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Garcia DR, Fletcher J, Goldsamt L, Bell DL, Zheng Y, Dunn Navarra AM. School-Based Protective Factors for HIV Prevention in the United States: Secondary Analysis of the Youth Risk Behavior Survey 2015-2019. J Assoc Nurses AIDS Care 2024:00001782-990000000-00124. [PMID: 39259519 DOI: 10.1097/jnc.0000000000000501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
ABSTRACT This secondary analysis of the National Youth Risk Behavior Survey (years 2015-2019) examines associations between school-based protective factors (i.e., safe school environments and academic achievement) and HIV risk behaviors among sexually experienced adolescent gay and bisexual men ( n = 644), a population with the highest prevalence of undiagnosed HIV infections. Demographics included Hispanics/Latinos (25%, n = 158), Other race/ethnicity (14%, n = 88), and non-Hispanic Blacks/African Americans (13%, n = 81). Adjusted models showed that protective factors reduced odds for early sexual debut, multiple sexual partners, sex under the influence of drugs/alcohol, and condomless sex, with an additive effect demonstrated when two protective factors were present. Hispanics/Latinos had greater odds of reporting multiple sexual partners and HIV testing, indicating opportunities for school-based HIV prevention and further research. Our findings provide support for school-based programs that aim to improve social and structural determinants of health and ultimately reduce adolescent HIV burdens.
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Affiliation(s)
- David R Garcia
- David R. Garcia, PhD, FNP-BC, NP-C, is an Assistant Professor and Provost's Postdoctoral Fellow, Rory Meyers College of Nursing, New York University, New York, New York, USA
- Jason Fletcher, PhD, is a Senior Biostatistician, Rory Meyers College of Nursing, New York University, New York, New York, USA
- Lloyd Goldsamt, PhD, is a Senior Research Scientist, Rory Meyers College of Nursing, New York University, New York, New York, USA
- David L. Bell, MD, MPH, is a Professor, Population and Family Health and Pediatrics, Columbia University Medical Center, New York, New York, USA
- Yaguang Zheng, PhD, RN, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA
- Ann-Margaret Dunn Navarra, PhD, CPNP-PC, FAAN, is an Associate Professor, Associate Dean of Nursing Research and Innovation, and Chair of the Department of Doctor of Philosophy in Nursing Studies, Stony Brook University School of Nursing, Stony Brook, New York, USA
| | - Jason Fletcher
- David R. Garcia, PhD, FNP-BC, NP-C, is an Assistant Professor and Provost's Postdoctoral Fellow, Rory Meyers College of Nursing, New York University, New York, New York, USA
- Jason Fletcher, PhD, is a Senior Biostatistician, Rory Meyers College of Nursing, New York University, New York, New York, USA
- Lloyd Goldsamt, PhD, is a Senior Research Scientist, Rory Meyers College of Nursing, New York University, New York, New York, USA
- David L. Bell, MD, MPH, is a Professor, Population and Family Health and Pediatrics, Columbia University Medical Center, New York, New York, USA
- Yaguang Zheng, PhD, RN, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA
- Ann-Margaret Dunn Navarra, PhD, CPNP-PC, FAAN, is an Associate Professor, Associate Dean of Nursing Research and Innovation, and Chair of the Department of Doctor of Philosophy in Nursing Studies, Stony Brook University School of Nursing, Stony Brook, New York, USA
| | - Lloyd Goldsamt
- David R. Garcia, PhD, FNP-BC, NP-C, is an Assistant Professor and Provost's Postdoctoral Fellow, Rory Meyers College of Nursing, New York University, New York, New York, USA
- Jason Fletcher, PhD, is a Senior Biostatistician, Rory Meyers College of Nursing, New York University, New York, New York, USA
- Lloyd Goldsamt, PhD, is a Senior Research Scientist, Rory Meyers College of Nursing, New York University, New York, New York, USA
- David L. Bell, MD, MPH, is a Professor, Population and Family Health and Pediatrics, Columbia University Medical Center, New York, New York, USA
- Yaguang Zheng, PhD, RN, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA
- Ann-Margaret Dunn Navarra, PhD, CPNP-PC, FAAN, is an Associate Professor, Associate Dean of Nursing Research and Innovation, and Chair of the Department of Doctor of Philosophy in Nursing Studies, Stony Brook University School of Nursing, Stony Brook, New York, USA
| | - David L Bell
- David R. Garcia, PhD, FNP-BC, NP-C, is an Assistant Professor and Provost's Postdoctoral Fellow, Rory Meyers College of Nursing, New York University, New York, New York, USA
- Jason Fletcher, PhD, is a Senior Biostatistician, Rory Meyers College of Nursing, New York University, New York, New York, USA
- Lloyd Goldsamt, PhD, is a Senior Research Scientist, Rory Meyers College of Nursing, New York University, New York, New York, USA
- David L. Bell, MD, MPH, is a Professor, Population and Family Health and Pediatrics, Columbia University Medical Center, New York, New York, USA
- Yaguang Zheng, PhD, RN, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA
- Ann-Margaret Dunn Navarra, PhD, CPNP-PC, FAAN, is an Associate Professor, Associate Dean of Nursing Research and Innovation, and Chair of the Department of Doctor of Philosophy in Nursing Studies, Stony Brook University School of Nursing, Stony Brook, New York, USA
| | - Yaguang Zheng
- David R. Garcia, PhD, FNP-BC, NP-C, is an Assistant Professor and Provost's Postdoctoral Fellow, Rory Meyers College of Nursing, New York University, New York, New York, USA
- Jason Fletcher, PhD, is a Senior Biostatistician, Rory Meyers College of Nursing, New York University, New York, New York, USA
- Lloyd Goldsamt, PhD, is a Senior Research Scientist, Rory Meyers College of Nursing, New York University, New York, New York, USA
- David L. Bell, MD, MPH, is a Professor, Population and Family Health and Pediatrics, Columbia University Medical Center, New York, New York, USA
- Yaguang Zheng, PhD, RN, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA
- Ann-Margaret Dunn Navarra, PhD, CPNP-PC, FAAN, is an Associate Professor, Associate Dean of Nursing Research and Innovation, and Chair of the Department of Doctor of Philosophy in Nursing Studies, Stony Brook University School of Nursing, Stony Brook, New York, USA
| | - Ann-Margaret Dunn Navarra
- David R. Garcia, PhD, FNP-BC, NP-C, is an Assistant Professor and Provost's Postdoctoral Fellow, Rory Meyers College of Nursing, New York University, New York, New York, USA
- Jason Fletcher, PhD, is a Senior Biostatistician, Rory Meyers College of Nursing, New York University, New York, New York, USA
- Lloyd Goldsamt, PhD, is a Senior Research Scientist, Rory Meyers College of Nursing, New York University, New York, New York, USA
- David L. Bell, MD, MPH, is a Professor, Population and Family Health and Pediatrics, Columbia University Medical Center, New York, New York, USA
- Yaguang Zheng, PhD, RN, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA
- Ann-Margaret Dunn Navarra, PhD, CPNP-PC, FAAN, is an Associate Professor, Associate Dean of Nursing Research and Innovation, and Chair of the Department of Doctor of Philosophy in Nursing Studies, Stony Brook University School of Nursing, Stony Brook, New York, USA
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Mereish EH. Oppression-Based Stress and Alcohol Inequities Among Sexual and Gender Minority People: An Intersectional Multilevel Framework. Alcohol Res 2024; 44:05. [PMID: 39246430 PMCID: PMC11379061 DOI: 10.35946/arcr.v44.1.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024] Open
Abstract
PURPOSE Sexual and gender minority (SGM) people are at heightened risk for alcohol use, hazardous drinking, and alcohol use disorder compared to heterosexual and cisgender individuals. This paper: (a) presents an oppression framework that integrates intersectionality, stress, stigma, and addiction-based theories to examine the complex and nuanced ways oppression-based stress (e.g., minority stress) leads to sexual orientation and gender identity inequities in alcohol use; (b) conducts a narrative review that summarizes recent and novel advancements in the literature on the impact of oppression-based stressors on alcohol use outcomes across structural, interpersonal, and intrapersonal domains among SGM people; and (c) provides future research and intervention directions for the alcohol field. SEARCH METHODS A select review of the literature was conducted on July 10, 2023, using multiple electronic databases (i.e., PsycInfo, PubMed, Web of Science) and focusing on studies that had examined the associations between oppression-based stressors and alcohol use outcomes across structural, interpersonal, and intrapersonal levels. Search terms focused on alcohol consumption; SGM people, particularly SGM people of color; and oppression-based stress. Cross-sectional studies that focused on heterosexism-based and anti-bisexual oppression-based stressors at the interpersonal or intrapersonal levels and alcohol use outcomes were excluded as they have been included in prior reviews of the literature. SEARCH RESULTS The initial and combined search across the databases resulted in 3,205 articles. Of those, the narrative review included 50 peer-reviewed articles that focused on the following four areas of the literature on the associations between oppression-based stressors and alcohol use outcomes: (1) experimental, longitudinal, and experience sampling studies of heterosexism- and anti-bisexual oppression-based stressors (22 articles); (2) any studies of cissexism-based stressors (12 articles); (3) any studies of intersectional oppression among SGM people of color (seven articles, one article overlapped with the first category and another overlapped with the fourth category); and (4) any studies of structural oppression (11 articles). DISCUSSION AND CONCLUSIONS Results of this narrative review indicate that mounting evidence implicates oppression-based stress in inequities in alcohol use, hazardous drinking, and alcohol use disorder in SGM populations. This reflects SGM people's embodiment of oppression and injustice at the structural, interpersonal, and intrapersonal levels. Given some inconsistent and mixed patterns of findings, future research needs greater specificity in drinking inclusion criteria, robust and well-validated measures, more attention to culturally and developmentally relevant moderating and mediating mechanisms across the lifespan, application of sophisticated methodologies, and integration of intersectional and addiction frameworks.
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Affiliation(s)
- Ethan H Mereish
- Lavender Lab, Department of Psychology, University of Maryland, College Park, Maryland
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Perez LG, Troxel WM, Tucker JS, Dunbar MS, Rodriguez A, Klein DJ, D'Amico EJ. Discrimination experiences and problematic alcohol and cannabis use in young adulthood. Am J Addict 2024. [PMID: 38978344 DOI: 10.1111/ajad.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/24/2024] [Accepted: 06/24/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Limited research has examined how discrimination in young adulthood relates to substance use. We examined how multiple and specific types (e.g., race-based) of experiences of unfair treatment are related to problematic alcohol and cannabis use. METHODS We analyzed cross-sectional data from a diverse cohort of young adults (mean age 24.7) predominantly residing in southern California (n = 2303) to examine associations of multiple (count) and specific experiences (race-, sexual orientation-, gender-based) of perceived everyday discrimination with self-reported alcohol and cannabis use outcomes (consequences, use disorders, and solitary use). We also tested interactions between the three specific discrimination experiences and sociodemographic characteristics (e.g., race-based discrimination × race/ethnicity). RESULTS In this diverse sample (e.g., 47% Latinx/o and 22% Asian; 22% sexual/gender diverse; 56% female) of young adults, about 46% reported up to four different discrimination experiences and 27% reported race-, 26% gender-, and 5% sexual orientation-based discrimination. Race- and gender-based discrimination and experiencing more types of discrimination were associated with worse cannabis use outcomes. Race-based discrimination was associated with fewer alcohol consequences and lower Alcohol Use Disorders Identification Test (AUDIT) scores. Associations with sexual orientation-based discrimination and the interactions were not significant. DISCUSSION AND CONCLUSIONS Findings build on limited research on associations of discrimination with cannabis use in young adults. More work is needed to understand the mechanisms by which discrimination influences drinking behaviors. SCIENTIFIC SIGNIFICANCE This study advances the field by examining the unique contributions of specific and multiple types of discrimination experiences in young adulthood, a critical developmental period in which substance use peaks.
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Fahey KML, Dermody SS, Cservenka A. The importance of community engagement in experimental stress and substance use research with marginalized groups: Lessons from research with sexual and gender minority populations. Drug Alcohol Depend 2024; 260:111349. [PMID: 38821835 DOI: 10.1016/j.drugalcdep.2024.111349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
There is a growing need for experimental stress paradigms tailored for use with marginalized groups to better understand the impact of experiencing minoritized stress on substance use outcome. Experimental stress research that examines the role of minority stress in substance use is not only innovative, but also has the potential to improve health equity. However, this research also has anticipated risks. As a result, community-engaged research (CEnR) is critical. CEnR can improve experimental stress and substance use research by engaging applicable communities in research design, recruitment, data interpretation, and dissemination. When conducting CEnR, there are also unique challenges and considerations that need to be taken into account. Recommendations are provided based on prior experiences in experimental stress induction and alcohol research with SGM (sexual and gender minority) groups.
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Affiliation(s)
- Kalina M L Fahey
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, NM, USA.
| | - Sarah S Dermody
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Anita Cservenka
- School of Psychological Science, Oregon State University, Corvallis, Oregon, Canada
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Ertl MM, Maroney MR, Becker A, Paschen-Wolff MM, Blankenau A, Hoffman S, Tross S. Sexual and Reproductive Justice and Health Equity for LGBTQ+ Women. JOURNAL OF LESBIAN STUDIES 2024:1-29. [PMID: 38946155 DOI: 10.1080/10894160.2024.2369434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
LGBTQ+ women have long been overlooked in sexual and reproductive health research. However, recent research has established that LGBTQ+ women have unique and specific needs that need to be addressed in order to improve effectiveness of sexual health education and practice with this historically and presently underserved population. Informed by a reproductive justice framework coupled with liberation psychology theory, this review discusses the current state of sexual and reproductive health and technologies among LGBTQ+ women. In particular, we focus on a range of HIV prevention and reproductive technologies and their use and promotion, including the internal condom, abortion, oral contraceptives, dapivirine ring, HIV pre-exposure prophylaxis, intrauterine device, and other less studied options, such as the contraceptive sponge. Grounded in an intersectional framing, this review acknowledges the intersecting systems of oppression that affect multiply marginalized women inequitably and disproportionately. A sociohistorical, critical lens is applied to acknowledge the well-documented racist origins of reproductive health technologies and ongoing coercive practices that have led to medical mistrust among marginalized and stigmatized communities, particularly racialized LGBTQ+ women, women with disabilities, and women who are poor or incarcerated. Moreover, we discuss the urgent need to center LGBTQ+ women in research and clinical care, community-engaged health promotion efforts, affirming non-heteronormative sexual health education, and health policies that prioritize autonomy and dismantle structural barriers for this population. We conclude with recommendations and future directions in this area to remedy entrenched disparities in health.
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Affiliation(s)
- Melissa M Ertl
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Meredith R Maroney
- Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Andréa Becker
- Department of Sociology, Hunter College, New York, NY, USA
| | - Margaret M Paschen-Wolff
- Department of Psychiatry, Division on Substance Use Disorders, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Amelia Blankenau
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Susie Hoffman
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Susan Tross
- Department of Psychiatry, Division on Substance Use Disorders, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, USA
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
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Coulaud PJ, Parent N, Stehr R, Salway T, Knight R. Acceptability of integrating mental health and substance use care within sexual health services among young sexual and gender minority men in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104459. [PMID: 38788388 DOI: 10.1016/j.drugpo.2024.104459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Despite well-established evidence showing that young sexual and gender minority (SGM) men experience disproportionate mental health and substance use inequities, few sexual health services provide mental health and substance use care. This qualitative study examined the experiences and perspectives about integrated care models within sexual health services among young SGM men experiencing mental health and substance use challenges. METHODS Semi-structured interviews were conducted with 50 SGM men aged 18-30 years who reported using substances with sex in Vancouver, Canada. Interviews were analyzed using thematic analysis. RESULTS Three themes were identified: 1) participants asserted that their sexual health, mental health and substance use-related health needs were interrelated and that not addressing all three concurrently could result in even more negative health outcomes. These concurrent health needs were described as stemming from the oppressive social conditions in which SGM men live. 2) Although sexual health clinics were considered a safe place to discuss sexual health needs, participants reported not being invited by health providers to engage in discussions about their mental health and substance use health-related needs. Participants also perceived how stigmas associated with mental health and substance use limited their ability to express and receive support. 3) Participants identified key characteristics they preferred and wanted within integrated care, including training for health providers on mental health and SGM men's health and connections (e.g., referral processes) between services. Participants also recommended integrating social support programs to help them address SGM-related social challenges. CONCLUSION Our findings highlight that SGM men's sexual health, mental health and substance use-related health needs and preferences are interrelated and should be addressed together. Tailored training and resources as well as structural adaptations to improve communication channels and collaborative connections between health providers are required to facilitate the development of integrated care for young SGM men.
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Affiliation(s)
- Pierre-Julien Coulaud
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.
| | - Natasha Parent
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rodney Stehr
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Rod Knight
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada; École de Santé Publique de l'Université de Montréal, Montréal, Québec, Canada; Centre de recherche en santé publique (CReSP), Montréal, Québec, Canada
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Perry NS, Nelson KM. Mental Health Care Use among Adolescent Sexual Minority Males Before and During COVID-19. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2024; 11:353-360. [PMID: 39268245 PMCID: PMC11390097 DOI: 10.1037/sgd0000592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
Adolescent (cisgender) sexual minority males (ASMM) face multiple mental health disparities. Yet surprisingly little is known about use of mental health care among ASMM. The current study examined mental health care use among ASMM, both lifetime use and during the COVID-19 pandemic. ASMM (N=154, ages 14-17 years) enrolled in Spring 2020 for a pilot randomized controlled trial of an online sexual health intervention. Participants were assessed at baseline and 3-month follow-up. Participants reported lifetime (at baseline) and recent (at follow-up) mental health care use. Anxiety and depressive symptoms were assessed at both timepoints. Differences in care use by sociodemographics, healthcare access, and mental health symptoms were established. More than half of participants reported clinically significant anxiety and depressive symptoms at baseline and at follow-up. Of those youth, fifty-three percent reported lifetime mental health care use, while only 28% reported recent care at follow-up. Being out to an accepting guardian (aOR=4.0, 95% CI: 1.9-8.4), having a primary care physician (aOR=2.6, 95% CI: 1.0-6.7), and having clinically significant symptoms (aOR=3.1, 95% CI: 1.5-6.5) were each independently associated with a greater odds of having received lifetime mental health care. Findings indicate that many ASMM in the sample received mental health care in their lifetimes. However, more participants endorsed clinically significant anxiety/depressive symptoms than received care at both timepoints. This disparity was even more pronounced approximately five months into the COVID-19 pandemic. Research and practice efforts must reduce care barriers and augment facilitators for all ASMM, with particular urgency during COVID-19 and its aftermath.
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Affiliation(s)
| | - Kimberly M Nelson
- Department of Community Health Sciences, Boston University School of Public Health
- Department of Psychiatry, Boston University School of Medicine
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Varatharajan T, Patte KA, de Groh M, Jiang Y, Leatherdale ST. Exploring differences in substance use behaviours among gender minority and non-gender minority youth: a cross-sectional analysis of the COMPASS study. Health Promot Chronic Dis Prev Can 2024; 44:179-190. [PMID: 38597806 PMCID: PMC11097744 DOI: 10.24095/hpcdp.44.4.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Research characterizing substance use disparities between gender minority youth (GMY) and non-GMY (i.e. girls and boys) is limited. The aim of this study was to examine the differences in substance use behaviours among gender identity (GI) groups and identify associated risk and protective factors. METHODS Cross-sectional data from Canadian secondary school students (n = 42 107) that participated in Year 8 (2019/20) or Year 9 (2020/21) of the COMPASS study were used. Hierarchal logistic regression models estimated current substance use (cigarettes, e-cigarettes, binge drinking, cannabis and nonmedical prescription opioids [NMPOs]). Predictor variables included sociodemographics, other substances, mental health outcomes, school connectedness, bullying and happy home life. Interaction terms were used to test mental health measures as moderators in the association between GI and substance use. RESULTS Compared to non-GMY, GMY reported a higher prevalence for all substance use outcomes. In the adjusted analyses, GMY had higher odds of cigarette, cannabis and NMPO use and lower odds for e-cigarette use relative to non-GMY. The likelihood of using any given substance was higher among individuals who were involved with other substances. School connectedness and happy home life had a protective effect for all substances except binge drinking. Bullying victimization was associated with greater odds of cigarette, e-cigarette use and NMPOs. Significant interactions between GI and all mental health measures were detected. CONCLUSION Findings highlight the importance of collecting a GI measure in youth population surveys and prioritizing GMY in substance use-related prevention, treatment and harm reduction programs. Future studies should investigate the effects of GI status on substance use onset and progression among Canadian adolescents over time.
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Affiliation(s)
- Thepikaa Varatharajan
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Karen A Patte
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | | | - Ying Jiang
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Scott T Leatherdale
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Paschen-Wolff MM, DeSousa A, Paine EA, Hughes TL, Campbell ANC. Experiences of and recommendations for LGBTQ+-affirming substance use services: an exploratory qualitative descriptive study with LGBTQ+ people who use opioids and other drugs. Subst Abuse Treat Prev Policy 2024; 19:2. [PMID: 38172902 PMCID: PMC10765665 DOI: 10.1186/s13011-023-00581-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/10/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, queer, and other LGBTQ populations (LGBTQ+; e.g., asexual individuals) have higher rates of substance use (SU) and disorders (SUD) compared to heterosexual and cisgender populations. Such disparities can be attributed to minority stress, including stigma and discrimination in healthcare settings. LGBTQ+-affirming SU treatment and related services remain limited. The purpose of this exploratory qualitative descriptive study was to characterize LGBTQ+ people's experiences in SU services and recommendations for LGBTQ+- affirming care. METHODS We conducted demographic surveys (characterized using descriptive statistics) and individual qualitative interviews with N = 23 LGBTQ+ people. We employed flexible coding and a thematic analysis approach to describe participants' experiences with stigma, discrimination, and support within SU services at the patient-, staff-, and organizational-level; and participant recommendations for how to make such services LGBTQ+-affirming. We highlighted components of minority stress and mitigators of adverse stress responses throughout our thematic analysis. RESULTS Patient-level experiences included bullying, name-calling, sexual harassment, and physical distancing from peers; and support via community-building with LGBTQ+ peers. Staff-level experiences included name-calling, denial of services, misgendering, lack of intervention in peer bullying, and assumptions about participants' sexuality; and support via staff advocacy for LGBTQ+ patients, holistic treatment models, and openly LGBTQ+ staff. Organizational-level experiences included stigma in binary gendered program structures; and support from programs with gender-affirming groups and housing, and in visual cues (e.g., rainbow flags) of affirming care. Stigma and discrimination led to minority stress processes like identity concealment and stress coping responses like SU relapse; support facilitated SU treatment engagement and retention. Recommendations for LGBTQ+-affirming care included non-discrimination policies, LGBTQ+-specific programming, hiring LGBTQ+ staff, routine staff sensitivity training, and gender-inclusive program structures. CONCLUSIONS LGBTQ+ people experience stigma and discrimination within SU services; supportive and affirming care is vital to reducing treatment barriers and promoting positive health outcomes. The current study offers concrete recommendations for how to deliver LGBTQ+-affirming care, which could reduce SU disparities and drug overdose mortality overall.
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Affiliation(s)
- Margaret M Paschen-Wolff
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Avery DeSousa
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Emily Allen Paine
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Tonda L Hughes
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, 560 W. 168th Street, New York, NY, 10032, USA
| | - Aimee N C Campbell
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
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Veldhuis CB, Kreski NT, Usseglio J, Keyes KM. Are Cisgender Women and Transgender and Nonbinary People Drinking More During the COVID-19 Pandemic? It Depends. Alcohol Res 2023; 43:05. [PMID: 38170029 PMCID: PMC10760999 DOI: 10.35946/arcr.v43.1.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
PURPOSE This narrative review of research conducted during the first 2 years of the COVID-19 pandemic examines whether alcohol use among cisgender women and transgender and nonbinary people increased during the pandemic. The overarching goal of the review is to inform intervention and prevention efforts to halt the narrowing of gender-related differences in alcohol use. SEARCH METHODS Eight databases (PubMed, APA PsycInfo, CINAHL, Embase, Scopus, Gender Studies Database, GenderWatch, and Web of Science) were searched for peer-reviewed literature, published between March 2020 and July 2022, that reported gender differences or findings specific to women, transgender or nonbinary people, and alcohol use during the pandemic. The search focused on studies conducted in the United States and excluded qualitative research. SEARCH RESULTS A total 4,132 records were identified, including 400 duplicates. Of the remaining 3,732 unique records for consideration in the review, 51 were ultimately included. Overall, most studies found increases in alcohol use as well as gender differences in alcohol use, with cisgender women experiencing the most serious consequences. The findings for transgender and nonbinary people were equivocal due to the dearth of research and because many studies aggregated across gender. DISCUSSION AND CONCLUSIONS Alcohol use by cisgender women seems to have increased during the pandemic; however, sizable limitations need to be considered, particularly the low number of studies on alcohol use during the pandemic that analyzed gender differences. This is of concern as gender differences in alcohol use had been narrowing before the pandemic; and this review suggests the gap has narrowed even further. Cisgender women and transgender and nonbinary people have experienced sizable stressors during the pandemic; thus, understanding the health and health behavior impacts of these stressors is critical to preventing the worsening of problematic alcohol use.
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Affiliation(s)
- Cindy B Veldhuis
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
| | - Noah T Kreski
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - John Usseglio
- Augustus C. Long Health Sciences Library, Columbia Irving Medical Center, Columbia University, New York, New York
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Hughes TL, Bochicchio L, Drabble L, Muntinga M, Jukema JS, Veldhuis CB, Bruck S, Bos H. Health disparities in one of the world's most progressive countries: a scoping review of mental health and substance use among sexual and gender minority people in the Netherlands. BMC Public Health 2023; 23:2533. [PMID: 38110908 PMCID: PMC10729573 DOI: 10.1186/s12889-023-17466-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Evidence from many parts of the world shows that sexual and gender minority (SGM) people have poorer health than their cisgender heterosexual counterparts. Minority stressors, particularly stigma and discrimination, have been identified as major contributors to sexual orientation- and gender identity-related health disparities, particularly negative mental health and behavioral health outcomes. To better understand factors that contribute to these disparities, we conducted a scoping review of SGM mental health and substance use research in the Netherlands-a country with a long-standing reputation as a pioneer in SGM equality. METHODS Using Joanna Briggs Institute guidelines and the PRISMA-ScR protocol, we searched seven databases to identify studies published between 2010 and 2022 that focused on substance use and/or mental health of SGM youth and adults in the Netherlands. RESULTS Although there was some evidence that SGM people in the Netherlands report fewer substance use and mental health concerns than those in less progressive countries, with very few exceptions studies found poorer outcomes among SGM participants than cisgender, heterosexual participants. However, this observation must be considered cautiously given major gaps in the literature. For example, only one study focused exclusively on adult sexual minority women, two focused on older SGM adults, and very little attention was given to nonbinary individuals. Most studies used non-probability samples that were quite homogenous. Many studies, especially those with youth, assessed sexual orientation based on sexual attraction; some studies of adults operationalized SGM status as having a same-sex partner. Importantly, we found no studies that directly assessed associations between structural-level stigma and health outcomes. Studies were mostly focused at the individual level and on health problems; very little attention was given to strengths or resilience. CONCLUSIONS Findings of persistent health disparities-despite the relatively long history of SGM supportive policies in the Netherlands-highlight the need for more research and greater attention to population groups that have been underrepresented. Such research would not only provide guidance on strategies to improve the health of SGM people in the Netherlands, but also in other countries that are seeking to reduce health inequities. Addressing SGM health disparities in the Netherlands and elsewhere is complex and requires a multifaceted approach that addresses individual, interpersonal and structural factors.
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Affiliation(s)
- Tonda L Hughes
- School of Nursing, Department of Psychiatry, Columbia University Irving Medical School, Center for Sexual and Gender Minority Health Research, 560 West 168 Street, New York, NY, USA.
| | - Lauren Bochicchio
- Columbia University School of Nursing Center for Sexual and Gender Minority Health Research, 560 West 168th Street, New York, NY, USA
| | - Laurie Drabble
- College of Health and Human Sciences, San Jose State University, One Washington Square, San Jose, CA, USA
| | - Maaike Muntinga
- Department of Ethics, Law and Humanities, Amsterdam UMC location VUmc, De Boelelaan 1118, Amsterdam, 1081 HZ, Netherlands
| | - Jan S Jukema
- School of Health, Saxion University of Applied Sciences, M. H. Tromplaan 28, Enschede, 7513 AB, Netherlands
| | - Cindy B Veldhuis
- Departments of Medical Social Sciences, Psychology, Psychiatry, and Obstetrics & Gynecology, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, USA
| | - Sunčica Bruck
- Kohnstamm Instituut, Keizer Karelplein 1, Amstelveen, 1185 HL, Netherlands
| | - Henny Bos
- Research Institute Child Development and Education, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, 1012 WX, Netherlands
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12
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Heinz A, Költő A, Taylor AB, Chan A. "Are You a Boy or a Girl?"-A Missing Response Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1695. [PMID: 37892357 PMCID: PMC10605027 DOI: 10.3390/children10101695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
Many adolescent health surveys ask if respondents are male or female. Non-response may be due to fear of de-anonymisation or being a gender-nonconforming youth. The present study investigates the frequency of non-response and its potential reasons. To this end, data from 54,833 adolescents aged 11-18 from six countries, participating in the 2018 Health Behaviour in School-aged Children (HBSC) study, were analysed. Respondents were divided into three groups: (1) "Responders" who answered both questions on age and gender, (2) "Age non-responders" who did not answer the question on age, and (3) "Gender non-responders" who answered the question on age but not the one on gender. These groups were compared regarding their non-response to other questions and regarding their health. Overall, 98.0% were responders, 1.6% were age non-responders and 0.4% were gender non-responders. On average, age non-responders skipped more questions (4.2 out or 64) than gender non-responders (3.2) and responders (2.1). Gender non-responders reported more psychosomatic complaints, more frequent substance use and lower family support than responders. This study shows that age and gender non-responders differ in their response styles, suggesting different reasons for skipping the gender question. The health disparities found between the groups suggest that further research should use a more nuanced approach, informed by LGBT+ youth's insights, to measure sex assigned at birth and gender identity.
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Affiliation(s)
- Andreas Heinz
- Department of Health, IU International University of Applied Sciences, Juri-Gagarin Ring 152, 99084 Erfurt, Germany
| | - András Költő
- Health Promotion Research Centre, National University of Ireland, University Rd., H91 TK33 Galway, Ireland;
| | - Ashley B. Taylor
- Stigma and Resilience Among Vulnerable Youth Centre, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Ace Chan
- Stigma and Resilience Among Vulnerable Youth Centre, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
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13
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Paschen-Wolff MM, DeSousa A, Paine EA, Hughes TL, Campbell ANC. Experiences of and recommendations for LGBTQ+-affirming substance use services: A qualitative study with LGBTQ+ people who use opioids and other drugs. RESEARCH SQUARE 2023:rs.3.rs-3303699. [PMID: 37693444 PMCID: PMC10491328 DOI: 10.21203/rs.3.rs-3303699/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background Lesbian, gay, bisexual, transgender, queer, and other LGBTQ populations (LGBTQ+; e.g., non-binary individuals) have higher rates of substance use (SU) and disorders (SUD) compared to heterosexual and cisgender populations. Such disparities can be attributed to minority stress, including stigma and discrimination in healthcare settings. LGBTQ+-affirming SU treatment and related services remain limited. The purpose of this qualitative study was to characterize LGBTQ + people's experiences in SU services and recommendations for LGBTQ+-affirming care. Methods We conducted demographic surveys (characterized using descriptive statistics) and individual qualitative interviews with N = 23 LGBTQ + people. We employed a flexible coding approach to describe participants' experiences with stigma, discrimination, and support within SU services; and participant recommendations for how to make such services LGBTQ+-affirming at the patient-, staff-, and organizational-level. We highlighted components of minority stress and mitigators of adverse stress responses throughout our thematic analysis. Results Patient-level experiences included bullying, name-calling, sexual harassment, and physical distancing from peers; and support via community-building with LGBTQ + peers. Staff-level experiences included name-calling, denial of services, misgendering, lack of intervention in peer bullying, and assumptions about participants' sexuality; and support via staff advocacy for LGBTQ + patients, holistic treatment models, and openly LGBTQ + staff. Organizational-level experiences included stigma in binary gendered program structures; and support from programs with gender-affirming groups and housing, and in visual cues (e.g., rainbow flags) of affirming care. Stigma and discrimination led to minority stress processes like identity concealment and stress coping responses like SU relapse; support facilitated SU treatment engagement and retention. Recommendations for LGBTQ+-affirming care included non-discrimination policies, routine pronoun sharing, LGBTQ+-specific programming, hiring LGBTQ + staff, routine staff sensitivity training, and gender-inclusive program structures. Conclusions LGBTQ + people experience stigma and discrimination within SU services; supportive and affirming care is vital to reducing treatment barriers and promoting positive health outcomes. The current study offers concrete recommendations for how to deliver LGBTQ+-affirming care, which could reduce SU disparities and drug overdose mortality overall.
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Affiliation(s)
| | - Avery DeSousa
- Columbia University Irving Medical Center and New York State Psychiatric Institute
| | - Emily Allen Paine
- Columbia University Irving Medical Center and New York State Psychiatric Institute
| | - Tonda L Hughes
- Columbia University Irving Medical Center and New York State Psychiatric Institute
| | - Aimee N C Campbell
- Columbia University Irving Medical Center and New York State Psychiatric Institute
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14
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Fahey KML, Kovacek K, Abramovich A, Dermody SS. Substance use prevalence, patterns, and correlates in transgender and gender diverse youth: A scoping review. Drug Alcohol Depend 2023; 250:110880. [PMID: 37480799 DOI: 10.1016/j.drugalcdep.2023.110880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/24/2023] [Accepted: 06/29/2023] [Indexed: 07/24/2023]
Abstract
Transgender and gender diverse (TGD) adults are at elevated risk of problematic substance use. While understanding substance use disparities in TGD youth is crucial for informing early preventions, there is no known synthesis of prevalence and correlates of substance use in TGD youth. The objectives of this study were to: 1) describe the prevalence and patterns of substance use in TGD youth, 2) identify and evaluate potential correlates of substance use, and 3) report the strengths and limitations of the current literature in recommendation of future steps. A PRISMA-guided systematic search was conducted to identify 55 studies that reported prevalence, patterns, or correlates of substance use in TGD youth aged 10-24 years; were published in the English language; and followed a quantitative design. Fifty-four (98.18%) studies examined prevalence and patterns, 23 (41.82%) examined correlates, and 12 (21.82%) examined moderators and mediators of substance use in TGD youth. Findings suggest TGD youth exhibit a moderate-to-high prevalence of recent substance use, including alcohol (23-31%), binge drinking (11-59%), cigarettes (10-59%), e-cigarettes (17-27%), and marijuana (17-46%). Additionally, results supported that greater victimization experiences, including those related and unrelated to being a gender minority, were associated with increased substance use risk. Few studies examined polysubstance use, resilience, and protective factors, or considered TGD subgroup differences, which we recommend in future research. Further, we recommend improving population-based surveys to better capture gender identity and related experiences.
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Affiliation(s)
| | | | - Alex Abramovich
- University of Toronto, Canada; Centre for Addiction and Mental Health, Canada
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15
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Kidd JD, Kaczmarkiewicz R, Kreski NT, Jackman K, George M, Hughes TL, Bockting WO. A qualitative study of alcohol use disorder psychotherapies for transgender and nonbinary individuals: Opportunities for cultural adaptation. Drug Alcohol Depend 2023; 248:109913. [PMID: 37182356 PMCID: PMC10330671 DOI: 10.1016/j.drugalcdep.2023.109913] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/29/2023] [Accepted: 04/29/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Transgender and nonbinary (TGNB) populations experience high rates of hazardous drinking (HD) and alcohol use disorder (AUD) as well as unique treatment barriers. This is due, in-part, to discrimination and stigma within and outside of the healthcare system. Cultural adaptation of clinical interventions can improve outcomes for marginalized populations, but no such adapted interventions exist for AUD among TGNB individuals. This study sought to understand how TGNB individuals perceive currently available AUD psychotherapies and to generate knowledge about potential areas for cultural adaptation. METHODS As part of a qualitative study of HD among TGNB individuals (N=27), participants were asked to imagine that they were clients in psychotherapy vignettes corresponding to cognitive behavioral therapy, motivational enhancement therapy, and twelve step facilitation. Interviews were audio-recorded and professionally transcribed. A coding team used an iterative codebook to guide coding. Categories emerged from this process that reflected participants' perceptions and allowed for the identification of potential cultural-adaptation targets. RESULTS Across all three psychotherapies, participants wanted therapists to explicitly discuss gender identity and culturally salient HD risk factors for TGNB individuals (e.g., discrimination, stigma, gender dysphoria). There were also modality-specific recommendations to incorporate principles of trauma-informed care into cognitive behavioral therapy, avoid motivational enhancement therapy exercises that oversimplify decision-making, and recognize that the twelve-step-facilitation concept of "powerlessness" may conflict with how many TGNB people see themselves. CONCLUSIONS These findings highlight areas for cultural adaptation that can be evaluated in future intervention trials in an effort to improve psychotherapy acceptability and efficacy for TGNB individuals.
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Affiliation(s)
- Jeremy D Kidd
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY10032, USA.
| | - Roma Kaczmarkiewicz
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY10032, USA.
| | - Noah T Kreski
- Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY10032, USA.
| | - Kasey Jackman
- Columbia University School of Nursing, 560 W. 168th Street, New York, NY10032, USA; New York-Presbyterian Hospital, 622 W. 168th Street, New York, NY10032, USA.
| | - Maureen George
- Columbia University School of Nursing, 560 W. 168th Street, New York, NY10032, USA.
| | - Tonda L Hughes
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY10032, USA; Columbia University School of Nursing, 560 W. 168th Street, New York, NY10032, USA.
| | - Walter O Bockting
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY10032, USA; Columbia University School of Nursing, 560 W. 168th Street, New York, NY10032, USA.
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16
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Kim HH, Goetz TG, Grieve V, Keuroghlian AS. Psychopharmacological Considerations for Gender-Affirming Hormone Therapy. Harv Rev Psychiatry 2023; 31:183-194. [PMID: 37437250 PMCID: PMC10348476 DOI: 10.1097/hrp.0000000000000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
ABSTRACT The field of transgender health has grown exponentially since the early 2010s. While this increased visibility has not been without controversy, there is growing acknowledgement of the needs of transgender, nonbinary, and gender expansive (TNG) patients and the health disparities they experience compared to the cisgender population. There is also increased interest among clinicians and trainees in providing gender-affirming care in all medical specialties. This is particularly relevant in psychiatry as mental health disparities in TNG patients have been well-documented. TNG patients experience significant minority stress and higher rates of psychiatric illness, self-harm, suicidality, and psychiatric hospitalization compared to their cisgender peers. In this review, we will cover potential interactions and side effects relevant to psychiatric medication management for the three most common medication classes prescribed as part of gender-affirming hormone therapy (GAHT): gonadotropin-releasing hormone receptor agonists, estradiol, and testosterone. Although no studies directly examining the efficacy of psychiatric medications or their interactions with GAHT for TNG patients have been published yet, we have synthesized the existing literature from both cisgender and TNG patients to shed light on health care disparities seen in TNG patients. Since clinicians' lack of comfort and familiarity with gender-affirming care contributes significantly to these disparities, we hope this narrative review will help psychiatric prescribers provide TNG patients with the same quality of care that cisgender patients receive.
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Affiliation(s)
- Hyun-Hee Kim
- From Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Drs. Kim and Keuroghlian); University of Pennsylvania Department of Psychiatry (Dr. Goetz); University of Pittsburgh Department of Pharmacy and Therapeutics (Dr. Grieve)
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17
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Sexual orientation and cannabis outcomes among Black Individuals: The role of cannabis use motives. Addict Behav 2023; 141:107635. [PMID: 36746107 DOI: 10.1016/j.addbeh.2023.107635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/16/2022] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
Sexual minority individuals report greater cannabis use and cannabis use related problems relative to straight individuals. Although sociocultural models suggest that sexual minority individuals may be especially vulnerable to using cannabis for high-risk motives such as coping motives, little attention has been paid to the role of cannabis use motives among sexual minority relative to straight individuals. Thus, the current study examined the role of cannabis use motives and cannabis-related problems among Black sexual minority and straight individuals that reported current (past 3-month) cannabis use (N = 137, 28.5 % of whom identify as sexual minority). Sexual minority participants endorsed more frequent cannabis use, and social, coping, enhancement, and expansion motives than straight participants. Conformity motives were not significantly related to sexual minority status. Multiple mediation model with all relevant motives included as putative mediators indicated that sexual minority status was related to cannabis problems indirectly via the effects of coping and expansion motives. Alternative models strengthen confidence in the directionality of these effects, although future prospective research will be an important next step. Findings may help inform treatment efforts among sexual minority individuals to reduce risk of negative cannabis outcomes.
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18
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Dyar C, Feinstein BA, Albright J, Newcomb ME, Whitton SW. Associations between Drinking Contexts, Minority Stress, and Problematic Alcohol Use among Sexual Minority Individuals Assigned Female at Birth. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2023; 10:292-303. [PMID: 37484479 PMCID: PMC10361668 DOI: 10.1037/sgd0000426] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Sexual minority individuals assigned female at birth (SM-AFAB) are at increased risk for problematic alcohol use compared to heterosexual women. Despite evidence that drinking locations and companions play an important role in problematic alcohol use among heterosexuals, few studies have examined these social contexts of alcohol use among SM-AFAB. To address this gap, the current study examined two aspects of social contexts in which SM-AFAB drink (locations and companions). We utilized two waves of data (six-months between waves) from an analytic sample of 392 SM-AFAB ages 17-33 from a larger longitudinal study. The goals were: (1) to identify classes of SM-AFAB based on the contexts in which they drank; (2) to examine the associations between drinking contexts, minority stressors, and problematic alcohol use; and (3) to examine changes in drinking contexts over time. Using latent class analysis, we identified four classes based on drinking locations and companions (private settings, social settings, social and private settings, multiple settings). These classes did not differ in minority stress. Drinking in multiple settings was associated with more problematic alcohol use within the same timepoint and these differences were maintained six months later. However, drinking in multiple settings did not predict subsequent changes in problematic alcohol use when problematic alcohol use at the prior wave was controlled for. Based on these findings, SM-AFAB who drink in multiple settings may be an important subpopulation for interventions to target. Interventions could focus on teaching SM-AFAB strategies to limit alcohol consumption and/or minimize alcohol-related consequences.
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Affiliation(s)
- Christina Dyar
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Brian A Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science
| | | | - Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
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19
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Kalinowski J, Layland EK, Eaton LA, Watson RJ. Strong Ethnic Identity Buffers the Association of Heterosexism with Substance Use Among Black Sexual Minority Men. J Racial Ethn Health Disparities 2023; 10:1270-1279. [PMID: 35556225 PMCID: PMC9936572 DOI: 10.1007/s40615-022-01312-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/08/2022] [Accepted: 04/21/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Heterosexist stigma, including microaggressions experienced in their own racial/ethnic communities, may partially explain disproportionate levels of substance use involvement among Black sexual minority men (BSMM). A strong sense of ethnic identity may provide BSMM with a protective resource. The purpose of this study was to explore associations between ethnic identity and substance use in BSMM. METHODS Data were from Black sexual minority men (n = 390 Mage = 25.28; SD = 2.81) in the PrEP and Substance Use National Survey collected from March 2020 to August 2020 that included self-reported cannabis, cocaine, methamphetamines, inhalants, hallucinogens, prescription drugs misuse, and overall substance use involvement. Using zero-inflated negative binomial regression, we assessed the association between heterosexist microaggressions within BSMM's racial/ethnic communities and substance use involvement, moderated by subjective sense of ethnic identity. RESULTS More than half of participants reported past 3-month substance use. Heterosexist microaggressions were associated with higher relative risk of cannabis use involvement (RR = 1.76; 95% CI 1.13-2.73) and overall substance use involvement (RR = 2.23; 95% CI 1.39-3.56). Stronger ethnic identity buffered the association of heterosexism on substance use involvement (cannabis: RR = 0.82; 95% CI 0.72-0.95; overall: RR = 0.77; 95% CI 0.66-0.89). CONCLUSION Nurturing ethnic identity development and reducing heterosexist stigma in Black communities may be a culturally responsive, two-pronged approach to reducing substance use involvement among BSMM. BSMM with strong ethnic identity demonstrated resilience to heterosexist stigma. Future research should examine the extent to which ethnic identity may be cultivated as a protective resource against substance use involvement.
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Affiliation(s)
- Jolaade Kalinowski
- Human Development and Family Sciences, University of Connecticut, Storrs, CT, 06279-1248, USA.
| | - Eric K Layland
- Center for Interdisciplinary Research On AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Lisa A Eaton
- Human Development and Family Sciences, University of Connecticut, Storrs, CT, 06279-1248, USA
| | - Ryan J Watson
- Human Development and Family Sciences, University of Connecticut, Storrs, CT, 06279-1248, USA
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McCurdy AL, Gower AL, Rider GN, Thomas D, Watson RJ, Eisenberg ME, Russell ST. Adolescent substance use at the intersections of foster care, sexual orientation and gender identity, racial/ethnic identity, and sex assigned at birth. CHILD ABUSE & NEGLECT 2023; 137:106042. [PMID: 36706614 PMCID: PMC10695276 DOI: 10.1016/j.chiabu.2023.106042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 01/04/2023] [Accepted: 01/12/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) youth are overrepresented in foster care and report greater substance use during adolescence. OBJECTIVE Using an intersectional lens, the current study investigates differences in foster care placement and variation in substance use at the intersections of foster care and sexual orientation, gender identity, racial/ethnic identities, and sex assigned at birth. PARTICIPANTS AND SETTINGS A sample of 121,910 LGBTQ youth (grades 6-12) completed either the Minnesota Student Survey in 2019, the California Healthy Kids Survey from 2017 to 2019, or the 2017 LGBTQ National Teen Study. METHODS Youth reported their substance use in the past 30 days (alcohol, binge drinking, cigarette, marijuana), social positions (sexual orientation, gender identity, racial/ethnic identities, sex assigned at birth), living arrangement (foster care or not), and grade in school. Logistic regression was used to examine the main and interaction effects of foster care and social positions on youth substance use. RESULTS Results indicated significant differences in substance use at the intersection of foster care placement and youth social positions. Significant two-way interactions for foster care placement and social positions emerged predicting alcohol, binge drinking, and marijuana use. CONCLUSIONS Findings show that LGBTQ youth in foster care are at higher risk for substance use than those not in foster care. Particular support is needed for lesbian, gay, and questioning youth, transgender youth, LGBTQ youth assigned male at birth, and Asian or Pacific Islander LGBTQ youth in foster care.
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Affiliation(s)
- Amy L McCurdy
- Department of Human Development and Family Sciences, University of Texas, 108 Dean Keeton St, Austin, TX 78712, USA.
| | - Amy L Gower
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, 717 Delaware St. SE, Minneapolis, MN 55414, USA.
| | - G Nic Rider
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, 1300 S 2nd St., Ste. 180, Minneapolis, MN 55454, USA.
| | - De'Shay Thomas
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, 717 Delaware St. SE, Minneapolis, MN 55414, USA.
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd U1058, Storrs, CT 06269, USA.
| | - Marla E Eisenberg
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, 717 Delaware St. SE, Minneapolis, MN 55414, USA.
| | - Stephen T Russell
- Department of Human Development and Family Sciences, University of Texas, 108 Dean Keeton St, Austin, TX 78712, USA.
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Morgan E, Dyar C, Feinstein B, Hudson H, D’Aquila R, McDade TW, Mustanski B. Inflammation Assessed by Latent Profiling is Associated with Stress and Suicidality but not Depression: Findings from the RADAR Cohort Study. ANNALS OF LGBTQ PUBLIC AND POPULATION HEALTH 2023; 4:1-13. [PMID: 37599862 PMCID: PMC10437120 DOI: 10.1891/lgbtq-2021-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Past research has suggested that sexual and gender minorities experience elevated levels of systemic inflammation which in turn has been linked to worse mental health outcomes. Therefore, the goals of this work are to develop a better understanding of the relationship between mental health variables and inflammation among this high-risk population. Data were collected among a sample of young men who have sex with men and transgender women (YMSM/TGW, N=685) aged 16-20 at the time of enrollment. Multiplex plasma cytokine and inflammatory biomarkers were quantified. Mental health variables were self-reported and included perceived stress, depression, and suicidal ideation. Latent profile analyses (i.e., latent class analyses intended for continuous variables) were utilized to identify four unique profiles of individuals with similar inflammatory markers followed by adjusted multinomial logistic regression to estimate the association between inflammatory profiles and mental health variables. Participants experienced moderate levels of perceived stress, normal levels of depression and ten percent reported suicidal ideation in the past six months. Multinomial regression models indicated that being in the highest inflammation profile, compared to the lowest inflammation profile, was significantly associated only with increased perceived stress and suicidal ideation. In sum, we observed significant relationships between inflammation and both perceived stress and suicidal ideation, but not between inflammation and depression. Future research should continue to assess these relationships using longitudinal data as they are intricate and likely bidirectional and may be key to reducing health disparities among this population.
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Affiliation(s)
- Ethan Morgan
- College of Nursing, Infectious Disease Institute, The Ohio State University, Columbus, OH
| | - Christina Dyar
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Brian Feinstein
- Department of Psychology, Rosalind Franklin University, North Chicago, IL
| | - Hannah Hudson
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Richard D’Aquila
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Thomas W. McDade
- Department of Anthropology and Institute for Policy Research, Northwestern University, Evanston, IL
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
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22
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Rosales R, Sellers CM, Lee CS, Santos B, O'Brien K, Colby SM. Examining Racial/Ethnic Differences in the Association of Victimization and Suicidal Thoughts and Behaviors with Alcohol Use Among Sexual Minority Youth. LGBT Health 2023; 10:109-120. [PMID: 36044041 PMCID: PMC9986026 DOI: 10.1089/lgbt.2021.0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Purpose: Integrating Minority Stress Theory and Bagge and Sher's Theoretical Framework of the Alcohol-Suicide Attempt Relation, this study aimed to test whether experiencing both minority stress and suicidal thoughts and behaviors (STBs) had a greater strength of association with Latinx and Black sexual minority youth (SMY)'s alcohol use compared with that of White SMY. Methods: Using data on 2341 non-Latinx Black, Latinx, and non-Latinx White SMY from the 2015 and 2017 Youth Risk Behavior Surveys, we tested the prevalence of STBs, victimization, and alcohol use for Black and Latinx participants compared with White participants. Multivariate logistic regression analyses tested the main effects of STBs, victimization, and race/ethnicity on alcohol use. Finally, interaction terms assessed the interaction among STBs, victimization, and race/ethnicity on alcohol use. Results: The results supported our hypothesis, based on Minority Stress Theory, that experiencing victimization would be associated with greater alcohol use. Results also supported Bagge and Sher's theoretical framework showing that suicide plan and attempts were associated with greater alcohol use. When taking all of these stressors into account, results showed that Latinx SMY who experienced victimization had greater current prevalence of alcohol use than their White counterparts. However, Latinx SMY who were victimized and experienced suicidal ideation reported lower alcohol use than White SMY. Conclusion: These findings support the double jeopardy and resiliency hypotheses, which suggest that minority stressors have differing associations for each racial/ethnic SMY group's alcohol use. More research is needed that helps to disentangle the protective and risk factors for alcohol use among Black and Latinx SMY.
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Affiliation(s)
- Robert Rosales
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Christina M. Sellers
- College of Social, Sciences, Policy, and Practice, School of Social Work, Simmons University, Boston, Massachusetts, USA
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Christina S. Lee
- School of Social Work, Boston University, Boston, Massachusetts, USA
| | - Bryan Santos
- Independent Researcher, Worcester, Massachusetts, USA
| | - Kimberly O'Brien
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Suzanne M. Colby
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island, USA
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23
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Paschen-Wolff MM, Kidd JD, Paine EA. The State of the Research on Opioid Outcomes Among Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexuality- and Gender-Diverse Populations: A Scoping Review. LGBT Health 2023; 10:1-17. [PMID: 36318023 PMCID: PMC10081720 DOI: 10.1089/lgbt.2022.0036] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: Research on opioid misuse, opioid use disorder (OUD), and overdose (i.e., opioid outcomes) among lesbian, gay, bisexual, transgender, queer, and other populations within the LGBTQ umbrella (LGBTQ+) remains sparse. The purpose of this scoping review was to characterize the state of the research on opioid outcomes among LGBTQ+ populations, and identify gaps in the extant literature and areas for future research. Methods: We conducted a scoping review of peer-reviewed, English language articles published between 2011 and 2020 that examined opioid outcomes among LGBTQ+ populations in the CINAHL, Embase, PubMed, and PsycINFO databases. We extracted data from articles that focused on opioid outcomes within their specific aims or purpose. We include a general summary for articles that secondarily described opioid outcomes among LGBTQ+ populations. Results: Of 113 published studies that examined opioid outcomes among LGBTQ+ populations, 10% (n = 11) were specifically designed to focus on this topic. Across studies, bisexual populations, particularly women, were at highest risk for opioid misuse and OUD. Few studies examined opioid outcomes by more than one dimension of sexual orientation (n = 3, 27%), race and/or ethnicity (n = 3, 27%), or age (n = 5, 45%). Only two included transgender or gender diverse samples; only one explicitly measured gender identity. Conclusions: Future research is needed to understand the impact of the opioid epidemic on LGBTQ+ people, particularly transgender and other gender diverse individuals, and the intersectional role of race, ethnicity, and age in opioid disparities among LGBTQ+ individuals. Additional research could contribute to the development of much-needed affirming OUD treatment and other services for LGBTQ+ people.
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Affiliation(s)
- Margaret M Paschen-Wolff
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center at New York State Psychiatric Institute, New York, New York, USA
| | - Jeremy D Kidd
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center at New York State Psychiatric Institute, New York, New York, USA
| | - Emily Allen Paine
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, New York, USA
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24
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Stojisavljevic S, Djikanovic B, Matejic B. "Today one partner, tomorrow another one, and no one is suspicious that you are gay": A Qualitative Study of Understanding HIV Related Risk Behavior Among MSM in Bosnia and Herzegovina. JOURNAL OF HOMOSEXUALITY 2022; 69:2532-2549. [PMID: 34280082 DOI: 10.1080/00918369.2021.1943280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Men who have Sex with Men (MSM) are often exposed to stigma and discrimination, especially in developing countries. Discrimination might have an impact on their sexual behavior. The proportion of MSM among HIV positive persons is rising in Bosnia and Herzegovina (B&H). The aim of this qualitative study was to understand the country context and HIV-related risk behaviors among MSM in B&H. We found that MSM in B&H have a dominant fear of expressing their sexual orientation in the homophobic societal environment, including their own family. Disclosures are often connected with escalated family violence, followed by the silence and ignorance. The fear of being connected to one particular partner and being labeled as a gay lead to the need of "masking" their sexual orientation, and having sexual intercourse with non-steady sexual partners. Although most MSM were aware of the risk of HIV and other STIs, the fear of rejection and remaining alone, shapes their decisions to agree to have sex without condoms.
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Affiliation(s)
- Stela Stojisavljevic
- Faculty of Medicine, Public Health Institute Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Bosiljka Djikanovic
- Faculty of Medicine University of Belgrade, Institute of Social Medicine and Centre - School of Public Health, University of Belgrade, Belgrade, Serbia
| | - Bojana Matejic
- Faculty of Medicine University of Belgrade, Institute of Social Medicine and Centre - School of Public Health, University of Belgrade, Belgrade, Serbia
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25
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Intersectional stigma subgroup differences in unhealthy drinking and disordered marijuana use among Black and Latino cisgender sexual minority young men. Drug Alcohol Depend 2022; 241:109652. [PMID: 36332595 PMCID: PMC10082566 DOI: 10.1016/j.drugalcdep.2022.109652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 09/18/2022] [Accepted: 09/27/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND We investigated associations of intersectional stigma subgroups with alcohol and marijuana use among Black and Latino sexual minority young men. Subgroups included Minimal Stigma (low to no stigma), Select Social Stigma (occasional stigma in social relationships), Multiform Heterosexism (internalized and interpersonal heterosexism from family/friends), Multiform Racism (racism across diverse contexts), Compound Stigma (frequent, ubiquitous racism and heterosexism). METHODS Cohort of Black and Latino cisgender sexual minority young men (n = 414; baseline ages 16-25) surveyed semiannually 2016-2019. Generalized estimating equations integrated with latent class analysis modeled linear and quadratic age effects and association of stigma subgroups with past 6-month alcohol use, marijuana use, unhealthy drinking, and marijuana use disorder symptoms. RESULTS All past 6-month substance use peaked between ages 21-23 years old. Across all ages and relative to Minimal Stigma, odds of drinking were higher in every subgroup and highest in Compound Stigma (OR=2.72, 95% CI 1.17-6.35); unhealthy drinking was higher in every subgroup and highest in Multiform Heterosexism (β = 3.31, 95% CI 1.92-3.89); marijuana use disorder symptoms were higher in most subgroups and highest in Compound Stigma (β = 1.30, 95% CI 0.76-1.85). Marijuana use odds did not differ among groups. CONCLUSION By examining intersectional stigma subgroups, we identified subgroups for whom substance use was elevated during a development period when use tends to be highest. Young men experiencing stigma patterns characterized primarily by heterosexism or heterosexism together with racism may be especially at risk for developing unhealthy drinking behaviors and marijuana use disorder symptoms.
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26
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Winer JM, Yule AM, Hadland SE, Bagley SM. Addressing adolescent substance use with a public health prevention framework: the case for harm reduction. Ann Med 2022; 54:2123-2136. [PMID: 35900132 PMCID: PMC9341337 DOI: 10.1080/07853890.2022.2104922] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/25/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Adolescence is a developmental stage defined in part by risk-taking. Risk-taking is critical to normal development and has important benefits including trying new activities and exploring new relationships. Risk-taking is also associated with the initiation of substance use. Because substance use often begins in adolescence, much focus has been on primary prevention with the goal of preventing initial substance use. Secondary or tertiary prevention approaches, such as counselling to eliminate substance use or offering treatment, are common approaches for adolescents with problematic substance use or a substance use disorder. While this is important, for some adolescents, treatment or cessation of use may not be desired. In these cases, Healthcare Practitioners (HCPs) can offer clear advice that incorporates harm reduction. Harm reduction, which is often applied for adults who use substances, reduces the negative impacts associated with drug use without requiring abstinence. Harm reduction is crucial to keeping adolescents safe and healthy and can offer opportunities for future engagement in treatment. The objective of this review is to describe strategies for integrating harm reduction principles in clinical settings that are developmentally appropriate. A patient-centered, harm reduction approach can validate perceived benefits of substance use, offer strategies to minimise harm, and advise reduction of use and abstinence.KEY MESSAGES:Substance use often begins in adolescence and traditional approaches are often rooted in prevention framework.Harm reduction should be incorporated for adolescents with problematic substance use or a substance use disorder.This review offers strategies for integration of harm reduction principles tailored towards adolescents.
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Affiliation(s)
- James Michael Winer
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Amy M. Yule
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Scott E. Hadland
- Division of Adolescent and Young Adult Medicine, MassGeneral Hospital for Children, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Sarah M. Bagley
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
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27
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Pham T, Akamu C, Do A, Tomita KK, Combs S. Systems of Care Implications in Hawai'i: Sexual and Gender Minorities. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:52-61. [PMID: 36660277 PMCID: PMC9783816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Sexual and gender minorities (SGM) are diverse groups of people who do not identify as heterosexual or cisgender. SGM communities include Lesbian, Gay, Bisexual, and Transgender (LGBT) individuals as well as people of other sexual orientations and gender identities. SGM communities are disproportionately affected by substance use disorders, with differential use of specific substances among persons based on sexual or gender identity. As understood through the minority stress model, substance use and misuse among SGM people are tied to risk and resiliency factors at all levels of the social ecological paradigm. Despite the disproportionate burden of substance use disorders on SGM people in Hawai'i, very few resources or programs exist to ameliorate the impact of substance use on this community. Although some models of care could be useful for SGM people, community-specific interventions are scarce, especially in Hawai'i. To successfully meet the needs of SGM people in Hawai'i, multi-level transformation of the substance use prevention and treatment landscape must address: culturally appropriate service delivery; workforce recruitment and development; nimble and adequate financing; consistent data collection and reporting; and systems-level policy updates.
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Affiliation(s)
- Thaddeus Pham
- Harm Reduction Services Branch, Communicable Disease and Public Health
Nursing, Division, Hawai‘i Department of Health, Honolulu, HI (TP)
- Hep Free Hawai‘i, Honolulu, HI (TP)
| | - Cade Akamu
- Department of Psychiatry, John A Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (CA)
- Office of Public Health Studies, Thompson School of Social Work and Public Health, University of Hawai‘i at Mānoa, Honolulu, HI (CA)
| | - Annie Do
- School of Public Health, University of Washington, Seattle, WA (AD)
| | - Kevin K. Tomita
- Harm Reduction Services Branch, Communicable Disease and Public Health
Nursing, Division, Hawai‘i Department of Health, Honolulu, HI (TP)
- Hep Free Hawai‘i, Honolulu, HI (TP)
- Department of Psychiatry, John A Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (CA)
- Office of Public Health Studies, Thompson School of Social Work and Public Health, University of Hawai‘i at Mānoa, Honolulu, HI (CA)
- School of Public Health, University of Washington, Seattle, WA (AD)
| | - Sarah Combs
- Harm Reduction Services Branch, Communicable Disease and Public Health
Nursing, Division, Hawai‘i Department of Health, Honolulu, HI (TP)
- Hep Free Hawai‘i, Honolulu, HI (TP)
- Department of Psychiatry, John A Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (CA)
- Office of Public Health Studies, Thompson School of Social Work and Public Health, University of Hawai‘i at Mānoa, Honolulu, HI (CA)
- School of Public Health, University of Washington, Seattle, WA (AD)
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28
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Abboud S, Veldhuis C, Ballout S, Nadeem F, Nyhan K, Hughes T. Sexual and gender minority health in the Middle East and North Africa Region: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100085. [PMID: 38745607 PMCID: PMC11080540 DOI: 10.1016/j.ijnsa.2022.100085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/18/2022] [Accepted: 06/25/2022] [Indexed: 01/05/2023] Open
Abstract
Background Researchers in studies from multiple countries suggest that sexual and gender minority people experience high rates of violence, stigma, and discrimination, as well as mistrust of health care providers and systems. Despite growing evidence related to sexual and gender minority health in North America and Europe, we know little about the health of this population in the Middle East and North Africa. Objectives We aimed to comprehensively examine the literature related to the health of sexual and gender minority people in the Middle East and North Africa and to identify research gaps and priorities. Design We conducted a scoping review informed by the framework recommended by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) tool. Data sources We searched the following databases: PubMed (using Medline All on the Ovid platform), PsycINFO (Ovid), CINAHL (Ebsco), and Embase (Ovid). The search strategy combined terms for the geographic region of interest (Middle East and North Africa) and the population of interest (sexual and gender minority). Each was operationalized using multiple search terms and, where available, controlled vocabulary terms. Review Methods Research articles were identified and assessed for inclusion using an explicit strategy. Relevant information was extracted and synthesized to present a descriptive summary of existing evidence. Results Research designs of the 98 articles we reviewed included quantitative (n = 73), qualitative (n = 20), and mixed methods (n = 5). Most studies were conducted in Lebanon (n = 33), Pakistan (n = 32), and Iran (n = 23) and focused mainly on gender minority individuals (n = 46) and men who have sex with men (n = 32). Five themes emerged from the review: sexual health (52; 53%); mental health (20; 20%); gender identity (17; 17%); violence and discrimination (7; 7%); and experiences with the healthcare system (2; 2%). Although researchers focused on multiple health outcomes in some studies, we included them under the theme most closely aligned with the main objective of the study. Conclusion Although our study is limited to few countries in the Middle East and North Africa region, we found that sexual and gender minority individuals face multiple adverse sexual and mental health outcomes and experience high rates of stigma, discrimination, and violence. More research is needed from countries outside of Lebanon, Pakistan, and Iran, including community-based participatory approaches and multi-level intervention development. Nurses and other healthcare providers in the region need training in providing inclusive care for this population.
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Affiliation(s)
- Sarah Abboud
- University of Illinois Chicago, College of Nursing, Chicago, IL, United States of America
| | - Cindy Veldhuis
- Columbia University, School of Nursing, New York, New York, United States of America
| | - Suha Ballout
- University of Massachusetts Boston, College of Nursing and Health Sciences, Boston, Massachusetts, United States of America
| | | | - Kate Nyhan
- Yale University Cushing/Whitney Medical Library, New Haven, Connecticut, United States of America
| | - Tonda Hughes
- Columbia University, School of Nursing, New York, New York, United States of America
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29
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Dash GF, Holt L, Kenyon EA, Carter EK, Ho D, Hudson KA, Feldstein Ewing SW. Detection of vaping, cannabis use, and hazardous prescription opioid use among adolescents. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:820-828. [PMID: 36030794 PMCID: PMC9588707 DOI: 10.1016/s2352-4642(22)00212-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 05/19/2023]
Abstract
There has been a global surge in adolescents' use of electronic nicotine delivery systems (vaping), cannabis (vaped and edible), and prescription opioids, collectively termed ECPO. The nature of ECPO use can make it difficult to detect due to few obvious immediate physical and behavioural signs, as well as subtle long-term effects that allow adolescents to transition from initial exploration into hazardous ECPO use without easy detection by care providers. Here, we address the nature of the presentation of ECPO use in adolescents (roughly age 13-18 years), including challenges in detecting use and related complications, which affect screening, prevention, and intervention. We begin by reviewing empirical data on these difficult to detect effects in adolescents, including acute effects at cellular and neural levels and long-term neurocognitive and developmental changes that precede outwardly detectable physical signs. We then provide concrete approaches for providers to screen for ECPO use in adolescents even in the absence of overt physical and behavioural symptoms. Finally, we conclude with direct practice recommendations for prevention and intervention.
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Affiliation(s)
- Genevieve F Dash
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA.
| | - Laura Holt
- Department of Psychology, Trinity College, Hartford, CT, USA
| | - Emily A Kenyon
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Emily K Carter
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Diana Ho
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Karen A Hudson
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
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30
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Dyar C, Kaysen D, Newcomb ME, Mustanski B. Event-level associations among minority stress, coping motives, and substance use among sexual minority women and gender diverse individuals. Addict Behav 2022; 134:107397. [PMID: 35700652 PMCID: PMC9732144 DOI: 10.1016/j.addbeh.2022.107397] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/27/2022] [Accepted: 06/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sexual minority women and gender diverse individuals (SMWGD) are at heightened risk for alcohol and cannabis use disorders compared to heterosexual and cisgender individuals, and their heightened risk has been attributed to minority stress. However, few longitudinal studies have examined mechanisms through which minority stress may impact substance use, and none have done so at the event-level. METHODS We utilized data from a 30-day ecological momentary assessment study of 429 SMWGD who used alcohol or cannabis regularly to test a mechanistic process in which minority stress predicts alcohol and cannabis use via coping motives for use at the event-level. RESULTS When individuals experienced more enacted stigma (e.g., microaggressions) than usual during one assessment, they were more likely to use cannabis to cope during the next. In turn, occasions when cannabis was used to cope were marked by more sessions of cannabis use, longer intoxication, higher subjective intoxication, and more cannabis consequences. Indirect effects of enacted stigma on cannabis use via coping motives were significant. However, only one of internalized stigma's indirect effects was significant, with internalized stigma predicting cannabis consequences via daily coping motives. No indirect effects predicting alcohol use were significant. CONCLUSIONS Findings provide robust evidence that using to cope is a mechanism through which enacted stigma predicts cannabis use and internalized stigma predicts cannabis consequences. Results did not provide evidence for similar associations for alcohol. Our findings suggest that interventions designed to reduce cannabis use among SMWGD should attend to their minority stress experiences and cannabis use motives and teach alternative coping strategies.
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Affiliation(s)
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
| | - Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, USA; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, USA; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, USA
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31
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Kidd JD, Everett BG, Corbeil T, Shea E, Hughes TL. Gender self-concept and hazardous drinking among sexual minority women: Results from the Chicago health and life experiences of women (CHLEW) study. Addict Behav 2022; 132:107366. [PMID: 35598531 PMCID: PMC9199430 DOI: 10.1016/j.addbeh.2022.107366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/25/2022] [Accepted: 05/10/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Sexual minority women (SMW; e.g., lesbian, bisexual) report substantially higher rates of hazardous drinking (HD) than heterosexual women.Yet, few studies have examined sub-group differences. In this study, we investigated the relationship between gender self-concept and HD among SMW. Research consistently shows a link between heavier drinking and masculinity. SMW are more likely than heterosexual women to be gender nonconforming, and masculinity among SMW is associated with increased minority stress, a key HD risk factor. METHODS We used Wave 3 data from the Chicago Health and Life Experiences of Women study, a longitudinal study of SMW (N = 598), which assessed participants' self-perceived levels of masculinity and femininity and their perception of how masculine/feminine others viewed them. Using multivariable logistic regression, we examined the association between gender self-concept and past 12-month heavy episodic drinking (HED), drinking-related problems, and alcohol dependence. RESULTS Controlling for demographics and minority stress, greater masculinity (both self-perceived and perceptions by others) was associated with higher odds of HED and alcohol dependence. Masculinity as perceived by others was associated with higher odds of drinking-related problems. Neither femininity measure was associated with HD. Additionally, minority stress (i.e., discrimination, stigma, internalized stigma) did not account for the relationship between gender self-concept and HD. CONCLUSIONS/IMPORTANCE In this sample, masculinity, particularly SMW's beliefs that others viewed them as masculine, was associated with HD. This association was not attributable to differences in minority stress and may be related to differences in gendered drinking norms, which could be targeted in intervention studies.
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Affiliation(s)
- Jeremy D Kidd
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Bethany G Everett
- Department of Sociology, University of Utah, Salt Lake City, UT, USAf.
| | - Thomas Corbeil
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Eileen Shea
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Tonda L Hughes
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; Columbia University School of Nursing, New York, NY, USA.
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32
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Kiekens WJ, Baams L, Fish JN, Watson RJ. Associations of Relationship Experiences, Dating Violence, Sexual Harassment, and Assault With Alcohol Use Among Sexual and Gender Minority Adolescents. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP15176-NP15204. [PMID: 33719695 PMCID: PMC8917816 DOI: 10.1177/08862605211001469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Sexual and gender minority (SGM) adolescents report higher rates of dating violence victimization compared with their heterosexual and cisgender peers. Research on dating violence often neglects diversity in sexual and gender identities and is limited to experiences in relationships. Further, given that dating violence and alcohol use are comorbid, research on experiences of dating violence could provide insights into alcohol use disparities among SGM adolescents. We aimed to map patterns of relationship experiences, sexual and physical dating violence, and sexual and physical assault and explored differences in these experiences among SGM adolescents. Further, we examined how these patterns explained alcohol use. We used a U.S. non-probability national web-based survey administered to 13-17-year-old SGM adolescents (N = 12,534). Using latent class analyses, four patterns were identified: low relationship experience, dating violence and harassment and assault (72.0%), intermediate dating experiences, sexual harassment, and assault and low levels of dating violence (13.1%), high dating experiences, dating violence, and sexual assault (8.6%), and high dating experiences, dating violence, and sexual harassment and assault (6.3%). Compared to lesbian and gay adolescents, bisexual adolescents reported more experiences with dating, dating violence, and sexual assault, whereas heterosexual adolescents reported fewer experiences with dating, dating violence, and sexual harassment and assault. Compared to cisgender boys, cisgender girls, transgender boys, and non-binary/assigned male at birth adolescents were more likely to experience dating violence inside and outside of relationship contexts. Experiences of dating, dating violence, and sexual harassment and assault were associated with both drinking frequency and heavy episodic drinking. Together, the findings emphasize the relevance of relationship experiences when studying dating violence and how dating violence and sexual harassment and assault might explain disparities in alcohol use.
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Affiliation(s)
| | - L Baams
- University of Groningen, The Netherlands
| | - J N Fish
- University of Maryland, College Park, USA
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Sarno EL, Dyar C, Newcomb ME, Whitton SW. Relationship quality and mental health among sexual and gender minorities. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2022; 36:770-779. [PMID: 34914423 PMCID: PMC9200904 DOI: 10.1037/fam0000944] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Sexual and gender minorities assigned female at birth (i.e., sexual minority women, transgender men, and gender diverse [SMW TGD] individuals) experience disproportionately high rates of anxiety, depression, and substance use problems. Romantic relationship involvement has been shown to be beneficial to mental health and substance use among sexual and gender minorities. However, few studies have explored the impact of relationship quality on mental health, or if high relationship quality can reduce the negative impact of minority stress on well-being in this population. The present study examined within-persons associations of romantic relationship quality with symptoms of anxiety and depression, and alcohol and cannabis use problems among SMW TGD individuals in romantic relationships, and tested relationship quality as a moderator of associations of minority stress with mental health and substance use. Participants were 213 SMW TGD individuals (mean age: 20.63; 70.9% cisgender women, 7.5% transgender men, and 19.2% gender diverse). Within-persons, higher relationship quality was associated with better mental health and substance use outcomes. Relationship quality at the between-persons level moderated the within-persons association of internalized heterosexism with depression, and of microaggressions with cannabis use problems. No other interaction effects were significant. The within-persons associations found in this study lend important support to relationship interventions based on theories that improvements in romantic relationship quality will result in improved well-being over time. Results can inform relationship education interventions to reduce mental health and substance use disparities in SMW TGD communities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Simulating the experience of searching for LGBTQ-specific opioid use disorder treatment in the United States. J Subst Abuse Treat 2022; 140:108828. [PMID: 35749919 DOI: 10.1016/j.jsat.2022.108828] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/15/2022] [Accepted: 06/07/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations experience opioid-related disparities compared to heterosexual and cisgender populations. LGBTQ-specific services are needed within opioid use disorder (OUD) treatment settings to minimize treatment barriers; research on the availability and accessibility of such services is limited. The purpose of the current study was to mimic the experience of an LGBTQ-identified individual searching for LGBTQ-specific OUD treatment services, using the SAMHSA National Directory of Drug and Alcohol Abuse Treatment Facilities - 2018 (Treatment Directory). METHODS We contacted treatment facilities listed in the Treatment Directory as providing both medications for OUD (MOUD) and "special programs/groups" for LGBTQ clients within states with the top 20 highest national opioid overdose rates. We used descriptive statistics to characterize the outcome of calls; and the overall number of facilities offering LGBTQ-specific services, MOUD, and both LGBTQ-specific services and MOUD in each state by 100,000 state population and in relation to opioid overdose mortality rates (programs-per-death rate). RESULTS Of the N = 570 treatment facilities contacted, n = 446 (78.25 %) were reached and answered our questions. Of n = 446 reached (all of which advertised both MOUD and LGBTQ-specific services), n = 366 (82.06 %) reported offering MOUD, n = 125 (28.03 %) reported offering special programs or groups for LGBTQ clients, and n = 107 (23.99 %) reported offering both MOUD and LGBTQ-specific services. Apart from Washington, DC, New Mexico, South Carolina, and West Virginia, which did not have any facilities that reported offering both MOUD and LGBTQ-specific services, Illinois had the lowest, and Michigan had the highest programs-per-death rate. Most of the northeastern states on our list (all but New Hampshire) clustered in the top two quarters of programs-per-death rates, while most of southeastern states (all but North Carolina) clustered in the bottom two quarters of programs-per-death rates. CONCLUSIONS The lack of LGBTQ-specific OUD treatment services may lead to missed opportunities for supporting LGBTQ people most in need of treatment; such treatment is especially crucial to prevent overdose mortality and improve the health of LGBTQ populations across the United States, particularly in the southeast.
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Kidd JD, Paschen-Wolff MM, Mericle AA, Caceres BA, Drabble LA, Hughes TL. A scoping review of alcohol, tobacco, and other drug use treatment interventions for sexual and gender minority populations. J Subst Abuse Treat 2022; 133:108539. [PMID: 34175174 PMCID: PMC8674383 DOI: 10.1016/j.jsat.2021.108539] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/28/2021] [Accepted: 06/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Alcohol, tobacco, and other drug use are among the most prevalent and important health disparities affecting sexual and gender minority (SGM; e.g., lesbian, gay, bisexual, transgender) populations. Although numerous government agencies and health experts have called for substance use intervention studies to address these disparities, such studies continue to be relatively rare. METHOD We conducted a scoping review of prevention and drug treatment intervention studies for alcohol, tobacco, and other drug use that were conducted with SGM adults. We searched three databases to identify pertinent English-language, peer-reviewed articles published between 1985 and 2019. RESULTS Our search yielded 71 articles. The majority focused on sexual minority men and studied individual or group psychotherapies for alcohol, tobacco, or methamphetamine use. CONCLUSION Our findings highlight the need for intervention research focused on sexual minority women and gender minority individuals and on cannabis and opioid use. There is also a need for more research that evaluates dyadic, population-level, and medication interventions.
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Affiliation(s)
- Jeremy D Kidd
- Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Margaret M Paschen-Wolff
- Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Amy A Mericle
- Alcohol Research Group at the Public Health Institute, 6001 Shellmound Street, Suite 450, Emeryville, CA 94608, USA.
| | - Billy A Caceres
- Columbia University School of Nursing, 560 W. 168th Street, New York, NY 10032, USA.
| | - Laurie A Drabble
- San Jose State University, College of Health and Human Sciences, One Washington Square, San Jose, CA 95191, USA.
| | - Tonda L Hughes
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA; Columbia University School of Nursing, 560 W. 168th Street, New York, NY 10032, USA.
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Subekti H, Rahmat I, Wilopo S. Stress-adaptation among Family of Adolescent with Substance Misuse: Systematic Literature Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Families of an adolescent with substance use disorders report significant burden and stress. Adequate coping strategies can modify the impact of stressful situations and increase family function.
AIM: The aim of the study was to systematically review the literature related to the coping strategies and adaptations used by family members of the adolescent with substance use disorders to manage their stress.
METHODS: We conducted electronic searches using MEDLINE (PubMed), EBSCO, databases to select studies on family stress, and coping strategies that were published from January 2000 to December 2020. The search terms were family, parent, father, mother, coping, caregiver, strategy, adaptation, adolescent, and substance use disorders.
RESULTS: We found 961 articles. After application of exclusion criteria and exclusion of redundant references, ten articles were thematically analyzed. The studies were organized into five categories: Engaged, tolerance, withdrawal, problem-focused, and emotion-focused coping strategies. The family members felt devastated by the incidents of violence and aggressive outbursts, and felt they failed as parents. As a result, the parents felt very isolated from other family members and friends, and ashamed of their children’s behavior. Most families used problem-focused and emotion-focused coping strategies in different combinations.
CONCLUSION: The identified studies show that the use of emotional focus coping is the coping strategy most often done by families. Problem focus coping involved family efforts to find sources of information and seek treatment services as a mechanism for adaptive coping strategy. However, a mixed methods study is still needed that clearly illustrates the types of coping strategies used in various cultural perspectives and social status.
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Xavier Hall CD, Morgan E, Bundy C, Foran JE, Janulis P, Newcomb ME, Mustanski B. Substance Use Predicts Sustained Viral Suppression in a Community Cohort of Sexual and Gender Minority Youth Living with HIV. AIDS Behav 2021; 25:3303-3315. [PMID: 33582890 DOI: 10.1007/s10461-021-03179-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 12/23/2022]
Abstract
Retention in care and sustained viral suppression are integral outcomes in the care continuum for people living with HIV (PLWH) and HIV prevention; however, less is known about how substance use predicts sustained viral suppression over time. This study seeks to examine the predictive effects of substance use on sustained viral suppression in a sample of cisgender sexual minority men and gender minority PLWH (n = 163) drawn from a longitudinal sample in the Chicago area collected 2015-2019. Using data from 3 visits separated by 6 months, participants were coded persistently detectable, inconsistently virally suppressed, and consistently virally suppressed (< 40 copies/mL at all visits). Multinomial logistic regressions were utilized. About 40% of participants had sustained viral suppression. In multinomial logistic regressions, CUDIT-R predicted persistent detectable status and stimulant use was associated with inconsistent viral suppression. Substance use may create challenges in achieving sustained viral suppression, which has important implications for care and prevention.
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Affiliation(s)
- Casey D Xavier Hall
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Ethan Morgan
- Infectious Disease Institute, College of Nursing, Ohio State University, Columbus, OH, USA
| | - Camille Bundy
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - James E Foran
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Patrick Janulis
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Michael E Newcomb
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
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Subekti H, Agus Wilopo S, Rahmat I. Stress Adaptation Among Family of Adolescent with Substance Use Disorders: Systematic Literature Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Families of an adolescent with substance use disorders report significant burden and stress. Adequate coping strategies can modify the impact of stressful situations and increase family function.
AIM: The objective of the study was to systematically review literature related to the coping strategies and adaptations used by family members of the adolescent with substance use disorders to manage their stress.
METHODS: We conducted electronic searches using MEDLINE (PubMed), EBSCO, databases to select studies on family stress, and coping strategies that were published from January 2000 to December 2020. The search terms were family, parent, father, mother, coping, caregiver, strategy, adaptation, adolescent, and substance use disorders.
RESULTS: We found 961 articles. After application of exclusion criteria and exclusion of redundant references, 10 articles were thematically analyzed. The studies were organized into five categories: Engaged, tolerance, withdrawal, problem-focused, and emotion-focused coping strategies. The family members felt devastated by the incidents of violence and aggressive outbursts, and felt that they failed as parents. As a result, the parents felt very isolated from other family members and friends, and ashamed of their children’s behavior. Most families used problem-focused and emotion-focused coping strategies in different combinations.
CONCLUSION: The identified studies show that the use of emotional focus coping is the coping strategy most often done by families. Problem focus coping involved family efforts to find sources of information and seek treatment services as a mechanism for adaptive coping strategy. However, a mixed methods study is still needed that clearly illustrates the types of coping strategies used in various cultural perspectives and social status.
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Behavioral Health in the Lesbian, Gay, Bisexual, Transgender, Questioning, and Other as Sexual and Gender Identities Community. PHYSICIAN ASSISTANT CLINICS 2021. [DOI: 10.1016/j.cpha.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cannabis use companions' gender and sexual orientation: Associations with problematic cannabis use in a sample of sexual minorities assigned female at birth. Addict Behav 2021; 118:106878. [PMID: 33652333 DOI: 10.1016/j.addbeh.2021.106878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Sexual minority women (SMW) are at heightened risk for problematic cannabis use compared to heterosexual women. Social learning theory posits that characteristics of one's cannabis use companions influence problematic use. However, most research on cannabis use among sexual minorities has focused on minority stress and not social learning theory. As such, the current study tested whether characteristics of one's cannabis use companions (gender and sexual orientation) were associated with changes in problematic use among cisgender SMW and non-binary individuals assigned female at birth. METHODS We utilized three waves of data (six-months between waves) from 321 cisgender SMW and sexual minority non-binary individuals assigned female at birth who participated in a larger study and reported using cannabis during at least one wave. We examined the prospective associations between using cannabis with five groups (SMW, sexual minority men, non-binary individuals, heterosexual women, and heterosexual men) and changes in problematic use six-months later. We also examined whether participant gender (cisgender woman vs. non-binary individual) moderated these associations. RESULTS Among cisgender SMW and sexual minority non-binary individuals, using cannabis with SMW and non-binary individuals, but not with sexual minority men, heterosexual men, or women, was associated with increases in problematic use six-months later. Gender did not moderate any associations between using cannabis with any group and problematic use. CONCLUSIONS Consistent with social learning theory, using cannabis with similar others was associated with increases in problematic use among cisgender SMW and sexual minority non-binary individuals. Future research should explore the mechanisms underlying these effects.
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Katz-Wise SL, Sarda V, Austin SB, Harris SK. Longitudinal effects of gender minority stressors on substance use and related risk and protective factors among gender minority adolescents. PLoS One 2021; 16:e0250500. [PMID: 34077452 PMCID: PMC8171963 DOI: 10.1371/journal.pone.0250500] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 04/07/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Gender minority (GM) adolescents, who have a different gender identity than their sex assigned at birth, may use substances as a coping strategy in response to GM-related stressors. This study examined longitudinal effects of gender minority stressors on substance use in GM adolescents, and related risk factors (internalized transphobia, depressive symptoms, anxious symptoms) and protective factors (resilience, gender-related pride, family functioning, social support, gender-related community connectedness). METHODS Participants were 30 GM adolescents, ages 13-17 years, from the U.S. community-based longitudinal Trans Teen and Family Narratives Project. Participants completed an online survey every 6 months across 2 years (5 waves; data collected 2015-2019). RESULTS Exposure to gender minority stressors was associated with higher odds of alcohol use. Across models, internalized transphobia (risk factor), resilience (protective factor), and gender-related pride (protective factor) were the most significant mediators of associations between gender minority stressors and substance use. Family functioning and social support (protective factors) significantly moderated the association between gender minority stressors and alcohol use, such that family functioning and social support were protective for alcohol use at lower levels of gender minority stress, but not at higher levels. CONCLUSION Results suggest that GM adolescents engage in substance use as a coping strategy in response to gender minority stressors. A number of hypothesized risk and protective factors mediated or moderated these associations. Future interventions with GM adolescents should focus efforts on addressing internalized transphobia as a risk factor and strengthening resilience, gender-related pride, and family functioning as protective factors for substance use.
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Affiliation(s)
- Sabra L. Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
| | - Vishnudas Sarda
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, United States of America
| | - S. Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
| | - Sion Kim Harris
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
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Jackman KB, Caceres BA, Kreuze EJ, Bockting WO. Suicidality among Gender Minority Youth: Analysis of 2017 Youth Risk Behavior Survey Data. Arch Suicide Res 2021; 25:208-223. [PMID: 31642392 PMCID: PMC7176535 DOI: 10.1080/13811118.2019.1678539] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We examined differences in suicidality based on gender identity while adjusting for known suicide risk factors in a sample of United States adolescents. Using data from the 2017 Youth Risk Behavior Survey we used logistic regression models to examine three suicide-related outcomes. Youth were categorized as transgender (1.3%), gender-questioning (1.4%), or cisgender (97.3%). In fully adjusted models, compared to cisgender youth, transgender youth had 2.71 (95% CI 1.50-4.92) higher odds of past-year suicide attempts and 2.54 (95% CI 1.05-6.15) higher odds of past-year suicide attempts requiring treatment. Gender-questioning youth had 2.31 (95% CI 1.48-3.60) higher odds of past-year suicidal ideation compared to cisgender youth. Policies and interventions are needed to reduce suicidality among gender minority youth, improve access to mental healthcare, and reduce peer victimization and substance use.
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Dyar C, Dworkin ER, Pirog S, Kaysen D. Social interaction anxiety and perceived coping efficacy: Mechanisms of the association between minority stress and drinking consequences among sexual minority women. Addict Behav 2021; 114:106718. [PMID: 33131969 DOI: 10.1016/j.addbeh.2020.106718] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 02/07/2023]
Abstract
Sexual minority women (SMW; individuals who identify as women and as lesbian, bisexual, or with another sexual minority identity) are at increased risk for problematic alcohol use compared to their heterosexual counterparts. This increased risk has been attributed to minority stress. However, longitudinal research examining associations between minority stress and alcohol use outcomes is extremely limited and examinations of these associations at the daily level are nearly non-existent. Further, few longitudinal studies have examined mechanisms through which minority stress may impact alcohol use. We utilized data from a 14-day daily diary study of 98 SMW to examine daily-level associations between experiences of minority stress, alcohol consumption and consequences, and two proposed mediators of these associations (perceived coping efficacy, social interaction anxiety). Results indicated that on days when participants experienced minority stress events, they experienced lower coping efficacy, higher social interaction anxiety, and more drinking consequences than usual. Minority stress was not associated with same-day alcohol consumption. Perceived coping efficacy and social interaction anxiety mediated the same-day association between minority stress and drinking consequences. No prospective associations were significant, suggesting that studies with multiple assessments per day may be necessary to detect immediate effects of minority stress. Findings highlight the potential impact of daily experiences of minority stress on alcohol consequences and provide evidence that two general psychological processes may be mechanisms through which minority stress impacts alcohol consequences. These results provide evidence of a need for interventions that teach SMW skills for coping with minority stress and its psychological consequences.
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Prevalence and minority-stress correlates of past 12-month prescription drug misuse in a national sample of transgender and gender nonbinary adults: Results from the U.S. Transgender Survey. Drug Alcohol Depend 2021; 219:108474. [PMID: 33360852 PMCID: PMC7856161 DOI: 10.1016/j.drugalcdep.2020.108474] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Prescription drug (PD) misuse, particularly opioid misuse, is a major US public health concern. While transgender and gender nonbinary (TGNB) individuals experience numerous health disparities, including substance use disparities, little research has focused on PD misuse in this population. METHODS Data for this secondary analysis come from the US Transgender Survey (N = 26,689). First, we examined bivariate differences in past 12-month PD misuse among binary transgender women, binary transgender men, nonbinary individuals assigned-female-at-birth (AFAB), and nonbinary individuals assigned-male-at-birth (AMAB). We then used multivariable logistic regression (separately based on sex-assigned-at-birth) to examine the relationship between gender-identity related discrimination and PD misuse. RESULTS PD misuse was significantly more common among binary transgender men (17.3 %), nonbinary AFAB individuals (18.7 %), and nonbinary AMAB individuals (18.0 %); compared to binary transgender women (13.5 %). In multivariable analyses, nonbinary identity was associated with higher odds of PD misuse among TGNB AFAB individuals (OR = 1.121; 95 %CI 1.021-1.232) and AMAB individuals (OR = 1.315; 95 % CI 1.133-1.527). Controlling for overall health status and psychological distress, public accommodations discrimination was associated with PD misuse among TGNB AMAB individuals (OR = 1.578, 95 %CI 1.354-1.839). Among both groups, healthcare discrimination was associated with PD misuse (AFAB OR = 1.388, 95 %CI 1.255-1.534; AMAB OR = 1.227, 95 %CI 1.073-1.404). CONCLUSION In this national sample of TGNB individuals, nonbinary individuals were at greater risk for PD misuse than binary individuals, possibly due to less societal affirmation. Similar to other TGNB health disparities, discrimination based on gender identity/expression was associated with PD misuse. This highlights the importance of interventions to reduce discrimination against TGNB individuals.
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Buttazzoni A, Tariq U, Thompson-Haile A, Burkhalter R, Cooke M, Minaker L. Adolescent Gender Identity, Sexual Orientation, and Cannabis Use: Potential Mediations by Internalizing Disorder Risk. HEALTH EDUCATION & BEHAVIOR 2021; 48:82-92. [PMID: 33103513 PMCID: PMC7791274 DOI: 10.1177/1090198120965509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIMS Adolescents who identify as nonbinary gender or as not heterosexual report higher levels of mental illness than their counterparts. Cannabis use is a commonly employed strategy to cope with mental illness symptoms among adolescents; however, cannabis use can have many deleterious health consequences for youth. Within the frame of minority stress theory, this study investigates the relationships between gender identity and sexual orientation, internalizing disorder symptoms, and cannabis use among adolescents. METHOD A national cross-sectional survey of a generalizable sample of high school students in Canada from the 2017 wave (N = 15,191) of the Cancer Risk Assessment in Youth Survey was analyzed in spring 2019. Mediation analyses were completed to examine risk of internalizing disorder symptoms as a potential mediator of the association between (1) gender identity and (2) sexual orientation, and cannabis use. RESULTS Indirect effects in all models show significantly higher levels of reported internalizing disorder symptoms for female (OR = 3.44, 95% CI [2.84, 4.18]) and nonbinary gender (OR = 3.75, 95% CI [2.16, 6.51]) compared with male students. Sexual minority adolescents had higher odds of internalizing disorder risk relative to non-sexual minority adolescents (OR = 3.13, 95% CI [2.63, 3.74]). Students who reported higher rates of internalizing disorder symptoms were more likely to have ever used cannabis. Patterns of partial mediation are also present among all groups. DISCUSSION/CONCLUSIONS Findings can be used to better inform mental health interventions for adolescents. Future study should explore specific mental health stressors of vulnerable adolescent groups with respect to cannabis use as a coping mechanism.
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Affiliation(s)
| | - Ulaina Tariq
- University of Waterloo, Waterloo,
Ontario, Canada
| | | | | | - Martin Cooke
- University of Waterloo, Waterloo,
Ontario, Canada
| | - Leia Minaker
- University of Waterloo, Waterloo,
Ontario, Canada
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Goetz TG, Becker JB, Mazure CM. Women, opioid use and addiction. FASEB J 2021; 35:e21303. [PMID: 33433026 DOI: 10.1096/fj.202002125r] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 12/22/2022]
Abstract
In the midst of the current coronavirus pandemic, the United States continues to struggle with an ongoing opioid epidemic, initially fueled by widespread prescribing of opioid medications during the 1990s. The primary reason for prescribing opioids is to treat pain. Women have more acute and chronic pain and have been prescribed these drugs in significantly greater numbers than men. Comparison of women and men with chronic pain also shows that women receive the majority of prescription opioids, and the use of these prescribed medications became the major pathway to misuse and addiction for women. Yet, recognition of the extent of women's exposure to opioids and the attendant consequences has been limited. Attempts to stem the overall tide of the epidemic focused on reducing the availability of prescription opioids. However, as these medications became more difficult to obtain and treatment opportunities were limited, many turned to other synthetic opioids, such as heroin and fentanyl. Thus, the public health crisis of opioid addiction has endured. This paper highlights the importance of understanding differences among women and men in opioid use and its biological and psychosocial effects to advance the gender-based treatment approaches and effective public health policy.
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Affiliation(s)
- Teddy G Goetz
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jill B Becker
- Biopsychology Area Chair, University of Michigan, Ann Arbor, MI, USA
| | - Carolyn M Mazure
- Department of Psychiatry, Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT, USA
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Dyar C, Feinstein BA, Crosby S, Newcomb ME, Whitton SW. Social Context of Cannabis Use: Associations with Problematic Use, Motives for Use, and Protective Behavioral Strategies among Sexual Minorities Assigned Female at Birth. ANNALS OF LGBTQ PUBLIC AND POPULATION HEALTH 2021; 2:299-314. [PMID: 34993507 PMCID: PMC8729452 DOI: 10.1891/lgbtq-2020-0075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Sexual and gender minorities assigned female at birth (SGM-AFAB) are at heightened risk for problematic cannabis use compared to heterosexual cisgender women. Despite evidence that social context influences patterns of substance use, no known studies have examined context of cannabis use among SGM-AFAB. The current study examined two aspects of social contexts of cannabis use (locations and companions) and their associations with problematic use, motives for use, and protective behavioral strategies among SGM-AFAB. We utilized three waves of data from 358 SGM-AFAB from a larger study. We aimed to: (1) identify subgroups of SGM-AFAB based on contexts in which they used cannabis; (2) examine changes in contexts over time; and (3) examine associations between contexts, problematic use, motives for use, and protective behavioral strategies. Using latent class analysis, we identified four classes: those who used cannabis at home; those who used with friends; those who used alone and with friends; and those who used in all contexts. Those who used in all contexts reported more problematic use, higher coping motives, and used fewer protective behavioral strategies compared to other classes. Transitioning to using cannabis in fewer contexts was associated with a subsequent decrease in problematic use. Classes that were most stable over time (using in all contexts or alone and with friends) were also those that were associated with more problematic use. Social context has important implications for problematic cannabis use among SGM-AFAB. As such, interventions may benefit from attending to social context to reduce problematic use in this population.
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Affiliation(s)
- Christina Dyar
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Brian A. Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science
| | - Shariell Crosby
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Michael E. Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
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Mereish EH, Miranda R. A Preliminary Experimental Study of Minority Stress, Startle Reactivity, and Alcohol Use among Heavy Drinking Sexual Minority Young Adults. Subst Use Misuse 2021; 56:162-168. [PMID: 33222602 DOI: 10.1080/10826084.2020.1846197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sexual minorities (e.g. lesbian, gay, bisexual) are at increased risk for alcohol use disorder (AUD) compared to heterosexuals. The minority stress model postulates that disparities in AUD stem, in part, from stress specific to sexual minorities (e.g. heterosexism). However, little research has examined psychophysiological markers of minority stress reactivity and how psychophysiological stress reactivity is associated with lifetime minority stress and alcohol use among sexual minorities. Emotion modulation of the startle response is a well-established paradigm for capturing psychophysiological stress reactivity under controlled laboratory conditions. Purpose: This preliminary study is the first to use the startle experimental paradigm to examine psychophysiological reactivity to stigma among sexual minorities. Procedures: Sexual minority participants (N = 20; 55% female), aged 18 to 27 years (M = 21.80, SD = 2.65), were recruited from the community. We compared startle reactivity in response to three types of stimuli (stigma, negative, and neutral) among heavy drinking sexual minority young adults. Although statistically underpowered, we also explored the associations between startle reactivity and self-reported drinking behaviors and lifetime minority stress. Results: Both stigma and general unpleasant stimuli produced more psychophysiological stress reactivity than neutral stimuli among sexual minorities. Psychophysiological stress reactivity was correlated with greater quantity of drinks reported on drinking days in the past month, but not greater frequency. Additionally, lifetime exposure to minority stress was associated with a blunted reactivity to stigma stimuli. Conclusions: These findings provide methodological advances and important implications for minority stress theory and alcohol use among sexual minorities.
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Affiliation(s)
- Ethan H Mereish
- Department of Health Studies, American University, Washington, DC, USA.,Center for Alcohol and Addiction Studies (CAAS), Brown University, Providence, Rhode Island, USA
| | - Robert Miranda
- Center for Alcohol and Addiction Studies (CAAS), Brown University, Providence, Rhode Island, USA
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Levinson JA, Greenfield PM, Signorelli JC. A Qualitative Analysis of Adolescent Responses to YouTube Videos Portraying Sexual and Gender Minority Experiences: Belonging, Community, and Information Seeking. FRONTIERS IN HUMAN DYNAMICS 2020. [DOI: 10.3389/fhumd.2020.598886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Sexual and gender minority youth are at risk for negative mental health outcomes, such as depression and suicide, due to stigma. Fortunately, sense of community, connection, and social support can ameliorate these deleterious effects. Youth express that most of their social support comes from peers and in-school organizations, but these sources require in-person interaction. Past research has identified social media sites as virtual and anonymous sources of support for these youth, but the role of YouTube specifically in this process has not been thoroughly explored. This study explores YouTube as a possible virtual source of support for sexual and gender minority youth by examining the ecological comments left on YouTube videos. A qualitative thematic analysis of YouTube comments resulted in six common themes in self-identified adolescents' YouTube comments: sharing, relating, information-seeking, gratitude, realization, and validation. Most commonly, adolescents shared feelings and experiences related to their identity, especially when they could relate to the experiences discussed in the videos. These young people also used their comments to ask for identity-related advice or information, treating the platform as a source of education. Results suggest that sexual minority youth's use of YouTube can be advantageous for social support and community, identity-related information, identity development, and overall well-being.
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Gambadauro P, Carli V, Wasserman D, Balazs J, Sarchiapone M, Hadlaczky G. Serious and persistent suicidality among European sexual minority youth. PLoS One 2020; 15:e0240840. [PMID: 33064760 PMCID: PMC7567377 DOI: 10.1371/journal.pone.0240840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/02/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Suicide is a leading cause of death among adolescents and more knowledge from high risk groups is needed in order to develop effective preventive strategies. The aim of this study was to evaluate the association between sexual minority status and suicidality in a multinational sample of European school pupils. METHODS A self-report questionnaire was delivered to 2046 adolescents (mean age 15.34±1.01; 56.3% females) recruited from 27 randomly selected schools in 6 European countries. Suicidal ideation, measured with the Paykel Suicide Scale (PSS), and lifetime suicide attempts were compared between heterosexual and sexual minority (i.e. those with a non-heterosexual orientation) youth. Poisson regression analyses studied the longitudinal association between sexual minority status and the rate of serious suicidal ideation, measured at three time-points during a 4-month period. Several variables, including alcohol and illegal drugs use, bullying, family interaction, school-related stress, economic status, and religiosity, were included in multivariable analysis. Sex-stratified analyses evaluated the association respectively among females and males. RESULTS Of 1958 pupils included in analysis (mean age 15.35±1.00; females 56.8%), 214 (10.9%) were categorized as sexual minority youth (SMY). When compared to heterosexual youth (HSY), SMY were significantly more exposed to substance abuse, bullying, school-related stress, and lower economic status. SMY pupils had significantly higher suicidal ideation scores (p<0.001; r 0.145) as well as higher prevalence of serious suicidal ideation (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.83-3.79) and previous suicide attempts (OR 2.72, 95%CI 1.77-4.18), compared to their HSY peers. The rate of serious suicidal ideation reports during the study was significantly higher among SMY compared to HSY (rate ratio [RR] 2.55, 95%CI 1.90-3.43). A significant difference was found even when controlling for the pupils' country as well as after adjustment for alcohol and illegal drugs use, bullying, family interaction, school-related stress, economic status, and religiosity (adjusted RR 1.73, 95%CI 1.23-2.48). Stratified analyses showed significant associations between SMY status and persistent serious suicidal ideation for both sexes, with a notably strong association among male pupils (females aRR 1.51, 95%CI 1.01-2.24; males aRR 3.84, 95%CI 1.94-7.59). CONCLUSIONS European sexual minority youth are a high-risk group for suicidality, independently from objective factors such as victimization or substance abuse. There is a need to develop primary and secondary preventive measures for sexual minority youth, including the management of context vulnerabilities and related distal stressors, before the establishment of proximal stressors. Context-targeting interventions may effectively focus on social and economic factors, as well as on the potentially different risk profile of female and male sexual minority youth.
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Affiliation(s)
- Pietro Gambadauro
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Res Medica Sweden, Uppsala, Sweden
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Judit Balazs
- Eötvös Loránd University, Institute of Psychology, Budapest, Hungary
- Bjørknes University College, Oslo, Norway
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Gergö Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
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