Sexual Identity Moderates Age, Cigarette Use, and Depressive Symptom Trajectories Across Developmental Age

Background

Evidence linking smoking and depressive symptoms is inconsistent, warranting longitudinal studies using robust methods to assess causal relationships.

Study Design

Group-based trajectory models were used to investigate associations between cigarette use and depressive symptoms across developmental age and the moderating effects of sexual identity.

Methods

Multilevel modeling was used to compare trajectories of depressive symptoms from the Adolescent Health Survey. Regions of significance were estimated using Johnson-Neyman significance intervals for interaction terms. We modeled depressive symptom trajectories as a function of age, smoking behavior, and sexual orientation interaction.

Results

The conditional model yielded an ICC of 0.34, indicating a strong clustering effect over time. Both age (β□= 0.069, p□<□0.001) and age-squared (β□= -0.002, p□<□0.001) were positively associated with initial values of depressive symptoms, demonstrating significantly steeper declines over time (βage = -0.001, p□<□0.001). Bisexual identification was positively associated with depressive symptoms (β□= 0.001, p□<□0.01) and cigarette use (β□= 0.014, p□<□0.001) trajectories were significantly higher among bisexual identities up through young adulthood.

Conclusions

Our result highlights the importance of focusing interventions for those of bisexual identity in adolescence and their long-term impact on bisexual populations who use cigarettes.

• Bisexual individuals experience distinct differences regarding smoking behaviors and depressive symptoms across developmental age.

• It is essential to stratify identities into their respective groups rather than conflating them into a sexual minority group identity.

• Early-life interventions are necessary to support minoritized populations, particularly those who identify as bisexual.

• Specific implementation of policies to improve mental health and smoking cessation for those identifying as bisexual is highly suggested.