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

Abstract

Lesbian, gay, and bisexual (LGB) people are affected by multiple health disparities and risk factors, including tobacco use. Few studies to date have examined tobacco use specifically in rural LGB populations, and none has investigated the intersections of identity, rural LGB culture, and tobacco. The purpose of this study was to explore the perspective of Appalachian LGB people regarding tobacco use. Methods Nineteen LGB-identified Appalachian residents participated in audiotaped, semi-structured interviews. Two authors analyzed and coded transcripts through constant comparison, and determined themes through consensus. Results Five themes emerged: the convergence of Appalachian and LGB identities, tacit awareness of LGB identity by others, culture and tobacco use, perceived associations with tobacco use, and health beliefs and health care. Conclusions LGB Appalachians connect stress and culture to tobacco, but seem less aware that partial concealment of their identity might be a source of the stress that could influence their smoking.

We are in This Together: Promoting Health Equity, Diversity, and Inclusion in Tobacco Research for Sexual and Gender Minority Populations

“…Several qualitative studies have invoked the Minority Stress Model to interpret SGM accounts related to tobacco use. 19 Other work has applied Borderland Theory and geographies of sexuality to understand bisexual smoking, 16 critical drug scholarship, and youth cultural practice to explore agency among young SGM smokers, 20 and the Social Resistance Framework and queer theory to interpret SGM experiences of tobacco denormalization. 17 Further engagement with theories of health behavior (eg, Social Practice Theory) and research frameworks specific to SGM and other minority groups (eg, Health Equity Promotion Model or asset-based frameworks) would enrich research design and data interpretation.…”

Understanding Sexual Minority Health Disparities in Rural Areas

“…Holman and Oswald () found that rural LGBTQ parents emphasized wanting to feel like a part of the community as well as have their sexuality salient enough within it to create “affirming and supporting GLBTQ‐specific resources for their children” (p. 452). In a study of tobacco use among LGB Appalachians, Bennett et al () suggest that their participants felt a strong connection to their rural communities despite those areas not having any local LGB community.…”

“…However, sexual minorities report through a multitude of research methods that there are many positive aspects to living in rural areas (Kirkey & Forsyth, ; Oswald & Culton, ). In the few studies that specifically measure the health outcomes of sexual minorities across rural and urban spaces, most found no significant health differences (Fisher et al, ; Wienke & Hill, ; Bennett, Ricks, & Howell, ; Farmer et al, ). These findings call into question: 1) the ‘rural effect,’ 2) rural access to resources, and 3) to what extent region (referring to cultural distinctions between the theorized conservativism of Southern and Midwestern states versus the more liberal Northeast) impacts the results in rural/urban sexual minority studies.…”

A Test of Feasibility and Acceptability of Online Mindfulness-Based Stress Reduction for Lesbian, Gay, and Bisexual Women and Men at Risk for High Stress: Pilot Study

“…Like many rural regions, Appalachia is socially a conservative region that upholds traditional values that preserve social traditions and morality that condemns LGB people. People with sexual orientations other than heterosexuality are regarded as perverted abnormalities and are systematically stigmatized, ostracized, and socially isolated [3]. It is also a region that lacks state and local antidiscrimination policies and laws [4], and this reinforces the interpersonal and structural stigmatization of sexual minorities [5].…”

“…It is also a region that lacks state and local antidiscrimination policies and laws [4], and this reinforces the interpersonal and structural stigmatization of sexual minorities [5]. Yet, Appalachian and sexual minority identities are both extremely important for this group [3,6] and rejecting either would be damaging to their self-concept and well-being.…”