“It’s just a way of fitting in:” Tobacco use and the lived experience of lesbian, gay, and bisexual appalachians

Lesbian, gay, and bisexual (LGB) people are affected by multiple health disparities and risk factors, including tobacco use. Few studies to date have examined tobacco use specifically in rural LGB populations, and none has investigated the intersections of identity, rural LGB culture, and tobacco. The purpose of this study was to explore the perspective of Appalachian LGB people regarding tobacco use. Methods. Nineteen LGB-identified Appalachian residents participated in audiotaped, semi-structured interviews. Two authors analyzed and coded transcripts through constant comparison, and determined themes through consensus. Results. Five themes emerged: the convergence of Appalachian and LGB identities, tacit awareness of LGB identity by others, culture and tobacco use, perceived associations with tobacco use, and health beliefs and health care. Conclusions. LGB Appalachians connect stress and culture to tobacco, but seem less aware that partial concealment of their identity might be a source of the stress that could influence their smoking.