Social Stress and Substance Use Disparities by Sexual Orientation Among High School Students

  • Richard Lowry
    Address correspondence to: Richard Lowry, MD, MS, Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Road, N.E. (Mailstop E-75), Atlanta GA 30329.
    Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Michelle M. Johns
    Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Leah E. Robin
    Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Laura K. Kann
    Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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      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.


      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).


      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.


      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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