Cigarette Smoking and Minority Stress Across Age Cohorts in a National Sample of Sexual Minorities: Results From the Generations Study

Abstract

Background Sexual minority populations in the United States have persistently higher rates of cigarette use than heterosexuals, partially driven by exposure to minority stressors (e.g., discrimination and victimization). Little is known about cigarette use across cohorts of sexual minority adults who came of age in distinctly different sociopolitical environments. Purpose To examine cigarette use and minority stressors across three age cohorts of U.S. sexual minority adults. Methods We used data from the Generations Study, a nationally representative sample (N = 1,500) of White, Black, and Latino/a sexual minority adults in three age cohorts (younger: 18–25 years; middle: 34–41 years; and older: 52–59 years). Survey data were collected from March 2016 to March 2017. We used sex-stratified logistic regression models to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between age cohort, minority stressors (discrimination and victimization), and two indicators of cigarette smoking (lifetime use and current use). Results Prevalence of current cigarette use in each age cohort was high (younger: 20%; middle: 33%; and older: 29%). Relative to the younger cohort, men and women in the middle- and older-age cohorts had significantly higher odds of lifetime and current smoking (e.g., men, current, aOR [95% CI]: middle = 2.47 [1.34, 4.52], older = 2.85 [1.66, 4.93]). Minority stressors were independently associated with higher odds of current smoking; when victimization was included, the magnitude of the association between age cohort and current smoking was diminished but remained significant. Conclusions Smoking cessation interventions must consider the role of minority stress and the unique needs of sexual minority people across the life course.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

“…TGD persons have a higher prevalence of tobacco use compared with cisgender individuals, which varies across the gender spectrum (Azagba et al., 2019 ; Buchting et al., 2017 ). This pattern is consistent with other populations experiencing minority stress (Gordon et al., 2021 ). PCPs can promote protective factors against tobacco use, including reducing exposure to personal or structural discrimination, having gender-affirming identification, and having health insurance (Kidd et al., 2018 ; Shires & Jafee, 2016).…”

Complete home smoking ban survey analysis: an opportunity to improve health equity among sexual minority adults in California, USA

“…Higher rates of tobacco use among sexual minorities have been linked to poor mental health and well-being, life dissatisfaction, stressors and discrimination/victimization related to sexual orientation [ 16 , 17 ]. Permissive community norms and nonjudgement towards tobacco use also relate to high rates of use and serve as barriers to cessation attempts [ 18 ].…”

“…Survey data used in this study only measured LGB therefore it may not be generalizable to the LGBT community. Living in communities with less LGBT-supportive environmental and community norms could increase the stress and thereby substance use and increase the disparity of home bans [ 16 ]. An additional study limitation was that the wording changed for several questions in 2016 that may result in some misclassifications.…”

Complete Home Smoking Ban Survey Analysis: An Opportunity to Improve Health Equity Among Sexual Minority Adults in California, USA

“…Higher rates of tobacco use among sexual minorities have been linked to poor mental health and well-being, life dissatisfaction, stressors and discrimination/victimization related to sexual orientation 14,15 . Permissive community norms and nonjudgement towards tobacco use also relate to high rates of use and serve as barriers to cessation attempts 16 .…”

“…Living in communities with less LGBT-supportive environmental and community norms could increase the stress and thereby substance use and increase the disparity of home bans 14 . An additional study limitation was that the wording changed for several questions in 2016 that may result in some misclassifications.…”