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Donahue K, Långström N, Lundström S, Lichtenstein P, Forsman M. Familial Factors, Victimization, and Psychological Health Among Sexual Minority Adolescents in Sweden. Am J Public Health 2016; 107:322-328. [PMID: 27997235 DOI: 10.2105/ajph.2016.303573] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the influences of victimization experience and familial factors on the association between sexual minority status and psychological health outcomes among adolescents. METHODS We used data from the Child and Adolescent Twin Study in Sweden, a prospective, population-based study of all twins born in Sweden since 1992. Cross-sectional analyses included individuals who completed assessments at age 18 years (n = 4898) from 2000 to 2013. We also compared psychological health among sexual minority adolescents and their nonminority co-twins. RESULTS Sexual minority adolescents were more likely than were unrelated nonminority adolescents to report victimization experiences, including emotional abuse, physical abuse or neglect, and sexual abuse. Sexual minority adolescents also reported significantly more symptoms of anxiety, depression, attention-deficit/hyperactivity disorder, disordered eating, and substance misuse in addition to increased parent-reported behavior problems. Victimization experience partially mediated these associations. However, when controlling for unmeasured familial confounding factors by comparing sexual minority adolescents to their same-sex, nonminority co-twins, the effect of sexual minority status on psychological health was almost entirely attenuated. CONCLUSIONS Familial factors-common genetic or environmental influences-may explain decreased psychological adjustment among sexual minority adolescents.
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Affiliation(s)
- Kelly Donahue
- Kelly Donahue is with the Department of Pediatrics Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis. Niklas Långström, Paul Lichtenstein, and Mats Forsman are with the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Niklas Långström and Mats Forsman are also with the Swedish Prison and Probation Administration, Norrköping, Sweden. Sebastian Lundström is with the Centre for Ethics, Law and Mental Health and the Gillberg Neuropsychiatry Centre, Gothenburg University, Sweden
| | - Niklas Långström
- Kelly Donahue is with the Department of Pediatrics Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis. Niklas Långström, Paul Lichtenstein, and Mats Forsman are with the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Niklas Långström and Mats Forsman are also with the Swedish Prison and Probation Administration, Norrköping, Sweden. Sebastian Lundström is with the Centre for Ethics, Law and Mental Health and the Gillberg Neuropsychiatry Centre, Gothenburg University, Sweden
| | - Sebastian Lundström
- Kelly Donahue is with the Department of Pediatrics Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis. Niklas Långström, Paul Lichtenstein, and Mats Forsman are with the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Niklas Långström and Mats Forsman are also with the Swedish Prison and Probation Administration, Norrköping, Sweden. Sebastian Lundström is with the Centre for Ethics, Law and Mental Health and the Gillberg Neuropsychiatry Centre, Gothenburg University, Sweden
| | - Paul Lichtenstein
- Kelly Donahue is with the Department of Pediatrics Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis. Niklas Långström, Paul Lichtenstein, and Mats Forsman are with the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Niklas Långström and Mats Forsman are also with the Swedish Prison and Probation Administration, Norrköping, Sweden. Sebastian Lundström is with the Centre for Ethics, Law and Mental Health and the Gillberg Neuropsychiatry Centre, Gothenburg University, Sweden
| | - Mats Forsman
- Kelly Donahue is with the Department of Pediatrics Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis. Niklas Långström, Paul Lichtenstein, and Mats Forsman are with the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Niklas Långström and Mats Forsman are also with the Swedish Prison and Probation Administration, Norrköping, Sweden. Sebastian Lundström is with the Centre for Ethics, Law and Mental Health and the Gillberg Neuropsychiatry Centre, Gothenburg University, Sweden
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102
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Jeong YM, Veldhuis CB, Aranda F, Hughes TL. Racial/ethnic differences in unmet needs for mental health and substance use treatment in a community-based sample of sexual minority women. J Clin Nurs 2016; 25:3557-3569. [PMID: 27461857 PMCID: PMC5819990 DOI: 10.1111/jocn.13477] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To examine the unmet needs for mental health and substance use treatment among a diverse sample of sexual minority women (lesbian, bisexual). BACKGROUND Sexual minority women are more likely than heterosexual women to report depression and hazardous drinking. However, relatively little is known about sexual minority women's use of mental health or substance use treatment services, particularly about whether use varies by race/ethnicity. DESIGN Cross-sectional analysis of existing data. METHODS Analyses included data from 699 Latina, African American and white sexual minority women interviewed in wave 3 of the 17-year Chicago Health and Life Experiences of Women study. Using logistic regression, we examined the associations among sexual identity, race/ethnicity, use of mental health and substance use treatment, as well as potential unmet need for treatment. RESULTS Overall, women in the study reported high levels of depression and alcohol dependence, and these varied by sexual identity and race/ethnicity. Use of mental health and substance use treatment also varied by race/ethnicity, as did potential unmet need for both mental health and substance use treatment. CONCLUSIONS Our findings that suggest although use of treatment among sexual minority women is high overall, there is a potentially sizable unmet need for mental health and substance use treatment that varies by race/ethnicity, with Latina women showing the greatest unmet need for treatment. RELEVANCE TO CLINICAL PRACTICE Nurses and other healthcare providers should be aware of the high rates of depression and hazardous drinking among sexual minority women, understand the factors that may increase the risk of these conditions among sexual minority women, the potentially high unmet need for mental health and substance use treatment - perhaps particularly among Latina women and be equipped to provide culturally sensitive care or refer to appropriate treatment services as needed.
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Affiliation(s)
- Yoo Mi Jeong
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Cindy B Veldhuis
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
- Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, IL, USA
| | - Frances Aranda
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Tonda L Hughes
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
- Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, IL, USA
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103
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Willging CE, Green AE, Ramos MM. Implementing school nursing strategies to reduce LGBTQ adolescent suicide: a randomized cluster trial study protocol. Implement Sci 2016; 11:145. [PMID: 27770819 PMCID: PMC5075193 DOI: 10.1186/s13012-016-0507-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reducing youth suicide in the United States (U.S.) is a national public health priority, and lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) youth are at elevated risk. The Centers for Disease Control and Prevention (CDC) endorses six evidence-based (EB) strategies that center on meeting the needs of LGBTQ youth in schools; however, fewer than 6 % of U.S. schools implement all of them. The proposed intervention model, "RLAS" (Implementing School Nursing Strategies to Reduce LGBTQ Adolescent Suicide), builds on the Exploration, Preparation, Implementation, and Sustainment (EPIS) conceptual framework and the Dynamic Adaptation Process (DAP) to implement EB strategies in U.S. high schools. The DAP accounts for the multilevel context of school settings and uses Implementation Resource Teams (IRTs) to facilitate appropriate expertise, advise on acceptable adaptations, and provide data feedback to make schools implementation ready and prepared to sustain changes. METHODS/DESIGN Mixed methods will be used to examine individual, school, and community factors influencing both implementation process and youth outcomes. A cluster randomized controlled trial will assess whether LGBTQ students and their peers in RLAS intervention schools (n = 20) report reductions in suicidality, depression, substance use, bullying, and truancy related to safety concerns compared to those in usual care schools (n = 20). Implementation progress and fidelity for each EB strategy in RLAS intervention schools will be examined using a modified version of the Stages of Implementation Completion checklist. During the implementation and sustainment phases, annual focus groups will be conducted with the 20 IRTs to document their experiences identifying and advancing adaptation supports to facilitate use of EB strategies and their perceptions of the DAP. DISCUSSION The DAP represents a data-informed, collaborative, multiple stakeholder approach to progress from exploration to sustainment and obtain fidelity during the implementation of EB strategies in school settings. This study is designed to address the real-world implications of enabling the use of EB strategies by school nurses with the goal of decreasing suicide and youth risk behaviors among LGBTQ youth. Through its participatory processes to refine and sustain EB strategies in high schools, the RLAS represents a novel contribution to implementation science. TRIAL REGISTRATION ClinicalTrials.gov, NCT02875535.
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Affiliation(s)
- Cathleen E Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, 612 Encino Place NE, Albuquerque, NM, USA.
| | - Amy E Green
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, MC 0812, La Jolla, San Diego, CA, 92093, USA.,Child and Adolescent Services Research Center, 3665 Kearny Villa Road, San Diego, CA, 92123, USA
| | - Mary M Ramos
- Department of Pediatrics, University of New Mexico, MSC10 5590, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA
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104
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Wilson SM, Gilmore AK, Rhew IC, Hodge KA, Kaysen DL. Minority stress is longitudinally associated with alcohol-related problems among sexual minority women. Addict Behav 2016; 61:80-3. [PMID: 27249806 PMCID: PMC4915988 DOI: 10.1016/j.addbeh.2016.05.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/28/2016] [Accepted: 05/19/2016] [Indexed: 11/22/2022]
Abstract
Compared to sexual minority men and heterosexual women, sexual minority women report elevated alcohol use in young adulthood. Heavy alcohol use and alcohol use disorders disproportionately affect sexual minority women across the lifespan, yet there is limited research investigating reasons for such associations. The present study investigates longitudinal associations between minority stress and both alcohol use as well as self-rated drinking consequences. Participants (N=1057) were self-identified lesbian (40.5%) and bisexual (59.5%) women between the ages of 18 to 25 recruited from across the U.S. using online advertisements. Participants completed four annual surveys. Hurdle mixed effects models were used to assess associations between minority stress and typical weekly drinking and drinking consequences one year later. Minority stress was not significantly associated with subsequent typical drinking. However, minority stress was significantly associated with having any alcohol consequences as well as the count of alcohol consequences one year later after controlling for covariates. Consistent with extant literature, this study provides evidence for a prospective association between minority stress experienced by sexual minority women and drinking consequences. This study also provides support for the potential impact of efforts to reduce minority stress faced by sexual minority women.
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Affiliation(s)
- Sarah M Wilson
- VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham VA Medical Center, United States.
| | - Amanda K Gilmore
- Medical University of South Carolina, Department of Psychiatry & Behavioral Sciences, National Crime Victims Research and Treatment Center, United States
| | - Isaac C Rhew
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States
| | - Kimberley A Hodge
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States
| | - Debra L Kaysen
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States
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105
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Watts T, Wilson KL, McNeill EB, Rosen BL, Moore ND, Smith ML. Factors Associated With Intentions to Engage in Vaginal Intercourse Among Sexually Abstinent Missouri High School Freshmen. THE JOURNAL OF SCHOOL HEALTH 2016; 86:751-758. [PMID: 27619766 DOI: 10.1111/josh.12431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 02/22/2016] [Accepted: 03/28/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND We examine personal characteristics, alcohol consumption, normative beliefs, household factors, and extracurricular engagement associated with intentions to have intercourse before marriage among abstinent students. METHODS Data were analyzed from 245 freshmen enrolled in a school-based abstinence-only-until-marriage program. Two binary logistic regression analyses identified factors associated with intentions to engage in intercourse before marriage and within the next year. RESULTS Approximately 21% and 14% of participants reported intentions to have intercourse. Respondents participated in 2.2 (standard deviation [SD] = 1.2) extracurricular activities. Freshmen who were male, perceived their friends to approve of premarital sex, and consumed alcohol were more likely to report intentions to have intercourse. For every additional extracurricular activity in which freshmen participated, they were less likely to report intentions to have intercourse within the next year (odds ratio [OR] = 0.56). CONCLUSIONS Factors such as extracurricular activities provide youth with opportunities to build supportive relationships, connect with peers and role models, and positively engage in schools and communities. Extracurricular activities typically already exist, have funding, and are generally well-supported. School-based strategies can increase teenagers' autonomy by providing a variety of activities to participate in and reduce unsupervised time. This, in turn, has the potential to decrease sexual risk taking behaviors.
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Affiliation(s)
- Timothy Watts
- Baby and Me Tobacco Free Health Educator, Laurens County Health Department, Clinton, SC 29325.
| | - Kelly L Wilson
- Department of Health and Kinesiology, College Station, TX 77843-4243.
| | - Elisa B McNeill
- Department of Health and Kinesiology, College Station, TX 77843-4243.
| | - Brittany L Rosen
- School of Human Services, University of Cincinnati, PO Box 210068, Cincinnati, OH 45221.
| | - Nancy Daley Moore
- Department of Health and Exercise Sciences, Truman State University, 100 East Normal, Kirksville, MO 63501.
| | - Matthew L Smith
- Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA 30602.
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106
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Parent Perspectives About Sexual Minority Adolescent Participation in Research and Requirements of Parental Permission. J Adolesc Health 2016; 59:443-9. [PMID: 27469192 DOI: 10.1016/j.jadohealth.2016.05.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/20/2016] [Accepted: 05/20/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE Lesbian, gay, bisexual, transgender, and other sexual and gender minority (LGBTQ) adolescents and young adults experience health inequities relative to heterosexuals but may be reluctant to participate in research that requires guardian permission. Institutional review boards are often reluctant to approve studies without parental permission because of concerns about parent reactions. There is little to no data from the parent's perspective on these issues. We aimed to understand parent perspectives on parental permission requirements for minimal risk studies of LGBTQ health inequities. METHODS We conducted semistructured interviews with 31 parents of LGBTQ individuals. We presented a vignette describing an HIV behavioral surveillance protocol and assessed beliefs about whether parental permission should be required under various conditions (i.e., varying adolescent demographics, study procedures). RESULTS Most parents (74.2%) believed that parental permission should not be required, and this percent increased when considering adolescent participants for whom permission would be less feasible or potentially more dangerous (e.g., homeless adolescents). Qualitative analyses revealed that many parents were concerned about research quality and negative consequences for adolescents if permission was required. Others wanted to help support their child in making decisions about research and health care. CONCLUSIONS Most parents believed that parental permission should not be required for a minimal risk study, and the reasons for their beliefs fell squarely in line with federal regulations regarding adolescent self-consent to research. Studies of LGBTQ adolescent health inequities should receive waivers of parental permission to obtain representative samples and minimize risk of harm to the adolescent.
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107
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Abstract
Many studies, reviews, and meta-analyses have reported elevated mental health problems for sexual minority (SM) individuals. This systematic review provides an update by including numerous recent studies, and explores whether SM individuals are at increased risk across selected mental health problems as per dimensions of sexual orientation (SO), genders, life-stages, geographic regions, and in higher quality studies. A systematic search in PubMed produced 199 studies appropriate for review. A clear majority of studies reported elevated risks for depression, anxiety, suicide attempts or suicides, and substance-related problems for SM men and women, as adolescents or adults from many geographic regions, and with varied SO dimensions (behaviour, attraction, identity), especially in more recent and higher quality studies. One notable exception is alcohol-related problems, where many studies reported zero or reversed effects, especially for SM men. All SM subgroups were at increased risk, but bisexual individuals were at highest risk in the majority of studies. Other subgroup and gender differences are more complex and are discussed. The review supports the long-standing mental health risk proposition for SM individuals, overall and as subgroups.
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Affiliation(s)
- Martin Plöderl
- a Department of Suicide Prevention , University Clinic of Psychiatry and Psychotherapy, University Institute of Clinical Psychology, Christian Doppler Clinic, Paracelsus Medical University , Salzburg , Austria
| | - Pierre Tremblay
- b Faculty of Social Work, University of Calgary , Calgary, Alberta , Canada
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108
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Kuyper L, de Roos S, Iedema J, Stevens G. Growing Up With the Right to Marry: Sexual Attraction, Substance Use, and Well-Being of Dutch Adolescents. J Adolesc Health 2016; 59:276-282. [PMID: 27423901 DOI: 10.1016/j.jadohealth.2016.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/30/2016] [Accepted: 05/16/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the well-being and substance use of sexual minority adolescents growing up in a tolerant society, we examined differences among same-sex attracted (SSA), those who do not know their attraction yet (not yet attracted [NYA]), and heterosexual Dutch adolescents. METHODS Unadjusted and adjusted logistic and linear multilevel analyses were performed using representative data of the 2013 Health Behaviour in School-Aged Children study (N = 5,995; 11-16 years old). The adjusted analyses controlled for sociodemographics (gender, age, education type, ethnicity, urbanicity, and religion). RESULTS Adjusted results showed that SSA adolescents substantially more often reported alcohol use (adjusted odds ratio [AOR] = 2.01), tobacco smoking (AOR = 2.37), and cannabis smoking (AOR = 3.52) than their heterosexual peers, while NYA participants less often reported alcohol use (AOR = .57) and equal levels of tobacco (AOR = .71) and cannabis smoking (AOR = .87) compared with heterosexual adolescents. SSA adolescents reported lower levels of life satisfaction (b = -1.25) and higher levels of psychosomatic complaints (b = .61) and emotional problems (b = 1.57) than heterosexual adolescents. NYA adolescents reported equal levels of life satisfaction (b = -.18) and psychosomatic complaints (b = .06) as heterosexual adolescents, but higher levels of emotional problems (b = .51). CONCLUSIONS In Dutch society, with over 20 years of inclusive policies for sexual minorities and generally tolerant population attitudes toward sexual minorities, SSA adolescents are still at increased risk of substance use and have lower levels of well-being compared with peers.
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Affiliation(s)
- Lisette Kuyper
- Department of Education, Minorities and Methodology, The Netherlands Institute for Social Research, The Hague, The Netherlands; Research Institute of Child Development and Education, Faculty of Social and Behavioral Sciences, University of Amsterdam, Amsterdam, The Netherlands.
| | - Simone de Roos
- Department of Care, Emancipation, and Time Use, The Netherlands Institute for Social Research, The Hague, The Netherlands
| | - Jurjen Iedema
- Department of Education, Minorities and Methodology, The Netherlands Institute for Social Research, The Hague, The Netherlands
| | - Gonneke Stevens
- Utrecht Centre for Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
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109
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Dermody SS, Marshal MP, Burton CM, Chisolm DJ. Risk of heavy drinking among sexual minority adolescents: indirect pathways through sexual orientation-related victimization and affiliation with substance-using peers. Addiction 2016; 111:1599-606. [PMID: 27018582 PMCID: PMC4983238 DOI: 10.1111/add.13409] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/23/2015] [Accepted: 03/23/2016] [Indexed: 01/22/2023]
Abstract
AIMS To test two indirect pathways through which sexual minority adolescents (SMAs) may be at risk for heavy episodic drinking (HED) including a socialization pathway via substance-using peer affiliations and social marginalization pathway via sexual minority-specific victimization and subsequent substance-using peer affiliations. DESIGN Analysis of the first three waves (6 months apart) of a longitudinal adolescent health risk study (2011-14). Participants were referred by medical providers or a screening system in providers' waiting rooms. SETTING Two large urban adolescent health clinics in Pennsylvania and Ohio, USA. PARTICIPANTS A total of 290 adolescents (ages 14-19 years, mean: 17.08) who were 71.0% female, 33.4% non-Hispanic white and 34.5% SMAs. MEASUREMENTS Self-reported sexual minority status (wave 1) and affiliation with substance-using peers (waves 1 and 2), and latent sexual-minority specific victimization (waves 1 and 2) and HED (waves 1 and 3) variables. FINDINGS Using mediation analyses in a structural equation modeling framework, there was a significant indirect effect of sexual minority status (wave 1) on HED (wave 3) via affiliation with substance-using peers [wave 2; indirect effect = 0.03, 95% confidence interval (CI) = 0.01, 0.07], after accounting for the indirect effect of sexual-orientation related victimization (wave 2; indirect effect = 0.10, 95% CI = 0.02-0.19). The social marginalization pathway was not supported, as victimization (wave 1) was not associated with affiliation with substance-using peers (wave 2; β = - 0.04, P = 0.66). Sex differences in the indirect effects were not detected (Ps > 0.10). CONCLUSIONS Sexual minority adolescents in the United States appear to exhibit increased heavy episodic drinking via an indirect socialization pathway, including affiliations with substance-using peers and a concurrent indirect pathway involving sexual minority-related victimization. The pathways appear to operate similarly for boys and girls.
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Affiliation(s)
| | - Michael P. Marshal
- Department of Psychiatry, School of Medicine, University of Pittsburgh,Department of Pediatrics, School of Medicine, University of Pittsburgh
| | - Chad M. Burton
- Department of Psychiatry, School of Medicine, University of Pittsburgh
| | - Deena J. Chisolm
- Department of Pediatrics, The Ohio State University and Nationwide Children’s Hospital
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110
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Montano GT, McCauley HL, Miller E, Chisolm DJ, Marshal MP. Differences in Parental Monitoring Components and Their Associated Health Indicators Between Sexual-Minority and Heterosexual Girls. JOURNAL OF GLBT FAMILY STUDIES 2016; 13:211-235. [PMID: 30872979 PMCID: PMC6413312 DOI: 10.1080/1550428x.2016.1200507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Our study sought to assess whether parental monitoring and their associations with health behaviors differed for heterosexual girls compared to sexual minority girls (girls who identified as lesbian or bisexual, endorsed same-sex attraction, or had same-sex romantic or sexualpartners). We analyzed three components of parental monitoring-adolescent disclosure, parental solicitation, and parental knowledge-between heterosexual and sexual minority girls.We also tested if the associations between these three constructs and adolescent relationship abuse, suicidality, heavy drinking, binge drinking, anxiety symptoms, and depressive symptoms were different for heterosexual girls compared to sexual minority girls. Sexual minority girls were less likely to disclose accurately to their parents their location and activities and perceived their parents asked less and knew less about their location and activities than did heterosexual girls. Heterosexual girls who reported higher levels of adolescent disclosure were less likely than were sexual minority girls to report suicidality and anxiety symptoms. Additionally, heterosexual girls who reported higher levels of parental knowledge were also less likely than were sexual minority girls to report anxiety and depressive symptoms. These findings suggest that parental monitoring may not be as protective forsexual minority girls as it is for heterosexual girls.
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Affiliation(s)
- Gerald T Montano
- Corresponding Author, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, School of Medicine Department of Pediatrics, , 3420 Fifth Avenue, Pittsburgh, PA 15213
| | - Heather L McCauley
- Assistant Professor, University of Pittsburgh School of Medicine Department of Pediatrics, , 3420 Fifth Avenue, Pittsburgh, PA 15213
| | - Elizabeth Miller
- Professor, University of Pittsburgh School of Medicine Department of Pediatrics, , 3420 Fifth Avenue, Pittsburgh, PA 15213
| | - Deena J Chisolm
- Associate Professor, The Ohio State University College of Medicine Department of Pediatrics, The Ohio State University College of Public Health, , 700 Children's Drive, Room JW4986, Columbus, OH 43205
| | - Michael P Marshal
- Associate Professor, University of Pittsburgh School of Medicine Department of Psychiatry, University of Pittsburgh School of Medicine Department of Pediatrics, , 3811 O'Hara Strett, Pittsburgh, PA 15213
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111
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Talley AE, Gilbert PA, Mitchell J, Goldbach J, Marshall BDL, Kaysen D. Addressing gaps on risk and resilience factors for alcohol use outcomes in sexual and gender minority populations. Drug Alcohol Rev 2016; 35:484-93. [PMID: 27072658 PMCID: PMC4930390 DOI: 10.1111/dar.12387] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/30/2015] [Accepted: 01/06/2016] [Indexed: 12/11/2022]
Abstract
ISSUES In 2011, the Institute of Medicine released a report that constituted the first comprehensive effort by a federal body to understand the current state of science pertinent to the health needs of sexual and gender minority populations. This mini-review summarises recent empirical, methodological and theoretical advances in alcohol-related research among to lesbian, gay, bisexual and transgender (LGBT) populations and highlights progress towards addressing gaps, with a particular interest in those identified by the Institute of Medicine report. APPROACH Articles published since 2011 were identified from PsycINFO and PubMed database searches, using various combinations of keyword identifiers (alcohol, alcohol abuse, substance abuse, LGBT, lesbian, gay, bisexual, transgender). Reference sections of included articles were also examined for additional citations. KEY FINDINGS Recent empirical work has contributed to a greater understanding of sub-group differences within this diverse population. Evidence has supported theorised influences that can account for alcohol-related disparities, yet important gaps remain. Studies that examine the role of gender identity and its intersection with sexual identity within transgender and gender non-conforming sub-populations are lacking. Methodological advances in this literature have begun to allow for examinations of how minority-specific and general risk factors of alcohol misuse may contribute to patterns of alcohol involvement over time and within social-relational contexts CONCLUSIONS The recommendations made in the current mini-review are meant to facilitate future collaborative efforts, scale development, thoughtful methodological design and analysis and theoretically driven nuanced hypotheses to better understand, and ultimately address, alcohol-related disparities among sexual and gender minority populations. [Talley AE, Gilbert PA, Mitchell J, Goldbach J, Marshall BDL, Kaysen D. Addressing gaps on risk and resilience factors for alcohol use outcomes in sexual and gender minority populations. Drug Alcohol Rev 2016;35:484-493].
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Affiliation(s)
- Amelia E. Talley
- Psychological Sciences, Texas Tech University, Lubbock, United States
| | - Paul A. Gilbert
- Community and Behavioral Health, University of Iowa, Iowa City, United States
| | - Jason Mitchell
- University of Miami Miller School of Medicine, Miami, United States
| | - Jeremy Goldbach
- School of Social Work, University of Southern California University of Southern California, Los Angeles, United States
| | - Brandon D. L. Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, United States
| | - Debra Kaysen
- Center for the Study of Health and Risk Behaviors, University of Washington, Seattle, United States
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112
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Feinstein BA, Newcomb ME. The role of substance use motives in the associations between minority stressors and substance use problems among young men who have sex with men. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2016; 3:357-366. [PMID: 27713906 DOI: 10.1037/sgd0000185] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Young men who have sex with men (YMSM) report higher rates of substance use than their heterosexual peers and minority stress has been posited as a risk factor for substance use. The associations between specific types of minority stress and substance use have been inconsistent throughout the literature and few studies have examined mechanisms underlying these associations. Drawing on minority stress theory and the motivational model of alcohol use, we propose that one mechanism underlying these associations may be people's motivations for using substances, including using substances to cope with negative emotions and to enhance pleasure. The goals of the current study were: (1) to examine the associations among minority stressors, substance use motives, and substance use problems; and (2) to examine substance use motives as mediators of the associations between minority stressors and substance use problems. Baseline self-report data were used from a cohort of 370 YMSM enrolled in a larger study of substance use and sexual behavior. Results indicated that using marijuana to cope mediated the association between victimization and marijuana use problems. Using other drugs to cope mediated the associations between victimization and drug use problems and between internalized stigma and drug use problems. Drinking to cope and to enhance pleasure mediated the association between internalized stigma and alcohol use problems. In sum, substance use motives, especially using substances to cope, act as mechanisms through which certain types of minority stress influence substance use problems among YMSM.
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Affiliation(s)
- Brian A Feinstein
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, 625 N. Michigan Ave., Suite 2700, Chicago, IL 60611
| | - Michael E Newcomb
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, 625 N. Michigan Ave., Suite 2700, Chicago, IL 60611
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113
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Li G, Pollitt AM, Russell ST. Depression and Sexual Orientation During Young Adulthood: Diversity Among Sexual Minority Subgroups and the Role of Gender Nonconformity. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:697-711. [PMID: 25868403 DOI: 10.1007/s10508-015-0515-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/24/2014] [Accepted: 12/20/2014] [Indexed: 05/03/2023]
Abstract
Sexual minority individuals are at an elevated risk for depression compared to their heterosexual counterparts, yet less is known about how depression status varies across sexual minority subgroups (i.e., mostly heterosexuals, bisexuals, and lesbians and gay men). Moreover, studies on the role of young adult gender nonconformity in the relation between sexual orientation and depression are scarce and have yielded mixed findings. The current study examined the disparities between sexual minorities and heterosexuals during young adulthood in concurrent depression near the beginning of young adulthood and prospective depression 6 years later, paying attention to the diversity within sexual minority subgroups and the role of gender nonconformity. Drawn from the National Longitudinal Study of Adolescent Health (N = 9421), we found that after accounting for demographics, sampling weight, and sampling design, self-identified mostly heterosexual and bisexual young adults, but not lesbians and gay men, reported significantly higher concurrent depression compared to heterosexuals; moreover, only mostly heterosexual young adults were more depressed than heterosexuals 6 years later. Furthermore, while young adult gender nonconforming behavior was associated with more concurrent depression regardless of sexual orientation, its negative impact on mental health decreased over time. Surprisingly, previous gender nonconformity predicted decreased prospective depression among lesbians and gay men whereas, among heterosexual individuals, increased gender nonconformity was not associated with prospective depression. Together, the results suggested the importance of investigating diversity and the influence of young adult gender nonconformity in future research on the mental health of sexual minorities.
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Affiliation(s)
- Gu Li
- Division of Family Studies and Human Development, Norton School of Family and Consumer Sciences, University of Arizona, Tucson, AZ, USA.
- Department of Psychology, Free School Lane, University of Cambridge, Cambridge, CB2 3RQ, UK.
| | - Amanda M Pollitt
- Division of Family Studies and Human Development, Norton School of Family and Consumer Sciences, University of Arizona, Tucson, AZ, USA
| | - Stephen T Russell
- Division of Family Studies and Human Development, Norton School of Family and Consumer Sciences, University of Arizona, Tucson, AZ, USA
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114
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Coulter RWS, Birkett M, Corliss HL, Hatzenbuehler ML, Mustanski B, Stall RD. Associations between LGBTQ-affirmative school climate and adolescent drinking behaviors. Drug Alcohol Depend 2016; 161:340-7. [PMID: 26946989 PMCID: PMC4792759 DOI: 10.1016/j.drugalcdep.2016.02.022] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 02/02/2016] [Accepted: 02/12/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND We investigated whether adolescents drank alcohol less frequently if they lived in jurisdictions with school climates that were more affirmative of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) individuals. METHODS Data from the 2010 School Health Profile survey, which measured LGBTQ school climate (e.g., percentage of schools with safe spaces and gay-straight alliances), were linked with pooled data from the 2005 and 2007 Youth Risk Behavior Survey, which measured sexual orientation identity, demographics, and alcohol use (number of drinking days, drinking days at school, and heavy episodic drinking days) in 8 jurisdictions. Two-level Poisson models tested the associations between school climate and alcohol use for each sexual-orientation subgroup. RESULTS Living in jurisdictions with more (versus less) affirmative LGBTQ school climates was significantly associated with: fewer heavy episodic drinking days for gay/lesbian (incidence-rate ratio [IRR]=0.70; 95% confidence interval [CI]: 0.56, 0.87; p=0.001) and heterosexual (IRR=0.80; 95% CI: 0.76, 0.83; p<0.001) adolescents; and fewer drinking days at school for adolescents unsure of their sexual orientation (IRR=0.57; 95% CI: 0.35, 0.93; p=0.024). CONCLUSIONS Fostering LGBTQ-affirmative school climates may reduce certain drinking behaviors for gay/lesbian adolescents, heterosexual adolescents, and adolescents unsure of their sexual orientation.
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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 15261, United States; Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, United States.
| | - Michelle Birkett
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Heather L Corliss
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, San Diego, CA 92182, United States
| | - Mark L Hatzenbuehler
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, United States
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Ron D Stall
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, United States; Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, United States
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115
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Coulter RWS, Marzell M, Saltz R, Stall R, Mair C. Sexual-orientation differences in drinking patterns and use of drinking contexts among college students. Drug Alcohol Depend 2016; 160:197-204. [PMID: 26827292 PMCID: PMC4767549 DOI: 10.1016/j.drugalcdep.2016.01.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 01/08/2016] [Accepted: 01/08/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Evidence suggests there are important sexual-orientation differences in alcohol consumption, particularly among women. Little is known about where gay/lesbian and bisexual college students drink or differences in drinking patterns derived from graduated frequency measures between heterosexual, gay/lesbian, and bisexual students. The goal of this analysis was to examine patterns of alcohol consumption-including drinking prevalence, quantity, frequency, and contexts of use-by sexual orientation. METHODS Data on sexual identity, gender, drinking behaviors, and drinking contexts were examined from repeated cross-sectional samples of undergraduate students attending 14 public California universities from 2003-2011 (n=58,903). Multivariable statistical techniques were employed to examine sexual-orientation differences stratified by gender. RESULTS Gay males, lesbians, and bisexual females were significantly more likely to report drinking alcohol in the current semester than their same-gender heterosexual peers (relative risks ranged from 1.07 to 1.10, p-values <0.01). Among current drinkers, bisexual females consumed 7 or more drinks and lesbians consumed 10 or more drinks on significantly more days than heterosexual females. On the other hand, gay male drinkers consumed 8 or more drinks on significantly fewer days than heterosexual male drinkers. Compared to their same-gender heterosexual peers: lesbian/gay and bisexual students drank less frequently at Greek parties (incidence rate ratios [IRRs] ranged from 0.52 to 0.73, p-values <0.01); lesbians (IRR=0.84, p=0.043) and bisexual males (IRR=0.82, p=0.009) drank less frequently at off-campus parties; and gay males drank more frequently outdoors (IRR=1.63, p<0.001) and at bars/restaurants (IRR=1.21, p=0.013). CONCLUSIONS Alcohol prevention programs and future research should consider sexual-orientation differences in drinking patterns and use of drinking contexts.
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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, United States; Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, United States.
| | - Miesha Marzell
- Department of Community and Behavioral Health, College of Public Health, The University of Iowa,145 N. Riverside Drive, Iowa City, IA 52242, United States
| | - Robert Saltz
- Prevention Research Center, Pacific Institute for Research & Evaluation, 180 Grand Avenue, Oakland, CA 94612, United States
| | - Ron Stall
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, United States; Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, United States
| | - Christina Mair
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, United States
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116
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He J, Assanangkornchai S, Cai L, McNeil E. Disparities in drinking patterns and risks among ethnic majority and minority groups in China: The roles of acculturation, religion, family and friends. Drug Alcohol Depend 2016; 159:198-206. [PMID: 26790824 DOI: 10.1016/j.drugalcdep.2015.12.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 11/27/2015] [Accepted: 12/18/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Studies investigating alcohol consumption related factors have rarely focused on the relationship between acculturation, religion and drinking patterns. The objective of this study is to explore the predictors of drinking patterns and their mutual relationships, especially acculturation, ethnicity and religion. METHODS A cross-sectional household survey using a multistage systematic sampling technique was conducted in Yunnan Province of China. A revised Vancouver Index of Acculturation (VIA) and Alcohol Use Disorder Identification Test (AUDIT) Chinese version were used to measure acculturation and drinking patterns. Structural equation modeling (SEM) was used to explore the structures of how predictors affect drinking patterns. RESULTS A total of 977 subjects aged 12-35 years were surveyed. A higher percentage of binge drinking was found among Lisu people. However, the proportion of drinking until intoxication was highest among Han. Gender and enculturation had both direct (standardized β=-0.193, -0.079) and indirect effects (standardized β=-0.126, 0.033) on risky drinking pattern; perceived risk of alcohol consumption (-0.065), family drinking environment (0.061), and friend drinking environment (0.352) affected risky drinking pattern directly, while education level (0.066), ethnicity (-0.038), acculturation (0.012), religious belief (-0.038), and age group (0.088) had indirect effects. CONCLUSION Risky drinking pattern was associated with gender and aboriginal culture enculturation both directly and indirectly, and related to mainstream culture acculturation and religious belief indirectly. Other demographic (such as education level) and social family factors (friend drinking environment for example) also had effects on risky drinking pattern.
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Affiliation(s)
- Jianhui He
- Department of Health Economics and Health Management, School of Public Health, Kunming Medical University, Chun Rong West Road 1168, Yu Hua Street, Chenggong New City, Kunming, Yunnan Province, PR China.
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla 90110, Thailand.
| | - Le Cai
- School of Public Health, Kunming Medical University, Chun Rong West Road 1168, Yu Hua Street, Chenggong New City, Kunming, Yunnan Province, PR China.
| | - Edward McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla 90110, Thailand.
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Abstract
Today's lesbian, gay, bisexual, and transgender (LGBT) youth come out at younger ages, and public support for LGBT issues has dramatically increased, so why do LGBT youth continue to be at high risk for compromised mental health? We provide an overview of the contemporary context for LGBT youth, followed by a review of current science on LGBT youth mental health. Research in the past decade has identified risk and protective factors for mental health, which point to promising directions for prevention, intervention, and treatment. Legal and policy successes have set the stage for advances in programs and practices that may foster LGBT youth mental health. Implications for clinical care are discussed, and important areas for new research and practice are identified.
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Affiliation(s)
| | - Jessica N Fish
- Population Research Center, University of Texas at Austin, Austin, Texas 78712; ,
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118
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Windle M. Drinking Over the Lifespan: Focus on Early Adolescents and Youth. Alcohol Res 2016; 38:95-101. [PMID: 27159816 PMCID: PMC4872619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Historical trends in alcohol use among U.S. adolescents, as well as data regarding alcohol-related traffic fatalities among youth, indicate decreases in alcohol use. Nevertheless, alcohol use patterns still indicate high rates of binge drinking and drunkenness and the co-occurrence of alcohol use among youth with risky sexual activity, illicit substance use, and poor school performance. This article discusses unique elements of alcohol use among adolescents relative to adults that pose risks for alcohol misuse and alcohol-related problems. These differences range from patterns of drinking to differential sensitivity to alcohol. Developmental differences between adolescents and adults also are discussed with regard to age-normative developmental tasks and distinctions in brain development that may affect differences in drinking patterns. Epidemiologic findings on sexual-minority youth are provided, as are global trends in alcohol use among early adolescents and youth. It is proposed that using information about differences between youth and adults will be helpful in directing future etiologic and intervention research by capitalizing on unique biological, psychological, and social factors that may affect the success of efforts to reduce alcohol use among early adolescents and youth.
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Affiliation(s)
- Michael Windle
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, Georgia
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119
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The Influence of Gender and Sexual Orientation on Alcohol Use and Alcohol-Related Problems: Toward a Global Perspective. Alcohol Res 2016; 38:121-32. [PMID: 27159819 PMCID: PMC4872607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Although there are wide differences in alcohol use patterns among countries, men are consistently more likely than women to be drinkers and to drink heavily. Studies of alcohol use among sexual minorities (SMs), however, reflect a more complex picture. Such research has found higher rates of alcohol use and alcohol-related problems among SM persons than among heterosexuals and greater differences between SM and heterosexual women than between SM and heterosexual men. A variety of factors may contribute to differences in alcohol use and alcohol-related problems between men and women and between SM and heterosexual people. An improved understanding of these factors is important to guide prevention and treatment efforts. Although there is a dearth of literature on use of alcohol by SMs in many parts of the world, especially lower- and middle-income countries, we attempt to review and integrate the sparse data that are available from these lower-resourced countries. The global perspective presented in this article is the first attempt to go beyond a general review of literature in the Western world to document the gender paradox in alcohol use among heterosexuals and SMs in diverse countries worldwide.
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120
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Coulter RW, Blosnich JR, Bukowski LA, Herrick AL, Siconolfi DE, Stall RD. Differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified young adults. Drug Alcohol Depend 2015; 154. [PMID: 26210734 PMCID: PMC4536098 DOI: 10.1016/j.drugalcdep.2015.07.006] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Little is known about differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified populations. Using data from a large-scale health survey, we compare the drinking patterns and prevalence of alcohol-related problems of transgender-identified individuals to nontransgender-identified males and females. For transgender-identified people, we examine how various forms of victimization relate to heavy episodic drinking (HED). METHODS Cross-sectional surveys were completed by 75,192 students aged 18-29 years attending 120 post-secondary educational institutions in the United States from 2011 to 2013. Self-reported measures included alcohol use, alcohol-related problems, victimization, and sociodemographics, including 3 gender-identity groups: transgender-identified individuals; nontransgender-identified males; and nontransgender-identified females. RESULTS Compared to transgender-identified individuals, nontransgender-identified males were more likely to report HED in the past 2 weeks (relative risk=1.42; p=0.006); however, nontransgender-identified males and females reported HED on fewer days than transgender-identified people (incidence-rate ratios [IRRs] ranged from 0.28 to 0.43; p-values<0.001). Compared to transgender-identified people, nontransgender-identified males and females had lower odds of past-year alcohol-related sexual assault and suicidal ideation (odds ratios ranged from 0.24 to 0.45; p-values<0.05). Among transgender-identified people, individuals who were sexually assaulted (IRR=3.21, p=0.011) or verbally threatened (IRR=2.42, p=0.021) in the past year had greater HED days than those who did not experience those forms of victimization. CONCLUSIONS Compared to transgender-identified people, nontransgender-identified males and females: have fewer HED occasions (despite nontransgender-identified males having greater prevalence of HED); and are at lower risk for alcohol-related sexual assaults and suicidal ideation. Experiences of sexual assault and verbal threats are associated with greater HED occasions for transgender-identified people.
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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 De Soto Street, Pittsburgh, PA, USA 15261
| | - John R. Blosnich
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh,130 De Soto Street, Pittsburgh, PA, USA 15261,Department of Veterans Affairs, Center for Health Equity Research and Promotion, University Drive C (151C-U), Building 30, Pittsburgh, PA, USA 15240
| | - Leigh A. Bukowski
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh,130 De Soto Street, Pittsburgh, PA, USA 15261
| | - A. L. Herrick
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh,130 De Soto Street, Pittsburgh, PA, USA 15261
| | - Daniel E. Siconolfi
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA 21205
| | - Ron D. Stall
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh,130 De Soto Street, Pittsburgh, PA, USA 15261
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121
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Hughes TL, Wilsnack SC, Kristjanson AF. Substance use and related problems among U.S. women who identify as mostly heterosexual. BMC Public Health 2015; 15:803. [PMID: 26289792 PMCID: PMC4546044 DOI: 10.1186/s12889-015-2143-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 08/11/2015] [Indexed: 11/22/2022] Open
Abstract
Background We used data from a nationally representative sample to compare substance use outcomes among adult women who identified as mostly heterosexual with those who identified as exclusively (only) heterosexual. Method We analyzed data from mostly heterosexual women and only heterosexual women in Wave 5 (2001) of the National Study of Health and Life Experiences of Women (weighted n = 1085). Results Mostly heterosexual women were significantly more likely than only heterosexual women to report every alcohol-related outcome included in our analyses except lifetime treatment. Odds of lifetime and past-year marijuana and cocaine use showed larger differences, with mostly heterosexual women nearly four times as likely as only heterosexual women to report lifetime cocaine use and five times as likely to report past-year use. Conclusions We recommend that researchers use measures of sexual identity that include more nuanced response options, and that health care providers learn about the existence, large numbers, and risk/protective factors associated with substance use patterns of mostly heterosexual women.
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Affiliation(s)
- Tonda L Hughes
- Building Interdisciplinary Research Careers in Women's Health (BIRCWH), University of Illinois at Chicago, College of Nursing (M/C 802), 845 S. Damen Ave Room 1160, IL 60612-7350, Chicago, U.S.
| | - Sharon C Wilsnack
- Department of Psychiatry and Behavioral Science, University of North Dakota, School of Medicine & Health Sciences, 501 North Columbia Road Stop 9037, 58202-9037, Grand Forks, ND, U.S.
| | - Arlinda F Kristjanson
- Department of Psychiatry and Behavioral Science, University of North Dakota, School of Medicine & Health Sciences, 501 North Columbia Road Stop 9037, 58202-9037, Grand Forks, ND, U.S.
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122
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Fish JN, Pasley K. Sexual (Minority) Trajectories, Mental Health, and Alcohol Use: A Longitudinal Study of Youth as They Transition to Adulthood. J Youth Adolesc 2015; 44:1508-27. [PMID: 25956289 PMCID: PMC8574130 DOI: 10.1007/s10964-015-0280-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
Abstract
Lesbian, gay, bisexual, and queer/questioning youth health disparities are well documented; however, study limitations restrict our understanding of how the temporal interplay among domains of sexuality (attraction, behavior, and identity) situate individuals to be more or less at risk for poor mental health and alcohol use across the transition to adulthood. Four waves of data from the National Longitudinal Study of Adolescent to Adult Health (n = 12,679; 51.29 % female) were used with repeated measures latent class analysis to estimate sexual trajectory groups designated by prospective reports of romantic attraction, sexual/romantic behavior, and sexual identity from adolescence to adulthood. Five unique trajectories emerged: two heterosexual groups (heterosexual early daters [58.37 %] and heterosexual later daters [29.83 %]) and three sexual minority groups (heteroflexible [6.44 %], later bisexually identified [3.32 %], and LG[B] identified [2.03 %]). These sexual trajectories differentiate risk for depressive symptomology, suicidal thoughts and behaviors, and alcohol use during adolescence and early adulthood. Groups where individuals first reported same-sex attraction and sexual minority identities in adulthood (heteroflexible and later bisexually identified) had similar levels of depression, suicidality, and greater substance use than those who largely reported same-sex attraction and behavior during adolescence (the LG[B] identified group). These later recognition groups showed greater risk for poor outcomes in waves where they also first reported these changes in attraction, behaviors, and identities. The emergence of three sexual minority groups reveal within-group differences in sexuality and sexual trajectories and how these experiences relate to risk and timing of risk across the transition to adulthood.
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Affiliation(s)
- Jessica N Fish
- Frances McClelland Institute for Children, Youth, and Families, Norton School of Family and Consumer Sciences, University of Arizona, 650 N. Park Ave, Rm. 235F, Tucson, AZ, 85721-0078, USA,
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123
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Talley AE, Aranda F, Hughes TL, Everett B, Johnson TP. Longitudinal Associations among Discordant Sexual Orientation Dimensions and Hazardous Drinking in a Cohort of Sexual Minority Women. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2015; 56:225-45. [PMID: 25911224 PMCID: PMC4456672 DOI: 10.1177/0022146515582099] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We examined differences between sexual minority women's (SMW's) sexual identity and sexual behavior or sexual attraction as potential contributors to hazardous drinking across a 10-year period. Data are from a longitudinal study examining drinking and drinking-related problems in a diverse, community-based sample of self-identified SMW (Wave 1: n = 447; Wave 2: n = 384; Wave 3: n = 354). Longitudinal cross-lagged models showed that SMW who report higher levels of identity-behavior or identity-attraction discordance may be at greater risk of concurrent and subsequent hazardous drinking. Results of multigroup models suggest that sexual orientation discordance is a more potent risk factor for risky drinking outcomes among SMW in older adulthood than in younger adulthood. Findings support that discordance between sexual orientation dimensions may contribute to hazardous drinking among SMW and provide evidence that cognitive-behavioral consistency is important for individuals expressing diverse and fluid sexual identities, attraction, and behavior.
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124
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McConnell EA, Birkett MA, Mustanski B. Typologies of Social Support and Associations with Mental Health Outcomes Among LGBT Youth. LGBT Health 2015; 2:55-61. [PMID: 26790019 DOI: 10.1089/lgbt.2014.0051] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Lesbian, gay, bisexual, and transgender (LGBT) youth show increased risk for a number of negative mental health outcomes, which research has linked to minority stressors such as victimization. Further, social support promotes positive mental health outcomes for LGBT youth, and different sources of social support show differential relationships with mental health outcomes. However, little is known about how combinations of different sources of support impact mental health. METHODS In the present study, we identify clusters of family, peer, and significant other social support and then examine demographic and mental health differences by cluster in an analytic sample of 232 LGBT youth between the ages of 16 and 20 years. RESULTS Using k-means cluster analysis, three social support cluster types were identified: high support (44.0% of participants), low support (21.6%), and non-family support (34.5%). A series of chi-square tests were used to examine demographic differences between these clusters, which were found for socio-economic status (SES). Regression analyses indicated that, while controlling for victimization, individuals within the three clusters showed different relationships with multiple mental health outcomes: loneliness, hopelessness, depression, anxiety, somatization, general symptom severity, and symptoms of major depressive disorder (MDD). CONCLUSION Findings suggest the combinations of sources of support LGBT youth receive are related to their mental health. Higher SES youth are more likely to receive support from family, peers, and significant others. For most mental health outcomes, family support appears to be an especially relevant and important source of support to target for LGBT youth.
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Affiliation(s)
| | - Michelle A Birkett
- 2 Department of Medical and Social Sciences, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
| | - Brian Mustanski
- 2 Department of Medical and Social Sciences, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
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Adekoya N, Truman B, Landen M. Incidence of notifiable diseases among American Indians/Alaska Natives - United States, 2007-2011. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2015; 64:16-9. [PMID: 25590681 PMCID: PMC4584794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
American Indian/Alaska Native (AI/AN) populations experience substantial disparities in the incidence of multiple diseases compared with other racial/ethnic groups in the United States. A major goal of Healthy People 2020 is to eliminate health disparities, monitor disease trends, and identify population groups and diseases for targeted interventions. High rates of certain infectious diseases continue to be a major problem facing AI/AN populations. During 1990-2011, incidence rates for some infectious diseases declined among AI/AN populations, but disparities remain and AI/AN populations are still disproportionately affected. To describe disparities in selected notifiable diseases among AI/ANs, CDC analyzed data from the National Notifiable Diseases Surveillance System (NNDSS) for 2007-2011, the most recent 5 years for which data are available. The results of this analysis of 26 infectious diseases indicate that incidence rates of 14 diseases were higher for AI/ANs than for whites. Interventions are needed to address and reduce disparities in chlamydia, gonorrhea, West Nile virus, spotted fever rickettsiosis, and other infections among AI/ANs.
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Affiliation(s)
- Nelson Adekoya
- Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Benedict Truman
- Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
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126
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Alexander SC, Fortenberry JD, Pollak KI, Bravender T, Østbye T, Shields CG. Physicians Use of Inclusive Sexual Orientation Language During Teenage Annual Visits. LGBT Health 2014; 1:283-91. [PMID: 26789857 DOI: 10.1089/lgbt.2014.0035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Physicians are encouraged to use inclusive language regarding sexuality in order to help all adolescent patients feel accepted. Non-inclusive language by physicians may influence relationships with adolescent patients, especially those with still-developing sexual identities. The aim of this study was to identify patterns of physicians' use of inclusive and non-inclusive language when discussing sexuality. METHOD A total of 393 conversations between 393 adolescents and 49 physicians from 11 clinics located throughout the Raleigh-Durham, North Carolina, area were audio recorded. Conversations were coded for the use of inclusive talk (language use that avoids the use of specific gender, sex, or sexual orientation language), direct non-inclusive talk (language use that assumes the teenager is heterosexual or exclusively engages in heterosexual sexual activity), and indirect non-inclusive talk (language use that frames talk heterosexually but does not pre-identify the adolescent as heterosexual). RESULTS Nearly two-thirds (63%, 245) of the visits contained some sexuality talk. Inclusive talk rarely occurred (3.3%) while non-inclusive language was predominant (48.1% direct and 48.6% indirect). There were no significant differences in language use by gender, age, adolescent race, or visit length. These non-significant findings suggest that all adolescents regardless of race, gender, or age are receiving non-inclusive sexuality talk from their providers. CONCLUSION Physicians are missing opportunities to create safe environments for teenagers to discuss sexuality. The examples of inclusive talk from this study may provide potentially useful ways to teach providers how to begin sexuality discussions, focusing on sexual attraction or asking about friends' sexual behavior, and maintain these discussions.
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Affiliation(s)
- Stewart C Alexander
- 1 Department of Consumer Science, Purdue University , West Lafayette, Indiana
| | - J Dennis Fortenberry
- 2 Department of Pediatrics, Indiana University School of Medicine , Indianapolis, Indiana
| | - Kathryn I Pollak
- 3 Cancer Prevention, Detection and Control Research Program, Duke University Medical Center , Durham, North Carolina.,4 Department of Community and Family Medicine, Duke University Medical Center , Durham, North Carolina
| | - Terrill Bravender
- 5 Division of Pediatrics and Communicable Diseases, University of Michigan , Ann Arbor, Michigan
| | - Truls Østbye
- 4 Department of Community and Family Medicine, Duke University Medical Center , Durham, North Carolina
| | - Cleveland G Shields
- 6 Department of Human Development and Family Studies, Purdue University , West Lafayette, Indiana
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127
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Roberts SP, Siegel MB, DeJong W, Naimi TS, Jernigan DH. The relationships between alcohol source, autonomy in brand selection, and brand preference among youth in the USA. Alcohol Alcohol 2014; 49:563-71. [PMID: 25113176 PMCID: PMC4128668 DOI: 10.1093/alcalc/agu034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 05/14/2014] [Accepted: 05/15/2014] [Indexed: 11/12/2022] Open
Abstract
AIMS We aimed to describe the sources from which youth in the USA commonly obtain alcohol, their role in selecting the brands they drink and the relationship of these variables to their indicated alcohol brand preferences. METHODS We recruited 1031 underage drinkers in the age range of 13-20 through an internet panel managed by Knowledge Networks. Respondents completed an online survey assessing their recent brand-specific alcohol use, the source of their most recently consumed alcohol and whether the respondent or another person selected the brand they drank. RESULTS Alcohol sources were more often passive than transactional. Nearly equal proportions of youth reported that they did versus did not choose the brand of their most recent drink. Analysis revealed that the brand preferences of passive versus active source drinkers were highly similar, as were the brand preferences of respondent versus non-respondent choice drinkers. Stratification of respondents by age did not significantly change these results. CONCLUSION Our findings suggest that youth are consuming a homogenous list of preferred brands regardless of the source of their most recently obtained alcohol or who selected the brand they drank.
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Affiliation(s)
- Sarah P Roberts
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Michael B Siegel
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - William DeJong
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Timothy S Naimi
- Department of Community Health Sciences and Section of General Internal Medicine, Boston University Schools of Medicine and Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - David H Jernigan
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 West Broadway, Room 292, Baltimore, MD 21205, USA
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128
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Seil KS, Desai MM, Smith MV. Sexual orientation, adult connectedness, substance use, and mental health outcomes among adolescents: findings from the 2009 New York City Youth Risk Behavior Survey. Am J Public Health 2014; 104:1950-6. [PMID: 25121812 DOI: 10.2105/ajph.2014.302050] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined associations between identifying as lesbian, gay, or bisexual (LGB) and lacking a connection with an adult at school on adolescent substance use and mental health outcomes including suicidality. METHODS We analyzed data from the 2009 New York City Youth Risk Behavior Survey (n=8910). Outcomes of interest included alcohol use, marijuana use, illicit drug use, depressive symptomatology, suicide ideation, and suicide attempt. RESULTS The prevalence of each outcome was significantly higher among LGB adolescents than heterosexual adolescents and among those who lacked an adult connection at school than among those who did have such a connection. Even when LGB adolescents had an adult connection at school, their odds of most outcomes were significantly higher than for heterosexual adolescents. Those LGB adolescents who lacked a school adult connection had the poorest outcomes (about 45% reported suicide ideation; 31% suicide attempt). CONCLUSIONS Adolescents who are LGB, particularly those who lack a connection with school adults, are at high risk for substance use and poorer mental health outcomes. Interventions should focus on boosting social support and improving outcomes for this vulnerable group.
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Affiliation(s)
- Kacie S Seil
- Kacie S. Seil and Mayur M. Desai are with Yale School of Public Health, Department of Chronic Disease Epidemiology, New Haven, CT. Megan V. Smith is with Yale School of Medicine, Department of Psychiatry, New Haven
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129
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Mayer KH, Garofalo R, Makadon HJ. Promoting the successful development of sexual and gender minority youths. Am J Public Health 2014; 104:976-81. [PMID: 24825194 PMCID: PMC4061989 DOI: 10.2105/ajph.2014.301876] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2013] [Indexed: 11/04/2022]
Abstract
Because of societal discomfort with atypical expressions of sexual orientation and gender identity, lesbian, gay, bisexual and transgender (LGBT) youths have experienced enhanced developmental challenges compared with their heterosexual peers. A recent special issue of the American Journal of Public Health delineated how social stigma affecting LGBT youths has resulted in a wide range of health disparities, ranging from increased prevalence of depression and substance use to downstream effects, such as an increased risk for cancer and cardiovascular disease when older. We review the clinical significance of these findings for health care professionals, who need to become informed about these associations to provide better care for their sexual and gender minority youth patients, and to be able to educate their parents and other caregivers.
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Affiliation(s)
- Kenneth H Mayer
- Kenneth H. Mayer and Harvey J. Makadon are with The Fenway Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Robert Garofalo is with the Northwestern University Feinberg Medical School, Lurie Children's Memorial Hospital, Chicago, IL
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130
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Reisner SL, Van Wagenen A, Gordon A, Calzo JP. Disparities in safety belt use by sexual orientation identity among US high school students. Am J Public Health 2013; 104:311-8. [PMID: 24328643 DOI: 10.2105/ajph.2013.301745] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined associations between adolescents' safety belt use and sexual orientation identity. METHODS We pooled data from the 2005 and 2007 Youth Risk Behavior Surveys (n = 26,468 weighted; mean age = 15.9 years; 35.4% White, 24.7% Black, 23.5% Latino, 16.4% other). We compared lesbian and gay (1.2%), bisexual (3.5%), and unsure (2.6%) youths with heterosexuals (92.7%) on a binary indicator of passenger safety belt use. We stratified weighted multivariable logistic regression models by sex and adjusted for survey wave and sampling design. RESULTS Overall, 12.6% of high school students reported "rarely" or "never" wearing safety belts. Sexual minority youths had increased odds of reporting nonuse relative to heterosexuals (48% higher for male bisexuals, 85% for lesbians, 46% for female bisexuals, and 51% for female unsure youths; P < .05), after adjustment for demographic (age, race/ethnicity), individual (body mass index, depression, bullying, binge drinking, riding with a drunk driver, academic achievement), and contextual (living in jurisdictions with secondary or primary safety belt laws, percentage below poverty, percentage same-sex households) risk factors. CONCLUSIONS Public health interventions should address sexual orientation identity disparities in safety belt use.
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Affiliation(s)
- Sari L Reisner
- Sari L. Reisner and Allegra Gordon are with the Department of Society, Human Development, and Health, Harvard School of Public Health, and Jerel P. Calzo is with the Department of Pediatrics, Harvard Medical School, Boston, MA. Sari L. Reisner is also with and Aimee Van Wagenen is with the Fenway Institute, Fenway Health, Boston. Jerel P. Calzo is also with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston
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Marshal MP, Dermody SS, Shultz ML, Sucato GS, Stepp SD, Chung T, Burton CM, Markovic N, Hipwell AE. Mental health and substance use disparities among urban adolescent lesbian and bisexual girls. J Am Psychiatr Nurses Assoc 2013; 19:271-9. [PMID: 24055956 PMCID: PMC4465355 DOI: 10.1177/1078390313503552] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sexual minority girls (SMGs) report large substance use disparities and victimization experiences, yet there is a dearth of research that focuses exclusively on SMGs. OBJECTIVE To examine substance use and mental health disparities among SMGs and to determine whether disparities were larger for African American compared with European American girls. METHOD Data were used from Wave 11 of the Pittsburgh Girls Study, a multiple-cohort, prospective study of urban girls. Girls for the current analysis were aged 16 to 19 years. Fifty-five percent were African American. One hundred and seventy-three (8.3%) identified as SMGs, and 1,891 identified as heterosexual. Multiple regression analyses controlling for age, race, and parent education were conducted. RESULTS SMGs reported a robust pattern of large disparities in externalizing, internalizing, and borderline personality disorder symptoms. There was little evidence to suggest disparities were moderated by race. CONCLUSION SMGs and their families would benefit from intervention and prevention programs to reduce disparities among this highly vulnerable population.
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Affiliation(s)
- Michael P Marshal
- Michael P. Marshal, PhD, University of Pittsburgh, Pittsburgh, PA, USA
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