The Association between Hazardous Drinking Indicators and Drinking Problem Concerns among Sexual Minority Women

Sexual minority women (SMW) report high rates of hazardous drinking (HD), treatment utilization that is not commensurate with need, and low perceived alcohol use severity. This study examined SMW's drinking problem concerns by sexual identity and other demographic characteristics, and the strength of associations between endorsement of unique HD indicators and drinking problem concerns. Data were from a supplemental sample of SMW added in Wave 3 of the longitudinal, community-based Chicago Health and Life Experiences of Women (CHLEW) study. HD was measured using a validated 13-item HD Index (HDI). Multivariable logistic regression models examined independent associations between past-five-year drinking problem concerns and each HD indicator. Twelve HD indicators were significantly associated with past-five-year drinking problem concerns, adjusting for age and sexual identity. Adjusted odds ratios varied from 2.44 for driving drunk to 15.52 for drinking first thing in the morning. After adjusting for number of HD indicators endorsed, associations were no longer significant, indicating that number of endorsed indicators was a more important predictor of drinking problem concerns than were individual HD indicators. Early intervention and harm reduction strategies could support SMW in addressing salient aspects of HD before progression to alcohol use disorder.

Testing Substance Use as a Mediator of Structural Stigma-Cardiovascular Health Associations in a Large Sample of Gay Men and Lesbian Women

Compared to heterosexual individuals, gay men and lesbian women experience multiple health inequities, including higher prevalence of substance use and cardiovascular disease (CVD). Gay men and lesbian women also face structural stigma, including laws that fail to protect or actively discriminate against them. These phenomena can be understood by considering two theories previously tested among gay men and lesbian women: minority stress and cognitive escape. Minority stress theory suggests being stigmatized for one's minority identity relates to negative health sequelae, while cognitive escape theory suggests escape-related behaviors may mediate links between chronic stress exposure and health. Using 2017 Behavioral Risk Factor Surveillance System data, we ran binary logistic regressions to test models in which binge drinking and cigarette smoking independently mediated links between structural stigma and health among gay men and lesbian women. Structural stigma was operationalized at the U.S. state level as number of sexual orientation anti-discrimination laws. Health was operationalized as presence of any CVD. Models were tested in an aggregated sample, and also in subsamples by sex. In bivariate and component-path analyses, structural stigma predicted smoking across samples. Structural stigma-binge drinking associations were more salient among lesbian women compared to gay men. Per Sobel test results, smoking mediated associations between structural stigma and CVD in the gay men sample, suggesting gay men may smoke to escape from structural stigma, with negative implications for cardiovascular health.

Mental Health of Sexual and Gender Minority Oncology Patients: Synthesis of Recommendations for Advancing Health Equity

Sexual and gender minority (SGM) individuals are at increased risk for several health concerns, including those related to mental health. This increased risk, combined with the unique psychosocial challenges faced by SGM cancer patients, leads to disparities in mental health outcomes across the cancer care continuum. Despite these disparities, little to no resources (e.g. SGM groups, SGM cancer-related literature) exist within most cancer institutes to target SGM populations for appropriate cancer care, such as cancer prevention, accessible treatment, end-of-life, and survivorship concerns, which all may impact psychological wellbeing. This paper synthesizes existing recommendations, both general and cancer-specific, pertaining to the mental health concerns of SGM individuals with hope to provide a valuable resource for cancer institutes and providers on how to better address the unique mental health outcomes of SGM cancer patients. Additional input was obtained from stakeholders from a large, Midwestern, NCI-designated cancer center in an effort to expand our understanding of SGM cancer patients' needs. Through review of relevant guidelines and recommendations and feedback from stakeholder meetings, five broad areas of recommendation for improving SGM cancer care were identified: welcoming environment, patient education and support, community connections, standard approach to care, and research. Rooted in pertinent psychological constructs, each recommendation provides suggestions for increasing attention to SGM patients' psychosocial oncological needs. These recommendations seek to establish culturally inclusive and responsive climates where all SGM cancer patients feel valued and respected.

Social Context of Cannabis Use: Associations With Problematic Use, Motives for Use, and Protective Behavioral Strategies Among Sexual and Gender Minorities Assigned Female at Birth

Sexual and gender minorities assigned female at birth (SGM-AFAB) are at heightened risk for problematic cannabis use compared to heterosexual cisgender women. Despite evidence that social context influences patterns of substance use, no known studies have examined context of cannabis use among SGM-AFAB. The current study examined two aspects of social contexts of cannabis use (locations and companions) and their associations with problematic use, motives for use, and protective behavioral strategies among SGM-AFAB. We utilized three waves of data from 358 SGM-AFAB from a larger study. We aimed to (a) identify subgroups of SGM-AFAB based on contexts in which they used cannabis; (b) examine changes in contexts over time; and (c) examine associations between contexts, problematic use, motives for use, and protective behavioral strategies. Using latent class analysis, we identified four classes: those who used cannabis at home; those who used with friends; those who used alone and with friends; and those who used in all contexts. Those who used in all contexts reported more problematic use, higher coping motives, and used fewer protective behavioral strategies compared to other classes. Transitioning to using cannabis in fewer contexts was associated with a subsequent decrease in problematic use. Classes that were most stable over time (using in all contexts or alone and with friends) were also those that were associated with more problematic use. Social context has important implications for problematic cannabis use among SGM-AFAB. As such, interventions may benefit from attending to social context to reduce problematic use in this population.

Psychiatric Disorders Mediates the Association between Sexual Orientation Discrimination and Substance Use Disorders among Sexual Minority Adults

Although sexual orientation discrimination (SO-discrimination) is associated with an increased risk of psychiatric and substance use disorders (SUD) among sexual minority (SM) adults, these relationships are not well understood, particularly in the context of SUD severity. To address this gap, we assessed the direct and indirect effect of SO-discrimination and sexual identity on psychiatric disorders and SUD severity in the context of stress and resilience among SM adults. We used data from 3,494 adults reporting nonheterosexual identity, attraction, or behavior collected as part of a nationally representative cross-sectional sample of adults in the United States. Structural equation modeling assessed potential pathways between SO-discrimination, psychiatric disorders, and SUD severity. Past-year psychiatric disorders and SUD severity were significantly correlated in the multivariate model. Concordant homosexual orientation was associated with reduced risk of psychiatric disorders, but not with past-year SUD severity. SO-discrimination was significantly associated with increased risk of psychiatric disorders, but was not a significant predictor of SUD severity. Notably, SO-discrimination was not directly associated with SUD severity, but was found to have a significant indirect effect on SUD severity through psychiatric disorders. SO-discrimination was directly associated with increased risk of psychiatric disorders, and psychiatric disorders mediated the pathway between SO-discrimination and SUD severity. Since psychiatric disorders and SUD are often cooccurring, these data indicate integrated assessment strategies and dual interventions for SM populations.

Proportion of U.S. Clinics Offering LGBT-Tailored Mental Health Services Decreased Over Time: A Panel Study of the National Mental Health Services Survey

Our objective was to characterize the proportion of U.S. mental health clinics that offered LGBT-tailored mental health services between 2014 and 2018. We used data from the National Mental Health Services Survey (NMHSS) to construct a mixed logistic model of availability of LGBT-tailored mental health services over time, by region (Northeast, South, Midwest and West), and by facility type (Veterans Administration, inpatient/residential, outpatient, community mental health centers and mixed). Our results show that the overall proportion of mental health clinics that offered LGBT-tailored services decreased from 2014 to 2018. Our results also indicate that Veteran Affairs clinics and facilities in the West and Northeast were most likely to offer LGBT-tailored mental health services. Given the temporal, regional, and facility gaps in LGBT-tailored mental health services availability, more effort should be dedicated to addressing this disparity.

Examining Sexual Orientation Differences in the Utilization of the Human Papillomavirus Vaccine, Human Papillomavirus Test, and Cervical Papanicolaou Test in Allegheny County, Pennsylvania

Despite sexual minorities' (SMs) increased risk for contracting human papillomavirus (HPV) and developing related cancers compared to their heterosexual peers, we know little about SM disparities in uptake of HPV vaccines and routine screenings. Therefore, this study examined sexuality differences in HPV preventive interventions and related screenings. From 2015 to 2016, Pennsylvania's Allegheny County Health Department commissioned a health survey of 9,026 adults in their catchment area using probability-based sampling. Multivariable models tested differences by sexual identity separately for cisgender men and women (heterosexual versus gay/lesbian, bisexual, and other) for lifetime receipt of HPV vaccine and number of HPV vaccines. Among women, we examined sexuality differences in HPV and cervical Pap tests, adjusting for age, race/ethnicity, education, marital status, and income. No differences in prevention utilization emerged when comparing heterosexual women to all SM women. However, exploratory analyses comparing heterosexual women to subgroups of SM women found lesbians had higher odds (adjusted odds ratio [AOR] = 5.27; 95% confidence interval [CI] = 1.15–24.09) of never receiving an HPV vaccine. Women who reported their sexuality as “other” had higher odds (AOR = 5.65; 95% CI = 1.03–31.02) of never receiving a cervical Pap test compared to heterosexual women. “Other” women had higher odds (AOR = 19.80; 95% CI = 1.64–239.16) of never receiving a cervical Pap test when compared to heterosexual women receiving one within the recommended screening guidelines. SM men's utilization was not significantly different from heterosexual men, though vaccination uptake for both groups was low. These findings highlight the need for additional public health surveillance to understand cancer prevention utilization among this underserved population.

Sexual Minority Outness and HIV/STI Stigma Over First Year Post-HIV/STI Diagnosis among Black Sexual Minority Men

Black sexual minority men in the southern United States continue to experience pronounced disparities related to the human immunodeficiency virus (HIV) and other sexually transmit- ted infections (STI). HIV/STI stigma undermines outcomes along the HIV and STI care continuums, and exacerbates HIV/STI disparities. Identifying who is at greater risk of experiencing HIV/STI stigma following diagnosis could inform targeted intervention efforts to address stigma and improve outcomes among vulnerable individuals. The current study therefore explored associations between sexual orientation outness and HIV/STI stigma in the first year post-HIV/STI diagnosis among Black sexual minority men in the southern United States. Data were drawn from a longitudinal study of 151 participants followed for the year following an HIV/STI diagnosis. Outness was measured before HIV/STI diagnosis, and HIV/STI stigma was measured monthly following diagnosis. Data were analyzed with multilevel models. Participants who were not fully out experienced greater internalized, enacted, and anticipated HIV/STI stigma immediately following their diagnosis than participants who were fully out. Moreover, outness moderated the trajectory of internalized HIV/STI stigma over the first year post-diagnosis: Participants who were not fully out initially experienced a faster decline in internalized HIV/STI stigma as compared to participants who were fully out. Findings suggest that Black sexual minority men who are not fully out may be particularly vulnerable to HIV/STI stigma following their diagnosis. Targeted intervention efforts could address HIV/STI stigma among vulnerable individuals during this time-period that is critical for linkage to and engagement in HIV/STI care.

The Family Environment and Its Relation to Health and Well-Being Among Sexual and Gender Minority Youth

We examined youth-reported family environments using multiple indicators (parent education, participants' first language spoken, and parent immigration status) to consider the family environment and its links to youth health and well-being. To do so, we utilized cluster analysis methodology to identify potential groupings of family environments among a national sample of 14,578 sexual and gender minority (SGM) youth from the LGBTQ National Teen Survey, collected in 2017. Three distinct clusters of SGM youth emerged, labeled “College-educated, U.S.-born parents,” “High school-educated, U.S.-born parents,” and “College-educated, immigrant parents.” “A series of one-way between-subjects ANCOVAs revealed each cluster significantly differed from each other on health and family outcomes, indicating that parent immigration status, parent education, and youth first spoken language are uniquely and collectively imperative for SGM youths' health and well-being.” Of note, despite reporting parents with the highest level of post-high school education, SGM youth in the “College-educated, immigrant parents” cluster reported the lowest levels of parental acceptance and the lowest levels of outness in comparison to the youth in the other two clusters. In light of these results, we review the importance of the need for more nuanced ways of defining the family context among vulnerable youth—in particular for SGM youth. Given that much of the research to date defines the family environment by single indicators (e.g., parent education), we review the importance of broadening our conceptualization and measurement of the “family environment.”

The Role of LGBTQ Identity Pride in the Associations among Discrimination, Social Support, and Depression in a Sample of LGBTQ Adolescents

The current study examined the role of LGBTQ identity pride in the associations among discrimination, social support, and depressive symptoms in a sample of LGBTQ youth. As part of a larger study, 13,440 LGBTQ youth completed a survey assessing depressive symptoms, past-year bullying, family rejection, general and LGBTQ-specific teacher support, general and LGBTQ-specific family support, and LGBTQ identity pride. Findings showed that greater bullying and family rejection were associated with lower LGBTQ identity pride and, in turn, greater depression. Conversely, greater general and LGBTQ-specific teacher support and greater general and LGBTQ-specific family support were associated with greater LGBTQ identity pride and, in turn, lower depression. All of the indirect effects were significant when the predictors were examined in separate models and most remained significant when the predictors were examined simultaneously. LGBTQ identity pride may be a mechanism linking discrimination and social support to depression among LGBTQ youth.