Multi-level Risk and Protective Factors for Vaping Onset and Escalation Among Youth: a Focus on LGBTQ + Disparities

Abstract Youth vaping remains a major public health concern, with sexual and gender minority youth experiencing disproportionately higher rates of e-cigarette use compared to their non-LGBTQ + peers. These disparities are not attributable to identity itself, but to social and structural conditions that shape exposure to risk and access to protection. This narrative review synthesizes evidence on shared and LGBTQ + -specific risk and protective factors for vaping initiation and escalation among youth aged 10–24 years. Guided by the Social Ecological Model, findings are organized across individual, interpersonal, organizational/community, and societal levels, and interpreted through two complementary mechanisms: a minority stress–related coping pathway and a socialization and identity pathway. Across levels, discrimination and stigma emerge as cross-cutting risk processes that intensify psychological distress, normalize vaping within social networks, and undermine protective environments. Protective factors, including identity affirmation, supportive relationships, affirming institutions, and inclusive policies, buffer these pathways and promote resilience. This review highlights limitations of one-size-fits-all prevention approaches and underscores the need for selective, mechanism-informed interventions that address both shared developmental risks and the structural drivers of LGBTQ + vaping disparities.