Variations in Substance Use and Disorders Among Sexual Minorities by Race/Ethnicity

Abstract

Purpose: Little is known about racial/ethnic minority substance use and disorder-related disparities among sexual minorities as compared to their heterosexual counterparts. This study aimed to understand the associations between sexual minority status and substance use and disorders among U.S. adults stratified by race/ethnicity. Methods: We analyzed data from a sample of U.S. adults (n = 35,981) surveyed during the 2012–2013 National Epidemiological Survey on Alcohol and Related Conditions-III. Respondents were categorized into four sexual minority statuses: heterosexual, gay/lesbian, bisexual, and conflicting. Respondents’ substance (tobacco, alcohol, and marijuana) use and disorders were also assessed using standard measures. Weighted multivariable logistic regressions were used to examine the relationships between sexual minority status and substance use and disorders, stratified by race/ethnicity, adjusting for socio-demographic characteristics. Results: Sexual minority adults experienced a higher prevalence of substance use and disorders than heterosexuals. For example, bisexuals were more likely than heterosexuals to use marijuana (AOR = 3.45, 95% CI = 2.64–4.50) and have tobacco use disorders (AOR = 2.58, 95% CI = 2.02–3.28). These associations were stronger among racial/ethnic minorities. For instance, bisexual non-Hispanic Blacks were more than twice as likely (AOR = 3.17, 95% CI = 2.16-4.65) to be current tobacco users than their heterosexual counterparts; while this association was weaker for bisexual non-Hispanic Whites (AOR = 1.99, 95% CI = 1.47–2.71). Conclusion: Sexual minority adults, especially those who are also racial/ethnic minorities, experience a significantly higher burden of substance use and disorders than heterosexuals. Efforts to screen and treat substance use and disorders among this particular population are critically needed to improve their health outcomes and reduce health disparities.

Keywords:

• Sexual orientation
• race and ethnicity
• health disparities
• substance use disorder
• substance use
• epidemiology
• tobacco use

Acknowledgements

Data for this study were from the respondents of the 2012–2013 National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III), which was sponsored, designed, and directed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Declaration of interest statement

Mx. Freitag, Dr. Chen-Sankey, and Dr. Choi conceptualized and designed the analysis. Mx. Freitag conducted data analysis and drafted the initial manuscript. All authors reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

The authors have no conflicts of interest relevant to this article. No competing financial interests exist.

Disclaimer statement

Comments and opinions expressed in this article belong to the authors and do not necessarily reflect those of the US Government, Department of Health and Human Services, National Institutes of Health, National Cancer Institute, or National Institute on Minority Health and Health Disparities. This project’s abstract was previously presented at the Society for Research on Nicotine and Tobacco’s Annual Meeting in March of 2020.

Data availability statement

Data from the NESARC-III may be requested at: https://www.niaaa.nih.gov/procedures-obtaining-dataset.

Additional information

Funding

This work and Drs. Choi and Julia-Chen-Sankey and Ms. Duarte were supported by the Division of Intramural Research, National Institute on Minority Health and Health Disparities. Mx. Freitag was supported by the Office of the Director, National Institutes of Health. Mr. Ramsey was supported by the National Institute on Minority Health and Health Disparities (NIH Grant Number F31MD014047). Dr. Chen-Sankey was also supported by the National Cancer Institute (NIH grant number K99CA242589). The work of Mx. Freitag was also supported by the Amgen Scholars Program at the National Institutes of Health (Summer 2019).