Smoking cessation disparities were structured by the intersection of race, sex, and sexual orientation rather than by sexual minority status alone, with smoking intensity, psychological distress, lower income, and non-White race among the strongest predictors of reduced cessation likelihood.
Key Findings
Results
Smoking intensity was among the strongest predictors of cessation outcomes over a one-year period among sexual minority adults.
Data were drawn from Waves 6 and 7 of the Population Assessment of Tobacco and Health (PATH) Study.
Complex Samples logistic regression models assessed baseline smoking intensity as a predictor of cessation one year later.
Higher smoking intensity at baseline was associated with reduced likelihood of cessation at follow-up.
Smoking intensity was identified alongside psychological distress as among the strongest predictors in the models.
Results
Psychological distress was among the strongest predictors of reduced smoking cessation likelihood among sexual minority adults.
Psychological distress was included as a baseline predictor in Complex Samples logistic regression models.
It was identified as one of the strongest predictors of cessation outcomes alongside smoking intensity.
The study assessed psychological distress alongside quality of life as part of a broader set of social and behavioral determinants.
Findings suggest mental health burden collectively shapes cessation outcomes in this population.
Results
Lower income was associated with reduced likelihood of smoking cessation among sexual minority adults.
Income was assessed at baseline as part of the Complex Samples logistic regression models.
Lower income predicted reduced cessation likelihood one year later.
Income was examined alongside education as a socioeconomic factor in the models.
Findings were interpreted as reflecting broader structural disadvantages influencing cessation outcomes.
Results
Non-White race was associated with reduced likelihood of smoking cessation.
Race was included as a predictor in the logistic regression models assessing cessation at one-year follow-up.
Non-White race was associated with reduced cessation likelihood after accounting for other factors.
Race was also incorporated into an intersectional variable combining race, sex, and sexual orientation.
The association persisted after accounting for smoking intensity, nicotine dependence, socioeconomic factors, psychological distress, and quality of life.
Results
Cessation outcomes varied significantly across an eight-category intersectional variable combining race, sex, and sexual orientation, with White heterosexual men exhibiting the most favorable cessation profile.
An eight-category intersectional variable was constructed by combining race, sex, and sexual orientation.
White heterosexual men showed the most favorable cessation profile among all groups examined.
Several other groups demonstrated reduced likelihood of quitting after accounting for smoking intensity, nicotine dependence, socioeconomic factors, psychological distress, and quality of life.
The findings indicate that cessation disparities are structured by the intersection of race, sex, and sexual orientation rather than by sexual minority status alone.
Methods
Nicotine dependence at baseline was included as a predictor of cessation outcomes in the longitudinal models.
Nicotine dependence was assessed at baseline (Wave 6) and included in the Complex Samples logistic regression models.
It was examined alongside smoking intensity as a behavioral dependence factor.
The study used data from Waves 6 and 7 of the PATH Study, representing approximately a one-year follow-up interval.
Nicotine dependence was one of several factors controlled for when examining intersectional group differences in cessation.
Methods
The study used a longitudinal population-based design drawing from Waves 6 and 7 of the Population Assessment of Tobacco and Health (PATH) Study.
PATH is a nationally representative longitudinal study of tobacco use in the United States.
Complex Samples logistic regression models were used to account for the complex survey design.
The outcome variable was smoking cessation assessed approximately one year after baseline.
Predictors included smoking intensity, nicotine dependence, race, income, education, psychological distress, and quality of life.
What This Means
This research suggests that when it comes to quitting smoking, sexual minority adults (people who identify as lesbian, gay, bisexual, or other non-heterosexual identities) face barriers that go beyond just being addicted to nicotine. Using a large, nationally representative U.S. survey tracked over one year, the study found that how heavily someone smokes and how much psychological distress they experience are among the strongest factors predicting whether they successfully quit. Having lower income and being a person of color were also linked to lower chances of quitting, even after accounting for smoking habits and mental health.
Importantly, the research found that quitting disparities are not simply about being a sexual minority — they depend on the combination of a person's race, sex, and sexual orientation together. White heterosexual men had the best outcomes for quitting, while many other groups — particularly those facing multiple overlapping minority identities — were less likely to quit. This suggests that the disadvantages people face in quitting smoking are layered and interconnected rather than stemming from any single characteristic.
This research suggests that one-size-fits-all smoking cessation programs may not be equally effective for everyone. Interventions aimed at helping people quit may work better if they address not just nicotine dependence and smoking habits, but also mental health support and the socioeconomic challenges that make quitting harder for people who face racial, economic, and sexual minority disadvantages simultaneously. Tailoring programs to specific subgroups experiencing these intersecting disadvantages could help reduce long-standing health disparities in smoking-related illness.
Steven A. Branstetter, Maya P. Matlack. (2026). Sexual Minority Adults and Smoking Cessation Outcomes: A Longitudinal Population-Based Study. Healthcare. https://doi.org/10.3390/healthcare14060705