Multilevel Factors Associated with Cannabis Use Disorder in an HIV Status-Neutral Cohort of Young Black Sexual and Gender Minority Adults Assigned Male at Birth—The N2P2 Cohort Study

Abstract As cannabis use becomes increasingly prevalent and legally accessible in the United States, cannabis use disorder (CUD) remains an important public health concern for Black sexually minoritized men (SMM) and transgender women (TW), who experience elevated cannabis use and intersecting social and structural stressors that may shape cannabis-related harms. Cross-sectional data were collected from October 2022 to May 2024 in the Chicago metropolitan statistical area to examine individual-level (.e.g., relationship status), interpersonal-level (e.g., social support), and community-level (e.g.., neighborhood safety) correlates associated with CUD [measured by the revised Cannabis Use Disorders Identification Test, (CUDIT-R)]. Guided by the Social Ecological Model, bivariate analyses and logistic regression models were used. A total of 538 participants were included in the analyses, with 52.6% ( n = 283) indicating a clinically significant risk of CUD. The mean age of the participants was 27.8 years (SD = 3.84) and most self-identified as cisgender men (83.5%). At the individual level, participants at risk for CUD had higher adjusted odds of using blunts as their primary consumption method (OR = 2.16, 95% CI: 1.31, 3.57) and lower adjusted odds of being in a relationship (OR = 0.61, 95% CI: 0.40, 0.93). Regarding interpersonal differences, participants who screened at risk of CUD had higher adjusted odds of reporting intimate partner violence (aOR 1.58, 95% CI: 1.04, 2.39) than those without CUD. Community factors were not significantly associated with CUD. Longitudinal research is needed to clarify how individual, interpersonal, community, and structural factors interact over time to shape CUD risk in legalized cannabis environments.