Intersectional Disparities in Adult Cigarette Smoking, E-Cigarette Use, and Cannabis Use Among Sexual and Gender and Racial and Ethnic Minorities in California.

Objectives. To examine how intersecting identities of sexual orientation, gender, race, and ethnicity are associated with cigarette smoking, e-cigarette use, cannabis use, tobacco quit attempts, and perceptions of health care among adults in California. Methods. We analyzed the pooled 2021-2022 California Health Interview Survey data (n = 45 916). Sexual and gender minorities (SGMs) were identified as a sexual minority (bisexual, lesbian, gay) or transgender. Using Poisson regression models with interaction terms between SGM and race and ethnicity, we examined intersectional associations with the outcomes. Results. Non-Hispanic White SGM adults had an increased risk of cigarette, e-cigarette, and cannabis use and co-use. Hispanic/Latino SGM adults (adjusted risk ratio [ARR] past-30-day cannabis use = 1.88; 95% confidence interval [CI] = 1.51, 2.33) and non-Hispanic Black SGM adults (ARR heavy smoking = 4.78; 95% CI = 2.34, 9.74) had a much higher risk of use behaviors compared with their non-SGM counterparts. Intersectional minorities were more likely to report perceived discrimination in health care. Conclusions. Intersectional identities influence tobacco, e-cigarette, and cannabis use and health care experiences. Tailored interventions are needed to reduce disparities and improve health care access in intersectional racial and ethnic and SGM minoritized populations. (Am J Public Health. Published online ahead of print August 27, 2026:e1-e12. https://doi.org/10.2105/AJPH.2026.308633).