Adolescent substance use at the intersections of foster care, sexual orientation and gender identity, racial/ethnic identity, and sex assigned at birth.

BACKGROUND: Lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) youth are overrepresented in foster care and report greater substance use during adolescence. OBJECTIVE: Using an intersectional lens, the current study investigates differences in foster care placement and variation in substance use at the intersections of foster care and sexual orientation, gender identity, racial/ethnic identities, and sex assigned at birth. PARTICIPANTS AND SETTINGS: A sample of 121,910 LGBTQ youth (grades 6-12) completed either the Minnesota Student Survey in 2019, the California Healthy Kids Survey from 2017 to 2019, or the 2017 LGBTQ National Teen Study. METHODS: Youth reported their substance use in the past 30 days (alcohol, binge drinking, cigarette, marijuana), social positions (sexual orientation, gender identity, racial/ethnic identities, sex assigned at birth), living arrangement (foster care or not), and grade in school. Logistic regression was used to examine the main and interaction effects of foster care and social positions on youth substance use. RESULTS: Results indicated significant differences in substance use at the intersection of foster care placement and youth social positions. Significant two-way interactions for foster care placement and social positions emerged predicting alcohol, binge drinking, and marijuana use. CONCLUSIONS: Findings show that LGBTQ youth in foster care are at higher risk for substance use than those not in foster care. Particular support is needed for lesbian, gay, and questioning youth, transgender youth, LGBTQ youth assigned male at birth, and Asian or Pacific Islander LGBTQ youth in foster care.

Application of an intersectional lens to bias-based bullying among LGBTQ+ youth of color in the United States.

Bias-based bullying influences health, academic success, and social wellbeing. However, little quantitative work takes an intersectional perspective to understand bias-based bullying among youth with marginalized social positions, which is critical to prevention. This paper describes the application of exhaustive chi-square automatic interaction detection (CHAID) to understand how prevalence of race-, gender-, and sexual orientation-based bullying varies for youth with different intersecting social positions. We used two datasets - the 2019 Minnesota Student Survey (MSS; N=80,456) and the 2017-2019 California Healthy Kids Survey (CHKS; N=512,067). Students self-reported sex assigned at birth, sexual orientation, gender identity, race/ethnicity, and presence of any race-, gender-, and sexual orientation-based bullying (MSS: past 30 days, CHKS: past 12 months). Exhaustive CHAID with a Bonferroni correction, a recommended approach for large, quantitative intersectionality research, was used for analyses. Exhaustive CHAID analyses identified a number of nodes of intersecting social positions with particularly high prevalences of bias-based bullying. Across both datasets, with varying timeframes and question wording, and all three forms of bias-based bullying, youth who identified as transgender, gender diverse, or were questioning their gender and also held other marginalized social positions were frequent targets of all forms of bias-based bullying. More work is needed to understand how systems of oppression work together to influence school-based bullying experiences. Effective prevention programs to improve the health of youth with marginalized social positions must acknowledge the complex and overlapping ways bias and stigma interact.

Exploring Bias-Based Bullying and Intersecting Social Positions as Correlates of Sexual Risk Behaviors Among Adolescents.

Purpose: The current study extends the limited body of intersectional research on adolescents' sexual health by examining experiences of bias-based bullying and multiple intersecting social positions associated with engagement in sexual risk behaviors. Methods: Participants were 14,968 sexually active 9th and 11th grade students surveyed as part of the 2019 Minnesota Student Survey (15% lesbian/gay/bisexual/queer/pansexual/questioning [LGBQ] and/or transgender/gender diverse [TGD] or gender questioning). Exhaustive Chi-square Automatic Interaction Detection analysis was used to identify experiences (i.e., bias-based bullying victimization) and intersecting social positions (i.e., sexual orientation identity; gender identity/modality; race/ethnicity; physical disabilities/chronic illness; mental health/behavioral/emotional problems) associated with the highest prevalence of three sexual risk behaviors. Results: Overall, 18% of adolescents reported 3+ sex partners in the last year, 14% reported drug/alcohol use before last sex, and 36% reported not discussing protection from sexually transmitted infections with new sexual partners. Adolescents with 2+ marginalized social positions, some of whom also experienced bias-based bullying, were part of 53% of the highest prevalence risk groups. For example, 42% of Multiracial or Latina/x/o gender questioning adolescents who identified as LGBQ reported 3+ sex partners in the last year-twice the sample average. Adolescents who were Black, American Indian/Alaska Native, Latina/x/o, Multiracial, TGD, or gender questioning were in the highest prevalence nodes across all outcomes. Conclusion: Adolescents with multiple marginalized social positions and who experience bias-based bullying engage in high-risk sexual behaviors at higher-than-average rates. Findings underscore the importance of addressing intersecting experiences of stigma to reduce high-risk sex behaviors and promote health equity among adolescents.

Substance Use Behaviors Among LGBTQ+ Youth of Color: Identification of the Populations Bearing the Greatest Burden in Three Large Samples.

PURPOSE: Research has identified persistent disparities in alcohol, e-cigarette, and marijuana use, by sexual orientation, gender identity, and race/ethnicity. Using an intersectionality framework, the present study analyzes three large datasets to identify intersecting social positions bearing the highest burden of substance use. METHODS: Data from adolescents in grades 9-12 in three samples (2019 Minnesota Student Survey, 2017-2019 California Healthy Kids Survey, and 2017 National Teen Survey) were harmonized for an analysis (N = 602,470). A Chi-squared Automatic Interaction Detection analysis compared the prevalence of four types of substance use across all combinations of four social positions (six racial/ethnic identities, five sexual orientations, three gender identities, and two sexes assigned at birth). For each substance, 10 intersectional groups with the highest prevalence of use were examined. RESULTS: In the full sample, 12%-14% of participants reported past 30-day alcohol, e-cigarette, or marijuana use and 7% reported past 30-day binge drinking. Several intersecting marginalized social positions were consistently found to bear a high burden of substance use. For example, transgender and gender diverse (TGD) Latina/x/o young people, particularly those assigned male at birth, were in the high prevalence groups for alcohol use, binge drinking, and marijuana use. Black TGD or gender-questioning youth were commonly in the high prevalence groups. DISCUSSION: Findings suggest that support, resources, and structural changes specifically tailored to youth with multiple marginalized identities (especially TGD) may be needed. The results argue for intersectional efforts that explicitly address racial/ethnic and cultural differences, while also integrating awareness and understanding of sexual and gender diversity.

Mental illness discrimination and support experienced by people who are of color and/or LGB: Considering intersecting identities.

Little is known about mental illness discrimination toward and supports for people with mental health conditions (MHCs) who are of color and/or lesbian, gay, or bisexual (LGB). Informed by an intersectionality framework that facilitates an understanding of intragroup dynamics, this exploratory qualitative study used in-depth interviews to ask 20 people with MHCs and family members of people with MHCs who also identified as of color and/or LGB about their experiences (a) with mental illness discrimination and supports within their identity communities and (b) in peer- and family-run programs. Participants of color reported that their racial-ethnic communities commonly deny that MHCs exist and shame people with MHCs, and LGB participants said that LGB communities often exclude and stereotype them. Interactions with others with MHCs and affirmation of lesbian and gay identities serve as recovery supports within identity communities. Peer- and family-run programs provide a sense of humanization and education, respectively but are sites of heterosexism and may not address the needs of people of color; identity-specific programs are therefore desired. We describe variations in experiences related to race, ethnicity, and sexuality intersections; no differences in descriptions of mental illness discrimination in the focal identity communities emerged between people with MHCs versus family members. Implications include that efforts are needed to address discrimination in identity communities and peer- and family-run programs, and service providers need to recognize that identity intersections affect experiences with discrimination and supports. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Bias-Based Bullying and Elevated Depressive Symptoms Among Sexual and Gender-Diverse Asian American, Native Hawaiian, and Pacific Islander Adolescents.

This cross-sectional study analyzes data from 2 statewide school surveys to document the experiences of sexual and gender minoritized Asian American, Native Hawaiian, and Pacific Islander students in grades 9 through 12 who reported bullying related to their identity.