Sexual Minority Adults and Smoking Cessation Outcomes: A Longitudinal Population-Based Study

Highlights: What are the main findings? Smoking cessation disparities were structured by the intersection of race, sex, and sexual orientation rather than by sexual minority status alone. Cessation outcomes differed across race, sex, and sexual orientation groups, with White heterosexual men showing the most favorable cessation profile and several other groups demonstrating a greater likelihood of continued smoking. What are the implications of the main findings? Smoking cessation inequities reflect both behavioral dependence and broader structural disadvantages. Interventions may be more effective when they address smoking intensity and nicotine dependence alongside mental health burden and socioeconomic barriers, while also recognizing that risk is patterned by the combined influence of race, sex, and sexual orientation. Findings underscore the importance of tailoring cessation interventions for subgroups experiencing intersecting sexual and racial minority disadvantages. Background/Objectives: Sexual minority (SM) adults experience higher cigarette smoking prevalence and poorer cessation outcomes than heterosexual adults, yet few empirically supported cessation programs are tailored to SM populations. In addition, the social and behavioral determinants of smoking disparities among SM remain understudied. A clearer understanding of factors associated with cessation in this population is necessary to inform targeted interventions. This study examined predictors of smoking cessation over a one-year period among sexual minority adults. Methods: Data were drawn from Waves 6 and 7 of the Population Assessment of Tobacco and Health (PATH) Study. Complex Samples logistic regression models assessed whether baseline smoking intensity, nicotine dependence, race, income, education, psychological distress, and quality of life predicted cessation one year later. An eight-category intersectional variable combined race, sex, and sexual orientation. Results: Smoking intensity and psychological distress were among the strongest predictors of cessation outcomes. Lower income and non-White race were also associated with reduced cessation likelihood. Cessation outcomes varied significantly across the combined race by sex by sexual orientation groups, with White heterosexual men exhibiting the most favorable cessation profile. Several other groups demonstrated reduced likelihood of quitting after accounting for smoking intensity, nicotine dependence, socioeconomic factors, psychological distress, and quality of life. Conclusions: Smoking cessation disparities operate across intersecting social identities. Behavioral dependence, socioeconomic disadvantages, and psychological distress collectively shape cessation outcomes. Effective interventions should address nicotine dependence within the broader structural and mental health contexts influencing racially and sexually minoritized populations.