Psychosocial Problems Associated With Homelessness in Sexual Minority Youths

Sexual minorities are overrepresented among homeless youths, and this is often related to reactions to their status as sexual minorities. While on the streets, they are at increased risk for victimization, substance and alcohol use, sexual risk behaviors, and mental health issues compared to homeless heterosexual youths. This article uses ecological systems theory to examine psychosocial problems associated with homelessness among sexual minority youths and reviews empirical literature examining outcomes related to homeless sexual minority youths including mental health, substance use, and sexual risk behavior. Implications for social work are discussed including practice, policy, and suggestions for future studies.     

Gender Minority Social Stress in Adolescence: Disparities in Adolescent Bullying and Substance Use by Gender Identity

Bullying and substance use represent serious public health issues facing adolescents in the United States. Few large-sample national studies have examined differences in these indicators by gender identity. The Teen Health and Technology Study (N = 5,542) sampled adolescents ages 13 to 18 years old online. Weighted multivariable logistic regression models investigated disparities in substance use and tested a gender minority social stress hypothesis, comparing gender minority youth (i.e., who are transgender/gender nonconforming and have a gender different from their sex assigned at birth) and cisgender (i.e., whose gender identity or expression matches theirs assigned at birth). Overall, 11.5% of youth self-identified as gender minority. Gender minority youth had increased odds of past-12-month alcohol use, marijuana use, and nonmarijuana illicit drug use. Gender minority youth disproportionately experienced bullying and harassment in the past 12 months, and this victimization was associated with increased odds of all substance use indicators. Bullying mediated the elevated odds of substance use for gender minority youth compared to cisgender adolescents. Findings support the use of gender minority stress perspectives in designing early interventions aimed at addressing the negative health sequelae of bullying and harassment.     

Mostly Heterosexual and Lesbian/Gay Young Adults: Differences in Mental Health and Substance Use and the Role of Minority Stress

Individuals mostly attracted to other-sex but also to same-sex partners are a distinct and common sexual orientation group with possibly increased levels of health problems. The current study examined whether mostly heterosexual individuals differed in mental health and substance use from lesbian/gay individuals and whether sexual minority risk and protective factors offer an explanation in a sample of 528 Dutch young adults (16 to 25 years old, M = 21.2 years). Mostly heterosexual participants reported higher levels of psychological distress, suicidality, drug use, and smoking than lesbian/gay participants and equal levels of binge drinking. They also reported higher levels of internalized negativity to same-sex attractions, less openness to family members and others, less community involvement, and lower numbers of lesbian/gay/bisexual friends. However, bootstrapped mediation analysis showed that the differences in minority stress risk and protective factors did not mediate most of the differences in mental health and substance use with one exception: higher levels of psychological distress were mediated by the higher levels of internalized negativity to same-sex attractions. The limited explanatory power of the minority stress factors combined with the elevated level of problems of mostly heterosexual individuals call for future studies examining other risk and protective factors.     

Differentiating the Social Service Needs of Homeless Sexual Minority Youths from those of Non-homeless Sexual Minority Youths

While homeless youths and sexual minority youths are at greater risk for negative life experiences, and homeless sexual minority youths are at greater risk than homeless heterosexual youths, little is known about the differential risks for homeless sexual minority youths compared to non-homeless sexual minority youths. Using a sample of 187 sexual minority youths from a community-based social service agency in Denver, Colorado, the findings of this study suggest that homeless sexual minority youths are at greater risk for victimization, mental health issues, substance abuse, and illegal or dangerous activities than their non-homeless counterparts. Implications for social work practice and social service provision are discussed.     

Minority Stress and Stress Proliferation Among Same‐Sex and Other Marginalized Couples

Drawing from 2 largely isolated approaches to the study of social stress—stress proliferation and minority stress—the authors theorize about stress and mental health among same‐sex couples. With this integrated stress framework, they hypothesized that couple‐level minority stressors may be experienced by individual partners and jointly by couples as a result of the stigmatized status of their same‐sex relationship—a novel concept. They also consider dyadic minority stress processes, which result from the relational experience of individual‐level minority stressors between partners. Because this framework includes stressors emanating from both status‐based (e.g., sexual minority) and role‐based (e.g., partner) stress domains, it facilitates the study of stress proliferation linking minority stress (e.g., discrimination), more commonly experienced relational stress (e.g., conflict), and mental health. This framework can be applied to the study of stress and health among other marginalized couples, such as interracial/ethnic, interfaith, and age‐discrepant couples.     

Gay Affirmative Cognitive Behavioral Therapy for Sexual Minority Youth: A Clinical Adaptation

Sexual minority youth (SMY) are at high risk for negative mental health outcomes such as depression, anxiety, substance abuse, and suicidality. However, there has been a disconnect between clinical social work practice and research with SMY, resulting in a lack of rigorous research that demonstrates the use of effective interventions. While cognitive behavioral therapy (CBT) has long been established as a best practice option for the general adolescent population suffering from mental health problems, knowledge about the use of CBT with SMY lags far behind. Thus, the purpose of this article is to present a clearly defined adaptation of CBT for SMY that integrates gay affirmative practices for youth (e.g., coming out, stigma and discrimination, the role of social support and community). Specifically, the authors: (a) discuss the impact of minority stress on SMY; (b) highlight the specific components of CBT that represent a good fit for SMY and also address the criticisms of using such an approach; (c) consider the importance of using gay affirmative practices with SMY; and (d) offer recommendations for incorporating gay affirmative practices into traditional CBT models to better meet the needs of SMY.     

Risk and Protective Factors Associated with Personal Mastery Among Sexual Minority African-American Female Sex Workers

Research among sexual minorities has traditionally examined problems such as substance use, HIV risk, mental health problems, and victimization. Among sexual minority street-based female sex workers, these vulnerabilities can be magnified. Grounded in theories of resilience, this study examines risk and protective factors associated with a high level of personal mastery among a vulnerable population of women. Data are drawn from baseline interviews from street-based African-American female sex workers enrolled in a randomized intervention trial in Miami, Florida. We compare sexual minority (N = 197) and heterosexual (N = 365) women on measures of risk and protective factors; among sexual minority women we present logistic regression analyses which reveal that severe mental distress and HIV transmission risk are associated with low levels of personal mastery, while protective factors of transportation access and social support are associated with high levels of personal mastery. These findings suggest that these protective factors may potentially facilitate the development of personal mastery and represent beneficial avenues for intervention efforts.     

Marginalized within the Margins: Minority Stress and Identity Centrality

Research documents how identity linked processes may have important health implications for people with marginalized or stigmatized identities. While previous work suggests that certain dimensions of identity may moderate the impact of minority stressors to wellbeing, work on identity centrality has yielded mixed findings about the directionality of the relationship between centrality and health. Given the importance of identity centrality on self-concept, this study highlights how differential exposure to minority stressors matters for identity construction. Drawing from 25 in-depth interviews on Black and Latino/a sexual minority adults, I examine perceptions of identity centrality and exposure to minority stressors. There are three key findings to highlight. First, results present evidence of intra-group variability in identity centrality. Second, results indicate that differential exposure to minority stress matters for perceptions of identity centrality. Finally, results note that differentiating between stigma and race related stressors is necessary to better understand experiences of minority stress.     

Minority Stress Theory: An Examination of Factors Surrounding Sexual Risk Behavior Among Gay and Bisexual Men Who Use Club Drugs

Background: Few studies have examined the impact of minority stress theory (MST) upon sexual risk behavior among gay and bisexual men using club drugs. Similar studies have focused on ethnic minorities and women; however, gay and bisexual men demonstrate greater likelihood for risk behaviors leading to HIV/AIDS. Objective: This study examines sexual risk behavior from the perspective of minority stress theory upon substance-using gay and bisexual men and their partners. Methods: Multivariable logistic regression analysis examined minority stress associations with participant sexual risk behaviors, drug use, and partner type, controlling for demographics. Results: 396 gay and 54 bisexual respondents, ages 18–67, reported at least one-time drug use while engaging in sexual risk behavior. In the adjusted model, expectations of rejection associated with lower odds of sexual risk behavior, while older age approached significance. Conclusions: Theoretical origins for examining risk behavior among gay and bisexual men may underscore risk and protective factors, while ultimately holding implications for prevention and treatment interventions.     

Mental Health Service Delivery to Sexual Minority and Gender Non-Conforming Students in Schools: A Winnicottian Approach

Current research highlights the increased risk factors that sexual minority (lesbian, gay, bisexual) and gender minority (transgender/gender non-conforming) students face as compared to their heterosexual and cisgender peers. These risk factors include higher rates of depression, suicide, substance use, school dropout, sexually transmitted infections, experiences with bullying on school campuses and increased risk of homelessness. Although this research has aided our understanding of the needs and risks of this population of youth, few articles have emerged from these data which offer a comprehensive theoretical approach to work clinically with these adolescents in school-based settings. This article explores how school mental health staff can address the behavioural health needs of sexual and gender minority students through the adoption of a Winnicottian theoretical approach. With an intensive focus on academic achievement, schools have historically been limited in their usage of evidence-based data to create programs which adequately address the mental health needs of student populations on their campuses. Yet, sexual and gender minority students are likely to be present in almost every school in the country. Schools can serve as gateways to mental health access and can offer innovative and culturally responsive practices across racial, ethnic, class, and geographic lines. As the single largest holders of the student population in the United States, schools have the ability to play a significant role in mental health service provision for sexual and gender minority youth.     

Associations of Bisexual-Specific Minority Stress and Health Among Cisgender and Transgender Adults with Bisexual Orientation

Among sexual minorities, bisexuals are at the greatest risk for poor health due in part to prejudice and stigma. This research examined associations of bisexual-specific minority stress and health among cisgender (non-transgender) and transgender adults with bisexual orientation. Participants were 488 adults (378 cisgender women, 49 cisgender men, 61 transgender individuals), age 18 to 66 years, with bisexual orientation based on identity and/or attractions to multiple genders. Participants completed an online survey. Hierarchical linear regression analyses were conducted with sexual minority stress and bisexual-specific minority stress as the predictors and physical health, measured by the 36-Item Short Form Survey (SF-36), as the outcome. Models controlled for demographic variables. Moderation analyses were conducted to test for gender differences. Greater bisexual-specific minority stress significantly predicted poorer overall physical health (β = ?0.16), greater pain (β = ?0.16), and poorer general health (β = ?0.25) above and beyond the effects of sexual minority stress. Gender moderated the association between bisexual-specific minority stress and health, such that bisexual-specific minority stress predicted overall physical health and role limitations for transgender individuals but not for cisgender women. Addressing bisexual-specific minority stress is necessary to improve the health and well-being of bisexual individuals.     

Ethnic Minority Families and Minority Gays and Lesbians

Attitudes toward sexuality differ within the diverse ethnic and racial communities that exist in the U.S., and the cultural values and beliefs surrounding sexuality play a major role in determining how individuals behave within their sociological context. The family unit is the domain where such values and beliefs are nurtured and developed. An individual's value system is shaped and reinforced within the family context which usually reflects the broader community norms. Disclosure of a gay or lesbian sexual preference and lifestyle by a family member presents challenges to ethnic minority families who tend not to discuss sexuality issues and presume a heterosexual orientation. For ethnic minority gays and lesbians the "coming out" process presents challenges in their identity formation processes and in their loyalties to one community over another. Ethnic gay men and lesbians need to live within three rigidly defined and strongly independent communities: the gay and lesbian community, the ethnic minority community, and the society at large. While each community provides fundamental needs, serious consequences emerge if such communities were to be visibly integrated and merged. It requires a constant effort to maintain oneself in three different worlds, each of which fails to support significant aspects of a person's life. The complications that arise may inhibit one's ability to adapt and to maximize personal potentials. The purpose of this paper is to examine the interaction and processes between ethnic minority communities and their gay and lesbian family members. A framework for understanding the process of change, that occurs for the gay or lesbian person as they attempt to resolve conflicts of dual minority membership, is presented. Implications for the practitioner is also discussed.     

Traumatic Experiences and Drug Use by LGB Adolescents: A Critical Review of Minority Stress

High rates of illicit drug use found among lesbian, gay, and bisexual (LGB) adolescents are often attributed to unique and chronic traumatic events tied to sexual minority identity. Although initiation of drug use is relatively common within adolescence, little research contributes to our understanding of the disparities found among LGB adolescents. This review synthesized existing literature to determine if the minority stress model is applicable to LGB drug use disparities and fits within a trauma framework. Findings indicate that minority stress experiences have been inconsistently related to drug use among LGB adolescents. Implications for future research and practice are described.     

Blending Prevention Models: An Effective Substance Use and HIV Prevention Program for Minority Youth

Illicit drug use and rates of HIV infection among youth have increased over the past decade, indicating the need effective substance use and HIV prevention programs. Particularly at risk are minority youth living in poor urban environments. This study examines effectiveness of an innovative prevention program that blends the “All Star” substance abuse prevention model with the “Popular Opinion Leader” model for HIV prevention. In general, the results indicate non-significant increases in drug and sex risk, behavior and significant positive changes and trends in related areas (i.e., changes in perception, self esteem) thought to be related to drug use and risky sexual behavior.Sally Stevens and Velia Leybas-Amedia are affiliated with the Southwest Institute for Research on Women, University of Arizona. Beth Bourdeau is affiliated with the Pima Prevention Partnership, Tucson, AZ. Lovelle McMichael and Alan Nyitray are affiliated with the Southern Arizona AIDS Foundation, Tucson, AZ. Financial assistance for this project was provided by the Substance Abuse and Mental Health Service Administration, Center for Substance Abuse Prevention Grant# SP08916. The opinions expressed herein are those of the authors and do not reflect official positions of the government. The Southern Arizona AIDS Foundation and the authors would like to acknowledge the staff at the Tucson Urban League Academy Charter School and Luz Social Services Charter School for their assistance and support of the Check Yourself Youth Team prevention project.     

Support,Discrimination, and Alcohol Use Among Racially/Ethnically Diverse Sexual Minority Youths

Rates of alcohol use for sexual minority youths are nearly twice that of their heterosexual peers, yet specific risk and protective factors associated with alcohol use among sexual minority youths remain unclear. Structural equation modeling is used to examine relations among alcohol use, peer and family support, and discrimination among 207 diverse sexual minority youths. Discrimination had no relationship to alcohol use; however, it was negatively associated with peer and family support. Peer support was associated with greater alcohol use among bisexual youths. This study adds to our understanding of the roles of discrimination, social support, and alcohol use among diverse sexual minority youths.     

Testing the Model Minority Stereotype: Youth Behaviors across Racial and Ethnic Groups

Using data from a large nationally representative sample of adolescents attending school, this study tests the stereotype that youth of Asian Pacific Islander ethnicity (API) are the model minority. The results suggest that, except for substance use, API American youth do not report fewer delinquent behaviors than white youth; in fact, API American youth report slightly higher numbers of aggressive offenses than white youth, and female API American youth report greater numbers of nonaggressive offenses than white female youth. Also, API American youth report higher rates of nonaggressive offenses and substance use than do black youth. The mental health and social service needs of API American youth are thus at least as great as those of white youth. The need for such services increases with the length of residency in the United States.     

Sexual Minority Women and Alcohol: Intersections between drinking, relational contexts, stress and coping

Few studies explore sexual minority women's experiences and perceptions of alcohol. Qualitative interviews were conducted with six sexual minority women who reported having sought help for alcohol problems in the past and six who did not. Themes emerged in two broad areas: stressors that contributed to heavy or problem drinking and factors that enhanced coping and reduced both stress and problem use. Alcohol use across groups was framed in terms of social context (e.g., bar patronage), stress management, and addiction. The findings of the study underscore the importance of considering the role of alcohol in managing stress as well coping factors that may inform social service interventions.     

Distressing Sexual Difficulties in Heterosexual and Non-Heterosexual Croatian Men: Assessing the Role of Minority Stress

Although research has shown a connection between minority stressors and internalizing mental health problems, the role of minority stress has mainly been neglected in the assessment of sexual problems among non-heterosexual men. Using online samples of heterosexual (n = 933) and non-heterosexual participants (n = 561) aged 18 to 50 years, this study aimed to comparatively assess sexual difficulties and problems and explore the role of minority stress in non-heterosexual men's sexual problems. Although the age-adjusted odds of reporting rapid ejaculation, delayed ejaculation, and sex-related anxiousness significantly differed between the two groups, the overall prevalence of sexual difficulties and the associated levels of distress did not significantly differ between the samples. In multivariate assessment, anxiety and depression significantly increased the odds of reporting distressing sexual difficulties among both heterosexual and non-heterosexual participants. In the non-heterosexual sample, positive body image significantly decreased the odds of experiencing sexual problems. Pointing to a role of minority stress, highest levels of victimization related to sexual orientation increased the risk of sexual problems. This association was partially mediated by negative emotions. Our findings offer some support for a recent call to include sexual orientation among the social determinants of health recognized by the World Health Organization.     

The Role of Stress,Family Coping,Ethnic Identity,and Mother-Daughter Relationships on Substance Use Among Gang-Affiliated Hispanic Females

ABSTRACT

Hispanic adolescent females are the largest group of minority adolescents in the nation and appear to be at great risk for substance use. This research is based on data generated from a cross-sectional study of 150 Mexican American gang-affiliated adolescent females to predict substance-use recurrence. Findings reveal that positive family relationships, and in particular, mother-daughter relationships are protective factors for alcohol- and tobacco-use recurrence. Furthermore, the ability of the immediate family to cope with difficulties, stress, and conflicts were significant in averting illicit drug recurrence. This research provides evidence of the role of the family as a protective factor among these adolescents, despite their gang affiliation and street orientation. Discussed is how these findings contribute to formulating effective intervention, prevention, and treatment responses aimed at this “beyond risk” population.