Heterosexist Discrimination, Critical Consciousness, and Use of Cigarettes, E-Cigarettes, and Cannabis Vaping in Sexual Minorities

Background and Purpose: National data shows that sexual minorities (SM) have higher rates of cigarette use, e-cigarette use, and cannabis vaping than their heterosexual counterparts. SMs are at higher risk for experiences of heterosexist discrimination due to homophobia that may increase their likelihood of using substances as a form of coping. There is a paucity of factors that can potentially mitigate effects of systemic and interpersonal forms of oppression and its relationship concerning the use of substances. The concept of critical consciousness (CC) helps individuals identify sociopolitical factors that influence and maintain systems of oppression – shifting individual blame to structural critiques. Thus, CC can be a potential protective factor from the negative effects of discrimination and its associations with the use of substances. The purpose of this paper is to examine the associations of heterosexist discrimination and the use of cigarettes, e-cigarettes, and cannabis vaping in SMs and evaluate if higher scores of CC will moderate this relationship.

Method: We analyzed data from the Lesbian, Gay, and Bisexual Strengths Survey (n=1,073) conducted in January 2025 with a national sample of sexual minorities through a Qualtrics panel. Measures included assessments of heterosexist discrimination, critical consciousness, and substance use. We employed logistic, multinomial, negative binomial, and zero-inflated negative binomial regression as appropriate and examined the interaction effect to conduct our analysis using Stata 18.

Results: Heterosexist discrimination was associated with lifetime cigarette use (OR = 1.22; 95% CI: 1.06, 1.39), cigarette use some days (RRR = 1.27; 95% CI: 1.06, 1.53) and every day (RRR = 1.33; 95% CI: 1.14, 1.55) compared to never, current cigarette use (IRR = 1.17; 95% CI: 1.08, 1.27), e-cigarette use some days (RRR = 1.37; 95% CI: 1.16, 1.62) and every day (RRR = 1.45; 95% CI: 1.23, 1.71) compared to never, vaping cannabis in the last 12 months (OR = 1.25; 95% CI: 1.10, 1.43), and vaping cannabis in the last 2 days or less (RRR = 1.33; 95% CI: 1.14, 1.55) compared to never. Critical reflection moderated heterosexist discrimination and cigarette use some days (RRR = 0.84; 95% CI: 0.72, 0.98). Critical action moderated heterosexist discrimination and e-cigarette use some days (RRR = 0.77; 95% CI: 0.66, 0.90), number of e-cigarette cartridges or pods (IRR = 1.13, 95% CI: 1.00, 1.27), and vaping cannabis in the last 3 days or more (RRR = 0.79; 95% CI: 0.65, 0.96).

Conclusions and Implications: The results show that experiences of heterosexist discrimination among SMs are associated with higher likelihood of using cigarettes, e-cigarettes, and vaping cannabis. The moderation analysis illustrates that higher scores of critical reflection and action moderated the relationship of heterosexist discrimination and some of the substances underscoring that having a critical understanding of oppressive systemic structures and engaging in activism can be protective factors.