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Learn More. Substantial evidence exists about the negative role of internalized homonegativity on the health and well-being of lesbian women and gay men.

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Using data from an ethnically-diverse sample of non-gay identified behaviorally-bisexual men, we examined the factor structure, construct validity, and reliability of the NATSBI. The reliability was also strong within each of various demographic subgroups within the sample e.

These findings on the reliability and validity of the NATSBI suggest that it is possible to assess internalized homonegativity based on sexual behavior rather than assuming specific sexual identity labels.

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To this day, same-sex sexual behaviors are highly stigmatized because of pervasive homophobic and biphobic beliefs, attitudes, and institutions. These societal beliefs and attitudes are internalized by individuals who self-identify as non-heterosexual e. The detrimental effects of internalized homonegativity or binegativity on various mental and physical health outcomes have been well-documented, particularly lesbian and gay people, and to a lesser extent, bisexual individuals.

Among others, internalized homonegativity is associated with poorer mental health e.

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Moreover, the internalization of homonegative and binegative attitudes may impede the development of a healthy and positive sexual identity Firestein, ; Fox, This issue raises concerns about the measurement of internalized homonegativity and its validity when used in samples comprised of people other than gay men, such as bisexual men and other men who have sex with men MSM who do not identify as gay. However, most measures of internalized homonegativity assume the relevance of this construct only to people who self-identify as gay or lesbian, regardless of their sexual behavior.

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ly, only two valid and reliable scales have been developed that include a subscale assessing internalized homonegativity or binegativity among bisexual individuals. Despite the applicability of the LGBIS and BII to bisexual individuals, they both assume a bisexual self-identification which limits their applicability to non-bisexual identified individuals.

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They are also limited in their use with mixed sexual orientation samples e. The reliance on measures of internalized homonegativity or binegativity that assume a bisexual or gay identity is particularly problematic when studying subgroups of behaviorally bisexual men, some of whom may not identify as bisexual.

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Yet studies of this bisexual subgroup or studies of bisexuals that include this subgroup are hampered because existing measures that assume a gay or bisexual identification would be inappropriate for this subgroup of bisexuals. For these reasons, examining and developing valid and reliable measures for assessing internalized negative attitudes towards same-sex behavior among individuals who do not necessarily identify as gay or bisexual are warranted.

More generally, a large proportion of research especially health-related research has shifted its focus from the sexual identity of the person e. For example, in HIV-related studies, sexual behavior e.

Therefore, these studies may include participants who do not identify as gay or bisexual, but nonetheless, engage in same-sex sexual behavior. Likewise, studies focusing on non-gay-identified individuals e.

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This mismatch between the conceptualization and measurement of internalized homonegativity raises methodological concerns with regard to the construct validity of the measures DeVellis, Eligible men had to: 1 be 18 years of age or older; 2 not identify as gay; 3 report having had anal or oral sex with a man in the past year; 4 report having had vaginal, anal, or oral sex in the past year with a woman who at the time they were married to or had a relationship with e.

Sample characteristics are presented in Table 1.

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The study sought to examine a subgroup of behaviorally bisexual men who did not disclose their sexual orientation to female partners, as it was anticipated that such concealment would have negative implications for social support, internalized homonegativity, mental health, substance use, and sexual risk behaviors. Bisexual men in a relationship with a female partner are less likely than men who are not in a relationship to disclose their same-sex behavior to friends and family, as well as female partners Kalichman et al, ; Stokes et al.

Thus, the decision was made to focus on men who were in a relationship or had recently been in one with a woman and who had not disclosed to any of their female partners in the past year.

The Social Construction of Sexual Identity

No constraints were placed on the level of emotional commitment of this relationship; thus, men were included if they reported a regular sexual but not necessarily romantic relationship with a woman. Quota sampling was employed to obtain approximately equal s of African American, Latino, and White men, and as many Asian and Native American men as possible.

These venues included gay bars, cruising parks, bathhouses, porn video stores, LGB organizations, and community-based HIV organizations. For venue recruitment, an ethnically diverse team of male recruiters approached every man who entered a venue and handed them a card containing study information. Targeting all men in venue helped to eliminate recruiter bias and the perception that individuals were singled out for the study.

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For internet recruitment, study information was posted in several sections of Craigslist. Recruitment on various other websites was also attempted, but proved unsuccessful. Advertisements were also placed in a free, daily newspaper with a general readership distributed throughout New York City. Recruitment materials stated that we were looked to interview men who had sex with both men and women and whose female partners did not know about their sex with men.

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Where possible, we provided the study website address for more information and a telephone for participants to call to be screened for eligibility. Because Craigslist prohibits the posting of telephone s or web addresses, participants were asked to the researchers in order to obtain the telephone and website address. This resulted in a final sample of eligible men for analysis. Eligible men were invited to our research offices where they completed a ed informed consent and then a brief interviewer-administered questionnaire IAQ that elicited basic demographic data and information to confirm their study eligibility e.

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Next, men were asked to complete a set of quantitative measures administered via audio computer-assisted self-interviewing ACASI. Finally, men participated in a semi-structured qualitative interview. For the current report, all measures were assessed via ACASI, with the exception of the demographic and descriptive variables described below. Data collection lasted an average of 3.

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All procedures described above were approved by the institutional review boards of the participating universities. The NHAI is the first published internalized homonegativity measure, and is the most widely-used scale to measure the construct to this day. For the purposes of this study, we used only two subscales of the NHAI, namely the personal homonegativity and disclosure discomfort subscales. Given that both subscales have been found to be important predictors of health and well-being in LGB populations e.

The NHAI contains multiple theoretical domains and the item content taps into multiple possible aspects of internalized homonegativity including fear of disclosing to others, seeking help to change sexuality, and perceived ability to maintain a long-term relationship with a man Shidlo, Such diverse item content lends confidence that the NHAI captures various aspects of the construct.

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Further, the NHAI was later revised by Shidlo RNHAI; to update and further improve the content validity such that the measure would better capture societal changes in the public attitude toward homosexuality. As such, much of the item content assumes that the participant identifies as gay. In order to make the RNHAI appropriate for use with this non-gay identified sample, the RNHAI items were modified from assessing negative attitudes and discomfort toward their sexual identity e. A total of seven of the original fifteen items of the personal homonegativity subscale were excluded in this study for various reasons: three items were removed because they assessed suicidality e.

Thus, the resulting personal homonegativity subscale in this study included eight items from the original RNHAI.

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One item from the original personal homonegativity was further modified as it referenced engaging in counseling, rather than seeking help more broadly, and was found to have a somewhat low item-total correlation in the original RNHAI development study Shidlo, In order to better assess the full range of both positive and negative psychological states, the study employed the depressive symptoms 4 items; e. Respondents were asked to indicate how often they experienced any of the listed symptoms during the past thirty days using a six-point Likert scale ranging from 1 All of the time to 6 None of the time for most of the items.

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All items were reverse scored, then the mean score for each subscale was computed, such that higher scores indicated greater frequency of depressive symptoms, anxiety-related symptoms, and positive affect. Items were presented on a 4-point Likert scale ranging from 1 Strongly disagree to 4 Strongly agreeand 5 of the items were reverse-coded e. In order to measure emotional support regarding same-sex behavior, we modified the same five items by specifying this type of support. For analysis purposes, we defined disclosure as both direct disclosures e.

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Responses to both subscales ranged between 0—4 as a count, with higher scores reflecting disclosure of same-sex sexual behavior to a greater of friends and family. The original SCS comprised of 10 items that assess concealment in general, and it was found to be valid and reliable for use with bisexual and gay men Potoczniak et al. A factor analysis conducted as part of a study with this sample Schrimshaw et al. The remaining 3 items e. Descriptive statistics were computed for all variables.

INTRODUCTION

All analyses were performed on the full sample of eligible cases using casewise deletion unless otherwise noted. PAF analysis was used to reveal the latent constructs that for the shared variance among the scale items.

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Factors with eigenvalues exceeding 1. The of factors were further confirming by analyzing the corresponding scree plot. After removing one item due to low factor loadings, we conducted another PAF analysis using the remaining 16 modified items, and following the same procedures described above. Item-total correlations were performed to examine whether any of the final 16 items is inconsistent with the average of the other items.

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To assess the construct i. Specifically, the first factor had an eigenvalue of 6. The scree plot was simultaneously analyzed to confirm the retention of three factors. Items with factor loadings greater than.

Eight items loaded on one factor, reflecting the personal homonegativity subscale, 5 items loaded on the second factor, reflecting the disclosure discomfort of the original RNHAI, and 3 items loaded on a third factor, reflecting the new privacy preference subscale. No items were found to double load based on the criteria of a secondary loading greater than. However, one item had low factor loadings on both the second.

The remaining 16 modified items were subjected to a second PAF. All three factors had an eigenvalue exceeding 1. The scree plot was also examined to confirm the retention of three factors.

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Eight items loaded on the first factor, reflecting the personal homonegativity subscale, five items loaded on the second factor, reflecting the disclosure discomfort of the original RNHAI, and three items loaded on the third factor, the privacy preference subscale.

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