The link between discrimination and cannabis use varied significantly across sexual orientation and gender identity groups

Discrimination (measured by the Everyday Discrimination Scale) was positively associated with cannabis use at low-to-moderate levels but the association was not significant at very high discrimination levels. The relationship between discrimination and substance use varied significantly by sexual orientation and gender identity, with pronounced differences among gender minority groups.

Cross-sectional analysis of 98,820 participants from the All of Us Research Program (2017-2022). Adjusted logistic regression examined the relationship between Everyday Discrimination Scale scores and past 3-month cannabis use. Interaction terms assessed differences across sexual orientation and gender modality groups.

The nonlinear finding is important: at very high levels of discrimination, the association with substance use weakened or reversed, potentially reflecting withdrawal, avoidance coping, or other survival strategies that differ from moderate-stress substance use patterns.

Most minority stress research assumes a linear relationship between discrimination and substance use. This study reveals a more nuanced picture where very high discrimination may paradoxically not predict increased use, challenging simple stress-coping models.

Cross-sectional design. All of Us Research Program may not be representative of all SGM populations. Self-reported discrimination and substance use. Imprecise estimates for some subgroups due to small sample sizes.