Cannabis use among sexual minority adults: insights from recent U.S. nationally representative data

Cannabis use among sexual minority (SM) populations, particularly through vaping (CV) and non-vaping (NVC) modes, has become increasingly relevant amid shifting legal and cultural norms. However, limited research has examined how these modalities relate to multidimensional aspects of sexual orientation. This study addresses this gap by exploring the associations between sexual identity, sexual attraction, and identity-attraction concordance or discordance with past 30-day CV and NVC among U.S. adults aged 18-64.

This study analyzed data from 2022 National Survey on Drug Use and Health (NSDUH), a nationally representative dataset (N = 40,030). Weighted multivariable logistic regression models were employed to examine the associations between cannabis use modalities and each facet of sexual orientation, adjusting for demographic variables and other substance use behaviors as covariates.

Among women, bisexual identity was linked to the highest odds of CV (adjusted odds ratio [aOR] = 2.57, 95 % confidence interval [CI] = 2.00-3.30) and NVC (aOR = 2.57, 95 % CI = 2.11-3.12). Women with same-sex or both-sex attraction demonstrated higher odds of both CV and NVC, and heterosexual-discordant women were also at increased risk. Among men, however, cannabis use disparities were more consistently linked to NVC.

The findings underscore the multifaceted nature of sexual orientation, highlighting distinct gender-specific and modality-dependent disparities in cannabis use among SM population. Recognizing and addressing these complexities can inform culturally attuned prevention and intervention efforts that account for unique stressors within these communities, reducing substance use-related harms and advancing health equity.