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Multilevel Stressors are Associated with Cannabis Use in Young Black Men and Black Transgender Women in Chicago: The Neighborhoods and Networks (N2) Cohort Study

Renessa Williams
University of Miami

Co-Authors: Ella Remund1, Ellen Almirol1, Yen-Tyng Chen2, Adam Carrico3, Jade Pagkas-Bather1, Denise Vidot4, Justin Knox5, John Schneider1, Dustin T Duncan6
1University of Chicago, 2Rutgers University, 3Florida International University, 4University of Miami, 5Columbia University, 6New York University

Introduction: Black gay, bisexual, and other sexual and gender minorities (SGM) must contend not only with racial minority stress (e.g., race-related housing and job discrimination, racism within and outside the LGBTQ+ community), but with sexual minority stress as well (e.g., sexual minority-related discrimination, SM-related violence, homophobia). According to the Sexual and Gender Minority (SGM) Health Disparities Research Framework, multilevel stress encompasses individual (e.g., socioeconomic status, demographics), interpersonal (e.g., discrimination), community (e.g., safe spaces) and structural (e.g., neighborhood conditions) factors that may further contribute to health inequities in the Black SGM community.  There is evidence to suggest cannabis use is linked to stress, therefore, assessing multi-level stressors may yield novel insights into the broader determinants of health that contribute to cannabis use.

Methods: Cross-sectional data from a Chicago-based cohort of Black men and Black transgender women aged 16-35 years were collected from October 2022 to February 2023 (N=553). Correlates were chosen based on the SGM framework, in which participants self-reported multilevel stressors including age, gender, income, employment, mental health, discrimination, violence, incarceration, neighborhood access and safety. Further, the Cannabis Use Disorders Identification Test (CUDIT-R) identified non-hazardous use, hazardous use, and possible cannabis use disorder based on established cutoffs. Bivariate analyses and regression models were used to examine the correlates associated with cannabis use.

Results: Among our sample of cannabis users (N=489, 88%), 62% were older than 27 years, 83% were cis-gender male, 59% were gay, and 55% were living with HIV. Among those who reported symptoms of possible cannabis use disorder (n=250, 51%), approximately 56% had experienced intimate partner violence (IPV), 37% had anxiety symptoms, and 44% were incarcerated, which was proportionally higher than those who reported hazardous or non-hazardous use.  Compared to those with non-hazardous use, those with possible use disorder had a significantly greater likelihood of reporting individual-level stress including anxiety symptoms (OR 2.27, 95% CI 1.24, 4.10, p<0.01) and microaggressions (OR 1.66, 95% CI 1.00, 2.75, p=0.05). Those with possible cannabis use disorder were also significantly more likely to experience IPV (OR 1.88, 95% CI 1.12, 3.15, p=0.02) compared to non-hazardous users, an interpersonal stressor. No significant differences were observed between participants with or without hazardous cannabis use.

Conclusion: Findings suggest multiple levels of stress are associated with cannabis use. Future research should consider how mental health, discrimination, and violence mediate cannabis usage to mitigate stress and improve health among Black SGM, a population underrepresented in health research.