Sexual and Gender Minority Youth’s Mental Health and Substance Use:Disparities, Mechanisms, and Protective Factors

This dissertation presents eight studies that aimed to better understand the poorer mental health and higher substance use among sexual and gender minority youth. Studies (1) improve our understanding of sexual and gender identity-based health disparities, (2) investigated driving these health disparities, and (3) examined protective factors against these health disparities. First, studies on disparities evidenced that mental health and substance use disparities between sexual and gender minority and heterosexual, cisgender youth are persistent. Thus, despite increasing societal acceptance of sexual and gender diversity, sexual and gender minority youth remain a vulnerable group. This stresses the importance of research that monitors and explains health disparities. Second, studies on mechanisms showed how stigma-related processes can contribute to poorer health among sexual and gender minority youth. Research should, however, explore other possible mechanisms that can explain poorer health outcomes among sexual and gender minority youth besides stigma-related mechanisms. Last, research that examined protective factors found that interpersonal but not structural protective factors attenuated the negative effects of stigma on health outcomes. Empirical research should further investigate which protective factors at different levels (e.g., personal, interpersonal, and structural) contribute to a better health of sexual and gender minority youth. Together, this dissertation provides a better understanding of the poorer mental health and higher substance use among sexual and gender minority youth

Sexual and Gender Identity-Based Microaggressions:Differences by Sexual and Gender Identity, and Sex Assigned at Birth Among Dutch Youth

Research describes several sexual and gender identity-based microaggressions that sexual and gender minority (SGM) people might experience. We aimed to examine the occurrence of different sexual and gender identity-based microaggressions among SGM youth and to identify differences by sexual and gender identity, and sex assigned at birth. Open-ended questions about daily experiences were coded for 16 types of sexual and gender identity-based microaggressions in two daily diary studies among Dutch SGM youth (Study 1: N = 90, M age = 17.64 SD = 1.78; Study 2: N = 393, M age = 18.36 SD = 2.65). Several types of microaggressions were identified, and there was sizable variability in the reported frequency. Overall, lesbian women and bisexual youth were less likely to report microaggressions than gay youth. Bisexual youth were less likely to report use of heterosexist or transphobic terminology than gay youth and youth assigned male at birth were less likely to report invalidation of LGBTQ identity than youth assigned female at birth. Last, gender minority youth were more likely to report familial microaggressions, invalidation of LGBTQ identity, and threatening behaviors than cisgender youth. Overall, this study provides empirical support using mixed qualitative and quantitative methods for theorized typologies of microaggressions among Dutch SGM 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

Associations of relationship experiences dating violence, sexual harassment, and assault with alcohol use among sexual and gender minority adolescents

Sexual and gender minority (SGM) adolescents report higher rates of dating violence victimization compared with their heterosexual and cisgender peers. Research on dating violence often neglects diversity in sexual and gender identities and is limited to experiences in relationships. Further, given that dating violence and alcohol use are comorbid, research on experiences of dating violence could provide insights into alcohol use disparities among SGM adolescents. We aimed to map patterns of relationship experiences, sexual and physical dating violence, and sexual and physical assault and explored differences in these experiences among SGM adolescents. Further, we examined how these patterns explained alcohol use. We used a U.S. non-probability national web-based survey administered to 13–17-year-old SGM adolescents (N = 12,534). Using latent class analyses, four patterns were identified: low relationship experience, dating violence and harassment and assault (72.0%), intermediate dating experiences, sexual harassment, and assault and low levels of dating violence (13.1%), high dating experiences, dating violence, and sexual assault (8.6%), and high dating experiences, dating violence, and sexual harassment and assault (6.3%). Compared to lesbian and gay adolescents, bisexual adolescents reported more experiences with dating, dating violence, and sexual assault, whereas heterosexual adolescents reported fewer experiences with dating, dating violence, and sexual harassment and assault. Compared to cisgender boys, cisgender girls, transgender boys, and non-binary/assigned male at birth adolescents were more likely to experience dating violence inside and outside of relationship contexts. Experiences of dating, dating violence, and sexual harassment and assault were associated with both drinking frequency and heavy episodic drinking. Together, the findings emphasize the relevance of relationship experiences when studying dating violence and how dating violence and sexual harassment and assault might explain disparities in alcohol use

Everyday Discrimination and Alcohol use among Sexual Minority Adults in a U.S. National Probability Sample

Objective: Limited research assesses how sexual orientation and gender identity and expression (SOGIE)-based discrimination affects alcohol use above and beyond non-SOGIE-related discrimination and how this may differ for sexual minority subgroups. We examined if SOGIE-related discrimination is additive in affecting alcohol use above and beyond non-SOGIE-related discrimination and examined differences in alcohol use, everyday discrimination, and the attribution of discrimination by sex and sexual identity. Methods: A national probability sample of sexual minority adults in the United States was used (N = 1311, female = 56.4%). Bivariate sexual identity and sex-based differences in drinking frequency, heavy episodic drinking (HED), everyday discrimination, and the attribution of discrimination were assessed. Sexual identity and sex-stratified logistic regression models were estimated, where everyday discrimination and the attribution of discrimination predicted drinking frequency and HED. Results: Several differences by sex assigned at birth and sexual identity in drinking frequency, HED, everyday discrimination, and the attribution of discrimination were found in bivariate analyses. In logistic regression models, experiencing SOGIE-related in addition to other types of discrimination was associated with higher odds of HED only for gay males. No other associations were found for everyday discrimination or the attribution of discrimination with drinking frequency or HED. Conclusions: Findings suggest sex and sexual identity-based differences in everyday discrimination and the attribution of discrimination

Sexual identity disparities in mental health among U.K. adults, U.S. adults, and U.S. adolescents:Examining heterogeneity by race/ethnicity

Lesbian, gay, and bisexual (LGB) people report poorer mental health than heterosexual people. However, there is heterogeneity in this disparity, and a racial/ethnic minority identity can contribute to this heterogeneity. When studying the intersecting effect of sexual identity and race/ethnicity on mental health, research often limits race/ethnicity categories, often uses adult samples from the U.S., and often uses samples that are not nationally representative. To overcome these limitations, the present study examined racial/ethnic heterogeneity in mental health disparities between heterosexual and LGB people in three nationally representative samples. The samples used were the 2011–2012 Understanding Society (U.K. adults; N = 43,904), the 2015 National Survey on Drug Use and Health (U.S. adults; N = 43,313), and the 2015 Youth Risk Behavior Survey (U.S. adolescents; N = 15,122). Using these samples enabled us to contrast the intersection of sexual identity and race/ethnicity across countries (for adults), and between life phases (in the U.S.). Across all three samples, LGB people—and particularly bisexual people—had a higher risk of impaired mental health than heterosexual people. For U.K. adults and U.S. adults, no intersecting effect of sexual identity and race/ethnicity were found. LGB adolescents of color reported better mental health compared with White LGB adolescents. More specifically, Black LGB adolescents reported better mental health compared to White LGB adolescents. Together, the present study contributes to a better understanding of the heterogeneity in mental health disparities for LGB people

Cigarette Smoking and Minority Stress Across Age Cohorts in a National Sample of Sexual Minorities:Results From the Generations Study

BACKGROUND: Sexual minority populations in the United States have persistently higher rates of cigarette use than heterosexuals, partially driven by exposure to minority stressors (e.g., discrimination and victimization). Little is known about cigarette use across cohorts of sexual minority adults who came of age in distinctly different sociopolitical environments. PURPOSE: To examine cigarette use and minority stressors across three age cohorts of U.S. sexual minority adults. METHODS: We used data from the Generations Study, a nationally representative sample (N = 1,500) of White, Black, and Latino/a sexual minority adults in three age cohorts (younger: 18–25 years; middle: 34–41 years; and older: 52–59 years). Survey data were collected from March 2016 to March 2017. We used sex-stratified logistic regression models to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between age cohort, minority stressors (discrimination and victimization), and two indicators of cigarette smoking (lifetime use and current use). RESULTS: Prevalence of current cigarette use in each age cohort was high (younger: 20%; middle: 33%; and older: 29%). Relative to the younger cohort, men and women in the middle- and older-age cohorts had significantly higher odds of lifetime and current smoking (e.g., men, current, aOR [95% CI]: middle = 2.47 [1.34, 4.52], older = 2.85 [1.66, 4.93]). Minority stressors were independently associated with higher odds of current smoking; when victimization was included, the magnitude of the association between age cohort and current smoking was diminished but remained significant. CONCLUSIONS: Smoking cessation interventions must consider the role of minority stress and the unique needs of sexual minority people across the life course

Explaining Health Disparities between Heterosexual and LGB Adolescents by Integrating the Minority Stress and Psychological Mediation Frameworks:Findings from the TRAILS Study

Lesbian, gay, and bisexual (LGB) adolescents experience elevated levels of internalizing problems and use more substances than heterosexual adolescents. The minority stress and psychological mediation framework are complementary theoretical frameworks that were developed to explain these disparities. However, limited empirical research has integrated both frameworks to study health disparities between heterosexual and LGB adolescents. This study attempts such an integration, using data from the first five waves (participant age 11–22) of the TRacking Adolescents’ Individual Lives Survey (TRAILS), a cohort study of Dutch adolescents (N = 1738; 151 LGB; 54.8% girls). It was tested whether an LGB identity was linked to internalizing problems and substance use through a serial mediation process, in which sexual identity would be associated with peer victimization and negative relationships with parents (first set of mediators, in keeping with the minority stress framework), which in turn would be associated with fear of negative social evaluation and a lack of social support (second set of mediators, in keeping with the psychological mediation framework), and eventually increasing the risk for internalizing problems and elevated levels of substance use. Moreover, it was tested whether the link between minority stress and substance use was mediated by peers’ substance use levels, as hypothesized by the psychological mediation framework. Compared to heterosexual participants, LGB participants reported more internalizing problems, smoked more cigarettes, and used more marijuana, but did not consume more alcohol. The relation between sexual identity and internalizing problems was mediated by peer victimization and parental rejection, which is in line with the minority stress framework. No statistically significant support was found for the psychological mediation framework. These findings provide a better understanding of the pathways through which sexual identity disparities in mental wellbeing and substance use come about

Sexual and Gender Identity-Based Microaggressions: Differences by Sexual and Gender Identity, and Sex Assigned at Birth Among Dutch Youth

Research describes several sexual and gender identity-based microaggressions that sexual and gender minority (SGM) people might experience. We aimed to examine the occurrence of different sexual and gender identity-based microaggressions among SGM youth and to identify differences by sexual and gender identity, and sex assigned at birth. Open-ended questions about daily experiences were coded for 16 types of sexual and gender identity-based microaggressions in two daily diary studies among Dutch SGM youth (Study 1: N = 90, M age = 17.64 SD = 1.78; Study 2: N = 393, M age = 18.36 SD = 2.65). Several types of microaggressions were identified, and there was sizable variability in the reported frequency. Overall, lesbian women and bisexual youth were less likely to report microaggressions than gay youth. Bisexual youth were less likely to report use of heterosexist or transphobic terminology than gay youth and youth assigned male at birth were less likely to report invalidation of LGBTQ identity than youth assigned female at birth. Last, gender minority youth were more likely to report familial microaggressions, invalidation of LGBTQ identity, and threatening behaviors than cisgender youth. Overall, this study provides empirical support using mixed qualitative and quantitative methods for theorized typologies of microaggressions among Dutch SGM youth