Exploring Factors Shaping Tobacco and Marijuana Use Among Sexual Minority Adolescents

This study sought to identify the predominant factors associated with tobacco and marijuana/cannabis use among adolescents according to their sexual identity.

Using the 2023 National Youth Tobacco Survey, we examined current use of e-cigarettes, cigarettes, and marijuana/cannabis vaping among adolescents. We used dominance analyses and logistic regression models to assess the relative importance of factors linked to tobacco and marijuana/cannabis use. The analyses were stratified by sexual identity (straight, sexual minorities, unsure) and grade levels (middle-school vs. high-school).

The study sample includes 6654 middle-school and 8274 high-school students. Three themes emerge from the dominance analysis. First, exposure to e-cigarette or cigarette use at home or in vehicles consistently ranked as the leading factor associated with smoking and vaping across school levels and sexual identity, explaining up to 44% of the predicted variance. Second, the perception of occasional e-cigarette or cigarette use as little to no harm was a top factor, linked to e-cigarette use among sexual minority students and straight high-school students, as well as cigarette use among straight students and sexual minority high-school students. It explained up to 21.6% and 26.5% of the variance in current e-cigarette and cigarette use, respectively. Third, mental stress was a dominant factor associated with tobacco and marijuana/cannabis use among sexual minority middle-school students, explaining up to 21% of the variance.

This study identifies modifiable factors linked to adolescent tobacco and marijuana use. Public health initiatives targeting these factors may reduce smoking and vaping, especially among sexual minority adolescents.

Adolescents in the LGBTQ+ community use tobacco and marijuana at higher rates than their straight peers. This study offers insight into the relative importance of a variety of sociodemographic and environmental factors contributing to increased use. The most dominant factors, identified as immediate environmental exposure, e-cigarette risk perceptions, and mental stress should be prioritized when developing targeted interventions to reduce smoking and vaping in this priority population.