Cigarette smoking, e-cigarette use, and sexual identity among high school students in the USA

Although tobacco use has decreased in the general population in recent years, smoking remains high among subpopulations. This study examined whether sexual identity is associated with cigarette smoking and e-cigarette use among high school students. Data were drawn from the US Youth Risk Behavior Surveillance System (n = 28811). We grouped participants according to sexual identity status. Propensity score matching technique was used to address covariate imbalance among sexual identity groups. Subgroup analyses were performed for male and female students. Of the four sexual identity groups analyzed in this study, bisexual adolescents had significantly higher odds of cigarette smoking (cigarette smoking, OR, 1.61; 95% CI, 1.24–2.08; cigarette smoking for ≥ 10 days, OR, 1.79; 95% CI, 1.28–2.51; cigarette smoking for ≥ 20 days, OR, 2.04; 95% CI, 1.38–3.03). Further, in a sex-based subgroup analysis, results showed significant differences, with bisexual females more likely to smoke cigarettes and use e-cigarettes for ≥ 20 days compared with heterosexual female adolescents. Conclusions: Sexual identity status is strongly associated with cigarette smoking and e-cigarette use. Female bisexual adolescents have an increased risk of cigarette smoking and e-cigarette use for ≥ 20 days. While tobacco control policies have been effective in reducing cigarette use in the general population, targeting policy toward sexual minorities is an important consideration.What is Known:• Sexual minority groups face a disproportionate amount of stress and have a heightened risk of substance use.• Methodological concerns exist in the extant literature, including limited data at the national level.What is New:• Propensity score matching was used to account for imbalances in sexual identity subgroups, and findings show significant heterogeneity in cigarette and e-cigarette use among sexual minority high school students.• Sexual identity status is strongly associated with cigarette smoking and e-cigarette use, especially among bisexual identity female subgroup.