Neurodivergence, Minority Stress, and Tobacco Use in a Sample of US Sexual and Gender Minoritized Young Adults.

Background: Minority stress is related to tobacco use inequities among sexual and gender minoritized young adults (SGM YAs). Neurodivergent SGM YAs may experience greater minority stress (from dual-minoritized identities) and tobacco use.

Methods: A 2023 survey assessed neurodivergence (defined as attention-deficit hyperactivity disorder [ADHD] or a learning-related condition), minority stressors (mental health symptoms, internalized SGM stigma, SGM community connectedness), and tobacco use (past-month cigarette, e-cigarette, any tobacco product use; number of products used) among SGM YAs (aged 18-34) in the United States. Multivariable regression examined associations of neurodivergence with minority stressors and tobacco use.

Results: Among SGM YAs (N = 1115; M_age = 25.34 [SD = 4.84]; 65.2% bisexual+, 29.5% monosexual, 4.8% another identity; 52.2% cisgender women, 29.8% cisgender men, 17.2% gender minority), 36.1% reported neurodivergence, 23.4% reported current cigarette use, 30.0% e-cigarette use, and 40.4% any tobacco use. On average, participants reporting current tobacco use used 2 to 3 products (M = 2.06 [SD = 1.25]). Neurodivergence was associated with higher odds of experiencing mental health symptoms (aOR = 1.53, 95% CI [1.19-1.95]), cigarette use (aOR = 1.48, 95% CI [1.07-2.05]), e-cigarette use (aOR = 1.80, 95% CI [1.35-2.42]), and any tobacco product use (aOR = 1.63, 95% CI [1.23-2.17]). Mental health symptoms were associated with cigarette (aOR = 1.63, 95% CI [1.19-2.25]), e-cigarette (aOR = 1.58, 95% CI [1.19-2.11]), and any tobacco product use (aOR = 1.48, 95% CI [1.13-1.96]).

Conclusions: Neurodivergent SGM YAs (vs those without ADHD or learning-related conditions) may have greater risk for mental health symptoms and related tobacco use, underscoring the need for appropriate and culturally competent mental healthcare to reduce tobacco use.