In Western Europe, the prevalence of cannabis use in boys decreased in a significant linear trend . In this study, the school level explained 13.4% of the outcome, which is in line with previous research , but the school funding level explained only 0.2%, which in Chile could be seen as a proxy for the family’s income situation. Families with higher income tend to have their children in private schools. For Europe and North America, cannabis use in adolescents became less characteristic for countries with high gross domestic product per capita and in families with high affluence, whereas it became more characteristic for boys with an increasing gender gap . Adolescents are especially sensitive to peer influence, social environments and social cues . Perceived availability and peer contacts were strongly associated with cannabis use in North America and Europe . In our study, having friends who regularly use cannabis was the most important factor associated with cannabis use. In line with the increase of prevalence in cannabis use, the use among friends also increased, so that a normalization of cannabis use may have occurred among adolescents. A majority of adolescents had friends who regularly use cannabis. Parental rejection has increased in contrast with the normalization hypothesis, the strength of association with cannabis use in adolescents has also increased. This could indicate that cannabis use is normalized among adolescents, while there is broad consensus among parents in Chile that cannabis use is not good for their adolescent children. Parental rules limiting cannabis use and support were associated with less cannabis use among adolescents in the literature . In Europe, time spent with parents has been described as a potential protective factor for lifetime cannabis use .
The international literature shows that the substance use of family members and parents increased the risk of use among teenagers , which may reflect in low parental rejection. Low risk perception has widely been associated with cannabis grow equipment use in adolescents. Low risk perception could predict the new incidence of cannabis use in the following year in the United States . Interventions aimed to promote the perception of harm of cannabis use may be useful for prevention among adolescents. Attitudes in the community, among parents and peers reciprocally influence the prevalence of cannabis use among adolescents over time . Further factors associated with the use of substances have been studied, such as, socioeconomic status, academic performance, parental monitoring, peer use, sports and leisure time activities among others . There may be common risk factors for the use of several substances in adolescents . However, the prevalence of different substances can show opposite trends. Therefore, it is necessary to address each substance specifically. The increase of cannabis use, while tobacco use decreased, and a positive association between the use of both substances, might indicate a trend that cannabis use is replacing tobacco use among adolescents. This may be related to more legal regulations in place restricting tobacco use among adults, while new regulations propose legalization of cannabis sales in Chile. This is in line with international trends to more permissive legislations regarding cannabis use in recent years . International recommendations orienting national policies do not encourage those policies to decriminalize cannabis use taking into consideration the risks especially for adolescents .The prevalence of adolescent cannabis use has more than doubled in Chile and exceeds the rates in all other countries of the Americas in line with the normalization hypothesis. This has come with important changes of prevalence and strength of association in factors associated with cannabis use. Adolescents now are more exposed to friends who use cannabis, which remains the single most important risk factor.
Parental rejection of cannabis use remains high, but low parental rejection is increasingly associated with cannabis use. These findings may inform new prevention strategies.Key shifts in regulatory policy and technological innovation in recent years have dramatically changed the nicotine and cannabis product landscape in the U.S. These changes appear to be particularly salient to shifting patterns of nicotine and cannabis use among young adults Since the early 2000s, cigarette use has declined among young adults, while cannabis use has steadily increased . Over this same period, perceptions of risk associated with regular use of cannabis among young adults have declined considerably . Moreover, electronic cigarettes are widely popular among young adults, both as a means of consuming nicotine and cannabis . For example, Ramo, Young-Wolff, and Prochaska found that prevalence of past-month e-cigarette use among young adults increased from 6% in 2009 to 41% in 2013 . Of concern, ecigarette use among young adults is prospectively associated with subsequent initiation of both cigarettes and cannabis . The public health significance of e-cigarette use is further underscored by the recent surge in acute vaping-related respiratory illness and death across the U.S. . Public health concerns around evolving patterns of nicotine and cannabis product use may be particularly relevant for sexual minority young adults, who report considerably higher rates of cigarette and cannabis use and dependence compared to their heterosexual peers. Longitudinal data show that sexual minority adolescents not only initiate cigarette and cannabis use at an earlier age than heterosexual adolescents, but also increase their use of both products into adulthood at a faster rate . This trend appears to be especially pronounced among bisexual females . The state of the literature on sexual minority-related disparities in ecigarette use among young adults is lacking relative to other popular substances used by this population . Moreover, the bulk of existing research on ecigarette use among sexual minority individuals focuses predominantly on adolescent or adult populations, leaving the interim developmental window of young adulthood largely neglected with limited exception .
The few studies that have assessed e-cigarette use among sexual minority individuals during young adulthood have utilized selective, circumscribed samples , college students , and frequent bar patrons . These studies generally indicate greater prevalence of e-cigarette use among sexual minority young adults , with especially high profiles of risk observed for bisexual and lesbian women . Young adulthood can be an especially challenging developmental window, which may partially explain its association with peak risk for substance use in the general population . Given that processes of sexual identity formation typically unfold during this period, risk for substance use among sexual minority young adults may be further compounded by feelings of confusion, repression, and internalized shame that accompany the integration of a stigmatized sexual identity into one’s self-concept . Recent evidence indicates that substance use disparities among sexual minorities are most pronounced during young adulthood , which further underscores the need for additional empirical evidence characterizing sexual minority individuals’ use of e-cigarettes during this formative developmental window. Beyond limitations stemming from the relative dearth of research on e-cigarette use, extant literature on sexual-minority-related disparities in nicotine and cannabis product use during young adulthood often collapse different identities into a single “sexual minority” group . This practice precludes any analysis of within-group variance in substance use outcomes, which is not ideal given growing evidence of especially high-risk profiles for nicotine and cannabis use among young sexual minority individuals who are female and/or bisexual . The current study used 2016 data from young adults in the Southern California Children’s Health study to evaluate the association of sexual identity with use of e-cigarettes,vertical grow system cigarettes, and cannabis, and to determine whether these associations differed by gender. The present study found that bisexual young adults, compared to other sexual identity sub-groups, had the greatest odds of use for nearly all nicotine and cannabis product use history outcomes evaluated. In addition to being more likely than heterosexual participants to report nicotine and cannabis product use, bisexual participants also exhibited higher odds of product use in comparison to lesbian and gay participants.
Although the small sample sizes for the bisexual comparisons likely reduced the power to detect statistically significant differences in prevalence estimates , these findings suggest that collapsing data across all sexual minority identities may mask the considerable variability that exists within this diverse population. As such, our results underscore the need for researchers and clinicians to move away from treating separate sexual minority identities as a monolithic group. Results from the current study cohere with previous cross-sectional studies demonstrating that bisexual adolescents’ and young adults’ risk for nicotine and cannabis product use is not only disproportionately high relative to heterosexual individuals, but to other sexual minority individuals as well . Additionally, examining the relation of sexual identity to separate categories of “prior use” , “infrequent past 30-day use” , and “frequent past 30-day use” , we provide important nuance to understanding gradients of hazardousness that characterize sexual minority young adults’ use of nicotine and cannabis products as well as the attendant risk for developing dependence on them. For example, prior studies have shown that bisexual young adults are more likely than heterosexual young adults to report any history of past 30-day nicotine and cannabis product use . Although we observed disparities between bisexual and heterosexual young adults for nearly every nicotine and cannabis product use history outcome evaluated, it is notable that the greatest of such disparities consistently emerged for the “frequent past 30-day” use category. Importantly, this finding not only suggests that bisexual young adults are more likely to report any history of current nicotine and cannabis product use, but also that they may be more likely to report high-risk patterns of current use. There are several possible explanations as to why bisexual young adults exhibited a higher risk profile for nicotine and cannabis product use than any other sexual identity sub-group in our study. Along with their gay and lesbian peers, bisexual young adults face stressors beyond those common to the emerging adulthood experience . Exposure to this type of sexual minority-specific stress has been implicated in the substance use of sexual minority young adults. For example, qualitative data demonstrate that sexual minority young adults report using substances to cope with internalized stigma, familial rejection, and structural stigma . In quantitative studies, exposure to sexual minority-specific stressors has been found to mediate disparities in substance use among sexual minority young adults . Beyond having to navigate homophobia, bisexual individuals also regularly confront stigma and erasure within the sexual minority community, where the legitimacy of bisexuality as a stable and authentic sexual identity is often dismissed . Prior work demonstrates that this kind of “double discrimination” routinely encountered by bisexual individuals in heterosexual and queer contexts alike exacerbates their motivation to smoke as a means of coping with uncomfortable situations related to their bisexuality .
A similar mechanism may account for the elevated prevalence of nicotine and cannabis product use observed among bisexual young adults in our study. With respect to cigarette use only, we also found that bisexual identity was significantly associated with higher odds of lifetime use among female, but not male, young adults in our sample. While it did not reach statistical significance, there was a non-significant trend of sexual identity × gender interaction with lifetime history of e-cigarette use . It will be important for future studies to further investigate this interaction to see if this this trend generalizes to other nicotine products. Although we were surprised that this interaction was not also observed for lifetime cannabis use, these findings align with an emergent trend in the literature showing compounded risk for substance use among sexual minority females . Bisexual-identified adolescent females report stronger pro-drug beliefs, lower resistance self-efficacy, higher perceived parental approval of their substance use, and greater exposure to substance-using peers than heterosexual-identified adolescent females—all of which have been found to prospectively predict disparities in substance use observed in emerging adulthood . It is likely that these factors play a role in the elevated odds of nicotine product use observed among bisexual female young adults here and in prior work. We found no significant differences in reported use of any nicotine and cannabis product between heterosexual young adults. However, given the small sample size of lesbian/gay individuals in this study, it is possible that it was under powered to detect group differences for this particular comparison. Nevertheless, this finding is surprising as it does not align with minority stress theory, which suggests that substance use is one coping mechanism that sexual minority individuals may utilize as a consequence of their disproportionate exposure to stigma-related stress .