Alcohol Use, Cannabis Use, and Discrimination by Sexual Orientation and Gender Identity Within the All of Us Research Program.

PURPOSE: Sexual and gender minority (SGM) populations face substance use disparities attributed to minority stress. We examined the relationship between discrimination and alcohol and cannabis use among SGM and cisgender heterosexual people.

METHOD: We conducted a cross-sectional analysis of the All of Us Research Program data (2017-2022) to examine the relationship between discrimination (Everyday Discrimination Scale [EDS]) and alcohol use (Alcohol Use Disorders Identification Test-consumption items [AUDIT-C]) and past 3-month cannabis use. Adjusted linear and logistic regression models were used for AUDIT-C scores and past 3-month cannabis use, respectively. We used interaction terms to assess how associations differed across sexual orientation and gender modality groups.

RESULTS

Among 98,820 participants, mean EDS scores were highest among gender minority (GM) people assigned female at birth (M = 14.78) and lowest among cisgender heterosexual men (M = 6.14). There was a nonlinear association between EDS and AUDIT-C scores. EDS scores were positively associated with AUDIT-C scores at low levels of discrimination; there was an inverse association at higher levels of EDS. EDS was associated with greater odds of past 3-month cannabis use, but associations were not significant at 2 standard deviations above mean EDS and higher. Interaction by sexual orientation and gender modality group was significant (p < 0.05), indicating that associations between discrimination and alcohol and cannabis use varied by group. Although estimates were largely imprecise, associations particularly varied among GM groups and cisgender sexual minority men.

CONCLUSION

Discrimination had a nonlinear relationship with alcohol and cannabis use, and these relationships were pronounced among SGM subgroups.