A Persistent Disparity: Smoking in Rural Sexual and Gender Minorities

Abstract

Purpose Sexual and gender minorities (SGM) smoke cigarettes at higher rates than the general population. Historically, research in SGM health issues was conducted in urban populations and recent population-based studies seldom have sufficient SGM participants to distinguish urban from rural. Given that rural populations also tend to have a smoking disparity, and that many SGM live in rural areas, it is vitally important to understand the intersection of rural residence, SGM identity, and smoking. This study analyzes the patterns of smoking in urban and rural SGM in a large sample. Methods We conducted an analysis of 4280 adult participants in the Out, Proud, and Healthy project with complete data on SGM status, smoking status, and zip code. Surveys were conducted at 6 Missouri Pride Festivals and online in 2012. Analysis involved descriptive and bivariate methods, and multivariable logistic regression. We used GIS mapping to demonstrate the dispersion of rural SGM participants. Results SGM had higher smoking proportion than the non-SGM recruited from these settings. In the multivariable model, SGM identity conferred 1.35 times the odds of being a current smoker when controlled for covariates. Rural residence was not independently significant, demonstrating the persistence of the smoking disparity in rural SGM. Mapping revealed widespread distribution of SGM in rural areas. Conclusion The SGM smoking disparity persists among rural SGM. These communities would benefit from continued research into interventions targeting both SGM and rural tobacco control measures. Recruitment at Pride Festivals may provide a venue for reaching rural SGM for intervention.

Prevalence of use and perceptions of risk of novel and other alternative tobacco products among sexual minority adults: Results from an online national survey, 2014–2015

“…We found that the overall prevalence of current cigarette smoking was higher among sexual minorities (22.5% in LGB adults) as compared to HET adults (15.3%), which is similar to the findings of other studies (Bennett et al, 2015; Fallin et al, 2015a; Fallin et al, 2015b; Johnson et al, 2016; King et al, 2012; Lee et al, 2009; Max et al, 2016). Justifications for this high prevalence include normative behavior of socializing at bars, to cope with stress, and having friends and family who smoke (Gruskin et al, 2008; Jannat-Khah et al, 2017; Remafedi, 2007).…”

“…Indeed, a systematic review of 42 studies conducted between 1987 and 2007 reported strong associations between LGB status and smoking, with odds ratios (ORs) between 1.5 and 2.5 (Lee et al, 2009). Thus, it has been well documented that sexual minority populations experience significant disparities related to tobacco use (Balsam et al, 2012; Bennett et al, 2015; Fallin et al, 2015a; Fallin et al, 2015b; King et al, 2012; Lee et al, 2009; Rath et al, 2013). One potential mechanism that explains this disparity is that LGB individuals experience stigma and harassment, discrimination, rejection from family, and even emotional and physical violence (Balsam et al, 2012; Gruskin et al, 2007).…”

“It’s Just a Way of Fitting In:” Tobacco Use and the Lived Experience of Lesbian, Gay, and Bisexual Appalachians

“…22,23,54 None, however, sought to elucidate associations to minority stress that might be more prominent for sexual minorities in the rural setting. The participants in our study endorsed their own assumption of minority stress, noting both stressors they experienced as sexual minorities in Appalachia and the predominant role that stress played in smoking behaviors, though many did not perceive that tobacco use was higher among LGB persons than the general population.…”

“…17–19 Various studies conducted in urban settings have demonstrated high rates of smoking among sexual minority populations in the United States. 3,6,20,21 Smoking prevalence among rural LGB persons is not well established but at least two studies provide evidence that in some areas the proportion of current smokers among LGBT in a rural state or rural areas of a state (45–46%) 22,23 exceeds even the general Appalachian rate (34%), 15 though no studies offer direct comparisons. Given the paucity of population-based surveys that include questions about sexual orientation, the actual patterns of smoking and tobacco use among rural sexual minorities remain unknown.…”

“…The few quantitative studies documenting high rates of smoking in rural LGBT samples did not explore reasons underlying this disparity or protective factors against it, 22,23 leaving a gap in which they suggest that targeted interventions with regard to prevention and cessation may be necessary. However, there is not enough understanding of rural LGBT tobacco use to design interventions or more comprehensive quantitative studies.…”