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Sexual Identity-Attraction Patterns and Substance Use Across Developmental Stages: Findings from the 2023 National
Timothy J Grigsby1, Darin Mains1, R Andrew Yockey2
1Department of Social and Behavioral Health, University of Nevada, 4505 S. Maryland Pkwy, Las Vegas, NV 89154, USA.
Objective:
Sexual minorities experience elevated substance use, but many epidemiological studies rely exclusively on sexual identity measures. Inclusion of sexual identity and sexual attraction items in the 2023 National Survey on Drug Use and Health (NSDUH) provides an opportunity to assess how sexual identity-attraction patterns relate to substance use across developmental stages.
Methods:
Data were from the 2023 NSDUH (N = 56,705), a nationally representative cross-sectional survey of individuals aged 12 years and older. Sexual identity and attraction were recoded into a five-category identity-attraction variable: coincident Ii.e. identity-attraction aligned) heterosexual, coincident sexual minority, branched (i.e., identity-attraction misaligned) heterosexual, branched sexual minority, and unknown/not reported. Outcomes included past-year alcohol, tobacco, marijuana, and illicit drug use. Analyses were stratified by adolescents (12-17), young adults (18-25), and adults (26+). Weighted prevalence estimates and survey-adjusted logistic regressions were conducted.
Results:
Across age groups, coincident and branched sexual minorities had consistently elevated odds of substance use relative to coincident heterosexuals. For example, compared to coincident heterosexuals, coincident sexual minority adults had higher odds of marijuana use (aOR = 3.53, 95% CI=2.87-4.34) as did branched sexual minorities (aOR = 3.46, 95% CI=2.76-4.35). Branched heterosexuals also demonstrated elevated risk, particularly for marijuana and illicit drug use. Respondents reporting unknown identity/attraction generally had lower odds of alcohol use.
Conclusions:
Sexual identity-attraction patterns are an important correlate of substance use across age groups. Public health surveillance and interventions should adopt multidimensional measures of sexual orientation to identify hidden high-risk groups and reduce persistent disparities.
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