# Elucidating minority stress influences on tobacco use at the intersection of sexual orientation and rurality

> **NIH NIH R01** · UNIVERSITY OF OKLAHOMA HLTH SCIENCES CTR · 2024 · $406,246

## Abstract

SUMMARY/ABSTRACT
The US tobacco market has evolved over the past decade with declines in cigarette use coupled with increases
in the use of other tobacco products (e.g., e-cigarettes, cigars, hookah, smokeless tobacco), particularly among
young adults (YAs). Sexual minority young adults (SMYAs) are a growing population disproportionately impacted
by tobacco use, as they report higher rates of current use, initiation of use, escalations in use, and fewer
successful quit attempts relative to heterosexual YAs. However, this research has historically focused on SMYAs
residing in urban areas, despite that 20% of US SMYAs reside in rural areas. This is a significant limitation, as:
1) rural YAs exhibit higher rates of tobacco use and related disease; and 2) SMYAs face unique challenges (e.g.,
mental health problems, family stress, less peer support, discrimination) that are likely amplified among those
living in rural areas due to greater community-based stigma toward SM individuals. This proposal is informed by
minority stress theory and leverages our team’s expertise in tobacco-related disparities among SMYA and
rural populations independently, as well as multiple methods, including longitudinal survey and ecological
momentary assessment (EMA) studies. The overall goal of this work is to address knowledge gaps in
prevention and cessation efforts targeting SMYAs, by assessing the intersection of rurality and sexual orientation
on use and escalations in use across a range of tobacco products, and the minority stress factors that contribute
to use disparities. The proposed study will involve a 2-year, 5-wave longitudinal survey study among 2,000
SMYAs representing rural and urban residence, as well as tobacco users, susceptible nonusers, and non-
susceptible nonusers. A subset of 150 rural and urban SMYA tobacco users will complete a 21-day EMA study
following wave 2, where they will track tobacco use and daily minority stressors to elucidate context-specific
fluctuations in tobacco use and related mechanisms in real time. We will address 2 specific aims: 1) Examine
minority stress factors (i.e., mental health problems, family stress, less peer support, discrimination) as mediators
of the associations between rural versus urban status and tobacco use outcomes (i.e., any current use, specific
product use, changes in use status/level) among SMYAs over time; and 2) Among tobacco users, examine day-
to-day and within-day fluctuations in the aforementioned minority stress factors and tobacco use outcomes, as
they occur in real time and in naturalistic settings among rural versus urban SMYAs. Led by a uniquely-poised
research team, this proposal is responsive to NIDA’s NOT-MD-22-012: Research on the Health of Sexual and
Gender Minority Populations and will be the first to elucidate mechanisms contributing to tobacco onset,
cessation, and escalations, as well as real-time influences on tobacco use at the intersection of sexual orientation
and rurality. Finding...

## Key facts

- **NIH application ID:** 10981148
- **Project number:** 1R01DA059480-01A1
- **Recipient organization:** UNIVERSITY OF OKLAHOMA HLTH SCIENCES CTR
- **Principal Investigator:** Katelyn Romm
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $406,246
- **Award type:** 1
- **Project period:** 2024-08-01 → 2029-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10981148

## Citation

> US National Institutes of Health, RePORTER application 10981148, Elucidating minority stress influences on tobacco use at the intersection of sexual orientation and rurality (1R01DA059480-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10981148. Licensed CC0.

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