Intersectional Effects of Sexual Orientation and Racial/Ethnic Discrimination on Substance Use Among Young Adult Sexual Minority Cisgender Women and Nonbinary People of Color: Testing Additive, Prominence, and Multiplicative Hypotheses

Studies examining the intersectional effects of sexual orientation and racial/ethnic discrimination among sexual minority people of color have produced mixed results, supporting a range of hypotheses. Some studies find that both types of discrimination additively predict poorer health (additive hypothesis), while others find that only one type of discrimination predicts health (prominence hypothesis). Still, other studies demonstrate multiplicative effects, whereby one type of discrimination has a stronger effect on health when the other type of discrimination is high (multiplicative hypothesis). The current study aims to add clarity to the literature by examining all three hypotheses separately for different racial/ethnic groups. We utilized data from a longitudinal study of substance use among sexual minority cisgender women of color and sexual minority gender-diverse people of color assigned female at birth. We tested all three hypotheses cross-sectionally and longitudinally. Results provided substantial support for the prominence hypothesis. Findings also provided some support for the multiplicative hypothesis and for unique patterns of interactions not directly theorized by any of the three hypotheses. Little evidence for the additive hypothesis was observed. Nuanced differences in patterns of findings across racial/ethnic groups were obscured when people of color were treated as a single homogeneous group. The most support was found for the prominence hypothesis; however, this hypothesis receives the least empirical attention, highlighting a direction for future research. Furthermore, results suggest that examining intersectional effects separately for different racial/ethnic groups may be more appropriate than combining all people of color in a single set of analyses.