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ISSN: 0095-2990 (print), 1097-9891 (electronic)
Am J Drug Alcohol Abuse, 2013; 39(4): 252258
! 2013 Informa Healthcare USA, Inc. DOI: 10.3109/00952990.2013.796962
REGULAR ARTICLE
Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA and 2Department of Respiratory Therapy, GA State
University, Atlanta, GA, USA
Abstract
Keywords
Background: College students identifying as Lesbian, Gay or Bisexual (LGB) are at increased
risk for substance use. Few studies have assessed correlates of concurrent substance use,
which increases the risk for substance use disorders. Objectives: The current study aimed
to (1) examine differences in substance use among male and female sexual minorities and
(2) explore the impact of psychosocial factors on the relationship between sexual identity and
concurrent substance use. Methods: A web-based survey assessing health behavior, psychosocial characteristics, attitudes and demographics was administered to students from six
colleges in the southeastern US. A total of 4840 students responded to the survey; 2.9%
reported a homosexual identity (n 111) and 3.5% reported a bisexual identity (n 135).
Multivariable modeling was used to assess the relationship between sexual identity and the
number of substances used, adjusting for demographic and psychosocial factors. Results:
Bisexual females were significantly more likely than their homosexual or heterosexual
counterparts to report tobacco use (p50.0001), binge drinking (p50.05) and marijuana use
(p50.0001) in the past 30 days. No differences in substances used existed among males.
Adjusted for age and ethnicity, homosexually- and bisexually-identified females were more
likely to have concurrent substance use than those who identified as heterosexual (p50.0001
and p50.0001, respectively). Adjusting for psychosocial factors decreased the magnitude and
significance of the association (p50.01 and p50.001, respectively). Conclusion: Female sexual
minorities are at high risk for substance use. Targeting specific psychosocial factors might be
useful in efforts to address use of tobacco, alcohol and marijuana among LGB young adults.
20
13
Introduction
History
DOI: 10.3109/00952990.2013.796962
Methods
Sample
Data for these analyses come from a larger cross-sectional
study on the health behaviors of college students. In 2010, a
random sample of students from six colleges in the southeastern US (5000 students at each school, and a census
of all students a two schools with enrollment less than 5000)
were invited to complete an online survey (n 24 055).
Of the students who received the invitation to participate,
4840 students returned a completed survey (20.1%). Only
participants who had complete data on sexual orientation,
smoking, binge drinking, marijuana use and psychosocial
questions were included in these analyses (n 3892).
Additional details about the study recruitment and study
design procedures can be found elsewhere (21). The Emory
University Institutional Review Board approved this study,
IRB# 00030631.
Measures
The online survey contained 230 questions and assessed
a variety of health behaviors, psychosocial characteristics,
attitudes and demographics. Sexual orientation was defined by
self-reported sexual identity, asking participants, What best
253
254
G. L. Schauer et al.
Results
The majority of the sample was female (71.2%), white or
black (46.7% and 37.7%, respectively), and attended a 4-year
school (63.0%). Among the total sample, 2.9% of students
reported a homosexual identity (n 111) and 3.5% reported a
bisexual identity (n 135). More specifically, among males,
4.5% reported being homosexual and 2.3% reported being
bisexual, while among females, 3.9% reported being bisexual
and 2.2% reported being homosexual (Table 1). Compared
to homosexual or heterosexual students, bisexual students
reported more depressive symptoms (p50.0001), higher
levels of stress (p50.001), lower satisfaction with life
(p50.0001), higher levels of sensation seeking (p50.0001),
lower levels of conscientiousness (p50.001), and lower levels
of emotional stability (p50.0001).
In addition, compared to homosexually or heterosexuallyidentified males, bisexual males reported more depressive
symptoms (p50.0001) and higher perceived stress
(p50.001) (Table 2). In looking at the Big-Five personality
traits, homosexually-identified males reported higher levels
or conscientiousness (p50.05) and openness (p50.01)
DOI: 10.3109/00952990.2013.796962
255
Table 1. Socio-demographic, psychosocial and substance use characteristics among college students of differing sexual orientations.
Variable
Sociodemographics
Age (SD)
Male (%)
Ethnicity (%)
White
Black
Other
Type of school (%)
Four-year
Two-year
Psychosocial factors
Depressive symptoms (SD)a
Perceived Stress Scale (SD)a
Satisfaction With Life Scale (SD)a
Sensation seeking (SD)
Big 5 Personality Traits (SD)
Extraversion
Agreeableness
Conscientiousness
Emotional stability
Openness
Substance use, past 30 days
Any alcohol use (%)a
No
Yes
Any binge drinking (%)a
No
Yes
Marijuana (%)a
No
Yes
Tobacco use (%)
No
Yes
Any substance use (%)
No
Yes
Substance use index (SD)a
Heterosexual n 3646
M(SD) or n (%)
Homosexual n 111
M(SD) or n (%)
Bisexual n 135
M(SD) or n (%)
p Value
23.52 (7.09)
1123 (28.85)
22.83 (5.07)
1046 (28.69)
23.57 (7.18)
51 (45.95)
22.81 (5.98)
26 (19.26)
0.2806
50.0001
1816 (46.66)
1467 (37.69)
609 (15.65)
1713 (46.98)
1379 (37.82)
554 (15.19)
36 (32.43)
51 (45.95)
24 (21.62)
67 (49.63)
37 (27.41)
31 (22.96)
2451 (62.98)
1441 (37.02)
2298 (63.03)
1348 (36.97)
78 (70.27)
33 (29.73)
75 (55.56)
60 (44.44)
1.24
6.16
22.26
3.32
(1.32)
(3.40)
(7.50)
(0.90)
1.20
6.09
22.42
3.30
(1.29)
(3.40)
(7.47)
(0.90)
1.43
6.75
20.89
3.44
(1.45)
(3.22)
(7.41)
(0.84)
1.93
7.43
19.25
3.68
(1.66)
(3.25)
(7.85)
(0.89)
50.0001
50.001
50.0001
50.0001
8.75
9.97
11.06
9.53
10.79
(2.86)
(2.31)
(2.43)
(2.75)
(2.31)
8.75
10.01
11.09
9.57
10.77
(2.86)
(2.31)
(2.42)
(2.73)
(2.30)
8.59
9.57
11.01
9.65
11.28
(2.97)
(2.13)
(2.29)
(2.77)
(2.31)
8.87
9.46
10.23
8.40
11.20
(2.86)
(2.34)
(2.64)
(3.02)
(2.40)
0.7483
50.05
50.001
50.0001
50.01
50.001
0.0571
1696 (43.58)
2196 (56.42)
1622 (44.49)
2024 (55.51)
35 (31.53)
76 (68.47)
39 (28.89)
96 (71.11)
50.0001
3029 (77.83)
863 (22.17)
2850 (77.91)
796 (21.83)
84 (74.63)
27 (24.32)
95 (70.24)
40 (29.63)
0.0866
3387 (87.02)
505 (12.98)
3202 (87.82)
444 (12.18)
85 (76.58)
26 (23.42)
100 (74.07)
35 (25.93)
50.0001
2712 (69.68)
1180 (30.32)
2565 (70.35)
1081 (29.65)
75 (67.57)
36 (32.43)
72 (53.33)
63 (46.67)
50.0001
2268 (58.27)
1624 (41.73)
0.65 (0.90)
2150 (58.97)
1496 (41.03)
0.64 (0.88)
56 (50.45)
55 (49.55)
0.80 (.98)
62 (45.93)
73 (54.07)
1.02 (1.11)
50.01
50.0001
Discussion
The current study provides novel and important information
regarding concurrent substance use among LGB-identifying
college students. Findings from this study suggest a significant association between sexual identity and the number of
substances used among female college students, with those
identifying as homosexual or bisexual having a higher odds of
increased substance use than their heterosexual counterparts.
Consistent with existing research (1719), after controlling
for demographic factors, the relationship between the number
of substances used and sexual identity was strongest among
women who were bisexually identified. However, the magnitude of association between bisexual identity and concurrent
substance use decreased significantly after adding psychosocial factors to the model. Interestingly, the magnitude of
association did not change substantially for homosexuallyidentified females, suggesting that psychosocial factors
confound the relationship between sexual orientation and
substance use in bisexual women. Indeed, in bivariate
analyses, data suggest that bisexual females have a unique
psychosocial identity, with more depressive symptoms, higher
perceived stress, lower satisfaction with life, higher levels of
sensation seeking, lower levels of agreeableness, lower levels
of contentiousness and lower emotional stability. More
research is needed to better understand why this unique
psychosocial profile might exist and how it might lead to
increased substance use.
Males in this sample did not differ in substance use
by sexual identity, and multivariable regressions did not
find significant association between sexual identity and
concurrent substance use among males. While a number of
studies have found a significant association between sexual
identity and illicit drug use among college males (17,19,28),
findings have been inconsistent with regard to the association
of sexual identity and binge drinking or cigarette smoking
(19,29). It is possible that no association existed in the
current study because we opted to combine substances
with differing associations into one substance use score.
841 (80.40)
205 (16.60)
620 (59.27)
426 (40.73)
481 (45.98)
565 (54.02)
0.92 (1.02)
899 (80.05)
224 (19.95)
669 (59.57)
454 (40.43)
521 (46.39)
602 (53.61)
0.92 (1.02)
711 (67.97)
335 (32.03)
766 (68.21)
357 (31.79)
(2.78)
(2.33)
(2.41)
(2.63)
(2.40)
424 (40.54)
622 (59.46)
8.40
9.51
10.68
10.08
10.54
(1.30)
(3.40)
(7.46)
(0.88)
447 (39.80)
676 (60.20)
(2.79)
(2.32)
(2.42)
(2.65)
(2.40)
8.42
9.52
10.67
10.04
10.59
1.10
5.74
21.71
3.44
633 (60.52)
413 (39.48)
687 (61.18)
436 (38.82)
(1.33)
(3.42)
(7.50)
(0.88)
546 (52.20)
321 (30.69)
179 (17.11)
575 (51.20)
348 (30.99)
200 (17.81)
1.14
5.84
21.62
3.46
24.07 (7.87)
24.00 (7.80)
Heterosexual
n 1046
M(SD) or
n (%)
(3.33)
(2.12)
(2.32)
(2.72)
(2.10)
(1.54)
(3.49)
(7.92)
(0.80)
27 (52.94)
24 (47.06)
0.78 (1.04)
35 (68.63)
16 (31.37)
39 (76.47)
12 (23.53)
39 (76.47)
12 (23.53)
15 (29.41)
36 (70.59)
8.88
9.60
11.09
9.63
11.63
1.45
6.71
21.18
3.72
39 (76.47)
12 (23.53)
19 (37.25)
20 (39.22)
12 (23.53)
22.43 (3.92)
Homosexual
n 51
M(SD) or
n (%)
(2.19)
(2.16)
(2.84)
(3.11)
(2.50)
(1.86)
(3.59)
(8.14)
(1.04)
13 (50.00)
13 (50.00)
1.15 (1.24)
14 (53.85)
12 (46.15)
19 (73.08)
7 (26.92)
16 (61.54)
10 (38.46)
8 (30.77)
18 (69.23)
8.35
9.50
9.58
9.19
10.54
2.21
7.96
18.96
3.56
15 (57.69)
11 (42.31)
10 (38.46)
7 (26.92)
9 (34.62)
24.50 (10.3)
Bisexual
n 26
M(SD) or
n (%)
0.3968
0.5812
0.3449
0.5268
0.3386
0.1810
0.4803
0.9712
50.05
0.1242
50.01
50.0001
50.001
0.1659
0.0735
0.0690
50.05
0.3261
p Value
(2.88)
(2.28)
(2.42)
(2.76)
(2.27)
(1.31)
(3.38)
(7.49)
(0.91)
1747 (63.09)
1022 (36.91)
0.55 (0.81)
2043 (73.78)
726 (26.22)
2488 (89.85)
281 (10.15)
2263 (81.73)
506 (18.27)
1249 (45.11)
1520 (54.89)
8.88
10.16
11.21
9.33
10.88
1.28
6.28
22.52
3.26
1764 (63.71)
1005 (36.29)
1241 (44.82)
1119 (40.41)
409 (14.77)
23.33 (6.77)
All females
n 2769
M(SD) or
n (%)
(2.88)
(2.27)
(2.41)
(2.74)
(2.26)
(1.29)
(3.40)
(7.45)
(0.91)
1669 (64.19)
931 (35.81)
0.52 (0.79)
1945 (74.81)
655 (25.19)
2361 (90.81)
239 (9.19)
2139 (82.27)
461 (17.73)
1198 (46.08)
1402 (53.92)
8.88
10.20
11.25
9.37
10.86
1.25
6.23
22.70
3.24
1665 (64.04)
935 (35.96)
1167 (44.88)
1058 (40.69)
375 (14.43)
23.37 (6.87)
Heterosexual
n 2600
M(SD) or
n (%)
(2.63)
(2.15)
(2.28)
(2.82)
(2.45)
(1.38)
(3.01)
(6.99)
(0.81)
29 (48.33)
31 (51.67)
0.82 (.93)
40 (66.67)
20 (33.33)
46 (76.67)
14 (23.33)
45 (75.00)
15 (25.00)
20 (33.33)
40 (66.67)
8.35
9.55
10.94
9.67
10.98
1.42
6.79
20.64
3.21
39 (65.00)
21 (35.00)
17 (28.33)
31 (51.67)
12 (20.00)
23.18 (5.88)
Homosexual
n 60
M(SD) or
n (%)
Female subsample
(2.99)
(2.39)
(2.59)
(2.98)
(2.36)
(1.61)
(3.16)
(7.81)
(0.86)
49 (44.95)
60 (55.05)
1.00 (1.08)
58 (53.21)
51 (46.79)
81 (74.31)
28 (25.69)
79 (72.48)
30 (27.52)
31 (28.44)
78 (71.56)
9.00
9.45
10.39
8.21
11.36
1.86
7.31
19.32
3.71
60 (55.05)
49 (44.95)
57 (52.29)
30 (27.52)
22 (20.18)
22.41 (4.36)
Bisexual
n 109
M(SD) or
n (%)
50.0001
50.0001
50.0001
50.0001
50.05
50.001
0.3302
50.001
50.001
50.0001
0.0735
50.0001
50.01
50.0001
50.0001
0.1570
50.01
0.3467
p Value
G. L. Schauer et al.
Sociodemographics
Age (SD)
Ethnicity (%)
White
Black
Other
Type of school (%)
Four-year
Two-year
Psychosocial factors
Depressive symptoms (SD)a
Perceived Stress Scale (SD)a
Satisfaction With Life Scale (SD)*
Sensation seeking (SD)
Big 5 Personality Traits (SD)
Extraversion
Agreeableness
Conscientiousness
Emotional Stability
Openness
Substance use, past 30 days
Any alcohol use (%)*
No
Yes
Any binge drinking (%)a
No
Yes
Marijuana (%)*
No
Yes
Cigarette smoking (%)
No
Yes
Any substance use (%)
No
Yes
Substance Use Index (SD)a
Variable
All males
n 1123
M(SD) or
n (%)
Male subsample
Table 2. Socio-demographic, psychosocial and substance use characteristics among male and female college students of differing sexual orientations.
256
Am J Drug Alcohol Abuse, 2013; 39(4): 252258
DOI: 10.3109/00952990.2013.796962
257
Table 3. Gender-specific multiple linear regression models identifying correlates of substance use score.
Males
Females
Model 1
Variable
Sexual orientation
Heterosexual
Homosexual
Bisexual
Age
Ethnicity
White
Black
Other
Depressive symptoms
Perceived stress
Satisfaction with life
Sensation seeking
Big 5: Extraversion
Big 5: Agreeableness
Big 5: Conscientiousness
Big 5: Emotional Stability
Big 5: Openness
Model 1
Model 1
Model 2d
SE
SE
SE
SE
Ref
0.04
0.35
0.14
0.18
0.788
0.058
Ref
0.15
0.09
0.14
0.19
0.286
0.655
Ref
0.39
0.43
0.09
0.07
Ref
0.32
0.27
0.10
0.07
0.01
0.004
50.05
0.005
0.004
0.228
0.01
0.002
50.000
1
50.0001
50.001
0.001
0.002
0.657
Ref
0.47
0.28
0.06
0.08
50.0001
50.001
Ref
0.42
-0.29
0.03
0.003
0.02
0.19
0.02
0.02
0.05
0.03
0.01
0.07
0.08
0.03
0.01
0.005
0.04
0.01
0.01
0.01
0.01
0.01
50.0001
50.001
0.273
0.807
50.0001
50.0001
50.05
0.090
50.001
50.05
0.625
Ref
0.34
0.29
0.03
0.04
50.0001
50.0001
Ref
0.32
0.31
0.04
0.005
0.01
0.14
0.03
0.01
0.04
0.001
0.01
0.03
0.04
0.01
0.01
0.002
0.02
0.01
0.01
0.01
0.01
0.01
50.0001
50.0001
50.01
0.444
50.001
50.0001
50.0001
0.263
50.0001
0.943
0.053
50.01
50.001
a 2
R 0.046.
R 0.1186.
R 0.056.
d 2
R 0.1472.
b 2
c 2
258
G. L. Schauer et al.
Declaration of interest
The authors report no conflicts of interest. The authors alone
are responsible for the content and writing of this article.
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