Tobacco and Cannabis Use and co-Use, and Cannabis Refusal Self-Efficacy Among Black Men: A Cross-Sectional Study Examining Differences Between Men Who Have Sex with Men (MSM) and Non-MSM

Cannabis and tobacco co-use is a public health concern among men who have sex with men (MSM), including Black MSM. Because many Black men initiate tobacco use with cannabis, identifying predictors of cannabis use is important. This study hypothesized that Black MSM would report more cannabis and tobacco use and lower cannabis refusal self-efficacy than Black non-MSM due to stress from their multiple minority status. The study compared Black MSM and non-MSM on substance use behaviors and perceptions. Guided by minority stress theory, path analysis tested whether indirect effects of MSM status on tobacco use operated through cannabis refusal self-efficacy and cannabis use. Participants were 202 Black men ages 18-34 (108 non-MSM; 94 MSM). In the past 30 days, 68 reported tobacco use, 121 reported cannabis use, and 62 reported co-use. MSM reported more tobacco and cannabis use and lower cannabis refusal self-efficacy than non-MSM. Several indirect effects were identified, including pathways between MSM status and cannabis use through cannabis refusal self-efficacy, between cannabis refusal self-efficacy and tobacco use through cannabis use, and sequential indirect effects between MSM status and tobacco use through both mechanisms. The results suggest harm reduction strategies for Black MSM should address co-use patterns and strengthen cannabis refusal self-efficacy.