Short communicationPredictors of substance use over time among gay, lesbian, and bisexual youths: An examination of three hypotheses
Introduction
Representative studies have found that gay, lesbian, and bisexual (GLB) youths are at substantially higher risk than heterosexuals are for cigarette, alcohol, and marijuana use (e.g., Bontempo & D'Augelli, 2002, Russell et al., 2002). However, little is known about the reasons for the high rates of substance use. The present longitudinal report examined three hypothesized reasons for substance use among GLB youths: childhood sexual abuse, gay-related stress, and the coming-out process.
The hypothesis that sexual abuse during childhood predicts higher rates of substance use has been widespread among heterosexuals (see Simpson & Miller, 2002, for review) and GLB populations (see Hughes & Eliason, 2002, for review). However, research on GLB adults has found inconsistent relations, such that childhood sexual abuse has been associated with greater use of some substances, but not of others (e.g., Hughes et al., 2001, Kalichman et al., 2001, Stall et al., 2001). The relation of childhood sexual abuse to substance use has not been examined among GLB youths.
The most widely hypothesized reason for the high rates of substance use among GLB individuals is the experience of gay-related stress (see Hughes & Eliason, 2002, for review). Gay-related stress refers to the experience of stigmatization for being GLB in a society in which homosexuality is negatively sanctioned (Rosario, Schrimshaw, Hunter, & Gwadz, 2002), including experiences of victimization, rejection, and other stressful events perpetrated against GLB individuals. Available research on substance use has generated mixed results. Verbal harassment and discrimination for being gay were associated with more alcohol and drug abuse among gay men McKirnan & Peterson, 1988, Stall et al., 2001, but not among lesbians Heffernan, 1998, McKirnan & Peterson, 1989. Among gay and bisexual male youths, gay-related stressful events were associated with more drug use, but not with alcohol use (Rosario, Rotheram-Borus, & Reid, 1996). The gay-related stress hypothesis remains unexamined among lesbian and bisexual female youths.
The process of identity development as GLB, frequently termed the “coming-out process,” has been hypothesized to predict substance use among GLB individuals. Research on the aspects of the coping-out process, as defined by Rosario, Hunter, Maguen, Gwadz, and Smith (2001), has found inconsistent results. Disclosure of one's sexuality has been associated with some forms of substance use, but not of others McKirnan & Peterson, 1989, Stall et al., 2001, and disclosure has been unrelated to substance use among gay and bisexual youths (Rosario et al., 1996). Other aspects have not been associated with substance use (i.e., internalized homophobia, Ross et al., 2001, and acceptance of GLB identity, Ghindia & Kola, 1996). Inconsistent findings may be due to nonlinear relations. A curvilinear relation was found between the affiliation with the GLB community and alcohol use, in which high and low (but not moderate) affiliations were associated with heavy alcohol use (Stall et al., 2001). However, unlike the nonlinear relation found by Stall et al. (2001), but based on careful consideration of the inconsistent findings in the literature we hypothesize that for youths, initial increases in substance use are followed by decreases in substance use as the coming-out process unfolds.
Several problems have been noted in the literature on substance use among GLB individuals, including little research on lesbian and bisexual females, little research on adolescents, and the absence of longitudinal research (see Hughes & Eliason, 2002, for review). The current longitudinal report extends the research literature by examining the ability of three hypotheses to account for changes in cigarette, alcohol, and marijuana use over time among GLB youths.
Section snippets
Participants
Youths, ages 14 to 21 years, were recruited from three gay-focused organizations (85%) and two college organizations (15%) in New York City. The sample consisted of 80 males and 76 females, with a mean age of 18.3 years (S.D.=1.65) at baseline. The youths were of Latino (37%), Black (35%), White (22%), and other ethnic (7%) backgrounds. The youths self-identified as gay/lesbian (66%), bisexual (31%), or other (3%). Details on the participants and procedure are available elsewhere (Rosario et
Results
The use and quantity of tobacco, alcohol, and marijuana were widespread and substantial (see Table 1). Change in the quantity of cigarette, alcohol, and marijuana use over time was examined by means of repeated measures ANOVA (see Table 1). Alcohol use increased significantly (P<.05) between baseline and 12 months, as did marijuana use between baseline and both 6 and 12 months. Cigarette use did not change significantly over time; therefore, no multivariate analyses were conducted of change in
Discussion
Little is known about the reasons for the high rates of substance use found among GLB youths. The results from this longitudinal study address potential routes by which substance use may develop among GLB youths. Counter to prevalent hypotheses, we found no evidence of increased substance use among youths who reported childhood sexual abuse or gay-related stress. However, the coming-out process—specifically, involvement in gay-related activities—was found to have significant curvilinear
Acknowledgements
This work was supported by center grant P50-MH43520 from the National Institute of Mental Health; Margaret Rosario, Principal Investigator, HIV Risk and Coming Out Among Gay and Lesbian Adolescents; and Anke A. Ehrhardt, Principal Investigator, HIV Center for Clinical and Behavioral Studies.
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