Sexual identity, inhaled substance use may impact adolescent asthma risk

A new study highlights a link between risk for asthma and sexual identity and inhaled substance use among adolescents.

“Available research suggests that compared to heterosexual adults, rates of asthma are higher among sexual minority adults, particularly sexual minority women,” Cindy B. Veldhuis, PhD, postdoctoral research scientist at Columbia University’s School of Nursing, and colleagues wrote in the Annals of the American Thoracic Society. “Much less is known about asthma among sexual minority youths, despite the relatively high prevalence of asthma among adolescents.”

Researchers evaluated data from 30,113 adolescents (50.7% female) who participated in the 2015 and 2017 Youth Risk Behavior Surveillance Surveys to examine the associations between asthma, sexual identity and inhaled substance use.

Adolescents reported whether they were ever diagnosed with asthma, current use of cigarettes, cigars/cigarillos, marijuana and electronic vapor products, and whether they ever used inhalants or synthetic marijuana.

Results showed a higher prevalence of asthma among lesbian/gay (28.1%) and bisexual (26.2%) respondents compared with heterosexual youths (21%). Relative risk for asthma was 42% higher among lesbian female youths and 26% higher among bisexual female youths compared with heterosexual female youths. Relative risk for asthma was 74% higher among gay male youths and 68% higher among bisexual male youths compared with heterosexual male youths, according to the results.

Higher risk for asthma was significantly associated with inhaled substance use. Lesbian and bisexual female youths reported higher use of inhaled substances compared with heterosexual female youths, while the researchers reported little difference use among male youths.

The researchers reported a positive relationship between asthma and use of synthetic marijuana (RRR = 1.38; 95% CI, 1.02-1.87) among female heterosexual youths, and a stronger relationship among lesbian female youths (RRR = 5.88; 95% CI, 2.1-16.6).

In multivariable models stratified by sex, inhaled substance use accounted for 12% of the increased relative risk for asthma in female lesbian youths and 9% of the increased relative risk in bisexual female youths, compared with heterosexual female youths. In males, use of inhaled substances accounted for 12% of the increased relative risk for asthma in gay male youths and 7% of the increased relative risk in bisexual male youths, according to the results.

“Although sexual minority youths have higher rates of inhaled substance use and higher rates of asthma, there were few sexual identity differences in the associations between asthma and use of specific types of inhaled substances. For example, the association between synthetic marijuana and asthma was significant for heterosexual female youths, but stronger for lesbian female youths. However, when all inhaled substances were added to the model, use of inhaled substances mediated the associations between asthma and substance use among both lesbian and bisexual female youths and among gay and bisexual male youths.

“This suggests that lesbian and bisexual female youths’ greater use of inhaled substances may account for their increased asthma risks. However, for gay and bisexual [male] youths, [there] was still a significant association between sexual identity and asthma risks, even when inhaled substance use was added to the model. This suggests that other unmeasured variables may partially account for gay and bisexual male youths’ higher asthma risks,” the researchers wrote.

Moreover, increased risk for developing asthma may also be impacted by typical stressors of adolescence, in addition to stress associated with sexual minority identity, coupled with increased use of inhaled substances, the researchers wrote.

According to the researchers, health care providers should provide counseling and referral for sexual minority youths who use inhaled substances, specifically in programs that offer culturally sensitive care and specialized interventions.

“School- and community-based interventions including gay/straight alliance groups and programs such as Safe Spaces, training educators to be more supportive and anti-bullying programs may provide buffers and tools to reduce stress and improve health and well-being among [sexual minority youths],” the researchers wrote. “These may further decrease the potential root causes of sexual identity-related disparities in asthma and inhaled substance use, as well as other health concerns.”