Interpersonal Health Care Discrimination and Delayed Alcohol Use Treatment Among Sexual Minority Adults With Multiple Stigmatized Identities.

Experiences of prejudice and discrimination contribute to heightened risk for alcohol use-related harm among sexual minority (SM) individuals. Discrimination in health care settings can also reduce help-seeking and treatment engagement. However, most research has focused on only one form of discrimination in isolation. This study used an intersectional stigma lens to examine associations between interpersonal health care discrimination and delayed alcohol use treatment among SM adults with multiple stigmatized identities. Interpersonal health care discrimination-based on one's sexual orientation, race-ethnicity, or both-and delayed treatment for alcohol use were examined among a nationally representative sample of SM adults from the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions (N = 3,201), the only nationally representative survey that assesses multiple domains of sexual orientation, experiences of health care discrimination, and treatment intentions and utilization. Multivariable logistic regression was used to identify factors associated with delayed treatment for alcohol use. Approximately one in five (18.9%) SM adults experienced interpersonal health care discrimination and 9.2% delayed treatment for alcohol use. Delayed treatment was more prevalent among SM adults than the general population of adults with lifetime alcohol use. Those reporting both sexual orientation and racial-ethnic discrimination had more than double the odds of delayed treatment than those reporting neither (adjusted odds ratio = 2.38, 95% confidence interval [1.17, 4.85]). Findings highlight the compounding effect of intersectional stigma on treatment delay. Interventions are needed to address intersectional stigma in health care settings and engage particularly marginalized subpopulations of SM adults in alcohol use treatment.