The Association Between Bi+ Stigma and Problematic Cannabis Use: Testing Coping Motives as an Underlying Mechanism

Distal and Proximal Minority Stressors on Patterns of Tobacco and Cannabis Use Among Young Bisexual Women

BACKGROUND

Bisexual women have high rates of tobacco and cannabis use, but few studies have examined co-use behavior in this population. Although the role of distal minority stressors (eg, discrimination) on substance use has been examined, fewer studies have examined proximal minority stressors (eg, negative sexual identity self-schemas). The current study was a secondary data analysis that examined patterns of tobacco and cannabis use, and the role of distal (instability of bisexuality, sexual irresponsibility of bisexual people, and hostility toward bisexual people) and proximal (illegitimacy of bisexuality, anticipated binegativity, internalized binegativity, and identity affirmation) bisexual-specific minority stressors among bisexual women.

METHODS

Participants were 224 young (aged 18-30 years old) self-identified bisexual women who reported on their past 30-day tobacco and cannabis use and completed measures of distal and proximal bisexual-specific minority stressors. Participants were categorized into one of 4 patterns: no use, tobacco use only, cannabis use only, and tobacco and cannabis co-use.

RESULTS

The most common pattern of past 30-day use was tobacco and cannabis co-use (39.1%). Results from a multinomial logistic regression revealed that bisexual women who reported higher illegitimacy of bisexuality, a proximal minority stressor, were significantly more likely to engage in tobacco and cannabis co-use, relative to no use.

DISCUSSION

Bisexual women have particularly high rates of substance use, with tobacco and cannabis co-use as the most common pattern. Incorporating the role of proximal minority stressors, and specifically, beliefs about the legitimacy of bisexuality, may be an important target of substance use interventions for bisexual women.

Sexual orientation-based microaggressions and cannabis use outcomes among sexual minority individuals: The impact of negative affect and coping-motivated cannabis use

INTRODUCTION

Sexual minority individuals report significantly more cannabis use and problems than their heterosexual peers, possibly due to their frequent experiences with sexual orientation-based microaggressions. As a result, sexual minority individuals may turn to cannabis use to cope with the negative affect associated with these experiences. No known studies have tested this hypothesis; therefore, the current study tested if sexual orientation microaggressions are positively associated with negative affect (anxiety and depression), cannabis coping motives, and cannabis-related outcomes (frequency, problems); if coping motives are positively associated with cannabis-related outcomes; and if negative affect and cannabis use to cope with negative affect serially mediate the relation between sexual orientation microaggressions and cannabis-related outcomes.

METHODS

Sexual minority undergraduate students who reported cannabis use in the past three months (N = 328; 71.3 % cis-female) completed an online survey.

RESULTS

Microaggressions were significantly positively correlated with anxiety, depression, coping-motivated cannabis use, cannabis-related problems, non-sexual orientation-related stress, and overt sexual orientation-based discrimination. Additionally, after controlling for non-sexual orientation-related stress and overt sexual orientation-based discrimination, microaggressions were indirectly positively related to cannabis use frequency and problems via the sequential effects of negative affect and coping motives. This relation remained significant when examining negative affect specific to sexual orientation microaggressions and cannabis use to cope with this microaggressions-specific negative affect.

CONCLUSIONS

Results highlight the adverse impact of sexual orientation microaggressions in terms of negative affect and negative cannabis-related outcomes.

Dissecting sexual minority subgroup differences in the association between depression, anxiety, and cognitive difficulties

INTRODUCTION

A growing body of research has demonstrated extensive mental health disparities affecting sexual minority populations, yet little research has assessed how these disparities may affect cognitive functioning among subgroups of sexual minorities.

METHODS

Data come from the 2021 National Health Information Survey (NHIS). Survey-weighted linear regression analyses were used to assess self-reported measures of cognition, stratified by subgroups sexual identity. In particular, we focused on the association between symptoms of depression or anxiety and each of the measures of cognition, adjusting for demographic covariates.

RESULTS

Among 31,994 NHIS participants in the 2021 survey, 5,658 (17.7%) reported at least some difficulty in remembering or concentrating. Basic demographic differences existed when assessing any cognitive difficulty, particularly for bisexual participants (aOR = 2.73; 95% CI: 2.07, 3.60) and participants identifying as a different identity (aOR = 4.22; 95% CI: 2.72, 6.56). Depression was significantly associated with cognitive difficulty with the largest relationship observed among gay/lesbian participants (aOR = 1.39; 95% CI: 1.29, 1.49). The association between anxiety and cognitive difficulty was smallest among bisexuals (aOR = 1.13; 95% CI: 1.08, 1.18) and relatively consistent across other subgroups: heterosexuals (aOR = 1.23; 95% CI: 1.22, 1.24), gay/lesbians (aOR = 1.27; 95% CI: 1.19, 1.36), and those with a different identity (aOR = 1.22; 95% CI: 1.10, 1.35).

CONCLUSION

There is a clear set of health disparities between sexual minority subgroups and heterosexuals across all cognitive difficulties. Future research should focus on developing a better understanding of differences in cognition based on sexual minority status while also working to ascertain how disparities vary among sexual minorities.

Trends in Cannabis and Alcohol Use by Sexual Identity in the 2015-2019 National Survey on Drug Use and Health

OBJECTIVE

Sexual minority individuals are at substantially elevated risk for both cannabis use disorder (CUD) and alcohol use disorder (AUD). Although recent increases in the legalization of cannabis have been linked to increases in cannabis use among the general population, few studies have examined if changes in cannabis use and CUD vary by sexual identity. The purpose of the current study was to examine sexual identity differences in trends for CUD and compare them to trends for AUD.

METHOD

We used data from 2015-2019 National Survey on Drug Use and Health to examine annual prevalence and year-specific disparities in cannabis use, CUD, heavy episodic drinking, and AUD. We also examined sex-specific sexual identity differences in linear trends for these substance use outcomes over this 5-year period.

RESULTS

All groups except lesbian females experienced significant increases in cannabis use rates from 2015 to 2019. Heterosexual males, heterosexual females, and bisexual females also experienced significant increases in CUD rates. In contrast, no group exhibited significant increases in heavy episodic drinking or AUD rates. Bisexual women exhibited some of the largest year-specific disparities in cannabis use and CUD as well as the largest growth in disparities across time.

CONCLUSIONS

The few changes in heavy episodic drinking and AUD alongside numerous changes in cannabis use and CUD suggest that changes in cannabis use may be attributable to legalization of cannabis use in many states during this period. Given profound disparities and increasing rates of CUD affecting bisexual females, further research is needed to identify factors that may explain their disproportionate burden.

A Review of Disparities in Cannabis Use and Cannabis Use Disorder Affecting Sexual and Gender Minority Populations and Evidence for Contributing Factors

Purpose of Review

Sexual and gender minorities (SGM) appear to be at elevated risk for cannabis use (CU) and cannabis use disorder (CUD) compared to cisgender heterosexuals. However, risk factors remain understudied among SGM. This review aims to summarize evidence for disparities in CU and CUD affecting SGM and factors contributing to these disparities.

Recent Findings

We found strong evidence that sexual minorities are at elevated risk for CU and CUD is elevated for sexual minority women. Evidence supports a concurrent association between minority stress and CUD symptoms. There is robust support for coping motives as a mechanism linking minority stress to subsequent CU and CUD. Studies also point to CU norms and contexts as potential risk factors.

Summary

SGM are at high risk for CU and CUD, and minority stress, CU norms, and contextual factors are implicated. Additional research is needed on CU among gender minorities, prospective effects of risk factors, and interventions for SGM.

Event-level associations among minority stress, coping motives, and substance use among sexual minority women and gender diverse individuals

BACKGROUND

Sexual minority women and gender diverse individuals (SMWGD) are at heightened risk for alcohol and cannabis use disorders compared to heterosexual and cisgender individuals, and their heightened risk has been attributed to minority stress. However, few longitudinal studies have examined mechanisms through which minority stress may impact substance use, and none have done so at the event-level.

METHODS

We utilized data from a 30-day ecological momentary assessment study of 429 SMWGD who used alcohol or cannabis regularly to test a mechanistic process in which minority stress predicts alcohol and cannabis use via coping motives for use at the event-level.

RESULTS

When individuals experienced more enacted stigma (e.g., microaggressions) than usual during one assessment, they were more likely to use cannabis to cope during the next. In turn, occasions when cannabis was used to cope were marked by more sessions of cannabis use, longer intoxication, higher subjective intoxication, and more cannabis consequences. Indirect effects of enacted stigma on cannabis use via coping motives were significant. However, only one of internalized stigma's indirect effects was significant, with internalized stigma predicting cannabis consequences via daily coping motives. No indirect effects predicting alcohol use were significant.

CONCLUSIONS

Findings provide robust evidence that using to cope is a mechanism through which enacted stigma predicts cannabis use and internalized stigma predicts cannabis consequences. Results did not provide evidence for similar associations for alcohol. Our findings suggest that interventions designed to reduce cannabis use among SMWGD should attend to their minority stress experiences and cannabis use motives and teach alternative coping strategies.