Cigarette and E-Cigarette Use Among LGBT+ Youths and Young Adults According to Strength of State-Level LGBT+ Equality Protections

Bibliographic Data

ID11018233
AuthorsElexis C Kierstead (0000-0002-8502-0451, All authors are with Truth Initiative’s Schroeder Institute, Washington, DC.), Stephanie N Yoon (0000-0002-7565-7977, All authors are with Truth Initiative’s Schroeder Institute, Washington, DC.), Madison L Iskra (0009-0003-7694-5406, All authors are with Truth Initiative’s Schroeder Institute, Washington, DC.), Barbara A Schillo (All authors are with Truth Initiative’s Schroeder Institute, Washington, DC.), Barbara Schillo (0000-0003-0847-2996, American Legacy Foundation), Jennifer M Kreslake (0000-0001-6605-1327, All authors are with Truth Initiative’s Schroeder Institute, Washington, DC.)
Year2025
Volume115
Issue6
Pages945-953
Publication date2025-06-01
Open AccessNo
TypeARTICLE
VenueAmerican Journal of Public Health (JOURNAL)
Journal identifiersISSN: 0090-0036 • E-ISSN: 1541-0048
PublisherAmerican Public Health Association (PUBLISHER • US)
DOI10.2105/ajph.2025.308008
PMID40014828
OpenAlexW4408014671
LanguageEN
References cited24

Objectives. To examine whether the state-level LGBT+ (lesbian, gay, bisexual, transgender, and other identities) legal protections where LGBT+ youths and young adults reside are associated with cigarette and e-cigarette use. Methods. We drew LGBT+ respondents (aged 15–31 years; n = 1255) from a national, probability-based survey conducted from August to December 2023. We scored each state for LGBT+ equality on a scale from restrictive to protective based on the Movement Advancement Project’s 2023 policy environment. Using weighted logistic regression models, we examined the relationship between current (past 30-day) cigarette and e-cigarette use and state LGBT+ equality protections, controlling for demographics and state tobacco control expenditure. Results. LGBT+ individuals in protective policy states had 65% lower odds (odds ratio [OR] = 0.35; 95% confidence interval [CI] = 0.16, 0.78) of current cigarette use, and 56% lower odds (OR = 0.44; 95% CI = 0.25, 0.79) of current e-cigarette use compared with those in restrictive policy states. Conclusions. LGBT+ individuals living in protective policy environments had lower odds of current cigarette and e-cigarette use, consistent with theoretical relationships between stress, discrimination, and harmful health behaviors. Public Health Implications. Protective policies may alleviate tobacco use disparities among the LGBT+ community. ( Am J Public Health. 2025;115(6):945–953. https://doi.org/10.2105/AJPH.2025.308008 )

Behavioral Risk Factor Surveillance System · Confidence interval · Environmental health · Health equity · Lesbian · Logistic regression · Odds · Odds ratio · Public health · Sociology · Tobacco control · Transgender · Demography · Electoral Systems and Political Participation · LGBTQ Health, Identity, and Policy · Medicine · Psychology · Smoking Behavior and Cessation · Gerontology

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