title: A Persistent Disparity: Smoking in Rural Sexual and Gender Minorities.
abstract: OBJECTIVE
  Sexual and gender minorities (SGM) smoke cigarettes at higher rates than the general population. Historically, research in SGM health issues was conducted in urban populations and recent population-based studies seldom have sufficient SGM participants to distinguish urban from rural. Given that rural populations also tend to have a smoking disparity, and that many SGM live in rural areas, it is vitally important to understand the intersection of rural residence, SGM identity, and smoking. This study analyzes the patterns of smoking in urban and rural SGM in a large sample.
  
  
  METHODS
  We conducted an analysis of 4280 adult participants in the Out, Proud, and Healthy project with complete data on SGM status, smoking status, and zip code. Surveys were conducted at 6 Missouri Pride Festivals and online in 2012. Analysis involved descriptive and bivariate methods, and multivariable logistic regression. We used GIS mapping to demonstrate the dispersion of rural SGM participants.
  
  
  RESULTS
  SGM had higher smoking proportion than the non-SGM recruited from these settings. In the multivariable model, SGM identity conferred 1.35 times the odds of being a current smoker when controlled for covariates. Rural residence was not independently significant, demonstrating the persistence of the smoking disparity in rural SGM. Mapping revealed widespread distribution of SGM in rural areas.
  
  
  CONCLUSIONS
  The SGM smoking disparity persists among rural SGM. These communities would benefit from continued research into interventions targeting both SGM and rural tobacco control measures. Recruitment at Pride Festivals may provide a venue for reaching rural SGM for intervention.
authors.affiliation: Department of Family & Community Medicine, University of Kentucky, Lexington KY, USA.
authors.forename: Keisa
authors.initials: K
authors.lastname: Bennett
authors.affiliation: Department of Family & Community Medicine, University of Missouri, Columbia MO, USA.
authors.forename: Jane A
authors.initials: JA
authors.lastname: McElroy
authors.affiliation: Academic Planning, Analytics & Technologies, University of Kentucky, Lexington KY, USA.
authors.forename: Andrew O
authors.initials: AO
authors.lastname: Johnson
authors.affiliation: Department of Health Sciences, Indiana University, Indianapolis IN, USA.
authors.forename: Niki
authors.initials: N
authors.lastname: Munk
authors.affiliation: Department of Family & Community Medicine, University of Missouri, Columbia MO, USA.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Everett
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D008923:Missouri / Q000453:epidemiology; D012424:Rural Population; D019529:Sexuality; D012907:Smoking / Q000453:epidemiology*; D064890:Social Determinants of Health; D011795:Surveys and Questionnaires; D063106:Transgender Persons; D014505:Urban Population
keywords: drug abuse; health disparities; sexual minorities; social determinants of health