Abstract
INTRODUCTION: Incorporating sexual identity fluidity and stability into the understanding of tobacco use patterns by sexual minority populations is particularly important, but less is known about how changes and stability in sexual identity relate to e-cigarette initiation. METHODS: Using three waves of the US Population Assessment of Tobacco Health Study (Waves 4-6 [2016-2021]), we examined the association of sexual identity change and stability with e-cigarette initiation among adults who never vaped at Wave 4 (N = 11 554). Changes in sexual identity were defined based on identity at Waves 4-6: (1) consistently heterosexual; (2) consistently Lesbian, Gay, Bisexual, or something else (LGB+); (3) heterosexual at Wave 4 and LGB+ at Wave 6; (4) all other identity changes. The outcome was ever e-cigarette use at Wave 6. RESULTS: Among adults who never vaped at Wave 4, N = 1022 (4.0%, weighted) initiated e-cigarettes by Wave 6. Overall, N = 10 166 (93.1%) reported consistently heterosexual identities, N = 513 (2.7%) consistently LGB+, N = 316 (1.8%) reported heterosexual identity at Wave 4 and LGB+ identity at Wave 6, and N = 298 (2.4%) reported all other identities. Among adults who never used e-cigarettes at Wave 4, those who reported heterosexual at Wave 4 and LGB+ identity at Wave 6 (vs. those who reported consistently heterosexual identity) were more likely to report e-cigarette initiation at Wave 6 (adjusted odds ratio = 1.78, 95% CI = 1.05, 3.01), after adjusting for covariates. CONCLUSIONS: This study found an increased risk of e-cigarette use initiation and continued use among US adults who changed their self-reported sexual identity from heterosexual identity to LGB+ identity. IMPLICATIONS: This study found an increased risk of e-cigarette use initiation and continued use among US adults who changed their self-reported sexual identity from heterosexual identity to LGB+ identity. Findings may inform the development of tailored interventions and clinical practices, capitalizing on the coming out phase as a teaching moment to communicate the potentially harmful effects of e-cigarette use among sexual minority individuals.