# Invisible minority stress and addictive behaviors: disparities in psychological distress and e-cigarette use among lesbian, gay, and bisexual adults in China

## TL;DR

This study finds that lesbian, gay, and bisexual adults in China experience higher psychological distress and e-cigarette use, which may be linked to minority stress and influenced by eHealth use.

## Contribution

The study introduces a moderated mediation model to explore e-cigarette use disparities among Chinese LGB individuals through the lens of minority stress.

## Key findings

- LGB individuals had 11.1% higher odds of psychological distress compared to heterosexual individuals.
- Psychological distress was associated with higher e-cigarette use among LGB individuals.
- eHealth use reduced disparities in psychological distress between LGB and heterosexual groups.

## Abstract

Evidence shows that lesbian, gay, and bisexual (LGB) groups face disparities in e-cigarette use, but little is known about e-cigarette use among the Chinese LGB population. China, with the largest LGB population and as the leading global producer in the e-cigarette industry, presents a unique context for studying this phenomenon.

Using the theoretical framework of minority stress, this study hypothesized a moderated mediation model to test the mediating effect of psychological distress and the moderating effect of eHealth use on the association between sexual orientation and e-cigarette use. Data from a nationally representative Chinese survey conducted between January and September 2023 (n = 4,901) were analyzed.

The results indicated that LGB individuals had 11.1% higher odds of distress compared to heterosexual populations, was associated with higher e-cigarette use (bp = 0.038, p < .001). However, the direct association between sexual minority identity and e-cigarette use was non-significant. Furthermore, eHealth use moderated the disparities in psychological distress between LGB and heterosexual groups (bp = − 0.160, p < .05).

The pattern of e-cigarette use among Chinese sexual minorities is distinct: e-cigarettes are less commercialized and serve mainly as a coping mechanism. These findings highlight the importance of mental health support and eHealth interventions in reducing psychological distress and e-cigarette use among LGB individuals in China.

The online version contains supplementary material available at 10.1186/s40359-025-03875-7.