Little is known about the consequences of tobacco smoking stigma on smokers and how smokers may internalize smoking-related stigma. This review summarizes existing literature on tobacco smoking ...self-stigma, investigating to what extent smokers are aware of negative stereotypes, agree with them and apply them to themselves.
We carried out a systematic search of Pubmed/Web of Science/PsycInfo databases for articles related to smoking self-stigma through June 2013. Reference lists and citations of included studies were also checked and experts were contacted. After screening articles for inclusion/exclusion criteria we performed a quality assessment and summarized findings according to the stages of self-stigma as conceptualized in Corrigan's progressive model of self-stigma (aware, agree, apply and harm). Initial searches yielded 570 articles.
Thirty of these articles (18 qualitative and 12 quantitative studies) met criteria for our review. Awareness of smoking stigma was virtually universal across studies. Coping strategies for smoking stigma and the degree to which individuals who smoke internalized this stigma varied both within and across studies. There was considerable variation in positive, negative, and non-significant consequences associated with smoking self-stigma. Limited evidence was found for subgroup differences in smoking-related stigma.
While there is some evidence that smoking self-stigma leads to reductions in smoking, this review also identified significant negative consequences of smoking self-stigma. Future research should assess the factors related to differences in how individuals respond to smoking stigma. Public health strategies which limit the stigmatization of smokers may be warranted.
•We used Corrigan's model to summarize tobacco smoking self-stigma literature.•Thirty qualitative and quantitative articles met criteria for review.•Awareness of smoking stigma was virtually universal among smokers across studies.•Coping strategies and stigma internalization varied across studies.•Positive and negative consequences were found as a result of smoking self-stigma.
•We examined heterogeneity in substance use disparities among LGB individuals.•Disparities varied significantly by age, gender, and sexual identity.•Gay/lesbian men and women had elevated rates at ...ages 18–25, but not all older ages.•Bisexual women had disparities on all substance use outcomes across ages 18–49.•Bisexual men and women had distinctly different patterns of disparities.
Sexual minorities (SMs) experience elevated rates of substance use behaviors and disorders relative to heterosexuals; minority stress is theorized to contribute to these disparities. As SMs are not a homogenous group, analyses that aggregate SMs across sexual identity, age, or gender obscure important variation among this population. To date, age- and gender-specific disparities have not been rigorously examined using a large national sample.
Using data on 67,354 adults (ages 18–49) from the 2015 and 2016 National Survey of Drug Use and Health we examined age- and gender-specific disparities in smoking, heavy episodic drinking, marijuana use, illicit drug use, and alcohol/substance use disorder. Age groups were ages 18–25, 26–34, and 35–49. Using logistic regression, we estimated age- and gender-specific odds ratios for gay/lesbian and bisexual individuals, relative to heterosexuals; analyses adjusted for demographic characteristics.
Bisexual women had significantly elevated odds of all outcomes at all ages, relative to heterosexual women. Gay/lesbian individuals had significantly elevated odds for nearly all outcomes compared to same-gender heterosexuals at ages 18–25, but not consistently at older ages. For bisexual men, significant disparities compared to heterosexual men were only observed at ages 35–49 for marijuana use and alcohol/substance use disorder.
We found notable within-group differences regarding SM disparities. While disparities were most pronounced in young adulthood for gay/lesbian individuals and mid-adulthood for bisexual men, bisexual women uniquely experienced disparities across all ages. Minority stress experiences may vary with respect to gender, age/cohort, and sexual identity, resulting in differential risk for substance use.
•Substance use disorders (alcohol, tobacco, cannabis, opioid) generally decrease with age.•Men have higher rates of substance use disorders than women at most ages from 18 to 90.•White participants ...report higher rates of most substance use disorders in young adulthood.•Black participants report higher or equal rates to white participants in midlife.
Although research has documented age differences in substance use, less is known about how prevalence of substance use disorders (SUDs) vary across age and differ by gender and race/ethnicity.
Time-varying effect models (TVEMs) were estimated on data from the National Epidemiologic Survey of Alcohol and Related Conditions–III (NESARC III; N = 36,309), a nationally representative survey of the adult population. The sample was 44% male; 53% White, 21% Black, 19% Hispanic/Latino, 6% other race/ethnicity. Prevalence of four SUDs (alcohol, tobacco, cannabis and opioid use disorders) were flexibly estimated across ages 18–90 by gender and race/ethnicity.
Estimated SUD prevalences were generally higher for men compared to women at most ages until the 70s. However, disparities by race/ethnicity varied with age, such that for most SUDs, estimated prevalences were higher for White participants at younger ages and Black participants at older ages.
Results suggest relatively constant disparities by gender across age, and a crossover effect for Black and White participants. Findings demonstrate that Black individuals in midlife may be an important target of intervention programs for some substances.
•Half of age 19/20 drinkers reported negative alcohol use consequences.•1/3 of non-binge and nearly 3/4 of binge drinkers reported negative consequences.•Vo-tech and 2-year college students reported ...more unsafe driving.•Negative consequences were more likely for women than men.•Negative consequences were less likely for those living with parents.
This study estimated the prevalence of negative consequences associated with alcohol use in a national sample of young adults one or two years after graduating from high school, focusing on differences by college attendance, living situation, binge drinking, and sex.
A subsample (N = 1068) of U.S. nationally representative Monitoring the Future study 12th grade students from 2006 to 2016 cohorts was followed-up at modal age 19 or 20 (in 2008–2017) and asked about negative consequences related to their own alcohol use during the past 12 months. Differences in prevalence were estimated and multivariable models examined associations with college attendance, living situation, binge drinking, and sex.
Half of surveyed U.S. 19/20 year-old alcohol users (a third of non-binge drinkers and almost three-quarters of binge drinkers) experienced negative consequences in the past year. The likelihood of experiencing several consequence types was significantly associated with college attendance prior to controlling for living situation. In multivariable models controlling for living situation, unsafe driving due to drinking remained more likely for students attending 2-year colleges or vocational/technical schools than for 4-year college students or non-attenders. In general, negative consequence risk was elevated among young adults not living with parents (vs. those living with parents) and women (vs. men).
Negative consequences from alcohol use are prevalent among young adults and differ by college attendance, living situation, binge drinking, and sex. Students at 2-year/vocational/technical schools are at particular risk for unsafe driving, warranting specific research attention and targeted intervention.
•Transphobic discrimination is multifaceted and pervasive.•7 in 10 transgender individuals have experienced discrimination in the past year.•Discrimination is associated with alcohol misuse among ...transgender people.
Alcohol misuse remains a leading preventable risk factor for morbidity and mortality in the United States. Evidence suggests that alcohol misuse is more prevalent among transgender populations. This study examined the association between transphobic discrimination and alcohol use/misuse among a large sample of transgender people.
Using the 2015 U.S. Transgender Survey (N = 27,715), logistic regression models were conducted to estimate the adjusted odds ratios (AOR) and 95 % confidence intervals (CI) of current alcohol use, past-month binge drinking (≥1 occasion of consuming ≥5 alcoholic beverages within the past month), and past-month frequent binge drinking (≥5 occasions of binge drinking within the past month) among transgender people.
Of the respondents, 60.4 % reported current alcohol use, 24.3 % reported past-month binge drinking, and 8.5 % reported past-month frequent binge drinking. The majority (70.1 %) had experienced some form of past-year transphobic discrimination. Experiencing 3+ forms of transphobic discrimination was significantly associated with past-month binge drinking (AOR = 1.49, 95 % CI = 1.37–1.62) and past-month frequent binge drinking (AOR = 1.57, 95 % CI = 1.37–1.79) than individuals who did not experience transphobic discrimination. Persons who cross-dress showed higher odds of current alcohol use (AOR = 1.52, 95 % CI = 1.32–1.74), past-month binge drinking (AOR = 2.51, 95 % CI = 2.21–2.85), and past-month frequent binge drinking (AOR = 4.13, 95 % CI = 3.45–4.94) than transgender women. Discrimination within public spaces and housing domains had the most robust associations with alcohol misuse.
Experiencing transphobic discrimination increased the odds of alcohol misuse among transgender people. Stakeholders and providers should be cognizant of the multifaceted nature of transphobic discrimination as unique social stressors that many transgender persons experience.
Lower perceived risk is a well-established risk factor for initiating substance use behaviors and an integral component of many health behavior theories. Established literature has shown that many ...substance use behaviors are more prevalent among individuals who identify as lesbian, gay, or bisexual than among those who identify as heterosexual. However, potential differences in perceived risk by sexual identity among individuals with no lifetime use have not been well characterized to date.
Data on 111,785 adults aged 18-34 years (including 11,377 lesbian, gay, and bisexual adults) were from the 2015-2019 National Survey on Drug Use and Health. Perceived risks (classified as great risk versus less than great risk) were assessed with 11 National Survey on Drug Use and Health survey items regarding 6 different substances (alcohol, cigarettes, marijuana, cocaine, lysergic acid diethylamide, and heroin). Survey-weighted and sex-stratified logistic regression models were used to estimate sexual identity differences regarding perceived great risk among those reporting no lifetime use. Analyses were conducted in 2021-2022.
Gay men, bisexual men, lesbian/gay women, and bisexual women were all significantly less likely than heterosexual peers to perceive great risk associated with specific marijuana, cocaine, lysergic acid diethylamide, and heroin use behaviors. Bisexual men and women were also significantly less likely than heterosexual peers to perceive great risk associated with binge drinking behaviors and smoking ≥1 packs of cigarettes daily.
This novel investigation among never users provides evidence that lesbian, gay, and bisexual adults perceive significantly lower risks associated with multiple substance use behaviors than heterosexual adults, which may indicate important sexual identity differences in susceptibility to substance use initiation.
Abstract Background The purpose of this study is to investigate disparities in substance use behaviors across gender and race/ethnicity as a flexible function of age from mid-adolescence through ...young adulthood. Methods Using data from the National Longitudinal Study of Adolescent Health, the time-varying effect model (TVEM) was used to examine gender and racial/ethnic differences in the prevalence of cigarette use, regular heavy episodic drinking (HED), and marijuana use as a smooth function of developmental age. Results Prevalence of cigarette use, regular HED, and marijuana use was higher for males than females overall, although gender differences varied with age. With regard to race, prevalence of each substance was higher for White than Hispanic or Black individuals; these differences increased considerably from ages 16 to 20, particularly for cigarette use. Differences in cigarette use by race/ethnicity were found across age, but were largest at age 18, when cigarette use peaks for White individuals, but continues to climb throughout the 20s among Hispanic and Black individuals. Conclusions These results suggest that substance use, particularly for certain population subgroups, increases past early adolescence. Disparities in substance use behaviors fluctuate considerably throughout adolescence and young adulthood, suggesting that targeted intervention programs are more critical at particular ages. These findings also demonstrate that TVEM can advance our understanding of health risk behaviors and their correlates across developmental time.
Research examining prospective links of e-cigarette use with cigarette, marijuana, and other substance use has been limited largely to 1–2-year follow-up periods and focused on younger adolescents. ...This study examined longitudinal associations of e-cigarette use with cigarette, marijuana, and other substance use initiation among U.S. adolescents and young adults (AYAs) across an eight-year period.
Adolescent (ages 12–17) and young adult (ages 18–25) data from waves 1–6 of the nationally representative Population Assessment of Tobacco and Health study (2013–2021) were used. Discrete time survival models with time-varying weights were employed to examine the risk of cigarette, marijuana, and other drug use initiation over an eight-year follow-up period among AYAs with no lifetime use of e-cigarettes/other tobacco, lifetime but no past 30-day use of e-cigarettes/other tobacco, past 30-day e-cigarettes only, other tobacco use only, or past 30-day e-cigarette/other tobacco use. We compare our time-varying weighting approach to a traditional time-invariant/complete case weighting approach.
Across six follow-up waves, all three past 30-day nicotine/tobacco use groups, including e-cigarettes only, had greater risk for cigarette, marijuana, and other drug use initiation relative to those not using nicotine/tobacco. The three past 30-day nicotine/tobacco use groups did not differ from each other in risk for marijuana use initiation. Associations were smaller in magnitude for young adults compared to adolescents, but significant for both age groups.
Substance use initiation risks persist beyond 1–2 years for U.S. AYAs using e-cigarettes. Prevention strategies to reduce AYA e-cigarette use are needed to reduce cancer-related risk.
•Risk for substance use initiation among those using e-cigarettes persists over 8 years of follow-up.•Risk for marijuana use initiation was equally strong across all nicotine/tobacco use groups.•Individuals using e-cigarettes remain at risk for substance use initiation in young adulthood.•The link of nicotine/tobacco use and marijuana use initiation increased over time.
Background
There is a well‐known link between attending college and engaging in excessive alcohol use. This study examines in a national sample how the association between student status and ...excessive alcohol use changes from late adolescence through young adulthood and whether the association of student status with excessive alcohol use is different for students residing with versus away from parents during the school year.
Methods
This study used cross‐sectional data from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of noninstitutionalized civilian adults residing in the United States. Our analyses included nonhigh school young adults who were ages 18 to 30 years (n = 8,645). Excessive alcohol use included past‐year (i) high‐intensity drinking (men: ≥10 standard drinks; women: ≥8) and (ii) exceeding weekly drinking guidelines (men: >14 drinks per week; women: >7). Students who resided away from their parents and students who lived with their parents during the school year were compared to nonstudents.
Results
Analyses using time‐varying effect modeling showed that the relationship of student status with excessive alcohol use varied as a function of age. Overall student status lost its association with excessive alcohol use in the early 20s, after controlling for demographics and other adult social roles. The association between student status and excessive alcohol use also varied considerably across age and depending on whether the student was residing with or away from parents.
Conclusions
The association of student status with excessive alcohol use is heterogeneous in terms of both age and living arrangements, suggesting opportunities for interventions targeting problematic alcohol use. Future research should examine additional sources of heterogeneity of students in their risk for excessive alcohol use.
This study examined, in a national sample of US adults, how the association between student status and excessive alcohol use changes from late adolescence through young adulthood and whether the association of student status with excessive alcohol use is different for students residing with versus away from parents during the school year. We found that student status does not universally confer similar risk for excessive alcohol use across the ages of 18–years or across living situations.
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