Abstract
INTRODUCTION: Sexual minority (SM) youth, especially those who identify as bisexual, have higher rates of nicotine and tobacco use and are more likely to become pregnant at a younger age than heterosexual youth. The goal of this study was to investigate the nicotine and tobacco experiences and motivations of SM people before and during pregnancy. AIMS AND METHODS: Pregnant and birthing individuals ages 16-24 who identified as a SM in an online survey were recruited for semi-structured video interviews about nicotine and tobacco use. Thirteen participants described nicotine and tobacco initiation, current or recent use, and cessation efforts. Using thematic analysis, the research team coded de-identified interview transcripts and identified themes related to their nicotine and tobacco use. RESULTS: Participants were cisgender women (average age = 19.6). Most identified as bisexual (86%) in addition to Black (36%) or biracial (36%). Four themes about nicotine and tobacco use were identified from participant interviews. Participants' reasons for nicotine and tobacco initiation were social, yet reasons for more regular use were stress-related. Participants' use of cigarettes was triggered by their cannabis use, and several substituted cannabis for cigarettes during cessation attempts. Participants identified pregnancy as a strong motivator to quit smoking, and attempted cessation without clinical assistance. CONCLUSIONS: Young SM people's greater risk of initiation and dependence on nicotine and tobacco products prior to conception may be related to social needs, stress, and use of cannabis. Current approaches and materials on smoking cessation are not being utilized by this population. IMPLICATIONS: This is the first qualitative study of nicotine and tobacco use among young pregnant SM people, primarily bisexual-identified, who are underrepresented in prenatal tobacco research. By telling their own stories, SM participants with lived experience of nicotine and tobacco use described the evolution of their motivations to use these products over time, cannabis use as a precipitant, the importance of pregnancy for smoking cessation, and perceptions about effective and ineffective factors in cessation efforts. The results of this study provide key information for prevention efforts to reduce tobacco-related health disparities for SM people.