Family Rejection and Cigarette Smoking Among Sexual and Gender Minority Adolescents in the USA



Sexual and gender minority (SGM) adolescents are more likely than their heterosexual and cisgender peers to smoke cigarettes. Family rejection has been associated with adverse health outcomes; however, few studies have examined whether SGM-specific family rejection is associated with cigarette smoking among SGM adolescents.


A non-probability sample of 11,005 SGM adolescents (M = 15.58, SD = 1.27) completed an online cross-sectional survey. Bivariate and multivariable analyses were conducted to examine associations between SGM-specific family rejection, sociodemographic variables, and smoking.


Approximately 7% of the sample currently smoked cigarettes. Pansexual, asexual, trans boys, and non-binary assigned female at birth adolescents had the highest SGM family rejection scores. In multivariable regression analyses, SGM-specific family rejection was independently associated with smoking after adjusting for covariates (AOR = 1.15, 95% CI 1.04, 1.28). Family support (AOR = 0.80, 95% CI 0.73, 0.88) and experiencing violence (AOR = 1.64, 95% CI 1.49, 1.82) were also associated with smoking in multivariable models. Adolescents who identified as bisexual versus gay/lesbian (AOR = 1.50, 95% CI 1.21, 1.85) and trans boys versus cisgender girls (AOR = 2.05, 95% CI 1.13, 3.71) had an increased odds of smoking. Those who disclosed their sexual orientation identity to most (AOR = 1.95, 95% CI 1.45, 2.63) and all (AOR = 1.60, 95% CI 1.21, 2.11) of their family/parents had increased odds of smoking.


Our findings underscore the importance of attending to the role of SGM-specific family rejection and distinctions with SGM adolescents in tobacco prevention and smoking cessation efforts.

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This research uses data from the LGBTQ Teen Study, designed by Ryan J. Watson and Rebecca M. Puhl in collaboration with the Human Rights Campaign, and supported by the Office for Vice President of Research at the University of Connecticut. The authors acknowledge the intensive efforts of Ellen Kahn, Gabe Murchison, and Liam Miranda in their support, conceptualization, and management related to the LGBTQ Teen Study.

Funding Information

Dr. Gamarel and Dr. Fleischer were supported by R37CA214787. Dr. Fish received support from the Eunice Kennedy Shriver National Center for Child Health and Human Development grant P2CHD041041, Maryland Population Research Center. Dr. Watson received support from the National Institute of Drug Abuse, K01DA047918.

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Correspondence to Kristi E. Gamarel.

Ethics declarations

All procedures were reviewed and approved by the Intuitional Review Board who granted permission for parental consent to be waived, indicating parental consent would potentially place youth at more risk than waiving the consent.

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The authors declare that they have no conflict of interest.

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Gamarel, K.E., Watson, R.J., Mouzoon, R. et al. Family Rejection and Cigarette Smoking Among Sexual and Gender Minority Adolescents in the USA. Int.J. Behav. Med. (2020).

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  • Sexual and gender minorities
  • Adolescents
  • Smoking
  • Family rejection