BACKGROUND: Sexual and/or gender minority (SGM) emerging adults use both cannabis and tobacco products at higher rates than their non-SGM peers. Co-use of cannabis and tobacco is of increasing public health concern, yet relatively little is known about co-use among SGM emerging adults.
METHODS: Data were from a cross-sectional survey (2020 – 2021) of 1,467 SGM (n = 868) and non-SGM (n = 623) emerging adults from California. To be eligible, participants reported using at least one tobacco product in the prior 30 days. We assessed differences in lifetime and recent (past 3-month) cannabis use, and in concurrent use of both substances, across six groups: cisgender heterosexual, cisgender sexual minority (SM), transgender/gender non-conforming (TGNC) participants assigned female at birth (AFAB), and cisgender heterosexual, cisgender SM, and TGNC participants assigned male at birth (AMAB).
RESULTS :Among AFAB, cisgender SM and TGNC participants (vs. cisgender heterosexual) had higher odds of lifetime (cisgender SM: aOR = 2.38, 95 % CI = 1.54, 3.72; TGNC: aOR = 1.97, 95 % CI = 1.17, 3.40) and recent cannabis use (cisgender SM: aOR = 1.72, 95 % CI = 1.29, 2.30; TGNC: aOR = 1.83, 95 % CI = 1.29, 2.61), and of concurrent use (cisgender SM: aOR = 1.49, 95 % CI = 1.11, 2.00; TGNC: aOR = 1.98, 95 % CI = 1.39, 2.82). No differences in cannabis and tobacco co-use were noted among AMAB.
CONCLUSION: Cisgender SM and TGNC AFAB are at high risk for cannabis and tobacco co-use. Prevention and harm reduction interventions should be tailored to these groups.
Cannabis use patterns among emerging adults in California who use tobacco: Differences by sexual identity, gender identity, and sex assigned at birth
Addictive Behaviors Reports, 22, 100624. doi: 10.1016/j.abrep.2025.100624. PMCID: PMC12302247.