Intersectional discrimination acutely and vicariously affects cessation outcomes and psychological processes between...

Smoking-concordant, same-sex couples face multilevel contextual challenges in their cessation attempts. Cross-sectional studies have documented positive association between perceived discrimination (PD) and smoking to explain the differences between heterosexual/cisgender and LGBTQ + groups. However, acute effects of PD or intersectional PD on cessation outcomes are rarely studied, especially in the context of romantic couples who share concordant smoking status. In this study, we focused on cessation-related outcomes among same-sex/same-gender, smoking concordant couples during an unaided quit attempt and examined the acute and vicarious effects of PD and intersectional PD captured via 4-week daily assessments.

In 2021-2023, same-sex/same-gender couples (N = 103 dyads, aged 21-68, 48.5 % female couples) responded to daily assessments on smartphone at the end of the day during a 4-week smoking quit attempt. Participants reported the occurrence of PD and intersectional PD, cigarettes and other substances used that day, perceived quit stress, and quit support. Multilevel dyadic analyses were conducted to examine four cessation-related outcomes: (1) likelihood of cigarette smoking; (2) likelihood of co-using multiple substances; (3) quit stress; and (4) quit support.

Participants' own PD was associated with greater likelihood of smoking (p = 0.04), greater quit stress (p < 0.001) and lower quit support (p = 0.007), but not with co-using. PD experienced by one's partner was acutely associated with increased smoking (p = 0.01) and lower quit support (p < 0.05). Intersectional PD acutely and vicariously was associated with quit stress and quit support (p's < 0.01), but not with likelihood of cigarette smoking or co-using.

We found that experiencing discrimination acutely leads to increased likelihood of smoking during a quit attempt among same-sex/same-gender smoking status concordant couples. We also documented adverse, vicarious effects of discrimination on quit-related process variables. Our findings suggest that coping strategies upon experiencing a discriminatory event may include smoking cigarettes, in part via the depletion of support received from one's romantic partner.