Elsevier

Social Science & Medicine

Volume 57, Issue 10, November 2003, Pages 1913-1923
Social Science & Medicine

Social influences on substance-use behaviors of gay, lesbian, and bisexual college students: findings from a national study

https://doi.org/10.1016/S0277-9536(03)00057-1Get rights and content

Abstract

A variety of social factors are expected to contribute to health behaviors among college students. The goal of this paper is to describe the relationships of two different aspects of the campus social environment, namely the campus resources for gay, lesbian, and bisexual (GLB) students and the campus-wide behavioral norms of substance use, to the individual substance-use behaviors of college students with same-sex experiences. Individual-level data come from 630 college students reporting same-sex experience, who were part of a national random sample returning questionnaires. Current cigarette smoking and binge drinking were examined. College-level data regarding the campus resources designed for GLB students were collected and used with campus-wide substance-use norms to predict individual substance use in logistic regression analyses. One-third to one-half of students reported current smoking and binge drinking, by sex and sex-partner category. The presence of GLB resources was inversely associated with women's smoking and directly associated with men's binge drinking behaviors. The proportion of students reporting same-sex behavior on campus was directly associated with these same outcomes, and behavioral norms were not associated with either outcome. Findings provide a glimpse into the influence of the social environment on the use of two of the most widely used substances at American colleges, and suggest that contextual approaches to explaining and controlling substance use may be important.

Introduction

Recent research on substance-use behaviors among college students has suggested that cigarette smoking and alcohol use are widespread on American college campuses (Sax, 1997; Centers for Disease Control and Prevention, 1997; Wechsler, Dowdall, Maenner, Gledhill-Hoyt, & Lee, 1998a; Wechsler, Rigotti, Gledhill-Hoyt, & Lee, 1998b; Wechsler, Lee, Kuo, & Lee, 2000; Rigotti, Lee, & Wechsler, 2000). While the overall smoking rate among adults has decreased steadily over the past several decades, the prevalence of current (i.e. past 30 day) smoking among college students has risen recently (Sax, 1997; Centers for Disease Control and Prevention, 1997; Wechsler et al., 1998b; Rigotti et al., 2000; Centers for Disease Control and Prevention, 2000). This is true despite the fact that smoking is much less common among college educated adults than among those with less education (Pamuk, Makuc, Heck, Reuben, & Lochner, 1998). Excessive alcohol use is also problematic among college students. One study found 44% of students reported binge drinking, and 23% engaged in this behavior frequently (Wechsler et al., 2000). Alcohol use was associated with a variety of academic, personal and social problems, including missing classes, having unprotected sex, driving while intoxicated, and generally “doing something you regret” (Wechsler et al., 1998a).

Very few studies have focused on gay, lesbian, and bisexual (GLB) college students. The many studies of sexual behavior using college samples are typically too small to include a large enough number of GLB students to make valid comparisons to straight students. The large national studies of college students, by contrast, have not included the questions on sexual orientation or same-sex behaviors necessary to identify groups for comparison. Research on GLB adolescents and adults, however, indicates that substance use is more prevalent among GLBs than among heterosexuals (Bradford, Ryan, & Rothblum, 1994; McKirnan & Peterson, 1989; National Institute on Drug Abuse, 1991; Cabaj, 1992; AMA, 1996; Garofalo, Wolf, Kessel, Palfrey, & DuRant, 1998), though this disparity may be less than was previously estimated (Hughes & Eliason, 2002). Indeed, one recent study indicated that substance-use rates were similar for students with only same-sex partners and those with opposite-sex partners, but women with both male and female partners were more likely to smoke cigarettes, binge drink, and use marijuana than other female college students (Eisenberg & Wechsler, in press).

Cigarette smoking and alcohol use behaviors among US college students stem from a variety of factors occurring at multiple levels. Personal factors such as age, race and involvement with fraternities, sororities and college athletics have been shown to be associated with smoking and binge drinking among college students (Wechsler, Dowdall, Davenport, & Castillo, 1995a; Rigotti et al., 2000; Nelson & Wechsler, 2001). In a comprehensive review, Hughes and Eliason (2002) detail the many risk and protective factors which may be particularly useful in understanding substance use in GLB populations, including personal factors (such social roles), social-psychological factors (such as stress), and interpersonal factors (such as peer and partner substance use). Little information exists, however, on the role of institutional or environmental factors which may also be influential to substance-use behaviors among GLBs.

Characteristics of the social sphere have been related to individual health behaviors and outcomes in a variety of domains (Amick, Levine, Tarlov, & Walsh, 1995; Yen & Syme, 1999; Berkman & Kawachi, 2000). In particular, a number of contextual variables describing the neighborhood context, local policies, pricing strategy, social climate of schools or geographic regions, or the behavioral norms of a reference group have been related to substance use among adolescents and adults (Harford & Grant, 1987; US Department of Health and Human Services, 1994; Karvonen & Rimpela, 1996; Beck & Treiman, 1996; Jones-Webb, Snowden, Herd, Short, & Hannan, 1997; Rountree & Clayton, 1999; Wechsler, Lee, Gledhill-Hoyt, & Nelson, 2001a; Wechsler, Lee, & Rigotti, 2001b; Czart, Pacula, Chaloupka, & Wechsler, 2001). To our knowledge, this type of environmental variable has not been examined for substance use among GLB college students.

The current study, therefore, is an exploration of the association of two elements of the college social environment with cigarette smoking and binge drinking among GLB college students. In particular, this study examines campus resources for GLB students and the behavioral norms (i.e. campus-wide prevalence) of smoking and drinking. We hypothesize that (a) GLB1 students at colleges with more comprehensive resources for GLBs will be less likely to use substances than their counterparts at colleges with fewer resources, and (b) GLB students at colleges where substance use is more prevalent among all students will be more likely to smoke and binge drink than those at colleges where use of these substances is less common.

Section snippets

Population, setting, data collection

This paper reports results from two data sources—individuals and colleges. Data come from the 1999 CAS, which used a nested random sampling strategy to survey students at American colleges and universities. One hundred and ninety-five institutions were randomly selected from a list of accredited 4-year colleges provided by the American Council on Education. The sample was selected using probability proportionate to the size of undergraduate enrollment at each institution. One hundred and forty

Student characteristics

Characteristics of the student sample are shown in Table 1. Over twice as many women reported both-sex partners as only same-sex partners. For men, this was reversed; approximately one-third more men reported only same-sex partners as both-sex.

The majority of students in the sample were of traditional college age (18–22 years) and were white, non-Hispanic. Most students were not married, but some proportion of respondents with only same-sex experience reported their status as married (5% of

Discussion

The results of this analysis suggest that aspects of the college institutional and social environment may be associated with the substance-use behaviors of GLB students, after controlling for several individual and college-level covariates. This was particularly evident for campus GLB resources, which were inversely related to women's smoking (as hypothesized) and directly related to men's binge drinking (contrary to expectations), and the proportion of students reporting same-sex experience,

Conclusions

This research provides an important first glimpse into the influence of the social environment on the use of two of the most widely used substances at American colleges and universities. The two measures of the institutional and social environment towards gay and lesbian students may in fact serve as a proxy for another social factor, such as a more general socio-political norm of openness or acceptance of “personal choice” activities such as same-sex behavior and substance use. While this type

Acknowledgements

This project was supported by the Robert Wood Johnson Foundation, Princeton, NJ; and the Gay and Lesbian Medical Association's Lesbian Health Fund. All human subjects consented to participation, and the Harvard School of Public Health Institutional Review Board exempted this study (due to anonymous data collection) on November 22, 1996. The authors wishes to thank Dr. Hang Lee and Dr. Stephen Gilman for their generous assistance with analysis, and Dr. Glorian Sorensen and Dr. Lisa Berkman for

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