Cannabis use companions' gender and sexual orientation: Associations with problematic cannabis use in a sample of sexual minorities assigned female at birth

Background: Sexual minority women (SMW) are at heightened risk for problematic cannabis use compared to heterosexual women. Social learning theory posits that characteristics of one's cannabis use companions influence problematic use. However, most research on cannabis use among sexual minorities has focused on minority stress and not social learning theory. As such, the current study tested whether characteristics of one's cannabis use companions (gender and sexual orientation) were associated with changes in problematic use among cisgender SMW and non-binary individuals assigned female at birth.

Methods: We utilized three waves of data (six-months between waves) from 321 cisgender SMW and sexual minority non-binary individuals assigned female at birth who participated in a larger study and reported using cannabis during at least one wave. We examined the prospective associations between using cannabis with five groups (SMW, sexual minority men, non-binary individuals, heterosexual women, and heterosexual men) and changes in problematic use six-months later. We also examined whether participant gender (cisgender woman vs. non-binary individual) moderated these associations.

Results: Among cisgender SMW and sexual minority non-binary individuals, using cannabis with SMW and non-binary individuals, but not with sexual minority men, heterosexual men, or women, was associated with increases in problematic use six-months later. Gender did not moderate any associations between using cannabis with any group and problematic use.

Conclusions: Consistent with social learning theory, using cannabis with similar others was associated with increases in problematic use among cisgender SMW and sexual minority non-binary individuals. Future research should explore the mechanisms underlying these effects.