Sexologies (2019) 28, e72—e81

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ORIGINAL ARTICLE

Attitudes towards the sexual rights of LGB

people: Factors involved in recognition and
denial夽
M. Silvaggi a,∗, S. Eleuteri b,c, M. Colombo d, V. Fava e,
C. Malandrino e, S. Simone f, C. Nanini g, C. Rossetto h,
S.G. Di Santo i

a
Institute of Clinical Sexology (ISC), via Savoia 78, 00198 Rome, Italy
b
Sapienza University of Rome, Piazzale Aldo Moro 5, 00100 Rome, Italy
c
World Association for Sexual Health (WAS), Italy
d
Piedmont Society of Clinical Sexology (SPSC), via Unione Sovietica, 335, 10135 Torino, Italy
e
Research group for sexology, via S. Sofia, 78, Catania, Italy
f
Institute of Research and training (IRF), via Luigi Alamanni, 23, 50123 Firenze, Italy
g
Interdisciplinary Centre for Research and Training in Sexology (CIRS), via Angelo Ceppi di Bairolo, 1/8,
16126 Genova, Italy
h
Study Center for Affective and Sexual Disorders Treatment (DAS), via G.T. Invrea 20/2, 16129 Genova,
Italy
i
Santa Lucia Foundation, via Ardeatina, 306/354, 00142 Roma, Italy

Available online 15 June 2019

KEYWORDS Summary Sexual rights (SR) are grounded in universal human rights, however, despite recent
Sexual rights; gains in equality, many lesbian, gay and bisexual (LGB) individuals and couples still face dis-
LGB; crimination. The aim of this study was to analyze the level of agreement of the Italian general
Homoparenting; population with the sexual rights of LGB people and couples. A further aim was to better under-
Sexual minority; stand the sociodemographic characteristics associated with the different level of recognition
Same sex couples; of the LGB SR. An online anonymous questionnaire was carried out to collect demographic data
Bisexual couples and information about the level of agreement/disagreement, coded on a 6-point likert scale,
with statements regarding the rights of heterosexual and LGB people. One thousand and seven

DOI of original article:https://doi.org/10.1016/j.sexol.2019.06.003.

夽
La version en français de cet article, publiée dans l’édition imprimée de la revue, est également disponible en ligne: doi: xxxxxxxxx.
∗ Corresponding author.

E-mail addresses: m.silvaggi@gmail.com (M. Silvaggi), stefano.eleuteri@gmail.com (S. Eleuteri), margher-c79@libero.it

(M. Colombo), valentinafavamp4@yahoo.it (V. Fava), chiaramalandrino@yahoo.it (C. Malandrino), sarasimone77@hotmail.com (S. Simone),
chiarananini@virgilio.it (C. Nanini), cristinarossetto@icloud.com (C. Rossetto), s.disanto@hsantalucia.it (S.G. Di Santo).

https://doi.org/10.1016/j.sexol.2019.06.004
1158-1360/© 2019 Elsevier Masson SAS. All rights reserved.
Attitudes towards the sexual rights of LGB people e73

out people who had access to the questionnaire met the inclusion criteria. The sample showed
overall moderate-high levels of agreement with SR of LGB men and women in high percentages,
and more than 85.0% declared themselves in favor of the right, for the LGB people, to have
a satisfactory sexuality. The participants showed a lower degree of agreement in relation to
the adoption of children by LGB couples. The most discriminated against are bisexuals of both
sexes. With respect to sociodemographic variables, being female, graduated, was observed as
related to a greater recognition of the rights considered. Being a believer and to a greater
extent being a believer churchgoer has been observed as a predictor of lesser recognition of
such LGB rights. Data shows how focusing efforts where possible on the knowledge of sexual
orientation to overcome stereotypes based on ignorance is crucial for LGB sexual and general
health.
© 2019 Elsevier Masson SAS. All rights reserved.

Introduction
Sexual rights (SR) are grounded in universal human rights
that are already recognized in international and regional
human rights documents. For sexual health to be attained
and maintained, the sexual rights of all persons must be
respected, protected and fulfilled (WAS Declaration of Sex-
ual Rights Kismodi et al., 2017; Giami, 2015).
Despite progressive changes in sociocultural attitudes,
many people still consider homosexuality to be an undesir-
able condition. While for some people it represents a moral
or religious problem, for others it is a political and social
problem, and for many it is a psychological and relational
problem (Rossi and Dean, 2013).
Negative attitudes towards gay and lesbian people are
very common (Rivers and D’Augelli, 2001; Heinze and Horn,
2009) and can lead discrimination against and the stigmati-
zation and victimization of this population (Hu et al., 2016;
Lingiardi et al., 2005; Fasoli et al., 2013).
Despite recent gains in equality, many lesbian, gay and
bisexual (LGB) individuals and couples still face discrimi-
nation (Beitsch, 2015). One example of this discrimination
concerns LGB rights to adopt children (DeVault and Miller,
2019). In addition to minority stressors experienced by
all sexual minorities (e.g., heterosexism and homophobia),
bisexual individuals experience unique bisexual-specific
minority stressors and stigma (e.g., biphobia or anti-bisexual
prejudice; Bostwick and Hequembourg, 2014; Brewster and
Moradi, 2010; Eleuteri et al., 2017; Dodge et al., 2016;
Roberts et al., 2015).
Public opinion polls suggest that most people consider
that same sex relationships should not receive the same
legal recognition as heterosexual relationships (Lax and
Phillips, 2009). The denial of equal rights associated with
sexual and couple partnership establishes same sex couples
as second-class citizens and may diminish LGB individuals’
social and psychological well-being (Herdt and Kertzner,
2006; King and Bartlett, 2006; Riggle et al., 2010).
Several factors, such as gender (Hooghe and Meeusen,
2012; Heinze and Horn, 2009; Lingiardi et al., 2005), inter-
personal contact with gay and lesbian people (Lingiardi
et al., 2005; Herek, 1994), political view (Lingiardi et al.,
2005; Wood and Bartkowski, 2004), beliefs about the etiol-
ogy of homosexuality (Heinze and Horn, 2009; Frias-Navarro
et al., 2015; Overby, 2014), gender role attitudes (Herek
et al., 2009; Harbaugh and Lindsey, 2015; Poteat and Ander-
son, 2012), religious beliefs (Lingiardi et al., 2005; Vincent
et al., 2011; Wood and Bartkowski, 2004) and education
(Ohlander et al., 2005; Van den Akker et al., 2012) were
found to be related to a different attitude towards sexual
minorities.
Researchers have also focused attention on attitudes
toward same sex marriage and have discovered that higher
levels of homophobia are associated with less tolerant atti-
tudes toward same sex couples (Frost, Lehavot and Meyer,
2013).
Objectives
To date, studies on attitudes towards LGB in Italy have been
directed only at adolescents (Santona and Tognasso, 2018),
university students (Lingiardi et al., 2005), aging people
(Baiocco et al., 2013), homosexual couples (Antonelli et al.,
2014) from specific cities or regions of Italy. For this rea-
son, although Italy shows very different cultures depending
on the geographical area or generation considered, data on
the attitudes of people of different ages and in the different
areas of Italy are missing,
The aim of this study was to analyze the level of agree-
ment of the Italian general population with the sexual rights
of LGB people and couples. Further objectives of the study
was to better understand the sociodemographic character-
istics associated with the different level of recognition of
LGB SR and which sexual minorities are most discriminated
against in their access to sexual rights, in relation to specific
sexual rights.
By obtaining this data it may be possible to understand
what the risk factors are of non-recognition of SR, taking
into account social characteristics, with regard to specific
sexual minorities and specific SR.
Materials and methods
This cross-sectional study was carried out in cooperation
between the Young Section of Italian Federation of Sci-
entific Sexology (FISS Youth) and the World Association of
e74 M. Silvaggi et al.

Sexual Health (WAS YIC). An online anonymous question-

Table 1 Descriptives.
naire was realized to collect demographic data (years of age;
biological sex; level of instruction; regional origin: North- Sample composition Frequencies
ern, Central or Southern-Islands Italy; occupation: student,
employed or unemployed-retired; sexual orientation: com- Sex
pletely heterosexual, mostly heterosexual, bisexual, mostly Male 281 (28.9)
homosexual and completely homosexual; relational status: Female 692 (71.1)
single, in a committed relationship, cohabiting with the Age
partner, married; religion (open question); religiosity: non- 18—29 348 (35.8)
believer, believer, practicing and information about the level 30—39 338 (34.7)
of agreement/disagreement, coded on a 6-point likert scale, 40 or more 287 (29.5)
with statements regarding the rights of heterosexual people Provenience
and LGB people to have a satisfying sexuality, to marry, to North 390 (40.1)
adopt children, to be hired for any job and to be free to Center 314 (32.3)
live their sexuality. The response options for each state- South and islands 269 (27.6)
ment were 1 = I strongly disagree; 2 = I partially disagree; Instruction
3 = I slightly disagree; 4 = I slightly agree; 5 = I partially agree; Undergraduate 332 (34.1)
6 = I completely agree). Participants had not the possibility Graduate 391 (40.2)
to express intermediate opinions between agreement and Post-graduate 250 (25.7)
disagreement or to not respond to one or more questions. Occupation
Persons aged 18 or over have been included. To being Student 206 (21.2)
born or to be resident out of Italy was an exclusion criteria. Employed 620 (63.7)
All analyses were performed with IBM SPSS version 21 Unemploied retired 147 (15.1)
(SPSS Inc. Chicago, IL, USA). Descriptive analyses included Sexual orientation
calculation of mean and standard deviations for continu- Heterosexual 730 (75.0)
ous variables, and absolute and percentage frequencies for Othera 243 (25.0)
categorical variables. Relational status
The Wilcoxon matched pairs test was used to compare, Single 285 (29.3)
for each statement, the level of agreement with the right of In a committed relationship 260 (26.7)
LGB to exercise each SR in question, in reference to the level Cohabiting with partner 190 (19.5)
of agreement granted to a heterosexual person of the same Married 238 (24.5)
gender (i.e. homosexual/bisexual women were compared to Religiosity
heterosexual women, and homosexual/bisexual men were Atheist/agnostic 464 (47.7)
compared to heterosexual men). The level of significance Believer 361 (37.2)
was established at 95% (P < 0.05). Churchgoer 148 (15.2)
Since answers to questions about SR were highly skewed a Not completely heterosexual, homosexual, bisexual or

towards higher scores for most questions, a very large num-
ber of empty cells was observed in ordinal regression models
that also failed to respect the assumption of proportional
odds. For this reason, answers were dichotomized: a score
of 1, 2 or 3 was classified as ‘‘disagreement’’ and a score of
4, 5, 6 as ‘‘agreement’’.
A multiple age- and gender-adjusted binary logistic
regression analysis was conducted to determine demo-
graphic variables that were independently associated with
agreement. Values were expressed as odds ratio (OR) and
95% confidence intervals (95% CI).
In order to exclude multicollinearity, the variance infla-
tion factor (VIF) was calculated for each predictor. Dummy
variables were obtained from categorical variables with
more than 2 categories and calculated by selecting for refe-
rence the categories with the larger fraction of the cases.
Even if our sample size was very large, a VIF greater than
2.5 (which corresponds to an R2 of 0.60) was considered
indicative of multicollinearity.
Results
One thousand and seven out of 1015 people who had
accessed the questionnaire provided informed consent to
the research. Of these, 8 who were not Italians, 13 who
queer.
were born abroad and 13 who resided in a foreign State at
the moment of the survey were excluded from statistical
comparisons.
The final sample is therefore composed of 973 subjects,
692 (71.1%) females and 281 (28.9%) males, aged between
18 and 84 years (mean age: 35.5 ± 11.7; median age: 33.0).
Descriptives are reported in Table 1.
The sample showed overall moderate-high levels of
agreement with SR of LGB men and women in high percent-
ages, and more than 85.0% declared themselves in favor of
the right, for the LGB people, to have a satisfactory sex-
uality (95.8% for homosexual men; 95.7% for homosexual
women; 92.9% for bisexual men; 93.2% for bisexual women;
to marry (90.8% for homosexual men; 91.2% for homosexual
women; 85.6% for bisexual men; 85.8% for bisexual women;
to be hired in every job (99.1% for homosexual men; 99.0%
for homosexual women; 98.9% for bisexual men; 98.9% for
bisexual women;, and to live freely their sexuality (97.1% for
homosexual men; 97.1% for homosexual women; 96.0% for
bisexual men; 96.8% for bisexual women. The participants
show a lower degree of agreement in relation to the adop-
tion of children by LGB couples (77.0% for homosexual male
couples; 78.8% for homosexual female couples; 73.6% for
Attitudes towards the sexual rights of LGB people
bisexual male couples; 73.8% for bisexual female couples;
with lower values for single individuals [63.8% for homosex-
ual men; 65.5% for homosexual women; 60.8% for bisexual
men; 63.4% for bisexual women]).
Comparisons across categories
The Wilcoxon Signed-Ranks Test indicated that the median
ranks for the SR of heterosexual men to have a satisfying sex-
uality were statistically significantly higher than the median
ranks for the same right attributed to homosexual (Z = 7.07;
P < 0.001) and bisexual men (Z = 9.89; P < 0.001).
Accordingly, significant difference existed compared
to the degree of agreement expressed for homosexual
(Z = 7.13; P < 0.001) and bisexual women (Z = 9.29; P < 0.001)
with regard to the reference sample, made up of heterosex-
ual women.
Conversely, the agreement accorded to this SR for men
and women within the same sexual orientation did not differ
significantly for homosexual (Z = 0.74; P = 0.460), or bisexual
people (Z = −0.08; P = 0.933).
The median ranks for the SR of heterosexual men to
get married were statistically significantly higher than the
median ranks for the same right attributed to homosexual
(Z = 10.16; P < 0.001) and bisexual men (Z = 13.21; P < 0.001).
A significant difference emerged in the agreement
expressed for this right of homosexual women (Z = 9.66;
P < 0.001) and bisexual women (Z = 12.80; P < 0.001) com-
pared to the reference sample of heterosexual women. The
degree of agreement accorded to this SR for men and women
within the same sexual orientation did not differ significan-
tly for homosexuals (Z = 1.54; P = 0.124), while the median
ranks for the SR of bisexual women to get married were sta-
tistically significantly higher than the median ranks for the
same right attributed to bisexual men (Z = −2.46; P = 0.014).
The median ranks for the SR of heterosexual single men
to adopt a child were statistically significantly higher than
the median ranks for the same right attributed to homosex-
ual (Z = 8.65; P < 0.001) and bisexual single men (Z = 10.47;
P < 0.001) but lower than the same right attributed to
homosexual (Z = −7.55; P < 0.001) and bisexual male couples
(Z = −4.53; P < 0.001).
Accordingly, significant differences existed compared
to the degree of agreement expressed for homosexual
(Z = 8.19; P < 0.001) and bisexual single women (Z = 8.82;
P < 0.001) with regard to the reference sample, made up of
heterosexual single women, while significant greater agree-
ment was attributed to homosexual (Z = −8.07; P < 0.001)
and bisexual female couples (Z = −4.37; P < 0.001) compared
to single women.
The median ranks for the SR of homosexual single
women, bisexual single women and homosexual female cou-
ples to adopt children were statistically significantly higher
than the median ranks for the same right attributed to
homosexual single men (Z = 3.17; P = 0.002) bisexual single
men (Z = 4.71; P < 0.001) and homosexual couples of men
(Z = 2.84; P = 0.005) while a homogeneity of responses has
been observed in attributing this SR to couples of bisexual
women or men (Z = 0.74; P = 0.458).
The median ranks for the SR of heterosexual men to
be hired for any job were statistically significantly higher
e75
than the median ranks for the same right attributed to
homosexual (Z = 2.67; P = 0.008) and bisexual men (Z = 3.09;
P = 0.002).
Accordingly, significant difference existed compared
to the degree of agreement expressed for homosexual
(Z = 2.97; P = 0.003) and bisexual women (Z = 3.45; P = 0.001)
with regard to the reference sample, made up of heterosex-
ual women.
The degree of agreement accorded to this SR for men and
women within the same sexual orientation did not differ sig-
nificantly for homosexual (Z = −0.80; P = 0.422) or bisexual
people (Z = −2.46; P = 0.014).
The median ranks for the SR of heterosexual men to live
freely their sexuality were statistically significantly higher
than the median ranks for the same right attributed to
homosexual (Z = 5.31; P < 0.001) and bisexual men (Z = 6.97;
P < 0.001). Accordingly, significant difference existed com-
pared to the degree of agreement expressed for homosexual
(Z = 5.67; P < 0.001) and bisexual women (Z = 6.63; P < 0.001)
with regard to the reference sample, made up of heterosex-
ual women. The degree of agreement accorded to this SR
for men and women within the same sexual orientation did
not differ significantly for homosexual (Z = −0.50; P = 0.615)
people (Z = −2.46; P = 0.014), while the median ranks for the
SR of bisexual women were statistically significantly higher
than the median ranks for the same right attributed to bisex-
ual men (Z = 2.81; P = 0.004).
Sociodemographic variables associated to SR
recognition of LGB people
The sociodemographic characteristics that characterize
people who recognize greater or lesser sexual rights to
LGBTs, showed obvious differences.
The female sex was associated with a significant increase
in the degree of agreement with almost all the SR of
homosexual and bisexual people. More in detail, women
agreed in significantly higher percentages than men regard-
ing the right for homosexual men and women to have a
satisfying sexuality (for homosexual men: OR. = 5.67; 95%
CI: 2.63—12.23; for homosexual women: OR. = 5.53; 95% CI:
2.58—11.87), to marry (Table 2), to adopt children (Table 3),
to be hired in any job (for homosexual men: OR. = 5.01; 95%
CI: 1.24—20.18; for homosexual women: OR. = 4.61; 95% CI:
1.18—17.98); higher percentages of agreement in women,
compared to men, were observed regarding the right for
homosexual men (OR. = 2.81 95% CI: 1.18—6.71) but not
for homosexual women (OR. = 1.88; 95% CI: 0.79—4.48) to
feel free to live their sexuality. Moreover, women agreed
in significantly higher percentages than men regarding the
right for bisexual men and women to marry (Table 2) and
regarding the right for bisexual women to be hired in any
job (OR. = 4.02; 95% CI: 1.11—14.62), whereas comparable
levels of agreement were found between sexes regarding
this SR for bisexual men (OR. = 2.16; 95% CI: 0.59—7.87).
Finally, significantly higher percentages of agreement were
observed between women, compared to men, regarding the
right for bisexual men to adopt (Table 3), to have a satisfy-
ing sexuality (bisexual men: OR. = 1.92; 95% CI: 1.08—3.41;
bisexual women: OR. = 1.33; 95% CI: 0.73—2.42) and to feel
 e76
Table 2 Sociodemographic features and agreement with the right of non-heterosexual persons to marry: absolute frequencies, percentages and results of the multiple logistic
regression analysis.
Responders Homosexual men Homosexual women Bisexual men Bisexual women
characteristics
n (%) OR (95% CI) P n (%) OR (95% CI) P n (%) OR (95% CI) P n (%) OR (95% CI) P
Sex
Male 237 (84.3) — — 240 (85.4) — — 229 (81.5) — — 227 (80.8) — —
Female 646 (93.4) 3 (1.76—5.11) 0.000 647 (93.5) 2.67 (1.55—4.59) 0.000 604 (87.3) 1.73 (1.11—2.7) 0.015 608 (87.9) 2 (1.28—3.12) 0.002
Age
18—29 333 (95.7) — — 334 (96) — — 321 (92.2) — — 322 (92.5) — —
30—39 312 (92.3) 0.86 (0.37—1.96) 0.711 311 (92) 0.66 (0.28—1.56) 0.341 288 (85.2) 0.68 (0.36—1.28) 0.228 288 (85.2) 0.56 (0.29—1.09) 0.087
40 or more 238 (82.9) 0.56 (0.24—1.27) 0.163 242 (84.3) 0.53 (0.22—1.27) 0.153 224 (78) 0.5 (0.26—0.97) 0.040 225 (78.4) 0.45 (0.23—0.89) 0.022
Provenience
North 345 (88.5) — — 344 (88.2) — — 335 (85.9) — — 333 (85.4) — —
Center 296 (94.3) 1.63 (0.85—3.12) 0.142 299 (95.2) 2.23 (1.13—4.4) 0.021 275 (87.6) 0.92 (0.56—1.51) 0.735 279 (88.9) 1.09 (0.66—1.81) 0.742
South and 242 (90) 1.14 (0.63—2.09) 0.659 244 (90.7) 1.35 (0.74—2.48) 0.328 223 (82.9) 0.75 (0.46—1.23) 0.257 223 (82.9) 0.81 (0.5—1.32) 0.401
islands
Instruction
Undergraduate 286 (86.1) — — 287 (86.4) — — 270 (81.3) — — 272 (81.9) — —
Graduate 362 (92.6) 1.42 (0.79—2.55) 0.245 363 (92.8) 1.46 (0.81—2.65) 0.209 338 (86.4) 1.37 (0.86—2.19) 0.186 337 (86.2) 1.19 (0.74—1.9) 0.479
Post-graduate 235 (94) 2.62 (1.31—5.24) 0.006 237 (94.8) 3.09 (1.5—6.37) 0.002 225 (90) 2.76 (1.57—4.86) 0.000 226 (90.4) 2.56 (1.44—4.56) 0.001
Occupation
Unemployed- 120 (81.6) — — 122 (83) — — 122 (83) — — 120 (81.6) — —
retired
Employed 561 (90.5) 2.66 (1.46—4.84) 0.001 564 (91) 2.69 (1.45—5) 0.002 517 (83.4) 1.1 (0.64—1.89) 0.731 522 (84.2) 1.37 (0.8—2.35) 0.250
Student 202 (98.1) 9.56 (2.74—33.35) 0.000 201 (97.6) 6.5 (1.98—21.36) 0.002 194 (94.2) 2.16 (0.92—5.08) 0.078 193 (93.7) 2.05 (0.89—4.76) 0.093
Heterosexual
Not 240 (98.8) — — 240 (98.8) — — 235 (96.7) — — 236 (97.1) — —
complete/noa
Completely 643 (88.1) 0.19 (0.06—0.63) 0.007 647 (88.6) 0.21 (0.06—0.72) 0.013 598 (81.9) 0.28 (0.13—0.6) 0.001 599 (82.1) 0.25 (0.11—0.56) 0.001
Relational status
Married 203 (85.3) — — 204 (85.7) — — 186 (78.2) — — 187 (78.6) — —
Cohabiting with 181 (95.3) 1.03 (0.44—2.43) 0.941 182 (95.8) 1.18 (0.48—2.86) 0.718 168 (88.4) 0.84 (0.45—1.55) 0.578 171 (90) 0.95 (0.5—1.81) 0.882
partner
In a committed 242 (93.1) 0.73 (0.36—1.51) 0.402 242 (93.1) 0.73 (0.35—1.52) 0.404 231 (88.8) 0.87 (0.49—1.57) 0.654 230 (88.5) 0.82 (0.45—1.47) 0.503
relationship
Single 257 (90.2) 0.82 (0.44—1.53) 0.535 259 (90.9) 0.91 (0.48—1.72) 0.775 248 (87) 1 (0.59—1.69) 0.989 247 (86.7) 0.95 (0.56—1.62) 0.863
Religiosity
Atheist/agnostic 451 (97.2) — — 451 (97.2) — — 439 (94.6) — — 441 (95) — —
Believer 319 (88.4) 0.24 (0.12—0.49) 0.000 323 (89.5) 0.28 (0.14—0.57) 0.000 297 (82.3) 0.32 (0.19—0.54) 0.000 295 (81.7) 0.28 (0.16—0.47) 0.000
Churchgoer 113 (76.4) 0.09 (0.04—0.18) 0.000 113 (76.4) 0.09 (0.04—0.19) 0.000 97 (65.5) 0.13 (0.07—0.23) 0.000 99 (66.9) 0.13 (0.07—0.23) 0.000
Significant differences respect to the reference are reported in bold.

M. Silvaggi et al.
a Not completely heterosexual, homosexual, bisexual or queer.
 Attitudes towards the sexual rights of LGB people
Table 3 Sociodemographic features and agreement with the right of non-heterosexual persons to adopt a child: absolute frequencies, percentages and results of the multiple
logistic regression analysis.
Responders Homosexual couples of men Homosexual couples of women Bisexual couples of men Bisexual couples of women
characteristics
n (%) OR (95% CI) P n (%) OR (95% CI) P n (%) OR (95% CI) P n (%) OR (95% CI) P
Sex
Male 193 (68.7) — — 200 (71.2) — — 189 (67.3) — — 194 (69) — —
Female 556 (80.3) 2.02 (1.37—2.97) 0.000 567 (81.9) 2.06 (1.38—3.07) 0.000 527 (76.2) 1.59 (1.1—2.3) 0.014 524 (75.7) 1.43 (0.98—2.08) 0.064
Age
18—29 293 (84.2) — — 298 (85.6) — — 289 (83) — — 285 (81.9) — —
30—39 266 (78.7) 0.98 (0.58—1.65) 0.933 269 (79.6) 0.98 (0.57—1.67) 0.935 249 (73.7) 0.86 (0.53—1.42) 0.559 249 (73.7) 0.86 (0.53—1.41) 0.547
40 or more 190 (66.2) 0.71 (0.41—1.22) 0.215 200 (69.7) 0.81 (0.46—1.41) 0.450 178 (62) 0.66 (0.4—1.11) 0.121 184 (64.1) 0.72 (0.43—1.21) 0.215
Provenience
North 288 (73.8) — — 294 (75.4) — — 278 (71.3) — — 280 (71.8) — —
Center 256 (81.5) 1.29 (0.85—1.96) 0.229 264 (84.1) 1.46 (0.94—2.25) 0.092 250 (79.6) 1.33 (0.89—1.98) 0.161 248 (79) 1.26 (0.84—1.89) 0.256
South and 205 (76.2) 1.2 (0.79—1.83) 0.398 209 (77.7) 1.26 (0.81—1.94) 0.305 188 (69.9) 0.94 (0.63—1.39) 0.742 190 (70.6) 0.99 (0.66—1.48) 0.960
islands
Instruction
226 (68.1) — — 236 (71.1) — — 220 (66.3) — — 220 (66.3) — —
Undergraduate
Graduate 312 (79.8) 1.81 (1.21—2.69) 0.004 319 (81.6) 1.81 (1.19—2.75) 0.005 300 (76.7) 1.74 (1.18—2.57) 0.005 296 (75.7) 1.74 (1.18—2.56) 0.005
211 (84.4) 3.26 (2.02—5.26) 0.000 212 (84.8) 2.92 (1.79—4.77) 0.000 196 (78.4) 2.59 (1.66—4.04) 0.000 202 (80.8) 3.1 (1.96—4.9) 0.000
Post-graduate
Occupation
107 (72.8) — — 108 (73.5) — — 104 (70.7) — — 103 (70.1) — —
Unemployed-
retired
Employed 460 (74.2) 1.03 (0.64—1.65) 0.910 472 (76.1) 1.14 (0.7—1.84) 0.601 431 (69.5) 0.91 (0.58—1.44) 0.693 435 (70.2) 0.95 (0.6—1.5) 0.825
Student 182 (88.3) 2.64 (1.33—5.22) 0.005 187 (90.8) 3.76 (1.83—7.75) 0.000 181 (87.9) 2.48 (1.28—4.79) 0.007 180 (87.4) 2.94 (1.53—5.65) 0.001
Heterosexual
Not 227 (93.4) — — 231 (95.1) — — 225 (92.6) — — 226 (93) — —
complete/noa
Completely 522 (71.5) 0.27 (0.15—0.48) 0.000 536 (73.4) 0.22 (0.11—0.41) 0.000 491 (67.3) 0.26 (0.15—0.45) 0.000 492 (67.4) 0.23 (0.14—0.41) 0.000
Relational
status
Married 166 (69.7) — — 176 (73.9) — — 149 (62.6) — — 159 (66.8) — —
Cohabiting 161 (84.7) 0.99 (0.57—1.73) 0.979 162 (85.3) 0.8 (0.45—1.42) 0.455 155 (81.6) 1.17 (0.7—1.96) 0.544 156 (82.1) 0.98 (0.58—1.67) 0.954
with partner
In a 202 (77.7) 0.56 (0.34—0.92) 0.023 205 (78.8) 0.44 (0.26—0.74) 0.002 196 (75.4) 0.7 (0.43—1.12) 0.139 192 (73.8) 0.49 (0.3—0.8) 0.005
committed
relationship
Single 220 (77.2) 0.79 (0.49—1.26) 0.317 224 (78.6) 0.65 (0.4—1.05) 0.077 216 (75.8) 1 (0.64—1.56) 0.995 211 (74) 0.68 (0.44—1.07) 0.098
Religiosity
Athe- 412 (88.8) — — 420 (90.5) — — 401 (86.4) — — 404 (87.1) — —
ist/agnostic
Believer 259 (71.7) 0.33 (0.22—0.5) 0.000 264 (73.1) 0.29 (0.19—0.45) 0.000 243 (67.3) 0.38 (0.26—0.55) 0.000 244 (67.6) 0.36 (0.24—0.53) 0.000
Churchgoer 78 (52.7) 0.14 (0.08—0.23) 0.000 83 (56.1) 0.13 (0.08—0.21) 0.000 72 (48.6) 0.18 (0.11—0.29) 0.000 70 (47.3) 0.15 (0.09—0.24) 0.000
Significant differences respect to the reference are reported in bold.
a Not completely heterosexual, homosexual, bisexual or queer.

e77
e78
free to live their sexuality (bisexual men: OR. = 2.13; 95% CI:
1.00—4.53; bisexual women: OR. = 2.2; 95% CI: 0.94—5.12).
Being a believer and to a greater extent being a
believer churchgoer was the strongest predictor for under-
recognition of LGB rights, with levels of agreement up to
9-fold decreased compared to atheists. The lowest levels of
agreement related to religious involvement were observed
in relation to the rights for LGB people to marry (Table 2)
and to adopt (Table 3). However, compared to atheists,
believers and churchgoers were always significantly or
almost significantly in higher percentages against the
right of non-heterosexual persons to feel free to live their
sexuality (believers/homosexual men: OR. = 0.23; 95% CI:
0.07—0.73; believers/homosexual women: OR. = 0.18; 95%
CI: 0.05—0.64; believers/bisexual men: OR. = 0.22; 95%
CI: 0.08—0.62; believers/bisexual women: OR. = 0.15; 95%
CI: 0.04—0.56; churchgoers/homosexual men: OR. = 0.14;
95% CI: 0.04—0.52; churchgoers/homosexual women:
OR. = 0.12; 95% CI: 0.03—0.48; churchgoers/bisexual
men: OR. = 0.10; 95% CI: 0.03—0.30; churchgoers/bisexual
women: OR. = 0.08; 95% CI: 0.02—0.30), to have a satisfying
sexuality (believers/homosexual men: OR. = 0.38; 95% CI:
0.14—1.01; believers/homosexual women: OR. = 0.37; 95%
CI: 0.14—0.98; believers/bisexual men: OR. = 0.36; 95%
CI: 0.18—0.73; believers/bisexual women: OR. = 0.34; 95%
CI: 0.17—0.71; churchgoers/homosexual men: OR. = 0.09;
95% CI: 0.03—0.25; churchgoers/homosexual women:
OR. = 0.09; 95% CI: 0.03—0.24; churchgoers/bisexual
men: OR. = 0.25; 95% CI: 0.11—0.54; churchgoers/bisexual
women: OR. = 0.21; 95% CI: 0.10—0.47), and to be hired
in any job, even if, in this case, a minimum of believers
(at least 98.6%) and churchgoers (at least 96.6%) declared
against this right for LGB people, therefore analyses
were conducted by combining multiple categories of the
variable (churchgoers/homosexual men = OR. = 0.14; 95%
CI: 0.04—0.52 taking as a reference believers and atheists
since these latter group expressed 100% agreement with the
SR for homosexual men to marry; churchgoers and believ-
ers/homosexual women: OR. = 0.12; 95% CI: 0.01—0.99;
churchgoers and believers/bisexual men: OR. = 0.13; 95%
CI: 0.01—1.06; churchgoers and believers/bisexual women:
OR. = 0.11; 95% CI: 0.01—0.87).
Sexual orientation was significantly associated with
agreement with the SR of LGB people to marry (Table 2)
and to adopt a child (Table 3), and to the SR of bisex-
ual people to have a satisfying sexuality, where being
non heterosexual was associated to increased recog-
nition (heterosexuals/bisexual men: OR. = 0.20; 95% CI:
0.06—0.68; heterosexuals/bisexual women: OR. = 0.23; 95%
CI: 0.07—0.77). Since 100% of the sub-sample of non-
heterosexual subjects who participated in our survey
declared in favor of the right for LGB people to be hired
for any job, it was not possible to include the sexual orien-
tation variable in the logistic regression analysis. However,
very high, although slightly lower, percentages of hetero-
sexual participants, ranging between 98.5% and 95.5% also
showed agreement with this right.
High levels of education, compared to being not
graduated, were invariably been associated with greater
recognition of SR. Graduates and post-graduates expressed
significantly higher agreement with the right of all cate-
gories of LGB people to adopt a child (Table 3) and to feel
M. Silvaggi et al.
free to live their sexuality (graduates/homosexual men:
OR. = 4.74; 95% CI: 1.58—14.25; graduates/homosexual
women: OR. = 4.87; 95% CI: 1.63—14.55; gradu-
ates/bisexual men: OR. = 3.66; 95% CI: 1.57—8.53;
graduates/bisexual women: OR. = 3.42; 95% CI: 1.33—8.78;
post-graduates/homosexual men: OR. = 2.83; 95% CI:
1.00—7.99; post-graduates/homosexual women: OR. = 3.63;
95% CI: 1.21—10.87; post-graduates/bisexual men:
OR. = 5.68; 95% CI: 1.98—16.26; post-graduates/bisexual
women: OR. = 4.12; 95% CI: 1.39—12.22), and with the right
of bisexual men to have a satisfying sexuality (graduates:
OR. = 2.18; 95% CI: 1.15—4.13; post-graduates: OR. = 2.38;
95% CI: 1.16—4.86). Post-graduates but not graduates
showed in higher percentages agreement with the SR of LGB
people to marry, compared to undergraduates (Table 2).
Graduates but not post-graduates showed in higher per-
centages agreement with the SR of homosexual people to
have a satisfying sexuality, compared to undergraduates
(for homosexual men: OR. = 2.85; 95% CI: 1.14—7.16; for
homosexual women: OR. = 2.45; 95% CI: 1.00—6.01). Other
comparisons showed non-significant differences across
levels of instruction. On the other hand, a significant
effect of education was not observed with respect to the
recognition of the right of LGB people to be employed in
any job. This can be due to the fact that non-graduates
declared in high percentages in agreement with the right of
homosexual persons (98.8%) and bisexual persons (91.0%)
to be hired for any work.
Being younger and being a student were associated, but
not invariably, with a significantly higher level of agree-
ment with the SRs of LGB people. Compared with subjects
aged 40 or over, people aged 18 to 29 declared themselves
more in favor of the right of LGB people to have satisfac-
tory sexuality, with significantly higher rates for homosexual
men (OR = 3.26 95% C.I. = 1.04—10.16) and women (OR = 4.31
95% C.I. = 1.42—13.03). Being younger was also associated
with a greater agreement with the right for bisexual peo-
ple to get married (Table 2), while being 40 or more,
compared to the younger age, seems to be less in agree-
ment with the right of homosexual men to be employed
in any job (OR = 0.10 95% C.I. = 0.01—0.83). Being a stu-
dent, compared to being unemployed (but not compared to
being employed) was associated with a greater recognition
of the rights of LGB people to have a satisfying sexuality
(for homosexual men: OR. = 8.40; 95% CI: 1.88—37.46; for
homosexual women: OR. = 10.55; 95% CI: 2.10—52.98; for
bisexual men: OR. = 5.05; 95% CI: 1.57—16.18; for bisexual
women: OR. = 3.28; 95% CI: 1.07—10.05) and to feel free
to live their sexuality (for homosexual men: OR. = 21.43;
95% CI: 2.23—205.89; for homosexual women: OR. = 16.85;
95% CI: 1.75—162.67; for bisexual men: OR. = 11.88; 95%
CI: 2.15—65.69; for bisexual women: OR. = 15.38; 95% CI:
1.61—146.69), and to adopt (Table 3). An association
between being students or employed and a greater agree-
ment with the right of homosexual persons to marry has also
been observed (Table 2).
The wide range of some confidence intervals indicates
that, although some variables are significantly associated
with greater or lesser recognition of the sexual rights
of LGB people, the importance of these variables in
determining recognition must still be clarified by further
studies.
Attitudes towards the sexual rights of LGB people
Regarding the possible association between sociodemo-
graphic variables, a very low level of multicollinearity was
present: a variance inflation factor (VIF) of 1.23 for students
was the highest VIF in tests for multicollinearity.
Limits
Results come from a convenience sample that was recruited
through the dissemination of the questionnaire on social net-
works, together with the request to the participants to share
the research with their contacts.
Our sample is therefore not fully representative of the
Italian general population, being basically younger than the
general population and consisting of a majority of women
and graduates/post-graduates. Therefore, the categories
that are most at risk of being less tolerant are under-
represented, i.e. people with a low level of education and
the elderly. In any case, statistical analyses indicate that
there is no univocal relationship between age and recogni-
tion of rights. Moreover, results are indeed able to observe
the existence of a direct relationship between educational
levels and recognition levels for the SR of non-heterosexual
persons. For this reason, even within the limits indicated
above, our results reveal the need for information-education
campaigns aimed at less instructed people.
Discussion
The literature review indicated that sexual minority individ-
uals were at increased risk for distress and a wide range of
physical (Frost et al., 2013; Lick et al., 2013; Hatzenbuehler
et al., 2013; Laska et al., 2015; Fredriksen-Goldsen et al.,
2017; Blosnich et al., 2016) and psychological, health con-
ditions for both men (Pachankis et al., 2015) and women
(Colledge et al., 2015; Puckett et al., 2016) especially
among youth (Hatzenbuehler, 2011).
In one study, Collier et al. (2015) compared beliefs about
and attitudes toward lesbians and gays in samples of Dutch
and American heterosexual adolescents. Findings indicated
the Dutch participants were more tolerant of lesbians and
gays, after adjusting for the gender, age, and racial/ethnic
minority status of the participants. However, between-
country differences were attenuated by accounting for the
beliefs about lesbians and gays that participants used to jus-
tify their attitudes. American participants were more likely
to justify their attitudes using beliefs related to social norms
and religious opposition, while the Dutch participants were
more likely to justify their attitudes using beliefs related to
individual rights and the biological/genetic basis of homo-
sexuality. The results suggest that the relative importance
of particular beliefs about lesbians and gays to attitudes at
the group level may be context-dependent but also that cer-
tain beliefs are salient to attitudes across national contexts.
Thus, it is important to stress that sociocultural climate in
Italy could influence our results, even if it is difficult to ana-
lyze the difference between our studies and others because,
to the best of our knowledge, no researches has specifically
addresses attitudes towards the different sexual rights of
LGB people.
These disparities are particularly pronounced for individ-
uals who identify as bisexual, report same and opposite sex
e79
attractions, and/or same and opposite sex sexual partners
(Dilley et al., 2010; Friedman et al., 2014; Colledge et al.,
2015; Dyar et al., 2019).
In accordance with the results of our study, the right to
a satisfactory sexuality is not granted to homosexual and
bisexual persons to the same extent as to heterosexuals,
with no significant differences with respect to the gender of
the LGB person.
Even the right to marry is not granted to LGB people to
the same extent as to heterosexual people. Furthermore, to
bisexual males, a lower right than females with the same
sexual orientation is recognized. These data are important
when one considers that the presence of laws prohibit-
ing same sex marriages has been associated with greater
psychological discomfort among the populations of sexual
minorities (Hatzenbuehler et al., 2010; Riggle et al., 2010).
Several researches confirmed LGB desire and inten-
tion to have children (Badgett, 2011; Gates, 2011; Gates
et al., 2007; Goldberg et al., 2012; Mallon, 2004). Often
stereotyped as not desiring children, prior research has
documented that LGB individuals consider parenting as a
rewarding milestone in their lives (Badgett, 2011; Goldberg
et al., 2012).
With regard to the right to adopt a child, relational status
seems to make a greater difference than sexual orienta-
tion. In fact, our sample recognized in higher percentages
the right for adoption of homosexual and bisexual couples
than that of heterosexual single men or women. A significant
lower level of agreement with the right to adopt a child is
reserved for LGB singles. Regarding gender differences, our
sample recognizes in higher percentages the right of adop-
tion to women, than to men of the same sexual orientation.
Compared to the right to be employed in any job, data
shows LGB people as less recognized if compared to het-
erosexuals for both men and women with no differences
between genders. In any case, this right is recognized in
higher percentages than sexual-parenting rights.
Even with respect to the right to live freely one’s own
sexuality, the data show that LGB people are less recog-
nized than heterosexuals and confirm the presence of gender
differences. In fact, this right is granted in higher per-
centages for bisexual women compared to bisexual males,
and for homosexual women compared to homosexual men.
This could be explained by the fact that men tend to
be more lenient and attracted by women with bisexual
behavior and this can also affect the comparisons with
women’s response. In fact, evidence from two indepen-
dent studies indicated that men were more likely than
women to mate with heterosexual individuals who occasion-
ally experience same sex attraction (Apostolou et al., 2017).
However, with this exception, in our study bisexual peo-
ple represent the category associated with less recognition
of sexual rights. These data are in agreement with cur-
rent literature: bisexual people are often stereotyped and
perceived as immoral, unstable and confused about their
sexual orientation; moreover they are considered hyper-
sexual, promiscuous and more likely to transmit sexually
transmitted diseases (Bostwick and Hequembourg, 2014;
Brewster and Moradi, 2010; Flanders et al., 2016; Dodge
et al., 2016). Our study is in agreement with literature,
in that we observed that high educated, female and non-
religious participants tended to be more permissive towards
e80
the SR of non-heterosexual people. It is not surprising that
religion have a strong impact on the acceptance of LGB rights
in Italy, since for the Catholic doctrine, non-heterosexual
sexual acts are publicly blamed and considered immoral and
‘‘contrary to natural laws’’ (Eleuteri and Farulla, 2016).
Conclusion
Although this study has some limitations, our data are fully
in agreement with the literature and have interesting impli-
cations regarding LGB sexual rights.
Firstly, bisexuals of both genders are the most dis-
criminated. However, what is most evident is that certain
characteristics of the population strongly affect the level of
recognition of LGB people rights: being a woman, having a
higher level of education, not being strongly religious are
related to a greater recognition of the sexual rights of the
LGB people. In addition, people who have declared them-
selves not completely heterosexual express higher levels of
acceptance of LGB sexual rights. The most recognized right
has turned out to be to be hired in any job. The least recog-
nized LGB sexual right was ‘‘to adopt a child’’. In this case,
it is also useful to note that homosexual and bisexual cou-
ples have a greater recognition than heterosexual singles of
both genders.
For this reason, it is necessary to work specifically on
populations with the highest risk factors of homophobic and
biphobic attitudes. Focusing efforts where possible on the
knowledge of sexual orientation to overcome stereotypes
based on ignorance. The normalization of homoparental
families should also be pursued through policies to dissemi-
nate correct and realistic knowledge.
Disclosure of interest
The authors declare that they have no competing interest.
References
Antonelli P, Dettore D, Lasagni I, Snyder DK, Balderrama-Durbin C.
Gay and lesbian couples in Italy: comparisons with heterosexual
couples. Fam Proc 2014;53(4):702—16.
Apostolou M, Shialos M, Khalil M, Paschali V. The evolution of female
same-sex attraction: the male choice hypothesis. Pers Individ
Diff 2017;116:372—8.
Badgett MVL. Social inclusion and the value of marriage equal-
ity in Massachusetts and the Netherlands. J Social Issues
2011;67(2):316—34.
Baiocco R, Nardelli N, Pezzuti L, Lingiardi V. Attitudes of Italian
heterosexual older adults towards lesbian and gay parenting.
Sex Res Soc Pol 2013;10:285—92.
Beitsch R. Despite same-sex marriage ruling, gay adoption
rights uncertain in some states; 2015 [Disponible sur :
https://www.pewtrusts.org/en/research-and-analysis/blogs/
stateline/2015/08/19/despite-same-sex-marriage-ruling-gay-
adoption-rights-uncertain-in-some-states].
Blosnich JR, Hanmer J, Yu L, Matthews DD, Kavalieratos D. Health
care use, health behaviors, and medical conditions among
individuals in same-sex and opposite-sex partnerships: a cross-
sectional observational analysis of the Medical Expenditures
Panel Survey (MEPS), 2003—2011. Med Care 2016;54(6):547—54.
M. Silvaggi et al.
Bostwick W, Hequembourg A. ‘‘Just a little hint’’: bisexual-specific
microaggressions and their connection to epistemic injustices.
Cult Health Sex 2014;16:488—503.
Brewster ME, Moradi B. Perceived experiences of anti- bisexual prej-
udice: instrument development and evaluation. J Couns Psychol
2010;57(4):451—68.
Colledge L, Hickson F, Reid D, Weatherburn P. Poorer mental health
in UK bisexual women than lesbians: evidence from the UK
2007 Stonewall Women’s Health Survey. J Pub Health (Oxf)
2015;37(3):427—37.
Collier KL, Horn SHMW, Sandfort TGM. Attitudes toward lesbians
and gays among American and Dutch adolescents. J Sex Res
2015;52(2):140—50.
DeVault A, Miller MK. Justification-suppression and normative
window of prejudice as determinants of bias toward les-
bians, gays, and bisexual adoption applicants. J Homosex
2019;66(4):465—86.
Dilley JA, Simmons KW, Boysun MJ, Pizacani BA, Stark MJ. Demon-
strating the importance and feasibility of including sexual
orientation in public health surveys: health disparities in the
Pacific northwest. Am J Public Health 2010;100(3):460—7.
Dodge B, Herbenick D, Friedman MR, Schick V, Fu TC, Bostwick W,
et al. Attitudes toward bisexual men and women among a nation-
ally representative probability sample of adults in the United
States. Plos One 2016;11:e0164430.
Dyar C, Taggart TC, Rodriguez-Seijas C, Thompson RGJ, Elliott
JC, Hasin DS, et al. Physical health disparities across dimen-
sions of sexual orientation, race/ethnicity, and sex: evidence
for increased risk among bisexual adults. Arch Sex Behav
2019;48(1):225—42.
Eleuteri S, Farulla C. Sexual counselling with Catholics: how to
cope with sexual issues with Catholic clients? Sex Relation Ther
2016;31(3):289—300.
Eleuteri S, Rossi R, Simonelli C. How to address working with older
bisexual clients and their partners? J Sex Med 2017;14(5):e241.
Fasoli F, Paladino MP, Carnaghi A. Le conseguenze del lin-
guaggio omofobo su omosessuali ed eterosessuali. Psi Soc
2013;2:177—92.
Flanders CE, Robinson M, Legge MM, Tarasoff LA. Negative iden-
tity experiences of bisexual and other non-monosexual people:
a qualitative report. J Gay Lesb Ment Health 2016;20:152—72.
Fredriksen-Goldsen KI, Kim HJ, Shui C, Bryan AEB. Chronic health
conditions and key health indicators among lesbian, gay, and
bisexual older US adults, 2013—2014. Am J Public Health
2017;107(8):1332—8.
Frias-Navarro D, Monterde-i-Bort H, Pascual-Soler M, Badenes-
Ribera L. Etiology of homosexuality and attitudes toward same-
sex parenting: a randomized study. J Sex Res 2015;52(2):151—61.
Friedman MR, Dodge B, Schick V, Herbenick D, Hubach R, Bowl-
ing J, et al. From bias to bisexual health disparities: attitudes
toward bisexual men and women in the united states. LGBT
Health 2014;1(4):309—18.
Frost DM, Lehavot K, Meyer IH. Minority stress and physical health
among sexual minority individuals. J Behav Med 2013;38(1):1—8,
http://dx.doi.org/10.1007/s10865-013-9523-8.
Gates GJ, Badgett MV, Macomber JE, Chambers K. Adoption
and foster care by lesbian and gay parents in the United
States. CA Los Angeles; 2007. p. 1—43 [Disponible sur :
https://www.urban.org/sites/default/files/publication/
46401/411437-Adoption-and-Foster-Care-by-Lesbian-and-Gay-
Parents-in-the-United-States.PDF].
Gates TG. Why employment discrimination matters: well-being and
the queer employee. J Workplace Rights 2011;16(1):107—28.
Giami A. Sexuality, health and human rights: the invention of sexual
rights. Sexologies 2015;24(3):e45—53.
Goldberg AE, Downing JB, Moyer AM. Why parenthood, and why
now? Gay men’s motivations for pursuing parenthood. Fam Relat
2012;61(1):157—74.
Attitudes towards the sexual rights of LGB people
Harbaugh E, Lindsey W. Attitudes toward homosexuality among
young adults: connections to gender role identity, gender-typed
activities, and religiosity. J Homosex 2015;62:1098—125.
Hatzenbuehler ML. The social environment and suicide attempts in
lesbian, gay, bisexual youth. Pediatrics 2011;127:896—903.
Hatzenbuehler ML, McLaughlin KA, Slopen N. Sexual orientation dis-
parities in cardiovascular biomarkers among young adults. Am J
Prev Med 2013;44(6):612—21.
Heinze JE, Horn SS. Intergroup contact and beliefs about homosex-
uality in adolescence. J Youth Adolesc 2009;38:937—51.
Herdt G, Kertzner R. I do, but I can’t: the impact of marriage denial
on the mental health and sexual citizenship of lesbians and gay
men in the United States. Sex Res Soc Pol 2006;3:33—49.
Herek GM. Assessing heterosexuals’ attitudes toward lesbians and
gay men: a review of empirical research with the ATLG scale.
In: Greene B, Herek GM, editors. Les gay psy: theory, research,
and clinical applications. Thousand Oaks: CA: Sage Publications;
1994.
Herek GM, Gillis JR, Cogan JC. Internalized stigma among sexual
minority adults: insights from a social psychological perspective.
J Couns Psychol 2009;56(1):32—43.
Hooghe M, Meeusen C. Homophobia and the transition to adulthood:
a three year panel study among Belgian late adolescents and
young adults, 2008—2011. J Youth Adol 2012;41:1197—207.
Hu JMA, Hu JMA, Huang GBA, Zheng X. Life satisfaction, self-
esteem, and loneliness among LGB adults and heterosexual
adults in China. J Homosex 2016;63(1):72—86.
King M, Bartlett A. What same sex civil partnerships may mean for
health. J Epid Comm Health 2006;60:188—91.
Kismodi E, Corona E, Maticka Tyndale E, Rubio Aurioles E, Coleman
E. Sexual rights as human rights: a guide for the WAS declaration
of sexual rights. Int J Sex Health 2017;29(51):1—92.
Laska MN, VanKim NA, Erickson DJ, Lust K, Eisenberg ME, Rosser BRS.
Disparities in weight and weight behaviors by sexual orientation
in college students. Am J Public Health 2015;105(1):111—21.
Lax JR, Phillips JH. Gay rights in the states: public opinion and policy
responsiveness. Am Pol Sci Rev 2009;103:367—86.
Lick DJ, Durso LE, Johnson KL. Minority stress and physical health
among sexual minorities. Pers Psychol Sci 2013;8(5):521—48.
Lingiardi V, Falanga S, D’Augelli AR. The evaluation of homofobia in
an Italian sample. Arch Sex Behav 2005;34:81—93.
e81
Mallon J. Gay men choosing parenthood. New York: Columbia Uni-
versity Press; 2004.
Ohlander J, Batalova J, Treas J. Explaining educational influ-
ences on attitudes toward homosexual relations. Soc Sci Res
2005;34:781—99.
Overby ML. Etiology and attitudes: beliefs about the origins of homo-
sexuality and their implications for public policy. J Homosex
2014;61:568—87.
Pachankis JE, Hatzenbuehler ML, Rendina HJ, Safren S, Parsons
JT. LGB — Affirmative cognitive-behavioral therapy for young
adult gay and bisexual men: a randomized controlled trial of a
transdiagnostic minority stress approach. J Consult Clin Psychol
2015;83(5):875—89.
Puckett JA, Surace FI, Heidi MA, Levitt M, Horne SG. Sexual orien-
tation identity in relation to minority stress and mental health
in sexual minority women. LGBT Health 2016;3(5):350—6.
Riggle E, Rostosky S, Horne S. Psychological distress, well-being,
and legal recognition in same-sex couple relationships. J Fam
Psychol 2010;24:82—6.
Rivers I, D’Augelli A. The victimization of lesbian, gay and bisexual
youths. In: D’Augelli A, Patterson C, editors. Lesbian, gay, and
bisexual identities and youth. New York: Oxford University Press;
2001. p. 199—223.
Roberts TS, Horne SG, Hoyt WT. Between a gay and a straight
place: bisexual individuals’ experiences with monosexism. J
Bisex 2015;15:554—69.
Rossi R, Dean J. Sexual orientationKirana E, Tripodi F, Reisman Y,
Porst H, editors. The EFS and ESSM syllabus of clinical sexology.
Amsterdam: Medix; 2013. p. 278—301.
Santona A, Tognasso G. Attitudes toward homosexuality in adoles-
cence: an Italian study. J Homosex 2018;65(3):361—78.
Van den Akker H, Van der Ploeg R, Scheepers P. Disapproval of
homosexuality: comparative research on individual and national
determinants of disapproval of homosexuality in 20 European
countries. Int J Public Opinion Res 2012;25:64—86.
Vincent W, Parrott DJ, Peterson JL. Effects of traditional gender
role norms and religious fundamentalism on self-identified het-
erosexual men’s attitudes, anger, and aggression toward gay men
and lesbians. Psychol Men Masc 2011;12(4):383—400.
Wood PB, Bartkowski JP. Attribution style and public policy attitudes
toward gay rights. Soc Sci Q 2004;85(1):58—74.