Lifetime use of multiple tobacco/nicotine products at the intersection of gender and sexual minority identity: Findings from the 2023 National Youth Tobacco Survey

Abstract Introduction Sexual and gender minority youth are at higher risk for tobacco/nicotine use than cisgender and/or heterosexual youth. Little is known about how the use of multiple tobacco/nicotine products differs among youth by sexual orientation and gender identity. This study sought to determine whether the lifetime number of tobacco/nicotine products differs by sexual orientation and gender identity. Methods This study is a cross-sectional analysis of nationally representative data on 14 457 students ages 9-19+ who participated in the 2023 National Youth Tobacco Survey. Weighted means, adjusted odds ratios, and adjusted incidence rate ratios were used to assess differences in the number of lifetime tobacco/nicotine products used by students in the following groups: cisgender, heterosexual; cisgender, sexual minority; gender minority, heterosexual; and gender and sexual minority youth. Results Adjusting for age, race/ethnicity, and sex, gender minority heterosexual youth used more than twice as many tobacco/nicotine products as their cisgender heterosexual peers, with an adjusted incidence rate ratio (aIRR) of 2.47; 95% confidence interval (CI), 1.10-5.56; P = .030. Gender and sexual minority youth also used twice as many methods as their cisgender heterosexual peers (aIRR, 2.05; 95% CI, 1.40-2.98; P < .001). Conclusion Among youth aged 9-19+ years, gender minority youth of any sexual orientation used a higher lifetime number of tobacco/nicotine products than did cisgender heterosexual youth. Prevention, harm reduction, and cessation programs for youth are needed to respond to the upward trend of multiple tobacco product use among youth and the specific needs of gender minority youth. Implications This study indicates that gender minority youth may face different tobacco/nicotine risks than both sexual minority and heterosexual youth. Future tobacco/nicotine research should be tailored to intersecting sexual orientation and gender identities. The specific needs of gender minority youth warrant consideration in tobacco/nicotine prevention and cessation programming, particularly with regard to multiple tobacco/nicotine product use.