This study aimed to provide insights into the experiences of lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ+) people within LGBTQ+ culture, and to explore how they disclose or conceal their sexual identities within different social environments. A qualitative study enabled me to become immersed within the stories of LGBTQ+ people, in order to better understand the construct and importance of LGBTQ+ culture. Through in-depth interviews and focus groups, 14 members of the LGBTQ+ community from around the nation volunteered to share their experiences with LGBTQ+ culture and their negotiation of identity within heterosexual culture. From participants’ stories, key themes were identified: sexual identity and the processes of integrating multiple aspects of identity (i.e., ethnic, religious, gender), characteristics and values within the LGBTQ+ and heterosexual cultures, and how LGBTQ+ people make decisions to conceal or “come out” about their sexual identity depending on the environment. Participants described three levels of identification as LGBTQ+: individual, proximal social group, and a broader LGBTQ+ culture. The narratives converged to reveal a process, contextual navigation, for how LGBTQ+ people conceal or disclose (“come out”) their sexual orientation depending on safety within a given environment. We suggest that people working with LGBTQ+ individuals should encourage engagement in the LGBTQ+ culture, as this may provide support for identity development and facilitate mental health outcomes.

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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.

Gratitude, or attention to and appreciation of the positive, is related to psychological well-being and less psychopathology, including suicidal thoughts and behaviors (STBs). However, to date, no published research has examined the gratitude-suicide relation among sexual minority (SM) adults (e.g., lesbian, gay, bisexual), a population at markedly greater risk for STBs. Further, the theoretical mechanisms underlying the impact of gratitude are understudied. The current study examined potential mechanisms that represent the four hypotheses (positive affect, schematic, coping, and broaden-and-build) that might explain the benefit of gratitude in relation to suicidal ideation (SI) among a sample of SM adults (N = 651). Less depressive symptoms (positive affect) and anticipated discrimination (schematic) and greater self-compassion (coping) and psychological flourishing (broaden-and-build) mediated the relation between gratitude and less SI. Therapeutic activities aimed at bolstering gratitude among SM individuals may have a beneficial effect on SI due to impact on psychopathology and psychological well-being.

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Sexual minorities, or those who do not identify as straight, experience stigma that has been associated with a number of health issues and decreased quality of life. The current study expands on previous explanations of the relationship between stigma experienced by sexual minorities and quality of life by examining self-compassion and authenticity as potential mediators. We proposed and examined a mediation model in which self-compassion and authenticity would explain the relationship between stigma and quality of life, using data from a sample of 213 sexual minorities. Results of structural equation modeling revealed that there was no direct relationship between public stigma and quality of life but that public stigma and quality of life were indirectly related through internalized stigma, authenticity, and self-compassion. These findings have implications for the understanding of sexual minority experience of stigma and highlight potential points of intervention for increasing quality of life among sexual minority individuals.

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Research examining the psychotherapy outcomes of sexual minority clients seen in routine clinical care is lacking. No studies could be identified in which sexual minority client outcomes were examined with a standardized measure. The pre-treatment mental health functioning of 600 sexual minority clients was compared with that of a randomly selected group matched to the minority group on male/female ratio. The post-treatment mental health functioning of 596 sexual minority clients was also examined and compared to a control group matched on female/male ratio, initial levels of mental health functioning, age, and marital status. Results indicated that sexual minority clients who reported experiencing distress regarding their sexual identity/orientation at intake evidenced significantly higher levels of psychological distress than the randomly selected group pre-treatment. No significant differences between sexual minority and control clients in overall mental health functioning was found post-treatment and sexual minorities in the sample evidenced treatment gains that were similar to control group clients when initial levels of functioning were matched. Sexual minority females reported experiencing more frequent suicidal thoughts pre- and post-treatment. Implications for psychotherapy in routine clinical care are discussed and recommendations for future research are offered.