LGBQ Microaggression and Smoking Among Sexual Minority College Students

Background: LGBQ microaggressions (e.g., “that’s so gay”) are often-unintentional verbal, behavioral and structural insults, assaults, and invalidations that denigrate sexual minorities. LGBQ microaggressions may be experienced during individual daily interactions and create stressful, exclusionary, uncertain, and even hostile social environments for LGBQ individuals. Among sexual minority college students, experiencing overt hostile discrimination and violence has previously been associated with elevated rates of smoking cigarettes compared to heterosexuals; however the relationship between LGBQ microaggressions and smoking is not known in the field. We hypothesized that frequent experience of LGBQ microaggressions would be associated with increased cigarette smoking among LGBQ college students.

Methods: We used data from a national anonymous online 2013 survey of sexual and gender minority college students (n=952); the analytical sample was limited to sexual minority students (n=546). We examined the dichotomous variables of any cigarette smoking and frequent/very frequent microaggressions on campus in the past month. Based on their previously identified association with smoking, we controlled for any experience of violence and any treat of violence on campus (both past year). We also controlled for demographics (age, sex, race, two SES indicators [Pell Grant eligibility; first in family to attend college]), a positive screen for risk-level alcohol use, and academic variables (intellectual development, developmental challenge, GPA). We used chi-squared and t-test analyses to test differences by smoking status. Multivariable logistic regression, including control variables, assessed the relationship between smoking and frequent experience of microaggression. The Michigan State University Institutional Review Board approved the survey study.

Results: Average respondent age was 22.6 years, 44% were male, 74% White, 47% were Pell Grant eligible and 25% were first in their family to attend college. There were 18% of respondents who reported smoking cigarettes and 26% reported frequent experience of microaggression in the past month. Positive AUDIT-C screen was found in 22%, 16% had experienced violence, and 48% had experienced threats of violence related to sexual orientation in the past year. In bivariate analyses, significant differences were found among smokers for more frequent experience of microaggression (χ²(1)=10.43, p=.001), more positive alcohol screens (χ²(1)=21.3, p<.001), and greater developmental challenge (t(533)=-2.42, p=.02). Past month frequent experience of microaggression was associated with an 82% increased odds (95% CI 1.05-3.16) of smoking in the past 30 days after controlling for demographics, academic variables, alcohol use, and violence indicators.

Conclusion: Frequent experience of microaggressions among LGBQ college students significantly increased their odds for engaging in an unhealthy behavior of smoking cigarettes in the past month. Future research should explore the mechanism for this relationship, as well as identify strategies to address LGBQ microaggressions on college campuses to protect the health of sexual minority students. Tobacco control efforts including prevention and treatment for LGBQ individuals should consider the experience of microaggression as a risk factor.