Substance use among lesbian, gay, and bisexual young people: the role of neighborhood, school, and family
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Disparities exist between lesbian, gay, and bisexual (LGB) young people and their non-LGB peers, with LGB young people continuing to use alcohol and other drugs into emerging adulthood at higher rates than non-LGB young persons.1–6 Our analyses were conducted with data from two nationally representative studies in the US, the National Longitudinal Study of Adolescent to Adult Health (Add Health) and the National Longitudinal Survey of Youth 1997 (NLSY|97). Using Add Health data, a marginal structural model and structural equation model were used to examine the effect of neighborhood economic advantage (N = 15,101 non-LGB and 5,031 LGB young persons) and neighborhood cohesion (N = 15,097 non-LGB and 5,004 LGB young persons) on the occurrence of alcohol and cannabis use disorders and alcohol use disorder symptoms. With the NLSY|97, logistic regression models assessed the association between parental support and binge drinking among LGB young persons (N = 302 LGB young persons), and whether living in a state with supportive LGB policies modified this association. We found living in a neighborhood with higher levels of neighborhood economic advantage was associated with a lower risk of alcohol [0.81 (0.72-0.90)] and cannabis use disorders [0.88 (075-1.04)]. Neighborhood advantage had a stronger protective effect for LGB [0.75 (0.58-0.96)] than non-LGB [0.99 (0.81-1.21)] young people when examining cannabis use disorders. Higher levels of neighborhood cohesion were mediated by family and school cohesion and were inversely associated with alcohol use disorder symptoms, with a stronger total effect among LGB [-0.05 (-0.10 - -0.01)] than non-LGB [-0.03 (-0.06 – 0.00)] young persons. Higher parental support was inversely associated with binge drinking among LGB young people [0.85 (0.51-1.43)] with a trend toward a more protective effect among LGB persons living in states with supportive LGB-related policies. Our findings contribute to the published literature by extending the research on neighborhood context and substance use outcomes to an LGB population. Building state-level and neighborhood assets has the potential to reduce substance use and abuse among LGB young persons.