Minority Individuals Research Articles

Chronic Joint Pain Disparities for U.S. Transgender Adults: Behavioral Risk Factor Surveillance System, 2020.

Purpose: Several studies have found that sexual minority individuals are at greater risk for chronic pain. However, these studies did not ask about gender identity, and research on chronic pain in transgender populations remains scarce. This present study examined the relationship between transgender status and chronic joint pain disorders among U.S. adults. Methods: Data were obtained from the 2020 Behavioral Risk Factor Surveillance System. We compared odds of chronic joint pain disorders by transgender status (n transgender = 967, cisgender = 217,943, don't know/not sure = 648, refused = 2072) using logistic regression adjusting for age. Results: After adjusting for age, transgender respondents reported greater odds of chronic joint pain disorders (adjusted odds ratio [AOR] = 1.24, 95% confidence interval [CI] = 1.05-1.48), compared with cisgender respondents. Odds for chronic joint pain disorders were lower for the "refused" group (AOR = 0.84, 95% CI = 0.76-0.93) and for those who answered "don't know/not sure" (AOR = 0.73, 95% CI = 0.61-0.88). Conclusion: Consistent with preliminary evidence and with the minority stress model, transgender respondents were at increased odds of chronic joint pain disorders when adjusting for age.

Potential Harm in the Psychological Treatment of Sexual and Gender Minority Youth.

Sexual and gender minority (SGM) individuals show disproportionately high rates of mental distress relative to their cisgender, heterosexual peers resulting from minority stress, or unique identity-related stressors. The majority of research on minority stress and mental health in SGM individuals has focused on adults, a notable gap given that SGM youth face unique developmental factors that intersect with identity development and availability of support resources. SGM youth therefore represent a critical population for the mental health workforce to serve competently. Mental health providers risk significant harm to their SGM youth clients if they do not understand the mechanisms underlying mental health disparities in this population. This article will review treatment practices that carry the potential for harm with SGM youth, including harms that are more overt and attempt to change SGM identities (i.e., so-called "conversion therapies"), and others that are more covert, such as neglecting to consider SGM identity in conceptualization and treatment (e.g., eating disorders), pathologizing SGM identity and behaviors (e.g., personality disorders, social anxiety), and reinforcing stigma related to SGM identities (e.g., obsessive-compulsive disorder). Accordingly, this article reviews each of these potential harms in detail and provides alternative recommendations for affirming and justice-based treatment for SGM youth.

Navigating LGBTQ+ visibility in Poland: evidence from a community experiencing minority stress

The aim of this study was to analyse the visibility management strategies used by individuals within the LGBTQ+ community in Poland. Narrative interviews were conducted with ten adults who had experienced minority stress, affecting their family, school, professional and social lives. In the process of coming out, all the interviewees had adopted at least two visibility management strategies. These strategies included avoidance, pretence/fitting in, escape, aggression/defence, and openness. Findings contribute to understanding of the visibility management strategies used by individuals who experience minority stress and illustrate the individual aspects of the visibility management process as influenced by the family and social context. The conclusions reached should be treated as the starting point for further research on visibility management among gender and sexuality minority individuals in Poland.

Perceptions of the Harm of Cigarettes, Mental Health, and Quality of Life Among Transgender Adults Who Smoke Menthol Cigarettes: Results from Wave 5 of the Population Assessment for Tobacco and Health (PATH) Study

Sexual and gender minority (SGM) individuals in the United States are at greater risk for combustible tobacco use and mental health problems compared to heterosexual and cisgender individuals. National data comparing associations of menthol cigarette use and mental health among transgender and cisgender individuals in the United States are lacking. The goals of the current study were to (1) characterize transgender and cisgender individuals who smoke menthol cigarettes, and (2) investigate cross-sectional associations between gender identity, harm perceptions of cigarettes, mental health experiences, and quality of life. Data were drawn from Wave 5 of the Population Assessment of Tobacco and Health (PATH) Study (2018–2019). A total of 3989 cisgender (mean [SD] age, 40.47 [0.32] years) and transgender (mean [SD] age, 38.36 [0.09] years) participants who reported current (past 30-day) menthol cigarette use were included in the analysis. Comparing transgender to cisgender groups, significant differences were found in associations between harm perceptions of cigarettes (adjusted odds ratio [AOR] 0.07; 95% CI: 0.02–0.28) and reported depression (AOR 4.57; 95% CI: 1.36–15.33). Collectively, these findings provide evidence that transgender adults who smoke menthol cigarettes are less likely than cisgender adults who smoke menthol cigarettes to perceive smoking as harmful to health and more likely to report recent experiences of depression.

The Mental Health of Sexual Minority Individuals: Five Explanatory Theories and Their Implications for Intervention and Future Research

Research on the disparity in common mental health problems borne by sexual minority individuals has entered a stage of increasing theoretical complexity. Indeed, such a substantial disparity is likely not determined by a singular cause and therefore warrants diverse etiological perspectives tested with increasingly rigorous methodologies. The research landscape is made even more complex by the constant and rapid shift in the ways in which sexual minority people understand and characterize their own identities and experiences. This review introduces readers to this complexity by summarizing the historical legacy of research on the sexual orientation disparity in mental health, describing five contemporary theoretical explanations for this disparity and their supporting evidence, and suggesting theoretically informed interventions for reducing this disparity. Last, we offer an agenda for future research to accurately model the complexity of the pathways and solutions to the disproportionately poorer mental health of sexual minority populations.

Coercive Control in 2SLGBTQQIA+ Relationships: A Scoping Review.

Existing measures and theories of intimate partner coercive control largely evaluate men's coercion of women. The extent of knowledge pertaining to intimate relationships among other genders and sexual identities is unclear. Guided by a theoretical framework of intersectionality, we examined and synthesized original studies on coercive control by (perpetration) or against (victimization) Two Spirit, lesbian, gay, bisexual, trans, queer, questioning, intersex, and asexual individuals within intimate partner relationships. We searched eight academic databases for records from 2014 through 2022 and hand-searched review articles' reference lists, supplemented with gray literature and website searches. Using duplicate screening, we identified 1,774 unique documents; 526 met preliminary eligibility criteria and 277 were retained for data extraction in duplicate. Coercive control was more common among minority individuals and was related to mental health challenges. Few studies reported on gender- or sexual-identity specific forms of coercive control, and an intersectional focus was uncommon. This review revealed a lack of agreed definition of coercive control or accepted standard of measurement, and a gap in research with individuals who identify as gender diverse, gender fluid or intersex, or those identifying their sexuality as asexual, pansexual, or sexually diverse.

Posttraumatic Stress Disorder and Emotion Regulation Difficulties among Sexual Minority Adults in Residential Substance Use Disorder Treatment

Background: PTSD rates are higher among lesbian, gay, bisexual, and other sexual minority individuals (LGB+), compared to heterosexual individuals. PTSD also frequently co-occurs with substance use disorders (SUDs). However, little is known about comorbid PTSD-SUD among LGB+ individuals. Further research is important given elevated rates of PTSD and SUD among LGB+ individuals and to inform culturally responsive practice. Objectives: This cross-sectional study examined trauma exposure, PTSD severity, and emotion regulation (ER) difficulties among LGB+ and heterosexual individuals in residential SUD treatment. We hypothesized that LGB+ individuals would report more trauma exposure and more severe PTSD and ER difficulties compared to heterosexual peers. We also hypothesized that adding ER difficulties to the hierarchical regression model would attenuate the contribution of sexual minority status to PTSD symptom severity. Results: Cross-sectional data were collected via questionnaires from 132 adults receiving residential SUD treatment (M age = 39.79 [SD = 12.26] years; 35% women, 65% men; 49% White, 40% Black, 11% multiracial/another race). Eighteen percent of the sample identified as LGB+ (29% gay or lesbian, 63% bisexual, and 8% other), and 82% identified as heterosexual. Consistent with hypotheses, LGB+ participants reported larger numbers of traumatic events (p < 0.01) and more severe PTSD symptoms (p < 0.01) and ER difficulties (p < 0.05). Controlling for trauma exposure, the association between sexual minority status and PTSD symptom severity became non-significant after adding ER difficulties to the model. Conclusion: This suggests that ER may play an important role in the relationship between sexual minority status and PTSD severity in individuals with SUD.

Providing Palliative Care for Sexual and Gender Minority Individuals: A Qualitative Interview Study of Physicians' Attitudes and Experiences.

Introduction: Sexual and gender minority (SGM) individuals face increased risk of receiving suboptimal care, including palliative care. Despite research demonstrating strategies to improve care, little is known about the experiences of palliative care clinicians providing care to these communities. Objectives: The primary aim of this study is to characterize attitudes and practices of palliative care physicians around providing care to SGM individuals. Design: This exploratory, qualitative study used semi-structured interviewing. Interviews were transcribed and coded using reflexive thematic analysis. Setting and Participants: Twenty-four palliative care physicians practicing in the homecare, hospice, and hospital settings from geographically diverse sites across Canada were recruited from palliative care organizations using convenience and snowball sampling. Results: Four main themes represent perspectives on improving palliative care for SGM individuals: (1) increasing experience with and knowledge about SGM communities increases clinicians' confidence and competency; (2) standardizing inclusive sexual orientation and gender identity (SOGI) data collection and documentation can improve patient care; (3) addressing individual, systemic, and societal biases may improve palliative care provided to SGM individuals; and (4) knowing SOGI improves care quality. Conclusions: Clinicians must familiarize themselves with the importance of SOGI to the care provided as well as the palliative care needs of SGM communities. Institutions should provide tailored training around the unique needs of SGM patients and implement policies and tools that standardize sexual and gender orientation data collection and documentation.

A paradox of ethnic politics? Minority language recognition and political trust in an authoritarian setting

Does a state's increased use of a minority language affect the political attitudes of minorities using that language? To explore the impact of minority language recognition on minority individuals’ political attitudes, we conducted an online survey experiment in Turkey, recruiting citizens of Kurdish origin. Our results point to a recognition paradox. While Kurdish people in Turkey become more satisfied with state services when these services are provided in the Kurdish language, this satisfaction does not increase trust in state institutions. On the other hand, the recognition of the minority language further increases demands for policies regarding that ethnic language.

The moderating effect of PTSD symptoms on associations between minority stressors and alcohol use and related problems in sexual minority young adults

Alcohol use and related problems may be prevalent among sexual minority young adults. Several sexual minority individuals endure minority stressors as well as disproportionate trauma exposure and PTSD symptoms compared to their heterosexual counterparts. We tested whether PTSD symptoms moderated the associations between minority stressors (heterosexist discrimination, internalized heterosexism, identity concealment, and identity disclosure) and alcohol use and related problems among 342 sexual minority young adults. PTSD symptoms strengthened the association between identity concealment and PTSD symptoms. Additionally, PTSD symptoms associated with alcohol use and internalized heterosexism associated with alcohol use. These findings may inform tailored alcohol misuse interventions for sexual minority young adults.

Association Between Exposure to LGBTQ-Targeted Tobacco Marketing and Tobacco Use Behaviors Among US Young Adults

Background A risk factor for tobacco use among sexual and gender minority people is exposure to tobacco marketing. This study aimed to assess exposure to tobacco marketing by sexual and gender identity via general venues (e.g., bars/clubs, newspapers/magazines), determine the frequency of targeted marketing via LGBTQ venues, and examine how exposure to tobacco marketing in LGBTQ venues relates to tobacco use among sexual and gender minority young adults. Methods We conducted an online survey of US young adults (ages 18–30 years) between July and August 2023. We estimated exposure to tobacco marketing in general and LGBTQ venues. We conducted adjusted logistic regression analyses to examine the association between frequency (“0 times [never],” “1 time,” “2 times,” “3 times,” “4 times,” “5 times or more”) of tobacco marketing exposure in general and LGBTQ venues and current (past-30-day) tobacco use among sexual and gender minority young adults. The models were adjusted for age, sex, race, alcohol and cannabis use. Results Among respondents (N = 1378), n = 682 (49.5%) identified as sexual and gender minority individuals. The top 3 LGBTQ venues for tobacco marketing were websites (15%), shows on streaming services (14%), and social media/apps (13%). More frequent exposure to LGBTQ marketing in LGBTQ stores (aOR = 1.58, 95% CI = 1.18, 2.11, p = 0.002), newspapers/magazines (aOR = 2.07, 95% CI = 1.30, 3.30, p = 0.002), and at events like Pride Festivals (aOR = 1.38, 95% CI = 1.11, 1.71, p = 0.003), were associated with current tobacco use among LGBTQ young adults. Conclusions This study highlights implications for tobacco marketing regulation such as regulation of tobacco marketing presence in LGBTQ venues.

Self-compassion as a mediator of the relationship between social support and identity affirmation in sexual minority adults

ABSTRACT Identity affirmation refers to comfort and pride in sexual minority identity, and consideration of this as a positive facet of one’s identity. Evidence demonstrates that identity affirmation is beneficial for sexual minority individuals, yet little is known about factors predicting identity affirmation. The current research examines social support as a predictor of identity affirmation in lesbian, gay, bisexual, and queer (LGBQ) adults, and tests whether self-compassion mediates this. A sample of 597 LGBQ adults (M age = 40.48 years, SD = 14.62) completed an online anonymous survey assessing demographic characteristics, self-compassion, social support, and identity affirmation. Social support predicted identity affirmation both directly, and indirectly via self-compassion, though sexual identity moderated these effects. Specifically, social support predicted greater identity affirmation via self-compassion among gay, lesbian, and bisexual individuals. However, among queer-identified individuals, there were no direct or indirect effects found. Results suggest that social connection may help to foster identity affirmation by enhancing attitudes of acceptance and kindness towards oneself, at least among gay, lesbian, and bisexual individuals. Findings also suggest there may be unique predictors of identity affirmation for queer-identified individuals, and further research is needed to identify these predictors. Interventions targeting social factors and self-compassion may warrant further investigation to assess whether they can help to cultivate identity affirmation in LGBQ adults.

Characterizing Event-Driven PrEP Use and Investigating its Association with Experiences of PrEP-Related Barriers Among a US National Sample of PrEP Users.

After a decade of implementation in the US, PrEP uptake remains underutilized by communities that would greatly benefit from it. Event-Driven (ED) PrEP is a potential avenue to increase uptake, however very little is known about its use in the US. We analyzed data derived from Together 5000, an internet-based U.S. national cohort of Sexual and Gender Minority (SGM) individuals aged 16-49years and at risk for HIV. First, we looked at predictors of ED PrEP use using a framework based on current US-based PrEP implementation-related variables. Then, we explored whether experiencing certain types of barriers were associated with choice of ED PrEP over daily PrEP using logistic regression analysis. Our findings showed that variables related to education and sexual behaviors were associated with ED PrEP choice, while experiencing barriers to daily PrEP had no effect. We found a gradient effect with education, where individuals who reported having some college had 3 times the odds of taking ED PrEP, those reporting a bachelor's degree had 3.25 times the odds, and those with graduate school education had 7.56 times the odds of choosing ED PrEP compared to those with a high school diploma or less. Individuals who reported having 2 or more hours of lead time for sex had 3.35 times the odds of using ED PrEP (aOR = 3.35, 95% CI 2.23-5.47). Participants who reported having an STI within the last 6months had 60% lower odds of using ED PrEP (aOR = 0.4, 95% CI 0.2-0.72). The use of ED PrEP is a promising pathway for expanding PrEP due to its success and protection levels. Our studies indicated that educational background and behavior influence PrEP choice. Ensuring PrEP candidates and users have access to information about new PrEP types may increase uptake and support implementation efforts.

Adapting to Individual Differences: An Experimental Study of Language Evolution in Heterogeneous Populations.

Variations in language abilities, use, and production style are ubiquitous within any given population. While research on language evolution has traditionally overlooked the potential importance of such individual differences, these can have an important impact on the trajectory of language evolution and ongoing change. To address this gap, we use a group communication game for studying this mechanism in the lab, in which micro-societies of interacting participants develop and use artificial languages to successfully communicate with each other. Importantly, one participant in the group is assigned a keyboard with a limited inventory of letters (simulating a speech impairment that individuals may encounter in real life), forcing them to communicate differently than the rest. We test how languages evolve in such heterogeneous groups and whether they adapt to accommodate the unique characteristics of individuals with language idiosyncrasies. Our results suggest that language evolves differently in groups where some individuals have distinct language abilities, eliciting more innovative elements at the cost of reduced communicative success and convergence. Furthermore, we observed strong partner-specific accommodation to the minority individual, which carried over to the group level. Importantly, the degree of group-wide adaptation was not uniform and depended on participants' attachment to established language forms. Our findings provide compelling evidence that individual differences can permeate and accumulate within a linguistic community, ultimately driving changes in languages over time. They also underscore the importance of integrating individual differences into future research on language evolution.

Effects of cannabis use on cigarette smoking cessation in LGBTQ+ individuals.

Sexual and gender minority individuals are more likely to use tobacco and cannabis and have lower cigarette cessation. This study examined cannabis use associations with daily cigarettes smoked in sexual and gender minority individuals before and during a quit attempt. Participants included dual smoking same-sex/gender couples from California that were willing to make a quit attempt (individual n = 205, 68.3% female sex). Participants reported baseline past 30-day cannabis use and number of cigarettes smoked and cannabis use (yes/no) during 35 nightly surveys. Individuals with current cannabis use reported baseline cannabis use and/or nightly survey cannabis use. Multilevel linear models predicted number of cigarettes smoked by cannabis use. Number of cigarettes decreased from before to during a quit attempt, but this decrease was smaller in individuals with current cannabis use compared to no current cannabis use (p < .001). In individuals with current cannabis use, number of cigarettes smoked was greater on days with cannabis use (p < .001). Furthermore, cannabis use that day increased overall number of cigarettes in those with relatively high overall cannabis use but only during a quit attempt in those with relatively low cannabis use (Within-Subject Cannabis Use × Between-Subject Cannabis Use × Quit Attempt interaction; p < .001). Sexual and gender minority individuals with cannabis and cigarette use may have a harder time quitting smoking than those who do not use cannabis. For those with cannabis use, guidance on not using cannabis during a quit attempt may improve cigarette cessation outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

An evaluation of measurement invariance of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition borderline personality disorder criteria across heterosexual, lesbian, gay, and bisexual adults.

There is a robust, yet poorly understood relationship between nonheterosexual orientation and borderline personality disorder (BPD), with lesbian, gay, and bisexual individuals evidencing greater BPD symptoms compared to heterosexual individuals. Recent evidence suggests possible psychometric bias in BPD diagnostic criteria leading to greater endorsement among sexual minority individuals, which hinders researchers' ability to make valid group comparisons. The present study utilized an epidemiological sample of 35,995 men and women to evaluate the extent of differential item functioning (DIF) among BPD criteria across sexual orientation groups using a multiple indicators multiple causes approach. All criteria except affective instability and emptiness indicated DIF for at least one sexual minority focal group, although both demonstrated DIF in sensitivity analyses. DIF was most consistently indicated for suicidality, efforts to avoid abandonment, and impulsivity. Contrary to predictions, DIF was mostly nonuniform with greater item discrimination for sexual minority groups compared to their heterosexual counterparts. Finally, all estimated effect sizes were small, suggesting that DIF was not practically meaningful and unlikely to impact the validity of group comparisons for BPD criteria across heterosexual and nonheterosexual men and women. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Modeling the Population Equity of Alzheimer Disease Treatments in the US

The arrival of new medications for Alzheimer disease (AD) has prompted efforts to measure their value using conventional cost-effectiveness analyses; however, these analyses focus on how much health improvement new medications generate per dollar spent. As AD disproportionately affects older adults, women, racial and ethnic minority individuals, and individuals with lower socioeconomic and educational levels, it is critical to also examine the health equity outcomes of treatment. To estimate the health equity impact of a hypothetical disease-modifying treatment for early AD in the US and to examine targeted policies to mitigate health care disparities. This economic evaluation, which used a distributional cost-effectiveness analysis, was conducted from June 16, 2022, to January 11, 2024. The study included subgroups defined by race and ethnicity and by social vulnerability quintiles in the US. A hypothetical disease-modifying treatment compared with best supportive care. The main outcomes were population-level quality-adjusted life-years (QALYs), lifetime costs, and net health benefits. The social welfare impact and change in health inequality were estimated using the Atkinson index. The distributional cost-effectiveness analysis simulated 316 037 100 individuals from the US population, including 25 subgroups defined by 5 categories of race and ethnicity and population quintiles of social vulnerability, with the fifth quintile representing the most socially vulnerable group. At an opportunity cost benchmark of $150 000 per QALY, treatment was associated with improved population health, adding 28 197 QALYs per year to the US population. Accounting for health inequality preferences (using an aversion level of 11, based on an Atkinson inequality aversion parameter that can range from 0 to infinity, with higher values assigning greater weight to health gains that accrue to the population with the lowest lifetime quality-adjusted life expectancy), treatment was associated with a 0.009% reduction in existing population health inequalities annually. Scenario analyses examining earlier and expanded treatment access suggested a population health improvement of up to 221 358 QALYs. The findings of this economic evaluation suggest that treatment for AD could improve population health and health equity. Policies to enable earlier diagnosis and treatment initiation, as well as expanded access to treatment, may further improve treatment and health equity impacts.

Stressors and symptoms explaining sexual orientation inequalities in mental health services usage: A longitudinal study with young adults

Abstract Background Sexual minority (i.e., lesbian, gay, and bisexual [LGB], and other non-heterosexual) individuals are more likely to use mental health services than heterosexuals; however, evidence is scarce about factors contributing to this difference. Methods This study uses longitudinal data from a population-based sample of young adults (aged 18- 36) in Sweden (N = 1,137). We use mediation analysis to examine whether common mental health symptoms (i.e., depressive, anxiety and social anxiety symptoms, suicidality, and alcohol use) mediate sexual orientation differences in mental health services use; and to understand whether adding general stressors (i.e., low social support, loneliness, and perceived stress) to these models increases the total effect explained. Afterwards, we use logistic regression models to understand how minority-specific stressors (e.g., family reaction and dimensions of sexual minority identity) predict mental health service use among sexual minority individuals (N = 498), adjusting for common mental health symptoms. Results Common mental health symptoms only partially mediate the associations and the direct effect for sexual orientation remain significant (β = 0.11, p &amp;lt; 0.01). Adding general stressors to these models only slightly increase the total effect explained and the direct effect remained significant (β = 0.11, p &amp;lt; 0.01). Among sexual minority individuals, after adjusting for common mental health symptoms, a difficult process of coming out (β = 0.12, p &amp;lt; 0.05) and negative family reaction towards one’s sexual orientation (β = 0.15, p &amp;lt; 0.05) predicted use of mental health services. Conclusions Overall, these results show that minority-specific stressors contribute to help-seeking behaviours among sexual minority individuals, regardless of psychiatric morbidity, highlighting the potential role of mental health services empowering sexual minority individuals to cope with minority stress.

11.O. Scientific session: Mental Health Among Sexual and Gender Minority Populations in Diverse Structural Stigma Environments

Abstract Research conducted across numerous countries finds that sexual minority (e.g., lesbian, gay, and bisexual [LGB]) and gender minority (e.g., transgender [T]) individuals represent high-risk populations for poor mental health and suicidality. These disparities are believed to be a consequence of a stigmatizing environment and sexual and gender minority individuals’ disproportionate exposure to stigma-based stress compared to cisgender (i.e., non-transgender) heterosexuals. Stigma occurs at multiple levels to compromise LGBT individuals’ health. At the structural level, stigma manifests as unjust laws, policies, and cultural norms that deny, or fail to protect, the equal rights of LGBT individuals. At the interpersonal level, stigma manifests as discrimination in social interactions, social exclusion, and outright victimization. At the individual level, stigma can tax LGBT individuals’ coping resources by requiring costly behavioral strategies such as concealment of one’s LGBT identity. In this workshop, four studies from different regional environment with varying degree of structural stigma will be presented, i.e., the USA, Switzerland, Rwanda, and Kenya. They resent novel findings on the processes and mechanism underlying LGBT populations increased risk of mental health and links between stigma experiences at different levels. Dr. Clark will present a study of how negative news media coverage influence suicidality among LGBT young adults in the USA using intensive longitudinal assessments. Dr. Pfister will present findings from in-depth interviews concerning suicidality with individuals representing a wide variety of sexual and gender minority identities in Switzerland. Dr. van der Star will present a study exploring how structural stigma environments are linked to interpersonal and individuals level stigma experiences in sexual minorities representing different generations of LGBT populations. Dr. Stojanovski will present data from surveys and interviews of LGBT populations in Kenya and Rwanda focusing on experiences of discrimination and mental health. Key messages • Negative media reporting, discrimination, and barriers to health care can influence mental health and suicidality among LGBT individuals. • Identity concealment may represent a mechanism through which sexual minorities navigate structurally stigmatizing climates.

Smoking Discrimination Moderates the Relationship between Smoking Stigma and Cigarettes Per Day among Sexual and Gender Minority Individuals

Background: Sexual and gender minority (SGM) individuals report rates of tobacco use that range from 19% to 40% compared to roughly 20% of the general population. Higher rates of tobacco use, compounded by stress from discrimination, contribute to lower cessation rates and worse smoking-related outcomes for SGM individuals. Having multiple stigmatized identities, such as identifying as SGM and being a person who uses cigarettes, may further increase smoking, and decrease the likelihood of cessation. Smoking-related stigma is one relatively unexplored factor that may be related to smoking frequency. Objectives: The present study sought to examine how smoking stigma was related to smoking frequency, and how discrmination moderates the relationship between smoking stigma and cigarettes per day. Results: A sample of 399 self-identified SGM individuals (M age = 36.69) was collected via Qualtrics Panels. Participants were primarily White and bisexual. Participants completed a battery of questions, including measures regarding smoking frequency (operationalized in this article as cigarettes per day [CPD]), smoking felt-stigma, smoking self-stigma, and smoking discrimination. Moderation analyses revealed significant interactions of felt- and self-stigma with smoking-related discrimination. For individuals who perceived higher levels of both self- and felt-stigma, experiencing increased smoking discrimination was associated with increased smoking frequency. However, there was no significant interaction with discrimination for individuals who had lower levels of felt- and self-stigma. Results have implications for smoking reduction and cessation. Helping individuals who have higher levels of felt- and self-stigma manage stress related to being stigmatized may motivate individuals to reduce smoking. Ultimately, these findings can play a role in crafting smoking reduction and cessation programs targeted toward SGM communities, particularly individuals who experience high levels of smoking-related stigma.