Do Substance Use Norms and Perceived Drug Availability Mediate Sexual Orientation Differences in Patterns of Substance Use? Results from the California Quality of Life Survey II

Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095-1772, USA.
Journal of studies on alcohol and drugs (Impact Factor: 2.76). 07/2012; 73(4):675-85. DOI: 10.15288/jsad.2012.73.675
Source: PubMed

ABSTRACT Illicit drug and heavy alcohol use is more common among sexual minorities compared with heterosexuals. This difference has sometimes been attributed to more tolerant substance use norms within the gay community, although evidence is sparse. The current study investigated the role of perceived drug availability and tolerant injunctive norms in mediating the linkage between minority sexual orientation status and higher rates of prior-year substance use.
We used data from the second California Quality of Life Survey (Cal-QOL II), a followback telephone survey in 2008-2009 of individuals first interviewed in the population-based 2007 California Health Interview Survey. The sample comprised 2,671 individuals, oversampled for minority sexual orientation. Respondents were administered a structured interview assessing past-year alcohol and illicit drug use, perceptions of perceived illicit drug availability, and injunctive norms concerning illicit drug and heavier alcohol use. We used structural equation modeling methods to test a mediational model linking sexual orientation and substance use behaviors via perceptions of drug availability and social norms pertaining to substance use.
Compared with heterosexual individuals, sexual minorities reported higher levels of substance use, perceived drug availability, and tolerant social norms. A successfully fitting model suggests that much of the association between minority sexual orientation and substance use is mediated by these sexual orientation-related differences in drug availability perceptions and tolerant norms for substance use.
Social environmental context, including subcultural norms and perceived drug availability, is an important factor influencing substance use among sexual minorities and should be addressed in community interventions.

Download full-text


Available from: Vickie Mays, May 08, 2014
47 Reads
  • Source
    • "Extensive research over the past several decades has documented increased rates of a host of health-related problems among bisexuals compared to heterosexuals, including substance use, obesity and eating disorders, mood and anxiety disorders, suicidality and self-harm, psychotic disorders, personality disorders, sexual and reproductive health problems, and general physical health issues (for reviews, see Bowen, Balsam, & Ender, 2008; Coker et al., 2010; Dean et al., 2000; Herek & Garnets, 2007; Marshal et al., 2008; Mayer et al., 2008). Large, population-based studies have confirmed prior nonrepresentative findings (Boehmer, Bowen, & Bauer, 2007; Bolton & Sareen, 2011; Cochran & Mays, 2007; McCabe, Hughes, Bostwick, West, & Boyd, 2009; McLaughlin, Hatzenbuehler, Xuan, & Conron, 2012; Mojola & Everett, 2012). Recently, several researchers have raised concerns that health problems may also be increased among MHs compared to heterosexuals (Bostwick, Boyd, Hughes, & McCabe, 2010; McCabe et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: We reviewed whether mostly heterosexuals, a sexual orientation group characterized by a small amount of same-sex sexuality, differ from heterosexuals and bisexuals on a variety of mental and physical health outcomes (e.g., internalizing problems, body dissatisfaction and disordered eating, obesity, sexual/reproductive health, physical health), health risk behaviors (e.g., substance use, sexual risk taking), and risk and protective factors (e.g., victimization, stressful/risky environment, socioeconomic status, personal and social relationships, gender nonconformity). A narrative and quantitative literature review was conducted of 60 papers covering 22 samples from five Western countries. Individual, mean, and median effect sizes (Cohen ds) were calculated whenever possible. Mostly heterosexuals reported higher levels of risk in most reviewed outcomes compared to heterosexuals (unweighted mean effect sizes ranged from 0.20 to 0.50) but typically somewhat lower than bisexuals (unweighted mean effect sizes ranged from -0.10 to -0.30). Various risk factors frequently reduced, but rarely eliminated, health disparities between mostly heterosexuals and heterosexuals. Findings are discussed through the lens of three potential explanations of elevated health risks among nonheterosexuals: minority stress, nonheterosexual lifestyles, and common causes. Because data on many outcomes were scarce or missing, particularly for men and in comparison with bisexuals, further research is needed.
    The Journal of Sex Research 04/2014; 51(4):410-45. DOI:10.1080/00224499.2014.883589 · 2.53 Impact Factor
  • Source
    • "At the same time, however, sexual minority individuals may become integrated into social networks or communities that are more tolerant of drug and alcohol use than heterosexual individuals (Carpiano et al. 2011). Substance use may play an important role in these communities as social outings may commonly occur in clubs and bars (Valentine and Skelton 2003; Trocki et al. 2005; Cochran et al. 2012), which have historically provided safety and protection from the homophobic discrimination and violence. As a result, involvement in these communities may increase acceptance and reduce minority-related stress while increasing sexual minority individuals' risk of hazardous drinking. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Sexual minority (lesbian and gay, bisexual, mostly heterosexual) individuals are at an increased risk for hazardous drinking than heterosexual individuals, but little is known about the nature of the disparities as adolescents reach adulthood. We used four waves of a nationally representative data set, the National Longitudinal Study of Adolescent Health (Add Health), to examine disparities of hazardous drinking outcomes between sexual minority and heterosexual men and women from adolescence to young adulthood. Participants were 14-18 years old at the first assessment (N = 12,379; 53 % female) and 27-31 years old at the fourth assessment. At the fourth assessment, 13 % self-identified as sexual minority individuals, 16 % were Hispanic, and 36 % were of minority race, including primarily African Americans (60 %) and Asian Americans (18 %). There were clear hazardous drinking disparities between sexual minority individuals and heterosexual individuals over time. During adolescence, sexual minority individuals, particularly females, reported higher levels of hazardous drinking. As study participants reached adulthood, the magnitude of the hazardous drinking disparities increased among sexual minorities, sexual minority men in particular. Additional research is needed to better understand the developmental mechanisms that underlie the emerging sexual orientation related disparities of hazardous drinking in young adulthood.
    Journal of Youth and Adolescence 01/2013; 43(1). DOI:10.1007/s10964-013-9905-9 · 2.72 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Using a sample of 482 ethnically diverse current substance using men who have sex with men who reported recent unprotected anal intercourse, this study compared health risk behaviors-substance use and sexual HIV risk-and one health protective factor-prosocial activities-between men who live in a gay neighborhood and those who do not. Data are drawn from comprehensive health and social risk assessments administered in South Florida. In a multivariate logistic regression model, methamphetamine use, high rates of receptive unprotected anal intercourse, and lower levels of prosocial engagement were found to be risk factors associated with gay neighborhood residence. Compared with living elsewhere, gay neighborhood residence appeared to be protective against cocaine use and substance dependence. Implications of the findings for prevention interventions are discussed, as is the need for further research regarding decisions about neighborhood residence and how neighborhood risk and protective factors emerge and are sustained.
    American journal of men's health 09/2012; 7(2). DOI:10.1177/1557988312458793 · 1.15 Impact Factor
Show more