Intersectionality of Sexual Orientation With Race and Ethnicity and Associations With E-Cigarette Use Status Among US Youth

Introduction: Although structural discrimination against sexual and racial/ethnicity minorities is a putative risk factor for youth tobacco use, understanding health disparities in youth E-cigarette use at the intersection of sexual orientation, race, and ethnicity is still lacking. This study aims to examine the differences in E-cigarette use prevalence among U.S. youth at the intersections of sexual orientation with race and ethnicity. Methods: E-cigarette use status (never, experimental, or current use) was analyzed among 38,510 U.S. youth using a pooled data set from the Youth Risk Behavior Surveillance System 2015 -2019. The weighted E-cigarette use status between youth at the intersections of sexual orientation with race and ethnicity was reported, stratified by sex. Multivariable multinomial regression adjust-ing for relevant covariates was further conducted. Data analyses were performed in April 2022. Results: After controlling for other covariates, the RRR of current E-cigarette use compared with never use between lesbian Black girls (and heterosexual Black girls) was higher than between lesbian White girls (and heterosexual White girls) (adjusted RRR=6.99; 95% CI=2.21, 22.14). The RRR of current E-cigarette use compared with never use between lesbian other race/multiracial girls (and heterosexual other race/multi-racial girls) was higher than between lesbian White girls (and hetero-sexual White girls) (adjusted RRR=3.60; 95% CI=1.06, 12.26). Conclusions: This study has shown that sexual minority Black girls were more likely to currently use E-cigarettes than heterosexual Black girls. Future studies should examine the underlying reasons for current E-cigarette use among girls with intersectional identities, including race and sexual orientation.