Disparities in the frequency of tobacco products use by sexual identity status

Background: Largely absent from the literature are studies examining differences in tobacco use frequency among sexual minority populations versus heterosexuals. The current study examined the frequency of tobacco product use (i.e., cigarette, e-cigarettes and cigars, smokeless tobacco, hookah, and heated tobacco products) among sexual minority students versus heterosexuals (straight). Methods: Data from the 2020 National Youth Tobacco Survey (n = 14,531) were analyzed to examine the association between sexual identity (lesbian or gay, bisexual, not sure, and heterosexual or straight) and tobacco use frequency. Negative binomial regression and zero-inflated negative binomial models were used to assess the association between sexual identity and each tobacco use frequency among current and ever users. Results: Current e-cigarettes users who identified as gay or lesbian used e-cigarette more frequently than heterosexual students. Multivariable count regression analysis showed that the e-cigarette use frequency in the past 30 days was significantly higher for gays or lesbians (IRR 1.45, 95% CI, 1.19–1.76) compared to heterosexuals. Similarly, gay or lesbian students who were current hookah users on average reported 81% more days of hookah use (IRR, 1.81, 95% CI, 1.08–3.03). The frequency of cigarette smoking was also significantly higher among bisexual cigarette smokers. No significant differences were found in other tobacco product use frequencies between sexual minority and heterosexual youths. Conclusion: Sexual identity was associated with tobacco use frequency, especially for e-cigarettes and hookah. Elevated tobacco use among sexual minority groups deserves special consideration among a population group that is highly vulnerable to marketing and advertisement targeting.