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In the United States, sexual minority (SM) status is associated with a number of health disparities. Based on mounting evidence, stigma and discrimination have been cited as key barriers to health equity for this population. We estimated the prevalence of three types of discrimination as a function of age among SM adults from the National Epidemiological Study of Alcohol Use and Related Conditions III (NESARC-III) (2012–2013). Among SM adults, reports of past-year general discrimination, victimization, and healthcare discrimination varied by age, with peaks in early adulthood and again in midlife. Age trends varied by biological sex, with males experiencing significantly more general discrimination, victimization, and healthcare discrimination at specific ages. Age trends also varied by sexual identity, as LGB-identifying SMs were significantly more likely to experience all forms of discrimination across all ages. Policies preventing homophobic discrimination and victimization are necessary given the pervasiveness of these experiences across adulthood.

LGBTQ youth are at greater risk for compromised health, yet large-scale health promotion programs for LGBTQ young people have been slow to develop. LGBTQ community-based organizations—which provide LGBTQ-focused support and services—have existed for decades, but have not been a focus of the LGBTQ youth health literature. The current study used a contemporary sample of LGBTQ youth (age 15–21;  M  = 18.81;  n  = 1045) to examine who participates in LGBTQ community-based organizations, and the association between participation and self-reported mental health and substance use. Youth who participated in LGBTQ community-based organizations were more likely to be assigned male at birth, transgender, youth of color, and accessing free-or-reduced lunch. Participation was associated with concurrent and longitudinal reports of mental health and substance use. LGBTQ community-based organizations may be an underutilized resource for promoting LGBTQ youth health.

Sexual and gender minority (SGM) youth are more likely to use alcohol than their heterosexual cisgender peers. At the same time, SGM youth experience sexuality- and gender identity-specific stressors known to exacerbate negative health outcomes. Though scholars have established a link between minority stressors (e.g., internalized stigma and victimization) and increased alcohol use for SGM youth as a whole, there is little indication of whether internalized stigma and victimization are more strongly associated with alcohol use for specific groups of SGM youth. A United States sample of 11,811 racially and geographically diverse 13–17 year old SGM youth was used to employ a series of gender-stratified multivariable regression models to examine the association among internalized stigma, victimization, and alcohol-related behaviors, and whether they differed for specific groups of sexual minority youth. Sexual orientation moderated several associations between sexual minority stressors (i.e., victimization and stigma) and youth’s alcohol use (i.e., recent use and heavy episodic drinking) across models stratified by gender (i.e., male, female, and non-binary). For example, bisexual boys had stronger associations between SGM-specific victimization and alcohol use frequency and heavy episodic drinking relative to gay boys; conversely, victimization and alcohol use frequency were more weakly associated among bisexual girls relative to lesbian/gay girls. Pansexual girls showed weaker associations between internalized stigma and alcohol use frequency compared to lesbian/gay girls. This paper demonstrates who among SGM youth are more likely to engage in alcohol-related behaviors as a function of differential forms of SGM-related victimization and stigma. These findings can inform substance use interventions that are tailored to youth of diverse sexual orientations and gender identities.

Purpose:  We propose a new theoretically grounded approach for estimating sexual orientation-related health risk that accounts for the unique and shared variance of sexual identity across other measures of sexual orientation (i.e., attraction and behavior). We argue and illustrate that this approach provides specificity not demonstrated by approaches that independently estimate and compare health risk based on sexual identity, attraction, and behavior. Methods:  Data were from the National Epidemiologic Survey on Alcohol and Related Conditions-III, collected in 2012–2013 (N = 36,309, ages 18 and older). The Karlson-Holm-Breen method tested the degree to which attraction- and behavior-based disparities in mental health and substance use disorders change after adjusting for sexual identity. Results:  Sexual attraction- and behavior-based disparities in mental health and substance use disorders statistically varied when comparing models that did and did not adjust for sexual identity. Adjusting for sexual identity appeared to have a larger influence on attraction- and behavior-based health associations among men; sexual minority and majority differences were attenuated on nearly every outcome after adjusting for sexual identity. This attenuation was less common among women. Among women, some behavior-based disparities were wider in sexual identity-adjusted models relative to unadjusted models. Conclusion:  We demonstrate more accurate approaches to capturing and comparing sexual orientation-related health disparities across multiple measures of sexual orientation, which account for the shared variance between sexual identity and measures of attraction and behavior. Adjusted estimates provide more specificity regarding relative health risk across specific subgroups of sexual minority people, and the intervention and prevention strategies needed to address them.

Supportive housing later in life tends to be a key concern for lesbian, gay, bisexual, and transgender (LGBT) elders. Most senior care providers are un(der)prepared to meet the needs of older LGBT adults. This study evaluated the efficacy of a 4 h, face-to-face, research-based, LGBT-diversity training designed to improve senior housing facility staff’s cultural competency regarding the needs of LGBT elders. Findings from this study found a significant increase in LGBT content knowledge between pre- and post-intervention assessments and a significant decrease in perceived preparedness when working with LGBT elders. These effects remained significant after controlling for staff designation, religion, educational attainment, and training session. Findings suggest that staff’s cultural competence affected their perceived readiness to address LGBT elders’ needs. Implications are related to the concept of cultural humility or the lifelong process of understanding others’ experiences based on the recognition of lack of un(der)preparedness to create a culturally supportive residential environment.

Black sexual and gender minorities (SGM) are at greater risk for HIV compared to their White, cisgender, heterosexual counterparts. Linkage to culturally sensitive health care is, therefore, pivotal for HIV prevention and treatment of Black SGM. Unfortunately, social and structural challenges undermine Black SGM individuals' abilities to obtain adequate health care services, indicating a need to understand Black SGM perceptions of health care. To address this gap, we interviewed Black men who have sex with men and transwomen about their experiences with health care providers. Participants discussed needs and concerns, including provider SGM identity diversity and education; assumptions, judgment, stigma, and discrimination; and ability to establish a personal bond, trust, and familiarity. Black SGM indicated that providers often did not meet their needs in different ways regarding their SGM identities. Findings suggest a need for provider cultural sensitivity education programs that address the needs of Black SGM in health care.

Sangeetha Madhavan, African American Studies Department

Laurie DeRose, Research Assistant Professor, Maryland Population Research Center

Jessica N. Fish, Family Science, investigates sexual-orientation-related disparities in mental, behavioral, and physical health

Seeds of Unity: Examining the Link Between Joint Land Titles and Women's Status in Western Uganda