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. Author manuscript; available in PMC: 2026 Oct 19.
Published in final edited form as: Addict Behav. 2025 Oct 19;172:108525. doi: 10.1016/j.addbeh.2025.108525

Associations of rural–urban residence with daily experiences of minority stress and tobacco use among sexual minority young adults

Katelyn F Romm a,b,*, Clark Gilford Jr a, Mahalaxmi Das a,c, McKenna Nhem a, Erin A Vogel a,b, Amy M Cohn a,b
PMCID: PMC12715810  NIHMSID: NIHMS2119042  PMID: 41124757

Abstract

Introduction.

Rural- vs. urban-residing sexual minority young adults (SMYAs) display higher tobacco use rates. Less work has identified minority stressors that contribute to geographic disparities in use, particularly at the daily level.

Methods.

We analyzed 2024 baseline and 14 days of daily survey data among 60 SMYAs (ages 18–34) reporting current tobacco use. Multilevel regression-based models with random intercepts and slopes examined between-person effects of rural-urban residence on daily minority stress (i.e., negative affect, positive affect, upsetting parent interactions, upsetting peer interactions, microaggressions) and daily tobacco use (aggregated across cigarettes, e-cigarettes, large cigars, little cigars/cigarillos, smokeless tobacco, nicotine pouches, hookah) and within-person effects of daily minority stress on same-day and next-day tobacco use, controlling for sociodemographics (i.e., age, sexual identity, gender identity, sex at birth, race and ethnicity).

Results.

Among this sample of 60 SMYAs (Mage=24.53 [SD=5.19]; 50% rural-residing; 31.7% monosexual, 46.7% bisexual+; 56.7% gender minority; 55.0% female; 47.5% racial/ethnic minority), rural (vs. urban) residence was associated with higher levels of daily upsetting interactions with parents and higher odds of microaggressions and tobacco use. Upsetting interactions with parents and microaggressions were in turn, associated with higher odds of same-day and next-day tobacco use.

Conclusions.

Minority stress experiences may impact SMYAs’ concurrent and subsequent tobacco use. These daily minority stress experiences and tobacco use episodes occur more often and at higher levels among rural- (vs. urban-) residing SMYAs, highlighting the need for interventions focused on promoting adaptive coping in response to minority stressors in real time, particularly for rural-residing SMYAs.

Keywords: geographic disparities, sexual minority young adults, minority stress, tobacco use, daily assessments

1. Introduction

Tobacco use is the leading cause of preventable death in the United States (US; Arrazola et al., 2025), and tobacco use rates are disproportionately high among sexual minority- (SM; i.e., gay, lesbian, bisexual, pansexual, queer, and/or another non-heterosexual identity; NASEM, 2022), relative to heterosexual-identifying individuals (Hinds et al., 2024). Tobacco use is especially prevalent among SM young adults (YAs), due to significant life changes that occur for YAs broadly (e.g., greater independence; Arnett, 2005, 2014) and developmental experiences specific to SMYAs (e.g., acknowledging, accepting, disclosing sexual identity; Hall et al., 2021). SMYAs display higher rates of current tobacco use, with 2023 data from the National Survey on Drug Use and Health (SAMHSA, 2025) showing higher rates of cigarette (SM: 17.0%, heterosexual: 12.5%), e-cigarette (SM: 27.9%, heterosexual: 19.8%), and aggregated tobacco use (cigarettes, e-cigarettes, smokeless tobacco [SLT], cigars; SM: 20.6%, heterosexual: 17.8%) for SM (vs. heterosexual) YAs ages 18–34.

SMYAs residing in rural (vs. urban) areas are especially likely to use cigarettes, e-cigarettes, and any tobacco product aggregated across products and report greater nicotine dependence severity (Azagba et al., 2022; Romm et al., 2025). According to minority stress theory, SMYAs face both distal (e.g., discrimination) and proximal (e.g., internalized stigma) stressors associated with their stigmatized sexual identity (Meyer, 2003). SM individuals may turn to the use of substances, like tobacco, to cope with these stressful experiences (Hatzenbuehler, 2009). Consistent with minority stress theory, research suggests that geographic disparities in tobacco use among SM individuals may be due, in part, to greater minority stress among SMYAs in rural (vs. urban) communities, including greater negative behaviors from parents, discrimination, and less connection to the SM community (Romm et al., 2025). Existing work has relied on cross-sectional or macro-level longitudinal surveys with assessments several months apart (Azagba et al., 2022; Romm et al., 2025) and thus, do not provide information on rural and urban SMYAs’ daily experiences of minority stress or how these experiences influence tobacco use on a day to day basis (Bolger & Laurenceau, 2013). Participants may be less likely to recall more subtle forms of minority stress, such as upsetting interactions with parents or peers and microaggressions (Livingston et al., 2017). Assessing minority stress experiences and tobacco use at the daily level is crucial to provide temporal precision regarding daily minority stressors that may lead to next-day tobacco use, while minimizing participants’ recall bias and maximizing ecological validity (Shiffman, 2009; Shiffman et al., 2008).

Some prior work using daily surveys or ecological momentary assessments (EMAs) among SM adults, broadly suggests that SM adults display variability in minority stress at the daily level, including negative emotions, internalized stigma, interpersonal stress, and discrimination (Braitman et al., 2021; Dyar et al., 2022; Dyar et al., 2024; Ehlke et al., 2022; Livingston et al., 2017; Sullivan et al., 2024; Wardecker et al., 2022; Wilchek-Aviad & Oren, 2023). These minority stressors were associated with greater likelihood of same-day and next-day substance use. However, to date, research has not examined whether rural SMYAs display higher levels of daily minority stress experiences than their urban counterparts and whether these minority stressors predict same-day and next-day tobacco use. Rural (vs. urban) communities have stronger negative attitudes toward SM individuals (Anderson & Maugeri, 2024; Worthen & Jones, 2024) and greater heteronormative values (Henriquez & Ahmad, 2021), likely exacerbating experiences of minority stress for SM individuals. Moreover, SM individuals in rural communities have less connection to the SM community (DiFulvio, 2011; Romm et al., 2025), fewer mental health resources (Maria et al., 2024), and less social support (Cohn & Leake, 2012; MAP, 2019). Thus, rural-residing SMYAs may experience more frequent daily minority stressors and greater coping-related tobacco use, given fewer healthy coping alternatives.

The current study examined between-person associations of rural-urban residence with daily minority stressors (i.e., negative affect, positive affect, upsetting interactions with parents, upsetting interactions with peers, microaggressions) and tobacco use (i.e., use of any tobacco product) and within-person associations of daily minority stress with same-day and next-day tobacco use. It was hypothesized that at the between-person level, rural (vs. urban) residence would be associated with greater experiences of minority stress and likelihood of tobacco use and at the within-person level, greater minority stress would be associated with greater likelihood of same-day and next-day tobacco use.

2. Methods

2.1. Participants and Procedures

The current study analyzed baseline and 14 days of once-daily survey data among YAs. Eligibility criteria included individuals aged 18–34 (consistent with the US Census definition of young adulthood and national data indicating greatest risk for tobacco use among those ages 18–34; US Census Bureau, 2017; SAMHSA, 2025) who report a SM identity (i.e., gay, lesbian, bisexual, pansexual, queer, and/or another non-heterosexual identity) and current “some day” or “everyday” use of any tobacco product (i.e., cigarettes, e-cigarettes, large cigars, little cigars/cigarillos, smokeless tobacco, nicotine pouches, and/or hookah). Participants also had to reside in Oklahoma (OK) or surrounding states in the Southern and Midwestern regions of the US, where tobacco use rates are highest,(Cornelius et al., 2022) including Arkansas (AR), Colorado (CO), Kansas (KS), Missouri (MO), New Mexico (NM), and Texas (TX). This study launched in January 2024 with recruitment occurring from January-July 2024 and was approved by the Site Blinded Institutional Review Board.

Study ads targeted eligible individuals and were posted on social media sites, including Facebook, Instagram, YouTube, TikTok, and Snapchat. Purposive, quota-based sampling ensured that 50% of the sample resided in a rural area (based on residential ZIP Code; USDA, 2010), ~50% reported female and male sex, respectively, and at least 40% reported a racial and/or ethnic minority identity. After clicking on an ad, individuals were directed to a webpage with a study description and screening questions assessing their age, ZIP Code, sexual identity, gender identity, sex at birth, race, ethnicity, and current tobacco use status. Those deemed preliminarily eligible were sent a link via email to the full study description and consent form in REDCap, completed a screener to confirm eligibility, and were administered the baseline survey (~20 minutes). Multiple steps were taken to prevent fraudulent and repeat survey responses, including withholding details of eligibility before screening, CAPTCHA verification, examining data (e.g., duplicate IP addresses, e-mail addresses, phone numbers, illogical responses, survey completion time), and confirming validity of contact information prior to issuing payment (Heffner et al., 2021; Pratt-Chapman et al., 2021).

Following baseline survey completion, participants were mailed a reloadable debit card to receive future study payments. After confirming receipt of the debit card, participants were sent a link to begin the first of 14 brief once-daily surveys (~5 minutes), which were completed via REDCap on their mobile device. On average, participants completed daily surveys on12.28 (SD=2.31) of 14 days (average completion rate = 87.7% [SD=16.5]). Daily survey invitations were sent to participants each morning with 3 reminders throughout the day. Participants had until 11:59pm that day to complete each daily survey. Of the total daily surveys completed, 58.7% were completed in the morning (before 12pm), 25.7% were completed in the afternoon (between 12pm and 5pm), and 15.7% were completed in the evening (between 5pm and 11:59pm).

Of the 3,913 individuals who clicked on an ad, 1,275 (32.6%) completed the pre-screening and 967 (75.8% of those who completed the pre-screening) were preliminarily eligible. Of those preliminarily eligible, 260 were contacted and 707 were not contacted due to certain subgroup target numbers already being met (i.e., 50% urban, 50% female, 50% non-Hispanic White). Of the 260 contacted, a total of 102 (39.2%) consented, of whom 100 were eligible (98.0%). Ineligibility reasons included falling outside of the eligible age range (n=1) and not residing in an eligible state (n=1). The baseline survey was fully completed by 68 participants (68.0%) and partially completed by 32 participants (32.0%, not included in final sample). Of the 68 participants who completed the baseline survey, 62 confirmed receipt of the debit card and were invited to participate in the 14-day daily surveys. Two participants were dropped from analyses due to completing fewer than 2 daily surveys, resulting in an analytic sample of 60 participants. Participants received $25 for completing the baseline assessment. For daily surveys, participants received $2 for each assessment completed, $5 per week for completing assessments on all 7 days, and $25 for completing at least 85% of all daily surveys (up to $63 total).

2.2. Measures

2.2.1. Baseline Survey Measures

At baseline, participants reported their age (assessed continuously), sexual identity (i.e., asexual, bisexual or pansexual, gay or lesbian, queer, another non-heterosexual identity), gender identity (i.e., cisgender man, cisgender woman, transgender man, transgender woman, nonbinary, questioning), sex at birth (i.e., female, male, another sex), race (i.e., White, Black, Asian, American Indian, more than one race), ethnicity (Hispanic, non-Hispanic), and employment (employed full-time, part-time, unemployed, student). Due to limited sample size across certain sociodemographic subgroups, responses for sexual identity were re-categorized into 3 categories: monosexual (i.e., gay or lesbian), bisexual+ (i.e., bisexual or pansexual), and another sexual identity (i.e., asexual, queer); responses for gender identity were re-categorized as gender minority (i.e., transgender, nonbinary, questioning) and cisgender; and responses for race and ethnicity were re-categorized as racial and/or ethnic minority (i.e., Black, Asian, American Indian, more than one race, and/or Hispanic) and non-Hispanic White (see Table 1 for additional information). Participants also reported their current residential zip code. The Department of Agriculture Rural-Urban Commuting Area (RUCA) codes categorized participants’ self-reported zip codes as “rural” (RUCA code of large rural town, small rural town, or isolated rural town) or “urban” (RUCA code of metropolitan; USDA, 2010) Additionally, participants reported on the number of days they used cigarettes, e-cigarettes, large cigars, little cigars/cigarillos, smokeless tobacco, and nicotine pouches (separately, for each product) in the past month (0–30 days).

Table 1.

Participant Characteristics and Descriptives for Key Study Variables, N=60

Baseline Survey Variables M (SD) or N (%)
Rural-Urban Residence, N (%)
  Urban 30 (50.0)
  Rural 30 (50.0)
Age, M (SD) 24.53 (5.19)
Sexual Identity, N (%)
  Monosexual 19 (31.7)
  Bisexual + 28 (46.7)
  Another sexual identity 13 (21.7)
Gender Identity, N (%)
  Cisgender 26 (43.3)
  Gender minority 34 (56.7)
Sex at Birth, N (%)
  Female 33 (55.0)
  Male 27 (45.0)
Race and Ethnicity, N (%)
  Non-Hispanic White 32 (52.5)
  Racial and/or ethnic minority 29 (47.5)
Employment Status, N (%)
  Employed full-time 10 (16.7)
  Employed part-time 23 (38.3)
  Unemployed 14 (23.3)
  Student 13 (21.7)
Past-month Tobacco Use, N (%)
  Cigarette use 46 (76.7)
  E-cigarette use 49 (81.7)
  Large cigar use 6 (10.0)
  Little cigar/cigarillo use 22 (36.7)
  Smokeless tobacco use 6 (10.0)
  Nicotine pouch use 13 (21.7)
  Hookah use 6 (10.0)
Daily Survey Variables M (SD) Range ICC
Positive affect a 2.87 (0.99) 1–5 .47
Negative affect a 2.52 (0.94) 1–5 .47
Upsetting parent interactions b 2.48 (2.30) 1–10 .53
Upsetting peer interactions b 2.49 (2.14) 1–10 .32
Microaggressions (% of days) 39.69 (34.54) 0–100 .65
Tobacco Use (% of days) c 87.03 (23.58) 0–100 .81
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Note.

a

Positive and negative affect assessed on a scale from 1 (very slightly or not at all) to 5 (extremely)

b

Upsetting parent and peer interactions assessed on a scale from 1 (not at all) to 10 (very). Tobacco use was aggregated across cigarette (M=38.67% of days [SD=41.31]), e-cigarette (M=55.68 [SD=43.33]), large cigar (M=1.07 [SD=5.01]), little cigar/cigarillo (M=7.63 [SD=21.89]), smokeless tobacco (M=0.60 [SD=2.41]), nicotine pouch (M=4.28 [SD=15.19]), and hookah (M=1.38 [SD=4.57]) use.

2.2.2. Daily Survey Measures

Participants indicated the extent to which they felt sad, stressed, irritable, bored, happy, relaxed, and accepted on the previous day, with response options ranging from 1 (very slightly or not at all) to 5 (extremely). Responses for sad, stressed, irritable, and bored were averaged to assess daily negative affect (α=.84) and responses for happy, relaxed, and accepted were averaged to assess daily positive affect (α=.89; Selya et al., 2015). To assess daily upsetting interactions with parents and peers, participants were first asked whether they communicated with at least one parent on the prior day (no, yes) and at least one peer (e.g., friend, roommate, classmate, co-worker) the prior day (no, yes). If participants reported any communication with a parent and/or peer, they were asked to indicate the extent to which the interaction(s) was upsetting from 1 (not at all) to 10 (very), respectively (Helgeson et al., 2009). Daily microaggressions were assessed with 4 items asking participants to indicate whether they experienced any of the following on the prior day (no, yes): 1) heard someone use an SM slur, 2) had someone assume they were heterosexual, 3) were treated with less courtesy or respect due to their sexual identity, and 4) had their feelings overlooked, misunderstood, or dismissed due to their sexual identity (Ehlke et al., 2022). Due to limited variability, scores for each day were aggregated into any (one or more) vs. no (0) experiences of microaggressions. Regarding tobacco use, participants indicated whether they used each of the following tobacco products on the prior day: cigarettes, e-cigarettes, large cigars, little cigars/cigarillos, smokeless tobacco, nicotine pouches, and hookah. Because few participants reported use of any cigar products (inclusive of large cigars and little cigars/cigarillos), smokeless tobacco, nicotine pouches, and hookah, responses were aggregated across all tobacco products.

2.3. Data Analysis

Analyses were conducted in Mplus version 8.11. There were a total of 728 completed daily surveys from 60 participants. The median completion rate was 92.9% (M=86.7, SD=19.8). Within completed surveys, less than 1% of data were missing. All variables fell within the acceptable range for both skewness (−2 to 2) and kurtosis (−7 to 7).

We examined multilevel regression-based models to account for participants nested within time, incorporating both random intercepts and random slopes to account for individual differences across participants. We first assessed between-person effects of rural-urban residence on daily minority stress and tobacco use controlling for assessment type (weekend/weekday) at the within-person level and age, sexual identity, gender identity, sex at birth, and race and ethnicity at the between-person level. We considered also controlling for survey completion time (morning, afternoon, evening) and participants’ employment status, but these variables were not associated with any key study variables and were thus, excluded for parsimony. Next, we examined concurrent associations of minority stress with tobacco use (unlagged models) followed by models examining prospective effects of minority stress on tobacco use (lagged models). In unlagged models, minority stress experiences predicted same-day tobacco use. In lagged models, minority stress during the prior day predicted tobacco use during the next day. Both unlagged and lagged models controlled for the aforementioned within- and between-person level covariates, as well as rural vs. urban residence at the between-person level. In lagged models, we included first-order autocorrelations for the outcome (i.e., correlation between tobacco use at t-1 with tobacco use at t) to control for the prior timepoint of the outcome. Within-person associations and autocorrelations were allowed to vary across individuals. We also conducted sensitivity analyses examining combustible tobacco product (i.e., cigarettes, large cigars, little cigars/cigarillos, hookah aggregated) and e-cigarette use as separate outcomes.

3. Results

3.1. Participant Characteristics

Shown in Table 1, participants were 24.53 years old (SD=5.19) on average; 50.0% resided in urban and rural areas, respectively; 31.7% reported a monosexual identity (i.e., gay or lesbian), 46.7% a bisexual+ identity (i.e., bisexual or pansexual), and 21.7% another sexual identity (i.e., asexual or queer); 56.7% reported a gender minority identity (i.e., transgender, nonbinary, questioning); and 55.0% were assigned female at birth. With regard to race, 63.3% identified as White, 6.7% Black, 1.7% Asian, 5.0% American Indian, and 23.3% more than one race. Additionally, 18.3% were Hispanic. Together, 47.5% were categorized as racial and/or ethnic minority. Regarding employment, 16.7% were employed full-time, 38.3% employed part-time, 23.3% unemployed, and 21.7% were students. On average, participants reported communicating with parents on 46.1% of days, and peers on 79.0% of days, experiencing any microaggressions related to their SM identity on 39.7% of days, and using tobacco on 87.0% of days. Table 1 includes means, standard deviations, and intraclass correlations for all daily survey variables included in the current study.

3.2. Associations of Rural vs. Urban Residence with Daily Minority Stress and Tobacco Use

As shown in Table 2, at the between-person level, rural- (vs. urban-) residing SMYAs reported higher levels of upsetting interactions with parents, higher odds of experiencing microaggressions, and higher odds of daily tobacco use. Additionally, participants older in age displayed lower odds of experiencing microaggressions, gender minority (vs. cisgender) participants reported higher levels of negative affect, and male (vs. female) participants reported lower levels of negative affect. Racial and/or ethnic minority (vs. non-Hispanic White) participants reported lower levels of positive affect, lower levels of upsetting interactions with parents, higher odds of microaggressions, and lower odds of tobacco use.

Table 2.

Associations of Rural-Urban Residence with Daily Minority Stress and Tobacco Use

Positive Affect Negative Affect Upsetting Parent Interactions Upsetting Peer Interactions Microaggressions Tobacco Use
Between-Person Variables B (SE) p B (SE) p B (SE) p B (SE) p aOR 95% CI aOR 95% CI
Rural-Urban Residence
  Urban REF REF REF REF REF REF REF REF REF REF REF REF
  Rural 0.02 (0.16) .915 0.06 (0.16) .719 0.58 (0.49) .023 0.06 (0.37) .876 1.25 1.06, 1.46 1.18 1.05, 1.33
Age −0.03 (0.02) .100 0.02 (0.02) .154 0.02 (0.05) .728 −0.02 (0.04) .554 0.98 0.96, 1.00 1.00 0.89, 1.18
Sexual identity
  Monosexual −0.04 (0.22) .856 0.24 (0.20) .232 0.88 (0.59) .135 −0.40 (0.45) .373 0.93 0.77, 1.13 1.03 0.18, 2.60
  Bisexual + REF REF REF REF REF REF REF REF REF REF REF REF
  Another sexual identity −0.07 (0.23) .772 −0.07 (0.21) .735 0.49 (0.60) .409 0.21 (0.45) .637 0.90 0.73, 1.09 0.95 0.82, 1.10
Gender identity
  Cisgender REF REF REF REF REF REF REF REF REF REF REF REF
  Gender minority −0.29 (0.20) .153 0.55 (0.18) .002 −0.60 (0.54) .269 −0.37 (0.41) .365 0.91 0.76, 1.09 0.98 0.86, 1.12
Sex at birth
  Female REF REF REF REF REF REF REF REF REF REF REF REF
  Male 0.11 (0.20) .577 −0.42 (0.18) .019 0.37 (0.52) .476 −0.02 (0.40) .960 1.14 0.95, 1.35 0.98 0.87, 1.11
Race/ethnicity
  NH White REF REF REF REF REF REF REF REF REF REF REF REF
  Racial and/or ethnic minority −0.38 (0.18) .039 0.02 (0.16) .897 −1.10 (0.49) .025 −0.08 (0.37) .838 1.17 1.07, 1.37 0.89 0.80, 0.99
Within-Person Variables
Week vs. Weekend
  Week day REF REF REF REF REF REF REF REF REF REF REF REF
  Weekend day 0.05 (0.06) .451 −0.08 (0.06) .138 −0.07 (0.20) .746 −0.01 (0.17) .980 0.98 0.92, 1.04 1.01 0.96, 1.04
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Note. Bolded values denote statistical significance at p <.05. B=unstandardized regression coefficient, SE=standard error, aOR = adjusted odds ratio, CI = confidence interval.

3.3. Concurrent Associations of Daily Minority Stress with Tobacco Use

As shown in Table 3, at the within-person level, upsetting interactions with parents and upsetting interactions with peers, as well as experiences of microaggressions were all associated with higher odds of tobacco use on that same day. Specifically, on days when participants experienced higher levels of upsetting interactions with parents and peers and any microaggressions, they reported higher odds of using tobacco that same day.

Table 3.

Associations of Daily Minority Stress with Same-Day and Next-Day Tobacco Use

Same-Day Tobacco Use (Unlagged Model) Next-Day Tobacco Use (Lagged Model)
Between-Person Variables aOR 95% CI aOR 95% CI
Rural-Urban Residence
  Urban REF REF REF REF
  Rural 4.23 0.21, 4.27 3.08 0.92, 5.44
Age 0.94 0.72, 1.22 0.95 0.81, 1.10
Sexual identity
  Monosexual 0.64 0.04, 2.15 1.20 0.27, 4.85
  Bisexual + REF REF REF REF
  Another sexual identity 0.09 0.01, 1.69 0.25 0.03, 1.15
Gender identity
  Cisgender REF REF REF REF
  Gender minority 6.09 0.25, 4.74 1.77 0.46, 7.43
Sex at birth
  Female REF REF REF REF
  Male 1.58 0.16, 2.66 2.42 0.63, 9.57
Race/ethnicity
  NH White REF REF REF REF
  Racial and/or ethnic minority 0.10 0.01, 2.14 0.21 0.04, 0.71
Within-Person Variables
Week vs. Weekend
  Week day REF REF REF REF
  Weekend day 0.79 0.25, 2.49 0.69 0.25, 1.93
Positive Affect 1.17 0.45, 3.04 0.86 0.32, 1.08
Negative Affect 1.81 0.59, 5.58 0.76 0.52, 1.11
Upsetting Parent Interactions 1.28 1.08, 2.04 1.88 1.08, 2.51
Upsetting Peer Interactions 1.75 1.12, 2.06 1.01 0.77, 1.29
Microaggressions 2.70 1.17, 5.72 2106 1.09, 4.54
Prior Day Tobacco Use -- -- 4.08 2.25, 8.94
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Note. Bolded values denote statistical significance at p <.05. aOR = adjusted odds ratio, CI = confidence interval.

3.4. Prospective Associations of Daily Minority Stress with Tobacco Use

As shown in Table 3, at the within-person level, upsetting interactions with parents and experiences of microaggressions were associated with higher odds of next-day tobacco use, controlling for tobacco use from the previous day. That is, on days when participants experienced higher levels of upsetting interactions with parents and any microaggressions, they displayed higher odds of using tobacco the following day. Between-person associations were consistent with those from the unlagged models.

3.5. Sensitivity Analyses

Sensitivity analyses (not shown in tables) indicated that rural (vs. urban) residence was associated with higher odds of daily combustible tobacco product use (aOR=1.37, 95% CI=1.14–1.65), but not daily e-cigarette use (aOR=1.01, 95% CI=0.82–1.24). In unlagged models assessing associations of rural-urban residence and minority stress factors with same-day tobacco use outcomes, higher levels of upsetting interactions with parents (aOR=1.11, 95% CI=1.03, 1.15) and microaggressions (aOR=1.13, 95% CI=1.05–1.16) were associated with higher odds of combustible tobacco product use. Microaggressions were also associated with higher odds of e-cigarette use (aOR=1.15, 95% CI=1.05–1.26). Finally, lagged models assessing associations with next-day tobacco use indicated that only prior day combustible tobacco product use and prior day e-cigarette use predicted higher odds of next-day combustible product use (aOR=6.99, 95% CI=2.67–18.32) and e-cigarette use (aOR=6.98, 95% CI=1.99–14.62), respectively.

4. Discussion

The current study extends prior work suggesting associations of rural (vs. urban) residence with minority stress and tobacco use among SM individuals assessed retrospectively and at a cross-section. Findings shed light on geographic differences in SMYAs’ daily minority stress experiences and tobacco use, as well as daily minority stress experiences that may influence higher rates of tobacco use among rural- (vs. urban-) residing SMYAs. Consistent with hypotheses based on minority stress theory, rural (vs. urban) residence was associated with greater minority stressors, as well as greater likelihood of tobacco use and these minority stress experiences were associated with both same-day and next-day tobacco use.

Rural (vs. urban) SMYAs reported greater likelihood of daily tobacco use, which is consistent with prior work showing rural-urban disparities in tobacco use (including cigarette, e-cigarette, and tobacco use aggregated across products) for SM individuals assessed retrospectively over the past 30 days (Azagba et al., 2022; Romm et al., 2025) Sensitivity analyses suggest that these findings may largely be driven by differences in combustible tobacco product use, rather than e-cigarette use. However, this finding should be interpreted with caution given limited power to detect significant differences for specific products. Moreover, rural (vs. urban) SMYAs in the current study experienced greater daily upsetting interactions with their parents and were more likely to experience daily microaggressions. Geographic differences in upsetting interactions with parents and microaggressions are likely due to greater negative attitudes toward SM individuals in rural communities, broadly (Anderson & Maugeri, 2024; Worthen & Jones, 2024). These negative attitudes may contribute to greater minority stress in the form of microaggressions from community members, as well as parents. To our knowledge, only one study has assessed a broad range of minority stress experiences in relation to SMYAs’ geographic residence (Romm et al., 2025). Although this prior work assessed these constructs retrospectively, asking participants to reflect on their experiences over the past year, findings were consistent with those from the current study indicating that rural- (vs. urban-) residing SMYAs reported greater receipt of negative parenting behaviors and discrimination (Romm et al., 2025).

Current findings expand upon prior research relying on retrospective reports of minority stress and tobacco use and suggest that greater upsetting interactions with parents and experiencing daily microaggressions were, in turn, associated with higher odds of both same-day and next-day tobacco use. Taken together, rural-residing SMYAs experienced greater daily upsetting interactions with parents and were more likely to experience daily microaggressions than urban-residing SMYAs. On days when SMYAs experienced greater upsetting interactions with parents and any microaggressions, they were more likely to use tobacco that same day, as well as the next day. It is noteworthy that these factors were associated with next-day tobacco use, even after accounting for tobacco use from the previous day. While prior work suggests that an accumulation of negative behaviors from parents and discrimination over a longer period of time (e.g., one year) is associated with past-month tobacco use (Gordon et al., 2021; Mattingly et al., 2022; Romm et al., 2023, 2025), our findings suggest that these minority stress-tobacco use associations also occur at the event level. That is, rather than requiring an accumulation of minority stress experiences over a longer period of time, minority stressors may impact tobacco use over relatively brief periods of time.

Findings have important implications for future research and tobacco cessation efforts. Findings urge researchers and public health officials to consider SMYAs’ geographic residence when assessing and developing prevention and intervention efforts aimed at reducing SMYAs’ tobacco use. With replication, findings provide support for the potential utility of developing interventions that aim to promote healthier coping in response to specific minority stressors (e.g., upsetting interactions with parents, microaggressions) in real time, such as just-in-time mobile health interventions, to reduce risk of using tobacco in response to these stressors, particularly for rural-residing SMYAs. It is also crucial to simultaneously develop public health messaging campaigns targeted to rural communities to promote acceptance of SM individuals to reduce experiences of microaggressions and upsetting interactions with parents that may lead to future tobacco use.

4.1. Limitations

The current findings should be interpreted in light of a few limitations. First, the sample size was relatively small, limiting our power to formally assess mediation models, compare daily associations of minority stress and tobacco use based on specific sexual identity, sex at birth, gender identity, racial identity, and/or ethnic identity, and a broader range of tobacco use outcomes. Future research capitalizing on a larger sample should formally test indirect effects models to elucidate minority stress mechanisms through which rurality predicts tobacco use. Second, participants were purposively recruited via social media based on sexual identity, geographic residence, and tobacco use status and thus, findings may not be generalizable to the broader population of SMYAs and use rates should not be interpreted as prevalence rates. Most participants resided in OK where stigma toward SM individuals is relatively high.(Project, 2024) Thus, minority stress experiences may occur more frequently, relative to other states throughout the US. Third, to keep daily surveys relatively brief, measures were not exhaustive. Future research should assess additional stressors that may vary at the daily level, such as rejection sensitivity and internalized stigma. Finally, our measure of daily microaggressions asked about those related to participants’ sexual identity only. Future research should assess experiences of minority stress specific to both sexual and gender identity to identify the influence of minority stress experienced at the intersection of these multiple identities.

4.2. Conclusions

The current study is among the first to assess associations of rural vs. urban residence with daily experiences of minority stress and tobacco use among SMYAs. Findings suggest that rural-residing SMYAs experience greater minority stressors (i.e., upsetting interactions with parents, microaggressions), relative to urban-residing SMYAs, and these minority stressors are, in turn, associated with greater likelihood of tobacco use the same day and the following day. Interventions aimed at reducing tobacco use among SMYAs must account for geographic residence, attend to real-time experiences of minority stress, and occur alongside public health messaging campaigns to promote community acceptance of SM individuals.

HIGHLIGHTS.

  • Rural (vs. urban) SMYAs reported greater daily minority stress experiences

  • Daily minority stress was associated with higher odds of same- and next-day tobacco use

  • Interventions should promote adaptive coping to real-time minority stress for rural SMYAs

Footnotes

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