Adolescent Sexual Minority Girls Are at Elevated Risk for Use of Multiple Substances

ABSTRACT

Background: Sexual minority youth, especially girls, are at risk for alcohol, cigarette, and marijuana use when these substances are examined individually. However, little is known about concurrent use of these substances (i.e., three-substance use) in relation to sexual orientation. Objectives: The present study compared profiles of past year alcohol, cigarette, and marijuana use between SMGs and heterosexual girls. In addition, because internalizing and externalizing symptoms are associated with substance use, we examined whether sexual orientation was associated with substance use profile over and above co-occurring psychopathology. Methods: Mixture modeling was used to identify patterns of alcohol (including binge drinking), cigarette, and marijuana use in the past year using a cross-sectional sample of urban adolescent girls (Pittsburgh Girls Study; N = 2,064; mean age = 17). Approximately 8% (n = 173) of the girls endorsed a lesbian or bisexual identity. Results: Five substance using classes were identified: low-level substance use (72%), marijuana use (5%), cigarette use (8%), alcohol use (8%), and three-substance use (7%). SMGs were at an increased risk for substance use than heterosexual girls, particularly three-substance use (OR = 6.69, p < .001), cigarette use (OR = 6.26, p < .001), and marijuana use (OR = 3.86, p < .001) classes. Substance use patterns were regressed on sexual orientation, internalizing symptoms (i.e., depression, anxiety), and externalizing symptoms (i.e., conduct problems, oppositional defiant disorder). The disparities remained robust after controlling for internalizing and externalizing symptoms. Conclusions/Importance: Clinicians and researchers should be aware of potential three-substance use among SMGs. Substance use interventions for SMG may benefit from targeting risk factors that cut-across several substances, particularly externalizing symptoms.

KEYWORDS:

• Bisexual
• lesbian
• substance use
• mixture modeling
• internalizing
• externalizing

Glossary

• Mixture modeling: An overarching term to describe person-centered analytic approach that identifies subgroups (or classes) of individuals who are homogenous based on relative levels of the outcome variables of interest. One example is latent class analysis, which identifies subgroups at a single point in time.

• Sexual minority girls (SMGs): A subset of sexual minority youth who are female and identify as lesbian or bisexual.

• Sexual minority youth (SMY): An overarching group of youth including individuals who identify as lesbian, gay, or bisexual.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Notes

1 While lesbian and bisexual girls were examined together as SMGs, chi-square tests demonstrated that both subgroups were equally represented in each substance use class (p's: .30-.90). Furthermore, t-tests and chi-square tests demonstrated that lesbian and bisexual girls did not differ in their levels of alcohol use (p = .28), cigarette use (p = .82), marijuana use (p = .78), and occurrence of binge drinking (p = .41).

Additional information

Funding

This work was supported by grants from the National Institute of Drug Abuse (R01 DA030385; R01 DA012237)

Notes on contributors

Sarah S. Dermody

Sarah S. Dermody, PhD, is a Canadian Institute of Health Research Postdoctoral Fellow at the Centre for Addiction and Mental Health in Toronto Ontario. Her research interests include identifying mechanisms underlying alcohol use, cigarette use, and co-use, and corresponding individual differences due to sex and sexual orientation.

Michael P. Marshal

Michael P. Marshal, PhD, is a licensed clinical psychologist and an Associate Professor of Psychiatry and Pediatrics at the University of Pittsburgh. His main research interests include substance use and mental health disparities among lesbian, gay, bisexual, and transgender youth.

JeeWon Cheong

JeeWon Cheong, PhD, is an Associate Professor in the Department of Health Education and Behavior at the University of Florida. Her research focuses on substance use and other risky health behaviors among adolescents and adults and statistical methods applied to health behaviors, including mediation analysis, longitudinal modeling, and evaluation of prevention/intervention programs.

Tammy Chung

Tammy Chung, PhD, is an associate professor at the Department of Psychiatry, University of Pittsburgh. She is involved in research on screening, assessment, developmental course, and treatment of adolescent substance use.

Stephanie D. Stepp

Stephanie D. Stepp, PhD, is an associate professor at the Department of Psychiatry and Psychology, University of Pittsburgh Medical Center. Her main research interest is in the developmental precursors of serious mental illness and substance abuse in adolescents and young adults.

Alison Hipwell

Alison Hipwell, PhD, ClinPsyD, is a Professor in the Department of Psychiatry at the University of Pittsburgh. Her research interests include the development of psychopathology and substance use in girls and women.