Cigarette Smoking in a National Sample of Sexual Minorities From Three Generations

Background: Sexual minorities (SMs) in the U.S. have persistently higher rates of cigarette use than heterosexuals, partially driven by minority stress (e.g., discrimination). However, little is known about relationships between minority stress processes and cigarette use across age cohorts of SM adults. Methods: Analyses included 1,333 White, Black, and Latino men and women from the Generations Study, a random-digit-dial national telephone survey of U.S. SMs in three age cohorts, representing distinct socio-political environments in which SMs came of age (younger: ages 18-25 years; middle: 34- 41 years; older: 52-59 years). We used demographic characteristic-adjusted logistic regression models to estimate odds ratios and 95% confidence intervals (aOR; 95%CI) for associations between age cohort, minority stress processes (continuous measures: past-year victimization, internalized homophobia, sexual identity concealment), and two indicators of cigarette smoking (dichotomous: lifetime use,current use). Results: Relative to the younger cohort, SMs in the middle and older age cohorts had significantly higher odds of lifetime smoking (aOR [95%CI]: middle=2.99 [2.23, 4.03], older=3.89 [2.90, 5.25]) and current smoking (aOR: middle=1.51 [1.07, 2.11], older=1.46 [1.04, 2.05]). Victimization was independently associated with higher odds of lifetime (aOR=1.73 [1.49, 2.01]) and current smoking (aOR=1.95 [1.66,2.30]). Adding victimization to base models modestly attenuated aORs for the association between age cohort and smoking outcomes. Associations between age cohort and current smoking became nonsignificant when sexual identity concealment and internalized homophobia were subsequently added to models. Conclusions: Smoking cessation interventions should consider multiple dimensions of minority stress and the unique needs of SMs across the life course