Associations between weight concern, bullying, cigarette use, and vaping among heterosexual and sexual minority female adolescents

OBJECTIVE: The objective of this study was to evaluate the influence of weight concern and bullying on sexual orientation disparities in cigarette use and vaping among adolescent females. STUDY DESIGN: Cross-sectional analysis. METHODS: Using pooled data from 2009 to 2019 Youth Risk Behavior Surveys (n = 233,437), multivariable logistic regression models examined cross-sectional associations between weight perception and change efforts, bullying, and smoking or vaping behaviors. RESULTS: Relative to heterosexual adolescent females, bisexual females had elevated odds of initiating smoking before age 13 (AOR = 1.57, 95% CI = 1.08-2.28), while lesbian (AOR = 3.92, 95% CI = 2.07-7.42) and bisexual (AOR = 3.39, 95% CI = 2.39-4.81) females reported elevated odds of current smoking. Attempts to lose and gain weight and bullying were associated with elevated odds of lifetime smoking across all sexual orientation groups. Bullying was associated with elevated odds of vaping among heterosexual, bisexual, and adolescent females not sure of their sexual orientation. Weight concern associations with vaping differed by sexual orientation; for example, attempts to gain weight were associated with elevated odds of vaping among all subgroups except lesbian adolescent females. CONCLUSION: Lesbian, bisexual, and adolescent females not sure of their sexual orientation were more likely to engage in smoking and vaping than their heterosexual peers. Disaggregating sexual minority subgroups revealed nuanced risk profiles for vaping, particularly for bisexual females, highlighting the importance of tailored prevention efforts to address sexual orientation disparities. Findings underscore the need for school-based interventions targeting weight concerns and bullying to address cigarette use and vaping.