Jessica N. Fish

Mental Health in Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth

Todays lesbian, gay, bisexual, and transgender (LGBT) youth come out at younger ages, and public support for LGBT issues has dramatically increased, so why do LGBT youth continue to be at high risk for compromised mental health? We provide an overview of the contemporary context for LGBT youth, followed by a review of current science on LGBT youth mental health. Research in the past decade has identified risk and protective factors for mental health, which point to promising directions for prevention, intervention, and treatment. Legal and policy successes have set the stage for advances in programs and practices that may foster LGBT youth mental health. Implications for clinical care are discussed, and important areas for new research and practice are identified.

Transgender Youth Substance Use Disparities: Results From a Population-Based Sample

PURPOSE The purpose of this study was to examine rates of substance use between transgender and nontransgender youth using a representative population-based sample and to examine mediating risk factors. METHODS A statewide cross-sectional sample of California middle and high schools collected between 2013 and 2015. This representative sample of students in California included 335 transgender and 31,737 nontransgender youth. Using multivariate linear and logistic regression, we assessed differences between transgender and nontransgender youth in substance use behaviors related to alcohol, cigarette, marijuana, other illicit drugs, polysubstance use, and heavy episodic drinking. Substance use was assessed with lifetime use, age of onset, and past 30-day use for alcohol, cigarettes, and marijuana. Past 30-day use was also assessed for other illicit drugs and polysubstance use. Models were adjusted for demographics and risk factors including victimization, depressive symptoms, and perceived risk of substance use. RESULTS The prevalence of substance use was 2.5-4 times higher for transgender youth compared with their nontransgender peers (depending on the substance). Transgender youth were also at greater risk for early age of onset and recent substance use than nontransgender youth. In addition, psychosocial risk factors related to victimization, depressive symptoms, and perceived risk of substance use partially mediated the relationship between gender identity and substance use. CONCLUSIONS Using data from the first representative study of youth to include a measure of gender identity, we show that transgender youth are at heightened risk for substance use compared with nontransgender peers. Future research is needed to identify the structural and psychosocial mechanisms that drive these disparities.

Have Mischievous Responders Misidentified Sexual Minority Youth Disparities in the National Longitudinal Study of Adolescent to Adult Health

The National Longitudinal Study of Adolescent to Adult Health (Add Health) has been instrumental in identifying sexual minority youth health disparities. Recent commentary suggested that some Wave 1 youth responders, especially males, intentionally mismarked same-sex attraction and, as a result, published reports of health disparities from these data may be suspect. We use two recently developed approaches to identify “jokesters” and mischievous responding and apply them to the Add Health data. First, we show that Wave 1 same-sex attracted youth, including those who later reported completely heterosexual identities in adulthood, were no more likely than different-sex attracted youth and consistently heterosexual participants to be “jokesters.” Second, after accounting for mischievous responses, we replicated six previously established disparities: depressive symptoms, suicidal ideation and behaviors, alcohol use, cocaine use, parental satisfaction, and school connectedness. Accounting for mischievousness resulted in the elimination of one observed disparity between heterosexual and sexual minority youth: suicidal ideation for males who reported romantic attraction to both sexes. Results also showed that accounting for mischievous responding may underestimate disparities for sexual minority youth, particularly females. Overall, results presented here support previous studies that identified health disparities among sexual minority youth using these data.

Sexual minority youth continue to smoke cigarettes earlier and more often than heterosexuals: Findings from population-based data

BACKGROUND An established body of research documents that sexual minority (i.e., lesbian, gay, and bisexual) populations are at higher risk for several adverse health behaviors and outcomes compared to their heterosexual counterparts. Smoking is one behavior where the gap is especially large, particularly among youth. Researchers have increasingly drawn attention to contextual determinants of health behaviors affecting sexual minority youth. PURPOSE Although these factors have evolved over time, few scholars have examined time as a contextual factor that affects sexual minority health behaviors or the level of inequality with heterosexual populations. We aimed to fill this gap. PROCEDURES We used eight years of data from the Massachusetts Youth Risk Behavior Survey (MYRBS), pooled into four waves, to determine whether gaps between sexual minority and heterosexual youth have widened or narrowed for three different indicators of smoking: having ever smoked, early onset smoking, and daily cigarette smoking in the past 30 days. RESULTS We find that, though rates of smoking for all youth in Massachusetts have declined since the late 1990s, significant disparities remain between sexual minority and heterosexual youth. CONCLUSIONS Findings may suggest that targeted tobacco control programs in Massachusetts are needed; perhaps shifts in social attitudes toward smoking have affected smoking behaviors in diverse segments of society.

Sexual Identity Disclosure and Awareness of HIV Prevention Methods Among Black Men Who Have Sex With Men

Black men who have sex with men (BMSM) are disproportionately affected by the human immunodeficiency virus (HIV) epidemic, yet we know little about how HIV-negative BMSM of different sexual orientations access HIV prevention strategies. Identity development, minority stress, and disclosure theories suggest that for people of different sexual orientations, disclosure of sexual identity may be related to health behaviors. We performed a latent class analysis on a sample of 650 BMSM (Mage = 33.78, SD = 11.44) from Atlanta, Georgia, to explore whether sexual orientation, disclosure of sexual identity, and relationship status were related to HIV prevention strategies, including awareness of PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) and frequency of HIV testing. We found three distinct BMSM classes referred to as (1) closeted bisexuals, (2) sexual identity managers, and (3) gay, out, and open; all classes primarily engaged in casual sex. Classes differed in their awareness and access to HIV prevention strategies. The closeted bisexual class was least aware of and least likely to access HIV prevention. Findings have important implications for future research, namely the consideration of sexual identity and disclosure among BMSM. With this knowledge, we may be able to engage BMSM in HIV/sexually transmitted infection (STI) prevention services.

Queering Methodologies to Understand Queer Families

Queering questions that which is normative. In this article, we discuss how, for the study of queer families, queering methodologies could reclaim traditional research methods that reflect historically dominant or privileged paradigms. We suggest that queer perspectives may be used to adapt mainstream (i.e., dominant, positivist, empirical) methods, creating possibilities for new, diverse understandings of queer families. We start with comments on the development and current standing of queer family research. We then reflect on several key conceptual and methodological tensions as they apply to queer family studies: lesbian, gay, bisexual, transgender, and queer individuals ↔ queer families, between-group ↔ within-group, and quantitative ↔ qualitative. In conclusion, we discuss how these methodological considerations provide researchers opportunities to conduct research not only about but for queer families. Such research may reflect the diversity of queer families and challenge the normativities and systems of privilege that constrain them.

Do differences matter? A typology of emerging adult romantic relationship

Romantic relationships among emerging adults (individuals aged 18–25 years) are typically homogenously classified both theoretically and empirically as “exploratory” and “unstable.” With a sample of college students (N = 340), we examined within-group variation among romantic relationships in emerging adulthood using latent class analyses. Four predictor variables indicated four types of romantic relationships among emerging adult college students: the committers (38%), the casual daters (23%), the settlers (30%), and the volatile daters (8%). Classes varied according to background variables such as gender and infidelity. Additionally, there was class variation for outcome variables such as breakup status and loneliness. Future research and implications are discussed.

Is Young Adulthood a Critical Period for Suicidal Behavior among Sexual Minorities? Results from a US National Sample

The developmental timing of suicide-related disparities between heterosexuals and sexual minorities (i.e., lesbian/gay and bisexual (LGB) people) is an understudied area that has critical prevention implications. In addition to developmentally situated experiences that shape risk for suicidality in the general population, sexual minorities also experience unique social stressors (e.g., anti-LGB stigma) that may alter their risk for suicidal behavior at different ages. Using a nationally representative US sample of adults, we assessed age-varying rates of suicidal behavior among heterosexuals and sexual minorities ages 18 to 60 and the age-varying association between anti-LGB discrimination and suicidal behavior. We also tested whether these age-varying prevalences and associations differed for men and women and for sexual minorities who did and did not endorse a sexual minority identity. Results indicate a critical period for suicide behavior risk for sexual minorities during young adulthood, with the highest rates of risk at age 18 followed by a steady decline until the early 40s. Disparities were particularly robust for sexual minorities who identified as lesbian, gay, or bisexual. This pattern was present for both men and women, though sexual minority women in their 30s were more likely to report suicidal behavior than heterosexuals and sexual minority men. Sexual minorities who experienced anti-LGB discrimination were more likely to report suicidal behavior, but the significance of this association was limited to those under 30. The effect of discrimination on suicidal behavior was stronger among young adult sexual minority men, relative to sexual minority women, but was present for a wider age range for sexual minority women (until age 30) relative to sexual minority men (until age 25).

Trends in Alcohol-Related Disparities Between Heterosexual and Sexual Minority Youth from 2007 to 2015: Findings from the Youth Risk Behavior Survey

PURPOSE The purpose of this study was to assess trends in alcohol-related disparities between heterosexual and sexual minority adolescents in the United States from 2007 to 2015. METHODS Data were pooled from the 2007, 2009, 2011, 2013, and 2015 Youth Risk Behavior Surveys (N = 207,367) to estimate trends, disparities, and changes in disparities of four alcohol-related behaviors (i.e., lifetime alcohol use, early onset use (<13 years of age), past 30-day use, and past 30-day heavy episodic drinking [HED]) among heterosexual youth and three subgroups of sexual minority youth (SMY) (i.e., gay/lesbian, bisexual, and unsure). Models were sex stratified and adjusted for age, race/ethnicity, and state of data collection. RESULTS The prevalence of all alcohol-related behaviors declined from 2007 to 2015 for heterosexual youth, but not as consistently for SMY. Disparities in alcohol-related behaviors between heterosexual youth and SMY largely remained stable or widened from 2007 to 2015. Disparities in lifetime alcohol use and past 30-day use were larger between heterosexual boys and gay boys in 2015 relative to 2007. Disparities in early onset use and past 30-day HED were also larger between heterosexual girls and lesbian girls in 2015 relative to 2007. The disparity in past 30-day use between heterosexual girls and bisexual girls was smaller in 2015 compared with 2007. CONCLUSIONS Despite overall declines in adolescent alcohol use, alcohol-related disparities between heterosexual youth and SMY persist and, for some SMY, they have widened.

Reconsidering the LGBT Climate Inventory: Understanding Support and Hostility for LGBTQ Employees in the Workplace

Workplace climate matters significantly for lesbian, gay, bisexual, queer, or other sexual minority (LGBQ) employees, given that the presence of workplace hostility or support can affect well-being. The Lesbian, Gay, Bisexual, and Transgender Climate Inventory (LGBTCI) is a measure of workplace climate for LGBQ individuals, intended to capture the full range of workplace climate from hostility to support. The purpose of this article is to provide evidence that the recommended scoring approach of the LGBTCI needs to be reconsidered. We used latent class analysis to estimate classes of work-related experiences in our sample of 442 LGBQ employees who completed the LGBTCI. A four-class solution fit the data best. Characteristics of each class were identified and consequently labeled: supportive work climate, tolerant work climate, ambiguous work climate, and hostile work climate. Findings suggest that a more accurate measure of workplace climate would include independent scales for support and hostility.