Dataset Information

Associations Among Childhood Household Dysfunction, Sexual Orientation, and DSM-5 Alcohol, Tobacco and Other Substance Use Disorders in Adulthood: Evidence From a National U.S. Survey.

ABSTRACT:

Objectives

This study examined the associations between childhood household dysfunction and adulthood past-year DSM-5 alcohol, tobacco, and other substance use disorders across sexual orientation subgroups (eg, lesbian/gay, bisexual, and heterosexual).

Methods

Prevalence estimates were based on National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III) data collected from structured diagnostic face-to-face interviews in a nationally representative sample of 36,309 U.S. adults. Multivariable regression was used to examine associations between childhood household dysfunction and past-year substance use disorders in adulthood.

Results

Sexual minorities, particularly sexual minority women, reported higher rates of childhood household dysfunction (eg, parental/household history of substance-related problems) and adulthood DSM-5 alcohol, tobacco, and substance use disorders. Results of multivariable analyses indicated that childhood histories of parental/household substance-related problems were associated with greater odds of past-year substance use disorders among sexual minorities than heterosexuals, and that such histories may moderate differences among sexual orientation subgroups. The risk of substance use disorders among sexual minority women relative to exclusively heterosexual women (ie, heterosexual-identified women without same-sex attraction or behavior) remained high, even when accounting for household dysfunction. In contrast, there were no such differences between sexual minority men and exclusively heterosexual men.

Conclusions

Sexual minorities are more likely to have childhood household dysfunction which in turn is associated with a higher risk of developing DSM-5 alcohol, tobacco, and substance use disorders in adulthood, especially among sexual minority women. Healthcare providers who care for individuals raised in dysfunctional households should carefully assess risk for substance use disorders and intervene as needed.

SUBMITTER: McCabe SE

PROVIDER: S-EPMC7898765 | 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:OBJECTIVES:To assess the association between tobacco and hazardous alcohol use and sexual orientation and whether such an association could be explained by other sociodemographic characteristics. DESIGN:Cross-sectional household survey conducted in 2014-2016. SETTING:England, UK. PARTICIPANTS:Representative English population sample (pooled n=43?866). MAIN OUTCOMES:Sexual orientation identity (lesbian/gay, bisexual, heterosexual, prefer-not-to-say); current tobacco and hazardous alcohol use (defined as Alcohol Use Disorders Identification Test Score ?8). All outcomes were self-reported. RESULTS:Due to interactions between sexual orientation and gender for substance use, analyses were stratified by gender. Tobacco use prevalence was significantly higher among lesbian/gay (women: 24.9%, 95% CI 19.2% to 32.6%; men: 25.9%, 95%?CI 21.3% to 31.0%) and bisexual participants (women: 32.4%, 95%?CI 25.9% to 39.6%; men: 30.7%, 95%?CI 23.7% to 30.7%) and significantly lower for prefer-not-to-say participants in women (15.5%, 95%?CI 13.5% to 17.8%) but not men (22.7%, 95%?CI 20.3% to 25.3%) compared with heterosexual participants (women: 17.5%, 95%?CI 17.0% to 18.0%; men: 20.4%, 95%?CI 19.9% to 21.0%; p<0.001 for omnibus test). Similarly, hazardous alcohol use was significantly more prevalent for lesbian/gay (women: 19.0%, 95%?CI 14.0% to 25.3%; men: 30.0%, 25.2%-35.3%) and bisexual participants (women: 24.4%, 95%?CI 18.7% to 31.3%; men: 24.3%, 95%?CI 17.9% to 32.1%) and lower for prefer-not-to-say participants (women: 4.1%, 95%?CI 3.0% to 5.4%; men: 13.7%; 95%?CI 11.8% to 16.0%) compared with heterosexuals (women: 8.3%, 95%?CI 7.9% to 8.7%; men: 18.4%, 95%?CI 17.9% to 18.9%; p<0.001 for omnibus test). However, after adjusting for sociodemographic confounders, tobacco use was similar across all sexual orientation groups among both women and men. By contrast, sexual orientation differences in hazardous alcohol use remained even after adjustment among women but not for bisexual and gay men. CONCLUSIONS:In England, higher rates of tobacco use among sexual minority men and women appear to be attributable to other sociodemographic factors. Higher rates of hazardous alcohol use among sexual minority men may also be attributable to these factors, whereas this is not the case for sexual minority women.