Original articleDevelopmental Differences in Sexual Orientation and Gender Identity–Related Substance Use Disparities: Findings From Population-Based Data
Section snippets
Sexual orientation and gender identity differences in substance use and abuse
There is irrefutable evidence supporting heightened risk for substance use among SGM youth [3,4,14]. Studies consistently document elevated rates of alcohol use, heavy episodic binge drinking, high-intensity binge drinking, combustible and e-cigarette use, marijuana use, and other illicit drugs among sexual minority (SM) relative to heterosexual adolescents [7,15,16]. Substance use among transgender youth is less well-understood. Available population-based cross-sectional studies find that
Data source and sample
Data are from the 2013-2014 and 2014-2015 cycles of California Healthy Kids Survey (CHKS). A biennial, cross-sectional school-based survey administered to students in 7th, 9th, and 11th grade classrooms, the CHKS is the largest statewide survey of middle and high school students in the U.S. Administered by WestEd, each cycle of the CHKS is administered over a 2-year period and tracks health risk and resilience among youth. Following direction from WestEd, we exclude youth whose data raise
Results
Sample demographic characteristics are presented in Table 1. The sample comprised 47.42% of non-SM boys, 47.11% of non-SM girls, 1.79% of SM boys, and 3.68% of SM girls. Overall, 1.11% of the sample were transgender. Bivariate analysis showed that, compared with non-SM boys and girls, SM boys and girls had about three times the prevalence of combustible cigarette use (4.77% vs. 13.36% for boys; 3.42% vs.14.52% for girls) and two times the prevalence of e-cigarette use (11.33% vs. 20.09% for
Discussion
We sought to address the lack of developmental studies examining SOGI-related substance use disparities by assessing whether age-specific prevalence rates of cigarette, alcohol, and marijuana use varied by SOGI. Our findings show that across all substances, SOGI differences in substance use were present by age 12 years and for the most part persisted across adolescence. In many cases, we also found that differences in substance use between SGM and non-SGM youth were often wider among older
Acknowledgments
Authors' contributions: J.N.F. conceptualized and designed the study and drafted the initial article. M.D.B. conducted the data analysis and drafted sections of the original article. S.T.R. provided access to the data and critical feedback and revisions on the original draft. All authors approved the final article as submitted and agree to be accountable for all aspects of the work.
References (41)
- et al.
Transgender youth substance use disparities: Results from a population-based sample
J Adolesc Health
(2017) - et al.
Early alcohol and smoking initiation: A contributor to sexual minority disparities in adult use
Am J Prev Med
(2019) Substance use and misuse among sexual and gender minority youth
Curr Opin Psychol
(2019)- et al.
Sexual and gender minority U.S. youth tobacco use: Population assessment of tobacco and health (PATH) study wave 3, 2015–2016
Am J Prev Med
(2019) - et al.
Sexual orientation and drug use in a longitudinal cohort study of U.S. adolescents
Addict Behav
(2010) - et al.
Peer social network processes and adolescent health behaviors: A systematic review
Prev Med
(2020) - et al.
Sexual-orientation disparities in cigarette smoking in a longitudinal cohort study of adolescents
Nicotine Tob Res
(2013) - et al.
Sexual orientation and adolescent substance use: A meta-analysis and methodological review
Addiction
(2008) - et al.
Minority stress and substance use in sexual minority adolescents: A meta-analysis
Prev Sci
(2014) - et al.
Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults
Pediatrics
(2009)
Gender minority social stress in adolescence: Disparities in adolescent bullying and substance use by gender identity
J Sex Res
Individual trajectories of substance use in lesbian, gay and bisexual youth and heterosexual youth
Addiction
Sexual-orientation differences in alcohol use trajectories and disorders in emerging adulthood: Results from a longitudinal cohort study in the United States
Addiction
A developmental perspective on alcohol and youths 16 to 20 years of age
Pediatrics
Substance use disorder in early midlife: A national prospective study on health and well-being correlates and long-term predictors
Subst Abuse Res Treat
Sexual minority youth, social change, and health: A developmental collision
Res Hum Dev
Mental health in lesbian, gay, bisexual, and transgender (LGBT) youth
Annu Rev Clin Psychol
Addressing gaps on risk and resilience factors for alcohol use outcomes in sexual and gender minority populations
Drug Alcohol Rev
Tobacco product use among lesbian, gay, and bisexual adolescents
Pediatrics
Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students—19 states and large urban school districts, 2017
Morb Mortal Wkly Rep
Cited by (19)
Substance use prevalence, patterns, and correlates in transgender and gender diverse youth: A scoping review
2023, Drug and Alcohol DependenceThe paradox of progress for sexual and gender diverse youth
2022, Current Opinion in PsychologyCitation Excerpt :Notably, transgender and gender diverse youth have experienced especially inequitable progress and vehement pushback in the United States and around the world. As data become available, studies document that U.S. transgender youth experience similar or greater disparities in mental health, substance use, and access to health care than cisgender heterosexual youth, and even their cisgender sexual minority peers [11,12]. Like cisgender sexual minority youth, transgender youth are acknowledging and disclosing their gender identity at younger ages [9], while structural and interpersonal stigma continues to instigate barriers to accessing social and medical support.
Changes in sexual identity and substance use during young adulthood
2022, Drug and Alcohol DependenceCitation Excerpt :For instance, among young adults (ages 18–25) in the 2018 National Survey on Drug Use and Health, 64% of LGBQ+ participants (vs. 54% of heterosexual participants) reported past 30 day alcohol use, 33% (vs. 21% of heterosexual participants) reported past 30 day cannabis use, and 27% (vs. 16% of heterosexual participants) reported lifetime cocaine use (The Trevor Project, 2020). LGBQ+ substance use disparities emerge early in adolescence (Fish et al., 2021; Marshal et al., 2008, 2009), increasing the risk for problematic substance use in adulthood and resulting in even greater health disparities (Schuler and Collins, 2019; US Department of Health and Human Services, 2014). It is thus vital to identify the myriad factors that contribute to the onset of LGBQ+ substance use disparities among young people.
Intersectional stigma subgroup differences in unhealthy drinking and disordered marijuana use among Black and Latino cisgender sexual minority young men
2022, Drug and Alcohol DependenceCitation Excerpt :Some youthful substance use is statistically normative (Brown et al., 2008; Chung, 2008) and, is expected to follow the observed trajectory of increasing use through late adolescence, peaking in early 20 s, and then declining through the late 20 s (Brook et al., 2011; Maggs and Schulenberg, 2004). Past research has examined between group differences in developmental trajectories of drinking and marijuana use (Chen and Jacobson, 2012; Dermody et al., 2014; Fish et al., 2021; Lee et al., 2021), but this study is among the first to examine substance use across the transition to adulthood among Black and Latino sexual minority men. Furthermore, in studies of between group differences in trajectories, most do not further examine stigma as drivers of these differences.
The nature of co-morbid psychopathology in adolescents with gender dysphoria
2022, Psychiatry ResearchCitation Excerpt :The GR adolescents displayed fewer externalizing symptoms than the MHR adolescents, which is consistent with the studies suggesting that internalizing symptoms are more prominent than externalizing symptoms among GR adolescents (Zucker et al., 2012; de Vries et al., 2016; Skagerberg et al., 2013). Adolescent population studies have seldom focused on externalizing behaviours and symptoms in transgender adolescents, but the few that have report increased externalizing problems compared to those found in general population samples (e.g., Day et al., 2017; Fish et al., 2021; Rider et al., 2019). The transgender identifying adolescents in these population samples may represent a different group from adolescents with clinically significant GD, since externalizing psychopathology does not seem to be a major problem for the GR group.
Conflicts of interest: The authors have no conflicts of interest to disclose.
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