The Relationship Between Discrimination and Substance Use Disorders Among Lesbian, Gay, and Bisexual Adults in the United States

Objectives. We examined the associations between 3 types of discrimination (sexual orientation, race, and gender) and substance use disorders in a large national sample in the United States that included 577 lesbian, gay, and bisexual (LGB) adults.Methods. Data were collected from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions, which used structured diagnostic face-to-face interviews.Results. More than two thirds of LGB adults reported at least 1 type of discrimination in their lifetimes. Multivariate analyses indicated that the odds of past-year substance use disorders were nearly 4 times greater among LGB adults who reported all 3 types of discrimination prior to the past year than for LGB adults who did not report discrimination (adjusted odds ratio = 3.85; 95% confidence interval = 1.71, 8.66).Conclusions. Health professionals should consider the role multiple types of discrimination plays in the development and treatment of substance use disorders among LGB adults.Substance use disorders have been shown to be more prevalent among lesbian, gay, and bisexual (LGB) adults than among heterosexual adults in the United States.^1–6 Despite this evidence, little empirical work has focused on why such differences exist between LGB and heterosexual adults. Many studies have posited that differences in rates of mental health problems and substance abuse are related to social stressors such as discrimination,^7–11 yet no large-scale national studies have examined the relationship between multiple types of discrimination and substance use disorders. Meyer''s minority stress model posits that discrimination, internalized homophobia, and social stigma can create a hostile and stressful social environment for LGB adults that contributes to mental health problems, including substance use disorders.^10,11 An assumption of this model is that minority stress is unique and additive to general stressors that all people experience.Meyer''s model connects the literature demonstrating higher odds of mental health problems and substance use disorders among LGB populations with well-established social science research that demonstrates the link between stress or stressful life events and poor health outcomes.^12–15 Lesbian, gay, and bisexual adults experience discrimination at the structural and institutional level, such as in access to housing, employment, medical care, and basic civil rights,^16,17 as well as at the individual level in the form of harassment and violence.^18–22 Discriminatory experiences have been shown to operate as stressors in the lives of LGB people and, in turn, they are significantly associated with psychiatric disorders,⁹ psychological distress,^9,20,23 and depressive symptoms.^20,24Although the minority stress model provides a useful theoretical framework for understanding health disparities among LGB adults, only a handful of studies have directly assessed discrimination among LGB populations, and even fewer have examined the relationships between discrimination and health outcomes. Extant research on health outcomes related to discrimination has focused on blood pressure,¹⁷ psychological distress,^24,25 mental health disorders,⁹ and general psychological and physical health.²⁶ Given that exposure to both acute and chronic stress has long been associated with substance abuse and relapse in the general population,^26,27 research on the association between experiences of discrimination and substance use disorders among LGB adults is warranted.In our investigation, we assumed that LGB adults are at heightened risk for substance use disorders as a consequence of cultural and environmental factors associated with being part of a stigmatized and marginalized population, not because of their sexual orientation. Building on previous work documenting the impact of multiple stigmatized statuses among sexual minority people^11,28,29 as well as the work of Krieger et al.,¹⁶ we sought to examine the relationships between 3 types of discrimination (sexual orientation, race/ethnicity, and gender) and substance use disorders. We used data from wave 2 of the 2004–2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to test the hypothesis that LGB adults who reported more types of discrimination would be more likely to meet criteria for substance use disorders than would those who reported fewer types or who did not report discrimination.     

Correlates of Mental Health Service Use Among Lesbian,Gay, and Bisexual Mothers and Prospective Mothers

ABSTRACT

Lesbian, gay, and bisexual women undertake parenting in a social context that may be associated with unique risk factors for perinatal depression. This cross-sectional study aimed to describe the mental health services used by women in the perinatal period and to identify potential correlates of mental health service use. Sixty-four women who were currently trying to conceive, pregnant, or the parent of a child less than one year of age were included. One-third of women reported some mental health service use within the past year; 30.6% of women reported a perceived unmet need for mental health services in the past year, with 40% of these women citing financial barriers as the reason for their unmet need. Women who were trying to get pregnant or who were less “out” were most likely to have had recent mental health service use. Women who had conceived by having sex with a man or who reported more than three episodes of discrimination were most likely to report unmet needs for mental health services. Providers may benefit from additional knowledge about the LBG social context that is relevant to perinatal health, and from identifying a strong referral network of skilled and affordable counsellors.     

Health Disparities Among Lesbian,Gay, and Bisexual Older Adults: Results From a Population-Based Study

Objectives. We investigated health disparities among lesbian, gay, and bisexual (LGB) adults aged 50 years and older.Methods. We analyzed data from the 2003–2010 Washington State Behavioral Risk Factor Surveillance System (n = 96 992) on health outcomes, chronic conditions, access to care, behaviors, and screening by gender and sexual orientation with adjusted logistic regressions.Results. LGB older adults had higher risk of disability, poor mental health, smoking, and excessive drinking than did heterosexuals. Lesbians and bisexual women had higher risk of cardiovascular disease and obesity, and gay and bisexual men had higher risk of poor physical health and living alone than did heterosexuals. Lesbians reported a higher rate of excessive drinking than did bisexual women; bisexual men reported a higher rate of diabetes and a lower rate of being tested for HIV than did gay men.Conclusions. Tailored interventions are needed to address the health disparities and unique health needs of LGB older adults. Research across the life course is needed to better understand health disparities by sexual orientation and age, and to assess subgroup differences within these communities.Changing demographics will make population aging a defining feature of the 21st century. Not only is the population older, it is becoming increasingly diverse.1 Existing research illustrates that older adults from socially and economically disadvantaged populations are at high risk of poor health and premature death.2 A commitment of the National Institutes of Health is to reduce and eliminate health disparities,3 which have been defined as differences in health outcomes for communities that have encountered systematic obstacles to health as a result of social, economic, and environmental disadvantage.4Social determinants of health disparities among older adults include age, race/ethnicity, and socioeconomic status.5 Centers for Disease Control and Prevention (CDC) and Healthy People 2020 identify health disparities related to sexual orientation as one of the main gaps in current health research.6 The Institute of Medicine identifies lesbian, gay, and bisexual (LGB) older adults as a population whose health needs are understudied.7 The institute has called for population-based studies to better assess the impact of background characteristics such as age on health outcomes among LGB adults. A review of 25 years of literature on LGB aging found that health research is glaringly sparse for this population and that most aging-related studies have used small, non-population-based samples.8Several important studies have begun to document health disparities by sexual orientation in population-based data and have revealed important differences in health between LGB adults and their heterosexual counterparts, including higher risks of poor mental health, smoking, and limitations in activities.9,10 Studies have found higher rates of excessive drinking among lesbians and bisexual women9,10 and higher rates of obesity among lesbians10,11 than among heterosexual women; bisexual men and women are at higher risk of limited health care access than are heterosexuals. In addition, important subgroup differences in health are beginning to be documented among LGB adults. For example, bisexual women are at higher risk than lesbians for mental distress and poor general health.12 A primary limitation of most existing population-based research is a failure to identify the specific health needs of LGB older adults. Most studies to date address the health needs of LGB adults aged 18 years and older9 or those younger than 65 years.10 This lack of attention to older adult health leaves unclear whether disparities diminish or persist or even become more pronounced in later life.A few studies have begun to examine health disparities among LGB adults aged 50 years and older.13,14 Wallace et al. analyzed data from the California Health Interview Survey and found that LGB adults aged 50 to 70 years report higher rates of mental distress, physical limitations, and poor general health than do their heterosexual counterparts. The researchers also found that older gay and bisexual men report higher rates of hypertension and diabetes than do heterosexual men.14 To better address the needs of an increasingly diverse older adult population and to develop responsive interventions and public health policies, health disparities research is needed for this at-risk group.Examining to what extent sexual orientation is related to health disparities among LGB older adults is a first step toward developing a more comprehensive understanding of their health and aging needs. We analyzed population-based data from the Washington State Behavioral Risk Factor Surveillance System (WA-BRFSS) to compare lesbians and bisexual women and gay and bisexual men with their heterosexual counterparts aged 50 years and older on key health indicators: outcomes, chronic conditions, access to care, behaviors, and screening. We also compared subgroups to identify differences in health disparities by sexual orientation among LGB older adults.     

Loneliness Among Older Lesbian,Gay, and Bisexual Adults: The Role of Minority Stress

Past research has consistently found that aging lesbians, gay men, and bisexuals (LGBs) are more apt to suffer from loneliness than their heterosexual counterparts. Data from the 2002 Gay Autumn survey (N = 122) were used to find out whether minority stress relates to higher levels of loneliness among older LGB adults in the Netherlands. We examined five minority stress factors: external objective stressful events, expectations of those events, internalized homonegativity, hiding and concealment of one’s LGB identity, and ameliorating processes. The results showed that greater insight into loneliness among older LGB adults was obtained when minority stress factors were considered. Older LGB adults who had experienced negative reactions, as well as aging LGBs who expected those reactions, had the highest levels of loneliness. Having an LGB social network buffered against the impact of minority stress. These minority stress processes added to the variance already explained by general factors that influenced levels of loneliness (partner relationships, general social network, physical health, and self-esteem). Interventions aimed at decreasing feelings of loneliness among older LGBs should be focused on decreasing societal homonegativity (to decrease the amount of negative and prejudiced reactions) and on the enhancement of social activities for LGB elderly.     

Upset Over Sexual versus Emotional Infidelity Among Gay,Lesbian, Bisexual,and Heterosexual Adults

One hypothesis derived from evolutionary perspectives is that men are more upset than women by sexual infidelity and women are more upset than men by emotional infidelity. The proposed explanation is that men, in contrast to women, face the risk of unwittingly investing in genetically unrelated offspring. Most studies, however, have relied on small college or community samples of heterosexual participants. We examined upset over sexual versus emotional jealousy among 63,894 gay, lesbian, bisexual, and heterosexual participants. Participants imagined which would upset them more: their partners having sex with someone else (but not falling in love with them) or their partners falling in love with someone else (but not having sex with them). Consistent with this evolutionary perspective, heterosexual men were more likely than heterosexual women to be upset by sexual infidelity (54 vs. 35 %) and less likely than heterosexual women to be upset by emotional infidelity (46 vs. 65 %). This gender difference emerged across age groups, income levels, history of being cheated on, history of being unfaithful, relationship type, and length. The gender difference, however, was limited to heterosexual participants. Bisexual men and women did not differ significantly from each other in upset over sexual infidelity (30 vs. 27 %), regardless of whether they were currently dating a man (35 vs. 29 %) or woman (28 vs. 20 %). Gay men and lesbian women also did not differ (32 vs. 34 %). The findings present strong evidence that a gender difference exists in a broad sample of U.S. adults, but only among heterosexuals.     

Victimization and Suicidality Among Dutch Lesbian,Gay, and Bisexual Youths

We examined Netherlands Institute for Social Research data, collected between May and August 2009, on 274 Dutch lesbian, gay, and bisexual youths. The data showed that victimization at school was associated with suicidal ideation and actual suicide attempts. Homophobic rejection by parents was also associated with actual suicide attempts. Suicidality in this population could be reduced by supporting coping strategies of lesbian, gay, and bisexual youths who are confronted with stigmatization by peers and parents, and by schools actively promoting acceptance of same-sex sexuality.Studies have shown that rates of suicidal ideation and suicide attempts among lesbian, gay, and bisexual (LGB) youths are higher than among heterosexually identified youths.1 Also, suicide attempts in LGB adolescents are positively associated with the parents’ negative responses to their offspring’s sexual orientation.2 Furthermore, victimization at school is positively related to lifetime suicide attempts and to suicidal ideation in the previous year.3,4 Although LGB adolescents experience victimization in various social contexts, it is not clear which social context (parents, family members outside the nuclear family, school, or neighborhood) is most crucial in determining suicidality. The present study is one of the first studies to examine this issue.     

Adverse Childhood Experiences Related to Poor Adult Health Among Lesbian,Gay, and Bisexual Individuals

Objectives. We explored the association of sexual orientation with poor adult health outcomes before and after adjustment for exposure to adverse childhood experiences (ACEs).Methods. Data were from the 2012 North Carolina, 2011 Washington, and 2011 and 2012 Wisconsin Behavioral Risk Factor Surveillance System (BRFSS) surveys regarding health risks, perceived poor health, and chronic conditions by sexual orientation and 8 categories of ACEs. There were 711 lesbian, gay, and bisexual (LGB) respondents and 29 690 heterosexual respondents.Results. LGB individuals had a higher prevalence of all ACEs than heterosexuals, with odds ratios ranging from 1.4 to 3.1. After adjustment for cumulative exposure to ACEs, sexual orientation was no longer associated with poor physical health, current smoking, and binge drinking. Associations with poor mental health, activity limitation, HIV risk behaviors, current asthma, depression, and disability remained, but were attenuated.Conclusions. The higher prevalence of ACEs among LGB individuals may account for some of their excess risk for poor adult health outcomes.Individuals identifying as lesbian, gay, or bisexual (LGB) make up between 2% and 6% of the US population, but they have been largely neglected by public health research.1–3 Inclusion of questions regarding sexual orientation on population-based surveys such as the Behavioral Risk Factor Surveillance System (BRFSS) survey, the National Health Interview Survey (NHIS), and others has helped public health and clinical practitioners identify health disparities and unique risk factors among this population.4 Even so, the existing research remains limited, with a heavy reliance on convenience samples, lack of comparison of LGB individuals with heterosexuals, and little data regarding disparities in physical health outcomes.5 The Institute of Medicine and Healthy People 2020 have identified health disparities and risk and protective factors among the LGB population as one of the main gaps in current health research.5,6Several studies have documented mental health and substance abuse disparities among LGB individuals. A recent meta-analysis found the risk of lifetime or past-year depression, anxiety, and alcohol and other substance dependence to be higher among LGB individuals than among heterosexuals.7 Results from population-based studies have demonstrated an increased prevalence of smoking among LGB individuals compared with heterosexuals.8–10 Results from the 2013 NHIS parallel these findings, with a higher prevalence of current smoking, binge drinking, and psychological distress among LGB individuals than among heterosexuals.1 Research regarding physical health outcomes, although more limited, has found LGB individuals to have a higher prevalence of asthma and activity limitation than heterosexuals, and lesbian and bisexual women to have a higher prevalence of asthma, poor physical health, cardiovascular disease risk, and obesity than heterosexual women.9–12Research has also identified disparities by sexual orientation for certain forms of childhood abuse and trauma. Both population- and community-based studies have found that a greater proportion of LGB adults report childhood sexual, physical, and emotional abuse than do heterosexual adults.13–18 A comprehensive review of the literature found that approximately 22.7% of gay and bisexual men and 34.5% of lesbian and bisexual women reported childhood sexual abuse. In that review, a direct comparison with experiences of childhood sexual abuse among heterosexual adults was not possible, given the relatively limited number of studies that have collected such comparison data.13 However, data from the National Epidemiologic Survey on Alcohol and Related Conditions found lesbian and bisexual women to be 3 times as likely as heterosexual women to report childhood sexual abuse, and gay men to be twice as likely as heterosexual men to report such abuse.14 Data from the National Study of Midlife Development in the United States revealed a greater proportion of LGB individuals than heterosexuals to report physical and emotional maltreatment by their parents.15To date, research on experiences of childhood abuse and trauma among the LGB population has lacked inclusion of measures of household dysfunction such as witnessing domestic violence or parental substance abuse in the household. A recent systematic review of the literature identified only 5 studies that examined experiences of household dysfunction among LGB individuals.19 The most comprehensive of these studies, by Andersen and Blosnich,20 used a population-based sample of both LGB individuals and heterosexuals who responded to questions on the adverse childhood experience (ACE) scale. The ACE scale captures 3 categories of childhood abuse (sexual, physical, and emotional abuse) and 5 categories of household dysfunction (adult mental illness, substance abuse, and domestic violence in the household; incarceration of a household member; and parental divorce or separation). In the Andersen and Blosnich study, LGB adults were more likely than heterosexuals to report each category of childhood abuse and all categories of household dysfunction, except parental divorce or separation. LGB individuals were also more likely to report exposure to more than 1 ACE category, or multiple ACEs, than heterosexuals.20 Such findings are important because cumulative exposure to childhood abuse and household dysfunction has been linked to numerous poor outcomes in adulthood among the general population.21,22 However, no other studies have addressed cumulative exposure to childhood abuse and trauma among the LGB population.19Despite research indicating that LGB individuals are at increased risk for both childhood adversity and certain health disparities, there has been relatively little research exploring the association between these constructs by sexual orientation.23 The National Alcohol Survey found that the association between sexual orientation and hazardous drinking among women was attenuated after adjustment for childhood sexual and physical abuse.24 In an analysis of the National Longitudinal Study of Adolescent Health, greater exposure to childhood physical or sexual abuse, homelessness, and intimate partner violence explained between 10% and 20% of the excess in risk of tobacco use, drug and alcohol abuse, and depression among LGB adolescents compared with heterosexuals.25 The majority of these studies focused only on sexual or physical abuse, and none included an assessment of cumulative exposure to multiple forms of childhood abuse and household dysfunction using the ACEs scale.We used a population-based sample of both LGB and heterosexual individuals to examine the association of sexual orientation with health risks, perceived poor health, and chronic conditions in adulthood before and after adjustment for cumulative exposure to ACEs.     

Human Papillomavirus Vaccination Among Young Adult Gay and Bisexual Men in the United States

Objectives. We examined human papillomavirus (HPV) vaccination among gay and bisexual men, a population with high rates of HPV infection and HPV-related disease.Methods. A national sample of gay and bisexual men aged 18 to 26 years (n = 428) completed online surveys in fall 2013. We identified correlates of HPV vaccination using multivariate logistic regression.Results. Overall, 13% of participants had received any doses of the HPV vaccine. About 83% who had received a health care provider recommendation for vaccination were vaccinated, compared with only 5% without a recommendation (P < .001). Vaccination was lower among participants who perceived greater barriers to getting vaccinated (odds ratio [OR] = 0.46; 95% confidence interval [CI] = 0.27, 0.78). Vaccination was higher among participants with higher levels of worry about getting HPV-related disease (OR = 1.54; 95% CI =  1.05, 2.27) or perceived positive social norms of HPV vaccination (OR = 1.57; 95% CI =  1.02, 2.43).Conclusions. HPV vaccine coverage is low among gay and bisexual men in the United States. Future efforts should focus on increasing provider recommendation for vaccination and should target other modifiable factors.Oncogenic human papillomavirus (HPV) types (mainly types 16 and 18) cause an estimated 93% of anal cancers, 63% of oropharyngeal cancers, and 36% of penile cancers among men in the United States.1 Nononcogenic HPV types 6 and 11 cause almost all anogenital warts.2 Gay and bisexual men have high rates of HPV infection and HPV-related disease. A recent review suggests that more than 50% of HIV-negative gay and bisexual men have an anogenital HPV infection.3 About 7% of gay and bisexual men report a history of genital warts.4 Anal cancer is also of great concern, with incidence among HIV-negative gay and bisexual men estimated to be 35 cases per 100 000 population.5 The anal cancer incidence rate among all men in the United States is just 1.6 cases per 100 000 population.6US guidelines began including the quadrivalent HPV vaccine (against HPV types 6, 11, 16, and 18) for males in October 2009.7 The Advisory Committee on Immunization Practices (ACIP) first provided a permissive recommendation that allowed the HPV vaccine to be given to males aged 9 to 26 years but did not include the vaccine in their routine vaccination schedule.7 In October 2011, the ACIP began recommending routine vaccination for boys aged 11 to 12 years with catch-up vaccination for males aged 13 to 21 years.8 Importantly, the ACIP recommends HPV vaccination for men who have sex with men through age 26 years.8The HPV vaccine series consists of 3 doses, with the second dose administered 1 to 2 months after the first dose, and the third dose is administered 6 months after the first dose.7 The quadrivalent HPV vaccine is currently approved to protect males against genital warts and anal cancer.9 Despite recommendations, recent data suggest that fewer than 21% of males in the United States have received any doses of the HPV vaccine.10–14Although several HPV-related disparities exist among gay and bisexual men, little research has addressed HPV vaccination among this population. Past studies have shown that knowledge about HPV and the HPV vaccine tends to be modest among gay and bisexual men.15–19 Many gay and bisexual men have indicated their willingness to get the HPV vaccine, with estimates ranging from 36% to 86%.16,18–20 Data on actual HPV vaccine coverage are sparse; a past study found only 7% of 68 young adult gay and bisexual men had received any doses of the HPV vaccine.11 This study was, however, conducted before the ACIP recommendation for routine vaccination of males.We built on this past research by examining HPV vaccination among a national sample of young adult gay and bisexual men in the recommended age range for HPV vaccination (18–26 years). We identified correlates of vaccination and why young adult gay and bisexual men are not getting the HPV vaccine. These data will help inform future programs for increasing HPV vaccination among this high-risk population.     

Responses to Discrimination and Psychiatric Disorders Among Black,Hispanic, Female,and Lesbian,Gay, and Bisexual Individuals

Objectives. We examined associations between perceived discrimination due to race/ethnicity, sexual orientation, or gender; responses to discrimination experiences; and psychiatric disorders.Methods. The sample included respondents in the 2004–2005 National Epidemiologic Survey on Alcohol and Related Conditions (n = 34 653). We analyzed the associations between self-reported past-year discrimination and past-year psychiatric disorders as assessed with structured diagnostic interviews among Black (n = 6587); Hispanic (n = 6359); lesbian, gay, and bisexual (LGB; n = 577); and female (n = 20 089) respondents.Results. Black respondents reported the highest levels of past-year discrimination, followed by LGB, Hispanic, and female respondents. Across groups, discrimination was associated with 12-month mood (odds ratio [ORs] = 2.1–3.1), anxiety (ORs = 1.8–3.3), and substance use (ORs = 1.6–3.5) disorders. Respondents who reported not accepting discrimination and not discussing it with others had higher odds of psychiatric disorders (ORs = 2.9–3.9) than did those who did not accept discrimination but did discuss it with others. Black respondents and women who accepted discrimination and did not talk about it with others had elevated rates of mood and anxiety disorders, respectively.Conclusions. Psychiatric disorders are more prevalent among individuals reporting past-year discrimination experiences. Certain responses to discrimination, particularly not disclosing it, are associated with psychiatric morbidity.The role of discrimination as a health determinant has increasingly become a focus of scholarly inquiry. Accumulating evidence points to the deleterious consequences of discrimination experiences on health.^1–6 The damaging effects of discrimination on mental health, in particular, are increasingly evident.^6–9 Experiences of discrimination, whether based on race/ethnicity, sexual orientation, or gender, have been linked to elevations in psychological distress and symptoms of psychopathology.^1,8,10–13 Although the relation between discrimination and psychiatric disorders has been studied less frequently, significant associations with major depression,^9,13 generalized anxiety disorder (GAD),⁹ early initiation of substance abuse,¹⁴ and a composite index of psychiatric morbidity¹⁵ have been reported.This research provides empirical documentation of the role of discrimination in shaping the distribution of adverse mental health outcomes at a population level, but numerous questions regarding these associations remain. Despite widespread exposure to discrimination, most members of stigmatized groups do not ultimately develop psychiatric disorders, which suggests the presence of factors that buffer some individuals against the negative mental health consequences of discrimination. How an individual responds to and copes with discrimination is one factor that may help to identify those most vulnerable to the development of psychiatric disorders after exposure to discrimination. Although several studies have examined coping strategies that members of stigmatized groups use in response to status-based discrimination,^16,17 few studies have considered the impact of these strategies on psychiatric disorders. Previous research has reported associations between responses to discrimination and blood pressure,^3,5 self-esteem, and psychological distress,^6,16 which suggest that such responses may have implications for psychiatric morbidity.Two dimensions of discrimination responses relevant to health outcomes are acceptance and disclosure. Previous research has suggested that these responses interact in complex ways. Among individuals who accept discrimination, disclosing the experience is associated with elevated blood pressure among Black men, whereas not disclosing the experience predicts higher blood pressure among Black women.³ Aside from that study, however, the extent to which responses to discrimination and their associations with health outcomes vary across stigmatized groups has rarely been examined empirically. Given the heterogeneity across groups in experiences of discrimination,^18–20 it is likely that members of stigmatized groups have developed divergent social norms or beliefs regarding appropriate responses to discriminatory actions. Consequently, it remains unclear (1) whether members of different stigmatized groups respond differently to discrimination, and (2) wct 6 whether these variations in responses translate into differential vulnerability to psychiatric disorders when discrimination is experienced. Such information may help to more effectively target preventive interventions, an important public health priority given group-based disparities in psychiatric morbidity.²¹In the present study, we addressed these gaps in the literature by examining whether psychiatric disorders were associated with perceived discrimination due to race/ethnicity, sexual orientation, or gender and with responses to discrimination experiences. We first examined the prevalence of past-year self-reported discrimination experiences based on race/ethnicity, sexual orientation, or gender in a US national sample. Second, we estimated the associations between discrimination experiences and the prevalence of psychiatric disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV),²² including mood, anxiety, and substance use disorders, thus providing the first such estimates across a range of disorders. Third, we examined the distribution of responses to discrimination across 2 domains (acceptance–nonacceptance and disclosure–nondisclosure). Finally, we estimated the associations between responses to discrimination and psychiatric disorders among individuals exposed to past-year discrimination.     

Correlates of Mental Health Treatment Receipt Among Asian Americans with Perceived Mental Health Problems

The Journal of Behavioral Health Services & Research - Compared with other ethnic groups, Asian Americans report the lowest rates of mental health treatment and service utilization. This is...     

The Dubious Assessment of Gay,Lesbian, and Bisexual Adolescents of Add Health

In this essay, we argue that researchers who base their investigations of nonheterosexuality derived from reports of romantic attractions of adolescent participants from Wave 1 of Add Health must account for their disappearance in future waves of data collection. The high prevalence of Wave 1 youth with either both-sex or same-sex romantic attractions was initially striking and unexpected. Subsequent data from Add Health indicated that this prevalence sharply declined over time such that over 70 % of these Wave 1 adolescents identified as exclusively heterosexual as Wave 4 young adults. Three explanations are proposed to account for the high prevalence rate and the temporal inconsistency: (1) gay adolescents going into the closet during their young adult years; (2) confusion regarding the use and meaning of romantic attraction as a proxy for sexual orientation; and (3) the existence of mischievous adolescents who played a “jokester” role by reporting same-sex attraction when none was present. Relying on Add Health data, we dismissed the first explanation as highly unlikely and found support for the other two. Importantly, these “dubious” gay, lesbian, and bisexual adolescents may have led researchers to erroneously conclude from the data that sexual-minority youth are more problematic than heterosexual youth in terms of physical, mental, and social health.     

A Profile of North Carolina Lesbian,Gay, and Bisexual Health Disparities, 2011

Objectives. We investigated the health profile of lesbian, gay, and bisexual (LGB) adults in North Carolina, the first state in the South to include a measure of sexual orientation identity in a probability-based statewide health survey.Methods. Using data from 9876 respondents in the 2011 North Carolina Behavioral Risk Factor Surveillance Survey, we compared sexual minorities to heterosexuals on a variety of health indicators.Results. LGB respondents were younger and more likely to be reached by cell phone. Many examined indicators were not different by sexual orientation. Significant results, however, were consistent with findings from state population surveys in other regions of the country, including disparities in mental health and, among women, smoking.Conclusions. Reporting LGB identity in North Carolina is associated with poorer health. The concentration of anti-LGB policies in the South warrants ongoing monitoring of LGB health disparities in North Carolina and in other Southeastern states for potential effects on the health and well-being of LGB populations.The unavailability of data from probability-based samples has been among the greatest impediments to identifying and addressing health disparities for lesbian, gay, and bisexual (LGB; or sexual minority) populations.1–3 The earliest studies restricted sampling of gay men and lesbians to psychiatric institutions and served to pathologize sexual minorities.4 Later efforts purposively sampled communities, providing more nuanced profiles of LGB health that proved instrumental in early identification of health disparities.5,6 Additionally, LGB and transgender communities themselves organized health data collection efforts even before the HIV/AIDS epidemic to document determinants of their health disparities, including barriers to health care, patterns of health behavior, and experiences of discrimination.7,8 Yet, notwithstanding the richness of these data, all nonprobability samples suffer from limitations of external validity.9 Concerns about the representativeness of data render studies using nonprobability sampling less influential in informing state and federal policy. Convenience samples have helped provide a burgeoning understanding of health disparities affecting LGB populations in the United States, alongside reports from the few states that have included sexual orientation in routine state surveillance.2 However, probability-based data about sexual minorities come primarily from surveys in a few states, including California,10 Massachusetts,11 New Mexico,12 Oregon,13 Vermont,14 and Washington,15 limiting the generalizability of results from these states to other parts of the country.Data on the health of sexual minorities may be particularly critical in the Southeastern United States, as this region generally bears a disproportionate burden of poorer health than do other parts of the country.16 Of additional concern is that many Southeastern states have failed to incorporate sexual minorities into existing laws (e.g., employment nondiscrimination) or have adopted new anti-LGB policies (e.g., prohibiting legal recognition of same-sex relationships), both of which may create and exacerbate unhealthful social environments for LGB populations, even as evidence of the health impact of local and state policies on LGB health grows.17–20 Differences in policy context by region and state relevant to LGB and transgender people are shown in Figure 1. This context may yield health profiles different from New England and the Pacific Northwest, areas that currently have a greater number of policies in place that support LGB and transgender rights. Nevertheless, a substantial number of LGB people live across the South.21,22 The Southeastern state of North Carolina is estimated to be home to more than 212 000 LGB people,23 and the 2010 US Census shows same-sex couples living in all of North Carolina’s 100 counties.24Open in a separate windowFIGURE 1—Lesbian, gay, bisexual, and transgender (LGBT)-specific policies across the United States by region: May 2013.In 2011, North Carolina became the first state in the South to include a sexual orientation identity question on its statewide Behavioral Risk Factor Surveillance Survey (BRFSS). We examined the profile of health disparities of the LGB population living in North Carolina across domains derived from Healthy People 2020 objectives. Specifically, we a priori selected available BRFSS indicators from which previous research had identified LGB disparities responsible for substantial morbidity and mortality, related risk factors for poor health, and factors that have public health policy relevance. We categorized these indicators across 6 domains: health status, chronic disease risk behavior, injury prevention, screening behavior, health care access, and social context (i.e., variables that reflect the social environment that can influence health or health behavior) to present a health profile of LGB North Carolinians.     

Relationship Commitment, Perceived Equity, and Sexual Enjoyment Among Young Adults in the United States

Very little is known about how enjoyment of sexual behavior is linked to the relationship context of the behavior among young adults in the United States. To examine this association, multivariate logistic and ordered logistic regression analyses were conducted using data from Wave III of the National Longitudinal Study of Adolescent Health, collected when the participants were 18 to 26 years old (N = 2,970). Analyses explored the associations between four measures of sexual enjoyment and three measures of relationship context. Perceived equity was associated with sexual enjoyment, but the pattern of associations differed by gender. Perceiving oneself to be underbenefited was associated with less enjoyment for all four measures of sexual enjoyment among women, but for only one measure among men. Perceiving oneself to be overbenefited was associated with less enjoyment for three of the sexual enjoyment measures among men, but for only two among women. Most of these associations were no longer significant when subjective relationship commitment was added to the models. Among both young adult men and women, subjective relationship commitment was associated with all four measures of sexual enjoyment. In contrast, formal relationship status was not consistently associated with any of the sexual enjoyment measures. Young adults perceiving that they are in more-committed relationships enjoy their partnered sexual acts more, on average, than those in less-committed relationships. Anticipation of higher sexual enjoyment could be used by public health campaigns to motivate young adults to engage in fewer, more-committed sexual partnerships.