Examining the relationship between mental health and e-cigarette initiation among sexual and gender minority youth and young adults in the United States compared to their cisgender, heterosexual peers, 2021-2023

Authors

Elexis C. Kierstead, Schroeder Institute, Truth Initiative, Washington DC, USA. Electronic address: lkierstead@truthinitiative.org.
Padmini Kucherlapaty, Schroeder Institute, Truth Initiative, Washington DC, USA.
Michael S. Liu, Schroeder Institute, Truth Initiative, Washington DC, USA.
Elizabeth K. Do, Schroeder Institute, Truth Initiative, Washington DC, USA; Milken Institute School of Public Health, George Washington University, Washington DC, USA.
Cassandra Brazinsky, Schroeder Institute, Truth Initiative, Washington DC, USA.
Elizabeth C. Hair, Schroeder Institute, Truth Initiative, Washington DC, USA; School of Global Public Health, New York University, New York, NY, USA; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.

Document Type

Journal Article

Publication Date

6-22-2025

Journal

Preventive medicine

Volume

198

DOI

10.1016/j.ypmed.2025.108331

Keywords

E-cigarette use; Health disparities; Mental health; Sexual and gender minority health

Abstract

OBJECTIVE: To understand the relationship between mental health, e-cigarette use and sexual and gender minority (SGM) identity given that minority stress worsens mental health and poor mental health increases the risk of e-cigarette use among SGM people. METHODS: Data were obtained from a United States probability-based longitudinal cohort study of 15-21 year olds, recruited in Fall 2021 and followed through Fall 2023. The analytic sample included participants who had not used e-cigarettes prior to Fall 2021 (N = 1908). Participants who identified as lesbian or gay, bisexual or another identity; or whose sex assigned at birth differed from their gender identity, were considered SGM. Mental health was assessed using the Depression, Anxiety, and Stress (DASS-21) scale. Weighted bivariate analyses examined mental health, e-cigarette initiation, and demographics by SGM identity. Weighted logistic regression models stratified by SGM identity examined the relationship between mental health and e-cigarette initiation, controlling for covariates. RESULTS: Approximately 21.6 % of the sample identified as SGM and 10.8 % initiated e-cigarette use by 2023. Significantly more SGM participants reported severe or extremely severe mental health symptoms (45.5 % vs. 22.4 %, p < 0.001). Poor mental health significantly predicted e-cigarette initiation among SGM participants (aOR: 2.50, 95 % CI: 1.10, 5.69), but not among non-SGM participants (aOR:1.65, 95 % CI: 0.97, 2.82). CONCLUSIONS: Results inform prevention and cessation messaging for SGM youth. Tailored mental health resources could reduce the burden of nicotine addiction on this community.

APA Citation

Kierstead, Elexis C.; Kucherlapaty, Padmini; Liu, Michael S.; Do, Elizabeth K.; Brazinsky, Cassandra; and Hair, Elizabeth C., "Examining the relationship between mental health and e-cigarette initiation among sexual and gender minority youth and young adults in the United States compared to their cisgender, heterosexual peers, 2021-2023" (2025). GW Authored Works. Paper 7387.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7387

Department

Epidemiology