Resilience Through Social Support: An Intersectional Analysis of Sexual Minority Women's Social Resources for Wellbeing.

Sexual minority women (SMW) are at higher risk for a range of health conditions (e.g. depression, anxiety, and alcohol use disorder) than heterosexual women. However, poor health outcomes do not occur for all SMW. Resilience provides a lens for understanding why some SMW maintain good mental and behavioral health despite the presence of multiple risk factors. Few studies have examined the resilience-promoting factor of social support in relation to depression, anxiety, and alcohol use disorder in SMW. There is a need for further research clarifying sources of social support (e.g. family, significant others, friends, LGBTQ+ community) associated with resilient outcomes for SMW. This study used data from a telephone-based survey of 520 SMW to examine the relationships between resilience and social support. We used multiple regression and tested for interactions with ethnoracial identity and sexual identity. Greater levels of overall social support were associated with greater resilience, as was social support from the LGBTQ+ community in particular. There were few differences in these relationships by ethnoracial identity, sexual identity, or their intersections. Interventions that increase social support across any of four support sources appear to have the potential to increase resilience and decrease mental and behavioral health risks for SMW.

Examining COVID-19 pandemic-related economic and household stress and its association with mental health, alcohol, and substance use in a national sample of Latinx sexual minority and heterosexual adults.

OBJECTIVE: Sexual minority adults of Latinx descent faced compounded intersectional stressors during the COVID-19 pandemic across socioeconomic and health domains. Latinx people have experienced some of the highest COVID-19 infection, hospitalization, and mortality rates in the United States in addition to significant economic challenges. Yet, current data have not observed the unique pandemic-related experiences of sexual minority Latinx (SML) adults. We examined sexual identity differences in economic and household stress, social support, mental health symptomatology (depression, anxiety), alcohol, and substance use among sexual minority and nonsexual minority Latinx adults in the United States. METHOD: Primary data were collected via the AmeriSpeak panel, a national probability sample of U.S.-based 2,286 Latinx adults [sexual minority = .34% (n = 465)]. Data were collected from November 2020 to January 2021, during the third wave of the COVID-19 pandemic. RESULTS: SML adults endorsed higher levels of economic and household stress, mental health symptomatology, and alcohol and substance use than nonsexual minority Latinx adults. Economic stress was associated with increased mental health symptomatology, alcohol, and substance use among SML adults. Social support moderated the association between economic stress and mental health symptomatology and substance use, but not alcohol use. CONCLUSION: Findings highlighted unique intersectional considerations among SML adults during the COVID-19 pandemic, including the importance of social support and the negative toll of economic stress on mental health and substance use. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

COVID-19 Concerns, Coping and Perceived Peer Norms: Correlates of Increased Alcohol and Marijuana Use Among Sexual Minority Women.

This study explored the impact of COVID-related concerns and other characteristics on alcohol and marijuana use among sexual minority women (SMW). Survey data from a racially/ethnically diverse sample of 338 SMW participants in the Chicago Health and Life Experiences of Women (CHLEW) study were used to examine correlates of three substance use outcomes: frequent intoxication (once a month or more), perceived increase in alcohol use, and perceived increase in marijuana use. Coping motives for alcohol use was positively associated with each of the substance use outcomes. Belief that peers (in terms of age, sexual identity, and gender) used alcohol often to cope was associated with higher odds of frequent intoxication. COVID-19 related financial concerns were positively associated with both frequent intoxication and increased marijuana use. Health and mental health concerns were associated with lower odds of frequent intoxication. Findings underscore the importance of enhancing coping skills, addressing perceived peer coping norms, and providing both economic and social support in intervention efforts.

Structural stigma and alcohol use among sexual and gender minority adults: A systematic review.

Background: Sexual and gender minority (SGM) people are more likely than their cisgender, heterosexual counterparts to report negative alcohol-related outcomes. Although the association between individual- and interpersonal-level minority stressors and negative alcohol-related outcomes among SGM people is well-established, structural-level minority stressors are understudied. This systematic review examined structural-level stigma and alcohol-related outcomes among SGM people to inform future research, interventions, and policy. Methods: We used five electronic databases to search for studies published between January 2010 and May 2022 that examined associations between structural stigma and alcohol use among SGM adults in the United States. Peer-reviewed, quantitative studies available in English were included. We conducted quality appraisal using the Joanna Briggs Institute checklist. Results: The final sample included 11 studies. Overall, there was moderate to strong support for a positive association between structural stigma and negative alcohol-related outcomes among SGM people, with differences by gender, sexual identity, race, and ethnicity. All studies used cross-sectional designs, and nearly half utilized non-probability samples. Transgender and nonbinary people, SGM people of color, and sexual identity subgroups beyond gay, lesbian, and heterosexual were underrepresented. Structural stigma was most commonly measured as a state-level index. Alcohol measures were heterogeneous. Multilevel stigma and resiliency factors were understudied. Conclusions: Addressing structural stigma is critical in reducing negative alcohol-related outcomes and inequities among SGM people. Research is needed that includes probability samples, longitudinal designs, and samples that reflect the diversity of SGM people. Future studies should examine the influence of multilevel stigma and resiliency factors on alcohol-related outcomes.

Examining perceived effects of same-sex marriage legalization among sexual minority women: Identifying demographic differences and factors related to alcohol use disorder, depression, and self-perceived health.

Background: Reductions in structural stigma, such as gaining access to legalized same-sex marriage, is associated with positive psychological and physical health outcomes among sexual minorities. However, these positive outcomes may be less robust among sexual minority women (SMW). Methods: This study examined how perceptions of the impact of legalized same-sex marriage among SMW may 1) differ by demographic characteristics and 2) predict alcohol use disorder, depression, and self-perceived health. A diverse sample of SMW (N=446) completed an online survey in 2020 assessing the perceived impact of legalized same-sex marriage across six social-ecological domains: 1) personal impact, 2) stigma-related concerns, 3) couple impact, 4) family support, 5) work/school impact, and 6) local social climate towards LGBTQ people. Results: Perceived impact across multiple domains differed by relationship status and sexual identity (e.g., lesbian compared to bisexual identity); only family support differed by race/ethnicity. Stigma-related concerns (e.g., experiencing or witnessing hostility or discrimination because of sexual identity, despite legalized same-sex marriage) were associated with greater odds of depression and lower odds of reporting excellent, very good, or good health. Odds of depression were lower among participants who reported higher personal impact, a greater number of family members supportive of same-sex marriage, and a more positive local social climate. Family support also predicted self-perceived health. However, participants who perceived increased support in work/school contexts after legalized same-sex marriage had higher odds of alcohol use disorder. Conclusions: Overall, findings underscore the importance of policy in improving health outcomes through reducing stigma-related concerns and improving social acceptance.

Corrigendum to 'Impact of the policy environment on substance use among sexual minority women'.

[This corrects the article PMC9262325.].

Examining the differential protective effects of women's spirituality and religiosity on alcohol and marijuana use by sexual identity.

The current study explored how religiosity and spirituality may differentially influence substance use by sexual identity based on a sample of adult sexual minority women (SMW; n = 437 lesbian; n = 323 bisexual) relative to a heterosexual comparison sample (n = 636). We examined three questions: (1) whether spirituality was differentially associated with alcohol and marijuana use by sexual identity; (2) whether religiosity was differentially associated with alcohol and marijuana use by sexual identity; (3) whether observed differences between spirituality or religiosity and substance use by sexual identity persisted after adjusting for religious environment. Measures included spirituality (importance of spirituality), religiosity (importance of religion, attending religious services), and past year substance use (alcohol use disorder [AUD], any marijuana use, and regular marijuana use). Higher levels of spirituality were associated with increased odds of AUD among both lesbian and bisexual respondents relative to heterosexuals. Higher levels of religiosity among lesbian participants were associated with increased odds of AUD relative to heterosexuals with higher levels of religiosity. Consistent with theories of minority stress, findings suggest that spirituality and religiosity are less protective for SMW than heterosexual women and, in some cases, may contribute to greater risk of substance use.

Impact of the policy environment on substance use among sexual minority women.

Background: Sexual minority women (SMW) are at greater risk for heavy episodic drinking, frequent marijuana use, and tobacco use than heterosexual women. Because past research has suggested the political and social environment may influence disparities in substance use by sexual orientation, this study examined associations of the U.S. state-level policy environment on substance use by SMW. Methods: A total of 732 SMW participants were recruited from two national online panels: a general population panel (n = 333) and a sexual minority-specific panel (n = 399). Past year substance use was defined by number of days of heavy episodic drinking (HED; 4+ drinks in a day), weekly tobacco use (once a week or more vs. less or none), and weekly marijuana use (once a week or more vs. less or none). Comprehensive state policy protection was defined by enactment of five policies protecting rights of sexual minorities. Regression models compared substance use outcomes for SMW living in states with comprehensive policy protections to SMW living in states with fewer or no protections. Models also assessed the impact of state policies related to alcohol (state monopoly on alcohol wholesale or retail sales), tobacco (state enactment of comprehensive smoke-free workplace laws) and marijuana (legalization of purchase, possession, or consumption of marijuana for recreational use). Results: Comprehensive policy protections were associated with fewer HED days. Recreational marijuana legalization was associated with higher odds of weekly use. Conclusions: Findings underscore the importance of policy protections for sexual minorities in reducing substance use, particularly HED, among SMW.

Comparing substance use outcomes by sexual identity among women: Differences using propensity score methods.

BACKGROUND: Differences in alcohol, tobacco, and other drug (ATOD) use by sexual identity vary across samples of women recruited using different sampling methods. We used propensity score (PS) weighting methods to address two methodological questions: (1) Do disparities between sexual minority women (SMW) and heterosexual women persist when differences in risk and protective factors are similarly distributed between groups, and (2) Does accounting for SMW-specific resiliency factors impact differences between non-probability samples of SMW? METHODS: Four samples included SMW from a longitudinal study with a nonprobability sample (n = 373), a national general population panel sample (n = 373), and a national LGBTQ-specific panel sample (n = 311), as well as a national probability sample of heterosexual women (n = 446). Between-groups analyses using double-robust PS weighted models estimated differences in ATOD use under hypothetical conditions in which samples have similar risk and protective factors. RESULTS: After PS weighting, imbalance in confounders between SMW and heterosexual samples was substantially reduced, but not eliminated. In double-robust PS weighted models, SMW samples consistently had significantly greater odds of drug use than heterosexuals, with odds from 8.8 to 5.6 times greater for frequent marijuana use and 4.8-3.2 greater for other drug use. Few differences between SMW samples in ATOD outcomes or other variables remained after PS weighting. CONCLUSION: Relative to heterosexual women, disparities in marijuana and other drug use among SMW are evident regardless of sampling strategy. The results provide some reassurance about the validity of large nonprobability samples, which remain an important recruitment strategy in research with SMW.

"Family before Anyone Else": A Qualitative Study on Family, Marginalization, and HIV among Hispanic or Latino/a/x Mexican Sexual Minority Males.

This study explored the influence family relationships have on HIV-related factors among Hispanic or Latino/a/x Mexican sexual minority cisgender males in San Antonio, TX, US. A total of 15 young adults (7 people living with HIV; PLWH) ages 21-30 completed a semi-structured interview. Data were transcribed verbatim and analyzed using thematic analysis. The following themes emerged: (1) family support; (2) mother-son relationships; (3) father-son relationships; (4) sibling support; (5) family marginalization of sexual minorities; and (6) internalized homophobia. People who reported being HIV negative were more likely to have a prominent mother-son relationship, strong sense of family, supportive siblings, and family acceptance as a sexual minority. PLWH were more likely to report a weak sense of family, being raised in a maternal-led household, and less likely to have a relationship with their father and siblings. Marginalization among participants regardless of HIV status included exposure to religious rhetoric stigmatizing sexual minorities and fathers' reinforcing Mexican traditional gender norms. In addition to encountering homophobia, PLWH were further marginalized by family members due to their HIV status. The findings suggest a need for greater attention to examining the impact of familial support of Hispanic or Latino/a/x Mexican sexual minority cisgender males as young adults with or at risk of HIV.

A scoping review of alcohol, tobacco, and other drug use treatment interventions for sexual and gender minority populations.

BACKGROUND: Alcohol, tobacco, and other drug use are among the most prevalent and important health disparities affecting sexual and gender minority (SGM; e.g., lesbian, gay, bisexual, transgender) populations. Although numerous government agencies and health experts have called for substance use intervention studies to address these disparities, such studies continue to be relatively rare. METHOD: We conducted a scoping review of prevention and drug treatment intervention studies for alcohol, tobacco, and other drug use that were conducted with SGM adults. We searched three databases to identify pertinent English-language, peer-reviewed articles published between 1985 and 2019. RESULTS: Our search yielded 71 articles. The majority focused on sexual minority men and studied individual or group psychotherapies for alcohol, tobacco, or methamphetamine use. CONCLUSION: Our findings highlight the need for intervention research focused on sexual minority women and gender minority individuals and on cannabis and opioid use. There is also a need for more research that evaluates dyadic, population-level, and medication interventions.

Challenges of virtual RDS for recruitment of sexual minority women for a behavioral health study.

Respondent driven sampling (RDS) is an approach commonly used to recruit nonprobability samples of rare and hard-to-find populations. The purpose of this study was to explore the utility of phone and web-based RDS methodology to sample sexual minority women (SMW) for participation in a telephone survey. Key features included 1) utilizing a national probability survey sample to select seeds; 2) web-based recruitment with emailed coupons; and 3) virtual processes for orienting, screening and scheduling potential participants for computer-assisted telephone interviews. Rather than resulting in a large diverse sample of SMW, only a small group of randomly selected women completed the survey and agreed to recruit their peers, and very few women recruited even one participant. Only seeds from the most recent of two waves of the probability study generated new SMW recruits. Three RDS attempts to recruit SMW over several years and findings from brief qualitative interviews revealed four key challenges to successful phone and web-based RDS with this population. First, population-based sampling precludes sampling based on participant characteristics that are often used in RDS. Second, methods that distance prospective participants from the research team may impede development of relationships, investment in the study, and motivation to participate. Third, recruitment for telephone surveys may be impeded by multiple burdens on seeds and recruits (e.g., survey length, understanding the study and RDS process). Finally, many seeds from a population-based sample may be needed, which is not generally feasible when working with a limited pool of potential seeds. This method may yield short recruitment chains, which would not meet key RDS assumptions for approximation of a probability sample. In conclusion, potential challenges to using RDS in studies with SMW, particularly those using virtual approaches, should be considered.

Experiences of the COVID-19 Pandemic Among African American, Latinx, and White Sexual Minority Women: A Descriptive Phenomenological Study.

From a systems perspective, the COVID-19 pandemic has caused global changes impacting the lives of individuals at all levels of interactions. Qualitative in-depth interviews were conducted with a sample of 18 African-American/Black, Hispanic/Latina/Latinx, and White sexual minority women (SMW) to explore experiences and adaptations during the COVID-19 pandemic. Interviews were analyzed using a descriptive phenomenological approach to understand how the complex and changing contexts of the pandemic impacted participants' lives. Analyses revealed participants were impacted in the context of their sexual identity in their experiences of coming out and being visible; creating social bubbles; their connection to the LGBTQ community; and dating. The pandemic, which took place concurrently with major political events including Black Lives Matter demonstrations and protests against police and White supremacist violence against people of color, resulted in additional impacts on Black and Latinx SMW related to safety, dialogues about race, and on-going systemic and cultural racism. Interviews also revealed general challenges in the areas of relationships, including with a partner and family; employment and the workplace; and interactions in public spaces. The findings underscore the importance of understanding the diverse range of experiences and impacts of the pandemic on SMW, including experiences related to their sexual identity and racial/racialized identity, as well as general experiences that may have additional consequences for SMW, and supports needed to help alleviate the negative impacts in the short and long-term.

Measuring the impact of legal recognition of same-sex marriage among sexual minority women.

Reductions in structural stigma, such as gaining access to legalized same-sex marriage, is associated with positive psychological and physical health outcomes among sexual minority adults. However, these positive outcomes may be less robust among sexual minority women (SMW; e.g., lesbian, bisexual, queer) than sexual minority men and new measures are needed to develop a more nuanced understanding of the impact of affirming policies on the health and well-being of SMW. This study assessed the psychometric properties of measures developed to assess the psychosocial impacts of legalized same-sex marriage on the lives of SMW. Participants (N=446) completed an online survey assessing the psychosocial impact of legalized same-sex marriage in five domains: 1) personal impact, 2) stigma-related concerns, 3) couple impact, 4) LGBTQ community impact, and 5) political/social environment. Psychometric properties of the scales were examined using traditional and Rasch analyses. Personal, concerns, couple, and political/social environment scales demonstrated high internal consistency (α > 0.80), and acceptable levels of reliability even when scales reduced to five items each. The LGBTQ community scale demonstrated adequate internal consistency (α = 0.79) and could only be reduced to 9 items. These scales may be useful in future studies of SMW health and well-being.

Differential Effects of State Policy Environments on Substance Use by Sexual Identity: Findings From the 2000-2015 National Alcohol Surveys.

INTRODUCTION: This study explored whether structural stigma, defined by U.S. state policies related to sexual minority rights, moderated the relationship between sexual identity identity and heavy drinking, alcohol problems, and marijuana use among men and women. METHODS: Using combined data from the National Alcohol Survey (NAS) series (2000, 2005, 2010, and 2015), the sample included 11,115 men (421 sexual minority and 10,694 heterosexual) and 14,395 women (413 sexual minority and 13,982 heterosexual). State policy environment was assessed using a time-varying dichotomous indicator of comprehensive protections for sexual minorities (4-6 protections vs. limited or no protections). Gender-stratified logistic regression analyses examined the differential effect of the policy environment by sexual identity on three past-year substance use outcomes: high-intensity drinking (8+ drinks/day), any DSM-5 alcohol use disorder, and marijuana use. RESULTS: Among women, sexual minority status was associated with increased odds of all alcohol and marijuana use outcomes. Among men, sexual minority status was associated with decreased odds of high-intensity drinking but increased use of marijuana. Comprehensive policy protections were associated significantly decreased odds of high-intensity drinking among sexual minority men and marginally significant decreases among women. CONCLUSIONS: Comprehensive policy protections appear to be protective for high-intensity drinking among sexual minority men and women. Findings underscore the importance of supportive policies in reducing risk of alcohol-related problems among sexual minorities.

Perceived psychosocial impacts of legalized same-sex marriage: A scoping review of sexual minority adults' experiences.

A growing body of literature provides important insights into the meaning and impact of the right to marry a same-sex partner among sexual minority people. We conducted a scoping review to 1) identify and describe the psychosocial impacts of equal marriage rights among sexual minority adults, and 2) explore sexual minority women (SMW) perceptions of equal marriage rights and whether psychosocial impacts differ by sex. Using Arksey and O'Malley's framework we reviewed peer-reviewed English-language publications from 2000 through 2019. We searched six databases (PubMed, PsycINFO, CINAHL, Web of Science, JSTOR, and Sociological Abstracts) to identify English language, peer-reviewed journal articles reporting findings from empirical studies with an explicit focus on the experiences and perceived impact of equal marriage rights among sexual minority adults. We found 59 studies that met our inclusion criteria. Studies identified positive psychosocial impacts of same-sex marriage (e.g., increased social acceptance, reduced stigma) across individual, interpersonal (dyad, family), community (sexual minority), and broader societal levels. Studies also found that, despite equal marriage rights, sexual minority stigma persists across these levels. Only a few studies examined differences by sex, and findings were mixed. Research to date has several limitations; for example, it disproportionately represents samples from the U.S. and White populations, and rarely examines differences by sexual or gender identity or other demographic characteristics. There is a need for additional research on the impact of equal marriage rights and same-sex marriage on the health and well-being of diverse sexual minorities across the globe.

Introduction to Special Issue: Impacts of the COVID-19 Pandemic on LGBTQ+ Health and Well-Being.

This special issue on the impacts of COVID-19 on LGBTQ+ health and well-being reports findings from nine articles with varied study designs, including data from multiple countries and all segments of LGBTQ+ communities. Key findings included the observation that pre-COVID mental health disparities predispose LGBTQ+ people to poorer outcomes; that technological communication aids are essential in maintaining some sense of community; and that substance use is perceived by sexual minority women as a means of coping with fears, stress, loneliness, and boredom. Studies in this special issue also document that community support is still a critical need, particularly among those who are sheltering at home with families of origin. Findings underscore the importance of addressing structural inequities, including advocating for rights; providing financial support for LGBTQ+ community organizations and networks; ensuring access to competent and affirming healthcare; and including vulnerable communities in disaster response and planning.

Understanding Alcohol and Marijuana Use among Sexual Minority Women during the COVID-19 Pandemic: A Descriptive Phenomenological Study.

Sexual minority women (SMW; e.g., lesbian, bisexual, queer) are at increased risk for heavy/hazardous drinking and marijuana use, which may be exacerbated by stress associated with the COVID-19 pandemic and efforts to mitigate its spread (e.g., sheltering at home). To explore their experiences and perceptions of alcohol and marijuana use in the context of COVID-19, qualitative in-depth interviews were conducted with a diverse sample of 16 SMW from a longitudinal study who previously reported being at least moderate drinkers to explore their experiences and perceptions of alcohol and marijuana use during the pandemic. We used descriptive phenomenological analysis to explore data from the interviews. Participants described how their alcohol/marijuana use intersected with the complex and changing context of the pandemic, revealing four themes: 1) losing and creating routine; 2) seeking recreation and relief; 3) connecting, reconnecting, and disconnecting; and 4) monitoring alcohol and marijuana use boundaries. Findings highlight the importance of fostering community supports and possible interventions informed by the experiences of SMW.

Harmful drinking, tobacco, and marijuana use in the 2000-2015 National Alcohol Surveys: Examining differential trends by sexual identity.

BACKGROUND: Population-based surveys document disparities in substance use among sexual minorities compared to heterosexuals, but few studies examine changes over time. This study compared changes in harmful drinking (including alcohol use disorders and high-intensity drinking), tobacco use, marijuana use, and simultaneous marijuana and alcohol co-use between heterosexual and sexual minority adults over a 15-year period. Methods: Gender-stratified logistic regression analyses using 4 waves of cross-sectional data from the National Alcohol Survey (2000, 2005, 2010, and 2015) were conducted to test overall trends over time and differences by sexual identity, as well as the interaction between survey year and sexual identity. Results: Among women, significant effects for sexual identity were present in all models, reflecting greater odds of use among sexual minorities across waves. Among men, significant effects for sexual identity were found for high-intensity drinking (reflecting less use among sexual minorities) as well as marijuana use and marijuana and alcohol co-use (reflecting more use among sexual minorities). For women and men, tobacco use generally decreased and both marijuana use and simultaneous marijuana and alcohol co-use increased during the study period. Although trends were largely driven by heterosexual respondents, only one instance of an interactive effect was found; reports of harmful drinking were generally stable over time among heterosexual women, but higher and more variable over time among sexual minority women. Conclusions: Findings highlight that differences in patterns of substance use by sexual identity persist and underscore the need for screening, prevention, and intervention, particularly for sexual minority women.

First comes marriage, then comes the election: Macro-level event impacts on African-American, Latina/x, and White sexual minority women.

Sexual minority women (SMW) may have different experiences of macro-level events, such as changes in marriage laws or election outcomes, related to their multiple identities. African American, Latina/x, and White identities intersect with gender/sex and sexual identity to influence experiences at the intrapersonal, interpersonal, social, and political levels of the socio-ecological environment. Participants include 100 African American, 35 Latina/x, and 164 White SMW (N = 299) in Wave 4 (2017-2019) of a longitudinal study of SMW's health conducted in the United States (Chicago Health and Life Experiences of Women Study). Responses to nine open-ended survey questions about marriage equality and the 2016 Presidential election were examined. Thematic analysis noted similarities across groups and focused on group differences in four areas: 1) personal well-being (including fear and anxiety about discrimination; risk associated with masculine presentation; and religion as stress and support); 2) interpersonal relationships (including relationships with partners, family, and in a community); 3) societal discrimination and prejudice (including harassment in public spaces and concerns about travel); and 4) civil rights, government harassment, and police-state violence. Emerging differences emphasized the impact of race/ethnicity and the intersection of race/ethnicity and gender on experiences of marriage equality and the 2016 election. Findings suggest that a more nuanced understanding of the experiences of individuals with different racial/racialized identities and the intersection of race/ethnicity with sexual identities is essential to creating culturally competent and effective supports for SMW.