Associations between tobacco use patterns and demographic characteristics of sexual minority and heterosexual youth: Results from a nationwide online survey.

Introduction: Youth are at risk for tobacco use, and previous research has pointed to increased vulnerabilities associated with sexual minority identity. For example, LGB youth have increased odds for using tobacco than their heterosexual peers, and bisexual youth have higher odds of smoking than other sexual identity groups. As new tobacco products proliferate and health risks from dual/poly use grow, increased understanding of tobacco use patterns by sexual minority youth is needed.

Methods: For 3117 youth, aged 13-18 years, who completed an online questionnaire in 2017 and identified their sexual orientation [minority (e.g. lesbian/gay, bisexual, or pansexual) vs majority (heterosexual)] and gender, we classified current tobacco use into four categories: e-cigarette only, other product only (such as cigarette, cigar, or smokeless tobacco; not an e-cigarette), dual/poly use, and no use. Analyses were conducted separately for male and female participants. Multinomial logistic regression was employed.

Results: Female sexual minority youth had nearly twofold odds of dual/ poly tobacco use (OR=1.95; 95% CI: 1.12-3.40), compared to their heterosexual counterparts. For male youth, sexual minority identification was not significantly associated with dual/poly use. No significant differences were found in sexual minority and heterosexual youth e-cigarette only or other tobacco only use groups. Tobacco use patterns also significantly differed by age, race, place of residence, and parental education level.

Conclusions: Study findings reveal greater odds of dual/poly tobacco use for female sexual minority youth. Tailored tobacco prevention and cessation programs or interventions are needed for sexual minority youth most at risk of tobacco use, especially multiple product use.