Leveraging Latent Class Modeling at the Intersection of Racism and Homonegativism: Identifying Subgroups of Black and Latino Sexual Minority Young Men and Links with Substance Use
Open Access
- Author:
- Layland, Eric Keith
- Graduate Program:
- Human Development and Family Studies
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- June 17, 2020
- Committee Members:
- Jennifer Lianne Maggs, Dissertation Advisor/Co-Advisor
Jennifer Lianne Maggs, Committee Chair/Co-Chair
Bethany Cara Bray, Dissertation Advisor/Co-Advisor
Samantha Lauren Tornello, Committee Member
Jessica Lynn Matsick, Outside Member
Bethany Cara Bray, Committee Chair/Co-Chair
Lesley Anne Ross, Program Head/Chair - Keywords:
- intersectionality
sexual minority
Black
Latino
racism
homophobia
latent class analysis
substance use
transition to adulthood
race
ethnicity
homonegativism
subgroups
gay
bisexual
men who have sex with men
person-centered methods
alcohol
drinking
marijuana
poppers
substance use disorder
cannabis
binge drinking
substance abuse
substance use dependence
social support
family support
friend support - Abstract:
- The transition to adulthood presents young men with a number of challenging tasks as they negotiate changing relationships and roles, develop increased independence, and navigate normative shifts in substance use and other risk taking. For Black and Latino sexual minority young men, normative tasks during the transition to adulthood are disturbed by experiences of racist and homonegative stigma. Both racism and homonegativism are pervasive and pernicious: Myriad studies support links between these types of stigma and health disparities. These stigmatizing experiences are contingent on an unequal balance of power that serves to keep Black and Latino sexual minority young men away from opportunities and within the bounds of heteronormativity. Elevated rates of substance use seen among Black and Latino sexual minority young men are partially attributable to the chronic stress associated with acute events and an on-going undercurrent of stigma (Hatzenbuehler, Phelan, & Link, 2013). Applying an intersectional framework to quantitative research on the health and development of Black and Latino sexual minority men demands modeling that represents not only the unique intersection of race and sexual orientation, but also reflects the systems of power and oppression that subvert healthy development toward optimal outcomes. Rather than assuming homogeneity across all Black and Latino sexual minority young men, this study examined within-group heterogeneity. Three aims were addressed: (1) Identify subgroups indicated by multidimensional experiences of racism and homonegativism; (2) Investigate associations between subgroups and substance use; (3) Examine the potentially protective effects of friend support and family social support during the transition to adulthood. Data were from a cohort of 435 Black and Latino sexual minority young men aged 16 to 25 years at baseline in Los Angeles (Healthy Young Men’s Cohort Study; Kipke et al., 2019). Participants provided self-reported data at five data occasions semiannually for 24 months. The marginal approach to longitudinal latent class analysis was used to identify latent classes indicated by multidimensional experiences of racism (e.g., police harassment, workplace discrimination, sexual objectification) and homonegativism (e.g., violent victimization, family rejection, identity concealment). Following identification of classes, associations between latent classes and substance use were estimated using fixed effects logistic and linear regression adjusted for demographic and contextual covariates (e.g., age, sex exchange, financial and food insecurity). Substance use included any past 6-month use (nicotine, marijuana, alcohol, binge drinking, and poppers) and both past 6-month and 30-day measures of substance use frequency (marijuana), level (nicotine, marijuana use disorder, alcohol-use risk), substance use disorders (marijuana abuse, dependence, and disorder; hazardous and harmful drinking, alcohol dependence), and substance use during sex (marijuana, binge drinking, poppers). To test the protective effect of social support, interactions between class membership and both friend support and family support were added to the regression models. Longitudinal latent class analysis identified five subgroups of person records indicated by multidimensional experiences of racism and homonegativism: Minimal Stigma (26% of person records), Homonegativism (17%), Sexual Racism (22%), Multiform Racism (24%), and Compound Stigma (11%). The Homonegativism, Multiform Racism, and Compound Stigma classes were also characterized by disproportionately high prevalence of economic strain indicated by engagement in sex exchange and experiences of unmet financial needs and food insecurity. Using the Minimal Stigma class as reference and controlling for demographic and contextual covariates, incidents of membership in the Homonegativism and Multiform Racism classes were associated with elevated odds or higher levels of substance use. However, the magnitudes of significant associations with elevated substance use (marijuana disorder, binge drinking during sex) were greatest for Compound Stigma. Contrary to expectations, results did not support the idea that friend or family support moderated or buffered the association between stigma class membership and levels of substance use. Supplemental analysis focused on age trajectories showed that substance use followed a quadratic trajectory with a peak around age 22 to 23, similar to other studies. This developmental curve was uniform across latent classes of stigma. The person-centered approach used in this study more holistically models the multidimensional experiences of Black and Latino sexual minority men and their experience with intersecting identities and multiple marginalization. This approach provides an example for how to apply an intersectional framework to quantitative analysis of developmental and health data. Associations between latent classes and substance use uncovered heterogeneity within the sample and demonstrated the utility of identifying classes to unpack who within a sample experiencing stigma and marginalization may be more likely to engage in substance use and disordered use. Overall level of use was much higher among classes experiencing more types and greater frequency of stigma, though not uniformly across all substance use outcomes. This study joins the chorus of intersectional research calling for the disruption of pervasive racism and homonegativism in order to break the fundamental connection between stigma and substance use among Black and Latino sexual minority young men.