Polysubstance use by sexual identity among US adults, 2021.

Abstract

Understanding polysubstance use among US sexual minority adults is important to serve as a population-level baseline to promote health equity around substance use prevention and public health strategies. This study quantifies the number of substances used by sexual identity among US adults. We used the 2021 National Survey on Drug Use and Health and included adults (aged ≥18) (unweighted n = 47,291). We conducted multivariable Poisson regression models to examine the number of substances used in the past year (count variable; range: 0-18) by sexual identity ("heterosexual", "gay/lesbian", "bisexual", "unknown" [don't know, refused, blank]), after adjusting for covariates (i.e., age, sex, race/ethnicity, income level, education level, having insurance status, living in urban area, past-year distress level (Kessler-6), any drug or alcohol use disorder in the past year, and sexual attraction). Of the total sample (51.4% were female, 12.1% were non-Hispanic Black and 17.0% were Hispanic adults), 88.3% were heterosexual, 2.4% were gay/lesbian, 5.0% were bisexual adults, and 4.3% reported "unknown" sexual identity. After adjusting for covariates, a greater number of substances were used in the past year among gay/lesbian individuals (aIRR = 1.44, 95% CI = 1.09, 1.75), bisexual individuals (aIRR =1.34, 95% CI = 1.26, 1.41), and individuals reporting an "unknown" sexual identity (aIRR = 1.22, 95% CI = 1.09, 1.36) (vs. heterosexual adults). Tailored substance use prevention and public health strategies specializing in sexual minority populations are warranted.