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Hatzenbuehler ML, Lattanner MR, McKetta S, Pachankis JE. Structural stigma and LGBTQ+ health: a narrative review of quantitative studies. Lancet Public Health 2024; 9:e109-e127. [PMID: 38307678 DOI: 10.1016/s2468-2667(23)00312-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 02/04/2024]
Abstract
Health disparities related to sexual orientation and gender identity exist across multiple outcomes. Scholarship has begun to evaluate whether structural stigma-ie, societal-level conditions, cultural norms, and institutional policies that constrain opportunities, resources, and wellbeing-contributes to health burdens among LGBTQ+ individuals. We conducted a comprehensive review of quantitative studies examining this hypothesis. We found 98 articles that linked objective (ie, non-self-reported) measures of structural stigma to mental (n=57), behavioural (ie, substance use; n=27; HIV/AIDS or sexually transmitted infection; n=20), and physical (n=20) health outcomes. There was generally consistent evidence that structural stigma increases risk of poor health among LGBTQ+ individuals. Several methodological strengths were identified, including the use of multiple measures (eg, laws or policies [59%, 58 of 98]), designs (eg, quasi-experiments [21%, 21 of 98]), and samples (eg, probability-based [56%, 55 of 98]). However, important gaps exist. Just over half of studies included area-level covariates or non-LGBTQ+ comparison groups, which are necessary to address alternative explanations for the observed associations. Additionally, while studies (n=90) have begun to identify candidate mechanisms, only nine (10%) formally tested mediation. We offer suggestions for future research to advance this literature, which has implications not only for the identification of structural determinants of LGBTQ+ health but also for the development of public health interventions that reduce LGBTQ+ health disparities.
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Affiliation(s)
| | - Micah R Lattanner
- Department of Public Health, Santa Clara University, Santa Clara, CA, USA
| | - Sarah McKetta
- Department of Population Medicine, Harvard University, Boston, MA, USA
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Cureton JL, Giegerich V, Ricciutti NM. Rurality and readiness: Addressing substance use via a community‐level assessment. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2022. [DOI: 10.1002/jaoc.12105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jenny L. Cureton
- Counselor Education and Supervision Kent State University Kent Ohio USA
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Navigating the LGB Data Landscape: A Review of Appropriate Secondary Data Sources for Sexuality and Substance Use Research in the UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031329. [PMID: 35162352 PMCID: PMC8835565 DOI: 10.3390/ijerph19031329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 12/05/2022]
Abstract
Research has found that sexual minority individuals are more likely to experience health inequalities and have higher rates of substance use compared with their heterosexual counterparts. This association between sexuality and health outcomes is increasingly being explored using quantitative methodologies within the context of public health, psychology and health geography. Much of this research, however, has relied on primary data, despite the wide availability of secondary sources, mainly survey data, collecting information on sexuality and different types of health outcomes and health risk behaviours, such as substance use. This study reviewed recent surveys in the UK that are appropriate for exploring topics related to LGB populations and substance use behaviours. We carried out a narrative review of secondary data sources in the UK to assess the accessibility and suitability of secondary sources for sexuality and substance use research. We identified eight cross-sectional and two longitudinal surveys that contained both sexuality and substance use data. We summarised the possible applications of each survey and the scope of questions within sexuality and substance use research that could be addressed by each survey. The identification of appropriate surveys in this review can allow researchers to extend the use of secondary data sources in the UK to examine substance use inequalities between sexuality groups, further advancing this key topic.
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Campbell C, Mena JA. LGBTQ+ Structural Stigma and College Counseling Center Website Friendliness. JOURNAL OF COLLEGE COUNSELING 2021. [DOI: 10.1002/jocc.12194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Titus AR, Gamarel KE, Thrasher JF, Meza R, Fleischer NL. State-Level Structural Stigma and Smoking Among Sexual Minority Adults in the USA, 2012-2014. Ann Behav Med 2021; 55:557-570. [PMID: 33196079 PMCID: PMC8171797 DOI: 10.1093/abm/kaaa086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Exposure to structural stigma (i.e., societal norms and policies that constrain access to resources) may help explain poor health outcomes among sexual minority (SM) individuals in the USA. PURPOSE We examined the relationship between structural stigma and smoking prevalence among U.S. SM and heterosexual adults. METHODS We adapted an index to capture multiple state-level structural stigma indicators, including attitudes toward same-sex marriage; the geographical density of same-sex couples; and state-level policies toward SMs. The outcome variable was current smoking, derived from the National Adult Tobacco Survey (2012-2014). Poisson regression models stratified by SM status were used to assess the relationship between structural stigma and the prevalence ratio (PR) of current smoking. We included a squared term for stigma to explore nonlinear relationships between stigma and smoking. Interaction terms were used to examine effect modification by sex. RESULTS Adjusted models suggested a curvilinear PR relationship between stigma and smoking for both SM (linear PR = 1.03 [0.97-1.08]; quadratic PR = 0.98 [0.97-1.00]) and heterosexual (linear PR = 1.00 [0.99-1.02]; quadratic PR = 0.99 [0.988-0.995]) adults. The quadratic term was significant (p < .05) for both SM and heterosexual respondents, however, the change in probability of smoking associated with structural stigma was more pronounced among SM individuals. Specifically, the highest and lowest exposures to stigma were associated with the lowest probabilities of smoking. There was no apparent effect modification by sex. CONCLUSIONS Findings lend support to addressing SM structural stigma as a driver of smoking, particularly among SM adults.
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Affiliation(s)
- Andrea R Titus
- Center for Social Epidemiology & Population Health and Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Nancy L Fleischer
- Center for Social Epidemiology & Population Health and Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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College Climate and Sexual Orientation Differences in Weight Status. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 21:422-433. [PMID: 31659611 DOI: 10.1007/s11121-019-01061-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Previous research has identified significant sexual orientation disparities in obesity. Contextual factors, like lack of anti-discrimination policies and gay-straight alliances, have been shown to be associated with health outcomes like poor mental health and substance use for lesbian, gay, and bisexual (LGB) individuals moreso than their heterosexual counterparts; however, little work to date has explored the role of contextual factors on sexual orientation disparities in obesity. Individual-level, serial cross-sectional data from the 2009-2013 College Student Health Survey, which includes 2- and 4-year college students (n = 29,118) attending 46 Minnesota colleges, were used. College-level data on LGB context were primarily collected through college websites. Multinomial logistic regression models were fit to examine associations between LGB college climate scores (including non-discrimination policies, presence of LGB or diversity-related student groups, LGB courses offered, LGB housing accommodations, and prevalence of LGB students) and students' weight status (underweight, healthy weight, overweight, and obese), based on self-reported height and weight. Higher LGB climate scores (i.e., more supportive environments) were associated with lower risk of overweight and obesity among all students. Sexual orientation-stratified findings among female students suggested that the association between LGB climate scores and weight status was similar to the overall female sample. Sexual orientation-stratified findings among male students showed a more complex relationship between LGB climate scores and weight status. More work is needed to disentangle the observed associations, and to investigate other contextual factors, like state- and city-level policies, social networks and norms, and individual resiliency within these contexts to better understand the contextual influences on sexual orientation disparities in obesity.
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Tan ASL, Hanby EP, Sanders-Jackson A, Lee S, Viswanath K, Potter J. Inequities in tobacco advertising exposure among young adult sexual, racial and ethnic minorities: examining intersectionality of sexual orientation with race and ethnicity. Tob Control 2021; 30:84-93. [PMID: 31857490 DOI: 10.1136/tobaccocontrol-2019-055313] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 11/08/2019] [Accepted: 11/18/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study examined sexual orientation differences in encoded exposure to tobacco product ads and intersections with race and ethnicity. METHODS We analysed data from young adults (18-24) from the US Population Assessment of Tobacco and Health Study in 2013 and 2014 (N=9110). First, we compared encoded exposure to cigarette, electronic cigarette (e-cigarette), cigar and smokeless tobacco ads between sexual minorities (lesbian/gay, bisexual and something else) versus heterosexual young adults. We then analysed encoded ad exposure across sexual orientation, racial and ethnic subgroups. Analyses controlled for demographic and tobacco use variables. RESULTS Bisexual women had significantly higher prevalence of encoded exposure to cigarette and cigar ads compared with heterosexual women, and significantly higher prevalence of encoded e-cigarette ad exposure compared with both heterosexual and lesbian/gay women. There were no significant differences in encoded ad exposure between lesbian versus heterosexual women and between gay or bisexual men versus heterosexual men. Compared with heterosexual white counterparts, increased encoded ad exposures were reported by heterosexual black women (cigarette and cigar ads), black heterosexual men (cigar ads) and bisexual black women (cigarette and cigar ads). Compared with heterosexual non- Hispanic counterparts, increased encoded ad exposures were reported by bisexual Hispanic women (cigarette, e-cigarette and cigar ads) and heterosexual Hispanic men (cigarettes and cigar ads). CONCLUSION Sexual minority women of colour and black heterosexual women and men have increased encoded exposure to certain forms of tobacco ads. Further research is needed to address the impact of tobacco ads among multiple minority individuals based on sex, sexual orientation, race and ethnicity.
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Affiliation(s)
- Andy S L Tan
- Department of Medical Oncology, Division of Population Sciences, Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Elaine P Hanby
- Department of Medical Oncology, Division of Population Sciences, Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ashley Sanders-Jackson
- Department of Advertising and Public Relations, College of Communication Arts and Science, Michigan State University, Lansing, Michigan, USA
| | - Stella Lee
- Department of Medical Oncology, Division of Population Sciences, Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kasisomayajula Viswanath
- Department of Medical Oncology, Division of Population Sciences, Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jennifer Potter
- The Fenway Institute at Fenway Health, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Lahey Health, Boston, Massachusetts, USA
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Hasan MZ, Cohen JE, Bishai D, Kennedy CE, Rao KD, Ahuja A, Gupta S. Social capital and peer influence of tobacco consumption: a cross-sectional study among household heads in rural Uttar Pradesh, India. BMJ Open 2020; 10:e037202. [PMID: 32606063 PMCID: PMC7328809 DOI: 10.1136/bmjopen-2020-037202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Having the world's second-largest tobacco-consuming population, tobacco control is a priority agenda of the Indian Government. Yet, there is no evidence of how peer influence and nature of social relationships-defined as social capital-affect tobacco use. This study aimed to explore the role of social capital and peer influence on tobacco consumption among household heads in rural Uttar Pradesh (UP), India. DESIGN AND SETTING This study was embedded within the baseline evaluation of Project Samuday. A cross-sectional multistage cluster survey was implemented in six census blocks of Hardoi and Sitapur districts of UP from June to August 2017. Self-reported tobacco consumption status of randomly selected 6218 household heads (≥18 years; men vs women=5312 vs 906) was assessed from 346 rural communities. Peer influence of tobacco use was measured by the non-self cluster proportion of tobacco consumption among respondents. Community engagement, social support, trust and social cohesion were separately measured as unique facets of social capital both at individual and community levels using the Shortened Adapted Social Capital Assessment Tool in India (SASCAT-I). The explanatory power of covariates was assessed using gender-stratified generalised estimating equations (GEE) with robust-variance estimator. RESULT Tobacco consumption patterns were starkly different for men and women (71% vs 14%). The peer influence only affected men (adjusted odds ratio (AOR)=1.10, 95% CI: 1.05 to 1.16, p<0.01), whereas women were more likely to consume tobacco if they were more engaged with community organisations (AOR=1.33, 95% CI=1.07 to 1.66, p<0.01). CONCLUSION Gender alters the way social engagement affects tobacco use in rural India. Countering peer influence on Indian men should be prioritised as a tobacco control strategy. Moreover, as gender mainstreaming is a critical egalitarian agenda in India, further research is needed to understand how social engagement affects tobacco consumption behaviours among women.
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Affiliation(s)
- Md Zabir Hasan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
- Institute for Global Tobacco Control (IGTC), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - David Bishai
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Krishna D Rao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Akshay Ahuja
- School of Public Policy, Central European University, Budapest, Hungary
| | - Shivam Gupta
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
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Assari S. Sex Differences in the Association between Cortical Thickness and Children's Behavioral Inhibition. JOURNAL OF PSYCHOLOGY & BEHAVIOR RESEARCH 2020; 2:49-64. [PMID: 33241229 DOI: 10.22158/jpbr.v2n2p49] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM To investigate sex differences in the association between cortical thickness and behavioral inhibition of 9-10 years old American children. MATERIALS AND METHODS This cross-sectional investigation used data from the Adolescent Brain Cognitive Development (ABCD) study. Baseline ABCD data of 10249 American children between ages 9 and 10 were analyzed. The independent variable was cortical thickness measured by structural brain magnetic resonance imaging (sMRI). The primary outcome, behavioral inhibition, was measured based on the behavioral inhibition system (BIS), and behavioral approach system (BAS). Sex was the moderator. Age, race, ethnicity, socioeconomic status indicators, and intracranial volume were covariates. RESULTS In the overall sample, high cortical thickness was not associated with behavioral inhibition in children. Sex showed a statistically significant interaction with cortical thickness's effect on children's behavioral inhibition, net of all confounders. The interaction indicated a statistically stronger positive effect of high cortical thickness on male behavioral inhibition compared to female children. CONCLUSION Cortical thickness is a determinant of behavioral inhibition for male but not female American children. Male but not female children show better behavioral inhabitation at higher levels of cortical thickness.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
- Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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Ylioja T, Cochran G, Woodford MR, Renn KA. Frequent Experience of LGBQ Microaggression on Campus Associated With Smoking Among Sexual Minority College Students. Nicotine Tob Res 2019; 20:340-346. [PMID: 27988489 DOI: 10.1093/ntr/ntw305] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 11/07/2016] [Indexed: 12/16/2022]
Abstract
Introduction Lesbian, gay, bisexual, or queer/questioning (LGBQ) microaggressions refer to often-unintentional insults, assaults, and invalidations that denigrate sexual minorities. While experiencing hostile discrimination and violence has previously been associated with elevated rates of smoking cigarettes for LGBQ college students, the relationship between LGBQ microaggressions and smoking is unknown. Methods Data from a national anonymous online survey of sexual and gender minority college students were used to examine the relationship between past month cigarette smoking and interpersonal LGBQ microaggressions. Multivariable logistic regression assessed the relationship between smoking and frequent (chronic) experiences of microaggressions, using a hierarchical procedure to control for demographics, predictors of smoking, and academic factors. Results Past year frequent LGBQ microaggression was reported by 48% of respondents and was more common among students who smoked in past 30 days. Experiencing past year physical violence was reported by 15% and did not differ by smoking status. Past year frequent experience of microaggressions was associated with increased odds of 1.72 (95% CI 1.03-2.87) for past 30-day smoking after adjusting for age, gender, race, socioeconomic indicators, alcohol misuse, physical violence, as well as academic stress and engagement. Conclusions The results indicate that frequently experiencing LGBQ microaggressions is a risk factor for LGBQ college students smoking cigarettes. The mechanisms underlying this relationship require additional research, as does identifying positive coping strategies and institutional strategies to address LGBQ microaggressions on campuses. Tobacco control efforts should consider the impact of microaggression on the social environment for the prevention and treatment of tobacco use among LGBQ individuals. Implications Microaggressions related to sexual minority identity include subtle forms of discrimination experienced during daily interactions that can create hostile and stressful social environments for a socially disadvantaged group. Prior research has demonstrated that LGBQ college students have higher rates of cigarette smoking, and that experiencing identity-based violence is a risk factor. This study revealed that experiencing frequent LGBQ microaggressions on college campus is associated with increased likelihood of current smoking among LGBQ college students.
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Affiliation(s)
- Thomas Ylioja
- School of Social Work, University of Pittsburgh, Pittsburgh, PA
| | - Gerald Cochran
- School of Social Work, University of Pittsburgh, Pittsburgh, PA.,School of Medicine, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Michael R Woodford
- Lyle S. Hallman Faculty of Social Work, Wilfrid Laurier University, Waterloo, ON
| | - Kristen A Renn
- College of Education, Department of Educational Administration, Michigan State University, East Lansing, MI
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Gower AL, Saewyc EM, Corliss HL, Kne L, Erickson DJ, Eisenberg ME. The LGBTQ Supportive Environments Inventory: Methods for Quantifying Supportive Environments for LGBTQ Youth. JOURNAL OF GAY & LESBIAN SOCIAL SERVICES 2019; 31:314-331. [PMID: 31327914 PMCID: PMC6640865 DOI: 10.1080/10538720.2019.1616023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The social environment in which lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth live influences health and wellbeing. We describe the development of the LGBTQ Supportive Environments Inventory (LGBTQ SEI), designed to quantify the LGBTQ-inclusiveness of social environments in the US and Canada. We quantify aspects of the social environment: 1) Presence/quality of LGBTQ youth-serving organizations; 2) LGBTQ-inclusive Community Resources; 3) Socioeconomic and Political environment. Using GIS tools, we aggregated data to buffers around 397 schools in 3 regions. The LGBTQ SEI can be used to assess the role of the social environment in reducing health disparities for LGBTQ youth.
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Affiliation(s)
- Amy L. Gower
- University of Minnesota, Division of General Pediatrics and Adolescent Health, 717 Delaware St. SE, Minneapolis, MN, 55414, USA
| | - Elizabeth M. Saewyc
- University of British Columbia, Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, CANADA
| | - Heather L. Corliss
- San Diego State University, Graduate School of Public Health and Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 100, San Diego, CA, 92123, USA
| | - Len Kne
- University of Minnesota, U-Spatial, Research Computing, Office of Vice President for Research, 267 19 Ave. S, Minneapolis, MN, 55455, USA
| | - Darin J. Erickson
- University of Minnesota, Division of Epidemiology and Community Health, 1300 S 2nd St, Minneapolis, MN 55454, USA
| | - Marla E. Eisenberg
- University of Minnesota, Division of General Pediatrics and Adolescent Health, 717 Delaware St. SE, Minneapolis, MN, 55414, USA
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Abstract
Many nurses practicing today lack basic education about LGBTQ (lesbian, gay, bisexual, transgender, queer) patient care. How can they better prepare to care for this population? This article provides insight on LGBTQ people, their health risks and disparities, and how nurses can work with LGBTQ patients to improve outcomes.
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Affiliation(s)
- Liz Margolies
- Liz Margolies is the founder and executive director of the National LGBT Cancer Network in New York City. Carlton G. Brown is a nurse consultant at Zenith Healthcare Solutions, LLC, in Portland, Ore., and a member of the Nursing2019 editorial board
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13
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Paschen-Wolff MM, Kelvin E, Wells BE, Campbell ANC, Grosskopf NA, Grov C. Changing Trends in Substance Use and Sexual Risk Disparities among Sexual Minority Women as a Function of Sexual Identity, Behavior, and Attraction: Findings from the National Survey of Family Growth, 2002-2015. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1137-1158. [PMID: 30756210 PMCID: PMC6489449 DOI: 10.1007/s10508-018-1333-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 06/09/2023]
Abstract
Components of sexual minority (SM) status-including lesbian or bisexual identity, having same-sex partners, or same-sex attraction-individually predict substance use and sexual risk behavior disparities among women. Few studies have measured differing associations by sexual orientation components (identity, behavior, and attraction), particularly over time. Data were drawn from the 2002-2015 National Survey of Family Growth female sample (n = 31,222). Multivariable logistic regression (adjusted for age, race/ethnicity, education, marital/cohabitation status, survey cycle, and population-weighted) compared past-year sexual risk behavior, binge drinking, drug use, and sexually transmitted infection treatment among sexual minority women (SMW) versus sexual majority women (SMJW) by each sexual orientation component separately and by all components combined, and tested for effect modification by survey cycle. In multivariable models, SM identity, behavior, and attraction individually predicted significantly greater odds of risk behaviors. SM identity became nonsignificant in final adjusted models with all three orientation components; non-monosexual attraction and behavior continued to predict significantly elevated odds of risk behaviors, remaining associated with sexual risk behavior and drug use over time (attenuated in some cases). Trends in disparities over time between SMW versus SMJW varied by sexual orientation indicator. In a shifting political and social context, research should include multidimensional sexual orientation constructs to accurately identify all SMW-especially those reporting non-monosexual behavior or attraction-and prioritize their health needs.
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Affiliation(s)
- Margaret M Paschen-Wolff
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
| | - Elizabeth Kelvin
- CUNY Institute for Implementation Science in Population Health, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, NY, USA
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Brooke E Wells
- Center for Human Sexuality Studies, Widener University, Chester, PA, USA
| | - Aimee N C Campbell
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Nicholas A Grosskopf
- Department of Health and Physical Education/Gerontological Studies and Services, York College of CUNY, Jamaica, NY, USA
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Christian Grov
- CUNY Institute for Implementation Science in Population Health, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, NY, USA
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
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14
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Leluțiu-Weinberger C, Manu M, Ionescu F, Dogaru B, Kovacs T, Dorobănțescu C, Predescu M, Surace A, Pachankis JE. An mHealth Intervention to Improve Young Gay and Bisexual Men's Sexual, Behavioral, and Mental Health in a Structurally Stigmatizing National Context. JMIR Mhealth Uhealth 2018; 6:e183. [PMID: 30429117 PMCID: PMC6262207 DOI: 10.2196/mhealth.9283] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 04/30/2018] [Accepted: 06/25/2018] [Indexed: 01/01/2023] Open
Abstract
Background Young gay and bisexual men (YGBM) in some Eastern European countries, such as Romania, face high stigma and discrimination, including in health care. Increasing HIV transmission is a concern given inadequate prevention, travel to high-prevalence countries, and popularity of sexual networking technologies. Objective This study aimed to adapt and pilot test, in Romania, a preliminarily efficacious mobile health (mHealth) HIV-prevention intervention, created in the United States, to reduce HIV risk among YGBM. Methods After an intervention formative phase, we enrolled 43 YGBM, mean age 23.2 (SD 3.6) years, who reported condomless sex with a male partner and at least 5 days of heavy drinking in the past 3 months. These YGBM completed up to eight 60-minute text-based counseling sessions grounded in motivational interviewing and cognitive behavioral skills training with trained counselors on a private study mobile platform. We conducted one-group pre-post intervention assessments of sexual (eg, HIV-risk behavior), behavioral (eg, alcohol use), and mental health (eg, depression) outcomes to evaluate the intervention impact. Results From baseline to follow-up, participants reported significant (1) increases in HIV-related knowledge (mean 4.6 vs mean 4.8; P=.001) and recent HIV testing (mean 2.8 vs mean 3.3; P=.05); (2) reductions in the number of days of heavy alcohol consumption (mean 12.8 vs mean 6.9; P=.005), and (3) increases in the self-efficacy of condom use (mean 3.3 vs mean 4.0; P=.01). Participants reported significant reductions in anxiety (mean 1.4 vs mean 1.0; P=.02) and depression (mean 1.5 vs mean 1.0; P=.003). The intervention yielded high acceptability and feasibility: 86% (38/44) of participants who began the intervention completed the minimum dose of 5 sessions, with an average of 7.1 sessions completed; evaluation interviews indicated that participation was rewarding and an “eye-opener” about HIV risk reduction, healthy identity development, and partner communication. Conclusions This first mHealth HIV risk-reduction pilot intervention for YGBM in Eastern Europe indicates preliminary efficacy and strong acceptability and feasibility. This mobile prevention tool lends itself to broad dissemination across various similar settings pending future efficacy testing in a large trial, especially in contexts where stigma keeps YGBM out of reach of affirmative health interventions.
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Affiliation(s)
- Corina Leluțiu-Weinberger
- François-Xavier Bagnoud Center, School of Nursing, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | | | | | - Bogdan Dogaru
- Population Services International Romania, Bucharest, Romania
| | - Tudor Kovacs
- Population Services International Romania, Bucharest, Romania
| | | | - Mioara Predescu
- National Institute of Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania
| | - Anthony Surace
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
| | - John E Pachankis
- Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
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15
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Treatment Outcomes Associated with Quitting Cigarettes Among Sexual Minority Men Living with HIV: Antiretroviral Adherence, Engagement in Care, and Sustained HIV RNA Suppression. AIDS Behav 2018; 22:2868-2876. [PMID: 29680935 DOI: 10.1007/s10461-018-2116-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Cigarette smoking is particularly harmful for sexual minority men living with HIV. This study aimed to find benefits of quitting by examining relationships between smoking and sustained HIV RNA suppression, recent CD4 count, ART medication adherence, and engagement in HIV medical care. Sexual minority men (n = 346), former or current smokers, received HIV care at a community health center. Survey responses were combined with electronic health record data in adjusted regression models. Most patients were Caucasian (87%) and 148 (46%) had incomes below the poverty level and 80% had sustained HIV RNA suppression. Compared to current smokers, former smokers had increased odds of sustaining HIV RNA suppression (OR 1.89; 95% CI 1.02-3.48) of reporting > 90% adherence (OR 2.25; 95% CI 1.21-4.17), and were less likely to miss appointments (OR 0.37; 95% CI 0.17-0.82). Heavier smokers (OR 0.36; 95% CI 0.17-0.77) and patients who smoked the longest (OR 0.31; 95% CI 0.14-0.68) had reduced odds of sustaining HIV RNA suppression. Smoking assessment, treatment, and referral could augment HIV outcomes for sexual minority men with HIV.
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16
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Eisenberg ME, Gower AL, McMorris BJ, Rider GN, Coleman E. Emotional Distress, Bullying Victimization, and Protective Factors Among Transgender and Gender Diverse Adolescents in City, Suburban, Town, and Rural Locations. J Rural Health 2018; 35:270-281. [PMID: 29940070 DOI: 10.1111/jrh.12311] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Understanding the root causes of the substantial disparities in risk and protective factors among transgender and gender diverse (TGD) adolescents is essential to the development and expansion of resources and supports for this vulnerable population. This study examines differences in emotional distress, bullying victimization, and protective factors among TGD high school students in city, suburban, town, and rural locations. METHODS Data come from a statewide school-based survey conducted in Minnesota in 2016 (n = 2,168 TGD youth). Analysis of covariance models were used to predict the prevalence of multiple indicators of emotional distress, bullying victimization, and protective factors across the 4 location categories, with multiple adjustments. FINDINGS Significant linear trends were observed for 2 emotional distress outcomes and 2 bullying victimization outcomes, with urban TGD students having the lowest rates and rural having the highest prevalences. Additional significant differences in emotional distress were noted, with unexpectedly high rates of depressive symptoms and suicidal ideation among suburban students. CONCLUSIONS Helping TGD adolescents in all types of locations identify resources and supportive professionals is critical to supporting this population.
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Affiliation(s)
- Marla E Eisenberg
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Amy L Gower
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | | | - G Nicole Rider
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Eli Coleman
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota
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Mereish EH. Addressing Research Gaps in Sexual and Gender Minority Adolescents' Substance Use and Misuse. J Adolesc Health 2018; 62:645-646. [PMID: 29784109 DOI: 10.1016/j.jadohealth.2018.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Ethan H Mereish
- Department of Health Studies, American University, Washington, D.C
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18
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Berger I, Mooney-Somers J. Smoking Cessation Programs for Lesbian, Gay, Bisexual, Transgender, and Intersex People: A Content-Based Systematic Review. Nicotine Tob Res 2018; 19:1408-1417. [PMID: 27613909 DOI: 10.1093/ntr/ntw216] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 08/26/2016] [Indexed: 12/24/2022]
Abstract
Introduction Tobacco use among lesbian, gay, bisexual, and transgender (LGBT) people is double the general population. Limited evidence suggests high smoking rates among intersex people. Lesbian, gay, bisexual, transgender, and intersex (LGBTI) people are a priority population in Australian health policy, particularly mental health and aging. Despite associations between smoking and noncommunicable diseases relevant to aging and mental health, LGBTI-targeted smoking cessation interventions in Australia have been limited to people living with HIV. Applying existing interventions to marginalized populations without modification and evaluation may fail and exacerbate inequities. Aims To assess outcomes and characterize the populations served, cultural modifications, and behavior change techniques (BCTs) of interventions to reduce LGBTI smoking. Methods We searched MEDLINE, six additional databases, and contacted authors to retrieve published and unpublished program evaluations. Results We retrieved 19 studies (3663 participants). None used control groups. Overall quit rate was 61.0% at the end of interventions and stabilized at 38.6% at 3-6 months. All studies included gay men, 13 included lesbians, 13 "LGBT," 12 bisexual people, five transgender people, and none included intersex people. Transgender people comprised 3% of participants. Of programs open to women, 27.8% of participants were women. Cultural modifications were used by 17 (89.5%) studies, commonly meeting in LGBT spaces, discussing social justice, and discussing LGBT-specific triggers. Common BCTs included providing normative information, boosting motivation/self-efficacy, relapse prevention, social support, action planning, and discussing consequences. Conclusions Quit rates were high; using control groups would improve evaluation. Existing programs may fail to reach groups other than gay men. Implications This review examines the evidence for LGBTI-targeted smoking cessation interventions. Populations within LGBTI are not proportionally represented in smoking cessation research, and no study addressed intersex smoking. Overall, LGBT-targeted interventions appear to be effective, and simply having an LGBT-specific group may be more effective than groups for the general population. More rigorous research is necessary to draw firm conclusions. Our study space analysis provides suggestions for areas of more targeted research on mechanisms underlying these complex interventions' success.
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Affiliation(s)
- Israel Berger
- Centre for Values, Ethics and Law in Medicine (VELiM), Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Julie Mooney-Somers
- Centre for Values, Ethics and Law in Medicine (VELiM), Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
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Bränström R, Pachankis JE. Sexual orientation disparities in the co-occurrence of substance use and psychological distress: a national population-based study (2008-2015). Soc Psychiatry Psychiatr Epidemiol 2018; 53:403-412. [PMID: 29450600 PMCID: PMC5862943 DOI: 10.1007/s00127-018-1491-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/24/2018] [Indexed: 01/04/2023]
Abstract
PURPOSE Although strong evidence documents the elevated prevalence of both substance use and mental health problems among sexual minorities (i.e., gay, lesbian, and bisexuals), relatively less research has examined whether risk of the co-occurrence of these factors is elevated among sexual minorities compared to heterosexuals. The object of this study was to (1) explore sexual orientation-based differences in substance use, psychological distress, and their co-occurrence in a representative sample in Sweden, and (2) examine if greater exposure to stressors, such as discrimination, victimization/threats, and social isolation, could explain these potential disparities and their co-occurrence. METHODS Data come from the cross-sectional Swedish National Public Health Survey, which collected random samples of individuals (16-84 years of age) annually from 2008 to 2015, with an overall response rate of 49.7% (n = 79,568 individuals; 1673 self-identified as lesbian, gay, or bisexual). Population-level sexual orientation differences in substance use (i.e., alcohol, tobacco, and cannabis) and psychological distress were examined. RESULTS Our findings showed significantly elevated prevalence of high-risk alcohol use, cannabis use, and daily tobacco smoking, among sexual minorities compared to heterosexuals. These substantial disparities in substance use more often co-occurred with psychological distress among sexual minorities than among heterosexuals. The elevated risk of co-occurring psychological distress and substance use was most notable among gay men relative to heterosexual men (adjusted odds ratio [AOR] = 2.65, CI 1.98, 3.55), and bisexual women relative to heterosexual women (AOR = 3.01, CI 2.43, 3.72). Multiple mediation analyses showed that experiences of discrimination, victimization, and social isolation partially explained the sexual orientation disparity in these co-occurring problems. CONCLUSIONS This study adds to a growing body of research showing that sexual minorities experience multiple threats to optimal health and points toward future interventions that address the shared sources of these overlapping health threats in stigma-related stress.
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Affiliation(s)
- Richard Bränström
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.
- Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77, Stockholm, Sweden.
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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20
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O'Cleirigh C, Elsesser SA, King D, Ehlinger PP, Bradford JB, Grasso C, Mayer KH. Characteristics and Correlates of Tobacco Use in a Community Sample of Sexual Minority Men and Women: Implications for Smoking Cessation Program Development. LGBT Health 2018; 5:197-202. [PMID: 29641316 DOI: 10.1089/lgbt.2016.0157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Tobacco use is the single most preventable cause of disease, death, and disability in the United States. Research suggests that sexual minorities have an increased risk for smoking and tobacco use. This study aimed to identify characteristics of patients affected by tobacco use disparities and examined demographic and substance use differences between tobacco users and nonusers in a sample of sexual minorities. METHODS Patients at an urban community health center (specializing in the needs of sexual and gender minorities) were invited to complete a cross-sectional 25-item questionnaire. RESULTS Of the 3068 questionnaire respondents, 1543 identified as gay, lesbian, or bisexual. Of these sexual minority respondents, most identified as White (84.4%), 67.3% identified as male and 32.7% as female, with a mean age of 37.7 (SD = 9.44). More than a quarter of sexual minority men (26.7%) and women (28.3%) reported current tobacco use. Among men, younger age (OR = 0.97, CI: 0.95-0.98, P < 0.001), less education (OR = 0.58, CI: 0.35-0.96, P < 0.01), heroin use (OR = 3.3, CI: 1.18-9.39, P < 0.05), and alcohol use (OR = 3.0, CI: 1.86-4.80, P < 0.001) were associated with increased odds of current tobacco use. Among women, younger age (OR = 0.97, CI: 0.95-0.99, P = 0.004), less education (OR = 0.45, CI: 0.22-0.91, P < 0.001), and alcohol use (OR = 3.78, CI: 1.87-7.65, P < 0.001) were associated with current tobacco use. CONCLUSION Cessation programs placed within the context of co-occurring substance and alcohol use for young sexual minority tobacco users from lower socioeconomic backgrounds may be particularly effective.
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Affiliation(s)
- Conall O'Cleirigh
- 1 Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School , Boston, Massachusetts.,2 The Fenway Institute , Fenway Health, Boston, Massachusetts
| | - Steven A Elsesser
- 3 Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia, Pennsylvania
| | - Dana King
- 2 The Fenway Institute , Fenway Health, Boston, Massachusetts
| | | | | | - Chris Grasso
- 2 The Fenway Institute , Fenway Health, Boston, Massachusetts
| | - Kenneth H Mayer
- 2 The Fenway Institute , Fenway Health, Boston, Massachusetts
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21
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Lelutiu-Weinberger C, Pachankis JE. Acceptability and Preliminary Efficacy of a Lesbian, Gay, Bisexual, and Transgender-Affirmative Mental Health Practice Training in a Highly Stigmatizing National Context. LGBT Health 2017; 4:360-370. [PMID: 28891750 DOI: 10.1089/lgbt.2016.0194] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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) individuals in Romania encounter pervasive stigma and discrimination and there is a high need for LGBT-competent mental health professionals (MHPs). We tested the impact of a pilot LGBT-affirmative training for MHPs in Romania on these professionals' LGBT-relevant attitudes, knowledge, and perception of clinical skills. METHODS We conducted a 2-day training for MHPs in Bucharest. Fifty-four attended and 33 provided training evaluation data at baseline and follow-up. RESULTS The majority of trainees were female (90%) and heterosexual (73%) with a mean age of 36.4 (SD = 7.7). From baseline to follow-up, trainees demonstrated a significant increase in perceived LGBT-relevant clinical skills (P < 0.001) and perceived knowledge (P < 0.05). LGBT-affirmative practice attitudes (P < 0.05) and comfort in addressing the mental health of LGBT individuals (P < 0.01) increased significantly, and homonegative and transnegative attitudes decreased significantly (P < 0.01). Negative attitudes toward LGBT individuals were low at both baseline and follow-up. The majority of trainees reported being highly interested in the training (84%), which they reported had prepared them to interact with and care for LGBT individuals (74%). CONCLUSION This pilot training appeared to be effective in increasing perceived LGBT competence among participating MHPs. This type of training model needs to be tested further in a randomized controlled trial with longer follow-up periods to assess intervention durability and implementation of clinical skills. Future trainings can be incorporated into existing curricula. National accreditation bodies might consider encouraging such training as part of standard educational requirements.
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Affiliation(s)
| | - John E Pachankis
- 2 Department of Social and Behavioral Sciences, Yale School of Public Health , New Haven, Connecticut
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22
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Tan ASL, Bigman CA, Nagler RH, Minsky S, Viswanath K. Comparing perceived effectiveness of FDA-proposed cigarette packaging graphic health warnings between sexual and gender minorities and heterosexual adults. Cancer Causes Control 2017; 28:1143-1155. [PMID: 28866791 DOI: 10.1007/s10552-017-0954-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND In 2012, the U.S. Food and Drug Administration proposed nine graphic health warnings (GHWs) on cigarette packaging that were rated equally effective across racial/ethnic, education, or income groups of adult smokers. However, data on GHW effectiveness among sexual and gender minority (SGM) adults, who have higher smoking prevalence, are currently lacking. This study analyzed whether perceived effectiveness of GHWs differed by gender and sexual orientation. METHODS Data came from a randomized experiment among 1,200 adults with an oversample from low socioeconomic status groups, conducted between 2013 and 2014 in three Massachusetts communities. Participants viewed and rated the effectiveness of nine GHWs. Mixed effects regression models predicted perceived effectiveness with gender and sexual orientation, adjusting for repeated measurements, GHWs viewed, age, race, ethnicity, smoking status, and health status. RESULTS Female heterosexuals rated GHWs as more effective than male heterosexual, lesbian, and transgender and other gender respondents. There was no significant difference between female and male heterosexuals versus gay, male bisexual, or female bisexual respondents. Differences by gender and sexual orientation were consistent across all nine GHWs. Significant correlates of higher perceived effectiveness included certain GHWs, older age, being African-American (vs white), being Hispanic (vs non-Hispanic), having less than high school education (vs associate degree or higher), and being current smokers (vs non-smokers). CONCLUSIONS Perceived effectiveness of GHWs was lower in certain SGM groups. We recommend further studies to understand the underlying mechanisms for these findings and investments in research and policy to communicate anti-smoking messages more effectively to SGM populations.
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Affiliation(s)
- Andy S L Tan
- Population Sciences Division, Center for Community Based Research, Dana-Farber Cancer Institute, Boston, MA, USA. .,Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.
| | - Cabral A Bigman
- Department of Communication, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Rebekah H Nagler
- Hubbard School of Journalism and Mass Communication, University of Minnesota, Minneapolis, MN, USA
| | - Sara Minsky
- Population Sciences Division, Center for Community Based Research, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kasisomayajula Viswanath
- Population Sciences Division, Center for Community Based Research, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
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23
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Wolff M, Wells B, Ventura-DiPersia C, Renson A, Grov C. Measuring Sexual Orientation: A Review and Critique of U.S. Data Collection Efforts and Implications for Health Policy. JOURNAL OF SEX RESEARCH 2017; 54:507-531. [PMID: 28010119 DOI: 10.1080/00224499.2016.1255872] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The U.S. Department of Health and Human Services' (HHS) Healthy People 2020 goals sought to improve health outcomes among sexual minorities; HHS acknowledged that a dearth of sexual orientation items in federal and state health surveys obscured a broad understanding of sexual minority-related health disparities. The HHS 2011 data progression plan aimed to advance sexual orientation data collection efforts at the national level. Sexual orientation is a complex, multidimensional construct often composed of sexual identity, sexual attraction, and sexual behavior, thus posing challenges to its quantitative and practical measurement and analysis. In this review, we (a) present existing sexual orientation constructs; (b) evaluate current HHS sexual orientation data collection efforts; (c) review post-2011 data progression plan research on sexual minority health disparities, drawing on HHS survey data; (d) highlight the importance of and (e) identify obstacles to multidimensional sexual orientation measurement and analysis; and (f) discuss methods for multidimensional sexual orientation analysis and propose a matrix for addressing discordance/branchedness within these analyses. Multidimensional sexual orientation data collection and analysis would elucidate sexual minority-related health disparities, guide related health policies, and enhance population-based estimates of sexual minority individuals to steer health care practices.
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Affiliation(s)
- Margaret Wolff
- a Department of Community Health and Social Science , CUNY Graduate School of Public Health and Health Policy
| | - Brooke Wells
- b Center for Human Sexuality Studies , Widener University
| | - Christina Ventura-DiPersia
- a Department of Community Health and Social Science , CUNY Graduate School of Public Health and Health Policy
- c Department of Physician Assistant Studies , Hofstra University
| | - Audrey Renson
- d Department of Epidemiology and Biostatistics , CUNY Graduate School of Public Health and Health Policy
| | - Christian Grov
- a Department of Community Health and Social Science , CUNY Graduate School of Public Health and Health Policy
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Baskerville NB, Dash D, Shuh A, Wong K, Abramowicz A, Yessis J, Kennedy RD. Tobacco use cessation interventions for lesbian, gay, bisexual, transgender and queer youth and young adults: A scoping review. Prev Med Rep 2017; 6:53-62. [PMID: 28271021 PMCID: PMC5328933 DOI: 10.1016/j.pmedr.2017.02.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 02/06/2017] [Accepted: 02/13/2017] [Indexed: 12/02/2022] Open
Abstract
Smoking prevalence among LGBTQ + youth and young adults is alarmingly high compared to their non-LGBTQ + peers. The purpose of the scoping review was to assess the current state of smoking prevention and cessation intervention research for LGBTQ + youth and young adults, identify and describe these interventions and their effectiveness, and identify gaps in both practice and research. A search for published literature was conducted in PubMed, Scopus, CINAHL, PsychInfo, and LGBT Life, as well as an in-depth search of the grey literature. All English articles published or written between January 2000 and February 2016 were extracted. The search identified 24 records, of which 21 were included; 11 from peer reviewed sources and 10 from the grey literature. Of these 21, only one study targeted young adults and only one study had smoking prevention as an objective. Records were extracted into evidence tables using a modified PICO framework and a narrative synthesis was conducted. The evidence to date is drawn from methodologically weak studies; however, group cessation counselling demonstrates high quit rates and community-based programs have been implemented, although very little evidence of outcomes exist. Better-controlled research studies are needed and limited evidence exists to guide implementation of interventions for LGBTQ + youth and young adults. This scoping review identified a large research gap in the area of prevention and cessation interventions for LGBTQ youth and young adults. There is a need for effective, community-informed, and engaged interventions specific to LGBTQ + youth and young adults for the prevention and cessation of tobacco. We conducted a scoping review on cessation programs for LGBTQ + young adults. A large research gap in the area of tobacco control for LGBTQ + young adults exists. Tobacco control interventions specific to LGBTQ + youth and young adults are needed.
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Affiliation(s)
- N. Bruce Baskerville
- Propel Centre for Population Health Impact, University of Waterloo, Canada
- Corresponding author at: Propel Centre for Population Health Impact, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada.Propel Centre for Population Health ImpactUniversity of WaterlooWaterlooOntarioN2L 3G1Canada
| | - Darly Dash
- Propel Centre for Population Health Impact, University of Waterloo, Canada
| | - Alanna Shuh
- Propel Centre for Population Health Impact, University of Waterloo, Canada
| | - Katy Wong
- Propel Centre for Population Health Impact, University of Waterloo, Canada
| | - Aneta Abramowicz
- Propel Centre for Population Health Impact, University of Waterloo, Canada
| | - Jennifer Yessis
- Propel Centre for Population Health Impact, University of Waterloo, Canada
| | - Ryan D. Kennedy
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, United States
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25
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Porta CM, Corliss HL, Wolowic JM, Johnson AZ, Fogel KF, Gower AL, Saewyc EM, Eisenberg ME. Go-along interviewing with LGBTQ youth in Canada and the United States. JOURNAL OF LGBT YOUTH 2017; 14:1-15. [PMID: 28943992 PMCID: PMC5603221 DOI: 10.1080/19361653.2016.1256245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Go-along interviews, which are interviews conducted whilst being in and moving within participant selected spaces, were conducted with 66 LGBTQ adolescents (14-19 years old) in their self-identified communities to explore perceived community attributes, including safe spaces, resources, and supports; this paper highlights methodological lessons learned. Successful recruitment in two countries and varied community settings required partnership with local LGBTQ supporting agencies, including school-based Gay Straight Alliances. Youth chose to walk, use public transportation, and drive to community locations, identifying numerous formal and informal resources in their communities. Participant reflections highlighted that go-along interviews can be conducted in safe ways that encourage LGBTQ youth to express themselves about communities in which they live, study, work, play, and relax.
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Affiliation(s)
- Carolyn M Porta
- University of Minnesota, School of Nursing, Minneapolis, MN, USA
| | - Heather L Corliss
- San Diego State University, School of Public Health, San Diego, CA, USA;
| | - Jennifer M Wolowic
- University of British Columbia, Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, Vancouver, BC, CANADA;
| | - Abigail Z Johnson
- University of Minnesota, Division of General Pediatrics and Adolescent Health, Minneapolis, MN, USA;
| | - Katie Fritz Fogel
- University of Minnesota, Division of General Pediatrics and Adolescent Health, Minneapolis, MN, USA;
| | - Amy L Gower
- University of Minnesota, Division of General Pediatrics and Adolescent Health, Minneapolis, MN, USA;
| | - Elizabeth M Saewyc
- University of British Columbia, Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, Vancouver, BC, CANADA;
| | - Marla E Eisenberg
- University of Minnesota, Division of General Pediatrics and Adolescent Health, Minneapolis, MN, USA;
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26
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Hatzenbuehler ML. Advancing Research on Structural Stigma and Sexual Orientation Disparities in Mental Health Among Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 46:463-475. [PMID: 27911583 DOI: 10.1080/15374416.2016.1247360] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Psychological research on stigma has focused largely on the perceptions of stigmatized individuals and their interpersonal interactions with the nonstigmatized. This work has been critical in documenting many of the ways in which stigma operates to harm those who are targeted. However, this research has also tended to overlook broader structural forms of stigma, which refer to societal-level conditions, cultural norms, and institutional policies and practices that constrain the lives of the stigmatized. In this article I describe the emerging field of research on structural stigma and review evidence documenting the harmful consequences of structural stigma for the mental/behavioral health of lesbian, gay, and bisexual youth. This research demonstrates that structural stigma represents an important, but thus far largely underrecognized, mechanism underlying mental health disparities related to sexual orientation among youth. I offer several suggestions to advance research in this area, including (a) adopting a life-course approach to the study of structural stigma; (b) developing novel measures of structural stigma; (c) expanding both the range of methods used for studying structural stigma and the sequelae of structural stigma that are evaluated; (d) identifying potential mediators and moderators of the structural stigma-health relationship; (e) examining intersectionalities; and (f) testing generalizability of structural stigma across other groups, with a particular focus on transgender youth. The implications of this research for preventive interventions and for public policy are also discussed.
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27
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Twenge JM, Sherman RA, Wells BE. Changes in American Adults' Reported Same-Sex Sexual Experiences and Attitudes, 1973-2014. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1713-1730. [PMID: 27251639 DOI: 10.1007/s10508-016-0769-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 02/18/2016] [Accepted: 05/04/2016] [Indexed: 06/05/2023]
Abstract
We examined change over time in the reported prevalence of men having sex with men and women having sex with women and acceptance of those behaviors in the nationally representative General Social Survey of U.S. adults (n's = 28,161-33,728, ages 18-96 years), 1972-2014. The number of U.S. adults who had at least one same-sex partner since age 18 doubled between the early 1990s and early 2010s (from 3.6 to 8.7 % for women and from 4.5 to 8.2 % for men). Bisexual behavior (having sex with both male and female partners) increased from 3.1 to 7.7 %, accounting for much of the rise, with little consistent change in those having sex exclusively with same-sex partners. The increase in same-sex partners was larger for women than for men, consistent with erotic plasticity theory. Attitudes toward same-sex sexual behavior also became substantially more accepting, d = .75, between the early 1970s and early 2010s. By 2014, 49 % of American adults believed that same-sex sexual activity was "not wrong at all," up from 11 % in 1973 and 13 % in 1990. Controlling for acceptance reduced, but did not eliminate, the increase in same-sex behavior over time. Mixed effects (hierarchical linear modeling) analyses separating age, time period, and cohort showed that the trends were primarily due to time period. Increases in same-sex sexual behavior were largest in the South and Midwest and among Whites, were mostly absent among Blacks, and were smaller among the religious. Overall, same-sex sexual behavior has become both more common (or at least more commonly reported) and more accepted.
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Affiliation(s)
- Jean M Twenge
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4611, USA.
| | - Ryne A Sherman
- Department of Psychology, Florida Atlantic University, Boca Raton, FL, USA
| | - Brooke E Wells
- Center for Human Sexuality Studies, Widener University, Chester, PA, USA
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Puckett JA, Newcomb ME, Garofalo R, Mustanski B. The Impact of Victimization and Neuroticism on Mental Health in Young Men who have Sex with Men: Internalized Homophobia as an Underlying Mechanism. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2016; 13:193-201. [PMID: 28138349 PMCID: PMC5270763 DOI: 10.1007/s13178-016-0239-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Sexual minorities experience greater mental health issues compared to heterosexuals due to minority stressors. This study focused on the impact of victimization and neuroticism on mental health in young men who have sex with men (YMSM), and the mediating role of internalized homophobia (IH). IH refers to when a sexual minority person internalizes social bias and develops a negative view of themselves, which is a likely process through which victimization and neuroticism impact mental health. Data were collected over three time points across 12 months, with 450 YMSM (mean age = 18.9) and an 80.7% retention rate. Two mediation analyses with bias-corrected bootstrapping using 1000 samples were conducted, controlling for age, race, and sexual orientation. Results revealed that victimization [F (9, 440) = 4.83, p < .001, R2 = .09] and neuroticism [F (9, 440) = 12.23, p < .001, R2 = .20] had a significant indirect effect on mental health via increased levels of IH. These findings show how external experiences of stigma and personality level characteristics may impact YMSM in terms of their sense of self. Furthermore, these results support addressing social conditions that marginalize YMSM in order to promote better mental health through decreasing IH.
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Affiliation(s)
- Jae A Puckett
- Assistant Professor, Clinical Psychology Program, University of South Dakota, 414 E. Clark, Vermillion, SD 57069
| | - Michael E Newcomb
- Assistant Professor, Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, 625 N. Michigan Ave., Suite 2700, Chicago, IL 60611
| | - Robert Garofalo
- Associate Professor, Ann & Robert H. Lurie Children's Hospital of Chicago, Center for Gender, Sexuality and HIV Prevention, 225 E. Chicago Ave., Chicago, IL 60611
| | - Brian Mustanski
- Associate Professor, Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences, 625 N Michigan Ave, Suite 2700, Chicago, IL 60657
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Bariola E, Lyons A, Leonard W. Gender-specific health implications of minority stress among lesbians and gay men. Aust N Z J Public Health 2016; 40:506-512. [PMID: 27372452 DOI: 10.1111/1753-6405.12539] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/01/2015] [Accepted: 02/01/2016] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Lesbians and gay men are exposed to unique minority stressors. We examined the health implications of one type of distal minority stressor (victimisation) and one type of proximal minority stressor (sexual identity concealment due to anticipated stigma) among lesbians and gay men. Gender-specific health implications were assessed. METHODS Data were collected via an online survey involving an Australian sample of 1,470 gay men and 1,264 lesbians. Survey questions assessed demographics, experiences of different forms of sexual identity-related victimisation and sexual identity concealment in a variety of contexts. Health outcomes included self-reported general health, illicit drug use, frequency of alcohol consumption, smoking status, and weight status. RESULTS Gay men reported higher rates of victimisation and identity concealment than lesbians. Controlling for demographic differences, experiences of victimisation were associated with poorer self-rated health, illicit drug use, and smoking among both gay men and lesbians. In contrast, identity concealment was linked with poorer health outcomes among lesbians only. CONCLUSIONS Our findings offer new insights into the potential antecedents of the health inequalities that have previously been reported for these populations.
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Affiliation(s)
- Emily Bariola
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Victoria
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Victoria
| | - William Leonard
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Victoria
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Beyond Smoking Prevalence: Exploring the Variability of Associations between Neighborhood Exposures across Two Nested Spatial Units and Two-Year Smoking Trajectory among Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13010106. [PMID: 26751461 PMCID: PMC4730497 DOI: 10.3390/ijerph13010106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 12/28/2015] [Accepted: 12/28/2015] [Indexed: 01/19/2023]
Abstract
Young adults have the highest prevalence of smoking amongst all age groups. Significant uptake occurs after high school age. Although neighborhood exposures have been found to be associated with smoking behavior, research on neighborhood exposures and the smoking trajectories among young adults, and on the role of geographic scale in shaping findings, is scarce. We examined associations between neighborhood exposures across two nested, increasingly large spatial units and smoking trajectory over two years among young adults living in Montreal, Canada. A sample of 2093 participants aged 18-25 years from the Interdisciplinary Study of Inequalities in Smoking (ISIS) was surveyed. The dependent variable was self-reported smoking trajectory over the course of two years. Residential addresses, data on presence of tobacco retail outlets, and the presence of smoking accommodation facilities were coded and linked to spatial units. Three-level multinomial models were used to examine associations. The likelihood of being a smoker for 2+ years was significantly greater among those living in larger spatial unit neighborhoods that had a greater presence of smoking accommodation. This association was not statistically significant at the smaller spatial units. Our findings highlight the importance of studying young adults' smoking trajectories in addition to static smoking outcomes, and point to the relevance of considering spatial scale in studies of neighborhoods and smoking.
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Relationship Between Tobacco Retailers' Point-of-Sale Marketing and the Density of Same-Sex Couples, 97 U.S. Counties, 2012. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015. [PMID: 26225987 PMCID: PMC4555248 DOI: 10.3390/ijerph120808790] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The reasons for higher rates of smoking among lesbian, gay, and bisexual (LGB) people than among heterosexual people are not well known. Research on internal migration and neighborhood selection suggests that LGB people are more likely to live in neighborhoods where the tobacco industry has historically targeted their marketing efforts (lower income, more racial/ethnic diversity). We used multi-level models to assess the relationship between the rate of same-sex couples per 1000 coupled households and 2012 marketing characteristics of tobacco retailers (n = 2231) in 1696 census tracts in 97 U.S. counties. We found no evidence of tobacco marketing at retailers differing by same-sex couple rates in census tracts with the exception of three findings in the opposite direction of our hypotheses: a small, significant positive relationship for the rate of same-sex male couples and the price of Newport Green (mentholated) cigarettes. For male and female same-sex couples, we also found a small negative relationship between tobacco advertisements and same-sex household rate. Tobacco retailers’ tobacco marketing characteristics do not differ substantially by the rate of same-sex couples in their neighborhood in ways that would promote LGB health disparities. Further work is needed to determine if these patterns are similar for non-partnered LGB people.
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Cochran SD, Mays VM. Mortality risks among persons reporting same-sex sexual partners: evidence from the 2008 General Social Survey-National Death Index data set. Am J Public Health 2015; 105:358-64. [PMID: 25033136 PMCID: PMC4289448 DOI: 10.2105/ajph.2014.301974] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We investigated the possibility that men who have sex with men (MSM) and women who have sex with women (WSW) may be at higher risk for early mortality associated with suicide and other sexual orientation-associated health risks. METHODS We used data from the 1988-2002 General Social Surveys, with respondents followed up for mortality status as of December 31, 2008. The surveys included 17 886 persons aged 18 years or older, who reported at least 1 lifetime sexual partner. Of these, 853 reported any same-sex partners; 17 033 reported only different-sex partners. Using gender-stratified analyses, we compared these 2 groups for all-cause mortality and HIV-, suicide-, and breast cancer-related mortality. RESULTS The WSW evidenced greater risk for suicide mortality than presumptively heterosexual women, but there was no evidence of similar sexual orientation-associated risk among men. All-cause mortality did not appear to differ by sexual orientation among either women or men. HIV-related deaths were not elevated among MSM or breast cancer deaths among WSW. CONCLUSIONS The elevated suicide mortality risk observed among WSW partially confirms public health concerns that sexual minorities experience greater burden from suicide-related mortality.
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Affiliation(s)
- Susan D Cochran
- Susan D. Cochran is with the departments of Epidemiology and Statistics, University of California, Los Angeles (UCLA) Fielding School of Public Health, Los Angeles. Vickie M. Mays is with the departments of Psychology and Health Policy and Management, UCLA. Both authors are also with the UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, Los Angeles
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Lee JGL, Matthews AK, McCullen CA, Melvin CL. Promotion of tobacco use cessation for lesbian, gay, bisexual, and transgender people: a systematic review. Am J Prev Med 2014; 47:823-31. [PMID: 25455123 PMCID: PMC4255587 DOI: 10.1016/j.amepre.2014.07.051] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 06/20/2014] [Accepted: 07/29/2014] [Indexed: 11/17/2022]
Abstract
CONTEXT Lesbian, gay, bisexual, and transgender (LGBT) people are at increased risk for the adverse effects of tobacco use, given their high prevalence of use, especially smoking. Evidence regarding cessation is limited. To determine if efficacious interventions are available and to aid the development of interventions, a systematic review was conducted of grey and peer-reviewed literature describing clinical, community, and policy interventions, as well as knowledge, attitudes, and behaviors regarding tobacco use cessation among LGBT people. EVIDENCE ACQUISITION Eight databases for articles from 1987 to April 23, 2014, were searched. In February-November 2013, authors and researchers were contacted to identify grey literature. EVIDENCE SYNTHESIS The search identified 57 records, of which 51 were included and 22 were from the grey literature; these were abstracted into evidence tables, and a narrative synthesis was conducted in October 2013-May 2014. Group cessation curricula tailored for LGBT populations were found feasible to implement and show evidence of effectiveness. Community interventions have been implemented by and for LGBT communities, although these interventions showed feasibility, no rigorous outcome evaluations exist. Clinical interventions show little difference between LGBT and heterosexual people. Focus groups suggest that care is needed in selecting the messaging used in media campaigns. CONCLUSIONS LGBT-serving organizations should implement existing evidence-based tobacco-dependence treatment and clinical systems to support treatment of tobacco use. A clear commitment from government and funders is needed to investigate whether sexual orientation and gender identity moderate the impacts of policy interventions, media campaigns, and clinical interventions.
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Affiliation(s)
- Joseph G L Lee
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Alicia K Matthews
- Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Cramer A McCullen
- Gillings School of Global Public Health, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cathy L Melvin
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
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Hatzenbuehler ML, McLaughlin KA. Structural stigma and hypothalamic-pituitary-adrenocortical axis reactivity in lesbian, gay, and bisexual young adults. Ann Behav Med 2014; 47:39-47. [PMID: 24154988 DOI: 10.1007/s12160-013-9556-9] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Youth exposed to extreme adverse life conditions have blunted cortisol responses to stress. PURPOSE This study aims to examine whether growing up in highly stigmatizing environments similarly shapes stigmatized individuals' physiological responses to identity-related stress. METHODS We recruited 74 lesbian, gay, and bisexual young adults (mean age = 23.68) from 24 states with varying levels of structural stigma surrounding homosexuality. State-level structural stigma was coded based on several dimensions, including policies that exclude sexual minorities from social institutions (e.g., same-sex marriage). Participants were exposed to a laboratory stressor, the Trier Social Stress Test (TSST), and neuroendocrine measures were collected. RESULTS Lesbian, gay, and bisexual young adults who were raised in highly stigmatizing environments as adolescents evidenced a blunted cortisol response following the TSST compared to those from low-stigma environments. CONCLUSIONS The stress of growing up in environments that target gays and lesbians for social exclusion may exert biological effects that are similar to traumatic life experiences.
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Affiliation(s)
- Mark L Hatzenbuehler
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 549.B, New York, NY, 10032, USA,
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Duncan DT, Kapadia F, Halkitis PN. Examination of spatial polygamy among young gay, bisexual, and other men who have sex with men in New York City: the P18 cohort study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:8962-83. [PMID: 25170685 PMCID: PMC4199000 DOI: 10.3390/ijerph110908962] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 11/16/2022]
Abstract
The few previous studies examining the influence of the neighborhood context on health and health behavior among young gay, bisexual, and other men who have sex with men (YMSM) have predominantly focused on residential neighborhoods. No studies have examined multiple neighborhood contexts among YMSM or the relationships between sociodemographic characteristics, psychosocial factors, social support network characteristics, health behaviors, and neighborhood concordance. In this study, we assessed spatial polygamy by determining the amount of concordance between residential, social, and sex neighborhoods (defined as boroughs) in addition to examining individual-level characteristics that may be associated with neighborhood concordance. These data come from the baseline assessment of Project 18, a cohort of racially and ethnically diverse YMSM residing in the New York City metropolitan area. Participants (N = 598) provided information on their residential, social, and sex boroughs as well as information on their sociodemographic characteristics, psychosocial factors, social support network characteristics, and health behaviors (e.g., substance use and condomless sex). Descriptive analyses were conducted to examine the distribution of boroughs reported across all three contexts, i.e., residential, social, and sex boroughs. Next, concordance between: (1) residential and social boroughs; (2) residential and sex boroughs; (3) social and sex boroughs; and (4) residential, social, and sex boroughs was assessed. Finally, bivariable analyses were conducted to examine the relationships between sociodemographic characteristics, psychosocial factors, social support network characteristics, and health behaviors in relation to borough concordance. Approximately two-thirds of participants reported concordance between residential/socializing, residential/sex, and sex/socializing boroughs, whereas 25% reported concordance between all three residential/socializing/sex boroughs. Borough concordance varied by some individual-level characteristics. For example, White YMSM and YMSM reporting lower perceived socioeconomic status were significantly more likely to report residential/socializing/sex borough concordance (p < 0.001). With regard to psychosocial factors, YMSM who reported experiencing gay-related stigma in public forums were more likely to report discordant socializing/sex and residential/socializing/sex boroughs (p < 0.001). Greater frequency of communication with network members (≥weekly) was associated with less residential/social borough concordance (p < 0.05). YMSM who reported residential/socializing/sex borough concordance were more likely to report recent (last 30 days) alcohol use, recent marijuana use, and recently engaging in condomless oral sex (all p < 0.05). These findings suggest that spatial polygamy, or an individual moving across and experiencing multiple neighborhood contexts, is prevalent among urban YMSM and that spatial polygamy varies by multiple individual-level characteristics. Future research among YMSM populations should consider multiple neighborhood contexts in order to provide a more nuanced understanding of how and which neighborhood contexts influence the health and well-being of YMSM. This further examination of spatial polygamy (and individual-level characteristics associated with it) may increase understanding of the most appropriate locations for targeted disease prevention and health promotion interventions (e.g., HIV prevention interventions).
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Affiliation(s)
- Dustin T. Duncan
- Department of Population Health, School of Medicine, New York University, New York, NY 10016, USA; E-Mails: (F.K.); (P.N.K.)
- Global Institute of Public Health, New York University, New York, NY 10003, USA
- Population Center, New York University, New York, NY 10012, USA
- Center for Health, Identity, Behavior and Prevention Studies, New York University, New York, NY 10003, USA
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-646-501-2674; Fax: + 1-646-501-2706
| | - Farzana Kapadia
- Department of Population Health, School of Medicine, New York University, New York, NY 10016, USA; E-Mails: (F.K.); (P.N.K.)
- Global Institute of Public Health, New York University, New York, NY 10003, USA
- Center for Health, Identity, Behavior and Prevention Studies, New York University, New York, NY 10003, USA
- Department of Nutrition, Food Studies and Public Health, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY 10003, USA
| | - Perry N. Halkitis
- Department of Population Health, School of Medicine, New York University, New York, NY 10016, USA; E-Mails: (F.K.); (P.N.K.)
- Global Institute of Public Health, New York University, New York, NY 10003, USA
- Population Center, New York University, New York, NY 10012, USA
- Center for Health, Identity, Behavior and Prevention Studies, New York University, New York, NY 10003, USA
- Department of Nutrition, Food Studies and Public Health, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY 10003, USA
- Department of Applied Psychology, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY 10003, USA
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Newcomb ME, Heinz AJ, Birkett M, Mustanski B. A longitudinal examination of risk and protective factors for cigarette smoking among lesbian, gay, bisexual, and transgender youth. J Adolesc Health 2014; 54:558-64. [PMID: 24388111 PMCID: PMC3999176 DOI: 10.1016/j.jadohealth.2013.10.208] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 10/09/2013] [Accepted: 10/11/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate change across development in two smoking outcomes (smoking status and rate), describe demographic differences in smoking, and longitudinally examine the effects of psychosocial variables on smoking (psychological distress, victimization, and social support) in lesbian, gay, bisexual, and transgender (LGBT) youth. METHODS Participants were 248 ethnically diverse LGBT youth (ages 16-20 years at baseline) from a longitudinal cohort study with six waves over 3.5 years. Baseline questionnaires included demographic variables and a measure of impulsivity, and longitudinal questionnaires included measures of cigarette smoking (status and average number of cigarettes smoked daily), LGBT-based victimization, psychological distress, and perceived social support. Analyses were conducted with hierarchical linear modeling. RESULTS Males had higher odds of smoking and smoking rate than females, but females' smoking rate increased more rapidly over time. Psychological distress was associated with higher odds of smoking and smoking rate at the same wave, and it predicted smoking rate at the subsequent wave. LGBT victimization was associated with higher odds of smoking at the same wave and predicted smoking rate at the subsequent wave. Finally, significant other support predicted higher odds of smoking and smoking rate at the subsequent wave, but family support was negatively correlated with smoking rate at the same wave. CONCLUSIONS There are several viable avenues for the development of smoking prevention interventions for LGBT youth. To optimize the efficacy of prevention strategies, we must consider experiences with victimization, the impact of psychological distress, and optimizing support from families and romantic partners.
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Affiliation(s)
- Michael E Newcomb
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
| | - Adrienne J Heinz
- Center for Healthcare Evaluation, VA Palo Alto Health Care, Menlo Park, California; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Michelle Birkett
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Corliss HL, Rosario M, Birkett MA, Newcomb ME, Buchting FO, Matthews AK. Sexual orientation disparities in adolescent cigarette smoking: intersections with race/ethnicity, gender, and age. Am J Public Health 2014; 104:1137-47. [PMID: 24825218 DOI: 10.2105/ajph.2013.301819] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined sexual orientation differences in adolescent smoking and intersections with race/ethnicity, gender, and age. METHODS We pooled Youth Risk Behavior Survey data collected in 2005 and 2007 from 14 jurisdictions; the analytic sample comprised observations from 13 of those jurisdictions (n = 64,397). We compared smoking behaviors of sexual minorities and heterosexuals on 2 dimensions of sexual orientation: identity (heterosexual, gay-lesbian, bisexual, unsure) and gender of lifetime sexual partners (only opposite sex, only same sex, or both sexes). Multivariable regressions examined whether race/ethnicity, gender, and age modified sexual orientation differences in smoking. RESULTS Sexual minorities smoked more than heterosexuals. Disparities varied by sexual orientation dimension: they were larger when we compared adolescents by identity rather than gender of sexual partners. In some instances race/ethnicity, gender, and age modified smoking disparities: Black lesbians-gays, Asian American and Pacific Islander lesbians-gays and bisexuals, younger bisexuals, and bisexual girls had greater risk. CONCLUSIONS Sexual orientation, race/ethnicity, gender, and age should be considered in research and practice to better understand and reduce disparities in adolescent smoking.
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Affiliation(s)
- Heather L Corliss
- At the time of the study, Heather L. Corliss was with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital/Harvard Medical School, Boston, MA. Margaret Rosario is with the Department of Psychology in Clinical Psychology, Health Psychology, and Clinical Science, and Basic and Applied Social Psychology, City University of New York-City College and Graduate Center, New York, NY. Michelle A. Birkett and Michael E. Newcomb are with the Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL. Francisco O. Buchting is with Horizons Foundation, San Francisco, CA. Alicia K. Matthews is with the Department of Health Systems Sciences, University of Illinois at Chicago
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Matthews DD, Lee JGL. A profile of North Carolina lesbian, gay, and bisexual health disparities, 2011. Am J Public Health 2014; 104:e98-e105. [PMID: 24825240 DOI: 10.2105/ajph.2013.301751] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated the health profile of lesbian, gay, and bisexual (LGB) adults in North Carolina, the first state in the South to include a measure of sexual orientation identity in a probability-based statewide health survey. METHODS Using data from 9876 respondents in the 2011 North Carolina Behavioral Risk Factor Surveillance Survey, we compared sexual minorities to heterosexuals on a variety of health indicators. RESULTS LGB respondents were younger and more likely to be reached by cell phone. Many examined indicators were not different by sexual orientation. Significant results, however, were consistent with findings from state population surveys in other regions of the country, including disparities in mental health and, among women, smoking. CONCLUSIONS Reporting LGB identity in North Carolina is associated with poorer health. The concentration of anti-LGB policies in the South warrants ongoing monitoring of LGB health disparities in North Carolina and in other Southeastern states for potential effects on the health and well-being of LGB populations.
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Affiliation(s)
- Derrick D Matthews
- At the time of this study, Derrick D. Matthews and Joseph G. L. Lee were with the Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
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Pachankis JE, Hatzenbuehler ML, Starks TJ. The influence of structural stigma and rejection sensitivity on young sexual minority men's daily tobacco and alcohol use. Soc Sci Med 2014; 103:67-75. [PMID: 24507912 DOI: 10.1016/j.socscimed.2013.10.005] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 10/25/2022]
Abstract
Stigma occurs at both individual and structural levels, but existing research tends to examine the effect of individual and structural forms of stigma in isolation, rather than considering potential synergistic effects. To address this gap, our study examined whether stigma at the individual level, namely gay-related rejection sensitivity, interacts with structural stigma to predict substance use among young sexual minority men. Sexual minority (n = 119) participants completed online measures of our constructs (e.g., rejection sensitivity). Participants currently resided across a broad array of geographic areas (i.e., 24 U.S. states), and had attended high school in 28 states, allowing us to capture sufficient variance in current and past forms of structural stigma, defined as (1) a lack of state-level policies providing equal opportunities for heterosexual and sexual minority individuals and (2) negative state-aggregated attitudes toward sexual minorities. To measure daily substance use, we utilized a daily diary approach, whereby all participants were asked to indicate whether they used tobacco or alcohol on nine consecutive days. Results indicated that structural stigma interacted with rejection sensitivity to predict tobacco and alcohol use, and that this relationship depended on the developmental timing of exposure to structural stigma. In contrast, rejection sensitivity did not mediate the relationship between structural stigma and substance use. These results suggest that psychological predispositions, such as rejection sensitivity, interact with features of the social environment, such as structural stigma, to predict important health behaviors among young sexual minority men. These results add to a growing body of research documenting the multiple levels through which stigma interacts to produce negative health outcomes among sexual minority individuals.
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Affiliation(s)
- John E Pachankis
- Division of Social and Behavioral Sciences, Yale School of Public Health, 60 College St., Laboratory for Epidemiology and Public Health, Suite 316, New Haven, CT 06520, United States.
| | - Mark L Hatzenbuehler
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, United States
| | - Tyrel J Starks
- Department of Psychology, Pace University, United States
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Mustanski B, Birkett M, Greene GJ, Hatzenbuehler ML, Newcomb ME. Envisioning an America without sexual orientation inequities in adolescent health. Am J Public Health 2014; 104:218-25. [PMID: 24328618 PMCID: PMC3935693 DOI: 10.2105/ajph.2013.301625] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2013] [Indexed: 11/04/2022]
Abstract
This article explicates a vision for social change throughout multiple levels of society necessary to eliminate sexual orientation health disparities in youths. We utilized the framework of Bronfenbrenner's ecological theory of development, a multisystemic model of development that considers direct and indirect influences of multiple levels of the environment. Within this multisystem model we discuss societal and political influences, educational systems, neighborhoods and communities, romantic relationships, families, and individuals. We stress that continued change toward equity in the treatment of lesbian, gay, and bisexual youths across these levels will break down the barriers for these youths to achieve healthy development on par with their heterosexual peers.
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Affiliation(s)
- Brian Mustanski
- Brian Mustanski, Michelle Birkett, George J. Greene, and Michael E. Newcomb are with Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. Mark L. Hatzenbuehler is with Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
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Hatzenbuehler ML, McLaughlin KA. Structural stigma and hypothalamic-pituitary-adrenocortical axis reactivity in lesbian, gay, and bisexual young adults. Ann Behav Med 2014. [PMID: 24154988 DOI: 10.1007/s126160-013-9556-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Youth exposed to extreme adverse life conditions have blunted cortisol responses to stress. PURPOSE This study aims to examine whether growing up in highly stigmatizing environments similarly shapes stigmatized individuals' physiological responses to identity-related stress. METHODS We recruited 74 lesbian, gay, and bisexual young adults (mean age = 23.68) from 24 states with varying levels of structural stigma surrounding homosexuality. State-level structural stigma was coded based on several dimensions, including policies that exclude sexual minorities from social institutions (e.g., same-sex marriage). Participants were exposed to a laboratory stressor, the Trier Social Stress Test (TSST), and neuroendocrine measures were collected. RESULTS Lesbian, gay, and bisexual young adults who were raised in highly stigmatizing environments as adolescents evidenced a blunted cortisol response following the TSST compared to those from low-stigma environments. CONCLUSIONS The stress of growing up in environments that target gays and lesbians for social exclusion may exert biological effects that are similar to traumatic life experiences.
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Affiliation(s)
- Mark L Hatzenbuehler
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 549.B, New York, NY, 10032, USA,
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Hatzenbuehler ML, Jun HJ, Corliss HL, Austin SB. Structural stigma and cigarette smoking in a prospective cohort study of sexual minority and heterosexual youth. Ann Behav Med 2014; 47:48-56. [PMID: 24136092 PMCID: PMC3945734 DOI: 10.1007/s12160-013-9548-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Sexual minority youth are more likely to smoke cigarettes than heterosexuals, but research into the determinants of these disparities is lacking. PURPOSE This study aimed to examine whether exposure to structural stigma predicts cigarette smoking in sexual minority youth. METHODS Prospective data from adolescents participating in the Growing Up Today Study (2000-2005) were utilized. RESULTS Among sexual minority youth, living in low structural stigma states (e.g., states with non-discrimination policies inclusive of sexual orientation) was associated with a lower risk of cigarette smoking after adjustment for individual-level risk factors (relative risk [RR] = 0.97; 95 % confidence interval [CI], 0.96, 0.99; p = 0.02). This association was marginally significant after additional controls for potential state-level confounders (RR = 0.97; 95 % CI, 0.93, 1.00; p = 0.06). In contrast, among heterosexual youth, structural stigma was not associated with past-year smoking rates, documenting specificity of these effects to sexual minority youth. CONCLUSIONS Structural stigma represents a potential risk factor for cigarette smoking among sexual minority adolescents.
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Affiliation(s)
- Mark L Hatzenbuehler
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th St, Room 549.B, New York, NY, 10032, USA,
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Duncan DT, Hatzenbuehler ML, Johnson RM. Neighborhood-level LGBT hate crimes and current illicit drug use among sexual minority youth. Drug Alcohol Depend 2014; 135:65-70. [PMID: 24326203 PMCID: PMC3919662 DOI: 10.1016/j.drugalcdep.2013.11.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 09/06/2013] [Accepted: 11/01/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate whether past-30 day illicit drug use among sexual minority youth was more common in neighborhoods with a greater prevalence of hate crimes targeting lesbian, gay, bisexual, and transgender (LGBT, or sexual minority) individuals. METHODS We used a population-based survey of public school youth in Boston, Massachusetts, consisting of 1292 9th-12th grade students from the 2008 Boston Youth Survey Geospatial Dataset (sexual minority n=108). Data on LGBT hate crimes involving assaults or assaults and battery between 2005 and 2008 were obtained from the Boston Police Department and linked to youths' residential address. Youth reported past-30 day use of marijuana and other illicit drugs. Wilcoxon-Mann-Whitney tests and corresponding p-values were computed to assess differences in substance use by neighborhood-level LGBT assault hate crime rate among sexual minority youth (n=103). RESULTS The LGBT assault hate crime rate in the neighborhoods of sexual minority youth who reported current marijuana use was 23.7 per 100,000, compared to 12.9 per 100,000 for sexual minority youth who reported no marijuana use (p=0.04). No associations between LGBT assault hate crimes and marijuana use among heterosexual youth (p>0.05) or between sexual minority marijuana use and overall neighborhood-level violent and property crimes (p>0.05) were detected, providing evidence for result specificity. CONCLUSIONS We found a significantly greater prevalence of marijuana use among sexual minority youth in neighborhoods with a higher prevalence of LGBT assault hate crimes. These results suggest that neighborhood context (i.e., LGBT hate crimes) may contribute to sexual orientation disparities in marijuana use.
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Affiliation(s)
- Dustin T Duncan
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA; Harvard Youth Violence Prevention Center, Harvard School of Public Health, Boston, MA, USA.
| | - Mark L Hatzenbuehler
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA; Center for the Study of Social Inequalities and Health, Columbia University, New York, NY, USA
| | - Renee M Johnson
- Harvard Youth Violence Prevention Center, Harvard School of Public Health, Boston, MA, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Cook JE, Purdie-Vaughns V, Meyer IH, Busch JT. Intervening within and across levels: A multilevel approach to stigma and public health. Soc Sci Med 2014; 103:101-109. [DOI: 10.1016/j.socscimed.2013.09.023] [Citation(s) in RCA: 180] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 06/28/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022]
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Lee JGL, Agnew-Brune CB, Clapp JA, Blosnich JR. Out smoking on the big screen: tobacco use in LGBT movies, 2000-2011. Tob Control 2013; 23:e156-8. [PMID: 24277775 DOI: 10.1136/tobaccocontrol-2013-051288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Lesbian, gay, bisexual and transgender (LGBT) people have significantly higher smoking prevalence than heterosexual people in the U.S.A. The reasons for this disparity remain unclear. Tobacco use in movies has a substantial influence on tobacco use behaviours, particularly among youth. Yet, no research has examined tobacco use in movies for LGBT audiences or containing LGBT characters. METHODS We identified 81 U.S. movies from 2000 to 2011 with a theatre release and with LGBT themes or characters. We then selected a random sample of these movies (n=45) for quantitative content analysis to examine the proportion of movies with depictions of tobacco use and the number of occurrences of tobacco use. RESULTS Tobacco use was depicted in 87% (95% CI 80% to 94%) of movies with an average of four occurrences of tobacco use per hour (95% CI 3 to 5). Only 15% (95% CI 8% to 23%) of movies and 3% of all depictions of tobacco use conveyed any harms of tobacco use. CONCLUSIONS Viewers of movies with LGBT themes or characters are exposed, on average, to one depiction of tobacco use for every 15 min of movie run-time. As a major component of the entertainment media environment, movies may contribute to smoking among LGBT people.
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Affiliation(s)
- Joseph G L Lee
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christine B Agnew-Brune
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - John R Blosnich
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
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Pachankis JE, Lelutiu-Weinberger C, Golub SA, Parsons JT. Developing an online health intervention for young gay and bisexual men. AIDS Behav 2013; 17:2986-98. [PMID: 23673791 DOI: 10.1007/s10461-013-0499-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Young gay and bisexual men continue to experience increases in HIV incidence in the US highlighting a need for competent health services, while the prominence of the internet in their social and sexual lives calls for novel preventive modalities. Toward this goal, we adapted an efficacious in-office HIV risk reduction intervention for online delivery. This paper describes the development of the online intervention and highlights the results of interviews and focus groups with the original intervention participants regarding effective adaptation and online delivery recommendations. The final intervention incorporates strategies for overcoming barriers to online intervention with this population and capitalizes on the unique strengths of online intervention delivery. The systematic process described in this paper can be used as a template for other researchers to develop online risk reduction programs and fills an important gap in the field's ability to maximally reach a critical risk group.
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Affiliation(s)
- John E Pachankis
- Department of Psychology, Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA,
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Structural stigma and hypothalamic-pituitary-adrenocortical axis reactivity in lesbian, gay, and bisexual young adults. ANNALS OF BEHAVIORAL MEDICINE : A PUBLICATION OF THE SOCIETY OF BEHAVIORAL MEDICINE 2013. [PMID: 24154988 DOI: 10.1007/s12160–013–9556–9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Youth exposed to extreme adverse life conditions have blunted cortisol responses to stress. PURPOSE This study aims to examine whether growing up in highly stigmatizing environments similarly shapes stigmatized individuals' physiological responses to identity-related stress. METHODS We recruited 74 lesbian, gay, and bisexual young adults (mean age = 23.68) from 24 states with varying levels of structural stigma surrounding homosexuality. State-level structural stigma was coded based on several dimensions, including policies that exclude sexual minorities from social institutions (e.g., same-sex marriage). Participants were exposed to a laboratory stressor, the Trier Social Stress Test (TSST), and neuroendocrine measures were collected. RESULTS Lesbian, gay, and bisexual young adults who were raised in highly stigmatizing environments as adolescents evidenced a blunted cortisol response following the TSST compared to those from low-stigma environments. CONCLUSIONS The stress of growing up in environments that target gays and lesbians for social exclusion may exert biological effects that are similar to traumatic life experiences.
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Johns MM, Pingel ES, Youatt EJ, Soler JH, McClelland SI, Bauermeister JA. LGBT community, social network characteristics, and smoking behaviors in young sexual minority women. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2013; 52:141-54. [PMID: 23783884 DOI: 10.1007/s10464-013-9584-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Smoking rates among young sexual minority women (YSMW) are disproportionately high as compared to heterosexual populations. While this disparity has commonly been attributed to the sexual minority stress process, little empirical work has explored what may protect YSMW from high rates of smoking. Using data (N = 471) from a cross-sectional study designed to investigate YSMW's (age 18-24) smoking behaviors and correlates; we explore the relationship of LGBT community connections, YSMW's social network characteristics, and stress to smoking behaviors (i.e., status, frequency, amount). Through this analysis, we find support for LGBT community connection as well as friendships with other sexual minorities as protective in relation to YSMW's smoking behaviors. We discuss the implications of our results, highlighting the need for future longitudinal research and interventions designed to bolster YSMW's connections to the LGBT community and their social networks.
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Affiliation(s)
- Michelle Marie Johns
- Center for Sexuality and Health Disparities, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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Pelullo CP, Di Giuseppe G, Angelillo IF. Frequency of discrimination, harassment, and violence in lesbian, gay men, and bisexual in Italy. PLoS One 2013; 8:e74446. [PMID: 23991220 PMCID: PMC3749994 DOI: 10.1371/journal.pone.0074446] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/02/2013] [Indexed: 11/19/2022] Open
Abstract
Background This cross-sectional study assessed the frequency of discrimination, harassment, and violence and the associated factors among a random sample of 1000 lesbian, gay men, and bisexual women and men recruited from randomly selected public venues in Italy. Methods A face-to-face interview sought information about: socio-demographics, frequency of discrimination, verbal harassment, and physical and sexual violence because of their sexual orientation, and their fear of suffering each types of victimization. Results In the whole sample, 28.3% and 11.9% self-reported at least one episode of victimization because of the sexual orientation in their lifetime and in the last year. Those unmarried, compared to the others, and with a college degree or higher, compared to less educated respondents, were more likely to have experienced an episode of victimization in their lifetime. Lesbians, compared to bisexual, had almost twice the odds of experiencing an episode of victimization. The most commonly reported experiences across the lifetime were verbal harassment, discrimination, and physical or sexual violence. Among those who had experienced one episode of victimization in their lifetime, 42.1% self-reported one episode in the last year. Perceived fear of suffering violence because of their sexual orientation, measured on a 10-point Likert scale with a higher score indicative of greater fear, ranges from 5.7 for verbal harassment to 6.4 for discrimination. Participants were more likely to have fear of suffering victimization because of their sexual orientation if they were female (compared to male), lesbian and gay men (compared to bisexual women and men), unmarried (compared to the others), and if they have already suffered an episode of victimization (compared to those who have not suffered an episode). Conclusions The study provides important insights into the violence experiences of lesbian, gay men, and bisexual women and men and the results may serve for improving policy initiatives to reduce such episodes.
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Affiliation(s)
- Concetta P. Pelullo
- Department of Experimental Medicine, Second University of Naples, Naples, Italy
| | | | - Italo F. Angelillo
- Department of Experimental Medicine, Second University of Naples, Naples, Italy
- * E-mail:
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Cochran SD, Bandiera FC, Mays VM. Sexual orientation-related differences in tobacco use and secondhand smoke exposure among US adults aged 20 to 59 years: 2003-2010 National Health and Nutrition Examination Surveys. Am J Public Health 2013; 103:1837-44. [PMID: 23948019 DOI: 10.2105/ajph.2013.301423] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated sexual orientation-related differences in tobacco use and secondhand smoke (SHS) exposure in a nationally representative sample of US adults. METHODS The 2003-2010 National Health and Nutrition Examination Surveys assessed 11 744 individuals aged 20 to 59 years for sexual orientation, tobacco use, and SHS exposure (cotinine levels ≥ 0.05 ng/mL in a nonsmoker). We used multivariate methods to compare tobacco use prevalence and SHS exposure among gay or lesbian (n = 180), bisexual (n = 273), homosexually experienced (n = 388), and exclusively heterosexual (n = 10 903) individuals, with adjustment for demographic confounding. RESULTS Lesbian and bisexual women evidenced higher rates of tobacco use than heterosexual women. Among nonsmokers, SHS exposure was more prevalent among lesbian and homosexually experienced women than among heterosexual women. Nonsmoking lesbians reported greater workplace exposure and bisexual women greater household exposure than heterosexual women did. Identical comparisons among men were not significant except for lower workplace exposure among nonsmoking gay men than among heterosexual men. CONCLUSIONS Nonsmoking sexual-minority women are more likely to be exposed to SHS than nonsmoking heterosexual women. Public health efforts to reduce SHS exposure in this vulnerable population are needed.
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Affiliation(s)
- Susan D Cochran
- Susan D. Cochran is with the Department of Epidemiology, the Fielding School of Public Health, the Department of Statistics, and the BRITE Center, University of California, Los Angeles. Frank C. Bandiera is with the Center for Tobacco Control Research and Education, University of California, San Francisco. Vickie M. Mays is with the Department of Health Services, the Fielding School of Public Health, the Department of Psychology, and the BRITE Center, University of California, Los Angeles
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