1
|
Houghtaling LM, Manning WD, Dush CMK. Coping Patterns During the COVID-19 Pandemic by Sexual and Gender Identity. JOURNAL OF HOMOSEXUALITY 2024; 71:2719-2739. [PMID: 37782080 PMCID: PMC10985047 DOI: 10.1080/00918369.2023.2260920] [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: 10/03/2023]
Abstract
National polls have shown that COVID-19 has been highly stressful, negatively affecting well-being and life satisfaction overall, but few studies have focused on individuals with sexual and gender diverse identities. Pandemic-related stress may increase engagement in adverse or negative health-related coping behaviors and decrease engagement in positive coping strategies, potentially exacerbating existing LGBTQ+ health disparities. Relying on a nationally representative population-based sample, we examine disparities in rates of negative and positive COVID-19 coping behaviors by sexual and gender identities. Using Poisson regression models adjusted for key sociodemographic and pandemic related factors, we found higher rates of negative and positive coping behaviors among certain sexual and gender diverse groups compared to their heterosexual and cisgender counterparts. Specifically, we find that lesbian and gay respondents reported more positive and negative coping strategies compared to heterosexual persons. We also found higher rates of negative coping behaviors among plurisexual (bisexual, pansexual, omnisexual) and noncisgender adults (transgender or other nonbinary gender identity) compared to heterosexual and cisgender adults, respectively. We contribute to prior studies by focusing on both negative and positive pandemic related coping among sexually and gender diverse populations. These responses to the pandemic may have long-term implications for the health and well-being of sexual and gender diverse individuals.
Collapse
Affiliation(s)
- Laura M. Houghtaling
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 300 West Bank Office Building, 1300 S. 2 St., Minneapolis, MN 55454, USA
| | - Wendy D. Manning
- Department of Sociology and Center for Family and Demographic Research, Bowling Green State University, Williams Hall, Bowling Green, Ohio 43408, USA
| | - Claire M. Kamp Dush
- Department of Sociology, University of Minnesota, 1031 Social Sciences Building, 267 19 Ave S., Minneapolis, MN 55455, USA
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Stewart SD, Manning WD, Gustafson KE, Kamp Dush C. Sexual and gender identities and alcohol use during the COVID-19 pandemic. PLoS One 2024; 19:e0308925. [PMID: 39241086 PMCID: PMC11379183 DOI: 10.1371/journal.pone.0308925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 08/01/2024] [Indexed: 09/08/2024] Open
Abstract
This study examined differences in alcohol use by sexual and gender identities during the COVID-19 pandemic, and assessed whether variation between groups was explained by pandemic-related stressors and minority stress. Data from 2,429 partnered adults in the National Couples' Health and Time Use Study (n = 3,593) collected from September 2020 to April 2021 were used to model drinking patterns (frequency, amount, and drinking to cope) by sexual and gender identities, COVID-19 stress and disruption, microaggressions, and supportive climate. Regression models indicated differences in drinking by gender and sexual identities, even controlling for demographic and socioeconomic factors. Gay, lesbian, and bisexual people had higher odds of drinking to cope with the pandemic than did heterosexual people, and cisgender men had higher odds than did cisgender women. Gay and lesbian people drank more regularly than did heterosexual people, as did cisgender men in relation to cisgender women. Exclusively bisexual people drank significantly more drinks than exclusively heterosexual people, and cisgender men drank significantly more drinks than did cisgender women and those who identified as trans/another gender identity. COVID-19 stress and minority stress were associated with greater alcohol consumption, but they did not account for these differentials. Moving forward, researchers will need to continuously assess these associations, as sources of discrimination and stress will persist beyond the pandemic. Although LGBTQ+ people have disproportionate sources of stress, they varied in how they used alcohol to cope. Potential sources of resilience among sexual and gender diverse individuals should be explored.
Collapse
Affiliation(s)
- Susan D Stewart
- Department of Sociology and Criminal Justice, Iowa State University, Ames, Iowa, United States of America
| | - Wendy D Manning
- Center for Family and Demographic Research and Department of Sociology, Bowling Green State University, Bowling Green, Ohio, United States of America
| | - Kristen E Gustafson
- Center for Family and Demographic Research and Department of Sociology, Bowling Green State University, Bowling Green, Ohio, United States of America
| | - Claire Kamp Dush
- Minnesota Population Center and Department of Sociology, University of Minnesota, Minneapolis, Minnesota, United States of America
| |
Collapse
|
4
|
Mereish EH. Oppression-Based Stress and Alcohol Inequities Among Sexual and Gender Minority People: An Intersectional Multilevel Framework. Alcohol Res 2024; 44:05. [PMID: 39246430 PMCID: PMC11379061 DOI: 10.35946/arcr.v44.1.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024] Open
Abstract
PURPOSE Sexual and gender minority (SGM) people are at heightened risk for alcohol use, hazardous drinking, and alcohol use disorder compared to heterosexual and cisgender individuals. This paper: (a) presents an oppression framework that integrates intersectionality, stress, stigma, and addiction-based theories to examine the complex and nuanced ways oppression-based stress (e.g., minority stress) leads to sexual orientation and gender identity inequities in alcohol use; (b) conducts a narrative review that summarizes recent and novel advancements in the literature on the impact of oppression-based stressors on alcohol use outcomes across structural, interpersonal, and intrapersonal domains among SGM people; and (c) provides future research and intervention directions for the alcohol field. SEARCH METHODS A select review of the literature was conducted on July 10, 2023, using multiple electronic databases (i.e., PsycInfo, PubMed, Web of Science) and focusing on studies that had examined the associations between oppression-based stressors and alcohol use outcomes across structural, interpersonal, and intrapersonal levels. Search terms focused on alcohol consumption; SGM people, particularly SGM people of color; and oppression-based stress. Cross-sectional studies that focused on heterosexism-based and anti-bisexual oppression-based stressors at the interpersonal or intrapersonal levels and alcohol use outcomes were excluded as they have been included in prior reviews of the literature. SEARCH RESULTS The initial and combined search across the databases resulted in 3,205 articles. Of those, the narrative review included 50 peer-reviewed articles that focused on the following four areas of the literature on the associations between oppression-based stressors and alcohol use outcomes: (1) experimental, longitudinal, and experience sampling studies of heterosexism- and anti-bisexual oppression-based stressors (22 articles); (2) any studies of cissexism-based stressors (12 articles); (3) any studies of intersectional oppression among SGM people of color (seven articles, one article overlapped with the first category and another overlapped with the fourth category); and (4) any studies of structural oppression (11 articles). DISCUSSION AND CONCLUSIONS Results of this narrative review indicate that mounting evidence implicates oppression-based stress in inequities in alcohol use, hazardous drinking, and alcohol use disorder in SGM populations. This reflects SGM people's embodiment of oppression and injustice at the structural, interpersonal, and intrapersonal levels. Given some inconsistent and mixed patterns of findings, future research needs greater specificity in drinking inclusion criteria, robust and well-validated measures, more attention to culturally and developmentally relevant moderating and mediating mechanisms across the lifespan, application of sophisticated methodologies, and integration of intersectional and addiction frameworks.
Collapse
Affiliation(s)
- Ethan H Mereish
- Lavender Lab, Department of Psychology, University of Maryland, College Park, Maryland
| |
Collapse
|
5
|
Eddie D, Prindle J, Somodi P, Gerstmann I, Dilkina B, Saba SK, DiGuiseppi G, Dennis M, Davis JP. Exploring predictors of substance use disorder treatment engagement with machine learning: The impact of social determinants of health in the therapeutic landscape. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209435. [PMID: 38852819 PMCID: PMC11300147 DOI: 10.1016/j.josat.2024.209435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 03/15/2024] [Accepted: 05/21/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Improved knowledge of factors that influence treatment engagement could help treatment providers and systems better engage patients. The present study used machine learning to explore associations between individual- and neighborhood-level factors, and SUD treatment engagement. METHODS This was a secondary analysis of the Global Appraisal of Individual Needs (GAIN) dataset and United States Census Bureau data utilizing random forest machine learning and generalized linear mixed modelling. Our sample (N = 15,873) included all people entering SUD treatment at GAIN sites from 2006 to 2012. Predictors included an array of demographic, psychosocial, treatment-specific, and clinical measures, as well as environment-level measures for the neighborhood in which patients received treatment. RESULTS Greater odds of treatment engagement were predicted by adolescent age and psychiatric comorbidity, and at the neighborhood-level, by low unemployment and high population density. Lower odds of treatment engagement were predicted by Black/African American race, and at the neighborhood-level by high rate of public assistance and high income inequality. Regardless of the degree of treatment engagement, individuals receiving treatment in areas with high unemployment, alcohol sale outlet concentration, and poverty had greater substance use and related problems at baseline. Although these differences reduced with treatment and over time, disparities remained. CONCLUSIONS Neighborhood-level factors appear to play an important role in SUD treatment engagement. Regardless of whether individuals engage with treatment, greater loading on social determinants of health such as unemployment, alcohol sale outlet density, and poverty in the therapeutic landscape are associated with worse SUD treatment outcomes.
Collapse
Affiliation(s)
- David Eddie
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, USA; Department of Psychiatry, Harvard Medical School, USA.
| | - John Prindle
- Suzanne Dworak-Peck School of Social Work, University of Southern California, USA
| | - Paul Somodi
- Viterbi School of Engineering, Computer Science, University of Southern California, USA
| | - Isaac Gerstmann
- Viterbi School of Engineering, Computer Science, University of Southern California, USA
| | - Bistra Dilkina
- Viterbi School of Engineering, Computer Science, University of Southern California, USA
| | - Shaddy K Saba
- Suzanne Dworak-Peck School of Social Work, University of Southern California, USA
| | - Graham DiGuiseppi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, USA
| | - Michael Dennis
- Lighthouse Institute, Chestnut Health Systems, Normal, IL, USA
| | | |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Xu Y, Wang Y, Chen Y, Zhang Y, Tong L, He Y, Fang J, Li R, Zhang X, Jin L. The Relationship Between Adverse Childhood Experiences and Subjective Cognitive Decline Based on Sexual Orientation. Clin Gerontol 2023:1-9. [PMID: 37955228 DOI: 10.1080/07317115.2023.2282484] [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] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Research indicates adverse childhood experiences (ACEs) were associated with subjective cognitive decline (SCD), with higher ACEs reported by sexual minoritized individuals (i.e. lesbian, gay, and bisexual; LGB). This study aimed to explore the relationships between ACEs and SCD based on sexual orientation in middle-aged and older adults. METHODS The study included 76,592 participants from the 2019-2020 Behavioral Risk Factor Surveillance Survey (BRFSS). Multivariate logistic regressions analyzed ACEs status, score, and type associations with SCD. RESULTS 2.18% of the participants identified as sexual minoritized individuals. More sexual minoritized individuals reported SCD compared to heterosexual individuals (10.70% for heterosexuals; 17.27% for sexual minoritized individuals). Positive association between SCD and ACEs status (OR = 2.18, 95%CI: 1.09-4.40) was identified among sexual minoritized individuals. CONCLUSIONS The association between ACEs and SCD was strong in both heterosexual and sexual minoritized populations. Given the higher experience of ACEs among sexual minoritized adults, the subsequent frequency of SCD among these adults also may be higher. CLINICAL IMPLICATIONS Sexual minoritized older adults may have a history of numerous ACEs, which could contribute to a greater burden of SCD. Clinicians and other stakeholders may wish to consider relationships between ACEs and SCD based on sexual orientation.
Collapse
Affiliation(s)
- Yan Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yanfang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yana Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Li Tong
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yue He
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Jiaxin Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Runhong Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Xinyao Zhang
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Lina Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| |
Collapse
|
9
|
Scheer JR, Behari K, Schwarz AA, Cascalheira CJ, Helminen EC, Pirog SA, Jaipuriyar V, Sullivan TP, Batchelder AW, Jackson SD. Expressive writing treatments to reduce PTSD symptom severity and negative alcohol-related outcomes among trauma-exposed sexual minority women and transgender/nonbinary people: Study protocol for a mixed-method pilot trial. Contemp Clin Trials Commun 2023; 35:101197. [PMID: 37671246 PMCID: PMC10475481 DOI: 10.1016/j.conctc.2023.101197] [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: 04/19/2023] [Revised: 07/21/2023] [Accepted: 08/18/2023] [Indexed: 09/07/2023] Open
Abstract
Background Sexual minority women (SMW) and transgender and/or nonbinary (TNB) individuals report an elevated prevalence of posttraumatic stress disorder (PTSD) symptoms and negative alcohol-related outcomes compared to heterosexual women and cisgender people. SMW and TNB individuals also face barriers to utilizing treatment, which can result in delayed or missed appointments. Accessible, feasible, and effective treatment approaches, such as web-based expressive writing (EW) treatments, are needed to address PTSD and negative alcohol-related outcomes in these populations. Method We describe the design of a mixed-method pilot randomized controlled trial which will compare an EW treatment adapted for SMW and TNB people (stigma-adapted EW) and trauma (i.e., non-adapted) EW with an active (neutral-event) control to determine acceptability and feasibility of a future fully powered randomized controlled trial. The sample will include 150 trauma-exposed SMW and TNB individuals from across the United States who will be randomly assigned to stigma-adapted EW (n = 50), trauma EW (n = 50), or control (n = 50). Participants will be assessed before treatment, one-week after the first writing session, and three-months after the first writing session. This paper identifies steps for evaluating the acceptability and feasibility of the proposed study and determining changes in outcomes resulting from adapted and non-adapted EW treatments to inform refinements. This paper also highlights our strategy for testing theory-driven mediators and moderators of treatment outcomes. Conclusions This mixed-method pilot trial will inform the first fully powered, self-administered, brief web-based treatment to reduce PTSD symptom severity and negative alcohol-related outcomes among trauma-exposed SMW and TNB individuals.
Collapse
Affiliation(s)
- Jillian R. Scheer
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Kriti Behari
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Aubriana A. Schwarz
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Cory J. Cascalheira
- Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, 88003, USA
- VA Puget Sound Health Care System, Seattle, WA, 98108, USA
| | - Emily C. Helminen
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Sophia A. Pirog
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Virinca Jaipuriyar
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Tami P. Sullivan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06501, USA
| | - Abigail W. Batchelder
- Harvard Medical School, Harvard University, Boston, MA, 02114, USA
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- The Fenway Institute, Fenway Health, Boston, MA, 02115, USA
| | - Skyler D. Jackson
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, 06501, USA
| |
Collapse
|
10
|
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.
Collapse
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
| | | |
Collapse
|
11
|
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).
Collapse
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
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Leone RM, Ehlke SJ, Norris A, Sandoval CM, Butler LV, Winstead B, Kelley M, Lewis RJ. A dyadic examination of alcohol use and intimate partner aggression among women in same-sex relationships. Addict Behav 2022; 129:107262. [PMID: 35131682 PMCID: PMC8957041 DOI: 10.1016/j.addbeh.2022.107262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/10/2022] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
Abstract
Despite considerable evidence linking alcohol use and intimate partner aggression among mixed-sex couples, scant research has examined this association in same-sex couples using a dyadic framework. The aim of the present study was to examine associations between one's own and their partner's alcohol use (i.e., drinks per week, hazardous alcohol use) and intimate partner aggression (physical, psychological) perpetration while accounting for the interdependence among partners in alcohol use. Participants were 326 women (Mage = 27.57, SD = 3.65) from 163 female-female couples who independently completed measures of drinks per week, hazardous alcohol use, psychological intimate partner aggression victimization and perpetration, and physical intimate partner aggression victimization and perpetration. Actor-partner interdependence structural equation models found that (1) actor drinks per week were positively associated with one's own physical assault perpetration (2) actor hazardous alcohol use was positively associated with one's own physical assault and psychological aggression perpetration and (3) partner drinks per week and hazardous alcohol use were positively associated with actor's psychological aggression perpetration. No other significant effects were detected. Collectively, findings highlight the nuanced relationship between alcohol use and intimate partner aggression among same-sex female couples and suggest that one's own alcohol use is associated with intimate partner psychological and physical aggression perpetration. In contrast, the only partner effect was partner's alcohol use in association with actor's psychological aggression perpetration. These findings differ from prior research with heterosexual couples and underscore the need for future research with same-sex couples rather than attempts to generalize findings across populations.
Collapse
Affiliation(s)
- Ruschelle M Leone
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, United States; Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, United States.
| | - Sarah J Ehlke
- University of Oklahoma Health Sciences Center, United States
| | - Alyssa Norris
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Lifespan Corporation, United States; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States
| | | | - Lauren V Butler
- Department of Psychology, Old Dominion University, United States
| | - Barbara Winstead
- Virginia Consortium Program in Clinical Psychology, United States; Department of Psychology, Old Dominion University, United States
| | - Michelle Kelley
- Virginia Consortium Program in Clinical Psychology, United States; Department of Psychology, Old Dominion University, United States
| | - Robin J Lewis
- Virginia Consortium Program in Clinical Psychology, United States; Department of Psychology, Old Dominion University, United States
| |
Collapse
|
15
|
Lopez-Vergara HI, Zapolski TCB, Leventhal AM. Intersection of minority health, health disparities, and social determinants of health with psychopharmacology and substance use. Exp Clin Psychopharmacol 2021; 29:427-428. [PMID: 34636584 PMCID: PMC8906390 DOI: 10.1037/pha0000522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
These articles provide a window into the breadth of issues at the intersection of MHDS with psychopharmacology and substance use. Integrating the fields of psychopharmacology and basic behavioral addictions science with research on MHDS is not only of public health importance, but can help further elucidate our understanding of human behavior in all of its complexity. As demonstrated here, a better understanding of the synergy between societal context(s) and individual-level processes can lead to interventions tailored to specific risk and resilience factors; interventions that are personalized and contextualized have the potential to improve the health of our society. We are very grateful to the authors for their contributions to this special issue. We hope that professionals from various disciplines who read this special issue become inspired to bridge psychopharmacological and social determinants perspectives in their own work, and, in turn, accelerate scientific progress within each field. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | - Adam M. Leventhal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
- Institute for Addiction Science, University of Southern California
| |
Collapse
|