Minority Stress, Mental Health, HIV risk, alcohol, and tobacco

So, I haven’t been keeping up with the vidding these past couple of weeks, which makes for a backlog of references. (I’m probably a bit odd in considering a written reading response to be the “easy way out” when I’m pressed for time!)   Only a few of those will be covered in the vlog below, which is homework and so only covers this week’s readings, which are on disparities in tobacco and alcohol use.

Also, I should preface the “vlog” with the fact that I still know next to nothing about video editing, but am trying to work on that.  For now, I’m working on at least creating thumbnails that are not part of the video itself.  I’ve done that previously with snapshots, but now I’m going with actual title cards.  The point to taking the “video response” option, after all, was to challenge myself to actually develop some skills in this area.  Down the road, I’d like to be able to do something like Dr. Scout does in the LGBT Wellness Vlog with having sort of “title cards” for each section.  Sadly, my tablet does not appear to be capable of doing much with video editing, and even my university computer does not have Windows Movie Maker or anything on it.  I may check out the library computers at some point to see if they do.  This campus is very arts-heavy, so it is sort of likely that the library computers would have that kind of software.  I hope.

Aaaaaanyway, on to the vloggy bit.


Bostwick, W.B., Boyd, C.J., Hughes, T.L., West, B.T., & McCabe, S.E. (2014). Discrimination and mental health among lesbian, gay, and bisexual adults in the United States. Am J Orthopsychiatry 84(1), 35-45.
The title is slightly misleading, as the authors took a more nuanced approach.  Yes, they were focused on LGB adults, but they also looked at racial/ethnic discrimination and gender discrimination.  They did find that experiencing more than one of those three types of discrimination over the past year was highly correlated with having mental health challenges over the past year.  What was really interesting, though, was that the only one of the three that was correlated with mental health issues regardless of any other type of discrimination was gender discrimination.  So it’s not just how much discrimination a person experiences or even just how many kinds, but also which types that matter.  (Also, yay, a probability sample!) Bisexuals, as usual, confused things by having higher mental health issues with less reported experiences of discrimination, which begs the question how one measures the effects of bi invisibility in all this.  The authors do suggest that this invisibility plays a role in what sorts of overt discrimination bisexuals may encounter.  Does invisibility confer its own stress, though?  Does it lead to accepting certain behaviors from others as normal when they are actually discriminatory?  Meyer’s minority stress model doesn’t make a distinction between L, G, and B, so it looks like that’s an area that needs development and further study.

Burkhalter, J.E., Warren, B., Shuk, E., Primavera, L., & Ostroff, J.S. (2009). Intention to quit smoking among lesbian, gay, bisexual, and transgender smokers. Nicotine Tob Res. 11(11), 1312-20.
This article uses the Theory of Planned Behavior (TPB) to look at how members of the LGBT community approach quitting smoking, in hopes of finding the most useful interventions to promote smoking cessation.  The link above goes to a description of this theory with a graphic that closely matches the one used in Fig 1 of this article (p. 1313).  So the study looked at intention to quit smoking, direct attitudes towards quitting smoking, indirect attitudes, subjective norms (i.e. what the person’s social support system is perceived to believe about the intent to quit), and behavioral control.  The authors also measured stress and depression using validated scales, as well as substance use and perceived susceptibility to cancer.  The element most highly correlated with intent to quit was affective behavioral belief or “feeling more like the person I want to be” (p. 1315), suggesting that focusing on interventions that link those sorts of aspirations to smoking cessation may be helpful in developing an effective cessation approach for LGBT people.

Centers for Disease Control. HIV among Gay and Bisexual Men. Retrieved from the World Wide Web on 11/17/2014 from http://www.cdc.gov/hiv/risk/gender/msm/facts/index.html

Easton, A., Jackson, K., Mowery, P., Comeau, D., & Sell, R.L. (2008). Adolescent same-sex and both-sex romantic attractions and relationships: Implications for smoking. American Journal of Public Health, 98, 462-7.
I think my main takeaway here is that longitudinal studies of adolescents are a pain, because some will always age out and get no followup.  That and, whether you are male or female, experiencing both-sex attractions and/or having romantic relationships with both boys and girls is a significant risk factor for tobacco use.  With the girls surveyed, those who reported only same-sex attractions or relationships also had a higher risk for smoking than those with only opposite-sex attractions or relationships.  And of course, the studies surveyed all made binary assumptions around sex and no distinction between sex and gender.

Everett, B.G., Schnars, P.W., Rosario, M., Garofalo, R., & Mustanski, B. (2014). Sexual orientation disparities in sexually transmitted infection risk behaviors and risk determinants among sexually active adolescent males: Results from a school-based sample. Am J Public Health, 104(6), 1107-12.

Fredriksen-Goldsen, K.I., Kim, H.J., Shiu, C., Goldsen, J., & Emlet, C.A. (2014). Successful aging among LGBT older adults: Physical and mental health-related quality of life by age group. Gerontologist 0(0), 1-15.
Other than the findings, the biggest takeaway from this article is the Resilience Framework.  First, resilience is defined as behavioral, functional, social, and cultural resources and capacities utilized under adverse circumstances” (Fredrickson-Goldson, 2007, cited in Fredrickson-Golden et al, 2014, p. 3).  The framework then looks at five dimensions: “social risks … identity management resources … social resources … health-promoting behaviors … and socioeconomic resources” (p. 3).

Haas, A. P.; Eliason, M.J.; Mays, V. M.; Mathy, R.M.; Cochran, S.D.; D’Augelli, A.R.; Silverman, M.M.; Fisher, P.W.; Hughes, T.; Rosario, M.; Russell, S.T.; Malley, E.; Reed, J.; Litts, D.A.; Haller, E.; Sell, R.L.; Remafedi, G.; Bradford, J.; Beautrais, A.L.; Brown, G.K.; Diamond, G.M.; Friedman, M.S.; Garofalo, R.; Turner, M.S.; Hollibaugh, A.; & Clayton, P.J. (2011). Suicide and suicide risk in lesbian, gay, bisexual and transgender populations: Review and recommendations. Journal of Homosexuality, 58(1), 10-51.
Let’s just start with a moment of awe for how anyone manages to pull together an article with 26 co-authors.  Okay, moving on.  Some of the risk factors found in this massive systematic review are not all that surprising: adolescents and young adults look to be at highest risk (though the authors note a lack of data on older adults and a disturbingly high rate of reported lifetime attempts from what data exists), mental illness, substance use, and HIV/AIDS.  I wouldn’t say it’s surprising that they turned up various levels of discrimination and stigma as risk factors, but I would say it’s incredibly useful for policy and advocacy that they noted a correlation with institutional discrimination, e.g. hetero- and cissexist legislation, and risk for suicide.  Of course, there are some substantial knowledge gaps, which the authors note, starting with the much more limited data available for transgender individuals than the already-limited data on lesbian, gay, and bisexual individuals (who may, it should be noted, include transgender individuals among their ranks). 

Hatzenbuehler, M.L., Keyes, K.M., Hamilton, A., & Hasin, D.S. (2014). State-level tobacco environments and sexual orientation disparities in tobacco use and dependence in the USA. Tob Control, 23, e127-e132. doi: 10.1136/tobaccocontrol-2013-051279.
It isn’t surprising that living somewhere with more restrictive policies on smoking reduces smoking for everyone. What is more interesting is that it also reduces the disparity in smoking between LGB-identified and straight-identified populations. While the cross-sectional design doesn’t allow for causality, one hypothesis from the authors is that states with stricter tobacco policies also tend to have more protections for sexual minorities. This could mean lower minority stress, for example, so it might not actually be the tobacco policies that are responsible. It would be interesting to see a study done just in a) a state with strict tobacco  policies but not strong sexual minority protections, b) a state with weak tobacco regulations but strong sexual minority protections, c) a state strong on both, and d) a state weak on both. I’m just not sure states fitting the bill for a & b exist.  

Hubbard, R. R., Snipes, D. J., Perrin, P. B., Morgan, M. R., Dejesus, A., & Bhattacharyya, S. (2013). Themes in heterosexuals’ responses when challenging LGBT prejudice. Sexuality Research and Social Policy, 10(4), 269-278. doi:10.1007/s13178-013-0127-4

Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36(1), 38-56.
So, this wasn’t assigned, but it seemed like a good idea to go read it, so I did. Meyer takes the idea of minority stress, previously focused strictly on racial or ethnic minority, and applies it to sexual minority.  His model looks at three ways in which a person who is a sexual minority may experience stress related to their minority status: internalized homophobia, expectations of stigma, and actual events of prejudice.  It’s worth noting that this was pre-Lawrence v. Texas, and the author does point out that homosexuality was, at the time of writing, illegal in 24 states.  It would be interesting to see this study replicated post-Obergefell v. Hodges and see what has changed and what hasn’t. 

Millett, G.A., Malebranche, D., & Peterson, J.L. (2007). HIV/AIDS prevention research among Black men who have sex with men: Current progress and future directions. In Meyer, I.H., Northridge, M.E. (Eds.). The Health of Sexual Minorities: Public Health Perspectives on Lesbian, Gay, Bisexual and Transgender Populations. New York, NY: Springer, 2007.
This chapter reviews a number of studies on Black MSM to see what is working and what needs improvement in terms of HIV prevention in this population.  They looked at a number of different factors, of which only four really showed similar relationships across the studies: “(1) Black MSM who reported a history of gonorrhea were more likely than Black MSM who did not report previous infection with gonorrhea to be HIV-positive; (2) Black MSM who reported low incomes were more likely than Black MSM who reported comparatively hjigher incomes to engage in greater sexual risk behaviors; (3) Black MSM who reported high psychological distress were more likely than Black MSM with lower psychological distress to engage in sexual risk behavior; and (4) Black MSM who disclosed their sexual behavior to others were more likely than Black MSM nondisclosers to have been tested for HIV” (p. 549).  The authors call for more research into, among other things, factors influencing health care utilization and the effects of discrimination and minority stress on health care access.

Midanik, L.T., Drabble, L., Trocki, K., & Sell, R.L. (2007). Sexual orientation and alcohol use: Identity versus behavior measures. Journal of LGBT Health Research, 3(1), 25-35.
We actually read this one last quarter, but at the time, our focus was on the identity vs behavior measures in and of themselves.  This time around, we’re looking at the alcohol use disparities.  Looking at women, the numbers are unsurprising.  Bi women, whether defined by sexual orientation identity or behavior, show the highest mean drinks per year, drinking 5+ days/week, social consequences, and % dependency by DSM criteria.  Next in line are lesbians, and sometimes not by that much of a gap, and finally heterosexual women.  Interestingly, women who had had sex only with women in the last 5 years, however, had one standout anomaly: zero social consequences.  Lesbian-identified women, however, had a non-zero number that was higher than heterosexual-identified women.  Things are a bit different with the men.  Gay and straight men actually had very similar measures for the most part, with gay men only slightly higher.  Bi-identified men actually looked to be doing better than either of the other groups, but when you measured behaviorally, that is men who’d had sex with both men and women over the past 5 years, all of a sudden, they are scoring higher on all the measures mentioned above, which is not a good thing.  One thing that makes it hard to infer things from this data is that anyone who reported no partners over the past five years was excluded from the data on behavioral measures.  I think that might actually have shed some useful light on things.  I imagine there are some interesting interactions involved between behavior and identity here.  For example, there is substantially more pressure on men to define themselves strictly as gay or straight than women.  So perhaps those whose identity is secure enough that they can actually label themselves as bisexual experience some protective factors around whatever enables them to do that, while men who have sex with both men and women but are pressured to maintain (even internally, perhaps) an identity label of gay or straight are experiencing higher rates of minority stress that they end up self-medicating with alcohol.  Again, there’s no way to say that with any certainty based on this data, but it’s a hypothesis I’d love to see tested.  Similarly, what is going on with lesbian-identified women having higher social consequences of alcohol consumption than women who’ve had sex only with women in the prior five years?  There are almost certainly some bi-identified women in with the behavioral group, and lesbian-identified women who had not had a sexual partner in the last five years were excluded.  So what do those facts mean?  Teasing some of this information out could help improve alcohol-abuse prevention strategies.

Pompili, M., Lester, D., Forte, A., Seretti, M.E., Erbuto, D., Lamis, D.A., Amore, M., & Girardi, P. (2014). Bisexuality and suicide: A systematic review of the current literature. The Journal of Sexual Medicine, 11,1903-13.

Reczek C, Liu H, & Spiker R. (2014). A Population-Based Study of Alcohol Use in Same-Sex and Different-Sex Unions. J Marriage Fam, 76(3), 557-572.
One of the arguments in favor of same-sex marriage recognition has been the notion of marital advantage in health. This study confirms that marriage is a protective factor in alcohol use for same-sex as well as different-sex couples.



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