Cigarette and E-Cigarette Use Among LGBT+ Youths and Young Adults According to Strength of State-Level LGBT+ Equality Protections.

Objectives. To examine whether the state-level LGBT+ (lesbian, gay, bisexual, transgender, and other identities) legal protections where LGBT+ youths and young adults reside are associated with cigarette and e-cigarette use. Methods. We drew LGBT+ respondents (aged 15-31 years; n = 1255) from a national, probability-based survey conducted from August to December 2023. We scored each state for LGBT+ equality on a scale from restrictive to protective based on the Movement Advancement Project's 2023 policy environment. Using weighted logistic regression models, we examined the relationship between current (past 30-day) cigarette and e-cigarette use and state LGBT+ equality protections, controlling for demographics and state tobacco control expenditure. Results. LGBT+ individuals in protective policy states had 65% lower odds (odds ratio [OR] = 0.35; 95% confidence interval [CI] = 0.16, 0.78) of current cigarette use, and 56% lower odds (OR = 0.44; 95% CI = 0.25, 0.79) of current e-cigarette use compared with those in restrictive policy states. Conclusions. LGBT+ individuals living in protective policy environments had lower odds of current cigarette and e-cigarette use, consistent with theoretical relationships between stress, discrimination, and harmful health behaviors. Public Health Implications. Protective policies may alleviate tobacco use disparities among the LGBT+ community. (Am J Public Health. 2025;115(6):945-953. https://doi.org/10.2105/AJPH.2025.308008).