An examination of the sexual health behaviors and cognitions of young U.S. community college students with respect to the intersection of gender and sexual identity.

Objective: To assess the sexual health of young community college students so that health promotion priorities can be identified and tailored programming can be implemented for this understudied population. Participants: A national sample of 1,678 community college students. Methods: Survey data was analyzed to understand trends in sexual health - including differences by gender and sexual identity. Results: While 54% of the sample have had vaginal sex and 16% have had anal sex, rates of condom use for these behaviors are low (respectively 51% and 42%). Only 52% of students have communicated with a medical professional about sexual health and 42% have been tested for STIs. Young men have the lowest odds of communicating with a medical professional about sexual health. Heterosexual men have particularly low odds of getting tested for STIs. Conclusions: Community college students need additional resources - eg, education, accessible health care - to promote their sexual health.

Disparities in Cannabis Use among Female and Male Sexual Minority Young Adults in the US: The Role of Parenting Behaviors.

Introduction: Despite cannabis use disparities among sexual minority (SM; vs. heterosexual) young adults (SMYAs), little research has explored social influences contributing to these disparities. This study examined sexual identity subgroup differences in parenting behaviors and associations among parenting behaviors and cannabis use behaviors among YA subgroups. Methods: Participants were female (N=416; 44.7% bisexual, 7.2% lesbian) and male (N=228; 11.0% bisexual, 13.2% gay) YAs (ages 18-29) recruited via social media from 6 US cities. Bivariate analyses examined differences in perceived parenting (psychological control, behavioral control, knowledge, autonomy support, warmth, communication, cannabis disapproval), any past-month (current) cannabis use, and current cannabis use frequency across sexual identity subgroups. Multivariable regression examined associations among sexual identity and parenting behaviors with cannabis use outcomes. Results: Among female YAs, bisexual (vs. heterosexual) YAs had greater odds of cannabis use, reported more frequent use, and reported greater parental psychological control and less behavioral control, autonomy support, warmth, and communication; greater psychological control was associated with both outcomes; less autonomy support was associated with current use; and less warmth and communication were associated with use frequency. Among male YAs, gay and bisexual (vs. heterosexual) YAs had greater odds of current use and reported more frequent use and greater psychological control; gay (vs. heterosexual) YAs reported greater behavioral control and less autonomy support, warmth, and communication; and greater psychological control and less warmth and communication were associated with both outcomes. Conclusions: Cannabis prevention/cessation programs should target specific parenting behaviors that differentially impact cannabis use outcomes among specific SMYA subgroups.

HIV Stigma, Sexual Identity Stigma and Online Coping Strategy of Gay, Bisexual and Queer People Living with HIV: A Moderated Mediation Study.

INTRODUCTION: Living with HIV/AIDS is more difficult for gay, bisexual, and queer (G- BQ) people as they face stigma on both the disease and sexuality, which puts significant stress on coping with stressors, and online platforms have become an alternative coping channel. METHOD: This study investigated the use of online coping strategies in moderating the HIV stigma mediated by sexual identity stigma on mental health in Malaysia. 123 GBQ people living with HIV between the ages of 20 and 39 participated in the study, responding to the HIV Stigma - Short Form Scale, adapted China MSM Stigma Scale, Online Coping Inventory, and DASS-21. RESULT: Results were analyzed using OLS, and logistic regression path modeling showed a statisti- cally significant indirect effect of sexual identity stigma mediating HIV stigma on depressive (ab = 0.1362), anxiety (ab = 0.1259), and stress (ab = 0.1636) levels. Problem-focused online coping strategy was found to moderate the indirect association between HIV stigma and depression levels via sexual identity stigma at low (ß = 0.2110, SE = 0.0741, p<.05) and moderate levels (ß = 0.1168, SE = 0.0465, p<.05). The findings demonstrated the compounding link between HIV and sexual identity stigmas on mental health and how online coping strategies can be used as a helpful coping resource to manage depressive symptoms for this community and mental health practition- ers. CONCLUSION: These findings can be beneficial to generate a better understanding of how double stigmas play a role in mental health and the types of online coping strategies adopted to process the stressors for GBQ individuals living with HIV in Malaysia.

Relevance and Ethical Issues of Diversity Equity and Inclusion Programs, circa 2024-2025.

A recent resolution with approximately 100 signatories entitled "Sunsetting All Diversity, Equity, and Inclusion (DEI) Programs" administered by the American Academy of Dermatology (AAD) sparked controversial debate within the field. Despite the AAD voting against the proposal to eliminate DEI initiatives, many underrepresented medical groups (URMs) wondered how to move forward and create safe spaces for everyone. We discuss the relevance of DEI programs in today's society and the ethical challenges that may arise. We conclude with actionable recommendations on how organizations can improve their current DEI strategies to ensure they are more inclusive and not perceived as discriminatory.

The Effect of Stigma and Social Networks on Role Expectations among African Immigrants Living with HIV.

This paper examines how African immigrants living with HIV negotiate and reconstruct their productive (i.e., educational and career opportunities), sexual, and reproductive identities. We used data from a mixed-methods study to explore how stigma and social networks in which participants were embedded shaped how they understood and negotiated their role expectations and responsibilities. Participants revealed how HIV not only changed their identities and limited their sex life, partner choices, and fundamental decisions about fertility and reproduction, but also presented them with the opportunity to reinvent/reshape their lives. Our analysis revealed that the cultural discourses about illness and HIV in participant's countries of origin, the acculturative and migratory stressors, and the competing influences and expectations from family and friends in their home and host countries shape their illness experience, and how they adjust to life with HIV. This paper builds on sociological understanding of illness experience as a social construct that shapes the ill person's identity, role, and function in society. Specifically, the paper contributes to discourses on how (i) participants' social location and identity (as transnational migrants adjusting to acculturative stressors associated with resettlement into a new country), (ii) cultural discourses about illness and HIV in their countries of origin, and (iii) embeddedness in transnational social networks influence health outcomes, including lived experiences with chronic illnesses and stigmatized conditions such as HIV.

Population Percentage and Population Size of Men Who Have Sex With Men in the United States, 2017-2021: Meta-Analysis of 5 Population-Based Surveys.

BACKGROUND: Male-to-male sexual transmission continues to account for the greatest proportion of new HIV diagnoses in the United States. However, calculating population-specific surveillance metrics for HIV and other sexually transmitted infections requires regularly updated estimates of the number and proportion of men who have sex with men (MSM) in the United States, which are not collected by census surveys. OBJECTIVE: The purpose of this analysis was to estimate the number and percentage of MSM in the United States from population-based surveys. METHODS: We used data from 5 population-based surveys to calculate weighted estimates of the proportion of MSM in the United States and pooled these estimates using meta-analytic procedures. We estimated the proportion of MSM using sexual behavior-based questions (encompassing anal or oral sex) for 3 recall periods-past 12 months, past 5 years, and lifetime. In addition, we estimated the proportion of MSM using self-reported identity and attraction survey responses. The total number of MSM and non-MSM in the United States were calculated from estimates of the percentage of MSM who reported sex with another man in the past 12 months. RESULTS: The percentage of MSM varied by recall period: 3.3% (95% CI 1.7%-4.9%) indicated sex with another male in the past 12 months, 4.7% (95% CI 0.0%-33.8%) in the past 5 years, and 6.2% (95% CI 2.9%-9.5%) in their lifetime. There were comparable percentages of men who identified as gay or bisexual (3.4%, 95% CI 2.2%-4.6%) or who indicated that they are attracted to other men (4.9%, 95% CI 3.1%-6.7%) based on pooled estimates. Our estimate of the total number of MSM in the United States is 4,230,000 (95% CI 2,179,000-6,281,000) based on the history of recent sexual behavior (sex with another man in the past 12 months). CONCLUSIONS: We calculated the pooled percentage and number of MSM in the United States from a meta-analysis of population-based surveys collected from 2017 to 2021. These estimates update and expand upon those derived from the Centers for Disease Control and Prevention in 2012 by including estimates of the percentage of MSM based on sexual identity and sexual attraction. The percentage and number of MSM in the United States is an important indicator for calculating population-specific disease rates and eligibility for preventive interventions such as pre-exposure prophylaxis.

Social media use and mental health indicators among US adolescents: A population-based study.

Social media use among young people has raised concerns about its potential impact on mental health. However, research is limited regarding whether certain subgroups may be differently affected. This study uses data from the 2022 National Youth Tobacco Survey, a nationally representative sample of middle and high school students aged approximately 11-18 years (n = 23,366). Mental health conditions were assessed using the Patient Health Questionnaire-4, and social media use was categorized by frequency levels. We employed multinomial logistic regression and a finite mixture Poisson model to explore the relationship between social media use, sexual identity, and mental health status. The study found a consistent association between social media use and mental health conditions, particularly among frequent users. The finite mixture model revealed two latent groups based on mental health status: a 'better' group with minimal or no poor mental health indicators and a 'worse' group with more indicators. For both groups, social media use was associated with mental health conditions, with a stronger association among frequent users. Notably, sexual minorities, especially bisexual students, were more likely to report poor mental health indicators. This study suggests that frequent social media use may adversely affect young people's mental health and that different youth subgroups may respond differently to social media use and mental health conditions.

Prevalence of sexual harassment and its association with aspects self-reported health: A cross-sectional study in Sweden.

AIMS: Sexual harassment is common and may have serious consequences for well-being and health. We investigated the prevalence of sexual harassment in the general population of Stockholm County across socio-demographic groups and sexual identity, and its association with self-reported health. METHODS: Experiences of sexual harassment in the previous 12 months and its associations with self-reported health (depression, anxiety, suicidal ideation) were assessed in 2021/2022 among a random sample of 22,890 residents in Stockholm County aged 16 and older. Analyses were done using descriptive statistics and multivariate logistic regression (odds ratios and 95% confidence intervals (CI)). Calibration weights were used to estimate population-representative rates with 95% CI. RESULTS: The highest weighted prevalence was observed among 16- to 24-year-olds (18.9%, 95% CI 16.9%-20.9%). Women (9.5%; 95% CI 8.8%-10.1%) reported a higher prevalence than men (2.9%; 95% CI 2.5%-3.3%). Compared to heterosexual people, bisexual and homosexual people reported a higher prevalence of sexual harassment. No significant difference was observed related to country of birth. People who were students, unemployed or on sick leave were more exposed than employed people, although this was not significant when adjusted for age and registered sex. Experiences of sexual harassment was associated with higher odds of all aspects of self-reported health. CONCLUSIONS: Experiences of sexual harassment in the general population are common and associated with adverse self-reported health. There is a need for enhanced efforts to prevent sexual harassment in the general population and to empower specific risk groups such as women and sexual minorities.

The juxtaposition of invalidation and "inviting in": a qualitative study of bisexual identity in South Africa.

Understanding one's sexual orientation plays a significant role in contributing to one's sexual identity and developing a coherent sense of self. Misconceptions and prevailing prejudices make it difficult for bisexual individuals to navigate their sexual identities in many societies. Disclosure of one's identity is accompanied by certain risks depending on how the information is received. However, disclosing one's identity can also be positive, especially as it assists in fostering relationships. This article derives from a descriptive study involving 14 semi-structured interviews with young adults aged 18-24 who identified as bisexual. Data were subjected to a reflexive thematic analysis. Themes of invalidation, belongingness and reclaiming through 'inviting in' were identified. By processing the feelings of invalidation regarding their bisexual identities which were placed upon them by their respective cultural groups, and society in general, participants were able to develop a sense of agency and reclaim their power. Findings highlight the need for further research on bisexuality, particularly in South Africa, and the need to understand how bisexual identity development occurs in interaction with other sexual and gender identities.

A Within-Person Examination of Alcohol Involved and Non-Alcohol Involved Internal and External Sexual Consent Communication.

OBJECTIVE: External consent communication and internal consent feelings may be influenced by alcohol consumption. However, whether the way someone communicates sexual consent differs when alcohol is or is not involved is not well understood. The goal of this study was to assess the within and between person effects of alcohol use, gender, and sexual identity on internal and external consent. METHOD: Young adults (n = 375) completed a 10-minute web administered survey about their internal and external consent in a recent alcohol and non-alcohol involved sexual encounter. External consent included five different behaviors to communicate consent. We conducted a repeated measures ANOVA to assess the within and between person effects of alcohol use, gender, and sexual identity on internal and external consent. RESULTS: Internal consent did not differ across sexual experiences or identities. In alcohol involved encounters, there was a decreased use of implicit communication. Heterosexual women used more verbal communication during alcohol encounters than sober encounters. Compared with men, women used more nonverbal and implicit communication across encounters. DISCUSSION: Alcohol use did not influence internal consent and was associated with a reduced use of implicit communication. The disinhibiting effects of alcohol may lead people to feeling more confident and open about expressing their sexual desires. Affirmative consent initiatives can use findings to encourage more clear communication and continue to educate on gender differences in sexual consent.

Subtypes of Alcohol Expectancies Are Differentially Associated With Alcohol Use for Bisexual and Heterosexual Women.

Background: Bisexual women, compared to heterosexual women, report greater amounts of alcohol use and heavy drinking. Alcohol expectancies (i.e., beliefs about alcohol outcomes) are a strong predictor of alcohol use, but few studies have examined the importance of alcohol expectancies in relation to alcohol use among bisexual women specifically or in comparison to heterosexual women. Objectives: The current study examined 262 heterosexual and 225 bisexual women using an online survey about alcohol use, sexual risk-taking, and alcohol expectancy subtypes (sexuality, tension reduction, and aggression). Results: Compared to heterosexual women, bisexual women reported greater sexuality and tension reduction expectancies after accounting for their level of drinking, but groups did not differ on aggression expectancies. Moreover, sexual identity status moderated the associations between sexuality and tension reduction expectancies and alcohol use, respectively. Specifically, our study findings suggested that sexuality and tension reduction alcohol expectancies were more strongly tied to alcohol use among bisexual women than heterosexual women. Conclusions: Taken together, in our study, bisexual women held stronger sexuality and tension reduction expectancies, as compared to heterosexual women. Interventions targeting alcohol expectancies may be considered when tailoring intervention content for this population.

Knowledge about HIV-Related Services Among Young Blacks with Diverse Sexual Identities: an Intra-racial Analysis.

Given the disproportionate representation in HIV/AIDS cases among young Black members of the LGBTQIA community, it is important to continue to identify both their ability to assess the knowledge that can foster healthier sexual outcomes as well as dynamics that may foster or undermine their efforts. The goal of this study is to examine whether 236 young Black persons ages 18-30 years old who are members of the LGBTQIA community know where to go locally to locate healthcare services to combat HIV/AIDS and other sexually transmitted health issues. Quantitative findings show the influence of self-identified sexual identity, age, and place of residence on knowledge about HIV-related services. The implications of these results illustrate the possible effects of place and identity development on knowledge about HIV-related services that can affect life chances and quality of life for certain members of this community.

Male, female, and mixed-sex poplar plantations support divergent soil microbial communities.

Males and females of dioecious plants have sex-specific adaptations to diverse habitats. The effects of inter- and intrasexual interactions in poplar plantations on composition, structure, and function of soil microbiota have not been explored in degraded areas. We conducted a series of greenhouse and field experiments to investigate how belowground competition, soil microbial communities, and seasonal variation nitrogen content differ among female, male, and mixed-sex Populus cathayana plantations. In the greenhouse experiment, female neighbors suppressed the growth of males under optimal nitrogen conditions. However, male neighbors enhanced stable isotope ratio of nitrogen (δ15 N) of females under intersexual competition. In the field, the root length density, root area density, and biomass of fine roots were lower in female plantations than in male or mixed-sex plantations. Bacterial networks of female, male, and mixed-sex plantations were characterized by different composition of hub nodes, including connectors, modules, and network hubs. The sex composition of plantations altered bacterial and fungal community structures according to Bray-Curtis distances, with 44% and 65% of variance explained by the root biomass, respectively. The total soil nitrogen content of mixed-sex plantation was higher than that in female plantation in spring and summer. The mixed-sex plantation also had a higher ß-1,4-N-acetyl-glucosaminidase activity in summer and a higher nitrification rate in autumn than the other two plantations. The seasonal soil N content, nitrification rate, and root distribution traits demonstrated spatiotemporal niche separation in the mixed-sex plantation. We argue that a strong female-female competition and limited nitrogen content could strongly impede plant growth and reduce the resistance of monosex plantations to climate change and the mixed-sex plantations constitutes a promising way to restore degraded land.

Operational status of mental health, substance use, and problem gambling services: A system-level snapshot two years into the COVID-19 pandemic.

BACKGROUND: The aim of this paper is to provide a system-level snapshot of the operational status of mental health, substance use, and problem gambling services 2 years into the pandemic in Ontario, Canada, with a specific focus on services that target individuals experiencing vulnerable circumstances (e.g., homelessness and legal issues). METHODS: We examined data from 6038 publicly funded community services that provide mental health, substance use, and problem gambling services in Ontario. We used descriptive statistics to describe counts and percentages by service type and specialisation of service delivery. We generated cross-tabulations to analyse the relationship between the service status and service type for each target population group. RESULTS: As of March 2022, 38.4% (n = 2321) of services were fully operational, including 36.0% (n = 1492) of mental health, 44.1% (n = 1037) of substance use, and 23.4% (n = 78) of problem gambling services. These service disruptions were also apparent among services tailored to sexual/gender identity (women/girls, men/boys, 2SLGBTQQIA + individuals), individuals with legal issues, with acquired brain injury, and those experiencing homelessness. CONCLUSION: Accessible community-based mental health, substance use and problem gambling services are critical supports, particularly for communities that have historically contended with higher needs and greater barriers to care relative to the general population. We discuss the public health implications of the findings for the ongoing pandemic response and future emergency preparedness planning for community-based mental health, substance use and problem gambling services.

Sexual Identity Development and Social Ecological Facilitators and Barriers of PrEP Uptake and Adherence Among Latinx Men Who Have Sex with Men.

Latinx gay, bisexual, and other men who have sex with men (LMSM) report lower pre-exposure prophylaxis (PrEP) use than their white, non-Latinx counterparts. We hypothesize that this disparity is partially attributable to social ecological factors that can be addressed via prevention interventions. In this retrospective study, we first examined data from 253 LMSM to determine whether theorized associations existed between acquisition of a PrEP prescription (uptake) in relation to several social ecological factors based on a conceptual framework of determinants of access to and uptake of PrEP for LMSM. We also explored relations between frequency of PrEP use (adherence) and social ecological factors with a subsample of 33 LMSM who had initiated PrEP 12 months prior to assessment. In this study, individual-level factors from this framework included age and socioeconomic status. Perceived access to medical care represented both individual- and community-level determinants of PrEP uptake and adherence. Interpersonal-level factors were social support and relationship status. Structural/cultural-level factors were sexual identity development status, the masculinity norm of heterosexual self-presentation, traditional Latinx masculine gender role beliefs of machismo and caballerismo, racial identity, and immigration status. Results indicated that older men and those who endorsed the synthesis/integration status of sexual identity development were more likely to acquire a PrEP prescription during their lifetime in comparison to peers. PrEP adherence was linked with being older, reporting higher socioeconomic status, reporting more appraisal social support, self-identifying as white-Latinx, being U.S.-born, and endorsing less sexual identity uncertainty and more heterosexual self-presentation. Results specify modifiable factors that may inform tailored, community-based prevention efforts to increase PrEP use and decrease existing HIV/AIDS disparities among LMSM.

Early Female Transgender Identity after Prenatal Exposure to Diethylstilbestrol: Report from a French National Diethylstilbestrol (DES) Cohort.

Diagnostic of transsexualism and gender incongruence are terms to describe individuals whose self-identity does not match their sex assignment at birth. A transgender woman is an individual assigned male at birth (AMAB) on the basis of the external or internal genitalia who identifies and lives as a woman. In recent decades, a significant increase in the number of transgender people has been reported. Although, its etiology is unknown, biological, anatomical, genetic, environmental and cultural factors have been suggested to contribute to gender variation. In XY animals, it has been shown that environmental endocrine disruptors, through their anti-androgenic activity, induce a female identity. In this work, we described four XY individuals who were exposed in utero to the xenoestrogen diethylstilbesterol (DES) and were part of the French HHORAGES cohort. They all reported a female transgender identity starting from childhood and adolescence. This high prevalence of male to female transgenderism (1.58%) in our cohort of 253 DES sons suggests that exposure to chemicals with xenoestrogen activity during fetal life may affect the male sex identity and behavior.

Coming to Voice as Total Top or Total Bottom: Autobiographical Acts and the Sexual Politics of Versatility on Reddit.

For gay, bisexual, and men who have sex with men (GBMSM), sexual versatility encompasses both insertive (top) and receptive (bottom) sexual practices. By contrast, "total top" and "total bottom" roles are often marginalized by those who advocate versatile roles for GBMSM. This article explores how GBMSM "come to voice" as total tops and total bottoms on the social media platform, Reddit. Reading posts and comments as autobiographical acts, the article analyses how total tops and bottoms assert the validity of their claim to sexual knowledge as total top or total bottom while negotiating the sexual politics of versatility on Reddit and beyond.

Who Cares? Unpaid Caregiving by Sexual Identity, Gender, and Partnership Status Among U.S. Adults.

Recent scholarship indicates that sexual minority adults have higher caregiving rates than heterosexuals and that women are more likely to be caregivers than men. However, little research has addressed how gender and sexuality intersect in shaping caregiving status. This study uses data from the Behavioral Risk Factor Surveillance System and aggregates a probability-based sample of adults living in 36 U.S. states between 2015 and 2021. We examine who provides care among adult heterosexual, lesbian, gay, and bisexual men and women. Results reveal that women are more likely to be caregivers than men, but only among heterosexuals. We find little variation in caregiving by sexuality among women, but bisexual men are more likely than heterosexual men to be caregivers; the latter result appears to be driven by unpartnered, bisexual men. Lastly, we contextualize caregivers' experiences and reveal selected descriptive differences in patterns of care recipient-caregiver relationships across gender and sexual identity groups. Our findings advance understanding of caregiving and changing family ties in an era of population aging and increasing diversity in sexual identities.

Responses to Sexual and Gender Identity Measures in Population-Level Data by Birth Cohort: A Research Note.

The measurement of sexual and gender identity in the United States has been evolving to generate more precise demographic estimates of the population and a better understanding of health and well-being. Younger cohorts of sexual- and gender-diverse adults are endorsing identities outside of the lesbian, gay, bisexual, and transgender (LGBT) labels. Current population-level surveys often include a category such as "something else" without providing further details, and doing so inadequately captures these diverse identities. In this research note, our analysis of the most recent federal data source to incorporate sexual and gender identity measures-the Household Pulse Survey-reveals that younger birth cohorts are more likely to select "something else" for their sexual identity and "none of these" for their gender identity. The observed sexual and gender identity response patterns across birth cohorts underscore the importance of developing and applying new strategies to directly measure sexual- and gender-diverse adults who identify with identities outside of those explicitly captured on surveys. The integration of sexual and gender identity measures in population-level surveys carries broader implications for civil rights and for addressing health inequities and therefore must be responsive to cohort differences in identification.