Mental Health Correlates of Cigarette Use in LGBT Individuals in the Southeastern United States

Background: Smoking prevalence for lesbian, gay, bisexual, and transgender (LGBT) individuals is higher than for heterosexual, cisgender individuals. Elevated smoking rates have been linked to psychiatric comorbidities, substance use, poverty, low education levels, and stress. Objectives: This study examined mental health (MH) correlates of cigarette use in LGBT individuals residing in a metropolitan area in the southeastern United States. Methods: Participants were 335 individuals from an LGBT health needs assessment (mean age 34.7; SD = 13.5; 63% gay/lesbian; 66% Caucasian; 81% cisgender). Demographics, current/past psychiatric diagnoses, number of poor MH days in the last 30, the Patient Health Questionnaire (PHQ) 2 depression screener, the Three-Item Loneliness Scale, and frequency of cigarette use were included. Analyses included bivariate correlations, analysis of variance (ANOVA), and regression. Results: Multiple demographic and MH factors were associated with smoker status and frequency of smoking. A logistic regression indicated that lower education and bipolar disorder were most strongly associated with being a smoker. For smokers, a hierarchical regression model including demographic and MH variables accounted for 17.6% of the variance in frequency of cigarette use. Only education, bipolar disorder, and the number of poor MH days were significant contributors in the overall model. Conclusions/Importance: Less education, bipolar disorder, and recurrent poor MH increase LGBT vulnerability to cigarette use. Access to LGBT-competent MH providers who can address culturally specific factors in tobacco cessation is crucial to reducing this health disparities.