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Sexual and gender minority (SGM) youth are more likely to use alcohol than their heterosexual cisgender peers. At the same time, SGM youth experience sexuality- and gender identity-specific stressors known to exacerbate negative health outcomes. Though scholars have established a link between minority stressors (e.g., internalized stigma and victimization) and increased alcohol use for SGM youth as a whole, there is little indication of whether internalized stigma and victimization are more strongly associated with alcohol use for specific groups of SGM youth. A United States sample of 11,811 racially and geographically diverse 13–17 year old SGM youth was used to employ a series of gender-stratified multivariable regression models to examine the association among internalized stigma, victimization, and alcohol-related behaviors, and whether they differed for specific groups of sexual minority youth. Sexual orientation moderated several associations between sexual minority stressors (i.e., victimization and stigma) and youth’s alcohol use (i.e., recent use and heavy episodic drinking) across models stratified by gender (i.e., male, female, and non-binary). For example, bisexual boys had stronger associations between SGM-specific victimization and alcohol use frequency and heavy episodic drinking relative to gay boys; conversely, victimization and alcohol use frequency were more weakly associated among bisexual girls relative to lesbian/gay girls. Pansexual girls showed weaker associations between internalized stigma and alcohol use frequency compared to lesbian/gay girls. This paper demonstrates who among SGM youth are more likely to engage in alcohol-related behaviors as a function of differential forms of SGM-related victimization and stigma. These findings can inform substance use interventions that are tailored to youth of diverse sexual orientations and gender identities.

Purpose:  Using representative school-based data and community-level primary data, we investigated how environmental factors (e.g., school and community climate) might be protective against substance use behaviors among a vulnerable population of adolescents. Methods:  We analyzed a sample of 2678 sexual minority adolescents using a combination of student-level data (British Columbia Adolescent Health Survey) and primary community-level data (assessing lesbian, gay, bisexual, transgender, and queer [LGBTQ]-specific community and school environments). Using multilevel logistic regression models, we examined associations between lifetime substance use (alcohol, illegal drugs, marijuana, nonmedical use of prescription drugs, and smoking) and community-level predictors (community and school LGBTQ supportiveness). Results:  Above and beyond student characteristics (e.g., age and years living in Canada), sexual minority adolescents residing in communities with more LGBTQ supports (i.e., more supportive climates) had lower odds of lifetime illegal drug use (for boys and girls), marijuana use (for girls), and smoking (for girls). Specifically, in communities with more frequent LGBTQ events (such as Pride events), the odds of substance use among sexual minority adolescents living in those communities was lower compared with their counterparts living in communities with fewer LGBTQ supports. Conclusions:  The availability of LGBTQ community-level organizations, events, and programs may serve as protective factors for substance use among sexual minority adolescents. In particular, LGBTQ-supportive community factors were negatively associated with substance use, which has important implications for our investment in community programs, laws, and organizations that advance the visibility and rights of LGBTQ people.

Purpose:  We propose a new theoretically grounded approach for estimating sexual orientation-related health risk that accounts for the unique and shared variance of sexual identity across other measures of sexual orientation (i.e., attraction and behavior). We argue and illustrate that this approach provides specificity not demonstrated by approaches that independently estimate and compare health risk based on sexual identity, attraction, and behavior. Methods:  Data were from the National Epidemiologic Survey on Alcohol and Related Conditions-III, collected in 2012–2013 (N = 36,309, ages 18 and older). The Karlson-Holm-Breen method tested the degree to which attraction- and behavior-based disparities in mental health and substance use disorders change after adjusting for sexual identity. Results:  Sexual attraction- and behavior-based disparities in mental health and substance use disorders statistically varied when comparing models that did and did not adjust for sexual identity. Adjusting for sexual identity appeared to have a larger influence on attraction- and behavior-based health associations among men; sexual minority and majority differences were attenuated on nearly every outcome after adjusting for sexual identity. This attenuation was less common among women. Among women, some behavior-based disparities were wider in sexual identity-adjusted models relative to unadjusted models. Conclusion:  We demonstrate more accurate approaches to capturing and comparing sexual orientation-related health disparities across multiple measures of sexual orientation, which account for the shared variance between sexual identity and measures of attraction and behavior. Adjusted estimates provide more specificity regarding relative health risk across specific subgroups of sexual minority people, and the intervention and prevention strategies needed to address them.

Scientific evidence regarding sexual minority populations has generally come from studies based on two types of samples: community-derived samples and probability samples. Probability samples are lauded as the gold standard of population research for their ability to represent the population of interest. However, while studies using community samples lack generalizability, they are often better able to assess population-specific concerns (e.g., minority stress) and are collected more rapidly, allowing them to be more responsive to changing population dynamics. Given these advantages, many sexual minority population studies rely on community samples. To identify how probability and community samples of sexual minorities are similar and different, we compared participant characteristics from two companion samples from the  Generations Study , each designed with the same demographic profile of U.S. sexual minority adults in mind. The first sample was recruited for a national probability survey, whereas the second was recruited for a multicommunity sample from four U.S. cities. We examined sociodemographic differences between the samples. Although there were several statistical differences between samples, the effect sizes were small for sociodemographic characteristics that defined the sample inclusion criteria: sex assigned at birth, race/ethnicity, and age cohort. The samples differed across other characteristics: bisexual respondents, respondents with less education, and those living in non-urban areas were underrepresented in the community sample. Our findings offer insights for recruiting community samples of sexual minority populations and for measuring sexual identity on probability surveys. They also bolster confidence in well-designed community samples as sources for data on sexual minority populations.

Supportive housing later in life tends to be a key concern for lesbian, gay, bisexual, and transgender (LGBT) elders. Most senior care providers are un(der)prepared to meet the needs of older LGBT adults. This study evaluated the efficacy of a 4 h, face-to-face, research-based, LGBT-diversity training designed to improve senior housing facility staff’s cultural competency regarding the needs of LGBT elders. Findings from this study found a significant increase in LGBT content knowledge between pre- and post-intervention assessments and a significant decrease in perceived preparedness when working with LGBT elders. These effects remained significant after controlling for staff designation, religion, educational attainment, and training session. Findings suggest that staff’s cultural competence affected their perceived readiness to address LGBT elders’ needs. Implications are related to the concept of cultural humility or the lifelong process of understanding others’ experiences based on the recognition of lack of un(der)preparedness to create a culturally supportive residential environment.

Provides a forum for health scholars across the UMD campus

Jessica N. Fish, Family Science, investigates sexual-orientation-related disparities in mental, behavioral, and physical health

The Sociology Department presents: The Prescription-to-Prison Pipeline: Medicalization and Criminalization of Pain

Complex interrelationships between race, sex, obesity and depression have been well-documented. Because of differences in associations between socioeconomic status (SES) and health by race, determining the role of SES may help to further explicate these relationships. The aim of this study was to determine how race and income interact with obesity on depression. Combining data from the 2007-2014 National Health and Nutrition Examination Survey, depressive symptoms was measured with the Patient Health Questionnaire-9 and obesity was assessed as body mass index ≥30 kg/m 2 . Three-way interactions between race, income and obesity on depressive symptoms were determined using ordered regression models. Significant interactions between race, middle income and obesity (OR = 0.66, 95% CI = 0.22-1.96) suggested that, among white women, obesity is positively associated with depressive symptoms across income levels, while obesity was not associated with depression for African American women at any income level. Obesity was only associated with depressive symptoms among middle-income white men (OR = 1.44, 95% CI = 1.02-2.03) and among high-income African American men (OR = 4.65, 95% CI = 1.48-14.59). The associations between obesity and depressive symptoms vary greatly by race and income. Findings from this study underscore the importance of addressing obesity and depression among higher income African American men.

O besity rates in the U.S. are associated with area-level, food-related characteristics. Studies have previously examined the role of structural racism (policies/practices that advantaged White Americans and deprived other racial/ethnic minority groups), but racial inequalities in socioeconomic status (SES) is a novel indicator. The aim of this study is to determine the associations between racial inequalities in SES with obesity and obesogenic environments. Data from 2007⁻2014 County Health Rankings and 2012⁻2016 County Business Patterns were combined to assess the associations between relative SES comparing Blacks to Whites with obesity, and number of grocery stores and fast food restaurants in U.S. counties. Random effects linear and Poisson regressions were used and stratified by county racial composition. Racial inequality in poverty, unemployment, and homeownership were associated with higher obesity rates. Racial inequality in median income, college graduates, and unemployment were associated with fewer grocery stores and more fast food restaurants. Associations varied by county racial composition. The results demonstrate that a novel indicator of structural racism on the county-level is associated with obesity and obesogenic environments. Associations vary by SES measure and county racial composition, suggesting the ability for targeted interventions to improve obesogenic environments and policies to eliminate racial inequalities in SES.