Sexual and gender minority youth had higher odds of future marijuana use but stress did not explain why

SGM youth had higher odds of past suicide attempts, major depressive disorder, and future marijuana use, but not future nicotine use. Contrary to the minority stress hypothesis, family conflict, discrimination, and trauma did not mediate the SGM-marijuana use association. However, these stressors were independently associated with outcomes: discrimination predicted all outcomes, trauma predicted suicide, nicotine, and marijuana use, and family conflict predicted all outcomes except depression.

ABCD Study data with SGM identity reported at baseline. Structural equation modeling (SEM) tested direct and indirect pathways linking SGM identity to mental health and behavioral outcomes including future marijuana and nicotine use.

The finding that stress does not explain the SGM-marijuana use link challenges the dominant minority stress framework and suggests other mechanisms are at play. This matters for intervention design: reducing discrimination and family conflict will help but may not close the marijuana use disparity.

The minority stress model predicts that stressors experienced by SGM youth explain their elevated substance use. This study's failure to find mediation suggests the pathway from SGM identity to marijuana use involves additional mechanisms, possibly including peer networks, identity exploration, or biological factors not captured by stress measures.

ABCD Study participants are children/adolescents; SGM identity may still be emerging. Stressor measures may not capture all relevant minority stress experiences. Marijuana use was measured at follow-up but initiation timing is uncertain. SEM assumes causal ordering that may not reflect the actual temporal sequence.