E-Cigarettes' Negative Impact on LGBTQ Young Adult Mental Health

Background and Purpose: A large body of research demonstrates significantly higher rates of tobacco product use by LGBTQ+ individuals compared to heterosexual/cisgender peers. LGBTQ+ adults smoke and vape at higher levels (16.1% vs. 12.3%; 13.0% vs. 3.7%, respectively) and transgender adults use tobacco products at four times the rate of cisgender adults. LGBTQ+ youth try e-cigarettes and currently use e-cigarettes at higher rates than their heterosexual/cisgender peers (49% vs. 39%; 18% vs. 13%, respectively). Research attributes higher rates of LGBTQ+ tobacco use to a combination of stigma, isolation, socialization, and industry marketing. LGBTQ+ people are two-four times more likely to experience mental health problems than heterosexual/cisgender people, and mental illness has been found to double the risk of smoking. Despite this bidirectional relationship documented with the general population, little research has examined the relationship between tobacco and mental health among LGBTQ+ young adults (ages 18-24), a critical period for tobacco use and mental health. Vaping’s recent emergence on the tobacco landscape and its increasing prevalence among youth call for research to examine the intersection of LGBTQ+ young adults’ mental health and e-cigarette use.

Methods: In 2023, researchers from the University of North Carolina and the NC Department of Health and Human Services collected cross-sectional survey data at 26 Pride festivals across the state. This survey is the largest and only survey of LGBTQ+ health needs to conducted in North Carolina. This purposive sample included 1,454 participants ages 18-24 years who self-identified as LGBTQ+. We conducted preliminary bivariate analyses (chi-squared tests and Spearman correlations) to explore relations among vaping and mental health problems.

Results: Tobacco use rates by gender identity found the following: cisgender women (32.9%), cisgender men (32.0%), trans women (32.2%), trans men (31.3%), nonbinary/genderqueer (30.1%). Correlational analyses showed positive correlations between vaping and negative mental health outcomes: anxiety (r = .221, p < .001 ), depression (r = .120, p < .01), suicidal ideation (r = .126, p < .01), suicide attempts (r = .135, p < .01), PTSD (r = .166, p = .001), adjustment disorder (r = .139, p < .004), and bipolar disorder (r = .163, p < .001). Vaping was positively correlated with violence victimization: sexual assault (r = .121, p = .012) and violence from a family member (r = .163, p <.001). All of these correlations are small to medium effect sizes.

Conclusions and Implications: Results support previous findings of high tobacco product use among LGBTQ+ young adults. Increased risk of experiencing poor mental health among LGBTQ+ individuals may, in part, drive these patterns in tobacco use. Nicotine stimulates the release of neurotransmitters (including dopamine) but ultimately leads to poorer mental health. Policy and programs aimed at reducing tobacco product use among this population may be optimized by addressing the high prevalence of mental health issues and trauma and developing positive social identity and integration. Future research, supported by increased availability of consistent, disaggregated data is needed to examine tobacco use prevalence, precipitates, and impacts, particularly among individuals holding intersectional identities.