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Sexual and gender minority (SGM) emerging adults are more likely to use alcohol than their heterosexual counterparts. These individuals, particularly those of color, face unique challenges that may contribute to this elevated risk. One such stressor is internalized homophobia, which has been shown to increase alcohol consumption and is often employed as a coping strategy. However, the mechanisms underlie this relationship remain inadequately understood. Based on the Minority Stress Model, the effects of internalized homophobia on alcohol use among this population may be exacerbated by conflicts in allegiances (CIA), an incompatibility between racial/ethnic and sexual identities. This analysis aimed to examine the mediating role of CIA in the association between internalized homophobia and alcohol use among a sample of SGM emerging adults of color in California.
Methods
Data were derived from a larger study exploring the disparities in tobacco product use among SGM emerging adults, conducted between 2020 and 2021 through both online and in-person recruitment strategies. For this analysis, we focused on individuals who identified themselves as cis-gender sexual minority men/women or transgender or gender nonconforming and identified as a person of color. We used the Internalized Homophobia Scale and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), and a previously validated 6-item scale to assess CIA. We first conducted multivariable linear regression to assess the association between internalized homophobia and alcohol use, adjusting for sociodemographic characteristics. Following this, we conducted a mediation analysis to examine the effect of CIA.
Results
The average age of SGM emerging adults of color in the sample (n = 533) was 22.9 (SD: 3.10), and 20% were students. Based on the ASSIST, 20.04 % and 34.78 % were scored at high and moderate risk of alcohol use. Multivariable regression revealed that higher levels of internalized homophobia was significantly associated with increased risk of alcohol use, after adjusting for sociodemographic characteristics (β = 0.415, p < 0.001). In mediation analysis, both the direct effect and indirect effect of internalized homophobia on alcohol use via CIA were significant (β = 0.343, p = 0.001; β = 0.142, p = 0.018, respectively). The model suggested the partial mediating role of CIA with 17.35 % of the effect of internalized homophobia on alcohol use was mediated by conflict in allegiances.
Conclusions
Our study highlights the heightened risk of alcohol use among SGM emerging adults of color, emphasizing the critical role of internalized homophobia and conflicts in allegiances in understanding and addressing alcohol-related disparities within this population. The mediating role of CIA suggests there might be a potential pathway between this association where conflicts in allegiances could further exacerbated the negative effect of internalized homophobia on alcohol use. These findings underscore the importance of addressing both internalized and experienced minority stressors encountered by SGM individuals of color, in interventions aimed to reducing hazard alcohol use. Future efforts should prioritize culturally sensitive approaches that considering the intersecting racial/ethnic and sexual and gender identifies of SGM emerging adults to mitigate alcohol use disparities among this population.