Prevalence and Correlates of Substance Use Among Sexual and Gender Minority Youth and Young Adults in North Carolina

Substance use is a critical public health concern disproportionately affecting sexual and gender minority (SGM) youth and young adults. Greater understanding is needed of substance use patterns among these populations, as well as relationships between demographic and psychosocial factors and use, particularly in the U.S. South. Data on substance use behaviors and risk and protective factors were collected via a statewide, cross-sectional telephone survey of North Carolina (NC) residents ages 12–25 (N = 15,000). Survey weights were applied to adjust prevalence estimates for selected NC population demographics and, among participants self-reporting a sexual and/or gender minority identity, we explored substance use by age group and used multivariable weighted logistic regression models to identify potential correlates. Among the SGM sample (n = 212), weighted prevalence of past 30-day alcohol use was 56.4% (nu = 108), cigarette use was 55.7% (nu = 99), nicotine vape use was 36.5% (nu = 63), marijuana use was 30.3% (nu = 56), and polysubstance use (i.e., simultaneous use of multiple substances with overlapping effects) was 42.7% (nu = 74). Several factors were associated with substance use, including race/ethnicity, gender identity, perceived harms, future orientation, perceived parental and peer use, and perceived discrimination. This analysis identified high substance use prevalence among SGM youth and young adults in NC. Findings can potentially inform culturally responsive, contextually relevant interventions to reduce substance use among SGM youth and young adults in the U.S. South.