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Addict Behav. 2015 Jul;46:14-8. doi: 10.1016/j.addbeh.2015.02.017. Epub 2015 Feb 27.

Structural stigma and sexual orientation disparities in adolescent drug use.

Author information

1
Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA. Electronic address: mlh2101@columbia.edu.
2
Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
3
Graduate School of Public Health, San Diego State University, San Diego, CA, USA; Channing Division of Network Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
4
Channing Division of Network Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.

Abstract

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.

KEYWORDS:

Adolescents; Illicit drug use; Sexual orientation; Stigma

PMID:
25753931
PMCID:
PMC4395540
DOI:
10.1016/j.addbeh.2015.02.017
[Indexed for MEDLINE]
Free PMC Article

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