Is Using Cannabis With Other Sexual and Gender Minorities Associated With Heavier Use Among Sexual Minority Women and Gender Diverse Individuals?

BACKGROUND: Limited research has focused on the role of social factors, such as using substances with other SGM, in disparities in alcohol and cannabis use affecting sexual and gender minorities (SGM). While two prior ecological momentary assessment (EMA) studies have examined associations between SGM status of others present during alcohol and cannabis use events and substance use, prior studies did not control for two critical unmeasured confounders (number of people present during substance use events and proportion intoxicated). METHODS: The current study aimed to address these limitations by examining differences in cannabis outcomes based on SGM status of others present, while controlling for these confounders. We used multilevel modeling of EMA data from 369 young adult sexual minority women and gender diverse individuals who regularly used cannabis and lived in the United States (collected in 2024). RESULTS: While using cannabis in mixed settings (SGM and non-SGM companions) was associated with more sessions, longer intoxication, and higher subjective intoxication compared to using cannabis with only non-SGM individuals, these associations became non-significant when number of people present and proportion intoxicated were controlled for. Two analyses indicated using cannabis with other SGM was associated with longer intoxication and more sessions even when other contextual factors were controlled for. CONCLUSIONS: Findings suggest that using cannabis with other SGM is associated with more sessions and longer intoxication. Results also indicate that associations between using cannabis in mixed settings and heavier cannabis use is an artifact of the larger number of people present in these settings.