Minority stress, depression, and cigarette smoking among Chinese gay versus bisexual men: a two-group structural equation model analyses

• Authors: Jingjing Li, Emory University; Danqin Huang, Wuhan University; Michael Windle, Emory University; Ngoc-Cam Escoffery, Emory University; Wei Wang, Xuzhou Medical University; Xiaoyan Li, Wuhan University; Kevin Tao, Georgia Institute of Technology; Regine Haardoerfer, Emory University; R Haardorfer, Emory University; Shiyue Li, Wuhan University; Carla Berg, Emory University; Hong Yan, Wuhan University
• Journal Title: BMC PUBLIC HEALTH
• Volume: Volume 21, Number 1
• Publisher: BMC | 2021-07-09, Pages 1358-1358
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1186/s12889-021-10888-5
• Subjects: Engineering, Biomedical; Health Sciences, Oncology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Public, Environmental & Occupational Health; Minority stress; Depression; Cigarette; Smoking; Gay men; Bisexual men; China; CONNOR-DAVIDSON RESILIENCE; SEXUAL RISK BEHAVIORS; SOCIAL SUPPORT; SUBSTANCE USE; TOBACCO USE; INTERNALIZED HOMOPHOBIA; REJECTION SENSITIVITY; HONG-KONG; HEALTH; SCALE

Abstract

Background: Literature in the West suggested that bisexual men have a higher smoking rate compared to gay men. Data on patterns of smoking among gay and bisexual men are limited in Eastern Asian countries like China. This study examined the cigarette smoking prevalence for gay versus bisexual men in China and their unique minority stress - smoking pathways. Methods: Between September 2017 and November 2018, we surveyed a convenience sample of 538 gay men and 138 bisexual men recruited from local sexual minority organizations in four metropolitan cities in China (i.e., Beijing, Wuhan, Nanchang, and Changsha). Measures included sexual orientation, sociodemographics, theory-based minority stressors, depressive symptoms, and past 30-day cigarette smoking. Two-group (gay men vs. bisexual men) structural equation modeling (SEM) was used to test possible distinct mechanisms between theory-based stressors, depressive symptoms, and cigarette smoking among gay men and bisexual men, respectively. Results: The mean age of participants was 26.51 (SD = 8.41) years old and 76.3% of them had at least a college degree. Bisexual men reported a higher rate of cigarette smoking compared to gay men (39.9% vs. 27.3%). Two-group SEM indicated that the pathways for cigarette smoking were not different between gay and bisexual men. Higher rejection anticipation was associated with greater depressive symptoms (standardized β = 0.32, p <.001), and depressive symptoms were not associated with cigarette smoking. Conclusions: Minority stress, specifically rejection anticipation, may be critical considerations in addressing depressive symptoms, but not smoking, among both gay and bisexual men in China.