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Flentje A, Sunder G, Ceja A, Lisha NE, Neilands TB, Aouizerat BE, Lubensky ME, Capriotti MR, Dastur Z, Lunn MR, Obedin-Maliver J. Cannabis use trajectories over time in relation to minority stress and gender among sexual and gender minority people. Addict Behav 2024; 157:108079. [PMID: 38878644 DOI: 10.1016/j.addbeh.2024.108079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/20/2024] [Accepted: 06/05/2024] [Indexed: 07/28/2024]
Abstract
Substance use disparities among sexual and gender minority (SGM) people are attributed to minority stress, but few studies have examined minority stress and cannabis use over time or investigated differences in cannabis use trajectories by less-studied gender subgroups. We examined if longitudinal cannabis use trajectories are related to baseline minority stressors and if gender differences persisted after accounting for minority stress. Cannabis use risk was measured annually over four years (2017-2021) within a longitudinal cohort study of SGM adults in the United States (N = 11,813). Discrimination and victimization, internalized stigma, disclosure and concealment, and safety and acceptance comprised minority stress (n = 5,673). Latent class growth curve mixture models identified five cannabis use trajectories: 'low or no risk', 'low moderate risk', 'high moderate risk', 'steep risk increase', and 'highest risk'. Participants who reported past-year discrimination and/or victimization at baseline had greater odds of membership in any cannabis risk category compared to the 'low risk' category (odds ratios [OR] 1.17-1.33). Internalized stigma was related to 'high moderate' and 'highest risk' cannabis use (ORs 1.27-1.38). After accounting for minority stress, compared to cisgender men, gender expansive people and transgender men had higher odds of 'low moderate risk' (ORs 1.61, 1.67) or 'high moderate risk' (ORs 2.09, 1.99), and transgender men had higher odds of 'highest risk' (OR 2.36) cannabis use. This study indicates minority stress is related to prospective cannabis use risk trajectories among SGM people, and transgender men and gender expansive people have greater odds of trajectories reflecting cannabis use risk.
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Affiliation(s)
- Annesa Flentje
- Community Health Systems, School of Nursing, University of California, San Francisco, CA, United States; Alliance Health Project, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, CA, United States; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, United States.
| | - Gowri Sunder
- Community Health Systems, School of Nursing, University of California, San Francisco, CA, United States; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, United States
| | - Alexis Ceja
- Community Health Systems, School of Nursing, University of California, San Francisco, CA, United States; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, United States
| | - Nadra E Lisha
- Center for Tobacco Control and Research and Education, University of California, San Francisco, CA, United States; Division of Prevention Science, Department of Medicine, University of California, San Francisco, CA, United States
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, CA, United States
| | - Bradley E Aouizerat
- College of Dentistry, Translational Research Center, New York University, New York, NY, United States; Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Micah E Lubensky
- Community Health Systems, School of Nursing, University of California, San Francisco, CA, United States; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, United States
| | - Matthew R Capriotti
- Department of Psychology, College of Social Sciences, San José State University, San José, CA, United States
| | - Zubin Dastur
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, United States; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, United States
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, United States; Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, United States; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, United States; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, United States
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2
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Huh J, Blevins B, Wong K, Lee R, Herzig SE, Unger JB, Oh H. The underrepresentation of racial/ethnic minorities in research on co-use of nicotine, alcohol, and/or cannabis via ecological momentary assessment methods: A narrative review. Drug Alcohol Depend 2024; 262:111391. [PMID: 39047639 PMCID: PMC11330314 DOI: 10.1016/j.drugalcdep.2024.111391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/29/2024] [Accepted: 07/04/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Co-use of nicotine, alcohol and/or cannabis is common among adults in the United States. Co-use may represent greater addiction severity than single substance use. Recent studies have examined the extent to which the frequency, order, simultaneity, motivations, and contextual factors associated with co-use differ from that of single use. Co-use has become prevalent among racial/ethnic minority individuals who exhibit distinct co-use patterns and related outcomes; however, most of these studies rely on cross-sectional or sparse longitudinal observations. Ecological momentary assessment (EMA) can illuminate such patterns and associations with time-varying contexts. This review summarizes EMA studies on co-use published from 2008 to 2023 involving racial/ethnic minority individuals and point to gaps. Our review addresses: 1) whether use of one substance leads to substitution or complementary use of another, 2) whether antecedents/contexts differ by co-use patterns and minority status, and 3) what consequences of co-use have been documented across co-use patterns or minority status. METHODS Search results yielded 465 articles, with 33 meeting inclusion criteria. We extracted study-level characteristics and synthesized the findings. RESULTS The findings largely focused on co-use patterns, categories of co-use, proximal antecedents and contexts, and consequences. Variations by minority status were rarely examined; few examined acute effects of unique experiences that may contribute to co-use among racial/ethnic minority adults. CONCLUSIONS The EMA literature on co-use is burgeoning in recent years and supports complementary hypothesis. More research to capture time-intensive data on experiences to contextualize the co-use among racial/ethnic minority groups with greater diversity in race/ethnicity is warranted.
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Affiliation(s)
- Jimi Huh
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA.
| | - Brittany Blevins
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA
| | - Kelly Wong
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA
| | - Ryan Lee
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA
| | - Shirin E Herzig
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA
| | - Hans Oh
- Suzanne Dworak-Peck School of Social Work, USC, USA
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3
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Martin-Storey A, Zhao Z, Toomey RB, Syvertsen AK. Sexual Minority Identity and Risky Alcohol Use: the Moderating Role of Aggressive Behavior. J Youth Adolesc 2024:10.1007/s10964-024-02057-9. [PMID: 39037558 DOI: 10.1007/s10964-024-02057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 07/09/2024] [Indexed: 07/23/2024]
Abstract
Adolescent alcohol use has significant consequences for concurrent and longitudinal health and wellbeing, with sexual minority youth consistently reporting higher levels of alcohol use than their heterosexual peers. Understanding how individual-difference variables like aggressive behavior are associated with variability in sexual minority adolescents' higher levels of alcohol use offers novel theoretical insight into this vulnerability. The 81,509 participants were drawn from the Profiles of Student life: Attitudes and Behavior Study. They were ages 14-17 years (M = 15.38, SD = 1.09) and 50.1% were cisgender girls. For sexual identity, 88% were heterosexual, 5% were mostly heterosexual, were 4% bisexual, were 1% mostly gay or lesbian, and were 1% being gay or lesbian. Participants reported on alcohol use, aggressive behavior, and sexual identity. Gay/lesbian and mostly gay/lesbian adolescents who reported higher aggressive behavior had higher levels of alcohol use than their heterosexual peers who also reported higher aggressive behavior. The way in which aggressive behavior amplified the link between mostly gay/lesbian and gay/lesbian identities and alcohol use suggests the need for more research examining how this trait may heighten both exposure and reaction to minority stressors among some subgroups of sexual minority youth.
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Affiliation(s)
- Alexa Martin-Storey
- Département de Psychoéducation, Université de Sherbrooke, 150 Place Charles Le Moyne, Longueuil, QC, J4K 0A8, Canada.
| | - Zhenqiang Zhao
- Psychology Department, Fordham University; 439 Dealy Hall, Bronx, NY, 10458, USA
| | - Russell B Toomey
- Norton School of Human Ecology, University of Arizona, Tucson, AZ, 85719, USA
| | - Amy K Syvertsen
- American Institutes for Research, 2150 River Plaza Drive, Suite 185, Sacramento, CA, 95833, USA
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McQuoid J, Regan T, Devkota J, Cheney MK, Kumar V, Oehlers J, Lopez-Paguyo K, Nguyen N, Meacham MC, Ling PM, Thrul J. Situations and roles of cannabis versus cigarette use: Integrating ecological momentary assessment with qualitative mapping interviews. Health Place 2024; 89:103314. [PMID: 39032204 DOI: 10.1016/j.healthplace.2024.103314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/24/2024] [Accepted: 07/04/2024] [Indexed: 07/22/2024]
Abstract
Use of both cannabis and tobacco has surpassed use of tobacco alone among young adults in California. To better understand why, we collected data with 32 young adults ages 18-30 in Northern California who regularly used cigarettes and cannabis and had diverse sexual, gender, racial, and ethnic identities. Geographically-explicit ecological momentary assessment (EMA; 30 days) was integrated with qualitative mapping interviews. We found contrasting situations of use for cannabis (e.g., around other people) versus cigarettes (e.g., recent discrimination) and different reasons for why participants chose one substance over the other (e.g., enhancing experiences vs. stepping away). Understanding when and why diverse young adults choose cannabis versus cigarettes as they navigate everyday environments helps explain how cannabis and tobacco retail markets shape substance use disparities over time.
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Affiliation(s)
- Julia McQuoid
- TSET Health Promotion Research Center, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Timothy Regan
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janardan Devkota
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marshall K Cheney
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
| | - Vaishnavi Kumar
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
| | - Julia Oehlers
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA; John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Kekoa Lopez-Paguyo
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
| | - Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Meredith C Meacham
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA; Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.
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5
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Yi M, Li X, Chiaramonte D, Sun S, Pan S, Soulliard Z, Eisenstadt BE, Ljótsson B, Hagaman A, Pachankis J. Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: A randomized controlled trial among sexual minority men in China. Behav Res Ther 2024; 181:104605. [PMID: 39029333 DOI: 10.1016/j.brat.2024.104605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/09/2024] [Accepted: 07/12/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVE LGBTQ-affirmative cognitive-behavioral therapy (CBT) addresses minority stress to improve sexual minority individuals' mental and behavioral health. This treatment has never been tested in high-stigma contexts like China using online delivery. METHOD Chinese young sexual minority men (n = 120; ages 16-30; HIV-negative; reporting depression and/or anxiety symptoms and past-90-day HIV-transmission-risk behavior), were randomized to receive 10 sessions of culturally adapted asynchronous LGBTQ-affirmative internet-based CBT (ICBT) or weekly assessments only. The primary outcome included HIV-transmission-risk behavior (i.e., past-30-day condomless anal sex). Secondary outcomes included HIV social-cognitive mechanisms (e.g., condom use self-efficacy), mental health (e.g., depression), and behavioral health (e.g., alcohol use), as well as minority stress (e.g., acceptance concerns), and universal (e.g., emotion regulation) mechanisms at baseline and 4- and 8-month follow-up. Moderation analyses examined treatment efficacy as a function of baseline stigma experiences and session completion. RESULTS Compared to assessment only, LGBTQ-affirmative ICBT did not yield greater reductions in HIV-transmission-risk behavior or social-cognitive mechanisms. However, LGBTQ-affirmative ICBT yielded greater improvements in depression (d = -0.50, d = -0.63) and anxiety (d = -0.51, d = -0.49) at 4- and 8-month follow-up, respectively; alcohol use (d = -0.40) at 8-month follow-up; and certain minority stress (e.g., internalized stigma) and universal (i.e., emotion dysregulation) mechanisms compared to assessment only. LGBTQ-affirmative ICBT was more efficacious for reducing HIV-transmission-risk behavior for participants with lower internalized stigma (d = 0.42). Greater session completion predicted greater reductions in suicidality and rumination. CONCLUSIONS LGBTQ-affirmative ICBT demonstrates preliminary efficacy for Chinese young sexual minority men. Findings can inform future interventions for young sexual minority men in contexts with limited affirmative supports.
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Affiliation(s)
- Mengyao Yi
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China.
| | | | - Shufang Sun
- Brown University School of Public Health, Providence, RI, USA
| | - Si Pan
- The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | | | | | | | - Ashley Hagaman
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - John Pachankis
- Yale School of Public Health, Yale University, New Haven, CT, USA.
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Surace A, Operario D, Kahler C. The association between discrimination and drinking among sexual minorities: A daily diary study. Addict Behav Rep 2024; 19:100554. [PMID: 38827376 PMCID: PMC11140561 DOI: 10.1016/j.abrep.2024.100554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/24/2024] [Accepted: 05/16/2024] [Indexed: 06/04/2024] Open
Abstract
Background Among sexual minorities (SMs), experiencing discrimination has been associated with greater substance use at the day-level. However, variations in sample characteristics and measures of day-level discrimination limit the generalizability of findings. Furthermore, it is unknown how positive experiences due to minority identity ("Minority Strengths") may impact the association between experiencing discrimination and same day drinking. Methods The present study extends prior research on discrimination and drinking using detailed discrimination measures, Minority Strengths measures, and a gender diverse sample. Participants (N = 61) were majority White (n = 45, 73.8 %) adult (mean age 26.8 years) self-identified SMs (e.g., 44.3 % identified as "gay") who engaged in alcohol use within the past month. Participants completed up to 31 days of daily diary surveys about their experiences and drinking. Recruitment took place in the northeastern U.S. from May to December 2021. Results Multilevel model analysis indicated that experiencing discrimination was associated with increased same day drinking among Black, Indigenous, people of color (BIPOC) participants but not among White participants. A significant gender by discrimination interaction indicated that cisgender men drank more the same day they experienced discrimination compared to cisgender women and transgender/non-binary participants. Minority Strengths had no impact on these relationships. Conclusions Results highlight that the experience of discrimination and its association with drinking may be influenced by a host of contextual factors that are attached to racial and gender identities. Future research should examine how discrimination in different contexts (e.g., regions) and based on specific identities may be associated with alcohol use.
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Affiliation(s)
- A. Surace
- Public Health Institute, Alcohol Research Group, Emeryville, USA
| | - D. Operario
- Department of Behavioral and Social Sciences, Rollins School of Public Health, Atlanta, USA
| | - C.W. Kahler
- Center for Alcohol and Addictions Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, USA
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7
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Flentje A, Sunder G, Ceja A, Lisha NE, Neilands TB, Aouizerat BE, Lubensky ME, Capriotti MR, Dastur Z, Lunn MR, Obedin-Maliver J. Substance Use Over Time Among Sexual and Gender Minority People: Differences at the Intersection of Sex and Gender. LGBT Health 2024; 11:269-281. [PMID: 38206680 DOI: 10.1089/lgbt.2023.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Purpose: Sexual and gender minority (SGM) people are at greater risk for substance use than heterosexual and cisgender people, but most prior work is limited by cross-sectional analyses or the examination of single substance use. This study examined substance use over time among SGM people to identify patterns of polysubstance use at the intersection of sex and gender. Methods: Data were collected annually over 4 years from SGM respondents (n = 11,822) in The Population Research in Identity and Disparities for Equality (PRIDE) Study. Differences in substance use patterns (any prior 30-day use of 15 substances) by gender subgroup were examined with latent class analysis, and multinomial regression models tested relationships between gender subgroup and substance use. Results: Eight classes of substance use were observed. The three most common patterns were low substance use (49%), heavy episodic alcohol use (≥5 alcoholic drinks on one occasion) with some cannabis and tobacco use (14%), and cannabis use with some tobacco and declining heavy episodic alcohol use (13%). Differences observed included lower odds of patterns defined by heavy episodic alcohol use with some cannabis and tobacco use in all gender subgroups relative to cisgender men and persons with low substance use (odds ratios [ORs] 0.26-0.60). Gender expansive people assigned female at birth, gender expansive people assigned male at birth, and transgender men had greater odds of reporting cannabis use with small percentages of heavy episodic alcohol and tobacco use (ORs: 1.41-1.60). Conclusion: This study suggests that there are unique patterns of polysubstance use over time among gender subgroups of SGM people.
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Affiliation(s)
- Annesa Flentje
- Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California, USA
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA
| | - Gowri Sunder
- Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California, USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA
| | - Alexis Ceja
- Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California, USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA
| | - Nadra E Lisha
- Center for Tobacco Control and Research and Education, University of California, San Francisco, San Francisco, California, USA
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Bradley E Aouizerat
- College of Dentistry, Translational Research Center, New York University, New York, New York, USA
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Micah E Lubensky
- Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California, USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA
| | - Matthew R Capriotti
- Department of Psychology, College of Social Sciences, San José State University, San José, California, USA
| | - Zubin Dastur
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
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8
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Dyar C, Dworkin ER, Kaysen D. Contexts of social alcohol and cannabis use among sexual minority cisgender women and gender diverse individuals: Event-level differences in alcohol and cannabis use patterns based on the sexual orientations and gender identities of substance use companions. Addict Behav 2024; 151:107935. [PMID: 38104420 PMCID: PMC10872884 DOI: 10.1016/j.addbeh.2023.107935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE Sexual minority women and gender diverse individuals assigned female at birth (SMWGD) are at elevated risk for alcohol and cannabis use disorders. It has been posited that characteristics of SMWGD's substance use companions (i.e., sexual orientation, gender identity) may influence their own use, but few studies have tested this. The current study aimed to examine whether quantity and consequences of substance use varied based on sexual orientations and gender identities (SOGI) of SMWGD's substance use companions. METHODS We utilized a 30-day ecological momentary assessment study of substance use among a sample of 429 SMWGD. We examined event-level associations between characteristics of substance use companions and quantity and consequences of substance use. RESULTS When SMWGD used alcohol/cannabis with most SOGI groups, they engaged in heavier drinking and cannabis use. Drinking with heterosexual men and SMW was associated with more drinking consequences. Drinking in settings with more SOGI groups and with both LGBTQ+ and heterosexual individuals was associated with heavier drinking and more consequences. Many contextual aspects of cannabis use settings predicted an increased likelihood of alcohol and cannabis co-use, while few contextual aspects of drinking settings were associated with co-use. CONCLUSION Results suggest that SMWGD engage in heavier substance use when individuals from a range of SOGI groups are present, highlighting that heavy alcohol and cannabis use is not limited to use with SMW and nonbinary individuals. Drinking in setting with more SOGI groups present (e.g., parties and bars) appears to be associated with particularly heavy drinking and consequences.
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Affiliation(s)
- Christina Dyar
- College of Nursing, Ohio State University, Columbus, OH, USA.
| | - Emily R Dworkin
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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9
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Tapia AL, Wallace ML, Hasler BP, Holmes J, Pedersen SL. Effect of daily discrimination on naturalistic sleep health features in young adults. Health Psychol 2024; 43:298-309. [PMID: 38190204 PMCID: PMC10939866 DOI: 10.1037/hea0001359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
OBJECTIVE Racial inequities in sleep health are well documented and may be partially attributable to discrimination experiences. However, the effects of acute discrimination experiences on same-night sleep health are understudied. We quantified naturalistic discrimination experiences captured using ecological momentary assessment (EMA) and examined whether reporting discrimination on a given day predicted sleep health that night. METHOD Participants completed baseline assessments and a 17-day EMA protocol, with text prompts delivered four times daily to collect discrimination experiences. Seven different daily sleep characteristics were ascertained each morning. Discrimination reasons (e.g., because of my racial identity) were reported by participants and categorized into any, racial, or nonracial discrimination. Outcomes included the seven sleep diary characteristics. We fit generalized linear mixed effects models for each sleep outcome and discrimination category, controlling for key covariates. RESULTS The analytic sample included 116 self-identified Black and White individuals (48% Black, 71% assigned female at birth, average age = 24.5 years). Among Black participants, race-based discrimination was associated with a 0.5-hr reduction in total sleep time (TST). Among White individuals, nonracial discrimination was associated with a 0.6-hr reduction in TST, an earlier sleep offset, and reduced sleep efficiency (partly attributable to more nighttime awakenings). CONCLUSIONS Young adults may sleep worse on nights after experiencing discrimination, and different types of discrimination affect different sleep outcomes for Black and White individuals. Future studies may consider developing treatments that account for different sleep vulnerabilities for people experiencing discrimination on a given day. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | - Meredith L. Wallace
- Department of Psychiatry, University of Pittsburgh
- Department of Statistics, University of Pittsburgh
- Department of Biostatistics, University of Pittsburgh
| | - Brant P. Hasler
- Department of Psychiatry, University of Pittsburgh
- Department of Psychology, University of Pittsburgh
- Clinical and Translational Science, University of Pittsburgh
| | | | - Sarah L. Pedersen
- Department of Psychiatry, University of Pittsburgh
- Department of Psychology, University of Pittsburgh
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10
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Rodríguez-Expósito B, Rieker JA, Uceda S, Beltrán-Velasco AI, Echeverry-Alzate V, Gómez-Ortega M, Positivo A, Reiriz M. Psychological characteristics associated with chemsex among men who have sex with men: Internalized homophobia, conscientiousness and serostatus as predictive factors. Int J Clin Health Psychol 2024; 24:100465. [PMID: 38737628 PMCID: PMC11088328 DOI: 10.1016/j.ijchp.2024.100465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/23/2024] [Indexed: 05/14/2024] Open
Abstract
Background Although significant progress has been made in the rights of the LGBTQ+ community, even today this population still faces stigma and discrimination that impacts their mental health. In the case of men who have sex with men, it has been demonstrated that the use of drugs in a sexual context (chemsex) is one of the coping mechanisms and means of escape to deal with these situations. Method We assessed 284 native Spanish speakers' participants, 45,4 % were not engaged in sexualised drug use (n = 129) while 54,6 % were chemsex users (n = 155) using 18,7 % of them the injected via. The participants completed six questionnaires about life and sexual satisfaction, depression, anxiety, internalised homophobia and personality. Bivariate and multivariable logistic regression were performed to assess the associations between sexual behaviour-related and psychological variables. Kruskal-Wallis H test was used to analysed the impact on mental health of the administration via. Results Aged, unprotected sexual relationships, positive serostatus, homonegativity and conscientiousness predicted the chemsex engagement. Furthermore, we found differences regarding the administration via. Conclusions We conclude that mental health significantly correlates with the practice of chemsex, highlighting the importance of integrating mental health considerations into the prevention of risky sexual behaviors.
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Affiliation(s)
- Benjamín Rodríguez-Expósito
- Nebrija University, Facultad de Lenguas y Educación, Universidad Antonio de Nebrija, Madrid 28240, Spain
- Departament of Psychology, UNED, Seville, Spain
| | - Jennifer A. Rieker
- NBC Group, Psychology Department, School of Life and Nature Sciences, Nebrija University, Madrid, Spain
| | - Sara Uceda
- NBC Group, Psychology Department, School of Life and Nature Sciences, Nebrija University, Madrid, Spain
| | | | - Víctor Echeverry-Alzate
- NBC Group, Psychology Department, School of Life and Nature Sciences, Nebrija University, Madrid, Spain
| | | | | | - Manuel Reiriz
- NBC Group, Psychology Department, School of Life and Nature Sciences, Nebrija University, Madrid, Spain
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Nicholas J, Bresin K. Everyday Sexual and Gender Minority Stress and Health: A Systematic Review of Experience Sampling Studies. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1221-1243. [PMID: 38172351 DOI: 10.1007/s10508-023-02779-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024]
Abstract
Sexual and gender minority stress is associated with negative physical and mental health outcomes, such as hypertension and depression. Expanding on previous reviews of the literature on cross-sectional and long-term prospective associations between sexual and gender minority stress and health outcomes, the current systematic review synthesizes the evidence on how everyday sexual and gender minority stress relates to momentary changes in health. The findings of 53 experience sampling studies published between 2007 and 2022 suggest that daily and momentary within-persons fluctuations in minority stressors are associated with cognitive-emotional (e.g., affect, suicidality), behavioral (e.g., substance use), social (e.g., relationship satisfaction), and physical health outcomes (e.g., somatic symptoms). These findings suggest that sexual and gender minority stress is a dynamic process that can vary within individuals over time and significantly impact everyday mental and physical health. We discuss the implications of these findings for minority stress theory, LGBTQ+ health research, LGBTQ+ affirming therapy, and prevention initiatives. The current experience sampling literature is limited by a lack of attention to gender minority stress and a focus on a limited range of health outcomes. Methodological and theoretical considerations for future experience sampling research are discussed in light of these limitations.
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Affiliation(s)
- Julia Nicholas
- Department of Psychological and Brain Sciences, University of Louisville, 317 Life Sciences Building, Louisville, KY, 40292, USA.
| | - Konrad Bresin
- Department of Psychological and Brain Sciences, University of Louisville, 317 Life Sciences Building, Louisville, KY, 40292, USA
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12
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Kaplan DM, Tidwell CA, Chung JM, Alisic E, Demiray B, Bruni M, Evora S, Gajewski-Nemes JA, Macbeth A, Mangelsdorf SN, Mascaro JS, Minor KS, Noga RN, Nugent NR, Polsinelli AJ, Rentscher KE, Resnikoff AW, Robbins ML, Slatcher RB, Tejeda-Padron AB, Mehl MR. Diversity, equity, and inclusivity in observational ambulatory assessment: Recommendations from two decades of Electronically Activated Recorder (EAR) research. Behav Res Methods 2024; 56:3207-3225. [PMID: 38066394 DOI: 10.3758/s13428-023-02293-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 05/30/2024]
Abstract
Ambient audio sampling methods such as the Electronically Activated Recorder (EAR) have become increasingly prominent in clinical and social sciences research. These methods record snippets of naturalistically assessed audio from participants' daily lives, enabling novel observational research about the daily social interactions, identities, environments, behaviors, and speech of populations of interest. In practice, these scientific opportunities are equaled by methodological challenges: researchers' own cultural backgrounds and identities can easily and unknowingly permeate the collection, coding, analysis, and interpretation of social data from daily life. Ambient audio sampling poses unique and significant challenges to cultural humility, diversity, equity, and inclusivity (DEI) in scientific research that require systematized attention. Motivated by this observation, an international consortium of 21 researchers who have used ambient audio sampling methodologies created a workgroup with the aim of improving upon existing published guidelines. We pooled formally and informally documented challenges pertaining to DEI in ambient audio sampling from our collective experience on 40+ studies (most of which used the EAR app) in clinical and healthy populations ranging from children to older adults. This article presents our resultant recommendations and argues for the incorporation of community-engaged research methods in observational ambulatory assessment designs looking forward. We provide concrete recommendations across each stage typical of an ambient audio sampling study (recruiting and enrolling participants, developing coding systems, training coders, handling multi-linguistic participants, data analysis and interpretation, and dissemination of results) as well as guiding questions that can be used to adapt these recommendations to project-specific constraints and needs.
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Affiliation(s)
- Deanna M Kaplan
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Colin A Tidwell
- Department of Psychology, University of Arizona, Tucson, USA
| | - Joanne M Chung
- Department of Psychology, University of Toronto Mississauga, Mississauga, Canada
| | - Eva Alisic
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Burcu Demiray
- Department of Psychology, University of Zurich, Zürich, Switzerland
| | - Michelle Bruni
- Department of Psychology, University of California-Riverside, Riverside, USA
| | - Selena Evora
- Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, USA
| | | | | | | | - Jennifer S Mascaro
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Kyle S Minor
- Department of Psychology, Indiana University - Purdue University Indianapolis, Indianapolis, USA
| | - Rebecca N Noga
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, USA
| | - Nicole R Nugent
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, USA
| | | | - Kelly E Rentscher
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, USA
| | | | - Megan L Robbins
- Department of Psychology, University of California-Riverside, Riverside, USA
| | | | | | - Matthias R Mehl
- Department of Psychology, University of Arizona, Tucson, USA
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13
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Rosati F, Pistella J, Coletta V, Baiocco R. Racialized Migrant Transgender Women Engaged in Sex Work: Double Binds and Identifications with the Community. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1153-1168. [PMID: 38347323 DOI: 10.1007/s10508-023-02804-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 03/09/2024]
Abstract
Racialized migrant transgender women engaged in sex work represent an understudied population. They face unique challenges resulting from their multiple marginalized identities, such as racialized transmisogyny. Since marginalized communities play a vital role in mitigating systemic stigma, it is essential to expand the literature on the community of this population. The present study used the frameworks of gender minority stress and intersectionality, along with a decolonial and transfeminist approach. Twenty participants aged between 28 and 66 years old (M = 43.15; SD = 10.49) took part in a semi-structured interview. Thematic analysis identified two main areas with ten corresponding themes. "The double bind of community" described the complex dynamics experienced by transgender refugees within their community, including (1) sex work between emancipation and exploitation, (2) non-prescribed treatments for gender affirmation, (3) negative experiences with the community, (4) positive impact of trans organizations, and (5) practical and economic support and exploitation. "The identification with the community" highlighted how participants positively or negatively identified with the community, containing: (6) awareness of one's privileges and oppressions, (7) internalized cisgenderism and assimilation, (8) gender euphoria; (9) sexual objectification, and (10) trans-generativity. The study evidenced the complex dynamics within marginalized communities. Trauma, stigma, and survival struggles can lead to violence and exploitation within the community. However, the community also has the potential to promote positive feelings and generativity. These findings have practical implications for social workers, healthcare practitioners, and researchers, emphasizing the need for appropriate and culturally competent care, including resources for coping with stress, fostering resilience, and facilitating post-traumatic growth.
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Affiliation(s)
- Fau Rosati
- Department of Human and Social Sciences, University of Valle d'Aosta, Str. Cappuccini, 2, 11100, Aosta, Italy.
| | - Jessica Pistella
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Valentina Coletta
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Roberto Baiocco
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
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Dyar C. The cumulative effects of stigma-related stress: Chronic stigma-related stress exposure exacerbates daily associations between enacted stigma and anxious/depressed affect. Soc Sci Med 2024; 344:116604. [PMID: 38281458 PMCID: PMC10923191 DOI: 10.1016/j.socscimed.2024.116604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE Sexual and gender minority individuals are at elevated risk for mood and anxiety disorders compared to heterosexual and cisgender individuals. Ecological momentary assessments studies have implicated experiences of enacted stigma (i.e., biased treatment) by linking these experiences with elevations in anxious and depressed affect. The current study utilizes a theory from the broader stress and affect literature to determine whether chronic enacted stigma exposure amplifies individuals' negative affective reactions to experiences of enacted stigma at the daily level. METHODS We used data from a 30-day ecological momentary assessment study with 429 sexual minority women and gender diverse sexual minorities assigned female at birth (SMWGD) living in the US in 2020-21 to determine whether concurrent and prospective event-level associations between enacted stigma, anxious/depressed affect, and perceived coping efficacy were moderated by chronic enacted stigma exposure. RESULTS Results demonstrate that individuals with moderate to high chronic stigma exposure experience larger increases in anxious/depressed affect and larger decreases in perceived coping efficacy following daily experiences of enacted stigma. Further, these effects of daily stigma on anxious/depressed affect persist for longer among individuals with high chronic stigma exposure. Interestingly, chronic stigma exposure did not moderate associations between daily general stressors (i.e., those unrelated to identity) and affect or perceived coping efficacy, suggesting that these effects are specific to stigma-related stressors. CONCLUSIONS These results help to advance our understanding of both long-term and daily effects of exposure to enacted stigma, highlighting the potentially profound cumulative effects of stigma exposure and the need to intervene in this cycle.
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Affiliation(s)
- Christina Dyar
- College of Nursing, Ohio State University, 393 Newton Hall 1585 Neil Ave Columbus, OH, 43210, USA.
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15
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Cook SH, Wood EP, Rodrigues M, Jachero Caldas J, Delorme M. Assessment of a Daily Diary Study Including Biospecimen Collections in a Sample of Sexual and Gender Minority Young Adults: Feasibility and Acceptability Study. JMIR Form Res 2024; 8:e52195. [PMID: 38373036 PMCID: PMC10912985 DOI: 10.2196/52195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/21/2023] [Accepted: 01/09/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Young sexual minority men (YSMM) engage in cardiometabolic risk behaviors (eg, substance use) at higher rates than their heterosexual counterparts. Theory and previous research suggest that these risk behaviors may stem, in part, from exposure to minority stress (ie, discrimination based on sexual identity and other identities such as race). OBJECTIVE This pilot study examined the feasibility and acceptability of a virtual 2-day daily diary study that examined daily experiences with discrimination, cardiometabolic risk behaviors (ie, sleep, physical activity, and substance use behaviors), and patterns of physiological stress and inflammation among YSMM aged 18 to 35 years. METHODS Participants (n=20) were recruited from the greater New York metropolitan area and engaged in a 2-day daily diary protocol wherein they provided web-based consent, took a web-based baseline survey, and then, starting the next day, provided 3 saliva samples a day for 2 consecutive days to measure salivary cortisol, engaged in 3 daily diaries per day, and provided 1 blood spot sample via the finger prick method to measure high-sensitivity C-reactive protein. At follow-up, participants were interviewed via videoconferencing to ascertain their experiences and feelings related to the study protocol. Qualitative analyses explored the feasibility and acceptability of the study protocol, and exploratory quantitative analyses explored the descriptive statistics and Pearson correlations among the main study variables of interest. RESULTS The retention rate was high (19/20, 95%) in our study sample. Qualitative analyses demonstrated that participants were willing to engage in similar, longer-term studies (eg, studies that include both week and weekend days) in the future and suggested the feasibility and acceptability of our study protocol among YSMM. However, participants noted several areas for improvement (eg, redundancy of survey items and difficulty pricking one's finger) that should be considered in future research. Preliminary quantitative analyses revealed a moderate negative correlation between everyday discrimination and mean cortisol levels (r=-0.51; P=.03). Furthermore, descriptive analyses suggest that that daily cortisol curves differ across races or ethnicities among YSMM. White and other-identified YSMM experienced the highest cortisol awakening response (mean 0.39, SD 0.21 µg/dL for White participants; mean 0.34, SD 0.34 µg/dL for others) with the steepest decline around bedtime (mean 0.05, SD 0.04 µg/dL for White participants; mean 0.09, SD 0.13 µg/dL for others) followed by a lower cortisol awakening response (mean 0.31, SD 0.11 µg/dL for Hispanic participants; mean 0.23, SD 0.15 µg/dL for Black participants) and a slower decline around bedtime (mean 0.10, SD 0.09 µg/dL for Hispanic participants; mean 0.03, SD 0.02 µg/dL for Black participants) among Hispanic and Black YSMM. CONCLUSIONS Overall, the results suggest that similar study protocols are feasible and acceptable among YSMM. Future research should highlight the pathways through which cardiovascular disease risk may arise among YSMM using longer-term study designs and more diverse study samples.
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Affiliation(s)
- Stephanie H Cook
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
- Department of Biostatistics, School of Global Public Health, New York University, New York, NY, United States
| | - Erica P Wood
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Mariana Rodrigues
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Janice Jachero Caldas
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Maxline Delorme
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
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Booth JM. Using EMA to explore the role of Black adolescents' experiences in activity spaces in momentary negative emotion and marijuana use. Health Place 2024; 85:103158. [PMID: 38070361 PMCID: PMC10922345 DOI: 10.1016/j.healthplace.2023.103158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 02/09/2024]
Abstract
Research examining the role of place in Black adolescents' health behaviors typically examines neighborhoods, with little attention paid to micro geographies such as activity spaces. Understanding experiences in activity spaces may be especially important for Black adolescents living in neighborhoods traditionally characterized as disadvantaged. The SPIN project recruited 75 Black adolescents living in a single neighborhood to complete ecological momentary assessments (EMA) about the activity spaces they encountered over a month. Perceptions of violence and social support in activity spaces in a day are related to marijuana use during the day, relationships partially explained by negative momentary emotions.
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Affiliation(s)
- Jaime M Booth
- University of Pittsburgh, School of Social Work, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA.
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17
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Salomaa AC, Berke D, Harper K, Valentine SE, Sloan CA, Hinds Z, Gyuro L, Herbitter C, Bryant WT, Shipherd JC, Livingston NA. A patient-centered model of mental health care for trauma and minority stress in transgender and gender diverse people: A bottom-up network analysis. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2024; 2024:10.1037/sgd0000705. [PMID: 38765785 PMCID: PMC11100088 DOI: 10.1037/sgd0000705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Transgender and gender diverse (TGD) individuals are disproportionately exposed to traumatic and high-impact minority stressors which can produce an array of transdiagnostic symptoms. Some clinical presentations align well with established evidence-based treatments, but others may require patient-centered modifications or combined approaches to address treatment needs. In this study, we employed a novel, bottom-up approach to derive insights into preferred intervention strategies for a broad range of trauma- and TGD-minority stress-related expressions of clinical distress. Participants (18 TGD individuals, 16 providers) completed a q-sort task by first sorting cards featuring traumatic experiences and/or minority stressors and transdiagnostic psychiatric symptoms into groups based on perceived similarity. Next, participants sorted interventions they believed to be most relevant for addressing these concerns/symptoms. We overlayed networks of stressors and symptoms with intervention networks to evaluate preferred intervention strategies. TGD networks revealed transdiagnostic clustering of intervention strategies and uniquely positioned the expectancy of future harm as a traumatic stressor. Provider networks were more granular in structure; both groups surprisingly emphasized the role of self-defense as intervention. While both networks had high overlap, their discrepancies highlight patient perspectives that practical, material, and structural changes should occur alongside traditional clinical interventions.
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Affiliation(s)
| | - Danielle Berke
- Hunter College, City University of New York
- The Graduate Center, City University of New York
| | - Kelly Harper
- National Center for PTSD, Behavioral Science Division
| | - Sarah E. Valentine
- Boston University Chobanian & Avedisian School of Medicine
- Boston Medical Center
| | - Colleen A. Sloan
- VA Boston Healthcare System
- Boston University Chobanian & Avedisian School of Medicine
| | - Zig Hinds
- VA Boston Healthcare System
- National Center for PTSD, Behavioral Science Division
| | - Lisa Gyuro
- VA Boston Healthcare System
- National Center for PTSD, Women’s Health Sciences Division
| | - Cara Herbitter
- VA Boston Healthcare System
- Boston University Chobanian & Avedisian School of Medicine
| | - William T. Bryant
- Ralph H. Johnson VA Medical Center
- Medical University of South Carolina
| | - Jillian C. Shipherd
- VA Boston Healthcare System
- Boston University Chobanian & Avedisian School of Medicine
- National Center for PTSD, Women’s Health Sciences Division
- LGBTQ+ Health Veterans Health Administration
| | - Nicholas A. Livingston
- VA Boston Healthcare System
- Boston University Chobanian & Avedisian School of Medicine
- National Center for PTSD, Behavioral Science Division
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Drabble LA, Munroe C, Cerezo A, Hughes TL. COVID-19 Concerns, Coping and Perceived Peer Norms: Correlates of Increased Alcohol and Marijuana Use Among Sexual Minority Women. JOURNAL OF HOMOSEXUALITY 2023:1-21. [PMID: 37976208 PMCID: PMC11098966 DOI: 10.1080/00918369.2023.2283835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
This study explored the impact of COVID-related concerns and other characteristics on alcohol and marijuana use among sexual minority women (SMW). Survey data from a racially/ethnically diverse sample of 338 SMW participants in the Chicago Health and Life Experiences of Women (CHLEW) study were used to examine correlates of three substance use outcomes: frequent intoxication (once a month or more), perceived increase in alcohol use, and perceived increase in marijuana use. Coping motives for alcohol use was positively associated with each of the substance use outcomes. Belief that peers (in terms of age, sexual identity, and gender) used alcohol often to cope was associated with higher odds of frequent intoxication. COVID-19 related financial concerns were positively associated with both frequent intoxication and increased marijuana use. Health and mental health concerns were associated with lower odds of frequent intoxication. Findings underscore the importance of enhancing coping skills, addressing perceived peer coping norms, and providing both economic and social support in intervention efforts.
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Affiliation(s)
- Laurie A Drabble
- College of Health and Human Sciences, San José State University, San José, California, USA
| | - Cat Munroe
- Public Health Institute, Alcohol Research Group, Alcohol Research Group, Emeryville, California, USA
| | - Alison Cerezo
- Dept. of Counseling, Clinical & School Psychology, University of California Santa Barbara, Santa Barbara, California, USA
| | - Tonda L Hughes
- Center for Sexual and Gender Minority Health Research, School of Nursing, Columbia University, New York, NY, USA
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Scheer JR, Cascalheira CJ, Helminen EC, Shaw TJ, Schwarz AA, Jaipuriar V, Brisbin CD, Batchelder AW, Sullivan TP, Jackson SD. "I Know Myself Again, Which Makes Me Motivated for Life": Feasibility and Acceptability of Using Experience Sampling Methods With Trauma-Exposed Sexual Minority Women. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:8692-8720. [PMID: 36789733 PMCID: PMC10238639 DOI: 10.1177/08862605231153888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Intensive longitudinal designs (e.g., experience sampling methods [ESMs]) hold promise for examining the dynamic interplay between daily adversity, coping strategies, and behavioral and mental health issues among marginalized populations. However, few studies have used intensive longitudinal designs with sexual minority women (SMW), an understudied and at-risk population. We assessed feasibility and acceptability of using once-daily, interval-contingent ESM with 161 trauma-exposed SMW (Mage = 29.1, SD = 7.57); 20.5% nonbinary; 32.3% queer; 52.2% people of color; 14.3% with annual incomes ≤$9,999; and 30.4% in Southern United States (U.S.). SMW completed one comprehensive online baseline assessment and once-daily brief online assessments for 14 days. Daily surveys assessed past-24-hour stressors, stress responses, and behavioral and mental health symptoms. At the end of the 14-day ESM period, SMW answered three open-ended questions about participating in this study and about research with SMW. Regarding feasibility, 151 participants (94.0%) initiated the post-baseline ESM study portion and 72 (45.0%) completed all 14 daily surveys. An average of 11.70 (median = 13, SD = 3.31) daily surveys (83.5%) were completed by those who initiated the ESM. ESM completion level varied by race/ethnicity and U.S. region. Qualitative acceptability data revealed several themes, namely that SMW (1) enjoyed participating and felt positively about the ESM experience, (2) felt supported to reflect on impacts of early and ongoing stressors, (3) appreciated the chance to self-reflect and challenge existing thought patterns and coping behaviors, (4) recognized their capacity to tolerate trauma-related distress, (5) recommended that researchers focus on SMW's diverse stressors and daily experiences, (6) wanted a rationale for providing sensitive information and more space to narrate their experiences, and (7) recognized the need for affirmative treatment and policies. Findings could inform modifications to ESM protocols to improve their feasibility and acceptability among trauma-exposed SMW and promote ongoing utility of this valuable method.
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Affiliation(s)
| | - Cory J Cascalheira
- Department of Psychology, Syracuse University, NY, USA
- New Mexico State University, Las Cruces, NM,USA
| | - Emily C Helminen
- Department of Psychology, Syracuse University, NY, USA
- Rochester Institute of Technology, Rochester, NY, USA
| | - Thomas J Shaw
- Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | | | | | - Cal D Brisbin
- Luskin School of Public Affairs, The University of California, Los Angeles, CA, USA
| | - Abigail W Batchelder
- Harvard Medical School, Harvard University, Boston, MA, USA
- Behavioral Medicine Program, Massachusetts General Hospital, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Tami P Sullivan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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20
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Simpson MD, Klibert JJ, Pritulsky CL, Weiss BJ. The Conditional Effects of Savoring on the Relationship between Minority Stress and Alcohol Misuse in an LGBTQIA + Sample. Subst Use Misuse 2023; 58:1367-1376. [PMID: 37313581 DOI: 10.1080/10826084.2023.2223268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: Alcohol-related difficulties are a significant public health concern in lesbian, gay, bisexual, transgender, questioning, intersex, asexual, and people with other sexual orientations and forms of gender identity (LGBTQIA+) communities. Considering these concerns, there is a strong push to develop affirming and strength-based prevention efforts. Unfortunately, such efforts are undermined by the lack of protective LGBTQIA + models for alcohol misuse. To this end, the purpose of the current study was to evaluate whether savoring, the ability to create, maintain, and prolong positive emotions, meets basic criteria for a protective factor for alcohol misuse in a sample of LGBTQIA + adults. Methods: The sample was comprised of 226 LGBTQIA + adults who completed an online survey. Results: Results indicated that savoring was inversely related to alcohol misuse. In addition, the relationship between minority stress and alcohol misuse varied as a function of savoring; at high levels of savoring (a score of 136.63 on the Savoring Beliefs Inventory), the relationship between minority stress and alcohol misuse was non-significant. Conclusions: In combination, these findings offer preliminary support for savoring as a protective factor for alcohol misuse among different LGBTQIA + communities. However, longitudinal and experimental research is needed to solidify the role of savoring in minimizing alcohol-related problems in this population.
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Cano MT, Reavis JV, Pennington DL. Perceived discrimination enhances the association between distress and impact related to the murder of George Floyd and unhealthy alcohol use in a survey sample of U.S. Veterans who report drinking. Addict Behav Rep 2023; 17:100481. [PMID: 36713472 PMCID: PMC9876779 DOI: 10.1016/j.abrep.2023.100481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/16/2022] [Accepted: 01/14/2023] [Indexed: 01/18/2023] Open
Abstract
Introduction On May 25, 2020, George Floyd was murdered by a Minneapolis police officer leading to increased social justice and antiracism movements (SJARM) across the United States. Vicarious exposure to racism and perceived discrimination are salient sources of distress which may lead to increased alcohol use as means of coping. The primary aim of the current study was to examine how perceived discrimination and the subjective impact and personal distress related to the SJARM following the George Floyd murder interact and relate to unhealthy alcohol use among U.S. Veterans. Methods 286 Veterans were assessed for unhealthy alcohol use (AUDIT-10), perceived discrimination (EDS), and subjective impact and personal distress related to the SJARM. Two moderation analyses were performed to examine whether subjective impact and personal distress moderated relations between perceived discrimination and alcohol use. In-depth follow-up analyses were conducted to examine differences and relationships among variables. Results In two different moderation models, perceived discrimination moderated the association between both subjective impact (p <.001) and personal distress (p <.001) felt by the SJARM and unhealthy alcohol use. In planned exploratory analyses, Veterans who reported perceived discrimination reported higher levels of unhealthy alcohol use (M = 14.71, SD = 9.39) than those who did not t(2 8 4) = 5.61, p <.001. In post-hoc analyses, racial/ethnic minorities were significantly more likely to report perceived racial discrimination (p <.001) while non-Hispanic Whites were more likely to report perceived discrimination based on education or income level (p <.01). Conclusions In the context of a socially unjust event amidst a global pandemic, perceived discrimination contributes to unhealthy alcohol use and subjective impact and personal distress associated with the SJARM following the murder of George Floyd. Results highlight the importance of addressing discrimination experiences in Veterans who seek alcohol treatment, particularly as rates of unhealthy alcohol use are on the rise.
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Affiliation(s)
- Monique T. Cano
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA 94143, United States
- San Francisco VA Health Care System, San Francisco, CA 94121, United States
| | - Jill V. Reavis
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA 94143, United States
- San Francisco VA Health Care System, San Francisco, CA 94121, United States
- Palo Alto University, Palo Alto, CA 94304, United States
| | - David L. Pennington
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA 94143, United States
- San Francisco VA Health Care System, San Francisco, CA 94121, United States
- Northern California Institute for Research and Education (NCIRE), San Francisco, CA 94121, United States
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22
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Wedel AV, Patterson JG, Lee DN, Stevens EM, Wagener TL, Keller-Hamilton B. E-Cigarette Use among Sexual Minoritized Women and Nonbinary People Assigned Female at Birth: Assessing the Roles of Discrimination, Perceived Stress, and Social Support. Subst Use Misuse 2023; 58:1102-1109. [PMID: 37199173 PMCID: PMC10247437 DOI: 10.1080/10826084.2023.2212056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Background: Young adult sexual minoritized women (SMW) are at disproportionate risk for e-cigarette use, which may in part be due to excess minority stress imposed by discrimination exposure. While discrimination exposure is associated with risk for combustible tobacco/nicotine use among SMW, similar associations have yet to be tested with e-cigarettes. Moreover, it is unknown if discrimination-related risk may be mitigated by protective factors such as social support. This study examined concurrent associations of discrimination, perceived stress, and social support with past 30-day e-cigarette use in a sample of young adult SMW during the COVID-19 pandemic. Methods: N = 501 SMW and nonbinary people assigned female at birth (AFAB) aged 18-30 completed an online survey. A series of logistic regressions examined associations of discrimination, perceived stress, and four forms of social support received during the COVID-19 pandemic with past-30-day e-cigarette use. Results: Among SMW, greater perceived stress (OR = 1.10, p = .03), but not discrimination exposure, was associated with e-cigarette use. Associations of discrimination with e-cigarette use were nonsignificant when most forms of social support (emotional, material/financial, and virtual) were accounted for. Associations of perceived stress with e-cigarette use were strongest among those who needed but did not receive material support. Conclusions: Perceived stress, but not discrimination exposure, was associated with risk for e-cigarette use among young SMW during the COVID-19 pandemic. Effects of nonspecific stress may be compounded by insufficient material/financial support.
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Affiliation(s)
- Amelia V. Wedel
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Joanne G. Patterson
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, Ohio, USA
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Donghee N. Lee
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Elise M. Stevens
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Theodore L. Wagener
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Brittney Keller-Hamilton
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
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23
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Botor NJB, Tuliao AP. A Scoping Review on the Role of Sexual Orientation and Gender Identity Microaggressions in Substance Use. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2023; 35:363-382. [PMID: 38601727 PMCID: PMC10903602 DOI: 10.1080/19317611.2023.2211975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/17/2023] [Accepted: 04/26/2023] [Indexed: 04/12/2024]
Abstract
Objectives Disparities in substance use patterns and outcomes are evident among sexual and gender minority groups. Sexual orientation and gender identity (SOGI) microaggression, or the subtle forms of aggression experienced by lesbian, gay, bisexual, transgender, gender non-conforming/non-binary, and gender diverse individuals, has recently been explored as a mechanism that leads to negative adjustment outcomes, including substance use. In this study we examined extant literature on the association between SOGI microaggression and substance use, and the intermediary factors that mediate or moderate this relationship. Method Scoping review method was used to systematically map the literature base using database aggregators (e.g., Scopus, EBSCO) following the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Results We found that SOGI microaggression is positively associated with substance use and negative consequences, and this relationship is mediated or moderated by motivational, relational, and identity processes. Conclusion These findings suggest the need to consider microaggression experience when working with clients of diverse sexual and gender identities. Likewise, additional studies are needed on other intermediary factors and effects of microaggression on substances other than alcohol. Most importantly, this study underscores the need for understanding the link between microaggression and substance use in greater efforts to promote sexual well-being and building competence in fostering the trifecta of sexual health, sexual rights, and sexual pleasure.
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Affiliation(s)
- Nephtaly Joel B. Botor
- Center for Addiction Recovery Research, Community, Family, and Addiction Sciences Department, College of Human Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Antover P. Tuliao
- Center for Addiction Recovery Research, Community, Family, and Addiction Sciences Department, College of Human Sciences, Texas Tech University, Lubbock, Texas, USA
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24
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Dyar C, Lee CM, Rhew IC, Kaysen D. Sexual minority stress and substance use: An investigation of when and under what circumstances minority stress predicts alcohol and cannabis use at the event-level. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:475-489. [PMID: 36931822 PMCID: PMC10164110 DOI: 10.1037/abn0000819] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Sexual minority women and gender diverse (SMWGD) individuals are at elevated risk for alcohol and cannabis use disorders compared with cisgender, heterosexual women. This has been attributed to the unique stressors that SMWGD experience (i.e., sexual minority stress); however, recent studies have found mixed evidence for a link between sexual minority stress and substance use. The current manuscript introduces and tests a novel theoretical model derived from integrating minority stress theory and the multistage model of drug addiction to explain these mixed findings. We used data from a 30-day ecological momentary assessment (EMA) study of substance use among SMWGD to determine whether event-level associations between enacted stigma (bias from others) and same-/next-day alcohol and cannabis use are dependent on an individual's typical pattern of substance use (e.g., frequency, quantity, motives, and substance use disorder [SUD] symptoms). Findings indicate that enacted stigma predicted an increased likelihood of alcohol and cannabis use among those who used frequently and those who had a probable alcohol or cannabis use disorder and predicted a decreased likelihood of use among those who used less frequently. Enacted stigma also predicted cannabis (but not alcohol) use among those who reported high coping motives for use. Findings provide initial evidence in support of an integrated model of minority stress theory and the multistage model of drug addiction. Findings suggest that alcohol and cannabis use disorder interventions for SMWGD would benefit from addressing sexual minority stress and coping skill-building. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Christine M. Lee
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Isaac C. Rhew
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
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25
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Livingston NA, Gatsby E, Shipherd JC, Lynch KE. Causes of alcohol-attributable death and associated years of potential life lost among LGB and non-LGB veteran men and women in Veterans Health Administration. Addict Behav 2023; 139:107587. [PMID: 36571942 DOI: 10.1016/j.addbeh.2022.107587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/08/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Alcohol use is a significant concern nationally and research now highlights higher rates of alcohol attributable death (AAD) and years of potential life lost (YPLL) among lesbian, gay, and bisexual (LGB) veterans compared to non-LGB veterans. In this study, we examined specific causes of AAD and associated YPLL between LGB and non-LGB veteran men and women to highlight needed outreach, prevention, and treatment strategies. METHODS Using data from the nationwide Veterans Health Administration electronic health record and National Death Index from 2014 to 2018, we examined the top ten ranked causes of AAD among LGB (n = 102,085) and non-LGB veteran (n = 5,300,521) men and women, as well as associated YPLL per AAD. RESULTS We observed higher rates of AAD among men than women, but higher rates among LGB veterans relative to their same-sex non-LGB counterparts. We noted greater YPLL per AAD among LGB men and all women compared to non-LGB men, even when of similar or same rank in cause of death. Acute-cause AAD death (e.g., alcohol-related suicide, poisonings) was ranked higher among LGB men and all women. YPLL was greater for both acute- and chronic-cause AAD (e.g., liver disease) among LGB men and all women compared to non-LGB men. CONCLUSIONS Causes of AAD differ between LGB and non-LGB men and women. The differences observed highlight disparities in acute- and chronic-cause AAD between groups help explain the higher number of YPLL per AAD that disfavor LGB men and women veterans, and essential next steps in primary and secondary prevention of hazardous drinking and mortality risk.
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Affiliation(s)
- Nicholas A Livingston
- Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States.
| | - Elise Gatsby
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Jillian C Shipherd
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States; LGBTQ+ Health Program, Veterans Health Administration, Washington, DC, United States; Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
| | - Kristine E Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, United States; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
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26
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Parnes JE, Mereish EH, Meisel SN, Treloar Padovano H, Miranda R. In the Presence of Parents: Parental Heterosexism and Momentary Negative Affect and Substance Craving Among Sexual Minority Youth. J Adolesc Health 2023; 72:230-236. [PMID: 36473778 PMCID: PMC10262696 DOI: 10.1016/j.jadohealth.2022.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 08/15/2022] [Accepted: 09/23/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE We examined the influence of parental heterosexism on in vivo negative affect and substance craving among sexual minority youth (SMY) who use nicotine and other substances, and if that relation was strengthened when in the presence of their parent(s). METHODS SMY (n = 42, ages 15-19) completed baseline assessments, including experiences of parental heterosexism (PH), and a 30-day ecological momentary assessment. Ecological momentary assessment reports included affective states (i.e., anger, anxiety, depression), substance craving (i.e., nicotine, cannabis, alcohol), and other contextual factors (e.g., presence of parents). Multilevel logistic regression models evaluated the study hypotheses. RESULTS PH was associated with greater odds of reporting in-the-moment anger, depression, cannabis craving, and alcohol craving. Parental presence was associated with lower odds of reporting anxiety or depression, and greater odds of reporting nicotine craving. There was a significant interaction when predicting the odds of reporting anxiety. For SMY low in PH, parental presence was related to lower odds of reporting anxiety. As PH increased, parental presence had diminishing associations with the odds of reporting anxiety. DISCUSSION Parenting behaviors can serve as protective and risk factors for negative affect and substance craving among SMY. Improving family-based interventions for SMY may be integral for enhancing healthy development and reducing health disparities.
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Affiliation(s)
- Jamie E Parnes
- Center for Alcohol and Addiction Studies, Department of Behavioral & Social Sciences, Brown University, Providence, Rhode Island; E. P. Bradley Hospital, Riverside, Rhode Island
| | - Ethan H Mereish
- Center for Alcohol and Addiction Studies, Department of Behavioral & Social Sciences, Brown University, Providence, Rhode Island; Department of Psychology, University of Maryland, College Park, Maryland; Department of Health Studies, American University, Washington, District of Columbia.
| | - Samuel N Meisel
- Center for Alcohol and Addiction Studies, Department of Behavioral & Social Sciences, Brown University, Providence, Rhode Island; E. P. Bradley Hospital, Riverside, Rhode Island
| | - Hayley Treloar Padovano
- Center for Alcohol and Addiction Studies, Department of Behavioral & Social Sciences, Brown University, Providence, Rhode Island
| | - Robert Miranda
- Center for Alcohol and Addiction Studies, Department of Behavioral & Social Sciences, Brown University, Providence, Rhode Island; E. P. Bradley Hospital, Riverside, Rhode Island
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27
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Kler S, Shepherd BF, Renteria R. Community Connectedness as a Moderator of the Association between Intersectional Microaggressions and Alcohol Use among Sexual and Gender Minoritized People of Color. Subst Use Misuse 2023; 58:129-138. [PMID: 36440902 DOI: 10.1080/10826084.2022.2149246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: Researchers have documented associations between discrete conceptualizations of microaggressions (e.g., sexual identity, gender identity, and racial identity microaggressions) and alcohol use among sexual and gender minoritized people of color (SGM-POC). However, little is known about the association between intersectional microaggressions and alcohol use among SGM-POC. Moreover, protective factors such as community connectedness have been examined via similar discrete conceptualizations instead of examining SGM-POC community connectedness with other SGM-POC individuals. Objectives: The purpose of this study was to explore the association between intersectional microaggressions and alcohol use among SGM-POC and test whether different types of community connectedness moderated this association. Methods: Cross-sectional data were collected from a sample of 267 SGM-POC individuals. Four moderation analyses were done to analyze whether different types of community connectedness (sexual identity, racial identity, gender identity, and SGM-POC identity community connectedness) were moderators of the association of intersectional microaggressions and alcohol use. Results: Intersectional microaggressions were significantly positively correlated with alcohol use. Furthermore, SGM-POC community connectedness moderated this association such that the association was stronger for individuals with higher levels of SGM-POC community connectedness, but not lower levels of SGM-POC community connectedness. Conclusions: These findings showcase the importance of assessing for intersectional microaggressions as a risk factor for alcohol use. Similarly, the findings suggest that SGM-POC community connectedness may be a protective factor against alcohol use for SGM-POC.
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Affiliation(s)
- Satveer Kler
- Southern Illinois University, Carbondale, IL, USA
| | - Benjamin F Shepherd
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Roberto Renteria
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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28
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A Comparison of Mathematical and Statistical Modeling with Longitudinal Data: An Application to Ecological Momentary Assessment of Behavior Change in Individuals with Alcohol Use Disorder. Bull Math Biol 2022; 85:5. [PMID: 36495364 DOI: 10.1007/s11538-022-01097-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 10/12/2022] [Indexed: 12/13/2022]
Abstract
Ecological momentary assessment (EMA) has been broadly used to collect real-time longitudinal data in behavioral research. Several analytic methods have been applied to EMA data to understand the changes of motivation, behavior, and emotions on a daily or within-day basis. One challenge when utilizing those methods on intensive datasets in the behavioral field is to understand when and why the methods are appropriate to investigate particular research questions. In this manuscript, we compared two widely used methods (generalized estimating equations and generalized linear mixed models) in behavioral research with three other less frequently used methods (Markov models, generalized linear mixed-effects Markov models, and differential equations) in behavioral research but widely used in other fields. The purpose of this manuscript is to illustrate the application of five distinct analytic methods to one dataset of intensive longitudinal data on drinking behavior, highlighting the utility of each method.
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29
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Mereish EH, Treloar Padovano H, Parlette B, Miranda R. Momentary Associations Among Minority Stress, Craving, Affect, and Nicotine Use Among Sexual Minority Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:877-891. [PMID: 35895311 PMCID: PMC9617755 DOI: 10.1080/15374416.2022.2093208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Sexual minority youth are more likely to use nicotine relative to heterosexual youth. The minority stress model posits these disparities are partly due to unique stress (i.e., minority stress) specific to their stigmatized identities. However, there is a dearth of research exploring the fine-grained dynamic interplay between minority stressors, mediating processes, and nicotine use in sexual minority youth's daily lives and natural environment. We leveraged ecological momentary assessment over a 30-day monitoring period to test the mediating effects of craving and negative and positive affect on the momentary associations between minority stressors and subsequent nicotine use among sexual minority youth who were active nicotine users and recruited from the community. METHODS Participants were 85 nicotine users, ages 15-19 years old (M age = 17.96, SD = 1.10; 56.6% cisgender female; 56.6% bisexual; 73.5% non-Hispanic White) and half (51.8%) were daily nicotine users. RESULTS Results indicated that exposure to a minority stressor was associated with momentary elevations in nicotine craving and negative affect and decreases in positive affect. Nicotine craving and positive affect were also associated with greater probability of subsequent nicotine use. The associations between minority stressors and subsequent nicotine use were mediated through craving and positive, but not negative affect. CONCLUSIONS Our findings provide the first ecological momentary assessment evidence of these associations among sexual minority youth and help support and advance both addictions and sexual minority-specific models (e.g., minority stress) of nicotine use among youth.
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Affiliation(s)
- Ethan H Mereish
- Lavender Lab, Department of Health Studies, American University
| | | | | | - Robert Miranda
- Center for Alcohol and Addiction Studies, Brown University
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30
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Talham CJ, Montiel Ishino FA, Williams F. A Socioecological Mixture Model of Asthma Prevalence Among Sexual Minority Adults in the United States. LGBT Health 2022; 9:526-533. [PMID: 35771945 PMCID: PMC9734020 DOI: 10.1089/lgbt.2021.0338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose: Sexual minority (SM) identity as well as sociodemographic and socioeconomic factors are associated with asthma prevalence. A syndemics framework analyzes disease conditions in a population and the social, economic, and environmental contexts in which they are found. We used a syndemic model of individual-level socioecological factors to identify profiles of asthma prevalence among SM adults. Methods: Latent class analysis (LCA) was conducted on a subpopulation of SM adults aged 18-59 years from the 2001 to 2016 National Health and Nutrition Examination Survey. Indicators in the LCA model included current asthma, gender, sexual identity, poverty-income ratio, education, and serum cotinine level. Multinomial logistic regression analyzed the effects of covariates (race/ethnicity, nativity, age, marital status, body mass index, lifetime smoking, and mental health care seeking) on identified profiles. Results: Four classes were identified among our sample of n = 1097 SM adults. Classes 1 and 2 had 19% and 18% conditional probabilities of current asthma, respectively, and were primarily female and bisexual. Classes 3 and 4 had 5% and 2% conditional probabilities of asthma, respectively, and were primarily male and gay. Classes 1 and 3 also had conditional probabilities of high income and educational attainment. Black individuals had higher odds than White individuals of being in Class 1 (odds ratio [OR] = 4.46, 95% confidence interval [CI] = 1.43-13.93), Class 2 (OR = 21.66, 95% CI = 7.50-62.60), and Class 4 (OR = 7.41, 95% CI = 2.05-26.71), relative to Class 3. Conclusion: Findings extend past literature that suggests within-group asthma disparities among SM adults. Informational campaigns on asthma management should target this community to avoid severe disease exacerbations.
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Affiliation(s)
- Charlotte J. Talham
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA.,Address correspondence to: Charlotte J. Talham, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 11545 Rockville Pike no. T10, Rockville, MD 20852, USA
| | - Francisco A. Montiel Ishino
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
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31
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Dyar C, Kaysen D, Newcomb ME, Mustanski B. Event-level associations among minority stress, coping motives, and substance use among sexual minority women and gender diverse individuals. Addict Behav 2022; 134:107397. [PMID: 35700652 PMCID: PMC9732144 DOI: 10.1016/j.addbeh.2022.107397] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/27/2022] [Accepted: 06/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sexual minority women and gender diverse individuals (SMWGD) are at heightened risk for alcohol and cannabis use disorders compared to heterosexual and cisgender individuals, and their heightened risk has been attributed to minority stress. However, few longitudinal studies have examined mechanisms through which minority stress may impact substance use, and none have done so at the event-level. METHODS We utilized data from a 30-day ecological momentary assessment study of 429 SMWGD who used alcohol or cannabis regularly to test a mechanistic process in which minority stress predicts alcohol and cannabis use via coping motives for use at the event-level. RESULTS When individuals experienced more enacted stigma (e.g., microaggressions) than usual during one assessment, they were more likely to use cannabis to cope during the next. In turn, occasions when cannabis was used to cope were marked by more sessions of cannabis use, longer intoxication, higher subjective intoxication, and more cannabis consequences. Indirect effects of enacted stigma on cannabis use via coping motives were significant. However, only one of internalized stigma's indirect effects was significant, with internalized stigma predicting cannabis consequences via daily coping motives. No indirect effects predicting alcohol use were significant. CONCLUSIONS Findings provide robust evidence that using to cope is a mechanism through which enacted stigma predicts cannabis use and internalized stigma predicts cannabis consequences. Results did not provide evidence for similar associations for alcohol. Our findings suggest that interventions designed to reduce cannabis use among SMWGD should attend to their minority stress experiences and cannabis use motives and teach alternative coping strategies.
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Affiliation(s)
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
| | - Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, USA; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, USA; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, USA
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32
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Lynch KE, Livingston NA, Gatsby E, Shipherd JC, DuVall SL, Williams EC. Alcohol-attributable deaths and years of potential life lost due to alcohol among veterans: Overall and between persons with minoritized and non-minoritized sexual orientations. Drug Alcohol Depend 2022; 237:109534. [PMID: 35717789 DOI: 10.1016/j.drugalcdep.2022.109534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Unhealthy alcohol use is disproportionally experienced by individuals with minoritized sexual orientations. Unlike the general US population, for whom the burden of alcohol as it relates to mortality is consistently monitored across time with national survey data, the impact of unhealthy alcohol use among veterans with minoritized sexual orientations, for whom addressing substance use is a national priority, is largely unknown. METHODS Using Alcohol Use Disorders Identification Test Consumption data from the Department of Veterans Affairs electronic health record and underlying cause of death from National Death Index from 2014 to 2018 we quantified alcohol consumption and related mortality among veterans with (n = 102,085) and without minoritized sexual orientations (n = 5300,521). Age adjusted rates of alcohol attributed deaths (AAD) per 100,000 persons and years of potential life lost (YPLL) were estimated by sexual orientation, sex, and sexual orientation stratified by sex. RESULTS Alcohol attributable deaths (n = 21,861) were higher among veterans with minoritized sexual orientations than veterans without after adjustment for age (486.5 deaths/100,000 versus 309.7 deaths/100,000, respectively). Veterans with minoritized sexual orientations also experienced more YPLL (13,772.8 years/100,000 versus 7618.9 years/100,000). Years of potential life lost per AAD was higher in women (33.2 years) than men (18.7 years). CONCLUSIONS Alcohol consumption results in substantial disability and death among veterans, particularly veterans with minoritized sexual orientations. Findings suggest need for increased alcohol-related services for all VA patients, and potential targeted approaches to for veterans with minoritized sexual orientations and women to offset risk for, and years of potential life lost from, alcohol attributable death.
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Affiliation(s)
- Kristine E Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA; Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84132, USA.
| | - Nicholas A Livingston
- Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA; Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Boston, MA 02118, USA
| | - Elise Gatsby
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| | - Jillian C Shipherd
- Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Boston, MA 02118, USA; Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA; LGBTQ+ Health Program, Veterans Health Administration, 810 Vermont Avenue NW, Washington, DC 20420, USA
| | - Scott L DuVall
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA; Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84132, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15th Avenue NW, Seattle, WA 98195, USA; Health Services Research & Development, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound 1660 S Columbian Way, Seattle, WA 98108, USA
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33
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Wardecker BM, Surachman A, Matsick JL, Almeida DM. Daily Stressor Exposure and Daily Well-Being Among Sexual Minority and Heterosexual Adults in the United States: Results from the National Study of Daily Experiences (NSDE). Ann Behav Med 2022; 56:536-550. [PMID: 34536005 PMCID: PMC9242545 DOI: 10.1093/abm/kaab062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Daily stress plays a significant role in mental and physical health. Negative mood (e.g., hopelessness) and physical symptoms (e.g., headaches) are responses often associated with daily stressors. It is theorized that some people or populations are more vulnerable or reactive to daily stressors. We propose sexual orientation as one factor that is associated with daily stress exposure and reactivity. PURPOSE To understand whether sexual minorities (SMs) differ from heterosexuals in their exposure and reactivity to general, non-sexual minority-specific stressors (e.g., arguments/disagreements, job concerns). METHODS We used daily diary data (n = 3,323 heterosexuals [52% identified as female and 85% identified as White]; n = 98 SMs [50% identified as female and 93% identified as White]) from the National Study of Daily Experiences (NSDE). Participants completed eight consecutive evening daily diary interviews (n days = 24,773; mean days completed = 7.24) and reported daily stress exposure and daily well-being. We used multilevel modeling as an approach to examine whether sexual orientation interacted with daily stressors to predict daily negative affect and physical health. RESULTS SMs tended to experience more daily stressors compared to heterosexuals; specifically, SMs reported at least one stressor on nearly half (48%) of the study days they completed, and heterosexuals reported at least one stressor on about two-fifths (41%) of the study days they completed. SMs also tended to experience more negative mood when they experienced a daily stressor compared to heterosexuals when they experienced a daily stressor. CONCLUSION We emphasize the importance of SMs' exposure and reactivity to general daily stressors and the implications of our results for the day-to-day lives and health of SMs.
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Affiliation(s)
- Britney M Wardecker
- College of Nursing, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
| | - Agus Surachman
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Jes L Matsick
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
- Department of Women’s, Gender, and Sexuality Studies, The Pennsylvania State University, University Park, PA, USA
| | - David M Almeida
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
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Dyar C, Feinstein BA, Bettin E, Davila J. Bisexual+ visibility attempts: Associations with minority stress, affect, and substance use in a daily diary study. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2022; 9:201-213. [PMID: 35832391 PMCID: PMC9272947 DOI: 10.1037/sgd0000469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
The efforts of bisexual+ people to make their sexual orientation visible are associated with positive and negative outcomes, but little is known about the temporality or directionality of these associations. Using data from a 28-day diary study with 208 bi+ individuals, we found that bi+ visibility attempts were concurrently associated with more positive affect, higher identity affirmation, less depressed/anxious affect, as well as more anti-bisexual experiences and rejection sensitivity. Prospectively, the likelihood of consuming alcohol (but not marijuana) was higher the day after making a visibility attempt, and positive affect was higher the day before making an attempt. Making visibility attempts in contexts that may have been more supportive (e.g., with friends, partners, and lesbian/gay individuals) was associated with more positive outcomes (e.g., more positive affect), while making attempts in contexts that may have been less supportive (e.g., with family, strangers, people who are unaccepting of bi+ identities, and heterosexual people) was associated with more negative outcomes (e.g., higher rejection sensitivity and more discrimination). These findings suggest that the contexts in which visibility attempts are made may play an important role in the impact that bi+ visibility attempts have on stigma-related stress and wellbeing.
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Affiliation(s)
- Christina Dyar
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Brian A Feinstein
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Emily Bettin
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
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Flentje A, Sunder G, Dilley JW, Neilands TB, Lisha NE, Katuzny KE, Carrico AW. AWARENESS: A cognitive behavioral intervention to reduce intersectional minority stress among sexual minority men living with HIV who use substances. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3. [PMID: 35813350 PMCID: PMC9262168 DOI: 10.1016/j.dadr.2022.100059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: The minority stress model is the primary explanatory model for disparities in substance use and other mental health problems among sexual minority men (SMM) compared to heterosexual men. This pilot randomized controlled trial tested the feasibility of AWARENESS, a novel 9-session cognitive-behavioral psychotherapeutic intervention that targets intersectional minority stress and stigma, among sexual minority men living with HIV who use substances. Methods: Feasibility was determined by the number of participants screened to obtain the target sample size, the percentage of eligible participants randomized, percentage of study intervention and assessment visits attended, time to complete study procedures, and percentage of data completeness of intervention assessments. Forty-two sexual minority men living with HIV with any illicit substance use or who reported at least one occasion of consuming five or more drinks in one setting in the last three months were randomized to AWARENESS (n = 22) or an attention control condition (n = 20). Results: Feasibility of the trial was supported, with adequate completion of study procedures and visits (73% completed all intervention sessions, 71% completed all study assessment sessions). This trial also demonstrated the feasibility of using AWARENESS skills and strategies in relation to multiple intersecting identities, with participants discussing an average of 5.7 identities (e.g., sexual orientation) or individual characteristics (e.g., socioeconomic status) in relation to intervention content. Conclusion: Our results support the feasibility of an AWARENESS trial to reduce intersectional minority stress related to multiple identities and characteristics among sexual minority men living with HIV who use substances
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Affiliation(s)
- Annesa Flentje
- Community Health Systems, School of Nursing, University of California, 2 Koret Way, N505, San Francisco, CA, 94143, United States of America
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, 1930 Market St, San Francisco, CA, 94102, United States of America
- Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Ave, San Francisco, CA, 94143, United States of America
- Corresponding author.
| | - Gowri Sunder
- Community Health Systems, School of Nursing, University of California, 2 Koret Way, N505, San Francisco, CA, 94143, United States of America
| | - James W. Dilley
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, 1930 Market St, San Francisco, CA, 94102, United States of America
- Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Ave, San Francisco, CA, 94143, United States of America
| | - Torsten B. Neilands
- Division of Prevention Science, Department of Medicine, University of California, 550 16th ST, San Francisco, CA, 94158, United States of America
| | - Nadra E. Lisha
- Center for Tobacco Control and Research and Education, University of California, 530 Parnassus Ave, San Francisco, CA, 94117, United States of America
| | - Katie E. Katuzny
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, 1930 Market St, San Francisco, CA, 94102, United States of America
| | - Adam W. Carrico
- University of Miami Department of Public Health Sciences, 1120 NW 14th ST #905, Miami, FL 33136, United States of America
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Abstract
Stigma changes over time: it waxes and wanes through history, is manifested within humans who develop over time and is tied to statuses (such as attributes, illnesses and identities) that have varying courses. Despite the inherent fluidity of stigma, theories, research and interventions typically treat associations between stigma and health as stagnant. Consequently, the literature provides little insight into when experiences of stigma are most harmful to health and when stigma interventions should be implemented. In this Perspective, we argue that integrating time into stigma research can accelerate progress towards understanding and intervening in associations between stigma and health inequities. We situate time in relation to key concepts in stigma research, identify three timescales that are relevant for understanding stigma (historical context, human development and status course), and outline a time-based research agenda to improve scientists’ ability to understand and address stigma to improve health. Associations between stigma and health are typically treated as stagnant. In this Perspective, Earnshaw et al. argue that considering stigma in relation to historical, human development and status course timescales can advance progress in understanding and addressing stigma to improve health.
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Adams LM, Miller AB. Mechanisms of Mental-Health Disparities Among Minoritized Groups: How Well Are the Top Journals in Clinical Psychology Representing This Work? Clin Psychol Sci 2022; 10:387-416. [PMID: 35602543 PMCID: PMC9122282 DOI: 10.1177/21677026211026979] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
We have known for decades that mental health disparities exist among minoritized groups, including race, ethnicity, sexual identities, gender identity and expression, ability, and others. Theories and frameworks that incorporate stressors unique to the experiences of minoritized groups, such as the biopsychosocial model of racism (Clark et al, 1999) and minority stress model (Meyer, 2003), offer testable mechanisms that may help explain, in part, mental health disparities. However, research addressing mechanisms of these disparities is still scarce and is not well represented in our top clinical psychology journals. This review critically examines the extent to which top tier clinical psychology journals publish work examining mechanisms of mental health disparities among minoritized populations. We find very few studies have been published in top clinical psychology journals that address mechanisms of mental health disparities. We examine potential reasons for this and discuss recommendations for future research.
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Crawford ND, Lewis TT. Adding Short-Term Social Pathways for COVID-19-Related Discrimination to Theoretical Frameworks and Structural Interventions. Am J Public Health 2022; 112:354-356. [PMID: 35196031 PMCID: PMC8887180 DOI: 10.2105/ajph.2021.306667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Natalie D Crawford
- Natalie D. Crawford is with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Tené T. Lewis is with the Department of Epidemiology, Rollins School of Public Health
| | - Tené T Lewis
- Natalie D. Crawford is with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Tené T. Lewis is with the Department of Epidemiology, Rollins School of Public Health
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Hinds Z, Herbitter C, Bryant WT, Newberger NG, Livingston NA. Hazardous Substance Use Among Sexual and Gender Minority Adults: A Deeper Look into Distal Minority Stressors. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2022; 10:10.1037/sgd0000583. [PMID: 37885566 PMCID: PMC10601395 DOI: 10.1037/sgd0000583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Discrimination and victimization drive health disparities among sexual and gender minority (SGM) individuals, yet little is known about the relative impacts of specific experience types on hazardous substance use. Using data from 704 SGM adults, we examined SGM-related discrimination vs. victimization and specific experiences as predictors of hazardous substance use. SGM-related victimization, not discrimination, predicted hazardous substance use, and SGM-related sexual assault and harassment predicted hazardous alcohol use, although only sexual assault predicted hazardous drug use. These findings implicate lifetime SGM-related victimization, and SGM-related sexual assault and harassment specifically, as key correlates of recent hazardous substance use among SGM adults.
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Affiliation(s)
- Zig Hinds
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
| | - Cara Herbitter
- VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - William T. Bryant
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, SC, USA
| | - Noam G. Newberger
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
| | - Nicholas A. Livingston
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
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Williams AJ, Arcelus J, Townsend E, Michail M. Feasibility and acceptability of experience sampling among LGBTQ+ young people with self-harmful thoughts and behaviours. Front Psychiatry 2022; 13:916164. [PMID: 36061288 PMCID: PMC9428709 DOI: 10.3389/fpsyt.2022.916164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
This study was the first to determine whether it was feasible and acceptable to use experience sampling methods (ESM) among LGBTQ+ young people, who had current experiences of self-harm. Sixteen LGBTQ+ young people (16-25 years old) took part in the experience sampling study. This included a baseline assessment, a 7-day ESM assessment (participants were sampled six times a day using a phone app), and the option of an interview at the end of the 7-day ESM assessment. Feasibility data was descriptively analysed, with pilot ESM data presented. Qualitative data was thematically analysed to determine the acceptability (barriers and facilitators) of taking part in this study. Study feasibility was assessed by enrolment rate (55.2%), participant retention across assessment period (100%), ESM app feasibility (87.5%), and good adherence to total number of ESM surveys (67.6%). Individual study adherence ranged between 43 and 95.2%. Study acceptability was assessed by participant interviews. Thematic analysis indicated four superordinate themes; (i) Self-reflection and awareness; (ii) Practicalities of ESM surveys; (iii) Daily timeframes; and (iv) Suggestions for future studies. Pilot ESM data demonstrates that there was fluctuation of depressive and anxiety symptoms within- and between- participants over the course of the study, however, greater sample power is needed for full analysis. This study demonstrated that ESM designs are feasible and acceptable among LGBTQ+ young people with current experiences of self-harm. Pilot data indicated that specific experiences and moods are likely to be important to self-harm. These potentially have a temporal influence on self-harm behaviour or ideation, and therefore should be examined in a fully powered sample.
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Affiliation(s)
- A J Williams
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom.,Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, United Kingdom.,Informatics, Faculty of Natural, Mathematical and Engineering Sciences, King's College London, London, United Kingdom
| | - Jon Arcelus
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Maria Michail
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
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Bettis AH, Burke TA, Nesi J, Liu RT. Digital Technologies for Emotion-Regulation Assessment and Intervention: A Conceptual Review. Clin Psychol Sci 2022; 10:3-26. [PMID: 35174006 PMCID: PMC8846444 DOI: 10.1177/21677026211011982] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
The ability to regulate emotions in response to stress is central to healthy development. While early research in emotion regulation predominantly employed static, self-report measurement, the past decade has seen a shift in focus toward understanding the dynamic nature of regulation processes. This is reflected in recent refinements in the definition of emotion regulation, which emphasize the importance of the ability to flexibly adapt regulation efforts across contexts. The latest proliferation of digital technologies employed in mental health research offers the opportunity to capture the state- and context-sensitive nature of emotion regulation. In this conceptual review, we examine the use of digital technologies (ecological momentary assessment; wearable and smartphone technology, physical activity, acoustic data, visual data, and geo-location; smart home technology; virtual reality; social media) in the assessment of emotion regulation and describe their application to interventions. We also discuss challenges and ethical considerations, and outline areas for future research.
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Affiliation(s)
| | | | | | - Richard T Liu
- Harvard Medical School
- Massachusetts General Hospital
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42
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Differences by sex and gender in the association between minority stress and alcohol use among sexual and gender minority youth: A daily diary study. Soc Sci Med 2021; 294:114679. [PMID: 35030397 PMCID: PMC7612808 DOI: 10.1016/j.socscimed.2021.114679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/23/2021] [Accepted: 12/21/2021] [Indexed: 12/12/2022]
Abstract
Rationale Sexual and gender minority (SGM) youth consume more alcohol than their heterosexual, cisgender peers. The experience of minority stress is theorized to explain these disparities. Research often neglects the day-to-day variability in minority stress that SGM youth encounter and whether alcohol use is associated with daily experiences of minority stress. Further, there is heterogeneity in alcohol use among SGM youth. Sex assigned at birth and gender identity could potentially explain this heterogeneity. Objective Therefore, this study aimed to examine whether daily experiences of minority stress were associated with daily alcohol use among SGM youth and how these associations differed by sex assigned at birth and gender identity. Methods A 14-day daily diary study was conducted among 393 Dutch SGM youth (M age = 18.36 SD = 2.65). Results Results showed few significant associations between both mean levels of minority stress and daily experiences with minority stress with alcohol use. However, higher mean levels of prejudice events were associated with higher odds of daily alcohol use (OR = 7.01, 95% CI: 1.20–40.89). Daily experiences with identity concealment were associated with lower odds of daily alcohol use for males (OR = 0.72, 95% CI: 0.60–0.86), but not for females (OR = 1.11, 95% CI: 0.93–1.32). Further, for cisgender youth, daily experiences with prejudice events were associated with higher odds of alcohol use (OR = 1.99, 95% CI: 1.05–3.78), but this was not the case for gender minority youth (OR = 0.42, 95% CI: 0.15–1.18). Conclusions The findings showed few significant associations between minority stressors and alcohol use, but daily experiences of concealment and prejudice events were associated with daily alcohol use and these associations varied by sex assigned at birth and gender identity, respectively.
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Tami-Maury I, Chen B, Sumbe A, Harrell MB. Timing of ENDS Uptake by Sexual Orientation among Adolescents and Young Adults in Urban Texas. Nicotine Tob Res 2021; 24:388-394. [PMID: 34865138 PMCID: PMC8842400 DOI: 10.1093/ntr/ntab181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/14/2021] [Indexed: 12/28/2022]
Abstract
Introduction Early-onset of Electronic Nicotine Delivering Systems (ENDS) use puts users at higher risk of developing a regular ENDS use pattern and/or transitioning to combusted tobacco products. Previous studies on ENDS use among adolescents have not considered sexual orientation as a fluid trait that can change over time. Our objective was to evaluate whether ENDS initiation differed by sexual orientation in a longitudinal, population-based cohort of adolescents transitioning into young adulthood in Texas. Methods Sample (n = 1712) was drawn from the Texas Adolescent Tobacco and Marketing Surveillance System (waves 5–11) and stratified into three groups, representing sexual orientation: (1) respondents who reported being heterosexuals at each wave (straight), (2) those who consistently self-identified as lesbian, gay or bisexual individuals (LGB), and (3) subjects who reported sexual orientation mobility across waves (mobile). Nonparametric models for interval-censored data were used to estimate the cumulative distribution of age at ENDS initiation by sexual orientation group. Cox models for interval-censored data were used to evaluate whether ENDS initiation varied by sexual orientation group after adjusting for sex assigned at birth, race/ethnicity, cohort, and socioeconomic status. Results Compared to Straight adolescents, the risk of earlier-onset of ENDS use was higher among mobile individuals (HR = 1.43, 95% CI: 1.12 to 1.83) and LGB individuals (HR = 1.49, 95% CI: 1.13 to 1.98), respectively, after adjusting for sociodemographic risk factors. Differences between Straight adolescents and LGB/mobile individuals became more pronounced with increasing age. Conclusion Analyzing sexual mobility overtime is necessary for understanding the risk associated with youth ENDS initiation and subsequent use. Implications Future research should use more accurate sexual orientation assessments to explore further the relationship between sexual orientation mobility and early-onset Electronic Nicotine Delivering Systems (ENDS) use. Understanding the implications of sexual orientation mobility on ENDS initiation will be critical for developing inclusive public health programs aimed at preventing or delaying ENDS use and for providing practical recommendations at state and local levels.
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Affiliation(s)
- Irene Tami-Maury
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Baojiang Chen
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Aslesha Sumbe
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Melissa B Harrell
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
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Auguste EE, Cruise KR, Jimenez MC. The Effects of Microaggressions on Depression in Young Adults of Color: Investigating the Impact of Traumatic Event Exposures and Trauma Reactions. J Trauma Stress 2021; 34:985-994. [PMID: 33772872 DOI: 10.1002/jts.22675] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 02/21/2021] [Accepted: 03/01/2021] [Indexed: 11/07/2022]
Abstract
Microaggressions are a common way that individuals experience racism in the United States. The current study examined the extent to which microaggressions contribute to mental health difficulties, namely trauma reactions and depression, after controlling for other traumatic event exposures. We sought to address gaps in the literature by quantitatively assessing the associations among microaggressions, posttraumatic stress symptoms, and depression symptoms. Participants were 140 young adults of color (68.8% female) who were recruited online. Linear regression analyses evidenced that microaggressions were uniquely associated with depression symptoms, B = 0.27, after controlling for lifetime traumatic event exposures, with this association partially mediated by trauma reactions, B = 0.49. These results suggest that microaggressions are a clinically relevant factor in understanding mental health problems reported by Black, Indigenous, and People of Color in the United States and warrant analysis, assessment, and intervention through a trauma lens.
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Affiliation(s)
- Evan E Auguste
- Department of Psychology, Fordham University, Bronx, New York, USA
| | - Keith R Cruise
- Department of Psychology, Fordham University, Bronx, New York, USA
| | - Maria C Jimenez
- Department of Psychology, Fordham University, Bronx, New York, USA
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Lewis RJ, Romano KA, Ehlke SJ, Lau-Barraco C, Sandoval CM, Glenn DJ, Heron KE. Minority stress and alcohol use in sexual minority women's daily lives. Exp Clin Psychopharmacol 2021; 29:501-510. [PMID: 34096757 PMCID: PMC8511332 DOI: 10.1037/pha0000484] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Sexual minority women (i.e., women who identify as lesbian, bisexual, or other non-heterosexual orientations) report more hazardous drinking compared to heterosexual women. Sexual minority stress (SMS), or experiences related to sexual orientation-based discrimination and marginalization, have been implicated as contributing to these disparities. The association between sexual minority stress and alcohol use has been supported in cross-sectional, and to a limited extent, longitudinal studies. Few studies, however, have examined associations between SMS and alcohol use in sexual minority women's daily lives. Young sexual minority women (age 18-35; N = 321) were recruited to participate in a 14-day daily diary study in which they reported each morning on their SMS and alcohol use (drinking or not; drinking quantity; alcohol consequences) from the previous day. SMS was operationalized in four ways (global negative SMS experiences, specific SMS events, concealment of identity, discrimination). Results from concurrent multilevel models revealed that on days when sexual minority women experienced more global negative SMS, any specific SMS event, or discrimination, they were more likely to drink. Further, prospective models indicated that participants drank more and were more likely to report binge drinking on the day after they experienced at least one SMS event. These findings extend prior research by demonstrating that the association between SMS and alcohol use extends to the daily level of analysis among sexual minority women. Understanding the connection between SMS and alcohol use among sexual minority women is imperative to developing culturally tailored interventions to improve the health and well-being of this at-risk group. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | - Sarah J Ehlke
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center
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Mann I, Jenzer T, Miranda R, Mereish EH. Minority Stress and Nicotine Use and Dependence among Sexual Minority Youth. Subst Use Misuse 2021; 56:2264-2268. [PMID: 34519262 PMCID: PMC8753784 DOI: 10.1080/10826084.2021.1972315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Sexual minority youth (SMY), especially those who are plurisexual (e.g. bisexual, pansexual, queer), are more likely to use nicotine or develop nicotine dependence than their heterosexual peers, and this disparity is often attributed to minority stress (e.g. discrimination). This study tested the association between minority stress and nicotine use and dependence among SMY and examined the moderating role of impulsivity. A sample of SMY (N = 85; aged 14-19; 80.6% White; 80% plurisexual) who were active nicotine users were recruited from the community. Results indicated that greater discrimination experiences were associated with more nicotine use days and higher nicotine dependence symptoms. However, impulsivity did not moderate the relationship between discrimination and nicotine use or dependence. These results highlight the potential importance of minority stress in understanding SMY's risk for nicotine use and dependence. This research suggests the need for identifying factors that could place some SMY at greater risk for nicotine use and dependence and points to potential clinical implications for nicotine cessation interventions for SMY.
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Affiliation(s)
- Iris Mann
- Skidmore College, Saratoga Springs, New York, USA
| | | | - Robert Miranda
- Brown University Center for Alcohol and Addiction Studies, Providence, Rhode Island, USA
| | - Ethan H Mereish
- Department of Health Studies, American University, Washington DC, USA
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MacCalman M, Harper LA, Anderson KG. Perceived Gender Match and Accepting Alcohol Offers From Peers in Emerging Adulthood. Alcohol Alcohol 2021; 55:667-673. [PMID: 32548631 DOI: 10.1093/alcalc/agaa054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/27/2020] [Accepted: 05/19/2020] [Indexed: 12/25/2022] Open
Abstract
AIMS Emerging adulthood (ages 18-25) has been associated with elevated alcohol use, yet little is known regarding gender identity and drinking contexts in this population. Our goals were to examine the effects of perceived gender match on alcohol use decision-making in social settings among emerging adults. METHODS Participants (N = 135; 64% white, 11 transgender) completed measures of alcohol consumption, alcohol expectancies and motives, and the Collegiate-Simulated Intoxication Digital Elicitation using an established Internet panel. We conducted a series of univariate analyses to examine the relation between perceived gender match and behavioral willingness (BW) to accept alcohol in a social context. RESULTS Participants identifying as men were significantly more likely to accept offers of alcohol when compared with women. While men and women did not differ in terms of BW when participants perceived a gender-matched actor making the offer, when there was a gender mismatch, women had significantly lower BW when compared with men. Though transgender participants were more likely to endorse hazardous drinking behaviors, there were no observable effects of transgender identity on BW. CONCLUSION In this sample, we found that men have a higher BW for alcohol than women and that trans identified persons are at increased risk for alcohol misuse. These findings support the need for more research examining the effect of gender identity on patterns of alcohol use and decision-making in mixed-gender contexts for emerging adults.
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Affiliation(s)
- Michelle MacCalman
- Department of Psychology, Adolescent Health Research Program, Reed College, 3203 SE Woodstock Blvd., Portland, OR 97202, USA
| | - Leia A Harper
- Department of Psychology, Adolescent Health Research Program, Reed College, 3203 SE Woodstock Blvd., Portland, OR 97202, USA
| | - Kristen G Anderson
- Department of Psychology, Adolescent Health Research Program, Reed College, 3203 SE Woodstock Blvd., Portland, OR 97202, USA
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Clark V, Kim SJ. Ecological Momentary Assessment and mHealth Interventions Among Men Who Have Sex With Men: Scoping Review. J Med Internet Res 2021; 23:e27751. [PMID: 34342585 PMCID: PMC8371491 DOI: 10.2196/27751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/07/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ecological momentary assessment (EMA) is a research design that allows for the measurement of nearly instantaneous experiences within the participant's natural environment. Using EMA can help improve recall bias, ecological validity, and patient engagement while enhancing personalization and the ubiquity of interventions. People that can benefit from the use of EMA are men who have sex with men (MSM). Previous EMA studies have been successful in capturing patterns of depression, anxiety, substance use, and risky sexual behavior. These findings are directly relevant to MSM, who have high rates of each of these psychological and behavioral outcomes. Although there is a driving force behind the growing literature surrounding EMAs among MSM, no synthesizing reviews yet exist. OBJECTIVE The aims of this study were to (1) synthesize the literature across fields on how EMA methods have been used among MSM, (2) better understand the feasibility and acceptability of EMA interventions among MSM, and (3) inform designs for future research studies on best evidence-based practices for EMA interventions. METHODS Based on 4 library databases, we conducted a scoping review of EMAs used within interventions among MSM. The eligibility criteria included peer-reviewed studies conducted in the United States and the use of EMA methodology in an intervention for MSM. Modeling after the Centers for Disease Control and Prevention's Compendium of Evidence-Based Interventions as the framework, we applied a typology that used 8 distinct review criteria, for example, sample size, design of the intervention, random assignment, design of the follow-up investigation, rate of retention, and rate of engagement. RESULTS Our results (k=15, N=952) indicated a range of sample sizes; the smallest sample size was 12, while the largest sample size was 120. Of the 15 studies, 7 (47%) focused on outcomes related to substance use or outcomes related to psychological experiences. Of the 15 studies, 5 (33%) implemented an EMA intervention across 30 days. Of the 15 studies, 2 studies (13%) used random assignment, and 2 studies (13%) had quasi-experimental designs. Of the 15 studies, 10 studies (67%) reported acceptable retention rates greater than 70%. The outcomes that had event-contingent prompts (ie, prompts after engaging in substance use) were not as effective in engaging participants, with overall engagement rates as low as 37%. CONCLUSIONS Our systematic scoping review indicates strong evidence that the EMA methodology is both feasible and acceptable at high rates among MSM, especially, when examining psychological and behavioral outcomes such as negative or positive affect, risky sexual behavior, or substance use. Further research on optimal designs of EMA interventions for MSM is warranted.
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Affiliation(s)
- Viktor Clark
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Sunny Jung Kim
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
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Cusack CE, Cooper M, Libbey N, Galupo MP. Rumination & eating psychopathology among trans and nonbinary individuals: A path analysis integrating minority stress. Eat Behav 2021; 42:101544. [PMID: 34358854 DOI: 10.1016/j.eatbeh.2021.101544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Abstract
UNLABELLED Ruminative thought patterns, defined as repetitive negative self-focused attention, are considered an avoidant coping strategy for managing stress. As trans and nonbinary (TNB) individuals commonly experience prejudice and discrimination in response to their gender identities (i.e. minority stressors), rumination over these stressors may contribute to heightened risk of psychopathology in these groups. Although rumination is a general risk factor for eating disorder (ED) psychopathology, no studies to date have examined whether eating- or gender-related ruminative patterns relate to maintenance of ED psychopathology for TNB individuals. This cross-sectional study investigated whether levels of rumination (both gender-related and ED-specific) mediated the relationship between minority stress and ED psychopathology. METHOD Participants were 242 TNB adults (Mage = 24.92, SD = 6.5, Range = 18-70) recruited online, who completed measures of minority stress, gender-related rumination, ED-specific rumination, and ED psychopathology. We used Preacher-Hayes' approach to examine the parallel mediation model, with gender-related and ED-specific rumination as potential mediators. RESULTS Gender-related rumination did not mediate the relation between gender minority stress and ED psychopathology, Indirect B = -0.00 [95% BCa CI: -0.01, 0.00]; however, ED-specific rumination was significant, indicating partial mediation, Indirect B = 0.01 [95% BCa CI: 0.00, 0.02]. CONCLUSION As gender minority stress and ED-specific rumination relate to ED psychopathology, it is essential that clinicians adopt an intersectional minority stress framework in understanding ED psychopathology among TNB individuals.
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50
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Flentje A, Clark KD, Cicero E, Capriotti MR, Lubensky ME, Sauceda J, Neilands TB, Lunn MR, Obedin-Maliver J. Minority Stress, Structural Stigma, and Physical Health Among Sexual and Gender Minority Individuals: Examining the Relative Strength of the Relationships. Ann Behav Med 2021; 56:573-591. [PMID: 34228052 PMCID: PMC9242547 DOI: 10.1093/abm/kaab051] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Sexual and gender minority (SGM; i.e., non-heterosexual and transgender or gender-expansive, respectively) people experience physical health disparities attributed to greater exposure to minority stress (experiences of discrimination or victimization, anticipation of discrimination or victimization, concealment of SGM status, and internalization of stigma) and structural stigma. Purpose To examine which components of minority stress and structural stigma have the strongest relationships with physical health among SGM people. Methods Participants (5,299 SGM people, 1,902 gender minority individuals) were from The Population Research in Identity and Disparities for Equality (PRIDE) Study. Dominance analyses estimated effect sizes showing how important each component of minority stress and structural stigma was to physical health outcomes. Results Among cisgender sexual minority women, transmasculine individuals, American Indian or Alaskan Native SGM individuals, Asian SGM individuals, and White SGM individuals a safe current environment for SGM people had the strongest relationship with physical health. For gender-expansive individuals and Black, African American, or African SGM individuals, the safety of the environment for SGM people in which they were raised had the strongest relationship with physical health. Among transfeminine individuals, victimization experiences had the strongest relationship with physical health. Among Hispanic, Latino, or Spanish individuals, accepting current environments had the strongest relationship with physical health. Among cisgender sexual minority men prejudice/discrimination experiences had the strongest relationship with physical health. Conclusion Safe community environments had the strongest relationships with physical health among most groups of SGM people. Increasing safety and buffering the effects of unsafe communities are important for SGM health.
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Affiliation(s)
- Annesa Flentje
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA.,Alliance Health Project, Department of Psychiatry, School of Medicine, University of California, San Francisco, CA, USA.,The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kristen D Clark
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | - Ethan Cicero
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | | | - Micah E Lubensky
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA.,The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA
| | - John Sauceda
- Division of Prevention Science, University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), UCSF Prevention Research Center, San Francisco, CA, USA
| | - Torsten B Neilands
- Division of Prevention Science, University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), UCSF Prevention Research Center, San Francisco, CA, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA.,Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA.,Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA.,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
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