Research has indicated that lesbian, gay, bisexual, and queer/questioning (LGBQ) adolescents have disproportionately high rates of substance use compared to heterosexual peers; yet certain features of schools and communities have been associated with lower substance use rates in this population. To advance this field, research examining multiple levels of influence using measures developed with youth input is needed. With community, school, and student data, this study tested hypotheses that LGBQ students attending high schools and living in communities with more LGBQ-supportive environments (assessed with a novel inventory tool) have lower odds of substance use behaviors (cigarette smoking, alcohol use, marijuana use, prescription drug misuse, and other drug use) than their peers in less supportive LGBQ environments. Multilevel models using data from 2454 LGBQ students (54.0% female, 63.9% non-Hispanic white) in 81 communities and adjusting for student and school covariates found that LGBQ adolescents who lived in areas with more community support had lower odds of frequent substance use, particularly among females. Expanding and strengthening community resources (e.g., LGBQ youth-serving organizations, LGBQ events such as a Pride parade, and LGBQ-friendly services) is recommended to further support LGBQ adolescents and reduce substance use disparities.
This is a preview of subscription content,to check access.
Access this article
Almeida, J., Johnson, R. M., Corliss, H. L., & Molnar, B. E. (2009). Emotional distress among LGBT youth: the influence of perceived discrimination based on sexual orientation. Journal of Youth and Adolescence, 38, 1001–1014. https://doi.org/10.1007/s10964-009-9397-9.
Boyd, C. J., Veliz, P. T., Stephenson, R., Hughes, T. L., & Mccabe, S. E. (2019). Severity of alcohol, tobacco, and drug use disorders among sexual minority individuals and their “Not Sure” counterparts. LGBT Health, 6(1), 15–22. https://doi.org/10.1089/lgbt.2018.0122.
Bronfenbrenner, U. (1979). The ecology of human development: experiments by nature and design. Cambridge, MA: Harvard University Press.
Brooks, V. (1981). Minority stress and lesbian women. In V. Brooks (Ed.) (pp. 71–90). Lexington, MA: Lexington Books.
Cochran, S. D., & Mays, V. M. (2009). Burden of psychiatric morbidity among lesbian, gay, and bisexual individuals in the California Quality of Life Survey. Journal of Abnormal Psychology, 118(3), 647–58. https://doi.org/10.1037/a0016501.
Corliss, H. L., Goodenow, C. S., Nichols, L., & Austin, S. B. (2011). High burden of homelessness among sexual-minority adolescents: findings from a representative Massachusetts high school sample. American Journal of Public Health, 101(9), 1683–9. https://doi.org/10.2105/AJPH.2011.300155.
Coulter, R., Birkett, M., Corliss, H. L., Hatzenbuehler, M. L., Mustanski, B., & Stall, R. D. (2016). Associations between LGBTQ-affirmative school climate and adolescent drinking behaviors. Drug and Alcohol Dependence, 161, 340–347.
Demissie, Z., Brener, N. D., Mcmanus, T., Shanklin, S. L., Hawkins, J., & Kann, L. (2014). School Health Profiles 2014: Characteristics of Health Programs Among Secondary Schools. School Health Profiles, 1–197. http://www.cdc.gov/healthyyouth/data/profiles/results.htm.
Domina, T., Brummet, Q., Pharris-ciurej, N., Porter, S. R., Penner, A., Penner, E., & Sanabria, T. (2017). Capturing more than poverty: school free and reduced-price lunch data and household income. CARRA Working Paper Series; Working Paper 2017-09. Washington, DC.
Eisenberg, M. E., Gower, A. L., McMorris, B. J., & Bucchianeri, M. M. (2015). Vulnerable bullies: perpetration of peer harassment in youth across sexual orientation, weight and disability status. American Journal of Public Health, e1–e8. https://doi.org/10.2105/AJPH.2015.302704.
Eisenberg, M. E., McMorris, B. J., Gower, A. L., & Chatterjee, D. (2016). Bullying victimization and emotional distress: is there strength in numbers for vulnerable youth? Journal of Psychosomatic Research, 86, 13–19. https://doi.org/10.1016/j.jpsychores.2016.04.007.
Eisenberg, M. E., Mehus, C. J., Saewyc, E. M., Corliss, H. L., Gower, A. L., Sullivan, R., & Porta, C. M. (2017). Helping young people stay afloat: a qualitative study of community resources and supports for LGBTQ adolescents in the United States and Canada. Journal of Homosexuality, 65(8), 969–989. https://doi.org/10.1080/00918369.2017.1364944.
Eisenberg, M. E., & Resnick, M. D. (2006). Suicidality among gay, lesbian and bisexual youth: the role of protective factors. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 39(5), 662–8. https://doi.org/10.1016/j.jadohealth.2006.04.024.
Esri (n.d.). Create Drive-Time Areas. doc.arcgis.com/en/arcgis-online/analyze/create-drive-time-areas.htm. Accessed 1 Feb 2018.
Fish, J. N., Watson, R. J., Russell, S. T., & Saewyc, E. M. (2017). Are alcohol-related disparities between sexual minority and heterosexual youth decreasing? Addiction, 112, 1931–1941. https://doi.org/10.1111/add.13896.
Gower, A. L., Forster, M., Gloppen, K., Johnson, A. Z., Eisenberg, M. E., Connett, J. E., & Borowsky, I. W. (2017). School practices to foster LGBT-supportive climate: associations with adolescent bullying involvement. Prevention Science. https://doi.org/10.1007/s11121-017-0847-4.
Gower, A. L., Rider, G. N., Brown, C., McMorris, B. J., Coleman, E., Taliaferro, L. A., & Eisenberg, M. E. (2018). Supporting transgender and gender diverse youth: protection against emotional distress and substance use. American Journal of Preventive Medicine, 55(6), 787–704. https://doi.org/10.1016/J.AMEPRE.2018.06.030.
Gower, A. L., Saewyc, E. M., Corliss, H. L., Kne, L., Erickson, D. J., & Eisenberg, M. E. (2019). The LGBTQ supportive environments inventory: methods for quantifying supportive environments for LGBTQ youth. Journal of Gay & Lesbian Social Services, 31(3), 314–331.
Hatzenbuehler, M. L. (2011). The social environment and suicide attempts in lesbian, gay, and bisexual youth. Pediatrics, 127(5), 896–903. https://doi.org/10.1542/peds.2010-3020.
Hatzenbuehler, M. L. (2017). Advancing research on structural stigma and sexual orientation disparities in mental health among youth. Journal of Clinical Child and Adolescent Psychology, 46(3), 463–475. https://doi.org/10.1080/15374416.2016.1247360.
Hatzenbuehler, M. L., Birkett, M., Van Wagenen, A., & Meyer, I. H. (2014). Protective school climates and reduced risk for suicide ideation in sexual minority youths. American Journal of Public Health, 104(2), 279–86. https://doi.org/10.2105/AJPH.2013.301508.
Hatzenbuehler, M. L., Jun, H. J., Corliss, H. L., & Austin, S. B. (2014). Structural stigma and cigarette smoking in a prospective cohort study of sexual minority and heterosexual youth. Annals of Behavioral Medicine, 47(1), 48–56. https://doi.org/10.1007/s12160-013-9548-9.
Hatzenbuehler, M. L., Jun, H. J., Corliss, H. L., & Bryn Austin, S. (2015). Structural stigma and sexual orientation disparities in adolescent drug use. Addictive Behaviors, 46, 14–18. https://doi.org/10.1016/j.addbeh.2015.02.017.
Hatzenbuehler, M. L., Pachankis, J. E., & Wolff, J. (2012). Religious climate and health risk behaviors in sexual minority youths: a population-based study. American Journal of Public Health, 102(4), 657–63. https://doi.org/10.2105/AJPH.2011.300517.
Heck, N. C., Flentje, A., & Cochran, B. N. (2013). Offsetting risks: high school gay-straight alliances and lesbian, gay, bisexual, and transgender (LGBT) youth. Psychology of Sexual Orientation and Gender Diversity, 1(2), 81–90. https://doi.org/10.1037/2329-0382.1.S.81.
Heidari, S., Babor, T., De Castro, P., Tort, S., & Curno, M. (2016). Sex and gender equity in research: Rationale for the SAGER guidelines and recommended use. Research Integrity and Peer Review, 1(2). https://doi.org/10.1186/s41073-016-0007-6.
Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. Washington, DC: National Academies Press.
Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Hawkins, J., & Zaza, S. (2016a). Youth risk behavior surveillance—United States, 2015. Morbidity and Mortality Weekly Report, 65(6), 1–180.
Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., … Ethier, K. (2018). Youth Risk Behavior Surveillance—United States, 2017. Morbidity and Mortality Weekly Report, 67(8) 1–114.
Kann, L., Olsen, E. O., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., & Zaza, S. (2016b). Sexual identity, sex of sexual contacts, and health-related behaviors among students in grades 9–12 — United States and selected sites, 2015. MMWR. Surveillance Summaries, 65(9), 1–202. https://doi.org/10.15585/mmwr.ss6509a1.
Kidd, J. D., Jackman, K. B., Wolff, M., Veldhuis, C. B., & Hughes, T. L. (2018). Risk and protective factors for substance use among sexual and gender minority youth: a scoping review. Current Addiction Reports, 5(2), 158–173. https://doi.org/10.1007/s40429-018-0196-9.Risk.
Konishi, C., Saewyc, E. M., Homma, Y., & Poon, C. (2013). Population-level evaluation of school-based interventions to prevent problem substance use among gay, lesbian and bisexual adolescents in Canada. Preventive Medicine, 57, 929–933.
Manson, S., Schroeder, J., Van Riper, D., & Ruggles, S. (2017). IPUMS national historical geographic information system: version 12.0 [database]. Minneapolis, MN: University of Minnesota. 10.18128/D050.V12.0.
McLeroy, K., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351–377.
Meyer, I. (1995). Minority stress and mental health in gay men. Journal of Health & Social Behavior, 36(1), 38–56.
Meyer, I. (2003). Minority Stress and Mental Health in Gay Men. In L. Garnets & D. Kimmel (Eds.). Psychological perspectives on lesbian, gay, and bisexual experiences. (2nd ed., pp. 699–731). New York, NY: Columbia University Press.
Minnesota Center for Health Statistics. (n.d.). Minnesota Student Survey. http://www.health.state.mn.us/divs/chs/mss/. Accesssed 11Oct 2016.
National Center for Education Statistics (NCES). (n.d.). http://nces.ed.gov/datalab/quickstats/createtable.aspx
Office of the Minnesota Secretary of State Steve Simon. (2012). Elections and voting: results for constitutional amendments. http://electionresults.sos.state.mn.us/Results/AmendmentResultsStatewide/1. Accessed 10 Jan 2018.
Poteat, V. P., Sinclair, K. O., Digiovanni, C. D., Koenig, B. W., & Russell, S. T. (2012). Gay—straight alliances are associated with student health: a multischool comparison of LGBTQ and heterosexual youth. Journal of Research on Adolescence, 23(2), 319–330. https://doi.org/10.1111/j.1532-7795.2012.00832.x.
Saewyc, E. M. (2011). Research on adolescent sexual orientation: development, health disparities, stigma and resilience. Journal of Research on Adolescence, 21(1), 256–272.
Saewyc, E. M., Homma, Y., Skay, C. L., Bearinger, L. H., Resnick, M. D., & Reis, E. (2009). Protective factors in the lives of bisexual adolescents in North America. American Journal of Public Health, 99(1), 110–7. https://doi.org/10.2105/AJPH.2007.123109.
Sallis, J., & Owen, N. (2002). Ecological Models of Health Behavior. In K. Glanz, B. K. Rimer, & F. M. Lewis (Eds.) Health Behavior: Theory, Research, and Practice. (3rd ed., pp. 462–484). San Francisco, CA: Josey-Bass.
Stata Corp. (2017). Stata statistical software. College Station, TX: StataCorp LLC.
Su, J., Supple, A., & Kuo, S. (2018). The role of individual and contextual factors in differentiating substance use profiles among adolescents. Substance Use & Misuse, 53(5), 734–743. https://doi.org/10.1080/10826084.2017.1363237.
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(2), 295–303. https://doi.org/10.2105/AJPH.2013.301627.
Watson, R. J., Goodenow, C., Porta, C. M., Adjei, J., & Saewyc, E. M. (2018a). Substance use among sexual minorities: Has it actually gotten better? Substance Use & Misuse, 53, 1221–1228. https://doi.org/10.1080/10826084.2017.1400563.
Watson, R. J., Lewis, N., Fish, J. N., & Goodenow, C. S. (2018b). Sexual minority youth continue to smoke cigarettes earlier and more often than heterosexual peers: Findings from population-based data. Drug and Alcohol Dependence, 183, 64–70. https://doi.org/10.1016/j.drugalcdep.2017.11.025.
Wolowic, J. M., Sullivan, R., Valdez, C. A. B., Porta, C. M., & Eisenberg, M. E. (2018). Come along with me: linking LGBTQ youth to supportive resources. International Journal of Child, Youth and Family Studies, 9(3), 1 https://doi.org/10.18357/ijcyfs93201818274.
Minnesota Student Survey data were provided by public school students in Minnesota via local public school districts and are managed by the Minnesota Student Survey Interagency Team.
MEE conceived of the study and drafted and revised the manuscript; DJE managed the data and conducted statistical analysis; ALG oversaw community-level data collection, aided in interpretation of data; LK created the spatial dataset and aided in interpretation of data; RJW participated in community-level data collection and aided in interpretation of data; HLC participated in the design of the study and aided in interpretation of data; EMS participated in the design of the study and aided in interpretation of data. All authors reviewed and critically revised multiple manuscript drafts and approved the final manuscript.
Data Sharing Declaration
This manuscript's data will not be deposited.
This research was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD078470. Watson acknowledges support from the National Institute of Drug Abuse under Award Number K01DA047918. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Conflict of Interest
The authors declare that they have no conflict of interest.
The University of Minnesota’s Institutional Review Board exempted this analysis from review due to use of existing anonymous student data and publicly available organizational and institutional (i.e. non-human) data.
Parental notification and student assent were used for surveys, in accordance with applicable federal laws.
Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Eisenberg, M.E., Erickson, D.J., Gower, A.L. et al. Supportive Community Resources Are Associated with Lower Risk of Substance Use among Lesbian, Gay, Bisexual, and Questioning Adolescents in Minnesota. J Youth Adolescence 49, 836–848 (2020). https://doi.org/10.1007/s10964-019-01100-4