title: Intersecting identities and substance use problems: sexual orientation, gender, race, and lifetime substance use problems.
abstract: OBJECTIVE
  Research has documented that sexual minorities are at greater risk for substance use than heterosexuals. However, there are limited studies and mixed findings when investigating these health disparities among racial and ethnic minority samples. We used an intersectionality framework to examine disparities in lifetime substance use problems between heterosexual and sexual minority men and women and within sexual minority groups among a racially diverse sample.
  
  
  METHODS
  A nonprobability sample of heterosexual (n = 1,091) and sexual minority (n = 1,465) patients from an urban community health center ranged in age from 18 to 72 years. Participants completed a brief patient survey and reported demographic information and history of lifetime substance use problems. Logistic regressions analyses were used to examine interactions between and among sexual orientation, gender, and race.
  
  
  RESULTS
  We found a significant three-way interaction among sexual orientation, gender, and race. Sexual minorities had a greater risk of self-reported lifetime substance use problems than heterosexuals, with nuanced gender and racial differences. Of greatest note, sexual minority women of color had greater risks than heterosexual women of color and than White sexual minority women. Sexual minority men of color did not differ in their risk when compared with heterosexual men of color, and they had lower risk than White sexual minority men.
  
  
  CONCLUSIONS
  The results of this study demonstrate that an intersectionality framework is crucial to clearly identify lifetime substance use disparities between racially diverse sexual minority and heterosexual men and women. Future research, treatment, and policy should use intersectionality approaches when addressing substance use disparities.
authors.affiliation: Department of Counseling, Developmental, and Educational Psychology, Boston College, Chestnut Hill, Massachusetts, Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts.
authors.forename: Ethan H
authors.initials: EH
authors.lastname: Mereish
authors.affiliation: Center for Population Research in LGBT Health, The Fenway Institute, Fenway Health, Boston, Massachusetts.
authors.forename: Judith B
authors.initials: JB
authors.lastname: Bradford
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001727:Bisexuality / Q000208:ethnology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D020010:Heterosexuality / Q000208:ethnology* / Q000523:psychology; D006716:Homosexuality / Q000208:ethnology* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000523:psychology; D044469:Racial Groups / Q000208:ethnology* / Q000523:psychology; D057566:Self Report; D012737:Sex Factors; D012725:Sexual Behavior / Q000208:ethnology / Q000523:psychology; D019529:Sexuality / Q000208:ethnology / Q000523:psychology; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology; D055815:Young Adult