Intersecting Identities among Hispanic Sexual Minority Youth and their Relationship with Substance Use and Depressive Symptoms

Abstract

Purpose:

The literature on risk and protective factors for substance use and depression among Hispanic sexual minority youth (HSMY) has largely focused on individual risk and/or protective factors, and not how the minoritization of intersecting identity markers may be linked to these outcomes among HSMY. The purpose of this study was to identify intersectional profiles by conducting a latent class analysis (LCA) of sexual orientation, acculturation, time in US, and language and evaluate how class membership is associated with substance use and depressive symptoms.

Methods:

This secondary data analysis included 974 Hispanic adolescent participants between the ages of 12 and 18 (24.4% HSMY). We first conducted a LCA of indicators of baseline sexual orientation, acculturation, time in the U.S., country of origin, and language preference to identify participant classes. We then evaluated whether there were differences across classes in relation to past 90-day substance use and depressive symptoms at follow-up.

Results:

A four-class solution was optimal: (1) English-speaking, integrated, US-born, non-SMY, (2) Spanish-speaking, separated, non-US-born, non-SMY, (3) English-speaking, culturally marginalized, US-born, HSMY, and (4) Spanish-speaking, culturally marginalized, non-US-born, HSMY. There were significant differences across classes on past 90-day substance use. Notably, class 3 was more likely to report substance use and depressive symptoms.

Conclusions:

We identified distinct profiles of Hispanic youth with varying identity markers and found significant differences in substance use and depressive symptoms across classes. Results suggest that there is a need for tailored preventive interventions to address the unique needs of these groups.

Significant health disparities exist between sexual minority youth (SMY) and non-sexual minority youth (non-SMY) in substance use and depressive symptoms [1, 2]. SMY who are also ethnic and/or racial minorities, such as Hispanic sexual minority youth (HSMY), are further disproportionately affected by adverse health outcomes (i.e., substance use and depressive symptoms) [3, 4]. Substance use and depressive symptoms often develop and are comorbid during adolescence, further amplifying the risk of these co-occurring outcomes among HSMY [5]. Reasons for health disparities related to substance use and depression among sexual minority populations such as HSMY are often attributed to chronic exposure to various sexual orientation-related stressors [6, 7].

Minority stress theory posits that sexual orientation and identity-related stressors, including actual or anticipated experiences of discrimination, prejudice, and stigma related to sexual minority orientations, are the underlying drivers of health disparities in sexual minority groups [6]. Minority stressors have also been linked to higher depressive symptoms [8] and substance use [9, 10] among sexual minority youth. Further, empirical evidence supports the theoretical notion that minority stress, such as internalized homonegativity and external discrimination, may dysregulate biological stress processes, leading to inflammatory responses [11]. This increased inflammatory response may increase negative mental health outcomes, perpetuating a negative feedback loop of minority stress, negative mental health, and substance use [12].

HSMY may experience additional minority stressors associated with their racial and ethnic minority identities. Among Hispanic families, there are often expectations related to cultural values and gendered norms that further exacerbate outcomes related to substance use and depressive symptoms for HSMY [13]. Examples of these cultural values and gendered norms include familismo, machismo, and marianismo, which emphasize loyalty to family, independence in men, and self-sacrifice and conformity in women, respectively. These values and norms may discourage HSMY from disclosing their sexual identity [13], instead sacrificing their own needs by concealing their sexual identity from their families to avoid conflict in the family unit [13], which may contribute to minority stress and ultimately lead to substance use [10] and depressive symptoms [14].

HSMY are therefore embedded in several intersecting systems of oppression related to sexual orientation and oftentimes culturally influenced gendered norms. Specifically, HSMY must navigate disclosure and/or expression of their sexual orientation among their Hispanic families who may uphold the cultural values and gendered norms from their country of origin that can be unsupportive of sexual minority groups. In addition, HSMY must also manage differences in cultural orientation, such as differences in language preference, within their families (i.e., between parent(s) and HSMY) that may also lead to adverse behavioral health outcomes [15].

Acculturation-related gaps within families can lead to conflict and stress. Acculturation describes the process of immigrant populations adopting the mainstream culture’s values over time [16]. Existing acculturative frameworks suggest that integrated individuals - those who maintain some values from their heritage culture and adopt some values of the mainstream culture – are more likely to experience positive psychological adaptation than those who are marginalized, separated, or assimilated [16]. Within these frameworks, marginalized individuals refer to those who do not uptake mainstream cultural values nor maintain heritage cultural values. Separated individuals are those who maintain cultural values of their heritage culture but do not uptake mainstream cultural values. Conversely, assimilated individuals are those who uptake mainstream cultural values but do not maintain those of their heritage culture [17].

Although racial/ethnic identity and maintenance of heritage cultural values have been found to be protective against outcomes such as depression [18] and substance use [19], cultural orientation processes, such as acculturation trajectories, may in fact worsen depression [20] and substance use outcomes [21]. Existing research on HSMY has largely examined how racial/ethnic identity centrality and sexual minority status interact [22], but not how cultural orientation processes (i.e., acculturation, time in US, and language) may interact with sexual minority status and lead to adolescent health outcomes such as depression and substance use. Moreover, there are salient identity markers (i.e., acculturation, time in US, country of origin, and language) that can further explain depressive symptoms and substance use among HSMY.

Intersectionality theory posits that simultaneous membership in multiple minoritized identity groups adversely affects health outcomes due to society’s marginalization of these identities [23]. Therefore, it is likely that HSMY have worse outcomes related to depressive symptoms and substance use relative to their Hispanic non-SMY peers because of the intersecting systems of oppression they experience based on their multiple minoritized identity markers (i.e., marginalization based on sexual orientation, acculturation, time in US, country of origin, and language). However, the nascent literature on risk and protective factors for HSMY has largely focused on the impact of individual risk (e.g., parent rejection) and/or protective (e.g., parent acceptance) factors on outcomes such as substance use and depression [7] as opposed to the impact of intersecting systems of oppression linked to identity markers such as sexual orientation, acculturation, time in US, and language on substance use and depression outcomes among HSMY.

Study Purpose

The examination of identity markers requires analytical approaches that can simultaneously consider the interdependence of salient identity markers and how they are linked to health outcomes among HSMY as traditional variable-centered approaches do not capture heterogeneity in populations based on a set of characteristics (i.e., intersecting identity markers). To account for the interdependence of identity markers among HSMY, the purpose of this longitudinal study was to identify intersectional profiles of HSMY by conducting a latent class analysis (LCA) of indicators of sexual orientation, acculturation, time in US, country of origin, and language. Additionally, we sought to evaluate how class membership is associated with substance use and depressive symptoms.

Methods

Participants

This study utilized harmonized quantitative data from four randomized controlled trials of family-based interventions with a total of 974 participants. Participant demographics can be found in Table 1. The first two studies are randomized controlled trials evaluating the relative effectiveness of an online parenting intervention for the prevention of substance use and sexual risk behaviors [24, 25]. The third study was a hybrid Type 1 effectiveness-implementation study evaluating the prevention/reduction of depressive and anxiety symptoms, suicidal ideation and behavior, and substance use [26]. The fourth study was a pilot study evaluating the feasibility and acceptability of a parenting intervention in preventing substance use, sexual behaviors that could lead to the acquisition of sexually transmitted infections, and depressive symptoms in Hispanic sexual minority youth [27]. Across all studies, a randomized control trial design was implemented, in which adolescents and their families were randomized to either the study’s respective experimental condition or a ‘community practice/prevention as usual’ control condition. Families who previously participated in a study were ineligible to participate in future studies, thus there were no duplicate cases. Study characteristics are presented in Table 2.

Table 1.

Participant Demographics

Variable Mean (SD) or N (%)	Overall Sample	Study 1	Study 2	Study 3	Study 4
Age (12–17)	13.96 (1.30)	13.81 (0.80)	13.90 (1.36)	15.53 (1.17)	14.02 (1.45)
Gender
Male	468 (48.2)	145 (63.0)	215 (47.1)	12 (40.0)	96 (37.6)
Female	502 (51.8)	85 (37.0)	241 (52.9)	17 (56.7)	159 (62.4)
Intersectional Identity Marker Indicators at Baseline
Sexual Minority Status
HSMY	225 (24.4)	29 (12.5)	85 (20.0)	30 (100.0)	81 (34.2)
Non-SMY	696 (75.6)	203 (87.5)	339 (80.0)	0	156 (65.8)
Acculturation (1–90)
Americanism	60.69 (18.67)	46.85 (7.90)	69.70 (16.59)	61.48 (17.21)	56.99 (20.48)
Hispanicism	60.83 (22.21)	36.55 (10.62)	71.36 (17.81)	65.93 (18.11)	64.16 (20.65)
Time in US
<3 years	233 (24.8)	42 (18.3)	112 (25.3)	1 (3.3)	78 (32.6)
3–10 years	159 (16.9)	45 (19.7)	59 (13.3)	8 (26.7)	47 (19.7)
More than 10 years	548 (58.3)	142 (62.0)	271 (61.3)	21 (70.0)	114 (47.7.)
Country of Origin
US	517 (54.0)	130 (57.0)	253 (55.6)	19 (63.3)	115 (46.9)
Outside of US	441 (46)	98 (43.0)	202 (44.4)	11 (36.7)	130 (53.1)
Language Preference
English	693 (71.9)	187 (81.7)	333 (73.0)	28 (93.3)	145 (58.2)
Spanish	271 (28.1)	42 (18.3)	123 (27.0)	2 (6.7)	104 (41.8)
Outcome Variables at Follow-Up
Depression
YSR (0–9)	6.27 (6.25)	6.27 (6.25)	-	-	-
CESD (0–60)	16.17 (11.67)	-	15.02 (11.86)	23.22 (12.21)	17.97 (10.70)
Past 90-day Substance Use
Yes	44 (6.3)	20 (11.1)	17 (4.8)	5 (17.2)	2 (1.4)
No	655 (93.7)	160 (88.9)	334 (95.2)	24 (82.8)	137 (98.6)

Note. Totals vary across variables due to item non-response.

Table 2.

Summary of characteristics for synthesized studies

Trial	Baseline Year	Assessment Time Points (months)								Outcome Variable		Sample Size
										Substance Usea	Depression	Sexual Minority Youth Subsample	Total Sample
		0	3	6	12	18	24	30	36
1	2017	X	X		X					Past 90-Day	YSRb	29d	230
2	2018	X		X	X		X		X	Past 90-Day	CES-Dc	85e	456
3	2020	X		X						Past 90-Day	CES-D	30e	30
4	2022	X	X	X		X				Past 90-Day	CES-D	81e	258
											Total	225e	974

^aA single item was used to capture any (i.e., yes or no) self-reported past 90-day use of illicit drugs (marijuana, cocaine, inhalants, and prescription drugs) across all studies.

^bThe Youth Self Report (YSR) Anxiety/Depression subscale examines symptoms of anxiety and depression.

^cThe Center Epidemiologic Studies Depression Scale (CES-D) assesses feelings of depression in the last week.

^dWe identified HSMY in the first study based on responses to questions that assessed the binary gender (men/guys, women/girls) of their sexual partners (i.e., sexual orientation).

^eHSMY were identified based on their self-reported responses to the Klein Sexual Orientation Grid (KSOG; [28]) to questions related to their identity, attraction, behavior, emotional connection, and fantasies to either the same or both sexes (i.e., sexual orientation and sexual identity).

All studies recruited Hispanic adolescents and one primary caregiver. Inclusion criteria included: (1) adolescent was of Hispanic immigrant origin, defined by at least one parent born in a Spanish-speaking country of the Americas, (2) adolescent was between the ages of 12 – 17 years, (3) adolescent was living with an adult primary caregiver who was willing to participate, and (4) families had broadband Internet access on a device, including (but not limited to) a smartphone, iPad, tablet, computer at their home or other location (e.g., school, library, etc.). Additional inclusion criteria for the third and fourth studies included: (1) parent reported low family functioning; or youth reported elevated depressive symptoms; or youth reported anxiety symptoms; or a history of suicidal behavior (ideation or attempts) for study 3 [26] and (1) adolescent reporting attraction to individuals of the same, or multiple genders, same gender sexual behavior, and/or reported identifying as gay, lesbian, or bisexual, and (2) adolescent had disclosed their sexual orientation to at least one parent (i.e., primary caregiver) for study 4 [27]. Data were harmonized using integrative data analysis (IDA). IDA allowed us to pool individual-level data across multiple studies with different samples while controlling for methodological and cohort differences [28]. All study procedures for the four studies and harmonization process were approved by the University of Miami Institutional Review Board.

Measures

Intersectional Identity Marker Indicators at Baseline

Sexual Orientation.

We identified HSMY in the first study based on responses to questions that assessed the binary gender (men/guys, women/girls) of their sexual partners (i.e., sexual behavior). Across time points, if a respondent indicated that they had a sexual partner of the same gender, they were labeled as HSMY [23]. For the remaining studies, HSMY were identified based on their self-reported responses to the Klein Sexual Orientation Grid (KSOG; [29]) to questions related to their identity, attraction, behavior, emotional connection, and fantasies to either the same or both sexes (i.e., sexual orientation and sexual identity). Responses to the KSOG were on a 7-point scale, ranging from “heterosexual only” to “homosexual only.” If a participant responded anything other than “heterosexual only” to any of the questions, they were labeled HSMY.

Acculturation.

To assess adolescent acculturation, adolescents responded to the Vancouver Index of Acculturation [30]. This continuous scale comprises two subscales of 11 items (22 in total), and measures degrees of enjoyment and comfort engaging in mainstream (Americanism, α = 0.89) and heritage (Hispanicism, α = 0.90) cultural practices (e.g., enjoyment of Hispanic/American music, comfort in speaking English/Spanish). Responses are rated on a 9-point Likert scale from 1 (disagree) to 9 (agree). Scores range from 10 to 90, when summed, with higher scores indicating a higher degree of enjoyment and comfort in the respective cultural practice. All studies used the same acculturation variable.

Time in U.S.

Adolescents were asked how many years they had lived in the United States. Response options included: less than 3 years, between 3 and 10 years, and more than 10 years. All studies used the same variable to evaluate time in the U.S.

Country of Origin.

Adolescents’ country of origin was indicated by U.S. or outside of the U.S. All studies used the same variable to evaluate country of origin.

Language Preference.

Language was determined by the language in which the survey was taken in, either English or Spanish. This was consistent across all studies.

Outcome Variables at Follow-Up

Substance Use.

Substance use items asked adolescents if, in their lifetime, they had ever: smoked a cigarette, e-cigarettes, drank alcohol (even a sip), used non-prescription drugs, or used any illicit drugs (i.e., marijuana, cocaine, inhalants, LSD, PCP, ecstasy, mushrooms, speed, ice, heroin). If adolescents endorsed any of those items, they were asked about recent use within the past 90 days. We created a binary variable to identify those participants who indicated past 90-day use (0 = No, 1 = Yes).

Depressive Symptoms.

Two continuous measures assessed depressive symptoms. The first was the Anxious/Depressed subscale of the Youth Self Report [31] which examines symptoms of anxiety and depression (13 items; α = 0.89). Response options pertaining to symptoms of anxiety and depression ranged on a three-point ordered categorical scale from “not true” to “very true or often true.” This measure captured depressive symptoms in Study 1. The remaining studies used the 20-item Center for Epidemiologic Studies Depression Scale [32] to measure average depressive symptomatology amongst adolescents (α = 0.89). Respondents were asked to report how often they felt symptoms of depression in the past week. Response choices ranged from “1 = rarely or none of the time (less than 1 day)” to “4 = All of the time (5–7 days).” For both measures, an average was calculated, with higher scores indicating more symptomatology.

Data Analytic Plan

Integrative data analyses (IDA) allowed us to pool individual-level data across multiple studies with different samples while controlling for methodological and cohort differences [28] and all analyses controlled for study membership. We first conducted a LCA of baseline indicators of sexual orientation, acculturation, time in U.S., country of origin, and language to identify groups, or “classes,” of participants, such that members of the class have a shared set of characteristics. No indicators were transformed given that LCA can incorporate both categorical and continuous indicators [33]. Once individuals were grouped into classes, the LCA provided parameter values that represented the probability of being in each class (membership) and the probability of endorsing each criterion. Models were evaluated using the Bayesian Information Criterion (BIC) and the sample-size adjusted Bayesian Information Criterion (SSBIC; with lower values preferred) [34], and Lo Mendell-Rubin likelihood ratio tests (LMR-LRT; a significant p-value of LMR-LRT indicates that the estimated k class has better fit compared to k-1 class) to identify the model that best fits the data [35] and entropy (with higher values preferred) [36]. In addition to fit statistics, class interpretability and class size (i.e., class size n ≥ 10% of total sample) were considered in the model enumeration process.

After identifying the optimal class solution, we used corrected three-step approaches, BCH or R3STEP [37, 38], to estimate outcomes related to past 90-day substance use and depressive symptoms at the 24 or36 month post-baseline follow-up depending on the individual study. These three-step approaches account for classification shift when estimating covariates (i.e., outcomes). Given the different outcome measures for depressive symptoms, we standardized the scores from the Youth Self-Report (YSR) and the Center for Epidemiologic Studies Depression Scale (CES-D) separately by converting each raw score into a z-score, thereby placing both measures on a common metric. We created an indicator variable that identifies the instrument used (i.e., YSR or CES-D) and then merged the standardized scores accordingly. This approach assumes that both instruments reliably capture the same underlying construct, and that standardization minimizes measurement differences, facilitating valid and interpretable comparisons across participants. All analyses were performed in MPlus 8.0 [33].

Results

Latent Class Analysis

A four-class solution was identified for the overall sample based on Information Criteria (IC), delineation of classes, class size, and interpretability (Table 3). Although IC statistics (i.e., AIC, BIC and SSBIC) were lower for a five-class solution, and the adjusted LMR-LRT was significant, there were concerns with that class solution due to conceptual overlap among some of the classes in those solutions and the small sample size of Class 2 (i.e., less than 5%, Table 3). Thus, we selected a four-class solution as the optimal class solution: (1) English-speaking, integrated, US-born, non-SMY (n = 300, 31.1%), (2) Spanish-speaking, separated, non-US-born, non-SMY (n = 242, 25.1%), (3) English-speaking, culturally marginalized, US-born, HSMY (n = 275, 28.5%), and (4) Spanish-speaking, culturally marginalized, non-US-born, HSMY (n = 147, 15.3%).

Table 3.

Fit indices for LCA models

	Class Size (n, %)	AIC	BIC	ssaBIC	Entropy	Adj. LMR-LRT (p value)
2 Class	(573, 59.3%, 393, 40.7%)	21156	21239	21185	0.914	1055.5 (0.000)
3 Class	(322, 33.4%), (260, 26.9%), (383, 39.7%)	20795	20917	20837	0.877	370.12 (0.000)
4 Class	(244, 25.2%), (268, 27.7%), (150, 15.5%), (305, 31.5%)	20337	20498	20393	0.889	465.14 (0.000)
5 Class	(143, 14.8%), (23, 2.5%), (292, 30.3%), (275, 28.4%), (232, 24%)	20243	20443	20313	0.901	55.941 (0.0005)

Substance Use and Depression Outcomes

The average of depressive symptoms and odds ratios for substance use across classes can be found in Table 4. There were significant differences across classes on past 90-day substance use (χ²(3) = 10.05, p < .05). Specifically, Class 3 had a higher probability of using substances relative to those in Classes 1 (χ²(1) = 5.33, p < .05), 2 (χ²(1) = 9.31, p < .01), and 4 (χ²(1) = 6.47, p < .05). Regarding depressive symptoms, there was a significant difference between Class 1 and Class 3 (χ2 = 4.633, p = 0.031). Specifically, Class 1 had a mean score of –0.150 \ whereas Class 3 had a mean score of 0.217, suggesting that individuals in Class 3 exhibited significantly higher depression scores than those in Class 1. Table 5 highlights parameter comparisons for depressive symptoms and substance use.

Table 4.

Average of Depressive Symptoms and Odds Ratios for Substance Use among Classes

Class	Average of depressive symptomsa,b	Average of depressive symptomsc	Percent who used drugs in past 90-daysa	Odds of substance use
Class 1: English-speaking, integrated, US-born, non-SMY	12.33 (12.09)	−.150	4.4%	1.31
Class 2: Spanish-speaking, separated, non-US-born, non-SMY	11.28 (9.95)	.034	11.7%	.85
Class 3: English-speaking, culturally marginalized, US-born, HSMY	16.23 (12.48)	.217	4.9%	3.23
Class 4: Spanish-speaking, culturally marginalized, non-US-born, HSMY	14.72 (10.78)	.016	3.3%	1

^aBased on follow-up (post-baseline) variable.

^bValues derived from one-way ANOVA comparing means across fixed classes and using raw scores.

^cValues represent means of standardized scores.

Table 5.

Parameter Comparisons

	Depressive Symptoms		Substance Use
Comparison	Chi-Square	p-value	Chi-Square	p-value
Overall Test	5.65	.13	10.05	< .05
Class 1 vs. 2	2.57	.11	.58	.45
Class 1 vs. 3	4.63	< .05	5.33	< .05
Class 1 vs. 4	2.09	.15	.210	.65
Class 2 vs. 3	1.15	.28	9.31	< .01
Class 2 vs. 4	.02	.88	.05	.83
Class 3 vs. 4	1.48	.22	6.47	< .05

Note. Class 1: English-speaking, integrated, US-born, non-SMY; Class 2: Spanish-speaking, separated, non-US-born, non-SMY; Class 3: English-speaking, culturally marginalized, US-born, HSMY; Class 4: Spanish-speaking, culturally marginalized, non-US-born, HSMY.

Discussion

The purpose of this study was to identify intersectional profiles by conducting an LCA of indicators of sexual orientation, acculturation, time in US, country of origin, and language. We then evaluated how class membership was associated with substance use and depressive symptoms. Among youth, we identified a four-class solution as optimal: Class 1) English-speaking, integrated, US-born, non-SMY Youth; Class 2) Spanish-speaking, separated, non-US born, non-SMY Youth; Class 3) English-speaking, culturally marginalized, US-born HSMY; and Class 4) Spanish-speaking, culturally marginalized, non-US-born HSMY. We found significant differences in adverse health outcomes (i.e., substance use and depressive symptoms) by class membership. Youth in Class 3 were more likely than youth in Classes 1, 2, and 4 to report substance use and reported, on average, more depressive symptoms than youth in Class 1.

Classes 1 and 2 consisted of non-SMY, with no significant differences in depressive symptoms or substance misuse noted between these two classes. This finding differs from existing literature that suggests separated youth (i.e., those who maintain cultural values of their heritage culture but do not uptake mainstream cultural values) may encounter additional stress due to being detached from mainstream cultural orientations and values [14], potentially leading to depressive symptoms and substance use when compared to culturally integrated youth (i.e., those who maintain some values from their heritage culture and adopt some values of the mainstream culture) [39]. One reason for this could be that South Florida is a minority (Hispanic) majority region [40], reducing youth stress associated with cultural orientation not being aligned with mainstream culture when compared to separated youth in communities where Hispanic identities are minoritized.

Classes 3 (English-speaking, culturally marginalized, US-born HSMY) and 4 (Spanish-speaking, culturally marginalized, non-US-born HSMY consisted of HSMY with significant differences in substance misuse. Class 3 had significantly higher odds of reporting past 90-day substance use than any other identified class, corroborating existing studies that have separately observed relationships between sexual orientation-related minority stressors, unhealthful acculturation processes, and substance use [10, 14]. As youth in Class 3 were more likely to report substance use than youth in Class 4, this study’s findings are consistent with nationally representative data demonstrating immigrant populations from Latin America and the Caribbean are significantly less likely to report substance use than their U.S.-born counterparts [41]. Our study extends this area of research by highlighting how acculturation processes may compound minority-related stressors, with compounded stress associated with feelings of alienation from heritage culture. Although both classes were culturally marginalized (i.e., those who do not uptake mainstream cultural values nor maintain heritage cultural values), our findings suggest that particularly among marginalized HSMY, connectedness to Hispanicism through language and nativity status is important. This differentiation suggests that while underlying stress associated with intersecting cultural marginalization and sexual minority identity profiles may contribute to greater substance use as a way of self-managing stress beyond those who belong to only one minoritized identity overall, there remains protective values associated with nativity and language preference. This finding is reinforced by Class 3’s profile of being more likely to be living in the US for more than 10 years, with length of residence often associated with shifts away from cultural heritage connection [41].

On average, Class 3 reported the highest number of depressive symptoms. Class 3 reported a significantly higher average of depressive symptoms than Class 1 (English-speaking, integrated, US-born, non-SMY Youth). As previously noted, the high number of depressive symptoms in this class is not surprising considering the existing mental health disparities between heterosexual and sexual minority youth [1, 2]. Our findings support the notion that a low affinity to heritage and mainstream cultural values (as is the case with marginalization) is associated with adverse mental health outcomes, such as depressive symptoms [3, 39]. One reason for this finding may be that HSMY who do not maintain heritage cultural values or acculturate toward mainstream cultural values may feel disconnected from both their family members and peers, respectively. While acculturation gaps between youth and parents generally negatively impact family dynamics, increasing the risk for cultural separation and adverse mental health outcomes [16], these gaps are exacerbated by the experience of HSMY. As youth who choose to disclose their sexual minority orientation face the potential for increased discrimination and marginalization [13], the compounding marginalization experienced by HSMY may further fuel the risk for depressive symptoms [4].

Implications for Preventive Interventions for HSMY

Informed by an intersectional perspective, the results of the latent class analysis underscore existing disparities in substance use and depressive symptoms between HSMY and non-SMY and have implications for preventive intervention development for HSMY. Our findings highlight how long-established disparities in substance use by sexual minority status [9, 10] were emphasized and attenuated by acculturation processes, language use, and nativity [13, 18–21]. Corroborating existing evidence that suggests there are protective effects of strong familial relationships [7], these findings reinforce the need for culturally syntonic preventive interventions to support HSMY with particular emphasis on cultural integration as protective towards depression [18] and substance use outcomes [19].

To prevent harmful outcomes related to substance use and depressive symptoms, interventions supporting HSMY must address the dual stigmatization of HSMY ethnic minority and sexual minority identities within their origin and mainstream cultures. Given the protective effects of familial support in interventions for HSMY and the protective effects of cultural integration, our findings reinforce the need for interventions at the family level [13]. Programs should work to address potential acculturation gaps between parents and their youth, with emphasis on cultural integration at the family level and SMY identity affirmation.. Future research is needed to disentangle additional community factors impacting the acculturation process to better understand, reinforce, and enhance the protective benefits of cultural connectivity in preventing depressive symptoms and substance use.

Limitations and Strengths

Several limitations must be acknowledged in this analysis. First, the samples were exclusively drawn from South Florida, a metropolitan region characterized by a diverse and heterogeneous Hispanic population with a majority from Caribbean countries and territories [40]. This demographic makeup may restrict the broader generalizability of the study’s findings to regions of the U.S. with homogenous Hispanic populations from other areas of Latin America. Second, some measures used in this study had bipolar or dichotomous response options that were then reflected in the four-class conceptualization. Future studies should incorporate advanced alternatives to bipolar and dichotomous responses to measure constructs like language, with English and Spanish language assessed separately with response options ranging from high to low. Additionally, variations in how sexual orientation was conceptualized (e.g., identity, behavior, attraction) and operationalized (e.g., single-item measures vs. multi-item scales) across studies may have contributed to heterogeneity in the observed classes, which could result in variation in how nuanced intersections with other indicators—such as acculturation and language—manifest within the classes. Third, given the interaction between acculturation status, depressive symptoms, and substance use, it is important to note class indicators were captured at one-time point, despite acculturation status changing over time [17], emphasizing the need for longitudinal studies capturing acculturation and outcome variables. Fourth, measures capturing both sexual identity (e.g., gay, lesbian) and orientation (e.g., attraction) were used to assign youth into SMY and non-SMY groups for this analysis. This may have conflated minority stressors across youth and failed to capture potential variability. Although significant differences in adverse health outcomes were found by group (SMY versus non-SMY), future studies with HSMY should be more attune to the nuances between sexual orientation and identity and how these distinctions inform intersectional approaches to research. Finally, while cultural attributes are typically reflected in overall acculturation scores [30], no additional measures of Hispanic cultural values and norms were captured in the parent studies. Future research must incorporate specific cultural attributes, such as familism, that may be important to understanding substance use and depressive symptom development and outcomes, specifically among HSMY. Future research would also benefit from incorporating community factors impacting the acculturation experience in diverse, heterogenous Hispanic communities to assess the potential need for tailored intervention components.

Conclusion

Few studies evaluate the confluence of these identity markers and how they subsequently impact substance use and depression. The findings of this study reveal heterogenous groups of Hispanic sexual minority youth who share common identity markers to help inform the prevention of depressive symptoms and substance use among this population.

Implications and Contributions:

Few studies evaluate the confluence of salient identity markers and how the minoritization of such markers may be associated with substance use and depression. The findings of this study reveal heterogenous groups of Hispanic sexual minority youth who share common identity markers to help inform the prevention of depressive symptoms and substance use among this population.