Intersectional Disparities in Adult Cigarette Smoking, E-Cigarette Use, and Cannabis Use Among Sexual and Gender and...

Objectives. To examine how intersecting identities of sexual orientation, gender, race, and ethnicity are associated with cigarette smoking, e-cigarette use, cannabis use, tobacco quit attempts, and perceptions of health care among adults in California. Methods. We analyzed the pooled 2021-2022 California Health Interview Survey data (n = 45 916). Sexual and gender minorities (SGMs) were identified as a sexual minority (bisexual, lesbian, gay) or transgender. Using Poisson regression models with interaction terms between SGM and race and ethnicity, we examined intersectional associations with the outcomes. Results. Non-Hispanic White SGM adults had an increased risk of cigarette, e-cigarette, and cannabis use and co-use. Hispanic/Latino SGM adults (adjusted risk ratio [ARR] past-30-day cannabis use = 1.88; 95% confidence interval [CI] = 1.51, 2.33) and non-Hispanic Black SGM adults (ARR heavy smoking = 4.78; 95% CI = 2.34, 9.74) had a much higher risk of use behaviors compared with their non-SGM counterparts. Intersectional minorities were more likely to report perceived discrimination in health care. Conclusions. Intersectional identities influence tobacco, e-cigarette, and cannabis use and health care experiences. Tailored interventions are needed to reduce disparities and improve health care access in intersectional racial and ethnic and SGM minoritized populations. (Am J Public Health. Published online ahead of print August 27, 2026:e1-e12. https://doi.org/10.2105/AJPH.2026.308633).