PROJECT SUMMARY/ABSTRACT
Sexual minority women (e.g., lesbian, bisexual, queer women) and gender diverse (e.g., non-binary)
sexual minorities assigned female at birth are at elevated risk for cannabis use disorder (CUD) compared to
heterosexual women. Alarmingly, rates of CUD are increasing for sexual minority women and gender diverse
individuals (SMWGD) as well as heterosexual women, with more rapid increases among SMWGD leading to
growing disparities in CUD. This highlights the urgent need for CUD research in both populations.
Examining event-level risk processes clarifies the temporal order of risk factors and CU in near-real time.
However, ecological momentary assessment (EMA) studies, including our own, provide mixed evidence for two
sets of risk factors for CU: risk factors related to increasing positive affect (positive reinforcement; e.g.,
enhancement motives, social use) and decreasing negative affect (negative reinforcement; e.g., coping
motives, solitary use). SMWGD also experience unique positive and negative reinforcement risk factors (e.g.,
CU with SMWGD; minority stress). Providing a potential explanation for mixed evidence, our preliminary
results and the multistage model of substance use suggest these two sets of risk factors may be relevant at
different stages of CUD, with positive reinforcement most relevant when CUD symptoms are absent to mild
and negative reinforcement becoming dominant when CUD symptoms become more severe. We propose to
empirically test a theoretical model that incorporates the multistage model and unique risk factors for SMWGD.
We will use a measurement burst design, with 5 semi-annual bursts of 14-days of EMA (2 surveys per day),
allowing us to examine changes in event-level effects of risk factors on CU as a function of longer-term (i.e.,
semi-annual) changes in CUD symptoms. We will include SMWGD and heterosexual women, allowing us to
identify similarities and differences in effects of shared risk factors on CU for these two groups, determine if
differences in CU trajectories contribute to CUD disparities, and identify unique risk factors for SMWGD.
The purpose of this R01 is to advance our understanding of CUD among SMWGD and heterosexual
women, with a focus on how event-level associations between risk factors and CU change as CUD develops.
We will use a measurement burst design, with 400 SMWGD and 200 heterosexual women (age 18-25) who
use cannabis at least weekly. The proposed study will accomplish three specific aims: 1) identify changes in
the effects of event-level risk factors on CU as CUD develops, 2) test for differences in effects of shared event-
level risk factors on CU for SMWGD and heterosexual women, and 3) determine if differences in CU
trajectories for SMWGD and heterosexual women contribute to disparities in the development of CUD. The
proposed study will inform efforts to increase efficacy of existing CUD interventions for heterosexual women
and determine which risk factors should be targeted in interventions for SMWGD. The proposed study is in
response to NOT-MD-19-001 and NIDA priorities to understand substance use disparities affecting SMWGD.
