Sexual Assault History Moderates Prospective Pathways From Sexual Orientation to Cannabis Use Outcomes

Sexual assault (SA) is highly prevalent in the United States, especially among young women. One of the consequences of SA is increased substance use, with extant studies focusing heavily on alcohol. There is sparse literature examining the associations between SA and cannabis use, despite the growing prevalence of cannabis. Research examining trauma more generally has shown associations between trauma exposure and cannabis. This suggests that SA may also be associated with cannabis use. One population that may be at elevated risk for both SA and cannabis use is sexual minority women (SMW). Minority related stress and distress after a SA may operate synergistically to lead to particularly high levels of cannabis use. The current study examined the interaction of lifetime SA history and sexual orientation predicting cannabis use in a longitudinal community sample of young adult women. The sample (M_age = 22.6) was largely White (84%, n = 146) and heterosexual (80%, n = 35). Data collection spanned 4 years with annual and daily assessments. A multilevel model was run to examine trajectories of cannabis use over 4 years and to test associations of SA and sexual orientation with cannabis use. No significant changes in cannabis use were observed over the 4 years; however, at baseline, SMW endorsed more cannabis use than heterosexual women (β = 1.41, IRR = 4.10, p = .007). Further, there was a marginally significant interaction between sexual orientation and SA history (β = 2.05, IRR = 7.80, p = .055) where SMW with a history of SA endorsed the highest levels of cannabis use. Findings support an intersectionality effect of sexual orientation and history of SA. This has implications for interventions, as post-SA treatments focus on alcohol and not cannabis, and may be missing a key target for a vulnerable population.