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Study breakdown

Sexual minority youth face higher rates of child maltreatment and at-risk cannabis use

Longitudinal CohortModerate evidence
The takeaway

Bisexual young adults showed the strongest associations with both child maltreatment exposure and at-risk cannabis use compared to heterosexual peers.

Youth health researchers, LGBTQ+ health advocates, substance use prevention specialists

7.45x increased odds of intimate partner violence for youth with uncertain sexual identity

What the researchers found

In a longitudinal study of 584 Canadian emerging adults tracked from ages 14-17 to 18-23, bisexual identity was associated with increased odds of depression, anxiety, at-risk alcohol use, and at-risk cannabis use compared to heterosexual identity. Bisexual identity also had the most robust relationships with all child maltreatment outcomes.

Why it matters

Sexual minority youth, particularly those identifying as bisexual, face compounding risks of maltreatment and substance use that demand targeted prevention. Understanding these intersecting vulnerabilities helps identify who needs early intervention most.

The numbers in context

n=584 emerging adults; bisexual identity had the most robust association with at-risk cannabis use; "I don't know" sexual identity showed 7.45 increased odds of intimate partner violence exposure

How the study worked

Data from the longitudinal Well-Being and Experiences (WE) Study in Manitoba, Canada, following 584 participants from 2017 (ages 14-17) to 2022 (ages 18-23). Descriptive statistics and logistic regression models compared outcomes across sexual identity groups.

What this study cannot tell us

Single Canadian province limits generalizability. Self-reported measures of maltreatment and substance use may underestimate true rates. Relatively small sample size for subgroup analyses across multiple sexual identity categories.

How to read the evidence

Longitudinal design with structured follow-up strengthens causal inference, though moderate sample size and single-province recruitment limit generalizability.

When this study was published

2025 publication analyzing data collected 2017-2022

The bigger picture

This study adds to growing evidence that substance use risk in young people cannot be separated from experiences of identity-based adversity and trauma, reinforcing the need for prevention approaches that address root causes rather than substances alone.

Questions still open

  • Do targeted maltreatment prevention programs for sexual minority youth reduce subsequent substance use risk? What protective factors buffer against at-risk cannabis use in bisexual emerging adults?

Common questions

Which sexual identity group showed the highest risk for cannabis use?
Bisexual identity had the most robust association with at-risk cannabis use compared to heterosexual identity, along with stronger links to depression and anxiety.
Did the study prove maltreatment causes cannabis use in sexual minorities?
No. The study found associations between sexual minority identity, maltreatment, and substance use, but the observational design cannot establish that maltreatment directly causes cannabis use.

Read the original research

Sexual identity, child maltreatment, mental health, and substance use among emerging adults aged 18 to 23 years.

Canadian journal of public health = Revue canadienne de sante publique, 116(5), 674-685

Citation

Afifi, Tracie O; Osorio, Ana; Fortier, Janique; Stewart-Tufescu, Ashley; Taillieu, Tamara L; McCarthy, Julie-Anne. (2025). Sexual identity, child maltreatment, mental health, and substance use among emerging adults aged 18 to 23 years.. Canadian journal of public health = Revue canadienne de sante publique, 116(5), 674-685. https://doi.org/10.17269/s41997-024-00992-5

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