Prior research describes significantly worse health outcomes experienced by lesbian, gay, bisexual, and transgender (LGBT) people relative to their heterosexual and cisgender counterparts. A prevalent research focus on urban LGBT populations has created a gap in understanding rural LGBT health care and outcomes from a holistic perspective. The present article provides a literature review focusing on the health and health care experiences of LGBT people living in rural areas and highlighting challenges and opportunities for growth in providing culturally competent rural health care. We conducted a systematic review that resulted in the inclusion of 58 articles focused on the health of rural LGBTQ people published between 1998 and February 2016. Findings clustered around 3 themes: (1) individual health outcomes and risk behaviors, (2) experiences of health care and interactions with the health care system, and (3) sociocultural factors at the intersection of rurality and health. Evidence-based recommendations for systemic change and interventions to promote health among rural LGBT people are provided.

Religion and spirituality are positive resources in the lives of many individuals (Pargament, Mahoney, Shafranske, Exline, & Jones, 2013). Although much of the existing research on the intersection of religious/spiritual and lesbian, gay, bisexual, transgender, and/or queer (LGBTQ) identities has focused on conflicts in these identities (Fontenot, 2013), a growing number of studies suggests that religious/spiritual LGBTQ people experience positive aspects similar to those emphasized in the general literature. We sought to extend previous findings by asking LGBTQ participants (N ϭ 314) to describe the positive aspects of identifying as both religious/spiritual and LGBTQ. Qualitative analysis revealed that the positive aspects were characterized by 5 themes: (a) Love and Acceptance for one's LGBTQ identity; (b) Deeper Meaning and Purpose due to having an LGBTQ perspective; (c) Empathy, Openness, and Compassionate Action rooted in LGBTQ identity and a passion to actively live religious/ spiritual values; (d) Positive Relationships with families, partners, and communities based in a shared religious/spiritual identity and authentic expression of LGBTQ identity; and (e) Spiritual Strength for coming out and coping with sexual or gender identity stigma and prejudice. Participants' responses suggest that religious/spiritual and LGBTQ identities interact in ways that synergistically enhance each other and may provide an important source of strength and support that can be mobilized in clinical practice.

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Research on heterosexual allies has focused on heterosexual identity development models and pathways to ally activism. The positive aspects or positive experiences of identifying as an ally to lesbian, gay, bisexual, and transgender (LGBT) identified individuals and communities have received little attention. Using an online survey of participants recruited from LGBT ally related social media, we collected open-ended responses to a question about the positive aspects of self-identifying as a heterosexual ally. A final analytic sample of 292 self-identified male and female heterosexual adults (age 18-71, M = 33.47, SD = 13.32) provided responses that generated 8 themes. Positive aspects of being a heterosexual ally were: (a) increased knowledge and awareness, (b) upholding values of justice, (c) beneficial individual relationships, (d) community belonging, (e) educating others, (f) being a role model, (g) using social privilege, and (h) speaking out and taking a stand. The findings suggest that being a heterosexual ally is rewarding and may enhance individual well-being. These findings provide information that may contribute to effective ally development efforts.

The Sexual Desire Inventory (SDI; Spector, Carey, & Steinberg, 1996) is one of the most popular scales used to measure dyadic and solitary sexual desire. Research on sexual desire has primarily focused on heterosexual cisgender experiences, and the SDI has not been validated in lesbian, gay, bisexual, trans, or queer (LGBTQ) populations. To address the dearth of research using the SDI on LGBTQ populations, the primary aim of this study was to examine the internal structure of the SDI by examining and comparing the fit of the original 2-factor structure suggested by Spector et al. (1996) with a 3-factor structure found by Moyano, Vallejo-Medina, & Sierra, (2017) in a sample of LGBTQ adults. The secondary aim of this study was to provide convergent evidence of validity for SDI scores. Findings provide evidence for a 3-factor structure solution of the SDI: (1) dyadic sexual desire for partner, (2) solitary sexual desire, and (3) dyadic sexual desire for attractive other. These findings are consistent with the structure reported by Moyano and colleagues (2017). Convergent validity with the SDI and the Hurlbert Index of Sexual Desire (Apt & Hurlbert, 1992) and Global Measure of Sexual Satisfaction (Lawrance & Byers, 1995) was also established. Results provide new information on the appropriateness of a 3-factor structure for using the SDI in an adult LGBTQ sample. The need for additional research on the SDI is discussed. Public Significance StatementSexual desire is significantly related to sexual satisfaction and overall well-being yet has been seldom studied in the LGBTQ population. The validation of the Sexual Desire Inventory in the LGBTQ population is important for future research to have psychometric strength in examining sexual desire in sexually diverse samples.

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Parental reactions to a child's lesbian, gay, bisexual, or transgender (LGBT) identity are impacted by a process of cognitive-affective experiences and behavioral responses that are influenced by contextual factors that may include parents' religious value system. The purpose of this study was to test a theoretically based model of parental acceptance that included cognitive-affective factors (cognitive flexibility, emotional regulation), religious-value based factors (religious fundamentalism, parental sanctification), and demographic characteristics (parent gender, parent sexual identity, child gender, and years out). Participants were 663 parents of LGBT children who submitted responses to an online survey. A Tobit regression analysis with a singleindicator latent variable approach revealed that higher levels of the control component of cognitive flexibility, lower religious fundamentalism, higher parental sanctification, parent gender (female), and parent sexual identity (nonheterosexual) were significantly associated with higher levels of parental acceptance. Findings suggest that attending to these factors in future research and clinical practice may be important to the health and well-being of families that include LGBT children. Public Significance StatementReligious values may play a complex role in the parental acceptance process. Religious fundamentalism may interfere with parental acceptance of lesbian, gay, bisexual, or transgender (LGBT) children, while in other religious contexts parental sanctification may facilitate parental acceptance.

Bisexuality researchers have explored various aspects of bisexual (“bi”) commitment, including how bi-identified individuals negotiate nonmonogamous relationships, relationship stability in couples with 1 bi-identified and 1 straight-identified partner, and patterns of commitment across the life cycle. However, no research to date has quantitatively explored bi-identified individuals’ attitudes toward monogamy itself. As part of an online survey exploring attitudes toward monogamy in a sample of 5,988 adults, the current study examined a subsample of 293 bi-identified persons’ attitudes toward monogamy. All participants completed the Monogamy Attitudes Scale to assess attitudes toward monogamy as enhancing or sacrificing, in addition to questions regarding the sources surrounding participants’ attitudes toward monogamy. Two 2 (Male/Female) × 4 (Gay/Straight/Bi/Questioning) ANOVA results indicated a significant difference based on sexual identity for attitudes toward monogamy as enhancing, F(5) = 103.38, p < .001, and as a sacrifice, F(5) = 62.48, p < .001. Bi individuals viewed monogamy as less enhancing than gay, lesbian, and straight individuals, and similar to uncertain or questioning individuals. Bi individuals viewed monogamy as more of a sacrifice than gay, lesbian, and straight individuals, and similar to uncertain or questioning individuals. Bi-identified men viewed monogamy as more of a sacrifice than bi-identified women, F(5) = 22.09, p < .001. Findings on the sources regarding monogamy are also discussed. Overall, bi individuals expressed less supportive attitudes toward monogamy compared to other sexual identity groups despite reporting their own personal relationships as monogamous and traditional. Implications of these findings in clinical, educational, and advocacy settings are discussed.