Substance Use Experiences Among Bisexual, Pansexual, and Queer (Bi+) Male Youth: A Qualitative Study of Motivations, Consequences, and Decision Making.

Sexual minority youth are at increased risk of substance use compared to their heterosexual peers, and bisexual youth appear to be at greatest risk. However, little is known about their motivations for and against using substances, how they make decisions, and what consequences they experience. We used qualitative data from a study of 54 cisgender and transgender male youth (ages 14-17 years) who reported attractions to more than one gender or regardless of gender (i.e., bisexual, pansexual, or queer; collectively referred to as bi+) to explore these aspects of substance use. Participants completed a survey and an interview, and interviews were thematically analyzed. Qualitative analyses revealed that participants described diverse motivations for using substances (e.g., to cope with stress, to experiment, to have fun) and for not using them (e.g., concern about consequences, not having access). The most common sources of stress were mental health problems, school, and family. They did not describe sexual orientation-related stress as a motivation for their use, but they acknowledged that it could influence others' use. Participants also described thinking about when, where, and with whom they were going to use prior to doing so (e.g., only using in safe places and with people who they trusted). Finally, they described a range of consequences they experienced (e.g., getting sick, getting in trouble), and a subset of transgender participants described experiencing dependence symptoms. These findings suggest that substance use prevention and harm reduction interventions for bi+ male youth should address diverse motivations for use, including general stressors, which are often overlooked compared to minority-specific stressors. Further, interventions should approach youth as capable of making decisions. Findings also highlight the particular need to address substance use among transgender youth.

Racial disparities in patient selection for liver transplantation: An ongoing challenge.

Ample evidence suggests continued racial disparities once listed for liver transplantation, though few studies examine disparities in the selection process for listing. The objective of this study, via retrospective chart review, was to determine whether listing for liver transplantation was influenced by socioeconomic status and race/ethnicity. We identified 1968 patients with end-stage liver disease who underwent evaluation at a large, Midwestern center from January 1, 2004 through December 31, 2012 (72.9% white, 19.6% black, and 7.5% other). Over half (54.6%) of evaluated patients were listed; the three most common reasons for not listing were medical contraindications (11.9%), patient expired during evaluation (7.0%), and psychosocial contraindications (5.9%). In multivariable logistic regressions (listed vs not listed), across the three racial categories, the odds of being listed were lower for alcohol-induced hepatitis (±hepatitis C), unmarried, more than one insurance, inadequate insurance, and lower annual household income quartile. Similar factors predicted time to transplant listing, including being identified as black race. Black race, even when adjusting for the above mentioned medical and socioeconomic factors, was associated with 26% lower odds of being listed and a longer time to listing decision compared to all other patients.

The Roles of Discrimination and Aging Concerns in the Mental Health of Sexual Minority Older Adults.

Purpose: Sexual minority (SM) older adults report poorer mental health than their heterosexual peers. While all older adults can experience age discrimination and other aging concerns (e.g., functional decline), SM older adults also experience sexual orientation-related discrimination and aging concerns (e.g., that they will have to be less open about their sexual orientation to get support as they age). The goals of this study were to examine the roles of (1) sexual orientation and age discrimination and (2) sexual orientation-specific and general aging concerns in depression and anxiety among SM older adults. Methods: As part of a larger study, 477 SM older adults (aged ≥50 years) completed an online survey in September 2021. The majority were gay/lesbian (83%), cisgender men (40%) or cisgender women (34%), and non-Latinx White (39%) or Latinx (34%). Analyses controlled for age, sexual orientation, gender identity, and race/ethnicity. Results: Sexual orientation discrimination and age discrimination were positively associated with depression and anxiety. A significant interaction indicated that sexual orientation discrimination was positively associated with anxiety at low, moderate, and high levels of age discrimination, but the association was strongest at the low level. Sexual orientation-specific and general aging concerns were also positively associated with depression and anxiety. Significant interactions indicated that sexual orientation-specific aging concerns were associated with higher depression and anxiety at low and moderate, but not high, levels of general aging concerns. Conclusions: A range of factors contribute to mental health among SM older adults and there are complex relationships between general and sexual orientation-specific factors.

College students' knowledge and management of food allergies.

OBJECTIVE: This study explored predictors of food allergy management in college students, including participants' reported allergy severity, history of allergic reactions, and allergy knowledge. Further, we compared allergy knowledge in participants with food allergy to a matched sample of college students without food allergy. Method: Participants were recruited from a larger nationwide study of knowledge and attitudes toward food allergy in college students, with purposeful oversampling of students with food allergies. Participants completed measures assessing their food allergy(ies), symptoms, history of reactions, and current allergy management behaviors. Participants with food allergies and control participants without food allergies completed a measure of food allergy knowledge. Results: Hierarchical regression revealed that food allergy knowledge accounted for an additional 20% of variance in students' allergy management behaviors, above and beyond severity and allergic reactions, R2=.39, F(3,48)=10.09, p<.001. There was not a statistically significant difference in food allergy knowledge between participants with food allergy and matched controls, t(49)=-1.85, p=.07, 95% CI=-1.42 to 0.06. Conclusions: This study suggests allergy knowledge is an important factor in food allergy management. Knowledge significantly predicted food allergy management behaviors above and beyond food allergy severity and recent food allergy reactions. College students with food allergies did not demonstrate greater knowledge than controls, suggesting a need for psychoeducational intervention to target college students' allergy knowledge as they transition to independent allergy management.

A Preliminary Survey Examining Predictors of Burnout in Pain Medicine Physicians in the United States.

BACKGROUND: Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job, defined by 3 dimensions: exhaustion, depersonalization, and reduced personal accomplishment. While there is a growing body of research on burnout in physicians, there is a dearth of literature on burnout in pain medicine physicians. OBJECTIVE: This study aimed to determine the incidence of burnout amongst pain medicine physicians and whether there are sociodemographic or psychological demand characteristics of the job setting that predict burnout in pain medicine physicians. STUDY DESIGN AND SETTING: Cross-section survey of pain medicine physicians across the United States. METHODS: Pain medicine physicians were asked questions on sociodemographics and professional characteristics and measures of decisional authority, psychological job demands, job insecurity, perceived coworker support, and job dissatisfaction. RESULTS: Two hundred seven pain medicine physicians' responses were analyzed, 60.4% reported high emotional exhaustion, 35.7% reported high depersonalization, and 19.3% reported low personal accomplishment. Greater psychological job demands and greater job dissatisfaction predicted greater emotional exhaustion. Younger age and greater job dissatisfaction predicted higher depersonalization. Lastly, lower coworker support and greater job dissatisfaction predicted lower personal accomplishment. There were no statistical violations of assumptions or collinearity. LIMITATIONS: Low response rate and potential for response bias limit generalizability of the study. CONCLUSION(S): Pain medicine physicians in the United States reported high levels of emotional exhaustion, often considered the most taxing aspect of burnout. Job dissatisfaction appeared to be the leading agent in the development of all 3 components of burnout in pain medicine physicians in the United States.