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Mammadli T, Hong C. Substance Use and Misuse among Sexual and Gender Minority Communities Living in Former Soviet Union Countries: A Scoping Review. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2024; 36:59-76. [PMID: 38600900 PMCID: PMC10903640 DOI: 10.1080/19317611.2024.2303517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/04/2024] [Indexed: 04/12/2024]
Abstract
Objectives We reviewed literature examining substance use among sexual and gender minorities (SGM) living in the former Soviet Union (USSR) nations. Methods Searches were conducted across five databases (PubMed, SocINDEX, CINAHL, PscyInfo, LGBTQ + Source) to identify peer-reviewed literature. Results Across 19 studies, high hazardous substance use prevalence was documented. Substance use was correlated with (a) sexual health and behaviors and (b) mental wellbeing and the use of other substances. Conclusion We discuss minority stress implications and challenges presented by the paucity of evidence in the literature examining substance use among SGM women and SGM living in countries unrepresented in reviewed studies.
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Affiliation(s)
- Tural Mammadli
- School of Social Work, University of Maryland, Baltimore, MD, USA
| | - Chenglin Hong
- Department of Social Welfare, University of California Los Angeles, Los Angeles, CA, USA
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Ridenour TA, Cruden G, Yang Y, Bonar EE, Rodriguez A, Saavedra LM, Hussong AM, Walton MA, Deeds B, Ford JL, Knight DK, Haggerty KP, Stormshak E, Kominsky TK, Ahrens KR, Woodward D, Feng X, Fiellin LE, Wilens TE, Klein DJ, Fernandes CS. Methodological Strategies for Prospective Harmonization of Studies: Application to 10 Distinct Outcomes Studies of Preventive Interventions Targeting Opioid Misuse. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:16-29. [PMID: 35976525 PMCID: PMC9935745 DOI: 10.1007/s11121-022-01412-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 02/02/2023]
Abstract
The Helping to End Addiction Long-Term (HEAL) Prevention Cooperative (HPC) is rapidly developing 10 distinct evidence-based interventions for implementation in a variety of settings to prevent opioid misuse and opioid use disorder. One HPC objective is to compare intervention impacts on opioid misuse initiation, escalation, severity, and disorder and identify whether any HPC interventions are more effective than others for types of individuals. It provides a rare opportunity to prospectively harmonize measures across distinct outcomes studies. This paper describes the needs, opportunities, strategies, and processes that were used to harmonize HPC data. They are illustrated with a strategy to measure opioid use that spans the spectrum of opioid use experiences (termed involvement) and is composed of common "anchor items" ranging from initiation to symptoms of opioid use disorder. The limitations and opportunities anticipated from this approach to data harmonization are reviewed. Lastly, implications for future research cooperatives and the broader HEAL data ecosystem are discussed.
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Affiliation(s)
- Ty A Ridenour
- RTI International, 3040 E. Cornwallis Rd., PO Box 12194, 326 Cox Bldg, Research Triangle Park, 27709-2194, NC, USA.
| | | | - Yang Yang
- Texas Christian University, Fort Worth, USA
| | | | | | - Lissette M Saavedra
- RTI International, 3040 E. Cornwallis Rd., PO Box 12194, 326 Cox Bldg, Research Triangle Park, 27709-2194, NC, USA
| | | | | | - Bethany Deeds
- National Institute On Drug Abuse, North Bethesda, USA
| | | | | | - Kevin P Haggerty
- Seattle Children's Hospital & University of Washington, Seattle, USA
| | | | | | - Kym R Ahrens
- Seattle Children's Hospital & University of Washington, Seattle, USA
| | | | - Xin Feng
- The Ohio State University, Columbus, USA
| | | | | | - David J Klein
- RAND Corporation, & University of California, Los Angeles, USA
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Szlyk HS, Gutierrez ZM, Peoples J, Baiden P, Doroshenko C, Li X, Cavazos-Rehg P. Factors associated with not ready to stop using substances among adults with an unmet treatment need: findings from the National Survey of Drug Use and Health 2015-2019. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:519-529. [PMID: 37506340 PMCID: PMC10979417 DOI: 10.1080/00952990.2023.2230611] [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: 09/08/2022] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023]
Abstract
Background: A better understanding of factors associated with not ready to stop using substances may inform provider engagement with clients who have an unmet treatment need.Objectives: This study explores how treatment barriers, the number of SUD symptoms, and types of substances used are associated with not ready to stop using substances among adults with an unmet treatment need.Methods: The data came from the 2015-2019 National Survey on Drug Use and Health. Eligible adults met DSM-IV criteria for substance abuse and dependence and reported an unmet need for treatment. Among our sample (N = 1,017), a majority self-identified as male (weighted 59.3%). We employed multivariable logistic regression to examine individual-level factors associated with not being ready to stop using substances.Results: About 38% of the respondents reported that they were not ready to stop using substances. Reporting access barriers (aOR = 0.44, 95% CI: 0.29, 0.68) and attitudinal barriers (aOR = 0.47, 95% CI: 0.28, 0.80) was associated with a lower odds of not ready to stop using. Each additional increase in SUD symptoms was associated with 23% higher odds of not being ready to stop using (aOR = 1.22, 95% CI: 1.12, 1.34). Having a diagnosis of alcohol and/or marijuana abuse or dependence was associated with higher odds of not being ready to stop using when compared to respondents without these diagnoses (aOR = 2.13, 95% CI: 1.33, 3.40; aOR = 1.82 95% CI: 1.11, 2.99).Conclusion: Not ready to stop using substances may be impacted by the type of SUD, number of SUD symptoms, and certain barriers like access and attitude to care.
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Affiliation(s)
- Hannah S. Szlyk
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | | | - JaNiene Peoples
- Brown School, Washington University in St. Louis; 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130
| | - Philip Baiden
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX, 76019
| | | | - Xiao Li
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
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Thomas SA, Clements-Nolle KD, Wagner KD, Omaye S, Lu M, Yang W. Protective Environmental Factors and Opioid Use Among Sexual Minority Youth. Am J Health Behav 2023; 47:618-627. [PMID: 37596742 DOI: 10.5993/ajhb.47.3.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
Objectives: Nonmedical use of prescription opioids (NMUPO) is a pressing public health concern and affects sexual minority youth (SMY) at greater rates than heterosexual youth. We investigated whether protective environmental factors-(1) Human Rights Campaign's state equality index (SEI) and (2) supportive school environments for LGBTQ youth, influenced NMUPO among SMY and non-SMY students. Methods: We combined data from the 2017-2019 Youth Risk Behavior Survey, 2016-2018 School Health Profiles, state-level socio-demographic and SEI data across 24 states (N=156,149). Generalized linear mixed models examined associations between (1) SEI and (2) supportive school environments for LGBTQ youth, with NMUPO, accounting for clustering at the school-and state-level. Results: Before adjustment, we found that youth in states with higher SEI were significantly less likely to engage in NMUPO compared to students in states with lower SEI, a relationship that became non-significant after adjustment. After adjusting for individual-and state-level indicators, SMY in states with supportive school environments for LGBTQ youth were less likely to engage in NMUPO. Conclusions: Supportive school environments for LGBTQ youth may play an important role in the health of SMY. Establishing more inclusive policies and supportive environments within schools may reduce NMUPO among SMY.
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Affiliation(s)
- Shawn A Thomas
- School of Public Health, University of Nevada, Reno, Reno, NV, United States
| | | | - Karla D Wagner
- School of Public Health, University of Nevada, Reno, Reno, NV, United States
| | - Stanley Omaye
- College of Agriculture, Biotechnology, & Natural Resources, University of Nevada, Reno, Reno, NV, United States
| | - Minggen Lu
- School of Public Health, University of Nevada, Reno, Reno, NV, United States
| | - Wei Yang
- School of Public Health, University of Nevada, Reno, Reno, NV, United States
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Ware OD, Austin AE, Srivastava A, Dawes HC, Baruah D, Hall WJ. Characteristics of Outpatient and Residential Substance Use Disorder Treatment Facilities with a Tailored LGBT Program. Subst Abuse 2023; 17:11782218231181274. [PMID: 37342586 PMCID: PMC10278416 DOI: 10.1177/11782218231181274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023]
Abstract
Lesbian, gay, bisexual, and transgender (LGBT) individuals have a high prevalence of substance use disorders (SUDs) and experience unique barriers to treatment. Little is known about the characteristics of SUD treatment facilities providing LGBT-tailored programs at the outpatient and residential levels of care. The purpose of this study is to examine the availability of LGBT-tailored programs in outpatient and residential SUD treatment facilities. Using the National Survey of Substance Abuse Treatment Services 2020, we conducted logistic regression to examine facility characteristics, including ownership, pay assistance, region, outreach, and telehealth services, associated with having an LGBT-tailored program among SUD treatment facilities. Outpatient facilities that were for-profit, had pay assistance, had community outreach services, and provided telemedicine/telehealth were more likely to have an LGBT-tailored program. Those that were government-owned, in the Midwest, and that accepted Medicaid were less likely to have an LGBT-tailored program. Residential facilities that were in the West, for-profit, and had community outreach services were more likely to have an LGBT-tailored program. This study offers a national examination of the availability of LGBT-tailored programs in SUD treatment facilities. Differences in availability based on ownership, region, pay assistance, and outreach highlight potential gaps in treatment availability.
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Affiliation(s)
- Orrin D. Ware
- University of North Carolina at Chapel Hill School of Social Work, Chapel Hill, NC, USA
| | - Anna E. Austin
- University of North Carolina at Chapel Hill Gillings School of Public Health, Chapel Hill, NC, USA
| | - Ankur Srivastava
- University of North Carolina at Chapel Hill School of Social Work, Chapel Hill, NC, USA
| | - Hayden C. Dawes
- University of North Carolina at Chapel Hill School of Social Work, Chapel Hill, NC, USA
| | - Dicky Baruah
- University of North Carolina at Chapel Hill School of Social Work, Chapel Hill, NC, USA
| | - William J. Hall
- University of North Carolina at Chapel Hill School of Social Work, Chapel Hill, NC, USA
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Pratt-Chapman ML, Wang Y, Quinn GP, Shirima S, Adler S, Brazinskaite R, Kamen C, Radix A, Warren B, Eckstrand K, Lopez AM. Cancer patient and provider responses to companion scales assessing experiences with LGBTQI-affirming healthcare. Front Oncol 2023; 13:869561. [PMID: 37064143 PMCID: PMC10103145 DOI: 10.3389/fonc.2023.869561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/22/2023] [Indexed: 04/03/2023] Open
Abstract
BackgroundSexual and gender minority (SGM) persons are at a higher risk for some cancers and may have poorer health outcomes as a result of ongoing minority stress, social stigma, and cisnormative, heteronormative healthcare environments. This study compared patient and provider experiences of affirming environmental and behavioral cues and also examined provider-reported knowledge, attitudes, behaviors, and clinical preparedness in caring for SGM patients among a convenience sample.MethodsNational convenience samples of oncology providers (n = 107) and patients (n = 88) were recruited separately via snowball sampling. No incentives were provided. After reverse coding of appropriate items for unidirectional analysis, lower scores on items indicated greater knowledge, more affirming attitudes or behaviors, and greater confidence in clinical preparedness to care for SGM patients. Pearson chi-square tests compared dichotomous variables and independent samples t-tests compared continuous variables. Other results were reported using descriptive frequencies.ResultsBoth patient and provider samples were predominantly female sex assigned at birth, cisgender, and heterosexual. Providers were more likely than patients to report affirming cues in clinic, as well as the ability for patients to easily document their name in use and pronouns. Providers were more likely to report asking about patient values and preferences of care versus patients’ recollection of being asked. Patients were more likely to report understanding why they were asked about both sex assigned at birth and gender identity compared to providers’ perceptions that patients would understand being asked about both. Patients were also more likely to report comfort with providers asking about sex assigned at birth and gender identity compared to providers’ perceptions of patient comfort. SGM providers had greater knowledge of SGM patient social determinants of health and cancer risks; felt more prepared to care for gay patients; were more likely to endorse the importance of knowing patient sexual orientation and gender identity; and were more likely to indicate a responsibility to learn about SGM patient needs and champion positive system changes for SGM patients compared to heterosexual/cisgender peers. Overall, providers wished for more SGM-specific training.ConclusionDifferences between patient and provider reports of affirming environments as well as differences between SGM and heterosexual/cisgender provider care support the need for expanded professional training specific to SGM cancer care.
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Affiliation(s)
- Mandi L. Pratt-Chapman
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
- The George Washington University Cancer Center, Washington, DC, United States
- Department of Community Health and Prevention, The George Washington University Milken Institute School of Public Health, Washington, DC, United States
- *Correspondence: Mandi L. Pratt-Chapman,
| | - Yan Wang
- The George Washington University Cancer Center, Washington, DC, United States
- Department of Community Health and Prevention, The George Washington University Milken Institute School of Public Health, Washington, DC, United States
| | - Gwendolyn P. Quinn
- Departments of OB-GYN and Population Health, Grossman School of Medicine, Perlmutter Cancer Center, New York University, New York, NY, United States
| | - Sylvia Shirima
- The George Washington University Cancer Center, Washington, DC, United States
| | - Sarah Adler
- The George Washington University Cancer Center, Washington, DC, United States
| | - Ruta Brazinskaite
- The George Washington University Cancer Center, Washington, DC, United States
| | - Charles Kamen
- Department of Surgery and Wilmot Cancer Institute, University of Rochester, Rochester, NY, United States
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY, United States
| | - Barbara Warren
- Mount Sinai Health System and School of Medicine, New York, NY, United States
| | - Kristen Eckstrand
- Department of Psychiatry, University of Pittsburgh, Pittsburg, PA, United States
| | - Ana Maria Lopez
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
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Paschen-Wolff MM, Kidd JD, Paine EA. The State of the Research on Opioid Outcomes Among Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexuality- and Gender-Diverse Populations: A Scoping Review. LGBT Health 2023; 10:1-17. [PMID: 36318023 PMCID: PMC10081720 DOI: 10.1089/lgbt.2022.0036] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: Research on opioid misuse, opioid use disorder (OUD), and overdose (i.e., opioid outcomes) among lesbian, gay, bisexual, transgender, queer, and other populations within the LGBTQ umbrella (LGBTQ+) remains sparse. The purpose of this scoping review was to characterize the state of the research on opioid outcomes among LGBTQ+ populations, and identify gaps in the extant literature and areas for future research. Methods: We conducted a scoping review of peer-reviewed, English language articles published between 2011 and 2020 that examined opioid outcomes among LGBTQ+ populations in the CINAHL, Embase, PubMed, and PsycINFO databases. We extracted data from articles that focused on opioid outcomes within their specific aims or purpose. We include a general summary for articles that secondarily described opioid outcomes among LGBTQ+ populations. Results: Of 113 published studies that examined opioid outcomes among LGBTQ+ populations, 10% (n = 11) were specifically designed to focus on this topic. Across studies, bisexual populations, particularly women, were at highest risk for opioid misuse and OUD. Few studies examined opioid outcomes by more than one dimension of sexual orientation (n = 3, 27%), race and/or ethnicity (n = 3, 27%), or age (n = 5, 45%). Only two included transgender or gender diverse samples; only one explicitly measured gender identity. Conclusions: Future research is needed to understand the impact of the opioid epidemic on LGBTQ+ people, particularly transgender and other gender diverse individuals, and the intersectional role of race, ethnicity, and age in opioid disparities among LGBTQ+ individuals. Additional research could contribute to the development of much-needed affirming OUD treatment and other services for LGBTQ+ people.
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Affiliation(s)
- Margaret M. Paschen-Wolff
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center at New York State Psychiatric Institute, New York, New York, USA
| | - Jeremy D. Kidd
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center at New York State Psychiatric Institute, New York, New York, USA
| | - Emily Allen Paine
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, New York, USA
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Batchelder AW, Foley JD, Stanton AM, Gorman KR, Morris JC, Scheer JR. Facets of Gender Expression and Discrimination in Relation to Alcohol and Other Drug Use Severity Among Sexual Minority Women and Gender Diverse Individuals Assigned Female at Birth. LGBT Health 2022; 10:191-201. [PMID: 36367714 PMCID: PMC10079249 DOI: 10.1089/lgbt.2022.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Sexual minority women and gender diverse individuals assigned female at birth (SMW+) consistently report more alcohol and other drug (AOD) use severity than heterosexual women, with greater disparities reported among bisexual plus (bi+) SMW (including bisexual, pansexual, queer, and those with attractions to more than one gender regardless of identity). Furthermore, emerging evidence suggests that SMW with masculine gender expression (e.g., SMW with masculine gender appearance) disproportionately experience problematic AOD use compared to those with feminine gender expression. The minority stress model, which has predominantly been investigated in relation to internalized homonegativity and sexuality-based discrimination, may also account for these AOD use disparities. This study examined gender expression, related discrimination, and AOD use severity among SMW+. Methods: In a 2020 sample of SMW+ (n = 236), we investigated AOD use severity in relation to gender expression (appearance, emotional expression, and gender roles) and gender expression-based discrimination after controlling for internalized homonegativity and sexuality-based discrimination through an online survey. Results: Masculine gender roles were associated with AOD use severity, whereas masculine appearance and emotional expression were not. In multivariable models, gender identity was inconsistently associated with alcohol use severity, sexuality-based discrimination was consistently associated with alcohol use severity and inconsistently associated with other drug use severity, and gender expression-based discrimination was associated with neither. Conclusion: This study emphasizes the importance of examining intersecting aspects of minority identity among SMW+, including facets of gender expression, in relation to AOD use severity.
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Affiliation(s)
- Abigail W. Batchelder
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Jacklyn D. Foley
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Amelia M. Stanton
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | | | - Jenna C. Morris
- Department of Internal Medicine, University of Rochester, Rochester, New York, USA
| | - Jillian R. Scheer
- Department of Psychology, Syracuse University, Syracuse, New York, USA
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Care of Individuals Who Identify as Lesbian, Gay, Bisexual, Transgender, Questioning and/or Queer, Intersex, or Asexual: A Position Paper. J Addict Nurs 2021; 32:220-224. [PMID: 34855320 DOI: 10.1097/jan.0000000000000433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Wojciechowski T. Relevance of the dual systems model for predicting drug/alcohol dependence in early adulthood among previously adjudicated young adults. Drug Alcohol Depend 2021; 226:108876. [PMID: 34225226 DOI: 10.1016/j.drugalcdep.2021.108876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/03/2021] [Accepted: 06/16/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND While the dual system model has been found to have utility for predicting drug use, examinations have yet to extend to the clinically relevant issue of drug/alcohol dependence. This study sought to provide better understanding of how the dual systems model constructs (impulse control and sensation-seeking) predicted risk for drug/alcohol dependence in early adulthood among a sample of young adults who were adjudicated for a serious offense as minors. METHODS Data from several waves of the Pathways to Desistance data were used in analyses. Logistic regression was used to model covariate effects on drug/alcohol dependence risk. RESULTS Findings indicated that lower impulse control predicted increased odds of meeting criteria for drug/alcohol dependence in early adulthood. Sensation-seeking was not a significant predictor of drug/alcohol dependence risk at follow-up. CONCLUSIONS Lower impulse control was predictive of drug/alcohol dependence risk. Prevention programming should seek to boost impulse control during adolescence to mitigate this risk and treatment programming should focus on impulse control training in order to treat drug/alcohol dependence in inpatient and outpatient contexts.
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Hughto JMW, Restar AJ, Wolfe HL, Gordon LK, Reisner SL, Biello KB, Cahill SR, Mimiaga MJ. Opioid pain medication misuse, concomitant substance misuse, and the unmet behavioral health treatment needs of transgender and gender diverse adults. Drug Alcohol Depend 2021; 222:108674. [PMID: 33773869 PMCID: PMC8058310 DOI: 10.1016/j.drugalcdep.2021.108674] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/16/2021] [Accepted: 02/24/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Limited research has explored risk factors for opioid pain medication misuse, concomitant substance misuse, and the unmet behavioral health treatment (BHTx) needs of transgender and gender diverse (TGD) adults. METHODS In 2019, TGD adults (N = 562) in Massachusetts and Rhode Island were purposively recruited and completed a psychosocial and behavioral health survey (95 % online; 5% in-person). Multivariable logistic regression was used to examine factors associated with past 12-month opioid pain medication misuse and unmet BHTx needs. RESULTS Overall, 24.4 % of participants were trans women; 32.0 % trans men; and 43.6 % were non-binary. Past-year substance misuse included: marijuana (56.8 %), hazardous drinking (37.5 %), hallucinogens (9.8 %), benzodiazepines (8.2 %), and opioid pain medication (8.0 %). Among participants with past-year substance misuse and BHtx need (n = 326), 81.3 % received BHtx and 18.7 % had unmet BHtx needs. Being a trans woman, having HIV, stigma in healthcare, and number of substances misused were associated with increased odds of past-year opioid pain medication misuse; high social connectedness was associated with decreased odds of opioid pain medication misuse (p-values<0.05). Younger age, stigma in healthcare, and misusing opioid pain medications were associated with increased odds of unmet BHTx needs; post-traumatic stress disorder and family support were associated with decreased odds of unmet BHtx needs (p-values<0.05). CONCLUSIONS Addressing disparities in opioid pain medication misuse among TGD people requires systematic improvements in healthcare access, including efforts to create TGD-inclusive BHtx environments with providers who are equipped to recognize and treat the social and structural drivers of TGD health inequities, including opioid pain medication misuse.
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Affiliation(s)
- Jaclyn M W Hughto
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, United States; Department of Epidemiology, School of Public Health, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, United States; Center for Promotion and Health Equity, Brown University, Box G-121-8, Providence, RI 02912, United States; The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, United States.
| | - Arjee J Restar
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States
| | - Hill L Wolfe
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, United States; Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Building 70, Bedford, MA, 01730, United States
| | - Lily K Gordon
- Warren Alpert School of Medicine, for Brown University, 222 Richmond Street, Providence, RI, 02903, United States
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, United States; General Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, United States; Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, United States
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, United States; Department of Epidemiology, School of Public Health, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, United States; Center for Promotion and Health Equity, Brown University, Box G-121-8, Providence, RI 02912, United States; The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, United States
| | - Sean R Cahill
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, United States; Bouve College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, United States
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, United States; Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, BOX 951772, 71-267 CHS, Los Angeles, CA, 90095, United States; Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine, University of California Los Angeles, BOX 951772, 71-267 CHS, Los Angeles, CA, 90095, United States; UCLA Center for LGBTQ Advocacy, Research & Health, BOX 951772, 71-267 CHS, Los Angeles, CA, 90095, United States.
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12
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Suarez S, Lupez E, Siegel J, Streed C. The Annual Examination for Lesbian, Gay, and Bisexual Patients. Prim Care 2021; 48:191-212. [PMID: 33985699 DOI: 10.1016/j.pop.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The annual examination is a comprehensive evaluation of patients in which all aspects of health and well-being are considered, including proper screening, appropriate preventive care, and recommendations and resources for healthy living. Clinicians commonly avoid certain topics with lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients because they may be unprepared to address their health needs. Therefore, clinicians should learn how to conduct an LGBTQ-friendly annual examination in order to provide high-quality care. This article focuses on both the general and unique health needs of lesbian, gay, bisexual, and queer patients; care for transgender and gender-diverse patients is considered elsewhere.
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Affiliation(s)
- Sebastian Suarez
- Internal Medicine Residency Program, Boston University Medical Center, 72 East Concord Street, Evans 124, Boston, MA 02118, USA.
| | - Emily Lupez
- Internal Medicine Residency Program, Boston University Medical Center, 72 East Concord Street, Evans 124, Boston, MA 02118, USA. https://twitter.com/emily_lupez
| | - Jennifer Siegel
- Internal Medicine Residency Program, Boston University Medical Center, 72 East Concord Street, Evans 124, Boston, MA 02118, USA; Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA; Center for Transgender Medicine & Surgery, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor Room 2082, Boston, MA 02118, USA. https://twitter.com/siegenatorJS
| | - Carl Streed
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA; Center for Transgender Medicine & Surgery, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor Room 2082, Boston, MA 02118, USA. https://twitter.com/cjstreed
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13
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Qeadan F, Barbeau WA, Shan L, Azagba S. Associations between sexual identity-attraction discordance, and prescription opioid misuse among adults. Prev Med 2021; 145:106401. [PMID: 33388332 DOI: 10.1016/j.ypmed.2020.106401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/03/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
Prior research has shown that sexual minorities are disproportionately affected by substance use disorders and prescription opioid misuse. While most studies explore how single dimensions of sexual orientation (i.e., identity, attraction, and behavior) are associated with substance use disorders, we aimed to explore how multiple dimensions of sexual orientation interact with substance use behaviors. Specifically, we examined sexual identity-attraction discordance, the situation when one's sexual identity does not match their socially-expected sexual attractions, with prescription opioid misuse. This study assessed the association between sexual identity-attraction discordance with prescription opioid misuse utilizing data from the National Survey on Drug Use and Health from 2015 to 2017 among adults while employing propensity score weighting with multivariable logistic regression. The study included 127,430 adult participants, of whom 1.3%, 4.4%, and 10.6% self-reported prescription opioid misuse in the past month, past year, and lifetime, respectively. Those with discordant sexual identity-attractions had higher odds of prescription opioid misuse in their lifetime (aOR= 1.22, 95% CI 1.07-1.40) when compared to those with concordant sexual identity-attractions. When stratified by sex, we found sexual identity-attraction discordant females had higher odds of prescription opioid misuse in their lifetime (aOR= 1.29, 95% CI 1.13-1.49); there was no association among males. These findings further emphasize the need to consider the dynamic nature of sexual orientation in substance use research.
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Affiliation(s)
- Fares Qeadan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Ste A, Salt Lake City, UT 84108, United States.
| | - William A Barbeau
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Ste A, Salt Lake City, UT 84108, United States.
| | - Lingpeng Shan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Ste A, Salt Lake City, UT 84108, United States.
| | - Sunday Azagba
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Ste A, Salt Lake City, UT 84108, United States.
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14
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Haeder SF, Sylvester S, Callaghan T. Shared Stigma: The Effect of LGBT Status on Attitudes About the Opioid Epidemic. WORLD MEDICAL & HEALTH POLICY 2021. [DOI: 10.1002/wmh3.391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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15
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Morgan E, Feinstein BA, Dyar C. Disparities in Prescription Opioid Misuse Affecting Sexual Minority Adults Are Attenuated by Depression and Suicidal Ideation. LGBT Health 2020; 7:431-438. [PMID: 33112701 DOI: 10.1089/lgbt.2020.0220] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose: Heightened rates of prescription opioid misuse have been observed among sexual minority (SM) compared with heterosexual populations. In addition, depression and suicidal ideation are risk factors for misuse, and they are also elevated among SM populations. The purpose of this analysis was to examine whether depression and suicidal ideation attenuate disparities in prescription opioid misuse among SM adults. Methods: Data came from a publicly available, nationally representative data set, the National Survey on Drug Use and Health, 2015-2018. Among adults, survey-weighted logistic regression was used to assess the relationship between sexual orientation and past-year opioid misuse adjusting for demographics and either past-year major depressive episode or suicidal ideation. Probabilities of prescription opioid misuse were also assessed under counterfactual rates of depression and suicidal ideation. Analyses were stratified by sex. Results: Among participants in the analytic sample (N = 169,759; SM = 11,268), 9254 (5.5%) reported past-year prescription opioid misuse. The overall rate of opioid misuse decreased from 6.2% in 2015 to 4.6% in 2018. The association between sexual orientation and opioid misuse was attenuated downward for gay men, lesbian women, and bisexual individuals (men and women) after adjusting for either major depressive episode or suicidal ideation, but opioid misuse remained higher among most SM groups. In addition, rates of opioid misuse were found to be lower in counterfactual analyses with a nearly 2.5- and 4-fold decrease in depression and suicidal ideation among gay men and bisexual women, respectively. Conclusion: Efforts to reduce disparities in depression and suicidal ideation affecting SM individuals may reduce disparities in prescription opioid misuse affecting this population.
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Affiliation(s)
- Ethan Morgan
- Infectious Disease Institute, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Brian A Feinstein
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
| | - Christina Dyar
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
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16
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Han BH, Duncan DT, Arcila-Mesa M, Palamar JJ. Co-occurring mental illness, drug use, and medical multimorbidity among lesbian, gay, and bisexual middle-aged and older adults in the United States: a nationally representative study. BMC Public Health 2020; 20:1123. [PMID: 32746891 PMCID: PMC7401198 DOI: 10.1186/s12889-020-09210-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 07/05/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Older lesbian, gay, and bisexual (LGB) adults are an underserved and understudied population that experience specific health disparities. The intersection of aging and chronic medical disease with a higher risk for substance use and mental illness may place older LGB adults at risk for co-occurring conditions and resulting comorbidity. Understanding multimorbidity among older LGB adults may help inform interventions to reduce disparities in health outcomes. METHODS Data come from the 2015 to 2017 National Surveys on Drug Use and Health (n = 25,880). We first determined whether sexual orientation was associated with reporting: past-year drug use, mental illness, and/or 2 or more chronic medical diseases. We then determined whether sexual orientation was associated with reporting co-occurrence of these conditions. This was done using multivariable logistic regression. Analyses were stratified by gender. RESULTS Compared to heterosexual men, gay men were at increased odds for reporting 2 or more chronic medical diseases (adjusted odds ratio [aOR] = 2.18, 95% confidence interval [CI] = 1.48, 3.21), and gay (aOR = 1.79, 95% CI = 1.09, 2.93) and bisexual men (aOR = 3.53, 95% CI = 2.03, 6.14) were at increased odds for reporting mental illness. Gay men (aOR = 2.95, 95CI = 1.60, 5.49) and bisexual men (aOR = 2.84, 95% CI = 1.58, 5.08) were at increased odds of reporting co-occurring conditions. Compared to heterosexual women, bisexual women were at increased odds for past-year drug use (aOR = 4.20, 95% CI = 2.55, 6.93), reporting mental illness (aOR = 1.94, 95% CI = 1.03, 3.67), and reporting co-occurring conditions (aOR = 3.25, 95% = 1.60, 6.62). CONCLUSIONS Middle-aged and older LGB adults in the United States are at high risk for experiencing co-occurring drug use, mental illness, and/or medical multimorbidity. Interventions for older sexual minority populations are needed to reduce disparities.
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Affiliation(s)
- Benjamin H Han
- Department of Population Health, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
| | - Dustin T Duncan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - Mauricio Arcila-Mesa
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Joseph J Palamar
- Department of Population Health, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA
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17
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Schuler MS, Collins RL. Sexual minority substance use disparities: Bisexual women at elevated risk relative to other sexual minority groups. Drug Alcohol Depend 2020; 206:107755. [PMID: 31810051 PMCID: PMC6980764 DOI: 10.1016/j.drugalcdep.2019.107755] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/02/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Prior studies characterizing sexual minority substance use disparities have primarily compared lesbian/gay and bisexual individuals, respectively or in combination, to heterosexual individuals. In light of emerging evidence that bisexual individuals may have particularly elevated substance use risk, we examine differences in recent substance use between bisexual and lesbian/gay individuals using national survey data. METHODS Data on 126,463 adults (including 8241 LGB adults) were from the 2015-2017 National Survey on Drug Use and Health. Substance use outcomes included binge drinking, cigarette smoking, cigar smoking, marijuana use, illicit drug use, opioid misuse, alcohol use disorder, nicotine dependence, and substance use disorder. Logistic regression was used to estimate sexual identity- and gender-specific odds ratios, controlling for demographic characteristics. Of particular interest were estimates comparing bisexual and lesbian/gay individuals of the same gender. RESULTS Both male and female sexual minority adults had significantly elevated rates of substance use compared to heterosexual adults. Furthermore, relative to lesbian/gay women, bisexual women had significantly elevated odds of binge drinking (aOR = 1.29), marijuana use (aOR = 1.42), illicit drug use (aOR = 1.55), opioid misuse (aOR = 1.53), and alcohol use disorder (aOR = 1.48). Relative to gay men, bisexual men had significantly elevated cigar use (aOR = 1.64). CONCLUSIONS Bisexual women were at significantly greater risk for multiple substance use behaviors relative to lesbian/gay women. We did not observe any substance use behaviors for which bisexual individuals had significantly lower risk than their lesbian/gay peers. These disparities may be explained, in part, by unique risk factors for substance use experienced by bisexual individuals, particularly bisexual women.
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