Discrimination, Stress, and Substance Use Among Ethnoracial Minority Gay, Bisexual, and Other Men Who Have Sex with Men: Findings from the NIH All of Us Research Program

BACKGROUND: Unhealthy alcohol, marijuana, and cocaine use are major public health concerns among ethnoracial minority gay, bisexual, and other men who have sex with men (GBMSM), who experience compounded stressors related to sexual and ethnoracial minority identities. Guided by the Minority Stress Model, this study examined pathways linking everyday discrimination, perceived stress, and substance use among ethnoracial minority GBMSM. OBJECTIVES: To examine whether everyday discrimination is associated with unhealthy alcohol use, whether perceived stress mediates the association between discrimination and unhealthy alcohol use, whether unhealthy alcohol use mediates the relationship between perceived stress and marijuana/cocaine use, and whether nativity moderates these associations. RESULTS: A secondary analysis was conducted using survey data from 683 ethnoracial minority GBMSM enrolled in the National Institutes of Health All of Us Research Program. Structural equation modeling was used to assess direct, indirect, and moderating pathways. Everyday discrimination was positively associated with unhealthy alcohol use (β = 0.25, 95% CI [0.03, 0.46]). Unhealthy alcohol use was associated with both marijuana use (β = 0.30, 95% CI [0.16, 0.43]) and cocaine use (β = 0.21, 95% CI [0.08, 0.34]). Evidence for perceived stress as a mediator of the discrimination-alcohol use association was inconclusive, and nativity did not demonstrate a conclusive moderating effect. CONCLUSIONS: Findings suggest that discrimination may influence substance use through mechanisms beyond self-reported stress and that unhealthy alcohol use may serve as a pathway to other substance involvement among ethnoracial minority GBMSM. Clinical screening for discrimination experiences and polysubstance use risk may help identify individuals at elevated risk. Future research is needed to clarify the mechanisms linking discrimination and substance use in this population.