Other Titles
Minority Stress as Mediator of ACE-Substance Use Pathways: Multigroup SEM Analysis of Sexual Minority Men and Women [Poster Title]
Abstract
Background: Adverse childhood experiences (ACEs) are known determinants of negative health outcomes. Sexual minority (SM) individuals have higher ACE scores than non-SM individuals, and as a result also have worse health outcomes.According to the WHO, ACEs such as abuse & neglect are among the most severe forms of stress an individual may face, with extant literature identifying SM status and ACEs as predictors of substance use. There is a paucity of evidence examining the pathways between ACEs and substance use in SMs. Burgeoning evidence indicates minority stress is a strong predictor of substance use in SMs.
Purpose: To examine the mediating effect of minority stress between ACEs and substance use in sexual minority men (SMM) and sexual minority women (SMW).
Methods: SMM and SMW across the United States were recruited through Qualtrics Panel Surveys, who completed a demographic questionnaire and standardized measures assessing ACEs, sexual and gender minority–specific ACEs (SGM-ACEs), minority stress, and substance use (alcohol, cannabis, and illicit drugs). Final analytic sample included 530 adults (265 SMM and 265 SMW; M age = 35.4, SD = 14.9). Structural equation modeling (SEM) was used to conduct invariance testing (configural, metric, and structural) and mediation analysis across SMM and SMW.
Results: Our overall model demonstrated good fit (X2 = 227.66, df = 74, p < .0001; CFI = .94; RMSEA = .06, 90% CI [.05, .07]; SRMR = .05). Multigroup SEM supported configural, metric, and structural invariance: Model 1 (baseline), X2 = 325.85, df = 149; Model 2 (metric), X2 = 339.04, df = 157, ΔX2 = 13.17, p = .106; Model 3 (structural weights), X2 = 343.12, df = 160, ΔX2 = 17.27, p = .100; Model 4 (structural covariances), X2 = 350.30, df = 167, ΔX2 = 24.45, p = .141. In mediation analyses, the indirect effect of ACEs on substance use via minority stress was significant among SMW (β = .21, 95% CI [.09, .35], p = .010) but not among SMM (β = .27, 95% CI [.04, .47], p = .066). A chi-square difference test comparing the unconstrained and structural-weights models was nonsignificant (ΔX2 = 17.27, p = .100), indicating no statistically significant difference in the indirect effect.
Conclusion: This study highlights the connection between ACEs, minority stress and substance use among SMM and SMW. Future studies should emphasize interventions and preventative methods to limit exposure to ACEs and minority stress.
Notes
References:
1. Crandall, A., Miller, J. R., Cheung, A., Novilla, L. K., Glade, R., Novilla, M. L. B., ... & Hanson, C. L. (2019). ACEs and counter-ACEs: How positive and negative childhood experiences influence adult health. Child abuse & neglect, 96, 104089.
2. Solberg, M. A., Carr, K. D., & Peters, R. M. (2024). Adverse childhood experiences and health outcomes among sexual and gender minorities: A systematic review. Journal of Child & Adolescent Trauma, 17(2), 627-639.
3. WHO. Adverse. Childhood Experiences International Questionnaire (ACE-IQ). World Health Organization; 2020. https://www.who.int/publications/m/item/adverse-ch ildhood-experiences-international-questionnaire-(ace-iq).
4. Venkatesh, U., Aparnavi, P., Mogan, K. A., Durga, R., Pearson, J., Kishore, S., ... & FASAI Study Group. (2024). Determinants of substance use among young people attending primary health centers in India. Cambridge Prisms: Global Mental Health, 11, e23.
5. Dyar, C., Lee, C. M., Rhew, I. C., & Kaysen, D. (2023). Sexual minority stress and substance use: An investigation of when and under what circumstances minority stress predicts alcohol and cannabis use at the event-level. Journal of psychopathology and clinical science, 132(4), 475.
6. Parent, M. C., Arriaga, A. S., Gobble, T., & Wille, L. (2019). Stress and substance use among sexual and gender minority individuals across the lifespan. Neurobiology of Stress, 10, 100146.
7. Dyar, C., Newcomb, M. E., & Mustanski, B. (2019). Longitudinal associations between minority stressors and substance use among sexual and gender minority individuals. Drug and alcohol dependence, 201, 205-211.
Sigma Membership
Lambda
Type
Poster
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Health Equity or Social Determinants of Health, Stress and Coping, Public and Community Health, Adverse Childhood Experiences, Sexual and Gender Minorities, Substance Use Disorders, Substance Use Disorders--Risk Factors
Recommended Citation
Shukla, Meghna and Schilt-Solberg, Marvin, "Minority Stress as Mediator of ACE-Substance Use Pathways: SEM Analysis of Sexual Minorities" (2026). International Nursing Research Congress (INRC). 56.
https://www.sigmarepository.org/inrc/2026/posters_2026/56
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-04
Minority Stress as Mediator of ACE-Substance Use Pathways: SEM Analysis of Sexual Minorities
Toronto, Ontario, Canada
Background: Adverse childhood experiences (ACEs) are known determinants of negative health outcomes. Sexual minority (SM) individuals have higher ACE scores than non-SM individuals, and as a result also have worse health outcomes.According to the WHO, ACEs such as abuse & neglect are among the most severe forms of stress an individual may face, with extant literature identifying SM status and ACEs as predictors of substance use. There is a paucity of evidence examining the pathways between ACEs and substance use in SMs. Burgeoning evidence indicates minority stress is a strong predictor of substance use in SMs.
Purpose: To examine the mediating effect of minority stress between ACEs and substance use in sexual minority men (SMM) and sexual minority women (SMW).
Methods: SMM and SMW across the United States were recruited through Qualtrics Panel Surveys, who completed a demographic questionnaire and standardized measures assessing ACEs, sexual and gender minority–specific ACEs (SGM-ACEs), minority stress, and substance use (alcohol, cannabis, and illicit drugs). Final analytic sample included 530 adults (265 SMM and 265 SMW; M age = 35.4, SD = 14.9). Structural equation modeling (SEM) was used to conduct invariance testing (configural, metric, and structural) and mediation analysis across SMM and SMW.
Results: Our overall model demonstrated good fit (X2 = 227.66, df = 74, p < .0001; CFI = .94; RMSEA = .06, 90% CI [.05, .07]; SRMR = .05). Multigroup SEM supported configural, metric, and structural invariance: Model 1 (baseline), X2 = 325.85, df = 149; Model 2 (metric), X2 = 339.04, df = 157, ΔX2 = 13.17, p = .106; Model 3 (structural weights), X2 = 343.12, df = 160, ΔX2 = 17.27, p = .100; Model 4 (structural covariances), X2 = 350.30, df = 167, ΔX2 = 24.45, p = .141. In mediation analyses, the indirect effect of ACEs on substance use via minority stress was significant among SMW (β = .21, 95% CI [.09, .35], p = .010) but not among SMM (β = .27, 95% CI [.04, .47], p = .066). A chi-square difference test comparing the unconstrained and structural-weights models was nonsignificant (ΔX2 = 17.27, p = .100), indicating no statistically significant difference in the indirect effect.
Conclusion: This study highlights the connection between ACEs, minority stress and substance use among SMM and SMW. Future studies should emphasize interventions and preventative methods to limit exposure to ACEs and minority stress.
Description
Sexual minority (SM) individuals have high Adverse Childhood Experiences (ACEs) and poor health outcomes..This study examined the mediating effect of minority stress between ACEs and substance use in 530 sexual minority men (SMM) and sexual minority women (SMW).Study results indicate that there is no difference in the mediating effect of minority stress on the ACE-substance use pathway between SMM & SMW.