Associations of sexual orientation and state-level antidiscrimination policy protections with alcohol, tobacco, and mental health outcomes in a U.S. sample of adolescents and adults.

INTRODUCTION

Structural stigma has important health implications for sexual minority individuals, including alcohol and tobacco use, and mental health. This study examined associations of structural stigma with alcohol and tobacco use and internalizing symptoms while considering sexual identity changes and multiple dimensions of sexual orientation among adolescents and adults in the U.S.

METHODS

This study used data from waves 1-5 of the Population Assessment of Tobacco and Health (PATH; n = 110,401 observations in the full sample and n = 10,417 observations among sexual minority individuals) and state-level sexual orientation and gender identity (SOGI) policy data from the Movement Advancement Project. Using mixed effects regression models stratified by sex, we examined the associations of sexual identity change, sexual identity-sexual attraction discordance, and SOGI policy protections with symptomatic alcohol use, tobacco dependence symptoms, and high levels of internalizing symptoms.

RESULTS

Among females, sexual identity-attraction discordance was associated with greater odds of symptomatic alcohol use (adjusted odds ratio [AOR] = 1.81; 95% confidence interval [CI] = 1.54, 2.13) and high internalizing symptoms (AOR = 1.47; 95% CI = 1.16, 1.86). A higher level of SOGI policy protections compared to a lower level of SOGI protections was associated with lower odds of symptomatic alcohol use (AOR = 0.46; 95% CI = 0.25, 0.87) and fewer tobacco dependence symptoms (β = -0.66; 95% CI = -1.20, -0.12) among sexual minority males. Higher levels of SOGI policy protections compared to lower protection levels was associated with lower odds of internalizing symptoms (AOR = 0.81; 95% CI = 0.66, 0.99) and fewer tobacco dependence symptoms (β = -0.56; 95% CI = -0.99, -0.13) among sexual minority females.

DISCUSSION

This work extends the literature on the potential impact of structural protections from stigma on sexual minority populations. Our findings underscore the importance of addressing structural stigma, which may, in turn, ameliorate the substance use and mental health disparities that sexual minority individuals experience.