Associations of Sexual Identity and Gender Identity With Multiple Cannabis Use Outcomes in Young Adulthood

Objective: Broadly, young adults who identify as sexual or gender minorities use cannabis at disproportionately high rates. However, it is unclear whether disparities differ across sexual or gender identities (e.g., gay/lesbian, bisexual, pansexual, non-binary), or across the wide range of cannabis products and modes of consumption. Method: Data were from a prospective cohort of young adults, originally recruited from 10 Southern California high schools (N = 2,706). Individuals were digitally surveyed four times as young adults (ages 18–23) from 2019 to 2022. Past 30-day frequency of five cannabis products (combustible cannabis, cannabis vapes, edibles, blunts, and concentrated cannabis products) and number of products used in the past 30 days were compared across seven sexual identities (heterosexual, asexual, bisexual, gay/lesbian, pansexual, queer or other identity, and questioning) and four gender identities (cisgender female, cisgender male, non-binary, and transgender) using time-varying contemporaneous associations after adjusting for sociodemographic factors (age, race/ethnicity, education, employment status, and financial status). Some sexual and gender identity groups had small sample sizes, which may limit the precision of estimates. Results: Compared to heterosexual participants, most sexual identities (except for asexual) reported more frequent use of cannabis products. For example, gay/lesbian participants exhibited a higher past 30-day cannabis use frequency across all five cannabis products, while bisexual participants exhibited a higher past 30-day cannabis use frequency across 4 out of 5 cannabis products. Among gender minority participants, transgender participants exhibited higher estimated frequencies of past 30-day cannabis use across 4 out of 5 cannabis products. Conclusions: Inclusive measurement of sexual and gender identity in research may aid in more precise identification of cannabis use disparities.