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. 2025 Sep 14.
doi: 10.1111/ajad.70087. Online ahead of print.

Substance use and sexual orientation among adolescents: Differences by age group and sex in the 2023 National Survey of Drug Use and Health

Timothy J Grigsby  1 , Rachel Hoopsick  2 , Dylan Barker  3 , Elise Devier  3 , Amber Amis  3 , R Andrew Yockey  3
Affiliations

Substance use and sexual orientation among adolescents: Differences by age group and sex in the 2023 National Survey of Drug Use and Health

Timothy J Grigsby et al. Am J Addict. .

Abstract

Background and objectives: Adolescent substance use is a critical public health concern with significant long-term consequences, yet research on disparities by sexual orientation remains limited. Despite the unique stressors faced by sexual minority youth-particularly bisexual individuals-that increase their risk for substance use, most studies investigate disparities among older adolescents and adults. Using recent national data, this study aims to fill this gap and inform targeted prevention and intervention efforts for sexual minority youth.

Methods: We leveraged data from the 2023 National Survey on Drug Use and Health from youth aged 12-17 (N = 10,361). Using weighted logistic regression models, we examined the separate relationships between sexual orientation and past-year substance use (i.e., tobacco, marijuana, and alcohol) stratified by age and sex assigned at birth.

Results: Among adolescents, 4.73% reported tobacco use, 11.2% reported marijuana use, and 17.2% reported alcohol use. Logistic regression models indicated that, compared to heterosexual youth, bisexual youth had higher odds of using tobacco (OR = 2.00, 95% CI = 1.37-2.90), marijuana (OR = 1.85, 95% CI = 1.43-2.40), and alcohol (OR = 1.32, 95% CI = 1.02-1.69), while gay/lesbian youth had lower odds of tobacco use (OR = 0.47, 95% CI = 0.24-0.94), but higher odds of alcohol (OR = 1.60, 95% CI = 1.06-2.44). Notable differences were observed across sex and age.

Conclusions and scientific significance: Findings from the current study highlight significant disparities in substance use among youth based on sexual orientation, particularly among bisexual adolescents. We recommend that prevention and intervention efforts incorporate age-specific and gender-sensitive approaches to address the unique stressors faced by sexual minority youth.

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