Essay: Risk factors for alcohol abuse in men who have sex with men

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  • Risk factors for alcohol abuse in men who have sex with men
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Annotated bibliography: Risk factors for alcohol abuse in men who have sex with men
Gilbert, P. A., Perreira, K., Eng, E., & Rhodes, S. D. (2014). Social stressors and alcohol use among immigrant sexual and gender minority Latinos in a non-traditional settlement state. Substance Use & Misuse, 49(11), 1365–1375.
This study examined the relationships between social stressors and alcohol use within Latino sexual and gender minority immigrants from non-traditional settlement states (i.e., atypical immigration destinations). The authors posited that sexual orientation discrimination, ethnic discrimination, internalized negative stereotypes about men who have sex with men (MSM), and migration as an adult would be linked with increased alcohol use, as such variables would intensify stress. They also expected to find English use, social comfort with other MSM, and internal comfort with one’s own sexual identity protective against alcohol use.
To test these hypotheses, the researchers pulled data from a longitudinal parent study that investigated HIV risk factors among immigrant sexual minority Latinos in North Carolina, a non-traditional settlement state that has experienced an increase in its Latino population. The present study focused on 190 participants and modeled any drinking in the past year using logistic regression and instances of heavy episodic drinking in the past 30 days using Poisson regression. Measures of ethnic discrimination, sexual orientation discrimination, internalized negative attitudes about MSM, use of English in a variety of settings, and availability of social support were collected during face-to-face interviews.
The results provided mixed support for the proposed hypotheses. Consistent with the first hypothesis, ethnic discrimination was associated with higher odds of being a current drinker and was positively associated with heavy episodic drinking, though this relationship was only present when social support was low. This moderation proved consistent with the literature’s views on stress-reactive drinking and the stress-buffering hypothesis. Surprisingly, there was no association between sexual orientation discrimination and any drinking outcome. The authors suggest that Latino MSM might be ashamed of attributing discrimination to their sexual orientation, which is very plausible considering the value placed on machismo among Latino men. This is certainly an interesting point that merits further consideration as future measures of self-reported discrimination among ethnic minority MSM are developed. For the second hypothesis, social support was negatively associated with drinking, though it moderated the relationship of English use with episodic drinking. The most notable aspect of this relationship to me found English use positively associated with heavy episodic drinking at one standard deviation below the group mean. A proposed explanation is that speaking more English thus exposes one to additional means of stress in daily interaction with more individuals. It seems as if the article glosses over the topic of language barriers, however, and I would be interested to see other studies investigate this topic alongside alcohol use in immigrant MSM.
While this study echoes the literature’s findings on the effects of minority stress and discrimination on alcohol use, it also feels rather disjointed at times and limited by the parent study’s chiefly HIV-based measures. Additionally, with 17% of participants identifying as a transgender, the findings may prove inconsistent, as there is no specification in the article as to whether these individuals are identifying as trans men (man who was assigned female at birth) or trans women (woman who was assigned male at birth). Which of these designations should be included in MSM research remains at a hotly debated topic, so future studies should certainly address this point if MSM samples will include unspecified gender minorities. Lastly, the study’s use of respondent-driven sampling (RDS) to recruit participants is certainly an effective way to investigate hard-to-reach populations, but it is still admittedly troublesome, as it is a form of “snowball sampling” (chain-referral methods) that is non-probabilistic. Though this concern for bias is accounted for via post-hoc weighting, in-depth ethnographic efforts that sought to gain knowledge of common social environments of this sample in advance may have provided alternate means of recruitment that were more random in nature.
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(2), 105–12.
Drawing from survey data collected in The San Francisco Young Men’s Health Study (see Osmond et al., 1994), this study attempted to construct a descriptive epidemiological profile for heavy alcohol and drug use in a multi-stage probability household sample of young adult MSM (n = 428). While parent study focused primarily on HIV infection and risk behaviors, the authors of the current study sought to highlight variables long hypothesized as contributing factors for heavy alcohol and drug use among MSM, such as socioeconomic status (SES) and education. Alcohol use was measured via reports of typical frequency and quantity of alcohol consumption during the previous year. Further demographic, sociocultural (e.g., how often one frequented gay bars), and sexual risk (frequency of unprotected episodes) measures were also collected.
Results found that frequent gay bar attendance was related to heavy alcohol use, which supports the argument for prevalent socialized drinking in the gay community. Further measures of the quality of experiences within such locales were not presented in this study, however. Such measures are certainly necessary in order to draw greater conclusions about the arena’s function in alcohol use. Additional results found markers of lower SES (few years of formal education or non-professional occupations) associated with frequent-heavy alcohol consumption. Notably, men in service and blue-collar positions were about two and a half times as likely to be identified as frequent-heavy drinkers when compared to men holding professional jobs. This finding suggests to me that the heightened rigidity of a corporate setting or elevated job responsibility usually associated with such positions serve as protective factors against heavy drinking. I would posit that perhaps men in such positions perceive that they have more at stake when weighing the effects of alcohol use on job performance and reputation, and therefore might be more cautious in regard to drinking frequently and heavily. It should also be noted that young men in the service industry are often exposed to normative drinking patterns on the job, especially when their employment revolves around nightlife locales where alcohol consumption is prevalent. This factor certainly can play a role in common drinking trend among men within this type of profession, so such a factor should be considered independent of SES in future studies.
This investigation provides notable concepts to consider when discussing risk factors for alcohol abuse among MSM, particularly regarding the occupational and educational effects on drinking. Also, while many other studies have sought to evaluate the general population of MSM using bar-based samples, this study pulled from a household sample. Such a method provides for a potentially more diverse perspective in regard to individual lifestyle differences. It would no doubt allow for a greater means of representation within the MSM population if more studies cast a wider net for participants in this manner.
There were a few notable concerns I had while examining this article. For one, the fact the study’s data was generated from areas of San Francisco where the prevalence of AIDS cases was particularly high limits its generalizability. Furthermore, the Frequency-Quantity scale was utilized to assess drinking practices, yet this measure is known to be quite brief and only assesses typical quantity and frequency per occasion. This means that days of occasional heavier drinking would go unreported in this retrospection-based measure of averages, data that could certainly be telling of problem alcohol use. I would be interested in seeing how a more in-depth assessment method might adjust these findings in a similarly structured study. Lastly, the parent study’s lack of direct focus on alcohol use outcomes may have also glossed over other potential risk factors for alcohol abuse, including psychosocial distress, experiences in the identity formation process, social norms, or quality of involvement in gay community. Further studies seeking to replicate this model would be wise to expand methods of and environments for recruitment and develop more comprehensive measures for alcohol use and its correlates.
Halkitis, P. N., Siconolfi, D. E., Stults, C. B., Barton, S., Bub, K., & Kapadia, F. (2014). Modeling substance use in emerging adult gay, bisexual, and other YMSM across time: The P18 cohort study. Drug and Alcohol Dependence, 145(716), 209–216.
For this analysis, the authors utilized data from The Project 18 (P18) Cohort Study, a prospective investigation of the production of syndemic conditions among a diverse sample of young men who have sex with men (YMSM) in the New York City area. Syndemic theory is an rich topic with potential to explain many substance use issues from broader perspectives, as it posits that simultaneous conditions—which can include problematic substance use, sexual behavior, and mental health burden—synergistically exacerbate one another and lead to a number of complex health outcomes. Despite the broader theoretical concerns of The P18 Cohort Study, however, the present study more simply sought to document the development and trajectories of substnace use within YMSM and elucidate the extend to which these trajectories are influenced by race/ethnicity and SES. The choice to focus on YMSM was supported by numerous findings highlighting the challenges that often accompany this population into emerging adulthood, often born of identity-related changes and stressors. As a referenced report from the National Survey on Drug Use and Health stated that the highest rates of substance abuse among emerging adults occurred between the ages of 18-20, Halkitis and colleagues focused primarily on a large and diverse sample of YMSM (n = 600) who were recruited at age 18 or 19.
The analyses presented in this study were based on baseline data and subsequent data collected from 6-, 12-, and 18-month visits. Race/ethnicity and perceived familial SES were self-reported, and substance use behavior during the last 30 days was obtained using the Timeline Followback (TLFB) measure, which focused on frequency of use here. In regard to the relationship between demographic variables and substance use, predictive analyses found that the rate of alcohol use at the 18-month follow-up was significantly higher for White MSM when compared to Hispanic, Asian/Pacific Islander, Black mixed race, and other YMSM. Black YMSM notably reported the lowest trajectories of alcohol use. Such finding echo a number of studies that have found White YMSM reporting higher drinking frequency than other ethnic/racial minority groups. However, I noted that there was no discussed measure of quantities consumed in these episodes, and therefore light or heavy drinking did not appear to be assessed. As previous studies have found that Latino drinkers can be more prone to heavy episodic drinking even when reporting lower drinking frequencies (Gilbert et al., 2014), expanding the alcohol use measure to address other variations of problem drinking might have provided for more nuanced views of the race/ethnicity factor.
The authors ultimately found that while race/ethnicity was associated with frequency of alcohol use by the end of the study period, it did not exhibit an effect on alcohol use frequency increases over time. This to me highlights the need to continue to investigate other demographic and psychosocial factors at the individual level that may predict such differences. As this is the only P18 study to focused heavily on alcohol use, I would also be very interested to see an analysis that accounts solely for drinking habits and the additional syndemic variables being investigated. Additionally, it would be elucidating to see these variables examined further into emerging adulthood after this “peak” of heavy substance use to see how consistently these trajectories tend to level off. While this study ultimately touched on various perspectives of note regarding what puts YMSM particularly at risk for alcohol abuse, it seemed to be but a precursor to a more in-depth examination that has yet to surface from the parent study (to my knowledge).
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.
In this study, the investigators aimed to examine alcohol use trajectories among LGB students during the highly influential transition from high school to college. Culling data from a longitudinal study that specifically tracked students’ drinking behaviors from their senior year through the first two semesters of their freshman year, the authors utilized multiple developmental models to address the potential risks that might explain alcohol use concerns within this population. These included the overload model, minority stress models, and the transition catalyst model. The use of such diverse models in this study made for quite the novel argument in regard to alcohol use among gay young adults, as it allows for a consideration of social-cognitive factors that can prove highly influential during this time of development, in addition to prevalent sexual orientation-related risk concerns.
The authors hypothesized that, when compared to their heterosexual peers, LGB individuals would exhibit higher levels of alcohol consumption and report greater peer influence, more positive alcohol expectancies, and greater perceptions that their peers were more accepting of alcohol use and drank more. An additional hypothesis suggested that social-cognitive influences would greatly influence drinking behavior. The sector of participants that piqued my interest was that made up of non-heterosexual (n = 64) and heterosexual (n = 830) men. Measures included demographics and sexual orientation, the latter of which was classified via reported sexual behavior as opposed to self-identification. This was a striking decision, but an understandable one considering the evolving nature of one’s sexual identity throughout the college years and the potential for some individuals to partake in certain sexual activities that they may feel comfortable associating with a label early on. The mean of four standardized variables measuring quantity and frequency of drinking was used as the outcome variable. Lastly, social norms, peer relationship quality, and alcohol expectancies were established as potential mediator variables.
Following multi-level analyses using various statistical procedures, results found that non-heterosexual men increased their alcohol use at higher rates than heterosexual men specifically during the transitional period from high school to freshman year. Over time, an increase in positive expectancies and higher perceived injunctive social norms predicted a greater increases in alcohol consumption across waves for non-heterosexual men. As there are data from further waves available in this study, I would be interested to see if the rates of alcohol consumption continued to increase significantly more for this group. Such a finding would certainly paint a more lucid picture regarding prime timeframes for intervention.
In the final mediation model, the primary mediator of the relationship between sexual orientation and changes in alcohol use in men was injunctive norms. This particular result provides a strong case for the generalizable nature of such social-cognitive influences across sexual orientation groups, which I felt was a highlight of this investigation. Considering social-cognitive influences allows for fresh perspective for addressing alcohol abuse in MSM that is not solely limited to factors of marginalization, discrimination or distress. Instead, this study exemplifies that social norms and associated perceptions of peer behaviors and attitudes can be equally powerful no matter one’s sexual orientation.
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), 615–38.
The authors of this study focused on three variables—internalized heterosexism (IH), shame-proneness, and guilt-proneness—and their relationship to problematic substance use among LGB men and women. A portion of gay men (n = 97) and bisexual men (n = 87) accounted for just under half of the total sample, which was recruited in Buffalo, New York. Internalized heterosexism (IH) is defined as a set of negative attitudes towards homosexuality within the self or in others, and can result in feelings of shame and/or guilt. The authors clarified the important definitional differences between these two terms early on: Shame is characterized by innately negative self-attributions and a desire to avoid or withdraw in the face of negative situations, while guilt can actually be more adaptive, leading people to make amends, apologize, or engage in other prosocial behaviors following negative situations. The concept of guilt as being potentially positive for sexual minority men was quite novel for me, but the authors’ clarifications and further support from the literature made for very solid arguments.
The authors hypothesized that guilt-proneness would serve as a protective factor against developing substance use issues, while shame-proneness would serve as a risk factor for these problems, as well as for greater levels of IH. Referring to past findings that found bisexuals at a higher risk for negative health outcomes, bisexual men were hypothesized to have higher alcohol severity and IH scores, as well as greater shame and less guilt when compared to gay men. The hypotheses were supported, as a significant negative association between guilt-proneness and alcohol severity scores were detected overall. Additionally, IH was positively associated with several substance-related variables, including alcohol use severity. Utilizing ANOVAs and ANCOVAs to examine between-group differences, further results found that sexual minority men were significantly than women to report higher levels of IH and higher levels of alcohol severity scores, which is a finding consistent with the literature on IH’s relationship with heightened alcohol abuse. Further supporting the current, but limited findings on bisexuals, bisexual men also reported the highest of these particular scores across all groups.
Though the topics and relationships examined in this investigation were supportive of other findings in the field, it was not without stark drawbacks upon closer observation. For one, the authors admittedly only recruited a portion of the sample using the RSD method (drawbacks of which were previously discussed via Gilbert et al., 2014). This is problematic considering that this method tends to work best with a larger sample on a number of additional waves removed from the initial seed participants to limit the effect of non-random sampling. However, it appears that the study was relegated to this method and encountered such difficulties because the authors did not target local gay bars, for fear that it would result in a sample biased towards individuals who drink more. Subsequently, this may have also resulted in a sample that was further misrepresentative of its greater population, as 43.4% of participants reported being unemployed, a factor that very well could account for the differences detected here.
Ultimately, the concepts presented in this paper—notably regarding the protective nature of guilt against alcohol abuse and higher risks for bisexual men—merit additional and more structured examinations. The interventional implications of guilt is particularly novel, and I would be interested to see this variable’s more complex functions regarding problem alcohol use examined in isolation.
Mutchler, M. G., McDavitt, B., & Gordon, K. K. (2014). “Becoming bold”: Alcohol use and sexual exploration among Black and Latino young men who have sex with men (YMSM). Journal of Sex Research, 51(6), 696–710.
Mutchler, McDavitt, and Gordon based this primarily qualitative study on the relationship between alcohol and sex among Black (n = 20) and Latino (n = 20) YMSM in Los Angeles County. Most notably, they sought to examine the role of sex-related alcohol expectancies as a motivating factor in alcohol use, a relationship that has not often been explored in other YMSM studies, which tend to focus more often on alcohol’s role in risky sexual behavior within this population. Operating under a grounded theory approach, the investigators utilized alcohol expectancy theory, emotional regulation theory, and sexual script theory to develop interview questions they hoped would point to prevalent themes within this sample of sexually active, frequent-drinking ethnic/racial minority YMSM.
Confirming the applicability of emotional regulation theory within this study, responses in these 90- to 120-minute interview sessions notably highlighted the use of alcohol in Black and Latino YMSM as a means of downregulating the anxiety and stigma often associated with engaging in same-sex partner intimacy. Multiple participants referred to their alcohol use as motivated by a desire to boldly explore their sexual identities, or, in less adaptive ways, have an excuse to explain their same-sex sexual activity away (e.g., “If I was drunk, I’m not really gay.”). That such motivators were commonly mentioned seems to suggest a potential means through which some social drinking norms common to YMSM (see Greenwood et al., 2001, and Hatzenbuehler et al., 2008) begin to surface as identity and intimacy practices develop.
Participant responses also pointed to the prevalence of alcohol-related sex scripts in this relationship, particularly highlighting the expected pleasurable nature of “drunk sex.” While such a perspective is interesting in regard to sex-related alcohol expectancies, it is not particularly unique to YMSM, or even Black and Latino men, for that matter, which the authors did ultimately acknowledge. In regard to sexual pleasure, however, the study also highlighted the use of alcohol in diminishing pain associated with receptive anal intercourse, especially for those who are engaging in this activity for the first time. Again, though anal sex is not unique to YMSM, the deeper perceived function of alcohol in this long-stigmatized practice among YMSM—acting as a facilitator for this significant and long-desired sexual experience—is arguably novel.
This study served to highlight key sex-related motivators for drinking in the greater YMSM population, expanding the view of risks to consider in potentially problematic alcohol use. Where it fell short, however, was in elucidating how any of these are particularly specific to Latinos or Black YMSM. Upon further review of the methods employed, the study would have likely produced richer results had more pertinent questions related to one’s experience as an ethnic/racial minority been included. Still, it provides a jumping off point for further research to approach alcohol abuse risks from a broader sociocultural viewpoint, particularly among ethnic/racial minority MSM.
Pollock, J. A., Halkitis, P. N., Moeller, R. W., Solomon, T. M., Barton, S. C., Blachman-Forshay, J., … Love, H. T. (2012). Alcohol use among young men who have sex with men. Substance Use & Misuse, 47(1), 12–21.
[Relevant Goals that inform the investigation of alcohol abuse GOALS — (1) to describe the occurrence of alcohol use among a population of urban YMSM; (2) to reveal associations between alcohol use and demographic factors, such as race/ethnicity, age, HIV status, and sexual orientation, and (3) to examine the use of alcohol during sexual encounters with casual partners.; PARTICIPANTS – YMSM age 13-29 (n = 558), SETTING – NYC; METHODS – Participants surveyed on touch screen PDA device, measures of sociodemographic, alcohol use, episodic sexual behaviors with casual partners; MENTION THAT THE DIVERSE ETHNIC/RACIAL SPREAD OF THE SAMPLE WAS GREAT]
[RESULTS OF NOTE & IMPLICATIONS – Mention especially high drinking rates (87%) , though drinking to intoxication is lower (38%). Mention White males and prevalence of drinking across the board. Mention being enrolled in school made one more likely to have consumed alcohl in the past three months, and unsurprising finding considering the examined effects of social influence on drinking (Hatzenbuehler et al., 2008). Mention all ages drink, although people 21+ were for times more likely, which is unsurprising due to the availability of alcohol at that point. Black YMSM were the least likely to have consumed alcohol in the three months prior to assessment, which is consistent with previous findings (Halkitis et al., 2014).]
[ADDITIONAL NOTES – People under 21 appear to be drinking quite regularly and thus interventional efforts should focus on targeting early education, especially among MSM. As alcohol is intertwined with many events within gay culture (e.g., pride events, circuit parties), as has also been noted in previous exploratory studies (see Stall et al., 2001. It is crucial that education on the risk factors associated with frequent and heavy alcohol use and are conveyed early on, especially for White YMSM.]
Stall, R., Paul, J., Greenwood, G., Pollack, L., Bein, E., Crosby, M., … Binson, D. (2001). Alcohol use, drug use and alcohol-related problems among men who have sex with men: The Urban Men’s Health Study. Addiction (Abingdon, England), 96(11), 1589–601.
[Purpose: To measure the prevalence and independent associations of heavy and problematic use of alcohol and recreational drugs among a household-based sample of urban MSM (men who have sex with men); Participants: n = 2172 ranging from 18-80, most in 30s, most college educated, 21% non-white ethnic minorities; most middle class; probability telephone sample was taken within zip codes of four large American cities estimated to have concentrations of at least 4% of households with a resident MSM (Chicago, LA, NYC, San Francisco); Measures administered via phone interviews, with participants reporting demographics, early life events, mental health status, social/sexual practices, connection with gay culture, instances of frequent/heavy alcohol use, prevalence of three or more alcohol related problems]
[RESULTS: 85% alcohol use for urban MSM, 12% three or more alcohol related problems; heavy-frequent alcohol use at 8%; frequent-heavy drinking/alcohol problems related to parental substance abuse, frequency of bar attendance, frequency of reading local gay media (association with community?)
[RESULTS 2: men with less education twice as likely to report frequent-heavy drinking than men at highest education levels – MENTION GREENWOOD; men with moderate levels of affiliation reported lowest levels of drinking, reflecting a balance between gay and non-gay social outlets as being protective; alcohol-related problems related to lower sense of wellbeing, fewer visits to sex clubs/bathhouses, anti-gay verbal harassment- GILBERT;
[The assessment methods are not ideal, 75 minutes to do phone interview, which can be taxing and may have affected responses; also leads to concern of confirmation of identity of participant– however technological limitations may have rendered this method necessary; they acknowledge this and mention that they had men conduct interviews to reduce self-disclosure bias; also mention that some subsamples not included in study, most notably being non-urban environments, data from which would have been ideal for comparison; also the active recruitment nature in general resulted in refusals, which may have led to sample biases, with common individual differences potentially accounting for a desire to accept study participation. Literature is supported in the focus on identification with the gay community as being an increasing risk. Though primarily correlative in nature due to cross-sectional approach, study overall gives a very well-organized picture to help identify risk factors that relate to frequent heavy alcohol use and alcohol-realted problems.
Tobin, K., Davey-Rothwell, M., Yang, C., Siconolfi, D., & Latkin, C. (2014). An examination of associations between social norms and risky alcohol use among African American men who have sex with men. Drug and Alcohol Dependence, 134(1), 218–221.
The investigators in this study sought to address the relationship between social norms and alcohol use among African American men who have sex with men (AA MSM), particularly given that alcohol tends to contribute to the risky sexual behavior and this population sees disproportionate rates of negative sexual health outcomes. Examining a sample of AA MSM (n = 142) from Baltimore, Maryland, the authors collected sociocultural demographics and self-reported descriptive and injunctive norms regarding frequency and quantity of alcohol consumption (e.g., ““How many of your friends have five or more drinks in one sitting?”, “How many of your friends would disapprove if you were to drink three or more times a week?”). Additionally, Alcohol Use Risk (AUR) was measured via AUDIT.
Bivariate associations between sociodemographic variables, perceived alcohol norms measures, and AUR were analyzed using chi-square and Fishers chi-square statistics (for categorical variables) and ANOVA (for continuous variables). Logistic regression was conducted for perceived alcohol norms and Alcohol Use Risk. Echoing results found in the study conducted by Hatzenbuehler, Corbin, and Fromme (2008) on social norms and alcohol use trajectories among LGB young adults, both descriptive alcohol norms (frequency and quantity) and injunctive norms (frequency only) were associated with AUR. The multivariable logistic regression analysis also found that high-risk alcohol use was associated with perceptions that peers were drinking frequently and in high quantities. Though consistent with the literature, I particularly found these findings fascinating given that the median age of the participants in this study was 43. That such peer-influenced associations are still evident into middle adulthood is, to me, a unique and seemingly under-explored perspective that I would love to see further elucidated in future studies.
This investigation proved to be quite complementary to the one conducted by Hatzenbuehler, Corbin, and Fromme (2008). Its focus on a sample comprised chiefly of AA MSM beyond emerging adulthood especially extends the generalizability of the notion that social norms can function as significant risk factors for alcohol use; this study was particularly strong in the cross-cultural and cross-cohort implications of these findings. The authors admittedly did not investigate the referent group of these perceived norms, so this would ideally be the next step in further establishing what kinds of models are commonly being perceived when MSM—and AA MSM in particular—are considering normative attitudes and behavior. Additionally, though the self-report measures for alcohol use were more than sufficient in this model, an event-level study delving deeper into these instances of alcohol consumption that also gathers information about concurrent social settings and peer activities would no doubt provide for an even more elucidating perspective on this issue.
Wong, C. F., Kipke, M. D., & Weiss, G. (2008). Risk factors for alcohol use, frequent use, and binge drinking among young men who have sex with men. Addictive Behaviors, 33(8), 1012–1020.
Like previous work on risk factors for alcohol use in the MSM literature (see Greenwood et al, 2001; Pollock et al., 2012; Stall et al., 2001), the authors of this study sought to examine a large, ethnically diverse sample of YMSM (N = 526) to identify recurrent demographic, psychosocial, and individual factors that contribute to varied drinking practices. No hypothesis was provided in this exploratory study, although the authors were informed by previous work that supported a distinct set of risks that tend to be specific to MSM, including social factors, stressful life events, and discrimination. The target population being examined included YMSM ages 18 to 24 in Los Angeles County who self-identified as Caucasian, African-American, or Latino of Mexican descent. These individuals were recruited in public settings frequented by YMSM and surveys were administered via computer-assisted interview (CAI) technology to provide measures for alcohol use, various socio-demographic variables, and other psychosocial variables related to the gay community and attitudes.
The results of this study identified commonly found socio-demographic risk factors for frequent use and binge drinking alike, including frequent gay bar attendance, drinking at a young age, prevalent peer risk behaviors, and being Caucasian, the latter of which has been well established across studies. One rather novel finding, however, was the identification of a unique demographic and psychosocial profile particular to occasional binge-drinkers (n = 57), but not frequent binge drinkers or light drinkers. This was characterized by a likelihood of being more depressed or distressed, having fewer friends who engage in risk behaviors, and being less likely to have attended gay bars more than once a week. This is a curious profile that would appear to be protective in nature at first glance, at least in respect to social risk factors for drinking. However, given that these men are not regular patrons of gay bars, one interpretation could be that these spurts of binge drinking accompany these infrequent visits, which may be so infrequent as a result of depression and an accompanying desire to withdraw from public spaces. Although the cross-sectional nature of this study makes the mechanisms of this psychosocial and demographic profile unclear as far as causation is concerned, it still provides further support for problem alcohol use intervention that addresses psychosocial health.
While this study presented strong and consistent findings supported elsewhere in the literature, the omission of Asian Americans in this study was particularly glaring and rather odd, especially given the strong presence of this population in California when compared to the other mainland U.S. states. The authors did not provide any reasoning for this non-inclusion, which somewhat calls into question the generalizable nature of the findings detailed in this article to the greater population of YMSM, even when just considering the state of California. Nonetheless, I felt this investigation successfully highlighted the adverse affective conditions and environmental factors that seem to prevail in the investigation of problem drinking risks. That the role of the gay bar in problem drinking has repeatedly surfaced in studies like this, follow-up studies would do well to give attention to these environments in more depth, explicating how they actively or passively facilitate the normalization of alcohol use in community social activities for MSM. In any case, further efforts to increase social settings that are not centered on alcohol or drug use for YMSM and to disentangle the long-standing association of alcohol with socialization in gay culture are necessary in regard to curbing problem alcohol use patterns in this group.

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