Introduction
Sexual minority youth often experience increased social stress due to prejudice, discrimination,
harassment, and victimization. Increased stress may help explain the disproportionate
use of substances like tobacco, alcohol, marijuana, and other illicit drug use by
sexual minority youth. This study examined the effect of social stress on substance
use disparities by sexual orientation among U.S. high school students.
Methods
In 2016, data from the national 2015 Youth Risk Behavior Survey, conducted among a
nationally representative sample of 15,624 U.S. high school students, were analyzed
to examine the effect of school-related (threatened/injured at school, bullied at
school, bullied electronically, felt unsafe at school) and non–school-related (forced
sexual intercourse, early sexual debut) social stress on substance use disparities
by sexual orientation, by comparing unadjusted prevalence ratios (PRs) and adjusted
(for social stressors, age, sex, and race/ethnicity) prevalence ratios (APRs).
Results
Unadjusted PRs reflected significantly (p<0.05 or 95% CI did not include 1.0) greater substance use among students who identified
as lesbian/gay or bisexual than students who identified as heterosexual. APRs for
injection drug use decreased substantially among lesbian/gay (PR=12.02 vs APR=2.14)
and bisexual (PR=2.62 vs APR=1.18) students; the APR for bisexual students became
nonsignificant. In addition, APRs among both lesbian/gay and bisexual students decreased
substantially and were no longer statistically significant for cocaine, methamphetamine,
and heroin use.
Conclusions
School-based substance use prevention programs might appropriately include strategies
to reduce social stress, including policies and practices designed to provide a safe
school environment and improved access to social and mental health services.
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Article info
Publication history
Published online: August 18, 2017
Identification
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Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine
