Objective Little is known about the consequences of tobacco smoking stigma on smokers and how smokers may internalize smoking-related stigma. This review summarizes existing literature on tobacco smoking self-stigma, investigating to what extent smokers are aware of negative stereotypes, agree with them and apply them to themselves. Methods We carried out a systematic search of Pubmed/Web of Science/PsycInfo databases for articles related to smoking self-stigma through June 2013. Reference lists and citations of included studies were also checked and experts were contacted. After screening articles for inclusion/exclusion criteria we performed a quality assessment and summarized findings according to the stages of self-stigma as conceptualized in Corrigan’s progressive model of self-stigma (aware, agree, apply and harm). Initial searches yielded 570 articles. Results Thirty of these articles (18 qualitative and 12 quantitative studies) met criteria for our review. Awareness of smoking stigma was virtually universal across studies. Coping strategies for smoking stigma and the degree to which individuals who smoke internalized this stigma varied both within and across studies. There was considerable variation in positive, negative, and non-significant consequences associated with smoking self-stigma. Limited evidence was found for subgroup differences in smokingrelated stigma. Conclusion While there is some evidence that smoking self-stigma leads to reductions in smoking, this review also identified significant negative consequences of smoking self-stigma. Future research should assess the factors related to differences in how individuals respond to smoking stigma. Public health strategies which limit the stigmatization of smokers may be warranted.

Background: Sexual minorities (SMs) experience elevated rates of substance use behaviors and disorders relative to heterosexuals; minority stress is theorized to contribute to these disparities. As SMs are not a homogenous group, analyses that aggregate SMs across sexual identity, age, or gender obscure important variation among this population. To date, age- and gender-specific disparities have not been rigorously examined using a large national sample. Methods: Using data on 67,354 adults (ages 18–49) from the 2015 and 2016 National Survey of Drug Use and Health we examined age- and gender-specific disparities in smoking, heavy episodic drinking, marijuana use, illicit drug use, and alcohol/substance use disorder. Age groups were ages 18–25, 26–34, and 35–49. Using logistic regression, we estimated age- and gender-specific odds ratios for gay/lesbian and bisexual individuals, relative to heterosexuals; analyses adjusted for demographic characteristics. Results: Bisexual women had significantly elevated odds of all outcomes at all ages, relative to heterosexual women. Gay/lesbian individuals had significantly elevated odds for nearly all outcomes compared to same-gender heterosexuals at ages 18–25, but not consistently at older ages. For bisexual men, significant disparities compared to heterosexual men were only observed at ages 35–49 for marijuana use and alcohol/substance use disorder. Conclusions: We find notable within-group differences regarding SM disparities. While disparities were most pronounced in young adulthood for gay/lesbian individuals and mid-adulthood for bisexual men, bisexual women uniquely experienced disparities across all ages. Minority stress experiences may vary with respect to gender, age/cohort, and sexual identity, resulting in differential risk for substance use.

Background The purpose of this study is to investigate disparities in substance use behaviors across gender and race/ethnicity as a flexible function of age from mid-adolescence through young adulthood. Methods Using data from the National Longitudinal Study of Adolescent Health, the time-varying effect model (TVEM) was used to examine gender and racial/ethnic differences in the prevalences of cigarette use, regular heavy episodic drinking (HED), and marijuana use as a smooth function of developmental age. Results Prevalences of cigarette use, regular HED, and marijuana use were higher for males than females overall, although gender differences varied with age. With regard to race, prevalence of each substance was higher for White than Hispanic or Black individuals; these differences increased considerably from age 16 to 20, particularly for cigarette use. Differences in cigarette use by race/ethnicity were found across age, but were largest at age 18, when cigarette use peaks for White individuals, but continues to climb throughout the 20s among Hispanic and Black individuals. Conclusions These results suggest that substance use, particularly for certain population subgroups, increases past early adolescence. Disparities in substance use behaviors fluctuate considerably throughout adolescence and young adulthood, suggesting that targeted intervention programs are more critical at particular ages. These findings also demonstrate that TVEM can advance our understanding of health risk behaviors and their correlates across developmental time.

Background Although research has documented age differences in substance use, less is known about how prevalence of substance use disorders (SUDs) vary across age and differ by gender and race/ethnicity. Methods Time-varying effect models (TVEMs) were estimated on data from the National Epidemiologic Survey of Alcohol and Related Conditions–III (NESARC III; N = 36,309), a nationally representative survey of the adult population. The sample was 44% male; 53% White, 21% Black, 19% Hispanic/Latino, 6% other race/ethnicity. Prevalence of four SUDs (alcohol, tobacco, cannabis and opioid use disorders) were flexibly estimated across ages 18–90 by gender and race/ethnicity. Results Estimated SUD prevalences were generally higher for men compared to women at most ages until the 70s. However, disparities by race/ethnicity varied with age, such that for most SUDs, estimated prevalences were higher for White participants at younger ages and Black participants at older ages. Discussion Results suggest relatively constant disparities by gender across age, and a crossover effect for Black and White participants. Findings demonstrate that Black individuals in midlife may be an important target of intervention programs for some substances.

Analyses focus on whether self-reported reasons for drinking alcohol change in their associations with high-intensity drinking across the transition to adulthood. Method: Self-report data on high-intensity drinking (10+ drinks) collected from the national Monitoring the Future study in 2005 to 2014 from those ages 18-26 were used (N = 2,664 [60% women] for all drinkers and 1,377 for heavy episodic [5+] drinkers; up to 6,541 person-waves). Time-varying effect modeling examined changes in the direction and magnitude of associations between eight reasons for drinking and high-intensity alcohol use across continuous age. Results: Four reasons to drink showed quite stable associations with high-intensity drinking across age: drinking to get away from problems, to get high, to relax, and to sleep. Associations between two reasons and high-intensity drinking decreased with age: anger/frustration and to have a good time. The association between drinking because of boredom and high-intensity drinking increased with age. Drinking because it tastes good had a weak association with highintensity drinking. Among heavy episodic drinkers, reasons for use also differentiated high-intensity drinking, with two exceptions: drinking to have a good time and to relax did not distinguish drinking 10+ drinks from drinking 5-9 drinks. Conclusions: Reasons for drinking are differentially associated with high-intensity drinking, compared with any other drinking and compared with lower intensity heavy drinking, across age during the transition to adulthood. Intervention programs seeking to mitigate alcohol-related harms should focus on reasons for use when they are the most developmentally salient.