Multifactorial discrimination, discrimination salience, and prevalent experiences of internalized homophobia in middle-aged and older MSM

Objectives: We sought to test whether discrimination salience and multifactorial discrimination were associated with prevalent experiences of internalized homophobia among middle-aged and older men who have sex with men (MSM). Methods: We analyzed data from 498 middle-aged and older MSM from the Multicenter AIDS Cohort Study (MACS) who reported any lifetime discrimination experience. We estimated the prevalence ratio of current internalized homophobia using multivariable Poisson regressions, accounting for discrimination salience, multifactorial discrimination, and covariates. We then assessed whether multifactorial discrimination moderated the association between discrimination salience and internalized homophobia. Results: Over half (56.4%) of our sample reported any current experience of internalized homophobia. More than two-thirds reported multifactorial discrimination (68.2%) and more than one-third (36.7%) reported moderate-to-high discrimination salience. Increases in discrimination salience (PR = 1.11; 95% CI: 1.03-1.20) were associated with any current internalized homophobia among middle-aged and older MSM. Multifactorial discrimination was not statistically associated with internalized homophobia and did not moderate the association between discrimination salience and internalized homophobia. Conclusions: Our study underscores internalized homophobia as a persisting concern among MSM in midlife and older adulthood. Our findings suggest that salience, as a characteristic of discrimination experiences, may have a greater impact on internalized homophobia compared with exposure. Future research efforts should assess facets of discrimination salience, such as severity, frequency, and chronicity, to better understand how discrimination shapes psychosocial well-being across the life course. Mental health advocates at policy, organizational, and community levels should aim to reduce intersectional stigma and address individual experiences of internalized homophobia

Childhood food insecurity, mental distress in young adulthood and the supplemental nutrition assistance program.

Food insecurity affects 14% of US homes with children and has been associated with increased mental health problems. Few studies have examined long-term consequences for mental health and the role of social policies. This study examined the association between childhood household food insecurity (HHFI) and young adult psychological distress, and the moderating role of caregiver psychological distress and the Supplemental Nutrition Assistance Program (SNAP) using data from the Panel Study of Income Dynamics (1995-2015). The sample comprised 2782 children ages 0-12 years in 1997. Past-year HHFI was measured using the USDA 18-item questionnaire in 1997, 1999, 2001 and 2003. Young adults' non-specific psychological distress was measured with the Kessler (K6) scale in 2005, 2007, 2009, 2011, 2013 and 2015. Three trajectories of food insecurity were identified: 1) Persistent food security (70.5%); 2) Intermediate/fluctuating food insecurity (24.6%), and; 3) Persistent food insecurity (4.9%). Compared to persistent food security, fluctuating and persistent food insecurity were associated with significantly higher levels of psychological distress. This association was robust to adjusting for socio-demographic factors, caregiver psychological distress, and family access to governmental supports: [Adj. ORs (95% CI's = 1.72 (1.59-1.85) and 2.06 (1.81-2.33)]. Having a caregiver who suffered from psychological distress (1997 and/or 2002) and growing up with persistent food insecurity placed children at greater risk for mental health problems. Access to SNAP attenuated this risk. Early HHFI is associated with psychological distress in young adulthood. Interventions to increase access to SNAP and address caregivers mental health may prevent mental health problems associated with childhood HHFI