Exploring Comfort with Gender Identity and Sexual Orientation Expression: A Cross-Sectional Pilot Study in a Region of the US Deep South

Abstract Introduction Individuals identifying as sexual and gender minority (SGM) experience stressors that contribute to minority stress. Identity concealment is a proximal stressor that can impact comfort with minority identity expression. This cross-sectional study examined differences in comfort with expression of gender identity and sexual orientation among adults in a region of the Southern US as an indirect measure of identity concealment. Methods Survey data on demographics, identity expression comfort, and LGBTQ + stress were collected from Alabama residents 18 years + from June 2022-May 2024. Two hundred twenty-two adults completed the survey, 75 (34%) identified as gender minority (GM), 172 (77%) as sexual minority (SM). Associations between variables were examined using chi-squared tests; multivariate logistic and ordinal regression models were used to identify factors associated with identity expression comfort and LGBTQ + stress. Results GM participants were less likely to report comfort with gender identity expression compared to cisgender participants. SM participants, except for queer participants, were less likely to report comfort with sexual orientation expression compared to heterosexual participants. Transgender female participants expressed the most LGBTQ + identity-related stress compared those identifying as cisgender SM. Conclusion Results support that differences in identity expression comfort and experiences of minority-related stress persist among a sample of SGM adults from the Southern US. Policy Implications Findings presented herein could inform policy discussions focused on addressing minority stress among SGM adults. These policies might consider additional legal protection for SGM individuals and training for healthcare professionals to improve affirming care in the US Deep South.