Stress and substance use among sexual and gender minority individuals across the lifespan.
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ABSTRACT:
SUBMITTER: Parent MC
PROVIDER: S-EPMC6430403 | biostudies-literature | 2019 Feb
REPOSITORIES: biostudies-literature
Publications
Stress and substance use among sexual and gender minority individuals across the lifespan.
Parent Mike C MC Arriaga Andrew S AS Gobble Teresa T Wille Lexie L
Neurobiology of stress 20181227
Sexual and gender minority (SGM) individuals face marked disparities in substance use. The present narrative review explores research on substance use in SGM communities using a minority stress theory lens. We define the SGM population and minority stress, and explore stresses and substance use disparities in adolescence, adulthood, and older age. Though research on this topic is beginning to highlight the relationship between stress and substance use for SGM individuals, more work is needed on ...[more]
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Project description:BackgroundSexual minority women and gender diverse individuals (SMWGD) are at heightened risk for alcohol and cannabis use disorders compared to heterosexual and cisgender individuals, and their heightened risk has been attributed to minority stress. However, few longitudinal studies have examined mechanisms through which minority stress may impact substance use, and none have done so at the event-level.MethodsWe utilized data from a 30-day ecological momentary assessment study of 429 SMWGD who used alcohol or cannabis regularly to test a mechanistic process in which minority stress predicts alcohol and cannabis use via coping motives for use at the event-level.ResultsWhen individuals experienced more enacted stigma (e.g., microaggressions) than usual during one assessment, they were more likely to use cannabis to cope during the next. In turn, occasions when cannabis was used to cope were marked by more sessions of cannabis use, longer intoxication, higher subjective intoxication, and more cannabis consequences. Indirect effects of enacted stigma on cannabis use via coping motives were significant. However, only one of internalized stigma's indirect effects was significant, with internalized stigma predicting cannabis consequences via daily coping motives. No indirect effects predicting alcohol use were significant.ConclusionsFindings provide robust evidence that using to cope is a mechanism through which enacted stigma predicts cannabis use and internalized stigma predicts cannabis consequences. Results did not provide evidence for similar associations for alcohol. Our findings suggest that interventions designed to reduce cannabis use among SMWGD should attend to their minority stress experiences and cannabis use motives and teach alternative coping strategies.
| S-EPMC9732144 | biostudies-literature
Project description:This study explored how sexual or gender minority (SGM) status influenced substance use (SU) treatment outcomes in a predominantly African American and unemployed sample of people with HIV. N = 60 participants were enrolled in an abstinence-focused inpatient SU treatment center, followed by outpatient treatment sessions. At 12-months follow-up, the survival rate (i.e. those who did not reuse substances) was 37.6% (non-SGM group) vs. 4.8% (SGM group). The impact of SGM status on reuse was .54 log odds, p = .11, which translates to a 71.8% increase in the hazard of reusing substances for SGM vs. non-SGM individuals. For both groups, frequency of reuse remained stable and problems associated with SU decreased over time. Results suggest a potentially clinically relevant finding that SGM individuals have possible heigh-tened risk of SU after a mixed inpatient-outpatient program. ClinicalTrials.gov trial registration number: NCT01351454.
| S-EPMC10601688 | biostudies-literature
Project description:BACKGROUND:Sexual minority adolescents are more likely than their heterosexual peers to use substances. This study tested factors that contribute to sexual orientation disparities in substance use among racially and ethnically diverse adolescents. Specifically, we examined how both minority stress (i.e., homophobic bullying) and social norms (i.e., descriptive and injunctive norms) may account for sexual orientation disparities in recent and lifetime use of four substances: tobacco, alcohol, marijuana, and prescription drugs. PROCEDURES:A probability sample of middle and high school students (N=3012; aged 11-18 years old; 71.2% racial and ethnic minorities) using random cluster methods was obtained in a mid-size school district in the Southeastern United States. RESULTS:Sexual minority adolescents were more likely than heterosexual adolescents to use substances, experience homophobic bullying, and report higher descriptive norms for close friends and more permissive injunctive norms for friends and parents. While accounting for sociodemographic characteristics, multiple mediation models concurrently testing all mediators indicated that higher descriptive and more permissive injunctive norms were significant mediators of the associations between sexual orientation and recent and lifetime use of the four substances, whereas homophobic bullying was not a significant mediator of the associations between sexual orientation and recent and lifetime use of any of the substances. CONCLUSIONS:Descriptive and injunctive norms, in conjunction with minority stress, are important to consider in explaining sexual orientation disparities in substance use among racially diverse adolescents. These results have implications for substance use interventions among sexual minority adolescents.
| S-EPMC5575887 | biostudies-literature
Project description:OBJECTIVE:Weight-based victimization (WBV) involves being the target of intentional physical, verbal, or psychological harm because of one's body weight. Youth experience harmful health consequences from WBV, but this literature has neglected sexual and gender minority (SGM) youth, despite their high rates of overweight and obesity, and mental health problems. The present study assessed health behaviors (substance use), self-rated health, perceived control over stressors, depressive symptoms and self-esteem as a function of WBV in a large, national sample of LGBTQ (lesbian, gay, bisexual, transgender, and queer) adolescents. METHOD:Participants (N = 9,838, Mage = 15.6 years, SD = 1.26) completed a web-based battery of questionnaires examining victimization, health, family, and school experiences of LGBTQ adolescents in the United States. RESULTS:WBV was associated with increased odds of alcohol use, binge drinking, marijuana use, and cigarette use, independent of adolescents' age, race, body mass index (BMI), sexual identity, gender identity, caregiver education, and U.S. region. Frequency of WBV at school and weight teasing from family members were both consistently associated with lower self-rated health, lower perceived control over stressors, lower self-esteem, and higher depressive symptom scores. CONCLUSIONS:These findings present the first large-scale evidence of the relationship between WBV and adverse health behaviors in SGM youth. Sexual minority youth who experience WBV, especially from family members, may be vulnerable to adverse health behaviors and low perceived health, regardless of their BMI. These findings highlight the importance of considering WBV when examining health behaviors in LGBTQ youth, and increased awareness of these issues among health care professionals. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
| S-EPMC7194133 | biostudies-literature
Project description:Purpose of reviewAlcohol and drug use are common among youth. Rates are especially high among sexual and gender minority youth (SGMY; lesbian, gay, bisexual, transgender). We conducted a scoping review of research on risk and protective factors for substance use among SGMY published between 2013-2017.Recent findingsNinety-seven studies met our inclusion criteria. Most focused on individual-level minority stress risk factors, particularly stigma. Fewer studies addressed protective factors such as social support or affirming policies, and few focused on gender minority youth (GMY). We identified important, yet understudied differences by race/ethnicity, sex assigned at birth, and sexual orientation.SummaryFindings highlight growing interest in this topic as well as methodological/topical gaps in the literature. Research is needed to examine SGMY substance use in nationally representative samples; expand information about GMY; investigate racial/ethnic and sex/gender differences; improve measurement; and increase translation of findings to support prevention and treatment interventions for this at-risk population.
| S-EPMC6214200 | biostudies-literature
Project description:Epidemiologic studies have consistently found elevated rates of alcohol and other substance use among sexual minority women (SMW), and despite calls for "LGBT-specific" services and culturally-tailored interventions, few such services exist. This study involved qualitative interviews with directors from substance use treatment programs (N=10) about how they addressed the needs of SMW. Strategies implemented primarily focused on creating a safe and welcoming environment for sexual minority clients. Findings highlight challenges involved in meeting the treatment needs of SMW and provide guidance to researchers and service providers on how to improve the quality of care for them.
| S-EPMC6469851 | biostudies-literature
Project description:PurposeThe impacts of Adverse Childhood Experiences (ACEs) on behavioral, mental, and physical health have been extensively investigated. As such, it is paramount to synthesize their quantified effects, especially within vulnerable populations. The goal of this scoping review was to collect, summarize, and synthesize existing research on ACEs and substance use (SU) in adult sexual and gender minority (SGM) populations.MethodsWebofScience, APA PsychInfo, LGBTQ+ Life (EBSCO), Google Scholar, and PubMed electronic databases were searched. We included reports published between 2014 and 2022 that assessed SU outcomes, ACEs in adult (18+) SGM populations, in the United States (US). We excluded those in which SU was not an outcome, measured community-based abuse or neglect, or investigated adulthood trauma. Data were extracted using the Matrix Method and categorized across three SU outcomes.ResultsTwenty reports were included in the review. Nineteen employed a cross-sectional design and 80% focused on a single SGM group (transgender women, bisexual Latino men, etc.). Nine of 11 manuscripts found SU frequency and quantity were higher among ACE exposed participants. Three of four studies found ACE exposure to correlate with substance use problems and substance misuse. Four of five studies found ACE exposure to be correlated with substance use disorders.ConclusionsLongitudinal research is needed to comprehend the impact of ACE on SU within the diverse subgroups of SGM adults. Investigators should prioritize the use of standard operationalizations of ACE and SU to improve comparability across studies and include diverse samples from the SGM community.
| S-EPMC10040327 | biostudies-literature
Project description:BackgroundLittle comparative data on substance use (SU) between sexual minority youth (SMY) and heterosexual youth (HET) is available. This study compares the prevalence of SU in an urban cohort between SMY and HET and evaluates demographic and psychosocial predictors of SU.MethodsData came from a prospective-longitudinal cohort study in an urban setting (N = 1297). SU and psychosocial variables such as internalizing symptoms, self-control, sensation-seeking, bullying-victimization, subjective stress, leisure activities, and peer influences were assessed with self-reports at age 17 and 20. SU was stratified by sex and sexual attraction, and the groups were compared using regression models, with demographic and psychosocial variables included as covariates.ResultsSMY- and HET-youth displayed differences in a number of psychosocial variables. Overall, SMY- and HET-youth differed in their 12-months prevalence of SU: At age 17, SMY-females had significantly higher rates of SU than HET-females for cannabis (aOR = 2.14, p = 0.04), ecstasy/MDMA (aOR = 4.29, p = 0.01), and hallucinogens (aOR = 5.59, p = 0.02). At age 20, SMY-females had significantly higher rates of SU than HET-females for tobacco (aOR = 2.06, p = 0.03), cannabis (aOR = 2.24, p = 0.004), ecstasy/MDMA (aOR = 3.93, p < 0.001), stimulants (aOR = 3.45, p = 0.002), and hallucinogens (aOR = 6.65, p < 0.001). SMY-males reported significantly lower rates for tobacco and cannabis than HET-males at age 17. At age 20, they reported significantly higher rates for the use of ecstasy/MDMA (aOR = 2.30, p = 0.04) and hallucinogens (aOR = 2.43, p = 0.03).ConclusionsGiven that psychosocial variables were significant covariates of SMY-status and SU, our results underline the importance of accounting for these when explaining differences in SU between adolescents. While differentiation by sex is established in most studies, such standardized comparisons are lacking with regards to sexual identities. But knowledge about SU of SMY is critical for designing effective interventions. This is especially true for SMY-females: Thus, SU in SMY-females early in life needs to be explored more thoroughly and addressed with adequate prevention measures.
| S-EPMC10505308 | biostudies-literature
Project description:PurposeGender minority (GM) adolescents, who have a different gender identity than their sex assigned at birth, may use substances as a coping strategy in response to GM-related stressors. This study examined longitudinal effects of gender minority stressors on substance use in GM adolescents, and related risk factors (internalized transphobia, depressive symptoms, anxious symptoms) and protective factors (resilience, gender-related pride, family functioning, social support, gender-related community connectedness).MethodsParticipants were 30 GM adolescents, ages 13-17 years, from the U.S. community-based longitudinal Trans Teen and Family Narratives Project. Participants completed an online survey every 6 months across 2 years (5 waves; data collected 2015-2019).ResultsExposure to gender minority stressors was associated with higher odds of alcohol use. Across models, internalized transphobia (risk factor), resilience (protective factor), and gender-related pride (protective factor) were the most significant mediators of associations between gender minority stressors and substance use. Family functioning and social support (protective factors) significantly moderated the association between gender minority stressors and alcohol use, such that family functioning and social support were protective for alcohol use at lower levels of gender minority stress, but not at higher levels.ConclusionResults suggest that GM adolescents engage in substance use as a coping strategy in response to gender minority stressors. A number of hypothesized risk and protective factors mediated or moderated these associations. Future interventions with GM adolescents should focus efforts on addressing internalized transphobia as a risk factor and strengthening resilience, gender-related pride, and family functioning as protective factors for substance use.
| S-EPMC8171963 | biostudies-literature
Project description:ObjectiveTo remedy the notable gap in evidence-based treatments for sexual minority women, this study tested the efficacy of a minority-stress-focused cognitive-behavioral treatment intended to improve this population's mental and behavioral health.MethodThe intervention, EQuIP (Empowering Queer Identities in Psychotherapy), was adapted from a transdiagnostic cognitive-behavioral treatment as also recently adapted for sexual minority men. Sexual minority women at risk of mental and behavioral health problems (n = 19) and expert providers with this population (n = 12) shaped the treatment's development, including by supporting its primary focus on universal and minority-stress-focused processes underlying this population's disproportionately poor mental and behavioral health. The resulting treatment was then delivered to young adult sexual minority women (n = 60; M age = 25.58; 41.67% racial/ethnic minority; 43.33% transgender/nonbinary) experiencing depression/anxiety and past 90-day heavy alcohol use.ResultsCompared to waitlist (n = 30), participants randomized to immediately receive EQuIP (n = 30) experienced significantly reduced depression and anxiety (d = 0.85, 0.86, respectively); effects for alcohol use problems were smaller (d = 0.29) and marginally significant. In pre- to post-intervention pooled analyses, effect sizes for minority stress processes (mean d = .25) and universal risk factors (mean d = .48), through which the treatment was expected to work, were small and moderate, respectively, and in the expected direction.ConclusionsThis study provides initial support for a minority-stress-focused transdiagnostic cognitive-behavioral treatment for sexual minority women. These first results can launch exploration of other mechanisms and modalities through which to equip this population with evidence-based support. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
| S-EPMC7597069 | biostudies-literature