Elevated Risky Sexual Behaviors Among Sexual Minority Girls: Indirect Risk Pathways Through Peer Victimization and Heavy Drinking.

Sexual minority girls (SMGs), compared with heterosexual females, are more likely to report negative sexual outcomes including earlier age of sexual intercourse debut, more lifetime and recent sexual partners, pregnancy involvement, and sex while intoxicated. Data describing the mechanisms related to these health disparities are limited. The purpose of this study was therefore to longitudinally assess the roles of sexual minority-related peer victimization and heavy episodic drinking (HED) as mediators of the relation between sexual minority status and sexual outcomes. The girls examined in this study were recruited into a longitudinal study of adolescent health from two large, urban adolescent medicine clinics affiliated with academic medical centers. The final sample for this analysis included 79 SMGs and a comparison group of 127 heterosexual girls aged between 14 and 19 years. Mediation models were run in the structural equation modeling framework. Our results provided evidence to support a serial multiple mediation pathway. SMGs were more likely to report sexual minority-related victimization, and sexual minority-related victimization predicted increased HED, which was subsequently found to prospectively predict increased sexual risk behaviors. Taken together, these novel findings indicate that both sexual minority-related victimization and HED may play important roles in explaining disparities in risky sexual behavior among SMGs.

Risk of heavy drinking among sexual minority adolescents: indirect pathways through sexual orientation-related victimization and affiliation with substance-using peers.

AIMS: To test two indirect pathways through which sexual minority adolescents (SMAs) may be at risk for heavy episodic drinking (HED) including a socialization pathway via substance-using peer affiliations and social marginalization pathway via sexual minority-specific victimization and subsequent substance-using peer affiliations. DESIGN: Analysis of the first three waves (6 months apart) of a longitudinal adolescent health risk study (2011-14). Participants were referred by medical providers or a screening system in providers' waiting rooms. SETTING: Two large urban adolescent health clinics in Pennsylvania and Ohio, USA. PARTICIPANTS: A total of 290 adolescents (ages 14-19 years, mean: 17.08) who were 71.0% female, 33.4% non-Hispanic white and 34.5% SMAs. MEASUREMENTS: Self-reported sexual minority status (wave 1) and affiliation with substance-using peers (waves 1 and 2), and latent sexual-minority specific victimization (waves 1 and 2) and HED (waves 1 and 3) variables. FINDINGS: Using mediation analyses in a structural equation modeling framework, there was a significant indirect effect of sexual minority status (wave 1) on HED (wave 3) via affiliation with substance-using peers [wave 2; indirect effect = 0.03, 95% confidence interval (CI) = 0.01, 0.07], after accounting for the indirect effect of sexual-orientation related victimization (wave 2; indirect effect = 0.10, 95% CI = 0.02-0.19). The social marginalization pathway was not supported, as victimization (wave 1) was not associated with affiliation with substance-using peers (wave 2; ß = - 0.04, P = 0.66). Sex differences in the indirect effects were not detected (Ps > 0.10). CONCLUSIONS: Sexual minority adolescents in the United States appear to exhibit increased heavy episodic drinking via an indirect socialization pathway, including affiliations with substance-using peers and a concurrent indirect pathway involving sexual minority-related victimization. The pathways appear to operate similarly for boys and girls.

School absenteeism and mental health among sexual minority youth and heterosexual youth.

Adolescent school absenteeism is associated with negative outcomes such as conduct disorders, substance abuse, and dropping out of school. Mental health factors, such as depression and anxiety, have been found to be associated with increased absenteeism from school. Sexual minority youth (youth who are attracted to the same sex or endorse a gay, lesbian, or bisexual identity) are a group at risk for increased absenteeism due to fear, avoidance, and higher rates of depression and anxiety than their heterosexual peers. The present study used longitudinal data to compare sexual minority youth and heterosexual youth on excused and unexcused absences from school and to evaluate differences in the relations between depression and anxiety symptoms and school absences among sexual minority youth and heterosexual youth. A total of 108 14- to 19-years-old adolescents (71% female and 26% sexual minority) completed self-report measures of excused and unexcused absences and depression and anxiety symptoms. Compared to heterosexual youth, sexual minority youth reported more excused and unexcused absences and more depression and anxiety symptoms. Sexual minority status significantly moderated the effects of depression and anxiety symptoms on unexcused absences such that depression and anxiety symptoms were stronger predictors of unexcused absences for sexual minority youth than for heterosexual youth. The results demonstrate that sexual minority status and mental health are important factors to consider when assessing school absenteeism and when developing interventions to prevent or reduce school absenteeism among adolescents.

Social problem solving among depressed adolescents is enhanced by structured psychotherapies.

OBJECTIVE: Changes in adolescent interpersonal behavior before and after an acute course of psychotherapy were investigated as outcomes and mediators of remission status in a previously described treatment study of depressed adolescents. Maternal depressive symptoms were examined as moderators of the association between psychotherapy condition and changes in adolescents' interpersonal behavior. METHOD: Adolescents (n = 63, mean age = 15.6 years, 77.8% female, 84.1% White) engaged in videotaped interactions with their mothers before randomization to cognitive behavior therapy (CBT), systemic behavior family therapy (SBFT), or nondirective supportive therapy (NST) and after 12-16 weeks of treatment. Adolescent involvement, problem solving, and dyadic conflict were examined. RESULTS: Improvements in adolescent problem solving were significantly associated with CBT and SBFT. Maternal depressive symptoms moderated the effect of CBT, but not SBFT, on adolescents' problem solving; adolescents experienced increases in problem solving only when their mothers had low or moderate levels of depressive symptoms. Improvements in adolescents' problem solving were associated with higher rates of remission across treatment conditions, but there were no significant indirect effects of SBFT on remission status through problem solving. Exploratory analyses revealed a significant indirect effect of CBT on remission status through changes in adolescent problem solving, but only when maternal depressive symptoms at study entry were low. CONCLUSIONS: Findings provide preliminary support for problem solving as an active treatment component of structured psychotherapies for depressed adolescents and suggest one pathway by which maternal depression may disrupt treatment efficacy for depressed adolescents treated with CBT.

Mental health and substance use disparities among urban adolescent lesbian and bisexual girls.

BACKGROUND: Sexual minority girls (SMGs) report large substance use disparities and victimization experiences, yet there is a dearth of research that focuses exclusively on SMGs. OBJECTIVE: To examine substance use and mental health disparities among SMGs and to determine whether disparities were larger for African American compared with European American girls. METHOD: Data were used from Wave 11 of the Pittsburgh Girls Study, a multiple-cohort, prospective study of urban girls. Girls for the current analysis were aged 16 to 19 years. Fifty-five percent were African American. One hundred and seventy-three (8.3%) identified as SMGs, and 1,891 identified as heterosexual. Multiple regression analyses controlling for age, race, and parent education were conducted. RESULTS: SMGs reported a robust pattern of large disparities in externalizing, internalizing, and borderline personality disorder symptoms. There was little evidence to suggest disparities were moderated by race. CONCLUSION: SMGs and their families would benefit from intervention and prevention programs to reduce disparities among this highly vulnerable population.

Cross-sectional evidence for a stress-negative affect pathway to substance use among sexual minority girls.

Sexual minority girls (SMGs) are four times more likely to engage in substance use than are heterosexual girls. A better understanding of the explanatory mechanisms of this disparity is needed to inform prevention and intervention programs. The goal of this study was to conduct a preliminary test of a "stress-negative affect" pathway by examining gay-related victimization and depression as mediators of substance use among SMGs. Adolescent girls (N = 156, 41% SMGs) were recruited from two urban adolescent medicine clinics to participate in an NIH-funded study of adolescent substance use. The average age was 17.0 years old and 57% were nonwhite. Mediation analyses were conducted in a multiple regression framework using SPSS and a mediation macro utilizing bias-corrected bootstrapping. Four models were estimated to test mediated pathways from sexual orientation to gay-related victimization (Mediator 1), to depression symptoms (Mediator 2), and then to each of four substance use variables: cigarettes, marijuana, alcohol, and heavy alcohol use. Significant mediated pathways (mediation tests with 95% CIs) were found for cigarette, alcohol and heavy alcohol use outcome variables. Results provide preliminary support for the minority stress hypothesis and the stress-negative affect pathway, and may inform the development of future prevention and intervention programs.

Trajectories of depressive symptoms and suicidality among heterosexual and sexual minority youth.

Sexual minority youth report higher rates of depression and suicidality than do heterosexual youth. Little is known, however, about whether these disparities continue as youth transition into young adulthood. The primary goals of this study were to describe and compare trajectories of adolescent depressive symptoms and suicidality among sexual minority and heterosexual youth, examine differences in depressive symptoms and suicidality trajectories across sexual orientation subgroups, and determine whether there are gender differences in these longitudinal disparities. Four waves of data from the National Longitudinal Study of Adolescent Health were analyzed using latent curve modeling (N = 12,379; 53% female). Results showed that the rates of depressive symptoms and suicidality in early adolescence were higher among sexual minority youth than among heterosexual youth, and that these disparities persisted over time as participants transitioned into young adulthood. Consistent with previous cross-sectional studies, the observed longitudinal disparities were largest for females and for bisexually-identified youth. Sexual minority youth may benefit from childhood and early adolescent prevention and intervention programs.

Sexual minority-related victimization as a mediator of mental health disparities in sexual minority youth: a longitudinal analysis.

Sexual minority youth (youth who are attracted to the same sex or endorse a gay/lesbian/bisexual identity) report significantly higher rates of depression and suicidality than heterosexual youth. The minority stress hypothesis contends that the stigma and discrimination experienced by sexual minority youth create a hostile social environment that can lead to chronic stress and mental health problems. The present study used longitudinal mediation models to directly test sexual minority-specific victimization as a potential explanatory mechanism of the mental health disparities of sexual minority youth. One hundred ninety-seven adolescents (14-19 years old; 70 % female; 29 % sexual minority) completed measures of sexual minority-specific victimization, depressive symptoms, and suicidality at two time points 6 months apart. Compared to heterosexual youth, sexual minority youth reported higher levels of sexual minority-specific victimization, depressive symptoms, and suicidality. Sexual minority-specific victimization significantly mediated the effect of sexual minority status on depressive symptoms and suicidality. The results support the minority stress hypothesis that targeted harassment and victimization are partly responsible for the higher levels of depressive symptoms and suicidality found in sexual minority youth. This research lends support to public policy initiatives that reduce bullying and hate crimes because reducing victimization can have a significant impact on the health and well-being of sexual minority youth.

Impulsivity moderates the relationship between implicit associations about alcohol and alcohol use.

Implicit associations about alcohol are strong predictors of alcohol use, as is the personality trait of impulsivity. This study examines the role of impulsivity as a moderator of the association between implicit associations about alcohol and alcohol use. Two hundred and 19 participants completed measures of positive and negative implicit associations, as measured by the Implicit Association Test (IAT) and self-report questionnaires of impulsivity and alcohol use in the past month. Trait impulsivity was broken down into five facets identified in previous research. All facets of impulsivity and positive implicit associations about alcohol were positively correlated with past month alcohol use. The urgency facets (positive and negative) of impulsivity (acting rashly in response to strong positive or negative mood) moderated the relationship between positive implicit associations about alcohol and alcohol use. Compared to individuals low on positive or negative urgency, individuals high on positive or negative urgency tended to report acting more in line with their positive implicit associations by reporting more drinking in the past month.

Differences in implicit associations about alcohol between blacks and whites following alcohol administration.

OBJECTIVE: Implicit cognitions about alcohol have been shown to be an important predictor of alcohol use. Relatively little research has been conducted on racial/ethnic differences in implicit cognitions or changes in implicit cognitions while intoxicated. This study examined differences between Blacks and Whites in positive and negative implicit associations about alcohol, as measured by the Implicit Association Test (IAT) and tested differences in IAT scores when participants were sober and intoxicated. METHOD: One hundred thirty-five young adults (46% of Black descent) participated in an alcohol-administration study, receiving a moderate dose of alcohol (0.72 g/kg alcohol for men, 0.65 g/kg for women). The IAT was administered in two sessions, one in which alcohol was administered (30 minutes after alcohol consumption) and one in which it was not, approximately 1 week apart. RESULTS: Repeated-measures mixed-factorial analyses of variance were conducted separately for positive and negative IAT scores. Blacks held lower positive and negative implicit cognitions about alcohol compared with Whites. Positive and negative IAT scores did not change as a function of intoxication. Positive explicit expectancies and self-reported past-month drinking behavior were related to positive IAT scores. Positive and negative IAT scores were also related to acute subjective response to alcohol, and this association differed by race. CONCLUSIONS: Results extend previous studies by providing evidence for racial differences in implicit cognitions about alcohol and by showing the stability of the IAT while participants are intoxicated. Future studies are needed to determine what factors contribute to racial differences in implicit cognitions.

Positive affect, intuition, and feelings of meaning.

Subjective rationality, or the feeling of meaning, was identified by William James (1893) as a central aspect of the non-sensory fringe of consciousness. Three studies examined the interaction of positive affect (PA) and individual differences in intuitive information processing in predicting feelings of meaning for various stimuli and life events. In Study 1 (N = 352), PA and intuition interacted to predict understanding for ambiguous quotes and abstract artwork. In Study 2 (N = 211), similar interactions were found for feelings of meaning for fans after their football team lost a conference championship game and for individuals not directly affected by Hurricane Katrina in events surrounding the hurricane. In Study 3 (N = 41), induced PA interacted with individual differences in intuition in predicting accuracy for coherence judgments for loosely related linguistic triads. Intuitive individuals in the positive mood condition recognized coherent triads more accurately than did other participants. Results are discussed in terms of the role of individual differences in intuitive information processing in the relationship of PA to cognition.

The health benefits of writing about positive experiences: the role of broadened cognition.

This study tested the potential to elicit a broadened attentional focus through writing about a positive life experience and to derive health benefits from such writing. Participants (n = 38) wrote for 20 min each day for 3 consecutive days about either a positive life experience or a control topic. Writing about positive experiences led to improved physical health (measured 4-6 weeks after writing) compared to control and higher levels of global cognitive focus after writing mediated this effect. Notably, while the positive writing condition was more broadened than control, positive affect was not responsible for this difference. Implications for disclosive writing and the broaden and build model are discussed.

Effects of (very) brief writing on health: the two-minute miracle.

This study tested the lower boundary of the dosage required to garner health benefits from written emotional expression. Participants wrote about either a personal trauma, a positive life experience, or a control topic for 2 minutes each day for 2 days. Emotion word usage in the essays was examined and physical health complaints were measured 4-6 weeks after the last writing session. Trauma and positive experience essays contained more emotional content than the control essays and such content was of a similar percentage to that demonstrated by past research. Both the trauma and the positive experience conditions reported fewer health complaints at follow-up than the control condition.

Ghosts, UFOs, and magic: positive affect and the experiential system.

Three studies examined the potential interactions of the experiential system and positive affect (PA) in predicting superstitious beliefs and sympathetic magic. In Study 1, experientiality and induced positive mood interacted to predict the emergence of belief in videos purporting to show unidentified flying objects or ghosts. In Study 2, naturally occurring PA interacted with experientiality to predict susceptibility to sympathetic magic, specifically difficulty in throwing darts at a picture of a baby (demonstrating the law of similarity). In Study 3, induced mood interacted with experientiality to predict sitting farther away from, and expressing less liking for, a partner who had stepped in excrement (demonstrating the law of contagion). Results are interpreted as indicating that PA promotes experiential processing. Implications for the psychology of nonrational beliefs and behaviors are discussed.