# Cannabis use patterns among emerging adults in California who use tobacco: Differences by sexual identity, gender identity, and sex assigned at birth

## TL;DR

Sexual and gender minority emerging adults assigned female at birth in California are more likely to use cannabis and tobacco together compared to their heterosexual and cisgender peers.

## Contribution

The study identifies higher odds of cannabis and tobacco co-use among sexual and gender minority AFAB emerging adults compared to non-SGM peers.

## Key findings

- Cisgender sexual minority and TGNC AFAB participants had higher odds of cannabis use and co-use compared to cisgender heterosexual AFAB participants.
- No significant differences in cannabis or co-use were observed among AMAB participants.
- Findings highlight the need for targeted prevention and harm reduction strategies for SGM AFAB individuals.

## Abstract

•SM (vs. heterosexual) AFAB participants had higher odds of cannabis use.•TGNC (vs. cisgender) AFAB participants had higher odds of cannabis use.•SM (vs. heterosexual) AFAB participants had higher odds of concurrent use.•TGNC (vs. cisgender) AFAB participants had higher odds of concurrent use.•No differences in cannabis use and co-use were noted among AMAB participants.

SM (vs. heterosexual) AFAB participants had higher odds of cannabis use.

TGNC (vs. cisgender) AFAB participants had higher odds of cannabis use.

SM (vs. heterosexual) AFAB participants had higher odds of concurrent use.

TGNC (vs. cisgender) AFAB participants had higher odds of concurrent use.

No differences in cannabis use and co-use were noted among AMAB participants.

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.

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).

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.

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.