Distinguished Professor of Psychology, Division of Life Sciences, College of Letters and Sciences and Distinguished Professor of Health Policy and Management, Fielding School of Public Health
Journal for Social Action in Counseling & Psychology, 2013
Psychological science offers a variety of methods to both understand and intervene when acts of p... more Psychological science offers a variety of methods to both understand and intervene when acts of potential racial or ethnic racism, bias or prejudice occur. The Trayvon Martin killing is a reminder of how vulnerable African American men and boys, especially young African American men, are to becoming victims of social inequities in our society. We examine several historical events of racial bias (the Los Angeles civil disturbance after the Rodney King verdict, the federal government’s launch of a “War on Drugs” and the killing of Trayvon Martin) to illustrate the ways in which behaviors of racism and race-based discrimination can be viewed from a psychological science lens in the hopes of eliminating and preventing these behaviors. If society is to help end the genocide of African American men and boys then we must broaden our focus from simply understanding instances of victimization to a larger concern with determining how policies, laws, and societal norms serve as the foundation ...
ABSTRACT Background: Previous studies have explored the relationship between the legacy of the Tu... more ABSTRACT Background: Previous studies have explored the relationship between the legacy of the Tuskegee Syphilis Experiment and reluctance of minorities to participate in HIV/AIDS related treatment or clinical research with mixed results. The purpose of this study was to examine community generated beliefs and conspiracy theories about HIV/AIDS based in the Tuskegee legacy and actual knowledge of the Tuskegee Syphilis Experiment. Methods: Telephone interviews were conducted with Black (n=510) and Latino (n=253) residents age 18-45 in low-income households in predominantly minority neighborhoods in Los Angeles as a part of a larger health survey. Results: Blacks were significantly more likely than Latinos to endorse HIV/AIDS conspiracy beliefs. When asked to describe the Tuskegee Syphilis Experiment, 72% and 94% of Blacks and Latinos, respectively, were unable to describe the experiment factually. Of those who had heard about the study, 7% and 3% of Blacks and Latinos, respectively, also could not provide factual details. For those who were aware and could report with accuracy there was a positive correlate of endorsement of the conspiracy statements', lower levels of AIDS knowledge and more likely to be Black. Conclusions: Results of this study raise questions about the extent to which the actual Tuskegee Syphilis Experiment is operating in the participation of African Americans in HIV/AIDS clinical trials, prevention and intervention efforts. Results suggest that we focus on other factors, particularly low levels of knowledge about HIV/AIDS and what symbolically is represented by Tuskegee, as a method for increasing HIV/AIDS research participation.
Illicit drug and heavy alcohol use is more common among sexual minorities compared with heterosex... more Illicit drug and heavy alcohol use is more common among sexual minorities compared with heterosexuals. This difference has sometimes been attributed to more tolerant substance use norms within the gay community, although evidence is sparse. The current study investigated the role of perceived drug availability and tolerant injunctive norms in mediating the linkage between minority sexual orientation status and higher rates of prior-year substance use. Method: We used data from the second California Quality of Life Survey (Cal-QOL II), a followback telephone survey in 2008-2009 of individuals fi rst interviewed in the population-based 2007 California Health Interview Survey. The sample comprised 2,671 individuals, oversampled for minority sexual orientation. Respondents were administered a structured interview assessing past-year alcohol and illicit drug use, perceptions of perceived illicit drug availability, and injunctive norms concerning illicit drug and heavier alcohol use. We used structural equation modeling methods to test a mediational model linking sexual orientation and substance use behaviors via perceptions of drug availability and social norms pertaining to substance use. Results: Compared with heterosexual individuals, sexual minorities reported higher levels of substance use, perceived drug availability, and tolerant social norms. A successfully fi tting model suggests that much of the association between minority sexual orientation and substance use is mediated by these sexual orientation-related differences in drug availability perceptions and tolerant norms for substance use. Conclusions: Social environmental context, including subcultural norms and perceived drug availability, is an important factor infl uencing substance use among sexual minorities and should be addressed in community interventions.
Using the California Quality of Life surveys, we examined suicidal ideation and attempts in 129 l... more Using the California Quality of Life surveys, we examined suicidal ideation and attempts in 129 lesbian, gay, and bisexual (LGB) veterans and in 315 heterosexual veterans in 2008–2009 and 2012–2013. Although there were no significant differences in the past 12-month suicidal ideation and lifetime attempts, LGB veterans had higher odds of lifetime suicidal ideation than heterosexual veterans (adjusted odds ratio = 3.00; 95% confidence interval = 1.38, 6.53). Suicide assessment and prevention efforts in LGB veterans could benefit from a life-course perspective regarding suicide risk.
Physicians' ability to diagnose and treat health care problems, particularly those with a psy... more Physicians' ability to diagnose and treat health care problems, particularly those with a psychosocial component, is facilitated by accurate information concerning the life-styles of their patients. White lesbians have been shown to be generally reluctant to disclose sexual orientation to their physicians, but little, if anything, is known about black lesbians. Black women, self-identified as bisexuals (N = 65) and lesbians (N = 529), were asked whether they had disclosed their homosexual behavior to their physicians. In the sample, only a third of the women had. Previous sexual experiences, both heterosexual and homosexual, were also queried to illuminate patterns of gynecologic health risk factors. Nearly all of the women reported previous heterosexual experiences.
Approximately 25 percent of persons diagnosed with acquired immunodeficiency syndrome (AIDS) have... more Approximately 25 percent of persons diagnosed with acquired immunodeficiency syndrome (AIDS) have been black. This paper examines three areas of concern when focusing on AIDS in the black population: differences from whites in patterns of transmission of the infection, cultural factors that may affect health education efforts, and ethnically relevant issues in the provision of medical care to black persons with AIDS. Recognition of these differences is important in developing appropriate AIDS-related services for the black population. First, the epidemiologic pattern of infection in the black population differs from whites. Although they represent only 12 percent of the American population, blacks make up nearly one-quarter of reported AIDS cases. Currently, it is estimated that between 1 and 1.4 percent of the black population may be infected with the human T-lymphotropic virus/lymphadenopathy-associated virus (HTLV-III/LAV), a rate estimated to be three times that of whites. In ad...
Social Psychiatry and Psychiatric Epidemiology, 2009
Objective Minority sexual orientation has been repeatedly linked to elevated rates of suicide att... more Objective Minority sexual orientation has been repeatedly linked to elevated rates of suicide attempts. Whether this translates into greater risk for suicide mortality is unclear. We investigated sexual orientation-related differences in suicide mortality in Denmark during the initial 12year period following legalization of same-sex registered domestic partnerships (RDPs). Method Using data from death certificates issued between 1990 and 2001 and population estimates from the Danish census, we estimated suicide mortality risk among individuals classified into one of three marital/cohabitation statuses: current/formerly in same-sex RDPs; current/formerly heterosexually married; or never married/registered. Results Risk for suicide mortality was associated with this proxy indicator of sexual orientation, but only significantly among men. The estimated age-adjusted suicide mortality risk for RDP men was nearly eight times greater than for men with positive histories of heterosexual marriage and nearly twice as high for men who had never married. Conclusions Suicide risk appears greatly elevated for men in same-sex partnerships in Denmark. To what extent this is true for similar gay and bisexual men who are not in such relationships is unknown, but these findings call for targeted suicide prevention programs aimed at reducing suicide risk among gay and bisexual men.
E pidemiological studies have shown higher prevalence rates of alcohol and drug disorders among s... more E pidemiological studies have shown higher prevalence rates of alcohol and drug disorders among some sexual minority populations (1-7). Similarly, the
Background. Recent studies find lesbians at greater risk for overweight and obesity than heterose... more Background. Recent studies find lesbians at greater risk for overweight and obesity than heterosexual women. While this may reflect differences in attitudes concerning weight and body shape, little is actually known about risk factors within this group. This study examines correlates of obesity and exercise frequency among lesbians and bisexual women. Methods. Data from a snowball sample (n ϭ 1209) of lesbians/bisexual women living in Los Angeles Country were utilized. Overweight was defined as BMI Ն 25 kg/m 2 ; obesity as BMI Ն 30. Associations between sociodemographic characteristics, exercise frequency, health indicators, and weight-related measures were evaluated to identify independent predictors of BMI and exercise frequency. Results. Prevalence of overweight and obesity among lesbians varied by racial/ethnic background. Higher BMI was associated with older age, poorer health status, lower educational attainment, relationship cohabitation, and lower exercise frequency. Higher BMI, perceptions of being overweight, and reporting a limiting health condition were identified as independent predictors of infrequent exercise. Women were generally quite accurate in self-perceptions of weight status. Conclusions. Correlates of overweight and obesity among lesbians and bisexual women are generally comparable to those observed in studies of heterosexual women. Evidence that lesbians' higher BMI is associated with higher levels of fitness is not supported.
Background: Illicit substance use and abuse may be an important contributor to behavioral health ... more Background: Illicit substance use and abuse may be an important contributor to behavioral health problems of lesbian and bisexual women. This paper describes the nature and extent of self-reported illicit and licit drug use, associated severity, and substance use-related helpseeking behaviors in an urban/metropolitan community sample of sexual minority women in California. Methods: Self-administered questionnaire data from 2011 lesbian and bisexual women recruited through multiple strategies were used. Multiple logistic regression was employed to describe patterns of reported drug use and to compare lifetime severity of drug use with demographic characteristics, recent drug use, indicators of current social and emotional problems, and help-seeking behaviors. Results: Drug use, especially marijuana (33% used in the past year), was fairly common. Overall, 16.2% of the women in the study reported lifetime drug use that was associated with self-reported severity of substance use, and another 10.8% indicated moderate-risk use. Extent of lifetime drug use was positively correlated with self-reported recent drug use as well as current life problems. Of the respondents who evidenced more problematic drug use, 41.5% indicated that they had received professional help for a substance use problem, and 16.3% wanted but had not received such help. Conclusions: The women in this study reported elevated rates of illicit drug use that was frequently associated with impairment and specific life problems. A significant proportion wanted and had not received professional treatment for their drug use problems. Future studies that examine pathways by which lesbians and bisexual women can obtain referrals and treatment for substance use problems are needed.
Background: Lesbians and bisexual women are more likely than other women to evidence a unique mix... more Background: Lesbians and bisexual women are more likely than other women to evidence a unique mix of common breast cancer risk factors. It is not known if this results in greater breast cancer mortality risk. We investigate possible sexual orientation-related differences in risk for fatal breast cancer in a large representative U.S. sample of married and cohabiting women. Methods: Between 1997 and 2003, the National Health Interview Survey (NHIS) interviewed married or cohabiting female participants, aged 18-80 years inclusively, who reported either a male (n = 136,174) or female (n = 693) coresidential relationship partner. These records are linked to the National Death Index to provide information on mortality status as of December 31, 2006. Employing these data, we estimated the age-adjusted relative risk (RR) and its 95% confidence interval (CI) for mortality attributed to breast cancer using a Cox proportional hazard model. Results: Women in same-sex couples, compared to women in different-sex relationships, had greater ageadjusted risk for fatal breast cancer (RR = 3.2, CI 1.01-10.21) but did not differ in their overall risk for mortality. Conclusions: Our findings provide tentative support that sexual orientation is differentially linked to risk of fatal breast cancer. These findings underscore the need to investigate further breast cancer morbidity and mortality risk among women with minority sexual orientation.
In recent population-based surveys, minority sexual orientation has been identified as a potentia... more In recent population-based surveys, minority sexual orientation has been identified as a potential risk indicator for psychiatric morbidity. However, methodological limitations in the studies to date have led to concerns that current estimates are biased due to inadequate measurement of sexual orientation and uncontrolled confounding from prevalent HIV infection. In the present study, the authors investigate associations between sexual orientation and mental health/substance use morbidity using information obtained from 2,272 individuals, including 652 sexual orientation minorities, age 18 to 72 years, interviewed in the California Quality of Life Survey. Results confirm that minority sexual orientation is a risk indicator for psychiatric morbidity. However, levels of increased risk vary within this subpopulation by both gender and patterns of sexual orientation expression. Among gay/bisexual men, much of this greater burden is related to concurrent HIV infection. Reducing excess mental health morbidity risk among sexual orientation minorities could result in possibly a 5% to 11% reduction in the burden of the disorders assessed here among the adult population. Sexual orientation represents an important, but relatively understudied, individual characteristic shaping risk for psychiatric morbidity.
Inequities in marriage laws and domestic partnership benefits may have implications for who bears... more Inequities in marriage laws and domestic partnership benefits may have implications for who bears the burden of health care costs. We examined a recent period in California to illuminate disparities in health insurance coverage faced by same-sex couples. Partnered gay men are less than half as likely (42 percent) as married heterosexual men to get employer-sponsored dependent coverage, and partnered lesbians have an even slimmer chance (28 percent) of getting dependent coverage compared to married heterosexual women. As a result of these much lower rates of employer-provided coverage, partnered lesbians and gay men are more than twice as likely to be uninsured as married heterosexuals. The exclusion of gay men and women from civil marriage and the failure of domestic partnership benefits to provide insurance parity contribute to unequal access to health coverage, with the probable result that more health spending is pushed onto these individuals and onto the public. A s the Patient Protection and Affordable Care Act of 2010 (PL 111-148) moves the United States toward a health care system of universal coverage, employer-sponsored health insurance will continue to be the main source of health care coverage for nonelderly employees and their spouses and families. At present, having access to employer-sponsored health insurance could be strongly tied to the legal institution of marriage. This article advances evidence that this is the case, and that as a result, nonmarried dependents of employed gay men and lesbians may end up bearing more of the costs of their health care than if they were married or otherwise eligible for full dependent coverage. It is uncertain to what extent this situation will be alleviated by the provisions of the health reform law that will take full effect in 2014.
Although recent attention has focused on the likelihood that contemporary sexual minority youth (... more Although recent attention has focused on the likelihood that contemporary sexual minority youth (i.e., gay, lesbian, bisexual [GLB]) are "coming out" at younger ages, few studies have examined whether early sexual orientation identity development is also present in older GLB cohorts. We analyzed retrospective data on the timing of sexual orientation milestones in a sample of sexual minorities drawn from the California Quality of Life Surveys. Latent profile analysis of 1,260 GLB adults, ages 18-84 years, identified 3 trajectories of development: early (n ϭ 951; milestones spanning ages 12-20), middle (n ϭ 239; milestones spanning ages 18-31), and late (n ϭ 70; milestones spanning ages 32-43). Motivated by previous research on variability in adolescent developmental trajectories, we identified 2 subgroups in post hoc analyses of the early profile group: child onset (n ϭ 284; milestones spanning ages 8-18) and teen onset (n ϭ 667; milestones spanning ages 14-22). Nearly all patterns of development were identity centered, with average age of self-identification as GLB preceding average age of first same-sex sexual activity. Overall, younger participants and the majority of older participants were classified to the early profile, suggesting that early development is common regardless of age cohort. The additional gender differences observed in the onset and pace of sexual orientation identity development warrant future research.
Results 4.1 Differences in demographic characteristics by union status 4.2 Multivariate analysis ... more Results 4.1 Differences in demographic characteristics by union status 4.2 Multivariate analysis of demographic correlates 4.3 Union status differences in attitudes and expectations about marriage among heterosexuals 4.4 Union type differences in perceptions of support from partners for heterosexuals, gay men and lesbians 5 Discussion 6 Acknowledgements References Appendix
Background Prior research has shown a higher prevalence of substance use and mental disorders amo... more Background Prior research has shown a higher prevalence of substance use and mental disorders among sexual minorities, however, the influence of sexual orientation on treatment seeking has not been widely studied. We use a model of help-seeking for vulnerable populations to investigate factors related to treatment for alcohol or drug use disorders and mental health disorders, focusing on the contributions of gender, sexual orientation, and need. Methods Survey data were obtained from a population-based probability sample of California residents that oversampled for sexual minorities. Logistic regression was used to model the enabling, predisposing, and need-related factors associated with past-year mental health or substance abuse treatment utilization among adults aged 18–64 (N = 2,074). Results Compared with individuals without a diagnosed disorder, those with any disorder were more likely to receive treatment. After controlling for both presence of disorder and other factors, les...
Journal for Social Action in Counseling & Psychology, 2013
Psychological science offers a variety of methods to both understand and intervene when acts of p... more Psychological science offers a variety of methods to both understand and intervene when acts of potential racial or ethnic racism, bias or prejudice occur. The Trayvon Martin killing is a reminder of how vulnerable African American men and boys, especially young African American men, are to becoming victims of social inequities in our society. We examine several historical events of racial bias (the Los Angeles civil disturbance after the Rodney King verdict, the federal government’s launch of a “War on Drugs” and the killing of Trayvon Martin) to illustrate the ways in which behaviors of racism and race-based discrimination can be viewed from a psychological science lens in the hopes of eliminating and preventing these behaviors. If society is to help end the genocide of African American men and boys then we must broaden our focus from simply understanding instances of victimization to a larger concern with determining how policies, laws, and societal norms serve as the foundation ...
ABSTRACT Background: Previous studies have explored the relationship between the legacy of the Tu... more ABSTRACT Background: Previous studies have explored the relationship between the legacy of the Tuskegee Syphilis Experiment and reluctance of minorities to participate in HIV/AIDS related treatment or clinical research with mixed results. The purpose of this study was to examine community generated beliefs and conspiracy theories about HIV/AIDS based in the Tuskegee legacy and actual knowledge of the Tuskegee Syphilis Experiment. Methods: Telephone interviews were conducted with Black (n=510) and Latino (n=253) residents age 18-45 in low-income households in predominantly minority neighborhoods in Los Angeles as a part of a larger health survey. Results: Blacks were significantly more likely than Latinos to endorse HIV/AIDS conspiracy beliefs. When asked to describe the Tuskegee Syphilis Experiment, 72% and 94% of Blacks and Latinos, respectively, were unable to describe the experiment factually. Of those who had heard about the study, 7% and 3% of Blacks and Latinos, respectively, also could not provide factual details. For those who were aware and could report with accuracy there was a positive correlate of endorsement of the conspiracy statements', lower levels of AIDS knowledge and more likely to be Black. Conclusions: Results of this study raise questions about the extent to which the actual Tuskegee Syphilis Experiment is operating in the participation of African Americans in HIV/AIDS clinical trials, prevention and intervention efforts. Results suggest that we focus on other factors, particularly low levels of knowledge about HIV/AIDS and what symbolically is represented by Tuskegee, as a method for increasing HIV/AIDS research participation.
Illicit drug and heavy alcohol use is more common among sexual minorities compared with heterosex... more Illicit drug and heavy alcohol use is more common among sexual minorities compared with heterosexuals. This difference has sometimes been attributed to more tolerant substance use norms within the gay community, although evidence is sparse. The current study investigated the role of perceived drug availability and tolerant injunctive norms in mediating the linkage between minority sexual orientation status and higher rates of prior-year substance use. Method: We used data from the second California Quality of Life Survey (Cal-QOL II), a followback telephone survey in 2008-2009 of individuals fi rst interviewed in the population-based 2007 California Health Interview Survey. The sample comprised 2,671 individuals, oversampled for minority sexual orientation. Respondents were administered a structured interview assessing past-year alcohol and illicit drug use, perceptions of perceived illicit drug availability, and injunctive norms concerning illicit drug and heavier alcohol use. We used structural equation modeling methods to test a mediational model linking sexual orientation and substance use behaviors via perceptions of drug availability and social norms pertaining to substance use. Results: Compared with heterosexual individuals, sexual minorities reported higher levels of substance use, perceived drug availability, and tolerant social norms. A successfully fi tting model suggests that much of the association between minority sexual orientation and substance use is mediated by these sexual orientation-related differences in drug availability perceptions and tolerant norms for substance use. Conclusions: Social environmental context, including subcultural norms and perceived drug availability, is an important factor infl uencing substance use among sexual minorities and should be addressed in community interventions.
Using the California Quality of Life surveys, we examined suicidal ideation and attempts in 129 l... more Using the California Quality of Life surveys, we examined suicidal ideation and attempts in 129 lesbian, gay, and bisexual (LGB) veterans and in 315 heterosexual veterans in 2008–2009 and 2012–2013. Although there were no significant differences in the past 12-month suicidal ideation and lifetime attempts, LGB veterans had higher odds of lifetime suicidal ideation than heterosexual veterans (adjusted odds ratio = 3.00; 95% confidence interval = 1.38, 6.53). Suicide assessment and prevention efforts in LGB veterans could benefit from a life-course perspective regarding suicide risk.
Physicians' ability to diagnose and treat health care problems, particularly those with a psy... more Physicians' ability to diagnose and treat health care problems, particularly those with a psychosocial component, is facilitated by accurate information concerning the life-styles of their patients. White lesbians have been shown to be generally reluctant to disclose sexual orientation to their physicians, but little, if anything, is known about black lesbians. Black women, self-identified as bisexuals (N = 65) and lesbians (N = 529), were asked whether they had disclosed their homosexual behavior to their physicians. In the sample, only a third of the women had. Previous sexual experiences, both heterosexual and homosexual, were also queried to illuminate patterns of gynecologic health risk factors. Nearly all of the women reported previous heterosexual experiences.
Approximately 25 percent of persons diagnosed with acquired immunodeficiency syndrome (AIDS) have... more Approximately 25 percent of persons diagnosed with acquired immunodeficiency syndrome (AIDS) have been black. This paper examines three areas of concern when focusing on AIDS in the black population: differences from whites in patterns of transmission of the infection, cultural factors that may affect health education efforts, and ethnically relevant issues in the provision of medical care to black persons with AIDS. Recognition of these differences is important in developing appropriate AIDS-related services for the black population. First, the epidemiologic pattern of infection in the black population differs from whites. Although they represent only 12 percent of the American population, blacks make up nearly one-quarter of reported AIDS cases. Currently, it is estimated that between 1 and 1.4 percent of the black population may be infected with the human T-lymphotropic virus/lymphadenopathy-associated virus (HTLV-III/LAV), a rate estimated to be three times that of whites. In ad...
Social Psychiatry and Psychiatric Epidemiology, 2009
Objective Minority sexual orientation has been repeatedly linked to elevated rates of suicide att... more Objective Minority sexual orientation has been repeatedly linked to elevated rates of suicide attempts. Whether this translates into greater risk for suicide mortality is unclear. We investigated sexual orientation-related differences in suicide mortality in Denmark during the initial 12year period following legalization of same-sex registered domestic partnerships (RDPs). Method Using data from death certificates issued between 1990 and 2001 and population estimates from the Danish census, we estimated suicide mortality risk among individuals classified into one of three marital/cohabitation statuses: current/formerly in same-sex RDPs; current/formerly heterosexually married; or never married/registered. Results Risk for suicide mortality was associated with this proxy indicator of sexual orientation, but only significantly among men. The estimated age-adjusted suicide mortality risk for RDP men was nearly eight times greater than for men with positive histories of heterosexual marriage and nearly twice as high for men who had never married. Conclusions Suicide risk appears greatly elevated for men in same-sex partnerships in Denmark. To what extent this is true for similar gay and bisexual men who are not in such relationships is unknown, but these findings call for targeted suicide prevention programs aimed at reducing suicide risk among gay and bisexual men.
E pidemiological studies have shown higher prevalence rates of alcohol and drug disorders among s... more E pidemiological studies have shown higher prevalence rates of alcohol and drug disorders among some sexual minority populations (1-7). Similarly, the
Background. Recent studies find lesbians at greater risk for overweight and obesity than heterose... more Background. Recent studies find lesbians at greater risk for overweight and obesity than heterosexual women. While this may reflect differences in attitudes concerning weight and body shape, little is actually known about risk factors within this group. This study examines correlates of obesity and exercise frequency among lesbians and bisexual women. Methods. Data from a snowball sample (n ϭ 1209) of lesbians/bisexual women living in Los Angeles Country were utilized. Overweight was defined as BMI Ն 25 kg/m 2 ; obesity as BMI Ն 30. Associations between sociodemographic characteristics, exercise frequency, health indicators, and weight-related measures were evaluated to identify independent predictors of BMI and exercise frequency. Results. Prevalence of overweight and obesity among lesbians varied by racial/ethnic background. Higher BMI was associated with older age, poorer health status, lower educational attainment, relationship cohabitation, and lower exercise frequency. Higher BMI, perceptions of being overweight, and reporting a limiting health condition were identified as independent predictors of infrequent exercise. Women were generally quite accurate in self-perceptions of weight status. Conclusions. Correlates of overweight and obesity among lesbians and bisexual women are generally comparable to those observed in studies of heterosexual women. Evidence that lesbians' higher BMI is associated with higher levels of fitness is not supported.
Background: Illicit substance use and abuse may be an important contributor to behavioral health ... more Background: Illicit substance use and abuse may be an important contributor to behavioral health problems of lesbian and bisexual women. This paper describes the nature and extent of self-reported illicit and licit drug use, associated severity, and substance use-related helpseeking behaviors in an urban/metropolitan community sample of sexual minority women in California. Methods: Self-administered questionnaire data from 2011 lesbian and bisexual women recruited through multiple strategies were used. Multiple logistic regression was employed to describe patterns of reported drug use and to compare lifetime severity of drug use with demographic characteristics, recent drug use, indicators of current social and emotional problems, and help-seeking behaviors. Results: Drug use, especially marijuana (33% used in the past year), was fairly common. Overall, 16.2% of the women in the study reported lifetime drug use that was associated with self-reported severity of substance use, and another 10.8% indicated moderate-risk use. Extent of lifetime drug use was positively correlated with self-reported recent drug use as well as current life problems. Of the respondents who evidenced more problematic drug use, 41.5% indicated that they had received professional help for a substance use problem, and 16.3% wanted but had not received such help. Conclusions: The women in this study reported elevated rates of illicit drug use that was frequently associated with impairment and specific life problems. A significant proportion wanted and had not received professional treatment for their drug use problems. Future studies that examine pathways by which lesbians and bisexual women can obtain referrals and treatment for substance use problems are needed.
Background: Lesbians and bisexual women are more likely than other women to evidence a unique mix... more Background: Lesbians and bisexual women are more likely than other women to evidence a unique mix of common breast cancer risk factors. It is not known if this results in greater breast cancer mortality risk. We investigate possible sexual orientation-related differences in risk for fatal breast cancer in a large representative U.S. sample of married and cohabiting women. Methods: Between 1997 and 2003, the National Health Interview Survey (NHIS) interviewed married or cohabiting female participants, aged 18-80 years inclusively, who reported either a male (n = 136,174) or female (n = 693) coresidential relationship partner. These records are linked to the National Death Index to provide information on mortality status as of December 31, 2006. Employing these data, we estimated the age-adjusted relative risk (RR) and its 95% confidence interval (CI) for mortality attributed to breast cancer using a Cox proportional hazard model. Results: Women in same-sex couples, compared to women in different-sex relationships, had greater ageadjusted risk for fatal breast cancer (RR = 3.2, CI 1.01-10.21) but did not differ in their overall risk for mortality. Conclusions: Our findings provide tentative support that sexual orientation is differentially linked to risk of fatal breast cancer. These findings underscore the need to investigate further breast cancer morbidity and mortality risk among women with minority sexual orientation.
In recent population-based surveys, minority sexual orientation has been identified as a potentia... more In recent population-based surveys, minority sexual orientation has been identified as a potential risk indicator for psychiatric morbidity. However, methodological limitations in the studies to date have led to concerns that current estimates are biased due to inadequate measurement of sexual orientation and uncontrolled confounding from prevalent HIV infection. In the present study, the authors investigate associations between sexual orientation and mental health/substance use morbidity using information obtained from 2,272 individuals, including 652 sexual orientation minorities, age 18 to 72 years, interviewed in the California Quality of Life Survey. Results confirm that minority sexual orientation is a risk indicator for psychiatric morbidity. However, levels of increased risk vary within this subpopulation by both gender and patterns of sexual orientation expression. Among gay/bisexual men, much of this greater burden is related to concurrent HIV infection. Reducing excess mental health morbidity risk among sexual orientation minorities could result in possibly a 5% to 11% reduction in the burden of the disorders assessed here among the adult population. Sexual orientation represents an important, but relatively understudied, individual characteristic shaping risk for psychiatric morbidity.
Inequities in marriage laws and domestic partnership benefits may have implications for who bears... more Inequities in marriage laws and domestic partnership benefits may have implications for who bears the burden of health care costs. We examined a recent period in California to illuminate disparities in health insurance coverage faced by same-sex couples. Partnered gay men are less than half as likely (42 percent) as married heterosexual men to get employer-sponsored dependent coverage, and partnered lesbians have an even slimmer chance (28 percent) of getting dependent coverage compared to married heterosexual women. As a result of these much lower rates of employer-provided coverage, partnered lesbians and gay men are more than twice as likely to be uninsured as married heterosexuals. The exclusion of gay men and women from civil marriage and the failure of domestic partnership benefits to provide insurance parity contribute to unequal access to health coverage, with the probable result that more health spending is pushed onto these individuals and onto the public. A s the Patient Protection and Affordable Care Act of 2010 (PL 111-148) moves the United States toward a health care system of universal coverage, employer-sponsored health insurance will continue to be the main source of health care coverage for nonelderly employees and their spouses and families. At present, having access to employer-sponsored health insurance could be strongly tied to the legal institution of marriage. This article advances evidence that this is the case, and that as a result, nonmarried dependents of employed gay men and lesbians may end up bearing more of the costs of their health care than if they were married or otherwise eligible for full dependent coverage. It is uncertain to what extent this situation will be alleviated by the provisions of the health reform law that will take full effect in 2014.
Although recent attention has focused on the likelihood that contemporary sexual minority youth (... more Although recent attention has focused on the likelihood that contemporary sexual minority youth (i.e., gay, lesbian, bisexual [GLB]) are "coming out" at younger ages, few studies have examined whether early sexual orientation identity development is also present in older GLB cohorts. We analyzed retrospective data on the timing of sexual orientation milestones in a sample of sexual minorities drawn from the California Quality of Life Surveys. Latent profile analysis of 1,260 GLB adults, ages 18-84 years, identified 3 trajectories of development: early (n ϭ 951; milestones spanning ages 12-20), middle (n ϭ 239; milestones spanning ages 18-31), and late (n ϭ 70; milestones spanning ages 32-43). Motivated by previous research on variability in adolescent developmental trajectories, we identified 2 subgroups in post hoc analyses of the early profile group: child onset (n ϭ 284; milestones spanning ages 8-18) and teen onset (n ϭ 667; milestones spanning ages 14-22). Nearly all patterns of development were identity centered, with average age of self-identification as GLB preceding average age of first same-sex sexual activity. Overall, younger participants and the majority of older participants were classified to the early profile, suggesting that early development is common regardless of age cohort. The additional gender differences observed in the onset and pace of sexual orientation identity development warrant future research.
Results 4.1 Differences in demographic characteristics by union status 4.2 Multivariate analysis ... more Results 4.1 Differences in demographic characteristics by union status 4.2 Multivariate analysis of demographic correlates 4.3 Union status differences in attitudes and expectations about marriage among heterosexuals 4.4 Union type differences in perceptions of support from partners for heterosexuals, gay men and lesbians 5 Discussion 6 Acknowledgements References Appendix
Background Prior research has shown a higher prevalence of substance use and mental disorders amo... more Background Prior research has shown a higher prevalence of substance use and mental disorders among sexual minorities, however, the influence of sexual orientation on treatment seeking has not been widely studied. We use a model of help-seeking for vulnerable populations to investigate factors related to treatment for alcohol or drug use disorders and mental health disorders, focusing on the contributions of gender, sexual orientation, and need. Methods Survey data were obtained from a population-based probability sample of California residents that oversampled for sexual minorities. Logistic regression was used to model the enabling, predisposing, and need-related factors associated with past-year mental health or substance abuse treatment utilization among adults aged 18–64 (N = 2,074). Results Compared with individuals without a diagnosed disorder, those with any disorder were more likely to receive treatment. After controlling for both presence of disorder and other factors, les...
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Papers by Vickie Mays