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Sexual orientation and adolescent substance use: a meta-analysis and methodological review

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Several decades of research have shown that lesbian, gay and bisexual (LGB) adults are at high risk for substance use and substance use disorders (SUDs). These problems may often start prior to young adulthood; however, relatively little is known about risk for substance use in LGB adolescents. The primary aims of this paper were to conduct a meta-analysis of the relationship between sexual orientation and adolescent substance use and a systematic review and critique of the methodological characteristics of this literature. Methods 

Medical and social science journals were searched using Medline and PsychInfo. Studies were included if they tested the relationship between sexual orientation and adolescent substance use. Eighteen published studies were identified. Data analysis procedures followed expert guidelines, and used National Institutes of Health (NIH)-sponsored meta-analysis software. Results 

LGB adolescents reported higher rates of substance use compared to heterosexual youth (overall odds ratio = 2.89, Cohen's d = 0.59). Effect sizes varied by gender, bisexuality status, sexual orientation definition and recruitment source. None of the studies tested mediation and only one tested moderation. One employed a matched comparison group design, one used a longitudinal design, and very few controlled for possible confounding variables. Conclusions 

The odds of substance use for LGB youth were, on average, 190% higher than for heterosexual youth and substantially higher within some subpopulations of LGB youth (340% higher for bisexual youth, 400% higher for females). Causal mechanisms, protective factors and alternative explanations for this effect, as well as long-term substance use outcomes in LGB youth, remain largely unknown.

Keywords: Adolescence; alcohol; bisexual; drugs; gay; lesbian; meta-analysis; sexual minority; sexual orientation; youth

Document Type: Research Article


Affiliations: 1: Department of Behavioral and Community Health Sciences, Graduate School of Public Health, Pittsburgh, PA, USA, 2: Department of Psychology, University of Washington, WA, USA and 3: Searchlight Consulting, Alexandria, VA, USA 4: Department of Pediatrics, Division of Adolescent Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA, 5: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,

Publication date: April 1, 2008

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