Substance Use Among a National Sample of Sexual and Gender Minority Adolescents: Intersections of Sex Assigned at Birth and Gender Identity

Substance use among trans and gender diverse young people in Australia: Patterns, correlates and motivations

INTRODUCTION

There is a dire paucity of research into the burden, correlates and motives of substance use among trans young people in Australia.

METHOD

Using data from a national survey of Australian trans young people (N = 859, Mage = 19.4), we estimated prevalence of past 6-month substance use (tobacco, alcohol, cannabis, other drugs) and lifetime substance use disorder diagnoses. Covariate-adjusted multivariate logistic regression models tested associations between substance use types with 18 interpersonal factors. Open-ended responses regarding substance use motives (n = 489) were qualitatively analysed using thematic analysis with an interpretative phenomenological approach.

RESULTS

Prevalence of lifetime substance use disorder diagnosis was 13.5% (95% confidence interval [CI] 11.1, 16.1). Alcohol use was most reported (72.4%; 95% CI 68.9, 75.6) followed by tobacco (31.1%; 95% CI 27.7, 34.6) and cannabis (30.6%; 95% CI 27.2, 34.2). Trans women reported highest rates of alcohol and cannabis use; use of other drugs was highest among trans men. Highest risk of substance use was observed among trans youth who experienced discrimination, intimate partner abuse, peer rejection and lack of family support (adjusted odds ratios ranging 1.5 to 3.0). Four multi-levelled themes of substance use motives were identified: circumstantial use, somatic use, feeling better about oneself and one's life, and harm reduction.

DISCUSSION AND CONCLUSIONS

While substance use among trans young is largely circumstantial, hedonistic and altruistic, facilitating self-exploration, friendship and community connectedness, substance use among trans young people is highly prevalent and may be used to cope with sleep difficulties, depression/anxiety and cisnormativity, including delays and waitlists for accessing gender-affirming care.

Prevalence, distribution, and inequitable co-occurrence of mental ill-health and substance use among gender and sexuality diverse young people in Australia: epidemiological findings from a population-based cohort study

PURPOSE

To estimate the prevalence, distribution, and co-occurrence of mental ill-health and substance use among gender and sexuality diverse young people relative to their cisgender and heterosexual peers in Australia using population-level, nationally representative data.

METHODS

We utilised Wave 8 (2018) data from the Longitudinal Study of Australian Children (N = 3037, Mage = 18.4) collected via an assessment protocol comprising interviews, direct observations, and assessments (on average 60 min per survey occasion). Weighted prevalence ratios and logistic regression models adjusted for demographic confounders were used to estimate the prevalence and distribution of mental ill-health (psychological distress, past 12-month self-harm thoughts and behaviours, past 12-month suicidal ideation, planning, attempt/s) and substance use outcomes (past 12-month cigarette, alcohol, and marijuana use) across gender identity (trans vs. cisgender), sexuality (gay/lesbian, bisexual, queer [those identifying with an 'other' sexuality identity that is not 'gay', 'lesbian', 'bisexual', or 'heterosexual'] vs. heterosexual) and sexuality diversity status (sexuality diverse vs heterosexual) subgroups. Sex-stratified prevalence rates and accompanying adjusted logistic regression models were also used to assess mental ill-health and substance use disparities by sexuality diversity status. Adjusted multinominal logistic regression models were used to test disparities in co-occurring outcomes by sexuality identity) sexuality status sub-groups, and Fisher's Exact Test of Independence for co-occurring disparities by gender identity (due to small sample size). All analyses used Wave 8 sample weights and adjusted for postcode-level clustering.

RESULTS

Among gender and sexuality diverse participants, 59 - 64% reported high or very high levels of psychological distress, 28 - 46% reported past 12-month self-harm ideation or attempts, and 26 - 46% reported past 12-month suicidal ideation, planning, or behaviour. We found significant disparities in high/very high levels of psychological distress, self-harm behaviours and suicidal behaviours among trans participants (adjusted odds ratios (aORs) ranged from 3.5 to 5.5) and sexuality diverse participants (aORs ranged from 3.5 to 3.9), compared with cisgender and heterosexual participants, respectively. Highest disparities in any past 12-month self-harm and suicidal behaviours appeared most pronounced among trans participants and queer participants compared with their cisgender, heterosexual counterparts. Minor differences by sex among sexuality diverse participants were observed for select mental ill-health outcomes. Sexuality diverse participants, and particularly sexuality diverse females, were significantly more likely to report past 12-month cigarette use and past 12-month marijuana use (adjusted odds ratio (aORs) ranging 1.4-1.6). Trans young people were at significantly elevated risk of mental ill-health in co-occurrence with cigarette and marijuana use compared with their cisgender peers (Fisher's Exact Test of Independence p < 0.05 for all), whereas sexuality diverse young people were at greater risk of co-occurring mental ill-health and cigarette co-use and marijuana co-use, compared with their non-sexuality diverse peers (adjusted multinomial odds ratios (aMORs) ranging 2.2-6.0).

CONCLUSION

Mental ill-health, substance use, and their co-occurrence disproportionately affects gender and sexuality diverse young people in Australia. Further research should study the longitudinal development of these disparities through adolescence, with close attention to the social, embodied contexts of substance use among LGBTQ + young people with the view to building LGBTQ + affirming models of harm reduction.

Screen use in transgender and gender-questioning adolescents: Findings from the Adolescent Brain Cognitive Development (ABCD) Study

OBJECTIVE

To assess the association between transgender or gender-questioning identity and screen use (recreational screen time and problematic screen use) in a demographically diverse national sample of early adolescents in the U.S.

METHODS

We analyzed cross-sectional data from Year 3 of the Adolescent Brain Cognitive DevelopmentSM Study (ABCD Study®, N = 9859, 2019-2021, mostly 12-13-years-old). Multiple linear regression analyses estimated the associations between transgender or questioning gender identity and screen time, as well as problematic use of video games, social media, and mobile phones, adjusting for confounders.

RESULTS

In a sample of 9859 adolescents (48.8% female, 47.6% racial/ethnic minority, 1.0% transgender, 1.1% gender-questioning), transgender adolescents reported 4.51 (95% CI 1.17-7.85) more hours of total daily recreational screen time including more time on television/movies, video games, texting, social media, and the internet, compared to cisgender adolescents. Gender-questioning adolescents reported 3.41 (95% CI 1.16-5.67) more hours of total daily recreational screen time compared to cisgender adolescents. Transgender identification and questioning one's gender identity was associated with higher problematic social media, video game, and mobile phone use, compared to cisgender identification.

CONCLUSIONS

Transgender and gender-questioning adolescents spend a disproportionate amount of time engaging in screen-based activities and have more problematic use across social media, video game, and mobile phone platforms.

Psychological Distress and Suicidality Among Transgender Young Adults in the United States

PURPOSE

Transgender young adults (TYA) are burdened by adverse mental health outcomes. Guided by intersectionality and minority stress frameworks, we compared prevalence of psychological distress and suicidality among TYA of different social identities to inform future interventions.

METHODS

In this secondary data analysis of 12,738 TYA, ages 18-25 years, from the 2015 United States Transgender Survey, we developed multivariable regression models examining associations between social identities and psychological distress and suicidality, adjusting for relevant covariates. Self-reported identities were used as proxies for minority stress resulting from structural oppressions related to gender binarism, transmisogyny, heterosexism, and racism.

RESULTS

Overall, 53% met criteria for serious psychological distress, and 66% reported suicidal ideation. Statistically higher odds of serious psychological distress and suicidal ideation and plan were found for TYA assigned male compared to assigned female at birth (adjusted odds ratios [aORs] = 1.14-1.50). Nonbinary TYA assigned male at birth also had lower odds of all outcomes compared to all other TYA (aORs = 0.6-0.7). Compared to White TYA, Latiné/x TYA were more likely to experience serious psychological distress (aOR = 1.19, 95% confidence interval: 1.02, 1.39) and multiracial TYA were more likely to report suicide plan(s) and attempt(s) (aORs = 1.25-1.30). Finally, compared to heterosexual TYA, bisexual/pansexual TYA were more likely to report suicide plan(s) (aOR = 1.28, 95% confidence intervals: 1.04, 1.52), and all sexual minority TYA were more likely to report serious psychological distress and suicidal ideation (aORs = 1.31-2.00).

DISCUSSION

Results highlight complex associations between intersectional minority stress and mental health outcomes among TYA. Associations between identities and mental health morbidity highlight an urgent need for targeted mental health interventions.

Gambling Behavior Among LGBTQ + Individuals: The Role of Gender and Gender Identity

While past literature suggests that LGBTQ + individuals may be at a greater risk for gambling related-harms and addiction, few studies have specifically looked at gambling behavior among LGBTQ + persons based on gender and gender identity. A study of LGBTQ + individuals in four U.S. States was conducted to assess differences in gender and gender identity for (1) gambling prevalence; (2) gambling behavior based on type and location; and (3) comorbidity with substance abuse and/or other problematic behaviors. Individuals assigned male at birth had greater prevalence of gambling than those assigned female at birth, regardless of current gender identity. Gender identity, on its own, is only significant for certain types of gambling and in some analysis only when combined with gender assigned at birth. Findings suggest that gender assigned at birth has a stronger relationship with gambling prevalence and behavior than adult gender identity.

Contexts of social alcohol and cannabis use among sexual minority cisgender women and gender diverse individuals: Event-level differences in alcohol and cannabis use patterns based on the sexual orientations and gender identities of substance use companions

PURPOSE

Sexual minority women and gender diverse individuals assigned female at birth (SMWGD) are at elevated risk for alcohol and cannabis use disorders. It has been posited that characteristics of SMWGD's substance use companions (i.e., sexual orientation, gender identity) may influence their own use, but few studies have tested this. The current study aimed to examine whether quantity and consequences of substance use varied based on sexual orientations and gender identities (SOGI) of SMWGD's substance use companions.

METHODS

We utilized a 30-day ecological momentary assessment study of substance use among a sample of 429 SMWGD. We examined event-level associations between characteristics of substance use companions and quantity and consequences of substance use.

RESULTS

When SMWGD used alcohol/cannabis with most SOGI groups, they engaged in heavier drinking and cannabis use. Drinking with heterosexual men and SMW was associated with more drinking consequences. Drinking in settings with more SOGI groups and with both LGBTQ+ and heterosexual individuals was associated with heavier drinking and more consequences. Many contextual aspects of cannabis use settings predicted an increased likelihood of alcohol and cannabis co-use, while few contextual aspects of drinking settings were associated with co-use.

CONCLUSION

Results suggest that SMWGD engage in heavier substance use when individuals from a range of SOGI groups are present, highlighting that heavy alcohol and cannabis use is not limited to use with SMW and nonbinary individuals. Drinking in setting with more SOGI groups present (e.g., parties and bars) appears to be associated with particularly heavy drinking and consequences.

Exploring differences in substance use behaviours among gender minority and non-gender minority youth: a cross-sectional analysis of the COMPASS study

INTRODUCTION

Research characterizing substance use disparities between gender minority youth (GMY) and non-GMY (i.e. girls and boys) is limited. The aim of this study was to examine the differences in substance use behaviours among gender identity (GI) groups and identify associated risk and protective factors.

METHODS

Cross-sectional data from Canadian secondary school students (n = 42 107) that participated in Year 8 (2019/20) or Year 9 (2020/21) of the COMPASS study were used. Hierarchal logistic regression models estimated current substance use (cigarettes, e-cigarettes, binge drinking, cannabis and nonmedical prescription opioids [NMPOs]). Predictor variables included sociodemographics, other substances, mental health outcomes, school connectedness, bullying and happy home life. Interaction terms were used to test mental health measures as moderators in the association between GI and substance use.

RESULTS

Compared to non-GMY, GMY reported a higher prevalence for all substance use outcomes. In the adjusted analyses, GMY had higher odds of cigarette, cannabis and NMPO use and lower odds for e-cigarette use relative to non-GMY. The likelihood of using any given substance was higher among individuals who were involved with other substances. School connectedness and happy home life had a protective effect for all substances except binge drinking. Bullying victimization was associated with greater odds of cigarette, e-cigarette use and NMPOs. Significant interactions between GI and all mental health measures were detected.

CONCLUSION

Findings highlight the importance of collecting a GI measure in youth population surveys and prioritizing GMY in substance use-related prevention, treatment and harm reduction programs. Future studies should investigate the effects of GI status on substance use onset and progression among Canadian adolescents over time.

Doomscrolling: Prospective associations between daily COVID news exposure, internalizing symptoms, and substance use among sexual and gender minority individuals assigned female at birth

Cross-sectional studies have demonstrated associations between COVID news exposure, anxiety, and depression. However, longitudinal research examining the directionality of these associations is extremely limited. Further, most studies have focused on the general population and neglected sexual and gender minority individuals (SGM), a population disproportionately impacted by the pandemic. To address these limitations, the current study utilized data from a 30-day diary study of SGM assigned female at birth (N = 429). We examined concurrent and prospective associations between COVID news exposure, depressed and anxious affect, COVID distress, substance use, and motives for use. Further, we examined associations between cumulative COVID news exposure across the diary period and prospective changes in anxiety, depression, and COVID distress. When participants were exposed to more COVID news, they experienced more depressed and anxious affect, more COVID distress, less positive affect, and were more likely to use alcohol and cannabis to cope. Further, when participants were exposed to more COVID news, they experienced subsequent increases in depressed affect, decreases in positive affect, and increases in the likelihood of using cannabis to cope. Findings also provided evidence of bi-directional prospective associations between COVID news exposure and COVID distress and of a cumulative impact of COVID news exposure on anxiety, depression, and COVID distress. Findings suggest that individuals should balance the need to remain informed about the pandemic and their own mental health when considering how much COVID news to consume.

Mental ill-health and substance use among sexuality diverse adolescents: The critical role of school climate and teacher self-efficacy

INTRODUCTION

Mental ill-health, substance use and their co-occurrence among sexuality diverse young people during earlier adolescence is relatively understudied. The preventive utility of positive school climate for sexuality diverse adolescents' mental health is also unclear, as well as the role of teachers in conferring this benefit.

METHOD

Using Wave 8 'B Cohort' data from the Longitudinal Study of Australian children (N = 3127, Mage = 14.3), prevalence ratios and odds ratios were used to assess prevalence and disparities in mental ill-health and substance use, and multinomial logistic regression for co-occurring outcomes, among sexuality diverse adolescents relative to heterosexual peers. Logistic regression was used to assess associations between school climate and teacher self-efficacy with sexuality diverse adolescents' mental health.

RESULTS

Mental ill-health prevalence ranged from 22% (suicidal thoughts/behaviour) to 46% (probable depressive disorders) and substance use between 66% (cigarette use) and 97% (alcohol use). Sexuality diverse participants were significantly more likely to report self-harm and high levels of emotional symptoms in co-occurrence with cigarette, alcohol and/or cannabis use. For each 1-point increase in school climate scores as measured by the Psychological Sense of School Membership scale, there was 10% reduction in sexuality diverse adolescents reporting high levels of emotional symptoms, probable depressive disorder, self-harm thoughts/behaviour and suicidal thoughts/behaviour. For each 1-point increase in lower perceived (worse) teacher self-efficacy scores as measured by four bespoke teacher self-efficacy items, odds of sexuality diverse adolescent-reported suicidal thoughts/behaviour increased by 80%.

DISCUSSION

Mental ill-health, substance use and especially their co-occurrence, are highly prevalent and pose significant and inequitable health and well-being risks. Schools represent a potential site for focusing future prevention efforts and educating and training teachers on sexuality diversity is a promising pathway towards optimising these.

Substance Misuse among Sexual and Gender Minorities: The Role of Everyday Discrimination and Identity

BACKGROUND

Sexual and gender minorities (SGMs) often deal with discrimination which can result in maladaptive coping like substance misuse, yet few studies have examined the association between everyday discrimination and various types of substance misuse among SGMs or whether there is heterogeneity in substance misuse or this relationship by SGM identity.

METHODS

Data from 1316 adult SGMs in the United States were recruited from Reddit between February and March 2022. SGM identities (sexual minorities assigned male at birth (AMAB), sexual minorities assigned female at birth (AFAB), gender minorities AMAB, gender minorities AFAB), everyday discrimination, depressive symptoms, marijuana and alcohol misuse, over-the-counter drug misuse, prescription drug misuse, and heroin use were measured, along with demographics. Multivariable logistic regressions examined relationships between everyday discrimination and each substance misuse outcome, adjusting for SGM identity, race/ethnicity, age, income, and depressive symptoms. Interaction terms between everyday discrimination and SGM identities were added to each model to test for moderation.

RESULTS

In fully adjusted models, with each additional unit of everyday discrimination score, there were significantly increased odds of substance misuse for all outcomes. SGM by everyday discrimination interactions was significant for alcohol misuse, over-the-counter drug misuse, and heroin use, with the association between everyday discrimination and substance misuse stronger among gender minorities.

CONCLUSIONS

Substance misuse varied by SGM identity. Everyday discrimination was associated with substance misuse, but there was heterogeneity in this relationship between SGM identity and substance. Substance use disorder treatment and prevention among SGMs should consider heterogeneity by SGM identity and substance.

Substance use prevalence, patterns, and correlates in transgender and gender diverse youth: A scoping review

Transgender and gender diverse (TGD) adults are at elevated risk of problematic substance use. While understanding substance use disparities in TGD youth is crucial for informing early preventions, there is no known synthesis of prevalence and correlates of substance use in TGD youth. The objectives of this study were to: 1) describe the prevalence and patterns of substance use in TGD youth, 2) identify and evaluate potential correlates of substance use, and 3) report the strengths and limitations of the current literature in recommendation of future steps. A PRISMA-guided systematic search was conducted to identify 55 studies that reported prevalence, patterns, or correlates of substance use in TGD youth aged 10-24 years; were published in the English language; and followed a quantitative design. Fifty-four (98.18%) studies examined prevalence and patterns, 23 (41.82%) examined correlates, and 12 (21.82%) examined moderators and mediators of substance use in TGD youth. Findings suggest TGD youth exhibit a moderate-to-high prevalence of recent substance use, including alcohol (23-31%), binge drinking (11-59%), cigarettes (10-59%), e-cigarettes (17-27%), and marijuana (17-46%). Additionally, results supported that greater victimization experiences, including those related and unrelated to being a gender minority, were associated with increased substance use risk. Few studies examined polysubstance use, resilience, and protective factors, or considered TGD subgroup differences, which we recommend in future research. Further, we recommend improving population-based surveys to better capture gender identity and related experiences.

Benzodiazepine, Z-drug, and sleep medication prescriptions in male and female people with opioid use disorder on buprenorphine and comorbid insomnia: an analysis of multistate insurance claims

STUDY OBJECTIVES

In adult populations, women are more likely than men to be prescribed benzodiazepines. However, such disparities have not been investigated in people with opioid use disorder (OUD) and insomnia receiving buprenorphine, a population with particularly high sedative/hypnotic receipt. This retrospective cohort study used administrative claims data from Merative MarketScan Commercial and MultiState Medicaid Databases (2006-2016) to investigate sex differences in the receipt of insomnia medication prescriptions among patients in OUD treatment with buprenorphine.

METHODS

We included people aged 12-64 years with diagnoses of insomnia and OUD-initiating buprenorphine during the study timeframe. The predictor variable was sex (female versus male). The primary outcome was receipt of insomnia medication prescription within 60 days of buprenorphine start, encompassing benzodiazepines, Z-drugs, or non-sedative/hypnotic insomnia medications (e.g. hydroxyzine, trazodone, and mirtazapine). Associations between sex and benzodiazepine, Z-drug, and other insomnia medication prescription receipt were estimated using Poisson regression models.

RESULTS

Our sample included 9510 individuals (female n = 4637; male n = 4873) initiating buprenorphine for OUD who also had insomnia, of whom 6569 (69.1%) received benzodiazepines, 3891 (40.9%) Z-drugs, and 8441 (88.8%) non-sedative/hypnotic medications. Poisson regression models, adjusting for sex differences in psychiatric comorbidities, found female sex to be associated with a slightly increased likelihood of prescription receipt: benzodiazepines (risk ratio [RR], RR = 1.17 [1.11-1.23]), Z-drugs (RR = 1.26 [1.18-1.34]), and non-sedative/hypnotic insomnia medication (RR = 1.07, [1.02-1.12]).

CONCLUSIONS

Sleep medications are commonly being prescribed to individuals with insomnia in OUD treatment with buprenorphine, with sex-based disparities indicating a higher prescribing impact among female than male OUD treatment patients.

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

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).

A Review of Disparities in Cannabis Use and Cannabis Use Disorder Affecting Sexual and Gender Minority Populations and Evidence for Contributing Factors

Purpose of Review

Sexual and gender minorities (SGM) appear to be at elevated risk for cannabis use (CU) and cannabis use disorder (CUD) compared to cisgender heterosexuals. However, risk factors remain understudied among SGM. This review aims to summarize evidence for disparities in CU and CUD affecting SGM and factors contributing to these disparities.

Recent Findings

We found strong evidence that sexual minorities are at elevated risk for CU and CUD is elevated for sexual minority women. Evidence supports a concurrent association between minority stress and CUD symptoms. There is robust support for coping motives as a mechanism linking minority stress to subsequent CU and CUD. Studies also point to CU norms and contexts as potential risk factors.

Summary

SGM are at high risk for CU and CUD, and minority stress, CU norms, and contextual factors are implicated. Additional research is needed on CU among gender minorities, prospective effects of risk factors, and interventions for SGM.

Event-level associations among minority stress, coping motives, and substance use among sexual minority women and gender diverse individuals

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.

Sexuality and Gender Identity Inequities in Substance Use Disorder and Its Treatment among American Indian, Alaska Native, and Native Hawaiian College Students

BACKGROUND

The aim of this study was to investigate inequities in substance use disorder (SUD) diagnosis, opioid misuse, marijuana misuse, SUD treatment utilization, and utilization of university mental health services among sexual and gender minority (SGM) American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) college students.

METHODS

Data consisting of 8,103 AI/AN/NH students' responses to the American College Health Association's National College Health Assessment survey from fall 2015 through spring 2019 were utilized for this study. Multivariable logistic regression models were used to compare the odds of SUD diagnosis, opioid misuse, and marijuana misuse in SGM AI/AN/NH students to cisgender, heterosexual peers. Unadjusted odds of SUD treatment utilization and utilization of university mental health services were also evaluated.

RESULTS

Compared to cisgender females, transgender (aOR = 4.43, 95% CI = 2.67-7.34) and gender diverse (aOR = 2.86, 95% CI = 1.61-5.07) students had significantly higher odds of SUD diagnosis. Similarly, significantly higher odds of SUD diagnosis were observed among sexual minorities, including gay/lesbian (aOR = 2.95, 95% CI = 1.71-5.09) and bisexual (aOR = 1.97, 95% CI = 1.30-2.99) students compared to heterosexual peers. Sexual minority students had significantly higher odds of utilizing university mental health services (uOR = 2.43, 95% CI = 1.22-4.84) than heterosexual peers. Odds of opioid misuse and marijuana misuse were also significantly increased among sexual minority students.

CONCLUSIONS

AI/AN/NH college students who identify as SGM have higher odds of SUD diagnosis, opioid misuse, and marijuana misuse than their cisgender, heterosexual peers. These findings highlight the need to consider tailored programming for SGM AI/AN/NH students in substance use prevention and intervention efforts in U.S. college settings.

Changes in sexual intentions of LGBT people and their adaptation to social life

PURPOSE

This study was conducted to evaluate the process of change in the sexual intentions of LGBT (lesbian, gay, bisexual, transgender) individuals and their experiences pertaining to adaptation to social life.

DESIGN AND METHODS

The participant introduction form and semi-structured interview form were administered to 18 LGBT people.

FINDINGS

Codes were classified by LGBT persons' "environment of birth and childhood," "experience of noticing changes in sexual intentions," "disclosing the change in sexual intentions for the first time," "reactions of the family and close circle," "problems experienced," "efforts made to solve the problems," "thoughts on having different sexual intentions in Turkey," and "future expectations."

PRACTICE IMPLICATIONS

Nurses should provide support for LGBT people to use effective resources that would assist them with their sexual intentions and the adjustment process.

Associations of Relationship Experiences, Dating Violence, Sexual Harassment, and Assault With Alcohol Use Among Sexual and Gender Minority Adolescents

Sexual and gender minority (SGM) adolescents report higher rates of dating violence victimization compared with their heterosexual and cisgender peers. Research on dating violence often neglects diversity in sexual and gender identities and is limited to experiences in relationships. Further, given that dating violence and alcohol use are comorbid, research on experiences of dating violence could provide insights into alcohol use disparities among SGM adolescents. We aimed to map patterns of relationship experiences, sexual and physical dating violence, and sexual and physical assault and explored differences in these experiences among SGM adolescents. Further, we examined how these patterns explained alcohol use. We used a U.S. non-probability national web-based survey administered to 13-17-year-old SGM adolescents (N = 12,534). Using latent class analyses, four patterns were identified: low relationship experience, dating violence and harassment and assault (72.0%), intermediate dating experiences, sexual harassment, and assault and low levels of dating violence (13.1%), high dating experiences, dating violence, and sexual assault (8.6%), and high dating experiences, dating violence, and sexual harassment and assault (6.3%). Compared to lesbian and gay adolescents, bisexual adolescents reported more experiences with dating, dating violence, and sexual assault, whereas heterosexual adolescents reported fewer experiences with dating, dating violence, and sexual harassment and assault. Compared to cisgender boys, cisgender girls, transgender boys, and non-binary/assigned male at birth adolescents were more likely to experience dating violence inside and outside of relationship contexts. Experiences of dating, dating violence, and sexual harassment and assault were associated with both drinking frequency and heavy episodic drinking. Together, the findings emphasize the relevance of relationship experiences when studying dating violence and how dating violence and sexual harassment and assault might explain disparities in alcohol use.

Perspectives on Cigarette Use, Vaping, and Antitobacco Campaigns Among Adolescent Sexual Minority Males and Gender Diverse Youth

Purpose: This qualitative study examined perceived benefits and drawbacks of smoking/vaping and attitudes toward antitobacco campaigns among adolescent sexual minority males and gender-diverse (ASMM/GD) youth. Methods: In July 2019, 215 U.S. ASMM/GD youth (mean_age 16.78, 95.3% cisgender male, 61.9% racial/ethnic minority) answered questions about smoking/vaping behaviors, motivations for smoking/vaping, and attitudes toward antitobacco campaigns via an online survey. Data were analyzed with thematic analysis. Results: Overall, 17.2% of participants had smoked cigarettes, and 34.9% had vaped. Teens described psychological (e.g., stress relief), chemical (e.g., nicotine buzz), and social incentives (e.g., fitting in with peers) for smoking/vaping. Teens also reported concerns about physical health, costs, and self-image as drawbacks of smoking/vaping. Most considered antitobacco campaigns unrelatable and uninteresting, while others reported that campaigns reinforced their decisions to not smoke/vape. Most participants wanted antitobacco campaigns to be tailored to the sexual and gender minority (SGM) community. Conclusions: These findings shed light on ASMM/GD youth's perspectives of smoking/vaping and antitobacco campaigns. Results suggest that equipping teens with skills to cope with minority stress and resisting peer pressure could indirectly reduce smoking/vaping, and that SGM-inclusive campaigns may better reach SGM adolescents.

Differences by sex and gender in the association between minority stress and alcohol use among sexual and gender minority youth: A daily diary study

Rationale

Sexual and gender minority (SGM) youth consume more alcohol than their heterosexual, cisgender peers. The experience of minority stress is theorized to explain these disparities. Research often neglects the day-to-day variability in minority stress that SGM youth encounter and whether alcohol use is associated with daily experiences of minority stress. Further, there is heterogeneity in alcohol use among SGM youth. Sex assigned at birth and gender identity could potentially explain this heterogeneity.

Objective

Therefore, this study aimed to examine whether daily experiences of minority stress were associated with daily alcohol use among SGM youth and how these associations differed by sex assigned at birth and gender identity.

Methods

A 14-day daily diary study was conducted among 393 Dutch SGM youth (M age = 18.36 SD = 2.65).

Results

Results showed few significant associations between both mean levels of minority stress and daily experiences with minority stress with alcohol use. However, higher mean levels of prejudice events were associated with higher odds of daily alcohol use (OR = 7.01, 95% CI: 1.20–40.89). Daily experiences with identity concealment were associated with lower odds of daily alcohol use for males (OR = 0.72, 95% CI: 0.60–0.86), but not for females (OR = 1.11, 95% CI: 0.93–1.32). Further, for cisgender youth, daily experiences with prejudice events were associated with higher odds of alcohol use (OR = 1.99, 95% CI: 1.05–3.78), but this was not the case for gender minority youth (OR = 0.42, 95% CI: 0.15–1.18).

Conclusions

The findings showed few significant associations between minority stressors and alcohol use, but daily experiences of concealment and prejudice events were associated with daily alcohol use and these associations varied by sex assigned at birth and gender identity, respectively.

Addiction among women and sexual minority groups

Gender-related alcohol and drug abuse problems are related not only to biologic differences but also to social and environment factors, all of which can influence the clinical presentation, consequences of use, and treatment approaches. The number of women becoming addicted to alcohol or drugs of abuse has significantly increased with women becoming the fastest-growing group of substance abusers in the United States. Given that women experience a more rapid progression of their addiction than men, it is important that we understand and address the differences to help develop prevention and treatment programs that are tailored for women, incorporating trauma assessment and management, comorbidities, financial independence, pregnancy, and child care.

Screening, Counseling, and Shared Decision Making for Alcohol Use with Transgender and Gender-Diverse Populations

At-risk alcohol use occurs among transgender and gender-diverse (TGD) populations, yet current alcohol use screening tools and guidelines do not distinguish between sex- and gender-related characteristics, having been developed without accounting for natal sex-based physiology, effects of gender-affirming medical care, and gendered drinking behavior among TGD people. More research on how sex- and gender-related factors independently influence alcohol use can help validate gender-inclusive screening protocols and develop evidence-based guidelines meaningful for people of all genders. In the interim, clinicians must be mindful of gender diversity and engage in transparent, collaborative discussions when screening for and counseling about alcohol use.