Among adolescents, exposure to smoking at home was the single strongest predictor of tobacco and cannabis use, while mental stress was especially important for LGBTQ+ middle schoolers.
Public health professionals, parents, and school administrators interested in teen substance use prevention.
Home smoking exposure explained up to 44% of predicted variance in teen tobacco/cannabis use
What the researchers found
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.
Why it matters
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.
The numbers in context
6,654 middle school + 8,274 high school students. Home exposure explained up to 44% of variance. Low risk perception explained up to 21.6% (e-cigarettes) and 26.5% (cigarettes) of variance. Mental stress explained up to 21% of variance among sexual minority middle schoolers.
How the study worked
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.
What this study cannot tell us
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.
How to read the evidence
Moderate: large nationally representative sample with sophisticated dominance analysis, though cross-sectional design limits causal inference.
When this study was published
2025 study using 2023 survey data.
The bigger picture
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.
Questions still open
- Would reducing home smoking exposure have the greatest impact on teen substance use prevention? How can mental health support be integrated into substance use prevention for LGBTQ+ youth?
Common questions
Why are LGBTQ+ teens at higher risk?
What was the most important modifiable risk factor?
Read the original research
Exploring Factors Shaping Tobacco and Marijuana Use Among Sexual Minority Adolescents.
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 27(11), 2097-2108
Citation
Lin, Meng-Yun; Lockhart, Darcy; Denlinger-Apte, Rachel. (2025). Exploring Factors Shaping Tobacco and Marijuana Use Among Sexual Minority Adolescents.. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 27(11), 2097-2108. https://doi.org/10.1093/ntr/ntaf097
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