Structural Factors and Sexual Orientation Disparities in Adolescent Substance Use: A Multi-Level Model

Studies consistently find sexual orientation disparities in tobacco, alcohol and marijuana use among adolescents in the United States (Goldbach, Tanner-Smith, Bagwell, & Dunlap, 2014; Hatzenbuehler, Jun, Corliss, & Austin, 2015; Kann et al., 2018; Marshal et al., 2008; Mustanski, Van Wagenen, Birkett, Eyster, & Corliss, 2014). Having documented this elevated risk, the field has turned to identifying mediators that may explain the sexual orientation disparity in substance use behaviors. There is growing evidence that one of the mediators of sexual orientation-based health disparities is structural stigma—defined as “societal-level conditions, cultural norms, and institutional policies that constrain the opportunities, resources, and well-being of the stigmatized” (Hatzenbuehler & Link, 2014, p.2). Structural stigma can in turn lead to greater stress and subsequent negative coping behaviors among sexual minorities (Hatzenbuehler et al., 2015; Hatzenbuehler & Link, 2014; Hatzenbuehler & McLaughlin, 2014; Pachankis, Hatzenbuehler, & Starks, 2014). However, most of this work has been conducted among adults and has focused on mental health outcomes (e.g., suicide attempts, psychiatric morbidity, mental distress) as opposed to specific substance use behaviors; further, if structural factors are found to affect sexual orientation health disparities and these can be altered, the gap between sexual minority and heterosexual substance use can be narrowed through policy change. State-level substance use policy (e.g., levels of taxation of cigarettes and alcohol, policies that remove adolescent access to driving upon substance use infractions) may also explain the gap in substance use prevalence between sexual minority and heterosexual youth because tobacco, alcohol and marijuana are also stigmatized substances and restrictive substance use environments may enhance the stigma attached to sexual minority youth. However, only one study has explored this research question, and it was conducted with an adult sample (Hatzenbuehler, Keyes, Hamilton, & Hasin, 2014). This project aims to address these gaps in the literature. It uses multi-level modeling to test the association between (1) state-level sexual minority structural stigma (SMSS) and (2) state-level substance use policy environments (SUPEs) and sexual orientation disparities in recent substance use as measured in the Youth Risk Behavior Surveillance Survey (YRBSS). Analyses were also conducted to assess the size and direction of the association between SMSS and SUPE and state-level prevalence of substance use within heterosexual and sexual minority youth subpopulations. Analyses were conducted in subpopulations of female and male youth. Support was found for the structural stigma hypothesis among girls but not boys. Higher overall measures of sexual minority structural stigma were associated with larger disparities in tobacco use, alcohol use, and marijuana use among girls. Higher scores on the SMSS scale were associated with tobacco use among sexual minority girls but not heterosexual girls. Individual indicators of structural stigma (e.g., specific state-level policies) were also associated with disparities in these outcomes, as well as with the other outcomes tested (binge drinking and drunk driving). No such associations were found among male youth. Very little support was found for the hypotheses that restrictive substance use policy environments would be associated with larger sexual orientation disparities in substance use and that heterosexual but not sexual minority youth would demonstrate lower prevalence of substance use in restrictive states. Among girls, no associations were found between scales measuring the restrictiveness of substance use and sexual orientation disparities in substance use. A smaller sexual orientation disparity in recent cigarette smoking was associated with one indicator of restrictiveness: state enforcement of underage tobacco sale laws. Among boys, no associations were found between scales measuring the restrictiveness of substance use and sexual orientation disparities in substance use; two indicators of restrictiveness were associated with smaller sexual orientation disparities in binge drinking and three indicators were associated with smaller sexual orientation disparities in drunk driving. Among heterosexual but not sexual minority boys, higher tobacco taxes were associated with lower prevalence of smoking. This study raises several questions for future research on structural factors that may explain sexual orientation disparities in substance use behaviors among youth. For instance, future work is needed to understand the gender differences in response to structural stigma among sexual minorities. Sexual minority girls may have greater rejection sensitivity than sexual minority boys and thus may be more likely to use substances in response to structural stigma; however, further research is needed to test this hypothesis. In addition, the current study lacked data on the implementation of substance use policy environments, which may have masked important effects. A study of SUPE that includes measures of implementation of restrictive substance use policies is therefore needed to expand the work reported herein. Finally, a better understanding of gender identity and expression is needed; while the YRBSS measures “sex” and not gender or gender expression in these datasets, more information about these topics will help to understand how these factors may play into experiences of structural stigma and substance use policy environments

Pocket Change: How Women and Girls of Color Do More with Less

Women and girls of color are pivotal frontline leaders and organizers in the powerful social change movements that pave the way for a more equitable and just democracy. Our report, Pocket Change: How Women and Girls of Color Do More With Less, seeks to better understand how they do this work and asks critical questions of philanthropy and donors: How is philanthropy supporting or not supporting women and girls of color? Are philanthropic practices in alignment with the breadth of advocacy and services that women of color-led organizations actually provide? How can we change our practices to center women and girls of color in our giving and hold ourselves accountable?As feminist activists and philanthropists working to advance gender and racial equity, we must grow and expand movements for equity while making space for taking care and healing. Each day brings significant challenges and pressures on women and girls of color, especially indigenous and transgender women. Pocket Change is a data-driven testament to how they rise to these challenges with ingenuity, resilience, fortitude, and integrity. These are unprecedented times, and there are many, many ways to engage in philanthropy and activism. We hope that Pocket Change will provide new tools and a mandate to give more, better, and with greater transparency to our gender and racial justice movements. The model of feminist, trust-based philanthropy that centers women and girls of color is needed now more than ever

Funding to Meet Changing Realities: LGBTI Organisations on the State of Funding in Europe and Central Asia

ILGA-Europe continues our needs assessment work in partnership with Strength in Numbers to make a case to both better align and increase funding for the work of LGBTI organisations in Europe and Central Asia.The first funding needs assessment was done in 2017 with the intention to shine a light on the activities undertaken by LGBTI organisations, particularly those that are underfunded compared to the importance that organisations give to them. The 2021 needs assessment continues this work, with additional intentions to detect changes in the funding landscape, as well as collect additional data about the lived realities of LGBTI activists and organisations operating in the context of COVID-19, and in many countries, anti-LGBTI and/or anti-gender rhetoric, threats and attacks. Ultimately, ILGA-Europe monitors the funding landscape with an eye to moving towards sustainability for LGBTI organisations, ensuring LGBTI people on the ground can access the services they need and are free from discrimination.Where sufficient data are available, it highlights disparities between regions, so donors and activists can be aware of gaps in resources identified by LGBTI activists. ILGA-Europe would like to see the report used as a tool to continue conversations between donors and movements to increase the funding available and align the priorities of donors with the needs and opportunities experienced by LGBTI movements. The report is also intended to reach LGBTI organisations, including ILGA-Europe members, with a view to enhancing our collective understanding of how funding can support the work of our movements

Funding for LGBTI Activism in Europe and Central Asia: Priorities and Access to Resources

ILGA-Europe wanted to learn more about the LGBTI movements' priorities in the rapidly-changing political, social and cultural environment we all find ourselves in. We were particularly curious to understand more about how your work is being resourced.The Funding for LGBTI Activism report distils the survey responses of 287 LGBTI organisations into one publication, written by Erin Howe and Somjen Frazer from Strength in Numbers for ILGA-Europe.Put simply, this report shows where funding is needed and signposts ways for funders to fund LGBTI activists in an ever-more strategic and sustainable way

Exploring How Disparities in Experiences of Violence and Substance Use Between Transgender and Cisgender Students Differ by Gender Expression

This report, Exploring How Disparities in Experiences of Violence and Substance Use Between Transgender and Cisgender Students Differ by Gender Expression, explores how a student's perceived gender expression intersects with their gender identity to inform health risk. A robust and growing set of evidence shows that transgender youth face higher rates of violence, substance use and other negative health outcomes. This report looks at both the rates of negative outcomes within transgender students across three categories of gender expression and also at the disparities (or gaps) between cisgender and transgender students across these categories. We use the categories "perceived feminine", "perceived androgynous" and "perceived masculine" to examine gender expression (see Figure 1 on page 6). We recognize that, with few exceptions, transgender perceived feminine youth are both most likely to experience health risks. Additionally, there are larger gaps between cisgender and transgender perceived feminine youth (compared to the gaps between cisgender and transgender perceived masculine youth or cisgender and transgender perceived androgynous students).Previous research developed by Advocates for Youth details the profound health disparities androgynous students, and transgender students, and particularly transgender students of color, endure relative to their gender conforming and cisgender peers. This project extends the previous work and contributes to answering additional questions about how transgender identity and perceived gender expression interact to explain health risks in violence and substance use

2019-2020 Tracking Report: LGBTQ Grantmaking by U.S. Foundations

The 2019-2020 Resource Tracking Report: Lesbian, Gay, Bisexual, Transgender, and Queer Grantmaking by U.S. Foundations (2022) explores the scope and character of U.S. foundation funding for LGBTQ communities and issues in calendar years 2019-2020. This 18th edition of the tracking report represents the next iteration of work from Funders for LGBTQ Issues in our ongoing effort to document the scale of philanthropic support for LGBTQ communities and issues.The report finds that foundation funding for LGBTQ communities and issues has fallen since its record high in 2018, totaling $193 million in 2019 and$201 million in 2020. This is concerning, as it comes at a time when, according to Giving USA, overall foundation support has soared. For every $100 awarded by U.S. foundations in 2020, only 23 cents specifically supported LGBTQ communities and issues

The Rise of Pregnancy Criminalization: A Pregnancy Justice Report

In 2013, Pregnancy Justice published the first comprehensive national documentation effort capturing pregnancy-related arrests and deprivations of liberty. The 2013 study identified 413 reported cases from 1973 through 2005, arising out of 44 states and the District of Columbia, and involving a range of pregnancy outcomes including abortions, live births, miscarriages, and stillbirths. Overwhelmingly, the cases occurred despite a lack of legal authority, in defiance of numerous and significant appellate court decisions dismissing or overturning such actions, and contrary to the extraordinary consensus across the medical community that prosecution undermines rather than improves maternal, fetal, and child health. In 86% of these cases, pregnant people faced prosecution through the use of existing criminal statutes intended for other purposes.This report begins where the first study left off, documenting cases of pregnancy criminalization from January 2006 until the Dobbs ruling in June 2022. What we found was deeply concerning. Over these 16.5 years, we identified 1,396 cases. In other words, of the 1,800 pregnancy criminalization cases that took place over the last half century, over three-quarters occurred after 2005. Through an alarming combination of carceral approaches to substance use and the spread of fetal personhood laws, state actors have increasingly penalized pregnant people. Understanding this disturbing phenomenon—including who is most affected, how, and under what pretense—will be essential to fighting for pregnant people's liberties as we enter the post-Dobbs era

Histories of forced sex and health outcomes among Southern African lesbian and bisexual women: a cross-sectional study

BACKGROUND: Experiences of forced sex have been shown to be prevalent in Southern Africa. Negative outcomes of forced sex have been documented in general populations of women and men and include alcohol abuse, drug use, mental health problems, mental distress, sexual health problems and poor overall health. This study is the first to examine experiences of forced sex and associated health problems among lesbian and bisexual women in Southern Africa. METHODS: This study is based on data collected as part of a collaborative endeavor involving various Southern African community-based organizations. Lesbian and bisexual women in four Southern African countries participated in a cross-sectional survey, for a total study sample of 591. RESULTS: Nearly one-third of participants had been forced to have sex at some time in their lives. Thirty-one percent of all women reported to have experienced forced sex at least once in their life: 14.9% reported forced sex by men only; 6.6% reported forced sex by women only; 9.6% had had forced sexual experiences with both men and women. Participants experienced forced sex by men as more serious than forced sex by women; forced sex by women was more likely to involve intimate partners compared to forced sex by men. Participants who experienced forced sex by men were more likely to report drug problems, mental distress and lower sense of belonging. Forced sex by women was associated with drinking problems and mental distress. Having experienced forced sex by both men and women was associated with lower sense of belonging to the LGBT community, drug use problem and mental distress. CONCLUSIONS: The findings indicate that forced sex among Southern African women is a serious issue that needs further exploration. Clinicians should be made aware of the prevalence and possible consequences of forced sex among lesbian and bisexual women. Policies and community interventions should be designed to address this problem