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1.  Lifetime victimization, hazardous drinking and depression among heterosexual and sexual minority women 
LGBT health  2014;1(3):192-203.
Purpose
Substantial research documents sexual-orientation-related mental health disparities, but relatively few studies have explored underlying causes of these disparities. The goals of this paper were to (1) understand how differences in sexual identity and victimization experiences influence risk of hazardous drinking and depression, and (2) describe variations across sexual minority subgroups.
Methods
We pooled data from the 2001 National Study of Health and Life Experiences of Women (NSHLEW) and the 2001 Chicago Health and Life Experiences of Women (CHLEW) study to compare rates of victimization, hazardous drinking, and depression between heterosexual women and sexual minority women (SMW), and to test the relationship between number of victimization experiences and the study outcomes in each of five sexual identity subgroups.
Results
Rates of each of the major study variables varied substantially by sexual identity, with bisexual and mostly heterosexual women showing significantly higher risk than heterosexual women on one or both of the study outcomes. Number of victimization experiences explained some, but not all, of the risk of hazardous drinking and depression among SMW.
Conclusions
Although victimization plays an important role, sexual-minority-specific stressors, such as stigma and discrimination, likely also helps explain substance use and mental health disparities among SMW.
doi:10.1089/lgbt.2014.0014
PMCID: PMC5089701  PMID: 26789712
Sexual identity; victimization; hazardous drinking; depression
2.  Public Health Opportunities for Promoting Health Equity in Cancer Prevention and Control in LGBT Populations 
LGBT health  2015;0(0):doi:10.1089/lgbt.2015.0109.
Advances in cancer prevention, detection, and treatment have led to reductions in morbidity and premature mortality and improvements in quality of life. However, not all Americans have benefitted equally from these advances, and certain populations experience continued disparities in cancer care. Although research and public health efforts have highlighted the experiences of some groups, other populations have been relatively understudied, such as lesbian, gay, bisexual, and transgender (LGBT) individuals. Public health efforts in surveillance, research, programs, and partnerships can provide opportunities to advance health equity for LGBT at the population level and lead to better health outcomes for LGBT individuals with cancer.
PMCID: PMC4639460  PMID: 26566532
access to care; epidemiology; health disparities
3.  Communicating with School Staff about Sexual Identity, Health and Safety: An Exploratory Study of the Experiences and Preferences of Black and Latino Teen Young Men who have Sex with Men 
LGBT health  2015;2(3):258-264.
Purpose
This exploratory study examined the experiences of black and Latino teen young men who have sex with men (YMSM) and their preferences for communication with school staff about matters related to sexual orientation.
Methods
Participants for this study were recruited in three urban centers in the United States and by multiple community-based organizations serving black and Latino YMSM. Eligible youth were male, black or Latino, ages 13-19, enrolled in 90 days of school in the previous 18 months, and reported attraction to or sexual behavior with other males, or identified as gay or bisexual. Participants completed Web-based questionnaires (n=415) and/or in-depth interviews (n=32).
Results
Questionnaire participants reported willingness to talk to at least one school staff member about: safety, dating and relationships, and feeling attracted to other guys (63.4%, 58.4%, and 55.9%, respectively). About one-third of the sample reported they would not talk with any school staff about these topics. Exploratory analyses revealed youth who experienced feeling unsafe at school and who had higher levels of trust in the information provided by school staff were more likely to be willing to talk with school staff about safety issues, dating, or same sex attraction (aOR=2.80 and aOR=4.85, respectively). Interview participants reported being most willing to talk to staff who (1) were able and willing to help them; (2) would keep discussions confidential, and (3) expressed genuine care. Preferences for confiding in school staff perceived to be LGBT and having similar racial/ethnic background were also noted.
Conclusion
Findings suggest school staff can serve as points of contact for reaching YMSM and professional development and interventions can be tailored to reach YMSM and connect them to services they need. Additional research is needed to understand how to increase YMSM comfort talking with school staff about sexual health or sexual identity concerns.
doi:10.1089/lgbt.2014.0087
PMCID: PMC4589529  PMID: 26436114
Adolescent; young men who have sex with men; lesbian, gay, bisexual, and transgender (LGBT); communication; school health; safety
4.  Factors Associated with Alcohol Use Before or During Sex Among Men Who Have Sex with Men in a Large Internet Sample from Asia 
LGBT health  2015;3(2):168-174.
We explored factors associated with alcohol use before or during sex among a sample of 10,861 men who have sex with men (MSM) in Asia who were recruited online for the study. Multinomial logistic regression analysis indicated that having sex under the influence of alcohol was associated with having multiple male partners, seeking partners primarily through gay bar/gym/dance party/friends, selling sex and using multiple drugs during the past 6 months, and unprotected anal sex. More efforts are needed to better assess alcohol use and misuse among MSM in Asia and understand contextual influences on alcohol use and HIV-related behaviors in order to implement culturally-specific interventions.
doi:10.1089/lgbt.2014.0041
PMCID: PMC4723287  PMID: 26789393
alcohol; Asia; men who have sex with men (MSM); sex
5.  Behavioral and Health Outcomes for HIV+ Young Transgender Women (YTW) Linked to and Engaged in Medical Care 
LGBT health  2015;3(2):162-167.
We describe health and psychosocial outcomes of HIV+ Young transgender women (YTW) engaged in care across the United States. When compared to other behaviorally infected youth (BIY), YTW reported higher rates of unemployment (25% vs 19%), limited educational (42% vs 13%), and suboptimal ART adherence (51% vs 30%). There was no difference in likelihood of having a detectable viral load (38% vs 39%) between groups. However, particular isolating psychosocial factors (unstable housing, depression, and lack of social support for attending appointments) increased predicted probability of viral detection to a greater extent among YTW which may have important health implications for this marginalized youth population.
doi:10.1089/lgbt.2014.0062
PMCID: PMC4723288  PMID: 26789394
HIV/AIDS; Transgender; LGBT Youth; Gender Identity; Access to Care
6.  Factors Associated with Alcohol Use Before or During Sex Among Men Who Have Sex with Men in a Large Internet Sample from Asia 
LGBT Health  2016;3(2):168-174.
Abstract
We explored factors associated with alcohol use before or during sex among a sample of 10,861 men who have sex with men (MSM) in Asia who were recruited online for the study. Multinomial logistic regression analysis indicated that having sex under the influence of alcohol was associated with having multiple male partners, seeking partners primarily through gay bar/gym/dance party/friends, selling sex and using multiple drugs during the past 6 months, and unprotected anal sex. More efforts are needed to better assess alcohol use and misuse among MSM in Asia and understand contextual influences on alcohol use and HIV-related behaviors in order to implement culturally-specific interventions.
doi:10.1089/lgbt.2014.0041
PMCID: PMC4723287  PMID: 26789393
alcohol; Asia; men who have sex with men (MSM); sex
7.  Behavioral and Health Outcomes for HIV+ Young Transgender Women Linked To and Engaged in Medical Care 
LGBT Health  2016;3(2):162-167.
Abstract
We describe health and psychosocial outcomes of HIV+ young transgender women (YTW) engaged in care across the United States. When compared to other behaviorally infected youth (BIY), YTW reported higher rates of unemployment (25% vs. 19%), limited educational achievement (42% vs 13%), and suboptimal ART adherence (51% vs. 30%). There was no difference in likelihood of having a detectable viral load (38% vs. 39%) between groups. However, particular isolating psychosocial factors (unstable housing, depression, and lack of social support for attending appointments) increased predicted probability of viral detection to a greater extent among YTW that may have important health implications for this marginalized youth population.
doi:10.1089/lgbt.2014.0062
PMCID: PMC4723288  PMID: 26789394
access to care; gender identity; HIV/AIDS; LGBT youth; transgender
8.  Same-sex sexuality and psychiatric disorders in the second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2) 
LGBT health  2014;1(4):292-301.
Purpose
Sexual orientation has been shown to be a risk factor for psychiatric disorders. This study compared whether sexual orientation-related disparities in the prevalence of psychiatric disorders are similar based on homosexual behavior versus attraction and tested whether, with increased acceptance of homosexuality, these disparities have diminished over time.
Methods
The Composite International Diagnostic Interview 3.0 was administered with a total of 6,646 Dutch persons, aged 18 to 64 years.
Results
Between 2.0% and 2.5% of the participants reported same-sex sexual behavior in the preceding year or same-sex attraction. Homosexually active persons and persons with same-sex attraction reported a higher prevalence of disorders than heterosexual persons. There were more disparities in the prevalence of disorders based on sexual attraction than based on sexual behavior. Comparing these results with a previous study, showed that no significant changes over time have occurred in the pattern of health disparities.
Conclusions
Sexual orientation continues to be a risk factor for psychiatric disorders, stressing the need for understanding the origins of these disparities.
PMCID: PMC4655175  PMID: 26609539
Sexual orientation; mental disorders; epidemiology; health status disparities; Netherlands
9.  A Persistent Disparity: Smoking in Rural Sexual and Gender Minorities 
LGBT health  2014;2(1):62-70.
Purpose
Sexual and gender minorities (SGM) smoke cigarettes at higher rates than the general population. Historically, research in SGM health issues was conducted in urban populations and recent population-based studies seldom have sufficient SGM participants to distinguish urban from rural. Given that rural populations also tend to have a smoking disparity, and that many SGM live in rural areas, it is vitally important to understand the intersection of rural residence, SGM identity, and smoking. This study analyzes the patterns of smoking in urban and rural SGM in a large sample.
Methods
We conducted an analysis of 4280 adult participants in the Out, Proud, and Healthy project with complete data on SGM status, smoking status, and zip code. Surveys were conducted at 6 Missouri Pride Festivals and online in 2012. Analysis involved descriptive and bivariate methods, and multivariable logistic regression. We used GIS mapping to demonstrate the dispersion of rural SGM participants.
Results
SGM had higher smoking proportion than the non-SGM recruited from these settings. In the multivariable model, SGM identity conferred 1.35 times the odds of being a current smoker when controlled for covariates. Rural residence was not independently significant, demonstrating the persistence of the smoking disparity in rural SGM. Mapping revealed widespread distribution of SGM in rural areas.
Conclusion
The SGM smoking disparity persists among rural SGM. These communities would benefit from continued research into interventions targeting both SGM and rural tobacco control measures. Recruitment at Pride Festivals may provide a venue for reaching rural SGM for intervention.
PMCID: PMC4436676  PMID: 26000317
health disparities; drug abuse; social determinants of health; sexual minorities
10.  Operational Definitions of Sexual Orientation and Estimates of Adolescent Health Risk Behaviors 
LGBT health  2013;1(1):42-49.
Purpose
Increasing attention to the health of lesbian, gay, and bisexual (LGB) populations comes with requisite circumspection about measuring sexual orientation in surveys. However, operationalizing these variables also requires considerable thought. This research sought to document the consequences of different operational definitions of sexual orientation by examining variation in health risk behaviors.
Methods
Using Massachusetts Youth Risk Behavior Survey data, we examined how operational definitions of sexual behavior and sexual identity influenced differences among three health behaviors known to disparately affect LGB populations: smoking, suicide risk, and methamphetamine use. Sexual behavior and sexual identity were also examined together to explore if they captured unique sources of variability in behavior.
Results
Estimates of health disparities changed as a result of using either sexual behavior or sexual identity. Youth who reported their sexual identity as “not sure” also had increased odds of health risk behavior. Disaggregating bisexual identity and behavior from same-sex identity and behavior frequently resulted in the attenuation or elimination of health disparities that would have otherwise been attributable to exclusively same-sex sexual minorities. Finally, sexual behavior and sexual identity explained unique and significant sources of variability in all three health behaviors.
Conclusion
Researchers using different operational definitions of sexual orientation could draw different conclusions, even when analyzing the same data, depending upon how they chose to represent sexual orientation in analyses. We discuss implications that these manipulations have on data interpretation and provide specific recommendations for best-practices when analyzing sexual orientation data collected from adolescent populations.
PMCID: PMC4123795  PMID: 25110718
adolescents; data analysis; health behavior; measurement; sexual orientation
11.  Knowledge and Attitudes about Pre-Exposure Prophylaxis (PrEP) among Sexually Active Men Who Have Sex with Men (MSM) Participating in New York City Gay Pride Events 
LGBT health  2014;1(2):93-97.
We conducted a street-based intercept survey with 480 men reporting sex with men (MSM) during June 2011 Gay Pride events in New York City (NYC). Awareness and knowledge of pre-exposure prophylaxis (PrEP) were limited. Many men believed that PrEP use should be encouraged, and that some of their friends would use it; and were interested in using it themselves. Men who believed that PrEP should only be taken before sex were more likely to endorse it and report greater likelihood of use.
doi:10.1089/lgbt.2013.0047
PMCID: PMC4204101  PMID: 25346930
HIV/AIDS; Gay; Access to Care
12.  FROM BIAS TO BISEXUAL HEALTH DISPARITIES: ATTITUDES TOWARD BISEXUAL MEN AND WOMEN IN THE UNITED STATES 
LGBT health  2014;1(4):309-318.
PUROPSE
A newly emergent literature suggest that bisexual men and women face profound health disparities in comparison to both heterosexual and homosexual individuals. Additionally, bisexual individuals often experience prejudice, stigma, and discrimination from both gay/lesbian and straight communities, termed “biphobia.” However, only limited research exists that empirically tests the extent and predictors of this double discrimination. The Bisexualities: Indiana Attitudes Survey (BIAS) was developed to test associations between biphobia and sexual identity.
METHODS
Using standard techniques, we developed and administered a scale to a purposive online sample of adults from a wide range of social networking websites. We conducted exploratory factor analysis to refine scales assessing attitudes toward bisexual men and bisexual women, respectively. Using generalized linear modeling, we assessed relationships between BIAS scores and sexual identity, adjusting for covariates.
RESULTS
Two separately gendered scales were developed, administered, and refined: BIAS-m (n=645), focusing on attitudes toward bisexual men; and BIAS-f (n=631), focusing on attitudes toward bisexual women. Across scales, sexual identity significantly predicted response variance. Lesbian/gay respondents had lower levels of bi-negative attitudes than their heterosexual counterparts (all p-values <.05); bisexual respondents had lower levels of bi-negative attitudes than their straight counterparts (all p-values <.001); and bisexual respondents had lower levels of bi-negative attitudes than their lesbian/gay counterparts (all p-values <.05). Within racial/ethnic minority respondents, biracial/multiracial status was associated with lower bi-negativity scores (all p-values <.05).
CONCLUSION
This study provides important quantitative support for theories related to biphobia and double discrimination. Our findings provide strong evidence for understanding how stereotypes and stigma may lead to dramatic disparities in depression, anxiety, stress, and other health outcomes among bisexual individuals in comparison to their heterosexual and homosexual counterparts. Our results yield valuable data for informing social awareness and intervention efforts that aim to decrease bi-negative attitudes within both straight and gay/lesbian communities, with the ultimate goal of alleviating health disparities among bisexual men and women.
PMCID: PMC4283842  PMID: 25568885
Bisexuality; attitudes; bisexual men; bisexual women; stigma
13.  Transgender Health Disparities: Comparing Full Cohort and Nested Matched-Pair Study Designs in a Community Health Center 
LGBT health  2014;1(3):177-184.
Purpose
U.S. health surveillance systems infrequently include measures to identify transgender respondents or monitor the health of this underserved and marginalized population.
Methods
From 2001–2002, transgender and non-transgender adults were sampled at a Massachusetts clinic. Health differences were formatively examined by transgender identity using a cross-sectional, clinic-based sample (n=2,653); and a nested matched-pair subsample (n=155).
Results
Both designs produced virtually identical findings: (1) the prevalence of HIV, substance abuse, and smoking did not differ significantly for transgender and non-transgender patients; (2) transgender patients were more likely to endorse a lifetime suicide attempt and ideation compared to non-transgender patients (p<0.05); (3) transgender patients disproportionately reported social stressors (violence, discrimination, childhood abuse) relative to non-transgender patients (p<0.05).
Conclusion
Findings suggest that a nested design may provide an effective methodology for using clinical data to study transgender health, and underscore the need for routine collection of gender identity in clinical settings.
doi:10.1089/lgbt.2014.0009
PMCID: PMC4219512  PMID: 25379511
Health disparity; transgender; gender identity; methods; study design
14.  Racial Disparities in Health Behaviors and Conditions Among Lesbian and Bisexual Women: The Role of Internalized Stigma 
LGBT health  2014;1(2):131-139.
There are documented disparities in physical health behaviors and conditions, such as physical activity and obesity, with regard to both race/ethnicity and sexual orientation. However, physical health disparities for lesbian and bisexual (LB) women who are also racial minorities are relatively unexplored. Minority stressors, such as internalized stigma, may account for disparities in such multiply marginalized populations. We sought to (1) characterize inequalities among non-Hispanic white and African American LB women and (2) examine the roles of internalized sexism and homophobia in disparities. Data on health behaviors (diet, physical activity); physical health (hypertension, diabetes, overweight/obesity); internalized sexism; and internalized homophobia were collected via a web-based survey. Recruitment ads were sent electronically to over 200 listservs, online groups, and organizations serving the lesbian, gay, and bisexual community in all 50 U.S. states. The analytic sample consisted of 954 white and 75 African American LB women. African American participants were more likely than white participants to report low fruit/vegetable intake and physical activity, a higher body mass index, and a history of diabetes and hypertension. There were no racial differences in internalized homophobia, but African American women reported higher levels of internalized sexism. Internalized sexism partially mediated racial disparities in physical activity and diabetes, but not in the other outcomes. Findings suggest that African American LB women may be at greater risk than their white counterparts for poor health and that internalized sexism may be a mediator of racial differences for certain behaviors and conditions.
doi:10.1089/lgbt.2013.0007
PMCID: PMC4212827  PMID: 25364769
bisexual; health disparities; lesbian/gay; physical health; race/ethnicity; women

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