Homophobic Bullying and Sexual Minority Youth Alcohol Use: Do Sex and Race/Ethnicity Matter?

Abstract

Purpose: Sexual minority youth (SMY) are more likely to use alcohol than their heterosexual peers, yet a lack of research on within-group differences and modifiable mechanisms has hindered efforts to address alcohol use disparities. The purpose of the current study was to examine differences in the mediating role of homophobic bullying on the association between sexual orientation identity and drinking frequency and heavy episodic drinking frequency by sex and race/ethnicity.

Methods: We used data from a subsample of 20,744 youth in seven states from the 2015 Youth Risk Behavior Survey, a population-based data set of 9-12th grade high school students in the United States. We included youth who self-identified as male or female; heterosexual, lesbian/gay, bisexual, or unsure of their sexual orientation identity; and White, Black, or Latino.

Results: Within-group comparisons demonstrated that SMY alcohol use disparities were concentrated among Latino bisexual and unsure youth. All subgroups of SMY at the intersection of race/ethnicity and sex were more likely than their heterosexual counterparts to report homophobic bullying. Homophobic bullying mediated alcohol use disparities for some, but not all, subgroups of SMY.

Conclusion: Homophobic bullying is a serious risk factor for SMY alcohol use, although youths' multiple identities may differentiate degrees of risk. Sexual orientation identity-related disparities in alcohol use among Latino, bisexual, and unsure youth were not fully attenuated when adjusted for homophobic bullying, which suggests that there may be additional factors that contribute to rates of alcohol use among these specific subgroups of SMY.

Keywords: adolescence; alcoholism; bullying; race/ethnicity; sex; sexual minorities.

FIG. 1.

Visual representation of the indirect effect of sexual orientation identity on drinking frequency and heavy episodic drinking frequency through homophobic bullying. The arrows in this figure indicate predicted associations. The path labeled a refers to the direct effect of sexual orientation identity on homophobic bullying. The paths labeled b refer to the conditional direct effect of homophobic bullying on drinking frequency and on heavy episodic drinking frequency, adjusting for sexual orientation identity. The paths labeled c′ refer to the conditional direct effect of sexual orientation identity on drinking frequency and on heavy episodic drinking frequency, adjusting for homophobic bullying.

FIG. 2.

Forest plot of the means, weighted proportions, and confidence intervals of drinking frequency, heavy episodic drinking frequency, and homophobic bullying by race/ethnicity, sexual orientation identity, and sex. The dotted lines in this figure indicate the overall means of drinking frequency (i.e., number of days drank in past 30 days) and heavy episodic drinking frequency (i.e., number of days drank 4 or more drinks in past 30 days) and proportions of youth who reported homophobic bullying (i.e., victim of teasing or name calling for being lesbian, gay, or bisexual). Solid squares in the figure indicate means or proportions for each group. Confidence intervals are indicated by the lines protruding from the mean/proportion squares. Actual mean/proportion and confidence interval values are shown to the right.