Addressing gaps on risk and resilience factors for alcohol use outcomes in sexual and gender minority populations

Non-alcoholic beverage consumption among US adults who consume alcohol

BACKGROUND AND AIMS

Non-alcoholic beverages (NABs) that mimic alcohol without inducing intoxication, such as non-alcoholic beers, non-alcoholic wines and spirit-free drinks, are increasing in popularity. It is unknown whether NABs help to mitigate or stimulate alcohol use. The present study aimed to describe NAB consumption practices among US adults consuming alcohol, characterize who is likely to consume NABs and examine whether NAB use influences desire for and perceived consumption of alcohol.

DESIGN AND PARTICIPANTS

The survey study used data collected June-July 2023 from an on-line convenience sample. The first survey (n = 1906) assessed frequency of NAB consumption among US adults who consume alcohol. A second more detailed survey on use patterns was conducted with 466 respondents who reported past-year NAB consumption, of whom 153 (32.83%) screened positive on the CAGE questionnaire for alcohol use disorder (AUD).

SETTING

This study took place in the United States.

MEASUREMENTS

NAB consumption measures included type of NAB consumed, frequency, quantity, first consumption age, consumption reasons, consumption contexts and perceived effect on desire for and consumption of alcohol. Alcohol use measures included frequency, quantity and first consumption age.

FINDINGS

Past-year NAB use was endorsed by 28.44% of respondents (61.70% ever used). Non-alcoholic liquor/'mocktails' were the most common NAB type consumed (83.69%). Compared with respondents without AUD, those who screened positive for AUD were significantly more likely to consume NABs in an effort to decrease or abstain from drinking alcohol [adjusted odds ratio (AOR) = 3.54, 95% confidence interval (CI) = 2.24-5.58] and 67.97% endorsed less alcohol consumption (3.23% endorsed more) due to their NAB use. NAB consumption frequency and quantity were significantly positively predicted by alcohol consumption frequency (AOR = 1.46, 95% CI = 1.17-1.83) and quantity (β = 0.25, 95% CI = 0.15-0.35), respectively.

CONCLUSION

Adults who consume alcohol and screen positive for alcohol use disorder report drinking non-alcoholic beverages as a harm reduction strategy.

At-Risk Drinking in US Adults with Health Conditions: Differences by Gender, Race, and Ethnicity in the National Survey of Drug Use and Health, 2015-2019

Few studies in the US address alcohol consumption patterns in adults with chronic health conditions, and little is known about race and ethnicity differences. This study examined at-risk drinking prevalence rates among US adults with hypertension, diabetes, heart condition or cancer and assessed differences by gender and, among adults aged 50 and older, by race and ethnicity. We used data from the 2015-2019 National Survey on Drug Use and Health (N = 209,183) to estimate (1) prevalence rates and (2) multivariable logistic regression models predicting odds of at-risk drinking among adults with hypertension, diabetes, heart condition, or cancer, compared to adults with none of these conditions. To examine subgroup differences, analyses were stratified by gender (ages 18-49 and ages 50 +) and by gender and race and ethnicity for adults ages 50 + . Results showed that all adults with diabetes and women ages 50 + with heart conditions in the full sample had lower odds of at-risk drinking relative to their counterparts without any of the four conditions. Men ages 50 + with hypertension had greater odds. In race and ethnicity assessments among adults ages 50 + , only non-Hispanic White (NHW) men and women with diabetes and heart conditions had lower odds, and NHW men and women and Hispanic men with hypertension had greater odds of at-risk drinking. There were differential associations of at-risk drinking with demographic and lifestyle indicators across race and ethnicity groups. These findings underscore tailored efforts in community and clinical settings to reduce at-risk drinking in subgroups with health condition diagnoses.

Association Between Religious Salience and Past-Year Substance Use by Sexual Identity and Sex Among Adults in the United States

Purpose: We examined if associations between religious salience and substance use outcomes differed by sexual identity and sex in a nationally representative sample of adults in the United States. Methods: Using data from the 2019 National Survey on Drug Use and Health (N = 41,216 adults), logistic regression models tested whether sexual identity and sex moderated the associations between religious salience (agreement on the importance of religious beliefs) and past-year alcohol and drug use and use disorders. Results: Religious salience reduced risk of alcohol use disorder, drug use, and drug use disorder for heterosexual, but not lesbian, gay, and bisexual (LGB), individuals. Three-way interactions indicated that religious salience was more protective against alcohol use and drug use and use disorder for bisexual men than bisexual women. Conclusions: Heterosexism common in dominant religious institutions in the United States might hamper the protective effect of religiosity on substance use for LGB individuals.

Awareness of LGBTQ+ health disparities: A survey study of complementary integrative health providers

OBJECTIVE

The purpose of this study was to survey awareness of lesbian, gay, bisexual, transgender, queer/questioning, plus health disparities among complementary integrative health providers; chiropractors, naturopaths, acupuncturists, and massage therapists and secondly, examine how providers' sexual and gender identity correlated with that awareness.

METHODS

An electronic survey was designed, which included demographic questions as well as closed-ended and Likert response items to measure provider awareness of LGBTQ+ patients and the health disparities they experience. Kruskal-Wallis H tests with pairwise comparisons were used to evaluate the differences between defined groups and their awareness of health disparities of LGBTQ+ adults and youth.

RESULTS

The survey showed that most complementary integrative health care providers agreed that LGBTQ+ individuals experience discrimination and health disparities. However, providers are unaware of the specific disparities experienced in this population, including increased risk of substance abuse and mental health issues. Pairwise comparison tests demonstrated that providers that identify as a part of the LGBTQ+ community are often more aware of disparities than their heterosexual cisgender counterparts.

CONCLUSION

Complementary integrative health care providers demonstrated some general awareness of LGBTQ+ health disparities yet most providers lacked awareness of specific disparities that pose major health risks for this community. Cultural competency training specific to LGBTQ+ individuals is lacking and may explain some of the findings in this study. This suggests that education is needed, both in professional educational programs and in the health care community by way of conferences, webinars, and other opportunities.

Sexual Assault, Posttraumatic Stress, Alcohol Use, and Suicidality Among Diverse College Students

Suicide is the second leading cause of death among college-aged populations. This study examined the association of demographics (sexual orientation, gender identity, age, and race), sexual assault, posttraumatic stress symptoms (PTSS), and alcohol use with suicidality, current urge to self-harm, and current suicidal intent among a diverse sample of college students (n = 2,160) from two universities. Over half of participants reported any suicidality (63.5%), 12% reported current urge to harm themselves, and 5% reported current suicidal intent. A linear regression indicated that participants who identified as a sexual minority, gender minority, consumed more drinks per week, and had more severe PTSS reported higher levels of suicidality. University also was associated with suicidality. A negative binomial regression demonstrated that participants who identified as a sexual minority and had more severe PTSS had more current urge to harm themselves. Further, a negative binomial regression demonstrated that first-generation college students, students with more severe sexual assault histories, and students with more severe PTSS had higher current suicidal intent. Findings suggest that risk factors may differ for college students' general suicidality, self-harm urges, and suicidal intent, suggesting that these may be separate constructs. More comprehensive models, incorporating multiple risk factors and multiple ways of assessing suicidality, are needed to better understand the range of college student suicidal behavior and risks.

Sexual Orientation Disparities in Depression and Substance Use Among Adults: Results from the Brazilian National Health Survey 2019

Purpose: We compared the prevalence of depression, hazardous alcohol use, daily tobacco use and hazardous alcohol and tobacco use (HATU) by sexual orientation and sex among Brazilian adults. Methods: Data were obtained from a national health survey conducted in 2019. This study included participants aged 18 years and older (N = 85,859). Adjusted prevalence ratios (APRs) and confidence intervals were estimated using Poisson regression models stratified by sex to examine the association between sexual orientation, depression, daily tobacco use, hazardous alcohol use, and HATU. Results: After controlling for the covariates, gay men showed a higher prevalence of depression, daily tobacco use, and HATU compared with heterosexual men (APR ranged from 1.71 to 1.92). Furthermore, bisexual men showed a higher prevalence (almost three times) of depression compared with heterosexual men. Lesbian women showed a higher prevalence of binge and heavy drinking, daily tobacco use, and HATU compared with heterosexual women (APR ranged from 2.55 to 4.44). Among bisexual women, the results were significant for all analyzed outcomes (APR ranged from 1.83 to 3.26). Conclusions: This study was the first to use a nationally representative survey to assess sexual orientation disparities related to depression and substance use by sex in Brazil. Our findings highlight the need for specific public policies aimed at the sexual minority population and for greater recognition and better management of these disorders by health professionals.

The Tsunamic Model of LGBTQ+ Deaths of Despair: A Systemic Review to Identify Risk Factors for Deaths of Despair Among LGBTQ+ People

The term Deaths of Despair (DOD) was introduced to capture the phenomenon of mortality associated with suicide, drug overdose, and alcoholic liver disease. The LGBTQ+ population consistently evidences disproportionately high rates of DOD. This study reviewed the literature on DOD within this community to create a conceptual model that identifies risk factors that work together to potentiate DOD in the LGBTQ+ community. Ten DOD-Related Factors were identified and used to create The Tsunamic Model of LGBTQ+ Deaths of Despair. DOD-Related Factors include: (1) Stigma, (2) Demographics, (3) Identity Development, (4) Internalized Homophobia, (5) Depression, (6) Victimization, (7) Isolation/Rejection, (8) Sensation Seeking, (9) Risky Behavior, and (10) Uninformed Care. Each factor is associated with increased risk for DOD among the LGBTQ+ community. This model can help health professionals by providing a framework for prevention and early intervention programs.

Interpersonal Victimization, Substance Use, and Mental Health Among Sexual and Gender Minority Youth: The Role of Self-concept Factors

Reducing substance use and negative mental health outcomes of interpersonal victimization among sexual and gender minority youth (SGMY) represents a critical public health priority. Victimized individuals often develop cognitive schemas, or organized knowledge structures consisting of traits, values, and memories about the self, such as self-concept factors, in response to interpersonal victimization. Prior studies demonstrate the role of self-concept factors (e.g., mastery, control, and self-esteem) in explaining the relationship between victimization and substance use and mental health. However, mastery, control, and self-esteem have not been explored as mediators of interpersonal victimization and health among SGMY. This study is among the first to apply cognitive schema models of trauma-related health symptoms using a large sample of SGMY to examine (a) whether interpersonal victimization is associated with substance use (i.e., alcohol use, cannabis use, and cigarette use) and mental health problems (i.e., depressive symptoms, self-perceived stress, self-rated health issues) and (b) whether diminished sense of mastery and control and lower self-esteem can partially explain elevated rates of substance use and mental health problems in this population. We used the U.S.-based 2017 LGBTQ National Teen Survey (n = 17,112; M_age = 15.57, SD = 1.27); 6,401 (37.4%) identified as gay or lesbian, 7,396 (43.2%) as cisgender women, and 10,245 (59.9%) as White. Substance use and mental health variables were positively associated with interpersonal victimization variables and negatively associated with self-concept factors. Self-concept factors partially mediated the relationship between interpersonal victimization and mental health. This model explained 74.2% of the variance in mental health and 28.4% of the variance in substance use. Cognitive coping may represent an important modifiable factor that can be targeted by trauma-focused interventions in efforts to improve victimized SGMY's mental health. Findings call for the development of identity-affirmative, evidence-based, and trauma-focused interventions for SGMY to improve this populations' overall health.

Leveraging Resilience-supportive Strategies to Enhance Protective Factors in Young Sexual Minority Men: A Scoping Review of HIV Behavioral Interventions Implemented in High-income Countries

Behavioral HIV interventions focused on strengthening young sexual minority men's (SMM) internal (assets) and external (resources) protective factors are promising, yet their evaluation as resilience-supportive strategies to minimize or negate HIV-related risks remain understudied. The objective of this scoping review was to describe resilience-supportive intervention strategies that have been used to achieve desired HIV behavioral outcomes and to identify how these strategies have been evaluated using a resilience analytic framework. Our scoping review uncovered 271 peer-reviewed articles, of which 38 were eligible for inclusion based on our review criteria. The majority of interventions relied on social support strategies as their primary resilience-supportive strategy. A third of interventions reviewed analyzed their findings from a deficits-focused model, another third used compensatory resilience models, and the remaining interventions employed a hybrid (i.e., deficit and compensatory model) strategy. None of the interventions evaluated their intervention effects using a risk-protective model. From our synthesis regarding the current state of research around resilience-informed interventions, we propose strategies to inform the design of resilience-supportive approaches and make recommendations to move the field forward on how to develop, implement, and measure young SMM's resiliency processes.

Gender self-concept and hazardous drinking among sexual minority women: Results from the Chicago health and life experiences of women (CHLEW) study

OBJECTIVE

Sexual minority women (SMW; e.g., lesbian, bisexual) report substantially higher rates of hazardous drinking (HD) than heterosexual women.Yet, few studies have examined sub-group differences. In this study, we investigated the relationship between gender self-concept and HD among SMW. Research consistently shows a link between heavier drinking and masculinity. SMW are more likely than heterosexual women to be gender nonconforming, and masculinity among SMW is associated with increased minority stress, a key HD risk factor.

METHODS

We used Wave 3 data from the Chicago Health and Life Experiences of Women study, a longitudinal study of SMW (N = 598), which assessed participants' self-perceived levels of masculinity and femininity and their perception of how masculine/feminine others viewed them. Using multivariable logistic regression, we examined the association between gender self-concept and past 12-month heavy episodic drinking (HED), drinking-related problems, and alcohol dependence.

RESULTS

Controlling for demographics and minority stress, greater masculinity (both self-perceived and perceptions by others) was associated with higher odds of HED and alcohol dependence. Masculinity as perceived by others was associated with higher odds of drinking-related problems. Neither femininity measure was associated with HD. Additionally, minority stress (i.e., discrimination, stigma, internalized stigma) did not account for the relationship between gender self-concept and HD.

CONCLUSIONS/IMPORTANCE

In this sample, masculinity, particularly SMW's beliefs that others viewed them as masculine, was associated with HD. This association was not attributable to differences in minority stress and may be related to differences in gendered drinking norms, which could be targeted in intervention studies.

An exploration of mental distress in transgender people in Ireland with reference to minority stress and dissonance theory

Introduction: Internationally mental distress is more prominent in the LGBTI community than the general population. The LGBTIreland study was set up to take stock of this in the Republic of Ireland. This paper reports on the analysis of the transgender group with reference to minority stress theory and cognitive dissonance theory. Method: An online survey was conducted addressing several aspects of mental health and distress that received responses from all groupings (n = 2,264) among which 12.3% (n = 279) identified as transgender. The survey consisted of several validated tools to measure depression, anxiety, stress (DASS-21), coping (CSES), self-esteem (RSES), alcohol and drugs misuse (AUDIT) and a variety of questions addressing demographics, experiential aspects, coping and self-related factors. Data analysis focused on predicting mental distress using DASS-general (composite of depression, anxiety and stress). Results: Transgender participants reported higher levels of mental distress, self-harm, suicidal ideation and attempts, and lower levels of self-esteem in comparison with the LGB groups, as well as the general population. Hierarchical multiple regression showed that 53% of variance in mental distress could be predicted from reduced self-esteem, the experience of harassment and not belonging in school. Furthermore, mental distress was highest among younger participants, those who were 'not out', those who had self-harmed and used avoidant coping. There was no significant difference in distress levels among those who had sought mental health support and those who had not. Conclusions: To understand mental distress in transgender people, the minority stress model is useful when taking into account both adverse external (environmental) and internal (cognitive/emotional) factors. The cognitive dissonance mechanism is essential in outlining the mechanism whereby gender incongruence is associated with psychological discomfort, low self-esteem and high mental distress.

Web-Based Alcohol and Sexual Assault Prevention Program With Tailored Content Based on Gender and Sexual Orientation: Preliminary Outcomes and Usability Study of Positive Change (+Change)

Background

Alcohol use and sexual assault are common on college campuses in the United States, and the rates of occurrence differ based on gender identity and sexual orientation.

Objective

We aimed to provide an assessment of the usability and preliminary outcomes of Positive Change (+Change), a program that provides integrated personalized feedback to target alcohol use, sexual assault victimization, sexual assault perpetration, and bystander intervention among cisgender heterosexual men, cisgender heterosexual women, and sexual minority men and women.

Methods

Participants included 24 undergraduate students from a large university in the Southwestern United States aged between 18 and 25 years who engaged in heavy episodic drinking in the past month. All procedures were conducted on the web, and participants completed a baseline survey, +Change, and a follow-up survey immediately after completing +Change.

Results

Our findings indicated that +Change was acceptable and usable among all participants, despite gender identity or sexual orientation. Furthermore, there were preliminary outcomes indicating the benefit for efficacy testing of +Change.

Conclusions

Importantly, +Change is the first program to target alcohol use, sexual assault victimization, sexual assault perpetration, and bystander intervention within the same program and to provide personalized content based on gender identity and sexual orientation.

Trial Registration

ClinicalTrials.gov NCT04089137; https://clinicaltrials.gov/ct2/show/NCT04089137

Everyday Discrimination and Alcohol use among Sexual Minority Adults in a U.S. National Probability Sample

Objective: Limited research assesses how sexual orientation and gender identity and expression (SOGIE)-based discrimination affects alcohol use above and beyond non-SOGIE-related discrimination and how this may differ for sexual minority subgroups. We examined if SOGIE-related discrimination is additive in affecting alcohol use above and beyond non-SOGIE-related discrimination and examined differences in alcohol use, everyday discrimination, and the attribution of discrimination by sex and sexual identity. Methods: A national probability sample of sexual minority adults in the United States was used (N = 1311, female = 56.4%). Bivariate sexual identity and sex-based differences in drinking frequency, heavy episodic drinking (HED), everyday discrimination, and the attribution of discrimination were assessed. Sexual identity and sex-stratified logistic regression models were estimated, where everyday discrimination and the attribution of discrimination predicted drinking frequency and HED. Results: Several differences by sex assigned at birth and sexual identity in drinking frequency, HED, everyday discrimination, and the attribution of discrimination were found in bivariate analyses. In logistic regression models, experiencing SOGIE-related in addition to other types of discrimination was associated with higher odds of HED only for gay males. No other associations were found for everyday discrimination or the attribution of discrimination with drinking frequency or HED. Conclusions: Findings suggest sex and sexual identity-based differences in everyday discrimination and the attribution of discrimination.

The impact of discrimination on substance use disorders among sexual minorities

This paper aimed to review the literature regarding the impact of discrimination on substance use disorders among Sexual Minorities (SM), with a focus on alcohol, opioids, stimulants, polydrug use, chemsex, cannabis and tobacco, as well as inequalities in the access to health care services. It is alarmingly clear that SM report higher rates of morbidity if compared to the general population. Health care delivery inequalities have also been reported in this special population. Also, the lack of data from low- and middle-income countries on substance use among SM is a major concern. Certainly, discrimination play a key-role among leading factors to substance abuse, continued use, disorders, and lower levels of preventive and treatment interventions. However, it may be difficult to estimate the impact of discrimination because of the lack of research data and different methodologies of literature studies. Moreover, SM are differently categorized and defined and evidences may be not comparable between studies. There is an urgent need of strategic guidelines and research investments aimed at prioritizing these populations disproportionately impacted by substance use. Equity-oriented policies and programs can facilitate opportunities and decrease substance use in these vulnerable subgroups, including community- and peer-led initiatives and nonjudgmental and inclusive health services.

Alcohol use and alcohol-related consequences based on gender and sexual orientation among college students

BACKGROUND AND OBJECTIVES

Research has not yet investigated how the association between alcohol and alcohol-related consequences differs across cisgender heterosexual women (CHW), cisgender heterosexual men (CHM), and sexual and gender minority (SGM) college students.

METHODS

Participants were N = 754 college students (34.5% CHW [n = 260]; 34.5% CHM [n = 260]; 31.0% SGM [n = 234]) between the ages 18 and 25 who completed a survey on sexual orientation, gender identity, alcohol use (i.e., average drinks per week), and alcohol-related consequences.

RESULTS

Among individuals who reported alcohol use, CHM reported significantly more drinks per week compared to CHW and SGM. The logistic model of a zero-inflated negative binomial regression indicated that excess zeros in the alcohol-related consequences were more likely among (1) nondrinkers and (2) SGM compared to CHM. The count portion of the model indicated that, among drinkers, there was a positive association between drinks per week and alcohol-related consequences. Estimated alcohol-related consequences per drink were 1.90% higher among CHW than CHM and 2.76% higher among SGM than CHM. Exploratory analyses did not find significant differences in outcomes between cisgender female and male sexual minority students.

DISCUSSION AND CONCLUSION

Findings suggest that although CHW and SGM students consume less alcohol than CHM, these students experience more alcohol-related consequences per drink.

SCIENTIFIC SIGNIFICANCE

This study advances the field's knowledge of alcohol use patterns and consequences among SGM college students. There is a need for alcohol education programming that is tailored to the unique experiences, identities, and minority stressors of SGM college students.

Aversive Self-Focus and Alcohol Consumption Behavior in Women with Sexual Identity-Uncertainty: Changes in Salivary Cortisol Stress Response Among Those who Drink-to-Cope

Background

Individuals who report sexual identity-uncertainty are at-risk for heavy alcohol consumption and alcohol use disorder symptomology. The current study examined the impact of states of aversive self-focus on subsequent consumption of ostensibly alcohol-containing beverages among a sample of women in early adulthood with varying levels of sexual identity-uncertainty (N = 75).

Methods

Utilizing a 2 (self-focus: negative vs. neutral) × 2 (attribution for any psychological discomfort: external vs. none given) between-subjects design with 3 within-person assessments of salivary cortisol, both a moderation model and mixed-effects general linear model were tested.

Results

States of aversive self-focus caused increases in overall consumption among women higher in sexual identity-uncertainty. Findings suggested consumption of ostensibly alcohol-containing beverages was more likely among women higher in sexual identity-uncertainty who also reported consuming beverages to cope with distress. Among women who reported higher levels of sexual identity-uncertainty and drinking-to-cope motives, salivary cortisol concentrations dampened more quickly over time, as they supposedly consumed alcohol.

Conclusion

Findings demonstrate that, among women reporting sexual identity-uncertainty who are motivated to consume alcohol to forget about troubles or worries, situations which evoke states of aversive self-focus may contribute to differences in alcohol consumption in early adulthood.

Predicting the Transition From Suicidal Ideation to Suicide Attempt Among Sexual and Gender Minority Youths

OBJECTIVE

Sexual and gender minority youths are more likely to consider, attempt, and die by suicide than are heterosexual and cisgender youths, yet little is known about how to predict future attempts or transitions from suicidal thoughts to behaviors. Additionally, adaptive measurement of psychopathology is a promising approach that may help characterize risk in this population. This study examined the validity of the Computerized Adaptive Test for Suicide Scale (CAT-SS) in predicting suicide attempts and the transition from suicidal ideation to attempt.

METHODS

The CAT-SS was administered to participants of two ongoing cohort studies of sexual and gender minority adolescents and young adults (N=1,006). Survival analyses examined longitudinal associations between CAT-SS scores and time to suicide attempt. Analyses were conducted for the full sample and stratified by those with and without a history of suicidal ideation, with comparisons between adaptive and static measures of depressive symptoms.

RESULTS

The CAT-SS predicted future suicide attempts in the overall sample (hazard ratio [HR]=1.34, 95% confidence interval [CI]=1.03-1.74). Among youths without a history of suicidal ideation, social support reduced the risk for attempts (HR=0.66, 95% CI=0.45-0.96). Among youths with a history of ideation, predictors of the transition from suicidal thoughts to attempts included baseline CAT-SS score (HR=1.51, 95% CI=1.06-2.15) and victimization (HR=2.48, 95% CI=1.10-5.59).

CONCLUSIONS

Risk and protective factors for suicide attempts differed between youths with and without a history of suicidal thoughts. The CAT-SS had validity in predicting future risk of the sample overall and of youths with suicidal ideation.

SUBSTANCE USE AMONG SEXUAL AND GENDER MINORITIES: ASSOCIATION WITH POLICE DISCRIMINATION AND POLICE MISTRUST

We investigated associations between experiences with police discrimination, police mistrust, and substance use in a convenience sample of 237 sexual and gender minority (SGM) adults in California. In a cross-sectional survey, collected between January 2016 and July 2017, participants reported substance use, lifetime experiences with SGM-related police discrimination, police mistrust, demographics and SGM visibility. In adjusted logistic regression models, we found a positive association between lifetime police discrimination and past-two-week heavy episodic drinking. Police mistrust also was positively associated with past-month marijuana use. Several significant interactions between lifetime police discrimination or police mistrust with other socially stigmatized identities including being African American, insecure housing, and being a gender minority on a few substance use outcomes suggest that effects of police discrimination and mistrust on substance use are stronger among participants with multiple stigmatized identities. Results suggest the importance of policies and interventions that focus on eliminating police discrimination and increasing police legitimacy to reduce risk of substance use among SGM individuals.

Alcohol use among sexual minority women: Methods used and lessons learned in the 20-Year Chicago Health and Life Experiences of Women Study

Background

Two decades ago, there was almost no research on alcohol use among sexual minority women (SMW, e.g., lesbian, bisexual). Since then, a growing body of scientific literature documents substantial sexual orientation-related disparities in alcohol use and alcohol-related problems. Research has identified multiple risk factors associated with high-risk/hazardous drinking among SMW. However, this research has almost exclusively used cross-sectional designs, limiting the ability to draw conclusions about processes through which sexual minority status affects alcohol use. Longitudinal designs, although very rare in research on alcohol use among SMW, are important for testing mediational mechanisms and necessary to understanding how changes in social determinants impact alcohol use.

Aim

To describe the processes and lessons learned in conducting a 20-year longitudinal study focused on alcohol use among SMW.

Methods

The Chicago Health and Life Experiences of Women (CHLEW) study includes five waves of data collection (2000-present) with an age and racially/ethnically diverse sample of 815 SMW (ages 18-83) originally recruited in the Chicago Metropolitan Area in Illinois, a midwestern state in the United States (U.S.). Measures and focus have evolved over the course of the study.

Results

The CHLEW study is the longest-running and most comprehensive study of SMW's drinking in the U.S. or elsewhere. Findings reported in more than 50 published manuscripts have contributed to understanding variations in SMW's risk for hazardous/harmful drinking based on sexual identity, age, race/ethnicity, sex/gender of partner, and many other factors.

Conclusions

By describing the process used in conducting this long-term study, its major findings, and the lessons learned, we hope to encourage and support other researchers in conducting longitudinal research focused on SMW's health. Such research is critically important in understanding and ultimately eliminating sexual orientation-related health disparities.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The Role of the Family in Alcohol Use Disorder Recovery for Adults

Alcohol use disorder (AUD) and family functioning are inextricably bound, and families are impacted negatively by AUD, but families show substantial improvements with AUD recovery. Family members can successfully motivate a person with AUD to initiate changes in drinking or to seek AUD treatment. During recovery, family members can provide active support for recovery. Several couple- or family-involved treatments for AUD have been developed and tested in rigorous efficacy trials. Efficacious treatments based in family systems theory or cognitive behavioral approaches focus on the concerned family member alone, or they engage the couple or family as a unit in the treatment. However, most treatments have been studied in fairly homogeneous, heterosexual, White, non-Hispanic populations, limiting the potential generalizability of these treatments. Substantial gaps remain in our understanding of family processes associated with the initiation and maintenance of AUD recovery among adults. This review outlines the existing literature and describes opportunities for future research to address knowledge gaps in understanding the mechanisms by which these treatments are efficacious, use of family-based treatments with diverse populations, integration of pharmacotherapies with family-involved treatment, role of families in recovery-oriented systems of care, and how to improve treatment development and dissemination.

Sexual Minority Disparities in Health and Well-Being as a Consequence of the COVID-19 Pandemic Differ by Sexual Identity

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has accentuated long-standing population health disparities in the United States. We examined how the pandemic and its social consequences may differentially impact sexual minority adults, relative to heterosexual adults. Methods: Data are from a U.S. national sample of adults (n = 2996; 18.06%) collected from online panels from April to May 2020. We used eight indicators of well-being-mental health, physical health, quality of life, stress, loneliness, psychological distress, alcohol use, and fatigue-to assess the degree to which sexual identity subgroups (i.e., heterosexual, gay/lesbian, bisexual, and "other" sexual minority) varied in retrospective pre- and postpandemic onset indicators of well-being and whether groups varied in their rate of change from pre- and postpandemic onset. Results: The results showed consistent patterns of decline in well-being across sexual identity subgroups, although changes in mental health, physical health, quality of life, stress, and psychological distress were more robust among sexual minority adults in general, relative to heterosexual adults. Adjusted multivariate models testing differences in change in retrospective pre- and postpandemic onset found that well-being among bisexual men and women was most negatively impacted by the pandemic. Conclusion: The COVID-19 pandemic may have distinct health consequences for sexual minority adults in the United States. Our findings support and further legitimize calls for more comprehensive surveillance and cultural responsiveness in emergency preparedness as it relates to sexual minority people and the COVID-19 pandemic.

A Gamified, Social Media-Inspired, Web-Based Personalized Normative Feedback Alcohol Intervention for Lesbian, Bisexual, and Queer-Identified Women: Protocol for a Hybrid Trial

BACKGROUND

Sexual minority women are more likely to drink alcohol, engage in heavy drinking, and experience alcohol-related problems than heterosexual women. However, culturally tailored interventions for this population have been slow to emerge.

OBJECTIVE

This type 1 effectiveness-implementation trial examines the feasibility and efficacy of a gamified, culturally tailored, personalized normative feedback (PNF) alcohol intervention for sexual minority women who psychologically identify as lesbian, bisexual, or queer (LBQ).

METHODS

The core components of a PNF intervention were delivered within LezParlay, a fun, social media-inspired, digital competition designed to challenge negative stereotypes about LBQ women and increase visibility. The competition was advertised on the web through social media platforms and collaboration with LBQ community organizations. After 2 rounds of play by a large cohort of LBQ women, a subsample of 500 drinkers already taking part in the competition were invited to participate in the evaluation study. Study participants were randomized to receive 1 of 3 unique sequences of PNF (ie, alcohol and stigma coping, alcohol and control, or control topics only) over 2 intervention rounds. Randomization was fully automated by the web app, and both researchers and participants were blinded.

RESULTS

Analyses will evaluate whether PNF on alcohol use reduces participants' drinking and negative consequences at 2 and 4 months postintervention; examine whether providing PNF on stigma-coping behaviors, in addition to alcohol use, further reduces alcohol use and consequences beyond PNF on alcohol alone; identify mediators and moderators of intervention efficacy; and examine broader LezParlay app engagement, acceptability, and perceived benefits.

CONCLUSIONS

This incognito intervention approach is uniquely oriented toward engaging and preventing alcohol-related risks among community populations of LBQ women who may view their heavy drinking as normative and not in need of change because of the visibility of alcohol use in sexual minority community spaces. Thus, this intervention strategy diverges from, and is intended to complement, more intensive programs being developed to meet the needs of LBQ women already motivated to reduce their consumption.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03884478; https://clinicaltrials.gov/ct2/show/NCT03884478.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/24647.

Social interaction anxiety and perceived coping efficacy: Mechanisms of the association between minority stress and drinking consequences among sexual minority women

Sexual minority women (SMW; individuals who identify as women and as lesbian, bisexual, or with another sexual minority identity) are at increased risk for problematic alcohol use compared to their heterosexual counterparts. This increased risk has been attributed to minority stress. However, longitudinal research examining associations between minority stress and alcohol use outcomes is extremely limited and examinations of these associations at the daily level are nearly non-existent. Further, few longitudinal studies have examined mechanisms through which minority stress may impact alcohol use. We utilized data from a 14-day daily diary study of 98 SMW to examine daily-level associations between experiences of minority stress, alcohol consumption and consequences, and two proposed mediators of these associations (perceived coping efficacy, social interaction anxiety). Results indicated that on days when participants experienced minority stress events, they experienced lower coping efficacy, higher social interaction anxiety, and more drinking consequences than usual. Minority stress was not associated with same-day alcohol consumption. Perceived coping efficacy and social interaction anxiety mediated the same-day association between minority stress and drinking consequences. No prospective associations were significant, suggesting that studies with multiple assessments per day may be necessary to detect immediate effects of minority stress. Findings highlight the potential impact of daily experiences of minority stress on alcohol consequences and provide evidence that two general psychological processes may be mechanisms through which minority stress impacts alcohol consequences. These results provide evidence of a need for interventions that teach SMW skills for coping with minority stress and its psychological consequences.

Prevalence and correlates of substance use among transgender adults: A systematic review

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.

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

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

Sexual Orientation Differences in Alcohol Use Disorder Across the Adult Life Course

INTRODUCTION

Sexual orientation‒related disparities in alcohol use disorder are well-established. Yet, the degree to which sexual orientation differences in alcohol use disorder vary across the life course is poorly understood. There is also a limited understanding of how exposure to minority stressors and their relationship with alcohol use disorder vary as a function of age.

METHODS

Using nationally representative data collected in 2012-2013, authors used sex-stratified time-varying effect models to estimate age-specific prevalence rates of alcohol use disorder among heterosexual and sexual minority adults aged 18-60 years (N=28,090). Among sexual minority adults (n=1,050), authors also assessed age-specific associations between exposure to lesbian, gay, and bisexual‒related discrimination and alcohol use disorder. Analyses were conducted in 2019.

RESULTS

Gay and bisexual male participants aged 18-45 years demonstrated the highest prevalence rates of alcohol use disorder (e.g., >45% at age 25 years), whereas lesbian, gay, and bisexual female participants were most likely to meet the criteria for alcohol use disorder between ages 45 and 55 years. Sexual minority adults who experienced discrimination in the past year had greater odds of alcohol use disorder between ages 23 and 34 years and again from ages 42 to 53 years; the association between discrimination and alcohol use disorder was strongest among sexual minority men.

CONCLUSIONS

Sexual orientation-related disparities in alcohol use disorder are dynamic across the life course and point to critical times for screening and intervention. Developmental perspectives of sexual minority health inequities demand focused research attention as findings will help to identify strategies for promoting sexual minority health at distinct points in the life course.

Parent-child Relationships and Sexual Minority Youth: Implications for Adult Alcohol Abuse

Sexual minority (lesbian, gay, bisexual, and same-sex attracted) youth and adults report elevated rates of alcohol use and abuse relative to their heterosexual peers; these differences are strongest for sexual minority girls and women. Although preliminary evidence suggests that unsupportive parenting and maladaptive parent-child relationship qualities are associated with concurrent substance use among sexual minority youth, questions remain about the long-term implications of these early familial experiences on drinking behaviors among sexual minority youth and adults. Nationally-representative prospective data (n = 14,800; 53.1% female; Wave 1 Mean age = 15.61; Wave 4 Mean age = 28.51) were used to test the longitudinal association between parent-child relationships and parental autonomy granting between the ages of 13-18, and sexual-orientation-related disparities in alcohol abuse during adulthood. The findings showed that adolescent same-sex attraction was associated with alcohol abuse during adulthood for sexual minority women and that deficits in parent-child relationship quality statistically mediated this association. No sexual orientation differences in alcohol abuse were found among men. The findings suggest that the quality of relationships with parents in early adolescence has long-lasting impact on sexual minority women's vulnerability for alcohol abuse. Early interventions that bolster supportive parent-child relationship qualities may have enduring consequences for sexual minority women's alcohol use across the life course.

Reconsidering Approaches to Estimating Health Disparities Across Multiple Measures of Sexual Orientation

Purpose: We propose a new theoretically grounded approach for estimating sexual orientation-related health risk that accounts for the unique and shared variance of sexual identity across other measures of sexual orientation (i.e., attraction and behavior). We argue and illustrate that this approach provides specificity not demonstrated by approaches that independently estimate and compare health risk based on sexual identity, attraction, and behavior. Methods: Data were from the National Epidemiologic Survey on Alcohol and Related Conditions-III, collected in 2012-2013 (N = 36,309, ages 18 and older). The Karlson-Holm-Breen method tested the degree to which attraction- and behavior-based disparities in mental health and substance use disorders change after adjusting for sexual identity. Results: Sexual attraction- and behavior-based disparities in mental health and substance use disorders statistically varied when comparing models that did and did not adjust for sexual identity. Adjusting for sexual identity appeared to have a larger influence on attraction- and behavior-based health associations among men; sexual minority and majority differences were attenuated on nearly every outcome after adjusting for sexual identity. This attenuation was less common among women. Among women, some behavior-based disparities were wider in sexual identity-adjusted models relative to unadjusted models. Conclusion: We demonstrate more accurate approaches to capturing and comparing sexual orientation-related health disparities across multiple measures of sexual orientation, which account for the shared variance between sexual identity and measures of attraction and behavior. Adjusted estimates provide more specificity regarding relative health risk across specific subgroups of sexual minority people, and the intervention and prevention strategies needed to address them.

Characterization of substance use among underrepresented sexual and gender minority participants in The Population Research in Identity and Disparities for Equality (PRIDE) Study

BACKGROUND

Profiles of substance use among less commonly described subgroups of sexual and gender minority (SGM) people (e.g., queer, genderqueer) remain largely unknown. Objective(s): To identify substance use differences among less commonly described SGM identity-based subgroups. Methods: The PRIDE Study is a national, online, longitudinal cohort study of self-identified SGM adults living in the U.S. Between 2015-2017, an iPhone application was used to administer three cross-sectional health questionnaires to participants, one of which included questions about binge alcohol, marijuana, and other drug use (substance use). This study was a secondary data analysis of participant responses to substance use survey items. Logistic regression and generalized linear modeling assessed relationships between sexual orientation or gender and use of or reported problems with substances within the past year. Results: Among the 1790 participants included in this study, 51.0% reported binge alcohol use, 39.8% reported marijuana use, and 19.7% reported other drug use (65.9% endorsed use of one or more of these) within the past year. Over 30% indicated substance use had been a problem in their life. Asexual individuals had lower odds of reporting past year binge alcohol and marijuana use (aOR: 0.27, 95% CI: 0.12-0.61; aOR: 0.38, 95% CI: 0.15-0.96, respectively), and queer participants had higher odds of reporting past year marijuana use (aOR: 2.52, 95% CI: 1.58-4.03) compared to lesbian participants. Gender nonbinary participants had lower odds of reporting past year binge alcohol use (aOR: 0.48, 95% CI: 0.32-0.71) and transmasculine participants had higher odds of reporting past year marijuana use (aOR: 2.18, 95% CI: 1.10-4.31) compared to cisgender women. Conclusions: Substance use heterogeneity exists between SGM groups. Comprehensive assessment of sexual orientation and gender may improve understanding of substance use and increase equity within support and treatment services for SGM populations. Highlights We examined substance use among less represented sexual and gender minority groups. Alcohol and other drug use were examined by both sexual orientation and gender identity. Analyses included identities such as queer, pansexual, genderqueer and nonbinary. Alcohol use differed across asexual, genderqueer and gender nonbinary groups. Marijuana use differed across queer, asexual and transmasculine groups.

Victimization as a mediator in the relationship between sexual orientation and adolescent alcohol use

This study aimed to identify differences in Korean adolescents' alcohol use behaviors according to their sexual orientation and the mediating effect of victimization in this relationship using nationally representative data. Data from the Korea Youth Risk Behavior Web-based Surveys were analyzed using logistic regression analysis. There were significant associations between sexual orientation and alcohol use behaviors. Heterosexual adolescents were significantly more likely to have drinking experience in lifetime than their homosexual and bisexual peers in adjusted analyses. Victimization significantly mediated the relationship between sexual orientation and alcohol use behaviors. Our findings suggest that reducing the prevalence of alcohol use by sexual orientation should involve interventions to prevent victimization in schools.

Normative Substance Use Antecedents among Sexual Minorities: A Scoping Review and Synthesis

Although sexual minority stress remains the dominant perspective for understanding disproportionate substance use among lesbian, gay and bisexual (LGB) populations, social norms are among the most predictive and commonly targeted substance use antecedents in other high-risk groups. This scoping review seeks to bring clarity to the body of norms-focused alcohol, tobacco, and other drug (ATOD) research conducted with LGBs over the past 20 years, identify intervention implications, and present priority directions for future research. Fifty-two peer-reviewed studies published between June 1999 and June 2019 were identified from searches of PubMed, PsycInfo, and Medline databases using combinations of terms related to: social norms; sexual orientation or sexual minority status; and, the use of alcohol, tobacco, and other drugs. A far greater number of studies focused on actual ATOD norms than perceived ATOD norms or discrepancies between actual or perceived norms, illuminating the need for additional research focused on these levels of analysis. Taken together, this literature suggests that: (1) perceived ATOD norms are reliable predictors of LGBs' ATOD use; (2) actual ATOD use norms are low among LGBs participating in representative, population-based survey studies; and, (3) LGBs over-estimate the ATOD use of peers. Thus, intervention strategies including personalized normative feedback, psychoeducation, and social branding may hold promise in reducing LGBs substance use. However, additional research is needed to increase our understanding of injunctive ATOD norms, identify meaningful LGB reference groups, elucidate environmental influences on ATOD norms, and examine relationships between stigma experiences, perceived norms, and ATOD use.

Illicit and Prescription Drug Misuse among Sexual Minority Women in the United States: A Protocol for a Scoping Review

BACKGROUND

The United States Institute of Medicine (IOM) published reports in 1999 and 2011 identifying drug use as a priority area for sexual minority health research, specifically focused on mechanisms contributing to drug use disparities and the development of tailored interventions. Limited research has prioritized sexual minority women (SMW) with the majority of substance use research among sexual minorities focused on adolescents and men who have sex with men. This scoping review will characterize the research literature related to illicit drug use and prescription drug misuse among SMW and sub-groups within the SMW population. Through this, we will identify: (1) specific substances used; (2) patterns of substance use; (3) risk and protective factors; (4) prevention interventions; and (5) drug treatment programs specific to SMW.

METHODS/DESIGN

This review will include studies with empirical data of illicit or prescription drug misuse among sexual minority women. Peer-reviewed quantitative research conducted in the United States and published in English from 2011-Present will be included. We will search Medline, PsycINFO, and Web of Science databases for relevant articles. Two independent reviewers will screen abstracts and relevant full-text studies for eligibility. Data will be extracted from eligible articles and results will be presented in narrative and tabular form as appropriate.

DISCUSSION

This work will identify gaps of knowledge in the research pertaining to illicit or prescription drug misuse among sexual minority women since the 2011 US IOM report. As a result of this work, we will propose directions for future research to address identified gaps.

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

Purpose: We examined how substance use differed as a function of sex assigned at birth and gender identity (cisgender, transgender, or nonbinary/genderqueer) by type of substance. We sought to test whether current gender identity and sex assigned at birth were key factors in substance use among a large contemporary sample that included transgender and nonbinary/genderqueer adolescents. Methods: We analyzed data from a large national U.S. sample of sexual and gender minority (SGM) adolescents (n = 11,129) collected between April and December 2017. Chi-square tests of independence were used to test whether substance use behaviors varied by sex assigned at birth and gender identity. A series of multivariate logistic regression models tested the odds of substance use by sex assigned at birth and gender identity, as well as the interaction between sex assigned at birth and gender identity. Results: More than half of our sample reported lifetime alcohol use, and one-fourth of the sample reported lifetime marijuana use. Adolescents assigned male at birth had higher prevalence of substance use compared with adolescents assigned female at birth (AFAB). Multivariate models elucidated greater risk for most substance use outcomes for transgender adolescents compared with cisgender adolescents. We found significant interaction effects between gender identity and sex assigned at birth for recent alcohol use and lifetime and recent cigarette use among adolescents AFAB. Conclusions: These findings have implications for stakeholders who develop nationally representative surveys, researchers who examine substance use disparities among SGM adolescents, and mental health professionals who treat underage substance use among vulnerable populations.

Understanding predictors of improvement in risky drinking in a U.S. multi-site, longitudinal cohort study of transgender individuals: Implications for culturally-tailored prevention and treatment efforts

OBJECTIVE

While transgender people report higher rates of risky drinking than the general population, no studies have examined transgender alcohol use longitudinally. This study investigated minority stress and identity development predictors of improvement in risky drinking among transgender individuals.

METHODS

Data come from a multi-site, longitudinal cohort study of U.S. transgender individuals (N = 330) and include measures of enacted stigma, felt stigma, identity development, and risky alcohol use. Theory-driven, hierarchical multivariable logistic regression was used to investigate the hypothesis that minority stress and identity development factors are related to improvement in risky drinking between baseline and 1-year follow-up.

RESULTS

Baseline risky drinkers (n = 106; 37.1%) were younger and more likely to have female sex assigned at birth. At 1-year follow-up, 68 baseline risky drinkers (64.2%) reported persistent risky drinking, while 38 (35.8%) reported improved drinking. Controlling for demographics and study site, female sex assigned at birth and enacted stigma were associated with lower odds of improved drinking. Non-white/Hispanic race/ethnicity, felt stigma, change in gender role/expression for 1-5 years, and diffuse-avoidant identity style were associated with higher odds of improvement.

CONCLUSIONS/IMPORTANCE

This is the first study to identity predictors of improvement in risky drinking among transgender individuals. Compared to trans-feminine individuals (assigned male at birth), trans-masculine individuals (assigned female at birth) were more likely to report risky drinking at baseline and had lower odds of improvement at 1-year follow-up. Improved drinking may be facilitated by preventing anti-transgender discrimination. Felt stigma and diffuse-avoidant identity style may lower alcohol risk via avoidance of drinking venues. Further research is needed to explicate these relationships and to inform culturally-tailored alcohol interventions for this at-risk population.

Sexual Orientation-Related Disparities in High-Intensity Binge Drinking: Findings from a Nationally Representative Sample

Purpose: The purpose of this study was to assess sexual orientation differences in high-intensity binge drinking using nationally representative data. Methods: Data were from the National Epidemiologic Survey on Alcohol and Related Conditions III (N = 36,309), a nationally representative sample of U.S. adults collected in 2012-2013. Sex-stratified adjusted logistic regression models were used to test sexual orientation differences in the prevalence of standard (4+ for women and 5+ for men) and high-intensity binge drinking (8+ and 12+ for women; 10+ and 15+ for men) across three dimensions of sexual orientation: sexual attraction, sexual behavior, and sexual identity. Results: Sexual minority women, whether defined on the basis of sexual attraction, behavior, or identity, were more likely than sexual majority women to engage in high-intensity binge drinking at two (adjusted odds ratios [aORs] ranging from 1.52 to 2.90) and three (aORs ranging from 1.61 to 3.27) times the standard cutoff for women (4+). Sexual minority men, depending on sexual orientation dimension, were equally or less likely than sexual majority men to engage in high-intensity binge drinking. Conclusion: This study is the first to document sexual orientation-related disparities in high-intensity binge drinking among adults in the United States using nationally representative data. The results suggest that differences in alcohol-related risk among sexual minority individuals vary depending on sex and sexual orientation dimension.

Sexual minority youth, social change, and health: A developmental collision

Few societal attitudes and opinions have changed as quickly as those regarding sexual minority people and rights. In the context of dramatic social change in the space of a single generation, there have been multiple policy changes toward social inclusion and rights for lesbian, gay, and bisexual (LGB) people, and perceptions that the sociocultural context for LGB people - perhaps particularly for youth - has improved. Yet recent evidence from the developmental sciences points to paradoxical findings: in many cases there have been growing rather than shrinking health disparities. In light of swift sociocultural changes, combined with emergent findings regarding the health and wellbeing of sexual minority youth, we suggest that there is a developmental collision between normative adolescent developmental processes and sexual minority youth identities and visibility. The result is a new reality for sexual minority youth health and disparities.

Patterns of childhood maltreatment and intimate partner violence, emotion dysregulation, and mental health symptoms among lesbian, gay, and bisexual emerging adults: A three-step latent class approach

BACKGROUND

Childhood abuse and neglect (CAN) and intimate partner violence victimization (IPV) is prevalent among lesbian, gay, and bisexual individuals (LGB). Identification of distinct patterns of childhood and adult victimization, including technology-mediated and face-to-face IPV, and their cumulative relations to mental/behavioral health challenges, among LGB people is needed to facilitate identification of at-risk individuals.

OBJECTIVE

Using latent class analysis, we first sought to identify patterns of lifetime interpersonal victimization, primarily five types of CAN and IPV in LGB emerging adults. Second, we examined if LGB-status and race/ethnicity predicted class-membership; third, we assessed differences between the latent classes on emotion dysregulation, depressive and anxiety symptoms, and alcohol use.

PARTICIPANTS

Participants were 288 LGB adults between 18-29 years (M = 25.35, SD = 2.76; 41.7% gay/lesbian) recruited via Amazon MTurk.

METHODS AND RESULTS

The 3-step LCA identified five-latent classes: high victimization, childhood emotional abuse and neglect, cybervictimization, adult face-to-face IPV, and lower victimization. People of color (including Hispanics) were more likely to be in the high victimization class, and bisexual individuals, especially bisexual women, in the childhood emotional abuse and neglect class. High victimization and childhood emotional abuse and neglect classes had elevated emotion dysregulation levels and depression and anxiety symptoms, and the high victimization class reported the highest levels of alcohol use.

CONCLUSION

Findings suggest a detrimental effect of cumulative interpersonal victimization on emotion dysregulation and the mental/behavioral health of LGB emerging adults, with bisexuals and LGB-people of color at heightened risk of cumulative victimization and of related mental/behavioral health challenges.

Sexual Minority Youth Report High-Intensity Binge Drinking: The Critical Role of School Victimization

PURPOSE

To examine standard binge drinking (≥4 drinks for females, ≥5 drinks for males) and high-intensity binge drinking (≥8 drinks for females, ≥10 drinks for males) among heterosexual and sexual minority youth in the US and whether reports of school-based victimization mediate this association.

METHODS

Survey data are from the 2015 Youth Risk Behavior Survey (YRBS; n = 10,839, M_age = 16.07). Logistic regression adjusted for race/ethnicity and age compared rates of standard and high-intensity binge drinking among heterosexual and sexual minority youth and whether experiences of school-based victimization mediated this association. Effects were tested in full sample and sex-stratified models.

RESULTS

Lesbian and bisexual girls and girls with male and female partners were more likely than heterosexual girls to report standard rates of binge drinking. Lesbian girls and girls reporting male and female sexual partners were more likely than heterosexual girls to report high-intensity binge drinking in the past 30 days. Compared with heterosexual boys, gay boys were significantly less likely to participate in high-intensity binge drinking. School-based victimization mediated all significant associations between sexual minority status and standard and high-intensity binge drinking, with the exception of lesbian girls.

CONCLUSION

Lesbian and behaviorally bisexual girls have elevated risk for high-intensity binge drinking relative to heterosexual girls. Findings point to the importance of policies that reduce school-based victimization as these experiences are associated with higher rates of standard and high-intensity binge drinking among sexual minority girls.

Testing a Model of Binegativity, Drinking-to-Cope Motives, Alcohol Use, and Sexual Coercion Among Self-Identified Bisexual Women

In the present study, we tested a sequential mediation model whereby binegativity was associated with sexual coercion through drinking to cope motives and alcohol use. Data were examined from 224 self-identified bisexual women (M age = 22.79; SD = 3.44) who took part in an online survey. Participants reported binegativity, alcohol use, drinking to cope motivations, and sexual coercion experiences for the previous 30 days. A total of 48.0% of the sample (n = 108) experienced sexual coercion in the past 30 days. Sequential mediation indicated more experiences of binegativity were associated with greater drinking to cope motives, which in turn, related to greater alcohol frequency and greater likelihood of sexual coercion. Alcohol quantity was not a significant mediator. Results suggest the importance of studying the impact of binegativity on bisexual women, as well as developing prevention programs that consider how this form of discrimination may contribute to drinking to cope motives, more frequent alcohol use, and increased risk for sexual coercion.

Trends in Alcohol-Related Disparities Between Heterosexual and Sexual Minority Youth from 2007 to 2015: Findings from the Youth Risk Behavior Survey

PURPOSE

The purpose of this study was to assess trends in alcohol-related disparities between heterosexual and sexual minority adolescents in the United States from 2007 to 2015.

METHODS

Data were pooled from the 2007, 2009, 2011, 2013, and 2015 Youth Risk Behavior Surveys (N = 207,367) to estimate trends, disparities, and changes in disparities of four alcohol-related behaviors (i.e., lifetime alcohol use, early onset use (<13 years of age), past 30-day use, and past 30-day heavy episodic drinking [HED]) among heterosexual youth and three subgroups of sexual minority youth (SMY) (i.e., gay/lesbian, bisexual, and unsure). Models were sex stratified and adjusted for age, race/ethnicity, and state of data collection.

RESULTS

The prevalence of all alcohol-related behaviors declined from 2007 to 2015 for heterosexual youth, but not as consistently for SMY. Disparities in alcohol-related behaviors between heterosexual youth and SMY largely remained stable or widened from 2007 to 2015. Disparities in lifetime alcohol use and past 30-day use were larger between heterosexual boys and gay boys in 2015 relative to 2007. Disparities in early onset use and past 30-day HED were also larger between heterosexual girls and lesbian girls in 2015 relative to 2007. The disparity in past 30-day use between heterosexual girls and bisexual girls was smaller in 2015 compared with 2007.

CONCLUSIONS

Despite overall declines in adolescent alcohol use, alcohol-related disparities between heterosexual youth and SMY persist and, for some SMY, they have widened.

Sexual Coercion, Drinking to Cope Motives, and Alcohol-Related Consequences among Self-Identified Bisexual Women

BACKGROUND

Given higher sexual victimization and greater alcohol use among bisexual women, a critical public health challenge is to understand within-group variation that may heighten or explain these associations in bisexual women.

OBJECTIVES

The present study tested a moderated-mediation model in which sexual coercion was hypothesized to be associated with alcohol-related consequences via drinking to cope motives in self-identified bisexual women who reported at least occasional binge drinking. Negative affect was hypothesized to moderate the sexual coercion-drinking to cope motives association.

METHODS

Participants were a community sample of 107 self-identified bisexual women (age M = 20.97, SD = 2.11) who completed an online survey and reported at least one binge drinking episode as well as engaging in sexual activity in the past 30 days.

RESULTS

Of these participants, 57 (53.3%) reported one or more experiences of sexual coercion in the past 30 days. Sexual coercion was associated with negative alcohol-related consequences via drinking to cope motives. Negative affect moderated the association between sexual coercion and drinking to cope motives such that the association was stronger among women with greater negative affect. Conclusions/Importance: Methods of addressing vulnerability to sexual coercion and educating young bisexual women about the association between sexual coercion and potentially problematic affective coping through alcohol use are needed.

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

AIMS

We estimated sexual-orientation differences in alcohol use trajectories during emerging adulthood, and tested whether alcohol use trajectories mediated sexual-orientation differences in alcohol use disorders (AUDs).

DESIGN

Longitudinal self-reported survey data from the Growing Up Today Study.

SETTING

United States.

PARTICIPANTS

A total of 12 493 participants aged 18-25 during the 2003, 2005, 2007 or 2010 surveys.

MEASUREMENTS

Stratified by gender, longitudinal latent class analyses estimated alcohol use trajectories (using past-year frequency, quantity and binge drinking from 2003 to 2010). Multinomial logistic regression tested differences in trajectory class memberships by sexual orientation [comparing completely heterosexual (CH) participants with sexual-minority subgroups: mainly heterosexual (MH), bisexual (BI) and gay/lesbian (GL) participants]. Modified Poisson regression and mediation analyses tested whether trajectories explained sexual-orientation differences in AUDs (past-year DSM-IV abuse/dependence in 2010).

FINDINGS

Six alcohol use trajectory classes emerged for women and five for men: these included heavy (23.5/36.9% of women/men), moderate (31.8/26.4% of women/men), escalation to moderately heavy (9.7/12.0% of women/men), light (17.0% for women only), legal (drinking onset at age 21; 11.1/15.7% of women/men) and non-drinkers (7.0/9.1% of women/men). Compared with CH women, MH and BI women had higher odds of being heavy, moderate, escalation to moderately heavy and light drinkers versus non-drinkers (odds ratios = 2.02-3.42; P-values < 0.01-0.04). Compared with CH men, MH men had higher odds of being heavy, moderate and legal drinkers versus non-drinkers (odds ratios = 2.24-3.34; P-values < 0.01-0.01). MH men and women, BI women and GLs had higher risk of AUDs in 2010 than their same-gender CH counterparts (risk ratios = 1.34-2.17; P-values < 0.01). Alcohol use trajectories mediated sexual-orientation differences in AUDs for MH and GL women (proportion of effect mediated = 30.8-31.1%; P-values < 0.01-0.02), but not for men.

CONCLUSIONS

In the United States, throughout emerging adulthood, several sexual-minority subgroups appear to have higher odds of belonging to heavier alcohol use trajectories than completely heterosexuals. These differences partially explained the higher risk of alcohol use disorders among mainly heterosexual and gay/lesbian women but not among sexual-minority men.

Sexual identity differences in high-intensity binge drinking: findings from a US national sample

AIM

To estimate sexual identity differences in high-intensity binge drinking.

DESIGN AND SETTING

Cross-sectional US adult health survey from 2014 and 2015.

PARTICIPANTS

US adults aged 18 and older (n = 215 684; n = 203 562 heterosexual, n = 2784 lesbian/gay, n = 2892 bisexual, n = 686 'other' and n = 1947 don't know/unsure).

MEASUREMENTS

Self-reported past 30-day standard binge and high-intensity binge drinking. Standard binge drinking cut-off values were 4+/5+ drinks for women and men, respectively. High-intensity binge drinking was measured as two and three times the standard level (8+ and 12+ drinks for women and 10+ and 15+ drinks for men).

FINDINGS

Lesbian and bisexual women were more likely than heterosexual women to report consuming 4+ drinks (adjusted odds ratio [aOR] =1.57, confidence interval [CI] = 1.18, 2.09 and aOR = 1.83, CI = 1.45, 2.30 for lesbian and bisexual women, respectively); 8+ drinks (aOR = 3.86, CI = 2.39, 6.24, aOR = 2.07, CI = 1.39, 3.07); and 12+ drinks (aOR = 3.81, CI = 1.77, 8.19, aOR = 2.54, CI = 1.25, 5.14) on a single occasion in the past 30 days. Generally, gay and bisexual men were no more likely than heterosexual men to report standard or high-intensity binge drinking. However, bisexual men were more likely than heterosexual men to consume 15+ drinks (aOR = 1.76, 95% CI = 1.01, 3.06). Rates of standard and high-intensity binge drinking were similar between heterosexual and unsure men and women. Men and women who indicated 'other' sexual identities were generally less likely than heterosexuals to report standard and high-intensity binge drinking, with the exception of 4+ drinks for women and 10+ drinks for men.

CONCLUSIONS

In the United States, sexual minority women are more likely, and sexual minority men are equally likely, to drink at standard and high-intensity binge drinking levels as their heterosexual counterparts.

Measuring alcohol use across the transition to adulthood: Racial/ethnic, sexual identity, and educational differences

BACKGROUND

Patterns of alcohol use change from adolescence to adulthood and may differ based on race/ethnicity, sexual identity, and education. If alcohol use measures do not operate consistently across groups and developmental periods, parameter estimates and conclusions may be biased.

OBJECTIVES

To test the measurement invariance of a multi-item alcohol use measure across groups defined by race/ethnicity, sexual identity, and college education during the transition to adulthood.

METHODS

Using three waves from the National Longitudinal Study of Adolescent to Adult Health, we tested configural, metric, and scalar invariance of a 3-item alcohol use measure for groups defined by race/ethnicity, sexual identity, and college education at three points during the transition to adulthood. We then assessed longitudinal measurement invariance to test the feasibility of modeling developmental changes in alcohol use within groups defined by these characteristics.

RESULTS

Overall, findings confirm notable variability in the construct reliability of a multi-item alcohol use measure during the transition to adulthood. The alcohol use measure failed tests of metric and scalar invariance, increasingly across ages, both between- and within-groups defined by race/ethnicity, sexual identity, and college education, particularly among females.

CONCLUSIONS

Measurement testing is a critical step when utilizing multi-item measures of alcohol use. Studies that do not account for the effects of group or longitudinal measurement non-invariance may be statistically biased, such that recommendations for risk and prevention efforts could be misguided.

Culturally Sensitive Chiropractic Care of the Transgender Community: A Narrative Review of the Literature

OBJECTIVES

Transgender individuals commonly experience barriers to quality health care and may suffer from unique musculoskeletal complaints. Although these needs are often inadequately addressed within the health care system, they could be attended to by the chiropractic community. This narrative review describes best practices for delivering culturally sensitive care to transgender patients within the context of chiropractic offices.

METHODS

A literature search generated peer-reviewed material on culturally competent care of the transgender community. Google Scholar and trans-health RSS feeds on social media were also searched to find relevant gray literature. Information pertinent to a chiropractic practice was identified and summarized.

RESULTS

Contemporary definitions of transgender, gender identity, and sexual orientation provide a framework for culturally sensitive language and clinic culture. Small changes in record keeping and office procedures can contribute to a more inclusive environment for transgender patients and improve a chiropractor's ability to collect important health history information. Special considerations during a musculoskeletal examination may be necessary to properly account for medical and nonmedical practices transgender patients may use to express their gender. Chiropractors should be aware of health care and social and advocacy resources for transgender individuals and recommend them to patients who may need additional support.

CONCLUSIONS

Small yet intentional modifications within the health care encounter can enable chiropractors to improve the health and well-being of transgender individuals and communities.

Ecological momentary assessment of daily discrimination experiences and nicotine, alcohol, and drug use among sexual and gender minority individuals

OBJECTIVE

Sexual and gender minority (SGM) individuals experience elevated rates of minority stress, which has been linked to higher rates of nicotine and substance use. Research on this disparity to date is largely predicated on methodology that is insensitive to within day SGM-based discrimination experiences, or their relation to momentary nicotine and substance use risk. We address this knowledge gap in the current study using ecological momentary assessment (EMA).

METHOD

Fifty SGM individuals, between 18 and 45 years of age, were recruited from an inland northwestern university, regardless of their nicotine or substance use history, and invited to participate in an EMA study. Each were prompted to provide data, six times daily (between 10:00 a.m. and 10:00 p.m.) for 14 days, regarding SGM-based discrimination, other forms of mistreatment, and nicotine, drug, and alcohol use since their last prompt.

RESULTS

Discrimination experiences that occurred since individuals' last measurement prompt were associated with greater odds of nicotine and substance use during the same measurement window. Substance use was also more likely to occur in relation to discrimination reported two measurements prior in lagged models. Relative to other forms of mistreatment, discrimination effects were consistently larger in magnitude and became stronger throughout the day/evening.

CONCLUSION

This study adds to existing minority stress research by highlighting the both immediate and delayed correlates of daily SGM-based discrimination experiences. These results also contribute to our understanding of daily stress processes and provide insight into ways we might mitigate these effects using real-time monitoring and intervention technology. (PsycINFO Database Record

Are alcohol-related disparities between sexual minority and heterosexual youth decreasing?

BACKGROUND AND AIMS

Although sexual orientation-related alcohol use disparities are well established, researchers have not identified whether disparities are diminishing as societal attitudes towards lesbian/gay and bisexual (LGB) people become more accepting. We examined changes in four alcohol-related disparities between heterosexual and LGB youth from 1998 to 2013 by (1) estimating the prevalence of these behaviors; (2) estimating disparities in alcohol-related outcomes between heterosexual and LGB youth within each wave year; and (3) testing whether the degree of difference in alcohol-related disparities between heterosexual and LGB youth has changed.

DESIGN

Logistic regression models and year × sexual orientation interactions with repeated, cross-sectional, provincially representative data.

SETTING

British Columbia, Canada.

PARTICIPANTS

Students (ages 12-19) from the 1998 (n = 22 858), 2003 (n = 29 323), 2008 (n = 25 254) and 2013 (n = 21 938) British Columbia Adolescent Health Survey (total n = 99 373, 48.7% male, mean age = 14.84).

MEASUREMENTS

We modeled age-adjusted differences in life-time alcohol use, age of onset, past 30-day drinking and past 30-day heavy episodic drinking between heterosexual and three subgroups of sexual minority youth (i.e. mostly heterosexual, bisexual and lesbian/gay).

FINDINGS

Generally, alcohol use declined for all youth, although less so among LGB youth [average adjusted odds ratio (aOR) = 0.58 and aOR = 0.53 for heterosexual males and females and aOR = 0.71 and aOR = 0.57 for sexual minority males and females, respectively). Within-year comparisons demonstrated elevated rates of alcohol use among LGB compared with heterosexual youth for each of the four survey years, especially among females. Findings indicate few changes over time; however, results show an increase in risky alcohol use from 1998 to 2013 among mostly heterosexual (aOR = 1.58 for life-time alcohol use, aOR = 1.58 for 30-day alcohol use and aOR = 1.34 for 30-day heavy episodic drinking), and bisexual (aOR = 1.95 for life-time alcohol use) females.

CONCLUSION

Despite the general decline in the prevalence of alcohol use among young people in Canada since 1998, lesbian/gay and bisexual youth in Canada continue to show elevated rates of alcohol use compared with heterosexual youth.