Testing reciprocal prospective associations between descriptive norms and alcohol and cannabis use among sexual minority women and gender diverse individuals assigned female at birth: Identification of relevant normative referents and correlates of d

Sexual minority women (SMW) and sexual minority gender diverse individuals (SMGD) are at elevated risk for alcohol and cannabis use disorders; however, very little research has examined the role of descriptive norms in these disparities. This study aimed to test reciprocal prospective associations between descriptive norms for different normative referents (e.g., women, SMW, gender diverse individuals) and alcohol and cannabis consumption and problems among SMW and SMGD individuals. We used data from a study of substance use among 429 SMW and SMGD individuals assigned female at birth. We also aimed to identify the most relevant normative referents for SMW and for SMGD individuals by examining the unique effects of more specific normative referents (e.g., SMW) while controlling for less specific referents (e.g., women). Further, we examined potential covariates of norms, including those derived from social and minority stress theories of substance use among sexual and gender minorities. Among SMW, perceptions of heavier alcohol/cannabis use among other SMW predicted subsequent increases in alcohol/cannabis problems, but not consumption. Among SMGD individuals, descriptive norms did not predict subsequent changes in alcohol/cannabis consumption or problems. Little evidence was found to support reciprocal associations. Concurrent and prospective correlates of norms were also identified. Findings indicate that SMW-specific norms are most relevant for SMW. Less evidence was found for associations between norms and substance use among SMGD individuals. We discuss potential implications for the adaptation of normative feedback interventions for SMW and SMGD individuals.