Rural-urban Residence, Minority Stress, and Tobacco Use among Sexual and Gender Minority Young Adults in Oklahoma and Surrounding States

Introduction. Sexual and/or gender minority young adults (SGM YAs) display high tobacco use rates but less is known regarding disparities among those residing in rural vs. urban areas. Methods. Among 609 U.S. SGM YAs (ages 18–25) who completed 2023/2024 surveys, multivariable regressions examined associations of: 1) rurality (vs. urbanicity) with minority stressors (negative behaviors from parents, discrimination, less peer support and SGM community connectedness); and 2) rurality and minority stressors with tobacco use for those assigned female (AFAB) or male (AMAB) at birth, separately. Results. Among SGM YAs AFAB, rurality predicted greater minority stress (negative parenting, discrimination, less SGM community connectedness). Rurality and minority stressors predicted past-month e-cigarette use, polytobacco use, and nicotine dependence. Among those AMAB, rurality predicted greater nicotine dependence. Conclusions. Findings provide insights into intervention targets for tobacco use among SGM YAs AFAB residing in rural areas with less SGM community connectedness (i.e., acceptance and resources).