Oppression-Based Stress and Alcohol Inequities Among Sexual and Gender Minority People: An Intersectional Multilevel Framework.

PURPOSE: Sexual and gender minority (SGM) people are at heightened risk for alcohol use, hazardous drinking, and alcohol use disorder compared to heterosexual and cisgender individuals. This paper: (a) presents an oppression framework that integrates intersectionality, stress, stigma, and addiction-based theories to examine the complex and nuanced ways oppression-based stress (e.g., minority stress) leads to sexual orientation and gender identity inequities in alcohol use; (b) conducts a narrative review that summarizes recent and novel advancements in the literature on the impact of oppression-based stressors on alcohol use outcomes across structural, interpersonal, and intrapersonal domains among SGM people; and (c) provides future research and intervention directions for the alcohol field. SEARCH METHODS: A select review of the literature was conducted on July 10, 2023, using multiple electronic databases (i.e., PsycInfo, PubMed, Web of Science) and focusing on studies that had examined the associations between oppression-based stressors and alcohol use outcomes across structural, interpersonal, and intrapersonal levels. Search terms focused on alcohol consumption; SGM people, particularly SGM people of color; and oppression-based stress. Cross-sectional studies that focused on heterosexism-based and anti-bisexual oppression-based stressors at the interpersonal or intrapersonal levels and alcohol use outcomes were excluded as they have been included in prior reviews of the literature. SEARCH RESULTS: The initial and combined search across the databases resulted in 3,205 articles. Of those, the narrative review included 50 peer-reviewed articles that focused on the following four areas of the literature on the associations between oppression-based stressors and alcohol use outcomes: (1) experimental, longitudinal, and experience sampling studies of heterosexism- and anti-bisexual oppression-based stressors (22 articles); (2) any studies of cissexism-based stressors (12 articles); (3) any studies of intersectional oppression among SGM people of color (seven articles, one article overlapped with the first category and another overlapped with the fourth category); and (4) any studies of structural oppression (11 articles). DISCUSSION AND CONCLUSIONS: Results of this narrative review indicate that mounting evidence implicates oppression-based stress in inequities in alcohol use, hazardous drinking, and alcohol use disorder in SGM populations. This reflects SGM people's embodiment of oppression and injustice at the structural, interpersonal, and intrapersonal levels. Given some inconsistent and mixed patterns of findings, future research needs greater specificity in drinking inclusion criteria, robust and well-validated measures, more attention to culturally and developmentally relevant moderating and mediating mechanisms across the lifespan, application of sophisticated methodologies, and integration of intersectional and addiction frameworks.

Momentary Minority Stress, Nicotine Use, and Craving: Moderation by Nicotine-Use Motives Among Sexual Minority Youth.

OBJECTIVE: This pre-registered analysis aimed to examine the moderating role of nicotine-use motives on the association between minority stress and nicotine use and craving among sexual minority youth. METHOD: Data stem from a 30-day ecological momentary assessment study conducted among 83 sexual minority youth ages 15-19 years old (M age = 17.96, SD = 1.10; 56.63% cisgender women; 73.5% non-Hispanic White). Participants were instructed to complete at least four assessments per day on wireless devices. Two types of multilevel models were estimated: models predicting day-level nicotine use and models predicting momentary nicotine use craving. RESULTS: Experiencing minority stressors was not associated with day-level nicotine use, but it was associated with greater momentary nicotine craving. Nicotine use-motives did not moderate the association between minority stress and nicotine use. In contrast, stress-reduction motives, assessed as a person-level trait, moderated the association between minority stress and nicotine craving, such that nicotine craving after experiencing a minority stressor was consistently higher relative to when minority stress had not been reported. Sensitivity analyses that examined associations between minority stress and nicotine use on a given day, regardless of temporal order, showed that minority stress was associated with higher odds of nicotine use on that day. CONCLUSIONS: Experiencing minority stressors did not predict day-level nicotine use but does contribute to greater momentary nicotine craving, informing minority stress theory. Consistency of the minority stress and nicotine craving relation, largely regardless of trait-level motives, highlights the potential context dependence of nicotine craving among sexual minority youth.Preregistration: This study was preregistered at osf.io/w5sz9.

Vicarious heterosexism-based stress induces alcohol, nicotine, and cannabis craving and negative affect among sexual minority young adults: An experimental study.

Purpose: Sexual minority young adults are at increased risk for hazardous drinking and alcohol use disorder compared to heterosexual adults. Heterosexism-based stressors contribute and often explain inequities in alcohol outcomes. However, the extant research primarily relies on correlational designs, and often neglects the importance of alcohol craving, despite its foundational role in addiction. Leveraging a novel experimental mood induction paradigm, this study examined the effects of exposure to vicarious heterosexism-based stress on alcohol craving and negative affect among sexual minority young adults who drink heavily. We also examined its effects on cannabis and nicotine craving among participants who used cannabis and nicotine, respectively. Lastly, we examined moderating factors that could influence the impact of exposure to heterosexism-based stress on alcohol craving. Methods: Participants were 101 heavy drinking sexual minority young adults, ages 20-35 (M = 26.46 years old; SD = 3.49), recruited from the community (51.5% female sex assigned at birth; 76.3% cisgender; 51.5% plurisexual; and 42.6% racial and ethnic minorities). They completed three mood induction trials counterbalanced over three visits on different days: heterosexism stress, general stress, and neutral. Structured interviews assessed criteria for DSM-5 alcohol use disorder (AUD) and substance use, and self-report measures assessed lifetime traumatic stressors. Results: Most participants met criteria for past-year AUD (74.7%). Exposure to heterosexism stress produced more negative affect and substance craving than the neutral mood induction, even while controlling for demographic variables and lifetime exposure to traumatic and heterosexism stressors. Exposure to heterosexism-based stress had large effects on alcohol craving among participants who had greater drinking to cope motives and heterosexism-specific rejection sensitivity, whereas the effects were small for those who had lower drinking to cope motives and heterosexism-specific rejection sensitivity. Demographic, lifetime stress, prior alcohol use, and AUD symptom severity variables were not significant moderators. Greater substance craving induced by heterosexism-based stress in the laboratory was associated with greater recent and current substance use. Conclusions: This study findings show that vicarious exposure to heterosexism elicits negative mood and alcohol, cannabis, and nicotine craving among sexual minority young adults who engaged in heavy drinking. The effects for alcohol craving were largest among those who endorse high levels of drinking to cope motives and heterosexism-based rejection sensitivity. These findings have implications for oppression-based stress and motivational models of addiction.

Binge Drinking Disparities by Grade, Race and Ethnicity, Sexual Orientation, and Gender Identity.

BACKGROUND AND OBJECTIVES: Binge drinking disparities between sexual and gender minority (SGM) students and their heterosexual, cisgender peers are well-established. Data limitations have precluded understandings of whether the onset and progression of these disparities differ by grade. Additionally, little is known about whether and how SGM-related binge drinking varies across groups of students coincidingly defined by sexual orientation or gender identity (SOGI), race, and ethnicity. In the current study, we used a large, statewide sample of secondary school students in California to describe the prevalence of binge drinking among subgroups of adolescents at the intersections of grade, race and ethnicity, and SOGI. METHODS: Data were from the 2017-2019 cycle of the California Healthy Kids Survey, one of the largest statewide cross-sectional surveys of secondary school students in the United States (n = 925 744). We described the grade-specific prevalence rates of past 30-day binge drinking by (1) grade level, (2) race and ethnicity, and (3) SOGI. Predicted probabilities estimated adjusted percentages of students' binge drinking by subgroups. RESULTS: SGM-related binge drinking differences were present early in secondary school. Several subgroups of SGM adolescents with minoritized racial and ethnic identities reported higher binge drinking rates relative to their same-grade, white, non-SGM peers. CONCLUSIONS: Prevention and intervention programs must consider developmentally- and culturally-informed strategies to most effectively promote health among minoritized students.

Intersectional Oppression-Based Stress, Drinking to Cope Motives, and Alcohol Use and Hazardous Drinking Among Sexual and Gender Minority Adolescents Who Are Black, Indigenous, and People of Color.

Purpose: This study examined the associations between intersectional oppression-based stress and recent alcohol use and hazardous drinking among sexual and gender minority (SGM; e.g., queer or transgender) adolescents who were Black, Indigenous, and People of Color (BIPOC), also known as queer and transgender BIPOC (QTBIPOC) adolescents, and the mediating role of coping motives (i.e., drinking to cope) on these associations. Methods: Data were from a subsample of QTBIPOC adolescents who used alcohol in the past year (n = 1365) from a national U.S. sample of SGM adolescents aged 13-18 years. Results: Intersectional oppression-based stressors were associated with greater odds of recent alcohol use and hazardous drinking, as well as greater coping motives. Coping motives mediated the associations between intersectional-based stressors and both recent alcohol use and hazardous drinking among the aggregate sample of QTBIPOC adolescents, as well as among some subgroups of BIPOC adolescents. Conclusions: The results of this study highlight that intersectional oppression-based stressors are prevalent among QTBIPOC adolescents and serve as a risk factor for alcohol use and hazardous drinking. Multilevel interventions are needed to target and dismantle intersectional oppressions to address alcohol inequities impacting QTBIPOC adolescents. Drinking to cope motives mediated the associations between intersectional oppression-based stress and drinking outcomes, underscoring another important mechanism to target within a context of oppression in drinking interventions.

Associations among intimate partner violence, suicidal ideation, suicide behaviors, non-suicidal self-injury, and psychological well-being in Black American emerging adults.

BACKGROUND: Suicidal ideation and behavior and non-suicidal self-injury (NSSI) among Black emerging adults is a major public health concern. Intimate partner violence (IPV) is a significant risk factor for suicidal ideation and behavior and NSSI, but there is little work examining the buffering effect of psychological well-being (PWB). The purpose of this study was to examine the associations between IPV, suicide ideation and behavior, and NSSI, and the moderating role of PWB on these associations. METHOD: Secondary data analyses were conducted using a subsample of Black American emerging adults (N = 4694) from the National College Health Assessment. RESULTS: IPV was associated with greater odds of suicide ideation, past-year suicide attempt, and NSSI. PWB was associated with lower odds of suicide ideation, past-year suicide attempt, and NSSI. PWB did not moderate the relationships between IPV and the outcomes. CONCLUSIONS: IPV was a risk factor for suicidal ideation, suicide attempt, and NSSI among Black American emerging adults. PWB was associated with lower suicidal ideation and behavior and NSSI engagement, suggesting it can be a protective factor. Bolstering PWB in Black communities may be beneficial in intervention and prevention efforts.

Experiences of stress and social safety among sexual and gender minority youth by disability status.

BACKGROUND: Though separate bodies of research have shown sexual and gender minority (SGM) youth, and youth with disabilities, separately, face distinct social and health disparities, little is known about youth who both identify as SGM and have disabilities. OBJECTIVE: The current study examined differences in wellbeing among SGM youth by disability category (i.e., physical, developmental, psychiatric) across victimization, bullying, dating violence, school safety, and experienced stress. METHODS: Using self-reported data from 9418 SGM youth aged 13-17 in the United States, multivariate linear regressions were conducted to examine how stress and social safety experiences varied across disability status. RESULTS: Compared to SGM youth without a disability, SGM youth across all disability categories (physical, developmental, psychiatric) had greater odds of LGBT- and disability-based victimization, greater average stress, as well as lower levels of school safety. SGM youth with any disability, physical disability, or psychiatric disability also had greater odds of dating violence compared to SGM youth without a disability. CONCLUSION: SGM youth with disabilities may be in particular need of targeted programs that address both disability and sexual/gender identities, and may benefit from increased supports across developmental contexts (e.g., against bullying in school). Stakeholders should consider how such support can be improved, tailored, and implemented, for SGM youth and the diversity of disabilities they have.

Daily associations between resilience factors, substance use, and affect among sexual minority youth.

OBJECTIVE: Past research has highlighted that sexual minority youth (SMY) are at particular risk for heightened substance use compared to their heterosexual peers; however, few studies have investigated the associations between resilience factors and substance use among SMY. In the present preregistered study, we examined the associations among three different forms of resilience factors (i.e., general social support, lesbian, gay, bisexual, transgender, and queer (LGBTQ)-identity affirmation, LGBTQ community involvement) and alcohol, nicotine, and cannabis use, as well as on positive and negative affect. METHOD: SMY (n = 82, ages 15-19, 56.1% cisgender women, 84.4% White) completed a baseline assessment then a 30-day ecological momentary assessment study. Multilevel regression models evaluated within-day and between-person associations between resilience factors and odds of substance use (alcohol, nicotine, cannabis), substance use quantity on use days (alcohol, cannabis), positive affect, and negative affect. RESULTS: On the day level, general social support was associated with greater positive affect, lesser negative affect, and greater drinks on drinking days. LGBTQ-identity affirmation was associated with greater positive affect, lesser negative affect, and greater odds of nicotine use. LGBTQ community involvement was associated with greater positive affect. CONCLUSIONS: These results highlight the nuanced ways that resilience may engender more positive affect and reduce negative affect while simultaneously promoting substance use. Future research disentangling the mechanisms connecting resilience and substance use among SMY is necessary. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

An experimental laboratory-based minority stress paradigm for alcohol research among sexual minority women: A pilot study.

BACKGROUND: Sexual minority women (SMW) use alcohol at higher rates and experience greater alcohol-related harms than their heterosexual counterparts. Evidence from observational studies suggests that minority stress (i.e., stress experienced due to marginalization in society) is an important risk factor among SMW, yet there is a lack of experimental evidence to establish a direct causal role of minority stress on alcohol use in this population. We adapted the preexisting personalized guided stress induction paradigm to conduct a pilot study of how minority stress is related to stress response (assessed via subjective measures and salivary cortisol) and mechanisms of alcohol use (craving, demand, and risky decision making) in SMW. METHODS: Using a within-subjects design (N = 8) cisgender SMW who endorsed high-risk drinking (≥1 heavy drinking episode in the past 30 days) completed three study visits: a script development session and two in-person imagery induction appointments (minority stress and neutral). Analyses examined feasibility and acceptability, stress response, and mechanisms of alcohol use. RESULTS: The paradigm significantly increased subjective stress response (g = 1.32). Data supported the feasibility, acceptability, and appropriateness of the paradigm for use with SMW. While the paradigm did not significantly change scores on minority stress and alcohol outcomes measures, effect sizes for craving and minority stress outcomes were in the small-to-medium range (gs = 0.24-0.54). CONCLUSIONS: The adapted minority stress paradigm appears to be feasible and appropriate for use with SMW to induce stress in laboratory settings. Future research can use this paradigm to understand the causal effects of minority stress on alcohol use and related outcomes.

Associations Among Enacted Stigma, Perceived Chances for Success, Life Satisfaction, and Substance Use Among Sexual Minority and Heterosexual Youth.

Background: Sexual minority youth report high rates of substance use compared to heterosexual youth. Stigma can diminish perceptions of future success and life satisfaction and contribute to elevated substance use. This study examined whether experiences of enacted stigma (i.e., discrimination) and substance use among sexual minority and heterosexual youth were indirectly associated through perceived chances for success and life satisfaction. Method: In a sample of 487 adolescents who indicated their sexual identity (58% female, M age = 16.0, 20% sexual minority), we assessed substance use status and factors that might explain sexual minority disparities in substance use. Using structural equation modeling, we examined indirect associations between sexual minority status and substance use status through these factors. Results: Compared to heterosexual youth, sexual minority youth reported greater stigma, which was associated with both lower perceived chances for success and life satisfaction, which were in turn associated with greater likelihood of substance use. Conclusions: Findings highlight the importance of attending to stigma, perceived chances for success, and general life satisfaction to understand and intervene to prevent substance use among sexual minority youth.

A daily diary study of minority stressors, suicidal ideation, nonsuicidal self-injury ideation, and affective mechanisms among sexual and gender minority youth.

Sexual and gender minority youth (SGMY) are at greater risk than their heterosexual and cisgender counterparts for suicidal thoughts and behaviors (STB) and nonsuicidal self-injury (NSSI). Unique stressors (i.e., minority stressors) specific to SGMY's stigmatized identities such as discrimination or concealment of one's identity are posited to explain these disparities. However, there is limited research examining the associations among minority stressors, affective mediating processes, and STB and NSSI in SGMY's daily lives. We conducted a 28-day daily diary study to test the mediating effects of daily negative and positive affect and emotion dysregulation between minority stressors and STB and NSSI among SGMY who were recruited from clinical and community settings. Participants were 92 SGMY, aged 12-19 years old (M = 16.45; SD = 1.81; 64% cisgender; 69% White). Results indicated that on days SGMY experienced external and internalized minority stressors, they reported greater intensity of suicidal and nonsuicidal self-injurious ideation and affective distress (i.e., greater negative affect, lower positive affect, and more emotion dysregulation). Greater affective reactivity processes were associated with greater suicidal and nonsuicidal self-injurious ideation intensity on the same day. Most of the within-person associations between external and internalized minority stressors and ideation intensity were mediated by heightened negative affect and emotion dysregulation but not lower positive affect. Our results provide the first evidence of these associations among SGMY, advance the minority stress model, and have implications for clinical interventions as we identified modifiable affective mechanisms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Heterosexist Bullying Victimization and Perpetration and Substance Use Among Heterosexual Adolescents.

BACKGROUND: Although heterosexist bullying mainly affects sexual minority adolescents, heterosexual adolescents may also be targets. Research is needed to understand the impact of heterosexist bullying victimization on heterosexual adolescents' behavioral health. Moreover, there is a dearth of research examining the negative consequences of perpetrating heterosexist bullying among heterosexual adolescents. The purpose of this study was to examine the associations between heterosexist bullying victimization and perpetration and substance use in a racially diverse sample of heterosexual adolescents. METHODS: A probability sample of middle and high school heterosexual students (N = 2,337; aged 11-19; 52.7% female; 35.9% Black or African American and 31.9% White) using random cluster methods was obtained from a southeastern US school district. Multiple logistic regression models were used to test the relationships between experiencing and perpetrating heterosexist bullying and substance use while accounting for sociodemographics. RESULTS: Of the participants, 7.1% reported heterosexist bullying victimization and 7.8% reported perpetration of heterosexist bullying. Of those engaging in heterosexist bullying, 29.5% also experienced it as a victim. Perpetrating heterosexist bullying was associated with greater odds of recent and lifetime alcohol, cigarette, e-cigarette, cannabis, and prescription drug use. Heterosexist bullying victimization was only associated with recent and lifetime cigarette use and lifetime e-cigarette use. CONCLUSIONS: The results demonstrate the negative correlates of heterosexist bullying victimization and perpetration on heterosexual adolescents' substance use. The findings underscore the need to address sexual stigma, such as heterosexist bullying, among not only adolescents experiencing it but also its perpetrators to help reduce substance use among all adolescents.

Mental and Physical Health Disparities Among Sexual and Gender Minority Adolescents Based on Disability Status.

Purpose: Sexual and gender minority (SGM) youth and youth with disabilities both experience health disparities. Little data exist on whether SGM youth with disabilities have worse health outcomes compared with SGM youth without disabilities. This study aimed to examine differences in health behaviors and outcomes among a sample of SGM youth by different types of disabilities. Methods: Secondary analyses were conducted with a subset (N = 9418) of the LGBTQ National Teen Survey, a comprehensive survey of risk and protective factors and health outcomes of SGM youth across the United States collected in 2017. Multiple types of disabilities (physical, cognitive, or psychiatric) and mental, behavioral, and physical health outcomes were self-reported. Results: Of the sample, 18.3% reported a disability. Significant findings included higher odds of exercise avoidance, greater depressive symptoms and sleep concerns, and lower self-esteem and overall health ratings among SGM youth who reported any form of disability compared with SGM youth who reported no disability. Youth with cognitive disabilities had lower odds of alcohol use than youth with no disability. Youth with psychiatric disabilities had higher odds of cannabis and cigarette use, and lower physical activity than youth with no disability. Youth with either psychiatric or physical disabilities reported higher body mass index than youth with no disability. Conclusion: SGM youth with disabilities experience greater health disparities than SGM youth with no reported disabilities. Results provide groundwork evidence about the impact of disability status on SGM adolescents. Disability-inclusive or -specific frameworks are needed for future interventions and studies of SGM youth.

Age Differences in the Associations Between Outness and Suicidality Among LGBTQ+ Youth.

OBJECTIVE: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth are at increased risk for suicidality compared to their heterosexual and cisgender peers, and outness (the extent to which an individual is open about their LGBTQ+ identity to others) is an important correlate of suicidality. However, previous research has led to mixed findings regarding whether outness functions as a risk or protective factor for suicidality, and the available evidence suggests that age may play an important role. As such, the goal of the current study was to examine whether the associations between outness and suicidality differed between LGBTQ+ adolescents (ages 12-17) and emerging adults (ages 18-24). METHOD: The analytic sample included 475 LGBTQ+ youth who completed an online survey after contacting a national, LGBTQ+ crisis service provider. RESULTS: Results indicated that age significantly moderated the association between outness and suicidal ideation, such that greater outness was significantly associated with greater suicidal ideation for adolescents, but not for emerging adults. In contrast, age did not significantly moderate the associations between outness and likelihood of a past suicide attempt or perceived likelihood of a future suicide attempt. However, the main effect of outness was significant in both models, such that greater outness was significantly associated with a greater likelihood of a past suicide attempt and a greater perceived likelihood of a future suicide attempt. CONCLUSIONS: These findings suggest that the associations between outness and suicidality among LGBTQ+ youth may depend on age as well as the dimension of suicidality (ideation versus attempt). HighlightsBeing more open about one's LGBTQ+ identity may confer risk for suicidality.The influence of outness on suicidal ideation may be strongest during adolescence.There is a need for LGBTQ+ affirming policies and laws to reduce suicidality.

In the Presence of Parents: Parental Heterosexism and Momentary Negative Affect and Substance Craving Among Sexual Minority Youth.

PURPOSE: We examined the influence of parental heterosexism on in vivo negative affect and substance craving among sexual minority youth (SMY) who use nicotine and other substances, and if that relation was strengthened when in the presence of their parent(s). METHODS: SMY (n = 42, ages 15-19) completed baseline assessments, including experiences of parental heterosexism (PH), and a 30-day ecological momentary assessment. Ecological momentary assessment reports included affective states (i.e., anger, anxiety, depression), substance craving (i.e., nicotine, cannabis, alcohol), and other contextual factors (e.g., presence of parents). Multilevel logistic regression models evaluated the study hypotheses. RESULTS: PH was associated with greater odds of reporting in-the-moment anger, depression, cannabis craving, and alcohol craving. Parental presence was associated with lower odds of reporting anxiety or depression, and greater odds of reporting nicotine craving. There was a significant interaction when predicting the odds of reporting anxiety. For SMY low in PH, parental presence was related to lower odds of reporting anxiety. As PH increased, parental presence had diminishing associations with the odds of reporting anxiety. DISCUSSION: Parenting behaviors can serve as protective and risk factors for negative affect and substance craving among SMY. Improving family-based interventions for SMY may be integral for enhancing healthy development and reducing health disparities.

Intersectional Minority Stress and Alcohol, Tobacco, and Cannabis Use Among Sexual and Gender Minority Adolescents of Color: Moderating Role of Family Support.

Purpose: We examined the associations between intersectional minority stress and substance use among sexual and gender minority (SGM) adolescents of color and the moderating role of family support on these associations. Methods: Data were from a national U.S. sample of SGM adolescents of color (N = 3423). Intersectional minority stress was assessed with the LGBT People of Color Microaggressions Scale. Results: Intersectional minority stress was associated with greater odds of recent and heavy alcohol and recent cannabis use, but not tobacco use. When examining specific domains of intersectional minority stress, racism from SGM communities was associated with greater odds of recent and heavy alcohol, and recent cannabis use, whereas heterosexism from same racial/ethnic communities was associated with greater odds of recent cigarette and cigar use. Family support was associated with lower substance use. Family support was not a significant moderator. Conclusions: Findings underscore the need to examine intersectional stressors that SGM adolescents of color experience and to bolster family supports to prevent substance use. Family support did not buffer the effects of intersectional minority stress on substance use outcomes, suggesting that other strategies, such as other forms of family support (e.g., identity-specific support) and community-level and structural changes that target reducing and dismantling oppression are needed to reduce the deleterious impact of intersectional minority stress.

Momentary Associations Among Minority Stress, Craving, Affect, and Nicotine Use Among Sexual Minority Youth.

OBJECTIVES: Sexual minority youth are more likely to use nicotine relative to heterosexual youth. The minority stress model posits these disparities are partly due to unique stress (i.e., minority stress) specific to their stigmatized identities. However, there is a dearth of research exploring the fine-grained dynamic interplay between minority stressors, mediating processes, and nicotine use in sexual minority youth's daily lives and natural environment. We leveraged ecological momentary assessment over a 30-day monitoring period to test the mediating effects of craving and negative and positive affect on the momentary associations between minority stressors and subsequent nicotine use among sexual minority youth who were active nicotine users and recruited from the community. METHODS: Participants were 85 nicotine users, ages 15-19 years old (M age = 17.96, SD = 1.10; 56.6% cisgender female; 56.6% bisexual; 73.5% non-Hispanic White) and half (51.8%) were daily nicotine users. RESULTS: Results indicated that exposure to a minority stressor was associated with momentary elevations in nicotine craving and negative affect and decreases in positive affect. Nicotine craving and positive affect were also associated with greater probability of subsequent nicotine use. The associations between minority stressors and subsequent nicotine use were mediated through craving and positive, but not negative affect. CONCLUSIONS: Our findings provide the first ecological momentary assessment evidence of these associations among sexual minority youth and help support and advance both addictions and sexual minority-specific models (e.g., minority stress) of nicotine use among youth.

The Association Between Daily Concealment and Affect Among Sexual and Gender Minority Adolescents: The Moderating Role of Family and Peer Support.

PURPOSE: There is a lack of research on the association between identity concealment and mental health among sexual and gender minority (SGM) adolescents and how social support may attenuate this association. Furthermore, research typically neglects the day-to-day variability in concealment experiences of SGM adolescents. Therefore, we examined the association between daily sexual orientation and gender identity concealment and positive and negative affect and the moderating role of family and peer support on this association among SGM adolescents. METHODS: A 21-day daily diary study among 94 SGM adolescents (mean [M] age = 16.10, standard deviation [SD] = 1.50; 31.9% gender minority; 44.7% youth of color) was conducted. Multilevel regression analyses tested the association between daily concealment and positive and negative affect and a cross-level interaction was used to assess the moderating effects of social supports. RESULTS: Daily concealment was associated with higher negative but not with positive affect. Family support was associated with lower daily negative affect but not with positive affect. Peer support was not significantly associated with negative or positive affect. Moderation results indicated that the association between daily concealment and negative affect was significant for adolescents who reported low or average levels of family support but was no longer significant for adolescents who reported high levels of family support. DISCUSSION: Daily identity concealment was positively associated with negative affect and this association was attenuated by family support. Future research and interventions should target families to improve the lives of SGM adolescents and to help reduce and eliminate mental health disparities.

Subtle and Intersectional Minority Stress and Depressive Symptoms Among Sexual and Gender Minority Adolescents of Color: Mediating Role of Self-Esteem and Sense of Mastery.

Little research has examined subtle, intersectional, and everyday minority stress, such as microaggressions specific to being a queer person of color, and its associations with depressive symptoms among sexual and gender minority adolescents (SGMA) of color. Moreover, research is needed to identify mechanisms that might explain the associations between minority stress and depression. This study examined the associations between subtle and intersectional minority stress (i.e., SGMA of color-specific microaggressions) and depressive symptoms among SGMA of color and tested self-concept factors (i.e., self-esteem and sense of mastery) as mediators of these associations. A large national US sample of SGMA of color (N = 3398; 31.8% transgender; 55.7% plurisexual) ages 13 to 17 years (M = 15.56, SD = 1.27) were recruited online. Participants' race/ethnicity were Asian/Pacific Islander (12.2%), Black/African American (13.2%), Hispanic/Latina(o)/x (30%), Native American/Alaska Native (1.2%), Middle Eastern (1.9%), Biracial or Multiracial (40%), and other racial/ethnic minority groups (1.7%). Over and above the effects of racism and SGM-based victimization, subtle intersectional minority stressors were associated with greater depressive symptoms and lower self-esteem and sense of mastery. Mediation analyses indicated that subtle intersectional minority stressors had indirect effects on depressive symptoms through lower self-esteem and sense of mastery for the aggregate sample of SGMA of color and most racial/ethnic groups in the sample. The results demonstrate that subtle and intersectional minority stress is a unique and significant form of minority stress that is a risk factor for depressive symptoms for SGMA of color. Moreover, our findings underscore self-concept mechanisms as targets for prevention and intervention.

Social Support as a Mediator of Anti-Bisexual Prejudice and Posttraumatic Stress Disorder Symptoms.

Among sexual minorities, bisexual individuals experience higher rates of victimization and symptoms of PTSD than their lesbian and gay peers as well as heterosexual individuals. Despite these disparities, little work has examined factors contributing to PTSD symptoms among bisexual adults. The current study examined the associations between bisexual-specific minority stress and PTSD symptoms in a sample of adults with bisexual orientation and tested social support as a potential mediator of this association. Participants were 488 adults (378 cisgender women, 49 cisgender men, 61 transgender individuals), ages 18 to 66 years, with bisexual orientation based on identity and/or attraction to multiple genders. Greater anti-bisexual prejudice was associated with greater PTSD symptoms (ß = 0.16) and lower social support (ß = -.16), while accounting for sociodemographics and sexual identity-based victimization. Social support was associated with lower PTSD symptoms (ß = -.25), while accounting for sociodemographics, sexual identity-based victimization, and anti-bisexual prejudice. Mediation analyses indicated that anti-bisexual prejudice was indirectly associated with greater PTSD symptoms through lower social support. Addressing bisexual-specific minority stress and its role in diminishing social support for bisexual individuals represents a critical component of trauma-informed research and intervention development in the bisexual community.