title: Adolescent Sexual Minority Girls Are at Elevated Risk for Use of Multiple Substances.
abstract: BACKGROUND
  Sexual minority youth, especially girls, are at risk for alcohol, cigarette, and marijuana use when these substances are examined individually. However, little is known about concurrent use of these substances (i.e., three-substance use) in relation to sexual orientation.
  
  
  OBJECTIVE
  The present study compared profiles of past year alcohol, cigarette, and marijuana use between SMGs and heterosexual girls. In addition, because internalizing and externalizing symptoms are associated with substance use, we examined whether sexual orientation was associated with substance use profile over and above co-occurring psychopathology.
  
  
  METHODS
  Mixture modeling was used to identify patterns of alcohol (including binge drinking), cigarette, and marijuana use in the past year using a cross-sectional sample of urban adolescent girls (Pittsburgh Girls Study; N = 2,064; mean age = 17). Approximately 8% (n = 173) of the girls endorsed a lesbian or bisexual identity.
  
  
  RESULTS
  Five substance using classes were identified: low-level substance use (72%), marijuana use (5%), cigarette use (8%), alcohol use (8%), and three-substance use (7%). SMGs were at an increased risk for substance use than heterosexual girls, particularly three-substance use (OR = 6.69, p < .001), cigarette use (OR = 6.26, p < .001), and marijuana use (OR = 3.86, p < .001) classes. Substance use patterns were regressed on sexual orientation, internalizing symptoms (i.e., depression, anxiety), and externalizing symptoms (i.e., conduct problems, oppositional defiant disorder). The disparities remained robust after controlling for internalizing and externalizing symptoms.
  
  
  CONCLUSIONS
  Clinicians and researchers should be aware of potential three-substance use among SMGs. Substance use interventions for SMG may benefit from targeting risk factors that cut-across several substances, particularly externalizing symptoms.
authors.affiliation: a Department of Psychology , University of Pittsburgh , Pittsburgh , Pennsylvania , USA.
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Dermody
authors.affiliation: b Department of Psychiatry , School of Medicine, University of Pittsburgh , Pennsylvania , USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Marshal
authors.affiliation: c Department of Health Behavior , University of Alabama at Birmingham , Birmingham , Alabama , USA.
authors.forename: JeeWon
authors.initials: J
authors.lastname: Cheong
authors.affiliation: b Department of Psychiatry , School of Medicine, University of Pittsburgh , Pennsylvania , USA.
authors.forename: Tammy
authors.initials: T
authors.lastname: Chung
authors.affiliation: b Department of Psychiatry , School of Medicine, University of Pittsburgh , Pennsylvania , USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: D Stepp
authors.affiliation: b Department of Psychiatry , School of Medicine, University of Pittsburgh , Pennsylvania , USA.
authors.forename: Alison
authors.initials: A
authors.lastname: Hipwell
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000428:Alcohol Drinking / Q000523:psychology*; D001727:Bisexuality / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D018452:Homosexuality, Female / Q000523:psychology*; D006801:Humans; D008385:Marijuana Smoking / Q000523:psychology; D012307:Risk Factors; D000072339:Sexual and Gender Minorities / Q000523:psychology*; D012907:Smoking / Q000523:psychology*; D019966:Substance-Related Disorders / Q000523:psychology*
keywords: Bisexual; externalizing; internalizing; lesbian; mixture modeling; substance use