Disparities in substance use behaviors and disorders among adult sexual minorities by age, gender, and sexual identity

Abstract

Background: Sexual minorities (SMs) experience elevated rates of substance use behaviors and disorders relative to heterosexuals; minority stress is theorized to contribute to these disparities. As SMs are not a homogenous group, analyses that aggregate SMs across sexual identity, age, or gender obscure important variation among this population. To date, age- and gender-specific disparities have not been rigorously examined using a large national sample. Methods: Using data on 67,354 adults (ages 18–49) from the 2015 and 2016 National Survey of Drug Use and Health we examined age- and gender-specific disparities in smoking, heavy episodic drinking, marijuana use, illicit drug use, and alcohol/substance use disorder. Age groups were ages 18–25, 26–34, and 35–49. Using logistic regression, we estimated age- and gender-specific odds ratios for gay/lesbian and bisexual individuals, relative to heterosexuals; analyses adjusted for demographic characteristics. Results: Bisexual women had significantly elevated odds of all outcomes at all ages, relative to heterosexual women. Gay/lesbian individuals had significantly elevated odds for nearly all outcomes compared to same-gender heterosexuals at ages 18–25, but not consistently at older ages. For bisexual men, significant disparities compared to heterosexual men were only observed at ages 35–49 for marijuana use and alcohol/substance use disorder. Conclusions: We find notable within-group differences regarding SM disparities. While disparities were most pronounced in young adulthood for gay/lesbian individuals and mid-adulthood for bisexual men, bisexual women uniquely experienced disparities across all ages. Minority stress experiences may vary with respect to gender, age/cohort, and sexual identity, resulting in differential risk for substance use.

Real-time predictors of smoking among sexual minority and heterosexual young adults: An ecological momentary assessment study

“…Finally, since three quarters of sexual minority smokers in our sample selfidentified as bisexual, our findings may be more representative of the unique experiences of this sexual minority subgroup. Tobacco use disparities may vary by distinct sexual minority identities (e.g., gay, lesbian) or different gender identities (e.g., transgender) (Callis, 2013; Hoffman et al, 2018; Schuler et al, 2018). Further research is warranted to better understand smoking antecedents among distinct sexual and gender identities.…”

Functional and structural social support, substance use and sexual orientation from a nationally representative sample of US adults

“…SM‐related discrimination has been found to be associated with increased tobacco, alcohol and drug use in SM populations , although differentially associated with substance use across SM identities . We found that while SM‐related discrimination was significantly higher among SM, discrimination was not significantly associated with SUD among SM‐identifying individuals.…”

“…Effective strategies to incorporate social support may require assessing the functional support received and tailoring interventions based on social networks. SM-related discrimination has been found to be associated with increased tobacco, alcohol and drug use in SM populations [13,17,62,63], although differentially associated with substance use across SM identities [8,13,64]. We found that while SM-related discrimination was significantly higher among SM, discrimination was not significantly associated with SUD among SM-identifying individuals.…”

“…However, SUD are not homogeneous among SM populations, and differences exist between male and female SM [3]. Although TUD is higher among all SM adults compared to heterosexual adults [5,6], SM women are more likely than SM men to use tobacco products [7,8]. Studies also have found AUD to be significantly higher among SM individuals [1,[8][9][10].…”

“…Although TUD is higher among all SM adults compared to heterosexual adults [5,6], SM women are more likely than SM men to use tobacco products [7,8]. Studies also have found AUD to be significantly higher among SM individuals [1,[8][9][10]. Higher burdens of stressors experienced by SM, including discrimination and stigma, are associated with substance use [11][12][13][14][15].…”