Sexual Identity as a Moderator of the Association Between Serious Psychological Distress and E-Cigarette Use Among US Adults, 2021–2023

BACKGROUND: Compared to adults without serious psychological distress (SPD), adults with SPD have higher e-cigarette use (i.e., nicotine vaping), and both SPD and vaping vary by sexual identity. This study examined whether sexual identity modified the association between SPD and e-cigarette use in a nationally representative US adult sample. METHODS: = 139,524). Logistic regression models of past-month e-cigarette use, including an interaction term between serious psychological distress (measured with Kessler-6; no, yes) and sexual identity (heterosexual/straight, gay/lesbian, bisexual) were estimated, adjusted for survey year, sociodemographics, other tobacco use, and substance use. Moderation was evaluated using regression-based marginal effects. Regression-based marginal effects indicated that SPD was associated with an increased predicted probability of e-cigarette use among heterosexual adults, but not among gay/lesbian or bisexual adults. However, bisexual adults exhibited the highest overall prevalence of e-cigarette use regardless of distress status. CONCLUSIONS: Serious psychological distress was associated with e-cigarette use, but the strength of this association differed by sexual identity. Findings highlight the importance of tailored e-cigarette prevention and cessation programs that recognize heterogeneity in e-cigarette use across sexual identity groups.