(72) Racial Differences in LGBTQ+ Substance Use: Insights from All of Us Data

Background & Introduction: Sexual and gender minority (SGM) individuals are differentially exposed to chronic stress, discrimination, and violence due to minority identities (Ebrahimi et al., 2024), which has been related to elevated risks for both single substance and polysubstance use (Trinh et al., 2022; Meresh et al., 2023). SGM with other minority identities, such as those who identify as Black, Indigenous, or other Person of Color (BIPOC), report rates of polysubstance use at two times the national average (Parent et al., 2019). Given the global disease burden of substance use disorders (SUD), it is critical to understand SUD risk for individuals with intersecting identities. While it is well-established that SGM are at a heightened risk for SUD, little research has utilized large-scale data to explore racial disparities in SUD for LGBTQ+ individuals, often relying on small convenience samples that limit the generalizability of findings. Our study sought to develop a more nuanced understanding of the occurrence of SUD in a racially diverse LGBTQ+ population and identify differences by racial group through data collected by the National Institutes of Health (NIH) All of Us Research Program (N=34,138).

Methods: Data were obtained from the All of Us Research Program, a longitudinal cohort study aiming to enroll a diverse group of one million+ individuals across the USA to accelerate biomedical research and improve human health. Data comprise demographics, electronic health records (EHR), and multiple surveys (i.e., basic survey, lifestyle survey, healthcare access survey, etc.).

Analyses were conducted using R Studio within the All of Us Researcher Workbench, a cloud-based platform. ICD-9 and ICD-10 codes defined clinical conditions. Descriptive analyses were conducted for demographics, chronic conditions, mental health, and survey scores for the LGBTQ+ population. For group comparisons, bivariate analyses were performed. Chi-square tests were used for categorical variables. Independent samples t-tests and one-way ANOVA were used for continuous variables with standardized mean difference percent (SMD%). SMD% were calculated to measure effect size differences in different groups. Tukey’s post-hoc tests were performed to identify group differences when ANOVA results were significant (p < .05).

We gratefully acknowledge the All of Us participants for their contributions, without whom this research would not have been possible. We also thank NIH’s All of Us Research Program for making available the participant data examined in this study.

Results:
From the 413,457 participants enrolled in All of Us, n = 34,138 identified as LGBTQ+. Of those who identified as LGBTQ+, 61.4% (n = 20,387) identified as White, non-hispanic, 16.1% (n=5,351) as Black, non-hispanic, 15.6% (n = 5,167) as Hispanic/Latina/o/e, and 6.9% (n=2,275) as other, Non-Hispanic. The majority of participants identified as cisgender women (53.3%) or cisgender men (36.1%), with 9% identifying as another gender, .09% as transgender men, and 0.7% as transgender women. The average age of participants was 45 years old. Approximately a third of participants had attended college for 1 to 3 years (28.4%), had never married (44.7%), had an annual income of less than 35k (42.4%), and had stable housing (73.9%).

Approximately 21% of LGBTQ+ participants had SUD, with 12.1% substance abuse, 12.3% nicotine, and 5.4% alcohol. Results revealed a significant effect of racial group on SUD. Compared to the three other racial groups, Black, non-Hispanic participants were more likely to have SUD (31.1%, p < 0.001, SMD 46.6%), substance abuse (19.6%, p < 0.001, SMD 40%), alcohol (8.8%, p < 0.001, SMD 27.3%), nicotine (21.4%, p < 0.001, SMD 41.3%).

Conclusion & Discussion:

Our findings highlight the heightened risk for BIPOC LGBTQ+ in the development of SUD, in-line with findings from smaller-scale, geographically limited studies. More specifically, our study found that Black, Non-Hispanic LGBTQ+ individuals were more likely to endorse SUD, including abuse, alcohol use, and nicotine use. Given that substances are often used to cope with minority stressor experiences, including LGBTQ+-based discrimination and racism, clinical intervention should be culturally-adapted to meet the needs of those with multiple minority identities and include intersectionality-informed SUD assessment and treatment. Moreover, intervention should be accessible, given the financial barriers experienced by these marginalized individuals.

References: Ebrahimi, C. T., Polanco-Roman, L., Saraiya, T. C., Bauer, A. G., & Hien, D. (2024, February 1). Historical Trauma and Polysubstance Use in Black Young Adults: The Role of Contemporary Racism. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. https://dx.doi.org/10.1037/tra0001652

Trinh, M.-H., Aguayo-Romero, R., & Reisner, S. L. (2022). Mental health and substance use risks and resiliencies in a U.S. sample of transgender and gender diverse adults. Social Psychiatry and Psychiatric Epidemiology, 57(11), 2305–2318. https://doi.org/10.1007/s00127-022-02359-y

Mereish, E. H., Fish, J. N., & Watson, R. J. (2023). Intersectional Minority Stress and Alcohol, Tobacco, and Cannabis Use Among Sexual and Gender Minority Adolescents of Color: Moderating Role of Family Support. LGBT Health, 10(1), 18-25–25. https://doi.org/10.1089/lgbt.2021.0430