Greater than 1 in 10 (10.6%) of youth aged 14–17 reported past-year blunt smoking. Demographic analyses revealed that more than one in five (21.6%) LGBT+ youth aged 14–17 reported past-year blunt use, and multivariate results revealed that LGBT+ were twice as likely to report use compared with non-LGBT+ youth. Multivariate results also demonstrated that African American and multiracial youth were more likely to report blunt use than White youth, and older youth (aged 17) were more likely than younger youth (aged 14). Blunt use is a commonly used combined marijuana and tobacco product among youth, with particularly vulnerable youth demonstrating higher use, which may lead to exposure to harmful bacteria [6] and increased risk for worsening pulmonary functioning [17] and adverse cardiovascular outcomes [18].

We found an increase in the prevalence of blunt use and higher risk as youth aged, with an increase in odds as age increased by year. Similarly, one study found that among young adults, risk continued to increase as respondents aged, with higher use among older young adults compared with younger young adults [19]. Given the popularity of blunt use on several social media sites [18] and in youth culture [12,20], as well as the fact that most drug initiation occurs in adolescence [21], and that blunts are seen as less harmful than other tobacco products [22], focusing on the harms of blunt use (e.g., dependence, pulmonary problems, etc.) at an earlier age may deter use.

Compared with White youth, the findings estimated racial/ethnic differences, such that African American and Mixed Race/Other youth were at higher risk, corroborating previous research [11], while Asian youth were at lower risk for the use of blunts in the past year. History reveals that blunt use and blunt culture were centered among Black males in the inner-city [23] and were a prime target for big tobacco companies to initiate messaging surrounding the positive aspects of tobacco [24]. Further, cigar products used for blunts have regularly been marketed to youth and minorities [5], which may expand the initiation and appeal of blunt products to developing youth. Prior studies have revealed that African American youth are most at risk for blunt use [11], and thus should be a prioritized population for intervention, considering they view blunts as safe alternatives to other tobacco products [25]. Interventions are needed to address harm reduction approaches toward marijuana and tobacco products among minority populations [26].

Finally, the main research question demonstrated that youth who identified as LGBT+ were more likely to report blunt use in the past year, compared with their non-LGBT+ counterparts, even when accounting for other demographic correlates. This may be in large part because LGBT+ youth are more likely to initiate the use of marijuana and associated products at an earlier age, compared with their non-LGBT+ counterparts [27]. Likewise, LGBT+ youth may engage in higher blunt use because of their social environment. One study of adolescents [28] examined the social contexts of blunt smoking and found that group smoking was an integral part of blunt use initiation, as this was a way to increase social bonding. This may extend to LGBT+ youth, a group that reports low levels of social support and high levels of loneliness, as a way to seek inclusion and social bonding.

Moreover, minority stress theory (MST) posits that a culmination of stress will ensue due to feeling ostracized from the general population [29], and this may lead to engaging in behaviors (e.g., blunt smoking) to reduce stress. Interventions are needed to reduce blunt use among LGBT+ youth, given that one of the goals of the Healthy People 2030 initiative is to “Improve the health, safety, and well-being of lesbian, gay, bisexual, and transgender (LGBT) individuals” [30].