Use of Cigarettes and E-Cigarettes/Vaping Among Transgender People: Results From the 2015 U.S. Transgender Survey

Abstract

This study examines the demographic characteristics, transgender-specific factors, and discrimination experiences associated with current cigarette smoking, e-cigarette use/vaping, and dual use in a large sample of transgender people. This was a secondary analysis of the 2015 U.S. Transgender Survey (n=27,715). Conducted in 2019, logistic regression models were used to estimate the AORs and 95% CIs of current smoking, e-cigarette use/vaping, and dual use among transgender people. Overall, 23.6% of respondents used cigarettes, 9.3% used e-cigarettes/vaping products, and 5.2% reported dual use within the past 30 days. Visually nonconforming individuals had greater odds (cigarettes: AOR=1.49, 95% CI=1.35, 1.65; e-cigarettes/vaping: AOR=1.43, 95% CI=1.25, 1.65; dual use: AOR=1.81, 95% CI=1.52, 2.15) than visually conforming individuals. Transgender people who had disclosed their transgender identity to their social networks had greater odds of cigarette smoking (AOR=1.30, 95% CI=1.17, 1.45), e-cigarette use/vaping (AOR=1.30, 95% CI=1.12, 1.52), and dual use (AOR=1.95, 95% CI=1.61, 2.35) than individuals who were out to none or some people within their networks. Experiencing discrimination (i.e., unequal treatment, verbal harassment, or physical assault) significantly increased the odds for cigarette smoking, e-cigarette use/vaping, and dual use. Transgender people who experienced all 3 types of discrimination had 2 times greater odds of current cigarette smoking (AOR=2.06, 95% CI=1.79, 2.37) and dual use (AOR=2.17, 95% CI=1.73, 2.74) than those who had not experienced discrimination. Discrimination, visual nonconformity, and being out as transgender increased the odds of cigarette smoking, e-cigarette use/vaping, and dual use. This study informs disease prevention efforts for transgender populations with increased risks for these health behaviors.