Perspectives on Injectable HIV Pre-Exposure Prophylaxis: A Qualitative Study of Health Care Providers in the United States.

The introduction of injectable HIV pre-exposure prophylaxis (PrEP) has the potential to significantly change the biomedical HIV prevention landscape. However, effective implementation will require health care providers to adopt, prescribe, and administer injectable PrEP within clinical settings. This study qualitatively examined challenges and benefit of injectable PrEP implementation from the perspective of health care providers. From April to August 2022, we conducted 19 in-depth interviews with current PrEP-prescribing health care providers in New York State, including 3 physician assistants, 5 physicians, and 11 nurse practitioners. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed to report semantic-level themes regarding injectable PrEP implementation. More than half of participants (61%) were aware of injectable PrEP; only 21% had experience prescribing it. Qualitative findings highlighted five themes. Three themes represented implementation challenges, including speculative concerns about side effects, appointment compliance, and practical and logistical considerations. The remaining two themes described benefits of injectable PrEP relative to oral PrEP, which included greater convenience and enhanced privacy. Findings from this qualitative study make significant applied contributions to the sparse knowledge on health care provider perspectives of injectable PrEP post-US Food and Drug Administration approval and their concerns and considerations regarding implementation in real-world clinical settings.

Contraceptive Behavior in Appalachia: Exploring Use, Nonuse, and Contraceptive Attitudes.

Very little is known about contraceptive behavior in Appalachia, a large geographic region in the eastern United States where even basic prevalence estimates of contraceptive use/nonuse are lacking. This study characterizes contraceptive behavior among Appalachians, including contraceptive use, reasons for use, and methods used; contraceptive nonuse and reasons for nonuse; and attitudes about contraception, including acceptability. This is a secondary analysis of a subsample of survey data collected on sexual and reproductive health attitudes, behaviors, and needs among reproductive-age women (18-49 years) living in the Appalachian region (n = 332). Results identify rates of contraceptive use (66.6%) and nonuse (33.1%) among Appalachian residents. Methods used most frequently included those that did not require prescription (i.e., external condoms and natural family planning methods) though many reported the use of intrauterine devices (IUDs). Among nonusers, fear of side effects from contraception and ambivalence towards pregnancy were most commonly selected as the most important reason for not using contraception. Contraception was considered acceptable by this sample overall, and these acceptability attitudes were significantly associated with contraceptive behavior.

Sexual Victimization Among Sexual and Gender Minoritized Groups: Recent Research and Future Directions.

PURPOSE OF THE REVIEW: Sexual victimization is a significant public health concern. Compared to heterosexual and cisgender peers, sexual and gender minoritized (SGM) individuals are at elevated risk for sexual victimization. Prominent theories suggest that this risk is due in part to the stigma SGM individuals face when navigating heteronormative cultures. The goal of this article is to review the prevalence, risk factors, and consequences of sexual victimization in SGM individuals. RECENT FINDINGS: Studies continue to show that SGM individuals-bisexual and/or gender minoritized in particular-are at higher risk for sexual victimization. Little work has focused on risk factors, though recent research continues to highlight post-victimization disparities among SGM individuals. Emerging studies also point to theoretically informed factors that may influence victimization risk and recovery, including sexual and gender-related stigma. To inform prevention and intervention efforts, future research would benefit from streamlining assessment, methodology, and dissemination practices.

Dyadic effects of minority stress and problematic alcohol use on sexual intimate partner violence in same sex couples.

Little is known about the factors that facilitate the perpetration of sexual violence within the context of same-sex romantic relationships (sexual intimate partner violence perpetration [S-IPV]). The present study sought to identify the effects of external and internal minority stress and problematic drinking on perpetration of S-IPV within a dyadic framework. A community-based sample of 137 sexual and gender minority (SGM) couples (N = 274; 59 male assigned at birth and 78 female assigned at birth couples) completed self-report surveys about minority stressors, alcohol use, and S-IPV perpetration. Multilevel logistic regression analyses were conducted within an actor-partner interdependence framework. This approach accounted for both actor effects (e.g., how much one's S-IPV perpetration is predicted by their own risk factors) and partner effects (e.g., how much one's S-IPV perpetration is influenced by their partner's risk factors). Both Actor external minority stress and internal minority stress were positively associated with Actor S-IPV perpetration. Actor problematic drinking was not associated with Actor S-IPV perpetration; however, Partner problematic drinking was positively associated with Actor S-IPV perpetration. Observed effects were robust above the addition of other risk factors. This research innovatively extricates S-IPV perpetration from other forms of IPV and indicates that Actor minority stress and Partner problematic drinking increase S-IPV likelihood. Results serve as a starting point for development of etiological models to inform the design of culturally-informed interventions to reduce S-IPV among SGM couples.

School-Based Nurse Practitioners' Perceptions of the Health Care Needs of Transgender and Gender Nonconforming Adolescents.

School-based nurse practitioners (NPs) can reduce health disparities for transgender and gender nonconforming (TGNC) adolescents. However, research is limited regarding their understanding of TGNC health. This study aimed to explore school-based NPs' perceptions of the health needs of TGNC adolescents. A qualitative, descriptive analysis utilizing a demographic survey and semi-structured interview questionnaire was conducted. School-based NPs (N = 6) were recruited via the New York School-Based Health Alliance listserv and through clinical networking. An essentialist, reflexive approach utilizing inductive thematic analysis was utilized. Four key themes and an overarching theme were identified. The overarching theme was the following: School-based NPs are primary resources-or "point people"-for TGNC adolescents seeking support, safety, and accessibility to health care. Findings identified the need for improvements in the areas of TGNC advocacy and education.

How deep is the cut? The influence of daily microaggressions on bisexual women's health.

Bisexual women experience disproportionately poorer health outcomes in comparison to lesbian and gay groups, and the general population, including inequities related to mental and physical health. Although bisexual-specific health inequities are increasingly well-documented, research examining putative causes of such inequities, as well as research that accounts for differences within bisexual populations - particularly among racial minorities- remains limited. To address these gaps, this paper reports findings from the Women's Daily Experiences Study (WoDES), a multi-method study that explored the relationship between microaggressions and health outcomes among racially/ethnically diverse cisgender, bisexual women in Chicago. Data from 28-day daily e-diaries (N = 2,104 observations; 99 participants, 57% women of color) were analyzed using multilevel modeling to (1) measure the frequency of microaggressions among bisexual women; (2) examine the influence of sexual orientation, racial, and gender microaggressions on mental and physical health; and (3) investigate how race influences relationships between microaggressions and health. Participants reported an average of 8.1 microaggressions in the previous 28 days, and at least one microaggression was reported for more than 42% of days (n = 802). Microaggressions of any type were associated with increased same-day negative affect and somatic complaints. Latina bisexual women experienced worse health outcomes in comparison to Black bisexual women. This study demonstrated the detrimental impact of microaggressions on the health of bisexual women and highlights the critical need for strategies on broader structural changes that could improve the health and well-being of bisexual women.

Scoping Review of Barriers and Facilitators of Breastfeeding in Women on Opioid Maintenance Therapy.

OBJECTIVE: To synthesize the literature on the barriers and facilitators of breastfeeding among women on opioid maintenance therapy (OMT) to inform nursing interventions and improve breastfeeding outcomes. DATA SOURCES: We searched 11 databases using the following key terms: breastfeeding, barriers, facilitators, promotion, and opioid. STUDY SELECTION: We included articles published in English since 2015 that addressed barriers and facilitators of breastfeeding in women on OMT. We did not limit our search to specific types of studies. Our search produced 65 records. After reviewing titles and abstracts, we assessed 21 full-text articles and excluded seven for lack of data related to our key terms. As a result, we included five qualitative studies, three reviews, three mixed-methods studies, two retrospective cohort studies, and one case report (14 articles) in our final review. DATA EXTRACTION: We extracted data from each article and sorted them in a table for analysis and synthesis. Data included study purpose, research questions, design and methodology, and findings specifically pertaining to the identification of barriers and facilitators of breastfeeding for women on OMT. DATA SYNTHESIS: We identified three themes related to facilitators of and barriers to breastfeeding: Information, Support, and Health Care System Factors. CONCLUSION: The results of our review suggest that most barriers and facilitators of breastfeeding in women on OMT are manageable with improved health care practices. Primary and acute care health professionals should modify practices to minimize barriers to breastfeeding. Nurses should provide better breastfeeding education and preparation, sensitive care in the immediate postpartum period, and extended follow-up after hospital discharge for women on OMT.

Rape Acknowledgment and Sexual Minority Women's Mental Health and Drinking Behaviors.

Adult sexual assault (ASA) has been linked to numerous negative psychological and behavioral outcomes. Recent research suggests that postassault adaptation may differ based on how the victim conceptualizes their ASA. For instance, women who label their rape experiences as such (i.e., acknowledged rape victims) report worse mental health symptoms than women who do not (i.e., unacknowledged rape victims). To date, this literature has focused exclusively on heterosexual women. Relative to heterosexuals, sexual minority women (SMW) are at greater risk for sexual assault and report worse postassault outcomes, yet little is known about rape acknowledgment in this at-risk population. Moreover, it is unclear how distal factors, such as childhood sexual abuse (CSA), may influence SMW's rape acknowledgment following ASA. A total of 205 self-identified lesbian and bisexual women were categorized into four groups (no ASA, ASA that did not involve rape, rape acknowledged, rape unacknowledged) and compared across mental health and drinking outcomes. Roughly, 42% of the sample experienced rape, and of those, 60% were acknowledged rape victims. Results revealed no statistical differences between acknowledged and unacknowledged rape victims in terms of mental health or alcohol use. However, relative to comparison groups, SMW who were acknowledged rape victims reported greater mental health symptoms, and both acknowledged and unacknowledged rape victims reported greater hazardous drinking. Among SMW with rape histories, greater CSA severity increased the probability of acknowledging rape. These findings provide valuable information regarding SMW's postassault adaptation and can contribute to interventions to assist SMW who experience sexual assault.

Prospective associations among relationship abuse, sexual harassment and bullying in a community sample of sexual minority and exclusively heterosexual youth.

INTRODUCTION: Sexual minority youth (SMY) are at significantly greater risk for experiencing adolescent relationship abuse (ARA) than exclusively heterosexual youth, yet little is known about the factors that elevate their risks for such abuse. Peer victimization (i.e., bullying, sexual harassment) has been associated with ARA among heterosexual youth. SMY experience higher rates of peer victimization than heterosexual youth, suggesting that it may be a risk factor for ARA among these youth. Using longitudinal data from a community sample of adolescents recruited from the northeastern US, we examined whether sexual identity was associated prospectively with ARA, and whether that relationship would be indirect, and mediated via bullying and sexual harassment at a 12-month follow-up. We expected to find higher rates of peer victimization and ARA among SMY than heterosexual youth, and we expected that sexual harassment and bullying would predict subsequent relationship abuse. METHODS: Adolescents (N = 800; 58% female; 81% European-American; 19% SMY) between 13 and 15 years (M = 14.45, SD = 0.85) completed a web survey at baseline, 6-months and 12-months. RESULTS: Consistent with prior studies, SMY reported higher rates of bullying, sexual harassment, and relationship abuse than heterosexual youth. SMY who reported sexual harassment at baseline were more likely to report relationship abuse over time. Contrary to our expectations, however, bully victimization did not predict subsequent relationship abuse. CONCLUSIONS: Sexual harassment can be particularly harmful for SMY because it targets gender and sexual identity at a formative developmental period and puts youth at risk for relationship abuse.

Concurrent Daily Alcohol and Tobacco Use among Sexual Minority and Heterosexual Women.

Background: Studies show that sexual minority women (SMW) report more hazardous alcohol use patterns and higher rates of tobacco use than exclusively heterosexual women. Despite the public health implications of drinking and smoking, especially when they co-occur, little is known about SMW's daily use patterns or the factors that may facilitate concurrent use. Objectives: The present study seeks to identify patterns of daily concurrent alcohol and tobacco use among SMW and heterosexual women, including socio-environmental drinking contexts of concurrent use. Methods: Data come from a community sample of lesbian, bisexual, and heterosexual women (N = 246) who completed up to 84 consecutive days of web-based reports about substance use. Results: Participants reported 4,012 drinking days (24%), 2,019 smoking days (12%), and 769 concurrent drinking and smoking days (5%). No differences were found between SMW and heterosexual women in the proportion of drinking days; however, SMW consumed more drinks on drinking days. SMW also reported a greater proportion of smoking days, more cigarettes smoked on smoking days, and a greater proportion of concurrent drinking and smoking days. Reciprocal daily relationships between alcohol and tobacco use were identified, and these relationships were strongest for bisexual women. Socio-environmental factors-including certain locations, situations, and companions-increased the likelihood of concurrent use for all women; however, few sexual identity differences were found in concurrent use contexts. Importance: Results expand our understanding about daily concurrent alcohol and tobacco use risk among SMW, and potentially inform treatment research to better address the unique experiences of this vulnerable group.

Maximizing respondent-driven sampling field procedures in the recruitment of sexual minorities for health research.

OBJECTIVES: Research to address the significant health burden experienced by sexual minority populations remains hampered by a lack of appropriate sampling methods to support evidence-based studies. Respondent-driven sampling offers one viable strategy to recruit these hidden populations. Because few studies systematically report their experiences using respondent-driven sampling to recruit sexual minorities, this article aligns with recent recommendations for the standardization of reporting and transparency in studies utilizing respondent-driven sampling. We (1) provide detailed descriptions about the successful execution of respondent-driven sampling in two community-based studies of sexual minority individuals, (2) outline procedures to enhance the effectiveness of respondent-driven sampling referral processes, (3) present mixed-methods results regarding the effectiveness of respondent-driven sampling in our studies, and (4) offer recommendations for other researchers when using respondent-driven sampling. METHODS: We successfully recruited 655 sexual minority men and women for two studies using respondent-driven sampling. RESULTS: Resulting metrics indicate the successful achievement of equilibrium in each study. In addition, exit interviews elucidated strategies to effectively target referrals who meet the study criteria and procedures to promote the study that will maximize referral chains and ensure attainment of equilibrium. CONCLUSION: Mixed-methods results suggest that respondent-driven sampling can be an effective means of recruiting a community-based sample of sexual minorities in smaller urban regions. Limitations are presented and suggestions are offered to researchers utilizing respondent-driven sampling in future studies.

Motivations and Consequences of Alcohol Use among Heavy Drinking Nonstudent Emerging Adults.

Research suggests that nonstudent emerging adults may be at elevated risk for alcohol-related problems in adulthood. The present study utilized a qualitative approach to broaden our understanding of the drinking-related perceptions and experiences of heavy drinking nonstudents, with the ultimate goal of generating meaningful knowledge that could aid intervention planning. Research aims were to identify nonstudent (1) drinking motivations and (2) drinking consequences. Eleven focus groups were conducted (n = 64 participants). Data analytic techniques were used to code transcripts and generate themes emerging from the group data. Analyses revealed three main themes emerged regarding nonstudent reasons for drinking (i.e., emotional, social, enhanced experiences). Four prominent themes were identified for drinking consequences (i.e., physical health, psychological health, risk-taking, life functioning). Our findings underscore several considerations related to intervening with this at-risk and understudied population.

University student perceptions about the motives for and consequences of nonmedical use of prescription drugs (NMUPD).

OBJECTIVE: The purpose of the current study was to increase qualitative understanding of student motives for and consequences associated with nonmedical use of prescription drugs. PARTICIPANTS: Sixty-one students participated in eight focus groups between April and November 2013. METHODS: Students described prescription drugs commonly used for nonmedical reasons, as well as the motives for and consequences associated with their use. Data were analyzed using thematic content analysis. RESULTS: Students reported stimulants as the most commonly used prescription drug for nonmedical reasons, least expensive, and easiest to obtain on campus, followed by benzodiazepines. Opioids were less commonly used, more expensive, and difficult to acquire. Motives and consequences varied by prescription drug class. CONCLUSIONS: Our qualitative findings extend previous research by suggesting differences in students' perceived motives for using and consequences associated with the different classes of prescription drugs. These findings provide implications for the development of preventive interventions.

Development and Validation of a Video Measure for Assessing Women's Risk Perception for Alcohol-Related Sexual Assault.

OBJECTIVE: Using an iterative process, a series of three video scenarios were developed for use as a standardized measure for assessing women's perception of risks for alcohol-related sexual assault (SA). The videos included ambiguous and clear behavioral and environmental risk cues. METHOD: Focus group discussions with young, female heavy drinkers (N = 42) were used to develop three videos at different risk levels (low, moderate, and high) in Study 1. Realism, reliability, and validity of the videos were assessed using multiple methods in Studies 2 and 3. One hundred-four women were used to compare differences in risk perception across the video risk level in Study 2. In Study 3 (N = 60), we assessed women's perceptions of the low and high risk videos under conditions of no alcohol and alcohol. RESULTS: The realism and reliability of the videos were good. Women who viewed the low risk video compared to women who viewed the moderate and high risk videos perceived less risk for SA. We found an interaction between alcohol and risk perception such that, women in the alcohol condition were less likely to perceive risk when watching the high risk video. CONCLUSIONS: As the video risk level increased, women's perception of risk increased. These findings provide convergent evidence for the validity of the video measure. Given the limited number of standardized scenarios for assessing risk perception for sexual assault, our findings suggest that these videos may provide a needed standardized measure.

Sexual assault risks among gay and bisexual men.

The goal of this study was to examine lifetime patterns of sexual assault and associated risks among a purposive sample of gay and bisexual men (N = 183; 18 to 35 years old, M = 24.3). Cross-sectional data were collected via written, self-administered questionnaires and face-to-face, event-based qualitative interviews. Alcohol severity scores indicated high rates of hazardous drinking (53.0%) and possible dependence (14.2%) among participants. One-half of men (50.8%) reported childhood sexual abuse (CSA), and 67.2% reported adult sexual assault (ASA). Average age at most recent ASA was 21 years. Most perpetrators (83.9%) of recent ASA incidents were male; 67.0% of participants reported consuming alcohol and/or drugs prior to the most recent incident. Regression findings indicated more severe CSA experiences and past alcohol-related problems predicted recent severe ASA. Although we found similarities between gay and bisexual men in lifetime sexual assault history, we found some distinct differences in ASA risk factors. Bisexual men reported higher alcohol severity scores, more female ASA perpetrators, higher internalized homophobia scores, and fewer male sexual partners than gay men. Findings suggest the need for interventions that reduce ASA risk among sexual minority men-and the potential benefits of focusing on alcohol consumption in risk reduction efforts.

Culturally (in)competent? Dismantling health care barriers for sexual minority women.

Lesbian and bisexual (LB) women exhibit elevated rates of a variety of behaviors (i.e., smoking, excessive caloric intake, physical inactivity, heavy alcohol consumption) that put them at risk for adverse health consequences. Furthermore, LB women experience numerous barriers to obtaining culturally competent health care. In this article we review risk behaviors and health care barriers and we discuss the role of stress as an important contributing factor in LB women's health outcomes. We suggest future research, health care delivery changes, and training improvements that will prepare social workers to effectively address the needs of their LB clients.

'Just a little hint': bisexual-specific microaggressions and their connection to epistemic injustices.

A growing body of evidence indicates disproportionate rates of mental health disorders among bisexual women compared to both heterosexual and lesbian women. Such disparities are often attributed to stressors related to minority status, including experiences of prejudice and discrimination. Prior research has made little distinction between the prejudicial experiences of bisexual groups as compared to lesbian/gay groups. Based on qualitative data gathered in focus groups with 10, predominantly White, bisexual-identified women, which occurred in a large city in the USA, we posit that differences in prejudicial experiences do exist for bisexual groups, and that such differences reside in the realms of the epistemic, yet have very real implications for bisexual women's daily lived experiences. We discuss everyday slights and insults, also known as microaggressions, reported by the participants vis-à-vis their bisexual identity. These bisexual-specific microaggressions include hostility; denial/dismissal; unintelligibility; pressure to change; lesbian, gay, bisexual and transgender legitimacy; dating exclusion; and hypersexuality. We consider how such microaggressions may adversely impact mental health and well-being and may assist in explaining the mental health disparities among bisexual women.

Mixed Drinks and Mixed Messages: Adolescent Girls' Perspectives on Alcohol and Sexuality.

Experimentation with alcohol and sexuality is a normative aspect of adolescent development. Yet both present distinct risks to adolescent females and are especially problematic when they intersect. Although youth are often cautioned about the dangers associated with having sex and using alcohol, popular entertainment media frequently depict the combination of alcohol and sexuality as carefree fun. It is unclear how adolescent females interpret these contradictory messages in their everyday lives. Focus group interviews were used to explore young women's understandings of the relation between alcohol and sexuality. Young women, ages 14-17 years (N = 97, 61% White), and their mothers were recruited through advertisements in local newspapers to participate in separate, simultaneous focus group interviews. Only data from the 15 daughters' groups are presented here. Qualitative analysis revealed that participants recognized the risks associated with combining alcohol and sex, yet they also perceived sexual advantages to drinking alcohol. Advantages included facilitating social and sexual interactions and excusing unsanctioned sexual behavior. Alcohol was also seen as increasing the likelihood of sexual regret and coercion through impaired judgment and self-advocacy abilities. Educational and prevention efforts need to consider adolescent developmental and social needs, as well as the influences of the larger cultural context in which youth function.

Sexual victimization and associated risks among lesbian and bisexual women.

This study examines relationships among childhood sexual abuse (CSA), risky alcohol use, and adult sexual victimization among bisexual and lesbian women. Half (51.2%) of women reported CSA and 71.2% reported adult sexual victimization. Perpetrators were generally male, and 56.4% of women's most recent adult sexual victimization incidents occurred after coming out. Regression results indicated that adult sexual victimization severity was associated with a bisexual identity, more severe CSA history, more lifetime sexual partners, and higher alcohol severity scores. Compared to lesbians, bisexual women reported more severe adult sexual victimization experiences, greater revictimization, riskier drinking patterns, and more lifetime male sexual partners.

Exploring shame, guilt, and risky substance use among sexual minority men and women.

This study examined the interrelations among shame-proneness, guilt-proneness, internalized heterosexism (IH), and problematic substance use among 389 gay, lesbian, and bisexual men and women. Problematic alcohol and drug use were positively related to shame-proneness and negatively related to guilt-proneness. Bisexuals reported riskier substance use behaviors, lower levels of guilt-proneness, and higher levels of IH than gay men and lesbians. Furthermore, study findings indicated that shame and IH are related. Additional investigations of these associations would supplement current understandings of sexual minority stress and advance the development of substance-related intervention and prevention efforts targeting sexual minorities.