Article Text

Download PDFPDF
Discrimination, identity connectedness and tobacco use in a sample of sexual and gender minority young adults
  1. Alex Budenz1,
  2. Jennifer Gaber2,
  3. Erik Crankshaw2,
  4. Andie Malterud1,
  5. Emily B Peterson1,
  6. Dana E Wagner3,
  7. Emily C Sanders1
  1. 1Center for Tobacco Products, Office of Health Communication and Education, U.S. Food and Drug Administration, Silver Spring, MD, USA
  2. 2Center for Health Analytics, Media and Policy, RTI International, Durham, NC, USA
  3. 3Research Department, Rescue Agency, San Diego, CA, USA
  1. Correspondence to Dr Alex Budenz, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD 10903, USA; Alexandra.Budenz{at}


Introduction Studies show that tobacco use among sexual and gender minority (SGM) populations is disproportionately higher than heterosexual or cisgender populations. However, few studies have examined tobacco use among SGM subgroups by race/ethnicity or associations between SGM-specific discrimination and connection to SGM identity and tobacco use.

Methods This study analysed survey data from 11 313 SGM (gay, lesbian, bisexual, other sexual minority or gender minority) young adults in the USA and reported current cigarette, e-cigarette, other tobacco (cigar, smokeless tobacco, hookah) and polytobacco use. We used multinomial logistic regression to estimate associations between (a) SGM subgroup, race/ethnicity, SGM-specific discrimination and SGM identity connection and (b) each tobacco use outcome (vs never use of tobacco). We conducted postestimation testing to assess predicted probabilities of tobacco use against the sample average.

Results Lesbian females (particularly black lesbian females) had higher-than-average probability of polytobacco use. White bisexual and lesbian participants had higher-than-average probability of cigarette and e-cigarette use, respectively. Higher levels of discrimination were associated with polytobacco use. Higher levels of identity connectedness were protective against certain tobacco use behaviours among gender minority participants and participants with high levels of discrimination experience.

Conclusions We found variations in tobacco use by SGM subgroups overall and by race/ethnicity. Discrimination may be a risk factor for certain tobacco use behaviours. However, SGM identity connectedness may be protective against tobacco use among gender minority individuals and individuals experiencing SGM-specific discrimination. These findings can inform targeted approaches to reach SGM subgroups at greater risk of tobacco use.

  • Disparities
  • Electronic nicotine delivery devices
  • Non-cigarette tobacco products
  • Priority/special populations

Data availability statement

No data are available.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors AB: guarantor, conceptualisation, analysis planning, writing, editing, leading manuscript. JG, EC: analysis planning, formal analysis, writing, editing. AM, EBP, ECS: conceptualisation, writing, editing. DEW: writing, editing.

  • Funding This work was supported by the US Food and Drug Administration Center for Tobacco Products (contract HHSF223201310001B).

  • Disclaimer This publication represents the views of the author(s) and does not represent US Food and Drug Administration position or policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.