Multiple and frequent tobacco product use by sexual minority youth in the United States: Results from the 2023 National Youth Tobacco Survey

TL;DR

Sexual minority youth in the US use tobacco products more often and in more ways than heterosexual youth, highlighting the need for targeted prevention efforts.

Contribution

The study provides new evidence on disparities in tobacco use patterns among sexual minority youth using the latest national survey data.

Findings

Gay/lesbian and asexual youth had higher rates of frequent and multiple tobacco product use compared to heterosexual youth.

Bisexual, pansexual, queer, and questioning youth were more likely to use non-combustible products like e-cigarettes.

Disparities in tobacco use by sexual identity suggest the need for tailored public health interventions.

Abstract

Understanding tobacco product use among sexual minority youth is important due to the exposure to nicotine and toxicants, which worsens tobacco-related health disparities. We used recent US national data to characterize tobacco product use by sexual identity.

Data were drawn from the 2023 National Youth Tobacco Survey (NYTS), a nationally representative survey of US middle and high school students (N = 20,503). Sexual identity categories included “heterosexual”, “gay/lesbian”, “bisexual/pansexual/queer”, “asexual”, “questioning”, “I do not know what this question means”, “something else”, and “decline to answer.” Outcomes were past-30-day (1) multiple tobacco product use (number of products) and (2) frequent tobacco product use (≥20 days). Weighted Poisson regression models examined associations between sexual identity and tobacco use, adjusting for covariates.

In 2023, there was more tobacco product use (adjusted prevalence ratio[aPR] = 2.35, 95 % CI = 1.15, 4.79) and more frequent tobacco product use among gay/lesbian (aPR = 2.89, 95 % CI = 1.42, 5.87) and asexual youths (aPR = 2.92, 95 % CI = 1.41, 6.04) (vs. heterosexual youth) in the past 30 days. Compared to heterosexual youth, gay/lesbian and asexual youth were more likely to report combustible tobacco use, while bisexual, pansexual, queer, and questioning youth were more likely to use non-combustible products, such as e-cigarettes and nicotine pouches.

This study observed more multiple and frequent tobacco product use among US sexual minority youth than heterosexual youth. These disparities by sexual identity emphasize the need for targeted tobacco prevention and cessation programs. Public health interventions should address unique stressors and risk factors contributing to tobacco use among sexual minority youth.