Cigarette Smoking in Sexual Minority Youth: A Concerning Trend :

Sexual minority (eg, lesbian, gay, and bisexual [LGB]) youth are at risk for adverse social determinants of health. As a result, they may also be more likely to smoke cigarettes. Fish et al. (10.1542/peds.2018-1671) looked at 404,583 students in 9^th to 12^th grades derived from six cohorts studied in the national biennial Youth Risk Behavior Surveys from 2005 to 2015.  The authors specifically studied youth trends in those who responded to lifetime cigarette use and/or were smoking at least 20 of the past 30+ days. While most disparities in lifetime cigarette use and heavy use narrowed over the ten-year period for sexual minority teens, of note was that disparities between those who were unsure of their sexual identity and those who were heterosexual increased over the ten years. This is just one of the many take-home findings from this study that can help us refine our conversations with sexual minority teens and do more to monitor smoking behaviors on those who question their own sexual identity (although it is still worth talking with those LGB teens who come out and identify themselves in these four groups since disparities also exist compared to heterosexuals even if these disparities are smaller than ten years ago).  Do you discuss smoking behaviors with your sexual minority patients? How about vaping (which this study does not discuss but suspect a future study from these authors or others will)?  While we may have plenty to talk about with our LGB patients, their smoking behaviors should not be left out of the discussion—and hope after reading this study, you’ll agree that that is the case.