Electronic Cigarette Use at the Intersection of Sexual Identity, Race/Ethnicity, and Sex among U.S.

Lee J, Winickoff JP, Tan ASL.
Electronic Cigarette Use at the Intersection of Sexual Identity, Race/Ethnicity, and Sex among U.S. Young Adults Ages 18-24 Years: Results from Population Assessment Tobacco and Health Study Wave 6 (2021)
AJPM Focus. 2025 Mar 29;4(3):100340. doi: 10.1016/j.focus.2025.100340. PMID: 40470105; PMCID: PMC12133688.

Background: E-cigarettes are commonly used tobacco products by young adults, including sexual minority individuals and racial/ethnic marginalized individuals. This study examines the prevalence of e-cigarette use at the intersections of sexual identity and race/ethnicity among U.S. young adults because of previous research indicating high levels of e-cigarette use among the sexual minority youth of color.

Methods: This study used the public adult dataset from Wave 6 of the Population Assessment of Tobacco and Health (PATH) Study (2021) and included young adults aged 18-24 years (N=10,633). The association between past-30-day e-cigarette use (yes, no), sexual identity (straight/heterosexual, gay/lesbian/bisexual/something else [LGB+]), race (White, Black, others), ethnicity (non-Hispanic, Hispanic), interactions between sexual identity and race, and interactions between sexual identity and ethnicity were analyzed, using adjusted binomial logistic regressions. These analyses were further stratified by sex and presented as adjusted predicted margins.

Results: The analysis showed that the adjusted predicted margin of past-30-day e-cigarette use between heterosexual versus LGB+ Black young adult females (4% versus 12%) is significantly different, while predicted margins between heterosexual versus LGB+ Black young adult males are not significantly different. There were no significant interactions between sexual identity and ethnicity in predicting e-cigarette use.

Conclusions: This study highlights that LGB+ Black young adult females may be at increased risk for e-cigarette use than heterosexual Black young adult females. The findings call for research on the reasons for the heterogeneity of e-cigarette use according to sex, sexual identity, and race.