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Tobacco Product Use Among Sexual Minority Adults

Findings From the 2012−2013 National Adult Tobacco Survey
Published:October 30, 2015DOI:https://doi.org/10.1016/j.amepre.2015.07.041

      Introduction

      A growing body of evidence reveals higher rates of tobacco use among sexual minority populations relative to non-minority (“straight”) populations. This study seeks to more fully characterize this disparity by examining tobacco use by distinct sexual identities and gender to better understand patterns of: (1) cigarette smoking and smoking history; and (2) use of other tobacco products including cigars, pipes, hookah, e-cigarettes, and smokeless tobacco.

      Methods

      Data from the 2012−2013 National Adult Tobacco Survey, a random-digit dialed landline and cellular telephone survey of U.S. adults aged ≥18 years, were analyzed in 2014. A sexual minority category was created by combining gay, lesbian, and bisexual responses, along with those who selected an option for other non-heterosexual identities.

      Results

      Smoking prevalence was higher among sexual minority adults (27.4%) than straight adults (17.3%). Cigarette smoking was particularly high among bisexual women (36.0%). Sexual minority women started smoking and transitioned to daily smoking earlier than their straight peers. Use of other tobacco products was higher among sexual minority women: prevalence of e-cigarette (12.4%), hookah (10.3%), and cigar use (7.2%) was more than triple that of their straight female peers (3.4%, 2.5%, and 1.3%, respectively). Likewise, prevalence of sexual minority men’s e-cigarette (7.9%) and hookah (12.8%) use exceeded that of straight men (4.7% and 4.5%, respectively).

      Conclusions

      Tobacco use is significantly higher among sexual minority than straight adults, particularly among sexual minority women. These findings underscore the importance of tobacco control efforts designed to reach sexual minorities and highlight the heterogeneity of tobacco use within this population.
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      References

        • IOM
        The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding.
        The National Academies Press, Washington, DC2011
        • Blosnich J.R.
        • Farmer G.W.
        • Lee J.G.L.
        • Silenzio V.M.B.
        • Bowen D.J.
        Health inequalities among sexual minority adults: evidence from ten U.S. States, 2010.
        Am J Prev Med. 2014; 46: 337-349https://doi.org/10.1016/j.amepre.2013.11.010
        • Blosnich J.
        • Lee J.G.
        • Horn K.
        A systematic review of the aetiology of tobacco disparities for sexual minorities.
        Tob Control. 2013; 22: 66-73https://doi.org/10.1136/tobaccocontrol-2011-050181
        • Lee J.G.
        • Griffin G.K.
        • Melvin C.L.
        Tobacco use among sexual minorities in the USA, 1987 to May 2007: a systematic review.
        Tob Control. 2009; 18: 275-282https://doi.org/10.1136/tc.2008.028241
        • Agaku I.T.
        • King B.A.
        • Husten C.G.
        • et al.
        Tobacco product use among adults—United States, 2012-2013.
        MMWR. 2014; 63: 542-547
        • Jamal A.
        • Agaku I.T.
        • O’Connor E.
        • et al.
        Current cigarette smoking among adults—United States, 2005-2013.
        MMWR. 2014; 63: 1108-1112
      1. Surgeon General’s Report: The health consequences of smoking—50 years of progress. CDC website. www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/. Accessed December 5, 2014.

        • King B.A.
        • Dube S.R.
        • Tynan M.A.
        Current tobacco use among adults in the United States: findings from the National Adult Tobacco Survey.
        Am J Public Health. 2012; 102: e93-e100https://doi.org/10.2105/AJPH.2012.301002
        • Rath J.M.
        • Villanti A.C.
        • Rubenstein R.A.
        • Vallone D.M.
        Tobacco use by sexual identity among young adults in the United States.
        Nicotine Tob Res. 2013; 15: 1822-1831https://doi.org/10.1093/ntr/ntt062
        • 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: 142-149https://doi.org/10.1016/S0749-3797(01)00331-2
        • Ward B.W.
        • Dahlhamer J.M.
        • Galinsky A.M.
        • Joestle S.S.
        Sexual orientation and health among U.S. adults: National Health Interview Survey, 2013.
        Natl Health Stat Report. 2014; (www.cdc.gov/nchs/data/nhsr/nhsr077.pdf): 77
        • Fallin A.
        • Goodin A.J.
        • King B.A.
        Menthol cigarette smoking among lesbian, gay, bisexual, and transgender adults.
        Am J Prev Med. 2015; 48: 93-97https://doi.org/10.1016/j.amepre.2014.07.044
      2. Saving 1 Million Lives for Pride: Surgeon General releases LGBT smoking video. LGBT HealthLink website. http://blog.lgbthealthlink.org/2014/06/27/saving-1-million-lives-for-pride-surgeon-general-releases-lgbt-smoking-video/. Accessed August 22, 2014.

        • Hatzenbuehler M.L.
        • Phelan J.C.
        • Link B.G.
        Stigma as a fundamental cause of population health inequalities.
        Am J Public Health. 2013; 103: 813-821https://doi.org/10.2105/AJPH.2012.301069
        • Hatzenbuehler M.L.
        How does sexual minority stigma “get under the skin”? A psychological mediation framework.
        Psychol Bull. 2009; 135: 707-730https://doi.org/10.1037/a0016441
        • Meyer I.H.
        Minority stress and mental health in gay men.
        J Health Soc Behav. 1995; 36: 38-56https://doi.org/10.2307/2137286
        • Meyer I.H.
        Prejudice as stress: conceptual and measurement problems.
        Am J Public Health. 2003; 93: 262-265https://doi.org/10.2105/AJPH.93.2.262
        • Rosario M.
        • Schrimshaw E.W.
        • Hunter J.
        Cigarette smoking as a coping strategy: negative implications for the subsequent psychological distress among lesbian, gay, and bisexual youths.
        J Pediatr Psychol. 2011; 36: 731-742https://doi.org/10.1093/jpepsy/jsp141
        • Dilley J.A.
        • Spigner C.
        • Boysun M.J.
        • Dent C.W.
        • Pizacani B.A.
        Does tobacco industry marketing excessively impact lesbian, gay and bisexual communities?.
        Tob Control. 2008; 17: 385-390https://doi.org/10.1136/tc.2007.024216
        • Offen N.
        • Smith E.A.
        • Malone R.E.
        From adversary to target market: the ACT-UP boycott of Philip Morris.
        Tob Control. 2003; 12: 203-207https://doi.org/10.1136/tc.12.2.203
        • Smith E.A.
        • Malone R.E.
        The outing of Philip Morris: advertising tobacco to gay men.
        Am J Public Health. 2003; 93: 988-993https://doi.org/10.2105/AJPH.93.6.988
        • Smith E.A.
        • Thomson K.
        • Offen N.
        • Malone R.E.
        “If you know you exist, it’s just marketing poison”: meanings of tobacco industry targeting in the lesbian, gay, bisexual, and transgender community.
        Am J Public Health. 2008; 98: 996-1003https://doi.org/10.2105/AJPH.2007.118174
        • Washington H.A.
        Burning love: big tobacco takes aim at LGBT youths.
        Am J Public Health. 2002; 92: 1086-1095https://doi.org/10.2105/AJPH.92.7.1086
      3. Project SCUM. Winston-Salem, NC: RJ Reynolds, 1995. University of California, San Francisco Industrial Documents Digital Library website. https://industrydocuments.library.ucsf.edu/tobacco/docs/#id=sfck0098. Accessed October 31, 2014.

        • Stevens P.
        • Carlson L.M.
        • Hinman J.M.
        An analysis of tobacco industry marketing to lesbian, gay, bisexual, and transgender (LGBT) populations: strategies for mainstream tobacco control and prevention.
        Health Promot Pract. 2004; 5: 129S-134Shttps://doi.org/10.1177/1524839904264617
        • Marshal M.P.
        • Friedman M.S.
        • Stall R.N.
        • Thompson A.L.
        Individual trajectories of substance use in lesbian, gay and bisexual youth and heterosexual youth.
        Addiction. 2009; 104: 974-981https://doi.org/10.1111/j.1360-0443.2009.02531.x
        • Fallin A.
        • Goodin A.
        • Lee Y.O.
        • Bennett K.
        Smoking characteristics among lesbian, gay, and bisexual adults.
        Prev Med. 2015; 74: 123-130https://doi.org/10.1016/j.ypmed.2014.11.026
        • Corliss H.L.
        • Wadler B.M.
        • Jun H.-J.
        • et al.
        Sexual-orientation disparities in cigarette smoking in a longitudinal cohort study of adolescents.
        Nicotine Tob Res. 2013; 15: 213-222https://doi.org/10.1093/ntr/nts114
        • Pepper J.K.
        • Brewer N.T.
        Electronic nicotine delivery system (electronic cigarette) awareness, use, reactions and beliefs: a systematic review.
        Tob Control. 2014; 23: 375-384https://doi.org/10.1136/tobaccocontrol-2013-051122
        • Dahlhamer J.M.
        • Galinsky A.M.
        • Joestl S.S.
        • Ward B.W.
        Sexual orientation in the 2013 National Health Interview Survey: a quality assessment.
        Vital Health Stat 2. 2014; : 1-32
        • Miller K.
        • Ryan J.M.
        Design, Development and Testing of the NHIS Sexual Identity Question.
        National Center for Health Statistics Questionnaire Design Research Laboratory, Atlanta, GA2011
      4. Cain VS. Improving measurement of sexual orientation in US Health Surveys. European Conference on Quality in Official Statistics, 2012. www.q2012.gr/articlefiles/sessions/29.1_%20Cain_Sexual%20Orientation%20CAIN.pdf. Accessed October 31, 2014.

      5. National Health Interview Survey 2000. Cancer Module. 2001. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Survey_Questionnaires/NHIS/2000/qcancerx.pdf. Accessed May 21, 2015.

      6. CDC. 2012−2013 National Adult Tobacco Survey weighting specifications. www.cdc.gov/tobacco/data_statistics/surveys/nats/pdfs/2012_13_weighting_methodology.pdf. Accessed May 21, 2015.

        • Trocki K.F.
        • Drabble L.A.
        • Midanik L.T.
        Tobacco, marijuana use and sensation-seeking: comparisons across gay, lesbian, bisexual and heterosexual groups.
        Psychol Addict Behav. 2009; 23: 620-631https://doi.org/10.1037/a0017334
        • Matthews A.K.
        • Riley R.B.
        • Everett B.
        • Hughes T.L.
        • Aranda F.
        • Johnson T.
        A longitudinal study of the correlates of persistent smoking among sexual minority women.
        Nicotine Tob Res. 2014; 16: 1199-1206https://doi.org/10.1093/ntr/ntu051
        • King M.
        • Semlyen J.
        • Tai S.S.
        • et al.
        A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people.
        BMC Psychiatry. 2008; 8: 70https://doi.org/10.1186/1471-244X-8-70
        • Balsam K.F.
        • Mohr J.J.
        Adaptation to sexual orientation stigma: a comparison of bisexual and lesbian/gay adults.
        J Counsel Psych. 2007; 54: 306-319https://doi.org/10.1037/0022-0167.54.3.306
        • Bostwick W.
        Assessing bisexual stigma and mental health status: a brief report.
        J Bisex. 2012; 12: 214-222https://doi.org/10.1080/15299716.2012.674860
        • Pompili M.
        • Lester D.
        • Forte A.
        • et al.
        Bisexuality and suicide: a systematic review of the current literature.
        J Sex Med. 2014; 11: 1903-1913https://doi.org/10.1111/jsm.12581
        • Fredriksen-Goldsen K.I.
        • Kim H.J.
        • Barkan S.E.
        • Balsam K.F.
        • Mincer L.S.
        Disparities in health-related quality of life: a comparison of lesbians and bisexual women.
        Am J Public Health. 2010; 100: 1903-1913https://doi.org/10.2105/AJPH.2009.177329
        • Przedworski J.M.
        • McAlpine D.D.
        • Karaca-Mandic P.
        • VanKim N.A.
        Health and health risks among sexual minority women: an examination of 3 subgroups.
        Am J Public Health. 2014; 104: 1045-1047https://doi.org/10.2105/AJPH.2013.301733
        • Conron K.J.
        • Mimiaga M.J.
        • Landers S.J.
        A population-based study of sexual orientation identity and gender differences in adult health.
        Am J Public Health. 2010; 100: 1953-1960https://doi.org/10.2105/AJPH.2009.174169
        • Cole E.R.
        Intersectionality and research in psychology.
        Am Psychol. 2009; 64: 170-180https://doi.org/10.1037/a0014564
        • Kendzor D.E.
        • Businelle M.S.
        • Reitzel L.R.
        • et al.
        Everyday discrimination is associated with nicotine dependence among African American, Latino, and white smokers.
        Nicotine Tob Res. 2014; 16: 633-640https://doi.org/10.1093/ntr/ntt198
        • Newcomb M.E.
        • Heinz A.J.
        • Birkett M.
        • Mustanski B.
        A longitudinal examination of risk and protective factors for cigarette smoking among lesbian, gay, bisexual and transgender youth.
        J Adolesc Health. 2014; 54: 558-564https://doi.org/10.1016/j.jadohealth.2013.10.208
        • Seil K.S.
        • Desai M.M.
        • Smith M.V.
        Sexual orientation, adult connectedness, substance use, and mental health outcomes among adolescents: findings from the 2009 New York City Youth Risk Behavior Survey.
        Am J Public Health. 2014; 104: 1950-1956https://doi.org/10.2105/AJPH.2014.302050
      7. Tips from former smokers: lesbian, gay, bisexual, and transgender (LGBT). CDC website. www.cdc.gov/tobacco/campaign/tips/groups/lgbt.html. Accessed October 31, 2014.

        • Matthews A.K.
        • Balsam K.
        • Hotton A.
        • Kuhns L.
        • Li C.-C.
        • Bowen D.J.
        Awareness of media-based antitobacco messages among a community sample of LGBT individuals.
        Health Promot Pract. 2014; 15: 857-866https://doi.org/10.1177/1524839914533343
      8. National Cancer Institute. The Role of the Media in Promoting and Reducing Tobacco Use. Tobacco Control Monograph No. 19. Bethesda, MD: U.S. DHHS, Public Health Service, NIH, National Cancer Institute; 2008. NIH Publication No. 07-6242.

      9. The GenIUSS Group; Herman JL, ed. Best Practices for Asking Questions to Identify Transgender and Other Gender Minority Respondents on Population-Based Surveys. Los Angeles, CA: The Williams Institute; 2014

      10. Chalabi M. Why we don’t know the size of the transgender population. FiveThirtyEightLife website. http://fivethirtyeight.com/features/why-we-dont-know-the-size-of-the-transgender-population/. Accessed August 6, 2014.

        • Grant J.M.
        • Mottet L.A.
        • Tanis J.
        • et al.
        Injustice at Every Turn: A Report of the National Transgender Discrimination Survey.
        National Center for Transgender Equality and National Gay and Lesbian Task Force, Washington, DC2011
        • IOM
        Collecting Sexual Orientation and Gender Identity Data in Electronic Health Records: Workshop Summary.
        The National Academies Press, Washington, DC2013
      11. U.S. DHHS. Advancing LGBT Health & Well-Being: 2014 Report. HHS LGBT Issues Coordinating Committee. www.hhs.gov/sites/default/files/dhhs-lgbt2014annualreport.pdf. Accessed January 12, 2015.

      12. Gates GJ, Newport F. Special report: 3.4% of U.S. adults identify as LGBT. Gallup website. www.gallup.com/poll/158066/special-report-adults-identify-lgbt.aspx. Accessed October 31, 2014.

      13. Hoffman J. How many Americans are lesbian, gay, or bisexual? The New York Times. July 21, 2014. http://well.blogs.nytimes.com/2014/07/21/how-many-americans-are-lesbian-gay-or-bisexual/?emc=eta1&_r=1. Accessed July 25, 2014.

      14. Somashekhar S. Gay-rights groups dispute federal survey’s estimate of population. The Washington Post. August 1, 2014. www.washingtonpost.com/national/gay-rights-groups-dispute-federal-surveys-estimate-of-population/2014/07/31/6e614f62-1731-11e4-9349-84d4a85be981_story.html. Accessed August 8, 2014.

        • Blosnich J.R.
        • Jarrett T.
        • Horn K.
        Racial and ethnic differences in current use of cigarettes, cigars, and hookahs among lesbian, gay, and bisexual young adults.
        Nicotine Tob Res. 2011; 13: 487-491https://doi.org/10.1093/ntr/ntq261
        • Hughes T.L.
        • Johnson T.P.
        • Matthews A.K.
        Sexual orientation and smoking: results from a multisite women’s health study.
        Subst Use Misuse. 2008; 43: 1218-1239https://doi.org/10.1080/10826080801914170

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