associations held after adjusting for the direct, within-person association of internalized homonegativity with drug use frequency. These results suggest that psychological distress explains at least some variance in drug use among Black and Hispanic/Latino SGD individuals. This highlights the importance of interventions that focus on mental health among Black and Hispanic/Latino SGD individuals who report drug use. [ABSTRACT FROM AUTHOR]

Despite significant and increasing numbers of students studying internationally, there are few data about the experiences of study abroad for various marginalized students, including transgender and gender expansive (TGE) students. Therefore, 15 TGE adults from the United States were interviewed about navigating gender and culture during undergraduate study abroad programs. Interviews were analyzed using consensual qualitative research (CQR). Participants shared how they benefited from international study and navigated intersecting social identities, including gender, which was complex and nuanced. They discussed how they actively managed issues of disclosure and its consequences, explored their identities and the influence of their social setting, and dealt with anticipated, deliberate, and unintentional harm from others. Relationships and community were priorities for participants when studying internationally; they explained how they determined whether to invest in relationships or not. Participants also clarified what their relationships looked like during study abroad, as well as unique considerations that arose from their marginalized identities. These findings can help inform the development of more inclusive, safe, and satisfying study abroad experiences for all students, especially TGE individuals; implications for future research and study abroad interventions are provided. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has created tremendous, and unequal, burdens on mental and physical health throughout the United States. Prior work suggests that LGBTQ+ individuals have experienced disproportionate harms during the COVID-19 pandemic, but potential mechanisms underlying these disparities remain unclear. In a large (N = 893) sample of US LGBTQ+ adults, we examined four theoretically derived risk factors as potential contributors to depression, anxiety, and suicidal ideation during the summer of 2020. Stressors and disruptions due to the COVID-19 pandemic were common, with over 25% of participants experiencing changes in their living situation, 40% reporting interruptions in health care access, and high levels of stress due to social isolation, financial concerns, and increased mental health symptoms. We found that social disconnection, disruptions in health care, financial strain, and efforts to avoid disclosing one's sexual orientation or gender identity at home were each associated with poorer mental health, with the largest effects evident for identity disclosure avoidance. Transgender and non-binary adults reported poorer mental health overall, but gender identity did not moderate the effects of other tested risk factors. Results highlight the importance of considering LGBTQ+ mental health in the context of minority stressors, in addition to more general social determinants of health. [ABSTRACT FROM AUTHOR]

Hypertension (HTN), a highly prevalent public issue affecting one in two adults in the United States, has recently been shown to differentially burden individuals belonging to marginalized communities, such as the lesbian, gay, bisexual, and transgender (LGBT) communities. The minority stress theory posits that a unique combination of marginalization-related psychosocial stressors and coping behaviors may underlie the increased burden of diseases like HTN in LGBT populations. Uncontrolled or poorly managed HTN often leads to the development of adverse cardiovascular outcomes, such as heart failure (HF). Despite our understanding of minority stress theory and demonstrated associations between LGBT identities and HTN, the mechanisms whereby psychosocial stress drives HTN in LGBT populations remain unclear. This mini-review discusses the physiological systems governing blood pressure and the epidemiology of HTN across different subgroups of LGBT people. In addition, we propose mechanisms demonstrated in the general population whereby psychological stress has been implicated in elevating blood pressure that may be occurring in LGBT populations. Finally, we discuss the limitations of current studies and methodological frameworks to make suggestions for study designs to better delineate the mechanisms of psychosocial stress-related HTN in LGBT communities. [ABSTRACT FROM AUTHOR]

Background: Last responders constitute an occupational category that includes all those that are involved in the postmortem care of deceased persons and their families. Last responders are exposed to several categories of work-related stressors that affect their health and well-being. COVID-19 exacerbated these stressors. Research to understand the consequences of COVID-19 on the health and wellbeing of last responders is nascent. This study aimed to assess COVID-19 related stress, coping and wellbeing among last responders in the United States. Methods: We conducted a national cross-sectional survey of last responders in July through September of 2020. The survey measured wellbeing, stress, coping, and stigma; COVID-19 experiences, and socio-demographics. A ridge regression model was fit for the outcome variables. Results: Analysis was conducted on 366 respondents from 43 states. Respondents were male (55.4%), age 50 + (57.4%), and White non-Hispanic (90.3%); 54% reported moderate-high stress and 41% endorsed mild-severe anxiety. Seventy-seven percent had experienced at least one form of stigma related to their occupation. Variables associated with higher perceived stress and anxiety included gender (female), shorter length of employment, perceiving a higher impact from COVID-19 on everyday life, and increased perceived stigma. Conclusions: Last responders are a critical part of the health care system. Throughout this pandemic, last responders have been frequently ignored and not prioritized for protection and support. Interventions to support last responders cope with stress, and to decrease anxiety are urgently needed. There is also a critical need to challenge community stigma towards last responders. [ABSTRACT FROM AUTHOR]

In the United States, sexual minority adolescents are among the subpopulations at the highest risk for suicide; yet, predictors of suicidality among this unique group remain significantly understudied. Drawing from Meyer's minority stress theory (MST), this study examines whether general stressors act as predictors of adolescent suicidality and whether differences exist in the variation of these effects between heterosexual and sexual minority adolescents. Specifically, multivariate logistic regression models were developed to examine the impact that victimization, school connectedness, and social support have on heterosexual and sexual minority adolescent suicidality using a sample of 166,176 U.S. adolescents drawn from the 2019 Minnesota Student Survey. Participants ranged from 10 to 18 years of age and identified as heterosexual, bisexual, gay or lesbian, questioning, pansexual, queer, or as none of these. Findings highlight that sexual minorities (Exp(B) = 1.870, p <.001) were roughly twice as likely to report suicidality compared to their heterosexual peers. All victimization measures were highly predictive of suicidality among heterosexual and sexual minority adolescents. Overall, adolescents who were less connected to their school setting and more socially isolated were also more likely to experience suicidality; however, such effects were not reflected uniformly in every item measuring school connectedness and social support. Findings highlight important avenues for policies implementation aimed at mitigating the effects of multiple sources of stressors on adolescents' mental health and reducing adolescents' suicide rates. Interventions tailored to the unique needs of sexual minority adolescents are needed to address their disproportionate representation among those at risk for suicide. [ABSTRACT FROM AUTHOR]

Experiences of racial discrimination are pervasive among Black youth, resulting in psychosocial problems such as depression and anxiety. Rumination plays a key role in linking racial discrimination and internalizing concerns. Developmental age has also been shown to influence the extent to which racial discrimination and rumination impact mental health; however, studies have yet to explore the interplay between these factors. This study examined the association between racial discrimination and internalizing concerns among Black youth, whether racial discrimination was indirectly associated with internalizing concerns through rumination, and whether developmental age moderated these direct and indirect effects. Participants included 158 pre- and early-adolescent youth recruited from a community sample (Mage = 11.56 years; 53% female). Data were from baseline questionnaire responses from a larger longitudinal study conducted in the Southeastern United States examining the effects of interpersonal stressors on youth mental health outcomes. Racial discrimination was directly and indirectly associated with internalizing concerns through rumination. Developmental age moderated the indirect link between racial discrimination and depressive symptoms via rumination with the association being stronger as participant age increased. The impact of racial discrimination on mental health among Black youth is informed by maladaptive coping strategies such as rumination and developmental age. Such factors help to identify who is most at risk for the impact of racial discrimination and potential intervening targets. Public Policy Relevance Statement: Racial discrimination has a significant negative impact on Black youth's mental health. The link between racial discrimination and mental health outcomes may be explained by rumination or repetitive thoughts about negative feelings or experiences. This study found rumination in the context of racial discrimination had a stronger negative impact on the mental health of older Black adolescents relative to their younger counterparts. Findings demonstrate that coping responses to racial discrimination may be age-dependent and emphasize the need for interventions that provide healthy and effective coping strategies for Black youth in response to racism, especially during the transition to adolescence. [ABSTRACT FROM AUTHOR]

This research sought to identify differences in perceived stress and personal resilience across gender, race, and different types of stressors (such as rent or mortgage stress) among a sample of United States residents experiencing the COVID‐19 pandemic. It used a cross‐sectional, convenience sampling design for primary survey data collected over 10 weeks starting in April 2020 (n=374). Independent t‐tests and binary logistic regression were performed to determine statistically significant differences between gender and race for perceived stress and personal resilience and to pinpoint key contributing factors. Results indicate women exhibited higher levels of stress, with non‐IPV (intimate partner violence) reporting women evidencing higher levels of resilience than IPV reporting women. Racial minority women were more likely to experience nutritional stress, whereas White women were more likely to worry about rent or mortgage stress. These findings provide insight into disparate impacts across vulnerable populations at the start of a crisis with implications for improving pre‐ and post‐disaster interventions. [ABSTRACT FROM AUTHOR]

Gender minority (GM) youth are at heightened risk for psychopathology, purportedly due to their experiences of GM stressors. However, few studies have examined how GM stressors are associated with depression and anxiety among GM youth. Furthermore, no prior studies have investigated how experiences of GM stressors differ across gender identity and race/ethnicity within a diverse sample of GM youth. A nationwide online cross-sectional survey of 1,943 fourteen- to 18-year-old GM adolescents (66.91% White, 11.73% multiracial, 8.49% Latinx, 7.10% Black, 3.09% Asian, 1.49% American Indian/Alaskan Native) in the United States assessed GM stressors (prejudice events, expectations of rejection, internalized transnegativity, and concealment) and mental health. Structural equation modeling was used to examine how GM stressors and depressive and anxiety symptoms differ across gender identity and race/ethnicity. Higher levels of each GM stressor were related to higher depressive symptoms. Prejudice events, expectations of rejection, and concealment were related to higher anxiety symptoms. Transmasculine and transfeminine youth reported higher levels of GM prejudice events and expectations of rejection, and higher mental health symptoms, than nonbinary youth. Findings were relatively consistent across racial/ethnic identities, with the exception that Black GM adolescents reported fewer GM prejudice events and expectations of rejection and indirectly exhibited lower mental health symptoms as compared to White GM youth. Researchers and clinicians should be attuned to how intersectional identities are related to stress and mental health among diverse GM youth. Recommendations for individual and structural-level interventions are discussed. General Scientific Summary: Gender minority youth are at heightened risk for depression and anxiety compared to cisgender peers. This study supports the theory that mental health symptoms among gender minority youth are associated with unique stressful experiences related to having a marginalized gender identity during adolescence. Risk for these stressful experiences and related mental health symptoms vary by gender identity and, to some extent, race/ethnicity. [ABSTRACT FROM AUTHOR]

Lesbian, gay, bisexual, transgender, queer/questioning, and other sexual and gender minority (LGBTQ+) asylum seekers are exposed to high rates of persecution. This study aimed to identify the forms of ill treatment and the impact of these experiences on the mental health of 66 self‐identified LGBTQ+ asylum seekers from 24 nations through the analysis of human rights program intakes, sworn declarations, and pro bono forensic psychological evaluation affidavits. The results indicate that participants experienced physical assault (92.4%), harassment and intimidation (84.8%), and sexual assault (56.1%). Psychological sequelae included symptoms of posttraumatic stress disorder (PTSD; 83.3%), depression (72.7%), and anxiety (57.6%). LGBTQ+ asylum seekers faced additional hazards upon arrival in the United States. Still, these asylum seekers experienced resilience as they leveraged internal and external support. The results can serve to inform clinical professionals about the range and impact of exposures to harm experienced by LGBTQ+ asylum seekers as well as possible strategies for support and advocacy for this diverse community. [ABSTRACT FROM AUTHOR]

Providing parents and their teenage children with an opportunity to experience voice modification techniques and discussions about mental health issues could alleviate some of their tremendous minority stress. Speech-language pathologists and counselors can use experiential learning and a multidimensional family approach to support parents and their trans teenagers to build connections and learn individual perspectives on their personal phases of transitioning. Participants of the 3-hour webinar included nine dyads of parents and youths across the United States. Topics on voice modification and mental health strategies were presented. Only parents completed the pre- and post-surveys to measure confidence in their knowledge to support their youth's voice and mental health needs. There were 10 Likert scale questions (5 voice, 5 mental health). The Kruskal–Wallis H -test results revealed that the median responses to the pre and post voice survey did not show a statistically significant change (H = 8.0, p = 0.342). Similarly, the mental health surveys did not reach significance (H = 8.0, p = 0.433). However, the growth trend shows strong promise for developing effective future experiential training workshops as a viable service provision for increasing parents' knowledge in supporting their trans child's voice and mental health needs. [ABSTRACT FROM AUTHOR]

Informed by minority stress and intersectionality frameworks, we examined 1) associations of sexual identity and race/ethnicity with probable diagnosis of post-traumatic stress disorder (PTSD-PD) among sexual minority women (SMW; e.g. lesbian, bisexual) and 2) potential additive and interactive associations of minority stressors (discrimination, stigma consciousness and internalised homonegativity) and potentially traumatic childhood and adulthood events (PTEs) with PTSD-PD. The data come from a large and diverse community sample in the United States of SMW (N=662; age range: 18–82; M=40.0, SD=14.0). The sample included 35.8% Black, 23.4% Latinx and 37.2% White participants. More than one-third of SMW (37.2%) had PTSD-PD with significantly higher prevalence among bisexual, particularly White bisexual women, than lesbian women. Discrimination, stigma consciousness and internalised homonegativity were each associated with higher odds of PTSD-PD, but only internalised homonegativity was additively associated with PTSD-PD above and beyond effects of PTEs. We found no evidence for interactive effects between PTEs and minority stressors. PTSD was strongly associated with childhood PTEs and with minority stressors above and beyond associations with adulthood PTEs and stressors. Our findings suggest a strong need to address effects of marginalization in treatment for PTSD, as minority stressors likely maintain and exacerbate effects of past traumas. [ABSTRACT FROM AUTHOR]

There is limited evolving literature on COVID-19 vaccine uptake and its barriers among sexual minority populations (lesbian, gay, bisexual, transgender, and queer [LGBTQ]), despite their increased COVID-19 risk factors. We assessed the differences in intention to receive the COVID-19 vaccine by self-reported likelihood of contracting COVID-19, anxiety/depression, discrimination frequency, social distancing stress, and sociodemographic factors across sexual orientation. An online national cross-sectional survey was conducted in the United States between 13 May 2021, and 9 January 2022, among adults aged ≥18 (n = 5404). Sexual minority individuals had a lower intention of receiving the COVID-19 vaccine (65.62%) than heterosexual individuals (67.56%). Disaggregation by sexual orientation, however, showed that gay participants had a higher intention of COVID-19 vaccination (80.41%) and lesbian (62.63%), bisexual (64.08%), and non-heterosexual, non-LGB sexual minority (56.34%) respondents had lower intentions of receiving the COVID-19 vaccine than heterosexual respondents. Sexual orientation significantly moderated the association between the perceived likelihood of receiving the COVID-19 vaccine and the self-reported likelihood of contracting COVID-19, anxiety/depression symptoms, and discrimination. Our findings further underline the importance of improving vaccination efforts and access among sexual minority individuals and other vulnerable groups. [ABSTRACT FROM AUTHOR]

Despite long being the target of racism, Asians and Asian Americans remain an understudied group regarding the mental health implications of racism. Even less is known about how Asians and Asian Americans may use religion to cope with racism and the resulting mental health implications. In this study, 330 Asian and Asian American adults from various regions of the USA were surveyed. The study results suggest that negative religious coping was associated with worsening depression, anxiety, and stress, particularly among Asian Indians, Asian Hindus, and Asian Muslims. In addition, negative religious coping may have exacerbated the deleterious effects of racism on mental health. Surprisingly, positive religious coping failed to provide any protection against racism-related mental health problems during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Primary care services are cornerstones for US health care, assuring preventive screening, maintenance of therapeutics, and access to specialty care. Sexual minority (SM) adults are less likely to have access to primary care services than their heterosexual counterparts. Additionally, access to health services among SM persons can vary by age. One plausible explanation for these disparities are experiences of minority stress. Thus, the purpose of this study was to explore the association between experiences of minority stress and access to primary care services among SM people in the United States across multiple age cohorts. A series of logistic regressions examined associations among multiple experiences of minority stress and access to primary care services. Analyses, stratified by age cohort, examined associations between experiences of minority stress and access to primary care services. Felt stigma, on average, was negatively associated with having a primary care provider among the full sample. The stratified analysis revealed that higher rates of felt stigma were negatively associated with having a primary care provider only among younger SM adults. This study offers novel information suggesting that unique experiences of minority stress are linked with barriers in access to primary care services among SM people. [ABSTRACT FROM AUTHOR]

Problematic substance use (SU) is a significant issue among LGBTQ+ individuals, but rates of treatment/help-seeking in this population remain low. This review aimed to investigate literature about intersectional stigma of SU and LGBTQ+ identity and its impact on SU help-seeking behaviours in the U.S. Eligible studies from eight-database were included if peer-reviewed, in English, from the U.S., published between 2000 and 2022, focused on SU, stigma, SU help-seeking behaviours, among LGBTQ+ adults. Of 458 search results, 50 underwent full-text review, 12 were included in the final sample. Minority Stress Theory emerged as a relevant theoretical framework. Findings revealed that increased SU as a coping strategy was associated with minority stress. Intersectional stigma negatively impacted SU treatment experience among LGBTQ+ individuals, leading to avoidance of help-seeking or poor treatment outcomes. Patterns of SU and impact of stigma among LGBTQ+ individuals differ, wherein bisexual and transgender individuals reported significantly more treatment barriers and unique stressors. LGBTQ+ individuals reported earlier age of SU onset and were more likely to encounter opportunities for SU. This review highlights the impact of intersectional stigma on SU help-seeking behaviour among LGBTQ+ individuals in the U.S. Recommendations are provided for future clinical practice, research, and policy to better support LGBTQ+ individuals. [ABSTRACT FROM AUTHOR]

Objectives Although a number of studies have documented cognitive health among older immigrants in the United States, little is known about how the life-course immigration experiences are associated with cognitive trajectories among older Chinese immigrants. We assess patterns of cognitive functioning and change over time and examine whether age at migration, reasons for migration, acculturation, perceived discrimination, and preferred dialects are related to cognitive trajectories. Methods The sample comprised 2,075 participants from the Population Study of Chinese Elderly (PINE), who completed a battery of cognitive tests at four time points (2011–2019). Latent class growth analysis and multinomial logistic regression were utilized. Results Three latent classes of cognitive trajectories were identified: the low functioning with the fastest decline (LCF, 12%), the moderate functioning with a medium decline rate (MCF, 39%), and the high functioning with the slowest decline (HCF, 48%). Perceiving more discrimination reduced, whereas speaking Taishanese increased the odds of being in the LCF and MCF. High acculturation only distinguished MCF from HCF after controlling for the known factors of cognitive health such as age, education, and social engagement. Discussion This study identifies a group of older Chinese immigrants who are especially vulnerable to cognitive impairment and indicates that the risk of cognitive decline appears to be elevated with lower levels of acculturation and unidentified racial discrimination. More research is needed to fully understand the underlying mechanisms that link the life-course immigration experiences to cognitive health outcomes in later life. [ABSTRACT FROM AUTHOR]

Purpose: Experiences of sexuality‐based discrimination (ie, minority stressors) against youth who identify as nonheterosexual (ie, sexual minority) have been associated with increased symptoms of anxiety, depression, and post‐traumatic stress disorder (PTSD) for sexual minority adolescents (SMA; ages 14‐17). However, little is known about the experiences of SMA living in rural communities across the United States. Thus, the present study sought to examine differences in mental health patterns between urban and rural dwelling SMA, and to see whether these differences are, at least in part, explained by experiences of lifetime minority stress. Methods: A nationwide sample of SMA residing in the United States (N = 2,558; aged 14‐17, M = 15.90 years, SD = 0.98) was recruited through purposive social media and respondent‐driven sampling methods to complete a cross‐sectional survey online. Measures included those of minority stress, urbanicity, and symptoms of anxiety, depression, and PTSD. Parallel multiple mediation (PMM) analysis was employed to test whether urbanicity was associated with anxiety, depressive, and PTSD symptoms through reported lifetime minority stress. Findings: On average, SMA living in rural areas significantly reported more lifetime minority stress, depressive, and PTSD symptoms than SMA living in urban settings. Results from our PMM analysis indicated that heightened experiences of lifetime minority stress indirectly linked the effects of living in rural areas on anxiety (b = –0.288, 95% CI = [–0.491, –0.085]), depressive (b = –0.158, 95% CI = [–0.270, –0.047), and PTSD symptoms PTSD (b = –0.349, 95% CI = [–0.596, –0.105]). The model accounted for 16.8%, 18%, and 24.1% of the variability in anxiety symptoms, depressive symptoms, and PTSD symptoms, respectively. Conclusions: SMA in our study who reside in rural areas reported elevated minority stress, depressive, and PTSD symptoms as compared to their urban dwelling peers. Our study found that lifetime experiences of minority stress fully mediated the relationship between urbanicity and both depressive and PTSD symptoms, and partially mediated the relationship between urbanicity and anxiety. These findings highlight the need to increase support for rural youth who are growing into adulthood and may find continuing challenges in their family, peer, and community relationships. [ABSTRACT FROM AUTHOR]

• We found 5 cannabis risk trajectories exist among sexual and gender minority people. • Past-year discrimination and victimization related to greater cannabis use risk. • Internalized stigma was related to greater odds of higher cannabis use risk. • After accounting for minority stress, gender expansive people had higher cannabis risk. • After accounting for minority stress, transgender men had higher cannabis risk. Substance use disparities among sexual and gender minority (SGM) people are attributed to minority stress, but few studies have examined minority stress and cannabis use over time or investigated differences in cannabis use trajectories by less-studied gender subgroups. We examined if longitudinal cannabis use trajectories are related to baseline minority stressors and if gender differences persisted after accounting for minority stress. Cannabis use risk was measured annually over four years (2017–2021) within a longitudinal cohort study of SGM adults in the United States (N = 11,813). Discrimination and victimization, internalized stigma, disclosure and concealment, and safety and acceptance comprised minority stress (n = 5,673). Latent class growth curve mixture models identified five cannabis use trajectories: 'low or no risk', 'low moderate risk', 'high moderate risk', 'steep risk increase', and 'highest risk'. Participants who reported past-year discrimination and/or victimization at baseline had greater odds of membership in any cannabis risk category compared to the 'low risk' category (odds ratios [OR] 1.17–1.33). Internalized stigma was related to 'high moderate' and 'highest risk' cannabis use (ORs 1.27–1.38). After accounting for minority stress, compared to cisgender men, gender expansive people and transgender men had higher odds of 'low moderate risk' (ORs 1.61, 1.67) or 'high moderate risk' (ORs 2.09, 1.99), and transgender men had higher odds of 'highest risk' (OR 2.36) cannabis use. This study indicates minority stress is related to prospective cannabis use risk trajectories among SGM people, and transgender men and gender expansive people have greater odds of trajectories reflecting cannabis use risk. [ABSTRACT FROM AUTHOR]

Sexual minorities are at greater risk for mental health difficulties than their heterosexual peers, and bisexual and asexual individuals may be at particularly heightened risk. However, the majority of the literature has failed to examine nuanced differences within the sexual minority community. We examined depression, anxiety and happiness as indicators of mental health, and belonging and coping as general psychological processes in 2,424 female and male college students who identified as gay/lesbian, asexual, or bisexual. The findings revealed a significant main effect for sexual orientation such that bisexual individuals scored significantly higher on depression and lower on happiness than asexual and gay/lesbian individuals. Gay/lesbian and bisexual individuals scored significantly higher on anxiety and lower on coping than asexual individuals. Asexual individuals reported greater belonging than bisexual individuals, and gay/lesbian individuals scored in between those groups. The results also revealed a significant main effect for gender such that women had higher levels of depression and anxiety, and lower levels of happiness and coping than men. Finally, gender did not moderate the relationship between sexual orientation and the outcome variables. These findings highlight that the sexual minority community is not a monolithic group in terms of mental health or general psychological processes. [ABSTRACT FROM AUTHOR]

In the United States, COVID-19 unfolded alongside profound racial trauma. Drawing on a population representative sample of twenty- to sixty-year-olds who were married or cohabiting, the National Couples’ Health and Time Study (N = 3,642), we examine two sources of stress: COVID-19 and racial trauma. We leverage the fully powered samples of respondents with racial-ethnic and sexual minority identities and find that COVID-19 and racial trauma stress were higher among individuals who were not White or heterosexual most likely due to racism, xenophobia, and cis-heterosexism at the individual and structural levels. Both COVID-19 and racial trauma stress were associated with poorer mental health outcomes even after a rich set of potential mechanistic indicators, including discrimination and social climate, were taken into account. We argue that the inclusion of assessments of stress are critical for understanding health and well-being among individuals affected by systemic and interpersonal discrimination. [ABSTRACT FROM AUTHOR]

Sexual minority people in the United States are less likely to have access to health services when compared to their heterosexual counterparts. Less is known about the within‐group sociodemographic memberships among sexual minority people regarding access to health services. Using data from a nationally representative sample, a series of univariate and bivariate analyses were used to determine associations between sociodemographic group membership and access to health services. Results suggest there are significant differences in access to health services within the sexual minority population. Differences in access to health services when considering sex‐at‐birth, sexual identity, age, race/ethnicity, urbanicity, education level and income status were found. These findings offer insight into the role sociodemographic group membership has on the equity of access to health services. Specifically, results indicated that disproportionate access to health services among sexual minority people were more pronounced among those with group membership who experience social marginalisation. This was particularly true for sexual minority people who were bisexual, younger, Black and Latinx, lower‐income earners and sexual minority people with less education attainment. Results from this study may be used to inform policies and practices aimed at improving access to health services including, but not limited to, the expansion of the Affordable Care Act and continued development of Federally Qualified Health Centers, while acknowledging the role of within‐group differences among sexual minority people. [ABSTRACT FROM AUTHOR]

Asian Americans are the fastest‐growing racial group in the United States. Contrary to the model minority myth, many Asian American youth experience mental health challenges. However, they are less likely to utilize school‐based mental health services than their non‐Asian American peers. A paucity of research addresses Asian American adolescents' understanding of mental health disorders and beliefs about helpful strategies for addressing psychological challenges within the school context. The present study utilized vignettes and semi‐structured interviews with 24 Asian American adolescents (M = 16.92, SD = 2.45, 79.17% females) to explore their understanding of eating disorders and depression and what they perceive as helpful strategies to address mental health challenges at school. Participants shared culture‐specific risk factors for these mental health disorders, such as high academic pressure, sociocultural pressures for thinness, and internalized model minority stereotype. Participants also proposed strategies to support youth mental health, including providing support, encouraging professional help‐seeking, reducing stigma, addressing confidentiality concerns, implementing school‐wide programs to promote mental health awareness, promoting positive coping strategies, and establishing strong connections between mental health providers and Asian American students. We discuss practical implications for school‐based mental health programs, practices, and providers. Keypoints: Asian American adolescents shared culture‐specific risk factors for mental health disorders, and proposed strategies to support Asian American youth's mental health (e.g., reducing stigma, addressing confidentiality concerns, implementing school‐wide mental health programs).School mental health professionals should acknowledge potential biases and stereotypes toward Asian American students, address cultural‐specific risk factors (e.g., model minority stereotypes), involve parents, and promote mental health literacy among both parents and youth to support Asian American students' mental health. [ABSTRACT FROM AUTHOR]

Purpose: Research suggests social support may protect sexual minorities from the harmful effects of victimization that undermine mental and sexual health wellness; however, this relationship has been underexplored among a diverse youth population. We examined the association between lifetime homonegative victimization, perceived stress in the last month, and resilience factors among a diverse sample of adolescent sexual minority males. Methods: Data were collected between June 2018 and April 2020 as part of the MyPEEPS Mobile study, a multi-site randomized controlled trial evaluating the effectiveness of a mobile behavioral HIV prevention intervention for adolescents living in the U.S. We analyzed baseline survey data from 542 sexual minority males, aged 13–18 years. We used bivariate analyses to examine relationships among variables and multivariable linear regression models to determine if resilience factors attenuated the association between homonegative victimization and perceived stress. Results: Perceived stress was positively associated with younger age, internalized homophobia, experiencing verbal victimization, threats of being outed, and threats of physical violence. Relying on online friends for support and having good family relations both attenuated the relationship between verbal victimization and perceived stress. However, neither of these resilience factors significantly weakened the associations between perceived stress, threats of physical violence, and being outed. Conclusion: Resilience factors, including peer and family support, may play an attenuating role in the relationship between homonegative victimization and perceived stress among adolescent sexual minority males. ClinicalTrials.gov Identifier: NCT03167606 [ABSTRACT FROM AUTHOR]

Parenthood is an aspiration shared by a majority of U.S. adults. However, previous research has found that sexual minority adults (e.g., lesbian, gay, bisexual [LGB]) are less likely than heterosexual counterparts to be parents or desire to become parents in the future. To date, few studies have examined how minority stress (i.e., everyday discrimination [ED], felt stigma [FS], and internalized homophobia [IH]) influences parenting desire, parenting likelihood, and expectation a gap between the two. Even fewer studies have examined the parenting aspirations of sexual minority individuals following nationwide legalization of same-sex marriage in the United States. We analyzed data from 487 childfree lesbian, gay, bisexual, and queer participants from two cohorts ("equality cohort": ages 18–25; "visibility" cohort: ages 34–41) from the Generations study, a national probability sample of sexual minority adults in the United States. As expected, we found that the visibility cohort adults had significantly lower parenting desire and parenting likelihood, and a greater parenting expectation gap than the equality cohort adults. Additionally, while everyday discrimination (ED) did not predict parenting aspirations, IH and FS predicted higher parenting desire and lower parenting likelihood, respectively. We found a cohort by FS interaction such that FS predicted even lower parenting likelihood in the visibility cohort adults. Our findings contribute to a growing body of research on sexual minority parenthood and may inform community practice and clinical support for sexual minority adults who pursue parenthood. [ABSTRACT FROM AUTHOR]