Elsevier

Addictive Behaviors

Volume 35, Issue 5, May 2010, Pages 517-521
Addictive Behaviors

Short Communication
Sexual orientation and drug use in a longitudinal cohort study of U.S. adolescents

https://doi.org/10.1016/j.addbeh.2009.12.019Get rights and content

Abstract

Adolescents with a minority sexual orientation (e.g., lesbian, gay, and bisexual) are more likely to use substances than their heterosexual peers. This study aimed to increase understanding of the development of drug use in this vulnerable population by: 1) comparing longitudinal patterns of past-year illicit drug use (e.g., marijuana, cocaine, and ecstasy) and misuse of prescription drugs among minority sexual orientation youth relative to heterosexual youth and, 2) examining how sexual orientation sub-group, gender, and age relate to variation in the risk of drug use. Data come from the Growing Up Today Study, a community-based cohort of U.S. adolescents who were assessed three times between 1999 and 2005 with self-administered questionnaires when they ranged in age from 12 to 23 years (N = 12,644; 74.9% of the original cohort). Multivariable repeated measures generalized estimating equations using modified Poisson regression were used to estimate relative risks. Participants indicating their sexual orientation was mostly heterosexual, bisexual, or lesbian/gay were more likely than completely heterosexual youth to report past-year illicit drug use and misuse of prescription drugs. Gender was an important modifier; bisexual females were most likely to report drug use. Age was also an important modifier of risk; differences in drug use between minority sexual orientation and heterosexual youth were larger during adolescence (12–17 years) than during emerging adulthood (18–23 years). Research must focus on identifying reasons why minority sexual orientation youth are at disproportionate risk for drug use. Such information is essential for developing interventions that are critically needed to reduce drug use in this population. Efforts need to begin early because large sexual orientation disparities in drug use are evident by adolescence.

Introduction

Adolescents who identify as lesbian, gay, or bisexual, or who report same-sex attractions and/or relationships are at disproportionate risk for using drugs (Marshal, et al., 2008). Evidence of sexual orientation disparities in adolescent drug use comes primarily from cross-sectional studies of high school (e.g., Faulkner and Cranston, 1998, Garofalo et al., 1998) or college (e.g., Eisenberg and Wechsler, 2003, Ford and Jasinski, 2006, McCabe, 2005) samples. These studies have found that minority sexual orientation youth are more likely than heterosexuals to report use of marijuana, cocaine, and other illicit drugs, and prescription drug misuse.

Despite evidence of greater drug use in this population, outstanding questions remain. There is uncertainty whether drug use vulnerability varies by age or developmental period (e.g., adolescence and young adulthood). Younger age of use is associated with worse sequelae (Fergusson et al., 2006, Lubman et al., 2007). There is also uncertainty about how gender and sub-group status (e.g., lesbian/gay and bisexual) influence risk of adolescent drug use. Sexual orientation disparities in substance use may be larger in females than males (Russell, Driscoll, & Truong, 2002). A community-based study of gay, lesbian, and bisexual youth found that females were more likely to report substance use than males (Rosario, Hunter, & Gwadz, 1997). In contrast, studies with general adolescent samples find that males are more than or equally as likely as females to report drug use (Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2008). Studies also suggest that among females, bisexuals are at elevated risk for drug use compared to lesbians or heterosexuals (Eisenberg and Wechsler, 2003, Ford and Jasinski, 2006, Russell et al., 2002). However, the extent to which gender and sexual orientation sub-group differences emerge during adolescence and how differences may vary across developmental periods remain understudied.

A recent meta-analysis and methodological review underscored the large gaps in understanding how sexual orientation is related to longitudinal substance use and identifying the most vulnerable sub-groups (Marshal et al., 2008). Our study objectives were to: 1) estimate sexual orientation differences in longitudinal patterns of past-year drug use among youth across ages 12 to 23 years; 2) examine if gender modified sexual orientation differences in the risk of past-year drug use; and 3) explore whether developmental period [adolescence versus emerging adulthood (Arnett, 2000)] modified associations between sexual orientation and drug use.

Section snippets

Study participants

Data come from the Growing Up Today Study (GUTS), a U.S. longitudinal cohort study of children of Nurses' Health Study II participants (Brigham and Women's Hospital and Harvard Medical School, 2009) begun in 1996 when the adolescents were between ages 9 and 14 years (N = 16,882). Participants predominately self-identified as non-Hispanic white (93%). More information about GUTS is available elsewhere (Field, et al., 1999). Institutional review board approval was obtained from Brigham and Women's

Sexual orientation differences in past-year prevalence of drug use

Mostly heterosexual, bisexual, and lesbian/gay youth were more likely to report using a variety of drugs in the prior year than their heterosexual peers (Table 1). Sexual orientation differences in drug use were generally larger among females and bisexuals. When gender modified the relationship between sexual orientation and drug use, the elevated risk experienced by sexual minorities relative to heterosexuals was larger among females than males. Gender-by-sexual-orientation statistical

Discussion

Results of this study demonstrate a heightened risk of past-year drug use among minority sexual orientation youth. In fact, drug use prevalences observed among the sexual minorities in GUTS were much higher than prevalences observed among same-aged respondents of the representative 2002 National Survey of Drug Use and Health, suggesting that sexual minority youth who are children of health care professionals are not protected from drug use.

While supporting previous findings (e.g., Boyd et al.,

Conclusions

This study provides further evidence that minority sexual orientation is a risk indicator for illicit drug use and misuse of prescription drugs during adolescence. Despite evidence that minority sexual orientation youth are at elevated risk for a variety of health concerns, including drug use, the health professions do not effectively address the specific needs of this population (Corliss et al., 2007, Sanchez et al., 2006, Tesar and Rovi, 1998). While the reasons that these youth are at high

Role of Funding Sources

This study was funded by grants DA23610, HD45763, DK46834, and HL03533 from the National Institutes of Health, grant RSGPB-04-009-01-CPPB from the American Cancer Society, and the Robert Wood Johnson Foundation. Drs. Corliss and Austin were also supported by the Leadership Education in Adolescent Health Project, Maternal and Child Health Bureau, Health Resources and Services Administration grant 6T71-MC00009-16. Funding sources had no role in the study design, collection, analysis or

Contributors

Drs. Corliss and Austin designed the study. Dr. Corliss and Ms. Wylie conducted data analysis. Dr. Wypij provided statistical consultation. All authors participated in the data interpretation. Dr. Corliss wrote the first draft of the manuscript. All authors contributed to critical revisions of the manuscript for important intellectual content and have approved the final manuscript. Drs. Corliss, Austin, and Frazier obtained funding.

Conflict of Interest

All authors declare that they have no conflicts of interest.

Acknowledgments

This study was funded by grants DA23610, HD45763, DK46834, and HL03533 from the National Institutes of Health, grant RSGPB-04-009-01-CPPB from the American Cancer Society, and the Robert Wood Johnson Foundation. Drs. Corliss and Austin were also supported by the Leadership Education in Adolescent Health Project, Maternal and Child Health Bureau, Health Resources and Services Administration grant 6T71-MC00009-17. The authors would like to thank the participants of the Growing Up Today Study and

References (41)

  • Nurses' Health Study

  • R.P. Cabaj et al.
  • S.D. Cochran et al.

    Prevalence of non-medical drug use and dependence among homosexually active men and women in the US population

    Addiction

    (2004)
  • B.N. Cochran et al.

    Do specialized services exist for LGBT individuals seeking treatment for substance misuse? A study of available treatment programs

    Substance Use Misuse

    (2007)
  • H.L. Corliss et al.

    Drug use, drug severity, and help-seeking behaviors of lesbian and bisexual women

    Journal of Womens Health

    (2006)
  • H.L. Corliss et al.

    Research, curricula, and resources related to lesbian, gay, bisexual, and transgender health in US schools of public health

    American Journal of Public Health

    (2007)
  • A.R. D'Augelli et al.

    Predicting the suicide attempts of lesbian, gay, and bisexual youth

    Suicide and Life-Threatening Behavior

    (2005)
  • A.H. Faulkner et al.

    Correlates of same-sex sexual behavior in a random sample of Massachusetts high school students

    American Journal Public Health

    (1998)
  • D.M. Fergusson et al.

    Cannabis use and other illicit drug use: Testing the cannabis gateway hypothesis

    Addiction

    (2006)
  • G.M. Fitzmaurice et al.

    Applied longitudinal analysis

    (2004)
  • Cited by (212)

    • Age-related patterns of cocaine and methamphetamine use across the life course in the United States: Disparities by gender and sexual identity among adults

      2023, Addictive Behaviors
      Citation Excerpt :

      Growing evidence suggests that disparities in substance use between individuals who identify as lesbian, gay, or bisexual (LGB) and their heterosexual counterparts (Kerridge et al., 2017; McCabe et al., 2013; Medley et al., 2015; Schuler et al., 2018, 2019) begin as early as substance use initiation. ( Corliss et al., 2010; Marshal et al., 2009) These disparities by sexual identity continue into adulthood for the majority of substances, including alcohol (McCabe et al., 2009; Pakula et al., 2016), marijuana (Demant et al., 2017; McCabe et al., 2009), cigarette use (Cochran et al., 2013; Corliss et al., 2014; Gonzales et al., 2016), illegal stimulants (cocaine and methamphetamine) (Schuler et al., 2019), and the nonmedical use of prescription drugs (Han et al., 2020). Patterns of use differ between LGB and heterosexual individuals, and by gender and sexual identity within the LGB community.

    • Peer experiences of LGBQ youth

      2023, Encyclopedia of Child and Adolescent Health, First Edition
    View all citing articles on Scopus
    View full text