The central goals of this competing renewal grant are to: (1) identify specific mediated pathways of risk for substance use and abuse among sexual minority girls (SMGs;girls who report same-sex sexual orientation) and (2) identify developmentally appropriate protective factors that can inform the development of novel prevention and intervention studies tailored for this high risk group. SMGs are 400% more likely to report substance use than are heterosexual girls. Recent results from grant years 1-3 showed that SMGs reported multiple mental health disparities including risky sexual behavior that were significant across all levels of all demographic covariates. SMG substance use disparities seen in adolescence increased as girls transition to young adulthood and change in binge drinking over time is more closely linked to suicidality in SMGs than it is in boys. In grant years 1-3 we were highly successful in documenting the persistence of SMG substance use disparities and identifying important psychosocial correlates of the disparities. Building on this foundation, we propose a heuristic model that articulates the most probable (empirically-supported, theory-driven) pathways of risk for substance use in SMGs. Dozens of conceptual models have been developed to describe risk for substance use among other at-risk teens;however no one has developed an empirically supported heuristic model that describes risk pathways for sexual minority youth. Preliminary data from grant years 1-3 and our proposed data sets (Add Health and the Pittsburgh Girls Study) show strong preliminary support for our hypothesized mediate pathways (stress-negative affect, social marginalization, and future expectations pathways). This proposal will build upon this foundation, and seeks to move the field forward by proposing and testing several longitudinal mediated pathways of risk and identify modifiable protective factors that will inform the design of a novel prevention and intervention program for SMGs.

Public Health Relevance

The primary goal of this study is to identify specific mediated pathways of risk for substance use among sexual minority girls (SMGs). Recent meta-analysis results showed that the odds of adolescent substance use for SMGs were 400% higher than they were for heterosexual girls. However, no studies to date have articulated and tested mediated pathways of this disparity, and no intervention studies have been conducted. We propose a new version of minority stress theory which will identify mediators and moderators (risk and protective factors) of substance use disparities among SMGs, and in doing so it will fill large gaps in the literature and provide critical information needed to design intervention programs for this high risk group.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Schulden, Jeffrey D
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University of Pittsburgh
Schools of Medicine
United States
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Wood, Sarah M; Schott, Whitney; Marshal, Michael P et al. (2017) Disparities in Body Mass Index Trajectories From Adolescence to Early Adulthood for Sexual Minority Women. J Adolesc Health 61:722-728
Dermody, Sarah S; Marshal, Michael P; Cheong, JeeWon et al. (2016) Adolescent Sexual Minority Girls Are at Elevated Risk for Use of Multiple Substances. Subst Use Misuse 51:574-85
Romens, Sarah E; Casement, Melynda D; McAloon, Rose et al. (2015) Adolescent girls' neural response to reward mediates the relation between childhood financial disadvantage and depression. J Child Psychol Psychiatry 56:1177-84
Talley, Amelia E; Hughes, Tonda L; Aranda, Frances et al. (2014) Exploring alcohol-use behaviors among heterosexual and sexual minority adolescents: intersections with sex, age, and race/ethnicity. Am J Public Health 104:295-303
Dermody, Sarah S; Marshal, Michael P; Cheong, Jeewon et al. (2014) Longitudinal disparities of hazardous drinking between sexual minority and heterosexual individuals from adolescence to young adulthood. J Youth Adolesc 43:30-9
Marshal, Michael P; Dermody, Sarah S; Shultz, Michelle L et al. (2013) Mental health and substance use disparities among urban adolescent lesbian and bisexual girls. J Am Psychiatr Nurses Assoc 19:271-9
Marshal, Michael P; Dermody, Sarah S; Cheong, Jeewon et al. (2013) Trajectories of depressive symptoms and suicidality among heterosexual and sexual minority youth. J Youth Adolesc 42:1243-56
Marshal, Michael P; Burton, Chad M; Chisolm, Deena J et al. (2013) Cross-sectional evidence for a stress-negative affect pathway to substance use among sexual minority girls. Clin Transl Sci 6:321-2
Hipwell, A E; Stepp, S D; Keenan, K et al. (2013) Examining links between sexual risk behaviors and dating violence involvement as a function of sexual orientation. J Pediatr Adolesc Gynecol 26:212-8
Marshal, Michael P; Sucato, Gina; Stepp, Stephanie D et al. (2012) Substance use and mental health disparities among sexual minority girls: results from the Pittsburgh girls study. J Pediatr Adolesc Gynecol 25:15-8

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