Ecological momentary assessment of daily minority stressors and cannabis and tobacco co-use among sexual minority young adults - PROJECT SUMMARY Past-month cannabis use and tobacco use, independently, is 2 times higher in sexual minority young adults (SMYAs) (defined here as lesbian, gay, queer, bisexual/bisexual+3) compared to their heterosexual peers.4 Young adulthood is a vulnerable period for substance use initiation and progression5-7, coming out8, 9, and experiencing sexual orientation discrimination.10 In fact, nearly 1 in 6 young adults (YAs) identifies as a sexual minority (SM). Bisexual and bisexual+ (bi/bi+) identity is the most common and fastest growing group of all SM identities,11 and individuals who identify as bi/bi+ are at greatest risk for tobacco and cannabis use, independently, relative to both heterosexual and gay/lesbian individuals.12,13 Cannabis and tobacco co-use (referred to as CAN-TOB co-use) has become increasingly popular in the general population14-20, particularly among young adults (YAs), yet little is known about CAN-TOB co-use in SMYAs.21 This is concerning, as CAN-TOB co-use is correlated with greater cannabis and nicotine dependence,22, 23 poorer tobacco and cannabis cessation outcomes,24, 25 as well as substance use and mental health problems,6, 26-31 relative to single use of either. The popularity of non-cigarette tobacco products (e-cigarettes, cigars, etc.) among SMYAs is also concerning, as these can be used as vehicles to consume cannabis.32-35 Minority Stress Theory36 indicates that coping with sexual minority stressors (e.g., experiences of discrimination) is an important reason for substance use among SM individuals.36, 37 Cannabis use has been associated with mood enhancement and tension-reduction, and may be particularly appealing to SMYAs as a means to cope with minority stress experiences. Certain patterns of CAN-TOB co-use, like blunt smoking, which result in an intense high38, 39, may appreciably temper or mitigate the negative mental and emotional impacts of daily and “in the moment” minority stressors, and encourage future use of cannabis or other substances, placing SM individuals at greater risk for negative consequences.40 Little data exist on day-to-day and “in the moment” minority stressors and how they are correlated with different patterns of CAN-TOB co-use and single use among SMYAs. This proposal addresses this gap by seeking to characterize different minority stressors among SMYAs and examine their associations to daily patterns of CAN-TOB co-use and single use, in a sample of 150 SMYAs (ages 18-25) who are current tobacco users and consume cannabis > 2 a week. It is responsive to NOT-OD-22-166 (Research on the Health of Bisexual and Bisexual+ People). Participants will track CAN-TOB single use and co-use as well as “in the moment” minority stressors (e.g., daily experiences of discrimination) twice daily for 28 days via ecological momentary assessment (EMA). We will characterize patterns of CAN-TOB single use and co-use and assess the indirect association of daily minority stressors on the association of sexual orientation (bi/bi+ vs. monosexual) with these patterns of use. Findings will inform the development of a future “just in time” intervention designed to target responses to minority stress experiences in “real time” to reduce CAN-TOB single use and co-use among SMYAs. The longer- term goal of this proposal is to identify the behavioral mechanisms contributing to substance use disparities in SM individuals and to evaluate feasible intervention targets to reduce health disparities across sub-groups of SM people.
