Results of this study demonstrate a heightened risk of past-year drug use among minority sexual orientation youth. In fact, drug use prevalences observed among the sexual minorities in GUTS were much higher than prevalences observed among same-aged respondents of the representative 2002 National Survey of Drug Use and Health, suggesting that sexual minority youth who are children of health care professionals are not protected from drug use.
While supporting previous findings (e.g., Boyd, McCabe, & d'Arcy, 2003
; Hahm, Wong, Huang, Ozonoff, & Lee, 2008
; McCabe, Boyd, Hughes, & d'Arcy, 2003
; Orenstein, 2001
), our study builds on the existing literature by illuminating how drug use risk associated with sexual orientation is modified by gender and age. Among heterosexuals, males had higher prevalence of past-year drug use than females. Conversely, this pattern was reversed for minority sexual orientation youth, with females showing higher prevalence than males. This was evident even for amphetamine use, which is commonly known to be a problem among gay and bisexual males (Cabaj, Galanter, & Kleber, 2008
), but less recognized as a drug that may also be used by lesbian and bisexual females. When gender modified associations between sexual orientation and drug use, larger sexual orientation differences were observed among females than males. Bisexual females had the highest past-year prevalence of drug use for all drug categories examined except heroin. These findings are congruent with a recent meta-analysis finding that sexual orientation disparities in substance use were largest in females and bisexuals (Marshal, et al., 2008
). Possible explanations for these inequalities must be examined and may include psychosocial factors related to gender expression, gender differences in how young women and men experience and cope with the stress of stigma and discrimination, biological factors, or joint effects of these factors (Rosario, Schrimshaw, & Hunter, 2008
; Wilson & Rahman, 2005
While sexual minority youth in this study were at elevated risk of past-year drug use during adolescence and emerging adulthood, disparities were amplified during adolescence when youth may be less well equipped developmentally to cope with the challenges of having a minority sexual orientation in a stigmatizing environment. This potential age disparity is alarming because younger onset of substance use is a robust predictor of later substance dependence (Anthony & Petronis, 1995
; Grant & Dawson, 1998
; Lynskey, Vink, & Boomsma, 2006
). Community studies of lesbian, gay, and bisexual youth suggest that younger age of recognizing and disclosing a minority sexual orientation are risk factors for experiencing maltreatment and poorer mental health (D'Augelli, et al., 2005
; Hershberger, Pilkington, & D'Augelli, 1997
; Pilkington & D'Augelli, 1995
). It is possible that such vulnerabilities may also increase drug use risk.
The extent that sexual orientation differences in age of onset of drug use may contribute to disparities in developmental outcomes and substance disorders requires further investigation. Sexual minority adults may suffer disproportionately from dysfunctional drug use (Cochran, Ackerman, Mays, & Ross, 2004
) and substance/abuse dependence compared to heterosexuals (Meyer, 2003
). Sexual minorities also experience barriers to accessing services for substance problems (Corliss, Grella, Mays, & Cochran, 2006
); when they do present for treatment, they may display greater co-morbid psychopathology and substance problems than heterosexuals (Cochran & Cauce, 2006
). Given that substance abuse treatment programs typically do not address the needs of lesbian, gay, and bisexual individuals (Cochran, Peavy, & Robohm, 2007
; Matthews & Selvidge, 2005
), prevention efforts are vital.
Study limitations include limited generalizability because GUTS is not a representative sample and the majority of participants are non-Hispanic white. Nonetheless, participants were enrolled into GUTS independent of their sexual orientation. Thus, findings are presumably less biased than what is characteristic of samples recruited through gay community settings. In addition, findings are based on self-reports of drug use. Longitudinal studies may also suffer from attrition bias, but how loss-to-follow-up might influence sexual orientation estimates of drug use is not known.