Jeremy T. Goldbach

Minority Stress and Substance Use in Sexual Minority Adolescents: A Meta-analysis

Lesbian, gay, and bisexual (LGB) adolescents report disparate rates of substance use, and often consume more cigarettes, alcohol, marijuana, cocaine, and ecstasy than their heterosexual peers. It is therefore crucial to understand the risk factors for substance use among LGB adolescents, particularly those unique to their minority status. In an effort to organize the current knowledge of minority-related risk factors for substance use among LGB youth, this study presents results from a systematic review and meta-analysis of the published research literature. Results from 12 unique studies of LGB youth indicated that the strongest risk factors for substance use were victimization, lack of supportive environments, psychological stress, internalizing/externalizing problem behavior, negative disclosure reactions, and housing status. Results are discussed in terms of their implications for targeted intervention programs that address minority stress risk factors for substance use among LGB youth.

Cyberbullying Perpetration and Victimization Among Middle-School Students

OBJECTIVES We examined correlations between gender, race, sexual identity, and technology use, and patterns of cyberbullying experiences and behaviors among middle-school students. METHODS We collected a probability sample of 1285 students alongside the 2012 Youth Risk Behavior Survey in Los Angeles Unified School District middle schools. We used logistic regressions to assess the correlates of being a cyberbully perpetrator, victim, and perpetrator-victim (i.e., bidirectional cyberbullying behavior). RESULTS In this sample, 6.6% reported being a cyberbully victim, 5.0% reported being a perpetrator, and 4.3% reported being a perpetrator-victim. Cyberbullying behavior frequently occurred on Facebook or via text messaging. Cyberbully perpetrators, victims, and perpetrators-victims all were more likely to report using the Internet for at least 3 hours per day. Sexual-minority students and students who texted at least 50 times per day were more likely to report cyberbullying victimization. Girls were more likely to report being perpetrators-victims. CONCLUSIONS Cyberbullying interventions should account for gender and sexual identity, as well as the possible benefits of educational interventions for intensive Internet users and frequent texters.

Acculturation-Related Stress and Mental Health Outcomes Among Three Generations of Hispanic Adolescents

Stress associated with acculturation and minority status among Hispanic youth is understudied. Using survey data from the Hispanic Stress Inventory–Adolescent Version (HSI-A), we examined psychosocial stress across eight domains including family economic stress and acculturation-gap stress in a national sample of three generations (first, second, and third or higher) of Hispanic adolescents (N = 1,263). Research questions addressed generation differences in frequency of stressor events (i.e., discrimination), appraisal of these events, and mental health symptoms. Results indicated that experiences of different categories of stress were significantly related to generation status. The first generation reported more stressors and greater stress appraisal than the third-generation adolescents. Similar levels of discrimination stress were reported by participants regardless of generation. The second-generation participants reported a greater number of Acculturation Gap Stressors than the third generation, and more delinquent and aggressor behaviors than first-generation participants. An acculturation paradox was found with greater stress exposure and stress appraisals in the first-generation youth, but with lower mental health symptoms than later generations. Family integrity and more traditional family values may buffer the negative impact of greater stressor exposure among immigrants and second-generation youth when compared with third-generation adolescents.

Self-harm Among Hispanic Adolescents: Investigating the Role of Culture-Related Stressors

PURPOSE Suicide is the third leading cause of death among adolescents. Research shows Hispanic adolescents report disproportionate rates of both suicidal ideation and attempts. The purpose of the present study was twofold. First, the present study aimed to document the presence of suicidal ideation and self-harm behavior in a large heterogeneous sample of Hispanic adolescents. Second, this study sought to identify specific and unique culturally relevant stressors that were associated with the higher self-reported suicidal thoughts and self-harm among Hispanic males and females separately. METHODS Data were collected on 1,651 Hispanic adolescents who completed the Hispanic Stress Inventory-Adolescent Version. RESULTS Results of both rates and culture-related stressors that associated with the high rates of suicidal ideation are presented. Of the eight subscales measured in the Hispanic Stress Inventory-Adolescent, four subscales were predictive of either suicidal ideation or self-harm. For males, Acculturation Gap Stress was associated with suicidal thoughts and Discrimination Stress was associated with both suicidal thoughts and self-harm behavior. For females, Family Drug Stress was associated with suicidal thoughts. Acculturation Gap Stress, Family Drug Stress, and Immigration Stress were all significantly associated with self-harm behaviors. CONCLUSIONS Findings are discussed as they inform future culturally competent prevention interventions and future research studies.

Religious Conflict, Sexual Identity, and Suicidal Behaviors among LGBT Young Adults

This is the first known study to explore how religious identity conflict impacts suicidal behaviors among lesbian, gay, bisexual, and transgender (LGBT) young adults and to test internalized homophobia as a mediator. A secondary analysis of 2,949 youth was conducted using a national dataset collected by OutProud in 2000. Three indicators of identity conflict and an internalized-homophobia scale (mediator), were included in logistic regressions with three different suicide variable outcomes. Internalized homophobia fully mediates one conflict indicator and partially mediates the other two indicators’ relationship with suicidal thoughts. Internalized homophobia also fully mediates the relationship between one conflict indicator and chronic suicidal thoughts. Two indicators were associated with twice the odds of a suicide attempt. LGBT young adults who mature in religious contexts have higher odds of suicidal thoughts, and more specifically chronic suicidal thoughts, as well as suicide attempt compared to other LGBT young adults. Internalized homophobia only accounts for portions of this conflict.

Using Qualitative Methods for Revising Items in the Hispanic Stress Inventory.

Despite progress in the development of measures to assess psychosocial stress experiences in the general population, a lack of culturally informed assessment instruments exist to enable clinicians and researchers to detect and accurately diagnosis mental health concerns among Hispanics. The Hispanic Stress Inventory (HSI) was developed specifically for Hispanic adults, however, significant social and geopolitical changes over the past two decades have affected the types and intensity of stress experienced by Hispanics. Immigration related policy changes, for example, affect stress experiences among newer immigrants from Mexico and other Latin American countries in ways that items in the original HSI may no longer capture the full range of today’s stressors. Using expert interviews from Hispanic mental health experts and data gathered in 16 community-based focus groups at two distinct study sites, the goal of the current study was to identify new item content to include in a revised HSI. Using content analysis of all interview data, a total of 155 new stressor items and seven unique stress domains were generated. Content validity analysis using Kappa coefficient reveal high interrater validity for new HSI item content. Findings are described in depth, and recommendations for future research are identified.

An Examination of Cultural Adaptations Performed by LGBT-Identified Youths to a Culturally Grounded, Evidence-Based Substance Abuse Intervention

Historically, substance abuse prevention programs are created with samples that conform to the majority population. Research shows that substance use risk factors are higher for lesbian, gay, bisexual, and transgender (LGBT) youths (Eisenberg & Wechsler, 2003), and LGBT youths report higher use of substances than their heterosexual counterparts (Lampinen, McGhee, & Martin, 2006; Marshal et al., 2008; Russell, Truong, & Driscoll, 2002). However, when compared to LGBT adults, knowledge of youth substance use is limited. Unfortunately, few interventions are tailored to LGBT youths. It is necessary to investigate the factors associated with substance use that are unique to this population in order to tailor interventions to their needs. A preliminary study was conducted which adapted an evidence-based prevention program with guidance from LGBT youths at a drop-in center. This article explores the qualitative findings of the curriculum adaptation and a focus group through use of a grounded theory method. Findings suggest that this population of youths are easily engaged in the adaptation process and provide unique and relevant adaptations. Implications for practice and research are discussed.

The Application of Minority Stress Theory to Marijuana Use Among Sexual Minority Adolescents

Previous research indicates that lesbian, gay, and bisexual (LGB) adolescents are at increased risk for substance use, including heightened rates of marijuana use. Minority stress theory suggests that difficult social situations create a state of chronic stress that leads to poor health outcomes for LGB adults; however, the applicability of this model has not been well explored in relation to substance use among LGB adolescents. The current study is a secondary analysis of the OutProud survey, conducted in 2000. The original study used purposive sampling to collect data from 1,911 LGB adolescents (age 12–17) across the United States, and represents the largest known study to explore experiences specific to identifying as LGB, such as homophobia and gay-related victimization. We used structural equation modeling (SEM) to explore the feasibility of applying a minority stress framework to understand marijuana use in this population. The final structural model for marijuana use in the LGB adolescent sample displayed excellent fit and modest explanatory power for marijuana use. Two of the five factors, community connectedness and internalized homophobia, were significantly (p < .05) associated with marijuana use. Findings suggest that minority stress theory may be appropriately applied to marijuana use in this population; however, better measurement of minority stress concepts for LGB adolescents is needed.

Addressing gaps on risk and resilience factors for alcohol use outcomes in sexual and gender minority populations

ISSUES In 2011, the Institute of Medicine released a report that constituted the first comprehensive effort by a federal body to understand the current state of science pertinent to the health needs of sexual and gender minority populations. This mini-review summarises recent empirical, methodological and theoretical advances in alcohol-related research among to lesbian, gay, bisexual and transgender (LGBT) populations and highlights progress towards addressing gaps, with a particular interest in those identified by the Institute of Medicine report. APPROACH Articles published since 2011 were identified from PsycINFO and PubMed database searches, using various combinations of keyword identifiers (alcohol, alcohol abuse, substance abuse, LGBT, lesbian, gay, bisexual, transgender). Reference sections of included articles were also examined for additional citations. KEY FINDINGS Recent empirical work has contributed to a greater understanding of sub-group differences within this diverse population. Evidence has supported theorised influences that can account for alcohol-related disparities, yet important gaps remain. Studies that examine the role of gender identity and its intersection with sexual identity within transgender and gender non-conforming sub-populations are lacking. Methodological advances in this literature have begun to allow for examinations of how minority-specific and general risk factors of alcohol misuse may contribute to patterns of alcohol involvement over time and within social-relational contexts CONCLUSIONS The recommendations made in the current mini-review are meant to facilitate future collaborative efforts, scale development, thoughtful methodological design and analysis and theoretically driven nuanced hypotheses to better understand, and ultimately address, alcohol-related disparities among sexual and gender minority populations. [Talley AE, Gilbert PA, Mitchell J, Goldbach J, Marshall BDL, Kaysen D. Addressing gaps on risk and resilience factors for alcohol use outcomes in sexual and gender minority populations. Drug Alcohol Rev 2016;35:484-493].

Examining differences in culturally based stress among clinical and nonclinical Hispanic adolescents

The purpose of the current study was to determine if, and how, Hispanic adolescents receiving clinical treatment differ from their peers who are not in treatment on the 8 domains (family economic stress, cultural or educational stress, acculturation-gap stress, immigration stress, discrimination stress, family immigration stress, community or gang-related stress) of cultural stress (HSI-A), and if the relation between cultural stress domains and depressive symptomology differed by group membership (clinical vs. nonclinical). The sample included 1,254 Hispanic adolescents. The clinical sample had significantly higher scores of cultural stress (p < .05) and mean depression scores (< .001). All 8 domains of HSI-A stress were correlated with depression (p < .05). In the general linear models (GLM), only family economic, acculturation gap, family immigration, discrimination, and family drug stress had a unique effect on depression and effect varied by group. Acculturation gap stress was associated with depression for the nonclinical group but not the clinical group (p < .001) and community gang stress was more strongly related to depression for the clinical group (p < .05).