E-cigarette use more common among sexual minority youth


In a recent study, the prevalence of e-cigarette use was greater among sexual minority youth than heterosexual or questioning youth.

Sexual minority youth (SMY) use e-cigarettes more frequently than other populations, according to a recent study.

E-cigarettes are now the most used tobacco product among US youth and young adults, reported in about 1 in 5 high school students and 1 in 20 middle school students. Studies have linked e-cigarette use to long-term health risks, and as e-cigarette use grows among youth, there is a need to understand disparities in e-cigarette use.

Because of the prejudice SMY face, investigators predicted this population may use e-cigarettes and other substances to manage social stressors. While research has found differences in e-cigarette use among SMY groups, evidence remains limited.

To address the limited research on e-cigarette use in SMY populations, investigators gathered and analyzed data from the 2020 and 2021 National Youth Tobacco Survey (NYTS), a national data set on tobacco use in middle school and high school students. 

The NYTS gathers data on tobacco products, secondhand smoke exposure, smoking cessation, ability to purchase or obtain tobacco products, and knowledge about tobacco products. The 2020 survey was filled out through school participation, while the 2021 survey was administered online.

E-cigarette use in the 30 days prior to the survey was the primary measure of the study. A brief description of e-cigarettes was given to participants, who answered questions on e-cigarette use and their sexual identity. Responses for sexual identity included gay or lesbian, bisexual, heterosexual, and not sure.

Data on participants’ sex, grade levels, race and ethnicity, tobacco use by household members, and other tobacco use was also gathered. Other nicotine produces included cigars, cigarettes, hookahs, smokeless tobacco, pipes, roll-your-own cigarettes, snus, dissolvable tobacco, and bidis.

There were 16,633 students surveyed, 81.4% of which were straight, 3.3% lesbian or gay, 9.7% bisexual, and 5.6% unsure. Non-Hispanic White individuals made up 51.6% of the cohort, Hispanic 24.9%, non-Hispanic other 11.9%, and non-Hispanic Black 11.6%. The percentage of male participants was slightly higher than the percentage of female participants.

Current e-cigarette use was reported in 14.7% of all high school students, 21.5% of gay or lesbian students, 18.1% of bisexual students, 14.4% of straight students, and 10.5% of students unsure about their identity.

Differences in the disparities between e-cigarette use varied based on race and ethnicity. The odds of e-cigarette use were 0.45 greater in non-Hispanic Black female patients compared to non-Hispanic White male patients. The use of e-cigarettes was significantly higher in Black lesbian, gay, and bisexual students compared to Black straight students.

While disparities varied based on race, ethnicity, and sex, e-cigarette use was overall more common in SMY populations. Discrimination could be a factor in higher e-cigarette use among these groups.


Azagba S, Ebling T, Shan L. Sexual minority youth e-cigarette use. Pediatrics. 2023;151(3). doi:10.1542/peds.2022-058414

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