Neighborhood-level LGBT hate crimes and current illicit drug use among sexual minority youth
Introduction
Adolescence is an important developmental period for the initiation of illicit drugs (Gruber and Pope, 2002, Latimer and Zur, 2010, CDC, 2012). National estimates report that 24.4% of 13–18 year olds report lifetime prevalence of illicit drugs (Swendsen et al., 2012). Marijuana is the most commonly used illicit drug among youth, by far (Johnston et al., 2003, Latimer and Zur, 2010). The 2011 High School Youth Risk Behavior Survey found that 39.9% of youth in the U.S. used marijuana in their lifetime and 23.1% of youth in the U.S. used marijuana in the last 30 days (CDC, 2012). Substance use in adolescence is associated with increased risk for substance use disorders, school failure, sexually transmitted infections, and other psychosocial and health problems (Behrendt et al., 2009, Chen et al., 2005, Gruber and Pope, 2002).
Both cross-sectional and longitudinal studies have shown that sexual minority youth (e.g., those who identify as lesbian, gay or bisexual or experience same-sex attractions and/or relationships) are more likely to use drugs than heterosexual youth (Corliss et al., 2010, Garofalo et al., 1998, Marshal et al., 2008, Russell et al., 2002). A meta-analysis found that the odds of substance use among sexual minority youth are nearly twice that of heterosexual youth (Marshal et al., 2008). Furthermore, sexual minority youth were 1.56 times more likely to report past 30-day marijuana use, and were 2.58 times more likely to report lifetime marijuana use, compared to their heterosexual peers (Marshal et al., 2008).
An Institute of Medicine (2011) report on sexual minority health disparities noted that the reasons for higher levels of substance use, including marijuana use, among sexual minority youth are largely unknown. However, the stigma related to sexual orientation is frequently cited as a risk factor for health disparities between sexual minority and heterosexual populations. Several studies have documented associations between various stigma-related stressors and substance use among sexual minority youth (Coker et al., 2010), including gay-related stressful life events (e.g., identity disclosure; Rosario et al., 1996), victimization at school (Bontempo and D’Augelli, 2002), and verbal/physical abuse (Savin-Williams, 1994). This research has provided important information on risk factors for substance use, including marijuana use, but has tended to focus on individual and interpersonal forms of stigma. Neighborhood environments play a significant role in shaping patterns of population health and health disparities (Berkman and Kawachi, 2000, Kawachi and Berkman, 2003, Link and Phelan, 1995, Marmot and Wilkinson, 2006). Although Healthy People 2020 suggested that neighborhood factors may influence sexual minority health, very limited research has examined whether neighborhood factors contribute to substance use among gay men (Buttram and Kurtz, 2013, Carpiano et al., 2011) and sexual minority adolescents (Hatzenbuehler et al., 2011).
We sought to address this gap in the literature by examining one neighborhood factor that is likely salient to the health of sexual minority youth—that of neighborhood-level hate crimes. Hate crimes are defined as “unlawful, violent, destructive or threatening conduct in which the perpetrator is motivated by prejudice toward the victim's putative social group” (Green et al., 2001). Sexual minorities are frequent targets of hate crimes (Herek, 2009); in fact, 17% of the 88,463 hates crimes in the U.S. from 1995 to 2008 were directed toward sexual minorities (FBI, 2012).
Previous empirical research with general (i.e., non-sexual minority) samples suggests that exposure to neighborhood violence is associated with youth substance use, including marijuana use (Copeland-Linder et al., 2011, Lambert et al., 2004). In these studies, neighborhood violence is conceptualized as a contextual effect. Thus, individuals do not have to experience violence directly to be negatively influenced by these social contexts. Similarly, even if sexual minority youth are not personally targets of LGBT hate crimes, living in neighborhoods with a greater prevalence of such crimes may nevertheless create a negative social climate for these individuals, contributing to increased levels of stress (Hatzenbuehler et al., 2011, Oswald et al., 2010). In turn, young sexual minorities may use marijuana and other substances to manage that stress (Boardman et al., 2001, Low et al., 2012). Based on this literature, we hypothesized that current marijuana use and other illicit drug use among sexual minority youth would be higher in neighborhoods with more LGBT hate crimes. To test this hypothesis, we obtained data on LGBT hate crimes from the Boston Police Department Community Disorders Unit and linked this information to individual-level data on drug use and sexual orientation from a population-based sample of Boston youth.
Section snippets
Sample
Individual-level data come from the 2008 Boston Youth Survey (BYS) Geospatial Dataset, which includes 9th–12th grade students in the Boston Public Schools system who took the BYS and provided their complete residential address (Azrael et al., 2009, Duncan et al., 2012, Duncan et al., 2013). Similar to the percentage of those schools included in the BYS survey (Green et al., 2011), approximately 74% of Boston Public School students in the 2007–2008 academic year were eligible for free or
Results
Table 1 presents the socio-demographic characteristics of the study sample. Sexual minority youth were significantly more likely than heterosexual youth to report past 30-day marijuana use and past 30-day illicit drug use. Approximately one-third of the sexual minority youth reported past-30 day marijuana use, compared to 18.4% of their heterosexual peers (X2 = 12.82, p < 0.01). Moreover, nearly 10% of the sexual minority sample reported other illicit drug use in the past 30 days, compared to only
Discussion
Similar to the results of our study, previous epidemiologic research has documented the existence of sexual orientation disparities in illicit drug use (Marshal et al., 2008); however, there is a noted dearth of research into the determinants of these disparities (IOM, 2011). In a population-based sample of Boston public high school students, we found a greater prevalence of current marijuana use among sexual minority youth who had a higher LGBT assault hate crime rate in their neighborhood.
Role of funding source
At the time of the study, D.T. Duncan was supported by the Alonzo Smythe Yerby Postdoctoral Fellowship at Harvard School of Public Health. M.L. Hatzenbuehler was supported by a grant from the National Institute on Drug Abuse (Grant # K01DA032558). R.M. Johnson was supported by a grant from the National Institute on Drug Abuse (Grant # K01DA031738). The 2008 Boston Youth Survey (BYS) was funded by a grant from the Centers for Disease Control and Prevention (Grant # U49CE00740) to the Harvard
Contributors
Dustin T. Duncan – had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis; study concept and design; geocoded and created the GIS measures of LGBT hate crimes; analysis and interpretation of data; drafting of the manuscript; statistical analysis.
Mark L. Hatzenbuehler – study concept and design; analysis and interpretation of data; critical revision of the manuscript for important intellectual content; study
Conflict of interest
The authors have no conflicts of interest to report.
Acknowledgements
The BYS was conducted in collaboration with the Boston Public Health Commission (Barbara Ferrer, Director), Boston's Office of Human Services (Larry Mayes, Chief), Boston Public Schools (Carol Johnson, Superintendent) and the Office of the Mayor, the Honorable Thomas M. Menino. The survey would not have been possible without the participation of the faculty, staff, administrators and students of Boston Public Schools as well as faculty, staff and students of Harvard School of Public Health and
References (59)
- et al.
Transitions from first substance use to substance use disorders in adolescence: is early onset associated with a rapid escalation?
Drug Alcohol Depend.
(2009) - et al.
Sexual orientation and bullying among adolescents in the growing up today study
J. Adolesc. Health
(2010) - et al.
Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths’ health risk behavior
J. Adolesc. Health
(2002) - et al.
Marijuana use among traumatic event-exposed adolescents: posttraumatic stress symptom frequency predicts coping motivations for use
Addict. Behav.
(2012) - et al.
Who becomes cannabis dependent soon after onset of use? Epidemiological evidence from the United States: 2000–2001
Drug Alcohol Depend.
(2005) - et al.
Sexual orientation and drug use in a longitudinal cohort study of U.S. adolescents
Addict. Behav.
(2010) Neighborhoods and health: where are we and were do we go from here?
Rev. Epidemiol. Sante Publique
(2007)- et al.
Victimization, use of violence, and drug use at school among male adolescents who engage in same-sex sexual behavior
J. Pediatr.
(1998) - et al.
Marijuana use among adolescents
Pediatr. Clin. North Am.
(2002) - et al.
Epidemiologic trends of adolescent use of alcohol, tobacco, and other drugs
Child Adolesc. Psychiatr. Clin. N. Am.
(2010)
Disproportionate exposure to early-life adversity and sexual orientation disparities in psychiatric morbidity
Child Abuse Negl.
Sexual violence victimization history and sexual risk indicators in a community-based urban cohort of “mostly heterosexual” and heterosexual young women
Am. J. Public Health
Creating a youth violence data system for Boston, Massachusetts
Austr. N. Z. J. Criminol.
Social Epidemiology
Neighborhood disadvantage, stress, and drug use among adults
J. Health Soc. Behav.
Posttraumatic stress symptom severity predicts marijuana use coping motives among traumatic event-exposed marijuana users
J. Trauma Stress
Reliability of the Youth Risk Behavior Survey Questionnaire
Am. J. Epidemiol.
Risk and protective factors associated with gay neighborhood residence
Am. J. Mens Health
Community and drug use among gay m the role of neighborhoods networks
Health J. Behav Soc.
2011 High School Youth Risk Behavior Survey
The health and health care of lesbian, gay, and bisexual adolescents
Annu. Rev. Public Health
Contextual stress and health risk behaviors among African American adolescents
J. Youth Adolesc.
Not ‘islands, entire of themselves’: exploring the spatial context of city-level robbery rates
J. Quant. Criminol.
Race, gender, and sexual orientation in hate crime victimization: identity politics or identity risk?
Violence Vict.
Validation of walk scores and transit scores for estimating neighborhood walkability and transit availability: a small-area analysis
GeoJournal
Racial differences in the built environment-body mass index relationship? A geospatial analysis of adolescents in urban neighborhoods
Int. J. Health Geogr.
Hate Crimes
The association between health risk behaviors and sexual orientation among a school-based sample of adolescents
Pediatrics
Sexual orientation and risk of suicide attempts among a representative sample of youth
Arch. Pediatr. Adolesc. Med.
Cited by (69)
Structural stigma and LGBTQ+ health: a narrative review of quantitative studies
2024, The Lancet Public HealthSubstance use and sexuality: Comparing sexual identity and attraction using a multilevel multivariate model
2021, Wellbeing, Space and SocietyAlcohol Use and Suicidality by Sexual Orientation Among U.S. Youth, 2009–2017
2020, American Journal of Preventive MedicineCitation Excerpt :In the same report, 36.2% of lesbian, gay, and bisexual respondents had made a suicide plan, and 29.4% had made an attempt.7 This high prevalence of suicide in SMY has been conceptualized using a minority stress framework,8,9 recognizing the complex influence of contextual factors on these disparities,10 including familial rejection,11,12 victimization,13–18 discrimination, and violence.19–21 Minority stress theory posits that stigma-induced and discriminatory forms of stress contribute to maladaptive coping mechanisms and chronic stress, ultimately affecting long-term health disparities in populations that experience discrimination.
Violence and substance use in sexual minorities: Data from the Second Brazilian National Alcohol and Drugs Survey (II BNADS)
2020, Archives of Psychiatric NursingCitation Excerpt :Additionally, sexual minorities also experience high rates of victimisation within intimate relationships (DiStefano, 2009; van Anders, 2015). Regarding exposure to violence, studies have shown that both lesbian and gay men report having suffered harassment or physical violence in their family due to their sexual orientation (Duncan, Hatzenbuehler, & Johnson, 2014). Compared with heterosexual adults, higher prevalence rates of gay and lesbian adults, and bisexual adults, reported having been victims of intimate partner violence (Gross, Aurand, & Addessa, 2000; VanKim & Padilla, 2010).