In this two-manuscript dissertation, framed through queer and minority stress theories, I focus on heteronormative pressures and their impact on sexual identity fluidity and health of lesbian, gay, and bisexual youth and young adults. Heteronormativity, or the expectation to meet heterosexual norms in relationships, may be stressful for lesbian, gay, and bisexual (LGB) youth and be linked to poorer health. In particular, I focus on bisexual young people because bisexual people can enter into either same- or different-gender relationships; these young people could experience pressure from family members and religious communities to conform to heterosexual norms, resulting in sexual identity transitions that could explain health differences between sexual minority groups. In the first manuscript, I conducted life history narratives interviews with 14 racially and ethnically diverse youth and young adults between the ages of 18-24 on how LGB youth make sense of expectations to conform to heterosexual norms and how their experiences vary based on youths’ characteristics. In the second manuscript, I used structural equation modeling analysis of one of the largest community samples of LGB youth and young adults between the ages of 15-21 in the U.S. to examine youths' current and future relationship desires in a broader system of heteronormative expectations and how these expectations operate as mechanisms to influence the mental health of sexual minority youth. Qualitative results from the first manuscript show that for many youth and youth adults, gender and sexuality intersect to influence their experiences of heteronormativity: Gender and sexuality were conflated for gay men who stated that their gender nonconformity meant that family members already knew their sexuality before they came out as gay. Many bisexual women described their experiences being gender conforming in which they struggled to legitimize their sexuality to others because they were feminine. Though gay and lesbian identities were present in discussions of gender, an expression of gender that signaled and was named as bisexuality was fundamentally missing in the interviews. That is, participants did not describe a gender presentation that would indicate someone attracted to more than one gender. Participants consistently considered childbearing, but not marriage, to be highly desirable. Latino participants discussed heteronormativity through the racialized lens of machismo. However, religion was a greater source of pressure to conform to heterosexuality for Latino participants than were racial communities. My quantitative results from the second manuscript showed that gay men, lesbian women, and bisexual men are more likely to desire same-gender marriages later in life compared to bisexual women, who are more likely to desire different-gender marriages. Participants who desired different-gender marriage were more likely to identify as a different sexual identity over time. However, neither relationship desires nor sexual identity transitions related to depressive symptoms. The findings of this manuscript suggest that initial transition to a sexual minority identity may be the most vulnerable time for youth. After this initial transition, lesbian, gay, and bisexual youth may be inoculated to stress related to identity transitions, even in the context of heteronormativity. This research informs queer and minority stress theories: Gender, sexuality, and family norms intersect to structure how youth understand heteronormativity and predicts whether youth maintain their sexual identity, but such norms might not be stressors that influence health after youth first identify as LGB.

Thesis advisor: James R. Mahalik / Most stage models of gay identity development posit that gay men follow a distinct hierarchical blueprint wherein internal identity processes (e.g. dismantling internalized homonegativity) co-occur with increasing disclosure of their sexual orientation to others (i.e. greater outness). However, some scholars contend that linear stage models lack flexibility and do not account for the diversity of gay men's experience (Fassinger & Miller, 1996). Specifically, gay men's internal and public identity processes may advance by way of distinct, unparallel pathways and for that reason should be evaluated in conjunction and independently of one another. Extending Meyer's (1995; 2003) minority stress model, this study examined the role of childhood gender behavior, adult masculinity, social support and socioeconomic status in explaining gay men's identity status and degree of outness. Five hundred eighteen gay men recruited from online sources (e.g. listservs, Usenet groups) completed measures assessing stigma, anti-gay attack, recalled childhood gender behavior, masculinity, social support, and socioeconomic status. Hierarchical and logistic regression analyses supported several hypotheses reflected in the findings that stigma, anti-gay attack, masculinity, and social support were significantly associated with gay men's identity status and outness. In addition, socioeconomic status moderated the relationship between masculinity and outness, as well as between minority stress (anti-gay attack) and identity status. Altogether, each of the factors examined in this study appear to play a unique role in explaining gay men's identity development and outness, underscoring the complexity of the social context that may intensify or alleviate the stress of these processes. The theoretical implications, future research, limitations, and recommendations for counselors are discussed. / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental, and Educational Psychology.

Thesis advisor: Paul Poteat / Sexual minorities (e.g., lesbian, gay, and bisexual individuals) are at higher risk for mental and physical health disparities than heterosexuals, and research has related some of these disparities to minority stressors such as institutional heterosexism, sexual prejudice, and discrimination. Yet, there is a dearth of research elucidating factors that predict the development of these health risks, and factors that protect and promote resiliency against them. Building on the minority stress model, the present study utilized relational cultural theory to situate sexual minority health disparities within a relational framework. Specifically, the study examined the mediating and moderating factors between the deleterious effects of distal stressors (i.e., heterosexist relational disconnections such as discrimination and victimization) and proximal stressors (i.e., self-disparaging relational images such as internalized homophobia, sexual orientation concealment) on mental and physical health for sexual minorities. Among 719 sexual minority adults, structural equation modeling analyses were used to test three models of: the relations between minority stressors and health; mediating effects of diminished agency, loneliness, and shame on the relations between minority stressors and health; and the moderated-mediation effects of growth-fostering relationships with peers, mentors, and community on the mediating pathways between minority stressors and health. Results indicated that heterosexist distal and proximal minority stressors predicted poor mental health (i.e., depression, anxiety, and suicidality) and physical health (i.e., cardiovascular disease risk, distressing physical symptoms). The relations between proximal minority stressors and health were mediated by diminished sense of agency, loneliness, and shame, and there were mixed results for the relations between distal stressors and health. Although the direct effects of growth-fostering relationships were significant in predicting lower levels of diminished agency, loneliness, and shame, these factors had mixed moderating effects. Findings have research, practice, and policy implications that underscore the possible mechanisms by which sexual minority stressors lead to poor health. Researchers and practitioners need to addresses and advocate against societal forces contributing to heterosexist relational disconnections and for sexual minority health policies and research. / Thesis (PhD) — Boston College, 2014. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental, and Educational Psychology.

Facial feminization surgery (FFS) is a set of procedures performed with the goal of creating a facial appearance that is considered phenotypically female. These procedures are usually sought by cisgender women but have become increasingly popular among male to female (MTF) transgender individuals. FFS has been shown to decrease appearance anxiety and increase quality of life. Sexual minorities, including transgender individuals, are subject to a unique set of stressors termed minority stress, which involves the interplay of perceived and outright discrimination. This type of stress has been shown to lead to adverse physical and mental health outcomes. The workplace is no exception to this type of discrimination, and workplace discrimination has specifically been associated with adverse physical health outcomes. However, there have been few studies to date evaluating workplace discrimination and transgender identity. This study aims to expand on that knowledge, and determine the potential role for FFS as an intervention to reduce perceived bias.

Lesbian, gay, and bisexual individuals must regularly navigate stigma, or social situations in which they are devalued because of their sexual orientation. The research has well established minority stress processes which link situations of stigma to reports of poor psychological well-being. However, protective factors leading to healthy psychological well-being are relatively understudied. This dissertation is a review of protective factors that have already emerged in the research and an assessment of these protective factors simultaneously to better understand how they influence psychological well-being. I recruited adult sexual minority participants using a comprehensive social media approach. I then tested mastery, problem-solving coping, cognitive flexibility, structural factors, social support, self-compassion, hope, community connectedness, meaning making, and emotional openness on both measurements of positive and negative psychological well-being. Boosted regression analyses were used to assess the relative influence of the protective factors and while accounting for multicollinearity among the many protective factors. This was followed by OLS regression for cross validation. Results of the boosted regression trees indicate that hope, mastery, self-compassion, and social support are the most influential protective factors. This was supported by the OLS regressions. These results point to individual and social factors that affect psychological well-being of sexual minorities. Ultimately this dissertation provides a focused target for future research on intervention using these top protective factors. Additionally, this dissertation expands protective factors previously only examined in lesbian, gay, and bisexual individuals to a broader sexual minority population.

Acculturation process has been associated with various mental health outcomes among Taiwanese/Chinese international students (Wang & Mallinckrodt, 2006; Zhang & Goodson, 2011), and those who also identify as sexual orientation minority may have unique acculturation processes compared to their heterosexual counterparts (Oba & Pope, 2013; Quach, Todd, Hepp, & Mancini, 2013). Limited understanding has been established on the impact of dual cultural exposures and the multiple marginalized identities may have on international sexual orientation minority’s sexual orientation identity development, particularly for women from countries with Chinese cultural heritages. Using Consensual Qualitative Research method, this dissertation focuses on gaining understanding of the experiences of Taiwanese sexual orientation minority women (nǚ tongzhi) developing sexual orientation identity during their residence in the U.S. Results indicate the overall accepting social and political atmosphere in the U.S. was an important factor in the acculturation and enculturation processes for Taiwanese nǚ tongzhi. Yet, these women experienced acculturative stress and multiple minority stress against their multifaceted identity. They also reported acculturative stress upon re-entry to Taiwan regarding managing their identity disclosure, and experiences of pressure to conform to cultural norms related to gender and heteronormative family structure. The manuscript concludes with strengths and limitations of the present study, suggestions for future research, and clinical implications for counseling psychologists.

The original purpose of this quantitative study was to compare 5 self-reported sexual minority stress (SMS) factors experienced by lesbian and gay police officers to discover if lesbian or gay police officers experience more SMS, and which factor, if any, is the biggest stressor for either group as measured using subscales of the Daily Heterosexist Experiences Questionnaire (DHEQ). This study partially incorporated minority-stress theory as applied to sexual minorities. This study used subscales from the DHEQ in anonymous, online surveys. Because of the low response rate, the study changed to compare the group of lesbian and gay police officers' self-reports on levels of feelings of vigilance, harassment/discrimination, isolation, vicarious trauma, and victimization as compared to the established population values. The central research question asked if there was a significant difference between lesbian and gay police officers and the established population on self-reported factors of SMS, as measured by the DHEQ. Two-tailed t tests were used to analyze the data. The results showed that lesbian and gay officers reported significantly less SMS as determined by the 5 factors on the DHEQ. The results of this study could provide an impact on how administrators treat lesbian and gay officers and how LGBT policies are created and implemented for internal and external (e.g. LGBT communities) interactions. The results of this study could also provide insight for police psychologists and other mental health practitioners about SMS.

This dissertation describes a qualitative study that explored the perceived barriers to reporting military sexual assaults that servicewomen experienced following a sexual assault while on active duty. The study aimed to answer the following research questions: (1) What barriers to reporting did servicewomen who survived sexual assault in a military setting perceive?; (2) What role did betrayal (the act of going against a promise) play in their decision? Semi-structured interviews with three servicewomen who were sexually assaulted while on active duty and did not report the assaults were analyzed using Interpretative Phenomenological Analysis. Four superordinate themes emerged from the data including (1) external factors, (2) internal processes, (3) interpersonal aspects, and (4) need for a cultural shift. A review of existing literature, research methodology implemented, a review of results including supporting quotes from participant narratives, and a discussion of the results will be presented in this dissertation. A minority stress model adapted for servicewomen will be explored, as well as implications for clinicians and suggestions for future research.

Body dissatisfaction is a growing problem in the gay male population, with serious implications for psychological and social well-being. Gay men tend to be at higher risk of body dissatisfaction than their heterosexual counterparts. They report lower levels of body satisfaction and have higher rates of risky behaviors such as anabolic steroid use, eating disorders, and over-exercising (Gil, 2007; Willoughby et al., 2008; Kaminski et al., 2004). It is difficult to determine the cause of this issue in the gay community; however, two theories have been proposed to help explain this phenomenon. Minority stress theory posits that it relates to added stress involved with being part of a minority group. Gender role strain theory identifies these concerns with the strain to conform to masculine gender roles. A common link to bridge the two theories together may be visibility management, which is the way gay men carefully disclose behaviors that would identify their sexual orientation (Lasser & Tharinger, 2003). The proposed method will include participants that will be approximately 130 gay men 18-23 years of age. Participants will be sought through online collection from universities in the United States. Participants will respond to empirically validated measures in regards to Minority Stress, Gender Role Strain, Visibility Management, and Body Dissatisfaction to help determine if what links there are between these variables. / text

Purpose : The purpose of this paper is to explore the influence demographic factors have on the way lesbians and gay men manage their sexual orientation at work. Design/methodology/approach : Based on data taken from a cross-sectional survey of 1308 gay and lesbian employees working in Germany, four regression models are proposed. The means of managing one's homosexuality at work was measured by the 31 items containing WSIMM from Anderson et al. (2001). Findings : Results indicate that being in a relationship is related to increased openness about one's homosexuality at work. Furthermore, it appears that the older and the more religious lesbian and gay employees are, the more open (and therefore less hidden) about their sexuality they are. Having a migratory background is related to being more guarded about one's sexual orientation, whereas personal mobility within the country is not related to the way one manages one's sexual orientation at work. Lesbians tend to be a little more open and less guarded about their homosexuality compared to gay men. Research limitations/implications : The focus of this research (and the related limitations) offers several starting and connecting points for more intersectional research on workforce diversity and diversity management. Practical implications : The study's findings indicate the need for an intersectional approach to organizational diversity management strategies. Exemplified by the dimension "sexual orientation" it can be shown that the impact each dimension has for an employee's everyday workplace experiences and behavior in terms of a certain manifestation of one dimension of diversity, can only be understood in terms of its interplay with other dimensions of diversity. Theoretical implications : The intersectional perspective on employees' stigma-related minority stress allows a deeper and more comprehensive understanding of the experiences of individuals in workplace settings. This theoretical framework proposed in this article can therefore be a connecting point for theoretically framing future studies on workforce diversity and diversity management. Originality/value : It is shown that manifestations of demographic factors that tend to broaden the individual's coping resources for stigma-relevant stressors, lead to more openness about one's homosexuality in the workplace. (author's abstract)