Rafael M. Diaz

Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay, and Bisexual Young Adults

OBJECTIVE. We examined specific family rejecting reactions to sexual orientation and gender expression during adolescence as predictors of current health problems in a sample of lesbian, gay, and bisexual young adults. METHODS. On the basis of previously collected in-depth interviews, we developed quantitative scales to assess retrospectively in young adults the frequency of parental and caregiver reactions to a lesbian, gay, or bisexual sexual orientation during adolescence. Our survey instrument also included measures of 9 negative health indicators, including mental health, substance abuse, and sexual risk. The survey was administered to a sample of 224 white and Latino self-identified lesbian, gay, and bisexual young adults, aged 21 to 25, recruited through diverse venues and organizations. Participants completed self-report questionnaires by using either computer-assisted or pencil-and-paper surveys. RESULTS. Higher rates of family rejection were significantly associated with poorer health outcomes. On the basis of odds ratios, lesbian, gay, and bisexual young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse compared with peers from families that reported no or low levels of family rejection. Latino men reported the highest number of negative family reactions to their sexual orientation in adolescence. CONCLUSIONS. This study establishes a clear link between specific parental and caregiver rejecting behaviors and negative health problems in young lesbian, gay, and bisexual adults. Providers who serve this population should assess and help educate families about the impact of rejecting behaviors. Counseling families, providing anticipatory guidance, and referring families for counseling and support can help make a critical difference in helping decrease risk and increasing well-being for lesbian, gay, and bisexual youth.

Lesbian, Gay, Bisexual, and Transgender Adolescent School Victimization: Implications for Young Adult Health and Adjustment

BACKGROUND Adolescent school victimization due to lesbian, gay, bisexual, or transgender (LGBT) status is commonplace, and is associated with compromised health and adjustment. Few studies have examined the long-term implications of LGBT school victimization for young adult adjustment. We examine the association between reports of LGBT school victimization and young adult psychosocial health and risk behavior. METHODS The young adult survey from the Family Acceptance Project included 245 LGBT young adults between the ages of 21 and 25 years, with an equal proportion of Latino and non-Latino White respondents. A 10-item retrospective scale assessed school victimization due to actual or perceived LGBT identity between the ages of 13 and 19 years. Multiple regression was used to test the association between LGBT school victimization and young adult depression, suicidal ideation, life satisfaction, self-esteem, and social integration, while controlling for background characteristics. Logistic regression was used to examine young adult suicide attempts, clinical levels of depression, heavy drinking and substance use problems, sexually transmitted disease (STD) diagnoses, and self-reported HIV risk. RESULTS Lesbian, gay, bisexual, and transgender-related school victimization is strongly linked to young adult mental health and risk for STDs and HIV; there is no strong association with substance use or abuse. Elevated levels of depression and suicidal ideation among males can be explained by their high rates of LGBT school victimization. CONCLUSIONS Reducing LGBT-related school victimization will likely result in significant long-term health gains and will reduce health disparities for LGBT people. Reducing the dramatic disparities for LGBT youth should be educational and public health priorities.

Gender-nonconforming lesbian, gay, bisexual, and transgender youth: school victimization and young adult psychosocial adjustment.

Past research documents that both adolescent gender nonconformity and the experience of school victimization are associated with high rates of negative psychosocial adjustment. Using data from the Family Acceptance Projects young adult survey, we examined associations among retrospective reports of adolescent gender nonconformity and adolescent school victimization due to perceived or actual lesbian, gay, bisexual, or transgender (LGBT) status, along with current reports of life satisfaction and depression. The participants included 245 LGBT young adults ranging in age from 21 to 25 years. Using structural equation modeling, we found that victimization due to perceived or actual LGBT status fully mediates the association between adolescent gender nonconformity and young adult psychosocial adjustment (i.e., life satisfaction and depression). Implications are addressed, including specific strategies that schools can implement to provide safer environments for gender-nonconforming LGBT students.

From Networks to Populations: The Development and Application of Respondent-Driven Sampling Among IDUs and Latino Gay Men

One of the challenges in studying HIV-risk behaviors among gay men is gathering information from a non-biased sample, as traditional probability sampling methods cannot be applied in gay populations. Respondent-Driven Sampling (RDS) has been proposed as a reliable and bias-free method to recruit “hidden” populations, such as gay men. The aim of this study is to assess the feasibility and effectiveness of RDS to sample Latino gay men and transgender persons. This was carried out when we used RDS to recruit participants into a study that investigated community involvement on HIV/AIDS sexual risk behaviors among Latino gay and bisexual men, and transgender (male-to-female) persons in Chicago and San Francisco. The population coverage of RDS was then compared to simulated time-location sampling (TLS). Recruitment differences were observed across cities, but the samples were comparable. RDS showed broader population coverage than TLS, especially among individuals at high risk for HIV.

Vygotsky and education: The social origins of self-regulation

A central theme in Vygotskys development theory is that cognitive development can be understood as the transformation of basic, biologically determined processes into higher psychological functions. According to the theory, the human child is endowed by nature with a wide range of perceptual, attentional, and memory capacities, such as the capacity to perceive contrast and movement, the capacity for eidetic memory, and arousal/habituation responses to environmental stimuli, to name a few. Such basic processes (also referred to by Vygotsky as “biological,” “natural,” or “elementary”), however, are substantially transformed in the context of socialization and education, particularly through the use of language, to constitute the higher psychological functions or the unique forms of human cognition. Our readings of Vygotsky suggest that this “transformation” from basic to higher functions consists mostly of an increasing self-regulation of processes and capacities that are originally bound to and controlled by the concrete, immediate stimulus field. In development, the infants eidetic, rudimentary memory processes are gradually transformed into the capacity for voluntary memory and the use of mnemonic strategies; the capacity to perceive salient stimulus features develops into the capacity for selective attention; arousal/habituation patterns develop into the capacity for vigilance, concentration, and sustained attention. The common denominators of these transformations or developmental changes are the decreasing power of immediate environmental contingencies and the increasing role of self-formulated plans and goals in the regulation of behavior and cognitive activity.

HIV Prevention Research for Men Who Have Sex with Men: A Systematic Review and Meta-analysis

Summary: A systematic review of HIV prevention reports published or distributed in the United States as of June 1998 yielded 9 rigorous controlled trials reporting intervention effects on unprotected sex for men who have sex with men. A summary measure of these effects was favorable (odds ratio, .69), statistically significant (95% confidence interval, 0.56‐0.86), and very homogeneous. This summary value indicates a 26% reduction in the proportion of men engaging in unprotected anal intercourse. The most clearly favorable effects were observed among interventions that promoted interpersonal skills, were delivered in community‐level formats, or focused on younger populations or those at higher behavioral risk. These studies demonstrate that interventions can promote risk reduction among men who have sex with men. Yet given the epidemiology of HIV in the United States, the small number of rigorous controlled intervention trials for this population is striking. Many more rigorous evaluations of HIV prevention efforts with men who have sex with men are needed to ascertain with confidence the effects of specific intervention components, population characteristics, and methodologic features.

Decisions to get HIV tested and to accept antiretroviral therapies among gay/bisexual men : implications for secondary prevention efforts

The objective of this study was to report prevalence rates of adherence by HIV-seropositive individuals to medical recommendations for the treatment of HIV infection, a behavioral pattern referred to as AIDS secondary prevention. We report cross-sectional data (n = 2,593) from two household-based and two bar-based samples of gay/bisexual men, gathered in 1992 in Tucson, Arizona, and Portland, Oregon. The main outcome variables were prevalence of HIV antibody testing and adherence to recommended secondary prevention behaviors to prevent onset of AIDS symptoms. Approximately one-third of the gay/bisexual men in these samples do not know their current HIV status. Of the gay/bisexual men who do know that they are HIV-seropositive, approximately three-fourths adhere to each of the secondary prevention recommendations, as appropriate to their stage of disease progression. In a multivariate logistic model, three variables distinguished between HIV-seropositive men who did and did not adhere: perceived antiviral treatment norms (OR = 1.4, CI = 1.1-1.7), perceived efficacy of secondary prevention treatments (OR = 1.4, CI = 1.1-1.7), and quality of the relationship with ones health-care provider (OR = 2.5, CI = 1.6-4.0). These findings indicate that efforts to support AIDS secondary prevention behaviors can occur not only through health education to change the perceptions of at-risk communities about the options available to delay the onset of opportunistic infections among HIV-seropositive individuals but also by enhancing effective doctor/patient communication.

High School Gay–Straight Alliances (GSAs) and Young Adult Well-Being: An Examination of GSA Presence, Participation, and Perceived Effectiveness

Gay–Straight Alliances (GSAs) are student-led, school-based clubs that aim to provide a safe environment in the school context for lesbian, gay, bisexual, and transgender (LGBT) students, as well as their straight allies. The present study examines the potential for GSAs to support positive youth development and to reduce associations among LGBT-specific school victimization and negative young adult well-being. The sample includes 245 LGBT young adults, ages 21–25, who retrospectively reported on the presence of a GSA in their high school, their participation in their schools GSA, and their perceptions of whether or not their GSA was effective in improving school safety. Findings revealed that the presence of a GSA, participation in a GSA, and perceived GSA effectiveness in promoting school safety were differentially associated with young adult well-being and, in some cases, buffered the negative association between LGBT-specific school victimization and well-being. Implications for future research and schools are discussed.

Gender Nonconformity, Homophobia, and Mental Distress in Latino Gay and Bisexual Men

This study explored whether gender nonconformity in gay and bisexual men is related to mental distress and if so, whether this relationship is mediated by negative experiences that are likely associated with gender nonconformity, including abuse and harassment. To study this question, data were analyzed from face-to face interviews with 912 self-identified gay and bisexual Latino men in three major U.S. cities collected by Diaz and colleagues (2001). Gay and bisexual Latino men who considered themselves to be effeminate had higher levels of mental distress and more frequently reported various negative experiences, compared with gay and bisexual Latino men who did not identify as effeminate. Higher levels of mental distress in effeminate men seemed to primarily result from more experiences of homophobia. Findings suggest the need for more attention to gender in research as well as counseling of sexual minority men.

Methodological issues in research on sexual behavior with Latino gay and bisexual men.

Latino gay men are at high risk for HIV/AIDS, and therefore it is critical that we increase our understanding of their sexual behavior. This paper discusses theoretical and methodological issues of conducting research with Latino gay and bisexual men. The importance of culture in psychological theory addressing sexual behavior is highlighted. Cultural and socioeconomic forces that impact the social construction of sexuality and sexual risk need to be taken into account to increase research validity. Social context and internalized sociocultural experiences can affect a variety of issues, including sexual scripts and the definition and fluidity of sexual orientation identity. Moreover, Latino gay mens sexuality may be influenced by experiences of oppression, discrimination, racism, and homophobia. Level of acculturation should also be considered. Measures that are developed by taking into account the cultural context and incorporating a Latino perspective are helpful in conducting meaningful research. Triangulation of quantitative and qualitative methods will help provide a picture rich in context and at the same time generalizable. The relationship between researchers and participants is affected by Latino cultural styles, and suggestions for approaches to conduct research in the Latino gay community are offered.