Validation of the Coping with Discrimination Scale in sexual minorities.

This article was downloaded by: [McMaster University] On: 23 February 2015, At: 06:17 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Journal of Homosexuality Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wjhm20

Validation of the Coping With Discrimination Scale in Sexual Minorities ab

a

Sakkaphat T. Ngamake MA , Susan E. Walch PhD & Jirapattara ab

Raveepatarakul PhD a

School of Psychological and Behavioral Sciences, The University of West Florida, Pensacola, Florida, USA b

Faculty of Psychology, Chulalongkorn University, Bangkok, Thailand Accepted author version posted online: 10 Dec 2013.Published online: 02 May 2014.

Click for updates To cite this article: Sakkaphat T. Ngamake MA, Susan E. Walch PhD & Jirapattara Raveepatarakul PhD (2014) Validation of the Coping With Discrimination Scale in Sexual Minorities, Journal of Homosexuality, 61:7, 1003-1024, DOI: 10.1080/00918369.2014.870849 To link to this article: http://dx.doi.org/10.1080/00918369.2014.870849

PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &

Downloaded by [McMaster University] at 06:17 23 February 2015

Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions

Journal of Homosexuality, 61:1003–1024, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 0091-8369 print/1540-3602 online DOI: 10.1080/00918369.2014.870849

Validation of the Coping With Discrimination Scale in Sexual Minorities SAKKAPHAT T. NGAMAKE, MA


School of Psychological and Behavioral Sciences, The University of West Florida, Pensacola, Florida, USA; Faculty of Psychology, Chulalongkorn University, Bangkok, Thailand

SUSAN E. WALCH, PhD School of Psychological and Behavioral Sciences, The University of West Florida, Pensacola, Florida, USA

JIRAPATTARA RAVEEPATARAKUL, PhD School of Psychological and Behavioral Sciences, The University of West Florida, Pensacola, Florida, USA; Faculty of Psychology, Chulalongkorn University, Bangkok, Thailand

The Coping With Discrimination Scale (CDS) shows promise as a self-report measure of strategies for coping with racial discrimination. To assess the psychometric properties of the measure for use with sexual minorities (i.e., gay, lesbian, bisexual, or GLB persons), a nonprobability sample of 371 GLB adults completed the instrument along with several standardized, self-report measures. Confirmatory factor analyses supported the five-factor structure of the original scale with the exclusion of five items. Adequate internal consistency reliability was found. Internalization, drug and alcohol use, and detachment subscales were correlated positively with measures of psychological distress and negatively with a measure of life satisfaction, providing evidence of construct validity. The education/advocacy and resistance subscales were largely unrelated to concurrently administered validation measures, consistent with prior findings. Coping strategy use varied as a function of primary sources of social support. The CDS appears to be a psychometrically sound measure of several discrimination coping strategies for use with sexual minorities.

Address correspondence to Susan E. Walch, School of Psychological and Behavioral Sciences, The University of West Florida, 11000 University Parkway, Pensacola, FL 32514, USA. E-mail: [email protected] 1003

1004

S. T. Ngamake et al.


KEYWORDS coping, discrimination, homosexuality, psychometrics

minority

groups,

Stigma related to sexual minority status can be a substantial source of stress among gay, lesbian, and bisexual (GLB) individuals (Miller & Major, 2000). In heterosexual society, sexual minorities frequently face sexual prejudice and discrimination, ranging from verbal harassment to physical violence (Huebner, Rebchook, & Kegeles, 2004). Findings from national probability samples have indicated that GLB adults report significantly greater rates of day-to-day and lifetime exposure to discrimination than do heterosexual adults (Mays & Cochran, 2001) with verbal harassment, personal/property crimes, and housing/employment discrimination attributed to sexual orientation reported by approximately 50%, 20%, and 10% of GLB adults, respectively (Herek, 2009). Those who are subject to these discriminatory behaviors often have elevated negative emotional states (e.g., depression and distress) and deteriorating physical health (Huebner & Davis, 2007; Pascoe & Richman, 2009; Walch, Ngamake, Bovornusvakool, & Walker, 2011). Furthermore, there is some evidence that the greater rates of psychological distress, psychiatric morbidity, and substance use difficulties observed among GLB adults are largely explained by their greater experience of discrimination than heterosexual adults (Mays & Cochran, 2001). Prominent coping theories (e.g., Lazarus & Folkman, 1984) have conceptualized the stress, appraisal, and coping process as dynamic, contextual, and transactional, with coping representing an array of cognitive and behavioral efforts aimed at managing the problems encountered by the individual and his or her reactions to those problems. Folkman and Moskowitz (2004) noted that coping and emotional regulation are strongly related and that coping is relevant to psychological distress and mental health outcomes, with escape-focused coping strategies (such as drug and alcohol use and detachment) generally associated with poorer mental health outcomes and problem-focused coping strategies (such as education/advocacy and resistance) yielding mixed findings depending on the nature of the stressor. More recently, researchers have also recognized “that positive emotion can occur with relatively high frequency, even in the most dire stressful context, and can occur during periods when depression and distress are significantly elevated” (Folkman & Moskowitz, 2004, p. 764). Coping strategies may also influence the meaning ascribed to stressful events, with positive and negative appraisals shaping more distal outcomes, such as life satisfaction. Many studies have demonstrated the moderating effect of coping on various stressor-outcome relationships (e.g., Parkes, 1990; Pineles et al., 2011; Stowell, Tumminaro, & Attarwala, 2008). However, studies examining the role of coping in the relationship between discrimination and mental


Validation of the CDS in Sexual Minorities

1005

and physical health outcomes are rare, especially among sexual minorities (Pascoe & Richman, 2009). A 2009 meta-analysis conducted by Pascoe and Richman identified 13 empirical studies that examined the relationship between perceived discrimination and health among sexual minority groups through 2007 and nine studies that examined coping as a moderator of the discrimination–health relationship among various minority groups. However, none of these had tested the role of coping strategies as a moderator of this relationship among GLB participants. More recently, Szymanski (2009) investigated potential moderators of the discrimination–stress relationship and found that self-esteem, but not social support and avoidant coping, could buffer the impact of discrimination on psychological distress among gay men. It is likely that the lack of information concerning the role of coping behaviors is related to the lack of a psychometrically sound instrument focusing specifically on how sexual minorities cope with discrimination. In 2010, Wei and colleagues developed the Coping With Discrimination Scale (CDS) to fill a gap in research studies on discrimination and coping. These authors (Wei, Alvarez, Ku, Russell, & Bonett, 2010) and other scholars (e.g., Manne, 2003; Ridder, 1997) have argued that because there are no coping strategies that work well with all stressors or under all situations, using instruments measuring coping strategies for nonspecific stressors might be problematic. For example, given a wide variety of coping strategies, most of the coping scales designed for all possible stressors are quite long and may not emphasize infrequent behaviors that are usually uncommon but pervasive only for specific stressors. Utilization of broad instruments could exhaust respondents and diminish the reliability of measurement. As a result, the items in the CDS were generated specifically from the literature on coping with discrimination and interviews among racial minorities, including five specific strategies used to deal with discrimination: education/advocacy, internalization, drug and alcohol use, resistance, and detachment. The education/advocacy strategy includes tactics to inform others about negative consequences and pervasiveness of discrimination. With the internalization strategy, minority individuals internally attribute discriminatory incidents to themselves personally, as opposed to external sources. Utilization of the drug and alcohol use strategy emerges when minority individuals use drugs or alcohol specifically to cope with or manage discrimination experiences as well as unpleasant emotional reactions. The resistance strategy consists of tactics to confront or challenge individuals who discriminate. The detachment strategy represents occasions when minority individuals disengage themselves from social support and have no idea what to do with discrimination. Although the CDS showed good psychometric properties for use with racial minority groups, the generalizability to sexual minorities is still unknown. The applicability of the CDS for use with sexual minority groups seems appropriate because its contents are consistent with those from theoretical


1006


models (e.g., Miller & Kaiser, 2001; Miller & Major, 2000) and qualitative studies conducted in sexual minority populations (e.g., Chung, Williams, & Dispenza, 2009). For example, internalizing discrimination by blaming oneself is compatible with (although not equivalent to) the concept of internalized homophobia, which is one of the minority stress processes proposed by Meyer (1995, 2003). Likewise, educating others and helping sexual minority friends manage the existence and impact of discrimination may strengthen group networks and bonds among sexual minority individuals. These can be paralleled to a form of minority coping that was described by Meyer as “a group-level resource, related to the group’s ability to mount self-enhancing structures to counteract stigma” (2003, p. 677). Furthermore, Chung et al. (2009) interviewed gays and lesbians on experiences of discrimination in the workplace and how they coped with them. Their coping behaviors were categorized into three main categories: social support, confrontation, and non-assertiveness, the latter of which are consistent with the resistance and detachment strategies in the CDS. Theoretically, psychological distress and mental health outcomes (such as depression symptoms, anxiety symptoms, and life satisfaction) would be expected to be related to coping with the stress of discrimination (e.g., Meyer, 2003). The present study aimed to examine the reliability and validity of the CDS for use with sexual minority respondents. In order to examine construct validity, measures of two theoretically-related variables used in the study by Wei et al. (2010) were retained (i.e., depression and life satisfaction). In addition, measures of two other variables important to GLB studies were added for construct validity purposes: internalized homophobia and anxiety (e.g., Meyer, 2003; Williamson, 2000). In a study investigating predictors of active and avoidant coping among gay men with HIV, Nicholson and Long (1990) found that internalized homophobia (defined as “fear or hatred toward homosexuality in oneself or in general,” p. 873) was positively associated with the practice of avoidant coping, including an acceptance of responsibility or self-blame for HIV (similar to the internalization coping strategy described above). In other words, gay men who engaged in avoidant coping including acceptance of responsibility or self-blame for their illness were more likely to endorse negative attitudes toward homosexuality. In addition, a fair amount of evidence has shown that internalized homophobia is related to an increase in substance use and depressive symptoms and a decrease in subjective wellbeing (Herek, Cogan, Gillis, & Glunt, 1997; Herek, Gillis, & Cogan, 2009; Lehavot & Simoni, 2011; Meyer, 2003; Williamson, 2000). Taken together, it was hypothesized that greater use of internalization, drug and alcohol use, and detachment strategies would be associated with greater internalized homophobia and depression symptoms and lesser satisfaction with life. A measure of anxiety symptoms was included in this study with regard to the concept of felt stigma defined by Herek (2007) to include both the



1007

actual experience of stigma, prejudice, or discrimination as well as the expectation, anticipation, or awareness of the possibility that one can be a target of prejudice and discrimination because of one’s sexual orientation. Sexual minorities may then develop vigilance behaviors as a way of coping with the anticipation of these circumstances (Allport, 1954). They may be likely to educate or even challenge the sources of discrimination and may also restrict their presence and behaviors in order not to provoke discrimination. Consequently, although such vigilance might serve to prevent discrimination from occurring, this vigilant state could raise the level of anxiety among GLB individuals. Hence, it was hypothesized that the education/advocacy, internalization, and resistance subscales would be correlated positively with anxiety. Social support is an important resource identified in many qualitative studies examining how sexual minority individuals cope with discrimination (Choi, Han, Paul, & Ayala, 2011; Chung et al., 2009; McDavitt et al., 2008; Wilson & Miller, 2002). For example, McDavitt et al. (2008) found that seeking gay-affirmative support is an important coping strategy, especially among gay and bisexual young men who could not find support from their family. The CDS does not fully capture the way minority people actively seek, utilize, or receive social support. Given that the detachment subscale includes social as well as cognitive avoidance, social support was expected to be negatively associated with this subscale. However, no additional hypotheses were stated since there are no theoretical writings or previous studies speculating the relationship between coping strategies and different sources of social support (e.g., family, friends, significant others, or GLB community). A measure of social support from various sources was included for exploratory purposes.

METHODS Participants Participants included 371 self-identified GLB individuals with an average age of 33.3 years (SD = 11.1), including 137 male (36.9%) and 234 female (63.1%) respondents. Other demographic characteristics (i.e., sexual orientation, race/ethnicity, education, and religious affiliation) are presented in Table 1. Although a nonprobability sample was obtained, the sample was sufficiently diverse and reasonably representative of the racial/ethnic distribution of the population in the southeastern region from which it was drawn (U.S. Census Bureau, 2011a), with higher educational attainment than the general U.S. population (U.S. Census Bureau, 2011b). As would be expected of a sample of individuals who identify as GLB, the majority of participants reported that they were out to more than just a few select people (Meyer & Wilson, 2009). However, the degree of disclosure of sexual orientation to others varied, with 59.6% of participants reporting

1008


TABLE 1 Demographic characteristics of the sample (N = 371)


Characteristic Sexual orientation Gay men Lesbian women Bisexual men and women Race/ethnicity Caucasian American Hispanic American Asian American/Pacific Islander African American Native American/Alaskan Native Biracial/multiracial Others Missing Education Less than 12 years 12 years/high school diploma/GED Technical or vocational certificate/some college Two-year college degree Four-year college degree Professional or graduate degree Religious affiliation Agnostic/Atheist Catholic Christian Others Missing Outness Not out to anyone Out to only a few people Out to half of the people I know Out to most of the people I know Out to almost everyone Missing

n

%

129 211 31

34.8 56.8 8.4

294 26 10 17 8 7 7 2

79.2 7.0 2.7 4.6 2.2 1.9 1.9 0.5

6 72 108 44 95 46

1.6 19.4 29.1 11.9 25.6 12.4

60 53 139 114 5

16.2 14.3 37.5 30.7 1.3

5 25 29 85 221 6

1.4 6.7 7.8 22.9 59.6 1.6

that they were out to almost everyone, 30.7% reporting that they were out to half or more of the people they knew, and 8.1% reporting that they were not out to anyone or out to only a few people (Table 1). Participants also reported a range of experiences with discrimination attributed to sexual orientation in the prior year. The average response to five items assessing the frequency of specific experiences with discrimination attributed to sexual orientation (i.e., how often participants heard people making homophobic jokes; were called a homophobic name; were made fun of or picked on; were treated unfairly by family members; were pushed, shoved, hit, or threatened with harm) revealed that 15.1% of participants experienced these forms of discrimination fairly/very often, while 67.1% experienced these forms of discrimination sometimes or almost never, and 12.1% never experienced these forms of discrimination in the prior year (5.7% not responding).


1009


Procedures This research study was approved by the Institutional Review Board of a university in the southeastern region of the United States. Participants were recruited on Pensacola Beach, Florida, over Memorial Day Weekend, a holiday weekend that draws tens of thousands of GLB tourists. Although this event draws many activists, it is not a conventional Pride celebration, as there are no planned marches, rallies, parades, or other large-scale activism events. Rather, the weekend is largely social and recreational, with numerous circuit parties. Although many attendees are open about their sexual orientation in their day-to-day lives or are out of the closet, many others attend from a distance as a way to step out of the closet for some time. Participants were recruited in person by a team of research assistants trained to screen for eligibility. Individuals were eligible for participation in the study if they were adults (i.e., over the age of 18) and identified as GLB. Individuals displaying overt signs of intoxication were excluded from participation. The nature of the study, as well as risks and benefits, was described verbally and in writing on an informed consent statement preceding the self-report research measures. Participation was anonymous and voluntary, and participants received a free t-shirt as an incentive.

Measures As part of a larger study, a survey packet consisted of questions regarding demographic variables (e.g., age, gender, sexual orientation, race/ethnicity, education, religious affiliation), one Likert-type item assessing level of disclosure of sexual orientation to others (or outness), five Likert-type items assessing the frequency of interpersonal experiences with discrimination on the basis of sexual orientation (described above; α = .83), one item asking how many alcoholic drinks the participants consumed on average per week, and the following standardized, self-report scales:

COPING WITH DISCRIMINATION SCALE (CDS) The CDS (Wei et al., 2010) is a 25-item scale measuring five specific strategies (i.e., education/advocacy, internalization, drug and alcohol use, resistance, and detachment) that minority individuals may use when coping with experiences of prejudice and discrimination. All 25 items of the original CDS are displayed in Table 2. Each strategy is assessed by a five-item subscale. Participants were instructed to think of how much each item describes the way they cope with discrimination in general. Items were responded to on a 6-point Likert-type scale ranging from 1 = never like me to 6 = always like me. Correlations between each subscale and theoretically-related variables (e.g., a positive relationship between the internalization subscale and

1010


TABLE 2 Internal consistency coefficients and factor loadings for confirmatory factor analyses of the Coping With Discrimination Scale Factor loading


Item Education/advocacy 21. I educate others about the negative impact of discrimination. 16. I help people to be better prepared to deal with discrimination. 11. I try to stop discrimination at the societal level. 6. I educate myself to be better prepared to deal with discrimination. 1. I try to educate people so that they are aware of discrimination. α Resistance 9. I get into an argument with the person. 4. I respond by attacking others’ ignorant beliefs. 24. I directly challenge the person who offended me. 14. I do not directly challenge the person. 19. I try not to fight with the person who offended me. α Drug and alcohol use 23. I use drugs or alcohol to numb my feelings. 3. I try to stop thinking about it by taking alcohol or drugs. 8. I use drugs or alcohol to take my mind off things. 13. I do not use drugs or alcohol to help me forget about discrimination. 18. I do not use alcohol or drugs to help me deal with it. α Internalization 10. I wonder if I did something to offend others. 20. I believe I may have triggered the incident. 15. I wonder if I did something wrong. 5. I wonder if I did something to provoke this incident. 25. I do not think that I caused this event to happen. α Detachment 7. I’ve stopped trying to do anything. 12. It’s hard for me to seek emotional support from other people. 22. I have no idea what to do. 17. I do not have anyone to turn to for support. 2. I do not talk with others about my feelings. α

CFA 1

CFA 2

.87 .86 .82 .73 .71

.86 .85 .82 .73 .72 .87

.67 .61 .54 −.33 −.37

.82 .72 .61 − − .70

.87 .86 .85 .04

.87 .85 .85 −

−.03

− .82

.84 .83 .80 .78 −.21

.85 .83 .80 .79 − .84

.71 .68 .66 .63 .48

.71 .67 .66 .62 .49 .69

Note. Item numbers were drawn from the original scale.

self-blame or a negative relationship between the detachment subscale and active coping) were shown in the original study, providing evidence of construct validity. Additionally, these five subscales cumulatively predicted mental health indicators (e.g., depression and self-esteem) above and beyond general coping strategies such as active coping and behavioral disengagement. All subscales had good internal consistency reliability in a sample of racial minorities (α = .72–.90). When examined over a two-week interval, four out of five subscales showed adequate to strong test-retest reliability (r = .48–.85; Wei et al., 2010).


1011


INTERNALIZED HOMOPHOBIA SCALE (IHP) Herek et al. (1997) developed the IHP by adapting interview content generated by Martin and Dean in 1987. This widely used scale consists of nine items describing negative attitudes and feelings that gay/lesbian/bisexual individuals may have toward themselves because of their sexual orientation (e.g., “I feel that being gay/lesbian/bisexual is a personal shortcoming for me”) with a response format of 0 = never, 1 = almost never, 2 = sometimes, and 3 = often. The scale was designed specifically for gay, lesbian, and bisexual people. Gay men and lesbians with high internalized homophobia were less likely to disclose their sexual orientation to their heterosexual friends and more likely to experience depressive symptoms (Herek et al., 1997), providing evidence for construct validity. Internal consistency reliability was acceptable in prior studies (α = .82–.88; Hamilton & Mahalik, 2009; Lehavot & Simoni, 2011) and in the present study (α = .87).

DEPRESSION ANXIETY STRESS SCALE (DASS) Two subscales (depression and anxiety, seven items each) of the 21-item short version of the DASS (Lovibond & Lovibond, 1995) were employed to assess depressive and anxiety symptoms. Item examples are “I could not seem to experience any positive feelings at all” (depression) and “I was worried about situations in which I might panic and make a fool of myself” (anxiety). The items were responded to on a 4-point severity/frequency scale, ranging from 0 = did not apply to me at all to 3 = applied to me very much or most of the time. When applied to a large, nonclinical sample in the United Kingdom, all three subscales (including stress) of the 21-item DASS showed an optimal factor structure, as well as negative correlations with scores representing positive affect and positive correlations with those representing negative affect (Henry & Crawford, 2005), indicating good concurrent and construct validity. Internal consistency reliability was more than adequate for the current sample (α = .89 for depression and .80 for anxiety subscales).

SATISFACTION WITH LIFE SCALE (SWLS) The SWLS (Diener, Emmons, Larsen, & Griffin, 1985) has five items designed to measure global life satisfaction, which is a cognitive evaluation of current life affairs compared to a subjective standard (e.g., “In most ways my life is close to my ideal”). In a sample of gay, lesbian, and bisexual individuals, the SWLS displayed a high internal consistency coefficient (α = .90) and was associated with self-esteem and distress, providing evidence of reliability and construct validity (Balsam & Mohr, 2007). Participants were instructed to rate

1012


their agreement on a 7-point Likert-type scale from 1 = strongly disagree to 7 = strongly agree. The scale yielded α = .87 for the present study.


MODIFIED VERSION SUPPORT (MSPSS)

OF THE

MULTIDIMENSIONAL SCALE

OF

PERCEIVED SOCIAL

The original version of the MSPSS (Zimet, Dahlem, Zimet, & Farley, 1988) has 12 items measuring perceived social support from three different sources (i.e., significant other, family, and friend subscales). Sample items from the original scale are “There is a special person who is around when I am in need,” “I get the emotional help and support I need from my family,” and “My friends really try to help me.” When used with sexual minority samples, these 12 items had good internal consistency coefficients (α = .86– .92), and their summed scores were negatively correlated with those of depression, anxiety, and alcohol and drug abuse (Lehavot & Simoni, 2011; Pachankis & Goldfried, 2010), providing evidence for reliability and construct validity. In the modified version, subscales assessing support from the GLB community and one’s religious group were included, using parallel items, as two additional sources of support. As noted earlier, the GLB community can be a primary source of support for sexual minority individuals who have been rejected by their family of origin (McDavitt et al., 2008). GLB individuals might be able to access information about social discrimination and effective methods to deal with it through members of the GLB community. Furthermore, many gay men in Wilson and Miller’s (2002) study reported that keeping faith through one’s own religious practices, participation, and worship was a good way to cope with sexual orientation discrimination. A preliminary analysis also suggests that positive religious coping was negatively correlated with depression among GLB individuals (Parenteau, Goodson, Ngamake, Palmer, & Walch, 2011). Exploring the relationship of coping strategies with perceived support from the GLB community and one’s religious group might expand mental health professionals’ understanding of the coping systems of sexual minorities. Thus, the scale used in the present study consisted of 20 items total, four for each source, with responses on a 7-point Likert-type scale ranging from 1 = very strongly disagree to 7 = very strongly agree. Internal consistency reliability was very strong within each source of social support (α = .94 for significant other, .93 for family, .91 for friend, .94 for GLB community, and .93 for religious group subscales).

Statistical Analyses In order to confirm the five-factor structure of the CDS developed by Wei et al. (2010), the statistical program LISREL 8.8 (Jöreskog & Sörbom, 2006)



1013

and the diagonally weighted least squares method (DWLS) for estimating parameters from the polychoric correlation matrix, with standard errors computed from the asymptotic covariance matrix, were used. The DWLS was employed here because each indicator in the model was represented by a single item, which was considered an ordinal variable (Jöreskog, 2005). Satorra-Bentler scaled chi-square, which is the default option for the DWLS, and selected approximate fit indices, including standardized root mean square residual (SRMR), comparative fit index (CFI), and root mean square error of approximation (RMSEA), were used to assess whether the measurement model was fitted to the observed data (Hu & Bentler, 1998), with cutoff values close to .08 for SRMR, .95 for CFI, and .06 for RMSEA indicating a good fit (Hu & Bentler, 1999). Bivariate and canonical correlation analyses were applied to examine the construct validity of the CDS. Because the scores representing internalized homophobia, depression, and anxiety were positively skewed, they were transformed by a square-root transformation. Finally, one-way analyses of variance (ANOVAs) with Bonferroni correction were used to explore differences in CDS scores among gay, lesbian, and bisexual participants.

RESULTS Validation of the CDS A confirmatory factor analysis based on the five-factor structure of the CDS did not produce a good fit, Satorra-Bentler scaled χ 2 (265, N = 371) = 1250.23, p < .05, SRMR = .127, CFI = .90, and RMSEA = .100 with 90% CI [.094, .106]. Parameter estimates (unstandardized factor loadings) of five negatively worded items were not statistically significant, and their standardized factor loadings were less than .40 (Table 2). Following Wei et al. (2010), two method factors were added: positive wording and negative wording. However, the model with the method factors did not yield an admissible solution. Five items with negative wording were then sequentially excluded from the measurement model, based on model fit indices, modification indices, and item correlations within each factor. A careful inspection of statistical indices and content validity of the scale suggested that these negatively worded items could not be retained in the final model. As a result, the five-factor model with 20 items was adequately fitted to the data, SatorraBentler scaled χ 2 (160, N = 371) = 384.31, p < .05, SRMR = .068, CFI = .97, and RMSEA = .061 with 90% CI [.053, .069]. Table 2 displays internal consistency coefficients for each factor (α ranged from .69 to .87) and factor loadings for two admissible solutions of the confirmatory factor analyses. Table 3 shows a correlation matrix between five subscales of the CDS and theoretically-related variables. The relationships among five subscales of the CDS were low to moderate in magnitude (r = .13–.61, p < .05), indicating distinct but interrelated constructs of coping strategies. Contrary to

1014


TABLE 3 A correlation matrix between five subscales of the CDS and concurrently administered construct validity measures (N = 330) 1

2

3

4

5

6

7

8

9


1. Education/advocacy − 2. Resistance .34∗ − 3. Drug and alcohol use .18∗ .32∗ − 4. Internalization .20∗ .30∗ .49∗ − 5. Detachment .13∗ .29∗ .49∗ .61∗ − 6. Actual alcohol use −.05 .00 .15∗ −.01 −.02 − 7. Internalized homophobia −.04 .01 .14∗ .24∗ .21∗ .02 − 8. Depression −.01 .09 .24∗ .18∗ .23∗ −.02 .17∗ − 9. Anxiety .01 .14∗ .27∗ .24∗ .22∗ .01 .08 .65∗ − ∗ ∗ ∗ ∗ 10. Life satisfaction .00 −.09 −.19 −.20 −.22 .02 −.20 −.49∗ −.30∗ ∗p

10

−

< .05.

the hypotheses, the education/advocacy subscale was not associated with any of the scores on the validation measures. As hypothesized, the resistance subscale was positively correlated with anxiety symptoms; however, it was unrelated to all other construct validity variables. A similar pattern of the relationships between the other three subscales (i.e., drug and alcohol use, internalization, and detachment) and four construct validity variables (i.e., internalized homophobia, depression, anxiety, and life satisfaction) was observed. That is, the scores representing these subscales were positively associated with the scores denoting internalized homophobia, depression, and anxiety and negatively associated with those of life satisfaction. Last, even though not as high as expected, the relationship between the drug and alcohol use subscale and average number of drinks per week was significantly positive.

Relationships Between the CDS and Perceived Social Support For exploratory purposes, the relationship between five subscales of the CDS and five sources of perceived social support (i.e., significant others, family, friends, the GLB community, and one’s religious group) was examined using a canonical correlation analysis. One canonical function was statistically significant and another was very close to the conventional standard, and the patterns of the relationships can be interpreted meaningfully for both of them. Table 4 shows canonical structures for these canonical functions. The highest correlation was .28, χ 2 (25, n = 368) = 56.17, p < .05. An examination of the canonical loadings (and cross-loadings) suggested that GLB individuals who received support from their friends, significant others, and the GLB community tended to use the education/advocacy strategy more frequently and the detachment strategy less frequently. When the variance explained by the first function was removed, the second correlation was

1015


TABLE 4 Canonical structures for two canonical functions between five subscales of the CDS and five sources of social support (N = 368)


Canonical loading

Coping with discrimination Education/advocacy Resistance Drug and alcohol use Internalization Detachment Perceived social support Significant others Family Friends GLB community Religious group

Canonical cross-loading

Function 1

Function 2

Function 1

Function 2

−.47 .05 .33 .31 .78

−.42 −.60 −.46 .23 −.21

−.13 .01 .09 .09 .22

−.08 −.12 −.09 .04 −.04

−.83 −.59 −.93 −.70 −.20

.09 .14 .17 −.58 .41

−.23 −.16 −.26 −.20 −.05

.01 .02 −.03 −.11 .08

marginally significant at .19, χ 2 (16, n = 368) = 25.46, p = .06. Although not statistically significant, it indicated that the frequency or magnitude of using the resistance strategy may be positively related to support from the GLB community. There were no dominant functions of perceived support from one’s family or religious group relevant to these five coping strategies.

Sexual Orientation Differences in Coping Strategies Unfortunately, due to a limited number of participants, the measurement invariance of the CDS between gay, lesbian, and bisexual participants could not be tested. However, differences in the extent to which the members of these groups have engaged in certain coping strategies were examined. Because each subscale had an unequal number of items, average scores rather than summed scores were compared. Table 5 shows means and standard deviations for the subscales of the CDS by participants’ sexual orientation. The results from a series of one-way analyses of variance suggested that there were no differences in the amount of strategies used between gay men, lesbian women, and bisexual individuals when coping with discrimination.

DISCUSSION The present study aimed to validate the CDS in a sample of sexual minorities and explored the relationship between five coping strategies and sources of social support. Without five negatively worded items, the application of the

1016


TABLE 5 Means and standard deviations of the average scores for five subscales of the CDS by participants’ sexual orientation


Education/advocacy Resistance Drug and alcohol use Internalization Detachment

Gay men (n = 129)

Lesbian women (n = 211)

Bisexual men and women (n = 31)

M

SD

M

SD

M

SD

M

SD

3.4 2.1 1.7 2.0 2.2

1.34 0.98 1.21 1.07 1.01

3.2 2.1 1.7 1.8 2.1

1.33 1.18 1.11 1.08 0.91

3.6 2.3 2.0 1.8 2.0

1.41 1.05 1.01 1.19 0.88

3.3 2.1 1.8 1.9 2.1

1.34 1.10 1.14 1.09 0.95

Total (N = 371)

CDS was robust in this particular sample, replicating the five-factor structure of the original scale validated for use with racial/ethnic minorities and demonstrating adequate to good evidence of internal consistency reliability and construct validity. All 20 items were loaded on the pre-specified factors with factor loadings more than .60, except one item (“I do not talk with others about my feelings,” a negatively worded item that was retained) with a factor loading of .49. The lower factor loading of this item may imply an important distinction between the detachment strategy used by racial minorities and that used by sexual minorities when coping with discrimination. Unlike racial minority status, sexual orientation identity can be concealed or disguised by regulating or changing one’s self-presentation and behaviors (Wilson & Miller, 2002). Thus, the specific tactic of the detachment strategy involving not talking to others about one’s feelings might reflect efforts to disengage from the problem and/or to conceal one’s sexual minority status. Also, the strong correlation between the internalization and detachment subscales (r = .61) might result from a common factor—a concealment strategy. The relatively low internal consistency of the detachment subscale might be explained by the fact that there are no core behaviors in this way of coping; rather, most of the items describe tactics that define the strategy by the absence of behaviors. Another explanation might be that two items (“It’s hard for me to seek emotional support from other people” and “I do not have anyone to turn to for support”) seem to reflect whether individuals possess resources of social support rather than whether they utilize the detachment strategy. For the resistance subscale, its lower internal consistency was not unexpected because only three items remained in this subscale after removal of two negatively worded items. With regard to statistical results for the five negatively worded items, it may be advisable to remove those items from the measurement model for use with sexual minority individuals. These negatively worded items may contribute to error variance by confusing respondents about the direction of their responses. Conventional wisdom regarding optimal question design



1017

(Krosnick & Presser, 2010) includes avoidance of the use of items with double or single negations, double-barreled questions that inquire about more than one thing at a time (e.g., “I do not use drugs or alcohol to help me forget about discrimination”), and nonspecific or ambiguous wording (e.g., “I do not directly challenge the person”). Replacement of these items with positively worded items (e.g., “I think that this event was caused by heterosexist people” versus “I do not think that I caused this event to happen”) might improve future versions of the CDS, particularly for the resistance subscale with only three items retained and a lower internal consistency coefficient, but further validation of these items and subscales would be required. Most of the correlations between the CDS and concurrently administered measures of theoretically-related variables were consistent with the hypotheses and the findings from Wei et al. (2010), providing evidence of construct validity of the CDS for use with sexual minorities. That is, drug and alcohol use, internalization, and detachment were positively related to internalized homophobia, as well as depressive and anxiety symptoms, and negatively related to levels of life satisfaction. These were not surprising results due to evidence of interrelationships among avoidant coping strategies, substance abuse, internalized homophobia, and psychological distress found in many studies of sexual minorities (e.g., Lock & Steiner, 1999; Meyer, 2003; Nicholson & Long, 1990; Sandfort, Bakker, Schellevis, & Vanwesenbeeck, 2009). A significant, positive relationship between the resistance subscale and anxiety symptoms provided partial support for the vigilance hypothesis in which GLB individuals, in heterosexual society, have to stay alert and/or regulate their presentation in order to avoid discriminatory treatment from others. Contrary to the hypotheses, use of the education/advocacy strategy was not correlated with any construct validity measures; however, prior research (Wei et al., 2010) has netted equivocal findings regarding these relationships, with some data indicating a relationship with life satisfaction and other data suggesting no significant correlations. Two interpretations for these results were proposed. First, in the process of developing the original CDS, Wei and colleagues proposed that the targets of education can be both within and outside the minority community. Coupled with the complexity of self-disclosure and others’ awareness of one’s sexual orientation, a lack of specificity regarding the targets of education/advocacy behaviors (e.g., receptive audiences of members of the GLB community versus uninterested or even hostile audiences of members of the heterosexual community) may obscure the functions of this strategy. Second, even though it was found that GLB individuals in this study had reported using the education/advocacy strategy most frequently, merely using this strategy may not affect mental and physical health outcomes. Rather, the consequences (e.g., success or failure) of using such a strategy may. For instance, Dane and MacDonald (2009) showed that acceptance by heterosexual friends and acquaintances can predict subjective


1018


well-being among GLB young adults above and beyond perceived social support from GLB friends. This can imply that the consequence (e.g., being accepted or rejected) of educating others about the prevalence and effect of discrimination may be a better predictor of psychological outcomes than the attempt to educate, in and of itself. Hence, for intervention purposes, it may be beneficial not only to suggest that GLB individuals educate others about discrimination but also teach them how to do it (e.g., role playing) in order to enhance the success rate of this strategy. In general, coping strategies have been conceptualized as moderators of stressful experiences (Lazarus & Folkman, 1984), at least when successful. Contemporary coping theories have suggested that some coping strategies are better suited than others for specific stressors (Cohen & McKay, 1984; Cohen & Wills, 1985), such as discrimination (Wei et al., 2010). Overall, findings of the present study suggested that three of the five coping strategies were associated with mental health outcomes in the expected direction, while two coping strategies were not correlated with most of the mental health outcomes. Use of the more active, confrontative, or problem-focused coping strategies of education/advocacy and resistance was unrelated to most mental health outcomes, while use of the more passive, avoidant, or emotion-focused strategies of drug and alcohol use, internalization, and detachment was associated with lower life satisfaction and greater psychological distress. Pascoe and Richman (2009) suggested a similar pattern of findings in their meta-analysis, which suggests that active coping strategies failed to serve as buffers but passive coping strategies tended to exacerbate discrimination stress outcomes. Taken together, these findings suggest that although the active, confrontative, or problem-focused coping strategies may offer limited benefits for coping with a relatively uncontrollable stressor such as discrimination, the passive, avoidant, or emotion-focused strategies may be more harmful than beneficial when coping with discrimination, particularly over the long term. Additional research using longitudinal designs may help to assess the test-retest reliability and predictive validity of the scales as well as identify the role of various coping strategies over the short and long term. Future research focusing on other coping strategies (e.g., positive reappraisal, seeking social support, self-control, spirituality) may identify strategies that can buffer the harmful impact of discrimination stress. Preliminary data from the present study suggest that the use of coping strategies varied as a function of major sources of social support. Friends, regardless of their sexual orientation, seemed to be the most influential source of support for discrimination coping. Sexual minority individuals who received more support from friends tended to execute the education/advocacy strategy more often and the detachment strategy less often. As noted above, reduced engagement in passive coping may be associated with better mental and physical health outcomes (Carver, Scheier, & Weintraub, 1989; Sandfort et al., 2009). Participants reporting high levels of



1019

support from the GLB community may be more likely to engage in resistance; this suggests that involvement in the GLB community is probably associated with more confrontative coping with discrimination. The roles of perceived support from family members and one’s religious group on how GLB individuals coped with discrimination were not as clear. These could partly come from the fact that the term family may be vague. Family may be different between younger and older participants, where the former may be more likely to refer to their family of origin and the latter might be more likely to refer to a family of their own creation (Zimet et al., 1988). Obviously, the support of one’s parents and one’s special persons (or one’s children) could differently influence the ways of coping among sexual minorities. Moreover, the diversity of religious affiliation among the participants (more than 10 different religions or religious denominations reported) and a range of beliefs and rituals may obscure the role of perceived support from religious group members as related to the five coping strategies examined in the present study. However, this examination of the relationship between coping strategies and perceived social support was exploratory, and future studies with strong theoretical grounding and more rigorous methodology are needed. Exploratory examination of relationships between coping strategy use and social support from various sources suggested that the interpersonal aspects of these active coping strategies may warrant additional research attention. The active coping strategies of education/advocacy and resistance reflect the use of more interpersonal interaction than the drug and alcohol use, internalization, and detachment strategies and social support was associated with greater use of the active strategies. This suggests that social support may serve as a moderator of the relationship between these active coping strategies and outcomes, obscuring the bivariate relationship between the education/advocacy or resistance strategy and outcomes such as internalized homophobia, depression, and life satisfaction. Future research might test the hypothesis that education/advocacy and resistance strategies may be associated with such coping outcomes only in the context of social support from a relevant source, such as family or the GLB community. It is conceivable that education/advocacy and resistance strategies may be successful in the context of adequate social support from relevant sources, while, conversely, these same strategies may elevate one’s level of discrimination stress in the absence of adequate social support from relevant sources.

CONCLUSION, STRENGTHS, AND LIMITATIONS In conclusion, the 20-item version of the CDS is a psychometrically sound instrument for assessing discrimination-related coping strategies among gay, lesbian, and bisexual adults across a broad age range. Although a nonprobability sample was used, the large-scale GLB-oriented event from


1020


which participants were recruited included a diverse group of individuals with varied levels of experience with discrimination and disclosure of sexual orientation or outness. Although conclusions regarding the prevalence of discrimination or coping strategies from nonprobability samples of GLB persons cannot be drawn with any confidence, the nonprobability sample obtained does permit examination of relationships among variables of interest and conclusions regarding the reliability and validity of the CDS for use with GLB adults in the community (Meyer & Wilson, 2009). Given the small number of bisexual individuals in the present study, the applicability of the CDS for these and other populations of sexual minorities (such as transgender and questioning persons) remains unclear. Similarly, representation by gay men of color and lesbians of color was limited, and additional validation of coping with discrimination among individuals with dual minority status (i.e., racial/ethnic minority and sexual minority) would be valuable, especially as the CDS assesses experiences with discrimination in general rather than experiences that are specifically restricted to sexual orientation, race/ethnicity, or other minority identities. The education/advocacy, drug and alcohol use, and internalization subscales appear to be particularly useful, with strong evidence of reliability and validity to support their use in research and, possibly, for future clinical use. The internal consistency reliability of the detachment and resistance subscales suggests that these subscales are adequate for research use. Future work on these two subscales may be indicated prior to clinical use. For example, psychometric evaluation of the addition of positively worded items in the resistance subscale could improve the reliability and validity of this subscale. In addition, future studies should take into consideration the interdependence of coping strategies and sources of social support in order to fully explain the intervening and buffering effects of these variables on the relationship between perceived discrimination and health outcomes. Future psychometric examination of the items of the detachment subscale might improve the reliability and validity of this subscale by examination of additional items that distinguish more clearly between detachment from others, including withdrawal, and concealment of sexual orientation, and the availability of social support. Also, it would be useful for researchers to use the CDS coupled with other standardized scales (e.g., perceived social support and disclosure or concealment of sexual orientation) to gain insight about cognitive and behavioral strategies sexual minorities and others use to cope with prejudice and discrimination.

FUNDING This research was supported in part by a grant from the Red Ribbon Charitable Foundation.


1021


REFERENCES Allport, G. W. (1954). The nature of prejudice. Reading, MA: Addison-Wesley. Balsam, K. F., & Mohr, J. J. (2007). Adaptation to sexual orientation stigma: A comparison of bisexual and lesbian/gay adults. Journal of Counseling Psychology, 54, 306–319. Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56, 267–283. Choi, K., Han, C., Paul, J., & Ayala, G. (2011). Strategies managing racism and homophobia among U.S. ethnic and racial minority men who have sex with men. AIDS Education and Prevention, 23, 145–158. Chung, Y., Williams, W., & Dispenza, F. (2009). Validating work discrimination and coping strategies models for sexual minorities. Career Development Quarterly, 58, 162–170. Cohen, S., & McKay, G. (1984). Social support, stress and the buffering hypothesis: A theoretical analysis. In A. Baum, S. Taylor, & J. Singer (Eds.), Handbook of psychology and health (pp. 253–267). Hillsdale, NJ: Erlbaum. Cohen, S., & Wills, T. (1985). Stress, social support, and buffering hypothesis. Psychological Bulletin, 98, 310–357. Dane, S., & MacDonald, G. (2009). Heterosexuals’ acceptance predicts the well-being of same-sex attracted young adults beyond ingroup support. Journal of Social and Personal Relationships, 26, 659–677. Diener, E., Emmons, R., Larsen, R., & Griffin, S. (1985). The Satisfaction With Life Scale. Journal of Personality Assessment, 49, 71–75. Folkman, S., & Moskowitz, J. (2004). Coping: Pitfalls and promises. Annual Review of Psychology, 55, 745–774. Hamilton, C. J., & Mahalik, J. R. (2009). Minority stress, masculinity, and social norms predicting gay men’s health risk behaviors. Journal of Counseling Psychology, 56, 132–141. Henry, J. D., & Crawford, J. R. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44, 227–239. Herek, G. M. (2007). Confronting sexual stigma and prejudice: Theory and practice. Journal of Social Issues, 63, 905–925. Herek, G. M. (2009). Hate crimes and stigma-related experiences among sexual minority adults in the United States: Prevalence estimates from a national probability sample. Journal of Interpersonal Violence, 24, 54–74. Herek, G. M., Cogan, J. C., Gillis, J. R., & Glunt, E. K. (1997). Correlates of internalized homophobia in a community sample of lesbians and gay men. Journal of the Gay and Lesbian Medical Association, 2, 17–25. Herek, G. M., Gillis, J. R., & Cogan, J. C. (2009). Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Journal of Counseling Psychology, 56, 32–43. Hu, L., & Bentler, P. (1998). Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychological Methods, 3, 424–453.


1022


Hu, L., & Bentler, P. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55. Huebner, D. M., & Davis, M. C. (2007). Perceived antigay discrimination and physical health outcomes. Health Psychology, 26, 627–634. Huebner, D. M., Rebchook, G. M., & Kegeles, S. M. (2004). Experiences of harassment, discrimination, and physical violence among young gay and bisexual men. American Journal of Public Health, 94, 1200–1203. Jöreskog, K. G. (2005). Structural equation modeling with ordinal variables using LISREL. Retrieved from http://www.ssicentral.com/lisrel/techdocs/ordinal.pdf Jöreskog, K., & Sörbom, D. (2006). LISREL 8.8 for Windows [Computer software]. Lincolnwood, IL: Scientific Software International. Krosnick, J., & Presser, S. (2010). Question and questionnaire design. In P. V. Marsden & J. D. Wright (Eds.), Handbook of survey research (pp. 263–313). New Milford, CT: Emerald Books. Lazarus, R., & Folkman, S. (1984). Stress, appraisal, and coping. New York, NY: Springer. Lehavot, K., & Simoni, J. (2011).The impact of minority stress on mental health and substance use among sexual minority women. Journal of Consulting and Clinical Psychology, 79, 159–170. Lock, J., & Steiner, H. (1999). Gay, lesbian, and bisexual youth risks for emotional, physical, and social problems: Results from a community-based survey. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 297–304. Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scale (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33, 335–343. Manne, S. (2003). Coping and social support. In A. M. Nezu, C. M. Nezu, & P. A. Geller (Vol. Eds.), Handbook of psychology: Vol. 9. Health psychology (pp. 51–74). Hoboken, NJ: Wiley. Martin, J. L., & Dean, L. L. (1987). Ego-dystonic Homosexuality Scale. Unpublished manuscript, Columbia University, New York. Mays, V. M., & Cochran, S. D. (2001). Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 91, 1869–1876. McDavitt, B., Iverson, E., Kubicek, K., Weiss, G., Wong, C., & Kipke, M. (2008). Strategies used by gay and bisexual young men to cope with heterosexism. Journal of Gay and Lesbian Social Services, 20, 354–380. Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697. Meyer, I. H., & Wilson, P. A. (2009). Sampling lesbian, gay, and bisexual populations. Journal of Consulting and Clinical Psychology, 56, 23–31.



1023

Miller, C. T., & Kaiser, C. R. (2001). A theoretical perspective on coping with stigma. Journal of Social Issues, 57, 73–92. Miller, C., & Major, B. (2000). Coping with stigma and prejudice. In T. F. Heatherton, R. E. Kleck, M. R. Hebl, & J. G. Hull (Eds.), The social psychology of stigma (pp. 243–272). New York, NY: Guilford Press. Nicholson, W. D., & Long, B. C. (1990). Self-esteem, social support, internalized homophobia, and coping strategies of HIV+ gay men. Journal of Consulting and Clinical Psychology, 58, 873–876. Pachankis, J. E., & Goldfried, M. R. (2010). Expressive writing for gay-related stress: Psychosocial benefits and mechanisms underlying improvement. Journal of Consulting and Clinical Psychology, 78, 98–110. Parenteau, S., Goodson, J., Ngamake, S., Palmer, D., & Walch, S. (2014). Religious coping, gender role orientation, and LGBTQ psychological adjustment. Manuscript in preparation. Parkes, K. R. (1990). Coping, negative affectivity, and the work environment: Additive and interactive predictors of mental health. Journal of Applied Psychology, 75, 399–409. Pascoe, E. A., & Richman, L. S. (2009). Perceived discrimination and health: A metaanalytic review. Psychological Bulletin, 135, 531–554. Pineles, S. L., Mostoufi, S. M., Ready, C. B., Street, A. E., Griffin, M. G., & Resick, P. A. (2011). Trauma reactivity, avoidant coping, and PTSD symptoms: A moderating relationship? Journal of Abnormal Psychology, 120, 240–246. Ridder, D. D. (1997). What is wrong with coping assessment? A review of conceptual and methodological issues. Psychology and Health, 12, 417–431. Sandfort, T., Bakker, F., Schellevis, F., & Vanwesenbeeck, I. (2009). Coping styles as mediator of sexual orientation-related health differences. Archives of Sexual Behavior, 38, 253–263. Stowell, J., Tumminaro, T., & Attarwala, M. (2008). Moderating effects of coping on the relationship between test anxiety and negative mood. Stress and Health, 24, 313–321. Szymanski, D. M. (2009). Examining potential moderators of the link between heterosexist events and gay and bisexual men’s psychological distress. Journal of Counseling Psychology, 56, 142–151. U.S. Census Bureau. (2011a). Statistical abstract of the United States: Resident population by sex, race, and Hispanic-origin status: 2000 to 2009. Retrieved from http://www.census.gov/compendia/statab/2011/tables/11s0006.pdf U.S. Census Bureau. (2011b). Statistical abstract of the United States: Educational attainment by race and Hispanic origin: 1970 to 2009. Retrieved from http:// www.census.gov/compendia/statab/2011/tables/11s0225.pdf Walch, S., Ngamake, S., Bovornusvakool, W., & Walker, S. (2014). Sticks and stones will break your bones and names can hurt you too: The relationship between perceived discrimination and GLBT mental and physical health concerns. Manuscript in preparation. Wei, M., Alvarez, A., Ku, T., Russell, D., & Bonett, D. (2010). Development and validation of a Coping With Discrimination Scale: Factor structure, reliability, and validity. Journal of Counseling Psychology, 57, 328–344.

1024



Williamson, I. R. (2000). Internalized homophobia and health issues affecting lesbians and gay men. Health Education Research, 15, 97–107. Wilson, B. D., & Miller, R. L. (2002). Strategies for managing heterosexism used among African American gay and bisexual men. Journal of Black Psychology, 28, 371–391. Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52, 30–41.

Perceived Discrimination and Social Relationship Functioning among Sexual Minorities: Structural Stigma as a Moderating Factor.

Out of the mainstream: sexual minorities and the mass media.

Perceived Discrimination Is an Independent Risk Factor for Suicidal Ideation among Sexual and Gender Minorities in Nepal.

The ecology of sexual health of sexual minorities in Guatemala City.

Cross-Cultural Validation and Psychometric Properties of the Arabic Brief Religious Coping Scale (A-BRCS).

Coping With Existential and Emotional Challenges: Development and Validation of the Self-Competence in Death Work Scale.

[Perspectives to improve the sexual health of sexual and gender identity minorities in Guatemala].

Misclassification and Undersampling of Sexual Minorities in Population Surveys.

Development and Validation of a Coping Scale for Caregivers in Malaysia.

The role of beliefs in sexual behavior of adolescents: Development and validation of an Adolescent Sexual Expectancies Scale (ASEXS).

Adaptation and Validation of the Sexual Assertiveness Scale (SAS) in a Sample of Male Drug Users.

Discrimination "toxic" to minorities, says public health expert.

A Persistent Disparity: Smoking in Rural Sexual and Gender Minorities.

Development and validation of the belief in Female Sexual Deceptiveness scale.

Assessing the reliability and validity of the Chinese Sexual Assault Symptom Scale (C-SASS): scale development and validation.

Coping with discrimination among Mexican American college students.

Ways of coping with premenstrual change: development and validation of a premenstrual coping measure.

Smoking Among Sexual Minorities: Are There Racial Differences?

Effects of Alcohol and Sexual Prejudice on Aggression Toward Sexual Minorities.

Minority Stress and Physical Health Among Sexual Minorities.

Sexual Compulsivity Scale, Compulsive Sexual Behavior Inventory, and Hypersexual Disorder Screening Inventory: Translation, Adaptation, and Validation for Use in Brazil.

Matching pain coping strategies to the individual: a prospective validation of the cognitive coping strategy inventory.

The role of personality in predicting drug and alcohol use among sexual minorities.

Stress, coping, and high-risk sexual behavior.