Adolescent Sexual Minority Girls Are at Elevated Risk for Use of Multiple Substances

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Unintended Pregnancy, Depression, and Hazardous Drinking in a Community-Based Sample of Sexual Minority Women

CONTEXT:

Unintended pregnancy is a stressful life event with important implications for women's health. Little research has examined sexual minority women's (SMW; lesbian, bisexual, mostly heterosexual) experiences of unintended pregnancy, and no studies have examined the relationship between unintended pregnancy, mental health, and negative coping behaviors in this population.

METHODS:

We used the Chicago Health and Life Experiences of Women (CHLEW) Study (n = 454), a diverse sample of SMW, to examine the relationship between self-reported unintended pregnancy, depressive symptoms, and hazardous drinking. We used generalized linear model-building techniques and adjusted for key sociodemographic controls, as well as unintended pregnancy risk factors, including childhood physical and sexual abuse and age of sexual debut.

RESULTS:

Twenty-four percent of the sample reported an unintended pregnancy. SMW who reported unintended pregnancies also reported significantly more depressive symptoms and greater risk of hazardous drinking. Adjusting for childhood abuse explained the relationship between unintended pregnancy and depressive symptoms, but not the relationship between unintended pregnancy and hazardous drinking.

CONCLUSIONS:

Unintended pregnancy among SMW is an understudied topic. Our results suggest that unintended pregnancy is not uncommon among SMW and highlight the need for more research to investigate the mechanisms that link unintended pregnancy to depression and to hazardous drinking within this population.

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By:  Everett BG1, McCabe KF2, Hughes TL3.

• 1 Department of Sociology, University of Utah, Salt Lake City, Utah.
• 2 Department of Sociology, University of Illinois at Chicago, Chicago, Illinois.
• 3 Department of Health Systems Science, University of Illinois at Chicago, Chicago, Illinois. 
• J Womens Health (Larchmt). 2016 Mar 15.

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Religiosity as a Protective Factor for Hazardous Drinking and Drug Use among Sexual Minority and Heterosexual Women

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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By:  Drabble L1, Trocki KF2, Klinger JL3.

• 1San José State University School of Social Work, One Washington Square, San José, CA 95192-0124, United States. Electronic address: laurie.drabble@sjsu.edu.
• 2Alcohol Research Group, Public Health Institute, 6475 Christie Ave. Suite 400, Emeryville, CA 94608, United States. Electronic address: ktrocki@arg.org.
• 3Alcohol Research Group, Public Health Institute, 6475 Christie Ave. Suite 400, Emeryville, CA 94608, United States. Electronic address: jklinger@arg.org. 
• Drug Alcohol Depend. 2016 Feb 2. pii: S0376-8716(16)00050-8. doi: 10.1016/j.drugalcdep.2016.01.022.

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Time-Site Survey of Substance Use, Sexual Behaviours, and HIV-Testing Practices among Women Attending Social Venues in Prague

AIM:

The rates of HIV acquired through heterosexual contact are increasing in the Czech Republic. This study explored potential HIV risk associations with alcohol, illicit drugs and sexual behaviors among adults from a community-based sample attending gay- and non-gay venues in Prague.

METHODS:

Women attending bars, cafes and beer gardens in central Prague responded to the self-administered, time-site survey. Alcohol use was measured by the AUDIT-C and CAGE questionnaires. Sexual network structuring identified number, gender and coital frequency with current and recent sexual partners. Statistical analysis included central tendency, chi-square and logistic regression. Female participants (n=124) ranged from 18 to 67 years of age (mean 29 years); 25% self-identified as non-heterosexual.

RESULTS:

We found alcohol to be the preferred drug of choice. Younger heterosexual women with new and casual sexual partners were more likely to use alcohol excessively. Women with children reported the least alcohol use. Sixty percent of the sample had never used condoms; condom-use was associated with longer relationship duration and discussions about HIV status with a sexual partner; non-use tended to occur among unmarried women with multiple male partners in short, serial sexual relationships. Women who sought HIV testing tended to be younger and more self-identified as non-heterosexual. Protective practices were rarely reported even when HIV transmission increases via heterosexual sexual partnering.

CONCLUSION:

Further research is recommended regarding cultural and contextual influences on HIV risk behaviors among Czech women.

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By:  Stemmler SM1,2, Hall TM1, Prokopík P3, Shoptaw S1.

• 1Center for Behavioral and Addiction Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, United States.
• 2California State University, Dominguez Hills, Carson, CA, United States.
• 3Charles University, Prague, Czech Republic.
• Cent Eur J Public Health. 2015 Jun;23(2):135-141. 

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Association of Alcohol Misuse with Sexual Identity and Sexual Behavior in Women Veterans

BACKGROUND:

Sexual minority women report greater alcohol misuse than heterosexual women in the general population, with more pronounced differences found among younger age groups. It is unknown whether these differences exist among women veterans.

OBJECTIVE:

We evaluated differences in alcohol misuse across two dimensions of sexual orientation (identity and behavior) among women veterans, and examined whether these differences were modified by age.

METHODS:

Women veterans were recruited via the internet to participate in an online survey. Participants provided information on their self-reported sexual identity and behavior and responded to the validated 3-item Alcohol Use Disorders Identification Test-Consumption questionnaire (AUDIT-C). Regression models were used to compare the prevalence of alcohol misuse (AUDIT-C ≥ 3) and severity (AUDIT-C scores) across sexual identity and behavior and to test effect modification by age.

RESULTS:

Among the 702 participants (36% lesbian/bisexual), prevalence and severity of alcohol misuse varied by both sexual identity and behavior, but there were significant interactions with age. Prevalence and severity of alcohol misuse were higher among relatively younger self-identified lesbians compared to heterosexual women. Similarly, both prevalence and severity of alcohol misuse were generally higher among younger women who had any sex with women compared to those who had sex only with men. Conclusions/Importance: In this online study of women veterans, younger sexual minority women were more likely to screen positive for alcohol misuse, and they had more severe alcohol misuse, than their heterosexual counterparts. Prevention and treatment efforts focused specifically on sexual minority women veterans may be needed.

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By:  Lehavot K1,2,3,4, Williams EC1,4, Millard SP2, Bradley KA1,4,5, Simpson TL2,3,6.

• 1a VA Health Services Research & Development, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound , Seattle , Washington , USA.
• 2b Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System , Seattle , Washington , USA.
• 3c Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle , Washington , USA.
• 4d Department of Health Services, University of Washington , Seattle , Washington , USA.
• 5e Group Health Research Institute , Seattle , Washington , USA.
• 6f Center of Excellence in Substance Abuse Treatment and Education (CESATE), VA Puget Sound Health Care System , Seattle , Washington , USA. 
• Subst Use Misuse. 2016 Jan 22:1-14.

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PTSD & Trauma-Related Difficulties in Sexual Minority Women: The Impact of Perceived Social Support

This study examined posttraumatic stress disorder (PTSD) and related symptoms among sexual minority (SM) and heterosexual women and the influence of social support on the relationship between SM status and symptoms. We hypothesized that SM women would endorse higher symptoms of PTSD and related difficulties and that social support would moderate the relationship between SM status and symptoms. 

The sample, women seeking treatment for PTSD related to interpersonal violence (n = 477; mean age = 36.07 years; 22.9% SM) completed clinician-administered measures of PTSD and self-report measures of trauma-related difficulties and social support. The rate of PTSD diagnosis was higher for SM women. Social support and SM status were significantly associated with suicidality, self-perceptions, depression, somatic complaints, and functional impairment. The interaction between social support and SM status was significant for both functional impairment (β = -.26) and somatic complaints (β = -.39). High social support had an equal, positive effect among SM and nonminority women, whereas low social support had a greater negative impact among SM women. 

Results suggested the particular salience of social support on functioning and symptom severity among SM women and the potential importance of including interventions addressing social support into PTSD treatments for SM women.

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By:  Weiss BJ1,2, Garvert DW1, Cloitre M1,2,3.

• 1National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.
• 2Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA.
• 3Department of Psychiatry and Child & Adolescent Psychiatry, New York University Medical Center, New York, New York, USA.

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Reciprocal Relationships Over Time Between Descriptive Norms and Alcohol Use in Young Adult Sexual Minority Women

Young adulthood, roughly ages 18-25, is a period of great risk for excessive consumption of alcohol, especially among sexual minority women (SMW). Despite the substantial literature examining the relationships between social norms and behavior in general, little attention has been given to the role of descriptive norms on the drinking behaviors of sexual minorities. 

The present study had 3 aims: to compare both typical woman descriptive norms and sexual minority-specific descriptive normative perceptions among a sample of SMW, to examine reciprocal associations between sexual minority-specific descriptive norms and alcohol consumption over time, and to examine whether these reciprocal associations were moderated by sexual orientation (i.e., whether 1 identifies as lesbian or bisexual). 

A national sample of 1,057 lesbian and bisexual women between the ages of 18 and 25 was enrolled in this study. Participants completed an online survey at 4 time points that assessed the constructs of interest. 

Results indicated that SMW consistently perceived that SMW drank more than their nonsexual minority peers; that SMW-specific descriptive drinking norms and alcohol consumption influenced 1 another over time in a reciprocal, feed-forward fashion; and that these associations were not moderated by sexual orientation. 

These findings highlight the importance of considering SMW-specific norms as an important factor in predicting alcohol consumption in SMW. Results further support the development and testing of normative interventions for high-risk drinking among SMW. 

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By: Litt DM, Lewis MA, Rhew IC, Hodge KA, Kaysen DL.

  

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Association of Skin Cancer and Indoor Tanning in Sexual Minority Men and Women

Skin cancer, the most common cancer in the United States, is highly associated with outdoor and indoor tanning behaviors. Although indoor tanning has been suggested to be more common among sexual minority (self-reported as homosexual, gay, or bisexual) men compared with heterosexual men, whether rates of skin cancer vary by sexual orientation is unknown.

To investigate whether skin cancer prevalence and indoor tanning behaviors vary by sexual orientation in the general population.

We performed a cross-sectional study using data from the 2001, 2003, 2005, and 2009 California Health Interview Surveys (CHISs) and the 2013 National Health Interview Survey (NHIS) of population-based samples of the California and US noninstitutionalized civilian population. Participants included 192 575 men and women 18 years or older who identified as heterosexual or a sexual minority.

Self-reported lifetime history of skin cancer and 12-month history of indoor tanning.

The study included 78 487 heterosexual men, 3083 sexual minority men, 107 976 heterosexual women, and 3029 sexual minority women. Sexual minority men were more likely than heterosexual men to report having skin cancer and having tanned indoors. Sexual minority women were less likely than heterosexual women to report having had nonmelanoma skin cancer  and having tanned indoors.

Sexual minority men indoor tan more frequently and report higher rates of skin cancer than heterosexual men. Primary and secondary prevention efforts targeted at sexual minority men might reduce risk factors for, and consequences of, skin cancer.

Full article at: http://goo.gl/8QSWpS

By: Mansh M1, Katz KA2, Linos E3, Chren MM4, Arron S4.

• 1Department of Dermatology, University of California, San Francisco 2Stanford University School of Medicine, Stanford, California.
• 2Department of Dermatology, Kaiser Permanente, Pleasanton, California.
• 3Department of Dermatology, University of California, San Francisco.
• 4Department of Dermatology, University of California, San Francisco4Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California.

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The Predictive Syndemic Effect of Multiple Psychosocial Problems on Health Care Costs and Utilization among Sexual Minority Women

Previous studies documenting sexual minority women's disproportionate risk for a range of medical, mental health, and substance use disorders have not provided a predictive framework for understanding their interrelations and outcomes. 

The present study aimed to address this gap by testing the syndemic effect of co-occurring psychosocial problems on 7-year health care costs and utilization among sexual minority women. The sample was comprised of sexual minority women (N = 341) who were seen at an urban LGBT-affirmative community health center. Medical and mental health care utilization and cost data were extracted from electronic medical records. 

Demographically adjusted regression models revealed that co-occurring psychosocial problems (i.e., childhood sexual abuse, partner violence, substance use, and mental health distress [history of suicide attempt]) were all strongly interrelated. The presence of these indicators had a syndemic (additive) effect on medical costs and utilization and mental health utilization over 7-year follow-up, but no effect on 7-year mental health costs. 

These results suggest that the presence and additive effect of these syndemic conditions may, in part, explain increased medical costs and utilization (and higher medical morbidity) among sexual minority women.

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By: Valentine SE1,2, Elsesser S3, Grasso C3, Safren SA1,2,3, Bradford JB3, Mereish E4, O'Cleirigh C5,6,7.

• 1Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.
• 2Harvard Medical School, Boston, MA, USA.
• 3The Fenway Institute, Fenway Health, Boston, MA, USA.
• 4Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA.
• 5Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA. cocleirigh@mgh.harvard.edu.
• 6Harvard Medical School, Boston, MA, USA.
• 7The Fenway Institute, Fenway Health, Boston, MA, USA

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Exploring Discrimination and Mental Health Disparities Faced By Black Sexual Minority Women Using a Minority Stress Framework

Black sexual minority women are triply marginalized due to their race, gender, and sexual orientation. We compared three dimensions of discrimination-frequency (regularity of occurrences), scope (number of types of discriminatory acts experienced), and number of bases (number of social statuses to which discrimination was attributed)-and self-reported mental health (depressive symptoms, psychological well-being, and social well-being) between 64 Black sexual minority women and each of two groups sharing two of three marginalized statuses: (a) 67 White sexual minority women and (b) 67 Black sexual minority men. 

Black sexual minority women reported greater discrimination frequency, scope, and number of bases and poorer psychological and social well-being than White sexual minority women and more discrimination bases, a higher level of depressive symptoms, and poorer social well-being than Black sexual minority men. We then tested and contrasted dimensions of discrimination as mediators between social status (race or gender) and mental health outcomes. Discrimination frequency and scope mediated the association between race and mental health, with a stronger effect via frequency among sexual minority women. Number of discrimination bases mediated the association between gender and mental health among Black sexual minorities. 

Future research and clinical practice would benefit from considering Black sexual minority women's mental health in a multidimensional minority stress context.

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By:  Calabrese SK1, Meyer IH2, Overstreet NM3, Haile R4, Hansen NB5.

• 1Yale School of Public Health/Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.
• 2The Williams Institute UCLA School of Law, University of California, Los Angeles, CA, USA.
• 3Department of Psychology, Clark University, Worcester, MA, USA.
• 4Public Health Department, State University of New York at Old Westbury, Old Westbury, NY, USA.
• 5Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA. 

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Adherence to Mammography Screening Guidelines Among Transgender Persons and Sexual Minority Women

We used retrospective (2012-2013) chart review to examine breast cancer screening among transgender persons and sexual minority women (n = 1263) attending an urban community health center in Massachusetts. 

Transgender were less likely than cisgender patients and bisexuals were less likely than heterosexuals and lesbians to adhere to mammography screening guidelines (respectively, adjusted odds ratios = 0.53 and 0.56; 95% confidence intervals = 0.31, 0.91 and 0.34, 0.92) after adjustment for sociodemographics. 

Enhanced cancer prevention outreach is needed among gender and sexual minorities.

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By: Bazzi AR1, Whorms DS1, King DS1, Potter J1.

• 1Angela Robertson Bazzi is with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Debra S. Whorms, Dana S. King, and Jennifer Potter are with Fenway Health, Boston. Jennifer Potter is also with the Harvard Medical School, Boston.
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