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LGBT Health. 2019 Apr;6(3):116-125. doi: 10.1089/lgbt.2018.0149. Epub 2019 Mar 1.

Latent Classes of Polysubstance Use Among Adolescents in the United States: Intersections of Sexual Identity with Sex, Age, and Race/Ethnicity.

Author information

1
1 Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
2
2 Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
3
3 Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
4
4 Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
5
5 Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia.
6
6 Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland.

Abstract

PURPOSE:

We aimed to estimate latent classes of concurrent polysubstance use and test for sexual orientation differences in latent class memberships with representative data from adolescents living in 19 U.S. states. We also tested whether sex, race/ethnicity, and age moderated the sexual identity differences in polysubstance use class memberships.

METHODS:

We analyzed data from 119,437 adolescents from 19 states who participated in the 2015 Youth Risk Behavior Survey. Latent class analysis characterized polysubstance use patterns based on self-reported frequency of lifetime and past-month use of alcohol (including heavy episodic drinking), tobacco (cigarettes, cigars, and smokeless tobacco), and marijuana. Multinomial logistic regression models tested differences in latent class memberships by sexual identity. Interaction terms tested whether sex, race/ethnicity, and age moderated the sexual identity differences in polysubstance use class memberships.

RESULTS:

A six-class model of polysubstance use fit the data best and included nonusers (61.5%), experimental users (12.2%), marijuana-alcohol users (14.8%), tobacco-alcohol users (3.8%), medium-frequency three-substance users (3.6%), and high-frequency three-substance users (4.1%). Gay/lesbian- and bisexual-identified adolescents had significantly higher odds than heterosexual-identified adolescents of being in all of the user classes compared with the nonuser class. These sexual identity differences in latent polysubstance use class memberships were generally larger for females than for males, varied occasionally by race/ethnicity, and were sometimes larger for younger ages.

CONCLUSION:

Compared with their heterosexual peers, gay/lesbian and bisexual adolescents-especially females-are at heightened risk of engaging in multiple types of polysubstance use. Designing, implementing, and evaluating interventions will likely reduce these sexual orientation disparities.

KEYWORDS:

YRBS; adolescents; polysubstance use; sex; sexual minority youth; sexual orientation

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