How intersecting identities shape cannabis use in teens

Research suggests that adolescents belonging to equity-deserving populations often experience pronounced health consequences due to barriers they face at the intersection of their social identities. Our study examined how current cannabis use varies among ethno-racial groups by gender identities. Cross-sectional data from 68,533 adolescents in the 2022/2023 COMPASS survey were analyzed. Logistic regression analysis using generalized estimating equations (GEEs) was conducted to determine the likelihood of current cannabis use among diverse ethno-racial groups stratified by gender identities. All models accounted for clustering by province, and were adjusted for age, perceived relative affluence, current binge drinking, and current e-cigarette use. Among cisgender girls, the highest risk group for current cannabis use were Multiethnic (aOR: 1.26, 95% CI: 1.18-1.35), Black/African and Caribbean (aOR: 1.05, 95% CI: 1.04-1.07), and "other ethno-racial group" (aOR: 1.55, 95% CI: 1.43-1.67) youth relative to White/European cisgender girls; the lowest risk group included East Asian, South Asian, Southeast Asian youth. Cisgender boys displayed similar risk profiles to cisgender girls. However, current cannabis use was significantly more likely among all racialized transgender and gender-diverse youth, except for Southwest Asian and North African, and Southeast Asian youth, relative to their White/European counterparts. Current cannabis use risk profiles varied by ethno-racial and gender identities. The findings suggest that culturally tailored education and prevention approaches incorporating an intersectional lens are warranted to address cannabis use among adolescents at risk.