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

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.