BACKGROUND: Since 2013, diagnoses of Hepatitis C among young adults and the number of opioid overdose deaths in Illinois have increased. We examined trends among Illinois high school students in reporting of sexual orientation, heroin use, and prescription drug misuse to inform outreach efforts.
METHODS: The Youth Risk Behavior Survey (YRBS) is administered every two years in a sample of U.S. high schools. A sexual orientation question was included on the Illinois YRBS from 2009–2015. Trends in responses to the sexual orientation and substance abuse questions were assessed using logistic regression with orthogonal coefficients. Differences in proportions were assessed using the Rao-Scott chi square test. The relationship between identifying as LGB to substance abuse was examined using logistic regression for combined years of data (2009–2015 for heroin use and 2011–2015 for prescription drug misuse) after adjusting for race/ethnicity, sex, and grade level. Analyses accounted for the multi-stage cluster survey design of the YRBS.
RESULTS: During 2009-2015, the proportion of Illinois high school students who identified as LGB increased linearly (p<0.0002). The largest increase was among bisexual students: in 2009, 3.5% (95% CI: 2.5%–4.5%) of students identified as bisexual compared to 6.8% (95% CI: 5.0%–8.7%) in 2015 (p<0.005). The proportion of students who identified as gay or lesbian also increased (p<0.005) from 2009 (1.3% (95% CI: 0.8%–1.7%) to 2015 (2.5% (95% CI: 1.6%–3.3%). During 2009-2015, there was no significant trend in the overall proportion of high school students who reported heroin use or prescription drug misuse. LGB students consistently reported higher rates of substance abuse: 13.2% (95% Confidence Interval (CI): 9.4%–17.0%) reported having used heroin compared to 2.0% (95% CI: 1.6%–2.3%) of non-LGB students in 2009–2015 (p<0.005) and 32.3% (95% CI: 27.9%–36.8%) reported having used prescription drugs without a prescription compared to 14.4% (95% CI: 12.7%–16.0%) of non-LGB students in 2011–2015 (p<0.005). When accounting for race/ethnicity, sex, and grade level, LGB students had significantly higher odds of reporting heroin use (Adjusted Odds Ratio (AOR)=8.4, 95% CI: 5.6–12.7) and reporting prescription drug misuse (AOR=3.1; 95% CI: 2.4–4.0).
CONCLUSIONS: The proportion of Illinois high school students who identify as LGB almost doubled from 2009 to 2015. Identifying as LGB was highly associated with both heroin use and prescription drug misuse. Educational initiatives and interventions to prevent and address substance abuse among youth should consider this high risk population.