The Association Between Sexual Identity and Cannabis Vaping Among U.S. Adults: Exploring Differences by Serious Psychological Distress.

Abstract

Cannabis vaping has gained popularity, particularly among sexual minority individuals. Sexual minority individuals experience high levels of serious psychological distress, which might worsen cannabis vaping disparities. This study examined cannabis vaping prevalence by sexual identity and serious psychological distress. Data were drawn from the U.S. 2022-2023 National Survey on Drug Use and Health (N=92,233). A weighted multivariable binomial logistic regression model assessed past-month cannabis vaping (no, yes) by sexual identity (heterosexual/straight, gay/lesbian, bisexual), past-month serious psychological distress (no, yes; assessed with Kessler-6), and their interaction. The model was adjusted for survey year and sociodemographic variables. The data analysis was conducted in May 2025. Among respondents, 2.7% identified as gay/lesbian, 5.4% identified as bisexual, 5.6% reported past-month cannabis vaping, and 7.6% experienced serious psychological distress. More bisexual (18.4%) and gay/lesbian (11.3%) adults reported past-month cannabis vaping than heterosexual adults (4.6%). Gay/lesbian adults with serious psychological distress (AOR=2.07, 95% CI=1.20, 3.59) and bisexual adults with serious psychological distress (AOR=1.97; 95% CI=1.57, 2.47) were more likely to vape cannabis than heterosexual adults who did not experience serious psychological distress. Serious psychological distress was a significant moderator of the association between sexual identity and cannabis vaping among U.S. adults. Findings provide important directions for future research, including the need to identify and examine specific sexual minority stressors and their interplay with cannabis vaping behaviors in this population.