@article{Yu2025c,

title = {Mediation Analysis of Internalized Homophobia, Self-esteem and Mental Health in Adolescent Sexual Minority Men: A Repeated Measures Study},

author = {Hyunmin Yu and Jennifer T. Tran and Stephen Bonett and James R. Wolfe and Keith J. Horvath and Amanda D. Castel and Lisa B. Hightow-Weidman and Patrick Sullivan and José A. Bauermeister},

doi = {10.1177/0044118x251338311},

issn = {1552-8499},

year  = {2025},

date = {2025-05-09},

urldate = {2025-05-09},

journal = {Youth & Society},

publisher = {SAGE Publications},

abstract = {<jats:p>

            Internalized homophobia (IH) negatively impacts the mental health of adolescent sexual minority men (ASMM), while self-esteem is posited to bolster their mental health. In a repeated-measures study with 599 ASMM (Mean age = 16.2 [

            <jats:italic>SD</jats:italic>

             = 1.3]; 75.6% racial and ethnic minorities), longitudinal structural equation models investigated the relationships among IH, self-esteem, and mental health (depression and anxiety), as well as the mediating role of self-esteem. Higher self-esteem at earlier time points was significantly associated with lower anxiety and depressive symptoms. The hypothesized mediation pathways were not statistically significant. Subgroup analyses revealed that the protective effect of self-esteem against anxiety was significant for racial and ethnic minority ASMM but not for their non-Hispanic White counterparts. These findings highlight the need for tailored interventions that address the unique experiences of ASMM from diverse racial and ethnic backgrounds.

          </jats:p>},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Yu2025e,

title = {Inclusive Hospital Policies, Nurse Burnout, and Job Turnover},

author = {Hyunmin Yu and José A. Bauermeister and Matthew D. McHugh and Tari Hanneman and Karen B. Lasater},

doi = {10.1097/nnr.0000000000000834},

issn = {1538-9847},

year  = {2025},

date = {2025-05-07},

publisher = {Ovid Technologies (Wolters Kluwer Health)},

abstract = {Abstract

          

            Background

            Organizational turnover among nurses is associated with high levels of burnout, which may be exacerbated by workplace discrimination and exclusionary organizational policies. The theory of inclusive organizations suggests that fostering inclusive workplace environments can positively affect job retention.

          

          

            Objectives

            This study examined the role of inclusive hospital policies in shaping nurses’ intentions to leave employment. We hypothesized that inclusive policies would reduce turnover intentions among all nurses, with a stronger effect among those experiencing high burnout.

          

          

            Methods

            This cross-sectional study analyzed three survey datasets from 2021: the RN4CAST-NY/IL data collected from registered nurses in New York and Illinois; the Healthcare Equality Index data, which assesses and scores hospitals’ inclusion efforts for lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender-diverse individuals; and the American Hospital Association Annual Survey. The dependent variable was nurses’ intent to leave their employer within a year. The independent variable was the Healthcare Equality Index score, with nurses’ high burnout serving as the moderating variable. Multilevel logistic regression with cross-level interaction was employed for the analysis.

          

          

            Results

            A total of 6,294 nurses from 111 hospitals were included in the study. An increase in the total Healthcare Equality Index score was associated with decreased odds of nurses intending to leave their employer. Nurses experiencing high burnout were more likely to intend to leave their employer compared to those without high burnout. Nurses’ high burnout status did not moderate the relationship between hospitals’ Healthcare Equality Index scores and nurses’ intent to leave.

          

          

            Discussion

            Inclusive hospital policies positively affect job retention regardless of nurses’ burnout status. Healthcare organizations should foster inclusive and supportive environments as one strategy to improve nurse retention and organizational stability.

          },

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {System-Level Factors Contributing to Burnout and Professional Well-Being Among Transgender and Gender-Diverse Nurses},

author = {Hyunmin Yu and Celsea Tibbitt and J. Margo Brooks Carthon and Karen B. Lasater and José A. Bauermeister and Matthew D. McHugh},

url = {https://www.liebertpub.com/doi/full/10.1089/heq.2024.0196},

year  = {2025},

date = {2025-05-01},

urldate = {2025-05-01},

journal = {Health Equity},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Watson2025,

title = {Acceptability and feasibility of HIV self-testing integration into publicly-funded HIV prevention services: Perspectives from HIV testing agency staff that provide HIV testing services to sexual and gender minority youth in Philadelphia County},

author = {Dovie L. Watson and Stephen Bonett and Steven Meanley and Sarah M. Wood and Kathleen A. Brady and José A. Bauermeister},

editor = {Hamufare Mugauri,},

doi = {10.1371/journal.pone.0320290},

issn = {1932-6203},

year  = {2025},

date = {2025-03-25},

journal = {PLoS ONE},

volume = {20},

number = {3},

publisher = {Public Library of Science (PLoS)},

abstract = {

Background

Increasing HIV testing among priority populations is a primary strategy of the Ending the HIV Epidemic initiative. In October 2019, the Philadelphia Department of Public Health (PDPH) established a program to distribute publicly-funded HIV self-testing (HIVST) kits to Philadelphia County residents aged 16 years and older.





Methods

Through a community-academic partnership, we used a cross-sectional sequential transformative mixed-methods design to examine perceived organizational factors, opportunities, and challenges to HIVST integration among agency staff at PDPH-funded agencies early in the COVID-19 pandemic due to decreased access to traditional in-person HIV testing services with a focus on agencies whose client populations included sexual and gender minority clients assigned male sex birth aged 13 to 24 years (not the sole population served at each agency). We integrated data from online surveys conducted with HIV testers (test counselors and testing leads), agency leaders (agency leads and directors), and care navigators (n =  42), and semi-structured interviews with HIV testers and agency leaders (n =  11) employed at PDPH-funded agencies.





Results

Many staff were familiar with HIVST (79%), and approximately two-thirds (64%) were likely to encourage HIVST to clients. In interviews, perceived benefits of HIVST integration were increased access to HIV testing, accommodation for client privacy, decreased risk of stigmatizing encounters, and testing program adaptability. Perceived challenges were loss of connection with clients, suboptimal linkage to HIV treatment and prevention services after self-testing, concerns regarding clients’ correct use or interpretation of test results, and client preference.





Conclusions

Agency staff described HIVST as a useful tool for expanding low-barrier HIV testing services; however, staff foresaw potential implementation challenges. To optimize HIVST as a long-term strategy, resources are needed to increase familiarity and comfort with HIVST and enhance staff’s capacity to establish meaningful client connections and link clients to post-test HIV treatment and pre-exposure prophylaxis services.

},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Yu2025b,

title = {Impact of hospitals’ LGBTQ+ inclusion efforts on patient satisfaction from 2016 to 2023: a retrospective longitudinal observational study},

author = {Hyunmin Yu and Matthew D. McHugh and José A. Bauermeister and Tari Hanneman and Heather Brom},

doi = {10.1136/bmjqs-2024-018235},

issn = {2044-5423},

year  = {2025},

date = {2025-03-06},

urldate = {2025-03-06},

journal = {BMJ Qual Saf},

publisher = {BMJ},

abstract = {<jats:sec><jats:title>Background</jats:title><jats:p>Given the emphasis on promoting inclusive policies, we investigated the relationship between US hospitals’ inclusion efforts for lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender-diverse (LGBTQ+) populations and patient satisfaction from 2016 to 2023.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This retrospective longitudinal observational study analysed 6 years of data between 2016 and 2023 from the Healthcare Equality Index (HEI), which measures hospitals’ LGBTQ+ inclusion efforts, and the Hospital Consumer Assessment of Healthcare Providers and Systems, which measures patient satisfaction. Generalised estimating equations (GEE) were used to obtain population-averaged estimates of the association between hospitals’ LGBTQ+ inclusion efforts—assessed by (1) their participation and (2) performance in the HEI (range: 0–100)—and patient satisfaction—measured by (1) patients’ hospital rating (range: 0–100) and (2) willingness to recommend the hospital (range: 0–100). We accounted for hospital characteristics, including medical teaching status, specialised service capability, hospital size, ownership, system membership, region and metropolitan location.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Compared with hospitals that never participated in the HEI, those that occasionally participated reported a 0.33-point higher patient rating (p=0.019, 95% CI 0.05, 0.60) and a 0.49-point higher patient recommendation score (p=0.011, 95% CI 0.11, 0.87). Those who always participated reported a 1.30-point higher rating (p<0.001, 95% CI 0.89, 1.70) and a 1.90-point higher recommendation score (p<0.001, 95% CI 1.36, 2.44). Among hospitals that participated in the HEI, a 10-point increase in the total HEI score was associated with a 0.10-point increase in patient ratings (p=0.031, 95% CI 0.01, 0.20) and a 0.15-point increase in patient recommendations (p=0.023, 95% CI 0.02, 0.28).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Hospitals engaging in LGBTQ+ inclusion efforts are associated with higher patient satisfaction.</jats:p></jats:sec>},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Yu2025,

title = {LGBTQ+ Inclusive Policies, Nurse Job Outcomes, and Quality of Care in Hospitals},

author = {Hyunmin Yu and Matthew D. McHugh and José A. Bauermeister and Tari Hanneman and Karen B. Lasater},

doi = {10.1001/jamanetworkopen.2025.1765},

issn = {2574-3805},

year  = {2025},

date = {2025-03-03},

journal = {JAMA Netw Open},

volume = {8},

number = {3},

publisher = {American Medical Association (AMA)},

abstract = {ImportanceDespite emphasis on the establishment of inclusive hospital policies, the impact of these policies on employees and organizations remains unknown.ObjectiveTo evaluate the association between inclusive policies for lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender minority (LGBTQ+) and nurse job outcomes as well as nurse-reported quality of care.Design, Setting, and ParticipantsThis cross-sectional study analyzed 4 survey datasets from 2021: the RN4CAST-NY/IL, including registered nurses from New York and Illinois, and the Healthcare Equality Index (HEI) data. The HEI evaluates and scores US health care facilities that voluntarily participate based on their LGBTQ+ inclusivity in policies, such as nondiscrimination policies and LGBTQ+ inclusive clinical services. The study used American Hospital Association Annual Survey data for hospital characteristics and Magnet organization data to classify hospitals by Magnet status. Data analyses were performed in December 2024.Main Outcomes and MeasuresNurse job outcomes included burnout and job dissatisfaction. Quality of care outcomes included nurses’ perceptions of care quality and their likelihood of recommending their hospital. The independent variable was LGBTQ+ Healthcare Equality Leader (HEI Leader) status, which signified hospitals with the highest levels of LGBTQ+ inclusion. Multilevel logistic regression models included nurse-level (age, race and ethnicity, gender, and years of experience at the current hospital) and hospital-level (Magnet status, size, teaching status, specialized service capability, and ownership) covariates.ResultsA total of 7343 nurses (mean [SD] age, 44.9 [13.4] years; 6584 [89.6%] women) from 111 hospitals were included in the study. Nurses in hospitals with HEI Leader status had lower odds of high burnout (adjusted odds ratio [AOR], 0.69; 95% CI, 0.52-0.92) and lower odds of job dissatisfaction (AOR, 0.62; 95% CI, 0.45-0.86) compared with those in hospitals without the status. They also had higher odds of reporting excellent or good quality of care (AOR, 1.83; 95% CI, 1.23-2.73) and higher odds of recommending their hospital (AOR, 1.72; 95% CI, 1.19-2.50).Conclusions and RelevanceIn this cross-sectional study, nurses in hospitals with high LGBTQ+ inclusion reported more favorable job outcomes and care quality. Hospitals should understand that implementing LGBTQ+ inclusive policies goes beyond compliance or diversity; it is essential for improving the work climate, enhancing staff well-being, and optimizing care delivery.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}