E-cigarette use at the intersection of sexual identity and race/ethnicity among US adults: Results from 2021-2023 National Health Interview Survey (NHIS).

Introduction: Understanding e-cigarette use among those with multiple intersecting marginalized identities is important since those individuals might experience intersectional minority stress, which is associated with tobacco use. This study examined the prevalence of e-cigarette use at the intersection of race/ethnicity and sexual identity among US adults.

Methods: We analyzed the pooled 2021 to 2023 National Health Interview Survey (NHIS) dataset adult samples (N=86655). We conducted an adjusted binomial logistic regression analysis to predict past-30-day e-cigarette use with sexual identity (straight, gay/lesbian/bisexual/something else [LGB+]), race/ethnicity (Non-Hispanic White, Non-Hispanic Black/African American, Non-Hispanic Asian, Non-Hispanic American Indian and Alaska Native, Hispanic, Other races) and an interaction term between sexual identity and race/ethnicity in one model, adjusted for age, education, cigarette smoking, and diagnoses of chronic diseases. The results were stratified by sex and the adjusted predicted margins were estimated.

Results: Among total respondents, 5.5% (weighted) reported past-30-day e-cigarette use, 5.3% were LGB+, 11.8% were non-Hispanic Black, 6.1% were non-Hispanic Asian, 1.4% were non-Hispanic American Indian and Alaska Native, and 17.2% were Hispanic. The overall interaction effect between sexual identity and race/ethnicity on outcome was significant among total respondents (p=0.004) and females (p<0.001), but not males. Among females, the adjusted predicted margins for current e-cigarette use between LGB+ individuals and heterosexual individuals in Hispanic groups (4.0% vs. 1.0%) were significantly different from those in the NH White group (4.4% vs. 3.4%).

Conclusion: Sexual minority adults in Hispanic groups, particularly Hispanic sexual minority females, may be at increased risk for e-cigarette use than Hispanic heterosexual females.

Implications: This study highlights the risk of e-cigarette use among sexual minority adults in non-White racial/ethnic groups, particularly Hispanic sexual minority females. These findings underscore the need for future research to understand the unique drivers of e-cigarette use among Hispanic sexual minority females.