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Transgender individuals are at heightened risk for self-injurious thoughts and behaviors (SITBs). Evidence suggests that middle childhood-aged transgender individuals experience elevated rates of non-suicidal self-injury (NSSI) and passive suicidal ideation (SI), compared to cisgender children. Little is known about gender identity-based disparities in SI more broadly and suicidal behavior (SB) in children aged 9 and 10. The aim of this study was to examine gender identity-based disparities in SITBs among children in middle childhood (pre-teens) in a US-based sample.Using data from the 3.0 baseline release of the Adolescent Brain Cognitive Development (ABCD) study, logistic regression models, unadjusted and adjusted for covariates, were performed to examine gender identity-based disparities in SITBs.In a model adjusted for birth sex, race/ethnicity, and household income, transgender children were at significantly higher odds for current (adjusted odds ratio [AOR] = 6.34) but not lifetime NSSI compared with cisgender children. Transgender children were at significantly higher odds for current and lifetime SI (AOR = 13.03; AOR = 5.39, respectively) and SB (AOR = 14.21; AOR = 12.64, respectively) compared with cisgender children.Gender identity-based disparities in SITBs may be present as early as age 9 and 10, demonstrating the need for SITB prevention and intervention efforts specific to transgender children.

In the tripartite influence model, appearance-ideal internalization is identified as a prominent risk factor for the development of body dissatisfaction and subsequent eating disorder (ED) behaviors. For men, prior research has emphasized the importance of both thin-ideal internalization and muscular-ideal internalization in explaining later ED behaviors and muscle dysmorphia (MD) symptoms. Previous research in heterosexual men has shown that the associations between muscular-ideal internalization and ED or MD symptoms may depend on whether the individual has also internalized the thin ideal. However, this interaction has not been examined in research with sexual minority men (SMM).The current study collected self-report data from 452 at risk SMM (i.e., endorsed body dissatisfaction), with ages ranging from 18 to 35 years. Linear regression models were conducted to test the interaction effects between thinness and muscularity internalization on ED symptoms, MD behaviors, and general body dissatisfaction. Simple slopes and the Johnson-Neyman technique were used to investigate significant interaction terms.Thin- and muscular-ideal internalization were positively associated with muscular appearance intolerance and dietary restriction with no significant interaction. Muscular drive for size was highest when both muscularity internalization and thinness internalization were high. Muscular-ideal internalization was positively associated with both cognitive restraint and general body dissatisfaction, but only at lower levels of thinness internalization.Given the interacting association between thinness and muscularity internalization and aspects of body dissatisfaction, attitudes, and behavior, prevention and intervention programs for EDs and MDs in SMM should seek to dismantle both thinness and muscularity internalization.Internalizing-or adopting as one's own-the ideal of a body with low body fat and high muscularity has been shown to lead to muscle dysmorphia and eating disorder symptoms in men. The current study examines whether the combination of thin-ideal and muscular-ideal internalization is associated with worse symptoms than either facet alone in sexual minority men. Treatment efforts in sexual minority men should address both types of internalization.

This cross-sectional study assesses the prevalence of disordered eating in children and its associations with sex, pubertal maturation, and weight.

Sexual assault, child abuse, and combat have been linked to eating disorders (EDs). However, noninterpersonal trauma is relatively understudied, and therefore it is unknown whether noninterpersonal trauma is associated with EDs. Furthermore, most previous studies do not account for multiple trauma exposures, or the relative association of traumatic events with EDs in the same statistical model.Multinomial regression was used to examine the association of lifetime ED diagnosis (anorexia nervosa [AN], bulimia nervosa [BN], binge eating disorder [BED]) with trauma type (sexual interpersonal, other interpersonal, war/combat, and noninterpersonal) in a nationally representative dataset of US adults in bivariate and multivariable (i.e., with all trauma types) models.Sexual interpersonal trauma was significantly positively associated with AN and BED in bivariate and multivariable models. In the multivariable model, only BED was found to be equally associated with sexual interpersonal, other interpersonal, and noninterpersonal trauma.These results indicate a strong positive association between sexual trauma and EDs, even when controlling for experiences of other trauma events. Future research should examine longitudinal mediators between trauma and EDs, especially sexual trauma, to identify what factors may explain this relationship.Individuals with eating disorders often experience traumatic events but it is unclear whether specific trauma types are more or less common in this population. This study found that only events such as rape and sexual assault are associated with anorexia nervosa, but that most trauma types are associated with binge eating disorder. Therefore, the relationship between trauma and binge eating disorder may function differently than other eating disorders.

Sexual minority men (SMM) are disproportionately at risk for suicidality. Furthermore, SMM are at elevated risk for appearance-ideal internalization and body dissatisfaction, which are both associated with suicidality. Theoretical recommendations suggest including interaction terms between appearance-ideal internalization and body dissatisfaction when examining deleterious health outcomes. To test these interactions and examine whether appearance-ideal internalization or body dissatisfaction impart greater suicidality, the current study analyzed associations between specific forms of appearance-ideal internalization and suicidality among SMM, and whether body dissatisfaction moderated these associations. Participants were 171 SMM recruited for an eating disorder prevention program. Analyses examined the association between thin and muscular-ideal internalization with count of suicide risk, with body fat and muscularity dissatisfaction moderating these associations. Zero-inflated Poisson regressions revealed that the association between thin-ideal internalization and suicide risk was moderated by body fat dissatisfaction, such that thin-ideal internalization was associated with increased suicide risk at high levels of body fat dissatisfaction. Muscularity concerns were not significantly associated with suicidality, suggesting that thinness concerns may be more salient than muscularity for suicidality among SMM. Future research should replicate findings among larger SMM samples and extend the current design into non-SMM samples to examine if results generalize to other vulnerable populations.

Objective: We examined sadness/hopelessness and suicide among racial/ethnic and sexual minority youth (SMY).Methods: 2017 Youth Risk Behavior Survey (YRBS) data on sadness/hopelessness and suicide were analyzed among White, Black, and Hispanic/Latino youth.Results: A main effect of sexual minority (SM) identity emerged for sadness/hopelessness, suicidal ideation, suicide plan, suicide attempts, and injurious attempts; SMY reported increased risk compared to their heterosexual peers. An interaction between Black race and SM identity emerged for sadness/hopelessness, suicidal ideation, and suicide plan; White SMY were at greater risk than Black SMY. A main effect of Black race on suicide attempts was found; Black youth reported increased risk of suicide attempts compared to White youth.Conclusions: Black SMY exhibited lower risk of sadness/hopelessness, suicide ideation, and suicide plans than their White SMY peers, whereas Black youth overall were more likely to report suicide attempts than their White peers.HIGHLIGHTSThere was an interaction of sexual minority identity and race (Black or White) for three outcomes.SM and Black identities were associated with higher risk for suicide attempts.Only SM identity was associated with increased risk of injurious suicide attempts.

Intimate partner violence (IPV) has been associated with increased prevalence of eating disorders. In men, disordered eating is often related to the muscularized ideal. Sexual minority men (SMM; e.g., gay, bisexual, etc.) are at higher risk for eating disorders and Latino SMM may be at particularly high risk; however, IPV and eating pathology has yet to be examined in this population. Therefore, the aim of this study is to elucidate the association between IPV and muscularity-related dissatisfaction and muscularity-oriented behavior in Latino SMM. Participants were 81 Latino SMM. Thirty participants (37% of the sample) met the cutoff score for experiencing IPV in the past month. In bivariate analyses, IPV was associated with muscularity-oriented behavior, but not muscularity-related dissatisfaction. In multivariable analyses, IPV was negatively associated with muscularity-related dissatisfaction with a small effect size and positively associated with muscularity-oriented behavior with a large effect size. It may be that SMM engage in muscle building behavior to increase self-esteem, regulate affect, or better physically protect themselves from their abusive partner. Future research should investigate motivation for muscle building behavior in individuals experiencing IPV.

This study assessed the occurrence of probable eating disorders (EDs), ED symptoms, probable body dysmorphic disorder (BDD), BDD symptoms, drive for muscularity, and appearance and performance enhancement drug (APED) misuse, in an ethnically/racially diverse sample of 962 cisgender sexual minority (SM) individuals in the United States, aged 18-30 years old. The overall occurrence of probable ED, probable BDD, and APED misuse in the current sample was 32.7 %, 50.9 %, and 30.6 %, respectively. With respect to ethnicity/race, Hispanic SMs reported the highest rates of EDs, BDD, APED misuse, and drive for muscularity, and may therefore be particularly at risk for developing body image disorders (BIDs). With respect to gender, SM men reported significantly greater drive for muscularity and APED misuse compared to SM women, while SM women reported significantly higher occurrence of probable ED and ED symptoms. The occurrence of EDs, BDD, and APED misuse were higher among SMs in this sample compared to previous rates found among heterosexual samples, suggesting that SMs, regardless of gender and ethnicity/race, are vulnerable to experiencing BIDs and APED misuse. Future research is needed to identify the mechanisms that place SMs at (increased) risk for BIDs, which will aid prevention/intervention development.

Objectives Sexual minority adolescents have previously been found to experience disparities in self-injurious thoughts and behaviors (SITBs) compared to heterosexual adolescents. However, there is a paucity of data on SITBs amongst children. Thus, the aim of the current study is to assess the prevalence of SITBs in a large sample of U.S. children and to test whether rates vary by sexual orientation. Methods Data were drawn from the 2.0 baseline release of the Adolescent Brain Cognitive Development (ABCD) study. The full sample included 11,777raw 9-10-year-old children (sexual minority n = 150raw). Children completed a computerized version of the youth Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5), including items assessing suicide ideation, suicide attempts, and nonsuicidal self-injury (NSSI). Unadjusted and adjusted models compared the prevalence of outcomes by sexual orientation. Models also compared the co-occurrence of NSSI and suicide ideation by sexual orientation. Results Across all outcomes, sexual minority children reported elevated prevalence rates compared to heterosexual children, with odds ratios ranging from 4.4 to 6.5. Among children who reported NSSI, a greater proportion of sexual minority versus heterosexual children reported co-occurring suicide ideation (OR = 3.8). Conclusions In a large sample of 9-10-year-old U.S. children, sexual orientation disparities emerged across NSSI, suicide ideation, and suicide attempts. Results indicate that sexual minority children are a vulnerable population for SITBs. Inclusion of children in prevention programs is encouraged. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mirror exposure (ME) is embedded within cognitive behavioral treatment of body image concern (BIC), and existing literature demonstrates its potential value as a BIC intervention. The purpose of the study is to provide a meta-analytic review of ME effects on attitudinal and behavioral BIC.Twelve studies met inclusion criteria, yielding six between-group and 18 within-group comparisons.Random effects models demonstrated a medium effect of ME versus control conditions, on attitudinal BIC, from pre- to immediate posttreatment, small effect at follow-up (1 to 4 weeks posttreatment), and large effect on behavioral BIC pre- to immediate posttreatment. However, small sample sizes yielded nonsignificant findings and significant heterogeneity. Exploratory moderator analyses-ME type, ME dosage (session frequency, duration), and diagnosis-demonstrated that, among single group pre-post designs, higher ME dosage may be instrumental to pre-posttreatment improvements. Consistent with this finding, individual studies with high dosages of ME demonstrated the largest effect sizes. Conclusion: Results may suggest a strong ME effect on BIC at high dosages (120 minutes). The current review highlights gaps in ME literature and the need for future clinical trials assessing ME, using a priori, high-quality research designs that further the understanding of ME's mechanisms of change.

Latino sexual minority men (SMM) have high HIV incidence rates but report low pre-exposure prophylaxis (PrEP) use. Medical mistrust predicts lower medical care use and could contribute to decreased PrEP engagement. This study examines how medical mistrust relates to the PrEP cascade among 151 Latino SMM aged 18–29. Logistic regressions were employed with medical mistrust predicting PrEP awareness, willingness, current use, and adherence. Greater medical mistrust was associated with decreased odds of all outcomes and may represent a barrier to PrEP engagement for Latino SMM. Further research should explore whether reducing medical mistrust among Latino SMM could increase PrEP engagement.

From 2010 to 2017, HIV diagnoses increased 17% among Latino sexual minority men (SMM) while decreasing 19% among White SMM and stabilizing among African American SMM. Traditional machismo is characterized by aggressiveness/power; caballerismo consists of family values/chivalry. Latino SMM high in traditional machismo may avoid seeking Pre-Exposure Prophylaxis (PrEP) to avoid being stigmatized as effeminate. Latino SMM high in caballerismo may be more likely to use PrEP to remain healthy for their family and/or partners. The current study explores the association between traditional machismo and caballerismo with four steps of the PrEP cascade. Participants were 151 HIV-negative/unknown Latino SMM living in San Diego, California (M = 24.18 years old) who completed an online study. Traditional machismo was associated with low odds of PrEP awareness, willingness, and adherence, and high odds of PrEP use. Caballerismo was associated with greater odds of PrEP awareness, willingness, use, and adherence. High levels of traditional machismo among Latino SMM may be a barrier to PrEP. Caballerismo may be a facilitator of PrEP awareness, willingness, use, and adherence. Programs which serve to move Latino SMM through the PrEP cascade may benefit from discussing culturally-relevant masculinity given the potential for their differential association with PrEP variables.

The Sociocultural Attitudes Towards Appearance Questionnaire-4 Revised (SATAQ-4R) is a measure of internalization (or belief and acceptance) of muscular, thin/low body fat, and general attractiveness ideals; and of sociocultural pressures experienced from family, peers, media, and significant others to achieve the ideal body. The current study examined the psychometric properties of the SATAQ-4R scores in a sample of sexual minority (non-heterosexual) men and women. Confirmatory factor analysis was employed to examine the factor structure in men (n = 479) and women (n = 482). The original 7-factor structure was replicated, and internal reliability coefficients for the seven subscale scores were acceptable (≥ .82 α and ω). For men and women, the thin/low body fat, family, peers, media, and significant others subscales exhibited significant positive medium-to-large associations with subscale scores on the Eating Disorder Examination-Questionnaire (EDE-Q), measuring aspects of eating pathology. The muscular ideal subscale exhibited a significant large correlation with the Drive for Muscularity Scale (DMS), measuring muscularity-related concerns. Both the muscular ideal and general attractiveness ideal subscale exhibited significant small or non-significant correlations with eating pathology. In sum, the SATAQ-4R scores demonstrated acceptable reliability and structural and convergent validity in samples of sexual minority men and women.

Young Latino men who have sex with men (MSM) are a highly vulnerable population for HIV infection. Pre-exposure prophylaxis (PrEP) is a novel biomedical HIV prevention tool that may aid in reducing the disparity in HIV incidence among Latino MSM. However, PrEP use is disproportionally low among Latino MSM and, therefore, identifying barriers along the PrEP continuum of care (the “PrEP cascade”) would provide insight into how to best deploy PrEP interventions. Syndemics theory is a prominent framework employed in HIV prevention; however, to date, no known studies have applied this theory to PrEP. Thus, the aim of the current study was to explore the association between syndemics and the PrEP cascade, including the degree to which psychosocial and structural syndemic constructs are related to the PrEP cascade. Participants were 151 young Latino MSM (M age = 24 years; SD = 3) residing in San Diego, California, who completed a battery of online self-report measures. Results indicated high levels of syndemic indicators and varying levels of engagement across the PrEP cascade. As syndemic indicators increased, the odds of engagement across the PrEP cascade were significantly lowered. Psychosocial and structural syndemic factors accounted for unique variance in the PrEP cascade. Results highlight the need for combination interventions that address both psychosocial and structural barriers to PrEP use and persistence among young Latino MSM.

Latino sexual minority men (SMM) have elevated anabolic-androgenic steroid (AAS) misuse in comparison to their heterosexual and non-Latino peers. Within a gender role framework, desire to present as masculine through heightened muscularity may be related to increased AAS misuse. To assess the association between AAS misuse and a culturally-distinct masculinity, this study examined the relationship of two aspects of machismo, traditional machismo and caballerismo, with AAS misuse in the past month. Participants were 141 young adult Latino SMM recruited from the San Diego area. Participants completed a self-report questionnaire online in English or Spanish, which included measures of machismo and AAS misuse. Out of 141 participants, 27 reported AAS misuse (19.1%). Traditional machismo was positively associated with AAS misuse and caballerismo was negatively associated with AAS misuse. Traditional machismo, which emphasizes dominance, may be positively associated with AAS misuse due to its facilitation of muscle development, which could enable physical intimidation; greater musculature may also counteract assumptions about femininity and sexual orientation. Caballerismo may be negatively associated with AAS by providing a flexible masculinity model that emphasizes social cohesion over dominance. Future AAS misuse interventions could include values-based work and cognitive restructuring of masculinity schemas.

OBJECTIVE Body dissatisfaction is intricately linked to the development of disordered eating. However, as male body dissatisfaction appears more oriented toward muscularity, versus thinness per se, existing measures of eating disorder psychopathology may lack sensitivity in capturing disordered eating that is muscularity-focused. The aim of the present study was to develop a specific measure of muscularity-oriented disordered eating-the muscularity-oriented eating test (MOET). METHOD Candidate items were generated and refined in consultation with eating disorder-focused researchers and focus groups of men with eating disorders. Examination of the MOET comprised two studies, consisting of 511 undergraduate men, divided into two component samples. In Study 1 (n = 307), candidate items were generated and refined via exploratory factor analysis (EFA). Confirmatory factor analysis (CFA) was then used to confirm the single factor structure in Study 2 (n = 204). RESULTS EFA revealed a 15-item single factor structure, which was later confirmed through CFA in a separate sample of undergraduate men. Furthermore, the MOET yielded evidence of internal consistency (Study 1: omega = 0.93, 95% CI [0.91, 0.94]; Study 2: omega = 0.92, 95% CI [0.90, 0.93]), 7-day (Study 1) and 21-days (Study 2) test-retest correlation (rs = .75, for Study 1 and 2) and convergent and divergent validity. DISCUSSION The MOET represents a psychometrically sound, novel measure of muscularity-oriented disordered eating. Future research should examine its utility in clinical samples and research into muscularity-oriented disordered eating.

Background Latino sexual minority men (SMM) may be a group disproportionately at risk for substance use than heterosexual Latino men and non-Latino SMM. As religiosity may be a culturally relevant factor, the current study aimed to explore the association of three subcomponents of religiosity: organizational religious activity (ORA; i.e., public religious activity), non-organizational religious activity (NORA; i.e., private religious activity), and intrinsic religiosity (IR; i.e., personal commitment to one's religion) in predicting illicit substance use. Method Participants were 151 Latino SMM recruited from San Diego County (M = 24.18 years of age, SD = 3.19), who completed online self-report questionnaires in English or Spanish. Binary outcome variables represented use of illicit substances in the past month vs. no use. Religiosity was assessed using the three subscales (ORA, NORA, and IR) of the Duke University Religion Index (DUREL). Acculturation was controlled for using the Bidimensional Acculturation Scale for Hispanics. Results ORA was associated with opiates (OR = 1.53, p = .04). NORA was associated with cocaine (OR = 1.69, p = .01), opiates (OR = 1.56, p = .04), amphetamines (OR = 1.67, p = .02), and sedatives (OR = 2.33, p = .001). IR was associated with amphetamines (OR = 1.34, p = .03). Conclusion NORA is positively associated with multiple illicit substances, and may represent greater internalization of anti-gay religious doctrines compared to other components of religiosity in Latino SMM. An intersectional approach addressing religious and sexual minority identity may be useful in substance use treatment for Latino SMM.

Background Eating disorders exhibit high comorbidity with other psychiatric disorders, most notably mood, substance use, and anxiety disorders. However, most studies examining psychiatric comorbidity are conducted in adolescents and adults. Therefore, the comorbidity among children living with eating disorders is unknown. The aim of this study was to characterize co-occurring psychiatric disorders with eating disorders in a US sample of children aged 9-10 years old utilizing the Adolescent Brain Cognitive Development study. Methods The analytic sample included 11,718 children aged 9-10 years. Anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding and eating disorder subtype diagnoses were examined. Statistical analyses were conducted using complex sampling. Odds ratios and 95% confidence intervals were calculated comparing the likelihood of being diagnosed for a psychiatric disorder when having an eating disorder, as compared to children without an eating disorder, children diagnosed with major depressive disorder, and children diagnosed with posttraumatic stress disorder using binary logistic regression. Results Co-occurring psychiatric disorders were substantially higher in children with eating disorders as compared to children without eating disorders, but not as compared to children diagnosed with major depressive disorder or posttraumatic stress disorder. The most common comorbidities for the eating disorder group were anxiety disorders (71.4%), attention deficit/hyperactivity disorder (47.9%), disruptive/impulse control disorders (45.0%), mood disorders (29.6%), and obsessive-compulsive disorder (28.8%), largely in line with previous research. Conclusions This study extends prior research finding high rates of comorbidity in eating disorders, specifically with anxiety, mood, and disruptive/impulse control disorders. Clinicians assessing for psychiatric disorders should be aware that eating disorders can occur in children 9 and 10 years old and are associated with severe comorbidity. Referrals for specialty mental health care should be considered.

The Drive for Muscularity Scale (DMS) is a commonly used measure used to assess the pursuit of muscularity. However, the factor structure of this measure has yet to be confirmed in a sample of sexual minority women. Moreover, the invariance of this measure across gender has also yet to be explored. The aim of the present study was, therefore, to conduct a confirmatory factor analysis (CFA) of the DMS in samples of both cisgender sexual minority men and women, and subsequently evaluate the measurement invariance by gender. The sample consisted of 962 cisgender sexual minority young adult men (N = 479) and women (N = 483). A series of CFAs were conducted, assessing both the one-factor and two-factor solutions of the DMS, with and without the inclusion of item 10 (“I think about taking anabolic steroids”). Across cisgender sexual minority young adult men and women, the 14-item two-factor solution demonstrated most appropriate fit, although the 15-item two-factor solution was also adequate among only women. Measurement invariance analyses indicated that the 14-item two-factor DMS can be used in samples of both cisgender sexual minority men and women. The present study was novel in exploring the factor structure of the DMS in sexual minority women and measurement invariance by gender; however, future research is needed to further corroborate these findings and assess measurement invariance by sexual orientation and race.

Sexual minority men (SMM) remain disproportionately burdened by sexually transmitted infections. Although gay community involvement has been theorized to be protective against many negative health outcomes, research examining the association between community involvement and condomless anal sex (CAS) has yielded conflicting results. The current study, conducted between 2018-2020, examined whether the importance one places on various aspects of community involvement was associated with CAS among a sample of young adult SMM aged 18-34 years with body image concerns (N = 180). Gay community involvement was measured using the Importance of Gay Community Scale, and the results of an exploratory factor analysis indicated the presence of two factors: "social activism" and "going out/nightlife." A zero-inflated Poisson regression was conducted to examine the association between gay "social activism," "going out/nightlife," and their interaction with the number of CAS partners. Upon examining a significant interaction, "social activism" had a protective effect against CAS at low levels of "going out/nightlife," but this effect was non-significant at higher levels. These results suggest that encouraging gay community involvement through activism could be effective at reducing CAS and addressing the health disparity that exists within this population.

Objective The present study aimed to investigate the factor structure of the Eating Disorder Examination Questionnaire (EDE-Q) in a large sample of cisgender sexual minority men and women, and subsequently, to evaluate measurement invariance by gender. Method The sample consisted of 962 sexual minority adult men (n = 479) and women (n = 483) who completed online self-report surveys. Confirmatory factor analysis was conducted using two previously supported factor structures (Friborg et al.'s four-factor model and Grilo et al.'s brief three-factor model) as well as the original four-factor structure of the EDE-Q. Results Results indicated that the best fitting models were Friborg et al.'s four-factor model (CFI = .974, RMSEA = .098, SRMR = .0 70) and Grilo et al.'s brief three-factor model (CFI = .999, RMSEA = .049, SRMR = .017). The model fit of both factor structures were nearly identical when examined separately for men and women. The original four-factor structure could not be supported in this sample. Measurement invariance analyses further indicated that the best fitting models were invariant by gender in sexual minority individuals. Internal consistency was adequate for all subscales of Friborg et al.'s and Grilo et al.'s models. Discussion The present study provides support for the use of the EDE-Q in sexual minority men and women. Additionally, findings demonstrate that the EDE-Q performs similarly in sexual minority men and women. Future research is needed to further evaluate measurement invariance of the EDE-Q by sexual orientation, gender identity, and race.

While prevalence rates for eating disorders in sexual minority men and boys (e.g., gay, bisexual) are difficult to estimate, research suggests that they are more likely to exhibit eating disorders and eating pathology as compared to heterosexual men and boys. Current models of eating pathology, originally developed and tested in heterosexual women and girls, have found some support among sexual minority men and boys but have also been modified to represent sexual minority-specific influences. Thus far, some work has been done modifying existing treatment and prevention protocols for this population; however, it remains to be seen how much modification is necessary to achieve positive outcomes.

The utility of traditional eating disorder measures in the assessment of muscularity-oriented disordered eating has been questioned. To address this limitation, the Muscularity-Oriented Eating Test (MOET) was recently developed and validated in a sample of U.S. college men. We aimed to develop a multicultural Spanish-language version of the MOET for use in Latin American samples and validate its use in a sample of Argentinian college men. Combined translation procedures were used to develop a version suitable for different Spanish-speaking populations. A total of 235 students (Mage = 23.47, SD = 5.61) participated in this study by completing a survey including the MOET. A sub-sample (n = 121) completed the MOET again after 1 week. A confirmatory factor analysis of a re-specified model of the original single-factor MOET, allowing for residual correlation between items associated to dietary rules (items 4-12), resulted in an adequate fit (χ2/df = 2.10, CFI = 0.94, TLI = 0.93, RMSEA 0.05 [90% CI = 0.04, 0.06] SRMR = 0.08). Further, the multicultural Spanish-language version of the MOET yielded evidence of internal consistency (omega = 0.83, 95% CI [0.79, 0.88], Cronbach's α = 0.83), a 1-week Intraclass Correlation Coefficient was considered for test-retest reliability (ICC = 0.82), item analysis, convergent validity with measures of eating disorder psychopathology, body dissatisfaction and weight-related behaviors, as well as for divergent validity with an unrelated construct. The availability of a multicultural Spanish-language version of the MOET may have utility in both clinical and research efforts related to muscularity-oriented disordered eating among Latino men.

Eating disorders affect individuals across all demographic strata and indicators of social location, including sex, age, weight, ability, socioeconomic position, race, and ethnicity. Sexual and gender minority populations are diverse subgroups who have been identified as exhibiting elevated prevalence of eating disorders and disordered weight and shape concerns. The goals of this chapter are threefold: (1) to review the state of the research on eating disorders and eating disorders treatment and prevention among sexual and gender minorities, including relevant theory and epidemiology on health inequities; (2) to discuss the state of evidence-based treatment and, by necessity, discuss critical gaps in research and clinical practice that have impeded the development of tailored and targeted eating disorder treatment and prevention for sexual and gender minority populations; and (3) to describe recommendations for future research and clinical practice. Given the paucity of formal evidence evaluating the efficacy of evidence-based treatment for sexual and gender minority populations, we issue 12 concrete recommendations derived from epidemiologic research and perspectives from providers and individuals with lived experience to help prioritize research efforts and guide the future development and implementation of evidence-based treatment of eating disorders for sexual and gender minority individuals.

Sexual minority men (SMM) face substantial disparities in rates of binge eating compared to heterosexual individuals, underscoring the need to study risk factors for the development of binge eating amongst SMM. One potential explanation for this disparity in binge eating is minority stress theory, which posits that minority groups face stressors, such as discrimination, due to their stigmatized position in society. Additionally, specific domains of discrimination may confer different levels of risk for binge eating. Therefore, the current study examined the association of various forms of discrimination, including appearance-based discrimination, and binge eating in a sample of SMM. A sample of 200 SMM (analytic sample of N=187) from the greater Boston area completed self-report questionnaires assessing frequency of different forms of perceived discrimination (appearance, sexual orientation, race, etc.) and binge eating. A hierarchical binary logistic regression model was used to examine the association of different forms of discrimination with binge eating. 9% of the sample reported binge eating. Appearance-based discrimination was the most common form of discrimination (47%), and was significantly associated with binge eating, over and above all other forms of discrimination and sociodemographic variables, OR=1.71, 95% CI=[1.24, 2.35], Wald χ2 (1)=10.65, p=.001. Findings suggest that appearance-based discrimination may be related to binge eating in SMM. Clinicians may consider assessing appearance-based discrimination among SMM patients.

BackgroundPromoting adolescent physical activity is crucial as this marks a time when physical activity rates decline.PurposeThis study examined motivation for physical activity from a self-determination theory (SDT) perspective in a large sample of adolescents in the USA across three settings: in school, out of school, and on weekends.MethodsParticipants (N = 1,661) were adolescents from the National Cancer Institute’s Family Life, Activity, Sun, Health, and Eating study. Participants had a mean age of 14.47 (standard deviation = 1.61) and were 50.2% female. In this national sample balanced to match the U.S. population on several key demographics, 64.2% were non-Hispanic White. Analyses included three linear regression models in which estimated weekly minutes of moderate-to-vigorous physical activity (MVPA) in school, out of school, and on weekends were entered as dependent variables. Five forms of motivation (intrinsic, integrated, identified, introjected, and external) were entered simultaneously as independent variables. Age, body mass index, gender, and race/ethnicity were also included as covariates.ResultsAll models were significant. For MVPA in school, external regulation, introjected regulation, identified regulation, and intrinsic motivation were positively associated with MVPA. For MVPA out of school, external regulation, introjected regulation, identified regulation, integrated regulation, and intrinsic motivation were positively associated with MVPA. For MVPA on weekends, integrated regulation, and intrinsic motivation were positively associated with MVPA.ConclusionsThe relationship between motivation and MVPA varies across settings. These findings have important implications for motivating adolescents to engage in physical activity and may inform future interventions aimed at increasing physical activity.

Interventions addressing syndemics and ART adherence are needed for individuals with uncontrolled HIV and psychosocial problems. Twenty-seven participants with detectable HIV plasma viral load (PVL) or recent STI participated in an open trial of transdiagnostic adherence counseling and cognitive behavioral therapy. Outcomes were collected at baseline, 4-, and 8-months. Log PVL improved from baseline to 4-month (γ = − 1.13, 95% CI − 1.72, − 0.55, p

Individuals develop coping skills in response to body image distress; however, the degree to which body image improvements are mediated by skill acquisition is unknown. The current study assessed skills-based mediators of CBT-BISC (n = 22) versus enhanced treatment-as-usual (n = 22) for sexual minority men with HIV and body image disturbance. Skills-based mediators included avoidance, appearance fixing, and acceptance and cognitive reappraisal. Results revealed that CBT-BISC significantly reduced body image disturbance and improved coping skills. Latent difference score mediation indicated that changes in acceptance and cognitive reappraisal significantly predicted body image disturbance changes (b = -.96, p = .001). These strategies may, therefore, have a unique role in reducing body image disturbance in sexual minority men with HIV. Clinicians may wish to prioritize these strategies in CBT-BISC. Future treatment research, with methodologically rigorous mediation designs, is needed to assess mechanisms of change and consequently improve efficacy.

Prior research has established that sexual minority (SM) individuals are more likely to experience disordered body image behaviors and concerns than heterosexual individuals. This increased risk may be explained by minority stress theory - that SM individuals are subject to SM-specific stressors, leading to health disparities - but this has not yet been fully examined. Furthermore, this theory states that SM community involvement may mitigate negative outcomes. The current study examines whether minority stress is associated with screening positive for an eating disorder, screening positive for body dysmorphic disorder, and appearance- and performance-enhancing drug misuse in a sample of SM individuals (483 women and 479 men) in the US. This study also examines whether the effect of minority stress is moderated by SM community involvement. Logistic regressions were conducted for each type of minority stress (internalized homophobia, sexual orientation concealment, and heterosexist discrimination) interacting with community involvement. After correction for multiple comparisons, all minority stressors and community involvement were positively associated with increased odds of disordered body image behaviors and concerns, with no evidence of a buffering effect for community involvement. The lack of a buffering effect is contrary to minority stress theory and may inform future prevention efforts.

Sexual minority adults report heightened body image disturbances, and may be more likely to meet criteria for body dysmorphic disorder (BDD) than their heterosexual counterparts. Given the poor outcomes associated with BDD, it is important to validate measures assessing dysmorphic symptoms among this at-risk group. The Dysmorphic Concern Questionnaire (DCQ) is a seven-item self-report measure intended to assess dysmorphic symptoms. The present study investigated racial, ethnic, and gender measurement invariance properties of the DCQ in a racially and ethnically diverse sample of sexual minority adults. The current results lend initial support for use of the DCQ to potentially detect BDD symptoms among White, Black, Latino, and Asian sexual minority men and women. This may inform future studies that wish to utilize the DCQ, such as investigations of mean level differences in dysmorphic concern. These findings may have important clinical applications, given the heightened risk of appearance-related concerns among diverse sexual minority adults.

Despite its potential to improve metabolic health outcomes, longitudinal physical activity (PA) patterns and their association with cardiometabolic disease among people living with HIV (PLWH) have not been well characterized. We investigated this relationship among PLWH in the Centers for AIDS Research Network of Integrated Clinical Systems with at least one PA self-report between 2008 and 2015. The 4-item Lipid Research Clinics PA instrument was used to categorize habitual PA levels as: Very Low, Low, Moderate, or High. We analyzed demographic differences in PA patterns. Multivariable generalized estimating equation regression models were fit to assess longitudinal associations of PA with blood pressure, lipid, and glucose levels. Logistic regression modeling was used to assess the odds of being diagnosed with obesity, cardiovascular disease (CVD), cerebrovascular disease, hypertension, diabetes, or multimorbidity. A total of 40,462 unique PA assessments were provided by 11,719 participants. Only 13% of PLWH reported High PA, while 68% reported Very Low/Low PA at baseline and did not increase PA levels during the study period. Compared to those reporting High PA, participants with Very Low PA had almost 2-fold increased risk for CVD. Very Low PA was also associated with several risk factors associated with CVD, most notably elevated triglycerides (odds ratio 25.4), obesity (odds ratio 1.9), hypertension (odds ratio 1.4), and diabetes (odds ratio 2.3; all p&nbsp

Body dysmorphic disorder (BDD) is associated with severe comorbidity and impairment. Muscle dysmorphia (MD) is a subtype of BDD which has rarely been assessed outside of undergraduate student samples. Further, there are limited data comparing MD to other psychiatric disorders, including BDD. Thus, the aim of the current study is to explore differences in symptom severity and conformity to masculine norms in men diagnosed with BDD or MD. Men from the greater Boston, Massachusetts area completed a one-time assessment, which included clinician-based structured interviews and self-report questionnaires assessing MD symptom severity, BDD symptom severity, and conformity to traditional masculine norms. The sample was N = 30 men (MD: n = 15; BDD: n = 15). Statistically significant medium to large effects emerged with the MD group experiencing greater MD and BDD symptom severity, and positive attitudes towards the use of violence to solve problems. Although not reaching statistical significance, additional medium-to-large effects also emerged with the MD group reporting greater emotional restriction/suppression, heterosexual self-presentation, and desired sexual promiscuity compared to the BDD group. Findings suggest that men diagnosed with MD may experience greater MD/BDD symptom severity and endorsement of some components of ‘traditional’ masculine norms, compared to men diagnosed with BDD. Results may suggest that addressing some forms of rigid masculine norms (e.g., use of violence) in therapy could be useful in treating MD; however, additional research comparing clinical samples of men with MD and BDD are needed to guide the nosology, assessment, and treatment of MD.

Body image disturbance is a common problem reported among sexual minority men living with HIV, and is associated with poor antiretroviral therapy (ART) adherence. Recently, a novel integrated intervention (cognitive behavioral therapy for body image and self-care; CBT-BISC) was developed and pilot tested to simultaneously improve body image and ART adherence in this population. Although CBT-BISC has demonstrated preliminary efficacy in improving ART adherence, the mechanisms of change are unknown. Utilizing data from a two-armed randomized controlled trial (N = 44 sexual minority men living with HIV), comparing CBT-BISC to an enhanced treatment as usual (ETAU) condition, sequential process mediation via latent difference scores was assessed, with changes in body image disturbance entered as the mechanism between treatment condition and changes in ART adherence. Participants assigned to CBT-BISC reported statistically significant reductions in body image disturbance post-intervention, which subsequently predicted changes in ART adherence from post-intervention to long term follow-up (b = 20.01, SE = 9.11, t = 2.19, p = 0.028). One pathway in which CBT-BISC positively impacts ART adherence is through reductions in body image disturbance. Body image disturbance represents one, of likely several, mechanism that prospectively predicts ART adherence among sexual minority men living with HIV.

Objective The tripartite influence model of body image identifies internalization of societal body ideals as a risk factor for developing body dissatisfaction, and subsequent disordered eating behavior. In men, internalization of two dimensions of body image ideals, thinness and muscularity, is associated with body dissatisfaction and eating concerns. However, it is unknown how thinness and muscularity internalization interact in predicting muscle dysmorphia and disordered eating in men. Method Data were collected online from 180 undergraduate men, with ages ranging from 18 to 33 years (19.6, SD = 2.6). Regression models were used to test the interactive effects of thinness and muscularity internalization on (a) muscle dysmorphia symptoms and (b) disordered eating. Subsequent simple slope analyses probed effects at the mean, and ±1 standard deviation of thinness internalization. Results Muscularity and thinness internalization were independently positively related to muscle dysmorphia symptoms and disordered eating. Additionally, a significant interaction revealed that muscularity internalization was increasingly related to muscle dysmorphia symptoms as thinness internalization decreased. Discussion Men who internalized the muscular ideal had higher levels of muscle dysmorphia when they did not highly internalize the thin ideal. However, greater internalization of both the muscularity and thin ideal independently may be most relevant in the development of disordered eating in men. Future research is needed to explore variability in experiences of muscle dysmorphia compared with disordered eating in males.

Background Hypertension is a major public health concern, given prevalence and morbidity. Among the general population, greater religious attendance is associated with lower blood pressure (BP). However, no known studies have examined the association between religious attendance and BP among sexual minorities. Purpose To examine the association between BP/hypertension and organizational religious activity as a function of sexual orientation. Methods Data were utilized from Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health), a publicly available, U.S. nationally representative data set. Of the 4,874 individuals included in analyses, 366 participants were identified as a sexual minority. An organizational religious activity variable was created by summing responses of two separate items. BP was measured as systolic blood pressure (SBP) and diastolic blood pressure (DBP). Increasing levels of clinical severity of hypertension were also examined. Relevant covariates were controlled for in two separate models. Significant interactions between religious attendance and sexual orientation were explored in simple slope analyses. Results Overall, results indicated that sexual orientation moderated the association between organizational religious activity, and BP/hypertension. Crossover interactions were present for the dependent variables SBP, DBP, and prehypertension and higher (prehypertension, and hypertension 1 and 2). Generally, a negative association between organizational religious activity and hypertension was revealed among the heterosexual group, whereas a positive association was found among the sexual minority group. Conclusions Organizational religious activity is differentially associated with BP/hypertension among sexual minority versus heterosexual individuals. Organizational religious activity may represent a risk factor for hypertension among sexual minority individuals.

OBJECTIVE To examine the association between depressive symptoms and indoor tanning among U.S. Hispanic adolescents. METHOD Data were collected from the 2015 Youth Risk Behavior Survey (YRBS). In the current study, only Hispanic adolescents were included, which yielded a total weighted sample of 2,667 (men: N = 1,368; women: N = 1,299). Gender was also explored as a moderator in the association between depressive symptoms (sadness or hopelessness and suicidality) and indoor tanning. Logistic regressions were used, with past 12 month indoor tanning behavior (0 vs. 1 or more sessions) entered as the dependent variable. RESULTS Across gender, sadness or hopelessness was associated with increased odds of indoor tanning (OR = 1.8, 95% CI [1.2, 3.0], p = .01); however, gender significantly moderated the association between suicidality and indoor tanning. Simple slope analyses revealed that suicidality was significantly associated with increased odds of indoor tanning only among boys (OR = 4.0, 95% CI [2.1, 7.5], p = .001) whereas a nonsignificant association was found among girls (OR = 0.8, 95% CI [0.4, 1.8], p = .65). CONCLUSIONS Results suggest there is a differential relationship between suicidality and indoor tanning as function of gender among U.S. Hispanic adolescents. Skin cancer prevention programs for Hispanic youth may wish to consider the role of gender and negative affect in targeted campaigns. (PsycINFO Database Record