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Soled KRS, Hoatson T, Monseur B, Everett B, Chakraborty P, Reynolds CA, Huang AK, McKetta S, Haneuse S, Charlton BM. Differences in medically assisted reproduction use by sexual identity and partnership: a prospective cohort of cisgender women. Hum Reprod 2024; 39:1323-1335. [PMID: 38689464 DOI: 10.1093/humrep/deae077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
STUDY QUESTION Does medically assisted reproduction (MAR) use among cisgender women differ among those with same-sex partners or lesbian/bisexual identities compared to peers with different-sex partners or heterosexual identities? SUMMARY ANSWER Women with same-sex partners or lesbian/bisexual identities are more likely to utilize any MAR but are no more likely to use ART (i.e. IVF, reciprocal IVF, embryo transfer, unspecified ART, ICSI, and gamete or zygote intrafallopian transfer) compared to non-ART MAR (i.e. IUI, ovulation induction, and intravaginal or intracervical insemination) than their different-sex partnered and completely heterosexual peers. WHAT IS KNOWN ALREADY Sexual minority women (SMW) form families in myriad ways, including through fostering, adoption, genetic, and/or biological routes. Emerging evidence suggests this population increasingly wants to form genetic and/or biological families, yet little is known about their family formation processes and conception needs. STUDY DESIGN, SIZE, DURATION The Growing Up Today Study is a US-based prospective cohort (n = 27 805). Participants were 9-17 years of age at enrollment (1996 and 2004). Biennial follow-up is ongoing, with data collected through 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS Cisgender women who met the following criteria were included in this sample: endorsed ever being pregnant; attempted a pregnancy in 2019 or 2021; and endorsed either a male- or female-sex partner OR responded to questions regarding their sexual identity during their conception window. The main outcome was any MAR use including ART (i.e. procedures involving micromanipulation of gametes) and non-ART MAR (i.e. nonmanipulation of gametes). Secondary outcomes included specific MAR procedures, time to conception, and trends across time. We assessed differences in any MAR use using weighted modified Poisson generalized estimating equations. MAIN RESULTS AND THE ROLE OF CHANCE Among 3519 participants, there were 6935 pregnancies/pregnancy attempts and 19.4% involved MAR. A total of 47 pregnancies or pregnancy attempts were among the same-sex partnered participants, while 91 were among bisexual participants and 37 among lesbian participants. Participants with same-sex, compared to different-sex partners were almost five times as likely to use MAR (risk ratio [95% CI]: 4.78 [4.06, 5.61]). Compared to completely heterosexual participants, there was greater MAR use among lesbian (4.00 [3.10, 5.16]) and bisexual (2.22 [1.60, 3.07]) participants compared to no MAR use; mostly heterosexual participants were also more likely to use ART (1.42 [1.11, 1.82]) compared to non-ART MAR. Among first pregnancies conceived using MAR, conception pathways differed by partnership and sexual identity groups; differences were largest for IUI, intravaginal insemination, and timed intercourse with ovulation induction. From 2002 to 2021, MAR use increased proportionally to total pregnancies/pregnancy attempts; ART use was increasingly common in later years among same-sex partnered and lesbian participants. LIMITATIONS, REASONS FOR CAUTION Our results are limited by the small number of SMW, the homogenous sample of mostly White, educated participants, the potential misclassification of MAR use when creating conception pathways unique to SMW, and the questionnaire's skip logic, which excluded certain participants from receiving MAR questions. WIDER IMPLICATIONS OF THE FINDINGS Previous studies on SMW family formation have primarily focused on clinical outcomes from ART procedures and perinatal outcomes by conception method, and have been almost exclusively limited to European, clinical samples that relied on partnership data only. Despite the small sample of SMW within a nonrepresentative study, this is the first study to our knowledge to use a nonclinical sample of cisgender women from across the USA to elucidate family formation pathways by partnership as well as sexual identity, including pathways that may be unique to SMW. This was made possible by our innovative approach to MAR categorization within a large, prospective dataset that collected detailed sexual orientation data. Specifically, lesbian, bisexual, and same-sex partnered participants used both ART and non-ART MAR at similar frequencies compared to heterosexual and different-sex partnered participants. This may signal differential access to conception pathways owing to structural barriers, emerging conception trends as family formation among SMW has increased, and a need for conception support beyond specialized providers and fertility clinics. STUDY FUNDING/COMPETING INTEREST(S) The research reported in this publication was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health (NIH), under award number R01MD015256. Additionally, KRSS is supported by NCI grant T32CA009001, AKH by the NCI T32CA057711, PC by the NHLBI T32HL098048, BM by the Stanford Maternal Child Health Research Institute Clinical Trainee Support Grant and the Diversity Fellowship from the American Society for Reproductive Medicine Research Institute, BGE by NICHD R01HD091405, and SM by the Thomas O. Pyle Fellowship through the Harvard Pilgrim Health Care Foundation and Harvard University, NHLBI T32HL098048, NIMH R01MH112384, and the William T. Grant Foundation grant number 187958. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The first author recently had a leadership role in the not-for-profit program, The Lesbian Health Fund, a research fund focused on improving the health and wellbeing of LGBTQ+ women and girls. The fund did not have any role in this study and the author's relationship with the fund did not bias the findings of this manuscript. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Kodiak R S Soled
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tabor Hoatson
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Brent Monseur
- Division of Reproductive Endocrinology and Infertility, Stanford School of Medicine, Palo Alto, CA, USA
| | - Bethany Everett
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Payal Chakraborty
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Colleen A Reynolds
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Aimee K Huang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sarah McKetta
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Brittany M Charlton
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Harvard Medical School & Brigham and Women's Hospital, Boston, MA, USA
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Bush R, Staiger PK, McNeill IM, Brown R, Orellana L, Lubman D, McNair R. Evaluation of an SMS Based Alcohol Intervention for Same Sex Attracted Women: A Randomized Controlled Trial to Examine Feasibility, Acceptability, and Efficacy. Subst Use Misuse 2024; 59:1157-1166. [PMID: 38407160 DOI: 10.1080/10826084.2024.2321257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
PURPOSE The purpose of this randomized controlled trial (Trial registration ID: redacted) was to examine the feasibility, acceptability, and efficacy of the Step One program, an SMS-based alcohol intervention for same-sex attracted women (SSAW). METHODS Ninety-seven SSAW who scored ≥8 on the Alcohol Use Disorders Identification Test (AUDIT) were randomly allocated to receive the Step One program (n = 47; mean age = 36.79) or a weekly message containing a link to a website with health information and support services for LGBT individuals (n = 50; mean age = 34.08). Participants completed questionnaires on alcohol use, wellbeing, and help-seeking at baseline (T1), intervention completion (T2; 4 wk after baseline) and 12 wk post-intervention (T3). In addition, participants in the intervention condition completed feasibility and accessibility measures at T2, and a subsample (n = 10) was interviewed about acceptability at T3. RESULTS Across conditions, participants significantly reduced their alcohol intake and improved their wellbeing and help-seeking over time. However, there were no significant differences between the intervention and control condition. Furthermore, frequency of help-seeking was low; only four intervention group participants and three control group participants began accessing support between T1 and T3. Overall, our findings indicate the intervention would benefit from revision prior to implementation. CONCLUSIONS Our approach was consistent with best practice in the development of an ecologically valid intervention; however, this intervention, in its current form, lacks the complexity desired by its users to optimally facilitate alcohol reduction among SSAW. Keywords: Alcohol intervention; Intervention mapping framework; Randomized controlled trial (RCT); Same-sex attracted women; Short-message service (SMS).
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Affiliation(s)
- Rachel Bush
- School of Psychology, Deakin University, Geelong, Australia
| | | | - Ilona M McNeill
- School of Psychology, Deakin University, Geelong, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Rhonda Brown
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | | | - Dan Lubman
- Turning Point, Monash University, Eastern Health, Richmond, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Carlton, Australia
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West BT, Engstrom CW, Schepis TS, Tani IJ, McCabe SE. How a "Something Else" Response Option for Sexual Identity Affects National Survey Estimates of Associations Between Sexual Identity, Reproductive Health, and Substance Use. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:107-126. [PMID: 37853260 PMCID: PMC10794379 DOI: 10.1007/s10508-023-02710-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/28/2023] [Accepted: 09/14/2023] [Indexed: 10/20/2023]
Abstract
This randomized experiment tested whether the inclusion of a "something else" response option for a question about sexual identity in a national health survey would significantly moderate estimated differences between sexual identity subgroups in terms of various health outcomes, including substance use and reproductive health. We conducted secondary analyses of data from five consecutive years of the National Survey of Family Growth (NSFG; 2015-2019), where two large national half-samples were randomly assigned to receive one of two different versions of a question about sexual identity (a four-category version that included a "something else" response option or a three-category version omitting this option). We focused on national estimates of differences between subgroups defined by sexual identity. Multivariable models indicated that the estimated subgroup differences changed in a statistically significant fashion when using the four-category version of the sexual identity question for several measures, including 16% of male measures (household size, past-year cigarette use, and past-year illicit drug use) and 15% of female measures (wanting a/another child, ever had a sexually transmitted disease, and past-year marijuana use). The absence of a "something else" response option for questions about sexual identity in national health surveys may cause respondents to select options that do not accurately describe their identities, and this can have a significant effect on national estimates of differences between sexual identity subgroups in terms of selected health outcomes.
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Affiliation(s)
- Brady T West
- Survey Research Center, 4118 Institute for Social Research, University of Michigan-Ann Arbor, 426 Thompson St., Ann Arbor, MI, 48106, USA.
| | - Curtiss W Engstrom
- Program in Survey and Data Science, University of Michigan-Ann Arbor, Ann Arbor, MI, USA
| | - Ty S Schepis
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - Ilmul J Tani
- Program in Survey and Data Science, University of Michigan-Ann Arbor, Ann Arbor, MI, USA
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Salomaa AC, Matsick JL, Exten C, Kruk M. Different Categorizations of Women's Sexual Orientation Reveal Unique Health Outcomes in a Nationally Representative U.S. Sample. Womens Health Issues 2023; 33:87-96. [PMID: 35989158 DOI: 10.1016/j.whi.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 05/24/2022] [Accepted: 07/18/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Sexual minority women (i.e., women minoritized for their sexualities) are identified as high risk for mental health and substance use problems; however, there is no consensus on the criteria by which women are categorized as sexual minority. Though there is some evidence suggesting that certain subgroups of women are at higher risk than others based on sexual orientation, different categorization schemes for sexual orientation have yet to be compared within the same sample. METHOD Using data from the National Epidemiologic Survey of Alcohol and Related Conditions-III (N = 19,528), we examined how multiple categorization schemes (i.e., identity, behavior, recency of sexual behavior) for categorizing women who have sex with women (WSW) yield different estimates of prevalence of mental health and substance use issues. We used chi-square and logistic regression to analyze the link between sexual orientation categorization schemes and health, categorizing by 1) self-identification only, 2) behavior only, and 3) the combination of self-identification and behavior (recent vs. past). RESULTS We discovered high prevalence rates of health problems among heterosexual-identified WSW who reported no recent sexual activity with women (i.e., previously had sex with women but not within the past 12 months); this category of women comprised 35% of all WSW. DISCUSSION Step by step, we found more detailed information about these women's experiences by moving to the complex categorization scheme (the combination of self-identification and behavior). Heterosexual-identified women who have had sex with women in their past (though not recently) presented as a large group with high prevalence rates of substance use and mental disorders. These women remain invisible to researchers who categorize sexual orientation only by sexual identity or by behavior and ignore the role of behavior change over time-imprecisely categorizing such women as heterosexual or as women who have sex with men. They thus are underserved by health research and represent a significant population for further study and intervention.
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Affiliation(s)
- Anna C Salomaa
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania
| | - Jes L Matsick
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania; Department of Women's, Gender, and Sexuality Studies, The Pennsylvania State University, University Park, Pennsylvania
| | - Cara Exten
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania
| | - Mary Kruk
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania; Department of Women's, Gender, and Sexuality Studies, The Pennsylvania State University, University Park, Pennsylvania.
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Bogen KW, Jones HR, Lorenz TK. Relational and Trait Factors Mediate the Associations between Women's Intoxication-Related Unwanted Sexual Experiences, Pleasure, and Desire. JOURNAL OF SEX RESEARCH 2022; 59:1175-1191. [PMID: 35262426 PMCID: PMC9458769 DOI: 10.1080/00224499.2022.2030661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Despite documented negative sexual health sequelae of unwanted sexual contact (USC), it is unclear why individuals who have experienced USC within the context of intoxication (intoxication-related USC) are at particular risk for poor sexual functioning. Intoxication-related USC may impact relational factors like relationship satisfaction, as trauma symptoms interfere with emotional closeness during sex. Additionally, although individual traits - such as sexual excitation and sensation seeking - affect the relationship between trauma and sexual functioning, it is unknown whether these factors differentially impact those who have experienced intoxication-related USC. Finally, because presence of a partner may evoke trauma-related symptoms during partnered (dyadic) sexual activity, mediators may differ across solitary versus dyadic sexual pleasure and desire. We tested relational and individual trait mediators of the association between intoxication-related USC and solitary and dyadic sexual pleasure and desire in a sample of heterosexual and sexual minority women. Trait factors consistently mediated the association between intoxication-related USC and both dyadic and solitary desire and pleasure, while relational factors such as emotional closeness were inconsistently related to sexual wellbeing. If replicated, these findings would suggest that trait factors may be useful targets for clinical sexual wellness interventions among sexuality-diverse women who have experienced intoxication-related USC.
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Affiliation(s)
- Katherine W. Bogen
- University of Nebraska – Lincoln, Department of Psychology; 238 Burnett Hall, Lincoln, NE 68588
- University of Nebraska – Lincoln, Center for Brain, Biology, and Behavior; C89 East Stadium, Lincoln, NE 68588
| | - Harper R. Jones
- University of Nebraska – Lincoln, Department of Psychology; 238 Burnett Hall, Lincoln, NE 68588
- University of Nebraska – Lincoln, Center for Brain, Biology, and Behavior; C89 East Stadium, Lincoln, NE 68588
| | - Tierney K. Lorenz
- University of Nebraska – Lincoln, Department of Psychology; 238 Burnett Hall, Lincoln, NE 68588
- University of Nebraska – Lincoln, Center for Brain, Biology, and Behavior; C89 East Stadium, Lincoln, NE 68588
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Perales F, Campbell AK, Everett BG, McNair R, Hughes TL. Prevalence and Sociodemographic Correlates of Identifying as Mainly Heterosexual: Stability and Change across Three Cohorts of Australian Women. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3459-3477. [PMID: 34008060 DOI: 10.1007/s10508-021-02000-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 06/12/2023]
Abstract
In recent decades, the ways in which sexual minorities identify have changed dramatically. In response, social and health surveys have begun offering a greater range of response options within sexual orientation questions-for example, intermediate categories for "mainly heterosexual" and "mainly lesbian/gay" alongside the more common response options of "heterosexual," "bisexual," and "lesbian/gay." Recent studies indicate that women who identify as "mainly heterosexual" report poorer health, greater health-risk behaviors, and higher rates of victimization than women identifying as "exclusively heterosexual." However, we know very little about the demographic profile of women who choose the "mainly heterosexual" identity label compared to the adjacent "exclusively heterosexual" or "bisexual" labels or about changes over time in the prevalence and correlates of "mainly heterosexual" identification. This study addressed these knowledge gaps by modeling unique, high-quality survey data from three national cohorts of Australian women (Australian Longitudinal Study on Women's Health, 2000-2017, n = 76,930 observations). Consistent with the facilitative environments model, we document stark cross-cohort increases in the percentage of Australian women identifying as "mainly heterosexual"-from ∼1% of those born in 1946-1951 to ∼26% of those born in 1989-1995, coinciding with comparable declines in the percentage of women identifying as "exclusively heterosexual." We also found evidence of cohort differences in the associations between key sociodemographic factors-such as age, education, and socioeconomic status-and the likelihood of women identifying as "mainly heterosexual." Finally, our results indicate that same-sex sexual attractions were more strongly associated with "mainly heterosexual" identification than was same-sex sexual behavior.
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Affiliation(s)
- Francisco Perales
- School of Social Science, University of Queensland, Michie Building (#9), St Lucia Campus, St Lucia, Brisbane, QLD, 4072, Australia.
| | - Alice K Campbell
- Institute for Social Science Research, University of Queensland, Brisbane, QLD, Australia
| | | | - Ruth McNair
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Tonda L Hughes
- School of Nursing and Department of Psychiatry, Columbia University, New York City, NY, USA
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Lorenz TK. Sexual excitation and sex-linked substance use predict overall cannabis use in mostly heterosexual and bisexual women. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:433-443. [PMID: 34114916 PMCID: PMC8380726 DOI: 10.1080/00952990.2021.1922429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 01/25/2023]
Abstract
Background: Bisexual and mostly heterosexual women report higher substance use than exclusively heterosexual or lesbian women. In sexual minority men, sex-linked substance use (SLSU) can increase risk for substance use problems; equivalent research in women is lacking.Objectives: To test if sexual excitation and inhibition mediate the association between sexual minority status and women's SLSU.Methods: We surveyed a convenience sample of 595 undergraduate women who identified as exclusively heterosexual (n = 499), mostly heterosexual (n = 59), or bisexual (n = 37). Participants reported on their last month use of alcohol, cannabis, and other drugs (e.g., cocaine) in sexual and non-sexual contexts, and symptoms of alcohol and non-alcohol drug use disorders (e.g., withdrawal symptoms). Drug use symptoms were collapsed across non-alcohol substances. We used structural equation modeling to test serial mediations of women's SLSU and overall drug and alcohol use.Results: Bisexual and mostly heterosexual women reported higher cannabis use (η2 = 0.030) and drug use disorder symptoms (η2 = 0.050) than heterosexual women. Mostly heterosexual women's SLSU was a stronger predictor of alcohol use (η2 = 0.019) and binge drinking frequency (η2 = 0.015) than for other orientation groups. Bisexual and mostly heterosexual women's higher sexual excitation predicted their higher SLSU, which in turn predicted higher cannabis use frequency and drug use disorder symptoms. However, sexual inhibition failed to mediate either SLSU or overall substance use.Conclusion: These findings point to SLSU as a mechanism by which sexual minority women may experience disparities in substance use related harms.
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Affiliation(s)
- Tierney K Lorenz
- Department of Psychology and Center for Brain, Biology & Behavior, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
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8
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Hughes TL, Wilsnack SC, Martin K, Matthews A(P, Johnson TP. Alcohol use among sexual minority women: Methods used and lessons learned in the 20-Year Chicago Health and Life Experiences of Women Study. INTERNATIONAL JOURNAL OF ALCOHOL AND DRUG RESEARCH 2021; 9:30-42. [PMID: 37946724 PMCID: PMC10634638 DOI: 10.7895/ijadr.289] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
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.
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Affiliation(s)
- Tonda L. Hughes
- School of Nursing and Department of Psychiatry, Columbia University
| | - Sharon C. Wilsnack
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine & Health Sciences
| | - Kelly Martin
- School of Nursing and Department of Psychiatry, Columbia University
| | | | - Timothy P. Johnson
- Center for Clinical and Translational Science, University of Illinois at Chicago
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Baams L, Ten Have M, de Graaf R, de Jonge P. Childhood trauma and bullying-victimization as an explanation for differences in mental disorders by sexual orientation. J Psychiatr Res 2021; 137:225-231. [PMID: 33691234 PMCID: PMC7612811 DOI: 10.1016/j.jpsychires.2021.02.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 02/03/2021] [Accepted: 02/17/2021] [Indexed: 11/18/2022]
Abstract
Sexual minority individuals are more likely to have mental disorders, including mood, anxiety, and substance use disorders, compared to heterosexual individuals. Whether experiencing trauma or bullying-victimization during childhood explains these differences is currently unclear. We used a psychiatric epidemiological general population-based study to assess whether childhood trauma severity and bullying-victimization before age 16 explains the difference by sexual attraction in mental disorders. Data from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2; N = 6392) were used to examine (1) whether same/both-sex attraction and predominantly other-sex attraction is linked to self-reports of childhood trauma (types and severity) and bullying-victimization, and (2) whether these experiences explain differences between these groups in lifetime and 12-month prevalence of DSM-IV disorders assessed by the Composite International Diagnostic Interview 3.0. Same/both-sex attracted individuals reported a higher childhood trauma severity score compared to exclusively other-sex attracted individuals (B = 0.93, SE = 0.20, p < .001), and were more likely to report bullying-victimization (OR = 2.51 95%CI[1.68, 3.74]). DSM-IV disorders were more prevalent among same/both-sex attracted individuals than among exclusively other-sex attracted individuals (ORs ranged from 1.57 to 4.68). There were no differences in DSM-IV disorders for predominantly other-sex attracted individuals. Childhood trauma severity explained between 9.0% and 57.0% of significant indirect associations between same/both-sex attraction and DSM-IV disorders. Sexual minority individuals experience more types of, and more severe childhood trauma, and are more likely to experience bullying-victimization. These negative experiences partly explained disparities in mental disorders.
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Affiliation(s)
| | - Margreet Ten Have
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), the Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), the Netherlands
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Freitag TM, Chen-Sankey JC, Duarte DA, Ramsey MW, Choi K. Variations in Substance Use and Disorders Among Sexual Minorities by Race/Ethnicity. Subst Use Misuse 2021; 56:921-928. [PMID: 33821743 PMCID: PMC9362562 DOI: 10.1080/10826084.2021.1899225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Little is known about racial/ethnic minority substance use and disorder-related disparities among sexual minorities as compared to their heterosexual counterparts. This study aimed to understand the associations between sexual minority status and substance use and disorders among U.S. adults stratified by race/ethnicity. Methods: We analyzed data from a sample of U.S. adults (n = 35,981) surveyed during the 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions-III. Respondents were categorized into four sexual minority statuses: heterosexual, gay/lesbian, bisexual, and conflicting. Respondents' substance (tobacco, alcohol, and marijuana) use and disorders were also assessed using standard measures. Weighted multivariable logistic regressions were used to examine the relationships between sexual minority status and substance use and disorders, stratified by race/ethnicity, adjusting for socio-demographic characteristics. Results: Sexual minority adults experienced a higher prevalence of substance use and disorders than heterosexuals. For example, bisexuals were more likely than heterosexuals to use marijuana (AOR = 3.45, 95% CI = 2.64-4.50) and have tobacco use disorders (AOR = 2.58, 95% CI = 2.02-3.28). These associations were stronger among racial/ethnic minorities. For instance, bisexual non-Hispanic Blacks were more than twice as likely (AOR = 3.17, 95% CI = 2.16-4.65) to be current tobacco users than their heterosexual counterparts; while this association was weaker for bisexual non-Hispanic Whites (AOR = 1.99, 95% CI = 1.47-2.71). Conclusion: Sexual minority adults, especially those who are also racial/ethnic minorities, experience a significantly higher burden of substance use and disorders than heterosexuals. Efforts to screen and treat substance use and disorders among this particular population are critically needed to improve their health outcomes and reduce health disparities.
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Affiliation(s)
- Thomas M Freitag
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD.,Dietrich School of Arts and Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Julia C Chen-Sankey
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD
| | - Danielle A Duarte
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD
| | | | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD
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11
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Trocki KF, Mericle AA, Drabble LA, Klinger JL, Veldhuis CB, Hughes TL, Karriker-Jaffe KJ. Investigating differential protective effects of marriage on substance use by sexual identity status. INTERNATIONAL JOURNAL OF ALCOHOL AND DRUG RESEARCH 2020; 8:69-80. [PMID: 33510823 PMCID: PMC7837608 DOI: 10.7895/ijadr.267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Research suggests that marriage is protective against substance use. However, few studies have examined whether this protective effect differs for sexual minorities, a population at increased risk for substance use. Using data from four waves of the cross-sectional U.S. National Alcohol Survey (NAS; 2000, 2005, 2010, and 2015), we investigated whether the protective effects of marriage varied by sexual identity. METHODS Sex-stratified logistic regression models were used to examine independent and interactive effects of current marital status (being married vs. not) and sexual minority status (lesbian/gay/bisexual vs. heterosexual) on high-intensity drinking, alcohol use disorder, and marijuana use in the past year. RESULTS Among both women and men, sexual minority status was generally associated with higher odds of these outcomes and marriage was consistently associated with lower odds. Differential effects of marriage by sexual identity with respect to marijuana use were found only among men; marriage was significantly associated with decreased odds of marijuana use among heterosexual men but increased odds among sexual minority men. CONCLUSIONS Marriage may be less consistently protective against hazardous drinking and marijuana use among sexual minorities than heterosexuals. Findings underscore the importance of both quantitative and qualitative studies designed to better understand disparities in substance use across both sexual identity and relationship statuses.
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Affiliation(s)
- Karen F. Trocki
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Amy A. Mericle
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Laurie A. Drabble
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
- San José State University College of Health and Human Sciences, One Washington Square, San Jose, CA 95192-0049, USA
| | - Jamie L. Klinger
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Cindy B. Veldhuis
- School of Nursing, Columbia University, 630 West 168 Street, Mail Box Code 6, New York, NY 10032, USA
| | - Tonda L. Hughes
- School of Nursing, Columbia University, 630 West 168 Street, Mail Box Code 6, New York, NY 10032, USA
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12
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Karriker-Jaffe KJ, Drabble L, Trocki KF, Hughes TL, Greenfield TK. Harm from Others' Drinking Among Sexual Minority Adults in the United States. LGBT Health 2020; 8:50-59. [PMID: 33337273 DOI: 10.1089/lgbt.2020.0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose: Due to discrimination and stigma, sexual minority adults may be more likely than their heterosexual counterparts to experience harms from other people's drinking. We compared prevalence of second-hand alcohol harms for sexual minority and heterosexual adults in the United States. Methods: Data from the 2014-15 U.S. National Alcohol Survey (n = 5516; 10.2% sexual minority adults) were analyzed using logistic regression with survey weights to account for sampling and nonresponse. Multivariable models included simple main effects of sexual identity on the past-year harm outcomes, as well as interactions of drinker status with sexual identity. Results: In bivariate results stratified by sex, bisexual women were significantly more likely than heterosexual women to report all five types of harms. Lesbian respondents had greater odds relative to heterosexual women of reporting harm by a friend/coworker and assault or physical harm by a drinker. Bisexual identity among men was associated with greater odds of reporting assault/physical harm relative to heterosexual men in bivariate models. In adjusted models, differences by sexual identity were substantially reduced, with significance remaining only for friend/coworker-perpetrated harms and assault/physical harm among lesbian respondents compared with heterosexual women. For assault/physical harm, an interaction of sexual identity with the respondent's own drinking showed that the increased odds of harm associated with heavy drinking was even greater among sexual minority respondents (both bisexual and lesbian/gay respondents) than among heterosexual respondents. Conclusion: These findings underscore the importance of preventive interventions that consider disparities in risk for alcohol-related harms, particularly interpersonal violence, among sexual minority adults in the United States.
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Affiliation(s)
| | - Laurie Drabble
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA.,College of Health and Human Sciences, San Jose State University, San Jose, California, USA
| | - Karen F Trocki
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - Tonda L Hughes
- School of Nursing and Department of Psychiatry, Columbia University, New York, New York, USA
| | - Thomas K Greenfield
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
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13
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Swiatlo AD, Kahn NF, Halpern CT. Intimate Partner Violence Perpetration and Victimization Among Young Adult Sexual Minorities. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2020; 52:97-105. [PMID: 32462714 PMCID: PMC7669537 DOI: 10.1363/psrh.12138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 01/17/2020] [Accepted: 03/04/2020] [Indexed: 05/24/2023]
Abstract
CONTEXT Intimate partner violence (IPV) among sexual minority young adults has been understudied, and victimization and perpetration estimates are needed. METHODS Data on 13,653 women and men aged 24-32 who participated in Wave 4 of the National Longitudinal Study of Adolescent to Adult Health were used to examine associations between sexual orientation and IPV perpetration and victimization in respondents' current or most recent relationship. Logistic regression analyses were used to identify associations between respondent characteristics and three IPV categories (physical violence, threatened violence and forced sex). RESULTS Some 94% of males and 80% of females identified as 100% heterosexual; 4% of males and 16% of females as mostly heterosexual; 1% of males and 2% of females as bisexual; and 2% of males and females as either mostly homosexual or 100% homosexual. Compared with their heterosexual counterparts, mostly heterosexual women were more likely to report having perpetrated or been a victim of physical IPV (odds ratios, 1.9 and 1.6, respectively), having threatened violence (2.0) and having been a victim of threatened violence and forced sex (1.6 for each); mostly heterosexual males were more likely to have been a perpetrator or victim of physical IPV (3.1 and 1.8, respectively) and a perpetrator of forced sex and threatened violence (2.0 and 1.8, respectively). Bisexual males had elevated odds of physical violence victimization (3.3) and forced sex victimization (4.9) and perpetration (5.0). CONCLUSIONS Some sexual minority groups are disproportionately affected by IPV, indicating a need for increased prevention efforts and for studies exploring the mechanisms underlying these differences.
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Affiliation(s)
- Alison D Swiatlo
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill
| | - Nicole F Kahn
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill
| | - Carolyn T Halpern
- Department of Maternal and Child Health and Carolina Population Center, University of North Carolina at Chapel Hill
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14
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McCauley HL, Jones KA, Rofey DL, Reid TA, Miller E, Coulter RWS. Sexual Assault, Alcohol Use, and Gender of Sexual Partners Among Cisgender Women Seeking Care at US College Health Centers, 2015-2018. Am J Public Health 2020; 110:850-856. [PMID: 32298176 DOI: 10.2105/ajph.2020.305586] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To assess differences by gender of sexual partner in the association between sexual assault and alcohol use among women seeking care in college health centers.Methods. This longitudinal study comprised 1578 women aged 18 to 24 years visiting 28 college health centers in Pennsylvania and West Virginia from 2015 to 2018. We used multilevel logistic regression and negative binomial regression, testing for interactions of gender of sexual partners, sexual assault, and prevalence and frequency of alcohol use and binge drinking.Results. Sexual assault was reported by 87.3% of women who had sex with women or with women and men (WSWM), 68.2% of women who had sex with men only (WSM), and 47.5% of women with no penetrative sexual partners. The relative associations between sexual assault and alcohol outcomes were smaller for WSWM (prevalence: odds ratios from 0.04 to 0.06; frequency: incidence rate ratios [IRRs] from 0.24 to 0.43) and larger for women who had no penetrative sexual partners (IRRs from 1.55 to 2.63), compared with WSM.Conclusions. Alcohol use patterns among women who have experienced sexual assault differ by gender of sexual partners.
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Affiliation(s)
- Heather L McCauley
- Heather L. McCauley is with the School of Social Work and Taylor A. Reid is with the Department of Human Development and Family Studies at Michigan State University, East Lansing. Kelley A. Jones and Elizabeth Miller are with the Department of Pediatrics and Dana L. Rofey is with the Department of Psychiatry at University of Pittsburgh School of Medicine, Pittsburgh, PA. Robert W. S. Coulter is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh
| | - Kelley A Jones
- Heather L. McCauley is with the School of Social Work and Taylor A. Reid is with the Department of Human Development and Family Studies at Michigan State University, East Lansing. Kelley A. Jones and Elizabeth Miller are with the Department of Pediatrics and Dana L. Rofey is with the Department of Psychiatry at University of Pittsburgh School of Medicine, Pittsburgh, PA. Robert W. S. Coulter is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh
| | - Dana L Rofey
- Heather L. McCauley is with the School of Social Work and Taylor A. Reid is with the Department of Human Development and Family Studies at Michigan State University, East Lansing. Kelley A. Jones and Elizabeth Miller are with the Department of Pediatrics and Dana L. Rofey is with the Department of Psychiatry at University of Pittsburgh School of Medicine, Pittsburgh, PA. Robert W. S. Coulter is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh
| | - Taylor A Reid
- Heather L. McCauley is with the School of Social Work and Taylor A. Reid is with the Department of Human Development and Family Studies at Michigan State University, East Lansing. Kelley A. Jones and Elizabeth Miller are with the Department of Pediatrics and Dana L. Rofey is with the Department of Psychiatry at University of Pittsburgh School of Medicine, Pittsburgh, PA. Robert W. S. Coulter is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh
| | - Elizabeth Miller
- Heather L. McCauley is with the School of Social Work and Taylor A. Reid is with the Department of Human Development and Family Studies at Michigan State University, East Lansing. Kelley A. Jones and Elizabeth Miller are with the Department of Pediatrics and Dana L. Rofey is with the Department of Psychiatry at University of Pittsburgh School of Medicine, Pittsburgh, PA. Robert W. S. Coulter is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh
| | - Robert W S Coulter
- Heather L. McCauley is with the School of Social Work and Taylor A. Reid is with the Department of Human Development and Family Studies at Michigan State University, East Lansing. Kelley A. Jones and Elizabeth Miller are with the Department of Pediatrics and Dana L. Rofey is with the Department of Psychiatry at University of Pittsburgh School of Medicine, Pittsburgh, PA. Robert W. S. Coulter is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh
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15
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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: 66] [Impact Index Per Article: 16.5] [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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16
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Drabble LA, Mericle AA, Karriker-Jaffe KJ, Trocki KF. Harmful drinking, tobacco, and marijuana use in the 2000-2015 National Alcohol Surveys: Examining differential trends by sexual identity. Subst Abus 2020; 42:317-328. [PMID: 31951792 PMCID: PMC7365749 DOI: 10.1080/08897077.2019.1709251] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Population-based surveys document disparities in substance use among sexual minorities compared to heterosexuals, but few studies examine changes over time. This study compared changes in harmful drinking (including alcohol use disorders and high-intensity drinking), tobacco use, marijuana use, and simultaneous marijuana and alcohol co-use between heterosexual and sexual minority adults over a 15-year period. Methods: Gender-stratified logistic regression analyses using 4 waves of cross-sectional data from the National Alcohol Survey (2000, 2005, 2010, and 2015) were conducted to test overall trends over time and differences by sexual identity, as well as the interaction between survey year and sexual identity. Results: Among women, significant effects for sexual identity were present in all models, reflecting greater odds of use among sexual minorities across waves. Among men, significant effects for sexual identity were found for high-intensity drinking (reflecting less use among sexual minorities) as well as marijuana use and marijuana and alcohol co-use (reflecting more use among sexual minorities). For women and men, tobacco use generally decreased and both marijuana use and simultaneous marijuana and alcohol co-use increased during the study period. Although trends were largely driven by heterosexual respondents, only one instance of an interactive effect was found; reports of harmful drinking were generally stable over time among heterosexual women, but higher and more variable over time among sexual minority women. Conclusions: Findings highlight that differences in patterns of substance use by sexual identity persist and underscore the need for screening, prevention, and intervention, particularly for sexual minority women.
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Affiliation(s)
- Laurie A Drabble
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
- College of Health and Human Sciences, San Jose State University, San Jose, CA, USA
| | - Amy A Mericle
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | | | - Karen F Trocki
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
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17
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Krueger EA, Fish JN, Upchurch DM. Sexual Orientation Disparities in Substance Use: Investigating Social Stress Mechanisms in a National Sample. Am J Prev Med 2020; 58:59-68. [PMID: 31761516 PMCID: PMC6925636 DOI: 10.1016/j.amepre.2019.08.034] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Sexual minorities are disproportionately more likely than heterosexuals to suffer from substance use disorders, but relatively little is known about differences in substance use disorders across diverse sexual minority subgroups. There is also limited understanding of how different social stressors account for sexual orientation disparities in substance use disorders. METHODS Using nationally representative data collected in 2012-2013 (n=34,597), differences in past-year DSM-5 alcohol, cannabis, and tobacco use disorders were assessed across 4 sexual orientation groups (heterosexuals and 3 sexual minority subgroups, lesbian/gay-, bisexual-, and heterosexual-identified sexual minorities). This study assessed whether stressful life events mediated substance use disorder disparities between heterosexuals and each sexual minority subgroup, and whether stressful life events and lesbian, gay, and bisexual discrimination events mediated these substance use disorder differences. Analyses were conducted in 2019. RESULTS For both men and women, substance use disorders and stress experiences varied by sexual identity. For example, compared with heterosexual men, larger proportions of gay and bisexual men had a past-year alcohol use disorder. Among women, all sexual minority subgroups had higher rates of each substance use disorder than heterosexuals. For each substance use disorder, stressful life events mediated disparities between heterosexuals and sexual minority subgroups, except for heterosexual-identified sexual minority men. Both stressful life events and lesbian, gay, and bisexual discrimination mediated substance use disorder differences between sexual minority subgroups, with stronger indirect effects through lesbian, gay, and bisexual discrimination for lesbians/gay men and stronger indirect effects through stressful life events for bisexual adults, generally. CONCLUSIONS Sexual minority subgroups have a greater prevalence of substance use disorders, mediated through both stressful life events and lesbian, gay, and bisexual discrimination. More research is needed to comprehensively assess the processes underlying sexual orientation substance use disparities.
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Affiliation(s)
- Evan A Krueger
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California.
| | - Jessica N Fish
- Department of Family Science, University of Maryland School of Public Health, College Park, Maryland
| | - Dawn M Upchurch
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California
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18
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Hequembourg AL, Blayney JA, Bostwick W, Van Ryzin M. Concurrent Daily Alcohol and Tobacco Use among Sexual Minority and Heterosexual Women. Subst Use Misuse 2020; 55:66-78. [PMID: 31446825 DOI: 10.1080/10826084.2019.1656252] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Studies show that sexual minority women (SMW) report more hazardous alcohol use patterns and higher rates of tobacco use than exclusively heterosexual women. Despite the public health implications of drinking and smoking, especially when they co-occur, little is known about SMW's daily use patterns or the factors that may facilitate concurrent use. Objectives: The present study seeks to identify patterns of daily concurrent alcohol and tobacco use among SMW and heterosexual women, including socio-environmental drinking contexts of concurrent use. Methods: Data come from a community sample of lesbian, bisexual, and heterosexual women (N = 246) who completed up to 84 consecutive days of web-based reports about substance use. Results: Participants reported 4,012 drinking days (24%), 2,019 smoking days (12%), and 769 concurrent drinking and smoking days (5%). No differences were found between SMW and heterosexual women in the proportion of drinking days; however, SMW consumed more drinks on drinking days. SMW also reported a greater proportion of smoking days, more cigarettes smoked on smoking days, and a greater proportion of concurrent drinking and smoking days. Reciprocal daily relationships between alcohol and tobacco use were identified, and these relationships were strongest for bisexual women. Socio-environmental factors-including certain locations, situations, and companions-increased the likelihood of concurrent use for all women; however, few sexual identity differences were found in concurrent use contexts. Importance: Results expand our understanding about daily concurrent alcohol and tobacco use risk among SMW, and potentially inform treatment research to better address the unique experiences of this vulnerable group.
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Affiliation(s)
- Amy L Hequembourg
- Research Institute on Addictions, University at Buffalo, The State University of New York, Buffalo, New York, USA.,School of Nursing, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Jessica A Blayney
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Wendy Bostwick
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
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19
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Solomon CA, Laditka SB, Forthofer M, Racine EF. Black-white disparities in alcohol consumption trends among women in the United States, 1990-2015. J Ethn Subst Abuse 2019; 20:625-646. [PMID: 31709927 DOI: 10.1080/15332640.2019.1685049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Alcohol consumption has more adverse consequences among African American women than among white women. Yet little is known about trends in alcohol consumption among African American women. Using the National Survey on Drug Use and Health, we examined trends in alcohol consumption among African American (n = 4,079) and white (n = 17,512) women, 1990-2015. We calculated population prevalence and used the Cochrane-Armitage test to examine trends, controlling for sociodemographic factors. In adjusted analyses, binge consumption increased for African American and white women; not consuming alcohol decreased among African Americans (all p < 0.05). Results highlight the need for culturally sensitive prevention and intervention strategies.
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Affiliation(s)
| | - Sarah B Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Melinda Forthofer
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Elizabeth F Racine
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina
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20
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Fish JN. Sexual Orientation-Related Disparities in High-Intensity Binge Drinking: Findings from a Nationally Representative Sample. LGBT Health 2019; 6:242-249. [PMID: 31184966 PMCID: PMC6645197 DOI: 10.1089/lgbt.2018.0244] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
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.
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Affiliation(s)
- Jessica N. Fish
- Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland
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21
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Steele SM, Belvy L, Veldhuis CB, Martin K, Nisi R, Hughes TL. Femininity, masculinity, and body image in a community-based sample of lesbian and bisexual women. Women Health 2019; 59:829-844. [PMID: 30786850 DOI: 10.1080/03630242.2019.1567645] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study expands the literature on body image among lesbian and bisexual women by examining the relationship between self-perceived gendered personality traits and expressions (i.e., sense of self in relation to cultural constructions of femininity and masculinity) and body satisfaction, a key body image construct. We used data from Wave 3 (2010-2012) of the Chicago Health and Life Experiences of Women (CHLEW) study. The CHLEW includes a novel measure of gender expression, with masculinity and femininity as distinct but overlapping constructs. In the large analytic sample (N = 553), we found both similarities and differences in the association between femininity/masculinity and body image in lesbian and bisexual women. Bisexual women reported significantly lower body satisfaction than lesbian women. Higher masculinity was associated with greater body satisfaction in the full sample, but the association was stronger for bisexual than lesbian women. Femininity was positively associated with body satisfaction only for bisexual women. These findings suggest that masculinity and femininity play different roles in body satisfaction for lesbian and bisexual women and highlight the importance of disaggregating sexual identity in studies of sexual minority women's health. Clinicians should routinely ask about sexual identity and gender expression, especially when presenting concerns involve body image or disordered eating.
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Affiliation(s)
- Sarah M Steele
- Department of Sociology, University of Illinois at Chicago , Chicago , Illinois , USA
| | - Lisa Belvy
- Mental Health Service, Veterans Affairs Northern California Health Care System , Martinez , California , USA
| | - Cindy B Veldhuis
- School of Nursing, Columbia University , New York , New York , USA
| | - Kelly Martin
- School of Nursing, Columbia University , New York , New York , USA
| | - Robyn Nisi
- College of Nursing, University of Illinois , Chicago , Illinois , USA
| | - Tonda L Hughes
- School of Nursing and Department of Psychiatry, Columbia University , New York , New York , USA
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22
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Bush R, Brown R, McNair R, Orellana L, Lubman DI, Staiger PK. Effectiveness of a culturally tailored SMS alcohol intervention for same-sex attracted women: protocol for an RCT. BMC WOMENS HEALTH 2019; 19:29. [PMID: 30728002 PMCID: PMC6364437 DOI: 10.1186/s12905-019-0729-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 01/28/2019] [Indexed: 11/10/2022]
Abstract
Background There is a large disparity between alcohol treatment access and prevalence of hazardous drinking among same-sex attracted women (SSAW). Yet, this population typically report low satisfaction with care and a reluctance to attend mainstream health services. Currently, there are few culturally tailored services for SSAW available despite evidence indicating that many feel uncomfortable in mainstream services. This paper describes the protocol of a randomised controlled trial aimed at examining the impact of a culturally sensitive four-week short message service (SMS) alcohol intervention on SSAW’s alcohol intake, wellbeing, and engagement with alcohol treatment. Methods A randomised controlled trial comparing a culturally tailored SMS intervention (The Step One Program) with a generic ‘thank you’ message, and a nested qualitative study to further explore the intervention’s feasibility and acceptability. The Step One Program was co-designed using an Intervention Mapping framework and engaging potential consumers in the developmental process. Participants are block randomised (1:1 ratio) and followed up at the completion of the intervention and at 12 weeks post-intervention. The primary outcomes are alcohol reduction (as measured by the Alcohol Use Disorders Identification Test and self-reported alcohol intake), wellbeing (as measured by the Personal Wellbeing Index – Adult), and help-seeking (as measured by the number of alcohol services accessed and frequency of access). Upon completion of the 12-week post-intervention survey, participants in the intervention group were contacted via email regarding a phone interview on intervention acceptability. Discussion This study may have important implications for clinical practice, improve healthcare access and equity for SSAW, and provide direction for future research in this field. The outcomes of the current study may stimulate the development of other culturally tailored health programs for SSAW. The results will inform whether individually tailoring the messages according to content and delivery frequency may be warranted to increase its acceptability. Trial registration This trial was registered with the Australian New Zealand Clinical Trials Registry (trial ID: ACTRN12617000768392).
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Affiliation(s)
- Rachel Bush
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Australia
| | - Rhonda Brown
- School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Australia
| | - Liliana Orellana
- Biostatistics Unit, Deakin University, 221 Burwood Highway, Burwood, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health and Eastern Health Clinical School, Monash University, 110 Church St, Fitzroy, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Australia. .,Centre for Drug Use, Addiction and Anti-Social Behaviour Research (CEDAAR), Deakin University, Geelong, Australia.
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Krueger EA, Meyer IH, Upchurch DM. Sexual Orientation Group Differences in Perceived Stress and Depressive Symptoms Among Young Adults in the United States. LGBT Health 2018; 5:242-249. [PMID: 29741980 DOI: 10.1089/lgbt.2017.0228] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Overall, sexual minorities have poorer mental health than heterosexual individuals, and stress is thought to underlie such disparities. However, sexual minorities include both those identifying as lesbian, gay, or bisexual (LGB) and many who do not (e.g., individuals identifying as mostly heterosexual, or as heterosexual but with discordant same-sex attractions or behaviors), and little is known about the mental health or stress experiences of non-LGB identified sexual minorities. This study assessed perceived stress and depressive symptom differences between concordant heterosexual individuals and three groups of sexual minority young adults (LGB, mostly heterosexual, and discordant heterosexual individuals). METHODS Data were from the National Longitudinal Study of Adolescent to Adult Health, Wave IV (2008-2009). Descriptive and bivariate statistics were estimated. Path analyses assessed whether perceived stress mediated differences in depressive symptomatology. Analyses were weighted and gender-stratified. RESULTS Mostly heterosexual individuals comprised the largest sexual minority group, for both men (3.58%) and women (15.88%). All sexual minority groups reported significantly more depressive symptoms than concordant heterosexual individuals, for both men and women (all P < 0.05). Among women, all sexual minority groups reported significantly higher perceived stress than concordant heterosexual individuals (all P < 0.05), which partially mediated elevations in depressive symptomatology (all P < 0.05). Mostly-heterosexual-identified men reported significantly higher perceived stress than concordant heterosexual men (P < 0.01), which partially mediated elevations in depressive symptomatology (P < 0.01). CONCLUSIONS Our results underscore the importance of assessing sexual orientation comprehensively to fully understand sexual minority health disparities. Additional research should examine the stressors specific to different sexual minority groups.
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Affiliation(s)
- Evan A Krueger
- 1 Department of Community Health Sciences, Fielding School of Public Health, University of California , Los Angeles, Los Angeles, California
| | - Ilan H Meyer
- 2 The Williams Institute, School of Law, University of California , Los Angeles, Los Angeles, California
| | - Dawn M Upchurch
- 1 Department of Community Health Sciences, Fielding School of Public Health, University of California , Los Angeles, Los Angeles, California
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24
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Sievert LL, Jaff N, Woods NF. Stress and midlife women's health. Womens Midlife Health 2018; 4:4. [PMID: 30766714 PMCID: PMC6297937 DOI: 10.1186/s40695-018-0034-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/25/2018] [Indexed: 11/24/2022] Open
Abstract
Stress is ubiquitous in everyday life, and chronic stress can have negative consequences for health and social welfare. Although a growing body of research addresses the relationships between stress, health, and quality of life, there is a gap in the literature with regard to the effects of stress among women at midlife. The purpose of this commentary is to provide a brief history of stress research, including various methods for measuring stress; discuss the physiological effects of stress; and review relevant studies about women at midlife in order to identify unanswered questions about stress. This commentary also serves as an introduction to a thematic series on stress and women’s midlife health where stress is examined in relation to a wide range of symptom experiences, in the context of family and negative life events, as associated with women’s work, and correlated with the challenges of violence and discrimination. The goal of this commentary and thematic series is to extend the conversation about stress to include women at midlife, and to examine where we are, and where we are going, in order to direct future research and provide relevant care for this growing population.
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Affiliation(s)
- Lynnette Leidy Sievert
- 1Department of Anthropology, UMass Amherst, Machmer Hall, 240 Hicks Way, Amherst, MA 01003-9278 USA
| | - Nicole Jaff
- 2Department of Chemical Pathology, University of the Witwatersrand, Johannesburg, South Africa
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Matthews AK, Cho YI, Hughes TL, Wilsnack SC, Aranda F, Johnson T. The Effects of Sexual Orientation on the Relationship Between Victimization Experiences and Smoking Status Among US Women. Nicotine Tob Res 2018; 20:332-339. [PMID: 28339840 PMCID: PMC5896486 DOI: 10.1093/ntr/ntx052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 02/28/2017] [Indexed: 11/13/2022]
Abstract
Introduction This study examined the relationships between experiences of childhood and adulthood victimization and current smoking among heterosexual and sexual minority women. The main hypothesis was that victimization experiences would predict current smoking status. Further, we hypothesized that the effect of childhood victimization on self-reported smoker status would be mediated by adult victimization. Methods Data are from two studies conducted in the United States that used similar methods and questionnaires in order to conduct a comparative analysis of women based on sexual orientation. Data from Wave 1 (2000-2001) of the Chicago Health and Life Experiences of Women (CHLEW) study and from Wave 5 (2001) of the National Study of Health and Life Experiences of Women (NSHLEW) study were used in these analyses. Results Twenty-eight percent of the sample reported current smoking. Victimization experiences were common, with 63.4% of participants reporting at least one type of victimization in childhood and 40.2% reporting at least one type in adulthood. Women who identified as heterosexual were less likely to be victimized during childhood than were women who identified as lesbian or bisexual. Adult victimization had a significant effect on current smoker status, and the effect of childhood victimization on smoker status was mediated by adult victimization. When examined by sexual orientation, this indirect relationship remained significant only among bisexual women in the sample. Conclusions Study findings make a valuable contribution to the literature on victimization and health risk behaviors such as smoking. Given the negative and long-term impact of victimization on women, strategies are needed that reduce the likelihood of victimization and subsequent engagement in health risk behaviors such as smoking. Implications The study findings make a valuable contribution to the literature on sexual minority women's health on the influence of victimization on health risk behaviors. With the goal of reducing the likelihood of adult victimization and subsequent engagement in health risk behaviors, programs and policies aimed at preventing victimization of women are warranted. Providers and community health agencies should assess and target physically and sexually abused sexual minority youth for mental health intervention with the goal of interrupting the progression from childhood victimization to adult victimization and subsequent engagement in health risk behaviors.
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Affiliation(s)
- Alicia K Matthews
- Department of Health Systems Sciences, College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Young Ik Cho
- Department of community and behavioral health promotion, University of Wisconsin Milwaukee, Zilber School of Public Health, Community and Behavioral Health Promotion, Milwaukee, WI
| | - Tonda L Hughes
- Department of Health Systems Sciences, College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Sharon C Wilsnack
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND
| | - Frances Aranda
- Rush University Medical Center, Department of Behavioral Studies, Chicago, IL
| | - Timothy Johnson
- Department of Behavioral Studies, Survey Research Laboratory, University of Illinois at Chicago, Chicago, IL
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Hancock DW, Talley AE, Bohanek J, Iserman MD, Ireland M. Sexual Orientation Self-Concept Ambiguity and Alcohol Use Disorder Symptomology: The Roles of Motivated Psychological Distancing and Drinking to Cope. J Stud Alcohol Drugs 2018; 79:96-101. [PMID: 29227237 PMCID: PMC5894861 DOI: 10.15288/jsad.2018.79.96] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Women whose sexual identity is not exclusively heterosexual are at risk for alcohol use disorder (AUD) and problematic drinking. A textual analytic approach focusing on motivated psychological distancing in language style use was used to detect sexual minority women who are at greatest risk for an AUD. METHOD Young adult women (N = 254) were asked to complete a self-report measure of sexual orientation self-concept ambiguity as well as free-write about their sexuality. In addition, they completed a questionnaire assessing AUD symptoms according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The Linguistic Inquiry and Word Count (LIWC) program assessed language markers within participant-written essays that reflected acute states of aversive self-focus (i.e., fewer first-person pronouns, fewer present-tense verbs). RESULTS Drinking to cope with negative affectivity mediated the relationship between sexual orientation self-concept ambiguity and AUD symptomology. This indirect effect was conditional, moderated by higher use of language reflecting motivated psychological distancing, such that the indirect effect was significant only for women whose writing included fewer instances of first-person pronouns and present-tense verbs (-1 SD) compared with those with greater instances of first-person pronouns and present-tense verbs (+1 SD), reflecting motivated psychological distancing. CONCLUSIONS Sexual minority women are at an increased risk for AUD. Further, this study suggests mechanisms that may exacerbate the relationship between sexual identity uncertainty and problematic drinking. The study presents a novel method of identifying individuals most at risk for alcohol misuse: detecting aversive self-focus in language style and word choice.
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Affiliation(s)
- David W. Hancock
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas
| | - Amelia E. Talley
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas,Correspondence may be sent to Amelia E. Talley at the Department of Psychological Sciences, Texas Tech University, Box 42051, Lubbock, TX 79409-2051, or via email at:
| | - Jennifer Bohanek
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Micah D. Iserman
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas
| | - Molly Ireland
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas
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Pennay A, McNair R, Hughes TL, Leonard W, Brown R, Lubman DI. Improving alcohol and mental health treatment for lesbian, bisexual and queer women: Identity matters. Aust N Z J Public Health 2017; 42:35-42. [PMID: 29235690 DOI: 10.1111/1753-6405.12739] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/01/2017] [Accepted: 09/01/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Lesbian, bisexual and queer (LBQ) women experience substantial unmet alcohol and mental health treatment needs. This paper explores the way in which sexual identity shapes experience, and needs, in relation to alcohol and mental health treatment, and presents key messages for improving treatment. METHODS Twenty-five in-depth interviews were undertaken with same-sex attracted Australian women, aged 19-71. Interview transcripts were analysed thematically. RESULTS Key messages offered by participants focused on language, disclosure and practitioner training. Variation in sexual identity did not alter treatment expectations or needs; however, we noted an important difference with respect to identity salience, with high LBQ identity salience linked with preference for disclosure and acknowledgement of sexual identity in treatment interactions, and low identity salience linked with a preference not to disclose and for sexual identity not to require acknowledgement in treatment. CONCLUSIONS Treatment providers may find it useful to gather information about the centrality of sexual identity to LBQ women as a means of overcoming treatment barriers related to heteronormative conventions and discrimination, language and disclosure. Implications for public health: Treatment providers should adopt more inclusive language, seek information about identity salience and the importance of sexual identity to the current treatment, and regularly pursue LBQ-related professional development upskilling.
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Affiliation(s)
- Amy Pennay
- Centre for Alcohol Policy Research, La Trobe University, Victoria
| | - Ruth McNair
- Department of General Practice, University of Melbourne, Victoria
| | - Tonda L Hughes
- School of Nursing and Department of Psychiatry, Columbia University, New York City, NY, US
| | | | - Rhonda Brown
- School of Nursing and Midwifery, Deakin University, Victoria
| | - Dan I Lubman
- Turning Point, Eastern Health, Victoria.,Eastern Health Clinical School, Monash University, Victoria
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Veldhuis CB, Talley AE, Hancock DW, Wilsnack SC, Hughes TL. Alcohol Use, Age, and Self-Rated Mental and Physical Health in a Community Sample of Lesbian and Bisexual Women. LGBT Health 2017; 4:419-426. [PMID: 29099308 DOI: 10.1089/lgbt.2017.0056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Given that self-perceptions of mental and physical health are important predictors of health outcomes and well-being, particularly among older adults, this study focuses on associations among age, alcohol consumption, and indicators of both self-rated mental health and self-rated physical health in a sample of sexual minority women (SMW). METHODS This study uses a community sample of SMW to examine the associations among age, drinking, and self-rated mental and physical health. RESULTS Heavy drinking among older adult SMW (55+) was less prevalent than among young SMW, ages 18-25 and ages 26-39, but similar to rates reported among SMW ages 40-54. In addition, older SMW reported significantly higher levels of self-rated mental health, compared with SMW in the other age groups, but we found no significant associations between age and self-rated physical health. Across all age groups, moderate drinkers reported better self-rated physical health than alcohol abstainers. CONCLUSIONS Overall, these results suggest that, among SMW, drinking does not decline as sharply with age as it does for heterosexual women in the general population. Given the current and projected increases in the aging population and the risks that heavy drinking presents for morbidity and mortality, interventions aimed at older SMW are needed.
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Affiliation(s)
- Cindy B Veldhuis
- 1 Center for Research on Women and Gender, University of Illinois at Chicago , Chicago, Illinois.,2 Department of Health Systems Science, College of Nursing, University of Illinois at Chicago , Chicago, Illinois.,3 School of Nursing, Columbia University , New York, New York
| | - Amelia E Talley
- 4 Department of Psychological Sciences, Texas Tech University , Lubbock, Texas
| | - David W Hancock
- 4 Department of Psychological Sciences, Texas Tech University , Lubbock, Texas
| | - Sharon C Wilsnack
- 5 Department of Psychiatry and Behavioral Science, University of North Dakota , Grand Forks, North Dakota
| | - Tonda L Hughes
- 2 Department of Health Systems Science, College of Nursing, University of Illinois at Chicago , Chicago, Illinois.,3 School of Nursing, Columbia University , New York, New York
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Fish JN, Watson RJ, Porta CM, Russell ST, Saewyc EM. Are alcohol-related disparities between sexual minority and heterosexual youth decreasing? Addiction 2017; 112:1931-1941. [PMID: 28678415 PMCID: PMC5633511 DOI: 10.1111/add.13896] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/26/2017] [Accepted: 05/26/2017] [Indexed: 01/12/2023]
Abstract
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.
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Affiliation(s)
- Jessica N. Fish
- Corresponding Author, Population Research Center, University of
Texas at Austin, 305 E. 23 St., Stop G1800, Austin, TX 78712,
, PH: 512-471-4270, F:
512-471-4886
| | - Ryan J. Watson
- Department of Human Development and Family Studies, University of
Connecticut, 348 Mansfield Road, U-1058, Storrs, CT 06269
| | - Carolyn M. Porta
- School of Nursing, University of Minnesota, School of Nursing, Mail
Stop 1331 5-140 WDH, 308 Harvard St. SE, Minneapolis, MN 55455
| | - Stephen T. Russell
- Human Development and Family Sciences, University of Texas at
Austin, 108 E. Dean Keeton St., Stop A2702, Austin, TX, 78712
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Szalacha LA, Hughes TL, McNair R, Loxton D. Mental health, sexual identity, and interpersonal violence: Findings from the Australian longitudinal Women's health study. BMC Womens Health 2017; 17:94. [PMID: 28964264 PMCID: PMC5622594 DOI: 10.1186/s12905-017-0452-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We examined the relationships among experiences of interpersonal violence, mental health, and sexual identity in a national sample of young adult women in Australia. METHODS We used existing data from the third (2003) wave of young adult women (aged 25-30) in the Australian Longitudinal Study on Women's Health (ALSWH). We conducted bivariate analyses and fit multiple and logistic regression models to test experiences of six types of interpersonal violence (physical abuse, severe physical abuse, emotional abuse, sexual abuse, harassment, and being in a violent relationship), and the number of types of violence experienced, as predictors of mental health. We compared types and number of types of violence across sexual identity subgroups. RESULTS Experiences of interpersonal violence varied significantly by sexual identity. Controlling for demographic characteristics, compared to exclusively heterosexual women, mainly heterosexual and bisexual women were significantly more likely to report physical, sexual, and emotional abuse. Mainly heterosexual and lesbian women were more likely to report severe physical abuse. Mainly heterosexual women were more than three times as likely to have been in a violent relationship in the past three years, and all three sexual minority subgroups were two to three times as likely to have experienced harassment. Bisexual women reported significantly higher levels of depression than any of the other sexual identity groups and scored lower on mental health than did exclusively heterosexual women. In linear regression models, interpersonal violence strongly predicted poorer mental health for lesbian and bisexual women. Notably, mental health indicators were similar for exclusively heterosexual and sexual minority women who did not report interpersonal violence. Experiencing multiple types of interpersonal violence was the strongest predictor of stress, anxiety and depression. CONCLUSIONS Interpersonal violence is a key contributor to mental health disparities, especially among women who identify as mainly heterosexual or bisexual. More research is needed that examines within-group differences to determine which subgroups are at greatest risk for various types of interpersonal violence. Such information is critical to the development of effective prevention and intervention strategies.
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Affiliation(s)
- Laura A. Szalacha
- Office of Nursing Research, College of Nursing, University of Arizona, Tucson, USA
| | - Tonda L. Hughes
- Nursing and Psychiatry, School of Nursing, Columbia University, New York City, USA
- Global Health Research, School of Nursing, Columbia University, New York City, USA
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Deborah Loxton
- Australian Longitudinal Study on Women’s Health, University of Newcastle, Melbourne, Australia
- Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, Australia
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31
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Slater ME, Godette D, Huang B, Ruan WJ, Kerridge BT. Sexual Orientation-Based Discrimination, Excessive Alcohol Use, and Substance Use Disorders Among Sexual Minority Adults. LGBT Health 2017; 4:337-344. [PMID: 28876167 DOI: 10.1089/lgbt.2016.0117] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The purpose of this study was to examine relationships between sexual orientation-based discrimination and excessive alcohol use and substance use disorders and to identify how these relationships differ by sexual identity, sex, race, Hispanic origin, and education among sexual minorities. METHODS We used logistic regression to analyze associations between discrimination and substance use measures among 1351 gay/lesbian, bisexual, or unsure adults from a nationally representative survey. Differential effects by sexual identity, sex, race, Hispanic origin, and education were assessed using interaction models followed by stratified models. RESULTS Discrimination was associated with increased odds of the following: exceeding weekly drinking limits [adjusted odds ratio (aOR) = 1.52, 95% confidence interval (CI): 1.12-2.08] among bisexuals, any substance use disorder (aOR = 2.04, 95% CI: 1.41-2.95) and nicotine use disorder (aOR = 1.52, 95% CI: 1.08-2.14) among Hispanic sexual minorities, and exceeding weekly drinking limits (aOR = 1.56, 95% CI: 1.08-2.26) among those with a high school degree or less. CONCLUSION Sexual orientation-based discrimination was associated with select substance use outcomes, especially among bisexuals, Hispanics, and less educated sexual minority adults, highlighting potential disparities associated with experiencing discrimination.
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Affiliation(s)
| | - Dionne Godette
- 2 National Institute on Alcohol Abuse and Alcoholism , Rockville, Maryland
| | - Boji Huang
- 2 National Institute on Alcohol Abuse and Alcoholism , Rockville, Maryland
| | - W June Ruan
- 2 National Institute on Alcohol Abuse and Alcoholism , Rockville, Maryland
| | - Bradley T Kerridge
- 3 Department of Epidemiology, Columbia University Mailman School of Public Health , New York, New York
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Abstract
BACKGROUND Prescription drug, e-cigarette, smokeless tobacco, and synthetic marijuana use has risen dramatically in the United States over the past decade. OBJECTIVES This paper investigates the use of risky substances among adolescents, and examines disparities between sexual minority (i.e., mostly heterosexual and lesbian, gay, bisexual; LGB) and heterosexual adolescents in use of novel and emerging substances. Given the public health risk and the imminence of these substances in the media, emerging drug use was examined in a county wide sample of adolescents in a Southern state. METHODS A probability sample of middle and high school students (N = 3012; ages 11-18) using random cluster methods was obtained in a mid-sized school district in the Southeastern United States. RESULTS LGB adolescents reported higher past-30 day and lifetime use of cigarettes (AORs =2.77, 2.90, respectively), smokeless tobacco (lifetime only: AOR = 1.88), e-cigarettes (lifetime only; AOR = 1.92), alcohol (AORs = 1.7, 2.20), marijuana (AORs = 3.02, 3.06), synesthetic marijuana (AORs = 3.77, 2.48), and prescription drugs (AORs = 3.82, 2.55). Adolescents who self-identified as "mostly heterosexual" reported higher lifetime cigarette use, and past 30-day use of e-cigarettes and prescription drugs as compared with heterosexual adolescents. CONCLUSIONS Our results are notable given the dearth of data documenting use of increasingly emerging or "trendy" substances such as prescription drugs. More research is needed to understand the underlying cause of these disparities, and efforts should be targeted toward this population to reduce negative outcomes from misuse.
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Affiliation(s)
- Jeremy T Goldbach
- a School of Social Work, University of Southern California , Los Angeles , California , USA
| | - Ethan H Mereish
- b Center for Alcohol and Addiction Studies, Brown University , Providence , Rhode Island , USA
| | - Claire Burgess
- c Department of Clinical Science , University of Southern California , Los Angeles , California , USA
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Everett BG, Talley AE, Hughes TL, Wilsnack SC, Johnson TP. Sexual Identity Mobility and Depressive Symptoms: A Longitudinal Analysis of Moderating Factors Among Sexual Minority Women. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1731-44. [PMID: 27255306 PMCID: PMC5500256 DOI: 10.1007/s10508-016-0755-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/30/2016] [Accepted: 04/06/2016] [Indexed: 05/18/2023]
Abstract
Sexual minority identity (bisexual, lesbian) is a known risk factor for depression in women. This study examined a facet of minority stress prevalent among women-sexual identity mobility-as an identity-related contributor to higher levels of depressive symptoms. We used three waves of data from the Chicago Health and Life Experiences of Women study, a longitudinal study of sexual minority women (N = 306). Random effects OLS regression models were constructed to examine the effect of sexual identity changes on depressive symptoms. We found that 25.6 % of the sample reported a sexual identity change between Wave I and Wave II, and 24.9 % reported a sexual identity change between Waves II and III. Women who reported a change in sexual identity also reported more depressive symptoms subsequent to identity change. This effect was moderated by the number of years participants had reported their baseline identity and by whether the participant had initiated a romantic relationship with a male partner.
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Affiliation(s)
- Bethany G Everett
- Department of Sociology, University of Utah, 380 S 1530 E Rm 301, Salt Lake City, UT, 84112, USA.
| | - Amelia E Talley
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Tonda L Hughes
- Department of Health Systems Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Sharon C Wilsnack
- Department of Psychiatry and Behavioral Science, University of North Dakota, Grand Forks, ND, USA
| | - Timothy P Johnson
- Survey Research Laboratory, University of Illinois at Chicago, Chicago, IL, USA
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Talley AE, Grimaldo G, Wilsnack SC, Hughes TL, Kristjanson AF. Childhood Victimization, Internalizing Symptoms, and Substance Use Among Women Who Identify as Mostly Heterosexual. LGBT Health 2016; 3:266-74. [PMID: 27269733 DOI: 10.1089/lgbt.2015.0073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE The current article examines substance use behavior and associated factors that contribute to risk of substance misuse, such as history of childhood victimization and reports of internalizing symptoms among women from various sexual identity subgroups. METHODS We recruited a convenience sample of 332 community and university student women (M age = 20.88). Approximately 61.1% of the sample (n = 203) identified as exclusively heterosexual (or "straight"; EH) at the time of the survey, whereas 21.4% (n = 71) identified as primarily heterosexual (or "mostly heterosexual"), 6.6% (n = 22) as bisexual (or "equally gay/lesbian and heterosexual"), 3.0% (n = 10) as primarily gay/lesbian (or "mostly gay/lesbian") and 7.8% (n = 26) as exclusively gay/lesbian. RESULTS Mostly heterosexual women were more likely than EH women to report childhood physical abuse and lifetime tobacco and marijuana use. Mostly heterosexual women also had higher levels of past-year alcohol use disorder symptomology, recent tobacco and marijuana use, and depressive symptoms. Mostly heterosexual women were more likely than bisexual women to have ever tried marijuana, although, among lifetime users, bisexual women reported more frequent recent use. CONCLUSION Mostly heterosexual women reported levels of pathological alcohol use, lifetime rates of tobacco and marijuana use, and recent depressive symptoms that were higher than EH women and relatively similar to lesbian and mostly lesbian women. Bisexual women reported heavier current use of marijuana and were more likely than mostly heterosexual women to report childhood sexual abuse. Implications for mental health services for clients who identify as non-EH are discussed.
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Affiliation(s)
- Amelia E Talley
- 1 Department of Psychological Sciences, Texas Tech University , Lubbock, Texas
| | - Gabriella Grimaldo
- 1 Department of Psychological Sciences, Texas Tech University , Lubbock, Texas
| | - Sharon C Wilsnack
- 2 Department of Psychiatry and Behavioral Science, University of North Dakota , Grand Forks, North Dakota
| | - Tonda L Hughes
- 3 Department of Health Systems Science, University of Illinois at Chicago , Chicago, Illinois
| | - Arlinda F Kristjanson
- 2 Department of Psychiatry and Behavioral Science, University of North Dakota , Grand Forks, North Dakota
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Otis MD, Oser CB, Staton-Tindall M. Violent Victimization and Substance Dependency: Comparing Rural Incarcerated Heterosexual and Sexual Minority Women. JOURNAL OF SOCIAL WORK PRACTICE IN THE ADDICTIONS 2016; 16:176-201. [PMID: 27660590 PMCID: PMC5027961 DOI: 10.1080/1533256x.2016.1143372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 11/30/2015] [Indexed: 05/30/2023]
Abstract
This exploratory study examines the relationship between sexual identity and violent victimization experiences as predictors of differences in illicit substance and alcohol use and substance use problems among a sample of incarcerated women in rural Appalachia (N = 400). Results indicated that, compared to heterosexual women, sexual minority women were more likely to have a lifetime history of weapon, physical, and sexual assault, and were younger at the time of their first violent victimization. Sexual minority women were younger than heterosexual women at the age of onset for intravenous drug use and at the time they first got drunk, and were more likely to report having overdosed. Multivariate analysis found violent victimization to be the strongest predictor of a history of overdose and substance use problems.
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Affiliation(s)
- Melanie D Otis
- College of Social Work, University of Kentucky, Lexington, KY, USA
| | - Carrie B Oser
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
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Drabble L, Trocki KF, Klinger JL. Religiosity as a protective factor for hazardous drinking and drug use among sexual minority and heterosexual women: Findings from the National Alcohol Survey. Drug Alcohol Depend 2016; 161:127-34. [PMID: 26857897 PMCID: PMC4792700 DOI: 10.1016/j.drugalcdep.2016.01.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 01/23/2016] [Accepted: 01/25/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Despite research documenting disparities in risk for alcohol-related problems among sexual minority women, few studies explore potential protective factors within this population. This study examines how religiosity may function as a protective or risk factor for alcohol-problems or other substance use among sexual minorities compared to heterosexuals. METHOD Data from 11,169 women who responded to sexual identity and sexual behavior questions from three population-based National Alcohol Survey waves (2000, 2005, 2010) were utilized for analyses of religiosity in relation to lifetime drinking, past year hazardous drinking, and past year drug use. RESULTS Religiosity was significantly greater among exclusively heterosexual women compared to all sexual minority groups (lesbian, bisexual and heterosexual women who report same sex partners). Lesbians reported the lowest rates of affiliation with religions/denominations discouraging alcohol use. Past year hazardous drinking and use of any illicit drugs were significantly lower among exclusively heterosexual women compared to all sexual minority groups. High religiosity was associated with lifetime alcohol abstention and was found to be protective against hazardous drinking and drug use among both sexual minority and heterosexual women. Reporting religious norms unfavorable to drinking was protective against hazardous drinking among exclusively heterosexual women but not sexual minority women. CONCLUSIONS Findings reveal the importance of considering sexual minority status in evaluation of religion or spirituality as protective among women. Future studies should explore religiosity in the context of other individual and environmental factors, such as positive identity development and community-level acceptance, which may be salient to resiliency among sexual minorities.
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Affiliation(s)
- Laurie Drabble
- San José State University School of Social Work, One Washington Square, San José, CA 95192-0124, United States.
| | - Karen F Trocki
- Alcohol Research Group, Public Health Institute, 6475 Christie Ave. Suite 400, Emeryville, CA 94608, United States.
| | - Jamie L Klinger
- Alcohol Research Group, Public Health Institute, 6475 Christie Ave. Suite 400, Emeryville, CA 94608, United States.
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