Sexual Minority Youth Show Distinct Cannabis Escalation Patterns from Ages 17 to 24 | Research

The takeaway

Swiss sexual minority males showed steep increases in cannabis and stimulant use from ages 17-24, surpassing all other groups in polysubstance use, while sexual minority females started high but plateaued — revealing different intervention timing needs.

LGBTQ+ youth health providers, substance use prevention designers, adolescent medicine specialists, and researchers studying sexual minority health disparities.

What the researchers found

Sexual minority males exhibited the sharpest escalation in cannabis, stimulant, and polysubstance use from 17-24, reaching the highest levels by 24, while sexual minority females started with high use at 17 that plateaued by 20-24. The proportion identifying as sexual minority nearly doubled from 11.3% at 17 to 23.4% at 24.

Why it matters

The distinct escalation timelines between sexual minority males (late sharp rise) and females (early high plateau) mean that one-size-fits-all prevention programs will miss their target — timing matters.

The numbers in context

N=1,384; SM proportion: 11.3% (age 17) → 23.4% (age 24); SM males: lowest at 17, highest PSU by 24; SM females: high at 17, plateau by 20; hair-tested validation at 20 and 24; predictors: peer SU, low self-control, sensation-seeking, internalizing symptoms

How the study worked

Longitudinal cohort analysis of 1,384 participants from the Zurich Project on Social Development from Childhood to Adulthood, with self-reported and hair-tested substance use at ages 17, 20, and 24, using linear mixed-effect models.

What this study cannot tell us

Swiss sample may not generalize globally; sexual minority identification changed over time (fluid identity); small SM subgroups limit statistical power; substance use norms differ across countries; hair testing captures only some substances.

How to read the evidence

Population-based longitudinal cohort with hair-tested biomarker validation provides strong developmental evidence, though Swiss context and changing SM identification limit generalizability.

When this study was published

Published 2026; data from the Zurich longitudinal project.

The bigger picture

These findings demonstrate that sexual orientation-related substance use disparities emerge through different developmental pathways, requiring prevention strategies tailored to both the population and developmental stage.

Questions still open

What drives the late escalation in SM males? Would earlier intervention for SM females prevent the high starting point at 17? Are these patterns similar in countries with different LGBTQ+ social acceptance levels?

Common questions

Do LGBTQ+ youth use more cannabis?

By age 24, sexual minority youth used more cannabis, stimulants, and ecstasy than heterosexual peers in this Swiss study, but the timing of escalation differed: females started high at 17 while males showed sharp increases in their early 20s.

When should prevention programs target sexual minority youth?

The answer depends on sex: sexual minority females need early intervention (before 17) as their use is already elevated, while sexual minority males need intervention in their late teens and early 20s when their use sharply escalates.

Read the original research

How do substance and polysubstance use trajectories differ by sexual attraction from ages 17 to 24? A community-based longitudinal cohort study in Switzerland.

BMJ public health, 4(1), e003583

View on PubMed ↗Publisher’s paper ↗

Citation

Janousch, Clarissa; Vock, Florian; Winter, Babette L; Hässler, Tabea; Eggenberger, Lukas; Bechtiger, Laura; Loher, Michelle; Binz, Tina Maria; Baumgartner, Markus R; Ribeaud, Denis; Eisner, Manuel; Quednow, Boris B; Shanahan, Lilly. (2026). How do substance and polysubstance use trajectories differ by sexual attraction from ages 17 to 24? A community-based longitudinal cohort study in Switzerland.. BMJ public health, 4(1), e003583. https://doi.org/10.1136/bmjph-2025-003583