State- and County-Level Cisheterosexism and Racism and Alcohol Use Among Racially and Ethnically Diverse Sexual and Gender Minority Adolescents

Abstract

This study examines the associations among structural cissexism and heterosexism (i.e., cisheterosexism), structural anti-Black racism, and alcohol use among racially and ethnically diverse sexual and gender minority adolescents (SGMA). Alcohol use is a well-documented inequity experienced by sexual and gender minority (SGM) populations including SGMA. Yet, little is known about the roles of structural oppression on SGMA alcohol use, particularly how multiple forms of structural oppression interact and affect SGMA of different racial and ethnic identities. Data were a sample of 8,403 SGMA aged 13-18 years in the United States. Exploratory factor analysis was used to measure structural anti-Black racism and structural cisheterosexism at both the state and county levels. Associations between structural oppression factors and alcohol use (past-month use, past-month hazardous use, and past-year use) were examined for SGMA who are Black, Indigenous and People of Color (IPOC), and White. For Black SGMA, higher state- or county-level cisheterosexism were associated with higher likelihoods of alcohol use in the majority of models. Structural anti-Black racism was not associated with alcohol use for Black SGMA. For White SGMA, higher state- and/or county-level cisheterosexism were associated with lower likelihoods of alcohol use in most models. Few associations between structural anti-Black racism or structural cisheterosexism and alcohol use were observed for IPOC SGMA. The relationships between structural anti-Black racism, structural cisheterosexism, and alcohol use may be markedly different for SGMA of different racial and ethnic identities. Future research should utilize intersectional approaches that incorporate racial and ethnic identities to understand and address SGMA alcohol use, a critical health inequity.