Gay, lesbian, and bisexual young people are more likely to use alcohol, e-cigarettes, cannabis, and tobacco than their heterosexual peers, a new study has found. Researchers say that stress from sexual orientation-based discrimination is to blame.

The study — published this autumn in the American Medical Association’s open-access medical journal, JAMA Network Open — looked at data on the habits of 28,291 middle and high school students taken from the Centers for Disease Control and Prevention’s (CDC) 2022 National Youth Tobacco Survey.

About 4.5% of student respondents self-identified as gay or lesbian, and 11.8% self-identified as bisexual. These percentages represent about 4,611 of the respondents.

Researchers found that 29.3% of non-heterosexual youths had used alcohol in the last 30 days, compared to 21.6% of heterosexual youth. About 25.6% of non-hetero youth self-reported cannabis use over the last 30 days, compared to 14% of heterosexual youth. Approximately 26.2% of non-hetero youth self-reported e-cigarette use, compared to 16.4% of hetero youth. Lastly, 9.1% of non-hetero youth self-reported cannabis use over the last 30 days, compared to 4.6% of heterosexual youth

Researchers found that bisexual youths were especially more likely to have vaped cannabis oil and e-cigarettes than their gay and heterosexual counterparts.

“It is well-documented that minority stress (eg, stress from sexual orientation-based discrimination) is associated with youth substance use, which may be consistent with vaping cannabis,” the study’s authors wrote. “Preliminary evidence from this study may inform future prevention strategies directed at reducing substance use disparities among sexual minority youth.”

The study’s findings reflect similar findings from past studies. A 2018 surveyfrom the Ohio Department of Health showed that LGBTQ+ teens were more likely to have vaped or smoked in the last 30 days compared to their straight counterparts.

A 2017 CDC study found that LGBTQ+ people were twice as likely to smoke than straight and cisgender people. Another study from the same year found that queer youth were more likely to smoke than straight and cis youth. One studyfound that LGBTQ+ people spend about $7.9 billion on cigarettes each year.