Discrimination, identity connectedness and tobacco use in a sample of sexual and gender minority young adults

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.

Final Evaluation Findings for This Free Life, a 3-Year, Multi-Market Tobacco Public Education Campaign for Gender and Sexual Minority Young Adults in the United States

INTRODUCTION

This Free Life was the first multi-market, primarily digital campaign designed to change tobacco-related beliefs among lesbian, gay, bisexual, and transgender (LGBT) young adults. Our evaluation sought to determine whether campaign exposure resulted in changes in tobacco-related beliefs. We summarize awareness and receptivity at the conclusion of the campaign and assess the effect of campaign exposure on tobacco-related beliefs in campaign treatment markets compared with control markets.

AIMS AND METHODS

Twenty-four US designated market areas were selected to receive the campaign or serve as control markets. A baseline survey was conducted in 2016, with six follow-up surveys conducted approximately 6 months apart over the course of the 3-year campaign. 12 324 LGBT young adult survey participants were recruited via intercept interviews and social media. Campaign effects on outcomes were estimated using difference-in-difference panel regression models, with p-values corrected for multiple comparisons.

RESULTS

Brand and ad awareness peaked in treatment markets approximately 2.5 years into the 3-year campaign and were significantly higher in treatment than control markets. Brand equity and ad receptivity were generally high and similar across LGBT subgroups. There were small but significant campaign effects on five tobacco-related beliefs, with difference-in-difference estimates ranging from 1.9 to 5.6 percentage points.

CONCLUSIONS

This Free Life, the first multi-market tobacco public education campaign for LGBT young adults, reached and resonated with a large and diverse population, and had a small effect on beliefs involving social aspects of smoking. These findings should inform future communication efforts aimed at reducing tobacco use among LGBT young adults.

IMPLICATIONS

Modest overall campaign effects suggest that further research on effective campaign messaging and delivery to LGBT young adults is needed. Campaign messaging style, delivery channels, and targeted outcomes likely contributed to these findings. Health communication efforts for LGBT young adults should consider the limitations of digital media in achieving sufficient exposure. Ad style and content optimized for a digital environment is an area that will benefit from further development.

Tobacco use among lesbian, gay, bisexual and transgender young adults varies by sexual and gender identity

BACKGROUND

Research shows that tobacco products are disproportionately used by sexual and gender minorities, known collectively as those who are lesbian, gay, bisexual, and transgender (LGBT). While usage varies within this population by identity, differences in tobacco use patterns are not well understood. The present study uses evaluation data for This Free Life, a tobacco public education campaign from the FDA, to examine differences in tobacco use among LGBT young adults by subgroups based on sex at birth, gender and sexual identity.

METHODS

Data are from 4,057 18-24 LGBT young adults who completed the baseline This Free Life evaluation survey in 2016. Multivariable logistic regression models examined differences in tobacco use (cigarettes, cigars, hookah and electronic nicotine products) and poly use (2+ of any product, 2+ combustibles, at least one combustible and one noncombustible) between LGBT subgroups (cisgender gay males, cisgender bisexual males, cisgender lesbian/gay females, cisgender bisexual females and gender minorities).

RESULTS

Sexual minority females were more likely than gay males to use any tobacco product, electronic nicotine products and hookah. Cisgender bisexuals were more likely than gay males and gender minorities to use electronic nicotine products. Cisgender bisexual males were less likely than all other groups to use cigarettes. Cisgender sexual minority females were more likely than gender minorities to engage in poly use.

CONCLUSIONS

Findings suggest that sexual minority females are more likely to use tobacco than other subgroups. More research can help campaign developers better understand reasons for intragroup differences in tobacco use among LGBT subgroups.

Recruiting Hard-to-Reach Populations for Survey Research: Using Facebook and Instagram Advertisements and In-Person Intercept in LGBT Bars and Nightclubs to Recruit LGBT Young Adults

Background

Tobacco public education campaigns focus increasingly on hard-to-reach populations at higher risk for smoking, prompting campaign creators and evaluators to develop strategies to reach hard-to-reach populations in virtual and physical spaces where they spend time.

Objective

The aim of this study was to describe two novel recruitment strategies (in-person intercept interviews in lesbian, gay, bisexual, and transgender [LGBT] social venues and targeted social media ads) and compares characteristics of participants recruited via these strategies for the US Food and Drug Administration’s This Free Life campaign evaluation targeting LGBT young adults who smoke cigarettes occasionally.

Methods

We recruited LGBT adults aged 18-24 years in the United States via Facebook and Instagram ads (N=1709, mean age 20.94, SD 1.94) or intercept in LGBT social venues (N=2348, mean age 21.98, SD 1.69) for the baseline evaluation survey. Covariates related to recruitment strategy were age; race or ethnicity; LGBT identity; education; pride event attendance; and alcohol, cigarette, and social media use.

Results

Lesbian or gay women (adjusted odds ratio, AOR 1.88, 95% CI 1.54-2.29, P<.001), bisexual men and women (AOR 1.46, 95% CI 1.17-1.82, P=.001), gender minorities (AOR 1.68, 95% CI 1.26-2.25, P<.001), and other sexual minorities (AOR 2.48, 95% CI 1.62-3.80, P<.001) were more likely than gay men to be recruited via social media (than intercept). Hispanic (AOR 0.73, 95% CI 0.61-0.89, P=.001) and other or multiracial, non-Hispanic participants (AOR 0.70, 95% CI 0.54-0.90, P=.006) were less likely than white, non-Hispanic participants to be recruited via social media. As age increased, odds of recruitment via social media decreased (AOR 0.76, 95% CI 0.72-0.80, P<.001). Participants with some college education (AOR 1.27, 95% CI 1.03-1.56, P=.03) were more likely than those with a college degree to be recruited via social media. Participants reporting past 30-day alcohol use were less likely to be recruited via social media (AOR 0.33, 95% CI 0.24-0.44, P<.001). Participants who reported past-year pride event attendance were more likely to be recruited via social media (AOR 1.31, 95% CI 1.06-1.64, P=.02), as well as those who used Facebook at least once daily (AOR 1.43, 95% CI 1.14-1.80, P=.002). Participants who reported using Instagram at least once daily were less likely to be recruited via social media (AOR 0.73, 95% CI 0.62-0.86, P<.001). Social media recruitment was faster (incidence rate ratio, IRR=3.31, 95% CI 3.11-3.52, P<.001) and less expensive (2.2% of combined social media and intercept recruitment cost) but had greater data quality issues—a larger percentage of social media respondents were lost because of duplicate and low-quality responses (374/4446, 8.41%) compared with intercept respondents lost to interviewer misrepresentation (15/4446, 0.34%; P<.001).

Conclusions

Social media combined with intercept provided access to important LGBT subpopulations (eg, gender and other sexual minorities) and a more diverse sample. Social media methods have more data quality issues but are faster and less expensive than intercept. Recruiting hard-to-reach populations via audience-tailored strategies enabled recruitment of one of the largest LGBT young adult samples, suggesting these methods’ promise for accessing hard-to-reach populations.

Quantifying the Impact of Participation in Local Tobacco Control Groups on the Psychological Empowerment of Involved Youth

A core component of Legacy’s Statewide Youth Movement Against Tobacco Use is the ability of state and local initiatives to empower youth to effect change in their communities. The authors’ conceptual framework proposes that youth empowerment is an outcome of the process by which youths become active participants in local efforts. Youths are proposed to attain specific skills (e.g., assertiveness, advocacy), attitudes (e.g., domain-specific self-efficacy, perceived sociopolitical control, participatory competence), and knowledge of relevant resources. All are proposed outcomes of their individual participation in these local efforts. Data collected in fall 2002 through a tested survey instrument designed to obtain data on key components of empowerment are presented. Regression modeling was used to examine the extent to which characteristics of empowerment are an outcome of individual participation in these groups. A summary of lessons learned pertaining to effectively measuring empowerment and enhancing the empowerment process through local initiatives is provided.

Movie smoking and youth initiation: parsing smoking imagery and other adult content

Objectives

To isolate the independent influence of exposure to smoking and other adult content in the movies on youth smoking uptake.

Methods

We used discrete time survival analysis to quantify the influence of exposure to smoking and other adult content in the movies on transitioning from (1) closed to open to smoking; (2) never to ever trying smoking; and (3) never to ever hitting, slapping, or shoving someone on two or more occasions in the past 30 days. The latter is a comparative outcome, hypothesized to have no correlation with exposure to smoking in the movies.

Results

Assessed separately, both exposure to smoking imagery and exposure to adult content were associated with increased likelihood of youth becoming open to smoking (OR = 1.09, 95% CI: 1.04–1.15 and OR = 1.10, 95% CI: 1.04–1.17) and having tried smoking (OR = 1.06, 95% CI: 1.00–1.12 and OR = 1.06, 95% CI: 1.00–1.13). Both measures were also separately associated with aggressive behavior (OR = 1.09, 95% CI: 1.04–1.14 and OR = 1.09, 95% CI: 1.04–1.15). A very high correlation between the two measures (0.995, p<0.000) prevented an assessment of their independent effects on smoking initiation.

Conclusion

Although exposure to smoking in the movies is correlated with smoking susceptibility and initiation, the high correlation between exposure to smoking in the movies and other adult content suggests that more research is needed to disentangle their independent influence on smoking.

The impact of state tobacco control program funding cuts on teens' exposure to tobacco control interventions: evidence from Florida

PURPOSE

Explore the impact of dramatic budget cuts to the Florida Tobacco Control Program (FTCP) on Florida teens' exposure to tobacco control interventions.

DESIGN

Survey data on teens in Florida and a comparison sample of the remainder of the United States. Data were collected in six waves between 2002 and 2006, with three waves collected before and three waves collected after the FTCP budget cut in fiscal year (FY) 2004.

SETTING

Florida.

SUBJECTS

Twelve- to 17-year-old teens in Florida and the remainder of the United States. Between spring 2002 and summer 2006, 7841 interviews of Florida teens and 10,875 interviews of teens in the remainder of the United States were conducted.

MEASURES

Exposure to FTCP interventions, including tobacco countermarketing, school and community organizations, and in-school tobacco prevention curricula.

ANALYSIS

Multivariable logistic regression models were used to test whether declines in Florida youth's exposure to FTCP interventions were associated with the FTCP budget cut.

RESULTS

Following the FY2004 FTCP budget cut, there were greater declines in teens' exposure to tobacco countermarketing campaigns in Florida compared with the remainder of the United States (odds ratio [OR]  =  .42; p < .001). The FY2004 budget cut also may have had an impact on exposure to in-school tobacco prevention curricula and school youth organizations (OR  =  .67; p < .001).

CONCLUSION

Program budget cuts in Florida resulted in significant declines in exposure to some FTCP interventions (particularly tobacco countermarketing). Research on the correlates of smoking suggests that these budget cuts could have a significant impact on tobacco-related outcomes among teens.

Media and secondhand smoke exposure: results from a national survey

OBJECTIVES

To investigate whether associations between anti-secondhand smoke (SHS) media, social cognitions about SHS, and home restrictions on smoking follow patterns observed in smoking behavior.

METHODS

Based on a nationally representative sample of 2348 US adults drawn from the American Legacy Foundation's American Smoking and Health Survey, we tested relationships among scales of anti-SHS media, social cognitions, and home restrictions.

RESULTS

We found anti-SHS media and SHS cognitions, as well as social cognitions and home restrictions, to be significantly associated. Social cognitions mediated the relationship between anti-SHS media and home restrictions.

CONCLUSIONS

Previously observed relationships between media, social cognitions, and smoking also exist for SHS. Anti-SHS media campaigns to increase home restrictions may help to reduce SHS exposure.

Conceptualizing youth empowerment within tobacco control

This article presents a conceptual framework that was developed to guide a national evaluation of the American Legacy Foundation's (Legacy) Statewide Youth Movement Against Tobacco Use (SYMATU) program. This program was designed to develop youth-led, youth-directed initiatives within local communities. Two evaluation studies were designed and implemented from 2000 through 2003: a cross-site study that collected standard data elements across all 17 programs and a case study of five programs that collected formative data on variables thought to affect program implementation. In developing the youth empowerment (YE) conceptual framework, the authors started by reviewing literature to identify the concepts necessary for these types of initiatives and present a summary of their findings here. This article focuses on the development of the authors'overarching conceptual framework used to guide their evaluation studies. Other articles contained within this special issue present results from each of the SYMATU evaluation studies.