Eaton et al. recently reported the prevalence and correlates of regularly drinking alcohol before sexual activity (presex drinking) among US adults.1 Although their study addressed an important gap in the literature, we were disappointed by the omission of sexual orientation from their analysis. Given established differences in alcohol use among gay, lesbian, and bisexual populations2,3 and indications that heavy drinking is associated with risky sexual behavior,4,5 we replicated their study to assess the role of sexual orientation.
We recreated the analytic sample of sexually active current drinkers in wave 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions, excluding 69 respondents for whom sexual identity was unsure, unknown, or missing. The resulting sample included 8669 men and 8753 women, approximately two percent of whom self-identified as a sexual minority (i.e., gay, lesbian, or bisexual). Following Eaton et al.,1 we used logistic regression to quantify bivariate associations between presex drinking and three categories of predictors (lifetime psychiatric disorders, lifetime substance use disorders, and demographic characteristics), retaining variables with bivariate associations of P < .05. Because sexual identity was associated with gender (X2 = 9.05; df = 1; P < .001), we stratified the final multivariable model to obtain separate estimates for women and men. All analyses were completed with SAS version 9.3 (SAS Institute, Cary, NC) using survey procedures to account for the complex sampling method.
We found that greater proportions of sexual minority men and women reported regular presex drinking than did their same-gender heterosexual peers (10% vs 4% of men; P < .001 and 4% vs 2% of women; P = .03). In the fully adjusted model (Appendix A, available as a supplement to this letter at http://www.ajph.org), there was no difference in odds of presex drinking by sexual identity among women (adjusted odds ratio [AOR] = 0.90; 95% CI = 0.41, 1.95; P = .79); however, sexual minority men had 35% greater odds of regular presex drinking than did their heterosexual peers (AOR = 1.35; 95% CI = 1.05, 1.73; P = .02). Furthermore, we noted that other correlates of presex drinking differed between and women.
Our replication study underscores the importance of considering sexual orientation, which the Institute of Medicine recommends including as a routine demographic variable in health research.6 These findings provide a more nuanced epidemiological profile of presex drinking than previously reported. Because sexual minority men had higher odds of presex drinking than heterosexual peers, targeted screening and early intervention efforts may reduce both alcohol and sexual health disparities among men who have sex with men.
References
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