Tobacco use among sexual minorities in the USA, 1987 to May 2007: a systematic review

Abstract

No language restrictions were used. Abstracts were identified in the literature search (n = 734) and were independently read and coded for inclusion or exclusion by two reviewers. When agreement was not reached, a third reviewer acted as arbitrator. Abstracts were included if they presented data collected in the US from 1987 to May 2007 and reported prevalence or correlation of tobacco use with sexual minority status. Studies reporting data from HIV-positive samples were excluded. The identified articles (n = 46) were independently read by two reviewers who recorded key outcome measures, including prevalence and/or odds ratios of tobacco use, sample size and domain of sexuality (identity, behaviour, or desire). Factors relating to study design and methodology were used to assess study quality according to nine criteria. Results: In the 42 included studies, 119 measures of tobacco prevalence or association were reported. The available evidence points to disparities in smoking among sexual minorities that are significantly higher than among the general population. Conclusions: Ongoing, targeted interventions addressing smoking among sexual minorities are warranted in tobacco control programs.Tobacco use is a major contributor to morbidity and mortality in the US and throughout the world.1 2 The relative burden of tobacco-related disease will be affected by disparities in tobacco use among different socio-demographic groups. In the US, disparities in smoking prevalence have been demonstrated by age, educational attainment, race/ethnicity and gender. With respect to sexual minority populations (including individuals with gay, lesbian, bisexual and transgender identity, and individuals with same-sex relationships and/or attraction), past research has suggested that sexual minority status is associated with higher risk of smoking. In 2001, Ryan and colleagues 4 conducted the first systematic review of smoking among sexual minority populations and identified 12 studies reporting smoking prevalence by sexual orientation. Although the review found some evidence for higher smoking prevalence among sexual minorities, the strength of its conclusions was limited by poor sampling methodology in the identified articles as well as variations in definitions of sexual orientation and smoking. A more recent but limited review of smoking among sexual minority women identified 16 studies and came to similar conclusions. 5This article updates previous reviews and reports findings from 42 studies, many with rigorous sampling designs, identified through a systematic search of the published literature from 1987 to May 2007. The identified studies answer our key question: what is the prevalence of tobacco use in sexual minority populations compared to the general population? Our review includes information on gender, sampling methodology, and the domain of sexuality used to determine sexual minority status. Domain of sexuality has been shown to influence the measurement of smoking prevalence, 6 and can be divided into at least three cate...

Associations of Discrimination and Violence With Smoking Among Emerging Adults: Differences by Gender and Sexual Orientation

“…First, consistent with prior research, we found that sexual minorities in our sample had significantly higher (nearly two-fold) current smoking status than heterosexuals (Lee et al, 2009). For the year the NCHA sample data were collected, the national current smoking (i.e., smoked ≥100 cigarettes in lifetime and smoked every day or some days), prevalence was 21.8% for people aged 18-24 years, with approximately 28.0% of men and 15.6% of women being current smokers within the age range of 18-24 years (Dube et al, 2010).…”

“…We use the term socially based stressor to indicate that the stressor was interpersonal and originated from the social environment, rather than a biologically based stressor (e.g., genetic or hormonal factors). There is substantial evidence demonstrating higher smoking prevalence among sexual minority men and women when compared with heterosexual men and women (Lee et al, 2009), and our initial hypotheses test whether these differences in smoking prevalence endure with our sample (i.e., compared with their heterosexual peers, significantly more sexual minority individuals will report smoking).…”

“…Literature also clearly documents disparities in smoking among lesbian, gay, and bisexual populations (i.e., sexual minorities) in the United States, suggesting 50%-70% higher prevalence than the general population (Austin et al, 2004;Garofalo, Wolf, Kessel, Palfrey, & DuRant, 1998;Gruskin, Greenwood, Matevia, Pollack, & Bye, 2007;Lee, Griffin, & Melvin, 2009;McCabe, Boyd, Hughes, & d'Arcy, 2003;Skinner, 1994;Stall, Greenwood, Acree, Paul, & Coates, 1999;Tang et al, 2004). Moreover, the American Lung Association (2010) published a special report of tobacco disparities among sexual minorities, harkening a call for more research.…”

Social Branding to Decrease Lesbian, Gay, Bisexual, and Transgender Young Adult Smoking

“…2 Almost all adult daily smokers began before age 26. 3 In addition, lesbian, gay, bisexual, and transgender (LGBT) individuals smoke at higher rates than the general population, 4 and this disparity extends to lesbian, gay, and bisexual young adults. 5 In a recent study by Rath and colleagues, 5 35% of lesbian and gay young adults and 27% of bisexual young adults had smoked in the past 30 days, compared to 18% of heterosexual young adults.…”

Perceived Sex Discrimination Amplifies the Effect of Antagonism on Cigarette Smoking

“…For example, African Americans who perceive racial/ethnic discrimination have greater odds of current smoking (Borrell, Artazcoz et al, 2010;Purnell et al, 2012). The prevalence of smoking also tends to be higher among other minority groups at high risk for discrimination (Greene & Britton, 2012;Lee, Griffin, & Melvin, 2009). Smoking is hypothesized to be one mechanism for coping with discrimination and the psychological distress (e.g., depressive symptoms, anger) that often accompanies such experiences (Purnell et al, 2012).…”