Housing instability, race/ethnicity, and sexual identity as intersectional factors in adolescent cannabis use

Introduction: This study examines the association between cannabis use and the intersection of housing instability with sexual identity and race/ethnicity among U.S. high school students. Methods: We utilized nationally representative survey data from high school students in 2021 and 2023 (n = 24,885), analyzed in 2024. The dependent variable was past 30-day cannabis use, and the primary independent variables were the intersection of housing instability with sexual identity and race/ethnicity. Propensity score weighting was used to balance characteristics between the intersectional variable groups, followed by logistic regression in the outcome model. Results: Results showed significantly higher odds of cannabis use among students with housing instability who identified as heterosexual (OR = 3.38, 95 %CI = 2.69–4.23), gay or lesbian (OR = 4.71, 95 %CI = 2.55–8.68), bisexual (OR = 3.89, 95 %CI = 1.90–7.96), and other sexual identities (OR = 7.73, 95 %CI = 4.24–14.08) compared to heterosexual students with stable housing. We also found higher odds of cannabis use for those with housing instability among non-Hispanic white students (OR = 3.59, 95 %CI = 2.78–4.63), non-Hispanic black students (OR = 3.24, 95 %CI = 2.10–5.00), non-Hispanic other students (OR = 3.08, 95 %CI = 2.13–4.45), and Hispanic students (OR = 5.24, 95 %CI = 3.59–7.65) compared to non-Hispanic white students with stable housing. Conclusions: The findings indicate a significant association between housing instability and cannabis use, particularly among sexual and racial/ethnic minorities. The intersectional analysis underscores the compounded challenges faced by these groups.