Skip to main content

Advertisement

SpringerLink
Log in

Cigarette smoking, e-cigarette use, and sexual identity among high school students in the USA

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Although tobacco use has decreased in the general population in recent years, smoking remains high among subpopulations. This study examined whether sexual identity is associated with cigarette smoking and e-cigarette use among high school students. Data were drawn from the US Youth Risk Behavior Surveillance System (n = 28811). We grouped participants according to sexual identity status. Propensity score matching technique was used to address covariate imbalance among sexual identity groups. Subgroup analyses were performed for male and female students. Of the four sexual identity groups analyzed in this study, bisexual adolescents had significantly higher odds of cigarette smoking (cigarette smoking, OR, 1.61; 95% CI, 1.24–2.08; cigarette smoking for ≥ 10 days, OR, 1.79; 95% CI, 1.28–2.51; cigarette smoking for ≥ 20 days, OR, 2.04; 95% CI, 1.38–3.03). Further, in a sex-based subgroup analysis, results showed significant differences, with bisexual females more likely to smoke cigarettes and use e-cigarettes for ≥ 20 days compared with heterosexual female adolescents.

Conclusions: Sexual identity status is strongly associated with cigarette smoking and e-cigarette use. Female bisexual adolescents have an increased risk of cigarette smoking and e-cigarette use for ≥ 20 days. While tobacco control policies have been effective in reducing cigarette use in the general population, targeting policy toward sexual minorities is an important consideration.

What is Known:

• Sexual minority groups face a disproportionate amount of stress and have a heightened risk of substance use.

• Methodological concerns exist in the extant literature, including limited data at the national level.

What is New:

• Propensity score matching was used to account for imbalances in sexual identity subgroups, and findings show significant heterogeneity in cigarette and e-cigarette use among sexual minority high school students.

• Sexual identity status is strongly associated with cigarette smoking and e-cigarette use, especially among bisexual identity female subgroup.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Jha P, Ramasundarahettige C, Landsman V, Rostron B, Thun M, Anderson RN, McAfee T, Peto R (2013) 21st-century hazards of smoking and benefits of cessation in the United States. N Engl J Med 368(4):341–350. https://doi.org/10.1056/NEJMsa1211128

    Article  CAS  PubMed  Google Scholar 

  2. Warren GW, Alberg AJ, Kraft AS, Cummings KM (2014) The 2014 Surgeon General’s report: “The Health Consequences of Smoking–50 Years of Progress”. Cancer. 120(13):1914–1916. https://doi.org/10.1002/cncr.28695

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bartecchi CE, MacKenzie TD, Schrier RW (1994) The human costs of tobacco use. N Engl J Med 330(13):907–912. https://doi.org/10.1056/NEJM199403313301307

    Article  CAS  PubMed  Google Scholar 

  4. Hankey GJ (1999) Smoking and risk of stroke. J Cardiovasc Risk 6(4):207–211

    Article  CAS  Google Scholar 

  5. Fagerström K (2002) The epidemiology of smoking: health consequences and benefits of cessation. Drugs. 62(Suppl 2):1–9. https://doi.org/10.2165/00003495-200262002-00001

    Article  PubMed  Google Scholar 

  6. Goniewicz ML, Knysak J, Gawron M, Kosmider L, Sobczak A, Kurek J, Prokopowicz A, Jablonska-Czapla M, Rosik-Dulewska C, Havel C, Jacob P III, Benowitz N (2014) Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tob Control 23(2):133–139. https://doi.org/10.1136/tobaccocontrol-2012-050859

    Article  Google Scholar 

  7. Polosa R, Morjaria JB, Prosperini U, Russo C, Pennisi A, Puleo R, Caruso M, Caponnetto P (2018) Health effects in COPD smokers who switch to electronic cigarettes: a retrospective-prospective 3-year follow-up. Int J Chron Obstruct Pulmon Dis 13:2533–2542. https://doi.org/10.2147/COPD.S161138

    Article  PubMed  PubMed Central  Google Scholar 

  8. Jensen RP, Luo W, Pankow JF, Strongin RM, Peyton DH (2015) Hidden formaldehyde in e-cigarette aerosols. N Engl J Med 372(4):392–394. https://doi.org/10.1056/NEJMc1413069

    Article  CAS  PubMed  Google Scholar 

  9. Soneji S, Barrington-Trimis JL, Wills TA, Leventhal AM, Unger JB, Gibson LA, Yang JW, Primack BA, Andrews JA, Miech RA, Spindle TR, Dick DM, Eissenberg T, Hornik RC, Dang R, Sargent JD (2017) Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults. JAMA Pediatr 171(8):788–797. https://doi.org/10.1001/jamapediatrics.2017.1488

    Article  PubMed  PubMed Central  Google Scholar 

  10. Bullen C, McRobbie H, Thornley S, Glover M, Lin R, Laugesen M (2010) Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial. Tob Control 19(2):98–103. https://doi.org/10.1136/tc.2009.031567

    Article  CAS  PubMed  Google Scholar 

  11. Dawkins L, Turner J, Hasna S, Soar K (2012) The electronic-cigarette: effects on desire to smoke, withdrawal symptoms and cognition. Addict Behav 37(8):970–973. https://doi.org/10.1016/j.addbeh.2012.03.004

    Article  PubMed  Google Scholar 

  12. Vansickel AR, Cobb CO, Weaver MF, Eissenberg TE (2010) A clinical laboratory model for evaluating the acute effects of electronic “cigarettes”: nicotine delivery profile and cardiovascular and subjective effects. Cancer Epidemiol Biomark Prev 19(8):1945–1953. https://doi.org/10.1158/1055-9965.EPI-10-0288

    Article  Google Scholar 

  13. Fallin A, Goodin AJ, King BA (2015) Menthol cigarette smoking among lesbian, gay, bisexual, and transgender adults. Am J Prev Med 48(1):93–97. https://doi.org/10.1016/j.amepre.2014.07.044

    Article  PubMed  Google Scholar 

  14. Johnson SE, Holder-Hayes E, Tessman GK, King BA, Alexander T, Zhao X (2016) Tobacco product use among sexual minority adults: findings from the 2012-2013 national adult tobacco survey. Am J Prev Med 50(4):e91–e100. https://doi.org/10.1016/j.amepre.2015.07.041

    Article  PubMed  Google Scholar 

  15. Lee JGL, Griffin GK, Melvin CL (2009) Tobacco use among sexual minorities in the USA, 1987 to May 2007: a systematic review. Tob Control 18(4):275–282. https://doi.org/10.1136/tc.2008.028241

    Article  CAS  PubMed  Google Scholar 

  16. Austin SB, Ziyadeh N, Fisher LB, Kahn JA, Colditz GA, Frazier AL (2004) Sexual orientation and tobacco use in a cohort study of US adolescent girls and boys. Arch Pediatr Adolesc Med 158(4):317–322. https://doi.org/10.1001/archpedi.158.4.317

    Article  PubMed  Google Scholar 

  17. Azagba S, Asbridge M, Langille D, Baskerville B (2014) Disparities in tobacco use by sexual orientation among high school students. Prev Med 69:307–311. https://doi.org/10.1016/j.ypmed.2014.07.042

    Article  PubMed  Google Scholar 

  18. Rath JM, Villanti AC, Rubenstein RA, Vallone DM (2013) Tobacco use by sexual identity among young adults in the United States. Nicotine Tob Res 15(11):1822–1831. https://doi.org/10.1093/ntr/ntt062

    Article  PubMed  Google Scholar 

  19. Jamal A, King BA, Neff LJ, Whitmill J, Babb SD, Graffunder CM (2016) Current cigarette smoking among adults - United States, 2005-2015. MMWR Morb Mortal Wkly Rep 65(44):1205–1211. https://doi.org/10.15585/mmwr.mm6544a2

    Article  PubMed  Google Scholar 

  20. Agaku IT, King BA, Husten CG et al (2014) Tobacco product use among adults--United States, 2012-2013. MMWR Morb Mortal Wkly Rep 63(25):542–547

    PubMed  PubMed Central  Google Scholar 

  21. Blosnich J, Lee JGL, Horn K (2013) A systematic review of the aetiology of tobacco disparities for sexual minorities. Tob Control 22(2):66–73. https://doi.org/10.1136/tobaccocontrol-2011-050181

    Article  PubMed  Google Scholar 

  22. Jamal A, Agaku IT, O’Connor E, King BA, Kenemer JB, Neff L (2014) Current cigarette smoking among adults-United States, 2005-2013. MMWR Morb Mortal Wkly Rep 63(47):1108–1112

    PubMed  PubMed Central  Google Scholar 

  23. Kasza KA, Ambrose BK, Conway KP, Borek N, Taylor K, Goniewicz ML, Cummings KM, Sharma E, Pearson JL, Green VR, Kaufman AR, Bansal-Travers M, Travers MJ, Kwan J, Tworek C, Cheng YC, Yang L, Pharris-Ciurej N, van Bemmel DM, Backinger CL, Compton WM, Hyland AJ (2017) Tobacco-product use by adults and youths in the United States in 2013 and 2014. N Engl J Med 376(4):342–353. https://doi.org/10.1056/NEJMsa1607538

    Article  PubMed  PubMed Central  Google Scholar 

  24. King BA, Dube SR, Tynan MA (2012) Current tobacco use among adults in the United States: findings from the National Adult Tobacco Survey. Am J Public Health 102(11):e93–e100. https://doi.org/10.2105/AJPH.2012.301002

    Article  PubMed  PubMed Central  Google Scholar 

  25. Offen N, Smith EA, Malone RE (2003) From adversary to target market: the ACT-UP boycott of Philip Morris. Tob Control 12(2):203–207

    Article  CAS  Google Scholar 

  26. Smith J, Thompson S, Lee K (2016) ‘Public enemy no. 1’: tobacco industry funding for the AIDS response. SAHARA J 13(1):41–52. https://doi.org/10.1080/17290376.2016.1164617

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ryan H, Wortley PM, Easton A, Pederson L, Greenwood G (2001) Smoking among lesbians, gays, and bisexuals: a review of the literature. Am J Prev Med 21(2):142–149. https://doi.org/10.1016/S0749-3797(01)00331-2

    Article  CAS  PubMed  Google Scholar 

  28. Meyer IH (2003) Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 129(5):674–697. https://doi.org/10.1037/0033-2909.129.5.674

    Article  PubMed  PubMed Central  Google Scholar 

  29. Sheahan SL, Garrity TF (1992) Stress and tobacco addiction. J Am Acad Nurse Pract 4(3):111–116. https://doi.org/10.1111/j.1745-7599.1992.tb00821.x

    Article  CAS  PubMed  Google Scholar 

  30. Dai H (2017) Tobacco product use among lesbian, gay, and bisexual adolescents. Pediatrics. 139(4):e20163276. https://doi.org/10.1542/peds.2016-3276

    Article  PubMed  Google Scholar 

  31. McCabe SE, Hughes TL, Bostwick W, Boyd CJ (2005) Assessment of difference in dimensions of sexual orientation: implications for substance use research in a college-age population. J Stud Alcohol 66(5):620–629

    Article  Google Scholar 

  32. Wheldon CW, Kaufman AR, Kasza KA, Moser RP (2018) Tobacco use among adults by sexual orientation: findings from the population assessment of tobacco and health study. LGBT Health 5(1):33–44. https://doi.org/10.1089/lgbt.2017.0175

    Article  PubMed  PubMed Central  Google Scholar 

  33. Corliss HL, Wadler BM, Jun H-J, Rosario M, Wypij D, Frazier AL, Austin SB (2013) Sexual-orientation disparities in cigarette smoking in a longitudinal cohort study of adolescents. Nicotine Tob Res 15(1):213–222. https://doi.org/10.1093/ntr/nts114

    Article  PubMed  Google Scholar 

  34. Watson RJ, Lewis NM, Fish JN, Goodenow C (2018) Sexual minority youth continue to smoke cigarettes earlier and more often than heterosexuals: findings from population-based data. Drug Alcohol Depend 184:64–70. https://doi.org/10.1016/j.drugalcdep.2017.11.025

    Article  PubMed  Google Scholar 

  35. Mereish EH, Goldbach JT, Burgess C, DiBello AM (2017) Sexual orientation, minority stress, social norms, and substance use among racially diverse adolescents. Drug Alcohol Depend 178:49–56. https://doi.org/10.1016/j.drugalcdep.2017.04.013

    Article  PubMed  PubMed Central  Google Scholar 

  36. Ylioja T, Cochran G, Woodford MR, Renn KA (2018) Frequent experience of LGBQ microaggression on campus associated with smoking among sexual minority college students. Nicotine Tob Res 20(3):340–346. https://doi.org/10.1093/ntr/ntw305

    Article  PubMed  Google Scholar 

  37. Kann L, McManus T, Harris WA, Shanklin SL, Flint KH, Queen B, Lowry R, Chyen D, Whittle L, Thornton J, Lim C, Bradford D, Yamakawa Y, Leon M, Brener N, Ethier KA (2018) Youth risk behavior surveillance - United States, 2017. MMWR Surveill Summ 67(8):1–114. https://doi.org/10.15585/mmwr.ss6708a1

    Article  PubMed  PubMed Central  Google Scholar 

  38. D’Agostino RB (1998) Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 17(19):2265–2281

    Article  Google Scholar 

  39. McCaffrey DF, Griffin BA, Almirall D, Slaughter ME, Ramchand R, Burgette LF (2013) A tutorial on propensity score estimation for multiple treatments using generalized boosted models. Stat Med 32(19):3388–3414. https://doi.org/10.1002/sim.5753

    Article  PubMed  PubMed Central  Google Scholar 

  40. Lee BK, Lessler J, Stuart EA (2010) Improving propensity score weighting using machine learning. Stat Med 29(3):337–346. https://doi.org/10.1002/sim.3782

    Article  PubMed  PubMed Central  Google Scholar 

  41. Ridgeway G, Kovalchik SA, Griffin BA, Kabeto MU (2015) Propensity score analysis with survey weighted data. J Causal Inference 3(2):237–249. https://doi.org/10.1515/jci-2014-0039

    Article  PubMed  PubMed Central  Google Scholar 

  42. Dugoff EH, Schuler M, Stuart EA (2014) Generalizing observational study results: applying propensity score methods to complex surveys. Health Serv Res 49(1):284–303. https://doi.org/10.1111/1475-6773.12090

    Article  PubMed  Google Scholar 

  43. Duke JC, Lee YO, Kim AE, Watson KA, Arnold KY, Nonnemaker JM, Porter L (2014) Exposure to electronic cigarette television advertisements among youth and young adults. Pediatrics. 134(1):e29–e36. https://doi.org/10.1542/peds.2014-0269

    Article  PubMed  Google Scholar 

  44. Grana R, Benowitz N, Glantz SA (2014) E-cigarettes: a scientific review. Circulation. 129(19):1972–1986

    Article  Google Scholar 

  45. Dilley JA, Spigner C, Boysun MJ, Dent CW, Pizacani BA (2008) Does tobacco industry marketing excessively impact lesbian, gay and bisexual communities? Tob Control 17(6):385–390. https://doi.org/10.1136/tc.2007.024216

    Article  CAS  PubMed  Google Scholar 

  46. Washington HA (2002) Burning love: big tobacco takes aim at LGBT youths. Am J Public Health 92(7):1086–1095. https://doi.org/10.2105/AJPH.92.7.1086

    Article  PubMed  PubMed Central  Google Scholar 

  47. Emory K, Buchting FO, Trinidad DR, Vera L, Emery SL (2018) Lesbian, gay, bisexual and transgender (LGBT) view it differently than non-LGBT: exposure to tobacco-related couponing, e-cigarette advertisements, and anti-tobacco messages on social and traditional media. Nicotine Tob Res 21:513–522. https://doi.org/10.1093/ntr/nty049

    Article  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Family and Preventive Medicine, Division of Public Health, University of Utah School of Medicine, 375 Chipeta Way, Salt Lake City, UT, 84108, USA

    Sunday Azagba, Keely Latham & Lingpeng Shan

Authors
  1. Sunday Azagba
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Keely Latham
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lingpeng Shan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SA conceptualized and designed the study, supervised all aspects of the study, contributed to the drafting of the manuscript, critically reviewed the manuscript, and approved the final manuscript as submitted. KL contributed to the drafting of the manuscript, critically reviewed the manuscript, and approved the final manuscript as submitted. LS conducted the data analysis, contributed to the drafting of the manuscript, critically reviewed the manuscript, and approved the final manuscript as submitted.

Corresponding author

Correspondence to Sunday Azagba.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Communicated by Mario Bianchetti

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 20 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Azagba, S., Latham, K. & Shan, L. Cigarette smoking, e-cigarette use, and sexual identity among high school students in the USA. Eur J Pediatr 178, 1343–1351 (2019). https://doi.org/10.1007/s00431-019-03420-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-019-03420-w

Keywords

Search

Navigation