Sexual orientation disparities in prescription drug misuse among a nationally representative sample of adolescents: Prevalence and correlates

- Sexual orientation disparities in prescription drug misuse are explored using the 2015 National Youth Risk Behavior Survey.
- Most female and male sexual minority adolescents are at elevated odds of ever misusing a prescription drug.
- Victimization experiences and poor mental health only partially account for these disparities.
- Findings for bisexual and racial/ethnic minority males are discrepant from previous studies, warranting further research.
- Interventions across socioecological levels are needed to reduce prescription drug misuse among sexual minority youth.

ObjectiveSexual minority adolescents (SMA) may be at disproportionate risk for misusing prescription psychotropic medications compared to their heterosexual peers. However, generalizable studies specific to this age group are lacking. The current study aimed to describe the prevalence of sexual orientation disparities in prescription drug misuse among a nationally representative sample of adolescents as well as to examine key correlates of misuse.MethodUsing data from the National Youth Risk Behavior Survey, we conducted stepwise multivariable weighted logistic regressions, sequentially controlling for demographics, experiences of victimization, mental health, and other illicit substance use.ResultsAdjusting for grade and race/ethnicity, female SMA and gay and unsure males had significantly elevated odds of ever misusing a prescription drug compared to heterosexual adolescents (ORs from 1.7-2.5). Most sexual orientation disparities among females remained significant with the addition of victimization and mental health covariates but attenuated completely after controlling for other illicit drug use. The effect for unsure males attenuated when victimization variables were included, but the effect for gay males remained significant through the final model. Controlling for other illicit drug use, mental health variables remained significant correlates for females whereas only forced sex was significant for males.ConclusionThese results suggest experiences of victimization and mental health partially account for the disparities in prescription drug misuse between SMA and heterosexual adolescents, and their effects may differ by sex. A combination of structural, individual coping, and universal drug prevention approaches should be used to make the largest impact on reducing these disparities.