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Connolly DJ, Eraslan E, Gilchrist G. Coronavirus (COVID-19) and sexualised drug use among men who have sex with men: a systematic review. Sex Health 2023; 20:375-384. [PMID: 37460309 DOI: 10.1071/sh23071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/27/2023] [Indexed: 10/12/2023]
Abstract
Drug-related harms, including harms from sexualised drug use (SDU), are disproportionately experienced by sexual and gender minority people, relative to their majority counterparts. Chemsex, a type of SDU practiced mainly by MSM, is associated with methamphetamine use and increased HIV seropositivity or risk of acquisition. Therefore, participants are at increased risk of immunocompromise. Existing evidence suggests that drug use increases following natural disasters. The impact of coronavirus disease 2019 (COVID-19) on chemsex is unknown. A PRISMA-adherent systematic review was conducted to synthesise reports of changes in the prevalence, frequency, or characteristics of drug use (and factors associated with these changes) following the onset of the COVID-19 pandemic. This report presents findings related to SDU/chemsex among MSM. A comprehensive search across nine databases, supplemented with backward-forward citation searching and contact with key opinion leaders, was conducted. Two reviewers carried out title-abstract screening, full-text screening, and data extraction. Following a final, single database search, nine studies were included in the narrative synthesis. More than half the sample were studies investigating HIV pre-exposure prophylaxis use. Twenty percent of participants in most studies reported chemsex participation. In four, participants reported a net increase or maintenance of chemsex participation during the pandemic and five reported a net decrease. Increased chemsex participation was associated with loneliness, cravings, and working during the pandemic. Decreased chemsex practice was associated with COVID-19-related fear. This synthesis suggests that chemsex practice continued, and for some MSM increased, throughout COVID-19 pandemic 'lockdowns'. This may have increased COVID-19 transmission and severity among potentially vulnerable MSM.
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Affiliation(s)
- Dean J Connolly
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Windsor Walk, London, UK
| | - Ece Eraslan
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Windsor Walk, London, UK
| | - Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Windsor Walk, London, UK
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Adams J, Asiasiga L, Neville S. The alcohol industry-A commercial determinant of poor health for Rainbow communities. Health Promot J Austr 2023; 34:903-909. [PMID: 36103136 DOI: 10.1002/hpja.665] [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: 06/08/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Alcohol use is an area of challenge for health promotion internationally. The alcohol industry operates as a key commercial determinant of health in that its actions contribute to alcohol misuse, resulting in a range of health and social harms to individuals, families and communities. Rainbow people (including those who identify as lesbian, gay, bisexual, transgender or gender diverse) are one group experiencing considerable harm from alcohol use. METHODS Data from 24 focus groups involving 131 people held in six cities in New Zealand during 2018, were used to explore local understandings of the ways in which the alcohol industry operates as a commercial determinant of health for Rainbow communities. The focus group discussions were analysed thematically. RESULTS Three key themes were identified. First, the alcohol industry was identified as present in the 'everyday', through targeted alcohol promotion to Rainbow people, and due to the centrality of bars to their social and cultural landscapes. Second, participants recognised the benefits of alcohol industry support for Rainbow communities. Last, an opposing view was articulated, with the alcohol industry and its commercial activities viewed negatively. CONCLUSIONS These findings highlight that alcohol as a commodity and the alcohol industry are successfully and firmly embedded within Rainbow communities. Overall, given alcohol is widely regarded in a positive way, this is likely to create difficulties for health promotion efforts to reduce alcohol related harm in these communities.
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Affiliation(s)
- Jeffery Adams
- SHORE & Whāriki Research Centre, Massey University, Auckland, New Zealand
| | - Lanuola Asiasiga
- SHORE & Whāriki Research Centre, Massey University, Auckland, New Zealand
| | - Stephen Neville
- Department of Nursing, Auckland University of Technology, Auckland, New Zealand
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Meads C, Zeeman L, Sherriff N, Aranda K. Prevalence of alcohol use amongst sexual and gender minority (LGBTQ+) communities in the UK: a systematic scoping review. Alcohol Alcohol 2023:7145918. [PMID: 37114766 DOI: 10.1093/alcalc/agad029] [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: 12/08/2022] [Revised: 03/20/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND globally, alcohol use rates vary by sexual orientation and gender identity (SOGI), but UK government statistics on alcohol use in the LGBTQ+ population are missing. AIM this systematic scoping review determined the prevalence of alcohol use amongst gender and sexual minority people in the UK. METHODS empirical UK studies from 2010 onwards reporting the prevalence of alcohol use in SOGI compared with heterosexual/cisgender people were included. Searches in MEDLINE, Embase, Web of Science, PsycINFO, CINAHL, Cochrane Library, Google Scholar, Google, charity websites and systematic reviews were conducted in October 2021, using SOGI, alcohol and prevalence terms. Citation checking was done by two authors, with disagreements resolved through discussion. Data extraction was done by one author (CM) and checked by another (LZ). Quality assessment was performed by study design, sample type and statistical analysis of results. A narrative synthesis was qualitatively combined with a tabular presentation of results. RESULTS database and website searches found 6607 potentially relevant citations, and 505 full texts were reviewed with 20 studies included, found in 21 publications and grey literature reports. Most were on sexual orientation, including 12 from large cohort studies. Harmful alcohol use is higher in LGBTQ+ people than heterosexual people in the UK, a result similar to that found in other countries. Qualitative data reflected alcohol's role as emotional support. Fewer asexual people drank alcohol compared with allosexual people, and there were no data available regarding intersex people. CONCLUSION funded cohort studies and service providers should routinely collect SOGI data. Standardized reporting of SOGI and alcohol use would improve comparability across studies.
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Affiliation(s)
- Catherine Meads
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, CB1 2LZ, UK
- Centre for Transforming Sexuality and Gender, University of Brighton, BN2 0JG, Brighton, UK
| | - Laetitia Zeeman
- Centre for Transforming Sexuality and Gender, University of Brighton, BN2 0JG, Brighton, UK
- School of Sport and Health Sciences, University of Brighton, Brighton, BN1 9PH, UK
| | - Nigel Sherriff
- Centre for Transforming Sexuality and Gender, University of Brighton, BN2 0JG, Brighton, UK
- School of Sport and Health Sciences, University of Brighton, Brighton, BN1 9PH, UK
| | - Kay Aranda
- Centre for Transforming Sexuality and Gender, University of Brighton, BN2 0JG, Brighton, UK
- School of Sport and Health Sciences, University of Brighton, Brighton, BN1 9PH, UK
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Dimova DED, O'Brien DR, Elliott PL, Frankis DJ, Emslie PC. Exploring the experiences of alcohol service use among LGBTQ+ people in Scotland: A qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103859. [PMID: 36166958 DOI: 10.1016/j.drugpo.2022.103859] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND People who identify as LGBTQ+ are more likely to drink excessively compared to heterosexual and cisgender people. Perceived barriers to accessing alcohol services may further increase the potential for alcohol related harm for LGBTQ+ people. This qualitative study explores the experiences of LGBTQ+ people who have used alcohol services, including peer support groups, in Scotland and their suggestions for how alcohol services could be improved. METHODS Participants were recruited using social media adverts, dating websites, organisations that work with LGBTQ+ clients and snowball sampling. Participants' (n = 14) experiences of alcohol services and peer support groups were explored through semi-structured interviews. Data were analysed using the Framework Approach and thematic analysis. RESULTS Many participants thought their drinking was closely associated with their LGBTQ+ identity, as a response to shame, stigma, or family rejection. Some service users had positive experiences of alcohol services. However, participants were rarely asked about their sexuality / gender identity and some reported a lack of discussion about how identity might impact drinking. There were common views across the sample that barriers experienced by others in the LGBTQ+ community were amplified for trans people. Service users recommended that services need to signal LGBTQ+ inclusivity and provide a safe space to discuss multiple issues (e.g., alcohol use, mental health, gender identity). Participants highlighted the importance of alcohol-free spaces in the LGBTQ+ communities. CONCLUSION The study has clear practice and policy implications. Alcohol services should provide a safe space for LGBTQ+ people and clearly indicate that. Service providers should be trained to discuss potential connections between LGBTQ+ identity and substance use. At a broader level, alcohol-free social spaces would help reduce alcohol-related harm in LGBTQ+ communities.
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Adams J, Asiasiga L, Neville S. Justifications for heavy alcohol use among gender and sexually diverse people. Glob Public Health 2021; 17:2018-2033. [PMID: 34369856 DOI: 10.1080/17441692.2021.1957492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A range of research reports that many gender and sexually diverse people drink alcohol at heavy levels. This study used 24 focus groups to explore shared understandings of alcohol use among gender and sexually diverse people living in New Zealand. An inductive, data-driven thematic analysis was employed to identify explanations for heavy drinking among gender and sexually diverse people. Three key explanations were articulated: alcohol is needed for socialising; drinking helps coping with stress; alcohol and drug treatment services are inadequate. These results demonstrate justifications for heavy drinking in certain contexts. This behaviour runs counter to public health approaches and messages that highlight low-risk levels of drinking or not drinking as desirable. Public health interventions should continue to address alcohol use at a whole population level but should be supplemented by policy and interventions that take into account the sociocultural contexts and structural conditions that encourage drinking among gender and sexually diverse people.
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Affiliation(s)
- Jeffery Adams
- SHORE & Whāriki Research Centre, Massey University, Auckland, New Zealand
| | - Lanuola Asiasiga
- SHORE & Whāriki Research Centre, Massey University, Auckland, New Zealand
| | - Stephen Neville
- Department of Nursing, Auckland University of Technology, Auckland, New Zealand
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Dimova ED, Elliott L, Frankis J, Drabble L, Wiencierz S, Emslie C. Alcohol interventions for LGBTQ+ adults: A systematic review. Drug Alcohol Rev 2021; 41:43-53. [PMID: 34333818 DOI: 10.1111/dar.13358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/10/2021] [Accepted: 06/27/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Gender and sexual minority populations are more likely to drink excessively compared to heterosexual and cisgender people. Existing reviews of alcohol interventions focus on specific subgroups within the lesbian, gay, bisexual, trans*, queer, questioning or otherwise gender or sexuality diverse (LGBTQ+) population and neither identify their theoretical basis nor examine how interventions are tailored to meet the needs of specific subgroups. METHODS This systematic review includes published studies reporting the effectiveness of interventions to reduce alcohol use in LGBTQ+ people. The review followed PRISMA guidelines. Quality was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. RESULTS The review includes 25 studies, with the earliest published in 2005. The majority (n = 20) focused on men who have sex with men; only two included sexual minority women and three included trans* people. Most studies were conducted in the USA (n = 21) and used a randomised design (n = 15). Five studies were assessed to be of strong quality, seven moderate and 13 weak. Interventions were mainly delivered face-to-face (n = 21). The most common approaches used to inform interventions were Motivational Interviewing (n = 8) and Cognitive Behavioural Therapy (n = 8). Nineteen studies reported a significant reduction in alcohol consumption. DISCUSSION AND CONCLUSIONS This review suggests that for interventions to be effective in reducing alcohol consumption in LGBTQ+ people, they need to be informed by theory and adapted for the target population. Alcohol interventions that focus on sexual minority women, trans* people and people with other gender identities are needed. The findings have implications for professionals who need to identify when gender and/or sexuality are peripheral or central to alcohol use.
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Wicki M, Marmet S, Studer J, Epaulard O, Gmel G. Curvilinear associations between sexual orientation and problematic substance use, behavioural addictions and mental health among young Swiss men. Addict Behav 2021; 112:106609. [PMID: 32861992 DOI: 10.1016/j.addbeh.2020.106609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/10/2020] [Accepted: 08/10/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS It is well documented that individuals with a minority sexual orientation face greater risks of problematic substance use (e.g. heavy episodic drinking, alcohol use disorder) and mental health problems. Far less is known about how that risk varies within this population and their risk of behavioural addictions. This study estimated the risks of problematic substance use, behavioural addiction and poor mental health across the spectrum of sexual orientation. SAMPLE AND METHOD A sample of young Swiss men (N = 5294; mean age = 25.5, SD = 1.25; representative of 21 of Switzerland's 26 cantons) completed a self-reporting questionnaire on sexual orientation (attraction, 5-point scale) and criterion variables: problematic substance use (e.g. alcohol, cigarettes, cannabis and other illegal drugs), behavioural addictions (gambling, gaming, cybersex, internet, smartphone, work, exercise) and indicators of mental health (e.g. depression, stress). Curvilinear associations between sexual orientation (heterosexual, mostly-heterosexual, bisexual, mostly-homosexual or homosexual individuals) and criterion variables were explored using fractional polynomial regressions. RESULTS Although there were differences across criterion variables, in general, the highest risks of problematic substance use, behavioural addictions and mental health problems were estimated for mostly-heterosexual, bisexual or mostly-homosexual men, followed by homosexual men, and with heterosexual men facing the lowest risk. DISCUSSION AND CONCLUSION Aggregating the spectrum of sexual orientations into two or three distinct groups blurs important internal group differences. Outcome-specific explanations beyond minority stress and biphobia are necessary to understand the pathways between sexual orientation and risky behaviours. Considering sexual orientation is important to provide targeted healthcare prevention and interventions.
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Prevalence and correlates of substance use among transgender adults: A systematic review. Addict Behav 2020; 111:106544. [PMID: 32717497 DOI: 10.1016/j.addbeh.2020.106544] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 06/23/2020] [Accepted: 07/05/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Minority stress theories suggest that high rates of discrimination experienced by transgender people are precipitants of substance use. This risk is likely exacerbated by an inadequate provision of trans-inclusive substance misuse services. However, the exclusion of transgender people from the general substance misuse literature makes it difficult to determine the extent to which transgender status influences substance use. A systematic review was undertaken to better understand the prevalence, patterns and correlates of substance use among this group. METHODS In accordance with the PRISMA guidance, a literature search was conducted to 29th May 2019 on PubMed, PsycINFO, Embase and Global Health databases. Primary quantitative studies, published in English, that reported the prevalence, patterns or correlates of substance use by transgender people were included, with no restriction on methodological design. RESULTS 653 unique records were identified, and 41 studies were included. Half the studies reported on both transgender men and transgender women and half transgender women only. There was high and excess prevalence of substance use among transgender compared with cisgender people, but insufficient evidence to estimate prevalence or quantify the risk for substance use. Correlates of substance use included transphobic discrimination or violence, unemployment and sex work, gender dysphoria, high visual gender non-conformity and intersectional sexual minority status. CONCLUSIONS The sparse findings lend support to the minority stress model. However, the overreliance of the literature on disproportionate investigation of transgender women with multiple intersectional disadvantages, means there are significant gaps regarding the wider transgender community. To ensure substance use treatment services are inclusive, gender identity should be recorded and targeted interventions available. Clinicians should be aware of the multiple, complex drivers of substance use and be prepared to ask about substance use and offer support. Given the high prevalence of trauma experienced by transgender people, trauma-informed psychosocial interventions may be useful in the management of problematic substance use in transgender adults.
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Cepeda A, Nowotny KM, Frankeberger J, Ramirez E, Rodriguez VE, Perdue T, Valdez A. Examination of multilevel domains of minority stress: Implications for drug use and mental and physical health among Latina women who have sex with women and men. PLoS One 2020; 15:e0230437. [PMID: 32214323 PMCID: PMC7098621 DOI: 10.1371/journal.pone.0230437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 03/01/2020] [Indexed: 11/19/2022] Open
Abstract
There has recently been growing attention and concern in the U.S. on the detrimental drug use and related health conditions impacting diverse sexual minority populations. While some evidence indicates that bisexual women are at increased risk of substance use, little attention has been given to disadvantaged and racial/ethnic minority bisexual women, who are particularly vulnerable to a complexity of stressors and risk. Using data from a 15-year longitudinal study in San Antonio, Texas, the current study examines drug use, incarceration histories, stressful life events, and infections among 206 young adult Mexican-American women who report engaging in sex with both men and women (WSWM) (n = 61) and those indicating having exclusively male sex partners (WSM) (n = 145). A bivariate analysis finds that WSWM experienced more frequent (p = 0.001) and longer total time incarcerated (p = 0.001), as well as exposure to more stressful life events (p = 0.003). WSWM also have higher rates of past 30 day injection drug use (p = 0.026) and related Hepatitis C Virus (HCV) infection (p = 0.001), as well as greater symptomatology associated with depression (p = 0.014), PTSD (p = 0.005), and suicidal ideation (p = 0.036). Findings indicate a significantly elevated risk profile for socio-economically marginalized WSWM. This knowledge is timely and central to policy discourse to develop interventions and health campaigns aimed at reducing and/or preventing further health disparities among this highly susceptible population of minority women.
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Affiliation(s)
- Alice Cepeda
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States of America
- * E-mail:
| | - Kathryn M. Nowotny
- Department of Sociology, University of Miami, Miami, FL, United States of America
| | - Jessica Frankeberger
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States America
| | - Esmeralda Ramirez
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States of America
| | - Victoria E. Rodriguez
- Department of Population Health and Disease Prevention, Program in Public Health, University of California, Irvine, Irvine, CA, United States America
| | - Tasha Perdue
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States of America
| | - Avelardo Valdez
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States of America
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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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Bauer C, Kaye SL, Brotto LA. Understanding Alcohol and Tobacco Consumption in Asexual Samples: A Mixed-Methods Approach. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:733-755. [PMID: 31863316 DOI: 10.1007/s10508-019-01570-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 06/10/2023]
Abstract
Existing research suggests significant differences in alcohol and tobacco consumption trends according to one's sexual orientation. However, asexual people have not yet been included in these comparisons. In this mixed-methods, two-part study, we sought to compare group differences in alcohol and tobacco consumption among sexual orientations, focusing on asexual people, sexual people, and those in the "gray" area between asexual and sexual (i.e., "gray-asexual"). Data for Study 1 came from four British studies: National Surveys of Sexual Attitude and Lifestyles I, II, and III in 1990, 2000, and 2010 (NATSAL I, II, III) and Towards Better Sexual Health (TBSH) in 2000. Sample sizes for each study by gender are: NATSAL I-M: 1923 F: 3511; NATSAL II-M: 4604 F: 6031; NATSAL III-M: 6122 F: 7966; TBSH-M: 347 F: 552. Notably, asexual and gray-asexual respondents were found to consume significantly less alcohol and were more likely to abstain from drinking alcohol altogether, compared to allosexual respondents. Differences in tobacco consumption were only statistically significant for asexual respondents in two of three studies that included tobacco consumption. Each of the four studies also found that asexual and gray-asexual respondents were more likely to be non-drinkers (40.0-77.8%, asexual and 28.1-50.1% gray-asexual, non-drinkers, respectively) than allosexual respondents (10.2-27.2%, non-drinkers). Interviews conducted in Study 2 identified somatic, social, and psychological experiences and motivations that may shed light on the reasons for lower drinking frequencies among asexual individuals. Variability in alcohol consumption levels among asexual, lesbian, gay, and bisexual respondents, and the general population raises new questions about the motivations for why people consume alcohol.
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Affiliation(s)
- Caroline Bauer
- Institute of Social and Economic Research and Policy, Columbia University, New York, NY, USA
| | - Sasha L Kaye
- Centre for Performance Science, Royal College of Music, London, England, UK
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.
- Department of Gynaecology, University of British Columbia, 2775 Laurel Street, 6th floor, Vancouver, BC, V5Z 1M9, Canada.
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Thitasan A, Aytar O, Annerbäck EM, Velandia M. Young people's health and risk behaviours in relation to their sexual orientation: A cross-sectional study of Thailand and Sweden. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 21:67-74. [PMID: 31395236 DOI: 10.1016/j.srhc.2019.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/13/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study examined the associations between sexual orientation of young people and their health and risk behaviours in Thailand and Sweden, and to explore similarities and differences between the countries. STUDY DESIGN A cross-sectional study using data from the Life and Health - Young surveys in Thailand and Sweden. Three different statistical analyses were used to examine the associations of the variables. RESULTS In total, 3869 students aged 16-18 years old were included: 1488 Thai students and 2381 Swedish students. Significantly more Thai (20%) than Swedish (9%) students identified themselves as bisexual, homosexual or unsure (p < .001). Bivariate analysis showed that, in Thailand, self-harm was more often reported by the homosexual, unsure, and bisexual groups than by the heterosexual group (p = .005). In Sweden, early sexual debut was more often reported by the unsure, bisexual, and homosexual groups than by the heterosexual group (p = .033). Multiple logistic regression analysis showed that homosexual and unsure sexual orientations were significantly associated with self-harm (p < .05) among Thai students. Unsure sexual orientation was significantly associated with early sexual debut (p = .04) among Swedish students. Multiple correspondence analysis indicated that sexual orientation was associated with health and risk behaviours, and varied by different subcategories of students' backgrounds such as country, sexual orientation, family structure and adult support. CONCLUSIONS Sexual minority young people reported more risk behaviours and poorer health than their heterosexual counterparts. The findings are useful for policy programmes on sexual and reproductive health and rights of young people.
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Affiliation(s)
- Anchalee Thitasan
- School of Health, Care and Social Welfare, Mälardalen University, Sweden; Boromarajonani, College of Nursing, Sunpasithiprasong, Thailand.
| | - Osman Aytar
- School of Health, Care and Social Welfare, Mälardalen University, P.O. Box 325, SE-631 05 Eskilstuna, Sweden.
| | - Eva-Maria Annerbäck
- Centre for Clinical Research, Uppsala University, Kungsgatan 41, S-63188 Eskilstuna, Sweden.
| | - Marianne Velandia
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, S-721 23 Västerås, Sweden.
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Caceres BA, Jackman KB, Ferrer L, Cato KD, Hughes TL. A scoping review of sexual minority women's health in Latin America and the Caribbean. Int J Nurs Stud 2019; 94:85-97. [PMID: 30947062 PMCID: PMC6570531 DOI: 10.1016/j.ijnurstu.2019.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 01/20/2019] [Accepted: 01/25/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Despite research documenting significant health disparities among sexual minority women (lesbian, bisexual, and other non-heterosexual women) in high-income countries, few studies of sexual minority women's health have been conducted in low- and middle-income countries. The purpose of this scoping review was to examine the empirical literature related to the health disparities and health needs of sexual minority women in Latin America and the Caribbean (LAC), and to identify research gaps and priorities. DESIGN A scoping review methodology was used. DATA SOURCES We conducted a comprehensive search of seven electronic databases. The search strategy combined keywords in three areas: sexual minority women, health, and LAC. English, Spanish, and Portuguese language studies published through 2017 in peer-reviewed journals were included. REVIEW METHODS A total 1471 articles were retrieved. An additional 5 articles were identified following descendancy search; 3 of these met inclusion criteria. After removal of duplicates and title and abstract screening, we screened the full text of 37 articles, of which 22 (representing 18 distinct studies) met inclusion criteria. At least two authors independently reviewed and abstracted data from all articles. RESULTS More than half of the studies were conducted in Brazil (n = 9) and Mexico (n = 5). Sexual health was the most studied health issue (n = 11). Sexual minority women were at elevated risk for sexually transmitted infections related to low use of barrier contraceptive methods during sexual encounters with men. Findings suggest that sexual minority women are generally distrustful of healthcare providers and view the healthcare system as heteronormative. Providers are believed to lack the knowledge and skills to provide culturally competent care to sexual minority women. Sexual minority women generally reported low levels of sexual health education and reluctance in seeking preventive screenings due to fear of mistreatment from healthcare providers. Sexual minority women also reported higher rates of poor mental health, disordered eating, and substance use (current tobacco and alcohol use) than heterosexual women. Gender-based violence was identified as a significant concern for sexual minority women in LAC. CONCLUSIONS Significant knowledge gaps regarding sexual minority women's health in LAC were identified. Additional investigation of understudied areas where health disparities have been observed in other global regions is needed. Future research should explore how the unique social stressors sexual minority women experience impact their health. Nurses and other healthcare providers in the region need training in providing culturally appropriate care for this population.
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Affiliation(s)
| | | | - Lilian Ferrer
- Director of International Affairs, School of Nursing, Pontificia Universidad Catolica de Chile, Chile
| | - Kenrick D Cato
- Columbia University School of Nursing, New York-Presbyterian Hospital, United States
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Stinchcombe A, Wilson K, Kortes-Miller K, Chambers L, Weaver B. Physical and mental health inequalities among aging lesbian, gay, and bisexual Canadians: cross-sectional results from the Canadian Longitudinal Study on Aging (CLSA). CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2018; 109:10.17269/s41997-018-0100-3. [PMID: 30003511 PMCID: PMC6964597 DOI: 10.17269/s41997-018-0100-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/07/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE International estimates suggest the presence of health inequalities among older sexual minorities (i.e., individuals who identify as lesbian, gay, or bisexual and are 65 years old or above). In this study, we investigated the presence of health inequalities among aging lesbian and bisexual females, as well as aging gay and bisexual males in Canada. METHODS We used baseline data from the Canadian Longitudinal Study on Aging (CLSA) Tracking and Comprehensive cohorts to cross-sectionally compare self-reported physical and mental health indicators by sex and sexual orientation. Within our analysis sample of 51,208 Canadians 45 years old and over, 2% (n = 1057) of respondents identified as lesbian, gay, or bisexual. RESULTS Compared to heterosexual female peers, lesbian and bisexual females had greater odds of heavy drinking (AOR = 1.8, 95% CI = 1.3-2.4) and being a former smoker (AOR = 1.5, 95% CI = 1.2-1.9). Gay and bisexual males had greater odds of reporting a diagnosis of cancer (AOR = 1.5, 95% CI = 1.0-1.9) and currently smoking (AOR = 1.5, 95% CI = 1.1-2.0), compared to heterosexual males. Female and male sexual minorities had greater odds of reporting mood disorders (including depression) and anxiety disorders relative to heterosexual peers of the same sex. CONCLUSION These findings highlight the importance of considering both sex and sexual orientation when developing approaches to support the physical and mental health of a diverse aging population in Canada.
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Affiliation(s)
- Arne Stinchcombe
- Faculty of Human Sciences, Saint Paul University, 223 Main St, Ottawa, Ontario, K1S 1C4, Canada.
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.
| | - Kimberley Wilson
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Katherine Kortes-Miller
- School of Social Work, Lakehead University, Thunder Bay, Ontario, Canada
- Centre for Education and Research on Aging & Health (CERAH), Lakehead University, Thunder Bay, Ontario, Canada
| | - Lori Chambers
- Department of Women's Studies, Lakehead University, Thunder Bay, Ontario, Canada
| | - Bruce Weaver
- Human Sciences Division, Northern Ontario School of Medicine (West Campus), Thunder Bay, Ontario, Canada
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Caceres BA, Brody AA, Halkitis PN, Dorsen C, Yu G, Chyun DA. Cardiovascular Disease Risk in Sexual Minority Women (18-59 Years Old): Findings from the National Health and Nutrition Examination Survey (2001-2012). Womens Health Issues 2018; 28:333-341. [PMID: 29661697 PMCID: PMC6063763 DOI: 10.1016/j.whi.2018.03.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 03/06/2018] [Accepted: 03/13/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Sexual minority women (lesbian and bisexual) experience significant stigma, which may increase their cardiovascular disease (CVD) risk. The purpose of this study was to examine the prevalence of modifiable risk factors for CVD (including mental distress, health behaviors, blood pressure, glycosylated hemoglobin, and total cholesterol) and CVD in sexual minority women compared with their heterosexual peers. MATERIALS AND METHODS A secondary analysis of the National Health and Nutrition Examination Survey (2001-2012) was conducted. Multiple imputation with chained equations was performed. Logistic regression models adjusted for relevant covariates were run. Self-report (medical history and medication use) and biomarkers for hypertension, diabetes, and high total cholesterol were examined. RESULTS The final analytic sample consisted of 7,503 that included 346 sexual minority women (4.6%). Sexual minority women were more likely to be younger, single, have a lower income, and lack health insurance. After covariate adjustment, sexual minority women exhibited excess CVD risk related to higher rates of frequent mental distress (adjusted odds ratio [AOR], 2.05; 95% confidence interval [CI], 1.45-2.88), current tobacco use (AOR, 2.11; 95% CI, 1.53-2.91), and binge drinking (AOR, 1.66; 95% CI, 1.17-2.34). Sexual minority women were more likely to be obese (AOR, 1.61; 95% CI, 1.23-2.33) and have glycosylated hemoglobin consistent with prediabetes (AOR, 1.56; 95% CI, 1.04-2.34). No differences were observed for other outcomes. CONCLUSIONS Sexual minority women demonstrated increased modifiable risk factors for CVD, but no difference in CVD diagnoses. Several emerging areas of research are highlighted, in particular, the need for CVD prevention efforts that target modifiable CVD risk in sexual minority women.
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Affiliation(s)
- Billy A Caceres
- Columbia School of Nursing, New York, New York; NYU Rory Meyers College of Nursing, New York, New York.
| | - Abraham A Brody
- Hartford Institute for Geriatric Nursing, New York, New York
| | - Perry N Halkitis
- Department of Biostatistics, Rutgers School of Public Health, Piscataway, New Jersey; Departments of Health Education and Behavioral Science, Rutgers University, Piscataway, New Jersey; Center for Health, Identity, Behavior & Prevention Studies, College of Global Public Health, New York University, New York, New York; Graduate School of Applied & Professional Psychology, Rutgers University, Piscataway, New Jersey
| | | | - Gary Yu
- NYU Rory Meyers College of Nursing, New York, New York
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Demant D, Hides L, Kavanagh DJ, White KM, Winstock AR, Ferris J. Differences in substance use between sexual orientations in a multi-country sample: findings from the Global Drug Survey 2015. J Public Health (Oxf) 2018; 39:532-541. [PMID: 27519959 DOI: 10.1093/pubmed/fdw069] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background This study examines substance use disparities among homosexual, bisexual and heterosexual adolescents and young adults from nine countries. Methods Data from 58 963 respondents (aged 16 and 35 years) to the 2015 'Global Drug Survey' were utilized. Rates of lifetime, last-year, last-month use and age of onset of 13 different substances were compared across sexual identity subgroups. Results Adolescents and young adults with a sexual minority identity generally reported higher rates of substance use and an earlier age of onset compared to their heterosexual counterparts. Differences in substance use were larger among female groups than male groups, and rates of substance use were generally higher among bisexuals than homosexuals of both genders. Conclusion Higher rates of substance use in bisexuals compared with homosexuals among both genders and larger differences between female groups highlight the importance of differentiating between sexual minority identities in substance use research, and in designing substance misuse interventions for people with a sexual minority identity.
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Affiliation(s)
- Daniel Demant
- School of Psychology and Counselling and Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Leanne Hides
- School of Psychology and Counselling and Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - David J Kavanagh
- School of Psychology and Counselling and Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Katherine M White
- School of Psychology and Counselling and Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | | | - Jason Ferris
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia.,ARC Centre for Excellence for Children and Families over the Life Course, Institute for Social Science Research, The University of Queensland, Brisbane, Australia
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Wilsnack RW, Kristjanson AF, Wilsnack SC, Bloomfield K, Grittner U, Crosby RD. The Harms That Drinkers Cause: Regional Variations Within Countries. INTERNATIONAL JOURNAL OF ALCOHOL AND DRUG RESEARCH 2018; 7:30-36. [PMID: 30740189 PMCID: PMC6366667 DOI: 10.7895/ijadr.254] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIMS Multinational studies of drinking and the harms it may cause typically treat countries as homogeneous. Neglecting variation within countries may lead to inaccurate conclusions about drinking behavior, and particularly about harms drinking causes for people other than the drinkers. This study is the first to examine whether drinkers' self-reported harms to others from drinking vary regionally within multiple countries. DESIGN SETTING AND PARTICIPANTS Analyses draw on survey data from 12,356 drinkers in 46 regions (governmental subunits) within 10 countries, collected as part of the GENACIS project (Wilsnack et al., 2009). MEASURES Drinkers reported on eight harms they may have caused others in the past 12 months because of their drinking. The likelihood of reporting one or more of these eight harms was evaluated by multilevel modeling (respondents nested within regions nested within countries), estimating random effects of country and region and fixed effects of gender, age, and regional prevalence of drinking. FINDINGS Reports of causing one or more drinking-related harms to others differed significantly by gender and age (but not by regional prevalence of drinking), but also differed significantly by regions within countries. CONCLUSIONS National and multinational evaluations of adverse effects of drinking on persons other than the drinkers should give more attention to how those effects may vary regionally within countries.
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Affiliation(s)
- Richard W Wilsnack
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
| | - Arlinda F Kristjanson
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
| | - Sharon C Wilsnack
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
| | - Kim Bloomfield
- Centre for Alcohol and Drug Research, Aarhus University, Copenhagen, Denmark
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ross D Crosby
- The Neuropsychiatric Research Institute, Fargo, North Dakota, USA
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Emslie C, Lennox J, Ireland L. The role of alcohol in identity construction among LGBT people: a qualitative study. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:1465-1479. [PMID: 28833252 DOI: 10.1111/1467-9566.12605] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Research suggests that alcohol use and misuse are higher among lesbian, gay and bisexual than heterosexual populations, yet the social context of drinking in sexual minority communities has rarely been examined. To explore lesbian, gay, bisexual and transgender (LGBT) people's relationship with alcohol, we conducted seven focus groups (N = 33) with pre-existing groups of friends and work colleagues (18 to 52 years) in Scotland, UK. We identified and analysed patterns in our data using thematic analysis. Respondents perceived heavy drinking as central to the commercial gay scene. Choice of drink and drinking vessel was an important part of identity construction. Respondents discussed the perception that gay men would drink alcopops and cocktails while lesbians would drink pints of beer. Even when stereotypes were dismissed as inaccurate, they were still thought to pressure people to drink 'appropriately'. Respondents who did not identify as male or female, and those who used drag, were particularly aware of their choice of drink as a means to express identity or to challenge people's preconceptions about gender. Researchers developing interventions to reduce alcohol-related harm in sexual minority populations need to take account of the central role of identity construction in LGBT drinking practices.
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Affiliation(s)
- Carol Emslie
- School of Health & Life Sciences, Glasgow Caledonian University, UK
| | - Jemma Lennox
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, UK. Formerly Glasgow Caledonian University
| | - Lana Ireland
- School of Health & Life Sciences, Glasgow Caledonian University, UK
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Shahab L, Brown J, Hagger-Johnson G, Michie S, Semlyen J, West R, Meads C. Sexual orientation identity and tobacco and hazardous alcohol use: findings from a cross-sectional English population survey. BMJ Open 2017; 7:e015058. [PMID: 29074508 PMCID: PMC5665254 DOI: 10.1136/bmjopen-2016-015058] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 06/09/2017] [Accepted: 06/30/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the association between tobacco and hazardous alcohol use and sexual orientation and whether such an association could be explained by other sociodemographic characteristics. DESIGN Cross-sectional household survey conducted in 2014-2016. SETTING England, UK. PARTICIPANTS Representative English population sample (pooled n=43 866). MAIN OUTCOMES Sexual orientation identity (lesbian/gay, bisexual, heterosexual, prefer-not-to-say); current tobacco and hazardous alcohol use (defined as Alcohol Use Disorders Identification Test Score ≥8). All outcomes were self-reported. RESULTS Due to interactions between sexual orientation and gender for substance use, analyses were stratified by gender. Tobacco use prevalence was significantly higher among lesbian/gay (women: 24.9%, 95% CI 19.2% to 32.6%; men: 25.9%, 95% CI 21.3% to 31.0%) and bisexual participants (women: 32.4%, 95% CI 25.9% to 39.6%; men: 30.7%, 95% CI 23.7% to 30.7%) and significantly lower for prefer-not-to-say participants in women (15.5%, 95% CI 13.5% to 17.8%) but not men (22.7%, 95% CI 20.3% to 25.3%) compared with heterosexual participants (women: 17.5%, 95% CI 17.0% to 18.0%; men: 20.4%, 95% CI 19.9% to 21.0%; p<0.001 for omnibus test). Similarly, hazardous alcohol use was significantly more prevalent for lesbian/gay (women: 19.0%, 95% CI 14.0% to 25.3%; men: 30.0%, 25.2%-35.3%) and bisexual participants (women: 24.4%, 95% CI 18.7% to 31.3%; men: 24.3%, 95% CI 17.9% to 32.1%) and lower for prefer-not-to-say participants (women: 4.1%, 95% CI 3.0% to 5.4%; men: 13.7%; 95% CI 11.8% to 16.0%) compared with heterosexuals (women: 8.3%, 95% CI 7.9% to 8.7%; men: 18.4%, 95% CI 17.9% to 18.9%; p<0.001 for omnibus test). However, after adjusting for sociodemographic confounders, tobacco use was similar across all sexual orientation groups among both women and men. By contrast, sexual orientation differences in hazardous alcohol use remained even after adjustment among women but not for bisexual and gay men. CONCLUSIONS In England, higher rates of tobacco use among sexual minority men and women appear to be attributable to other sociodemographic factors. Higher rates of hazardous alcohol use among sexual minority men may also be attributable to these factors, whereas this is not the case for sexual minority women.
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Affiliation(s)
- Lion Shahab
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Gareth Hagger-Johnson
- Administrative Data Research Centre for England (ADRC-E), Farr Institute, University College London, London, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Joanna Semlyen
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Catherine Meads
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Cambridge, UK
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Caceres BA, Brody A, Luscombe RE, Primiano JE, Marusca P, Sitts EM, Chyun D. A Systematic Review of Cardiovascular Disease in Sexual Minorities. Am J Public Health 2017; 107:e13-e21. [PMID: 28207331 PMCID: PMC5343694 DOI: 10.2105/ajph.2016.303630] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Mental health and HIV disparities are well documented among sexual minorities, but there is a dearth of research on other chronic conditions. Cardiovascular disease remains the leading cause of death worldwide. Although sexual minorities have high rates of several modifiable risk factors for cardiovascular disease (including stress, tobacco use, and alcohol consumption), there is a paucity of research in this area. OBJECTIVES In this systematic review, we synthesized and critiqued the existing evidence on cardiovascular disease among sexual minority adults. SEARCH METHODS We conducted a thorough literature search of 6 electronic databases for studies published between January 1985 and December 2015 that compared cardiovascular disease risk or prevalence between sexual minority and heterosexual adults. SELECTION CRITERIA We included peer-reviewed English-language studies that compared cardiovascular disease risk or diagnoses between sexual minority and heterosexual individuals older than 18 years. We excluded reviews, case studies, and gray literature. A total of 31 studies met inclusion criteria. DATA COLLECTION AND ANALYSIS At least 2 authors independently abstracted data from each study. We performed quality assessment of retrieved studies using the Crowe Critical Appraisal Tool. MAIN RESULTS Sexual minority women exhibited greater cardiovascular disease risk related to tobacco use, alcohol consumption, illicit drug use, poor mental health, and body mass index, whereas sexual minority men experienced excess risk related to tobacco use, illicit drug use, and poor mental health. We identified several limitations in the extant literature. The majority of included studies were cross-sectional analyses that used self-reported measures of cardiovascular disease. Even though we observed elevated cardiovascular disease risk, we found few differences in cardiovascular disease diagnoses (including hypertension, diabetes, and high cholesterol). Overall, 23 of the 26 studies that examined cardiovascular disease diagnoses used subjective measures. Only 7 studies used a combination of biomarkers and self-report measures to establish cardiovascular disease risk and diagnoses. AUTHORS' CONCLUSIONS Social conditions appear to exert a negative effect on cardiovascular disease risk among sexual minorities. Although we found few differences in cardiovascular disease diagnoses, we identified an elevated risk for cardiovascular disease in both sexual minority men and women. There is a need for research that incorporates subjective and objective measures of cardiovascular disease risk. Public Health Implications: Cardiovascular disease is a major health concern for clinicians, public health practitioners, and policymakers. This systematic review supports the need for culturally appropriate interventions that address cardiovascular disease risk in sexual minority adults.
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Affiliation(s)
- Billy A Caceres
- All the authors are with the Rory Meyers College of Nursing, New York University, New York, NY
| | - Abraham Brody
- All the authors are with the Rory Meyers College of Nursing, New York University, New York, NY
| | - Rachel E Luscombe
- All the authors are with the Rory Meyers College of Nursing, New York University, New York, NY
| | - Jillian E Primiano
- All the authors are with the Rory Meyers College of Nursing, New York University, New York, NY
| | - Peter Marusca
- All the authors are with the Rory Meyers College of Nursing, New York University, New York, NY
| | - Edward M Sitts
- All the authors are with the Rory Meyers College of Nursing, New York University, New York, NY
| | - Deborah Chyun
- All the authors are with the Rory Meyers College of Nursing, New York University, New York, NY
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Caceres BA, Brody A, Chyun D. Recommendations for cardiovascular disease research with lesbian, gay and bisexual adults. J Clin Nurs 2016; 25:3728-3742. [PMID: 27239792 PMCID: PMC5121075 DOI: 10.1111/jocn.13415] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2016] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES The purpose of this paper is to provide recommendations to strengthen cardiovascular disease research with lesbian, gay and bisexual adults, and highlight implications for practice. BACKGROUND Lesbian, gay and bisexual individuals face significant discrimination that negatively impacts their health. Health disparities research in lesbian, gay and bisexual adults have focused on mental health, sexually transmitted infections and substance use. Although cardiovascular disease is the leading cause of death and many lesbian, gay and bisexual adults report increased risk factors for cardiovascular disease, there has been limited research in this area. DESIGN This paper is a critical review. METHODS A literature search was conducted that compared cardiovascular disease risk and/or prevalence between lesbian, gay and bisexual and heterosexual adults. RESULTS Measures to assess cardiovascular disease risk factors and diagnoses varied widely across the 31 included studies. There was a lack of standardisation in definitions used for alcohol consumption, illicit drug use, mental health and self-rated physical health. Most studies that reported body mass index relied on participant self-report. Few studies included measures of physical activity and diet and those that did lacked standardisation. Only seven studies used laboratory data to establish diagnosis of cardiovascular disease. CONCLUSIONS This study is the first comprehensive review on this topic. In cardiovascular disease research with lesbian, gay and bisexual adults, there is a need for: (1) inclusion of stress as a risk factor for cardiovascular disease, (2) standardised measures, (3) objective measures for determining the presence of cardiovascular disease, (4) data from electronic health records to strengthen the study of cardiovascular disease in this population. RELEVANCE TO CLINICAL PRACTICE Strengthening cardiovascular disease research in lesbian, gay and bisexual adults is an important step in addressing health disparities in this population. Nurses and other healthcare professionals should assess sexual orientation in routine health assessments.
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Affiliation(s)
- Billy A Caceres
- New York University Rory Meyers College of Nursing, New York, NY, USA
| | - Abraham Brody
- New York University Rory Meyers College of Nursing, New York, NY, USA
| | - Deborah Chyun
- New York University Rory Meyers College of Nursing, New York, NY, USA
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Abstract
Many studies, reviews, and meta-analyses have reported elevated mental health problems for sexual minority (SM) individuals. This systematic review provides an update by including numerous recent studies, and explores whether SM individuals are at increased risk across selected mental health problems as per dimensions of sexual orientation (SO), genders, life-stages, geographic regions, and in higher quality studies. A systematic search in PubMed produced 199 studies appropriate for review. A clear majority of studies reported elevated risks for depression, anxiety, suicide attempts or suicides, and substance-related problems for SM men and women, as adolescents or adults from many geographic regions, and with varied SO dimensions (behaviour, attraction, identity), especially in more recent and higher quality studies. One notable exception is alcohol-related problems, where many studies reported zero or reversed effects, especially for SM men. All SM subgroups were at increased risk, but bisexual individuals were at highest risk in the majority of studies. Other subgroup and gender differences are more complex and are discussed. The review supports the long-standing mental health risk proposition for SM individuals, overall and as subgroups.
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Affiliation(s)
- Martin Plöderl
- a Department of Suicide Prevention , University Clinic of Psychiatry and Psychotherapy, University Institute of Clinical Psychology, Christian Doppler Clinic, Paracelsus Medical University , Salzburg , Austria
| | - Pierre Tremblay
- b Faculty of Social Work, University of Calgary , Calgary, Alberta , Canada
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Simonsen RK, Hald GM, Kristensen E, Giraldi A. Long-Term Follow-Up of Individuals Undergoing Sex-Reassignment Surgery: Somatic Morbidity and Cause of Death. Sex Med 2016; 4:e60-8. [PMID: 26944779 PMCID: PMC4822482 DOI: 10.1016/j.esxm.2016.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/07/2016] [Accepted: 01/13/2016] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Studies of mortality and somatic well-being after sex-reassignment surgery (SRS) of transsexual individuals are equivocal. Accordingly, the present study investigated mortality and somatic morbidity using a sample of transsexual individuals who comprised 98% (n = 104) of all surgically reassigned transsexual individuals in Denmark. AIMS To investigate somatic morbidity before and after SRS and cause of death and its relation to somatic morbidity after SRS in Danish individuals who underwent SRS from 1978 through 2010. METHODS Somatic morbidity and mortality in 104 sex-reassigned individuals were identified retrospectively by data from the Danish National Health Register and the Cause of Death Register. MAIN OUTCOME MEASURES Somatic morbidity and cause of death. RESULTS Overall, 19.2% of the sample were registered with somatic morbidity before SRS and 23.1% after SRS (P = not significant). In total, 8.6% had somatic morbidity before and after SRS. The most common diagnostic category was cardiovascular disease, affecting 18 individuals, 9 before and 14 after SRS, and 5 of those 14 who were affected after SRS had cardiovascular disease before and after SRS. Ten individuals died after SRS at an average age of 53.5 ± 7.9 years (male to female) and 53.5 ± 7.3 years (female to male). CONCLUSION Of 98% of all Danish transsexuals who officially underwent SRS from 1978 through 2010, one in three had somatic morbidity and approximately 1 in 10 had died. No significant differences in somatic morbidity or mortality were found between male-to-female and female-to-male individuals. Despite the young average age at death and the relatively larger number of individuals with somatic morbidity, the present study design does not allow for determination of casual relations between, for example, specific types of hormonal or surgical treatment received and somatic morbidity and mortality.
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Affiliation(s)
| | - Gert Martin Hald
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ellids Kristensen
- Sexological Clinic, Psychiatric Center Copenhagen, Copenhagen, Denmark
| | - Annamaria Giraldi
- Sexological Clinic, Psychiatric Center Copenhagen, Copenhagen, Denmark
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The Influence of Gender and Sexual Orientation on Alcohol Use and Alcohol-Related Problems: Toward a Global Perspective. Alcohol Res 2016; 38:121-32. [PMID: 27159819 PMCID: PMC4872607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Although there are wide differences in alcohol use patterns among countries, men are consistently more likely than women to be drinkers and to drink heavily. Studies of alcohol use among sexual minorities (SMs), however, reflect a more complex picture. Such research has found higher rates of alcohol use and alcohol-related problems among SM persons than among heterosexuals and greater differences between SM and heterosexual women than between SM and heterosexual men. A variety of factors may contribute to differences in alcohol use and alcohol-related problems between men and women and between SM and heterosexual people. An improved understanding of these factors is important to guide prevention and treatment efforts. Although there is a dearth of literature on use of alcohol by SMs in many parts of the world, especially lower- and middle-income countries, we attempt to review and integrate the sparse data that are available from these lower-resourced countries. The global perspective presented in this article is the first attempt to go beyond a general review of literature in the Western world to document the gender paradox in alcohol use among heterosexuals and SMs in diverse countries worldwide.
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Bos HMW, Boschloo L, Schoevers RA, Sandfort TGM. Depression and anxiety in patients with and without same-sex attraction: differences in clinical expression, lifestyle factors, and vulnerability indicators. Brain Behav 2015; 5:e00363. [PMID: 26445702 PMCID: PMC4589810 DOI: 10.1002/brb3.363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 05/08/2015] [Accepted: 06/07/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of this study was to compare clinical expressions (severity and loneliness), lifestyle factors (substance use), and vulnerability indicators (stressful childhood experiences) in patients with any same-sex attraction versus heterosexual patients diagnosed with depression and/or anxiety disorder. Little is known about this, even though it is now well documented that depression and anxiety are more prevalent among persons with same-sex attraction. METHOD Data, derived from the Netherlands Study of Depression and Anxiety (NESDA), allowed us to compare patients with a same-sex (n = 122) and an exclusively opposite-sex (n = 1658) attraction. Persons with same-sex attraction included persons who were attracted to both sexes. Data were collected by means of the Composite International Diagnostic Interview and paper-and pencil questionnaires. RESULTS Seven percent of the patients reported any same-sex orientation. Clinical expression of depression and anxiety did not differ in relation to sexual attraction. Regarding substance use, same-sex attracted women reported more drug use than heterosexual women (drug use: 16.2% vs. 6.6%, P = 0.003). Regarding stressful childhood experiences, men with any same-sex attraction reported more sexual abuse during childhood than men with a heterosexual orientation (20.4% vs. 8.5%, P = 0.005). CONCLUSIONS For women with same-sex attraction substance use (especially illicit drug use) might be a coping mechanism to deal with existing symptoms or with the minority stressors they have to deal with; for same-sex attracted men stressful childhood experiences might reflect an aspect of etiology.
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Affiliation(s)
- Henny M W Bos
- Faculty of Social and Behavioral Sciences, Research Institute of Child Development and Education Nieuwe Prinsengracht 130, 1018 VZ, Amsterdam, the Netherlands
| | - Lynn Boschloo
- Faculty of Medical Sciences, Academic Centre of Psychiatry, University of Groningen Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Robert A Schoevers
- Faculty of Medical Sciences, Academic Centre of Psychiatry, University of Groningen Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Theo G M Sandfort
- Division of Gender, Sexuality and Health, New York Psychiatric Institute and Department of Psychiatry, Columbia University 1051 Riverside Drive, Unit 15, New York, New York, 10032
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Lee JH, Gamarel KE, Kahler CW, Marshall BD, van den Berg JJ, Bryant K, Zaller ND, Operario D. Co-occurring psychiatric and drug use disorders among sexual minority men with lifetime alcohol use disorders. Drug Alcohol Depend 2015; 151:167-72. [PMID: 25913886 PMCID: PMC4447561 DOI: 10.1016/j.drugalcdep.2015.03.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 03/15/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Emerging evidence indicates multiple health risks associated with harmful alcohol use among sexual minority men in the United States. In particular, sexual minority men with alcohol use disorders (AUD) might have greater co-occurring health problems compared with heterosexual men. We used nationally representative data to compare the prevalence of diagnostic co-occurring psychiatric disorders and drug use disorders (DUD) among sexual minority men with AUD compared with heterosexual males with a lifetime AUD diagnosis. METHODS We analyzed data from 6899 adult males with AUD participating in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Using weighted multivariable logistic regression models, we compared the odds of lifetime diagnosis of mood disorders, anxiety disorders, and drug use disorders in sexual minority and heterosexual adult males with AUD. RESULTS Of participants included in this analysis, 176 (2.6%) self-identified as a sexual minority. In adjusted analyses, sexual minority men with AUD were more likely than heterosexual men with AUD to have any mood disorder (including major depressive episode), any anxiety disorder (including panic disorder without agoraphobia, specific phobia, posttraumatic stress disorder, and generalized anxiety disorder), and lifetime DUD. CONCLUSIONS The elevated co-occurrence of psychiatric disorders and DUD among sexual minority men with AUD suggests that future research is warranted. A better understanding of the etiology of diagnostic co-occurring mental health and substance use disorders among sexual minority men is needed in order to develop effective integrated prevention and treatment programs.
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Affiliation(s)
- Ji Hyun Lee
- School of Public Health, Brown University, Providence, RI, USA
| | - Kristi E. Gamarel
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | - Jacob J. van den Berg
- The Warren Alpert Medical School of Brown University and Division of Infectious Diseases, the Miriam Hospital, Providence, RI, USA
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, Rockville, MD, USA
| | - Nickolas D. Zaller
- Fay W. Boozman College of Public Health, University of Arkansas, Little Rock, AR, USA
| | - Don Operario
- School of Public Health, Brown University, Providence, RI, USA.
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Matthews A, Li CC, Aranda F, Torres L, Vargas M, Conrad M. The influence of acculturation on substance use behaviors among Latina sexual minority women: the mediating role of discrimination. Subst Use Misuse 2014; 49:1888-98. [PMID: 24941026 DOI: 10.3109/10826084.2014.913632] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A large body of work has demonstrated that sexual minority women have elevated rates of substance use morbidity, as compared with heterosexual women, and that this might be especially true for women of color. OBJECTIVES This study examines the influence of acculturation and discrimination on substance use among Latina sexual minority women. METHODS Data were collected from 2007 to 2008 as part of a larger community-based survey in the greater Chicago area. Scales measured discrimination, acculturation, and substance use. Structural equation modeling validated scales and examined their relationships, which were further described via mediation analysis. RESULTS Increased acculturation leads to substance use and this relationship is partially mediated by discrimination (Sobel test = 2.10; p < .05). CONCLUSIONS/IMPORTANCE: Implications of these findings and directions for future research are discussed. Funding was provided by several women's and public health organizations.
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De Santis JP, Valdes B, Provencio-Vasquez E, Patsdaughter CA, Gattamorta KA. A Comparison of Substance Use Behaviors of Hispanic Men by Sexual Orientation. NURSING AND HEALTH (ALHAMBRA, CALIF.) 2014; 2:9-17. [PMID: 25419537 DOI: 10.13189/nh.2014.020102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND/SIGNIFICANCE Substance use is a public health concern in the United States. Hispanic men in the United States experience disproportionate rates of substance use when compared to other ethnic groups. Previous research with the general population of Hispanic men has identified factors that are related and may contribute to substance use. In addition, Hispanic men who have sex with men (HMSM) may experience additional social factors that may result in substance use. Despite the body of research on substance use among Hispanic men, no study to date has compared the substance use behaviors of Hispanic men by sexual orientation. OBJECTIVES The purpose of this study was to compare the substance use behaviors of Hispanic men by sexual orientation. METHODS A cross-sectional descriptive design was used to collect data from 164 community-dwelling Hispanic men (i.e., 77 heterosexual men and 87 HMSM) who resided in the South Florida area. Participants completed standardized measures of substance use and demographic characteristics. RESULTS Findings suggested that heterosexual men had higher rates of substance use when compared to MSM. No differences were found among the two groups of men in terms of alcohol intoxication. Religion, education, and income were not predictors of substance use. When health insurance status was controlled, MSM were less likely to report substance use. IMPLICATIONS As a population, Hispanic men continue to experience health disparities in terms of substance use. Because substance use renders Hispanic men at risk for other health issues, more research is needed to understand the co-occurring health disparities experienced by Hispanic men who reside in the United States.
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Affiliation(s)
- Joseph P De Santis
- University of Miami School of Nursing & Health Studies, Center of Excellence for Health Disparities Research: EL CENTRO, Coral Gables, FL
| | - Beatriz Valdes
- University of Miami School of Nursing & Health Studies, Center of Excellence for Health Disparities Research: EL CENTRO, Coral Gables, FL ; Florida International University College of Nursing & Health Sciences, Miami, FL
| | | | - Carol A Patsdaughter
- Florida International University College of Nursing & Health Sciences, Miami, FL
| | - Karina A Gattamorta
- University of Miami School of Nursing & Health Studies, Center of Excellence for Health Disparities Research: EL CENTRO, Coral Gables, FL
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Drabble L, Trocki KF. Alcohol in the life narratives of women: Commonalities and differences by sexual orientation. ADDICTION RESEARCH & THEORY 2014; 22:186-194. [PMID: 24955083 PMCID: PMC4063308 DOI: 10.3109/16066359.2013.806651] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
AIM The aim of this study was to explore social representations of alcohol use among women, with a focus on possible differences between sexual minority and heterosexual women. METHODS This qualitative study was part of a larger study examining mediators of heavier drinking among sexual minority women (lesbian identified, bisexual identified, and heterosexual identified with same sex partners) compared to heterosexual women based on the National Alcohol Survey. Qualitative in-depth life history interviews were conducted over the telephone with 48 women who had participated in the 2009-2010 National Alcohol Survey, including respondents representing different sexual orientation groups. Questions explored the lives and experiences of women, and how use of alcohol may connect to those experiences. FINDINGS Representations about normative and risky use included social use, use in relation to community connection, addictive use and self-medication. Other representations common across groups included articulation of boundaries that were defined by negative exemplars, marked by indicators of loss of control, and maintained through selective engagement of social networks. Although representations across groups were similar, some representations, such as alcohol use in fostering community connection, appeared to be more salient for sexual minority women. The findings of the study underscore the importance of considering both commonalities and potential differences among women by sexual orientation in meanings and perceived risks associated with alcohol use in future research and intervention efforts.
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Affiliation(s)
- Laurie Drabble
- San José State University School of Social Work, Associate Professor, One Washington Square, San José, CA 95192-0124, (408) 924-5836
| | - Karen F. Trocki
- Research Scientist, Alcohol Research Group, Public Health Institute, 6475 Christie Ave. Suite 400, Emeryville, CA 94608
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Blosnich JR, Farmer GW, Lee JGL, Silenzio VMB, Bowen DJ. Health inequalities among sexual minority adults: evidence from ten U.S. states, 2010. Am J Prev Med 2014; 46:337-49. [PMID: 24650836 PMCID: PMC4102129 DOI: 10.1016/j.amepre.2013.11.010] [Citation(s) in RCA: 206] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/07/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Improving the health of lesbian, gay, and bisexual (LGB) individuals is a Healthy People 2020 goal; however, the IOM highlighted the paucity of information currently available about LGB populations. PURPOSE To compare health indicators by gender and sexual orientation statuses. METHODS Data are from Behavioral Risk Factor Surveillance System surveys conducted January-December of 2010 with population-based samples of non-institutionalized U.S. adults aged over 18 years (N=93,414) in ten states that asked about respondents' sexual orientation (response rates=41.1%-65.6%). Analyses were stratified by gender and sexual orientation to compare indicators of mental health, physical health, risk behaviors, preventive health behaviors, screening tests, health care utilization, and medical diagnoses. Analyses were conducted in March 2013. RESULTS Overall, 2.4% (95% CI=2.2, 2.7) of the sample identified as LGB. All sexual minority groups were more likely to be current smokers than their heterosexual peers. Compared with heterosexual women, lesbian women had more than 30% decreased odds of having an annual routine physical exam, and bisexual women had more than 2.5 times the odds of not seeking medical care owing to cost. Compared with heterosexual men, gay men were less likely to be overweight or obese, and bisexual men were twice as likely to report a lifetime asthma diagnosis. CONCLUSIONS This study represents one of the largest samples of LGB adults and finds important health inequalities, including that bisexual women bear particularly high burdens of health disparities. Further work is needed to identify causes of and intervention for these disparities.
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Affiliation(s)
- John R Blosnich
- Department of Psychiatry, School of Medicine & Dentistry, University of Rochester, Rochester, New York; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
| | - Grant W Farmer
- Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, St. Louis, Missouri
| | - Joseph G L Lee
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Vincent M B Silenzio
- Department of Psychiatry, School of Medicine & Dentistry, University of Rochester, Rochester, New York
| | - Deborah J Bowen
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, Massachusetts
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Matthews AK, Cho YI, Hughes T, Wilsnack SC, Johnson T, Martin K. The relationships of sexual identity, hazardous drinking, and drinking expectancies with risky sexual behaviors in a community sample of lesbian and bisexual women. J Am Psychiatr Nurses Assoc 2013; 19:259-70. [PMID: 24071822 PMCID: PMC5088734 DOI: 10.1177/1078390313505644] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This study examined the influence of demographic characteristics, sexual identity, hazardous drinking, and sexuality/intimacy enhancement alcohol expectancies on rates of risky sexual behaviors in a community sample of women who self-identified as lesbian, mostly lesbian, and bisexual (N = 349). Structured interview data were collected as part of a larger longitudinal study of sexual minority women's health, the Chicago Health and Life Experiences of Women study. We used structural equation modeling, controlling for demographic characteristics, to evaluate the influence of sexual identity, hazardous drinking, and alcohol-related sexuality/intimacy enhancement expectancies on sexual risk behaviors. Controlling for demographic characteristics and for sexual identity, higher levels of both hazardous drinking and sexuality/intimacy enhancement alcohol expectancies were associated with higher sexual risk scores. The final model predicted 36% of the variance in risky sexual behavior scores. Our findings regarding the central role of alcohol use and sexuality/intimacy enhancement expectancies in sexual risk behaviors among sexual minority women are consistent with previous research focusing on predominantly heterosexual women. Future efforts at sexual risk reduction in sexual minority women will need to address the influences of alcohol use and drinking-related expectancies on sexual behaviors and decision making.
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Affiliation(s)
- Alicia K Matthews
- Alicia K. Matthews, PhD, University of Illinois at Chicago, IL, USA; Howard Brown Health Center, Chicago, IL, USA
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Hagger-Johnson G, Taibjee R, Semlyen J, Fitchie I, Fish J, Meads C, Varney J. Sexual orientation identity in relation to smoking history and alcohol use at age 18/19: cross-sectional associations from the Longitudinal Study of Young People in England (LSYPE). BMJ Open 2013; 3:e002810. [PMID: 23985386 PMCID: PMC3758978 DOI: 10.1136/bmjopen-2013-002810] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Information about the health behaviours of minority groups is essential for addressing health inequalities. We evaluated the association among lesbian, gay or bisexual (LGB) sexual orientation identity and smoking and alcohol use in young people in England. DESIGN Data drawn from wave 6 of the Longitudinal Study of Young People in England (LSYPE). SETTING Self-completion questionnaires during home visits, face-to-face interviews and web-based questionnaires. PARTICIPANTS Data from 7698 participants (3762 men) with information on sexual orientation identity and health behaviours at age 18/19. OUTCOME MEASURES Cigarette smoking history, alcohol drinking frequency and risky single occasion drinking (RSOD). RESULTS LGB identity was reported by 3.1% of participants (55 gay, 33 lesbian, 35 bisexual male, 111 bisexual female), 3.5% when adjusting for the survey design. Adjusting for a range of covariates, identification as lesbian/gay was found to be associated with smoking (OR=2.23, 95% CI 1.42 to 3.51), alcohol drinking >2 days/week (OR=1.99, 95% CI 1.25 to 3.17) and RSOD (OR=1.80, 95% CI 1.13 to 2.86) more than weekly. Bisexual identity was associated with smoking history (OR=1.84, 95% CI 1.30 to 2.61) but not alcohol drinking >2 days/week (OR=1.20, 95% CI 0.79 to 1.81) or RSOD (OR=1.04, 95% CI 0.71 to 2.86). CONCLUSIONS In a sample of more than 7600 young people aged 18/19 years in England, lesbian/gay identity is associated with cigarette smoking, drinking alcohol frequency and RSOD. Bisexual identity is associated with smoking but not RSOD or frequent alcohol drinking.
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Affiliation(s)
- Gareth Hagger-Johnson
- MRC Centre of Epidemiology for Child Health, University College London, London, UK
- Department of Epidemiology and Public Health, University College London, London, UK
- Gay and Lesbian Association of Doctors and Dentists (GLADD), London, UK
| | - Rafik Taibjee
- Gay and Lesbian Association of Doctors and Dentists (GLADD), London, UK
- Merton Medical Practice, London, UK
| | - Joanna Semlyen
- Department of Psychology, London Metropolitan University, London, UK
| | - Isla Fitchie
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Julie Fish
- Department of Social Work, De Montfort University, Leicester, UK
| | - Catherine Meads
- Health Economics Research Group, Brunel University, London, UK
| | - Justin Varney
- Gay and Lesbian Association of Doctors and Dentists (GLADD), London, UK
- NHS Barking & Dagenham/London Borough of Barking and Dagenham, London, UK
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Wilsnack SC. The GENACIS project: a review of findings and some implications for global needs in women-focused substance abuse prevention and intervention. Subst Abuse Rehabil 2012; 3:5-15. [PMID: 24474872 PMCID: PMC3889179 DOI: 10.2147/sar.s21343] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Gender, Alcohol, and Culture: An International Study (GENACIS) is a collaborative study of gender-related and cultural influences on alcohol use and alcohol-related problems of women and men. Members conduct comparative analyses of data from comparable general population surveys in 38 countries on five continents. This paper presents GENACIS findings that (1) age-related declines in drinking are uncommon outside North America and Europe; (2) groups of women at increased risk for hazardous drinking include women who cohabit, women with fewer social roles, more highly educated women in lower-income countries, and sexual minority women in North America; (3) heavier alcohol use shows strong and cross-culturally consistent associations with increased likelihood and severity of intimate partner violence; and (4) one effect or accompaniment of rapid social, economic, and gender-role change in traditional societies may be increased drinking among formerly abstinent women. These findings have potentially important implications for women-focused intervention and policy. Substance abuse services should include attention to middle-aged and older women, who may have different risk factors, symptoms, and treatment issues than their younger counterparts. Creative, targeted prevention is needed for high-risk groups of women. Programs to reduce violence between intimate partners must include attention to the pervasive role of alcohol use in intimate partner aggression. Social and economic empowerment of women, together with social marketing of norms of abstention or low-risk drinking, may help prevent increased hazardous alcohol use among women in countries undergoing rapid social change. Greater attention to effects of gender, culture, and their interactions can inform the design of more effective prevention, intervention, and policy to reduce the substantial global costs of alcohol abuse in both women and men.
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Affiliation(s)
- Sharon C Wilsnack
- Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
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