Table 1 Survey measures

Independent Variable: Structural stigma

Attitudes toward sexual minoritized people¹

1. “Homosexual couples should have the right to marry one another”

2. “If somebody in your community suggested that a book in favor of homosexuality should be taken out of your public library, would you favor removing this book, or not?”

3. “Should a man who admits that he is a homosexual be allowed to teach in a college or university, or not?”

4. “Suppose a gay person wanted to make a speech in your community. Should he be allowed to speak, or not?”

5. “What about sexual relations between two adults of the same sex–do you think it is always wrong, almost always wrong, wrong only sometimes, or not wrong at all?”

1 = Level of anti-gay prejudice at the regional-level (indicated by percent negative responses to items) was above the average anti-gay prejudice at the US national-level.

0 = Indicated that the level of anti-gay prejudice at the state-level was below the US national level.

Three of the four questions were already written as dichotomous, such that we could compare the percent of negative responses to those questions at the regional level to the national level. Two questions required conversion to a dichotomous response to ensure consistency across the five items. For the first item, related to homosexual sexual relations, we summed the percent of responses indicating that same-sex relations were wrong at least to some degree before comparing the percent of prejudicial responses at the regional- and national-levels. For the second item, related to the rights of homosexual couples to marry, we summed the percent of responses indicating that homosexual relations were wrong at least to some degree before comparing the percent of prejudicial responses at the regional- and national-levels. We then summed the five anti-gay prejudice questions into a single summed value (0–5) that represented the sum prejudicial attitudes at a regional level. These data are only available at the aggregate level by region, so the results from each region were extrapolated to individual states to give a state-level estimate of anti-gay prejudice.

Absence of Protective Policies²

Protective policies for SGM people include protections against employment discrimination, housing discrimination, discrimination in public accommodations, credit discrimination, and discrimination against state employees. Different states have differing policies protecting SGM people from these kinds of discrimination. The Movement Advancement Project collected and summarized these policies by state. States included some policies that only protected lesbian, gay, and bisexual (LGB) individuals, while some also included protections for transgender individuals.

1 = The absence of a law in 2022 that protected against discrimination based on gender identity in each of the 5 domains as a “1” (range 0–5). We also coded the absence of a law that protected projected against discrimination based on sexual orientation in each of the five domains as a “1” (range 0–5).

0 = Presence of a protective law

These two subscales were summed to create a total score (0–10) representing the lack of absence of SGM protective policies at the state-level. These data were accessed and saved in May 2023. However, the MAP website indicates there was no need for an update (e.g. there were no changes in State laws) since December 10, 2020.

Recently Introduced or Passed Discriminatory State Policy³

Differing bills targeting SGM rights have been under consideration and enacted in state-level legislatures across the country. We gathered data from the American Civil Liberties Union (ACLU) documenting the PRESENCE of discriminatory bills that were introduced and which died, were referred to committee or the governor, or were introduced and signed into law in the 2022 legislative session. These bills centered around ten topical areas across two domains: Anti-Transgender Bills (these bills included: restricting healthcare for transgender youth, single-sex facility restrictions, excluding transgender youth from athletics, other school or curriculum restrictions, restrictions on accessing accurate ID, and other bills that target transgender and nonbinary people for discrimination) and Religious exemption Bills (these bills included: Religious Freedom Restoration Acts, Religious exemptions in healthcare implicating SGM people, religious exemptions in adoption and foster care, and other religious exemption bills).

1 = The introduction of a bill in 2022 in each topical area across the three domains in the state (range 0–10)

And/or

1 = Adoption AND signing into law of a bill in 2022 in each of the topical areas in the state (range 0–10).

0 = No law passed or introduced in that topical area in the state

These two subscales were summed to create a total score (0–20) representing the presence of SGM discriminatory policies introduced in the 2022 legislative session.

Mediators

Depletion of economic resources

Food Security⁴

The questions in this scale ask you about your feelings and thoughts during the past 12 MONTHS. In each case, please indicate how often you felt or thought a certain way.

1. How often in the past 12 months, were you worried or stressed about having enough money to buy nutritious meals?

2. How often in the past 12 months did you worry your food would run out before you got money to buy more?

3. How often in the past 12 months, did the food you bought not last and you didn’t have money to get more?

Answer options ranged from 1 (Never) to 5 (Very Often).

Responses were summed (Cronbach’s alpha: SGM = 0.90, non-SGM = 0.91 Range: 3–15)

Perceived Financial Stress

The questions in this scale ask you about your feelings and thoughts during the past 12 MONTHS. In each case, please indicate how often you felt or thought a certain way.

1. How often in the past 12 months, were you worried or stressed about having enough money to pay your rent or mortgage?

2. How often in the past 12 months, were you worried or stressed about having enough money to pay for needed medical care or medication?

3. How often in the past 12 months, were you worried or stressed about having enough money to pay other bills (for example: phone, car, credit cards)?

Answer options ranged from 1 (Never) to 5 (Very Often).

Items were summed to construct a single measure of financial strain (Cronbach’s alpha: SGM = 0.86, non-SGM = 0.88; Range: 3–15)

Interpersonal Discrimination ⁵

In your day-to-day life, how often do any of the following things happen to you?

1. You are treated with less courtesy or respect than other people are.

2. You receive poorer service than other people at restaurants or stores.

3. People act as if they think you are not smart.

4. People act as if they are afraid of you.

5. You are called names or insulted.

6. You are threatened or harassed.

Answer options ranged from 1 (Never) to 5 (Almost every day).

Items were summed and averaged (Cronbach’s alpha = SGM = 0.84, non-SGM = 0.86; Range 1–5).

Perceived Stress⁶

The questions in this scale ask you about your feelings and thoughts during the last month. In each case, please indicate how often you felt or thought a certain way.

1. In the last month, how often have you felt that you were unable to control the important things in your life?

2. In the last month, how often have you felt confident about your ability to handle your personal problems?

3. In the last month, how often have you felt that things were going your way?

4. In the last month, how often have you felt difficulties were piling up so high that you could not overcome them?

Answer options ranged from 1 (Never) to 5 (Very Often).

Items were summed and averaged (Cronbach’s alpha = SGM = 0.83, non-SGM = 0.81; Range 1–5).

Demographics

Race/ethnicity

What racial and/or ethnic groups do you identify with? (Check all that apply)

o Asian

o Black/African American

o Hispanic/Latinx/Latino/Latina

o Middle Eastern

o Native American or Alaskan Native

o Pacific Islander

o White/Caucasian

o I use other words to describe my race and ethnicity

0 = “White/Caucasian”

1 = “BIPOC+” (all other response options, including those that selected multiple races)

Age

How old are you? (years)

This was an open response option.

Responses were transformed into a binary categorical variable.

0 = 18–24 years

1 = 25–35 years

Education

demo_educ What is your highest grade completed?

o 11th grade

o High school diploma or GED

o Technical school (Vocational Technical, Career Certificate, etc.)

o Some college (not graduated)

o Associate’s Degree

o Bachelor’s Degree

o Master’s Degree

o Doctoral Degree or other terminal Professional Degree (e.g. MD, JD)

0 = No four-year degree

1 = Four-year degree or higher

Sexual Orientation and Gender Identity

We know that sexuality and gender are complex and fluid. One challenge with research is that we need to group people into a smaller number of categories for statistical analyses. We think it is important to include LGBTQ people of diverse sexual and gender identities, but we don’t want to assign you to a group that doesn’t feel representative of who you are.  

 So, we want you to tell us: If you had to be counted in one sexual identity and one gender identity group, what would you choose?

If I had to choose, my sexual identity group would be:

o A lesbian / gay category

o A bisexual / bi+ / pansexual / plurisexual category

o A heterosexual category

o An asexual category

o Unsure because…(please specify)

If I had to choose, my gender identity group would be:

o A trans/transgender category (usually refers to people who were assigned a sex and gender at birth that does not accurately represent them)

o A cisgender category (usually refers to people who endorse the same sex and/or gender they were assigned at birth)

o A nonbinary category ( ususally refers to someone who has an identity other than exclusively woman/female or man/male)

0 = Cisgender and Heterosexual

1 = SGM (participants who described their sexual identity group as lesbian, bisexual, or asexual, or participants who described their gender identity group as transgender or nonbinary)

Dependent Variable: Current Tobacco use

Nicotine vaping

Have you ever used a nicotine vape or e-cigarette even one time? (Yes/No)

Do you currently use e-cigarettes or electronic nicotine vapes every day, some days, or not at all?

0 = Reported either never using an e-cigarette/nicotine vape, or ever used an e-cigarette/nicotine vape but currently not at all.

1 = Currently uses e-cigarettes/nicotine vapes some days or every day.

Combustible cigarette smoking

Have you ever smoked a combustible tobacco cigarette, even just one puff? (Yes/No)

Do you currently smoke cigarettes every day, some days, or not at all?

0 = Reported either never smoked a combustible cigarette, or ever smoked a combustible cigarette but currently not at all.

1 = Currently smokes combustible cigarettes some days or every day.