Intersecting Disparities: The Role of Race/Ethnicity, Sexual Identity, and Internalized Homophobia as Predictors of Sexual Minority Female Youths' Smoking Status

Smoking disparities exist across sex, age, and race/ethnicity in the United States. The role of sexual identity as a social determinant of health has received less attention in the literature. Sexual minority females (SMF; i.e., women who identify their sexuality as lesbian, bisexual or something other (e.g., queer) than heterosexual) are more likely to smoke than heterosexual counterparts. Data on the correlates of SMF smoking are limited, yet suggest that SMF youth may smoke as a strategy to cope with sexual minority stress. Using data from a cross-sectional web-survey of SMF youth (N=478; ages 18-24; 75% smokers), we examined the multivariate relationships between smoking status and demographic (race/ethnicity, sexual identity, age, urbanicity) and psychological correlates (depression, anxiety, internalized homophobia and self-esteem). Using stepwise logistic regression, we entered race/ethnicity, sexual identity, age, and urbanicity into the model. Blacks (AOR=4.27) and Latinas (AOR=4.81) were more likely to smoke than Whites. Similarly, bisexual (AOR=.60) and queer (AOR=.16) women were less likely than lesbians to smoke. Smoking likelihood increased with age (AOR=1.23). Participants living in suburban neighborhoods were less likely to smoke than those in urban neighborhoods (AOR=.37). Once we entered the psychological correlates into the model, we found that internalized homophobia was associated with smoking (AOR=3.14), washing away the differences noted across race/ethnicity and sexual identities. We found no other relationships with the psychological correlates. Based on these findings, we discuss the importance of addressing internalized homophobia in smoking campaigns and underscore the role of sexuality as a social determinant of health.