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Harlow AF, Liu F, Young LE, Coreas SI, Rahman T, Unger JB, Leventhal AM, Barrington-Trimis JL, Krueger EA. Sexual and Gender Identity Disparities in Nicotine and Tobacco Use Susceptibility and Prevalence: Disaggregating Emerging Identities Among Adolescents From California, USA. Nicotine Tob Res 2024; 26:203-211. [PMID: 37493636 PMCID: PMC10803110 DOI: 10.1093/ntr/ntad131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Prior studies report nicotine/tobacco use disparities for sexual and gender minority (SGM) youth but have insufficiently characterized SGM identity diversity. AIMS AND METHODS Adolescents (mean age = 15.2) from 11 high schools in Southern California completed surveys in Fall 2021. Ever use of combustible (cigarettes, cigars, hookah) and noncombustible (e-cigarettes, e-hookah, heated tobacco, smokeless/snus, oral nicotine) nicotine/tobacco (among overall sample, n = 3795) and susceptibility to future initiation of cigarettes, e-cigarettes, and flavored non-tobacco oral nicotine (among n = 3331 tobacco-naïve youth) were compared across four gender (male/masculine, female/feminine, transgender male/female, non-binary) and seven sexual (heterosexual, bisexual, pansexual, queer, questioning, gay/lesbian, asexual) identities. RESULTS Non-binary (vs. cisgender male) youth had greater prevalence of ever combustible (prevalence ratio [PR] = 2.86, 95% confidence intervals (CI): 1.76 to 4.66) and non-combustible (PR = 1.94, 95% CI: 1.31 to 2.86) nicotine/tobacco use, and susceptibility to future nicotine/tobacco initiation (PR range = 2.32-2.68). Transgender (vs. cisgender male) youth had greater susceptibility to nicotine/tobacco use (PR range = 1.73-1.95), but not greater tobacco use prevalence. There was greater prevalence of non-combustible nicotine/tobacco use (PR range = 1.78-1.97) and susceptibility to nicotine/tobacco initiation (PR range = 1.36-2.18) for all sexual minority (vs. heterosexual) identities, except for asexual. Bisexual (PR = 2.03, 95% CI: 1.30 to 3.16) and queer (PR = 2.87, 95% CI: 1.31 to 6.27) youth had higher ever combustible tobacco use than heterosexual youth. Questioning (vs. heterosexual) youth were more susceptible to future tobacco initiation (PR range = 1.36-2.05) but did not differ in ever use. CONCLUSIONS Disparities in nicotine/tobacco use and susceptibility were present with similar effect sizes across most, but not all, SGM identities. Inclusive measurement of SGM identities in research and surveillance may inform more precise tobacco control efforts to reduce disparities. IMPLICATIONS Among high school students from Southern California with substantial diversity in sexual and gender identities, there was greater prevalence of tobacco use and susceptibility to future tobacco initiation for most, but not all, sexual and gender minority youth, including those with emerging sexual and gender identities such as non-binary, queer and pansexual. Additionally, findings indicate that tobacco control initiatives targeting youth who are questioning their sexual identities may be particularly important for preventing tobacco use initiation. This study reinforces the importance of measuring diversity within the LGBTQ + community for tobacco use research, and highlights how inclusive measurement can inform more precise tobacco control interventions.
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Affiliation(s)
- Alyssa F Harlow
- University of Southern California, Department of Population and Public Health Sciences, Los Angeles, CA, USA
- University of Southern California, Institute for Addiction Science, Los Angeles, CA, USA
| | - Fei Liu
- University of Southern California, Department of Population and Public Health Sciences, Los Angeles, CA, USA
| | - Lindsay E Young
- University of Southern California, Institute for Addiction Science, Los Angeles, CA, USA
- University of Southern California, Annenberg School for Communication and Journalism, Los Angeles, CA, USA
| | - Saida I Coreas
- University of Southern California, Department of Population and Public Health Sciences, Los Angeles, CA, USA
| | - Tahsin Rahman
- University of Southern California, Department of Population and Public Health Sciences, Los Angeles, CA, USA
| | - Jennifer B Unger
- University of Southern California, Department of Population and Public Health Sciences, Los Angeles, CA, USA
- University of Southern California, Institute for Addiction Science, Los Angeles, CA, USA
| | - Adam M Leventhal
- University of Southern California, Department of Population and Public Health Sciences, Los Angeles, CA, USA
- University of Southern California, Institute for Addiction Science, Los Angeles, CA, USA
| | - Jessica L Barrington-Trimis
- University of Southern California, Department of Population and Public Health Sciences, Los Angeles, CA, USA
- University of Southern California, Institute for Addiction Science, Los Angeles, CA, USA
| | - Evan A Krueger
- Tulane University, School of Social Work, New Orleans, LA, USA
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Edwards K, Manoharan A, Asfar T, Kareff S, Lopes G, Rodriguez E, Olazagasti C. Disparities in Electronic Cigarette Use: A Narrative Review. Crit Rev Oncog 2024; 29:91-98. [PMID: 38683156 DOI: 10.1615/critrevoncog.2024051128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
The prevalence of electronic cigarette use has been declared an epidemic by the U.S. Surgeon General in 2018, particularly among youth aged 18-24 years old. Little is known about the differential use of e-cigarettes by different groups. PubMed, Cochrane, and Google Scholar were used to find relevant articles. A total of 77 articles were included. The extant literature reveals disparities in e-cigarette use by race/ethnicity and sexuality/gender. There are conflicting conclusions regarding disparities by socioeconomic status.
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Affiliation(s)
| | - Aysswarya Manoharan
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Taghrid Asfar
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Samuel Kareff
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gilberto Lopes
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Estelamari Rodriguez
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Coral Olazagasti
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Culbreth RE, Salazar LF, Spears CA, Crosby R, Hayat MJ, Aycock DM. Stressors Associated with Tobacco Use Among Trans Women. Transgend Health 2023; 8:282-292. [PMID: 37342482 PMCID: PMC10277983 DOI: 10.1089/trgh.2020.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose Tobacco use is prevalent among sexual and gender minorities (SGM), yet few studies have examined the specific drivers of tobacco use among trans women. The purpose of this study is to examine the impact of proximal, distal, and structural stressors associated with tobacco use among trans women. Methods This study is based on a cross-sectional sample of trans women (n=162) living in Chicago and Atlanta. Analyses were conducted to examine the association between stressors, protective factors, and tobacco use using a structural equation modeling framework. Proximal stressors (transgender roles scale, transgender congruence scale, internalized stigma, and internalized moral acceptability) were operationalized as a higher order latent factor, while distal stressors were operationalized as observed variables (discrimination, intimate partner violence, sex work, rape, child sexual abuse, HIV, and violence). Protective factors included social support, trans-related family support, and trans-related peer support. All analyses adjusted for sociodemographic variables (age, race/ethnicity, education, homelessness and health insurance). Results The prevalence of smoking among trans women in this study was 42.9%. In the final model, homelessness (odds ratio [OR]: 3.78; 95% confidence interval [CI]: 1.97, 7.25), intimate partner violence (OR: 2.14; 95% CI: 1.07, 4.28), and commercial sex work (OR: 2.22; 95% CI: 1.09, 4.56) were all associated with tobacco use. There was no association between proximal stressors and tobacco use. Conclusion Among trans women, tobacco use prevalence was high. Tobacco use was associated with homelessness, intimate partner violence, and commercial sex work. Targeted tobacco cessation programs should account for the co-occurring stressors that trans women face.
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Affiliation(s)
- Rachel E. Culbreth
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia, USA
- Center for Research on Interpersonal Violence, Georgia State University, Atlanta, Georgia, USA
| | - Laura F. Salazar
- Center for Research on Interpersonal Violence, Georgia State University, Atlanta, Georgia, USA
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Claire A. Spears
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Richard Crosby
- Department of Health Behavior and Society, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
- Kinsey Institute for Research on Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
| | - Matthew J. Hayat
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Dawn M. Aycock
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia, USA
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Evans-Polce RJ, Veliz P, Kcomt L, Boyd CJ, Esteban McCabe S. Examining sexual identity stability and change over time and associations with tobacco use in a nationally representative US sample. Addict Behav 2023; 141:107661. [PMID: 36821882 PMCID: PMC10570932 DOI: 10.1016/j.addbeh.2023.107661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Epidemiologic research has found sexual minority identifying individuals are disproportionately burdened by tobacco use and tobacco use disorder (TUD). However, these studies often conceptualize sexual identity as time-invariant. This study examined sexual identity over time and whether a transition to a sexual minority identity was associated with tobacco outcomes. METHODS This study used data from Waves 1-4 of the Population Assessment of Tobacco and Health (2013/14-2016/18) study (adolescents and adults aged ≥ 14 years; n = 26,553). We examined associations of sexual identity stability and change with changes in the number of tobacco products used and TUD symptoms. RESULTS Males and females who experienced two or more changes in sexual identity and females who changed from a heterosexual to a sexual minority identity were more likely to have an increase in two or more tobacco products and increase TUD symptoms compared to heterosexual-stable males and females. Gay-stable males were less likely to increase TUD symptoms compared to heterosexual-stable males. CONCLUSIONS Experiencing a change in sexual identity may be a particularly vulnerable period for increases in tobacco products used and TUD. It may be important to provide tobacco use intervention and support resources to individuals coming out as a sexual minority and those fluid in their sexual identity.
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Affiliation(s)
- Rebecca J Evans-Polce
- Center for the Study of Drugs, Alcohol, Smoking and Health Department of Health Behavior and Biological Sciences, School of Nursing University of Michigan, Ann Arbor, MI, United States.
| | - Philip Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health Department of Health Behavior and Biological Sciences, School of Nursing University of Michigan, Ann Arbor, MI, United States; Institute for Social Research University of Michigan, Ann Arbor, MI, United States
| | - Luisa Kcomt
- Center for the Study of Drugs, Alcohol, Smoking and Health Department of Health Behavior and Biological Sciences, School of Nursing University of Michigan, Ann Arbor, MI, United States; School of Social Work, Wayne State University, Detroit, MI, United States
| | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health Department of Health Behavior and Biological Sciences, School of Nursing University of Michigan, Ann Arbor, MI, United States; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, United States; Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States; Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health Department of Health Behavior and Biological Sciences, School of Nursing University of Michigan, Ann Arbor, MI, United States; Institute for Social Research University of Michigan, Ann Arbor, MI, United States; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, United States; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States; Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, United States
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Kcomt L, Evans-Polce RJ, Engstrom CW, Boyd CJ, Veliz PT, West BT, McCabe SE. Tobacco Use Among Gender-Varying and Gender-Stable Adolescents and Adults Living in the United States. Nicotine Tob Res 2022; 24:1498-1503. [PMID: 35417560 PMCID: PMC9356686 DOI: 10.1093/ntr/ntac098] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION This study examines the proportion of the United States adolescents and adults who are variable (ie, at least one change in gender identity) versus stable in their gender identities over time, and whether they differ significantly in their nicotine/tobacco use after adjusting for key covariates. METHODS We fit multivariable logistic regression models to data from Waves 2-4 (2014/15-2016/18) of the Population Assessment of Tobacco and Health (PATH), a nationally representative study (n = 33 197 U.S. adolescents and adults aged ≥14 years). We examined associations of gender stability/variability over three waves with tobacco use at wave 4 (2016-2018). Differences in any past 30-day tobacco, cigarette, e-cigarette, other tobacco, and poly-tobacco use were assessed among cisgender-stable, transgender-stable, and gender-varying respondents. RESULTS An estimated 1.0% of adolescents and adults were classified as gender-varying. Prevalence of any past 30-day tobacco use was higher among gender-varying individuals (42.7%) than among gender-stable individuals (transgender-stable, 37.8% and cisgender-stable, 26.7%). There were no significant differences in the odds of nicotine/tobacco use between the two gender-stable groups. However, gender-varying respondents had significant increased odds of any past 30-day tobacco use (adjusted odds ratio [AOR] = 2.0, 95% confidence interval [CI] = 1.3 to 3.0), cigarette use (AOR = 1.7, 95% CI = 1.1 to 2.5), e-cigarette use (AOR = 2.2, 95% CI = 1.4-3.5), other tobacco use (AOR = 2.2, 95% CI = 1.4 to 3.4), and poly-tobacco use (AOR = 2.0, 95% CI = 1.3 to 3.1) compared with cisgender-stable individuals. CONCLUSIONS Gender-varying individuals are at higher risk for nicotine/tobacco use, placing them at greater risk for tobacco-related health consequences. IMPLICATIONS Despite increased knowledge about transgender health in recent years, there remains a paucity of research about gender-varying individuals. This study is the first to examine the proportion of gender-varying individuals in the United States using a longitudinal, nationally representative sample and to explore differences in nicotine/tobacco use among gender-varying and gender-stable individuals. Our findings suggest that gender-varying people have an increased risk for nicotine/tobacco use, placing them at higher risk for tobacco-related health consequences. This study increases knowledge about nicotine/tobacco use among this under-represented population in research and underscores the importance of developing an awareness of gender diversity.
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Affiliation(s)
- Luisa Kcomt
- School of Social Work, Wayne State University, Detroit MI, USA
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca J Evans-Polce
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Curtiss W Engstrom
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, Department of Psychiatry, Rachel Upjohn Building, University of Michigan, Ann Arbor, MI, USA
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Philip T Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA
| | - Brady T West
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
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Tan S, Cen P, Fang T, Yang X, Zhang Y, Zhu J, Huang H, Wang M, Jiang L, Mo J, Ning C. Chained multimediator model of sexual orientation disclosure, sexual minority stigma, sexual minority identity, social support, and resilience among ymsms. BMC Public Health 2022; 22:797. [PMID: 35449098 PMCID: PMC9026989 DOI: 10.1186/s12889-022-13231-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/11/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction This study aimed to investigate sexual orientation disclosure and mental health among young men who have sex with men (YMSMs). To this end, we constructed a chained multimediator model of sexual minority stigma, sexual minority identity, social support, and resilience, with the moderator of sexual orientation disclosure. Methods We conducted a cross-sectional survey of 345 YMSMs in Nanning, China. Bivariate analysis was used to evaluate factors associated with sexual orientation disclosure. Sexual minority stigma was used to predict identity, with social support as the step 1 mediator and resilience as the step 2 mediator. Sexual minority identity was analyzed using a chained moderated mediation model; sexual orientation disclosure was included as a moderator in all models to control its confounding effect. Results The average age of YMSMs was 20.0 ± 1.3 years. Bivariate analysis indicated that YMSMs who disclosed sexual orientation may have experienced less stigma (15.49 ± 3.02 vs 16.21 ± 2.74), obtained more social support (65.98 ± 11.18 vs 63.19 ± 11.13), had strong psychological resilience (37.40 ± 8.57 vs 35.39 ± 7.73), and had a more positive self-identity (104.12 ± 21.10 vs 95.35 ± 16.67); differences between subgroups were statistically significant (p < 0.05). Sexual minority stigma, perceived stigma, and enacted stigma were significantly associated with social support and resilience. The association between sexual minority stigma and sexual minority identity was significantly mediated by social support (indirect effect [95% CI] = − 3.307 [− 4.782, − 1.907]). Resilience significantly mediated the same association for identity (− 2.544 [− 4.052, − 1.114]). The chained relationship from sexual minority stigma to social support, resilience, and identity was also significant, with an indirect effect of − 0.404 [− 0.621, − 0.249]. Conclusion Among YMSMs in China, sexual minority stigma affects sexual minority identity through social support and resilience. Given the psychological effects of stigma, social support and resilience must be considered to better promote positive self-identity and mental health among YMSMs.
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Affiliation(s)
- Sumin Tan
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Ping Cen
- Nanning Municipal Center for Disease Prevention and Control, Nanning, Guangxi, China.,School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Ting Fang
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Xing Yang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Yun Zhang
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Jiawen Zhu
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Haimei Huang
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Min Wang
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Li Jiang
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Jieling Mo
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China.
| | - Chuanyi Ning
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China.
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Addressing the critical role of gender identity and sex in the planning, analysis, and conduct of clinical trials. ACTA ACUST UNITED AC 2021; 7:59-62. [PMID: 34532571 DOI: 10.21801/ppcrj.2021.72.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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The Association of Asthma, Sexual Identity, and Inhaled Substance Use among U.S. Adolescents. Ann Am Thorac Soc 2021; 18:273-280. [PMID: 33027599 DOI: 10.1513/annalsats.202001-062oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rationale: Minority sexual identity appears to confer asthma risks. Although associations between inhaled substances and asthma are established, these have not been examined among sexual minority youths. Given sexual minority adolescents' disproportionately high rates of substance use, research is needed to fill this important gap.Objectives: Using a representative sample of adolescents from the United States, we 1) examined associations among asthma, sexual identity, and inhaled substance use and tested 2a) whether sexual identity moderates relationships between asthma and inhaled substance use and 2b) whether inhaled substance use mediates associations between sexual identity and asthma.Methods: Data are from the 2015 and 2017 Youth Risk Behavior Surveillance Survey. Adolescents (n = 30,113) reported if they were ever diagnosed with asthma, current use of cigarettes, cigars and/or cigarillos, marijuana, and electronic vapor products and if they ever used inhalants or synthetic marijuana. We used logistic regression to examine associations between asthma, sexual identity, and inhaled substance use controlling for age, race or ethnicity, and body mass index percentile, stratified by sex.Results: Lesbian, gay, and bisexual respondents had higher relative risks for asthma than heterosexual youth. Sexual minority female youths had significantly higher relative risks than heterosexual female youths for use of every inhaled substance. There were few sexual identity differences in inhaled substance use among male youths. Inhaled substance use was significantly associated with higher risks for asthma. In general, associations between each individual inhaled substance and asthma did not differ between sexual minority and heterosexual youths. However, when all inhaled substances were added into the models concurrently, inhaled substance use appeared to mediate associations with asthma among lesbian and bisexual female youths, and partially mediated these associations among sexual minority male youths.Conclusions: Sexual identity and inhaled substance use appear to play important roles in asthma risk. However, these variables do not fully explain the risk, suggesting that other unmeasured variables (e.g., stress and victimization) may be implicated in risks for both inhaled substance use and asthma. It is important that clinicians providing care to adolescents ask about sexual identity and inhaled substance use. Effective approaches to reducing inhaled substance use among adolescents, especially sexual minorities, are needed.
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Kcomt L, Evans-Polce RJ, Veliz PT, Boyd CJ, McCabe SE. Use of Cigarettes and E-Cigarettes/Vaping Among Transgender People: Results From the 2015 U.S. Transgender Survey. Am J Prev Med 2020; 59:538-547. [PMID: 32826126 PMCID: PMC7508765 DOI: 10.1016/j.amepre.2020.03.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION This study examines the demographic characteristics, transgender-specific factors, and discrimination experiences associated with current cigarette smoking, e-cigarette use/vaping, and dual use in a large sample of transgender people. METHODS This was a secondary analysis of the 2015 U.S. Transgender Survey (n=27,715). Conducted in 2019, logistic regression models were used to estimate the AORs and 95% CIs of current smoking, e-cigarette use/vaping, and dual use among transgender people. RESULTS Overall, 23.6% of respondents used cigarettes, 9.3% used e-cigarettes/vaping products, and 5.2% reported dual use within the past 30 days. Visually nonconforming individuals had greater odds (cigarettes: AOR=1.49, 95% CI=1.35, 1.65; e-cigarettes/vaping: AOR=1.43, 95% CI=1.25, 1.65; dual use: AOR=1.81, 95% CI=1.52, 2.15) than visually conforming individuals. Transgender people who had disclosed their transgender identity to their social networks had greater odds of cigarette smoking (AOR=1.30, 95% CI=1.17, 1.45), e-cigarette use/vaping (AOR=1.30, 95% CI=1.12, 1.52), and dual use (AOR=1.95, 95% CI=1.61, 2.35) than individuals who were out to none or some people within their networks. Experiencing discrimination (i.e., unequal treatment, verbal harassment, or physical assault) significantly increased the odds for cigarette smoking, e-cigarette use/vaping, and dual use. Transgender people who experienced all 3 types of discrimination had 2 times greater odds of current cigarette smoking (AOR=2.06, 95% CI=1.79, 2.37) and dual use (AOR=2.17, 95% CI=1.73, 2.74) than those who had not experienced discrimination. CONCLUSIONS Discrimination, visual nonconformity, and being out as transgender increased the odds of cigarette smoking, e-cigarette use/vaping, and dual use. This study informs disease prevention efforts for transgender populations with increased risks for these health behaviors.
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Affiliation(s)
- Luisa Kcomt
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan.
| | - Rebecca J Evans-Polce
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Phil T Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan; Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan; Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Sean E McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan; Institute for Social Research, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan; Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, Michigan
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Vogel EA, Ramo DE, Meacham MC, Prochaska JJ, Delucchi KL, Humfleet GL. The Put It Out Project (POP) Facebook Intervention for Young Sexual and Gender Minority Smokers: Outcomes of a Pilot, Randomized, Controlled Trial. Nicotine Tob Res 2020; 22:1614-1621. [PMID: 31562765 PMCID: PMC7443590 DOI: 10.1093/ntr/ntz184] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/19/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION This trial investigated whether a Facebook smoking cessation intervention culturally tailored to young sexual and gender minority (SGM) smokers (versus non-tailored) would increase smoking abstinence. METHODS Participants were 165 SGM young adult US smokers (age 18-25) recruited from Facebook in April 2018 and randomized to an SGM-tailored (POP; N = 84) or non-tailored (TSP-SGM; N = 81) intervention. Interventions delivered weekly live counseling sessions and 90 daily Facebook posts to participants in Facebook groups. Primary analyses compared POP and TSP-SGM on biochemically verified smoking abstinence (yes/no; primary outcome), self-reported 7-day point prevalence abstinence (yes/no), reduction in cigarettes per week by 50+% from baseline (yes/no), making a quit attempt during treatment (yes/no), and stage of change (precontemplation/contemplation vs. preparation/action). Supplemental analyses compared POP to two historical control groups. RESULTS POP participants were more likely than TSP-SGM participants to report smoking abstinence at 3 (23.8% vs. 12.3%; OR = 2.50; p = .03) and 6 months (34.5% vs. 12.3%; OR = 4.06; p < .001) and reduction in smoking at 3 months (52.4% vs. 39.5%; OR = 2.11; p = .03). Biochemically verified smoking abstinence did not significantly differ between POP and TSP-SGM at 3 (OR = 2.00; p = .33) or 6 months (OR = 3.12; p = .08), potentially due to challenges with remote biochemical verification. In supplemental analyses, POP participants were more likely to report abstinence at 3 (OR = 6.82, p = .01) and 6 (OR = 2.75, p = .03) months and reduced smoking at 3 months (OR = 2.72, p = .01) than participants who received a referral to Smokefree.gov. CONCLUSIONS This pilot study provides preliminary support for the effectiveness of a Facebook smoking cessation intervention tailored to SGM young adults. IMPLICATIONS SGM individuals have disproportionately high smoking prevalence. It is unclear whether smoking cessation interventions culturally tailored to the SGM community are more effective than non-tailored interventions. This pilot trial found preliminary evidence that an SGM-tailored Facebook smoking cessation intervention increased reported abstinence from smoking, compared to a non-tailored intervention. TRIAL REGISTRATION NCT03259360.
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Affiliation(s)
- Erin A Vogel
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA
| | - Danielle E Ramo
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA
- Hopelab, San Francisco, CA
| | - Meredith C Meacham
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA
| | - Kevin L Delucchi
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA
| | - Gary L Humfleet
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA
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