{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T04:19:59Z","timestamp":1787545199212,"version":"build-2736575974"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Sexual and gender minority youth are at higher risk for tobacco\/nicotine use than cisgender and\/or heterosexual youth. Little is known about how the use of multiple tobacco\/nicotine products differs among youth by sexual orientation and gender identity. This study sought to determine whether the lifetime number of tobacco\/nicotine products differs by sexual orientation and gender identity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study is a cross-sectional analysis of nationally representative data on 14\u2009457 students ages 9-19+ who participated in the 2023 National Youth Tobacco Survey. Weighted means, adjusted odds ratios, and adjusted incidence rate ratios were used to assess differences in the number of lifetime tobacco\/nicotine products used by students in the following groups: cisgender, heterosexual; cisgender, sexual minority; gender minority, heterosexual; and gender and sexual minority youth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Adjusting for age, race\/ethnicity, and sex, gender minority heterosexual youth used more than twice as many tobacco\/nicotine products as their cisgender heterosexual peers, with an adjusted incidence rate ratio (aIRR) of 2.47; 95% confidence interval (CI), 1.10-5.56; P\u2009=\u2009.030. Gender and sexual minority youth also used twice as many methods as their cisgender heterosexual peers (aIRR, 2.05; 95% CI, 1.40-2.98; P\u2009&amp;lt;\u2009.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among youth aged 9-19+ years, gender minority youth of any sexual orientation used a higher lifetime number of tobacco\/nicotine products than did cisgender heterosexual youth. Prevention, harm reduction, and cessation programs for youth are needed to respond to the upward trend of multiple tobacco product use among youth and the specific needs of gender minority youth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>This study indicates that gender minority youth may face different tobacco\/nicotine risks than both sexual minority and heterosexual youth. Future tobacco\/nicotine research should be tailored to intersecting sexual orientation and gender identities. The specific needs of gender minority youth warrant consideration in tobacco\/nicotine prevention and cessation programming, particularly with regard to multiple tobacco\/nicotine product use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ntr\/ntag067","type":"journal-article","created":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T12:43:30Z","timestamp":1774701810000},"page":"1510-1518","source":"Crossref","is-referenced-by-count":0,"title":["Lifetime use of multiple tobacco\/nicotine products at the intersection of gender and sexual minority identity: Findings from the 2023 National Youth Tobacco Survey"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6186-8071","authenticated-orcid":false,"given":"Laura F","family":"Goodfield","sequence":"first","affiliation":[{"name":"Milken Institute School of Public Health, George Washington University , Washington, DC 20037 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5400-6649","authenticated-orcid":false,"given":"Kevin C","family":"Heslin","sequence":"additional","affiliation":[{"name":"Milken Institute School of Public Health, George Washington University , Washington, DC 20037 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"2026082400120035900_ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.ss7105a1","article-title":"Tobacco product use and associated factors among middle and high school students \u2014 National Youth Tobacco Survey, United States, 2021","volume":"71","author":"Gentzke","year":"2022","journal-title":"MMWR Surveill Summ"},{"key":"2026082400120035900_ref2","first-page":"1021","article-title":"Tobacco use among middle and high school students \u2014 United States, 2013. Centers for disease","volume":"63","author":"Arrazola","year":"2014","journal-title":"Control"},{"key":"2026082400120035900_ref3","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.drugalcdep.2019.04.011","article-title":"The rise of e-cigarettes, pod mod devices, and JUUL among youth: factors influencing use, health implications, and downstream effects","volume":"201","author":"Fadus","year":"2019","journal-title":"Drug Alcohol Depend"},{"key":"2026082400120035900_ref4","doi-asserted-by":"publisher","first-page":"e256739","DOI":"10.1001\/jamanetworkopen.2025.6739","article-title":"Nicotine pouch and E-cigarette use and Co-use among US youths in 2023 and 2024","volume":"8","author":"Han","year":"2025","journal-title":"JAMA Netw Open"},{"key":"2026082400120035900_ref5","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.15585\/mmwr.mm7145a1","article-title":"Tobacco product use among middle and high school students \u2014 United States, 2022","volume":"71","author":"Park-Lee","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026082400120035900_ref6","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.15585\/mmwr.mm7244a1","article-title":"Tobacco product use among U.S. middle and high school students \u2014 National Youth Tobacco Survey, 2023","volume":"72","author":"Birdsey","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026082400120035900_ref7","doi-asserted-by":"publisher","first-page":"917","DOI":"10.15585\/mmwr.mm7341a2","article-title":"Tobacco product use among middle and high school students \u2014 National Youth Tobacco Survey, United States, 2024","volume":"73","author":"Jamal","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026082400120035900_ref8","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1007\/s40429-020-00345-5","article-title":"A breath of knowledge: overview of current adolescent E-cigarette prevention and cessation programs","volume":"7","author":"Liu","year":"2020","journal-title":"Curr Addict Rep"},{"key":"2026082400120035900_ref9","doi-asserted-by":"publisher","first-page":"488","DOI":"10.14485\/hbpr.8.6.1","article-title":"Perceived barriers to and recommendations for cessation among poly-tobacco-using Young adults","volume":"8","author":"Le","year":"2021","journal-title":"Health Behav Policy Rev"},{"key":"2026082400120035900_ref10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18332\/tpc\/172416","article-title":"E-cigarette cessation interest and quit attempts among young adults reporting exclusive e-cigarette use or dual use with other tobacco products: how can we reach them?","volume":"9","author":"Le","year":"2023","journal-title":"Tob Prev Cessat"},{"key":"2026082400120035900_ref11","doi-asserted-by":"publisher","first-page":"1946","DOI":"10.2105\/AJPH.2009.163147","article-title":"The relationship between discrimination and substance use disorders among lesbian, gay, and bisexual adults in the United States","volume":"100","author":"McCabe","year":"2010","journal-title":"Am J Public Health"},{"key":"2026082400120035900_ref12","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1111\/j.1467-9566.2011.01376.x","article-title":"From personal tragedy to personal challenge: responses to stigma among sober living home residents and operators","volume":"34","author":"Heslin","year":"2012","journal-title":"Sociol Health Illn"},{"key":"2026082400120035900_ref13","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1186\/s12939-025-02487-2","article-title":"Examining pathways between structural stigma and tobacco use: a comparison among young adults living in the United States by sexual orientation and gender identity","volume":"24","author":"Figueroa","year":"2025","journal-title":"Int J Equity Health"},{"key":"2026082400120035900_ref14","doi-asserted-by":"publisher","DOI":"10.1093\/acprof:oso\/9780199765218.003.0018","volume-title":"Handbook of Psychology and Sexual Orientation","author":"Meyer","year":"2012"},{"key":"2026082400120035900_ref15","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1093\/ntr\/ntad131","article-title":"Sexual and gender identity disparities in nicotine and tobacco use susceptibility and prevalence: disaggregating emerging identities among adolescents from California, USA","volume":"26","author":"Harlow","year":"2023","journal-title":"Nicotine Tob Res"},{"key":"2026082400120035900_ref16","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.drugalcdep.2017.11.025","article-title":"Sexual minority youth continue to smoke cigarettes earlier and more often than heterosexuals: findings from population-based data","volume":"184","author":"Watson","year":"2018","journal-title":"Drug Alcohol Depend"},{"key":"2026082400120035900_ref17","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1136\/tc.2008.028241","article-title":"Tobacco use among sexual minorities in the USA, 1987 to May 2007: a systematic review","volume":"18","author":"Lee","year":"2009","journal-title":"Tob Control"},{"key":"2026082400120035900_ref18","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1016\/j.jadohealth.2017.06.024","article-title":"Transgender youth substance use disparities: results from a population-based sample","volume":"61","author":"Day","year":"2017","journal-title":"J Adolesc Health Off Publ Soc Adolesc Med"},{"key":"2026082400120035900_ref19","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1016\/j.amepre.2019.03.021","article-title":"Sexual and gender minority U.S. youth tobacco use: population assessment of tobacco and health (PATH) study wave 3, 2015-2016","volume":"57","author":"Johnson","year":"2019","journal-title":"Am J Prev Med"},{"key":"2026082400120035900_ref20","volume-title":"Centers for Disease Control and Prevention (US)"},{"key":"2026082400120035900_ref21","doi-asserted-by":"publisher","volume-title":"Psychol Sex Orientat Gend Divers","author":"Scroggs","DOI":"10.1037\/sgd0000647"},{"key":"2026082400120035900_ref22","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.addbeh.2019.03.005","article-title":"Sexual and gender minority young adults\u2019 smoking characteristics: assessing differences by sexual orientation and gender identity","volume":"95","author":"Vogel","year":"2019","journal-title":"Addict Behav"},{"key":"2026082400120035900_ref23","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1089\/lgbt.2019.0005","article-title":"Cigarette smoking among youth at the intersection of sexual orientation and gender identity","volume":"6","author":"Wheldon","year":"2019","journal-title":"LGBT Health"},{"key":"2026082400120035900_ref24","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.drugalcdep.2019.04.013","article-title":"Tobacco use among lesbian, gay, bisexual and transgender young adults varies by sexual and gender identity","volume":"201","author":"Delahanty","year":"2019","journal-title":"Drug Alcohol Depend"},{"key":"2026082400120035900_ref25","doi-asserted-by":"publisher","first-page":"108246","DOI":"10.1016\/j.addbeh.2025.108246","article-title":"Examining tobacco use at the intersection of gender, sexual orientation, race, and ethnicity using national U.S. data of sexual and gender diverse youth","volume":"163","author":"Watson","year":"2025","journal-title":"Addict Behav"},{"key":"2026082400120035900_ref26","article-title":"Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics","volume":"1989","author":"Crenshaw","year":"2015","journal-title":"Univ Chic Leg Forum"},{"key":"2026082400120035900_ref27","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1093\/ntr\/ntac110","article-title":"Incorporating intersectionality as a framework for equity-minded tobacco control research: a call for collective action toward a paradigm shift","volume":"25","author":"Tan","year":"2023","journal-title":"Nicotine Tob Res"},{"key":"2026082400120035900_ref28","doi-asserted-by":"publisher","first-page":"1614","DOI":"10.1093\/ntr\/ntw028","article-title":"Risk profiles of youth single, dual, and poly tobacco users","volume":"18","author":"Ali","year":"2016","journal-title":"Nicotine Tob Res Off J Soc Res Nicotine Tob"},{"key":"2026082400120035900_ref29","doi-asserted-by":"publisher","first-page":"102207","DOI":"10.1016\/j.pmedr.2023.102207","article-title":"Patterns of tobacco product use and substance misuse among adolescents in the United States","volume":"33","author":"Erhabor","year":"2023","journal-title":"Prev Med Rep"},{"key":"2026082400120035900_ref30","doi-asserted-by":"publisher","volume-title":"Prev Med Rep","author":"Lee","DOI":"10.1016\/j.pmedr.2025.103069"},{"key":"2026082400120035900_ref31","first-page":"1","year":"2024"},{"key":"2026082400120035900_ref32","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1001\/jamapediatrics.2017.4173","article-title":"Association of Noncigarette Tobacco Product use with future cigarette smoking among youth in the population assessment of tobacco and health (PATH) study, 2013-2015","volume":"172","author":"Watkins","year":"2018","journal-title":"JAMA Pediatr"},{"key":"2026082400120035900_ref33","volume-title":"Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General."},{"key":"2026082400120035900_ref34","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1136\/tobaccocontrol-2014-051638","article-title":"Multiple tobacco product use among US adolescents and young adults","volume":"25","author":"Soneji","year":"2016","journal-title":"Tob Control"},{"key":"2026082400120035900_ref35","doi-asserted-by":"publisher","first-page":"106284","DOI":"10.1016\/j.ypmed.2020.106284","article-title":"Patterns of tobacco use and nicotine dependence among youth, United States, 2017\u20132018","volume":"141","author":"Gomez","year":"2020","journal-title":"Prev Med"},{"key":"2026082400120035900_ref36","volume-title":"The Impact of 2023 Legislation on Trans Youth","author":"Mallory","year":"2023"},{"key":"2026082400120035900_ref37","doi-asserted-by":"publisher","first-page":"107119","DOI":"10.1016\/j.ypmed.2022.107119","article-title":"E-cigarette and combusted tobacco abstinence among young adults: secondary analyses from a U.S.-based randomized controlled trial of vaping cessation","volume":"165","author":"Graham","year":"2022","journal-title":"Prev Med"},{"key":"2026082400120035900_ref38","doi-asserted-by":"publisher","first-page":"E336","DOI":"10.9778\/cmajo.20210325","article-title":"Scoping review of guidance on cessation interventions for electronic cigarettes and dual electronic and combustible cigarettes use","volume":"11","author":"Kundu","year":"2023","journal-title":"CMAJ Open"},{"key":"2026082400120035900_ref39","doi-asserted-by":"publisher","first-page":"e63156","DOI":"10.2196\/63156","article-title":"Desires and needs for quitting both e-cigarettes and cigarettes among Young adults: formative qualitative study informing the development of a smartphone intervention for dual tobacco cessation","volume":"8","author":"Nguyen","year":"2024","journal-title":"JMIR Form Res"},{"key":"2026082400120035900_ref40","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1002\/ajh.21059","article-title":"Smoking increases the risk of venous thrombosis and acts synergistically with oral contraceptive use","volume":"83","author":"Pomp","year":"2008","journal-title":"Am J Hematol"},{"key":"2026082400120035900_ref41","doi-asserted-by":"publisher","first-page":"1461","DOI":"10.1161\/CIRCULATIONAHA.118.038584","article-title":"Occurrence of acute cardiovascular events in transgender individuals receiving hormone therapy","volume":"139","author":"Nota","year":"2019","journal-title":"Circulation."},{"key":"2026082400120035900_ref42","doi-asserted-by":"publisher","first-page":"S13","DOI":"10.1093\/ejendo\/lvad170","article-title":"Cardiovascular disease in transgender people: a systematic review and meta-analysis","volume":"190","author":"van Zijverden","year":"2024","journal-title":"Eur J Endocrinol"},{"key":"2026082400120035900_ref43","doi-asserted-by":"publisher","first-page":"102332","DOI":"10.1016\/j.pmedr.2023.102332","article-title":"Informing the development of interventions for e-cigarette use and prevention of transition to cigarette smoking in young adults: a qualitative study","volume":"35","author":"Tran","year":"2023","journal-title":"Prev Med Rep"},{"key":"2026082400120035900_ref44","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1016\/j.amepre.2019.10.008","article-title":"Risk of stroke with E-cigarette and combustible cigarette use in Young adults","volume":"58","author":"Parekh","year":"2020","journal-title":"Am J Prev Med"},{"key":"2026082400120035900_ref45","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1016\/j.tcm.2016.03.001","article-title":"Cardiovascular toxicity of nicotine: implications for electronic cigarette use","volume":"26","author":"Benowitz","year":"2016","journal-title":"Trends Cardiovasc Med"},{"key":"2026082400120035900_ref46","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1093\/ntr\/ntad018","article-title":"Tobacco cessation and prevention interventions for sexual and\/or gender minority-identified people and the theories that underpin them: a scoping review","volume":"25","author":"McQuoid","year":"2023","journal-title":"Nicotine Tob Res"},{"key":"2026082400120035900_ref47","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1111\/add.16400","article-title":"Effectiveness of culturally tailoring smoking cessation interventions for reducing or quitting combustible tobacco: a systematic review and meta-analyses","volume":"119","author":"Leinberger-Jabari","year":"2024","journal-title":"Addiction."},{"key":"2026082400120035900_ref48","doi-asserted-by":"publisher","first-page":"171","DOI":"10.3102\/0013189X14534297","article-title":"Inaccurate estimation of disparities due to mischievous responders: several suggestions to assess conclusions","volume":"43","author":"Robinson-Cimpian","year":"2014","journal-title":"Educ Res"},{"key":"2026082400120035900_ref49"}],"container-title":["Nicotine &amp; Tobacco Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ntr\/advance-article-pdf\/doi\/10.1093\/ntr\/ntag067\/67783707\/ntag067.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/28\/9\/1510\/67783707\/ntag067.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/28\/9\/1510\/67783707\/ntag067.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T04:12:11Z","timestamp":1787544731000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ntr\/article\/28\/9\/1510\/8586495"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,3]]},"references-count":49,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,4,3]]},"published-print":{"date-parts":[[2026,8,24]]}},"URL":"https:\/\/doi.org\/10.1093\/ntr\/ntag067","relation":{},"ISSN":["1469-994X"],"issn-type":[{"value":"1469-994X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9]]},"published":{"date-parts":[[2026,4,3]]}}}