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
Authors: Kcomt Luisa , Evans-Polce Rebecca J , Engstrom Curtiss W , West Brady T , McCabe Sean Esteban 
Published: September 2020

Abstract

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 or ethnic discrimination and sexual orientation discrimination, and tobacco use disorder (TUD) severity has not been examined.

Aims and Methods
Using data from the 2012–2013 National Epidemiologic Survey of Alcohol and Related Conditions-III (n = 36 309 US adults), we conducted multivariable logistic regression analyses to examine the associations among racial or ethnic discrimination, sexual orientation discrimination, and TUD severity for lesbian or gay-, bisexual-, and heterosexual-identified adults. Consistent with the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (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 or ethnic discrimination were associated with significantly greater odds of past-year moderate-to-severe TUD among sexual minorities (adjusted odds ratio [AOR] = 1.03, 95% confidence interval [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 &lt; .005) and heterosexuals (AOR range: 1.71–3.53, p &lt; .005). Among sexual minorities, higher levels of racial or 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 or 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 or ethnic and sexual orientation discrimination are associated with DSM-5 TUD severity among sexual minority and heterosexual populations. Individuals exposed to multiple minority stressors may have increased vulnerability for developing TUD and related adverse health consequences. Our study underscores the importance of considering racial or 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 TUD severity may attenuate the tobacco use disparities between sexual minority and heterosexual adults.