Alcohol Use and Suicidality by Sexual Orientation Among U.S. Youth, 2009-2017.

INTRODUCTION: Alcohol use and suicidality remain serious risks for U.S. youth. Research has established that disparities exist in these outcomes between heterosexual and sexual minority youth. However, research into the associations between alcohol use and suicidality has yet to consider the differential role of sexual orientation. METHODS: Using a pooled, diverse sample from the 2009-2017 Youth Risk Behavior Survey, associations of alcohol use and suicidality by sex and sexual orientation, and changes in these outcomes over time, were investigated. Analyses were conducted in 2019. RESULTS: Suicidality was highest among nonheterosexuals, who ranged from twofold to sevenfold higher odds to report suicidality across all time points, with the most striking disparities among male sexual minority youth. Rates among all students remained stable or increased over time; notable exceptions included a decrease in suicide attempts among bisexual students. Among all students, current alcohol use was associated with elevated levels of suicidality. For female students, the association between drinking and suicidality did not significantly differ by sexual identity; for male students, it was significant regardless of sexual identity and most pronounced among not sure youth. CONCLUSIONS: These results emphasize the need for additional research into the relationship between contemporaneous alcohol use and suicidality, with attention to differences based on sex, sexual orientation, and other factors that may impact these relationships. There is a particular need for research to examine the temporal nature of the association such that evidence-informed, high-impact interventions can be developed to improve suicidality outcomes among sexual minority youth.

Racial/Ethnic Differences in Mental Health, Substance Use, and Bullying Victimization Among Self-Identified Bisexual High School-Aged Youth.

Purpose: Sexual minority youth are at increased risk for mental health problems and substance use, and accumulating evidence indicates that bisexual youth are at greatest risk. However, bisexual youth are not a homogenous group and scholars have called for greater attention to the intersections of multiple marginalized identities. As such, we examined racial/ethnic differences in mental health (sadness/hopelessness and suicidal ideation), substance use (cigarette use, binge drinking, marijuana use, and other illicit drug use), and bullying (in-person and electronic) among self-identified bisexual high school-aged youth (overall and by sex). Method: Data from the local versions of the Youth Risk Behavior Survey were pooled across jurisdictions and years (2011-2015), resulting in an analytic sample of 18,515 bisexual youth who were racially/ethnically diverse. Results: Black and Hispanic bisexual youth were less likely to report in-person and electronic bullying than White bisexual youth. In addition, Black bisexual youth were less likely to report sadness/hopelessness and suicidal ideation than White, Hispanic, and Other race/ethnicity bisexual youth. Black bisexual female youth were also less likely to report cigarette use, binge drinking, and other illicit drug use than White bisexual female youth. In contrast to most of our findings, Black bisexual youth were more likely to report marijuana use than White bisexual youth. Most of the significant racial/ethnic differences in mental health and substance use remained significant after controlling for bullying. Conclusion: These findings highlight the heterogeneity of bisexual youth and the need to consider multiple marginalized identities to understand the health disparities affecting this diverse population.

Alcohol Use and Disordered Eating in a US Sample of Heterosexual and Sexual Minority Adolescents.

OBJECTIVE: To expand knowledge of co-occurring alcohol use and disordered eating behaviors (DEB) among sexual minority (ie, nonheterosexual) youth. METHOD: Using pooled 2009 to 2015 US Youth Risk Behavior Surveys (322,687 students; 7.3% lesbian, gay, bisexual), multivariable logistic regression models examined the following: (1) associations of age of onset of drinking and past month binge drinking with past year DEB (fasting, diet pill use, purging, steroid use); and (2) effect modification by sexual orientation. RESULTS: Alcohol use and sexual minority identity were independently associated with elevated odds for diet pill use and purging among female adolescents, and with fasting and steroid use among male adolescents. Odds of fasting increased with greater frequency of monthly binge drinking among heterosexual adolescent female youth, and odds of diet pill use increased with greater frequency of monthly binge drinking among heterosexual adolescent male youth. DEB prevalence was particularly pronounced among adolescents who binge drank and who were not sure of their sexual orientation identity. Among male adolescents not sure of their sexual orientation identity, those who binge drank more than 1 day in the past month had 8.63 to 23.62 times the odds of using diet pills relative to those who did not binge drink, and 13.37 to 26.42 times the odds of purging relative to those who did not binge drink. CONCLUSION: More research is needed on psychosocial factors underlying alcohol use and DEB in youth of all sexual orientations.

Bias From Potentially Mischievous Responders on Large-Scale Estimates of Lesbian, Gay, Bisexual, or Questioning (LGBQ)-Heterosexual Youth Health Disparities.

OBJECTIVES: To determine how sensitive estimates of lesbian, gay, bisexual, or questioning (LGBQ)-heterosexual youth health disparities are to the presence of potentially mischievous responders. METHODS: We used US data from the 2015 Youth Risk Behavior Survey, pooled across jurisdictions that included a question about sexual identity for a total sample of 148 960 students. We used boosted regressions (a machine-learning technique) to identify unusual patterns of responses to 7 screener items presumably unrelated to LGBQ identification, which generated an index of suspected mischievousness. We estimated LGBQ-heterosexual youth disparities on 20 health outcomes; then we removed 1% of suspected mischievous responders at a time and re-estimated disparities to assess the robustness of original estimates. RESULTS: Accounting for suspected mischievousness reduced estimates of the average LGBQ-heterosexual youth health disparity by up to 46% for boys and 23% for girls; however, screening did not affect all outcomes equally. Drug- and alcohol-related disparities were most affected, particularly among boys, but bullying and suicidal ideation were unaffected. CONCLUSIONS: Including screener items in public health data sets and performing rigorous sensitivity analyses can support the validity of youth health estimates.

Sexual orientation disparities in prescription drug misuse among a nationally representative sample of adolescents: Prevalence and correlates.

OBJECTIVE: Sexual minority adolescents (SMA) may be at disproportionate risk for misusing prescription psychotropic medications compared to their heterosexual peers. However, generalizable studies specific to this age group are lacking. The current study aimed to describe the prevalence of sexual orientation disparities in prescription drug misuse among a nationally representative sample of adolescents as well as to examine key correlates of misuse. METHOD: Using data from the National Youth Risk Behavior Survey, we conducted stepwise multivariable weighted logistic regressions, sequentially controlling for demographics, experiences of victimization, mental health, and other illicit substance use. RESULTS: Adjusting for grade and race/ethnicity, female SMA and gay and unsure males had significantly elevated odds of ever misusing a prescription drug compared to heterosexual adolescents (ORs from 1.7-2.5). Most sexual orientation disparities among females remained significant with the addition of victimization and mental health covariates but attenuated completely after controlling for other illicit drug use. The effect for unsure males attenuated when victimization variables were included, but the effect for gay males remained significant through the final model. Controlling for other illicit drug use, mental health variables remained significant correlates for females whereas only forced sex was significant for males. CONCLUSION: These results suggest experiences of victimization and mental health partially account for the disparities in prescription drug misuse between SMA and heterosexual adolescents, and their effects may differ by sex. A combination of structural, individual coping, and universal drug prevention approaches should be used to make the largest impact on reducing these disparities.