Research at IRWG


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Health, Stress, and Tobacco Use Disparities among Sexual Minority Populations

Primary Investigator(s): 
Sean Esteban McCabe; Co-Investigators: Carol J. Boyd, Philip T. Veliz
In Collaboration With/Organization: 
National Institutes of Health
Award Year: 

There is a growing body of research indicating that lesbian, gay and bisexual (LGB) individuals (sexual minorities) are at heightened risk of cigarette smoking, e-cigarette use, and other tobacco/nicotine use. Cigarette smoking is responsible for more than 480,000 deaths per year in the U.S., including an estimated 41,000 deaths resulting from secondhand smoke exposure.30 However, well-designed research with LGB individuals is scant, so conclusions are constrained. Methodological limitations, such as small, non-representative samples and a lack of heterosexual comparison groups and reliable measures have compromised the validity of much of the research on tobacco/nicotine use among sexual minorities. Even studies that use probability samples are often limited by restricted definitions of sexual orientation: sexual attraction, sexual behavior, and sexual identity are rarely all assessed in the same study. Additionally, these studies use dated measures (e.g., tobacco use disorder (TUD) severity based on DSM-5 criteria are lacking), and small samples not allowing for examination of potential variations by age, gender, race/ethnicity and SES.

To date, no large-scale nationally representative studies have examined tobacco-related health disparities among sexual minorities. Moreover, data on comorbidity of DSM-5 TUD and mental health disorders among sexual minorities is severely lacking. To address these gaps, we propose a study that will greatly advance our understanding of the relationships among sexual orientation, discrimination, stress, and DSM-5 TUD. Health risks vary across sexual orientation subgroups, particularly those related to tobacco/nicotine use and other substance use, but very little work has focused on why these health disparities exist. The absence of explanatory frameworks hampers the ability to effectively prevent, mitigate or treat DSM-5 TUD and other DSM-5 mental health disorders in at-risk populations. To this end, we will consider the role of stressful life events (e.g., death of a family member), sexual orientation discrimination (individual-level and institutional-level), co-morbid mental health disorders and other key risk/resilience factors as possible contributors to the risk of DSM-5 TUD (including nicotine and tobacco products).

The proposed study aims to:

Aim 1: Examine the prevalence of (a) cigarette smoking, e-cigarette use, and other tobacco/nicotine use, (b) DSM-5 TUD severity (nicotine and tobacco products), and (c) comorbidity of DSM-5 TUD and DSM-5 mental health disorders based on sexual orientation (attraction, behavior, and identity). Examine variation in these relationships by age, gender, race/ethnicity, and SES.

Aim 2: Assess disability (e.g., general health, physical functioning, and social functioning), help seeking (e.g., counseling, nicotine replacement products, and medication), and recovery (e.g., early and sustained remission) associated with tobacco/nicotine use and DSM-5 TUD based on sexual orientation. Examine variations by age, gender, race/ethnicity, and SES.

Aim 3: Determine the relationships among stressful events (e.g., death of a family member), sexual orientation discrimination (individual-level and institutional-level), tobacco/nicotine use, and DSM-5 TUD among sexual minority and heterosexual adults based on the Comprehensive Developmental and Minority Stress Model (CDMSM). Examine variations by age, gender, race/ethnicity, and SES.

The proposed study will use data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III). The NESARC-III surveyed a large nationally representative sample of adults 18 years and older who reside in the U.S. The project will take advantage of the unique opportunities afforded by the NESARC-III: (1) the inclusion of measures of all three major sexual orientation dimensions (i.e., attraction, behavior and identity); (2) the availability of a racially/ethnically diverse sample with large numbers of sexual minorities (ranging from 1,198 based on behavior to 3,222 based on attraction); and (3) the wealth of data on cigarette smoking, other nicotine/tobacco use, DSM-5 TUD, and DSM-5 mental health disorders. In addition, the available measures of stressful life events and sexual orientation discrimination will enable assessment of two major risk factors presumed to account for differential vulnerability among sexual minorities.

Findings from this project will greatly enhance the understanding of tobacco/nicotine use and DSM-5 TUD among sexual minorities in the U.S., and will provide critical information for enhancing assessment, prevention and treatment of this disorder among sexual minority and heterosexual adults.

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