Tobacco Use among Sexual Minority Men and Women in the United States and China Restricted; Files Only

Li, Jingjing (Spring 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/cf95jc440?locale=en
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Abstract

Tobacco use is a significant public health problem in both Western and Eastern countries. An emerging line of studies suggests that lesbians, gays, and bisexuals (LGBs) are at increased risk for tobacco use in both the US and China, especially during young adulthood. However, the distinctive, accumulative risk profiles of tobacco use across sexual minority subgroups, particularly as distinguished by sex, remain inadequately understood. Additionally, the increasingly prevalent use of alternative tobacco products (ATPs), such as little cigars and cigarillos (LCCs), e-cigarettes, and hookah, have further complicated our understanding of the at-risk populations for tobacco use. There is a lack of research that explores the distinctive patterns in the association of sexual orientation, sex, and tobacco products that may be driving the tobacco disparities among sexual minorities in both countries. To advance our knowledge base regarding tobacco-related disparities in this vulnerable population, this dissertation addresses three research aims:

Aim 1: To systematically review and meta-analyze the empirical evidence on the distinctive sexual orientation and sex patterns in tobacco use among sexual minority men and women in the US.

Aim 2: To examine the relationship of sex and sexual orientation to tobacco use among young adults in the US.

Aim 3: To examine the relationship between minority stress, depression, and tobacco use among Chinese gay men versus bisexual men.

This dissertation research was guided by Minority Stress Theory (Meyer, 2003), which acknowledges that the higher rates of tobacco use among sexual minority young adults were explained by their sexual minority status. This series of studies makes novel contributions to the existing literature by providing evidence on the distinctive profiles in LGB use of tobacco products, as well as by determining what subgroups are most at-risk for negative health behaviors and outcomes. Additionally, the information provided by this research helps health educators and researchers to better understand tobacco use in key populations cross-culturally and aid in the development of more tailored tobacco intervention programming in both US and China.

Table of Contents

CHAPTER 1: Overview.. 1

Methods. 8

Significance. 11

References. 12

CHAPTER 2: Tobacco use at the intersection of sex and sexual minority subgroup status in the US, 2007-2018: A systematic review and meta-analysis. 22

BACKGROUND.. 24

METHODS. 26

RESULTS. 31

DISCUSSION.. 36

Conclusions. 41

Appendix A. Database Search Worksheet 76

Appendix B. Reference list for systematic review.. 79

Appendix C. Reference list for meta-analysis. 89

References. 97

CHAPTER 3: Sex and sexual orientation in relation to tobacco use among young adult college student in the US: A cross-sectional study 102

BACKGROUND.. 104

METHODS. 106

RESULTS. 109

DISCUSSION.. 112

CONCLUSIONS. 118

References. 125

CHAPTER 4: Minority stress, depression and tobacco use among Chinese gay and bisexual men: Two-group structural equation model analyses. 133

BACKGROUND.. 135

METHODS. 139

RESULTS. 145

DISCUSSION.. 148

CONCLUSIONS. 152

CHAPTER 5: Summary and Conclusions. 167

BACKGROUND.. 167

SUMMARY OF FINDINGS. 167

IMPLICATIONS. 170

STRENGTH AND LIMITATIONS. 171

DIRECTION FOR FUTURE RESEARCH.. 172

CONCLUSIONS. 173

Reference. 175

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