Moderate-to-Severe Tobacco Use Disorder and Discrimination Among U.S. Sexual Minority Older Adults.

OBJECTIVES: The dearth of research on age-related differences in risk factors for tobacco use disorder (TUD) among sexual minorities, particularly among older adults, can obscure the differential needs of sexual minority age groups for tobacco prevention and cessation. We examined the association of cumulative ethnic/racial discrimination and sexual orientation discrimination with moderate-to-severe TUD among U.S. sexual minority adults aged 50 years and older. METHOD: We analyzed cross-sectional data from the National Epidemiologic Survey of Alcohol and Related Conditions-III (n = 36,309 U.S. adults). Our sample consisted of 1,258 adults (lesbian/gay-, bisexual-, and heterosexual-identified adults with same-sex attraction/behavior) aged ≥50 years. Multivariable logistic regression analyses estimated the association of cumulative lifetime ethnic/racial discrimination and sexual orientation discrimination with past-year moderate-to-severe TUD and tested whether the association differed for adults aged 50-64 years versus those aged ≥65 years. RESULTS: An estimated 8.1% of the sample met criteria for moderate-to-severe TUD. Lifetime ethnic/racial discrimination and sexual orientation discrimination was not significantly associated with moderate-to-severe TUD for adults aged ≥50 years. However, a significant 2-way interaction was found between discrimination and age. In age-stratified analyses, greater discrimination was significantly associated with greater risk for moderate-to-severe TUD for adults aged ≥65 years, but not adults aged 50-64 years. DISCUSSION: Greater cumulative discrimination based on ethnicity/race and sexual orientation was associated with increased risk for moderate-to-severe TUD among sexual minority adults aged ≥65 years. Our findings underscore the importance of age considerations in understanding the role of discrimination in the assessment and treatment of TUD.

Alcohol, Tobacco, and Comorbid Psychiatric Disorders and Associations With Sexual Identity and Stress-Related Correlates.

OBJECTIVE: The authors examined psychiatric comorbidities associated with alcohol use disorders and tobacco use disorders among heterosexual, bisexual, and gay and lesbian men and women in the United States and whether stress-related factors were predictive of comorbidities. METHODS: The authors used data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013, N=36,309) to examine the co-occurrence of past-year alcohol or tobacco use disorder with past-year anxiety disorders, mood disorders, and posttraumatic stress disorder by sexual identity (heterosexual, bisexual, gay or lesbian) and sex. The authors also examined the association of stress-related factors and social support with the presence of comorbidities. RESULTS: Comorbidities were more prevalent among women and sexual minorities, particularly bisexual women. More than half of bisexual (55%) and gay or lesbian (51%) individuals who met criteria for a past-year alcohol use disorder had a psychiatric comorbidity, while only one-third of heterosexual individuals who met criteria for a past-year alcohol use disorder did. Similar differences were found among those who met criteria for a past-year tobacco use disorder. Among sexual minorities, the frequency of sexual orientation discrimination (adjusted odds ratio range=1.08-1.10), number of stressful life events (adjusted odds ratio range=1.25-1.43), and number of adverse childhood experiences (adjusted odds ratio range=1.04-1.18) were significantly associated with greater odds of comorbidities. Greater social support was significantly inversely associated with tobacco use disorder comorbidities (adjusted odds ratio range=0.96-0.97). CONCLUSIONS: This research suggests that integrated substance use and mental health prevention and treatment programs are needed, particularly for individuals who identify as sexual minorities. The increased stressors experienced by sexual minority individuals may be important drivers of these high levels of comorbidities.

Concepções homofóbicas de estudantes do ensino médio / Conceptions homophobes des élèves du secondaire / Concepciones homofóbicas de los estudiantes de secundaria / Homophobic conceptions of high school students

Este trabalho apresenta os resultados de um estudo realizado com 2.159 alunos e alunas do ensino médio de três cidades do interior paulista. Os dados, obtidos pelo uso de uma escala Likert, foram analisados por uma técnica estatística multivariada. Análise fatorial foi realizada, e seis fatores (extraídos pelo método das componentes principais e o método de rotação oblíqua) favoreceram a interpretação das possíveis correlações entre as concepções homofóbicas apresentadas nos itens. O estudo mostrou que a tolerância moderada em relação à homossexualidade dos jovens da amostra é uma realidade que necessita de atenção das políticas públicas em educação, visando estratégias para a desconstrução de estereótipos de gênero e erradicação da homofobia, lesbofobia e transfobia entre adolescentes.

Cet article présente les résultats d'une étude menée avec 2,159 lycéens et lycéennes provenants de trois villes à la campagne de l'État de São Paulo, au Brésil. Les données obtenues par une échelle de Likert ont été analysées par une technique statistique multivariée. En ce qui concerne l'analyse factorielle, la méthode utilisée pour extraire les facteurs était le principal composant et la méthode de rotation oblique, dans lequel les six facteurs obtenus ont aidé à l'interprétation des corrélations possibles entre les points de vue présentés dans les articles homophobes. L'étude a révélé que la tolérance modérée pour les homosexuels, les lesbiennes et les personnes transgenres dans ce jeune échantillon est une réalité qui a besoin d'attention des politiques publiques en matière d'éducation ciblant les stratégies pour la déconstruction des stéréotypes de genre et l'éradication de l'homophobie, lesbophobie et la transphobie parmi les adolescents.

Este trabajo presenta los resultados de un estudio realizado con 2,159 estudiantes de secundaria de ambos los sexos a partir de tres ciudades en el interior del Estado de São Paulo, Brasil. Los datos obtenidos mediante la escala Likert fueron analizados por la técnica estadística multivariante. Sobre el análisis de los factores, el método utilizado para la extracción de los factores fue el componente principal y el método de rotación oblicua, en el que los seis factores obtenidos ayudan a la interpretación de las posibles correlaciones entre las opiniones homofóbicas presentados en artículos. El estudio reveló que la tolerancia moderada para gays, lesbianas y transexuales en los jóvenes de la amuestra es una realidad que necesita la atención de las políticas públicas en materia de educación dirigidas a las estrategias para la deconstrucción de los estereotipos de género y la erradicación de la homofobia, lesbofobia y transfobia entre los adolescentes.

This paper presents the results of a study carried on with 2,159 male and female high school students from three cities in the countryside of São Paulo State, Brazil. The data obtained by a Likert scale were analyzed by a multivariate statistical technique. Regarding the factor analysis, the method used for extracting the factors was the major component and oblique rotation method, in which the six factors obtained aid to interpreting the possible correlations among the homophobic views presented in items. The study revealed that moderate tolerance for gay, lesbian and transgender people in this young sample is a reality that needs attention of public policies in education targeting strategies for the deconstruction of gender stereotypes and eradication of homophobia, lesbophobia and transphobia among adolescents.

Factors Associated With High-Risk Alcohol Consumption Among LGB Older Adults: The Roles of Gender, Social Support, Perceived Stress, Discrimination, and Stigma.

PURPOSE OF THE STUDY: Lesbian, gay, and bisexual (LGB) adults have elevated rates of high-risk alcohol consumption compared with heterosexual adults. Although drinking tends to decline with age in the general population, we know little about LGB older adults' drinking. Using 2014 data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS), we aimed to identify factors associated with high-risk drinking in LGB older adults. DESIGN AND METHODS: A U.S. sample of 2,351 LGB adults aged 50-98 years completed a survey about personal and social experiences, substance use, and health. Multinomial logistic regression was conducted to identify predictors of past-month high-risk alcohol consumption. RESULTS: Approximately one fifth (20.6%) of LGB older adults reported high-risk drinking, with nonsignificantly different rates between men (22.4%) and women (18.4%). For women, current smoking and greater social support were associated with greater likelihood of high-risk drinking; older age, higher income, recovery from addiction, and greater perceived stress were associated with lower likelihood. For men, higher income, current smoking, and greater day-to-day discrimination were associated with greater likelihood of high-risk drinking; transgender identity and recovery from addiction were associated with lower likelihood. IMPLICATIONS: Social contexts and perceived drinking norms may encourage higher levels of alcohol consumption in LGB older women, whereas men's drinking may be linked with discrimination-related stress. Prevention and intervention with this population should take into account gender differences and sexual minority-specific risk factors. With future waves of data, we will be able to examine LGB older adults' drinking trajectories over time.

Homonegative Attitudes and Risk Behaviors for HIV and Other Sexually Transmitted Infections Among Sexually Active Men in the United States.

OBJECTIVES: We examined associations between homonegative attitudes and HIV and other sexually transmitted infection (HIV/STI) risk behaviors among sexually active US men. METHODS: We used the 2006-2010 National Survey of Family Growth (n = 10 403) and multivariable logistic regression models to examine homonegative attitudes in relation to condom use, number of past-year sex partners, HIV/STI testing, and STI diagnoses. RESULTS: Among men who had sex with men, homonegative attitudes were associated with lower odds of condom use during anal sex with women (before the past year) and past-year STI testing. Among men who had sex with men and women, homonegative attitudes were associated with lower odds of condom use during vaginal sex and sex with men, having 4 or more partners, and HIV testing ever. Among men who had sex with women, homonegative attitudes were associated with lower odds of condom use during vaginal sex and sex with men (before the past year), HIV testing ever, and contracting herpes, human papillomavirus, or syphilis. CONCLUSIONS: Homonegative attitudes may promote HIV/STI acquisition and transmission among sexually active men of all sexual orientations. Interventions should address homonegative attitudes in the United States.

Características sociodemográficas, bienestar subjetivo y homofobia en una muestra de hombres gay en tres ciudades chilenas / Socio-demographic characteristics, subjective well-being, and homophobia experienced by a sample of gay men from three cities in Chile / Características sociodemográficas, bem-estar subjetivo e homofobia em uma amostra de homens gays em três cidades chilenas

Este artículo describe y caracteriza sociodemográficamente a una muestra de hombres gay en tres ciudades de Chile. Además, describe sus niveles de homofobia y bienestar subjetivo. Mediante un muestreo en cadena tipo bola de nieve se encuestó a 325 hombres que se autodefinieron como gay. Entre los principales hallazgos se encontró altos niveles de discriminación y victimización percibida. Además en comparación con estudios similares efectuados en el país, los encuestados presentan niveles mayores de bienestar social. La edad de los encuestados aporta diferencias para los niveles de bienestar social y no para las otras medidas. También, las personas con estudios superiores reportan mayores niveles de victimización y un mayor impacto vital de las situaciones de discriminación. Asimismo, si bien las personas que residen en Santiago reportan un mayor impacto relativo de los hechos de agresión, presentan mejores niveles de bienestar social y felicidad en comparación a las personas que viven en otras regiones.

This article describes the socio-demographic characteristics of a sample of gay men in three cities in Chile, as well as experience with homophobia and subjective well-being. Snowball sampling was used to interview 325 gay men. The main findings included high levels of perceived discrimination and victimization, but interviewees reported higher levels of social well-being compared to studies elsewhere in the country. Age was related to differences in levels of social well-being, but not other variables. Individuals with university education reported higher levels of victimization and greater impact of discrimination on their lives. Gay men in Santiago reported a higher relative impact from incidents of aggression, but better levels of social well-being and happiness compared to those in other regions of Chile.

Este artigo descreve e caracteriza sociodemograficamente uma amostra de homens gay em três cidades do Chile, abordando também seus níveis de homofobia e bem-estar subjetivo. Por meio de uma amostra em série do tipo bola de neve foram entrevistados 325 homens autoidentificados como gay. Entre os principais achados evidenciaram-se altos níveis de discriminação e vitimização percebida, em comparação com estudos similares realizados no país. Os entrevistados apresentaram níveis maiores de bem-estar social. A idade dos entrevistados aporta diferenças para os níveis de bem-estar social e não para as outras medidas. As pessoas com estudos superiores reportam também maiores níveis de vitimização e um maior impacto vital das situações de discriminação. Adicionalmente, embora as pessoas que residem em Santiago reportem um maior impacto de agressões, eles apresentam melhores níveis de bem-estar social e felicidade em comparação com pessoas que moram em outras regiões.

Female-to-male transmasculine adult health: a mixed-methods community-based needs assessment.

BACKGROUND: There is a dearth of health research about transgender people. OBJECTIVES: This mixed-methods study sought to formatively investigate the health and perceived health needs of female-to-male transmasculine adults. DESIGN: A cross-sectional quantitative needs assessment (n = 73) and qualitative open-ended input (n = 19) were conducted in June 2011. A latent class analysis modeled six binary health indicators (depression, alcohol use, current smoking, asthma, physical inactivity, overweight status) to identify clusters of presenting health issues. RESULTS: Four clusters of health indicators emerged: (a) depression; (b) syndemic (all indicators); (c) alcohol use, overweight status; and (d) smoking, physical inactivity, overweight status. Transphobic discrimination in health care and avoiding care were each associated with membership in the syndemic class. Qualitative themes included personal health care needs, community needs, and resilience and protective factors. CONCLUSIONS: Findings fill an important gap about the health of transmasculine communities, including the need for public health efforts that holistically address concomitant health concerns.

Estudo descritivo da homofobia e vulnerabilidade ao HIV/Aids das travestis da Região Metropolitana do Recife, Brasil / Descriptive study of homophobia and vulnerability to HIV/Aids of the transvestites in the Metropolitan Region of Recife, Brazil

O estudo buscou conhecer as vulnerabilidades ao HIV/Aids das travestis da Região Metropolitana do Recife. Optou-se por utilizar o método amostral conduzido pelo entrevistado, conhecido por Respondent Driven Sampling (RDS). Entre as 110 travestis foram encontrados altos índices de homofobia em locais como: serviços de segurança, locais de trabalho, ambiente familiar e religioso, vizinhança, escola, comércio, locais de lazer e nos serviços de saúde. Entre as situações de violência sofridas destacam-se a agressão verbal (81,8%) e física (68,2%). O teste de HIV realizado alguma vez na vida foi observado em 84,4%. Encontrou-se um alto nível de conhecimento sobre as formas de prevenção e transmissão da infecção pelo HIV. A maioria iniciou a vida sexual antes dos 15 anos e sem o uso do preservativo. No contexto da epidemia do HIV/Aids observa-se que as estratégias de promoção da saúde só poderão ser eficazes se forem considerados fatores que ampliam a compreensão da vulnerabilidade ao HIV/Aids, como a homofobia.

This study sought to ascertain the vulnerabilities to HIV/Aids of transvestites of the Metropolitan Region of Recife. The Respondent-Driven Sampling (RDS) method was selected for data collection. Among the 110 transvestites, high indices of homophobia were found in locations such as: security services, work facilities, family and religious environments, neighborhood, school, stores, leisure spaces, and healthcare services. Among the situations of violence experienced, the predominant cases involved verbal aggression (81.8%) and physical aggression (68.2%). The HIV test carried out at some stage in their lives was reported by 84.4% of the subjects. A high level of knowledge of the forms of HIV prevention and transmission was detected. The majority of the transvestites began their sexual activity before 15 years of age without condom use. It was seen that in the context of the HIV/Aids epidemic, the strategies for health promotion can only be effective if factors for enhancing the understanding of the vulnerability to HIV/Aids, such as homophobia, are considered.