"People Don't Generally Want or Accept You As a Person": Processes of Enacted Stigma and Smoking in Bipoc Sexual Minority Men Who Smoke Daily

Background and Purpose: While smoking overall has been declining in the past decade, smoking remains higher in certain groups such as men, Black, Indigenous, and People of Color (BIPOC), and sexual minorities (SM) relative to their counterparts. Despite this phenomenon, very few studies have explored how the intersections of these identities can influence smoking. Studies have shown that one of the primary contributors of smoking are experiences of enacted stigma or discrimination. Given that BIPOC SM men experience higher rates of enacted stigma because of their minoritized identities and smoke at higher rates, the purpose of this study is to 1) examine the processes of experiencing enacted stigma and smoking, and 2) to identify potential protective factors from the negative effects of stigma on smoking among BIPOC SM men who smoke daily.

Methods: Participants were recruited online (e.g., Craigslist, Instagram, and X) and through LGBTQ+ organization listservs. Inclusion criteria were 21 years old or older, male, gay, BIPOC, English proficient, resided in the U.S., has access to Zoom, and self-reported daily current use (≥ 25 days or more in the past 30 days) of cigarettes and/or Electronic Nicotine Delivery Systems (ENDS; e.g., e-cigarette, vape pen). Participants were interviewed over Zoom for a total of 75 minutes and were asked questions about experiences of enacted stigma, decision-making process of smoking, and other coping mechanisms. Interviews were transcribed, de-identified, coded using Dedoose, and analyzed by two trained coders using reflexive thematic analysis. The coders conducted iterative coding, discussed any discrepancies to gain a deeper understanding of the data, collated the codes and identified shared pattern meanings, and developed categories and sub-categories to create themes and sub-themes. The coders also implemented reflexive memoing throughout the process to critically interrogate how the coders’ identities and experiences may have influenced the data analysis process.

Results: Sixteen participants were interviewed. The mean age was 33 years old (SD=9.61), 56% used both cigarettes and ENDS, and participants identified as Black/African American, Asian American, Latinx/e, and mixed race (Black/African American & Native American). The three overarching themes were intersecting identities influence enacted stigma, smoking in response to enacted stigma, and protective factors from enacted stigma and smoking. Participants discussed how the intersectionality of their minoritized identities impacted experiences of enacted stigma within and outside of their communities. In addition, participants used cigarettes and/or ENDS devices to temporarily escape from negative feelings and emotions and would use their smoking devices from the anticipation of experiencing enacted stigma. Finally, participants shared how having a strong sense of their identity was a protective factor from experiences of stigma and leaning towards their community for support in helping process negative experiences as an alternative to smoking.

Conclusions and Implications: This study underscores the need for collaborative efforts between fields of social work and public health to strengthen efforts of challenging and eradicating oppressive institutions that reinforce stigma and substance use. More importantly, it is imperative to identify protective factors to help exploited populations develop strength-based solutions to advocate towards systemic change.