Which teens are more likely to vape? Research shows surprising patterns across race and sexuality groups

Researchers estimate that half of all high school students in the United States have tried vaping at least once. One third of these students vape regularly. Since e-cigarettes were introduced to the U.S. in 2013, they've become more and more popular, especially among teens. From 2019-2020, the popularity of disposable e-cigarette use among U.S. high school students who currently vaped went up by 1,000%, from 2.4% to 26.5%, according to the CDC.

Since nicotine in e-cigarettes is highly addictive, and e-cigarette use in teens leads to higher risks of smoking regular cigarettes later in life, researchers want to know more about which groups of teens are currently vaping and underlying reasons that put them at risk to start.

A study published today in the American Journal of Preventive Medicine has used survey data from more than 38,000 U.S. high school students from 2015-2019 to determine how prevalent vaping is in different sexual orientation, race, and ethnicity groups. What the researchers found are dramatic differences in vaping rates across these markers of identity, and sometimes in surprising patterns.

Co-written by Andy Tan, associate professor at the Annenberg School for Communication; and Juhan Lee, a postdoctoral research fellow at the Yale University School of Medicine, the study fills in a wide gap that exists in e-cigarette studies: research on vaping prevalence among young people at the intersections of more than one minoritized identity.

The study uncovered significant differences in the prevalence of current e-cigarette use between lesbian and heterosexual girls when comparing across racial groups.

Current e-cigarette use was higher in Black girls who identify as lesbian compared to Black girls who identify as heterosexual (18.2% versus 7.1%). The rate was also higher in multiracial girls who identify as lesbian compared to multiracial girls who identify as heterosexual (17.9% versus 11.9%). On the other hand, white girls who identify as lesbian were found to be at lower risk of current vaping compared to white girls who identify as heterosexual (9.1% versus 16.1%).

Among boys, there were no significant interactions between sexual orientation and race or ethnicity in relation to vaping prevalence.

Previous surveys of gay and lesbian teens suggest that e-cigarette use might be a coping mechanism to deal with the stress of sexual orientation or gender identity-based discrimination or bullying, or a way to bond with others in their social circle, the authors say. However, prior studies have not reported how e-cigarette use prevalence among youth differ at the intersections of sexual orientation, sex, race, and ethnicity.

One possible reason for finding disparities in e-cigarette use at the intersection of sexual orientation and race among girls, but not boys may be due to higher levels of targeted e-cigarette marketing toward queer women of color, the authors say.

Prior research has found that when compared to white heterosexual young women (aged 18-24), bisexual Black women and bisexual Hispanic women reported higher levels of exposure to ads for tobacco products, while there were no substantial differences in exposure to these ads among young adult men.

"For years, the tobacco industry has targeted marketing toward traditionally marginalized groups, whether in clubs, bars, Pride events, or through magazines," says Tan, who is also director of the Health Communication & Equity Lab. "Sexual, racial, and ethnic minority youth are more likely to report engaging with online tobacco advertising including e-cigarette ads on social media."

Tan says he hopes the findings from this study can jumpstart further research and interventions to prevent teen vaping at the intersections of sexual orientation, race, and ethnicity. He is currently leading research to develop and test the effectiveness of anti-vaping campaigns on social media tailored for sexual and gender minority youth.