Sexual and Gender Minority Young Adult Coping Disparities During the COVID-19 Pandemic

doi:10.1016/j.jadohealth.2021.07.021

Journal of Adolescent Health

Volume 69, Issue 5, November 2021, Pages 746-753

https://doi.org/10.1016/j.jadohealth.2021.07.021 Get rights and content

Abstract

Purpose

The COVID-19 pandemic has exacerbated several existing health disparities in the U.S. Sexual and gender minority (SGM) health disparities may also be widening during the pandemic, though few studies have assessed this question. This study examined SGM young adult disparities in health-related behaviors to cope with isolation during the pandemic.

Methods

Respondents from a prospective cohort of Southern California young adults (N = 2,298) reported whether they engaged in various strategies (e.g., substance use, diet, exercise, relaxation) to cope with isolation during the pandemic (each: yes/no). Differences in coping were assessed across five SGM subgroups: heterosexual men and women, lesbian, gay, bisexual, pansexual, queer (LGBQ) men and women, transgender/nonbinary (TNB) respondents. Negative binomial regressions estimated sexual/gender identity differences in the number of positive or negative behaviors endorsed, adjusting for sociodemographic characteristics and prepandemic health behaviors. Differences were also tested across individual coping behaviors.

Results

Heterosexual women (IRR = 1.11 [1.01–1.21]), LGBQ men (IRR = 1.31 [1.12–1.54]), LGBQ women (IRR = 1.33 [1.19–1.49]), and TNB respondents (IRR = 1.29 [1.03–1.61]) engaged in more negative coping behaviors than heterosexual men. LGBQ men (IRR = 1.19 [1.02–1.39]) and LGBQ women (IRR = 1.20 [1.08–1.34]) also reported more negative coping behaviors versus heterosexual women. Generally, LGBQ men reported the highest prevalence of substance use, while LGBQ women and TNB reported the highest prevalence of adverse eating behaviors and self-harm.

Conclusions

SGM young adults may be disproportionately, adversely impacted by the COVID-19 pandemic. Tailored public health and clinical interventions are needed to decrease pandemic-related SGM health disparities.

Section snippets

Study design

Data were from a prospective cohort of young adults in Southern California, originally recruited in fall 2013 from 10 Los Angeles, CA metropolitan area high schools, when students were in ninth grade (mean age: 14.1; N = 3,396). Respondents have since been surveyed repeatedly, with biannual surveys conducted throughout high school and roughly annual surveys administered following the completion of high school in 2017. Further details about the study design can be found elsewhere [32]. Data from

Sample characteristics

In the sample (N = 2,298), 792 (34.5%) were heterosexual men, 1,021 (44.4%) were heterosexual women, 120 (5.2%) were LGBQ men, 313 (13.6%) were LGBQ women, and 52 (2.3%) were TNB (Table 1), consistent with national estimates [36]. There were several demographic differences by sexual/gender identity. The groups differed by race/ethnicity (p = .005), with for instance, higher proportions of heterosexual women (57.8%) and LGBQ women (59.7%) reporting they were Latinx, compared to heterosexual men

Discussion

This study provides new evidence that young adults have used a wide range of behavioral strategies to cope with social distancing and isolation during the COVID-19 pandemic, with key differences noted between SGM and non-SGM young adults. Namely, SGM (vs. non-SGM) respondents were more likely to engage in negative, but less so positive, coping strategies. All SGM subgroups reported engaging in a higher number of negative coping behaviors than heterosexual men, as well as heterosexual women

Funding Sources

This project was supported in part by award numbers U54CA180905 and R01CA229617 from the National Cancer Institute (NCI), award number 27-IR-0034 from the California Tobacco-Related Disease Research Program (TRDRP), and award number K01DA042950 from the National Institute on Drug Abuse (NIDA).

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Pandemic-Related Changes in the Prevalence of Early Adolescent Alcohol and Drug Use, 2020–2021: Data From a Multisite Cohort Study
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In 2018–2019, 9,270 youth aged 11.5–13.0 completed a prepandemic assessment of past-month alcohol and drug use, then up to seven during-pandemic assessments between May 2020 and May 2021. We compared the prevalence of substance use among same-age youth across these eight timepoints.
Pandemic-related decreases in the past-month prevalence of alcohol use were detectable in May 2020, grew larger over time, and remained substantial in May 2021 (0.3% vs. 3.2% prepandemic, p <.001). Pandemic-related increases in inhalant use (p = .04) and prescription drug misuse (p < .001) were detectable in May 2020, shrunk over time, and were smaller but still detectable in May 2021(0.1%-0.2% vs. 0% pre-pandemic). Pandemic-related increases in nicotine use were detectable between May 2020 and March 2021 and no longer significantly different from prepandemic levels in May 2021 (0.5% vs. 0.2% prepandemic, p = .09). There was significant heterogeneity in pandemic-related change in substance use at some timepoints, with increased rates among youth identified as Black or Hispanic or in lower-income families versus stable or decreased rates among youth identified as White or in higher-income families.
Among youth ages 11.5–13.0 years old, rates of alcohol use remained dramatically reduced in May 2021 relative to prepandemic and rates of prescription drug misuse and inhalant use remained modestly increased. Differences remained despite the partial restoration of prepandemic life, raising questions about whether youth who spent early adolescence under pandemic conditions may exhibit persistently different patterns of substance use.
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Addressing systemic discrimination faced by LGBTQ + youth must be seen as a public health priority. LGBTQ + youth must be included in decision-making (policy and practice) that impacts them and their health. Meanwhile, the vital sanctuary and support provided by LGBTQ + youth groups must be bolstered to address limitations and gaps in provision due to growing public sector cuts. This is necessary to reduce or buffer the multiple intersecting inequalities faced by LGBTQ + youth. Finally, more research is needed to fully understand the crisis of health inequalities faced by LGBTQ + youth in England.
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Citation Excerpt :
Finally, the follow-up wave of data collection occurred between May–August, 2020, around the beginning of the COVID-19 pandemic and associated lockdowns, when overall substance use increased in certain groups and decreased in others. While sexual identity change-based disparities in substance use should not theoretically be affected by the pandemic, we cannot rule out the possibility that COVID-19 related stress (Salerno et al., 2020) and differential coping behaviors observed between LGBQ+ and heterosexual young adults (Krueger et al., 2021) contributed to our findings. This study provides evidence in support of the association between LGBQ+ identity and substance use.
Sexual identity is dynamic, and changes in identity (e.g., from heterosexual to lesbian, gay, bisexual, or queer [LGBQ+]) are common during young adulthood. It is not well-understood how sexual identity changes may be associated with substance use risk.
Two waves of data (baseline: October, 2018–October, 2019; follow-up: May–October, 2020) were used from a prospective cohort of young adults (N = 1896; mean age=21.2). Frequency of past 30-day use and new initiation of five substance use outcomes (alcohol, any tobacco, e-cigarettes, cannabis, illicit drugs) were compared across four groups: consistently heterosexual (N = 1567), consistently LGBQ+ (N = 244), heterosexual to LGBQ+ (N = 65), and LGBQ+ to heterosexual (N = 20).
Consistently LGBQ+ (vs. consistently heterosexual) participants reported greater frequency of past 30-day use of alcohol (aOR=1.34, 95% CI=1.04–1.72), any tobacco products (aOR=1.88, CI=1.34–2.63), e-cigarettes (aOR=1.49, CI=1.01–2.19), cannabis (aOR=1.36, CI=1.01–1.84), and illicit drugs (aOR=2.84, CI=1.77–4.56). Heterosexual to LGBQ+ (vs. consistently heterosexual) participants reported greater frequency of past 30-day use of any tobacco products (aOR=1.87, CI=1.06–3.33) and illicit drugs (aOR=2.48, CI=1.10–5.62), and had greater risk of initiating alcohol (aRR=1.82, CI=1.02–3.25) and cannabis use (aRR=2.90, CI=1.81–4.64). LGBQ+ to heterosexual (vs. consistently LGBQ+) participants reported lower frequency of past 30-day use of alcohol (aOR=0.35, CI=0.14–0.88) and any tobacco products (aOR=0.15, CI=0.03–0.80).
Identifying as LGBQ+ was associated with increased risk for frequent substance use, and newly adopting an LGBQ+ identity was associated with increased risk for new substance use initiation. Prevention and treatment interventions may need to tailor messaging to young people who have newly adopted an LGBQ+ identity.
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View all citing articles on Scopus

: Conflicts of interest: All study authors have indicated that they have no potential conflicts of interest to disclose.

: Clinical trial registration: Not applicable.

View full text

Original articleSexual and Gender Minority Young Adult Coping Disparities During the COVID-19 Pandemic

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Study design

Sample characteristics

Discussion

Funding Sources

Am J Prev Med

Psychiatry Res

J Adolesc Health

J Adolesc Health

COVID-19 exacerbating inequalities in the US

Lancet

Racial health disparities and Covid-19—caution and context

N Engl J Med

COVID-19 and racial/ethnic disparities

JAMA

The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding

Why lesbian, gay, bisexual, and transgender public health?

Am J Public Health

Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States

Am J Public Health

Addressing the disproportionate impacts of the COVID-19 pandemic on sexual and gender minority populations in the United States: Actions toward equity

LGBT health

Doctors worry coronavirus pandemic may hit LGBTQ people harder than most

“The Untold Side of COVID-19”: Struggle and perspectives of the sexual minorities

J Psychosexual Health

Sexual and gender minority health vulnerabilities during the COVID-19 health crisis

Am J Hum Biol

Health vulnerabilities to COVID-19 among LGBT adults in California

Economic vulnerabilities to COVID-19 among LGBT Adults in California

Vulnerabilities to COVID-19 among transgender adults in the U.S.

Are sociodemographic, lifestyle, and psychosocial characteristics associated with sexual orientation group differences in mental health disparities? Results from a national population-based study

Social Psychiatry Psychiatr Epidemiol

Cigarette smoking disparities between sexual minority and heterosexual youth

Pediatrics

Original article
Sexual and Gender Minority Young Adult Coping Disparities During the COVID-19 Pandemic