There is an increasing movement recognizing LGBT rights in the international arena. In China, “tongzhi” (a Chinese term for LGBT) still face massive discrimination due mainly to the Chinese government’s repressive indifference policy. This thesis follows Kees Waaldijk’s developmental pattern theory of the recognition of gay rights, starting from decriminalisation, anti-discrimination, and reaching partnership legislation. It examines this theoretic pattern in relation to the development of sexual minority rights in the United Nations (UN), European and Canadian human rights law systems. Although every jurisdiction has its own unique aspects, each basically followed Waaldijk’s pattern. The thesis concludes that the application of privacy, equality and non-discrimination principles have helped sexual minorities to achieve equal rights in a variety of fields. The thesis further examines whether the experiences within these three human rights systems can be adopted in the Chinese context. Since the UN laws are soft laws, they will help influence legal reform for tongzhi rights in China but will not be a decisive factor. With regard to the regional human rights model, unlike Council of Europe and the European Union, the Association of Southeast Asian Nations (ASEAN) is unlikely to push the development of human rights in China due to the lack of a strong tie between China and ASEAN member states. The Canadian experience is inspiring but will not be easily duplicated due to the lack of democratic institutions and the absence of an effective judicial review system and judicial independence in China. It is anticipated that the Waaldijk pattern cannot be reproduced in the Chinese context. China will take a top-down reform route in terms of the tongzhi rights development. The central authorities will likely adjust relevant policies to the tongzhi group once a crisis has generated sufficient social pressure that would influence the central authorities to consider changing their repressive indifference policy. Same-sex marriage law is anticipated to be the first tongzhi human right legislation in China due to the Chinese traditional culture of tolerance, the support found among academics, and the current political environment.

Studies consistently find sexual orientation disparities in tobacco, alcohol and marijuana use among adolescents in the United States (Goldbach, Tanner-Smith, Bagwell, & Dunlap, 2014; Hatzenbuehler, Jun, Corliss, & Austin, 2015; Kann et al., 2018; Marshal et al., 2008; Mustanski, Van Wagenen, Birkett, Eyster, & Corliss, 2014). Having documented this elevated risk, the field has turned to identifying mediators that may explain the sexual orientation disparity in substance use behaviors. There is growing evidence that one of the mediators of sexual orientation-based health disparities is structural stigma—defined as “societal-level conditions, cultural norms, and institutional policies that constrain the opportunities, resources, and well-being of the stigmatized” (Hatzenbuehler & Link, 2014, p.2). Structural stigma can in turn lead to greater stress and subsequent negative coping behaviors among sexual minorities (Hatzenbuehler et al., 2015; Hatzenbuehler & Link, 2014; Hatzenbuehler & McLaughlin, 2014; Pachankis, Hatzenbuehler, & Starks, 2014). However, most of this work has been conducted among adults and has focused on mental health outcomes (e.g., suicide attempts, psychiatric morbidity, mental distress) as opposed to specific substance use behaviors; further, if structural factors are found to affect sexual orientation health disparities and these can be altered, the gap between sexual minority and heterosexual substance use can be narrowed through policy change. State-level substance use policy (e.g., levels of taxation of cigarettes and alcohol, policies that remove adolescent access to driving upon substance use infractions) may also explain the gap in substance use prevalence between sexual minority and heterosexual youth because tobacco, alcohol and marijuana are also stigmatized substances and restrictive substance use environments may enhance the stigma attached to sexual minority youth. However, only one study has explored this research question, and it was conducted with an adult sample (Hatzenbuehler, Keyes, Hamilton, & Hasin, 2014). This project aims to address these gaps in the literature. It uses multi-level modeling to test the association between (1) state-level sexual minority structural stigma (SMSS) and (2) state-level substance use policy environments (SUPEs) and sexual orientation disparities in recent substance use as measured in the Youth Risk Behavior Surveillance Survey (YRBSS). Analyses were also conducted to assess the size and direction of the association between SMSS and SUPE and state-level prevalence of substance use within heterosexual and sexual minority youth subpopulations. Analyses were conducted in subpopulations of female and male youth. Support was found for the structural stigma hypothesis among girls but not boys. Higher overall measures of sexual minority structural stigma were associated with larger disparities in tobacco use, alcohol use, and marijuana use among girls. Higher scores on the SMSS scale were associated with tobacco use among sexual minority girls but not heterosexual girls. Individual indicators of structural stigma (e.g., specific state-level policies) were also associated with disparities in these outcomes, as well as with the other outcomes tested (binge drinking and drunk driving). No such associations were found among male youth. Very little support was found for the hypotheses that restrictive substance use policy environments would be associated with larger sexual orientation disparities in substance use and that heterosexual but not sexual minority youth would demonstrate lower prevalence of substance use in restrictive states. Among girls, no associations were found between scales measuring the restrictiveness of substance use and sexual orientation disparities in substance use. A smaller sexual orientation disparity in recent cigarette smoking was associated with one indicator of restrictiveness: state enforcement of underage tobacco sale laws. Among boys, no associations were found between scales measuring the restrictiveness of substance use and sexual orientation disparities in substance use; two indicators of restrictiveness were associated with smaller sexual orientation disparities in binge drinking and three indicators were associated with smaller sexual orientation disparities in drunk driving. Among heterosexual but not sexual minority boys, higher tobacco taxes were associated with lower prevalence of smoking. This study raises several questions for future research on structural factors that may explain sexual orientation disparities in substance use behaviors among youth. For instance, future work is needed to understand the gender differences in response to structural stigma among sexual minorities. Sexual minority girls may have greater rejection sensitivity than sexual minority boys and thus may be more likely to use substances in response to structural stigma; however, further research is needed to test this hypothesis. In addition, the current study lacked data on the implementation of substance use policy environments, which may have masked important effects. A study of SUPE that includes measures of implementation of restrictive substance use policies is therefore needed to expand the work reported herein. Finally, a better understanding of gender identity and expression is needed; while the YRBSS measures “sex” and not gender or gender expression in these datasets, more information about these topics will help to understand how these factors may play into experiences of structural stigma and substance use policy environments.

The thesis deals with issues of LGBT movement in the Czech Republic in the context of the ongoing campaign "We are fair" for equal marriage. The intention was to try to find out on the basis of in-depth semi-structured interviews with LGBT activists how these activists perceive the status of sexual minorities in the Czech Republic and the related situation of the Czech LGBT movement with regard to its emancipatory potential. It turned out that the activists sensitively perceived the limits of the conditionality of the tolerance of Czech society and that they were aware of the changes in the social and political context in relation to minorities. However, particular minorities are not perceived in the same way by the society, and according to activists, LGBT rights can even be a tool for legitimizing aversion to other minorities, especially religious or ethnic minorities. On the level of reflection on the ongoiong campaign's strategies, activists put the emphasis on political lobbying for equal marriage, with the support of community mobilization and the formation of collective identity defined by the requirement of equal marriage. From the perspective of activists, it is therefore important to balance the professionalized lobbying with grassroots activism. Although, according to activists, the...

The lesbian, gay, bisexual, and transgender (LGBT) community continues to experience worse health outcomes than their heterosexual counterparts. Inequities in health care include low health insurance rates, high rates of stress due to systemic discrimination and stigma, and a lack of cultural competency in the health care system. Gender and sexual minority (GSM) people are at higher risk of mental health disorders, sexually transmitted infections (STIs) and human immunodeficiency virus (HIV), substance use and abuse, cancer, suicide, and other disorders/diseases. A lack of cultural competency in health care systems perpetuates these health disparities and inequities in care that burden the LGBT community. This project?s purpose was to evaluate the effectiveness of an online educational intervention on enhancing health professionals? cultural competence of GSM health. This study used a one-group pre-, post-, and follow-up survey intervention, quasi-experimental design to evaluate the effectiveness of an educational intervention on improving health professionals? knowledge, clinical preparedness, and attitudinal awareness of GSM health. The study?s setting was at a primary care center with clinics spread across three rural counties in North Dakota with a combined population of less than 14,000. This study used convenience sampling, and the recruitment of participants included a project presentation at the health care organization where the project would take place and an email invitation. Thirty-six participants completed the pre-survey, 11 of those 36 participants completed the educational intervention and post-survey, and six of those 11 participants completed the follow-up survey four weeks after completing the educational intervention. The instrument used for the presurvey, post-survey, and follow-up survey was the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS). A paired sample t-test was used to compare pre, post, and four-week follow-up LGBT-DOCSS mean scores. The results indicated a statistically significant improvement in LGBT-DOCSS mean score on the post-survey (p = 0.0011) and four-week follow-up (p = 0.01) compared to the pre-survey. Additionally, the majority of participants reported that this educational intervention was valuable to their practice. This project revealed that an online educational intervention effectively enhanced health professionals? cultural competence of GSM health.

"In this study we sought to compare eating disorder attitudes and behaviors, and proneness to an eating disorder ("ED proneness"), between gay men, lesbian women, and transgender and gender non-conforming (TGNC) adults. A further aim was to identify and compare risk and protective factors, and examine a mediational model based on the interpersonal theory of eating disorders (IPT-ED), whereby the association between interpersonal factors and ED proneness would be mediated by psychological constructs pertaining to the self and negative affect. Data was obtained from a larger national study of health risk and protective factors among sexual minority and gender diverse populations. The sample included 97 gay men, 82 lesbian women, and 138 TGNC adults. Participants completed the National College Health Assessment, Eating Disorders Screen for Primary Care, Patient Health Questionnaire Depression scale, Generalized Anxiety Disorder 7 scale, Self-Compassion Scale-Short Form, Negative Social Exchange subscale of the Multidimensional Health Profile, Interpersonal Needs Questionnaire, and Perceived Stigma Scale. There was a significant difference between groups in ED proneness, with lesbian women (66.7%) having a significantly higher percentage than gay men (47.6%). There was also a significant difference between groups in weight-based self-worth, with the lowest percentage in gay men (63%) and the highest percentage in lesbian women (82%), as well as dissatisfaction with eating patterns, with the highest percentage in TGNC adults (69.8%) and the lowest percentage in gay men (47.7%). There was a low percentage of inappropriate compensatory behaviors, with no significant difference between groups. Logistic regression analyses showed that the predictor variables of ED proneness were depression, perceived stigma, and self-compassion in gay men; depression in lesbian women; and self-compassion in the TGNC adults. Mediation analyses showed that thwarted belongingness (i.e., an unmet to belong) and perceived stigma had an indirect association with ED proneness that was mediated by self-compassion and depression (for perceived stigma alone) in gay men, depression in lesbian women, and self-compassion in TGNC adults. The interpersonal theory of eating disorders therefore extends to sexual minority and gender diverse populations; however, the results suggest a broadening of theoretical models and intervention programs to include the role of stigma and self-compassion."

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Indiana University-Purdue University Indianapolis (IUPUI) / Youth in the foster care system receive less sexual and reproductive health education, experience higher levels of negative sexual health outcomes, and engage in more risky sexual behaviors than peers not in the foster care system. Counteracting these concerns requires understanding the processes that contribute to these outcomes. A conceptual model interfacing traditional identity development theories and social constructionist theories of social sexualization was developed that posited sociosexual input factors of sexual education and socialization, sexual abuse history, and adverse childhood experiences affect youths’ sexual identity development, which then impacts youths’ level of sexual health. Hierarchical linear regression determined the level of impact of sexual socialization on sexual health within a sample of youth formerly in the foster care system (n = 219). Whether sexual identity development level mediated the relationship between sexuality-related discussions and sexual health was tested as well as how relationship quality moderates the effects of sexuality-related topic discussions on sexual identity development. Further analysis explored differences between the experiences of youth who identified as sexual minorities and their peers who identified as heterosexual. Results indicated that gender identity, sexual orientation, adverse childhood experiences, sexual abuse history, and sexuality-related discussions with foster parents and with peers all impact sexual health. All four dimensions of sexual identity development significantly contributed to sexual health outcomes. Mediation occurred with two of the four sexual identity development dimensions, whereas no moderation effects were indicated. Youth who identified as sexual minorities and youth who identified as heterosexual had significantly different scores on three of four sexual identity development dimensions and youth who identified as sexual minorities had worse sexual health outcomes. Results indicate the importance of the sexual identity development process on sexual health and that youths’ sexual orientation identity must be considered when designing interventions to improve sexual health outcomes.

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