摘要：Objectives. Nationally representative data were used to examine associations of romantic attractions and relationships with substance use and abuse. Methods. Data from the Add Health Study were examined. Youths reporting same-sex and both-sex romantic attractions and relationships were compared with those reporting opposite-sex attractions. Survey regression and logistic regression were used to control for sample design effects. Results. In the case of certain outcomes, romantic attraction affected males differently than females. Youths with both-sex attractions were at a somewhat higher risk for substance use and abuse than were heterosexual youths; females with same-sex attractions were also at higher risk for some outcomes. Sexual-minority youths varied little from heterosexual youths in regard to trajectories of substance use and abuse. Conclusions. These findings highlight the importance of distinguishing between youths with only same-sex attractions and those with both-sex attractions. These findings also call into question previous findings indicating that sexual-minority youths are automatically “at risk.” Substance abuse is a critical problem among youths in the United States. 1 Among the groups believed to be at highest risk are those with same-sex sexual orientations—those who are lesbian, gay, or bisexual (LGB). 2 Most relevant research has been based, however, on nonrepresentative samples of self-identified LGB youths. For example, one study of 154 LGB youths showed that lifetime substance use, as well as symptoms of substance use (dependency of use and trouble with school, friends, and family), was prevalent and frequent. 3 In another recent study of more than 130 predominantly Black and Hispanic LGB youths, substance use rates appeared to be higher than those present in the general adolescent population. 4 In that study, 63% of participants had used alcohol, 33% had used marijuana, and 14% had used cocaine in the previous 3 months, 5 as compared with corresponding rates for the general adolescent population of 51%, 22%, and 2% (each referring to the previous month). 1 Several more recent studies have used population-based data to examine associations between same-sex sexual identity or sexual behaviors and substance use and abuse. Data from the 1993 Massachusetts Youth Risk Behavior Survey (YRBS) showed that youths engaging in same-sex sexual behavior were significantly more likely to use alcohol, marijuana, cocaine, and other illegal drugs. 6 Similarly, a study focusing on the 1995 Massachusetts YRBS revealed that self-identified LGB youths were more likely than their peers to begin marijuana and alcohol use early (before the age of 13 years), to have higher lifetime rates of crack/cocaine use, and to report more recent use of tobacco. 7 A second study involving the same data source showed that the high rates of substance use among LGB youths and youths who were “unsure” of their sexual orientation were associated with increased reports of suicidality among lesbian and bisexual female youths. 8 Finally, data from the 1995 Vermont YRBS showed that male youths engaging in same-sex sexual behaviors were more likely than other sexually active male youths to smoke cigarettes, use tobacco, drink alcohol, and use marijuana at school. 9 In contrast to these results from state-based YRBS samples, a recent community-based study of 106 LGB and 224 “unsure” youths revealed that these young people were not at greater risk for substance abuse than their peers. 10 Overall, past studies indicate that youths who engage in same-sex sexual behavior or who report an LGB identity are at greater risk for substance use and abuse. We considered the issues of adolescent same-sex sexual orientation and substance use and abuse using data from the first and second waves of the National Longitudinal Study of Adolescent Health (the Add Health Study). The Add Health Study cohort represented the first available national sample in which information about same-sex romantic attractions and relationships and their associations with substance use and abuse was included. As a result, the study provided an opportunity to study trajectories of substance use and abuse behavior among youths reporting same-sex attractions and relationships as well as an opportunity to examine differences between same-sex and both-sex attractions and relationships. On the basis of past research, we anticipated that same-sex attractions and relationships would be associated with higher rates of substance use and abuse. These higher anticipated rates led us to expect corresponding significant increases in substance use and abuse over time. From the limited past research on adolescent bisexuality, 11 we anticipated that youths attracted to members of both sexes would also report higher initial levels of substance use and abuse and subsequent significant increases. Past research on LGB youths provides little reason to expect higher substance use or abuse rates among gay youths than among lesbian youths, or vice versa.
