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

Alex Budenz; Jennifer Gaber; Erik Crankshaw; Andie Malterud; Emily B Peterson; Dana E Wagner; Emily C Sanders

doi:10.1136/tc-2022-057451

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

Tob Control. 2022 Dec 7:tobaccocontrol-2022-057451. doi: 10.1136/tc-2022-057451. Online ahead of print.

Authors

Alex Budenz¹, Jennifer Gaber², Erik Crankshaw², Andie Malterud³, Emily B Peterson³, Dana E Wagner⁴, Emily C Sanders³

Affiliations

¹ Center for Tobacco Products, Office of Health Communication and Education, U.S. Food and Drug Administration, Silver Spring, MD, USA Alexandra.Budenz@fda.hhs.gov.
² Center for Health Analytics, Media and Policy, RTI International, Durham, NC, USA.
³ Center for Tobacco Products, Office of Health Communication and Education, U.S. Food and Drug Administration, Silver Spring, MD, USA.
⁴ Research Department, Rescue Agency, San Diego, CA, USA.

PMID: 36601779
DOI: 10.1136/tc-2022-057451

Abstract

Introduction: Studies show that tobacco use among sexual and gender minority (SGM) populations is disproportionately higher than heterosexual or cisgender populations. However, few studies have examined tobacco use among SGM subgroups by race/ethnicity or associations between SGM-specific discrimination and connection to SGM identity and tobacco use.

Methods: This study analysed survey data from 11 313 SGM (gay, lesbian, bisexual, other sexual minority or gender minority) young adults in the USA and reported current cigarette, e-cigarette, other tobacco (cigar, smokeless tobacco, hookah) and polytobacco use. We used multinomial logistic regression to estimate associations between (a) SGM subgroup, race/ethnicity, SGM-specific discrimination and SGM identity connection and (b) each tobacco use outcome (vs never use of tobacco). We conducted postestimation testing to assess predicted probabilities of tobacco use against the sample average.

Results: Lesbian females (particularly black lesbian females) had higher-than-average probability of polytobacco use. White bisexual and lesbian participants had higher-than-average probability of cigarette and e-cigarette use, respectively. Higher levels of discrimination were associated with polytobacco use. Higher levels of identity connectedness were protective against certain tobacco use behaviours among gender minority participants and participants with high levels of discrimination experience.

Conclusions: We found variations in tobacco use by SGM subgroups overall and by race/ethnicity. Discrimination may be a risk factor for certain tobacco use behaviours. However, SGM identity connectedness may be protective against tobacco use among gender minority individuals and individuals experiencing SGM-specific discrimination. These findings can inform targeted approaches to reach SGM subgroups at greater risk of tobacco use.

Keywords: Disparities; Electronic nicotine delivery devices; Non-cigarette tobacco products; Priority/special populations.