Sexual and Gender Minority Youth Alcohol Use: Within-Group Differences in Associations with Internalized Stigma and Victimization

  • Ryan J. WatsonEmail author
  • Jessica N. Fish
  • V. Paul Poteat
  • Taylor Rathus
Empirical Research


Sexual and gender minority (SGM) youth are more likely to use alcohol than their heterosexual cisgender peers. At the same time, SGM youth experience sexuality- and gender identity-specific stressors known to exacerbate negative health outcomes. Though scholars have established a link between minority stressors (e.g., internalized stigma and victimization) and increased alcohol use for SGM youth as a whole, there is little indication of whether internalized stigma and victimization are more strongly associated with alcohol use for specific groups of SGM youth. A United States sample of 11,811 racially and geographically diverse 13–17 year old SGM youth was used to employ a series of gender-stratified multivariable regression models to examine the association among internalized stigma, victimization, and alcohol-related behaviors, and whether they differed for specific groups of sexual minority youth. Sexual orientation moderated several associations between sexual minority stressors (i.e., victimization and stigma) and youth’s alcohol use (i.e., recent use and heavy episodic drinking) across models stratified by gender (i.e., male, female, and non-binary). For example, bisexual boys had stronger associations between SGM-specific victimization and alcohol use frequency and heavy episodic drinking relative to gay boys; conversely, victimization and alcohol use frequency were more weakly associated among bisexual girls relative to lesbian/gay girls. Pansexual girls showed weaker associations between internalized stigma and alcohol use frequency compared to lesbian/gay girls. This paper demonstrates who among SGM youth are more likely to engage in alcohol-related behaviors as a function of differential forms of SGM-related victimization and stigma. These findings can inform substance use interventions that are tailored to youth of diverse sexual orientations and gender identities.


Sexual gender minority Internalized stigma Bisexual health Heavy episodic drinking 



This research uses data from the LGBTQ National Teen Study, designed by Ryan J. Watson and Rebecca M. Puhl in collaboration with the Human Rights Campaign, and supported by the Office for Vice President of Research at the University of Connecticut. The authors acknowledge the important contributions of Ellen Kahn, Gabe Murchison, and Liam Miranda in their support, conceptualization, and management related to the LGBTQ National Teen Study.

Authors’ Contributions

R.J.W. conceived of the study, participated in its design and coordination, conceptualized the analytic strategy, and drafted the manuscript; J.N.F. participated in the design, conceptualizing of the analytic strategy, interpretation of the data, drafting of the manuscript, and critical review of the manuscript; P.P. participated in performing the analyses for the project, conceptualizing the analytic strategy, and contributed to writing portions of the manuscript; T.R. drafted portions of the manuscript, interpreted results, and critically reviewed multiple versions. All authors read and approved the final manuscript.


This work was supported through funding by the National Institutes of Drug Abuse (grants R03DA046827 and K01DA047918), the Eunice Kennedy Shriver National Center for Child Health and Human Development (grant P2CHD041041) awarded to the Maryland Population Research Center, the Centers for Disease Control and Prevention for a cooperative agreement (grant U48DP006382), and the National Institutes of Mental Health (grant T32MH074387). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Data Sharing and Declaration

This manuscript’s data will not be deposited.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All study procedures were approved by the University of Connecticut IRB board, protocol H16-322.

Informed Consent

Informed assent was obtained from all youth participants included in the study. A waiver of parental consent was obtained from the IRB related to this study.


  1. Amadio, D. M., & Chung, Y. B. (2004). Internalized homophobia and substance use among lesbian, gay, and bisexual persons. Journal of Gay & Lesbian Social Services, 17, 83–101. Scholar
  2. Baiocco, R., D’Alessio, M., & Laghi, F. (2010). Binge drinking among gay, and lesbian youths: The role of internalized sexual stigma, self-disclosure, and individuals’ sense of connectedness to the gay community. Addictive Behaviors, 35, 896–899. Scholar
  3. Birkett, M., Espelage, D. L., & Koenig, B. (2009). LGB and questioning students in schools: The moderating effects of homophobic bullying and school climate onnegative outcomes. Journal of Youth and Adolescence, 38, 989–1000. Scholar
  4. Bontempo, D. E., & D’Augelli, A. R. (2002). Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths’ health risk behavior. Journal of Adolescent Health, 30, 364–374. Scholar
  5. Bos, H., van Beusekom, G., & Sandfort, T. (2016). Drinking motives, alcohol use, and sexual attraction in youth. Journal of Sex Research, 53(3), 309–312.CrossRefGoogle Scholar
  6. Coulter, R. W., Blosnich, J. R., Bukowski, L. A., Herrick, A. L., Siconolfi, D. E., & Stall, R. D. (2015). Differences in alcohol use and alcohol-related problems between transgender-and nontransgender-identified young adults. Drug and Alcohol Dependence, 154, 251–259. Scholar
  7. Day, J. K., Fish, J. N., Perez-Brumer, A., Hatzenbuehler, M. L., & Russell, S. T. (2017). Transgender youth substance use disparities: results from a population-based sample. Journal of Adolescent Health, 61, 729–735. Scholar
  8. Eisenberg, M. E., Gower, A. L., McMorris, B. J., Rider, G. N., Shea, G., & Coleman, E. (2017). Risk and protective factors in the lives of transgender/gender nonconforming adolescents. Journal of Adolescent Health, 61, 521–526. Scholar
  9. Feinstein, B. A., Turner, B. C., Beach, L. B., Korpak, A. K., & Phillips, G. (2019). Racial/ethnic differences in mental health, substance use, and bullying victimization among self-identified bisexual high school-aged youth. LGBT Health, Online Early View. Scholar
  10. Fish, J. N., & Baams, L. (2018). Trends in alcohol-related disparities between heterosexual and sexual minority youth from 2007 to 2015: Findings from the Youth Risk Behavior Survey. LGBT Health, 5, 359–367. Scholar
  11. Fish, J. N., Schulenberg, J. E., & Russell, S. T. (2018). Sexual minority youth report high-intensity binge drinking: the critical role of school victimization. Journal of Adolescent Health, 64, 186–193. Scholar
  12. Fish, J. N., Watson, R. J., Porta, C., Russell, S. T., & Saewyc, E. (2016). Are alcohol-related disparities between sexual minority and heterosexual youth decreasing? Addiction, 112, 1931–1941. Scholar
  13. Gilbert, P. A., Pass, L. E., Keuroghlian, A. S., Greenfield, T. K., & Reisner, S. L. (2018). Alcohol research with transgender populations: a systematic review and recommendations to strengthen future studies. Drug and Alcohol Dependence, 186, 138–146. Scholar
  14. Goldbach, J. T., Tanner-Smith, E. E., Bagwell, M., & Dunlap, S. (2014). Minority stress and substance use in sexual minority adolescents: a meta-analysis. Prevention Science, 15, 350–363. Scholar
  15. Hatzenbuehler, M. L., Schwab-Reese, L., Ranapurwala, S. I., Hertz, M. F., & Ramirez, M. R. (2015). Associations between antibullying policies and bullying in 25 states. JAMA Pediatrics, 169, e152411–e152411. Scholar
  16. Hughes, T. L., Wilsnack, S. C., & Kantor, L. W. (2016). The influence of gender and sexual orientation on alcohol use and alcohol-related problems: toward a global perspective. Alcohol Research, 38, 121–132.PubMedGoogle Scholar
  17. Institute of Medicine (IOM). (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington (DC): National Academies Press.Google Scholar
  18. Kaestle, C. E., & Ivory, A. H. (2012). A forgotten sexuality: Content analysis of bisexuality in the medical literature over two decades. Journal of Bisexuality, 12, 35–48. Scholar
  19. Kann, L., Olsen, E. O., & McManus, T. (2016). Sexual identity, sex of sexual contacts, and health-related behaviors among students in grades 9–12—United States and selected sites, 2015. MMWR Surveillance Summary, 65, 1–202.Google Scholar
  20. Marshal, M. P., Friedman, M. S., Stall, R., King, K. M., Miles, J., & Gold, M. A. et al. (2008). Sexual orientation and adolescent substance use: A meta-analysis and methodological review. Addiction, 103, 546–556. Scholar
  21. Mereish, E. H., & Miranda, R. (2019). Exposure to stigma elicits negative affect and alcohol craving among young adult sexual minority heavy drinkers. Alcoholism: Clinical and Experimental Research, 43, 1263–1272.Google Scholar
  22. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin, 129, 674–697. Scholar
  23. Mohr, J., & Fassinger, R. (2000). Measuring dimensions of lesbian and gay male experience. Measurement and Evaluation in Counseling and Development, 33(2), 66–90.CrossRefGoogle Scholar
  24. Muthén, L. K., & Muthén, B. (2019). Mplus. The comprehensive modelling program for applied researchers: user’s guide, 5.
  25. National Institutes of Alcohol Abuse and Alcoholism. (2019). Drinking levels defined. National Institutes of Alcohol Abuse and Alcoholism.
  26. Phillips, II, E., Wang, T. W., Husten, C. G., Corey, C. G., Apelberg, B. J., Jamal, A., & King, B. A. (2017). Tobacco product use among adults—United States, 2015. MMWR. Morbidity and Mortality Weekly Report, 66, 1209–1215. Scholar
  27. Pitkänen, T., Kokko, K., Lyyra, A. L., & Pulkkinen, L. (2008). A developmental approach to alcohol drinking behaviour in adulthood: a follow-up study from age 8 to age 42. Addiction, 103, 48–68. Scholar
  28. Pollitt, A. M., Mallory, A. B., & Fish, J. N. (2018). Homophobic bullying and sexual minority youth alcohol use: Do sex and race/ethnicity matter? LGBT Health, 5, 412–420. Scholar
  29. Puhl, R. M., Himmelstein, M., & Watson, R. J. (2019). Weight-based victimization among sexual and gender minority adolescents: Findings from a diverse national sample. Pediatric Obesity, 14, e12514. Scholar
  30. Reisner, S. L., White, J. M., Bradford, J. B., & Mimiaga, M. J. (2014). Transgender health disparities: comparing full cohort and nested matched-pair study designs in a community health center. LGBT Health, 1, 177–184. Scholar
  31. Robinson-Cimpian, J. P. (2014). Inaccurate estimation of disparities due to mischievous responders: several suggestions to assess conclusions. Educational Researcher, 43, 171–185. Scholar
  32. Russell, S. T., & Fish, J. N. (2019). Sexual minority youth, social change, and health: a developmental collision. Research in Human Development, 16, 5–20. Scholar
  33. Russell, S. T., Sinclair, K. O., Poteat, V. P., & Koenig, B. W. (2012). Adolescent health and harassment based on discriminatory bias. American Journal of Public Health, 102, 493–495. Scholar
  34. Ryan, C., Russell, S. T., Huebner, D., Diaz, R., & Sanchez, J. (2010). Family acceptance in adolescence and the health of LGBT young adults. Journal of Child and Adolescent Psychiatric Nursing, 23, 205–213. Scholar
  35. Shidlo, A In B. Greene, G. M. Herek, (Eds) (1994). Internalized homophobia: Conceptual and empirical issues in measurement. Psychological perspectives on lesbian and gay issues, Vol. 1. Lesbian and gay psychology: Theory, research, and clinical applications. (pp. 176–205). Thousand Oaks, CA: US: Sage Publications, Inc.
  36. Smalley, K. B., Warren, J. C., & Barefoot, K. N. (2016). Differences in health risk behaviors across understudied LGBT subgroups. Health Psychology, 35, 103–114. Scholar
  37. Taliaferro, L. A., Gloppen, K. M., Muehlenkamp, J. J., & Eisenberg, M. E. (2018). Depression and suicidality among bisexual youth: a nationally representative sample. Journal of LGBT Youth, 15, 16–31. Scholar
  38. Talley, A. E., Hughes, T. L., Aranda, F., Birkett, M., & Marshal, M. P. (2014). Exploring alcohol-use behaviors among heterosexual and sexual minority adolescents: intersections with sex, age, and race/ethnicity. American Journal of Public Health, 104, 295–303. Scholar
  39. Toomey, R. B., Syvertsen, A. K., & Shramko, M. (2018). Transgender adolescent suicide behavior. Pediatrics, 142, e20174218. Scholar
  40. Watson, R. J., Veale, J. F., Gordon, A. R., Clark, B. A., & Saewyc, E. M. (2019a). Risk and protective factors for transgender youths’ substance use. Preventive Medicine Reports, 15, 100905. Scholar
  41. Watson R.J., Wheldon, C.W., & Puhl, R.M. (2019b) Evidence of diverse identities in a large national sample of sexual and gender minority adolescents. Journal of Research on Adolescence, Online Early View, 1–12. (in press).
  42. White, A., & Hingson, R. (2013). The burden of alcohol use: excessive alcohol consumption and related consequences among college students. Alcohol Research: Current Reviews, 35, 201–218.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Human Development and Family SciencesUniversity of ConnecticutStorrsUSA
  2. 2.Department of Family Science, School of Public HealthUniversity of MarylandCollege ParkUSA
  3. 3.Department of Counseling, Developmental, and Educational PsychologyBoston CollegeChestnut HillUSA

Personalised recommendations