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Background: Compared with their cisgender heterosexual peers, youth who are Two-Spirit, lesbian, gay, bisexual, transgender, and queer and those who use other terms related to gender or sexual diversity (2SLGBTQ+) are at elevated risk for mental health difficulties and suicidality. The social experiences of 2SLGBTQ+ youth, including the impact of minority stress, access to social support, and experiences of negative social interactions, may contribute to this disparity., Data and Methods: Participants were 2,047 youth aged 15 to 24 years who responded to the 2022 Mental Health and Access to Care Survey. The 2SLGBTQ+ population was derived from youth reports of their gender, sex at birth, and sexual orientation. Two dimensions of social experiences were assessed using the Social Provisions Scale and the Negative Social Interactions Scale. Symptoms of mental health and substance use disorders were assessed via computer-assisted diagnostic interview using a modified version of the World Health Organization Composite International Diagnostic Interview (CIDI). Use of formal and informal mental health supports was self-reported by youth., Results: Results indicated significant group differences in the proportion of youth meeting criteria for any CIDI disorder, a major depressive episode, generalized anxiety disorder, and suicidal ideation in the past 12 months. For example, 56% (95% confidence interval [CI]: 49 to 63) of 2SLGBTQ+ youth met criteria for any CIDI disorder, compared with 29% (95% CI: 26 to 32) of cisgender heterosexual youth. Logistic regression models suggested that after adjusting for demographic covariates, 2SLGBTQ+ youth were at elevated risk of these mental health conditions compared with their cisgender heterosexual peers. These differences remained apparent after adjusting for social support and negative social interactions. Among those meeting criteria for any disorder, 2SLGBTQ+ youth were more likely to report receiving formal and informal mental health support., Interpretation: 2SLGBTQ+ youth are at elevated risk of several indicators of poor mental health compared with their cisgender heterosexual peers - differences which are not fully explained by their access to social support and negative social interactions. Some of the remaining differences may potentially be explained by the impact of unmeasured aspects of minority stress on 2SLGBTQ+ youth.

Background: Rates of cocaine use disorder (CUD) among men who have sex with men (MSM) are high and rising. Among MSM, cocaine use is associated with negative socioeconomic, medical, and psychological outcomes. There are no FDA-approved pharmacotherapy options to treat CUD, and psychosocial interventions demonstrate limited efficacy. While there have been numerous trials evaluating possible medications for CUD, there is a scarcity of qualitative data on the barriers and facilitators of medication-assisted treatment., Methods: Semi-structured interviews were conducted with 16 participants enrolled in a phase II randomized control trial evaluating extended-release lorcaserin among MSM with CUD. Participants were asked about their motivations for enrolling in the study, attitudes towards taking a medication for CUD, barriers and facilitators of study pill adherence, and their general study experience. Interviews were analyzed using an inductive and exploratory approach to thematic analysis., Results: Participants were highly motivated to reduce cocaine use and viewed pharmacotherapy as a viable and desirable treatment option. Pharmacotherapy was seen as having fewer access and adherence structural barriers compared to existing psychosocial therapies. Medication reminders facilitated pill taking, while side effects, travel, and active substance use presented barriers to study pill adherence. Disclosure of study participation within social networks was variable pointing to anticipated substance use and treatment stigma., Conclusions: Our study highlights important factors affecting the acceptability and uptake of medication-assisted treatment for CUD among a diverse sample of MSM. These findings can help guide the development and implementation of future pharmacotherapy options for CUD and other substance use disorders in this key population., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Institutional Review Board at the University of California, San Francisco (#17-21502). All participants provided written consent to participate. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests., (© 2024. The Author(s).)

Background: Seven million lesbian, gay, and bisexual (LGB) adults will be aged >50 years by 2030; assessing and addressing their risk for cardiovascular disease is critical., Methods and Results: We analyzed a nationwide cohort using the Veterans Health Administration data. Sexual orientation (SO) was classified via a validated natural language processing algorithm. Prevalent atherosclerotic cardiovascular disease (ASCVD) (history of acute myocardial infarction, ischemic stroke, or revascularization) was identified via International Classification of Diseases, Ninth and Tenth Revision ( ICD-9 and ICD-10 ) codes. The index date was the date of the first primary care appointment on or after October 1, 2009. We ascertained covariates and prevalent ASCVD in the year following the index date; the baseline date was 1 year after the index date. We calculated sample statistics by sex and SO and used logistic regression analyses to assess associations between SO and prevalent ASCVD. Of 1 102 193 veterans with natural language processing-defined SO data, 170 861 were classified as LGB. Prevalent ASCVD was present among 25 031 (4105 LGB). Adjusting for age, sex, race, and Hispanic ethnicity, LGB veterans had 1.24 [1.19-1.28] greater odds of prevalent ASCVD versus non-LGB identified veterans. This association remained significant upon additional adjustment for the ASCVD risk factors substance use, anxiety, and depression (odds ratio [OR],1.17 [95% CI, 1.13-1.21]). Among a subset with self-reported SO, findings were consistent (OR, 1.53 [95% CI, 1.20-1.95])., Conclusions: This is one of the first studies to examine cardiovascular risk factors and disease of the veteran population stratified by natural language processing-defined SO. Future research must explore psychological, behavioral, and physiological mechanisms that result in poorer cardiovascular health among LGB veterans.

Background and Purpose: This study aimed to develop and test a novel model integrating social-learning and self-medication frameworks by examining the association between self-efficacy to resist alcohol and other drug (AOD) use and daily AOD use and unhealthy drinking risk among trauma-exposed sexual minority women (SMW) and transgender and gender-diverse (TGD) people. We examined whether minority stressors moderated these associations., Methods: Data were from 57 trauma-exposed SMW and TGD people who participated in a 14-day daily diary study. Multilevel binary logistic models and ordinal logistic models were employed to examine associations between self-efficacy to resist AOD use and daily AOD use and unhealthy drinking risk at within- and between-person levels. We assessed same- and cross-level interactions between daily self-efficacy to resist AOD use and minority stressors in predicting AOD use and unhealthy drinking risk within the same 24-hour period (i.e., standardized as 6 pm to 6 pm; hereafter referred to as "same-day")., Results: Self-efficacy to resist AOD use was associated with lower AOD use and unhealthy drinking risk. Minority stressors were associated with daily AOD use. Among those who experienced higher (vs. lower) average sexual minority stressors over the 2-week daily diary period, higher-than-usual self-efficacy to resist AOD use was less protective in decreasing risk of same-day unhealthy drinking., Conclusions: Interventions aiming to mitigate AOD use and unhealthy drinking risk by bolstering self-efficacy to resist AOD use should consider the impact of recent cumulative exposure to sexual minority stressors in this population. Further, policy efforts are needed to reduce perpetuation of stigma., (© Society of Behavioral Medicine 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

We conducted a longitudinal randomized controlled experiment between September 2021 and May 2022 to evaluate whether anti-tobacco industry beliefs and attitudes mediate the effect of culturally tailored anti-smoking messages on quit intentions among US young adult sexual minority women (SMW) ages 18-30 who smoke. Participants were randomized to view up to a total of 20 tailored versus non-tailored messages over one month. Outcomes were assessed at baseline and one-month follow-up. We fit a structural equation model testing the effect of LGBTQ + community-tailored, anti-smoking messages on quit intentions and mediating roles of anti-industry attitudes and beliefs (n = 966). Anti-industry beliefs (indirect effect size = 0.024, 95% confidence interval [CI] = [0.040, 0.056]) and attitudes (indirect effect size = 0.034, 95% CI = [0.006, 0.077]) significantly mediated the effect of the tailored condition on quit intentions. These findings suggest that LGBTQ + -tailored cues in anti-smoking messaging may promote quit intentions indirectly through influencing young adult SMW's beliefs and attitudes about the tobacco industry. Future campaigns to promote quitting among young adult SMW who smoke should consider incorporating themes to change their beliefs and attitudes about the tobacco industry.Trial registration This study was registered in ClinicalTrials.gov (NCT04812795) on 24/03/2021., Competing Interests: Declarations Competing interests MRL has received consulting fees from Hims, Inc. (2019-present), Folx Health, Inc. (2019-2021), and Otsuka Pharmaceutical Development and Commercialization, Inc. (2023). JOM has consulted for Sage Therapeutics (2017), Ibis Reproductive Health (2017-2018, 2020-present), Hims, Incorporated (2019-present), and Folx, Incorporated (2019-present). None of these engagements influenced or are pertinent to the work described in this manuscript. All other authors do not have any competing interest to declare., (© 2024. The Author(s).)

In Brief: There are some unique aspects to providing trauma-informed reproductive care to transgender and nonbinary people, who are affected by minority stress, stigma, and particular forms of trauma; we review the evidence and suggest strategies for the provision of trauma-informed reproductive care to gender minorities., Abstract: Stigma and minority stress affect the health of transgender and nonbinary (TGNB) people, leading to disparities across a range of outcomes. Barriers to accessing care, including reproductive care, further complicate these health disparities. Interpersonal stigma within the healthcare system, and high rates of physical and sexual violence survivorship, make TGNB people particularly vulnerable to healthcare trauma and poor care. This is particularly true among TGNB people with multiple intersecting marginalized identities. Trauma-informed care provides a framework for medical practitioners to provide safe, holistic, and sensitive care. Scant academic literature discusses trauma-informed reproductive care for TGNB individuals. We present a narrative review of the evidence for trauma-informed reproductive care for TGNB people and suggest potential application and implementation.

Background: The well-being of LGBTQ + medical students can be influenced by religiosity, family support, and the disclosure of their gender identity or sexual orientation. These factors have frequently been overlooked and warrant further consideration in creating a supportive environment for all students., Methods: This multicenter study investigated two main outcomes including the differences in religiosity and perceived family support between LGBTQ + and non-LGBTQ + medical students in Thailand, and the gender disclosure to family among LGBTQ + medical students. It was conducted among students from five medical schools across Thailand, using online questionnaires during the academic year 2021-2022. Data were collected on demographic characteristics, religiosity, gender identity/sexual orientation disclosure to family, and perceived family support. Comparisons between groups were conducted using chi-square test and Wilcoxon rank-sum test., Results: Of the 1,322 participants, 31.2% identified themselves as LGBTQ+, among whom 81.8% were Buddhists. The proportion of non-religious LGBTQ + students was significantly higher (vs. non-LGBTQ+; 15.0% vs. 8.4%, respectively; p = 0.001). However, there was no statistical difference in religiosity between LGBTQ + and non-LGBTQ + students as well as between LGBTQ + subgroups. Although, 74% of LGBTQ + students reported good family support, significantly more LGBTQ + students perceived poor family support (vs. non-LGBTQ+, 7.0% vs. 4.7%; p = 0.002). Regarding the disclosure of gender identity or sexual orientation to the family, the majority of LGBTQ + individuals indicated either a non-disclosure or uncertainty. There were significant associations between perceived family support and the likelihood of disclosing one's identity to family members, as better perceived support was associated with higher disclosure rates., Conclusions: No statistically significant difference in religiosity was found between LGBTQ + and non-LGBTQ + students. The majority of LGBTQ + medical students reported receiving good family support; however, among those who perceived their family's support to be lacking, there was a greater tendency to conceal their gender identity from their families. For future studies, it is crucial to investigate whether this concealment extends to other spheres of their lives and to assess the potential impact on their well-being, including mental health and quality of life., Competing Interests: Declarations Ethical approval and consent to participate This study was approved by Institutional Review Boards at each site: Mahidol University (167/2022), Chulalongkorn University (0006/2022), Khon Kaen University (HE651083), Prince of Songkla University (65-085-3-1), and Chiang Mai University (PSY-2565-08832). Informed consent to participate in the study was obtained from all participants. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Conflict of interest The authors report no conflicts of interest with respect to the research, authorship, or publication of this article., (© 2024. The Author(s).)

Background: Men who have sex with men studying in universities (MSM-US) frequently face multiple sexual minority stressors that potentially lead to maladaptive emotional regulations and mental problems. This study compared the prevalence of depression/insomnia between MSM-US and non-MSM male university students (NUS) and hypothesized that the potential differences would be mediated via emotional dysregulation styles (rumination and catastrophizing)., Methods: The study design was a cross-sectional study. NUS were recruited from a university-based survey using cluster sampling in three universities in China from June to October 2018, while MSM-US from the same university-based survey and the other community-based survey using convenience sampling. The effective samples size was 2,531 (292 MSM-US and 2,239 NUS). Structural equation modeling (SEM) was performed., Results: MSM-US had significantly higher prevalence of both probable depression (55.1% versus 35.7%; OR = 4.85, 95% CI: 3.38-6.94) and moderate-to-severe clinical insomnia (17.3% versus 4.1%; OR = 2.21, 95% CI: 1.73-2.83) than NUS. MSM-US were also more likely than NUS to use emotional dysregulation styles (rumination/catastrophizing), which were correlated with probable depression/insomnia (r = 0.17 to 0.31). In the SEM, the differences in depression/insomnia between MSM-US and NUS were partially mediated by the latent variable of emotional dysregulation (rumination and catastrophizing), with effect sizes of 55.0% for probable depression and 33.6% for insomnia, respectively., Conclusions: Depression and insomnia were prevalent among male university students in Sichuan, China. Furthermore, MSM-US were at increased risk than NUS for both mental problems; emotional dysregulation partially explained such differences. Future studies are warranted to confirm the findings, develop tailored interventions to address general and MSM-specific stressors and reduce rumination and catastrophizing, and examine whether similar patterns exist in other sexual minority groups., Competing Interests: Declarations Ethical approval and consent to participate The study was approved by the Survey and Behavioral Research Ethics Committee of the Chinese University of Hong Kong (No. SBRE-21-0635). All participants provided informed consent. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: In May 2022, a global surge in mpox cases, typically endemic to Western and Central Africa, particularly affected gay, bisexual, and other men who have sex with men (gbMSM). This study examines gbMSM communities' experiences and perceptions around Ireland's public health response to the outbreak., Methods: A cross-sectional mixed-methods online survey was conducted. Qualitative data were analysed using reflexive thematic analysis informed by critical realism., Findings: A total of 163 gay and bisexual men took part in the survey. Participants accessed information from diverse sources, reporting varying levels of trustworthiness. Overall, participants were well-informed. Four themes were developed from the qualitative data: (1) Perceptions of the mpox response: divergence in urgency, priority, and care; (2) The mpox outbreak as a sign of otherness for gbMSM; (3) The potential for othering through mpox prevention practices; and (4) mpox, memory and fear., Discussion: While community-led initiatives were effective, significant challenges included stigmatisation, discrimination, and mistrust towards public health institutions, influenced by institutionalised homophobia. The study underscores the need for inclusive, culturally sensitive, and transparent public health strategies., Conclusion: The mpox outbreak highlights the importance of robust community collaboration in public health interventions. Future strategies must ensure equitable access to information, vaccination, and care, and address broader structural inequalities to foster trust and engagement within affected communities., Competing Interests: The authors have declared that no competing interests exist, (Copyright: © 2024 Gilmore et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Studies show that tobacco use among sexual and gender minority (SGM) populations is disproportionately higher than heterosexual or cisgender populations. However, few studies have examined tobacco use among SGM subgroups by race/ethnicity or associations between SGM-specific discrimination and connection to SGM identity and tobacco use., Methods: This study analysed survey data from 11 313 SGM (gay, lesbian, bisexual, other sexual minority or gender minority) young adults in the USA and reported current cigarette, e-cigarette, other tobacco (cigar, smokeless tobacco, hookah) and polytobacco use. We used multinomial logistic regression to estimate associations between (a) SGM subgroup, race/ethnicity, SGM-specific discrimination and SGM identity connection and (b) each tobacco use outcome (vs never use of tobacco). We conducted postestimation testing to assess predicted probabilities of tobacco use against the sample average., Results: Lesbian females (particularly black lesbian females) had higher-than-average probability of polytobacco use. White bisexual and lesbian participants had higher-than-average probability of cigarette and e-cigarette use, respectively. Higher levels of discrimination were associated with polytobacco use. Higher levels of identity connectedness were protective against certain tobacco use behaviours among gender minority participants and participants with high levels of discrimination experience., Conclusions: We found variations in tobacco use by SGM subgroups overall and by race/ethnicity. Discrimination may be a risk factor for certain tobacco use behaviours. However, SGM identity connectedness may be protective against tobacco use among gender minority individuals and individuals experiencing SGM-specific discrimination. These findings can inform targeted approaches to reach SGM subgroups at greater risk of tobacco use., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To summarise the research literature on the impacts or perceptions of policies to end tobacco use at a population level (ie, tobacco endgame policies) among people from eight priority population groups (experiencing mental illness, substance use disorders, HIV, homelessness, unemployment or low incomes, who identify as lesbian, gay, bisexual, transgender, queer or intersex (LGBTQI+) or who have experienced incarceration)., Methods: Guided by JBI Scoping Review Methodology, we searched six databases for original research examining the impacts or perceptions of 12 tobacco endgame policies among eight priority populations published since 2000. We report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist., Results: Of the 18 included studies, one described perceptions of five endgame policies among people on low incomes in Aotearoa (New Zealand), and 17 focused on the effectiveness or impacts of a very low nicotine content (VLNC) cigarette standard among people experiencing mental illness (n=14), substance use disorders (n=8), low incomes (n=6), unemployment (n=1) or who identify as LGBTQI+ (n=1) in the USA. These studies provide evidence that VLNC cigarettes can reduce tobacco smoking, cigarette cravings, nicotine withdrawal and nicotine dependence among these populations., Conclusions: Most of the tobacco endgame literature related to these priority populations focuses on VLNC cigarettes. Identified research gaps include the effectiveness of endgame policies for reducing smoking, impacts (both expected and unexpected) and policy perceptions among these priority populations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Drawing on interviews with 31 2SLGBTQ+ people labeled with developmental and/or intellectual disabilities, this exploratory study focuses on participants' experiences navigating mainstream queer social spaces. The current study is an explorative qualitative view at the intersection of the 2SLGBTQ+ and disability community. There is a call for more inclusive spaces for people with disabilities within queer social areas. Although queer spaces attempt to be free and inclusive, many have inaccessible activities and locations. The findings depict that individuals with lived experiences are not often represented in the 2SLGBTQ+ community due to a lack of inclusion. Participants highlighted feelings of rejection as people with disabilities were not represented in many 2SLGBTQ+ focused groups or organizations. The current paper calls attention to creating more inclusive intersectional spaces to promote inclusivity and ensure people with disabilities have the opportunity to contribute through an active role in the 2SLGBTQ+ community.

Despite the growing recognition of their harmful effects, sexual orientation change efforts (SOCE) continue to be practiced in various societies. This study examines the experiences of 11 sexual minority individuals in Hong Kong who have undergone SOCE. The findings reveal the pervasive influence of deeply ingrained homonegativity values within religious, family, educational, and soiocultural contexts during LGBTQ+ individuals' formative years. These prevailing stigmas compelled them to pursue SOCE through different methods. However, these methods have been proven ineffective and psychologically harmful, leading to increased distress and internalized homonegativity. The availability of knowledge and access to affirming LGBTQ+ values within religious, community, and sociocultural spheres played a crucial role in helping the respondents come to accept their sexual orientation and cease their attempts at SOCE. This study shed light on how the interplay of Chinese familial values and Christian doctrine in Hong Kong contributes to the promotion of homonegativity, consequently restricting the diverse expressions of sexuality. It is important to recognize that the notion of individuals actively "choosing" to undergo SOCE is misguided, as these decisions are often driven by social stigma and external pressures. Progress in this area requires confronting the systemic heteronormativity embedded within Hong Kong's cultural fabric.

The term "gay community" has been criticized for its inability to explain the pluralities in a specific cultural and political context. Based on in-depth interviews with 63 non-heterosexual males in Bulgaria, this study aims to revisit the theories of gay communities in a non-Western, post-communist context. The data from this study suggest that (1) the idea of a "gay community" is often rejected due to anti-communist notions and explicit engagement with individualism as anti-communitarianism; (2) belonging to a gay community is subjective, and initial verbal detachment from gay communities does not indicate a lack of factual belonging to such communities; (3) the concepts of "personal communities" and "family of choice" remain relatively irrelevant in the Bulgarian context; (4) the most significant factor for attachment to a gay community is the notion of "gay culture" and "gay scene"; (5) recent forms of "sexual attachments" have led to a certain political involvement; and (6) the "anti-gender campaigns" have revitalized the importance of gay communities and have brought an increasing number of respondents to certain involvement in gay communities and networks, challenging the theories of "post-gay" societies.

Tourism plays a key role for gay people, as it is not only a way to escape from work, but also a source of liberation and self-embracement. This role can be particularly valued in societies and political environments that are perceived as hostile toward this group. The present study examines the travel motivations and habits of gay and lesbian people, based on a questionnaire sample of 1473 respondents. The results show that for this group, but especially for women, acceptance and an open culture are of paramount importance when choosing a destination. In contrast, services and events specifically targeted at this sector, which are popular in the Western world, do not typically influence decision-making (they tend to be more attractive to women). Sex per se is not a travel motivator for this group, but is an important feature of travel for men. In addition to gender, the services and activities that an individual engages in while traveling are influenced by the degree of their sexual embracement, the place of residence and the company with which the individual travels.

Sexual and gender minority (SGM) youth are at risk for adverse health outcomes because of stigma and discrimination exposure. Individuals' beliefs about the biological origin of SGM identity are linked to their negative attitudes and biases against SGM populations, which can also apply to pediatric healthcare providers. The current study outlines validation of the Etiology Beliefs about Sexual and Gender Minority Youth (EB-SGM) scale, a 12-item measure designed to assess adults' beliefs about youths' biological versus environmental SGM etiology. College students ( N  = 285; study 1), community adults ( N  = 258; study 2), and pediatric providers ( N  = 104; study 3) completed the EB-SGM and other self-report measures. Exploratory factor analysis (EFA) in study 1 revealed a three-factor structure: beliefs about gender nonconforming behavior, beliefs about gender identity, and beliefs about sexual attraction/behavior. Confirmatory factor analysis (CFA) in study 2 suggested a bi-factor structure, which was replicated in study 3. The EB-SGM demonstrated adequate concurrent and discriminant validity. We also examined bivariate correlations between etiology beliefs and sociodemographic characteristics across samples. Findings indicate that EB-SGM is a psychometrically sound instrument to measure adults' etiology beliefs. The EB-SGM has the potential to be used as a screening measure to enhance pediatric healthcare providers' SGM training.

Intergroup contact is important to reduce prejudice toward sexual minorities. Yet little is known regarding how kindergarten teachers' contact experiences with sexual minority affect their attitudes toward sexual minorities and their beliefs regarding same-sex family parents' parenting skills and same-sex family children's adjustment. This cross-sectional study recruited kindergarten teachers ( n  = 261; mean age = 38.8 years) in Taiwan in 2021-2022. A self-reported online questionnaire was administered which included questions about quantity and quality of contact experiences with lesbians, gay men (LG) and same-sex families, attitudes toward same-sex families, beliefs regarding same-sex parenting skills, and children's adjustment. Hierarchical multiple regression was used for analysis. The results showed that higher quality of contact with LG was associated with lower prejudice toward LG and with a more positive belief regarding same-sex parents' parenting skills and children's adjustment in same-sex families. The contact experience with same-sex families has an association with positive beliefs regarding same-sex family parents and children. After adjustment of quality of contact, quantity of contact did not show association with attitude toward LG or beliefs regarding same-sex family parents and children. The findings suggest that the quality of contact experience with LG is an important factor to reduce the stereotype against same-sex families.

The representation of gays and lesbians on Chilean television has increased steadily over the last decades. This paper offers an analysis of the role these images had in the processes of sexual identification of a sample of 25 members of the audience who identify as gays or lesbians. Through a thematic analysis of semi-structured interviews, it is shown that the respondents believed that the televisual representations of homosexuality have contributed to further marginalize gay and lesbian lives. This strengthened damaging feelings that fed into a sense of shame that was originating from multiple institutions and texts, thus complicating their processes of self-recognition and self-acceptance during their childhood and adolescence. Taking examples of how participants described their relationship with these representations and the ways in which they circulated socially, it is argued that they could only articulate their identification as gays or lesbians by disassociating themselves from these images and establishing a clear difference in regard to them. This was in a process in which several other informational and experiential opportunities came into play, which allowed them to resignify the categories gay/lesbian and lead less conflictive processes of identification.

This study explored the impact of COVID-related concerns and other characteristics on alcohol and marijuana use among sexual minority women (SMW). Survey data from a racially/ethnically diverse sample of 338 SMW participants in the Chicago Health and Life Experiences of Women (CHLEW) study were used to examine correlates of three substance use outcomes: frequent intoxication (once a month or more), perceived increase in alcohol use, and perceived increase in marijuana use. Coping motives for alcohol use was positively associated with each of the substance use outcomes. Belief that peers (in terms of age, sexual identity, and gender) used alcohol often to cope was associated with higher odds of frequent intoxication. COVID-19 related financial concerns were positively associated with both frequent intoxication and increased marijuana use. Health and mental health concerns were associated with lower odds of frequent intoxication. Findings underscore the importance of enhancing coping skills, addressing perceived peer coping norms, and providing both economic and social support in intervention efforts.

Queer individuals experience unique stressors related to their minority status, negatively impacting their mental health. One factor contributing to these disparities is exposure to minority stress, which involves social stressors related to minority status. Previous research has focused on the negative impacts of minority stress, with less attention to its impact on positive psychological functioning. This study explored the relationship between minority stress and psychological well-being among 270 queer individuals in German-speaking countries. Participants completed an online survey assessing minority stress and psychological well-being. Analyses of Covariance indicated that proximal factors of minority stress-such as self-stigma, concealment, and expectations of rejection-had a particularly negative impact on psychological well-being, but no effects could be found for gender and sexual orientation. Additionally, gender identity but not sexual orientation had a significant effect on minority stress, with non-binary and other gender identities reporting higher minority stress compared to females. Thematic analysis revealed concerns about survey inclusivity, gender identity challenges, and intersectionality of minority identities. Our findings emphasize the significant impact of minority stress on the psychological well-being of queer individuals, particularly non-binary people and those with diverse gender identities, while demonstrating the need for inclusive research methodologies, tailored interventions, and policies addressing the diverse experiences within the queer community., (© 2024. The Author(s).)

Purpose: This study aims to examine attitudes toward LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning, and more) physicians among Thai psychiatric patients and to identify associated factors across three regions of Thailand., Patients and Methods: A cross-sectional survey was conducted from June to August 2023 in Central, Northern, and Southern Thailand. The Attitudes Toward LGBTQ+ Physician Questionnaire and a patient-doctor relationship questionnaire were utilized. Data analysis involved descriptive statistics and linear regression., Results: The study included 543 participants with a median age of 37 years (IQR 26-52), predominantly female (68.9%) and Buddhist (78.1%). The median score for perceived attitudes toward LGBTQ+ physicians was 86 (IQR 73.0-95.5), with significant regional variations. Most participants perceived LGBTQ+ physicians as normal (85.5%) and integral to society (94.5%). A significant portion disagreed with the idea that being an LGBTQ+ physician was sinful (85.3%) or immoral (84.0%). However, 20.3% expressed discomfort with the possibility of LGBTQ+ physicians conducting private physical examinations. Lower perceived attitudes were associated with older age and being Muslim. Conversely, higher education, female gender, having LGBTQ+ connections, and a reported gender non-conformity showed a correlation with more positive attitudes., Conclusion: Thai psychiatric patients generally hold positive attitudes toward LGBTQ+ physicians, though demographic factors influence these attitudes. There needs to be a particular focus on improving attitudes regarding conducting private physical examinations to maximize patient comfort and trust., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Pitanupong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Importance: Few studies have explored the association between sexual and gender minority (SGM) status and occupational well-being among health care workers., Objectives: To assess the prevalence of burnout, professional fulfillment, intent to leave, anxiety, and depression by self-reported SGM status., Design, Setting, and Participants: This cross-sectional survey study collected data from October 2019 to July 2021, from 8 academic medical institutions participating in the Healthcare Professional Well-Being Academic Consortium. The survey, including questions on SGM status, was administered to attending physicians and trainees. Statistical analyses were performed from June 1, 2023, to February 29, 2024., Exposure: SGM status was determined via self-reported sexual orientation and gender identity., Main Outcomes and Measures: Primary outcomes measured were the Professional Fulfillment Index (burnout and professional fulfillment), intent to leave, and self-reported anxiety and depression using the Patient-Reported Outcomes Measurement Information System short-form 4-item measure., Results: Of 20 541 attendings and 6900 trainees, 8376 attendings and 2564 trainees responded and provided SGM status. Of these respondents, 386 attendings (4.6%) and 212 trainees (8.3%) identified as SGM. Compared with their non-SGM peers, SGM attendings had a lower prevalence of professional fulfillment (133 of 386 [34.5%] vs 3200 of 7922 [40.4%]) and a higher prevalence of burnout (181 of 382 [47.4%] vs 2791 of 7883 [35.4%]) and intent to leave (125 of 376 [33.2%] vs 2433 of 7873 [30.9%]) (all P < .001). Compared with their non-SGM peers, SGM trainees had a lower prevalence of professional fulfillment (63 of 211 [29.9%] vs 833 of 2333 [35.7%]) and a higher prevalence of burnout (108 of 211 [51.2%] vs 954 of 2332 [40.9%]) (both P < .001). After adjusting for age and race and ethnicity, SGM attendings had higher odds of burnout than their non-SGM peers (adjusted odds ratio, 1.57 [95% CI, 1.27-1.94]; P < .001). Results for burnout were similar among the SGM trainees compared with their non-SGM peers (adjusted odds ratio, 1.47 [1.10-1.96]; P = .01)., Conclusions and Relevance: In this cross-sectional survey study of academic physicians and trainees, SGM attendings and trainees had higher levels of burnout and lower levels of professional fulfillment. SGM attendings had greater intent to leave than their non-SGM peers, but trainees did not. These disparities represent an opportunity for further exploration to retain SGM health care workers.

Aims: The aim of this 4-year follow-up study was to examine the predictive effects of demographics, three types of sexual stigma, three types of self-identity confusion, anxiety, depression, family support and problematic Internet use before the coronavirus disease 2019 (COVID-19) pandemic on new-onset suicide risk and persistent suicide risk in young adult lesbian, gay and bisexual individuals who experienced the COVID-19 pandemic in Taiwan., Methods: Baseline data were collected from 1,000 lesbian, gay and bisexual individuals in 2018 and 2019. Outcome data on suicide risk were collected again in 2023. The suicide module of the Mini International Neuropsychiatric Interview was used to assess suicide risk in terms of thoughts of death, desire to self-harm, thoughts of suicide, plans for suicide and suicide attempts in the preceding month at the initial and follow-up assessments. Baseline three types of sexual stigma, self-identity disturbance, depression, anxiety and problematic Internet use were used to examine their prediction of new-onset suicide risk and persistent suicide risk at follow-up., Results: In total, 673 individuals participated in the follow-up survey. Notably, 16.5% of the participants who had no suicide risk at baseline had new-onset suicide risk at follow-up; 46.4% of the participants who had suicide risk at baseline also had suicide risk at follow-up. Participants who were transgender ( p  = .003), who perceived greater levels of microaggression ( p  < .001), and who had greater levels of problematic Internet use at baseline ( p  = .024) were more likely to have new-onset suicide risk at follow-up. Participants who had greater levels of self-identity confusion were more likely to have persistent suicide risk at follow-up ( p  = .023)., Conclusion: Intervention strategies for reducing suicide risk in lesbian, gay and bisexual individuals should be developed with consideration of the predictors identified in this study.

Importance: Food insecurity is associated with numerous adverse health outcomes. Little is known about the prevalence of and risks for food insecurity among veterans identifying as lesbian, gay, bisexual, queer, and similar (LGBQ+), a population facing unique social barriers and medical comorbidities., Objective: To examine food insecurity and potential risk factors among LGBQ+ veterans., Design, Setting, and Participants: This retrospective, cross-sectional study used administrative data from all US Veterans Health Administration (VHA) facilities nationally. Participants included veterans screened for food insecurity between March 1, 2021, and August 31, 2023., Exposure: Positive response to food insecurity screening administered in VHA facilities as part of routine clinical care., Main Outcomes and Measures: Prevalence of and sociodemographic, clinical, and psychosocial factors associated with food insecurity among veterans identifying as LGBQ+ or heterosexual and those with "don't know" responses regarding their sexual orientation., Results: Of 3 580 148 veterans screened, the mean (SD) age was 61.6 (0.4) years; 3 192 507 (89.2%) were assigned male sex at birth. A total of 83 292 veterans (2.3%) identified as LGBQ+, and 10 183 (0.3%) had "don't know" responses. LGBQ+ veterans (5352 [6.4%]) and veterans with "don't know" responses (635 [6.2%]) were more than twice as likely as heterosexual veterans (90 426 [2.6%]) to have positive screen results for food insecurity. While risk factors for food insecurity were similar for veterans across sexual orientation groups, LGBQ+ veterans had higher rates of several risk factors compared with heterosexual veterans, including age younger than 45 years (45.3% vs 19.5%), female sex assigned at birth (44.1% vs 10.0%), being in a minoritized racial or ethnic group (34.7% vs 29.8%), unmarried or unpartnered status (69.1% vs 39.7%), low income (16.4% vs 14.9%), homelessness or housing instability (10.3% vs 5.4%), anxiety (7.7% vs 4.3%), depression (31.1% vs 19.3%), suicidality (3.6% vs 1.4%), posttraumatic stress disorder (42.2% vs 30.2%), substance use disorder (13.1% vs 9.0%), military sexual trauma (24.0% vs 5.4%), and recent intimate partner violence (2.6% vs 1.4%)., Conclusions and Relevance: In this cohort study of veterans screened for food insecurity, LGBQ+ veterans and those with "don't know" responses for sexual orientation experienced food insecurity at nearly 2.5 times the rate of heterosexual veterans. While risk factors for food insecurity were similar across groups, LGBQ+ veterans faced a higher prevalence of particular risks, including homelessness and several mental health and trauma-related comorbidities. Future work should examine targeted screening and interventions tailored to identifying and addressing food insecurity in this population, given their increased vulnerability and burden of food insecurity.

Background Pre-exposure prophylaxis (PrEP) use has been attributed to heightened rates of sexually transmitted infections (STIs), ostensibly due to increased condomless anal sex (CAS) and greater frequency of STI testing. Few qualitative studies have assessed how gay, bisexual and queer men (GBQM) who use PrEP perceive STIs and how these attitudes have evolved post-PrEP uptake. We investigated the perspectives of current and former PrEP users on STIs. Methods Annual, in-depth longitudinal interviews were conducted with 38 current and former PrEP users in Ontario (n =18) and British Columbia (n =20), Canada, as part of a mixed-methods implementation science study (2020-2022). Over 3years, 109 interviews were conducted. Data analysis included reflexive thematic coding and longitudinal recurrent cross-sectional analysis using NVivo 12. Results Four STI-related themes emerged: (1) lack of STI-related concerns due to treatment and prevention optimism, (2) stigma-related concerns, (3) perceived risk among other PrEP users due to increased CAS, and (4) inconsistent testing concerns among non-PrEP users. Over time, some STI-related anxieties decreased with increased knowledge and reduced stigma. However, concerns persisted for other participants due to perceived risky sexual behaviours among other PrEP users and non-PrEP users. Both current and former PrEP users who expressed STI-related apprehensions consistently indicated adopting risk-reduction strategies, including condom use and having fewer sexual partners throughout the study. Conclusions Findings show how varied STI perceptions and experiences among current and former PrEP users shaped sexual decision-making over time. Providers, public health experts, and policymakers should develop a more comprehensive strategy to address STI concerns among GBQM.

LGBTQ+ people and communities continue to survive and thrive within the context of complex and unrelenting personal, structural, and collective trauma. Psychological research has examined this adaptive capacity through frameworks of resilience and posttraumatic growth. Through multidisciplinary engagement, we have identified limitations of these frameworks when they are applied to LGBTQ+ communities. In the first half of this article, we reconceptualize resilience and posttraumatic growth as queer thriving and offer the Möbius strip as a metaphor to challenge and expand normative ideas around direction, trajectory, timeline, and outcomes of positive change through adversity. In the second half of this article, we explore pathways to queer thriving within an LGBTQ+ intergenerational community project-an ethnographic experiment-that we have cofacilitated since 2019. We view generational divisions in LGBTQ+ communities as both a reflection and a form of trauma. In our ethnographic experiment, LGBTQ+ younger and older adults have the rare opportunity to heal this division by coming together for storytelling, dialogue, and artmaking around themes and issues important to their lives. In this article, we present three ethnographic vignettes that powerfully illustrate the potential for queer thriving through intergenerational social connection. We conclude by emphasizing the importance of mixed-disciplinary, community-engaged, and descriptive approaches to examining resilience and posttraumatic growth within marginalized communities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Despite experiencing disproportionately high rates of trauma exposure and traumatic stress, sexual and gender minority populations are underrepresented in research on posttraumatic growth (PTG). Data from two waves of semistructured life review phenomenological interviews with 14 sexual minority women and nonbinary individuals were analyzed to explore sexual minority women and nonbinary individuals' lived experiences of growth and healing from exposure to traumatic events. Three main themes were identified: (1) healing through interpersonal connection; (2) new learning about the self and relationships; and (3) healing as political. The first theme describes the central role of interpersonal connection; whereas some participants described seeking and receiving social support from others, most discussed the value of healing with others. The second theme characterizes new learning following trauma, such as learning that, in healthy and safe relationships, one can be loved for who they are. The third theme encompasses how participants politicized their PTG and that even the process of politicizing the traumatic experience itself facilitated growth, as participants understood their struggle as connected to larger systems of oppression, contributing to further identity development. Our findings suggest that sexual minority women and nonbinary individuals experience PTG as a political, iteratively individual and relational process of queer worldmaking (Berlant & Warner, 1998). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objectives: There are no statewide statistics regarding the health of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) Alabamians. To fill this gap, we used data collected by the Southern Equality Research and Policy Center to compare Alabama with other southern US states regarding the health and well-being of LGBTQ+ people., Methods: We tested for unadjusted differences between Alabama and other southern states using χ 2 tests for dichotomous outcomes and the Wilcoxon rank-sum test for ordinal outcomes. Multivariate logistic models predicted dichotomous outcomes from an Alabama indicator, a continuous rurality variable, and a racial and ethnic minority indicator to control for differences in rurality and racial and ethnic composition; multivariate linear regression was used to approximate the point estimate of adjusted differences., Results: Alabama and other southern states had statistically similar and high levels of abuse, harassment, and poor mental and physical health. Alabamians lived in ZIP codes with somewhat higher rural-urban commuting area code rurality scores (AL 1.76; South 1.70; P = 0.036, where 1 is the most urban category). More than one-fourth of Alabama respondents reported experiencing self-harming behaviors; one-third reported suicidal ideation (33.1%); more than half reported anxiety disorders (57.6%); more than two-thirds reported being depressed (69.2%); and 25% to 75% experienced or feared emotional and physical abuse because of their identity. Multivariate adjusted results were generally similar to unadjusted results., Conclusions: Alabama LGBTQ+ populations, who live in more rural settings than in most prior studies, experience markedly poor outcomes.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) cancer survivors disproportionately experience physical and mental health comorbidities compared with their heterosexual and cisgender counterparts. A recent study by Waters and colleagues evaluates associations between LGBTQ+ identity and physical and mental health comorbidities and activity limitations using Behavioral Risk Factor Surveillance System data. Consistent with previous work, their findings suggest that LGBTQ+ survivors have higher odds of several chronic conditions, including asthma, depressive disorders, heart attacks, kidney disease, stroke, and diabetes, as well as reporting disabilities related to vision and cognition and difficulty with activities of daily living, including walking, dressing, and running errands. Waters and colleagues expand on previous work by providing estimates separately for sexual orientation and gender identity. Their results for lesbian, gay, and bisexual survivors were similar to those for LGBTQ+ survivors overall. In novel findings, they report much stronger associations between identifying as transgender or gender nonconforming and nearly all comorbidities compared with cisgender survivors, including those who identify as lesbian, gay, or bisexual. This commentary advocates for the importance of future work considering the drivers of disparities in cancer outcomes based on sexual orientation and gender identity. See related article by Waters et al., p. 1405., (©2024 American Association for Cancer Research.)

We conducted a multilevel meta-analysis of 390 effect sizes from 167 studies with 157,923 participants examining the relationship between connectedness with lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) communities and health-related outcomes, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We conducted our initial search in January 2023 in APA PsycInfo, ERIC, Medline, and Open Dissertations, selecting studies that (a) measured LGBTQ+ community connectedness, (b) measured health, and (c) provided an estimate of the relationship between LGBTQ+ community connectedness and health. We found that connectedness with LGBTQ+ communities promotes mental health (r = .11), well-being (r = .17), and physical health (r = .09). Conversely, we found that connectedness with LGBTQ+ communities promotes substance use among younger participants, likely through behavioral engagement with LGBTQ+ others. We found that connectedness with LGBTQ+ communities was related to less mental health and more suicidality for younger people, likely because younger LGBTQ+ people seek out connectedness in response to this psychological distress. We also found that connectedness was not as health-promoting for LGBTQ+ individuals with multiple marginalized identities and that psychological feelings of belongingness with LGBTQ+ communities are generally more health-promoting than behavioral community engagement. Results from a narrative review and moderation meta-analyses suggested that, contrary to predictions made by minority stress theory, connectedness with LGBTQ+ communities does not buffer the relationship between minority stressors and health. Rather, meta-analytic mediation analyses suggested that proximal minority stressors negatively impact health-related outcomes by reducing connectedness with LGBTQ+ communities and that distal minority stressors are often less impactful on health-related outcomes because they promote connectedness with LGBTQ+ communities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Sexual and gender minority (SGM) individuals experience significantly higher levels of depression, anxiety, and behavioral comorbidities (i.e., substance use, suicide) compared to heterosexual and cisgender individuals. LGBTQ-affirmative psychotherapy aims to ameliorate the adverse psychosocial processes, ultimately caused by stigma, that underlie this disparity. Over the past two decades, the mental health field has introduced professional guidelines and treatment protocols for LGBTQ-affirmative psychotherapy, and established their efficacy across distinct SGM populations, delivery modalities, and settings. This state of the science review outlines the history, current evidence, and future directions of LGBTQ-affirmative psychotherapy. It provides an historical account of clinically relevant research for SGM populations and outlines the factors that moved the field from pathologizing perspectives to affirmative approaches. It then discusses the current evidence for LGBTQ-affirmative psychotherapy, as well as studies identifying treatment moderators, including race/ethnicity and stigma exposure, as well as potential treatment mechanisms, including hypervigilance, shame, negative self-schemas, unassertiveness, and emotion dysregulation. SGM individuals can only benefit from LGBTQ-affirmative psychotherapy if protocols are widely available and used by therapists. To this end, the article presents current findings on implementation and dissemination, such as therapist training, and different treatment delivery modalities. Finally, the article outlines an agenda for future research to advance the field of LGBTQ-affirmative psychotherapy, including identifying treatment mechanisms, successfully implementing and disseminating treatment protocols, determining which contexts and client characteristics warrant adaptations to current protocols, and understanding how LGBTQ-affirmative psychotherapy can interact with structural and systemic conditions to exert the strongest possible impact on SGM mental health., (Copyright © 2024 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved.)

Background: Studies have posited that substance use is associated with, or contributes to, homelessness for 2S/LGBTQ+ youth. However, interconnections between these issues are poorly articulated., Methods: This community-based photovoice study describes the narratives used by 2S/LGBTQ+ youth about how substance use featured in their pathways to homelessness. Employing constructionist narrative analysis, two storylines were inductively derived from participant-produced photographs and photovoice interviews with 32 2S/LGBTQ+ youth in Vancouver, Canada., Results: Taking refuge narratives centered on 2S/LGBTQ+ youths' use of substances to cope with intersecting hardships and minority stressors they had faced growing up, and when transitioning to homelessness. From playing into precarity narratives focused on the shifting possibilities and tensions of what sexualized crystal methamphetamine use can surface for 2S/LGBTQ+ youth in terms of facilitating connection and release and simultaneously invoking discomforts, including eviction from their family home., Conclusions: These narratives can usefully be anticipated and recognized to better understand and address the social contexts in which 2S/LGBTQ+ youth experience substance use and associated harms, especially homelessness. They affirm the need for tailored supports for 2S/LGBTQ+ youth who use drugs in the lead-up to and after becoming homeless, including the provision of care that better recognizes youths' pursuits of becoming and belonging in the context of marginalization, and that takes a harm reduction approach to addressing the role of substance use in these pursuits., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: In Kazakhstan, the HIV epidemic has a significant impact on marginalized groups such as gay, bisexual and other men who have sex with men (GBMSM), exacerbated by homophobic attitudes (in society) and (resulting) minority stress. This stress often leads to coping behaviors such as chemsex - the use of synthetic stimulants to enhance sexual experiences. Our study explores the motivations and perceived risks associated with chemsex among GBMSM in Almaty., Methods: We conducted semi-structured in-depth interviews with 21 chemsex participants self-identified as GBMSM in Almaty, Kazakhstan. Participants were recruited through community-based organizations to ensure a diverse sample in terms of age and ethnicity. Thematic analysis was used to identify key themes related to motivations and risks., Results: Participants practiced chemsex to seek liberation from societal norms and personal inhibitions, increase sexual pleasure, and escape daily stressors. Chemsex sessions provided intensified sexual experiences, emotional comfort, and social connections, challenging constraints on sexual behavior. Participants recognized significant risks, including mental and physical health issues, social stigma, and violence victimisation. Despite these risks, the desire for the perceived benefits of chemsex, particularly feelings of freedom and happiness, underscored its appeal., Conclusions: The study reveals a complex dynamic in which chemsex serves as a coping mechanism for minority stress, a source of sexual liberation, and a social connector for GBMSM in Kazakhstan, while also posing significant health risks. These findings emphasize the need for targeted harm reduction strategies, mental health support, and community-building efforts that are responsive to the experiences and needs of GBMSM who engage in chemsex., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

A dominant view among researchers is that boys' sexual interactions with adult men are traumatizing. In contrast, many gay men recall childhood sexual experiences with adult males as positive. The current study tested for both of these outcomes by examining recalled boyhood sexual experiences of older gay men. Interviews were conducted in the 1970-1980s, and thus, before the public view became popular that child-adult sexual interactions must be traumatizing. Quantitative analyses suggested that gay men with boyhood sexual experiences with adult males (n = 7, mostly aged 11-16 at first experience with men aged 20s to 50s) were as well adjusted as those without these experiences (n = 10), and these experiences were usually viewed positively (71%). Narrative analyses indicated that adjustment problems in adulthood were not related to these early sexual experiences but to other factors such as parental abusiveness, societal intolerance, internalized homophobia, or social isolation., Competing Interests: Declarations. Conflict of interest: Not applicable. Ethical Approval: This article performed secondary analysis of previously published material, so ethical approval was not required., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Conversion practices are associated with psychological morbidity, yet few studies have evaluated differences between efforts to change gender identity, sexual orientation, or both. We aimed to examine the individual and joint association of conversion practice recall targeted at gender identity or sexual orientation, or both, with current mental health symptoms among sexual and gender minority people., Methods: This cross-sectional study used data from The PRIDE Study, a US-based, online, prospective cohort study of sexual and gender minority adults who were recruited through social media, digital advertisements, and sexual and gender minority community-based events and organisations. For this analysis, we included participants who completed a lifetime questionnaire in 2019-20 and a subsequent annual questionnaire in 2020-21 without missing outcome data. All questionnaires were in English. The exposure was lifetime recall of conversion practice targeting gender identity alone, sexual orientation alone, or both (versus no conversion practice). Mental health outcomes were continuous measures: Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire 9-item (depression) scale, Post-Traumatic Stress Disorder Checklist 6-item scale, and Suicide Behaviors Questionnaire-Revised scale. We used linear regression to analyse the associations of conversion practice recall and mental health symptoms, controlling for demographic and childhood factors and stratified between cisgender and transgender and gender diverse groups. Sensitivity analyses evaluated the potential impact of unmeasured confounding. Analyses were conducted in R. We included people with related lived experience in the design and implementation of this study., Findings: Of 6601 participants who completed the lifetime questionnaire in 2019-20, 4440 completed the subsequent annual questionnaire in 2020 or 2021, and 4426 did not have missing outcome data. Of the 4426 included participants, 4073 (92·0%) identified as White (either alone or in combination with other ethnoracial options), 460 (10·4%) identified with multiple ethnoracial identities, and 1923 (43·4%) were transgender and gender diverse. Participants' age ranged from 18 years to 84 years (median 31·7 years, IQR 25·5-44·1). 149 (3·4%) participants reported sexual orientation-related conversion practice alone, 43 (1·0%) reported gender identity-related conversion practice alone, and 42 (1·0%) reported both. Recalling both forms of conversion practice was most strongly associated with greater post-traumatic stress disorder (PTSD; β 2·84, 95% CI 0·94-4·74) and suicidality (2·14, 0·95-3·32) symptoms. Recall of only sexual orientation-related conversion practice was associated with greater symptoms of PTSD (1·10, 0·22-1·98). Recall of gender identity-related conversion practice alone was most strongly associated with greater depressive symptoms (3·24, 1·03-5·46). Only associations for suicidality differed between cisgender and transgender and gender diverse participants, although the latter showed higher mental health symptoms overall. Findings were moderately robust to potential sources of unmeasured confounding in sensitivity analysis., Interpretation: Recall of conversion practice exposure was associated with a range of mental health symptoms among sexual and gender minority people. These findings support calls to ban conversion practices because of their effects as a structural determinant of mental health., Funding: Gill Foundation, Dona Rockstad, and Patient-Centered Outcomes Research Institute., Competing Interests: Declaration of interests CGS received consultation fees from EverlyWell, The Texas Health Institute, and L'Oreal, and is the current President of the United States Professional Association for Transgender Health. JO-M has received consultation fees from Ibis Reproductive Health, Hims, Folx Health, Sage Therapeutics, and Upstream on topics unrelated to this work; and participates in the Quality Family Planning 2.0 Advisory Board in the Office of Populations Affairs and Contraception: Medical Advisory Board in the Center for Disease Control and Prevention. MRL received consultation fees from Otsuka Pharmaceutical Development and Commercialization, and the American Dental Association on topics unrelated to this work; and is a Scientific Advisory Board member for SPARK and Simons Foundation. NKT is a Resource Access Board member for the All of Us Research Program. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Background: The Brief COPE is a widely used coping instrument, but there is a paucity of research regarding its ability to measure coping among sexual minority (SM) persons., Objective: This study determined the psychometric properties of the Brief COPE and identified coping domains among a sample of SM individuals., Methods: An online survey was conducted with 530 SM persons in the United States. Participants completed the dispositional version of the Brief COPE. Confirmatory factor analysis (CFA) determined construct validity. Cronbach's alpha examined the reliability of resulting domains. Exploratory structural equation modeling (ESEM) was employed to identify coping domains and criterion-related validity was assessed by examining the relationship of the domains with substance use measures (alcohol, cannabis, and drug use)., Results: CFA replicated the original 14-factor structure. ESEM identified 3 second-order domains with acceptable fit (chi-square [χ 2 ] = 905.81; degrees of freedom [d f ] = 334, P  < .001; comparative fit index [CFI] = 0.90; root mean square error of approximation = 0.06; 90% confidence interval = 0.05-0.06; and standardized root mean residual = 0.08). The 3 second-order domains demonstrated good reliability: adaptive (ω = 0.84), support (ω = 0.85), and disengaged coping (ω = 0.84). Disengaged coping exhibited the strongest correlations with substance use outcomes., Conclusions: Findings provide evidence to support the reliability and validity of the Brief COPE and validates its use with SM persons., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: While research with sexual minority men (SMM) has focused on disparities related to HIV, substance use and mental health, synergistic psychosocial pathways driving these epidemics remain underexplored. We used syndemic theory to assess how psychosocial factors sustain methamphetamine use and hinder recovery efforts for SMM living with HIV., Methods: A triangulation of network analyses and constructivist grounded theory approaches is utilised to elucidate pathways through which psychosocial factors influence methamphetamine use among this population. Survey data (N = 129) are used for quantitative analyses and a purposive sub-sample (n = 24) was recruited for semi-structured interviews for qualitative analyses., Findings: The network analysis revealed two statistically significant bivariate associations: between post-traumatic stress disorder and depression symptoms (b = 0.37, SD = 0.07, 95% confidence interval [0.23, 0.49]) and between depression symptoms and negative affect (b = 0.26, SD = 0.07, 95% confidence interval [0.12, 0.38]). Findings from the constructivist grounded theory analysis supplement the network analysis by offering a nuanced take on how negative affect, post-traumatic stress disorder, and depression symptoms operate synergistically to promote methamphetamine use and impede recovery efforts., Discussion and Conclusions: Participants relay experiences of using methamphetamine to cope with these psychosocial factors through avoidance, escapism, mood elevation, and numbing of emotions. Findings suggest that centring these psychosocial factors may inform more effective, holistic interventions for this high-priority population., (© 2024 Australasian Professional Society on Alcohol and other Drugs.)

Mental health disparities in transgender and gender diverse (TGD) populations call for more research examining gender minority stressors (GMS) as antecedents to their psychological distress, especially for the long-underrepresented groups living in conservative societies towards gender minorities. Furthermore, some questions remain underexamined, including the relative, independent influences of various GMS on TGD people's mental well-being (i.e., uniqueness of each stressor); how these stressors would configurate with each other in distinctive patterns to characterize subgroups of TGD people (i.e., beyond-average heterogeneity); and how these stressors would constitute a psychological network and vary in their centrality in that network (i.e., holistic complexity). To narrow such gaps, we examined the links between GMS and TGD people's psychological distress, using survey data collected in 2023 from 410 Chinese TGD people (Mean age  = 22.33 years, SD = 4.27; 306 transgender, 70 non-binary/gender-queer/gender-fluid, 26 agender/gender-neutral, 3 intersex, and 5 others). We approached such links from three perspectives. First, variable-centered analyses indicated that while different GMS were considered simultaneously, internalized transphobia, preoccupation with gender dysphoria, and gender-related victimization were uniquely associated with psychological distress. Second, person-centered analyses yielded a 3-profile solution. Psychological distress varied systematically across profiles. Last, network analyses revealed a 3-cluster structure: Distal, Proximal Internal, and TGD-Specific Stressors. Preoccupation with gender dysphoria was the most central node. These findings contribute to a more nuanced understanding of the implications of GMS for TGD people's mental well-being. GMS related to internal struggles with gender identity might be among the central intervention targets to prevent/reduce TGD people's psychological distress., Competing Interests: Declarations. Conflicts of interest: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Ethics Approval: This study was performed in line with the principles of the Declaration of Helsinki, in accord with APA ethical standards and within the terms of the institutional review board at the study’s home institution (Project Title: Body Image and Eating Disorders of Transgenders in Chinese Context; IRB approval institution: The Chinese University of Hong Kong, Shenzhen, Protocol No. EF20230329001). Informed Consent: Freely-given, informed consent to participate in the study had been appropriately obtained from all participants. Transparency and Openness: This study’s design and its analysis plan were not pre-registered. All data, materials, and analysis code for this study are available upon reasonable request by emailing the corresponding author. The data and narrative interpretation presented in this article have not been previously disseminated or shared in any form on any platforms., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This article explores the relationship between gender, sexuality and alcohol consumption among lesbian, bisexual, and queer (LBQ) women in Australia. On average, LBQ women consume alcohol at a higher rate than heterosexual women, yet the use of alcohol and its gendered meanings in this population remain under-explored. We conducted semi-structured interviews with 42 cisgender women, 10 transgender women, and 8 non-binary people who identify as lesbian, bisexual, and/or queer. Participants were aged 18-72. Interviews explored participants' experiences with alcohol, gender, and sexuality. Interviews were thematically analysed, informed by a critical alcohol and other drug scholarship lens. While 'minority stress' is often cited as a key factor in explaining LBQ women's high rates of alcohol consumption, our findings suggest a more complex relationship between drinking, gender and sexuality. Drinking is gendered for LBQ women, enabling both performance of and resistance to gendered norms. Additionally, alcohol emerged as a tool for navigating gendered vulnerability in public spaces, with some participants shaping their alcohol intake to their environment. Our findings highlight the need for approaches to LBQ women's health that recognise alcohol as a social tool that can facilitate confidence, pleasure, and community connection. Rather than focusing solely on risk and vulnerability, policies and health promotion efforts should consider the diverse ways in which LBQ women use alcohol to navigate their identities and social environments., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: During COVID-19, sexual minority groups may have experienced heightened mental health challenges, amplified by unique stressors and the effects of pandemic-related restrictions. This study investigates the differential impact of the pandemic on mental health across sexual orientations, leveraging population-representative data to explore these disparities., Study Design: Prospective cohort design., Methods: Data from the United Kingdom Household Longitudinal Study (waves 8-12) was used. Monthly COVID-19 incidence rates at the regional level were used to indicate pandemic severity. Mental health outcomes were evaluated using the Mental Component Score of the Short Form-12 (MCS-12) survey. To examine whether COVID-19 led to differential impacts across sexual orientation, fixed-effect longitudinal models were employed, controlling for individual and time-variant covariates., Results: Lesbian women experienced a significant mental health decline during the COVID-19 pandemic, with a 3.10 MCS-12 score decrease (95 % confidence interval (CI): -5.77 to -0.43) and an 11.0 % higher likelihood of depression (95%CI: -0.3 % to 22.3 %, p = 0.057) compared to heterosexual women. Conversely, the impact on the mental health of heterosexual women was negative but not significant (-0.22; 95%CI: -0.47 to -0.04). Bisexual individuals and other women showed non-significant mental health declines. For men, COVID-19's effect on heterosexuals was similarly non-significant (-0.21; 95%CI: -0.48 to 0.1), with no significant differences observed in gay, bisexual, and other men., Conclusions: Sexual minority individuals, especially lesbian women, faced heightened mental health challenges during COVID-19, emphasizing the urgency for targeted interventions., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Two-Spirit, lesbian, gay, bisexual, transgender, queer, and other sexual minority (2S/LGBTQ+) youth between the ages of 14 and 29 experience inequities in homelessness and substance use. Research in this area has explored substance use as a determinant of homelessness and/or as a coping mechanism, yet far less attention has been directed to the potentially generative role of drugs in this marginalizing context. This community-based photovoice study leverages data from 61 semi-structured interviews with 32 2S/LGBTQ+ youth experiencing homelessness and unstable housing to examine how drugs shape their practices and contexts of homemaking. Analysis followed a reflexive thematic approach and was informed theoretically by perspectives on home- and place-making, a momentum-stagnation analytical frame, and a narcofeminist ethics of care. This framing centred attention on the possibilities of what drugs can do for 2S/LGBTQ+ youth in terms of shaping selves, homes, and worlds while homeless. We inductively derived three themes: (i) chasing comforts, (ii) striking down stagnation, and (iii) producing precarity. 2S/LGBTQ+ youth consumed substances in chasing comforts including warmth, relief, and a sense of clarity and being more at ease within the context of homelessness and social and material inequity. Their substance use was also a means for striking down stagnation and engendering momentum as they worked to carve out better homes and futures for themselves. Youth frequently drew attention to the temporality and limits of these benefits, however, cautioning that drugs could also turn to producing new forms of precarity that limited what they expected and experienced as possible with respect to their homemaking projects. Findings highlight the generative potential of drugs in the making of home/lessness and provide critical direction for policy and service delivery, including for supports to further consider and attend to the social contexts, meanings, and effects of 2S/LGBTQ+ youths' substance use in connection with homelessness., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Survivors of childhood sexual abuse (CSA) often experience long-term adverse mental health effects, a trend that has been observed in research focusing on men who have sex with men (MSM), especially Black MSM., Objective: The aim of this study was to investigate the direct and indirect effects of childhood sexual abuse on depression symptoms among Black MSM through early sexual debut, histories of incarceration, ethnic identity, and social support. In addition, we examine the role of social support and ethnic identity as mediators of depression symptoms., Participants and Setting: The HPTN 073 study enrolled and followed 226 HIV-uninfected Black MSM in three US cities (Los Angeles; Washington, DC; and Chapel Hill, North Carolina) from February 2013 to September 2015. Study participants were offered once-daily oral emtricitabine/tenofovir preexposure prophylaxis combined with counseling and followed for 52 weeks., Methods: A path analysis was used to examine direct and indirect effects of CSA experiences on depression symptoms through incarceration, early sexual debut ethnic identity, and social support, and to see whether social support and ethnic identity mediated the relationship between incarceration and depression symptoms., Results: Our results indicate that childhood sexual abuse was direct and positively associated with early sexual debut (β = 0.21, p < .001). Both ethnic identity (β = -0.14, p < .001) and social support (β = -0.82, p < .001) were direct and negatively associated with depressive symptoms., Conclusion: Our research underscores the significant impact of CSA factors on the life trajectories of some Black MSM, including experiences such as incarceration, sexual debut, and depression symptoms., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Importance: With a recent surge in anti-lesbian, gay, bisexual, transgender, or queer (LGBTQ+) policies and associated news and media coverage, there is a need to study the association of LGBTQ+ focused news or media exposure and short-term changes in suicidal ideation (SI) among LGBTQ+ youth., Objective: To examine within-person direct and indirect associations between exposure to general and LGBTQ+ negative news or media and SI intensity through expectations of rejection., Design, Setting, and Participants: This intensive longitudinal cohort study used a smartphone-based ecological momentary assessment (EMA) protocol wherein participants responded to EMAs 3 times per day for 28 consecutive days. Young adults aged 18 to 24 years who self-identified as LGBTQ+, resided in Tennessee, and had past-year SI and at least mild depression (defined as a score ≥5 on the Patient Health Questionnaire-9) were eligible for inclusion. Participants were recruited through social media advertisements, LGBTQ+ community organizations, and mental and behavioral health clinics. Participants were recruited between March 30, 2023, and August 23, 2023, and data analyses were conducted from August 28, 2023, through April 20, 2024., Exposures: At each EMA, participants reported on recent exposure to negative news or media. A 3-level categorical exposure variable denoted (1) no news or media exposure (reference); (2) exposure to general negative news or media; and (3) exposure to LGBTQ+ negative news or media. Each EMA also assessed expectations of rejection due to LGBTQ+ identity on a scale of 0 (not at all) through 10 (very much)., Main Outcomes and Measures: Three primary outcomes assessed current (ie, "right now") intensity of active SI, passive SI, and self-harm ideation, each measured on a scale from 0 (not at all) to 10 (very strong). Multilevel modeling approaches were used to account for the hierarchical structure of EMA data, with assessments (level 1) nested within people (level 2). Linear mixed models and multilevel mediation models were used to examine within-person associations between exposure to negative news or media and the 3 primary outcomes, as well as the mediating role of expectations of rejection., Results: Of 31 total participants, 22 were assigned female sex at birth (71%), and 16 (52%) self-identified as transgender or gender diverse. The median (IQR) participant age was 21 (18-22) years, and a total of 2189 EMAs were completed, with a median (range) compliance of 90.5% (41.7%-100%). At the within-person level, recent exposure to LGBTQ+ negative news or media was significantly associated with increased active SI (estimate [b], 0.14; 95% CI, 0.04-0.25; P = .009), passive SI (b, 0.23; 95% CI, 0.04-0.41; P = .02), and self-harm ideation (b, 0.13; 95% CI, 0.02-0.23; P = .02). No statistically significant associations were detected for exposure to general negative news or media. In multilevel mediation models, heightened expectations of rejection explained some of the total effect of exposure to LGBTQ+ negative news or media on active SI (23%) and passive SI (37%)., Conclusions and Relevance: This intensive longitudinal cohort study found that SI intensity modestly increased in the hours immediately following exposure to LGBTQ+ negative news or media among LGBTQ+ young adults. These findings have timely implications for research and intervention, particularly within sociopolitical and geographic contexts where news or media coverage about LGBTQ+ topics is intensified.

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. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Discrimination and stigma are significant barriers to healthcare for the LGBTQIAPN+ community, necessitating a deeper analysis of their sociocultural causes. There is a notable gap in the literature regarding the understanding of socio-discursive representations and their impact on the stigmatization and pathologization of sexual minorities in the context of communicable diseases. This study aims to discuss the understanding of the sociodiscursive aspects of the health-disease process, particularly in stigmatized infectious diseases affecting the LGBTQIAPN+ community. The focus is on examining how news articles, or the set of analyzed texts (corpus), shape these perceptions. We conducted documentary research with a qualitative and discursive approach using news articles retrieved from Google News Ⓡ about diseases affecting the LGBTQIAPN+ population from 2011 to 2022. The analysis was based on critical discourse analysis, processed using MAXQDA and IRAMUTEQ software. The identified representations predominantly align with biomedical ideology, manifesting in a discourse that normalizes and medicalizes (normative-curative discourse), and notable for its pathologizing and stigmatizing nature. Six classes were found: Ethical professional dilemmas facing stigma, infection and contamination of the LGBT+ population, prejudice and discrimination in the form of information, stigma related to sexual behavior/orientation, Vulnerability and stigma related to infectious diseases, and strategies for minimizing health risk/stigma for the LGBT+ public. The most relevant analytical categories were related to infectious diseases and sexual identity. These themes were identified, indicating that media representations reinforce stigma and maintain unequal health practices (verticalization) for the LGBT+ community. Understanding these patterns within a broader historical context is crucial for promoting health education and strategies that challenge internalized prejudice. The need to reformulate cultural norms and develop health information and education policies is urgent. These policies should be led by professionals with a comprehensive and humanized vision, addressing the diverse needs of the LGBT+ population., Competing Interests: Declarations. Conflict of interest: No potential conflict of interest was reported by the authors. Ethical Approval: As these are public data under a shared domain, the study was not submitted for ethical approval., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Previous studies found vaccination uptake of vaccine-preventable diseases (VPD) to be associated with race/ethnicity and medical mistrust among key populations, however, few studies examine Hepatitis A vaccination uptake., Methods: This cross-sectional study used online survey data collected from NJ and NY residents identifying as lesbian, gay, bisexual, transgender, queer (LGBTQ+) from October 2021 through November 2022., Results: This study used a subsample of 222 gay, bisexual, and other cisgender men, 66.7% White, with mean age 41.22 years (SD = 15.23), and 60% fully vaccinated for Hepatitis A. Overall, average group-based medical mistrust scores did not differ among non-vaccinated participants compared to fully or partially vaccinated participants. However, higher group-based medical mistrust scores were associated with non-White identifying participants, and were highest among Hispanic/Latinx (2.68, sd = 0.43) and Black non-Hispanic (2.58, sd = 0.50) participants ( p < .001). Vaccination patterns did not differ among fear or vaccine confidence-based items., Conclusions: Our results contribute to the limited knowledge of differences in Hepatitis A vaccination uptake among men who have sex with men, and support the need for targeted intervention programs that acknowledge the diverse population of LGBTQ + identifying individuals and their associated health behaviors., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Abstract: This study quantitatively examined factors related to young men who have sex with men (YMSM)'s decisions to use pre-exposure prophylaxis (PrEP) by their history of PrEP use and qualitatively elicited their perspectives on PrEP options. Higher proportions of YMSM who had never used (vs. ever used) PrEP considered the following factors as important in their decisions to use PrEP: (a) Returning to PrEP follow-up visits ( p = .02), (b) having to talk about sex/PrEP with providers ( p = .013), (c) people assuming they are infected with HIV ( p = .021), (d) family finding out about their PrEP use ( p = .001), and (e) friends finding out about their PrEP use ( p = .008). Through inductive content analysis, qualitative data showed that a higher proportion of YMSM who had never used PrEP (vs. ever used) expressed concerns about HIV stigma from nonaffirming health care providers and the potential risk of inadvertently revealing their LGBTQ+ identity to others, which were described as potential barriers to PrEP use. Overall, our findings suggest that future interventions may consider tailoring PrEP messaging to YMSM's history of PrEP use, which may ultimately increase PrEP uptake and adherence., (Copyright © 2024 Association of Nurses in AIDS Care.)

In North America, LGBTQ+ youth have high rates of cannabis use and face mental health issues. We conducted a photovoice study to describe the perspectives, needs, and motivations of forty-six LGBTQ+ youth who use cannabis as they access mental healthcare services. Participants' photographs were discussed in individual semi-structured interviews conducted by peer researchers. Following a thematic analysis of the interview transcripts, we first found that, beyond medication, LGBTQ+ youth sought mental health services facilitating introspection to better understand their sexual and gender identities and mental health. Second, participants sought affirming health professionals but often felt judged by providers. Third, access to desired services was often described as uncertain and taxing, which impacted their mental health. Fourth, participants' agency was determined by their experience with mental health services, which translated into resilience to tackle access challenges and cannabis use to mitigate their mental health struggles. Our findings point to the need for mental healthcare delivery that goes beyond medication provision but which in addition foster therapeutic processes based on a holistic understanding of mental health. A trusting dynamic between health professionals and LGBTQ+ youth is imperative to counteract the feelings of stigma experienced by LGBTQ+ youth using cannabis in Canada.

Prejudice toward the LGBT community has become prevalent in Poland under the ultraconservative populist government. The results of three studies conducted between 2018 and 2019 (N 1  = 879, N 2  = 324, and N 3  = 374) indicate that Polish collective narcissism-the belief that the exaggerated greatness of the nation is not recognized by others-is associated with implicit homophobia assessed as the intuitive disapproval of gay men and automatic evaluative preference of heterosexuality over homosexuality. Those associations were to a large extent explained by the relationships between collective narcissism and (1) the belief that groups defined by sexual orientations are essentially distinct; (2) the belief that homosexuality is a personal choice, not genetically determined or culturally universal. The experimental results of Study 3 indicated that inducing the belief that non-normative sexuality is genetically determined and culturally universal reduced automatic preference for heterosexuality over homosexuality (but not intuitive disapproval of gay men) across levels of collective narcissism (contrary to predictions). The obtained results complete the picture of the association of narcissistic beliefs about the nation and homophobia emerging from previous studies. National narcissism is linked not only to explicit but also to latent, implicit homophobia likely to be triggered by increased presence of national narcissism in public discourse. Moreover, national narcissism is linked to implicit homophobia, especially via the agentic belief that sexual orientation is a matter of choice. Changing this belief reduces implicit homophobia also among national narcissists., Competing Interests: Declarations. Competing interests: The authors disclose no conflict of interest. Informed Consent: All participants were presented with an informed consent form prior to taking part in the studies reported here. Research Involving Human Participants: All studies received ethical approval from the universities’ ethics committees. The procedures used in the studies reported here adhere to the tenets of the Declaration of Helsinki. Ethical Approval: Ethical approval has been granted by the universities' ethics committees., (© 2024. The Author(s).)

Sexual minority men (SMM) are disproportionately affected by HIV. Although pre-exposure prophylaxis (PrEP) is an effective way of reducing HIV incidence, PrEP use has remained relatively low. Social support may be one effective factor in increasing PrEP use among SMM, but the association between social support and PrEP use/adherence is not well understood. The objective of this paper was to summarize the current literature on the association of social support and PrEP use among SMM in the United States. A systematic search was conducted using six different databases MEDLINE / PubMed, PsycINFO, Cochrane CENTRAL, Google Scholar, Embase, and Web of Science using terms established from keywords and medical subject headings (MeSH) terms before being adapted to each database. Data were extracted for key study factors (e.g., study population, geographic location, study design) and main findings. This search produced eleven articles: ten manuscripts and one conference abstract. Of these, two were randomized control trials, two were interventions, three were qualitative, and four were cross-sectional. The studies were widespread across the country, but most were in major metropolitan areas. From the articles included in this review, findings were inconsistent in the association between social support; some studies showed null findings, others that only certain sources of social support were significant, and others that there was a significant association between social support and PrEP use. This review highlights the complexity of the relationship between social support and PrEP use among SMM, indicating the need for further research to identify specific types and sources of support that effectively enhance PrEP uptake and adherence. Targeted interventions based on these insights could significantly reduce HIV incidence in the population., (© 2024. The Author(s).)