Discrimination, identity connectedness and tobacco use in a sample of sexual and gender minority young adults

Measuring cigarette and e-cigarette use over time among LGBT+ youth and young adults using a repeat cross-sectional survey, 2022-2024

INTRODUCTION

LGBT+ individuals in the U.S. use tobacco products more than their heterosexual and cisgender peers. Although existing literature identifies this trend, more research using recent, national data from a large sample is needed to better examine trends over time.

METHODS

A repeat cross-sectional survey of approximately n=300 youth and young adults aged 15-24 was fielded weekly from October of 2022 to June of 2024, resulting in a total sample of N=25,675. This sample was used to examine cigarette and e-cigarette use over time among LGBT+ and non-LGBT+ youth and young adults. Cigarette and e-cigarette use was also examined by specific sexual orientation and gender identity, using the aggregated sample.

RESULTS

From October 2022 - June 2024, cigarette and e-cigarette use were consistently higher among LGBT+ youth and young adults, compared to their cisgender and heterosexual peers. Compared to heterosexual young people, gay/lesbian and bisexual young people reported higher cigarette and e-cigarette use. Male-identifying individuals reported the highest cigarette use while, female young people reported the highest e-cigarette use. Transgender and gender diverse individuals reported lower cigarette and e-cigarette use than cisgender young people.

CONCLUSIONS

Tobacco use disparities persist among LGBT+ youth and young adults. Sexual minority respondents showed elevated risk of tobacco use, while gender minority youth saw lower rates of tobacco use, although prevalence remains high. Future research should continue to investigate LGBT+ tobacco use using national surveillance methods. Effective programs for tobacco prevention and cessation are necessary to advance health equity among LGBT+ youth and young adults.

IMPLICATIONS

This study finds persistently elevated tobacco use among LGBT+ youth and young adults over a two-year period, highlighting the importance of continued tobacco use surveillance, as well as the development of programmatic interventions to reduce LGBT+ tobacco use. These analyses also inform future work further investigating differences in tobacco use by sexual orientation and gender identity among young people. This work provides a call to action to focus efforts on reducing tobacco use among LGBT+ youth, improving the long-term health of this population and increasing health equity.

Minority stressors and tobacco use among a US sample of sexual and gender minority young adults

INTRODUCTION

Young adults who are sexual and gender minorities (SGM) are at the highest risk for tobacco initiation in young adulthood. Minority stress theory suggests that sexual orientation and gender identity (SOGI)-based discrimination may contribute to nicotine and tobacco use disparities. Our study aimed to quantify the association between SOGI-based distal minority stressors and current tobacco use among SGM young adults living in the United States (US).

METHODS

Eligible participants-including young adults (aged 18-35 years old), who identified as SGM, and were currently residing in the US (N=1116) -were recruited via Prolific into an online survey. We applied stepwise binary regressions with backward selection to model the association between average past 30-day distal minority stress and current tobacco use (i.e., combustible cigarettes or e-cigarettes), controlling for perceived stress and sociodemographic covariates. We also tested interactions between minority stress and SGM status. Exploratory analyses assessed associations between minority stress and current tobacco use among YA, stratified by SGM subgroup.

RESULTS

A 1-unit increase in experiencing minority stress in the past 30-days was associated with 1.02 greater odds of current tobacco use among SGM young adults. No difference between SGM subgroups in this association was found. Examining stratified SGM subgroups, a 1-unit increase in minority stress was associated with 1.11 greater odds of current tobacco among transgender adults only.

CONCLUSION

Distal minority stress is differentially associated with current tobacco use for transgender young adults, which suggests that tobacco prevention and cessation interventions may need tailoring for subgroups.

IMPLICATIONS

This study details the influence of minority stress on current tobacco use among sexual and gender minority (SGM) young adults. Findings underscore the need for targeted and tailored approaches to tobacco control, wherein SGM young adults most at-risk are engaged in cessation interventions that address minority stress as a contributing factor to tobacco use and which support their resilience. To promote health equity, tobacco control must address the contexts that engender minority stress. Assessment of policy impacts on SGM tobacco use and the effectiveness of interventions disseminated within SGM-supportive and discriminatory policy environments are important next steps.

Emotion Regulation Moderates Associations between Discrimination and Cannabis Use Patterns among Sexual Minority Young Adult Women

Background

Sexual minority young adults (SMYAs) experience discrimination and have high cannabis use prevalence. Discrimination may be associated with cannabis use, including hazardous use and co-use with tobacco, depending on emotion regulation and gender.

Methods

Fall 2020 survey data assessed discrimination, use frequency of emotion regulation strategies (i.e., cognitive reappraisal, expressive suppression), current cannabis use, hazardous use, and cannabis-tobacco dual use among SMYAs (age 18-34) in 6 United States metropolitan areas (women: n=450, M age =24.1, SD=4.7, 69.6% bisexual, 18.2% lesbian/gay, 12.2% other; men: n=254, M age=24.7, SD=4.5, 33.5% bisexual, 54.3% gay, 12.2% other). Multivariable logistic regression examined the moderating roles of cognitive reappraisal and expressive suppression on associations of discrimination with cannabis use outcomes, stratified by gender and adjusted for age, race and ethnicity, and employment.

Results

Among SMYA women, 89.5% experienced any discrimination; 53.1% reported current cannabis use, of whom 49.4% and 47.7% reported hazardous use and cannabis-tobacco dual use, respectively. Adjusting for sociodemographics, experiencing greater discrimination was associated with greater odds of hazardous cannabis use (aOR=1.08, 95% CI [1.02, 1.15]) and cannabis-tobacco dual use (aOR=1.04, 95% CI [1.01, 1.08]) among SMYA women with greater use of expressive suppression. Among SMYA men, 83.9% experienced any discrimination; 49.2% reported current cannabis use, of whom 55.2% and 44.0% reported hazardous use and cannabis-tobacco dual use. Discrimination and emotion regulation were unrelated to cannabis use outcomes among men. Conclusions: Given high rates of discrimination experiences among SMYAs, emotion regulation skills training may empower SMYAs, particularly women, to cope with discrimination without using cannabis.

Harm perceptions of vaping nicotine relative to cigarette smoking among sexual and gender minority young adults

INTRODUCTION

To address gaps in existing research, the current study used a mixed-methods approach to describe, contextualise and understand harm perceptions of vaping nicotine relative to cigarette smoking and associations with nicotine and tobacco (NT) use among young adults who identify their genders and sexualities in ways that classify them as sexual and gender minorities (SGM).

METHODS

Results are based on cross-sectional surveys and online qualitative interviews with 98 SGM young adults (18-25 years old) in California's San Francisco Bay Area who currently or formerly used combustible tobacco. We generated a measure assessing participants' relative harm perceptions of e-cigarette use versus cigarette smoking and identified those who perceived cigarette smoking as more harmful than e-cigarette use compared to those who perceived it to be equally or less harmful.

RESULTS

We found that relative harm perceptions of cigarette smoking versus e-cigarette use are likely related to much uncertainty and confusion about the harms of e-cigarette use. Moreover, findings illustrate that public health messages regarding the risks of e-cigarette use may have unintended consequences of increasing cigarette use to replace e-cigarette use for some SGM young adults, a practice that is incongruent with scientific evidence demonstrating that cigarettes and other combustible tobacco products are riskier than e-cigarettes and other forms of NT use.

DISCUSSION AND CONCLUSIONS

Results suggest the need for evidence-based, clear, and direct messaging about the relative harms of cigarettes versus e-cigarettes to reduce NT-related inequities in SGM populations.