“To smoke feels gender”: A Photovoice Study of Cannabis Use Among Transgender and Non-Binary Youth

Background: Transgender, non-binary and gender non-conforming (herein, ‘TGNC’) youth (15-24 years old) face overlapping minority stressors (e.g., gender discrimination, lack of access to gender-affirming care, rejection, violence) that contribute to unfair and modifiable differences (i.e., inequities) in mental health and substance use outcomes. Previous research has identified that TGNC youth have some of the highest rates of cannabis use in Canada, though the social context and gendered dimensions of cannabis use within this population remain poorly understood. This presentation explores how cannabis use intersects with the gender experiences of TGNC youth. 
Methods: This community-based participatory research study utilized photovoice methodology and in-depth, semi-structured interviews (2021-2022) with 27 TGNC youth from across British Columbia. Interviews sought to elicit discussion regarding gender, mental health, and cannabis use experiences, as well as potential interconnections between these issues. Data analysis leveraged social constructivist grounded theory, in conjunction with poststructuralist feminist and queer scholarship. The study engaged the Youth Action Committee, comprising TGNC youth who use or have used substances, to facilitate data triangulation and refine the analysis.
Results: Three overarching themes were generated pertaining to cannabis use and gender experiences amongst TGNC youth. First, participants used cannabis purposefully and strategically to enact diverse gender expressions and embodiments. Second, they leveraged cannabis to support introspection whilst mobilizing identity discovery and development. Finally, participants mobilized cannabis as a vehicle for accessing moments of gender euphoria and affirmation. Together, these results illustrate that TGNC youth are using cannabis based on diverse motivations, often related to their shared experience of navigating gender and transness in a cisheteropatriarchal society.
Conclusions: This presentation underscores that TGNC youth use cannabis as an intentional means of facilitating their mental health, well-being, identity development and self-expression. The study reveals important experiential and embodied dimensions of cannabis use that are critical to acknowledge and value in pertinent health and social service delivery contexts. Findings offer direction for care providers to leverage harm reduction strategies and educational resources to guide TGNC and other youth to use cannabis as safely as possible, and to experience desired effects while being better equipped to identify and mitigate cannabis-related risks and harms. This support is likely to be more effective if provided using equity-oriented and de-stigmatizing approaches that are responsive to clients’ lived experiences and evolving social contexts, including with respect to gender-related pursuits and inequities.