Associations between sexual orientation discrimination and substance use disorders: differences by age in US adults
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Sexual minorities are at heightened risk for substance use disorders (SUDs). Discrimination based on sexual orientation may be an important factor in this increased risk, but differences across age have not been systematically examined. We examined age-varying associations of sexual orientation discrimination with alcohol use disorder (AUD), tobacco use disorder (TUD), and drug use disorder (DUD).
We used data from US participants aged 18–50 years who reported non-heterosexual identity, attraction, or behavior (N = 2375) in a nationally representative survey. We examined the prevalence of sexual orientation discrimination across age and its salience as a risk factor for AUD, TUD, and DUD for gay/lesbian, bisexual, and heterosexual identifying individuals using time-varying effect modeling.
Sexual orientation discrimination was most prevalent in early young adulthood but was positively associated with greater odds of AUD, TUD, and DUD only at later ages. We found statistically significant associations at ages 24.5–40.0 for AUD, ages 32.5–42.9 for DUD, and ages 39.3–43.2 for TUD. For example, discrimination at age 30 was associated with 2.1 times greater odds of AUD (95% CI 1.3, 3.3) compared to those who reported no discrimination at that age. Discrimination at age 35 was associated with 2.8 times greater odds of DUD (95% CI 1.2, 6.6) relative to no discrimination.
Sexual orientation discrimination is significantly associated with SUDs and risk varies across age. Thus, age should be considered in the development of prevention and treatment of AUD, TUD, and DUD, particularly for sexual minorities.
KeywordsSexual minorities Substance use disorders Discrimination Time-varying effect models
This research was supported by Grants R01AA025684 (PI: McCabe) and R01AA013328 (PI: Hughes) from the National Institute on Alcohol Abuse and Alcoholism, R01DA043696 (PI: Boyd) and R01DA036541 (PI: McCabe) from the National Institute on Drug Abuse, and R01CA212517 (PI: McCabe) from the National Cancer Institute.
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
- 5.Coulter RWS, Jun HJ, Calzo JP, Truong NL, Mair C, Markovic N, Charlton BM, Silvestre AJ, Stall R, Corliss HL (2018) Sexual-orientation differences in alcohol use trajectories and disorders in emerging adulthood: results from a longitudinal cohort study in the United States. Addiction 113(9):1619–1632CrossRefGoogle Scholar
- 11.Grant BF, Chu A, Sigman R, Amsbary M, Kali J, Sugawara Y, Goldstein R (2014) Source and accuracy statement: National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC III). National Institute on Alcohol Abuse and Alcoholism, RockvilleGoogle Scholar
- 12.Grant BF, Goldstein RB, Smith SM, Jung J, Zhang H, Chou SP, Pickering RP, Ruan WJ, Huang B, Saha TD, Aivadyan C, Greenstein E, Hasin DS (2015) The alcohol use disorder and Associated Disabilities Interview Schedule-5(AUDADIS-5): reliability of substance use and psychiatric disorder modules in a general population sample. Drug Alcohol Depend 148:27–33CrossRefGoogle Scholar
- 14.Hastie T, Tibshirani R (1993) Varying-coefficient models. J R Stat Soc Ser B (Methodological) 55:757–779Google Scholar
- 17.Kerridge BT, Pickering RP, Saha TD, Ruan WJ, Chou SP, Zhang H, Hasin DS (2017) Prevalence, sociodemographic correlates and DSM-5 substance use disorders and other psychiatric disorders among sexual minorities in the United States. Drug Alcohol Depend 170:82–92. https://doi.org/10.1016/j.drugalcdep.2016.10.038 CrossRefPubMedGoogle Scholar
- 19.Li R, Dziak JD, Tan X, Huang L, Wagner AT, Yang J (2015) TVEM (Time-varying Effect Model) SAS Macro Users’ Guide (Version 3.1.0). University Park, PA, p 2. http://methodology.psu.edu
- 28.Reeves WC, Strine TW, Pratt LA, Thompson W, Ahluwalia I, Dhingra SS, McKnight-Eily LR, Harrison L, D’Angelo DV, Williams L, Morrow B, Gould D, Safran MA (2011) Mental illness surveillance among adults in the United States. Morbidity and Mortality Weekly Report CDC Surveillance Summaries, vol 60, no (Suppl. 3), pp 1–29. https://www.cdc.gov/mmwr/preview/mmwrhtml/ su6003a1.htm
- 32.Substance Abuse and Mental Health Services Administration (2018) Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication No. SMA 18-5068, NSDUH Series H-53). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/
- 36.U.S. Department of Health and Human Services (2014) The health consequences of smoking—50 years of progress: a report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, AtlantaGoogle Scholar
- 39.World Health Organization (2011) WHO report on the global tobacco epidemic. World Health Organization, GenevaGoogle Scholar