Skip to main content

Advertisement

SpringerLink
Log in

Internalized Homophobia and Drug Use in a National Cohort of Gay and Bisexual Men: Examining Depression, Sexual Anxiety, and Gay Community Attachment as Mediating Factors

  • Original Paper
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

The minority stress process of internalized homophobia (IH) has been associated with a range of adverse health outcomes among gay and bisexual men (GBM). However, evidence is mixed regarding the effect of IH on drug use, suggesting the potential role of multiple mediated pathways. Researchers have linked depression, sexual anxiety, and gay community attachment with IH. Depression, sexual anxiety, and gay community attachment have also been linked with drug use and drug-related problems suggesting potential mediating roles. A U.S. national sample of 1071 HIV-negative GBM completed at-home surveys, including measures of sociodemographic characteristics, IH, depression, sexual anxiety, gay community attachment, and drug use and associated problems. Adjusting for sociodemographic characteristics, depression mediated the association between IH and recent drug use. IH was positively associated with depression, and depression was positively associated with recent drug use. Gay community attachment partially mediated drug-related problems. IH had a positive direct association with drug-related problems and a negative direct association with gay community attachment. Gay community attachment had a positive association with drug-related problems. IH was positively associated with sexual anxiety, but sexual anxiety was not associated with either drug outcome. Efforts to reduce IH among HIV-negative GBM are likely to have a positive impact on mental health problems, as well as reduce risk for drug use and drug-related problems. Gay communities could provide the social support necessary for reducing IH; however, emphasis on community level interventions that address factors that increase risk for drug-related problems remains important.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Barlow, D. H. (1986). Causes of sexual dysfunction: The role of anxiety and cognitive interference. Journal of Consulting and Clinical Psychology, 54(2), 140–148. doi:10.1037/0022-006X.54.2.140.

    Article  PubMed  Google Scholar 

  • Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182. doi:10.1037/0022-3514.51.6.1173.

    Article  PubMed  Google Scholar 

  • Barrett, D. C., Bolan, G., Joy, D., Counts, K., Doll, L., & Harrison, J. (1995). Coping strategies, substance use, sexual activity, and HIV sexual risks in a sample of gay male STD patients. Journal of Applied Social Psychology, 25(12), 1058–1072. doi:10.1111/j.1559-1816.1995.tb00617.x.

    Article  Google Scholar 

  • Brubaker, M. D., Garrett, M. T., & Dew, B. J. (2009). Examining the relationship between internalized heterosexism and substance abuse among lesbian, gay, and bisexual individuals: A critical review. Journal of LGBT Issues in Counseling, 3(1), 62–89. doi:10.1080/15538600902754494.

    Article  Google Scholar 

  • Burns, M. N., Kamen, C., Lehman, K. A., & Beach, S. R. (2012). Minority stress and attributions for discriminatory events predict social anxiety in gay men. Cognitive Therapy and Research, 36(1), 25–35.

    Article  Google Scholar 

  • Cabaj, R. P. (2000). Substance abuse, internalized homophobia, and gay men and lesbians: Psychodynamic issues and clinical implications. Journal of Gay and Lesbian Psychotherapy, 3(3–4), 5–24. doi:10.1300/J236v03n03_02.

    Article  Google Scholar 

  • Carpiano, R. M., Kelly, B. C., Easterbrook, A., & Parsons, J. T. (2011). Community and drug use among gay men the role of neighborhoods and networks. Journal of Health and Social Behavior, 52(1), 74–90.

    Article  PubMed  Google Scholar 

  • Cheng, Z. (2003). Issues and standards in counseling lesbians and gay men with substance abuse concerns. Journal of Mental Health Counseling, 25(4), 323–336. doi:10.17744/mehc.25.4.nb107j9cqdc5j7ld.

    Article  Google Scholar 

  • Cochran, S. D., Sullivan, J. G., & Mays, V. M. (2003). Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. Journal of Consulting and Clinical Psychology, 71(1), 53.

    Article  PubMed  PubMed Central  Google Scholar 

  • Collins, R. L., Kanouse, D. E., Gifford, A. L., Senterfitt, J. W., Schuster, M. A., McCaffrey, D. F., … Wenger, N. S. (2001). Changes in health-promoting behavior following diagnosis with HIV: Prevalence and correlates in a national probability sample. Health Psychology, 20(5), 351–360. doi:10.1037/0278-6133.20.5.351.

    Article  PubMed  Google Scholar 

  • Coxe, S., West, S. G., & Aiken, L. S. (2009). The analysis of count data: A gentle introduction to Poisson Regression and its alternatives. Journal of Personality Assessment, 91(2), 121–136. doi:10.1080/00223890802634175.

    Article  PubMed  Google Scholar 

  • Cramer, R. J., Colbourn, S. L., Gemberling, T. M., Graham, J., & Stroud, C. H. (2015). Substance-related coping, HIV-related factors, and mental health among an HIV-positive sexual minority community sample. AIDS Care, 27, 1063–1068. doi:10.1080/09540121.2015.1024097.

    Article  PubMed  Google Scholar 

  • D’Augelli, A. R., Grossman, A. H., Hershberger, S. L., & O’Connell, T. S. (2001). Aspects of mental health among older lesbian, gay, and bisexual adults. Aging and Mental Health, 5(2), 149–158. doi:10.1080/713650002.

    Article  PubMed  Google Scholar 

  • Degenhardt, L., Hall, W., & Lynskey, M. (2001). Alcohol, cannabis and tobacco use among Australians: A comparison of their associations with other drug use and use disorders, affective and anxiety disorders, and psychosis. Addiction, 96(11), 1603–1614. doi:10.1080/09652140120080732.

    Article  PubMed  Google Scholar 

  • Dupras, A. (1994). Internalized homophobia and psychosexual adjustment among gay men. Psychological Reports, 75(1, Pt 1), 23–28. doi:10.2466/pr0.1994.75.1.23.

    Article  PubMed  Google Scholar 

  • Feinstein, B. A., Goldfried, M. R., & Davila, J. (2012). The relationship between experiences of discrimination and mental health among lesbians and gay men: An examination of internalized homonegativity and rejection sensitivity as potential mechanisms. Journal of Consulting and Clinical Psychology, 80, 917–927.

    Article  PubMed  Google Scholar 

  • Frost, D. M., & Meyer, I. H. (2009). Internalized homophobia and relationship quality among lesbians, gay men, and bisexuals. Journal of Counseling Psychology, 56(1), 97–109. doi:10.1037/a0012844.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gold, S. D., Marx, B. P., & Lexington, J. M. (2007). Gay male sexual assault survivors: The relations among internalized homophobia, experiential avoidance, and psychological symptom severity. Behaviour Research and Therapy, 45(3), 549–562. doi:10.1016/j.brat.2006.05.006.

    Article  PubMed  Google Scholar 

  • Green, K. E., & Feinstein, B. A. (2012). Substance use in lesbian, gay, and bisexual populations: An update on empirical research and implications for treatment. Psychology of Addictive Behaviors, 26(2), 265–278. doi:10.1037/a0025424.

    Article  PubMed  Google Scholar 

  • Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring individual differences in implicit cognition: The implicit association test. Journal of Personality and Social Psychology, 74(6), 1464–1480. doi:10.1037/0022-3514.74.6.1464.

    Article  PubMed  Google Scholar 

  • Greenwood, G. L., White, E. W., Page-Shafer, K., Bein, E., Osmond, D. H., Paul, J., & Stall, R. D. (2001). Correlates of heavy substance use among young gay and bisexual men: The San Francisco Young Men’s Health Study. Drug and Alcohol Dependence, 61, 105–112.

    Article  PubMed  Google Scholar 

  • Grov, C., Bimbi, D. S., Nanin, J. E., & Parsons, J. T. (2006). Exploring racial and ethnic differences in recreational drug use among gay and bisexual men in New York City and Los Angeles. Journal of Drug Education, 36(2), 105–123.

    PubMed  Google Scholar 

  • Grov, C., Cain, D., Whitfield, T. H., Rendina, H. J., Pawson, M., Ventuneac, A., & Parsons, J. T. (2016). Recruiting a US national sample of HIV-negative gay and bisexual men to complete at-home self-administered HIV/STI testing and surveys: Challenges and opportunities. Sexuality Research and Social Policy, 13(1), 1–21.

    Article  PubMed  PubMed Central  Google Scholar 

  • Halkitis, P. N., Fischgrund, B. N., & Parsons, J. T. (2005). Explanations for methamphetamine use among gay and bisexual men in New York City. Substance Use and Misuse, 40(9–10), 1331–1345. doi:10.1081/JA-200066900.

    Article  PubMed  Google Scholar 

  • Hamilton, C. J., & Mahalik, J. R. (2009). Minority stress, masculinity, and social norms predicting gay men’s health risk behaviors. Journal of Counseling Psychology, 56(1), 132–141. doi:10.1037/a0014440.

    Article  Google Scholar 

  • Hatzenbuehler, M. L. (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin, 135, 707–730.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hatzenbuehler, M. L., Corbin, W. R., & Fromme, K. (2008). Trajectories and determinants of alcohol use among LGB young adults and their heterosexual peers: Results from a prospective study. Developmental Psychology, 44(1), 81–90.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hatzenbuehler, M. L., Dovidio, J. F., Nolen-Hoeksema, S., & Phills, C. E. (2009). An implicit measure of anti-gay attitudes: Prospective associations with emotion regulation strategies and psychological distress. Journal of Experimental Social Psychology, 45(6), 1316–1320. doi:10.1016/j.jesp.2009.08.005.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hatzenbuehler, M. L., Jun, H.-J., Corliss, H. L., & Austin, S. B. (2015). Structural stigma and sexual orientation disparities in adolescent drug use. Addictive Behaviors, 46, 14–18. doi:10.1016/j.addbeh.2015.02.017.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hayes, A. F. (2009). Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Communication Monographs, 76(4), 408–420. doi:10.1080/03637750903310360.

    Article  Google Scholar 

  • Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. doi:10.1016/j.brat.2005.06.006.

    Article  PubMed  Google Scholar 

  • Hequembourg, A. L., & Dearing, R. L. (2013). Exploring shame, guilt, and risky substance use among sexual minority men and women. Journal of Homosexuality, 60(4), 615–638. doi:10.1080/00918369.2013.760365.

    Article  PubMed  PubMed Central  Google Scholar 

  • Herek, G. M., Gillis, J. R., & Cogan, J. C. (2009). Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Journal of Counseling Psychology, 56(1), 32.

    Article  Google Scholar 

  • Hirshfield, S., Chiasson, M. A., Wagmiller, R. L., Jr., Remien, R. H., Humberstone, M., Scheinmann, R., & Grov, C. (2010). Sexual dysfunction in an Internet sample of U.S. men who have sex with men. Journal of Sexual Medicine, 7(9), 3104–3114. doi:10.1111/j.1743-6109.2009.01636.x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ibañez, G. E., Purcell, D. W., Stall, R., Parsons, J. T., & Gómez, C. A. (2005). Sexual risk, substance use, and psychological distress in HIV-positive gay and bisexual men who also inject drugs. AIDS, 19, S49–S55.

    Article  PubMed  Google Scholar 

  • Igartua, K. J., Gill, K., & Montoro, R. (2003). Internalized homophobia: A factor in depression, anxiety, and suicide in the gay and lesbian population. Canadian Journal of Community Mental Health, 22(2), 15–30.

    Article  PubMed  Google Scholar 

  • Johnson, A. S., Hall, H. I., Hu, X., Lansky, A., Holtgrave, D. R., & Mermin, J. (2014). Trends in diagnoses of HIV infection in the United States, 2002–2011. Journal of the American Medical Association, 312(4), 432–434.

    Article  PubMed  Google Scholar 

  • Johnson, M. O., Carrico, A. W., Chesney, M. A., & Morin, S. F. (2008). Internalized heterosexism among HIV-positive, gay-identified men: Implications for HIV prevention and care. Journal of Consulting Clinical Psychology, 76(5), 829–839. doi:10.1037/0022-006x.76.5.829.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kecojevic, A., Wong, C. F., Corliss, H. L., & Lankenau, S. E. (2015). Risk factors for high levels of prescription drug misuse and illicit drug use among substance-using young men who have sex with men (YMSM). Drug and Alcohol Dependence, 150, 156–163. doi:10.1016/j.drugalcdep.2015.02.031.

    Article  PubMed  Google Scholar 

  • Kerridge, B. T., Pickering, R. P., Saha, T. D., Ruan, W. J., Chou, S. P., Zhang, H., … Hasin, D. S. (2017). Prevalence, sociodemographic correlates and DSM-5 substance use disorders and other psychiatric disorders among sexual minorities in the United States. Drug and Alcohol Dependence, 170, 82–92. doi:10.1016/j.drugalcdep.2016.10.038.

    Article  PubMed  Google Scholar 

  • Kessler, R. (2003). The impairments caused by social phobia in the general population: Implications for intervention. Acta Psychiatrica Scandinavica, 108(s417), 19–27.

    Article  Google Scholar 

  • Klitzman, R. L., Greenberg, J. D., Pollack, L. M., & Dolezal, C. (2002). MDMA (‘ecstasy’) use, and its association with high risk behaviors, mental health, and other factors among gay/bisexual men in New York City. Drug and Alcohol Dependence, 66(2), 115–125.

    Article  PubMed  Google Scholar 

  • Langdridge, D. (2007). Gay affirmative therapy: A theoretical framework and defence. Journal of Gay and Lesbian Psychotherapy, 11(1/2), 27–43. doi:10.1300/J236v11n01_03.

    Article  Google Scholar 

  • Lea, T., de Wit, J., & Reynolds, R. (2014). Minority stress in lesbian, gay, and bisexual young adults in Australia: Associations with psychological distress, suicidality, and substance use. Archives of Sexual Behavior, 43(8), 1571–1578. doi:10.1007/s10508-014-0266-6.

    Article  PubMed  Google Scholar 

  • Lee, J. H., Gamarel, K. E., Kahler, C. W., Marshall, B. D. L., van den Berg, J. J., Bryant, K., … Operario, D. (2015). Co-occurring psychiatric and drug use disorders among sexual minority men with lifetime alcohol use disorders. Drug and Alcohol Dependence, 151, 167–172. doi:10.1016/j.drugalcdep.2015.03.018.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lee, R. S., Kochman, A., & Sikkema, K. (2002). Internalized stigma among people living with HIV-AIDS. AIDS and Behavior, 6(4), 309–319. doi:10.1023/A:1021144511957.

    Article  Google Scholar 

  • Lelutiu-Weinberger, C., Pachankis, J. E., Golub, S. A., Walker, J. N. J., Bamonte, A. J., & Parsons, J. T. (2013). Age cohort differences in the effects of gay-related stigma, anxiety and identification with the gay community on sexual risk and substance use. AIDS and Behavior, 17, 340–349.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lick, D. J., Durso, L. E., & Johnson, K. L. (2013). Minority stress and physical health among sexual minorities. Perspectives on Psychological Science, 8(5), 521–548. doi:10.1177/1745691613497965.

    Article  PubMed  Google Scholar 

  • Livingston, N. A., Oost, K. M., Heck, N. C., & Cochran, B. N. (2015). The role of personality in predicting drug and alcohol use among sexual minorities. Psychology of Addictive Behaviors, 29(2), 414–419. doi:10.1037/adb0000034.

    Article  PubMed  Google Scholar 

  • Martin, J. L., & Dean, L. L. (1988). The impact of AIDS on gay men: A research instrument, 1988. Unpublished technical report. New York: Columbia University.

  • Maxwell, S. E., & Cole, D. A. (2007). Bias in cross-sectional analyses of longitudinal mediation. Psychological Methods, 12(1), 23–44. doi:10.1037/1082-989X.12.1.23.

    Article  PubMed  Google Scholar 

  • Mays, V. M., Cochran, S. D., & Zamudio, A. (2004). HIV prevention research: Are we meeting the needs of African American men who have sex with men? Journal of Black Psychology, 30(1), 78–105.

    Article  PubMed  PubMed Central  Google Scholar 

  • McCabe, S. E., Bostwick, W. B., Hughes, T. L., West, B. T., & Boyd, C. J. (2010). The relationship between discrimination and substance use disorders among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 100(10), 1946–1952. doi:10.2105/AJPH.2009.163147.

    Article  PubMed  PubMed Central  Google Scholar 

  • McKirnan, D. J., Ostrow, D. G., & Hope, B. (1996). Sex, drugs and escape: A psychological model of HIV-risk sexual behaviours. AIDS Care, 8(6), 655–669.

    Article  PubMed  Google Scholar 

  • McKirnan, D. J., Vanable, P. A., Ostrow, D. G., & Hope, B. (2001). Expectancies of sexual “escape” and sexual risk among drug- and alcohol-involved gay and bisexual men. Journal of Substance Abuse, 13(1–2), 137–154. doi:10.1016/S0899-3289(01)00063-3.

    Article  PubMed  Google Scholar 

  • Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56.

    Article  PubMed  Google Scholar 

  • Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697.

    Article  PubMed  PubMed Central  Google Scholar 

  • Meyer, I. H., & Dean, L. (1998). Internalized homophobia, intimacy and sexual behaviour among gay and bisexual men. In G. Herek (Ed.), Stigma and sexual orientation (pp. 160–186). Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  • Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change. New York: Guilford press.

    Google Scholar 

  • Mimiaga, M. J., Reisner, S. L., Fontaine, Y.-M., Bland, S. E., Driscoll, M. A., Isenberg, D., … Mayer, K. H. (2010). Walking the line: Stimulant use during sex and HIV risk behavior among Black urban MSM. Drug and Alcohol Dependence, 110(1–2), 30–37. doi:10.1016/j.drugalcdep.2010.01.017.

    Article  PubMed  PubMed Central  Google Scholar 

  • Morandini, J. S., Blaszczynski, A., Ross, M. W., Costa, D. S. J., & Dar-Nimrod, I. (2015). Essentialist beliefs, sexual identity uncertainty, internalized homonegativity and psychological wellbeing in gay men. Journal of Counseling Psychology, 62(3), 413–424. doi:10.1037/cou0000072.

    Article  PubMed  Google Scholar 

  • Mustanski, B., Andrews, R., Herrick, A., Stall, R., & Schnarrs, P. W. (2013). A syndemic of psychosocial health disparities and associations with risk for attempting suicide among young sexual minority men. American Journal of Public Health, 104(2), 287–294. doi:10.2105/AJPH.2013.301744.

    Article  PubMed  Google Scholar 

  • Newcomb, M. E., & Mustanski, B. (2010). Internalized homophobia and internalizing mental health problems: A meta-analytic review. Clinical Psychology Review, 30(20708315), 1019–1029.

    Article  PubMed  Google Scholar 

  • Nicholson, W. D., & Long, B. C. (1990). Self-esteem, social support, internalized homophobia, and coping strategies of HIV + gay men. Journal of Consulting and Clinical Psychology, 58(6), 873–876. doi:10.1037/0022-006X.58.6.873.

    Article  PubMed  Google Scholar 

  • Pachankis, J. E. (2015). A transdiagnostic minority stress treatment approach for gay and bisexual men’s syndemic health conditions. Archives of Sexual Behavior, 44(7), 1843–1860. doi:10.1007/s10508-015-0480-x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pachankis, J. E., Hatzenbuehler, M. L., & Starks, T. J. (2014). The influence of structural stigma and rejection sensitivity on young sexual minority men’s daily tobacco and alcohol use. Social Science and Medicine, 103(24507912), 67–75.

    Article  PubMed  PubMed Central  Google Scholar 

  • Parsons, J. T., Grov, C., & Golub, S. A. (2012). Sexual compulsivity, co-occurring psychosocial health problems, and HIV risk among gay and bisexual men: Further evidence of a syndemic. American Journal of Public Health, 102(1), 156–162.

    Article  PubMed  PubMed Central  Google Scholar 

  • Parsons, J. T., Lelutiu-Weinberger, C., Botsko, M., & Golub, S. A. (2014). A randomized controlled trial utilizing motivational interviewing to reduce HIV risk and drug use in young gay and bisexual men. Journal of Consulting and Clinical Psychology, 82(1), 9–18. doi:10.1037/a0035311.

    Article  PubMed  Google Scholar 

  • Quinn, K., Dickson-Gomez, J., Di Franceisco, W., Kelly, J. A., St. Lawrence, J. S., Amirkhanian, Y. A., & Broaddus, M. (2015). Correlates of internalized homonegativity among black men who have sex with men. AIDS Education and Prevention, 27(3), 212–226. doi:10.1521/aeap.2015.27.3.212.

    Article  PubMed  PubMed Central  Google Scholar 

  • Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. doi:10.1177/014662167700100306.

    Article  Google Scholar 

  • Reisner, S. L., Mimiaga, M. J., Bland, S., Skeer, M., Cranston, K., Isenberg, D., … Mayer, K. H. (2010). Problematic alcohol use and HIV risk among Black men who have sex with men in Massachusetts. AIDS Care, 22(5), 577–587. doi:10.1080/09540120903311482.

    Article  PubMed  Google Scholar 

  • Rosario, M., Schrimshaw, E. W., & Hunter, J. (2006). A model of sexual risk behaviors among young gay and bisexual men: Longitudinal associations of mental health, substance abuse, sexual abuse, and the coming-out process. AIDS Education and Prevention, 18, 444–460.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rosario, M., Schrimshaw, E. W., & Hunter, J. (2009). Disclosure of sexual orientation and subsequent substance use and abuse among lesbian, gay, and bisexual youths: Critical role of disclosure reactions. Psychology of Addictive Behaviors, 23, 175–184.

    Article  PubMed  PubMed Central  Google Scholar 

  • Safren, S. A., O’Cleirigh, C. M., Bullis, J. R., Otto, M. W., Stein, M. D., & Pollack, M. H. (2012). Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 80(3), 404–415. doi:10.1037/a0028208.

    Article  PubMed  PubMed Central  Google Scholar 

  • Schrimshaw, E. W., Siegel, K., Downing, M. J., Jr., & Parsons, J. T. (2013). Disclosure and concealment of sexual orientation and the mental health of non-gay-identified, behaviorally bisexual men. Journal of Consulting and Clinical Psychology, 81(1), 141–153. doi:10.1037/a0031272.

    Article  PubMed  Google Scholar 

  • Shoptaw, S., Weiss, R. E., Munjas, B., Hucks-Ortiz, C., Young, S. D., Larkins, S., … Gorbach, P. M. (2009). Homonegativity, substance use, sexual risk behaviors, and HIV status in poor and ethnic men who have sex with men in Los Angeles. Journal of Urban Health, 86(Suppl. 1), 77–92.

    Article  PubMed  PubMed Central  Google Scholar 

  • Skinner, H. A. (1982). The Drug Abuse Screening Test. Addictive Behaviors, 7(4), 363–371.

    Article  PubMed  Google Scholar 

  • Snell, W. E. (1998). The multidimensional sexual self-concept questionnaire. In C. M. Davis, W. L. Yarber, R. Bauseman, G. Schreer, & S. L. Davis (Eds.), Handbook of sexuality-related measures (pp. 521–524). Newbury Park, CA: Sage.

    Google Scholar 

  • Stall, R., Paul, J. P., Greenwood, G., Pollack, L. M., Bein, E., Crosby, G. M., … Catania, J. A. (2001). Alcohol use, drug use and alcohol-related problems among men who have sex with men: The Urban Men’s Health Study. Addiction, 96(11), 1589–1601. doi:10.1046/j.1360-0443.2001.961115896.x.

    Article  PubMed  Google Scholar 

  • Starks, T. J., Millar, B. M., Tuck, A. N., & Wells, B. E. (2015). The role of sexual expectancies of substance use as a mediator between adult attachment and drug use among gay and bisexual men. Drug and Alcohol Dependence, 153, 187–193.

    Article  PubMed  PubMed Central  Google Scholar 

  • Traube, D. E., Schrager, S. M., Holloway, I. W., Weiss, G., & Kipke, M. D. (2013). Environmental risk, social cognition, and drug use among young men who have sex with men: Longitudinal effects of minority status on health processes and outcomes. Drug and Alcohol Dependence, 127(1–3), 1–7. doi:10.1016/j.drugalcdep.2012.06.007.

    Article  PubMed  Google Scholar 

  • Wagner, G., Brondolo, E., & Rabkin, J. (1997). Internalized homophobia in a sample of HIV + gay men, and its relationship to psychological distress, coping, and illness progression. Journal of Homosexuality, 32(2), 91–106. doi:10.1300/J082v32n02_06.

    Article  Google Scholar 

  • Weber, G. N. (2008). Using to numb the pain: Substance use and abuse among lesbian, gay and bisexual individuals. Journal of Mental Health Counseling, 30(1), 31–48.

    Article  Google Scholar 

  • Weiss, B. J., & Hope, D. A. (2011). A preliminary investigation of worry content in sexual minorities. Journal of Anxiety Disorders, 25(2), 244–250. doi:10.1016/j.janxdis.2010.09.009.

    Article  PubMed  Google Scholar 

  • Wolitski, R., Jones, K., Wasserman, J., & Smith, J. (2006). Self-identification as “down low” among men who have sex with men (MSM) from 12 US cities. AIDS and Behavior, 10(5), 519–529. doi:10.1007/s10461-006-9095-5.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The One Thousand Strong study was funded by a research Grant from the National Institute on Drug Abuse (R01 DA036466: Jeffrey T. Parsons and Christian Grov, MPIs). Raymond Moody’s effort was funded by a supplement to the parent Grant (R01 DA036466-S2). Special thanks to the other members of the One Thousand Strong study team (Tyrel Starks, Ana Ventuneac, H. Jonathon Rendina, Mark Pawson, Michael Castro, Ruben Jimenez, Chloe Mirzayi, Brett Millar, Thomas Whitfield, and Jonathan Lassiter) and other staff from the Center for HIV/AIDS Educational Studies and Training (Chris Hietikko, Andrew Cortopassi, Brian Salfas, Doug Keeler, Qurrat-Ul Ain, Chris Murphy, and Carlos Ponton). Thank you to the staff at Community Marketing, Inc. (David Paisley, Heather Torch, and Thomas Roth) as well as Patrick Sullivan, Jessica Ingersoll, Deborah Abdul-Ali, and Doris Igwe at the Emory Center for AIDS Research (P30 AI050409). Finally, a special thanks to Jeffrey Schulden and Pamela Goodlow at NIDA. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York, New York, NY, 10018, USA

    Raymond L. Moody, Tyrel J. Starks, Christian Grov & Jeffrey T. Parsons

  2. Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of the City University of New York, New York, NY, USA

    Raymond L. Moody, Tyrel J. Starks & Jeffrey T. Parsons

  3. Department of Psychology, Hunter College of the City University of New York, New York, NY, USA

    Tyrel J. Starks & Jeffrey T. Parsons

  4. City University of New York School of Public Health, New York, NY, USA

    Christian Grov

Authors
  1. Raymond L. Moody
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tyrel J. Starks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christian Grov
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeffrey T. Parsons
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeffrey T. Parsons.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moody, R.L., Starks, T.J., Grov, C. et al. Internalized Homophobia and Drug Use in a National Cohort of Gay and Bisexual Men: Examining Depression, Sexual Anxiety, and Gay Community Attachment as Mediating Factors. Arch Sex Behav 47, 1133–1144 (2018). https://doi.org/10.1007/s10508-017-1009-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-017-1009-2

Keywords

Search

Navigation