Project Summary
Sexual minorities exhibit significantly higher rates of substance use (SU) and substance use disorders
(SUD) compared to their heterosexual counterparts. The vast majority of SU research among sexual
minorities, however, has focused on urban populations with little work comparing patterns of SU between rural
and urban dwelling sexual minorities. Past work with heterosexual populations has observed strong differences
in SU patterns based on urbanicity. Utilization and success of SU treatment programs have also been found to
vary widely based on urbanicity of residence, with rural environments suffering from a lack of treatment options
and an increased burden of SUD. Additionally, chronic SU has been linked to a number of chronic physical
health problems (e.g. cardiovascular disease). Consistent with their higher rates of SU, both sexual minority
populations and rural heterosexual populations experience a disproportionate burden of SU-associated chronic
diseases. It is therefore likely that SU and chronic disease rates will be even further elevated among
understudied rural sexual minorities, making them an extremely high-risk group. Given their potential risk, it is
vital to develop a better understanding of how SU, unmet treatment need, and SU-associated chronic diseases
differ between rural and urban dwelling sexual minority.
The proposed R03 Small Research Grant Program will utilize data from a nationally representative
study, namely the National Survey on Drug Use and Health (NSDUH). This survey is an annual cross-sectional
household survey of non-institutionalized individuals living in the United States and includes measures of
alcohol, tobacco, and drug use, substance use treatment, and a number of SU-associated chronic diseases
(e.g. cardiovascular disease, cancer). We will analyze data from all years of NSDUH that have data on sexual
identity and are available at commencement of analyses (2015-2020). Data will be used to assess disparities
in the aggregate prevalence of focal variables and variations in these disparities by year (via time-varying
effects) in all three specific aims: 1) assess disparities in SU and SUD between rural and urban sexual
minorities and determine whether sexual orientation disparities in SU vary by urbanicity; 2) delineate
differences in treatment utilization and unmet treatment need among rural versus urban sexual minorities and
determine whether disparities in treatment between heterosexual and sexual minority populations vary by
urbanicity; and 3) determine whether SU-associated chronic disease disparities exist between rural and urban
sexual minorities and whether sexual orientation disparities in chronic diseases vary by urbanicity. This
proposal is the first step in a program of research which ultimately aims to develop behavioral and biomedical
interventions tailored to the specific needs of rural and urban sexual minority populations.
