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Introduction Youth are at risk for tobacco use, and previous research has pointed to increased vulnerabilities associated with sexual minority identity. For example, LGB youth have increased odds for using tobacco than their heterosexual peers, and bisexual youth have higher odds of smoking than other sexual identity groups. As new tobacco products proliferate and health risks from dual/poly use grow, increased understanding of tobacco use patterns by sexual minority youth is needed. Methods For 3117 youth, aged 13-18 years, who completed an online questionnaire in 2017 and identified their sexual orientation [minority (e.g. lesbian/gay, bisexual, or pansexual) vs majority (heterosexual)] and gender, we classified current tobacco use into four categories: e-cigarette only, other product only (such as cigarette, cigar, or smokeless tobacco; not an e-cigarette), dual/poly use, and no use. Analyses were conducted separately for male and female participants. Multinomial logistic regression was employed. Results Female sexual minority youth had nearly twofold odds of dual/ poly tobacco use (OR=1.95; 95% CI: 1.12-3.40), compared to their heterosexual counterparts. For male youth, sexual minority identification was not significantly associated with dual/poly use. No significant differences were found in sexual minority and heterosexual youth e-cigarette only or other tobacco only use groups. Tobacco use patterns also significantly differed by age, race, place of residence, and parental education level. Conclusions Study findings reveal greater odds of dual/poly tobacco use for female sexual minority youth. Tailored tobacco prevention and cessation programs or interventions are needed for sexual minority youth most at risk of tobacco use, especially multiple product use.

Introduction Youth tobacco use rates in Appalachia exceed the US national average, and e-cigarette use has increased. Thus, further research is needed to understand how these youth receive and share product information. Methods Middle and high school students in rural Appalachia were surveyed (N=1103). The primary outcome, tobacco use, was categorized as: never users, cigarette-only users, smokeless-only users, e-cigarette-only users, and polytobacco users. Associations between receiving or sharing conventional tobacco-related or e-cigarette-related information via specific communication channels and tobacco use were assessed. Results Participants who received tobacco information from friends and family (FF) (OR=1.87; 95% CI: 1.35-2.57), public displays (PUB) (OR=1.49; 95% CI: 1.09-2.05), and digital media (DIG) (OR=1.95; 95% CI: 1.41-2.70) and e-cigarette information via the same communication channels, FF (OR=2.65; 95% CI: 1.93-3.65), PUB (OR=1.62; 95% CI: 1.17-2.26), and DIG (OR=2.24; 95% CI: 1.61-3.12), had greater odds of being polytobacco users, compared to never users. Participants who received e-cigarette-related information from FF (OR=2.42; 95% CI: 1.42-4.13) and PUB (OR=2.13; 95% CI: 1.25-3.65) had greater odds of being e-cigarette-only users compared to never users. Participants who shared e-cigarette-related information with FF had greater odds of being e-cigarette-only users (OR=3.16; 95% CI: 1.80-5.58) and polytobacco users (OR=4.48; 95% CI: 3.16-6.35) compared to never users. Conclusions Receiving and sharing tobacco-related and e-cigarette-related information via multiple communication channels is associated with e-cigarette and polytobacco use among Appalachian youth. Several channels may need to be utilized in health campaigns to influence youth.

Introduction In Appalachia, youth tobacco-use rates remain higher than the U.S. national average. Past research has indicated that several factors are related to high rates of tobacco use among Appalachian youth (e.g. low socioeconomic status, rural lifestyles). Of the Appalachian states, Kentucky has one of the highest rates of youth tobacco use. The aim of this study was to explore views of tobacco among Kentucky youth living in Appalachian counties. Methods In Fall 2014 - Spring 2015, focus group interviews were conducted with middle and high school students (N=109) in Appalachian counties in Kentucky. Each focus group session included open-ended questions and was conducted by trained facilitators. Focus group transcriptions and field notes were analyzed for themes. Results Study participants described an entrenched culture of tobacco. Three themes exemplified this culture. First, adult behavior served to enable youth tobacco use (e.g. teachers ignoring dip use in class, adults smoking with youth). Second, tobacco is easily accessible to youth (e.g. restrictions on youth sales are often ignored, family members provide). Third, symbols of tobacco are prevalent (e.g. festivals celebrating tobacco heritage, tobacco barns, and tobacco marketing logos). Conclusions Youth participants described a deeply rooted tobacco culture, which they believed was unlikely to change. Additional studies and health education efforts are needed in these rural communities. Further, stricter enforcement of tobacco sales and marketing restrictions may be helpful in protecting this vulnerable population.