An Examination of the Minority Stress Model and Cigarette Smoking among Lesbian, Gay, and Bisexual (LGB) United States Military Veterans: Implications for Smoking Cessation Intervention Development

Abstract

Lesbian, gay, and bisexual (LGB) individuals and United States military Veterans are more likely to report current cigarette smoking compared to the general adult population. The intersection between a LGB identity and Veteran status places LGB Veterans at increased risk for smoking. The purpose of this study is to assess whether past-year cigarette smoking among LGB Veterans is explained by constructs within the Minority Stress Model, a conceptual framework, developed to understand how sexual orientation-related stressors as well as coping and social support influence health behaviors. In addition to minority stress, this study assessed differences in cigarette smoking motives and stages of change in smoking cessation, which may partially explain the high prevalence of cigarette smoking among LGB Veterans. We used cross-sectional baseline data from the Health for Every Veteran Study, which used a prospective cohort design to understand mental health problems and health risk behaviors among heterosexual and lesbian, gay, bisexual, and transgender (LGBT) Veterans. In Aim 1, we tested whether interpersonal minority stressors (discrimination, harassment, victimization, trauma, social exclusion, and family rejection), intrapersonal minority stressors (identity concealment and internalized homophobia), and LGB-specific military stressors were associated with past-year smoking versus no past-year smoking. In Aim 2, we tested whether coping and three types of social support (general, Veteran-specific, and LGBT-specific) moderated the associations between interpersonal minority stressors, intrapersonal minority stressors, and/or LGB-specific military stressors and past-year smoking. In Aim 3, we examined differences in cigarette smoking motives and stages of change in smoking cessation among Veterans with past-year smoking by gender and sexual orientation. In Aim 1, we found that several interpersonal stressors, including harassment, victimization, and family rejection were associated past-year smoking. In Aim 2, we found that coping and social support buffered the associations between minority stressors and LGB-specific military stressors with past-year smoking, but also exacerbated the association between social exclusion and past-year smoking. In Aim 3, we found that gay men reported higher social smoking motives compared to heterosexual men and higher boredom relief smoking motives compared to bisexual men in age-adjusted models. Findings among women Veterans indicate that lesbian women were more likely to be in more advanced stages of quitting or had already quit in the past year. Future smoking cessation interventions should consider focusing on interpersonal minority stressors, social and boredom relief smoking motives, and teaching positive coping skills while leveraging social support to aid LGB Veterans in smoking cessation.