Racial/Ethnic Discrimination, Sexual Orientation Discrimination, and Severity of Tobacco Use Disorde
Thursday, October 22, 2020
Posted by: Natalia Gromov
Kcomt
L, Evans-Polce RJ, Engstrom CW, West BT, McCabe SE.
Racial/Ethnic
Discrimination, Sexual Orientation Discrimination, and Severity of Tobacco Use
Disorder in the United States: Results from the National Epidemiologic Survey
on Alcohol and Related Conditions-III.
Nicotine Tob Res. 2020 Sep 30:ntaa197. doi: 10.1093/ntr/ntaa197. Epub ahead of
print. PMID: 32996575.
Introduction: Tobacco
use is more prevalent among sexual minority populations relative to
heterosexual populations. Discrimination is a known risk factor for tobacco
use. However, the relationship between exposure to different forms of
discrimination, such as racial/ethnic discrimination and sexual orientation
discrimination, and tobacco use disorder (TUD) severity has not been examined. Methods: Using
data from the 2012-2013 National Epidemiologic Survey of Alcohol and Related
Conditions-III (n=36,309 U.S. adults), we conducted multivariable logistic regression
analyses to examine the associations among racial/ethnic discrimination, sexual
orientation discrimination, and TUD severity for lesbian/gay-, bisexual-, and
heterosexual-identified adults. Consistent with the DSM-5, past-year
moderate-to-severe TUD was defined as the presence of ≥4 DSM-5 TUD symptoms. Results: Higher
levels of lifetime racial/ethnic discrimination were associated with
significantly greater odds of past-year moderate-to-severe TUD among sexual
minorities (AOR=1.03, 95% CI=1.01-1.05) and heterosexuals (AOR=1.04, 95%
CI=1.03-1.05). Stressful life events, mood disorder, and anxiety disorder had
significant associations with moderate-to-severe TUD among sexual minorities
(AOR range: 1.86-5.22, p<.005) and heterosexuals (AOR range: 1.71-3.53,
p<.005). Among sexual minorities, higher levels of racial/ethnic and/or
sexual orientation discrimination were associated with greater odds of any TUD
(AOR=1.02, 95% CI=1.01-1.03). Conclusions: Sexual
minorities and heterosexuals who experience higher levels of racial/ethnic
discrimination are at heightened risk of having moderate-to-severe TUD.
Exposure to higher levels of discrimination also increases the risk of having
any TUD among sexual minority adults. Health providers and tobacco cessation professionals
should be cognizant of the minority stressors experienced by their clients and
their potential impact on TUD severity. Implications: This
study is the first to show how experiences of racial/ethnic and sexual
orientation discrimination are associated with DSM-5 tobacco use disorder
severity among sexual minority and heterosexual populations. Individuals
exposed to multiple minority stressors may have increased vulnerability for
developing tobacco use disorder and related adverse health consequences. Our
study underscores the importance of considering racial/ethnic discrimination
and the multiple minority statuses that individuals may hold. Eliminating all
forms of discrimination and developing interventions that are sensitive to the
role that discrimination plays in tobacco use disorder severity may attenuate
the tobacco use disparities between sexual minority and heterosexual adults.
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