{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:36:44Z","timestamp":1792787804871,"version":"4.5.0"},"reference-count":58,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Health Canada Substance Use and Addiction Program","id":[{"id":"https:\/\/ror.org\/05p8nb362","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Cancer Institute","award":["P01CA200512"],"award-info":[{"award-number":["P01CA200512"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["LGBT Health"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>Adolescents with internalizing mental health (IMH) symptoms are more likely to use nicotine\/tobacco products; however, the association with gender identity remains unclear. We examined differences in the relationship between IMH symptoms and nicotine\/tobacco use by gender identity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Data came from the U.S. arm of the International Tobacco Control Youth Tobacco and Vaping Survey, an online cross-sectional survey of adolescents aged 16\u201319, conducted from 2020 to 2023 (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 28,959). Current nicotine\/tobacco use was categorized as: (1) no use, (2) exclusive combustible product use, (3) exclusive noncombustible product use, and (4) use of both product types. Current depression and anxiety symptoms were aggregated into an IMH symptoms variable (yes\/no). Gender identity was determined based on responses to questions regarding current gender identity and sex assigned at birth. Analyses examined differences in IMH symptoms and nicotine\/tobacco use by gender identity and the potential moderating role of gender identity in the relation between IMH symptoms and nicotine\/tobacco use.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Risk for nicotine\/tobacco use and IMH symptoms varied across gender identities. Transgender women reported the highest prevalence of any product use (29%) followed by transgender men (24%), cisgender men (22%), cisgender women (19%), and gender nonconforming (GNC) adolescents (14%). GNC adolescents reported the highest prevalence of IMH symptoms (85%), followed by transgender men (80%), cisgender women (67%), transgender women (65%), and cisgender men (45%). We found significant interactions between IMH symptoms and gender identity (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This study revealed the importance of disaggregating GNC and transgender identities in research related to nicotine\/tobacco use and mental health among adolescents.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23258292261422233","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T17:04:21Z","timestamp":1771607061000},"page":"167-178","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Association Between Mental Health and Nicotine\/Tobacco Use by Disaggregated Gender Identities Among U.S. Adolescents, 2020\u20132023"],"prefix":"10.1177","volume":"13","author":[{"given":"Emily E.","family":"Hackworth","sequence":"first","affiliation":[{"name":"Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA."},{"name":"Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D\u00e8sir\u00e9e","family":"Vida\u00f1a-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riley","family":"O\u2019Neal","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine T.","family":"Hinds","sequence":"additional","affiliation":[{"name":"Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, USA."},{"name":"Department of Psychological, Health, and Learning Sciences, The University of Houston, Houston, Texas, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea R.","family":"Titus","sequence":"additional","affiliation":[{"name":"Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minji","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Fillo","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hammond","sequence":"additional","affiliation":[{"name":"School of Public Health Sciences, University of Waterloo, Waterloo, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James F.","family":"Thrasher","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"e_1_3_4_2_2","unstructured":"Center for Tobacco Products. 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