Sexual assault, drinking norms, and drinking behavior among a national sample of lesbian and bisexual women

The association between alcohol use and sexual assault victimization among college students differs by gender identity and race

PURPOSE

Alcohol use and sexual assault (SA) are common on college campuses. The purpose of this study is to examine if the association between alcohol use and SA differs by gender identity, sexual orientation, race, or ethnicity.

METHODS

A total of 3,243 college students aged 18-25 at two large, minority-serving, public universities in the southwest and southeast United States completed an online survey about alcohol and sexual behaviors. Two negative binomial regressions were conducted to examine main effects and interaction effects.

RESULTS

Almost half of the sample reported a SA victimization history. The main effects negative binomial regression indicated that more drinks per week, older age, identifying as a cisgender woman (vs. cisgender man), identifying as a gender minority (vs. cisgender man), and identifying as a sexual minority (vs. heterosexual) were associated with more severe SA victimization. Participants who identified as Latine (vs. non-Latine White) reported less severe SA. The negative binomial regression assessing interactions indicated that the association between alcohol use and SA severity was stronger among cisgender women and gender minority identities than cisgender men, and Black identities than non-Latine White identities.

CONCLUSION

Findings suggests that alcohol use is an important factor for SA severity among all students, but that the association is stronger among some with marginalized identities. Given that perpetrators target people who hold some marginalized identities, prevention programming could address cisnormative, heteronormative, and White normative ideas about alcohol and sex to attain social justice and health equity.

Health Outcomes of Sexual Minority Women Who Have Experienced Adverse Childhood Experiences: A Scoping Review

Sexual minority women (SMW; e.g., lesbian, bisexual) report higher rates of almost every negative physical health (e.g., asthma, arthritis, cardiovascular disease), mental health (e.g., depression, anxiety), and substance use outcome compared to heterosexual women. Adverse Childhood Experiences (ACEs) have been identified as risk factors for negative health outcomes. Despite this, no study to date has synthesized existing literature examining ACEs and health outcomes among SMW. This gap is important because SMW are significantly more likely than heterosexual women to report every type of ACE and a higher total number of ACEs. Therefore, using a scoping review methodology, we sought to expand understanding of the relationship between ACEs and health outcomes among SMW. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for. Scoping Reviews protocol, we searched five databases: Web of Science, PsycInfo, CINAHL, PubMed, and Embase for studies published between January 2000 and June 2021 that examined mental health, physical health, and/or substance use risk factors and outcomes among adult cisgender SMW who report ACEs. Our search yielded 840 unique results. Studies were screened independently by two authors to determine eligibility, and 42 met full inclusion criteria. Our findings provide strong evidence that ACEs are an important risk factor for multiple negative mental health and substance use outcomes among SMW. However, findings were mixed with respect to some health risk behaviors and physical health outcomes among SMW, highlighting the need for future research to clarify these relationships.

Associations among sexual assault, posttraumatic stress, drinking to cope with anxiety, and alcohol use based on gender identity and sexual orientation

BACKGROUND

Sexual assault (SA) is experienced by a substantial proportion of emerging adult college students and is associated with elevated rates of posttraumatic stress disorder (PTSD) and alcohol use. This study examines the mediating role of posttraumatic stress symptoms (PTSS) in the associations among SA severity, drinking to cope with anxiety, and average weekly drinks while considering the moderating roles of gender identity and sexual orientation.

METHODS

A total of 2160 college students who were diverse in gender (cisgender women, 64.4%; cisgender men, 30.6%, and transgender and gender diverse [TGD] individuals = 4.9%) and sexual orientation (heterosexual = 68.0%, LGBQ+ = 32.0%) completed measures of SA severity, PTSS, drinking to cope with anxiety motives, and average weekly drinks.

RESULTS

The mediation model for the full sample indicated significant indirect effects of SA severity on drinking to cope with anxiety through PTSS, but not on average weekly drinks. Moderation analyses revealed differential relationships between the variables based on both gender identity and sexual orientation. For instance, the association between SA severity and PTSS was stronger for cisgender women and TGD individuals than cisgender men, and for LGBQ+ individuals than heterosexual individuals. While the association between PTSS and average weekly drinks was only significant for cisgender men, the association between PTSS and drinking to cope with anxiety was significant for both cisgender men and women but not TGD individuals. Furthermore, the association between SA severity and drinking to cope with anxiety was stronger for cisgender women than cisgender men.

CONCLUSIONS

Findings from this study demonstrate sexual orientation and gender identity differences and similarities in the associations of SA severity, PTSS, drinking to cope with anxiety, and alcohol use. Results are discussed in relation to the self-medication hypothesis and tailoring interventions for diverse groups.

Just One Shot? The Contextual Effects of Matched and Unmatched Intoxication on Perceptions of Consent in Ambiguous Alcohol-fueled Sexual Encounters

The current research examined how contextual factors-the quantity of alcohol consumed by each partner, and whether this quantity matched-influenced how alcohol-fueled sexual encounters were perceived with regard to consent, coercion, sexual assault, and perceived responsibility of the focal partner for the outcome of the encounter. Across four studies (Ntotal = 535), participants read vignettes in which one person described a sexual encounter they had following a night out drinking. These scenarios differed within studies as a function of quantified alcohol consumed (1 shot; 15 shots) and whether both people in the vignettes consumed the same amount of alcohol (matched; unmatched). They also differed between studies as a function of whether the couples described were mixed gender or same gender. Across all four studies, scenarios in which both people in the scenario consumed different quantities of alcohol (i.e., 15 vs. 1 shot) were seen as less consensual, more coercive, and more likely to be an assault compared to scenarios where consumption was matched, especially at lower levels of intoxication (i.e., 1 shot each vs. 15 shots each). However, focal partners were also seen as less responsible for the outcome of the interaction when levels of intoxication were unmatched compared to matched. This pattern replicated across scenarios depicting same-gender and mixed-gender couples. These findings suggest that people prioritize information regarding whether sexual partners are "matched" or "unmatched" in terms of their intoxication when evaluating whether ambiguous sexual encounters are consensual and perceived individual responsibility.

Mental health and substance use among sexual minority women who report childhood sexual abuse: A systematic literature review

OBJECTIVE

A growing body of literature provides evidence that sexual minority women (SMW; e.g., lesbian, bisexual) are at greater risk of negative mental health and substance use outcomes than are heterosexual women. While minority stress may partially explain these disparities, it does not fully account for them. Therefore, it is necessary to identify how other risk factors (i.e., childhood sexual abuse [CSA]) contribute to SMW's increased risk of negative mental health and substance use outcomes.

METHOD

We conducted a systematic literature review to identify and synthesize the state of knowledge about CSA and mental health and substance use outcomes among SMW. Two independent reviewers screened 347 articles identified in searches of five databases (Web of Science, PsycInfo, CINAHL, PubMed, and Embase). Eligible articles were peer-reviewed, reported quantitative or mixed methods results focused on mental health or substance use outcomes among adult SMW with a history of CSA.

RESULTS

Twenty-four papers were included in the review. Findings clearly show that SMW report higher rates of CSA than heterosexual women. Findings also suggest that CSA may mediate the relationship between minority sexual identity and some negative outcomes.

CONCLUSIONS

Future studies should include minority stress factors, a broader range of mental health outcomes (apart from substance use and suicide), and more nuanced measures of CSA. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Social Support as a Buffer of the Association between Sexual Assault and Trauma Symptoms Among Transgender and Gender Diverse Individuals

The prevalence of experiencing sexual assault is alarmingly high among Transgender and Gender Diverse people (TGD; people whose gender identities and/or expressions are not traditionally associated with their sex assigned at birth) and is associated with various mental health sequalae. Perceived social support has been shown to abate the negative outcomes of sexual assault among cisgender individuals, yet little is known about this association among TGD people, especially which provider of support (i.e., family, friends, or significant others) may be most beneficial. To that end, 191 TGD adults were recruited through Amazon's Mechanical Turk to examine perceived social support as a potential moderator of the association between sexual assault victimization and post-sexual assault trauma symptomology. Results showed an interaction trending toward significance between sexual assault and support from a significant other. Decomposition of this interaction demonstrated that sexual assault was associated with post-assault trauma symptoms when support from a significant other was low (ß = .25, p < .05) but not high (ß = .10, p = .089). The interaction between sexual assault and perceived social support was not significant for perceived support from friends (p = .133) or family (p = .954). Findings highlight the need for additional research on perceived social support as a potential buffering mechanism between sexual assault and post-assault symptomology in TGD people.

Does Alcohol Consumption Influence People's Perceptions of Their Own and a Drinking Partner's Ability to Consent to Sexual Behavior in a Non-sexualized Drinking Context?

The purpose of this study was to examine the extent that alcohol consumption affected participants' perceptions of their own and their friend's ability to consent to sex in a non-bar drinking environment. We interviewed 176 people at tailgates in dyads about their own and their friends' alcohol consumption, intoxication symptoms, and ability to consent. Participants reported consuming a mean of 4.6 drinks and had a breath alcohol concentration (BrAC) of .075 on average, but few thought they or their friend had diminished cognitive function. Accordingly, 92.6% indicated they could consent to sex and 81.8% indicated their friend could consent to sex. Number of drinks people reported consuming, self-reported intoxication levels and symptoms, and BrACs were not significantly related to participants' perceptions of their own or their friends' ability to consent to sex. However, gender pairing of the dyad was significant; those in man-man pairs were more likely than those in woman-woman pairs to indicate their friend could consent and they would allow their friend to have sex if approached by an interested party. Participants also indicated that they did not perceive themselves or their friends to be "too intoxicated" as common reasons why they believed they and their friend could consent. Because alcohol-facilitated sexual assault is common among college students, we recommend sexual assault prevention educators focus on raising awareness regarding alcohol's negative cognitive effects, particularly related to consent communication.

Epidemiology of opioid use in pregnancy

The world has been experiencing an opioid epidemic for over 20 years, and rates of use and overdose among women, including during pregnancy, have risen markedly. Women receive more prescriptions for opioids compared to men. Data suggest that 20% of women filled at least one prescription for an opioid during their pregnancy, and the prevalence of prenatal exposure averaged 14%. Opioid use by women, especially during pregnancy and while breastfeeding, and management and treatment is complex for healthcare providers, especially related to methadone treatment, pain management during labour, neonatal opioid withdrawal syndrome, nutritional issues and maternal withdrawal. Opioid use during pregnancy has been associated with maternal, foetal and infant complications, and overdose has become a leading cause of death in post-partum women in some countries. Universal screening for opioid use disorder (OUD) is recommended in pregnancy, and prevention and treatment programs that meet the specific needs of women are important to understand and consider as the world continues to try to anticipate and respond to the realities of the opioid epidemic.

An Inherently Masculine Practice: Understanding the Sexual Victimization of Queer Women

Sexual violence is a widespread social issue, and sexual victimization is especially prevalent among queer-identified women. Still, there is little research on queer women's experiences of sexual violence or explanations for the high rate of victimization. This study uses data from 40 open-ended interviews to investigate queer women's experiences with sexual violence and those who perpetrate it. Respondents answered questions about the characteristics of their sexual assaults and perpetrators, as well as connections the survivors perceive between their sexual assaults and sexual identities. Findings indicate that the perpetrators of such sexual assaults invoke an expression of masculinity, regardless of the perpetrator's gender identity at the time of violence. To understand the nuanced role of masculinity in queer assailant's assaults, we develop the concept of "righteous masculinity," which refers to a traditional (and, in this case, violent) masculinity invoked by marginalized people in an attempt to reclaim power. We find that sexual violence against queer women is an especially powerful way to enact masculinity through drawing upon misogyny and homophobia simultaneously, providing an explanation for the high rates of sexual victimization among queer women. We argue that centering masculinity can help scholars and activists better challenge the sexual victimization of queer women and deepen understanding of the links between gender-based violence and masculinity.

Physical and Sexual Victimization Class Membership and Alcohol Misuse and Consequences among Sexual Minority and Heterosexual Female Youth

OBJECTIVE

Evidence demonstrates sexual orientation disparities in physical and sexual victimization and alcohol misuse and consequences among female youth; however, most extant research has used variable-centered approaches. The current study used latent class analysis (LCA), a person-centered approach, to: (1) model female youths' physical and sexual victimization; (2) examine sexual orientation disparities in physical and sexual victimization latent class membership; (3) and use physical and sexual victimization latent class membership to predict female youths' engagement in alcohol misuse and related consequences.

METHOD

Participants were 7,185 youth assigned female sex at birth (77.0% heterosexual, 12.8% bisexual, 2.3% gay or lesbian; 46.8% racial minority) in grades 9 - 12 who completed the 2017 Youth Risk Behavior Survey - a school-based, cross-sectional survey.

RESULTS

LCA uncovered four classes: (1) "Poly-Victimization Class," (2) "No Victimization Class," (3) "Past-Year Sexual Victimization Class," and (4) "Lifetime Rape Class." Sexual orientation emerged as a significant predictor of class membership. Latent classes 3 and 4 were uniquely associated with alcohol misuse and consequences (i.e., binge drinking, riding with a drinking driver, and drinking and driving) among female youth.

CONCLUSIONS

Our findings help to elucidate the patterns of physical and sexual victimization regarding timeline, tactic used, and context among female youth; sexual orientation disparities in latent class membership; and alcohol misuse correlates of class membership. Prevention efforts aimed at reducing physical and sexual victimization may ultimately reduce female youths' risk of binge drinking, riding with drinking drivers, and drinking and driving.

Rape Acknowledgment and Sexual Minority Women's Mental Health and Drinking Behaviors

Adult sexual assault (ASA) has been linked to numerous negative psychological and behavioral outcomes. Recent research suggests that postassault adaptation may differ based on how the victim conceptualizes their ASA. For instance, women who label their rape experiences as such (i.e., acknowledged rape victims) report worse mental health symptoms than women who do not (i.e., unacknowledged rape victims). To date, this literature has focused exclusively on heterosexual women. Relative to heterosexuals, sexual minority women (SMW) are at greater risk for sexual assault and report worse postassault outcomes, yet little is known about rape acknowledgment in this at-risk population. Moreover, it is unclear how distal factors, such as childhood sexual abuse (CSA), may influence SMW's rape acknowledgment following ASA. A total of 205 self-identified lesbian and bisexual women were categorized into four groups (no ASA, ASA that did not involve rape, rape acknowledged, rape unacknowledged) and compared across mental health and drinking outcomes. Roughly, 42% of the sample experienced rape, and of those, 60% were acknowledged rape victims. Results revealed no statistical differences between acknowledged and unacknowledged rape victims in terms of mental health or alcohol use. However, relative to comparison groups, SMW who were acknowledged rape victims reported greater mental health symptoms, and both acknowledged and unacknowledged rape victims reported greater hazardous drinking. Among SMW with rape histories, greater CSA severity increased the probability of acknowledging rape. These findings provide valuable information regarding SMW's postassault adaptation and can contribute to interventions to assist SMW who experience sexual assault.

Intersections between Young Women's Racial/Ethnic Identities and Sexual Orientation on Rates of Sexual Violence and Substance Use

Background

Little is known about whether there are differences in rates of sexual violence and its association with substance use based on women's identities, specifically the intersection of their race/ethnicity and sexual orientation.

Method

Women (N = 546; 18 to 29 years of age) recruited from a reproductive healthcare clinic reported their race, ethnicity, sexual orientation, sexual violence history and substance use. Five logistic regressions examined (a) rates of sexual violence, and (b) the strength of the associations between sexual violence and four substance use outcomes (heavy alcohol use, marijuana use, cigarette use, number of cigarettes used) based on sexual orientation. Subsequent logistic regressions examined race/ethnicity as a moderator of the associations between sexual orientation and (a) rates of sexual violence and (b) substance use.

Results

Most women surveyed were heterosexual (64%), and 35% of all women reported unwanted sex. Sexual minority women (SMW) reported higher rates of sexual violence and substance use than heterosexual women. Sexual violence was more strongly associated with heavy alcohol use, but not with marijuana or cigarette use, for SMW than heterosexual women. Rates of sexual violence varied based on the intersection of sexual orientation and race/ethnicity. Although SMW were more likely to report sexual violence than heterosexual women, this association was weaker for Black/Latinx women than for non-Hispanic White women (aOR = 0.39, 95%CI [0.18, 0.82]). Race/ethnicity did not moderate the strength of associations between sexual violence and substance use.

Conclusions

SMW exhibit increased risk for sexual violence and substance use, and victimization was associated with heavy alcohol use. Few racial/ethnic differences emerged as a function of sexual orientation, so SMW are a group with unique needs around sexual violence experiences and substance use, regardless of race/ethnicity. Healthcare providers should be aware of the link between substance use and prior victimization when treating SMW.

Young Bisexual People's Experiences of Sexual Violence: A Mixed-Methods Study

Bisexual people are at an increased vulnerability for sexual victimization in comparison to heterosexual people, as well as gay and lesbian people. As the majority of first sexual violence experiences happen prior to age 25 for bisexual women, young bisexual people are particularly vulnerable. Despite consistent evidence of this health disparity, little is known about what factors might increase young bisexual people's risk for sexual victimization, or how they access support post-victimization. The current study addresses this gap through a mixed-method investigation of young bisexual people's experiences of sexual violence with a sample of 245 bisexual people age 18-25. Quantitative results indicate that bisexual stigma significantly predicts a greater likelihood of reporting an experience of sexual violence. Qualitative findings support that while not all participants felt bisexual stigma related to their experience of sexual violence, some felt negative bisexual stereotypes were substantial factors. Interview participants found connecting with other survivors, particularly LGBTQ+ and bisexual survivors, to be beneficial. Some participants encountered barriers to accessing support, such as discrimination in schools. Sexual violence researchers should consider bisexual stigma as an important factor, and support services the potential positive impact of bisexual-specific survivor support.

A transdiagnostic minority stress intervention for gender diverse sexual minority women's depression, anxiety, and unhealthy alcohol use: A randomized controlled trial

OBJECTIVE

To remedy the notable gap in evidence-based treatments for sexual minority women, this study tested the efficacy of a minority-stress-focused cognitive-behavioral treatment intended to improve this population's mental and behavioral health.

METHOD

The intervention, EQuIP (Empowering Queer Identities in Psychotherapy), was adapted from a transdiagnostic cognitive-behavioral treatment as also recently adapted for sexual minority men. Sexual minority women at risk of mental and behavioral health problems (n = 19) and expert providers with this population (n = 12) shaped the treatment's development, including by supporting its primary focus on universal and minority-stress-focused processes underlying this population's disproportionately poor mental and behavioral health. The resulting treatment was then delivered to young adult sexual minority women (n = 60; M age = 25.58; 41.67% racial/ethnic minority; 43.33% transgender/nonbinary) experiencing depression/anxiety and past 90-day heavy alcohol use.

RESULTS

Compared to waitlist (n = 30), participants randomized to immediately receive EQuIP (n = 30) experienced significantly reduced depression and anxiety (d = 0.85, 0.86, respectively); effects for alcohol use problems were smaller (d = 0.29) and marginally significant. In pre- to post-intervention pooled analyses, effect sizes for minority stress processes (mean d = .25) and universal risk factors (mean d = .48), through which the treatment was expected to work, were small and moderate, respectively, and in the expected direction.

CONCLUSIONS

This study provides initial support for a minority-stress-focused transdiagnostic cognitive-behavioral treatment for sexual minority women. These first results can launch exploration of other mechanisms and modalities through which to equip this population with evidence-based support. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

"I never told anyone until the #metoo movement": What can we learn from sexual abuse and sexual assault disclosures made through social media?

BACKGROUND

Social media is providing new avenues for survivors to disclose sexual abuse and/or assault. Since the creation of #MeToo (2017), and the larger MeToo movement founded by American activist Tarana Burke in 2006, millions are disclosing sexual assaults and past childhood sexual abuse on-line.

OBJECTIVE

Social media for disclosing the highly stigmatized problem of sexual abuse/assault was studied to build knowledge about on-line disclosures.

PARTICIPANTS AND SETTING

Participants were tweeters and posters on Twitter and Reddit. Purposive sampling captured on-line sexual abuse/assault disclosures from September 28, 2018 to October 16, 2018 for thematic analysis.

METHOD

Using a phenomenological design 171 social media posts were analyzed for deeper understanding into new options for disclosing sexual abuse and/or sexual assault. Posts were independently coded by the authors. Sampling was stopped when categorical saturation was reached with no new information coming forward on the research question.

RESULTS

Themes that emerged showed the MeToo/#MeToo movement is precipitating sexual abuse/assault disclosures on social media in unprecedented ways; posters identified internal barriers, mixed responses from family, and friends/peers, as well as variable responses from professionals. While some conditions for sexual abuse/assault disclosures have improved, barriers still exist.

CONCLUSION

Social media represents an environmental shift for disclosing sexual violence. Sexual abuse/assault survivors have found voice through social media after periods of silence and being silenced, turning to posting on-line when people and systems have failed to validate and support them. Further investigation is needed on the impacts of on-line sexual abuse and/or assault disclosures.

An Exploration of Sexual Assault Survivors' Discourse Online on Help-Seeking

Although sexual assault is associated with significant negative psychological health outcomes, few survivors seek support from formal providers. This study explored the barriers to accessing and benefitting from services for sexual assault, as disclosed in narrative posts on social media, using qualitative methodology. Of the 1,179 narratives posted to the subreddit'r/rapecounseling' that were reviewed, 81 data extracts from 52 women were included in this study based on predefined inclusion/exclusion criteria. Six themes were identified that prevented survivors from accessing or benefitting from help. Internal barriers included feeling overwhelmed and avoidance-based coping. External barriers included availability of services, suitability of services, and therapist-caused harms. Stigma was the only barrier that was experienced both internally and externally. These findings suggest a need for more supportive mental health services.

Bisexual Stigma, Sexual Violence, and Sexual Health Among Bisexual and Other Plurisexual Women: A Cross-Sectional Survey Study

Bisexual women experience higher rates of sexual victimization relative to heterosexual and lesbian women, and worse sexual health outcomes. Though these health disparities are well documented in the literature, few empirical data have been published on what factors are driving these disparities. Further, research documenting sexual victimization and health of plurisexual (i.e., attracted to more than one gender) women group all participants as bisexual. We do not know whether these experiences are similar across subgroups of plurisexual women. The current study reports on data from a cross-sectional survey, analyzing the relationships between bisexual-specific stigma and sexual violence, as well as other sexual health outcomes, across a sexually diverse group of plurisexual participants. Findings indicate that bisexual stigma is a significant predictor of lifetime sexual violence (odds ratio [OR] = 1.99, p = .015) and verbal coercion (OR = 2.60, p = .004), but not other outcomes. There are differences across sexual identity categories, with bisexual participants being less likely to report sexual violence and verbal coercion, and less likely to access sexually transmitted infection/human immunodeficiency syndrome testing, compared to other plurisexual groups. Our findings support that bisexual stigma is an important factor to consider in understanding sexual violence disparities experienced by bisexual and other plurisexual women.

Bisexual Women's Reports of Descriptive Drinking Norms for Heterosexual, Bisexual, and Lesbian Women

Bisexual women drink more than lesbian and heterosexual women. However, few studies have examined factors that influence drinking among bisexual women. Although descriptive drinking norms are strong predictors of drinking, little research has examined how drinking norms influence alcohol use for bisexual women. The present study examined bisexual women's reports of descriptive drinking norms for bisexual, lesbian, and heterosexual women, and associations with their own frequency of alcohol consumption, quantity, binge drinking, and hazardous alcohol use. Participants were 179 self-identified bisexual women between 18 and 30 years old who reported past 30-day drinking. Participants perceived more frequent alcohol use for bisexual and heterosexual women as compared to lesbian women. Further, participants perceived higher alcohol quantity for heterosexual as compared to lesbian women, but norms for alcohol quantity did not differ between bisexual women and other groups. Descriptive drinking norms about bisexual women were positively related to participants' frequency of alcohol consumption, binge drinking, and hazardous alcohol use. In contrast, descriptive drinking norms about heterosexual women were negatively associated with participants' binge drinking and hazardous alcohol use. Findings document the importance of assessing drinking norms separately for bisexual, lesbian, and heterosexual women. Alcohol interventions that include information about drinking norms for bisexual women specifically may be more effective at reducing hazardous drinking.

Lifetime Trauma and Cardiometabolic Risk in Sexual Minority Women

Background: Sexual minority women (SMW; such as lesbian, bisexual, and mostly lesbian) exhibit excess cardiometabolic risk, yet factors that contribute to cardiometabolic risk in this population are poorly understood. Trauma exposure has been posited as a contributor to cardiometabolic risk in SMW. Materials and Methods: An analysis of data from Wave 3 of the Chicago Health and Life Experiences of Women Study was conducted. Multinomial logistic regression was used to examine correlates of trauma. Next, multiple logistic regression was used to examine the associations of different forms of trauma throughout the life course (childhood, adulthood, and lifetime), with psychosocial and behavioral risk factors and self-reported cardiometabolic risk (obesity, hypertension, and diabetes) in SMW adjusted for relevant covariates. Results: A total of 547 participants were included. Older age was associated with higher rates of childhood and adulthood trauma. SMW of color reported higher rates of childhood trauma than white participants. Higher education was associated with lower rates of adulthood trauma. All forms of trauma were associated with probable diagnosis of post-traumatic stress disorder and lower perceived social support. Adult trauma was associated with anxiety, whereas childhood and lifetime trauma were associated with higher odds of depression. No significant associations between forms of trauma and behavioral risk factors were noted, except that childhood trauma was associated with higher odds of past-3-month overeating. Logistic regression models examining the association of trauma and cardiometabolic risk revealed that childhood trauma was an independent risk factor for diabetes. Adulthood and lifetime trauma were significantly associated with obesity and hypertension. Conclusions: Trauma emerged as an independent risk factor for cardiometabolic risk in SMW. These findings suggest that clinicians should screen for trauma as a cardiovascular risk factor in SMW, with special attention to SMW most at risk.

Adverse Childhood Experiences and the Presence of Cancer Risk Factors in Adulthood: A Scoping Review of the Literature From 2005 to 2015

Exposure to Adverse Childhood Experiences (ACEs) is associated with a host of harmful outcomes, including increased risk for cancer. A scoping review was conducted to gain a better understanding of how ACEs have been studied in association with risk factors for cancer. This review includes 155 quantitative, peer-reviewed articles published between 2005 and 2015 that examined associations between ACEs and modifiable cancer risk factors, including alcohol, environmental carcinogens, chronic inflammation, sex hormones, immunosuppression, infectious agents, obesity, radiation, ultraviolet (UV) radiation, and tobacco, among U.S. adults. This review highlights the growing body of research connecting ACEs to cancer risk factors, particularly alcohol, obesity, and tobacco. Fewer studies investigated the links between ACEs and chronic inflammation or infectious agents. No included publications investigated associations between ACEs and environmental carcinogens, hormones, immunosuppression, radiation, or ultraviolet radiation. Mitigating the impact of ACEs may provide innovative ways to effect comprehensive, upstream cancer prevention.

Risk and Protective Factors for Substance Use among Sexual and Gender Minority Youth: A Scoping Review

Purpose of Review

Alcohol and drug use are common among youth. Rates are especially high among sexual and gender minority youth (SGMY; lesbian, gay, bisexual, transgender). We conducted a scoping review of research on risk and protective factors for substance use among SGMY published between 2013-2017.

Recent Findings

Ninety-seven studies met our inclusion criteria. Most focused on individual-level minority stress risk factors, particularly stigma. Fewer studies addressed protective factors such as social support or affirming policies, and few focused on gender minority youth (GMY). We identified important, yet understudied differences by race/ethnicity, sex assigned at birth, and sexual orientation.

Summary

Findings highlight growing interest in this topic as well as methodological/topical gaps in the literature. Research is needed to examine SGMY substance use in nationally representative samples; expand information about GMY; investigate racial/ethnic and sex/gender differences; improve measurement; and increase translation of findings to support prevention and treatment interventions for this at-risk population.

Effects of sexual assault on alcohol use and consequences among young adult sexual minority women

OBJECTIVE

The purpose of this study was to examine effects of sexual assault victimization on later typical alcohol use and alcohol-related consequences among young sexual minority women (SMW).

METHOD

Data were collected over 4 annual assessments from a national sample of 1,057 women who identified as lesbian or bisexual and were 18- to 25-years-old at baseline. Marginal structural modeling, an analytic approach that accounts for time-varying confounding through the use of inverse probability weighting, was used to examine effects of sexual assault and its severity (none, moderate, severe) on typical weekly number of drinks consumed and number of alcohol-related consequences 1-year later as well as 2-year cumulative sexual assault severity on alcohol outcomes at 36-month follow-up.

RESULTS

Findings showed that compared with not experiencing any sexual assault, severe sexual assault at the prior assessment was associated with a 71% higher number of typical weekly drinks (count ratio [CR] = 1.71; 95% confidence interval [CI] [1.27, 2.31]) and 63% higher number of alcohol-related consequences (CR = 1.63; 95% CI [1.21, 2.20]). Effects were attenuated when comparing moderate to no sexual assault; however, the linear trend across sexual assault categories was statistically significant for both outcomes. There were also effects of cumulative levels of sexual assault severity over 2 years on increased typical drinking and alcohol-related consequences at end of follow-up.

CONCLUSIONS

Sexual assault may be an important cause of alcohol misuse among SMW. These findings further highlight the need for strategies to reduce the risk of sexual assault among SMW. (PsycINFO Database Record

Family Risk Factors Among Women With Addiction-Related Problems: An Integrative Review

CONTEXT

Recent years have produced many articles about women's addiction and its risk factors and the consequences of substance use and misuse in the emotional, social, psychological, and economic domains of life. Family vulnerabilities are one of the most important variables contributing to addiction among women. Thus, the purpose of this article is to investigate areas of family life that lead to women's taking up and maintaining drug and alcohol abuse.

EVIDENCE ACQUISITION

A database search of PubMed, ScienceDirect, Springer, and Google Scholar was conducted using the following keywords: "women and addiction", "women addiction and family", "addiction", "substance abuse" and "family". For the first step, we chose studies that were conducted between 2000 and 2015, and for the second step, studies conducted before 2000. We categorized all search results into three main groups: processes related to family disturbances, factors related to parenting styles, and variables related to partners.

RESULTS

Partners, parenting styles, and family disturbances are three main factors affecting children growing up in a family and their inclination toward addiction. Some of these pathways are complicated and indirect, and some are straightforward.

CONCLUSIONS

Future research should pay more attention to the mechanisms and pathways mediating or moderating the relationship between family risk factors and addiction in women. Clinicians and researchers should keep in mind these vulnerabilities and take into consideration factors special to processes related to addiction in women.

Addressing gaps on risk and resilience factors for alcohol use outcomes in sexual and gender minority populations

ISSUES

In 2011, the Institute of Medicine released a report that constituted the first comprehensive effort by a federal body to understand the current state of science pertinent to the health needs of sexual and gender minority populations. This mini-review summarises recent empirical, methodological and theoretical advances in alcohol-related research among to lesbian, gay, bisexual and transgender (LGBT) populations and highlights progress towards addressing gaps, with a particular interest in those identified by the Institute of Medicine report.

APPROACH

Articles published since 2011 were identified from PsycINFO and PubMed database searches, using various combinations of keyword identifiers (alcohol, alcohol abuse, substance abuse, LGBT, lesbian, gay, bisexual, transgender). Reference sections of included articles were also examined for additional citations.

KEY FINDINGS

Recent empirical work has contributed to a greater understanding of sub-group differences within this diverse population. Evidence has supported theorised influences that can account for alcohol-related disparities, yet important gaps remain. Studies that examine the role of gender identity and its intersection with sexual identity within transgender and gender non-conforming sub-populations are lacking. Methodological advances in this literature have begun to allow for examinations of how minority-specific and general risk factors of alcohol misuse may contribute to patterns of alcohol involvement over time and within social-relational contexts

CONCLUSIONS

The recommendations made in the current mini-review are meant to facilitate future collaborative efforts, scale development, thoughtful methodological design and analysis and theoretically driven nuanced hypotheses to better understand, and ultimately address, alcohol-related disparities among sexual and gender minority populations. [Talley AE, Gilbert PA, Mitchell J, Goldbach J, Marshall BDL, Kaysen D. Addressing gaps on risk and resilience factors for alcohol use outcomes in sexual and gender minority populations. Drug Alcohol Rev 2016;35:484-493].

Do lesbians overestimate alcohol use norms? Exploring the potential utility of personalized normative feedback interventions to reduce high-risk drinking in Southern California lesbian communities

This study examines the potential utility of social norms-based approaches to reduce heavy alcohol use in lesbian community settings. In a sample of 278 Southern Californian lesbians recruited from social media networks to complete an online survey, the majority of participants overestimated the quantity of alcohol consumed by their lesbian peers and more frequent lesbian bar attendance was associated with elevated perceptions of how much other lesbians drink. Greater than 90% of participants expressed interest in receiving personalized normative feedback, suggesting that culturally tailored personalized normative feedback interventions focused on correcting perceptions of heavy drinking may be successful in mitigating the alcohol-related risks of lesbians in Southern California, and potentially beyond.

The role of social drinking factors in the relationship between incapacitated sexual assault and drinking before sexual activity

White House Council on Women and Girls (2014) highlighted sexual assault prevention as a high priority issue in need of immediate attention. A risk factor associated with sexual assault victimization and revictimization is drinking before sexual activity. The current study examined the relationship between incapacitated sexual assault (ISA) and drinking before sexual activity. Given the typical social context of both drinking before sexual activity and sexual assault in college settings, social-related drinking factors including drinking to conform motives, social drinking motives, and perceived drinking norms were examined. Six hundred and three undergraduate college women completed a survey online assessing history of ISA, social factors associated with drinking, and frequency of drinking before sexual activity. Path analysis indicated that both ISA before college and since entering college were associated with higher perceived drinking norms, more social drinking motive endorsement, and more drinking to conform. However, only higher perceived drinking norms and more social drinking motive endorsement were associated with both more severe ISA histories and more frequent drinking before sexual activity. Thus, a more severe ISA history was indeed associated with more frequent drinking before sexual activity and social factors related to drinking played a significant role in this relationship. Social factors can be easily targeted through brief interventions and these findings can inform future programming to promote more careful use of alcohol in social and sexual situations.

Mental health consequences of violence against women and girls

PURPOSE OF REVIEW

Recent studies on mental health consequences of violence against women and girls were reviewed in a range of situations.

RECENT FINDINGS

Although several studies continued to show cross-sectional associations between child sexual abuse (CSA) and mental health outcomes, a few prospective studies showed a robust association between CSA and depression. Studies on the impact of dating violence are still at a nascent stage and focus on antecedents of violence rather than its consequences. Women at higher risk, such as adolescents, migrants, the homeless, and women in the perinatal period have been studied and specific vulnerabilities identified. Women reporting bidirectional violence had higher rates of depression and post-traumatic stress disorder (PTSD). Cumulative violence, severity of violence, and recent violence are associated with higher morbidity. Studies among women in conflict zones have emphasized the role of different forms of sexual and physical violence on mental health.

SUMMARY

Newer emerging areas that need more research include mental health consequences of women in conflict zones and among same sex relationships. There are also few studies on the violence experience of both older women and adolescents. The need to better delineate the psychopathology of complex manifestations of PTSD is underscored.

Stressful childhood experiences and health outcomes in sexual minority populations: a systematic review

PURPOSE

Stressful childhood experiences (SCE) are associated with many different health outcomes, such as psychiatric symptoms, physical illnesses, alcohol and drug abuse, and victimization experiences. Lesbian, gay, bisexual, and transgender (LGBT) people are at risk to be victims of SCE and show higher prevalence of SCE when compared with heterosexual controls.

METHODS

This review analyzed systematically 73 articles that addressed different types of SCE in sexual minority populations and included items of household dysfunction. The samples included adults who identified either their sexual orientation as non-heterosexual or their gender identity as transgender.

RESULTS

The studies reported childhood sexual abuse (CSA), childhood physical abuse (CPA), childhood emotional abuse (CEA), childhood physical neglect, and childhood emotional neglect. Items of household dysfunction were substance abuse of caregiver, parental separation, family history of mental illness, incarceration of caregiver, and witnessing violence. Prevalence of CSA showed a median of 33.5 % for studies using non-probability sampling and 20.7 % for those with probability sampling, the rates for CPA were 23.5 % (non-probability sampling) and 28.7 % (probability sampling). For CEA, the rates were 48.5 %, non-probability sampling, and 47.5 %, probability sampling. Outcomes related to SCE in LGBT populations included psychiatric symptoms, substance abuse, revictimization, dysfunctional behavioral adjustments, and others.

CONCLUSIONS

LGBT populations showed high prevalence of SCE. Outcomes related to SCE ranged from psychiatric symptoms and disorders to physical ailments. Most studies were based in the USA. Future research should aim to target culturally different LGBT population in the rest of the world.