Black transgender youth are six times more likely to use e-cigarettes than Black cisgender youth and almost three times more likely than white transgender youth, according to research presented at a Tuesday APHA Annual Meeting session on “E-Cigarettes and Youth Use.”

Research has shown there is likely a greater risk of e-cigarette use among transgender adolescents, but it’s been less clear when it comes to race and ethnicity, said Jennifer Felner, a postdoctoral research fellow at San Diego State University.

“We have this unitary focus on identity when it comes to health disparities research,” Felner said. “There’s really not enough information about subgroups of adolescents or young people, particularly those with multiple marginalized or multiple minoritized identities and what their trends in vaping and other substance use-related behaviors might be.”

woman at counter with e-cigarettesFelner and colleagues used a sample from the 2017-2018 and 2018-2019 California Healthy Kids Survey, which is administered to seventh-, 9th- and 11th-grade students. They asked about frequency of vaping use in the past 30 days, gender identity and racial identity.

They found that 82% of transgender students reported no vaping in the past 30 days, compared to 91% of cisgender students and 91% of students who said they were unsure if they were transgender.

“We still see a lot of young people are not vaping in the last 30 days, which is great, but…there’s a disparity between the transgender vaping relative to the cisgender vaping among participants,” Felner noted.

Researchers found significant disparities among transgender teenagers’ e-cigarette use across all racial categories when compared to their cisgender counterparts. Black transgender youth were six times more likely to use e-cigarettes than Black cisgender youth. The next largest gap was among Asian transgender students, who were almost three-and-a-half times more likely than Asian cisgender teenagers to vape. There was a disparity among transgender white students, but it was much smaller, at 1.18 times more likely than white cisgender teens.

Furthermore, researchers found that white cisgender teens were more likely to vape than cisgender teens of all other racial categories except American Indian and Alaskan Native youth, which was only slightly higher. But, the transgender student data showed the reverse — white transgender teenagers vaped fewer times in 30 days than all other racial and ethnicity categories.

“This is really showing us intersectionality and, theoretically, that multiplicative relationship between being someone who is both transgender and a racial/ethnic minority,” Felner said.

She said their findings show the need for more research, as well as prevention campaigns targeted specifically to transgender adolescents of color.

“One of the questions that remains is is this related to transgender stigma and racism that then creates more stress — or exposure to greater levels of stress — and thus results in more maladaptive or negative coping among trans adolescents,” Felner told attendees.

In the photo: E-cigarette products are on sale in June 2019 at Smoke and Gift Shop in San Francisco. Photo by Justin Sullivan, courtesy Getty Images.