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Review: Sexual and gender minority youth face multiple risk factors for substance use

Previous literature has documented that sexual minority youth (SMY; i.e., lesbian, gay, and bisexual individuals) and gender minority youth (GMY; i.e., transgender and genderqueer individuals) experience greater health risks and may engage in substance use at disparate rates, compared to their cisgender and heterosexual peers. A recent scoping review investigated risk and protective factors for substance use among SMY and GMY. Peer-reviewed literature on substance use (excluding tobacco use, behavioral addictions, laxative abuse, and non-prescribed hormone use) among GMY and SMY under 25 years of age were examined. Only articles published between 2013 and 2017 were included. The final sample consisted of 97 articles, of which nearly two-thirds (n = 63) utilized convenience samples and over three-quarters (n = 75) were cross-sectional in design. Thirty-six percent (n = 35) of the sample examined minority stress as a predictor of substance use. Alcohol was the mostly commonly studied substance (n = 77 articles), followed by cannabis use (n = 37) and non-cannabis drug use (n = 16). Among alcohol-focused studies, enacted stigma and perceived homophobia generally predicted drinking behaviors among SMY, while higher education attainment, school engagement, and earlier SMY identification, and adaptive personality traits were identified as protective factors. Sixty-six studies focused on drug use among SMY. Results indicated enacted stigma predicted cocaine, methamphetamine, heroin, injection drug, and cannabis use among this group. Physical victimization and bullying were also important predictors of drug use among SMY. Protective factors against drug use for SMY included higher socioeconomic status and self-esteem, as well as state policies (i.e., marriage equality). Only 9.3% of the sample (n = 9 articles) examined substance use among GMY. Findings from these studies indicated enacted stigma predicted substance use among this group. Healthcare discrimination and bullying were also identified as risk factors for certain subgroups of GMY. GMY were more likely than their cisgender peers to report using alcohol to cope with stress. Just over 20% of studies in the sample (n = 20) examined racial/ethnic differences in substance use among SMY (none focused on racial/ethnic differences among GMY). Results indicated SMY of color reported disproportionately high rates of stigma and bullying, which were both associated with higher risk of substance use. Limitations of this scoping review included reliance on self-report across all studies, relatively little focus on GMY alone, and variability in measures that made cross-study comparisons challenging.

Take away: In this scoping review of 97 studies, minority stress and bullying were identified as risk factors for alcohol and drug use among sexual and gender minority youth. Relatively few studies focused on gender minority youth alone or racial/ethnic differences among sexual and gender minority youth, thereby identifying a gap in the literature.

Kidd, J.D., Jackman, K.B., Wolff, M., Veldhuis, C.B. & Hughes, T.L. (2018). Risk and protective factors for substance use among sexual and gender minority youth: A scoping review. Current Addiction Reports, 5(2), 158-173. doi: 10.1007/s40429-018-0196-9

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