RAND Corporation, 20 Park Plaza #920, Boston, MA 02116, USA.
The Methodology Center, The Pennsylvania State University, 424 Health and Human Development Building, University Park, PA 16802, USA.
Drug Alcohol Depend. 2018 Aug 1;189:139-146. doi: 10.1016/j.drugalcdep.2018.05.008. Epub 2018 Jun 19.
Sexual minorities (SMs) experience elevated rates of substance use behaviors and disorders relative to heterosexuals; minority stress is theorized to contribute to these disparities. As SMs are not a homogenous group, analyses that aggregate SMs across sexual identity, age, or gender obscure important variation among this population. To date, age- and gender-specific disparities have not been rigorously examined using a large national sample.
Using data on 67,354 adults (ages 18-49) from the 2015 and 2016 National Survey of Drug Use and Health we examined age- and gender-specific disparities in smoking, heavy episodic drinking, marijuana use, illicit drug use, and alcohol/substance use disorder. Age groups were ages 18-25, 26-34, and 35-49. Using logistic regression, we estimated age- and gender-specific odds ratios for gay/lesbian and bisexual individuals, relative to heterosexuals; analyses adjusted for demographic characteristics.
Bisexual women had significantly elevated odds of all outcomes at all ages, relative to heterosexual women. Gay/lesbian individuals had significantly elevated odds for nearly all outcomes compared to same-gender heterosexuals at ages 18-25, but not consistently at older ages. For bisexual men, significant disparities compared to heterosexual men were only observed at ages 35-49 for marijuana use and alcohol/substance use disorder.
We found notable within-group differences regarding SM disparities. While disparities were most pronounced in young adulthood for gay/lesbian individuals and mid-adulthood for bisexual men, bisexual women uniquely experienced disparities across all ages. Minority stress experiences may vary with respect to gender, age/cohort, and sexual identity, resulting in differential risk for substance use.
性少数群体（SM）的物质使用行为和障碍发生率相对高于异性恋者；少数群体的压力被认为是造成这些差异的原因。由于 SM 不是一个同质群体，因此将 SM 按性身份、年龄或性别进行汇总的分析掩盖了这一人群中的重要差异。迄今为止，还没有使用大型全国样本对年龄和性别特定的差异进行严格的检查。
我们使用了 2015 年和 2016 年全国药物使用和健康调查中 67354 名成年人（18-49 岁）的数据，研究了吸烟、重度间歇性饮酒、大麻使用、非法药物使用和酒精/物质使用障碍在年龄和性别方面的差异。年龄组分别为 18-25 岁、26-34 岁和 35-49 岁。使用逻辑回归，我们估计了同性恋/女同性恋和双性恋个体相对于异性恋者的年龄和性别特定的比值比；分析调整了人口统计学特征。
与异性恋女性相比，所有年龄段的双性恋女性都有显著更高的所有结果的几率。18-25 岁的同性恋/女同性恋个体与同性别异性恋者相比，几乎所有结果的几率都显著升高，但在年龄较大时并非如此。对于双性恋男性，只有在 35-49 岁时，大麻使用和酒精/物质使用障碍与异性恋男性相比才存在显著差异。
我们发现了有关 SM 差异的显著的群体内差异。虽然在同性恋/女同性恋个体的年轻成年期和双性恋男性的中年期差异最为明显，但双性恋女性在所有年龄段都经历了独特的差异。少数群体的压力体验可能因性别、年龄/队列和性身份而异，从而导致对物质使用的不同风险。
