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. 2026 Oct 11;50(10):e70422. doi: 10.1111/acer.70422

Associations Between Social Contexts of Alcohol and Cannabis Use and Perceived Descriptive Norms in Sexual Minority Women and Gender Diverse Individuals Assigned Female at Birth

Haley A Edison 1, Christina Dyar 1,✉
PMCID: PMC13655202  PMID: 42860560

ABSTRACT

Background

Existing literature primarily uses minority stress theory as an explanation for disparities in alcohol and cannabis use affecting sexual and gender minority (SGM) populations. Far less research has examined the roles of other factors, such as social norms. Elevated perceived descriptive norms for similar peer groups have been linked to individuals' increased alcohol and cannabis use, making descriptive norms a potential key risk factor for problematic alcohol and cannabis use among SGM groups. No studies to date have examined the development of descriptive norms in SGM people. The current study aimed to further the understanding of the development of descriptive norms for alcohol and cannabis use in sexual minority women and gender diverse (SMWGD) individuals assigned female at birth by examining cross‐sectional and prospective associations between frequency of alcohol and cannabis use with other SGM people and perceived descriptive alcohol and cannabis norms using regression models.

Methods

We used data from a baseline survey, follow‐up survey, and a 30‐day EMA period from a longitudinal study of 409 SMWGD individuals ages 18–25 years old.

Results

Drinking more frequently with SGM individuals during the EMA period was cross‐sectionally associated with higher perceived frequency of drinking among SMWGD individuals at baseline and prospectively predicted increases in the perceived frequency of drinking among SMWGD individuals from baseline to follow‐up. None of the concurrent or prospective associations between frequency of using cannabis with SGM individuals during the EMA period and descriptive norms for cannabis use among SMWGD individuals were significant.

Conclusions

These findings provide important information about the development of descriptive norms for alcohol and cannabis use in SMWGD individuals, which can be used to inform earlier norms‐based substance use interventions in this population. Predicting elevated descriptive norms in this population also provides novel intervention targets for norms‐based interventions.

Keywords: alcohol use, cannabis use, descriptive norms, sexual and gender minority, social contexts

Among a sample of young adult (18–25 years old) sexual minority women and gender diverse (SMWGD) individuals assigned female at birth, drinking more frequently with other sexual and gender minority (SGM) individuals was cross‐sectionally associated with higher perceived descriptive drinking norms in SMWGD people and prospectively associated with increased perceived descriptive drinking norms in SMWGD people at follow‐up. The same model was tested for cannabis use and was not significant.

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1. Introduction

Compared to heterosexual cisgender people, sexual (i.e., those with nonheterosexual identities) and gender (i.e., those identifying outside of the gender binary) minority (SGM) people are at elevated risk for alcohol and cannabis use disorders (e.g., Gonzales 2020; Hughto et al. 2021; Kerridge et al. 2017; Krueger et al. 2020; Philbin et al. 2019; Rice et al. 2019). Of the SGM population, young adults (18–25‐year‐olds) are affected by the largest substance use and substance use disorder (SUD) disparities (Schuler et al. 2018, 2019). Sexual minority cisgender women experience larger disparities in alcohol and cannabis use disorders than those experienced by sexual minority cisgender men (e.g., Dyar 2022; Dyar et al. 2023; Hughes et al. 2020; King et al. 2008). Additionally, gender diverse individuals assigned female at birth are at higher risk of alcohol and cannabis use disorders compared to gender diverse individuals assigned male at birth (Ruppert et al. 2021). Further, gender diverse young adults assigned female at birth tend to use substances at similar rates to young adult sexual minority cisgender women (Fahey et al. 2023). Existing literature primarily focuses on minority stress theory as an explanation for the SUD disparities among sexual minority women and gender diverse (SMWGD) individuals assigned female at birth, positing the unique stressors associated with their minoritized sexual and gender identities increases the risk of SUDs (Meyer 2003). Far less research has examined the roles of other factors that may contribute to elevated rates of SUDs in this population, such as social norms. Social norms are strong predictors of substance use in high‐risk groups in the general population (Boyle et al. 2020). Though research involving the effects of social norms on substance use among the SMWGD population is still emerging, it is theorized that social norms may be important modifiable risk factors for alcohol and cannabis use disorders in this population as well (Boyle et al. 2020; Dyar 2022).

1.1. Social Norms and Substance Use

The concept of social norms refers to one's perceptions of peer groups' typical behaviors, and these normative perceptions influence one's own behavior (Cialdini et al. 1990). One type of social norm that strongly predicts individuals' substance use behaviors is descriptive norms, defined as one's perceptions of others' typical use of substances (i.e., quantity or frequency of substance use, or how common substance use is perceived to be; Borsari and Carey 2003; Cialdini et al. 1990). Social norms theory posits that individuals' perceptions of descriptive norms (or perceived descriptive norms) tend to overestimate their peers' substance use (Berkowitz 2004; Perkins 1997). These misperceptions (or elevated perceived descriptive norms) then lead to increases in the individuals' own substance use behaviors to match their perceptions of social norms among their peers (Borsari and Carey 2003; Perkins and Berkowitz 1986; Perkins et al. 1999). Several studies of young adults in the general population show that elevated perceived descriptive norms for alcohol prospectively predict individuals' increased drinking (e.g., Angosta et al. 2023; Dumas et al. 2019; Ferrer et al. 2012; Graupensperger et al. 2020). In these longitudinal studies, higher perceived descriptive drinking norms are consistently and positively associated with subsequent drinking behavior. These prospective associations operate through both between‐person differences (where individuals who perceive higher peer drinking generally consume more alcohol) and within‐person fluctuations (where elevated perceptions relative to one's own baseline prospectively predict increases in personal drinking behavior). Similarly, prospective and cross‐sectional research on cannabis use demonstrates that higher perceived descriptive norms predict greater cannabis use frequency, quantity, and related consequences among young adults in the general population (Buckner 2013; Dempsey et al. 2016; Neighbors et al. 2008; Romm et al. 2022; Wang et al. 2025). These studies indicate that perceived descriptive norms for alcohol and cannabis are strong predictors of young adults' alcohol and cannabis use behaviors in the general population. Additionally, they are important modifiable risk factors, as they have been successfully used as targets for interventions in the general population. Effective interventions based on social norms theory have been developed and commonly used in the general population, particularly in young adult populations. Personalized normative feedback (PNF) is one such intervention that targets perceived descriptive norms by correcting common misperceptions of these norms for substance use for relevant social groups. Studies show that PNF effectively reduces individuals' problematic substance use (Berkowitz 2004; Lemmel and Morina 2024; Lewis and Neighbors 2006).

Recent studies indicate that elevated perceived descriptive norms for alcohol and cannabis are positively associated with increased drinking and cannabis use among SGM young adults. Specifically, higher perceived descriptive norms among SMW predicted increased alcohol consumption longitudinally (Litt et al. 2015) and were correlated with greater cannabis use outcomes (Romm et al. 2023). Additionally, Dyar et al. (2024) demonstrated that elevated perceived descriptive norms among young adult SMW for both alcohol and cannabis were associated with increases in alcohol and cannabis use problems. Further, two studies found that elevated perceived descriptive norms mediate sexual orientation disparities in substance use; Hatzenbuehler et al. (2008) showed this indirect effect for alcohol use among young adult SMW, and Mereish et al. (2017) found that descriptive norms mediated the association between sexual orientation and both alcohol and cannabis use among sexual minority adolescents. Taken together, these studies suggest that perceived descriptive norms may be strong predictors of problematic alcohol and cannabis use among young adult SMWGD individuals.

Another important concept to understand about how descriptive norms influence one's substance use behaviors is that the perceived descriptive norms for the most proximal (or similar) social groups are the most influential on one's own behavior (Berkowitz 2004; Borsari and Carey 2003; Rimal 2008; Rimal et al. 2005). For example, in the general population, perceived descriptive drinking norms for close friends (Collins and Spelman 2013; Lac and Donaldson 2018), same‐gender peers (Larimer et al. 2009; Lewis and Clemens 2008), or peers with the same group identity (e.g., fraternity or sorority, residence hall, or sports team; Graupensperger et al. 2020; Hummer et al. 2012; Larimer et al. 2011; Neighbors et al. 2010) are more strongly associated with young adults' drinking behaviors and problems than perceptions of more distal peer groups. Similarly, perceived descriptive norms for more proximal reference groups (close friends, family members, or same group identities) are also more strongly associated with young adults' cannabis use behaviors and problems (Buckner 2013; Ecker and Buckner 2014; Wang et al. 2025). Among SMWGD populations, perceived descriptive norms for same‐gender, sexual minority people have been shown to be more highly correlated with individuals' own alcohol and cannabis use than perceived descriptive norms for same‐gender, heterosexual people (Dyar et al. 2024; Ehlke et al. 2019; Litt et al. 2015). Thus, when examining descriptive norms among SMWGD individuals, it is important to measure perceptions of individuals with similar gender and sexual identities.

Perceived descriptive norms may be especially powerful risk factors for problematic alcohol and cannabis use in the young adult SMWGD population for two additional key reasons. First, it is theorized that substance use is more normative among SMWGD groups than it is among heterosexual cisgender women, which may also contribute to elevated rates of SUDs among SMWGD people (Condit et al. 2011; Dworkin et al. 2018; Green and Feinstein 2012; Parks et al. 2007). The perceptions of substance use being more normative among SMWGD individuals than heterosexual cisgender people likely initially developed because of the prevalence of alcohol‐ and drug‐centric spaces (e.g., bars and clubs) in the SGM community (Condit et al. 2011; Hatzenbuehler et al. 2008; Litt et al. 2015; Parks et al. 2007; Parks and Heller 2013). SMWGD individuals are more likely to spend time in these substance use‐centric spaces and use substances in these spaces than heterosexual cisgender people (Boyle et al. 2020; Dworkin et al. 2018; Fairlie et al. 2018; Green and Feinstein 2012; Parks and Heller 2013; Trocki et al. 2005). Second, studies show that SGM people overestimate substance use descriptive norms for fellow SGM people, further indicating that descriptive norms are an especially important risk factor to understand in this population. Boyle et al. (2016) found that a majority of SMW significantly overestimated how much their peers (other SMW) drank, and that these elevated perceived descriptive norms were associated with more frequent lesbian bar attendance. These findings also support the idea of substance use being more normative among SMWGD individuals due to the prevalence and popularity of alcohol‐ and drug‐centric community spaces. Additionally, Boyle et al. (2017) found that SGM individuals widely perceived their SGM peers to use alcohol and drugs to cope with stressful events, much more than their peers actually used alcohol and drugs. Individuals who held these overestimated descriptive norms had much greater odds of using alcohol and drugs to cope than those who did not hold these misperceptions. Because substance use is more normative among SMWGD groups and these groups tend to overestimate their peers' substance use, descriptive norms are a key modifiable risk factor to understand for this population. In order to develop specifically tailored interventions targeting perceived descriptive norms for this population, it is critical to understand how these norms develop.

1.1.1. Predicting Descriptive Norms and the Effects of Social Contexts

Although emerging research among SMWGD populations indicates that perceived descriptive norms strongly influence individuals' alcohol and cannabis use behaviors, far less is known about how these elevated descriptive norms develop (Mollen et al. 2010). Identifying behavioral antecedents of descriptive norms is critical because these findings would allow norms‐based interventions to be used to prevent the development of problematic substance use. Specifically, pinpointing early behavioral predictors for elevated descriptive norms would allow clinicians to identify vulnerable individuals and provide targeted prevention with norms‐based strategies (such as PNF) before the elevated norms led to alcohol or cannabis use disorders. Therefore, predicting elevated descriptive norms is essential to optimize the prevention of alcohol and cannabis use disorders among the young adult SMWGD population.

Descriptive norms for substance use are thought to develop primarily through observing others using substances in social contexts (Borsari and Carey 2003; Miller and Prentice 1996). In alcohol‐ and drug‐centric community spaces, SMWGD individuals may observe other SMWGD people engaging in heavy alcohol or cannabis use behaviors (Boyle et al. 2020). Although these observations may only represent a small portion of their peer group, these public observations of others' substance use are more noticeable and memorable than people engaging in minimal substance use or not using substances at all (Berkowitz 2004). Thus, these observations become more salient and lead to misperceptions that others in their peer groups are engaging in heavier substance use than they actually are (i.e., elevated descriptive norms). These elevated descriptive norms then inform their normative beliefs about their relevant peer groups, contributing to individuals' own heavier susbtance use. Given this background, social contexts of alcohol and cannabis use (i.e., who an individual is using alcohol or cannabis with) may influence the development of elevated descriptive norms among SMWGD individuals. Specifically, using alcohol or cannabis with other SGM individuals (proximal peer groups) may lead to elevated descriptive norms in this population.

1.2. The Present Study

The aim of the present study is to further the understanding of the development of descriptive norms for alcohol and cannabis use in SMWGD individuals by examining cross‐sectional and prospective associations between frequency of alcohol and cannabis use with other SGM people and perceived descriptive norms for alcohol and cannabis use in SMWGD people. We hypothesized that using alcohol and cannabis in social contexts with other SGM people would: (1) be cross‐sectionally associated with higher perceived descriptive norms of alcohol and cannabis use for SMWGD people and (2) prospectively predict increases in perceived descriptive norms of alcohol and cannabis use for SMWGD people.

2. Methods

2.1. Participants and Procedures

The current analyses used data from a longitudinal study of substance use among 429 SMWGD individuals conducted between August 2020 and May 2021. Participants were recruited via online advertisements on social media (e.g., Facebook). The study included a baseline assessment (day 0), a 30‐day EMA study (days 1–30), and a follow‐up assessment, which participants completed remotely. The follow‐up assessment was sent to participants on day 31 and participants had up to 14 days to complete it. This study uses data from the baseline and follow‐up assessments. The study received IRB approval at Northwestern University. See Dyar et al. (2022) for further details about the study.

Eligible participants were (1) US residents; (2) 18–25 years old; (3) assigned female at birth; (4) identified as women or under the nonbinary/gender diverse umbrella (e.g., nonbinary, genderqueer, agender, gender fluid); (5) identified as lesbian, bisexual, pansexual, or queer; and (6) met alcohol or cannabis use criteria (i.e., reported having four or more drinks at least twice and/or using cannabis on at least 3 days in the past month). Participants were paid up to $150: $20 for baseline, $20 for follow‐up, $1 for each EMA survey, and a $5 bonus for every six EMA surveys completed in a row.

The analytic sample included participants who reported at least one instance of alcohol or cannabis use during the EMA period (total n = 409). The analytic sample was comprised predominately of people of color, with 65.5% identifying with at least one minoritized racial/ethnic identity. More than a quarter of participants were gender diverse (27.1%). See Table 1 for additional demographic information. The majority of participants completed both the baseline and follow‐up assessments, with 17 participants in the analytic sample (4.1%) not completing the follow‐up assessment.

TABLE 1.

Demographics of analytic sample at baseline (N = 409).

Demographic variable n %
Sexual identity
Lesbian/gay 106 25.9
Bisexual 106 25.9
Pansexual 89 21.8
Queer 108 26.4
Race/ethnicity a
White 230 56.2
Black 92 22.5
Latine 122 29.8
Asian 52 12.7
Other race/ethnicity 80 19.6
Gender identity
Cisgender woman 298 72.9
Gender minority 111 27.1
Age (M, SD) 22.26 (2.00)
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a

Percentages add up to more than 100% because participants could select multiple racial/ethnic identities.

2.2. Measures

2.2.1. Alcohol and Cannabis Variables: Assessed at Baseline and Follow‐Up

Alcohol and Cannabis Use Norms were assessed by asking participants to indicate the perceived quantity and frequency of alcohol and cannabis use for groups of individuals. The following item structures were used for each alcohol use norm: “How many days, on average, do you think a typical [group descriptor] drinks during a typical month?” and “How many drinks, on average, do you think a typical [group descriptor] has during a typical occasion?” The following item structures were used for each cannabis use norm: “How many days, on average, do you think a typical [group descriptor] uses cannabis during a typical month?” and “How many hours, on average, do you think a typical [group descriptor] is stoned or high on a typical day when they used cannabis?” Sexual minority women were asked to answer these questions with regard to “a typical [lesbian/bisexual/pansexual/queer] woman your age.” Sexual minority gender diverse participants were asked to answer questions about “a typical [lesbian/bisexual/pansexual/queer] [nonbinary/genderqueer/other identity] person your age.” Participants' own sexual and gender identities were piped into the spaces denoted by, so that they answered questions about people who shared their specific identities. Response options for the frequency items ranged from 0 (never) to 8 (daily), while responses for the quantity items ranged from 0 (0 drinks/hours) to 10 (10 or more drinks/hours). These items were adapted from the measure of norms used by Litt et al. (2015).

Quantity and frequency of alcohol and cannabis use were assessed by asking participants to indicate “How many days, on average, do you drink/use cannabis during a typical month?”; “How many drinks, on average, do you have during a typical occasion?”; “How many hours, on average, are you stoned or high on a typical day when you used cannabis?” Participants were asked to consider the past 30 days in responding to these items. Response options for the frequency items ranged from 0 (never) to 8 (daily), while responses for the quantity items ranged from 0 (0 drinks/hours) to 10 (10 or more drinks/hours).

2.2.2. Alcohol and Cannabis Use Variables Assessed During EMA Period

Sexual orientation and gender identity of substance use companions were measured during EMA surveys when participants indicated having used alcohol or cannabis with other people. Participants were asked “which of the following best describes those you were using marijuana with.” “Drinking” was substituted for “using marijuana” on days when alcohol was consumed with other people. Response options: LGBTQ+ women, LGBTQ+ men, nonbinary individuals, straight women, and straight men. Participants could select multiple responses. As norms were assessed at the individual level, we created a sum of the number of observations during which participants used alcohol with LGBTQ+ women, LGBTQ+ men, and/or nonbinary individuals for each participant and used this to represent how frequently a participant drank with SGM individuals. Individuals who reported drinking only in solitary settings during the EMA period were assigned a value of 0 for frequency of drinking with SGM individuals. An equivalent individual‐level sum score was created for cannabis use.

2.3. Data Analysis Plan

Analyses were conducted with SPSS Version 29. The analytic sample for concurrent analyses of alcohol use included 375 individuals who reported drinking at least once during the EMA period and reported drinking at least once in the past month at baseline. 16 participants in the alcohol analytic sample (4.3%) did not complete their follow‐up assessment and were included in concurrent analyses and excluded from prospective analyses. The analytic sample for cannabis analyses included 297 participants who reported using cannabis at least once during the EMA period and reported using cannabis at least once in the past month at baseline. Of this analytic sample, 12 participants (4.0%) did not complete their follow‐up survey and were included in concurrent analyses and excluded from prospective analyses. Within completed surveys, no data were missing on the variables used in these analyses.

In the first set of regression analyses, we examined cross‐sectional associations between frequency of substance use with SGM people during the EMA period and descriptive norms for substance use (frequency and quantity norms) for SMWGD individuals. Models for alcohol use included frequency of drinking with SGM individuals predicting descriptive norms for drinking frequency for SMWGD people and descriptive norms for drinking quantity among SMWGD people. Models for cannabis use included frequency of cannabis use with SGM individuals predicting descriptive norms for cannabis use frequency and duration of intoxication among SMWGD people. First, we examined these associations when controlling only for demographic covariates (i.e., age, sexual identity, gender, and race/ethnicity). Then, we added participant's own reported frequency or quantity of alcohol or cannabis use as a covariate, such that the participant's own use variable matched the outcome variable. For example, in the model of the association between frequency of drinking with SGM individuals and descriptive norms for drinking frequency among SMWGD people, we controlled for participants' own drinking frequency. Models in which participants' own use was controlled for were conducted because of strong associations between individuals' own substance use and their perceptions of the use of similar others (Dyar et al. 2024; Litt et al. 2015; Romm et al. 2022).

In the second set of regression models, we examined prospective associations between frequency of substance use with SGM individuals and descriptive norms for SMWGD people at follow‐up, controlling for descriptive norms for SMWGD people at baseline. These models were intended to determine whether using more frequently with SGM people during the EMA period predicted changes in descriptive norms for SMWGD individuals from baseline to follow‐up. Demographic covariates described above were also included in these models.

A set of sensitivity analyses was also conducted to determine whether the inclusion of individuals who did not engage in any social substance use during the EMA period in analyses affected results. In the main analyses, individuals who did not report any social alcohol use were coded as having not engaged in drinking with SGM individuals (n = 20; value of 0) on the frequency of drinking with SGM individuals and the same approach was taken for those reporting no social cannabis use (n = 41). In these sensitivity analyses, individuals who reported no social alcohol or cannabis use were excluded from analyses.

3. Results

Participants reported drinking or using cannabis with SGM individuals 5–6 times on average during the 30‐day EMA period. Participants reported that they perceived other SMWGD people as drinking or using cannabis approximately once per week on average and as drinking 3.52 drinks or being intoxicated from cannabis use for 3.62 h when they did use cannabis. These were very similar to what participants reported for their own typical substance use. See Table 2 for additional descriptives.

TABLE 2.

Correlations, means, and standard deviations.

Variables 1 2 3 4 5 6 7
1. Frequency of substance use with SGM — 0.22** −0.08 0.23** −0.06 0.28** −0.08
2. Baseline: SGM substance use frequency norms 0.01 — 0.14* 0.53** 0.03 0.36** −0.11*
3. Baseline: SGM substance use quantity norms −0.04 0.36** — 0.01 0.58** −0.15* 0.58**
4. Follow‐Up: SGM substance use frequency norms −0.07 0.64** 0.32** — 0.06 0.30** −0.09
5. Follow‐Up: SGM substance use quantity norms −0.06 0.28** 0.54** 0.38** — −0.13* 0.45**
6. Baseline: own substance use frequency 0.35** 0.22** −0.02 0.17* −0.05 — −0.04
7. Baseline: own substance use quantity 0.09 0.10 0.43** 0.12* 0.41** 0.31** —
M (SD) Alcohol 5.31 (5.78) 4.85 (1.44) 3.52 (1.33) 4.81 (1.45) 3.29 (1.33) 4.65 (1.69) 3.50 (1.54)
M (SD) Cannabis 6.67 (8.90) 4.62 (1.83) 3.62 (1.50) 4.62 (1.83) 3.48 (1.49) 5.24 (2.33) 3.67 (1.82)
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Note: Correlations above the diagonal are associations for alcohol variables, whereas those below the diagonal are for cannabis use variables.

Abbreviation: SGM, sexual and gender minority.

*

p < 0.05.

**

p < 0.001.

Analyses of alcohol use indicated that drinking more frequently with SGM individuals during the EMA period was cross‐sectionally associated with higher perceived frequency of drinking among SMWGD people at baseline (β = 0.17, p < 0.001; Table 3). This association remained significant when participants' own drinking frequencies were controlled for (β = 0.11, p = 0.03). Further, drinking more frequently with SGM individuals during the EMA period prospectively predicted increases in the perceived frequency of drinking among SMWGD people from baseline to follow‐up (β = 0.10, p = 0.03). Drinking more frequently with SGM individuals was not associated with descriptive norms for the amount of alcohol consumed among SGM individuals in either cross‐sectional or prospective models.

TABLE 3.

Predictors of SGM drinking norms.

Predictor Outcome b SE 95% CI for b β p
Frequency of drinking with SGM Baseline: SGM drinking frequency norms 0.04 0.01 0.02, 0.07 0.17 < 0.001
Frequency of drinking with SGM Baseline: SGM drinking frequency norms 0.03 0.01 0.003, 0.05 0.11 0.03
Baseline own drinking frequency 0.23 0.05 0.13, 0.32 0.25 < 0.001
Frequency of drinking with SGM Follow‐Up: SGM drinking frequency norms 0.02 0.01 0.002, 0.05 0.10 0.03
Baseline: SGM drinking frequency norms 0.47 0.05 0.37, 0.56 0.46 < 0.001
Frequency of drinking with SGM Baseline: SGM drinking quantity norms −0.004 0.01 −0.03, 0.02 −0.02 0.75
Frequency of drinking with SGM Baseline: SGM drinking quantity norms −0.001 0.01 −0.02, 0.02 −0.01 0.88
Baseline own drinking quantity 0.50 0.04 0.43, 0.58 0.57 < 0.001
Frequency of drinking with SGM Follow‐up: SGM drinking quantity norms 0.001 0.01 −0.02, 0.02 0.002 0.96
Baseline: SGM drinking quantity norms 0.56 0.05 0.47, 0.65 0.55 < 0.001
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Note: Additional covariates included: sexual identity, race/ethnicity, gender, and age.

Abbreviations: b, unstandardized regression coefficient; SGM, sexual and gender minority; β, standardized regression coefficient.

None of the concurrent or prospective associations between frequency of using cannabis with SGM individuals during the EMA period and descriptive norms for cannabis use among SMWGD individuals were significant (Table 4).

TABLE 4.

Predictors of SGM cannabis use (CU) norms.

Predictor Outcome b SE 95% CI for b β p
Frequency of CU with SGM Baseline: SGM CU frequency norms 0.01 0.01 −0.02, 0.03 0.03 0.60
Frequency of CU with SGM Baseline: SGM CU frequency norms −0.01 0.01 −0.04, 0.01 −0.06 0.32
Baseline: own CU frequency 0.21 0.05 0.10, 0.31 0.24 < 0.001
Frequency of CU with SGM Follow‐Up: SGM CU frequency norms −0.02 0.01 −0.04, 0.000 −0.09 0.05
Baseline: SGM CU frequency norms 0.67 0.05 0.58, 0.77 0.64 < 0.001
Frequency of CU with SGM Baseline: SGM CU duration intoxication norms −0.001 0.01 −0.02, 0.02 −0.01 0.89
Frequency of CU with SGM Baseline: SGM CU duration intoxication norms −0.01 0.01 −0.03, 0.01 −0.05 0.34
Baseline: own CU duration intoxication 0.34 0.04 0.25, 0.43 0.41 < 0.001
Frequency of CU with SGM Follow‐Up: SGM CU duration intoxication norms −0.01 0.01 −0.02, 0.01 −0.05 0.34
Baseline: SGM CU Duration Intoxication Norms 0.46 0.05 0.36, 0.57 0.47 < 0.001
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Note: Additional covariates included: sexual identity, race/ethnicity, gender, and age.

Abbreviations: b, unstandardized regression coefficient; CU, cannabis use; SGM, sexual and gender minority; β, standardized regression coefficient.

Sensitivity analyses in which individuals who did not engage in social alcohol or cannabis use during the EMA period were excluded demonstrated the same pattern of results as the main analyses presented above. Given the similarity of the results, parameters are not presented in the manuscript.

4. Discussion

To our knowledge, this study is the first to examine associations between frequency of alcohol and cannabis use with other SGM people and perceived descriptive norms for alcohol and cannabis among SMWGD individuals. Our hypotheses regarding alcohol use were supported: using alcohol in social contexts with other SGM people was cross‐sectionally associated with higher perceived descriptive norms of SGM people's alcohol use and prospectively predicted increases in these norms over time. Specifically, participants who drank with other SGM people more often perceived that SMWGD individuals drank more often on average than participants who drank with other SGM people less often. Further, when participants drank with other SGM people more often, they experienced increases in how frequently they believed that other SMWGD individuals drank at follow‐up. This is consistent with the theory that observing similar peers (in this case, other SGM people) drinking more often may confirm preexisting notions that these peers drink more heavily than heterosexual cisgender individuals, leading to increases in descriptive norms for SGM people (Condit et al. 2011; Dworkin et al. 2018; Dyar et al. 2021; Parks et al. 2007). Although no studies to our knowledge have examined the social contexts of alcohol use predicting perceived descriptive norms for drinking, these findings are consistent with related research investigating bidirectional relationships between drinking and perceived descriptive norms. Among the general population, Neighbors et al. (2006) and Ferrer et al. (2012) found evidence of college students' drinking behaviors prospectively predicting elevated perceived descriptive norms. A few additional studies also found evidence of reciprocal, feed‐forward, positive associations between drinking behaviors and perceived descriptive norms among SMW (Litt et al. 2015), among adolescents (Meisel and Colder 2020), and among college students' alcohol consequences (Lee et al. 2010). Conversely, two studies found little evidence of reciprocal associations between alcohol use and perceived descriptive norms among young adults in the general population (Graupensperger et al. 2020) and young adult SMWGD individuals (Dyar et al. 2024). Our findings provide additional context to the mixed findings of predicting perceived descriptive norms for alcohol use in the prior literature. These novel findings suggest that it may not be solely the drinking behavior itself that predicts elevated descriptive norms, but the social contexts of the drinking behavior may also play an important role. These findings provide nuanced insight into modifiable risk factors for elevated alcohol descriptive norms among young adult SMWGD individuals, which can inform specifically targeted interventions for problematic drinking in this population.

4.1. Relationship Between Cannabis Use and Descriptive Norms

In contrast to our alcohol findings, our hypotheses regarding social contexts of cannabis use were not supported; we found no evidence of cross‐sectional or prospective associations between using cannabis with other SGM people and perceived descriptive norms for cannabis use among SMWGD individuals. There may be unique factors related to cannabis use specifically that led to these unexpected findings, particularly for individuals who use cannabis heavily. For example, the centrality of cannabis use to an individual's identity (i.e., how much they view cannabis use as a part of their identity) influences the relationship between descriptive norms and cannabis use in young adults in the general population (Montes and Napper 2019; Neighbors et al. 2013). The centrality of cannabis use to individuals' identities was found to moderate the effects of perceived norms; perceived norms were only strongly associated with cannabis use among those whose identities were more strongly tied to cannabis use (Neighbors et al. 2013). Further, Montes and Napper (2019) found that the degree to which an individual incorporated cannabis use into their personal identity (i.e., how important cannabis use is to who they are as a person) may be a stronger predictor of an individual's cannabis use than descriptive norms. In fact, they speculate that individuals who use cannabis heavily may be motivated by perceptions of their cannabis use as rebelling against normative behavior. Blevins et al. (2018) also found that descriptive norms and associated interventions were not as influential for friend groups consisting of individuals who use cannabis heavily and hypothesized that this is because the groups' heavy cannabis use is already outside of normative behavior. These studies show that there may be unique, important factors contributing to cannabis use other than perceived descriptive norms, especially for those who use cannabis heavily. This may explain why we did not find significant relationships between social contexts of cannabis use and descriptive norms. Future research should seek to explore how these other factors use may influence cannabis norms among SGM people.

4.2. Clinical Implications

Given high rates of alcohol and cannabis use disorders among SMWGD individuals (Hughto et al. 2021; Kerridge et al. 2017; Krueger et al. 2020; Philbin et al. 2019), there is a need for SUD interventions that are culturally relevant and specifically tailored for the SMWGD population (Burger and Pachankis 2024; Pachankis 2018). Currently, there are extremely few studies testing interventions for alcohol use disorder among SMWGD individuals, and to our knowledge, there are no tested interventions for cannabis use disorder specific to SMWGD individuals (Kidd et al. 2022). Furthermore, there has been little research dedicated to determining necessary adaptations to existing SUD interventions to make them appropriately tailored to SMWGD populations (Dimova et al. 2022). Most of the proposed adaptations for SUD interventions specific to SGM populations have been based on minority stress theory (Shorey et al. 2022). The findings in this study provide novel information about additional modifiable risk factors that could help guide alcohol interventions for SMWGD individuals, beyond minority stress theory.

There is extensive evidence that personalized normative feedback (PNF) is an important, efficacious, and feasible intervention for problematic alcohol use in young adults in the general population (Lemmel and Morina 2024). PNF works by correcting overestimations of peers' alcohol use; this effectively reduces individuals' drinking. Although there is less literature on PNF specifically in SGM populations, recent findings suggest that targeting descriptive norms for SGM individuals with the same sexual orientation and gender identity as the participant may reduce the individuals' own drinking (Boyle et al. 2022; Dimova et al. 2022; Shorey et al. 2022). The study findings provide an additional, novel strategy to tailor PNF interventions for SMWGD populations. Given that there is evidence for social contexts of drinking with other SGM individuals predicting higher descriptive norms for alcohol use, it may be beneficial to utilize these specific social contexts as reference groups within PNF interventions. For example, rather than broadly matching individuals to peers with the same identities, these findings indicate it may be beneficial for clinicians to use context‐specific normative feedback to address how individuals' social contexts of drinking (especially social contexts centered around the SGM community) affect their drinking attitudes and problematic behaviors.

Furthermore, our findings of social alcohol use with SGM people prospectively predicting elevated descriptive norms among SMWGD individuals indicate that PNF may be effective when utilized as a preventive intervention for problematic alcohol use. Clinicians can use this behavioral antecedent to identify vulnerable individuals who would be good candidates for PNF much earlier. Providing earlier norms‐based interventions for these at‐risk individuals may disrupt the relationship between social contexts of alcohol use, elevated perceived drinking norms, and problematic drinking behaviors before alcohol use disorder develops. Additionally, there is some evidence that PNF‐related environmental adaptations of SGM community spaces in which substance use occurs may also reduce problematic substance use among SGM individuals (Dimova et al. 2022). Our findings support the implementation of these environmental adaptations; this type of adaptation is another way to disrupt the relationship between social contexts of drinking and elevated drinking norms. For example, alcohol‐centric SGM community spaces like bars or clubs could incorporate PNF‐based messaging in the form of signage within the space, which may curb the influence of social drinking and the resulting elevated descriptive norms.

4.3. Limitations

The following limitations are of note in considering the results of this study. First, this study only included sexual minority people assigned female at birth who were US residents, 18–25 years old, and reported having four or more drinks at least twice and/or using cannabis on at least 3 days in the past month. It is unknown if the same results would occur in sexual minority people assigned male at birth, those outside of the United States, adolescents, adults over age 25, and people who engaged in less alcohol and/or cannabis use. Additionally, participants were not asked specific questions about how much alcohol or cannabis other SGM people who were present during substance use events were consuming. Given that research suggests that drinking with others who are consuming more alcohol is associated with heavier use (Merrill et al. 2021; Miller et al. 2013), heavier alcohol or cannabis consumption among SGM companions may also influence SMWGD individuals' own use. Future research should examine the prospective prediction of descriptive norms in these other groups and the effects of how heavily the other people were using alcohol or cannabis in the social contexts.

5. Conclusions

Despite these limitations, this study provides novel findings about associations between using alcohol and cannabis in social contexts with SGM people and perceived descriptive norms for young adult SMWGD individuals. These individuals are at higher risk of alcohol and cannabis use disorders than their heterosexual cisgender peers. Perceived descriptive norms are known to influence individuals' alcohol and cannabis use, but there is little known about the development of these norms. To our knowledge, no studies to date have attempted to identify predictors of these norms among SMWGD individuals. The novel findings that drinking socially with other SGM people predicts elevated descriptive norms for alcohol use among SMWGD individuals provide new information about behavioral antecedents for elevated descriptive norms, which are established risk factors for problematic alcohol use. This information allows clinicians to identify vulnerable individuals much earlier and provide norms‐based interventions before the behaviors escalate to alcohol use disorders. Thus, these findings provide a more nuanced understanding of an important modifiable risk factor for problematic alcohol use among SMWGD populations, a critical issue for this group.

Funding

Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number K01 DA046716 and R01DA58642 (PI: Dyar). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Ethics Statement

This study was approved by the IRB at Northwestern University (IRB # 2021B0225).

Conflicts of Interest

The authors declare no conflicts of interest.

Acknowledgments

We would like to thank Project QUEST study participants for their vital contributions to understanding alcohol and cannabis use among young adults.

Data Availability Statement

Deidentified data are available from the study team after the development of a data sharing agreement. Data analysis code is available from the authors upon request. This study was not preregistered.

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Data Availability Statement

Deidentified data are available from the study team after the development of a data sharing agreement. Data analysis code is available from the authors upon request. This study was not preregistered.

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