Prescription drug misuse, other substance use, and sexual identity: The significance of educational status and psychological distress in US young adults

Does the approach used to measure sexual identity affect estimates of health disparities differently by race? A randomized experiment from the National Survey of Family Growth

The inclusion of "something else" as a response option for survey questions about sexual identity has been shown to significantly moderate estimated differences between sexual identity subgroups in the distributions of various health outcomes in national health surveys, specifically for substance use/misuse and reproductive health. This moderation effect may be larger depending on the respondent's race, possibly due to the intersectionality of multiple minority identities and compounding minority stressors. To test this hypothesis, we conducted secondary analyses of data from five consecutive years of the National Survey of Family Growth (2015-2019) [n = 18,903 (8510 males, 10,393 females)] in the United States, where respondents were randomly assigned to receive either a four-category version of the sexual identity question that included "something else" as a response option along with lesbian/gay, bisexual, and heterosexual, or a three-category version that omitted "something else." We focused on model-based estimates of distributions of health outcomes across subgroups defined by both race and sexual identity and tested the race moderation hypothesis using three-way interactions involving sexual identity, question type received (four-category vs. three-category), and race (Black, White, and other). Based on this randomized experiment, we found evidence of significant differences between the four-category and three-category question versions of sexual identity, in terms of the associations between sexual identity and several health outcomes, along with moderation of these differences by the respondent's race. For some outcomes, such as wanting a child or another child, the magnitudes of the estimated sexual identity differences among racial minority individuals, specifically between bisexual and heterosexual women, were sensitive to the measurement of sexual identity. These results further suggest a need for improved sexual minority measurement, especially among racial minorities. These differences were also mostly found among women, suggesting further intersectionality of groups exposed to specific stressors.

Let's Connect: Impact Evaluation of an Intervention to Reduce Mental Health Disparities Among People Who are LGBTQ+

Lesbian, gay, bisexual, transgender, queer, or similarly identified (LGBTQ+) people experience substantial mental health disparities compared to heterosexuals. The "Let's Connect" intervention was designed to improve mental health outcomes for LGBTQ+ people. This impact evaluation aimed to assess effectiveness of this intervention during its pilot phase, using a single arm pilot trial. Respondents completed baseline surveys at intervention start, a post survey on the last day of the intervention (at 6 weeks), then a follow-up survey 6 weeks after the intervention ended (at 12 weeks). Pre-post differences in outcomes were analyzed using paired t-tests, chi-square tests, and generalized estimating equations to evaluate impact on mental health outcomes at 6 and 12 weeks, and identify characteristics associated with loss to follow-up. The average value of all three outcome measures decreased substantially between the baseline and post surveys; all of these differences were highly statistically significant, and further decreased between the end of the intervention at 6 weeks and the 12 week follow-up survey. Let's Connect participants did experience substantial improvements in mental health outcomes, on average, between the start and end of this intervention. Further study of this intervention using a randomized design and control group is warranted.

Z-Drug Use and Benzodiazepine Use and Misuse Among LGB Populations: The Role of Psychological Distress

BACKGROUND

Z-drugs (hypnotics such as zolpidem, zopiclone, and zaleplon) and benzodiazepines (BZDs) are sedative medications with misuse liability. The goals of this study are to report the (1) prevalence of past-year any Z-drug use, any BZD use, and any BZD misuse by sexual identity category and psychological distress; (2) associations among these 3 categories between sexual identity and past-year psychological distress; (3) associations among these 3 categories with sexual identity by past-year psychological distress status.

METHODS

Data were collected from the National Survey on Drug Use and Health (years 2015-2019 [n = 210,392]), a yearly representative national household survey of the American population. We report prevalences of any Z-drug use, any BZD use, and any BZD misuse by sexual identity and past-year psychological distress status. We ran logistic regressions with complex survey design with the 3 dichotomous variables described above as the dependent variables, stratified and not-stratified by psychological distress.

RESULTS

Prevalence of any Z-drug an BZD use and any BZD misuse were higher among LGB (lesbian/gay/bisexual) populations, especially gay men and bisexual women. Psychological distress was positively associated with any Z-drug and BZD use and any BZD misuse. Women were at higher risk of Z-drug (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.18-1.37) and BZD use (OR, 1.64; 95% CI, 1.55-1.73), but lower risk of BZD misuse (OR, 0.82; 95% CI, 0.76-0.88). When stratifying by psychological distress, differences between LGB and heterosexuals were more pronounced among those without past-year psychological distress, especially gay men and bisexual women.

CONCLUSIONS

The presence of psychological distress attenuates the disparities between LGB and heterosexual individuals in Z-drug use and BZD use and misuse.

How a "Something Else" Response Option for Sexual Identity Affects National Survey Estimates of Associations Between Sexual Identity, Reproductive Health, and Substance Use

This randomized experiment tested whether the inclusion of a "something else" response option for a question about sexual identity in a national health survey would significantly moderate estimated differences between sexual identity subgroups in terms of various health outcomes, including substance use and reproductive health. We conducted secondary analyses of data from five consecutive years of the National Survey of Family Growth (NSFG; 2015-2019), where two large national half-samples were randomly assigned to receive one of two different versions of a question about sexual identity (a four-category version that included a "something else" response option or a three-category version omitting this option). We focused on national estimates of differences between subgroups defined by sexual identity. Multivariable models indicated that the estimated subgroup differences changed in a statistically significant fashion when using the four-category version of the sexual identity question for several measures, including 16% of male measures (household size, past-year cigarette use, and past-year illicit drug use) and 15% of female measures (wanting a/another child, ever had a sexually transmitted disease, and past-year marijuana use). The absence of a "something else" response option for questions about sexual identity in national health surveys may cause respondents to select options that do not accurately describe their identities, and this can have a significant effect on national estimates of differences between sexual identity subgroups in terms of selected health outcomes.

Severity of behavioral addiction symptoms among young adults using non-prescribed sedatives/hypnotics

Introduction

Young adulthood is considered a critical period in terms of non-medical use of sedatives/hypnotics (NMUSH) as well as different types of behavioral addictions (BAs). However, the relationship between these behaviors has received scarce attention among young adult samples. Therefore, the aim of the present study was to investigate the association between NMUSH and symptoms of distinct BAs among young adults.

Materials and methods

Analyses were conducted based on the data of two large sample studies (including a representative sample) carried out with young adult samples. The following BAs were assessed: problematic internet use, problematic video gaming, problematic social media use, problem gambling, exercise addiction, eating disorders, compulsive buying behavior, problematic mobile phone use, work addiction, and hair pulling. Symptoms of distinct BAs were analyzed in three groups formed based on the NMUSH: non-users, lifetime users, and current users.

Results

The symptoms of problematic internet use, problematic social media use, problem gambling, exercise addiction, eating disorders, compulsive buying behavior and work addiction were significantly more severe among lifetime and/or current non-medical sedative and hypnotic users, compared to the non-user participants. The symptoms of problematic mobile phone use were the most severe in the non-user group.

Conclusions

The results suggest co-occurrence between NMUSH and distinct BAs among young adults. These findings draw attention to the need for preventive interventions for this high-risk population.

[Appropriate Use and Abuse of Sedative-Hypnotic Drugs]

The incidence of insomnia has been increasing in recent years. In addition, due to the impact of the COVID-19 pandemic, more and more people are experiencing a variety of insomniac problems, including having difficulty in sleep initation, waking up too early, and short sleep duration. Chronic insomnia may seriously affect patients' life and work, increase their risks of developing physical and mental illnesses, and cause crushing social and economic burdens. Sedative-hypnotics, including benzodiazepine agonists, melatonin receptor agonists, orexin receptor antagonists, and antidepressants with hypnotic effects, are widely used to treat most patients suffering from insomnia. However, there is the phenomenon of the non-medical use and abuse of sedative-hypnotic drugs, especially benzodiazepine receptor agonists. The abuse of sedative-hypnotic drugs may lead to mental and physical dependence, cognitive impairment, depression and anxiety, as well as an increased risks of falls and death. Therefore, drug regulatory authorities in China and other countries have issued relevant policies to reinforce regulation. Herein, we reviewed the prevalent use and safety of sedative-hypnotic drugs and proposed suggestions concerning their appropriate use. Both the efficacy and safety of sedative-hypnotic drugs should be carefully considered so that patients suffering from insomnia receive thorough and prompt treatment and the problem of potential abuse of sedative-hypnotic drugs is assessed in an objective and scientific manner. We also hope to provide references for the standardized clinical use of insomnia drugs.