COVID-19 Concerns, Coping and Perceived Peer Norms: Correlates of Increased Alcohol and Marijuana Use Among Sexual Minority Women.

This study explored the impact of COVID-related concerns and other characteristics on alcohol and marijuana use among sexual minority women (SMW). Survey data from a racially/ethnically diverse sample of 338 SMW participants in the Chicago Health and Life Experiences of Women (CHLEW) study were used to examine correlates of three substance use outcomes: frequent intoxication (once a month or more), perceived increase in alcohol use, and perceived increase in marijuana use. Coping motives for alcohol use was positively associated with each of the substance use outcomes. Belief that peers (in terms of age, sexual identity, and gender) used alcohol often to cope was associated with higher odds of frequent intoxication. COVID-19 related financial concerns were positively associated with both frequent intoxication and increased marijuana use. Health and mental health concerns were associated with lower odds of frequent intoxication. Findings underscore the importance of enhancing coping skills, addressing perceived peer coping norms, and providing both economic and social support in intervention efforts.

Examining perceived effects of same-sex marriage legalization among sexual minority women: Identifying demographic differences and factors related to alcohol use disorder, depression, and self-perceived health.

Background: Reductions in structural stigma, such as gaining access to legalized same-sex marriage, is associated with positive psychological and physical health outcomes among sexual minorities. However, these positive outcomes may be less robust among sexual minority women (SMW). Methods: This study examined how perceptions of the impact of legalized same-sex marriage among SMW may 1) differ by demographic characteristics and 2) predict alcohol use disorder, depression, and self-perceived health. A diverse sample of SMW (N=446) completed an online survey in 2020 assessing the perceived impact of legalized same-sex marriage across six social-ecological domains: 1) personal impact, 2) stigma-related concerns, 3) couple impact, 4) family support, 5) work/school impact, and 6) local social climate towards LGBTQ people. Results: Perceived impact across multiple domains differed by relationship status and sexual identity (e.g., lesbian compared to bisexual identity); only family support differed by race/ethnicity. Stigma-related concerns (e.g., experiencing or witnessing hostility or discrimination because of sexual identity, despite legalized same-sex marriage) were associated with greater odds of depression and lower odds of reporting excellent, very good, or good health. Odds of depression were lower among participants who reported higher personal impact, a greater number of family members supportive of same-sex marriage, and a more positive local social climate. Family support also predicted self-perceived health. However, participants who perceived increased support in work/school contexts after legalized same-sex marriage had higher odds of alcohol use disorder. Conclusions: Overall, findings underscore the importance of policy in improving health outcomes through reducing stigma-related concerns and improving social acceptance.

Corrigendum to 'Impact of the policy environment on substance use among sexual minority women'.

[This corrects the article PMC9262325.].

Examining the differential protective effects of women's spirituality and religiosity on alcohol and marijuana use by sexual identity.

The current study explored how religiosity and spirituality may differentially influence substance use by sexual identity based on a sample of adult sexual minority women (SMW; n = 437 lesbian; n = 323 bisexual) relative to a heterosexual comparison sample (n = 636). We examined three questions: (1) whether spirituality was differentially associated with alcohol and marijuana use by sexual identity; (2) whether religiosity was differentially associated with alcohol and marijuana use by sexual identity; (3) whether observed differences between spirituality or religiosity and substance use by sexual identity persisted after adjusting for religious environment. Measures included spirituality (importance of spirituality), religiosity (importance of religion, attending religious services), and past year substance use (alcohol use disorder [AUD], any marijuana use, and regular marijuana use). Higher levels of spirituality were associated with increased odds of AUD among both lesbian and bisexual respondents relative to heterosexuals. Higher levels of religiosity among lesbian participants were associated with increased odds of AUD relative to heterosexuals with higher levels of religiosity. Consistent with theories of minority stress, findings suggest that spirituality and religiosity are less protective for SMW than heterosexual women and, in some cases, may contribute to greater risk of substance use.

Impact of the policy environment on substance use among sexual minority women.

Background: Sexual minority women (SMW) are at greater risk for heavy episodic drinking, frequent marijuana use, and tobacco use than heterosexual women. Because past research has suggested the political and social environment may influence disparities in substance use by sexual orientation, this study examined associations of the U.S. state-level policy environment on substance use by SMW. Methods: A total of 732 SMW participants were recruited from two national online panels: a general population panel (n = 333) and a sexual minority-specific panel (n = 399). Past year substance use was defined by number of days of heavy episodic drinking (HED; 4+ drinks in a day), weekly tobacco use (once a week or more vs. less or none), and weekly marijuana use (once a week or more vs. less or none). Comprehensive state policy protection was defined by enactment of five policies protecting rights of sexual minorities. Regression models compared substance use outcomes for SMW living in states with comprehensive policy protections to SMW living in states with fewer or no protections. Models also assessed the impact of state policies related to alcohol (state monopoly on alcohol wholesale or retail sales), tobacco (state enactment of comprehensive smoke-free workplace laws) and marijuana (legalization of purchase, possession, or consumption of marijuana for recreational use). Results: Comprehensive policy protections were associated with fewer HED days. Recreational marijuana legalization was associated with higher odds of weekly use. Conclusions: Findings underscore the importance of policy protections for sexual minorities in reducing substance use, particularly HED, among SMW.

Comparing substance use outcomes by sexual identity among women: Differences using propensity score methods.

BACKGROUND: Differences in alcohol, tobacco, and other drug (ATOD) use by sexual identity vary across samples of women recruited using different sampling methods. We used propensity score (PS) weighting methods to address two methodological questions: (1) Do disparities between sexual minority women (SMW) and heterosexual women persist when differences in risk and protective factors are similarly distributed between groups, and (2) Does accounting for SMW-specific resiliency factors impact differences between non-probability samples of SMW? METHODS: Four samples included SMW from a longitudinal study with a nonprobability sample (n = 373), a national general population panel sample (n = 373), and a national LGBTQ-specific panel sample (n = 311), as well as a national probability sample of heterosexual women (n = 446). Between-groups analyses using double-robust PS weighted models estimated differences in ATOD use under hypothetical conditions in which samples have similar risk and protective factors. RESULTS: After PS weighting, imbalance in confounders between SMW and heterosexual samples was substantially reduced, but not eliminated. In double-robust PS weighted models, SMW samples consistently had significantly greater odds of drug use than heterosexuals, with odds from 8.8 to 5.6 times greater for frequent marijuana use and 4.8-3.2 greater for other drug use. Few differences between SMW samples in ATOD outcomes or other variables remained after PS weighting. CONCLUSION: Relative to heterosexual women, disparities in marijuana and other drug use among SMW are evident regardless of sampling strategy. The results provide some reassurance about the validity of large nonprobability samples, which remain an important recruitment strategy in research with SMW.

Drug-facilitated sexual assault, impaired trauma memory, and implications for mental health treatment.

Background: Sexual assault (SA) is a highly prevalent global public health problem and a robust predictor of posttraumatic stress disorder (PTSD), substance use disorder (SUD), and suicidality. A large percentage are drug or alcohol facilitated (DFSA), impairing trauma memory and affecting the application of evidence-based treatments. Despite these problems, few have investigated DFSA-specific mental health (MH) needs. Objective: Goals of this study were (1) to identify psychological sequelae characterizing DFSA towards explaining why symptoms have been treatment-refractory, comparing survivors with involuntary substance ingestion (forced, covert: DFSA-I), voluntary ingestion (DFSA-V), and non-DFSA; and (2) to determine how impaired trauma memory relates to the development of PTSD and depression symptoms. Method: Data from a retrospective chart review of 74 adults receiving SA MH services at an outpatient trauma center are presented. The sample includes a 2-year cohort seen acutely at an urban rape treatment center. The study is one of the first to examine therapy records beyond case studies for DFSA. Logistic, Poisson, and negative binomial regression analyses of quantitative data and qualitative thematic analysis of trauma cognitions and treatment foci were conducted. Results: DFSA-V had five times greater odds of SUD, and notable substance-related self-blame compared to DFSA-I. DFSA-I had prominent relationship distress and self-blame for missing danger of perpetrator drugging. Survivors with impaired trauma memory had significantly fewer hyper-arousal and overall PTSD symptoms, and specifically less hypervigilance. No differences were found in re-experiencing symptoms. Conclusion: Impaired trauma memory is common in DFSA and is associated with fewer baseline hyper-arousal and overall PTS. Despite this, DFSA issues including re-experiencing symptoms that are particularly distressing without the ability to cognitively connect the intrusions contribute to increased treatment needs. Impaired memory limits the application of evidence-based treatments, and collectively these findings call for the development of trauma-specific treatment protocols to enhance recovery for DFSA survivors. HIGHLIGHTS: Survivors of drug-facilitated sexual assault have prominent PTSD including reexperiencing, though trauma memory may not be encoded. • Those absent trauma memory have less hyperarousal, but DFSA complications explain why it is treatment refractory and inform treatment development.

Antecedentes: La agresión sexual (AS) es un problema de salud pública mundial de alta prevalencia y es un sólido predictor del trastorno de estrés postraumático (TEPT), del trastorno por uso de sustancias (TUS) y de suicidalidad. Un gran porcentaje de AS son facilitadas por drogas o alcohol (ASFDA), deteriorando la memoria del trauma y afectando la aplicación de tratamientos basados en la evidencia. A pesar de estos problemas, pocos han investigado las necesidades de salud mental (SM) específicas de los ASFDA.Objetivo: Los objetivos de este estudio fueron; primero, identificar las secuelas psicológicas que caracterizan a las ASFDA para explicar por qué los síntomas han sido refractarios al tratamiento. Para ello, se comparó a sobrevivientes a una ingestión involuntaria de sustancias (forzada, encubierta: ASFDA-I), a una ingestión voluntaria (ASFDA-V), y a una AS no-ASFDA; y, segundo; determinar cómo el deterioro de la memoria del trauma se relaciona con el desarrollo de síntomas del TEPT y depresión.Método: Se presentan los datos de una revisión retrospectiva de las historias clínicas de 74 adultos que recibieron servicios de SM por AS en un centro de trauma para pacientes ambulatorios. La muestra incluye a una cohorte de 2 años en donde los casos de AS fueron vistos de forma aguda en un centro urbano de tratamiento para violación. El estudio es uno de los primeros, más allá de los estudios de casos, en examinar los registros de terapia por ASFDA. Se realizaron análisis de regresión logística, Poisson y binomial negativa de datos cuantitativos y un análisis temático cualitativo de las cogniciones del trauma y los puntos clave del tratamiento.Resultados: Los ASFDA-V tuvieron cinco veces más probabilidades de TUS y de un notable sentimiento de culpa relacionado con las sustancias comparado con los ASFDA-I. Las ASFDA tenían problemas de relación importantes y sentimientos de culpa por haber pasado por alto el peligro de que el agresor se drogara. Los sobrevivientes con deterioro de la memoria traumática tuvieron significativamente menos síntomas de hiperactivación y del TEPT en general y, específicamente, menos hipervigilancia. No se encontraron diferencias en los síntomas de reexperimentación.Conclusión: El deterioro de la memoria traumática es común en las ASFDA y se asocia con menos hiperactivación de base y síntomas postraumáticos en general. A pesar de esto, los problemas de los ASFDA incluyen a los síntomas de reexperimentación que son particularmente angustiantes y que restan la capacidad de conectar cognitivamente las intrusiones, por lo que contribuyen a aumentar las necesidades de tratamiento. El deterioro de la memoria limita la aplicación de tratamientos basados en la evidencia y, en conjunto, estos hallazgos exigen el desarrollo de protocolos de tratamiento específicos para trauma para mejorar la recuperación de los sobrevivientes a las ASFDA.

Female-Perpetrated Sexual Violence: A Survey of Survivors of Female-Perpetrated Childhood Sexual Abuse and Adult Sexual Assault.

Individuals who experience female-perpetrated sexual assault (FPSA) are underrepresented in the sexual victimization literature. Much of the existing research on FPSA centers on child welfare-involved families and convicted or incarcerated female sexual offenders, with limited research devoted to victims of FPSA. The current study included a diverse sample of 138 community adults who experienced one or more incident of FPSA, and sought to (a) describe individuals who experienced FPSA, including their overall trauma exposure, (b) describe perpetrator age and relationship to the respondent, (c) explore whether respondents labeled FPSA as sexual assault and disclosed it to others, and (d) examine the prevalence of depressive and posttraumatic symptoms in this population. Of the respondents, 61.6% experienced childhood FPSA, 18.8% experienced adulthood FPSA, and 19.6% experienced both childhood and adulthood FPSA. Survivors of FPSA were highly trauma exposed; 71.7% reported a male-perpetrated victimization, over 90% reported any childhood sexual abuse, over 60% reported any adulthood victimization, 55.1% reported victimizations in both childhood and adulthood, and 78.3% endorsed any revictimization. Perpetrators of FPSA were often known individuals, including friends, family members, babysitters, and romantic partners. Incidents of female perpetrators co-offending with males accounted for only 5.5%-8.5% of FPSA events, contrary to myths about female offending. Incidents of FPSA were often labeled as sexual assault in retrospect, but only 54.3% of respondents ever disclosed an incident of FPSA. Depressive and posttraumatic symptoms were common. Results indicate FPSA is typically perpetrated by individuals acting alone who are known to and close to the victim. Incidents of FPSA may not be labeled as sexual abuse or assault at the time of the event, are not frequently disclosed, and may carry long-term mental health consequences for survivors. Significant research efforts are needed to better identify and help these underrecognized, highly trauma burdened survivors of violence.

Experiences of the COVID-19 Pandemic Among African American, Latinx, and White Sexual Minority Women: A Descriptive Phenomenological Study.

From a systems perspective, the COVID-19 pandemic has caused global changes impacting the lives of individuals at all levels of interactions. Qualitative in-depth interviews were conducted with a sample of 18 African-American/Black, Hispanic/Latina/Latinx, and White sexual minority women (SMW) to explore experiences and adaptations during the COVID-19 pandemic. Interviews were analyzed using a descriptive phenomenological approach to understand how the complex and changing contexts of the pandemic impacted participants' lives. Analyses revealed participants were impacted in the context of their sexual identity in their experiences of coming out and being visible; creating social bubbles; their connection to the LGBTQ community; and dating. The pandemic, which took place concurrently with major political events including Black Lives Matter demonstrations and protests against police and White supremacist violence against people of color, resulted in additional impacts on Black and Latinx SMW related to safety, dialogues about race, and on-going systemic and cultural racism. Interviews also revealed general challenges in the areas of relationships, including with a partner and family; employment and the workplace; and interactions in public spaces. The findings underscore the importance of understanding the diverse range of experiences and impacts of the pandemic on SMW, including experiences related to their sexual identity and racial/racialized identity, as well as general experiences that may have additional consequences for SMW, and supports needed to help alleviate the negative impacts in the short and long-term.

Measuring the impact of legal recognition of same-sex marriage among sexual minority women.

Reductions in structural stigma, such as gaining access to legalized same-sex marriage, is associated with positive psychological and physical health outcomes among sexual minority adults. However, these positive outcomes may be less robust among sexual minority women (SMW; e.g., lesbian, bisexual, queer) than sexual minority men and new measures are needed to develop a more nuanced understanding of the impact of affirming policies on the health and well-being of SMW. This study assessed the psychometric properties of measures developed to assess the psychosocial impacts of legalized same-sex marriage on the lives of SMW. Participants (N=446) completed an online survey assessing the psychosocial impact of legalized same-sex marriage in five domains: 1) personal impact, 2) stigma-related concerns, 3) couple impact, 4) LGBTQ community impact, and 5) political/social environment. Psychometric properties of the scales were examined using traditional and Rasch analyses. Personal, concerns, couple, and political/social environment scales demonstrated high internal consistency (α > 0.80), and acceptable levels of reliability even when scales reduced to five items each. The LGBTQ community scale demonstrated adequate internal consistency (α = 0.79) and could only be reduced to 9 items. These scales may be useful in future studies of SMW health and well-being.

Understanding Alcohol and Marijuana Use among Sexual Minority Women during the COVID-19 Pandemic: A Descriptive Phenomenological Study.

Sexual minority women (SMW; e.g., lesbian, bisexual, queer) are at increased risk for heavy/hazardous drinking and marijuana use, which may be exacerbated by stress associated with the COVID-19 pandemic and efforts to mitigate its spread (e.g., sheltering at home). To explore their experiences and perceptions of alcohol and marijuana use in the context of COVID-19, qualitative in-depth interviews were conducted with a diverse sample of 16 SMW from a longitudinal study who previously reported being at least moderate drinkers to explore their experiences and perceptions of alcohol and marijuana use during the pandemic. We used descriptive phenomenological analysis to explore data from the interviews. Participants described how their alcohol/marijuana use intersected with the complex and changing context of the pandemic, revealing four themes: 1) losing and creating routine; 2) seeking recreation and relief; 3) connecting, reconnecting, and disconnecting; and 4) monitoring alcohol and marijuana use boundaries. Findings highlight the importance of fostering community supports and possible interventions informed by the experiences of SMW.

The Impact of Peer and Family Functioning on Transgender and Gender-Diverse Children's Mental Health.

Although high levels of internalizing and externalizing psychopathology have been documented among transgender and gender-diverse (TGD) youth, contextual factors influencing the development of psychopathology among TGD children are relatively understudied. The current study tested the interaction between two relational factors, children's caregiver-reported peer relations and family functioning, on TGD children's internalizing and externalizing symptoms. The sample consisted of 49 primary caregivers of TGD children, who were age 6-12 at baseline. A cross-sectional path analysis was run to test the relations between peer relations, family functioning, and their interaction on internalizing and externalizing symptoms. A longitudinal path analysis was run to test the relations between variables over time. In the cross-sectional model, among families with adequate family functioning, peer problems were associated with greater internalizing symptoms. Among families that were functioning poorly, there was not a significant relationship between peer problems and internalizing symptoms. Further, among children who did not experience peer problems, poorer family functioning was associated with greater internalizing symptoms. Peer problems, but not family functioning or the interaction term, was associated with externalizing symptoms. Longitudinal analyses did not support the hypothesis of an interaction between peer relations and family functioning. The current research indicated that poor peer relations and poor family functioning each confer risk for internalizing symptoms among TGD children, and poor peer relations carries risk for externalizing symptoms among TGD youth.

Trans and gender-nonconforming children and their caregivers: Gender presentations, peer relations, and well-being at baseline.

This study, involving a community-based sample of 45 predominantly white primary caregivers of 45 trans and gender-nonconforming (TGNC) children between 6 and 12 years of age, provides descriptive data on children's gender presentations, peer relations, and well-being. Most (n = 31; 69%) of the children were cross-gender identified (CGI). That is, 17 of 28 children assigned male at birth explicitly and consistently identified as girls, and 14 of 17 children assigned female at birth explicitly and consistently identified as boys. The 14 remaining children appeared to have nonbinary gender identities (e.g., "boy-girl") or to identify with the sex and gender they were assigned at birth but were gender-nonconforming, or their gender identities were uncertain. This subgroup was labeled non-CGI. Most of the children were in the normal range for internalizing (64%), externalizing (67%), and total behavior problems (62%), yet a sizable minority were in the borderline-clinical/clinical range for these symptoms. Children in the CGI group had fewer internalizing and total problems than children in the non-CGI group. Child's degree of gender conformity, caregiver's level of anxiety, and child's peer relations were correlated with children's well-being; children in the CGI group were reported to have better peer relations than children in the non-CGI group. Caregivers' rates of depression and anxiety appeared to be similar to normative samples, although anxiety may have been slightly elevated. Findings from this study add to a small but growing body of literature that documents the well-being of TGNC children growing up in supportive and affirming familial environments. (PsycINFO Database Record