Is everyday discrimination linked to unhealthy substance use in minority GBMSM?
A new study, funded by a 2024 APNA Research Grant, says yes. This study, by Wonkyung (Chang) Kniffen, a postdoctoral fellow in the Department of Psychiatry at the University of Rochester Medical Center, offers insights into how everyday discrimination impacts substance use among ethnoracial gay, bisexual, and other men who have sex with men (GBMSM).
“Unhealthy alcohol use, along with heavy marijuana and cocaine use, has become a significant public health issue among ethnoracial GBMSM,” Kniffen says.
“The relationship between stress and substance use is particularly pronounced in GBMSM populations, where it is often linked to minority stress factors like expectations of discrimination and internalized stigma.”
The Study
Kniffen sought to explore how the cumulative stress from multiple sources of discrimination (ethnic, racial, immigrant status, and sexual orientation) affects ethnoracial minority GBMSM. Guided by the Minority Stress Model, the study used secondary data from the NIH All of Us Research Program in structural equation modeling to examine associations among discrimination, perceived stress, unhealthy alcohol use, and other substance use.
Key Findings
Based on a sample size of 683 participants (mean age 47.7; 77% gay, 23% bisexual), findings include that everyday discrimination is linked to unhealthy alcohol use. This unhealthy alcohol use is in turn connected to higher rates of marijuana and cocaine use.
However, perceived stress did not fully explain these patterns. This suggests that substance use may also be influenced by the social contexts where drinking and drug use are normalized.
Applications for Psychiatric-Mental Health Nursing Practice
“Interventions should address discrimination, promote supportive communities, and offer alternatives to substance-centered social spaces,” Kniffen says.
“These results indicate that discrimination is a key factor in substance use disparities and point to the need for strategies that reduce discrimination and support healthier coping.”
These findings are currently under peer review at Substance Use & Misuse and were presented as a poster at the APNA Annual Conference in October 2025.
Looking to the future, Kniffen will continue to build on this research: “Furthering this study, I’m focusing on substance use disorders, biomarkers, and medical comorbidities during my fellowship,” she says.
