Examining tobacco use at the intersection of gender, sexual orientation, race, and ethnicity using national U.S. data of sexual and gender diverse youth

Objectives: To expand the literature documenting that tobacco use inequities persist and continue to increase for minoritized youth populations by exploring patterns of tobacco use across multiple intersections of sexual, gender, racial, and ethnic identities. Studies with this focus are needed to understand the degree to which tobacco use varies across groups who hold multiple minoritized identities. Methods: The current study used a novel analytical approach— Exhaustive Chi-square Automatic Interaction Detection – to examine lifetime cigarette use among a U.S.-based sample of sexual and gender diverse youth collected in 2022. Exhaustive Chi-square Automatic Interaction Detection is a data-driven, decision-tree approach that uses successive Chi-square tests to iteratively cycle through all interactions among categorical independent variables, splitting where categories differ significantly with respect to the dependent variable. Participants identified as sexual and/or gender diverse youth, resided in the U.S., and were between 13–18 years of age (N = 9,504). Results: Several important patterns emerged: The groups with the highest prevalence of cigarette experimentation included transgender boys, cisgender boys, and non-binary youth. These adolescents were likely to also hold minoritized racial and ethnic identities, and identify with plurisexual identities. Some age-related differences in patterns emerged; across grades, transgender boys and Multiracial sexually and gender diverse youth were a part of high prevalence cigarette experimentation groups. Conclusions: The results highlight the complex patterns of cigarette use differences in heterogenous sexual and gender diverse populations, particularly across gender, sexual, and ethnoracial identities.