ann. behav. med. DOI 10.1007/s12160-016-9794-8
ORIGINAL ARTICLE
New to New York: Ecological and Psychological Predictors of Health Among Recently Arrived Young Adult Gay and Bisexual Urban Migrants John E. Pachankis, PhD 1 & Adam I. Eldahan, MPH 1 & Sarit A. Golub, PhD, MPH 2,3
# The Society of Behavioral Medicine 2016
Abstract Background Young gay and bisexual men might move to urban enclaves to escape homophobic environments and achieve greater sexual and social freedom, yet little is known about the health risks that these young migrants face. Purpose Drawing on recent qualitative depictions of gay and bisexual men’s urban ecologies and psychological research on motivation and goal pursuit, we investigated migration-related motivations, experiences, health risks, and their associations among young gay and bisexual men in New York City. Method Gay and bisexual men (n = 273; ages 18–29) who had moved to New York City within the past 12 months completed an online survey regarding their hometowns, new urban experiences, migration motivations, and health risks. Results Not having a college degree, HIV infection, hometown stigma, within-US migration, and moving to outside a gay-dense neighborhood were associated with moving to escape stress; hometown structural stigma and domestic migration were associated with moving for opportunity. Migrating from larger US-based hometowns, having recently arrived, and moving for opportunity predicted HIV transmission risk. Social isolation predicted lower drug use but more mental health problems. Higher income predicted lower HIV and * John E. Pachankis
[email protected]
1
Department of Chronic Disease Epidemiology, Social and Behavioral Sciences Division, Yale School of Public Health, Yale University, New Haven, CT 06510, USA
2
Department of Psychology, Hunter College of the City University of New York, New York NY, USA
3
Department of Psychology, The Graduate Center, City University of New York, New York NY, USA
mental health risk but higher alcohol risk. Hometown interpersonal discrimination predicted all health risks, but hometown structural stigma protected against drug risk. Conclusion Findings offer a comprehensive picture of young gay and bisexual male migrants’ experiences and health risks and help build a theory of high-risk migration. Results can inform structural- and individual-level interventions to support the health of this sizeable and vulnerable segment of the urban population. Keywords Migration . Stigma . HIV . Substance use . Alcohol use . Mental health . Sexual minority . Minority stress . Geography . Urban Although population-based evidence is lacking regarding the prevalence of migration among sexual minority young adults, converging evidence suggests that migration occurs frequently among this population. Nearly half of the US population moves in an average 5-year period [1], with about 33 % moving to another town and 15 % to another state [2]; 13 % of the US population have moved from another country [3]. Young adults experience the highest rates of migration of any age group given the life course transitions that take place during this developmental stage, including finding work, going to college, getting married, and having children [4]. Because young sexual minorities, compared to heterosexuals, perceive disproportionate constraints to achieving personal goals in their hometowns [5], they may be disproportionately motivated to move to larger, more supportive locales. While urban migration, like other major life transitions [e.g., 8], might be associated with health risks, the health risks of urban migration among young gay and bisexual men have only recently been examined and almost solely qualitatively [6, 7, 9–11]. This qualitative research suggests an emerging
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theory of gay and bisexual men’s urban migration, whereby gay and bisexual men move to urban enclaves to escape homophobic environments and achieve sexual and social freedom [e.g., 6, 7] yet might encounter psychosocial and ecological health threats upon arrival. As reviewed below, this research suggests that the degree of risk upon arrival to a new urban home might be shaped by migrants’ (1) hometown characteristics, (2) experiences upon arrival, and (3) psychological motivations and goals for migration. Research suggests that hometown characteristics potentially related to migrants’ health might include hometown population size, country of origin, and hometown stigma and discrimination. Young gay and bisexual men who had moved to New York City from small towns qualitatively reported being relatively unprepared for the numerous sexual opportunities and normative lack of communication about condom use, HIV status, and testing history with sex partners, who are easily met through social and sexual networking technologies [9]. Yet, the possibility that men who move from other large cities might already be exposed to risk, and therefore disproportionately engaging in it, compared to men from small towns remains unconsidered. Men who move from other countries or cultures might be particularly unprepared to navigate risks in urban US gay subcultures, which have been described as relatively closed to outsiders, therefore limiting international migrants’ access to local supports [6, 12]; alternatively, consistent with a “healthy migrant” effect [13], international migrants may be steeled against risk. Further, hometowns characterized by sexual minority structural stigma and discrimination are associated with health risk behaviors among young adult gay and bisexual men [e.g., 14], and preliminary evidence suggests that hometown stigma and discrimination might continue to exert health risks even after moving to a new place [15]. Experiences upon arrival, including moving with low income, possessing few social supports upon arrival, living outside of a gay-dense neighborhood, and arriving very recently, can also theoretically drive health risks. Gay and bisexual migrants might give up accrued hometown economic and social capital to move to a new urban home [12], which may facilitate risk for new young arrivals by driving sex work to supplement income or submission to risky behavior as a form of establishing intimacy in lonely surroundings [6, 7, 9, 11]. Further, while living in a gay enclave might provide a sense of belonging and support, living in gay-dense neighborhoods has also been shown to be associated with health risks given the ease of access to sexual and substance use outlets in these neighborhoods [12, 16]. The period immediately after migration might pose particular health vulnerability, as recent migrants have been theorized to seek quick and easy connections through sexual intimacy and substance use [12, 17] while simultaneously contending with the stress of a major life transition [18]. While findings from one of the few related
quantitative investigations suggest that the first several years after moving to an urban area are associated with particularly high risk of HIV infection [12], the risk of very recent migration among gay and bisexual men has not been investigated. Recent qualitative research indicates that young gay and bisexual men move to New York City to minimize stress and/or maximize opportunities [e.g., 9], but no research has investigated the association of these migration motivations with health risks. Most young adult migrants, regardless of sexual orientation, move to pursue work or school opportunities [4], and psychological theory and research on selfregulation suggest that motivation to attain these specific and important goals should protect against unhealthy temptations [19, 20]. Approach and avoidance motivations represent distinct components of goal pursuit [e.g., 21] with distinct implications for healthy self-regulation [22, 23]. Individuals primarily motivated to avoid stress might paradoxically experience more stress, and therefore more health risk, than individuals motivated to pursue opportunity [24]. Based on this research, the health of migrants who move to escape might be compromised not only by the stressful situations that instigated their migration but also by stronger negative reactions to the stress of moving and to stressors encountered in their new urban surroundings. Conversely, men who move to pursue opportunity might indeed encounter more positive experiences upon migrating, including rewarding social experiences [25]. The implications of these particular motivations for migrants’ health remain unexplored. The research reviewed above suggests a theory whereby gay and bisexual men move to urban enclaves to escape homophobic environments and achieve sexual and social freedom [e.g., 6, 7], encountering health risks upon arrival as determined by their hometown characteristics, experiences upon arrival, and psychological motivations and goals for migration. Yet, the components of such a theory have never been systematically examined in a quantitative survey of recent migration and health risk. Therefore, based on this research and theory, we conducted what is, to our knowledge, the first quantitative investigation of the ecological and psychological determinants of health among recently arrived young adult (aged 18– 29 years) gay and bisexual male migrants to New York City. New York City is a common destination for young adult migrants [4] and contains the largest number of gay and bisexual men and the largest number of HIV cases in the USA [26, 27]. We specifically investigated migration-related motivations, experiences, health risks, and their associations among young gay and bisexual new migrants to New York City. Given the lack of descriptive data on young adult gay and bisexual migrants to urban areas, we first examined differences in personal background factors, hometown characteristics, and current New York City experiences according to whether migrants moved to escape stress, to pursue opportunity, or for work or school. Specifically, we hypothesized that
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men with lower educational attainment, those who are single, HIV-positive, from small hometowns, or from hometowns with high structural stigma and frequent interpersonal discrimination would report moving to New York City to escape stress and pursue opportunity. We then characterized the health risks facing the sample and predicted these risks from demographic and hometown characteristics, experiences upon arrival, and migration motivations. We specifically hypothesized that health risk would be predicted by (1) moving from hometowns that are small, outside the USA, and characterized by high sexual minority structural stigma and interpersonal discrimination; (2) moving with a lower income and lack of social support, living in a gay-dense neighborhood, and very recent migration; (3) and moving to escape stress. We expected that moving to pursue goals, including work and school, would protect against risk. Health risk outcomes included HIV transmission risk, heavy substance use, alcohol use problems, and mental health concerns, given that young adult gay and bisexual men are at high risk of these outcomes [28], which fuel each other [29], peak in young adulthood [30], and might be precipitated by migration [18]. Findings are expected to help identify the most vulnerable young adult gay and bisexual migrants and the particular health risks they face, with the goal of developing effective interventions to mitigate those health risks.
Method Participants and Procedure The study was advertised from October to December 2014 on gay-specific social media, including social and sexual networking mobile applications, social networking websites, and email listservs. Overall, 2052 individuals completed an eligibility screen. Eligibility was defined as aged 18–29 years, having moved to New York City in the past 12 months, and identifying as a gay or bisexual man. Based on these criteria, 428 men were eligible to complete the survey and received a $10 gift card. To ensure that our analytic sample contained only valid responses, we omitted responses from identical IP addresses that were submitted within several minutes of each other or that contained similar responses (e.g., identical hometowns), participants who did not produce a valid New York City ZIP code or neighborhood in free text responses, and those who did not complete all demographic data or the majority of health outcome questionnaires. Our final analytic sample, therefore, consisted of 273 respondents. Omitted responses did not significantly differ from retained responses on any demographic variables. All participants provided informed consent; the Institutional Review Boards of [Yale University and Hunter College of the City University of New York] approved the study.
As indicated in Table 1, the majority of participants were gay-identified, single, HIV-negative, had completed college or were currently enrolled in college, and were either employed full time or enrolled as a student. Participants were diverse with regard to class background and over one third reported growing up working class or poor. One third was from a hometown with a population of less than 50,000; 13.2 % were from non-US hometowns and were moving from outside of the USA. Most currently lived in a neighborhood with a higher-than-average density of same-sex households, earned less than $30,000 per year, knew at least one person in New York City upon arrival and had arrived in the past 6 months. Only six men (2.2 %) reported having previously lived in a city larger than New York, including Beijing, Mexico City, Seoul, and Shanghai. Measures Demographics Participants indicated their sexual identity, education, employment status, class background, relationship status, and HIV status from the options listed in Table 1. Hometown Characteristics We used a two-step approach to capture participants’ hometown, given that some participants’ hometowns might not influence their current behavior, for example, if they had not lived in that place since early childhood or for a meaningful period of time. Thus, participants indicated their hometown (“What city/town do you consider your hometown?”) and the last place that they had lived for at least 6 months before moving to New York City (“Think about the last city/town that you lived in for at least 6 months before moving to New York City. What is the name of this town/city?”). Participants were then asked to indicate the relative influence of these two places (“Thinking about your experiences in [hometown] and [last town], which place would you say has influenced you most?”). We coded a participant’s response to the first question as his hometown unless he indicated that his last city/town was more influential (n = 72, 26.4 %), in which case we coded that more influential town as his hometown. If a participant indicated that both towns were equally influential (n = 12, 4.4 %) or that neither town was influential (n = 91, 33.3 %), we considered his response to the first question to be his hometown. We then coded whether the participant was an international migrant and the population size of his hometown using 2010 US Census data. Hometown population size was log transformed to correct its skew. We assessed hometown structural stigma using 10 items adapted from the Growing Up LGBT in America study [5]. Specifically, participants rated 10 institutions in their hometowns (e.g., workplace and high school) in
ann. behav. med. Table 1
Demographic, hometown, and current urban characteristics of newly arrived young gay and bisexual men in New York City (n = 273) Number
Percent
Gay, queer, or homosexual Bisexual
242 28
88.6 10.3
Heterosexual/straight, sex with men
1
0.4
2
0.7
High school, GED, or less Some college or Associate degree
15 53
5.5 19.4
Currently in college Four-year college degree
38 123
13.9 45.1
Graduate school
44
Demographic characteristics
Number
Percent
90 183
33.0 67.0
237 36
86.8 13.2
Hometown structural stigma (1–4)
Mean 2.10
SD 0.65
Hometown interpersonal discrimination (1–6)
1.77
0.75
16.1
Experiences upon arrival
Number
Percent
9 47 126 74
3.3 17.2 46.2 27.1
Live in gay dense neighborhood Proportion of same-sex couples ≤ 1 % Proportion of same-sex couples > 1 % Current income Less than $30,000/year
39 234
14.3 85.7
208
76.2
17
6.2
65
23.8
Sexual orientation
Other Education
Parents’ class background Rich Upper middle class Middle class Working class Poor
Hometown characteristics Hometown size
Employment status
Small town (population $30,000) Gay-dense neighborhood (logit) Knew no one in NYC Recently arrived Migration motivations Move to escape Move for opportunity Move for work/school
0.001 0.001 0.543 0.004
a
Model adjusted for education status, class background, HIV status, sexual orientation, and relationship status
b
Model adjusted for education status, employment status, HIV status, and relationship status
0.071 0.57 (0.29, 1.13) 0.812 0.039 0.17 (0.03, 0.85) 0.277
0.109 0.031
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factors as covariates in models predicting each respective outcome.
What Hometown, Arrival, and Motivational Factors Predict Alcohol Use Problems?
What Hometown, Arrival, and Motivational Factors Predict HIV Transmission Risk?
As shown in Table 4, hometown interpersonal discrimination and higher income predicted problematic alcohol use in the multivariable model. In the bivariate models, moving for work or school was associated with lower odds of problematic alcohol use as compared to moving for other reasons, but this became marginally significant in the multivariable model.
As shown in Table 3, in the multivariable model, a higher odds of engaging in HIV transmission risk was associated with being from a smaller town, having migrated from within the USA, being from a hometown with higher interpersonal discrimination, moving with lower income, having recently arrived, and moving to pursue opportunity. In bivariate models, hometown structural stigma and moving to escape and moving for work or school were also associated with higher odds of HIV transmission risk behavior, but these associations became non-significant in the multivariable model. What Hometown, Arrival, and Motivational Factors Predict Heavy Substance Use? As shown in Table 3, migrating from outside the USA, being from a structurally stigmatizing hometown, and knowing no one upon arrival was associated with lower odds of heavy substance use than migrating from within the USA, being from a supportive hometown, or having social contacts. Hometown discrimination was associated with higher odds of heavy substance use.
What Hometown, Arrival, and Motivational Factors Predict Poor Mental Health? As shown in Table 4, hometown interpersonal discrimination, lower income, and knowing no one in New York City upon moving were associated with poor mental health in the multivariable model. Hometown structural stigma and moving to escape stress were also associated with poorer mental health in the bivariate model, but these associations became nonsignificant in the multivariable model. How Do Effects of Hometown, Arrival, and Motivational Factors Differ in Models Excluding International Migrants? In models that exclude international migrants (n = 36), the magnitude and direction of effects remain similar for all asso-
Table 4 Alcohol use and mental health problems by hometown characteristics, New York City experiences, and migration motivations among newly arrived young gay and bisexual men in New York City (n = 273) Alcohol use problems Bivariate model
Hometown characteristics Town size (log) Migrated from outside USA Structural stigma Interpersonal discrimination Experiences upon arrival Income (>$30,000) Gay-dense neighborhood (logit) Knew no one in NYC Recently arrived Migration motivations Move to escape Move for opportunity Move for work/school a
Model adjusted for HIV status
B (SE)
p
−0.43 (0.33) −1.45 (1.02) 0.04 (0.53) 1.36 (0.45)
0.194 0.166 0.944 0.003
Mental health problems (7 days) Multivariable modela
Bivariate model
B (SE)
p
B (SE)
p
B (SE)
p
0.014
0.01 (0.04) 0.02 (0.12) 0.13 (0.06) 0.34 (0.05)
0.756 0.850 0.038 0.001
−0.04 (0.06) 0.34 (0.06)
0.575 0.001
1.14 (0.47)
Multivariable modela
1.96 (0.68)
0.004
1.56 (0.68)
0.023
−0.16 (0.08)
0.043
−0.16 (0.07)
0.036
1.59 (0.97) 1.29 (1.04) −0.93 (0.70)
0.100 0.217 0.186
1.38 (0.96)
0.149
0.01 (0.11) 0.24 (0.12) 0.01 (0.08)
0.899 0.045 0.875
0.29 (0.11)
0.011
0.50 (0.53) 0.62 (0.50) −1.47 (0.71)
0.343 0.209 0.038
0.27 (0.13) 0.10 (0.06) −0.11 (0.08)
0.028 0.076 0.197
0.03 (0.06) 0.06 (0.06)
0.603 0.339
−1.19 (0.69)
0.085
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ciations between hometown, arrival, and motivational factors and risk outcomes.
Discussion Using a comprehensive survey administered to recently arrived young gay and bisexual migrants to New York City, we examined associations between ecological and psychological aspects of their migration with four health risk behaviors that disproportionately affect this population. Results extend emerging qualitative evidence regarding gay and bisexual young adults’ migration to characterize specific determinants of health risks among this potentially vulnerable group. Participants reported encountering moderate degrees of hometown stigma and discrimination and indicated moving to New York City to both escape stress and pursue opportunity. Nearly two thirds of participants had moved to New York City specifically for work or school. Participants who had less than a college degree, were HIV-positive, who migrated from within the USA, and had experienced high hometown stigma and discrimination were particularly likely to report moving to New York City to escape stress. Men who migrated to escape stress were also more likely to be living outside a gay-dense neighborhood upon arrival to New York City. Men who migrated from within the USA and those who experienced high hometown stigma and discrimination were also likely to report moving to New York City to pursue opportunity. Our sample was at particularly high risk; almost three quarters reported at least one of the four health risks we assessed. Hometown interpersonal discrimination was strongly related to all assessed health risks, including HIV transmission risk, heavy substance use, alcohol use problems, and mental health problems, although hometown structural stigma climate was associated with lower odds of heavy drug use. Being from outside the USA was protective against HIV transmission risk and heavy substance use. Higher income was associated with higher risk of alcohol use problems but lower odds of HIV transmission risk behavior and mental health problems. Social isolation strongly predicted mental health risk but lower odds of heavy drug use. Having arrived in the past 6 months predicted higher odds of HIV transmission risk behavior than having lived in New York City longer. Living in a gay-dense neighborhood was not associated with odds of any risk. Moving to pursue opportunity was associated with HIV transmission risk behavior, while moving to escape stress or for work or school was not associated with odds of any risk. Our findings extend the existing qualitative research on gay and bisexual men’s urban migration to the specific correlates of this migration and the features of migration associated with health risks for past-year migrants. Specifically, results
suggest that men with fewer hometown opportunities because of lower education attainment, HIV infection, or experiences of hometown structural stigma and interpersonal discrimination are particularly likely to move to escape stress. Recent arrival, moving with lower income, and moving from a larger locale were associated with HIV transmission risk. These results confirm and challenge extant findings. For instance, our findings confirm the results of qualitative studies showing that young gay and bisexual migrants to New York City move to escape hometown stress and pursue opportunity [6, 7, 9–11, 17]. Further, whereas previous research suggests that the first several years after migration are associated with HIV transmission risk [12], the present study is the first to our knowledge to show that the first few months following migration appear to be particularly risky. Results also extend previous research showing an inverse association between income and both HIV transmission risk and mental health problems to the specific socioeconomic situation of young migrants [40]. Qualitative research suggests that young gay and bisexual men from small towns may be relatively unprepared for risks of “big city life” and therefore succumb to risk [9]. Yet, the results of the present study suggest that men who move from larger cities, like the majority of our sample, are actually at higher risk for HIV than men who move from smaller locales, suggesting that migrants, especially those from larger cities/ towns, may have been exposed to risk contexts even before their migration to New York. Hometown interpersonal discrimination was the most robust predictor of risk in the present study, predicting all assessed risk factors. While previous research shows that interpersonal discrimination is associated with HIV transmission risk, substance use, and mental health problems for sexual minority young adults [e.g., 41, 42], our results suggest that associations between discrimination taking place in migrants’ hometowns and these risks persist even upon moving to more supportive climates. Unexpectedly, however, we found an inverse association between hometown structural stigma and substance use, contradicting previous results showing a positive association between these variables [14]. However, emerging evidence suggests that structural stigma may protect against risk behaviors that occur in social contexts with other gay and bisexual men because structural stigma can keep gay and bisexual men removed from contact with each other [43]. To the extent that substance use takes place with other gay and bisexual men, hometown structural stigma may impede the social contact necessary for this behavior to emerge even upon recent migration. Confounds, however, at either the structural level (e.g., average hometown income) or individual level (e.g., sexual orientation concealment) might also explain these associations. Further, recent research suggests that hometown structural stigma interacts with individual-level
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processes, such as one’s sensitivity to stigma-related rejection, to predict substance use risk [15], paving the way for future research on person-by-context interactions in explaining sexual minority migrant health. The fact that migrants with higher incomes were at higher risk of alcohol use problems stands in contrast to previous research among young gay and bisexual men in San Francisco showing that those who occupied lower socioeconomic statuses were at higher risk for heavy alcohol consumption [34]. Several possibilities awaiting future research might explain this contrast, including socioeconomic or substance use norm differences between San Francisco and New York, historical differences given the significant time period between the two studies, or factors specific to migration among the present sample. Yet, other findings are consistent with previous research not specifically focused on migrants. For instance, lower income and social isolation were associated with poorer mental health, consistent with research on socioeconomic differentials in mental health risk among general samples of sexual minorities [44]. Social isolation also predicted mental health problems, consistent with previous research among sexual minorities [e.g., 45], and protected against heavy drug use, consistent with research suggesting that heavy drug use among gay and bisexual men occurs in social contexts [34, 46]. However, living in a gay-dense neighborhood was not associated with any health risk, in contrast to studies suggesting that urban gay communities, and the venues available within them, exacerbate such risk [10, 46]. The present finding that migrants from outside the USA reported lower odds of HIV transmission risk and heavy drug use is consistent with research supporting the healthy migrant effect, whereby healthy, compared to unhealthy, individuals differentially migrate to the USA [13]. Contrary to our hypotheses regarding migration motivations, we found that men who moved to New York City to escape stress were not at elevated risk for any outcome, while those who moved to pursue opportunity were particularly likely to engage in HIV transmission risk. Also contrary to hypotheses, moving to New York City for the specific goal of work or school did not protect against alcohol use problems. Perhaps, migrants who reported moving to escape stress did not find that New York City was any personally healthier than their hometowns, which may have been stressful precisely because they were unhealthy. Perhaps those who reported moving to pursue opportunity were more likely to seek those opportunities through riskier sexual contacts. Mechanisms underlying these unexpected findings await future research. Our findings preliminarily suggest several intervention strategies. Programs that help young gay and bisexual migrants, especially those who have very recently moved, find social support outside sex risk and substance use scenes represent one potential way to protect health. Helping them cope with the mental health sequelae of hometown stress upon
urban arrival also holds promise. Mental health treatments specifically geared toward fostering healthy identity development despite minority stress have shown preliminary evidence for improving mental and sexual health and substance use outcomes among young adult gay and bisexual men [47]. Preliminary data also suggest the potential promise of delivering such interventions via social media [e.g., 48]. Given the success of our sampling approach using social media, health programs for new migrants could be advertised and delivered via this route. Interventions that help young migrants find stable housing and work, as well as pursue important personal goals despite the possibility of sexual risk, might simultaneously be able to provide the support and structure necessary to motivate these young men away from risk behavior. Given the cross-sectional design of this study, we cannot infer that any migration experience causes, or even precedes, health risks. Future research utilizing longitudinal designs before and after migration would overcome this limitation. Similarly, recruiting a comparison group of non-migrants would help establish causality. Known healthy migrant selection biases [13] could potentially be overcome by comparing the health risk trajectories of migrants from particularly highand low-risk hometowns. Further, our findings might be influenced by same-source reporting biases, whereby health status influences self-reported stress exposure [49]. Future research utilizing objective measures of migration experiences and interviewer-based health assessments could overcome this limitation. Although we recruited participants across several venues, our sample is ultimately subject to biases introduced by not capturing sexual minority men who might not identify as gay or bisexual or those who might not have access to social media. While we nonetheless recruited a socioeconomically diverse sample of migrants who had moved from across the USA and world, future research ought to also assess the experiences of sexual minority men who are less visible to social scientists [e.g., 50]. The present dataset does not contain information on participants’ ethnic or racial background, which impels future studies to examine differences in migration experiences, motivations, and risk across diverse ethnical and racial groups. The present dataset also does not contain information regarding participants’ exact age within the 18–29year-old category leaving the possibility for future research to explore that age might represent a confound between certain predictors (e.g., recent migration) and risk. Finally, we did not collect information on migrants’ full migration histories, including the number of former places lived and the risks encountered in those places. In fact, one third of our sample noted that neither their hometowns nor previous towns were particularly influential to them, suggesting that unmeasured features of other locations might exert influence on health. In conclusion, our findings provide the most comprehensive picture to date of the health risks facing young adult gay and bisexual men who have recently moved to New York City,
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extending preliminary research on young adult gay and bisexual men’s experiences of urban migration. Consistent with migrants in previous qualitative studies, our high-risk sample reported moving to New York City to escape stress and to pursue opportunity. Associations of various health risks with migrants’ hometown discrimination and current urban context, including social isolation, recent arrival, and low income, are consistent with emerging theories of young gay and bisexual men’s high-risk migration [10, 12] but also challenge other assumptions in the literature (e.g., that moving from small towns leaves young gay and bisexual men unprepared to navigate urban risks) [9]. Results of this study suggest preliminary targets for intervention. Programs that facilitate social support outside of sex risk and substance use scenes, encourage healthy goal pursuit, and promote healthy identity development away from the threat of hometown discrimination might possess particular promise. Future research utilizing longitudinal designs and matched samples of non-migrants can extend the results of this research to establish causal threats to the health of this sizeable and vulnerable segment of the urban population. Acknowledgments The authors would like to thank Justin Cai, Gabe Murchison, Xinru Ren, and Inna Saboshchuk for their database programming and data management efforts.
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Compliance with Ethical Standards Conflict of Interest Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards Authors Pachankis, Eldahan, and Golub declare that they have no conflict of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.
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16. Ethical Approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed Consent Informed consent was obtained from all individual participants included in the study.
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