Associations of discrimination and violence with smoking frequency among sexual minority young adults

Gay and bisexual people (i.e., sexual minorities) smoke more than the general population, but reasons for this disparity are largely unexplored. Smokers often cite external stress as a trigger for smoking, and studies with racial/ethnic minorities have documented an association between discrimination and smoking behaviors, suggesting that minority stress (i.e., stigma tied to minority status) can affect health behaviors. Using secondary analysis of cross sectional data from the Fall 2008 National College Health Assessment, we (a) examined prevalence of past-year discrimination and victimization (i.e., threat; assault; fight; sexual assault) among young adult (ages 18-24) sexual minorities (n=1,416), and (b) tested associations between these factors and smoking frequency (never smoked; smoked, but not in last 30 days; smoked in last 30 days; smoked daily). Among sexual minorities, females reported more sexual assault than males, and males reported more discrimination than females; no gender differences occurred in smoking frequency. Multivariate ordinal logistic regression analysis of smoking frequency among sexual minorities, adjusted for age, sex, and race, indicated that experiencing discrimination and verbal threats were associated with increased smoking frequency. Analyses stratified by gender and adjusted for age and race showed that among males, only fighting was significantly associated with increased smoking frequency. Among sexual minority females, being verbally threatened and experiencing discrimination were associated with greater frequency of smoking. Although limited both in measurement of discrimination and statistical power due to sample size, these results are among the first to examine the relation between discrimination and victimization with smoking frequency in a sample of young adult sexual minorities. More study is needed to examine specific pathways and interactions of social stressors on sexual minorities' risk behaviors.