Perceptions of Marijuana Decriminalization Among Young Sexual and Gender Minorities in Chicago: An Initial Measure Validation and Test of Longitudinal Associations with Use

Abstract

Background: There is a high rate of marijuana use among young sexual and gender minorities (SGM) and, as a result of recent state-level, fragmented marijuana laws, there is also likely high variability in their perceptions of marijuana decriminalization (PMD).

Methods: Data came from two cohorts of young SGM (aged 16–29) in Chicago, RADAR and FAB400, recruited from 2015 to 2017 (N=1,114). We developed a measure to assess PMD among this population, performed initial validation, and assessed its relationship to longitudinal changes in patterns of marijuana use and geographic distribution.

Results: In multivariable models, mean PMD score was prospectively associated with general (adjusted odds ratio [aOR]=2.00; 95% confidence interval [CI]: 1.46–2.77), but not problematic marijuana use. An increase in perceived decriminalization also predicted a significant increase in odds of general (aOR=1.67; 95% CI: 1.18–2.39) marijuana use. Significant concentrations of high PMD scores existed in across the city.

Conclusion: These results suggest further study of longitudinal changes in marijuana use as decriminalization or legalization increases in the U.S. to better understand shifting trends in use.

Introduction

Marijuana use is more prevalent among young adults (aged 18–25) than among older adults in the U.S.¹ In a recent report by the Substance Abuse and Mental Health Services Administration, the rate of marijuana use among young adults increased from 27.8% in 2008 to 33.0% in 2016.² A corresponding rise was observed among those who used marijuana in the past month, from 16.6% in 2008 to 20.8% in 2016.² Examining differences by race and ethnicity, the rate of marijuana use has historically been higher among black and Hispanic/Latinx individuals compared to white individuals.^3,4 More recent changes have been observed, however, where rates of marijuana use among young black adults has declined, rates among young white adults has increased, and rates have remained stable among young Hispanic adults.² Further, sexual and gender minorities (SGM) were found to be significantly more likely to abuse illicit substances (e.g., marijuana) compared to their heterosexual counterparts.⁵ For example, SGM report the use of marijuana at rates more than double that of heterosexuals^6–8 with particularly high rates among black SGM.^9–11 Given the high rate of marijuana use among SGM and an increasing number of U.S. states legalizing or decriminalizing recreational and medical marijuana use, it is timely to develop a better understanding of the attitudes toward marijuana decriminalization among this population to develop a better understanding of its changing patterns of use.

Some studies of adolescents and young adults have found that bisexual individuals report higher rates of marijuana use than their heterosexual peers.^7,12 Studies regarding gay-identified men are more indeterminate, with some finding that gay men are more likely to report marijuana use compared to their heterosexual peers,⁷ whereas others do not find a significant difference.^12,13 Mixed findings are also observed when conducted within the population of men who have sex with men (MSM), one found that bisexual men use marijuana at a significantly higher rate than gay men,¹³ while another found no significant difference between the groups.¹⁴ Bisexual women, on the contrary, are significantly more likely to use marijuana than both lesbian and heterosexual women.^15–17 Together these findings suggest that bisexual SGM use marijuana at a higher rate than their heterosexual peers, but that findings are less conclusive within the population of MSM. To better understand variability among this population, it is necessary to first gain a better understanding of the differences in use between gay and bisexual SGM.

Not only is marijuana use more common than other drugs among young SGM, but it is also more common among those diagnosed with HIV. MSM and transgender women are significantly more likely to be diagnosed with HIV than their heterosexual peers.¹⁸ For example, one recent study noted that 59.8% of people living with HIV had used marijuana in the past 6 months.¹⁹ Research on marijuana use among MSM and transgender women has largely focused on medical or recreational use among HIV-diagnosed individuals and has largely been lacking among HIV-negative individuals. In those that have included HIV-negative individuals, the majority of research on MSM and transgender women indicates that marijuana users were more likely to be unaware of their HIV status⁹ to have multiple sexual partners in the past year,²⁰ and to participate in both group sex and condomless sex.¹⁰ As such, given the high prevalence of HIV among sexual minority men and transgender women, any research on marijuana use in this population should consider HIV status as a key variable.

Given the increasing legalization and decriminalization of marijuana and forthcoming medically sanctioned uses, it is key to develop a better understanding of how these changes may affect marijuana use. The difference between these two is key, legalization is the legally sanctioned use and possession of marijuana, while decriminalization of marijuana typically refers to the replacement of criminal sanctions with civil, fine-based penalties. This is particularly important given that there is high potential for confusion about which jurisdictions have legalized recreational marijuana use versus those who have decriminalized possession but where recreational use remains illegal. For example, Illinois has decriminalized marijuana possession (up to 10 g) and has approved the purchase and use of medical marijuana, but the recreational use of marijuana remains illegal. Citizens in states that have decriminalized but not legalized may vary in their beliefs about legal consequences of marijuana possession; particularly communities that may have more interactions with the policy and experiences with the criminal justice system, such as people of color,²¹ may be less likely to endorse beliefs about decriminalization. This changing legal landscape offers an opportunity to examine how perceptions of decriminalization are related to use and problematic use. No established measure of these perceptions exists, so we developed and performed initial validation of a novel four-item measure to assess perceptions of marijuana decriminalization (PMD). Data come from two large cohorts of sexual and gender minority men and women in Chicago to: (1) assess the relationship between change in PMD score and patterns of marijuana use; (2) assess longitudinal changes in PMD; and (3) examine the relationship between PMD score and marijuana-related arrests in Chicago to assess the validity of these perceptions.

Materials and Methods

Study design and recruitment

Data were collected as part of two ongoing longitudinal cohort studies, RADAR and FAB400, both studying young SGM living in the Chicago metropolitan area. These studies were designed as companion studies with similar design and measurement to facilitate combined data analyses, with each focusing on separate SGM populations (RADAR examines SGM-AMAB [assigned male at birth] and FAB400 examines SGM-AFAB [assigned female at birth]). The primary objective of the RADAR cohort study is to apply a multilevel perspective²² to a syndemic²³ of health issues associated with substance use and HIV among a diverse population of SGM-AMAB, including cisgender men, transgender women, and non-binary individuals AMAB. FAB400 studies SGM-AFAB (including cisgender women, transgender men, and nonbinary individuals AFAB), focusing on their health, development, and intimate relationships. Diverse methods for participant recruitment for each study have been previously described^24–26 and were selected for both studies to achieve the multiple cohort, accelerated longitudinal design.²⁷ Each cohort was recruited using an incentivized snowball sampling approach, in which participants were initially recruited directly from various sources (i.e., SGM community organizations, health fairs, high school/college groups, and Facebook) and allowed to refer peers into the study. At the time of enrollment into their respective cohorts, all participants were between 16 and 20 years of age, AMAB (RADAR) or AFAB (FAB400), spoke English, and either identified with a sexual or gender minority label, reported same-sex attractions, or reported same-sex sexual behavior. Participants have been followed longitudinally, with study visits occurring every 6 months. Data were collected via a computer-assisted self-interview (CASI). Subjects who were unable to complete in-person interviews (i.e., moved away from Chicago area) completed select measures online via a remote CASI.

RADAR and FAB400 data were combined into a single data set for analysis. The data reported here were collected from RADAR participants who had study visits between August 17, 2017 and August 24, 2018. The data collected from FAB400 were obtained between May 22, 2018 and December 17, 2018. All data collection occurred after Illinois had decriminalized marijuana in July 2016.²⁸

The analytic sample was limited to individuals who received and completed the measure (RADAR n=858, FAB400 n=256, Total N=1,114) between the aforementioned dates. To examine measure stability, a random subset of RADAR participants completed the measure twice with the second assessment occurring 6 months after initial completion (n=363). To facilitate analyses between time points, the difference in PMD scores was calculated with higher scores indicating an increase in perception of marijuana decriminalization.

Measures

Perceptions of marijuana decriminalization

The PMD measure was developed for use in the current studies and aims to assess how participants view decriminalization and attitudes toward decriminalization. The measure will allow current and future studies to assess changes in viewpoints toward decriminalization as its use continues to become more common. The measure included four items scored on a 5-point Likert scale with a value of “1” corresponding to “strongly disagree” and “5” corresponding to “strongly agree.” No items were reverse coded. Mean scores were calculated from the four items. The measure demonstrated adequate internal consistency (α=0.78). The following items were included:

• (1)The police don't really care if people smoke marijuana in public.
• (2)I wouldn't be worried about carrying a small amount of marijuana in public.
• (3)If police catch me smoking marijuana, it's not that big of a deal.
• (4)Smoking marijuana isn't really considered to be a crime where I live.

Demographics

Participants were asked to provide demographic information at each visit, including age, race/ethnicity, sex assigned at birth, gender identity, and sexual orientation. For purposes of these analyses, participants reporting a Hispanic/Latinx ethnicity were coded as such, regardless of their racial identity. Socioeconomic factors were also assessed by asking participants to provide information on their level of education and employment status. Participants were also asked about their history of incarceration or detention by authorities. For the purposes of analyses, history of incarceration and history of detention were combined into a single binary variable.

HIV status

Fingerstick blood samples were collected as part of each RADAR participant's visit. Each participant's HIV infection status (as well as acute infection) was determined using the Alere™ Determine™ HIV1/2 Ab/Ag Combo 4th generation point-of-care (POC) test. Those who tested positive on the POC HIV tests received confirmatory HIV antigen and antibody immunoassay testing following current Centers for Disease Control and Prevention (CDC) HIV testing guidelines.²⁹

Substance use behaviors

Marijuana use was operationalized and assessed in two ways. First, its use was self-reported and was operationalized as a dichotomous variable (i.e., any use in the past 6 months and no use in the past 6 months). Second, marijuana use and associated problems were assessed using an eight-item screen instrument, the Cannabis Use Disorder Identification Test (CUDIT).³⁰ CUDIT scores ranged from 0 to 32 and were operationalized as a continuous variable with higher scores indicating more problematic use. All other drug use (cocaine/crack, heroin, methamphetamines, GHB, ketamine, poppers, inhalants, hallucinogens/psychedelics, ecstasy, stimulants, depressants, pain killers, or erectile medications) combined into a single binary variable, indicating the use of any other drug in the past 6 months or no other drug use in the past 6 months.

Geographic data

Data related to marijuana use arrests were obtained from the Chicago Police Department (CPD) through Freedom of Information Act (FOIA) request number P450144. Arrest record data were provided and summated at the police district level within the City of Chicago boundaries. Participant's residence at the time of interview was used for purposes of data analysis.

Statistical analyses

Analysis of Variance (ANOVA) and Pearson's correlations were used, where appropriate, to determine whether mean PMD scores were associated with demographic characteristics and substance use behaviors. A multivariable linear regression model was then utilized to examine whether various factors were associated with mean PMD score. In this manner, we were able to determine which characteristics had a significant association with PMD score while accounting for differences in demographic characteristics, substance use behaviors, and history of incarceration. Using RADAR data only, two additional multivariable linear regression models were used to assess the association between either marijuana use or CUDIT scores and the difference in mean PMD score between times t and t+1, adjusting for PMD score at time t and demographic characteristics. These analyses allowed us to (1) determine whether a change in PMD score was associated with overall and problematic marijuana use, respectively, and (2) determine whether PMD score at time t was associated with either overall or problematic use at time t+1. Finally, we stratified these analyses to examine how these relationships may differ by race and ethnicity. All covariates identified as statistically significant at the p≤0.05 level in bivariate analyses using the Wald test statistic, or known confounders, were included in all multivariable regression models. All analyses were performed in RStudio v1.1353.³¹

Geographic analyses

Using residence at the time of interview, mean PMD score for each participant was plotted and analyzed using optimized hot-spot analysis in ArcMap v10.6.1.

Results

As shown in Table 1, the mean age of participants in this analytic sample was 22.84 years (standard deviation [SD]=3.37). With regard to participants' self-identified sexual orientation, 662 (59.5%) identified as gay/lesbian, 211 (18.9%) identified as bisexual, and 239 (21.5%) identified with another sexual orientation. Participants self-reported race, with 356 (32.0%) identifying as black, 303 (18.2%) identifying as white, 317 (28.5%) identifying as Hispanic or Latinx, and 136 (12.2%) identifying as a different or mixed race. Among all participants, 782 (70.3%) identified as cis-male, 170 (15.3%) identified as cis-female, and 156 (14.0%) identified as a gender minority. Nearly three-quarters of participants reported marijuana use in the past 6 months (779, 70.1%), while 344 (30.9%) reported any other drug use in the past 6 months. Mean CUDIT score across all participants was 5.65 (SD=5.85) suggesting nonproblematic marijuana use as the mean score.³⁰ Regarding history of arrest or detention by police, 32 (3.0%) participants reported having been arrested/detained by the police in the past 6 months. Among RADAR participants only, those who were HIV-positive reported significantly higher PMD scores (β=0.27; 95% confidence interval [CI]: 0.09–0.44) than HIV-negative individuals.

Table 1.

Demographic Characteristics of Analytic Sample, RADAR and FAB400, Chicago (N=1,114)

Characteristics	Total	Mean PMD score (SD)	pa
Age, mean (SD)	22.84 (3.37)	2.45 (0.94)b	0.59
Sexual orientation, n (%)			0.39
Gay/lesbian	662 (59.5)	2.43 (0.95)
Bisexual	211 (18.9)	2.53 (0.94)
Other	239 (21.5)	2.44 (0.92)
Race/ethnicity, n (%)			0.16
Black	356 (32.0)	2.38 (1.05)
White	303 (18.2)	2.55 (0.88)
Hispanic/Latinx	317 (28.5)	2.44 (0.88)
Other	136 (12.2)	2.44 (0.90)
Gender identity, n (%)			0.05
Cis-male	782 (70.3)	2.47 (0.95)
Cis-female	170 (15.3)	2.29 (0.92)
Gender minority	156 (14.0)	2.51 (0.90)
Education, n (%)			0.83
<High school	80 (7.2)	2.52 (0.99)
High school/GED	188 (16.9)	2.48 (1.03)
Some college/associate	651 (58.5)	2.45 (0.91)
≥Bachelor degree	183 (16.5)	2.41 (0.93)
Marijuana use,dn (%)			<0.001
Never	331 (29.8)	2.11 (0.83)
≥1 time	779 (70.1)	2.60 (0.95)
CUDIT score,c mean (SD)	5.65 (5.85)	—	<0.001
Other drug use,dn (%)			<0.001
Never	768 (69.1)	2.35 (0.93)
≥1 drug	344 (30.9)	2.67 (0.93)
Arrest/detention,dn (%)			0.80
No	1079 (97.0)	2.45 (0.94)
Yes	32 (3.0)	2.40 (1.02)

^aUsing ANOVA or Pearson's correlation coefficients across PMD scores, where appropriate.

^bMean score across all participants in the analytic sample.

^cAssessed using the CUDIT test and scoring method.²⁷

^dIn the past 6 months.

ANOVA, analysis of variance; CUDIT, Cannabis Use Disorder Identification Test; GED, general education development; PMD, perceptions of marijuana decriminalization; SD, standard deviation.

Mean perception of marijuana decriminalization scores across all participants (Table 1) were 2.45 (SD=0.94; range: 1–5). The majority of participant's scores fell below 3 (726, 65.3%), a score between somewhat disagreeing that marijuana is decriminalized and neither agreeing nor disagreeing. Scores were also examined among a subset of RADAR participants across two time points separated by 6 months (n=363). The range of differences in mean scores between time points was −4 to +3 with a strong correlation across time points (r=0.61, p<0.001). This indicates that some individuals varied widely in their perception of marijuana decriminalization between visits, but overall there was a high degree of stability.

Regression analyses

Table 2 presents multivariable model results examining mean PMD score at time t. Similar significant results were observed in the bivariate models (data not shown). Compared to gay/lesbian participants, bisexual participants reported significantly higher PMD scores (β=0.15; 95% CI: 0.005–0.30). Significantly higher PMD scores were observed among those who reported any marijuana use (β=0.44; 95% CI: 0.31–0.56) and any other drug use (β=0.16; 95% CI: 0.04–0.29) in the past 6 months. Marginal differences in PMD score were observed among cis-women compared to cis-men (β=−0.15; 95% CI: −0.32 to 0.02) and among white participants compared to black participants (β=0.14; 95% CI: −0.01 to 0.29). Finally, no significant differences were observed with regard to age or history of arrest/detention in the past 6 months.

Table 2.

Linear Regression Models of Mean Marijuana Decriminalization Scores at Time t with Selected Characteristics, RADAR and FAB400, Chicago 2015–2017 (N=1,105)

Characteristic	Model 1
	Adjusted coefficient	95% CI
Age	0.01	−0.004 to 0.03
Gender
Cis-male	Ref	—
Cis-female	−0.15	−0.32 to 0.02
Gender minority	0.01	−0.18 to 0.19
Sexual orientation
Gay/lesbian	Ref	—
Bisexual	0.15*	0.005 to 0.30
Other	0.06	−0.11 to 0.22
Race/ethnicity
Black	Ref	—
White	0.14	−0.01 to 0.29
Hispanic	0.04	−0.11 to 0.18
Other	0.04	−0.14 to 0.22
Marijuana usea
Never	Ref	—
≥1 time	0.44***	0.31 to 0.56
CUDIT scorec	—	—
Any other drug useb
Never	Ref	—
≥1 drug	0.16**	0.04 to 0.29
Arrest/detention historyb
No	Ref	—
Yes	−0.15	−0.47 to 0.18

^aAmong those who report any marijuana use in the past 6 months.

^bIn the past 6 months.

^cAssessed using the CUDIT test and scoring method.²⁷

^*p<0.05; ^**p<0.01; ^***p<0.001.

CI, confidence interval.

Table 3 presents multivariable models examining the association between the differences in PMD scores between times t and t+1 (where higher values indicate an increase in perceived decriminalization) and marijuana use or CUDIT scores. Both models are adjusted for marijuana use at time t, mean PMD score at time t, age, race/ethnicity, sexual orientation, and other drug use. In these analyses, an increase in perceived decriminalization from time t to t+1 was associated with a significantly higher odds of marijuana use at time t+1 (adjusted odds ratio [aOR]=1.64; 95% CI: 1.01–2.73). A higher mean PMD score at time t was also associated with a significantly greater odds of marijuana use at time t+1 (aOR=1.72; 95% CI: 1.11–2.72). When stratified by race and ethnicity, these findings continued to be observed only among Hispanic/Latinx participants. In this study, an increase in perceived decriminalization from time t to t+1 was associated with a significantly lower odds of marijuana use at time t+1 (aOR=0.95; 95% CI: 1.02–7.27) and a higher mean PMD score at time t was also associated with a significantly greater odds of marijuana use at time t+1 (aOR=1.15; 95% CI: 1.26–9.30). No other significant findings were observed among black, white, or other/multiracial participants.

Table 3.

Adjusted Regression Models of Difference in Mean Perceptions of Marijuana Decriminalization Score Between Study Visits with Two Separate Marijuana Use Variables

Characteristic	Marijuana use (time t+1)a,b (n=232)		CUDIT score (time t+1)a,c (n=353)
	aOR	95% CI	Adjusted β	95% CI
Overall
Difference in PMD score	1.64*	1.01 to 2.73	0.35	−0.20 to 0.90
Mean PMD score (time t)	1.72***	1.11 to 2.72	0.31	−0.20 to 0.82
Black
Difference in PMD score	0.94	0.39 to 2.37	0.01	−0.94 to 0.96
Mean PMD score (time t)	1.37	0.60 to 3.40	−0.39	−1.35 to 0.57
White
Difference in PMD score	1.77	0.65 to 5.00	1.17*	0.23 to 2.12
Mean PMD score (time t)	1.46	0.64 to 3.58	0.51	−0.29 to 1.32
Hispanic/Latinx
Difference in PMD score	2.57*	1.02 to 7.27	0.70	−0.41 to 1.82
Mean PMD score (time t)	3.15*	1.26 to 9.30	1.02	−0.03 to 2.07
Other/multiracial
Difference in PMD score	2.38	0.24 to 33.72	−0.11	−1.78 to 1.56
Mean PMD score (time t)	4.20	0.69 to 49.59	0.84	−0.74 to 2.42

Results presented among full sample and stratified by race, RADAR, Chicago 2015–2017.

^aAdjusted for marijuana use at time t, age, race/ethnicity, sexual orientation, and other drug use.

^bUse assessed in the past 6 months using logistic regression.

^cAssessed at t+1 using the CUDIT test and scoring method³⁰ using linear regression.

^*p<0.05; ^***p<0.001.

aOR, adjusted odds ratio.

In combined analyses, in neither case was a difference in perceived decriminalization or mean PMD score significantly associated with problematic marijuana use, measured via CUDIT score. In stratified analyses, among white participants, an increase in perceived decriminalization from time t to t+1 was associated with a significantly higher CUDIT score (β=1.17; 95% CI: 0.23–2.12). No other significant findings were observed among black, Hispanic/Latinx, or other/multiracial participants.

Geographic analysis

Figure 1 depicts the distribution of PMD score for all participants by police district of residence at the time of the baseline interview. Lighter shades in this figure represent fewer marijuana-related arrests with the largest concentrations of arrests occurring on the south and west sides of the city. Results of the optimized hotspot analysis suggest that a significant concentration of high PMD scores existed in the northeastern region of the city, a region also containing the lowest concentration of marijuana-related arrests. A second smaller hotspot was also observed in the south-central region of the city.

FIG. 1.

Distribution of perception of marijuana decriminalization score for all participants by police district of residence at the time of the baseline interview. Shaded districts represent the number of marijuana-related arrests in each district, while colored dots indicate significance of optimized hot spot analyses.

Discussion

Among SGM youth in Chicago, we found that nearly three-quarters of individuals had used marijuana in the past 6 months, while only one-third reported any other drug use. At the time of data collection, Illinois had not legalized recreational use of marijuana, medical marijuana use was legalized in August 2013 (approved conditions include HIV/AIDS, cancer, Parkinson's disease, and fibromyalgia) and possession of <10 g of marijuana was decriminalized in July 2016. We found that the majority of individuals did not perceive marijuana as being decriminalized; however, differences were observed across demographic and behavioral characteristics. Specifically, bisexual participants, marijuana users, and people who use other drugs each reported significantly higher PMD. The level of PMD score at the first timepoint was also prospectively associated with general marijuana use, but not problematic use, at the second time point, although these findings differed by race and ethnicity. Finally, a large cluster of high PMD scores was observed on the north side of the city in a region with a low number of marijuana-related arrests.

Findings provide evidence of the initial validity of the newly developed PMD scale. In terms of reliability, results indicate high internal consistency among items and good test–retest reliability over a relatively long period between assessments (i.e., 6 months). The measure also demonstrated convergent validity via large positive associations between perceived decriminalization and current marijuana use, marijuana use problems, and other drug use. These results indicate that this measure has good psychometric properties and is appropriate for assessing PMD, particularly in jurisdictions where the criminalization of marijuana remains unclear (e.g., Chicago 2015–2019). These findings also indicate that living in a community with fewer marijuana-related arrests is associated with higher perceived decriminalization. Longitudinal associations linking increases in perceived decriminalization, and increases in marijuana use provide further evidence of the utility and predictive validity of this measure.

Bisexual participants perceived marijuana use as more decriminalized than gay or lesbian participants. Given the strong association between marijuana use and PMD score, this suggests that sexual orientation differences in perceived decriminalization may contribute to differences in rates of marijuana use.^6–8,12,13 As coping with stress is a common motivation for using marijuana,³² it is possible that bisexual individuals may be more likely to use marijuana to cope with the additional stressors that bisexuals experience as a result of the stigmatization of bisexuality (e.g., bias from both lesbian/gay and heterosexual populations, being stereotyped as unsure of one's sexual orientation).^33,34 Marijuana use and perceptions of decriminalization may also be bidirectionally associated. In other words, use of marijuana may increase perceptions of marijuana use as decriminalized, while having a higher perception of decriminalization may lead to greater use regardless of exposure to stress and stigma. Additional research is needed to examine factors that may explain bisexual individuals' higher perceptions of the decriminalization of marijuana use.

In addition, those diagnosed with HIV had significantly higher PMD. This may occur because HIV is a diagnosis approved for the use of medical marijuana, which may potentially lead these individuals to conclude that its overall use is decriminalized. For example, past research has found that, in the past 6 months, 59.8% of HIV-positive individuals had used marijuana in some form¹⁹ with 44.3% reporting both therapeutic and recreational marijuana use, while 55.7% reported only recreational use.¹⁹ Beyond recreational use, other reasons given for marijuana use include a desire to increase sexual pleasure³⁵ and the reduction of HIV-related symptoms such as depression,³⁶ loss of appetite,³⁷ and pain.³⁸ Combined with this past work, it is therefore unsurprising that we observed slightly higher marijuana use as well as significantly higher PMD among those who were diagnosed with HIV, compared to HIV-negative participants.

While we found several factors associated with PMD, our findings should be considered in the context of their limitations. For the purposes of examining longitudinal trends, we utilized only those participants who had completed the measure at two separate time points and these were only available among those in the RADAR cohort. Future studies should aim to assess PMD longitudinally among SGM-AFAB participants to develop better understanding of trends over time. In addition, this study was designed to be an initial validation of the new PMD measure, and as such, further validation may be beneficial. Finally, this was a community sample rather than a probability sample and, as such, findings may not generalize to the larger population of SGM.

Even in the context of these limitations, we have presented initial validation of a new measure for assessing PMD among SGM. We observed a significant association between an increase in perception of marijuana decriminalization and increases general marijuana use but not problematic marijuana use. We have also demonstrated that bisexual and HIV-positive participants, compared to gay and HIV-negative participants, respectively, have a higher perception of marijuana decriminalization. In addition, we observed that geographic areas with a higher number of marijuana-related arrests have a lower perception of marijuana decriminalization and also tend to be areas populated more heavily by racial and ethnic minorities. Together, these findings suggest that a rise in marijuana use among SGM populations is likely as legalization and decriminalization continue.

Abbreviations Used

AFAB

assigned female at birth

AMAB

assigned male at birth

ANOVA

analysis of variance

aOR

adjusted odds ratio

CASI

computer-assisted self-interview

CDC

Centers for Disease Control and Prevention

CI

confidence interval

CPD

Chicago Police Department

CUDIT

Cannabis Use Disorder Identification Test

FOIA

Freedom of Information Act

GED

general education development

MSM

men who have sex with men

PMD

perceptions of marijuana decriminalization

POC

point-of-care

SD

standard deviation

SGM

sexual and gender minorities

Disclaimer

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse, the National Institute of Child Health and Human Development, or the National Institutes of Health. The sponsor had no involvement in the conduct of the research or the preparation of the article.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

This work was supported by grants from the National Institute on Drug Abuse at the National Institutes of Health (U01DA036939, PI: B.M.; F32DA046313, PI: E.M.; K01DA046716, PI: C.D.) and from the National Institute of Child Health and Human Development (R01HD086170; PI: S.W.W.). This work also benefited from collaborative infrastructure enabled by the Third Coast Center for AIDS Research (CFAR), an NIH funded center (P30 AI117943).

Cite this article as: Morgan E, Dyar C, Hayford CS, Whitton SW, Newcomb ME, Mustanski B (2021) Perceptions of marijuana decriminalization among young sexual and gender minorities in Chicago: an initial measure validation and test of longitudinal associations with use, Cannabis and Cannabinoid Research 6:2, 156–164, DOI: 10.1089/can.2019.0072.