Ethnicity & Health

ISSN: 1355-7858 (Print) 1465-3419 (Online) Journal homepage: http://www.tandfonline.com/loi/ceth20

Experiences of racism, sexual objectification and

alcohol use among gay and bisexual men of colour

Rusty Souleymanov, David J. Brennan, Clemon George, Richard Utama &

Andre Ceranto

To cite this article: Rusty Souleymanov, David J. Brennan, Clemon George, Richard Utama &
Andre Ceranto (2018): Experiences of racism, sexual objectification and alcohol use among gay
and bisexual men of colour, Ethnicity & Health, DOI: 10.1080/13557858.2018.1439895

To link to this article: https://doi.org/10.1080/13557858.2018.1439895

Published online: 18 Feb 2018.

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ETHNICITY & HEALTH, 2018
https://doi.org/10.1080/13557858.2018.1439895

Experiences of racism, sexual objectification and alcohol use

among gay and bisexual men of colour
Rusty Souleymanova, David J. Brennana, Clemon Georgeb, Richard Utamac and
Andre Cerantod
a
Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada; bFaculty of Health
Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada; cAsian Community AIDS
Services, Toronto, ON, Canada; dFife House, Toronto, ON, Canada

ABSTRACT ARTICLE HISTORY

Objective: Previous research has shown that experiences of racial Received 24 October 2016
discrimination and sexual objectification are associated with Accepted 24 January 2018
health risk behaviours among gay and bisexual men of colour.
KEYWORDS
However, little is known about whether racial discrimination and Ethnoracialized gay and
sexual objectification are associated with alcohol use among this bisexual men; sexual
population. This community-based study examined the objectification; racism;
association between racial discrimination, sexual objectification alcohol use
and alcohol use in a sample of 369 gay and bisexual men of
colour (Black/African/Caribbean, Latino/Latin American, South
Asian, and East and Southeast Asian) in Toronto.
Design: Data were drawn from an online survey designed to
examine issues of racism, homophobia, health and well-being
among gay and bisexual men of colour in Toronto. Regression
analysis assessed the relationship between scores on the Racism
and Life Experiences Scale, Sexual Objectification Scale, and the
CAGE questionnaire (a screen for alcohol use disorder).
Results: Multivariable logistic regression analyses revealed that
experiences of racism and sexual objectification are significantly
and positively associated with a screening for alcohol use
disorder. The interactions between Latino/Latin American race/
ethnicity and experience of sexual objectification were also
positively associated with a screening for alcohol use disorder.
Conclusions: Health professionals should consider the role of racial
discrimination and sexual objectification within the context of risk
and treatment for alcohol use disorders, harm reduction, and HIV
prevention for gay and bisexual men of colour.

Previous research has highlighted that self-reported racial discrimination and sexual
objectification are associated with poorer self-reported physical and mental health out-
comes among gay and bisexual men of colour (Bogart et al. 2011; Brennan et al. 2013;
Han 2006; Wong et al. 2010). Alcohol misuse constitutes an important public health
concern, and detection of alcohol use disorders through a clinical screening is important
for the prevention of alcohol-related morbidity and mortality (Dhalla and Kopec 2007).

CONTACT Rusty Souleymanov rusty.souleymanov@mail.utoronto.ca University of Toronto, Factor-Inwentash

Faculty of Social Work, 246 Bloor St. W., Toronto, ON, Canada M5S 1V4
© 2018 Informa UK Limited, trading as Taylor & Francis Group
2 R. SOULEYMANOV ET AL.

While racial and ethnic disparities have emerged as important variables in understand-
ing the higher prevalence of physical health concerns among gay and bisexual men of
colour in the United States, health research among North American gay and bisexual
men does not critically engage in discussions on race or racialization (Husbands et al.
2013). Furthermore, most research with ethnoracialized gay and bisexual men in North
America has focused on HIV/AIDS issues and was predominantly conducted in a U.S.
context. Research never examined the issues of racial and sexual objectification in relation
to health behaviours, such as alcohol misuse.
Dermody and colleagues (2014) found that that during the transition to young adulthood,
gay and bisexual adolescent males’ risk of heavy drinking increases faster than their hetero-
sexual peers’ risk (although this study did not include race/ethnicity as a covariate). Other
scholarship also suggests that Latino and Asian American gay and bisexual men are less
likely than heterosexually classified men to meet criteria for recent substance use dependency
or abuse (Cochran et al. 2007). Finally, some work also suggests that psychological predispo-
sitions, such as rejection sensitivity, interact with stigma, to predict alcohol use behaviours
among young sexual minority men (Pachankis, Hatzenbuehler, and Starks 2014).
In addition, while previous research has established a relationship between self-
reported racial discrimination and alcohol use among heterosexual men (Borrell et al.
2007), little is known about the effects of this relationship for gay and bisexual men. There-
fore, in this paper we examine the relationship between sexual objectification, racism and
alcohol use behaviours among gay and bisexual men of colour in Toronto.

Deleterious Health Effects of Racial Discrimination

Gay and bisexual men of colour are disadvantaged by institutionalized, systemic racism
and homophobia (Giwa and Greensmith 2012). They are also affected by physical and
verbal assaults, sexual objectification and differential treatment based on one’s race
(Brennan et al. 2013; Crichlow 2013; Diaz, Ayala, and Bein 2004; Giwa and Greensmith
2012; Walcott 2006). The physical and mental health difficulties experienced by gay
and bisexual men of colour are related to a social context of racial discrimination and
may lead to psychological distress (|Diaz et al. 2001; 2004), or sexual risk-taking (Han
et al. 2014).
Numerous studies find that when individuals experience discrimination, they are more
likely to engage in behaviours that pose risks to their health. Racial discrimination has
emerged in epidemiological research as an important factor that may contribute
towards elevated health risks for people of colour (Borrell et al. 2007). Psychological pro-
cesses through which individuals learn to anxiously anticipate experiences of race-based
discrimination and prejudice towards the social group they belong to have been associated
with negative health outcomes (Mendoza-Denton et al. 2002; Pachankis, Hatzenbuehler,
and Starks 2014).
Bruce, Ramirez-Valles, and Campbell (2008) examined the associations between racial
and homosexual stigma, substance use, and sexual risk behaviours among a sample of
Latino gay and bisexual men and male-to-female transgender persons (n = 643) in
Chicago and San Francisco. The authors attempted to disentangle two different stigmas,
racial and homosexual, and their association with substance use among this population,
and found that perceived racial and homosexual stigma were not significantly associated
 ETHNICITY & HEALTH 3

with substance use and sexual risk behaviour in this study. Other scholars however hypoth-
esize that racial discrimination may lead to negative health outcomes through detrimental
health behaviours, such as the use of harmful substances (Borrell et al. 2007). Empirical
studies suggest individuals’ experiences of racial discrimination produce emotional and
stress responses, which cause a lowered activation of the inhibitory processes, and make
it difficult to control stress responses or certain health behaviours (e.g. use of alcohol) (Bau-
meister et al. 2005; Borrell et al. 2007; Richman and Lattanner 2014; Williams, Neighbors,
and Jackson 2003). One study examined the relationship between racism, homophobia and
drug use among an ethnically diverse sample (n = 526) of young men who have sex with
men in the U.S., and found that discrimination placed these men at increased risk for
illicit drug use, such as crack, cocaine, methamphetamines, ecstasy, GHB, Ketamine, LSD,
PCP, mushrooms, poppers, marijuana, and prescription drugs (Wong et al. 2010).
Among HIV-positive Black (n = 181) and Latino (n = 167) gay and bisexual men, research
shows that experiencing greater racial discrimination is associated with poorer immune
functioning, more visits to emergency departments, and more AIDS-related symptoms
(Bogart et al. 2011). Importantly, scholars also highlighted that due to racism in the gay
community MSM tend to be socially isolated and thus express an intense need for closeness
and emotional connection that in turn, often under the influence of alcohol or other sub-
stances may lead to high-risk sexual activities (Poon et al. 2005).
Gilbert and colleagues (2015) examined how associations between sexual orientation
and alcohol abuse might be conditional on race and ethnicity. The authors compared
exclusively heterosexual men to men who self-identified as gay and bisexual, and found
an enhanced protective effect for Black and Latino gay and bisexual men (who were at
lower risk for alcohol abuse) compared to both White heterosexual men and same-
race/ethnicity heterosexual men. Another study examined various differences in relation
to alcohol consumption among African American (n = 400), Asian (n = 392) compared
to Latino (n = 398) gay and bisexual men, and found that rates of use were lowest
among African Americans (Paul et al. 2014). Scholars pointed out the need to further
explore factors related to homophobia and racism to answer how these experiences
may affect alcohol use and abuse.

Sexual Objectification & Health

Sexual objectification refers to the treatment of a human body as a collection of body parts
(e.g. a penis), for the use of another person, with the effect of dehumanizing individuals
(Teunis 2007). Sexual objectification has been identified as an important correlate of
mental and physical health concerns (Calogero 2009; Moradi, Dirks, and Matteson
2005). Objectification theory, which emerged from research on body image, represents
a framework conducive to understanding how sociocultural pressures (internalization of
body image ideals, pressure to be thin or muscular, body objectification based on race,
sexual orientation, or gender expression) are translated into health risks and psychological
risk factors that can promote negative physical and mental health outcomes (Moradi
2010). One research study among a sample of undergraduate male students (n = 502,
86% White European descent) suggested that heavier amounts of alcohol consumption
and more frequent alcohol use was positively associated with college men engaging in
more sexually objectifying behaviours against women, including body evaluation of
4 R. SOULEYMANOV ET AL.

women, as well as more unwanted explicit sexual advances toward them (Gervais, DiLillo,
and McChargue 2014). Recent studies also suggest that sexual objectification may have
more salient effects on health-risk behaviour among heterosexual women compared to
heterosexual men (Eisenberg, Johnson, and Zucker 2017). In the United States, among
a sample of young adult women (n = 289, 18–30 years old, 89% White participants) inter-
nalized sexual objectification was positively correlated with alcohol abuse (Carr and Szy-
manski 2011). Carr and Szymanski (2011) explained this by suggesting that some women
were abusing alcohol in order to deal with pressures to obtain the ideals of beauty and sexi-
ness promoted in U.S. culture.
However, while advances in objectification theory and research have primarily focused
on women, there is now evidence to suggest that men’s bodies are becoming increasingly
objectified (Pope et al. 2001). Concerns with meeting the muscular ideal appear to be
shared among both heterosexual men and gay and bisexual men (Tiggemann, Martins,
and Kirkbride 2007); however, when objectification research focused on gay and bisexual
men (Wiseman and Moradi 2010), studies employed predominantly White samples of gay
and bisexual men, thus rendering the experiences of ethnoracialized gay and bisexual men
invisible in scholarship.
To our knowledge, no studies have looked at the association between sexual objectifica-
tion and alcohol use disorders among gay and bisexual men of colour. However, work by
Han (2006) suggested that negative stereotypes perpetuated in the mainstream gay com-
munity may become internalized by gay and bisexual men of colour. Research also docu-
mented how sexual racism (racism occurring in sexual contexts) is particularly prevalent
within the mainstream gay community (Plummer 2007). For instance, the qualitative
phase of the Imagine Men’s Health study provided substantial evidence of how the
body objectification of ethnoracialized gay and bisexual men of colour is influenced by
the intersection of forms of social oppression such as racism, ethnocentrism, homophobia,
and gender norms (Brennan et al. 2013). For example, Black gay and bisexual men (n = 19)
reported concerns they were stereotyped and objectified as always being muscular, mascu-
line, with large penises, and discussed issues regarding dominant gender roles that Black
men are expected to perform (Brennan et al. 2013). Therefore, sexual objectification of gay
and bisexual men of colour may in fact be a constitutive element of racism (Teunis 2007).
Indeed, sexual objectification functions as an instrument of racism in gay/queer male
communities in North America, and manifests its power in the sexual and social relations
of gay and bisexual men (Teunis 2007). Ethnicity and race, unlike other categories of
difference are some of the most salient markers organizing sexual encounters between
gay and bisexual men arranged on online/mobile dating apps and websites (Raj 2011).
Racist and sexually objectifying remarks are common within online cruising spaces for
gay and bisexual men (Raj 2011).
Given the persistent effects of racism among White gay and bisexual men communities,
gay and bisexual men of colour experience tremendous pressure to meet the expectation of
achieving a physically attractive body in the predominantly White gay male culture, and
are confronted with body image ideals that that seek to exoticize their bodies in ways that
are dehumanizing and that impact self-esteem and wellbeing (Brennan et al. 2013).
Research also highlights that gay and bisexual men of colour actively resist racial and
gender-based stereotypes and avoid contexts that they perceive would predictably engen-
der objectification of their bodies (Brennan et al. 2013).
 ETHNICITY & HEALTH 5

Not recognizing sexual objectification as an oppressive phenomenon maintains the

specific manner in which whiteness, racism, colonialism, and ethnocentrism continue
to be stable features in the social life of the gay community. Indeed, the pressure of
racial discrimination and its intersection with sexual objectification presents a significant
issue for gay and bisexual men of colour and warrants further investigation. Existing
studies (identified in this review) which examined discrimination and substance use
among gay and bisexual men of colour have focused solely on racial and ethnic minority
gay and bisexual men in the United States. Many of the reviewed studies have reported
findings of exclusively heterosexual samples and have not considered alternative
sources/proxies of discrimination for gay and bisexual men of colour, such as sexual objec-
tification. Additional research needs to clarify what other factors may be related to alcohol
abuse among gay and bisexual men of colour.

The Current Study

Previous research has established a relationship between self-reported racial discrimi-
nation and alcohol use, primarily among heterosexual-identifying men (Borrell et al.
2007). Similarly, small qualitative studies have identified sexual objectification as a
potentially important variable in understanding health-related behaviours, such as
eating disorders and sexual risk among gay and bisexual men of colour (Brennan
et al. 2013). Little is known about the relationships between self-reported racism,
sexual objectification, and alcohol use for ethnoracialized gay and bisexual men of
colour. The present study sought to address this research gap. We hypothesize that
experiences of racial discrimination and sexual objectification will be associated with
a positive screen for alcohol use disorders among this sample of gay and bisexual
men of colour.

Methods
Design and recruitment
The data used in this paper were collected through an online survey method as part of the
quantitative phase of the Imagine Men’s Health study (the qualitative phase is described in
Brennan et al. 2013). Imagine Men’s Health was a community-based research study
designed to examine issues of racism, homophobia, body image, health and well-being
among gay and bisexual men of colour in Toronto.
For this study, gay and bisexual men were recruited from the four largest ethnoracial
communities in Toronto, including East/Southeast Asian, Latino/Latin American (includ-
ing Brazilian men), South Asian, and Black/African/Caribbean. South Asian, Black/
African/Caribbean, East/Southeast Asian, and Latino/Latin American groups are four
largest ethnoracial communities in Toronto (Statistics Canada 2011). Study participants
were grouped in these four ethnoracial categories as recruitment took part through Tor-
onto’s sexual health agencies, which serve gay and bisexual men of colour from each of
these four ethnoracial communities.
The study was conducted in collaboration with a community advisory committee,
which consisted of 14 gay and bisexual men, representing each of the aforementioned
6 R. SOULEYMANOV ET AL.

ethnoracial communities, and who assisted the research team with the development of the
survey, recruitment, and data analysis and interpretation of the results. For this study, the
members of the community advisory committee felt it was reasonable to combine partici-
pants in these groups a priori given that local services designed for Latino and Latin Amer-
ican gay men often provide services to Brazilian men, while services designed for African
Canadians also provide services for gay and bisexual men from Caribbean countries. Fur-
thermore, combining Latino with Brazilian identities is sometimes used and thought of as
Ibero-American, meaning that these were countries mostly colonized by Spain and/or
Portugal (or from Spain or Portugal) that have some similar characteristics and history
(Gastaldo et al. 2002). At the beginning of the survey, participants were presented with
these four options to self-select their ethnicity and race in the survey. Next, participants
were also given the option to define in more detail qualitatively in the survey their
ethnic background, in the following format: ‘In the previous question, there was a list
of ethnic backgrounds. However, this list may or may not specify how you identify.
Regardless of your answer to the previous question, how do you identify your ethnic back-
ground?’ Therefore, participants were classified into these specific ethnoracial groups
depending on: (a) the race/ethnicity category they selected at the beginning of the
survey and (b) the ethnic category they self-identified qualitatively. All procedures were
approved by the University of Toronto Research Ethics Boards.
All participants resided in Canada at the time of data collection. Eligibility criteria
included: (1) being at least 18 years of age; (2) identifying as a gay or bisexual man or a
man who had had sex with another man in the last 12 months; (3) identifying with at
least one of the four aforementioned ethnoracial communities in Toronto; (4) living or
working in Toronto; and (5) English proficiency.

Measures
Demographic measures
Socio-cultural demographics included age, race/ethnicity (pre-determined in the eligi-
bility, but with the option to define in more detail qualitatively in the survey), household
income (CAN$0–9999, $10,000–29,999, $30,000–59,999, $60,000+), sexual orientation
(gay/same-gender-loving/homosexual and bisexual). The numbers of heterosexually-iden-
tifying men were low (n = 5), and they were removed from further analyses. Other demo-
graphics included: education (high school or less, some post-secondary education, and
Bachelor’s degree or greater), employment status (employed, unemployed), and HIV
status (positive, negative, unknown).

Racism and life experiences scale

Experiences of racism were measured by the Racism and Life Experiences Scale (Harrell,
Merchant, and Young 1997), which consists of 9 items that assess participants’ perceptions
and experiences of racism in their lives (e.g. ‘During the past year, how much have you
personally experienced racism, racial discrimination or racial prejudice?’). Participants
used the five-point Likert-type scale (0 = Not at all/None, 4 = Very often/Extreme) to indi-
cate the frequency and extent to which they have experienced racism in their lives. All
items are summed up with higher scores on this scale reflecting more self-reported experi-
ences of racism in participants’ lives. This scale has been shown to have excellent internal
 ETHNICITY & HEALTH 7

consistency (α = .87; Peters 2004) with a population of African Americans. Cronbach’s

alpha for the current sample was .89.

Sexual objectification experiences scale

Experiences of sexual objectification were measured using the 17-item Sexual Objectifica-
tion Experiences Scale (Wiseman and Moradi 2010). Using a six-point Likert-type scale
(1 = Never, 6 = Almost all of the time) participants indicated how often in the past year
they had experienced events on the scale (e.g. ‘Had sexual comments made about parts
of my body or clothing’). Items are summed up with higher scores on this scale reflecting
greater levels of perceived sexual objectification. This scale has been shown to have excel-
lent internal consistency (α = .91; Wiseman and Moradi 2010). Cronbach’s alpha for the
current sample was .92.

Cage questionnaire
The screen for alcohol use disorder (binary outcome variable) was measured using the 4-
item CAGE questionnaire (Ewing 1984). Sample question included: ‘Have you ever had a
drink first thing in the morning to steady your nerves or to get rid of a hangover?’ The
CAGE questionnaire has a strong grounding in the psychological mechanisms involved
in the development of alcoholism (O’Brien 2008). All 4 items are summed up on this
scale. A score of two or greater (the cut-off score) indicates a presence of an alcohol use dis-
order. The data were categorized based on the cut-off score, and coded into a binary variable
representing potential alcohol use disorder (a score of 2 and greater, or a score less than 2).
In previous research CAGE has demonstrated high test-retest reliability (0.80–0.95) and
adequate correlations (0.62–0.70) with other alcohol use screening instruments, such as
AUDIT and SMAST (Dhalla and Kopec 2007). Other studies have also assessed the positive
clinical predictive value of CAGE as a screening tool for alcohol abuse among Latinos living
in the U.S. (73%) (Saitz et al. 1999), and American Indians (98%) (Saremi et al. 2001). This is
the first study on this instrument that examined differences based on participants’ sexual
orientation. Cronbach’s alpha for the current sample was .70.

Data analysis
All data analyses were conducted using SPSS 21(IBM Corp. 2012). First, descriptive ana-
lyses and tests for the assumptions of normality were conducted using histograms and
analyses of tests for skewness and kurtosis. No distribution concerns were identified. Sec-
ondly, bivariate analyses were conducted using Chi-Square for categorical variables, as well
as Pearson correlations and t-tests/ANOVA for continuous variables. After significant
associations were identified in bivariate tests, multivariable analyses were conducted
using binary logistic regression with reported odds ratios, Wald-statistic (likehood ratio
test using maximum likehood estimation), and 95% confidence intervals.

Participant characteristics
A total of 389 gay and bisexual men completed the survey. Due to missing data, after the
listwise deletion procedure, the final study sample included 369 gay and bisexual men of
colour. We conducted bivariate analyses to determine whether there were any patterns to
8 R. SOULEYMANOV ET AL.

Table 1. Demographic characteristics (N = 369).

Characteristic Frequency (n) Percentage (%) or Mean (S.D.)
Race
Black, African, Caribbean 80 21.7
East/South East Asian 101 27.4
Latino, Latin American 91 24.7
South Asian 76 20.6
Mixed 21 5.7
Sexual orientation
Gay 310 84.0
Bisexual 59 16.0
Age years (mean, SD) 33.1 (8.6)
18–24 61 16.5
25–29 93 25.2
30–39 124 33.6
40–49 78 22.1
50+ 13 3.5
Household income (CDN $)
0–9999 68 18.4
10,000–29,999 103 27.9
30,000–59,999 102 27.6
60,000+ 96 26.0
Highest education level completed
High School or Less 81 22.0
Some Post-Secondary/College 99 26.8
Bachelor Degree or Greater 189 51.8
HIV Status
Negative 276 74.8
Positive 64 17.3
nknown 29 7.9
Alcohol use
Yes 304 82.3
No 65 17.7
CAGE screen for alcohol use disorder
Negative 292 79.2
Positive 77 20.8
Note: Total numbers vary due to missing data.
S.D. = Standard Deviation; HIV = Human Immunodeficiency Virus.

the missing data. No significant associations emerged between the variables of interest,
including demographics. Demographics are presented in Table 1. The mean age was 33
years (SD = 8.6). Many respondents were born outside Canada (68.6%), and lived in
urban areas (74.6%). For respondents who were born outside Canada, the average
number of years they lived in Canada was 12 (SD = 10.5). No significant associations
emerged between the number of years each participant lived in Canada and the CAGE
variable (p > .05). Further, 51.9% were single, 27.8% were married or partnered, 15.7%
were currently dating, and 4.6% were separated or widowed. Alcohol use was reported
by 82.3%. The mean score on the sexual objectification scale was 2.34 (SD = 0.74), and
13.36 (SD = 6.37) on the racism and life experiences scale.

Results
Relationship between alcohol use, sexual objectification, and experiences of
racism
In the bivariate analysis, there was a significant association between screening positive for
alcohol use disorder (as measured by the CAGE questionnaire), experiences of sexual
 ETHNICITY & HEALTH 9

objectification (t = 3.73, p = .001, d = .47) and experiences of racism (t = 2.41, p = .02, d

= .31), such that participants who reported higher scores on these scales were also more
likely to report higher scores on the CAGE questionnaire. The scores on the CAGE ques-
tionnaire were also significantly associated with age (t = 2.03, p = .04), such that younger
participants were more likely to report higher scores on the CAGE questionnaire.
Correlational analyses (Pearson correlation) were used to examine bivariate relation-
ships between continuously distributed variables. These analyses revealed a weak but
significant relationship between the scores on the sexual objectification scale and experi-
ences of racism (r = .26, p = .001), such that participants who reported higher scores on
sexual objectification were also more likely to report higher scores on the experiences of
racism.

Ethnoracial group differences on racism and life experiences scale, sexual

objectification scale, and alcohol use
There were significant differences among ethnoracial groups with regard to scores on the
Racism and Life Experiences scale (F = 9.41, p = .001, η 2 = 0.09). Sheffe’s post-hoc test
revealed that Latino / Latin American gay and bisexual men reported significantly
fewer experiences of racism (M = 10.34, SD = 5.01), compared to South Asian (M = 15.6,
SD = 7.42, p = .001), Black/African/Caribbean (M = 13.7, SD = 5.56, p = .01), and East/
Southeast Asian gay and bisexual men (M = 13.51, SD = 6.31, p = .01).
There were also significant differences among ethnoracial groups with regard to
scores on the Experiences of Sexual Objectification scale (F = 6.69, p = .001, η2 = 0.06).
East/Southeast participants (M = 2.1, SD = .51), reported significantly fewer experiences
of sexual objectification compared to Black/African/Caribbean (M = 2.48, SD = .71, p
= .01) and Latino/ Latin American (M = 2.46, SD = .92, p = .02). There were no signifi-
cant interactions effects between race/ethnicity, CAGE scores, and scores on the
sexual objectification or racism experiences scale. Finally, chi-square test revealed that
Black/African/Caribbean men were less likely than any other ethnoracial group to
screen positive for alcohol use disorder (χ 2 = 21.86, p = .001), as measured by the
CAGE questionnaire.

Associations between race, experiences of racism, sexual objectification and

alcohol use
In the logistic regression model variables were entered using two blocks. In block one, the
socio-demographic variables were entered to control for demographic and confounding
variables. In block two, the theoretical variables of interest (Experiences of Racism, Experi-
ences of Sexual Objectification) were entered. In the last block, we tested for interactions
between race/ethnicity, experiences of racism and sexual objectification in relation to
alcohol use. Scores on the CAGE questionnaire were entered as a dependent variable.
No multicollinearity problems were identified.
The results of the model (Table 2) revealed a significant logistic regression model for
alcohol use disorder (as measured by the CAGE questionnaire) among this sample of
gay and bisexual men of colour (χ2 = 28.69, p < .05). This model had a very good fit
with the sample data (−2 Log Likelihood = 311.12, Hosmer and Lemeshow chi-square
10 R. SOULEYMANOV ET AL.

test of goodness-of-fit, χ2 = 6.35, p > .05, Nagelkerke R2 = .13). Finally, as determined by

self-report of alcohol use, the model successfully predicted 80.5% of the cases.
The results of the logistic regression analyses revealed the significant association
between the experiences of racism, sexual objectification, and alcohol use. Specifically,
the experiences of racism (AOR = 1.04, S.E. = .26, 95% CI = 1.01–2.10, p = .03), and experi-
ences of sexual objectification (AOR = 1.44, S.E. = .25, 95% CI = 1.18–3.19, p = .03) were
significantly associated with alcohol use disorder (as measured by the CAGE
questionnaire).
There were no significant interactions between race/ethnicity and experiences of racism
in relation to alcohol use (p > .05). There were also no significant interactions between
race/ethnicity, experiences of racism, and sexual objectification in relation to alcohol
use (p > .05). Finally, there were also no interactions between experiences of racism and
sexual objectification in relation to alcohol use (p > .05). Because there were no significant
interactions, we removed these interaction terms from the model. However, among the
interaction that remained significant was the interaction term related to Latino/Latin
American ethnicity and the experience of sexual objectification on alcohol use (AOR =
1.06, S.E. = .31, 95% CI = 1.02–2.05, p = .04). In other words, sexual objectification had a
stronger relationship with alcohol use for Latino/Latin American gay and bisexual men.
We kept these interaction terms in our model. Therefore, our final model accounting
for alcohol use among gay and bisexual men of colour included experiences of racism,
experiences of sexual objectification, and these interaction terms.

Table 2. Multiple logistic regression of sociodemographic and psychosocial variables on alcohol use
disorder among gay and bisexual men of colour (N = 369).
B SE AOR 95% CI Wald statistic
Socio-demographic variables
Age −.025 0.20 0.97 [0.93, 1.01] 1.59
Race (ref = East, Southeast Asian)
Black, African, Caribbean 0.33 0.49 0.71 [0.29, 1.73] 0.55
Latino, Latin American 0.57 0.44 0.97 [0.24, 1.33] 1.68
South Asian 0.40 0.34 0.56 [0.28, 1.21] 2.77
Mixed 0.22 0.76 0.67 [0.23, 3.10] 4.02
Household income (ref = CDN$60,000+)
0–9999 −0.32 0.54 0.72 [0.19, 1.70] 0.35
10,000–29,000 0.30 0.42 0.96 [0.51, 2.56] 0.06
30,000–59,999 0.34 0.38 1.35 [0.63, 2.80] 0.61
Education level (ref = Bachelor’s degree)
High school or less 0.32 0.40 1.37 [0.63, 3.00] 0.89
Some post-secondary −0.36 0.26 0.85 [0.52, 2.17] 0.06
Sexual orientation (ref = gay/homosexual)
Bisexual −0.41 0.43 0.66 [0.28, 1.50] 1.92
Employment status (ref = employed)
Unemployed −0.40 0.42 0.97 [0.42, 2.20] 0.07
HIV status (ref = HIV-negative)
HIV-positive 0.53 0.42 1.05 [0.46, 2.40] 0.08
HIV-unknown 0.80 0.50 2.22 [0.82, 6.10] 2.49
Psychosocial variables
Experiences of Racism 0.41 0.26 1.04* [1.01, 2.10] 2.58
Sexual Objectification 0.66 0.25 1.44* [1.18, 3.19] 6.88
Interaction terms
Latino/Latin American X sexual objectification 0.58 0.32 1.06* [1.02, 2.05] 3.29
Note: SE = standard error; AOR = adjusted odds ratio; CI = confidence interval; Ref. = reference group.
*p < .05.
 ETHNICITY & HEALTH 11

Discussion
This study showed an association between self-reported racism, sexual objectification
experiences, and a measure for alcohol use disorder among an ethnoracially diverse
sample of gay and bisexual men, after controlling for demographics. This relatively new
area of inquiry highlights important results. These results are consistent with previous
studies that show the deleterious effects of racism on multiple physical and mental
health outcomes among people of colour (Bogart et al. 2011; Diaz et al. 2001; Borrell
et al. 2007; Cole, Kemeny, and Taylor 1997; Gee 2002; Karlsen and Nazroo 2002;
Klonoff and Landrine 2000; Paradies 2006; Schulz et al. 2000; Tull et al. 1999). The
relationship between racism and drug use among gay and bisexual men of colour has
been established in previous literature (Wong et al. 2010). This study adds to this research
by suggesting a relationship between racism, sexual objectification and effects on alcohol
use among gay and bisexual men of colour.
Scores on the sexual objectification scale were also associated with a positive screen on
the alcohol use disorders scale. To the best of our knowledge, this study is among the first
that examines the association between sexual objectification and alcohol use among gay
and bisexual men. Previous research (De Santis et al. 2012; Drummond 2005; Wilton
2009) has already confirmed that gay and bisexual men of colour experience tremendous
pressures to meet the expectations of achieving a youthful, physically attractive, and mus-
cular appearance that is predominant in white/Caucasian gay male culture. The findings
from this study contribute to this line of research, by suggesting that pressures of sexual
objectification and experiences of racism may relate to alcohol use behaviours among
gay and bisexual men of colour.
The significance of the interaction between Latino/Latin American ethnicity and the
experience of sexual objectification on alcohol use indicates that the effects of sexual objec-
tification on alcohol use differed between ethnoracial groups of gay and bisexual men.
These results bear some similarities to findings from a study by Wong et al. (2010) who
found a significant interaction between African American ethnicity and experience of
racism in gay social settings with regards to substance use among gay men. Future longi-
tudinal research should investigate the effects of racism and sexual objectification on sub-
stance use practices among this population.
While alcohol use in the current sample was reported by 82.3%, the majority of
respondents (79.2%) scored below the CAGE clinical cut-off, and only 20.8% scored
around or above the clinical cut-off. This percentage is similar (22.9%) to other
studies with white/Caucasian gay and bisexual men (Parsons et al. 2004). The findings
from this study also suggest that younger participants were more likely to report higher
scores on the CAGE questionnaire. Income was not related to alcohol use for this
sample. This finding is significant given that previous research has suggested that
lower income is associated with health disparities like HIV risk among gay and bisexual
men (Adler 2006).
The results from this study complement the objectification theory (Moradi 2010) by
suggesting that disproportionate stress based on racial and sexual objectification experi-
enced by gay and bisexual men of colour may be rated to other negative health outcomes,
such as alcohol misuse. These findings are significant, given that within the context of the
gay community, problems of racism and sexual objectification continue to be ignored, yet
12 R. SOULEYMANOV ET AL.

the experiences of gay and bisexual men of colour show that sexual objectification is linked
to racial prejudice (Teunis 2007). Given the relationship that racial discrimination and
sexual objectification have on the stress and overall health of gay and bisexual men of
colour, including alcohol use, there is a need to continue investigating the relationship
between these factors among gay and bisexual men of colour.

Limitations
First, it is important to acknowledge what constitutes heavy drinking (e.g. clinical signifi-
cance) is a debated issue given variations based on one’s socio-economic and cultural
context (Agic et al. 2015). While clinicians may use particular thresholds (e.g. 5 drinks
a day for men) defining heavy drinking (O’Brien 2008), the strength of the CAGE ques-
tionnaire is that it instead moves the discussion towards the behavioural effects of the
drinking rather than towards a particular number of drinks per day. However, while
the CAGE questionnaire is easily applied in clinical practice, a positive screening for
alcohol use disorder on the questionnaire should be followed by another diagnostic
evaluation.
Secondly, given that a high proportion of participants were born outside of Canada,
another limitation of using cross-sectional data is the lack of information about partici-
pants’ substance use prior to immigration to Canada. It might be important to elucidate
whether GBM also had high rates of alcohol use prior to living in Canada and how
exposure to racism after immigrating to Canada increases one’s engagement in health
risk behaviours, such as alcohol misuse. Our study, however, found no significant associ-
ations between the number of years participants lived in Canada and the CAGE variable
for participants who were born outside Canada.
Thirdly, this study considered only measures of self-reported perceptions and experi-
ences of racism (individual-level discrimination). It should be clear that in focusing on
self-reported racism, this paper considers only a very specific (individual, interpersonal-
level) conceptualization of the multifarious phenomenon of racism and does not
attempt a comprehensive assessment of the impact of systemic or institutional racism
on population health. Despite these limitations, the findings have important implications
for research and policy.
Finally, given the cross-sectional nature of our study, we cannot ascertain the exact
direction of study findings (e.g. that racism and sexual objectification are causing
higher alcohol consumption among gay and bisexual men of colour). Thus, no statements
can be made about the causal relationship between these variables. It is also important to
point out alternative interpretations of these findings. For example, one cross-sectional
study examining the effects of sexual objectification among women documented how
other factors such as self-objectification, body shame, and depression, were found to
mediate the link between sexual objectification and increased alcohol use (Carr and Szy-
manski 2011). Stall, Friedman, and Catania (2008) also suggest that substance use among
urban gay and bisexual men may be related to multiple other factors including: interna-
lized homophobia, sexual risk-taking, mental health burdens including depression and
anxiety, stress, negative self-esteem, negative body image, and stigma. Thus, it is possible
that other factors (not captured in this research study) mediated the relationship between
these variables. It may also be true that greater alcohol use by gay and bisexual men might
 ETHNICITY & HEALTH 13

lead to increased risk of gay and bisexual men engaging in sexual objectification of each
other. Future longitudinal research needs to obviate the relationship direction between
substance use and these variables.

Implications
The results from this study have implications for intervention strategies to reduce alcohol
and drug-related harms, as well as other health disparities faced by ethnoracialized gay and
bisexual men. Interventions that reduce racism through provincial/state or federal-level
laws and policies (which afford gay and bisexual men of colour the same opportunities
as white gay and bisexual men or heterosexual people and offer protections against dis-
crimination) can potentially alleviate drug and alcohol-related harms at their source for
large segments of this population. Structural interventions should also be accompanied
by funding for drug and alcohol abuse, as well as harm reduction programmes specifically
designed for gay and bisexual men of colour. Tailored drug and alcohol use interventions
(that take into account issues of racism and sexual objectification) can facilitate environ-
ments, which are conducive to the wellbeing of gay and bisexual men of colour and may
communicate a sense of belonging or safety.
Service providers should develop interventions that target community culture with regard
to racism and body objectification. Community interventions, which address media rep-
resentations of gay and bisexual men of colour and are aimed at addressing racism and
body objectification within the broader gay culture may be helpful. Research has documented
how media representations of gay and bisexual men of colour have tended to be exceedingly
problematic, tokenistic and stereotypical (Brennan et al. 2013). These representations have
many salient repercussions for the health and well-being of gay and bisexual men of
colour. Service providers should develop interventions that target community culture with
regard to body objectification and body image ideals, as well as interventions that critically
examine the representations of gay and bisexual men of colour in traditional media, or in
media targeting gay and bisexual men (Brennan et al. 2013). Such interventions may also
be helpful to gay and bisexual men in promoting their own health and well-being and encou-
rage gay and bisexual men of colour to continue to be critical of the ways in which they are
characterized and stereotyped in the media or community. Health professionals should con-
sider the role racial discrimination and sexual objectification may play in the treatment of
alcohol use disorders within the context of substance abuse treatment, harm reduction and
HIV prevention for gay and bisexual men of colour.

Conclusions
In summary, this study shows an association between self-reported racism and sexual
objectification experiences and alcohol misuse. Future research needs to elucidate how
coping resources and resiliencies mediate this relationship and to draw causal inferences
about the associations between racial and sexual objectification, and alcohol use disorders
(and drug use) for gay and bisexual men of colour. The implications of this study suggest
that when developing future drug or alcohol use prevention, treatment and harm
reduction outreach, community education programmes, or interventions for gay and
bisexual men of colour, it would be critical to include materials, resources and topics
14 R. SOULEYMANOV ET AL.

that focus on the experiences of racism and sexual objectification as these are important
components related to developing better health and overall wellness for gay and bisexual
men of colour.

Disclosure statement
No potential conflict of interest was reported by the authors.

Funding
This research was supported by the Social Sciences and Humanities Research Council of Canada
[grant number 410-2009-2134] to Dr. David J. Brennan.

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