United States: LGBT+ youth smoke and vape more than their peers

A new study[1] from the Truth Initiative finds that a higher proportion of lesbian, gay, bisexual and transgender adolescents and young adults used tobacco and vaping products in 2021 in the United States compared to their non-LGBT+ peers, showing that disparities in smoking among LGBT+ youth persist and have extended to vaping products.

Truth Initiative researchers analyzed survey data from a sample of 6,122 young people aged 15 to 31 interviewed between July 2021 and October 2021 as part of a longitudinal cohort study. Young people were asked about their sexual orientation, gender identity, and cigarette and vaping product use.

Higher tobacco and vaping product use in the LGBT+ community

The study found that youth who identify as LGBT+ more frequently report ever smoking tobacco cigarettes (34 % vs. 26 %) and using them during the survey (8 % vs. 6 %) than their non-LGBT+ peers. For vaping, nearly half of them (49%) have ever used vaping products, compared to 39% of youth who do not identify as LGBT+. Regular use of e-cigarettes is also higher (18 % vs. 13 %).

The results also showed significant disparities in consumption within the community. Young people identifying as bisexual are the most numerous to have reported having already consumed tobacco cigarettes: 41 % compared to 33% of gays/lesbians and 26 % of young people declaring themselves heterosexual. Similarly, with regard to the proportion of those consuming products at the time of the study, it is respectively 10 % for young people identifying as bisexual, compared to 7% of gays/lesbians and 6% of heterosexuals. Regarding the consumption of vaping products, there are also gaps: 57 % compared to 48% of gays/lesbians and 39 % of heterosexuals. E-cigarette use at the time of the study was 22 % among youth identifying as bisexual, compared to 20 % among gay/lesbian and 13 % among heterosexual individuals.

Tobacco use and vaping habits are similar among youth who do not identify as cisgender, including transgender and nonbinary youth. For example, nonbinary youth are more likely to have ever used tobacco cigarettes (36 % vs. 27 %) and e-cigarettes (54 % vs. 40 %). Nearly twice as many nonbinary youth currently use tobacco cigarettes (11 % vs. 6 %) and e-cigarettes (17 % vs. 14 %) compared to their cisgender peers.

Transgender people also report being more frequent users of tobacco cigarettes (30 % vs. 27 %) and e-cigarettes (43 % vs. 40 %) compared to their cisgender peers.

The LGBT+ community remains a prime target for the tobacco industry

The tobacco industry has spent decades directly targeting LGBT+ people, contributing to high smoking prevalence among this population. More recently, tobacco companies have leveraged social media to advertise e-cigarettes, and LGBT+ people report significantly more exposure to tobacco and vaping-related content on social media than their non-LGBT+ counterparts.

Figure 1 - Source Truth Initiative

In 2000, confidential documents from tobacco company RJ Reynolds were leaked revealing the controversial marketing strategy "Project SCUM" (Sub-Culture Urban Marketing) aimed to increase cigarette sales by targeting gay men and the homeless with strategically placed ads and displays in community centers and specialty stores.

The need for targeted prevention campaigns

In addition to targeted marketing by tobacco companies, the authors point to increased stress related to stigma, social disenfranchisement, and discrimination as drivers of tobacco and vaping product use among this community. They suggest that the persistently high prevalence of smoking and vaping product use among this population underscores the critical need for prevention and intervention efforts specifically targeted at LGBT+ youth. This targeting should include both primary prevention and cessation support for smoking and vaping. The authors also call for more nuanced research on smoking/nicotine use by sexual orientation and gender identity. For example, many national youth surveillance surveys do not offer the option to identify as nonbinary, a population that may represent at least half of noncisgender youth and that reports a high prevalence of smoking/vaping.

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[1] Report, LGBT+ young people smoke and vape at a higher prevalence than non-LGBT+ peers, Truth Initiative, published July 3, 2024, accessed July 12, 2024