{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:36:57Z","timestamp":1793320617566,"version":"4.5.0"},"reference-count":44,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Rita and Hillman Foundation"},{"name":"University of Rochester Research Award","award":["University of Rochester School of Nursing Research"],"award-info":[{"award-number":["University of Rochester School of Nursing Research"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Int Assoc Provid AIDS Care"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To identify key social and structural factors associated with hazardous alcohol and problematic drug use among sexual and gender minority (SGM) adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional secondary analysis of 2016 to 2019 data from the Generations Study, a probability sample of 1518 SGM adults. Hazardous alcohol and problematic drug use were measured using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) and Drug Use Disorder Identification Test (DUDIT). Candidate predictors included sociodemographic characteristics, minority stressors, adverse childhood experiences, health indicators, and social support. Interpretable machine-learning models with SHapley Additive exPlanations characterized multilevel correlates of 3-level risk categories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Hazardous alcohol use was linked to past smoking, lower social support, cancer history, housing instability, and identity-related stressors. Problematic drug use was linked to conversion-therapy exposure, housing discrimination, legal encounters, and mental-health indicators; prediction was more accurate for drug- than alcohol-use risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Structural vulnerability, discrimination, and identity-related stressors emerged as intervention targets to reduce substance-use disparities in SGM adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259582251409855","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T15:19:29Z","timestamp":1766503169000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Exploring Social and Structural Determinants of Substance Use Among Sexual and Gender Minority Adults in the United States"],"prefix":"10.1177","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8771-561X","authenticated-orcid":false,"given":"Chen","family":"Zhang","sequence":"first","affiliation":[{"name":"University of Rochester"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"Tang","sequence":"additional","affiliation":[{"name":"University of Rochester"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wonkyung","family":"Kniffen","sequence":"additional","affiliation":[{"name":"University of Rochester"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2515-4431","authenticated-orcid":false,"given":"Yu","family":"Liu","sequence":"additional","affiliation":[{"name":"University of Rochester"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"SAMHSA. 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Understand neighborhood-level stressor and resilience sources healthcare discrimination and alcohol use among sexual minority groups in the United States: Insights from the all of us. Paper presented at: The Society for the Scientific Study of Sexuality Conference San Diego CA; 2024."},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp24X738813"},{"key":"e_1_3_3_7_2","first-page":"117822182211118","article-title":"Rethinking unhealthy alcohol use in the United States: A structured review","volume":"16","author":"Volpicelli JR","year":"2022","unstructured":"Volpicelli JR, Menzies P. Rethinking unhealthy alcohol use in the United States: A structured review. 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