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Thesis advisor: Susan Kelly-Weeder / Background: Sexual minority youth experience many sexual health inequities compared to heterosexual youth. Research conducted over the past several decades has concluded that both parent-adolescent sex communication and school-based sex education are effective in reducing levels of sexual risk behavior in heterosexual youth. A much smaller number of studies have examined the experiences and effectiveness of sex education or PASC among sexual minority youth. Purpose: This three-manuscript dissertation seeks to extend understanding about the experiences of sexual minority and heterosexual youth with learning about sex and sexuality at school and at home and how these learning experiences affect sexual risk behavior. The purpose of this dissertation is to examine parent-adolescent sex communication from the perspective of sexual minority youth and their parents, assess the impact of different types of sex education on sexual intercourse and contraceptive behavior of sexual minority and heterosexual adolescent females, and revise and extend a scale designed to measure sexual minority youth perceptions of sexual-minority-inclusivity in sex education. Methods: In the first manuscript, we conducted an integrated review that described how parents and SGM youth perceive their sex communication experiences and synthesized findings about the associations between parent-adolescent sex communication and sexual health outcomes among SGM youth. In the second manuscript, we used National Survey of Family Growth data to describe the total sex education content received by an individual, examine the impact of different sex education types on sexual intercourse and contraceptive behavior of adolescent females, and examine differences by sexual identity. In phase one of the last study, we revised a scale to measure SMYA perceptions of sexual minority-inclusivity in school-based sex education received before the age of 18 years. Phase two involved implementing a pilot study to measure the reliability and conduct a Rasch analysis of the revised scale. Results: The integrated review results suggest that parent-adolescent sex communication was complicated by barriers to communication and was limited, heteronormative, and influenced by SGM disclosure. Parent-adolescent sex communication may improve sexual health outcomes, but adequate parental education/guidance is lacking. Secondary data analysis results suggest that compared to their heterosexual peers, sexual minorities were more likely to report no sex education and less likely to report receipt of abstinence-only education. Nearly all types of education had a statistically significant effect on sexual behavioral outcomes (intercourse in the past 12 months and type of contraceptive use) as compared to no sex education. Scale revision and psychometric analyses suggested that the new scale has strong psychometric properties, including reliability, content validity, and measurement precision. Conclusion: Overall, this dissertation has highlighted the ways that home and school-based sources of sexual health information do not currently meet the needs of SM youth. The sexual health education of SM youth is complicated by a lack of comfort, knowledge, and resources experienced by both teachers and parents. Qualitative studies suggest that both sources of sexual health information tend to be focused on heterosexual needs, leaving SMY feeling frustrated and invisible. This dissertation has also highlighted the need for quantitative measures to extend understanding of the impact of parent-adolescent sex communication and sex education on sexual minority youth. The revised scale presented in Chapter 4 provides a promising measurement tool to inform the development and evaluation of sexual minority-inclusive sex education programs. The results of this dissertation will ultimately contribute to the development of programs and interventions to support SM-inclusivity in school-based, family-based, and healthcare provider-based sexual health education. / Thesis (PhD) — Boston College, 2022. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

This thesis is an examination of the representation of trans characters like Bridget from GuiltyGear Strive(2021). By analyzing trans representation in movies and games, the typical tropesof trans characters were found, and conducting a close reading of the visual design of Bridgetto see where she represents and differs from these tropes. The results of the close readingfound that Bridget's shape language conveys a harmless appearance, differing from the tropeof violence. The color scheme conveys harmonious and youthful, contrasting trope ofdysphoria. Bridget's cute appearance makes her similar to the trope of ambiguity. Bridget'suse of toys as weapons makes her comedic without becoming the butt of the joke. Bridget isnot treated as disgusting nor focused on the male gaze. This thesis concludes that Bridgetmainly differs by not being as adult-oriented, showing it can represent trans identity withoutrelying on these negative tropes.

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Exposure to negative media messages related to LGBTQ+ issues have been associated with negative affect, depression, stress, and psychological distress among that population (e.g. Rotosky, Riggle, Horne, & Miller, 2009). Frost and Fingerhut (2016) have suggested that this exposure to negative media messages is a form of distal minority stress, which has been theorized to contribute to anticipated stigma or unfair treatment (Meyer, 2003). Thus, in the present study, we predicted that individuals who were exposed to more negative messages in the media will have more negative feelings about the election, report more anxiety and fear, and anticipate more discrimination due to their LGBT identity. Further, we hypothesized that negative feelings about the election would relate to more anxiety, fear, anticipated discrimination. However, because connection with the LGBTQ+ community and spiritual well-being have been associated with better mental health (Pflum et al., 2015; Greenfield et al., 2009), the current study explored whether community connection and spirituality relate to the other relations tested. Participants (N = 207) were recruited online through various social media platforms and participated in an online survey using Survey Monkey. The survey included the following measures: the Exposure to Negative Campaign Messages (adapted; Frost & Fingerhut, 2016), a self-created Presidential Election 2016 Response Questionnaire, Discrimination Scale (adapted; Kessler, Mickelson, and Williams, 1999), Connectedness to the LGBT Community Scale (Frost & Meyer, 2012), State-Trait Anxiety Form for Adults (Form Y1; Spielberg, Gorsuch, Lushene, Vagg, & Jacobs, 1977), Fear and Sense of Control Scale (Salcioglu, Urhan, Pirinccioglu, & Aydin, 2016), Spiritual Index of Well-Being Scale (Daaleman & Frey, 2004), Centrality Scale (Quinn, Williams, Quintana, Gaskins, & Pishori, 2014), and questions about frequently used social media sites. Results revealed, contrary to our hypotheses, that more negative messages in the media was not significantly related to negative feelings about the presidential election, r = .05, p = .524, or state-trait anxiety, r = .079, p = .341. In support of our hypotheses, negative feelings about the presidential election were significantly related to more anticipated discrimination in everyday life, r = .631, p < .001, state-trait anxiety, r = .577, p < .001, and fear, r = .663, p < .001. Exploratory analyses revealed that those with more negative feelings about the election felt less connected to the LGBTQ+ community, r = -.224, p = .001, and had a lower spiritual life schema, r = -.362, p < .001. Additional exploratory findings highlight the possibility that spiritual well-being may moderate the effect of being exposed to negative media messages and should be examined more specifically in the future. In sum, feelings resulting from media exposure may be more influential to mental health than media exposure itself.

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Rural populations are traditionally understudied, especially as it is concerned with the experiences of sexual minority women. Previous research has found that sexual minorities experience worse health outcomes in comparison to heterosexual individuals, which could be due to minority stress (the unique stressors they face as sexual minorities, such as discrimination and concealment of sexual orientation) (Meyer, 2003). More recent research has found that the relationship between minority stress and health outcomes has been mediated by social variables, like social isolation (Hatzenbuehler et al., 2009). Thus, the current study examined the indirect effects of proximal minority stress of concealment on self-rated health and quality of life through various social factors (community connectedness, social support, indirect support seeking, and belongingness). Participants included 134 sexual minority women in Northeast Tennessee. Participants completed the following measures: the Short Form LIHS (Szynmanski & Chung, 2001); Indirect Social Seeking Scale (Barbee & Cunningham, 1995); the Multidimensional Scale of Perceived Social Support (Zimet, Dahlem, Zimet, & Farley, 1988); the Belongingness Scale (Malone et al., 2012); the Connectedness to the LGBT Community Scale (Frost & Meyer, 2012); WHOQOL-BREF (World Health Organization, 1998); SF36v2 (Health Survey, 1996). In order to test that belongingness, social support, indirect support seeking, and community connectedness mediated the relationship between concealment to quality of life and self-rated health, a mediational analysis was conducted using PROCESS (Hayes, 2014) macro. Analysis showed that concealment was indirectly linked through belongingness with quality of life and self-related health. Concealment significantly predicted belongingness (b = -.327, p = .021), which in turn significantly predicted self-rated health life (b = .214, p = .004) and quality of life (b = .251, p < .001). A mediational analysis was conducted, and it was found that concealment had an indirect effect on self-rated health through belongingness (effect = -.070, 95% CI = -.1865, -.0105) and indirect effect on quality of life through belongingness (effect = -.066, 95% CI = -.161, -.001). All other mediational analyses were nonsignificant. Our results suggest that cognitive aspects of social life, like perceived belongingness, may be an important mechanism through which minority stress affects health.