Substance Use and Adverse Childhood Events Among Sexual Minority Young Adults in the U.S.
Flynn, Anna Bachman
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Sexual minority people in the United States are at increased risk of tobacco, alcohol, and other substance use, increasing their exposure to negative sequelae such as injury, cancer, and overdose. Adverse childhood events (ACEs) (e.g. abuse and witnessing violence) are important correlates of later substance use and are prevalent among sexual minority people. Using data from the National Longitudinal Study of Adolescent Health, Waves I (ages 12-18) and III (ages 18-24), patterns of substance use (alcohol, tobacco, other drugs) and ACEs (abuse, neglect, social services involvement, witnessing and experiencing violence) were modeled with latent class analysis techniques. Transitions from ACEs to substance use patterns were modeled with latent transition analysis. Logistic regression was used to determine whether sexual minority (mostly heterosexual, bisexual, mostly homosexual, and homosexual) people were more likely to demonstrate particular patterns and transitions compared to heterosexual people. A normative substance use class and a poly-substance use class were identified. Sexual minority young adults had higher odds of inclusion in the poly-substance use class than in the normative substance use class (OR = 3.03, p < 0.001). A low ACEs class, an abuse and social services involvement class, and a witnessing and experiencing violence class were identified. Sexual minority young adults had higher odds of inclusion in the abuse and social services involvement class (OR = 1.61, p < 0.05) and bisexual young adults in particular had higher odds of inclusion in the witnessing and experiencing violence class (OR = 2.99, p < 0.01). Sexual minority young adults had lower odds of transitioning from the low ACEs class to the normative substance use class compared to heterosexual people (OR = 0.30, p < 0.001). Results indicate that sexual minority young adults are at high risk of detrimental ACEs patterns and of demonstrating poly-substance use patterns in young adulthood. Both ACEs and substance use prevention approaches tailored to the unique needs of sexual minority people are indicated. Substance use treatment approaches among sexual minority young adults could be most effective if they simultaneously address concurrent physical and mental health issues and incorporate trauma-informed care.