Social Networks and Sexual and Gender Minority Disparities in Alcohol Use and Consequences Among First-Year College Students

Abstract

Purpose:

In this work, we investigate the association between social relationships and alcohol use and the related consequences of sexual and gender minority (SGM) college students, and we highlight the importance of SGM social networks as a potential protective factor among SGM college students.

Methods:

The study used data from 1340 students (47.2% White and non-Hispanic, 55.4% assigned female at birth, 16.3% SGM), which were collected during the 2016 fall semester of the first year of college at one university. The study collected information about alcohol use and related consequences and about the social networks of participants through a peer nomination survey.

Results:

Regardless of SGM status, students who nominated at least one SGM peer reported significantly lower drinks per week (β = −0.69, p = 0.04) and heavy drinking frequency (β = −0.38, p = 0.02) after adjusting for relevant covariates including peer drinking. SGM participants showed a significantly stronger negative association between having an SGM peer and heavy drinking frequency and alcohol-related consequences than their cisgender heterosexual counterparts (β = −0.90, p = 0.04; β = −1.32, p = 0.03).

Conclusion:

These findings highlight the importance of SGM social networks as a potential protective factor for reducing alcohol use and related consequences among SGM college students. College campuses should identify ways to support connections among SGM students.

Clinical trials registration number is NCT02895984.

Introduction

Rates of heavy drinking and alcohol-related consequences are highest among 18- to 25-year olds,^1–3 and increase significantly during the high school to college transition.^4,5 Approximately 60% of college students report having consumed alcohol in the past 30 days and nearly 35% report at least one heavy drinking episode (defined as four or more drinks on one occasion for females or five or more drinks on one occasion for males) in the past 30 days.^6,7 Among young adults, heavy drinking has been associated with negative consequences, including sexual assault, unintended injury, hospitalization, and death.^3,7,8 Sexual and gender minority (SGM) identity milestones have been associated with depressive and anxiety symptoms,⁹ which in turn have been associated with increased alcohol use.^10,11

The transition from high school to college is a risky developmental period for heavy drinking, which may adversely impact academic and social transitions.^1,2,12,13 The traditional age of entering college is also the age at which many individuals experience sexual and gender identity milestones, including self-identification and disclosure to friends and family, which can serve as stressors.^14,15 Therefore, the first year of college may be a particularly critical time for increased alcohol use among SGM students.

SGM college students may be at particularly high risk for heavy alcohol use. SGM is an umbrella term that refers to individuals who identify as lesbian, gay, bisexual, and transgender, as well as those whose sexual orientation, gender identity, and expressions do not align with socially prescribed expectations associated with sexuality and gender.¹⁶ Prior studies have documented higher rates of alcohol use and heavy drinking among sexual minority adolescents^17–19 and young adults,^18,20–23 relative to their cisgender heterosexual counterparts. Although probability samples have historically not included measures of gender identity, higher rates of alcohol use have been documented among gender minority youth in nonprobability samples.^24,25 With few exceptions,^26,27 less is known about transgender college students specifically. Although SGM people are conceptually distinct, members of these groups have historically had a marginalized social status of “other” because of departures from heterosexuality and gender norms, and as a result have experienced stigma, prejudice, discrimination, violence, and a general lack of attention to their health needs.¹⁶

The minority stress model, which has been further adapted for gender minority communities, posits that social stressors associated with minority status including discrimination, victimization, internalized heterosexism, transgender-specific stigma, and concealment^28–30 can lead to negative physical and mental health outcomes³⁰ including greater hazardous alcohol use.^22,31,32 Minority stress has been suggested as an explanation for higher rates of substance use among SGM communities including sexual minority women.³³

One of the most robust predictors of heavy drinking among college students is the social environment.³⁴ Having heavy drinking friends has been associated with proalcohol beliefs and heavier drinking among college students,^35–38 and peer affiliations related to alcohol use have been found to be especially important in the first semester of college.³⁹ The social network theory offers an approach for studying peer affiliations for drinking behaviors in college.^36,40–42 In a review of college social network studies, increased alcohol use was associated with a higher likelihood of relationships with other alcohol users, greater popularity in the network, friendship nomination agreement, and a more tightly interconnected network.⁴²

To our knowledge, only one study has examined relationships between alcohol use and sexual orientation using a social network framework. Hatzenbuehler et al.⁴³ found that sexual minority youth nominated more peers who misused alcohol compared with their heterosexual counterparts, which in turn explained the high rates of alcohol misuse observed among sexual minority youth.

Studies are yet to include gender identity in peer network studies or examine the role of social networks in alcohol use among gender minority college students. This is particularly important given there is some evidence suggesting that social networks may be protective for men who have sex with men,⁴⁴ and may buffer the effect of minority stress on health outcomes.^30,31,44 Specifically, having SGM peers has been associated with reduced stress among youth⁴⁵ and may reduce the need to misuse alcohol as a coping mechanism.⁴⁶ Furthermore, community connections with SGM members have been cited as integral to reducing isolation that might be experienced as a sexual and/or gender minority person living in a heterosexist and cissexist society.²⁹

The overarching goal of the current study was to use social network theory and analysis to investigate the social networks of SGM students in a first-year college class and specifically the extent to which network characteristics were associated with alcohol use and related consequences. We aimed to address the following research questions:

• (1)Do SGM students report greater alcohol use, heavy drinking, and alcohol-related consequences than cisgender heterosexual students?
• (2)Do participants (regardless of sexual or gender identity) who report at least one SGM peer in their social network report different levels of alcohol use and related consequences compared with participants who do not nominate at least one SGM peer?
• (3)Does the association between nominating at least one SGM peer and alcohol use and related consequences differ between those who identify as SGM and their cisgender heterosexual identified counterparts?

Methods

Participants

Participants were first-year students at a private midsize university in the northeast and living in residential housing designated for first-year students. To be eligible to participate, in addition to living in residential housing designated for first-year students, participants were either at least 18 years old and had consented to the study, or provided assent and parental/guardian consent. Of the participants eligible to participate (N = 1660), 1340 completed the baseline survey and had data for these analyses (81% of those eligible, 55.4% female, 47.2% non-Hispanic White).

Procedures

Data were collected as part of a longitudinal study examining a social network of first-year college students. Eligible participants were recruited beginning in August 2016 and could enroll in the study through the end of the 2-week period during which the baseline survey was available (the end of October 2016). Participants were recruited to participate using a variety of techniques, including advertisements sent to their home and campus mailboxes, via email, and at in-person events held throughout the campus during the first half of the semester. All participants 18 years and older provided informed consent. Participants who were younger than 18 years provided assent along with parental contact information to receive parental consent.

The consent form explicitly informed students that their name would be available for others to choose on a pulldown list of all students in the class unless they declined to participate and opted out of being on the list. Students who did not respond remained on the network survey nomination list. Participants who enrolled before the baseline survey were sent an authenticated link to a web-based survey 6 weeks after the start of the semester; participants who enrolled during the 2-week time frame when the survey was active were immediately transferred to the survey after completing consent. Participants who completed the baseline survey received a $50 electronic Amazon gift card via email. For additional details about study procedures, see Barnett et al.⁴⁷ The study was approved by the Institutional Review Board at Brown University.

Measures

SGM status

We used a two-step method to assess gender identity: participants were first asked their sex assigned on their original birth certificate (i.e., male or female) and then asked to provide their current gender identity with response options of male, female, trans male/trans man, trans female/trans woman, genderqueer/gender nonconforming, or different identity with an open-ended response option.⁴⁸

To measure sexual orientation identity, participants were asked, “Do you consider yourself to be:” with options of “Heterosexual or straight,” “Gay or lesbian,” “Bisexual” or “Not described above”. Individuals who indicated that their sexual orientation was not described in the available answers were given the opportunity to specify their answer in an open-ended response option. SGM status was assigned if: (1) birth sex was listed as different from the reported gender identity; and (2) the respondent identified as gay, lesbian, or bisexual. Study authors together reviewed the open-ended options (N = 46), which for 22 responses (e.g., “queer”) were coded as SGM.^*

Alcohol use and related consequences

Participants were asked to indicate the number of days they consumed at least one alcoholic beverage in the past 30 days, along with the average number of drinks they consumed during drinking days in the past 30 days. These two items were then used to determine the average number of drinks per week for each participant by multiplying them together to determine the average number of drinks in a 30-day period, and then multiplying by 7/30 to attain the average number of drinks per 7-day period. In addition, participants were asked to indicate the number of days in the past 30 days that they had consumed 4+/5+ (female/male) drinks as a measure of heavy drinking frequency.

To assess the consequences resulting from alcohol use, we used the Brief Young Adult Alcohol Consequences Questionnaire (B-YAACQ).⁴⁹ The B-YAACQ consists of 24 dichotomous (yes/no) items on which participants are asked to endorse whether they have experienced each consequence in the past 30 days. Example items include the following: “When drinking, I have done impulsive things I later regretted” and “I have passed out from drinking.” These items were only asked of individuals who reported consuming alcohol in the past 30 days. The Cronbach's alpha for the scale in this sample was 0.82.

Network measure

Participants were asked to nominate up to 10 students in their first-year class who were important to them. Participants provided the person's first name and last initial and then were presented with a pull-down menu containing all of the students in the first-year class (except those students who opted out), a method that was used in a previous study at the same university.⁴⁰ Before the survey launch, all students were assigned an ID number, which allowed for the presentation of names only on the pull-down names' menu, but stored selections only by ID in the data set.

The number of nominations made by each participant is referred to as their number of out-ties and is a measure of network expansiveness or sociability. Of the (maximum of 10) nominations made by each participant, we calculated the number of the nominees who were categorized as SGM (see the SGM Status section), and created a binary variable for each participant indicating if they had nominated at least one person who identified as SGM in the questionnaire. We also calculated the average drinks per week among each individual's nominees.

Demographic information

Participants responded to items measuring age, race/ethnicity, athlete status, first-generation college student status, and receipt of financial aid. The registrar also provided information about whether participants lived in substance-free housing.

Data analysis

To describe the differences between SGM students and their cisgender heterosexual counterparts in the study, we calculated the mean and standard deviation (SD) of age, and the percent of each categorical variable (sex assigned at birth, race, athlete status, and first-generation status) stratified by SGM status. We also calculated the mean and SD of out-ties, number of SGM peer nominations, and average drinking among nominees.

To answer each of the three research questions, we used three outcomes of interest (drinks per week, frequency of heavy drinking, and alcohol-related consequences). To examine whether SGM students have different alcohol use and consequences than their cisgender heterosexual counterparts, we fit three network-autocorrelation models (one model for each separate outcome variable) with the binary variable SGM status as the determinant. To assess whether alcohol use and related consequences differed between students who did and did not nominate at least one SGM peer as part of their social network, we fit three network autocorrelation models (one model for each separate outcome variable) with SGM status and an indicator of nominating at least one SGM peer as the determinant.

Finally, to assess whether the association between alcohol use and related consequences and having at least one SGM peer differed for SGM students and their cisgender heterosexual counterparts, we constructed regression models with main effects for SGM status, a variable indicating that they had nominated at least one SGM individual, and an interaction term for these two variables.

All models adjusted for race, sex assigned at birth, the average drinking of the peers nominated, the number of nominations made, first-generation status, financial aid status, athlete status, and living in a substance-free dormitory. All analyses were conducted in R version 3.5.1 using the spdep package,⁵⁰ which accounts for the correlation between individuals in the social network.

Results

Of the 1340 students included in our analysis, 218 (16.3%) identified as SGM. Participant characteristics by sexual orientation and gender identity are shown in Table 1. Participants were on average 18.7 years old (SD = 0.51), 55.4% female, 15.0% Hispanic/Latino, 47.2% non-Hispanic White, 22.5% non-Hispanic Asian, 6.2% non-Hispanic Black, 8.1% multiple races/ethnicities, and 1.1% other. SGM students nominated 5.9 peers on average (SD = 3.0), while cisgender heterosexual counterparts nominated 5.5 peers on average (SD = 3.0). SGM students nominated 1.9 SGM peers (SD = 1.7), whereas their cisgender heterosexual counterparts nominated 0.8 SGM peers (SD = 1.1). Nominees of SGM students reported drinking 4.7 drinks per week on average (SD = 4.5), and nominees of cisgender heterosexual students reported drinking 5.2 drinks per week (SD = 4.7).

Table 1.

Demographic and Network Information by Sexual Orientation and Gender Identity

	Sexual and gender minority studentsa (n = 218)	Cisgender and heterosexual students (n = 1122)	Total (n = 1340)
	Mean (SD) or N (%)	Mean (SD) or N (%)	Mean (SD) or N (%)
Demographic information
Age	18.6 (0.51)	18.7 (0.51)	18.65 (0.51)
Birth sex
Female	129 (59.2%)	613 (54.6%)	742 (55.4%)
Male	89 (40.8%)	509 (45.4%)	598 (44.6%)
Race
Non-Hispanic White	107 (49.1%)	526 (46.9%)	633 (47.2%)
All other racial/ethnic categories	105 (48.2%)	587 (52.3%)	692 (51.6%)
Athlete	6 (2.8%)	181 (16.1%)	187 (14.0%)
Financial aid recipient	116 (53.2%)	515 (45.9%)	631 (47.1%)
First generation	42 (19.3%)	183 (16.3%)	225 (16.8%)
Live in substance-free housing	28 (12.8%)	154 (13.7)	182 (13.6%)
Alcohol use and consequences
Drinks per week	4.64 (5.88)	4.84 (6.36)	4.80 (6.28)
Frequency of heavy drinking	2.04 (3.10)	2.12 (2.94)	2.10 (2.96)
Drinking consequences	3.89 (3.51)	3.74 (3.43)	3.77 (3.44)
Social network characteristics
Social network nominations	5.9 (3.0)	5.5 (3.0)	5.6 (3.0)
Social network nominations of SGM peers	1.9 (1.7)	0.8 (1.1)	1.0 (1.3)
Average drinks per week of social network nominations	4.7 (4.5)	5.2 (4.7)	5.05 (4.6)

^a Gender minority: trans man/trans male (n = 2), trans woman/trans female (n = 1), genderqueer/gender nonconforming (n = 8), different gender identity (n = 6). Sexual orientation minority: gay or lesbian (n = 63), bisexual (n = 126), different sexual orientation (n = 22), in total there were 17 who were categorized as a gender minority and 211 who were categorized as a sexual orientation minority, with 10 categorized as both a sexual minority and a gender minority.

SD, standard deviation; SGM, sexual and gender minority.

We did not find significant differences in the average number of drinks per week (β = 0.25, standard error [SE] = 0.40, p = 0.54), heavy drinking frequency (β = 0.22, SE = 0.20, p = 0.28), or alcohol-related consequences (β = 0.49, SE = 0.29, p = 0.09) between SGM students and their cisgender heterosexual counterparts after adjusting for the possible confounders.

There were significant differences in the average number of drinks per week (β = −0.69, SE = 0.33, p = 0.04), and heavy drinking frequency (β = −0.38, SE = 0.17, p = 0.02), between participants who had nominated at least one SGM peer and those who did not nominate any SGM peers in their networks after adjusting for the possible confounders and the participant's own SGM status. However, we did not find evidence for a difference in alcohol-related consequences (β = −0.13, SE = 0.25, p = 0.60). Nominating at least one SGM peer corresponded with a significantly lower average number of drinks per week and a lower heavy drinking frequency.

Lastly, we found that SGM students who nominated at least one SGM peer in their network had lower (although not significantly lower) average number of drinks per week (β = −1.31, SE = 0.89, p = 0.14), lower heavy drinking frequency (β = −0.90, SE = 0.43, p = 0.04), and lower alcohol-related consequence scores (β = −1.32, SE = 0.63, p = 0.03) than their cisgender heterosexual counterparts who nominated at least one SGM peer in their network after adjusting for the possible confounders. These interactions are displayed in Figures 1–3. Among individuals who identified as cisgender heterosexual, nominating at least one SGM peer in their network was significantly associated with a lower average number of drinks per week (β = −0.97, SE = 0.45, p = 0.03), but not heavy drinking frequency, or alcohol-related consequence scores.

FIG. 1.

Interaction between SGM status, and having at least one SGM peer: drinks per week. CH, cisgender heterosexual; SGM, sexual and gender minority.

FIG. 2.

Interaction between SGM status, and having at least one SGM peer: heavy drinking frequency.

FIG. 3.

Interaction between SGM status, and having at least one SGM peer: drinking consequences.

Discussion

This study extends prior research to consider sexual orientation and gender identity in peer networks in understanding alcohol use and related consequences among first-year college students. The study included a large sample of students observed in the first semester of college, reflecting a time when both social ties and alcohol use are highly salient. One out of six participants identified as a sexual or gender minority and the average number of SGM peers nominated by participants was one. Using social network methods allowed for the peers themselves (who were also participants) to report their sexual orientation and gender identity, providing accuracy of measurement on this variable, and additional demographic information provided important controls for analyses.

Our first research question was whether alcohol use and related consequences differed between SGM students and their cisgender heterosexual counterparts. Unlike findings from other college student samples,^21,22 we found no significant differences in alcohol use or related consequences between these two groups of students. It is possible that our restricted age group and the inclusion of one campus precluded us from finding statistically significant differences.

Next, across all participants, there were significant alcohol use differences between students who did and did not nominate at least one SGM peer, with those nominating an SGM peer reporting lower drinks per week and lower heavy drinking, with no significant difference in alcohol-related consequences. These analyses controlled for the drinking of the peers themselves, which may indicate that simply having an SGM friend is associated with lower alcohol use, regardless of the friend's drinking. As found in other SGM samples,^44–46 having close SGM peers may be protective against minority stress and social isolation for first-year SGM students. These findings suggest that college campuses should consider programming that builds community connections for SGM students in their first year of college, and evaluating whether that reduces social isolation and possibly alcohol use. Importantly, our finding was a main effect, indicating that having one or more SGM peers may also be protective for cisgender heterosexual students.

In further interaction analyses, we found that SGM students who nominated other SGM peers in their network reported significantly lower rates of heavy alcohol use and related consequences than cisgender heterosexual identified students who nominated one or more SGM peers. This finding suggests that community connection with other SGM peers may reduce the likelihood of hazardous alcohol use and related problems among SGM first-year college students to a greater extent than for non-SGM students. It is possible that the community connection with other SGM students buffers the effect of minority stress and the inclination to use alcohol to cope with this stress; this would explain the differential relationship between having an SGM peer and hazardous drinking for the SGM and non-SGM students.

Future research is needed to further examine whether minority stress is associated with these findings and how social networks may offset the negative effects of minority stress and reduce alcohol misuse.

Limitations

This investigation has several limitations. First, we were unable to examine differences across subgroups of SGM students due to insufficient sample sizes for some strata. Second, peers were only identified among the first-year class network; students may have had other SGM peers who were not included in the analyses, and therefore, it is possible that we underrepresented the number of SGM peers and the contribution of SGM peer affiliation to alcohol use behaviors. Third, the study was conducted at a university and within a state that may be more accepting of SGM status than other locations, potentially limiting generalizability. Fourth, the cross-sectional nature of the study does not allow for causal inference about the associations with alcohol use and related consequences, and these associations may be different at different stages of students' college careers.

Fifth, we did not specifically consider the alcohol use of peers in the network; this study was focused on determining whether having SGM peers was associated with alcohol use among participants; and we controlled for the alcohol use of those peers, but certainly the degree of alcohol use among peers (SGM or not) is a critical factor in need of further research. Finally, we were unable to examine the potential pathways (e.g., social isolation) through which social networks may influence alcohol use among SGM students.

Conclusion

The results of this study provide insights into the role of social network connections for alcohol use and related problems among SGM students. Although prior research has found that sexual orientation disparities in alcohol use may be attributable to peer networks, the results of our study suggest that identifying at least one SGM peer may be protective against hazardous drinking for SGM first-year college students. These findings provide support for developing, implementing, and evaluating school-based interventions on college campuses that focus on fostering social networks for SGM students.

Authors' Contributions

M.Q.O. conceptualized the article, conducted analyses, and wrote parts of the article. M.A.C. assisted with conceptualizing and planning analyses, interpreting results, and drafting the article. S.G.B. prepared the data for analyses, contributed to the interpretation of outcomes, and wrote parts of the article. K.E.G. conceptualized the article and contributed to the interpretation of outcomes. N.P.B. conducted the original data collection, prepared data for analysis, contributed to planning of analyses and interpretation of outcomes, and wrote and edited parts of the article. All coauthors contributed to the conception of the work and to the acquisition, analysis, or interpretation of the data. All coauthors contributed to the writing process and reviewed and approved the article before submission. There were no contributors who did not meet the requirements for authorship.

Disclaimer

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

This research was supported, in part, by R01 AA023522 to Dr. Barnett from the National Institute on Alcohol Abuse and Alcoholism.