Role of Sex on the Relationship Between Sexual Minority Status and Past 30-Day Marijuana Use Among High School Students (YRBS, 2015-2019)

Abstract Background Sexual minority status (SMS) is a known risk factor for marijuana use among youth in the United States (US). Limited research has examined the differing relationship between SMS and marijuana use across males and females. This study examined the modifying effect of sex on the relationship between sexual minority status (SMS) and past 30-day marijuana use among youth. Methods Data were pooled from the 2015, 2017, and 2019 Youth Risk Behavior Surveillance survey. Participants were 9th through 12th grade students in the US (n=37,870). An interaction model (SMS*sex) and models stratified by sex tested effect modification. Covariates included race/ethnicity, grade, tobacco use, illicit drug use, and survey year. Results The association between SMS and past 30-day marijuana use differed statistically by sex assigned at birth. Among females, SMS was associated with 1.33 greater odds of past 30-day marijuana use. Conversely, among males, SMS was associated with 0.70 lower odds of past 30-day marijuana. Interaction model was statistically significant. Conclusion SMS is associated with greater odds of being a past 30-day marijuana user among females but lower odds among males. Prevention and education programs aimed at youth should consider these factors during development and implementation. Longitudinal research is needed to further examine the nuances of the relationship observed in this analysis.