{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T20:31:11Z","timestamp":1791318671041,"version":"4.3.1"},"reference-count":51,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000027","name":"National Institute on Alcohol Abuse and Alcoholism","doi-asserted-by":"publisher","award":["K08 AA025011"],"award-info":[{"award-number":["K08 AA025011"]}],"id":[{"id":"10.13039\/100000027","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000027","name":"National Institute on Alcohol Abuse and Alcoholism","doi-asserted-by":"publisher","award":["R01AA029989"],"award-info":[{"award-number":["R01AA029989"]}],"id":[{"id":"10.13039\/100000027","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Sexual minority youth report significantly higher rates of substance use than heterosexual youth, yet a comprehensive and systematic evaluation and synthesis of the magnitude of this inequity has not been conducted. The purpose of this study was to conduct a meta\u2010analysis to assess the magnitude of overall inequities in substance use between sexual minority and heterosexual youth and examine demographic and methodological moderating factors that might impact variability in substance use patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A meta\u2010analysis of studies that examined sexual orientation inequities in substance use. We conducted a comprehensive literature search across four electronic databases (PubMed, APA PsycINFO, Web of Science, ProQuest; January 2008\u2013July 2024). Studies were eligible if they included a youth participant population (mean sample age of 25\u2009years or younger), examined differences in substance use between sexual minority and heterosexual groups, and published between 2008 and 2024 in English. Primary outcomes were any measures of substance use; secondary outcome was age of substance use initiation. Following PRISMA guidelines, reviewers independently reviewed and extracted data. Analyses employed random\u2010effects models, with robust variance estimation to account for dependency among multiple effect sizes within studies. Analyses examined continuous and dichotomous outcomes separately. Bivariate meta\u2010regression examined moderators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 304 studies of 5\u2009928\u2009282 youth, sexual minority youth reported greater quantity and frequency of all assessed substances (i.e. alcohol, nicotine, cannabis, prescription drugs, powder cocaine, crack cocaine, meth\/amphetamine, 3,4\u2010methylenedioxymethamphetamine, heroin, and other substances) and engaged in more polysubstance use than heterosexual youth. For continuous outcomes, Hedges' g ranged from 0.10 (95% confidence interval [CI], 0.05\u20130.15, I\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u200999.52, participants\u2009=\u2009354\u2009201, studies\u2009=\u200948) for alcohol to 0.40 (95% CI, 0.21\u20130.59, I\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u2009100.00, participants\u2009=\u200930\u2009679, studies\u2009=\u20095) for mixed\/polysubstance use. Dichotomous outcomes showed consistently elevated odds ratios, ranging from 1.34 (95% CI: 1.24\u20131.46, I\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u200996.01, participants\u2009=\u20093\u2009500\u2009203, studies\u2009=\u2009128) for alcohol to 4.63 (95% CI, 2.91\u20137.38, I\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u200986.35, participants\u2009=\u2009391\u2009827, studies\u2009=\u200910) for heroin use. Sexual minority youth also had earlier ages of initiation (all substance outcomes: odds ratio, 1.45; 95% CI, 1.04\u20132.03, I\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u200995.39, participants\u2009=\u2009619\u2009187, studies\u2009=\u200911). Moderation results indicated that inequities were larger for plurisexual youth (e.g. bisexual, pansexual), sexual minority girls and young women, and adolescents 18\u2009years of age or younger. The magnitude of inequities was also larger for lifetime measures of use compared with measures of recent use.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Sexual minority youth \u2014 particularly those who are plurisexual, sexual minority girls and young women, and adolescents 18\u2009years of age or younger \u2014 appear to engage in substance use at higher rates than heterosexual youth.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70301","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T08:46:04Z","timestamp":1766565964000},"page":"1048-1063","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A meta\u2010analysis of sexual orientation inequities in substance use among 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