Cannabis use among adolescents remains a pressing public health concern in the United States, particularly in light of continuing state-level changes in the legalization of use, easier availability, new cannabis-delivery methods, and marketing of youth-focused cannabis products (e.g. candy, baked goods) (Ebling et al., 2024, Substance Abuse and Mental Health Services Administration, 2021). National surveillance studies conducted in the past 5 years indicate that approximately one in six high school students used cannabis in the preceding month, (Centers for Disease Control and Prevention, 2024) with higher rates of use in each successive grade (Miech et al., 2024, Farokhnia et al., 2024). Recent reviews of extant literature conclude that cannabis use has been cross-sectionally associated with emotional distress and poor academic performance among adolescents (Substance Abuse and Mental Health Services Administration, 2021). Similar reviews identify strong longitudinal evidence showing negative impacts of cannabis on brain development and cognitive function, (Scheyer et al., 2023, Urits et al., 2021, Gorey et al., 2019) and research suggests these outcomes may be tied to more frequent use, particularly when use is initiated in adolescence (Scheyer et al., 2023, Urits et al., 2021, Gorey et al., 2019, Volkow et al., 2014).

Numerous psychosocial factors are established correlates of cannabis use among adolescents, including perceptions of risk, approval or disapproval of significant others (e.g., family, friends), and peer norms (Brook et al., 2001, Guttmannova et al., 2019, Harrison and Kanbur N, 2024, Substance Abuse and Mental Health Services Administration, 2021, Yang et al., 2022). For example, adolescents who perceive that their parents do not believe cannabis use is risky are 1.5 times more likely to use cannabis themselves (compared to youth who report their parents hold beliefs of greater risk). Generally speaking, past research indicates adolescents believe cannabis use confers at least some risk, that their friends and family would disapprove of experimental and/or regular use, and that a majority of their peers do not use cannabis regularly (although perceptions of peer use are highly inflated) (Substance Abuse and Mental Health Services Administration, 2021, Substance Abuse and Mental Health Services Administration, 2020). Substantial variation in these perceptions has been noted by grade. For example, a Monitoring the Future study found that younger students were more likely than those in older grades to view cannabis use as risky (Miech et al., 2024). Promotive attitudes have become more prevalent over the past decade alongside policy shifts towards legalization; for example, perceptions of friends’ disapproval of cannabis use has declined considerably over the past several decades (Miech et al., 2024).

Recent research using repeated cross-sectional data from national U.S. adolescent samples has found disparities in cannabis use across social positions. Female adolescents are more likely than male adolescents to have recently used cannabis, (Miech et al., 2024, Centers for Disease Control and Prevention, 2023) and studies have identified several disparities by racial and ethnic identity (Centers for Disease Control and Prevention, 2023, Miech et al., 2024, Substance Abuse and Mental Health Services Administration, 2021). For example, Monitoring the Future has found the prevalence of past 12 month cannabis use to be higher for Black/African American students than White or Hispanic students (33 % vs. 25–26 %) (Miech et al., 2024). Lesbian, gay, bisexual, transgender, gender diverse, queer, and questioning (LGBTQ+) youth also use cannabis more than cisgender heterosexual students (Centers for Disease Control and Prevention, 1991). Studies have also found differences in cannabis use across economic indicators such as parental education. Adolescents whose parent(s) had not completed college had a higher prevalence of cannabis use than those with college-educated parents (Keyes et al., 2022). Interestingly, this disparity may be more pronounced among younger youth (i.e. 8th grade students, age 13–14 in most U.S. schools) than older youth (12th grade, age 17–18) where the difference in prevalence of use by parental education is negligible (Miech et al., 2024).

In contrast, little research has explored disparities in cannabis-related attitudes. One study conducted with California students in 2013–2019 (with legalization of adult recreational cannabis use in 2016) found that perceived peer and parental approval of cannabis in adolescence differentially predicted uptake of cannabis use in young adulthood, with stronger associations among White young people than among Asian or Hispanic young people (Hummer et al., 2022). We are not aware of research that has examined additional disparities in these attitudes among U.S. youth.

Despite clear evidence of identity-based disparities in cannabis use, only a small number of studies have examined either use or promotive psychosocial factors across multiple intersecting social positions (Watson et al., 2020, Eisenberg et al., 2022, Gerke et al., 2024, Feinstein et al., 2019, Vance et al., 2023). For example, in our previous research with 2019 surveillance data from Minnesota (pre-legalization) and California (post-legalization), we found that youth of color who also identified as LGBQ+ (including identities such as pansexual and queer) or transgender/gender diverse (TGD) had disproportionally high rates of substance use, including any recent cannabis use (Eisenberg et al., 2022). Another study using a national dataset has further demonstrated disparities in intentions to use substances (including cannabis) among U.S. children ages 9–12, with those having multiple marginalized identities and experiencing multiple types of discrimination showing elevated levels of intention to use (Wang et al., 2024). To our knowledge, this body of research has not extended to frequent cannabis use or related attitudes among youth with multiple marginalized social positions.

Disparities in substance use, including cannabis, are attributable in part to minority stressors such as bias-based bullying (Gower et al., 2025b, Swann et al., 2020, Vance et al., 2023, Wang et al., 2024, Watson et al., 2019a) – an interpersonal experience reflecting structural forms of stigma and discrimination (e.g. racism, heteronormativity, cisgenderism). The new temporal intersectional minority stress model (Rivas-Koehl et al., 2023) integrates the Minority Stress Theory (Brooks, 1981, Meyer, 2003) with an intersectionality framework (Crenshaw, 1994, Bowleg, 2012) and considers historical, generational, and developmental time (Rivas-Koehl et al., 2023). In brief, it posits that health and well-being are shaped by stressors specific to occupying marginalized social positions (e.g. experiences of discrimination regarding social class and racial, ethnic, sexual, and gender identities), which stem from oppressive social structures. Coping mechanisms are included in this model, in that they may buffer against the ill effects of multilevel stressors and mitigate the impact on well-being. Among adolescents, substance use may be a coping mechanism to deal with stigmatizing interpersonal interactions and structural systems (Patrick et al., 2019, Patrick et al., 2024). Although the present study is not a test of this full model, the framework is useful when considering disparities in health and related behaviors and attitudes, in that it explicitly addresses intersecting marginalized identities and also suggests mechanisms which may aid in interpretation of the observed differences.

Building on the extant research and using recommended methods for studies of intersectional disparities, the present study examines how regular cannabis use and related psychosocial factors (i.e., perceptions of risk, approval from parents and friends, and peer norms of use) differ across racial, ethnic, sexual, gender, and economic social positions in a large statewide survey of adolescents. The focus on regular use reflects concerns about cognitive and emotional outcomes associated with more frequent use and extends the literature that typically operationalizes cannabis use as any in the past month or past year. In the contemporary policy context of cannabis legalization, results may inform substance use education activities, trends towards greater normalization and acceptance of cannabis use (Pew Research, 2024), and oppressive structures impacting multiply marginalized adolescents.