Health among Lesbian, Gay, Bisexual and Questioning Teens in Hawai‘i: The Role of Social Support in Reducing Problematic Alcohol Use and Suicide Attempts

Lowery St John, Tonya
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[Honolulu] : [University of Hawaii at Manoa], [December 2015]
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Sexual minorities (SMs), gay, lesbian, bisexual and questioning individuals, experience poorer mental and physical health outcomes and increased likelihood of engaging in risky sexual behaviors, tobacco, alcohol and other illicit drug use compared to heterosexuals. The Minority Stress Model explains this excess risk by positing that unique external stressors in the SM population combine with internal stress responses to produce physiological responses and behaviors that impact the mental and physical health of SMs. These negative stressors can be mediated by personal internal and external environmental factors and mitigated by social supports. This dissertation uses data from the 2011 and 2013 Hawaii Youth Risk Behavior Survey of public high school students to explore key health issues among SM youth (SMY). The first study examined how the operationalization of the construct of sexual orientation impacts the odds of current cigarette smoking, current alcohol use and suicide attempt in the past 12 months among SMY compared to their heterosexual counterparts. There were significant differences in risk behaviors by sex, and operational definition of sexual orientation. Self-identification as SMY and sexual behavior seem to capture distinct risks. Students who are not sexually active, or who are questioning their sexual identity, should be included as a separate category in analyses rather than grouped with SMY. The second study explores alcohol use among SMY, uses the CRAFFT brief screening tool for adolescents to discern problematic alcohol use and examines the role of social supports in mediating problematic alcohol use among SMY. Social supports were important predictors of problematic use and parental disapproval of underage drinking was strongly associated with lower problematic alcohol use. The final study describes suicidal behavior among SMY and scrutinizes the role of social supports in mediating the excess risk of recent suicide attempts, controlling for measures of victimization. Victimization was strongly associated with suicide risk; adult support outside of school was protective. Together these studies may help set standards for appropriate analytical methods for SMY and contribute to the body of research on the role of interpersonal social supports in reducing the negative effects of stress on the health of SMY.
Ph.D. University of Hawaii at Manoa 2015.
Includes bibliographical references.
Adolescents, LGB, SMY, tobacco, alcohol, suicide attempts, YRBS, CRAFFT
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Theses for the degree of Doctor of Philosophy (University of Hawaii at Manoa). Public Health Sciences/Epidemiology
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