Age Differences in Sexual-Orientation-Related Substance Use Disparities among Youth: Findings from Population-Based Data

• In Event: 2-201 - Findings on adolescent substance use when diversity and inclusion are prioritized

Integrative Statement

A robust body of literature documents sexual-orientation-related disparities in substance use (Marshal et al, 2008). Importantly, studies documenting sexual orientation differences in substance use often find significant differences in both youth and adult samples, including longitudinal studies that document changing disparities across the transition to adulthood (Marshal et al., 2009). Common approaches to documenting sexual orientation differences in substance use do not often utilize age-based designs, which offer unique perspectives about when sexual-orientation-related disparities emerge and their course during adolescence. These perspectives are important when we consider that adolescence is a common time for substance use onset and acceleration. Age-based studies documenting sexual-orientation-related disparities among youth are therefore particularly critical to understanding when sexual-orientation-related disparities in substance use emerge. To better understand when sexual orientation disparities in substance use emerge and inform the timing of prevention efforts aimed to address them, the current study uses population-based data to document age-specific sexual-orientation-related disparities in past-month alcohol, cigarette, and marijuana use among youth age 12 to 18.
Data and Analytic Approach. We use cross-sectional data from the 2013 and 2015 California Health Kids Survey (CHKS). A biennial school-based survey administered to students in 7th, 9th, and 11th grade, the CHKS is the largest statewide survey of middle and high school students in the United States. Our sample (N = 673,426) includes youth who provide valid data for age (range 12-18) and sexual identity (heterosexual [ref], lesbian/gay, bisexual, and questioning). Past-month alcohol (including binge drinking), cigarette, and marijuana use was assessed by asking “During the past 30 days, on how many days did you [use substance]? Response options ranged from 0 days = 0 to 20 – 30 days = 6. Items were dichotomized to reflect recent use (yes = 1, no = 0). Age specific prevalence of substance use between heterosexual and sexual minority youth were calculated using regression models with three-way interactions between age, sexual minority status, and sex adjusting for race/ethnicity and parental education. The resulting estimates reflect the percentage of youth who report recent substance use for each age year.
Results. Sexual orientation differences in recent cigarette, alcohol, and marijuana use were already present among youth by age 12 (see Figure 1), although the degree of differences between heterosexual and sexual minority youth varied by age. Sexual-orientation-related disparities in cigarette use, for example, widened with increasing age: Among 12-year-olds, there was an 8% difference in the prevalence of recent cigarette use between heterosexual and sexual minority girls, but a 20% difference among 18-year-olds. Sexual minority girls also evidenced greater substance use for most age years relative to both heterosexual and sexual minority boys.
Discussion. Findings provide the first age-specific estimates of recent cigarette, alcohol, and marijuana use disparities between heterosexual and sexual minority youth using population-based data. Results suggestion that substance use disparities are present prior to the age of 12 and that prevention efforts to address sexual-orientation-related substance use disparities are necessary at early ages.

Authors

• Jessica N. Fish, University of Maryland College Park
  Presenting Author

• Stephen T. Russell, University of Texas at Austin
  Non-Presenting Author