Risk of heavy drinking among sexual minority adolescents: indirect pathways through sexual orientation-related victimization and affiliation with substance-using peers

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To test two indirect pathways through which sexual minority adolescents (SMAs) may be at risk for heavy episodic drinking (HED) including a socialization pathway via substance-using peer affiliations and social marginalization pathway via sexual minority-specific victimization and subsequent substance-using peer affiliations.


Analysis of the first three waves (6 months apart) of a longitudinal adolescent health risk study (2011–14). Participants were referred by medical providers or a screening system in providers' waiting rooms.


Two large urban adolescent health clinics in Pennsylvania and Ohio, USA.


A total of 290 adolescents (ages 14–19 years, mean: 17.08) who were 71.0% female, 33.4% non-Hispanic white and 34.5% SMAs.


Self-reported sexual minority status (wave 1) and affiliation with substance-using peers (waves 1 and 2), and latent sexual-minority specific victimization (waves 1 and 2) and HED (waves 1 and 3) variables.


Using mediation analyses in a structural equation modeling framework, there was a significant indirect effect of sexual minority status (wave 1) on HED (wave 3) via affiliation with substance-using peers [wave 2; indirect effect = 0.03, 95% confidence interval (CI) = 0.01, 0.07], after accounting for the indirect effect of sexual-orientation related victimization (wave 2; indirect effect = 0.10, 95% CI = 0.02–0.19). The social marginalization pathway was not supported, as victimization (wave 1) was not associated with affiliation with substance-using peers (wave 2; β = − 0.04, P = 0.66). Sex differences in the indirect effects were not detected (Ps > 0.10).


Sexual minority adolescents in the United States appear to exhibit increased heavy episodic drinking via an indirect socialization pathway, including affiliations with substance-using peers and a concurrent indirect pathway involving sexual minority-related victimization. The pathways appear to operate similarly for boys and girls.

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