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This study investigates the influences for, methods of, and impact of sexual orientation change efforts (SOCE) on transgender individuals. SOCE uses methods such as religious practices, behavioral modification, cognitive reframing, and counseling as ways to change sexual orientation from homosexual to heterosexual (Fjelstrom, 2013). This phenomenological, multiple case study analysis examines individual cases of SOCE to find cross-sectional themes among participants. The study identified participants who were influenced to undergo SOCE due to familial attitudes towards transgender identity. Participants described various methods used to suppress their gender identity during SOCE. They reported being negatively impacted by SOCE, experiencing issues such as loss of faith, interpersonal harm, feelings of inauthenticity, lack of trust, negative self-esteem and sexual dysfunction. This study aims to advocate for policy change regarding SOCE and to bring awareness on the use of SOCE among transgender individuals.

My dissertation explores the demographics and composition of sexual minority populations in the United States, their labor market experiences, and public policy, respectively. Using a novel method of Cross-Survey Multiple Imputation (CSMI), I create a unique dataset which allows me to examine the demographic profile of lesbian, gay, and bisexual (LGB) populations at the national and state levels. I then measure the prevalence of discrimination experienced by these groups in the labor market through regression analyses and decompositions of wages. Finally, I examine the effectiveness of sexual orientation nondiscrimination policies at the state level. My analyses show that LGB people make up just over four percent of the national population, a sizeable minority though smaller than popular and historical estimates. I show that LGB people tend to be younger, more racially and ethnically diverse, and slightly more educated than the heterosexual majority. However, LGB people are also more likely to be unemployed, more likely to be living below the poverty line, and less likely to have health insurance than heterosexual people. I find that lesbian women and gay men earn a wage premium over similarly situated heterosexual women and men while bisexual men and women experience a significant wage penalty relative to heterosexual men and women. After cataloguing and analyzing all state-level sexual orientation nondiscrimination policies for textual themes, I test for policy effectiveness. My analyses suggest that while policies raise the wages of all workers, the specific effects of policies on LGB workers’ wages are inconsistent, suggesting other factors play a role in shaping wage differentials. / Sociology

Sexual minorities, or those who do not identify as straight, face stigmatizing experiences which can lead to disparities in physical and mental health, as well as social and economic resources. Additionally, transgender and gender non-conforming (TGNC) persons, or those whose sex assigned at birth is not fully aligned with their gender identity, experience similar disparities related to stigma and lack of resources. The current study aimed to examine quality of life and drug use between TGNC and cisgender (or non-TGNC) individuals who all identify as sexual minorities to explore how being TGNC may further widen gaps in quality of life beyond sexual orientation. We examined four components of quality of life – physical, psychological, social, and environmental. Additionally, we examined frequency of use of various drugs as a component of quality of life and risk behavior. Within a sample of 213 sexual minorities, 63 (29.6%) identified as TGNC. Independent samples t-test were run to examine differences in quality of life Page 180 2017 Appalachian Student Research Forum and drug use between TGNC and cisgender participants. TGNC participants reported significantly lower physical quality of life (M=13.35, SD=2.97) than cisgender participants (M=14.99, SD=2.59), t(211)=-4.05, p<.001; lower psychological quality of life (M=11.24, SD=3.18) than cisgender participants (M=12.62, SD=2.99), t(211)=-3.04, p=.003; and lower environmental quality of life (M=15.41, SD=2.78) than cisgender participants (M=16.83, SD=2.94), t(211)=-3.25, p=.001. Additionally, TGNC participants reported higher use of sleep medications (M=0.87, SD=2.01) than cisgender participants (M=0.39, SD=1.29), t(210)=2.06, p=0.040; higher use of opioids (M=0.30, SD=0.98) than cisgender participants (M=0.05, SD=0.38), t(210)=2.66, p=.008; and higher use of barbiturates (M=0.03, SD=0.18) than cisgender participants (M=0.00, SD=0.00),t(211)=2.21, p=.028. These findings indicate that experiences related to gender identity may explain additional disparities in quality of life above and beyond those related to sexual orientation, and that future research should examine multiple identity characteristics when attempting to explain health disparities.

This study uses a constructivist grounded theory approach to investigate the meaning of “coming out” for LGBQ individuals. Analysis of open-ended interviews with 30 LGBQ persons revealed three main themes. First, coming out does not have a universal meaning among LGBQ persons; rather, it varies on the basis of an individual’s experiences, social environment, and personal beliefs and values. Coming out is a transformative process, and an important element in identity formation and maintenance. Second, despite being attracted only to members of the same sex, ten interviewees engaged in a queer apologetic, a kind of identity compromise whereby individuals disclose a bisexual identity that they believe satisfies their personal attractions for only members of the same sex and society’s expectation that they be attracted to members of the opposite sex. Third, both gender conformity (e.g., female=feminine) and gender non-conformity (e.g., female=masculine) present unique challenges to coming out. Because they are assumed to be straight, gender conformists must make a more concerted effort to come out. Gender non-conformists may experience greater ease coming out broadly because they are “assumed gay,” but they also experience greater opposition from family and friends who resist gender non-conformity. This study provides important insight into the meaning of coming out as well the influences of heteronormativity and gender presentation on coming out. Implication and recommendations for future research are included.

Higher levels of allostatic load (AL), a composite measure of the impact of chronic stress on the body, are found among socially marginalized groups compared to privileged groups. AL is associated with premature aging and death, as well as a variety of chronic health conditions that impact quality of life. Effects of AL may be offset by physical activity (PA). Queer populations (including those who identify as lesbian, gay, or bisexual) may be at risk for elevated AL due to repeated exposure to discrimination in the form of sexual minority stress. There is mixed literature on sexual orientation differences in PA and research on AL among queer populations is limited. This study describes sexual orientation differences in the 1) prevalence of PA and mean AL levels and 2) association between PA and AL. Data from the 2001-2015 National Health and Nutrition Examination Survey were used to fit sex-stratified linear regression models assessing sexual orientation (heterosexual, gay/lesbian, bisexual, and heterosexual with same-sex experience) differences as well as sexual orientation-specific associations in PA and AL. AL was assessed using 8 biomarkers, while PA was assessed using metabolic equivalent of task (MET)-hours/week calculated from the Global Physical Activity Questionnaire. Models were adjusted for race/ethnicity, income, education, relationship status, veteran status, and citizenship status. Overall, heterosexual adults reported more PA than their same-sex queer counterparts. Gay men had lower (0.8), while bisexual men had higher AL scores (1.9) than heterosexual men (1.2). Among women, AL score was similar across sexual orientation groups. Overall, more PA was associated with lower AL scores among men and women (badjusted = -0.00508, padjusted=-0.00505, punadjusted =-0.00934, punadjusted =-0.03269, p=0.04), and heterosexual women with same-sex experience (bunadjusted =-0.01059, p=0.02). After adjusting for covariates the association was no longer statistically significant. Consistent with previous work, PA was inversely associated with AL score. PA may be an important modifiable behavior to mitigate some sexual orientation disparities in health.

Background: Since the early 1960s, survival rates among cancer survivors have been increasing. Surviving cancer can be a stressful experience due to the multifaceted changes that come with diagnosis, treatment, and recovery. Therefore, studying the mental health of cancer survivors is vital for their well-being. Among queer groups (including those identifying as gay, lesbian, or bisexual), poor mental health is more prevalent than among heterosexuals. However, cancer survivorship among queer populations is not well studied. This study examines the association between cancer survivorship and poor mental health, focusing on potential sexual orientation differences. Methods: Data are from the 2019-2021 National Health Interview Survey. Participants identified as straight (n=65,006), gay or lesbian (n=1,271), or bisexual (n=1,100). Diagnosis of anxiety and depression as well as the frequency of anxiety and depressive symptoms were regressed on cancer survivorship (assessed based on cancer diagnosis) using logistic models. Using a subsample of 2019 rotating core participants, we assessed anxiety, using the Generalized Anxiety Disorder-7 (GAD-7) scale, and depression, using the Patient Health Questionnaire-8 (PHQ-8) symptoms, to account for a potential lack of diagnosis. Models were adjusted for sociodemographic covariates and were stratified by sex. Results: After adjusting for sociodemographic characteristics there was no significant association between cancer diagnosis and mental health in the overall sample. However, when examining sexual identity-specific estimates, among bisexual males, cancer survivors had higher odds of “daily” anxiety [OR=8.07 CI (1.23,52.81)] and “weekly or monthly” depressive symptoms [OR=15.23 CI (3.17, 73.22)]. While among bisexual females, cancer survivors had significantly higher odds of anxiety diagnosis [OR=3.03 CI (1.37, 6.71)] than those who never had cancer. Moreover, bisexual male cancer survivors had higher GAD-7 [β =10.39 (4.03, 16.75)] and PHQ-8 [β =13.59 (6.03, 21.16)] scores than those who never had cancer. No other significant associations were found for other sexual identity groups. Our test for effect modification based on sexual identity on the association between cancer diagnosis and mental health outcomes suggested that the association between cancer diagnosis and mental health outcomes were similar across sexual identity groups. The p-values ranged from 0.11 to 0.92. Conclusion: Bisexual cancer survivors may experience poorer mental health than those who have not had cancer, suggesting a potential need for more targeted mental health intervention and cancer survivorship support. However, small sample sizes suggest that additional work with larger samples of cancer survivors is needed to corroborate these findings.

This study examined the relationships among psychological variables of sexual prejudice, psychological adjustment, and identity development. It was hypothesized that sexual orientation prejudice would be negatively related to psychological adjustment. It was further hypothesized that identity formation would moderate the relationship between sexual orientation prejudice and psychological adjustment. Participants were 200 college students, ages ranged from 18-48 (M = 21.96, SD = 4.87). Sexual orientation for the participants included self-identified labels of Heterosexual (88.5%), Homosexual (6.5%), Bisexual (3.5%), Pansexual (1%), and Demisexual (0.5%). Survey data were collected through a Psychology Research Experience website (SONA). Results revealed a negative correlation between Heterophobia, and Life Satisfaction. However, no statistically significant correlation was found between Homophobia and Life Satisfaction. Heterophobia (but not Homophobia) was significantly correlated with identity Exploration in Depth and Identification with Commitment. The measure of sexual adjustment revealed both Heterophobia and Homophobia positively correlated with Sexual Anxiety and Sexual Fear. The identity variables (Sexual Exploration and Sexual Commitment) were found to be related to sexual orientation prejudice. The moderator hypothesis was partially supported in that two moderator variables significantly interacted with sexual orientation prejudice (Heterophobia) and psychological adjustment (Sexual Anxiety and Sexual Fear). However, more research is needed to further elucidate the intricate relationships among psychological variables of sexual orientation prejudice, psychological adjustment, and identity development.

Homophobia plays a significant role in the treatment of individuals who identify as lesbian, gay, bisexual, or transgender (LGBT). The purpose of this study is to explore the presence of these types of negative attitudes as they present themselves in the nursing workforce. 520 registered nurses were contacted via email to partake in a survey assessing homophobic attitudes and perceptions regarding nursing care of LGBT persons. A total of 27 registered nurses responded and the resulting data were analyzed using descriptive statistics. A majority of registered nurses were female (89.3%), greater than 40 years of age (75%), white (75%), heterosexual (96.4%), and Christian (67.9%) with a Bachelor’s degree or less (57.1%). Homophobia scores averaged 27 on a scale from 12-60, higher scores translating to greater homophobia levels. This value is on the lower end of the scale, which interprets to lower levels of homophobia among the participants. While some of these scores did show the existence of negative attitudes toward LGBT individuals among participants, further investigation is needed with a larger, more representative sample. As a result, it is difficult to determine whether LGBT relations are improving with registered nurses.

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