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Testing Minority Stress and Psychological Mediation Explanations of Substance Use Disparities by Sexual Orientation

Thu, April 12, 2:45 to 3:45pm, Hilton, Floor: Second Floor, Marquette Ballroom


Research indicates that lesbian, gay, and bisexual (LGB) adolescents report higher levels of substance use than heterosexual adolescents (Goldbach, Tanner-Smith, Bagwell, & Dunlap, 2014). Several frameworks have been developed for the explanation of these disparities. First, the minority stress framework (Meyer, 2003) states that external events like discrimination and rejection, the expectation of and vigilance against these external events, and the internalization of negative societal attitudes against LGBs constitute elevated stress levels for LGB individuals in comparison to heterosexuals. Substance use can be seen as a coping mechanism for these minority stressors. Second, the psychological mediation framework (Hatzenbuehler, 2009) has been developed as a more fine-grained extension of the minority stress framework. It states that minority stress can create elevations in general stress processes. These general stress processes are thought to mediate the relation between minority stressors and substance use.

The aim of the present study was to test substance use disparities between LGB and heterosexual adolescents and asses to what extent the two aforementioned frameworks explained these disparities. Following the minority stress framework, we tested how being bullied and parental rejection mediated the effect of sexual orientation on substance use. Following the psychological mediation framework, it was tested whether social support of friends and substance use levels of friends mediated the effects of being bullied and parental rejection on substance use. Data came from the first five waves of the TRacking Adolescents Individual Lives Survey (TRAILS), a longitudinal Dutch cohort study. Of the 1738 respondents (54.8 % girls) that provided information on sexual orientation, 34 respondents identified as lesbian or gay, 117 as bisexual. Substance use was measured by alcohol use, smoking and marijuana use at wave 4 (M age = 19.1, 52 % girls). Analyses were performed on the LGB group as a whole, but also stratified by gender, and with bisexuals only being compared with heterosexuals. Before analyses, LGB respondents were propensity score matched with heterosexual students on socio-economic background variables and parental substance use, employing multiple neighbors within caliper matching (.025 caliper). First, it was tested if there was a direct relation between sexual orientation and substance use (see Table 1). LGB respondents reported higher levels of smoking and marijuana use, but not alcohol use. Differences were most pronounced for GB boys and bisexuals. Path analyses were performed in order to explain smoking and marijuana use disparities. Outcomes of the path analyses for bisexuals are displayed in Figure 1. Bootstrap analyses indicated that the association between bisexuality and smoking was partially mediated by being bullied (95% BC CI [-0.07;-0.01]). The associations between being bullied and parental rejection and substance use were on their turn mediated by substance use levels of friends, with being bullied leading to lower levels of friends’ substance use, which was opposite to psychological mediation framework expectations. Similar patterns were found for (GB) boys. We conclude that some substance use disparities between LGB and heterosexual adolescents were found, which were partially explained by minority stress and psychological mediation mechanisms.