title: Risk of heavy drinking among sexual minority adolescents: indirect pathways through sexual orientation-related victimization and affiliation with substance-using peers.
abstract: 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.
  
  
  
  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.
  
  
  
  Two large urban adolescent health clinics in Pennsylvania and Ohio, USA.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Dermody
authors.affiliation: Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.|Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Marshal
authors.affiliation: Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Chad M
authors.initials: CM
authors.lastname: Burton
authors.affiliation: Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Deena J
authors.initials: DJ
authors.lastname: Chisolm
mesh_terms: D000293:Adolescent; D000435:Alcoholic Intoxication / Q000453:epidemiology*; D063425:Binge Drinking / Q000453:epidemiology*; D016022:Case-Control Studies; D019548:Crime Victims / Q000706:statistics & numerical data*; D005260:Female; D020010:Heterosexuality / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009820:Ohio / Q000453:epidemiology; D010379:Peer Group; D010414:Pennsylvania / Q000453:epidemiology; D012725:Sexual Behavior; D000072339:Sexual and Gender Minorities / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D055815:Young Adult
keywords: Adolescence; heavy episodic drinking; longitudinal; peer substance use; sexual minority; sexual orientation