Brazilian LGBTQ+ adolescents, especially those assigned female at birth, had nearly twice the odds of cannabis use and started using substances earlier than cisgender heterosexual peers.
Public health professionals; substance use prevention researchers; those working with LGBTQ+ youth populations.
LGBTQ+ youth had 1.94x odds of lifetime cannabis use
What the researchers found
LGBTQ+ adolescents in Brazil had significantly higher lifetime prevalence of cannabis use (OR=1.94) and tobacco use (OR=1.66) compared to cisgender heterosexual peers. These differences were driven entirely by participants assigned female at birth, with no significant differences among males.
Why it matters
This is one of few studies from a low- or middle-income country examining substance use disparities among LGBTQ+ youth, revealing that the pattern seen in US/European data also holds in Brazil, with a striking sex-assigned-at-birth difference.
The numbers in context
Cannabis OR=1.94 (95% CI 1.42-2.64). Tobacco OR=1.66 (95% CI 1.22-2.26). Differences driven by those assigned female at birth. LGBTQ+ females reported earlier initiation of alcohol (p=0.001), tobacco (p<0.05), and cannabis (p<0.001).
How the study worked
Longitudinal community-based cohort study (Brazilian High-Risk Cohort Study) following 1,492 participants aged 9-21 across two waves. Assessed sexual orientation, gender identity, and lifetime use of alcohol, tobacco, cannabis, and cocaine.
What this study cannot tell us
Self-reported substance use. Brazilian cultural context may not generalize to all LMICs. Lifetime prevalence doesn't capture current use patterns. Sexual orientation and gender identity categories may not capture full diversity.
How to read the evidence
Longitudinal cohort study with reasonable sample size, but relies on self-reported data.
When this study was published
2025 study
The bigger picture
Minority stress theory suggests that the psychosocial stressors facing LGBTQ+ youth may drive higher substance use. The sex-assigned-at-birth difference suggests these stressors may disproportionately affect certain subgroups.
Questions still open
- Why were differences concentrated among those assigned female at birth? Would targeted prevention programs reduce these disparities? How does intersectionality with race and socioeconomic status affect these patterns in Brazil?
Common questions
Why were differences only seen in those assigned female at birth?
Is this pattern unique to Brazil?
Read the original research
Patterns of substance use and initiation among LGBTQIAPN+ youth in Brazil: Evidence from a population-based cohort.
International review of psychiatry (Abingdon, England), 37(6-7), 639-650
Citation
Figueiredo, Caio Petrus Monteiro; Alves Bezerra, Henrique; Miguel, Euripedes Constantino; Rohde, Luis Augusto; Salum, Giovanni Abrahão; Pan, Pedro Mario; Caye, Arthur. (2025). Patterns of substance use and initiation among LGBTQIAPN+ youth in Brazil: Evidence from a population-based cohort.. International review of psychiatry (Abingdon, England), 37(6-7), 639-650. https://doi.org/10.1080/09540261.2025.2573758
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