Patterns of Cigarette and Electronic Cigarette Dependence Among Sexual and Gender Minority Emerging Adults: Differences across Identity Groups

Background and Purpose: Cigarette smoking remains a leading cause of preventable morbidity, and the rapid rise of electronic cigarette (e-cigarette) use has introduced new forms of nicotine exposure with distinct behavioral and physiological dependence profiles. Sexual and gender minority emerging adults (SGMEAs) experience disproportionately high rates of tobacco use, yet little has been done to examine patterns of dependence using validated scales across subgroups and product types, including cigarettes and e-cigarette. This analysis aims to examine the prevalence of cigarette and e-cigarette dependence and examine the within-group differences between cisgender sexual minority men (SMM), cisgender sexual minority women (SMW), and transgender or gender nonconforming (TGNC) emerging adults.

Methods: Data were drawn from a larger study investigating disparities in tobacco product use among SGMEAs aged 18-29 years old in California, U.S. Analysis focused on participants who self-identified as SGM (n = 834), including SMM participants (n = 204), SMW participants (n = 371), and TGNC participants (n = 259). Nicotine dependence for cigarette and e-cigarette was assessed using the 10-item Penn State Nicotine Dependence Index (range: 0–20), categorized as high (≥13), medium (9–12), low (4–8) and no (0–3) dependence. We conducted One-way ANOVA and Chi-square tests to examine group differences in dependence across SMM, SMW, and TGNC participants.

Results: The average age of SGMEAs was 23.1 years (SD = 3.1), with 38.1 % self-identified as White, 21.5 % Hispanic/Latinx,11.8 % Asian, and 19.3 % were identified as multiracial. 477 participants (57.2%) reported cigarette use, and 569 participants (68.2%) reported e-cigarette use. The mean dependence scores were 6.77 (SD = 0.17) and 6.27 (SD = 0.18) for cigarettes and e-cigarettes. TGNC participants reported the highest mean dependence scores for both cigarettes (M = 6.81, SD = 0.35) and e-cigarettes (M = 7.86, SD = 0.43), compared to SMM and SMW participants. For cigarettes, 13.4% of participants were classified as high dependence, 21.1% as moderate, 34.8% as low and 30.6% as not dependent. For e-cigarettes, the corresponding proportions were 18.5%, 19.9%, 30.6%, and 31.1%, respectively. High dependence was most prevalent among SMM for cigarettes (14.7%) and among TGNC participants for e-cigarettes (22.8%), whereas SMW participants most frequently fell within the not dependent category for both cigarettes (34.2%) and e-cigarettes (34.5%). Despite these distributional differences, no statistically significant subgroup differences in cigarette or e-cigarette dependence scores were detected.

Conclusion and Implication: The present findings demonstrate the initial steps for understanding the differences of tobacco use within SGMEA subgroups, which have been missing from the larger body of research currently available. Even though subgroups did not demonstrate statistically significant differences, further research into this area will provide more insight into nicotine dependence within SGMEAs. Future work within this area should focus on the development of culturally responsive cessation interventions that consider the lived experiences of SGMEAs and the specific challenges they face, as well as creating tobacco control strategies on a broader scale that address the needs of this high-risk group.