Background <p>Evidence shows that lesbian, gay, and bisexual (LGB) groups face disparities in e-cigarette use, but little is known about e-cigarette use among the Chinese LGB population. China, with the largest LGB population and as the leading global producer in the e-cigarette industry, presents a unique context for studying this phenomenon.</p> Methods <p>Using the theoretical framework of minority stress, this study hypothesized a moderated mediation model to test the mediating effect of psychological distress and the moderating effect of eHealth use on the association between sexual orientation and e-cigarette use. Data from a nationally representative Chinese survey conducted between January and September 2023 (<i>n</i> = 4,901) were analyzed.</p> Results <p>The results indicated that LGB individuals had 11.1% higher odds of distress compared to heterosexual populations, was associated with higher e-cigarette use (<i>bp</i> = 0.038, <i>p</i> &lt; .001). However, the direct association between sexual minority identity and e-cigarette use was non-significant. Furthermore, eHealth use moderated the disparities in psychological distress between LGB and heterosexual groups (<i>bp</i> = − 0.160, <i>p</i> &lt; .05).</p> Conclusion <p>The pattern of e-cigarette use among Chinese sexual minorities is distinct: e-cigarettes are less commercialized and serve mainly as a coping mechanism. These findings highlight the importance of mental health support and eHealth interventions in reducing psychological distress and e-cigarette use among LGB individuals in China.</p>