Associations Between Sexual Orientation Dimensions and Cardiometabolic Diseases: Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III).

OBJECTIVE: Sexual orientation can be measured across identity, attraction, and behavior. Sexual minorities are at increased risk of cardiovascular disease (CVD) and diabetes; however, it is not known whether cardiometabolic disease risk varies across these dimensions. METHODS: We analyzed cross-sectional data from 36,309 adults who participated in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III; 2012-2013). Participants were categorized as heterosexual (reference), lesbian/gay, or bisexual across identity, attraction, and behavior using structured clinical interview data. Prevalent CVD (myocardial infarction, stroke, angina, or arteriosclerosis) and diabetes were assessed by self-report. RESULTS: Demographics (age, sex, race/ethnicity, education, and income) adjusted logistic regression models revealed bisexual behavior (i.e., people reporting sexual activity with both man- and woman-identifying individuals), but not lesbian/gay behavior (i.e., people reporting sexual activity exclusively with same-sex individuals), was associated with an increased odds of prevalent CVD (OR = 1.44, 95% CI: 1.08-1.91, p = .013) and prevalent diabetes (OR = 1.39, 95% CI: 1.09-1.77, p = .007). Contrastingly, sexual minority identity (i.e., self-concept) and attraction (i.e., one's sexual/romantic feelings) were not associated with prevalent CVD or diabetes. CONCLUSIONS: Our results in a nationally representative sample indicate the sexual orientation dimension of behavior is linked with prevalent CVD and diabetes. This finding suggests that assessing multiple sexual orientation dimensions may aid in identifying sexual minority subgroups in greatest need of cardiometabolic disease prevention efforts. While mechanisms such as stigma and minority stress have been proposed, future studies are required to elucidate mechanisms underlying the bisexual behavior-cardiometabolic disease relationship.

On the Relationship Between Online Heterosexist Discrimination and Mental Health and Substance Use Among LGBTQ+ Young Adults.

LGBTQ+ individuals experience disproportionately higher rates of mental health and substance use difficulties. Discrimination is a significant factor in explaining these disparities. Meyer's (2003) minority stress theory (MST) indicates that proximal group-specific processes mediate the relationship between discrimination and health outcomes, with the effects moderated by other social factors. However, online discrimination has been understudied among LGBTQ+ people. Focusing on LGBTQ+ young adults experiencing online heterosexist discrimination (OHD), the current study aimed to investigate the effect of OHD on mental health outcomes and explore whether the effect was mediated by proximal factors of internalized heterosexism, online concealment, and acceptance concerns and moderated by social support. Path analysis was used to examine the effects. A total of 383 LGBTQ+ young adults (18-35) from an introductory psychology subject pool, two online crowdsourcing platforms, and the community completed a questionnaire assessing these constructs. OHD was associated with increased psychological distress and cannabis use. Two proximal stressors (acceptance concerns and sexual orientation concealment) mediated the relationship between OHD and psychological distress. Sexual orientation concealment also mediated the relationship between OHD and cannabis use. There was no evidence that online social support from LGBTQ+ peers moderated any of the relationships. MST is a viable guiding framework for exploring OHD. Acceptance concerns and online concealment are important constructs to consider and may be potential treatment targets for individuals experiencing psychological distress or engaging in cannabis use due to OHD.

Racial discrimination and substance use among African American youth: Personal and collective self-esteem as mechanisms.

Little is known about the mechanisms of the relationship between racial discrimination and substance use among Black youth. The current study examined the role of collective self-esteem and personal self-esteem in this relationship among Black adolescents in grades 5 through 12 (N = 1514; 57% female). Regression analyses estimated direct effects of perceived racial discrimination on substance use and indirect effects of discrimination on substance use through personal and collective self-esteem. Controlling for grade and sex, results revealed significant indirect effects such that experiences of discrimination were positively associated with substance use through lower reports of collective and personal self-esteem. Findings suggest that bolstering personal and race-related esteem may mitigate the deleterious influence of discrimination among Black youth.

Who gets screened and who tests positive? Drug screening among justice-involved youth in a midwestern urban county.

BACKGROUND: Given high rates of substance use among justice-involved youth, justice systems have attempted to monitor use through drug screening (DS) procedures. However, there is discretion in deciding who is screened for substance use, as not every youth who encounters the system is screened. The aim of the current study was to examine factors associated with selection for and results of oral DS among justice-involved youth assigned to probation to better inform potential DS policy. Electronic court records from 4,668 youth with first-incident records assigned to probation in a midwestern urban county's juvenile justice system between 2011 and 2016 were included in the analytical sample. Race/ethnicity, gender, age, number of charges and charge type for the current incident were included as independent variables. RESULTS: Multivariable hierarchical logistic regression analyses indicated that males were more likely to be assigned to DS (aOR = 0.40, 95%CI [0.34, 0.46]), and more likely to test positive for use (aOR = 0.43, 95% CI [0.34, 0.54]) than females. As age increased, youth were less likely to be assigned to DS (aOR = 0.91, 95% CI [0.87, 0.94]), with non-significant differences in DS results. Greater number of charges were associated with a higher likelihood of being assigned to DS (aOR = 1.55, 95% CI [1.43, 1.68]). Youth with violent offenses were more likely to be assigned to DS than those with other offense types (property offenses, drug offenses, statutory offenses, disorderly conduct, and all other offenses), but less likely to test positive for use. CONCLUSIONS: Many factors were associated with differences in DS, but these factors were not always associated with differential DS results. Demographic or charge-based decisions may not be appropriate for DS assignment.

Clinician Willingness to Prescribe Medications for Opioid Use Disorder to Adolescents in Indiana.

Importance: Prescribing medications for opioid use disorders (MOUD), including buprenorphine, naltrexone, and methadone, to adolescents remains an underused evidence-based strategy for reducing harms associated with opioid use. Objective: To identify potential associations between clinician- and community-level characteristics regarding clinicians' self-reported willingness to prescribe MOUD to adolescents. Design, Setting, and Participants: This cross-sectional study included a phone survey of Indiana clinicians and spatial analysis of community-level characteristics. Clinicians were eligible for inclusion in analyses if actively providing health care and listed on the Buprenorphine Practitioner Locator website, a publicly available national registry of clinicians possessing a waiver to legally prescribe buprenorphine (ie, waivered clinicians). Exposures: Community-level characteristics, including total population, rurality or urbanicity, percentage with incomes below the federal poverty line, and racial or ethnic makeup. Main Outcomes and Measures: Clinicians were asked about their willingness to prescribe MOUD to adolescents younger than 18 years if clinically indicated. Responses were recorded as no, yes, or yes with conditions. Results: Among the 871 clinicians listed on the website as of July 2022, 832 were eligible for inclusion and contacted by phone. Among waivered clinicians, 759 (91.2%) reported being unwilling to prescribe MOUD to adolescents, 73 clinicians (8.8%) reported willingness to prescribe MOUD to adolescents, and only 24 (2.9%) would do so without conditions. A multivariable logistic regression model including spatially lagged community-level variables showed that, among areas with waivered clinicians, clinicians practicing in more populated areas were significantly less likely to prescribe to adolescents (ß = 0.65; 95% CI, 0.49-0.87; P = .003). Similarly, those in more rural areas were significantly more likely to prescribe to adolescents (ß = 1.27; 95% CI, 1.02-1.58; P = .03). Variation in clinician willingness to prescribe was not explained by other community-level characteristics. Among all waivered clinicians, advanced practice clinicians were less likely than physicians to report willingness to prescribe (ß = 0.58; 95% CI, 0.35-0.97; P = .04), as were physicians without any specialty training relevant to MOUD prescribing when compared with family medicine clinicians (ß = 0.40; 95% CI, 0.18-0.89; P = .03). A small subgroup of waivered clinicians had training in pediatrics (13 clinicians [1.6%]), and none were willing to prescribe MOUD to adolescents. Conclusions and Relevance: From this cross-sectional study, it appears that Indiana adolescents continued to face gaps in access to MOUD treatment, despite its well-established efficacy. Programs that support primary care practitioners, including family medicine clinicians and pediatricians, in safe and appropriate use of MOUD in adolescents may bridge these gaps.

Measures of self-reported identity associated with sex and gender: Relations with collegiate drinking.

OBJECTIVE: Quantitative research has typically relied on categorical measures of sex assigned at birth (SAAB) and gender, with heterogeneous findings in terms of their associations with alcohol-related behavior. This investigation examined continuous indices of self-identification as an alternative to categorical operationalizations in alcohol research. METHOD: Eight hundred ninety-three undergraduate students (74.6% cisgender women, 20.3% cisgender men, 3.9% nonbinary, and 1.2% transgender), recruited from the Midwest and Pacific Northwest of the United States, completed online measures of SAAB (male/female), gender (categorical), continuous indices of identification (femaleness, maleness, and bidirectional), and alcohol consumption (Cahalan Indices; Daily Drinking Questionnaire-Revised; Alcohol Use Disorders Identification Test [AUDIT]). RESULTS: Novel continuous measures of identification were associated with categorical indices of SAAB and gender as predicted. While none of the self-identification indices (continuous or categorical) predicted current drinking (consumption in the past 30 days), they evidenced relatively consistent, albeit small effects, across quantity-frequency of drinking and AUDIT scores for current drinkers. Higher scores on maleness and bidirectional indices of identification were associated with greater consumption, while greater endorsement of femaleness and being a cisgender woman (vs. a cisgender man) were related to less drinking. CONCLUSIONS: Continuous self-reported identification items performed well when describing drinking behavior in college students. The inclusion of dimensional scales of identity broadens our ability to capture differing self-conceptualizations in research.