Risk of heavy drinking among sexual minority adolescents: indirect pathways through sexual orientation-related victimization and affiliation with substance-using peers

• Published in: Addiction (Abingdon, England) England), 2016-09, Vol.111 (9), p.1599-1606
• Main Authors: Dermody, Sarah S., Marshal, Michael P., Burton, Chad M., Chisolm, Deena J.
• Format: Article
• Language: English
• Subjects: Adolescence; Adolescent; Alcoholic Intoxication - epidemiology; Alcoholism; Binge Drinking - epidemiology; Case-Control Studies; Crime Victims - statistics & numerical data; Female; heavy episodic drinking; Heterosexuality - statistics & numerical data; Humans; longitudinal; Longitudinal Studies; Male; Ohio - epidemiology; Peer Group; peer substance use; Peers; Pennsylvania - epidemiology; Sexual and Gender Minorities - statistics & numerical data; Sexual Behavior; sexual minority; sexual orientation; Social exclusion; Socialization; Substance-Related Disorders - epidemiology; Teenagers; Victimization; Young Adult
• ISSN: 0965-2140; 1360-0443
• DOI: 10.1111/add.13409

Aims To test two indirect pathways through which sexual minority adolescents (SMAs) may be at risk for heavy episodic drinking (HED) including a socialization pathway via substance‐using peer affiliations and social marginalization pathway via sexual minority‐specific victimization and subsequent substance‐using peer affiliations. Design Analysis of the first three waves (6 months apart) of a longitudinal adolescent health risk study (2011–14). Participants were referred by medical providers or a screening system in providers' waiting rooms. Setting Two large urban adolescent health clinics in Pennsylvania and Ohio, USA. Participants A total of 290 adolescents (ages 14–19 years, mean: 17.08) who were 71.0% female, 33.4% non‐Hispanic white and 34.5% SMAs. Measurements Self‐reported sexual minority status (wave 1) and affiliation with substance‐using peers (waves 1 and 2), and latent sexual‐minority specific victimization (waves 1 and 2) and HED (waves 1 and 3) variables. Findings Using mediation analyses in a structural equation modeling framework, there was a significant indirect effect of sexual minority status (wave 1) on HED (wave 3) via affiliation with substance‐using peers [wave 2; indirect effect = 0.03, 95% confidence interval (CI) = 0.01, 0.07], after accounting for the indirect effect of sexual‐orientation related victimization (wave 2; indirect effect = 0.10, 95% CI = 0.02–0.19). The social marginalization pathway was not supported, as victimization (wave 1) was not associated with affiliation with substance‐using peers (wave 2; β = − 0.04, P = 0.66). Sex differences in the indirect effects were not detected (Ps > 0.10). Conclusions Sexual minority adolescents in the United States appear to exhibit increased heavy episodic drinking via an indirect socialization pathway, including affiliations with substance‐using peers and a concurrent indirect pathway involving sexual minority‐related victimization. The pathways appear to operate similarly for boys and girls.