The aim was to examine the effects of sexual identity, educational status, and their interaction on the past-year prevalence of controlled prescription use and prescription drug misuse (PDM) in U.S. young adults, 18–25 years.
Methods
Data were from the 2015–2017 National Survey on Drug Use and Health (young adult N = 38,298). Past-year prescription opioid, stimulant and benzodiazepine use and PDM were outcomes, with PDM defined as use without a prescription or in ways not intended by the prescriber. Separate regressions by sex evaluated the relationship between prescription medication use or PDM prevalence and sexual identity, educational status/attainment (college student/graduate versus non-college), their interaction and past-year psychological distress.
Results
Sexual identity minority young adults had higher rates of prescription use and PDM than heterosexual young adults. After accounting for educational status, though, bisexual men rarely differed from heterosexual men; after including psychological distress, gay men rarely differed from heterosexual men. Versus heterosexual women, lesbian (adjusted odds ratio [AOR] = 2.33, 95% confidence interval [95% CI] = 1.47–2.30) and bisexual (AOR= 1.78, 95% CI = 1.27–2.50) young adult women had higher rates of prescription opioid misuse, after adjusting for educational status, psychological distress and sociodemographics. Versus heterosexual men, benzodiazepine PDM was elevated in gay men (AOR = 1.91, 95% CI= 1.02–3.58). Educational status was generally associated with lower rates of prescription use and PDM, except for stimulant PDM.
Conclusions
Screening for psychological distress and PDM is needed in sexual identity minority young adults, especially for prescription opioid misuse among sexual identity minority women. Culturally-sensitive intervention should be considered for those with elevated psychological distress or signs of PDM. Further research on the sex differences found in the link between psychological distress and sexual identity minority opioid and stimulant PDM is warranted.
KerridgeBT, PickeringRP, SahaTD, . Prevalence, sociodemographic correlates and DSM-5 substance use disorders and other psychiatric disorders among sexual minorities in the United States. Drug Alcohol Depend. 2017;170:82–92.
2.
CochranSD, MaysVM, SullivanJG.Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. J Consult Clin Psychol. 2003;71(1):53–61.
3.
GreenKE, FeinsteinBA.Substance use in lesbian, gay, and bisexual populations: an update on empirical research and implications for treatment. Psychol Addict Behav. 2012;26(2):265–278.
4.
MedleyG, LipariRN, BoseJ, CribbDS, KroutilLA, McHenryG. Sexual orientation and estimates of adult substance use and mental health: results from the 2015 National Survey on Drug Use and Health. Retrieved from http://www.samhsa.gov/data/2016.
5.
KingM, SemlyenJ, TaiSS, . A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry. 2008;8:70.
6.
PloderlM, TremblayP.Mental health of sexual minorities. A systematic review. Int Rev Psychiatry. 2015;27(5):367–385.
7.
MeyerIH.Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–697.
8.
McCabeSE, BostwickWB, HughesTL, WestBT, BoydCJ.The relationship between discrimination and substance use disorders among lesbian, gay, and bisexual adults in the United States. Am J Public Health. 2010;100(10):1946–1952.
9.
ParentMC, ArriagaAS, GobbleT, WilleL.Stress and substance use among sexual and gender minority individuals across the lifespan. Neurobiol Stress. 2019;10:100146
10.
SlaterME, GodetteD, HuangB, RuanWJ, KerridgeBT.Sexual orientation-based discrimination, excessive alcohol use, and substance use disorders among sexual minority adults. LGBT Health. 2017;4(5):337–344.
11.
LeeJH, GamarelKE, BryantKJ, ZallerND, OperarioD.Discrimination, mental health, and substance use disorders among sexual minority populations. LGBT Health. 2016;3(4):258–265.
12.
BostwickWB, BoydCJ, HughesTL, McCabeSE.Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States. Am J Public Health. 2010;100(3):468–475.
13.
BostwickWB, BoydCJ, HughesTL, WestBT, McCabeSE.Discrimination and mental health among lesbian, gay, and bisexual adults in the United States. Am J Orthopsychiatry. 2014;84(1):35–45.
14.
. Pew Research Center.A Survey of LGBT Americans: Attitudes, Experiences and Values in Changing Times. Washington, DC: Pew Research Center; 2013.
15.
EatonAA, RiosD.Social challenges faced by queer Latino college men: navigating negative responses to coming out in a double minority sample of emerging adults. Cultur Divers Ethnic Minor Psychol. 2017;23(4):457–467.
16.
BarnesDM, HatzenbuehlerML, HamiltonAD, KeyesKM.Sexual orientation disparities in mental health: the moderating role of educational attainment. Soc Psychiatry Psychiatr Epidemiol. 2014;49(9):1447–1454.
17.
BlancoC, OkudaM, WrightC, . Mental health of college students and their non-college-attending peers: results from the National Epidemiologic Study on Alcohol and Related Conditions. Arch Gen Psychiatry. 2008;65(12):1429–1437.
18.
Linden-CarmichaelAN, LanzaST.Drinking patterns of college- and non-college-attending young adults: is high-intensity drinking only a college phenomenon?Subst Use Misuse. 2018;53(13):2157–2164.
19.
CarterAC, BrandonKO, GoldmanMS.The college and noncollege experience: a review of the factors that influence drinking behavior in young adulthood. J Stud Alcohol Drugs. 2010;71(5):742–750.
20.
SchulenbergJE, JohnstonLD, O'MalleyPM, BachmanJG, MiechRA, PatrickME.Monitoring the Future National Survey Results on Drug Use, 1975–2018: Volume II, College Students and Adults Ages 19–60. Ann Arbor, MI: Institute for Social Research, The University of Michigan; 2019.
21.
SchmitzRM, TylerKA.LGBTQ + young adults on the street and on campus: identity as a product of social context. J Homosex. 2018;65(2):197–223.
22.
KerrDL, SanturriL, PetersP.A comparison of lesbian, bisexual, and heterosexual college undergraduate women on selected mental health issues. J Am Coll Health. 2013;61(4):185–194.
23.
GrantJE, OdlaugBL, DerbyshireK, SchreiberLR, LustK, ChristensonG.Mental health and clinical correlates in lesbian, gay, bisexual, and queer young adults. J Am Coll Health. 2014;62(1):75–78.
24.
PrzedworskiJM, VanKimNA, EisenbergME, McAlpineDD, LustKA, LaskaMN.Self-reported mental disorders and distress by sexual orientation: results of the Minnesota College Student Health Survey. Am J Prev Med. 2015;49(1):29–40.
25.
BaamsL, De LucaSM, BrownsonC.Use of mental health services among college students by sexual orientation. LGBT Health. 2018;5(7):421–430.
26.
Katz-WiseSL, RosarioM, CalzoJP, SchererEA, SardaV, AustinSB.Associations of timing of sexual orientation developmental milestones and other sexual minority stressors with internalizing mental health symptoms among sexual minority young adults. Arch Sex Behav. 2017;46(5):1441–1452.
27.
BeT, SchepisTS.Nonmedical use of prescription medications in young adults. Adolesc Med State Art Rev. 2013;24(3):597–610.
28.
Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2018.
29.
SchepisTS, TeterCJ, McCabeSE.Prescription drug use, misuse and related substance use disorder symptoms vary by educational status and attainment in U.S. adolescents and young adults. Drug Alcohol Depend. 2018;189:172–177.
30.
McCabeSE, TeterCJ, BoydCJ, WilensTE, SchepisTS.Sources of prescription medication misuse among young adults in the United States: the role of educational status. J Clin Psychiatry. 2018;79(2):17m11958.
31.
MartinsSS, KimJH, ChenLY, . Nonmedical prescription drug use among US young adults by educational attainment. Soc Psychiatry Psychiatr Epidemiol. 2015;50(5):713–724.
32.
DagirmanjianFR, McDanielAE, ShadickR.Sexual orientation and college students’ reasons for nonmedical use of prescription drugs. Subst Use Misuse. 2017;52(8):1011–1018.
33.
LiDH, MustanskiB.Prevalence and correlates of prescription drug misuse among a racially diverse sample of young sexual minority men. LGBT Health. 2018;5(2):95–104.
34.
SchulerMS, DickAW, SteinBD.Sexual minority disparities in opioid misuse, perceived heroin risk and heroin access among a national sample of US adults. Drug Alcohol Depend. 2019;201:78–84.
35.
DuncanDT, ZweigS, HambrickHR, PalamarJJ.Sexual orientation disparities in prescription opioid misuse among U.S. adults. Am J Prev Med. 2019;56(1):17–26.
36.
RosarioM, ReisnerSL, CorlissHL, WypijD, CalzoJ, AustinSB.Sexual-orientation disparities in substance use in emerging adults: a function of stress and attachment paradigms. Psychol Addict Behav. 2014;28(3):790–804.
37.
WellsBE, KellyBC, RendinaHJ, ParsonsJT.Prescription drug misuse and sexual behavior among young adults. J Sex Res. 2015;52(6):659–668.
38.
McCabeSE, VelizP, SchulenbergJE.Adolescent context of exposure to prescription opioids and substance use disorder symptoms at age 35: a national longitudinal study. Pain. 2016;157(10):2173–2178.
39.
MiechR, JohnstonL, O'MalleyPM, KeyesKM, HeardK.Prescription opioids in adolescence and future opioid misuse. Pediatrics. 2015;136(5):e1169–e1177.
40.
GrantBF, ChuA, SigmanR.Source and Accuracy Statement: National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). Rockville, MD: National Institute on Alcohol Abuse and Alcoholism; 2014.
41.
Center for Behavioral Health Statistics and Quality. 2016 National Survey on Drug Use and Health: Methodological Summary and Definitions. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2017.
42.
Substance Abuse and Mental Health Services Administration. Reliability of Key Measures in the National Survey on Drug Use and Health (Methodology series M-8, HHS Publication No. SMA 09-4425). Rockville, MD: Office of Applied Studies; 2010.
43.
Center for Behavioral Health Statistics and Quality. 2016 National Survey on Drug Use and Health: Methodological Resource Book (Section 8, data collection final report). Rockville, MD: Substance Abuse and Mental Health Services Administration; 2017.
44.
Center for Behavioral Health Statistics and Quality. 2015 National Survey on Drug Use and Health Public Use File Codebook. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2016.
45.
LuiCK, KerrWC, MuliaN, YeY.Educational differences in alcohol consumption and heavy drinking: an age-period-cohort perspective. Drug Alcohol Depend. 2018;186:36–43.
46.
CrosnoeR, KendigS, BennerA.College-going and trajectories of drinking from adolescence into adulthood. J Health Soc Behav. 2017;58(2):252–269.
47.
ThompsonK, LeadbeaterB, AmesM, MerrinGJ.Associations between marijuana use trajectories and educational and occupational success in young adulthood. Prev Sci. 2019;20(2):257–269.
48.
KesslerRC, BarkerPR, ColpeLJ, . Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003;60(2):184–189.
49.
ArriaAM, CaldeiraKM, AllenHK, BugbeeBA, VincentKB, O'GradyKE.Prevalence and incidence of drug use among college students: an 8-year longitudinal analysis. Am J Drug Alcohol Abuse. 2017;43(6):711–718.
50.
MollbornS, EverettB.Understanding the educational attainment of sexual minority women and men. Res Soc Stratif Mobil. 2015;41:40–55.
51.
Center for Behavioral Health Statistics and Quality. 2016 National Survey on Drug Use and Health: Methodological Resource Book (Section 13: statistical inference report). Rockville, MD: Substance Abuse and Mental Health Services Administration; 2017.
52.
Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug Use and Health: Methodological Resource Book (Section 11: person-level sampling weight calibration). Rockville, MD: Substance Abuse and Mental Health Services Administration; 2019.
53.
O'MalleyPM, BachmanJG, JohnstonLD.Reliability and consistency in self-reports of drug use. Int J Addict. 1983;18(6):805–824.
54.
JohnstonLD, O'MalleyPM.Issues of validity and population coverage in student surveys of drug use. NIDA Res Monogr. 1985;57:31–54.
55.
SchrimshawEW, RosarioM, Meyer-BahlburgHFL, Scharf-MatlickAA.Test-retest reliability of self-reported sexual behavior, sexual orientation, and psychosexual milestones among gay, lesbian, and bisexual youths. Arch Sex Behav. 2006;35(2):225–234.
56.
Center for Behavioral Health Statistics and Quality. National Survey on Drug Use and Health (NSDUH): Summary of Methodological Studies, 1971-2014. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014.
57.
KruegerEA, MeyerIH, UpchurchDM.Sexual orientation group differences in perceived stress and depressive symptoms among young adults in the United States. LGBT Health. 2018;5(4):242–249.
58.
McCabeSE, MatthewsAK, LeeJGL, VelizP, HughesTL, BoydCJ.Tobacco use and sexual orientation in a national cross-sectional study: age, race/ethnicity, and sexual identity-attraction differences. Am J Prev Med. 2018;54(6):736–745.
59.
JiangY, Reilly-ChammatR, CooperT, Viner-BrownS.Disparities in health risk behaviors and health conditions among rhode island sexual minority and unsure high school students. J Sch Health. 2018;88(11):803–812.
60.
BoydCJ, McCabeSE, CranfordJA, . Heavy episodic drinking and its consequences: the protective effects of same-sex, residential living-learning communities for undergraduate women. Addict Behav. 2008;33(8):987–993.
