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Rice JK, Anderson-Carpenter KD, Ellis JD. Risk factors of substance use treatment gaps among a nationally representative sample of black American adults in relation to sexual minority status and health insurance coverage. BMC Psychol 2024; 12:271. [PMID: 38750576 PMCID: PMC11094979 DOI: 10.1186/s40359-023-01352-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Little research has investigated predictors of specialty substance use treatment gaps among Black adults. This study examined differential odds of experiencing self-reported, past-year treatment gaps among Black adults with respect to sexual minority status and health insurance coverage, accounting for social cofactors. METHOD This cross-sectional study comprised 36,098 Black Americans aged 18 and older who completed the 2015-2019 National Survey on Drug Use and Health (NSDUH) and provided responses for all selected survey items. Design-based multivariable logistic regression models were used to examine predictors of drug and alcohol treatment gaps. RESULTS Sexual minority Black adults reported greater odds of experiencing treatment gaps to specialty treatment (i.e., inpatient hospital, inpatient/outpatient rehabilitation facility, or mental health center) compared to Black heterosexuals in adjusted models (Gay or lesbian: AOR = 2.01, 95% CI = 1.39-2.89; Bisexual: AOR = 2.35, 95% CI = 1.77-3.12), with bisexual Black women experiencing the greatest odds (AOR = 3.10, 95% CI = 2.33-4.14). Black adults with no health insurance were significantly more likely to report substance use treatment gaps relative to their peers with health insurance coverage (AOR = 50, 95% CI = 1.26-1.78). CONCLUSION The results suggest a critical need for more investigations into patterns of specialty substance use treatment gaps within Black populations and for developing sexual identity-affirming mechanisms for closing the disparity gap, particularly for Black sexual minorities and those who lack health insurance coverage.
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Affiliation(s)
- Josiah K Rice
- Department of Psychology, Michigan State University, 316 Physics Road, East Lansing, MI, 48824, USA
| | | | - Javon D Ellis
- Department of Psychology, Michigan State University, 316 Physics Road, East Lansing, MI, 48824, USA
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Bhuptani PH, Zhang Y, Danzey L, Bali A, Langdon K, Orchowski LM. Interpersonal trauma, shame, and substance use: A systematic review. Drug Alcohol Depend 2024; 258:111253. [PMID: 38552599 PMCID: PMC11090047 DOI: 10.1016/j.drugalcdep.2024.111253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/21/2024] [Accepted: 02/24/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Interpersonal trauma is a risk factor for a wide array of adverse mental health outcomes, including substance use. Research has begun investigating the role of shame in the intersection between substance use and interpersonal trauma. The current systematic review summarizes the existing literature documenting the relation among shame, substance use, and interpersonal trauma. METHOD Articles were collected using a Boolean search strategy of terms related to interpersonal trauma, substance use, and shame across six databases. Independent search and screening by three researchers led to a final review of 27 articles, 15 of which were qualitative studies. RESULTS Findings highlight robust associations among shame, interpersonal violence, and substance use across varied samples. Findings emphasize that increased shame is associated with greater substance use among survivors of interpersonal violence and elevated shame and greater interpersonal violence are present among individuals who use substances given the high prevalence rates. Burgeoning research suggests that shame mediates the relationship between interpersonal violence and substance use. CONCLUSION Results from our review suggest that shame may be an important treatment target for individuals presenting with substance use and a history of interpersonal violence. Future studies, with longitudinal designs, are needed to parse out the temporal relation among shame, substance use, and interpersonal violence.
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Affiliation(s)
- Prachi H Bhuptani
- Rhode Island Hospital, Providence, RI, USA; Brown University, Providence, RI, USA.
| | | | - Lauren Danzey
- Rhode Island Hospital, Providence, RI, USA; Brown University, Providence, RI, USA
| | - Aanandita Bali
- Rhode Island Hospital, Providence, RI, USA; Brown University, Providence, RI, USA
| | - Kirsten Langdon
- Rhode Island Hospital, Providence, RI, USA; Brown University, Providence, RI, USA
| | - Lindsay M Orchowski
- Rhode Island Hospital, Providence, RI, USA; Brown University, Providence, RI, USA
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Williams ND, Turpin RE, Boekeloo BO, King-Marshall EC, Fish JN. Black Sexual Minority Adults' Avoidance of Professional Mental Health Care. Psychiatr Serv 2024; 75:40-47. [PMID: 37386879 DOI: 10.1176/appi.ps.20220445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
OBJECTIVE The authors sought to determine whether Black sexual minority individuals were more likely than White sexual minority individuals to postpone or avoid professional mental health care (PMHC) and, if so, to identify the reasons for postponing or avoiding care. METHODS Analyses were conducted with a subsample of cisgender Black (N=78) and White (N=398) sexual minority individuals from a larger survey of U.S. adults administered via MTurk in 2020 (N=1,012). Logistic regression models were used to identify racial differences in overall postponement or avoidance of care as well as differences in the prevalence of each of nine reasons for postponing or avoiding care. RESULTS Black sexual minority individuals were more likely than their White counterparts to report ever postponing or avoiding PMHC (average marginal effect [AME]=13.7 percentage points, 95% CI=5.4-21.9). Black sexual minority people also were more likely than their White counterparts to cite beliefs that they should work out their problems on their own (AME=13.1 percentage points, 95% CI=1.2-24.9) or with family and friends (AME=17.5 percentage points, 95% CI=6.0-29.1) and to cite providers' refusal to treat them (AME=17.4 percentage points, 95% CI=7.6-27.1) as reasons for postponing or avoiding care. CONCLUSIONS Black sexual minority individuals were more likely than their White counterparts to report delaying or avoiding PMHC. Personal beliefs about managing mental health and providers' refusal to offer treatment influenced Black sexual minority individuals' willingness or ability to seek PMHC.
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Affiliation(s)
- Natasha D Williams
- University of Maryland Prevention Research Center, University of Maryland, College Park (all authors); Departments of Family Science (Williams, Fish) and Behavioral and Community Health (Boekeloo, King-Marshall), School of Public Health, University of Maryland, College Park; Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, Virginia (Turpin)
| | - Rodman E Turpin
- University of Maryland Prevention Research Center, University of Maryland, College Park (all authors); Departments of Family Science (Williams, Fish) and Behavioral and Community Health (Boekeloo, King-Marshall), School of Public Health, University of Maryland, College Park; Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, Virginia (Turpin)
| | - Bradley O Boekeloo
- University of Maryland Prevention Research Center, University of Maryland, College Park (all authors); Departments of Family Science (Williams, Fish) and Behavioral and Community Health (Boekeloo, King-Marshall), School of Public Health, University of Maryland, College Park; Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, Virginia (Turpin)
| | - Evelyn C King-Marshall
- University of Maryland Prevention Research Center, University of Maryland, College Park (all authors); Departments of Family Science (Williams, Fish) and Behavioral and Community Health (Boekeloo, King-Marshall), School of Public Health, University of Maryland, College Park; Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, Virginia (Turpin)
| | - Jessica N Fish
- University of Maryland Prevention Research Center, University of Maryland, College Park (all authors); Departments of Family Science (Williams, Fish) and Behavioral and Community Health (Boekeloo, King-Marshall), School of Public Health, University of Maryland, College Park; Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, Virginia (Turpin)
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Veldhuis CB, Kreski NT, Usseglio J, Keyes KM. Are Cisgender Women and Transgender and Nonbinary People Drinking More During the COVID-19 Pandemic? It Depends. Alcohol Res 2023; 43:05. [PMID: 38170029 PMCID: PMC10760999 DOI: 10.35946/arcr.v43.1.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
PURPOSE This narrative review of research conducted during the first 2 years of the COVID-19 pandemic examines whether alcohol use among cisgender women and transgender and nonbinary people increased during the pandemic. The overarching goal of the review is to inform intervention and prevention efforts to halt the narrowing of gender-related differences in alcohol use. SEARCH METHODS Eight databases (PubMed, APA PsycInfo, CINAHL, Embase, Scopus, Gender Studies Database, GenderWatch, and Web of Science) were searched for peer-reviewed literature, published between March 2020 and July 2022, that reported gender differences or findings specific to women, transgender or nonbinary people, and alcohol use during the pandemic. The search focused on studies conducted in the United States and excluded qualitative research. SEARCH RESULTS A total 4,132 records were identified, including 400 duplicates. Of the remaining 3,732 unique records for consideration in the review, 51 were ultimately included. Overall, most studies found increases in alcohol use as well as gender differences in alcohol use, with cisgender women experiencing the most serious consequences. The findings for transgender and nonbinary people were equivocal due to the dearth of research and because many studies aggregated across gender. DISCUSSION AND CONCLUSIONS Alcohol use by cisgender women seems to have increased during the pandemic; however, sizable limitations need to be considered, particularly the low number of studies on alcohol use during the pandemic that analyzed gender differences. This is of concern as gender differences in alcohol use had been narrowing before the pandemic; and this review suggests the gap has narrowed even further. Cisgender women and transgender and nonbinary people have experienced sizable stressors during the pandemic; thus, understanding the health and health behavior impacts of these stressors is critical to preventing the worsening of problematic alcohol use.
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Affiliation(s)
- Cindy B Veldhuis
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
| | - Noah T Kreski
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - John Usseglio
- Augustus C. Long Health Sciences Library, Columbia Irving Medical Center, Columbia University, New York, New York
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Scheer JR, Clark KA, McConocha E, Wang K, Pachankis JE. Toward Cognitive-Behavioral Therapy for Sexual Minority Women: Voices From Stakeholders and Community Members. COGNITIVE AND BEHAVIORAL PRACTICE 2023; 30:471-494. [PMID: 37547128 PMCID: PMC10403251 DOI: 10.1016/j.cbpra.2022.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Sexual minority women (SMW) experience an elevated risk of mental health problems compared to heterosexual women. However, knowledge gaps remain regarding whether cognitive-behavioral therapy (CBT) interventions meet SMW's mental health needs. Further, virtually no studies have integrated stakeholder (i.e., researchers with content expertise in SMW's health and clinical providers who work with SMW) and community member (i.e., SMW) perspectives to identify CBT approaches that address SMW-specific issues. This study used qualitative data gathered from 39 SMW who reported depression, anxiety, suicidality, and heavy drinking in the past 3 months and 16 content experts and clinical providers to obtain information relevant to enhancing CBT for SMW. In addition, we used thematic analysis to identify themes related to the adaptation and delivery of CBT for SMW. Building on prior literature, this study's findings revealed seven considerations for delivering mental health services to SMW: (1) attending to SMW's diverse gender identities and expressions; (2) focusing on SMW's nonbinary stressors; (3) formulating SMW's gender-based stressors within a feminist framework; (4) applying intersectionality frameworks; (5) incorporating issues of diversity, multiculturalism, and social justice; (6) addressing the role of trauma exposure; and (7) addressing the role of alcohol use in SMW's lives. These considerations are reviewed in terms of their implications for clinical practice, with a focus on enhancing applications of existing CBT interventions, to best respond to the unique needs of this population.
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Xavier Hall CD, Harris R, Burns P, Girod C, Yount KM, Wong FY. Utilizing Latent Class Analysis to Assess the Association of Intersectional Stigma on Mental Health Outcomes Among Young Adult Black, Indigenous, and Sexual Minority Women of Color. LGBT Health 2023; 10:463-470. [PMID: 36951670 PMCID: PMC10468552 DOI: 10.1089/lgbt.2022.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
Purpose: Discrimination has detrimental effects on mental health, particularly among Black, Indigenous, and people of color who are also sexual minority women (BIPOC SMW); however, measurement of multiple intersecting forms of discrimination (e.g., race, gender, and sexual identity discrimination among BIPOC SMW) poses methodological challenges. This analysis uses latent class analysis (LCA) to examine the influences of discrimination on mental health in a convenience sample of BIPOC SMW. Methods: Online survey data from BIPOC SMW aged 18-29 years (n = 324) were used to estimate latent classes for discrimination type (race, gender, and sexual identity). Data for this study were collected from July to October 2018. Adjusted linear regressions examined the influences of discrimination profiles on perceived stress and depressive symptoms. Results: Utilizing LCA, the following four classes emerged: (1) low discrimination; (2) mid-level discrimination; (3) high racial, medium gender, and low sexual identity discrimination; (4) high discrimination. Classes 3 and 4 were positively associated with perceived stress and depressive symptoms relative to Class 1 in adjusted models. Conclusion: This analysis highlights the importance of intersectionality and the adverse impact of multiple forms of discrimination on mental health outcomes for BIPOC SMW. Respondents reporting higher levels of racial or multiple forms of discrimination had poorer mental health outcomes. LCA is a promising analytical tool for investigating intersectional stigma and discrimination. There is an urgent need to develop tailored, culturally appropriate intersectional mental health interventions to address the multiple identities and oppressions faced by BIPOC SMW.
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Affiliation(s)
- Casey D. Xavier Hall
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, Florida, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Rachel Harris
- College of Social Work, Florida State University, Tallahassee, Florida, USA
| | - Paul Burns
- John D. Bower School of Population Health, Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Kathryn M. Yount
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Sociology, Emory University, Atlanta, Georgia, USA
| | - Frankie Y. Wong
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, Florida, USA
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
- Department of Epidemiology, Fudan University, Shanghai, China
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Behler AC, George N, Collibee C, Hamilton L, Oleson EB, Thamotharan S. A conceptual framework for queer, black womxn sexual assault survivors: an adaptation of the minoritised stress model. CULTURE, HEALTH & SEXUALITY 2023; 25:791-802. [PMID: 35900895 DOI: 10.1080/13691058.2022.2089734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 06/10/2022] [Indexed: 06/02/2023]
Abstract
Queer, Black womxn experience sexual assault at an alarming rate in the USA leading to adverse mental and physical health outcomes in survivors. A synthesis of the literature was conducted to understand their unique lived experiences and needs. This article proposes an adapted Meyer's Minoritised Stress framework to understand salient clinical factors impacting Queer, Black womxn sexual assault survivors, including those associated with multiple minoritised identities: Queer-based trauma, race-based trauma, cultural betrayal trauma, and misogynoir. Given the high rates of victimisation, marginalisation and discrimination, psychologists and others working with members of this population should engage with and address these factors to provide culturally responsive, sexually affirming and effective mental health treatment and care.
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Affiliation(s)
| | - Nevita George
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Charlene Collibee
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Lindsey Hamilton
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Erik B Oleson
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Sneha Thamotharan
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
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Dyar C. A Review of Disparities in Cannabis Use and Cannabis Use Disorder Affecting Sexual and Gender Minority Populations and Evidence for Contributing Factors. CURRENT ADDICTION REPORTS 2022; 9:589-597. [PMID: 37637872 PMCID: PMC10449003 DOI: 10.1007/s40429-022-00452-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 11/08/2022]
Abstract
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.
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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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Moreland A, Crum K, Rostad WL, Stefanescu A, Whitaker D. Examining an In-Home Behavioral Parent Training Protocol Among Parents Who Use Substances Involved Child Welfare: Effectiveness of SafeCare. CHILD MALTREATMENT 2022; 27:671-682. [PMID: 34730030 PMCID: PMC9061898 DOI: 10.1177/10775595211046940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Given the detrimental impact of substance use (SU) on both parent and child outcomes including child maltreatment, research and service efforts have focused on incorporating parenting resources into integrated SU treatment programs. While promising, it is imperative to examine and test parenting programs in a variety of settings. This study examined whether SU moderated the relationship between treatment condition and parenting outcomes among parents who participated in SafeCare, and parent ratings of engagement, service satisfaction, and perceived cultural competency of services. Results indicated that SU did not moderate the relationship between treatment condition and abuse potential, but did moderate this relationship for depression and parental distress such that parents with higher levels of SU reported less improvement in depression and parental distress. Results underscore that SU problems may impact the effectiveness of SC on specific risk factors, such as depression and parental distress, potentially indicating unique treatment needs and the need to adapt interventions to ensure treatment success. In addition, this study found that SafeCare was not found to be beneficial for parents with SU problems above and beyond the treatment as usual condition. Finally, results indicated that parents with SU concerns and without SU concerns engaged very similarly in SafeCare.
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Kidd JD, Everett BG, Corbeil T, Shea E, Hughes TL. Gender self-concept and hazardous drinking among sexual minority women: Results from the Chicago health and life experiences of women (CHLEW) study. Addict Behav 2022; 132:107366. [PMID: 35598531 PMCID: PMC9199430 DOI: 10.1016/j.addbeh.2022.107366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/25/2022] [Accepted: 05/10/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Sexual minority women (SMW; e.g., lesbian, bisexual) report substantially higher rates of hazardous drinking (HD) than heterosexual women.Yet, few studies have examined sub-group differences. In this study, we investigated the relationship between gender self-concept and HD among SMW. Research consistently shows a link between heavier drinking and masculinity. SMW are more likely than heterosexual women to be gender nonconforming, and masculinity among SMW is associated with increased minority stress, a key HD risk factor. METHODS We used Wave 3 data from the Chicago Health and Life Experiences of Women study, a longitudinal study of SMW (N = 598), which assessed participants' self-perceived levels of masculinity and femininity and their perception of how masculine/feminine others viewed them. Using multivariable logistic regression, we examined the association between gender self-concept and past 12-month heavy episodic drinking (HED), drinking-related problems, and alcohol dependence. RESULTS Controlling for demographics and minority stress, greater masculinity (both self-perceived and perceptions by others) was associated with higher odds of HED and alcohol dependence. Masculinity as perceived by others was associated with higher odds of drinking-related problems. Neither femininity measure was associated with HD. Additionally, minority stress (i.e., discrimination, stigma, internalized stigma) did not account for the relationship between gender self-concept and HD. CONCLUSIONS/IMPORTANCE In this sample, masculinity, particularly SMW's beliefs that others viewed them as masculine, was associated with HD. This association was not attributable to differences in minority stress and may be related to differences in gendered drinking norms, which could be targeted in intervention studies.
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Affiliation(s)
- Jeremy D Kidd
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Bethany G Everett
- Department of Sociology, University of Utah, Salt Lake City, UT, USAf.
| | - Thomas Corbeil
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Eileen Shea
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Tonda L Hughes
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; Columbia University School of Nursing, New York, NY, USA.
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12
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Veldhuis CB, Juster RP, Corbeil T, Wall M, Poteat T, Hughes TL. Testing whether the combination of victimization and minority stressors exacerbate PTSD risks in a diverse community sample of sexual minority women. PSYCHOLOGY & SEXUALITY 2022; 14:252-278. [PMID: 38549608 PMCID: PMC10978045 DOI: 10.1080/19419899.2022.2106147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
Abstract
Informed by minority stress and intersectionality frameworks, we examined: 1) associations of sexual identity and race/ethnicity with probable diagnosis of post-traumatic stress disorder (PTSD-PD) among sexual minority women (SMW; e.g., lesbian, bisexual); and 2) potential additive and interactive associations of minority stressors (discrimination, stigma consciousness, and internalized homonegativity) and potentially traumatic childhood and adulthood events (PTEs) with PTSD-PD. Data come from a large and diverse community sample of SMW (N = 662; age range: 18-82; M = 40.0, SD = 14.0). The sample included 35.8% Black, 23.4% Latinx, and 37.2% White participants. Logistic regressions tested associations of sexual identity and race/ethnicity, minority stressors, and PTEs with PTSD-PD. More than one-third of SMW (37.2%) had PTSD-PD with significantly higher prevalence among bisexual, particularly White bisexual women, than lesbian women. Discrimination, stigma consciousness, and internalized homonegativity were each associated with higher odds of PTSD-PD, but only internalized homonegativity was additively associated with PTSD-PD in mutually adjusted models above and beyond effects of PTEs. No evidence for interactive effects between PTEs and minority stressors was found. In a diverse community sample of sexual minority women, PTSD is strongly associated with potentially traumatic childhood events and with minority stressors above and beyond the associations with other potentially traumatic events and stressors in adulthood. Our findings suggest a strong need for therapists to address the effects of stigma and homophobia in treatment for PTSD, as these minority stressors likely maintain and exacerbate the effects of past traumas.
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Affiliation(s)
| | | | - Thomas Corbeil
- Mental Health Data Science, New York State Psychiatric Institute
| | - Melanie Wall
- Mental Health Data Science, New York State Psychiatric Institute
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill
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13
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Simulating the experience of searching for LGBTQ-specific opioid use disorder treatment in the United States. J Subst Abuse Treat 2022; 140:108828. [PMID: 35749919 DOI: 10.1016/j.jsat.2022.108828] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/15/2022] [Accepted: 06/07/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations experience opioid-related disparities compared to heterosexual and cisgender populations. LGBTQ-specific services are needed within opioid use disorder (OUD) treatment settings to minimize treatment barriers; research on the availability and accessibility of such services is limited. The purpose of the current study was to mimic the experience of an LGBTQ-identified individual searching for LGBTQ-specific OUD treatment services, using the SAMHSA National Directory of Drug and Alcohol Abuse Treatment Facilities - 2018 (Treatment Directory). METHODS We contacted treatment facilities listed in the Treatment Directory as providing both medications for OUD (MOUD) and "special programs/groups" for LGBTQ clients within states with the top 20 highest national opioid overdose rates. We used descriptive statistics to characterize the outcome of calls; and the overall number of facilities offering LGBTQ-specific services, MOUD, and both LGBTQ-specific services and MOUD in each state by 100,000 state population and in relation to opioid overdose mortality rates (programs-per-death rate). RESULTS Of the N = 570 treatment facilities contacted, n = 446 (78.25 %) were reached and answered our questions. Of n = 446 reached (all of which advertised both MOUD and LGBTQ-specific services), n = 366 (82.06 %) reported offering MOUD, n = 125 (28.03 %) reported offering special programs or groups for LGBTQ clients, and n = 107 (23.99 %) reported offering both MOUD and LGBTQ-specific services. Apart from Washington, DC, New Mexico, South Carolina, and West Virginia, which did not have any facilities that reported offering both MOUD and LGBTQ-specific services, Illinois had the lowest, and Michigan had the highest programs-per-death rate. Most of the northeastern states on our list (all but New Hampshire) clustered in the top two quarters of programs-per-death rates, while most of southeastern states (all but North Carolina) clustered in the bottom two quarters of programs-per-death rates. CONCLUSIONS The lack of LGBTQ-specific OUD treatment services may lead to missed opportunities for supporting LGBTQ people most in need of treatment; such treatment is especially crucial to prevent overdose mortality and improve the health of LGBTQ populations across the United States, particularly in the southeast.
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14
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Flanders CE, Tarasoff LA, VanKim N. Sexual Violence and Mental Health among Young Bi+ and Lesbian Women and Gender Minoritized People. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022; 27:483-502. [PMID: 38078053 PMCID: PMC10706698 DOI: 10.1080/19359705.2022.2072036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/23/2022] [Indexed: 10/18/2022]
Abstract
Introduction Sexual minoritized people report worse mental health and are at risk of sexual violence compared to their heterosexual peers. Method We conducted a survey to explore sexual stigma, sexual violence, and mental health among 326 bi+ and lesbian women and gender minoritized people age 18-25. Results Mental health did not differ by sexual identity; sexual stigma and violence were associated with negative mental health symptoms, as were identifying as BIPOC, as trans or nonbinary, or having less formal education. Conclusion Sexual stigma and violence are related to mental health among young bi+ and lesbian women and gender minoritized people.
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Affiliation(s)
- Corey E Flanders
- Department of Psychology and Education, Mount Holyoke College, 50 College St., South Hadley, MA 01075. (413) 538-2052
| | - Lesley A Tarasoff
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON
| | - Nicole VanKim
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA
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15
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Silveri G, Schimmenti S, Prina E, Gios L, Mirandola M, Converti M, Fiorillo A, Pinna F, Ventriglio A, Galeazzi GM, Sherriff N, Zeeman L, Amaddeo F, Paribello P, Pinna F, Giallanella D, Gaggiano C, Ventriglio A, Converti M, Fiorillo A, Galeazzi GM, Marchi M, Arcolin E, Fiore G, Mirandola M, Schimmenti S, Silveri G, Prina E, Amaddeo F, Bragazzi NL. Barriers in care pathways and unmet mental health needs in LGBTIQ + communities. Int Rev Psychiatry 2022; 34:215-229. [PMID: 36151825 DOI: 10.1080/09540261.2022.2075256] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Lesbian, gay, bisexual, transgender, intersex, queer people and minority gender identities and sexualities (LGBTIQ+) are often stigmatized and experience discrimination in health care settings, leading to poorer mental health outcomes and unmet needs compared to heterosexual and cisgendered peers. It is thus imperative that mental health providers consider and address structural challenges in order to reduce mental health inequalities of this population. This narrative review assessed the barriers that may prevent access to care and the pathways for care in LGBTIQ + communities. PubMed, PsycInfo, Embase, and Scopus were searched for papers published between December 2021 and February 2022. A total of 107 papers were included with studies reflecting five themes: (1) Unmet mental health needs; (2) Young people; (3) Substance abuse and addiction; (4) Barriers and pathways to care; and (5) Interventions. Findings demonstrate that LGBTIQ + people experience stigmatization and higher rates of substance misuse and mental ill health, which may lead to barriers in accessing health care services, and fewer tailored interventions being provided. These findings have implications for policy, health care screening, and how specialist services are structured. Substantial gaps in the evidence-base exist, and future research should examine how mental health care providers can challenge social issues that maintain discriminatory and stigmatizing practices, and support LGBTIQ + individuals to sustain their resilience.
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Affiliation(s)
- Giada Silveri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Simone Schimmenti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy.,School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of integrated activity of Mental Health and Pathological Dependencies, USL-IRCSS company of Reggio Emilia, Reggio Emilia, Italy
| | - Nigel Sherriff
- School of Sport and Health Sciences, University of Brighton, Brighton, UK.,Centre for Transforming Sexuality and Gender, University of Brighton, Brighton, UK
| | - Laetitia Zeeman
- School of Sport and Health Sciences, University of Brighton, Brighton, UK.,Centre for Transforming Sexuality and Gender, University of Brighton, Brighton, UK
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Pasquale Paribello
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Daniela Giallanella
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | - Costanza Gaggiano
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Arcolin
- Department of Mental Health and Drug Abuse, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gianluca Fiore
- Department of Mental Health and Drug Abuse, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Simone Schimmenti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giada Silveri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
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16
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Scheer JR, Batchelder AW, Bochicchio LA, Kidd JD, Hughes TL. Alcohol use, behavioral and mental health help-seeking, and treatment satisfaction among sexual minority women. Alcohol Clin Exp Res 2022; 46:641-656. [PMID: 35318685 PMCID: PMC9018513 DOI: 10.1111/acer.14789] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/23/2022] [Accepted: 01/31/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Sexual minority women (SMW) report higher rates of heavy episodic drinking (HED) and adverse alcohol-related outcomes, including poor mental health, than heterosexual women. These disparities indicate a greater need for behavioral and mental health treatment for SMW. This study examined associations among alcohol outcomes, behavioral and mental health help-seeking, and treatment satisfaction among SMW by age, sexual identity, race/ethnicity, and income. METHODS Participants included a community sample of 695 SMW (Mage = 40.0, SD = 14.1; 74.1% lesbian, 25.9% bisexual; 37.6% White, 35.8% Black, 23.2% Latinx; 26.3% annual income $14,999 or less). We used bivariate analyses to characterize the sample's demographic characteristics and multivariable logistic regression analyses to examine associations among variables. RESULTS SMW subgroups based on age, race/ethnicity, and annual income differed in alcohol outcomes (i.e., HED, DSM-IV alcohol dependence, alcohol-related problem consequences, alcohol problem recognition, and motivation to reduce drinking); help-seeking; and treatment satisfaction. SMW who engaged in help-seeking for alcohol-related concerns were more likely than those who did not to meet criteria for DSM-IV alcohol dependence (adjusted odds ratio [aOR] = 7.13; 95% CI = 2.77; 18.36), endorse alcohol-related problem consequences (aOR = 11.44; 95% CI = 3.88; 33.71), recognize problematic drinking (aOR = 14.56; 95% CI = 3.37; 62.97), and report motivation to reduce drinking (aOR = 5.26; 95% CI = 1.74; 15.88). SMW's alcohol outcomes did not differ based on their satisfaction with treatment or with providers. CONCLUSIONS This study's findings confirm SMW's elevated risk for HED and other alcohol-related outcomes and underscore the importance of identity-affirmative and accessible behavioral and mental health treatment for young, Black, and low-income SMW. Clinicians and intervention scientists should develop or enhance existing brief behavioral and mental health treatments for SMW engaging in HED who may not recognize that their drinking is problematic or who are not motivated to reduce drinking.
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Affiliation(s)
| | - Abigail W. Batchelder
- Harvard Medical School, Harvard University, Boston, MA
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- The Fenway Institute, Fenway Health, Boston, MA
| | - Lauren A. Bochicchio
- School of Nursing and Department of Psychiatry, Columbia University, New York, NY
| | - Jeremy D. Kidd
- Columbia University Irving Medical Center, New York, NY
- New York State Psychiatric Institute, New York, NY
| | - Tonda L. Hughes
- School of Nursing and Department of Psychiatry, Columbia University, New York, NY
- Columbia University Irving Medical Center, New York, NY
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17
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Recovery among sexual minorities in the united states population: Prevalence, characteristics, quality of life and functioning compared with heterosexual majority. Drug Alcohol Depend 2022; 232:109290. [PMID: 35032857 PMCID: PMC8885881 DOI: 10.1016/j.drugalcdep.2022.109290] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Lesbian, gay, and bisexual individuals ("sexual minorities" [SMs]) are overrepresented among individuals suffering from alcohol and other drug (AOD) problems. However, little is known regarding differences, particularly in functioning and well-being, between SMs and heterosexuals in recovery from AOD problems. METHOD Cross-sectional, nationally representative sample of US adults who resolved an AOD problem (N = 2002; National Recovery Study [Kelly et al., 2017]). Univariate analyses tested for differences between SMs and heterosexuals on socio-demographic, AOD use/treatment and clinical/legal factors. Unadjusted regressions tested for group differences on indices of current functioning and well-being. Multivariable regressions investigated factors that differentiated groups to understand which might explain any observed group disparities in functioning and well-being. LOWESS analyses explored differences across time in recovery on functioning/well-being. RESULTS Prevalence of SMs in the US recovery population was 11.7% (n = 220). Compared with heterosexuals (88.3%, n = 1666), SMs had shorter time in recovery (OR=0.97; 95% CI: 0.96, 0.99); were less likely to be employed (OR=0.64; 95% CI: 0.43, 0.96); and more likely to have a co-occurring psychiatric disorder (OR=2.24; 95% CI: 1.49, 3.37), an arrest history (OR=1.61; 95% CI: 1.08, 2.39), and report opioids as primary substance (OR=2.50; 95% CI: 1.18, 5.28). Unadjusted models showed, compared to heterosexuals, SMs had significantly worse levels on all functioning and well-being outcomes. Adjusted models explained most differences, except for psychological distress. CONCLUSION SMs evince more problematic clinical/legal histories and face greater psychosocial challenges in recovery. Research is needed to understand the unique experiences of recovering SMs in order to better address observed functioning and well-being disparities.
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18
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Amos N, Bourne A, Hill AO, Power J, McNair R, Mooney-Somers J, Pennay A, Carman M, Lyons A. Alcohol and tobacco consumption among Australian sexual minority women: Patterns of use and service engagement. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 100:103516. [PMID: 34753044 DOI: 10.1016/j.drugpo.2021.103516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sexual minority women consume both alcohol and tobacco at higher rates than heterosexual women. However, various sociodemographic and cultural factors associated with these practices among sexual minority women in Australia are not well understood, nor are the factors associated with seeking alcohol-related support. METHODS This study utilised data from cisgender sexual minority women respondents of Private Lives 3: a national, online, cross-sectional survey of the health and wellbeing of LGBTIQ adults in Australia aged 18+ conducted in 2019. Multivariable analyses were performed to identify co-existing smoking and alcohol use, sociodemographic factors associated with smoking, alcohol consumption and seeking alcohol-related support. RESULTS Of 2,647 sexual minority women respondents, 16.90% were currently smoking tobacco, 7.67% smoking tobacco daily and 60.50% reported potentially risky patterns of alcohol consumption. Tobacco and potentially risky alcohol consumption were found to frequently co-occur. Women who identified as queer were more likely than lesbian identifying women to currently smoke tobacco and to smoke tobacco daily. Tobacco consumption was associated with increased age, unemployment, low-mid range income and secondary-school education, while potential risky drinking was associated with living in outer urban or rural areas and being Australian born . Self-reporting having struggled with alcohol in the past twelve months was associated with residential location. Less than 3% of the sample has sought help for alcohol use. Seeking support was more likely as women aged, and with potentially risky drinking, and much more likely with self-perceived struggles with alcohol. CONCLUSIONS The findings highlight the need for future alcohol and tobacco use health promotion strategies focussing on sexual minority women to attend to within group differences that relate to risk of higher consumption. They also highlight the need for approaches that empower sexual minority women to self-identify when they are struggling with alcohol use and encourage seeking support with organisations that are affirming of sexual minority women.
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Affiliation(s)
- Natalie Amos
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Victoria, 3086, Australia.
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Victoria, 3086, Australia
| | - Adam O Hill
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Victoria, 3086, Australia
| | - Jennifer Power
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Victoria, 3086, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Level 3, 780 Elizabeth St, Melbourne, Victoria, 3004, Australia
| | - Julie Mooney-Somers
- University of Sydney, Faculty of Medicine and Health, Sydney Health Ethics, Level 1 Medical Foundation Building, 91-97 Parramatta Road, Camperdown, NSW, 2050, Australia
| | - Amy Pennay
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Building NR1, Bundoora, Victoria, 3086, Australia
| | - Marina Carman
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Victoria, 3086, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Victoria, 3086, Australia
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19
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Paschen-Wolff MM, Putney JM, Corbeil T, Tse-Hwei C, Hughes TL. The Association between Hazardous Drinking Indicators and Drinking Problem Concerns among Sexual Minority Women. ANNALS OF LGBTQ PUBLIC AND POPULATION HEALTH 2021; 2:317-335. [PMID: 37920249 PMCID: PMC10621598 DOI: 10.1891/lgbtq-2020-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Sexual minority women (SMW) report high rates of hazardous drinking (HD), treatment utilization that is not commensurate with need, and low perceived alcohol use severity. This study examined SMW's drinking problem concerns by sexual identity and other demographic characteristics, and the strength of associations between endorsement of unique HD indicators and drinking problem concerns. Data were from a supplemental sample of SMW added in Wave 3 of the longitudinal, community-based Chicago Health and Life Experiences of Women (CHLEW) study. HD was measured using a validated 13-item HD Index (HDI). Multivariable logistic regression models examined independent associations between past-five-year drinking problem concerns and each HD indicator. Twelve HD indicators were significantly associated with past-five-year drinking problem concerns, adjusting for age and sexual identity. Adjusted odds ratios varied from 2.44 for driving drunk to 15.52 for drinking first thing in the morning. After adjusting for number of HD indicators endorsed, associations were no longer significant, indicating that number of endorsed indicators was a more important predictor of drinking problem concerns than were individual HD indicators. Early intervention and harm reduction strategies could support SMW in addressing salient aspects of HD before progression to alcohol use disorder.
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Affiliation(s)
- Margaret M. Paschen-Wolff
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
- Columbia University Irving Medical Center, Department of Psychiatry, New York, NY, USA
| | | | - Thomas Corbeil
- Columbia University Irving Medical Center, Department of Psychiatry, Mental Health Data Science Division, New York, NY, USA
| | - Choo Tse-Hwei
- Columbia University Irving Medical Center, Department of Psychiatry, Mental Health Data Science Division, New York, NY, USA
| | - Tonda L. Hughes
- Columbia University Irving Medical Center, Department of Psychiatry, New York, NY, USA
- Columbia University School of Nursing, New York, NY, USA
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20
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Riggle EDB, Drabble LA, Bochicchio LA, Wootton AR, Veldhuis CB, Munroe C, Hughes TL. Experiences of the COVID-19 Pandemic Among African American, Latinx, and White Sexual Minority Women: A Descriptive Phenomenological Study. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2021; 8:145-158. [PMID: 34746332 DOI: 10.1037/sgd0000510] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
From a systems perspective, the COVID-19 pandemic has caused global changes impacting the lives of individuals at all levels of interactions. Qualitative in-depth interviews were conducted with a sample of 18 African-American/Black, Hispanic/Latina/Latinx, and White sexual minority women (SMW) to explore experiences and adaptations during the COVID-19 pandemic. Interviews were analyzed using a descriptive phenomenological approach to understand how the complex and changing contexts of the pandemic impacted participants' lives. Analyses revealed participants were impacted in the context of their sexual identity in their experiences of coming out and being visible; creating social bubbles; their connection to the LGBTQ community; and dating. The pandemic, which took place concurrently with major political events including Black Lives Matter demonstrations and protests against police and White supremacist violence against people of color, resulted in additional impacts on Black and Latinx SMW related to safety, dialogues about race, and on-going systemic and cultural racism. Interviews also revealed general challenges in the areas of relationships, including with a partner and family; employment and the workplace; and interactions in public spaces. The findings underscore the importance of understanding the diverse range of experiences and impacts of the pandemic on SMW, including experiences related to their sexual identity and racial/racialized identity, as well as general experiences that may have additional consequences for SMW, and supports needed to help alleviate the negative impacts in the short and long-term.
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Affiliation(s)
- Ellen D B Riggle
- Department of Political Science and Department of Gender and Women's Studies, University of Kentucky, Lexington, KY
| | - Laurie A Drabble
- College of Health & Human Sciences, San José State University, San José, CA
| | | | - Angie R Wootton
- School of Social Welfare, University of California Berkeley, Berkeley, CA
| | | | | | - Tonda L Hughes
- School of Nursing & Department of Psychiatry, Columbia University, New York City, NY
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21
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Beck DC, Veliz PT, McCabe SE, Boyd CJ, Evans-Polce R. Cigarette, e-cigarette, and dual use during the third trimester of pregnancy in a national sample of heterosexual and sexual minority women. Am J Addict 2021; 30:593-600. [PMID: 34472675 DOI: 10.1111/ajad.13217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/15/2021] [Accepted: 08/11/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Research investigating e-cigarettes/e-products and dual use with cigarettes among pregnant sexual minority individuals in the United States is lacking. This study addresses this gap using a national sample. METHODS Two waves of national panel data (2015-2018) from the Population Assessment of Tobacco and Health study were used. The sample included 1842 women, 237 identified as sexual minorities (n = 17 lesbian, n = 177 bisexual, n = 43 something else), who indicated pregnancy during the past 12 months at Waves 3 or 4. Covariates included race, ethnicity, past-year income, and education. Cigarette, e-cigarette, or dual use was examined during the last trimester. RESULTS Sexual minorities had higher adjusted odds of cigarette use during their last trimester of pregnancy relative to heterosexual women (adjusted odds ratio [AOR] = 1.55, 95% confidence interval [CI] = 1.08, 2.23). Bisexual women had higher odds of smoking cigarettes during their third trimester compared with heterosexual women (AOR = 1.82, 95% CI = 1.21, 2.72). Lesbian women were more likely to use e-cigarettes/e-products (AOR = 9.15, 95% CI = 2.29, 36.5) and indicate dual use (AOR = 6.00, 95% CI = 1.43, 25.1) during their third trimester of pregnancy compared with heterosexual women. CONCLUSION AND SCIENTIFIC SIGNIFICANCE Maternal health among US sexual minority women would benefit from clinicians equipped to provide accurate information and support for Food and Drug Administration-approved smoking cessation, information about e-cigarettes/e-products, and dual use. This study is the first to examine cigarette, e-cigarette, and dual use during the third trimester of pregnancy using a national sample, with specific attention to differences in sexual orientation.
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Affiliation(s)
- Dana C Beck
- National Clinician Scholars Program, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Phil T Veliz
- Center for the Study of Drugs, Alcohol, Smoking, and Health, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Sean E McCabe
- Center for the Study of Drugs, Alcohol, Smoking, and Health, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking, and Health, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Rebecca Evans-Polce
- Center for the Study of Drugs, Alcohol, Smoking, and Health, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
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22
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Krasnova A, Diaz JE, Philbin MM, Mauro PM. Disparities in substance use disorder treatment use and perceived need by sexual identity and gender among adults in the United States. Drug Alcohol Depend 2021; 226:108828. [PMID: 34325282 PMCID: PMC8477369 DOI: 10.1016/j.drugalcdep.2021.108828] [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: 11/25/2020] [Revised: 04/30/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Substance use disorder (SUD) treatment use is low in the United States. We assessed differences in treatment use and perceived need by sexual identity (i.e., lesbian, gay, bisexual, heterosexual) and gender among adults with a past-year SUD. METHODS We pooled data from the 2015-2019 National Survey on Drug Use and Health for adults (18+) who met past-year DSM-IV SUD criteria and self-reported sexual identity (n = 21,926). Weighted multivariable logistic regressions estimated odds of past-year: 1) any SUD treatment; 2) specialty SUD treatment; 3) perceived SUD treatment need by sexual identity, stratified by gender and adjusted for socio-demographics. RESULTS Any past-year SUD treatment use was low among adult men (heterosexual [10.4 %], gay [15.5 %], and bisexual [7.1 %]) and women (heterosexual [9.9 %], gay/lesbian [11.9 %], and bisexual [13.2 %]). Patterns were similar for specialty SUD treatment and perceived treatment need. Adjusted odds of any SUD treatment use were higher among gay men (aOR = 1.65 [95 % Confidence Interval 1.10-2.46]) and bisexual women (aOR = 1.31 [1.01-1.69]) than their heterosexual peers. Compared to their heterosexual counterparts, adjusted odds of perceived SUD treatment need were higher among bisexual women (aOR = 1.65 [1.22-2.25]), gay men (aOR = 1.76 [1.09-2.84]), and bisexual men (aOR = 2.39 [1.35-4.24]). CONCLUSIONS Most adults with SUD did not receive treatment. Gay men and bisexual women were more likely to receive treatment and reported higher perceived SUD treatment need than heterosexual peers. Facilitating treatment access and engagement is needed to reduce unmet needs among marginalized people who perceive SUD treatment need.
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Affiliation(s)
- Anna Krasnova
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.
| | - José E Diaz
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Morgan M Philbin
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Pia M Mauro
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
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Masa R, Shangani S, Operario D. Socioeconomic Status and Psychosocial Resources Mediate Racial/Ethnic Differences in Psychological Health Among Gay and Bisexual Men: A Longitudinal Analysis Using Structural Equation Modeling. Am J Mens Health 2021; 15:15579883211001197. [PMID: 33724073 PMCID: PMC7970305 DOI: 10.1177/15579883211001197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A large body of research demonstrates disparities in psychological health attributed to sexual minority identity, racial/ethnic minority identity, and socioeconomic status (SES). Fewer studies have explicated the role of these multiple attributes on psychological health and explored the role of SES and psychosocial resources in determining outcomes. We analyzed data from Project STRIDE, a longitudinal survey involving a diverse sample of gay and bisexual adult men (n = 198). Using structural equation modeling, we tested hypothesized direct and indirect effects of race/ethnicity, SES, and three psychosocial mediational variables (collective self-efficacy, everyday discrimination, internalized homophobia) on two outcome variables-psychological and social well-being-assessed at 1-year follow-up. Our model indicated that: (1) race/ethnicity and SES were significantly associated with each other and with each psychosocial mediator; (2) higher SES was directly and indirectly associated with both measures of well-being; and (3) collective self-esteem and everyday discrimination mediated the association between SES and both measures of well-being. The model also indicated that racial/ethnic associations with psychological mediators and outcomes are evident in the context of SES, but these effects might be suppressed when the model does not consider SES. Findings highlight the critical role of SES and race/ethnicity in determining the psychological and social well-being of sexual minority men. Specification of mediating variables-collective self-efficacy, everyday discrimination, internalized homophobia-indicates potential intervention targets to improve psychological and social health in sexual minority men. Associations between race/ethnicity and SES support the need for intersectional frameworks in addressing the health of sexual minority men.
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Affiliation(s)
- Rainier Masa
- School of Social Work, University of North Carolina, Chapel Hill, NC, USA
| | - Sylvia Shangani
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA
| | - Don Operario
- School of Public Health, Brown University, Providence, RI, USA
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McCabe SE, West BT, Matthews AK, Evans-Polce R, Lee JG, Hughes TL, Veliz P, McCabe V, Boyd CJ. Sexual Orientation, Tobacco Use, and Tobacco Cessation Treatment-Seeking: Results From a National U.S. Survey. Behav Med 2021; 47:120-130. [PMID: 32703084 PMCID: PMC7854762 DOI: 10.1080/08964289.2019.1676191] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Despite higher rates of tobacco use and smoking-related diseases among sexual minorities, tobacco cessation treatment-seeking behaviors (e.g., medication, nicotine replacement products) remain poorly understood across sexual orientation subgroups. This study examines tobacco cessation treatment-seeking behaviors associated with Diagnostic and Statistical Manual of Mental Disorders, 5th Edition tobacco use disorder (TUD) across the three major sexual orientation dimensions (identity, attraction, behavior) in U.S. adults. Prevalence estimates reflect data collected from a 2012-2013 national sample of adults 18 years and older. More than three-fourths of U.S. adults with TUD had never engaged in tobacco cessation treatment-seeking behaviors, regardless of sexual orientation. Despite having the highest rates of TUD, bisexual men and women had some of the lowest rates of tobacco cessation treatment-seeking. Men who identified as gay, reported same-sex attraction, or reported same-sex behaviors had the highest rates of tobacco cessation treatment-seeking. In contrast, women with same-sex attraction or same-sex behavior had higher rates of TUD but were less likely to engage in tobacco cessation treatment-seeking behaviors than women with only other-sex attraction or other-sex behavior, respectively. Heterosexual women were more likely to engage in tobacco cessation treatment-seeking than heterosexual men; this sex difference was not present for sexual minorities. Medications and nicotine replacement therapy products were the most prevalent forms of treatment-seeking. There were notable differences in tobacco cessation treatment-seeking behaviors based on sex and sexual orientation. Findings highlight the underutilization of tobacco cessation treatment-seeking among all U.S. adults and point to important factors to consider when working with sexual minorities who are trying to reduce or stop using tobacco.
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Affiliation(s)
- Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan,Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan,Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Brady T. West
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Alicia K. Matthews
- College of Nursing, Department of Health Systems Science, University of Illinois at Chicago, Chicago, Illinois
| | - Rebecca Evans-Polce
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Joseph G.L. Lee
- Department of Health Education and Promotion, College of Health and Human Performance, and Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Tonda L. Hughes
- School of Nursing and Department of Psychiatry, Columbia University, New York, New York
| | - Phil Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan,Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Vita McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan,St. Joseph Mercy Ann Arbor, St. Joseph Mercy Health System, Ypsilanti, Michigan
| | - Carol J. Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan,Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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25
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Veldhuis CB, Hughes TL, Drabble L, Wilsnack S, Matthews A. Do relationships provide the same levels of protection against heavy drinking for lesbian and bisexual women? An intersectional approach. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2020; 7:337-352. [PMID: 34485591 PMCID: PMC8411928 DOI: 10.1037/sgd0000383] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Sexual minority women (SMW; e.g., lesbian, bisexual) are more likely than heterosexual women to be heavy drinkers, with bisexual women showing the highest risk. There is ample literature demonstrating that intimate relationships protect against stress-related health risk behaviors in the general population. However, very little research has focused on SMW's relationships and far less is known about the relationships of SMW of color. Using intersectionality theory as our framework, we tested two competing models to determine whether the effects of minority sexual identity (lesbian, bisexual) and race/ethnicity (African American, Latinx, White) are: 1) additive, or 2) multiplicative in the associations between relationship status and heavy drinking. METHODS Data are from a diverse sample of cisgender sexual minority women (N = 641) interviewed in Wave 3 of the CHLEW study, a 20-year longitudinal study of SMW's health. RESULTS Findings from two- and three-way interactions provide mixed evidence for both the additive and multiplicative hypotheses; support for each varied by sexual identity and race/ethnicity. Overall, we found that Latinx SMW, particularly single and bisexual Latinx SMW report the highest rates of heavy drinking compared to their cohabiting and lesbian counterparts, respectively. African American single SMW reported significantly higher rates of heavy drinking compared to their cohabiting counterparts. CONCLUSION Our findings suggest that the protective qualities of SMW's intimate relationships vary based on sexual identity and race/ethnicity-and the intersections between them. These results highlight that research among SMW that does not take into account multiple marginalized identities may obscure differences. PUBLIC SIGNIFICANCE Little research has focused on health within sexual minority women's relationships, particularly among sexual minority women of color. Given the potential additive or multiplicative effects of multiple sources of oppression such as heterosexism, racism, and sexism, understanding the potential protective effects of relationships is important. Our findings demonstrate that the protective qualities of intimate relationships among SMW vary based on sexual identity and race/ethnicity - and the intersections between them.
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Affiliation(s)
| | - Tonda L Hughes
- School of Nursing, Columbia University
- College of Nursing, University of Illinois at Chicago
| | | | - Sharon Wilsnack
- School of Medicine & Health Sciences, University of North Dakota
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26
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Covariates of hazardous alcohol use among sexual and gender minorities in Texas: Identifying the most vulnerable. Addict Behav 2020; 105:106327. [PMID: 32044679 DOI: 10.1016/j.addbeh.2020.106327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Information is limited on the prevalence of hazardous drinking and associated covariates among sexual and gender minority (SGM) persons. These analyses estimated the prevalence of hazardous drinking and identified associated covariates. METHODS A total of 1273 SGM adolescents and adults living in Texas completed an online survey between March 2016 and January 2017. Variables associated with hazardous drinking at the bivariate-level (p < 0.10) were entered into multiple logistic regression models to estimate the strength of their association. RESULTS More than a third (39.1%) of participants meet criteria for hazardous drinking. Compared to non-hazardous drinkers, hazardous drinkers were younger (x- = 20.7 [SD = 8.9] vs. x- = 26.5 [SD = 13.8]) and more likely to be Hispanic (41.5% vs. 26.2%). Hazardous drinkers were more likely to report using substances in past 12 months, including opioids (15.3% vs. 6.7%), stimulants (26.3% vs. 12.7%), and marijuana (37.6% vs. 21.2%). More hazardous drinkers reported injecting drugs (12.3% vs. 5.8%) and having a history of incarceration (14.1% vs. 7.3%). They were less likely to be diagnosed with depression (50.2% vs. 56.5%). When entered into a multivariate logistic regression model, hazardous drinkers were more likely to be younger (aOR = 0.97 [0.95, 0.98]), Hispanic (aOR = 1.5 [1.2, 2.0]), have a history of incarceration (aOR = 2.4 [1.5, 3.6]), and use a substance, not including marijuana (aOR = 1.7 [1.3, 2.3]). They were less likely to be diagnosed with depression (aOR = 0.73 [0.6, 0.9]). CONCLUSIONS Our findings highlight the intersection of race and ethnicity, mental health, criminal justice involvement, and substance use and the need for tailored interventions that address underlying determinants.
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27
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Hughes TL, Veldhuis CB, Drabble LA, Wilsnack SC. Research on alcohol and other drug (AOD) use among sexual minority women: A global scoping review. PLoS One 2020; 15:e0229869. [PMID: 32187200 PMCID: PMC7080264 DOI: 10.1371/journal.pone.0229869] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 02/15/2020] [Indexed: 12/31/2022] Open
Abstract
Until the 1980s, the limited research on alcohol and other drug (AOD) use among sexual minority women (SMW) focused on alcohol and used samples recruited from gay bars, resulting in inflated estimates of hazardous drinking. Over the past several decades the number of AOD studies with SMW has increased dramatically. To characterize this literature, we conducted a scoping review to answer the following questions: What do we know, and what are the gaps in research about AOD use among SMW? We searched multiple electronic databases (Medline [PubMed], CINAHL, PsycInfo, and Web of Science) for peer-reviewed research articles about AOD use among adult SMW published between January 1, 2000 and May 31, 2017. After duplicates were removed the search identified 4,204 articles. We reviewed the titles and abstracts and removed articles that did not meet inclusion criteria. We used full-text review of the remaining 229 articles to make a final determination regarding inclusion and we retained 181 articles for review. Although the quantity of AOD research with SMW has grown substantially, the great majority of studies have been conducted in the United States (US) and most focus on hazardous drinking; relatively little research has focused on other drugs. In addition, although there has been marked improvement in theories and methods used in this research, many gaps and limitations remain. Examples are the lack of longitudinal research; reliance on samples that tend to over-represent white, well-educated, and relatively young women; sparse attention to mechanisms underlying the disproportionately high rates of AOD use among SMW; and the absence of intervention research. In general, more high-quality research on SMW's use of AODs is needed, but gaps and limitations are particularly large in non-western countries. Addressing these research gaps and limitations is essential for providing information that can be used to develop more effective prevention and early intervention strategies, as well as for informing policies that can help to reduce risky drinking and drug misuse among SMW.
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Affiliation(s)
- Tonda L. Hughes
- School of Nursing, Columbia University, New York, New York, United States of America
| | - Cindy B. Veldhuis
- School of Nursing, Columbia University, New York, New York, United States of America
| | - Laurie A. Drabble
- San Jose State University, San Jose, California, United States of America
| | - Sharon C. Wilsnack
- University of North Dakota, Grand Forks, North Dakota, United States of America
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28
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Cerezo A, Cummings M, Holmes M, Williams C. Identity as Resistance: Identity Formation at the Intersection of Race, Gender Identity, and Sexual Orientation. PSYCHOLOGY OF WOMEN QUARTERLY 2020; 44:67-83. [PMID: 32194296 PMCID: PMC7081969 DOI: 10.1177/0361684319875977] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although the concept of intersectionality has gained widespread attention in psychological research, there remains a significant gap related to the impact of intersectionality on identity formation for persons negotiating multiple minority statuses. This gap is especially pronounced among sexual and gender expansive women of Latinx and African American descent-two groups that face disparate personal and public health risks but are largely ignored in the research literature. In response to this gap, we carried out a qualitative study using constructivist grounded theory with 20 Latinx and African American sexual minority, gender expansive women to understand participants' experiences of forming an intersectional social identity. Following an exploration of identity formation related to the specific domains of race, gender identity, and sexual orientation, we prompted participants to consider how each of the specified identity domains impacted the formation and experience of an overall intersectional identity (e.g., how racial position impacted gender identity and/or sexual identity formation). Findings revealed four major themes that were critical in identity formation: (a) family and cultural expectations, (b) freedom to explore identity, (c) the constant negotiation of insider/outsider status, and (d) identity integration as an act of resistance. Implications for future research and psychological services are discussed.
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29
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Cerezo A, Williams C, Cummings M, Ching D, Holmes M. Minority Stress and Drinking: Connecting Race, Gender Identity and Sexual Orientation. COUNSELING PSYCHOLOGIST 2019. [DOI: 10.1177/0011000019887493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We carried out a constructivist grounded theory-based qualitative exploration on the relations between intersectional minority stress and drinking among a community sample of 20 Latinx and African American sexual minority, gender expansive women. Our overarching goal was to illuminate the nuanced ways in which participants’ lived experiences; in relation to race and ethnicity, gender identity, and sexual orientation, intersected to create complex forms of minority stress rarely captured in the research literature. Semi-structured interviews and lifeline methodology were employed to assess participants’ major life stressors and drinking history; particularly, when and how drinking became a regular part of participants’ lives. Our findings indicated that drinking was primarily connected to same-sex romantic partnerships, cultural and familial ties to alcohol, social norms within queer spaces, familial rejection and loss of racial and ethnic community, and chronic stress. Recommendations for research, practice, advocacy, education, and training are discussed.
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Affiliation(s)
| | | | | | - Derek Ching
- San Francisco State University, San Francisco, CA, USA
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30
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Lewis RJ, Ehlke SJ, Shappie AT, Braitman AL, Heron KE. Health Disparities Among Exclusively Lesbian, Mostly Lesbian, and Bisexual Young Women. LGBT Health 2019; 6:400-408. [PMID: 31738644 DOI: 10.1089/lgbt.2019.0055] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Health disparities have been identified between groups of diverse young sexual minority women (SMW) and heterosexual women. This approach may generate sufficient group sizes for statistical analyses but obscures important differences. Moreover, some young women may not identify as "lesbian" or "bisexual" but somewhere in between. This study examined health and sexual minority identity-specific outcomes among three groups of SMW-women who identify as "exclusively lesbian," "mostly lesbian," and "bisexual." Methods: Participants were 990 young (18-30 years old) SMW (exclusively lesbian: n = 305, mostly lesbian: n = 133, bisexual: n = 552) who completed an online survey, including information about mental and physical health symptoms, hazardous drinking, and identity uncertainty. Those who reported alcohol use in the past 30 days responded to questions about their alcohol use and alcohol-related negative consequences. Results: Controlling for demographic differences, health outcomes varied significantly by identity. Mostly lesbian and bisexual women reported the most depression, anxiety, and physical health symptoms; mostly lesbian women reported the highest levels of hazardous drinking. Among those who reported drinking, mostly lesbian women drank the most frequently and reported the most alcohol-related consequences. Mostly lesbian women reported the most identity uncertainty. Conclusion: Mostly lesbian women were similar to bisexual women on several health outcomes. They appear unique, however, in drinking behavior and identity uncertainty. Collapsing across identities in health research may affect outcomes.
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Affiliation(s)
- Robin J Lewis
- Department of Psychology, Old Dominion University, Norfolk, Virginia.,Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia
| | - Sarah J Ehlke
- Department of Psychology, Old Dominion University, Norfolk, Virginia
| | | | - Abby L Braitman
- Department of Psychology, Old Dominion University, Norfolk, Virginia.,Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia
| | - Kristin E Heron
- Department of Psychology, Old Dominion University, Norfolk, Virginia.,Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia
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31
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Soinio JII, Paavilainen E, Kylmä JPO. Lesbian and bisexual women’s experiences of health care: “Do not say, ‘husband’, say, ‘spouse’”. J Clin Nurs 2019; 29:94-106. [DOI: 10.1111/jocn.15062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 08/13/2019] [Accepted: 09/03/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Eija Paavilainen
- Faculty of Social Sciences Nursing Science Tampere University Tampere Finland
- South Ostrobothnia Hospital District Seinäjoki Finland
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32
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Abstract
Sexual minority women are more likely to delay care, less likely to have a usual place of care, and more likely to exhibit higher risk behaviors such as smoking, obesity, heavy drinking resulting in a disproportionate number of chronic conditions. It is imperative for obstetrician-gynecologists to be at the forefront of providing comprehensive health care to all women, no matter their sexual orientation. This article seeks to discuss health care disparities as well as health behaviors and outcomes in this population. In addition, it will review the appropriate recommendations for clinical care of sexual minority women for the obstetrician/gynecologist.
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33
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Everett BG, Kominiarek MA, Mollborn S, Adkins DE, Hughes TL. Sexual Orientation Disparities in Pregnancy and Infant Outcomes. Matern Child Health J 2019; 23:72-81. [PMID: 30019158 DOI: 10.1007/s10995-018-2595-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objectives Little is known about maternal and infant health among sexual minority women (SMW), despite the large body of research documenting their multiple preconception risk factors. This study used data from the 2006-2015 National Survey of Family Growth (NSFG) to investigate sexual orientation inequities in pregnancy and birth outcomes, including miscarriage, stillbirth, preterm birth, and birth weight. Methods Women reported 19,955 study eligible pregnancies and 15,996 singleton live births. Sexual orientation was measured using self-reported identity and histories of same-sex sexual experiences (heterosexual-WSM [women who only report sex with men]; heterosexual-WSW [women who report sex with women]; bisexual, and lesbian). Logistic regression models were used that adjusted for several maternal characteristics. Results Compared to heterosexual-WSM, heterosexual-WSW (OR 1.25, 95% CI 1.00-1.58) and bisexual and lesbian women (OR 1.77, 95% CI 1.34-2.35) were more likely to report miscarriage, and bisexual and lesbian women were more likely to report a pregnancy ending in stillbirth (OR 2.85, 95% CI 1.40-5.83). Lesbian women were more likely to report low birth weight infants (OR 2.64, 95% CI 1.38-5.07) and bisexual and lesbian women were more likely to report very preterm births (OR 1.84, 95% CI 1.11-3.04) compared to heterosexual-WSM. Conclusions for Practice This study documents significant sexual orientation inequities in pregnancy and birth outcomes. More research is needed to understand the mechanisms that underlie disparate outcomes and to develop interventions to improve sexual minority women's maternal and infant health.
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Affiliation(s)
- Bethany G Everett
- Department of Sociology, University of Utah, 380 S 1530 E, Rm 301, Salt Lake City, UT, 84112, USA.
| | - Michelle A Kominiarek
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stefanie Mollborn
- Institute of Behavioral Science and Department of Sociology, University of Colorado Boulder, Boulder, CO, USA
| | - Daniel E Adkins
- Department of Sociology, University of Utah, 380 S 1530 E, Rm 301, Salt Lake City, UT, 84112, USA.,Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Tonda L Hughes
- School of Nursing, Columbia University, New York, NY, USA
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Ritter A, Mellor R, Chalmers J, Sunderland M, Lancaster K. Key Considerations in Planning for Substance Use Treatment: Estimating Treatment Need and Demand. J Stud Alcohol Drugs Suppl 2019; Sup 18:22-30. [PMID: 30681945 PMCID: PMC6377022 DOI: 10.15288/jsads.2019.s18.22] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 02/07/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Estimates of the extent of treatment need (defined by the presence of a diagnosis for which there is an effective treatment available) and treatment demand (defined as treatment seeking) are essential parts of effective treatment planning, service provision, and treatment funding. This article reviews the existing literature on approaches to estimating need and demand and the use of models to inform such estimation, and then considers the implications for health planners. METHOD A thematic review of the literature was undertaken, with a focus on covering the key concepts and research methods that have been used to date. RESULTS Both need and demand are important estimates in planning for services but contain many difficulties in moving from the theory of measurement to the practicalities of establishing these figures. Furthermore, the simple quantum of need or demand is limited in its usefulness unless it is matched with consideration of different treatment types and their relative intensity, and/or explored as a function of geography and subpopulation. Modeling can assist with establishing more fine-tuned planning estimates, and is able to take into account both client severity and the various treatment types that might be available. CONCLUSIONS Moving from relatively simplistic estimates of need and demand for treatment, this review has shown that although such estimation can inform national or subnational treatment planning, more sophisticated models are required for alcohol and other drug treatment planning. These can help health planners to determine the appropriate amount and mix of treatments for substance use disorders.
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Affiliation(s)
- Alison Ritter
- Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW,
Australia
| | - Richard Mellor
- Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW,
Australia
| | - Jenny Chalmers
- Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW,
Australia
| | - Matthew Sunderland
- Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW,
Australia
| | - Kari Lancaster
- Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW,
Australia
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35
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Bostwick WB, Hughes TL, Steffen A, Veldhuis CB, Wilsnack SC. Depression and Victimization in a Community Sample of Bisexual and Lesbian Women: An Intersectional Approach. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:131-141. [PMID: 29968037 PMCID: PMC6314920 DOI: 10.1007/s10508-018-1247-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 05/02/2018] [Accepted: 05/26/2018] [Indexed: 05/06/2023]
Abstract
Mental health inequities among bisexual and lesbian women are well-documented. Compared to heterosexual women, both bisexual and lesbian women are more likely to report lifetime depressive disorders, with bisexual women often faring the worst on mental health outcomes. Risk factors for depression, such as victimization in childhood and adulthood, are also more prevalent among bisexual women. Less is known about the intersection of racial/ethnic and sexual minority identities, and how depression and victimization may differ across these multiple, co-occurring identities. Data were from Wave 3 of the Chicago Health and Life Experiences of Women study, an 18-year, community-based longitudinal study of sexual minority women's health. We constructed a six-category "intersection" variable based on sexual identity and race/ethnicity to examine group differences in lifetime depression and victimization. We tested childhood and adult victimization as moderators of lifetime depression (n = 600). A majority (58.2%) of the total sample met criteria for lifetime depression. When considering the intersection of race/ethnicity and sexual identity, Black bisexual and Black lesbian women had significantly lower odds of depression than White lesbian women, despite their higher reports of victimization. Latina bisexual and lesbian women did not differ from White lesbians on depression. Victimization did not moderate the association between the intersection variable and depression. More research is needed to better understand risk and protective factors for depression among racially/ethnically diverse sexual minority women (SWM). We highlight the need to deliberately oversample SWM of color to accomplish this goal.
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Affiliation(s)
- Wendy B. Bostwick
- Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, IL 60612;
| | | | - Alana Steffen
- Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, IL 60612;
| | | | - Sharon C. Wilsnack
- Department of Psychiatry and Behavioral Science, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND
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36
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Veldhuis CB, Hughes TL, Drabble L, Wilsnack SC, Riggle EDB, Rostosky SS. Relationship Status and Drinking-Related Outcomes in a Community Sample of Lesbian and Bisexual Women. JOURNAL OF SOCIAL AND PERSONAL RELATIONSHIPS 2019; 36:244-268. [PMID: 30581248 PMCID: PMC6298438 DOI: 10.1177/0265407517726183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Although marriage tends to be protective against hazardous drinking among women in the general population, few studies have compared drinking rates, levels, or problems based on relationship status among sexual minority women (SMW; lesbian, bisexual). We examined associations between relationship status (committed relationship/cohabiting; committed/not cohabiting; single) and past-year drinking outcomes using data from a diverse sample of 696 SMW interviewed in wave 3 of the 17-year longitudinal Chicago Health and Life Experiences of Women study. The mean age of SMW in the sample was 40.01 (SD = 14.15; range 18-82). A little more than one-third (37%) of the sample was white, 36% was African American, and 23% Latina; 4% reported another or multi- race/ethnicity. Compared to SMW in committed cohabiting relationships, single SMW were significantly more likely to be heavy drinkers. SMW in committed non-cohabiting relationships were more likely to report alcohol-related problem consequences, and both single SMW and those in committed non-cohabiting relationships were more likely to report one or more symptoms of potential alcohol dependence. Findings underscore the importance of exploring relationship factors that may influence drinking and drinking-related problems among SMW.
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Affiliation(s)
- Cindy B Veldhuis
- Center for Research on Women and Gender, University of Illinois at Chicago
- College of Nursing, University of Illinois at Chicago
- School of Nursing, Columbia University
| | - Tonda L Hughes
- Center for Research on Women and Gender, University of Illinois at Chicago
- College of Nursing, University of Illinois at Chicago
- School of Nursing, Columbia University
| | | | - Sharon C Wilsnack
- Department of Psychiatry and Behavioral Science, University of North Dakota
| | - Ellen D B Riggle
- Political Science and Gender and Women's Studies, University of Kentucky
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Health service use by same-sex attracted Australian women for alcohol and mental health issues: a cross-sectional study. BJGP Open 2018; 2:bjgpopen18X101565. [PMID: 30564720 PMCID: PMC6184099 DOI: 10.3399/bjgpopen18x101565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/20/2018] [Indexed: 12/05/2022] Open
Abstract
Background Same-sex attracted women (SSAW) have higher rates of alcohol and mental health problems than heterosexual women, but utilisation of and satisfaction with treatment is limited. Aim This study investigated the influences on health service use for alcohol and mental health problems among SSAW. Design & setting The Gelberg-Andersen behavioural model of health service utilisation was used to generate outcome variables. Method A convenience sample of 521 community-connected Australian SSAW completed an online survey. Health service use according to sexual identity was compared using χ2 analysis. Binary logistic regression examined associations between the independent variables with treatment utilisation. Results Reports of alcohol treatment were very low. Only 41.1% of participants with service need had utilised mental health and alcohol treatment. Bisexual women (adjusted odds ratio [AOR] = 2.76) and those with ‘other’ identities (AOR = 2.38) were more likely to use services than lesbian women. Enablers to service use were having a regular GP (AOR = 3.02); disclosure of sexuality to the GP (AOR = 2.42); lesbian, gay, bisexual and transgender (LGBT) community-connectedness (AOR = 1.11); and intimate partner violence ([IPV] AOR = 2.51). Social support was associated with a reduction in treatment use (AOR = 0.97). Significant access barriers included not feeling ready for help, and previous negative experiences related to sexual identity. Conclusion Disclosing sexual identity to a regular, trusted GP correlated with improved utilisation of alcohol and mental health treatment for SSAW. The benefits of seeking help for alcohol use, and of accessing LGBT-inclusive GPs to do so, should be promoted to SSAW.
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Ross LE, Salway T, Tarasoff LA, MacKay JM, Hawkins BW, Fehr CP. Prevalence of Depression and Anxiety Among Bisexual People Compared to Gay, Lesbian, and Heterosexual Individuals:A Systematic Review and Meta-Analysis. JOURNAL OF SEX RESEARCH 2018; 55:435-456. [PMID: 29099625 DOI: 10.1080/00224499.2017.1387755] [Citation(s) in RCA: 255] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Over the past decade, evidence has accumulated to suggest that bisexual people experience higher rates of poor mental health outcomes compared to both heterosexual and gay/lesbian individuals. However, no previous meta-analyses have been conducted to establish the magnitude of these disparities. To address this research gap, we conducted a systematic review and meta-analysis of studies that reported bisexual-specific data on standardized measures of depression or anxiety. Of the 1,074 full-text articles reviewed, 1,023 were ineligible, predominantly because they did not report separate data for bisexual people (n = 562 studies). Ultimately, 52 eligible studies could be pooled in the analysis. Results indicate that across both outcomes, there is a consistent pattern of lowest rates of depression and anxiety among heterosexual people, while bisexual people exhibit higher or equivalent rates in comparison to lesbian/gay people. On the basis of empirical and theoretical literature, we propose three interrelated contributors to these disparities: experiences of sexual orientation-based discrimination, bisexual invisibility/erasure, and lack of bisexual-affirmative support. Implications for interventions to improve the health and well-being of bisexual people are proposed.
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Affiliation(s)
- Lori E Ross
- a Dalla Lana School of Public Health , University of Toronto
- b Institute for Mental Health Policy Research , Centre for Addiction and Mental Health
| | - Travis Salway
- a Dalla Lana School of Public Health , University of Toronto
| | | | - Jenna M MacKay
- b Institute for Mental Health Policy Research , Centre for Addiction and Mental Health
| | - Blake W Hawkins
- c Interdisciplinary Studies Graduate Program , University of British Columbia
| | - Charles P Fehr
- a Dalla Lana School of Public Health , University of Toronto
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Drabble LA, Trocki KF, Korcha RA, Klinger JL, Veldhuis CB, Hughes TL. Comparing substance use and mental health outcomes among sexual minority and heterosexual women in probability and non-probability samples. Drug Alcohol Depend 2018; 185:285-292. [PMID: 29482053 PMCID: PMC5889720 DOI: 10.1016/j.drugalcdep.2017.12.036] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/24/2017] [Accepted: 12/28/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine similarities and differences in demographics and key substance use and mental health outcomes in a probability sample of heterosexual women and two samples of sexual minority women (SMW), one recruited using probability and the other using non-probability methods. METHODS Using data from four waves of the National Alcohol Survey (NAS; n = 315 SMW; 10,523 heterosexual women) and Wave 3 of the Chicago Health and Life Experiences of Women (CHLEW; n = 688 SMW) study, we examined hazardous drinking, drug use, tobacco use, depression, and help-seeking for alcohol or other drug problems. RESULTS Compared to SMW in the probability sample, SMW in the non-probability sample were older, more likely to be college educated, and more likely to be in a partnered relationship. Compared to heterosexuals, SMW in both the probability and non-probability samples had greater odds of past-year hazardous drinking, marijuana use, and other drug use. We found similar results for lifetime help-seeking for alcohol or drug problems, past week depression, and co-occurring hazardous drinking and depression. In comparisons with heterosexual women, the magnitude of difference for drug use was greater for the SMW non-probability sample; for tobacco use, the difference was greater for the SMW probability sample. CONCLUSION Given the difficulties recruiting probability samples of SMW, researchers will continue to use non-probability samples in the foreseeable future. Thus, understanding how findings may differ between probability and non-probability samples is critically important in advancing research on sexual-orientation-related health disparities.
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Affiliation(s)
- Laurie A. Drabble
- School of Social Work San José State University, One Washington Square, San José, CA 95192-0124
| | - Karen F. Trocki
- Alcohol Research Group, 6001 Shellmound St,, Suite 450, Emeryville CA 94608
| | - Rachael A. Korcha
- Alcohol Research Group, 6001 Shellmound St,, Suite 450, Emeryville CA 94608
| | - Jamie L. Klinger
- Alcohol Research Group, 6001 Shellmound St,, Suite 450, Emeryville CA 94608
| | - Cindy B. Veldhuis
- School of Nursing, Columbia University, 630 West 168th Street, Mail Box Code 6, New York, NY 10032
| | - Tonda L. Hughes
- School of Nursing, Columbia University, 630 West 168th Street, Mail Box Code 6, New York, NY 10032,Department of Psychiatry, Columbia University, 630 West 168th Street, Mail Box Code 6, New York, NY 10032
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Pennay A, McNair R, Hughes TL, Leonard W, Brown R, Lubman DI. Improving alcohol and mental health treatment for lesbian, bisexual and queer women: Identity matters. Aust N Z J Public Health 2017; 42:35-42. [PMID: 29235690 DOI: 10.1111/1753-6405.12739] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/01/2017] [Accepted: 09/01/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Lesbian, bisexual and queer (LBQ) women experience substantial unmet alcohol and mental health treatment needs. This paper explores the way in which sexual identity shapes experience, and needs, in relation to alcohol and mental health treatment, and presents key messages for improving treatment. METHODS Twenty-five in-depth interviews were undertaken with same-sex attracted Australian women, aged 19-71. Interview transcripts were analysed thematically. RESULTS Key messages offered by participants focused on language, disclosure and practitioner training. Variation in sexual identity did not alter treatment expectations or needs; however, we noted an important difference with respect to identity salience, with high LBQ identity salience linked with preference for disclosure and acknowledgement of sexual identity in treatment interactions, and low identity salience linked with a preference not to disclose and for sexual identity not to require acknowledgement in treatment. CONCLUSIONS Treatment providers may find it useful to gather information about the centrality of sexual identity to LBQ women as a means of overcoming treatment barriers related to heteronormative conventions and discrimination, language and disclosure. Implications for public health: Treatment providers should adopt more inclusive language, seek information about identity salience and the importance of sexual identity to the current treatment, and regularly pursue LBQ-related professional development upskilling.
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Affiliation(s)
- Amy Pennay
- Centre for Alcohol Policy Research, La Trobe University, Victoria
| | - Ruth McNair
- Department of General Practice, University of Melbourne, Victoria
| | - Tonda L Hughes
- School of Nursing and Department of Psychiatry, Columbia University, New York City, NY, US
| | | | - Rhonda Brown
- School of Nursing and Midwifery, Deakin University, Victoria
| | - Dan I Lubman
- Turning Point, Eastern Health, Victoria.,Eastern Health Clinical School, Monash University, Victoria
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Drabble L, Veldhuis CB, Riley BB, Rostosky S, Hughes TL. Relationship of Religiosity and Spirituality to Hazardous Drinking, Drug Use, and Depression Among Sexual Minority Women. JOURNAL OF HOMOSEXUALITY 2017; 65:1734-1757. [PMID: 28929909 PMCID: PMC5860995 DOI: 10.1080/00918369.2017.1383116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Using data from Wave 3 of the Chicago Health and Life Experiences of Women (CHLEW) study (N = 699), we explored whether religiosity and spirituality were associated with risk of hazardous drinking, drug use, and depression among sexual minority women (SMW; i.e., lesbian, bisexual) and possible differences by race/ethnicity. Participants were more likely to endorse spirituality than religiosity, and endorsement of each was highest among African American SMW. We found no protective effect of religiosity or spirituality for hazardous drinking or drug use. An association initially found between identifying as very spiritual and past-year depression disappeared when controlling for help-seeking. Among SMW with high religiosity, African American SMW were more likely than White SMW to report hazardous drinking. Latina SMW with higher spirituality were more likely than White SMW to report drug use. Results suggest that religiosity and spirituality affect subgroups differently, which should be considered in future research on resiliency among SMW.
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Affiliation(s)
- Laurie Drabble
- a School of Social Work, San José State University , San Jose , California , USA
| | - Cindy B Veldhuis
- b School of Nursing , Columbia University , New York , New York , USA
| | - Barth B Riley
- c Independent Research Consultant, Chicago, Illinois, USA
| | - Sharon Rostosky
- d Educational, School, & Counseling Psychology , University of Kentucky , Lexington , Kentucky , USA
| | - Tonda L Hughes
- e School of Nursing & Department of Psychiatry , Columbia University , New York , New York , USA
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