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1.  Structural racism and myocardial infarction in the United States 
There is a growing research literature suggesting that racism is an important risk factor undermining the health of Blacks in the United States. Racism can take many forms, ranging from interpersonal interactions to institutional/structural conditions and practices. Existing research, however, tends to focus on individual forms of racial discrimination using self-report measures. Far less attention has been paid to whether structural racism may disadvantage the health of Blacks in the United States. The current study addresses gaps in the existing research by using novel measures of structural racism and by explicitly testing the hypothesis that structural racism is a risk factor for myocardial infarction among Blacks in the United States. State-level indicators of structural racism included four domains: (1) political participation; (2) employment and job status; (3) educational attainment; and (4) judicial treatment. State-level racial disparities across these domains were proposed to represent the systematic exclusion of Blacks from resources and mobility in society. Data on past-year myocardial infarction were obtained from the National Epidemiologic Survey on Alcohol and Related Conditions (non-Hispanic Black: N = 8245; non-Hispanic White: N = 24,507), a nationally representative survey of the U.S. civilian, non-institutionalized population aged 18 and older. Models were adjusted for individual-level confounders (age, sex, education, household income, medical insurance) as well as for state-level disparities in poverty. Results indicated that Blacks living in states with high levels of structural racism were generally more likely to report past-year myocardial infarction than Blacks living in low-structural racism states. Conversely, Whites living in high structural racism states experienced null or lower odds of myocardial infarction compared to Whites living in low-structural racism states. These results raise the provocative possibility that structural racism may not only harm the targets of stigma but also benefit those who wield the power to enact stigma and discrimination.
doi:10.1016/j.socscimed.2013.07.021
PMCID: PMC4133127  PMID: 24507909
Structural racism; Stigma; Health inequalities; Cardiovascular disease
2.  HATZENBUEHLER ET AL. RESPOND 
doi:10.2105/AJPH.2013.301430
PMCID: PMC4007864  PMID: 23763427
3.  Inclusive Anti-Bullying Policies and Reduced Risk of Suicide Attempts in Lesbian and Gay Youth 
Purpose
To evaluate whether anti-bullying policies that are inclusive of sexual orientation are associated with a reduced prevalence of suicide attempts among lesbian, gay, and bisexual (LGB) youths.
Methods
31,852 11th grade public school students (1,413 LGB individuals; 4.4%) in Oregon completed the Oregon Healthy Teens (OHT) survey in 2006–2008. The independent variable was the proportion of school districts in the 34 counties participating in the OHT survey that adopted anti-bullying policies inclusive of sexual orientation. The outcome measure was any self-reported suicide attempt in the past 12 months. Results were stratified by sexual orientation.
Results
Lesbian and gay youths living in counties with fewer school districts with inclusive anti-bullying policies were 2.25 times (95% C.I.: 1.13, 4.49) more likely to have attempted suicide in the past year compared to those living in counties where more districts had these policies. Inclusive anti-bullying policies were significantly associated with a reduced risk for suicide attempts among lesbian and gay youths even after controlling for sociodemographic characteristics (sex, race/ethnicity) and exposure to peer victimization (OR=0.18, 95% CI: 0.03–0.92). In contrast, anti-bullying policies that did not include sexual orientation were not associated with lower suicide attempts among lesbian and gay youths (OR=0.38, 95% CI: 0.02–7.33).
Conclusions
Inclusive anti-bullying policies may exert protective effects for the mental health of lesbian and gay youths, including reducing their risk for suicide attempts.
doi:10.1016/j.jadohealth.2012.08.010
PMCID: PMC3696185  PMID: 23790196
anti-bullying policies; sexual orientation; suicide attempts
4.  Sexual Orientation Disparities in Cardiovascular Biomarkers Among Young Adults 
Background
Emerging evidence from general population studies suggests that lesbian, gay and bisexual (LGB) adults are more likely to experience adverse cardiovascular outcomes relative to heterosexuals. No studies have examined whether sexual orientation disparities exist in biomarkers of early cardiovascular disease risk.
Purpose
To determine whether sexual orientation disparities in biomarkers of early cardiovascular risk are present among young adults.
Methods
Data come from Wave IV (2008–2009) of the National Longitudinal Study for Adolescent Health (N=12,451), a prospective nationally representative study of U.S. adolescents followed into young adulthood (mean age: 28.9 years). A total of 520 respondents identified as lesbian, gay, or bisexual. Biomarkers included C-reactive protein, glycosylated hemoglobin, systolic and diastolic blood pressure, and pulse rate. Analyses were conducted in 2012.
Results
In gender-stratified models adjusted for demographics (age, race/ethnicity); SES (income, education); health behaviors (smoking, regular physical activity, alcohol consumption); and BMI, gay and bisexual men had significant elevations in C-reactive protein, diastolic blood pressure, and pulse rate, compared to heterosexual men. Despite having more risk factors for cardiovascular disease, including smoking, heavy alcohol consumption, and higher BMI, lesbians and bisexual women had lower levels of C-reactive protein than heterosexual women in fully adjusted models.
Conclusions
Evidence was found for sexual orientation disparities in biomarkers of cardiovascular risk among young adults, particularly in gay and bisexual men. These findings, if confirmed in other studies, suggest that disruptions in core physiologic processes that ultimately confer risk for cardiovascular disease may occur early in the life course for sexual minority men.
doi:10.1016/j.amepre.2013.01.027
PMCID: PMC3659331  PMID: 23683979
5.  Social Networks and Risk for Depressive Symptoms in a National Sample of Sexual Minority Youth 
Social science & medicine (1982)  2012;75(7):1184-1191.
The aim of the study was to examine the social networks of sexual minority youths and to determine the associations between social networks and depressive symptoms. Data were obtained from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative cohort study of American adolescents (N=14,212). Wave 1 (1994–1995) collected extensive information about the social networks of participants through peer nomination inventories, as well as measures of sexual minority status and depressive symptoms. Using social network data, we examined three characteristics of adolescents’ social relationships: (1) social isolation; (2) degree of connectedness; and (3) social status. Sexual minority youths, particularly females, were more isolated, less connected, and had lower social status in peer networks than opposite-sex attracted youths. Among sexual minority male (but not female) youths, greater isolation as well as lower connectedness and status within a network were associated with greater depressive symptoms. Moreover, greater isolation in social networks partially explained the association between sexual minority status and depressive symptoms among males. Finally, a significant 3-way interaction indicated that the association between social isolation and depression was stronger for sexual minority male youths than non-minority youths and sexual minority females. These results suggest that the social networks in which sexual minority male youths are embedded may confer risk for depressive symptoms, underscoring the importance of considering peer networks in both research and interventions targeting sexual minority male adolescents.
doi:10.1016/j.socscimed.2012.05.030
PMCID: PMC3407288  PMID: 22771037
USA; sexual orientation; social networks; depression; minorities; adolescents
6.  Emotion Dysregulation as a Mechanism Linking Stress Exposure to Adolescent Aggressive Behavior 
Journal of abnormal child psychology  2012;40(7):1111-1122.
Exposure to stress is associated with a wide range of internalizing and externalizing problems in adolescents, including aggressive behavior. Extant research examining mechanisms underlying the associations between stress and youth aggression has consistently identified social information processing pathways that are disrupted by exposure to violence and increase risk of aggressive behavior. In the current study, we use longitudinal data to examine emotion dysregulation as a potential mechanism linking a broader range of stressful experiences to aggressive behavior in a diverse sample of early adolescents (N=1065). Specifically, we examined the longitudinal associations of peer victimization and stressful life events with emotion dysregulation and aggressive behavior. Structural equation modeling was used to create latent constructs of emotion dysregulation and aggression. Both stressful life events and peer victimization predicted subsequent increases in emotion dysregulation over a 4-month period. These increases in emotion dysregulation, in turn, were associated with increases in aggression over the subsequent 3 months. Longitudinal mediation models showed that emotion dysregulation mediated the relationship of both peer victimization (z=2.35, p=0.019) and stressful life events (z=2.32, p=0.020) with aggressive behavior. Increasing the use of adaptive emotion regulation strategies is an important target for interventions aimed at preventing the onset of adolescent aggressive behavior.
doi:10.1007/s10802-012-9629-4
PMCID: PMC3448707  PMID: 22466516
Stress; Peer victimization; Aggression; Emotion regulation; Adolescence
7.  Associations Between Perceived Weight Discrimination and the Prevalence of Psychiatric Disorders in the General Population 
Obesity (Silver Spring, Md.)  2009;17(11):2033-2039.
Despite the increased prevalence of weight discrimination, few studies have examined the association between perceived weight discrimination and the prevalence of current psychiatric disorders in the general population. This study utilized a subsample of overweight and obese individuals (N = 22,231) from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a cross-sectional nationally representative study of noninstitutionalized US adults. Perceived weight discrimination is associated with substantial psychiatric morbidity and comorbidity. These results remained significant after adjusting for a potential confound, perceived stress. Moreover, social support did not buffer against the adverse effects of perceived weight discrimination on mental health. Controlling for BMI did not diminish the associations, indicating that perceived weight discrimination is potentially harmful to mental health regardless of weight. These results highlight the urgent need for a multifaceted approach to address this important public health issue, including interventions to assist overweight individuals in coping with the mental health sequelae of perceived weight discrimination.
doi:10.1038/oby.2009.131
PMCID: PMC3767420  PMID: 19390520
8.  Disproportionate Exposure to Early-Life Adversity and Sexual Orientation Disparities in Psychiatric Morbidity 
Child abuse & neglect  2012;36(9):645-655.
Objectives
Lesbian, gay, and bisexual (LGB) populations exhibit elevated rates of psychiatric disorders compared to heterosexuals, and these disparities emerge early in the life course. We examined the role of exposure to early-life victimization and adversity—including physical and sexual abuse, homelessness, and intimate partner violence—in explaining sexual orientation disparities in mental health among adolescents and young adults.
Methods
Data were drawn from the National Longitudinal Study of Adolescent Health, Wave 3 (2001–2002), a nationally representative survey of adolescents. Participants included gay/lesbian (n=227), bisexual (n=245), and heterosexual (n=13,490) youths, ages 18–27. We examined differences in the prevalence of exposure to child physical or sexual abuse, homelessness or expulsion from one’s home by caregivers, and physical and sexual intimate partner violence according to sexual orientation. Next we examined the associations of these exposures with symptoms of psychopathology including suicidal ideation and attempts, depression, binge drinking, illicit drug use, tobacco use, alcohol abuse, and drug abuse. Finally, we determined whether exposure to victimization and adversity explained the association between sexual orientation and psychopathology.
Results
Gay/lesbian and bisexual respondents had higher levels of psychopathology than heterosexuals across all outcomes. Gay/lesbian respondents had higher odds of exposure to child abuse and housing adversity, and bisexual respondents had higher odds of exposure to child abuse, housing adversity, and intimate partner violence, than heterosexuals. Greater exposure to these adversities explained between 10–20% of the relative excess of suicidality, depression, tobacco use, and symptoms of alcohol and drug abuse among LGB youths compared to heterosexuals. Exposure to victimization and adversity experiences in childhood and adolescence significantly mediated the association of both gay/lesbian and bisexual orientation with suicidality, depressive symptoms, tobacco use, and alcohol abuse.
Conclusions
Exposure to victimization in early-life family and romantic relationships explains, in part, sexual orientation disparities in a wide range of mental health and substance use outcomes, highlighting novel targets for preventive interventions aimed at reducing these disparities.
doi:10.1016/j.chiabu.2012.07.004
PMCID: PMC3445753  PMID: 22964371
9.  Stressful life experiences, alcohol consumption, and alcohol use disorders: the epidemiologic evidence for four main types of stressors 
Psychopharmacology  2011;218(1):1-17.
Background
Exposure to stress is potentially important in the pathway to alcohol use and alcohol use disorders. Stressors occur at multiple time points across the life course, with varying degrees of chronicity and severity.
Method
We review evidence from epidemiologic studies on the relationship between four different stressors (fateful/catastrophic events, child maltreatment, common adult stressful life events in interpersonal, occupational, financial, and legal domains, and minority stress) and alcohol consumption and alcohol use disorders.
Results
Studies generally demonstrate an increase in alcohol consumption in response to exposure to terrorism or other disasters. Research has demonstrated little increase in incident alcohol use disorders, but individuals with a history of alcohol use disorders are more likely to report drinking to cope with the traumatic event. Childhood maltreatment is a consistent risk factor for early onset of drinking in adolescence and adult alcohol use disorders, and accumulating evidence suggests that specific polymorphisms may interact with child maltreatment to increase risk for alcohol consumption and disorder. Stressful life events such as divorce and job loss increase the risk of alcohol disorders, but epidemiologic consensus on the specificity of these associations across gender has not been reached. Finally, both perceptions of discrimination and objective indicators of discrimination are associated with alcohol use and alcohol use disorders among racial/ethnic and sexual minorities.
Conclusion
Taken together, these literatures demonstrate that exposure to stress is an important component in individual differences in risk for alcohol consumption and alcohol use disorders. However, many areas of this research remain to be studied, including greater attention to the role of various stressors in the course of alcohol use disorders and potential risk moderators when individuals are exposed to stressors.
doi:10.1007/s00213-011-2236-1
PMCID: PMC3755727  PMID: 21373787
Alcohol; Stress
10.  How Does Stigma “Get Under the Skin”? 
Psychological science  2009;20(10):1282-1289.
Stigma is a risk factor for mental health problems, but few studies have considered how stigma leads to psychological distress. The present research examined whether specific emotion-regulation strategies account for the stigma-distress association. In an experience-sampling study, rumination and suppression occurred more on days when stigma-related stressors were reported than on days when these stressors were not reported, and rumination mediated the relationship between stigma-related stress and psychological distress. The effect of social support on distress was moderated by the concealability of the stigma: Lesbian, gay, and bisexual (LGB) respondents reported more isolation and less social support than African American respondents subsequent to experiencing stigma-related stressors, whereas African Americans reported greater social support than LGB participants. Social isolation mediated the stigma-distress association among LGB respondents. In a second experimental study, participants who ruminated following the recall of an autobiographical discrimination event exhibited prolonged distress on both implicit and explicit measures relative to participants who distracted themselves; this finding provides support for a causal role of rumination in the stigma-distress relationship.
doi:10.1111/j.1467-9280.2009.02441.x
PMCID: PMC3687354  PMID: 19765237
11.  Stigma as a Fundamental Cause of Population Health Inequalities 
American journal of public health  2013;103(5):813-821.
Bodies of research pertaining to specific stigmatized statuses have typically developed in separate domains and have focused on single outcomes at 1 level of analysis, thereby obscuring the full significance of stigma as a fundamental driver of population health. Here we provide illustrative evidence on the health consequences of stigma and present a conceptual framework describing the psychological and structural pathways through which stigma influences health. Because of its pervasiveness, its disruption of multiple life domains (e.g., resources, social relationships, and coping behaviors), and its corrosive impact on the health of populations, stigma should be considered alongside the other major organizing concepts for research on social determinants of population health.
doi:10.2105/AJPH.2012.301069
PMCID: PMC3682466  PMID: 23488505
12.  Effect of Same-Sex Marriage Laws on Health Care Use and Expenditures in Sexual Minority Men: A Quasi-Natural Experiment 
American journal of public health  2011;102(2):285-291.
Objectives
We sought to determine whether health care use and expenditures among gay and bisexual men were reduced following the enactment of samesex marriage laws in Massachusetts in 2003.
Methods
We used quasi-experimental, prospective data from 1211 sexual minority male patients in a community-based health center in Massachusetts.
Results
In the 12 months after the legalization of same-sex marriage, sexual minority men had a statistically significant decrease in medical care visits (mean= 5.00 vs mean=4.67; P=.05; Cohen’s d=0.17), mental health care visits (mean= 24.72 vs mean= 22.20; P=.03; Cohen’s d=0.35), and mental health care costs (mean= $2442.28 vs mean= $2137.38; P= .01; Cohen’s d=0.41), compared with the 12 months before the law change. These effects were not modified by partnership status, indicating that the health effect of same-sex marriage laws was similar for partnered and nonpartnered men.
Conclusions
Policies that confer protections to same-sex couples may be effective in reducing health care use and costs among sexual minority men.
doi:10.2105/AJPH.2011.300382
PMCID: PMC3484969  PMID: 22390442
13.  Prospective Associations Between HIV-Related Stigma, Transmission Risk Behaviors, and Adverse Mental Health Outcomes in Men Who Have Sex with Men 
Background
The vast majority of research on HIV-related stigma has been cross sectional, and few studies have examined whether experiencing stigma is associated with sexual risk behaviors.
Purpose
The purpose of this study is to examine the prospective relationships between experiencing HIV-related stigma and symptoms of anxiety and depression, as well as sexual transmission risk behavior.
Methods
The sample included HIV-infected men who have sex with men (n = 314) who participated in a secondary HIV-prevention study at their primary care site. Participants were assessed at baseline, and then completed follow-up assessments at 3, 6, 9, and 12 months.
Results
Experiencing HIV-related stigma was prospectively associated with symptoms of depression (β = 0.16, p < .001), panic (β = 0.11, p = .01), and generalized anxiety (β = 0.05, p = .05). In addition, perceiving HIV-related stigma was prospectively associated with transmission risk behaviors, including unprotected receptive or insertive anal intercourse with HIV-seronegative or status unknown partners (β = 0.06, p = .047).
Conclusions
Experiencing HIV-related stigma may increase risk for sexual transmission risk behavior and mental health problems.
doi:10.1007/s12160-011-9275-z
PMCID: PMC3651589  PMID: 21533623
HIV-related stigma; HIV risk behaviors; Depression; Anxiety; MSM
14.  Emotion Dysregulation and Adolescent Psychopathology: A Prospective Study 
Behaviour research and therapy  2011;49(9):544-554.
Background
Emotion regulation deficits have been consistently linked to psychopathology in cross-sectional studies. However, the direction of the relationship between emotion regulation and psychopathology is unclear. This study examined the longitudinal and reciprocal relationships between emotion regulation deficits and psychopathology in adolescents.
Methods
Emotion dysregulation and symptomatology (depression, anxiety, aggressive behavior, and eating pathology) were assessed in a large, diverse sample of adolescents (N = 1,065) at two time points separated by seven months. Structural equation modeling was used to examine the longitudinal and reciprocal relationships between emotion dysregulation and symptoms of psychopathology.
Results
The three distinct emotion processes examined here (emotional understanding, dysregulated expression of sadness and anger, and ruminative responses to distress) formed a unitary latent emotion dysregulation factor. Emotion dysregulation predicted increases in anxiety symptoms, aggressive behavior, and eating pathology after controlling for baseline symptoms but did not predict depressive symptoms. In contrast, none of the four types of psychopathology predicted increases in emotion dysregulation after controlling for baseline emotion dysregulation.
Conclusions
Emotion dysregulation appears to be an important transdiagnostic factor that increases risk for a wide range of psychopathology outcomes in adolescence. These results suggest targets for preventive interventions during this developmental period of risk.
doi:10.1016/j.brat.2011.06.003
PMCID: PMC3153591  PMID: 21718967
emotion regulation; depression; anxiety; aggression; eating pathology; adolescence
15.  The protective effects of social/contextual factors on psychiatric morbidity in LGB populations 
Background Lesbian, gay and bisexual (LGB) populations evidence higher rates of psychiatric disorders than heterosexuals, but most LGB individuals do not have mental-health problems. The present study examined risk modifiers at the social/contextual level that may protect LGB individuals from the development of psychiatric disorders.
Methods Data are drawn from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N = 34 653), a nationally representative study of non-institutionalized US adults. Risk variables included social isolation and economic adversity. High state-level concentration of same-sex couples, obtained from the US Census, was examined as a protective factor.
Results The past-year prevalence of major depression and generalized anxiety disorder was lower among LGB respondents living in states with higher concentrations of same-sex couples, compared with LGB respondents in states with lower concentrations. Additionally, the increased risk for mood and anxiety disorders among LGB individuals exposed to economic adversity and social isolation was evident only in states with low concentrations of same-sex couples. These interactions between the risk and protective factors were not found among heterosexuals, suggesting specificity of the effects to LGB individuals. Results were not attenuated after controlling for socio-demographic factors, state-level income inequality, state-level policies targeting LGBs and state-level attitudes towards LGB-relevant issues.
Conclusions These results provide evidence for the protective effect of social/contextual influences on the prevalence of psychiatric disorders in LGB individuals. Measures of the social environment should be incorporated into future research on the mental health of LGB populations.
doi:10.1093/ije/dyr019
PMCID: PMC3156367  PMID: 21330343
Sexual orientation; social epidemiology; mental health
16.  Discrimination and Alcohol-Related Problems among College Students: A Prospective Examination of Mediating Effects 
Drug and alcohol dependence  2010;115(3):213-220.
Background
Discrimination is a risk factor for health-risk behaviors, including alcohol abuse. Far less is known about the mechanisms through which discrimination leads to alcohol-related problems, particularly during high-risk developmental periods such as young adulthood.
Methods
The present study tested a mediation model using prospective data from a large, diverse sample of 1,539 college students. This model hypothesized that discrimination would be associated with established cognitive (positive alcohol expectancies) and affective (negative affect and coping motives) risk factors for alcohol-related problems, which would account for the prospective association between discrimination and alcohol problems.
Results
Structural Equation Modeling indicated that discrimination was associated cross-sectionally with negative affect and more coping motives for drinking, but not with greater alcohol expectancies. Coping motives mediated the prospective relationship between discrimination and alcohol-related problems. Additionally, results indicated significant indirect effects from discrimination to alcohol-related problems through negative affect and coping motives. These associations were evident for multiple groups confronting status-based discrimination, including women, racial/ethnic minorities, and lesbian/gay/bisexual individuals.
Conclusions
This study identified potential affective mechanisms linking discrimination to alcohol-related problems. Results suggest several avenues for prevention and intervention efforts with individuals from socially disadvantaged groups.
doi:10.1016/j.drugalcdep.2010.11.002
PMCID: PMC3090712  PMID: 21145669
discrimination; alcohol-related problems; coping motives; alcohol expectancies; negative affect; college students
17.  The Social Environment and Suicide Attempts in Lesbian, Gay, and Bisexual Youth 
Pediatrics  2011;127(5):896-903.
OBJECTIVE:
To determine whether the social environment surrounding lesbian, gay, and bisexual youth may contribute to their higher rates of suicide attempts, controlling for individual-level risk factors.
METHODS:
A total of 31 852 11th grade students (1413 [4.4%] lesbian, gay, and bisexual individuals) in Oregon completed the Oregon Healthy Teens survey in 2006–2008. We created a composite index of the social environment in 34 counties, including (1) the proportion of same-sex couples, (2) the proportion of registered Democrats, (3) the presence of gay-straight alliances in schools, and (4) school policies (nondiscrimination and antibullying) that specifically protected lesbian, gay, and bisexual students.
RESULTS:
Lesbian, gay, and bisexual youth were significantly more likely to attempt suicide in the previous 12 months, compared with heterosexuals (21.5% vs 4.2%). Among lesbian, gay, and bisexual youth, the risk of attempting suicide was 20% greater in unsupportive environments compared to supportive environments. A more supportive social environment was significantly associated with fewer suicide attempts, controlling for sociodemographic variables and multiple risk factors for suicide attempts, including depressive symptoms, binge drinking, peer victimization, and physical abuse by an adult (odds ratio: 0.97 [95% confidence interval: 0.96–0.99]).
CONCLUSIONS:
This study documents an association between an objective measure of the social environment and suicide attempts among lesbian, gay, and bisexual youth. The social environment appears to confer risk for suicide attempts over and above individual-level risk factors. These results have important implications for the development of policies and interventions to reduce sexual orientation–related disparities in suicide attempts.
doi:10.1542/peds.2010-3020
PMCID: PMC3081186  PMID: 21502225
suicide attempts; sexual orientation; disparities; social determinants of health
18.  Trajectories and Determinants of Alcohol Use Among LGB Young Adults and Their Heterosexual Peers: Results From a Prospective Study 
Developmental psychology  2008;44(1):81-90.
Lesbians, gays, and bisexuals (LGBs) are at increased risk for alcohol use during young adulthood, but the mechanisms remain inadequately understood. The aim of the present study was to examine the trajectories and determinants of alcohol use among LGB young adults who were sampled prospectively. The sample included 111 LGB individuals (47 women and 64 men) and 2,109 heterosexuals (1,279 women and 830 men), who were assessed at three time points: during the summer after their senior year of high school and during the fall and spring of their freshman year of college. Hierarchical linear modeling analyses indicated that lesbians consumed more alcohol than their heterosexual peers during high school, whereas gay men increased their alcohol use at greater rates than heterosexual men during the initial transition to college. Positive alcohol expectancies and social norms mediated this relation for both men and women. The results extend the generalizability of these processes and highlight the importance of considering normative social–cognitive influences in the development of alcohol use among LGB young adults.
doi:10.1037/0012-1649.44.1.81
PMCID: PMC3039602  PMID: 18194007
alcohol use; LGB young adults; social norms; alcohol expectancies
19.  An Implicit Measure of Anti-Gay Attitudes: Prospective Associations with Emotion Regulation Strategies and Psychological Distress 
Members of stigmatized groups are at increased risk for mental health problems, and recent research has suggested that emotion dysregulation may be one mechanism explaining the stigma-distress association. However, little is known regarding characteristics that predict vulnerabilities to emotion dysregulation and subsequent distress. We examined whether anti-gay attitudes would predict poorer emotion regulation and greater psychological distress in 31 lesbian, gay, and bisexual (LGB) respondents. Respondents completed implicit and explicit attitude measures at baseline, and participated in an experience sampling study examining stigma-related stressors, emotion regulation strategies, and mood over the course of ten days. Implicit and explicit attitude measures were not correlated. LGB respondents with greater implicit anti-gay attitudes engaged in significantly more rumination and suppression and reported more psychological distress. Rumination fully mediated the prospective association between implicit prejudicial attitudes and psychological distress, and suppression was a marginally significant mediator.
doi:10.1016/j.jesp.2009.08.005
PMCID: PMC2791410  PMID: 20161465
stigma; emotion regulation; psychological distress; implicit attitudes; LGB
20.  Emotion Dysregulation as a Mechanism Linking Peer Victimization to Internalizing Symptoms in Adolescents 
Peer victimization experiences represent developmentally salient stressors among adolescents and are associated with the development of internalizing symptoms. However, the mechanisms linking peer victimization to adolescent psychopathology remain inadequately understood. This study examined emotion dysregulation as a mechanism linking peer stress to changes in internalizing symptoms among adolescents in a longitudinal design. Peer victimization was assessed in a large (N = 1,065) racially diverse (86.6% non-White) sample of adolescents ages 11 to 14 using the Revised Peer Experiences Questionnaire. Emotion dysregulation and symptoms of depression and anxiety were also assessed. Structural equation modeling was used to create a latent construct of emotion dysregulation from measures of discrete emotion processes and of peer victimization and internalizing symptoms. Peer victimization was associated with increased emotion dysregulation over a 4-month period. Increases in emotion dysregulation mediated the relationship between relational and reputational, but not overt, victimization and changes in internalizing symptoms over a 7-month period. Evidence for a reciprocal relationship between internalizing symptoms and relational victimization was found, but emotion dysregulation did not mediate this relationship. The implications for preventive interventions are discussed.
doi:10.1037/a0015760
PMCID: PMC2778003  PMID: 19803569
peer victimization; emotion regulation; depression; anxiety; internalizing symptoms
21.  Responses to Discrimination and Psychiatric Disorders Among Black, Hispanic, Female, and Lesbian, Gay, and Bisexual Individuals 
American journal of public health  2010;100(8):1477-1484.
Objectives
We examined associations between perceived discrimination due to race/ethnicity, sexual orientation, or gender; responses to discrimination experiences; and psychiatric disorders.
Methods
The sample included respondents in the 2004 to 2005 National Epidemiologic Survey on Alcohol and Related Conditions (N|=|34|653). We analyzed the associations between self-reported past-year discrimination and past-year psychiatric disorders as assessed with structured diagnostic interviews among Black (N|=|6,587); Hispanic (N|=|6,359); lesbian, gay, and bisexual (LGB) (N|=|577); and female (N|=|20|089) respondents.
Results
Black respondents reported the highest levels of past-year discrimination, followed by LGB, Hispanic, and female respondents. Across groups, discrimination was associated with 12-month mood [odds ratio (ORs)|=|2.1–3.1], anxiety (ORs|=|1.8–3.3), and substance use (ORs|=|1.6–3.5) disorders. Respondents who reported not accepting discrimination and not discussing it with others had higher odds of psychiatric disorders (ORs|=|2.9–3.9) than did those who did not accept discrimination but did discuss it with others. Black respondents and women who accepted discrimination and did not talk about it with others had elevated rates of mood and anxiety disorders, respectively.
Conclusions
Psychiatric disorders are more prevalent among individuals reporting past-year discrimination experiences. Certain responses to discrimination, particularly not disclosing it, are associated with psychiatric morbidity.
doi:10.2105/AJPH.2009.181586
PMCID: PMC2901295  PMID: 20558791
22.  Emotion regulation and internalizing symptoms in a longitudinal study of sexual minority and heterosexual adolescents 
Background
Sexual minority adolescents appear to be at increased risk for internalizing disorders relative to their heterosexual peers, but there is a paucity of research explaining this elevated risk. Emotion regulation deficits are increasingly understood as important predictors of internalizing psychopathology among general samples of adolescents. The present study sought to examine whether deficits in emotion regulation could account for disparities in internalizing symptoms between sexual minority and heterosexual adolescents.
Methods
The present study utilized longitudinal data from a racially/ethnically diverse (68% non-Hispanic Black and Hispanic/Latino) community sample of 1,071 middle school students (ages 11–14).
Results
Adolescents who endorsed same-sex attraction evidenced higher rates of internalizing symptoms at both time points. Structural equation modeling indicated that sexual minority adolescents exhibited greater deficits in emotion regulation (rumination and poor emotional awareness) than their heterosexual peers. Emotion regulation deficits in turn mediated the relationship between sexual minority status and symptoms of depression and anxiety.
Conclusions
The results demonstrate the importance of considering normative psychological processes in the development of internalizing symptomatology among sexual minority adolescents, and suggest emotion regulation deficits as specific targets of prevention and intervention efforts with this population. Future studies are needed to determine whether stigma-related stressors are responsible for emotion regulation deficits among sexual minority youth.
doi:10.1111/j.1469-7610.2008.01924.x
PMCID: PMC2881586  PMID: 18564066
Depression; anxiety; emotion regulation; sexual minority youth
23.  Stressful Life Events, Anxiety Sensitivity, and Internalizing Symptoms in Adolescents 
Journal of abnormal psychology  2009;118(3):659-669.
Anxiety sensitivity represents a robust risk factor for the development of anxiety symptoms among both adolescents and adults. However, the development of anxiety sensitivity among adolescents remains inadequately understood. In this study, the authors examined the role of stressful life events as a risk factor for the development of elevated anxiety sensitivity. Anxiety sensitivity was then examined in a longitudinal design as a mechanism linking stressful life events to changes in anxiety symptoms. Stressful life events, anxiety sensitivity, and internalizing symptoms were assessed in a diverse community sample of adolescents (N = 1,065) at 3 time points spanning 7 months. The results indicated that stressful life events were longitudinally associated with increases in anxiety sensitivity and that certain types of stressful life events, specifically events related to health and events related to family discord, were differentially predictive of increases in anxiety sensitivity. Moreover, anxiety sensitivity mediated the longitudinal relation between stressful life events and anxiety symptoms. Evidence was also found for the predictive specificity of anxiety sensitivity to symptoms of anxiety but not depression.
doi:10.1037/a0016499
PMCID: PMC2881589  PMID: 19685962
anxiety sensitivity; stress; anxiety; depression; adolescence
24.  Mechanisms Linking Stressful Life Events and Mental Health Problems in a Prospective, Community-Based Sample of Adolescents 
Purpose
Stressful life events represent potent risk factors for the development of internalizing symptoms among adolescents. However the mechanisms linking stress to adolescent psychopathology remain inadequately understood. This study examined the role of emotion dysregulation as a mechanism linking stress to changes in internalizing symptoms among adolescents.
Methods
This study used a short-term longitudinal design. Stressful life events were assessed in a large diverse sample of adolescents (N = 1065), and emotion dysregulation and symptomatology outcomes were assessed at two subsequent time points. Structural equation modeling was used to examine the role of emotion dysregulation as a mediator of the association between stress and subsequent changes in internalizing symptoms.
Results
Emotion dysregulation mediated the relationship between stressful life events and changes in internalizing symptoms over time. Sobel’s test indicated a significant indirect effect of stressful life events on subsequent symptoms of depression (z = 5.05, p < .001) and anxiety (z = 4.95, p < .001) through emotion dysregulation.
Conclusions
Stressful life events appear to disrupt the adaptive processing of emotion among adolescents. Emotion dysregulation represents an intrapersonal mechanism linking stress to poor mental health outcomes. The implications for preventive interventions are discussed.
doi:10.1016/j.jadohealth.2008.06.019
PMCID: PMC2881598  PMID: 19167664
Stress; Emotion regulation; Depression; Anxiety; Adolescence
25.  How Does Sexual Minority Stigma “Get Under the Skin”? A Psychological Mediation Framework 
Psychological bulletin  2009;135(5):707-730.
Sexual minorities are at increased risk for multiple mental health burdens compared to heterosexuals. The field has identified two distinct determinants of this risk, including group-specific minority stressors and general psychological processes that are common across sexual orientations. The goal of the present paper is to develop a theoretical framework that integrates the important insights from these literatures. The framework postulates that (a) sexual minorities confront increased stress exposure resulting from stigma; (b) this stigma-related stress creates elevations in general emotion dysregulation, social/interpersonal problems, and cognitive processes conferring risk for psychopathology; and (c) these processes in turn mediate the relationship between stigma-related stress and psychopathology. It is argued that this framework can, theoretically, illuminate how stigma adversely affects mental health and, practically, inform clinical interventions. Evidence for the predictive validity of this framework is reviewed, with particular attention paid to illustrative examples from research on depression, anxiety, and alcohol use disorders.
doi:10.1037/a0016441
PMCID: PMC2789474  PMID: 19702379
stigma-related stress; general psychological processes; mediation; LGB populations; mental health disparities

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