Social factors, systemic factors, and familial discrimination contribute to increased risk of poverty, housing insecurity, health disparities and social isolation especially among the LGBTQ community’s most vulnerable.More LGBTQ adults have no health insurance compared to 12% of non-LGBTQ adults with greater disparities in LGBTQ of color , transgender adults , and transgender adults of color.Overall, LGBTQ populations are at greater risk of COVID-19 exposures and at risk of both economic and health complications than non-LGBTQ people.Moreover, a study of 2,732 cisgender gay and other men who have sex with men from 103 countries reported loss of employment due to the pandemic , inability to receive COVID-19 related financial benefits and reduction or cutting of meals completely during the pandemic.Another study of 1,051 MSM found that 47.1% experienced problems with buying food, 17.3% with paying for rent, 32.4% with decreased work hours, and 19.1% reported losing a job due to COVID-19.Overall drug use around the world has risen from 210 million in 2009 to 269 million in 2018 with 192 million people reporting cannabis use.17 Within the United States, about 46% of the US population reported past year cannabis use in 2019.This includes about 12 million individuals 18 to 25 years of age and 33 million adults 26 or older reporting past year cannabis use in 2019.Cannabis is composed of two main components, Δ9-tetrahydrocannabinol , the psychoactive element, and cannabidiol , the non-psychoactive element.Cannabis is predominantly dried flower that can be smoked as cigarettes , or with pipes, water pipes , cannabis vaporizers , e-cigarettes for cannabis extracts, and rigs for cannabis extracts.Other modes of cannabis use include edibles, topicals, and sprays.However, smoked cannabis is the most popular mode of use in the US.Salles et al.found people smoked 13 joints per week on average prior to the pandemic compared to 9.75 joints during the pandemic.However, this study was limited by small sample size and did not encompass all forms of cannabis use behaviors.On the other hand, Brenneke et al.and Assaf et al.reported slight increases in cannabis use frequency during the pandemic, but overall use was comparable to pre-pandemic levels.It was also reported that mode of cannabis use stayed the same pre-pandemic and during the pandemic with most respondents reporting a method for cannabis inhalation , vaporizing plant, wax/dab, and/or vaping oil/concentrates.Data for this dissertation was collected by the COVID-19 Cannabis Survey.The COVID- 19 Cannabis Survey, supported by US National Institute on Drug Abuse and Semel Charitable Foundation, is an anonymous cross-sectional web-based survey of respondents who use cannabis and cannabidiol in the United States.Participants were included in the survey if they were 18 years of age or older, living within the United States, and indicated non-medical drying rack cannabis, cannabis for medical use, or CBD use in the last 12 months.The survey was sent out in August – September 2020 where 2,000 respondents were recruited.After exclusion criteria were applied, 1,883 respondents were eligible and completed the survey.Recruitment was based on a convenience sample of respondents on internet-based platforms including Reddit, Bluelight , Craigslist, and Twitter.

The study advertisement stated the following: “Have you used cannabis or CBD in the past year? Participate in a UCLA survey ”.Duplicate responses or “ballot stuffing” was restricted by limiting one response for each unique internet protocol address.The survey took approximately 20 to 30 minutes to complete, and participants were remunerated $5 for completing the survey.In this single survey, cannabis and CBD behaviors were assessed at two, 3-month time periods.Participants were initially asked about their non-medical/medical cannabis and CBD use behaviors three months before the COVID-19 pandemic.A reference date of January to mid-March 2020 was deemed as 3 months before the pandemic; hereby noted as before the pandemic.Following questions before the COVID-19 pandemic, respondents were asked about non-medical/medical cannabis and CBD use behaviors in the past three months at the time of the survey.These questions were a proxy for non-medical/medical cannabis and CBD use behaviors during the COVID-19 pandemic; hereby noted as during the pandemic.Questions on non-medical cannabis, medical cannabis, and CBD were asked separately.Data from this survey include cannabis and CBD frequency of use, reasons for changing cannabis use during the COVID-19 pandemic, sharing behaviors of prepared cannabis and cannabis-related paraphernalia, education, sex, age, sexual orientation, and geographical location.This study received institutional review board approval from the University of California, Los Angeles.All respondents received online informed consent.This study examines changes in reported sharing of prepared cannabis and cannabis related paraphernalia during the COVID-19 pandemic – risks of concern for increasing transmission of this respiratory infection.Our study found an overall decrease in sharing of prepared cannabis and cannabis-related paraphernalia during the pandemic across all levels of sharing with the largest decreases observed among those reporting a higher frequency of sharing before the pandemic.Moreover, sharing of cannabis between the two time periods varied differently by sex and frequency of cannabis use before the pandemic.Those who self-identified as female had a larger percent change in no sharing of cannabis during the pandemic compared to males.Those who self reported ≥weekly cannabis use before the pandemic also had a larger percent change in no sharing during the pandemic compared to those who used cannabis ≤ monthly.Moreover, a smaller proportion of those reporting no sharing obtained their cannabis from a friends or family most of the time compared to those reporting any sharing while more respondents reporting no sharing indicated increased cannabis use because of time at home compared to 69% of those reporting any sharing.Thus, we hypothesize that these reductions in sharing of prepared cannabis and cannabisrelated paraphernalia may have served as a risk mitigation strategy for COVID-19 infection, may have been a consequence of not seeing others, or both.

Sharing of paraphernalia for cannabis, tobacco, and crack cocaine use has previously been demonstrated as a risk factor for respiratory infections such as COVID-19.For instance, a cluster of tuberculosis cases has been linked to sharing of a cannabis pipe.Sharing of tobacco water pipes has also been shown to increase the risk of respiratory bacterial and viral infections.In the early stage of the pandemic, the World Health Organization and other researchers highlighted potential risks with COVID-19 transmission through sharing of tobacco and e-cigarette smoking and recommended not to share.Likewise, implementation of safe crack use kits to reduce sharing of smoking paraphernalia for COVID-19 prevention was advocated in the United Kingdom.To the best of our knowledge, no risk mitigation strategies or official public health messaging toward sharing of prepared cannabis and cannabis-related paraphernalia during the COVID-19 pandemic have been suggested in the United States.However, education around sharing smoking paraphernalia and distribution of safe crack use kits have previously been shown to reduce sharing.Thus, public health messaging and education toward sharing practices of prepared cannabis and cannabis-related paraphernalia like “Puff, Puff, Don’t Pass,” may be useful for risk mitigation of COVID-19 infection especially during future COVID-19 peaks.Messaging may also be useful with other respiratory infections such as during the cold and influenza season.Additionally, this study identified variables associated with sharing of cannabis during the pandemic.First, those reporting ≥weekly cannabis use during the pandemic had lower odds of sharing compared to those who used cannabis ≤ monthly after adjusting for age, sex, sexual orientation, education, and state’s cannabis regulation status.This may be the case as more respondents reporting ≥weekly cannabis use reported increasing their cannabis use because of time at home and social distancing measures compared to 46% and 38% of those reporting ≤ monthly respectively.Second, as age increased, the odds of any sharing during the pandemic decreased.Thus, one hypothesis is that older individuals may not share as a risk mitigation for COVID-19 given increased risk of COVID-19 severity among older groups.On the other hand, younger adults may have a lower risk perception toward COVID-19 and thus lower acceptance of COVID-19 mitigation strategies.Moreover, US Census region, was associated with increased odds of sharing prepared cannabis and cannabis-related behaviors during the pandemic.Specifically, those from the Midwest, Northeast, and South had higher odds of sharing compared to those from the West.This may be the case given differences in COVID-19 state policy and public health messaging between these regions.Overall, there were 1,112 respondents who reported non-medical cannabis use in the past twelve months.Of which, 340 self-identified as sexual minority compared to 752 as non-sexual minority.SM individuals were primarily Hispanic/Latino/a/x and non-Hispanic White compared to non-SM individuals who were primarily nonHispanic White.

A larger proportion of SM individuals had a high school or less than high school degree compared to non-SM individuals.Finally, there were more SM individuals from the Northeast compared to non-SM and less SM individuals from the South compared to 34.31% of non-SM individuals.During the pandemic, 43.82% of SM individuals reported daily/weekly non-medical cannabis use in the past three months compared to 62.10% of non-SM individuals.Meanwhile, more SM individuals reported any sharing of prepared cannabis or cannabis-related paraphernalia during the pandemic compared to 72.75% of non-SM individuals.Most SM and non-SM respondents reported an inhalation method as the most frequent mode of cannabis use during the pandemic.Tobacco, alcohol,commercial greenhouse supplies and other substance use was reported by 60.00%, 47.65%, and 36.47% SM respondents respectively compared to 57.05%, 52.13%, and 27.39% among non-SM respectively.Changes in non-medical cannabis frequency of use was similar for SM and non-SM as 24.71% of SM and 24.87% of non-SM had increased use.Changes in cannabis frequency of use was similar among SM and non-SM women and SM and non-SM men.However, there was a difference in changes of sharing among SM compared to non-SM where 26.91% of SM had decreased sharing compared to 34.80% of non-SM respondents.This difference was greater among men where 19.66% of SM had decreased sharing compared to 36.11% of non-SM men.Frequency of cannabis use during the pandemic was associated with sexual orientation, age, education, tobacco use, and alcohol use.The odds of daily/weekly cannabis use among SM respondents was 0.49 times that of non-SM respondents in the unadjusted model.After adjusting for age, education, tobacco use, and alcohol use, the odds of daily/weekly cannabis use among SM respondents was 0.55 times that of non-SM respondents.Ten year increases in age and alcohol use were positively associated with daily/weekly cannabis use during the pandemic.However, tobacco use and education were negatively associated with daily/weekly cannabis use during the pandemic.Among men, the odds of daily/weekly cannabis use during the pandemic was 0.39 times that for SM respondents compared to non-SM men after adjusting for age, education, tobacco use, and alcohol use.Sharing of prepared cannabis and cannabis-related paraphernalia during the pandemic was associated with sexual orientation, age, education, and tobacco use.In the unadjusted model, the odds of any sharing were greater for SM individuals compared to non-SM individuals.After adjusting for age, education, and tobacco use, the odds of any sharing during the pandemic among SM respondents was 1.60 compared to non-SM respondents.Ten-year increases in age and education were negatively associated with any sharing whereas tobacco use was positively associated with any sharing during the pandemic.Among men, the odds of any sharing were 2.19 times higher for SM men compared to non-SM men after conditioning on age, education, and tobacco use.This study presents findings on frequency of non-medical cannabis use and sharing of prepared cannabis and cannabis-related paraphernalia during the COVID-19 pandemic among SM and non-SM individuals.First, SM and non-SM individuals reported similar increases in frequency of cannabis use during the pandemic , a finding comparable to Slemon et al.Nevertheless, SM respondents were less likely to report daily/weekly cannabis use during the pandemic compared to non-SM individuals.The point estimate was even larger for SM men compared to non-SM men.Previous literature has highlighted that SM individuals are more likely to use cannabis and to have cannabis use disorder compared to their non-SM counterparts.However, studies reporting this have only looked at any cannabis use with minimal literature examining the characteristics of cannabis use behaviors, particularly among those who report some level of cannabis use.Thus, the findings from this study extends the context in the literature of more specific use behaviors by looking at frequency of use among those who use cannabis.This study suggests that among those who use cannabis, non-SM may use it at higher frequencies than SM.On the other hand, use of tobacco and other substances were higher among SM respondents in our study population which may substitute frequency of cannabis use.Second, SM respondents were more likely to report sharing of cannabis during the pandemic compared to non-SM respondents with higher odds for SM men compared to non-SM men.