Hatzenbuehler Mark L, Jun Hee-Jin, Corliss Heather L, Bryn Austin S
Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
Addict Behav. 2015 Jul;46:14-8. doi: 10.1016/j.addbeh.2015.02.017. Epub 2015 Feb 27.
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.
尽管流行病学研究已证实青少年和青年成年人在非法药物使用方面存在巨大的性取向差异，但这些差异的决定因素仍未得到充分研究。本研究旨在确定在以对性少数群体高度污名化为特征的州，非法药物使用中的性取向差异是否会加剧。州层面的结构性污名使用基于一个4项综合指数的先前建立的测量方法进行编码：（1）同性伴侣密度；（2）每所公立高中的男女同性恋联盟比例；（3）5项与性取向歧视相关的政策（如同性婚姻、就业非歧视）；（4）公众对同性恋的看法（来自41次全国民意调查的汇总答复）。该指数与“今日成长研究”的个体层面数据相关联，这是一项基于社区的青少年前瞻性研究（2001 - 2010年）。性少数群体报告的非法药物使用比其异性恋同龄人更多。然而，对于男性和女性而言，性取向状况与结构性污名之间存在统计学上的显著交互作用，即在控制个体和州层面的混杂因素后，大麻和非法药物使用中的性取向差异在高结构性污名州比在低结构性污名州更为明显。例如，在男性中，表明性取向与大麻使用之间关联的风险比在高结构性污名州比在低结构性污名州高24%，在女性中则高28%。社会政策和态度形式的污名可能导致非法药物使用中的性取向差异。
