Developmental Differences in Sexual Orientation and Gender Identity-Related Substance Use Disparities: Findings From Population-Based Data

Purpose: Despite well-established substance use disparities between sexual and gender minority adolescents and their heterosexual, cisgender peers, there remain questions about whether there are developmental differences in the onset and progression of these disparities across adolescence. These perspectives are critical for prevention efforts. We therefore estimate age-based patterns of five substance use behaviors across groups of adolescents defined by sexual orientation and gender identity (SOGI).

Methods: Data are from the 2013-2015 cycles of the California Healthy Kids Survey (N = 634,454). Substance use was assessed with past 30-day e-cigarette use, combustible cigarette use, alcohol use, heavy episodic drinking, and marijuana use. Two- and three-way interactions were used to assess differences in age-specific prevalence rates of each substance by (1) sex and sexual identity; and (2) gender identity.

Results: Across all substances, SOGI differences in past 30-day use were present by age 12 years. Most disparities persisted to age 18 years and older. SOGI disparities in combustible and e-cigarette use were wider in late adolescence. Analyses by sexual identity show that sexual minority girls reported the highest rates of substance use across age, followed by sexual minority boys.

Conclusions: SOGI differences in substance use emerged in early adolescence and appeared to persist and accelerate by late adolescence. Sexual minority girls had the highest rates of substance use across all ages. The findings underscore the urgent need for screening and prevention strategies to reduce substance use for sexual and gender minority youth.