This National Youth Tobacco Survey data demonstrate that there are significant differences in the use of substances by students reporting bisexual, gay, or lesbian sexualities. When compared to students reporting being heterosexual, students who reported being bisexual reported a 1.6-fold increased use of e-cigarettes, a 2.1-fold increased use of cigarettes, and a 1.9-fold increased use of marijuana. Students who reported being gay or lesbian reported a 1.5-fold increased use of e-cigarettes, a 1.9-fold increased use of cigarettes, and a 1.7-fold increased use of marijuana. These findings of increased use of tobacco and marijuana among adolescents of bisexual, gay or lesbian sexualities mirror those of previous studies done on adults that have found that substance use is higher in LGBTQ individuals than in heterosexual individuals.^{9 -11} While research on LGBTQ youth is limited, ⁵ Kerr et al found that LGBTQ college students had higher rates of alcohol, tobacco, and other drug use and misuse than heterosexual college students. While this study identifies significant associations between sexual orientation responses and substance use, socioeconomic factors, and mental health indicators, it is important to understand the observational design of this study limits any inference about causative relationships.

Explanations for why LGBTQ individuals have higher rates of use are not fully understood. It has been suggested by the Minority Stress Theory that members of the LGBTQ community have experienced chronic stressors related to their sexual orientation and that this has led to victimization, prejudice, and discrimination experiences that are unique to their community. ¹² These experiences include structural and institutionalized discrimination, personal interactions of prejudice or victimization, the expectation of rejection or of victimization, and the internalization of others’ negative social attitudes toward LGBTQ individuals. This theory has been used to explain reason why LGBTQ individuals report higher rates of anxiety, depression, and other psychological disorders and why this population has higher rates of substance use and abuse.^12,13 Psychological disorders and formal diagnosis of depression and anxiety are outside of the scope of the NYTS, but the results in this study do show that students who reported being bisexual, gay, or lesbian had higher rates of having little interest and pleasure in doing things, feeling down, depressed or hopeless, feeling nervous anxious, or on edge, and are unable to stop or control their worrying than their heterosexual counterparts. Although this study doesn’t directly measure all aspects of Minority Stress Theory, the findings align with the theory’s predictions. LGBTQ students reported higher rates of substance use and reported more indicators of mental health challenges than their heterosexual counterparts. These findings suggest that the minority stressors outlined by the theory may contribute to the observed differences. Future research should try to understand the specific stressors experienced by LGBTQ adolescents and their cumulative effects on health outcomes to better understand the interaction between minority stress and health-related behaviors.

Questions about homelife for students who took the NYTS also provide insight into potential socioeconomic differences between LGBTQ students and their heterosexual counterparts. This study found that bisexual students reported higher rates of living in families that did not own a vehicle and higher rates of not traveling on vacation in the past 12 months. Gay or lesbian students also reported higher rates of living in families that did not own a vehicle, didn’t own a computer, and having higher rates of not traveling on vacation in the past 12 months compared to heterosexual students. While this study cannot conclusively attribute characteristics of LGBTQ students to higher rates of poverty or limited access to resources, the results do offer insights into potential socioeconomic differences within these subpopulations. These potential socioeconomic challenges may be indicative of broader systemic issues that could impact family dynamics, access to education, and overall quality of life for LGBTQ youth. This context would be crucial in developing targeted interventions and support systems. Policymakers and healthcare professionals alike should consider the broader societal factors that contribute to the disparities observed in our study and should address any economic inequalities that could be affecting the over-all well-being within these communities. Future research could explore these connections in depth to provide a more complete understanding of economic differences observed among LGBTQ adolescents.

The use of surveys like the NYTS in adolescents with a wide range of ages has many limitations and requires several assumptions. Among them, it is assumed that the participants understood the questions and that they are aware of, can correctly identify, and can accurately recall the substances they have ever used in the past. For this study and the survey questions it relies on, it is important that adolescents understand and accurately report their sexuality at a mean age of 14.5 years. Adolescents undergo rapid developmental changes during this period of their lives, and their own self-awareness, cognitive abilities, and comprehension levels can all influence the accuracy of their responses. They may interpret questions differently by their developmental stage, cultural background, or personal experiences, or they may even provide responses that align with societal expectations. There are also a number of responses that were excluded from the final analysis because of missing data to the relevant survey questions. The effect of these missing responses should be minimal due to the very large number of responses analyzed, but it is impossible to conclude that they would have had no effect. Furthermore, the location where the student completed the survey could influence their survey responses, and the presence of other individuals, including parents or guardians, could have changed participant responses. Future studies may benefit from exploring age-specific nuances in survey administration and consider employing age-appropriate language or strategies to ensure participant comprehension and encourage accurate reporting.