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. Author manuscript; available in PMC: 2025 Jan 1.
Published in final edited form as: Subst Use Misuse. 2023 Dec 1;59(1):136–142. doi: 10.1080/10826084.2023.2262024

Recency of Cannabis Vaping in Sexual Minorities in Wave 5 of the Population Assessment of Tobacco and Health (PATH) Study

Dale Dagar Maglalang 1,2,*, Yuanyuan Hu 1, Daniel Baslock 1, Jeanelle Dyan Daus 3, Manuel Cano 4, Jasjit S Ahluwalia 2,5,6
PMCID: PMC10842009  NIHMSID: NIHMS1939101  PMID: 37750356

Abstract

Background:

Cannabis vaping is increasing in the United States. Among populations at-risk are sexual minorities (SM) who are more likely to vape cannabis compared to their heterosexual counterparts. Cannabis vaping has been associated with negative health outcomes and concomitant use of other substances with increased risk with more recent use.

Objectives:

This study examined the association between SM identification and recency of cannabis vaping (the last occasion that a participant used their vape device with cannabis) and number of puffs (the count of puffs that the participant took during their most recent use of their vape device with cannabis) using Wave 5 of the Population Assessment of Tobacco and Health (PATH) Study.

Results:

In a weighted sample of participants who reported ever vaping cannabis (N=5,331), 15% identified as SM, about 60% vaped cannabis in the past 3 or more days, and the mean number of puffs was 2 (SE=0.17). Using multinomial logistic regression and zero-inflated negative binomial regression, the results showed that compared to heterosexual adults who reported not recently vaping cannabis, SM had higher probabilities of vaping cannabis in the past 3 or more days, 1–2 days, and the day of interview.

Conclusion:

SM individuals were more likely to recently vape cannabis, placing them at higher risk for respiratory diseases and use of other substances. Public health researchers and practitioners need to identify reasons for cannabis vaping in this population and implement targeted public health messaging to inform SM communities of the potential health effects of cannabis vaping.

Keywords: cannabis vaping, sexual minorities, LGBTQ+, THC

Introduction

The use of electronic nicotine delivery system (ENDS) devices to vape cannabis has gained prominence in the past several years (Chadi et al., 2020; Dai & Hao, 2017). A study using data from the Behavioral Risk Factor Surveillance System found that the prevalence of past 30-day cannabis vaping in United States (U.S.) adults increased from 1.0% to 2.0% between 2017 and 2019 (Boakye et al., 2021). With respect to sexual minorities (SM), the prevalence of cannabis vaping in 2019 was higher in lesbian and gay (4.6%) and bisexual (2.7%) individuals, relative to heterosexual individuals (1.4%) (Boakye et al., 2021).

Cannabis vaping constitutes inhaling tetrahydrocannabinol (THC) using a vaporizer or dab pen that heats to the point of vaporization, turning cannabis or cannabis concentrates into vapor which is then inhaled (Stogner & Miller, 2015). Vaporizers typically work with cannabis flower or oil, while dab pens use a waxy cannabis concentrate. Vaporizers and dab pens share common characteristics, including running on battery power, re-useable cartridges, a chamber that holds vapor, and heating technology (Chadi et al., 2020). The outbreak of e-cigarette or vaping use-associated lung injury (EVALI) in 2019 drew public attention to the negative side effects of vaping, as the use of THC-containing products was reported in 76% of cases of EVALI (Siegel et al., 2019). Although few studies have examined the long-term health outcomes of cannabis vaping, it has been associated with lung inflammation, lung damage, and bronchitis symptoms of wheezing or whistling (Bhat et al., 2023; Boyd et al., 2021; Braymiller et al., 2020). Cannabis vaping has also been associated with a higher likelihood of concurrent nicotine use, heavy alcohol use, binge drinking, and other risky behaviors (Boakye et al., 2021).

Within the U.S. population, nascent studies on cannabis vaping suggest that SM are potentially at risk. Studies have shown higher use of cannabis and e-cigarettes in SM than in heterosexual populations (Al Rifai et al., 2020; Dunbar et al., 2022), and a study using nationally representative data found higher current cannabis vaping in SM individuals (8.7%) compared to their heterosexual counterparts (7.2%) (Mattingly et al., 2022). A longitudinal study with a regional convenience sample in Texas also indicated that SM college students had twice the odds of cannabis vaping compared to heterosexual-identified college students (Hinds et al., 2023). Experiences of minority stress, such as internalized stigma and victimization due to one’s SM identity, have been associated with increased anxiety and depression, leading to cannabis use (Dyar, 2022; Dyar et al., 2020) and e-cigarette use (Valera et al., 2021) as coping mechanisms. However, coping from stressors are not the only reason why SM individuals may use cannabis. Other motives include enhancing their sexual experience (Currin et al., 2019), relaxing (Bochicchio et al., 2021), and feeling a sense of fulfillment (Flores et al., 2023).

The few published studies that included data on cannabis vaping in SM populations have primarily measured cannabis vaping as either past 30-day use (Boakye et al., 2021) or aggregated frequency of use to dichotomized categories (Mattingly et al., 2022). This article extends the literature by examining the associations between SM identity and the recency of cannabis vaping and number of puffs when vaping cannabis, using nationally-representative data. Recency of cannabis vaping in this context is defined as the latest time that an individual has used their vape device with cannabis, and number of puffs refers to the number of puffs taken by the individual during their most recent use of a vape device with cannabis. Studies have shown that vaping with cannabis three or more times in the past month was associated with higher odds of wheezing (Boyd et al., 2021; Braymiller et al., 2020), implying more harmful health outcomes. Furthermore, while studies on cannabis vaping are still emerging, previous studies on recency of cannabis found associations with concurrent use of other substances, such as alcohol and prescription sedatives (Jones & McCance-Katz, 2019) and psychotic like experiences in young adults (Spriggens & Hides, 2015). However, other studies also found benefits of understanding the effects of recency of cannabis use, such as reduced HIV-related inflammatory biomarkers in people living with HIV (Ellis et al., 2020) and improved neuropsychological performance in people living with schizophrenia (Coulston et al., 2007). Given the previous literature on the effects of recency of cannabis use, the implementation of more studies on the effects of vaping cannabis can help researchers better understand its potential effects in different populations. We hypothesize that compared to heterosexual individuals, SM individuals will have a higher likelihood of recency of cannabis vaping and more puffs when vaping cannabis.

Methods

Study Population

We conducted a secondary data analysis of the publicly-available Population Assessment of Tobacco and Health (PATH) Study, a nationally representative longitudinal study of tobacco and nicotine use in adults and youth (United States Department of Health and Human Services et al., 2022). This study analyzed wave 5 of the PATH Study collected between December 2018 through November 2019 with 34,309 participants. We restricted the analysis to adult participants who responded “yes” (n=7,206) to the question, “Have you ever used marijuana, marijuana concentrates, marijuana waxes, THC, or hash oils in an electronic product such as an e-cigarette, vape, mod, personal vaporizer, e-hookah, or hookah pen?” and who did not have missing data on variables in the study, resulting in an analytic sample of 5,331.

Measures

Primary outcome variable

Recency of cannabis vaping

We chose recency of cannabis vaping as the primary outcome for this study because of the discussion among researchers that there has not been a standardized measure of what constitutes a puff in ENDS devices due to the heterogeneity in devices, duration of inhalation, and amount of nicotine available in products (Soule et al., 2023; Yamaguchi et al., 2022). Therefore, using recency of cannabis vaping can be an additional form of measurement to better understand ENDS use behavior. Recency of cannabis vaping was measured with the question, “When did you last use marijuana, marijuana concentrates, marijuana waxes, THC, or hash oils in an electronic product such as an e-cigarette, vape, mod, personal vaporizer, e-hookah, or hookah pen?” Response categories were the following: in the past hour; sometime today, but more than an hour ago; yesterday; day before yesterday; three or more days ago; don’t know; or refused. We recoded the categories as none, 3 or more days ago, 1–2 days ago, and today. Participants who reported “don’t know” (n=69) and “refused” (n=28) were dropped and those who responded with inapplicable (n=1,029) were categorized as none. Participants categorized as inapplicable were those who vaped cannabis in their lifetime but may not be currently vaping cannabis. We retained these observations to maximize statistical power.

Secondary outcome variable

Puffs of vaping with cannabis

Puffs of vaping with cannabis was measured as a count response variable with the question, “How many puffs of marijuana, marijuana concentrates, marijuana waxes, THC, or hash oils from an electronic product [have/did] you [taken/take]?” We also counted those who were categorized as inapplicable (n=5,424) with those who responded 0 (n=59), yielding a total of n=5,483, to maximize statistical power.

Primary independent variable

The primary independent variable is SM identity, measured with the question, “Do you consider yourself to be…” with response categories of straight, lesbian or gay, bisexual, something else, or “don’t know.” The variable was recoded to straight and SM (lesbian or gay, bisexual, or something else).

Covariates:

age (18–24, 25–34, & 35+), sex (men & women), marital status (never married, married, & widowed, divorced, or separated), education (less than a high school [HS] degree, general education [GED]/HS degree, some college, & college degree or higher), home ownership (own a house & do not own a house), and annual household income (less than $10k, $10k - $24,999, $25k - $49,999, $50k - $99,999, $100k or more). These variables were chosen as covariates because they are known confounders of the primary independent and dependent variables (Drope et al., 2018; Matthews et al., 2018; Singh et al., 2017).

Statistical Analyses

Descriptive statistics were used to examine the distribution of the variables used in the models. We used Stata 17 SE to analyze the data. To determine how to analyze recency of cannabis vaping in the last 30 days, the omodel package (Wolfe, 1997) was used to assess whether to implement an ordinal logistic regression or a multinomial logistic regression. The results showed that proportional odds assumptions were violated (Prob > chi2 = 0.0001); thus, a multinomial logistic regression was deemed more appropriate for analysis. It is important to evaluate the proportional odds in an ordinal variable because of the assumption that “no input variable has a disproportionate effect on a specific level of the outcome variable” (McNulty, 2021). To determine how to analyze the count variable, puffs with cannabis, a model of goodness of fit was checked using the countfit package (Long & Freese, 2001). The Akaike Information Criterion (AIC) and Schwartz-Bayesian Information Criterion (BIC) showed smaller values for a zero-inflated negative binomial regression (AIC = 16399.989; BIC = 16528.619), indicating a better fit. In addition, while the complete sample was n=7,206, about n=1,875 had missing observations. We opted for a complete case analysis only because of the technical limitation to analyze imputed data with zero-inflated negative binomial regression in Stata and smoking studies have suggested using a zero-inflated negative binomial regression analysis when handling data with excessive zeroes and overdispersion (Pittman et al., 2020). However, we conducted a sensitivity analysis of imputed data of independent variables with missing observations, using a negative binomial regression model, included in the appendix for comparison. We implemented a negative binomial regression to analyze the data since the results from the countfit package indicated that it was the second-best fit (AIC = 16485.857; BIC = 16553.556).

Two models were created for each outcome; the first model was a discrete model between the primary independent variable, SM, and outcome variables. In the fully adjusted model, we controlled for race, sex, age, education, marital status, household income, and home ownership. Weighted estimates, provided by the PATH study (United States Department of Health and Human Services et al., 2022), were calculated to reflect the U.S. adult population when Wave 5 was collected. We used the Variance Inflation Factor (VIF) to assess for multicollinearity, which showed that the models were below 2.0, which indicates that the variables were not highly correlated with one another. Previous studies have shown that VIF values over 4 indicated high collinearity (O’Brien, 2007).

Results

As presented in Table 1, the analytic sample consisted of N=5,331 adults, including 933 SM. Based on weighted estimates representative of the US adult population, among individuals who reported ever vaping cannabis, 15% (standard error (SE)=0.59) identified as SM. Regarding self-reported recency of cannabis vaping in the overall sample, 60% vaped with cannabis in the past 3 or more days, 14% in the past 1–2 days, and 10% vaped on the day of interview. The mean count of vaping puffs with cannabis was 2.0 (SE=0.17). Approximately 56% were identified as men, 40% were 35 years old or older, 64% were non-Hispanic White, 40% earned some college degree, 55% were never married, 25% had a household income of $50,000 - $99,999, and 68% did not own a home. Among individuals identified as SM, 64% vaped with cannabis in the past 3 or more days, 16% in the past 1–2 days, and 12% on the day of the interview. The mean count of puffs with cannabis was 2.0 (SE=0.18).

Table 1.

Characteristics of 5,331 US adults who reported ever vaping cannabis in the Population Assessment of Tobacco and Health (PATH) Study, 2018-2019

Characteristic Total sample (N=5,331)
n (Percentage/Mean; Standard Error)a 		Sexual Minorities (n=933)
n (Percentage/Mean; Standard Error)a 		Heterosexual (n=4,398)
n (Percentage/Mean; Standard Error)a
Recency of cannabis vaping:
 None 768 (16.5%; 0.61) 78 (8.3%; 1.19) 690 (18.0%; 0.70)
 3 or more days ago 3,228 (59.6%; 0.84) 594 (64.3%; 1.83) 2,634 (58.8%; 1.00)
 1–2 days ago 799 (14.1%; 0.53) 156 (15.8%; 1.36) 643 (13.4%; 0.64)
 Today 536 (9.8%;0.54) 105 (11.7%; 1.36) 431 (9.42%; 0.55)
Number of puffs, during most recent cannabis vaping − (2.0; 0.17) − (2.0; 0.18) − (2.1; 0.20)
Sexual orientation:
 Heterosexual 4,398 (84.7%; 0.59)    
 Sexual Minority (SM)1 933 (15.4%; 0.59)    
Sex
 Men 2,720 (55.8%; 0.79) 274 (37.1%; 2.07) 2,446 (59.2%; 0.92)
 Women 2,611 (44.2%; 0.79) 659 (62.9%; 2.07) 1952 (40.8%; 0.92)
Age, years
 18–24 2,144 (26.2%; 0.70) 470 (36.7%; 1.91) 1,674 (24.3%; 0.77)
 25–34 1,719 (33.9%; 0.75) 314 (36.8%; 2.17) 1,405 (33.4%; 0.79)
 35+ 1,468 (39.3%; 0.94) 149 (26.5%; 2.17) 1,319 (42.3%; 1.01)
Race/ethnicity:
 NH White 3,062 (63.8%; 0.98) 522 (63.4%; 1.98) 2,540 (63.8%; 1.01)
 NH Black 686 (12.1%; 0.65) 115 (9.95%; 1.06) 571 (12.5%; 0.73)
 Hispanic 1,091 (16.1%; 0.73) 198 (18.4%; 1.60) 893 (15.7%; 0.74)
 Other 492 (8.1%; 0.52) 98 (8.2%; 1.24) 394 (8.03%; 0.55)
Educational attainment
 Less than high school 548 (9.1%; 0.49) 93 (7.6%; 0.79) 455 (9.3%; 0.55)
 High school or GED 1,629 (28.7%; 0.79) 279 (27.5%; 1.62) 1,350 (28.9%; 0.89)
 Some college 2,191 (40.0%; 0.82) 397 (41.4%; 2.22) 1,794 (39.8%; 0.92)
 College or higher 963 (22.3%; 0.85) 164 (23.6%; 1.96) 799 (22.0%; 0.93)
Marital status
 Never married 3,385 (54.8%; 0.95) 712 (71.9%; 1.72) 2,673 (51.7%; 1.10)
 Married 1,196 (27.7%; 0.74) 131 (15.8%; 1.26) 1,065 (29.9%; 0.87)
 Widowed 750 (17.5%; 0.76) 90 (12.4%; 1.45) 660 (18.4%; 0.87)
Household income, $
 Less than 10k 906 (14.4%; 0.62) 179 (16.1%; 1.34) 727 (14%; 0.66)
 10k - 24,999 1,143 (20.4%; 0.77) 236 (24.2%; 1.62) 907 (19.7%; 0.80)
 25k - 49,999 1,260 (23.8%; 0.71) 221 (23.9%; 1.90) 1,039 (23.8%; 0.69)
 50k - 99,999 1,195 (24.7%; 0.78) 178 (20.8%; 2.03) 1,017 (25.4%; 0.83)
 100k or more 827 (16.7%; 0.73) 119 (15%; 1.92) 708 (17.1%; 0.78)
Homeownership status
 Owns a home 1,452 (32.3%; 0.85) 181 (24.1%; 2.23) 1,271 (33.6%; 0.93)
 Does not own a home 3,879 (67.9%; 0.85) 752 (76.0%; 2.23) 3,127 (66.4%); 0.93)
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Note. Sample of 5,331 participants without missing data on any variable in the analyses.

1

Category includes individuals self-identified as lesbian, gay, bisexual, or “something else;”

a

Weighted results; percentages may not total 100 due to rounding.

Abbreviations. NH = Non-Hispanic; GED = General Educational Development; − = not applicable

Table 2 presents the unadjusted and fully-adjusted multinomial logistic regression and zero-inflated negative binomial regression results. Compared to adults who identified as heterosexual who did not vape cannabis recently, adults who identified as SM had higher relative probabilities of vaping with cannabis in the past 3 or more days (RRR = 1.85; 95% CI: 1.27–2.67), in the past 1–2 days (RRR = 2.00; 95% CI: 1.28, 3.11), or today (RRR = 2.36; 95% CI: 1.55–3.60), after accounting for variance attributed to race, age, marital status, sex, education, income, and homeownership. In other words, the expected relative risk of cannabis vaping in the past 3 or more days, in the past 1–2 days, or today is higher for SM compared to heterosexual individuals who reported no use. No significant association was observed between SM identification and number of puffs of cannabis vaping (in the adjusted model: β = 0.86; 95% CI: 0.66, 1.13; p=0.275 for the count portion of the model; β = −0.36; 95% CI: −1.07, 0.34; p=0.312 for the logit portion of the model).

Table 2.

Results of multinomial and zero-inflated negative binomial regression models predicting recency of cannabis vaping, or number of puffs during most recent cannabis vaping, for US adults who reported ever vaping cannabis in the Population Assessment of Tobacco and Health (PATH) Study, 2018-2019 (n=5,331)

Outcome 1:
Recency of Cannabis Vaping (Relative to “No Use”)		 Outcome 2:
Number of Puffs
≥3 days ago RRR (95% CI) 1–2 days ago RRR (95% CI) Today RRR (95% CI) No Puffs (Logit Model) β (95% CI) Number of Puffs (Count Model) β (95% CI)
Unadjusted model
 Sexual Minority (heterosexual, ref.) 2.39*** (1.69–3.38) 2.50*** (1.67–3.74) 2.71*** (1.86–3.97) −0.42* (−0.78 – −0.06) 0.76 (0.55 – 1.06)
Adjusted model
 Sexual Minority (heterosexual, ref.) 1.85** (1.27–2.67) 2.00** (1.28–3.11) 2.36*** (1.55–3.60) −0.36 (−1.07–0.34) 0.86 (0.66–1.13)
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Notes. Sample of 5,331 participants without missing data on any variable in the analyses. Weighted results. Unadjusted models regress the outcome on the exposure variable (self-identification as a sexual minority); adjusted models add race, age, marital status, sex, education, income, and homeownership.

Abbreviations. RRR = relative-risk ratio; CI = confidence interval; ref. = reference category

*

p < .05.

**

p < .01.

***

p < .001

Discussion

The purpose of the study was to examine the association between SM identity and recency of cannabis vaping and number of puffs, using a nationally-representative sample of U.S. adults. This study’s strength is not only expanding the literature on cannabis vaping with a focus on recency of use (Boakye et al., 2021; Mattingly et al., 2022), but it specifically focuses on SM populations, underscoring the susceptibility of SM individuals to substance use compared to heterosexual individuals. Findings showed that relative to heterosexual participants who reported not recently vaping with cannabis, SM identification was associated with increased recent cannabis vaping. Notably, the ratio of the likelihood of cannabis vaping continued to increase among SM who recently reported cannabis vaping in the past 1–2 days and on the day of interview. Understanding the implications of the recency of cannabis vaping is imperative due to the potential health effects of more recent use of vaping cannabis.

Although research on this subject is in its early stages, studies have documented associations of cannabis vaping with adverse health behaviors (Jones & McCance-Katz, 2019; Spriggens & Hides, 2015) and outcomes (Bhat et al., 2023; Boyd et al., 2021; Braymiller et al., 2020). More recent use of cannabis vaping can possibly heighten the use of other substances (Jones & McCance-Katz, 2019) in SMs which already have higher substance use prevalence compared to heterosexual populations (Schuler et al., 2020). Moreover, since cannabis vaping has also been associated with some detrimental respiratory effects (Boyd et al., 2021; Braymiller et al., 2020), this continues to place SM individuals in a vulnerable position because compared to their heterosexual counterparts, SMs are less likely to have health insurance or seek health services and have higher odds of pulmonary disease and later stage diagnosis because of a lack of inclusive and gender-affirming care in healthcare settings (Alencar Albuquerque et al., 2016; Margolies & Brown, 2018; Ward et al., 2015). Furthermore, SM also continue to experience increased rates of discrimination in the U.S. with the implementation of systemic discriminatory laws and policies such as the “Don’t say gay Bill” in Florida (American Civil Liberties Union, 2023) that will continue to expose SM individuals to stressors. The stresses brought on by experiences of discrimination related to their sexual orientation and gender identity can potentially lead to increased cannabis vaping to cope. Future studies might consider using ecological momentary assessments to understand in time experiences of daily minoritized stressors and cannabis vaping.

In contrast to findings regarding the recency of cannabis vaping, analyses involving the number of puffs reported for cannabis vaping (today, yesterday, or the day before) did not provide evidence of a statistically significant association with SM identification. Researchers have identified several challenges inherent in measuring the intensity of vaping, particularly when relying on self-report measures such as the number of puffs (Soule et al., 2023). Studies suggest that the number of puffs from e-cigarettes varies not only between individuals but also within individuals, as any given person may not be consistent in the number of puffs taken each day, with larger numbers of puffs often taken during weekends (Dautzenberg & Bricard, 2015). This variation may also extend to those using e-cigarettes for cannabis specifically. As such, further research would be needed to determine whether SM identification is associated with differences in cannabis vaping intensity or quantity as more standardized and optimized measures are introduced and established in the field.

Limitations

The findings of this study should be interpreted in light of some limitations. Although we use the term SM, the questionnaire offered limited identifications for participants to choose from (lesbian, gay, bisexual, or “something else”). This may not be entirely reflective of the spectrum of individuals who identify as SM and sexual gender minorities. Another limitation of the study is that our analysis implemented a complete case analysis of the data. However, we conducted a sensitivity analysis using data of imputed independent variables with missing observations (See Appendix A). The analysis with imputed data had similar outcomes with the complete case analysis for recency of vaping cannabis, but the count model using negative binomial regression showed increased puffs of cannabis in SM compared to heterosexual individuals, although not statistically significant. However, this analysis does not account for the excess of zeros in the data which skews the outcome.

Conclusion

This study found that compared to heterosexual individuals who did not vape cannabis recently, SM individuals had a higher likelihood of recent cannabis vaping, with a higher risk of using in the past 1–2 days and the day of interview. These findings underscore SM populations’ elevated risk of substance use, which increases vulnerability to disease and addiction. Future studies should consider examining the intersectionality of people’s identities, such as how one’s SM identity intersects with one’s race or ethnicity, which may illuminate further disparities within groups. Public health researchers and practitioners need to advocate for eliminating discriminatory policies targeting SM populations that may lead individuals to increase cannabis vaping to cope with daily and systemic stressors. Providers who work with SM individuals may wish to initiate open dialogues regarding vaping use, potentially incorporating Screening, Brief Intervention, and Referral to Treatment (SBIRT) strategies, as well as motivational interviewing and harm-reduction approaches. Furthermore, targeted public health prevention needs to be implemented in this population to raise awareness regarding the potential health effects of cannabis vaping.

Funding:

Drs. Maglalang and Ahluwalia were supported in part by P20GM130414 (PI: Monti), an NIH funded Center of Biomedical Research Excellence (COBRE).

Appendix A. Results of multinomial and negative binomial regression models predicting recency of cannabis vaping, or number of puffs during most recent cannabis vaping, for US adults who reported ever vaping cannabis in the Population Assessment of Tobacco and Health (PATH) Study, 2018–2019 using imputed data from independent variables with missing observations.

Outcome 1:
Recency of Cannabis Vaping (Relative to “No Use”)		 Outcome 2:
Number of Puffs β (95% CI)
≥3 days ago RRR (95% CI) 1–2 days ago RRR (95% CI) Today RRR (95% CI)
Unadjusted modela,b
 Sexual Minority (heterosexual, ref.) 1.92*** (1.55–2.38) 2.11*** (1.64–2.71) 2.33*** (1.78–3.05) 0.94 (0.75 – 1.16)
Adjusted modelc,d
 Sexual Minority (heterosexual, ref.) 1.58*** (1.26–1.99) 1.81*** (1.39–2.37) 2.19*** (1.65–2.91) 1.20 (0.96–1.50)
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Notes. Number of observations varies because only independent variables with missing observations were imputed:

a.

n=7,109;

b.

n=7,181;

c.

n=7,102;

d.

n=7,158 (a & c are for outcome 1, and b and c are for outcome 2). Weighted results. Unadjusted models regress the outcome on the exposure variable (self-identification as a sexual minority); adjusted models add race, age, marital status, sex, education, income, and homeownership.

Abbreviations. RRR = relative-risk ratio; CI = confidence interval; ref. = reference category.

*

p < .05.

**

p < .01.

***

p < .001

Footnotes

Disclosure: Dr. Ahluwalia received sponsored funds for travel expenses as a speaker for the 2021 and 2022 annual GTNF conference. Dr. Ahluwalia also serves as a consultant and has equity in a start-up company, Respira Technologies. The rest of the authors have no competing interests to declare.

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