Housing Instability, E-cigarette, and Tobacco Use by Sexual Identity in US High Schoolers

Azagba S, Sajith de Silva G, Ebling T.
Housing Instability, E-cigarette, and Tobacco Use by Sexual Identity in US High Schoolers
Pediatrics. 2025 Jun 1;155(6):e2024069626. doi: 10.1542/peds.2024-069626. PMID: 40404175.

Introduction: The relationship between housing instability and e-cigarette and traditional tobacco use, particularly for sexual minority students, has received little attention. This study investigates the association between housing instability, e-cigarettes, and traditional tobacco use in sexual minorities and heterosexual adolescents.

Methods: We used 2021 and 2023 Youth Risk Behavior Survey data (n = 23 834). Multivariable logistic regression analyses examined associations of housing instability, sexual identity, and e-cigarette and traditional tobacco use. Using various combinations of sexual identity and housing instability, predicted probabilities of current e-cigarette and traditional tobacco use were estimated.

Results: The findings indicated higher e-cigarette and tobacco use among students experiencing housing instability. The intersection of housing instability and sexual identity was significantly associated with e-cigarette and tobacco use. The predicted probability of e-cigarette use was higher among sexual minority male (45.8%) and female (54.8%) students experiencing housing instability compared with heterosexual male (10.6%) and female (14.5%) students not experiencing housing instability. Sexual minority students experiencing housing instability had significantly higher odds of e-cigarette use compared with those with stable housing (odds ratio, 4.91; 95% CI, 3.14-7.69). Sexual minority male and female students experiencing unstable housing had significantly greater odds of e-cigarette and tobacco use compared with their heterosexual peers experiencing unstable housing.

Conclusion: Our findings indicate that housing instability may influence the association between sexual identity and e-cigarette and traditional tobacco use, suggesting a unique vulnerability for sexual minority youth experiencing unstable housing. Public health programs addressing housing instability and the specific needs of sexual minority youth could be beneficial.