E-cigarette, tobacco, and cannabis vaping among diverse sexual and gender identities in U.S. high school students

Objectives: This study investigated the associations between diverse sexual and gender identities and adolescent use of e-cigarettes, tobacco products, and cannabis vaping. Study design: Cross-sectional study. Methods: Data were collected from a nationally representative sample of high school students in 2023. Multivariable logistic regression analyses were employed to examine the relationships between sexual orientation, gender identity, and transgender status with e-cigarette, tobacco, and cannabis vaping. Results: Bisexual, pansexual, or queer students had the highest prevalence of e-cigarette use at 16.12 %, followed by gay or lesbian students at 14.46 %. Asexual students were more likely to vape cannabis (aOR = 2.22, 95 % CI = 1.08–4.56) compared to heterosexual students. Nonbinary, genderfluid, or genderqueer students had higher odds of e-cigarette use (aOR = 2.10, 95 % CI = 1.16–3.80) compared to boys. Bisexual, pansexual, or queer students were also more likely to use e-cigarettes (aOR = 2.47, 95 % CI = 1.59–3.83) and vape cannabis (aOR = 1.87, 95 % CI = 1.17–2.98) compared to heterosexual students. Transgender or questioning students had higher odds of e-cigarette use (aOR = 2.35, 95 % CI = 1.11–5.00) and other tobacco product use (aOR = 3.51, 95 % CI = 1.38–8.96) compared to non-transgender students. Conclusions: Findings reveal significant disparities in substance use behaviors among sexual and gender minority (SGM) youth compared to their heterosexual and cisgender peers. These results highlight the need for tailored prevention and intervention strategies to address the unique needs of SGM youth.