Age and Sexual Orientation Differences in Perceptions of the Harms and Benefits of Cannabis Among Adults in the United States

Abstract

Objective: Research on how public perceptions of cannabis vary across adulthood and by sexual orientation remains limited despite expanding legalization in the U.S. Method: Using 2024 Health Information National Trends Survey (HINTS) data (N = 4,402), we analyzed perceived harms or benefits of cannabis on a six-point scale from "very harmful" to "very beneficial.” Weighted ordinal logistic regression assessed associations with age and sexual orientation, adjusting for demographics, health status, and psychological distress. Results: 17.7% viewed cannabis as very harmful, 9.8% somewhat harmful, 29.5% both harmful and beneficial, 10.8% neither harmful nor beneficial, 20.2% somewhat beneficial, and 12.0% very beneficial. Younger adults (aged 18–29) were more likely to hold favorable views than those aged 65+ (AOR = 2.32; 95% CI [1.62, 3.33]). Lesbian/gay (AOR = 1.68; 95% CI [1.10, 2.58]) and bisexual (AOR = 1.81; 95% CI [1.06, 3.06]) adults were more likely to hold favorable views than straight adults. The association between sexual orientation and cannabis-related perceptions varied by age (age × sexual orientation: Wald F(6, 44) = 3.07, p = .013). Among bisexual adults, perceived cannabis benefits increased sharply with age, from approximately 38% at ages 30–44 to 79% at ages 45–64 and 96% at age 65+, while perceived harms decreased from approximately 22% at ages 30–44 to 4% at ages 45–64 and 1% at age 65+. Conclusions: Cannabis perceptions vary significantly by age and sexual orientation suggesting intervention strategies should be tailored to reflect diverse views held across the life course and by sexual identity.