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Objective: To explore experiences, beliefs, and information-seeking behavior around COVID-19 among college students in Oklahoma. Participants: Fifteen college students participated during the pandemic period from April to July 2020. Methods: An exploratory, qualitative research approach method was used to discover students' experiences, beliefs, and information-seeking behaviors around COVID-19. Exploration of beliefs was guided by the Health Belief Model. Results: Students engaged in COVID-19 information-seeking behaviors predominantly through Internet sites, broadcast news, health professionals, and governmental sources. Students experienced emotional burden as a result of COVID-19 misinformation in these sources. While most students perceived a low chance of acquiring the virus due to their lack of underlying medical conditions, they were still concerned about the consequences of becoming infected. Students noted the difficulty of physical distancing while on campus. Conclusions: Colleges/universities should maximize the dissemination of timely, valid health information for the safety of their students and the broader community. [ABSTRACT FROM AUTHOR]

Because most parent-adolescent sex communication studies are from the perspectives of sexual and gender minority (SGM) adolescents rather than their parents, we surveyed 54 parents of SGM adolescents in the Southern region in the U.S. about their HIV-related parent-adolescent sex communication (PASC) practices. We compared topics discussed between the sexual activity and sexual orientation/gender identity of their adolescent. We found significant differences between parents having a sexually-active adolescent or not and parents discussing the importance of using condoms and what their adolescent should do if the adolescent contracts HIV. We provide future directions to further examine and improve PASC between parents and their SGM adolescents. [ABSTRACT FROM AUTHOR]

HIV service providers are the primary implementers of HIV care services, but rural HIV service providers are under researched. We used an interpretative phenomenological analysis to explore rural HIV service providers' lived experiences of working in HIV care, who work in a rural region of a Midwestern state in the United States. From July to August 2019, 15 HIV service providers participated in a one-hour semi-structured telephone interview that elicited their experiences working in the rural HIV care continuum. Participants were tired of constantly educating and working to reduce HIV stigma; however, they received support from family and friends once they educated them about HIV. Participants felt they lacked control over systems and they developed emotional-based coping to address constant occupational stressors. Findings highlight the importance of resiliency and advocacy research and practice across ecological levels. [ABSTRACT FROM AUTHOR]

Sexual minority men have consistently shown to be at-risk for adverse mental health outcomes due to minority stress, yet studies show some men successfully navigate these barriers. What is less known are the environmental and social/emotional factors to which minority stress is amplified (or attenuated). We comparatively investigate rural versus urban sexual minority men and how levels of 'outness' (the degree to which an individual discloses their sexual identity to others around them) interacts with gay-related rejection anxieties (a specific type of minority stress). Results broadly show that 1. higher levels of gay-related rejection are statistically associated with higher levels of loneliness, and 2. outness moderated this link in rural, but not urban men. In other words, higher levels of outness amplified the deleterious effects of gay-related rejection in the rural sample only. Although previous research shows mixed results in regards to how coming out affects the mental health of sexual minority men, our stratified results show that rural men may be at a higher risk for deleterious mental health with higher levels of outness. Implications from this study bolster the mental health field, particular mental health practitioners working with rural sexual minority men and the aftermath of coming out. [ABSTRACT FROM AUTHOR]

Adverse Childhood Experiences (ACEs) show predictive utility concerning binge drinking. However, the literature is limited by 1. a focus on cumulative ACEs with little regard to specific domains, 2. a focus on those with the highest ACE scores, and 3. little consideration for gender differences. These approaches are problematic as ACE categories are fundamentally different, yet little distinction is given to specific ACE domains. The current study investigates which individual and dual ACE domain combinations are associated with binge drinking. Data were obtained from the Behavioral Risk Factor Surveillance System (2011-2017; N = 80,391). A series of ANCOVAs were conducted to determine the association between single and dual combination ACE domains and binge drinking. Results show gendered effects of ACEs on binge drinking such that at 0, 1, and 2 ACEs, males reported statistically higher rates. For males with exactly two ACEs, combinations of either sexual abuse or family incarceration presented the highest levels of binge drinking- with the highest mean binge drinking score being the exact combination of the two. This contrasts with males with 1 ACE, where experiencing family incarceration or sexual abuse, as a single domain, did not represent significant risk above the average of having a single ACE. Results suggest that males may be resilient to either of these domains as singular events, yet when found in combination, may present a synergistic effect that increases the likelihood of binge drinking. Due to lower overall binge drinking rates, no significant patterns were found among females. [ABSTRACT FROM AUTHOR]

This community-based study explored the lived experiences of being in and going through the rural HIV care continuum among 15 gay and bisexual men (GBM) with HIV who live in a rural area of a Midwestern state. Our analysis adapted a six-step interpretative phenomenological analysis. Five themes emerged that reflected the five continuum stages: 1) Diagnosis means death, 2) Linkage to care means uncertainty, 3) HIV care improves the quality of life lost pre- or peri-diagnosis, 4) ART implies life, and 5) Undetectable addresses the medical but not social aspects of HIV. Participants recalled they faced and continue to face social determinants, stigma, and chronic and mental health conditions. Findings provide future research directions and practical implications to address social determinants of health, promote chronic and mental health, and reduce interpersonal stigma throughout all HIV care continuum stages. [ABSTRACT FROM AUTHOR]

Pre-exposure prophylaxis (PrEP) efficacy in preventing HIV among gay, bisexual, and other men who have sex with men (MSM) is dependent upon adherence. Little is known about the PrEP adherence experiences among MSM who live in rural areas of the US. This qualitative study was informed by a modified version of Straussian Grounded Theory. Thirty-four 34 rural Midwestern MSM participated in telephone interviews that assessed their PrEP adherence factors. Overall, participants adhered to the PrEP regimen, ranging from missing none to a couple of doses per month. Participants had high self-efficacy (competence) and self-reliance (autonomy) in taking PrEP daily. Participants incorporated PrEP into their already existing routines. Participants were motivated to adhere to prevent HIV acquisition and be financially responsible. All participants mentioned their PrEP provider discussed the importance of adherence with PrEP's effectiveness, but future patient-provider PrEP adherence communication varied among participants. Future PrEP adherence interventions should address counseling strategies that leverage these constructs to support pill taking. Future research should explore patient-provider conversations surrounding PrEP adherence to inform provider- and patient-level interventions. [ABSTRACT FROM AUTHOR]

The current study sought to explore the motivations adults have for engaging in sexting behaviours with their relationship partners. Previous research mainly focuses on emerging adult and adolescent populations. With estimates of adults engaging in sexting approaching 50%, the current study used a qualitative approach to analyse responses from participants about their motivations to sext their relationship partners. With 157 (79 male) valid responses, the majority (86) of respondents identified sex related reasons for engaging in sexting. However, a sizeable minority (50) identified a non-sex related reason of physical distance from their partner(s) as a motivation to sext. This unique finding highlights the benefit that individuals who are physically separated from their partners gain by engaging in sexting. Participants in the current study shared aspects of engaging in sexting that were similar to other motivations found in previous research on sexting, but they framed these within the construct of being physically separated from their relationship partner(s). The results imply that distance may be an underlying motivation for some adults who engage in sexting behaviours with their partner(s). [ABSTRACT FROM AUTHOR]

Previous models of sexual minority orientation identity development have theorized disclosure of current orientation as important in accepting one's sexual minority identity. Furthermore, research into disclosure of sexual orientation highlights positive outcomes for disclosure and negative outcomes for concealment of sexual minority identity. These models, however, fail to incorporate the socio-cultural context of the individual. Using a grounded theory approach, we conducted 40 interviews with individuals who identified with a sexual minority identity living in rural areas in Oklahoma, a primarily socio-politically conservative state in the U.S. Data collection continued until thematic saturation was reached. Three main themes were identified by participants in regards to navigating disclosure of sexual orientation: (1) assessment of consequences to disclosure; (2) situational disclosure of sexual orientation; and (3) disclosure of current sexual orientation. Rural sexual minority men navigate disclosing their sexual orientation by considering the socio-cultural environment where they live and the acceptance and/or rejection of important individuals in their lives. This consideration demonstrates the importance of considering disclosure as a step in sexual minority identity development, not actual disclosure of sexual minority identity. A preliminary model of navigating disclosure is proposed and implications are discussed. [ABSTRACT FROM AUTHOR]

Given the dearth of research exploring mental health differences between rural and urban men who have sex with men (MSM), we sought to examine differences in depressive symptomology and loneliness. Concurrently we examined the mediating effects of loneliness on the link between geographic locale and depressive symptoms via a mediation model. Data were collected from 156 MSM in Oklahoma. Results show urban MSM have significantly higher levels of both depressive symptomology and loneliness. Mediation analyses revealed that the link between urban/rural locale and depressive symptomology was mediated by loneliness. In other words, identifying as urban MSM may result in higher levels of depressive symptomology through feelings of loneliness. The rationale for this includes the possibility that rural MSM may have strong online social support 'networks' which act as a protective factor against loneliness and depressive symptomology, or that elements of urban environments increase stress in urban MSM. It is also possible that the urban landscape of Oklahoma does not provide the same level of acceptance as other urban areas in more liberal parts of the country. Interventions at the individual or community level should consider geographic location as a mesosystem factor that impacts the mental health of MSM. [ABSTRACT FROM AUTHOR]

Background: One well documented reason that individuals use alcohol and drugs is the belief that these substances will increase satisfaction of a sexual experience or somehow otherwise enhance the sexual experience. However, the unique experiences of MSM residing in rural areas are not well represented in the scientific literature. Methods: We conducted 40 interviews with individuals who identified as a man who has sex with men and lived in rural areas in Oklahoma, a primarily rural and socio-politically conservative state in the United States. Data collection continued until thematic saturation was reached. Results: Three main substances (and themes) were identified by participants: 1) marijuana (focus on the experience/person), alcohol (more open/playful and reduces anxiety), and methamphetamines (stamina and arousal). Conclusions: While the themes for alcohol and methamphetamines were in line with previous research, this is one of the first studies to identify the sex expectancies of marijuana of increasing the ability to focus on the sexual experience and/or the partner. Taken together, participants endorsed some type of positive substance use sex expectancies. These results highlight the importance of accounting for substance use sex expectancies when developing interventions to reduce substance use and risky sexual behaviors. [ABSTRACT FROM AUTHOR]

Little is known about motivations of adults who sext their relationship partners. Participants (N = 126, 71 male) completed an online questionnaire to assess their motivations for sexting their current relationship partner(s). The results of a MANOVA indicated the overwhelming motivation was to initiate sexual behaviors for all groups. Other motivations of instrumental/aggressive reasons were significantly higher for heterosexual men, and body image reinforcement was significantly higher for sexual-minority men. With results indicating the main motivation to sext was to initiate sexual behaviors, the potential of using sexting as an intervention to increase sexual intimacy in relationships is discussed. [ABSTRACT FROM AUTHOR]

Rural men who have sex with men (MSM) are particularly vulnerable to HIV/STI infections, though most outreach efforts to reach MSM have been focused on urban populations. More attention is needed to study effective ways of reaching/recruiting rural MSM, yet little is known about their preferences; particularly as studies show significant differences in the behaviors and perceptions of rural versus urban MSM. Our study uses a qualitative instrument to gauge what outreach methods are most effective from the perspective of 40, rural MSM. Outreach facilitators included online marketing, emphasizing rural areas, while outreach barriers included traditional forms of print media/advertising, or anything that may jeopardize anonymity. Implications for future outreach in rural areas and limitations are also discussed. [ABSTRACT FROM AUTHOR]

Higher levels of loneliness in men who have sex with men (MSM) are associated with negative outcomes such as depression, anxiety, and sexual impulsivity. By identifying what may reduce loneliness in MSM, counselors and public health professionals can alleviate the distress of their clients. A significant hierarchical multiple regression controlling for relationship status, F(9, 105) = 16.36, p < 0.001, R2 =.62, indicated that higher levels of self-forgiveness (β = −.19, p = .04) and perceived social support (β = −.49, p < .001) predicted lower levels of loneliness in MSM. Implications and limitations are discussed. [ABSTRACT FROM AUTHOR]

The information shared in schools on sex education in the USA is highly variable depending on the state and sometimes city in which a student lives. Gay and bisexual students living in a socially conservative, primarily rural state such as Oklahoma often receive little information about sexual health information that pertains to their behaviours unless it is discussing the dangers of sex. Using a qualitative approach, 20 gay and bisexual men currently residing in Oklahoma completed semi-structured interviews about their experiences with sex education and alternate ways to compensate for lack of information provided. Participants noted an awareness of the lack of meaningful sex education or if it was offered, a primary focus on abstinence-only until marriage heteronormative curricula. Participants described various ways they compensated for lack of sex education including accessing pornography and information from the internet. With the current socio-political environment of Oklahoma, it is unlikely wholesale changes to the sex education curricula can be made. The importance of public health professionals using the internet and peer educators to deliver inclusive and informative sexual health information remains salient and viable for men who reside in socio-politically conservative areas like Oklahoma. [ABSTRACT FROM PUBLISHER]

Purpose:This study aimed to determine what predicts a man who identifies as MSM living in a conservative state to inform his provider of his sexual behaviors and/or his sexual orientation.Methods:We administered an anonymous online survey to 148 men who reported seeing a general medical provider in the last 12 months. All participants resided in Oklahoma.Results:When controlling for HIV status, previous STI diagnosis, and age, logistic regression modeling yielded significant results (x2(9) = 31.22,p<.001) predicting 70.3% of cases. Age and overall disclosure of sexual orientation and/or sexual behaviors were significant predictors.Conclusion:Individuals who did not disclose their sexual orientation or same-sex behaviors to friends and family members were less likely to inform their providers of their sexual orientation. Disclosure of MSM status provides additional opportunities to enhance primary and secondary prevention strategies in rural and conservative areas that are necessary to optimize health, including but not limited to HIV screening and discussion of pre-exposure prophylaxis that their counterparts in urban settings more readily receive. [ABSTRACT FROM PUBLISHER]

Since few researchers have analyzed sexting behaviors in nonuniversity-based adult samples, we sought to determine if sexting is associated with negative psychological correlates and risky sexual behaviors in this population. Analysis of individuals who indicated having vaginal or anal sex in the past 12 months and who identified as single (n = 377) showed that condomless sex is independent of sexting behaviors. Results for those in committed relationships (n = 374) and having had vaginal or anal sex in the past 12 months also demonstrated condomless sex and sexting behaviors were not related. Furthermore, alcohol consumption and relational health were predictive of sexting behaviors in adults in committed relationships. These findings demonstrate that while risky sexual behavior and negative psychological correlates are associated with sexting and younger populations, the same might not be true for a nonuniversity-based, older adult sample. [ABSTRACT FROM AUTHOR]

Previous research on sexual practices and commitment to monogamy of individuals has primarily been conducted on populations who endorse traditional sexual orientation labels of heterosexual, bisexual, and homosexual. Recent studies, however, demonstrate 16% of men and 37% women demonstrate some form of non-heterosexual attraction, behaviour, or fantasy although they endorse a heterosexual orientation status. The present study explored the impact of attitudes towards monogamy and casual sex for individuals who endorse non-heterosexual impulses but a heterosexual sexual orientation. A sample of 1,614 heterosexual men and women completed a voluntary questionnaire about sexual orientation, attraction, behaviours, and their attitudes towards casual sex and monogamy. Results revealed individuals who reported non-heterosexual sexual impulses endorsed increased acceptance of non-monogamous behaviour and increased acceptance of casual sex. Findings demonstrate the importance of providing education to clients about sexual orientation development, as well as ensuring that mental health providers and researchers alike do not force traditional labels of sexual orientation onto individuals. Furthermore, results indicate counsellors should establish a framework to engage couples and individuals in discussing their desires for casual sex and non-monogamy in an environment which is both accepting and understanding of that person’s experience. [ABSTRACT FROM AUTHOR]

Given that few researchers have addressed sexting among adult samples, we sought to evaluate the prevalence of adults who sext, their sexting behaviors, and how it impacted relationship satisfaction. Analyses on the sample (N = 1171) revealed that heterosexual women are negatively impacted if they do not reciprocate a sext message; yet nonheterosexual women, and men in general, are not negatively impacted. This finding can be best understood within the framework of relational cultural theory (RCT). Implications for future research and for the practice of mental health providers are discussed. [ABSTRACT FROM AUTHOR]

Extant research on quality of life in gay, bisexual, and other men who have sex with men (MSM) primarily capture the social milieu and psychosocial outcomes of those living in urban rather than rural settings. Much of this can be attributed to the high demand for services in areas with greater concentrations of sexual minorities. As MSM in rural communities are both underrepresented in research and susceptible to social estrangement from each other, our study assessed the impacts of several aspects of their social milieu—recency of access to community resources for gay/bisexual men and time socializing with other gay/bisexual men—on loneliness, as well as the mediating role of perceived connectedness to the local gay/bisexual community on this association. Using purposive sampling and Internet-based direct marketing, we recruited 225 MSM aged 18 or older in rural and mixed rural areas in south-central Indiana. We performed a path analysis to test our hypothesized model. Recency of access to community resources was positively associated with perceived connectedness to the gay/bisexual community, which in turn was protective against loneliness. Findings indicate that improving accessibility to venues or activities for rural MSM could serve to facilitate community-building and benefit their psychosocial well-being. [ABSTRACT FROM PUBLISHER]

Although research on childhood gender nonconformity (CGN) has shown to be the only consistently correlated measure with adult self-identification of sexual orientation for men and women, little research has focused on other dimensions of sexual orientation are also correlated with CGN. In an online survey of adults (N = 2,372), information on participants’ self-identified sexual orientations, sexual attractions, sexual behaviors, and sexual fantasies correlated with recalled CGN. The only significant predictor that an adult would recall CGN behaviors was sexual attraction. Implications of the findings as well as limitations to the current study are discussed. [ABSTRACT FROM PUBLISHER]

Most previous studies of the sexual behaviour of gay, bisexual and other men who have sex with men living with HIV are based on samples of men recruited within relatively urban and suburban areas of the USA. The aim of the present study was to explore the potential challenges associated with HIV-related stigma and residing in a relatively rural area. We conducted a qualitative study based in south-central Indiana, a relatively rural area of the USA. Twenty-three HIV-positive gay, bisexual and other men who have sex with men, aged 21–48 years, were interviewed on topics regarding community engagement, perceived HIV-related stigma, relationship formation, sexual behaviour and HIV status disclosure. Findings indicate HIV-related stigma is commonly reported at the interpersonal and community levels. Because of this, men face complex situations on how and when to disclose their HIV status to members of their social and sexual networks. Although many participants reported many challenges associated with relationship formation, all expressed a desire for romantic and/or sexual connections with other men and/or women. Results suggest that new programmatic approaches are necessary to inform the work of social service and medical providers on mechanisms to intervene and combat stigma and discrimination inherent in communities, programmes and policies. [ABSTRACT FROM PUBLISHER]

In this study we used grounded theory methodology to understand the influence of loneliness in YMSM in terms of HIV risk behavior. Twenty-two YMSM, 18–29 years of age, of HIV-negative/unknown status were interviewed. Results indicated that loneliness is defined in two ways: emotional and social. A cyclical pattern emerged that included negative symptoms, “self-treatment” of loneliness through drug use and sex, temporary relief, remorse related to engaging in HIV risk behaviors, negative self-image, and ultimately the reemergence of initial loneliness symptoms. Results suggest that loneliness in YMSM plays a greater role in HIV-related behavior than previously understood. A preliminary explanatory model, implications, and directions for future research are discussed. [ABSTRACT FROM PUBLISHER]

An introduction is presented in which the editor discusses healthcare facilities, social work and counseling available for the lesbian, Gay, Bisexual, Transgender (LGBTQ) community.