Patterns of marijuana use and sexual violence among sexual minority high school students: Perspectives from the California Healthy Kids Survey

Abstract

Background: Sexual minority students are at risk for adverse outcomes associated with substance use and violence. The vast majority of research literature, however, has focused on university students and alcohol consumption. There is an increased need to understand the distinct vulnerabilities of youth who have a non-heterosexual sexual orientation, and marijuana use as more state legalize and normalize the recreational use of marijuana in various forms. This study examines marijuana use and sexual victimization among high school students by sexual minority status. Methods: We analyzed data from 9th (n=50,973) and 11th (n=41,692) graders who participated in the California Healthy Kids Survey during the 2018-2019 school year. Students were asked to report their sexual identity and orientation (‘straight,’ ‘gay/lesbian,’ ‘bisexual,’ ‘something else,’ ‘I am not sure yet’, ‘decline to respond’), whether they had ever been sexually assaulted, marijuana use in their lifetime and past 30 days, and demographic characteristics. We conducted multi-level logistic regression analysis to assess relationships between lifetime and past-30-day marijuana use, sexual minority status and sexual victimization (SV). Analyses were performed using Stata, version 15.1. Results: The initial model indicated that the interaction terms for sexual minority status and sexual assault were not significantly associated with lifetime and past 30-day marijuana use. Analyses without the interaction terms suggest that students who identify as gay or lesbian, and who selected ‘I am not sure yet’ and ‘something else’ had higher odds of reporting past-30-day marijuana use than their ‘straight’ peers (OR=1.50 p<0.01 95%CI: 1.15, 1.96; OR=1.34 p<0.01 95%CI: 1.20, 1.50; OR=2.33 p<0.01 95%CI: 2.11, 2.59). Results also suggested that students who identified as gay or lesbian, bisexual, and students who selected ‘something else’ as their sexual orientation had higher odds to report lifetime marijuana use than their ‘straight’ peers (OR=1.90 p<0.01 95%CI: 1.43, 2.52; OR=1.45 p<0.05 95%CI: 1.03, 2.04; OR=1.57 p<0.01 95%CI: 1.29, 1.92). However, students who declined to respond about their sexuality are less likely to report lifetime marijuana use than their ‘straight’ peers (OR=0.82 p<0.05 95%CI: .68, .99) Additionally, students who reported sexual assault have almost six times higher odds of reporting lifetime and past-30-day and lifetime marijuana use (OR=6.68 p<0.01 95%CI: 3.99, 11.20; OR=6.03 p<0.01 95%CI: 3.80, 9.56). Overall, students who are in 11th grade, are male, and Hispanic have higher odds of reporting marijuana use. Conclusion: Overall, risks of marijuana use tend to be more pronounced among sexual minority students who have experienced sexual violence. Our findings suggest that students who identified as ‘something else’ may be at particular risk. These results are congruent with prior research on college populations that have identified undergraduate students who are bisexual and unsure of their sexual identity at heightened risk for SA. Greater efforts are needed to examine the intersection of substance use and sexual victimization and the disproportionate burden facing adolescents across multiple categories of sexual orientation.