Latinx Sexual Minority Adolescent Substance Use: State of the Science and Call for Intersectional Minority Stressors and Protective Factors

Purpose of review

Latinx sexual minority adolescents (LSMA) are at an intersection of ethnic and sexual minority (SM) status and may experience heighten risk of substance use and related problems. These youth may also hold unique protective factors that help mitigate the effects of minority stress and curb substance use. Little is known, however, about the intersectional minority stressors (i.e., due to ethnicity and SM status) and protective factors related to substance use among this population.

Recent Findings

According to the minority stress model, there are unique minority stressors and resiliency factors that can help explain differences in behavioral health rates between white SM and SM of color. Research supports the notion that minority stressors (e.g., stigma/risk, homophobic bullying, and family rejection of SM status) confer risk for substance use among LSMA. In terms of resilience, less is known, but there may be some protective factors that have not been measured that could explain lower rates in some substances (i.e., club drugs and methamphetamine).

Summary

Little is known about how the intersections of ethnicity and SM status are associated with substance use in adolescence. Future research should assess the temporal relationship of multilevel (i.e., intrapersonal, relational, and system), intersectional (i.e., ethnicity and SM status) minority stressors and protective factors unique to LSMA on substance use. We propose that the findings from these future studies will help to create socioculturally appropriate behavioral health treatments that consider the intersectional risks and strengths within the LSMA population.

Double Impact: A Dyadic Discrimination Model for Poor, Minority, and Pregnant Couples

Frequent daily discrimination compounds the negative health impacts of those with multiple marginalized identities, including pregnant mothers and their children. We used a dyadic, moderated, mediated model of 296 young, expectant, poor, urban, primarily minority couples. In this study, we explored if a multiple pathway discrimination model explained the relationship between multiple marginalized identities and health (depression and stress). We also examined if a mediated (discrimination moderated by gender) model, within a minority-stress and intersectional framework explained the relationship with depression and stress for couples. We observed that frequent daily discrimination was associated with negative health outcomes (depression and stress). Women reported significantly more depression than men. Frequent daily discrimination mediated the relationship between multiple marginalized identities and depression and stress and having a partner with multiple marginations increased one's personal depression and stress. Our observations suggest that discrimination's impact on health is experienced during pregnancy and the more marginalized identities one carries, the more impact it may have. Further, having a partner with multiple marginalized identities also impacts the depression and stress reported by women. Inventions to address depression and stress outcomes may be strengthened by considering multiple marginalized identities and include couples.

Professional Help-Seeking in Men Experiencing Sexual Problems - The Role of Sexual Identity and Minority Stress

BACKGROUND

Only a minority of men experiencing sexual problems will seek professional help and the proportion of gay or bisexual men can be even lower.

AIM

To investigate if sexual identity and minority stress are related to professional help-seeking in Polish gay and bisexual men.

METHODS

Sexual identity was measured with the standard question: "Do you consider yourself to be heterosexual, gay, or bisexual?" Men who provided a complete set of answers to the study tools and replied "yes" to the question: "Have you ever had a problem with sexual functioning that lasted at least several months?" were included (Ntotal =644, Nstraight = 203, Ngay = 324, Nbi = 117). A simple question on help-seeking was: "Did you seek professional assistance then?" Other data were gathered with the use of a self-constructed questionnaire. Minority stress processes, that is, internalized homophobia, expectations of rejection, and identity concealment, were measured with the subscales of the Sexual Minority Stress Scale. Bivariate analyses and multivariate logistic regressions were performed to test the statistical significance of sexual identity and minority stress processes as predictors of professional help-seeking.

OUTCOMES

Contacting a specialist when experiencing a sexual problem.

RESULTS

A total of 84.5% of all men did not seek professional help. Gay identity (OR = 0.58, P = .045), as opposed to bisexual identity, was significantly related to reduced odds of consulting a specialist. Age (OR = 1.03, P = .005), number of doctor's visits per year (OR = 1.51, P < .001), and a psychiatric diagnosis (OR = 1.65, P = .043) were positively related to help-seeking behaviors. Identity concealment significantly decreased the likelihood of consulting a specialist (OR = 0.94, P = .017).

CLINICAL TRANSLATION

Specialists need to be aware that gay identity and identity concealment may prevent a proportion of men from seeking their help and thus should be publicly explicit about their inclusive and nonpathologizing approach to sexual diversity.

STRENGTHS AND LIMITATIONS

The major strengths of the study include the use of a relatively large sample size and data from the little recognized Polish context characterized by a predominantly hostile anti-LGBT social climate, and exploration of a neglected topic of substantial significance at the public and individual levels. The major limitations are the use of nonprobability sampling, cross-sectional self-report design, and a single question to capture the presence of sexual problems with no measurement of associated distress.

CONCLUSION

Gay men are at risk of avoiding help-seeking when experiencing sexual problems because of identity concealment. Grabski B., Kasparek K., Koziara K., et al. Professional Help-Seeking in Men Experiencing Sexual Problems - The Role of Sexual Identity and Minority Stress. J Sex Med 2022;19:1090-1097.

The relationship between minority stress factors and suicidal ideation and behaviours amongst transgender and gender non-conforming adults: A systematic review

BACKGROUND

The impact of Minority Stress (MS) upon suicidal ideation and behaviours amongst Transgender and Gender Non-Conforming (TGNC) adults is not sufficiently understood, hence our intervention efforts on an individual and societal level are limited. This review aims to evaluate recent literature that reports on the association between MS and suicidal ideation and behaviours amongst TGNC adults.

METHODS

PsycINFO, Web of Science, MEDLINE, CINAHL and EMBASE were systematically searched for relevant articles. Peer reviewed and grey literature were considered. Included papers reported quantitative analyses on associations between MS factors and suicidal ideation and behaviours amongst TGNC adults. The quality of papers was assessed.

RESULTS

28 papers were identified as eligible. Findings suggested positive associations between external and internal minority stressors and suicidal ideation and behaviour. Dysfunctional individual coping was associated with a greater likelihood of suicide attempts. Community resilience was negatively associated with suicidal outcomes, but did not consistently buffer the effects of minority stress.

LIMITATIONS

Overall quality of included papers was 'poor'. Almost all papers were cross-sectional by design, therefore causality cannot be inferred. Many papers measured variables using non-standardised measures undermining the reliability and validity of reported results.

CONCLUSIONS

Findings offer support to the application of MS theory to the understanding of suicidal ideation and behaviour amongst TGNC. Future research should use standardised measures and longitudinal designs to better support the investigation of directionality and causality. More research is needed to understand the complex interactions between minority stress factors and the role of resilience in this population.

The relationship between sexual and gender stigma and suicide attempt and ideation among LGBTQI + populations in Thailand: findings from a national survey

PURPOSE

Thailand has one of the highest suicide rates in Southeast Asia; yet, little is known about suicidality among lesbian, gay, bisexual, trans, queer, intersex, and other gender and sexually diverse (LGBTQI +) people living in the region, who may experience elevated risk for suicide. We sought to identify the prevalence of lifetime suicidal attempts and ideation among a nationally recruited sample of LGBTQI + people in Thailand. We further examined the relationship between levels of sexual/gender stigma and suicidal attempt and ideation.

METHODS

Data were derived from a national online survey of Thai LGBTQI + individuals between January and March 2018. Multivariable logistic regression was used to examine the relationship between sexual/gender stigma scales, adapting a previously validated instrument, and suicide attempt and ideation.

RESULTS

Among 1,290 LGBTQI + participants, the median age was 27 years. The prevalence of suicide attempt and ideation was 16.8% and 50.7%, respectively. In multivariable analyses, after adjusting for potential confounders, experiences of perceived and enacted sexual/gender stigma were independently and positively associated with suicide attempt (adjusted odds ratio [AOR] = 1.25; 95% confidence interval CI:1.10-1.41 and AOR = 1.31; 95% CI:1.11-1.55, respectively) and ideation (AOR = 1.30; 95% CI:1.17-1.43 and AOR = 1.34; 95% CI:1.14-1.58, respectively).

CONCLUSION

One-sixth of the sample reported a suicide attempt, while a half reported ever contemplating suicide. Both experiences of perceived and enacted sexual/gender stigma were associated with lifetime suicide attempt and ideation. Multi-level interventions are needed to decrease stigma and in turn suicide among LGBTQ + people in Thailand, including anti-discrimination policies and support for mental health and well-being.

First comes marriage, then comes the election: Macro-level event impacts on African-American, Latina/x, and White sexual minority women

Sexual minority women (SMW) may have different experiences of macro-level events, such as changes in marriage laws or election outcomes, related to their multiple identities. African American, Latina/x, and White identities intersect with gender/sex and sexual identity to influence experiences at the intrapersonal, interpersonal, social, and political levels of the socio-ecological environment. Participants include 100 African American, 35 Latina/x, and 164 White SMW (N = 299) in Wave 4 (2017-2019) of a longitudinal study of SMW's health conducted in the United States (Chicago Health and Life Experiences of Women Study). Responses to nine open-ended survey questions about marriage equality and the 2016 Presidential election were examined. Thematic analysis noted similarities across groups and focused on group differences in four areas: 1) personal well-being (including fear and anxiety about discrimination; risk associated with masculine presentation; and religion as stress and support); 2) interpersonal relationships (including relationships with partners, family, and in a community); 3) societal discrimination and prejudice (including harassment in public spaces and concerns about travel); and 4) civil rights, government harassment, and police-state violence. Emerging differences emphasized the impact of race/ethnicity and the intersection of race/ethnicity and gender on experiences of marriage equality and the 2016 election. Findings suggest that a more nuanced understanding of the experiences of individuals with different racial/racialized identities and the intersection of race/ethnicity with sexual identities is essential to creating culturally competent and effective supports for SMW.

Disclosure of Sexual Identities Across Social-Relational Contexts: Findings from a National Sample of Black Sexual Minority Men

Black sexual minority men (BSMM) in the USA navigate a range of factors that may influence the extent to which they disclose or conceal their sexual identity in various social contexts. To date, few studies have investigated the correlates of sexual identity disclosure or concealment among BSMM across multiple life domains. Guided by a minority stress perspective and intersectionality, we analyzed data from N = 809 BSMM who participated in the Social Justice Sexuality Survey. We conducted ordinary least squares regression to examine the relative weight of perceptions of homophobia, religiosity, LGBT community connectedness, racial identity salience, and sexual identity salience on disclosure of sexual identity in six social-relational contexts: (1) family, (2) friends, (3) neighbors, (4) religious community, (5) work, and (6) online. Findings indicate that BSMM disclosed their sexual identity unevenly across social-relational contexts. Notably, LGBTQ community connectedness and sexual identity importance were consistent predictors of sexual identity disclosure across contexts. In contrast, perceptions of homophobia were not related to sexual identity disclosure, suggesting that other factors may be more salient for BSMM when deciding to disclose their sexual identity. Finally, bisexual men consistently reported lower levels of sexual identity disclosure relative to gay men in all six contexts. Study findings have important implications for future research on sexual identity disclosure with diverse samples of BSMM.

Resilience Factors and Suicide Risk for a Sample of Transgender Clients

This study explored how individual- and community-based resilience factors operated together in order to reduce risk of suicide for a sample of transgender therapy clients. We collected cross-sectional survey data from 106 transgender therapy clients at a local community center, including demographic information, experiences of relational support, participants' emotional stability, and risk for suicide. Results from our mediation analysis indicated that high levels of perceived relational support are related to reduced risk for suicide and that this happens by way of a person's emotional stability. Clinical implications for family therapists are discussed based on the significant indirect effect found in this study.

Minority Stress and Same-Sex Relationship Satisfaction: The Role of Concealment Motivation

Most lesbian, gay, and bisexual (LGB) people want a stable, satisfying romantic relationship. Although many of the predictors of relationship outcomes are similar to those of heterosexual couples, same-sex couples face some additional challenges associated with minority stress that also impact upon relationship quality. Here, we investigate the association between minority stressors and relationship quality in a sample of 363 adults (M age = 30.37, SD = 10.78) currently in a same-sex romantic relationship. Internalized homophobia and difficulties accepting one's LGB identity were each negatively associated with relationship satisfaction via heightened concealment motivation. We also examined the protective role of identity affirmation on relationship quality, finding a direct positive relationship between the two variables. Minority stressors were negatively associated with couple relationship satisfaction via heightened concealment motivation. The finding that identity affirmation directly predicted increased couple satisfaction also highlights the important role of protective factors in same-sex couple relationships.

The Effects of Intersecting Stigma: A Longitudinal Examination of Minority Stress, Mental Health, and Substance Use among Black, Latino, and Multiracial Gay and Bisexual Men

OBJECTIVE

Although Black, Latino, and multiracial gay and bisexual men (GBM) are disproportionately affected by health inequities facing GBM more broadly in the United States (CDC, 2017), there is a dearth of research examining how intersectional stigma affects psychological and behavioral outcomes such as depressive and anxiety symptoms and substance use. Based in minority stress and intersectionality theories, this study examined the main and intersectional effects of racial discrimination and gay rejection sensitivity on emotion regulation difficulties, depressive and anxiety symptoms, and later drug use and heavy drinking.

METHOD

We collected longitudinal data from 170 GBM of Black, Latino, or multiracial descent. Measurements included baseline racial discrimination, gay rejection sensitivity, and emotion regulation difficulties, 6 month depressive and anxiety symptoms, and baseline to 12 month heavy drinking and drug use. We analyzed data using longitudinal structural equation models.

RESULTS

Our results indicated that racial discrimination and its interaction with gay rejection sensitivity were significantly associated with higher levels of emotion regulation difficulties, which predicted higher levels of depressive and anxiety symptoms at 6 months, which, in turn, predicted higher levels of heavy drinking, but not drug use, at 12 months. Moreover, the total indirect effect from the stigma variables to heavy drinking was statistically significant.

CONCLUSIONS

These findings indicate that it is critical for researchers and clinicians to consider the effects of intersecting racial and sexual minority stress on emotion regulation in the persistence of psychological and behavioral health inequities facing Black, Latino, and multiracial GBM.

Sexual Health Care Practitioners' Evaluation of Men Who Have Sex With Men

BACKGROUND

The Institute of Medicine Report and Department of Health and Human Services Healthy People 2020 Initiative have called for steps to address health disparities facing sexual minorities.

AIM

We sought to characterize the practice patterns of sexual health specialists as they relate to men who have sex with men (MSM).

METHODS

Surveys were electronically mailed to 696 members of the Sexual Medicine Society of North America (SMSNA). Responses were compared using descriptive statistics and χ² analysis with Yates correction where appropriate.

OUTCOMES

Outcomes were SMSNA members' demographics, their assessment of their patients' sexual orientation, and adaptation of care to address the specific needs of their MSM patients.

RESULTS

92 (13.2%) Members responded. While 93.3% of respondents reported treating MSM patients, only 51.7% routinely asked about sexual orientation. Of those that do not ask, 41.9% responded that sexual orientation is irrelevant to their patients' care and 25.6% responded that patients will disclose this information if the patient thinks it is important. Practitioners inquiring about sexual orientation were more likely to practice in urban settings; more likely to inquire about a greater number of sexual behaviors; more likely to tailor their care to lesbian, gay, bisexual, and transgender needs; and more likely to endorse the notion that homosexual/bisexual patients have unique sexual dysfunction concerns.

CLINICAL TRANSLATION

Limited and uneven inquiry about sexual orientation necessitates efforts aimed at tailoring care to the needs of sexual minority patients.

STRENGTHS & LIMITATIONS

This survey addresses a gap in the literature by investigating predictors and practical consequences of practitioner inquiry about sexual orientation. Limitations include a low response rate, disparate study population, the potential influence of respondent social desirability biases, and spurious associations due to a multiplicity of statistical tests.

CONCLUSION

Only about half of surveyed SMSNA members ask their patients' sexual orientation; inquiry about sexual orientation was associated with practice setting and with provider practice patterns and attitudes. Saheb Kashaf M, Butler PR, Cordon-Galiano BH, et al. Sexual Health Care Practitioners' Evaluation of Men Who Have Sex With Men. J Sex Med 2018;15:942-946.

The Role of Social Support and Gay Identity in the Stress Processes of a Sample of Caucasian Gay Men

Though research has demonstrated that gay men suffer stress-related mental health disparities compared to heterosexuals, little is known about factors that protect gay individuals from poor mental health and that buffer them in the face of minority stress. Using a daily diary approach, the current study examined three factors that may protect individuals from poor mental health: social support from friends, social support from family, and gay identity. Caucasian gay men (N = 89) completed a study purported to examine the everyday life experiences of gay individuals. Participants completed baseline measures of social support from friends and family, gay identity (i.e., sense of belonging to the gay community), and depression. Participants then completed measures of minority stress and negative affect at the end of each day for 14 consecutive days. Though all three predictors were negatively related to depression at baseline, only friend support remained significant when all predictors were included simultaneously. For the daily data, HLM was used to examine the moderating role that each of the predictors served in the daily minority stress-mental health link. Only friend support moderated the link. Those with more friend support experienced little change in negative affect from average to above-average minority stress days. However, those with less support experienced increases in negative affect from average to above-average minority stress days. The research highlights the importance of friend support for coping, while also suggesting that predictors of minority stress may differ when stress is assessed retrospectively versus daily.

Stigma and Family Relationships of Middle-Aged Gay Men in Recovery

The primary objective of this study was to explore how middle-aged gay men in recovery cope with stigma and family relationships. For gay men, perceptions of acceptance of their sexual orientation and degree of social connectedness can play a role in their recovery from alcohol and substance use disorders. Yet gay men may have a more difficult time accessing certain family-level health resources because their families of origin may stigmatize, reject or silence them on account of their sexual orientation. Semi-structured interviews were used to explore how participants in recovery constructed and coped with their experiences of stigma, family relationships, and alcohol and substance use. Participants (30 gay men aged 50-64) completed a questionnaire and interview. We used constructivist Grounded Theory method and Minority Stress Theory as a theoretical framework to interpret the data. We identified the following themes: Internalization of Stigma, Changes in Coping Strategies, and Ongoing Stigma. Future research should explore how to incorporate familial support into gay men's recovery, address ongoing internalized stigma, and develop a social response to stigma, rather than leaving it to individuals to confront on their own.