Abstract
Lesbian, gay, and bisexual (LGB) adolescents report disparate rates of substance use, and often consume more cigarettes, alcohol, marijuana, cocaine, and ecstasy than their heterosexual peers. It is therefore crucial to understand the risk factors for substance use among LGB adolescents, particularly those unique to their minority status. In an effort to organize the current knowledge of minority-related risk factors for substance use among LGB youth, this study presents results from a systematic review and meta-analysis of the published research literature. Results from 12 unique studies of LGB youth indicated that the strongest risk factors for substance use were victimization, lack of supportive environments, psychological stress, internalizing/externalizing problem behavior, negative disclosure reactions, and housing status. Results are discussed in terms of their implications for targeted intervention programs that address minority stress risk factors for substance use among LGB youth.
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Notes
The authors recognize that several other subgroups fall within the umbrella of “sexual minority” (e.g., transgender); however, in order to conduct the meta-analytic approaches, the study was limited to sexual behavior: lesbian, gay, and bisexual (LGB).
This strategy was necessary to avoid violating the assumption that all effect sizes within a given analysis are statistically independent. Sensitivity analysis (not shown but available upon request) that examined effects separately within each type of substance use outcome were substantively similar to those reported here that combine across substance use outcome types. Because results were substantively unchanged, and the small number of studies and low statistical power associated with those analyses, we elected to present results combined across substances. However, Table 1 provides the effect sizes split by each type of substance use outcome for readers interested in substance-specific effects.
Minority stress categories refer broadly to risk factors unique to a specific minority group within a population. Even when the entire population experiences a particular risk factor, its prevalence and consequences may be contextually or qualitatively different among a specific minority subset of the population. For instance, physical victimization due to sexual orientation is clearly a minority stress risk factor, as it is experienced only by LGB youth (or youth perceived as LGB). Thus, although physical victimization occurs for both LGB and heterosexual youth, it can be conceptualized as a minority stress risk factor when experienced by LGB youth. Physical victimization may be directly related to LGB minority status, even if such minority related specificity is not explicitly measured in a given risk factor scale.
References
Studies included in the meta-analysis are marked with an asterisk
*Bontempo, D. E., & D’Augelli, A. R. (2002). Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths’ health risk behavior. Journal of Adolescent Health, 30, 364–374. doi:10.1016/S1054-139X(01)00415-3
Bouris, A., Guilamo-Ramos, V., Jaccard, J., Ballan, M., Lesesne, C. A., & Gonzalez, B. (2011). Early adolescent romantic relationships and maternal approval among inner city Latino families. AIDS and Behavior, 16, 1570–1583. doi:10.1007/s10461-011-0034-8.
Castro, F. G., Barrera, M. J., & Martinez, C. R. (2004). The cultural adaptation of prevention intervention: Resolving tensions between fidelity and fit. Prevention Science, 5, 41–45. doi:10.1023/B:PREV.0000013980.12412.cd.
Cervantes, R., Goldbach, J., & Santos, S. (2011). Familia Adelante: A multi-risk prevention intervention for Latino families. The Journal of Primary Prevention, 32, 225–234. doi:10.1007/s10935-011-0251-y.
Cole, S. W., Kemeny, M. E., Taylor, S. E., & Visscher, B. R. (1996). Elevated physical health risk among gay men who conceal their homosexual identity. Health Psychology, 15, 243–251.
Corliss, H. L., Rosario, M., Wypij, D., Wylie, S. A., Frazier, A. L., & Austin, S. B. (2010). Sexual orientation and drug use in a longitudinal cohort study of U.S. adolescents. Addictive Behaviors, 35, 517–521. doi:10.1016/j.addbeh.2009.12.019.
*Darwich, L., Hymel, S., & Waterhouse, T. (2012). School avoidance and substance use among lesbian, gay, bisexual, and questioning youths: The impact of peer victimization and adult support. Journal of Educational Psychology, 104(2), 381–392
D'Augelli, A. R. (2006). Developmental and contextual factors and mental health among lesbian, gay, and bisexual youths. In A. Omoto & H. S. Kurtzman (Eds.), Sexual orientation and mental health: Examining identity and development in lesbian, gay, and bisexual people. Contemporary perspectives on lesbian, gay, and bisexual psychology (pp. 37–53). Washington: American Psychological Association.
D’Augelli, A. R., & Grossman, A. H. (2001). Disclosure of sexual orientation, victimization, and mental health among lesbian, gay, and bisexual older adults. Journal of Interpersonal Violence, 16, 1008–1027.
Dom, G., Sabbe, B., Hustijn, W., & Van Den Brink, W. (2005). Substance use disorders and the orbitofrontal cortex: Systematic review of behavioural decision-making and neuroimaging studies. The British Journal of Psychiatry, 187, 209–220. doi:10.1192/bjp.187.3.209.
Elze, D. E. (2007). Research with sexual minority youth. Journal of Gay and Lesbian Social Services, 18, 73–99.
Emery, E. M., McDermott, R. J., Holcomb, D. R., & Marty, P. J. (2009). The relationship between youth substance use and area–specific self–esteem. Journal of School Health, 63, 224–228.
*Espelage, D. L., Aragon, S. R., Birkett, M., & Koenig, B. W. (2008). Homophobic teasing, psychological outcomes, and sexual orientation among high school students: What influence do parents and schools have? School Psychology Review, 37, 202–216
Garofalo, R., Wolf, R. C., Kessel, S., Palfrey, J., & DuRant, R. H. (1998). The association between health risk behaviors and sexual orientation among a school-based sample of adolescents. Pediatrics, 101, 895–902.
Goldbach, J. T., & Holleran Steiker, L. K. (2011). An examination of cultural adaptations performed by LGBT-Identified youths to a culturally grounded, evidence-based substance abuse intervention. Journal of Gay and Lesbian Social Services, 23, 188–203. doi:10.1080/10538720.2011.560135.
Grant, B. F., Stinson, F. S., & Harford, T. C. (2001). Age at onset of alcohol use and DSM-IV alcohol abuse and dependence: A 12-year follow-up. Journal of Substance Abuse, 13, 493–504. doi:10.1016/S0899-3289(01)00096-7.
Hecht, M. L., Marsiglia, F. F., Elek, E., Wagstaff, D. A., Kulis, S., Dustman, P., & Miller-Day, M. (2003). Culturally grounded substance use prevention: An evaluation of keepin’ it R.E.A.L. curriculum. Prevention Science, 4, 233–248. doi:10.1023/A:1026016131401.
Herrick, A. L., Matthews, A. K., & Garofalo, R. (2010). Health risk behaviors in an urban sample of young women who have sex with women. Journal of Lesbian Studies, 14, 80–92. doi:10.1080/10894160903060440.
Holleran Steiker, L. K., Goldbach, J., Hopson, L. M., & Powell, T. (2011). The value of cultural adaptation processes: Older youth participants as substance abuse preventionists. Child and Adolescent Social Work Journal, 28, 495–509. doi:10.1007/s10560-011-0246-9.
Holloway, I. W., Traube, D. E., Rice, E., Schrager, S. S., Palinkas, L. A., Richardson, J., & Kipke, M. (2012). Community and individual factors associated with cigarette smoking among young men who have sex with men. Journal of Research on Adolescence, 22, 199–205. doi:10.1111/j.1532- 7795.2011.00774.x.
Hughes, T. L., & Eliason, M. (2002). Coming-out process related to substance use among gay, lesbian and bisexual teens. The Brown University Digest of Addiction Theory & Application, 24, 3–4.
Jones, C. L., & Battjes, R. J (1985). The contexts and caveats of prevention research on drug abuse. NIDA Research Monograph, 56, 1–12
Kandel, D., Johnson, J., Bird, H., & Camino, G. (1997). Psychiatric disorders associated with substance use among children and adolescents: Findings from the Methods for Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Journal of Abnormal Child Psychology, 25, 121–132. doi:10.1023/A:1025779412167.
Kumpfer, K. L., & Alvarado, R. (2003). Family-strengthening approaches for the prevention of youth problem behaviors. American Psychologist, 58, 457–465. doi:10.1037/0003-066X.58.6-7.457.
Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis. Thousand Oaks: Sage.
Marshal, M. P., Friedman, M. S., Stall, R., King, K. M., Miles, J., Gold, M. A., & Morse, J. Q. (2008). Sexual orientation and adolescent substance use: A meta-analysis and methodological review. Addiction, 103, 546–556. doi:10.1111/j.1360-0443.2008.02149.x.
Marshal, M. P., Friedman, M. S., Stall, R., & Thompson, A. L. (2009). Individual trajectories of substance use in lesbian, gay and bisexual youth and heterosexual youth. Addiction, 104, 974–981. doi:10.1111/j.1360-0443.2009.02531.x.
Marsiglia, F. F., Holleran, L., & Jackson, K. M. (2000). Assessing the effect of internal and external resources on school-based substance abuse prevention. Social Work Education, 22, 145–161. doi:10.1093/cs/22.3.145.
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.
Miller, T., & Hendrie, D. (2009). Substance abuse prevention dollars and cents: A cost-benefit analysis. DHHS Pub. No. (SMA) 07-4298. Rockville: Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration.
McCabe, S. E., Bostwick, W. B., Hughes, T. L., West, B. T., & Boyd, C. J. (2010). The relationship between discrimination and substance use disorders among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 100, 1946.
Moon, M. W., Fornili, K., & O’Briant, A. L. (2007). Risk comparison among youth who report sex with same-sex versus both-sex partners. Youth & Society, 38, 267–284. doi:10.1177/0044118X06287689.
Institute of Medicine (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions. In M. E. O’Connell, T. Boat, & K. E. Warner (Eds.), Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Washington: The National Academies Press.
*Padilla, Y. C., Crisp, C., & Rew, D. L. (2010). Parental acceptance and illegal drug use among gay, lesbian, and bisexual adolescents: Results from a national survey. Social Work, 55, 265–275
*Pearson, J., Muller, C., & Wilkinson, L. (2007). Adolescent same-sex attraction and academic outcomes: The role of school attachment and engagement. Social Problems, 54, 523–542. doi:10.1525/sp.2007.54.4.523
Pilkington, N. W., & D’Augelli, A. R. (1995). Victimization of lesbian, gay, and bisexual youth in community settings. Journal of Community Psychology, 23, 34–56. doi:10.1002/1520-6629(199501)23.
Postmes, T., & Branscombe, N. R. (2002). Influence of long-term racial environmental composition on subjective well-being in African Americans. Journal of Personality and Social Psychology, 83, 735–751.
*Poteat, V. P., Aragon, S. R., Espelage, D. L., & Koenig, B. W. (2009). Psychosocial concerns of sexual minority youth: Complexity and caution in youth differences. Journal of Consulting and Clinical Psychology, 77, 196–201. doi:10.1037/a0014158
Ragins, B. R. (2004). Sexual orientation in the workplace: The unique work and career experiences of gay, lesbian and bisexual workers. Research in Personnel and Human Resources Management, 23, 35–120.
Rehm, J., Taylor, B., & Room, R. (2006). Global burden of disease from alcohol, illicit drugs and tobacco. Drug and Alcohol Review, 25, 503–513. doi:10.1080/09595230600944453.
Remafedi, G. (1987). Adolescent homosexuality: Psychological and medical implications. Pediatrics, 79, 331–337.
*Rosario, M., Hunter, J., & Gwad, M. (1997). Exploration of substance use among lesbian, gay, and bisexual youth: Prevalence and correlates. Journal of Adolescent Research, 12, 454–476
*Rosario, M., Rotheram-Borus, M., & Reid, H. (1996). Gay-related stress and its correlates among gay and bisexual male adolescents of predominantly black and Hispanic background. Journal of Community Psychology, 24, 136–159. doi:10.1002/(SICI)1520-6629(199604)24:2 < 136::AID-JCOP5 > 3.0.CO;2-X
*Rosario, M., Schrimshaw, E., & Hunter, J. (2009). Disclosure of sexual orientation and subsequent substance use and abuse among lesbian, gay, and bisexual youths: critical role of disclosure reactions. Psychology of Addictive Behavior, 23, 175–184. doi:10.1037/a0014284
*Rosario, M., Schrimshaw, E., & Hunter, J. (2008). Butch/femme differences in substance use and abuse among young lesbian and bisexual women: Examination and potential explanations. Substance Use & Misuse, 43, 1002–1015. doi:10.1080/10826080801914402
*Rosario, M., Schrimshaw, E. W., & Hunter, J. (2004). Predictors of substance use over time among gay, lesbian, and bisexual youths: An examination of three hypotheses. Addictive Behaviors, 29(8), 1623–1631
*Rosario, M., Schrimshaw, E. W., Hunter, J., & Gwadz, M. (2002). Gay-related stress and emotional distress among gay, lesbian and bisexual youths: A longitudinal examination. Journal of Consulting and Clinical Psychology, 70(4), 967–975. doi:10.1037/0022-006X.70.4.967
*Rostosky, S., Danner, F., & Riggle, E. (2007). Is religiosity a protective factor against substance use in young adulthood? Only if you're straight! The Journal of Adolescent Health, 40, 440–447. doi:10.1016/j.jadohealth.2006.11.144
Rothstein, H. R., Sutton, A. J., & Borenstein, M. (2005). Publication bias in meta-analysis: Prevention, assessment and adjustments. West Sussex: Wiley. doi:10.1002/0470870168.
Russell, S. T., Driscoll, A. K., & Truong, N. (2002). Adolescent same-sex romantic attractions and relationships: Implications for substance use and abuse. American Journal of Public Health, 922, 198–202. doi:10.2105/AJPH.92.2.198.
Russell, S. T., Franz, B. T., & Driscoll, A. K. (2001). Same-sex romantic attraction and the experience of violence in adolescence. American Journal of Public Health, 91, 903–906. doi:10.2105/AJPH.91.6.903.
*Savin-Williams, R. C., & Ream, G. L. (2003). Suicide attempts among sexual-minority male youth. Journal of Clinical Child & Adolescent Psychology, 32, 509–522. doi:10.1207/S15374424JCCP3204_3
Solorio, R., Swendeman, D., & Rotheram-Borus, M. J. (2003). Risks among young gay and bisexual men living with HIV. AIDS Education and Prevention, 15, 80–90.
Stronski, H., & Remafedi, G. (1998). Adolescent homosexuality. Advances in Pediatrics, 45, 107–144.
Substance Abuse and Mental Health Services Administration (2011). Leading change: A plan for SAMHSA’s roles and actions 2011–2014. HHS Publication No. (SMA) 11–4629. Rockville: Substance Abuse and Mental Health Services Administration. Retrieved from http://store.samhsa.gov/shin/content/SMA11-4629/01-FullDocument.pdf
Traube, D. E., Holloway, I. W., Schrager, S. M., & Kipke, M. D. (2012). Utilizing social action theory as a framework to determine correlates of illicit drug use among young men who have sex with men. Psychology of Addictive Behaviors, 26, 78–88.
Tyler, K. A., & Melander, L. A. (2013). Child abuse, street victimization, and substance use among homeless young adults. Youth & Society. doi:10.1177/0044118X12471354.
US Department of Health and Human Services (2011). Substance Abuse and Mental Health Services Administration’s national registry of evidence based programs and practices. Rockville: Substance Abuse and Mental Health Services Administration.
US Department of Health and Human Services (2001). Mental health: Culture, race, and ethnicity. A supplement to mental health: A report of the Surgeon General. Rockville: U.S. Department of Health and Human Services.
Vega, W. A., Zimmerman, R. S., Warheit, G. J., Apospori, E., & Gil, A. G. (1993). Risk factors for early adolescent drug use in four ethnic and racial groups. American Journal of Public Health, 83, 185–189. doi:10.2105/AJPH.83.2.185.
Vega, W. A., Alderete, E., Kolody, B., & Aguilar-Gaxiola, S. (1998). Illicit drug use among Mexicans and Mexican Americans in California: The effects of gender and acculturation. Addiction, 93, 1839–1850. doi:10.1046/j.1360-0443.1998.931218399.x.
Waller, M. A. (2001). Resilience in ecosystemic context: Evolution of the concept. American Journal of Public Health, 83, 185–189. doi:10.1037/0002-9432.71.3.290.
Weber, G. N. (2008). Using to numb the pain: Substance use and abuse among lesbian, gay, and bisexual individuals. Journal of Mental Health Counseling, 30, 31–48.
*Willoughby, B., Doty, N., & Malik, N. (2010). Victimization, family rejection, and outcomes of gay, lesbian, and bisexual young people: The role of negative GLB identity. Journal of GLBT Family Studies, 6, 403–424. doi:10.1080/15504280903035761
*Wright, E. R., & Perry, B. L. (2006). Sexual identity distress, social support and the health of gay, lesbian and bisexual youth. Journal of Homosexuality, 51, 81–110. doi:10.1300/J082v51n01_05
Wu, L. T., & Anthony, J. C. (1999). Tobacco smoking and depressed mood in late childhood and early adolescence. American Journal of Public Health, 89, 1837–1840. doi:10.2105/AJPH.89.12.1837.
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Goldbach, J.T., Tanner-Smith, E.E., Bagwell, M. et al. Minority Stress and Substance Use in Sexual Minority Adolescents: A Meta-analysis. Prev Sci 15, 350–363 (2014). https://doi.org/10.1007/s11121-013-0393-7
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DOI: https://doi.org/10.1007/s11121-013-0393-7