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Abstract
Previous research indicates that lesbian, gay, and bisexual (LGB) adolescents are at increased risk for substance use, including heightened rates of marijuana use. Minority stress theory suggests that difficult social situations create a state of chronic stress that leads to poor health outcomes for LGB adults; however, the applicability of this model has not been well explored in relation to substance use among LGB adolescents. The current study is a secondary analysis of the OutProud survey, conducted in 2000. The original study used purposive sampling to collect data from 1,911 LGB adolescents (age 12–17) across the United States, and represents the largest known study to explore experiences specific to identifying as LGB, such as homophobia and gay-related victimization. We used structural equation modeling (SEM) to explore the feasibility of applying a minority stress framework to understand marijuana use in this population. The final structural model for marijuana use in the LGB adolescent sample displayed excellent fit and modest explanatory power for marijuana use. Two of the five factors, community connectedness and internalized homophobia, were significantly (p < .05) associated with marijuana use. Findings suggest that minority stress theory may be appropriately applied to marijuana use in this population; however, better measurement of minority stress concepts for LGB adolescents is needed.
THE AUTHORS
Dr. Jeremy T. Goldbach, Ph. D., LMSW, joined the USC School of Social Work in 2012 after completing both his master's and doctoral degrees in social work at The University of Texas at Austin. His dissertation, “Toward the prevention of high risk behavior in sexual minority adolescents,” explored the relationship between minority stress and marijuana use by lesbian, gay, and bisexual adolescents. His work at UT-Austin was funded through the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Prevention (CSAP), specializing in prevention science.
Dr. Goldbach's, Ph.D., MS, research interest involves understanding the relationship between minority stress and behavioral health outcomes, with a special focus on the experiences of sexual minority (lesbian, gay, bi-sexual) and ethnic minority youth. He has funding through the National Institutes of Health Clinical and Translational Science Institute (CTSI) to pilot an intervention for Latino youth and families called Familia Adelante. This multi-risk reduction intervention focuses on reducing behavioral health problems through the reduction of cultural stressors, including discrimination and acculturative experiences. Dr. Goldbach has also received funding through the Zumberge Small Grant Program to explore stress and behavioral health outcomes in a qualitative sample of racially and ethnically diverse lesbian, gay and bisexual adolescents. Lastly, Dr. Goldbach serves as project evaluator with the National Association of Social Workers (NASW) HIV/AIDS Spectrum: Mental Health Training and Education of Social Workers Project. His practice background includes both clinical and community organizing. Before returning for his doctoral education, Goldbach oversaw a large community-organizing project in Texas that funded 32 community coalitions to reduce substance use concerns through environmental, policy-based strategy. His teaching interests include direct social work practice, human behavior, and research with vulnerable populations.
THE AUTHORS
Dr. Sheree M. Schrager, LCSW, is the Director of Research for the Division of Hospital Medicine at CHLA. Her primary work is supporting the development of CHLA-affiliated researchers in all aspects of quantitative research methodology, including experimental and nonexperimental study design, survey development, implementation protocols, and data analysis and reporting, with a particular focus on advanced statistical methods. In this role, she serves as a methodologist, project manager, and mentor on a variety of research projects related to pediatric, adolescent, and emerging adult health and risk behavior in partnership with faculty throughout seven divisions, including Hospital Medicine, Adolescent Medicine, General Pediatrics, Maternal- Fetal Medicine, Neonatology, Cardiology, and Endocrinology.
Dr. Schrager joined Children's Hospital Los Angeles after receiving her PhD in psychology from the University of Wisconsin-Madison in 2008; she previously earned her MS in Statistics from UW-Madison in 2006. She is the Co- Investigator of two NIDA-funded R01 grants to study substance abuse among child welfare involved teens and medical marijuana use among adolescents and young adults in Los Angeles County. Her key research areas include: maternal mental health and its role in infant outcomes; primary care for children with special health care
THE AUTHORS
needs; biopsychosocial outcomes of transgender youth and adolescents; and health, functioning, and risk behavior among high-risk adolescents and young adults. She has coauthored seven evidence-based clinical quality measures for the primary care of complex pediatric patients recognized by AHRQ’s National Guideline Clearinghouse. In addition to basic biostatistical and psychometric approaches, her methodological expertise encompasses general linear and multiple regression models, hierarchical linear modeling, structural equation modeling (SEM) and associated latent variable modeling techniques, and meta-analytic procedures. Dr. Schrager also works on several CHLA-based quality improvement (QI) initiatives, including: compliance with pediatric asthma care guidelines; effectiveness of the CV Acute unit; accuracy in admission medication reconciliation; and adherence to sedation weaning guidelines. Her teaching responsibilities at CHLA include the IMPACT residency program, support of faculty and trainees in the California Interdisciplinary Leadership Education in Neurodevelopmental and Related Disabilities (CA-LEND) Training Program, development of a social-behavioral research training program for medical fellows, and a monthly introductory research training series for faculty and fellows in the Division of Hospital Medicine.
Shannon L. Dunlap, Ph.D., LMSW, graduated with a bachelor degree in Psychology from the University of Maryland, College Park. Following her undergraduate studies she worked as an overnight shelter counselor for homeless and street engaged youth at Larkin Street Youth Services in San Francisco. She then graduated from the University of Southern California with an MSW, cum laude, in 2005. Following her MSW education, she was a clinical therapist at the Gay Lesbian Adolescent Social Services in Los Angeles, working with lesbian, gay, bisexual and transgender (LGBT) youth living in group homes. During this time, she also worked as a clinical child and family therapist at a DMH funded mental health clinic in Torrance California. In 2007, Shannon moved to Denver Colorado where she worked for four years as a clinical social worker within the Children's Hospital Immunodeficiency Program. As part of a trans-disciplinary team, she worked closely with newly and perinatally infected youth living with HIV as well as young pregnant women living with HIV. In 2011, she moved back to Los Angeles and worked as a Research Assistant for two research studies at USC: one looking at the social networks of homeless youth; and another looking at minority stress experiences among LGBT adolescents. During this time she also completed a year-long research internship at Children's Hospital Los Angeles, working primarily on cross-sex hormone and peri-pubertal hormone research studies for transgender and gender non-conforming youth. Currently, she is a second year doctoral student at UCLA and has been working as a research assistant with Dr. Ian Holloway and the World Arts and Culture Department facilitating focus groups and conducting qualitative data analysis on AMP!, an arts based multiple level HIV Prevention Program. Her current research areas include adolescent sexual health, HIV prevention, stigma, and LGBT adolescent stress.
Dr. Ian W. Holloway—Professor Holloway's research focuses on HIV and substance abuse prevention for vulnerable youth. He is particularly interested in how social networks (both interpersonal and venue-based) influence decision-making related to health risk behavior. Dr. Holloway recently completed a study entitled, “Social Network and Contextual Influences of Substance Use and HIV Risk Among Young Men Who Have Sex With Men”, which was funded by the National Institute of Drug Abuse. He is core scientist of the UCLA Center for HIV Intervention, Prevention, and Treatment Services (CHIPTS). This Center, funded by the National Institute of Mental Health, fosters interdisciplinary and community collaborations to develop strategies for integrating, promoting, and diffusing HIV detection, prevention, and care. Dr. Holloway holds dual master degrees in social work and public health from Columbia University. His doctorate is in social work from the University of Southern California.