Tuesday, April 1, 2025
4/1/2025
Elucidating minority stress influences on tobacco use at the intersection of sexual orientation and rurality - SUMMARY/ABSTRACT The US tobacco market has evolved over the past decade with declines in cigarette use coupled with increases in the use of other tobacco products (e.g., e-cigarettes, cigars, hookah, smokeless tobacco), particularly among young adults (YAs). Sexual minority young adults (SMYAs) are a growing population disproportionately impacted by tobacco use, as they report higher rates of current use, initiation of use, escalations in use, and fewer successful quit attempts relative to heterosexual YAs. However, this research has historically focused on SMYAs residing in urban areas, despite that 20% of US SMYAs reside in rural areas. This is a significant limitation, as: 1) rural YAs exhibit higher rates of tobacco use and related disease; and 2) SMYAs face unique challenges (e.g., mental health problems, family stress, less peer support, discrimination) that are likely amplified among those living in rural areas due to greater community-based stigma toward SM individuals. This proposal is informed by minority stress theory and leverages our team’s expertise in tobacco-related disparities among SMYA and rural populations independently, as well as multiple methods, including longitudinal survey and ecological momentary assessment (EMA) studies. The overall goal of this work is to address knowledge gaps in prevention and cessation efforts targeting SMYAs, by assessing the intersection of rurality and sexual orientation on use and escalations in use across a range of tobacco products, and the minority stress factors that contribute to use disparities. The proposed study will involve a 2-year, 5-wave longitudinal survey study among 2,000 SMYAs representing rural and urban residence, as well as tobacco users, susceptible nonusers, and non- susceptible nonusers. A subset of 150 rural and urban SMYA tobacco users will complete a 21-day EMA study following wave 2, where they will track tobacco use and daily minority stressors to elucidate context-specific fluctuations in tobacco use and related mechanisms in real time. We will address 2 specific aims: 1) Examine minority stress factors (i.e., mental health problems, family stress, less peer support, discrimination) as mediators of the associations between rural versus urban status and tobacco use outcomes (i.e., any current use, specific product use, changes in use status/level) among SMYAs over time; and 2) Among tobacco users, examine day- to-day and within-day fluctuations in the aforementioned minority stress factors and tobacco use outcomes, as they occur in real time and in naturalistic settings among rural versus urban SMYAs. Led by a uniquely-poised research team, this proposal is responsive to NIDA’s NOT-MD-22-012: Research on the Health of Sexual and Gender Minority Populations and will be the first to elucidate mechanisms contributing to tobacco onset, cessation, and escalations, as well as real-time influences on tobacco use at the intersection of sexual orientation and rurality. Findings will lead to the development of targeted and culturally congruent prevention and cessation efforts to reduce disparities among this population at disparate risk for tobacco use and related disease.
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