Sexual-orientation differences in alcohol use trajectories and disorders in emerging adulthood: results from a longitudinal cohort study in the United States

Cancer in people who identify as lesbian, gay, bisexual, transgender, queer, or gender-nonconforming

BACKGROUND

Individuals who identify as lesbian, gay, bisexual, transgender, queer, intersex, or gender-nonconforming (LGBTQ+) experience discrimination and minority stress that may lead to elevated cancer risk.

METHODS

In the absence of population-based cancer occurrence information for this population, this article comprehensively examines contemporary, age-adjusted cancer risk factor and screening prevalence using data from the National Health Interview Survey, Behavioral Risk Factor Surveillance System, and National Youth Tobacco Survey, and provides a literature review of cancer incidence and barriers to care.

RESULTS

Lesbian, gay, and bisexual adults are more likely to smoke cigarettes than heterosexual adults (16% compared to 12% in 2021-2022), with the largest disparity among bisexual women. For example, 34% of bisexual women aged 40-49 years and 24% of those 50 and older smoke compared to 12% and 11%, respectively, of heterosexual women. Smoking is also elevated among youth who identify as lesbian, gay, or bisexual (4%) or transgender (5%) compared to heterosexual or cisgender (1%). Excess body weight is elevated among lesbian and bisexual women (68% vs. 61% among heterosexual women), largely due to higher obesity prevalence among bisexual women (43% vs. 38% among lesbian women and 33% among heterosexual women). Bisexual women also have a higher prevalence of no leisure-time physical activity (35% vs. 28% among heterosexual women), as do transgender individuals (30%-31% vs. 21%-25% among cisgender individuals). Heavier alcohol intake among lesbian, gay, and bisexual individuals is confined to bisexual women, with 14% consuming more than 7 drinks/week versus 6% of heterosexual women. In contrast, prevalence of cancer screening and risk reducing vaccinations in LGBTQ+ individuals is similar to or higher than their heterosexual/cisgender counterparts except for lower cervical and colorectal cancer screening among transgender men.

CONCLUSIONS

People within the LGBTQ+ population have a higher prevalence of smoking, obesity, and alcohol consumption compared to heterosexual and cisgender people, suggesting a higher cancer burden. Health systems have an opportunity to help inform these disparities through the routine collection of information on sexual orientation and gender identity to facilitate cancer surveillance and to mitigate them through education to increase awareness of LGBTQ+ health needs.

Trends in binge drinking in the United States by LGBTQ+ identity, gender, and age, 2014-2022

BACKGROUND

People who identify as lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ+) have higher rates of risky drinking than their cisgender, heterosexual peers. It is unknown to what extent recent age and gender trends in binge drinking vary by LGBTQ+ identity.

METHODS

We used nationally representative, serial, cross-sectional surveys from men and women in the 2014-2022 Behavioral Risk Factor Surveillance System (N = 2,099,959) to examine trends in past-month binge drinking by LGBTQ+ identity, gender, and age (18-29, 30-44, 45 and older). We estimated stratum-specific prevalence ratios for an average 1-year increase in prevalence of past-month binge drinking using survey-weighted log-binomial models, controlling for education, race/ethnicity, marriage, and parenthood status.

RESULTS

In the beginning of the study period, LGBTQ+ women endorsed binge drinking at higher prevalences than their cisgender, heterosexual peers (i.e., 2014 predicted probability for women ages 30-44: 0.22 for LGBTQ+, 0.15 for cisgender, heterosexual). LGBTQ+ disparities in women's drinking attenuated over the study period among women in midlife (30-44 age group) due to increases in binge drinking among cisgender, heterosexual women (Prevalence Ratio [PR]: 1.025, 95% CI 1.018-1.033). Among men, we saw no evidence of LGBTQ+ disparities in binge drinking probabilities or in binge drinking trends across all age groups.

CONCLUSIONS

Disparities in mid-life binge drinking between LGBTQ+ and cisgender women have begun to diminish. These disparities are closing not because LGBTQ+ women are binge drinking less, but because cisgender, heterosexual women in midlife are binge drinking more.

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.

Universal Sexual Violence Intervention Effects in a Cluster-Randomized Trial: Moderation by Sexual Orientation

Sexual minority (e.g., gay/lesbian, bisexual, and queer) students are more likely than their heterosexual peers to experience sexual violence (SV) during college. Interventions that prevent SV and improve SV care-seeking behaviors for sexual minority students are lacking. Giving Information for Trauma Support and Safety (GIFTSS) is an evidence-based universal SV intervention implemented by providers during college health and counseling visits. Compared to controls, GIFTSS participants reported greater self-efficacy to use SV harm reduction strategies and SV disclosure during clinical visits. However, GIFTSS' effectiveness for sexual minority participants is unknown. The current study examines whether sexual orientation moderates GIFTSS' effects on numerous SV-related outcomes (i.e., to test whether intervention effects at 4 and 12 months differed based on sexual orientation). Across 28 college campuses in Pennsylvania and West Virginia, 2,291 students participated in a two-arm cluster-randomized controlled trial. We used mixed models with two- and three-way interaction terms to test whether sexual orientation modified GIFTSS' effects at 4- and 12-month follow-up on participants': SV recognition; knowledge of and self-efficacy to enact SV harm reduction strategies; intentions to intervene; knowledge of and self-efficacy to use SV-related services; SV disclosure during visits; and recent SV exposure. Overall, 22.1% of participants were sexual minorities (n = 507). Sexual orientation moderated GIFTSS effectiveness as indicated by significant three-way interaction (p = .01) at 12-month follow-up, and knowledge of SV services decreased for heterosexual participants (β = -.23) but increased for sexual minority participants (β = .23). Our study indicates that universal provider-based education may promote greater knowledge of SV services among sexual minority than heterosexual participants, and population-specific interventions are needed that reduce sexual minority students' SV exposure, service utilization, and other critical aspects of SV prevention on university campuses.Clinical Trial Registration: Registry name: College Health Center-based Alcohol and Sexual Violence Intervention (GIFTSS), Registration number: NCT02355470, Web link: https://clinicaltrials.gov/ct2/show/NCT02355470, Deidentified individual participant data will not be made available.

The peer to career pipeline: An observational study of peer worker trainee characteristics and training completion likelihood

INTRODUCTION

Peer recovery support services (PRSS) for substance use disorder (SUD) are a flexible and evidence-based intervention employed across multiple settings and for a variety of populations. These services have expanded over the past two decades, but there is little research on recruitment and training of prospective peer workers - the peer to career pipeline. This study observed training outcomes for applicants to a peer worker scholarship program in Texas.

METHODS

A total of 448 participants provided baseline personal history information, and a subset of participants (n = 239) completed optional psychosocial surveys. Logistic regression analysis tested associations of personal history and psychosocial variables with three training stage completion outcomes: classroom training completion, placement at an internship site, and full certification.

RESULTS

The greatest decline in advancement between stages occurred in the transition between classroom training (78.1 % of participants completed) and internship placement (43.3 % of participants completed). Participants were diverse in terms of race/ethnicity and life experiences salient to the peer worker role, but Hispanic/Latinx peer workers were under-represented. Past work with a SUD peer worker, age, and having a bachelor's degree were each positively associated with training stage completion across multiple models, while having basic technological access, being a woman, and veteran status were each positively associated with training stage completion in only one model. Years since recovery initiation date, non-monosexual orientation, White race, and quality of life were each negatively associated with training stage completion in only one model.

CONCLUSIONS

The existing peer workforce may be a key source of recruitment for new peer workers; thus retention of existing workers is key to ensuring continued expansion of these services. Additional support may be required to recruit and retain younger peer worker trainees, men trainees, Hispanic/Latinx trainees, trainees who lack basic technological access, or trainees without bachelor's degrees. Unanswered questions about the peer workforce remain and must be addressed to ensure that an appropriately diverse workforce is recruited, that disparities in training outcomes are minimized or prevented, and that existing peer workers are well-supported.

Psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT) across cross-cultural subgroups, genders, and sexual orientations: Findings from the International Sex Survey (ISS)

INTRODUCTION

Despite being a widely used screening questionnaire, there is no consensus on the most appropriate measurement model for the Alcohol Use Disorders Identification Test (AUDIT). Furthermore, there have been limited studies on its measurement invariance across cross-cultural subgroups, genders, and sexual orientations.

AIMS

The present study aimed to examine the fit of different measurement models for the AUDIT and its measurement invariance across a wide range of subgroups by country, language, gender, and sexual orientation.

METHODS

Responses concerning past-year alcohol use from the participants of the cross-sectional International Sex Survey were considered (N = 62,943; Mage: 32.73; SD = 12.59). Confirmatory factor analysis, as well as measurement invariance tests were performed for 21 countries, 14 languages, three genders, and four sexual-orientation subgroups that met the minimum sample size requirement for inclusion in these analyses.

RESULTS

A two-factor model with factors describing 'alcohol use' (items 1-3) and 'alcohol problems' (items 4-10) showed the best model fit across countries, languages, genders, and sexual orientations. For the former two, scalar and latent mean levels of invariance were reached considering different criteria. For gender and sexual orientation, a latent mean level of invariance was reached.

CONCLUSIONS

In line with the two-factor model, the calculation of separate alcohol-use and alcohol-problem scores is recommended when using the AUDIT. The high levels of measurement invariance achieved for the AUDIT support its use in cross-cultural research, capable also of meaningful comparisons among genders and sexual orientations.

Associations of adult roles and minority stressors with trajectories of alcohol dependence symptoms throughout adulthood among sexual minority women

OBJECTIVE

In the present study, we sought to identify trajectories of symptoms of potential alcohol dependence (AD) among adult sexual minority women (SMW). Theoretical correlates were examined in relation to the empirically identified trajectories.

METHOD

Data were collected at three time points between 2000 and 2012 from SMW drinkers (n = 434) enrolled in a longitudinal study (M Age = 37.49 at baseline, SD = 11.55). Using an accelerated-cohort longitudinal design, latent growth curve mixture models identified homogeneous patterns of any past-year symptoms of potential AD. Correlates of trajectories included alcohol-related developmental risk factors, adult roles, and exposure to minority stressors.

RESULTS

Three trajectories were identified that captured risk of symptoms of potential AD over time, reflecting: (a) relatively consistent, low risk over time; (b) deceleration in risk throughout adulthood; (c) relatively persistent, high risk over time. Consistent with prior work, SMW drinkers who reported higher levels of perceived stigma or masculinity showed persistently high risk of reporting at least one past-year symptom of potential AD.

CONCLUSIONS

Most SMW drinkers report deceleration in risk of AD symptoms over time. Findings have implications for prevention and intervention efforts tailored to SMW drinkers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Life course differences in heavy episodic drinking behaviors across age, gender, and sexual identity in the United States

•This study examines heavy episodic drinking across age, gender, and sexual identity.•Gay/lesbian and bisexual females experience persistent disparities across age.•Gay and bisexual males experience age specific disparities.•Sexual minority adults in the US report complex patterns of heavy alcohol use.•Heavy drinking disparities do not mirror patterns of alcohol use disorders.

Social Networks and Sexual and Gender Minority Disparities in Alcohol Use and Consequences Among First-Year College Students

Purpose: In this work, we investigate the association between social relationships and alcohol use and the related consequences of sexual and gender minority (SGM) college students, and we highlight the importance of SGM social networks as a potential protective factor among SGM college students. Methods: The study used data from 1340 students (47.2% White and non-Hispanic, 55.4% assigned female at birth, 16.3% SGM), which were collected during the 2016 fall semester of the first year of college at one university. The study collected information about alcohol use and related consequences and about the social networks of participants through a peer nomination survey. Results: Regardless of SGM status, students who nominated at least one SGM peer reported significantly lower drinks per week (β = -0.69, p = 0.04) and heavy drinking frequency (β = -0.38, p = 0.02) after adjusting for relevant covariates including peer drinking. SGM participants showed a significantly stronger negative association between having an SGM peer and heavy drinking frequency and alcohol-related consequences than their cisgender heterosexual counterparts (β = -0.90, p = 0.04; β = -1.32, p = 0.03). Conclusion: These findings highlight the importance of SGM social networks as a potential protective factor for reducing alcohol use and related consequences among SGM college students. College campuses should identify ways to support connections among SGM students. Clinical trials registration number is NCT02895984.

Alcohol-attributable deaths and years of potential life lost due to alcohol among veterans: Overall and between persons with minoritized and non-minoritized sexual orientations

BACKGROUND

Unhealthy alcohol use is disproportionally experienced by individuals with minoritized sexual orientations. Unlike the general US population, for whom the burden of alcohol as it relates to mortality is consistently monitored across time with national survey data, the impact of unhealthy alcohol use among veterans with minoritized sexual orientations, for whom addressing substance use is a national priority, is largely unknown.

METHODS

Using Alcohol Use Disorders Identification Test Consumption data from the Department of Veterans Affairs electronic health record and underlying cause of death from National Death Index from 2014 to 2018 we quantified alcohol consumption and related mortality among veterans with (n = 102,085) and without minoritized sexual orientations (n = 5300,521). Age adjusted rates of alcohol attributed deaths (AAD) per 100,000 persons and years of potential life lost (YPLL) were estimated by sexual orientation, sex, and sexual orientation stratified by sex.

RESULTS

Alcohol attributable deaths (n = 21,861) were higher among veterans with minoritized sexual orientations than veterans without after adjustment for age (486.5 deaths/100,000 versus 309.7 deaths/100,000, respectively). Veterans with minoritized sexual orientations also experienced more YPLL (13,772.8 years/100,000 versus 7618.9 years/100,000). Years of potential life lost per AAD was higher in women (33.2 years) than men (18.7 years).

CONCLUSIONS

Alcohol consumption results in substantial disability and death among veterans, particularly veterans with minoritized sexual orientations. Findings suggest need for increased alcohol-related services for all VA patients, and potential targeted approaches to for veterans with minoritized sexual orientations and women to offset risk for, and years of potential life lost from, alcohol attributable death.

Multiple diverse drinking trajectories among sexual minority women: Unique and joint prediction by minority stress and social influence risk factors

BACKGROUND

Sexual minority populations are at heightened risk for alcohol use disorders compared to heterosexual populations, and these disparities are particularly pronounced for sexual minority women (SMW). Little research has examined the diversity of drinking trajectories among sexual minorities, despite evidence that such trajectories have high predictive utility and are useful in understanding how risk factors may be uniquely associated with specific trajectories.

METHOD

We utilized four waves of data (12 months between waves) from a sample of 1,057 SMW ages 18-25 at Wave 1. The goals were to (a) identify multiple distinct trajectories of alcohol use; (b) examine the predictive utility of these trajectories; and (c) test associations between minority stress (e.g., discrimination) and social influence (e.g., sexual minority community involvement) risk factors and alcohol trajectories.

RESULTS

Using growth mixture modeling, we identified five classes based on drinking patterns at Wave 1 and change over time (stable low, stable high drinking, stable high HED, low increasing, and high decreasing). These classes were differentially associated with Wave 1 levels and changes in alcohol consequences. Minority stressors uniquely predicted a low increasing trajectory, while social influences uniquely predicted a stable high trajectory. Both minority stress and social risk factors predicted high decreasing and stable high HED trajectories.

CONCLUSIONS

Findings indicate that some drinking trajectories among SMW appear similar to those found in the general population, while others appear unique. Results provide insight into how minority stress and social influence risk factors may uniquely and jointly contribute to disparities affecting this population.

Gambling, Gaming, and Internet Behavior in a Sexual Minority Perspective. A Cross-Sectional Study in Seven European Countries

Background

Addictive behavior of gambling, gaming and internet activity is partly a new research domain and has not been well investigated with regard to sexual minority populations. Although health disparities between sexual minorities and the general population are well documented, there is a lack of inclusion of sexual minorities in both research and clinic. Among lesbian, gay and bisexual populations certain features could be present that play a role for the development of addictive behaviors, such as social isolation and increased risk of other psychiatric problems. The aim of this study was to investigate problem gambling, problem gaming and problematic internet behavior in a European context and if it is affected by sexual orientation status.

Methods

An online web-survey was distributed among web-panels in England, Poland, Switzerland, Italy, Spain, Denmark, and Sweden in 2017-2018.

Result

10 983 complete answers were collected. 7.1% of the participants had a sexual minority status (n = 774). Regression models found that there was no difference in gambling, gaming and internet behavior among heterosexual and sexual minority men. Sexual minority women were associated with problematic gambling and gaming behavior, when also controlling for age and nationality. When also controlling for psychological distress, women defining as having another sexual minority status than lesbian and bisexual remained significant for having a problematic gaming behavior (AOR = 2.3).

Conclusion

An awareness of female sexual minority perspectives is relevant in facilities treating behavioral addiction as well as in future research in behavioral addiction. More research is needed in problematic gambling and gaming behavior in different sexual minority populations with regard to psychiatric comorbidity and living conditions. An inclusion of sexual minority groups defining as other than gay and bisexual is needed in future research. No significant differences were found between heterosexual and sexual minority men in adjusted analysis in this study.

Depression and Suicide Literacy among Canadian Sexual and Gender Minorities

The purpose of this study was to examine and compare depression and suicide literacy among Canadian sexual and gender minorities (SGM). Online surveys comprised of the 22-item depression literacy scale (D-LIT) and the 12-item literacy of suicide scale (LOSS) were completed by 2,778 individuals identifying as SGM. Relationships between depression and suicide literacy and demographic characteristics were evaluated using multivariable linear regression. Overall, SGM correctly answered 71.3% of the questions from the D-LIT and 76.5% of the LOSS. D-LIT scores were significantly lower among cisgender men and D-LIT and LOSS scores were lower among transgender women when compared to cisgender women. LOSS and D-LIT scores were significantly lower among SGM without a university degree (compared to those with a university degree) and among SGM from ethnic minority groups (compared to White SGM). D-LIT scores, but not LOSS scores, were significantly lower among Indigenous SGM compared to White SGM. The findings provide evidence of differences in suicide and depression literacy between SGM subgroups along multiple social axes. Interventions to increase depression and suicide literacy should be prioritized as part of a mental health promotion strategy for SGM, targeting subgroups with lower literacy levels, including cisgender men, transgender women, Indigenous people, racialized minorities, and those without a university degree.

Developmental Differences in Sexual Orientation and Gender Identity-Related Substance Use Disparities: Findings From Population-Based Data

PURPOSE

Despite well-established substance use disparities between sexual and gender minority adolescents and their heterosexual, cisgender peers, there remain questions about whether there are developmental differences in the onset and progression of these disparities across adolescence. These perspectives are critical for prevention efforts. We therefore estimate age-based patterns of five substance use behaviors across groups of adolescents defined by sexual orientation and gender identity (SOGI).

METHODS

Data are from the 2013-2015 cycles of the California Healthy Kids Survey (N = 634,454). Substance use was assessed with past 30-day e-cigarette use, combustible cigarette use, alcohol use, heavy episodic drinking, and marijuana use. Two- and three-way interactions were used to assess differences in age-specific prevalence rates of each substance by (1) sex and sexual identity; and (2) gender identity.

RESULTS

Across all substances, SOGI differences in past 30-day use were present by age 12 years. Most disparities persisted to age 18 years and older. SOGI disparities in combustible and e-cigarette use were wider in late adolescence. Analyses by sexual identity show that sexual minority girls reported the highest rates of substance use across age, followed by sexual minority boys.

CONCLUSIONS

SOGI differences in substance use emerged in early adolescence and appeared to persist and accelerate by late adolescence. Sexual minority girls had the highest rates of substance use across all ages. The findings underscore the urgent need for screening and prevention strategies to reduce substance use for sexual and gender minority youth.

A Preliminary Experimental Study of Minority Stress, Startle Reactivity, and Alcohol Use among Heavy Drinking Sexual Minority Young Adults

Sexual minorities (e.g. lesbian, gay, bisexual) are at increased risk for alcohol use disorder (AUD) compared to heterosexuals. The minority stress model postulates that disparities in AUD stem, in part, from stress specific to sexual minorities (e.g. heterosexism). However, little research has examined psychophysiological markers of minority stress reactivity and how psychophysiological stress reactivity is associated with lifetime minority stress and alcohol use among sexual minorities. Emotion modulation of the startle response is a well-established paradigm for capturing psychophysiological stress reactivity under controlled laboratory conditions. Purpose: This preliminary study is the first to use the startle experimental paradigm to examine psychophysiological reactivity to stigma among sexual minorities. Procedures: Sexual minority participants (N = 20; 55% female), aged 18 to 27 years (M = 21.80, SD = 2.65), were recruited from the community. We compared startle reactivity in response to three types of stimuli (stigma, negative, and neutral) among heavy drinking sexual minority young adults. Although statistically underpowered, we also explored the associations between startle reactivity and self-reported drinking behaviors and lifetime minority stress. Results: Both stigma and general unpleasant stimuli produced more psychophysiological stress reactivity than neutral stimuli among sexual minorities. Psychophysiological stress reactivity was correlated with greater quantity of drinks reported on drinking days in the past month, but not greater frequency. Additionally, lifetime exposure to minority stress was associated with a blunted reactivity to stigma stimuli. Conclusions: These findings provide methodological advances and important implications for minority stress theory and alcohol use among sexual minorities.

Longitudinal changes in alcohol use and binge-drinking among young-adult college students: Analyses of predictors across system levels

BACKGROUND

Longitudinal research regarding young-adult college student alcohol use behaviors is needed to identify risk factors and inform interventions, particularly with regard to binge-drinking.

METHODS

Data from 3,418 US college students (aged 18-25) in a two-year, six-wave panel study (64.6% female, 63.4% White) were used to examine alcohol use and binge-drinking trajectories, as well as predictors of differing trajectories across individual (sociodemographics, depressive symptoms, ADHD symptoms, early-onset substance use), interpersonal (adverse childhood events, social support, parental substance use), and community factors (college type, rural/urban).

RESULTS

Baseline alcohol use was associated with being White, higher parental education, early-onset use of alcohol, cigarettes, and marijuana, greater social support, parental alcohol use, attending private institutions, and rurality (p's < 0.01). Greater alcohol use over time was predicted by being White and attending private institutions (p's < 0.01). Multivariable regression indicated that predictors of binge-drinking at any assessment included older age, sexual minority, greater ADHD symptoms, early-onset substance use, parental alcohol use, attending private institutions, and rurality (p's < 0.01). GMM indicated 4 binge-drinking trajectory classes: Dabblers (89.94% of the sample), Slow decelerators (7.35%), Accelerators (1.86%), and Fast decelerators (0.84%). Fast and Slow decelerators were older; Dabblers and Fast decelerators were more likely female; Accelerators reported more depressive symptoms; Dabblers were less likely early-onset substance users; and those from rural settings were more likely Slow decelerators vs. Dabblers (p's < 0.05).

CONCLUSIONS

Intervention efforts should be informed by data regarding those most likely to drink, binge-drink, and escalate use (e.g., Whites, men, early-onset users, parental use, private college students, rural).

Structural vulnerabilities and HIV risk among sexual minority female sex workers (SM-FSW) by identity and behavior in Baltimore, MD

BACKGROUND

Research suggests sexual minority female sex workers (SM-FSW) face elevated structural vulnerability and HIV risk compared to their heterosexual counterparts. Structural vulnerabilities reflect societal level factors (e.g., sexism, homophobia, racism) that constrain an individual's agency, particularly related to health outcomes. This study examines the association between SM status by identity and behavior, structural vulnerability, and HIV risk among a sample of street-based FSW.

METHODS

The current study utilizes baseline data from the SAPPHIRE study, a prospective cohort of cis gender and transgender FSW in Baltimore, MD, recruited through targeted time-location sampling from April 2016 to January 2017. The current analysis focuses on cisgender women. The baseline survey ascertained demographics, substance use, intimate partner violence (IPV), and sex work characteristics. Multivariable models were constructed using self-identity and behaviorally defined SM status as independent variables with vulnerability outcomes (e.g., injection drug use, injection speedball, binge drinking, homelessness, physical IPV, ever had a pimp, and being a minor at sex work entry (age < 18)) as dependent variables.

RESULTS

Of the participants (n = 247), 25.5% (n = 63) self-identified as a SM by identity (e.g., gay or bisexual), and 8.5% (n = 21) reported SM behavior (e.g., same-gender sexual behavior) in the past 3 months. In multivariable logistic regression models, SM status by identity was associated with increased odds of injection drug use, binge drinking, homelessness, physical IPV, and being a minor at sex work entry. SM status by behavior was associated with increased odds of binge drinking, homelessness, ever having a pimp, and being a minor at sex work entry.

CONCLUSION

The study indicates disproportionate structural vulnerability and heightened HIV risk among SM-FSW, as compared to their heterosexual counterparts, with differences in their profile by sexual identity and behavior. Findings suggest a need for nuanced interventions tailored to these populations.

Sexual Assault, Alcohol Use, and Gender of Sexual Partners Among Cisgender Women Seeking Care at US College Health Centers, 2015-2018

Objectives. To assess differences by gender of sexual partner in the association between sexual assault and alcohol use among women seeking care in college health centers.Methods. This longitudinal study comprised 1578 women aged 18 to 24 years visiting 28 college health centers in Pennsylvania and West Virginia from 2015 to 2018. We used multilevel logistic regression and negative binomial regression, testing for interactions of gender of sexual partners, sexual assault, and prevalence and frequency of alcohol use and binge drinking.Results. Sexual assault was reported by 87.3% of women who had sex with women or with women and men (WSWM), 68.2% of women who had sex with men only (WSM), and 47.5% of women with no penetrative sexual partners. The relative associations between sexual assault and alcohol outcomes were smaller for WSWM (prevalence: odds ratios from 0.04 to 0.06; frequency: incidence rate ratios [IRRs] from 0.24 to 0.43) and larger for women who had no penetrative sexual partners (IRRs from 1.55 to 2.63), compared with WSM.Conclusions. Alcohol use patterns among women who have experienced sexual assault differ by gender of sexual partners.

Harmful drinking, tobacco, and marijuana use in the 2000-2015 National Alcohol Surveys: Examining differential trends by sexual identity

BACKGROUND

Population-based surveys document disparities in substance use among sexual minorities compared to heterosexuals, but few studies examine changes over time. This study compared changes in harmful drinking (including alcohol use disorders and high-intensity drinking), tobacco use, marijuana use, and simultaneous marijuana and alcohol co-use between heterosexual and sexual minority adults over a 15-year period. Methods: Gender-stratified logistic regression analyses using 4 waves of cross-sectional data from the National Alcohol Survey (2000, 2005, 2010, and 2015) were conducted to test overall trends over time and differences by sexual identity, as well as the interaction between survey year and sexual identity. Results: Among women, significant effects for sexual identity were present in all models, reflecting greater odds of use among sexual minorities across waves. Among men, significant effects for sexual identity were found for high-intensity drinking (reflecting less use among sexual minorities) as well as marijuana use and marijuana and alcohol co-use (reflecting more use among sexual minorities). For women and men, tobacco use generally decreased and both marijuana use and simultaneous marijuana and alcohol co-use increased during the study period. Although trends were largely driven by heterosexual respondents, only one instance of an interactive effect was found; reports of harmful drinking were generally stable over time among heterosexual women, but higher and more variable over time among sexual minority women. Conclusions: Findings highlight that differences in patterns of substance use by sexual identity persist and underscore the need for screening, prevention, and intervention, particularly for sexual minority women.

Sexual Orientation and Hypertension Risk Reduction Behaviors Among Adults with High Blood Pressure

Introduction

Hypertension is a significant modifiable risk factor for cardiovascular disease (CVD), the leading cause of death in the U.S. Evidence is emerging showing disparities in CVD risk between sexual minorities and heterosexuals. Engagement in CVD risk reduction behaviors may account for differences. We examined CVD risk reduction for hypertension between sexual minorities and heterosexuals using data from the 2017 Behavioral Risk Factor Surveillance System.

Methods

Using bivariate and multivariable logistic regression analyses, we compared medical advice and actions taken (taking medicine, changing eating habits, cutting down on sale, reducing alcohol and exercising) to control blood pressure in sexual minority and heterosexual respondents. Analyses were conducted in 2019.

Results

Approximately 35% of the sample indicated being told by a health professional they had high blood pressure. Sexual minorities were less likely to report reduced alcohol intake to lower their blood pressure (AOR=.515, 95% CI=.300, .883). One sex specific difference between sexual minority women and heterosexual women was found; sexual minority women were less likely to indicate being advised by a health professional to take medications to lower blood pressure when compared to heterosexual women.

Conclusions

Strategies are needed to reduce alcohol consumption in sexual minority individuals. Uncovering the reasons for the lack of adherence by both sexual minority patients and health care providers can guide future interventions to improve adherence and reduce hypertension as a CVD risk.

Associations between sexual orientation discrimination and substance use disorders: differences by age in US adults

PURPOSE

Sexual minorities are at heightened risk for substance use disorders (SUDs). Discrimination based on sexual orientation may be an important factor in this increased risk, but differences across age have not been systematically examined. We examined age-varying associations of sexual orientation discrimination with alcohol use disorder (AUD), tobacco use disorder (TUD), and drug use disorder (DUD).

METHODS

We used data from US participants aged 18-50 years who reported non-heterosexual identity, attraction, or behavior (N = 2375) in a nationally representative survey. We examined the prevalence of sexual orientation discrimination across age and its salience as a risk factor for AUD, TUD, and DUD for gay/lesbian, bisexual, and heterosexual identifying individuals using time-varying effect modeling.

RESULTS

Sexual orientation discrimination was most prevalent in early young adulthood but was positively associated with greater odds of AUD, TUD, and DUD only at later ages. We found statistically significant associations at ages 24.5-40.0 for AUD, ages 32.5-42.9 for DUD, and ages 39.3-43.2 for TUD. For example, discrimination at age 30 was associated with 2.1 times greater odds of AUD (95% CI 1.3, 3.3) compared to those who reported no discrimination at that age. Discrimination at age 35 was associated with 2.8 times greater odds of DUD (95% CI 1.2, 6.6) relative to no discrimination.

CONCLUSIONS

Sexual orientation discrimination is significantly associated with SUDs and risk varies across age. Thus, age should be considered in the development of prevention and treatment of AUD, TUD, and DUD, particularly for sexual minorities.

Sexual orientation and gender identity disparities in substance use disorders during young adulthood in a United States longitudinal cohort

BACKGROUND

This study examined associations of sexual orientation and gender identity with prevalence of substance use disorders (SUDs) and co-occurring multiple SUDs in the past 12-months during young adulthood in a United States longitudinal cohort.

METHODS

Questionnaires self-administered in 2010 and 2015 assessed probable past 12-month nicotine dependence, alcohol abuse and dependence, and drug abuse and dependence among 12,428 participants of an ongoing cohort study when they were ages 20-35 years. Binary or multinomial logistic regressions using generalized estimating equations were used to estimate differences by sexual orientation and gender identity in the odds of SUDs and multiple SUDs, stratified by sex assigned at birth.

RESULTS

Compared with completely heterosexuals (CH), sexual minority (SM; i.e., mostly heterosexual, bisexual, lesbian/gay) participants were generally more likely to have a SUD, including multiple SUDs. Among participants assigned female at birth, adjusted odds ratios (AORs) for SUDs comparing SMs to CHs ranged from 1.61 to 6.97 (ps<.05); among participants assigned male at birth, AORs ranged from 1.30 to 3.08, and were statistically significant for 62% of the estimates. Apart from elevated alcohol dependence among gender minority participants assigned male at birth compared with cisgender males (AOR: 2.30; p < .05), gender identity was not associated with prevalence of SUDs.

CONCLUSIONS

Sexual and gender minority (SGM) young adults disproportionately evidence SUDs, as well as co-occurring multiple SUDs. Findings related to gender identity and bisexuals assigned male at birth should be interpreted with caution due to small sample sizes. SUD prevention and treatment efforts should focus on SGM young adults.

Effects of familial and non-familial warmth during childhood and adolescence on sexual-orientation disparities in alcohol use trajectories and disorder during emerging adulthood

BACKGROUND

We investigated sexual-orientation differences in typologies of self-reported familial and non-familial warmth in childhood (before age 11) and adolescence (ages 11-17); and tested whether warmth explained sexual minority emerging adults' (ages 18-25) heightened odds of having heavier alcohol use trajectories (AUTs) and heightened risk for past-year alcohol use disorder (AUD) compared to completely heterosexuals.

METHODS

Using self-reported data from the U.S.-based Growing Up Today Study cohort, latent class analyses identified typologies of familial and non-familial warmth during childhood and adolescence. Multivariable regression models tested our objectives.

RESULTS

Six warmth classes emerged, including: High-High (i.e., high familial and high non-familial warmth, respectively); High-Moderate; Moderate-Moderate; Moderate-Occasional; Occasional-Occasional; and Low-Low. Among women, sexual minorities had higher odds than completely heterosexuals of being in the Moderate-Moderate, Moderate-Occasional, and Occasional-Occasional versus the High-High warmth class. There were not significant associations between sexual orientation and warmth classes for men. Lower warmth classes were generally associated with greater past-year AUD, and mediated heightened disparities in AUD for sexual minority women versus completely heterosexual women (4.3% mediated), but not among men. Warmth classes were generally unassociated with AUTs, and did not mediate sexual-orientation differences in AUTs.

CONCLUSIONS

Lower warmth was associated with greater alcohol-related problems, but not alcohol use itself. Warmth explained a small proportion of AUD disparities for sexual minority women-but not for men.

Stressors and Drinking in Sexual Minority Women: The Mediating Role of Emotion Dysregulation

Sexual minority women are at elevated risk for exposure to stressors (both traumatic and discriminatory) and have higher rates of alcohol consumption and problems. The psychological mediation framework (Hatzenbuehler, 2009) suggests that both general (e.g., traumatic events to which minorities and nonminorities may be exposed) and minority-group-specific (e.g., discrimination) stressors contribute to psychopathology through mediators such as emotion dysregulation. Guided by this framework, the present study longitudinally examined the relationship between stressors and problematic drinking outcomes (i.e., binge drinking and alcohol-related problems), as mediated by emotion dysregulation, in sexual minority women (SMW). It addressed two research questions: (1) whether stressors longitudinally predict problematic drinking outcomes in SMW, as mediated by emotion dysregulation, and (2) for which specific forms of stressor (i.e., traumatic events and/or discrimination) this mediational relationship is present. Young adult women (N = 1057) who identified as lesbian or bisexual completed annual measures of daily heterosexism, traumas, and drinking outcomes for four years, and completed a measure of emotion dysregulation during the third year of data collection. We found an indirect relationship between discrimination and problematic drinking outcomes via emotion dysregulation. These findings are consistent with the psychological mediation framework (Hatzenbuehler, 2009) and suggest that SMW group-specific processes such as discrimination may be especially important in conferring risk for problem drinking via emotion dysregulation. Clinicians are advised to assess unique stressors faced by SMW and their potential contribution to problematic drinking outcomes, and to target emotion dysregulation in alcohol treatments.

Health considerations for transgender women and remaining unknowns: a narrative review

Transgender (trans) women (TW) were assigned male at birth but have a female gender identity or gender expression. The literature on management and health outcomes of TW has grown recently with more publication of research. This has coincided with increasing awareness of gender diversity as communities around the world identify and address health disparities among trans people. In this narrative review, we aim to comprehensively summarize health considerations for TW and identify TW-related research areas that will provide answers to remaining unknowns surrounding TW's health. We cover up-to-date information on: (1) feminizing gender-affirming hormone therapy (GAHT); (2) benefits associated with GAHT, particularly quality of life, mental health, breast development and bone health; (3) potential risks associated with GAHT, including cardiovascular disease and infertility; and (4) other health considerations like HIV/AIDS, breast cancer, other tumours, voice therapy, dermatology, the brain and cognition, and aging. Although equally deserving of mention, feminizing gender-affirming surgery, paediatric and adolescent populations, and gender nonbinary individuals are beyond the scope of this review. While much of the data we discuss come from Europe, the creation of a United States transgender cohort has already contributed important retrospective data that are also summarized here. Much remains to be determined regarding health considerations for TW. Patients and providers will benefit from larger and longer prospective studies involving TW, particularly regarding the effects of aging, race and ethnicity, type of hormonal treatment (e.g. different oestrogens, anti-androgens) and routes of administration (e.g. oral, parenteral, transdermal) on all the topics we address.

Latent Classes of Polysubstance Use Among Adolescents in the United States: Intersections of Sexual Identity with Sex, Age, and Race/Ethnicity

PURPOSE

We aimed to estimate latent classes of concurrent polysubstance use and test for sexual orientation differences in latent class memberships with representative data from adolescents living in 19 U.S. states. We also tested whether sex, race/ethnicity, and age moderated the sexual identity differences in polysubstance use class memberships.

METHODS

We analyzed data from 119,437 adolescents from 19 states who participated in the 2015 Youth Risk Behavior Survey. Latent class analysis characterized polysubstance use patterns based on self-reported frequency of lifetime and past-month use of alcohol (including heavy episodic drinking), tobacco (cigarettes, cigars, and smokeless tobacco), and marijuana. Multinomial logistic regression models tested differences in latent class memberships by sexual identity. Interaction terms tested whether sex, race/ethnicity, and age moderated the sexual identity differences in polysubstance use class memberships.

RESULTS

A six-class model of polysubstance use fit the data best and included nonusers (61.5%), experimental users (12.2%), marijuana-alcohol users (14.8%), tobacco-alcohol users (3.8%), medium-frequency three-substance users (3.6%), and high-frequency three-substance users (4.1%). Gay/lesbian- and bisexual-identified adolescents had significantly higher odds than heterosexual-identified adolescents of being in all of the user classes compared with the nonuser class. These sexual identity differences in latent polysubstance use class memberships were generally larger for females than for males, varied occasionally by race/ethnicity, and were sometimes larger for younger ages.

CONCLUSION

Compared with their heterosexual peers, gay/lesbian and bisexual adolescents-especially females-are at heightened risk of engaging in multiple types of polysubstance use. Designing, implementing, and evaluating interventions will likely reduce these sexual orientation disparities.

Problematic Gaming and Internet Use but Not Gambling May Be Overrepresented in Sexual Minorities - A Pilot Population Web Survey Study

Background: Substance-related addictive disorders are known to be overrepresented in non-heterosexual individuals, but it is largely unknown whether this is also the case for behavioral addictions such as problem gaming and gambling. This study aimed, in a pilot web survey design, to assess whether problematic gambling, gaming and internet use may be more common in individuals with a non-heterosexual orientation. Methods: An online survey was distributed through media and social media, and answered by 605 individuals (51% women and 11% non-heterosexual). Problem gambling, problem gaming and problematic internet use were measured through structured screening instruments (the CLiP, the GAS and the PRIUSS, respectively). Results: Problem gaming and problematic internet use were significantly more prevalent in non-heterosexual subjects. Instead, problem gambling did not differ between heterosexual and non-heterosexual respondents. Psychological distress and social media use for more than 3 h daily were significantly more common in non-heterosexual respondents. In the overall sample, gaming and gambling were associated statistically. Conclusion: Based on the present pilot online survey, problematic gaming and internet use, but not problem gambling, may be more common in non-heterosexual populations. This area merits more and larger studies, and potentially preventive efforts aimed for non-heterosexual individuals in the population. Possible explanations and study limitations are discussed in the paper.