Annesa Flentje

All Publications

• LGBTQIA+ People's Perspectives on LGBTQIA+-Targeted State Policies and Mental Health: A Qualitative Study. JAMA network open Last, B. S., Poupard, M., Williamson, N., Jans, L., Arora, A., Tran, N. K., Obedin-Maliver, J., Lunn, M. R., Flentje, A. 2026; 9 (1): e2546538

  Abstract

  There has been a rise in state policies targeting the rights of lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender minority (LGBTQIA+) people in the United States. Although large-scale studies have quantified associations between these policies and LGBTQIA+ people's mental health, less research has centered the first-hand accounts of LGBTQIA+ people.To examine LGBTQIA+ people's accounts of how they perceive these policies to be impacting their mental health.From July to October 2024, 1-hour, semistructured, virtual interviews were conducted with LGBTQIA+ adults living in states that had recently proposed or enacted state LGBTQIA+-targeted policies. The state policies included: (1) gender-affirming care restrictions; (2) sports bans for transgender and nonbinary (TNB) people; (3) public bathroom bans for TNB people; (4) school restrictions of sexual orientation and/or gender identity discussions; and (5) religious exemptions, which permit individuals and service organizations to withhold services from LGBTQIA+ people for religious reasons.Transcripts were analyzed using thematic analysis, focusing on participants' perceptions of the mental health impacts of these policies.Interviews with the 61 adult participants in the sample (median [IQR] age, 35 [30-48] years; 13 cisgender men [21.3%], 19 cisgender women [31.1%], 16 nonbinary people [26.2%], 8 transgender men [13.1%], 2 transgender women [3.3%], and 3 people with another gender identity [4.9%]) revealed that LGBTQIA+ people perceive these policies to negatively impact their mental health. These perceived impacts were organized into 3 themes: (1) chronic worry and hypervigilance, (2) social isolation, and (3) hopelessness and powerlessness. A fourth cross-cutting theme was also identified: participants perceived these policies' mental health impacts to be unequal and more pronounced for those most frequently targeted by these policies (eg, youths, TNB people), racially and ethnically minoritized people, those without social and financial resources, and those living in rural areas.In this qualitative study, LGBTQIA+ adults in the United States perceived LGBTQIA+-targeted policies to have profound and unequal impacts on their mental health. As LGBTQIA+-targeted policies increase in number, multilevel resources and supports are necessary to support LGBTQIA+ people's well-being.

  View details for DOI 10.1001/jamanetworkopen.2025.46538

  View details for PubMedID 41481295

• US State Policies and Mental Health Symptoms Among Sexual and Gender Minority Adults. JAMA network open Last, B. S., Tran, N. K., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R., Flentje, A. 2025; 8 (5): e2512189

  Abstract

  A recent increase in state policies targeting gender minority (GM; transgender and gender-diverse) people may affect the mental health of sexual and gender minority (SGM; nonheterosexual and/or GM) people and GM people specifically.To estimate changes in mental health symptoms associated with enactment of anti-GM state policies among SGM people and GM people specifically.This repeated cross-sectional study used a staggered difference-in-differences analysis to examine the associations between anti-GM policies in the US and mean changes in mental health symptoms among 8733 SGM adults who completed annual questionnaires between April 1, 2020, and June 1, 2023, for The Population Research in Identity and Disparities for Equality (PRIDE) Study, a national, prospective, continuously enrolling online cohort study of SGM adults.Living in a state with 1 or more of the following enacted policies: (1) bathroom restrictions for GM people, (2) sports bans for GM young people participating in school sports, and (3) bans on gender-affirming care for young people.Mean levels of anxiety (measured using the 7-item Generalized Anxiety Disorder scale [GAD-7]; total score range, 0-21), depression (measured using the 9-item Patient Health Questionnaire scale [PHQ-9]; total score range, 0-27), and posttraumatic stress disorder (PTSD) symptoms (measured using the 6-item PTSD Checklist scale [PCL-6]; total score range, 6-30). For all 3 scales, higher scores indicate more severe symptoms.Among all 8733 SGM participants in the sample (median age, 32.5 years [IQR, 26.0-45.0 years]; 2024 cisgender men [23.2%], 2355 cisgender women [27.0%], 2198 gender-diverse adults assigned female at birth [25.2%], 321 gender-diverse adults assigned male at birth [3.7%], 1294 transgender men [14.8%], and 541 transgender women [6.2%]), anti-GM policy enactment was associated with significant increases in anxiety (GAD-7 score, 0.8 points [95% CI, 0.2-1.4 points]) and PTSD (PCL-6 score, 0.8 points [95% CI, 0.1-1.4 points]) symptoms in states that enacted anti-GM policies compared with states that did not but was not associated with significant increases in depression symptoms (PHQ-9 score, 0.6 points [95% CI, -0.1 to 1.4 points]). In the GM subsample (n = 4354), nonsignificant changes in anxiety (GAD-7 score, 0.6 points [95% CI, -0.2 to 1.4 points]), depression (PHQ-9 score, 0.1 points [95% CI, -0.9 to 1.1 points]), and PTSD (PCL-6 score, 0.7 points [95% CI, -0.2 to 1.6 points]) symptoms were observed after policy enactment in states that enacted anti-GM policies compared with states that did not. Gender minority adults had high mental health symptoms across the study period.In this study of 8733 SGM adults using difference-in-differences analysis, anti-GM policies were associated with worse mental health symptoms among SGM adults but no changes in mental health symptoms among GM adults. As these policies proliferate, it is important to consider how they may affect mental health.

  View details for DOI 10.1001/jamanetworkopen.2025.12189

  View details for PubMedID 40408106

• In Order to Count, Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual People Must Be Counted HEALTH PSYCHOLOGY Beach, L. B., Flentje, A., Freeman, J. B. 2025; 44 (3): 332-334

  Abstract

  The collection of sexual orientation and gender identity (SOGI) data across surveillance, health care, and research contexts generates data that can inform evidence-based improvements in governmental public health services, clinical care, and health outcomes for sexual and gender minority (SGM) individuals. To achieve this promise, however, SOGI data collection must result in applied positive individual or community benefit. providing a clear rationale and ensuring the confidentiality of SOGI data collection are important for people to be willing to disclose accurate SOGI information, especially LGBTQIA+ people. SOGI data collection practitioners should recognize that the SOGI lexicon evolves over time, thus SOGI measures should be updated as community terminology changes. Finally, as SOGI data are collected, it is crucial for maximum public health equity impact to partner with LGBTQIA+ people and communities to ensure these data inform practices and policies to support LGBTQIA+ population health and well-being at scale. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

  View details for DOI 10.1037/hea0001478

  View details for Web of Science ID 001429034000003

  View details for PubMedID 39992779

• Differential gene expression in response to AWARENESS: A randomized controlled trial of an intersectional minority stress intervention. Health psychology : official journal of the Division of Health Psychology, American Psychological Association Flentje, A., Sunder, G., Carrico, A. W., Asam, K., Neilands, T. B., Lisha, N. E., Dilley, J., Flowers, E., Kober, K., Aouizerat, B. 2025; 44 (3): 291-296

  Abstract

  Past correlational research has shown that minority stress has direct and indirect effects on the biology of sexual minority people. This pilot randomized controlled trial (RCT) examined the potential of AWARENESS, a nine-session cognitive behavioral intervention to reduce intersectional minority stress, to alter gene expression related to immune function, inflammation, and HIV disease progression.Between 2016 and 2019, 25 sexual minority men living with HIV with recent substance use (n = 12 in AWARENESS and n = 13 in control) were enrolled, a subset with complete gene expression data among the 41 individuals within the parent RCT. Blood samples were taken prior to the intervention, at the 9-week conclusion of the intervention, and at 4 months postrandomization, and leukocyte RNA was sequenced for all samples. The authors examined differential expression analyses of single genes and overrepresentation analysis of gene sets.Neither AWARENESS nor the control condition was related to the differential expression of single genes. Overrepresentation analysis suggested that AWARENESS was related to changes over time in gene expression in leukocyte RNA in 52 gene sets (q < .05), many of which are related to immune function, while the active control condition was related to changes in gene expression among genes in only one gene set. When AWARENESS was compared to the control condition, four gene sets evidenced an overrepresentation of genes reflecting change over time.This RCT suggests that AWARENESS is associated with changes in gene expression, primarily focused on changes in genes associated with immune processes. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

  View details for DOI 10.1037/hea0001451

  View details for PubMedID 39992775

  View details for PubMedCentralID PMC11893081

• Minority stress in relation to biological outcomes among sexual and gender minority people: a systematic review and update. Journal of behavioral medicine Flentje, A., Sunder, G., Tebbe, E. 2025; 48 (1): 22-42

  Abstract

  Here we present an updated systematic review identifying studies published 2019-2024, since our prior systematic review in 2020, that examine the association between minority stress and a biological outcome among sexual and gender minority (SGM) people. Pubmed, Web of Science, and Embase were queried to identify studies that examined an association between minority stress (including prejudice events and conditions, anticipation of rejection and discrimination, concealment or disclosure of SGM identity(ies), internalized stigma, or structural stigma) and a biological health outcome among SGM people. Included studies were coded for methodological approaches, study population, minority stress measure, biological outcomes, count of overall analyses, and count of analyses where an association was detected. Fifty-nine studies met inclusion criteria and included a total of 391 analyses between an element of minority stress and a biological outcome, among which 38% of analyses detected an association (44% detected this association when study outliers were removed). All elements of minority stress demonstrated associations with outcomes: multicomponent measures, prejudice events and conditions, and structural stigma demonstrated the highest proportion of associations. Associations with minority stress were detected for general physical health, sleep, immune, cardiovascular, metabolic, hormonal, brain health, allostatic load, epigenetic and transcriptional regulation. The highest proportion of associations were detected among sleep, immune, cardiovascular, and hormonal outcomes. These studies evidence associations between minority stress and biological outcomes among gender minority people in addition to evidence among sexual minority people. Future research should consider increasing rigor in methodology and expanding our understanding of moderators and mediators of these relationships.

  View details for DOI 10.1007/s10865-024-00539-6

  View details for PubMedID 39789402

  View details for PubMedCentralID PMC12163722

• Relationships between structural stigma, societal stigma, and minority stress among gender minority people. Scientific reports Clark, K. D., Lunn, M. R., Sevelius, J. M., Dawson-Rose, C., Weiss, S. J., Neilands, T. B., Lubensky, M. E., Obedin-Maliver, J., Flentje, A. 2025; 15 (1): 2996

  Abstract

  Structural stigma towards gender minority (GM; people whose current gender does not align with sex assigned at birth) people is an important contributor to minority stress (i.e., stress experienced due to one's marginalized GM identity), although existing variables are unclear in their inclusion of social norms, or societal stigma, as a key component of the construct. We examined potential variables representing structural stigma, including variables that are inclusive of societal stigma, to identify those that most strongly relate to minority stress outcomes. We tested variables identified in the literature as measures of structural stigma inclusive of societal stigma (LGBT + Business Climate Index, state voting behaviors, and Google Trends search data), the most commonly used structural stigma variable (State Policy Environment Tally), and proxy variables (region, population density) for comparison. The relationships between structural stigma and minority stress model outcomes were tested in a sample of GM participants from The Population Research in Identity and Disparities for Equality (PRIDE) Study (N = 2,094) 2019 Annual Questionnaire using a structural equation model (SEM). Lower structural stigma (i.e., higher LGBT Business Climate Index) was associated with lower experienced stigma (β= -0.260, p < .01) and lower anticipated stigma (β= -0.433, p < .001). Greater conservative voting behavior was associated with less experienced stigma (β= -0.103, p < .01). Living in a more densely populated county was also associated with lower anticipated stigma (β=-0.108, p < .001) and greater identity outness (β = 0.053, p < .05). Two of the identified structural stigma variables that were inclusive of societal stigma (i.e., LGBT + Business Climate Index, conservative voting behaviors) and one proxy variable (population density) were associated with minority stress outcomes. However, the most commonly used variable for structural stigma (State Policy Environment Tally) was not associated with any outcomes. The State LGBT + Business Climate Index showed the most promise for use as a structural stigma variable in future research. The application of this variable should be investigated further to explore its association with health outcomes and to inform efforts to reduce health equity barriers experienced by GM people through addressing structural stigma in a manner inclusive of societal stigma.

  View details for DOI 10.1038/s41598-024-85013-8

  View details for PubMedID 39848993

  View details for PubMedCentralID 4689648

• Trauma Symptoms, Minority Stress, and Substance Use: Implications for Trauma Treatment in Sexual and Gender Minority Communities Psychology of Sexual Orientation and Gender Diversity Flentje, A., Ceja, A., Dilley, J. W., Lisha, N. E., Cloitre, M., Artime, T. M., Shumway, M., Einhorn, L., Edward, D., Ong, L., Lubensky, M. E., Neilands, T. B., Obedin-Maliver, J., Lunn, M. R. 2025

  View details for DOI 10.1037/sgd0000783

• Affirming sexual and gender diversity in an elementary school after school program: a case study JOURNAL OF LGBT YOUTH Davis, K. M., Kimport, K., Einhorn, L., Satyanarayana, S., Brennan, J., Pereida, E., Capriotti, M., Flentje, A. 2024

  View details for DOI 10.1080/19361653.2024.2408235

  View details for Web of Science ID 001320495300001

• A positive affect intervention alters leukocyte DNA methylation in sexual minority men with HIV who use methamphetamine. Brain, behavior, and immunity Carrico, A. W., Cherenack, E. M., Flentje, A., Moskowitz, J. T., Asam, K., Ghanooni, D., Chavez, J. V., Neilands, T. B., Dilworth, S. E., Rubin, L. H., Gouse, H., Fuchs, D., Paul, R. H., Aouizerat, B. E. 2024; 120: 151-158

  Abstract

  This epigenomics sub-study embedded within a randomized controlled trial examined whether an evidenced-based behavioral intervention model that decreased stimulant use altered leukocyte DNA methylation (DNAm).Sexual minority men with HIV who use methamphetamine were randomized to a five-session positive affect intervention (n = 32) or an attention-control condition (n = 21), both delivered during three months of contingency management for stimulant abstinence. All participants exhibited sustained HIV virologic control - an HIV viral load less than 40 copies/mL at baseline and six months post-randomization. The Illumina EPIC BeadChip measured leukocyte methylation of cytosine-phosphate-guanosine (CpG) sites mapping onto five a priori candidate genes of interest (i.e., ADRB2, BDNF, FKBP5, NR3C1, OXTR). Functional DNAm pathways and soluble markers of immune dysfunction were secondary outcomes.Compared to the attention-control condition, the positive affect intervention significantly decreased methylation of CpG sites on genes that regulate β2 adrenergic and oxytocin receptors. There was an inconsistent pattern for the direction of the intervention effects on methylation of CpG sites on genes for glucocorticoid receptors and brain-derived neurotrophic factor. Pathway analyses adjusting for the false discovery rate (padj < 0.05) revealed significant intervention-related alterations in DNAm of Reactome pathways corresponding to neural function as well as dopamine, glutamate, and serotonin release. Positive affect intervention effects on DNAm were accompanied by significant reductions in the self-reported frequency of stimulant use.There is an epigenetic signature of an evidence-based behavioral intervention model that reduced stimulant use, which will guide the identification of biomarkers for treatment responses.

  View details for DOI 10.1016/j.bbi.2024.05.025

  View details for PubMedID 38777283

  View details for PubMedCentralID PMC11269022

• Cannabis use trajectories over time in relation to minority stress and gender among sexual and gender minority people. Addictive behaviors Flentje, A., Sunder, G., Ceja, A., Lisha, N. E., Neilands, T. B., Aouizerat, B. E., Lubensky, M. E., Capriotti, M. R., Dastur, Z., Lunn, M. R., Obedin-Maliver, J. 2024; 157: 108079

  Abstract

  Substance use disparities among sexual and gender minority (SGM) people are attributed to minority stress, but few studies have examined minority stress and cannabis use over time or investigated differences in cannabis use trajectories by less-studied gender subgroups. We examined if longitudinal cannabis use trajectories are related to baseline minority stressors and if gender differences persisted after accounting for minority stress. Cannabis use risk was measured annually over four years (2017-2021) within a longitudinal cohort study of SGM adults in the United States (N = 11,813). Discrimination and victimization, internalized stigma, disclosure and concealment, and safety and acceptance comprised minority stress (n = 5,673). Latent class growth curve mixture models identified five cannabis use trajectories: 'low or no risk', 'low moderate risk', 'high moderate risk', 'steep risk increase', and 'highest risk'. Participants who reported past-year discrimination and/or victimization at baseline had greater odds of membership in any cannabis risk category compared to the 'low risk' category (odds ratios [OR] 1.17-1.33). Internalized stigma was related to 'high moderate' and 'highest risk' cannabis use (ORs 1.27-1.38). After accounting for minority stress, compared to cisgender men, gender expansive people and transgender men had higher odds of 'low moderate risk' (ORs 1.61, 1.67) or 'high moderate risk' (ORs 2.09, 1.99), and transgender men had higher odds of 'highest risk' (OR 2.36) cannabis use. This study indicates minority stress is related to prospective cannabis use risk trajectories among SGM people, and transgender men and gender expansive people have greater odds of trajectories reflecting cannabis use risk.

  View details for DOI 10.1016/j.addbeh.2024.108079

  View details for PubMedID 38878644

• Intimate partner violence is related to future alcohol use among a nationwide sample of LGBTQIA+ people: Results from The PRIDE Study. Drug and alcohol dependence Metheny, N., Tran, N. K., Scott, D., Dastur, Z., Lubensky, M. E., Lunn, M. R., Obedin-Maliver, J., Flentje, A. 2024; 260: 111342

  Abstract

  Lesbian, gay, bisexual, transgender, queer, intersex, aromantic and asexual (LGBTQIA+) communities in the United States experience higher rates of alcohol use than the general population. While experiencing intimate partner violence (IPV) is thought to lead to increased alcohol use in LGBTQIA+ people, little research has investigated the temporal relationship between IPV and alcohol use in this population.Data from two annual questionnaires of The Population Research in Identity and Disparities for Equality Study (The PRIDE Study) longitudinal cohort (n=3,783) were included. Overall IPV and three sub-types (physical, sexual, and emotional) - measured in 2021 using the extended Hurt, Insult, Threaten, Scream (E-HITS) screening tool - was examined as a predictor of Alcohol Use Disorders Identification Test (AUDIT) score in 2022 using multivariable linear regression to assess linear and quadratic associations. Models were adjusted for sociodemographic characteristics and history of alcohol use.One-quarter (24.7%) of respondents reported experiencing past-year IPV in 2021. The mean AUDIT score in 2022 was 3.52 (SD = 4.13). In adjusted models, both linear (B: 0.26, 95% CI: 0.14, 0.38) and quadratic (B: -0.03, 95% CI: -0.04, -0.01) terms for overall IPV were significantly associated with next-year AUDIT score. These patterns were mirrored in each IPV sub-type, were not attenuated when accounting for relationship characteristics, and were heterogeneous across gender identity groups.These results provide evidence of a temporal relationship between IPV and alcohol use in LGBTQIA+ communities, suggesting that efforts to prevent and mitigate IPV may help reduce alcohol use disparities in this population.

  View details for DOI 10.1016/j.drugalcdep.2024.111342

  View details for PubMedID 38820909

• Localized and widespread chronic pain in sexual and gender minority people-an analysis of the PRIDE study. Pain medicine (Malden, Mass.) Chadwick, A. L., Lisha, N. E., Lubensky, M. E., Dastur, Z., Lunn, M. R., Obedin-Maliver, J., Flentje, A. 2024

  View details for DOI 10.1093/pm/pnae023

  View details for PubMedID 38530776

• Mental health treatment experiences among sexual and gender minority individuals: Trauma exposure, barriers, microaggressions, and treatment satisfaction JOURNAL OF GAY & LESBIAN MENTAL HEALTH Artime, T. M., Rosenfeld, E. A., Ong, L., Lisha, N. E., Dilley, J. W., Shumway, M., Edward, D., Ceja, A., Einhorn, L., Lubensky, M. E., Dastur, Z., Lunn, M. R., Obedin-Maliver, J., Cloitre, M., Flentje, A. 2024

  View details for DOI 10.1080/19359705.2024.2315976

  View details for Web of Science ID 001176136600001

• Substance Use Over Time Among Sexual and Gender Minority People: Differences at the Intersection of Sex and Gender. LGBT health Flentje, A., Sunder, G., Ceja, A., Lisha, N. E., Neilands, T. B., Aouizerat, B. E., Lubensky, M. E., Capriotti, M. R., Dastur, Z., Lunn, M. R., Obedin-Maliver, J. 2024

  Abstract

  Purpose: Sexual and gender minority (SGM) people are at greater risk for substance use than heterosexual and cisgender people, but most prior work is limited by cross-sectional analyses or the examination of single substance use. This study examined substance use over time among SGM people to identify patterns of polysubstance use at the intersection of sex and gender. Methods: Data were collected annually over 4 years from SGM respondents (n = 11,822) in The Population Research in Identity and Disparities for Equality (PRIDE) Study. Differences in substance use patterns (any prior 30-day use of 15 substances) by gender subgroup were examined with latent class analysis, and multinomial regression models tested relationships between gender subgroup and substance use. Results: Eight classes of substance use were observed. The three most common patterns were low substance use (49%), heavy episodic alcohol use (≥5 alcoholic drinks on one occasion) with some cannabis and tobacco use (14%), and cannabis use with some tobacco and declining heavy episodic alcohol use (13%). Differences observed included lower odds of patterns defined by heavy episodic alcohol use with some cannabis and tobacco use in all gender subgroups relative to cisgender men and persons with low substance use (odds ratios [ORs] 0.26-0.60). Gender expansive people assigned female at birth, gender expansive people assigned male at birth, and transgender men had greater odds of reporting cannabis use with small percentages of heavy episodic alcohol and tobacco use (ORs: 1.41-1.60). Conclusion: This study suggests that there are unique patterns of polysubstance use over time among gender subgroups of SGM people.

  View details for DOI 10.1089/lgbt.2023.0055

  View details for PubMedID 38206680

• An Automated Algorithm for Classifying Expansive Responses for Gender Identity Psychology of Sexual Orientation and Gender Diversity Ceja, A., Raygani, S., Conner, B. T., Lisha, N. E., Bryan-Lees, K. B., Lubensky, M. E., Lunn, M. R., Obedin-Maliver, J., Flentje, A. 2024

  View details for DOI 10.1037/sgd0000762

• A Pragmatic, Person-Centered View of Cannabis in the United States: Pursuing Care That Transcends Beliefs. Substance abuse Bosley, H. G., Peña, J. M., Penn, A. D., Sorensen, J. L., Tierney, M., Flentje, A. 2023; 44 (4): 337-347

  Abstract

  Rates of cannabis use are increasing in the United States, likely as a result of changes in societal attitudes and expanding legalization. Although many patients report wanting to discuss the risks and benefits of cannabis use with their clinical providers, many providers hold conflicting beliefs regarding cannabis use and often do not engage patients in discussion about cannabis. This dilemma is underscored by the limitations imposed on cannabis related research, and lack of empirically based best-practice guidelines for clinicians when addressing cannabis use with patients.We aimed to briefly summarize clinician and patient attitudes toward cannabis use and review current clinical guidelines and provide suggestions to assist health care providers and clinicians in increasing their comfort and skill in discussing cannabis use with patients.A narrative review on attitudes toward cannabis use and clinical guidelines was performed to summarize the literature and provide evidence-based recommendations.Attitudes toward cannabis use have been shaped by personal and political factors and contribute to clinician hesitance in speaking with patients about the topic. Administrative barriers have hindered the development of clearer public health guidelines that might enable the dissemination of evidence-based information on the health effects of cannabis use and might ultimately lead to better health outcomes.Not discussing cannabis use with patients may be a crucial missed opportunity for harm reduction. In the absence of empirically supported best-practice guidelines, a person-centered approach can facilitate conversations on the harms and benefits of cannabis use.

  View details for DOI 10.1177/08897077231202836

  View details for PubMedID 37902034

• Societal stigma and mistreatment in healthcare among gender minority people: a cross-sectional study. International journal for equity in health Clark, K. D., Lunn, M. R., Bosse, J. D., Sevelius, J. M., Dawson-Rose, C., Weiss, S. J., Lubensky, M. E., Obedin-Maliver, J., Flentje, A. 2023; 22 (1): 162

  Abstract

  Gender minority (GM; individuals whose gender is not aligned with that traditionally associated with the sex that was assigned to them at birth) people have widely reported mistreatment in healthcare settings. Mistreatment is enacted by individuals within society who hold stigmatizing beliefs. However, the relationship between healthcare mistreatment and societal stigma (i.e., the degree to which society disapproves of GM people) is unclear and not measured consistently.We analyzed data from 2,031 GM participants in The Population Research in Identity and Disparities for Equality (PRIDE) Study's 2019 Annual Questionnaire to determine whether societal stigma was associated with participants' past-year reports of mistreatment (defined as denial of healthcare services and/or lower quality care) in medical or mental healthcare settings. We created a proxy measure of societal stigma by incorporating variables validated in existing literature. Participants reported whether they had experienced mistreatment in medical and mental health settings independently.Healthcare denial and/or lower quality care during the past year was reported by 18.8% of our sample for medical settings and 12.5% for mental health settings. We found no associations between the societal stigma variables and past-year reports of healthcare denial and/or lower quality care in medical or mental healthcare settings.Although a high proportion of GM people reported past-year healthcare mistreatment in both medical and mental health settings, mistreatment had no relationship with societal stigma. Factors other than societal stigma may be more important predictors of healthcare mistreatment, such as healthcare workers' knowledge of and attitudes toward GM people. However, other measures of societal stigma, or different types of mistreatment, may show stronger associations. Identifying key factors that contribute to mistreatment can serve as targets for intervention in communities and healthcare settings.

  View details for DOI 10.1186/s12939-023-01975-7

  View details for PubMedID 37620832

  View details for PubMedCentralID 8297154

• AWARENESS: A cognitive behavioral intervention to reduce intersectional minority stress among sexual minority men living with HIV who use substances. Drug and alcohol dependence reports Flentje, A., Sunder, G., Dilley, J. W., Neilands, T. B., Lisha, N. E., Katuzny, K. E., Carrico, A. W. 2022; 3

  Abstract

  The minority stress model is the primary explanatory model for disparities in substance use and other mental health problems among sexual minority men (SMM) compared to heterosexual men. This pilot randomized controlled trial tested the feasibility of AWARENESS, a novel 9-session cognitive-behavioral psychotherapeutic intervention that targets intersectional minority stress and stigma, among sexual minority men living with HIV who use substances.Feasibility was determined by the number of participants screened to obtain the target sample size, the percentage of eligible participants randomized, percentage of study intervention and assessment visits attended, time to complete study procedures, and percentage of data completeness of intervention assessments. Forty-two sexual minority men living with HIV with any illicit substance use or who reported at least one occasion of consuming five or more drinks in one setting in the last three months were randomized to AWARENESS (n = 22) or an attention control condition (n = 20).Feasibility of the trial was supported, with adequate completion of study procedures and visits (73% completed all intervention sessions, 71% completed all study assessment sessions). This trial also demonstrated the feasibility of using AWARENESS skills and strategies in relation to multiple intersecting identities, with participants discussing an average of 5.7 identities (e.g., sexual orientation) or individual characteristics (e.g., socioeconomic status) in relation to intervention content.Our results support the feasibility of an AWARENESS trial to reduce intersectional minority stress related to multiple identities and characteristics among sexual minority men living with HIV who use substances.

  View details for DOI 10.1016/j.dadr.2022.100059

  View details for PubMedID 35813350

  View details for PubMedCentralID PMC9262168

• The relationship between minority stress and biological outcomes: A systematic review. Journal of behavioral medicine Flentje, A., Heck, N. C., Brennan, J. M., Meyer, I. H. 2020; 43 (5): 673-694

  Abstract

  Sexual minority (non-heterosexual) individuals experience higher rates of physical health problems. Minority stress has been the primary explanatory model to account for this disparity. The purpose of this study was to identify in published research empirically established relationships between minority stress processes and biological outcomes and identify avenues for future research. The PubMed database was queried with search terms relevant to minority stress and a comprehensive list of physical and biological outcomes. To be included in the analysis, studies had to examine the relationship between minority stress and a biological outcome among sexual minority individuals. Those meeting inclusion criteria were coded for key variables including methodology used, positive and null results, participant characteristics, and specific minority stress processes and biological outcomes considered. In total, 26 studies met inclusion criteria. Studies tested relationships between specific minority stress processes including prejudice, expectations of prejudice, concealment of sexual orientation, and internalized stigma and multiple biological outcomes, such as overall physical health, immune response, HIV specific outcomes, cardiovascular outcomes, metabolic outcomes, cancer related outcomes, and hormonal outcomes. Studies included both analyses that detected this relationship (42% of analyses) and analyses that did not detect this relationship (58%). There is substantial evidence to support the relationship between minority stress and biological outcomes, yet additional research is needed to identify the measurements and outcomes that have the most rigorous and replicable results.

  View details for DOI 10.1007/s10865-019-00120-6

  View details for PubMedID 31863268

  View details for PubMedCentralID PMC7430236

• AWARENESS: Development of a cognitive-behavioral intervention to address intersectional minority stress for sexual minority men living with HIV who use substances. Psychotherapy (Chicago, Ill.) Flentje, A. 2020; 57 (1): 35-49

  Abstract

  Sexual minority (i.e., nonheterosexual) individuals are at greater risk than heterosexual individuals for substance use and poor mental health attributed to exposure to minority stress (Meyer, 2003). Minority stress is stress that places an additional burden on sexual minority people over and above the stress experienced by heterosexual people. Sexual minority men may also be subject to minority stress related to intersecting identities or individual characteristics (e.g., HIV status, race). This study obtained initial feedback about the AWARENESS intervention from sexual minority men living with HIV who use substances and determined the feasibility of the intervention to address minority stress related to intersecting identities. AWARENESS is a 9-session cognitive-behavioral intervention targeting minority stress as a driver of greater substance use and poorer mental and physical health. Ten sexual minority men living with HIV who were episodic substance users (>1 episode of illicit drug use or binge drinking in the previous 3 months) began the intervention. Feedback on the intervention was obtained through open-ended interviews analyzed using thematic analysis and Likert scale questionnaires about experiences with the intervention. Therapists tracked identities discussed in relation to minority stress to evaluate feasibility of AWARENESS to address intersectional minority stress. Participants identified they gained cognitive-behavioral skills to cope with intersectional minority stress and described destigmatization and integration of identities. Participants discussed an average of 3.2 identity characteristics in addition to sexual minority status in relation to intervention content. This study lays the groundwork for additional testing of this intervention. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

  View details for DOI 10.1037/pst0000243

  View details for PubMedID 31368744

  View details for PubMedCentralID PMC6994327

• Screening gender minority people for harmful alcohol use. PloS one Flentje, A. n., Barger, B. T., Capriotti, M. R., Lubensky, M. E., Tierney, M. n., Obedin-Maliver, J. n., Lunn, M. R. 2020; 15 (4): e0231022

  Abstract

  This study identifies how to screen for harmful alcohol use among gender minority (e.g., transgender and gender-expansive) people using brief screening methods and identifies which screening methods perform best among gender-expansive, transfeminine, and transmasculine subgroups, as screening recommendations are not currently available. Using 2018 Annual Questionnaire data from The PRIDE Study, area under the curve (AUC) values were compared to identify which screening methods ("4 or more" or "5 or more" drinks on one occasion in the past year, or one or more items from the Alcohol Use Disorders Identification Test [AUDIT]) best predicted (i) harmful alcohol use and (ii) one or more past year alcohol dependence symptoms or consequences. Among 1892 participants, "5 or more" drinks on one occasion (AUC ranges: 0.82-0.86) performed better than "4 or more" drinks (AUC ranges: 0.78-0.81) in predicting harmful drinking. The screening methods "4 or more" drinks, "5 or more" drinks, and the consumption items of the AUDIT (AUDIT-C) using a cutoff score of 3 all maximized sensitivity and specificity to predict alcohol dependence symptoms or consequences in gender minority people overall (AUC: 0.77-0.78). Screening for "5 or more" drinks on one occasion within the past year performed as well as or better than other screening methods to detect both harmful drinking and alcohol dependence-related symptoms or consequences. This single-item screening method can identify if more extensive alcohol use assessment is warranted with gender minority people.

  View details for DOI 10.1371/journal.pone.0231022

  View details for PubMedID 32255781

• Depression and Anxiety Changes Among Sexual and Gender Minority People Coinciding with Onset of COVID-19 Pandemic. Journal of general internal medicine Flentje, A. n., Obedin-Maliver, J. n., Lubensky, M. E., Dastur, Z. n., Neilands, T. n., Lunn, M. R. 2020

  View details for DOI 10.1007/s11606-020-05970-4

  View details for PubMedID 32556877

• Using mobile technology to engage sexual and gender minorities in clinical research. PloS one Lunn, M. R., Capriotti, M. R., Flentje, A. n., Bibbins-Domingo, K. n., Pletcher, M. J., Triano, A. J., Sooksaman, C. n., Frazier, J. n., Obedin-Maliver, J. n. 2019; 14 (5): e0216282

  Abstract

  Historical and current stigmatizing and discriminatory experiences drive sexual and gender minority (SGM) people away from health care and clinical research. Being medically underserved, they face numerous disparities that make them vulnerable to poor health outcomes. Effective methods to engage and recruit SGM people into clinical research studies are needed.To promote health equity and understand SGM health needs, we sought to design an online, national, longitudinal cohort study entitled The PRIDE (Population Research in Identity and Disparities for Equality) Study that enabled SGM people to safely participate, provide demographic and health data, and generate SGM health-related research ideas.We developed an iPhone mobile application ("app") to engage and recruit SGM people to The PRIDE Study-Phase 1. Participants completed demographic and health surveys and joined in asynchronous discussions about SGM health-related topics important to them for future study.The PRIDE Study-Phase 1 consented 18,099 participants. Of them, 16,394 provided data. More than 98% identified as a sexual minority, and more than 15% identified as a gender minority. The sample was diverse in terms of sexual orientation, gender identity, age, race, ethnicity, geographic location, education, and individual income. Participants completed 24,022 surveys, provided 3,544 health topics important to them, and cast 60,522 votes indicating their opinion of a particular health topic.We developed an iPhone app that recruited SGM adults and collected demographic and health data for a new national online cohort study. Digital engagement features empowered participants to become committed stakeholders in the research development process. We believe this is the first time that a mobile app has been used to specifically engage and recruit large numbers of an underrepresented population for clinical research. Similar approaches may be successful, convenient, and cost-effective at engaging and recruiting other vulnerable populations into clinical research studies.

  View details for DOI 10.1371/journal.pone.0216282

  View details for PubMedID 31048870

• A digital health research platform for community engagement, recruitment, and retention of sexual and gender minority adults in a national longitudinal cohort study--The PRIDE Study. Journal of the American Medical Informatics Association : JAMIA Lunn, M. R., Lubensky, M. n., Hunt, C. n., Flentje, A. n., Capriotti, M. R., Sooksaman, C. n., Harnett, T. n., Currie, D. n., Neal, C. n., Obedin-Maliver, J. n. 2019

  Abstract

  Sexual and gender minority (SGM) people are underrepresented in research. We sought to create a digital research platform to engage, recruit, and retain SGM people in a national, longitudinal, dynamic, cohort study (The PRIDE Study) of SGM health.We partnered with design and development firms and engaged SGM community members to build a secure, cloud-based, containerized, microservices-based, feature-rich, research platform. We created PRIDEnet, a national network of individuals and organizations that actively engaged SGM communities in all stages of health research. The PRIDE Study participants were recruited via in-person outreach, communications to PRIDEnet constituents, social media advertising, and word-of-mouth. Participants completed surveys to report demographic as well as physical, mental, and social health data.We built a secure digital research platform with engaging functionality that engaged SGM people and recruited and retained 13 731 diverse individuals in 2 years. A sizeable sample of 3813 gender minority people (32.8% of cohort) were recruited despite representing only approximately 0.6% of the population. Participants engaged with the platform and completed comprehensive annual surveys- including questions about sensitive and stigmatizing topics- to create a data resource and join a cohort for ongoing SGM health research.With an appealing digital platform, recruitment and engagement in online-only longitudinal cohort studies are possible. Participant engagement with meaningful, bidirectional relationships creates stakeholders and enables study cocreation. Research about effective tactics to engage, recruit, and maintain active participation from all communities is needed.This digital research platform successfully recruited and engaged diverse SGM participants in The PRIDE Study. A similar approach may be successful in partnership with other underrepresented and vulnerable populations.

  View details for DOI 10.1093/jamia/ocz082

  View details for PubMedID 31162545

• Body talk: Correlates of gut-immune dysregulation phenotypes in people living with HIV who use methamphetamine. Brain, behavior, & immunity - health Vincent, W., Flentje, A., Dominguez, B. S., Paul, R. H., Pahwa, S., Pallikkuth, S., Roach, M., Fuchs, D., Dilworth, S. E., Neilands, T. B., Hunt, P. W., Sunder, G., Lentz, C., Telaak, S., Carrico, A. W. 2026; 51: 101156

  Abstract

  Microbial translocation, immune activation, inflammation, and dysregulated metabolism of neurotransmitter precursors are interacting pathophysiologic processes linked to neuropsychiatric comorbidities and faster HIV disease progression. We examined correlates of distinct phenotypes of gut-immune dysregulation in people living with HIV (PWH) who use methamphetamine.Participants were 122 PWH who had biochemically confirmed recent methamphetamine use, including non-injection use. Peripheral plasma markers reflected: intestinal permeability, microbial translocation, immune activation, inflammation, and dysregulated metabolism of neurotransmitter precursors. Using latent profile analysis (i.e., clustering) of these markers, we identified gut-immune phenotypes and their clinical, demographic, and stigma-related correlates.Three immune profiles emerged: (1) low gut-immune dysregulation with lower microbial translocation, macrophage activation, inflammation, and tryptophan catabolism; (2) moderate gut-immune dysregulation with all markers within average range; and (3) high gut-immune dysregulation with higher microbial translocation, immune activation, inflammation, and tryptophan catabolism. In adjusted analyses, higher viral load (one log10 copy/ml; AOR = 1.97, 95 % CI = 1.02-3.82), injection of methamphetamine (AOR = 3.60, 95 % CI = 1.23-10.50), and internalized stigma (AOR = 1.78, 95 % CI = 1.01-3.15) were associated with having a moderate gut-immune dysregulation profile. Additionally, higher viral load (AOR = 2.98, 95 % CI = 1.53-5.24) and injecting methamphetamine (AOR = 5.45, 95 % CI = 1.34-17.78) were associated with having a high gut-immune dysregulation profile.Distinct patterns of microbial translocation, immune activation, inflammation, and metabolism of amino acid precursors distinguished gut-immune phenotypes of PWH reporting injection methamphetamine use and greater internalized stigma. Interventions tailored to PWH who inject methamphetamine or struggle with internalized stigma could optimize HIV-related health outcomes.

  View details for DOI 10.1016/j.bbih.2025.101156

  View details for PubMedID 41479557

  View details for PubMedCentralID PMC12753493

• Phenotypic characteristics of chronic pain and pain-related factors in gender minority persons: a cross-sectional study. Pain Merchant, G., Ratri, A., Wolff, S. F., Stewart, N., Marsh, C., Jackson, Q., Flentje, A., McMillan, M., Schulze, E., Cusick, T., Gray, M., Chadwick, A. L. 2025

  Abstract

  ABSTRACT: Gender minority (GM) persons have been reported to experience chronic pain at higher rates than the general population, yet comprehensive pain phenotyping in this group remains underexplored. The goal of this cross-sectional study was to characterize chronic pain and pain-related factors in GM persons and examine associations of these characteristics with gender identity and gender-affirming hormone therapy (GHT). One hundred three GM adults completed validated questionnaires assessing pain characteristics and severity, sleep, fatigue, stress, trauma, and the chronic overlapping pain condition (COPC) screener. Participants included those who identify as transgender men (TGM), transgender women (TGW), and gender-expansive persons (all assigned female sex at birth). Overall, 50.5% of the entire cohort reported the presence of chronic pain. Transgender men and gender-expansive persons reported greater pain severity, pain interference, fibromyalgianess, stress, and sleep disturbances compared with TGW. Widespread pain was common (36%-45.8% across groups), and 15.5% of the entire cohort met criteria for fibromyalgia. Transgender men and gender-expansive individuals also had increased numbers of COPCs than TGW. Stress, but not GHT type or gender identity, was significantly associated with chronic pain in multivariable models. Chronic pain and nociplastic symptoms are highly prevalent among GM persons, particularly among TGM and gender-expansive persons, and stress appears to be a key contributor to the pain phenotype. These findings underscore the need for longitudinal research into the biopsychosocial drivers of chronic pain in the GM population and the effects of GHT on pain in GM persons.

  View details for DOI 10.1097/j.pain.0000000000003900

  View details for PubMedID 41452118

• Age-Related Trends in Eating-Pathology Symptoms Among Sexual Minority Adults. European eating disorders review : the journal of the Eating Disorders Association Nagata, J. M., Otmar, C. D., Potes, C., Murakami, K., Lavender, J. M., Compte, E. J., Brown, T. A., Forbush, K. T., Flentje, A., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R. 2025

  Abstract

  To examine how eating-disorder symptoms vary by chronological age and sexual orientation in sexual minority adults.Cross-sectional data came from 2062 cisgender sexual minority participants (925 gay men, 573 lesbian women, 116 bi+ men, 448 bi+ women; age = 47.8 years, range = 18-96). Eight subscales from the Eating Pathology Symptoms Inventory were examined. A multivariate multivariable general linear model tested main and interaction effects of age and sexual orientation; significant multivariate multivariable findings were probed with false-discovery-rate-adjusted univariate regressions.Older age was associated with lower body dissatisfaction, binge eating, and muscle-building behaviours, but higher cognitive restraint and negative attitudes toward obesity. Age-by-group interactions indicated that body dissatisfaction and binge eating were higher among older cisgender bi+ women, whereas muscularity-oriented behaviours were lower in lesbian and bi+ women compared to gay men. Associations remained after socioeconomic covariate adjustment.Findings suggested that levels of eating pathology varied based on age and across sexual minority groups. Bi+ women showed increasing body dissatisfaction and binge eating with age, while lesbian and bi+ women reported lower muscularity-oriented behaviours relative to gay men. Life-course prevention and treatment strategies should address identity-specific stress ecologies and the needs of adult sexual minority populations.

  View details for DOI 10.1002/erv.70065

  View details for PubMedID 41361934

• Validation of the Brief Assessment of Stress and Eating (BASE) in cisgender gay men and lesbian women. Journal of eating disorders Nagata, J. M., Otmar, C. D., Murakami, K., Potes, C., Lavender, J. M., Compte, E. J., Brown, T. A., Forbush, K. T., Flentje, A., Obedin-Maliver, J., Lunn, M. R. 2025

  Abstract

  Sexual minority adults are at elevated risk for eating disorders (EDs), yet existing screening tools have rarely been validated in this population. Most ED screening instruments have been validated in predominately cisgender, heterosexual female samples limiting their generalizability to populations with different symptom patterns. Validation studies in cisgender sexual minority (SM) adults are critical to improving detection and addressing disparities in ED identification. The present study evaluated the psychometric performance of the Brief Assessment of Stress and Eating (BASE), a validated 10-item screening tool that assesses DSM-5-aligned eating disorder symptoms and subclinical dysregulated eating behaviors, in a national sample of cisgender gay men and lesbian women.Participants were 1,498 cisgender SM adults (61.7% gay men, 38.3% lesbian women) recruited from The PRIDE Study, a U.S.-based longitudinal cohort of sexual and gender minority adults. Respondents completed the BASE, SCOFF questionnaire, and the Eating Disorder Diagnostic Scale-5 (EDDS-5) which we used to derive probable DSM-5 eating disorder (probable ED) status. Receiver operating characteristic (ROC) and precision-recall (PR) curve analyses were conducted to evaluate classification accuracy and identify optimal thresholds.Both the BASE and SCOFF performed significantly above chance in detecting EDDS-5-derived probable EDs. Among gay men, the BASE (AUC: ROC = 0.785, PRC = 0.702) outperformed the SCOFF (ROC = 0.744, PRC = 0.630). In lesbian women, the two screeners performed similarly (BASE AUC = 0.807; SCOFF AUC = 0.806). Optimal BASE thresholds varied by group with higher sensitivity at lower cutoffs (e.g., ≥ 7).The BASE provides a reliable, efficient alternative to traditional instruments for screening eating disorders in sexual minority adults, with good performance for identifying EDDS-5-derived probable EDs. Findings support the BASE as a reliable and valid screening tool for use with cisgender SM adults in community, healthcare, and research contexts.

  View details for DOI 10.1186/s40337-025-01482-w

  View details for PubMedID 41345685

• Breastfeeding and Chestfeeding Experiences of Cisgender Sexual Minority Women, Transgender, and Gender Diverse Parents. Journal of human lactation : official journal of International Lactation Consultant Association Tordoff, D. M., Lunn, M. R., Ariel, D., Crowe, S., Lubensky, M. E., Flentje, A., Obedin-Maliver, J. 2025: 8903344251391163

  Abstract

  Sexual and gender minority adults are increasingly growing their families and having children, yet there is limited information on the lactation experiences of sexual and gender minority parents.Using data from The PRIDE Study, a national cohort of sexual and gender minority adults in the United States, we examined patterns and correlates of lifetime breast/chestfeeding among sexual minority (i.e., lesbian, bisexual, queer) cisgender women, transgender women, transgender men, and gender diverse individuals who were parents.Our analysis included 1,562 parents aged 19-83 years with a median of two children (IQR 1-3). Among this population, 941 (60.2%) were sexual minority cisgender women, 232 (14.9%) transgender women, 199 (12.7%) transgender men, and 190 (12.2%) gender diverse parents assigned female at birth. Among 962 parents who had ever carried a pregnancy and delivered a child, sexual minority cisgender women were most likely to have ever breast/chestfed (91.7%), followed by gender diverse parents (88.8%) and transgender men (83.3%). No other demographic factors were associated with ever breast/chestfeeding. Few participants (6.7%) had ever breast/chestfed a child from another person's pregnancy. Ever having delivered a child and having an increasing number of children were associated with ever breast/chestfeeding a child from another person's pregnancy. In addition, seven (3%) transgender women had ever breast/chestfed a child.In our cohort, rates of lifetime breast/chestfeeding were high among sexual and gender minority parents who had ever carried a pregnancy. Breast/chestfeeding provides important health and infant-parent bonding benefits in families where one or more parents has the interest in and capacity for lactation. Co-lactation and/or lactation induction may be particularly beneficial for sexual and gender minority families.

  View details for DOI 10.1177/08903344251391163

  View details for PubMedID 41277793

• Alcohol Use, Cannabis Use, and Discrimination by Sexual Orientation and Gender Identity Within the All of Us Research Program. LGBT health Sunder, G., Tran, N. K., Peña, J. M., Lunn, M. R., Obedin-Maliver, J., Flentje, A. 2025

  Abstract

  Purpose: Sexual and gender minority (SGM) populations face substance use disparities attributed to minority stress. We examined the relationship between discrimination and alcohol and cannabis use among SGM and cisgender heterosexual people. Method: We conducted a cross-sectional analysis of the All of Us Research Program data (2017-2022) to examine the relationship between discrimination (Everyday Discrimination Scale [EDS]) and alcohol use (Alcohol Use Disorders Identification Test-consumption items [AUDIT-C]) and past 3-month cannabis use. Adjusted linear and logistic regression models were used for AUDIT-C scores and past 3-month cannabis use, respectively. We used interaction terms to assess how associations differed across sexual orientation and gender modality groups. Results: Among 98,820 participants, mean EDS scores were highest among gender minority (GM) people assigned female at birth (M = 14.78) and lowest among cisgender heterosexual men (M = 6.14). There was a nonlinear association between EDS and AUDIT-C scores. EDS scores were positively associated with AUDIT-C scores at low levels of discrimination; there was an inverse association at higher levels of EDS. EDS was associated with greater odds of past 3-month cannabis use, but associations were not significant at 2 standard deviations above mean EDS and higher. Interaction by sexual orientation and gender modality group was significant (p < 0.05), indicating that associations between discrimination and alcohol and cannabis use varied by group. Although estimates were largely imprecise, associations particularly varied among GM groups and cisgender sexual minority men. Conclusion: Discrimination had a nonlinear relationship with alcohol and cannabis use, and these relationships were pronounced among SGM subgroups.

  View details for DOI 10.1177/23258292251390584

  View details for PubMedID 41204713

• Social determinants of health as risk and protective factors for health care access among sexual and gender minority parents. Research square Zhang, A., Leonard, S. A., Lubensky, M. E., Flentje, A., Lunn, M. R., Benedict, C., Tordoff, D. M., Obedin-Maliver, J. 2025

  Abstract

  Sexual and gender minority (SGM) people are increasingly becoming parents. To examine the relationship between social determinants of health (SDOH) and health care access among SGM parents, we used 2018-2019 prospective cohort data from The PRIDE Study. We compared health care access between 555 SGM parents and 555 age-matched SGM non-parents. We then used modified Poisson regression to assess the association between SDOH at baseline and health care access at one-year follow-up among SGM parents. We found that SGM parents and SGM non-parents reported differences in SGM identity disclosure to health care providers and health care utilization. SGM parents were less likely than SGM non-parents to disclose SGM identity to health care providers (p < 0.001) and reported more health care avoidance (p = 0.021). Among SGM parents, greater SGM identity concealment (aRR 1.13, 95% CI 1.05-1.22) and increased social isolation (aRR 1.06, 95% CI 1.01-1.10) predicted increased health care avoidance attributed to fear of disrespect or mistreatment. Increased social isolation (aRR 1.05, 95% CI 1.01-1.09) also predicted increased all-cause delayed health care access. Among SGM parents, these proxy measures of interpersonal-level and community-level SDOH suggested risk and protective factors influencing health care access.

  View details for DOI 10.21203/rs.3.rs-7661476/v1

  View details for PubMedID 41282169

  View details for PubMedCentralID PMC12633508

• "If I can accept my queerness, I can accept my body as it is": Understanding weight-related perspectives and stigma from sexual minority women FRONTIERS IN PSYCHIATRY Fowler, L. A., Wang, Y., Wall, C., Velkovich, A., Harrop, E. N., Vazquez, M. M., Mensah, J., Flentje, A., Mann, E. S. 2025; 16

  View details for DOI 10.3389/fpsyt.2025.1687680

  View details for Web of Science ID 001594311200001

• Age-related trends in eating pathology symptoms among transgender and gender-diverse adults. Eating and weight disorders : EWD Nagata, J. M., Otmar, C. D., Lee, C. M., Compte, E. J., Lavender, J. M., Brown, T. A., Forbush, K. T., Flentje, A., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R. 2025; 30 (1): 62

  Abstract

  This study examined how eating disorder symptoms, assessed by the Eating Pathology Symptoms Inventory (EPSI), vary across chronological age in a large national (USA) sample of transgender and gender-diverse (TGD) adults.Participants were 2098 TGD adults-including transgender men (n = 599), transgender women (n = 293), and gender-diverse individuals (n = 1,206, including nonbinary and those who identified with "another gender identity")-enrolled in The PRIDE Study. A multivariate general linear model tested the effects of chronological age, gender group (with gender-diverse as the reference), and their interaction on the eight EPSI scales.Multivariate analyses showed significant main effects of age (V = .045, p < .001) and gender group (V = .098, p < .001), but no significant age-by-group interaction. Older age was associated with greater Cognitive Restraint (β = .22, p < .001), Negative Attitudes toward Obesity (β = .22, p < .001), and Excessive Exercise (β = .12, p = .001). Compared to gender-diverse individuals, transgender men exhibited higher Muscle Building, Cognitive Restraint, and Excessive Exercise scores, whereas transgender women reported higher Binge Eating, Purging, Cognitive Restraint, and Negative Attitudes toward Obesity, but lower Muscle Building. A single significant interaction indicated that transgender women showed stronger age-related differences in Purging.These findings contribute to growing evidence that disordered eating symptoms may not simply resolve with age among TGD individuals and necessitate lifespan-sensitive approaches to eating disorder care. These patterns likely capture a mix of aging processes and cohort-specific exposures to weight-normative and cis-normative ideals. Level of evidence Level V: based on descriptive studies.

  View details for DOI 10.1007/s40519-025-01779-4

  View details for PubMedID 40802033

  View details for PubMedCentralID 10214585

• Progestogen Experience Among Transgender Women and Gender Diverse Adults Assigned Male at Birth in the United States. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists Chang, J. J., Tran, N. K., Flentje, A., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R., Ariel, D. 2025

  Abstract

  Progestogens are often sought as part of estrogen-based gender-affirming hormone therapy (E-GAHT) in transgender and gender diverse (TGD) adults assigned male sex at birth (AMAB). Few studies describe their use or impact. The purpose of this study is to describe and evaluate the patient experience with progestogens for E-GAHT.Through a cross-sectional, mixed-methods concurrent embedded design study, an online cohort of TGD AMAB adults with feminine/transfeminine or non-binary gender identity in the United States was surveyed about progestogen use patterns, initiation reasons, perceived impact of progestogens, side effects, and care satisfaction.543 participants completed the study. Among 310 progestogen users, the most common progestogens were oral micronized progesterone (58.4%), rectal micronized progesterone (10.6%), and oral medroxyprogesterone acetate (7.7%). Breast development (85.2%) was the most cited reason for progestogen initiation. Most progestogen users perceived improvement in breast development (79.6%) and sense of femininity (81.3%). Fewer participants reported changes in libido, sleep, and memory. Common side effects were breast pain (28.7%) and mood fluctuation (21.9%). Cases of lower extremity venous thrombosis (n=6), pulmonary embolism (n=4), and stroke (n=4) were reported. Most users expressed satisfaction with progestogens (71.9%) but also reported barriers and lack of clarity surrounding effectiveness or whether to initiate.In the largest survey describing progestogen experience in E-GAHT to date, over half of TGD AMAB adults used progestogens. While most report satisfaction with use, further objective evidence on the benefits of progestogens is needed to clarify its clinical impact as part of E-GAHT.

  View details for DOI 10.1016/j.eprac.2025.06.028

  View details for PubMedID 40633693

• Unmet Subsistence and Mental Health Needs in Women Experiencing Homelessness: Rethinking Care Models for Improved Outcomes. Journal of general internal medicine Ngo, T. P., Neilands, T. B., Flentje, A., Dilworth, S. E., Riley, E. 2025

  Abstract

  Women experiencing homelessness or unstable housing (WEH) exhibit disproportionately high rates of depression and anxiety. While existing research links unmet subsistence needs (e.g., housing and food insecurity) to mental health (MH), the intersection of these unmet needs with health and social factors on MH disparities remains underexplored.We examined associations between unmet subsistence needs and MH symptoms among WEH, focusing on interactions with health and social-related factors, including sleep disturbances, pain, and HIV status.Cross-sectional analysis using baseline data from the PULSE cohort study.245 women recruited from shelters, free meal programs, and street encampments.We measured anxiety with the Generalized Anxiety Disorder 7-item (GAD-7) and depression with the Patient Health Questionnaire (PHQ-9). Unmet subsistence needs included insufficient access to shelter, food, clothing, and hygiene resources.Nearly half (49%) of WEH had moderate to severe depression, 36% had moderate to severe anxiety, and nearly 40% had at least one unmet subsistence need. WEH with ≥ 2 unmet needs had almost four times the odds of depression (AOR = 3.96, 95% CI = 1.84, 8.51) and nearly three times the odds of anxiety (AOR = 2.83, 95% CI = 1.39, 5.77) than those without unmet needs. Sleep disturbance and pain were also associated with higher odds of depression (AOR = 4.46, 95% CI = 2.28, 8.71; AOR = 7.01, 95% CI: 3.40, 14.44) and anxiety (AOR = 5.01, 95% CI = 2.70, 9.31; AOR = 3.60, 95% CI = 1.73, 7.50). HIV modified the effect of unmet needs, with seven times higher odds of anxiety among women with HIV who also had ≥ 2 unmet needs (AOR = 7.11, 95% CI = 1.06, 48.00).Unmet subsistence needs, sleep disturbances, and pain contribute to depression and anxiety among WEH, particularly those living with HIV. Low-barrier care models that address social needs alongside medical care may improve MH outcomes in WEH.

  View details for DOI 10.1007/s11606-025-09709-x

  View details for PubMedID 40610668

  View details for PubMedCentralID 4151936

• The hidden human cost of defunded LGBTQIA+ health research. Nature medicine Kinitz, D. J., Lubensky, M. E., Tran, N. K., Flentje, A., Lunn, M. R. 2025

  View details for DOI 10.1038/s41591-025-03794-5

  View details for PubMedID 40579548

  View details for PubMedCentralID 10187482

• Side Effect Profiles of Nonhormonal, Nonsurgical Gender-Affirming Body Modifications. LGBT health Schwartz, B. L., Tran, N. K., Mayo, J. A., Peitzmeier, S. M., Poteat, T. C., Lubensky, M. E., Flentje, A., Obedin-Maliver, J., Lunn, M. R. 2025

  Abstract

  Purpose: Binding, packing, using stand-to-pee (STP) devices, and tucking are nonhormonal, nonsurgical gender-affirming body modifications (GABMs) that are used to affirm gender expression. This study sought to describe the sociodemographic characteristics of and side effects experienced by those using GABMs. Methods: We conducted a cross-sectional study of The Population Research in Identity and Disparities for Equality Study participants who completed the 2023 Annual Questionnaire. Data on sociodemographics and self-reported side effects were collected and analyzed using descriptive statistics. Results: Of 6296 participants, 1694 reported GABMs including binding (n = 995), packing (n = 590), using an STP device (n = 351), and tucking (n = 265). Each GABM had a distinct side effect profile. Pain (2.0%-48.2% past-year prevalence) and dermatologic concerns (0.5%-23.2% past-year prevalence) were reported across GABMs. Conclusion: While GABMs promote mental health and patient safety, they carry a risk of adverse physical health effects. Providers play a vital role in managing GABM-associated side effects to ensure patients can continue to affirm their gender identities.

  View details for DOI 10.1089/lgbt.2024.0319

  View details for PubMedID 40434894

• Methods of family building used by sexual and gender minority adults in the United States. Human reproduction (Oxford, England) Tordoff, D. M., Leonard, S. A., Zhang, J., Snow, A., Monseur, B., Bahati, M. A., Armea-Warren, C., Moretti, D., Lubensky, M. E., Flentje, A., Lunn, M. R., Obedin-Maliver, J. 2025

  Abstract

  What methods are used by sexual and gender minority (SGM) parents to build their families?SGM parents used diverse methods to build their families, which varied both by gender identity and age.Despite experiencing significant barriers to becoming parents, 63% of SGM adults aged 18-35 years old are considering having children or expanding their family. Data on US same-sex couples demonstrate that although most same-sex parents (68%) are genetically related to their children, they are more likely to adopt, foster, and be step-parents compared with different-sex couples.Cross-sectional analysis of 2018-2020 data from The PRIDE Study, a community-engaged longitudinal cohort study of SGM adults living in the USA. This analysis included 2122 SGM parents with 4712 children (median of 2 children per parent).Primary exposures were SGM subgroups (cisgender sexual minority men, cisgender sexual minority women, gender diverse people assigned female at birth [AFAB], gender diverse people assigned male at birth [AMAB], transgender men, and transgender women) and age cohorts (18-39, 40-54, and 55 and older). The primary outcome was method of family building, grouped into three overarching categories defined as (1) pregnancy from sexual activity, (2) pregnancy without sexual activity (e.g. use of donor gametes, surrogacy), and (3) a method other than pregnancy (e.g. adoption, fostering, step-parenting). We used logistic regression models to evaluate differences in methods of family building used by SGM subgroup and age groups.Overall, 56% of SGM adults became parents through pregnancy from sexual activity, 14% became parents through pregnancy without sexual activity, and 28% became parents from a method other than pregnancy. Transgender women, gender diverse parents, and cisgender men had a higher odds of using pregnancy through sexual activity to become parents and were less likely to become parents using pregnancy without sexual activity compared with cisgender women. Conversely, transgender men were less likely to use pregnancy through sexual activity (aOR 0.57, 95% CI 0.44, 0.73) and over twice as likely to use methods other than pregnancy (aOR 2.39, 95% CI 1.86, 3.06) compared to cisgender women. Parents aged 18-39 and 40-54 years old were twice as likely to use pregnancy without sexual activity compared with parents aged 55+ years old (Age 18-39: aOR 2.16, 95% CI: 1.55, 2.99; Age 40-54: aOR 1.92, 95% CI: 1.39, 2.66).Our convenience sample was predominantly White. We are unable to infer information about the preferred methods or attempted but unsuccessful methods of family building.The number of SGM parents is likely to grow, given that younger generations are more likely to identify as SGM, desire children, and have access to medically assisted reproduction. Clinicians must be aware of the diversity of methods SGM parents used to become parents and the financial, legal, and institutional barriers that SGM people navigate when building their families.Funding for this work was provided by the Stanford Maternal and Child Health Research Institute Seed Grant program to J.O.M. and S.L. and the Stanford University School of Medicine Department of Obstetrics and Gynecology. Research reported in this article was partially funded through a Patient-Centered Outcomes Research Institute (PCORI) Award [award number PPRN-1501-26848] to M.R.L. The statements in this article are solely the responsibility of the authors and do not necessarily represent the views of PCORI, its Board of Governors or Methodology Committee, or the National Institutes of Health. J.O.M. was partially supported by the National Institute of Diabetes, Digestive, and Kidney Disorders [grant number K12DK111028]. A.F. was partially supported by the National Institute on Drug Abuse [grant number K23DA039800]. The funding sponsors had no role in study design; the data collection, analysis, and interpretation of data; the writing of the report; the decision to submit the article for publication; or the preparation of the manuscript. Dr Obedin-Maliver has received grants and consultation fees from Ibis Reproductive Health, Hims and Hers Health Inc., Folx Health Inc., Sage Therapeutics and Upstream Inc. on topics unrelated to this work. Dr Lunn received consultation fees from Hims and Hers Health Inc., Folx Health Inc., Otsuka Pharmaceutical Development and Commercialization, Inc., and the American Dental Association on topics unrelated to this work. All other authors have no conflicts of interest to report.None.

  View details for DOI 10.1093/humrep/deaf098

  View details for PubMedID 40409753

• Community norms of the Eating Pathology Symptoms Inventory (EPSI) in transgender and gender-diverse adults. Eating behaviors Nagata, J. M., Otmar, C. D., Lee, C. M., Compte, E. J., Lavender, J. M., Brown, T. A., Forbush, K. T., Flentje, A., Lubensky, M. E., Lunn, M. R., Obedin-Maliver, J. 2025; 58: 101993

  Abstract

  Transgender and gender-diverse (TGD) individuals are at a higher risk for eating disorders, yet existing community norms for many eating disorder measures predominantly derive from cisgender populations. This study aimed to establish community norms for the Eating Pathology Symptoms Inventory (EPSI) among TGD adults (Forbush et al., 2013). The sample included 1206 gender-diverse people, 599 transgender men, and 293 transgender women from The PRIDE Study, a national longitudinal cohort of sexual and gender minority adults in the United States. We report mean scores, standard deviations, medians, interquartile ranges, and percentile ranks for the eight EPSI scales within TGD populations. Transgender women exhibited significantly higher scores on the Cognitive Restraint, Excessive Exercise, and Negative Attitudes Toward Obesity scales compared to transgender men and gender-diverse people. Conversely, transgender men showed significantly higher scores on the Muscle Building scale relative to transgender women and gender-diverse people. These findings suggest distinct patterns of eating pathology symptoms among TGD individuals and emphasize the need for clinicians to consider gender identity when assessing eating disorder symptoms.

  View details for DOI 10.1016/j.eatbeh.2025.101993

  View details for PubMedID 40435686

• Factor structure, internal consistency, and measurement invariance of the Eating Pathology Symptoms Inventory (EPSI) in a national U.S. sample of cisgender gay men and lesbian women. Journal of eating disorders Nagata, J. M., Otmar, C. D., Kim, A. E., Compte, E. J., Lavender, J. M., Brown, T. A., Forbush, K. T., Flentje, A., Lubensky, M. E., Lunn, M. R., Obedin-Maliver, J. 2025; 13 (1): 83

  Abstract

  The Eating Pathology Symptoms Inventory (EPSI) is a questionnaire that assesses the severity of eating-disorder symptoms. This study aimed to examine the factor structure and measurement invariance of the EPSI in a large national U.S. sample of cisgender gay men and lesbian women.The sample consisted of 1,498 cisgender sexual minority adults, including cisgender gay men (n = 925) and cisgender lesbian women (n = 573), who completed online self-report surveys. Using a split-half approach, exploratory factor analysis (EFA) was conducted in the first subset of each sample to identify underlying factor structures, followed by confirmatory factor analysis (CFA) to confirm model fit in the second subset of each sample. Multi-group confirmatory factor analysis (MG-CFA) was used to assess measurement invariance across the two sexual minority groups.The EPSI eight-factor structure was supported across both cisgender sexual minority groups with strong model fit: cisgender gay men (CFI = 0.96, RMSEA = 0.04, SRMR = 0.06) and cisgender lesbian women (CFI = 0.94, RMSEA = 0.05, SRMR = 0.07). Measurement invariance analyses indicated that the EPSI was invariant across groups. Internal consistency, assessed using McDonald's omega, was acceptable for all scales (ωs = 0.75 to 0.95).This study provides support for the utility of the EPSI in cisgender gay men and lesbian women populations, including measurement invariance that allows for meaningful comparisons across groups. Specifically, the EPSI performs reliably and consistently as a measure of eating pathology across adult cisgender gay men and cisgender lesbian women.

  View details for DOI 10.1186/s40337-025-01277-z

  View details for PubMedID 40369683

  View details for PubMedCentralID PMC12076874

• Factor Structure, Internal Consistency, and Measurement Invariance of the Eating Pathology Symptoms Inventory (EPSI) in Transgender and Gender-Diverse Adults. The International journal of eating disorders Nagata, J. M., Otmar, C. D., Lopez, A., Compte, E. J., Lavender, J. M., Brown, T. A., Forbush, K. T., Flentje, A., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R. 2025

  Abstract

  This study aimed to examine the psychometric properties, including factor structure, internal consistency, and measurement invariance of the Eating Pathology Symptoms Inventory (EPSI) in a large national sample of transgender and gender-diverse (TGD) adults.The sample consisted of 2098 TGD adults-including transgender men (n = 599), transgender women (n = 293), and gender-diverse individuals (n = 1206)-who completed online self-report surveys. Using a subset of the sample, exploratory factor analysis (EFA) was conducted to identify underlying factor structures, followed by confirmatory factor analysis (CFA) to confirm the model fit within each population in the remainder of the sample. Multi-group confirmatory factor analysis (MG-CFA) was used to assess measurement invariance across transgender men, transgender women, and gender-diverse individuals.The EPSI's eight-factor structure was supported across all three TGD groups with strong model fit: transgender men (CFI = 0.985, RMSEA = 0.047, SRMR = 0.078), transgender women (CFI = 0.948, RMSEA = 0.048, SRMR = 0.085), and gender-diverse individuals (CFI = 0.962, RMSEA = 0.040, SRMR = 0.060). Measurement invariance analyses supported that the EPSI was invariant across the groups, facilitating meaningful group comparisons using the inventory. Internal consistency, assessed using McDonald's omega, was acceptable for all subscales (ω = 0.74-0.94).This study provides psychometric support for the EPSI in TGD groups. The results indicate that the EPSI performs reliably and consistently across these groups for assessing eating pathology among gender minority people.

  View details for DOI 10.1002/eat.24433

  View details for PubMedID 40183494

• Community norms of the Eating Pathology Symptoms Inventory (EPSI) in cisgender sexual minority adults. Eating and weight disorders : EWD Nagata, J. M., Otmar, C. D., Lee, C. M., Compte, E. J., Lavender, J. M., Brown, T. A., Forbush, K. T., Flentje, A., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R. 2025; 30 (1): 34

  Abstract

  Cisgender sexual minority adults are at elevated risk for eating disorders; however, community norms for certain eating disorder measures are lacking for this population. This study aimed to establish community norms for the Eating Pathology Symptom Inventory (EPSI) among cisgender gay, lesbian, bisexual + (individuals who identify as bisexual or pansexual; bi +) adults.Cross-sectional data were analyzed from 2062 cisgender participants-including 925 gay men, 573 lesbian women, 116 bi + men, and 448 bi + women-enrolled in The PRIDE Study, a national longitudinal cohort of sexual and gender minority adults in the United States. Participants completed the EPSI, and descriptive statistics were calculated for the eight EPSI scales.We report mean scores, standard deviations, medians, interquartile ranges, and percentile ranks for the eight EPSI scales within cisgender sexual minority populations. Distinct patterns of eating-pathology symptoms were evidenced among the cisgender sexual minority groups. Cisgender bi + women exhibited the highest scores for Body Dissatisfaction, Binge Eating, and Restricting compared to other groups, whereas cisgender bi + men reported the highest scores for Excessive Exercise. Cisgender gay men had significantly higher scores for Muscle Building and Negative Attitudes Toward Obesity compared to other groups.These findings offer valuable benchmarks for interpreting EPSI scores in the assessment and treatment of eating disorders among cisgender sexual minority individuals.Level V: based on descriptive results.

  View details for DOI 10.1007/s40519-025-01742-3

  View details for PubMedID 40183833

  View details for PubMedCentralID 10379623

• Associations of minority stress and employment discrimination with job quality among sexual- and gender-minority workers. Scandinavian journal of work, environment & health Kinitz, D. J., Tran, N. K., Shahidi, F. V., Maslak, J. T., Flentje, A., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R. 2025

  Abstract

  This study aimed to describe how minority stress and employment discrimination are associated with job quality (ie, employment type and income) among sexual- and gender-minority (SGM) workers.We conducted a pooled cross-sectional analysis of the 2021 and 2022 surveys from a national study of SGM adults in the United States. Using multinomial logistic regression models and stratification by six gender groups, we examined associations of minority stress and past-year employment discrimination with job quality.Among 4221 workers, 22.0% experienced precarious employment and 6.8% were unemployed. Approximately half earned ≤US$50 000. The mean minority stress score was 14.41, indicating moderate-to-severe minority stress. A one-standard-deviation increase in minority stress was associated with higher odds of precarious employment [adjusted odds ratio (ORadj) 1.17, 95% confidence interval (CI) 1.08-1.26], unemployment [ORadj 1.36 (95% CI 1.19-1.56)], earning ≤$20 000 USD [ORadj 1.57 (95% CI 1.36-1.80)], and earning US$20 001-50 000 [ORadj 1.48 (95% CI 1.32-1.66)]. Employment discrimination was reported by 14.4% of all workers and was associated with precarious employment [ORadj 1.25 (95% CI 1.01-1.54)], unemployment [ORadj 2.11 (95% CI 1.54-2.89)], and earning US$20 001-50 000 compared to ≥US$100 001 [ORadj 1.45 (95% CI 1.07-1.96)]. Transgender and gender-diverse (TGD) workers faced poorer job quality, greater minority stress, and employment discrimination than cisgender sexual minority workers.Higher minority stress levels and employment discrimination were associated with worse job quality among SGM workers. Future labor market reforms should reduce minority stress and employment discrimination, as well as improve job quality, for SGM workers.

  View details for DOI 10.5271/sjweh.4221

  View details for PubMedID 40159312

• Neighborhood-level adversity and inflammation among sexual minority men living with HIV. Health psychology : official journal of the Division of Health Psychology, American Psychological Association Ghanooni, D., Carrico, A. W., Flentje, A., Moreno, P. I., Harkness, A., Dilworth, S., Pahwa, S., Pallikkuth, S., Regan, S., Aouizerat, B. E., Duncan, D. T. 2025; 44 (3): 188-196

  Abstract

  This cross-sectional study investigated the associations of neighborhood-level factors with immune activation, systemic inflammation, and leukocyte telomere length in 110 sexual minority men with human immunodeficiency virus.From 2013 to 2017, sexual minority men with human immunodeficiency virus who used stimulants were recruited in San Francisco, California and provided blood samples to measure the markers of immune activation, systemic inflammation, and leukocyte telomere length. To measure neighborhood-level indices, the home address for each participant was geocoded and linked to data from the Centers for Disease Control and Prevention. Hierarchical linear modeling was employed to investigate the associations of neighborhood-level factors with systemic inflammation and leukocyte telomere length.After adjusting for age, stimulant use, self-reported income, level of education, and race and ethnicity, residing in neighborhoods with greater percentages of poverty (β = .33, p < .001) and a higher proportion of racial/ethnic minority residents (β = .26, p < .05) were independently associated with higher levels of interleukin-6. Additionally, residing in neighborhoods with higher percentage of uninsured individuals was independently associated with higher tumor necrosis factor-alpha (β = .24, p < .05). Indices of neighborhood-level adversity were additionally associated with providing a urine sample that was reactive for stimulants (OR = 1.31, p = .002), which was, in turn, associated with shorter leukocyte telomere length (β = -.31, p < .05).Future longitudinal research should examine the biobehavioral pathways linking neighborhood-level factors and stimulant use with systemic inflammation and cellular aging. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

  View details for DOI 10.1037/hea0001479

  View details for PubMedID 39992764

  View details for PubMedCentralID PMC11856452

• Trauma Symptoms, Minority Stress, and Substance Use: Implications for Trauma Treatment in Sexual and Gender Minority Communities. Psychology of sexual orientation and gender diversity Flentje, A., Ceja, A., Dilley, J. W., Lisha, N. E., Cloitre, M., Artime, T. M., Shumway, M., Einhorn, L., Edward, D., Ong, L., Lubensky, M. E., Neilands, T. B., Obedin-Maliver, J., Lunn, M. R. 2025

  Abstract

  Posttraumatic stress symptoms are very high among sexual and/or gender minority (SGM) people. Development and testing of trauma interventions with SGM people is needed, but first we need to understand who among SGM people are at greatest risk of posttraumatic stress symptoms, how minority stress may contribute, and the frequency of substance use comorbidity with significant posttraumatic stress symptoms among SGM people. General linear models and logistic regressions were used to examine demographic differences, minority stress, and substance use related to posttraumatic stress symptoms among a national sample of SGM people (N = 4,589, M age = 32.1, 55% cisgender). All gender groups had greater posttraumatic stress symptoms than the reference group of cisgender men. All sexual orientation groups, except for straight/heterosexual SGM people, had greater posttraumatic stress symptoms than participants in the reference gay/lesbian group. Younger age or identifying as American Indian or Alaska Native, or Hispanic, Latino, or Spanish was associated with more posttraumatic stress symptoms. Non-specific and SGM-specific minority stress were each related to greater odds of significant posttraumatic stress symptoms, even after accounting for Criterion A events. Among participants with significant posttraumatic stress symptoms, 13.6% were at risk for alcohol use disorder, and 56.4% were at risk for other substance use disorder. Marginalized SGM subgroups have more posttraumatic stress symptoms. Interventions for SGM people should consider minority stress coping strategies and substance use comorbidities.

  View details for DOI 10.1037/sgd0000783

  View details for PubMedID 41059480

  View details for PubMedCentralID PMC12499634

• Exposure to intimate partner violence and subsequent substance use among a nationwide sample of LGBTQIA+ people: results of The PRIDE Study. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine Metheny, N., Tran, N. K., Dusing, G. J., Scott, D., Lubensky, M. E., Lunn, M. R., Obedin-Maliver, J., Flentje, A. 2025; 59 (1)

  Abstract

  Individuals who are lesbian, gay, bisexual, transgender, queer or questioning, intersex, aromantic, asexual, or another sexual or gender minority (LGBTQIA+) are at greater risk of both intimate partner violence (IPV) and substance use compared to their cisgender, heterosexual counterparts. However, knowledge regarding the complex relationship between IPV and substance use in LGBTQIA+ communities is limited.This study used data from 2 years of The PRIDE (Population Research in Identity and Disparities for Equality) Study, a nationwide, community-based sample of LGBTQIA+ adults in the United States. Past-year IPV in 2021 was measured using the Extended-Hurt, Insulted, Threaten, Scream scale. Substances used in 2022 were measured via the NIDA-Modified Alcohol, Smoking, and Substance Involvement Screening Test (NM ASSIST). Linear and modified Poisson regression models explored temporal relationships between past-year IPV and prospective substance use.Participants (n = 3745) were relatively young (median= 34 years, interquartile range: 27.6-48.5) and represented diverse LGBTQIA+ subcommunities. Approximately one-quarter (23.7%) were cisgender women and 17% were cisgender men. Half (49.2%) were gender minority people. Overall, one-quarter (24.6%) reported exposure to IPV in 2021. In adjusted models, past-year IPV was associated with prospective substance use (risk ratio [RR]: 1.11; 95% CI, 1.03-1.19). Additionally, more frequent IPV was associated with a higher prospective NM ASSIST score for cannabis (B: 0.22; 95% CI, 0.08-0.36), stimulants (B: 0.20; 95% CI, 0.06-0.35), hallucinogens (B: 0.07; 95% CI, 0.02-0.12), and narcotics (B: 0.12; 95% CI, 0.03-0.20).Exposure to IPV in 2021 was linked to greater substance use in 2022. Findings underscore the role of IPV in substance use among LGBTQIA+ people. Furthermore, they point to the need for increased IPV screening and referral among LGBTQIA+ people, as well as the potential efficacy of trauma-informed substance use interventions that address IPV.

  View details for DOI 10.1093/abm/kaaf091

  View details for PubMedID 41214893

  View details for PubMedCentralID PMC12602189

• Understanding differences in types of social support and their effects on mental health over time for trans and nonbinary adults. Psychology of sexual orientation and gender diversity Tebbe, E., Lisha, N. E., Neilands, T. B., Lubensky, M. E., Dastur, Z., Lunn, M. R., Obedin-Maliver, J., Flentje, A. 2025

  Abstract

  Although research has shown that social support generally is beneficial to mental health among trans and nonbinary (TNB) adults, less is known regarding what forms of support and the degree to which they mitigate the harms of minority stress on mental health over time. This study investigated differences in types of social support and their association with mental health over time in a sample of 2,411 TNB adults, predominantly younger in age (53% 18-30 years old), diverse in sexual orientation (97.5%, LGBQA+, 2.5% straight/heterosexual), gender identity (53.3% non-binary, 26% trans man, 12.4% trans woman), and similar in race and ethnicity to the US national population. We conducted a latent profile analysis (LPA) to identify social support typologies. A three-profile solution classified participants into a Low (39.6%), Moderate (40.7%), or High Support profile (19.7%). Significant variability in gender-related support experiences was noted for those in the Moderate and High Support profiles, while those in the Low Support profile had almost uniformly little to no support from family. Mental health outcomes differed between the profiles; Low Support participants reported significantly worse depression and PTSD symptoms; demographically, the greatest proportion of participants with marginalized identities clustered in the Low Support profile. Finally, we tested profile membership as a moderating variable in the association of minority stressors with mental health over time. Few significant differences emerged between groups, suggesting that being in a higher support profile may not necessarily buffer the harms of minority stress on mental health over time. Intervention implications are discussed.

  View details for DOI 10.1037/sgd0000789

  View details for PubMedID 40881963

  View details for PubMedCentralID PMC12380377

• Anxiety and Depression Symptoms Among Sexual and Gender Minority People by Disability Status: Findings From The PRIDE Study, 2019-2020 Annals of LGBTQ Public and Population Health Lamba, S., Mayo, J., Lubensky, M. E., Dastur, Z., Flentje, A., Obedin-Maliver, J., Lunn, M. R. 2025; 6 (2)

  View details for DOI 10.1891/LGBTQ-2024-0011

• Healthcare provider communication and current contraceptive use among transgender men and gender-diverse people: results from an online, cross-sectional survey in the United States. Contraception Berry, J., Obedin-Maliver, J., Ragosta, S., Hastings, J., Lunn, M. R., Flentje, A., Capriotti, M. R., Dastur, Z., Lubensky, M. E., Inman, E. M., Moseson, H. 2024: 110784

  Abstract

  To explore whether discussing contraceptive use with a healthcare provider is associated with current contraceptive use among transgender men and gender-diverse (TMGD) individuals.In 2019, we conducted a cross-sectional survey among transgender men and gender-diverse adults in the United States who were assigned female or intersex at birth. We measured whether respondents had ever discussed contraception with a healthcare provider as well as current use of contraception, reasons for use, and barriers to use. We described frequencies and ranges for key variables and implemented a series of nested logistic regression models to evaluate the association between ever having spoken to a provider about contraception and current use of contraception for any reason, overall and by method type.Among 1,694 respondents, about half (48%) were currently using a method of contraception for any reason, most commonly barrier methods (17%) and long-acting-reversible-contraception (LARC) (17%). Compared to those who never had a conversation about contraception with a provider, respondents who spoke with a provider were more likely to be currently using contraception - particularly among those who self-initiated the conversation (aOR: 3.8, 95% CI: 2.5-5.6). Having discussed contraception with a healthcare provider was most strongly associated with current LARC use.Having had a conversation with a provider about contraception use was positively associated with current contraception use among a large, national sample of transgender men and gender-diverse people. Facilitating patient participation in contraception counseling for transgender and gender-diverse patients should be emphasized in provider training.Given formidable barriers to healthcare faced by TMGD people, training providers on how to initiate affirming and relevant conversations with TMGD patients about contraceptive needs and preferences is essential, as are efforts to educate and empower TMGD individuals to advocate for the information they need in these interactions.

  View details for DOI 10.1016/j.contraception.2024.110784

  View details for PubMedID 39701207

• Factor structure and psychometric properties of the Muscle Dysmorphic Disorder Inventory (MDDI) among transgender women. Body image Nagata, J. M., Compte, E. J., McGuire, F. H., Lavender, J. M., Brown, T. A., Capriotti, M. R., Flentje, A., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R. 2024; 51: 101798

  Abstract

  Muscle dysmorphia (MD) is characterized by extreme preoccupation with insufficient muscularity that prompts pathological behaviors and distress/impairment. The Muscle Dysmorphic Disorder Inventory (MDDI) - a widely used measure of MD symptoms - has yet to be validated among transgender women, despite emerging evidence suggesting risk for muscularity-oriented concerns in this population. We examined the MDDI factor structure as well as the reliability and validity of its subscales in a sample of 181 transgender women ages 19-73 years who participated in a national longitudinal cohort study of U.S. sexual and gender minority adults. Confirmatory factor analysis was used to examine model fit for the original three-factor structure of the MDDI (drive for size, appearance intolerance, functional impairment). A re-specified three-factor model allowing covariance of residuals for two conceptually related items demonstrated good overall fit (χ2/df = 1.33, CFI =.94, TLI =.93, RMSEA =.06 [95 % CI =.01,.09], SRMR =.07). Moreover, results supported the internal consistency and convergent and discriminant validity of the MDDI subscales in transgender women. Findings inform the use of the MDDI among transgender women and provide a foundation to support future research on the MDDI and MD symptoms among gender minority populations.

  View details for DOI 10.1016/j.bodyim.2024.101798

  View details for PubMedID 39405723

• Conversion practice recall and mental health symptoms in sexual and gender minority adults in the USA: a cross-sectional study. The lancet. Psychiatry Tran, N. K., Lett, E., Cassese, B., Streed, C. G., Kinitz, D. J., Ingram, S., Sprague, K., Dastur, Z., Lubensky, M. E., Flentje, A., Obedin-Maliver, J., Lunn, M. R. 2024

  Abstract

  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.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.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.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.Gill Foundation, Dona Rockstand, and Patient-Centered Outcomes Research Institute.

  View details for DOI 10.1016/S2215-0366(24)00251-7

  View details for PubMedID 39362229

• Contraceptive use among transgender men and gender diverse individuals in the United States: reasons for use, non-use, and methods used for pregnancy prevention. Contraception Obedin-Maliver, J., Snow, A., Ragosta, S., Fix, L., Hastings, J., Lubensky, M. E., Capriotti, M. R., Dastur, Z., Flentje, A., Lunn, M. R., Moseson, H. 2024: 110719

  Abstract

  To describe contraceptive use for pregnancy prevention among transgender men and gender diverse (TGD) individuals assigned female or intersex at birth (AFIAB) and explore whether contraceptive use differs by testosterone use.We analyzed data from a cross-sectional, online survey of N=1,694 TGD individuals AFIAB recruited in 2019 through a community-facing website and a national community-engaged cohort study of sexual and/or gender minority (SGM) adults in the US. Descriptive and regression analyses characterized the current and ever use of contraceptive methods for pregnancy prevention, stratified by testosterone use, and described reasons for contraceptive use/non-use.Most respondents (71.0%) had used contraception before with 49.4% using it for pregnancy prevention. The methods for pregnancy prevention that were most frequently ever used for pregnancy prevention included: external condoms (91.8%), combined hormonal contraceptive pills (63.0%), and withdrawal (45.9%). The methods most frequently currently used for pregnancy prevention included: external condoms (35.4%), hormonal IUD (24.8%), and abstinence (19.2%). Some reported formerly (n=55, 6.6%) or currently (n=30, 3.6%) relying on testosterone for pregnancy prevention. Only 4 of the 33 reasons for contraceptive use and non-use differed by testosterone use group. The most reported reasons for never using contraception were not engaging in penis-in-vagina sex (5.7%) or no sex with individuals who produce sperm (4.8%).Most TGD individuals AFIAB have used contraception, and almost half for pregnancy prevention. The most used methods require minimal and/or non-invasive healthcare system interaction. Some respondents relied on testosterone as birth control, despite a lack of efficacy evidence.

  View details for DOI 10.1016/j.contraception.2024.110719

  View details for PubMedID 39341444

• Levels and outcomes of 12-step participation among sexual and gender minority subgroups. Journal of substance use and addiction treatment McGeough, B. L., Zemore, S. E., Dastur, Z., Neilands, T. B., Lisha, N. E., Lunn, M. R., Obedin-Maliver, J., Lubensky, M. E., Flentje, A. 2024: 209519

  Abstract

  Sexual minority (e.g., bisexual, gay, lesbian, queer) and gender minority (e.g., transgender, non-binary, gender expansive) individuals (SGMI) experience higher rates of alcohol and other substance use disorders than their heterosexual and cisgender (i.e., non-transgender) counterparts. 12-Step programs are currently the most common source of support for alcohol and other substance use-related problems in the United States. Little is known about rates and levels of participation and outcomes of SGMI in 12-Step programs. Examining SGMI with a lifetime alcohol or other substance use disorder, this study aims to: 1) describe lifetime attendance rates (any vs. none) and levels of participation (number of program activities) in 12-Step groups among SGMI overall and compare rates of attendance and levels of participation across sexual and gender minority identities and 2) determine how lifetime level of participation in 12-Step programs relates to past-year alcohol and other substance use outcomes.We used data collected through The PRIDE Study, a national, large-scale, longitudinal health study of adult SGMI, administering supplemental questions to assess alcohol and other substance use disorders and 12-step participation. Zero-Inflated Negative Binomial models (N = 1353) run with sexual and gender identities as predictors of lifetime 12-step attendance (yes/no) and level of 12-Step participation determine if greater levels of 12-Step participation were associated with lower levels of past-year Alcohol and Substance Use Disorder (AUD & SUD) symptoms. The study ran models for those with lifetime AUD (n = 1074) and SUD (n = 659) separately.Participants who engaged in greater levels of 12-Step participation had lower levels of past-year AUD and SUD symptoms. Gay and queer respondents with AUD were more likely and lesbian respondents with SUD were less likely than other participants to have ever participated in 12-Step programs. All other associations between sexual/gender identities and 12-Step participation disappeared when age was added to the model.This study provides preliminary evidence that 12-Step participation may be an effective resource for reducing AUD and SUD symptoms among SGMI. Younger SGMI and SGMI holding sexual/gender identities other than gay and queer may require additional support to initiate participation in 12-Step programs.

  View details for DOI 10.1016/j.josat.2024.209519

  View details for PubMedID 39260805

• The experiences of sexual and gender minority participants with a remote biospecimen collection protocol. Annals of LGBTQ public and population health Panyanouvong, N., Lella, P., Sunder, G., Lubensky, M. E., Dastur, Z., Aouizerat, B., Lisha, N., Neilands, T., Flowers, E., Lunn, M. R., Obedin-Maliver, J., Flentje, A. 2024; 5 (3): 206-222

  Abstract

  Sexual and gender minority (SGM) communities are underrepresented in biomedical studies, highlighting the importance of developing biospecimen collection protocols aimed at engaging SGM participants. We aimed to learn more about SGM participants' experiences with a remote (i.e., not performed at a central location) biospecimen collection study pioneered by The PRIDE Study, a cohort study of SGM adults residing in the United States and its territories. Feedback was collected from 112 SGM participants following blood donation for a parent study investigating the relationship between minority stress, substance use, and epigenetic markers of substance use and minority stress. We used an inductive and collaborative approach to qualitative analysis and identified major themes and areas for protocol improvement. Major themes among participant feedback were: (1) communication with the research team, (2) convenience of donation, (3) interactions with clinical laboratory staff, and (4) anonymity and privacy. Most participants indicated that they experienced little to no problems during the donation process and expressed approval for the clarity and transparency of the informed consent process, ease of communication with the research team, and measures taken to protect participant confidentiality during their appointment. The most common challenges encountered by participants related to the inconvenience of handling and transporting study materials to the clinical laboratory site and clinical laboratory staff's unfamiliarity with the study protocol. Some participants indicated a preference for more elements of the study protocol (e.g., transporting collection materials) to be left to the responsibility of the research team. Future studies should carefully consider the delegation of responsibility between participants and the research team to balance both study reach and participant accessibility. Alternative formats, such as at-home collection or collaboration with community health workers, may further enhance participant satisfaction and convenience.

  View details for DOI 10.1891/lgbtq-2023-0045

  View details for PubMedID 40487144

  View details for PubMedCentralID PMC12140397

• An Automated Algorithm for Classifying Expansive Responses for Gender Identity. Psychology of sexual orientation and gender diversity Ceja, A., Raygani, S., Conner, B. T., Lisha, N. E., Bryant-Lees, K. B., Lubensky, M. E., Lunn, M. R., Obedin-Maliver, J., Flentje, A. 2024

  Abstract

  Current two-step measures of gender identity do not prescribe methods for using expanded responses (e.g., multiple selections) among sexual and gender minority (SGM) people, though they want the opportunity to provide these responses. To increase statistical power using expanded gender identity responses, we created an automated algorithm to generate analyzable categories. Participants' expanded gender identity responses and sex assigned at birth were used to create five categories (i.e., cisgender men, cisgender women, gender expansive individuals, transgender men, and transgender women) from a cohort of SGM people (N = 6,312, 53% cisgender individuals). Data was collected from June 2020 to June 2021. Chi-square tests were performed to assess the association between the algorithm-generated and participant-selected gender categories, and to identify demographic differences between participants in the algorithm-generated categories. Forty-six percent of our sample may have been classified into an "other" category without an algorithm due to writing their own response (5.7%), selecting "another gender identity" (5.7%), or selecting multiple (42.6%) or less commonly described (10.2%) gender identities. There was a relationship between the categories formed by our algorithm and participants' single category selection (χ2 [20] = 19,000, p < .001). Concordance rates were high (97-99%) among all groups except for participants classified as gender expansive (74.3%). Without an algorithm to incorporate expanded gender identity responses, almost half of the sample may have been classified into an "other" category or dropped from analyses. Our algorithm successfully classified participants into analyzable categories from expanded gender responses.

  View details for DOI 10.1037/sgd0000762

  View details for PubMedID 41267672

  View details for PubMedCentralID PMC12629618

• Pathways to parenthood among transgender men and gender diverse people assigned female or intersex at birth in the United States: analysis of a Cross-Sectional 2019 Survey. AJOG global reports Bane, S. S., Obedin-Maliver, J., Ragosta, S., Hastings, J., Lunn, M. R., Flentje, A., Capriotti, M. R., Lubensky, M. E., Tordoff, D. M., Moseson, H. 2024; 4 (3): 100381

  Abstract

  To assess pathways to parenthood, pregnancy outcomes, future pregnancy desire, and fertility counseling experiences among a cross-sectional sample of transgender men and gender diverse individuals assigned female or intersex at birth in the United States.Participants were recruited from The Population Research in Identity and Disparities for Equality (PRIDE) Study and the general public. Eligible participants for this analysis were able to read and understand English, assigned female or intersex at birth, US residents, 18+ years old, and identified as transgender, nonbinary, or gender diverse. We analyzed responses to close-ended survey questions, overall and stratified by gender identity, race/ethnicity, and testosterone use. We also qualitatively assessed open-text responses on fertility counseling.Among the 1694 participants, median age was 27 years (range: 18-72), 12% had ever been pregnant, and 12% were parents. Carrying a pregnancy where the individual was the egg source (36%) was the most common pathway to parenthood. Individuals with an exclusively binary gender identity (ie, transgender man or man) more often reported becoming parents through adoption than individuals with gender diverse identities (19% vs 12%). A third of individuals did not receive fertility counseling prior to initiating testosterone; individuals who exclusively reported nonbinary identities were recommended to investigate fertility preservation options less often (36%) compared to transgender men (50%).Transgender men and gender diverse individuals who were assigned female or intersex at birth build their families through a variety of pathways, including pregnancy, stepparenting, and adoption. Clinicians should avoid making assumptions about reproductive desires in these populations based on gender identities or testosterone use and should provide consistent fertility counseling prior to and after hormone initiation.

  View details for DOI 10.1016/j.xagr.2024.100381

  View details for PubMedID 39253027

  View details for PubMedCentralID PMC11381974

• Structural Determinants of Health and Markers of Immune Activation and Systemic Inflammation in Sexual Minority Men With and Without HIV. Journal of urban health : bulletin of the New York Academy of Medicine Ghanooni, D., Flentje, A., Hirshfield, S., Horvath, K. J., Moreno, P. I., Harkness, A., Ross, E. J., Dilworth, S. E., Pahwa, S., Pallikkuth, S., Carrico, A. W. 2024; 101 (4): 867-877

  Abstract

  Among sexual minority men (SMM), HIV and use of stimulants such as methamphetamine are linked with immune activation and systemic inflammation. Throughout the COVID-19 pandemic, SMM encountered financial challenges and structural obstacles that might have uniquely contributed to immune dysregulation and systemic inflammation, beyond the impacts of HIV and stimulant use. Between August 2020 and February 2022, 72 SMM with and without HIV residing in South Florida enrolled in a COVID-19 prospective cohort study. Multiple linear regression analyses examined unemployment, homelessness, and history of arrest as structural correlates of soluble markers of immune activation (i.e., sCD14 and sCD163) and inflammation (i.e., sTNF-α receptors I and II) at baseline after adjusting for HIV status, stimulant use, and recent SARS-CoV-2 infection. Enrolled participants were predominantly Latino (59%), gay-identified (85%), and with a mean age of 38 (SD, 12) years with approximately one-third (38%) of participants living with HIV. After adjusting for HIV status, SARS-CoV-2 infection, and recent stimulant use, unemployment independently predicted higher levels of sCD163 (β = 0.24, p = 0.04) and sTNF-α receptor I (β = 0.26, p = 0.02). Homelessness (β = 0.25, p = 0.02) and history of arrest (β = 0.24, p = 0.04) independently predicted higher levels of sCD14 after adjusting for HIV status, SARS-CoV-2 infection, and recent stimulant use. Independent associations exist between structural barriers and immune activation and systemic inflammation in SMM with and without HIV. Future longitudinal research should further elucidate complex bio-behavioral mechanisms linking structural factors with immune activation and inflammation.

  View details for DOI 10.1007/s11524-024-00882-8

  View details for PubMedID 38831153

  View details for PubMedCentralID PMC11329474

• Parenthood and the Physical and Mental Health of Sexual and Gender Minority Parents: A Cross-Sectional, Observational Analysis from The PRIDE Study. Annals of epidemiology Tordoff, D. M., Lunn, M. R., Snow, A., Monseur, B., Flentje, A., Lubensky, M. E., Dastur, Z., Kaysen, D., Leonard, S. A., Obedin-Maliver, J. 2024

  Abstract

  To compare the physical and mental health of sexual and gender minority (SGM) parents to SGM non-parents.A cross-sectional analysis using 2018-2020 data from The PRIDE Study, a national longitudinal cohort of SGM adults. We used Poisson regression adjusted for age, gender, relationship status, race/ethnicity, household income, and education to assess the association between parental status and each outcome.Among 9,625 SGM participants, 1,460 (15%) were parents. Older participants were more likely to be parents: 2% of participants aged 18-30, 18% aged 30-39, and 38% aged 40+ were parents. In adjusted analyses, parenthood was associated with greater depression, anxiety, and post-traumatic stress symptoms as well as ever cigarette smoking. Among individuals assigned female sex at birth, parents were twice as likely to have been diagnosed with pelvic inflammatory disease compared to non-parents. There was no association between parenthood status and alcohol use, substance use, diabetes, HIV, hypertension, or autism.In this national cohort of SGM adults, parenthood was associated with differences in physical and mental health measures. Understanding how parenthood influences the health and well-being of the estimated 3 million SGM parents in the US will help our health systems support diverse families.

  View details for DOI 10.1016/j.annepidem.2024.07.046

  View details for PubMedID 39038746

• Chronic pelvic pain among transgender men and gender diverse adults assigned female at birth. Andrology Tordoff, D. M., Lunn, M. R., Flentje, A., Atashroo, D., Chen, B., Dastur, Z., Lubensky, M. E., Capriotti, M., Obedin-Maliver, J. 2024

  Abstract

  There are limited data on pelvic pain among transgender men and gender diverse people, and the impact of testosterone on pelvic pain is poorly understood.Characterize the prevalence and correlates of chronic pelvic pain (CPP) among transgender men and gender diverse people and examine the association between testosterone use and CPP.We used 2020-2022 data from The Population Research in Identity and Disparities for Equality (PRIDE) Study, an online prospective cohort study of sexual and gender minority adults in the United States, to conduct complementary cross-sectional and longitudinal analyses. Our primary outcome was self-reported CPP lasting 3 months or longer measured using the Michigan Body Map.Among 2579 transgender men and gender diverse people assigned female at birth included in our sample, 457 (18%) reported CPP. CPP correlates included: inflammatory bowel disease, irritable bowel syndrome (IBS), kidney stones, pelvic inflammatory disease, polycystic ovary syndrome (PCOS), uterine fibroids, current hormonal intrauterine device use, prior pregnancy, vaginal delivery, hysterectomy, and oophorectomy. Individuals with CPP reported a high prevalence of IBS (37%), PCOS (20%), uterine fibroids (9%), post-traumatic stress disorder (51%), and severe depression and anxiety symptoms (42% and 25%, respectively). Current testosterone use was associated with a 21% lower prevalence of CPP (adjusted prevalence ratio (aPR) 0.79, 95% confidence interval [CI]: 0.65-0.96). In longitudinal analyses (N = 79), 15 (19%) participants reported any CPP after initiating testosterone: eight (56%) of whom reported CPP prior to testosterone initiation, and seven (47%) who reported new-onset CPP.The relationship between CPP and testosterone is complex. Although testosterone use was associated with a lower prevalence of CPP, some transgender and gender diverse individuals experienced new-onset pelvic pain after testosterone initiation. Given the significant impact that CPP can have on mental health and quality of life, future research must examine the role of testosterone in specific underlying etiologies of CPP and identify potential therapies.

  View details for DOI 10.1111/andr.13703

  View details for PubMedID 39011578

• Inequities in Conversion Practice Exposure at the Intersection of Ethnoracial and Gender Identities. American journal of public health Tran, N. K., Lett, E., Flentje, A., Ingram, S., Lubensky, M. E., Dastur, Z., Obedin-Maliver, J., Lunn, M. R. 2024; 114 (4): 424-434

  Abstract

  Objectives. To examine inequities in conversion practice exposure across intersections of ethnoracial groups and gender identity in the United States. Methods. Data were obtained from The Population Research in Identity and Disparities for Equality Study of sexual and gender minority people from 2019 to 2021 (n = 9274). We considered 3 outcomes: lifetime exposure, age of first exposure, and period between first and last exposure among those exposed to conversion practices. We used log-binomial, Cox proportional hazards, and negative binomial models to examine inequities by ethnoracial groups and gender identity adjusting for confounders. We considered additive interaction. Results. Conversion practice prevalence was highest among minoritized ethnoracial transgender and nonbinary participants (TNB; 8.6%). Compared with White cisgender participants, minoritized ethnoracial TNB participants had twice the prevalence (prevalence ratio = 2.16; 95% confidence interval [CI] = 1.62, 2.86) and risk (hazard ratio = 2.04; 95% CI = 1.51, 2.69) of conversion practice exposure. Furthermore, there was evidence of a positive additive interaction for age of first exposure. Conclusions. Minoritized ethnoracial TNB participants were most likely to recall experiencing conversion practices. Public Health Implications. Policies banning conversion practices may reduce the disproportionate burden experienced by minoritized ethnoracial TNB participants. (Am J Public Health. 2024;114(4):424-434. https://doi.org/10.2105/AJPH.2024.307580).

  View details for DOI 10.2105/AJPH.2024.307580

  View details for PubMedID 38478865

• Mental Health Treatment Experiences among Sexual and Gender Minority Individuals: Trauma Exposure, Barriers, Microaggressions, and Treatment Satisfaction. Journal of gay & lesbian mental health Artime, T. M., Rosenfeld, E. A., Ong, L., Lisha, N. E., Dilley, J. W., Shumway, M., Edward, D., Ceja, A., Einhorn, L., Lubensky, M. E., Dastur, Z., Lunn, M. R., Obedin-Maliver, J., Cloitre, M., Flentje, A. 2024

  Abstract

  While trauma experiences and treatment-seeking are common among sexual and gender minority (SGM) individuals, little is known about their specific experiences in psychotherapy, including treatment types, characteristics (e.g., length, episodes), barriers, satisfaction, and microaggressions.SGM individuals (N = 2685) from a national cohort study completed a survey.The majority (87%) of participants endorsed past therapy, including for trauma (56%). Ratings of therapy barriers and microaggressions were low and satisfaction with therapy was high. However, therapy experiences differed based on sexual orientation, gender, and if the therapy was focused on trauma.Effective treatments for trauma should be informed by the needs of the diverse groups that comprise the SGM community.

  View details for DOI 10.1080/19359705.2024.2315976

  View details for PubMedID 40787632

  View details for PubMedCentralID PMC12330875

• Interest in over-the-counter progestin-only pills among transgender, nonbinary, and gender-expansive individuals in the United States. American journal of obstetrics and gynecology Grindlay, K., Obedin-Maliver, J., Ragosta, S., Hastings, J., Lunn, M. R., Flentje, A., Capriotti, M. R., Dastur, Z., Lubensky, M. E., Moseson, H. 2024

  Abstract

  In July 2023, the US Food and Drug Administration approved the first non-prescription oral contraceptive, a progestin-only pill, in the United States. Transgender, nonbinary, and gender-expansive people assigned female or intersex at birth face substantial contraceptive access barriers and may benefit from over-the-counter oral contraceptive access. However, no prior research has explored their perspectives on this topic.To measure interest in over-the-counter progestin-only pill use among transgender, nonbinary, and gender-expansive individuals assigned female or intersex at birth.We conducted an online, cross-sectional survey from May-September 2019 (before Food and Drug approval of a progestin-only pill) with a convenience sample of transgender, nonbinary, and gender-expansive people assigned female or intersex at birth, aged 18-49 years, from across the United States. Using descriptive statistics and logistic regression analyses, we estimated interest in over-the-counter progestin-only pill use (our outcome) overall and by sociodemographic and reproductive health characteristics (our exposures). We ran separate logistic regression models for each exposure. In each model, we included the minimally sufficient adjustment set to control for confounding pathways between the exposure and outcome. For the model for age, we ran a univariable logistic regression model; for all other exposures, we ran multivariable logistic regression models.Among 1,415 participants in our sample (median age: 26 years), 45.0% (636/1,415; 95% CI: 42.3-47.6%) were interested in over-the-counter progestin-only pill use. In separate logistic regression models for each exposure, there were higher odds of interest among participants who were aged 18-24 years (OR 1.67, 95% CI: 1.33-2.10; versus aged 25-34 years), uninsured (aOR 1.91, 95% CI: 1.24-2.93; versus insured), currently using oral contraceptives (aOR 1.69, 95% CI: 1.17-2.44; versus non-users), had ≤high school degree (aOR 3.02, 95% CI: 1.94-4.71; versus college degree), had ever used progestin-only pills (aOR 2.32, 95% CI: 1.70-3.17; versus never-users), and who wanted to avoid estrogen generally (aOR 1.32, 95% CI: 1.04-1.67 versus those who did not want to avoid estrogen generally) or specifically because they viewed it as a "feminizing" hormone (aOR 1.72, 95% CI: 1.36-2.19; versus those who did not want to avoid estrogen because they viewed it as a "feminizing" hormone). There were lower odds of interest among participants with a graduate or professional degree (aOR 0.70, 95% CI: 0.51-0.96; versus college degree), who were sterilized (aOR 0.31, 95% CI: 0.12-0.79; versus not sterilized), and who had ever used testosterone for gender affirmation (aOR 0.72, 95% CI: 0.57-0.90; versus never-users).Transgender, nonbinary, and gender-expansive individuals are interested in over-the-counter progestin-only pill access, and its availability has the potential to improve contraceptive access for this population.

  View details for DOI 10.1016/j.ajog.2024.02.006

  View details for PubMedID 38365096

• Family building and pregnancy experiences of cisgender sexual minority women. AJOG global reports Tordoff, D. M., Moseson, H., Ragosta, S., Hastings, J., Flentje, A., Capriotti, M. R., Lubensky, M. E., Lunn, M. R., Obedin-Maliver, J. 2024; 4 (1): 100298

  Abstract

  Although 10% to 20% of cisgender women aged 18 to 40 years have a sexual minority identity (eg, bisexual, lesbian, and queer), there is limited research on the family building and pregnancy experiences of sexual minority cisgender women. Improving our understanding of the family building and pregnancy experiences of cisgender sexual minority women is critical for improving the perinatal health of this population.This study aimed to compare the mode of family building, past pregnancy experiences, and future pregnancy intentions among cisgender sexual minority women by sexual orientation.This is an observational study which was conducted using cross-sectional data collected in 2019 from a national sample of 1369 cisgender sexual minority women aged 18 to 45 years.Most participants (n=794, 58%) endorsed multiple sexual orientations, most commonly queer (n=641, 47%), lesbian (n=640, 47%), and/or bisexual (n=583, 43%). There were 243 (18%) cisgender sexual minority women who were parents. Pregnancy was used by 74% (181/243) of women to build their families. Among participants who used pregnancy, 60% (108/181) became pregnant through sexual activity with another parent of the child, whereas 27% (64/243) of women used donor sperm. An additional 10% (n=24) became parents through second-parent adoption, 10% (n=25) through adoption, and 14% (n=35) through step-parenting. Bisexual women more often used sexual activity to become parents (61/100, 61%) compared with queer (40/89, 45%) and lesbian women (40/130, 31%). In contrast, lesbian (50/130, 39%) and queer (25/89, 27%) women more often used donor sperm to become parents compared with bisexual women (11/100, 11%). Among the 266 (19%) cisgender sexual minority women who had ever been pregnant, there were 545 pregnancies (mean, 2.05 pregnancies per woman). Among those pregnancies, 59% (n=327) resulted in live birth, 23% (n=126) resulted in miscarriage, 15% (n=83) resulted in abortion, and 2% (n=9) resulted in ectopic pregnancy. A quarter of women had future pregnancy intentions, with no differences by sexual orientation. Overall, few participants (16%) reported that all of their healthcare providers were aware of their sexual orientation.Cisgender sexual minority women primarily built their families through pregnancy and a quarter have future pregnancy desires. In addition, there were important differences in family building methods used by sexual orientation. Providers should be aware of the pregnancy and family-building patterns, plans, and needs of cisgender sexual minority women.

  View details for DOI 10.1016/j.xagr.2023.100298

  View details for PubMedID 38269079

  View details for PubMedCentralID PMC10806344

• Our Needs Have Been Ignored for a Long Time: Factors Affecting the Willingness of Black and Hispanic/Latinx Sexual and Gender Minority Communities to Donate Biospecimens Annals of LGBTQ Public and Population Health Ceja, A., Bruno, V., Panyanouvong, N., Aguilar, J., Raygani, S., Lubensky, M. E., Dastur, Z., Lunn, M. R., Obedin-Maliver, J., Flentje, A. 2024

  View details for DOI 10.1891/LGBTQ-2023-0022

• Active Social Media Use and Health Indicators Among Sexual and Gender Minority Adults. LGBT health Vogel, E. A., Flentje, A., Lunn, M. R., Obedin-Maliver, J., Capriotti, M. R., Ramo, D. E., Prochaska, J. J. 2023

  Abstract

  Purpose: Sexual and gender minority (SGM) individuals may receive social support through active use of social media (i.e., posting and interacting). This study examined associations between active social media use, social support, and health indicators in a large sample of SGM adults in the United States. Methods: Data were derived from the 2017 wave of The PRIDE Study, a national cohort study of SGM health. SGM-identified adults reporting social media use (N = 5995) completed measures of active social media use, social support, depressive symptoms, cigarette smoking, hazardous drinking, sleep, and physical activity. Regression models examined main and interactive effects of active social media use and social support on health indicators. Results: The sample reported a moderate level of active social media use (mean [M] = 3.2 [1.0], scale = 1-5) and relatively high social support (M = 16.7 [3.3], scale = 4-20); 31.8% reported moderate-to-severe depressive symptoms. Participants with greater active social media use were more likely to experience depressive symptoms (adjusted odds ratio [AOR] = 1.18, 95% confidence interval [CI] = 1.10-1.26), cigarette smoking (AOR = 1.11, 95% CI = 1.01-1.22), insufficient sleep (AOR = 1.13, 95% CI = 1.06-1.21), and physical inactivity (AOR = 1.09, 95% CI = 1.02-1.15) than those with less active social media use. Active social media use did not significantly interact with social support to predict any health indicators (p values >0.159). Conclusions: Among SGM adults, active social media use was associated with several negative health indicators. Active social media use may increase health risks, or SGM adults with poor health may actively use social media to maintain social connections. Moderate active social media use may be compatible with health.

  View details for DOI 10.1089/lgbt.2023.0170

  View details for PubMedID 38153392

• Asking sexual orientation and gender identity on health surveys: Findings from cognitive interviews in the United States across sexual orientations and genders. SSM. Qualitative research in health Pho, A. T., Bates, N., Snow, A., Zhang, A., Logan, R., Dastur, Z., Lubensky, M. E., Flentje, A., Lunn, M. R., Obedin-Maliver, J. 2023; 4

  Abstract

  Questions assessing sexual orientation and gender identity (SOGI) are not consistently asked on U.S.-based health surveys and, as a result, sexual and gender minority (SGM) people are often invisible, obscuring insight into their health. The purpose of this study was to explore how people across different sexual orientations and genders preferred to be asked about SOGI on U.S.-based health surveys. Using in-depth cognitive interviews with 14 non-SGM (cisgender heterosexual men and women) and 30 SGM participants (cisgender sexual minority people as well as transgender and gender diverse people of any sexual orientation), we identified four major themes relating to SOGI disclosure: (1) purpose for asking, (2) context of information collection, (3) distrust of the government, and (4) fear. While many participants were open to disclosing SOGI information on a federal health survey, non-SGM and SGM participants questioned the survey's purpose and expressed governmental distrust. However, unlike non-SGM participants, SGM participants indicated that they might change their answers depending on the survey context. SGM participants indicated they would be more willing to disclose SOGI information in a personal medical context or for a local community survey rather than a federal health survey. Further, unlike non-SGM participants, SGM participants expressed fear for their safety when disclosing SOGI information. Our study suggests that concerns regarding SOGI disclosure and what is disclosed differ between non-SGM and SGM people. Some SGM people may change their answers or not respond to SOGI questions depending on context and perceived safety. These findings have health and research implications as efforts are made to enhance understanding of SGM health and the health needs of SGM people by augmenting the use of SOGI questions.

  View details for DOI 10.1016/j.ssmqr.2023.100344

  View details for PubMedID 40852178

  View details for PubMedCentralID PMC12369996

• Acceptability of Biospecimen Collection Among Sexual and/or Gender Minority Adults in the United States. Annals of LGBTQ public and population health Cicero, E. C., Lunn, M. R., Obedin-Maliver, J., Sunder, G., Lubensky, M. E., Capriotti, M. R., Flentje, A. 2023; 4 (4): 311-344

  Abstract

  Health studies using biospecimens have an underrepresentation of sexual and/or gender minority (SGM) participants, making it difficult to use data to advance SGM health knowledge. This study examined: 1) the willingness of SGM adults to provide research biospecimens, 2) if SGM groups differ in their willingness, 3) the relationship of demographic characteristics with willingness, and 4) the ideas/concerns of SGM adults toward providing research biospecimens. Data collected in 2018-2019 from The Population Research in Identity and Disparities for Equality Study were analyzed. Regressions examined willingness to provide biospecimens (blood, buccal swab, hair, saliva, and urine) across SGM groups (cisgender sexual minority [SM] men, cisgender SM women, gender-expansive, transfeminine, and transmasculine adults; N = 4,982) and the relationship of demographics with a willingness to provide each biospecimen type. A thematic analysis of an open-ended item elucidated SGM adults' (N = 776) perspective toward providing biospecimens. Most SGM adults were willing to provide biospecimens. Cisgender SM women were less willing to provide some types (blood 54% and urine 63%) than the other groups. Cisgender SM men were most willing to provide all types. Older age, identifying as pansexual, and income >$50,000/year were associated with increased odds of providing biospecimen(s). Gender identity was a significant predictor for all biospecimen types. A gender identity other than cisgender man was associated with 1.6-2.4× lower odds of providing biospecimen(s). Participants expressed concerns about data confidentiality and privacy, data access and misuse, research purposes, and inadvertent disclosure of SGM status. SGM adults' concerns about donating biospecimens can be used to create an affirming and inclusive methodology.

  View details for DOI 10.1891/lgbtq-2022-0021

  View details for PubMedID 39234441

  View details for PubMedCentralID PMC11374103

• Investigating the factor structure and measurement invariance of the eating disorder examination questionnaire (EDE-Q) among cisgender gay men and lesbian women from the United States. Journal of eating disorders Compte, E. J., McGuire, F. H., Brown, T. A., Lavender, J. M., Murray, S. B., Capriotti, M. R., Flentje, A., Lubensky, M. E., Lunn, M. R., Obedin-Maliver, J., Nagata, J. M. 2023; 11 (1): 164

  Abstract

  Although the Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used self-report assessments of eating disorder symptoms, evidence indicates potential limitations with its original factor structure and associated psychometric properties in a variety of populations, including sexual minority populations. The aims of the current investigation were to explore several previously published EDE-Q factor structures and to examine internal consistency and measurement invariance of the best-fitting EDE-Q model in a large community sample of cisgender gay men and cisgender lesbian women.Data were drawn from 1624 adults (1060 cisgender gay men, 564 cisgender lesbian women) who participated in The PRIDE Study, a large-scale longitudinal cohort study of sexual and gender minorities from the United States. A series of confirmatory factor analyses (CFAs) were conducted to explore the fit of eight proposed EDE-Q models; internal consistency (Cronbach's alphas, Omega coefficients) and measurement invariance (multi-group CFA) were subsequently evaluated.A brief seven-item, three-factor (dietary restraint, shape/weight overvaluation, body dissatisfaction) model of the EDE-Q from Grilo et al. (Obes Surg. 23:657-662, 2013), consistently evidenced the best fit across cisgender gay men and lesbian women. The internal consistencies of the three subscales were adequate in both groups, and measurement invariance across the groups was supported.Taken together, these findings support the use of the seven-item, three-factor version of the EDE-Q for assessing eating disorder symptomatology in cisgender gay men and lesbian women. Future studies can confirm the current findings in focused examinations of the seven-item, three-factor EDE-Q in diverse sexual minority samples across race, ethnicity, socioeconomic status, and age ranges.

  View details for DOI 10.1186/s40337-023-00880-2

  View details for PubMedID 37736682

  View details for PubMedCentralID 7566158

• Testosterone Use and Sexual Function among Transgender Men and Gender Diverse People Assigned Female at Birth. American journal of obstetrics and gynecology Tordoff, D. M., Lunn, M. R., Chen, B., Flentje, A., Dastur, Z., Lubensky, M. E., Capriotti, M., Obedin-Maliver, J. 2023

  Abstract

  Testosterone use among transgender people likely impacts their experience of sexual function and vulvovaginal pain via several complex pathways. Testosterone use is associated with decreased estrogen in the vagina and atrophic vaginal tissue, which may be associated with decreased vaginal lubrication and/or discomfort during sexual activity. At the same time, increased gender affirmation through testosterone use may be associated with improved sexual function. However, data on pelvic and vulvovaginal pain among transgender men and nonbinary people assigned female at birth is scarce.To assess the association between testosterone and sexual function, with a focus on symptoms that are commonly associated with vaginal atrophy.We conducted a cross-sectional analysis of 1,219 participants ages 18-72 years old using 2019-2021 data from an online, prospective, longitudinal, cohort study of sexual and/or gender minority people in the US (The PRIDE Study). Our analysis included adult transgender men and gender diverse participants assigned female at birth who were categorized as never, current, and former testosterone users. Sexual function was measured across eight Patient-Reported Outcomes Measurement Information System (PROMIS) Sexual Function and Satisfaction (SexFS) domains.Overall, 516 (42.3%) had never used testosterone and 602 (49.4%) currently used testosterone. Median duration of use was 37.7 months (range 7 days to >27 years). Most participants (64.6%) reported genital pain/discomfort during sexual activity in the past 30 days, most commonly in the vagina/frontal genital opening (52.2%), followed by the clitoris (29.1%) and labia (24.5%). Current testosterone use was associated with higher interest in sexual activity (β=6.32, 95% CI: 4.91-7.74) and more vaginal pain/discomfort during sexual activity (β=1.80, 95% CI: 0.61-3.00). No associations were observed between current testosterone use and satisfaction with sex life, lubrication, labial pain/discomfort, or orgasm pleasure.Testosterone use among transgender men and gender diverse people was associated with a higher interest in sexual activity and ability to orgasm as well as vaginal pain/discomfort during sexual activity. Notably, the available evidence demonstrates that >60% of transgender men experience vulvovaginal pain during sexual activity. The causes of pelvic and vulvovaginal pain are poorly understood but are likely multifactorial and include physiological (e.g., testosterone-associated vaginal atrophy) and psychological factors (e.g., gender affirmation). Given this high burden, there is an urgent need to identify effective and acceptable interventions for this population.

  View details for DOI 10.1016/j.ajog.2023.08.035

  View details for PubMedID 37678647

• Self-Reported Barriers to Care Among Sexual and Gender Minority People With Disabilities: Findings From The PRIDE Study, 2019-2020. American journal of public health Lamba, S., Obedin-Maliver, J., Mayo, J., Flentje, A., Lubensky, M. E., Dastur, Z., Lunn, M. R. 2023: e1-e10

  Abstract

  Objectives. To examine the associations of self-reported disability status with health care access barriers for sexual and gender minority (SGM) people. Methods. The Population Research in Identity and Disparities for Equality (PRIDE) Study participants lived in the United States or its territories, completed the 2019 annual questionnaire (n = 4961), and self-reported their disability and health care access experiences, including whether they had a primary care provider, were uninsured, delayed care, and were unable to obtain care. We classified disabilities as physical, mental, intellectual, and other; compared participants to those without disabilities; and performed logistic regression to determine the associations of disability status and health care access barriers. Results. SGM people with disabilities were less likely to have a usual place to seek health care (69.0% vs 75.3%; P ≤ .001) and more often reported being mistreated or disrespected as reasons to delay care (29.0% vs 10.2%; P ≤ .001). SGM people with disabilities were more likely to delay care (adjusted odds ratio [AOR] = 3.28; 95% confidence interval [CI] = 2.83, 3.81) and be unable to obtain care (AOR = 3.10; 95% CI = 2.59, 3.71). Conclusions. Future work should address culturally competent health care to ameliorate disparities for the SGM disability community. (Am J Public Health. Published online ahead of print July 20, 2023:e1-e10. https://doi.org/10.2105/AJPH.2023.307333).

  View details for DOI 10.2105/AJPH.2023.307333

  View details for PubMedID 37471680

• Prevalence of 12 Common Health Conditions in Sexual and Gender Minority Participants in the All of Us Research Program. JAMA network open Tran, N. K., Lunn, M. R., Schulkey, C. E., Tesfaye, S., Nambiar, S., Chatterjee, S., Kozlowski, D., Lozano, P., Randal, F. T., Mo, Y., Qi, S., Hundertmark, E., Eastburn, C., Pho, A. T., Dastur, Z., Lubensky, M. E., Flentje, A., Obedin-Maliver, J. 2023; 6 (7): e2324969

  Abstract

  Limited data describe the health status of sexual or gender minority (SGM) people due to inaccurate and inconsistent ascertainment of gender identity, sex assigned at birth, and sexual orientation.To evaluate whether the prevalence of 12 health conditions is higher among SGM adults in the All of Us Research Program data compared with cisgender heterosexual (non-SGM) people.This cross-sectional study used data from a multidisciplinary research consortium, the All of Us Research Program, that links participant-reported survey information to electronic health records (EHR) and physical measurements. In total, 372 082 US adults recruited and enrolled at an All of Us health care provider organization or by directly visiting the enrollment website from May 31, 2017, to January 1, 2022, and were assessed for study eligibility.Self-identified gender identity and sexual orientation group.Twelve health conditions were evaluated: 11 using EHR data and 1, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), using participants' physical measurements. Logistic regression (adjusting for age, income, and employment, enrollment year, and US Census division) was used to obtain adjusted odds ratios (AORs) for the associations between each SGM group and health condition compared with a non-SGM reference group.The analytic sample included 346 868 participants (median [IQR] age, 55 [39-68] years; 30 763 [8.9%] self-identified as SGM). Among participants with available BMI (80.2%) and EHR data (69.4%), SGM groups had higher odds of anxiety, depression, HIV diagnosis, and tobacco use disorder but lower odds of cardiovascular disease, kidney disease, diabetes, and hypertension. Estimated associations for asthma (AOR, 0.39 [95% CI, 0.24-0.63] for gender diverse people assigned male at birth; AOR, 0.51 [95% CI, 0.38-0.69] for transgender women), a BMI of 25 or higher (AOR, 1.65 [95% CI, 1.38-1.96] for transgender men), cancer (AOR, 1.15 [95% CI, 1.07-1.23] for cisgender sexual minority men; AOR, 0.88 [95% CI, 0.81-0.95] for cisgender sexual minority women), and substance use disorder (AOR, 0.35 [95% CI, 0.24-0.52] for gender diverse people assigned female at birth; AOR, 0.65 [95% CI, 0.49-0.87] for transgender men) varied substantially across SGM groups compared with non-SGM groups.In this cross-sectional analysis of data from the All of Us Research Program, SGM participants experienced health inequities that varied by group and condition. The All of Us Research Program can be a valuable resource for conducting health research focused on SGM people.

  View details for DOI 10.1001/jamanetworkopen.2023.24969

  View details for PubMedID 37523187

• Challenges and pitfalls in research understanding the immunological impacts of minority stress among sexual and gender minority populations. Brain, behavior, and immunity Flentje, A. 2023; 111: 30-31

  View details for DOI 10.1016/j.bbi.2023.03.021

  View details for PubMedID 36990298

  View details for PubMedCentralID PMC10273493

• Reducing Drug Overdose Deaths Significant Changes Needed in US Drug Treatment Policy JOURNAL OF PSYCHOSOCIAL NURSING AND MENTAL HEALTH SERVICES Tierney, M., Flentje, A. 2023; 61 (6): 7-10

  Abstract

  Slow and incremental changes in federal and state drug policies are neither meeting treatment needs nor reversing yearly increases in drug-related mortality. U.S. drug policies convey confounding messages that non-sanctioned substance use leads to health problems that need treatment while simultaneously being legal problems that must be punished. As a result, drug treatments remain a sequestered component of health care, with onerous treatment requirements for patients and providers that act as barriers to the treatment that policies seek to allow. A new direction in drug policy is needed that broadens rather than restricts access to care and that also focuses on prevention. Policies must consider the totality of health and wellness, not just "last resort" safety nets for urgent needs. For substantive change in drug-related morbidity and mortality, forward-thinking policy must focus more on addiction prevention and address the known risks of developing a substance use disorder. [Journal of Psychosocial Nursing and Mental Health Services, 61(6), 7-10.].

  View details for DOI 10.3928/02793695-20230510-01

  View details for Web of Science ID 001010474400002

  View details for PubMedID 37261971

• Reports of Negative Interactions with Healthcare Providers among Transgender, Nonbinary, and Gender-Expansive People assigned Female at Birth in the United States: Results from an Online, Cross-Sectional Survey. International journal of environmental research and public health Inman, E. M., Obedin-Maliver, J., Ragosta, S., Hastings, J., Berry, J., Lunn, M. R., Flentje, A., Capriotti, M. R., Lubensky, M. E., Stoeffler, A., Dastur, Z., Moseson, H. 2023; 20 (11)

  Abstract

  Over one million people in the United States are transgender, nonbinary, or gender expansive (TGE). TGE individuals, particularly those who have pursued gender-affirming care, often need to disclose their identities in the process of seeking healthcare. Unfortunately, TGE individuals often report negative experiences with healthcare providers (HCPs). We conducted a cross-sectional online survey of 1684 TGE people assigned female or intersex at birth in the United States to evaluate the quality of their healthcare experiences. Most respondents (70.1%, n = 1180) reported at least one negative interaction with an HCP in the past year, ranging from an unsolicited harmful opinion about gender identity to physical attacks and abuse. In an adjusted logistic regression model, those who had pursued gender-affirming medical care (51.9% of the sample, n = 874) had 8.1 times the odds (95% CI: 4.1-17.1) of reporting any negative interaction with an HCP in the past year, compared to those who had not pursued gender-affirming care, and tended to report a higher number of such negative interactions. These findings suggest that HCPs are failing to create safe, high-quality care interactions for TGE populations. Improving care quality and reducing bias is crucial for improving the health and well-being of TGE people.

  View details for DOI 10.3390/ijerph20116007

  View details for PubMedID 37297611

• Investigating the factor structure and measurement invariance of the Eating Disorder Examination-Questionnaire (EDE-Q) in a community sample of gender minority adults from the United States. The International journal of eating disorders Nagata, J. M., Compte, E. J., McGuire, F. H., Brown, T. A., Lavender, J. M., Murray, S. B., Capriotti, M. R., Flentje, A., Lubensky, M. E., Lunn, M. R., Obedin-Maliver, J. 2023

  Abstract

  The Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used self-report assessments of eating disorder symptoms. However, evidence indicates potential problems with its original factor structure and associated psychometric properties in a variety of populations, including gender minority populations. The aim of the current investigation was to explore several previously published EDE-Q factor structures and to examine internal consistency and measurement invariance of the best-fitting EDE-Q model in a large community sample of gender minority adults.Data were drawn from 1567 adults (337 transgender men, 180 transgender women, and 1050 gender-expansive individuals) who participated in The PRIDE Study, a large-scale longitudinal cohort study of sexual and gender minorities from the United States. A series of confirmatory factor analyses (CFAs) were conducted to explore the fit of eight proposed EDE-Q models; internal consistency (Cronbach's alphas, Omega coefficients) and measurement invariance (multi-group CFA) were subsequently evaluated.A brief seven-item, three-factor (dietary restraint, shape/weight overvaluation, body dissatisfaction) model of the EDE-Q consistently evidenced the best fit across gender minority groups (transgender men, transgender women, gender-expansive individuals). The internal consistencies of the three subscales were adequate in all groups, and measurement invariance across the groups was supported.Taken together, these findings support the use of the seven-item, three-factor version of the EDE-Q for assessing eating disorder symptomatology in gender minority populations. Future studies can confirm the current findings in focused examinations of the seven-item, three-factor EDE-Q in diverse gender minority samples across race, ethnicity, socioeconomic status, and age ranges.Although transgender individuals have greater risk of developing an eating disorder, the factor structure of the Eating Disorder Examination-Questionnaire, one of the most widely used eating disorder assessment measures, has not been explored in transgender adults. We found that a seven-item model including three factors of dietary restraint, shape and weight overvaluation, and body dissatisfaction had the best fit among transgender and nonbinary adults.

  View details for DOI 10.1002/eat.23978

  View details for PubMedID 37163420

• Our pride, our joy: An intersectional constructivist grounded theory analysis of resources that promote resilience in SGM communities. PloS one Edwards, O. W., Lev, E., Obedin-Maliver, J., Lunn, M. R., Lubensky, M. E., Capriotti, M. R., Garrett-Walker, J. J., Flentje, A. 2023; 18 (2): e0280787

  Abstract

  Sexual and gender minority (SGM) communities, including lesbian, gay, bisexual, transgender, queer, intersex, asexual, and Two-Spirit people, have historically been researched from a deficits-based approach that fails to highlight the ways communities survive and thrive in the face of adversity. This study endeavored to create a model of resources that promote SGM resilience using a sample that amplified traditionally underrepresented perspectives, including individuals from racial and/or ethnic minority groups, trans and/or gender diverse individuals, individuals on the asexual spectrum, and older adults.Participant responses to three open-ended questions from The PRIDE Study's (an online national longitudinal cohort study of SGM people) 2018 Annual Questionnaire were analyzed using constructivist grounded theory. These questions examined what brings people joy and what they appreciate most about their SGM identity. Participants (n = 315) were randomly selected from a larger sample of people who had responded to demographic questions and at least one open-ended question (N = 4,030) in a manner to ensure diverse representation across race/ethnicity, gender identity, sexual orientation, age, and region of residence.The proposed model includes social resources (Connecting with Others, Cultivating Family, Helping Others, Participating in Culture and Spirituality), affective generative resources (Engaging in Enriching Pursuits, Accessing Economic Resources), and introspective resources (Exploring One's Authentic Self, Persevering through Hardship) that are theorized to contribute to SGM resilience across the life course.SGM communities may tap into various resources to promote resilience. As public health practitioners, we can help to foster this resilience by resourcing and supporting initiatives that foster social connection, create spaces for community members to engage with various types of enrichment, facilitate access to economic resources, and provide support and inclusion for all SGM community members.

  View details for DOI 10.1371/journal.pone.0280787

  View details for PubMedID 36735687

• Understanding the social and community support experiences of sexual and gender minority individuals in 12-Step programs. Journal of gay & lesbian social services McGeough, B. L., Paceley, M., Zemore, S. E., Lunn, M. R., Obedin-Maliver, J., Lubensky, M. E., Flentje, A. 2023; 35 (4): 398-419

  Abstract

  Sexual and gender minority individuals (e.g., gay, bisexual, non-binary, transgender; SGMI) are 2-6 times as likely as cisgender heterosexual individuals to experience alcohol or other substance use disorders. SGMI participate in 12-Step groups, such as Alcoholics Anonymous (AA), at high rates. Though social support is an established mechanism through which 12-Step programs support reductions in substance use, little is known about SGMI's experiences of the social support in 12-Step programs. This qualitative study aims to understand the experiences of social and community support among SGMI involved in 12-Step programs. This study employed thematic analysis to interpret open-ended responses from 302 SGMI who had participated in 12-Step programs. Data was from The PRIDE Study, a large, national, online. longitudinal, cohort study of SGMI. Two themes emerged about how SGMI experienced social and community support in 12-Step programs: beneficial connections and harmful environments. Beneficial connections included a sense of community, shared experiences, and skills provision. Harmful environments included marginalization, oppression, violence, and bullying. This study highlights the variability of experiences of SGMI participating in 12-Step programs. These findings suggest that many SGMI may benefit from 12-Step programs but may need support in coping with potential harms that can emerge through participation.

  View details for DOI 10.1080/10538720.2023.2172759

  View details for PubMedID 38152636

  View details for PubMedCentralID PMC10752627

• Understanding the social and community support experiences of sexual and gender minority individuals in 12-Step programs JOURNAL OF GAY & LESBIAN SOCIAL SERVICES McGeough, B. L., Paceley, M., Zemore, S. E., Lunn, M. R., Obedin-Maliver, J., Lubensky, M. E., Flentje, A. 2023

  View details for DOI 10.1080/10538720.2023.2172759

  View details for Web of Science ID 000918390600001

• Factors contributing to delay in family building among sexual/gender minority people in the COVID19 pandemic Waldrop, A. R., Zhang, J., Flentje, A., Lunn, M. R., Lubensky, M. E., Leonard, S. A., Dastur, Z., Obedin-Maliver, J. MOSBY-ELSEVIER. 2023: S434

  View details for Web of Science ID 000909337401223

• Sleep disturbance and suicide risk among sexual and gender minority people. Neurobiology of stress Dolsen, E. A., Byers, A. L., Flentje, A., Goulet, J. L., Jasuja, G. K., Lynch, K. E., Maguen, S., Neylan, T. C. 2022; 21: 100488

  Abstract

  Sleep disturbance has emerged as an independent, mechanistic, and modifiable risk factor for suicide. Sexual and gender minority (SGM) people disproportionately experience sleep disturbance and are at higher risk of death by suicide relative to cisgender and/or heterosexual individuals. The present narrative review evaluates nascent research related to sleep disturbance and suicide-related thoughts and behaviors (STBs) among SGM populations, and discusses how experiences of minority stress may explain heightened risk among SGM people. Although there is a growing understanding of the link between sleep disturbance and STBs, most research has not been conducted in SGM populations or has not examined suicide as an outcome. Research is needed to examine whether and how aspects of sleep disturbances relate to STBs among SGM people in order to better tailor sleep treatments for SGM populations.

  View details for DOI 10.1016/j.ynstr.2022.100488

  View details for PubMedID 36164391

  View details for PubMedCentralID PMC9508603

• Sexual Minority Stress and Cellular Aging in Methamphetamine-Using Sexual Minority Men With Treated HIV. Psychosomatic medicine Ghanooni, D., Carrico, A. W., Williams, R., Glynn, T. R., Moskowitz, J. T., Pahwa, S., Pallikkuth, S., Roach, M. E., Dilworth, S., Aouizerat, B. E., Flentje, A. 2022; 84 (8): 949-956

  Abstract

  Sexual minority men (e.g., gay, bisexual, and other men who have sex with men) experience stigma and sexual minority stress, which are theorized to drive negative health outcomes. Sexual minority men with treated HIV display persistent immune dysregulation, which could be amplified by sexual minority stress responses to potentiate cellular aging.This cross-sectional study included 52 sexual minority men living with HIV who had undetectable viral load (<40 copies/mL) and biologically confirmed recent methamphetamine use. Participants completed measures assessing sexual minority stress and openness about sexual minority status (i.e., outness). DNA methylation-derived outcomes included the following: the extrinsic epigenetic age acceleration clock, telomere length, naive CD4+ T-helper cells, and naive CD8+ T-cytotoxic/suppressor cells.After adjusting for negative affect and recent stimulant use, higher sexual minority stress was associated with a faster extrinsic epigenetic age acceleration clock ( β = 0.29, p = .030), shorter telomere length ( β = -0.43, p = .002), and fewer naive CD4+ (β = -0.57, p < .001) and naive CD8+ T cells ( β = -0.57, p < .001). Greater outness was associated with higher naive CD4+ ( β = 0.32, p = .030) and naive CD8+ T cells ( β = 0.38, p = .008) as well as lower plasma interleukin 6 ( β = -0.33, p = .027).Sexual minority stress processes are associated with markers of cellular aging and inflammation in methamphetamine-using sexual minority men living with HIV. Longitudinal research should elucidate biobehavioral mechanisms linking sexual minority stress processes with accelerated cellular aging in those with and without HIV.

  View details for DOI 10.1097/PSY.0000000000001123

  View details for PubMedID 35980781

  View details for PubMedCentralID PMC9553259

• Disordered Eating and Body Dissatisfaction in Transgender and Gender-Expansive Adults: An Evaluation and Integration of the Gender Minority Stress and Resilience and Tripartite Influence Models. Behavior therapy Muratore, L. A., Flentje, A., Schuster, D., Capriotti, M. R. 2022; 53 (5): 869-886

  Abstract

  Transgender and gender-expansive (TGE) people, including transgender and nonbinary individuals, experience elevated rates of body dissatisfaction and disordered eating compared to cisgender individuals, but little is known about why. To address this research gap, we compared the ability of TGE-specific factors as proposed in the gender minority stress and resilience (GMSR) model, general psychological factors contained in the tripartite influence (TI) model, and an integration of these frameworks to explain body dissatisfaction and disordered eating among TGE individuals. Regression analyses were conducted to test the models' abilities to explain experiences reported in a survey of 93 U.S. TGE adults, including 43 transgender women respondents (46.2%) and 31 transgender men respondents (33.3%). Participants were diverse with regard to age (M = 34.19, SD = 12.02) and ethnoracial background (e.g., 29.0% Hispanic/Latinx, 17.2% Black/African American, 6.5% American Indian/Alaska Native; 5.4% multiracial). Results demonstrated both models' abilities to explain body dissatisfaction and disordered eating independently, except for the relationship between body dissatisfaction and the thinness-oriented TI model. An integration of the models better explained body dissatisfaction and disordered eating compared to either model alone. Notably, some findings did not align with the two frameworks, suggesting existing models may not adequately describe pathways through which disordered eating emerges in TGE populations. Specifically, body dissatisfaction showed no significant relationship with disordered eating and was not well explained by the TI model, and higher gender identity pride was related to greater disordered eating symptoms. Implications for clinical care and future research are discussed.

  View details for DOI 10.1016/j.beth.2022.02.006

  View details for PubMedID 35987545

• State-Level Policy Environments, Discrimination, and Victimization among Sexual and Gender Minority People. International journal of environmental research and public health Clark, K. D., Lunn, M. R., Lev, E. M., Trujillo, M. A., Lubensky, M. E., Capriotti, M. R., Hoffmann, T. J., Obedin-Maliver, J., Flentje, A. 2022; 19 (16)

  Abstract

  Legislation has been passed in some states to reduce discrimination and victimization toward sexual and gender minority people (SGM; people who are not solely heterosexual and/or whose gender identity is not equal to what is socially associated with sex assigned at birth). The purpose of these analyses is to test whether state-level policy environments are associated with past-year discrimination and victimization among SGM people. Cross-sectional data from The Population Research in Identity and Disparities for Equality (PRIDE) Study annual questionnaire (collected 2018-2019), a national study of the health of SGM adults in the USA, were used for these analyses. Measures included related to discrimination, victimization, and demographic characteristics. State-level policy environments were measured using data from the Movement Advancement Project. Logistic regression analyses evaluated state-level policy environment scores and past-year discrimination and victimization among gender identity categories. In this sample, 7044 people (gender minority n = 2530) were included. Cisgender sexual minority (odds ratio [OR] = 1.007, p = 0.041) and the gender expansive subgroup of gender minority people (OR = 1.010, p = 0.047) in states with more protective policy environments had greater odds of discrimination. The gender expansive subgroup was found to have greater odds of victimization in states with more protective policy environments (OR = 1.003, p < 0.05). There was no relationship between state-level policy environments and victimization among any other study groups. SGM people may experience increased risk for discrimination and victimization despite legislative protections, posing continued risks for poor health outcomes and marginalization. Evaluation of factors (e.g., implementation strategies, systems of accountability) that influence the effectiveness of state-level polices on the reported experiences of discrimination and victimization among SGM people is needed.

  View details for DOI 10.3390/ijerph19169916

  View details for PubMedID 36011548

• Health Insurance Prevalence Among Gender Minority People: A Systematic Review and Meta-Analysis. Transgender health Clark, K. D., Sherman, A. D., Flentje, A. 2022; 7 (4): 292-302

  Abstract

  Gender minority (GM) (people whose gender does not align with the sex assigned at birth) people have historically been insured at lower rates than the general population. The purpose of this review is to (1) assess the prevalence of health insurance among GM adults in the United States, (2) examine prevalence by gender, and (3) examine trends in prevalence before and after implementation of the Affordable Care Act.Published articles from PubMed, EMBASE, and Web of Science databases before April 26th, 2019, were included. This review is registered on PROSPERO (CRD42019133627). Analysis was guided by a random-effects model to obtain a meta-prevalence estimate for all GM people and stratified by gender subgroup. Heterogeneity was assessed using a Q-test and I 2 measure.Of 55 included articles, a random pooled estimate showed that 75% GM people were insured (95% confidence interval [CI]: 0.71-0.79; p<0.001). Subgroup analysis by gender determined 70% of transgender women (95% CI: 0.64-0.76; p<0.001; I 2=97.16%) and 80% of transgender men (95% CI: 0.77-0.83; p=0.01; I 2=54.51%) were insured. Too few studies provided health insurance prevalence data for gender-expansive participants (GM people who do not identify as solely man or woman) to conduct analysis.The pooled prevalence of health insurance among GM people found in this review is considerably lower than the general population. Standardized collection of gender across research and health care will improve identification of vulnerable individuals who experience this barrier to preventative and acute care services.

  View details for DOI 10.1089/trgh.2020.0182

  View details for PubMedID 36033215

  View details for PubMedCentralID PMC9398476

• Subjective Cognitive Decline Associated with Discrimination in Medical Settings among Transgender and Nonbinary Older Adults International Journal of Environmental Research and Public Health Lambrou, N. H., Gleason, C. E., Obedin-Maliver, J., Lunn, M. R., Flentje, A., Lubensky, M. E., Flatt, J. D. 2022; 19 (15)

  Abstract

  Transgender and nonbinary (TNB) individuals report greater subjective cognitive decline (SCD) compared to non-TNB people. SCD involves self-reported problems with memory and thinking and is a potential risk for Alzheimer's disease and related dementias (ADRD). We explored psychosocial factors, such as discrimination in medical settings, associated with SCD in a sample of TNB older adults.We utilized cross-sectional data on aging health, SCD (memory complaints and worsening memory in the past year), and discrimination in medical settings from The PRIDE Study for LGBTQ+ adults aged 50+ including TNB adults (n = 115). Associations were tested using multivariate logistic regression.Nearly 16% of TNB participants rated their memory as poor/fair, and 17% reported that their memory was worse than a year ago. TNB older adults with SCD were more likely to report experiencing discrimination in medical settings. After adjustment, those reporting discrimination in medical settings had 4.5 times higher odds of reporting worsening memory than those who did not (OR: 4.5; 95%-CI: 1.5-13.2; p = 0.006), and 7.5 times more likely to report poor/fair memory (OR: 7.49; 95%-CI: 1.7-32.8; p = 0.008); Conclusions: TNB older adults reported high frequencies of SCD and discrimination in medical settings. Further research exploring affirmative cognitive screening and healthcare services is needed.

  View details for DOI 10.3390/ijerph19159168

• Healthcare Mistreatment, State-Level Policy Protections, and Healthcare Avoidance Among Gender Minority People. Sexuality research & social policy : journal of NSRC : SR & SP Clark, K. D., Luong, S., Lunn, M. R., Flowers, E., Bahalkeh, E., Lubensky, M. E., Capriotti, M. R., Obedin-Maliver, J., Flentje, A. 2022; 19 (4): 1717-1730

  Abstract

  This study examined whether past experiences of mistreatment in healthcare were associated with greater healthcare avoidance due to anticipated mistreatment among gender minority (GM) people. We evaluated whether state-level healthcare policy protections moderated this relationship.Data from the 2018 Annual Questionnaire of The PRIDE Study, a national longitudinal study on sexual and gender minority people's health, were used in these analyses. Logistic regression modeling tested relationships between lifetime healthcare mistreatment due to gender identity or expression and past-year healthcare avoidance due to anticipated mistreatment among GM participants. Interactions between lifetime healthcare mistreatment and state-level healthcare policy protections and their relationship with past-year healthcare avoidance were tested.Participants reporting any lifetime healthcare mistreatment had greater odds of past-year healthcare avoidance due to anticipated mistreatment among gender expansive people (n = 1290, OR = 4.71 [CI]: 3.57-6.20), transfeminine people (n = 263, OR = 10.32 [CI]: 4.72-22.59), and transmasculine people (n = 471, OR = 3.90 [CI]: 2.50-6.13). Presence of state-level healthcare policy protections did not moderate this relationship in any study groups.For GM people, reporting lifetime healthcare mistreatment was associated with healthcare avoidance due to anticipated mistreatment. State-level healthcare policy protections were not a moderating factor in this relationship. Efforts to evaluate the implementation and enforcement of state-level policies are needed. Continued efforts to understand instances of and to diminish healthcare mistreatment of GM people are recommended.The online version contains supplementary material available at 10.1007/s13178-022-00748-1.

  View details for DOI 10.1007/s13178-022-00748-1

  View details for PubMedID 36458212

  View details for PubMedCentralID PMC9701649

• Migraine, Migraine Disability, Trauma, and Discrimination in Sexual and Gender Minority Individuals. Neurology Rosendale, N., Guterman, E. L., Obedin-Maliver, J., Flentje, A., Capriotti, M. R., Lubensky, M. E., Lunn, M. R. 2022

  Abstract

  OBJECTIVE: This study sought to describe migrainous headache frequency and severity and to examine the relationship between trauma, discrimination, and migraine-associated disability in a sample of sexual and/or gender minority (SGM) adults.METHODS: We performed a cross-sectional study of SGM people in The Population Research in Identity and Disparities for Equality (PRIDE) Study from August-October 2018. The primary exposure was any trauma or discrimination, regardless of attribution. The primary outcome was moderate-severe migraine disability, as defined by a Migraine Disability Assessment (MIDAS) Questionnaire score ≥11. We performed descriptive analysis comparing respondents with any migrainous headache to those without. Multivariable logistic regression examined the association between trauma/discrimination and migraine disability, controlling first for sociodemographic and clinical factors and then for psychiatric comorbidities.RESULTS: Of the 3,325 total respondents, 1,126 (33.9%) screened positive for migrainous headache by ID-Migraine criteria. Most people with migraine self-reported moderate (n=768, 68.2%) or severe (n=253, 22.5%) intensity. The median MIDAS score was 11 (interquartile range [IQR] 5-25). Most respondents with migraine (n=1055, 93.7%) reported a history of trauma or discrimination. In unadjusted analysis, exposure to both trauma and discrimination was associated with higher odds of moderate-severe disability (OR 1.76, 95% CI 1.34-2.32). After adjustment for self-reported psychiatric comorbidities of anxiety, depression, and post-traumatic stress disorder, this association lost statistical significance.CONCLUSION: Migrainous headache is common among our sample of SGM adults, and prior experiences with trauma and discrimination is associated with increased migraine disability. Our findings suggest that psychiatric comorbidities play a significant role in this relationship, identifying a potentially modifiable risk factor for disability in SGM people with migraine.

  View details for DOI 10.1212/WNL.0000000000200941

  View details for PubMedID 35817570

• Psychometric evaluation of the muscle dysmorphic disorder inventory (MDDI) among gender-expansive people. Journal of eating disorders Compte, E. J., Cattle, C. J., Lavender, J. M., Brown, T. A., Murray, S. B., Capriotti, M. R., Flentje, A., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R., Nagata, J. M. 2022; 10 (1): 95

  Abstract

  Muscle dysmorphia is generally classified as a specific form of body dysmorphic disorder characterized by a pathological drive for muscularity and the preoccupation that one is too small or not sufficiently muscular. The majority of research on the condition has been conducted in cisgender men with a paucity of literature on gender minority people, a population that is at risk for muscle dysmorphia. One of the most widely used measures of muscle dysmorphia symptoms, the Muscle Dysmorphic Disorder Inventory (MDDI), has not been psychometrically validated for use in gender minority samples, the aim of the present study.We evaluated the psychometric properties of the MDDI in a sample of 1031 gender-expansive individuals (gender minority people whose gender identity differs from that assumed for their sex assigned at birth and is not exclusively binary man or woman) aged 18-74 who were part of The PRIDE Study, a large-scale, U.S., longitudinal cohort study.Using a two-step, split-sample exploratory and confirmatory factor analytic approach, we found support for the original three-factor structure of the measure. The subscales showed adequate internal consistency, and convergent validity was supported based on significant associations of the MDDI subscale scores with theoretically related scores on a widely used measure of disordered eating.These findings provided novel support for adequate psychometric properties of the MDDI in a sample of gender-expansive individuals, facilitating the use of this measure in future research on muscle dysmorphia in this understudied and at-risk population.

  View details for DOI 10.1186/s40337-022-00618-6

  View details for PubMedID 35794647

• Psychometric validation of the Muscle Dysmorphic Disorder Inventory (MDDI) among U.S. transgender men. Body image Nagata, J. M., Compte, E. J., McGuire, F. H., Lavender, J. M., Murray, S. B., Brown, T. A., Capriotti, M. R., Flentje, A., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R. 2022; 42: 43-49

  Abstract

  Muscle dysmorphia (MD) is characterized by a pervasive belief or fear of insufficient muscularity and an elevated drive for muscularity, representing the pathological and extreme pursuit of muscularity. Psychometric properties of one of the most widely used measures of MD symptoms-the Muscle Dysmorphic Disorder Inventory (MDDI)-have yet to be evaluated in transgender men despite emerging evidence suggesting differential risk for MD symptoms in this population. In this study, we assessed the psychometric properties of the MDDI in a sample of 330 transgender men ages 18-67 years who participated in a large-scale national longitudinal cohort study of sexual and gender minority adults in the U.S. Using a two-step, split-sample approach, an initial exploratory factor analysis supported a three-factor structure and a subsequent confirmatory factor analysis of a re-specified three-factor model demonstrated good overall fit (χ2/df = 1.84, CFI =0.94, TLI =0.92, RMSEA =0.07 [90% CI =0.05,.09], SRMR =0.08). Moreover, results supported the internal consistency and convergent validity of the MDDI subscales in transgender men. Findings inform the use of the MDDI among transgender men and provide a foundation to support further work on the MDDI and MD symptoms among gender minority populations.

  View details for DOI 10.1016/j.bodyim.2022.05.001

  View details for PubMedID 35653965

• COVID-19 News and Its Association with the Mental Health of Sexual and Gender Minority Adults: A Cross-Sectional Study. JMIR public health and surveillance Clark, K. D., Lunn, M. R., Sherman, A. D., Bosley, H. G., Lubensky, M. E., Obedin-Maliver, J., Dastur, Z., Flentje, A. 2022

  Abstract

  BACKGROUND: Sexual and gender minority (SGM; people whose sexual orientation is not heterosexual and/or whose gender identity varies from what is traditionally associated with the sex assigned to them at birth) people experience high rates of trauma and significant disparities in anxiety and post-traumatic stress disorder (PTSD). Exposure to traumatic stressors, such as news related to COVID-19, may be associated with symptoms of anxiety and PTSD.OBJECTIVE: to evaluate the relationship of COVID-19 news exposure with anxiety and PTSD symptoms in a sample of SGM adults in the United States (US).METHODS: Data were collected between March 23 and August 2, 2020 from The PRIDE Study, a national, longitudinal, cohort study of SGM people. Regression analyses were used to analyze the relationship between self-reported news exposure and (1) symptoms of anxiety using the General Anxiety Disorder (GAD) 7-item Scale and (2) symptoms of COVID-related PTSD using the Impact of Events Scale-Revised (IES-R).RESULTS: Our sample included a total of 3,079 SGM participants. Each unit increase in COVID-19-related news exposure was associated with greater anxiety symptoms (OR=1.77,95% CI [1.63, 1.93], P<.001) and 1.93 greater odds of PTSD (95% CI [1.74, 2.14], P<.001).CONCLUSIONS: Our study found that COVID-19 news exposure was positively associated with greater symptoms of anxiety and PTSD among SGM people. This supports previous literature in other populations where greater news exposure was associated with poorer mental health. Further research is needed to determine the direction of this relationship and to evaluate for differences among SGM subgroups with multiple marginalized identities.CLINICALTRIAL:

  View details for DOI 10.2196/34710

  View details for PubMedID 35486805

• Integrating LGBTQ+ health into medical education. The clinical teacher Raygani, S., Mangosing, D., Clark, K. D., Luong, S., Flentje, A., Sarah, G. 2022; 19 (2): 166-171

  Abstract

  LGBTQ+ people experience significant barriers in accessing health care including inadequate provider knowledge and stigma in health care settings. Undergraduate medical education programs have increased efforts to integrate LGBTQ+ health topics, such as comprehensive sexual history taking and gender-affirming practices, into their curriculums to provide clinically inclusive care for LGBTQ+ patients.A Topic Steward was appointed to oversee the integration of LGBTQ+ health topics throughout the existing undergraduate medical curriculum. The aim was to expand the LGBTQ+ health curriculum for undergraduate medical students through teaching comprehensive sexual history taking; offering specialty-specific LGBTQ+ health education through clerkships; describing the difference between sex assigned at birth, gender identity, and gender expression; describing the difference between sexual orientation and sexual behaviour; identifying health care disparities that LGBTQ+ people experience; and developing an inclusive approach to providing medical care for LGBTQ+ patients.The program started in July 2017 with UCSFSOM students in their first, second, or third years (~150 medical students per year) participating in the integrated curriculum that included didactic lectures, small group discussions, and LGBTQ+ clerkship opportunities. The hours of LGBTQ+ health curriculum at the UCSFSOM increased from 4.5 hours to 15-20 hours in approximately 2 years under the Topic Steward approach.The next step is to develop standardised tools for assessing LGBTQ+ health competencies for medical students. This involves integrating more questions regarding LGBTQ+ health topics in traditional exams at UCSFSOM and developing specialty-specific assessment instruments that other medical schools could administer to test core competencies in LGBTQ+ health.

  View details for DOI 10.1111/tct.13463

  View details for PubMedID 35118807

• Appearance and performance-enhancing drugs and supplements, eating disorders, and muscle dysmorphia among gender minority people. The International journal of eating disorders Nagata, J. M., McGuire, F. H., Lavender, J. M., Brown, T. A., Murray, S. B., Greene, R. E., Compte, E. J., Flentje, A., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R. 2022

  Abstract

  OBJECTIVE: Appearance and performance-enhancing drugs and supplements (APEDS) can be used to enhance muscle growth, athletic performance, and physical appearance. The aim of this study was to examine the lifetime use of APEDS and associations with eating disorder and muscle dysmorphia symptoms among gender minority people.METHOD: Participants were 1653 gender minority individuals (1120 gender-expansive [defined as a broad range of gender identities that are generally situated outside of the woman-man gender binary, e.g., genderqueer, nonbinary] people, 352 transgender men, and 181 transgender women) recruited from The Population Research in Identity and Disparities for Equality Study in 2018. Regression analyses stratified by gender identity examined associations of any APEDS use with eating disorder and muscle dysmorphia symptom scores.RESULTS: Lifetime APEDS use was common across groups (30.7% of gender-expansive people, 45.2% of transgender men, and 14.9% of transgender women). Protein supplements and creatine supplements were the most commonly used APEDS. Among gender-expansive people and transgender men, lifetime use of any APEDS was significantly associated with higher eating disorder scores, dietary restraint, binge eating, compelled/driven exercise, and muscle dysmorphia symptoms. Any APEDS use was additionally associated with laxative use among gender-expansive people. Among transgender women, use of any APEDS was not significantly associated with eating disorder or muscle dysmorphia symptoms.DISCUSSION: APEDS use is common and associated with eating disorder and muscle dysmorphia symptoms in gender-expansive people and transgender men, thus highlighting the importance of assessing for these behaviors and symptoms among these populations, particularly in clinical settings.PUBLIC SIGNIFICANCE: This study aimed to examine APEDS use among gender minority people. We found that 30.7% of gender-expansive (e.g., nonbinary) people, 45.2% of transgender men, and 14.9% of transgender women reported lifetime APEDS use, which was associated with eating disorder and muscle dysmorphia symptoms in transgender men and gender-expansive people. Clinicians should assess for these behaviors in gender minority populations.

  View details for DOI 10.1002/eat.23708

  View details for PubMedID 35352378

• Mental Health Monitor: Counteracting Stigmatizing Diagnoses in the DSM-5 Lev, E., Edwards, W., Cohen, J., Flentje, A. Social Work Today. 2022 (22): 30
• Associations among romantic and sexual partner history and muscle dysmorphia symptoms, disordered eating, and appearance- and performance-enhancing drugs and supplement use among cisgender gay men. Body image Nagata, J. M., DeBenedetto, A. M., Brown, T. A., Lavender, J. M., Murray, S. B., Capriotti, M. R., Flentje, A., Lubensky, M. E., Cattle, C. J., Obedin-Maliver, J., Lunn, M. R. 2022; 41: 67-73

  Abstract

  This study examined relationship status (e.g., single versus not single) and number of sexual partners in relation to muscularity- and disordered eating-related attitudes and behaviors among 1090 cisgender gay men enrolled in The PRIDE Study in 2018. Participants completed measures assessing muscle dysmorphia (MD) symptoms, disordered eating attitudes and behaviors, and appearance- and performance-enhancing drug or supplement (APEDS) use. In linear regression models adjusting for theoretically relevant covariates, neither relationship status nor number of past-month sexual partners was associated with disordered eating attitudes. In terms of MD symptoms, single (versus not single) relationship status was associated with greater appearance intolerance, and a greater number of sexual partners was associated with greater drive for size and functional impairment. In adjusted logistic regression models, a greater number of past-month sexual partners was associated with use of anabolic-androgenic steroids, synthetic performance-enhancing substances, protein supplements, and creatine supplements, as well as greater likelihood of engaging in compelled/driven exercise. Across all associations, effect sizes were generally small. Overall, results support that inquiring about sexual partners may have utility in evaluating risk for muscularity-oriented attitudes and behaviors among cisgender gay men. Future work will need to replicate these findings, particularly in more diverse samples.

  View details for DOI 10.1016/j.bodyim.2022.02.004

  View details for PubMedID 35228105

• Appearance and performance-enhancing drugs and supplements (APEDS): Lifetime use and associations with eating disorder and muscle dysmorphia symptoms among cisgender sexual minority people. Eating behaviors Nagata, J. M., McGuire, F. H., Lavender, J. M., Brown, T. A., Murray, S. B., Compte, E. J., Cattle, C. J., Flentje, A., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R. 2022; 44: 101595

  Abstract

  Appearance and performance-enhancing drugs and supplements (APEDS) are used to enhance muscle growth, athletic performance, and physical appearance. The aim of this study was to examine the lifetime use of APEDS and associations with eating disorder and muscle dysmorphia symptoms among cisgender sexual minority people.Participants were cisgender sexual minority people (1090 gay men, 100 bisexual plus men, 564 lesbian women, and 507 bisexual plus women) recruited from The PRIDE Study in 2018 who reported lifetime APEDS use and completed the Eating Disorder Examination-Questionnaire (EDE-Q) and the Muscle Dysmorphic Disorder Inventory (MDDI). Regression analyses stratified by gender and sexual orientation examined associations of any APEDS use with EDE-Q and MDDI scores.Lifetime APEDS use was common across the four groups of cisgender sexual minority people (44% of gay men, 42% of bisexual plus men, 29% of lesbian women, and 30% of bisexual plus women). Protein supplements and creatine supplements were the most commonly used APEDS. Any APEDS use was associated with higher EDE-Q scores on one or more subscales in all sexual minority groups. Further, any APEDS use was associated with higher MDDI Total Scores in all groups; any APEDS use was associated with all MDDI subscale scores in cisgender gay men only.APEDS use is common and associated with eating disorder and muscle dysmorphia symptoms in sexual minority men and women, thus highlighting the importance of assessing for these behaviors and symptoms among these populations in clinical settings.

  View details for DOI 10.1016/j.eatbeh.2022.101595

  View details for PubMedID 35066385

• Do Ask, Tell, and Show: Contextual Factors Affecting Sexual Orientation and Gender Identity Disclosure for Sexual and Gender Minority People. LGBT health Suen, L. W., Lunn, M. R., Sevelius, J. M., Flentje, A., Capriotti, M. R., Lubensky, M. E., Hunt, C., Weber, S., Bahati, M., Rescate, A., Dastur, Z., Obedin-Maliver, J. 2022

  Abstract

  Purpose: Sexual and gender minority (SGM) people-including members of lesbian, gay, bisexual, transgender, and queer communities-remain underrepresented in health research due to poor collection of sexual orientation and gender identity (SOGI) data. We sought to understand the contextual factors affecting how SGM research participants interact with SOGI questions to enhance participant experience and increase the accuracy and sensitivity of research findings. Methods: We recruited SGM adults for in-person semi-structured focus groups or online cognitive interviews from 2016 to 2018. During focus groups and cognitive interviews, we asked participants to respond to SOGI question sets. We employed template analysis to describe the contextual factors that affected SGM participants' responses to SOGI questions. Results: We had a total of 74 participants, including 55 participants organized into nine focus groups and 19 participants in cognitive interviews. Most self-identified as a sexual minority person (88%), and 51% identified as a gender minority person. Two main themes were: (1) the need to know the relevance (of why SOGI questions are asked) and (2) the importance of environmental and contextual cues (communicating physical safety and freedom from discrimination that influenced SOGI disclosure). Conclusions: Contextualizing the relevance of SOGI data sought could help improve the accuracy and sensitivity of data collection efforts. Environmental cues that communicate acceptance and safety for SGM individuals in research settings may support disclosure. Researchers should consider these contextual factors when designing future studies to improve research experiences for SGM individuals and increase the likelihood of future participation.

  View details for DOI 10.1089/lgbt.2021.0159

  View details for PubMedID 35073205

• Pregnancy intentions and outcomes among transgender, nonbinary, and gender-expansive people assigned female or intersex at birth in the United States: Results from a national, quantitative survey. International journal of transgender health Moseson, H., Fix, L., Hastings, J., Stoeffler, A., Lunn, M. R., Flentje, A., Lubensky, M. E., Capriotti, M. R., Ragosta, S., Forsberg, H., Obedin-Maliver, J. 2021; 22 (1-2): 30-41

  Abstract

  Background: Transgender, nonbinary, and gender-expansive (TGE) people experience pregnancy. Quantitative data about pregnancy intentions and outcomes of TGE people are needed to identify patterns in pregnancy intentions and outcomes and to inform clinicians how best to provide gender-affirming and competent pregnancy care. Aims: We sought to collect data on pregnancy intentions and outcomes among TGE people assigned female or intersex at birth in the United States. Methods: Collaboratively with a study-specific community advisory team, we designed a customizable, online survey to measure sexual and reproductive health experiences among TGE people. Eligible participants included survey respondents who identified as a man or within the umbrella of transgender, nonbinary, or gender-expansive identities; were 18 years or older; able to complete an electronic survey in English; lived in the United States; and were assigned female or intersex at birth. Participants were recruited through The PRIDE Study - a national, online, longitudinal cohort study of sexual and gender minority people - and externally via online social media postings, TGE community e-mail distribution lists, in-person TGE community events, and academic and community conferences. We conducted descriptive analyses of pregnancy-related outcomes and report frequencies overall and by racial and ethnic identity, pregnancy intention, or testosterone use. Results: Out of 1,694 eligible TGE respondents who provided reproductive history data, 210 (12%) had been pregnant. Of these, 115 (55%) had one prior pregnancy, 47 (22%) had two prior pregnancies, and 48 (23%) had three or more prior pregnancies. Of the 433 pregnancies, 169 (39%) resulted in live birth, 142 (33%) miscarried, 92 (21%) ended in abortion, two (0.5%) ended in stillbirth, two (0.5%) had an ectopic pregnancy, and seven (2%) were still pregnant; nineteen pregnancies (4%) had an unknown outcome. Among live births, 39 (23%) were delivered via cesarean section. Across all pregnancies, 233 (54%) were unintended. Fifteen pregnancies occurred after initiation of testosterone, and four pregnancies occurred while taking testosterone. Among all participants, 186 (11%) wanted a future pregnancy, and 275 (16%) were unsure; 182 (11%) felt "at risk" for an unintended pregnancy. Discussion: TGE people in the United States plan for pregnancy, experience pregnancy (intended and unintended) and all pregnancy outcomes, and are engaged in family building. Sexual and reproductive health clinicians and counselors should avoid assumptions about pregnancy capacity or intentions based on a patient's presumed or stated gender or engagement with gender-affirming hormone therapy.

  View details for DOI 10.1080/26895269.2020.1841058

  View details for PubMedID 34796363

  View details for PubMedCentralID PMC8040680

• From 'Shark-Week' to 'Mangina': An Analysis of Words Used by People of Marginalized Sexual Orientations and/or Gender Identities to Replace Common Sexual and Reproductive Health Terms. Health equity Ragosta, S., Obedin-Maliver, J., Fix, L., Stoeffler, A., Hastings, J., Capriotti, M. R., Flentje, A., Lubensky, M. E., Lunn, M. R., Moseson, H. 2021; 5 (1): 707-717

  Abstract

  Purpose: To explore sexual and reproductive health (SRH)-related word-use among sexual and gender minority (SGM) individuals in the United States. Methods: In 2019, we fielded an online quantitative survey on the SRH experiences of SGM adults. Eligible participants included transgender, nonbinary, and gender-expansive (TGE) people assigned female or intersex at birth, and cisgender sexual minority women (CSMW) in the United States. The survey asked participants to indicate if they used each of nine SRH terms, and if not, to provide the word(s) they used. We analyzed patterns in replacement words provided by respondents and tested for differences by gender category with tests of proportions. Results: Among 1704 TGE and 1370 CSMW respondents, 613 (36%) TGE respondents and 92 (7%) CSMW respondents replaced at least 1 SRH term (p-for-difference <0.001). Many (23%) replacement words/phrases were entirely unique. For six out of the nine terms, TGE respondents indicated that use of the provided term would depend on the context, the term did not apply to them, or they did not have a replacement word/phrase that worked for them. Conclusions: SRH terms commonly used in clinical and research settings cause discomfort and dysphoria among some SGM individuals. To address inequities in access to and quality of SRH care among SGM individuals, and to overcome long standing fear of mistreatment in clinical settings, more intentional word-use and elicitation from providers and researchers could increase the quality and affirming nature of clinical and research experiences for SGM people.

  View details for DOI 10.1089/heq.2021.0022

  View details for PubMedID 34909540

  View details for PubMedCentralID PMC8665782

• Comparing substance use and mental health among sexual and gender minority and heterosexual cisgender youth experiencing homelessness. PloS one Hao, J., Beld, M., Khoddam-Khorasani, L., Flentje, A., Kersey, E., Mousseau, H., Frank, J., Leonard, A., Kevany, S., Dawson-Rose, C. 2021; 16 (3): e0248077

  Abstract

  Youth homelessness has been demonstrated to disproportionately affect sexual and gender minority (SGM) youth compared to heterosexual cisgender peers. In this context, we aimed to compare health risks between service-seeking SGM and heterosexual cisgender youth experiencing homelessness, including harmful risks stemming from substance use and severity of symptoms of mental health disorders. We recruited 100 racially diverse, unstably housed participants aged 18-24 who access services at an urban non-profit organization in San Francisco, CA. Data analysis included 56 SGM participants who identified as gay, lesbian, bisexual, pansexual, unsure, transgender, and nongender, and 44 heterosexual cisgender participants. In contrast to previous studies reporting significantly higher frequency of substance use and more severe symptoms of depression, generalized anxiety, and post-traumatic stress disorder among SGM youth compared to heterosexual cisgender peers, many of these health disparities were not observed in our diverse study population of service-seeking youth. Furthermore, with the exception of methamphetamine, SGM participants did not exhibit greater harmful risks resulting from substance use, such as health, social, financial, and legal complications. We discuss the reduced burden of health disparities between SGM and heterosexual cisgender youth in our service-seeking study population within the context of gender- and sexuality-affirming programming offered at the partnering community organization. We conclude that longitudinal data on these tailored community-level interventions are needed to further explore the reduced burden of health disparities observed among service-seeking SGM youth experiencing homelessness in San Francisco in order to continue supporting pathways out of homelessness for youth of all sexual and gender identities nationwide.

  View details for DOI 10.1371/journal.pone.0248077

  View details for PubMedID 33705446

  View details for PubMedCentralID PMC7951876

• Intersecting minority statuses and tryptophan degradation among stimulant-using, sexual minority men living with HIV. Journal of consulting and clinical psychology Vincent, W., Carrico, A. W., Dilworth, S. E., Fuchs, D., Neilands, T. B., Moskowitz, J. T., Flentje, A. 2021; 89 (3): 156-165

  Abstract

  Disclosure of one's sexual orientation as a sexual-minority (SM) person (i.e., being "out") may affect HIV-related health outcomes. This longitudinal study examined whether race/ethnicity moderated effects of outness on the plasma kynurenine/tryptophan (KT) ratio, a marker of dysregulated serotonin metabolism due to immune activation that predicts clinical HIV progression.Participants were African American, Hispanic/Latino, and non-Hispanic White, methamphetamine-using SM men living with HIV (N = 97) who completed self-report scales of outness and SM stress at baseline for a randomized controlled trial of a positive affect intervention. Linear mixed modeling was used to test whether race/ethnicity and experimental condition moderated the association of baseline outness with the KT ratio at baseline, 6, 12, and 15 months controlling for SM stress, sociodemographics, HIV disease markers, and recent stimulant use.The interactions of outness by race/ethnicity and outness by experimental condition on the KT ratio were significant. Greater outness predicted a lower KT ratio over time in non-Hispanic White SM men, but not among SM men of color (MOC). Greater outness predicted a lower KT ratio over time for SM men in the control, but not among those in the intervention arm.Being more out may be protective for non-Hispanic White SM men, but not for their SM MOC peers. Outness mattered for participants who did not receive the positive affect intervention. Findings underscore the potentially different contexts and consequences of outness depending on SM men's race/ethnicity and whether they received a positive affect intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

  View details for DOI 10.1037/ccp0000586

  View details for PubMedID 33829804

  View details for PubMedCentralID PMC8547766

• Abortion attempts without clinical supervision among transgender, nonbinary and gender-expansive people in the United States. BMJ sexual & reproductive health Moseson, H. n., Fix, L. n., Gerdts, C. n., Ragosta, S. n., Hastings, J. n., Stoeffler, A. n., Goldberg, E. A., Lunn, M. R., Flentje, A. n., Capriotti, M. R., Lubensky, M. E., Obedin-Maliver, J. n. 2021

  Abstract

  Transgender, nonbinary and gender-expansive (TGE) people face barriers to abortion care and may consider abortion without clinical supervision.In 2019, we recruited participants for an online survey about sexual and reproductive health. Eligible participants were TGE people assigned female or intersex at birth, 18 years and older, from across the United States, and recruited through The PRIDE Study or via online and in-person postings.Of 1694 TGE participants, 76 people (36% of those ever pregnant) reported considering trying to end a pregnancy on their own without clinical supervision, and a subset of these (n=40; 19% of those ever pregnant) reported attempting to do so. Methods fell into four broad categories: herbs (n=15, 38%), physical trauma (n=10, 25%), vitamin C (n=8, 20%) and substance use (n=7, 18%). Reasons given for abortion without clinical supervision ranged from perceived efficiency and desire for privacy, to structural issues including a lack of health insurance coverage, legal restrictions, denials of or mistreatment within clinical care, and cost.These data highlight a high proportion of sampled TGE people who have attempted abortion without clinical supervision. This could reflect formidable barriers to facility-based abortion care as well as a strong desire for privacy and autonomy in the abortion process. Efforts are needed to connect TGE people with information on safe and effective methods of self-managed abortion and to dismantle barriers to clinical abortion care so that TGE people may freely choose a safe, effective abortion in either setting.

  View details for DOI 10.1136/bmjsrh-2020-200966

  View details for PubMedID 33674348

• Understanding co-occurring depression symptoms and alcohol use symptoms among cisgender sexual minority women JOURNAL OF GAY & LESBIAN SOCIAL SERVICES McGeough, B. L., Aguilera, A., Capriotti, M. R., Obedin-Maliver, J., Lubensky, M. E., Lunn, M. R., Flentje, A. 2021; 33 (4): 427-450

  View details for DOI 10.1080/10538720.2021.1886214

  View details for Web of Science ID 000750624600002

• Online health information seeking, health literacy, and human papillomavirus vaccination among transgender and gender-diverse people. Journal of the American Medical Informatics Association : JAMIA Pho, A. T., Bakken, S., Lunn, M. R., Lubensky, M. E., Flentje, A., Dastur, Z., Obedin-Maliver, J. 2021

  Abstract

  The purpose of this study is to describe online health information seeking among a sample of transgender and gender diverse (TGD) people compared with cisgender sexual minority people to explore associations with human papillomavirus (HPV) vaccination, and whether general health literacy and eHealth literacy moderate this relationship.We performed a cross-sectional online survey of TGD and cisgender sexual minority participants from The PRIDE Study, a longitudinal, U.S.-based, national health study of sexual and gender minority people. We employed multivariable logistic regression to model the association of online health information seeking and HPV vaccination.The online survey yielded 3258 responses. Compared with cisgender sexual minority participants, TGD had increased odds of reporting HPV vaccination (aOR, 1.5; 95% CI, 1.1-2.2) but decreased odds when they had looked for information about vaccines online (aOR, 0.7; 95% CI, 0.5-0.9). TGD participants had over twice the odds of reporting HPV vaccination if they visited a social networking site like Facebook (aOR, 2.4; 95% CI, 1.1-5.6). No moderating effects from general or eHealth literacy were observed.Decreased reporting of HPV vaccination among TGD people after searching for vaccine information online suggests vaccine hesitancy, which may potentially be related to the quality of online content. Increased reporting of vaccination after using social media may be related to peer validation.Future studies should investigate potential deterrents to HPV vaccination in online health information to enhance its effectiveness and further explore which aspects of social media might increase vaccine uptake among TGD people.

  View details for DOI 10.1093/jamia/ocab150

  View details for PubMedID 34383916

• Community norms of the Muscle Dysmorphic Disorder Inventory (MDDI) among gender minority populations. Journal of eating disorders Nagata, J. M., Compte, E. J., McGuire, F. H., Lavender, J. M., Brown, T. A., Murray, S. B., Flentje, A., Capriotti, M. R., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R. 2021; 9 (1): 87

  Abstract

  Representing the pathological extreme pursuit of muscularity, muscle dysmorphia (MD) is characterized by a pervasive belief or fear around insufficient muscularity and an elevated drive for muscularity. Despite evidence of heightened body image-related concerns among gender minority populations, little is known about the degree of MD symptoms among gender minorities, particularly based on Muscle Dysmorphic Disorder Inventory (MDDI) scores. The objective of this study was to assess community norms of the MDDI in gender-expansive people, transgender men, and transgender women.Data from participants in The PRIDE Study, an existing study of health outcomes in sexual and gender minority people, were examined. We calculated means, standard deviations, and percentiles for the MDDI total and subscale scores among gender-expansive people (i.e., those who identify outside of the binary system of man or woman; n = 1023), transgender men (n = 326), and transgender women (n = 177). The Kruskal-Wallis test was used to assess group differences and post hoc Dunn's tests were used to examine pairwise differences.Transgender men reported the highest mean MDDI total score (30.5 ± 7.5), followed by gender-expansive people (27.2 ± 6.7), then transgender women (24.6 ± 5.7). The differences in total MDDI score were driven largely by the Drive for Size subscale and, to a lesser extent, the Functional Impairment subscale. There were no significant differences in the Appearance Intolerance subscale among the three groups.Transgender men reported higher Drive for Size, Functional Impairment, and Total MDDI scores compared to gender-expansive people and transgender women. These norms provide insights into the experience of MD symptoms among gender minorities and can aid researchers and clinicians in the interpretation of MDDI scores among gender minority populations.

  View details for DOI 10.1186/s40337-021-00442-4

  View details for PubMedID 34261536

• Minority Stress, Structural Stigma, and Physical Health Among Sexual and Gender Minority Individuals: Examining the Relative Strength of the Relationships. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine Flentje, A., Clark, K. D., Cicero, E., Capriotti, M. R., Lubensky, M. E., Sauceda, J., Neilands, T. B., Lunn, M. R., Obedin-Maliver, J. 2021

  Abstract

  Sexual and gender minority (SGM; i.e., non-heterosexual and transgender or gender-expansive, respectively) people experience physical health disparities attributed to greater exposure to minority stress (experiences of discrimination or victimization, anticipation of discrimination or victimization, concealment of SGM status, and internalization of stigma) and structural stigma.To examine which components of minority stress and structural stigma have the strongest relationships with physical health among SGM people.Participants (5,299 SGM people, 1,902 gender minority individuals) were from The Population Research in Identity and Disparities for Equality (PRIDE) Study. Dominance analyses estimated effect sizes showing how important each component of minority stress and structural stigma was to physical health outcomes.Among cisgender sexual minority women, transmasculine individuals, American Indian or Alaskan Native SGM individuals, Asian SGM individuals, and White SGM individuals a safe current environment for SGM people had the strongest relationship with physical health. For gender-expansive individuals and Black, African American, or African SGM individuals, the safety of the environment for SGM people in which they were raised had the strongest relationship with physical health. Among transfeminine individuals, victimization experiences had the strongest relationship with physical health. Among Hispanic, Latino, or Spanish individuals, accepting current environments had the strongest relationship with physical health. Among cisgender sexual minority men prejudice/discrimination experiences had the strongest relationship with physical health.Safe community environments had the strongest relationships with physical health among most groups of SGM people. Increasing safety and buffering the effects of unsafe communities are important for SGM health.

  View details for DOI 10.1093/abm/kaab051

  View details for PubMedID 34228052

• Community norms of the Muscle Dysmorphic Disorder Inventory (MDDI) among cisgender sexual minority men and women. BMC psychiatry Nagata, J. M., Compte, E. J., Cattle, C. J., Lavender, J. M., Brown, T. A., Murray, S. B., Flentje, A., Capriotti, M. R., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R. 2021; 21 (1): 297

  Abstract

  Representing the pathological extreme pursuit of muscularity, muscle dysmorphia (MD) is characterized by a pervasive belief or fear around insufficient muscularity and an elevated drive for muscularity. Despite evidence of elevated body image-related concerns among sexual minority populations, little is known about the degree of muscle dysmorphia (MD) symptoms among sexual minorities, particularly based on Muscle Dysmorphic Disorder Inventory (MDDI) scores. The objective of this study was to examine the nature and severity of MD symptoms in cisgender sexual minority men and women and provide community norms of the MDDI for these populations.Data from participants in The PRIDE Study, an existing study of health outcomes in sexual and gender minority people from the United States, were examined. Participants included cisgender gay men (N = 1090), cisgender bisexual plus (bisexual, pansexual, and/or polysexual) men (N = 100), cisgender lesbian women (N = 563), and cisgender bisexual plus women (N = 507). We calculated means, standard deviations (SD), and percentiles for the MDDI total and subscale scores for cisgender sexual minority men and women. We compared MDDI scores by sexual orientation using linear regression models, both unadjusted and adjusted for sociodemographics.Overall, the sample was 85.2% White, 3.0% Asian or Pacific Islander, 2.0% Black, 0.5% Native American, 3.9% multiracial, and 6.6% Hispanic/Latino/a. The mean age was 38.6 (SD = 14.3) and 69.4% had a college degree or higher. Means (SD) for the MDDI total score were 27.4 (7.7) for cisgender gay men, 26.4 (6.4) for cisgender bisexual plus men, 24.3 (6.1) for cisgender lesbian women, and 24.6 (5.5) for cisgender bisexual plus women. There were no significant differences in MDDI scores between cisgender gay and bisexual plus men, or between cisgender lesbian women and bisexual plus women in unadjusted or adjusted models.These normative data provide insights into the experience of MD symptoms among cisgender sexual minority men and women and can aid researchers and clinicians in the evaluation of MD symptoms and interpretation of MDDI scores in sexual minority populations.

  View details for DOI 10.1186/s12888-021-03302-2

  View details for PubMedID 34103034

• Psychometric evaluation of the Muscle Dysmorphic Disorder Inventory (MDDI) among cisgender gay men and cisgender lesbian women. Body image Compte, E. J., Cattle, C. J., Lavender, J. M., Murray, S. B., Brown, T. A., Capriotti, M. R., Flentje, A. n., Lubensky, M. E., Obedin-Maliver, J. n., Lunn, M. R., Nagata, J. M. 2021; 38: 241–50

  Abstract

  Despite increasing empirical interest in muscle dysmorphia (MD), a dearth of research has assessed this construct in sexual minority populations. In particular, the psychometric properties of one of the most widely used measures of MD symptoms-the Muscle Dysmorphic Disorder Inventory (MDDI)-have not been evaluated in sexual minority populations despite emerging evidence suggesting differential risk for MD symptoms across sexual orientation groups. In this study, we assessed the psychometric properties of the MDDI in a sample of 715 cisgender gay men and 404 cisgender lesbian women ages 18-50 years who participated in a large-scale national longitudinal cohort study of sexual and gender minority adults. The factor structure of the MDDI was examined in each sample using a two-step, split-sample exploratory and confirmatory factor analytic approach. Exploratory factor analysis supported a three-factor structure in both samples, which were confirmed by confirmatory factor analysis. Moreover, results supported the internal consistency reliability and convergent validity of the MDDI subscales in both samples. Cumulatively, these findings suggest that the MDDI is an appropriate measure of MD symptoms among cisgender gay men and cisgender lesbian women.

  View details for DOI 10.1016/j.bodyim.2021.04.008

  View details for PubMedID 33962223

• Pregnancy intentions and outcomes among transgender, nonbinary, and gender-expansive people assigned female or intersex at birth in the United States: Results from a national, quantitative survey INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH Moseson, H., Fix, L., Hastings, J., Stoeffler, A., Lunn, M. R., Flentje, A., Lubensky, M. E., Capriotti, M. R., Ragosta, S., Forsberg, H., Obedin-Maliver, J. 2020

  View details for DOI 10.1080/26895269.2020.1841058

  View details for Web of Science ID 000592692400001

• Quantifying Sexual Orientation Among Homeless and Unstably Housed Women in a Longitudinal Study: Identity, Behavior, and Fluctuations Over a Three-Year Period. Journal of homosexuality Flentje, A., Brennan, J., Satyanarayana, S., Shumway, M., Riley, E. 2020; 67 (2): 244-264

  Abstract

  Sexual orientation has been linked to certain health conditions, and yet quantifying sexual orientation in longitudinal studies is challenging. This study examined different methods of accounting for sexual orientation in a cohort study of 300 homeless and unstably housed women followed every 6 months over 3 years. Altogether, 39.7% (n = 119) could be considered sexual minority at one or more time points based on identity and/or behavior; 16.3% (n = 49) reported shifts in sexual identity. Only 24.0% (n = 72) were identified as sexual minority through a single measure of sexual identity, 27.0% (n = 81) were identified with a single measure of identity and behavior, 33.0% (n = 99) were identified through annual measures of identity and behavior, and 22.0%-22.3% (n = 66-67) were identified through latent class analysis including all identity/behavior measures. This study found that sexual fluidity is common in unstably housed women, and many sexual minority women would be missed in longitudinal studies with different methods of accounting for sexual orientation.

  View details for DOI 10.1080/00918369.2018.1536417

  View details for PubMedID 30403568

  View details for PubMedCentralID PMC6504620

• Real-time associations between discrimination and anxious and depressed mood among sexual and gender minorities: The moderating effects of lifetime victimization and identity concealment. Psychology of sexual orientation and gender diversity Livingston, N. A., Flentje, A., Brennan, J., Mereish, E. H., Reed, O., Cochran, B. N. 2020; 7 (2): 132-141

  Abstract

  Sexual and gender minorities (SGM) experience higher rates of depression and anxiety, which are linked to higher rates of discrimination and victimization. SGM individuals may conceal their SGM identities to decrease discrimination and victimization exposure; however, these experiences still occur, and concealment itself is often associated with greater anxiety and depression. However, it remains unclear whether lifetime victimization and identity concealment moderate the effect of day-to-day discrimination, which we evaluated in the current study using ecological momentary assessment (EMA).Fifty SGM participants (Mage=21.82, SD=4.70; 84% White) completed baseline assessment (e.g., concealment and lifetime victimization) followed by EMA of daily discrimination and anxious and depressed mood for 14 days.As hypothesized, daily discrimination predicted momentary increases in anxious and depressed mood, b = .34, p < .001. Notably, these effects were more pronounced among individuals who reported higher levels of identity concealment, b = .25, p < .001, and previous SGM-based victimization experiences (marginally), b = .18, p = .05. Main effects of cumulative lifetime victimization and identity concealment, measured at baseline, were associated with higher ratings of anxious and depressed mood over the two-week study.While identity concealment may reduce exposure to discrimination and victimization, we found that concealment and prior victimization predict heightened reactivity to daily discrimination experiences. Additional research is needed to further explicate real-time effects of minority stress exposure, and to develop interventions that may mitigate risk among SGM individuals with prior victimization exposure and higher levels of identity concealment in particular.

  View details for DOI 10.1037/sgd0000371

  View details for PubMedID 34026920

  View details for PubMedCentralID PMC8132594

• Play provides social connection for older adults with serious mental illness: A grounded theory analysis of a 10-week exergame intervention. Aging & mental health Dobbins, S., Hubbard, E., Flentje, A., Dawson-Rose, C., Leutwyler, H. 2020; 24 (4): 596-603

  Abstract

  Introduction: The number of older adults with serious mental illness (SMI) is predicted to reach 15 million by 2030. Social isolation is known to contribute to morbidity and mortality, and those with SMI experience more social isolation than older adults in the general population. Social isolation in these older adults is complex and involves factors including organic psychopathology, effects of medications and/or other substances, medical co-morbidity, disability, and social stigma. The burgeoning field of inquiry of exergames, which are video games with gestural interfaces, for older adults has found that they are safe, effective, enjoyable, and may decrease social isolation. This qualitative study was conducted to gain insight into the effects of group exergame play on the psychosocial wellbeing of older adults with SMI.Methods: We explored the psychosocial effects of a 10-week group exergame program for 16 older adults with SMI using grounded theory methodology within a symbolic interactionist framework.Results: Participants experienced positive social contact, engaged in social attunement, and expressed motivation to take risks and face problem-solving and physical challenges. Two interrelated concepts emerged from the integrated data: Social connectedness and competence. The theoretical construct that was abducted from these concepts was that play and playfulness were the vehicle for many interacting social processes to take place.Conclusion: Group play through exergames for older adults with SMI may promote recovery and healthy aging by increasing social integration, improving self-efficacy, and promoting physical health through exercise.

  View details for DOI 10.1080/13607863.2018.1544218

  View details for PubMedID 30586998

  View details for PubMedCentralID PMC6597314

• Characterization of substance use among underrepresented sexual and gender minority participants in The Population Research in Identity and Disparities for Equality (PRIDE) Study. Substance abuse Barger, B. T., Obedin-Maliver, J. n., Capriotti, M. R., Lunn, M. R., Flentje, A. n. 2020: 1–12

  Abstract

  Background: Profiles of substance use among less commonly described subgroups of sexual and gender minority (SGM) people (e.g., queer, genderqueer) remain largely unknown. Objective(s): To identify substance use differences among less commonly described SGM identity-based subgroups. Methods: The PRIDE Study is a national, online, longitudinal cohort study of self-identified SGM adults living in the U.S. Between 2015-2017, an iPhone application was used to administer three cross-sectional health questionnaires to participants, one of which included questions about binge alcohol, marijuana, and other drug use (substance use). This study was a secondary data analysis of participant responses to substance use survey items. Logistic regression and generalized linear modeling assessed relationships between sexual orientation or gender and use of or reported problems with substances within the past year. Results: Among the 1790 participants included in this study, 51.0% reported binge alcohol use, 39.8% reported marijuana use, and 19.7% reported other drug use (65.9% endorsed use of one or more of these) within the past year. Over 30% indicated substance use had been a problem in their life. Asexual individuals had lower odds of reporting past year binge alcohol and marijuana use (aOR: 0.27, 95% CI: 0.12-0.61; aOR: 0.38, 95% CI: 0.15-0.96, respectively), and queer participants had higher odds of reporting past year marijuana use (aOR: 2.52, 95% CI: 1.58-4.03) compared to lesbian participants. Gender nonbinary participants had lower odds of reporting past year binge alcohol use (aOR: 0.48, 95% CI: 0.32-0.71) and transmasculine participants had higher odds of reporting past year marijuana use (aOR: 2.18, 95% CI: 1.10-4.31) compared to cisgender women. Conclusions: Substance use heterogeneity exists between SGM groups. Comprehensive assessment of sexual orientation and gender may improve understanding of substance use and increase equity within support and treatment services for SGM populations.HighlightsWe examined substance use among less represented sexual and gender minority groups.Alcohol and other drug use were examined by both sexual orientation and gender identity.Analyses included identities such as queer, pansexual, genderqueer and nonbinary.Alcohol use differed across asexual, genderqueer and gender nonbinary groups.Marijuana use differed across queer, asexual and transmasculine groups.

  View details for DOI 10.1080/08897077.2019.1702610

  View details for PubMedID 32032500

• Community norms for the Eating Disorder Examination Questionnaire (EDE-Q) among gender-expansive populations. Journal of eating disorders Nagata, J. M., Compte, E. J., Cattle, C. J., Flentje, A. n., Capriotti, M. R., Lubensky, M. E., Murray, S. B., Obedin-Maliver, J. n., Lunn, M. R. 2020; 8 (1): 74

  Abstract

  Gender-expansive individuals (i.e., those who identify outside of the binary system of man or woman) are a marginalized group that faces discrimination and have a high burden of mental health problems, but there is a paucity of research on eating disorders in this population. This study aimed to describe the community norms for the Eating Disorder Examination Questionnaire (EDE-Q) in gender-expansive populations.The participants were 988 gender-expansive individuals (defined as neither exclusively cisgender nor binary transgender) from The PRIDE study, an existing longitudinal cohort study of health outcomes in sexual and gender minority people.We present the mean scores, standard deviations, and percentile ranks for the Global score and four subscale scores of the EDE-Q in this group as a whole and stratified by sex assigned at birth. Gender-expansive individuals reported any occurrence (≥1/28 days) of dietary restraint (23.0%), objective binge episodes (12.9%), excessive exercise (7.4%), self-induced vomiting (1.4%), or laxative misuse (1.2%). We found no statistically significant differences by sex assigned at birth. Compared to a prior study of transgender men and women, there were no significant differences in eating attitudes or disordered eating behaviors noted between gender-expansive individuals and transgender men. Transgender women reported higher Restraint and Shape Concern subscale scores compared to gender-expansive individuals. Compared to a prior study of presumed cisgender men 18-26 years, our age-matched gender-expansive sample had higher Eating, Weight, and Shape Concern subscales and Global Score, but reported a lower frequency of objective binge episodes and excessive exercise. Compared to a prior study of presumed cisgender women 18-25 years, our age-matched gender-expansive sample had a higher Shape Concern subscale score, a lower Restraint subscale score, and lower frequencies of self-induced vomiting, laxative misuse, and excessive exercise.Gender-expansive individuals reported lower Restraint and Shape Concern scores than transgender women; higher Eating, Weight, and Shape Concern scores than presumed cisgender men; and lower Restraint but higher Shape Concern scores than presumed cisgender women. These norms can help clinicians in treating this population and interpreting the EDE-Q scores of their gender-expansive patients.

  View details for DOI 10.1186/s40337-020-00352-x

  View details for PubMedID 33292636

• Community norms for the eating disorder examination questionnaire (EDE-Q) among cisgender bisexual plus women and men. Eating and weight disorders : EWD Nagata, J. M., Compte, E. J., Murray, S. B., Schauer, R. n., Pak, E. n., Flentje, A. n., Capriotti, M. R., Lubensky, M. E., Lunn, M. R., Obedin-Maliver, J. n. 2020

  Abstract

  Cisgender bisexual plus (including bisexual, pansexual, and polysexual) women and men experience unique health concerns including eating disorders. The purpose of this study was to develop community norms for eating disorder attitudes and disordered eating behaviors in cisgender bisexual plus women and men using the Eating Disorders Examination Questionnaire (EDE-Q).Participants were cisgender bisexual plus women (n = 462) and men (n = 93) participants in The PRIDE Study, an existing study of sexual and gender minority people.Mean and standard deviation of EDE-Q scores among cisgender bisexual plus women and men, respectively, were: Global (1.75 ± 1.26, 1.56 ± 1.18), Restraint (1.34 ± 1.44, 1.42 ± 1.53), Eating Concern (0.96 ± 1.13, 0.63 ± 0.96), Weight Concern 2.27 ± 1.55, 1.89 ± 1.46), and Shape Concern 42 ± 1.62, 2.30 ± 1.57). Among cisgender bisexual plus women and men, respectively, 27.5% and 22.6% scored in the clinically significant range on the Global score. Bisexual plus women and men reported any occurrence (≥ 1/28 days) of dietary restraint (19.3%, 23.7%), objective binge episodes (11.1%, 10.8%), excessive exercise (4.5%, 5.4%), self-induced vomiting (1.7%, 0.0%), and laxative misuse (0.4%, 1.1%), respectively. A lower percentage of age-matched cisgender bisexual plus women (18-25 years) reported any occurrence of objective binge episodes, self-induced vomiting, laxative misuse, and excessive exercise than previously published in young women. Age-matched cisgender bisexual plus men (18-26 years) reported higher weight concern subscale scores than previously published in young men.These norms should aid clinicians in applying and interpreting the EDE-Q scores of cisgender bisexual plus women and men.Level V: cross-sectional descriptive study.

  View details for DOI 10.1007/s40519-020-01070-8

  View details for PubMedID 33270173

• Abortion experiences and preferences of transgender, nonbinary, and gender-expansive people in the United States. American journal of obstetrics and gynecology Moseson, H. n., Fix, L. n., Ragosta, S. n., Forsberg, H. n., Hastings, J. n., Stoeffler, A. n., Lunn, M. R., Flentje, A. n., Capriotti, M. R., Lubensky, M. E., Obedin-Maliver, J. n. 2020

  Abstract

  Transgender, nonbinary, and gender-expansive (TGE) people who were assigned female or intersex at birth experience pregnancy and have abortions. No data have been published on individual abortion experiences or preferences of this understudied population.To fill existing evidence gaps on the abortion experiences and preferences of TGE people in the United States to inform policies and practices to improve access to and quality of abortion care for this population.In 2019, we recruited TGE people assigned female or intersex at birth and aged 18 years and older from across the United States to participate in an online survey about sexual and reproductive health recruited through The PRIDE Study and online postings. We descriptively analyzed closed- and open-ended survey responses related to pregnancy history, abortion experiences, preferences for abortion method, recommendations to improve abortion care for TGE people, and respondent sociodemographic characteristics.The majority of the 1,694 respondents were less than 30 years of age. Respondents represented multiple gender identities and sexual orientations and resided across all four United States Census Regions. Overall, 210 (12%) respondents had ever been pregnant; these 210 reported 421 total pregnancies, of which 92 (22%) ended in abortion. For respondents' most recent abortion, 41 (61%) were surgical, 23 (34%) were medication, and 3 (4.5%) used another method (primarily herbal). Most recent abortions took place at or before nine weeks gestation (n=41, 61%). If they were to need an abortion today, respondents preferred medication abortion to surgical abortion three to one (n=703 versus n=217), but 514 (30%) respondents did not know which method they would prefer. Reasons for medication abortion preference among the 703 respondents included a belief that it is the least invasive method (n=553, 79%) and the most private method (n=388, 55%). To improve accessibility and quality of abortion care for TGE patients, respondents most frequently recommended that abortion clinics adopt gender-neutral or gender-affirming intake forms, that providers utilize gender-neutral language, and that greater privacy be incorporated into the clinic.These data contribute significantly to the evidence base on individual experiences of and preferences for abortion care for TGE people. Findings can be used to adapt abortion care to better include and affirm the experiences of this underserved population.

  View details for DOI 10.1016/j.ajog.2020.09.035

  View details for PubMedID 32986990

• What Sexual and Gender Minority People Want Researchers to Know About Sexual Orientation and Gender Identity Questions: A Qualitative Study. Archives of sexual behavior Suen, L. W., Lunn, M. R., Katuzny, K. n., Finn, S. n., Duncan, L. n., Sevelius, J. n., Flentje, A. n., Capriotti, M. R., Lubensky, M. E., Hunt, C. n., Weber, S. n., Bibbins-Domingo, K. n., Obedin-Maliver, J. n. 2020

  Abstract

  Sexual and gender minority (SGM) people-including members of the lesbian, gay, bisexual, transgender, and queer communities-are understudied and underrepresented in research. Current sexual orientation and gender identity (SOGI) questions do not sufficiently engage SGM people, and there is a critical gap in understanding how SOGI questions reduce inclusion and accurate empirical representation. We conducted a qualitative study to answer the question, "For SGM people, what are the major limitations with current SOGI questions?" Focus groups probed reactions to SOGI questions adapted from prior national surveys and clinical best practice guidelines. Questions were refined and presented in semi-structured cognitive interviews. Template analysis using a priori themes guided analysis. There were 74 participants: 55 in nine focus groups and 19 in cognitive interviews. Participants were diverse: 51.3% identified as gender minorities, 87.8% as sexual minorities, 8.1% as Hispanic/Latinx, 13.5% as Black or African-American, and 43.2% as Non-white. Two major themes emerged: (1) SOGI questions did not allow for identity fluidity and complexity, reducing inclusion and representation, and (2) SOGI question stems and answer choices were often not clear as to which SOGI dimension was being assessed. To our knowledge, this represents the largest body of qualitative data studying SGM perspectives when responding to SOGI questions. We present recommendations for future development and use of SOGI measures. Attention to these topics may improve meaningful participation of SGM people in research and implementation of such research within and for SGM communities.

  View details for DOI 10.1007/s10508-020-01810-y

  View details for PubMedID 32875381

• Eating disorder attitudes and disordered eating behaviors as measured by the Eating Disorder Examination Questionnaire (EDE-Q) among cisgender lesbian women. Body image Nagata, J. M., Murray, S. B., Flentje, A. n., Compte, E. J., Schauer, R. n., Pak, E. n., Capriotti, M. R., Lubensky, M. E., Lunn, M. R., Obedin-Maliver, J. n. 2020; 34: 215–20

  Abstract

  The Eating Disorder Examination Questionnaire (EDE-Q) is a measure of eating disorder attitudes and disordered eating behaviors. Prior descriptive studies of the EDE-Q for women either did not assess or omitted reporting sexual orientation. This study's objective was to assess eating disorder attitudes and disordered eating behaviors as measured by the EDE-Q among cisgender lesbian women. We present mean scores and standard deviations for the EDE-Q among 563 self-identified cisgender lesbian women ages 18-77 who were recruited from The PRIDE Study in 2018. Among cisgender lesbian women, 3.4 % scored in the clinically significant range on the Restraint, 1.6 % on the Eating Concern, 9.1 % on the Weight Concern, 13.9 % on the Shape Concern, and 3.9 % on the Global Score scales of the EDE-Q. We found that 13.5 % of participants reported any occurrence (≥1/28 days) of dietary restriction, 8.7 % for objective binge episodes, 5.3 % for excessive exercise, .4% for self-induced vomiting, and .4% for laxative misuse. Participants reported a current (1.8 %) or lifetime (7.1 %) diagnosis of an eating disorder by a clinician. These EDE-Q descriptive data capture eating disorder attitudes and disordered eating behaviors among cisgender lesbian women and may aid clinicians and researchers in interpreting the EDE-Q in this specific population.

  View details for DOI 10.1016/j.bodyim.2020.06.005

  View details for PubMedID 32652490

• Community norms for the Eating Disorder Examination Questionnaire (EDE-Q) among transgender men and women. Eating behaviors Nagata, J. M., Murray, S. B., Compte, E. J., Pak, E. H., Schauer, R. n., Flentje, A. n., Capriotti, M. R., Lubensky, M. E., Lunn, M. R., Obedin-Maliver, J. n. 2020; 37: 101381

  Abstract

  Transgender men and women may be at risk for eating disorders, but prior community norms of the Eating Disorders Examination Questionnaire (EDE-Q) are based on presumed cisgender men and woman and have not intentionally included transgender people. The objective of this study was to develop community norms for eating disorder attitudes and disordered eating behaviors in transgender men and women using the EDE-Q. Participants were 312 transgender men and 172 transgender women participants in The PRIDE Study, an existing cohort study of sexual and gender minority people. We present mean scores, standard deviations, and percentile ranks for the Global score and four subscale scores of the EDE-Q in transgender men and women. Transgender men and women reported any occurrence (≥1/week) of dietary restraint (25.0% and 27.9%), objective binge episodes (11.2% and 12.8%), excessive exercise (8.0% and 8.1%), self-induced vomiting (1.6% and 1.7%), and laxative misuse (.3% and .6%), respectively. Compared to a prior study of presumed cisgender men 18-26 years (Lavender, De Young, & Anderson, 2010), our age-matched subsample of transgender men reported lower rates of objective binge episodes and excessive exercise. Compared to a prior study of presumed cisgender women 18-42 years (Mond, Hay, Rodgers, & Owen, 2006), we found that an age-matched sample of transgender women reported higher rates of dietary restraint but lower rates of excessive exercise. These norms should aid clinicians in applying and researchers in investigating and interpreting the EDE-Q scores of transgender men and women.

  View details for DOI 10.1016/j.eatbeh.2020.101381

  View details for PubMedID 32416588

• Development of an affirming and customizable electronic survey of sexual and reproductive health experiences for transgender and gender nonbinary people. PloS one Moseson, H. n., Lunn, M. R., Katz, A. n., Fix, L. n., Durden, M. n., Stoeffler, A. n., Hastings, J. n., Cudlitz, L. n., Goldberg, E. n., Lesser-Lee, B. n., Letcher, L. n., Reyes, A. n., Flentje, A. n., Capriotti, M. R., Lubensky, M. E., Obedin-Maliver, J. n. 2020; 15 (5): e0232154

  Abstract

  To address pervasive measurement biases in sexual and reproductive health (SRH) research, our interdisciplinary team created an affirming, customizable electronic survey to measure experiences with contraceptive use, pregnancy, and abortion for transgender and gender nonbinary people assigned female or intersex at birth and cisgender sexual minority women. Between May 2018 and April 2019, we developed a questionnaire with 328 items across 10 domains including gender identity; language used for sexual and reproductive anatomy and events; gender affirmation process history; sexual orientation and sexual activity; contraceptive use and preferences; pregnancy history and desires; abortion history and preferences; priorities for sexual and reproductive health care; family building experiences; and sociodemographic characteristics. Recognizing that the words people use for their sexual and reproductive anatomy can vary, we programmed the survey to allow participants to input the words they use to describe their bodies, and then used those customized words to replace traditional medical terms throughout the survey. This process-oriented paper aims to describe the rationale for and collaborative development of an affirming, customizable survey of the SRH needs and experiences of sexual and gender minorities, and to present summary demographic characteristics of 3,110 people who completed the survey. We also present data on usage of customizable words, and offer the full text of the survey, as well as code for programming the survey and cleaning the data, for others to use directly or as guidelines for how to measure SRH outcomes with greater sensitivity to gender diversity and a range of sexual orientations.

  View details for DOI 10.1371/journal.pone.0232154

  View details for PubMedID 32365110

• Supporting sexual and gender minority health: Research priorities from mental health professionals JOURNAL OF GAY & LESBIAN MENTAL HEALTH Clark, K. D., Capriotti, M. R., Obedin-Maliver, J., Lunn, M. R., Lubensky, M. E., Flentje, A. 2019

  View details for DOI 10.1080/19359705.2019.1700865

  View details for Web of Science ID 000503440300001

• A Pilot Study Using a Multistaged Integrated Analysis of Gene Expression and Methylation to Evaluate Mechanisms for Evening Fatigue in Women Who Received Chemotherapy for Breast Cancer. Biological research for nursing Flowers, E., Flentje, A., Levine, J., Olshen, A., Hammer, M., Paul, S., Conley, Y., Miaskowski, C., Kober, K. M. 2019; 21 (2): 142-156

  Abstract

  Fatigue is the most common symptom associated with cancer and its treatment. Investigation of molecular mechanisms associated with fatigue may identify new therapeutic targets.The objective of this pilot study was to evaluate the relationships between gene expression and methylation status and evening fatigue severity in women with breast cancer who received chemotherapy.Latent class analysis (LCA) was used to identify evening fatigue phenotypes. In this analysis, the lowest (i.e., moderate, n = 7) and highest (i.e., very high, n = 29) fatigue-severity classes identified using LCA were analyzed via two stages. First, a total of 32,609 transcripts from whole blood were evaluated for differences in expression levels between the classes. Next, 637 methylation sites located within the putative transcription factor binding sites for those genes demonstrating differential expression were evaluated for differential methylation state between the classes.A total of 89 transcripts in 75 unique genes were differentially expressed between the moderate (the lowest fatigue-severity class identified) and very high evening fatigue classes. In addition, 23 differentially methylated probes and three differentially methylated regions were found between the moderate and very high evening fatigue classes.Using a multistaged integrated analysis of gene expression and methylation, differential methylation was identified in the regulatory regions of genes associated with previously hypothesized mechanisms for fatigue, including inflammation, immune function, neurotransmission, circadian rhythm, skeletal muscle energy, carbohydrate metabolism, and renal function as well as core biological processes including gene transcription and the cell-cycle regulation.

  View details for DOI 10.1177/1099800418823286

  View details for PubMedID 30701989

  View details for PubMedCentralID PMC6700896

• Community norms for the Eating Disorder Examination Questionnaire among cisgender gay men. European eating disorders review : the journal of the Eating Disorders Association Nagata, J. M., Capriotti, M. R., Murray, S. B., Compte, E. J., Griffiths, S. n., Bibbins-Domingo, K. n., Obedin-Maliver, J. n., Flentje, A. n., Lubensky, M. E., Lunn, M. R. 2019

  Abstract

  Prior norms of the Eating Disorders Examination Questionnaire (EDE-Q) among men have not considered sexual orientation. This study's objective was to assess EDE-Q community norms among cisgender gay men.Participants were 978 self-identified cisgender gay men from The PRIDE Study recruited in 2018.We present mean scores and standard deviations for the EDE-Q among cisgender gay men ages 18-82. Among cisgender gay men, 4.0% scored in the clinically significant range on the global score, 5.7% on the restraint, 2.1% on the eating concern, 10.5% on the weight concern, and 21.4% on the shape concern subscales of the EDE-Q. The global score as well as weight and shape concerns in a young adult subsample (18-26 years) from The PRIDE Study were higher than previously reported norms in young men (Lavender, 2010). Participants reported any occurrence (≥1/28 days) of dietary restraint (19.8%), objective binge episodes (10.9%), excessive exercise (10.1%), laxative misuse (1.1%), and self-induced vomiting (0.6%). Binge eating, excessive exercise, and self-induced vomiting in The PRIDE Study subsample were lower than previously reported in young men.We provide EDE-Q norms among cisgender gay men, which should aid clinicians and researchers to interpret the EDE-Q scores of cisgender gay men.

  View details for DOI 10.1002/erv.2708

  View details for PubMedID 31793119

• Recent stimulant use and leukocyte gene expression in methamphetamine users with treated HIV infection. Brain, behavior, and immunity Carrico, A. W., Flentje, A., Kober, K., Lee, S., Hunt, P., Riley, E. D., Shoptaw, S., Flowers, E., Dilworth, S. E., Pahwa, S., Aouizerat, B. E. 2018; 71: 108-115

  Abstract

  Stimulant use may accelerate HIV disease progression through biological and behavioral pathways. However, scant research with treated HIV-positive persons has examined stimulant-associated alterations in pathophysiologic processes relevant to HIV pathogenesis. In a sample of 55 HIV-positive, methamphetamine-using sexual minority men with a viral load less than 200 copies/mL, we conducted RNA sequencing to examine patterns of leukocyte gene expression in participants who had a urine sample that was reactive for stimulants (n = 27) as compared to those who tested non-reactive (n = 28). Results indicated differential expression of 32 genes and perturbation of 168 pathways in recent stimulant users. We observed statistically significant differential expression of single genes previously associated with HIV latency, cell cycle regulation, and immune activation in recent stimulant users (false discovery rate p < 0.10). Pathway analyses indicated enrichment for genes associated with inflammation, innate immune activation, neuroendocrine hormone regulation, and neurotransmitter synthesis. Recent stimulant users displayed concurrent elevations in plasma levels of tumor necrosis factor - alpha (TNF-α) but not interleukin 6 (IL-6). Further research is needed to examine the bio-behavioral mechanisms whereby stimulant use may contribute to HIV persistence and disease progression.

  View details for DOI 10.1016/j.bbi.2018.04.004

  View details for PubMedID 29679637

  View details for PubMedCentralID PMC6003871

• Minority stress and leukocyte gene expression in sexual minority men living with treated HIV infection. Brain, behavior, and immunity Flentje, A., Kober, K. M., Carrico, A. W., Neilands, T. B., Flowers, E., Heck, N. C., Aouizerat, B. E. 2018; 70: 335-345

  Abstract

  Sexual minority (i.e., non-heterosexual) individuals experience poorer mental and physical health, accounted for in part by the additional burden of sexual minority stress occurring from being situated in a culture favoring heteronormativity. Informed by previous research, the purpose of this study was to identify the relationship between sexual minority stress and leukocyte gene expression related to inflammation, cancer, immune function, and cardiovascular function. Sexual minority men living with HIV who were on anti-retroviral medication, had viral load < 200 copies/mL, and had biologically confirmed, recent methamphetamine use completed minority stress measures and submitted blood samples for RNA sequencing on leukocytes. Differential gene expression and pathway analyses were conducted comparing those with clinically elevated minority stress (n = 18) and those who did not meet the clinical cutoff (n = 20), covarying reactive urine toxicology results for very recent stimulant use. In total, 90 differentially expressed genes and 138 gene set pathways evidencing 2-directional perturbation were observed at false discovery rate (FDR) < 0.10. Of these, 41 of the differentially expressed genes and 35 of the 2-directionally perturbed pathways were identified as functionally related to hypothesized mechanisms of inflammation, cancer, immune function, and cardiovascular function. The neuroactive-ligand receptor pathway (implicated in cancer development) was identified using signaling pathway impact analysis. Our results suggest several potential biological pathways for future work investigating the relationship between sexual minority stress and health.

  View details for DOI 10.1016/j.bbi.2018.03.016

  View details for PubMedID 29548994

  View details for PubMedCentralID PMC5953835

• Recommendations for practitioners LGBT Health: Meeting the Health Needs of Gender and Sexual Minorities Capriotti, M., Flentje, A. edited by Smalley, B., Warren, J. C., Barefoot, N. 2018
• Ecological momentary assessment of daily discrimination experiences and nicotine, alcohol, and drug use among sexual and gender minority individuals. Journal of consulting and clinical psychology Livingston, N. A., Flentje, A., Heck, N. C., Szalda-Petree, A., Cochran, B. N. 2017; 85 (12): 1131-1143

  Abstract

  Sexual and gender minority (SGM) individuals experience elevated rates of minority stress, which has been linked to higher rates of nicotine and substance use. Research on this disparity to date is largely predicated on methodology that is insensitive to within day SGM-based discrimination experiences, or their relation to momentary nicotine and substance use risk. We address this knowledge gap in the current study using ecological momentary assessment (EMA).Fifty SGM individuals, between 18 and 45 years of age, were recruited from an inland northwestern university, regardless of their nicotine or substance use history, and invited to participate in an EMA study. Each were prompted to provide data, six times daily (between 10:00 a.m. and 10:00 p.m.) for 14 days, regarding SGM-based discrimination, other forms of mistreatment, and nicotine, drug, and alcohol use since their last prompt.Discrimination experiences that occurred since individuals' last measurement prompt were associated with greater odds of nicotine and substance use during the same measurement window. Substance use was also more likely to occur in relation to discrimination reported two measurements prior in lagged models. Relative to other forms of mistreatment, discrimination effects were consistently larger in magnitude and became stronger throughout the day/evening.This study adds to existing minority stress research by highlighting the both immediate and delayed correlates of daily SGM-based discrimination experiences. These results also contribute to our understanding of daily stress processes and provide insight into ways we might mitigate these effects using real-time monitoring and intervention technology. (PsycINFO Database Record

  View details for DOI 10.1037/ccp0000252

  View details for PubMedID 29189029

  View details for PubMedCentralID PMC5726448

• The relationship between childhood abuse and violent victimization in homeless and marginally housed women: The role of dissociation as a potential mediator. Psychological trauma : theory, research, practice and policy Young, D. A., Shumway, M., Flentje, A., Riley, E. D. 2017; 9 (5): 613-621

  Abstract

  Previous studies have established a link between childhood abuse and dissociation. Other work has shown childhood abuse increases the likelihood of violent victimization in adulthood. Although it has been posited that dissociation may mediate childhood abuse and adult violent victimization, research investigating this hypothesis is sparse, particularly for extremely vulnerable populations such as homeless and unstably housed individuals. investigated the relationship between childhood abuse and dissociation on violent victimization in a cohort of homeless and unstably housed women. We also assessed whether dissociation mediated childhood abuse and violent victimization in this sample.Participants were asked at an initial assessment and a 6-month follow-up to report any physical or sexual violence experienced in the previous 6 months. Questionnaires recording history of specific types of childhood abuse, dissociation, and other factors were also recorded at the initial assessment.Hierarchical logistic regression models revealed that childhood sexual abuse (Odds ratio [OR] = 3.10, p < .01) and severe dissociation (OR = 1.99, p < .01) were significantly associated with recent physical violence, and childhood sexual abuse (OR = 3.88, p < .01) and dissociation (OR = 1.87, p < .05) were also associated with recent sexual violence. Dissociation mediated neither childhood abuse on recent physical violence or recent sexual violence.Developing approaches that effectively identify and treat dissociation as a part of an overall framework of trauma-informed care in homeless and unstably housed women may be an effective way to decrease future physical violence in this vulnerable population. (PsycINFO Database Record

  View details for DOI 10.1037/tra0000288

  View details for PubMedID 28581316

  View details for PubMedCentralID PMC5589487

• Cigarette Smoking among Women Who Are Homeless or Unstably Housed: Examining the Role of Food Insecurity. Journal of urban health : bulletin of the New York Academy of Medicine Kim, J. E., Flentje, A., Tsoh, J. Y., Riley, E. D. 2017; 94 (4): 514-524

  Abstract

  Smoking prevalence remains high among individuals who are homeless, partly due to stressors related to homelessness. Beyond housing insecurity, homelessness involves financial stresses and unmet subsistence needs. In particular, food insecurity contributes to negative health outcomes and other health risks. This study examined associations between food insecurity severity and smoking among homeless and marginally housed women in San Francisco, California. We used data from 247 women from a longitudinal cohort study. Generalized estimating equations were used to estimate longitudinal associations between study factors and smoking based on data from five biannual assessment points between 2009 and 2012. The longitudinal adjusted odds of smoking were higher among severely food insecure individuals compared to those who were not food insecure (AOR = 1.68, 95% CI [1.02, 2.78]), while associations with other study factors, including demographics, time, HIV status, mental health, and substance use (except marijuana use), did not reach levels of significance. Similar adjusted longitudinal results were observed when food insecurity was the dependent variable and smoking an independent variable, suggesting the possibility of a bidirectional association. Considering unmet needs, such as food and hunger, may improve comprehensive smoking cessation strategies targeting individuals for whom mainstream tobacco control efforts have not been effective. Similarly, offering improved access to smoking cessation resources should be considered in efforts to address food insecurity among individuals experiencing homelessness.

  View details for DOI 10.1007/s11524-017-0166-x

  View details for PubMedID 28589340

  View details for PubMedCentralID PMC5533665

• Spirituality/religiosity, substance use, and HIV testing among young black men who have sex with men. Drug and alcohol dependence Carrico, A. W., Storholm, E. D., Flentje, A., Arnold, E. A., Pollack, L. M., Neilands, T. B., Rebchook, G. M., Peterson, J. L., Eke, A., Johnson, W., Kegeles, S. M. 2017; 174: 106-112

  Abstract

  Spirituality and religiosity may serve as both a resource and a barrier to HIV prevention with young black men who have sex with men (YBMSM). We examined indices of spirituality/religiosity as correlates of binge drinking, stimulant use, and recent HIV testing in a sample of YBMSM.From 2011-2013, annual venue-based surveys of sexually active YBMSM ages 18-29 were conducted in Dallas and Houston, Texas. Binge drinking and stimulant use were assessed in the past two months. Participants recently tested for HIV (i.e., within the past six months) were compared to those without recent HIV testing (i.e., never tested or tested more than six months ago).Among the 1565 HIV-negative or HIV-unknown YBMSM enrolled, more engagement in spiritual and religious activities was associated with greater odds of reporting stimulant use (Adjusted Odds Ratio [AOR]=1.20; 95% CI=1.04-1.40) while higher spiritual coping was associated with lower odds of reporting stimulant use (AOR=0.66; 95% CI=0.56-0.78). Binge drinking was independently associated with 29% lower odds of recent HIV testing (AOR=0.71; 95% CI=0.55-0.92), but lower odds of binge drinking did not mediate the association of engagement in spiritual and religious activities with 27% greater odds of recent HIV testing (AOR=1.27; 95% CI=1.11-1.46).Among YBMSM, culturally tailored approaches addressing spirituality/religiosity could support prevention of stimulant use and increase HIV testing. In particular, expanded efforts are needed to promote HIV testing in binge drinkers.

  View details for DOI 10.1016/j.drugalcdep.2017.01.024

  View details for PubMedID 28319751

  View details for PubMedCentralID PMC5482005

• Psychiatric Risk in Unstably Housed Sexual Minority Women: Relationship between Sexual and Racial Minority Status and Human Immunodeficiency Virus and Psychiatric Diagnoses. Women's health issues : official publication of the Jacobs Institute of Women's Health Flentje, A., Shumway, M., Wong, L. H., Riley, E. D. 2017; 27 (3): 294-301

  Abstract

  Stress associated with minority statuses has been linked to mental health disorders. However, research conducted exclusively among impoverished women, a population known to be at risk for poor health owing to overlapping risks, is sparse. We sought to determine if homeless and unstably housed sexual minority (i.e., nonheterosexual) women were at greater psychiatric risk than their heterosexual counterparts. We also sought to determine if racial/ethnic minority and human immunodeficiency virus status contributed to psychiatric risks.Homeless/unstably housed women living in San Francisco between 2008 and 2010 were followed biannually over 3 years. Generalized estimating equation analysis identified significant correlates of any substance use, mood, or anxiety disorder, as well as the total number of psychiatric disorders.Among 300 women, 24% reported nonheterosexual identity at the first study visit. Consistent with minority stress theory, lesbian and bisexual identity were associated with higher levels of mental health comorbidity, and bisexual identity was related to greater rates of substance use disorders and mood disorders. Unique to this study, we found that identity assessed 1 or 2 years prior does not predict current substance disorders, but current identity does. In addition, women who were infected with the human immunodeficiency virus also had higher rates of mental health comorbidity and substance use disorders. Contrary to psychosocial stress theory, racial/ethnic minority status was associated with reduced odds of substance use disorder in this population. Recent homelessness was related to greater risk of anxiety disorder.Best research and health care practices should include the assessment of sexual orientation and housing status when addressing risks for mental health and substance disorders among low-income women.

  View details for DOI 10.1016/j.whi.2016.12.005

  View details for PubMedID 28108194

  View details for PubMedCentralID PMC5435529

• Omitted data in randomized controlled trials for anxiety and depression: A systematic review of the inclusion of sexual orientation and gender identity. Journal of consulting and clinical psychology Heck, N. C., Mirabito, L. A., LeMaire, K., Livingston, N. A., Flentje, A. 2017; 85 (1): 72-76

  Abstract

  The current study examined the frequency with which randomized controlled trials (RCTs) of behavioral and psychological interventions for anxiety and depression include data pertaining to participant sexual orientation and nonbinary gender identities.Using systematic review methodology, the databases PubMed and PsycINFO were searched to identify RCTs published in 2004, 2009, and 2014. Random selections of 400 articles per database per year (2,400 articles in total) were considered for inclusion in the review. Articles meeting inclusion criteria were read and coded by the research team to identify whether the trial reported data pertaining to participant sexual orientation and nonbinary gender identities. Additional trial characteristics were also identified and indexed in our database (e.g., sample size, funding source).Of the 232 articles meeting inclusion criteria, only 1 reported participants' sexual orientation, and zero articles included nonbinary gender identities. A total of 52,769 participants were represented in the trials, 93 of which were conducted in the United States, and 43 acknowledged the National Institutes of Health as a source of funding.Despite known mental health disparities on the basis of sexual orientation and nonbinary gender identification, researchers evaluating interventions for anxiety and depression are not reporting on these important demographic characteristics. Reporting practices must change to ensure that our interventions generalize to lesbian, gay, bisexual, and transgender persons. (PsycINFO Database Record

  View details for DOI 10.1037/ccp0000123

  View details for PubMedID 27845517

  View details for PubMedCentralID PMC5161712

• Mental and Physical Health among Homeless Sexual and Gender Minorities in a Major Urban US City. Journal of urban health : bulletin of the New York Academy of Medicine Flentje, A., Leon, A., Carrico, A., Zheng, D., Dilley, J. 2016; 93 (6): 997-1009

  Abstract

  Sexual and gender minorities have been shown to have greater rates of mental health, substance use disorders, and specific types of health problems compared to heterosexuals. Among the homeless population in several US urban areas, sexual and gender minorities are overrepresented but few studies have examined the mental and physical health status of homeless sexual and gender minorities, with studies on homeless gender minorities being particularly hard to find. Using survey data obtained from the city and county of San Francisco (2015 Homeless Survey), this study examined differences in causes of homelessness, physical and mental health problems, and domestic violence among homeless sexual and gender minorities and their heterosexual and cisgender (i.e., non-transgender) counterparts, respectively. Lesbians and bisexual women, and gay and bisexual men did not differ from their cisgender heterosexual counterparts. Cisgender men who identified as queer or "other" in response to sexual orientation questions had higher rates of psychiatric problems and posttraumatic stress disorder, while cisgender women who identified as queer or "other" had higher rates of psychiatric problems and drug and alcohol use. Transgender men who were homeless were found to be particularly at risk for physical health problems, mental health problems, and domestic violence or abuse. Transgender women were more likely to report posttraumatic stress disorder. This study suggests that transgender men and cisgender sexual minority men and women who identify as queer or "other" are groups among the homeless that may benefit from increased outreach and services.

  View details for DOI 10.1007/s11524-016-0084-3

  View details for PubMedID 27699581

  View details for PubMedCentralID PMC5126021

• Multiple Types of Childhood and Adult Violence Among Homeless and Unstably Housed Women in San Francisco. Violence and victims Wong, L. H., Shumway, M., Flentje, A., Riley, E. D. 2016; 31 (6): 1171-1182

  Abstract

  This study examined the relationship between different forms of childhood violence (emotional, physical, and sexual) and these same forms of violence in adulthood, using a crosssectional baseline survey of 298 homeless and unstably housed women in San Francisco, California. We also examined other related factors, including mental illnesses diagnosis, sex exchange, jail time, HIV status, and sociodemographic information. Regression analysis indicated that although several of these factors were associated with experiences of violence as an adult, specific types of child violence (e.g., sexual violence) predicted instances of that same type of violence as an adult but not necessarily other types. Thus, risk of adult violence among low-income women may be better predicted and addressed through histories of same-type childhood violence, despite years of intervening exposures and stressors.

  View details for DOI 10.1891/0886-6708.VV-D-15-00132

  View details for PubMedID 27640925

  View details for PubMedCentralID PMC5629968

• Sexual orientation and treatment-seeking for depression in a multilingual worldwide sample. Journal of affective disorders Rutter, T. M., Flentje, A., Dilley, J. W., Barakat, S., Liu, N. H., Gross, M. S., Muñoz, R. F., Leykin, Y. 2016; 206: 87-93

  Abstract

  Prior research has found higher rates of mental health problems among sexual minority individuals. We examine treatment-seeking for depression, as well as its relationship with sexual orientation, in a large, multilingual, international sample.Participants in an automated, quintilingual internet-based depression screening tool were screened for depression, and completed several background measures, including sexual orientation (with an option to decline to state) and past and current depression treatment seeking.3695 participants screened positive for current or past depression and responded to the sexual orientation question. Those who declined to state their sexual orientation were far less likely to seek any treatment than individuals endorsing any orientation; they were especially unlikely to seek psychotherapy. Individuals identifying as bisexual sought both psychotherapy and alternative treatments at a higher rate than other groups. An interaction was observed between sexual orientation and gender, such that lesbian women were especially likely to have used psychotherapy. Other variables that emerged as significant predictors of treatment-seeking for depression included age and participant's language.Limitations include possible misinterpretation of translated terms due to regional differences, and possible limits to generalizability due to this study being conducted on the internet.Our results suggest that individuals who decline to state their sexual orientation may be more likely to forgo effective treatments for depression. Further studies of depression service utilization should focus on developing treatment modalities that could better engage sexual minority individuals, especially those who are reluctant to disclose their orientation.

  View details for DOI 10.1016/j.jad.2016.07.003

  View details for PubMedID 27466746

  View details for PubMedCentralID PMC5077638

• Navigating Barriers to Vocational Rehabilitation for HIV-Positive Persons. AIDS and behavior Gómez, W., Flentje, A., Schustack, A., Ramirez-Forcier, J., Andrews, B., Dilworth, S. E., Riley, E. D., Curotto, A., Carrico, A. W. 2016; 20 (5): 1132-42

  Abstract

  This study documented the outcomes of 108 HIV-positive persons receiving vocational rehabilitation services. Over a 12-month follow-up, participants reported significantly decreased odds of any unstable housing [Adjusted Odds Ratio (AOR) = 0.21; 95 % CI 0.05-0.90; p < .05] and increased odds of being employed at least part-time (AOR = 10.19; 95 % CI 2.40-43.21; p < .01). However, reductions in perceived barriers to employment and increases in income were more pronounced among those not receiving disability benefits at baseline. This was consistent with findings from baseline qualitative interviews with 22 participants where those not on disability were subject to bureaucratic hurdles to rapidly accessing benefits and anticipated stigma of being on disability that propelled them to rejoin the workforce. Vocational rehabilitation could address key structural barriers to optimizing HIV treatment as prevention, and novel approaches are needed to improve outcomes among individuals receiving disability benefits.

  View details for DOI 10.1007/s10461-015-1261-1

  View details for PubMedID 26696259

  View details for PubMedCentralID PMC4840061

• Scientific writing seminar for early-stage investigators in substance abuse research. Substance abuse Guydish, J., Masson, C., Flentje, A., Shopshire, M., Sorensen, J. L. 2016; 37 (1): 238-41

  Abstract

  There is little information on how to increase the scientific writing productivity of early-stage investigators in the addictions field. A scientific writing seminar is presented in this article, aiming to encourage manuscript writing and dissemination of addiction research, and outcomes are reported for 14 years of the seminar.In 14 years, there were 113 postdoctoral fellow enrollments in a 6-month writing seminar. Records of submission and publication rates of manuscripts were collected for 14 cohorts.Of the 113 participant enrollments, 97 (86%) submitted a manuscript for publication, and 87 participants (77%) published their manuscript.A scientific writing seminar may benefit writing productivity, but more research is needed to compare this training model with other existing models.

  View details for DOI 10.1080/08897077.2015.1028698

  View details for PubMedID 25893689

  View details for PubMedCentralID PMC4615274

• Meeting the Needs of Lesbian, Gay, and Bisexual Clients in Substance Abuse Treatment. Counselor (Deerfield Beach, Fla.) Flentje, A., Livingston, N. A., Sorensen, J. L. 2016; 17 (3): 54-59

  View details for PubMedID 28111527

  View details for PubMedCentralID PMC5245827

• Mental and Physical Health Needs of Lesbian, Gay, and Bisexual Clients in Substance Abuse Treatment. Journal of substance abuse treatment Flentje, A., Livingston, N. A., Roley, J., Sorensen, J. L. 2015; 58: 78-83

  Abstract

  Lesbian, gay, and bisexual (LGB) orientation predicts greater substance use, treatment utilization, and poorer mental and physical health, but health needs of LGB individuals in substance abuse treatment remain largely unknown. The purpose of this study was to identify differences in mental and physical health needs of LGB individuals in substance abuse treatment.Substance abuse treatment admissions data from the County of San Francisco were used in this investigation of differences in mental and physical health problems and service utilization between LGB (n=1,441) and heterosexual individuals (n=11,770).LGB individuals were more likely to have mental health diagnoses (adjORs ranging from 1.86 to 4.00) and current mental health prescription medications (adjORs from 1.79 to 4.99) than heterosexual counterparts. Gay and bisexual men and bisexual women but not lesbian women, were more likely to be receiving mental health treatment. Gay men and bisexual women were more likely than heterosexual counterparts to report physical health problems. Gay and bisexual men and bisexual women but not lesbian women were more likely to be receiving health care. There were no differences between LGB individuals and heterosexual counterparts in the number of emergency room visits or hospital overnight stays.This study found that LGB individuals entering substance abuse treatment have greater mental and physical health needs than heterosexual counterparts. Implications for healthcare integration, research, and practice are discussed.

  View details for DOI 10.1016/j.jsat.2015.06.022

  View details for PubMedID 26314505

  View details for PubMedCentralID PMC4581963

• Substance use among lesbian, gay, and bisexual clients entering substance abuse treatment: Comparisons to heterosexual clients. Journal of consulting and clinical psychology Flentje, A., Heck, N. C., Sorensen, J. L. 2015; 83 (2): 325-34

  Abstract

  This study evaluated whether sexual orientation-specific differences in substance use behaviors exist among adults entering substance abuse treatment.Admissions records (July 2007-December 2009) were examined for treatment programs in San Francisco, California receiving government funding. Lesbian, gay, and bisexual (LGB) persons (n = 1,441) were compared to heterosexual persons (n = 11,770) separately by sex, examining primary problem substance of abuse, route of administration, age of first use, and frequency of use prior to treatment.Regarding bisexual males, the only significant finding of note was greater prevalence of methamphetamine as the primary substance of abuse. When compared to heterosexual men, gay and bisexual men evidenced greater rates of primary problem methamphetamine use (44.5% and 21.8%, respectively, vs. 7.7%, adjusted odds ratios [ORs] 6.43 and 2.94), and there was lower primary heroin use among gay men (9.3% vs. 25.8%, OR 0.35). Among LGB individuals, race and ethnicity did not predict primary problem substance, except that among LGB men and women, a non-White race predicted cocaine use (OR 4.83 and 6.40, respectively), and among lesbian and bisexual women, Hispanic ethnicity predicted lower odds of primary cocaine use (OR 0.24). When compared to heterosexual men, gay men were more likely to smoke their primary problem substance (OR 1.61), first used this substance at an older age (M = 23.16 vs. M = 18.55, p < .001), and used this substance fewer days prior to treatment (M = 8.75 vs. M = 11.41, p < .001). There were no differences between heterosexual and lesbian or bisexual women.There were unique patterns of substance use for gay and bisexual men entering substance abuse treatment, but women did not evidence differences. Gay men evidenced unique factors that may reflect less severity of use when entering treatment including fewer days of use and a later age of initiation of their primary problem substances. The results underscore the importance of being sensitive to differences between gay, bisexual, and heterosexual males when considering substance use disorders. (PsycINFO Database Record

  View details for DOI 10.1037/a0038724

  View details for PubMedID 25622196

  View details for PubMedCentralID PMC4380585

• Missing data in substance abuse research? Researchers' reporting practices of sexual orientation and gender identity. Drug and alcohol dependence Flentje, A., Bacca, C. L., Cochran, B. N. 2015; 147: 280-4

  Abstract

  Lesbian, gay, bisexual, and transgender individuals are at higher risk for substance use and substance use disorders than heterosexual individuals and are more likely to seek substance use treatment, yet sexual orientation and gender identity are frequently not reported in the research literature. The purpose of this study was to identify if sexual orientation and gender identity are being reported in the recent substance use literature, and if this has changed over time.The PsycINFO and PubMed databases were searched for articles released in 2007 and 2012 using the term "substance abuse" and 200 articles were randomly selected from each time period and database. Articles were coded for the presence or absence of sexual orientation and gender identity information.Participants' sexual orientation was reported in 3.0% and 4.9% of the 2007 and 2.3% and 6.5% of the 2012 sample, in PsycINFO and PubMed sample articles, respectively, while non-binary gender identity was reported in 0% and 1.0% of the 2007 sample and 2.3% and 1.9% of the 2012 PsycINFO and PubMed sample articles. There were no differences in rates of reporting over time.Sexual orientation and gender identity are rarely reported in the substance abuse literature, and there has not been a change in reporting practices between 2007 and 2012. Recommendations for future investigators in reporting sexual orientation and gender identity are included.

  View details for DOI 10.1016/j.drugalcdep.2014.11.012

  View details for PubMedID 25496705

  View details for PubMedCentralID PMC4297716

• Experiences of ex-ex-gay individuals in sexual reorientation therapy: reasons for seeking treatment, perceived helpfulness and harmfulness of treatment, and post-treatment identification. Journal of homosexuality Flentje, A., Heck, N. C., Cochran, B. N. 2014; 61 (9): 1242-68

  Abstract

  Therapy meant to change someone's sexual orientation, or reorientation therapy, is still in practice despite statements from the major mental health organizations of its potential for harm. This qualitative study used an inductive content analysis strategy (Patton, 2002) to examine the experiences of thirty-eight individuals (31 males and seven females) who have been through a total of 113 episodes of reorientation therapy and currently identify as gay or lesbian. Religious beliefs were frequently cited as the reason for seeking reorientation therapy. Frequently endorsed themes of helpful components of reorientation therapy included connecting with others and feeling accepted. Harmful aspects of reorientation therapy included experiences of shame and negative impacts on mental health. Common reasons for identifying as LGB after the therapy included self-acceptance and coming to believe that sexual orientation change was not possible. The findings of this study were consistent with recommendations by the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation (2009), which concluded that helpful aspects of reorientation therapy could be achieved through affirmative treatment methods while avoiding potential harms that may be associated with reorientation therapy. Limitations of the findings, including a small, self-selected sample, are discussed.

  View details for DOI 10.1080/00918369.2014.926763

  View details for PubMedID 24960142

• Community-based harm reduction substance abuse treatment with methamphetamine-using men who have sex with men. Journal of urban health : bulletin of the New York Academy of Medicine Carrico, A. W., Flentje, A., Gruber, V. A., Woods, W. J., Discepola, M. V., Dilworth, S. E., Neilands, T. B., Jain, J., Siever, M. D. 2014; 91 (3): 555-67

  Abstract

  Harm reduction approaches endeavor to assist individuals with avoiding the most detrimental consequences of risk taking behaviors, but limited research has documented the outcomes of harm reduction substance abuse treatment. In total, 211 methamphetamine-using men who have sex with men (MSM) enrolled in two outcome studies of substance abuse treatment programs that were implementing an evidence-based, cognitive-behavioral intervention (i.e., the Matrix Model) from a harm reduction perspective. Study 1 (N = 123) examined changes in self-reported substance use, Addiction Severity Index (ASI) composite scores, and HIV care indicators over a 12-month follow-up. Study 2 (N = 88) assessed changes in substance use, sexual risk taking, and HIV care indicators over a 6-month follow-up. Participants in study 1 reported reductions in cocaine/crack use as well as decreases in the ASI drug and employment composite scores. Among HIV-positive participants in study 1 (n = 75), 47 % initiated or consistently utilized anti-retroviral therapy and this was paralleled by significant increases in self-reported undetectable HIV viral load. Study 2 participants reported reductions in methamphetamine use, erectile dysfunction medication use in combination with other substances, and sexual risk-taking behavior while using methamphetamine. Participants in both studies reported concurrent increases in marijuana use. Taken together, these studies are among the first to observe that clients may reduce stimulant use and concomitant sexual risk-taking behavior during harm reduction substance abuse treatment. Randomized controlled trials are needed to examine the differential effectiveness of harm reduction and abstinence-based approaches to substance abuse treatment.

  View details for DOI 10.1007/s11524-014-9870-y

  View details for PubMedID 24744105

  View details for PubMedCentralID PMC4074324

• Characteristics of transgender individuals entering substance abuse treatment. Addictive behaviors Flentje, A., Heck, N. C., Sorensen, J. L. 2014; 39 (5): 969-75

  Abstract

  Little is known about the needs or characteristics of transgender individuals in substance abuse treatment settings. Transgender (n=199) and non-transgender (cisgender, n=13,440) individuals were compared on psychosocial factors related to treatment, health risk behaviors, medical and mental health status and utilization, and substance use behaviors within a database that documented individuals entering substance abuse treatment in San Francisco, CA from 2007 to 2009 using logistic and linear regression analyses (run separately by identified gender). Transgender men (assigned birth sex of female) differed from cisgender men across many psychosocial factors, including having more recent employment, less legal system involvement, greater incidence of living with a substance abuser, and greater family conflict, while transgender women (assigned birth sex of male) were less likely to have minor children than cisgender women. Transgender women reported greater needle use, and HIV testing rates were greater among transgender women. Transgender men and women reported higher rates of physical health problems, mental health diagnoses, and psychiatric medications, but there were no differences in service utilization. There were no differences in substance use behaviors except that transgender women were more likely to endorse primary methamphetamine use. Transgender individuals evidence unique strengths and challenges that could inform targeted services in substance abuse treatment.

  View details for DOI 10.1016/j.addbeh.2014.01.011

  View details for PubMedID 24561017

  View details for PubMedCentralID PMC4130569

• Factors predicting development of opioid use disorders among individuals who receive an initial opioid prescription: mathematical modeling using a database of commercially-insured individuals. Drug and alcohol dependence Cochran, B. N., Flentje, A., Heck, N. C., Van Den Bos, J., Perlman, D., Torres, J., Valuck, R., Carter, J. 2014; 138: 202-8

  Abstract

  Prescription drug abuse in the United States and elsewhere in the world is increasing at an alarming rate with non-medical opioid use, in particular, increasing to epidemic proportions over the past two decades. It is imperative to identify individuals most likely to develop opioid abuse or dependence to inform large-scale, targeted prevention efforts.The present investigation utilized a large commercial insurance claims database to identify demographic, mental health, physical health, and healthcare service utilization variables that differentiate persons who receive an opioid abuse or dependence diagnosis within two years of filling an opioid prescription (OUDs) from those who do not receive such a diagnosis within the same time frame (non-OUDs).When compared to non-OUDs, OUDs were more likely to: (1) be male (59.9% vs. 44.2% for non-OUDs) and younger (M=37.9 vs. 47.7); (2) have a prescription history of more opioids (1.7 vs. 1.2), and more days supply of opioids (M=272.5, vs. M=33.2; (3) have prescriptions filled at more pharmacies (M=3.3 per year vs. M=1.3); (4) have greater rates of psychiatric disorders; (5) utilize more medical and psychiatric services; and (6) be prescribed more concomitant medications. A predictive model incorporating these findings was 79.5% concordant with actual OUDs in the data set.Understanding correlates of OUD development can help to predict risk and inform prevention efforts.

  View details for DOI 10.1016/j.drugalcdep.2014.02.701

  View details for PubMedID 24679839

  View details for PubMedCentralID PMC4046908

• Reducing risk for illicit drug use and prescription drug misuse: High school gay-straight alliances and lesbian, gay, bisexual, and transgender youth. Addictive behaviors Heck, N. C., Livingston, N. A., Flentje, A., Oost, K., Stewart, B. T., Cochran, B. N. 2014; 39 (4): 824-8

  Abstract

  Previous research suggests that lesbian, gay, bisexual, and transgender (LGBT) youth are at elevated risk for using illicit drugs and misusing prescription drugs relative to heterosexual youth. Previous research also indicates that LGBT youth who attend high schools with a gay-straight alliance (GSA) report having fewer alcohol problems and lower levels of cigarette smoking. The present study investigates whether the absence of a GSA is associated with risk for illicit drug use and prescription drug misuse in a sample of 475 LGBT high school students (M age=16.79) who completed an online survey. After controlling for demographic variables and risk factors associated with illicit drug use, the results of 12 logistic regression analyses revealed that LGBT youth attending a high school without a GSA evidenced increased risk for using cocaine (adjusted odds ratio [adjOR]=3.11; 95% confidence interval [95% CI]=1.23-7.86), hallucinogens (adjOR=2.59; 95% CI=1.18-5.70), and marijuana (adjOR=2.22; 95% CI=1.37-3.59) relative to peers attending a high school with a GSA. Youth without a GSA also evidenced increased risk for the misuse of ADHD medication (adjOR=2.00; 95% CI=1.02-3.92) and prescription pain medication (adjOR=2.00; 95% CI=1.10-3.65). These findings extend the research base related to GSAs and further demonstrate the importance of providing LGBT youth with opportunities for socialization and support within the school setting. Important limitations of the present study are reviewed.

  View details for DOI 10.1016/j.addbeh.2014.01.007

  View details for PubMedID 24531638

  View details for PubMedCentralID PMC4066611

• Mass media and HIV prevention Encyclopedia of AIDS Flentje, A., Sorensen, J. L. edited by Hope, T. J., Richman, D., Stevenson, M. 2014
• Mental health characteristics of sexual minority veterans. Journal of homosexuality Cochran, B. N., Balsam, K., Flentje, A., Malte, C. A., Simpson, T. 2013; 60 (2-3): 419-35

  Abstract

  This study examines the mental health characteristics of sexual minority (lesbian, gay, and bisexual, or LGB) veterans, compared these characteristics to those of an existing Veterans Affairs (VA) sample, and examined the relationship between mental health and anxiety around concealment of LGB identity while in the military. Data regarding LGB veterans' (n = 409) military experiences and current mental health were collected via an online survey; comparison data (n = 15,000) were retrieved from a VA data warehouse. LGB veterans were more likely to screen positive for posttraumatic stress disorder (PTSD), depression, and alcohol problems than the comparison sample. Anxiety around concealment of one's sexual orientation while in the service was related to current depression and PTSD symptoms.

  View details for DOI 10.1080/00918369.2013.744932

  View details for PubMedID 23414280

• Sexual Reorientation Therapy Interventions: Perspectives of Ex-Ex-Gay Individuals JOURNAL OF GAY & LESBIAN MENTAL HEALTH Flentje, A., Heck, N. C., Cochran, B. N. 2013; 17 (3): 256-277

  View details for DOI 10.1080/19359705.2013.773268

  View details for Web of Science ID 000212478400002

• Empirically supported drug treatment for all: Helping a nation get "Clean". PsycCritiques Flentje, A., Sorensen, J. L. 2013; 58 (45)

  Abstract

  Reviews the book Clean: Overcoming Addiction and Ending America's Greatest Tragedy by David Sheff. This book provides, in layman's language, an overview of the full range of addiction science including: initiation of substance use, the neuroscience of addiction, prevention, treatment, and drug policy. Sheff has done extensive research for the book, including interviews of both individuals who have been affected by substance use disorders and experts in all aspects of addiction science as well as summaries of up to date empirical literature. The book includes a plan for targeting drug problems in the U.S. at multiple levels including: prevention, treatment, and drug policy. The author describes and encourages the use of empirically supported treatments for substance use disorders. The primary intended audience of the book appears to be individuals who have loved ones with addiction problems. The book is likely less useful for the psychologist who is accustomed to reading primary literature, but it could be a helpful book to which to refer people who may want additional information about substance use disorders and their treatment.

  View details for DOI 10.1037/a0034836

  View details for PubMedID 24976802

  View details for PubMedCentralID PMC4071450

• Offsetting Risks: High School Gay-Straight Alliances and Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth SCHOOL PSYCHOLOGY QUARTERLY Heck, N. C., Flentje, A., Cochran, B. N. 2011; 26 (2): 161-174

  View details for DOI 10.1037/a0023226

  View details for Web of Science ID 000291630100006

• Alternative hypotheses The Encyclopedia of Research Design Denis, D. J., Flentje, A., Burfeind, C. edited by Salkind, N. J. Sage Publications. 2010
• The Impact of Extratherapeutic Encounters: Individual Reactions to Both Hypothetical and Actual Incidental Contact With the Therapist PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE Cochran, B. N., Stewart, A. J., Kiklevich, A. M., Flentje, A., Wong, C. C. 2009; 40 (5): 510-517

  View details for DOI 10.1037/a0016146

  View details for Web of Science ID 000270927100011

• Does the impact of anti-drinking and driving Public Service Announcements differ based on message type and viewer characteristics? Journal of drug education Santa, A. F., Cochran, B. N. 2008; 38 (2): 109-29

  Abstract

  The purpose of this study was to inform future Public Service Announcement (PSA) development by examining the potential effectiveness of different types of anti-driving under the influence (DUI) PSAs for persons with different characteristics. PSAs utilizing empathy, fear, and informational approaches were shown to persons recruited from psychology courses (n = 137) and individuals that were mandated to treatment following a DUI offense (n = 17). The empathy approach was perceived to be the most effective and evoked the most negative affect, followed by fear and informational approaches. Less experience with DUI, lower sensation seeking, higher motivation to change, and higher perception of dangerousness of DUI all emerged as good predictors of higher perceived effectiveness of anti-DUI PSAs. Gender differences in perceived effectiveness were examined for fear and empathy PSAs, with inconclusive findings.

  View details for DOI 10.2190/DE.38.2.b

  View details for PubMedID 18724653

• Faith-Based Organizations: A Potential Partner in Rural Transportation Journal of Public Transporation Seekins, T., Bridges, S., Santa, A., Denis, D. J., Hartsell, A. 2008

  View details for DOI 10.5038/2375-0901.11.1.6

• Drugs and alcohol The Greenwood Encyclopedia of Love, Courtship, and Sexuality through History Cochran, B., Santa, A. edited by Howell, J. 2008: 69-72
• Differentiating LGBT individuals in substance abuse treatment: analyses based on sexuality and drug preference. Journal of LGBT health research Cochran, B. N., Peavy, K. M., Santa, A. F. 2007; 3 (2): 63-75

  Abstract

  In a prior study (Cochran & Cauce, 2006), LGBT individuals seeking treatment demonstrated greater substance use severity, more psychosocial stressors, and increased use of psychiatric services when compared to their heterosexual counterparts. That study, and similar to others in the field of LGBT research, collapsed LGBT individuals into a single category and did not examine individual differences within this category. The present study utilizes the same sample of LGBT clients (N = 610); however, an exploratory cluster analysis was conducted, based on drug preference, to determine which subcategories exist within this unique sample. In a subsequent set of analyses, the sample was divided based on sexuality to determine if there were differences between these groups on psychosocial functioning variables. Results indicated three distinct clusters, which differed in both demographic characteristics and severity of substance use problems. Groups based on sexuality differed in terms of primary problem substance, as well as psychosocial variables. Implications for treatment of these subgroups are discussed.

  View details for DOI 10.1300/J463v03n02_07

  View details for PubMedID 19835042