Substance Use and Sexual Orientation Among East and Southeast Asian Adolescents in Canada

The purpose of this study was to examine the relationship between substance use and sexual orientation among Asian adolescents in Canada. We analyzed an East and Southeast Asian subsample of a province-wide, school-based survey (weighted N = 51,349). Compared to heterosexual adolescents of the same gender, gay, lesbian, bisexual, and mostly heterosexual adolescents were more likely to use alcohol, marijuana, or other illicit drugs. Particularly, sexual minority girls were at increased risk for substance use. The findings suggest the need for substance use prevention interventions that are sensitive to gender, sexual orientation, and culture.     

Substance Use Among Sexual Minority Collegiate Athletes: A National Study

Background: The empirical research examining substance use among sexual minority collegiate athletes is sparse. Problematically, this group may be at a greater risk of substance use due to their marginalized status within the context of sport. Objectives: We examined different types of substance use during the past 30 days, and diagnosis of substance use disorders during the past 12 months, among sexual minority collegiate athletes. Methods: This study uses data from college students for the fall semester between 2008 and 2012 from the American College Health Association-National College Health Assessment. Results: Sexual minority collegiate athletes had greater odds of past 30-day cigarette use, past 30-day alcohol use, past 30-day marijuana use, and indicating being diagnosed or treated for a substance use disorder during the past 12 months when compared to either heterosexual collegiate athletes or heterosexual nonathletes, but had similar odds on these outcomes when compared to sexual minority nonathletes. Sexual minority collegiate athletes also had greater odds of binge drinking during the past 2 weeks when compared to either heterosexual nonathletes or sexual minority nonathletes, but had similar odds on this outcome when compared to heterosexual collegiate athletes. Additional analyses by gender reveal that male sexual minority athletes are at the greatest risk of being diagnosed or treated for a substance use disorder. Conclusions: Possible explanations as to why sexual minority collegiate athletes (particularly males) may be at a greater risk of substance use disorders could include the difficulty of trying to maintain an athletic identity within a social environment that is traditionally homophobic.     

Substance Use among Sexual Minorities: Has it Actually Gotten Better?

Background: Despite efforts to decrease substance use, rates among sexual minority youth (SMY) remain higher than among heterosexuals. Substance use is a leading contributor to morbidity and mortality in adulthood, and SMY's use of substances is related to poorer mental and emotional health. Objectives: We sought to document the trends in substance use for a large sample of youth over 14 years with special attention to SMY. In addition, we tested whether there were disparities in substance use behaviors between SMY and heterosexual youth. Last, we examined changes in disparities over time in substance use among SMY. Methods: We analyzed data from 8 waves of the Massachusetts YRBS (N = 26,002, M_age = 16), from 1999 to 2013, to investigate trends and disparities in current tobacco, alcohol, and cannabis use for heterosexual youth and SMY. We used logistic regression interaction models to test whether these disparities have widened or narrowed for SMY, as compared to heterosexuals, over the span of 14 years. Results: In absolute terms, substance use rates decreased for nearly all youth between 1999 and 2013. There were striking disparities in substance use between heterosexual youth and all sexual minority subgroups. These disparities in substance use narrowed among males but remained unchanged or worsened among females. Conclusions/Importance: Trends in substance use are changing over time, but not in the same ways for all sexual minority subgroups. Patterns are worsening for females. These findings suggest that we need to address the needs of LGB populations in novel ways.     

Age of Sexual Debut and Cannabis Use in the United States

Background: Understanding the interrelationships between risky health behaviors is critical for health promotion efforts. Conceptual frameworks for understanding substance misuse (e.g. stepping-stone models) have not yet widely incorporated other risky behaviors, including those related to sexual health. Objectives: The goals of this study were to assess the relationship between early sexual debut and cannabis use, examine the role of licit substance use in this association, and evaluate differences by gender and race/ethnicity. Methods: Data came from the National Comorbidity Survey-Replication (NCS-R). Primary analysis was restricted to respondents who reported sexual debut at ≥12 years (n = 5,036). Age at sexual debut was categorized as early (<18 years), average (18 years) and late (>18 years). Logistic regression was used to assess the relationship between age at sexual debut and cannabis use. Interaction terms were used to evaluate effect modification by gender and race/ethnicity. Results: Later age of sexual debut was associated with lower odds of cannabis use relative to the average age of debut (AOR = 0.50, 95% CI = 0.37–0.66). For every year that respondents delayed their sexual debut, the relative odds of lifetime cannabis use declined by 17%. After accounting for alcohol and tobacco use the association between early sexual debut and cannabis was attenuated (AOR = 0.90, 95% CI = 0.68–1.20), while later age of debut remained protective (AOR = 0.57, 95% CI = 0.42–0.78). Results were generally consistent across race/ethnicity and gender. Conclusions: Multifactorial intervention strategies targeting both sexual health and substance use may be warranted.     

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

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.     

Sexual orientation, gender, and alcohol use in a cohort study of U.S. adolescent girls and boys

BACKGROUND: Sexual minority youth may be at elevated risk for alcohol use relative to heterosexual youth, but the reasons underlying higher rates and whether there may be gender differences in risk are not known. METHODS: Cross-sectional survey data from 9731 early and middle adolescent girls and boys in the Growing Up Today Study in 1999 were examined to assess sexual orientation and gender patterns in alcohol use. Multivariable regression models estimated associations between sexual orientation and alcohol-related behaviors, such as binge drinking and drinking before age 12 years. Models controlled for sociodemographic and psychosocial factors, with heterosexuals as the reference. RESULTS: Girls who described themselves as "mostly heterosexual" and lesbian/bisexual girls were at elevated risk compared to heterosexual girls on almost all alcohol-related behaviors and exposures. "Mostly heterosexual" boys were also at elevated risk. No significant differences in alcohol-related behaviors were observed between gay/bisexual and heterosexual boys. Gender-by-sexual orientation interactions were statistically significant for LGB but not other orientations, indicating that lesbian/bisexual girls experienced elevated risk above and beyond that of gay/bisexual boys relative to same-gender heterosexual peers. CONCLUSIONS: In early and middle adolescence, sexual minority girls and "mostly heterosexual" boys experienced consistent patterns of elevated risk for alcohol use.     

The Effects of Interventions to Prevent Substance Use Among Adolescents: A Systematic Review

The aim of this systematic review is to describe and evaluate the effects of interventions used for preventing or reducing substance use among adolescents under 18 years of age. Studies (N = 27) available in CINAHL and PubMed from 2007 to 2010 were included. Results showed that family-based interventions and combined interventions have significant outcomes for substance use among adolescents. Similarly, school-based interventions were effective in providing knowledge about substance use, which eventually reduced the substance use. Further research should be conducted in different cultures as well as on computer-based interventions targeting both genders.     

The curvilinear effects of sexual orientation on young adult substance use

Alcohol, tobacco, and marijuana are commonly used by adolescents and linked with harmful health-related outcomes (e.g. injury, dependence). Moreover, heavy episodic (binge) drinking predicts more severe consequences. When examined by sexual orientation, highest rates of substance use have been found among bisexual individuals, with lower use at either end of the spectrum. When examined also by sex, this curvilinear trend is maintained among women but not men. These substance use patterns were identified using group differences (i.e. heterosexual vs. bisexual vs. homosexual). However, evidence suggests that sexual orientation is a continuous, not categorical, variable. This study examined the hypotheses that sexual orientation and commonly used substances (heavy episodic drinking, tobacco, marijuana) would have a quadratic relation among women, but not among men. Six negative binomial regressions tested study hypotheses using data from 7372 participants. Results indicated that sexual orientation had a quadratic relation with heavy episodic drinking, tobacco use, and marijuana use among women, as hypothesized. Additionally, a quadratic relation was found between marijuana use and sexual orientation among men. These findings indicate that women identifying as having mixed sexual orientation are at higher risk than women at either end of the sexual orientation continuum for substance use and related negative outcomes. For men, this is only true for marijuana use and resultant negative consequences. This observed increased use may relate to coping with increased stressors, which has been linked to more problematic use. By better understanding LBG identities and behaviors, clinicians and researchers will be more adept at identifying risk factors and better understanding the nuances across the sexual orientation spectrum.     

Associations of Father's Lifetime Cannabis Use Disorder with Child's Initiation of Cannabis Use,Alcohol Use,and Sexual Intercourse by Child Gender

Background: Early initiation of alcohol use, cannabis use, and sexual intercourse among adolescents is an important public health concern in the United States. Parents' history of substance use disorder is an important contributing factor for children's problem behaviors. Objectives: The associations of fathers' lifetime cannabis use disorder with children's initiation of cannabis use, alcohol use, and sexual intercourse were examined. In addition, child's gender was considered as a moderator of each association. Methods: Data from two companion longitudinal studies was utilized, the Rochester Youth Developmental Study and its intergenerational extension, the Rochester Intergenerational Study. Multiple linear regression analyses were conducted to examine the associations of the father's lifetime cannabis use disorder with the child's initiation of cannabis use, alcohol use, and sexual intercourse. To test gender differences in the associations, the study sample was stratified by child's gender. Results: The average age of first cannabis use (b = –3.71, p < .05), alcohol use (b = –3.65, p < .05), and sexual intercourse (b = –2.94, p < .05) among daughters of fathers with a lifetime cannabis use disorder was lower than that of their counterparts after adjusting for all other control variables, whereas no significant differences were detected in a father–son relationship. Conclusions: Homotypic continuity of cannabis use, as well as heterotypic continuity from the father's cannabis use to the child's alcohol use and sexual intercourse existed in a father–daughter relationship. These findings suggest that family-based interventions for female adolescents whose father has suffered from a cannabis use disorder be developed to prevent better adolescents' early substance use and sexual intercourse.     

Association Between Using Smartphone Dating Applications and Alcohol and Recreational Drug Use in Conjunction With Sexual Activities in College Students

Background: The association between using smartphone dating applications (apps) and substance use in conjunction with sexual activities was only examined in homosexual men. This association was poorly understood in heterosexual samples. Objective: To explore the association between using dating apps and alcohol, and use of recreational drug in conjunction with sexual activities in college students. Design: 666 students from four universities in Hong Kong were recruited in this cross-sectional study in the year 2015. Outcome measures included the use of dating apps, sexual history, and drug and alcohol use. Multivariable logistic regressions were employed. Results: The use of dating apps for more than 1 year was found to be associated with recreational drug use in conjunction with sexual activities (adjusted odds ratio: 7.23). Other risk factors of recreational drug use in conjunction with sexual activities included being bisexual/homosexual male, a smoker, and having one's first sexual intercourse at the age of less than 16 years. The use of dating apps was not a risk factor for alcohol consumption in conjunction with sexual activities. Risk factors for alcohol consumption in conjunction with sexual activities included being older, having monthly income more than HKD5,000, and a smoker. Furthermore, risk factors for alcohol consumption in conjunction with the last sexual activity included currently being in a dating relationship, a smoker, and having sex with a casual partner. Conclusions: Using dating apps is an emerging risk factor of drug misuse. Interventions for practising safe sex and preventing drug use should be targeted at dating app users.     

No end to the crisis without an end to the waiver

ABSTRACT. Background: National adolescent drug use surveys are distributed in United States schools. Survey results determine trends in drug use and inform research and prevention efforts; however, students who have dropped out of school or were truant the day of the survey are excluded. Examining drug trends in a high-risk population (adolescents admitted for drug treatment) may better characterize drug users and their use patterns. Methods: The current study examined questionnaires completed by 939 adolescents admitted for substance abuse treatment between 1995 and 2010. Results: Age of first use (ranging from 13.2 years for alcohol to 15.1 years for cocaine) was significantly younger for cigarettes, alcohol, and cannabis than for “harder” drugs such as cocaine and heroin, and adolescents increased their use of almost every substance (except inhalants) with increasing age. This was not true of national data. Additionally, in the national data, less than 1.5% of participants reported using any of the harder drugs more than 5 times, but in the McLean data, even for harder drugs, >10% of adolescents used >50 times. Conclusions: In the high-risk sample examined here, progression to harder drugs is accelerated and increases with age regardless of sex. These data underscore the importance of prevention and immediate treatment when adolescent substance use is identified.     

Adolescent Substance Use and Sensation-Seeking on Sexual Behaviors Among Young Adults from Continuation High Schools

Background: Youth from continuation high schools report greater substance use and sensation-seeking than youth from regular high schools, yet their long-term consequences on age at sexual onset and the number of sexual partners are unknown. Objective: To examine substance use, sensation-seeking and sexual behaviors by gender and race/ethnicity and the effects of substance use and sensation-seeking in adolescence on age at sexual initiation and numbers of sexual partners by young adulthood. Methods: Baseline and 4-year follow-up data on youth from 14 continuation high schools in Southern California who participated in a drug abuse prevention intervention were analyzed. Structural equation modeling assessed whether or not substance use or sensation-seeking in adolescence predicted age at sexual onset and numbers of sexual partners by young adulthood. Results: Latinos had lower sensation-seeking and frequency of substance use and a later age at sexual onset than non-Latinos. Males were more likely than females to have multiple lifetime and recent sexual partners. The effects of adolescent substance use on the number of sexual partners by young adulthood were mediated fully by their age at sexual initiation. Sensation-seeking had no direct or indirect effects on sexual behaviors. Conclusions/Importance: Factors leading to and actual sexual risk behaviors among youth from continuation high schools vary by race/ethnicity and gender. Targeting these antecedent factors by race/ethnicity and gender may improve prevention efforts.     

A latent class analysis of the co-occurrence of sexual violence,substance use,and mental health in youth

Purpose: The purpose of this study was to understand co-occurrence of sexual violence, substance use, and mental health in youth and see if there are differences in experiences among sexual identities, races, and genders. Methods: The 2017 Youth Risk Behavior Survey sampled 14,638 high school students. Latent class analysis was used to understand the relationship between incidence of sexual violence, substance use, and depression and suicidality in a nationally representative sample. The model controlled for demographic and bullying covariates. Results: A four-class solution provided optimal fit. Classes were low risk (51.8%); low violence, frequent substance use, and high depression and suicidal ideation (29.7%); experienced violence and moderate mental health issues(5.1%); and some violence, high substance use, and high depression and suicidal ideation (13.4%). Youth who identified as sexual minority youth were almost 2.5–5 times more likely to be in the three higher risk classes than their heterosexual peers. Those who identified as “I don’t know” were almost 3 times more likely to be in the three higher risk classes than heterosexual youth. Multiracial youth had higher likelihood of being in the three riskier classes compared to Caucasian youth. Females were 2.5 and 3 times more likely to be in the low violence and some violence classes compared to males. Conclusion: The study’s finding distinct classes of co-occurring behavioral and mental health outcomes fill gaps in the current literature and informs practitioners that LGB youth and bi/multiracial youth were at an elevated risk of co-occurring victimization, substance use, and mental health problems.     

Differences Between Adolescents Who Complete and Fail to Complete Residential Substance Abuse Treatment

ABSTRACT

This study examined the admission characteristics associated with failure to complete residential substance abuse treatment among male adolescents. Of 160 admissions, 48 (30%) completed treatment. Having commercial health insurance (P= .005), having a family history of a substance use disorder (P= .05), and living with only one biological parent (P= .015) were admission characteristics associated with non-completion. Those reporting a history of physical or sexual abuse also appeared to be at risk for non-completion (P= .014); none of these participants completed the treatment. Interventions that improve residential substance abuse treatment retention for adolescents are needed.     

An Examination of Gender Differences in the Association of Adolescent Substance use with Eating and Weight Loss Attitudes

Objective: To assess gender differences in the relationship between eating and weight loss attitudes (EWAs), and 30-day tobacco and alcohol use among adolescents, while controlling for potential confounds (age, country of birth, psychological distress, pubertal development, peer alcohol and tobacco use, and sexual activity). Methods: School students aged between 11 and 17 years (N = 10,273) from high schools in the State of Victoria (Australia) completed surveys in class under conditions of anonymity and confidentiality. Results: The interaction between EWAs and gender was significant for tobacco use but not for alcohol use, indicating that the effect of EWAs on tobacco use, but not alcohol use, vary by gender. Conclusions: Tobacco use was related to EWAs in adolescent females but not males, and this is consistent with the possibility that females use tobacco in an instrumental fashion to control weight. Implications and Contribution: Female adolescents high in eating and weight loss attitudes were more likely to engage in tobacco use. In contrast, eating and weight loss attitudes were not related to male tobacco use. These results point to the potential importance of developing gender-specific approaches towards addressing problematic behaviors in adolescent populations.     

Sexual Orientation Disparities in Substance Misuse: The Role of Childhood Abuse and Intimate Partner Violence Among Patients in Care at an Urban Community Health Center

This study examined disparities in lifetime substance misuse by sexual orientation among 2,653 patients engaged in care at an urban community health center in Boston, MA, as well as the potential mediating roles of childhood abuse <age 15 (CA) and intimate partner violence (IPV). Violence indicators were highly associated with substance misuse, as was identifying as a sexual minority compared to heterosexual. CA and IPV experiences partly explained disparities in substance abuse by sexual orientation with differences seen by sex. Clinicians should assess history of CA and IPV among sexual minorities presenting with a history of substance abuse disorders. The study's limitations are noted.