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Krueger EA, Fish JN, Upchurch DM. Sexual Orientation Disparities in Substance Use: Investigating Social Stress Mechanisms in a National Sample. Am J Prev Med 2020; 58:59-68. [PMID: 31761516 PMCID: PMC6925636 DOI: 10.1016/j.amepre.2019.08.034] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Sexual minorities are disproportionately more likely than heterosexuals to suffer from substance use disorders, but relatively little is known about differences in substance use disorders across diverse sexual minority subgroups. There is also limited understanding of how different social stressors account for sexual orientation disparities in substance use disorders. METHODS Using nationally representative data collected in 2012-2013 (n=34,597), differences in past-year DSM-5 alcohol, cannabis, and tobacco use disorders were assessed across 4 sexual orientation groups (heterosexuals and 3 sexual minority subgroups, lesbian/gay-, bisexual-, and heterosexual-identified sexual minorities). This study assessed whether stressful life events mediated substance use disorder disparities between heterosexuals and each sexual minority subgroup, and whether stressful life events and lesbian, gay, and bisexual discrimination events mediated these substance use disorder differences. Analyses were conducted in 2019. RESULTS For both men and women, substance use disorders and stress experiences varied by sexual identity. For example, compared with heterosexual men, larger proportions of gay and bisexual men had a past-year alcohol use disorder. Among women, all sexual minority subgroups had higher rates of each substance use disorder than heterosexuals. For each substance use disorder, stressful life events mediated disparities between heterosexuals and sexual minority subgroups, except for heterosexual-identified sexual minority men. Both stressful life events and lesbian, gay, and bisexual discrimination mediated substance use disorder differences between sexual minority subgroups, with stronger indirect effects through lesbian, gay, and bisexual discrimination for lesbians/gay men and stronger indirect effects through stressful life events for bisexual adults, generally. CONCLUSIONS Sexual minority subgroups have a greater prevalence of substance use disorders, mediated through both stressful life events and lesbian, gay, and bisexual discrimination. More research is needed to comprehensively assess the processes underlying sexual orientation substance use disparities.
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Affiliation(s)
- Evan A Krueger
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California.
| | - Jessica N Fish
- Department of Family Science, University of Maryland School of Public Health, College Park, Maryland
| | - Dawn M Upchurch
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California
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52
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Schuler MS, Collins RL. Sexual minority substance use disparities: Bisexual women at elevated risk relative to other sexual minority groups. Drug Alcohol Depend 2020; 206:107755. [PMID: 31810051 PMCID: PMC6980764 DOI: 10.1016/j.drugalcdep.2019.107755] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/02/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Prior studies characterizing sexual minority substance use disparities have primarily compared lesbian/gay and bisexual individuals, respectively or in combination, to heterosexual individuals. In light of emerging evidence that bisexual individuals may have particularly elevated substance use risk, we examine differences in recent substance use between bisexual and lesbian/gay individuals using national survey data. METHODS Data on 126,463 adults (including 8241 LGB adults) were from the 2015-2017 National Survey on Drug Use and Health. Substance use outcomes included binge drinking, cigarette smoking, cigar smoking, marijuana use, illicit drug use, opioid misuse, alcohol use disorder, nicotine dependence, and substance use disorder. Logistic regression was used to estimate sexual identity- and gender-specific odds ratios, controlling for demographic characteristics. Of particular interest were estimates comparing bisexual and lesbian/gay individuals of the same gender. RESULTS Both male and female sexual minority adults had significantly elevated rates of substance use compared to heterosexual adults. Furthermore, relative to lesbian/gay women, bisexual women had significantly elevated odds of binge drinking (aOR = 1.29), marijuana use (aOR = 1.42), illicit drug use (aOR = 1.55), opioid misuse (aOR = 1.53), and alcohol use disorder (aOR = 1.48). Relative to gay men, bisexual men had significantly elevated cigar use (aOR = 1.64). CONCLUSIONS Bisexual women were at significantly greater risk for multiple substance use behaviors relative to lesbian/gay women. We did not observe any substance use behaviors for which bisexual individuals had significantly lower risk than their lesbian/gay peers. These disparities may be explained, in part, by unique risk factors for substance use experienced by bisexual individuals, particularly bisexual women.
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53
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Jun HJ, Webb-Morgan M, Felner JK, Wisdom JP, Haley SJ, Austin SB, Katuska LM, Corliss HL. Sexual orientation and gender identity disparities in substance use disorders during young adulthood in a United States longitudinal cohort. Drug Alcohol Depend 2019; 205:107619. [PMID: 31678835 PMCID: PMC7437659 DOI: 10.1016/j.drugalcdep.2019.107619] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND This study examined associations of sexual orientation and gender identity with prevalence of substance use disorders (SUDs) and co-occurring multiple SUDs in the past 12-months during young adulthood in a United States longitudinal cohort. METHODS Questionnaires self-administered in 2010 and 2015 assessed probable past 12-month nicotine dependence, alcohol abuse and dependence, and drug abuse and dependence among 12,428 participants of an ongoing cohort study when they were ages 20-35 years. Binary or multinomial logistic regressions using generalized estimating equations were used to estimate differences by sexual orientation and gender identity in the odds of SUDs and multiple SUDs, stratified by sex assigned at birth. RESULTS Compared with completely heterosexuals (CH), sexual minority (SM; i.e., mostly heterosexual, bisexual, lesbian/gay) participants were generally more likely to have a SUD, including multiple SUDs. Among participants assigned female at birth, adjusted odds ratios (AORs) for SUDs comparing SMs to CHs ranged from 1.61 to 6.97 (ps<.05); among participants assigned male at birth, AORs ranged from 1.30 to 3.08, and were statistically significant for 62% of the estimates. Apart from elevated alcohol dependence among gender minority participants assigned male at birth compared with cisgender males (AOR: 2.30; p < .05), gender identity was not associated with prevalence of SUDs. CONCLUSIONS Sexual and gender minority (SGM) young adults disproportionately evidence SUDs, as well as co-occurring multiple SUDs. Findings related to gender identity and bisexuals assigned male at birth should be interpreted with caution due to small sample sizes. SUD prevention and treatment efforts should focus on SGM young adults.
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Affiliation(s)
- Hee-Jin Jun
- School of Public Health, San Diego State University, San Diego, CA, USA,Institute for Behavioral and Community Health, San Diego State University, San Diego, CA
| | - Megan Webb-Morgan
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Jennifer K. Felner
- School of Public Health, San Diego State University, San Diego, CA, USA,Institute for Behavioral and Community Health, San Diego State University, San Diego, CA
| | | | - Sean J. Haley
- Department of Health Policy and Management, School of Public Health, City University of New York, New York, NY, USA
| | - S. Bryn Austin
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Laura M. Katuska
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Heather L. Corliss
- School of Public Health, San Diego State University, San Diego, CA, USA,Institute for Behavioral and Community Health, San Diego State University, San Diego, CA,Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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54
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Phillips Ii G, Turner B, Felt D, Han Y, Marro R, Beach LB. Trends in Alcohol Use Behaviors by Sexual Identity and Behavior Among High School Students, 2007-2017. J Adolesc Health 2019; 65:760-768. [PMID: 31519427 PMCID: PMC6874756 DOI: 10.1016/j.jadohealth.2019.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE Certain groups, particularly sexual minority youth, demonstrate notable disparities in alcohol use risk. Assessing trends in alcohol use behaviors by sexual orientation over time is therefore important to the epidemiologic study of adolescent health equity. METHODS We analyzed age at first drink, lifetime drinking behavior, current drinking, and binge drinking in a large, national sample of high school youth across six time points, beginning in 2007 and biennially through 2017. We assessed trends by sex, sexual identity, and sexual behavior, controlling for race/ethnicity and age. RESULTS Our results demonstrated that, although overall alcohol use is decreasing among youth, disparities between heterosexual and sexual minority youth remain significant. The largest decreases were seen in current alcohol use among lesbian youth, which fell from a prevalence of 56.1% in 2007 to 38.9% in 2017, and among bisexual females (64.3% in 2007 to 41.1% in 2017). Despite this, alcohol use behaviors were still elevated among lesbian and bisexual female youth compared with heterosexual sex-matched counterparts. Heterosexual-identified male students saw significant decreases in alcohol use, whereas most alcohol use behaviors among sexual minority males decreased but not to a statistically significant degree, with the exception of binge drinking among those who identified as gay (2007: 36.0% to 2017: 12.6%) and bisexual (2007: 24.7% to 2017: 11.6%). Results by sexual behavior are presented within. CONCLUSIONS Sexual minority youth continued to demonstrate markedly high prevalence of alcohol use behaviors compared with heterosexual peers across all time points. Downward trends in alcohol use may thus mask serious population health risks if not adequately explored. Research and health promotion efforts must consider sexual minority orientation to avoid incomplete or inaccurate representation of findings.
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Affiliation(s)
- Gregory Phillips Ii
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Blair Turner
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dylan Felt
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ying Han
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rachel Marro
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lauren B Beach
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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55
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Peralta RL, Victory E, Thompson CL. Alcohol use disorder in sexual minority adults: Age- and sex- specific prevalence estimates from a national survey, 2015-2017. Drug Alcohol Depend 2019; 205:107673. [PMID: 31707274 DOI: 10.1016/j.drugalcdep.2019.107673] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/09/2019] [Accepted: 09/30/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Alcohol use disorders (AUD) occur frequently in sexual minority (SM) adults (identifying as gay, lesbian or bisexual). Age-specific prevalence estimates, particularly during middle and older ages, remain obscure. With questions for sexual identity recently included in the National Survey of Drug Use and Health (NSDUH), increased precision is possible. This study investigates the age-specific estimate for AUD in sexual minority versus sexual majority adults. METHODS Analysis of the 2015-2017 NSDUH, ages 18-years-and-older (N = 128,740). We estimate age-specific, 12-month DSM-IV AUD prevalence and adjusted prevalence ratios (via Poisson regression) by sexual identity. Adjusted models control for demographic, social, and mental health variables. Post-hoc analysis included age-specific estimates after redefining SM to include any same-sex attraction. RESULTS The age-specific estimate showed peak AUD prevalence at age ∼28 for all SMs, compared to age ∼23 for heterosexuals. By subgroup, gay men ages 18-23, had the highest AUD prevalence at 18.8% (CI: 13.5%, 25.5%). Bisexual women ages 24-29 had the highest disparity, a prevalence ratio (reference heterosexual women) of 2.59 (CI: 2.15, 3.13). Above age 50, the definition of SM is salient: in this age group, prevalence of AUD converges for heterosexuals and SMs that include individuals with any same-sex attraction. CONCLUSION In this largest study to date, SMs have a high prevalence of AUD. A disparity in the age-by-age estimates emerges by age 25 when AUD occurrence declines in heterosexuals but increases in SMs. A prevalence disparity occurs with each successive age strata, but by age 50-and-older, the difference is null.
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Affiliation(s)
- Robert L Peralta
- Department of Sociology, The University of Akron, 260 Olin Hall, Akron, OH, 44325-1905 USA.
| | - Eric Victory
- Department of Sociology, The University of Akron, 260 Olin Hall, Akron, OH, 44325-1905 USA
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56
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Demant D, Saliba B. Queer binge: harmful alcohol use among sexual minority young people in Australia. Public Health 2019; 179:18-26. [PMID: 31715550 DOI: 10.1016/j.puhe.2019.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/14/2019] [Accepted: 09/30/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The literature suggests that sexual minority young people (SMYP) use alcohol at disproportionate levels when compared with their heterosexual counterparts. Little is known about alcohol dependency symptoms and correlations between high-risk alcohol use/dependency symptoms and minority stress in this population in general and between subgroups. STUDY DESIGN Cross-sectional study. METHODS Descriptive statistics, adjusted odds ratios, and analysis of covariance were used to determine high-risk alcohol use, dependency symptoms, differences between subgroups, and correlations between alcohol use, dependency symptoms, and minority stress. RESULTS A total of 1556 Australian SMYPs aged 18 to 35 years completed the survey. Fifty percent of the participants reported high-risk alcohol consumption with significant differences between subgroups. Typical dependency symptoms such as 'health, social, legal or financial problems due to alcohol consumption' (16.8%, n = 247) were identified in large parts of the sample. High-risk consumption and dependency symptoms were significantly correlated with minority stress. CONCLUSION High levels of high-risk alcohol use and dependency symptoms were found, largely consistent with existing literature. However, disparities are not distributed equally in this population, suggesting that future health promotion interventions should focus on SMYP subgroups. Significant correlations between minority stress and dependency symptoms/high-risk use suggest a potential route for future interventions in these populations.
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Affiliation(s)
- Daniel Demant
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Ultimo, Australia; School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
| | - Bernard Saliba
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Ultimo, Australia
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57
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Feinstein BA, Rhew IC, Hodge KA, Hughes TL, Kaysen D. Changes in Sexual Identity and Associations With Alcohol Use and Depression Among Young Adult Sexual Minority Women. J Stud Alcohol Drugs 2019; 80:623-630. [PMID: 31790352 PMCID: PMC6900995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 08/20/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Sexual minority women report more problematic alcohol use and depression than heterosexual women. Despite evidence that sexual identity can change over time, most studies treat it as a static construct. As a result, little is known about the extent to which changes in sexual identity influence alcohol use and depression. The current study examined (a) changes in sexual identity over 36 months, (b) the associations between the number of changes in sexual identity and measures of alcohol use (typical weekly alcohol consumption, peak drinking, and alcohol-related consequences) and depression at the final assessment, and (c) baseline sexual identity as a moderator of the associations. METHOD The analyses used four waves of data from a national U.S. sample of sexual minority women ages 18-25 (n = 1,057). RESULTS One third (34%) of participants reported at least one change in sexual identity over the course of the study. The number of changes in sexual identity was positively associated with typical weekly alcohol consumption and depression but was not significantly associated with peak drinking or alcohol-related consequences. None of the associations were moderated by baseline sexual identity. CONCLUSIONS These findings provide additional evidence that sexual identity continues to change over time for a sizeable proportion of young adult sexual minority women and these changes are relevant to their health and well-being.
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Affiliation(s)
- Brian A. Feinstein
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
| | - Isaac C. Rhew
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington
| | - Kimberley A. Hodge
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, Washington
| | - Tonda L. Hughes
- School of Nursing, Columbia University, New York, New York
- Department of Psychiatry, Columbia University, New York, New York
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington
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58
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Feinstein BA, Rhew IC, Hodge KA, Hughes TL, Kaysen D. Changes in Sexual Identity and Associations With Alcohol Use and Depression Among Young Adult Sexual Minority Women. J Stud Alcohol Drugs 2019; 80:623-630. [PMID: 31790352 PMCID: PMC6900995 DOI: 10.15288/jsad.2019.80.623] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 08/20/2019] [Indexed: 06/16/2024] Open
Abstract
OBJECTIVE Sexual minority women report more problematic alcohol use and depression than heterosexual women. Despite evidence that sexual identity can change over time, most studies treat it as a static construct. As a result, little is known about the extent to which changes in sexual identity influence alcohol use and depression. The current study examined (a) changes in sexual identity over 36 months, (b) the associations between the number of changes in sexual identity and measures of alcohol use (typical weekly alcohol consumption, peak drinking, and alcohol-related consequences) and depression at the final assessment, and (c) baseline sexual identity as a moderator of the associations. METHOD The analyses used four waves of data from a national U.S. sample of sexual minority women ages 18-25 (n = 1,057). RESULTS One third (34%) of participants reported at least one change in sexual identity over the course of the study. The number of changes in sexual identity was positively associated with typical weekly alcohol consumption and depression but was not significantly associated with peak drinking or alcohol-related consequences. None of the associations were moderated by baseline sexual identity. CONCLUSIONS These findings provide additional evidence that sexual identity continues to change over time for a sizeable proportion of young adult sexual minority women and these changes are relevant to their health and well-being.
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Affiliation(s)
- Brian A. Feinstein
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
| | - Isaac C. Rhew
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington
| | - Kimberley A. Hodge
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, Washington
| | - Tonda L. Hughes
- School of Nursing, Columbia University, New York, New York
- Department of Psychiatry, Columbia University, New York, New York
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington
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59
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Watson RJ, Fish JN, Poteat VP, Rathus T. Sexual and Gender Minority Youth Alcohol Use: Within-Group Differences in Associations with Internalized Stigma and Victimization. J Youth Adolesc 2019; 48:2403-2417. [PMID: 31605292 DOI: 10.1007/s10964-019-01130-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/21/2019] [Indexed: 01/24/2023]
Abstract
Sexual and gender minority (SGM) youth are more likely to use alcohol than their heterosexual cisgender peers. At the same time, SGM youth experience sexuality- and gender identity-specific stressors known to exacerbate negative health outcomes. Though scholars have established a link between minority stressors (e.g., internalized stigma and victimization) and increased alcohol use for SGM youth as a whole, there is little indication of whether internalized stigma and victimization are more strongly associated with alcohol use for specific groups of SGM youth. A United States sample of 11,811 racially and geographically diverse 13-17 year old SGM youth was used to employ a series of gender-stratified multivariable regression models to examine the association among internalized stigma, victimization, and alcohol-related behaviors, and whether they differed for specific groups of sexual minority youth. Sexual orientation moderated several associations between sexual minority stressors (i.e., victimization and stigma) and youth's alcohol use (i.e., recent use and heavy episodic drinking) across models stratified by gender (i.e., male, female, and non-binary). For example, bisexual boys had stronger associations between SGM-specific victimization and alcohol use frequency and heavy episodic drinking relative to gay boys; conversely, victimization and alcohol use frequency were more weakly associated among bisexual girls relative to lesbian/gay girls. Pansexual girls showed weaker associations between internalized stigma and alcohol use frequency compared to lesbian/gay girls. This paper demonstrates who among SGM youth are more likely to engage in alcohol-related behaviors as a function of differential forms of SGM-related victimization and stigma. These findings can inform substance use interventions that are tailored to youth of diverse sexual orientations and gender identities.
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Affiliation(s)
- Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT, 06269, USA.
| | - Jessica N Fish
- Department of Family Science, School of Public Health, University of Maryland, 1142 Valley Drive, College Park, MD, 20742, USA
| | - V Paul Poteat
- Department of Counseling, Developmental, and Educational Psychology, Boston College, Campion Hall 307, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA
| | - Taylor Rathus
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT, 06269, USA
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Goodin A, Elswick A, Fallin-Bennett A. Mental health disparities and high-risk alcohol use among non-heterosexual high school students. Perspect Psychiatr Care 2019; 55:570-575. [PMID: 31066062 DOI: 10.1111/ppc.12394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/14/2019] [Accepted: 04/21/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To examine disparities in mental health and high-risk alcohol use among high school students by sexual orientation, and the impact of having access to an adult with whom to talk. DESIGN AND METHODS Cross-sectional survey, from the 2015 Kentucky Youth Risk Behavior Survey. Logistic regression estimated the relationship between being "non-heterosexual" on mental health (e.g, suicidal ideation/attempt) and alcohol behaviors (e.g, binge drinking), controlling for demographics and "having an adult to talk to." FINDINGS Non-heterosexual students were more likely to report all adverse outcomes and risk was lower among students who report "having an adult to talk to." PRACTICE IMPLICATIONS Psychiatric nurses need to assess sexual minority youth for access to positive adult relationships.
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Affiliation(s)
- Amie Goodin
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida
| | - Alex Elswick
- Department of Family Science, University of Kentucky, Lexington, Kentucky
| | - Amanda Fallin-Bennett
- University of Kentucky College of Nursing, University of Kentucky, Lexington, Kentucky
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Coulter RWS, Egan JE, Kinsky S, Friedman MR, Eckstrand KL, Frankeberger J, Folb BL, Mair C, Markovic N, Silvestre A, Stall R, Miller E. Mental Health, Drug, and Violence Interventions for Sexual/Gender Minorities: A Systematic Review. Pediatrics 2019; 144:e20183367. [PMID: 31427462 PMCID: PMC6855817 DOI: 10.1542/peds.2018-3367] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2019] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Compared with cisgender (nontransgender), heterosexual youth, sexual and gender minority youth (SGMY) experience great inequities in substance use, mental health problems, and violence victimization, thereby making them a priority population for interventions. OBJECTIVE To systematically review interventions and their effectiveness in preventing or reducing substance use, mental health problems, and violence victimization among SGMY. DATA SOURCES PubMed, PsycINFO, and Education Resources Information Center. STUDY SELECTION Selected studies were published from January 2000 to 2019, included randomized and nonrandomized designs with pretest and posttest data, and assessed substance use, mental health problems, or violence victimization outcomes among SGMY. DATA EXTRACTION Data extracted were intervention descriptions, sample details, measurements, results, and methodologic rigor. RESULTS With this review, we identified 9 interventions for mental health, 2 for substance use, and 1 for violence victimization. One SGMY-inclusive intervention examined coordinated mental health services. Five sexual minority-specific interventions included multiple state-level policy interventions, a therapist-administered family-based intervention, a computer-based intervention, and an online intervention. Three gender minority-specific interventions included transition-related gender-affirming care interventions. All interventions improved mental health outcomes, 2 reduced substance use, and 1 reduced bullying victimization. One study had strong methodologic quality, but the remaining studies' results must be interpreted cautiously because of suboptimal methodologic quality. LIMITATIONS There exists a small collection of diverse interventions for reducing substance use, mental health problems, and violence victimization among SGMY. CONCLUSIONS The dearth of interventions identified in this review is likely insufficient to mitigate the substantial inequities in substance use, mental health problems, and violence among SGMY.
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Affiliation(s)
- Robert W S Coulter
- Departments of Behavioral and Community Health Sciences and
- Center for LGBT Health Research, Graduate School of Public Health, and
- Department of Medicine, School of Medicine, and
- Department of Pediatrics, School of Medicine, University of Pittsburgh and Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - James E Egan
- Departments of Behavioral and Community Health Sciences and
- Center for LGBT Health Research, Graduate School of Public Health, and
| | - Suzanne Kinsky
- Departments of Behavioral and Community Health Sciences and
- Center for LGBT Health Research, Graduate School of Public Health, and
- Center for High-Value Health Care, UPMC, Pittsburgh, Pennsylvania; and
| | - M Reuel Friedman
- Center for LGBT Health Research, Graduate School of Public Health, and
- Infectious Diseases and Microbiology, and
| | | | | | - Barbara L Folb
- Departments of Behavioral and Community Health Sciences and
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christina Mair
- Departments of Behavioral and Community Health Sciences and
| | - Nina Markovic
- Center for LGBT Health Research, Graduate School of Public Health, and
- Department of Dental Public Health, School of Dental Medicine
| | - Anthony Silvestre
- Center for LGBT Health Research, Graduate School of Public Health, and
| | - Ron Stall
- Departments of Behavioral and Community Health Sciences and
- Center for LGBT Health Research, Graduate School of Public Health, and
| | - Elizabeth Miller
- Departments of Behavioral and Community Health Sciences and
- Department of Pediatrics, School of Medicine, University of Pittsburgh and Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Mereish EH, Sheskier M, Hawthorne D, Goldbach JT. Sexual orientation disparities in mental health and substance use among Black American young people in the USA: effects of cyber and bias-based victimisation. CULTURE, HEALTH & SEXUALITY 2019; 21:985-998. [PMID: 30601086 PMCID: PMC6602804 DOI: 10.1080/13691058.2018.1532113] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/27/2018] [Indexed: 05/05/2023]
Abstract
Few studies have explored sexual orientation disparities in mental health and substance use outcomes among racial minorities. This study examined sexual orientation disparities in depression, suicidality and substance use among Black American young people in the USA, and the mediating role of cyber and bias-based victimisation in accounting for these disparities. Secondary analyses were performed on data from a probability sample of young people (N = 1,129) collected in a school district in the south-eastern USA. Participants reported socio-demographics, depressive symptoms, suicidality, substance use and experiences of bias-based and cyber victimisation. With some exceptions, Black participants who were lesbian, gay, bisexual or mostly heterosexual reported higher rates of depression, suicidal ideation, suicide planning and substance use than Black heterosexual participants. Black lesbian, gay, bisexual and mostly heterosexual participants reported more cyber and bias-based victimisation than Black heterosexual participants. Sexual orientation disparities in mental health and, to some extent, substance use were partially explained by both forms of victimisation. Further research is needed to address the role of bias-based and cyber victimisation in disparities in mental health and substance use among Black sexual minority young people. The present study carries implications for prevention and treatment efforts for racially diverse sexual minorities.
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Affiliation(s)
- Ethan H. Mereish
- Department of Health Studies, American University, Washington, DC, USA
| | - Mikela Sheskier
- Department of Psychology, American University, Washington, DC, USA
| | - David Hawthorne
- Department of Health Studies, American University, Washington, DC, USA
| | - Jeremy T. Goldbach
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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Caputi TL, Smith LR, Strathdee SA, Ayers JW. Substance Use Among Lesbian, Gay, Bisexual, and Questioning Adolescents in the United States, 2015. Am J Public Health 2019; 108:1031-1034. [PMID: 29995487 DOI: 10.2105/ajph.2018.304446] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To provide current national estimates of lesbian, gay, bisexual, and questioning (LGBQ) adolescents' (grades 9-12) substance use risks. METHODS The 2015 national Youth Risk Behavior Survey included questions for 19 substance use outcomes covering 15 substances. LGBQ adolescents' substance use was described and their risk relative to heterosexual adolescents was estimated after controlling for sociodemographic confounders. RESULTS In controlled analyses, we found that LGBQ adolescents were 1.12 (95% confidence interval [CI] = 1.06, 1.19) times as likely as heterosexual adolescents to report any lifetime and 1.27 (95% CI = 1.14, 1.41) times as likely to report past 30-day substance use. LGBQ adolescents were at significantly greater risk for all but 1 studied substance, including alcohol, cigarettes, cigars, cocaine, ecstasy, electronic vapor usage ("vaping"), hallucinogens, heroin, inhalants, marijuana, methamphetamine, prescription drugs (without physician direction), steroids, and synthetic marijuana. CONCLUSIONS LGBQ adolescents are at substantially greater risk for substance use. Public Health Implications. Policymakers should invest in prevention and early intervention resources to address substance use risks among LGBQ adolescents.
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Affiliation(s)
- Theodore L Caputi
- Theodore L. Caputi is with the School of Public Health, College of Medicine and Health, University College Cork, Cork, Republic of Ireland. Laramie R. Smith and Steffanie A. Strathdee are with the Division of Infectious Disease and Global Public Health, School of Medicine, University of California, San Diego. John W. Ayers is with the Graduate School of Public Health, San Diego State University
| | - Laramie R Smith
- Theodore L. Caputi is with the School of Public Health, College of Medicine and Health, University College Cork, Cork, Republic of Ireland. Laramie R. Smith and Steffanie A. Strathdee are with the Division of Infectious Disease and Global Public Health, School of Medicine, University of California, San Diego. John W. Ayers is with the Graduate School of Public Health, San Diego State University
| | - Steffanie A Strathdee
- Theodore L. Caputi is with the School of Public Health, College of Medicine and Health, University College Cork, Cork, Republic of Ireland. Laramie R. Smith and Steffanie A. Strathdee are with the Division of Infectious Disease and Global Public Health, School of Medicine, University of California, San Diego. John W. Ayers is with the Graduate School of Public Health, San Diego State University
| | - John W Ayers
- Theodore L. Caputi is with the School of Public Health, College of Medicine and Health, University College Cork, Cork, Republic of Ireland. Laramie R. Smith and Steffanie A. Strathdee are with the Division of Infectious Disease and Global Public Health, School of Medicine, University of California, San Diego. John W. Ayers is with the Graduate School of Public Health, San Diego State University
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Supportive Community Resources Are Associated with Lower Risk of Substance Use among Lesbian, Gay, Bisexual, and Questioning Adolescents in Minnesota. J Youth Adolesc 2019; 49:836-848. [PMID: 31446582 DOI: 10.1007/s10964-019-01100-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/30/2019] [Indexed: 12/28/2022]
Abstract
Research has indicated that lesbian, gay, bisexual, and queer/questioning (LGBQ) adolescents have disproportionately high rates of substance use compared to heterosexual peers; yet certain features of schools and communities have been associated with lower substance use rates in this population. To advance this field, research examining multiple levels of influence using measures developed with youth input is needed. With community, school, and student data, this study tested hypotheses that LGBQ students attending high schools and living in communities with more LGBQ-supportive environments (assessed with a novel inventory tool) have lower odds of substance use behaviors (cigarette smoking, alcohol use, marijuana use, prescription drug misuse, and other drug use) than their peers in less supportive LGBQ environments. Multilevel models using data from 2454 LGBQ students (54.0% female, 63.9% non-Hispanic white) in 81 communities and adjusting for student and school covariates found that LGBQ adolescents who lived in areas with more community support had lower odds of frequent substance use, particularly among females. Expanding and strengthening community resources (e.g., LGBQ youth-serving organizations, LGBQ events such as a Pride parade, and LGBQ-friendly services) is recommended to further support LGBQ adolescents and reduce substance use disparities.
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Romantic Attraction and Substance Use in 15-Year-Old Adolescents from Eight European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173063. [PMID: 31450730 PMCID: PMC6747452 DOI: 10.3390/ijerph16173063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 11/16/2022]
Abstract
Sexual minority youth are at higher risk of substance use than heterosexual youth. However, most evidence in this area is from North America, and it is unclear whether the findings can be generalized to other cultures and countries. In this investigation, we used data from the 2014 Health Behaviour in School-aged Children (HBSC) study to compare substance use in same- and both-gender attracted 15-year-old adolescents from eight European countries (n = 14,545) to that of their peers who reported opposite-gender attraction or have not been romantically attracted to anyone. Both-gender attracted, and to a lesser extent, same-gender attracted adolescents were significantly more likely to smoke cigarettes, consume alcohol, get drunk and use cannabis, or be involved in multiple substance use in the last 30 days compared to their opposite-gender attracted peers. Those adolescents who have not been in love had significantly lower odds for substance use than all other youth. The pattern of results remained the same after adjusting for country, gender and family affluence. These findings are compatible with the minority stress and romantic stress theories. They suggest that sexual minority stigma (and love on its own) may contribute to higher substance use among adolescents in European countries.
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Caceres BA, Hickey KT, Heitkemper EM, Hughes TL. An intersectional approach to examine sleep duration in sexual minority adults in the United States: findings from the Behavioral Risk Factor Surveillance System. Sleep Health 2019; 5:621-629. [PMID: 31377249 DOI: 10.1016/j.sleh.2019.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 05/20/2019] [Accepted: 06/18/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Investigate sexual identity differences in sleep duration and the multiplicative effect of sexual identity and race/ethnicity among US adults. DESIGN Cross-sectional. PARTICIPANTS The sample consisted of 267,906 participants from the Behavioral Risk Factor Surveillance System. MEASUREMENTS Sleep duration was categorized as very short (≤4 hours), short (5-6 hours), adequate (7-8 hours), or long (≥9 hours). Sex-stratified multinomial logistic regressions were used to examine sexual identity differences in sleep duration. We then examined sleep duration by comparing sexual minorities to (1) same-race/-ethnicity heterosexuals and (2) White participants with the same sexual identity. RESULTS Sexual minority women had higher odds of very short sleep compared to heterosexual women, regardless of race/ethnicity. Black gay men had higher rates of very short sleep but lower rates of long sleep relative to Black heterosexual men. Latino and Asian/Pacific Islander bisexual men reported higher rates of short sleep than their heterosexual counterparts. Black lesbian and other-race bisexual women were more likely to have very short sleep than their heterosexual peers. Black lesbian women also had higher rates of long sleep. Analyses examining racial/ethnic differences by sexual identity found that Black and Latino gay men reported higher rates of very short sleep compared to White gay men. Black bisexual women had higher rates of short sleep duration than White bisexual women. CONCLUSIONS More research is needed to understand how to promote sleep health among sexual minorities, particularly racial/ethnic minorities, and the impact of inadequate sleep duration on health outcomes in this population.
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Affiliation(s)
- Billy A Caceres
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032.
| | - Kathleen T Hickey
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032
| | - Elizabeth M Heitkemper
- Department of Biomedical Informatics, Columbia University, 622 W 168th St, PH20, New York, NY 10032
| | - Tonda L Hughes
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032
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Perales F, Campbell A. Early roots of sexual-orientation health disparities: associations between sexual attraction, health and well-being in a national sample of Australian adolescents. J Epidemiol Community Health 2019; 73:954-962. [DOI: 10.1136/jech-2018-211588] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 05/31/2019] [Accepted: 06/27/2019] [Indexed: 11/04/2022]
Abstract
BackgroundResearch documents substantial adolescent health disparities by sexual orientation, but studies are confined to a small number of countries—chiefly the USA. We provide first-time evidence of associations between sexual orientation and adolescent health/well-being in a new country—Australia. We also add to knowledge by examining health/well-being outcomes not previously analysed in national samples, considering adolescents reporting no sexual attractions, and rank-ordering sexual-orientation health disparities by magnitude.MethodsData from an Australian national probability sample of 14/15 years old (Longitudinal Study of Australian Children, n=3318) and regression models adjusted for confounding and for multiple comparisons were used to examine the associations between sexual attraction and 30 outcomes spanning multiple domains of health/well-being—including socio-emotional functioning, health-related quality of life, depressive symptoms, health-related behaviours, social support, self-harm, suicidality, victimisation, self-concept, school belonging and global health/well-being assessments.ResultsLesbian, gay, bisexual and questioning adolescents displayed significantly worse health/well-being than their heterosexual peers in all outcomes (p<0.05). The magnitude of the disparities ranged between 0.13 and 0.75 SD, and was largest in the domains of self-harm, suicidality, peer problems and emotional problems. There were fewer differences between the heterosexual and no-attraction groups. Worse outcomes were observed among both-sex-attracted adolescents compared with same-sex-attracted adolescents, and sexual-minority girls compared with sexual-minority boys.ConclusionsConsistent with the minority stress model and recent international scholarship, sexual-minority status is an important risk factor for poor adolescent health/well-being across domains in Australia. Interventions aimed at addressing sexual-orientation health disparities within Australian adolescent populations are urgently required.
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Affiliation(s)
| | - Tonda L Hughes
- Professor and Director of Global Health Research, Columbia University School of Nursing
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Feinstein BA, Turner BC, Beach LB, Korpak AK, Phillips G. Racial/Ethnic Differences in Mental Health, Substance Use, and Bullying Victimization Among Self-Identified Bisexual High School-Aged Youth. LGBT Health 2019; 6:174-183. [PMID: 31033384 PMCID: PMC6551981 DOI: 10.1089/lgbt.2018.0229] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose: Sexual minority youth are at increased risk for mental health problems and substance use, and accumulating evidence indicates that bisexual youth are at greatest risk. However, bisexual youth are not a homogenous group and scholars have called for greater attention to the intersections of multiple marginalized identities. As such, we examined racial/ethnic differences in mental health (sadness/hopelessness and suicidal ideation), substance use (cigarette use, binge drinking, marijuana use, and other illicit drug use), and bullying (in-person and electronic) among self-identified bisexual high school-aged youth (overall and by sex). Method: Data from the local versions of the Youth Risk Behavior Survey were pooled across jurisdictions and years (2011-2015), resulting in an analytic sample of 18,515 bisexual youth who were racially/ethnically diverse. Results: Black and Hispanic bisexual youth were less likely to report in-person and electronic bullying than White bisexual youth. In addition, Black bisexual youth were less likely to report sadness/hopelessness and suicidal ideation than White, Hispanic, and Other race/ethnicity bisexual youth. Black bisexual female youth were also less likely to report cigarette use, binge drinking, and other illicit drug use than White bisexual female youth. In contrast to most of our findings, Black bisexual youth were more likely to report marijuana use than White bisexual youth. Most of the significant racial/ethnic differences in mental health and substance use remained significant after controlling for bullying. Conclusion: These findings highlight the heterogeneity of bisexual youth and the need to consider multiple marginalized identities to understand the health disparities affecting this diverse population.
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Affiliation(s)
- Brian A. Feinstein
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
| | - Blair C. Turner
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lauren B. Beach
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Aaron K. Korpak
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Gregory Phillips
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Talley AE, Turner B, Foster AM, Phillips G. Sexual Minority Youth at Risk of Early and Persistent Alcohol, Tobacco, and Marijuana Use. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1073-1086. [PMID: 30604172 PMCID: PMC6993957 DOI: 10.1007/s10508-018-1275-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 07/07/2018] [Accepted: 07/10/2018] [Indexed: 05/31/2023]
Abstract
The current study sought to examine substance use disparities among sexual minority youth. The current subsample of 348,175 students participated in the Youth Risk Behavior Surveillance System (YRBSS) study from years 2005 to 2015 (biennially) in jurisdictions that asked at least one question about sexual minority status. Latent class analysis was used to identify implicit classes of sexual minority youth, based on respondents' sexual identity and sexual behavior. Sex-stratified regression models were run to determine the association between class membership and age of onset and persistent use of alcohol, tobacco, and marijuana. Findings showed that sexual minority female subgroups were primarily distinguished by sexual identity (e.g., "lesbian," "bisexual"), whereas sexual minority male subgroups were primarily distinguished by sexual behavior. Female lesbian and bisexual youth were at risk of initiating substance use at younger ages and, among lifetime users, were more likely to persist in their tobacco and marijuana use over time, relative to sexually active female heterosexual youth. Among lifetime users, male youth with partners of both sexes were at greater risk of persistent use of alcohol, tobacco, and marijuana over time and earlier ages of first use. Recommendations for intervention and prevention programs geared toward reducing sexual minority youth substance use are provided.
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Affiliation(s)
- Amelia E Talley
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, 79409, USA.
| | - Blair Turner
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Anthony M Foster
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, 79409, USA
| | - Gregory Phillips
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
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Coulter RWS, Ware D, Fish JN, Plankey MW. Latent Classes of Polysubstance Use Among Adolescents in the United States: Intersections of Sexual Identity with Sex, Age, and Race/Ethnicity. LGBT Health 2019; 6:116-125. [PMID: 30822259 DOI: 10.1089/lgbt.2018.0149] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We aimed to estimate latent classes of concurrent polysubstance use and test for sexual orientation differences in latent class memberships with representative data from adolescents living in 19 U.S. states. We also tested whether sex, race/ethnicity, and age moderated the sexual identity differences in polysubstance use class memberships. METHODS We analyzed data from 119,437 adolescents from 19 states who participated in the 2015 Youth Risk Behavior Survey. Latent class analysis characterized polysubstance use patterns based on self-reported frequency of lifetime and past-month use of alcohol (including heavy episodic drinking), tobacco (cigarettes, cigars, and smokeless tobacco), and marijuana. Multinomial logistic regression models tested differences in latent class memberships by sexual identity. Interaction terms tested whether sex, race/ethnicity, and age moderated the sexual identity differences in polysubstance use class memberships. RESULTS A six-class model of polysubstance use fit the data best and included nonusers (61.5%), experimental users (12.2%), marijuana-alcohol users (14.8%), tobacco-alcohol users (3.8%), medium-frequency three-substance users (3.6%), and high-frequency three-substance users (4.1%). Gay/lesbian- and bisexual-identified adolescents had significantly higher odds than heterosexual-identified adolescents of being in all of the user classes compared with the nonuser class. These sexual identity differences in latent polysubstance use class memberships were generally larger for females than for males, varied occasionally by race/ethnicity, and were sometimes larger for younger ages. CONCLUSION Compared with their heterosexual peers, gay/lesbian and bisexual adolescents-especially females-are at heightened risk of engaging in multiple types of polysubstance use. Designing, implementing, and evaluating interventions will likely reduce these sexual orientation disparities.
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Affiliation(s)
- Robert W S Coulter
- 1 Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.,2 Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.,3 Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.,4 Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Deanna Ware
- 5 Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia
| | - Jessica N Fish
- 6 Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland
| | - Michael W Plankey
- 5 Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia
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Coulter RW, Sang JM, Louth-Marquez W, Henderson ER, Espelage D, Hunter SC, DeLucas M, Abebe KZ, Miller E, Morrill BA, Hieftje K, Friedman MS, Egan JE. Pilot Testing the Feasibility of a Game Intervention Aimed at Improving Help Seeking and Coping Among Sexual and Gender Minority Youth: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e12164. [PMID: 30767903 PMCID: PMC6416896 DOI: 10.2196/12164] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/10/2018] [Indexed: 01/19/2023] Open
Abstract
Background Sexual and gender minority youth (SGMY; eg, lesbian, gay, bisexual, and transgender youth) experience myriad substance use and mental health disparities compared with their cisgender (nontransgender) heterosexual peers. Despite much research showing these disparities are driven by experiences of bullying and cyberbullying victimization, few interventions have aimed to improve the health of bullied SGMY. One possible way to improve the health of bullied SGMY is via a Web-accessible game intervention. Nevertheless, little research has examined the feasibility of using a Web-accessible game intervention with SGMY. Objective This study aimed to describe the protocol for a randomized controlled trial (RCT) pilot, testing the feasibility and limited efficacy of a game-based intervention for increasing help-seeking–related knowledge, intentions, self-efficacy, behaviors, productive coping skills use, and coping flexibility and reducing health risk factors and behaviors among SGMY. Methods We enrolled 240 SGMY aged 14 to 18 years residing in the United States into a 2-arm prospective RCT. The intervention is a theory-based, community-informed, computer-based, role playing game with 3 primary components: encouraging help-seeking behaviors, encouraging use of productive coping, and raising awareness of Web-based resources. SGMY randomized to both the intervention and control conditions will receive a list of SGMY-inclusive resources, covering a variety of health-related topics. Control condition participants received only the list of resources. Notably, all study procedures are conducted via the internet. We conveniently sampled SGMY using Web-based advertisements. Study assessments occur at enrollment, 1 month after enrollment, and 2 months after enrollment. The primary outcomes of this feasibility study include implementation procedures, game demand, and game acceptability. Secondary outcomes include help-seeking intentions, self-efficacy, and behaviors; productive coping strategies and coping flexibility; and knowledge and use of Web-based resources. Tertiary outcomes include bullying and cyberbullying victimization, loneliness, mental health issues, substance use, and internalized sexual and gender minority stigma. Results From April to July 2018, 240 participants were enrolled and randomized. Half of the enrolled participants (n=120) were randomized into the intervention condition and half (n=120) into the control condition. At baseline, 52.1% (125/240) of the participants identified as gay or lesbian, 26.7% (64/240) as bisexual, 24.2% (58/240) as queer, and 11.7% (28/240) as another nonheterosexual identity. Nearly half (113/240) of participants were a gender minority: 36.7% (88/240) were cisgender boys, and 16.3% (39/240) were cisgender girls. There were no differences in demographic characteristics between intervention and control condition participants. Conclusions Web-accessible game interventions overcome common impediments of face-to-face interventions and present a unique opportunity to reach SGMY and improve their health. This trial will provide data on feasibility and limited efficacy that can inform future Web-based studies and a larger RCT aimed at improving health equity for SGMY. Trial Registration ClinicalTrials.gov NCT03501264; https://clinicaltrials.gov/ct2/show/NCT03501264 (Archived by WebCite at http://www.webcitation.org/72HpafarW) International Registered Report Identifier (IRRID) DERR1-10.2196/12164
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Affiliation(s)
| | - Jordan M Sang
- University of Pittsburgh, Pittsburgh, PA, United States
| | | | | | - Dorothy Espelage
- College of Health and Human Performance, University of Florida, Gainesville, FL, United States
| | - Simon C Hunter
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | | | | | | | | | | | | | - James E Egan
- University of Pittsburgh, Pittsburgh, PA, United States
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Fish JN, Schulenberg JE, Russell ST. Sexual Minority Youth Report High-Intensity Binge Drinking: The Critical Role of School Victimization. J Adolesc Health 2019; 64:186-193. [PMID: 30660247 PMCID: PMC8142791 DOI: 10.1016/j.jadohealth.2018.07.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 07/02/2018] [Accepted: 07/02/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE To examine standard binge drinking (≥4 drinks for females, ≥5 drinks for males) and high-intensity binge drinking (≥8 drinks for females, ≥10 drinks for males) among heterosexual and sexual minority youth in the US and whether reports of school-based victimization mediate this association. METHODS Survey data are from the 2015 Youth Risk Behavior Survey (YRBS; n = 10,839, Mage = 16.07). Logistic regression adjusted for race/ethnicity and age compared rates of standard and high-intensity binge drinking among heterosexual and sexual minority youth and whether experiences of school-based victimization mediated this association. Effects were tested in full sample and sex-stratified models. RESULTS Lesbian and bisexual girls and girls with male and female partners were more likely than heterosexual girls to report standard rates of binge drinking. Lesbian girls and girls reporting male and female sexual partners were more likely than heterosexual girls to report high-intensity binge drinking in the past 30 days. Compared with heterosexual boys, gay boys were significantly less likely to participate in high-intensity binge drinking. School-based victimization mediated all significant associations between sexual minority status and standard and high-intensity binge drinking, with the exception of lesbian girls. CONCLUSION Lesbian and behaviorally bisexual girls have elevated risk for high-intensity binge drinking relative to heterosexual girls. Findings point to the importance of policies that reduce school-based victimization as these experiences are associated with higher rates of standard and high-intensity binge drinking among sexual minority girls.
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Affiliation(s)
- Jessica N Fish
- Population Research Center, Human Development and Family Sciences, University of Texas at Austin, Austin, Texas.
| | - John E Schulenberg
- Institute for Social Research and Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Stephen T Russell
- Human Development and Family Sciences, University of Texas at Austin, Austin, Texas
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Greene MZ, Hughes TL, Hanlon A, Huang L, Sommers MS, Meghani SH. Predicting cervical cancer screening among sexual minority women using Classification and Regression Tree analysis. Prev Med Rep 2018; 13:153-159. [PMID: 30591857 PMCID: PMC6305684 DOI: 10.1016/j.pmedr.2018.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/02/2018] [Accepted: 11/10/2018] [Indexed: 12/24/2022] Open
Abstract
Cervical cancer screening is a critical preventive healthcare service for all women. Sexual minority women (SMW) in the United States experience multiple health disparities including decreased access to and use of cervical cancer screening. The mechanisms driving these disparities are not clear and SMW with multiple marginalized identities may be more likely to miss recommended cervical cancer screening. This study aimed to identify subgroups of SMW that are more and less likely to be screened for cervical cancer according to American Cancer Society guidelines. We used cross-sectional data from the latest (2010-2012) wave of the Chicago Health and Life Experiences of Women (CHLEW) Study (N = 691). Informed by intersectionality theory, we performed classification and regression tree (CART) modeling to construct a data-driven, predictive model of subgroups of SMW who were more and less likely to receive guideline-recommended screening. Notably, the CART model did not include commonly tested variables such as race/ethnicity or level of income or education. The model did identify subgroups with low likelihood of receiving screening and several novel variables that may be important in understanding SMW's use of cervical cancer screening; lifetime number of sexual partners, age at drinking onset, childhood physical abuse, and internalized homonegativity. Our results point to the importance of early life experiences and identity development processes in shaping patterns of preventive healthcare use among adult SMW. Our analysis also demonstrated the potential value of CART modeling techniques for evaluating how multiple variables interact in complex ways to predict cervical cancer screening.
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Affiliation(s)
- Madelyne Z Greene
- University of Wisconsin-Madison Department of Obstetrics and Gynecology, 610 Walnut St. Suite #667, Madison 53726, WI, USA
| | - Tonda L Hughes
- Columbia University School of Nursing, 560 W 168th St, New York 10032, NY, USA
| | - Alexandra Hanlon
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia 19126, PA, USA
| | - Liming Huang
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia 19126, PA, USA
| | - Marilyn S Sommers
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia 19126, PA, USA
| | - Salimah H Meghani
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia 19126, PA, USA
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Risk of polysubstance use among sexual minority and heterosexual youth. Drug Alcohol Depend 2018; 192:38-44. [PMID: 30205306 DOI: 10.1016/j.drugalcdep.2018.07.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/05/2018] [Accepted: 07/24/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Relative to heterosexual youth, sexual minority youth exhibit increased substance use. Risk for polysubstance use, which magnifies drug-related harms, remains largely unexamined for sexual minority youth. This investigation used a nationally-representative dataset to compare polysubstance use patterns between sexual minority and heterosexual youth. METHODS The cross-sectional 2015 CDC's Youth Risk Behavior Surveillance System (N = 15,624) was utilized. Latent mixture modeling empirically identified subgroups of youth based on self-reported past-month use of alcohol, cigarettes, chewing tobacco/snus/snuff, cigars/cigarillos/little cigars, e-cigarettes, marijuana, and past-month binge drinking (all dichotomized: 0 = none; 1 = at least once). Adjusting for race/ethnicity, sex, and age, the risk for being in each substance-using class, was compared between youth who self-identified as heterosexual and gay/lesbian, bisexual, or "not sure." RESULTS Five classes were supported: "non-users" (68.19%), "alcohol users" (13.08%; elevated alcohol use and binge drinking probabilities), "nicotine/marijuana co-users" (5.80%; elevated nicotine and marijuana use), "poly-substance/e-cigarette users" (5.35%; elevated on all substances except tobacco-containing products), and "polysubstance/tobacco users" (7.59%; elevated for all substances). Relative to heterosexual youth, gay/lesbian-identified youth were at risk of being "nicotine and marijuana co-users", bisexual youth were at risk of being in all four substance-using classes, and the "not sure" youth were at risk of being "polysubstance/tobacco users." Select disparities were larger for youth who were also female or a minority race/ethnicity. CONCLUSIONS Sexual minority youth, particularly bisexual youth, were at increased risk relative to heterosexual youth for polysubstance use. Polysubstance use warrants attention in substance use interventions, including interventions tailored for sexual minority youth.
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76
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English D, Rendina HJ, Parsons JT. The Effects of Intersecting Stigma: A Longitudinal Examination of Minority Stress, Mental Health, and Substance Use among Black, Latino, and Multiracial Gay and Bisexual Men. PSYCHOLOGY OF VIOLENCE 2018; 8:669-679. [PMID: 30881729 PMCID: PMC6415673 DOI: 10.1037/vio0000218] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE Although Black, Latino, and multiracial gay and bisexual men (GBM) are disproportionately affected by health inequities facing GBM more broadly in the United States (CDC, 2017), there is a dearth of research examining how intersectional stigma affects psychological and behavioral outcomes such as depressive and anxiety symptoms and substance use. Based in minority stress and intersectionality theories, this study examined the main and intersectional effects of racial discrimination and gay rejection sensitivity on emotion regulation difficulties, depressive and anxiety symptoms, and later drug use and heavy drinking. METHOD We collected longitudinal data from 170 GBM of Black, Latino, or multiracial descent. Measurements included baseline racial discrimination, gay rejection sensitivity, and emotion regulation difficulties, 6 month depressive and anxiety symptoms, and baseline to 12 month heavy drinking and drug use. We analyzed data using longitudinal structural equation models. RESULTS Our results indicated that racial discrimination and its interaction with gay rejection sensitivity were significantly associated with higher levels of emotion regulation difficulties, which predicted higher levels of depressive and anxiety symptoms at 6 months, which, in turn, predicted higher levels of heavy drinking, but not drug use, at 12 months. Moreover, the total indirect effect from the stigma variables to heavy drinking was statistically significant. CONCLUSIONS These findings indicate that it is critical for researchers and clinicians to consider the effects of intersecting racial and sexual minority stress on emotion regulation in the persistence of psychological and behavioral health inequities facing Black, Latino, and multiracial GBM.
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Affiliation(s)
- Devin English
- The Center for HIV/AIDS Educational Studies & Training (CHEST), New York, NY, USA
| | - H. Jonathon Rendina
- The Center for HIV/AIDS Educational Studies & Training (CHEST), New York, NY, USA
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of the City University of New York (CUNY), New York, NY, USA
| | - Jeffrey T. Parsons
- The Center for HIV/AIDS Educational Studies & Training (CHEST), New York, NY, USA
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of the City University of New York (CUNY), New York, NY, USA
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77
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Jiang Y, Reilly-Chammat R, Cooper T, Viner-Brown S. Disparities in Health Risk Behaviors and Health Conditions Among Rhode Island Sexual Minority and Unsure High School Students. THE JOURNAL OF SCHOOL HEALTH 2018; 88:803-812. [PMID: 30300929 DOI: 10.1111/josh.12688] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/06/2017] [Accepted: 07/20/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Sexual minority students have higher risk for health-related behaviors. We examined 5 domains including 34 health risk behaviors and health conditions among sexual minorities and unsure students in Rhode Island. We also included sexual contact of heterosexually identified students to capture heterosexually identified students who may be considered sexual minorities by their behavior. METHODS We used the 2007-2015 Rhode Island Youth Risk Behavior Survey data (N = 14,264). We categorized students into 4 groups: students self-identified as heterosexual and reported no sexual contact with same sex only or both sexes (group 1); self-identified as heterosexual and reported sexual contact with same sex only or both sexes (group 2); self-identified as lesbian, gay, bisexual (group 3); and responded as unsure (group 4). We used multivariable adjusted logistic regression analyses to evaluate associations of sexual minority and unsure students with 34 health risk behaviors and health conditions accounting for complex sampling design. RESULTS Students in groups 2-4 were more likely to engage in health-risk behaviors including violent behaviors, attempted suicide, substance use, and no physical activity than their peers. CONCLUSIONS As sexual minority youth continue to report higher rates of health-related risk behaviors, targeted evidence-based prevention approaches must focus on reducing these risk behaviors among those youth.
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Affiliation(s)
- Yongwen Jiang
- Center for Health Data and Analysis, Rhode Island Department of Health, Three Capitol Hill, Providence, RI 02908
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02912
| | - Rosemary Reilly-Chammat
- Office of Student, Community and Academic Supports, Rhode Island Department of Elementary and Secondary Education, 255 Westminster Street, Providence, RI 02903
| | - Tara Cooper
- Rhode Island Department of Health, Three Capitol Hill, Suite 407, Providence, RI 02908
| | - Samara Viner-Brown
- Center for Health Data and Analysis, Rhode Island Department of Health, Three Capitol Hill, Providence, RI 02908
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78
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Pollitt AM, Mallory AB, Fish JN. Homophobic Bullying and Sexual Minority Youth Alcohol Use: Do Sex and Race/Ethnicity Matter? LGBT Health 2018; 5:412-420. [PMID: 30334685 PMCID: PMC6207147 DOI: 10.1089/lgbt.2018.0031] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Sexual minority youth (SMY) are more likely to use alcohol than their heterosexual peers, yet a lack of research on within-group differences and modifiable mechanisms has hindered efforts to address alcohol use disparities. The purpose of the current study was to examine differences in the mediating role of homophobic bullying on the association between sexual orientation identity and drinking frequency and heavy episodic drinking frequency by sex and race/ethnicity. METHODS We used data from a subsample of 20,744 youth in seven states from the 2015 Youth Risk Behavior Survey, a population-based data set of 9-12th grade high school students in the United States. We included youth who self-identified as male or female; heterosexual, lesbian/gay, bisexual, or unsure of their sexual orientation identity; and White, Black, or Latino. RESULTS Within-group comparisons demonstrated that SMY alcohol use disparities were concentrated among Latino bisexual and unsure youth. All subgroups of SMY at the intersection of race/ethnicity and sex were more likely than their heterosexual counterparts to report homophobic bullying. Homophobic bullying mediated alcohol use disparities for some, but not all, subgroups of SMY. CONCLUSION Homophobic bullying is a serious risk factor for SMY alcohol use, although youths' multiple identities may differentiate degrees of risk. Sexual orientation identity-related disparities in alcohol use among Latino, bisexual, and unsure youth were not fully attenuated when adjusted for homophobic bullying, which suggests that there may be additional factors that contribute to rates of alcohol use among these specific subgroups of SMY.
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Affiliation(s)
- Amanda M. Pollitt
- Population Research Center, The University of Texas at Austin, Austin, Texas
| | - Allen B. Mallory
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, Texas
| | - Jessica N. Fish
- Population Research Center, The University of Texas at Austin, Austin, Texas
- Department of Family Science, University of Maryland, College Park, Maryland
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79
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Macapagal K, Feinstein BA, Puckett JA, Newcomb ME. Improving Young Male Couples' Sexual and Relationship Health in the 2GETHER Program: Intervention Techniques, Environments of Care, and Societal Considerations. COGNITIVE AND BEHAVIORAL PRACTICE 2018; 26:254-269. [PMID: 31787835 DOI: 10.1016/j.cbpra.2018.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Young male couples are at high risk for acquiring human immunodeficiency virus (HIV). However, few HIV prevention programs meet the needs of young male couples that express an interest in how to maintain healthy relationships. As such, we developed 2GETHER, a couple-based program that integrates HIV risk reduction and sexual health information into a relationship education program specific to young male couples. 2GETHER was guided by cognitive-behavioral theories of HIV risk reduction and relationship functioning and was informed by a social-ecological perspective to address factors within and outside the couple that can impact sexual and relationship health. As a micro-level intervention, 2GETHER intervenes directly with couples via psychoeducation and cognitive-behavioral strategies to change couples' communication patterns, sexual health behaviors, and relationship satisfaction. Successful implementation of 2GETHER requires mezzo-level interventions that create an affirming environment of care for sexual-minority individuals and facilitators who are culturally competent in working with young male couples. Although macro-level interventions to change societal acceptance of and policies germane to sexual-minority couples are beyond the scope of 2GETHER, we discuss how clinicians can advocate for systemic changes to improve sexual-minority couples' health, and how 2GETHER addresses the impact of such macro-level factors on the couple's relationship. Our experience developing and testing 2GETHER indicates that HIV prevention programs for young male couples should reflect the unique contexts shaping sexual-minority individuals' relationships and lives, and that programs should intervene within and across multiple levels when possible to improve health for sexual-minority men.
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80
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Schuler MS, Rice CE, Evans-Polce RJ, Collins RL. Disparities in substance use behaviors and disorders among adult sexual minorities by age, gender, and sexual identity. Drug Alcohol Depend 2018; 189:139-146. [PMID: 29944989 PMCID: PMC6083846 DOI: 10.1016/j.drugalcdep.2018.05.008] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/08/2018] [Accepted: 05/08/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sexual minorities (SMs) experience elevated rates of substance use behaviors and disorders relative to heterosexuals; minority stress is theorized to contribute to these disparities. As SMs are not a homogenous group, analyses that aggregate SMs across sexual identity, age, or gender obscure important variation among this population. To date, age- and gender-specific disparities have not been rigorously examined using a large national sample. METHODS Using data on 67,354 adults (ages 18-49) from the 2015 and 2016 National Survey of Drug Use and Health we examined age- and gender-specific disparities in smoking, heavy episodic drinking, marijuana use, illicit drug use, and alcohol/substance use disorder. Age groups were ages 18-25, 26-34, and 35-49. Using logistic regression, we estimated age- and gender-specific odds ratios for gay/lesbian and bisexual individuals, relative to heterosexuals; analyses adjusted for demographic characteristics. RESULTS Bisexual women had significantly elevated odds of all outcomes at all ages, relative to heterosexual women. Gay/lesbian individuals had significantly elevated odds for nearly all outcomes compared to same-gender heterosexuals at ages 18-25, but not consistently at older ages. For bisexual men, significant disparities compared to heterosexual men were only observed at ages 35-49 for marijuana use and alcohol/substance use disorder. CONCLUSIONS We found notable within-group differences regarding SM disparities. While disparities were most pronounced in young adulthood for gay/lesbian individuals and mid-adulthood for bisexual men, bisexual women uniquely experienced disparities across all ages. Minority stress experiences may vary with respect to gender, age/cohort, and sexual identity, resulting in differential risk for substance use.
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Affiliation(s)
- Megan S Schuler
- RAND Corporation, 20 Park Plaza #920, Boston, MA 02116, USA.
| | - Cara E Rice
- The Methodology Center, The Pennsylvania State University, 424 Health and Human Development Building, University Park, PA 16802, USA.
| | - Rebecca J Evans-Polce
- Institute of Social Research, University of Michigan, 426 Thompson St., Ann Arbor, MI 48104, USA.
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81
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Fish JN, Baams L. Trends in Alcohol-Related Disparities Between Heterosexual and Sexual Minority Youth from 2007 to 2015: Findings from the Youth Risk Behavior Survey. LGBT Health 2018; 5:359-367. [PMID: 30010480 DOI: 10.1089/lgbt.2017.0212] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE The purpose of this study was to assess trends in alcohol-related disparities between heterosexual and sexual minority adolescents in the United States from 2007 to 2015. METHODS Data were pooled from the 2007, 2009, 2011, 2013, and 2015 Youth Risk Behavior Surveys (N = 207,367) to estimate trends, disparities, and changes in disparities of four alcohol-related behaviors (i.e., lifetime alcohol use, early onset use (<13 years of age), past 30-day use, and past 30-day heavy episodic drinking [HED]) among heterosexual youth and three subgroups of sexual minority youth (SMY) (i.e., gay/lesbian, bisexual, and unsure). Models were sex stratified and adjusted for age, race/ethnicity, and state of data collection. RESULTS The prevalence of all alcohol-related behaviors declined from 2007 to 2015 for heterosexual youth, but not as consistently for SMY. Disparities in alcohol-related behaviors between heterosexual youth and SMY largely remained stable or widened from 2007 to 2015. Disparities in lifetime alcohol use and past 30-day use were larger between heterosexual boys and gay boys in 2015 relative to 2007. Disparities in early onset use and past 30-day HED were also larger between heterosexual girls and lesbian girls in 2015 relative to 2007. The disparity in past 30-day use between heterosexual girls and bisexual girls was smaller in 2015 compared with 2007. CONCLUSIONS Despite overall declines in adolescent alcohol use, alcohol-related disparities between heterosexual youth and SMY persist and, for some SMY, they have widened.
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Affiliation(s)
- Jessica N Fish
- 1 Population Research Center, The University of Texas at Austin , Austin, Texas.,2 Department of Human Development and Family Sciences, The University of Texas at Austin , Austin, Texas
| | - Laura Baams
- 3 Department of Pedagogical and Educational Sciences, University of Groningen , Groningen, The Netherlands
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Newcomb ME, Swann G, Mohr D, Mustanski B. Do Diary Studies Cause Behavior Change? An Examination of Reactivity in Sexual Risk and Substance Use in Young Men Who Have Sex with Men. AIDS Behav 2018; 22:2284-2295. [PMID: 29332235 DOI: 10.1007/s10461-018-2027-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Behavioral diaries are frequently used for observing sexual and substance use behaviors, but participating in diary studies may cause behavior change. This study examined change in sexual and substance use behaviors among young men who have sex with men (YMSM) in a two-month diary study compared to control. An analytic sample of 324 YMSM was randomized to receive daily diaries, weekly diaries, or no diaries (control) for 2 months. Half of the diary participants were randomized to receive automated weekly feedback. Between-subjects analyses found no evidence of change in sexual or substance use behaviors from baseline to 2-month follow-up when comparing the diary conditions to control. Within-persons growth mixture models of all diary data showed significant decreases in condomless anal sex (CAS) and illicit drug use. Weekly automated feedback had no effect on behavior change. Findings provide evidence of change in CAS and illicit drug use amongst diary participants.
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Affiliation(s)
- Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Suite 2700, Chicago, IL, 60611, USA.
| | - Gregory Swann
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Suite 2700, Chicago, IL, 60611, USA
| | - David Mohr
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Suite 2700, Chicago, IL, 60611, USA
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Kelley ML, Ehlke SJ, Lewis RJ, Braitman AL, Bostwick W, Heron KE, Lau-Barraco C. Sexual Coercion, Drinking to Cope Motives, and Alcohol-Related Consequences among Self-Identified Bisexual Women. Subst Use Misuse 2018; 53:1146-1157. [PMID: 29278972 PMCID: PMC5935574 DOI: 10.1080/10826084.2017.1400565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Given higher sexual victimization and greater alcohol use among bisexual women, a critical public health challenge is to understand within-group variation that may heighten or explain these associations in bisexual women. OBJECTIVES The present study tested a moderated-mediation model in which sexual coercion was hypothesized to be associated with alcohol-related consequences via drinking to cope motives in self-identified bisexual women who reported at least occasional binge drinking. Negative affect was hypothesized to moderate the sexual coercion-drinking to cope motives association. METHODS Participants were a community sample of 107 self-identified bisexual women (age M = 20.97, SD = 2.11) who completed an online survey and reported at least one binge drinking episode as well as engaging in sexual activity in the past 30 days. RESULTS Of these participants, 57 (53.3%) reported one or more experiences of sexual coercion in the past 30 days. Sexual coercion was associated with negative alcohol-related consequences via drinking to cope motives. Negative affect moderated the association between sexual coercion and drinking to cope motives such that the association was stronger among women with greater negative affect. Conclusions/Importance: Methods of addressing vulnerability to sexual coercion and educating young bisexual women about the association between sexual coercion and potentially problematic affective coping through alcohol use are needed.
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Affiliation(s)
- Michelle L. Kelley
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia, USA
| | - Sarah J. Ehlke
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
| | - Robin J. Lewis
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia, USA
| | - Abby L. Braitman
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
| | - Wendy Bostwick
- Health Systems Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kristin E. Heron
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia, USA
| | - Cathy Lau-Barraco
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia, USA
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84
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Coulter RWS, Bersamin M, Russell ST, Mair C. The Effects of Gender- and Sexuality-Based Harassment on Lesbian, Gay, Bisexual, and Transgender Substance Use Disparities. J Adolesc Health 2018; 62:688-700. [PMID: 29241986 PMCID: PMC5963978 DOI: 10.1016/j.jadohealth.2017.10.004] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE We tested three competing models about whether gender- and sexuality-based harassment at school have nonindependent, additive, or interactive effects on adolescents' electronic cigarette use (i.e., vaping), cigarette smoking, alcohol use, and heavy episodic drinking (HED). We also tested whether harassment mediated substance use disparities between lesbian, gay, bisexual, transgender (LGBT) adolescents and their cisgender heterosexual peers. METHODS We analyzed cross-sectional data from the 2013-2014 California Healthy Kids Survey, including 316,766 students in grades 7, 9, and 11 from more than 1,500 middle and high schools. We used logistic regression models and interaction terms to estimate associations of past-year gender- and sexuality-based harassment at school on past-month substance use, and the Karlson-Holm-Breen method to test whether harassment mediated LGBT disparities in substance use. RESULTS Vaping, smoking, drinking, HED, and gender- and sexuality-based harassment were higher for transgender adolescents than for cisgender males and females, and for adolescents who were lesbian, gay, or bisexual only versus heterosexual only. Gender- and sexuality-based harassments were independently associated with greater odds of using each substance in every grade. These two types of harassment had positive interactions with each other for vaping in grade 11, smoking in grade 11, and HED in grades 9 and 11. Gender- and sexuality-based harassment significantly mediated many of the LGBT disparities in substance use. CONCLUSIONS Gender- and sexuality-based harassment at school independently or interactively produced LGBT disparities in substance use. Reducing these types of discrimination in schools will likely mitigate these disparities.
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Affiliation(s)
- Robert W S Coulter
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; Clinical and Translational Science Institute, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.
| | - Melina Bersamin
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
| | - Stephen T Russell
- Department of Human Development and Family Sciences, Population Research Center, University of Texas at Austin, Austin, Texas
| | - Christina Mair
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Risk and Protective Factors for Substance Use among Sexual and Gender Minority Youth: A Scoping Review. CURRENT ADDICTION REPORTS 2018; 5:158-173. [PMID: 30393591 DOI: 10.1007/s40429-018-0196-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose of Review Alcohol and drug use are common among youth. Rates are especially high among sexual and gender minority youth (SGMY; lesbian, gay, bisexual, transgender). We conducted a scoping review of research on risk and protective factors for substance use among SGMY published between 2013-2017. Recent Findings Ninety-seven studies met our inclusion criteria. Most focused on individual-level minority stress risk factors, particularly stigma. Fewer studies addressed protective factors such as social support or affirming policies, and few focused on gender minority youth (GMY). We identified important, yet understudied differences by race/ethnicity, sex assigned at birth, and sexual orientation. Summary Findings highlight growing interest in this topic as well as methodological/topical gaps in the literature. Research is needed to examine SGMY substance use in nationally representative samples; expand information about GMY; investigate racial/ethnic and sex/gender differences; improve measurement; and increase translation of findings to support prevention and treatment interventions for this at-risk population.
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86
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Coulter RWS, Mair C, Miller E, Blosnich JR, Matthews DD, McCauley HL. Prevalence of Past-Year Sexual Assault Victimization Among Undergraduate Students: Exploring Differences by and Intersections of Gender Identity, Sexual Identity, and Race/Ethnicity. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 18:726-736. [PMID: 28210919 DOI: 10.1007/s11121-017-0762-8] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A critical step in developing sexual assault prevention and treatment is identifying groups at high risk for sexual assault. We explored the independent and interaction effects of sexual identity, gender identity, and race/ethnicity on past-year sexual assault among college students. From 2011 to 2013, 71,421 undergraduate students from 120 US post-secondary education institutions completed cross-sectional surveys. We fit multilevel logistic regression models to examine differences in past-year sexual assault. Compared to cisgender (i.e., non-transgender) men, cisgender women (adjusted odds ratios [AOR] = 2.47; 95% confidence interval [CI] 2.29, 2.68) and transgender people (AOR = 3.93; 95% CI 2.68, 5.76) had higher odds of sexual assault. Among cisgender people, gays/lesbians had higher odds of sexual assault than heterosexuals for men (AOR = 3.50; 95% CI 2.81, 4.35) but not for women (AOR = 1.13; 95% CI 0.87, 1.46). People unsure of their sexual identity had higher odds of sexual assault than heterosexuals, but effects were larger among cisgender men (AOR = 2.92; 95% CI 2.10, 4.08) than cisgender women (AOR = 1.68; 95% CI 1.40, 2.02). Bisexuals had higher odds of sexual assault than heterosexuals with similar magnitude among cisgender men (AOR = 3.19; 95% CI 2.37, 4.27) and women (AOR = 2.31; 95% CI 2.05, 2.60). Among transgender people, Blacks had higher odds of sexual assault than Whites (AOR = 8.26; 95% CI 1.09, 62.82). Predicted probabilities of sexual assault ranged from 2.6 (API cisgender men) to 57.7% (Black transgender people). Epidemiologic research and interventions should consider intersections of gender identity, sexual identity, and race/ethnicity to better tailor sexual assault prevention and treatment for college students.
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Affiliation(s)
- Robert W S Coulter
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261, USA. .,Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Christina Mair
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - John R Blosnich
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Veterans Affairs, Center for Health Equity Research and Promotion, Pittsburgh, PA, USA
| | - Derrick D Matthews
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Heather L McCauley
- Department of Human Development and Family Studies, College of Social Science, Michigan State University, East Lansing, MI, USA
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87
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Coulter RWS, Jun HJ, Calzo JP, Truong NL, Mair C, Markovic N, Charlton BM, Silvestre AJ, Stall R, Corliss HL. Sexual-orientation differences in alcohol use trajectories and disorders in emerging adulthood: results from a longitudinal cohort study in the United States. Addiction 2018; 113:10.1111/add.14251. [PMID: 29679419 PMCID: PMC6667315 DOI: 10.1111/add.14251] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/26/2017] [Accepted: 04/06/2018] [Indexed: 01/12/2023]
Abstract
AIMS We estimated sexual-orientation differences in alcohol use trajectories during emerging adulthood, and tested whether alcohol use trajectories mediated sexual-orientation differences in alcohol use disorders (AUDs). DESIGN Longitudinal self-reported survey data from the Growing Up Today Study. SETTING United States. PARTICIPANTS A total of 12 493 participants aged 18-25 during the 2003, 2005, 2007 or 2010 surveys. MEASUREMENTS Stratified by gender, longitudinal latent class analyses estimated alcohol use trajectories (using past-year frequency, quantity and binge drinking from 2003 to 2010). Multinomial logistic regression tested differences in trajectory class memberships by sexual orientation [comparing completely heterosexual (CH) participants with sexual-minority subgroups: mainly heterosexual (MH), bisexual (BI) and gay/lesbian (GL) participants]. Modified Poisson regression and mediation analyses tested whether trajectories explained sexual-orientation differences in AUDs (past-year DSM-IV abuse/dependence in 2010). FINDINGS Six alcohol use trajectory classes emerged for women and five for men: these included heavy (23.5/36.9% of women/men), moderate (31.8/26.4% of women/men), escalation to moderately heavy (9.7/12.0% of women/men), light (17.0% for women only), legal (drinking onset at age 21; 11.1/15.7% of women/men) and non-drinkers (7.0/9.1% of women/men). Compared with CH women, MH and BI women had higher odds of being heavy, moderate, escalation to moderately heavy and light drinkers versus non-drinkers (odds ratios = 2.02-3.42; P-values < 0.01-0.04). Compared with CH men, MH men had higher odds of being heavy, moderate and legal drinkers versus non-drinkers (odds ratios = 2.24-3.34; P-values < 0.01-0.01). MH men and women, BI women and GLs had higher risk of AUDs in 2010 than their same-gender CH counterparts (risk ratios = 1.34-2.17; P-values < 0.01). Alcohol use trajectories mediated sexual-orientation differences in AUDs for MH and GL women (proportion of effect mediated = 30.8-31.1%; P-values < 0.01-0.02), but not for men. CONCLUSIONS In the United States, throughout emerging adulthood, several sexual-minority subgroups appear to have higher odds of belonging to heavier alcohol use trajectories than completely heterosexuals. These differences partially explained the higher risk of alcohol use disorders among mainly heterosexual and gay/lesbian women but not among sexual-minority men.
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Affiliation(s)
- Robert W. S. Coulter
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Division of Adolescent and Young Adult Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hee-Jin Jun
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Jerel P. Calzo
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Nhan L. Truong
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Christina Mair
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nina Markovic
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brittany M. Charlton
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anthony J. Silvestre
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ron Stall
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Heather L. Corliss
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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88
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Parent MC, Bradstreet TC. Sexual orientation, bullying for being labeled gay or bisexual, and steroid use among US adolescent boys. J Health Psychol 2018; 23:608-617. [PMID: 28810404 PMCID: PMC10704393 DOI: 10.1177/1359105317692144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023] Open
Abstract
Use of anabolic-androgenic steroids is a public health concern for adolescent boys. This study examined bullying based on being labeled gay/bisexual and steroid use among US adolescent boys, including sexual orientation disparities. Data from 2660 boys from the 2015 Youth Behavior Risk Survey were used. Among heterosexual boys, steroid use was higher among those who reported being bullied due to being labeled gay or bisexual. No such relationship existed among non-heterosexual boys. The results speak to the need to address issues of masculinity in clinical work with boys and young men.
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89
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Fish JN, Pollitt AM, Schulenberg JE, Russell ST. Measuring alcohol use across the transition to adulthood: Racial/ethnic, sexual identity, and educational differences. Addict Behav 2018; 77:193-202. [PMID: 29055208 PMCID: PMC5701868 DOI: 10.1016/j.addbeh.2017.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 10/01/2017] [Accepted: 10/09/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patterns of alcohol use change from adolescence to adulthood and may differ based on race/ethnicity, sexual identity, and education. If alcohol use measures do not operate consistently across groups and developmental periods, parameter estimates and conclusions may be biased. OBJECTIVES To test the measurement invariance of a multi-item alcohol use measure across groups defined by race/ethnicity, sexual identity, and college education during the transition to adulthood. METHODS Using three waves from the National Longitudinal Study of Adolescent to Adult Health, we tested configural, metric, and scalar invariance of a 3-item alcohol use measure for groups defined by race/ethnicity, sexual identity, and college education at three points during the transition to adulthood. We then assessed longitudinal measurement invariance to test the feasibility of modeling developmental changes in alcohol use within groups defined by these characteristics. RESULTS Overall, findings confirm notable variability in the construct reliability of a multi-item alcohol use measure during the transition to adulthood. The alcohol use measure failed tests of metric and scalar invariance, increasingly across ages, both between- and within-groups defined by race/ethnicity, sexual identity, and college education, particularly among females. CONCLUSIONS Measurement testing is a critical step when utilizing multi-item measures of alcohol use. Studies that do not account for the effects of group or longitudinal measurement non-invariance may be statistically biased, such that recommendations for risk and prevention efforts could be misguided.
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Affiliation(s)
- Jessica N Fish
- Population Research Center, University of Texas at Austin, 305 E. 23rd St., Stop G1800, Austin, TX 78712, United States.
| | - Amanda M Pollitt
- Norton School of Family and Consumer Sciences, University of Arizona, 650 N. Park Ave., Tucson, AZ 85721-0078, United States.
| | - John E Schulenberg
- Institute for Social Research and Department of Psychology, University of Michigan, 426 Thompson St., Ann Arbor, MI 48106-1248, United States.
| | - Stephen T Russell
- Human Development and Family Sciences, University of Texas at Austin, 108 E. Dean Keeton St., Stop A2702, Austin, TX 78712, United States.
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90
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Fish JN, Hughes TL. Alcohol Expectancies, Heavy Drinking, and Indicators of Alcohol Use Disorders in a Community-Based Sample of Lesbian and Bisexual Women. LGBT Health 2018; 5:105-111. [PMID: 29297753 DOI: 10.1089/lgbt.2017.0145] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The aim of this study was to examine the associations among alcohol expectancies, heavy episodic drinking (HED), and indicators of alcohol abuse and dependence in a community sample of lesbian and bisexual women. METHODS We used adjusted logistic regression models to assess associations between alcohol expectancies and alcohol-related outcomes. RESULTS Drinking expectancies were positively related to outcomes. Expectancies of "forgetting worries when depressed" were positively related to HED, whereas expectancies of increased aggression and ability to express anger were positively related to indicators of alcohol abuse and dependence. Associations did not differ by sexual identity or race/ethnicity. CONCLUSION These findings suggest that alcohol expectancies are an important factor in determining risk for alcohol misuse/abuse among lesbian and bisexual women that could inform prevention, intervention, and treatment efforts.
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Affiliation(s)
- Jessica N Fish
- 1 Population Research Center, University of Texas at Austin , Austin, Texas.,2 Department of Human Development and Family Sciences, University of Texas at Austin , Austin, Texas
| | - Tonda L Hughes
- 3 School of Nursing, Columbia University , New York, New York
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91
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Day JK, Fish JN, Perez-Brumer A, Hatzenbuehler ML, Russell ST. Transgender Youth Substance Use Disparities: Results From a Population-Based Sample. J Adolesc Health 2017; 61:729-735. [PMID: 28942238 PMCID: PMC6802742 DOI: 10.1016/j.jadohealth.2017.06.024] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/26/2017] [Accepted: 06/29/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to examine rates of substance use between transgender and nontransgender youth using a representative population-based sample and to examine mediating risk factors. METHODS A statewide cross-sectional sample of California middle and high schools collected between 2013 and 2015. This representative sample of students in California included 335 transgender and 31,737 nontransgender youth. Using multivariate linear and logistic regression, we assessed differences between transgender and nontransgender youth in substance use behaviors related to alcohol, cigarette, marijuana, other illicit drugs, polysubstance use, and heavy episodic drinking. Substance use was assessed with lifetime use, age of onset, and past 30-day use for alcohol, cigarettes, and marijuana. Past 30-day use was also assessed for other illicit drugs and polysubstance use. Models were adjusted for demographics and risk factors including victimization, depressive symptoms, and perceived risk of substance use. RESULTS The prevalence of substance use was 2.5-4 times higher for transgender youth compared with their nontransgender peers (depending on the substance). Transgender youth were also at greater risk for early age of onset and recent substance use than nontransgender youth. In addition, psychosocial risk factors related to victimization, depressive symptoms, and perceived risk of substance use partially mediated the relationship between gender identity and substance use. CONCLUSIONS Using data from the first representative study of youth to include a measure of gender identity, we show that transgender youth are at heightened risk for substance use compared with nontransgender peers. Future research is needed to identify the structural and psychosocial mechanisms that drive these disparities.
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Affiliation(s)
- Jack K Day
- Population Research Center, Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, Texas.
| | - Jessica N Fish
- Population Research Center, Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, Texas
| | - Amaya Perez-Brumer
- Population Research Center, Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, Texas
| | - Mark L Hatzenbuehler
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, New York
| | - Stephen T Russell
- Population Research Center, Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, Texas
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92
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Fish JN, Watson RJ, Porta CM, Russell ST, Saewyc EM. Are alcohol-related disparities between sexual minority and heterosexual youth decreasing? Addiction 2017; 112:1931-1941. [PMID: 28678415 PMCID: PMC5633511 DOI: 10.1111/add.13896] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/26/2017] [Accepted: 05/26/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS Although sexual orientation-related alcohol use disparities are well established, researchers have not identified whether disparities are diminishing as societal attitudes towards lesbian/gay and bisexual (LGB) people become more accepting. We examined changes in four alcohol-related disparities between heterosexual and LGB youth from 1998 to 2013 by (1) estimating the prevalence of these behaviors; (2) estimating disparities in alcohol-related outcomes between heterosexual and LGB youth within each wave year; and (3) testing whether the degree of difference in alcohol-related disparities between heterosexual and LGB youth has changed. DESIGN Logistic regression models and year × sexual orientation interactions with repeated, cross-sectional, provincially representative data. SETTING British Columbia, Canada. PARTICIPANTS Students (ages 12-19) from the 1998 (n = 22 858), 2003 (n = 29 323), 2008 (n = 25 254) and 2013 (n = 21 938) British Columbia Adolescent Health Survey (total n = 99 373, 48.7% male, mean age = 14.84). MEASUREMENTS We modeled age-adjusted differences in life-time alcohol use, age of onset, past 30-day drinking and past 30-day heavy episodic drinking between heterosexual and three subgroups of sexual minority youth (i.e. mostly heterosexual, bisexual and lesbian/gay). FINDINGS Generally, alcohol use declined for all youth, although less so among LGB youth [average adjusted odds ratio (aOR) = 0.58 and aOR = 0.53 for heterosexual males and females and aOR = 0.71 and aOR = 0.57 for sexual minority males and females, respectively). Within-year comparisons demonstrated elevated rates of alcohol use among LGB compared with heterosexual youth for each of the four survey years, especially among females. Findings indicate few changes over time; however, results show an increase in risky alcohol use from 1998 to 2013 among mostly heterosexual (aOR = 1.58 for life-time alcohol use, aOR = 1.58 for 30-day alcohol use and aOR = 1.34 for 30-day heavy episodic drinking), and bisexual (aOR = 1.95 for life-time alcohol use) females. CONCLUSION Despite the general decline in the prevalence of alcohol use among young people in Canada since 1998, lesbian/gay and bisexual youth in Canada continue to show elevated rates of alcohol use compared with heterosexual youth.
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Affiliation(s)
- Jessica N. Fish
- Corresponding Author, Population Research Center, University of
Texas at Austin, 305 E. 23 St., Stop G1800, Austin, TX 78712,
, PH: 512-471-4270, F:
512-471-4886
| | - Ryan J. Watson
- Department of Human Development and Family Studies, University of
Connecticut, 348 Mansfield Road, U-1058, Storrs, CT 06269
| | - Carolyn M. Porta
- School of Nursing, University of Minnesota, School of Nursing, Mail
Stop 1331 5-140 WDH, 308 Harvard St. SE, Minneapolis, MN 55455
| | - Stephen T. Russell
- Human Development and Family Sciences, University of Texas at
Austin, 108 E. Dean Keeton St., Stop A2702, Austin, TX, 78712
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93
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Lowry R, Johns MM, Robin LE, Kann LK. Social Stress and Substance Use Disparities by Sexual Orientation Among High School Students. Am J Prev Med 2017; 53:547-558. [PMID: 28826950 DOI: 10.1016/j.amepre.2017.06.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 05/17/2017] [Accepted: 06/09/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Sexual minority youth often experience increased social stress due to prejudice, discrimination, harassment, and victimization. Increased stress may help explain the disproportionate use of substances like tobacco, alcohol, marijuana, and other illicit drug use by sexual minority youth. This study examined the effect of social stress on substance use disparities by sexual orientation among U.S. high school students. METHODS In 2016, data from the national 2015 Youth Risk Behavior Survey, conducted among a nationally representative sample of 15,624 U.S. high school students, were analyzed to examine the effect of school-related (threatened/injured at school, bullied at school, bullied electronically, felt unsafe at school) and non-school-related (forced sexual intercourse, early sexual debut) social stress on substance use disparities by sexual orientation, by comparing unadjusted prevalence ratios (PRs) and adjusted (for social stressors, age, sex, and race/ethnicity) prevalence ratios (APRs). RESULTS Unadjusted PRs reflected significantly (p<0.05 or 95% CI did not include 1.0) greater substance use among students who identified as lesbian/gay or bisexual than students who identified as heterosexual. APRs for injection drug use decreased substantially among lesbian/gay (PR=12.02 vs APR=2.14) and bisexual (PR=2.62 vs APR=1.18) students; the APR for bisexual students became nonsignificant. In addition, APRs among both lesbian/gay and bisexual students decreased substantially and were no longer statistically significant for cocaine, methamphetamine, and heroin use. CONCLUSIONS School-based substance use prevention programs might appropriately include strategies to reduce social stress, including policies and practices designed to provide a safe school environment and improved access to social and mental health services.
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Affiliation(s)
- Richard Lowry
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Michelle M Johns
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leah E Robin
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laura K Kann
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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94
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Swann G, Bettin E, Clifford A, Newcomb ME, Mustanski B. Trajectories of alcohol, marijuana, and illicit drug use in a diverse sample of young men who have sex with men. Drug Alcohol Depend 2017; 178:231-242. [PMID: 28667941 PMCID: PMC5616183 DOI: 10.1016/j.drugalcdep.2017.05.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 05/04/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Cross-sectional research has found that young men who have sex with men (YMSM) are more likely to engage in heavy drinking and to have higher rates of marijuana and other illicit drug use compared to their heterosexual peers, but considerably less is known about their patterns of substance use over time. METHODS In this study, we combined two longitudinal samples of racially diverse YMSM (N=552) and modeled their substance use trajectories from late-adolescence to young adulthood, including their frequency of alcohol use, frequency of marijuana use, and poly-drug use, using piecewise latent curve growth modeling to model change from ages 17-21 and change from ages 22-24. RESULTS We found that all three substance use behaviors increased linearly over the adolescent-to-adult transition. The trajectories for all three substance use behaviors were significantly correlated from ages 17-21. Black YMSM had significantly lower growth from ages 17-21 in alcohol, marijuana, and poly-drug use compared to White YMSM. Hispanic/Latino YMSM had significantly higher growth from ages 22-24 in alcohol use but significantly lower growth in poly-drug use compared to White YMSM. YMSM with higher alcohol frequency slopes and YMSM with higher marijuana use slopes were more likely to have alcohol-related and marijuana-related problems, respectively, at the last wave of the study. CONCLUSIONS The results of the present study suggest that the transition from adolescence to adulthood for YMSM is a time of increasing and co-varying substance use and may be a critical period for substance use behaviors to grow into substance use problems.
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Affiliation(s)
| | | | | | | | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, United States.
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95
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Phillips G, Turner B, Salamanca P, Birkett M, Hatzenbuehler ML, Newcomb ME, Marro R, Mustanski B. Victimization as a mediator of alcohol use disparities between sexual minority subgroups and sexual majority youth using the 2015 National Youth Risk Behavior Survey. Drug Alcohol Depend 2017; 178:355-362. [PMID: 28692946 PMCID: PMC5555415 DOI: 10.1016/j.drugalcdep.2017.05.040] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/18/2017] [Accepted: 05/18/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Alcohol use among underage youth is a significant public health concern. According to the National Institute on Alcohol Abuse and Alcoholism, alcohol is the "drug of choice" among adolescents, meaning more youth use and abuse alcohol than any other substance. Prevalence of alcohol use is disproportionately higher among sexual minority youth (SMY) than among their heterosexual peers. We examined sexual identity and sexual behavior disparities in alcohol use, and the mediational role of bullying in a sample of high school students. METHODS Data from the 2015 National Youth Risk Behavior Survey were used to assess the association between sexual minority status (identity and behavior) and alcohol use with weighted logistic regression. Due to well-documented differences between males and females, we stratified models by gender. Physical and cyberbullying were examined as mediators of the relationship between sexual minority status and alcohol use. RESULTS We detected associations between certain subgroups of sexual minority youth and alcohol use across all four drinking variables (ever drank alcohol, age at first drink, current alcohol use, and binge drinking). Most of these associations were found among bisexual-identified youth and students with both male and female sexual partners; these individuals had up to twice the odds of engaging in alcohol use behaviors when compared with sexual majority students. Associations were strongest among females. Bullying mediated sexual minority status and alcohol use only among bisexual females. CONCLUSIONS As disparities in alcohol use differ by gender, sexual identity, and sexual behavior, interventions should be targeted accordingly.
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Affiliation(s)
- Gregory Phillips
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA.
| | - Blair Turner
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA
| | - Paul Salamanca
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA
| | - Michelle Birkett
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA
| | - Mark L Hatzenbuehler
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th St., New York City, NY 10032, USA
| | - Michael E Newcomb
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA
| | - Rachel Marro
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA
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96
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Newcomb ME, Macapagal KR, Feinstein BA, Bettin E, Swann G, Whitton SW. Integrating HIV Prevention and Relationship Education for Young Same-Sex Male Couples: A Pilot Trial of the 2GETHER Intervention. AIDS Behav 2017; 21:2464-2478. [PMID: 28083833 DOI: 10.1007/s10461-017-1674-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Young men who have sex with men are at high risk for HIV, and most new HIV infections occur in serious relationships. This pilot study assessed the feasibility, acceptability and preliminary efficacy of the 2GETHER couples-based HIV prevention and relationship education intervention for young same-sex male couples. We enrolled 57 young male couples (N = 114) into a four-session hybrid group and individual intervention. We assessed acceptability via post-session surveys and exit interviews, and we examined preliminary efficacy at a two week posttest. The vast majority of participants (93%) reported exclusively positive impressions of 2GETHER, and all components received high mean ratings. We observed decreases in HIV risk behavior, increases in information, motivation and behavioral skills related to HIV prevention, and improvement in relationship investment between pretest and posttest. Integrating relationship education and sexual health programming may be an effective way to reduce HIV transmissions in young male couples.
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Affiliation(s)
- Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Kathryn R Macapagal
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Brian A Feinstein
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Emily Bettin
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Gregory Swann
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sarah W Whitton
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
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97
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Feinstein BA, Newcomb ME. Event-Level Associations Among Drinking Motives, Alcohol Consumption, and Condomless Anal Sex in a Sample of Young Men Who Have Sex With Men. AIDS Behav 2017; 21:1904-1913. [PMID: 28251377 PMCID: PMC5493499 DOI: 10.1007/s10461-017-1734-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Young men who have sex with men (YMSM) are at increased risk for HIV and problematic alcohol use. Drinking motives are associated with alcohol use in cross-sectional studies, but their associations with alcohol use and condomless anal sex (CAS) at the event-level remain unclear. The current study examined these event-level associations in a sample of 189 YMSM who completed self-report measures on a daily or weekly basis for two months. Participants were recruited between August 2014 and April 2015 for a randomized trial designed to study behavioral reactivity in diary studies. YMSM consumed more alcohol on days when they drank to cope, to enhance pleasure, or to be more social. CAS with casual partners was more likely on days when they consumed more alcohol. Drinking motives were not associated with CAS. Interventions may benefit from addressing drinking motives and the influence of alcohol use on CAS in different types of relationships.
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Affiliation(s)
- Brian A Feinstein
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave, Suite 2700, Chicago, IL, 60611, USA.
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA.
| | - Michael E Newcomb
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave, Suite 2700, Chicago, IL, 60611, USA
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA
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98
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Rodgers SM. Transitional Age Lesbian, Gay, Bisexual, Transgender, and Questioning Youth: Issues of Diversity, Integrated Identities, and Mental Health. Child Adolesc Psychiatr Clin N Am 2017; 26:297-309. [PMID: 28314457 DOI: 10.1016/j.chc.2016.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Although most LGBTQ youth become healthy young adults, they often face considerable stress over the course of their lives because of bullying, victimization, and overt/covert discrimination. Families, educational and religious institutions, health care professionals, and communities help shape the experience of LGBTQ transitional age youth. LGBTQ youth have higher rates of depression, suicide, anxiety, posttraumatic stress disorder, alcohol and drug use, and preventable sexually transmitted diseases. When best practice guidelines are followed and key stakeholders take action to support LGBTQ youth, health disparities begin to disappear. Much can be done to change the trajectory for LGBTQ youth through advocacy, education, culturally competent health care, and policy-making.
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Affiliation(s)
- Scott M Rodgers
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
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De Kock C, Decorte T, Vanderplasschen W, Derluyn I, Sacco M. Studying ethnicity, problem substance use and treatment: From epidemiology to social change. DRUGS: EDUCATION, PREVENTION AND POLICY 2017. [DOI: 10.1080/09687637.2016.1239696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Charlotte De Kock
- Department of Criminology Penal Law and Social Law, Institute for Social Drug Research (ISD),
| | - Tom Decorte
- Department of Criminology Penal Law and Social Law, Institute for Social Drug Research (ISD),
| | | | - Ilse Derluyn
- Department of Social Work and social pedagogy, Ghent University, Ghent, Belgium, and
| | - Muriel Sacco
- Institut de sociologie, GERME, Université Libre de Bruxelles, Brussels, Belgium
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100
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Mustanski B, Madkins K, Greene GJ, Parsons JT, Johnson BA, Sullivan P, Bass M, Abel R. Internet-Based HIV Prevention With At-Home Sexually Transmitted Infection Testing for Young Men Having Sex With Men: Study Protocol of a Randomized Controlled Trial of Keep It Up! 2.0. JMIR Res Protoc 2017; 6:e1. [PMID: 28062389 PMCID: PMC5251167 DOI: 10.2196/resprot.5740] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/26/2016] [Accepted: 11/23/2016] [Indexed: 12/03/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) infections are increasing among young men who have sex with men (YMSM), yet few HIV prevention programs have studied this population. Keep It Up! (KIU!), an online HIV prevention program tailored to diverse YMSM, was developed to fill this gap. The KIU! 2.0 randomized controlled trial (RCT) was launched to establish intervention efficacy. Objective The objective of the KIU! study is to advance scientific knowledge of technology-based behavioral HIV prevention, as well as improve public health by establishing the efficacy of an innovative electronic health (eHealth) prevention program for ethnically and racially diverse YMSM. The intervention is initiated upon receipt of a negative HIV test result, based on the theory that testing negative is a teachable moment for future prevention behaviors. Methods This is a two-group, active-control RCT of the online KIU! intervention. The intervention condition includes modules that use videos, animation, games, and interactive exercises to address HIV knowledge, motivation for safer behaviors, self-efficacy, and behavioral skills. The control condition reflects HIV information that is readily available on many websites, with the aim to understand how the KIU! intervention improves upon information that is currently available online. Follow-up assessments are administered at 3, 6, and 12 months for each arm. Testing for urethral and rectal sexually transmitted infections (STIs) is completed at baseline and at 12-month follow-up for all participants, and at 3- and 6-month follow-ups for participants who test positive at baseline. The primary behavioral outcome is unprotected anal sex at all follow-up points, and the primary biomedical outcome is incident STIs at 12-month follow-up. Results Consistent with study aims, the KIU! technology has been successfully integrated into a widely-used health technology platform. Baseline enrollment for the RCT was completed on December 30, 2015 (N=901), and assessment of intervention outcomes is ongoing at 3-, 6-, and 12-month time points. Upon collection of all data, and after the efficacy of the intervention has been evaluated, we will explore whether the KIU! intervention has differential efficacy across subgroups of YMSM based on ethnicity/race and relationship status. Conclusions Our approach is innovative in linking an eHealth solution to HIV and STI home testing, as well as serving as a model for integrating scalable behavioral prevention into other biomedical prevention strategies. Trial Registration Clinicaltrials.gov NCT01836445; https://clinicaltrials.gov/ct2/show/NCT01836445 (Archived by WebCite at http://www.webcitation.org/6myMFlxnC)
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Affiliation(s)
- Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Krystal Madkins
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - George J Greene
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Jeffrey T Parsons
- Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States.,Graduate Center of the City University, New York, NY, United States
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United States
| | - Patrick Sullivan
- Department of Epidemiology, Emory University, Atlanta, GA, United States
| | - Michael Bass
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Rebekah Abel
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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