Structural stigma and cigarette smoking in a prospective cohort study of sexual minority and heterosexual youth

Abstract

Background: Sexual minority youth are more likely to smoke cigarettes than heterosexuals, but research into the determinants of these disparities is lacking. Purpose: This study aimed to examine whether exposure to structural stigma predicts cigarette smoking in sexual minority youth. Methods: Prospective data from adolescents participating in the Growing Up Today Study (2000-2005) were utilized. Results: Among sexual minority youth, living in low structural stigma states (e.g., states with non-discrimination policies inclusive of sexual orientation) was associated with a lower risk of cigarette smoking after adjustment for individual-level risk factors (relative risk [RR] = 0.97; 95 % confidence interval [CI], 0.96, 0.99; p = 0.02). This association was marginally significant after additional controls for potential state-level confounders (RR = 0.97; 95 % CI, 0.93, 1.00; p = 0.06). In contrast, among heterosexual youth, structural stigma was not associated with past-year smoking rates, documenting specificity of these effects to sexual minority youth. Conclusions: Structural stigma represents a potential risk factor for cigarette smoking among sexual minority adolescents. © 2013 The Society of Behavioral Medicine.