Dataset Information

Sexual Orientation Differences in Alcohol Use Disorder Across the Adult Life Course.

ABSTRACT:

Introduction

Sexual orientation‒related disparities in alcohol use disorder are well-established. Yet, the degree to which sexual orientation differences in alcohol use disorder vary across the life course is poorly understood. There is also a limited understanding of how exposure to minority stressors and their relationship with alcohol use disorder vary as a function of age.

Methods

Using nationally representative data collected in 2012-2013, authors used sex-stratified time-varying effect models to estimate age-specific prevalence rates of alcohol use disorder among heterosexual and sexual minority adults aged 18-60 years (N=28,090). Among sexual minority adults (n=1,050), authors also assessed age-specific associations between exposure to lesbian, gay, and bisexual‒related discrimination and alcohol use disorder. Analyses were conducted in 2019.

Results

Gay and bisexual male participants aged 18-45 years demonstrated the highest prevalence rates of alcohol use disorder (e.g., >45% at age 25 years), whereas lesbian, gay, and bisexual female participants were most likely to meet the criteria for alcohol use disorder between ages 45 and 55 years. Sexual minority adults who experienced discrimination in the past year had greater odds of alcohol use disorder between ages 23 and 34 years and again from ages 42 to 53 years; the association between discrimination and alcohol use disorder was strongest among sexual minority men.

Conclusions

Sexual orientation-related disparities in alcohol use disorder are dynamic across the life course and point to critical times for screening and intervention. Developmental perspectives of sexual minority health inequities demand focused research attention as findings will help to identify strategies for promoting sexual minority health at distinct points in the life course.

SUBMITTER: Fish JN

PROVIDER: S-EPMC7483372 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:Sexual minorities are more likely than their heterosexual counterparts to develop alcohol use disorder (AUD), and understanding the underlying reasons for this heightened risk is a public health priority. This study examined relationships between sexual orientation discrimination and DSM-5 AUD severity. METHODS:The 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions III conducted in-person interviews with a nationally representative sample of U.S. adults (N = 36,309). Approximately 2.8% of the target population self-identified as lesbian, gay, or bisexual, 3.1% had at least 1 past-year same-sex sexual partner, and 8.3% reported same-sex sexual attraction. RESULTS:Adults who identified as lesbian, gay, bisexual, heterosexual with same-sex attraction and/or current same-sex sexual partners, and those not sure of their sexual identity, had higher rates of individual DSM-5 AUD criteria than heterosexual-identified adults with only opposite-sex attraction and sexual partners. Respondents who were bisexual or unsure of their sexual identity consistently had the highest probabilities of endorsing each of these AUD criteria relative to the other subgroups. Differences in AUD severity across sexual orientation subgroups were much larger among women than among men. Sexual minorities who experienced higher levels of sexual orientation discrimination had significantly higher levels of AUD severity than sexual minorities who experienced lower levels or no discrimination. In particular, greater levels of sexual orientation discrimination increased the odds of impaired control criteria and pharmacologic criteria. Associations between prior-to-past-year sexual orientation discrimination and AUD severity were not as robust as those involving past-year discrimination. CONCLUSIONS:Sexual minorities are at substantially greater risk of severe DSM-5 AUD, and this is particularly true among those who experience high levels of sexual orientation discrimination. Findings indicate that proximal experiences of discrimination are more salient than distal experiences. AUD treatment should address recent sexual orientation discrimination given that such experiences are associated with more severe AUD.

Project description:AIMS:We estimated sexual-orientation differences in alcohol use trajectories during emerging adulthood, and tested whether alcohol use trajectories mediated sexual-orientation differences in alcohol use disorders (AUDs). DESIGN:Longitudinal self-reported survey data from the Growing Up Today Study. SETTING:United States. PARTICIPANTS:A total of 12?493 participants aged 18-25 during the 2003, 2005, 2007 or 2010 surveys. MEASUREMENTS:Stratified by gender, longitudinal latent class analyses estimated alcohol use trajectories (using past-year frequency, quantity and binge drinking from 2003 to 2010). Multinomial logistic regression tested differences in trajectory class memberships by sexual orientation [comparing completely heterosexual (CH) participants with sexual-minority subgroups: mainly heterosexual (MH), bisexual (BI) and gay/lesbian (GL) participants]. Modified Poisson regression and mediation analyses tested whether trajectories explained sexual-orientation differences in AUDs (past-year DSM-IV abuse/dependence in 2010). FINDINGS:Six alcohol use trajectory classes emerged for women and five for men: these included heavy (23.5/36.9% of women/men), moderate (31.8/26.4% of women/men), escalation to moderately heavy (9.7/12.0% of women/men), light (17.0% for women only), legal (drinking onset at age 21; 11.1/15.7% of women/men) and non-drinkers (7.0/9.1% of women/men). Compared with CH women, MH and BI women had higher odds of being heavy, moderate, escalation to moderately heavy and light drinkers versus non-drinkers (odds ratios = 2.02-3.42; P-values < 0.01-0.04). Compared with CH men, MH men had higher odds of being heavy, moderate and legal drinkers versus non-drinkers (odds ratios = 2.24-3.34; P-values < 0.01-0.01). MH men and women, BI women and GLs had higher risk of AUDs in 2010 than their same-gender CH counterparts (risk ratios = 1.34-2.17; P-values < 0.01). Alcohol use trajectories mediated sexual-orientation differences in AUDs for MH and GL women (proportion of effect mediated = 30.8-31.1%; P-values < 0.01-0.02), but not for men. CONCLUSIONS:In the United States, throughout emerging adulthood, several sexual-minority subgroups appear to have higher odds of belonging to heavier alcohol use trajectories than completely heterosexuals. These differences partially explained the higher risk of alcohol use disorders among mainly heterosexual and gay/lesbian women but not among sexual-minority men.