Trajectories of alcohol and cigarette use among sexual minority and heterosexual girls

Providing Lesbian, Gay, Bisexual, Transgender, Nonbinary, and Queer Adolescents With Nurturance, Trustworthiness, and Safety: Protocol for Pilot Cluster Randomized Controlled Trial Design

BACKGROUND

Sexual and gender minority youths (lesbian, gay, bisexual, transgender, nonbinary, and queer individuals) face elevated risks of substance use (eg, alcohol and tobacco) and mental health issues (eg, depressive symptoms and suicidality) compared to their cisgender heterosexual peers. These inequities are hypothesized to be reduced by building supportive high school environments via the training of school staff. An intervention that trains school staff to better understand and support sexual and gender minority youths and engage in positive bystander behaviors that protect them from bullying exposure may reduce disparities in drug and alcohol use among them. Experts, school staff, and sexual and gender minority youths developed Providing LGBTQ+ Adolescents with Nurturance, Trustworthiness, and Safety (PLANTS), a web-based intervention to train school staff on how to support, affirm, and protect sexual and gender minority youths.

OBJECTIVE

This paper describes the design of the PLANTS pilot trial primarily aimed at assessing its acceptability, usability, appropriateness, and feasibility. We hypothesize PLANTS will have high acceptability, usability, appropriateness, and feasibility as rated by the school staff. Secondary objectives focus on implementation, safety, and pre-post changes in high school staff outcomes, including self-efficacy and skills (eg, active-empathic listening and bullying intervention). Exploratory objectives focus on the impact of PLANTS on student health outcomes.

METHODS

In a 2-arm cluster randomized controlled trial, high schools in Massachusetts are allocated to PLANTS or an active comparator group (publicly available sexual and gender minority youths resources or training). High school staff complete pretest and posttest surveys containing validated scales. Primary outcomes are validated measures of acceptability, usability, appropriateness, and feasibility of the intervention completed by staff during posttest surveys. To test our primary hypotheses for each outcome, we will calculate means and 95% CIs and P values using 1-sample 2-sided t tests against a priori thresholds or benchmarks of success. Secondary outcomes include staff's active-empathetic listening skills, self-efficacy for working with sexual and gender minority youths, bystander intervention behaviors for bullying and cyberbullying, and self-efficacy for PLANTS' change objectives completed during pretest and posttest staff surveys. Staff can also complete a posttest interview guided by the Information-Motivation-Behavior model and Consolidated Framework for Implementation Research. Exploratory outcomes include student-level data collected via the 2021 and 2023 MetroWest Adolescent Health Surveys, a health behavior surveillance system in 30 Massachusetts schools.

RESULTS

School enrollment began in May 2023 and participant enrollment began in June 2023. Data collection is expected to be completed by February 2024.

CONCLUSIONS

This pilot trial will yield important information about the PLANTS intervention and provide necessary information to conduct a fully powered trial of the efficacy of PLANTS for reducing the deleterious health inequities experienced by sexual and gender minority youths.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05897827; https://clinicaltrials.gov/study/NCT05897827.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55210.

Life course differences in heavy episodic drinking behaviors across age, gender, and sexual identity in the United States

•This study examines heavy episodic drinking across age, gender, and sexual identity.•Gay/lesbian and bisexual females experience persistent disparities across age.•Gay and bisexual males experience age specific disparities.•Sexual minority adults in the US report complex patterns of heavy alcohol use.•Heavy drinking disparities do not mirror patterns of alcohol use disorders.

Sexual minority status, school-based violence, and current tobacco use among youth

INTRODUCTION

Sexual minority individuals experience elevated risk for smoking and violence due to a combination of general and unique identity-based risk factors. This study examined associations among sexual minority status, school-based violence, and tobacco use, among youth.

METHODS

Data for this secondary data analysis consisted of Chicago-specific data from the 2019 Youth Risk Behavior Surveillance System (n=1562). Current use (≥1 day during the previous 30 days) of any tobacco product (cigarettes, e-cigarettes, smokeless tobacco, and cigars) and school-based violence (avoided school because they felt unsafe, were threatened/injured with a weapon, were in a physical fight, and were bullied) were estimated by sexual orientation (heterosexual vs gay, lesbian, bisexual, and unsure). A chi-squared test was used to investigate associations among the variables. Path analysis was employed to examine possible mediation effects of school-based violence.

RESULTS

Thirty percent of sexual minority youth and 11.5% of heterosexual youth reported current tobacco use (χ²=55.91; p<0.001). Nearly one-third (31.8%) of youth reported school-based violence, with a higher rate (41.2%) reported by sexual minority youth compared to heterosexual youth (28.1%; χ²=19.48; p<0.001). Path analysis confirmed these associations, controlling for sex, age, and race/ethnicity. The model showed that sexual minority status increased odds of current tobacco use by a factor of 1.8 (95% CI: 1.3-2.6) via its relationship with school-based violence, explaining 33.8% of the total association between sexual minority status and tobacco use.

CONCLUSIONS

Tobacco use was higher among sexual minority youth. School-based violence partially mediated the association between sexual minority status and tobacco use. Findings highlight the need for tobacco prevention and treatment efforts for sexual minority youth and school-based interventions to reduce exposure to violence.

Momentary Associations Among Minority Stress, Craving, Affect, and Nicotine Use Among Sexual Minority Youth

OBJECTIVES

Sexual minority youth are more likely to use nicotine relative to heterosexual youth. The minority stress model posits these disparities are partly due to unique stress (i.e., minority stress) specific to their stigmatized identities. However, there is a dearth of research exploring the fine-grained dynamic interplay between minority stressors, mediating processes, and nicotine use in sexual minority youth's daily lives and natural environment. We leveraged ecological momentary assessment over a 30-day monitoring period to test the mediating effects of craving and negative and positive affect on the momentary associations between minority stressors and subsequent nicotine use among sexual minority youth who were active nicotine users and recruited from the community.

METHODS

Participants were 85 nicotine users, ages 15-19 years old (M age = 17.96, SD = 1.10; 56.6% cisgender female; 56.6% bisexual; 73.5% non-Hispanic White) and half (51.8%) were daily nicotine users.

RESULTS

Results indicated that exposure to a minority stressor was associated with momentary elevations in nicotine craving and negative affect and decreases in positive affect. Nicotine craving and positive affect were also associated with greater probability of subsequent nicotine use. The associations between minority stressors and subsequent nicotine use were mediated through craving and positive, but not negative affect.

CONCLUSIONS

Our findings provide the first ecological momentary assessment evidence of these associations among sexual minority youth and help support and advance both addictions and sexual minority-specific models (e.g., minority stress) of nicotine use among youth.

The Impact of the COVID-19 Pandemic on Sexual Health in Cis Women Living in Germany

BACKGROUND

Preliminary research shows a substantial impact of the COVID-19 pandemic on women's sexual health, whereby empirical work on sexual well-being of minoritized sexual identities is still rare.

AIM

The objective of this study was to explore sexual health in heterosexual, lesbian and bisexual cis women during the first wave of COVID-19 pandemic in Germany.

METHODS

An anonymous nationwide online survey was conducted among cis women during the first nationwide lockdown in Germany from April 20th to July 20th, 2020. The questionnaire was distributed via e-mail, online chats and social-media platforms.

OUTCOMES

Demographic variables and self-report measures from the Sexual Behavior Questionnaire (SBQ-G) "before the pandemic" and "since the pandemic" were collected.

RESULTS

A total of 1,368 cis women participants were included: heterosexual women (n = 844), lesbian women (n = 293), bisexual women (n = 231). Results indicate overall decrease in frequency of sexual contacts and masturbation during the COVID-19 pandemic. Regarding differences before and during the pandemic lesbian women showed significant changes in sexual arousal whereas heterosexual women showed significant changes in all dimensions except capability to enjoy sexual intercourse. The data of bisexual women showed significant changes in almost all dimensions except for frequency of sexual intercourse and sexual arousal. Results of the multiple regression analysis revealed that being younger than 36 years-old, and being in a relationship as well as being heterosexual (compared with being lesbian) is positively associated with general satisfaction with sexual life during the pandemic.

CLINICAL IMPLICATIONS

The findings suggest that during a pandemic sexual and mental health care for (cis) women should be provided and address the specific needs of sexual minority groups.

STRENGTHS & LIMITATIONS

This is the first study to describe sexual behavior in heterosexual, lesbian and bisexual women during the COVID-19 pandemic in Germany. Limitations, however, include the fact that the data described were obtained at only one time point so there is a possibility of recall bias, and that the results cannot be generalized because of the underrepresentation of women over age 46.

CONCLUSION

This study examined the impact of the COVID-19 pandemic and resulting social constraints on the sexual health of particular groups of lesbian and bisexual women, which may improve preparedness for future public health and policy crises. Batz F, Lermer E, Hatzler L, et al. The Impact of the COVID-19 Pandemic on Sexual Health in Cis Women Living in Germany. J Sex Med 2022;19:907-922.

Alcohol and tobacco consumption among Australian sexual minority women: Patterns of use and service engagement

BACKGROUND

Sexual minority women consume both alcohol and tobacco at higher rates than heterosexual women. However, various sociodemographic and cultural factors associated with these practices among sexual minority women in Australia are not well understood, nor are the factors associated with seeking alcohol-related support.

METHODS

This study utilised data from cisgender sexual minority women respondents of Private Lives 3: a national, online, cross-sectional survey of the health and wellbeing of LGBTIQ adults in Australia aged 18+ conducted in 2019. Multivariable analyses were performed to identify co-existing smoking and alcohol use, sociodemographic factors associated with smoking, alcohol consumption and seeking alcohol-related support.

RESULTS

Of 2,647 sexual minority women respondents, 16.90% were currently smoking tobacco, 7.67% smoking tobacco daily and 60.50% reported potentially risky patterns of alcohol consumption. Tobacco and potentially risky alcohol consumption were found to frequently co-occur. Women who identified as queer were more likely than lesbian identifying women to currently smoke tobacco and to smoke tobacco daily. Tobacco consumption was associated with increased age, unemployment, low-mid range income and secondary-school education, while potential risky drinking was associated with living in outer urban or rural areas and being Australian born . Self-reporting having struggled with alcohol in the past twelve months was associated with residential location. Less than 3% of the sample has sought help for alcohol use. Seeking support was more likely as women aged, and with potentially risky drinking, and much more likely with self-perceived struggles with alcohol.

CONCLUSIONS

The findings highlight the need for future alcohol and tobacco use health promotion strategies focussing on sexual minority women to attend to within group differences that relate to risk of higher consumption. They also highlight the need for approaches that empower sexual minority women to self-identify when they are struggling with alcohol use and encourage seeking support with organisations that are affirming of sexual minority women.

Substance use and sexual minority status: examining the mediating roles of stress and emotion dysregulation in young adult women

Sexual minority women (SMW) report higher rates of substance use and disorder across the lifespan, and greater levels of minority stress in adolescence and young adulthood. Minority stress mediation models propose that higher levels of social stressors may increase emotion dysregulation, which in turn increases the propensity toward substance misuse. Few studies, however, have prospectively examined the impact of stressors and emotion dysregulation among SMW on early and escalating substance use. This longitudinal study examined whether emotion dysregulation and social stress mediated the association between sexual minority status and developing substance use (ages 17 through 22 years) in a sample of 2,201 heterosexual and 246 SMW participants in the Pittsburgh Girls Study. Results supported serial mediation processes of marijuana use risk: SMW reported higher levels of social stress in late adolescence, which in turn predicted greater emotion dysregulation that was associated with greater marijuana use by young adulthood.

Disparities in the frequency of tobacco products use by sexual identity status

BACKGROUND

Largely absent from the literature are studies examining differences in tobacco use frequency among sexual minority populations versus heterosexuals. The current study examined the frequency of tobacco product use (i.e., cigarette, e-cigarettes and cigars, smokeless tobacco, hookah, and heated tobacco products) among sexual minority students versus heterosexuals (straight).

METHODS

Data from the 2020 National Youth Tobacco Survey (n = 14,531) were analyzed to examine the association between sexual identity (lesbian or gay, bisexual, not sure, and heterosexual or straight) and tobacco use frequency. Negative binomial regression and zero-inflated negative binomial models were used to assess the association between sexual identity and each tobacco use frequency among current and ever users.

RESULTS

Current e-cigarettes users who identified as gay or lesbian used e-cigarette more frequently than heterosexual students. Multivariable count regression analysis showed that the e-cigarette use frequency in the past 30 days was significantly higher for gays or lesbians (IRR 1.45, 95% CI, 1.19-1.76) compared to heterosexuals. Similarly, gay or lesbian students who were current hookah users on average reported 81% more days of hookah use (IRR, 1.81, 95% CI, 1.08-3.03). The frequency of cigarette smoking was also significantly higher among bisexual cigarette smokers. No significant differences were found in other tobacco product use frequencies between sexual minority and heterosexual youths.

CONCLUSION

Sexual identity was associated with tobacco use frequency, especially for e-cigarettes and hookah. Elevated tobacco use among sexual minority groups deserves special consideration among a population group that is highly vulnerable to marketing and advertisement targeting.

Racial/Ethnic, Sex, Sexual Orientation, and Socioeconomic Disparities in Suicidal Trajectories and Mental Health Treatment Among Adolescents Transitioning to Young Adulthood in the USA: A Population-Based Cohort Study

Suicide is the second leading cause of death for people aged 10-34 years old. Limited research has documented extant heterogeneities in suicide across the life course and among diverse sociodemographic groups. There is also limited research on the influences of mental health utilization on suicidal trajectories across the life course. This study aims to: (1) identify racial/ethnic, sex, sexual orientation, socioeconomic status, and intersectional differences in suicidal trajectories among adolescents transitioning to adulthood; and (2) examine influences of mental health service utilization on disparities in suicidal trajectories. The study included 9421 respondents (Mage = 14.99 [SD = 1.61]) from Waves I-IV National Longitudinal Study of Adolescent to Adult Health (1994-2008). Latent class growth analyses were used to identify trajectories of suicidal ideation and suicide attempts. Multivariate multinomial logistic regression was used to examine the influences of mental health treatment and sociodemographic characteristics on suicidal trajectories. Three suicidal ideation (low-stable, high-decreasing, moderate-decreasing-increasing) and two suicide attempt (low-stable, moderate-decreasing) trajectories were identified. Compared with the low-stable trajectories, the risks of being in high-decreasing suicidal ideation trajectories were higher among females (AOR = 1.45, 95% CI 1.01-2.13) and sexual minorities (AOR = 1.82, 95% CI 1.21-2.74). Sexual minorities (AOR = 2.63, 95% CI 1.69-4.08) and low-SES adolescents (AOR = 1.79, 95% CI 1.08-2.98) were more likely to be in the moderate-decreasing suicide attempt group. Mental health service utilization predicted engagement in high-risk suicidal trajectories. Sociodemographic disparities in suicidal trajectories initiate early and persist over time. Individuals in high-risk trajectories received mental health treatment during adolescence. Suicide prevention should target vulnerable subpopulations and mental health service utilization in the early stage.

E-cigarette, cigarette, and cannabis use patterns as a function of sexual identity in a sample of Southern California young adults

PURPOSE

Sexual minority young adults report greater cigarette and cannabis use. Emerging evidence suggests this trend may extend to e-cigarettes. The current study evaluated the relationship between sexual identity and prevalence of e-cigarette, cigarette, and cannabis use and whether such associations differ by gender.

METHODS

Cross-sectional, regionally representative data of young adults (M[SD]age = 20.02 [0.60] years; n heterosexual = 1314; n bisexual = 77; n lesbian/gay = 28) from Wave III (2016) of the Southern California Children's Health Study were analyzed in 2019. Logistic regression analyses were conducted with sexual identity as the predictor and product use (never, prior, infrequent past 30-day [1-2 days], frequent past 30-day [3-5+ days]) as the outcome in separate models by substance (e-cigarettes, cigarettes, cannabis).

RESULTS

Bisexual individuals were the highest-risk sub-group for nearly all outcomes, with over five times the odds of reporting frequent past 30-day use for e-cigarettes (Odds Ratio [OR]: 6.68; 95% Confidence Interval [CI]: 2.80, 15.9), cigarettes (OR: 5.42; 95% CI: 2.37, 12.4), and cannabis (OR: 8.43; 95% CI: 4.40, 16.1) compared to heterosexual individuals. Although the sample size for lesbian/gay participants was small, bisexual (vs. lesbian/gay) participants also had greater odds of reporting prior use of nicotine products and frequent past 30-day cannabis use. A significant sexual identity × gender interaction emerged for lifetime cigarette use, wherein bisexual (vs. heterosexual) identity was only associated with greater odds of use for females (p < .01).

CONCLUSIONS

Sexual minority-related disparities in substance use among young adults appear to generalize to e-cigarettes, with bisexual young adults exhibiting especially high profiles of risk.

Sexual Orientation, Adverse Childhood Experiences, and Comorbid DSM-5 Substance Use and Mental Health Disorders

OBJECTIVE

To assess the relationships between adverse childhood experiences (ACEs) and comorbid Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) substance use and mental health disorders across 5 sexual orientation subgroups: lesbian/gay, bisexual, unsure, discordant heterosexual (ie, heterosexual-identified with same-sex attraction or behavior), and concordant heterosexual.

METHODS

Data were from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, a cross-sectional, nationally representative survey of non-institutionalized US adults. Data were collected in households via structured diagnostic face-to-face interviews; the overall response rate was 60.1%. The sample included 36,309 US adults aged 18 years and older.

RESULTS

Sexual minorities (gay, lesbian, bisexual), especially bisexual women, reported the highest prevalence of ACEs and comorbid substance use and mental health disorders. Approximately 43.8% of bisexual women reported 4 or more ACEs, and 38.0% of bisexual women reported comorbid substance use and mental health disorders. Multivariable regression analyses indicated a curvilinear relationship between ACEs and comorbid substance use and mental health disorders, and sexual minorities consistently had a higher ACE mean than concordant heterosexual respondents. The majority of sexual minorities with high levels of ACEs had comorbid substance use and mental health disorders.

CONCLUSIONS

Sexual minorities are exposed to more ACEs than their heterosexual counterparts in the US. We found evidence that US sexual minorities are at higher risk of comorbid substance use and mental health disorders. These findings reinforce the importance of identifying exposure to ACEs and developing trauma-informed interventions to treat comorbidities in those exposed to multiple ACEs, especially sexual minorities.​.

Romantic Attraction and Substance Use in 15-Year-Old Adolescents from Eight European Countries

Sexual minority youth are at higher risk of substance use than heterosexual youth. However, most evidence in this area is from North America, and it is unclear whether the findings can be generalized to other cultures and countries. In this investigation, we used data from the 2014 Health Behaviour in School-aged Children (HBSC) study to compare substance use in same- and both-gender attracted 15-year-old adolescents from eight European countries (n = 14,545) to that of their peers who reported opposite-gender attraction or have not been romantically attracted to anyone. Both-gender attracted, and to a lesser extent, same-gender attracted adolescents were significantly more likely to smoke cigarettes, consume alcohol, get drunk and use cannabis, or be involved in multiple substance use in the last 30 days compared to their opposite-gender attracted peers. Those adolescents who have not been in love had significantly lower odds for substance use than all other youth. The pattern of results remained the same after adjusting for country, gender and family affluence. These findings are compatible with the minority stress and romantic stress theories. They suggest that sexual minority stigma (and love on its own) may contribute to higher substance use among adolescents in European countries.

Tobacco use in the sexual borderlands: The smoking contexts and practices of bisexual young adults

Little is known about why bisexual people use tobacco at higher rates than any other sexual identity group. Non-binary sexualities, such as bisexuality, exist within the socially constructed borderland between homosexuality and heterosexuality. Exploration of the everyday smoking contexts and practices of bisexual individuals may reveal unique mechanisms driving tobacco use. We employed a novel mixed method, integrating real-time, smartphone-administered surveys of (non)smoking situations, location tracking, spatial visualization of participant data, and subsequent map-led interviews. Participants (n = 17; ages 18-26, California) identified as bisexual, pansexual, and/or queer. Most were cisgender women. Survey smoking patterns and situational predictors were similar to other young adults'. However, interviews revealed unique roles of tobacco use in participants' navigation of differently sexualized spaces in everyday life: 1) stepping away from uncomfortable situations related to bisexual identity; 2) facilitating belonging to LGBTQ+ community; and 3) recovering from bisexual identity perception management. Similar studies can examine the place-embedded practices and spatio-temporal patterns of other substance use and other stigmatized identity experiences.

Cigarette Smoking Disparities Between Sexual Minority and Heterosexual Youth

BACKGROUND

Using a population-based sample of youth, we examined rates of cigarette use and trends in cigarette use disparities between heterosexual youth and 3 subgroups of sexual minority youth (SMY) (ie, lesbian or gay, bisexual, and unsure) from 2005 to 2015.

METHODS

Data are from 6 cohorts of the Youth Risk Behavior Survey, a national, biennial, school-based survey of ninth- to 12th-grade students in the United States (n = 404 583). Sex-stratified analyses conducted in 2017 examined trends in 2 cigarette-related behaviors: lifetime cigarette use and heavy cigarette use (20+ days in the past 30).

RESULTS

Disparities in lifetime cigarette use between lesbian and heterosexual girls were statistically smaller in 2015 relative to 2005 (adjusted odds ratio [aOR] 0.29; 95% confidence interval [CI] 0.12-0.75; P = .011). Sexual orientation disparities in heavy use were narrower for bisexual boys in 2015 compared with 2005 (aOR 0.39; 95% CI 0.17-0.90; P = .028). Girls and boys unsure of their sexual identity had wider disparities in heavy use in 2015 (aOR 3.85; 95% CI 1.39-11.10; P = .009) relative to 2005 (aOR 2.44; 95% CI 1.22-5.00; P = .012).

CONCLUSIONS

SMY remain at greater risk for cigarette-related behaviors despite greater acceptance of lesbian, gay, and bisexual people in the United States. Focused policies and programs aimed at reducing rates of SMY cigarette use are warranted, particularly for youth questioning their sexual identity.

Group-based trajectories of parent-child communication and parental knowledge between sexual minority and heterosexual girls and their associations with substance use

INTRODUCTION

Sexual minority girls (SMGs) may be at high risk for substance use partially due to anti-gay discrimination. Low levels of parent-child communication and parental knowledge may contribute to this risk. This study seeks to identify parent-child communication and parental knowledge trajectories, determine the likelihood of SMGs following these trajectories, and describe the relationships between these trajectories, sexual orientation, and substance use.

METHODS

This is a secondary data analysis of the Pittsburgh Girls Study (N = 2450), a longitudinal study on the changes in behaviors among girls throughout childhood. We generated group trajectory models of parentchild communication and parental knowledge starting from age 12 to age 17 years. We then tested the likelihood of SMGs belonging to these group trajectories and the association between group trajectory membership and substance use at age 18 years.

RESULTS

SMGs were more likely than were heterosexual girls to follow the infrequent decreasing parent-child communication trajectory and the slowly decreasing parental knowledge trajectory and were more likely than were heterosexual girls to engage in substance use at age 18 years. Parent-child communication and parental knowledge trajectories were statistically significant mediators between sexual orientation and substance use.

CONCLUSION

Frequency of parent-child communication and levels of parental knowledge may be determinants of substance use among SMGs. These results have implications for developing substance use prevention programs among sexual minority youth targeting parent-child relationships.

Sexual identity, same-same relationships, and health dynamics: New evidence from Australia

Prior research has found that opposite-sex marital and cohabiting relationships are associated with improvements in health. However, studies examining the health dynamics of same-sex relationships are sparser because few nationally representative longitudinal datasets collect information on adults' sexual identity. Using newly available data on sexual minorities from the Household, Income and Labour Dynamics in Australia (HILDA) Survey, we estimate the effects of Lesbian/Gay/Bisexual (LGB) identification and same-sex relationships on health dynamics. We document two key findings. First, sexual minorities in Australia are more likely to engage in risky health behaviors and report worse health than their heterosexual counterparts. Second, after exploiting the longitudinal nature of the HILDA and accounting for selection into relationships using the dynamic panel approach of Kohn and Averett (2014), we find that while opposite-sex partnerships are associated with a 3 to 7 percentage-point decline in risky health behaviors and improved physical and mental health, the health benefits of same-sex relationships are weaker, particularly for men.

Measuring alcohol use across the transition to adulthood: Racial/ethnic, sexual identity, and educational differences

BACKGROUND

Patterns of alcohol use change from adolescence to adulthood and may differ based on race/ethnicity, sexual identity, and education. If alcohol use measures do not operate consistently across groups and developmental periods, parameter estimates and conclusions may be biased.

OBJECTIVES

To test the measurement invariance of a multi-item alcohol use measure across groups defined by race/ethnicity, sexual identity, and college education during the transition to adulthood.

METHODS

Using three waves from the National Longitudinal Study of Adolescent to Adult Health, we tested configural, metric, and scalar invariance of a 3-item alcohol use measure for groups defined by race/ethnicity, sexual identity, and college education at three points during the transition to adulthood. We then assessed longitudinal measurement invariance to test the feasibility of modeling developmental changes in alcohol use within groups defined by these characteristics.

RESULTS

Overall, findings confirm notable variability in the construct reliability of a multi-item alcohol use measure during the transition to adulthood. The alcohol use measure failed tests of metric and scalar invariance, increasingly across ages, both between- and within-groups defined by race/ethnicity, sexual identity, and college education, particularly among females.

CONCLUSIONS

Measurement testing is a critical step when utilizing multi-item measures of alcohol use. Studies that do not account for the effects of group or longitudinal measurement non-invariance may be statistically biased, such that recommendations for risk and prevention efforts could be misguided.

Trends in Parental Monitoring and Knowledge Over Time Between Sexual Minority and Heterosexual Girls

This study assessed whether trajectories of parental monitoring components were different for sexual minority girls (SMGs) compared to heterosexual girls. We recruited 14-19-year-old girls from two adolescent medicine clinics. We estimated growth curve models to compare how components of parental monitoring-adolescent disclosure, parental solicitation, and parental knowledge-changed over 2 years for SMGs and heterosexual girls. SMGs and heterosexual girls had similar trajectory slopes and quadratic forms of adolescent disclosure, but SMGs had consistently lower adolescent disclosure scores. Parental knowledge trajectories indicated differential intercepts and slopes for SMGs compared to heterosexual girls, suggesting potential higher risk for maladaptive behaviors. Results of this study suggest that parental monitoring may operate differently over time for SMGs compared to heterosexual girls.

Validating a Hazardous Drinking Index in a Sample of Sexual Minority Women: Reliability, Validity, and Predictive Accuracy

BACKGROUND

Although sexual minority women (SMW) are at increased risk of hazardous drinking (HD), efforts to validate HD measures have yet to focus on this population.

OBJECTIVES

Validation of a 13-item Hazardous Drinking Index (HDI) in a large sample of SMW.

METHODS

Data were from 700 adult SMW (age 18-82) enrolled in the Chicago Health and Life Experiences of Women study. Criterion measures included counts of depressive symptoms and post-traumatic stress disorder (PTSD) symptoms, average daily and 30-day ethanol consumption, risky sexual behavior, and Diagnostic and Statistical Manual (DSM-IV) measures of alcohol abuse/dependence. Analyses included assessment of internal consistency, construction of receiver operating characteristic (ROC) curves to predict alcohol abuse/dependence, and correlations between HDI and criterion measures. We compared the psychometric properties (diagnostic accuracy and correlates of hazardous drinking) of the HDI to the commonly used CAGE instrument.

RESULTS

KR-20 reliability for the HDI was 0.80, compared to 0.74 for the CAGE. Predictive accuracy, as measured by the area under the receiver operating characteristic curve for alcohol abuse/dependence, was HDI: 0.89; CAGE: 0.84. The HDI evidenced the best predictive efficacy and tradeoff between sensitivity and specificity. Results supported the concurrent validity of the HDI measure.

CONCLUSIONS

The Hazardous Drinking Index is a reliable and valid measure of hazardous drinking for sexual minority women.

Recommendations for cardiovascular disease research with lesbian, gay and bisexual adults

AIMS AND OBJECTIVES

The purpose of this paper is to provide recommendations to strengthen cardiovascular disease research with lesbian, gay and bisexual adults, and highlight implications for practice.

BACKGROUND

Lesbian, gay and bisexual individuals face significant discrimination that negatively impacts their health. Health disparities research in lesbian, gay and bisexual adults have focused on mental health, sexually transmitted infections and substance use. Although cardiovascular disease is the leading cause of death and many lesbian, gay and bisexual adults report increased risk factors for cardiovascular disease, there has been limited research in this area.

DESIGN

This paper is a critical review.

METHODS

A literature search was conducted that compared cardiovascular disease risk and/or prevalence between lesbian, gay and bisexual and heterosexual adults.

RESULTS

Measures to assess cardiovascular disease risk factors and diagnoses varied widely across the 31 included studies. There was a lack of standardisation in definitions used for alcohol consumption, illicit drug use, mental health and self-rated physical health. Most studies that reported body mass index relied on participant self-report. Few studies included measures of physical activity and diet and those that did lacked standardisation. Only seven studies used laboratory data to establish diagnosis of cardiovascular disease.

CONCLUSIONS

This study is the first comprehensive review on this topic. In cardiovascular disease research with lesbian, gay and bisexual adults, there is a need for: (1) inclusion of stress as a risk factor for cardiovascular disease, (2) standardised measures, (3) objective measures for determining the presence of cardiovascular disease, (4) data from electronic health records to strengthen the study of cardiovascular disease in this population.

RELEVANCE TO CLINICAL PRACTICE

Strengthening cardiovascular disease research in lesbian, gay and bisexual adults is an important step in addressing health disparities in this population. Nurses and other healthcare professionals should assess sexual orientation in routine health assessments.

College Status, Perceived Drinking Norms, and Alcohol Use among Sexual Minority Women

Lesbian, gay, and bisexual young adults are at elevated risk for drinking compared to heterosexual young adults, and this discrepancy is particularly striking for sexual minority women (SMW). Perceived social norms are strong predictors of young adult alcohol use, especially among college students. The college environment is often one where increases in alcohol use are seen, but the impact of college status on SMW's drinking has been understudied. The present study explored patterns of alcohol use and consequences among SMW and the extent to which social norms relate to use and consequences. Participants were recruited via social networking sites for a larger national study on SMW's health behaviors. Present analyses focused on 875 SMW between 18 and 25 who were categorized as either a 2-year college student (n = 196), 4-year college student (n = 418), or non-student (n = 261). Several differences emerged between college and non-college SMW, with non-college women reporting higher alcohol use and social norms compared to 4-year college women. In terms of alcohol-related consequences, students in both 2-year and 4-year colleges reported a higher likelihood of any consequences. There was some evidence that perceived norms partially explained differences in typical drinking among the college status groups. The present findings suggest that college may play a protective role against heavy drinking for this population of young women, however, the results are not straightforward and additional research is warranted.

Mental health of sexual minorities. A systematic review

Many studies, reviews, and meta-analyses have reported elevated mental health problems for sexual minority (SM) individuals. This systematic review provides an update by including numerous recent studies, and explores whether SM individuals are at increased risk across selected mental health problems as per dimensions of sexual orientation (SO), genders, life-stages, geographic regions, and in higher quality studies. A systematic search in PubMed produced 199 studies appropriate for review. A clear majority of studies reported elevated risks for depression, anxiety, suicide attempts or suicides, and substance-related problems for SM men and women, as adolescents or adults from many geographic regions, and with varied SO dimensions (behaviour, attraction, identity), especially in more recent and higher quality studies. One notable exception is alcohol-related problems, where many studies reported zero or reversed effects, especially for SM men. All SM subgroups were at increased risk, but bisexual individuals were at highest risk in the majority of studies. Other subgroup and gender differences are more complex and are discussed. The review supports the long-standing mental health risk proposition for SM individuals, overall and as subgroups.

Risk of heavy drinking among sexual minority adolescents: indirect pathways through sexual orientation-related victimization and affiliation with substance-using peers

AIMS

To test two indirect pathways through which sexual minority adolescents (SMAs) may be at risk for heavy episodic drinking (HED) including a socialization pathway via substance-using peer affiliations and social marginalization pathway via sexual minority-specific victimization and subsequent substance-using peer affiliations.

DESIGN

Analysis of the first three waves (6 months apart) of a longitudinal adolescent health risk study (2011-14). Participants were referred by medical providers or a screening system in providers' waiting rooms.

SETTING

Two large urban adolescent health clinics in Pennsylvania and Ohio, USA.

PARTICIPANTS

A total of 290 adolescents (ages 14-19 years, mean: 17.08) who were 71.0% female, 33.4% non-Hispanic white and 34.5% SMAs.

MEASUREMENTS

Self-reported sexual minority status (wave 1) and affiliation with substance-using peers (waves 1 and 2), and latent sexual-minority specific victimization (waves 1 and 2) and HED (waves 1 and 3) variables.

FINDINGS

Using mediation analyses in a structural equation modeling framework, there was a significant indirect effect of sexual minority status (wave 1) on HED (wave 3) via affiliation with substance-using peers [wave 2; indirect effect = 0.03, 95% confidence interval (CI) = 0.01, 0.07], after accounting for the indirect effect of sexual-orientation related victimization (wave 2; indirect effect = 0.10, 95% CI = 0.02-0.19). The social marginalization pathway was not supported, as victimization (wave 1) was not associated with affiliation with substance-using peers (wave 2; β = - 0.04, P = 0.66). Sex differences in the indirect effects were not detected (Ps > 0.10).

CONCLUSIONS

Sexual minority adolescents in the United States appear to exhibit increased heavy episodic drinking via an indirect socialization pathway, including affiliations with substance-using peers and a concurrent indirect pathway involving sexual minority-related victimization. The pathways appear to operate similarly for boys and girls.

Addressing gaps on risk and resilience factors for alcohol use outcomes in sexual and gender minority populations

ISSUES

In 2011, the Institute of Medicine released a report that constituted the first comprehensive effort by a federal body to understand the current state of science pertinent to the health needs of sexual and gender minority populations. This mini-review summarises recent empirical, methodological and theoretical advances in alcohol-related research among to lesbian, gay, bisexual and transgender (LGBT) populations and highlights progress towards addressing gaps, with a particular interest in those identified by the Institute of Medicine report.

APPROACH

Articles published since 2011 were identified from PsycINFO and PubMed database searches, using various combinations of keyword identifiers (alcohol, alcohol abuse, substance abuse, LGBT, lesbian, gay, bisexual, transgender). Reference sections of included articles were also examined for additional citations.

KEY FINDINGS

Recent empirical work has contributed to a greater understanding of sub-group differences within this diverse population. Evidence has supported theorised influences that can account for alcohol-related disparities, yet important gaps remain. Studies that examine the role of gender identity and its intersection with sexual identity within transgender and gender non-conforming sub-populations are lacking. Methodological advances in this literature have begun to allow for examinations of how minority-specific and general risk factors of alcohol misuse may contribute to patterns of alcohol involvement over time and within social-relational contexts

CONCLUSIONS

The recommendations made in the current mini-review are meant to facilitate future collaborative efforts, scale development, thoughtful methodological design and analysis and theoretically driven nuanced hypotheses to better understand, and ultimately address, alcohol-related disparities among sexual and gender minority populations. [Talley AE, Gilbert PA, Mitchell J, Goldbach J, Marshall BDL, Kaysen D. Addressing gaps on risk and resilience factors for alcohol use outcomes in sexual and gender minority populations. Drug Alcohol Rev 2016;35:484-493].

Sexual orientation, treatment utilization, and barriers for alcohol related problems: Findings from a nationally representative sample

BACKGROUND

Gay, lesbian, and bisexual (GLB) individuals appear to have an increased likelihood of alcohol use disorders and treatment utilization for alcohol related problems compared to heterosexual individuals. Despite this increase, treatment utilization rates among GLB individuals remain low. In an effort to address this, our paper examined whether or not GLB individuals encounter unique barriers when pursuing treatment for alcohol related problems.

METHODS

Using data from the National Epidemiologic Survey on Alcohol Related Conditions (NESARC), we examined service sector specific factors, some of which included (a) utilization rates, (b) self-reported treatment barriers, and (c) whether or not there were emergent differences among GLB individuals, after controlling for socio-demographic and clinical characteristics.

RESULTS

Findings indicated that GLB individuals reported higher severity rates for alcohol use disorders when compared to heterosexual individuals, and were significantly more likely to utilize treatment services for alcohol related problems, however, not across all treatment sectors. While similar patterns were observed when examining barriers to treatment, bisexual individuals reported significantly more barriers than heterosexual and gay/lesbian individuals.

CONCLUSION

These findings underscored the importance of identifying and developing interventions that addresses treatment barriers associated with alcohol use service utilization among GLB populations, and creating improved outreach and education programs to better address stigmas associated with substance use and sexuality.

Adolescent Sexual Minority Girls Are at Elevated Risk for Use of Multiple Substances

BACKGROUND

Sexual minority youth, especially girls, are at risk for alcohol, cigarette, and marijuana use when these substances are examined individually. However, little is known about concurrent use of these substances (i.e., three-substance use) in relation to sexual orientation.

OBJECTIVES

The present study compared profiles of past year alcohol, cigarette, and marijuana use between SMGs and heterosexual girls. In addition, because internalizing and externalizing symptoms are associated with substance use, we examined whether sexual orientation was associated with substance use profile over and above co-occurring psychopathology.

METHODS

Mixture modeling was used to identify patterns of alcohol (including binge drinking), cigarette, and marijuana use in the past year using a cross-sectional sample of urban adolescent girls (Pittsburgh Girls Study; N = 2,064; mean age = 17). Approximately 8% (n = 173) of the girls endorsed a lesbian or bisexual identity.

RESULTS

Five substance using classes were identified: low-level substance use (72%), marijuana use (5%), cigarette use (8%), alcohol use (8%), and three-substance use (7%). SMGs were at an increased risk for substance use than heterosexual girls, particularly three-substance use (OR = 6.69, p < .001), cigarette use (OR = 6.26, p < .001), and marijuana use (OR = 3.86, p < .001) classes. Substance use patterns were regressed on sexual orientation, internalizing symptoms (i.e., depression, anxiety), and externalizing symptoms (i.e., conduct problems, oppositional defiant disorder). The disparities remained robust after controlling for internalizing and externalizing symptoms.

CONCLUSIONS/IMPORTANCE

Clinicians and researchers should be aware of potential three-substance use among SMGs. Substance use interventions for SMG may benefit from targeting risk factors that cut-across several substances, particularly externalizing symptoms.

Strategies employed by sexual minority adolescents to cope with minority stress

Sexual minority adolescents (SMA) experience disparities in health and behavioral health outcomes, including high rates of depression, anxiety, self-harm, substance use, HIV risk behavior, suicidal ideation, and suicide attempts. These outcomes are commonly attributed to minority stress. Stress experiences are different for SMA than their adult counterparts. For example, disclosing their sexual orientation may be more likely to result in homelessness because these youth more often live with parents or other family members. Although stress in this population has been explored in previous research, very little is known about how SMA cope. Relying upon an adolescent coping model, this study examined the coping strategies, responses, and resources of SMA related to stress. Forty-eight racially and ethnically diverse SMA (age 14-19) were recruited for 90-minute tape-recorded interviews. The semi-structured interviews were guided by a life history calendar. Recordings were transcribed verbatim and entered into QSR NVivo. All transcripts were coded by two members of the research team and went through a consensus process. Forty-three unique coping statements emerged that fit with the Compas model of adolescent coping. SMA cope with minority stress in similar ways to heterosexual youth coping with general stress, but findings suggest that SMA may also use different kinds of coping resources. Although further research is needed, the present study identified a variety of ways SMA cope with stress and can inform future research on the development interventions.

Sexual (Minority) Trajectories, Mental Health, and Alcohol Use: A Longitudinal Study of Youth as They Transition to Adulthood

Lesbian, gay, bisexual, and queer/questioning youth health disparities are well documented; however, study limitations restrict our understanding of how the temporal interplay among domains of sexuality (attraction, behavior, and identity) situate individuals to be more or less at risk for poor mental health and alcohol use across the transition to adulthood. Four waves of data from the National Longitudinal Study of Adolescent to Adult Health (n = 12,679; 51.29 % female) were used with repeated measures latent class analysis to estimate sexual trajectory groups designated by prospective reports of romantic attraction, sexual/romantic behavior, and sexual identity from adolescence to adulthood. Five unique trajectories emerged: two heterosexual groups (heterosexual early daters [58.37 %] and heterosexual later daters [29.83 %]) and three sexual minority groups (heteroflexible [6.44 %], later bisexually identified [3.32 %], and LG[B] identified [2.03 %]). These sexual trajectories differentiate risk for depressive symptomology, suicidal thoughts and behaviors, and alcohol use during adolescence and early adulthood. Groups where individuals first reported same-sex attraction and sexual minority identities in adulthood (heteroflexible and later bisexually identified) had similar levels of depression, suicidality, and greater substance use than those who largely reported same-sex attraction and behavior during adolescence (the LG[B] identified group). These later recognition groups showed greater risk for poor outcomes in waves where they also first reported these changes in attraction, behaviors, and identities. The emergence of three sexual minority groups reveal within-group differences in sexuality and sexual trajectories and how these experiences relate to risk and timing of risk across the transition to adulthood.

A Longitudinal Investigation of Syndemic Conditions Among Young Gay, Bisexual, and Other MSM: The P18 Cohort Study

The persistence of disparities in STI/HIV risk among a new generation of emerging adult gay, bisexual, and other men who have sex with men (YMSM) warrant holistic frameworks and new methodologies for investigating the behaviors related to STI/HIV in this group. In order to better understand the continued existence of these disparities in STI/HIV risk among YMSM, the present study evaluated the presence and persistence of syndemic conditions among YMSM by examining the co-occurrence of alcohol and drug use, unprotected sexual behavior, and mental health burden over time. Four waves of data, collected over the first 18 months of a 7 wave, 36-month prospective cohort study of YMSM (n=600) were used to examine the extent to which measurement models of drug use, unprotected sexual behavior, and mental health burden remained consistent across time using latent class modeling. Health challenges persisted across time as these YMSM emerged into young adulthood and the measurement models for the latent constructs of drug use and unprotected sexual behavior were essentially consistent across time whereas models for mental health burden varied over time. In addition to confirming the the robustness of our measurement models which capture a more holistic understandings of the health conditions of drug use, unprotected sex, and mental health burden, these findings underscore the ongoing health challenges YMSM face as they mature into young adulthood. These ongoing health challenges, which have been understood as forming a syndemic, persist over time, and add further evidence to support ongoing and vigilant comprehensive health programming for sexual minority men that move beyond a sole focus on HIV.

Exploring young adult sexual minority women's perspectives on LGBTQ smoking

Smoking rates are higher among lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals than among heterosexuals. These disparities are exacerbated during the transition from youth to young adulthood. The current study uses in-depth qualitative interviews to understand perceptions of LGBTQ smoking among LBQ-identified women (N=30, ages 18-24). Major themes identified include the belief that smoking was a way of overcoming stressors faced by heterosexual and LGBTQ young adults alike, a mechanism to relieve sexuality-related stressors, and an ingrained part of LGBTQ culture. Results suggest unique stressors influence LGBTQ smokers. Implications for smoking cessation interventions for LGBTQ youth are discussed.

Sexual orientation and alcohol problem use among U.K. adolescents: an indirect link through depressed mood

BACKGROUND AND AIMS

Sexual minority adolescents are more likely to engage in alcohol use than their heterosexual counterparts; however, the underlying reasons remain unclear and longitudinal research is limited. Owing to evidence that this group also experiences greater depressive symptoms than their peers, we aimed to (i) assess to what extent depressed mood explains the increased likelihood of engaging in alcohol use among sexual minority adolescents, and (ii) explore potential gender-specific patterns.

DESIGN

Structural equation modelling was used to test the indirect relationship between sexual orientation and alcohol use through depressed mood, with heterosexuals as the reference group.

SETTINGS AND PARTICIPANTS

A total of 3710 adolescents (12% sexual minority), from the Avon Longitudinal Study of Parents and Children (ALSPAC) study, assessed between the ages of 15 and 18 years.

MEASUREMENTS

Sexual orientation was assessed at age 15, while alcohol use was measured using the Alcohol Use Disorders Identification Test (AUDIT) at age 18. Depressed mood was indexed by the Short Mood and Feelings Questionnaire (SMFQ) at age 16.

FINDINGS

Sexual minority adolescents were more likely to engage in alcohol problem use compared to their heterosexual counterparts [Btotal  = 0.12, 95% confidence interval (CI) = 0.04-0.20, P = 0.003]. Depressed mood explained 21% of the link between sexual orientation and alcohol use after adjustment for covariates and earlier measures (Z = 3.2, P = 0.001). No gender differences were observed.

CONCLUSIONS

A higher prevalence of alcohol problem use in adolescents who are gay, lesbian or bisexual is partly explained by increased rates of depression in this group.

Developmental trajectories of substance use among sexual minority girls: associations with sexual victimization and sexual health risk

PURPOSE

To examine mechanisms underlying the development of sexual health risk behaviors in sexual minority girls (SMGs) and its association with sexual victimization.

METHODS

Data were drawn from the Project on Human Development in Chicago Neighborhoods cohorts, aged 15 and 18 years (N = 391; 54 SMGs).

RESULTS

Sexual minority girls reported more sexual victimization and steeper positive trajectories of substance misuse over time than heterosexual girls. Growth in alcohol use during adolescence mediated the link between SMG status and past year number of partners, whereas growth in marijuana use mediated the link between SMG status and self-reported sexually transmitted diseases (STDs). Adding unwanted sexual experiences to the models resulted in a reduction of significance in the direct or indirect effects from SMG status on the sexual health outcomes. Unwanted sexual experiences emerged as a robust predictor directly and indirectly related to past-year number of partners via growth in alcohol use. Unwanted sexual experiences also directly predicted STD history.

CONCLUSIONS

The increased risk of SMGs for alcohol and marijuana during adolescence, higher rates of sexual partners, and STD diagnosis may also be linked to their significant risk for sexual victimization. Findings highlight the importance of preventive interventions targeting victimization of SMGs.

LGBT community, social network characteristics, and smoking behaviors in young sexual minority women

Smoking rates among young sexual minority women (YSMW) are disproportionately high as compared to heterosexual populations. While this disparity has commonly been attributed to the sexual minority stress process, little empirical work has explored what may protect YSMW from high rates of smoking. Using data (N = 471) from a cross-sectional study designed to investigate YSMW's (age 18-24) smoking behaviors and correlates; we explore the relationship of LGBT community connections, YSMW's social network characteristics, and stress to smoking behaviors (i.e., status, frequency, amount). Through this analysis, we find support for LGBT community connection as well as friendships with other sexual minorities as protective in relation to YSMW's smoking behaviors. We discuss the implications of our results, highlighting the need for future longitudinal research and interventions designed to bolster YSMW's connections to the LGBT community and their social networks.

Mental health and substance use disparities among urban adolescent lesbian and bisexual girls

BACKGROUND

Sexual minority girls (SMGs) report large substance use disparities and victimization experiences, yet there is a dearth of research that focuses exclusively on SMGs.

OBJECTIVE

To examine substance use and mental health disparities among SMGs and to determine whether disparities were larger for African American compared with European American girls.

METHOD

Data were used from Wave 11 of the Pittsburgh Girls Study, a multiple-cohort, prospective study of urban girls. Girls for the current analysis were aged 16 to 19 years. Fifty-five percent were African American. One hundred and seventy-three (8.3%) identified as SMGs, and 1,891 identified as heterosexual. Multiple regression analyses controlling for age, race, and parent education were conducted.

RESULTS

SMGs reported a robust pattern of large disparities in externalizing, internalizing, and borderline personality disorder symptoms. There was little evidence to suggest disparities were moderated by race.

CONCLUSION

SMGs and their families would benefit from intervention and prevention programs to reduce disparities among this highly vulnerable population.

Trajectories of depressive symptoms and suicidality among heterosexual and sexual minority youth

Sexual minority youth report higher rates of depression and suicidality than do heterosexual youth. Little is known, however, about whether these disparities continue as youth transition into young adulthood. The primary goals of this study were to describe and compare trajectories of adolescent depressive symptoms and suicidality among sexual minority and heterosexual youth, examine differences in depressive symptoms and suicidality trajectories across sexual orientation subgroups, and determine whether there are gender differences in these longitudinal disparities. Four waves of data from the National Longitudinal Study of Adolescent Health were analyzed using latent curve modeling (N = 12,379; 53% female). Results showed that the rates of depressive symptoms and suicidality in early adolescence were higher among sexual minority youth than among heterosexual youth, and that these disparities persisted over time as participants transitioned into young adulthood. Consistent with previous cross-sectional studies, the observed longitudinal disparities were largest for females and for bisexually-identified youth. Sexual minority youth may benefit from childhood and early adolescent prevention and intervention programs.

Longitudinal disparities of hazardous drinking between sexual minority and heterosexual individuals from adolescence to young adulthood

Sexual minority (lesbian and gay, bisexual, mostly heterosexual) individuals are at an increased risk for hazardous drinking than heterosexual individuals, but little is known about the nature of the disparities as adolescents reach adulthood. We used four waves of a nationally representative data set, the National Longitudinal Study of Adolescent Health (Add Health), to examine disparities of hazardous drinking outcomes between sexual minority and heterosexual men and women from adolescence to young adulthood. Participants were 14-18 years old at the first assessment (N = 12,379; 53 % female) and 27-31 years old at the fourth assessment. At the fourth assessment, 13 % self-identified as sexual minority individuals, 16 % were Hispanic, and 36 % were of minority race, including primarily African Americans (60 %) and Asian Americans (18 %). There were clear hazardous drinking disparities between sexual minority individuals and heterosexual individuals over time. During adolescence, sexual minority individuals, particularly females, reported higher levels of hazardous drinking. As study participants reached adulthood, the magnitude of the hazardous drinking disparities increased among sexual minorities, sexual minority men in particular. Additional research is needed to better understand the developmental mechanisms that underlie the emerging sexual orientation related disparities of hazardous drinking in young adulthood.