Frances Aranda

Mental Health and Suicidality Among Racially/Ethnically Diverse Sexual Minority Youths

OBJECTIVES We examined the relationships among sexual minority status, sex, and mental health and suicidality, in a racially/ethnically diverse sample of adolescents. METHODS Using pooled data from 2005 and 2007 Youth Risk Behavior Surveys within 14 jurisdictions, we used hierarchical linear modeling to examine 6 mental health outcomes across 6 racial/ethnic groups, intersecting with sexual minority status and sex. Based on an omnibus measure of sexual minority status, there were 6245 sexual minority adolescents in the current study. The total sample was n = 72,691. RESULTS Compared with heterosexual peers, sexual minorities reported higher odds of feeling sad; suicidal ideation, planning and attempts; suicide attempt treated by a doctor or nurse, and self-harm. Among sexual minorities, compared with White youths, Asian and Black youths had lower odds of many outcomes, whereas American Native/Pacific Islander, Latino, and Multiracial youths had higher odds. CONCLUSIONS Although in general, sexual minority youths were at heightened risk for suicidal outcomes, risk varied based on sex and on race/ethnicity. More research is needed to better understand the manner in which sex and race/ethnicity intersect among sexual minorities to influence risk and protective factors, and ultimately, mental health outcomes.

Exploring Alcohol-Use Behaviors Among Heterosexual and Sexual Minority Adolescents: Intersections With Sex, Age, and Race/Ethnicity

OBJECTIVES We examined sexual orientation status differences in alcohol use among youths aged 13 to 18 years or older, and whether differences were moderated by sex, age, or race/ethnicity. METHODS We pooled data from the 2005 and 2007 Youth Risk Behavior Surveys and conducted weighted analyses, adjusting for complex design effects. We operationalized sexual orientation status with items assessing sexual orientation identity, sexual behavior, sexual attraction, or combinations of these. RESULTS Compared with exclusively heterosexual youths, sexual-minority youths were more likely to report each of the primary study outcomes (i.e., lifetime and past-month alcohol use, past-month heavy episodic drinking, earlier onset of drinking, and more frequent past-month drinking). Alcohol-use disparities were larger and more robust for (1) bisexual youths than lesbian or gay youths, (2) girls than boys, and (3) younger than older youths. Few differences in outcomes were moderated by race/ethnicity. CONCLUSIONS Bisexual youths, sexual-minority girls, and younger sexual-minority youths showed the largest alcohol-use disparities. Research is needed that focuses on identifying explanatory or mediating mechanisms, psychiatric or mental health comorbidities, and long-term consequences of early onset alcohol use, particularly frequent or heavy use, among sexual-minority youths.

A Qualitative Exploration of African-Americans' Attitudes Toward Mental Illness and Mental Illness Treatment Seeking

This article presents data from a qualitative study of mental illness attitudes and mental health service use in a community sample of African-Americans (N=70). Specifically, we examined cultural factors that shape community norms, including mental illness stigma, attitudes and behaviors. Focus groups were used to examine the influence of culture on broad thematic categories associated with mental illness and mental health service use. The following five thematic categories were examined: (a) descriptive terms and causes of mental illness, (b) cultural norms regarding mental health, (c) attitudes toward mental health service use (d) presence and determinants of mental illness stigma, and (e) strategies for reducing mental illness stigma and increasing access and use of mental health services. Thematic categories were selected based on the applicability of the information for education and stigma reduction intervention programs. Study findings have relevance for the development of culturally appropriate education and stigma change interventions for African-Americans.

Longitudinal Associations among Discordant Sexual Orientation Dimensions and Hazardous Drinking in a Cohort of Sexual Minority Women.

We examined differences between sexual minority women’s (SMW’s) sexual identity and sexual behavior or sexual attraction as potential contributors to hazardous drinking across a 10-year period. Data are from a longitudinal study examining drinking and drinking-related problems in a diverse, community-based sample of self-identified SMW (Wave 1: n = 447; Wave 2: n = 384; Wave 3: n = 354). Longitudinal cross-lagged models showed that SMW who report higher levels of identity-behavior or identity-attraction discordance may be at greater risk of concurrent and subsequent hazardous drinking. Results of multigroup models suggest that sexual orientation discordance is a more potent risk factor for risky drinking outcomes among SMW in older adulthood than in younger adulthood. Findings support that discordance between sexual orientation dimensions may contribute to hazardous drinking among SMW and provide evidence that cognitive-behavioral consistency is important for individuals expressing diverse and fluid sexual identities, attraction, and behavior.

Psychological distress in african american lesbian and heterosexual women.

SUMMARY Similarities and differences in indicators of psychological distress, risk factors for distress, and methods of coping were assessed in African American lesbians and heterosexual women. Despite similar rates of risk factors, lesbians reported more indicators of psychological distress and more frequent use of alcohol or other drugs in response to stress. In addition, findings reflect an overall trend toward higher rates of drinking, alcohol-related problems, and use of other legal and illegal drugs among lesbians.

A longitudinal study of the correlates of persistent smoking among sexual minority women.

INTRODUCTION We conducted a longitudinal evaluation of factors associated with persistent smoking behaviors among sexual minority women (SMW; lesbians and bisexual women). METHODS Structured interview data were collected as part of a larger longitudinal study of SMWs health: the Chicago Health and Life Experiences of Women study. We conducted multivariate analyses to evaluate the influence of 4 groups of predictor variables on smoking: (a) demographic, (b) childhood victimization, (c) other substance use, and (d) health variables. RESULTS At Wave 1, 30.9% (n = 138) of participants reported current smoking, with substance-use and demographic factors having the strongest relationships to smoking status. The majority (84.9%) of Wave 1 smokers were also smoking at Wave 2. Among demographic variables, level of education was inversely associated with continued smoking. With respect to substance use, hazardous drinking and cocaine/heroin use were significantly associated with continued smoking. None of the victimization or health variables predicted smoking status. CONCLUSIONS Consistent with previous studies, smoking rates in this sample of SMW were elevated. Despite intensive efforts to reduce smoking in the general population, 84% of SMW smokers continued smoking from Wave 1 to Wave 2. Findings suggest that the majority of SMW will continue to smoke over time. Additional research is needed to increase motivation and access to smoking cessation resources.

Racial/ethnic differences in unmet needs for mental health and substance use treatment in a community-based sample of sexual minority women

AIMS AND OBJECTIVES To examine the unmet needs for mental health and substance use treatment among a diverse sample of sexual minority women (lesbian, bisexual). BACKGROUND Sexual minority women are more likely than heterosexual women to report depression and hazardous drinking. However, relatively little is known about sexual minority womens use of mental health or substance use treatment services, particularly about whether use varies by race/ethnicity. DESIGN Cross-sectional analysis of existing data. METHODS Analyses included data from 699 Latina, African American and white sexual minority women interviewed in wave 3 of the 17-year Chicago Health and Life Experiences of Women study. Using logistic regression, we examined the associations among sexual identity, race/ethnicity, use of mental health and substance use treatment, as well as potential unmet need for treatment. RESULTS Overall, women in the study reported high levels of depression and alcohol dependence, and these varied by sexual identity and race/ethnicity. Use of mental health and substance use treatment also varied by race/ethnicity, as did potential unmet need for both mental health and substance use treatment. CONCLUSIONS Our findings that suggest although use of treatment among sexual minority women is high overall, there is a potentially sizable unmet need for mental health and substance use treatment that varies by race/ethnicity, with Latina women showing the greatest unmet need for treatment. RELEVANCE TO CLINICAL PRACTICE Nurses and other healthcare providers should be aware of the high rates of depression and hazardous drinking among sexual minority women, understand the factors that may increase the risk of these conditions among sexual minority women, the potentially high unmet need for mental health and substance use treatment - perhaps particularly among Latina women and be equipped to provide culturally sensitive care or refer to appropriate treatment services as needed.

Breast and Cervical Cancer Screening Behaviors of African American Sexual Minority Women

Background: African American women experience elevated risk for breast and cervical cancer compared to White women. Health risk behaviors and cancer screening practices are known to contribute to cancer disparities; however, little is known about the relationship between race, sexual orientation, and cancer risk. The objective of this paper is to report on engagement in a range of health risk behaviors associated with cancer and adherence to cancer screening guidelines among African American Women sexual minority women. Methods: This was a cross sectional descriptive study. Data were collected using a self-administered survey instrument. Participants (N=226) were a convenience sample of urban African American sexual minority women recruited as part of a community health needs assessment study. Results: Cancer risk behaviors were prevalent including high rates of obesity, physical inactivity, tobacco and alcohol use. Despite these health risk behaviors, perceptions of cancer risk were low. Eight-five percent of women over the age of forty reported ever having a mammogram and 69% reported having the screening examine in the previous year. The majority of participants reported ever having a Pap test but reports of past year screening were low (68%). Predictors of ever having a mammogram were older age and having a physician recommendation to screen. Past year mammography was associated with perceived cancer risk with those reporting higher perceived risk less likely to have been screened in the past year. None of our study variables were associated with adherence to cervical cancer screening guidelines. Conclusions: Study findings suggest the need for increased efforts to reduce cancer risk behaviors and to encourage adherence to routine cancer screening among African American sexual minority women. Provider recommendations play an important role in breast cancer screening adherence. Additional research is needed to better understand barriers and facilitators to adherence to cervical cancer screening in this population.

The influence of acculturation on substance use behaviors among Latina sexual minority women: the mediating role of discrimination.

Background: A large body of work has demonstrated that sexual minority women have elevated rates of substance use morbidity, as compared with heterosexual women, and that this might be especially true for women of color. Objectives: This study examines the influence of acculturation and discrimination on substance use among Latina sexual minority women. Methods: Data were collected from 2007 to 2008 as part of a larger community-based survey in the greater Chicago area. Scales measured discrimination, acculturation, and substance use. Structural equation modeling validated scales and examined their relationships, which were further described via mediation analysis. Results: Increased acculturation leads to substance use and this relationship is partially mediated by discrimination (Sobel test = 2.10; p < .05). Conclusions/Importance: Implications of these findings and directions for future research are discussed. Funding was provided by several womens and public health organizations.

The Needs of Racial/Ethnic LGBT Individuals Across the Cancer Care Continuum

In the past two decades there has been a proliferation of research, services and political and social advocacy for sexual minority individuals. Despite these gains, knowledge about sexual minorities of color remains quite limited. The majority of studies on LGBT and cancer are hindered by low representation of non-Whites and few studies have large enough samples of people of color to permit reliable statistical analyses and meaningful results. Smaller-scale studies that rely on volunteer samples often include larger proportions of race/ethnic minority women, but even studies that purposefully target these groups are limited by relatively small subgroup sample sizes, particularly for groups other than African American and Latina. At least part of the problem of recruitment of LGBT individuals of color relates to historical distrust of research and White researchers in communities of color. However, other factors likely include the lack of cultural competency of researchers, failure to utilize evidence-based and proven approaches to recruit and retain individuals of color, research protocols that include exclusion criteria that disproportionately impact participants of color, and the reluctance of some people to disclose a sexual- or gender-minority status, to name just a few challenges. Against this backdrop of limited empirical data, we provide an overview of the unique issues facing LGBT individuals of color, and provide a discussion of general and unique risk factors across the cancer control continuum.