Alcohol and tobacco use patterns among heterosexually and homosexually experienced California women

Sexual and gender identities and alcohol use during the COVID-19 pandemic

This study examined differences in alcohol use by sexual and gender identities during the COVID-19 pandemic, and assessed whether variation between groups was explained by pandemic-related stressors and minority stress. Data from 2,429 partnered adults in the National Couples' Health and Time Use Study (n = 3,593) collected from September 2020 to April 2021 were used to model drinking patterns (frequency, amount, and drinking to cope) by sexual and gender identities, COVID-19 stress and disruption, microaggressions, and supportive climate. Regression models indicated differences in drinking by gender and sexual identities, even controlling for demographic and socioeconomic factors. Gay, lesbian, and bisexual people had higher odds of drinking to cope with the pandemic than did heterosexual people, and cisgender men had higher odds than did cisgender women. Gay and lesbian people drank more regularly than did heterosexual people, as did cisgender men in relation to cisgender women. Exclusively bisexual people drank significantly more drinks than exclusively heterosexual people, and cisgender men drank significantly more drinks than did cisgender women and those who identified as trans/another gender identity. COVID-19 stress and minority stress were associated with greater alcohol consumption, but they did not account for these differentials. Moving forward, researchers will need to continuously assess these associations, as sources of discrimination and stress will persist beyond the pandemic. Although LGBTQ+ people have disproportionate sources of stress, they varied in how they used alcohol to cope. Potential sources of resilience among sexual and gender diverse individuals should be explored.

How Does Sexual Identity-Attraction Discordance Influence Suicide Risk? A Study on Male and Female Adults in the U.S

BACKGROUND

Suicide continues to be one of the main causes of death among adults in the U.S. Research showed an association between sexual identity-attraction discordance (IAD) and adverse health outcomes, including suicidal ideation.

METHODS

We sought to determine whether sexual IAD is associated with self-injurious thoughts and behaviors (SITBs), namely suicidal thoughts, plans, and suicide attempts, in the past year. We examined data from adults participating in the most recent six waves (2015-2020) of the National Survey on Drug Use and Health.

RESULTS

Men who report sexual identity-attraction discordance were at greater risk of reporting suicidal thoughts (aOR = 3.67, 95% CI: 2.24-6.00) and plans (aOR = 5.71, 95% CI: 3.32-9.81) in the past year. Stratified by sexual identity, results showed that gay (aOR = 5.92, 95% CI: 1.54-22.7) and bisexual men (aOR = 4.38, 95% CI: 2.17-8.83) had higher odds of reporting suicide plans and heterosexual (aOR = 2.66, 95% CI: 1.06-6.68), gay (aOR = 7.05, 95% CI: 1.88-26.4), and bisexual men (aOR = 5.30, 95% CI: 4.37-22.9) had higher odds of suicide attempts when compared to men with concordant sexual identity-attraction. We found that bisexual women who report sexual identity-attraction discordance had less odds of reporting suicidal thoughts (aOR = 0.36, 95% CI: 0.21-0.63) and suicide plans (aOR = 0.43, 95% CI: 0.20-0.89) than women with concordant sexual identity-attraction. Among bisexual-identified males, those who experience sexual identity-attraction discordance were at greater risk for past-year suicidal thoughts (aOR = 3.82, 95% CI: 2.12-6.91) and suicide attempts (aOR = 5.30, 95% CI: 2.13-13.1) when compared to bisexual men with concordant sexual identity-attraction.

CONCLUSION

Sexual IAD is associated with SITB and particularly concerning results emerged concerning bisexual-identified men.

An Analysis of Tobacco and Marijuana Use by Middle School and High School Bisexual and Homosexual Students Surveyed by the National Youth Tobacco Survey From 2020 to 2022

OBJECTIVES

This study aimed to analyze tobacco and marijuana use by middle and high school students identifying as bisexual, gay, lesbian, or heterosexual using data from the National Youth Tobacco Survey (NYTS) spanning from 2020 to 2022. By comparing substance use patterns among different sexual orientation groups, the study sought to identify disparities and potential socioeconomic factors influencing these behaviors.

METHODS

Data from the 2020 to 2022 NYTS were analyzed, focusing on responses regarding ever use of cigarettes, e-cigarettes, and marijuana by students of varying sexual orientations. Descriptive statistics and chi-square tests were employed to analyze differences in substance use and socioeconomic indicators between sexual orientation groups.

RESULTS

Of the 37 541 students included in the analysis, significant differences in substance use were observed among bisexual, gay, lesbian, and heterosexual students. Bisexual and gay/lesbian students exhibited higher rates of ever use of cigarettes, e-cigarettes, and marijuana compared to heterosexual students. In addition, socioeconomic differences, such as lower rates of family vehicle ownership and reduced access to vacations, were noted among bisexual and gay/lesbian students.

CONCLUSIONS

The findings underscore significant differences in tobacco and marijuana use by adolescents based on sexual orientation, mirroring differences observed in LGBTQ adults. These results highlight the importance of targeted interventions, educational initiatives, and support systems tailored to the unique needs of LGBTQ youth. Addressing socioeconomic disparities and fostering inclusive environments are crucial steps in promoting the health and well-being of LGBTQ adolescents. Continued research and collaborative efforts are essential in mitigating health disparities and creating equitable environments for all adolescents.

Healthcare Stereotype Threat and Health Outcomes Among LGB Individuals

BACKGROUND/PURPOSE

Health disparities between sexual minorities and heterosexuals are well documented and have been explained by differential access to healthcare as well as exposure to discrimination. The current research examines the role that healthcare stereotype threat, or the fear of being judged by healthcare providers based on negative group stereotypes, plays in the health of LGB individuals.

METHODS

LGB individuals (N = 1507) in three age cohorts were recruited via random digit dialing to participate in a larger study on sexual minority health. Participants completed measures assessing healthcare stereotype threat, lifetime health diagnoses, life satisfaction, and number of bad physical health days and personal distress in the past 30 days.

RESULTS

Healthcare stereotype threat was associated with higher psychological distress and number of reported bad physical health days. Additionally, the Younger and Middle cohorts reported more stereotype threat than the Older cohort, but reported significantly higher levels of life satisfaction in the face of this threat than those in the Older cohort.

CONCLUSIONS

Healthcare stereotype threat was related to poorer mental and physical health among LGB individuals; this was true when these outcomes were assessed over the past 30 days but not when they were assessed in general. Cohort differences in healthcare stereotype threat suggest potential important within group variation that needs further investigating. The research broadens the contexts to which stereotype threat is relevant and establishes a stressor related to LGB health.

Internalized Heterosexism and Substance Use: A Meta-Analysis

Sexual minority individuals report greater rates of substance use compared to their heterosexual counterparts. Internalized heterosexism (IH) is one critical factor underlying this disparity. There has been a proliferation of studies examining IH as a correlate of substance use; however, results of these studies have been mixed. The purpose of the current multilevel meta-analysis was to explain these mixed findings by identifying factors that moderate the overall relationship between IH and substance use. Results from the analysis of 49 studies (209 effect sizes and 162,674 participants) demonstrated a positive overall relationship between IH and substance use ( r = .065). This relationship was significantly moderated by sexual orientation, gender, and type of substance. Increased IH was linked to increased use of heroin ( r = .173), cocaine ( r = .135), tobacco ( r = .100), and alcohol ( r = .070). Implications for research, practice, and policy are discussed.

Sexual Shame and Emotion Dysregulation: Key Roles in the Association between Internalized Homonegativity and Sexual Compulsivity

Sexual minority men (SMM) are at increased risk for mental health problems due to effects of sexual minority stigma (e.g., internalized homonegativity (IH)). Both IH and emotion dysregulation are contributors to sexual compulsivity; however, the role of feelings of sexual shame have not been examined in this association. A sample of 982 HIV-negative SMM completed online surveys (Mage = 42.4, SD = 13.74). Path analyses indicated significant direct effects of IH on sexual shame (β = 0.44, p < .001), emotion dysregulation (β = 0.19, p < .001), and sexual compulsivity (β = 0.22, p < .001). Modeled simultaneously, the association between sexual shame and sexual compulsivity (β = 0.26, p < .001) was significant, as was the association between emotion dysregulation and sexual compulsivity (β = 0.27, p < .001). Finally, an indirect effect of IH on sexual compulsivity through both sexual shame (p < .001) and emotion dysregulation (p < .001) was significant, and the association between IH and sexual compulsivity was reduced to non-significant (β = 0.01, p = .74). Targeting feelings of sexual shame and emotion dysregulation in clinical interventions may help reduce the negative health impact of sexual compulsivity among SMM.

Sexual and Gender Minorities and Risk Behaviours among University Students in Italy

Sexual and gender minorities (SGM) may experience stigma, discrimination and show higher prevalence of behavioural risk factors than heterosexual counterparts. In Italy, the information on SGM is scarce and outdated. The present cross-sectional study aims to provide a more up-to-date estimate of the SGM proportion in young adults and to assess differences in the adoption of risk behaviours compared to their heterosexual counterparts. The study involved university students aged 18-25. Information on socio-demographic and behavioural characteristics were collected. The effect of sexual orientation on risk behaviours was assessed with a multinomial single-step logistic regression analysis. A total of 9988 participants were included. Overall, 518 students (5.2%) self-identified as SGM. While lesbians showed significantly higher odds of only non-regular use of protective barriers (AOR: 11.16), bisexuals showed higher odds for frequent drinking (AOR: 2.67), smoking (AOR: 1.85), multiple sexual partnerships (AOR: 1.78) and non-regular use of protective barriers (AOR: 1.90) compared with heterosexual women. Gay men showed higher odds of multiple sexual partnerships compared with heterosexual males (AOR: 5.52). SGM accounted for 5.2% of the sample, slightly more than the proportion found in the general population, but substantially in line with similarly aged populations abroad. Our findings confirm that unhealthy risk behaviours are more frequent among LGBTQ+, in particular among bisexual women. Rather than targeting specific subpopulations, our study aims to show the need for health promotion interventions that aim at the empowerment of all students regardless of sexual orientation, being aware that SGMs can benefit to a relatively greater extent.

Same-Sex Couples and Cognitive Impairment: Evidence From the Health and Retirement Study

OBJECTIVES

We provide the first nationally representative population-based study of cognitive disparities among same-sex and different-sex couples in the United States.

METHODS

We analyzed data from the Health and Retirement Study (2000-2016). The sample included 23,669 respondents (196 same-sex partners and 23,473 different-sex partners) aged 50 and older who contributed to 85,117 person-period records (496 from same-sex partners and 84,621 from different-sex partners). Cognitive impairment was assessed using the modified version of the Telephone Interview for Cognitive Status. Mixed-effects discrete-time hazard regression models were estimated to predict the odds of cognitive impairment.

RESULTS

The estimated odds of cognitive impairment were 78% (p < .01) higher for same-sex partners than for different-sex partners. This disparity was mainly explained by differences in marital status and, to a much lesser extent, by differences in physical and mental health. Specifically, a significantly higher proportion of same-sex partners than different-sex partners were cohabiting rather than legally married (72.98% vs. 5.42% in the study sample), and cohabitors had a significantly higher risk of cognitive impairment than their married counterparts (odds ratio = 1.53, p < .001).

DISCUSSION

The findings indicate that designing and implementing public policies and programs that work to eliminate societal homophobia, especially among older adults, is a critical step in reducing the elevated risk of cognitive impairment among older same-sex couples.

A Gamified, Social Media-Inspired, Web-Based Personalized Normative Feedback Alcohol Intervention for Lesbian, Bisexual, and Queer-Identified Women: Protocol for a Hybrid Trial

BACKGROUND

Sexual minority women are more likely to drink alcohol, engage in heavy drinking, and experience alcohol-related problems than heterosexual women. However, culturally tailored interventions for this population have been slow to emerge.

OBJECTIVE

This type 1 effectiveness-implementation trial examines the feasibility and efficacy of a gamified, culturally tailored, personalized normative feedback (PNF) alcohol intervention for sexual minority women who psychologically identify as lesbian, bisexual, or queer (LBQ).

METHODS

The core components of a PNF intervention were delivered within LezParlay, a fun, social media-inspired, digital competition designed to challenge negative stereotypes about LBQ women and increase visibility. The competition was advertised on the web through social media platforms and collaboration with LBQ community organizations. After 2 rounds of play by a large cohort of LBQ women, a subsample of 500 drinkers already taking part in the competition were invited to participate in the evaluation study. Study participants were randomized to receive 1 of 3 unique sequences of PNF (ie, alcohol and stigma coping, alcohol and control, or control topics only) over 2 intervention rounds. Randomization was fully automated by the web app, and both researchers and participants were blinded.

RESULTS

Analyses will evaluate whether PNF on alcohol use reduces participants' drinking and negative consequences at 2 and 4 months postintervention; examine whether providing PNF on stigma-coping behaviors, in addition to alcohol use, further reduces alcohol use and consequences beyond PNF on alcohol alone; identify mediators and moderators of intervention efficacy; and examine broader LezParlay app engagement, acceptability, and perceived benefits.

CONCLUSIONS

This incognito intervention approach is uniquely oriented toward engaging and preventing alcohol-related risks among community populations of LBQ women who may view their heavy drinking as normative and not in need of change because of the visibility of alcohol use in sexual minority community spaces. Thus, this intervention strategy diverges from, and is intended to complement, more intensive programs being developed to meet the needs of LBQ women already motivated to reduce their consumption.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03884478; https://clinicaltrials.gov/ct2/show/NCT03884478.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/24647.

Barriers to palliative care in sexual and gender minority patients with cancer: A scoping review of the literature

The Institute of Medicine reports lesbian, gay, bisexual and transgender (LGBT) individuals having the highest rates of tobacco, alcohol and drug use leading to elevated cancer risks. Due to fear of discrimination and lack of healthcare practitioner education, LGBT patients may be more likely to present with advanced stages of cancer resulting in suboptimal palliative care. The purpose of this scoping review is to explore what is known from the existing literature about the barriers to providing culturally competent cancer-related palliative care to LGBT patients. This review will use the five-stage framework for conducting a scoping review developed by Arksey and O'Malley. The PubMed, Scopus, PsychINFO and Cochrane electronic databases were searched resulting in 1,442 citations. Eligibility criteria consisted of all peer-reviewed journal articles in the English language between 2007 and 2020 resulting in 10 manuscripts. Barriers to palliative cancer care for the LGBT include discrimination, criminalisation, persecution, fear, distress, social isolation, disenfranchised grief, bereavement, tacit acknowledgment, homophobia and mistrust of healthcare providers. Limited healthcare-specific knowledge by both providers and patients, poor preparation of legal aspects of advanced care planning and end-of-life care were underprovided to LGBT persons. As a result of these barriers, palliative care is likely to be provided for LGBT patients with cancer in a deficient manner, perpetuating marginalisation and healthcare inequities. Minimal research investigates these barriers and healthcare curriculums do not provide practitioners skills for administering culturally sensitive palliative care to LGBT patients.

LGBT individuals' opinions about their health care experiences: A qualitative research study

AIM

To determine the health problems of LGBT individuals and the conditions of their utilization of health care services from their own perspectives.

BACKGROUND

Although the health care services have improved over the last decades, LGBT individual still face unique challenges when seeking health care services.

METHOD

This study was performed using the phenomenological technique as a qualitative research method. The sample consisted of 18 LGBT individuals selected using purposive sampling. Data were collected by semi-structured interviews using focus group and analysed using content analysis.

RESULTS

Two main themes emerged as a result of the content analysis: awareness and status of benefiting from health care.

CONCLUSION

To obtain quality care for LGBT individuals, the health care professionals need a persistent awareness-specific knowledge of LGBT health issues.

IMPLICATIONS FOR NURSING MANAGEMENT

The findings of this study can be a warning for managers and policymakers to plan seriously to reform health care services infrastructures. Content about the health needs of LGBT individuals can be added to the curriculum of medical and nursing schools.

Examining the Attitudes and Behaviors of Health-care Providers Toward LGBT Patients in Lebanon

The present cross-sectional descriptive study examined the attitudes and behaviors of health-care providers toward LGBT patients in Lebanon. Participants (N = 141) generally showed positive attitudes and behaviors toward LGBT patients. Mental health providers were significantly less likely to believe that homosexuality is a mental health disorder or that it is unnatural to identify with a gender identity other than one's biological sex when compared to non-mental health providers. Mental health providers were also more likely to be willing to address transgender people by their gender pronouns, and to believe that homosexuality is a natural variation on the sexual orientation spectrum when compared to non-mental health providers. Findings show favorable attitudes and behaviors of health-care providers toward LGBT individuals when compared to previous investigations in Lebanon. Implications on the educational, research, and policy levels are discussed.

SUBSTANCE USE AMONG SEXUAL AND GENDER MINORITIES: ASSOCIATION WITH POLICE DISCRIMINATION AND POLICE MISTRUST

We investigated associations between experiences with police discrimination, police mistrust, and substance use in a convenience sample of 237 sexual and gender minority (SGM) adults in California. In a cross-sectional survey, collected between January 2016 and July 2017, participants reported substance use, lifetime experiences with SGM-related police discrimination, police mistrust, demographics and SGM visibility. In adjusted logistic regression models, we found a positive association between lifetime police discrimination and past-two-week heavy episodic drinking. Police mistrust also was positively associated with past-month marijuana use. Several significant interactions between lifetime police discrimination or police mistrust with other socially stigmatized identities including being African American, insecure housing, and being a gender minority on a few substance use outcomes suggest that effects of police discrimination and mistrust on substance use are stronger among participants with multiple stigmatized identities. Results suggest the importance of policies and interventions that focus on eliminating police discrimination and increasing police legitimacy to reduce risk of substance use among SGM individuals.

Differences in how spouses influence each other's alcohol use in same- and different-sex marriages: A daily diary study

RATIONALE

Different-sex spouses influence each other's alcohol consumption, with women having more influence on their spouses than men. Because women drink less than men, this long-term influence partly explains why married men and women consume less alcohol than their unmarried peers. However, much less is known about possible gender differences in the ways spouses influence each other's alcohol use on a day-to-day basis in same-compared to different-sex marriages. Because sexual minority people are at higher risk for alcohol use disorders compared to their heterosexual counterparts, such knowledge could shed light on ways to reduce this risk and alcohol use disparities between sexual minority and heterosexual people.

METHOD

We use 10 days of diary data collected in 2014-2015 in the United States from 157 female same-sex, 106 male same-sex, and 115 different-sex married couples in midlife (ages 35-65) to examine how one spouse's drinking influences how much the other spouse drinks on the following day.

RESULTS

Men reported higher levels of daily drinking than women; after including covariates, men in different-sex marriages reported drinking at the highest levels. Results from actor-partner interdependence models show that men in same- and different-sex marriages drink more, and women in different-sex marriages drink less when their spouse drinks more the previous day. Female same-sex spouses did not change their drinking behaviors in response to their spouse's drinking.

CONCLUSIONS

Overall higher rates of drinking among men in same-sex marriages suggest an accumulation effect of drinking that may contribute to sexual minority health disparities. Women and men in different-sex marriages may be engaging in social control or navigating masculinity norms. Women in same-sex marriages may not feel the need to adjust to low levels of drinking by their spouses. Findings suggest that spousal influence over alcohol consumption unfolds differently in same-sex compared to different-sex marriages.

Hungarian Medical Students' Knowledge About and Attitude Toward Homosexual, Bisexual, and Transsexual Individuals

Discrimination that LGBTQ individuals experience in health care settings might affect their health and intention of using health care services. However, health needs of LGBTQ patients are still inappropriately addressed in the medical curriculum. First-, third-, and fourth-year medical students (N = 569) from the four Hungarian medical universities participated in a study in 2017 to assess knowledge about homosexuality, homonegativity, and their attitude as health care professionals toward sexual minorities. We found that higher levels of knowledge about homosexuality were associated with lower levels of homonegativity, upper-grade level in university, not being religious, and having close LGBTQ acquaintances. Our results suggest that it may be necessary to introduce LGBTQ themes in the medical curricula (not only in Hungary, but also in other countries) in order to improve the knowledge and attitude of medical students and thereby improve the health care of LGBTQ individuals.

Lesbians' use of popular social media sites is associated with perceived drinking norms & interest in receiving personalized normative feedback on alcohol use

Alcohol-related problems disproportionately impact sexual minority women. Recent research suggests that lesbian-identified women overestimate peer drinking norms and therefore, personalized normative feedback (PNF) may be an appropriate and efficacious intervention strategy for reducing alcohol-related risks in this population. To inform the development and packaging of such interventions, this study examines lesbians' use of the popular social media sites Facebook, Instagram, Snapchat, and Twitter in relation to alcohol consumption, perceptions of peer drinking norms, confidence in normative perceptions, and interest in receiving alcohol PNF. Findings suggest that the lesbians who are most likely to benefit from a PNF alcohol intervention may also be the most readily reached via social media sites. Alcohol interventions that both recruit and deliver PNF via widely used social media platforms such as Facebook and Instagram represent a promising and cost-effective strategy to reduce heavy drinking among lesbians.

Tobacco Use among Women Firefighters

OBJECTIVES

Firefighters play a crucial role in protecting the lives and property of the communities they serve. Health and readiness for duty among women firefighters is of great concern because they are a significantly understudied group in this critical occupation. A tobacco-free fire service has been strongly promoted, but there are no published data on the extent and types of tobacco use among women firefighters.

METHODS

Data were collected as part of a national online study of the health of women in the fire service.

RESULTS

A total of 1,712 women firefighters completed questions regarding tobacco use. Unadjusted smoking and smokeless tobacco rates were 5.1% and 1.2%, respectively. Age standardized smoking rates were lower than those of male firefighters and U.S. adult women. Smokeless tobacco use prevalence was very low compared with male firefighters, but comparable with U.S. adult women. Tobacco users were more likely to have lower education and income and were younger when compared with those who did not use tobacco. There was a strong association between tobacco use and problem and binge drinking.

CONCLUSIONS

Current findings suggest that the rates of cigarette and smokeless tobacco use are relatively low among women firefighters. Unhealthy lifestyle behaviors such as problem and binge drinking were strongly associated with tobacco use.

The Association of Lesbian, Gay, and Bisexual Identity Facets With Smoking Dependence Motives

Introduction

Lesbian, gay, and bisexual (LGB) adults have higher rates of smoking than heterosexual adults. LGB individuals face unique stressors, including challenges associated with having a LGB identity. The extent to which these unique stressors are related to dependence motives in LGB adult smokers, however, has not been previously explored. The current study was conducted to redress these gaps.

Methods

Participants (N = 52; Mage = 42.8; 55.8% Black/African American) were recruited from the local community. Identity facets were measured by the Lesbian, Gay, and Bisexual Identity Scale (LGBIS). Dependence motives were measured by the Brief Wisconsin Inventory of Smoking Dependence Motives. Linear multiple regressions were calculated with the predictors of seven LGBIS subscales for primary and secondary dependence motives, respectively.

Results

Primary dependence motives (core nicotine dependence features) were predicted by affirmation of LGB identity (β = 0.44). Secondary dependence motives (eg, taste, cognitive/affective enhancement) were predicted by uncertainty of LGB identity (β = 0.43).

Conclusions

LGB identity affirmation was associated with primary dependence motives, suggesting that a positive view of one's sexual orientation is a risk factor for dependence. It may be that identity affirmation is related to stronger involvement with the LGB community, which has smoking-friendly norms. Identity uncertainty was associated with secondary dependence motives; this unique identity challenge may represent a stressor contributing to smoking dependence. Findings can help explain the higher rate of smoking in LGB populations and offer avenues to better tailor smoking cessation interventions.

Implications

The current study is the first to examine multidimensional aspects of LGB identity in explaining smoking dependence motives among LGB adults. Results reveal that LGB identity challenges are associated with dependence motives, suggesting that interventions targeting these challenges may be help reduce LGB smoking disparities. Specifically, reducing identity uncertainty may help reduce smoking dependence. Though identity affirmation was a smoking dependence correlate, it is counterproductive to reduce affirmation, given its association with other positive health outcomes. Rather, interventions to change LGB community norms around smoking appear warranted, given the documented high overlap between affirmation and community affiliation.

Sexual Orientation and Diabetes During the Transition to Adulthood

Purpose: The purpose of this study was to examine how sexual orientation in adolescence and young adulthood was linked to diabetes risk. Methods: Data were drawn from the 1994-2008 National Longitudinal Study of Adolescent to Adult Health. The baseline sample included 4330 girls and 3510 boys ages 12-18. Guided by the life course approach, we considered both the timing and continuity of sexual orientation-broadly defined by sexual identity, sexual attraction, sexual contact, and romantic/sexual relationships-by differentiating respondents into four categories: sexual minority in both adolescence and adulthood, sexual minority in adulthood only, sexual minority in adolescence only, and heterosexual in both adolescence and young adulthood. Diabetes was identified using A1c and glucose biomarkers and self-reports of diabetes diagnosis or medication use. Results: Results from logistic regression models indicated that in comparison with their continuously heterosexual counterparts, respondents reporting sexual minority status in adulthood only or continuously in both adolescence and adulthood had higher diabetes risk in adulthood. However, respondents reporting sexual minority status in adolescence only were not different in diabetes risk in adulthood. The association between diabetes risk and continuous sexual minority status was stronger among women than among men. Conclusions: Sexual minority health disparities emerge early in the life course during adolescence and young adulthood. These findings highlight the importance of designing and implementing policies and public programs to alleviate minority stress early in life to reduce health disparities.

Patterns of childhood maltreatment and intimate partner violence, emotion dysregulation, and mental health symptoms among lesbian, gay, and bisexual emerging adults: A three-step latent class approach

BACKGROUND

Childhood abuse and neglect (CAN) and intimate partner violence victimization (IPV) is prevalent among lesbian, gay, and bisexual individuals (LGB). Identification of distinct patterns of childhood and adult victimization, including technology-mediated and face-to-face IPV, and their cumulative relations to mental/behavioral health challenges, among LGB people is needed to facilitate identification of at-risk individuals.

OBJECTIVE

Using latent class analysis, we first sought to identify patterns of lifetime interpersonal victimization, primarily five types of CAN and IPV in LGB emerging adults. Second, we examined if LGB-status and race/ethnicity predicted class-membership; third, we assessed differences between the latent classes on emotion dysregulation, depressive and anxiety symptoms, and alcohol use.

PARTICIPANTS

Participants were 288 LGB adults between 18-29 years (M = 25.35, SD = 2.76; 41.7% gay/lesbian) recruited via Amazon MTurk.

METHODS AND RESULTS

The 3-step LCA identified five-latent classes: high victimization, childhood emotional abuse and neglect, cybervictimization, adult face-to-face IPV, and lower victimization. People of color (including Hispanics) were more likely to be in the high victimization class, and bisexual individuals, especially bisexual women, in the childhood emotional abuse and neglect class. High victimization and childhood emotional abuse and neglect classes had elevated emotion dysregulation levels and depression and anxiety symptoms, and the high victimization class reported the highest levels of alcohol use.

CONCLUSION

Findings suggest a detrimental effect of cumulative interpersonal victimization on emotion dysregulation and the mental/behavioral health of LGB emerging adults, with bisexuals and LGB-people of color at heightened risk of cumulative victimization and of related mental/behavioral health challenges.

Stress and substance use among sexual and gender minority individuals across the lifespan

Sexual and gender minority (SGM) individuals face marked disparities in substance use. The present narrative review explores research on substance use in SGM communities using a minority stress theory lens. We define the SGM population and minority stress, and explore stresses and substance use disparities in adolescence, adulthood, and older age. Though research on this topic is beginning to highlight the relationship between stress and substance use for SGM individuals, more work is needed on older SGM populations and in translating research findings to effective interventions.

Mental health and substance use among women and men at the intersections of identities and experiences of discrimination: insights from the intersectionality framework

Background

Intersectionality theory focuses on how one’s human experiences are constituted by mutually reinforcing interactions between different aspects of one’s identities, such as race, class, gender, and sexual orientation. In this study, we asked: 1) Do associations between intersecting identities (race and sexual orientation) and mental health (depressive symptoms) and substance use (alcohol, tobacco, and marijuana) differ between men and women? and 2) How do single or intersecting self-reports of perceived racial and/or sexual orientation discrimination influence mental health and substance use outcomes for men and women? We compared results of assessing identities versus experiences of discrimination.

Methods

Multivariable regressions were conducted on cross-sectional data from 2315 Black and White college students. Predictors included measures of sociodemographic characteristics and experiences of discrimination. Outcomes included past 2-week depressive symptoms (PHQ-9), past 30-day alcohol use, past 30-day tobacco use, and past 30-day marijuana use.

Results

Intersecting identities and experience of discrimination had different associations with outcomes. Among women, self-reporting both forms of discrimination was associated with higher depressive symptoms and substance use. For example, compared to women experiencing no discrimination, women experiencing both forms of discrimination had higher depressive symptoms (B = 3.63, CI = [2.22–5.03]), alcohol use (B = 1.65, CI = [0.56–2.73]), tobacco use (OR = 3.45, CI = [1.97–6.05]), and marijuana use (OR = 3.38, CI = [1.80–6.31]). However, compared to White heterosexual women, White sexual minority women had higher risks for all outcomes (B = 3.16 and CI = [2.03–4.29] for depressive symptoms, B = 1.45 and CI = [0.58–2.32] for alcohol use, OR = 2.21 and CI = [1.32–3.70] for tobacco use, and OR = 3.01 and CI = [1.77–5.12] for marijuana use); while Black sexual minority women had higher tobacco (OR = 2.64, CI = [1.39–5.02]) and marijuana use (OR = 2.81, CI = [1.33–5.92]) only. Compared to White heterosexual men, White sexual minority men had higher depressive symptoms (B = 1.90, CI = [0.52–3.28]) and marijuana use (OR = 2.37, CI = [1.24–4.49]).

Conclusions

Our results highlight the deleterious impacts of racial discrimination and sexual orientation discrimination on health, in particular for women. Future studies should distinguish between and jointly assess intersecting social positions (e.g., identities) and processes (e.g., interpersonal experience of discrimination or forms of structural oppression).

Race/Ethnicity and Sexual Orientation Disparities in Mental Health, Sexism, and Social Support among Women Veterans

OBJECTIVE

To identify patterns of risk and resilience by the intersections of race/ethnicity and sexual orientation in mental health symptom severity, sexism, and social support among U.S. women veterans.

METHODS

A national sample of women veterans (n = 648, 38% sexual minority, 15% racial/ethnic minority) was recruited online in 2013 using social networking websites and listservs. Using cross-sectional survey data, we evaluated main and interactive associations between race/ethnicity and sexual orientation on depression, anxiety, posttraumatic stress, unhealthy alcohol use, sexism, and social support. Models were adjusted for other demographic characteristics.

RESULTS

Across depression, anxiety, and sexism, White heterosexual women reported the least distress and racial/ethnic minority heterosexual women the most distress (race/ethnicity x sexual orientation interactions p < .05). Among White women, sexual minority women reported greater levels of depression, anxiety, and sexism than heterosexual women. The effects were the opposite among racial/ethnic minority women, where heterosexual women reported similar or worse depression, anxiety, and sexism than sexual minority women. There were no race/ethnicity or sexual orientation interaction effects on posttraumatic stress symptoms or unhealthy alcohol use and marginally significant effects on social support.

CONCLUSIONS

Among women veterans, race/ethnicity and sexual orientation were associated with mental health and sexism, alone and in combination. Findings suggest that those who were both racial/ethnic and sexual minorities may develop resilience from their lived experience. On the other hand, women veterans with a minority race/ethnicity or a minority sexual orientation appeared more vulnerable to adverse outcomes and may need targeted care.

The Role of Multiple Social Identities in Discrimination and Perceived Smoking-Related Stigma among Sexual and Gender Minority Current or Former Smokers

AIMS

We investigated how intersections of being a racial minority (i.e. being African American) and economically-disadvantaged (i.e. housing insecurity) may influence experiences with discrimination and perceptions of smoking-related stigma among sexual and gender minority (SGM) current and former smokers. Methods: Survey data were collected from 227 SGM current and former smokers in California (19-65 years old), oversampling African American participants. Participants reported their race, ethnicity, past month housing insecurity, number of lifetime experiences with SGM discrimination, and perceptions of smoking-related stigma.

FINDINGS

Using univariate General Linear Models and controlling for age, ethnicity, and SGM visibility, we found a significant interaction between being African American and facing housing insecurity on experiences with SGM discrimination [F(1,220)=7.21, p=0.01], perceived smoker stigma [F(1,220)=5.48, p=0.02], perceived differential treatment due to smoking [F(1,220)=10.03, p=0.00], and social withdrawal from non-smokers [F(1,220)=6.18, p=0.01]. These interactions suggest that economically-disadvantaged African American SGM current or former smokers experience increased levels of discrimination and perceive more smoking-related stigma compared to other SGM current and former smokers. Conclusions: Results suggest that people's multiple identities intersect to intensify oppression and inequities for some people and raise questions about the unintended consequences of stigmatizing smokers for reducing smoking among SGM adults.

Health Care of Sexual Minority Women

Sexual minority women may be invisible in health care settings unless practitioners ask every patient about sexual attractions/behaviors and identity. Sexual minority women need to feel comfortable and able to share information about their sexual identity, partners, and lives. No medical diagnoses are found more commonly in sexual minority women, but problems such as overweight/obesity, increased tobacco and alcohol use, increased mental health problems, and a past history of childhood sexual abuse are common. These factors intertwine when treating sexual minority women.

Recruitment of breast cancer survivors and their caregivers: implications for dyad research and practice

Breast cancer survivors' informal caregivers experience adverse health outcomes and could benefit from interventions. Studies of caregivers' participation in research, to date, have assumed heterosexuality. The aim of this study is to identify factors associated with caregiver participation among survivors with diversity in sexual orientation. We recruited breast cancer survivors into a telephone survey and asked them to invite a caregiver. Logistic regression identified factors associated with caregivers' participation. Among 297 survivors, 12 (4 %) had no caregivers, 82 (28 %) refused to provide caregiver information, 203 (68 %) provided caregiver contact, and 167 (56 %) had caregivers participate. Caregiver participation was more likely among sexual minority than heterosexual survivors (aOR: 1.89; 95 % CI: 1.08, 3.32), dyads with higher cohesion, and among caregivers who were partners. Caregiver participation was less likely among survivors with lower education and higher comorbidity. Findings provide insight into recruitment of diverse dyads into cancer survivorship research that will ultimately inform intervention design.

More Than a Feeling? An Empirical Analysis of the Dual-Continua Model on a National Sample of Lesbian, Gay, and Bisexual Identified Canadians

The goal of the study is to investigate whether positive mental health complements mental illness within a theoretically informed (the dual-continua model) and psychometrically tested (the Mental Health Continuum-Short Form) framework. National-level, population-based data from the 2012 Canadian Community Health Survey on Mental Health (CCHS-MH) was used, with comparisons between sexual minority and heterosexual adults. Results show that gay, lesbian, and bisexual Canadians have substantially lower rates of positive mental health and are more likely to have been diagnosed with a mental illness, with the disparities between health and illness being the most pronounced among lesbians and bisexual females. Results show considerable support for the dual-continua model, which posits that the absence of health does not automatically translate into the presence of illness, and vice versa. Suggestions are made for practitioners and researchers toward the use of the dual-continua model as a surveillance tool, especially among sexual minority individuals.

A descriptive analysis of where and with whom lesbian versus bisexual women drink

Purpose

Sexual minority women (SMW) are at increased risk for alcohol use disorders and related problems. Social context (e.g., where and with whom one drinks) has been identified as an important factor associated with drinking behavior, but little is known about social context among SMW. An improved understanding of social context among SMW has the potential to inform efforts to reduce problematic drinking and its consequences in this high-risk population.

Methods

We examined where and with whom SMW drink in a national sample recruited via social media (N = 1,057).

Results

SMW reported more frequent drinking in private locations (compared to public locations), with friends and romantic partners (compared to family members and strangers), and in locations with both heterosexuals and sexual minorities (compared to mostly or exclusively sexual minorities). Additionally, lesbians reported more frequent drinking in bars and in locations with more sexual minorities compared to bisexual women.

Conclusion

Interventions to reduce problematic drinking among SMW may benefit from addressing social context.

Healthy Weight in Lesbian and Bisexual Women Aged 40 and Older: An Effective Intervention in 10 Cities Using Tailored Approaches

BACKGROUND

Lesbian and bisexual women are more likely to be overweight or obese than heterosexual women, leading to increased weight-related health risks.

METHODS

Overweight women aged 40 or older who self-identified as lesbian, bisexual, or "something else" participated in five pilot interventions of 12 or 16 weeks' duration. These tailored interventions took place at lesbian and bisexual community partner locations and incorporated weekly group meetings, nutrition education, and physical activity. Three sites had non-intervention comparison groups. Standardized questionnaires assessed consumption of fruits and vegetables, sugar-sweetened beverages, alcohol, physical activity, and quality of life. Weight and waist-to-height ratio were obtained through direct measurement or self-report.

ANALYTICAL PLAN

Within-person changes from pre-intervention to post-intervention were measured using paired comparisons. Participant characteristics that influenced the achievement of nine health objectives were analyzed. Achievement of health objectives across three program components (mindfulness approach, gym membership, and pedometer use) was compared with the comparison group using generalized linear models.

RESULTS

Of the 266 intervention participants, 95% achieved at least one of the health objectives, with 58% achieving three or more. Participants in the pedometer (n = 43) and mindfulness (n = 160) programs were more likely to increase total physical activity minutes (relative risk [RR], 1.67; 95% confidence interval [CI], 1.18-2.36; p = .004; RR, 1.38; 95% CI, 1.01-1.89; p = .042, respectively) and those in the gym program (n = 63) were more likely to decrease their waist-to-height ratio (RR, 1.89; 95% CI, 0.97-3.68, p = .06) compared with the comparison group (n = 67).

CONCLUSION

This effective multisite intervention improved several healthy behaviors in lesbian and bisexual women and showed that tailored approaches can work for this population.

Sexual Orientation Self-Concept Ambiguity: Scale Adaptation and Validation

The current article describes the adaptation of a measure of sexual orientation self-concept ambiguity (SSA) from an existing measure of general self-concept clarity. Latent "trait" scores of SSA reflect the extent to which a person's beliefs about their own sexual orientation are perceived as inconsistent, unreliable, or incongruent. Sexual minority and heterosexual women ( n = 348), ages 18 to 30, completed a cross-sectional survey. Categorical confirmatory factor analysis guided the selection of items to form a 10-item, self-report measure of SSA. In the current report, we also examine (a) reliability of the 10-item scale score, (b) measurement invariance based on respondents' sexual identity status and age group, and (c) correlations with preexisting surveys that purport to measure similar constructs and theoretical correlates. Evidence for internal reliability, measurement invariance (based on respondent sex), and convergent validity was also investigated in an independent, validation sample. The lowest SSA scores were reported by women who self-ascribed an exclusively heterosexual or exclusively lesbian/gay sexual identity, whereas those who reported a bisexual, mostly lesbian/gay, or mostly heterosexual identity, reported relatively higher SSA scores.

Are Outness and Community Involvement Risk or Protective Factors for Alcohol and Drug Abuse Among Sexual Minority Women?

Sexual minority women (SMW) are at increased risk for substance abuse compared to heterosexual women. Two psychosocial factors that have been implicated in SMW's substance abuse are outness and LGBT community involvement, but findings have been mixed as to whether these are risk or protective factors. One possible explanation is that they may have different consequences for subgroups of SMW (lesbians, bisexual women, and queer women). While being open about one's sexual orientation and involved in the community may be protective for lesbians, discrimination against bisexual women may lead these same factors to contribute to substance abuse for bisexual women. It is unclear how these associations will operate for queer women, given limited research on this subpopulation. The current study examined whether sexual identity moderated the associations between outness and community involvement with alcohol and drug abuse. We also examined whether perceived discrimination would help explain why these associations may be different for subgroups of SMW. A sample of 288 self-identified SMW (113 lesbians, 106 bisexual women, and 69 queer women) completed an online survey. Higher outness was associated with higher alcohol and drug abuse for bisexual women, but not for lesbians or queer women. Similarly, higher community involvement was associated with higher drug abuse for bisexual women, but not for lesbians or queer women. Among bisexual women, the association between community involvement and drug abuse was mediated by perceived discrimination. Further, the association between outness and drug abuse was mediated by both community involvement and perceived discrimination. Findings demonstrate that outness and community involvement function as risk factors for substance abuse for bisexual women, in part due to their associations with discrimination.

The Health Disparities of Same-Sex Cohabitors at the Intersection of Race-Ethnicity and Gender

We work from a minority stress perspective to theorize health disparities across union status at the intersection of sexual minority status, race-ethnicity, and gender. We use pooled data from the Integrated National Health Interview Surveys (1997–2014) to assess a wide range of health outcomes, including self-rated physical health, psychological distress, and health behaviors. Results suggest that same-sex cohabitors face substantial health disadvantages relative to different-sex married individuals, with little variation by race-ethnicity and gender. Fewer health differences are found for same-sex cohabitors in comparison with both different-sex cohabitors and unpartnered singles, although greater variation by gender and race-ethnicity is found across these comparisons. This study highlights the importance of integrating intersectionality and minority stress theories to guide future research examining sexual minority health disparities. Results suggest that the sexual minority health disadvantage, as well as the potential health boost of same-sex marriage, may depend on the intersection of race-ethnicity and gender.

Disparities in Physical Health Conditions Among Lesbian and Bisexual Women: A Systematic Review of Population-Based Studies

We conducted a systematic review to assess evidence for disparities for lesbian and bisexual women (i.e., sexual minority women [SMW]) in comparison with heterosexual women across a range of nine physical health conditions. Among the k = 11 studies meeting eligibility criteria, almost every comparison (i.e., heterosexual vs. (a) lesbian, (b) bisexual, or (c) both lesbian and bisexual women) was in a direction indicating SMW disparities. Despite limited power due to small samples of SMW, we found evidence of disparities as indicated by a statistically significant adjusted odds ratios for asthma (5 of 7 comparisons), obesity (8 of 12), arthritis (2 of 3), global ratings of physical health (4 of 7), and cardiovascular disease (1 of 1). Evidence was lacking for cancer (1 of 4), diabetes and hypertension (both 1 of 5), and high cholesterol (0 of 3). Future work should confirm findings in more diverse, larger samples and should examine potential explanatory factors.

Racial/ethnic differences in unmet needs for mental health and substance use treatment in a community-based sample of sexual minority women

AIMS AND OBJECTIVES

To examine the unmet needs for mental health and substance use treatment among a diverse sample of sexual minority women (lesbian, bisexual).

BACKGROUND

Sexual minority women are more likely than heterosexual women to report depression and hazardous drinking. However, relatively little is known about sexual minority women's use of mental health or substance use treatment services, particularly about whether use varies by race/ethnicity.

DESIGN

Cross-sectional analysis of existing data.

METHODS

Analyses included data from 699 Latina, African American and white sexual minority women interviewed in wave 3 of the 17-year Chicago Health and Life Experiences of Women study. Using logistic regression, we examined the associations among sexual identity, race/ethnicity, use of mental health and substance use treatment, as well as potential unmet need for treatment.

RESULTS

Overall, women in the study reported high levels of depression and alcohol dependence, and these varied by sexual identity and race/ethnicity. Use of mental health and substance use treatment also varied by race/ethnicity, as did potential unmet need for both mental health and substance use treatment.

CONCLUSIONS

Our findings that suggest although use of treatment among sexual minority women is high overall, there is a potentially sizable unmet need for mental health and substance use treatment that varies by race/ethnicity, with Latina women showing the greatest unmet need for treatment.

RELEVANCE TO CLINICAL PRACTICE

Nurses and other healthcare providers should be aware of the high rates of depression and hazardous drinking among sexual minority women, understand the factors that may increase the risk of these conditions among sexual minority women, the potentially high unmet need for mental health and substance use treatment - perhaps particularly among Latina women and be equipped to provide culturally sensitive care or refer to appropriate treatment services as needed.

Mental health of sexual minorities. A systematic review

Many studies, reviews, and meta-analyses have reported elevated mental health problems for sexual minority (SM) individuals. This systematic review provides an update by including numerous recent studies, and explores whether SM individuals are at increased risk across selected mental health problems as per dimensions of sexual orientation (SO), genders, life-stages, geographic regions, and in higher quality studies. A systematic search in PubMed produced 199 studies appropriate for review. A clear majority of studies reported elevated risks for depression, anxiety, suicide attempts or suicides, and substance-related problems for SM men and women, as adolescents or adults from many geographic regions, and with varied SO dimensions (behaviour, attraction, identity), especially in more recent and higher quality studies. One notable exception is alcohol-related problems, where many studies reported zero or reversed effects, especially for SM men. All SM subgroups were at increased risk, but bisexual individuals were at highest risk in the majority of studies. Other subgroup and gender differences are more complex and are discussed. The review supports the long-standing mental health risk proposition for SM individuals, overall and as subgroups.

Sexual orientation identity disparities in health behaviors, outcomes, and services use among men and women in the United States: a cross-sectional study

Background

Research shows that sexual minorities (e.g., lesbian, gay, and bisexual individuals) experience higher levels of discrimination, stigma, and stress and are at higher risk of some poor health outcomes and health behaviors compared to their heterosexual counterparts. However, the majority of studies have examined sexual orientation disparities in a narrow range of health outcomes and behaviors using convenience samples comprised of either men or women living in restricted geographic areas.

Methods

To investigate the relationship between sexual orientation identity and health among U.S. women and men, we used Poisson regression with robust variance to estimate prevalence ratios for health behaviors, outcomes, and services use comparing sexual minorities to heterosexual individuals using 2013 and 2014 National Health Interview Survey data (N = 69,270).

Results

Three percent of the sample identified as sexual minorities. Compared to heterosexual women, lesbian (prevalence ratio (PR) = 1.65 [95 % confidence interval (CI): 1.14, 2.37]) and bisexual (PR = 2.16 [1.46, 3.18]) women were more likely to report heavy drinking. Lesbians had a higher prevalence of obesity (PR = 1.20 [1.02, 1.42]), stroke (PR = 1.96 [1.14, 3.39]), and functional limitation (PR = 1.17 [1.02, 1.34] than heterosexual women. Gay men were more likely to have hypertension (PR = 1.21 [1.03, 1.43]) and heart disease (PR = 1.39 [1.02, 1.88]). Despite no difference in health insurance status, sexual minorities were more likely than heterosexual individuals to delay seeking healthcare because of cost; however, members of this group were also  more likely to have received an HIV test and initiated HPV vaccination.

Conclusion

Sexual minorities had a higher prevalence of some poor health behaviors and outcomes.

Violent Victimization and Substance Dependency: Comparing Rural Incarcerated Heterosexual and Sexual Minority Women

This exploratory study examines the relationship between sexual identity and violent victimization experiences as predictors of differences in illicit substance and alcohol use and substance use problems among a sample of incarcerated women in rural Appalachia (N = 400). Results indicated that, compared to heterosexual women, sexual minority women were more likely to have a lifetime history of weapon, physical, and sexual assault, and were younger at the time of their first violent victimization. Sexual minority women were younger than heterosexual women at the age of onset for intravenous drug use and at the time they first got drunk, and were more likely to report having overdosed. Multivariate analysis found violent victimization to be the strongest predictor of a history of overdose and substance use problems.

Sexual-orientation differences in drinking patterns and use of drinking contexts among college students

BACKGROUND

Evidence suggests there are important sexual-orientation differences in alcohol consumption, particularly among women. Little is known about where gay/lesbian and bisexual college students drink or differences in drinking patterns derived from graduated frequency measures between heterosexual, gay/lesbian, and bisexual students. The goal of this analysis was to examine patterns of alcohol consumption-including drinking prevalence, quantity, frequency, and contexts of use-by sexual orientation.

METHODS

Data on sexual identity, gender, drinking behaviors, and drinking contexts were examined from repeated cross-sectional samples of undergraduate students attending 14 public California universities from 2003-2011 (n=58,903). Multivariable statistical techniques were employed to examine sexual-orientation differences stratified by gender.

RESULTS

Gay males, lesbians, and bisexual females were significantly more likely to report drinking alcohol in the current semester than their same-gender heterosexual peers (relative risks ranged from 1.07 to 1.10, p-values <0.01). Among current drinkers, bisexual females consumed 7 or more drinks and lesbians consumed 10 or more drinks on significantly more days than heterosexual females. On the other hand, gay male drinkers consumed 8 or more drinks on significantly fewer days than heterosexual male drinkers. Compared to their same-gender heterosexual peers: lesbian/gay and bisexual students drank less frequently at Greek parties (incidence rate ratios [IRRs] ranged from 0.52 to 0.73, p-values <0.01); lesbians (IRR=0.84, p=0.043) and bisexual males (IRR=0.82, p=0.009) drank less frequently at off-campus parties; and gay males drank more frequently outdoors (IRR=1.63, p<0.001) and at bars/restaurants (IRR=1.21, p=0.013).

CONCLUSIONS

Alcohol prevention programs and future research should consider sexual-orientation differences in drinking patterns and use of drinking contexts.

Primary care of women who have sex with women. Recommendations from the research

Research on women who have sex with women has increased in the last decade. Attention has been brought to this group of women through the IOM report, which noted a lack of research related to their care. Most of the research has not been published in nursing literature. This article reviews this literature with recommendations for primary care practice.

Fear of cancer recurrence in survivor and caregiver dyads: differences by sexual orientation and how dyad members influence each other

PURPOSE

The purpose of this study was to identify explanatory factors of fear of recurrence (FOR) in breast cancer survivors of different sexual orientations and their caregivers and to assess the directionality in the survivor and caregiver dyads' FOR.

METHODS

We recruited survivors of non-metastatic breast cancer of different sexual orientations and invited their caregivers into this study. Using a telephone survey, we collected data from 167 survivor and caregiver dyads. Using simultaneous equation models and a stepwise selection process, we identified the significant determinants of survivors' and caregivers' FOR and determined the directionality of survivors' and caregivers' FOR. Weighting the model by the inverse propensity score ensured that differences by sexual orientation in age and proportion of life in the caregiver-survivor relationship were accounted for.

RESULTS

Caregivers' FOR predicted survivors' FOR, and sexual orientation had a significant effect on survivors' FOR, in that sexual minority women reported less FOR than heterosexual women. Other determinants of survivors' FOR included their medical characteristics, coresidence with caregivers, and caregivers' social support and use of counseling. Caregivers' FOR was related to their social support and survivors' medical characteristics.

CONCLUSIONS

This study suggests a need for caregiver interventions. Because survivors' FOR is affected by caregivers' FOR, caregiver interventions will likely benefit survivors' FOR.

IMPLICATIONS FOR CANCER SURVIVORS

Both sexual minority and heterosexual breast cancer survivors' FOR are affected by their caregivers' FOR, which suggests that the caregivers of breast cancer survivors are central for the survivors' well-being and shall therefore be integrated into the care process.

Tobacco Use and Its Relationship to Social Determinants of Health in LGBT Populations of a Midwestern State

PURPOSE

Researchers have documented that lesbian, gay, bisexual, and transgender (LGBT) people have a higher proportion of tobacco use as compared to general population smoking rates. This study examined the relationships between tobacco use and social determinants of health in a sample of self-identifying LGBT people who spend time in Nebraska.

METHODS

A community-based participatory research approach was used to develop an online survey to assess the physical, mental, social, and sexual health of LGBT populations who live, work, or play in Nebraska. Chi-squared and logistic regression analyses explored the use of tobacco among respondents.

RESULTS

Of the 770 people who completed the survey, 763 respondents completed questions about smoking status. The prevalence of current smoking among these 763 respondents was 26.47%. Some LGBT-specific social determinants of health had significant relationships to smoking status. However, after controlling for known risk factors of smoking in logistic regression models, these variables were not related to smoking status.

CONCLUSIONS

This study shows that there is a significant relationship between smoking and several general social determinants of health, including employment status, education, and income as well as binge drinking. Limitations include lack of adequate survey respondents to divide subgroups of LGBT individuals and inherent limitations of convenience sampling, which may not allow for an accurate representation of the situation faced by LGBT in Nebraska. In addition to this, the list of LGBT-specific determinants of health used in the survey may not be exhaustive, and there may be additional factors facing LGBT individuals. Public health professionals can use this information in designing smoking reduction campaigns for LGBT populations in Nebraska and culturally similar regions of the United States. These programs and interventions may want to consider a more holistic approach to smoking cessation grounded in the social-ecological model.

Mental Health in Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth

Today's lesbian, gay, bisexual, and transgender (LGBT) youth come out at younger ages, and public support for LGBT issues has dramatically increased, so why do LGBT youth continue to be at high risk for compromised mental health? We provide an overview of the contemporary context for LGBT youth, followed by a review of current science on LGBT youth mental health. Research in the past decade has identified risk and protective factors for mental health, which point to promising directions for prevention, intervention, and treatment. Legal and policy successes have set the stage for advances in programs and practices that may foster LGBT youth mental health. Implications for clinical care are discussed, and important areas for new research and practice are identified.

The Predictive Syndemic Effect of Multiple Psychosocial Problems on Health Care Costs and Utilization among Sexual Minority Women

Previous studies documenting sexual minority women's disproportionate risk for a range of medical, mental health, and substance use disorders have not provided a predictive framework for understanding their interrelations and outcomes. The present study aimed to address this gap by testing the syndemic effect of co-occurring psychosocial problems on 7-year health care costs and utilization among sexual minority women. The sample was comprised of sexual minority women (N = 341) who were seen at an urban LGBT-affirmative community health center. Medical and mental health care utilization and cost data were extracted from electronic medical records. Demographically adjusted regression models revealed that co-occurring psychosocial problems (i.e., childhood sexual abuse, partner violence, substance use, and mental health distress [history of suicide attempt]) were all strongly interrelated. The presence of these indicators had a syndemic (additive) effect on medical costs and utilization and mental health utilization over 7-year follow-up, but no effect on 7-year mental health costs. These results suggest that the presence and additive effect of these syndemic conditions may, in part, explain increased medical costs and utilization (and higher medical morbidity) among sexual minority women.

Sexual identity and prevalence of alcohol and other drug use among Australians in the general population

BACKGROUND

International research assessing differences in the prevalence of alcohol and other drug (AOD) use among Lesbian Gay Bisexual and Transgender (LGBTI) and heterosexual populations shows elevated prevalence rates of substance use among LGBTI people. To date no research has been published investigating these differences at a population level among both men and women in Australia.

METHODS

The 2013 National Drug Strategy Household Survey, a multistage stratified population sample collecting data on AOD use in the Australian population over 14 years of age, was analysed for differences between gay and bisexual (GB) men and lesbian/gay and bisexual (LGB) women and their heterosexual counterparts in: (1) the prevalence of lifetime and past year tobacco and AOD use; (2) age of initiation of tobacco and AOD use; and (3) frequency of alcohol and cannabis use, and history of AOD treatment.

RESULTS

There were elevated rates of past year cannabis (22.4%), ecstasy (11.8%) and methamphetamine (9.7%) use among GB men compared to heterosexual men (12.4%, 2.9% and 2.5%). LGB women also reported elevated rates of past year use (tobacco - 23.7%; cannabis - 24.6%) compared to heterosexual women (10.6% and 7.1%). LGB women initiated tobacco (15.2 years) and alcohol (15.5 years) at an earlier age than heterosexual women (16.6 and 17.7 years), and were significantly more likely to report daily alcohol consumption (OR 3.2, 95% CI: 2.1, 5.1), and weekly or more frequent cannabis use (OR 1.7, 95%CI: 1.1, 3.1).

CONCLUSIONS

These findings are indicative of the need for more responsive and targeted AOD harm reduction and treatment services for LGBTI communities in Australia. Of concern is the elevated risk among LGB women for earlier initiation of substance use, and the development of problematic consumption patterns. Further research, investigating the risk and protective factors for AOD use among LGB women is warranted.

Intragroup Variance in Lesbian, Gay, and Bisexual Tobacco Use Behaviors: Evidence That Subgroups Matter, Notably Bisexual Women

INTRODUCTION

Emerging evidence suggests bisexual populations are at increased risk for a variety of negative health outcomes, including tobacco use. Lesbian, gay, and bisexual (LGB) populations are at increased risk for cigarette smoking, but research on LGB subpopulations' use of tobacco products beyond cigarettes and tobacco use differences across LGB subgroups is in its infancy. This study explores differences in use of tobacco products across LGB subgroups, including gender differences among bisexuals.

METHODS

This study reports results from a 2013 nationally-representative cross-sectional online survey of US adults (N = 17 087). Weighted tobacco use prevalence and adjusted logistic regression results are reported.

RESULTS

LGB populations reported higher current use of any tobacco product (35.7%) and current use of cigarettes (32.0%), e-cigarettes (8.9%), regular (5.5%) and small cigars (11.6%), compared with non-LGB. Bisexual (odds ratio [OR] = 2.6, 95% confidence interval [CI]: 1.7-3.9) and lesbian (OR = 1.7, 95% CI: 1.0-2.7) women have higher odds of any tobacco use than heterosexual women; including greater odds of regular (OR = 2.9, 95% CI: 1.2-7.0 and OR = 2.2, 95% CI: 1.3-3.9; respectively) and small cigar use (OR = 2.4, 95% CI: 1.4-4.1 and OR = 3.2, 95% CI: 2.0-5.1; respectively). Gay men had lower odds of cigar use (OR = 0.4, 95% CI: 0.2-0.8) than heterosexual men.

CONCLUSIONS

This is the first US adult population study to assess differences in use of various tobacco products across adult LGB subpopulations and by gender, confirming their increased risk of use and illuminating differences by subgroup and gender. Exploring LGB as a unified population appears inadequate to accurately characterize LGB tobacco use risk. Tobacco-related LGB health inequities, particularly among bisexual and lesbian women, may be greater than previously indicated.

IMPLICATIONS

This manuscript provides important contributions to the field of tobacco control and prevention, and more specifically to LGB tobacco-related health disparities research. This is among the first population level studies to explore various tobacco use across LGB populations and across genders, comparing results to non-LGB populations in a national study. We provide novel evidence that bisexual women in particular, have a higher risk for use of various tobacco products, compared with other LGB subpopulations. In order to address this disparity, tobacco control professionals need to be made aware of these important differences in tobacco use behavior.

Depression and anxiety in patients with and without same-sex attraction: differences in clinical expression, lifestyle factors, and vulnerability indicators

BACKGROUND

The aim of this study was to compare clinical expressions (severity and loneliness), lifestyle factors (substance use), and vulnerability indicators (stressful childhood experiences) in patients with any same-sex attraction versus heterosexual patients diagnosed with depression and/or anxiety disorder. Little is known about this, even though it is now well documented that depression and anxiety are more prevalent among persons with same-sex attraction.

METHOD

Data, derived from the Netherlands Study of Depression and Anxiety (NESDA), allowed us to compare patients with a same-sex (n = 122) and an exclusively opposite-sex (n = 1658) attraction. Persons with same-sex attraction included persons who were attracted to both sexes. Data were collected by means of the Composite International Diagnostic Interview and paper-and pencil questionnaires.

RESULTS

Seven percent of the patients reported any same-sex orientation. Clinical expression of depression and anxiety did not differ in relation to sexual attraction. Regarding substance use, same-sex attracted women reported more drug use than heterosexual women (drug use: 16.2% vs. 6.6%, P = 0.003). Regarding stressful childhood experiences, men with any same-sex attraction reported more sexual abuse during childhood than men with a heterosexual orientation (20.4% vs. 8.5%, P = 0.005).

CONCLUSIONS

For women with same-sex attraction substance use (especially illicit drug use) might be a coping mechanism to deal with existing symptoms or with the minority stressors they have to deal with; for same-sex attracted men stressful childhood experiences might reflect an aspect of etiology.

Minority Stress and Physical Health Among Sexual Minorities

Lesbian, gay, and bisexual (LGB) individuals suffer serious mental health disparities relative to their heterosexual peers, and researchers have linked these disparities to difficult social experiences (e.g., antigay victimization) and internalized biases (e.g., internalized homophobia) that arouse stress. A recent and growing body of evidence suggests that LGB individuals also suffer physical health disparities relative to heterosexuals, ranging from poor general health status to increased risk for cancer and heightened diagnoses of cardiovascular disease, asthma, diabetes, and other chronic conditions. Despite recent advances in this literature, the causes of LGB physical health problems remain relatively opaque. In this article, we review empirical findings related to LGB physical health disparities and argue that such disparities are related to the experience of minority stress-that is, stress caused by experiences with antigay stigma. In light of this minority stress model, we highlight gaps in the current literature and outline five research steps necessary for developing a comprehensive knowledge of the social determinants of LGB physical health.