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Book Chapters

Hart, T. A., Vernon, J. R. G., & *Smith, N. G. (2019). Sexual health interventions for HIV-negative sexual minority men. In J. Pachankis & S. Safren (Eds.), Handbook of evidence-based mental health practice with LGBT clients (pp. 313-338). New York: Oxford University Press.


HIV disproportionately affects sexual minority men (SMM) in the U.S. OBJECTIVE We sought to determine past HIV post-exposure prophylaxis (PEP) use and current pre-exposure prophylaxis (PrEP) use among an online sample of cisgender and transgender men who have sex with men. METHODS In 2019, HIV-negative and unknown status SMM (n=63,015) were recruited via geosocial networking apps, social media, and other online venues to participate in a brief eligibility screening survey. Individuals were asked about past PEP and current PrEP use. We examined associations of demographics, socioeconomic indicators, recent club drug use, and current PrEP use on past PEP use using fully-adjusted logistic regression. RESULTS Prior PEP use was relatively uncommon (11.3%), with 2.66 times more men reporting current PrEP use (30.1%). Most (85.9%) past PEP users were current PrEP users, representing 32.2% of all current PrEP users. In multivariable analysis, current PrEP users had 20.1 times higher odds (95%CI: 18.6-21.6) of past PEP use compared to non-PrEP users. Other factors significantly (p<0.001) associated with past PEP use but with smaller effect sizes included: older age (>24 years old) compared to younger age (AOR=1.15); bisexual identity compared to gay (AOR=0.86); Latino, Black, and other/multiracial race/ethnicity compared to white, individually (AORs=1.37-1.52); having health insurance (AOR=0.80); and recent club drug use (AOR=1.19). CONCLUSIONS Prior PEP use was relatively uncommon in our online sample of SMM, but our findings indicate PEP could potentially be a gateway to PrEP. Advertising and prescribing PEP could support efforts to increase PrEP.

*Smith, N. G. (2017). Resilience across the lifespan: Adulthood. In K. L. Eckstrand & J. Potter (Eds.), Trauma, resilience, and health promotion for LGBT patients: What every healthcare provider should know (pp. 75-88). New York: Springer.


This chapter reviews the literature on resilience in lesbian, gay, bisexual, and transgender (LGBT) adults. Resilience as a result of LGBT minority stress is explored, followed by an overview of LGBT strengths identified in the context of positive psychology research. Specific areas of resilience are then explored. These include growth resulting from coming out, interpersonal factors implicated in resilience, and individual difference resilience factors. Individual difference factors reviewed include faith, religion, and spirituality; personality-related factors; and cultural factors. The specific topic of resilience against suicidality is addressed, followed by a review of emerging data including stress biomarkers and affirmative approaches to LGBT resilience promotion. The chapter ends with suggested strategies for promoting resilience in the context of patient/healthcare provider relationships and a case scenario highlighting resilience promotion among LGBT adults.

Juster, R. P., Seeman, T., McEwen, B. S., Picard, M., Mahar, I., Mechawar, N., Sindi, S., *Smith, N. G., Souza-Talarico, J., Sarnyai, Z., Lanoix, D., Plusquellec, P., Ouellet-Morin, I., & Lupien, S. J. (2016). Social inequalities and the road to allostatic load: From vulnerability to resiliency. In D. Cicchetti (Ed.), Developmental psychopathology: Risk, resilience, and intervention (3rd ed., Vol. 4, pp. 381-434). New York: Wile


The developmental trajectories that render individuals vulnerable toward or resilient against diseases of the mind and body are major themes in stress theory, research, and practice. As the field of developmental psychopathology expands our understanding of the multicausal mechanisms involved, vulnerability and resilience are increasingly conceptualized not as static states but rather as probabilistic processes that vary according to the contexts and the consequences investigated. Resilience is therefore defined as a dynamic process that promotes positive adaptation among individuals exposed to severe forms of adversity, stress, and/or trauma. In order to further identify the intertwined risk factors and protective factors associated with diverse developmental pathways that promote resilience, scientists require multilevel analyses and refined measures of biopsychosocial stress among disadvantaged populations. The social determinants of health literature focusing on stress pathophysiology apply increasingly integrative mind-body perspectives to understand how social inequalities influence disease susceptibilities. In this spirit, the neurobiologist Sterling and the epidemiologist Eyer coined the term allostasis to describe dynamic, multifaceted biological processes that maintain physiological stability by recalibrating homeostatic parameters and matching them appropriately to meet environmental demands. Analogous to our understanding of resilient systems that have the capacity to dynamically adjust and stabilize systems to adapt to perturbations, allostatic processes likewise alter metabolic functioning via compensatory and anticipatory mechanisms for which the brain is the commander in chief. In formulating the concept of allostasis that has since revolutionized our views of what constitutes adaptive and maladaptive stress physiology. Sterling and Eyer proposed that age and socioeconomic differentials in cardiovascular hyperarousal represented physiological recalibrations to the needs of adversity. (PsycInfo Database Record (c) 2020 APA, all rights reserved)