Responding to "Don't Say Gay" Laws in the US: Research Priorities and Considerations for Health Equity

The complex representation and contradicting results linking sexual orientation to allostatic load

This commentary discusses a publication by Katsuya Oi and Amanda M. Pollitt using the National Longitudinal Study of Adolescent to Adult Health to assess presumed sexual orientation effects on allostatic load, the 'wear and tear' of chronic stress. Their findings indicate that discordant heterosexual women-those whose sexual attractions or behaviors do not align with their heterosexual identity-experience notably higher allostatic load compared to other sub-groups. In contrast, women who identify as non-heterosexual did not exhibit significantly elevated allostatic load. Several theoretical problems, interpretative inadequacies, issues with terminology, and misrepresentation of the existing literature limit the full impact of this original work. In the spirit of collegial critique, the objective of this commentary is to offer potential resolutions and considerations for future research among sexually diverse as well as gender diverse populations.

Associations Between Policy and Health for Sexual and Gender Minority Youth in the United States: A Scoping Review

Strengthening policy research and its translation is essential to improving sexual and gender minority youth (SGMY) health. We conducted a scoping review of studies testing the relationship between policy and health for SGMY (aged 13-26) living in the United States to document the scope of research in this area and identify opportunities to advance research in SGMY health policy. Guided by the Population, Concept, and Context framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist, we searched seven databases for English peer-reviewed studies published between 2000 and 2023 that tested the association between individual or composite measures of policy and mental health, substance use, or sexual health for SGMY aged 26 or younger. Twenty-one studies met the inclusion criteria. Most were cross-sectional and heavily relied on Youth Risk Behavior Survey data. Eighteen studies observed significant associations between policy and health for SGMY; only two assessed this association specifically for transgender youth. SGMY health and policy scholarship would advance through improved sexual orientation and (in particular) gender identity data collection in national data sources, measurement guidance and design testing, a greater use of longitudinal and quasiexperimental methods, and assessment of proximal mechanisms and implementation strategies through which policies impact health.

Comparing Behavioral Health of Lesbian, Gay, Bisexual, Questioning, and Heterosexual Middle School Students

Purpose: Lesbian, gay, bisexual, and questioning (LGBQ) high schoolers experience high prevalence of poor behavioral health, but little is known about LGBQ middle schoolers. We sought to quantify behavioral health disparities of LGBQ middle school students. Methods: Using 2021 New Mexico Middle School Youth Risk and Resiliency Survey data (N = 12,400), we estimated the size of the LGBQ middle school population and calculated adjusted risk ratios to investigate behavioral health disparities between LGBQ and heterosexual youth. Results: A quarter of the sample identified as LGBQ. These youth reported significantly more suicidal behaviors and poorer mental health than heterosexual youth. LGBQ youth were more likely to use most substances compared with heterosexual youth. Conclusion: LGBQ middle school students demonstrated high prevalence of poor behavioral health. These findings show that disparities begin earlier than previously assumed and underscore that sociocultural landscapes for sexually diverse youth remain challenging.

Increasing STI and HIV Preventive Behaviors and Addressing Community-Prioritized Social Determinants of Health Among Young GBQMSM and Transgender Women of Color: Piloting a Bilingual Multilevel Intervention

BACKGROUND

Sexually transmitted infections (STIs) and HIV disproportionately affect young people; gay, bisexual, queer, and other men who have sex with men (GBQMSM); transgender women; and persons of color. Our community-based participatory research partnership developed and implemented Impact Triad, a bilingual multilevel intervention harnessing peer navigation and mHealth to increase STI/HIV preventive behaviors and address 4 community-prioritized social determinants of health-education, employment, social support, and discrimination-among young African American/Black and Latine GBQMSM and transgender women.

METHODS

Fifteen community-based peer navigators were trained to work within their social networks for 12 months. Each navigator engaged 5 social network members who completed baseline and immediate post-intervention assessments (retention rate, 97.3%). Regression modeling was used to assess changes in outcomes between baseline and follow-up.

RESULTS

Among 74 enrolled social network members, the average age was 27.8 years; 61% identified as African American/Black, 31% as Latine, and 8% as multiracial/multiethnic. The majority self-identified as cisgender men and 8% as transgender women; 78% identified as gay. About half reported monthly income below $1000.Compared with baseline, at follow-up, social network members increased: STI screening (P = 0.001), HIV testing (P = 0.001), condom use (P = 0.03), and preexposure prophylaxis use (P = 0.02). Knowledge of preexposure prophylaxis (P < 0.0001) and of community-based educational (P = 0.047), job-training (P = 0.002), and job-finding resources (P = 0.02) also increased. Social support increased (P < 0.0001) and perceived discrimination decreased (P < 0.01).

CONCLUSIONS

Pilot findings suggest that Impact Triad is promising in increasing STI/HIV protective behaviors and addressing social determinants of health among young GBQMSM and transgender women of color; further testing is warranted.

Mapping the Impact of Anti-LGBT Legislation on Graduate Surgical Education

BACKGROUND

LGBTQ medical students and surgery residents face myriad structural barriers. The American Civil Liberties Union (ACLU) reports 492 pieces of state-level legislation targeting Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) people in the past year. These bills including bans on medical care, "don't say gay" bills, exclusion from anti-discrimination protections, and more. These bills may limit where medical students pursue surgical training STUDY DESIGN: The Movement Advancement Project and the ACLU legislative databases were consulted to determine whether states (plus Puerto Rico and the District of Columbia) currently had or were actively considering anti-LGBTQ legislation. This information was then mapped against data from the 2023 National Residency Match Program. US News rankings of top surgical training programs were utilized as well.

RESULTS

There were 2803 general surgical training spots, of which 1597 (57%) were located in states which currently have anti-LGBTQ legislation in place. 245 (9%) of training spots are in states which do not have such legislation but are currently considering anti-LGBTQ legislation. Of the top 20 residency programs, 11 (55%) were in states with anti-LGBTQ legislation. In affiliated specialties, 50 (54%), 118 (57%), and 24 (49%) surgical training positions for integrated vascular, plastic, and thoracic surgery, respectively, are in states that currently have anti-LGBTQ legislation in place. In total, 63% of fellowship opportunities were in states with Anti-LGBTQ legislation in place CONCLUSION: A majority of graduate surgical education occurs in states with anti-LGBTQ legislation, potentially limiting residency options for people who value protection of LGBTQ rights.

The Relationship Between a Hospital's Magnet Status and LGBTQ+ Inclusivity in Policies and Practices in US Hospitals

LGBTQ+ individuals face discrimination in healthcare settings. Magnet hospitals have been associated with positive patient outcomes, yet it remains uncertain whether Magnet designation is associated with hospitals' LGBTQ+ inclusivity in policies and practices. This study examined 801 American hospitals across 47 states that participated in the Healthcare Equality Index (HEI) in 2021. Multilevel modeling was utilized to investigate the association between Magnet status and HEI scores, adjusting for hospital type and state-level covariates, including LGBTQ+ inclusiveness in laws, political climate, racial/ethnic minority population, and Medicaid expansion status. Among the 801 hospitals, 32.1% (257 hospitals) held Magnet status. Magnet hospitals demonstrated higher HEI scores compared to non-Magnet hospitals (γ = 2.13, p = 0.022), despite significant variations across states (intraclass correlation = 0.22). No significant cross-level interactions were found. Overall, Magnet designation is independently associated with improved LGBTQ+ inclusivity in hospitals regardless of the state in which the hospital is located. Policymakers and healthcare leaders should consider leveraging the Magnet Recognition Program as a benchmark for promoting LGBTQ+ inclusivity within hospitals. Additionally, all healthcare institutions should prioritize comprehensive evaluations and improvements to their policies and practices to ensure inclusivity for LGBTQ+ patients.

Reproductive Healthcare After Dobbs: Rethinking Obstetric Harm in the United States

The obstetric violence framework proposes that clinicians harm pregnant people through physical and psychological mistreatment and violations of autonomy. In this article, we analyze interviews with 54 obstetrician-gynecologists (OB-GYNs) practicing in US states with near-total abortion bans to show how similar harms may also be performed through actions of the state. Reframing obstetric harm to include the behind-the-scenes work of state legislators as a looming presence in the clinical encounter permits us to see OB-GYNs from a different vantage point, and to understand their role as experiencing - and not just perpetuating - obstetric harm.

A National Survey to Assess LGBTQ+ Curricular Needs in Pediatrics Residency Programs

OBJECTIVE

Despite incremental increases in lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) health education, there are no uniform training requirements in graduate medical education and the extent to which pediatrics residency programs incorporate LGBTQ+ curricula remains unknown. We aimed to assess the current state of LGBTQ+ health education in pediatrics residency programs.

METHODS

We surveyed all 202 Accreditation Council for Graduate Medical Education (ACGME)-accredited categorical pediatrics program directors (PDs) in the United States. PDs were contacted via the Association for Pediatrics Program Directors (APPD) listserv with a link to an anonymous electronic survey.

RESULTS

We had a 53.4% response rate (107/202) with representation from all regions, sizes, and settings. Only 7.5% of programs have robust LGBTQ+ curricula, but many (71%) offer some sessions. About half (54.2%) believe their residents are not at all or somewhat prepared to care for LGBTQ+ patients after training. Many PDs are not at all or somewhat confident their residents learn about gender affirming care (49.5%) or are aware of community resources for LGBTQ+ youth (54.2%). In 91% of programs, 0-25% of faculty educate trainees about LGBTQ+ health. The majority (74.8%) of PDs are very or moderately likely to implement a standardized LGBTQ+ health curriculum. The most prominent barriers were inadequate time (55.1%) and lack of faculty training (51.4%).

CONCLUSION

Many pediatrics programs have implemented some LGBTQ+ health education; however, PDs lack confidence in residents' abilities to independently care for LGBTQ+ youth after training. An accessible and standardized curriculum is not only needed but desired by programs.

Sexual Minority Identity and Risky Alcohol Use: the Moderating Role of Aggressive Behavior

Adolescent alcohol use has significant consequences for concurrent and longitudinal health and wellbeing, with sexual minority youth consistently reporting higher levels of alcohol use than their heterosexual peers. Understanding how individual-difference variables like aggressive behavior are associated with variability in sexual minority adolescents' higher levels of alcohol use offers novel theoretical insight into this vulnerability. The 81,509 participants were drawn from the Profiles of Student life: Attitudes and Behavior Study. They were ages 14-17 years (M = 15.38, SD = 1.09) and 50.1% were cisgender girls. For sexual identity, 88% were heterosexual, 5% were mostly heterosexual, were 4% bisexual, were 1% mostly gay or lesbian, and were 1% being gay or lesbian. Participants reported on alcohol use, aggressive behavior, and sexual identity. Gay/lesbian and mostly gay/lesbian adolescents who reported higher aggressive behavior had higher levels of alcohol use than their heterosexual peers who also reported higher aggressive behavior. The way in which aggressive behavior amplified the link between mostly gay/lesbian and gay/lesbian identities and alcohol use suggests the need for more research examining how this trait may heighten both exposure and reaction to minority stressors among some subgroups of sexual minority youth.

Gender-Sexuality Alliance Experiences and LGBTQ+ Inclusive School Policies and Practices Predict Youth's School Belonging

Gender-Sexuality Alliances (GSAs) and inclusive school policies and practices that affirm youth with minoritized sexual orientations or gender identities (e.g., lesbian, gay, bisexual, transgender, queer youth; LGBTQ+ youth) are two sources of support for LGBTQ+ youth that could promote school belonging. The current study tested a three-level multilevel model in which youth's GSA experiences and the degree to which their schools implemented LGBTQ+ inclusive policies and practices predicted their school belonging over a six-month period. Participants included 627 youth (87% LGBQ+ youth, 45% transgender or nonbinary youth, 48% youth of color) ages 11-22 (Mage = 15.13) in 51 GSAs. At the within-individual level, youth reported greater school belonging on occasions following months when they felt their peers and advisors were more responsive to their needs and when they had taken on more leadership in the GSA. At the between-individual level, youth who generally felt their peers were more responsive over the study period reported greater school belonging than others. At the between-GSA level, GSA members in schools that more thoroughly implemented LGBTQ+ inclusive policies and practices reported greater school belonging over the study period. These findings underscore the relevance of GSAs and inclusive policies and practices in establishing welcoming school environments.

Sexual identity differences in the association between psychological distress and cardiometabolic health among women: 2013-2018 National Health Interview Survey

Poor psychological health has been consistently documented for sexually minoritized women. However, little is known about the association between poor psychological health and physical health. This study examined associations between psychological distress and cardiometabolic health, including cardiovascular disease risk conditions (hypertension, high cholesterol, and diabetes) and diagnoses (stroke, coronary heart disease, myocardial infarction, and angina), by sexual identity among women. Data are from the 2013-2018 National Health Interview Survey and included 102,279 women, who were straight (n = 97,909), lesbian/gay (n = 1,424), bisexual (n = 1,235), something else (n = 360), did not know (n = 712), and refused to disclose (n = 639). Multivariable multinomial logistic regression models were fit to estimate associations between psychological distress (measured with Kessler-6) and cardiometabolic health (self-reported diagnosis) and to examine sexual-identity differences in these associations. Covariates included sociodemographic characteristics. Overall, severe psychological distress was associated with significantly higher odds of having a cardiometabolic health condition (OR = 2.66). These associations generally did not statistically significantly differ based on sexual identity. However, potential substantive differences in the magnitude of the association existed among lesbian/gay (OR = 4.00) compared to straight women (OR = 2.73). Moreover, women who identified as gay/lesbian, bisexual, "something else," or "I don't know" all reported significantly higher prevalence of severe psychological distress than straight women. Given the overall positive association between psychological distress and cardiometabolic health as well as the higher prevalence of severe psychological distress among sexual minority women, more work is needed to longitudinally examine the effects of psychological distress on health among sexually minoritized women. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Human Immunodeficiency Virus in the South: An Epidemic Within an Epidemic

The authors examine the HIV epidemic in the Southern United States, emphasizing its severe impact on minority and young populations. The authors highlight challenges including limited health care access, systemic racism influencing social determinants of health, and lesbian, gay, bisexual, transgender, and queer+ stigma. The South faces a critical human immunodeficiency virus (HIV) workforce shortage, especially in rural areas, and struggles with coexisting syndemics like other sexually transmitted infections and substance-use disorders. The authors describe comprehensive strategies such as Medicaid expansion, workforce enhancement, stigma reduction, and policy reforms to improve HIV prevention and treatment, emphasizing the need for a multifaceted approach to improve health outcomes for those living with HIV in the South.

Examining the relationship between proposed anti-LGBTQ+ legislation and LGBTQ+ college student mental health: findings from the Healthy Minds Study, 2021-2022

Objective: This study aimed to investigate the association between proposed anti-LGBTQ+ legislation and depressive symptoms among LGBTQ+ college students. Participants: Participants (N = 72,135) included LGBTQ+ college students (N = 21,466) from over 530 colleges and universities, including technical and community institutions, across the United States who took part in the Healthy Minds Study (HMS). Methods: Data on proposed anti-LGBTQ+ legislation introduced in 2021-2022 were collected from all 50 US states, categorized, and analyzed. Individual-level data for 2021-2022 were obtained from the HMS, and a multilevel analysis was conducted to assess the association between proposed anti-LGBTQ+ legislation and depressive symptoms while considering individual factors. Results: A significant positive association between proposed anti-LGBTQ+ legislation and increased depressive symptoms among LGBTQ+ college students was found. This association remained significant after controlling for individual-level stressors and identities, including a sense of belonging, campus environment perceptions, first-generation student status, and transgender or gender non-conforming identity (TGNC). Conclusions: The findings underscore the need for mental health support and inclusive policies for LGBTQ+ college students, particularly in regions where anti-LGBTQ+ legislation is proposed or enacted, to mitigate the potential negative impact of multiple factors on their mental well-being.

HIV Testing Deserts and Vulnerability Among Adolescents and Young Adults in Tampa Bay, Florida

PURPOSE

Human immunodeficiency virus (HIV) burden among Florida adolescents and young adults (AYA, aged 13-24 years), particularly in Tampa Bay, is among the highest in the nation. We sought to determine the association between zip code-level test site accessibility and AYA HIV burden, compare this association with adult (aged 25-44 years) HIV burden, and identify local AYA HIV testing deserts. We further aimed to identify the association between test site accessibility and population-level markers of social disadvantage.

METHODS

We geocoded HIV test sites and determined the percent surface area per zip code within 15-minute walking distance to ≥ 1 test sites (PSA15) in Pinellas and Hillsborough counties. We calculated Pearson's correlation coefficients for the association of PSA15 and HIV burden by age group and, separately, the association of PSA15 and population-level characteristics.

RESULTS

Of the 96 zip codes analyzed, 36.5% had a PSA15 for HIV testing of 0%. The association between PSA15 and HIV burden was substantially higher for adults (r = 0.51, p < .001) than for AYA (r = 0.09, p = .38). Overall, we identified four potential AYA testing deserts. We also found that greater PSA15 was correlated with greater %Black/African-American residents (r = 0.32, p = .002), greater %residents living in poverty (r = 0.27, p = .008), and lower child opportunity index scores (r = -0.29, p = .004).

DISCUSSION

Walking-accessible HIV test sites in Tampa Bay were limited and geographically distributed largely based on adult HIV burden, population-level markers of social disadvantage, and among areas with higher percentages of Black/African-American residents. Test site distribution was less correlated with AYA HIV burden, leaving this population vulnerable across multiple testing deserts.

Sexual and gender minority stress and clinical symptom severity in psychiatrically hospitalized adolescents

This study examined the role of lifetime and past 30-day experiences of sexual and gender minority (SGM) stress on clinical symptom severity in 286 psychiatrically hospitalized adolescents. Participants completed measures of clinical symptoms, and SGM adolescents (n = 176, 61.5 %) reported on minority stress experiences across three domains (i.e., negative expectancies, internalized homonegativity, homonegative climate). SGM adolescents reported greater clinical symptom severity than non-SGM adolescents. Most SGM adolescents (77.3%) reported lifetime minority stress exposure, endorsing an average of 3.3 stressors (SD = 2.9). Among those endorsing lifetime minority stress history, 76.1% reported past 30-day minority stress exposure. Lifetime and recent minority stress exposure were positively associated with clinical symptom severity. Findings support the importance of assessing SGM identities and minority stress experiences in psychiatric settings and supporting youth in coping with these experiences.

Differential Associations of Depressive Symptomology to HIV Care Engagement Among Young Black Sexual Minority Men with HIV (YBSMM+) in the US South: A Multi-Group Analysis of Mood, Intimate Partner Violence, and Alcohol Use

Young Black Sexual Minority Men with HIV (YBSMM+) in the US South encounter multiple socio-structural challenges that contribute to disproportionately poor HIV-related outcomes across the care continuum. Depression, anxiety, intimate partner violence (IPV), and alcohol use are prominent factors that negatively impact engagement with HIV care. Syndemic theory posits that these multiple factors interact synergistically to promote poor outcomes; however, depression itself is highly heterogeneous in presentation, which may pose issues when examining associations to HIV care engagement. This study sought to better understand the associations of specific depressive symptomology subtypes, generalized anxiety, experienced IPV, and alcohol use on HIV care engagement for YBSMM+. Results showed that interpersonally oriented depressive symptomatology was associated with increased HIV care engagement among YBSMM + who abstained from alcohol. On the other hand, among YBSMM + who frequently binge drank, combined negative affect and somatic components of depressive symptomatology and frequency of IPV experiences were associated with decreased HIV care engagement while generalized anxiety was associated with increased HIV care engagement. The findings suggest that the negative affect and somatic components of depression may be particularly salient for HIV care engagement among YBSMM + who binge drink frequently. Developing targeted interventions that address these specific conditions while accounting for the nuances of mood-based symptomatology could improve intervention efforts geared towards improving HIV care engagement among YBSMM+.

Elucidating Intimate Partner Violence Rate Disparities Between Same- and Opposite-Sex Couples: A Demographic Approach

Studies on intimate partner violence (IPV) rates typically find higher rates for same-sex couples than opposite-sex couples. Regardless of sexual orientation, the risk for IPV perpetration is concentrated among young adults. Given that the HIV/AIDS epidemic significantly lowered the life expectancy of sexual minority men and that recent social movements have encouraged more youths to "come out," population age differences may contribute to the observed differences in IPV rates between same- and opposite-sex couples. The present study applies direct age standardization and decomposition techniques to data from the National Incident-Based Reporting System and the American Community Survey to examine this possibility across 2,584 same-sex male, 4,029 same-sex female, and 284,614 opposite-sex physical IPV incidents. The results of the direct standardization procedures indicate physical IPV rates for same-sex male and same-sex female households would be 11.8% and 27.3% lower, respectively, if they had the same population age structure as opposite-sex households. The results of the decompositions indicate that differences in population age structure contribute 48% and 44% of the elevation in IPV rates in same-sex male and same-sex female households, respectively, compared to opposite-sex households. These findings demonstrate the promise of demographic methods to explain differences in offending rates between groups. These results suggest the need for prevention and intervention strategies aimed at youths. Future studies should be conducted with data on sexual orientation and gender identity to better elucidate the contribution of population age structure among various sexual and gender minority groups. Research comparing trends among sexual minority populations to the heterosexual population in particular should account for age where possible.

Preventing sexual violence in sexual orientation and gender diverse communities: A call to action

Background: Members of the lesbian, gay, bisexual, transgender, queer, and other sexual orientation and gender diverse (SOGD) communities are at disproportionately higher risk for sexual violence compared to cisgender heterosexual people. Despite this elevated risk, relatively few sexual violence prevention efforts effectively reduce these victimization disparities based on sexual orientation or gender identity.Objective: This narrative review provides an overview of the prevalence of sexual violence in the SOGD communities, delineates risk factors for sexual victimization among SOGD community members, and reviews and evaluates existing prevention efforts for the SOGD communities. We outline specific recommendations for ensuring that prevention efforts meet the needs of the SOGD communities.Method: Drawing on ecological systems theory and public health approaches to sexual violence prevention, we outline current approaches and opportunities for preventionists and scholars to push the field forward.Results: There have been promising prevention programmes designed to be implemented within SOGD communities specifically; however, it is important that general primary prevention programmes endeavour to specifically address sexual violence perpetrated against SOGD people. While many packaged programmes that endeavour to prevent sexual violence across all gender identities and sexual orientations are inclusive of SOGD participants, more programming is needed that integrates anti-oppression training to target social norms that perpetuate SOGD-specific rape myths and normalize sexual violence against SOGD community members.Conclusion: Ecological prevention strategies in line with a public health approach for primary prevention may be particularly valuable for reducing victimization disparities based on SOGD status and identity. Comprehensive sexual education and anti-discrimination policies should be considered front-line prevention programming. To assess if these strategies are effective, the implementation of large-scale surveillance surveys that use comprehensive assessments of sexual orientation, gender identity, and sexual violence are needed. Using theoretically grounded implementation strategies for prevention programmes can ensure effective programme delivery.

Governing with contagion: Pandemic politics, COVID-19, and undermining public health in Florida

The United States approached the COVID-19 pandemic with inconsistent responses that varied by state. In Florida, legislators passed laws contrary to mitigating the pandemic. These laws included banning county and municipal efforts to control the spread of COVID-19 through mask mandates, social distancing, and prohibiting vaccination mandates during infectious disease epidemics. Moreover, the Legislature simultaneously prioritized policies of social exclusion, passing bills that constrained the rights of transgender individuals, Black Lives Matter protestors, and educators. In this article, I use the perspectives of critical medical anthropology and "governing through contagion" to examine Florida's COVID-19 response. I argue the COVID-19 pandemic provided an opportunity for legislators to obfuscate their political power and advance a politics of social division while simultaneously passing policies that undermined human health. I refer to this process as governing with contagion: Using a pandemic as a politically expedient backdrop to conceal power and simultaneously harm human health.

Health equity: A concept analysis

BACKGROUND

Although health equity is critically important for healthcare delivery, there are inconsistencies in its definitions or lack of definitions.

PURPOSE

Develop a comprehensive understanding of health equity to guide nursing practice and healthcare policy.

METHOD

Walker and Avant's concept analysis method was used to establish defining attributes, antecedents, consequences, and empirical referents of health equity.

FINDINGS

Health equity defining attributes are grounded in ethical principles, the absence of unfair and avoidable differences, and fair and just opportunities to attain a person's full health potential. Health equity antecedents are categorized into environmental; financial or economic; law, politics, and policy; societal and structural; research; and digital and technology.

DISCUSSION

Health equity's antecedents are useful to distinguish health disparities from health outcomes resulting from individual preferences. To achieve health equity, organizations need to focus on addressing the antecedents.

Sexual minorities and substance use treatment utilization: New evidence from a national sample

INTRODUCTION

Minority stress theory suggests that sexual minorities would be, on average, less likely than heterosexual individuals to seek out substance use treatment (due to concerns of stigma and rejection). However, prior research on the subject is mixed, and largely dated. In light of historic increases in societal acceptance and legal protections for sexual minorities, the field needs an up-to-date assessment of treatment utilization among this population.

METHODS

This study used data from the 2015-2019 National Survey on Drug Use and Health to examine the association between key independent variables (sexual identity, gender) and substance use treatment utilization using binary logistic regression. We conducted analyses using a sample of adults with a past-year substance use disorder (N = 21,926).

RESULTS

Controlling for demographic factors, with heterosexual individuals as the comparison group, gay/lesbian individuals (AOR = 2.12, CI = 1.19-3.77) were significantly more likely and bisexual individuals (AOR = 0.49, CI = 0.24-1.00) significantly less likely to report treatment utilization. Bisexual individuals were also less likely than gay/lesbian individuals to report treatment utilization (AOR = 0.10, CI = 0.05-0.23). Interaction tests examining sexual orientation and gender showed no difference in treatment utilization between gay men and lesbian women, and revealed that bisexual identity was associated with decreased likelihood of treatment utilization for men (p = .004) but not for women.

CONCLUSION

Sexual orientation, particularly in the context of social identity, plays a significant role in substance use treatment utilization. Bisexual men face unique barriers to treatment, which is concerning given the high rates of substance use among this and other sexual minority populations.