To over-sample SMW who identified as African American or Latinx, each wave of recruitment targeted a random sample that was one-third African American/Black, one-third Latinx, and one-third unrestricted by race/ethnicity. Participants were compensated through the panel companies following their standard payment protocols. The participation rate for the general panel sample was 45 % and the participation rate for the LGBT sample was 28.7 %. Heterosexual participants were recruited from a pool of former participants in the National Alcohol Survey , a national probability survey. The NAS is a cross-sectional probability survey of adults ages 18 or older in the U.S., conducted approximately every-five years that used computer-assisted interviewer with a random sample of both landlines and cell phones with oversampling in low-population states and oversampling in Black- and Latinx-dense areas. Participants from the probability survey were eligible for random selection in the present study if they selected “female” as their gender and “only heterosexual or straight” in response to a question asking them to choose the category that best described their sexual orientation. A random sample of 1,961 heterosexual women who participated in the 2015 NAS were invited to participate in the current study. Computer assisted telephone interviews were completed with 623 respondents .
The general panel sample and the national probability survey sample included only binary “male/female” response options and did not assess whether respondents were assigned female at birth. The LGBT-specific panel allowed participants to select multiple sex and gender identities; however, pipp drying racks to be consistent with categorizations in the general panel and probability samples, only participants from this panel were included in the current study if they selected “female” as their gender . Although we refer to participants as“women” in this paper, we acknowledge that study participants may have endorsed other gender categories had they been provided such options. The SMW samples were initially screened based on endorsing sexual minority identity and the heterosexual comparison sample was selected based on prior endorsement of heterosexual identity; the few participants who selected “mostly heterosexual” in the current study were combined with those endorsing heterosexual or straight identity. As shown in Table 1, 44.6 % of the study sample was from the national population-based survey, one-quarter was from the LGBT panel sample, and close to one-third was from the general panel sample. Approximately 46 % of the sample identified as heterosexual; 23 % identified as bisexual and 31 % as lesbian. The majority of the sample was<50 years old , college-educated , currently employed , and currently partnered ; just under one-half identified their race as White. Although the majority also reported being Protestant, Catholic, Jewish, or some other religion, a quarter of the sample reported not having a religious affiliation.
Table 1 displays characteristics by sexual identity. Differences by sexual identity were found with respect to age, race/ethnicity, educational attainment, current employment, partner status, current religion, current religious environment, and study sample.In the current study we examined differences in the associations of religiosity and importance of spirituality with AUD and marijuana use by sexual identity in a large sample of adult sexual minority and heterosexual women. Consistent with prior research, importance of spirituality, importance of religion, and participation in religious services were independently associated with lower odds of substance use. However, this protective effect varied by sexual identity, particularly in regard to AUD. In analyses of the interaction between spirituality and the study outcomes, we found that greater importance of spirituality was associated with greater odds of AUD among both lesbian and bisexual women, but was protective for heterosexual women. Among study participants who reported the highest levels religious importance odds of AUD were also greater among lesbian women than heterosexual women. These findings are consistent with minority stress theory, which suggests that religiosity and spirituality are less protective for SMW than heterosexual women and, in some cases, may contribute to greater risk of substance use. Findings are also consistent with research results indicating that religiosity is not protective against, and is sometimes associated with, increased heavy episodic drinking among adolescent and young adult SMW . Although our study did not explore participants’ subjective experiences and meanings of religiosity and spirituality, findings from qualitative research suggests that although religion or spirituality may provide support for some sexual minorities, it can also be associated with unique stressors which may contribute to adverse psychological and health outcomes .
It may also be possible that some SMW are turning to accessible coping outlets to deal with minority stress—including both spirituality and substance use. Findings from tests of interaction between religious attendance and sexual identity approached but did not reach statistical significance in relation to past year AUD or any marijuana use in the past year. Lack of significant differences may be related to the markedly lower levels of religious service attendance reported by SMW relative to heterosexual women, which may have reduced our ability to detect differential risk by sexual identity. These findings underscore the importance of future research considering religious behavior, such as attending religious services, in addition to religiosity or spirituality, given the potential of each to contribute to disparately negative behavioral health outcomes for SMW. We also explored potential differences in outcomes among participants based on religious environment—specifically, whether the study outcomes differed for participants involved in religious environments that were unwelcoming to LGBT people. Differences by sexual identity in interaction models were attenuated and no longer significant when we added this variable. Our ability to explore this question in greater depth was limited by the relatively small number of SMW participants who reported that they attended services in unwelcoming religious environments . Although the percentage of participants reporting attendance at LGBT welcoming environments was similar across sexual identity groups , over 80 % of SMW, compared with 48.5 % of heterosexual women, described themselves as not affiliated with or attending services. These demographic differences are consistent with literature suggesting that sexual minorities are more likely than heterosexuals to dissociate from religious institutions entirely or seek alternatives to disaffirming religions . Studies with larger samples of SMW who attend religious services that are both welcoming and unwelcoming of LGBT people are needed to explore the potential impact of the immediate religious environment on substance use outcomes.Findings should be interpreted in the context of study limitations. Although the SMW participants were drawn from two large national panel samples of SMW, they were not recruited using probability sampling methods, which may limit generalizability. As noted above, the great majority of SMW did not participate in religious services, which limited our ability to explore the impact of religious environment on substance use outcomes. There were also some limitations related to measurement. We assessed importance of religion, religious attendance, and importance of spirituality each with a single item. Although the use of single items are common in survey research, there are other measures that capture different dimensions of religiosity not captured in the current study, such as organizational, nonorganizational, vertical grow room and subjective religiosity ; daily spiritual experiences such as awe, inner peace, gratitude, transcendent experiences ; or facets of religiosity that may be particularly salient to health such as religious coping and religious social support .
It is possible that a measure of religious coping or a multi-dimensional measure of spirituality would have yielded different results. Furthermore, it was not possible to assess the degree to which participants conflated religiosity and spirituality; multidimensional measures may have allowed for a more nuanced exploration of the impact of spirituality independent of religiosity. Measures of religious environment also differed between the SMW and heterosexual women, which may have contributed to the different distributions of “non-affirming” attendance by sexual identity. Given research suggesting differences in perceived importance of religion and religious affiliation by race and ethnicity among SMW , future studies might examine possible subgroup differences in the associations of religiosity and spirituality to substance use outcomes. Finally, differences between the two panel samples may have influenced the findings in the current study. Although research suggests that substance use is typically greater among SMW relative to heterosexual women regardless of the sample or measures used , LGBT specific panels may reach individuals whose characteristics differ than LGBT peers recruited from general samples .Findings from this study contribute to previous research suggesting that religiosity and spirituality are less protective against alcohol and marijuana use among SMW than among heterosexual women, and, in fact may be a risk factor for some SMW. Furthermore, risk and protection may differ for lesbian and bisexual women. Findings underscore the importance of research on risk factors for substance use among SMW that include distinct measures of religion and spirituality, and that disaggregate bisexual and lesbian subgroups in analyses.The prevalence of type 2 diabetes mellitus is increasing, and it is projected that in the USA alone, type 2 DM will increase to 48.3 million by 2050. In addition to defects in pancreatic b-cell function and insulin sensitivity, systemic inflammation is thought to be involved in its pathogenesis.1 2 Marijuana is the most commonly used illicit drug in the USA and is currently used by 14.4 million Americans.The major psychoactive CB is delta 9-tetrahydrocannabinol whose effect is mediated through the CB1 and the CB2 subtypes of CB receptors found in the brain and lymphoid tissues. The endocannabinoids, a group of neuromodulatory lipids also bind to these receptors. Cannabis, THC and other CBs have been shown to have both beneficial6 and detrimental effects. Marijuana users have higher caloric intake while eating less nutrient-rich foods, yet have similar or slightly lower body mass index than non users. We hypothesised that the prevalence of DM would be reduced in marijuana users due to the presence of one or more CBs because of their immunomodulatory and anti-inflammatory properties. We assessed the association between DM and marijuana use among adults aged 20e59 years in a national sample of the general population.Data on marijuana use were collected by self-report. Non-marijuana users included never users and those who reported ever having used marijuana, but who had not used marijuana in the past month . We classified participants who reported using marijuana in the past month by frequency of use as either light current users or heavy current users as previously described. The definition of marijuana for purposes of this survey includes ‘hash,’ ‘pot’ or ‘grass’ or any other references to the Cannabis plant. The phrase ‘used marijuana’ refers to either smoking or ingesting marijuana. Subjects were defined as having DM if they answer ‘yes’ to the question ‘Have you ever been told you have sugar/diabetes?’ or had a fasting blood glucose level $126 mg/dl . Of the 719 patients with DM, 418 answered the question about whether they take insulin and 116 reported that they do take insulin. Of those, nine reported that they began using insulin at age #20 years, the majority being likely to have type 1 DM, although a few may have had type 2 DM. Thus, we estimate that 1.5% of patients with DM had type 1 DM, and because of this low number, we analysed all subjects with DM together. There was no difference in any of our analyses if the nine patients of age #20 years were excluded. The study included 151 pregnant women . Of them, eight women had diabetes. There was no difference in the use of marijuana by DM. Because of the low number in the diabetes category, we included them in the analysis. A series of sensitivity analyses excluding the pregnant women showed no difference. Plasma glucose and whole blood haemoglobin A1c were measured at the University of MissouriColumbia School of Medicine Department of Child Health, Diabetes Reference Laboratory, Columbia, Missouri, by David Goldstein, MD, director. Subjects were classified as obese/non-obese according to the BMI level using a cut-off of 30 kg/m2 . We analysed data related to DM, age, gender, race/ ethnicity, education level, family history of DM, physical activity, BMI, cigarette smoking, cocaine use, alcohol use, total serum cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, serum 25-hydroxy vitamin D , HbA1c, fasting plasma glucose level, C reactive protein level and the serum levels of less robust inflammatory markers count and uric acid that have been previously used in NHANES III analysis.