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Tobacco Use and Sexual Orientation in a National Cross-sectional Study: Age, Race/Ethnicity, and Sexual Identity–Attraction Differences

  • Sean Esteban McCabe
    Correspondence
    Address correspondence to: Sean Esteban McCabe, PhD, Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, 400 N. Ingalls, Ann Arbor MI 48109
    Affiliations
    Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan

    Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan
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  • Alicia K. Matthews
    Affiliations
    College of Nursing, Department of Health Systems Science, University of Illinois at Chicago, Chicago, Illinois
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  • Joseph G.L. Lee
    Affiliations
    College of Health and Human Performance, Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina
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  • Phil Veliz
    Affiliations
    Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan

    Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan
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  • Tonda L. Hughes
    Affiliations
    School of Nursing and Department of Psychiatry, Columbia University, New York, New York
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  • Carol J. Boyd
    Affiliations
    Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan

    Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan

    Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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      Introduction

      The purpose of this study is to determine the past-year prevalence estimates of any nicotine/tobacco use, cigarette smoking, and DSM-5 tobacco use disorder based on sexual identity among U.S. adults, and to examine potential variations in these estimates by age, race/ethnicity, and sexual identity–attraction concordance/discordance.

      Methods

      The 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions collected data via in-person interviews with a cross-sectional nationally representative sample of non-institutionalized adults (response rate=60.1%) and analyses for the present study were conducted in 2017.

      Results

      Any past-year nicotine/tobacco use, cigarette smoking, and DSM-5 tobacco use disorder were most prevalent among sexual minority–identified adults compared with heterosexual-identified adults, with notable variations based on sex, age, race/ethnicity, and sexual identity–attraction discordance. Elevated rates of any nicotine/tobacco use, cigarette smoking, and DSM-5 tobacco use disorder among sexual minorities were most prevalent among younger lesbian women and gay men, and all age groups of bisexual men and women. The odds of any nicotine/tobacco use, cigarette smoking, and DSM-5 tobacco use disorder were significantly greater among sexual identity–attraction discordant women and significantly lower among sexual identity–attraction discordant men.

      Conclusions

      These findings provide valuable new information about sexual minority subgroups, such as self-identified bisexual older adults and sexual identity–attraction discordant women, that appear to be at higher risk for adverse smoking-related health consequences as a result of their elevated rates of cigarette smoking. Additional attention is warranted to examine these high-risk subpopulations prospectively and, if the results are replicated with larger samples, this information can be used to target smoking-cessation and lung cancer screening efforts.
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      References

        • Hill S.
        • Amos A.
        • Clifford D.
        • Platt S.
        Impact of tobacco control interventions on socioeconomic inequalities in smoking: review of the evidence.
        Tob Control. 2014; 23: e89-e97https://doi.org/10.1136/tobaccocontrol-2013-051110
        • 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
        • Fredriksen-Goldsen K.I.
        • Kim H.J.
        • Barkan S.E.
        • Muraco A.
        • Hoy-Ellis C.P.
        Health disparities among lesbian, gay, and bisexual older adults: results from a population-based study.
        Am J Public Health. 2013; 103: 1802-1809https://doi.org/10.2105/AJPH.2012.301110
        • Lindström M.
        • Axelsson J.
        • Modén B.
        • Rosvall M.
        Sexual orientation, social capital and daily smoking: a population-based study.
        BMC Public Health. 2014; 14: 565https://doi.org/10.1186/1471-2458-14-565
        • Johnson S.E.
        • Holder-Hayes E.
        • Tessman G.K.
        • King B.A.
        • Alexander T.
        • Zhao X.
        Tobacco product use among sexual minority adults: findings from the 2012–2013 National Adult Tobacco Survey.
        Am J Prev Med. 2016; 50: e91-e100https://doi.org/10.1016/j.amepre.2015.07.041
        • Kasza K.A.
        • Ambrose B.K.
        • Conway K.P.
        • et al.
        Tobacco-product use by adults and youths in the Unted States in 2013 and 2014.
        N Engl J Med. 2017; 376: 342-353https://doi.org/10.1056/NEJMsa1607538
        • Kerridge B.T.
        • Pickering R.P.
        • Saha T.D.
        • et al.
        Prevalence, sociodemographic correlates and DSM-5 substance use disorders and other psychiatric disorders among sexual minorities in the United States.
        Drug Alcohol Depend. 2017; 170: 82-92https://doi.org/10.1016/j.drugalcdep.2016.10.038
        • 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
        • Lee J.G.
        • Blosnich J.R.
        • Melvin C.L.
        Up in smoke: vanishing evidence of tobacco disparities in the Institute of Medicine’s report on sexual and gender minority health.
        Am J Public Health. 2012; 102: 2041-2043https://doi.org/10.2105/AJPH.2012.300746
      1. Medley G, Lipari RN, Bose J, Cribb DS, Kroutil LA, McHenry G. Sexual orientation and estimates of adult substance use and mental health: results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. www.samhsa.gov/data/. Published 2016. Accessed October 10, 2017.

        • 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: 620-629https://doi.org/10.15288/jsa.2005.66.620
        • Matthews D.D.
        • Lee J.G.
        A profile of North Carolina lesbian, gay, and bisexual health disparities, 2011.
        Am J Public Health. 2014; 104: e98-e105https://doi.org/10.2105/AJPH.2013.301751
        • 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: 198-202https://doi.org/10.2105/AJPH.92.2.198
        • Drabble L.
        • Midanik L.T.
        • Trocki K.
        Reports of alcohol consumption and alcohol-related problems among homosexual, bisexual, and heterosexual respondents: results from the 2000 National Alcohol Survey.
        J Stud Alcohol. 2005; 66: 111-120https://doi.org/10.15288/jsa.2005.66.111
        • Matthews A.K.
        • Riley B.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
        • McCabe S.E.
        • Hughes T.L.
        • Bostwick W.B.
        • West B.T.
        • Boyd C.J.
        Sexual orientation, substance use behaviors, and substance dependence in the United States.
        Addiction. 2009; 104: 1333-1345https://doi.org/10.1111/j.1360-0443.2009.02596.x
        • Talley A.E.
        • Aranda F.
        • Hughes T.L.
        • Everett B.
        • Johnson T.P.
        Longitudinal associations among discordant sexual orientation dimensions and hazardous drinking in a cohort of sexual minority women.
        J Health Soc Behav. 2015; 56: 225-245https://doi.org/10.1177/0022146515582099
        • 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
        • Ortiz K.S.
        • Duncan D.T.
        • Blosnich J.R.
        • Salloum R.G.
        • Battle J.
        Smoking among sexual minorities: are there racial differences?.
        Nicotine Tob Res. 2015; 17: 1362-1368https://doi.org/10.1093/ntr/ntv001
        • Green K.E.
        • Feinstein B.A.
        Substance use in lesbian, gay, and bisexual populations: an update on empirical research and implications for treatment.
        Psychol Addict Behav. 2012; 26: 265-278https://doi.org/10.1037/a0025424
        • National Academy of Medicine
        The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding.
        National Academies Press, Washington, DC2011
        • Bauer G.R.
        • Jairam J.A.
        • Baidoobonso S.M.
        Sexual health, risk behaviors, and substance use in heterosexual-identified women with female sex partners: 2002 U.S. National Survey of Family Growth.
        Sex Transm Dis. 2010; 37: 531-537https://doi.org/10.1097/OLQ.0b013e3181d785f4
        • Gattis M.N.
        • Sacco P.
        • Cunningham-Williams R.M.
        Substance use and mental health disorders among heterosexual identified men and women who have same-sex partners or same-sex attraction: results from the national epidemiological survey on alcohol and related conditions.
        Arch Sex Behav. 2012; 41: 1185-1197https://doi.org/10.1007/s10508-012-9910-1
        • Meyer I.H.
        Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence.
        Psychol Bull. 2003; 129: 674-697https://doi.org/10.1037/0033-2909.129.5.674
        • Lee J.G.
        • Agnew-Brune C.B.
        • Clapp J.A.
        • Blosnich J.R.
        Out smoking on the big screen: tobacco use in LGBT movies, 2000–2011.
        Tob Control. 2014; 23: e156-e158https://doi.org/10.1136/tobaccocontrol-2013-051288
        • Pachankis J.E.
        The psychological implications of concealing a stigma: a cognitive-affective-behavioral model.
        Psychol Bull. 2007; 133: 328-345https://doi.org/10.1037/0033-2909.133.2.328
        • Emory K.
        • Kim Y.
        • Buchting F.
        • Vera L.
        • Huang J.
        • Emery S.L.
        Intergroup variance in lesbian, gay, and bisexual tobacco use behaviors: evidence that subgroups matter, notably bisexual women.
        Nicotine Tob Res. 2016; 18: 1494-1501https://doi.org/10.1093/ntr/ntv208
        • Copen C.
        • Chandra A.
        • Febo-Vazquez I.
        Sexual behavior, sexual attraction, and sexual orientation among adults aged 18–44 in the United States: data from the 2011–2013 National Survey of Family Growth.
        Natl Health Stat Rep. 2016; 88: 1-14
        • Laumann E.O.
        • Gagnon J.H.
        • Michael R.T.
        • Michaels S.
        The Social Organization of Sexuality.
        University of Chicago Press, Chicago, IL1994
        • Grant B.F.
        • Chu A.
        • Sigman R.
        • et al.
        Source and Accuracy Statement for the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC- III).
        National Institute on Alcohol Abuse and Alcoholism, Rockville, MD2015
        • Grant B.F.
        • Dawson D.A.
        • Stinson F.S.
        • Chou P.S.
        • Kay W.
        • Pickering R.
        The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample.
        Drug Alcohol Depend. 2003; 71: 7-16https://doi.org/10.1016/S0376-8716(03)00070-X
        • Grant B.F.
        • Goldstein R.B.
        • Smith S.M.
        • et al.
        The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5): reliability of substance use and psychiatric disorder modules in a general population sample.
        Drug Alcohol Depend. 2015; 148: 27-33https://doi.org/10.1016/j.drugalcdep.2014.11.026
        • Hasin D.S.
        • Greenstein E.
        • Aivadyan C.
        • et al.
        The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5): procedural validity of substance use disorders modules through clinical re-appraisal in a general population sample.
        Drug Alcohol Depend. 2015; 148: 40-46https://doi.org/10.1016/j.drugalcdep.2014.12.011
        • Gruskin E.P.
        • Gordon N.
        Gay/lesbian sexual orientation increases risk for cigarette smoking and heavy drinking among members of a large Northern California health plan.
        BMC Public Health. 2006; 6: 241https://doi.org/10.1186/1471-2458-6-241
        • Mays V.M.
        • Yancey A.K.
        • Cochran S.D.
        • Weber M.
        • Fielding J.E.
        Heterogeneity of health disparities among African American, Hispanic, and Asian American women: unrecognized influences of sexual orientation.
        Am J Public Health. 2002; 92: 632-639https://doi.org/10.2105/AJPH.92.4.632
        • Saladin M.E.
        • Gray K.M.
        • Carpenter M.J.
        • LaRowe S.D.
        • DeSantis S.M.
        • Upadhyaya H.P.
        Gender differences in craving and cue reactivity to smoking and negative affect/stress cues.
        Am J Addict. 2012; 21: 210-220https://doi.org/10.1111/j.1521-0391.2012.00232.x
        • Compton W.M.
        • Dawson D.
        • Duffy S.Q.
        • Grant B.F.
        The effect of inmate populations on estimates of DSM-IV alcohol and drug use disorders in the United States.
        Am J Psychiatry. 2010; 167: 473-474https://doi.org/10.1176/appi.ajp.2009.09081087
        • Meyer I.H.
        • Flores A.R.
        • Stemple L.
        • Romero A.P.
        • Wilson B.D.W.
        • Herman J.L.
        Incarceration rates and traits of sexual minorities in the United States: National Inmate Survey, 2011–2012.
        Am J Public Health. 2017; 107: 234-240https://doi.org/10.2105/AJPH.2016.303576