Minority stress mediates associations of sexual minority state policies and tobacco use among US sexual minority young adults

Abstract

Introduction

State policies surrounding sexual minority (SM) rights are associated with tobacco use among SM individuals. Research is scant regarding the role of distinct SM policy categories on SM young adults’ (SMYAs) tobacco use and mechanisms explaining these associations.

Methods

We analyzed 2023 survey data from 1100 SMYAs (ages 18–34; 14.2 % gender minority; 66.1 % bisexual+, 29.1 % monosexual; 53.2 % racial/ethnic minority) with representation across 45 US states and DC. Regression-based models examined: 1) direct associations of residing in states with negative and limited (vs. comprehensive) SM state policies with respect to 7 policy categories (relationship/parent recognition, nondiscrimination, religious exemptions, LGBTQ youth, healthcare, criminal justice, gender identity documents) with minority stress (mental health, internalized stigma, community connectedness); 2) direct associations of policy categories and minority stress with tobacco use (past-month cigarette, e-cigarette, any tobacco use, number of products used); and 3) indirect associations of policy categories with tobacco use through minority stress.

Results

Relative to residing in states with comprehensive policies, residing in states with limited relationship/parent recognition policies indirectly predicted higher odds of e-cigarette use through mental health; weaker nondiscrimination policies indirectly predicted using more tobacco products through internalized stigma; and negative healthcare policies indirectly predicted higher odds of cigarette and any tobacco use through community connectedness.

Conclusions

These novel findings regarding associations among distinct SM policy categories, minority stress mediators, and tobacco use outcomes warrant further examination to better understand these distinct mechanisms, ultimately to inform SM-related policy and advocacy efforts, as well as tobacco prevention and cessation efforts.