Multi-level Risk and Protective Factors for Vaping Onset and Escalation Among Youth: a Focus on LGBTQ + Disparities

Area of Science:

• Public Health
• Adolescent Health
• Social Epidemiology

Background:

• Youth vaping is a significant public health issue.
• Sexual and gender minority (SGM) youth exhibit higher e-cigarette use rates than non-LGBTQ+ peers.
• Disparities are linked to social and structural factors, not identity alone.

Purpose of the Study:

• To review risk and protective factors for vaping among youth aged 10-24.
• To examine shared and LGBTQ+-specific factors influencing vaping initiation and escalation.
• To synthesize evidence through the Social Ecological Model and identify intervention targets.

Main Methods:

• Narrative review of existing literature.
• Application of the Social Ecological Model across multiple levels (individual to societal).
• Interpretation through minority stress and socialization/identity pathways.

Main Results:

• Discrimination and stigma are key risks, increasing distress and normalizing vaping.
• Supportive relationships, identity affirmation, and inclusive policies act as protective factors.
• Vaping disparities are driven by structural inequities and social conditions.

Conclusions:

• "One-size-fits-all" prevention strategies are insufficient for addressing youth vaping disparities.
• Interventions should be selective, mechanism-informed, and target structural drivers.
• Promoting resilience requires addressing both shared risks and LGBTQ+-specific challenges.