Thesis (Ph.D. in Educational Leadership) -- University of Dayton. / Title from PDF t.p. (viewed 10/06/09). Advisor: Carolyn Ridenour. Includes bibliographical references (p. 184-200).

Mortality related to smoking continues to be one of the foremost preventable public health issues. Smoking amongst sexual minorities (those who have a sexual attraction to or sexual contact with people of the same sex and/or of both sexes or a sexual identity of gay/lesbian or bisexual) remains significantly greater than the general population and those with only opposite sex attractions or sexual contacts. While smoking prevalence has dropped since the late 1990's in the general population, smoking among sexual minorities remains disproportionately greater than heterosexuals. Methods: A secondary data analysis was completed using two United States data sets: the 2013 Youth Risk Behavior Survey (YRBS) and the first wave of the National Longitudinal Study of Adolescent to Adult Health (Add Health) dataset collected in 1994. The analyses focused on high school students, grades 9-12. The purpose was two-fold. First, the goal was to develop a profile of smoking indicators in sexual minority youth in the 1994 Add Health dataset and in the 2013 YRBS dataset. Profiles include six smoking-related indicators: 1) ever smoked; 2) age of first cigarette smoked; 3) current smoking; 4) frequent smoking; 5) daily smoking; and 6) attempts to quit smoking. Second, the goal was to compare sexual minority youth to their heterosexual peers within each data set to identify the scope of any disparities in smoking behaviors. Results: Disparities in smoking behaviors were found in both comparisons between the heterosexual and sexual minority youth. Prevalence of all smoking behaviors was greater for sexual minority youth in both data sets. The smoking disparities were greater in the sexual minority youth in the 2013 YRBS sample. Between the 1994 Add Health and 2013 YRBS samples, smoking behaviors in sexual minority youth showed a decrease in all smoking behaviors, but not as significant as their heterosexual peers. Youth who are attracted to both sexes or identify as bisexual consistently have a greater prevalence in smoking behaviors.Conclusion: A growing disparity exists between sexual minority youth and their heterosexual peers related to smoking behaviors. Public health policy and programming needs to focus on earlier prevention efforts related to psycho-sexual development with targeted policy and curriculum around the adoption of negative health behaviors in sexual minority youth, especially those who have both sex attractions, have sexual contact with both sexes or identify as bisexual.

This study examines differences in well-being between sexual minority and heterosexual college students and identifies factors associated with well-being among sexual minority college students. A secondary analysis of cross-sectional web-based survey data was conducted. Using propensity score matching, 43 sexual minority students were matched to 43 heterosexual students on age, race, sex, and year in school. Sexual minorities had significantly lower well-being scores compared to heterosexual college students. Among sexual minorities, physical activity, depression, thoughts of suicide, and sleep quality were all predictive of well-being. Understanding issues related to well-being among sexual minorities is important and strategies need to be developed to improve well-being.

Sexual minorities face unique stressors that contribute to worse mental health (Meyer, 2003). Positive psychology interventions may be able to ameliorate this. The current study pilot tested an identityspecific positive psychology intervention among 20 sexual minorities. Results suggest that the intervention reduced depressive symptoms, anxiety symptoms, and anticipated discrimination on the basis of sexual orientation. This implies that positive psychology interventions may be able to address health disparities among sexual minorities.

Individuals who identify themselves as sexual or gender minorities report experienced and anticipated stigma known as minority stress. This stigma or stress has been consistently linked with worse mental health outcomes (e.g., depression, anxiety) compared with non-stigmatized (heterosexual, cisgender) individuals. However, little is understood about sexual minorities who also identify as gender minorities. This “doubly stigmatized” subgroup of the population may be transgender or gender-nonconforming or non-binary while simultaneously holding a non-heterosexual identity. This study sought to explore whether stigma and minority stress processes were different between individuals who identified as sexual minority/ gender majority (n=148) versus sexual and gender minority (n=167). Results revealed that individuals who were both sexual and gender minorities reported significantly more depressive and anxiety symptoms, greater minority stress, and fewer support resources. Moreover, increased minority stress (anticipated discrimination) and fewer support resources explained the disparity in mental health (bootstrapped indirect effects = -.4111 se=.1720 95%CI=-.8675, -.1634) between sexual and gender SATURDAY PROGRAM • JUNE 22, 2019 103 minority versus sexual minority/gender majority participants. Community connection was further examined as a potential moderating resource. Findings are discussed in relation to multiple stigmatized identities, the intersections of sexuality and gender identity, and the need for both future research and support resources for this population.

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Gay men living with HIV (MLWH) are often adversely affected by stigma related to both their serostatus and their sexual orientation, and the experience of living with HIV appears to increase feelings of internalized homophobia (IH). Little research attention has focused, however, on factors that may buffer the impact of HIV-stigma and IH on well-being among men living with HIV. Self-compassion, which consists of self-kindness, common humanity, and mindfulness, has been associated with resilience against the negative effects of stigma on well-being. We hypothesized that HIV-stigma would be indirectly related to poorer psychological well-being through increased levels of IH. Moreover, we expected that self-compassion would attenuate the negative effects of HIV-stigma on well-being through IH. Our sample consisted of 90 ethnically diverse gay MLWH. Participants completed an online questionnaire that assessed levels of HIV-stigma, IH, self-compassion, depression, anxiety, and positive and negative affect. After controlling for a variety of sociodemographic, health, and social characteristics, results revealed that more HIV-stigma was indirectly related to more depressive symptoms and anxiety through higher IH. Moreover, self-compassion emerged as a moderator of the indirect association of HIV-stigma on higher negative affect through higher IH, such that this indirect effect was significant for those with low self-compassion, but not for those with high self-compassion. Compassion-focused practices should be explored as a means of increasing resilience among gay MLWH.

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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.