Sexual Identity and Tobacco Use in a Venue-Based Sample of Adolescents and Young Adults


      Tobacco use has been found to be more prevalent among lesbian, gay, bisexual, and transgender (LGBT) adults than among the general population, but there is little information about LGBT youth. This study examined tobacco use in relation to sexual identity in a community venue-based sample of youth.


      Time–space sampling was used to select individuals aged 13–24 years visiting venues frequented by both LGBT and non-LGBT youth, including drop-in and recreational centers, cafes, bars, and a park. ORs for the association between LGBT identity and tobacco use were estimated using logistic regression models with adjustment for demographic covariates and venue selection. The two main outcomes were lifetime and last-30-day cigarette smoking. Sixteen secondary outcomes pertained to the type, initiation, frequency, and quantity of tobacco use; symptoms of dependence; and cessation.


      Seventy-seven percent (500/653) of eligible participants completed surveys by interview in 2005–2006. Sixty-three percent smoked in the last 30 days, 22% smoked more than 30 days ago, and 17% reported no prior cigarette smoking. LGBT identity predicted any prior cigarette use (OR 2.2, 95% CI=1.7, 3.2), but not recent use. Compared to non-LGBT youth, LGBT participants were less likely to use smokeless tobacco (OR 0.6, 95% CI=0.5, 0.7) and to want to quit smoking cigarettes (OR 0.6, 95% CI=0.5, 0.8). Other tobacco-related attitudes and behaviors were similar.


      Few meaningful differences in tobacco use were related to sexual identity. The remarkably high levels of cigarette smoking in the sample highlights the need for prevention and cessation resources.
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        • Ryan H.
        • Wortley P.M.
        • Easton A.
        • Pederson L.
        • Greenwood G.
        Smoking among lesbians, gays, and bisexuals: a review of the literature.
        Am J Prev Med. 2001; 21: 142-149
        • Rosario M.
        • Hunter J.
        • Gwadz M.
        Exploration of substance use among lesbian, gay, and bisexual youth: prevalence and correlates.
        J Adolesc Res. 1997; 12: 454-476
        • Garofalo R.
        • Wolf R.C.
        • Kessel S.
        • Palfrey S.J.
        • DuRant R.H.
        The association between health risk behaviors and sexual orientation among a school-based sample of adolescents.
        Pediatrics. 1998; 101: 895-902
        • Bontempo D.E.
        • D'Augelli A.R.
        Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths' health risk behavior.
        J Adolesc Health. 2002; 30: 364-374
        • Russell S.T.
        • Driscoll A.K.
        • Truong N.
        Adolescent same-sex romantic attractions and relationships: implications for substance use and abuse.
        Am J Public Health. 2002; 92: 198-202
        • Faulkner A.H.
        • Cranston K.
        Correlates of same-sex sexual behavior in a random sample of Massachusetts high school students.
        Am J Public Health. 1998; 88: 262-266
        • Eisenberg M.
        • Wechsler H.
        Substance use behaviors among college students with same-sex and opposite-sex experience: results from a national study.
        Addict Behav. 2003; 28: 899-913
        • Eisenberg M.E.
        • Wechsler H.
        Social influences on substance-use behaviors of gay, lesbian, and bisexual college students: findings from a national study.
        Soc Sci Med. 2003; 57: 1913-1923
        • Ridner S.L.
        • Frost K.
        • Lajoie A.S.
        Health information and risk behaviors among lesbian, gay, and bisexual college students.
        J Am Acad Nurse Pract. 2006; 18: 374-378
        • McCabe S.E.
        • Boyd C.
        • Hughes T.L.
        • d'Arcy H.
        Sexual identity and substance use among undergraduate students.
        Subst Abus. 2003; 24: 77-91
        • McCabe S.E.
        • Hughes T.L.
        • Boyd C.J.
        Substance use and misuse: are bisexual women at greater risk?.
        J Psychoactive Drugs. 2004; 36: 217-225
        • Austin S.B.
        • Ziyadeh N.
        • Fisher L.B.
        • Kahn J.A.
        • Colditz G.A.
        • Frazier A.L.
        Sexual orientation and tobacco use in a cohort study of U.S. adolescent girls and boys.
        Arch Pediatr Adolesc Med. 2004; 158: 317-322
        • McCabe S.E.
        • Hughes T.L.
        • Bostwick W.
        • Boyd C.J.
        Assessment of difference in dimensions of sexual orientation: implications for substance use research in a college-age population.
        J Stud Alcohol. 2005; 66: 620-629
        • Remafedi G.
        Adolescent homosexuality: psychosocial and medical implications.
        Pediatrics. 1987; 79: 331-337
        • Brener N.D.
        • Kann L.
        • Kinchen S.A.
        • et al.
        Methodology of the youth risk behavior surveillance system.
        MMWR Recomm Rep. 2004; 53: 1-13
        • Money J.
        Gender: history, theory and usage of the term in sexology and its relationship to nature/nurture.
        J Sex Marital Ther. 1985; 11: 71-79
        • Rosenbaum P.
        Heterogeneity and causality: unit heterogeneity and design sensitivity in observational studies.
        Am Stat. 2005; 59: 147-152
        • Resnick M.D.
        • Blum R.W.
        The association of consensual sexual intercourse during childhood with adolescent health risk and behaviors.
        Pediatrics. 1994; 94: 907-913
        • Remafedi G.
        • Carol H.
        Preventing tobacco use among lesbian, gay, bisexual, and transgender youths.
        Nicotine Tob Res. 2005; 7: 249-256
        • Remafedi G.
        Lesbian, gay, bisexual, and transgender youths: who smokes, and why?.
        Nicotine Tob Res. 2007; 9: S65-S71
      1. CDC. Brief street interview/ quantitative interview. Atlanta GA, 2001.

        • Kinsey A.C.
        • Pomeroy W.B.
        • Martin C.E.
        Sexual behavior in the human male.
        W.B. Saunders, Philadelphia1948
        • Remafedi G.
        • Resnick M.
        • Blum R.
        • Harris L.
        Demography of sexual orientation in adolescents.
        Pediatrics. 1992; 89: 714-721
      2. Youth tobacco surveillance—United States, 2000.
        MMWR CDC Surveill Summ. 2001; 50: 1-84
        • Brener N.D.
        • Collins J.L.
        • Kann L.
        • Warren C.W.
        • Williams B.I.
        Reliability of the youth risk behavior survey questionnaire.
        Am J Epidemiol. 1995; 141: 575-580
        • Kann L.
        • Kinchen S.A.
        • Williams B.I.
        • et al.
        Youth risk behavior surveillance—United States, 1999.
        J Sch Health. 2000; 70: 271-285
        • Johnston L.D.
        • O'Malley P.M.
        • Bachman J.G.
        Monitoring the future national results on adolescent drug use: overview of key findings, 2001.
        National Institute on Drug Abuse, Bethesda MD2002
        • Pierce J.P.
        • Gilpin E.A.
        Impact of over-the-counter sales on effectiveness of pharmaceutical aids for smoking cessation.
        JAMA. 2002; 288: 1260-1264
      3. Minnesota Department of Health, Blue Cross and Blue Shield of Minnesota, Minnesota Partnership for Action Against Tobacco, University of Minnesota. Patterns of smoking among Minnesota's young adults.

        • Mackellar D.
        • Valleroy L.
        • Karon J.
        • Lemp G.
        • Janssen R.
        The young men's survey: methods for estimating HIV seroprevalence and risk factors among young men who have sex with men.
        Public Health Rep. 1996; 111: 138-144
      4. Minnesota Department of Health Center for Health Statistics. Changes in tobacco use by Minnesota Youth, 2000–2005: Results from the Minnesota youth tobacco survey. 2005.

      5. U.S. Census Bureau. United States Census 2000. 2007.

        • Kalton G.
        Sampling flow of mobile human populations.
        Surv Methodol. 1991; 17: 183-194
        • Kalton G.
        Sampling considerations in research on HIV risk and illness.
        in: Ostrow D.G. Kessler R.C. Plenum Press, New York1993
        • Remafedi G.
        Suicidality in a venue-based sample of young men who have sex with men.
        J Adolesc Health. 2002; 31: 305-310
        • Pollack L.M.
        • Osmond D.H.
        • Paul J.P.
        • Catania J.A.
        Evaluation of the Center for Disease Control and Prevention's HIV behavioral surveillance of men who have sex with men: sampling issues.
        Sex Transm Dis. 2005; 32: 581-589
        • Stueve A.
        • O'Donnell L.N.
        • Duran R.
        • San D.A.
        • Blome J.
        Time–space sampling in minority communities: results with young Latino men who have sex with men.
        Am J Public Health. 2001; 91: 922-926
        • Guenther-Grey C.A.
        • Varnell S.
        • Weiser J.I.
        • et al.
        Trends in sexual risk-taking among urban young men who have sex with men, 1999–2002.
        J Natl Med Assoc. 2005; 97: 38S-43S
        • Lemp G.F.
        • Hirozawa A.M.
        • Givertz D.
        • et al.
        Seroprevalence of HIV and risk behaviors among young homosexual and bisexual men.
        JAMA. 1994; 272: 449-454
        • Valleroy L.A.
        • MacKellar D.A.
        • Karon J.M.
        • et al.
        HIV prevalence and associated risks in young men who have sex with men.
        JAMA. 2000; 284: 198-204
        • Muhib F.B.
        • Lin L.S.
        • Stueve A.
        • et al.
        A venue-based method for sampling hard-to-reach populations.
        Public Health Rep. 2001; 116: 216-222
        • Robinson W.T.
        • Risser J.M.
        • McGoy S.
        • et al.
        Recruiting injection drug users: a three-site comparison of results and experiences with respondent-driven and targeted sampling procedures.
        J Urban Health. 2006; 83: 29-38
        • Kelly B.C.
        • Parsons J.T.
        • Wells B.E.
        Prevalence and predictors of club drug use among club-going young adults in New York city.
        J Urban Health. 2006; 83: 884-895
        • Choi K.H.
        • McFarland W.
        • Neilands T.B.
        • et al.
        High level of hepatitis B infection and ongoing risk among Asian/Pacific Islander men who have sex with men, San Francisco, 2000–2001.
        Sex Transm Dis. 2005; 32: 44-48
        • Parsons J.T.
        • Kelly B.C.
        • Wells B.E.
        Differences in club drug use between heterosexual and lesbian/bisexual females.
        Addict Behav. 2006; 31: 2344-2349
      6. Harris Interactive. Six out of ten adults surveyed prefer smoke-free bars and clubs. 2003.

      7. Harris Interactive. HIV/AIDS and heart disease should be nation's top health care priorities, according to new national survey of gays and nongays. 2003.