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Introduction Lesbian, gay, and bisexual (LGB) individuals and Veterans are more likely to report current smoking than the general adult population in the United States. The Minority Stress Model may explain the high prevalence of cigarette smoking among LGB individuals, who experience unique interpersonal (e.g. discrimination) and intrapersonal (e.g. identity concealment) stressors related to their minoritized sexual orientation. Aims and Methods This study assessed whether three types of stressors (interpersonal, intrapersonal, and LGB-specific military) were associated with past-year smoking among LGB Veterans. Veterans were recruited online for a prospective cohort study. We conducted secondary data analysis of baseline surveys collected from 2019 to 2020. The study sample included cisgender, LGB Veterans (n = 463). Adjusted nested multivariable logistic regression models were used to estimate the association of each stressor with past-year cigarette smoking. Results Participants were mostly male (54.0%), non-Hispanic white (82.1%), and at least a college graduate (58.5%). LGB Veterans who were younger, had lower levels of education, income, and healthcare coverage, higher general stressors, and post-traumatic stress disorder and depression symptoms were more likely to smoke in the past year (n = 98, 21.2%). The adjusted odds of past-year smoking were higher among those who reported higher levels of harassment (aOR = 1.13, 95% confidence interval [CI]: 1.01 to 1.26), victimization (aOR = 1.13, 95% CI: 1.02 to 1.43), and family rejection (aOR = 1.13, 95% CI: 1.08 to 1.36). Conclusions Multiple interpersonal stressors were associated with past-year smoking, highlighting the need to intervene on these stressors. Future interventions should aim to address policies that reduce prejudice against LGB Veterans, while helping those who smoke identify and develop positive coping skills that support cessation. Implications Our findings contribute to the growing body of literature on tobacco use disparities among LGB individuals, particularly LGB Veterans. Results of this analysis provide some evidence for the Minority Stress Model as a conceptual model for understanding and intervening in disparities in smoking prevalence among LGB Veterans. [ABSTRACT FROM AUTHOR]

Purpose: To examine differences across gender and sexual orientation in cigarette smoking motives and stages of change in smoking cessation among Veterans. Design: Secondary data analysis of cross-sectional baseline surveys from a prospective cohort study. Setting: United States, self-administered online survey. Participants: Cisgender Veterans who reported past-year smoking (N = 146); 66.4% identified as lesbian, gay, or bisexual and 52.1% were men. Measures: Smoking motives (i.e., social, self-confidence, boredom relief, and affect regulation), with higher scores indicating stronger motivation to smoke. Stages of change categories included precontemplation, contemplation/preparation, and action/maintenance. Analysis: Analyses were stratified by gender and sexual orientation. Age-adjusted linear regression models estimated differences in smoking motives scores and multinomial logistic regression models estimated differences in stages of change categories relative to the precontemplation stage (reference category). Results: In this Veteran sample, gay men reported higher social smoking motives vs heterosexual men (β = 1.50 (95% CI:.04, 2.97), P -value =.045) and higher boredom relief smoking motives vs bisexual men (β = 1.53 (95% CI:.06, 2.29), P -value =.041) in age-adjusted models. Lesbian women were more likely to be in the action/maintenance stage relative to the precontemplation stage when compared to both heterosexual women (aRRR = 4.88 (95% CI: 1.00, 23.79) P -value =.050) and bisexual women (aRRR = 16.46 (95% CI: 2.12, 127.57), P -value =.007) after adjusting for age. Conclusion: Smoking cessation interventions may benefit from enhancing peer support for gay men. Given bisexual and heterosexual women were in less advance stages of change, there may be a greater need for motivational interventions to encourage quitting and additional support to assist with cessation efforts. Overall, findings highlight the diversity of cigarette use within LGB communities. [ABSTRACT FROM AUTHOR]

Tailored tobacco cessation interventions focusing on minoritized communities are proliferating, but the extent to which these interventions address the needs of individuals with multiple minoritized social identities is unclear. We developed Empowered, Queer, Quitting, and Living (EQQUAL), an avatar-led digital smoking cessation intervention tailored for lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and more (LGBTQIA+) young adults based on acceptance and commitment therapy (ACT), via a multistage user-centered design process. The purpose was to evaluate feedback from EQQUAL development activities using an intersectional lens. Intersectionality is a paradigm created by Kimberlé Crenshaw illustrating the multiple social identities each person possesses along with the marginalization of these different social identities. We conducted a rapid deductive content analysis focused on intersectional design gaps using interviewer notes from user testing (n = 7), a diary study (n = 8), and treatment satisfaction responses from a single-arm trial of the EQQUAL intervention (n = 22). Feedback related to intersectional design fell under three broad themes: (a) inadequate representativeness of the avatar, (2) inadequate representativeness within the program broadly, and (3) non-inclusive ACT intervention content. Feedback on inclusiveness included reference to socioeconomic status, race/ethnicity, religious/cultural affiliation, and ability/disability. Although we previously found that EQQUAL was highly acceptable and showed promise in terms of efficacy in a single-arm pilot trial, we identified several gaps in intersectional design as the iterative intervention development proceeded. Because intersectional design is a critical part of developing interventions with a health equity focus, applying standardized procedures for intersectional design and analysis could improve intervention design and better address tobacco cessation treatment needs of individuals who may experience multiple forms of marginalization. [ABSTRACT FROM AUTHOR]

The National Center for Advancing Translational Sciences has called for more comprehensive research with priority populations to reduce disparities and for the development of additional resources to assist researchers in implementing these recommendations. Here we report the development and initial evaluation of five Priority Populations Toolkits, which are resources developed by the University of Illinois Center for Clinical and Translational Science to meet these goals. Three aims guide the content: increasing knowledge, facilitating communication, and improving research design. Materials were curated from scientific literature reviews and Internet searches and revised iteratively. Analytics and user surveys provide information about usage. In 22 months, 387 unique users accessed the toolkits. The top reason for usage was to improve research recruitment. Comprehensive toolkits for working with priority populations show promising potential for increasing knowledge and readiness to work with underrepresented populations. Further toolkit development and evaluation of effectiveness are warranted. [ABSTRACT FROM AUTHOR]

The Society of Behavioral Medicine supports the inclusion of gender and sexual minorities in all local, state, and national tobacco prevention and control activities. These activities include surveillance of tobacco use and cessation activities, targeted outreach and awareness campaigns, increasing access to culturally appropriate tobacco use dependence treatments, and restricting disproportionate marketing to lesbian, gay, bisexual, and transgender communities by the tobacco industry, especially for mentholated tobacco products. [ABSTRACT FROM AUTHOR]

Introduction: Limited research has characterized poly-tobacco use (i.e., use of at least two nicotine/tobacco products) among adults with sexual minoritized (SM) identities (i.e., lesbian, gay, and bisexual). Additional work is needed to examine disparities in use by sexual orientation identity and determine whether these disparities differ by sex. We aimed to examine the prevalence of tobacco product use and poly-tobacco use by sexual orientation identity and sex among a nationally representative sample of U.S. adults., Methods: Data were drawn from 32,352 adult respondents (34.9% 18-24 years; 10.4% SM; 51.4% female) at Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health (PATH) Study. Logistic regression models tested main and interactive effects of sexual orientation identity and sex on tobacco product use and poly-tobacco use., Results: SM (vs. heterosexual) participants were more likely to report use of cigarettes, e-cigarettes, hookah, filtered cigars, and cigarillos (ORs=1.71-3.27), and poly-tobacco use (OR=1.83). Male (vs. female) participants, regardless of sexual orientation identity, were more likely to report use of each tobacco product (ORs=1.30-28.73) and poly-tobacco use (OR=1.73). Significant interactions revealed stronger associations between sexual orientation identity and cigarette and e-cigarette use among SM females (vs. heterosexual females) and SM males (vs. heterosexual males; aORs=1.42-4.10). Tobacco use further varied within SM and heterosexual groups based on sex., Conclusions: This study contributes to a growing literature demonstrating disparities in tobacco use among SM individuals. Findings underscore the need for comprehensive assessment of associations between sexual orientation identity and sex in tobacco use treatment., Implications: This study examines the intersection of sexual orientation identity, sex, and tobacco use among a nationally representative sample of U.S. adults. Findings highlight tobacco-related disparities among sexual minoritized individuals and underscore the importance of routine monitoring and intervening to reduce the disproportionate prevalence of tobacco use among this population., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)