Alcohol, Marijuana & Illicit Drug Use at the Intersection of Sexual Identity and Race/Ethnicity in a National Sample of High School Youth Open Access

Abstract

Introduction: LGBTQ+ youth are more likely to use alcohol, marijuana, and illicit substances than heterosexual youth, and rates of substance use have risen among racial/ethnic minority youth in the past two decades. Substance use is a multifaceted health issue, intertwined with psychosocial factors like mental health, violence, and victimization, which disproportionately affect LGBTQ+ and racial/ethnic minority youth. However, few quantitative studies have thoroughly considered the role of intersectionality in shaping youth substance use behaviors.

 

Methods: This study applied an intersectional lens to minority stress theory through secondary analysis of nationally representative Youth Risk Behavior Survey data collected from 2015-2019 (n=44,066). Sequential logistic regressions produced adjusted odds ratios (AORs) for alcohol, marijuana, and illicit drug use outcomes, with main effects and interaction effects for sexual identity and race/ethnicity. Models also considered the role of related psychosocial factors (including depression, bullying, victimization and sexual violence).

 

Results: After adjusting for age, sex, and psychosocial factors, Black gay/lesbian youth had higher odds of alcohol use (AOR=2.23, p<.05) and illicit drug use (AOR=3.90, p<.01) and Black bisexual youth had higher odds of alcohol use (AOR=2.42, p<.001) and illicit drug use (AOR=1.78, p<.05) compared to white heterosexual youth. Interactions terms for Hispanic/Latinx unsure youth for alcohol use, and Black gay/lesbian and bisexual youth for marijuana use, all became non-significant after the addition of psychosocial factors to the model.

 

Discussion: Significant interaction effects reveal important differences in youth substance use behaviors depending on the intersecting identities they hold, above and beyond the effects of sexual identity or race/ethnicity alone. In addition, psychosocial factors had strong relationships with all three substance use behaviors, and partial support for applying an intersectional lens to minority stress theory was found. Intersectionality must be applied to future research in order to consider the simultaneous and interlocking identities that affect youth health behaviors.

Table of Contents

CHAPTER 1: INTRODUCTION................................................................................................................... 1

Introduction.................................................................................................................................... 1

Theoretical Framework...................................................................................................................... 1

Problem Statement............................................................................................................................ 8

Research Question............................................................................................................................. 9

Significance Statement...................................................................................................................... 10

Definition of Key Terms...................................................................................................................... 12

CHAPTER 2: REVIEW OF THE LITERATURE................................................................................................ 14

Introduction.................................................................................................................................. 14

Minority Stress & Intersectionality...................................................................................................... 14

Why Study Youth Substance Use?........................................................................................................ 15

Youth Substance Use Prevalence.......................................................................................................... 17

Youth Substance Use Trends by Race/Ethnicity................................................................................. 18

Youth Substance Use Trends by Sexual Identity................................................................................. 20

Substance Use Trends by Age and Sex............................................................................................. 21

Minority Stress & Substance Use......................................................................................................... 22

Stress and Substance Use Among Youth.......................................................................................... 23

Bullying & Peer Victimization......................................................................................................... 25

Discrimination............................................................................................................................ 28

Sexual Violence & Dating Violence.................................................................................................. 29

Mental Health Problems............................................................................................................... 30

Unique Impacts of Minority Stress on Adolescents............................................................................. 32

Summary of the Current Problem........................................................................................................ 39

CHAPTER 3: METHODS......................................................................................................................... 40

Introduction.................................................................................................................................. 40

Study Purpose............................................................................................................................ 40

Research Aims............................................................................................................................ 41

Human Subjects Approval............................................................................................................. 41

Population and Sample...................................................................................................................... 42

Youth Risk Behavior Survey........................................................................................................... 42

Measures....................................................................................................................................... 47

Alcohol, Marijuana and Illicit Drug Use............................................................................................ 47

Personal Demographic Characteristics............................................................................................ 49

Additional Variables of Interest...................................................................................................... 50

Data Analysis Methodology............................................................................................................... 51

Preliminary Analyses.................................................................................................................... 51

Primary Analyses........................................................................................................................ 54

Assessment of Research Aims........................................................................................................ 55

CHAPTER 4: RESULTS........................................................................................................................... 57

Introduction.................................................................................................................................. 57

Study Purpose............................................................................................................................ 57

Key Findings.................................................................................................................................... 58

Preliminary Analyses.................................................................................................................... 58

Primary Analyses by Study Aim...................................................................................................... 69

Summary of Findings........................................................................................................................ 84

CHAPTER 5: DISCUSSION...................................................................................................................... 86

Introduction.................................................................................................................................. 86

Summary of Study............................................................................................................................ 86

Discussion of Key Results................................................................................................................... 87

Research Aim 1........................................................................................................................... 87

Research Aim 2........................................................................................................................... 89

Overall Findings.......................................................................................................................... 92

Strengths and Limitations.................................................................................................................. 94

Strengths................................................................................................................................... 94

Limitations................................................................................................................................. 95

Implications and Recommendations...................................................................................................... 96

Implications for School Health Promotion........................................................................................ 96

Future Directions......................................................................................................................... 97

Conclusion..................................................................................................................................... 98

REFERENCES..................................................................................................................................... 100

APPENDIX........................................................................................................................................ 110

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Education, Health Psychology, Behavioral Sciences
Keyword	Illicit Drug Use Race/Ethnicity Marijuana LGBTQ Youth Minority Stress Youth Adolescent Health Substance Use Intersectionality Behavioral Sciences LGBTQ Health Sexual Minority Youth LGBTQ Alcohol Mental Health Racial/Ethnic Minority Youth Sexual Identity
Committee Chair / Thesis Advisor	Nehl, Eric J., Emory University
Committee Members	Hall, Casey Xavier, Institute for Sexual and Gender Minority Health, Northwestern University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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