Identifying dominant factors that impact hazardous alcohol use among sexual and gender minority groups.

Sexual and gender minority (SGM) people report higher rates of hazardous alcohol use relative to heterosexual and cisgender people. Although research has identified factors that contribute to these disparities, few studies include both general and SGM-specific correlates of alcohol outcomes or quantify which factors have the strongest effects. Methods. We used dominance analysis with data from SGM participants in a 2024 national survey (N = 1524) to evaluate the relative importance of multiple factors on past-year heavy drinking days (i.e., days on which participants drank 5 + standard drinks) and alcohol use disorder (AUD). SGM-specific variables included peer drinking behavior, perceived drinking to cope among SGM peers, perceived neighborhood SGM social climate, discrimination based on sexual/gender identity, gender expression, and connection to LGBTQ + communities. General independent variables included demographic characteristics, drinking to cope, past-year depression symptoms, early onset of drinking, family history of alcohol problems, frequency of drinking in bars, and sensation seeking. Results: Dominance analyses showed that drinking to cope was the strongest predictor of both heavy drinking days and AUD, consistently dominating all other variables. For heavy drinking days, other key variables included frequent drinking in bars and experiences of SGM discrimination. For AUD, drinking in bars and peer drinking behavior emerged as the next most important variables after coping motives. Conclusions: Findings provide insights into the dominant factors contributing to a higher risk among SGM populations, which may aid in the development of interventions.