Substance abuse and mental health disparities: Comparisons across sexual identity groups in a national sample of young Australian women

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Abstract

A growing body of research amply documents health disparities related to substance abuse among sexual minority women. However, relatively little research has examined risk factors or predictors of substance use in this population and even less has explored differences among sexual minority subgroups. Using data from 8850 women aged 25–30 years in the 2003 survey of the Australian Longitudinal Study on Women’s Health Survey (ALSWH) we compared rates of substance use (alcohol, marijuana and other illicit drugs) and potential predictors (e.g., depression, anxiety, perceived stress, lower levels of social support) across four sexual identity groups—exclusively heterosexual, mainly heterosexual, bisexual and lesbian. Using statistical weighting of the sample and controlling for demographic characteristics we fitted logistic regression models to estimate adjusted odds ratios for substance use. Compared with exclusively heterosexual women sexual minority women reported significantly higher levels of substance use—but there was notable variation among the three sexual minority subgroups. Women who identified as mainly heterosexual were significantly more likely than exclusively heterosexual women to report at-risk drinking and those who identified as bisexual were more likely to report marijuana use. Mainly heterosexual and bisexual women were also more likely to report binge drinking. Findings implicate stress as an important predictor of substance use and emphasize the need for research that more systematically examines the relationships between minority stress and substance use in sexual minority women. Findings of variations in risk across sexual minority subgroups suggest prevention and intervention strategies aimed at reducing health disparities should be targeted toward specific sexual minority subgroups.

Section snippets

Study participants

The sample includes participants from the youngest cohort in the ALSWH, a prospective study that began in 1996 with the goal of tracking the health of women in three age cohorts (aged 18–23, 45–50 and 70–75 at baseline) for at least 20 years. We chose to focus on the youngest cohort because it was the only age cohort in which both illicit drug use and sexual identity was assessed. The ALSWH research team randomly selected the sample from the database of Medicare Australia, the universal

Sample characteristics

Each of the demographic characteristics of the sample differed significantly by sexual identity (see Table 1). Women who identified as exclusively heterosexual were most likely to be married (44.0%), to have children (32.8%), to have incomes of $37,000/year or more (66.5%) and to live in rural or remote areas (40.4%). Those who identified as lesbian were significantly older (M = 27.5, SD = 1.4) than women in the other three sexual identity groups (F(3, 7605) = 2.98, p = .03), and were most

Discussion

Findings of higher rates on almost all measures of substance use among sexual minority women compared with exclusively heterosexual women support our first hypothesis and are consistent with previous population-based studies from New Zealand (Fergusson et al., 2005), the Netherlands (Sandfort, deGraf, Bijl, & Schnabel, 2001) and the U.S. (Gilman et al., 2001). Patterns of substance use are also consistent with an earlier (wave 2) survey of the ALWHS young cohort (Hillier et al., 2003) and

Acknowledgements

This study was funded by the Gay and Lesbian Medical Association’s Lesbian Health Fund in the United States. The Australian Longitudinal Study on Women’s Health is conducted by a team of researchers at the University of Newcastle and the University of Queensland. We are grateful to the Australian Government Department of Health and Ageing for funding the study, and to the women who participated.

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