LGB (lesbian, gay, and bisexual) state policy protections and substance use disparities

Abstract

LGB (lesbian, gay, and bisexual) individuals have higher rates of tobacco and alcohol use than the general population. While protective social policies have been found to reduce these disparities, their long-term impact remains largely unknown. In this study, we used data from waves 3 (2001-2002) and 4 (2008-2009) of the National Longitudinal Study of Adolescent to Adult Health to assess the impact of exposure to LGB state policy protections during emerging adulthood on substance use in young adulthood. Using multivariable Poisson models, we evaluated whether emerging adulthood was a critical period of exposure and quantified the relative reduction in substance use disparities between LGB and heterosexual individuals living in more protective states. Findings suggest that LGB individuals living in states with more policy protections during emerging adulthood had a significantly lower prevalence of tobacco use and binge drinking in young adulthood compared with those in less protective states. These findings were not observed among heterosexual individuals, indicating that policy effects were specific to LGB individuals. Furthermore, these protections appeared to reduce overall substance use disparities, especially among female participants. It is critical to continue evaluating policy protections to safeguard the health of the LGB community, especially considering the potential erosion of these vital protections.

Keywords: LGB health; epidemiology; social policies; substance use.

Figure 1.

Model-based predicted probabilities of substance use based on the number of LGB state protections. The plots represent predicted probabilities, which were estimated from Poisson models with robust estimators that included an interaction between sexual orientation and number of LGB state policy protections as a categorical variable. Models were adjusted for age, sex (for full-sample analysis), race, and tract-level proportion of people who (1) lived below the poverty level, (2) have completed a college degree, and (3) were in same-sex-partner households. Error bars are based on the standard error. When sample sizes are large (as is the case in this analysis), SEs and 95% CIs are roughly equivalent, and the use of SEs was selected to simplify presentation. The sample included Add Health participants in wave 4 who also had data on LGB policies available during emerging adulthood (wave 3). State policy variables were measured in wave 3, and outcomes in wave 4. Abbreviations: Add Health, National Longitudinal Study of Adolescent to Adult Health; LGB, lesbian, gay, bisexual.