Research

Tonda Hughes, PhD, MSN, Funded Projects

Sexual Orientation, Substance Use and Mental Health

Funding Source: National Institute on Drug Abuse

Role on the Grant: Co-Investigator

Investigators: Sean Esteban McCabe, Ph.D.-University of Michigan-Principal Investigator, Carol J. Boyd, Ph.D, RN.-University of Michigan-Co-Investigator, Wendy Bostwick, Ph.D- Adler School of Professional Psychology-Co-Investigator

Dates: 09/30/07 - 08/31/09

Abstract: This exploratory project uses an existing nationally representative dataset to assess the relationships among sexual orientation, perceived discrimination, substance abuse, mental health, and treatment utilization in the United States . Past research has generally found lesbian, gay and bisexual (LGB) individuals are at heightened risk for substance use and mental health disorders but these studies have been plagued by methodological limitations, including small, non-representative samples and lack of heterosexual comparison groups. To date, no large-scale nationally representative studies have examined the epidemiology of substance use and mental health disorders among self-identified LGB individuals and almost no data on treatment utilization among sexual minorities exists. In this project we are analyzing data from the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of 34,653 U.S. adults 18 years and older in the United States . The specific aims are to: (1) assess the prevalence and co-occurrence of substance use behaviors, DSM-IV substance use, mood and anxiety disorders based on sexual orientation; (2) estimate substance abuse and mental health treatment utilization based on sexual orientation among respondents with and without DSM-IV diagnoses; and (3) examine the association between perceived discrimination and substance use and mental health outcomes among sexual minorities. The project takes advantage of the unique opportunities afforded by the 2004-2005 NESARC: the availability of an ample and ethnically diverse sample with large numbers of sexual minority women and men; the inclusion of multiple measures of sexual orientation; and the wealth of data on DSM-IV substance use, mood and anxiety disorders, and treatment utilization. Findings from this project will enhance understanding of the epidemiology of substance use and mental health disorders among both heterosexuals and sexual minorities in the United States , and will provide information to improve the assessment, prevention and treatment of these disorders.

Childhood Sexual Abuse and Health: Meaning Making in the Contexts of Race/Ethnicity and Sexual Orientation

Funding Source: Center for Reducing Risks in Vulnerable Populations

Role on the Grant: Co-Principal Investigator

Investigators: Laura Szalacha, PhD, Principal Investigator, University of Illinois at Chicago, Cheryl Parks, PhD, MSW , Co-Investigator, University of Connecticut

Dates: June 2008-July 2010

Abstract: Lesbians and women of color are two of the six U.S. population groups identified by Healthy People 2010 as suffering from substantial health disparities (USDHHS, 2000). While ample research has documented heightened vulnerability of sexual minority women and of racial/ethnic minority women, few studies have examined the potentially additive or interactive effects of living with these two marginalized and stigmatized statuses. Childhood sexual abuse (CSA) is a major social problem, with rates in community samples of women typically between 20% and 38%. CSA is associated with multiple long-term negative health consequences, such as anxiety, depression, sexual and relationship problems, risky sexual behaviors, eating disorders, substance abuse and suicidality. Although women who self-identify as lesbian report high rates of CSA as well as high rates of many physical and mental health problems that have been associated with CSA, very little research on CSA among lesbians has been done, and no studies on CSA have been conducted with racial/ethnic minority lesbians. Thus, our specific aims are to: (1) Conduct life-history interviews with African American, Latina, and White lesbians, to explore the intersections among CSA, race/ethnicity, lesbian sexual orientation, and health; and (2) Use existing quantitative data from the Chicago Health and Life Experiences of Women (CHLEW), to test emerging hypotheses derived from the qualitative interviews about relationships among CSA, race/ethnicity, sexual orientation, and health outcomes.

The study uses a mixed-method research design that incorporates new data from in-depth, qualitative life history interviewing with existing longitudinal survey data from the CHLEW study. The project will take advantage of the unusual opportunities afforded by the CHLEW, including its longitudinal design, high retention rates, large sample, racial/ethnic and socioeconomic diversity, and the wealth of data already collected on CSA and health. The broad scope of the existing quantitative data, together with new in-depth qualitative data, will greatly enhance understanding of lesbians' responses to CSA, including health risks and behavioral outcomes and the influence of race/ethnicity and sexual orientation on these outcomes. This information is critical for explicating similarities and differences in health risks across various subgroups of women and for developing culturally appropriate interventions. Data from this pilot study will be used in the development of a larger proposal focusing on CSA and health among sexual minority women.

Examining Health Risks Across Sexual Identity Groups

Role on the Grant : Principal Investigator

Funding Source: Gay and Lesbian Medical Association Lesbian Health Fund

Dates: February 2008-March 2010

Investigators: Laura Szalacha, PhD, Co-Principal Investigator, University of Illinois at Chicago, Ruth McNair, MD, Co-Principal Investigator, University of Melbourne , Australia

Abstract:

Sexual minorities (lesbian, gay, bisexual and transgender people) are one of six U.S. population groups identified by Healthy People 2010 as suffering substantial health disparities (USDHHS, 2000). While ample research has documented heightened vulnerability among sexual minorities as a whole, few studies identify which sexual minority subgroups are at greatest risk. In the proposed project we will examine differences in health risks among women of varying sexual identities with the ultimate goal of providing critical information for the development of prevention and intervention strategies that address the characteristics and needs of those who are most vulnerable.

This innovative study uses secondary data from three large, longitudinal datasets to examine relationships between sexual identity and health. Together, the Chicago Health and Life Experiences of Women study (CHLEW), the National Study of Health and Life Experiences of Women (NSHLEW), and the Women's Health Australia (WHA) study provide an unprecedented opportunity to examine a broad range of health indicators in women across sexual identity groups. Our primary aim is to examine and compare prevalence rates of health status indicators (e.g., depression, BMI), health risk behaviors (e.g., smoking, alcohol use, cancer screening), and barriers to health care (e.g., current health insurance status, regular source of medical care) among women in five sexual identity categories (only heterosexual, mostly heterosexual, bisexual, mostly lesbian, only lesbian) to determine which groups are at greatest health risk. A secondary, more exploratory aim is to examine changes in sexual identity at two time points and to determine whether changes in sexual identity are associated with changes in health risk.

Results of this study will have important implications for research, policy and clinical practice. We expect that our findings will add to earlier evidence that sexual identity is not a static characteristic. This information is critically important in decisions about the inclusion and retention of sexual orientation questions in large, national surveys. Results of the proposed study also have important methodological implications. In addition to helping clarify whether risks differ across the five sexual identity groups, results can be used to refine questions about sexual identity in future studies. Finally, understanding health risks among women of varying sexual identities will assist health care providers and program planners in identifying subgroups of women at greatest risk so that health promotion initiatives and clinical interventions can be optimally tailored to address the needs of women who are most vulnerable.

Building Interdisciplinary Research Careers in Women's Health

Role on the Grant : Co-Investigator

Dates: September 2007-July 2012

Investigators: Stacie Geller, PhD, Principal Investigator, Sarah Kilpatrick, MD, PhD, MD, Project Director & Co-Investigator

Abstract: The University of Illinois at Chicago's ( UIC ) women's health research career development program, Building Interdisciplinary Research Careers in Women's Health (BIRCWH) is a collaborative effort among UIC's National Center of Excellence in Women's Health (CoE) , the Department of Obstetrics and Gynecology , and UIC 's six health colleges: Medicine , Nursing , Pharmacy , Dentistry , Applied Health Sciences , and the School of Public Health . The overall purpose of this BIRCWH program is to institutionalize a generative scholar training program that will optimize the success of junior faculty in developing a substantive and sustained research program in women's health science. The program will contribute substantially to the development of a diverse multidisciplinary basic science, clinical, and community research work force through the interdisciplinary training, mentorship, and career development of junior investigators. These investigators will accelerate the translation of research findings into evidence-based policies and practices that improve the health of women and girls in the U.S. The program utilizes the rich academic, research, and training resources available at UIC and builds on a pilot interdisciplinary career development program. In this pilot program, implemented in January 2006, junior faculty scholars are advised by an interdisciplinary group of senior women's health research faculty, and are paired with two senior faculty mentors.

The UIC BIRCWH program will train up to eight BIRCWH junior faculty scholars during the 5 year funding period to become independent women's health investigators. The program consists of a core and tailored curriculum, research training, mentoring (by 2 senior researchers), individualized career planning, and a research project. A diverse group of scholars are selected who focus on research in one of five areas in which UIC has particular strengths: reproductive health, midlife and aging, cancer in women, heart disease in women, and underserved populations. These areas encompass health and illness issues which are unique to women, more prevalent in women, or are different in women than in men. Health disparities are an underlying theme in much of the research on women's health, regardless of level of analysis, reflecting the diverse urban environment in which UIC is situated.

UIC 's conceptual approach to women's health and to research about women's health is to view women's health in terms of life stages and on a continuum. Work in women's health ranges from the molecular and cellular level to the community level; these levels are inter-related. Therefore, UIC 's research programs are translational and incorporate multiple levels of analysis.

Cumulative Stress and Hazardous Drinking in a Community Sample of Lesbians

Funding Source: National Institute on Alcohol Abuse and Alcoholism, National Institute of Health

Role on the Grant: Principal Investigator

Co-Investigators: Timothy Johnson, PhD, Professor, School of Public Health, University of Illinois at Chicago; Alicia Matthews, PhD, Associate Professor at the University of Illinois at Chicago, College of Nursing; Laura Szalacha, PhD, Research Assistant Professor and Biostatistician, Arizona State; Sharon Wilsnack, PhD, Chester Fritz Distinguished Professor at the University of North Dakota.

Dates: May 1, 2009 - April 31, 2014

Abstract: Studies using both probability and nonprobability samples provide ample evidence of lesbians' vulnerability to hazardous drinking. However, very little is known about the factors that increase lesbians' risk for hazardous drinking. We propose to build on and extend our study of sexual identity and drinking, using both cross-sectional and longitudinal data to model effects of cumulative stress on hazardous drinking among lesbians. Lesbians report high rates of traumatic events. Added to these acute stressors are chronic stressors unique to sexual minorities, creating cumulative stress that may be compounded in lesbians of color. Data will be collected from a large, diverse sample of 384 adult lesbians (50% racial/ethnic minority) interviewed previously in 2000 and 2004 and from a new panel (n=250) recruited by respondent-driven sampling, with oversampling of young (age 18–25), Black, and Latina lesbians. Data will be collected in computer-assisted personal interviews conducted by highly trained female interviewers. The specific aims of the proposed study are (1) to test models of the relationships between cumulative stress and hazardous drinking in lesbians using cross-sectional data; (2) to test models of the relationships between early and later risk factors and hazardous drinking using longitudinal data from the new survey and our previous surveys (3 time points for the original sample); and (3) to compare longitudinal models of associations among early and later risk factors and hazardous drinking in our lesbian sample and in a subsample of heterosexual women from the National Study of Health and Life Experiences of Women (NSHLEW).

Cross-sectional analyses will permit fuller assessment of racial/ethnic minority, age and cohort effects on hazardous drinking. We will use structural equation modeling to determine whether the accumulation of early risk factors (e.g., childhood sexual abuse) and adult risk factors (e.g., adult sexual assault, sexual-minority stressors, and racial/ethnic-minority stressors) predict hazardous drinking in lesbians, and to identify characteristics of lesbians at highest risk for hazardous drinking. Longitudinal analyses will allow us to examine changes in drinking patterns and problems over time, and to compare patterns and predictors of drinking changes in lesbians with those among heterosexual women in the NSHLEW.

The proposed study, combined with the 2000 and 2004 surveys, will provide the most comprehensive data yet available on the characteristics and determinants of hazardous drinking among lesbians. Such information is critical for explicating similarities and differences across subgroups of women and for planning prevention and treatment strategies to effectively target the needs of these groups. Findings will have important scientific and public health implications for identifying groups at greatest risk for hazardous drinking and for developing culturally sensitive prevention and intervention strategies.

Sexual Minority Women and High Risk Drinking

Funding Source: University of Washington

Role on the Grant: co-Investigator

Dates: 4/1/10 - 3/31/15

Abstract: The broad, long-term objective of the current research is to reduce the prevalence of problem drinking and related harm in lesbian and bisexual women. Prior research has established that lesbian, gay, and bisexual (LGB) youth are at elevated risk for problem drinking compared to heterosexual youth; this disparity is particularly striking for young lesbian and bisexual women. The proposed research aims to evaluate both self-medication and normative social influences as potential mechanisms of drinking behavior among young sexual minority women (SMW). Although more is known regarding the relative prevalence of drinking behaviors in SMW, there is relatively less research examining risk factors for drinking that are specific to this population. Furthermore, few studies have examined possible mediators and moderators drinking in SMW, especially studies utilizing longitudinal or event-level methodologies. These methodologies are critical in order to reduce recall distortion, adequately examine temporal relationships between variables, and understand the development of high risk drinking over time. The current research builds on our prior work on using longitudinal and experience sampling methodologies to test models of health risk behaviors in emerging adults, women, and in sexual minorities. The purpose of the present application is test the role of self-medication and coping motives and the role of social norms and identity salience in predicting drinking behavior among young (age 18-25) SMW. We will examine both how these behaviors change over time and will also conduct a smaller exploratory study to examine drinking at the event-level. To accomplish this objective the study will include women who identify as lesbian or bisexual (n=670) recruited through online networking communities and advertisements. Drinking behavior and proposed mediators and moderators of drinking will be assessed annually for three years. A subgroup of 100 women will complete two weeks of daily measures annually to examine risk factors and drinking behavior at the daily level. Specific aims are: 1) testing a self-medication model of high risk drinking in SMW, where stressors, psychological distress, and drinking to cope are examined in relation to drinking outcomes over time; 2) testing a normative social influences model of high risk drinking in SMW, where social contexts, social norms, and identity salience are examined in relation to drinking outcomes over time; 3) To examine event-level within-person relationships between stress, psychological distress, covariation in social contexts (SMW-specific versus non), and situation-specific drinking norms in predicting daily drinking behavior.