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Sexual Orientation Disparities in Substance Use: Investigating Social Stress Mechanisms in a National Sample.
Am J Prev Med. 2020 01; 58(1):59-68.AJ

Abstract

INTRODUCTION

Sexual minorities are disproportionately more likely than heterosexuals to suffer from substance use disorders, but relatively little is known about differences in substance use disorders across diverse sexual minority subgroups. There is also limited understanding of how different social stressors account for sexual orientation disparities in substance use disorders.

METHODS

Using nationally representative data collected in 2012-2013 (n=34,597), differences in past-year DSM-5 alcohol, cannabis, and tobacco use disorders were assessed across 4 sexual orientation groups (heterosexuals and 3 sexual minority subgroups, lesbian/gay-, bisexual-, and heterosexual-identified sexual minorities). This study assessed whether stressful life events mediated substance use disorder disparities between heterosexuals and each sexual minority subgroup, and whether stressful life events and lesbian, gay, and bisexual discrimination events mediated these substance use disorder differences. Analyses were conducted in 2019.

RESULTS

For both men and women, substance use disorders and stress experiences varied by sexual identity. For example, compared with heterosexual men, larger proportions of gay and bisexual men had a past-year alcohol use disorder. Among women, all sexual minority subgroups had higher rates of each substance use disorder than heterosexuals. For each substance use disorder, stressful life events mediated disparities between heterosexuals and sexual minority subgroups, except for heterosexual-identified sexual minority men. Both stressful life events and lesbian, gay, and bisexual discrimination mediated substance use disorder differences between sexual minority subgroups, with stronger indirect effects through lesbian, gay, and bisexual discrimination for lesbians/gay men and stronger indirect effects through stressful life events for bisexual adults, generally.

CONCLUSIONS

Sexual minority subgroups have a greater prevalence of substance use disorders, mediated through both stressful life events and lesbian, gay, and bisexual discrimination. More research is needed to comprehensively assess the processes underlying sexual orientation substance use disparities.

Authors+Show Affiliations

Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California. Electronic address: eakrueger@ucla.edu.Department of Family Science, University of Maryland School of Public Health, College Park, Maryland.Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

31761516

Citation

Krueger, Evan A., et al. "Sexual Orientation Disparities in Substance Use: Investigating Social Stress Mechanisms in a National Sample." American Journal of Preventive Medicine, vol. 58, no. 1, 2020, pp. 59-68.
Krueger EA, Fish JN, Upchurch DM. Sexual Orientation Disparities in Substance Use: Investigating Social Stress Mechanisms in a National Sample. Am J Prev Med. 2020;58(1):59-68.
Krueger, E. A., Fish, J. N., & Upchurch, D. M. (2020). Sexual Orientation Disparities in Substance Use: Investigating Social Stress Mechanisms in a National Sample. American Journal of Preventive Medicine, 58(1), 59-68. https://doi.org/10.1016/j.amepre.2019.08.034
Krueger EA, Fish JN, Upchurch DM. Sexual Orientation Disparities in Substance Use: Investigating Social Stress Mechanisms in a National Sample. Am J Prev Med. 2020;58(1):59-68. PubMed PMID: 31761516.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sexual Orientation Disparities in Substance Use: Investigating Social Stress Mechanisms in a National Sample. AU - Krueger,Evan A, AU - Fish,Jessica N, AU - Upchurch,Dawn M, Y1 - 2019/11/21/ PY - 2019/03/08/received PY - 2019/08/28/revised PY - 2019/08/29/accepted PY - 2019/11/26/pubmed PY - 2020/11/3/medline PY - 2019/11/26/entrez SP - 59 EP - 68 JF - American journal of preventive medicine JO - Am J Prev Med VL - 58 IS - 1 N2 - INTRODUCTION: Sexual minorities are disproportionately more likely than heterosexuals to suffer from substance use disorders, but relatively little is known about differences in substance use disorders across diverse sexual minority subgroups. There is also limited understanding of how different social stressors account for sexual orientation disparities in substance use disorders. METHODS: Using nationally representative data collected in 2012-2013 (n=34,597), differences in past-year DSM-5 alcohol, cannabis, and tobacco use disorders were assessed across 4 sexual orientation groups (heterosexuals and 3 sexual minority subgroups, lesbian/gay-, bisexual-, and heterosexual-identified sexual minorities). This study assessed whether stressful life events mediated substance use disorder disparities between heterosexuals and each sexual minority subgroup, and whether stressful life events and lesbian, gay, and bisexual discrimination events mediated these substance use disorder differences. Analyses were conducted in 2019. RESULTS: For both men and women, substance use disorders and stress experiences varied by sexual identity. For example, compared with heterosexual men, larger proportions of gay and bisexual men had a past-year alcohol use disorder. Among women, all sexual minority subgroups had higher rates of each substance use disorder than heterosexuals. For each substance use disorder, stressful life events mediated disparities between heterosexuals and sexual minority subgroups, except for heterosexual-identified sexual minority men. Both stressful life events and lesbian, gay, and bisexual discrimination mediated substance use disorder differences between sexual minority subgroups, with stronger indirect effects through lesbian, gay, and bisexual discrimination for lesbians/gay men and stronger indirect effects through stressful life events for bisexual adults, generally. CONCLUSIONS: Sexual minority subgroups have a greater prevalence of substance use disorders, mediated through both stressful life events and lesbian, gay, and bisexual discrimination. More research is needed to comprehensively assess the processes underlying sexual orientation substance use disparities. SN - 1873-2607 UR - https://www.unboundmedicine.com/medline/citation/31761516/Sexual_Orientation_Disparities_in_Substance_Use:_Investigating_Social_Stress_Mechanisms_in_a_National_Sample_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-3797(19)30411-8 DB - PRIME DP - Unbound Medicine ER -