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      The Intersections Between Sexual Orientation, Latine Ethnicity, Social Determinants of Health, and Lifetime Suicide Attempts in a Sample Being Assessed for Entry to Co-Occurring Mental Health and Substance Use Disorder Treatment

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          Abstract

          Purpose:

          Few studies have examined the relationship between the intersections of lesbian, gay, and bisexual (LGB) sexual orientation, Latine ethnicity, and lifetime suicide attempts in Latine individuals with substance use disorder. This study examines this intersection and controls for social determinants of health, mental health disorder symptoms, and substance use disorder symptoms in a sample of Latine adults entering treatment for co-occurring disorders.

          Method:

          Bivariate statistics and multivariate logistic regression were used to analyze assessment data (n = 360) from a bilingual/bicultural integrated behavioral health system serving Latine communities in Massachusetts to examine the relationship between sexual orientation, Latine ethnicity, and history of lifetime suicide attempts. We controlled for social determinants of health, mental health disorders, and substance use disorder (SUD) factors significantly associated with lifetime suicide attempts at the bivariate level.

          Results:

          Over 27% of the sample and 35% of Puerto Ricans (PR) reported lifetime suicide attempts. The logistic regression identified that PR clients were 78% more likely to have attempted suicide in a lifetime compared to non-PR clients. Clients identifying as LGB were 3.2 times more likely to report having attempted suicide in their lifetime compared to heterosexual clients. Unemployed clients were 2.4 times more likely to report having attempted suicide in their lifetime compared to employed clients.

          Conclusion:

          Findings identify high rates of lifetime suicide attempts among LGBs and PRs entering SUD treatment. Targeted outreach and treatment efforts designed to address intersectionality for this underserved population are needed.

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          Most cited references44

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          Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence.

          Ilan Meyer (2003)
          In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress--explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.
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            The problem with the phrase women and minorities: intersectionality-an important theoretical framework for public health.

            Intersectionality is a theoretical framework that posits that multiple social categories (e.g., race, ethnicity, gender, sexual orientation, socioeconomic status) intersect at the micro level of individual experience to reflect multiple interlocking systems of privilege and oppression at the macro, social-structural level (e.g., racism, sexism, heterosexism). Public health's commitment to social justice makes it a natural fit with intersectionality's focus on multiple historically oppressed populations. Yet despite a plethora of research focused on these populations, public health studies that reflect intersectionality in their theoretical frameworks, designs, analyses, or interpretations are rare. Accordingly, I describe the history and central tenets of intersectionality, address some theoretical and methodological challenges, and highlight the benefits of intersectionality for public health theory, research, and policy.
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              Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults.

              We examined specific family rejecting reactions to sexual orientation and gender expression during adolescence as predictors of current health problems in a sample of lesbian, gay, and bisexual young adults. On the basis of previously collected in-depth interviews, we developed quantitative scales to assess retrospectively in young adults the frequency of parental and caregiver reactions to a lesbian, gay, or bisexual sexual orientation during adolescence. Our survey instrument also included measures of 9 negative health indicators, including mental health, substance abuse, and sexual risk. The survey was administered to a sample of 224 white and Latino self-identified lesbian, gay, and bisexual young adults, aged 21 to 25, recruited through diverse venues and organizations. Participants completed self-report questionnaires by using either computer-assisted or pencil-and-paper surveys. Higher rates of family rejection were significantly associated with poorer health outcomes. On the basis of odds ratios, lesbian, gay, and bisexual young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse compared with peers from families that reported no or low levels of family rejection. Latino men reported the highest number of negative family reactions to their sexual orientation in adolescence. This study establishes a clear link between specific parental and caregiver rejecting behaviors and negative health problems in young lesbian, gay, and bisexual adults. Providers who serve this population should assess and help educate families about the impact of rejecting behaviors. Counseling families, providing anticipatory guidance, and referring families for counseling and support can help make a critical difference in helping decrease risk and increasing well-being for lesbian, gay, and bisexual youth.
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                Author and article information

                Journal
                J Prim Care Community Health
                J Prim Care Community Health
                JPC
                spjpc
                Journal of Primary Care & Community Health
                SAGE Publications (Sage CA: Los Angeles, CA )
                2150-1319
                2150-1327
                21 March 2024
                Jan-Dec 2024
                : 15
                : 21501319241240425
                Affiliations
                [1 ]University of Denver, Denver, CO, USA
                [2 ]Community-Led Solutions, LLC, Boston, MA, USA
                [3 ]Casa Esperanza, Inc., Roxbury, MA, USA
                [4 ]Brandeis University, Waltham, MA, USA
                Author notes
                [*]Akeem Modeste-James, Cross-National Behavioral-Health Laboratory, Graduate School of Social Work, University of Denver, 2148 S. High Street, Denver, CO 80208, USA. Email: Akeem.Modeste-James@ 123456du.edu
                Author information
                https://orcid.org/0000-0003-0729-0680
                Article
                10.1177_21501319241240425
                10.1177/21501319241240425
                10958810
                38511864
                978d1369-d647-4d31-944a-99a55945990e
                © The Author(s) 2024

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 28 December 2023
                : 7 February 2024
                : 27 February 2024
                Funding
                Funded by: Center for Substance Abuse Prevention, FundRef https://doi.org/10.13039/100005269;
                Award ID: CSAT TI080784
                Funded by: Center for Substance Abuse Prevention, FundRef https://doi.org/10.13039/100005269;
                Award ID: CMHS SM80754
                Funded by: Center for Substance Abuse Prevention, FundRef https://doi.org/10.13039/100005269;
                Award ID: CMHS SM82420
                Funded by: Center for Substance Abuse Prevention, FundRef https://doi.org/10.13039/100005269;
                Award ID: CSAT TI080903
                Funded by: Center for Substance Abuse Prevention, FundRef https://doi.org/10.13039/100005269;
                Award ID: CSAT TI081614
                Funded by: Center for Substance Abuse Prevention, FundRef https://doi.org/10.13039/100005269;
                Award ID: CSAT TI082188
                Funded by: Center for Substance Abuse Prevention, FundRef https://doi.org/10.13039/100005269;
                Award ID: TI080655
                Categories
                Original Research
                Custom metadata
                January-December 2024
                ts1

                social determinants of health,substance use disorder,lifetime suicide attempts,latine ethnicity,intersectionality

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