Vaping habits differ by race and sexual orientation among teens, study finds

Some teen girls of color who identify as lesbian are more likely than their white or heterosexual peers to use e-cigarettes, researchers from Penn and Yale have reported.

Using data from a Centers for Disease Control and Prevention survey of more than 38,000 American teenagers between 2015 and 2019, researchers at the University of Pennsylvania’s Annenberg School for Communication and Yale University School of Medicine set out to discover how vaping may have an outsized prevalence among certain groups of teens.

What they learned about girls and e-cigarettes was in line with a hypothesis they’d developed based on prior research on e-cigarette advertising and young women.

Juhan Lee, a coauthor of the paper and a postdoctoral research fellow at Yale, said he wanted to study not only how e-cigarette use among youth differs by race and sexual orientation but also how prevalent vaping is among teenagers at the intersection of those identities.

It’s a gap in research that Lee said is crucial to fill, since both nonwhite and LGBT Americans are more likely to see marketing for and engage in both e-cigarette use and traditional cigarette smoking.

The study found that 18.2% of Black girls who identified as lesbian said they were currently using e-cigarettes, as opposed to 7.1% of Black girls identifying as heterosexual. Multiracial girls who identified as lesbian were also six percentage points higher than their heterosexual-identifying counterparts to smoke e-cigarettes.

But white teenage girls who identified as heterosexual were more likely than peers who identified as lesbian to vape.

Among boys, heterosexual white boys reported the highest rates of current e-cigarette use, at 17.5%. And the study found that, among non-Hispanic, Black and white boys, and boys who reported other racial identities, identifying as any orientation other than heterosexual had a “potential protective effect.” In other words, those groups were less likely to use e-cigarettes.

It’s unclear why these disparities exist, and why boys aren’t affected in the same way girls are, Lee said. Prior research by the paper’s other coauthor, Penn associate professor Andy Tan, shows that young adult women who identify as LGBT are more likely to be exposed to e-cigarette ads. That could explain the higher vaping rates among that population.

Other research has shown that LGBT people often report smoking to cope with the stress of discrimination and marginalization, Lee said. That might translate to e-cigarettes as well. “There’s a lot of hate speech about sexual orientation,” he said, noting the passage or consideration of bills in several states prohibiting discussion of sexual orientation or gender identity in schools. “That might stress someone who identifies as a sexual minority.”

Tan said that more research is needed to determine why these disparities exist but that it’s crucial for policymakers to address structural racism and discrimination when addressing the rise of vaping among teenagers.

Philadelphia is among several cities that have moved to curtail the purchasing of e-cigarettes by teenagers — and tobacco use and advertisements in low-income neighborhoods, where smoking products and ads are highly concentrated.

It’s also crucial to promote vaping prevention programs, Tan said, instead of only addressing teens who already vape.

“We really need policy and decision-makers to address the underlying structural factors leading to this in the first place — homophobia and anti-LGBT discriminatory policies leading to increased stress can exacerbate health disparities,” he said. “They have to not only address policies related to tobacco use but structural, discriminatory policies as well.”