Examining levels of social support, concealment and disclosure and heterosexism as health indicators in sexual minority women who smoke

Abstract

Recent evidence suggests self-identified sexual minority women (SMW) smoke at higher rates than gay men and heterosexual women. A limited amount of research for this disparity points to factors that include tobacco company targeted marketing, genetic differences, gender-based metabolic differences, coping styles such as identity concealment, social support, and stigma related stress. This cross-sectional online study aimed to examine the relationship of social support, concealment and disclosure of sexual identity, experiences of heterosexism and perceived smoking stigma as health indicators in SMW who smoke and those who do not smoke. Recruitment through various social media sites such as Facebook, Reddit, employer organizations and community centers produced 260 (n=260) cisgender SMW who met study criteria. The majority of respondents were white, the average age was 44, with average incomes of $60,000 and most had a college degree. Two-thirds identified as lesbian and one third were bisexual. There were no differences in smoking status and smoking rates between SMW. Smoking prevalence for the sample was 19.2%, and 55% had smoked at least 100 cigarettes in their lifetime. Of those that smoked, 54% were every day smokers, and 46% smoked some days. Smokers, when compared to non-smokers, reported higher rates of distress on experiences of heterosexism, but showed no difference in social support, and identity concealment and disclosure. Age was associated with both outness and concealment of identity, the intensity of daily heterosexist experiences and smoking stigma regardless of smoking status. Younger SMW experienced higher degrees of distress related to daily heterosexist experiences, but sexual identity was not significant for this variable. This outcome suggests minority stress processes factor into early sexual identity development. The prominence of age as a significant correlation to multiple variables should be noted for future studies of SMW. Recommendations include reducing sexual minority stigma through early prevention efforts targeting structural stigma with health promotion and advocacy efforts. Smoking cessation programs should assess levels of sexual minority stress in participants and tailor cognitive interventions that increase coping skills in stigmatizing environments. Lastly, health educators are urged to design prevention programs targeting young SMW that intervene on multiple levels of the environment. Sexual identity development milestones and the interaction of minority stress processes should inform these efforts.