Substance Use
STATE-SPECIFIC E-CIGARETTE USE AMONG US YOUTH BY SEXUAL ORIENTATION, 2019-2021 YOUTH RISK BEHAVIOR SURVEY Mohammad Ebrahimi Kalan* Mohammad Ebrahimi Kalan Ateeqa iJAZ Archana Vardhan Omolayo Joy Anjorin Lisa L Lindley Rima Nakkash
Introduction: Evidence indicates higher rates of electronic cigarette (e-cigarette) use among lesbian, gay, bisexual, and transgender (LGBT) youth compared to their cisgender heterosexual peers, which is a significant concern in the US. In this nationally representative sample of US youth, we aimed to explore the state-specific weighted prevalence of e-cigarette use among LGBT youth and how it differs from their cisgender heterosexual peers.
Methods: A pooled analysis was conducted using data from the 2019 and 2021 Youth Risk Behavior Survey. Overall, 37 US states collected data from high school students (grades 9-12; N= 271,614) on sexual identities (LGBT, n= 40848) and cisgender heterosexual (n= 230,766). The weighted prevalence of current (past 30-day) use of e-cigarettes by US states was reported. A multivariable regression model was performed to examine the association between sexual identity and vaping e-cigarettes controlling for potential confounders including demographics (i.e., age, sex, race/ethnicity, and school grade), current cigarette use, and other tobacco products use. Weighted adjusted odds ratios (AOR) and corresponding 95% confidence intervals (95%CIs) were reported. Data for the state of California was collected only for the 2019 YRBS.
Results: In 2019-21, current e-cigarette vaping was higher among US LGBT than cisgender heterosexual youths (28 vs 19%; p<.001). The weighted prevalence of current vaping was predominant among LGBT (vs. cisgender heterosexual) in several US states including West Virginia (41% vs. 30%; p=.02), North Carolina (40% vs. 29%; p<.0001), New Mexico (39% vs. 28%; p<.0001), Ohio (39% vs. 18%;p=.0013), North Dakota (35% vs. 26%;p=.0014), and Kentucky (34% vs.17%;p<.0001). The lowest prevalence of current vaping among LGBT (vs. cisgender heterosexual) youth was in Alabama (19% vs. 20%; p= 0.25) and California (19% vs.18%;p=.933). The multivariable regression model showed that compared to cisgender heterosexual peers, US LGBT youth were at greater risk of vaping (AOR= 1.37;95%CI:1.01-1.86; p<.001) in 2019-21, after accounting for the aforementioned confounders.
Conclusions: This nationally representative study adds to the existing literature that e-cigarette use among LGBT youth is prevalent in the US, with a wide spectrum within US states. National and state-level vaping prevention strategies should consider sexual identities in designing, developing, and implementing targeted tailored vaping prevention and cessation programs.