Objectives. We examined interrelationships among the 3 dimensions of sexual orientation-self-identity, sexual attraction, and sexual experience-and their associations with substance use among adolescents and young adults. Methods. To estimate total and net associations of sexual identity, attraction, and experience with use of tobacco, drugs, and alcohol, we applied logistic regression to cross-sectional data from the National Survey of Family Growth Cycle 6. Results. We found a lack of concordance among the different dimensions of sexual orientation. More youths reported same-gender sexual attraction and same-gender sexual experiences than identified as lesbian, gay, or bisexual. Estimates of substance use prevalence differed significantly by gender and across dimensions of sexual orientation. Sexual experience was the most consistent predictor of substance use. Women and men with no sexual experience had the lowest odds of all forms of substance use; those reporting sexual experience with partners of both genders had the highest odds. Conclusions. Our findings indicate that sexual identity was less strongly associated with substance use than sexual experience and attraction were, pointing to the need for more nuanced indicators of sexual orientation in public health studies. (Am J Public Health. Published online ahead of print October 20, 2011:e1-e9. doi:10.2105/AJPH.2011.300261).
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