UMD-PRC Reports and Briefs

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    2022 UMD-PRC Community Health Needs Assessment Report: Investigating Tobacco Use and Cessation Experiences of LGBTQ Youth and Young Adults in Prince George’s and Montgomery County, Maryland
    (2023) University of Maryland Prevention Research Center
    Funded by the Centers for Disease Control and Prevention (CDC), the current needs assessment was led by the University of Maryland Prevention Research Center (UMD-PRC) in conjunction with the UMD Center for Health Literacy and the Maryland Department of Health to better understand tobacco use among Black and Latino/a/x lesbian, gay, bisexual, transgender, queer, and other sexual and gender diverse (LGBTQ) youth and young adults in Prince George’s and Montgomery counties. The Maryland Department of Health and the University of Maryland Institutional Review Boards approved the project. The goals of the community needs assessment were to identify health needs among Black and Latino/a/x LGBTQ communities related to tobacco use, factors associated with health and tobacco use for these communities, and the strengths and resources available to address these needs and associated factors. The degree to which existing tobacco prevention and cessation health campaigns resonate with Black and Latino/a/x young adults was also assessed. Needs Assessment The needs assessment took place from April to September 2022 and included seven focus groups with Black and Latino/a/x LGBTQ people aged 18-30 with various histories of tobacco use, key informant interviews with community stakeholders, analysis of state-level health surveillance data, a review of county and state tobacco resources and programs, and a literature review of existing tobacco and cessation messaging focused on LGBTQ communities. The project’s Community Advisory Board (CAB) – comprised of Black, Latino/a/x, and LGBTQ-focused service providers and community members in Prince George’s and Montgomery counties – provided feedback the report. They also offered ideas regarding action items that resulted from the data. Results will inform upcoming project initiatives, including the development of a health communication campaign and community outreach programs. The assessment yielded the following findings: State Surveillance Data • We used data from the 2018-2019 Maryland Youth Risk Behavioral Survey/Youth Tobacco Survey (YRBS/YTS, aged ~13-18) and 2018-2019 Maryland Behavioral Risk Factor Surveillance System (BRFSS, aged 18 and older). • Our sample was restricted to participants from Prince George’s and Montgomery counties and analyzed to assess tobacco use behaviors by sexual orientation and gender identity, as well as correlates of these behaviors. • Results showed greater cigarette use, e-cigarette use, cigar use, and early initiation among LGBTa residents relative to cisgender, heterosexual residents (i.e., non-LGBT). • We did not observe differences in poor physical and mental health days between adult LGBT and non-LGBT respondents. • Among youth, all tobacco use behaviors were higher among LGBT youth who reported feeling sad or hopeless and experiences of bullying when compared to LGBT youth who did not experience these feelings and interactions. Focus Groups • Seven focus groups were conducted with residents aged 18-30 in Prince George’s and Montgomery counties (30 participants total). • Participants discussed using tobacco to cope with life stressors. • Focus group conversations highlighted the links between tobacco use, mental health, and discrimination. • Participants were unaware of most general or community-specific tobacco prevention and cessation resources. Stakeholders Interviews • Six key informant interviews were conducted with community service professionals from organizations serving LGBTQ, Black, and/or Latino/a/x residents in Prince George’s and Montgomery counties. • One organization reported an increase in tobacco use among clients since the start of the COVID-19 pandemic. • All stakeholders were interested in receiving tobacco prevention and cessation resources and support. • Stakeholder interviewers emphasized the mental health and substance use concerns among clients. Top Issues and Priorities Through stakeholder interviews, focus group discussions, and review of the literature and existing campaigns, the following priorities were established: • Tobacco use services do not appear to be a priority for local LGBTQ-serving organizations. • Tobacco prevention/cessation messaging and services should be paired with other topics, including mental health, stigma, coping, and peer pressure. • Our initial age range of focus (12-30 years) is too large to develop a single tailored communication health campaign; therefore, we will restrict our focus to Black and Latino/a/x youth aged 15-20. This decision was based on our literature review and focus group findings, but also to emphasize prevention and cessation early in the life course. • Communication channels for exposure to tobacco advertisements and prevention messages differed across both Black and Latino/a/x focus groups, suggesting channel preferences for our own tobacco messages. • Tobacco prevention and cessation campaign messages should be disseminated in traditional and digital formats that consider preferences and needs. • Smoking prevention and cessation messages for Black and Hispanic LGBTQ young adults must be carefully tailored to avoid stereotypes while appealing to cultural values. • The literature review shows a critical gap in existing research that tests and evaluates the effectiveness of tobacco and prevention control (TPC) messaging targeted at Black and Latino/a/x LGBTQ communities.
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    Be YOU!: A collaborative effort to address minority stress for LGBTQ + youth in school settings
    (Journal of Gay & Lesbian Social Services, 2022) Fish, Jessica N.; Kapostasy, Sarah; Russell, Stephen T.
    LGBTQ youth often experience unsafe school climates and are at greater risk for compromised mental health relative to their heterosexual and cisgender peers. The psychological mediation model posits that these health inequities are produced by minority stress, which operates through several key mechanisms: rumination, emotion regulation, and coping. Efforts toward designing social services that might address these mechanisms, and thus improve LGBTQ youth well-being, are limited. Informed by empirical research and therapeutic practices, Be YOU! was conceived as a school-based empowerment program that provides LGBTQ youth with an accessible, safe space where they build skills to reduce rumination and promote emotion regulation and coping strategies for dealing with minority stressors. Developed collaboratively among a local LGBTQ youth center, a local school-based community organization, and university researchers, the Be YOU! partnership effectively circumvented barriers to accessing social services for LGBTQ youth. Findings from the pilot program evaluation showed that youth participation was associated with increased emotion regulation and decreased rumination. The practical impact on and positive feedback from LGBTQ youth suggest that there are measurable benefits and longterm promise in strategic multi-sector partnerships that address social services needs of LGBTQ youth and strengthen their ability to navigate minority stress.
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    Black Sexual Minority Adults’ Avoidance of Professional Mental Health Care
    (Psychiatric Services, 2023) Williams, Natasha D.; Turpin, Rodman E.; Boekeloo, Bradley O.; King-Marshall, Evelyn C.; Fish, Jessica N.
    Objective: The authors sought to determine whether Black sexual minority individuals were more likely than White sexual minority individuals to postpone or avoid professional mental health care (PMHC) and, if so, to identify the reasons for postponing or avoiding care. Methods: Analyses were conducted with a subsample of cisgender Black (N=78) and White (N=398) sexual minority individuals from a larger survey of U.S. adults administered via MTurk in 2020 (N=1,012). Logistic regression models were used to identify racial differences in overall postponement or avoidance of care as well as differences in the prevalence of each of nine reasons for postponing or avoiding care. Results: Black sexual minority individuals were more likely than their White counterparts to report ever postponing or avoiding PMHC (average marginal effect [AME]=13.7 percentage points, 95% CI=5.4–21.9). Black sexual minority people also were more likely than their White counterparts to cite beliefs that they should work out their problems on their own (AME=13.1 percentage points, 95% CI=1.2–24.9) or with family and friends (AME=17.5 percentage points, 95% CI=6.0–29.1) and to cite providers’ refusal to treat them (AME=17.4 percentage points, 95% CI=7.6–27.1) as reasons for postponing or avoiding care. Conclusions: Black sexual minority individuals were more likely than their White counterparts to report delaying or avoiding PMHC. Personal beliefs about managing mental health and providers’ refusal to offer treatment influenced Black sexual minority individuals’ willingness or ability to seek PMHC.
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    Covid-19-Related Stress Among LGBTQ+ University Students: Results of a U.S. National Survey
    (2020-09) Salerno, John P.; Pease, M; Devadas, Jackson; Nketia, Bryanna; Fish, Jessica N.
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    “Each week feels like a mountain”: The impact of COVID-19 on mental health providers’ well-being and clinical work.
    (Professional Psychology: Research and Practice, 2023) Mittal, Mona; Morgan, Amy A.; Du, Jingshuai; Jiang, Jessica; Boekeloo, Bradley; Fish, Jessica N.
    The SARS-CoV-2 (COVID-19) pandemic has placed a tremendous strain on health care providers. Although there is a burgeoning body of literature on how COVID-19 has impacted frontline health care workers (i.e., providers treating COVID-19 patients), little attention has been dedicated to second-line workers (i.e., providers treating the mental health of people impacted by COVID-19). In this article, we present findings from a thematic analysis of open-text responses (n = 136) examining how COVID-19 shaped both the well-being of second-line workers, specifically mental health providers, as well as their clinical work in the early months of the COVID-19 pandemic in the United States. Results indicated that mental health providers were experiencing significant COVID-19-related burnout and poor physical and mental health outcomes. Participants described diminished negative effects on the quality of their clinical care from the burnout and trauma associated with COVID-19. Many also demonstrated resilience, identifying the duality of both negative (e.g., exhaustion) and positive (e.g., pride in helping others) meaning derived from their second-line work experiences. We conclude with recommendations for preventing and addressing burnout among mental health professionals in the era of COVID-19 and subsequent health emergencies.
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    Healthy People 2030: New LGBT Objectives
    (2020-09) Williams, Natasha D.; Tralka, Hannah; Fish, Jessica N.; Turpin, Rodman E.
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    LGBTQ+ Health Disparities
    (2021) Bridges, Abbie; UMD-PRC
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    The paradox of progress for sexual and gender diverse youth
    (Current Opinion in Psychology, 2022) Fish, Jessica N.; Russell, Stephen T.
    In this essay, we explore diversity in sexual and gender identities, with a focus on implications of the current politicized moment for lesbian, gay, bisexual, transgender, queer, or questioning youth. As youth come out at younger ages, their personal identity development collides with the adolescence period characterized by peer influence, stigma, and possible victimization. We consider the changing and diverse experiences of coming out in adolescence for sexual and gender diverse youth. The current social and political moment offers possibilities for new identities, yet anti-LGBTQ + legislative and policy actions have crucial implications for health and wellbeing for youth.
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    Professional Expectations of Provider LGBTQ Competence: Where We Are and Where We Need to Go
    (Journal of Gay & Lesbian Mental Health, 2022) Williams, Natasha D.; Winer, Brennan; Aparicio, Elizabeth M.; Smith-Bynum, Mia A.; Boekeloo, Bradley O.; Fish, Jessica N.
    Introduction: Mental and behavioral health professional organizations use their governing documents to set expectations of provider competence in working with LGBTQ+ clients. Method: The codes of ethics and training program accreditation guidelines of nine mental and behavioral health disciplines (n=16) were analyzed using template analysis. Results: Coding resulted in fives themes: mission and values, direct practice, clinician education, culturally competent professional development, and advocacy. Expectations for provider competency vary greatly across disciplines. Conclusion: Having a mental and behavioral health workforce that is uniformly competent in meeting the unique needs of LGBTQ populations is key for supporting the mental and behavioral health of LGBTQ persons.
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    Research and Practice with LGBTQ+ Populations: What You Need to Know
    (2020) University of Maryland Prevention Research Center; University of California San Francisco Prevention Research Center
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    Technical Report: Gender Identity Differences in Health Care Access and Satisfaction
    (2020-08) Williams, Natasha D.; Turpin, Rodman E.; Boekeloo, Bradley O.; Fish, Jessica N.
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    UMD-PRC Progress Report: Competencies for Mental Health Clinicians working with LGBTQ+ People in Mental Health Care
    (2022-09) Smith-Bynum, Mia A.; Aparicio, Elizabeth M.; Shin, Richard Q.; Lare, Sean; Vigorito, Michael; Fish, Jessica N.; Williams, Natasha D.; Boekeloo, Bradley O.
    The University of Maryland Prevention Research Center (UMD-PRC) is one of 26 federally funded Prevention Research Centers in the United States. Each Prevention Research Center is charged with the task of studying “how people and their communities can avoid or counter the risks for chronic illnesses.” The UMD-PRC’s mission is as follows: “In collaboration with LGBTQ+ partner organizations, we promote evidence-based training of students and mental health care providers in culturally sensitive and inclusive practices.” The UMD-PRC selected the CDC definition of cultural competence to guide the development of the competencies. The CDC defines cultural competence as “effectively operating in different cultural contexts and altering practices to reach different cultural groups.” The Sexual and Gender Diversity Learning Community (SGDLC) competencies are intended to serve as a complement to the existing official professional competencies for clinical practice produced by various mental health professions, namely the American Counseling Association (ACA), the American Psychological Association (APA), and the National Association of Social Work (NASW). They are also intended to provide guidance to the professions where limited to no guidance is in place at the time of this writing. The SGDLC competencies for clinical practice are intentionally rudimentary in scope. As such, they provide an onramp for clinicians seeking to eventually master the comprehensive practice guidelines within their profession. They can also be used to provide guidance for the creation of educational modules for training programs in which limited faculty expertise is available. The SGDLC competencies outline the basic skills clinicians must acquire as they pursue mastery of the comprehensive guidelines endorsed by specific professional organizations (i.e., APA, ACA, NASW). To that end, the UMD-PRC sought to identify the most essential clinical competencies needed to serve the client population.
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    What motivates community mental and behavioral health organizations to participate in LGBTQ+ cultural competency trainings?
    (American Journal of Orthopsychiatry, 2022) Fish, Jessica N.; King-Marshall, Evelyn, C.; Williams, Natasha D.; Aparicio, Elizabeth M.; Tralka, Hannah M.; Boekeloo, Bradley O.
    The constantly evolving language, understanding, and cultural context regarding the mental health of lesbian, gay, bisexual, transgender, queer, and other sexual and gender diverse individuals (LGBTQ+) require mental health providers to obtain LGBTQ+ cultural competency training to be affirmative and effective with this population. Unfortunately, many providers are not obtaining this ongoing training and mental health disparities continue to plague LGBTQ+ populations. Guided by the Consolidation Framework for Implementation Research (CFIR), we conducted eight focus groups with community mental and behavioral health organization (MBHO) administrators (e.g., directors, clinical supervisors) and therapists to explore what factors facilitated or inhibited their adoption and implementation of a multicomponent LGBTQ+ cultural competency training program that required administrator and therapist participation in multiple learning sessions over several months (i.e., workshop, clinical consultation, and organizational technical assistance). Results from template analysis supported CFIR-aligned themes, including characteristics of individuals, inner setting, outer setting, and process, and two additional codes—marketing and other/previous training opportunities—emerged from the focus group data. Findings suggest that therapists are motivated to engage in such a program because they want to feel more efficacious, and administrators see the benefits of LGBTQ+ training programs for their clientele and marketing. Barriers to adoption and implementation include cost and personnel resistance, although participants believed these barriers were surmountable. Emphasizing therapist efficacy, clientele need, and benefits for marketing mental and behavioral health services could motivate MBHOs’ and therapists’ adoption and implementation of LGBTQ+ cultural competency training.