1. Sexual minority (homosexual or bisexual) boys had a significantly greater lifetime prevalence of anabolic-androgenic steroid (AAS) misuse compared to heterosexual boys (21% vs 4%).
2. As compared to heterosexual boys, sexual minority boys also reported significantly greater levels of moderate and severe AAS misuse.
Evidence Rating Level: 2 (Good)
Study Rundown: Anabolic-androgenic steroids (AAS) are substances often taken to enhance strength, performance, and muscularity. Sexual minority (homosexual and bisexual) adolescent males may be at increased risk of AAS misuse in addition to and as a result of other maladaptive outcomes, such as substance abuse, depression, and body image dissatisfaction. The current study examined the prevalence of lifetime misuse of AAS in relation to sexual orientation in US adolescent boys. Sexual minority boys were found to have a significantly greater lifetime prevalence of AAS misuse compared to heterosexual boys (21% vs 4%). Sexual minority boys also reported significantly greater levels of moderate and severe AAS misuse. Depressive symptoms/suicidality, victimization, and substance use were all significant intermediate variables. One limitation of the study is its cross-sectional design, which prevents identification of temporal influences or bidirectional relationships. These results have implications for prevention efforts addressing AAS misuse in sexual minority adolescent boys, which physicians could address with their patients at routine healthcare visits.
In-Depth [cross-sectional study]: A total of 17,250 adolescent males were surveyed, with 635 (3.7%) classified as sexual minorities, identifying as either homosexual or bisexual. Data was taken from the Youth Risk Behavior Survey (YRBS). Sexual minority boys were found to have a significantly greater lifetime prevalence of AAS misuse compared to heterosexual boys (21% vs 4%, OR = 5.8, 95% CI 4.1-8.2). As compared to heterosexual boys, sexual minority boys also reported significantly greater levels of moderate (8% vs 1.5%, OR = 5.7, 9% CI 3.4-9.6) and severe (4% vs 0.7%, OR = 5.7, 95% CI 2.7-11.9) AAS misuse. Simultaneous multiple mediation indicated that sexual minority classification was significantly associated with increased victimization, increased depressive symptoms/suicidality, and increased substance use; these three variables were all associated with increased AAS misuse. With these variables controlled, the direct effect of sexual minority status on AAS misuse decreased, but remained significant. Substance use appeared to have a stronger association with AAS misuse than depressive/suicidality and victimization.
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