Nicotine/tobacco product use and dependence symptoms among US adolescents and adults: Differences by age, sex, and sexual identity.

INTRODUCTION Sexual minorities are at increased risk for tobacco use; however, there is heterogeneity in this risk by sociodemographic factors. This study sought to understand if vulnerability to tobacco use among U.S. sexual minorities varies by age group. METHODS For this study we used data from wave 4 of the Population Assessment of Tobacco and Health (PATH) adolescent and adult surveys (n=37,959), a nationally representative survey. We examined five nicotine/tobacco use outcomes by sex and sexual identity across four age groups. The five outcomes included past 30-day e-cigarette use, past 30-day cigarette use, past 30-day other tobacco use, the number of tobacco products used, and nicotine dependence symptoms. RESULTS For males, sexual identity differences were greatest in middle adulthood, particularly for bisexual males; adjusted odds ratios [aORs] and adjusted incident rate ratios [aIRRs] ranged from 2.08-5.59 in middle adulthood compared to 0.83-1.62 in adolescence. For females, sexual identity differences were persistent from adolescence through middle adulthood. We found significant differences most consistently for nicotine dependence symptoms when comparing gay/lesbian and bisexual females across multiple age groups; aIRRs ranged from 1.90 in middle adulthood to 3.26 in adolescence). CONCLUSIONS Risk among sexual minorities varied considerably across age groups and by nicotine/tobacco product and severity of symptoms. Our findings underscore the importance of looking beyond single tobacco products when examining nicotine/tobacco differences related to sexual identity and in examining differences by age group. Our results demonstrating of age-varying risk among sexual minorities has important implications for tobacco prevention and cessation efforts.