Disparities in trajectories of cigarette and E-cigarette use across sexual orientation groups of young adult men and women in the US

Queering vaping: A qualitative analysis of lesbian, bisexual, and queer women's E-cigarette use in Australia

BACKGROUND

Vaping has emerged as a prominent practice among lesbian, bisexual, and queer (LBQ) women in Australia. Despite its growing prevalence, the socio-cultural dimensions of vaping in LBQ communities remain underexplored. This study examines how vaping functions as a contested site of queer sociability, identity expression, and resistance. Using queer theoretical perspectives, we interrogate the ways LBQ women navigate the aesthetic, social, and political dimensions of vaping within Australia's unique policy landscape.

METHODS

Sixty semi-structured interviews were conducted with LBQ cis and trans women and non-binary individuals aged 18-72 in Australia. A reflexive thematic analysis was employed, informed by queer theory, to explore participants' accounts of vaping.

FINDINGS

Participants framed vaping as a performative practice tied to queer aesthetics, gender expression, and community bonding. While vaping facilitated intimacy and sociability in queer spaces, its association with stigma and youth culture complicated its subversive potential for some. Vaping emerged as a mode of resistance to normative public health narratives, yet also reproduced tensions around deviance and identity.

CONCLUSION

Vaping is a dynamic, contested queer practice, reflecting LBQ women's negotiations of identity, community, and agency within restrictive policy environments. Policy and public health strategies must consider the queer socio-cultural meanings and community practices that shape vaping, to avoid reinforcing stigma and unintended harms to LGBTQ+ communities.

Trends and Sociodemographic Differences in Tobacco/Nicotine Transitions Among U.S. Adolescents and Young Adults Using e-cigarettes, 2014-2023

PURPOSE

E-cigarette use among adolescents and young adults (AYAs) remains prevalent in the United States and is linked with combustible tobacco product use. This study examines sociodemographic differences (i.e., sex, age, sexual identity, transgender identity, race, ethnicity, and income) in transitions from e-cigarette use to other forms of tobacco use among AYAs from 2014 to 2023.

METHODS

AYAs aged 14-25 years from the nationally representative Population Assessment of Tobacco and Health study waves 2-7 (2014/15-2022/23) were used to examine transitions in e-cigarette and combustible tobacco use over 1-to-2-year periods (n = 7,523). Using multinomial logistic regression models, we examined associations of sociodemographic characteristics and wave with e-cigarette and combustible tobacco transitions.

RESULTS

Maintaining e-cigarette use only (21.2% in 2014/15-49.2% in 2022/23) and transitioning from e-cigarette and combustible use (i.e., dual use) to e-cigarettes only (7.6% in 2014/15-29.7% in 2022/23) increased over time. Simultaneously, transitioning from e-cigarettes to dual use (18.2% in 2014/15-17.9% in 2022/23) and maintaining dual use remained steady. Bisexual individuals were more likely to transition from e-cigarette use only to dual use (adjusted relative risk ratio = 2.07; 95% confidence interval = 1.44, 2.99) and maintain dual use (adjusted relative risk ratio = 2.01; 95% confidence interval = 1.43, 2.84), compared to heterosexual individuals. Female, Hispanic, and Black individuals were less likely to transition to dual use or maintain dual use compared to male, non-Hispanic, and White individuals, respectively.

DISCUSSION

Findings identify important sociodemographic groups at greater risk of transitions to combustible tobacco use that warrant attention in future research and prevention strategies to reduce health disparities.

Sexual identity differences in ideal cardiovascular health among cisgender adults in the All of Us Research Program

BACKGROUND

Cardiovascular health (CVH) disparities have been documented among sexual minority adults, yet prior research has focused on individual CVH metrics. We sought to examine sexual identity differences in CVH using the American Heart Association's composite measure of ideal CVH, which provides a more comprehensive assessment of future CVD risk.

METHODS

Data from the All of Us Research Program were analyzed. Sexual identity was categorized as heterosexual, gay/lesbian, bisexual, or other. Individual CVH health metrics and cumulative ideal CVH (range 0-100) were assessed. We ran sex-stratified multiple linear regression models to estimate differences across individual CVH metrics and cumulative ideal CVH between sexual minority and heterosexual adults. We also explored differences in CVH across racial/ethnic and age groups.

RESULTS

The sample included 11 047 cisgender adults with a mean age of 61.1 years (± 13.85); 80% were non-Hispanic White. Lesbian women, gay men, and bisexual women reported greater nicotine exposure than their heterosexual counterparts. Compared to heterosexual men, gay men (B [95% CI] = -8.95 [-14.50, -3.39]) had worse physical activity scores. Gay men also had better body mass index scores than heterosexual men (B [95% CI] = 3.21 [0.09, 6.33]). Bisexual women and men had lower cumulative ideal CVH scores than heterosexual adults. Exploratory analyses revealed several differences in individual CVH metrics and cumulative ideal CVH across racial/ethnic and age groups.

CONCLUSIONS

Clinical interventions to improve the CVH of bisexual adults are needed. Findings can inform the design of interventions that are tailored for specific subgroups of sexual minority adults.

Rural-urban movement and stability in relation to minority stress-related factors, tobacco norms, and tobacco use among a sample of US sexual minority-identifying young adults

PURPOSE

Sexual minority young adults (SMYAs) residing in rural (vs. urban) areas report higher tobacco use rates. Less work has assessed associations of rural-urban residential movement/stability with SMYAs' tobacco use and factors driving these associations.

METHODS

We analyzed 2023 survey data from 1082 US SMYAs (aged 18-34). Multivariable regressions controlling for sociodemographics examined associations of: (1) rural-urban movement/stability (urban stability, rural-urban movement, rural stability [REF]) with minority stress-related factors (mental health symptoms, internalized stigma), perceived tobacco norms (peer tobacco use, social acceptability of tobacco use), and tobacco use (past-month cigarette, e-cigarette, any tobacco use, number of products used); and (2) minority stress-related factors and tobacco norms with tobacco use.

FINDINGS

Relative to SMYAs reporting rural stability, those reporting rural-urban movement and urban stability displayed lower odds of any tobacco use and mental health symptoms, and less peer tobacco use. Those reporting rural-urban movement also reported lower odds of cigarette use and less internalized stigma. Peer tobacco use was associated with higher odds of cigarette and any tobacco use; reporting ≥ moderate mental health symptoms and greater internalized stigma and social acceptability was associated with higher odds of cigarette use.

CONCLUSIONS

These novel findings provide preliminary evidence that, relative to their SM peers who reside in rural areas, SMYAs who move from rural to urban areas may experience less minority stress-related factors and lower tobacco use norms, which may reduce risk for cigarette and other tobacco use. Findings highlight the need for public health messaging interventions targeting SMYAs in rural communities.

Measuring cigarette and e-cigarette use over time among LGBT+ youth and young adults using a repeat cross-sectional survey, 2022-2024

INTRODUCTION

LGBT+ individuals in the U.S. use tobacco products more than their heterosexual and cisgender peers. Although existing literature identifies this trend, more research using recent, national data from a large sample is needed to better examine trends over time.

METHODS

A repeat cross-sectional survey of approximately n=300 youth and young adults aged 15-24 was fielded weekly from October of 2022 to June of 2024, resulting in a total sample of N=25,675. This sample was used to examine cigarette and e-cigarette use over time among LGBT+ and non-LGBT+ youth and young adults. Cigarette and e-cigarette use was also examined by specific sexual orientation and gender identity, using the aggregated sample.

RESULTS

From October 2022 - June 2024, cigarette and e-cigarette use were consistently higher among LGBT+ youth and young adults, compared to their cisgender and heterosexual peers. Compared to heterosexual young people, gay/lesbian and bisexual young people reported higher cigarette and e-cigarette use. Male-identifying individuals reported the highest cigarette use while, female young people reported the highest e-cigarette use. Transgender and gender diverse individuals reported lower cigarette and e-cigarette use than cisgender young people.

CONCLUSIONS

Tobacco use disparities persist among LGBT+ youth and young adults. Sexual minority respondents showed elevated risk of tobacco use, while gender minority youth saw lower rates of tobacco use, although prevalence remains high. Future research should continue to investigate LGBT+ tobacco use using national surveillance methods. Effective programs for tobacco prevention and cessation are necessary to advance health equity among LGBT+ youth and young adults.

IMPLICATIONS

This study finds persistently elevated tobacco use among LGBT+ youth and young adults over a two-year period, highlighting the importance of continued tobacco use surveillance, as well as the development of programmatic interventions to reduce LGBT+ tobacco use. These analyses also inform future work further investigating differences in tobacco use by sexual orientation and gender identity among young people. This work provides a call to action to focus efforts on reducing tobacco use among LGBT+ youth, improving the long-term health of this population and increasing health equity.

Patterns of Tobacco and Cannabis Use Among Sexual Minority Females and Males From PATH Wave 5: The Role of Sociodemographic and Psychosocial Correlates

INTRODUCTION

Although sexual minority (SM; vs heterosexual) individuals display higher rates of tobacco and cannabis use, limited research has examined sociodemographic and psychosocial correlates of single and co-use among this population.

METHODS

Participants were SM-identifying female (N = 2419; Mage = 27.80; 50.0% racial/ethnic minority) and male (N = 1142; Mage = 30.34; 46.1% racial/ethnic minority) adults from Wave 5 of the Population Assessment of Tobacco and Health study. Multinomial logistic regressions examined sociodemographic (ie, sexual identity, age, race/ethnicity, education, income) and psychosocial (ie, alcohol use, mental health, substance use) correlates of single and co-use (ie, no use [referent], tobacco-only, cannabis-only, co-use), controlling for state cannabis legalization, among SM females and males, separately.

RESULTS

The proportions of SM females reporting no use, tobacco-only, cannabis-only, and co-use were 37.9%, 24.0%, 10.5%, and 27.6%, respectively. Among males, 40.6%, 27.8%, 10.1%, and 21.5% reported no use, tobacco-only, cannabis-only, and co-use, respectively. Among females and males, substance use problems were associated with all 3 use groups (vs no use); past-month alcohol use was associated with cannabis-only and co-use; and mental health symptoms were associated with co-use (and cannabis-only in males). Sociodemographic correlates among females were: tobacco-only-identifying as bisexual (vs lesbian), White (vs Black), older, lower education, and lower income; cannabis-only-bisexual, other race (vs White); and co-use-White (vs Hispanic), lower education, and lower income. Among males, sociodemographic correlates were: tobacco-only-older, lower education, and lower income; cannabis-only-Black (vs White) and higher income.

CONCLUSIONS

Public health efforts to reduce tobacco and cannabis use among SM adults should target single versus co-use patterns and their corresponding sociodemographic, mental health, and substance use profiles.

e-Cigarette Tobacco Flavors, Public Health, and Toxicity: Narrative Review

BACKGROUND

Recently, the US Food and Drug Administration implemented enforcement priorities against all flavored, cartridge-based e-cigarettes other than menthol and tobacco flavors. This ban undermined the products' appeal to vapers, so e-cigarette manufacturers added flavorants of other attractive flavors into tobacco-flavored e-cigarettes and reestablished appeal.

OBJECTIVE

This review aims to analyze the impact of the addition of other flavorants in tobacco-flavored e-cigarettes on both human and public health issues and to propose further research as well as potential interventions.

METHODS

Searches for relevant literature published between 2018 and 2023 were performed. Cited articles about the toxicity of e-cigarette chemicals included those published before 2018, and governmental websites and documents were also included for crucial information.

RESULTS

Both the sales of e-cigarettes and posts on social media suggested that the manufacturers' strategy was successful. The reestablished appeal causes not only a public health issue but also threats to the health of individual vapers. Research has shown an increase in toxicity associated with the flavorants commonly used in flavored e-cigarettes, which are likely added to tobacco-flavored e-cigarettes based on tobacco-derived and synthetic tobacco-free nicotine, and these other flavors are associated with higher clinical symptoms not often induced solely by natural, traditional tobacco flavors.

CONCLUSIONS

The additional health risks posed by the flavorants are pronounced even without considering the toxicological interactions of the different tobacco flavorants, and more research should be done to understand the health risks thoroughly and to take proper actions accordingly for the regulation of these emerging products.