title: Structural stigma and sexual orientation disparities in adolescent drug use.
abstract: Although epidemiologic studies have established the existence of large sexual orientation disparities in illicit drug use among adolescents and young adults, the determinants of these disparities remain understudied. This study sought to determine whether sexual orientation disparities in illicit drug use are potentiated in states that are characterized by high levels of stigma surrounding sexual minorities. State-level structural stigma was coded using a previously established measure based on a 4-item composite index: (1) density of same-sex couples; (2) proportion of Gay-Straight Alliances per public high school; (3) 5 policies related to sexual orientation discrimination (e.g., same-sex marriage, employment non-discrimination); and (4) public opinion toward homosexuality (aggregated responses from 41 national polls). The index was linked to individual-level data from the Growing Up Today Study, a prospective community-based study of adolescents (2001-2010). Sexual minorities report greater illicit drug use than their heterosexual peers. However, for both men and women, there were statistically significant interactions between sexual orientation status and structural stigma, such that sexual orientation disparities in marijuana and illicit drug use were more pronounced in high-structural stigma states than in low-structural stigma states, controlling for individual- and state-level confounders. For instance, among men, the risk ratio indicating the association between sexual orientation and marijuana use was 24% greater in high- versus low-structural stigma states, and for women it was 28% greater in high- versus low-structural stigma states. Stigma in the form of social policies and attitudes may contribute to sexual orientation disparities in illicit drug use.
authors.affiliation: Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA. Electronic address: mlh2101@columbia.edu.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Hatzenbuehler
authors.affiliation: Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
authors.forename: Hee-Jin
authors.initials: HJ
authors.lastname: Jun
authors.affiliation: Graduate School of Public Health, San Diego State University, San Diego, CA, USA; Channing Division of Network Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Corliss
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Bryn Austin
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012725:Sexual Behavior / Q000523:psychology*; D057545:Social Stigma; D019966:Substance-Related Disorders / Q000523:psychology*
chemical_list: D013287:Illicit Drugs
keywords: Adolescents; Illicit drug use; Sexual orientation; Stigma