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Minority Stress and Substance Use in Sexual Minority Adolescents: A Meta-analysis

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Abstract

Lesbian, gay, and bisexual (LGB) adolescents report disparate rates of substance use, and often consume more cigarettes, alcohol, marijuana, cocaine, and ecstasy than their heterosexual peers. It is therefore crucial to understand the risk factors for substance use among LGB adolescents, particularly those unique to their minority status. In an effort to organize the current knowledge of minority-related risk factors for substance use among LGB youth, this study presents results from a systematic review and meta-analysis of the published research literature. Results from 12 unique studies of LGB youth indicated that the strongest risk factors for substance use were victimization, lack of supportive environments, psychological stress, internalizing/externalizing problem behavior, negative disclosure reactions, and housing status. Results are discussed in terms of their implications for targeted intervention programs that address minority stress risk factors for substance use among LGB youth.

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Notes

  1. The authors recognize that several other subgroups fall within the umbrella of “sexual minority” (e.g., transgender); however, in order to conduct the meta-analytic approaches, the study was limited to sexual behavior: lesbian, gay, and bisexual (LGB).

  2. This strategy was necessary to avoid violating the assumption that all effect sizes within a given analysis are statistically independent. Sensitivity analysis (not shown but available upon request) that examined effects separately within each type of substance use outcome were substantively similar to those reported here that combine across substance use outcome types. Because results were substantively unchanged, and the small number of studies and low statistical power associated with those analyses, we elected to present results combined across substances. However, Table 1 provides the effect sizes split by each type of substance use outcome for readers interested in substance-specific effects.

  3. Minority stress categories refer broadly to risk factors unique to a specific minority group within a population. Even when the entire population experiences a particular risk factor, its prevalence and consequences may be contextually or qualitatively different among a specific minority subset of the population. For instance, physical victimization due to sexual orientation is clearly a minority stress risk factor, as it is experienced only by LGB youth (or youth perceived as LGB). Thus, although physical victimization occurs for both LGB and heterosexual youth, it can be conceptualized as a minority stress risk factor when experienced by LGB youth. Physical victimization may be directly related to LGB minority status, even if such minority related specificity is not explicitly measured in a given risk factor scale.

References

Studies included in the meta-analysis are marked with an asterisk

  • *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. doi:10.1016/S1054-139X(01)00415-3

    Google Scholar 

  • Bouris, A., Guilamo-Ramos, V., Jaccard, J., Ballan, M., Lesesne, C. A., & Gonzalez, B. (2011). Early adolescent romantic relationships and maternal approval among inner city Latino families. AIDS and Behavior, 16, 1570–1583. doi:10.1007/s10461-011-0034-8.

    Article  Google Scholar 

  • Castro, F. G., Barrera, M. J., & Martinez, C. R. (2004). The cultural adaptation of prevention intervention: Resolving tensions between fidelity and fit. Prevention Science, 5, 41–45. doi:10.1023/B:PREV.0000013980.12412.cd.

    Article  PubMed  Google Scholar 

  • Cervantes, R., Goldbach, J., & Santos, S. (2011). Familia Adelante: A multi-risk prevention intervention for Latino families. The Journal of Primary Prevention, 32, 225–234. doi:10.1007/s10935-011-0251-y.

    Article  PubMed Central  PubMed  Google Scholar 

  • Cole, S. W., Kemeny, M. E., Taylor, S. E., & Visscher, B. R. (1996). Elevated physical health risk among gay men who conceal their homosexual identity. Health Psychology, 15, 243–251.

    Article  CAS  PubMed  Google Scholar 

  • Corliss, H. L., Rosario, M., Wypij, D., Wylie, S. A., Frazier, A. L., & Austin, S. B. (2010). Sexual orientation and drug use in a longitudinal cohort study of U.S. adolescents. Addictive Behaviors, 35, 517–521. doi:10.1016/j.addbeh.2009.12.019.

    Article  PubMed Central  PubMed  Google Scholar 

  • *Darwich, L., Hymel, S., & Waterhouse, T. (2012). School avoidance and substance use among lesbian, gay, bisexual, and questioning youths: The impact of peer victimization and adult support. Journal of Educational Psychology, 104(2), 381–392

    Google Scholar 

  • D'Augelli, A. R. (2006). Developmental and contextual factors and mental health among lesbian, gay, and bisexual youths. In A. Omoto & H. S. Kurtzman (Eds.), Sexual orientation and mental health: Examining identity and development in lesbian, gay, and bisexual people. Contemporary perspectives on lesbian, gay, and bisexual psychology (pp. 37–53). Washington: American Psychological Association.

    Chapter  Google Scholar 

  • D’Augelli, A. R., & Grossman, A. H. (2001). Disclosure of sexual orientation, victimization, and mental health among lesbian, gay, and bisexual older adults. Journal of Interpersonal Violence, 16, 1008–1027.

    Article  Google Scholar 

  • Dom, G., Sabbe, B., Hustijn, W., & Van Den Brink, W. (2005). Substance use disorders and the orbitofrontal cortex: Systematic review of behavioural decision-making and neuroimaging studies. The British Journal of Psychiatry, 187, 209–220. doi:10.1192/bjp.187.3.209.

    Article  CAS  PubMed  Google Scholar 

  • Elze, D. E. (2007). Research with sexual minority youth. Journal of Gay and Lesbian Social Services, 18, 73–99.

    Article  Google Scholar 

  • Emery, E. M., McDermott, R. J., Holcomb, D. R., & Marty, P. J. (2009). The relationship between youth substance use and area–specific self–esteem. Journal of School Health, 63, 224–228.

    Article  Google Scholar 

  • *Espelage, D. L., Aragon, S. R., Birkett, M., & Koenig, B. W. (2008). Homophobic teasing, psychological outcomes, and sexual orientation among high school students: What influence do parents and schools have? School Psychology Review, 37, 202–216

    Google Scholar 

  • Garofalo, R., Wolf, R. C., Kessel, S., Palfrey, J., & DuRant, R. H. (1998). The association between health risk behaviors and sexual orientation among a school-based sample of adolescents. Pediatrics, 101, 895–902.

    Article  CAS  PubMed  Google Scholar 

  • Goldbach, J. T., & Holleran Steiker, L. K. (2011). An examination of cultural adaptations performed by LGBT-Identified youths to a culturally grounded, evidence-based substance abuse intervention. Journal of Gay and Lesbian Social Services, 23, 188–203. doi:10.1080/10538720.2011.560135.

    Article  Google Scholar 

  • Grant, B. F., Stinson, F. S., & Harford, T. C. (2001). Age at onset of alcohol use and DSM-IV alcohol abuse and dependence: A 12-year follow-up. Journal of Substance Abuse, 13, 493–504. doi:10.1016/S0899-3289(01)00096-7.

    Article  CAS  PubMed  Google Scholar 

  • Hecht, M. L., Marsiglia, F. F., Elek, E., Wagstaff, D. A., Kulis, S., Dustman, P., & Miller-Day, M. (2003). Culturally grounded substance use prevention: An evaluation of keepin’ it R.E.A.L. curriculum. Prevention Science, 4, 233–248. doi:10.1023/A:1026016131401.

    Article  PubMed  Google Scholar 

  • Herrick, A. L., Matthews, A. K., & Garofalo, R. (2010). Health risk behaviors in an urban sample of young women who have sex with women. Journal of Lesbian Studies, 14, 80–92. doi:10.1080/10894160903060440.

    Article  PubMed  Google Scholar 

  • Holleran Steiker, L. K., Goldbach, J., Hopson, L. M., & Powell, T. (2011). The value of cultural adaptation processes: Older youth participants as substance abuse preventionists. Child and Adolescent Social Work Journal, 28, 495–509. doi:10.1007/s10560-011-0246-9.

    Article  Google Scholar 

  • Holloway, I. W., Traube, D. E., Rice, E., Schrager, S. S., Palinkas, L. A., Richardson, J., & Kipke, M. (2012). Community and individual factors associated with cigarette smoking among young men who have sex with men. Journal of Research on Adolescence, 22, 199–205. doi:10.1111/j.1532- 7795.2011.00774.x.

    Article  PubMed Central  PubMed  Google Scholar 

  • Hughes, T. L., & Eliason, M. (2002). Coming-out process related to substance use among gay, lesbian and bisexual teens. The Brown University Digest of Addiction Theory & Application, 24, 3–4.

    Google Scholar 

  • Jones, C. L., & Battjes, R. J (1985). The contexts and caveats of prevention research on drug abuse. NIDA Research Monograph, 56, 1–12

    Google Scholar 

  • Kandel, D., Johnson, J., Bird, H., & Camino, G. (1997). Psychiatric disorders associated with substance use among children and adolescents: Findings from the Methods for Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Journal of Abnormal Child Psychology, 25, 121–132. doi:10.1023/A:1025779412167.

    Article  CAS  PubMed  Google Scholar 

  • Kumpfer, K. L., & Alvarado, R. (2003). Family-strengthening approaches for the prevention of youth problem behaviors. American Psychologist, 58, 457–465. doi:10.1037/0003-066X.58.6-7.457.

    Article  PubMed  Google Scholar 

  • Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis. Thousand Oaks: Sage.

    Google Scholar 

  • Marshal, M. P., Friedman, M. S., Stall, R., King, K. M., Miles, J., Gold, M. A., & Morse, J. Q. (2008). Sexual orientation and adolescent substance use: A meta-analysis and methodological review. Addiction, 103, 546–556. doi:10.1111/j.1360-0443.2008.02149.x.

    Article  PubMed Central  PubMed  Google Scholar 

  • Marshal, M. P., Friedman, M. S., Stall, R., & Thompson, A. L. (2009). Individual trajectories of substance use in lesbian, gay and bisexual youth and heterosexual youth. Addiction, 104, 974–981. doi:10.1111/j.1360-0443.2009.02531.x.

    Article  PubMed Central  PubMed  Google Scholar 

  • Marsiglia, F. F., Holleran, L., & Jackson, K. M. (2000). Assessing the effect of internal and external resources on school-based substance abuse prevention. Social Work Education, 22, 145–161. doi:10.1093/cs/22.3.145.

    Google Scholar 

  • 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.

    Article  PubMed Central  PubMed  Google Scholar 

  • Miller, T., & Hendrie, D. (2009). Substance abuse prevention dollars and cents: A cost-benefit analysis. DHHS Pub. No. (SMA) 07-4298. Rockville: Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration.

  • McCabe, S. E., Bostwick, W. B., Hughes, T. L., West, B. T., & Boyd, C. J. (2010). The relationship between discrimination and substance use disorders among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 100, 1946.

  • Moon, M. W., Fornili, K., & O’Briant, A. L. (2007). Risk comparison among youth who report sex with same-sex versus both-sex partners. Youth & Society, 38, 267–284. doi:10.1177/0044118X06287689.

    Article  Google Scholar 

  • Institute of Medicine (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions. In M. E. O’Connell, T. Boat, & K. E. Warner (Eds.), Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Washington: The National Academies Press.

    Google Scholar 

  • *Padilla, Y. C., Crisp, C., & Rew, D. L. (2010). Parental acceptance and illegal drug use among gay, lesbian, and bisexual adolescents: Results from a national survey. Social Work, 55, 265–275

    Google Scholar 

  • *Pearson, J., Muller, C., & Wilkinson, L. (2007). Adolescent same-sex attraction and academic outcomes: The role of school attachment and engagement. Social Problems, 54, 523–542. doi:10.1525/sp.2007.54.4.523

    Google Scholar 

  • Pilkington, N. W., & D’Augelli, A. R. (1995). Victimization of lesbian, gay, and bisexual youth in community settings. Journal of Community Psychology, 23, 34–56. doi:10.1002/1520-6629(199501)23.

    Article  Google Scholar 

  • Postmes, T., & Branscombe, N. R. (2002). Influence of long-term racial environmental composition on subjective well-being in African Americans. Journal of Personality and Social Psychology, 83, 735–751.

    Article  PubMed  Google Scholar 

  • *Poteat, V. P., Aragon, S. R., Espelage, D. L., & Koenig, B. W. (2009). Psychosocial concerns of sexual minority youth: Complexity and caution in youth differences. Journal of Consulting and Clinical Psychology, 77, 196–201. doi:10.1037/a0014158

    Google Scholar 

  • Ragins, B. R. (2004). Sexual orientation in the workplace: The unique work and career experiences of gay, lesbian and bisexual workers. Research in Personnel and Human Resources Management, 23, 35–120.

    Google Scholar 

  • Rehm, J., Taylor, B., & Room, R. (2006). Global burden of disease from alcohol, illicit drugs and tobacco. Drug and Alcohol Review, 25, 503–513. doi:10.1080/09595230600944453.

    Article  PubMed  Google Scholar 

  • Remafedi, G. (1987). Adolescent homosexuality: Psychological and medical implications. Pediatrics, 79, 331–337.

    CAS  PubMed  Google Scholar 

  • *Rosario, M., Hunter, J., & Gwad, M. (1997). Exploration of substance use among lesbian, gay, and bisexual youth: Prevalence and correlates. Journal of Adolescent Research, 12, 454–476

    Google Scholar 

  • *Rosario, M., Rotheram-Borus, M., & Reid, H. (1996). Gay-related stress and its correlates among gay and bisexual male adolescents of predominantly black and Hispanic background. Journal of Community Psychology, 24, 136–159. doi:10.1002/(SICI)1520-6629(199604)24:2 < 136::AID-JCOP5 > 3.0.CO;2-X

  • *Rosario, M., Schrimshaw, E., & Hunter, J. (2009). Disclosure of sexual orientation and subsequent substance use and abuse among lesbian, gay, and bisexual youths: critical role of disclosure reactions. Psychology of Addictive Behavior, 23, 175–184. doi:10.1037/a0014284

  • *Rosario, M., Schrimshaw, E., & Hunter, J. (2008). Butch/femme differences in substance use and abuse among young lesbian and bisexual women: Examination and potential explanations. Substance Use & Misuse, 43, 10021015. doi:10.1080/10826080801914402

  • *Rosario, M., Schrimshaw, E. W., & Hunter, J. (2004). Predictors of substance use over time among gay, lesbian, and bisexual youths: An examination of three hypotheses. Addictive Behaviors, 29(8), 16231631

    Google Scholar 

  • *Rosario, M., Schrimshaw, E. W., Hunter, J., & Gwadz, M. (2002). Gay-related stress and emotional distress among gay, lesbian and bisexual youths: A longitudinal examination. Journal of Consulting and Clinical Psychology, 70(4), 967–975. doi:10.1037/0022-006X.70.4.967

    Google Scholar 

  • *Rostosky, S., Danner, F., & Riggle, E. (2007). Is religiosity a protective factor against substance use in young adulthood? Only if you're straight! The Journal of Adolescent Health, 40, 440–447. doi:10.1016/j.jadohealth.2006.11.144

    Google Scholar 

  • Rothstein, H. R., Sutton, A. J., & Borenstein, M. (2005). Publication bias in meta-analysis: Prevention, assessment and adjustments. West Sussex: Wiley. doi:10.1002/0470870168.

    Book  Google Scholar 

  • Russell, S. T., Driscoll, A. K., & Truong, N. (2002). Adolescent same-sex romantic attractions and relationships: Implications for substance use and abuse. American Journal of Public Health, 922, 198–202. doi:10.2105/AJPH.92.2.198.

    Article  Google Scholar 

  • Russell, S. T., Franz, B. T., & Driscoll, A. K. (2001). Same-sex romantic attraction and the experience of violence in adolescence. American Journal of Public Health, 91, 903–906. doi:10.2105/AJPH.91.6.903.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • *Savin-Williams, R. C., & Ream, G. L. (2003). Suicide attempts among sexual-minority male youth. Journal of Clinical Child & Adolescent Psychology, 32, 509–522. doi:10.1207/S15374424JCCP3204_3

    Google Scholar 

  • Solorio, R., Swendeman, D., & Rotheram-Borus, M. J. (2003). Risks among young gay and bisexual men living with HIV. AIDS Education and Prevention, 15, 80–90.

    Article  PubMed  Google Scholar 

  • Stronski, H., & Remafedi, G. (1998). Adolescent homosexuality. Advances in Pediatrics, 45, 107–144.

    Google Scholar 

  • Substance Abuse and Mental Health Services Administration (2011). Leading change: A plan for SAMHSA’s roles and actions 2011–2014. HHS Publication No. (SMA) 11–4629. Rockville: Substance Abuse and Mental Health Services Administration. Retrieved from http://store.samhsa.gov/shin/content/SMA11-4629/01-FullDocument.pdf

  • Traube, D. E., Holloway, I. W., Schrager, S. M., & Kipke, M. D. (2012). Utilizing social action theory as a framework to determine correlates of illicit drug use among young men who have sex with men. Psychology of Addictive Behaviors, 26, 78–88.

    Article  PubMed Central  PubMed  Google Scholar 

  • Tyler, K. A., & Melander, L. A. (2013). Child abuse, street victimization, and substance use among homeless young adults. Youth & Society. doi:10.1177/0044118X12471354.

  • US Department of Health and Human Services (2011). Substance Abuse and Mental Health Services Administration’s national registry of evidence based programs and practices. Rockville: Substance Abuse and Mental Health Services Administration.

  • US Department of Health and Human Services (2001). Mental health: Culture, race, and ethnicity. A supplement to mental health: A report of the Surgeon General. Rockville: U.S. Department of Health and Human Services.

  • Vega, W. A., Zimmerman, R. S., Warheit, G. J., Apospori, E., & Gil, A. G. (1993). Risk factors for early adolescent drug use in four ethnic and racial groups. American Journal of Public Health, 83, 185–189. doi:10.2105/AJPH.83.2.185.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Vega, W. A., Alderete, E., Kolody, B., & Aguilar-Gaxiola, S. (1998). Illicit drug use among Mexicans and Mexican Americans in California: The effects of gender and acculturation. Addiction, 93, 1839–1850. doi:10.1046/j.1360-0443.1998.931218399.x.

    Article  CAS  PubMed  Google Scholar 

  • Waller, M. A. (2001). Resilience in ecosystemic context: Evolution of the concept. American Journal of Public Health, 83, 185–189. doi:10.1037/0002-9432.71.3.290.

    Google Scholar 

  • Weber, G. N. (2008). Using to numb the pain: Substance use and abuse among lesbian, gay, and bisexual individuals. Journal of Mental Health Counseling, 30, 31–48.

    Google Scholar 

  • *Willoughby, B., Doty, N., & Malik, N. (2010). Victimization, family rejection, and outcomes of gay, lesbian, and bisexual young people: The role of negative GLB identity. Journal of GLBT Family Studies, 6, 403424. doi:10.1080/15504280903035761

    Google Scholar 

  • *Wright, E. R., & Perry, B. L. (2006). Sexual identity distress, social support and the health of gay, lesbian and bisexual youth. Journal of Homosexuality, 51, 81–110. doi:10.1300/J082v51n01_05

    Google Scholar 

  • Wu, L. T., & Anthony, J. C. (1999). Tobacco smoking and depressed mood in late childhood and early adolescence. American Journal of Public Health, 89, 1837–1840. doi:10.2105/AJPH.89.12.1837.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

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Goldbach, J.T., Tanner-Smith, E.E., Bagwell, M. et al. Minority Stress and Substance Use in Sexual Minority Adolescents: A Meta-analysis. Prev Sci 15, 350–363 (2014). https://doi.org/10.1007/s11121-013-0393-7

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