Intersectionality of Sexual Orientation With Race and Ethnicity and Associations With E-Cigarette Use Status Among U.S. Youth

Perceived discrimination and youth vaping: The role of intersectional identities

INTRODUCTION

Electronic cigarettes (also termed e-cigarette or vapes) often contain nicotine, an addictive psychoactive substance, which can have harmful effects during adolescence. Frequent experiences of discrimination are one risk factor shown to increase susceptibility to tobacco use, especially for individuals that identify as a social minority. Applying Intersectionality Theory, this research examined the relationship between youth experiences of discrimination and vape use at the intersection of race/ethnicity and sexual orientation.

METHOD

Cross-sectional survey data from 4747 youth (ages 12-17) that participated in the 2022 Teens, Nicotine, and Tobacco Project (TNT) online survey were used to evaluate the impact of discrimination on vape use for lesbian, gay, bisexual, and/or queer/questioning (LGBQ+) youth of color.

RESULTS

Multivariable regression analyses showed that identifying as both a sexual and racial/ethnic minority was a risk factor for experiencing discrimination. Frequent discrimination and reporting discrimination due to sexual orientation was associated with a greater likelihood of ever and current vaping. Path models supported that discrimination mediated the relationship between intersectional identity and vape use. LGBQ+ youth of color reported more frequent discrimination, which was associated with a greater likelihood of ever/current vape use.

CONCLUSIONS

Intersectionality Theory aids in understanding how discrimination can exacerbate tobacco-related disparities for youth with multiple minority identities. Findings corroborate the importance of measuring discrimination in public health surveys. Effective tobacco interventions could incorporate strategies to cope with discrimination-related stress.

An Almost Empty Scoping Review: State of the Research on Tobacco Prevention and Cessation Messaging Strategies for Black and/or Latine LGBTQ+ Youth and Young Adults

Research has yet to offer strong recommendations for effective tobacco prevention and cessation messaging that can reduce tobacco-related health disparities among Black and/or Latine LGBTQ+ youth and young adults. As a result of predatory marketing strategies and community stressors, among other factors, LGBTQ+ youth and young adults use tobacco products at higher rates than their non-LGBTQ+ peers. These disparities are uniquely complex among Black and/or Latine youth and young adults within the LGBTQ+ community, but there has been little research addressing the communication strategies that can promote tobacco prevention and cessation for these groups. Given the promise and history of successful health communication campaigns for tobacco control, this research is crucial. We thus conducted a scoping review to identify trends and gaps in the empirical research published from 2002-2022 that analyzed tobacco prevention and cessation communication strategies for Black and/or Latine LGBTQ+ youth and young adults (ages 12-30) living in the United States. Despite an initial search query of 3,182 articles after deleting duplicates, only five articles were eligible for inclusion, three of which evaluated the This Free Life campaign. Accordingly, we view our scoping review as an almost empty review. Although our results offer preliminary insight into messaging strategies used in these campaigns, our larger contribution is to expose the scarcity of tobacco-related communication research being conducted among Black and/or Latine LGBTQ+ communities. Given the marginalization these communities face, we issue a call to action for researchers and campaign designers and offer a series of suggestions for future research.

A developmental framework for understanding the influence of sex and gender on health: Pediatric pain as an exemplar

Sex differences are a robust finding in many areas of adult health, including cardiovascular disease, psychiatric disorders, and chronic pain. However, many sex differences are not consistently observed until after the onset of puberty. This has led to the hypothesis that hormones are primary contributors to sex differences in health outcomes, largely ignoring the relative contributions of early developmental influences, emerging psychosocial factors, gender, and the interaction between these variables. In this paper, we argue that a comprehensive understanding of sex and gender contributions to health outcomes should start as early as conception and take an iterative biopsychosocial-developmental perspective that considers intersecting social positions. We present a conceptual framework, informed by a review of the literature in basic, clinical, and social science that captures how critical developmental stages for both sex and gender can affect children's health and longer-term outcomes. The literature on pediatric chronic pain is used as a worked example of how the framework can be applied to understanding different chronic conditions.

Prenatal Substance Use Among Young Pregnant Sexual Minority People

Purpose: Sexual minority (SM) youth have higher rates of substance use and pregnancy but are absent from the prenatal substance use literature. We modeled the impact of SM identity and syndemic factors on prenatal substance use among 14- to 21-year-olds. Methods: Pregnant people completed an online survey (n = 357). Prenatal substance use was regressed on SM identity, controlling for other syndemic factors (e.g., depressive symptoms, intimate partner violence) and household substance use. Results: Pregnant SM participants (n = 125) were primarily bisexual and were more likely to use tobacco and illicit drugs than heterosexual participants (n = 232). The association between SM identity and prenatal tobacco use was not attenuated by syndemic factors, prenatal cannabis use, or household tobacco use. Conclusion: SM people need increased support for smoking cessation to redress health inequities in tobacco use, prevent prenatal exposures to tobacco, and limit the long-term consequences of tobacco use on health.

Awareness of electronic cigarette industry practices and their associations with anti-electronic cigarette attitudes among susceptible US young adults

BACKGROUND

Public education exposing cigarette industry practices have been effective in changing attitudes and preventing smoking among young people. It is unclear how much young adults are aware of e-cigarette industry practices, and how this awareness relates to anti-e-cigarette attitudes. We examined demographic correlates of awareness of e-cigarette industry practices and anti-e-cigarette attitudes, and the association between awareness of these practices with anti-e-cigarette attitudes.

METHODS

A US sample of young adults aged 18-30 years who do not use commercial tobacco products but are susceptible to e-cigarette use were cross-sectionally surveyed through online panel services from August 2021 to January 2022. Respondents reported their demographics, awareness of cigarette industry practices, awareness of e-cigarette industry practices and their level of agreement with four anti-e-cigarette attitude statements. We used multivariable linear regressions to examine demographic associations and the relationship between awareness of e-cigarette industry practices with each anti-e-cigarette attitude, adjusting for demographics and awareness of cigarette industry practices.

RESULTS

Generally, Hispanic and Black young adults (vs White) and those with

DISCUSSION

Public education exposing e-cigarette industry practices may promote anti-e-cigarette attitudes among susceptible young adults who do not use commercial tobacco products. Future research should investigate the utility of anti-e-cigarette industry messaging.

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Key Words

• Denormalization
• Electronic nicotine delivery devices
• Prevention

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Grants

• R00 CA272919 NCI NIH HHS
• U54 CA267735 NCI NIH HHS
• ZIA MD000006 Intramural NIH HHS

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Affiliation(s)

Lilianna Phan Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA Department of Community Health and Prevention, Dornsife School of Public Health and Division of Graduate Nursing, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
Kelvin Choi Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA

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Intersectionality and adolescent medicine: an overview

PURPOSE OF REVIEW

This review defines intersectionality, discusses recent studies that use an intersectional framework in adolescent health research, and outlines ways where clinicians can use intersectionality to address health disparities in youth of color through clinical practice, research, and advocacy.

RECENT FINDINGS

Research using an intersectional framework can identify populations at risk for certain disorders or behaviors. Recent studies in adolescent health research using an intersectional lens identified lesbian girls of color as an at-risk population for e-cigarette use, demonstrated lower skin color satisfaction among Black girls of all ages predicted greater binge-eating disorder symptoms, and showed that two-thirds of Latine (gender-neutral term that refers to people with Latin American roots) youth who recently immigrated to the United States experienced at least one traumatic event during their migration journey, putting them at risk for PTSD and other mental health disorders.

SUMMARY

Intersectionality refers to how multiple social identities intersect to produce a specific experience that reflects overlapping systems of oppression. Diverse youth contain multiple identities that intersect to produce unique experiences and health inequities. Using an intersectional framework acknowledges that youth of color are not homogenous. Intersectionality becomes an important tool to care for marginalized youth and advance health equity.