Date of Award

January 2025

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

John E. Pachankis

Second Advisor

Danielle Chiaramonte

Abstract

Cannabis use has increased substantially among U.S. adults, yet disparities by sexual orientation and sex remain underexplored, particularly regarding frequency and consumption modality (Hammond et al., 2022; Dyar, 2022). Leveraging 2022–2023 Behavioral Risk Factor Surveillance System (BRFSS) data from eight U.S. states, this study examined patterns of past-month cannabis use among U.S. adults, stratified by sexual orientation–sex group (e.g., bisexual women, gay men).Guided by minority stress theory and prior research (Dyar, 2022; Meyer, 2003; Poole et al., 2021; Schofield et al., 2023), we hypothesized that sexual minority adults, especially bisexual individuals across both sexes, would report: (1) higher prevalence of past-month cannabis use; (2) more frequent use among past-month users; and (3) greater engagement in non-traditional and multimodal consumption (e.g., vaping, edibles, dabbing) than their heterosexual peers. Bisexual women reported the highest prevalence of cannabis use (39.7%), with bisexual (32.5%) and gay (29.6%) men also exceeding heterosexual peers (17.2%). Adjusted odds of cannabis use were significantly higher among bisexual women (AOR = 2.49; p < .001), bisexual men (AOR = 1.57; p = .026), and gay men (AOR = 1.64; p = .022) compared to heterosexual counterparts. Among past-month users, bisexual women (18.7 days/month) reported significantly more frequent use than heterosexual women (16.0 days/month) (IRR = 1.14; p = .044); no significant frequency differences were found among men. Multimodal use (e.g., using two or more consumption modalities in a month) was most common among bisexual men (68.0%) and bisexual women (59.4%). In adjusted models, bisexual men (AOR = 2.30; p = .003) and bisexual women (AOR = 1.88; p = .002) had significantly greater odds of multimodal use than heterosexual peers. These findings reveal consistent disparities across prevalence, frequency, and modality—particularly among bisexual adults—and underscore the need for identity-informed public health surveillance and interventions. As cannabis use becomes increasingly normalized, inclusive data systems and targeted harm reduction strategies are essential for addressing inequities in cannabis-related behaviors.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 12/16/2025

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