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Study breakdown

Black men who have sex with men reported more cannabis use and lower ability to refuse cannabis than other Black men

Cross SectionalModerate evidence
The takeaway

Black MSM reported higher rates of tobacco and cannabis use and lower cannabis refusal self-efficacy than Black non-MSM, with cannabis use mediating the pathway from sexual minority status to tobacco use.

Substance use researchers, LGBTQ+ health providers, harm reduction specialists

121 of 202 Black men reported cannabis use in the past 30 days

What the researchers found

MSM reported more tobacco and cannabis use and lower cannabis refusal self-efficacy; path analysis showed indirect effects linking MSM status to tobacco use through cannabis refusal self-efficacy and cannabis use.

Why it matters

Cannabis and tobacco co-use patterns differ across populations, and understanding how minority stress drives substance use among Black MSM can inform targeted harm reduction.

The numbers in context

202 participants; 68 reported tobacco use, 121 reported cannabis use, 62 reported co-use in past 30 days; MSM had higher rates across all measures.

How the study worked

Cross-sectional study of 202 Black men ages 18-34 (94 MSM, 108 non-MSM); measured past-30-day substance use and cannabis refusal self-efficacy; path analysis guided by minority stress theory.

What this study cannot tell us

Cross-sectional design prevents causal claims; convenience sample may not represent all Black MSM; self-reported substance use; single geographic area.

How to read the evidence

Path analysis with theory-driven model, but cross-sectional design and convenience sample limit generalizability.

When this study was published

Published 2025

The bigger picture

Minority stress theory suggests intersecting identities (Black, male, sexual minority) compound substance use risk, with cannabis refusal self-efficacy as a potential intervention target.

Questions still open

  • Would strengthening cannabis refusal self-efficacy reduce both cannabis and tobacco use in Black MSM? Do these patterns hold across different age groups and regions?

Common questions

Did sexual orientation affect cannabis use among Black men?
Yes. Black MSM reported higher rates of cannabis use, tobacco use, co-use, and lower cannabis refusal self-efficacy compared to Black non-MSM.
How were cannabis and tobacco use connected?
Path analysis found cannabis use mediated the relationship between MSM status and tobacco use, suggesting cannabis use may serve as a pathway to tobacco among Black MSM.

Read the original research

Tobacco and Cannabis Use and co-Use, and Cannabis Refusal Self-Efficacy Among Black Men: A Cross-Sectional Study Examining Differences Between Men Who Have Sex with Men (MSM) and Non-MSM.

Substance use & misuse, 1-9

Citation

Chang, Kyle; D'Anna, Laura Hoyt; Owens, Jaelen; Wood, Jefferson L. (2025). Tobacco and Cannabis Use and co-Use, and Cannabis Refusal Self-Efficacy Among Black Men: A Cross-Sectional Study Examining Differences Between Men Who Have Sex with Men (MSM) and Non-MSM.. Substance use & misuse, 1-9. https://doi.org/10.1080/10826084.2025.2592877

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