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


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.

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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.

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Correspondence to Ryan J. Watson.

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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.

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Watson, R.J., Fish, J.N., Poteat, V.P. et al. Sexual and Gender Minority Youth Alcohol Use: Within-Group Differences in Associations with Internalized Stigma and Victimization. J Youth Adolescence 48, 2403–2417 (2019).

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