(90) Cannabis and Nicotine Use: Coping Mechanisms Among LGBTQIA+ College Students

Background & Introduction: Cannabis and nicotine use are significant public health concerns among college students, with use of both substances on the rise. The US Surgeon General recently described the alarming rise of electronic cigarette (e-cigarette) use among young adults as an epidemic. Alongside the growing concerns about e-cigarette use, is the increasing use of cannabis among college students. In 2016, cannabis use among full-time college students was 39%, a 30-year high. Lesbian, gay, bisexual, transgender, intersex, asexual, and other individuals who do not identify as heterosexual and/or cisgender (LGBTQIA+) adolescents and adults have well-documented disparities in rates of cannabis and e-cigarette use relative to their non-LGBTQIA+ peers. Prior research has shown that LGBTQIA+ young adults begin using substances earlier than their peers, substance use escalates more quickly, and these differences may persist over the life course. Limited research has assessed stress, coping, cannabis, and nicotine use among LGBTQIA+ college students compared to their heterosexual peers. The purpose of this study was to assess differences in coping and nicotine and cannabis use among college students, with attention to sexual orientation. The goal is to better understand how students cope with stress through using substances and how this may differ by sexual orientation.

Methods: Undergraduate students (N=205) completed a cross-sectional survey that collected information about their stress, coping, and substance use behaviors over the last month. The mean age was 18.96 (SD=1.62), 77.6% were women, 31.2% were LGBTQIA+, 59% Non-Hispanic White, and 61.5% were freshmen. Cannabis was the most used substance with 41.5% of participant reporting using it within the last month, 17.6% reported using nicotine from e-cigarettes, 24.4% reporting using cannabis and e-cigarettes, and 16.6% reported using neither cannabis nor e-cigarettes. The Addiction Severity Index (ASI; McLellan et al., 2006) assessed the participants’ use of cannabis (any form) or nicotine (e-cigarettes), the frequency of their use, and last date of use. The Perceived Stress Scale (PSS; Cohen et al., 1983) assessed how often within the last month that the participants felt stressed. The Brief COPE inventory (Carver, 1997) assessed the coping strategies and styles (avoidant coping, emotion-focused coping, and problem-focused coping) of the participants. The Marijuana Decisional Balance Scale (MDB; Elliott et al., 2011) was used to investigate motivations behind cannabis use. The E-Cigarette Outcome Expectancy Measure (Barker et al., 2019) was used to investigate participants' perceptions of outcomes associated with e-cigarette use.

Results: There was a significant difference in positive reasons for using cannabis in the LGBTQIA+ group (M = 25.97, SD = 7.37) compared to the heterosexual group (M = 20.90, SD = 8.34); t(131.58)=4.32, p < 0.01). There was a significant difference in problem-focused coping for the LGBTQIA+ group (M = 22.95, SD = 4.22) compared to the heterosexual group (M = 21.16, SD = 5.03); t(202)= -2.49, p < 0.01). There was a significant difference in emotion-focused coping for the LGBTQIA+ group (M = 31.27, SD = 5.26) compared to the heterosexual group (M = 29.04, SD = 6.15); t(202)= -2.51, p < 0.05). With the LGBTQIA+ group reporting significantly more positive reasons for using cannabis, higher problem-focused coping, and higher emotion-focused coping compared to the heterosexual group.
There was a significant effect of avoidant coping on substance use at the p<.05 level for the four conditions [F (3, 200) = 3.54, p = 0.02]. Post hoc comparisons using the Tukey HSD test indicated that the mean avoidant coping score for the no use (M =14.79, SD =5.00) was significantly lower than the nicotine and cannabis use group (M = 17.80, SD =4.23).
There was a significant effect of emotion-focused coping on substance use at the p<.05 level for the four conditions [F (3, 200) = 3.36, p = 0.02]. Post hoc comparisons using the Tukey HSD test indicated that the mean score for the nicotine group (M =27.78, SD =4.66) was significantly lower than the nicotine and cannabis group (M = 31.69, SD =5.01).
An exploratory Chi-Square analysis was conducted to assess nicotine and cannabis use differences between LGBTQIA+ and heterosexual students. In the LGBTQIA+ group, observed frequencies indicated that 39 individuals used cannabis, in contrast to 5 who used nicotine, 11 who used both nicotine and cannabis, and 9 who used neither nicotine nor cannabis (Expected frequencies: cannabis = 26.5, Nicotine = 11.2, both = 16.5, Neither = 10.6). Similarly, for the heterosexual group, 46 individuals used cannabis, in contrast to 31 who used nicotine, 39 who used both nicotine and cannabis, and 25 who used neither nicotine nor cannabis (Expected frequencies: cannabis = 58.5, Nicotine = 24.8, both = 34.4, Neither = 23.4). The Chi-Square Test yielded significant results [χ²(3) = 15.88, p < .01, V = 0.28, p < 0.01]. These results imply a statistically significant association between sexual orientation and cannabis use.

Conclusion & Discussion: Our results indicate that participants who reported using nicotine and cannabis in the past month reported higher avoidant coping behaviors compared to participants who had not used nicotine or cannabis in the past month. Participants who reported using nicotine and cannabis in the past month also reported higher emotion-focused coping compared to participant that only used nicotine in the past month. Results also show significantly higher problem-focused coping and emotion-focused coping among LGBTQIA+ compared heterosexual students and found that LGBTQIA+ students reported significantly more positive reasons for using cannabis.
This study was limited by the self-report nature of the surveys and the majority freshman and female sample that may not be generalizable to other populations.
The goal of this line of research is to better understand patterns behind students coping and use of substances. These patterns may differ among sexual and gender minority students and interventions that address these unique stressors and motivations behind substance use may be more effective.

References: Barker, Joshua O., Kelley, Dannielle E., Noar, Seth M., Reboussin, Beth A., Cornacchione Ross, Jennifer, & Sutfin, Erin L. (2019). E-cigarette outcome expectancies among nationally representative samples of adolescents and young adults. Substance Use & Misuse, Vol 54(12), 1970-1979.
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Elliott, Jennifer C., Carey, Kate B., & Scott-Sheldon, Lori A. J. (2011). Development of a decisional balance scale for young adult marijuana use. Psychology of Addictive Behaviors, Vol 25(1), 90-100
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