Objectives Sexual and gender minority (SGM) individuals experience elevated rates of minority stress, which has been linked to higher rates of nicotine and substance use. Research on this disparity to date is largely predicated on methodology that is insensitive to within day SGM-based discrimination experiences, or their relation to momentary nicotine and substance use risk. We address this knowledge gap in the current study using ecological momentary assessment (EMA). Method Fifty SGM individuals, between 18 and 45, were recruited from an inland Northwestern University, regardless of their nicotine or substance use history, and invited to participate in an EMA study. Each were prompted to provide data, six times daily (between 10am and 10pm) for 14 days, regarding SGM-based discrimination, other forms of mistreatment, and nicotine, drug, and alcohol use since their last prompt. Results Discrimination experiences that occurred since individuals’ last measurement prompt were associated with greater odds of nicotine and substance use during the same measurement window. Substance use was also more likely to occur in relation to discrimination reported two measurements prior in lagged models. Relative to other forms of mistreatment, discrimination effects were consistently larger in magnitude and became stronger throughout the day/evening. Conclusion This study adds to existing minority stress research by highlighting the both immediate and delayed correlates of daily SGM-based discrimination experiences. These results also contribute to our understanding of daily stress processes and provide insight into ways we might mitigate these effects using real-time monitoring and intervention technology.

Objective:LGBT veterans experience high rates of trauma, discrimination, and minority stress. However, guidelines for case conceptualization and treatment remain limited. The aim of the current study was to examine the experiences of trauma and other high impact experiences among LGBT veterans to inform case conceptualization and treatment. Method: We recruited 47 LGBT veterans with a history of exposure to LGBT-related Criterion A trauma and performed semistructured interviews about their experiences in trauma treatment, barriers to engagement, and treatment needs and preferences. We used thematic analysis of qualitative codes guided by inductive and deductive approaches to characterize the variety of trauma and high impact experiences reported. Results: LGBT veterans disclosed a range of clinically relevant stressors, including Criterion A traumatic events, minority stress, and microaggression experiences, including interpersonal and institutional discrimination perpetrated by fellow service members/veterans, citizens, therapy group members, and health care providers. Conclusion: These data provide a unique account of LGBT veteran's identity-related trauma and concomitant interpersonal and institutional discrimination, microaggression experiences, minority stress, and traumatic stress symptoms. Findings highlight existing service gaps regarding evidence-based treatments for the sequalae of trauma, discrimination, microaggressions, and minority stress. In addition, we noted past and present issues in military and health care settings that may lead to or exacerbate trauma-related distress and discourage treatment seeking among LGBT veterans. We provide suggestions for clinical work with LGBT veterans and encourage ongoing research and development to eliminate remaining service gaps. Clinical Impact StatementLGBT veterans are exposed to higher rates of trauma than their nonveteran LGBT counterparts and non-LGBT veterans. They also must cope with other highly impactful experiences such as discrimination, microaggressions, and minority stress. Reactions to these events may create overlapping symptom clusters that may interfere with trauma treatment and recovery, especially under circumstances of persistent threat (e.g., ongoing discrimination). Existing empirically supported trauma treatments were not developed for LGBT veterans, or to treat discrimination, microaggressions, or minority stress; treatments that address these latter concerns are not trauma-focused. This work highlights the critical need for further research and development to meet this population's treatment needs.

Previous research suggests that lesbian, gay, bisexual, and transgender youth are at elevated risk for using illicit drugs and misusing prescription drugs relative to heterosexual youth. Previous research also indicates that LGBT youth who attend high schools with GSAs report having fewer alcohol problems and lower levels of cigarette smoking. The present study investigates whether the absence of a GSAs is associated with risk for illicit drug use and prescription drug misuse in a sample of 475 LGBT high school students (M age = 16.79) who completed an online survey. After controlling for demographic variables and risk factors associated with illicit drug use, the results of 12 logistic regression analyses revealed that LGBT youth attending a high school without a GSA evidenced increased risk for using cocaine (adjusted odds ratio [adjOR] = 3.11; 95% confidence interval [95% CI] = 1.23–7.86), hallucinogens (adjOR = 2.59; 95% CI = 1.18–5.70), and marijuana (adjOR = 2.22; 95% CI = 1.37–3.59) relative to peers attending a high school with a GSA. Youth without a GSA also evidenced increased risk for the misuse of ADHD medication (adjOR = 2.00; 95% CI = 1.02–3.92), and prescription pain medication (adjOR = 2.00; 95% CI = 1.10–3.65). These findings extend the research base related to GSAs and further demonstrate the importance of providing LGBT youth with opportunities for socialization and support within the school setting. Important limitations of the present study are reviewed.

Sexual and gender minorities (SGMs) experience higher rates of depression and anxiety, which are linked to higher rates of discrimination and victimization. SGM individuals may conceal their SGM identities to decrease discrimination and victimization exposure, yet these experiences still occur and concealment itself is often associated with greater anxiety and depression. However, it remains unclear whether lifetime victimization and identity concealment moderate the effect of day-to-day discrimination, which we evaluated in the current study using ecological momentary assessment (EMA). Fifty SGM participants (M age ϭ 21.82, SD ϭ 4.70; 84% White) completed baseline assessment (e.g., concealment and lifetime victimization) followed by EMA of daily discrimination and anxious and depressed mood for 14 days. As hypothesized, daily discrimination predicted momentary increases in anxious and depressed mood, b ϭ .34, p Ͻ .001. Notably, these effects were more pronounced among individuals who reported higher levels of identity concealment, b ϭ .25, p Ͻ .001, and previous SGM-based victimization experiences (marginally), b ϭ .18, p ϭ .05. Main effects of cumulative lifetime victimization and identity concealment, measured at baseline, were associated with higher ratings of anxious and depressed mood over the 2-week study. While identity concealment may reduce exposure to discrimination and victimization, we found that concealment and prior victimization predict heightened reactivity to daily discrimination experiences. Additional research is needed to further explicate real-time effects of minority stress exposure, and to develop interventions that may mitigate risk among SGM individuals with prior victimization exposure and higher levels of identity concealment in particular. Public Significance StatementIn the current study, we further establish the temporal associations between daily discrimination and anxious and depressed mood among sexual and gender minorities (SGMs), and extend these findings to the daily level using ecological momentary assessment. We found that daily discrimination has immediate effects on anxious and depressed mood, which was more pronounced among individuals with higher levels of accumulated SGM-based victimization experiences throughout life and higher levels of identity concealment.