Background: Research has documented disparities in substance use among sexual and gender minority youth (SGMY) compared to their peers. The present study sought to identify SGMY with intersecting minoritized social positions (i.e., gender, sexual identity, and race/ethnicity) who may share disproportionate burdens of alcohol use, binge drinking, marijuana use, and use of other recreational drugs.
Methods: Data were drawn from the 2022 LGBTQ National Teen Survey, which included 10,967 SGMY aged 13-18 living in the United States. We applied exhaustive Chi-squared Automatic Interaction Detection (CHAID) analyses to assess the prevalence of past-30-day substance use across combinations of gender, sexual identity, and race/ethnicity. CHAID, a tree-based analytic technique, identifies the most significant predictors of substance use and reveals subgroups at highest risk. This approach provides a quantitative, intersectional understanding of how marginalized identities interact to influence substance use behaviors.
Results: Alcohol use was the most prevalent form of substance use in the sample (19.9%), followed by marijuana use (15.4%), binge drinking (14.2%), and other drug use (2.5%). For both alcohol and marijuana use, sexual identity emerged as the primary factor distinguishing between groups. Alcohol use was highest among queer youth (24.7%), regardless of gender or race/ethnicity, and among pansexual, gay/lesbian, and bisexual cisgender boys and girls who did not identify as Asian (25.1-28.6%). Marijuana use was also most prevalent among queer (21.8%) and pansexual or bisexual youth (17.7%), regardless of gender or race/ethnicity. Among gay/lesbian youth, marijuana use was higher for transgender boys, cisgender boys, and non-binary youth (15.7%) compared to transgender girls, cisgender girls, and questioning youth (10.5%). For binge drinking and other drug use, gender was the only significant differentiator, with cisgender boys having the highest prevalence in both categories (22.8% for binge drinking, 4.0% for other drug use).
Conclusions: These findings emphasize the urgent need for tailored prevention and intervention programs that address the specific substance use risks faced by SGMY, particularly queer-identified youth and cisgender boys. Interventions should also account for the intersecting roles of gender and racial/ethnic identities, as disparities within some sexual identity subgroups suggest that one-size-fits-all approaches may be insufficient.