Characterizing the polytobacco behaviors of sexual minority young adult college students

Single-use, co-use, and polysubstance use of alcohol, tobacco, and cannabis in sexual minority and heterosexual females

BACKGROUND AND OBJECTIVE

Alcohol, tobacco, and cannabis use are more prevalent in sexual minority females than heterosexual females, and their use is associated with adverse consequences. Identifying disparities in substance use patterns by sexual identity may inform interventions targeting this vulnerable group. This study examined differences between heterosexual and sexual minority females on patterns of past 30-day tobacco, alcohol, and cannabis use.

METHODS

N = 3020 females (18.8% sexual minority) completed an online survey (September 2020-October 2021) that queried about past 30-day tobacco/nicotine (cigarettes, e-cigarettes, large cigar/LCCs, and other products), alcohol, and cannabis use. Participants were classified into one of eight patterns: no use, tobacco/nicotine-only, alcohol-only, cannabis-only, alcohol and tobacco/nicotine, tobacco/nicotine and cannabis, alcohol and cannabis, and polysubstance use. A multinomial logistic regression model examined the association between sexual identity and each substance use group, controlling for demographics.

RESULTS

Across both groups, no substance use was the most common pattern. Polysubstance use was the most common substance use pattern among sexual minority females. In adjusted regression models, sexual minority females were more likely to report cannabis-only (adjusted odds ratio [AOR] = 2.58), tobacco/nicotine and cannabis co-use (AOR = 1.74), alcohol and cannabis co-use (AOR = 2.50), and polysubstance use (AOR = 2.60), compared to heterosexual females. [Correction added on 23 November 2022, after first online publication: In the preceding paragraph, the AOR and CI values were corrected.] DISCUSSION AND CONCLUSIONS: Substance use patterns that involve cannabis are more common among sexual minority females.

SCIENTIFIC SIGNIFICANCE

This study extends prior research by using a large sample of females to examine differences based on sexual identity in patterns of tobacco/nicotine, alcohol, and cannabis use beyond single substance use and considers co-use and polysubstance use.

E-cigarette, cigarette, and cannabis use patterns as a function of sexual identity in a sample of Southern California young adults

PURPOSE

Sexual minority young adults report greater cigarette and cannabis use. Emerging evidence suggests this trend may extend to e-cigarettes. The current study evaluated the relationship between sexual identity and prevalence of e-cigarette, cigarette, and cannabis use and whether such associations differ by gender.

METHODS

Cross-sectional, regionally representative data of young adults (M[SD]age = 20.02 [0.60] years; n heterosexual = 1314; n bisexual = 77; n lesbian/gay = 28) from Wave III (2016) of the Southern California Children's Health Study were analyzed in 2019. Logistic regression analyses were conducted with sexual identity as the predictor and product use (never, prior, infrequent past 30-day [1-2 days], frequent past 30-day [3-5+ days]) as the outcome in separate models by substance (e-cigarettes, cigarettes, cannabis).

RESULTS

Bisexual individuals were the highest-risk sub-group for nearly all outcomes, with over five times the odds of reporting frequent past 30-day use for e-cigarettes (Odds Ratio [OR]: 6.68; 95% Confidence Interval [CI]: 2.80, 15.9), cigarettes (OR: 5.42; 95% CI: 2.37, 12.4), and cannabis (OR: 8.43; 95% CI: 4.40, 16.1) compared to heterosexual individuals. Although the sample size for lesbian/gay participants was small, bisexual (vs. lesbian/gay) participants also had greater odds of reporting prior use of nicotine products and frequent past 30-day cannabis use. A significant sexual identity × gender interaction emerged for lifetime cigarette use, wherein bisexual (vs. heterosexual) identity was only associated with greater odds of use for females (p < .01).

CONCLUSIONS

Sexual minority-related disparities in substance use among young adults appear to generalize to e-cigarettes, with bisexual young adults exhibiting especially high profiles of risk.