Smoking behavior and social identity: Correlates of Phantom Smoking Among Lesbian, Gay, Bisexual, Transgender, and Other Sexual and Gender Diverse Young Adults

Introduction: LGBTQ+ populations and people who smoke face stigma. This may lead to distancing oneself from smoking-related stigma by becoming phantom smokers (i.e., reporting smoking, but not identifying as a smoker). We explored correlates of phantom cigarette smoking among LGBTQ+ young adults.

Methods: Participants were U.S. young adults (18 to 24 years) who identified as LGBTQ+, reported any past 30-day cigarette smoking and had a valid response for smoker self-identification (unique N= 5,545). We incorporated data from participants who completed one or more of the seven surveys from FDA's This Free Life campaign evaluation (February 2016-July 2019). Multivariable panel regression models with unweighted data examined phantom smoking correlates.

Results: Over 60% of the sample were phantom smokers. Compared with self-identified smokers, phantom smokers were younger, more likely to be gay men than lesbian/gay women, and more likely to be non-Hispanic White than non-Hispanic Black, Hispanic or non-Hispanic people of other races/ethnicities. Phantom smokers were more likely to have a college plus education (vs. high school or less) and report past 30-day alcohol use. Phantom smokers smoked on fewer of the past 30 days and were less likely to report positive cessation attitudes, nicotine dependence, and current e-cigarette or other tobacco product use.

Conclusions: This is the first known study to explore factors associated with phantom smoking among LGBTQ+ young adults. Over half of young adult smokers were phantom smokers. Tobacco education for LGBTQ+ populations should consider phantom smoking and cessation implications to tailor content for phantom and self-identified smokers.

Implications: We examined predictors of phantom smoking (current smoking but denying smoker identity) among LGBTQ+ young adult smokers, which has not yet been explored among this population. Phantom (vs. self-identified) smokers were less likely to be lesbian/gay women (vs. gay men) or from a racial/ethnic minority group and more likely to report past 30-day alcohol use. Phantom smokers reported less tobacco use, lower nicotine dependence, and less favorable cessation attitudes. Phantom smokers comprised most smokers in our sample. Findings suggest the importance of addressing this unique aspect of LGBTQ+ smoking in research, clinical settings, and tailored tobacco public education messages.