Sexual-Orientation Disparities in Cigarette Smoking: The Role of Positive Youth Development

Background: Sexual-minority youth (SMY) have a much higher prevalence of cigarette smoking than heterosexuals. Little is known about the relations between positive youth development (PYD) and sexual orientation on cigarette smoking among youth. Methods: We used data from 1020 girls and 570 boys (ages 13-18 years) from Wave 6 of the 4-H Study of PYD, a study of U.S. youth sampled from schools and after-school programs. PYD was measured using the validated Five Cs model—Competence, Confidence, Connection, Character, and Caring (Bowers et al., 2010)—where higher values represent greater PYD. Sexual orientation was measured via sexual attraction: 7.2% reported having same- or both-gender sexual attractions (henceforth, sexual-minority youth). Past-year cigarette smoking was dichotomous (yes/no). Multivariable logistic regression models were used to estimate sexual orientation and PYD effects on smoking, controlling for age, gender, race/ethnicity, and smoking behaviors of friends and family. We also tested interactions between PYD and sexual orientation. Results: SMY were more likely to smoke than heterosexuals (odds ratio [OR]=3.22; p<0.001). For all youth, greater Competence (OR=0.79), Character (OR=0.79), and Connection (OR=0.78) were independently associated with reduced odds of smoking (all p-values<0.05). There was a significant interaction between sexual orientation and Confidence (OR=0.43; p<0.001), such that greater Confidence was associated with reduced odds of smoking for SMY but not for heterosexuals. Conclusions: In general, greater PYD is associated with reduced smoking behaviors, especially for SMY. Importantly, our findings can be used to inform smoking prevention interventions for youth.