Rising vaping rates among lesbian, gay,

and bisexual young people outpace peers,

widening tobacco use gap
Research has long shown that lesbian, gay, and
bisexual individuals use tobacco products at higher
rates than their heterosexual peers, due, in part,
to decades of tobacco industry efforts to target this
population. New Truth Initiative® research identifies
that this trend is worsening — and extends to
e-cigarettes. Between 2020 and 2021, e-cigarette
use rates rose at higher rates among lesbian, gay,
and bisexual youth compared to heterosexual youth.
These disparate increases in vaping threaten to widen
the gap in nicotine addiction and physical and mental
health concerns in a population already burdened by
discrimination and stigma.

E-CIGARETTE USE ACCELERATES

AMONG LESBIAN, GAY, AND BISEXUAL
YOUNG PEOPLE
Lesbian, gay, and bisexual youth and young adults
use and try e-cigarettes at a higher rate than their
heterosexual peers, according to an analysis of Between 2020 and 2021,
Truth Initiative surveys conducted in 2020 and 2021.
The analysis uses data from the 2020 and 2021
e-cigarette use rates rose at
Truth Longitudinal Cohort survey, a national cohort higher rates among lesbian,
established in 2014 to evaluate truth®, one of the
largest and most successful youth tobacco prevention gay, and bisexual youth compared
campaigns in the United States. Because the survey
asked about sexual orientation but not gender identity,
to heterosexual youth.
results from this survey focus only on lesbian, gay,
and bisexual individuals — referred to in this report
as LGB. Truth Initiative aims to update future data
collections to include transgender individuals.

June 2022 LGB E-CIGARETTE USE

 The survey was administered in 2020 to 7,003 15-30-year-olds, of
whom 1,018 were LGB, and in 2021 to 6,411 14-33-year-olds, 1,037
of whom identified as LGB. Survey results indicate that rates of LGB
youth and young adults ever trying and currently using e-cigarettes
increased between 2020 and 2021:
> Higher rates of trying e-cigarettes: Young people who identify
as LGB reported that they had ever vaped at much higher rates
than their heterosexual peers (52.1% vs 38.6%).

> Higher rates of currently using e-cigarettes: In 2021, LGB

young people currently vaped at higher rates than their
heterosexual peers (19.8% vs. 13.2%).

> Rates increase over time: Between 2020 and 2021, the
difference between LGB and heterosexual young people who
currently vape increased by 32%, and those who had ever tried
e-cigarettes increased by 26%.

E-cigarette use among youth and young adults

by sexual orientation

60%
% Past 30 day e-cigarette use

50% 52.1%
48.0%
40% 38.6%
37.7%
30%

20% 19.8%
17.2%
12.2% 13.2%
10%

0%
2020 2021

Heterosexual Ever Use LGB Ever Use

Heterosexual Current Use LGB Current Use
LGB e-cigarette use
increased more than
While current and ever e-cigarette use increased over time heterosexual e-cigarette
among Truth Initiative’s entire survey sample, LGB e-cigarette
use increased more than heterosexual e-cigarette use, effectively use, effectively widening
widening the gap between vaping rates based on sexual orientation,
pointing to growing problems with vaping use in this population.
the gap between vaping
rates based on sexual
orientation.

June 2022 LGB E-CIGARETTE USE 2

 Expanding decades of targeted
tobacco marketing to e-cigarettes
The tobacco industry has a well-documented history of targeting the LGBT community
since the 1990s, including advertising in LGBT publications, using corporate philanthropy as
“evidence” of its support of the LGBT community, and hosting community outreach efforts. In
1995, Tobacco giant R.J. Reynolds’ created “Project SCUM” (Sub-Culture Urban Marketing) to
boost cigarette sales by targeting gay men and homeless individuals with advertisements and
displays placed in communities and stores.1 Tactics continue to evolve, extending to corporate
efforts to be named LGBT-friendly workplaces. For example, Reynolds American Inc. was
designated a “Best Place to Work for LGBTQ Equality” by the Human Rights Campaign in
2020, despite its history of targeted marketing.2

Now, e-cigarette companies continue to target the LGBT community by sponsoring events,
including the e-cigarette company VaporFi’s sponsorship of an annual gay pride festival in
Miami.3 As a result, LGBT adults have seen and heard more e-cigarette ads than non-LGBT
adults, and there is evidence that this trend affects LGBT youth.4-6 Further research is needed
to determine the effect of Big Tobacco’s marketing on LGBT e-cigarette use.

WHY ARE LGB VAPING RATES INCREASING

FASTER THAN HETEROSEXUAL VAPING?
Sexual minorities have used tobacco at higher rates than their
heterosexual counterparts for years. Past research has shown
that lesbian, gay, and bisexual adults smoked cigarettes at rates
significantly higher than straight adults7 and were nearly twice as
likely to use e-cigarettes and little cigars as their straight peers8.
Widening disparities in LGB tobacco use rates may be intertwined
with myriad issues facing this community, including sustained
minority stress and deteriorating mental health exacerbated by the
COVID-19 pandemic and an increasingly hostile political environment
that has fueled increased violence, hate speech, and discriminatory
legislation against the LGBT community.

June 2022 LGB E-CIGARETTE USE 3

 MINORITY STRESS INCREASES E-CIGARETTE USE
AMONG LGB INDIVIDUALS
Research shows that stress related to homophobia and transphobia
increases e-cigarette use among LGBT youth.9,10 Violence,
harassment, bullying, and discrimination contribute to more stress
among LGBT youth.
> Gender- and sexuality-based harassment has been linked to
increased e-cigarette use among LGBT high school students.9

> LGB young adults report rates of physical and sexual abuse
two to three times higher than their non-sexual minority
peers. These adverse childhood experiences have been
linked to increased odds of e-cigarette use among sexual
minorities.11,12

RECENT EVENTS HAVE DAMAGED MENTAL

HEALTH AMONG THE LGB COMMUNITY
Lawmakers across the country introduced and passed a record
number of anti-LGBT bills in 2021,13 warranting investigation into
how these events may be affecting mental health outcomes among
LGBT youth. A recent report from the Trevor Project identified that
66% of LGBTQ+ youth reported that the conversation around new
policies negatively affected their mental health.14 Nicotine use
Additionally, the ongoing COVID-19 pandemic has
disproportionately impacted youth. LGBT youth reported worse
and mental health
mental health outcomes attributable to the pandemic than non- Nicotine use can worsen mental health
LGBT youth, and reported feeling less connected to their families symptoms, including feelings of anxiety
and less safe at home.15 LGBT youth populations often experience and depression,20,21 but about half of
unsupportive home lives and, without the peer support experienced young vapers who vaped frequently
from their larger community, many youth had challenging reported that they need to vape to cope
lockdown periods during the early months of the pandemic. As with stress or anxiety.22 LGBT youth
a result of hostile home lives and traumatic lockdowns, LGBT already face a mental health crisis
youth experienced enhanced mental health consequences from largely linked to discrimination, bullying,
the pandemic including elevated levels of depression, PTSD, and and a lack of support from families and
COVID-19 related worries and grief.16 Amid great stress, LGBT schools.23 Tobacco industry marketing
people are smoking and vaping to cope with COVID-19 related tailored to the LGBT community taps
stress and anxiety.10 into the mental health concerns of this
For transgender Americans, 2021 was the deadliest year on record. vulnerable population by speaking to
Greater homophobic and transphobic violence and discrimination desire for acceptance by members of a
is associated with higher odds of smoking cigarettes.17-19 More marginalized population and a need to
research is needed to determine if violence and discrimination is cope with the stress of discrimination.
also associated with higher e-cigarette use. Findings that vaping is [See our report on “Colliding Crises:
associated with elevated stress and anxiety suggest that this may Youth Mental Health and Nicotine Use.”]
well be the case.10

June 2022 LGB E-CIGARETTE USE 4

 CALL TO ACTION: REDUCING VAPING RATES
AMONG SEXUAL AND GENDER MINORITIES
Recent findings point to a growing problem of sexual minority youth
vaping at rates higher than their heterosexual counterparts, and call
for targeted research, cessation programs, and policy interventions to
reduce vaping use and initiation among youth.

Truth Initiative recommends the following to further the work in this

field and reduce the increasing gap in e-cigarette use:
> Improve data collection on topics including tobacco use rates,
perceptions, and disease risk in the LGBT community to ensure a
more robust picture of tobacco use among this group. Researchers
need to be able to accurately measure vaping rates in the LGBT
community as a first step in tackling disparate vaping rates.
Surveys should ask about sexual orientation and gender identity as Researchers need to be
separate entities to avoid underestimating vaping rates.
able to accurately measure
> Conduct additional research on reducing vaping specifically in
the LGBT community. Further research should identify effective
vaping rates in the LGBT
methods to reduce e-cigarette use specifically among sexual and community as a first step
gender minority populations. These efforts should account for
stressors specific to the LGBT community.
in tackling disparate
> Ensure access to cessation services and reduce barriers to
vaping rates.
care for the LGBT community. Cessation and outreach programs
should be tailored and targeted to the unique challenges and
experiences of LGBT youth.10

> Address mental health concerns: Increasing access to mental

health resources to combat the unique stressors felt by the LGBT
community is key in addressing elevated risk of tobacco product
use. This might include schools updating policies and statements
on bullying, harassment, and discrimination, and facilitating
platforms where LGBT individuals can plug into social support
networks.

> Evaluate tobacco control policies in the community: Tobacco

control policies should be evaluated on their effectiveness
in reducing vaping rates specifically in the LGBT community.
Additional research and updated policies on advertising, event
sponsorship, and PR campaigns aimed at the LGBT community
*Terminology in this document
are critical.
varies and is based on the
The tobacco industry has invested significant resources to promote studies cited. Truth Initiative
tobacco use to gender and sexual minorities. An equally ambitious recognizes that some of these
research agenda is needed to combat these efforts to ensure that a terms are no longer preferred
vulnerable community does not continue vaping at disproportionately in the LGBT community.
high rates.

June 2022 LGB E-CIGARETTE USE 5

 REFERENCES
1 Unknown. PROJECT SCUM, 1995:9. 12 Doxbeck, C.R., J.A. Jaeger, and J.M. Bleasdale, Understanding
pathways to e-cigarette use across sexual identity: A multi-group
2 Reynolds American Inc. Group earns top marks in 2020 Corporate
structural equation model. Addictive Behaviors, 2021. 114: p.
Equality Index, designated a “Best Place to Work for LGBTQ
106748.
Equality”.
13 Ronan, W., 2021 Officially Becomes Worst Year in Recent History
3 Durand, A. Vape Sponsor at Miami Gay Pride Festival. 2014
for LGBTQ State Legislative Attacks as Unprecedented Number of
[6/6/2022]; Available from: https://www.vaporfi.com/blog/vaporfi-
States Enact Record-Shattering Number of Anti-LGBTQ Measures
is-proud-to-be-a-sponsor-at-the-2014-miami-beach-gay-pride-
Into Law, in Human Rights Campaign. 2021.
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14 Project, T.T. Issues Impacting LGBTQ Youth. 2022 6/6/2022];
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Available from: https://www.thetrevorproject.org/wp-content/
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June 2022 LGB E-CIGARETTE USE