Sexual minority women have been repeatedly overlooked in violence against women research. As a result, we know little about the experiences and needs of non-heterosexual or gender non-conforming survivors. Given the paucity of information available on this topic, this study was exploratory in nature and used a phenomenological approach. Open-ended, unstructured interviews focused on the lived experience of surviving sexual violence and the impact that this experience has had on the survivors’ same-sex sexuality. While a number of reoccurring themes generated from this project are well represented within the broad and well-developed canon of sexual violence research, participants also introduced features unique to LBQ and same-sex attracted women. Results from this project are intended to begin a long overdue dialogue about the needs of this understudied community of survivors.

Rural populations are traditionally understudied, especially as it is concerned with the experiences of sexual minority women and the experiences of internalized stigma (negative attitudes towards the self) are often related to poor health outcomes within the LGBTQ+ community (Meyer, 2003). This relationship has been found to be mediated by rumination, suppression, and social isolation, which has been generalized to cognitive, coping, and social mediators (Hatzenbuehler, Nolen-Hoeksema, & Dovidio 2009). The current study examines the indirect effect of internalized stigma on self-rated health and quality of life through cognitive mediators (self-esteem, self-compassion, and feelings of guilt and shame) in sexual minority women located in northeast Tennessee (N=134). Participants completed the following scales: Perceived Self Stigma Scale (Mickelson, 2001), Rosenberg Self-Esteem Scale (Rosenberg, 1965), Self-Compassion Scale- Short Form (Raes, Pommier, Neff, & Van Gucht, 2011), Personal Feelings Questionnaire (Harder & Zalma, 1990), WHOQOL-BREF (World Health Organization, 1998), and the SF-36v2 (Health Survey, 1996). Results suggested that only self-esteem mediated the relationship between internalized stigma and both self-rated health and quality of life. Analyses were conducted via the data software SPSS. Internalized stigma was found to predict self-esteem (b = -0.153, p =.023). In turn, self-esteem was then predictive of self-rated health (b = .399, p =.043) and quality of life (b = 0.438, p = .007). A mediational analysis was conducted using a PROCESS (Hayes, 2014) macro to test the hypothesis that self-esteem acts as a mediator between internalized stigma and quality of life and self-rated health. There was an indirect effect of internalized stigma on quality of life (effect = -.067, 95% CI (-.157, -.016)) and self-rated health (effect = -.061, 95% CI (-.151, -.013)) through self-esteem. All other regression and mediational analyses with self-compassion, shame, and guilt were nonsignificant. With these findings, clinical therapy may be improved for sexual minority women by focusing on internalized stigma as an underlying cause of lower self-esteem and poor health. If the focus of therapy becomes internalized stigma, based on our findings, reduction of internalized stigma could increase self-esteem and in turn increase self-rated health and quality of life in sexual minority women.

Many women experience sexual violence, but bisexual women are at particularly high risk for such victimization. Theories attempting to explain women’s risk for sexual violence have focused on numerous risk factors (e.g., childhood abuse, substance use, sexual risk behavior, among others); however, many of these factors have not been explored with sexual minority survivors. The current study used multiple groups path analysis within a structural equation modeling framework in order to test a theory-driven model of victimization risk, first among a general sample of women, and then among subsamples of heterosexual, lesbian, and bisexual women. The prospective model included childhood sexual, physical, and emotional abuse as three separate exogenous variables; sexual risk behavior, alcohol use, and drug use as separate mediators; and a count-based adult sexual victimization score as the outcome. The prospective model was trimmed until it best represented the observed data for the full sample, which saw the inclusion of childhood sexual and physical abuse as the only exogenous variables, sexual risk behavior as the only mediating variable, and adult sexual victimization as the outcome. Sexual risk behavior mediated the relationship between both childhood abuse variables and adult sexual victimization for the general sample of women. However, within the multiple groups model, sexual risk behavior mediated the relationship between childhood physical abuse and adult sexual victimization among bisexual women only. A mediational relationship between childhood sexual abuse and adult sexual victimization via sexual risk behavior approached significance among bisexual women only. A second-stage moderating effect approached significance whereby the relationship between sexual risk behavior and adult victimization was stronger for heterosexual women than for bisexual women. Additionally, the direct effect of childhood sexual abuse on adult sexual victimization was stronger for lesbian women than for bisexual women. Relationships among variables and the novel and unique findings pertaining to bisexual women’s victimization risk are framed as the compounding effect of childhood trauma and social stigmatization of bisexuality. Implications and future directions are described.

Researchers examining clinically-relevant trends for sexual minority women have found evidence of psychological distress and greater utilization of mental health services compared to heterosexually-identified women. However, the results of many research studies with this population have methodological limitations surrounding recruitment of participants, cross-sectional methods, and participant report of clinical services utilized. Few researchers have sought to analyze actual clinical presentation, service utilization, or clinical outcome of sexual minority women in a treatment-setting. This study is an in-depth clinical analysis of 215 sexual minority woman who sought services at a large Midwestern university counseling center over a period of two years and nine months. The analyses conducted allowed for the initial clinical presentation, service utilization, and clinical outcome of sexual minority women to be described and compared to comparative samples of service-seeking female college students. Sexual minority women were found to have a greater incidence of prior suicidality and prior counseling compared to heterosexual women at the same agency. Sexual minority women also reported greater symptoms of social anxiety, eating concerns, and family distress than heterosexual women at the same agency. Of seven examined predictors of service utilization, sexual minority identity label, age, and academic term of service initiation differentiated brief and extended service utilization from moderate service utilization. Prior use of counseling, psychological distress, racial-ethnic minority status, and time in the semester of initiation of services were not significant predictors of service utilization. Implications and limitations of these findings are presented, and future directions for research and intervention are discussed.

No description available.

No description available.

Counselors are called to address barriers to human growth and development through advocacy (ACA, 2014), such as those posed by inequitable health care access for socially disadvantaged groups (CDC, 2013; IOM, 2011). Health care contributes to positive health outcomes (Healthy People 2020) and is therefore an important component of advancing health equity among marginalized populations, such as older sexual minority women (SMW) with disabilities. Despite evidence of disparate health care access and health outcomes, no research to date has explored the health needs or health care experiences of disabled older SMW. This study therefore sought to address this gap in the literature by: identifying current levels of health care access and barriers among older SMW with disabilities; exploring predictors of health care access among older SMW with disabilities; and identifying protective factors, such as social support and resilience, that moderate the relationship between health care access barriers and health outcomes. Results obtained from a sample of 208 respondents provided baseline data about health care access and barriers among older SMW with disabilities. Generally, respondents had a place to receive health care, but few had access LGBTQIA+-specific health services despite indicating that this type of health care was important to them. Only about half had accessed mental health services in the last six months, and people who had accessed mental health care perceived it to be easier to access than people who had not. Respondents most highly endorsed external barriers related to cost of health care, and they reported higher health care stereotype threat related to age and disability compared to gender and sexuality. External barriers to health care were predictive of most health care access indicators (e.g., utilization of general and specific health services, as well as health outcomes). Among internal barriers, sexuality- and disability-related health care stereotype threat emerged as predictors of health care access and health outcomes respectively. Similarly, acceptability of health services, accessibility of health services, and affordability of health services were specific external barrier categories that appeared to influence health care access and outcomes among older SMW with disabilities. Neither resilience nor social support moderated the relationship of external access barriers to physical or mental health outcomes. However, resilience had a significant independent relationship with physical health outcomes, and both resilience and social support had significant independent relationships with mental health outcomes. These findings illustrate the structural factors related to health care access and outcomes for older SMW with disabilities, as posited by health equity frameworks (Braveman, 2014). The most influential internal barriers related to health care stereotype threat, which may develop in response to minority stressors specific to health care settings. The findings of this study support lifespan perspectives on LGBTQIA+ health (Fredriksen-Goldsen, Simoni et al., 2014), as well as minority stress processes (Meyer, 2003), as frameworks for understanding LGBTQIA+ health in later life. Implications for counselors, counselor educators, community organizations, and policies are discussed. / Doctor of Philosophy / LGBTQIA+ older adults are at increased risk of negative health outcomes, but helping professions have limited resources for understanding their health care needs at present. Because nearly half of older sexual minority women (SMW) have disabilities, this study examined health care access and outcomes among older SMW with disabilities. This is relevant to counseling given the field's focus on social justice, advocacy, and equity, as well as the interconnected nature of physical and mental health. Across different ways of measuring health care access, external barriers related to health care systems and societal injustice were related to whether older SMW with disabilities could access health care. Health care stereotype threat, or internalized stigma related to experiences in health care, predicted health care access and health among disabled older SMW as well. These findings suggest that poor health care utilization and poorer health outcomes among older SMW with disabilities are the result of structural oppression rather than individual choices, which requires systemic interventions to correct. More research is needed to determine how counselors and other helping professionals can enhance strengths to support health among older SMW with disabilities.

Sexual minority women (SMW) demonstrate lower rates of cervical cancer screening than heterosexual women. This is concerning as lesbian and bisexual women tend to engage in higher rates of substance-related cancer risk behaviors, unprotected sex, and tend to have higher body mass indices, all of which are risk factors for cancer development. Another major risk factor, screening avoidance, places SMW at increased risk for the development of high grade cervical lesions in the absence of early detection practices, which is likely to impact overall cervical cancer morbidity in this population. The aim of the present study was to utilize the Health Equity Promotion Model in order to investigate the interplay of medical heterosexism, social and community, behavioral, biological, and social identity/position factors on cervical cancer screening rates in a sample of SMW from a large metro area in the southeastern United States. 145 women who identify as sexual minorities were recruited from local LGBT-friendly venues, events, community organizations, email LISTSERVs, and related social media accounts and were asked to complete a fifteen-minute survey. A series of bivariate correlation, t-test, and multivariate regression analyses were run. Findings from mediation analyses demonstrated that health communication factors mediated the relationship between perceived medical heterosexism and cervical cancer screening outcomes. Further, after accounting for demographic factors, greater provider communication quality, provider trust, eHealth literacy, and ever having an HIV test significantly and differentially predicted cervical cancer screening outcomes in the multivariate models (ps < .05). Findings suggest that health communication factors play an important role in facilitating cervical cancer screenings for SMW, and provider training interventions and policy that focus on reducing medical heterosexism may aid in improving patient-provider relationships in this population.

This dissertation is a history of Accra residents’ memory and experiences with family planning programs in the capital of Ghana from national independence in 1957 through the 1990s. In the final chapter I extend my analysis to the present to explore the ways that the NDC Generation, the youngest generation in this study, are currently navigating fertility decisions and parenting. Beginning my analysis at independence allows me to explore how the discourses of nation-building reignited existing, and facilitated new, negotiations over gender, sexuality, fertility and family as the government and everyday people sought to build prosperous lives as individuals, families, communities, and as a nation. Examining family planning discourses and programs through the 1990s is useful because members of this generation were adolescents and young adults during a particularly dynamic moment in population, family planning, and sexual health. During this decade, international paradigmatic shift in population programs, renewed government emphasis on curbing population growth and corresponding attention on women’s rights and contributions to nation-building, and increased government promotion of sex education and HIV/AIDS programming for children. Including the perspectives of Accra residents who grew up in the 1990s allows us to examine how contestations over the course of several periods of political and economic stability and instability have led to the current moment as members of this cohort build their own families.In this dissertation I ask: how have government and NGO actors promoted family planning as useful for particular ideas of economic development, national prosperity, biomedical reproductive health, and promoting gendered roles in nation-building? how have Ghanaians interpreted and engaged with these discourses and family planning programs throughout their lives from adolescence to adulthood as they navigated decisions regarding their reproductive health, family size, roles as parents and spouses? how have Ghanaians seen family planning in relation to their own ideals of gender, sexuality and family, and how have these ideals have shifted over the course of their lives? And finally, how have those that did not fit the presumed model of family planning discourses and programs—monogamous, heterosexual marriages—seen family planning as relevant to their sexual and reproductive health and desires? I utilize oral histories to analyze shifts in women and men’s perspectives regarding fertility, reproduction, and health across their own life course and in the context of broader political, social and economic change. With assistance from Theodora Agyeampong Oduro and Steven Danso, I conducted 206 life history interviews with Ghanaians aged 35+, who grew up in, and/or raised their children in Accra, with the vast majority being low-income with a middle-school education or less. Centering life history interviews was crucial for moving beyond a focus on state and institution-led population, health, and social initiatives, and instead evaluate the perspectives of everyday people as they experienced reproductive health and family planning campaigns. I investigate the ways that peoples’ views of what it means to be a woman or man at various phases of life between adolescence, adulthood, parenthood, and old age have shifted as they have navigated these stages themselves, and watched their elders and children do the same. Analyzing these ideas in relation to peoples’ perspectives on and engagement with the family planning movement over the course of their lifetimes allows me to examine how gender and age have impacted their approaches to parenthood, spousal relationships, fertility, reproductive health, family, and sexual behavior. I include 26 interviews with lesbian and bisexual women as part of this dissertation to investigate the perspectives of people who have historically been marginalized or altogether ignored in discourses of family planning, population, and nation-building. I examine how these women have seen family planning as valuable to their own lives and the LGBT+ community more broadly. My analysis of government policies using archival sources is in service of better understanding the frameworks that shaped government interventions in population and family planning that Ghanaians experienced. When possible, I privileged government and NGO sources that were directly aimed at the public, such as advertisements and documents that reveal program strategies, rather than those that illuminate the inner workings of these institutions. I made this choice to ensure that my exploration of government efforts concentrated on aspects that were visible to the public, and that would potentially have been reflected in peoples’ memories of population and family planning efforts. By tracing the life histories of women and men alongside government interventions in the realm of family planning, I merge life histories with national history to examine how everyday people and government actors have engaged with this idea and influenced each other to form ideas about the future of women, men, families, and the nation. The first major argument of my dissertation is that the family planning movement was a turning point in the history of reproduction in Ghana. Everyday people and early family planning advocates distinguished between existing fertility management methods and family planning programs. Each group contributed to local definitions of these concepts and highlighted that the latter was new and distinct. The second argument is that in their views of the value of family planning movement, people across generations have been primarily concerned with the impact on their own health, social, and religious lives rather than the broader community, and were mostly uninterested in dictating other peoples’ participation. The third argument is that Accra residents’ openness about discussing sex education and family planning has increased over time despite the fact that questions of women’s and men’s sexual’ morality have remained. However, concerns over morality have shifted from focusing on women’s sexual behavior towards more general worries of increased social vices such as petty crime, loitering, and drug use. The fourth argument is that the family planning movement has been interpreted by both governments and everyday people first and foremost in terms of economic impact rather than potential to shift social norms regarding gender, family and sexuality. Ideals of family and gender roles have remained similar across all generations with the exception of the youngest generation in this study. Moreover, people have articulated support for shared financial and childcare responsibilities between spouses and small family sizes in terms of economic circumstances rather than interest in women’s rights or gender equality.

Plusieurs enquêtes états-uniennes et canadiennes montrent que les personnes de la diversité sexuelle et de genre sont plus vulnérables face aux problèmes de santé mentale (détresse psychologique, dépression, troubles anxieux, problèmes de consommation, etc.) et plus à risque d’être victimes de violences conjugales au cours de leur vie. Mais cette population n’est pas homogène : parmi les différents sous-groupes de la communauté LGBTQ+ (lesbienne, gai, bisexuel·le, trans, queer et autre), les femmes de la diversité sexuelle sont particulièrement vulnérables face à ces problématiques. Le modèle du stress minoritaire explique cette vulnérabilité par le fait que les personnes de la diversité sexuelle et de genre souffrent de facteurs de stress spécifiques qui peuvent avoir des conséquences sur leur santé mentale et leurs relations. Ces facteurs peuvent être exogènes, c’est-à-dire provenir de l’extérieur de l’individu, comme les préjudices vécus dus à son identité sexuelle et de genre (harcèlement, discrimination, violence physique, etc.). Mais ils peuvent aussi être endogènes, c’est-à-dire provenant de l’individu lui-même. Ils sont alors plus subjectifs, comme le fait de s’attendre à être stigmatisé (la stigmatisation anticipée), le non-dévoilement de son identité sexuelle et/ou de genre et l’homophobie ou la transphobie intériorisée. L’objectif principal de ce mémoire est d’examiner l’impact des facteurs de stress minoritaire et des différentes formes de victimisation conjugale sur les symptômes de dépression et d’anxiété chez les femmes de la diversité sexuelle, en fonction de leur identité sexuelle et de genre. Pour réaliser cette étude, 209 personnes qui s’identifient comme femme (âge moyen = 33,9 ans), vivant au Canada et qui ont vécu des violences dans une relation intime avec une femme par le passé ont répondu à notre questionnaire en ligne. Nous avons mesuré l’identité sexuelle et de genre, la victimisation conjugale, les facteurs de stress minoritaire, et les symptômes de dépression et d’anxiété. Des régressions hiérarchiques montrent que les sentiments négatifs sur son appartenance à la diversité sexuelle sont positivement associés aux symptômes de dépression et d’anxiété, même après avoir contrôlé pour l’âge, l’ethnie, l’identité sexuelle et de genre et la victimisation. La victimisation psychologique est également positivement associée aux symptômes d’anxiété et la victimisation sexuelle aux symptômes de dépression. L’âge est négativement associé aux symptômes d’anxiété et ne pas être attiré strictement par les femmes (s’identifier comme bisexuel·le, pansexuel·le, queer ou autre) est positivement associé aux symptômes de dépression dans notre échantillon. Ces résultats apportent de nouvelles informations sur l’association entre les violences conjugales, le stress minoritaire et la santé mentale. Ainsi, ce mémoire montre l’impact de la victimisation conjugale sur la santé mentale des femmes de la diversité sexuelle ayant été victimes de violences conjugales. Il met également en avant l’impact significatif des sentiments négatifs sur son appartenance à la diversité sexuelle, une composante de l’homophobie intériorisée, sur les symptômes d’anxiété et de dépression. Il vient souligner la nécessité d’évaluer les besoins de cette population, et plus largement de toute la diversité sexuelle et de genre, et d’adapter les interventions auprès des victimes de violences conjugales à ces besoins. / Canadian and American population surveys show that people from the sexual diversity and gender-diverse people are more at risk of mental health problems (psychological distress, depression, anxiety disorders, substance use problems) and of being victims of intimate partner violence (IPV) in their lifetime. But the LGBTQ+ (lesbian, gay, bisexual, transgender, queer and other) community is not homogeneous: between the different subgroups of this population, sexual minority women (SMW) are at particularly high risk of experiencing stigma, mental health problems and being victims of IPV. This vulnerability can be explained by the sexual and gender minority stress model, stating that sexual and gender minority people suffer from specific stress factors added to general stressors, leading to more mental health and relationship problems. Those stress factors can be distal, such as prejudice events one suffers from based on their sexual or gender identity (harassment, discrimination, physical violence, etc.). But they can also be proximal, and therefore more subjective, such as expecting to be rejected or discriminated (also called stigma consciousness), concealing one’s sexual or gender identity, or suffering from internalized homophobia or transphobia. The main goal of this Master’s thesis was to assess the impact of minority stress factors and of different forms of past IPV victimization on the current mental health of Canadian SMW, as a function of their sexual and gender identity. In total, 209 individuals identifying as women (M age = 33,9), living in Canada and who lived in a violent intimate relationship with a woman in the past answered our online survey. Questionnaire assessed sexual orientation and gender identity, IPV behaviors, minority stress factors, and symptoms of depression and anxiety. Hierarchical regressions showed that psychological aggression was positively associated with anxiety symptoms and sexual coercion with depressive symptoms. Not being strictly attracted to women (i.e. identifying as bisexual, pansexual, queer or something else) was also associated to high symptoms of depression and age was negatively associated to anxiety symptoms. After controlling for age, race/ethnicity, sexual and gender identity and IPV victimization, having negative feelings about being a SMW was strongly associated with both depression and anxiety symptoms. This Master’s thesis provides new information on the interconnected associations among IPV, minority stress and SMW’s mental health. It shows the importance of LGBTQ+ specific stress factors, particularly of negative feelings about being a SMW, on the mental health of SMW IPV survivors. It highlights the necessity to evaluate the needs of SMW IPV survivors and, more broadly, of all sexual and gender minorities. This could allow clinical intervention to be more adapted to the needs of LGBTQ+ IPV victims and therefore help buffer against victimization they are faced by.