Annals of LGBTQ public and population health最新文献

Drinking more than intended is associated with alcohol consequences in the general population, and some risk factors have been identified. However, it is unclear whether these risk factors generalize to sexual and gender minority individuals (SGM) and whether unique SGM risk factors may also contribute to drinking more than intended. Research with the general population has also neglected the examination of using more cannabis than intended and the potential role of substance use motives. We aimed to address these gaps by examining contextual, motivational, and SGM-specific risk factors for using more alcohol or cannabis than intended at the daily level. We used ecological momentary assessment data from 366 sexual minority women and gender diverse individuals assigned female at birth. Social drinking was associated with drinking more than intended, consistent with prior work. Additional novel risk factors also emerged, including social, enhancement, and conformity motives. Several risk factors for drinking more than intended extended to using more cannabis than intended (i.e., social use; social, conformity, enhancement motives), while one cannabis-specific factor emerged (i.e., coping motives). Only one SGM-specific risk factor predicted drinking more than intended (i.e., drinking with SGM). Together, findings highlight several potential targets for interventions aiming to reduce consequences associated with drinking more than intended. For example, interventions may encourage SGM young adults to adjust their protective behavioral strategies so that they would be adequate if they drank more than intended.

Transgender and gender diverse young adults (TGDYA) report higher prevalence of substance use than cisgender peers, but little is known about how patterns of substance use may differ among TGDYA subgroups. Understanding heterogeneity in substance use among TGDYA can inform tailored substance use disorder (SUD) prevention. This study described prevalence of seven types of substance use among TGDYA across various social identities and lived experiences. Data were analyzed from 12,525 TGDYA ages 18-25 years from the 2015 United States Transgender Survey. Participants completed a one-time online survey that assessed multiple substance use outcomes (alcohol use, heavy episodic drinking, marijuana use, cigarette, e-cigarette or vape product use, other illicit drug use, non-medical prescription use), social identity correlates (binary vs. nonbinary gender identity, sex assigned at birth, race/ethnicity, sexual orientation), and covariates/confounders. All social identity correlates were significantly associated with increased use of at least one substance, though directionality of subgroup risk varied. For example, nonbinary respondents were more likely than binary respondents to report some types of substance use (e.g., alcohol), but less likely to report other types (e.g., e-cigarette). All covariates were also significantly associated with increased use of at least one substance, with visual gender-nonconformity and sex work evincing the most consistent associations across substances. Findings demonstrate extensive intracommunity diversity in substance use prevalence among TGDYA. Tailored SUD prevention must account for such diversity, and future research must further quantify the impact of intersecting identities, gendered norms, and socioeconomic context on substance use among TGDYA.

Though prior studies have explored barriers that transgender and nonbinary (TNB) adolescents experience in receiving gender-affirming medical care (GAMC), few have sought to understand how these barriers may differ among racial and ethnic minority groups. Accordingly, this study used data from a survey of TNB young adults (ages 18-20) to explore how barriers to GAMC during adolescence varied by race and ethnicity. T-tests evaluated differences in the impact of 11 potential barriers when comparing members of each racial and ethnic group to those who did not identify with that racial or ethnic group. Results showed that Indigenous respondents indicated that parental unwillingness to consent for GAMC and attend a clinic visit and not being able to find a clinic contributed significantly more compared to those who did not identify as Indigenous. Black respondents indicated that not knowing it was possible to receive GAMC during adolescence and previous negative experiences in healthcare related to race or ethnicity contributed significantly more to their inability to receive GAMC during adolescence compared to those who did not identify as Black. Latine respondents indicated that parental unwillingness to consent for GAMC and attend a clinic visit, worries about cost, and previous negative experiences in healthcare due to race or ethnicity contributed significantly more compared to those who did not identify as Latine. Overall, results suggest disproportionate barriers in access to GAMC during adolescence among Indigenous, Black, and Latine TNB individuals and illustrate a need for additional resources and interventions to promote more equitable access.

Many transgender individuals experience significant barriers to accessing gender-affirming healthcare, and healthcare access and experiences can vary greatly depending on the location. Specifically, transgender individuals in the Southeastern United States may face unique challenges compared with individuals in other geographic regions. However, much of the statewide, regional, and national data on transgender individuals' healthcare experiences is from 2015 or earlier. The present study was conducted to help address this gap in the current research literature. Transgender individuals (n = 747) from the 2019 Southern LGBTQ Health Survey were asked qualitative questions regarding their healthcare experiences. Participants' experiences included themes related to factors affecting healthcare access, including cost, health insurance, urbanicity, and traveling to receive care. Moreover, gender-affirming healthcare and disaffirming healthcare (e.g., affirming language and clinic policies and clinical providers) were prominent themes discussed by participants. Experiences of stigma and discrimination, including anticipated stigma, intersectional stigma and privilege, and decisions around identity disclosure, were also discussed. Findings have direct implications for policy and practice.

Few studies have compared cardiovascular disease (CVD) risk factors in sexual minority and heterosexual adults. It remains unclear whether changes in sexual identity over time are associated with increased CVD risk. The purposes of this longitudinal study were to: 1) compare sex differences in CVD risk factors across sexual identity subgroups, 2) examine CVD risk factors based on changes in sexual identity, and 3) to examine sex-stratified variations in CVD risk factors. Analyses of the Population Assessment of Tobacco and Health (PATH) study data assessed the longitudinal association of changes in sexual identity with self-reported CVD risk factors (alcohol misuse, cigarette smoking, sedentary behavior, high cholesterol, high blood pressure, obesity). Based on changes in sexual identity between baseline/wave 1 and wave 5, 91.7% (n = 15884) of the sample were heterosexual-stable, 1.1% (n = 265) were gay/lesbian-stable, and 0.8% (n = 265) bisexual-stable. Less than two percent (1.5%; n = 376) indicated one heterosexual (sexual majority)-to-sexual minority change, 1.4% (n =299) reported one sexual minority-to-heterosexual change, 0.7% (n= 202), one or more sexual minority-to-sexual minority changes, 1.4% (n = 345) heterosexual-to-sexual minority-to-heterosexual change, and 1.3% (n = 365) indicated two or more changes with no distinct pattern. Among women, two or more changes in sexual identity with no distinct pattern were associated with increased odds of past 30-day alcohol misuse compared to heterosexual-stable women. Associations between changes in sexual identity and alcohol misuse among women suggest the need for greater screening among healthcare providers who work with this population.