Smoking Initiation among Diverse
Classes of Sexual Minority Adolescents
and Young Adults
Christine Kaestle
Tobacco industry targets
sexual minorities
2
Controversies
• Smoking research has profoundly
neglected sexual minority groups
• Most tobacco surveillance data does not
include sexual orientation
• Even less info on diversity and resilience factors
• Invisibility of sexual minorities in tobacco
prevention interventions
3
Controversies
• Apparent contradictions and debate
over extent of health inequities
• large discrepancies
• magnitude
• consistency
4
My Research Questions
• Are sexual minority youth more vulnerable
to smoking initiation?
• Are risks unevenly distributed across
sexuality and racial and ethnic subgroups
in systematic ways?
• Can protective factors have amplified
effects for some subgroups compared to
others?
5
• Data from Waves I through IV
• Nationally representative
• Grades 7-12 in 1995 (Wave I)
• In-home, computer-assisted questionnaires
• Wave IV in 2009 (ages 24-32)
• About 10,000 participated in all waves
Measuring critical concepts
• Age of smoking milestones
• Sexual orientation
7
Timing of initiation: Importance
• Timing of smoking initiation
• Younger → higher rates of lung cancer
• Younger → increased dependence
• Younger → decreased cessation
• I explored longitudinal reports of initiation
timing in my first of a series of manuscripts
from this study…
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Timing of initiation: Telescoping
• I found increased ages of smoking in later reports:
• Average increase of about 2 years
• ¼ had increased age of daily smoking by 4 years
• Forward telescoping: over time, people reduce their estimate of
elapsed time since an event.
• In a longitudinal or retrospective study, using later data
will result in substantially later onset age reports.
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Kaestle, C. E. (in press) Age of smoking milestones: Longitudinal
inconsistencies and recanting. Journal of Adolescent Health.
Timing of initiation: Bias
• What predicts smoking reporting inconsistencies and
recanting in longitudinal data?
• More inconsistencies and recanting: those who started younger,
African American, Latino, and Asian respondents, males.
• Not associated: depression, same-sex attractions or
relationships, and family structure.
• Stability of reports of adolescent smoking is biased by
age of onset, sex, and race.
• Should use reports that are most proximal to initiation.
10
Kaestle, C. E. (in press) Age of smoking milestones: Longitudinal
inconsistencies and recanting. Journal of Adolescent Health.
Operationalizing Sexual Minority Status
Orientation measures often
used alone in research
Reconceptualized as
Multidimensional
Sexual orientation identity most
common; omits those who engage
in same-sex sexual behavior but do
not self-identify as a sexual minority
Same-sex relationship behaviors
more concrete behavioral definition,
but it limits the sample to those who
have had the opportunity to engage
in same-sex behavior
Same-sex romantic attractions
avoids missing youth who feel
attracted to the same sex but have
not had an opportunity to act
Self-Label
Orientation
Identity
Romantic
Attraction
Sexual
Behavior
Longitudinal Latent Class Analysis
• Person-centered approach
• Incorporates multiple dimensions:
• self-labeling
• relationship behavior
• attraction
• Identifies subgroups with unique
patterns over time
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LLCA: 8 Classes
Class
sexually active heterosexuals
late bloomer heterosexuals
mid bloomer heterosexuals
mostly hetero identity
emerging bisexuality
asexual
sexually active homosexuals
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later-blooming non-heterosexual
Description
opposite-sex partners, opposite sex attraction,
hetero identity
no sex and no attractions build to opposite-sex
partners, attractions, and hetero identity
opposite-sex attraction throughout but oppositesex partners start later, hetero identity
attract to opposite, opposite-sex partners, but
mostly hetero identity
growing levels of both-sex activity and
attractions, identity is mostly hetero or bisexual
abstains from sex, fewer attractions reported,
hetero, mostly hetero, or no orient identity
same-sex attractions, same-sex partners, and
homosexual identity
increasing spectrum of identity and behavior
LLCA: 8 Classes
sexually active heterosexuals
mid bloomer heterosexuals
emerging bisexuality
sexually active homosexuals
late bloomer heterosexuals
mostly hetero identity
asexual
later-blooming non-heterosexual
16.2
30.2
5.5
15.1
3.5
3.2
1.5
1.4
38.6
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Survival Analysis: Age of Initiation
Asexual
Late het
Mid het
Late non-het
Active hom
Active het
Bisex
Mostly het
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Survival Analysis: Age of Initiation
Active het
Active hom
Bisex
16
Survival Analysis: Age of Initiation
Asexual
Late het
Mid het
Active hom
Active het
Bisex
17
Survival Analysis: Age of Initiation
Asexual
Late het
Mid het
Late non-het
Active hom
Active het
Bisex
Mostly het
18
Diverse Population
• Racial and Ethnic Heterogeneity
• minority social identities interact
• racism within LGBT communities
• heterosexism within racial/ethnic communities
• different smoking initiation patterns?
19
Race: White Only
Asexual
Late het
Mid het
Mostly het
20
Late non-het
Active het
Active hom
Bisex
Race: African-American Only
Asexual
Mid het
Late het
Late non-het
Active het
Bisex
Mostly het
Active hom
21
African-American and White
Active het, Black
Active hom, Black
Active het, White
Active hom, White
22
Social Support as a Buffer?
• Stress and Social Support
• Why do some youth exposed to stress do
better than others?
• Resiliency and protective factors
• Social support protects people from stressful
events by helping them cope
• Buffer negative impacts of stress on health
related outcomes
23
Mentor Role Example
Active het, Black, Mentor
Active het, Black, NO Mentor
Active hom, Black, NO Mentor
Active hom, Black, Mentor
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Conclusions
• Sexual minority subgroups experience
different smoking initiation patterns
• Sexual minority status interacts with
race/ethnicity to shape these patterns
• Social support, such as mentors, can
attenuate the effect of sexual minority
status for some subgroups
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Discussion
• Solves contradictions in literature
• Timing
• Measurement
• Shows early and cumulative disparities
• Prevention policy must address
• Informs the targeting and customizing
interventions to unique subgroups
• Diversity: orientation, race, and resources
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Future Research
• Systematic review of smoking prevention interventions
for sexual minority youth
• VT graduate students Danielle Liggett and Hoa Nguyen
• Drugs, discrimination, and resilience among gay men
• Dr. Anthony Lyons at LaTrobe University, Melbourne
• Utility of the Theory of Planned Behavior to predict
short-term and long-term smoking and alcohol
outcomes: A cross-national study
• Dr. John Toumbourou at Deakin University, Melbourne
• Population Assessment of Tobacco and Health (PATH)
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Thank You