Associations of Sexual Identity and Gender Identity with Substance Use and Mental Health in Young Adulthood

Bibliographic Data

ID21645693
AuthorsDayoung Bae (0000-0002-0429-1154, Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, corresponding author), Adam M Leventhal (0000-0002-1217-525X, Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine), Alyssa F Harlow (0000-0001-6744-6988, Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine), Dae‐Hee Han (0000-0002-2929-5928, Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine), Evan A Krueger (0000-0002-2796-3013, Tulane University), Jessica L Barrington-Trimis (0000-0002-3331-0326, Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine), Bridgid Mariko Conn (0000-0002-8649-1642, University of Southern California), Junhan Cho (0000-0002-6617-1625, Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine)
Year2026
Volume61
Issue4
Pages609-619
Publication date2026-03-21
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueSubstance Use & Misuse (JOURNAL)
Journal identifiersISSN: 1082-6084 • E-ISSN: 1532-2491
PublisherInforma UK Limited (PUBLISHER • GB)
DOI10.1080/10826084.2025.2569792
PMID41102932
OpenAlexW4415274528
LanguageEN
References cited52

Background Research showing that sexual and gender minority (SGM) young adults are at increased risk of substance use and mental health symptoms have insufficiently accounted for SGM identity diversity. This study examined differences in substance use and mental health symptoms among young adults with diverse sexual (heterosexual, lesbian/gay, asexual, bisexual, pansexual, and queer) and gender (cisgender, transgender, and on-binary) identities.Methods Five longitudinal survey waves (2019–2023) of young adults (n = 2724; mean age = 21.7) from Southern California were used to estimate time-varying contemporaneous associations of SGM identities with eight outcomes. Outcomes were: past 30-d alcohol, combustible cigarette, e-cigarette, or other drug (e.g., prescription painkillers, stimulants) use and binge drinking, and depression and anxiety symptoms.Results Young adults with transgender and non-binary identities (vs. cisgender female) reported higher cigarette, e-cigarette, and other drug use, and greater depression. Bisexual identities showed higher use in all six substance outcomes, gay/lesbian identities reported increased alcohol and combustible cigarette use, and pansexual identities reported higher e-cigarette and other drug use (vs. heterosexual). All sexual minority identities displayed higher depression and anxiety levels, except asexual identities, who showed positive associations with depression symptoms only. Associations did not vary by time, stable vs. dynamic identity status, or sexual identity-gender identity intersections.Conclusion Young adults with SGM identities report significantly higher levels of substance use and mental health problems compared to cisgender and heterosexual identities, with heterogeneity in associations across diverse SGM identities. Inclusive SGM assessment could inform precise and tailored young adult behavioral health prevention and treatment

Gender identity · Mental health · Sexual behavior · Sexual identity · Sexual minority · Sexual orientation · Substance use · Young adult · Adolescent Sexual and Reproductive Health · LGBTQ Health, Identity, and Policy · Sexuality, Behavior, and Technology

Tools

Open DOI