Perceived Mental Health, Cigarettes Per Day and Time to First Cigarette Among Female Sexual Minority Smokers

Abstract Objective:This study explores how mental health and socio-demographic factors influence smoking behaviors and nicotine dependence among sexual minority females (SMF). Methods:Data from Wave 5 of the Population Assessment of Tobacco and Health (PATH) study, with 34,309 adults, were analyzed. Participants reported sexual orientation, smoking habits, and perceived mental health. Conditional process analysis assessed how mental health mediates the relationship between sexual minority status and smoking. Results:SMF had a higher smoking prevalence (28.2%) compared to heterosexual women (24.5%), but smoked fewer cigarettes per day (12.90 vs. 13.67) and had lower nicotine dependence, as indicated by a longer time to first cigarette (139.94 vs. 95.88 minutes). Mental health fully mediated the association between sexual minority status and smoking frequency. Lower income was linked to poorer mental health and higher smoking frequency, but not nicotine dependence. Conclusions:SMF smoke more frequently but are less nicotine-dependent than heterosexual women. Mental health challenges and socio-economic factors drive smoking behaviors in SMF. Addressing these factors may reduce smoking in this population.