Home Exposure to Smoking and Low Risk Perception Were Top Factors Driving Teen Tobacco and Cannabis Use

Exposure to e-cigarette or cigarette use at home or in vehicles was the leading factor associated with smoking and vaping across all groups, explaining up to 44% of predicted variance. Perceiving occasional use as low-harm was also a top factor. For sexual minority middle schoolers, mental stress was a dominant factor explaining up to 21% of variance in tobacco and marijuana use.

Analysis of the 2023 National Youth Tobacco Survey with dominance analyses and logistic regression stratified by sexual identity (straight, sexual minority, unsure) and grade level (middle school vs high school). Sample: 6,654 middle school and 8,274 high school students.

LGBTQ+ youth use tobacco and marijuana at higher rates. This study identifies the most influential modifiable factors for each group, allowing prevention programs to be tailored to the populations that need them most.

Prevention programs often take a one-size-fits-all approach. These findings suggest that targeting home smoking exposure for all teens, risk perceptions for high schoolers, and mental health support for LGBTQ+ middle schoolers could improve intervention effectiveness.

Cross-sectional design cannot prove these factors cause use. Self-reported data may undercount both substance use and sexual minority identity. The "unsure" category is heterogeneous.