Abstract
PURPOSE: This study sought to identify the predominant factors associated with tobacco and marijuana/cannabis use among adolescents according to their sexual identity. METHODS: Using the 2023 National Youth Tobacco Survey, we examined current use of e-cigarettes, cigarettes, and marijuana/cannabis vaping among adolescents. We used dominance analyses and logistic regression models to assess the relative importance of factors linked to tobacco and marijuana/cannabis use. The analyses were stratified by sexual identity (straight, sexual minorities, unsure) and grade levels (middle-school vs. high-school). RESULTS: The study sample includes 6654 middle-school and 8274 high-school students. Three themes emerge from the dominance analysis. First, exposure to e-cigarette or cigarette use at home or in vehicles consistently ranked as the leading factor associated with smoking and vaping across school levels and sexual identity, explaining up to 44% of the predicted variance. Second, the perception of occasional e-cigarette or cigarette use as little to no harm was a top factor, linked to e-cigarette use among sexual minority students and straight high-school students, as well as cigarette use among straight students and sexual minority high-school students. It explained up to 21.6% and 26.5% of the variance in current e-cigarette and cigarette use, respectively. Third, mental stress was a dominant factor associated with tobacco and marijuana/cannabis use among sexual minority middle-school students, explaining up to 21% of the variance. CONCLUSIONS: This study identifies modifiable factors linked to adolescent tobacco and marijuana use. Public health initiatives targeting these factors may reduce smoking and vaping, especially among sexual minority adolescents. IMPLICATIONS: Adolescents in the LGBTQ+ community use tobacco and marijuana at higher rates than their straight peers. This study offers insight into the relative importance of a variety of sociodemographic and environmental factors contributing to increased use. The most dominant factors, identified as immediate environmental exposure, e-cigarette risk perceptions, and mental stress should be prioritized when developing targeted interventions to reduce smoking and vaping in this priority population.