Carolyn F. Wong

A Meta-Analysis of Disparities in Childhood Sexual Abuse, Parental Physical Abuse, and Peer Victimization Among Sexual Minority and Sexual Nonminority Individuals

OBJECTIVES We compared the likelihood of childhood sexual abuse (under age 18), parental physical abuse, and peer victimization based on sexual orientation. METHODS We conducted a meta-analysis of adolescent school-based studies that compared the likelihood of childhood abuse among sexual minorities vs sexual nonminorities. RESULTS Sexual minority individuals were on average 3.8, 1.2, 1.7, and 2.4 times more likely to experience sexual abuse, parental physical abuse, or assault at school or to miss school through fear, respectively. Moderation analysis showed that disparities between sexual minority and sexual nonminority individuals were larger for (1) males than females for sexual abuse, (2) females than males for assault at school, and (3) bisexual than gay and lesbian for both parental physical abuse and missing school through fear. Disparities did not change between the 1990s and the 2000s. CONCLUSIONS The higher rates of abuse experienced by sexual minority youths may be one of the driving mechanisms underlying higher rates of mental health problems, substance use, risky sexual behavior, and HIV reported by sexual minority adults.

Harassment, Discrimination, Violence and Illicit Drug Use among Young Men Who Have Sex with Men

We examined the relationship among social discrimination, violence, and illicit drug use among an ethnically diverse cohort of young men who have sex with men (YMSM) residing in Los Angeles. Five Hundred twenty-six YMSM (aged 18-24 years) were recruited using a venue-based, stratified probability sampling design. Surveys assessed childhood financial hardship, violence (physical assault, sexual assault, intimate partner violence), social discrimination (homophobia and racism), and illicit drug use in the past 3 months. Analyses examined main and interaction effects of key variables on drug use. Experiences of financial hardship, physical intimate partner violence and homophobia predicted drug use. Although African American participants were less likely to report drug use than their Caucasian peers, those who experienced greater sexual racism were at significantly greater risk for drug use. Racial/ethnic minority YMSM were at increased risk for experiencing various forms of social discrimination and violence that place them at increased risk for drug use.

Risk factors for alcohol use, frequent use, and binge drinking among young men who have sex with men

We examined the prevalence and patterns of alcohol use within a large, ethnically diverse sample of young men who have sex with men (YMSM) and identified psychosocial correlates of these alcohol-use patterns. A sample of 526 YMSM (ages 18-24 years) was recruited in Los Angeles, CA using a venue-based, stratified probability sampling design. Based on criteria used by previous research with young adults, participants were assigned to one of four alcohol-use/non-use groups according to frequency and number of drinks per sitting in the last 30 days. Findings revealed a high prevalence of alcohol use (91%) within the sample, with 21% reporting binge drinking; of binge drinkers, 40% reported frequent binge drinking. Multinomial logistic regression analyses revealed that race/ethnicity, gay bar attendance, depression, sensation seeking, peer risk behaviors, and age of alcohol initiation significantly differentiated between non-/light users from frequent and binge drinkers. Results also indicated unique psychosocial profiles among frequent/binge drinkers. The heterogeneity of predictors associated with different patterns of alcohol use highlights the need to consider unique risk profiles and alcohol-use trajectories according to exposure to different risk and protective factors.

Residential Status as a Risk Factor for Drug Use and HIV Risk Among Young Men Who Have Sex with Men

There is growing behavioral and epidemiological evidence to suggest that young men who have sex with men (YMSM) are at high risk for becoming HIV-infected. Unfortunately, relatively little research has been conducted to examine the range of individual, social, and community-level factors that put these young men at increased risk. To address existing gaps in the literature, the Healthy Young Men’s (HYM) Study was launched in Los Angeles to examine the range of factors associated with HIV risk and protective behaviors within an ethnically diverse sample of 526 YMSM recruited using a venue-based stratified probability sampling design. In this paper we present findings that demonstrate that YMSM who experience residential instability, who have been forced to leave their home because of their sexuality, and/or who are precariously housed are at significantly greater risk for drug use and involvement in HIV risk-related behaviors.

Minority Stress Experiences and Psychological Well-Being: The Impact of Support from and Connection to Social Networks Within the Los Angeles House and Ball Communities

African American young men who have sex with men (AAYMSM) from the House and Ball communities are at high risk for HIV infection. Because these communities are not only sources of risk but also support for AAYMSM, researchers must also consider the resources these communities possess. This knowledge will assist in the formulation of more effective prevention strategies and intervention approaches. Using minority stress theory as a framework, the current study illustrates the impact minority stress has on the psychological well-being of a sample of MSM from the Los Angeles House and Ball communities and investigates how these factors affect the relationship between minority stress and psychological well-being. Surveys were administered to participants over the course of a year. Structural equation modeling was used to estimate a model of the associations between minority stressors, support, connection to social network, and psychological well-being/distress (N = 233). The results indicated significant associations between different sources of minority stress, including distal minority stress (e.g., racism, homophobia), gay identification, and internalized homophobia. Minority stressors were in turn significantly associated with greater distress. However, greater instrumental support significantly reduced the effects of distal minority stress on distress. Greater connection to social network also significantly reduced stress associated with gay identification on distress. The findings captured the diverse sources of minority stress faced by this population and how these stressors are interrelated to impact mental health. The results also illustrate how support from and connection to social networks can reduce the negative impact of minority stress experiences.

Misuse of Prescription and Illicit Drugs Among High-risk Young Adults in Los Angeles and New York

Background Prescription drug misuse among young adults is increasingly viewed as a public health concern, yet most research has focused on student populations and excluded high-risk groups. Furthermore, research on populations who report recent prescription drug misuse is limited. This study examined patterns of prescription drug misuse among high-risk young adults in Los Angeles (LA) and New York (NY), which represent different local markets for illicit and prescription drugs. Design and Methods Between 2009 and 2011, 596 young adults (16 to 25 years old) who had misused prescription drugs within the past 90 days were interviewed in Los Angeles and New York. Sampling was stratified to enroll three groups of high-risk young adults: injection drug users (IDUs); homeless persons; and polydrug users. Results In both sites, lifetime history of receiving a prescription for an opioid, tranquilizer, or stimulant was high and commonly preceded misuse. Moreover, initiation of opioids occurred before heroin and initiation of prescription stimulants happened prior to illicit stimulants. NY participants more frequently misused oxycodone, heroin, and cocaine, and LA participants more frequently misused codeine, marijuana, and methamphetamine. Combining prescription and illicit drugs during drug using events was commonly reported in both sites. Opioids and tranquilizers were used as substitutes for other drugs, e.g., heroin, when these drugs were not available. Conclusion Patterns of drug use among high-risk young adults in Los Angeles and New York appear to be linked to differences in local markets in each city for illicit drugs and diverted prescription drugs.

Strategies Used by Gay and Bisexual Young Men to Cope With Heterosexism

ABSTRACT Although the pervasiveness of heterosexism in the lives of gay and bisexual youth is well established, little is known about the strategies these youth use to cope with stigma and discrimination based on their sexual minority status. In this qualitative study, the authors present findings and implications for clinical practice based on interviews with 43 gay and bisexual young men. Respondents’ coping strategies are discussed in relation to current theory and research on coping with stigma, as well as the emerging field of emotion regulation. The narratives from the current study suggest that the emotion regulation paradigm is well suited to understanding the functions of strategies for coping with heterosexism and similar types of stigma.

Initiation into Prescription Drug Misuse: Differences between Lesbian, Gay, Bisexual, Transgender (LGBT) and Heterosexual High-Risk Young Adults in Los Angeles and New York

OBJECTIVE Prescription drug misuse is an important public health problem in the U.S., particularly among adolescents and young adults. Few studies have examined factors contributing to initiation into prescription drug misuse, including sexual orientation and childhood abuse and neglect. The purpose of the present study is to investigate the relationship between initiation into the misuse of prescription drugs (opioids, tranquilizers, and stimulants), sexual identity, and individual and family determinants. METHOD Results are based upon data from a cross-sectional survey of 596 youth (polydrug users, homeless youth, and injection drug users) aged 16 to 25 who reported current prescription drug misuse. Participants were recruited in Los Angeles and New York City between 2009 and 2011. We compared initiation behaviors between sexual minority and heterosexual youth and examined factors modifying the relationship between sexual identity and earlier initiation into prescription drug misuse. RESULTS Sexual minority youth were more likely to report histories of initiation into misuse of prescription opioids and tranquilizers. Further, they were more likely to report various types of childhood abuse than heterosexual youth. However, multivariate analyses indicated that age of first prescribed drug was the most significant factor associated with initiation into misuse of all three categories of prescription drugs. CONCLUSIONS The correlates of initiation into prescription drug misuse are multidimensional and offer opportunities for further research. Identifying additional factors contributing to initiation into prescription drug misuse is essential towards developing interventions that may reduce future drug use among young adults.

Coping and emotion regulation profiles as predictors of nonmedical prescription drug and illicit drug use among high-risk young adults

BACKGROUND Deficits in the ability to organize, integrate, and modulate emotions, thoughts, and behaviors when dealing with stress have been found to be related to the onset and escalation of substance use among adolescents and young adults. However, limited research has focused on understanding how coping and emotion regulation tendencies might be associated with different patterns of prescription and illicit drug use, particularly among high-risk young adults who may already face additional challenges relative to lower-risk populations. METHODS Young adults aged 16-25 years who had misused prescription drugs within the past 90 days were interviewed in Los Angeles and New York. The current study utilized latent profile analysis to empirically derive coping and emotion regulation typologies/profiles that are then used to predict different patterns of substance use (N=560). RESULTS Four latent classes/groups were identified: (1) suppressors, (2) others-reliant copers, (3) self-reliant copers and (4) active copers. Distinct patterns of prescription and illicit drug misuse were found among different coping/emotion regulation profiles, including differences in age of initiation of opiates, tranquilizers, and illicit drugs, recent injection drug use, substance use-related problems, and past 90-day use of tranquilizers, heroin, and cocaine. Specifically, suppressors and others-reliant copers evidenced more problematic patterns of substance use compared to active copers. CONCLUSION This is among the first studies to show how coping and emotion regulation profiles predict distinct patterns of substance use. Results provide the groundwork for additional investigations that could have significant prevention and clinical implications for substance-using high-risk young adults.

The Impact of Recent Stressful Experiences on HIV-Risk Related Behaviors

Limited research has captured the wide varieties of distinct, but interrelated, life stressors that young men who have sex with men (YMSM) experience as emerging adults. We examined the way recent experiences of a diverse set of stressors predict illicit drug use, alcohol misuse, and inconsistent condom use (i.e., unprotected anal intercourse) among an ethnically diverse cohort of YMSM (N=526). Results indicated that stress related to financial and health concerns were associated with increased risk for substance use, while health concerns and partner-related stress were associated with sexual risk-taking. Additional analyses indicated drug use and alcohol misuse did not significantly mediate the impact that stressors have on sexual risk. Findings show that stressors from different life domains can have impact on different HIV-risk behavior. Results challenge the way diverse stressful life experiences are conceptualized for this population.