Disparities between the substance use rates of sexual or gender minority (SGM) youth and the rates of youth identifying as heterosexual (i.e., attracted to the opposite sex) and cisgender (i.e., gender identity corresponds to birth sex) have given rise to calls for 1) research to understand the specific risk and protective factors relating to substance use in SGM youth and 2) the development of corresponding intervention programming In three papers, this dissertation explores predictors for substance use among SGM youth and describes methods of targeted recruitment for a prevention intervention program tailored to SGM youth. In the first paper, comparing the contributing factors of substance use between sexual minority and heterosexual youth revealed that although many predictors were associated with use in both groups, sadness, suicidal ideation, difficulty concentrating, and forced sexual encounters were the most consistent and substantial contributors to the explanation of the difference in use rates between groups. In the second paper, risk and protective factors identified from social learning theory and minority stress theory, including perceived stress, problem-solving skills, self-esteem, self-efficacy, substance refusal skills, and peer use of substance, were generally associated with past-month substance use. Peer use of substance and substance refusal skills, in particular, were consistently and robustly associated with substance use in the sample of SGM youth, and their intersection provides insight into themes to address in future intervention development. Issues of disclosure and parental permission have made recruiting representative samples of SGM youth challenging, and the third paper offers insight into an inexpensive and time-efficient means of recruiting SGM youth for participation in such research. The specificity with which Facebook ads can be targeted to hard-to-reach populations makes it a preferred tool for researchers who seek to recruit SGM youth. Taken together, the three papers of this dissertation can serve as a guide for the development and execution of substance use prevention research that is tailored to the specific needs of SGM youth.

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

No description available.

Gay/Straight Alliances aimed at providing sexual minority youth and their allies with support, social events, and activism and education opportunities have proliferated in high schools in the United States over the past two decades. This study employs a qualitative, grounded theory approach to examine how sexual minority youth and their allies navigate gender, sexuality, and social movement participation. A year and a half of observation and 16 semi-structured individual interviews were conducted with Gay/Straight Alliance members in a high school setting in the southeastern United States. The study reveals that, through the lens of frame analysis, the G/SA is analogous to larger and more organized social movement organizations. The findings also suggest members often struggle and engage with issues surrounding sexuality, including its origins, coming out as a process, and judgments and evaluations surrounding sex and desire. Additionally, the findings address elements of gender conformity and nonconformity

No description available.

While most researchers agree that there is nothing inherently pathological about a sexual minority orientation (Savin-Willimas, 2005), sexual minority youth often face additional mental health challenges. Among the specific challenges experienced by sexual minority youth are increased rates of depression (D'Augelli, 2002; Galiher, Rostosky, & Hughes, 2004; Russell & Joyner, 2001), suicidal ideation (Balsam, Beauchaine, Mickey, & Rothblum, 2005; Russell & Joyner, 2001), substance abuse (Garofalo, Wolf, Kessel, Palfrey, & DuRant, 1998), and victimization (D'Augelli, Pilkington, & Hershberger, 2002; Elze, 2003; Russell, Franz, & Driscoll, 2001). Although research is beginning to address protective factors, we do not yet have a complete understanding of specific protective factors, particularly within the school, that promote resiliency within this group. The current study utilized a correlational design to evaluate the experiences of 377 sexual minority youth and examine the link between social support and specific mental health indicators (depression, suicidal ideation, substance use, and victimization). The youth in this study were drawn from community drop-in centers for sexual minority youth. Participants completed questionnaires and participated in a face-to-face interview to provide information regarding depression, suicidal ideation, substance use, victimization. Additionally, participants provided information regarding their feelings of being supported by their friends, whether or not their school had a support/discussion group for sexual minority youth, and if so, whether they attended the group. No significant relationships were found between the social support factors (social support from friends, presence of support group in school) and decreased substance use or suicidal ideation. Contrary to research indicating positive outcomes for students who attend schools with a Gay-Straight Alliance (GSA; GLSEN, 2011), youth in the current study whose school had a support group reported increased depression when compared to youth whose school did not have a support group. However, a significant relationship was found between increased perceived social support from friends and decreased depression scores. These findings suggest the need for advocacy within schools to create supportive environments that are accessible to all sexual minority youth and that provide the opportunity to increase social networks and access to supportive peers. / School Psychology

Social institutions in rural communities tend to be highly interrelated and social ties tend to be dense and multiplex. Human ecological theoretical models posit that all institutions in which an individual is embedded interact in complex ways. As such, this dissertation examines the influences of school, faith, family, and risk contexts on the grade point averages of students who attended school in nonmetropolitan counties in Appalachian Kentucky. Using data disaggregated by gender from nearly 5,000 adolescents, I identified risk and protective factors on grade point averages by attraction type (exclusively opposite-sex attracted, same-sex attracted, and unsure of attraction), identified differences in grade point averages between attraction types, and identified mediators and moderators of the relationship between attraction type and grade point average. School belonging positively influenced the grade point averages of unsure males and religious belief negatively influenced the grade point averages of same-sex attracted males. In general, sexual minority students reported lower grade point averages than their exclusively opposite-sex attracted peers. Among same-sex attracted males and females, this disparity in grade point average was mediated by school belonging. Among unsure males the variation in grade point average was largely explained by engagement in risk behaviors. The relationship between sexual attraction and grade point average was moderated by religiosity, marijuana use, and labor market optimism.

The purpose of this study was to identify school-based practices that lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth endorse as ways for high schools to provide social, emotional, and academic support to LGBTQ youth. A diverse sample of LGBTQ high school students (N = 18) from one large urban school district in a southeastern state participated in individual semi-structured interviews and/or small group brainstorming sessions. Eleven individual interviews were conducted to gather detailed accounts of a) supportive behaviors and policies that youth had experienced in their schools, as well as b) supportive behaviors and policies that were suggested as desired supports that had not actually been experienced. Participants' sentiments were coded based on the source of support (i.e., teachers, school mental health providers, administrators, policies, resources), nature of support (i.e., proactive, reactive), and social context of the support (i.e., impacting single students through one-on-one setting, impacting more than one student or groups of students). Three brainstorming sessions that included a total of 13 students were conducted to gather additional ideas from youth on ways for schools and school staff to provide support. Frequency counts of individual interview data indicated that teachers provided more experienced and desired supports than any other school-based source of support. Of the desired supports that participants had not actually experienced, Proactive Supports Impacting Groups were the most frequently described Support Type for teachers, school mental health providers, and administrators. Content Themes emerged within Support Types (e.g., Proactive Support Impacting Individuals, Reactive Support Impacting Groups) capture sentiments that were shared across multiple participants' responses. Data from interviews and brainstorming sessions were also analyzed together through a constant-comparative reduction process, resulting in 162 Specific Educator Behaviors/Policies corresponding to 8 Big Ideas of school-based supports for LGBTQ high school students: (1) Using Respectful Language and Interactions with Students; (2) Providing Comfort, Assistance, and Advice Matched to Student Needs; (3) Facilitating Connections with Community Supports; (4) Providing LGBTQ-Related Materials and Information; (5) Allowing and Supporting School-Based GSA and Pride Activities; (6) Addressing Professional Development, Human Resources, and School Culture Related Issues; (7) Implementing Policies that Address Bullying and Harassment of LGBTQ Students; and (8) Implementing Policies that Respectfully Account for Students' Diversity.) Pragmatic implications for teachers, school mental health providers, and administrators are discussed.

Thesis (M.S.W.) -- Ohio State University, 2005. / Includes bibliographical references (leaves 109-114). Available online via OhioLINK's ETD Center

This dissertation examines the influences of LGBTQ positive school climate and state-level anti-bullying policy with sexual and gender minority (SGM) identity enumeration on weight and victimization disparities among sexual minority adolescents. Compared to their heterosexual peers, sexual minority adolescents (those who identify as gay/lesbian or bisexual, or who are unsure of their sexual identity) have higher odds of having obesity and experiencing school violence victimization. The effects of school climate and anti-bullying policy that seek to specifically provide protections for LGBTQ adolescents on the health outcomes of obesity and school violence have rarely been examined, and especially in tandem. Decreasing disparities in both these outcomes would help improve quality of life and decrease morbidity. Therefore, the overall objective of this dissertation is to help fill several gaps in the literature related to obesity, school violence, school climate, and state-level anti-bullying policy with SGM identity enumeration. An adapted Social Ecological Model guided conceptualization and design of the three studies included. Chapter 1 introduces the current state of adolescent obesity, including trends in obesity over time, contextual influences on obesity, and obesity disparities among sexual minority adolescents. Existing research on school violence victimization, school climate, and SGM enumerated policy are also introduced and described. Chapter 2, a systematic review, aimed to systematically search and review the literature on the effects of positive school climate on weight-related health behaviors and risk factors for obesity. Overall, we found that LGBTQ adolescents in more positive school climates reported lower levels of bullying victimization, depressive and suicidal feelings, and sexual orientation-based harassment than those in less positive school climates. Results were more mixed for studies examining the effects of positive school climate on alcohol, tobacco, and other drug use. Chapter 3, a cross-sectional analysis of the Center for Disease Control and Prevention’s (CDC’s) Youth Risk Behavior Surveys (YRBS) and School Health Profiles (SHP) from 2010–2019, examined and compared the associations among sexual identity, school violence victimization, and obesity across varying levels of LGBTQ school climate in ten United States school districts. We found that for both female and male adolescents, regardless of sexual identity, those who reported two or more counts of school violence victimization had significantly higher odds of obesity compared to those who reported no violence victimization experienced in the last 12 months (1.33 and 1.24 greater odds, respectively). We also found that in the presence of more positive LGBTQ school climates, adolescents had 0.85 lower odds of obesity compared to those in the presence of less positive LGBTQ school climates. Chapter 4, a quasi-experimental difference-in-differences analysis of state-level anti-bullying policies and state-level CDC YRBS data from 1999–2019, examined the causal effect of anti-bullying policies with SGM identity enumeration on bullying and obesity trends over time. We found that adolescent girls had a significant 1.0 percentage point decrease in the probability of bullying victimization in the period post SGM enumeration enactment. For boys, this association was slightly stronger with a 3.2 percentage point decrease in the probability of bullying victimization in the post-period. However, when we examined subgroups of sexual minority adolescents specifically, we found the average treatment effects for SGM enumeration were even stronger for sexual minority girls and boys—with a 6.4 percentage point decrease in the probability of being bullied for sexual minority girls and a 6.0 percentage point decrease for sexual minority boys. Results for the obesity outcome showed that in the post-period, obesity rates increased for sexual minority girls and boys, an unintended effect that should be explored in future research that considers temporality of relationships among these outcome variables. Finally, Chapter 5 summarizes the studies included in the dissertation, identifies strengths and limitations, reviews key findings, and discusses implications for policy, practice, and future research. Using strong quantitative statistical methods, our primary contribution to the public health literature is that LGBTQ positive school climates and inclusive, SGM enumerated anti-bullying policies work to help decrease odds of obesity and rates of bullying victimization, respectively, for both heterosexual and sexual minority adolescents—highlighting how specific protections for one group of adolescents can extend benefits to all adolescents.