Examining E-Cigarette Use and Mental Health Among Bipoc Sexual and Gender Minority Young Adults

Background and Purpose: Black, Indigenous and People of Color (BIPOC) sexual and gender minority (SGM) young adults have to cope with stressors related to their minoritized identities (e.g., homophobia, heterosexism, stigmatization, rejection). Studies indicate SGM populations report greater rates of smoking than their cisgender and heterosexual counterparts. According to minority stress theory, cigarette and e-cigarette use may be a mechanism SGM populations employ to cope with identity-related stressors that result from sexual orientation and gender minority identity-specific oppression, discrimination, and victimization. Prior research demonstrates that SGM adolescents are twice as likely as cisgender heterosexual adolescents to smoke cigarettes, placing them at heightened risk of tobacco-related health issues (e.g., respiratory illness, cancer). Stress related to minoritized identities may increase the use of cigarettes and e-cigarettes among minoritized youth. Among SGM teens, rates of smoking/vaping are greater among sexual minority males than among those assigned female sex at birth. Additional research demonstrates that e-cigarette use in young adult sexual minority women is disproportionately higher than among heterosexual women and young adult sexual minority men. Given the increase of e-cigarette usage and the stressors faced by BIPOC SGM people, additional research is needed to identify relevant factors for prevention and intervention with this population. Thus, the present study addresses associations between mental health, past cigarette usage, and gender identity and presentation associated with e-cigarette usage among BIPOC SGM young adults.

Methods: This study drew longitudinal data from a subsample of BIPOC SGM young adults in the National Longitudinal Study of Adolescent to Adult Health (N = 1,120). Multiple regression was used to test the association of e-cigarette usage in the past 30 days with gender identity and presentation, previous depression and anxiety diagnosis, and previous cigarette usage. Analyses incorporated survey weights to adjust for sample selection and produce national representative estimates, while also controlling for other protective and risk factors.

Results: Several significant predictors of e-cigarette usage were identified. First, there were no significant differences in e-cigarette usage between cisgender and transgender and gender-diverse young adults or racial/ethnic identities, after adjusting for other factors. However, there was a significant association with gender presentation, such that more masculine gender presentation was significantly associated with greater e-cigarette usage (b=1.14, p < .001). Mixed findings emerged with mental health: consistent with hypotheses, depression diagnosis was associated with greater e-cigarette usage (b=.84, p <.05), but counter to hypotheses, anxiety diagnosis was associated with lower e-cigarette usage (b=-1.23, p <.01). Lastly, previous cigarette usage was significantly associated with higher e-cigarette usage (b=.07, p <.001).

Conclusions and Implications: In summary, findings suggest that mental health is associated with the e-cigarette usage of BIPOC SGM young adults, but not in consistent directions. Likewise, past cigarette usage may be linked to the transition to e-cigarette usage, and thus may be a target for public health prevention and intervention programs with this specific population. Lastly, the associations with gender presentation raise further questions that need further replication and exploration.