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Introduction: Sexual minorities are disproportionately more likely than heterosexuals to suffer from substance use disorders, but relatively little is known about differences in substance use disorders across diverse sexual minority subgroups. There is also limited understanding of how different social stressors account for sexual orientation disparities in substance use disorders. Methods: Using nationally representative data collected in 2012−2013 (n=34,597), differences in past-year DSM-5 alcohol, cannabis, and tobacco use disorders were assessed across 4 sexual orientation groups (heterosexuals and 3 sexual minority subgroups, lesbian/gay-, bisexual-, and heterosexual-identified sexual minorities). This study assessed whether stressful life events mediated substance use disorder disparities between heterosexuals and each sexual minority subgroup, and whether stressful life events and lesbian, gay, and bisexual discrimination events mediated these substance use disorder differences. Analyses were conducted in 2019. Results: For both men and women, substance use disorders and stress experiences varied by sexual identity. For example, compared with heterosexual men, larger proportions of gay and bisexual men had a past-year alcohol use disorder. Among women, all sexual minority subgroups had higher rates of each substance use disorder than heterosexuals. For each substance use disorder, stressful life events mediated disparities between heterosexuals and sexual minority subgroups, except for heterosexual-identified sexual minority men. Both stressful life events and lesbian, gay, and bisexual discrimination mediated substance use disorder differences between sexual minority subgroups, with stronger indirect effects through lesbian, gay, and bisexual discrimination for lesbians/gay men and stronger indirect effects through stressful life events for bisexual adults, generally. Conclusions: Sexual minority subgroups have a greater prevalence of substance use disorders, mediated through both stressful life events and lesbian, gay, and bisexual discrimination. More research is needed to comprehensively assess the processes underlying sexual orientation substance use disparities.

Theoretical and empirical integration of the rejection sensitivity (RS) model to sexual minority people is one of the few attempts to extend existing theoretical frameworks that explain mental health disparities for this population, namely the minority stress framework (Meyer,  2003 ) and its extensions (Hatzenbuehler,  2009 ; Testa, Habarth, Peta, Balsam, & Bockting,  2015 ). Theoretical origins of RS are rooted in the desire to understand how rejection from significant others affects subsequent other close relationships (Downey & Feldman,  1996 ). This was later extended to conceptualize rejection based on membership of a stigmatized group and modified to understand sexual orientation-related RS among sexual minorities (Dyar, Feinstein, Eaton, & London,  2016 ; Pachankis, Goldfried, & Ramrattan,  2008 ). Feinstein ( 2019 ) brings new life to this adapted application by grounding and integrating the basic tenets of sexual orientation-related RS alongside a critical health compromising process of minority stress: vigilance. Meyer theorized vigilance as a core form of proximal minority stressors and explains that “LGB people learn to anticipate—indeed, expect—negative regard from members of the dominant culture. To ward off potential negative regard, discrimination, and violence, they must be vigilant” and this vigilance is “related to feared possible (even if imagined) negative events” (Meyer,  2003 , p. 680–681). Feinstein explains that existing theoretical frameworks (Hatzenbuehler,  2009 ; Meyer,  2003 ) mention vigilance and RS as important processes, but lack a comprehensive integration of these concepts. Given that schemas for RS are formed early in the life course, we focus on the applicability to sexual minority adolescents, and other marginalized groups.

They are one of the four research groups chosen for the data contract

Access to new dataset opens up research opportunities

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.

LGBTQ youth are at greater risk for compromised health, yet large-scale health promotion programs for LGBTQ young people have been slow to develop. LGBTQ community-based organizations—which provide LGBTQ-focused support and services—have existed for decades, but have not been a focus of the LGBTQ youth health literature. The current study used a contemporary sample of LGBTQ youth (age 15–21;  M  = 18.81;  n  = 1045) to examine who participates in LGBTQ community-based organizations, and the association between participation and self-reported mental health and substance use. Youth who participated in LGBTQ community-based organizations were more likely to be assigned male at birth, transgender, youth of color, and accessing free-or-reduced lunch. Participation was associated with concurrent and longitudinal reports of mental health and substance use. LGBTQ community-based organizations may be an underutilized resource for promoting LGBTQ youth health.

Objectives To assess risk and protective factors associated with bacterial vaginosis (BV) chronicity ascertained by Nugent score criteria. Methods A longitudinal cohort study included 255 sexually experienced, postmenarcheal women who provided weekly self-collected vaginal swabs for up to 2 years. Vaginal swabs were scored using Nugent criteria and classified as normal (≤3), intermediate (4–6) and Nugent-BV (≥7). Detailed behavioural/health information were assessed every 6 months. A per-woman longitudinal summary measure of BV chronicity was defined as the percentage of each woman’s weekly vaginal assessments scored as Nugent-BV over a 6-month interval. Risk and protective factors associated with BV chronicity were assessed using multiple linear regression with generalised estimating equations. Results Average BV chronicity was 39% across all follow-up periods. After adjustment, factors associated with BV chronicity included baseline Nugent-BV (β=35.3, 95% CI 28.6 to 42.0) compared with normal baseline Nugent scores and use of unprotected water for bathing (ie, rainwater, pond, lake/stream) (β=12.0, 95% CI 3.4 to 20.5) compared with protected water sources (ie, well, tap, borehole). Women had fewer BV occurrences if they were currently pregnant (β=−6.6, 95% CI −12.1 to 1.1), reported consistent condom use (β=−7.7, 95% CI −14.2 to 1.3) or their partner was circumcised (β=−5.8, 95% CI −11.3 to 0.3). Conclusions Factors associated with higher and lower values of BV chronicity were multifactorial. Notably, higher values of BV chronicity were associated with potentially contaminated bathing water. Future studies should examine the role of waterborne microbial agents in the pathogenesis of BV.

In the United States, sexual minority (SM) status is associated with a number of health disparities. Based on mounting evidence, stigma and discrimination have been cited as key barriers to health equity for this population. We estimated the prevalence of three types of discrimination as a function of age among SM adults from the National Epidemiological Study of Alcohol Use and Related Conditions III (NESARC-III) (2012–2013). Among SM adults, reports of past-year general discrimination, victimization, and healthcare discrimination varied by age, with peaks in early adulthood and again in midlife. Age trends varied by biological sex, with males experiencing significantly more general discrimination, victimization, and healthcare discrimination at specific ages. Age trends also varied by sexual identity, as LGB-identifying SMs were significantly more likely to experience all forms of discrimination across all ages. Policies preventing homophobic discrimination and victimization are necessary given the pervasiveness of these experiences across adulthood.

Abstract Sexual and gender minority (SGM) youth face marginalization and oppression on the basis of their SGM identity, and they often lack traditional support systems to deal with these minority stressors. SGM community resources may alleviate the impact of the stressors that SGM youth face, but these have not been studied in relation to the size and climate of SGM youth's communities. This mixed-methods study examined the relationship between community size and the climate toward SGM individuals and the availability and utilization of SGM community resources. Survey findings indicate that nonmetropolitan communities were associated with less availability and utilization; hostile communities were associated with lower availability only. Interview findings reveal nuanced complexities on the relationship between community and resource provision. Implications for future research and community practice are discussed.