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Quisenberry AJ, Osborn CC, Pike Moore S, Schneller L, John L, Klein EG, Trapl E. ENDS function as a complement for cigarillos in sexual and gender minority young adult women. Nicotine Tob Res 2024:ntae197. [PMID: 39159047 DOI: 10.1093/ntr/ntae197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Indexed: 08/21/2024]
Abstract
INTRODUCTION Cigarillos are the second most used tobacco product among younger populations. The highest prevalence of use of cigars is among sexual and gender minority (SGM) women. Policy interventions like flavor bans and the availability of alternative tobacco products may have a disparate effect. METHODS The current study utilized an online store analog, The Experimental Tobacco Marketplace (ETM), to investigate the effects of cigarillo and ENDS flavor bans on tobacco product purchasing. SGM (n=72) and cisgender heterosexual (Cis-Het; n =46) women viewed conditions in which cigarillo flavors were available or unavailable and ENDS flavors available or unavailable and the interaction between the two. Mixed models were conducted on each dependent variable with condition, price, and SGM identity as predictors and nicotine dependence, annual income, and race/ethnicity as covariates. Simple linear regressions were performed to determine the substitution profile for each tobacco product. Condition showed no effect. RESULTS We found a main effect of price on cigarillo purchasing and a main effect of SGM identity in which SGM women purchased more ENDS than CisHet women. A complementary association between cigarillos and ENDS in which ENDS purchasing decreased as cigarillo purchasing decreased was found. This association was irrespective of flavor ban conditions and among SGM women only. CONCLUSIONS These results suggest that flavor availability of cigarillos and ENDS may not influence women who use cigarillos to move to another tobacco product and that women SGM cigarillo users are not likely to substitute their cigarillo smoking behavior with ENDS. IMPLICATIONS The results of this study suggest that SGM women are not likely to quit using cigarillos if flavors are removed from the market and instead will use unflavored products. Substituting their cigarillo use with ENDS does not appear likely given the complementary relation found between cigarillos and ENDS. The substitution patterns found for cigarettes and ENDS are not found for cigarillos and ENDS among young adult women who use cigarillos, further demonstrating the need for research on the conditions in which people who use cigarillos will decrease consumption or switch to a potentially less harmful product.
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Affiliation(s)
- Amanda J Quisenberry
- Assistant Professor of Oncology, Assistant Member, Department of Health Behavior, Carlton House A-408, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Catherine C Osborn
- Project Manager, CFLASH, Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, 11000 Cedar Avenue, Room 447, Cleveland, OH
| | - Stephanie Pike Moore
- Research Scientist, Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, 11000 Cedar Avenue, Room 452, Cleveland, OH
| | - Liane Schneller
- HRI Scientist, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Lovina John
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Elizabeth G Klein
- Professor, Heath Behavior and Health Promotion, The Ohio State University, 1841 Neil Avenue, 358 Cunz Hall, Columbus, OH
| | - Erika Trapl
- Professor, Dept. of Population and Quantitative Health Sciences, Director, Prevention Research Center for Healthy Neighborhoods, Associate Director of Community Outreach and Engagement, Case Comprehensive Cancer Center, Case Western Reserve University, 11000 Cedar Ave., BioEnterprise, Room 445, Cleveland, Ohio
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Triplette M, Giustini N, Anderson N, Go T, Scout NFN, Heffner JL. A Multistakeholder Qualitative Study to Inform Sexual Orientation and Gender Identity Data Collection in the Cancer Care Setting. LGBT Health 2024. [PMID: 39158354 DOI: 10.1089/lgbt.2024.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024] Open
Abstract
Purpose: Sexual and gender minoritized (SGM) populations face health disparities along the cancer care continuum, although attempts to define these disparities are limited by a lack of comprehensive sexual orientation and gender identity (SOGI) data collection. The objective of this study was to interview a diverse group of stakeholders to understand attitudes, barriers, and facilitators to inform data collection approaches in a cancer care setting. Methods: This was a qualitative study conducted from March to July 2023 with paired surveys of stakeholders including patients, caregivers, providers, and cancer registry staff. Twenty participants across these categories, including half who identified as SGM, completed surveys and interviews. Qualitative data were reduced to themes with exemplar quotations using rapid qualitative analysis methods and compared to survey data. Results: Themes revealed general support for SOGI data collection as part of holistic cancer care, and all participants acknowledged that specific SOGI-related information, particularly correct pronoun usage, was essential to inform patient-centered care. Themes revealed tensions around optimal SOGI data collection methods, mixed opinions on the relevance of sexual orientation, experiences of discrimination and discomfort related to SOGI, and limited acknowledgment of population benefits of SOGI data collection. Conclusion: Themes demonstrated overall support for SOGI data collection but also revealed several barriers, such as a lack of recognition of population benefits and experiences of discrimination and discomfort, that will need to be addressed to comprehensively collect these data. Based on diverse preferences and limitations of all methods of collection, a multimodal approach may be needed to optimize completion.
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Affiliation(s)
- Matthew Triplette
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Nicholas Giustini
- Division of Hematology and Oncology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Nicolas Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Tiffany Go
- Office of Patient Experience, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - N F N Scout
- The National LGBT Cancer Network, Providence, Rhode Island, USA
| | - Jaimee L Heffner
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA
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Smith K, Cooper SD. An examination of nurse practitioner students' perceptions of knowledge, confidence, and experiences related to caring for lesbian, gay, bisexual, transgender, and queer or questioning patients: A national perspective. J Am Assoc Nurse Pract 2024:01741002-990000000-00232. [PMID: 38959237 DOI: 10.1097/jxx.0000000000001043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/24/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) individuals are significantly less likely to have a primary health care provider, be uninsured, and postpone medical care. A health care provider's lack of knowledge in LGBTQ+ health needs, low confidence in discussing sexuality, and bias can result in LGBTQ+ patients choosing to delay or avoid seeking care. These are missed opportunities for health care providers to recognize their unique needs, provide education and preventive screenings and care, and manage chronic conditions. PURPOSE The aim of this study was to examine nurse practitioner students' perceptions of knowledge, confidence, and experiences related to caring for LGBTQ+ patients. METHODOLOGY Using a descriptive, cross-sectional survey research design, a 29-item online survey was distributed through email to nurse practitioner students (n = 419) across the United States. RESULTS Overall, nurse practitioners (NP) students demonstrated infrequent questioning related to gender preferences, sexual terms, and clarification of relationships. Results showed that 77.9% of NP students within two terms of graduation had not received any LGBTQ+-specific training. Almost 75% of the NP students reported not routinely asking about sexuality, and 82% reported infrequently or never asking gender identity. Furthermore, 93.1% of respondents reported providers infrequently or never ask about preferred gender or pronouns, and 86% reported providers infrequently inquire about sexual identity in primary care visits. CONCLUSIONS Study findings demonstrate the uniqueness of managing care for LGBTQ+ patients and importance for more detailed LGBTQ+ health training in curricula in NP programs. IMPLICATIONS Closing the gap in health care for LGBTQ+ patients is paramount in addressing global health disparities and population care.
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Affiliation(s)
- Kathy Smith
- St. David's School of Nursing, Texas State University, Round Rock, Texas
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Hinds JT, Russell ST, Weinberger AH. Smoking cessation among sexual minority women: Differences in cigarette quit ratios across age, race/ethnicity, and sexual orientation. Prev Med 2024:108035. [PMID: 38852889 DOI: 10.1016/j.ypmed.2024.108035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/22/2024] [Accepted: 06/06/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVE Sexual minority (SM) women experience tobacco-related disparities and report a higher prevalence of cigarette use, as well as subgroup differences in use, but little is known about their quitting behavior. This study used data from a national sample of United States SM women to examine cigarette quit ratios overall and by age, race/ethnicity, and sexual orientation. METHODS Using baseline survey data from the Generations Study (2016-2017, N = 812), we calculated quit ratios among SM women reporting lifetime smoking (100+ cigarettes) who reported currently smoking "not at all" relative to those reporting smoking "every day or some days." Quitting was compared across cohort, race/ethnicity, and sexual orientation, controlling for household income. RESULTS SM women reporting lifetime smoking in the older cohort were significantly more likely to report quitting than those in the younger cohort. Bisexual women also reported a greater likelihood of quitting than gay/lesbian women. There was no association between race/ethnicity and the probability of quitting smoking. CONCLUSIONS SM women remain a priority for tobacco prevention and cessation efforts. There is evidence that the probability of quitting cigarettes differs across sexual orientation and age cohorts, which has implications for tailoring of interventions and tobacco communications.
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Affiliation(s)
- Josephine T Hinds
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA.
| | - Stephen T Russell
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Departments of Epidemiology & Population Health and Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
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Ganz O, Schulz JA, Ehlke SJ, King Jensen JL, Villanti AC. Cigarette smoking behaviors and nicotine dependence at the intersection of sexual identity and sex in the United States: Findings from the National Survey on Drug Use and Health. Prev Med Rep 2024; 38:102593. [PMID: 38283968 PMCID: PMC10820633 DOI: 10.1016/j.pmedr.2024.102593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Abstract
INTRODUCTION Cigarette smoking is disproportionately high among lesbian, gay, and bisexual (LGB) adults. Yet, collapsing these identities into a monolith can disguise important within group disparities (e.g., lesbian/gay versus bisexual female). The purpose of this study is to report recent national prevalence estimates and trends of cigarette smoking behaviors and nicotine dependence by sexual identity and sex. METHODS Data were from the 2015-2019 National Survey on Drug Use and Health (n = 210,392; adults 18+), a nationally representative, repeated cross-sectional study of substance use and mental health in the U.S. We examined bivariate and multivariable associations between sexual identity and cigarette smoking measures (i.e., former smoking, lifetime smoking, current smoking, current daily smoking, nicotine dependence) by sex. We also examined linear time trends in current and former smoking. Covariates included age, race/ethnicity, education, annual household income, and survey year. RESULTS Bisexual women had the highest unadjusted prevalence of current smoking (31 %) and lowest of former smoking (25 %). LGB females and males had higher adjusted prevalence of current smoking, daily smoking, and nicotine dependence than heterosexual adults. Bisexual females and gay and bisexual males had lower adjusted prevalence of former smoking (adjusted prevalence ratio range: 0.78-0.85) than heterosexual counterparts. DISCUSSION This is the first study to identify disproportionately low prevalence of former smoking among bisexual females. Paired with findings of high prevalence of current cigarette smoking and nicotine dependence, these data suggest that tobacco control interventions targeted toward bisexual females are urgently needed to reduce the burden of cigarette smoking among these individuals.
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Affiliation(s)
- Ollie Ganz
- Institute for Nicotine and Tobacco Studies, Rutgers Biomedical and Health Sciences, 303 George Street, Suite 500, New Brunswick, NJ 08901, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, 693 Hoes Lane West, Piscataway, NJ 08854, USA
| | - Jonathan A. Schulz
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401, USA
| | - Sarah J. Ehlke
- Department of Psychology, Old Dominion University, 5115 Hampton Blvd., Norfolk, VA 23529, USA
| | - Jessica L. King Jensen
- Institute for Nicotine and Tobacco Studies, Rutgers Biomedical and Health Sciences, 303 George Street, Suite 500, New Brunswick, NJ 08901, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 317 George Street, New Brunswick, NJ 08901, USA
| | - Andrea C. Villanti
- Institute for Nicotine and Tobacco Studies, Rutgers Biomedical and Health Sciences, 303 George Street, Suite 500, New Brunswick, NJ 08901, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, 693 Hoes Lane West, Piscataway, NJ 08854, USA
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Anderson CM, Tedeschi GJ, Cummins SE, Lienemann BA, Zhuang YL, Gordon B, Hernández S, Zhu SH. LGBTQ Utilization of a Statewide Tobacco Quitline: Engagement and Quitting Behavior, 2010-2022. Nicotine Tob Res 2024; 26:54-62. [PMID: 37632451 DOI: 10.1093/ntr/ntad160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/22/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals use tobacco at disproportionately high rates but are as likely as straight tobacco users to want to quit and to use quitlines. Little is known about the demographics and geographic distribution of LGBTQ quitline participants, their engagement with services, or their long-term outcomes. AIMS AND METHODS Californians (N = 333 429) who enrolled in a statewide quitline 2010-2022 were asked about their sexual and gender minority (SGM) status and other baseline characteristics. All were offered telephone counseling. A subset (n = 19 431) was followed up at seven months. Data were analyzed in 2023 by SGM status (LGBTQ vs. straight) and county type (rural vs. urban). RESULTS Overall, 7.0% of participants were LGBTQ, including 7.4% and 5.4% of urban and rural participants, respectively. LGBTQ participants were younger than straight participants but had similar cigarette consumption. Fewer LGBTQ participants reported a physical health condition (42.1% vs. 48.4%) but more reported a behavioral health condition (71.1% vs. 54.5%; both p's < .001). Among both LGBTQ and straight participants, nearly 9 in 10 chose counseling and both groups completed nearly three sessions on average. The groups had equivalent 30-day abstinence rates (24.5% vs. 23.2%; p = .263). Similar patterns were seen in urban and rural subgroups. CONCLUSIONS LGBTQ tobacco users engaged with and appeared to benefit from a statewide quitline even though it was not LGBTQ community-based. A quitline with staff trained in LGBTQ cultural competence can help address the high prevalence of tobacco use in the LGBTQ community and reach members wherever they live. IMPLICATIONS This study describes how participants of a statewide tobacco quitline broke down by sexual orientation and gender. It compares participants both by SGM status and by type of county to provide a more complete picture of quitline participation both in urban areas where LGBTQ community-based cessation programs may exist and in rural areas where they generally do not. To our knowledge, it is the first study to compare LGBTQ and straight participants on their use of quitline services and quitting aids, satisfaction with services received, and rates of attempting quitting and achieving prolonged abstinence from smoking.
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Affiliation(s)
| | - Gary J Tedeschi
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Sharon E Cummins
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Brianna A Lienemann
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Yue-Lin Zhuang
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Bob Gordon
- California LGBT Tobacco Education Partnership, San Francisco, CA, USA
| | - Sandra Hernández
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Shu-Hong Zhu
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
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Sharma S, Shukla S, Kamate SK, Kalsi R, Jain M, Walia S, Kumari S. An Exploratory Research Comparing Oral Health, Pattern of Substance Abuse and Nicotine Dependence among LGBT, Female Sex Workers and Heterogenders. J Contemp Dent Pract 2023; 24:991-997. [PMID: 38317398 DOI: 10.5005/jp-journals-10024-3608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
AIM Lesbian, gay, bisexual, transgender, and queer (LGBTQ), female sex workers (FSW), and heterogenders are those unconventional groups of the society who are identified with major unacceptance. Thus, the present study is conducted to assess and compare the oral health status, substance abuse pattern and nicotine dependence using Fagerstrom nicotine dependence scale (FNDP) among the LGBTQ, FSW, and heterogender in a defined location of Gautam Buddha Nagar, district in West U.P. MATERIALS AND METHODS The present exploratory research included three study groups, the LGBTQ, FSW, and heterogenders (HG) residing in the same habitat. Purposive snowball sampling was conducted for the accessibility of the unapproachable population in the defined geographical location at Gautam Budha Nagar, district in West Uttar Pradesh. The data collection of a total of 177 participants was done using a pre-validated, pretested proforma consisting of three different parts including WHO oral health assessment form for adults, 2013, questionnaire regarding pattern of substance abuse and FNDS. Data were recorded and statistically analyzed using SPSS. RESULTS Prevalence of oral health disorders including dental caries, periodontal disease as well as oral mucosal lesions were more commonly found among the LGBTQ participants followed by FSW and the differences were found to be statistically significant. In context of altered habits, 100% of the participants in the present study were reported with smokeless tobacco habits whereas majority of the FSW were reported with a habit of smoking tobacco. CONCLUSION In addition to belonging to ethnic and sexual minority, and having minimal or low education status, and low socioeconomic status, the present study groups are reported to have suboptimal access to quality healthcare and are further reported with high level of substance abuse as well as nicotine dependence. CLINICAL SIGNIFICANCE The present study is an attempt to provide base line data for further research and provide data to the policy makers so as to increase the healthcare access to the present groups. How to cite this article: Sharma S, Shukla S, Kamate SK, et al. An Exploratory Research Comparing Oral Health, Pattern of Substance Abuse and Nicotine Dependence among LGBT, Female Sex Workers and Heterogenders. J Contemp Dent Pract 2023;24(12):991-997.
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Affiliation(s)
- Swati Sharma
- Department of Public Health Dentistry, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India, Phone: +91 9958383743, e-mail:
| | - Sakshi Shukla
- Department of Public Health Dentistry, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Shivlingesh K Kamate
- Department of Public Health Dentistry, Institute of Dental Sciences, Bareilly International University, Bareilly, Uttar Pradesh, India
| | - Rupali Kalsi
- Department of Dentistry, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
| | - Meena Jain
- Department of Public Health Dentistry, Manav Rachna Dental College, SDS, MRIIRS, Faridabad, Haryana, India
| | - Simon Walia
- Department of Public Health Dentistry, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Sonali Kumari
- Department of Public Health Dentistry, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India
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Tundealao S, Titiloye T. Comparing Smokeless Tobacco Use between Male-to-Female and Female-to-Male Transgender Adults in the United States. Subst Use Misuse 2023; 58:1343-1349. [PMID: 37243498 DOI: 10.1080/10826084.2023.2217902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Background: The shifted gender social norms and tobacco cessation advice associated with estrogen therapy as a result of thrombosis risk could be responsible for the tobacco use differences between Male-to-Female (MTF) and Female-to-Male (FTM) transgender adults. Research has established this disparity in cigarette smoking, but none has looked at smokeless tobacco. Aim: This study aimed to compare smokeless tobacco use MTF and FTM transgender adults in the United States. Furthermore, it assessed the other potential determinants of smokeless tobacco use among the transgender population. Methods: The study analyzed data from the 2021 Behavioral Risk Factor Surveillance System (BRFSS), which included 1,070 transgender individuals aged 18 and above (382 MTF and 688 FTM). Gender identity (MTF vs. FTM) was used to predict smokeless tobacco use using logistic regression, adjusting for other socio-demographic and behavioral determinants. Results: The prevalence of smokeless tobacco use among the transgender population was 5.7%, 3.8% among MTF, 6.3% among FTM, and 6.7% among gender non-conforming transgender individuals. FTM transgender individuals were 2.23 times more likely to use smokeless tobacco than MTF transgender individuals. Smokeless tobacco use among MTF and FTM transgender individuals was also significantly associated with being older than 54 years (OR = 1.94), having a high school education or lower (OR = 1.98), living with at least a child (OR = 2.17), a current smoker (OR = 1.78) and a current e-cigarette user (OR = 2.97). Discussion: This study found a significant difference in smokeless tobacco use among transgender subgroups and addressed a critical tobacco knowledge gap among this population.
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Affiliation(s)
- Samuel Tundealao
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center, Houston, Texas, USA
| | - Tolulope Titiloye
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center, Houston, Texas, USA
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Colston DC, Cruz JL, Simard BJ, Fleischer NL. A Systematic Review Evaluating Disparities in State-Run Quitline Utilization and Effectiveness in the U.S. AJPM FOCUS 2023; 2:100042. [PMID: 37789942 PMCID: PMC10546598 DOI: 10.1016/j.focus.2022.100042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Context Cigarette smoking is a public health problem in the U.S. and is marked by pervasive sociodemographic disparities. State-run quitlines may offer greater access to cessation services that could in turn help to reduce smoking disparities. The aim of this review was to synthesize the body of literature regarding sociodemographic disparities in the utilization and effectiveness of state-run quitlines. Evidence acquisition The PRISMA guidelines were followed in conducting this review. Included articles were published between January 1, 1992 and May 28, 2019 and sourced from PubMed and Web of Science. Studies that evaluated state-run quitline utilization or effectiveness (cessation) by sex, race/ethnicity, sexual or gender identity, or SES (income, education, insurance) were included. Evidence synthesis Our search yielded 2,091 unique articles, 17 of which met the criteria for inclusion. This review found that quitline utilization was higher among Black and Asian/Pacific Islander individuals than among White individuals and among people with lower income and lower education than among people with higher income and higher education. Quitline use was associated with less smoking cessation among females than among males, among American Indian/Alaskan Native individuals than among individuals from all other races and ethnicities, and among individuals of lower than among those of higher income and education. Conclusions This review found that although communities disproportionately affected by smoking utilize quitlines more commonly than their White and more affluent peers, disparities in cessation persist for American Indian/Alaskan Native and individuals from lower SES groups who use quitlines.
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Affiliation(s)
- David C. Colston
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Jennifer L. Cruz
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Bethany J. Simard
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Nancy L. Fleischer
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
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10
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A double disparity: Rural sexual minorities and tobacco use among U.S. adults. Addict Behav 2023; 137:107527. [PMID: 36308838 DOI: 10.1016/j.addbeh.2022.107527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/15/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Marginalized groups continue to face an uneven distribution of the risks and consequences of smoking cigarettes, with rural/urban geography and sexual orientation status examined independently. However, little is known about the intersection of rural/urban geography and sexual orientation regarding tobacco use disparities. This study examined rural-urban sexual minority differences in tobacco use in the United States. METHODS Data came from the 2018-2020 Behavioral Risk Factor Survey System (N = 675,221). We estimated cigarette smoking prevalence for each year of survey data by rural/urban status and sexual orientation. Multivariable logistic regressions were used to assess associations of rural/urban location and sexual orientation status with cigarette use. Additional Multivariable logistic regressions were conducted, including stratified analyses by sex on multiple sexual orientation categories. FINDINGS Cigarette smoking was higher among participants who lived in rural areas and identified as lesbian or gay and bisexual. Furthermore, the disparities in smoking rates were significantly different, with 38 % higher odds of smoking among rural sexual minorities than urban sexual minorities (aOR = 1.38, 95 % CI = 1.19, 1.60). Stronger odds of cigarette smoking were found among rural gays or lesbians (aOR = 1.83, 95 % CI = 1.47, 2.28) and rural bisexuals (aOR = 2.40, 95 % CI = 2.03, 2.84) compared to urban straight counterparts. CONCLUSION Findings highlight rural populations, particularly sexual minorities, might have an elevated risk of cigarette use. Prevention and cessation efforts that help these especially disadvantaged groups will be beneficial in addressing tobacco use disparities.
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Budenz A, Gaber J, Crankshaw E, Malterud A, Peterson EB, Wagner DE, Sanders EC. Discrimination, identity connectedness and tobacco use in a sample of sexual and gender minority young adults. Tob Control 2022:tc-2022-057451. [PMID: 36601779 DOI: 10.1136/tc-2022-057451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Studies show that tobacco use among sexual and gender minority (SGM) populations is disproportionately higher than heterosexual or cisgender populations. However, few studies have examined tobacco use among SGM subgroups by race/ethnicity or associations between SGM-specific discrimination and connection to SGM identity and tobacco use. METHODS This study analysed survey data from 11 313 SGM (gay, lesbian, bisexual, other sexual minority or gender minority) young adults in the USA and reported current cigarette, e-cigarette, other tobacco (cigar, smokeless tobacco, hookah) and polytobacco use. We used multinomial logistic regression to estimate associations between (a) SGM subgroup, race/ethnicity, SGM-specific discrimination and SGM identity connection and (b) each tobacco use outcome (vs never use of tobacco). We conducted postestimation testing to assess predicted probabilities of tobacco use against the sample average. RESULTS Lesbian females (particularly black lesbian females) had higher-than-average probability of polytobacco use. White bisexual and lesbian participants had higher-than-average probability of cigarette and e-cigarette use, respectively. Higher levels of discrimination were associated with polytobacco use. Higher levels of identity connectedness were protective against certain tobacco use behaviours among gender minority participants and participants with high levels of discrimination experience. CONCLUSIONS We found variations in tobacco use by SGM subgroups overall and by race/ethnicity. Discrimination may be a risk factor for certain tobacco use behaviours. However, SGM identity connectedness may be protective against tobacco use among gender minority individuals and individuals experiencing SGM-specific discrimination. These findings can inform targeted approaches to reach SGM subgroups at greater risk of tobacco use.
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Affiliation(s)
- Alex Budenz
- Center for Tobacco Products, Office of Health Communication and Education, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Jennifer Gaber
- Center for Health Analytics, Media and Policy, RTI International, Durham, NC, USA
| | - Erik Crankshaw
- Center for Health Analytics, Media and Policy, RTI International, Durham, NC, USA
| | - Andie Malterud
- Center for Tobacco Products, Office of Health Communication and Education, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Emily B Peterson
- Center for Tobacco Products, Office of Health Communication and Education, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Dana E Wagner
- Research Department, Rescue Agency, San Diego, CA, USA
| | - Emily C Sanders
- Center for Tobacco Products, Office of Health Communication and Education, U.S. Food and Drug Administration, Silver Spring, MD, USA
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12
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Schuler MS, Evans-Polce RJ. Perceived Substance Use Risks Among Never Users: Sexual Identity Differences in a Sample of U.S. Young Adults. Am J Prev Med 2022; 63:987-996. [PMID: 36115799 PMCID: PMC10198135 DOI: 10.1016/j.amepre.2022.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/24/2022] [Accepted: 07/06/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Lower perceived risk is a well-established risk factor for initiating substance use behaviors and an integral component of many health behavior theories. Established literature has shown that many substance use behaviors are more prevalent among individuals who identify as lesbian, gay, or bisexual than among those who identify as heterosexual. However, potential differences in perceived risk by sexual identity among individuals with no lifetime use have not been well characterized to date. METHODS Data on 111,785 adults aged 18-34 years (including 11,377 lesbian, gay, and bisexual adults) were from the 2015-2019 National Survey on Drug Use and Health. Perceived risks (classified as great risk versus less than great risk) were assessed with 11 National Survey on Drug Use and Health survey items regarding 6 different substances (alcohol, cigarettes, marijuana, cocaine, lysergic acid diethylamide, and heroin). Survey-weighted and sex-stratified logistic regression models were used to estimate sexual identity differences regarding perceived great risk among those reporting no lifetime use. Analyses were conducted in 2021-2022. RESULTS Gay men, bisexual men, lesbian/gay women, and bisexual women were all significantly less likely than heterosexual peers to perceive great risk associated with specific marijuana, cocaine, lysergic acid diethylamide, and heroin use behaviors. Bisexual men and women were also significantly less likely than heterosexual peers to perceive great risk associated with binge drinking behaviors and smoking ≥1 packs of cigarettes daily. CONCLUSIONS This novel investigation among never users provides evidence that lesbian, gay, and bisexual adults perceive significantly lower risks associated with multiple substance use behaviors than heterosexual adults, which may indicate important sexual identity differences in susceptibility to substance use initiation.
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Affiliation(s)
| | - Rebecca J Evans-Polce
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan
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13
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Wang Y, Duan Z, Emery SL, Weaver SR, Self-Brown SR, Ashley DL, Huang J. Intentions and Attempts to Quit Smoking Among Sexual Minoritized Adult Smokers After Exposure to the Tips From Former Smokers Campaign. JAMA Netw Open 2022; 5:e2211060. [PMID: 35532934 PMCID: PMC9086838 DOI: 10.1001/jamanetworkopen.2022.11060] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Significant disparities exist in smoking behaviors by sexual minority status in the US. OBJECTIVE To examine potential differences in the associations between exposure to the Tips From Former Smokers (Tips) campaign and intentions and attempts to quit smoking by sexual minority status. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the wave 5 survey of the Population Assessment of Tobacco and Health study. Data from 8072 adults who were currently established cigarette smokers were collected from December 2018 to November 2019 and analyzed in August 2021. The Population Assessment of Tobacco and Health study is an ongoing cohort study representative of the noninstitutionalized US population. Sample weights were applied to account for the complex sampling strategies. EXPOSURES Dichotomized self-reported frequent Tips exposure (often and very often) and infrequent exposure (never, rarely, and sometimes). MAIN OUTCOMES AND MEASURES Outcomes were intention to quit within 12 months, any serious quit attempts in the past 12 months, and number of serious quit attempts in the past 12 months. Multivariate logistic and ordinal logistic regressions were used to estimate the weighted associations between exposure and each outcome. Interactions between Tips exposure and sexual minority status were examined to explore potential differences. RESULTS A total of 8072 participants (mean [SD] age, 44.7 [14.8] years; 3888 [53.2%] male; 4962 [67.4%] non-Hispanic White; and 915 [9.5%] sexual minoritized individuals [ie, those who identified as lesbian, gay, bisexual, or another minoritized sexual identity]) were included. Frequent Tips exposure was associated with higher odds of quit intentions and attempts overall (adjusted odds ratio [aOR], 1.25; 95% CI, 1.07-1.46 for intention to quit within 12 months; aOR, 1.26; 95% CI, 1.08-1.47 for serious quit attempts in the past 12 months; and aOR, 1.24; 95% CI, 1.06-1.44 for number of serious quit attempts in the past 12 months). These associations were significantly stronger for heterosexual smokers than sexual minoritized smokers, as indicated by the significant interaction terms (aOR, 0.58; 95% CI, 0.36-0.96 for intention to quit within 12 months; aOR, 0.41; 95% CI, 0.24-0.70 for serious quit attempts in the past 12 months; and aOR, 0.40; 95% CI, 0.24-0.67 for number of serious quit attempts in the past 12 months). Subgroup analysis showed that heterosexual smokers who reported frequent Tips exposure were more likely to intend to quit within 12 months (aOR, 1.29; 95% CI, 1.10-1.53), have had any serious quit attempts in the past 12 months (aOR, 1.34; 95% CI, 1.13-1.58), and have had more serious quit attempts (aOR, 1.32; 95% CI, 1.12-1.54) than heterosexual smokers who reported infrequent exposure. In contrast, there was no association for sexual minoritized smokers (aOR, 0.82; 95% CI, 0.52-1.30 for intention to quit within 12 months; aOR, 0.65; 95% CI, 0.39-1.07 for serious quit attempts in the past 12 months; and aOR, 0.62; 95% CI, 0.38-1.00 for number of serious quit attempts in the past 12 months). CONCLUSIONS AND RELEVANCE These findings suggest that significant differences exist in the associations between Tips exposure and quit intentions or attempts by sexual minority status. More targeted campaign content for sexual minoritized smokers may be needed to increase quit intentions and attempts among this group.
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Affiliation(s)
- Yu Wang
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta
| | - Zongshuan Duan
- Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Sherry L. Emery
- National Opinion Research Center at University of Chicago, Chicago, Illinois
| | - Scott R. Weaver
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta
| | - Shannon R. Self-Brown
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta
| | - David L. Ashley
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta
| | - Jidong Huang
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta
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14
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Adzrago D, Shi Y, Fujimoto K. Association between perceived health risks of e-cigarettes and actual e-cigarette use, based on cigarette smoking status and sexual and gender minority status among U.S. adults. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2022; 31:1-11. [PMID: 35036291 PMCID: PMC8747865 DOI: 10.1007/s10389-021-01674-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/07/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is a lack of consensus in the literature about the association between the perceived health risks of e-cigarettes and their actual use, an association that may be based on cigarette smoking status or sexual and gender minority status. This study examined the moderating effect of these variables as well as differences in e-cigarette use between and within perceived harmfulness of e-cigarettes and cigarette smoking among U.S. adults. METHODS The data were drawn from the 2020 and 2019 Health Information National Trends Survey (HINTS 5), Cycles 4 and 3, on adults (N = 9303). We estimated weighted multivariable logistic regression models and conducted marginal analyses based on perceived harmfulness of e-cigarettes. RESULTS Of the study population, 30.75% currently used e-cigarettes daily or some days. No significant difference in e-cigarette use was found between sexual minorities and heterosexuals, but there was a significant interaction between sexual identity and perceived harmfulness of e-cigarettes. Compared to non-smokers, current daily or some days cigarette smokers were more likely to use e-cigarettes (AOR = 3.48, 95% CI = 1.25, 9.72). Those who perceived e-cigarettes to be just as harmful as actual cigarettes (AOR = 0.13, 95% CI = 0.06, 0.27) or more harmful (AOR = 0.03, 95% CI = 0.01, 0.10), or were uncertain (AOR = 0.18, 95% CI = 0.08, 0.45), were less likely to use e-cigarettes compared to those who perceived e-cigarettes to be less harmful. Former and current cigarette smokers who perceived e-cigarettes as less harmful had a higher probability of using e-cigarettes daily or some days than did non-cigarette smokers. For the current and former cigarette smoking groups, those who perceived e-cigarettes as less harmful had the highest probability of current e-cigarette use than did those who were uncertain or perceived e-cigarettes as just as harmful, whereas the probability was not significant for those who perceived e-cigarettes as more harmful. CONCLUSION Current daily or some days use of e-cigarettes is associated with current daily or some days cigarette smoking and lowered perceived harmfulness of e-cigarettes among the U.S. adult population. Tailored health promotion and intervention efforts may reduce the potential perceived health and behavioral/lifestyle risks related to the use of tobacco products, especially the use of e-cigarettes daily among former and current cigarette smokers as well as those who perceive e-cigarettes as less harmful.
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Affiliation(s)
- David Adzrago
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, 7000 Fannin, Suite 2502A, Houston, TX 77030 USA
| | - Yue Shi
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, 7000 Fannin, Suite 2502A, Houston, TX 77030 USA
| | - Kayo Fujimoto
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, 7000 Fannin, Suite 2502A, Houston, TX 77030 USA
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15
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King JL, Shan L, Azagba S. Trends in sexual orientation disparities in cigarette smoking: Intersections between race/ethnicity and sex. Prev Med 2021; 153:106760. [PMID: 34352307 PMCID: PMC9008567 DOI: 10.1016/j.ypmed.2021.106760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 07/17/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022]
Abstract
Cigarette smoking is disproportionately high among sexual minority populations, but it is unclear whether these disparities exist among race/ethnicity subgroups. This study examined trends in sexual orientation disparities in cigarette smoking by race/ethnicity. Data are from the 2014-2019 Behavioral Risk Factor Surveillance System (N = 1,194,768). Trend analyses compared cigarette smoking by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic other) and sexual orientation (straight, lesbian or gay, bisexual, something else/don't know/refused). Multivariable analyses examined associations between sexual orientation and cigarette use for each race/ethnicity, controlling for other sociodemographic characteristics. Between 2014 and 2019, lesbian or gay, and bisexual populations consistently had higher smoking rates than straight populations, which held across race/ethnicity. Among non-Hispanic White adults, lesbians (OR = 1.51, 95% CI = 1.29, 1.76), bisexual females (OR = 1.56, 95% CI = 1.39, 1.75), gay (OR = 1.38, 95% CI = 1.22, 1.55), and bisexual males (OR = 1.22, 95% CI = 1.04, 1.43) had higher odds of smoking compared those self-identifying as straight. Among non-Hispanic Black adults, lesbians (OR = 1.90, 95% CI =1.33, 2.73) and bisexual females (OR = 1.85, 95% CI =1.42, 2.41) were more likely to currently smoke. Among Hispanic adults, those self-identifying as lesbian or gay (OR = 1.58, 95% CI = 1.19, 2.09) or bisexual (OR = 2.40, 95% CI = 1.88, 3.07) were more likely to currently smoke, though the associations were not significant in Hispanic males. Disparities in cigarette smoking by race/ethnicity and sexual orientation suggest that aggregating these groups mask important differences and limit efforts to target those most at risk.
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Affiliation(s)
- Jessica L King
- Department of Health, Kinesiology, & Recreation, University of Utah, Salt Lake City, UT, USA
| | - Lingpeng Shan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sunday Azagba
- Penn State College of Nursing, University Park, PA, USA.
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16
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Evans-Polce RJ, Veliz P, Kcomt L, Boyd CJ, McCabe SE. Nicotine and Tobacco Product Use and Dependence Symptoms Among US Adolescents and Adults: Differences by Age, Sex, and Sexual Identity. Nicotine Tob Res 2021; 23:2065-2074. [PMID: 34125909 PMCID: PMC8570663 DOI: 10.1093/ntr/ntab127] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/11/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Sexual minorities are at increased risk for tobacco use; however, there is heterogeneity in this risk by sociodemographic factors. AIMS AND METHODS This study sought to understand if vulnerability to tobacco use among US sexual minorities varies by age group. For this study we used data from wave 4 of the Population Assessment of Tobacco and Health adolescent and adult surveys (n = 37 959), a nationally representative survey. We examined five nicotine/tobacco use outcomes by sex and sexual identity across four age groups. The five outcomes included past 30-day e-cigarette use, past 30-day cigarette use, past 30-day other tobacco use, the number of tobacco products used, and nicotine dependence symptoms. RESULTS For males, sexual identity differences were greatest in middle adulthood, particularly for bisexual males; adjusted odds ratios and adjusted incident rate ratios ranged from 2.08 to 5.59 in middle adulthood compared to 0.83-1.62 in adolescence. For females, sexual identity differences were persistent from adolescence through middle adulthood. We found significant differences most consistently for nicotine dependence symptoms when comparing gay/lesbian and bisexual females across multiple age groups; adjusted incident rate ratios ranged from 1.90 in middle adulthood to 3.26 in adolescence. CONCLUSIONS Risk among sexual minorities varied considerably across age groups and by nicotine/tobacco product and severity of symptoms. Our findings underscore the importance of looking beyond single tobacco products when examining nicotine/tobacco differences related to sexual identity and in examining differences by age group. Our results demonstrating age-varying risk among sexual minorities have important implications for tobacco prevention and cessation efforts. IMPLICATIONS This study identifies important age variation in sexual minority differences in tobacco use, particularly among males. This study also shows that many sexual minorities not only have higher risk for tobacco and nicotine product use but also use significantly more tobacco products and have higher nicotine dependence symptom scores. These results have important implications for implementation of nicotine and tobacco prevention and cessation strategies for sexual minority adolescents and adults.
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Affiliation(s)
- Rebecca J Evans-Polce
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Philip Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Luisa Kcomt
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
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17
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Rodríguez-Bolaños R, Arillo-Santillán E, Guzmán-Rodríguez C, Barrientos-Gutiérrez I, Gallegos-Carrillo K, Titus A, Cruz-Jiménez L, Thrasher JF. Similarities and Differences in Substance Use Patterns Among Lesbian, Gay, Bisexual, and Heterosexual Mexican Adult Smokers. LGBT Health 2021; 8:545-553. [DOI: 10.1089/lgbt.2020.0457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rosibel Rodríguez-Bolaños
- Tobacco Research Department, Population Health Research Center, Mexican National Institute of Public Health, Cuernavaca, Mexico
| | - Edna Arillo-Santillán
- Tobacco Research Department, Population Health Research Center, Mexican National Institute of Public Health, Cuernavaca, Mexico
| | | | - Inti Barrientos-Gutiérrez
- Center for Evaluation and Survey Research, Mexican National Institute of Public Health, Cuernavaca, Mexico
| | - Katia Gallegos-Carrillo
- Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Cuernavaca, Mexico
| | - Andrea Titus
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Lizeth Cruz-Jiménez
- Center for Evaluation and Survey Research, Mexican National Institute of Public Health, Cuernavaca, Mexico
| | - James F. Thrasher
- Tobacco Research Department, Population Health Research Center, Mexican National Institute of Public Health, Cuernavaca, Mexico
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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18
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Patterson JG, Hinton A, Cooper SE, Wewers ME. Differences in Quit Attempts, Successful Quits, Methods, and Motivations in a Longitudinal Cohort of Adult Tobacco Users by Sexual Orientation. Nicotine Tob Res 2021; 23:1952-1957. [PMID: 34060633 PMCID: PMC8562360 DOI: 10.1093/ntr/ntab116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/28/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Sexual minority (SM) tobacco users are less likely to successfully quit than heterosexuals, yet little evidence describes cessation behaviors in this population over time. AIMS AND METHODS Our study investigated quit motivations, attempts, and methods in a longitudinal cohort of adult tobacco users by sexual orientation. Participants (N = 1177) completed interviews every 6 months through 48 months and reported quit attempts (24-hour tobacco free), successful quits (7-day point prevalence abstinence), motivations, and methods. Chi-squared and Fisher's exact tests assessed differences by heterosexual and SM orientation, gender, and quit outcome (attempt-only vs. successful quit). RESULTS Quit rates were similar for heterosexual and SM adults. Over half attempted to quit at least once over 48 months, but few remained abstinent (SM: 16.9%; heterosexual: 12.1%). Most used nicotine replacement therapy (SM: 31.9%; heterosexual: 26.1%) or tobacco product substitution (SM: 27.7%; heterosexual: 21.2%). Few used quitlines (SM: 4.3%; heterosexual: 1.3%) or Internet-based programs (SM: 6.4%; heterosexual: 1.3%). Quit motivations included health concerns, family, and physical fitness. Participants reporting a successful quit were more likely to report a household member quit smoking than 24-hour quit attempters. Among participants reporting a successful quit, more SM than heterosexual participants reported that a coworker quit smoking (55.6% vs. 33.1%, p = .009). CONCLUSIONS We found few differences between heterosexual and SM tobacco users in our sample. Many repeatedly attempt to quit, yet few used evidence-based methods. Leveraging online quit programs, health messages, and family members in tailored cessation interventions may help SM and heterosexual tobacco users successfully quit. IMPLICATIONS SM and heterosexual tobacco users evidenced few differences in quit behaviors. Over 4 years, a majority attempted to quit, with over a third making repeated quit attempts. Nicotine replacement therapy and tobacco product substitution were mostly used during quit attempts; however, more SM than heterosexual men reported using web-based quit programs. Personal health and family concerns were universal motivations to quit, yet SM women also cited physical fitness as a primary motivation. Tobacco users reporting that a household member stopped smoking were more likely to successfully quit. More SM than heterosexual men reported that a coworker quit smoking.
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Affiliation(s)
| | - Alice Hinton
- Ohio State University College of Public Health, Division
of Biostatistics, Columbus, OH, USA
| | - Sarah E Cooper
- Ohio State University College of Public Health, Division
of Health Behavior and Health Promotion, Columbus,
OH, USA
| | - Mary Ellen Wewers
- Ohio State University Comprehensive Cancer
Center, Columbus, OH, USA
- Ohio State University College of Public Health, Division
of Health Behavior and Health Promotion, Columbus,
OH, USA
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19
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Hartnett CS, Butler Z, Everett BG. Disparities in smoking during pregnancy by sexual orientation and race-ethnicity. SSM Popul Health 2021; 15:100831. [PMID: 34169137 PMCID: PMC8207226 DOI: 10.1016/j.ssmph.2021.100831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/20/2022] Open
Abstract
The intersection between sexual orientation and race-ethnicity is emerging as an important dynamic for health. Prior research indicates that sexual orientation can have very different health implications for White, Black, and Latina individuals and that these patterns are unpredictable. Here we use U.S. data from the National Survey of Family Growth (2006-2019, n = 15,163 pregnancies) to examine how an important health indicator - smoking during pregnancy - is shaped jointly by sexual orientation and race-ethnicity. Smoking during pregnancy was more common among sexual minority women (both bisexual-identified and heterosexual-identified who expressed same-gender attraction/behavior), compared to heterosexual women. Second, the association between sexual orientation and smoking during pregnancy differed by race-ethnicity: sexual minority status was more strongly associated with smoking among Latina women, compared to White women. Finally, the subgroup with the highest rates of smoking during pregnancy was bisexual White women. These findings indicate that smoking rates among pregnant sexual minority women warrant attention (regardless of race-ethnicity), particularly as births within this group are rising. It is important to address structural factors that may create more stress for sexual minority women, since smoking is often a response to stress. These findings also highlight the role of heterogeneity: low smoking rates among pregnant Latina women mask within-group disparities.
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Affiliation(s)
- Caroline Sten Hartnett
- Department of Sociology, Sloan College #321, University of South Carolina, Columbia, SC, 29205, USA
| | - Zackery Butler
- Department of Sociology, Sloan College #321, University of South Carolina, Columbia, SC, 29205, USA
| | - Bethany G. Everett
- Department of Sociology, 380 S 1530 E Room 301, University of Utah, Salt Lake City, UT, 84112, USA
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20
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Azagba S, Shan L. Tobacco Craving, Nicotine Dependence, and Quit Intentions among LGB and Non-LGB High School Students: A Quasi-Experimental Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9000. [PMID: 34501586 PMCID: PMC8431691 DOI: 10.3390/ijerph18179000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022]
Abstract
There is evidence of higher tobacco use among lesbian or gay and bisexual (LGB) populations. However, a limited number of studies have examined whether there are differences in potential indicators of future tobacco cessation behaviors between LGB and non-LGB populations. This study examined whether sexual identity is associated with craving, nicotine dependence, and quit intentions among high school students. Data were drawn from the 2020 National Youth Tobacco Survey (n = 1642). A propensity score matching (PSM) technique was used to address covariate imbalance among sexual identity groups. Additionally, subgroup analyses were performed for both males and females. The PSM results showed higher odds of craving among students who were gay or lesbian (aOR, 1.70; 95% CI = 1.13-2.55) and bisexual (aOR, 1.89; 95% CI = 1.23-2.92) compared to heterosexual (straight) students. In the sex-based subgroup analyses, we found that gay or lesbian (aOR, 1.92; 95% CI = 1.10-3.34) and bisexual (aOR, 3.12; 95% CI, 1.46-6.66) male students had significantly higher odds of craving when compared to heterosexual/straight male adolescents. However, the association was not significant in female students. Additionally, female bisexuals had significantly lower odds for quit intention (aOR, 0.48; 95% CI = 0.29-0.81) when compared to heterosexual/straight female adolescents. Results also showed no significant differences between LGB and non-LGB students for nicotine dependence. Sexual minority adolescents, especially male adolescents, were more likely to have tobacco cravings and bisexual females had lower odds of quit intention than heterosexual peers. Prevention efforts targeting this subpopulation may be beneficial.
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Affiliation(s)
- Sunday Azagba
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA 16802, USA
| | - Lingpeng Shan
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH 43210, USA;
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21
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Ganz O, Delnevo CD. Cigarette Smoking and the Role of Menthol in Tobacco Use Inequalities for Sexual Minorities. Nicotine Tob Res 2021; 23:1942-1946. [PMID: 34255831 DOI: 10.1093/ntr/ntab101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 05/10/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Cigarette smoking is disproportionately common among sexual minorities. While menthol market share has increased in the past decade, research on menthol cigarette smoking among sexual minorities is scant. For this study, we examined menthol cigarette smoking in the United States, by sex and sexual identity using a nationally representative sample of adults. AIMS AND METHODS We pooled data from the 2015-2019 National Survey on Drug Use and Health. We used chi-square tests and multivariable logistic regression models to examine (1) past 30-day cigarette use, (2) past 30-day menthol use, and (3) menthol preference among adults who have smoked cigarettes in the past 30 days for the following groups: heterosexual/straight males, heterosexual/straight females, gay males, gay/lesbian females, bisexual males, and bisexual females. Data were analyzed in September 2020. RESULTS Bivariate analyses revealed that prevalence of cigarette smoking and menthol cigarette smoking were higher among sexual minorities compared with heterosexual respondents, and that preference for menthol was highest among lesbian/gay and bisexual females who smoke. Multivariable models showed that compared with heterosexual females who smoke, odds of menthol preference were lower among heterosexual/straight and bisexual males who smoke, and higher among bisexual females. CONCLUSIONS Our study found that menthol preference was disproportionately high among sexual minorities who smoke-bisexual and gay/lesbian females who smoke in particular. Research is needed to understand why menthol use is common among sexual minorities who smoke. IMPLICATIONS Using data from a nationally representative study, this study makes a unique contribution to literature by identifying differences in menthol smoking between sexual minority subgroups. Specifically, we found that menthol smoking was highest among sexual minority females (ie, lesbian/gay and bisexual females) compared with other sexual minorities. These findings highlight the need for targeted interventions to prevent menthol cigarette initiation among sexual minorities, as well as to promote smoking cessation among sexual minorities who smoke menthol cigarettes, with an emphasis on sexual minority females. Future research should examine the impact of a potential menthol ban on these inequalities.
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Affiliation(s)
- Ollie Ganz
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA.,Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA.,Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
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22
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Gordon AR, Fish JN, Kiekens WJ, Lightfoot M, Frost DM, Russell ST. Cigarette Smoking and Minority Stress Across Age Cohorts in a National Sample of Sexual Minorities: Results From the Generations Study. Ann Behav Med 2021; 55:530-542. [PMID: 32970788 DOI: 10.1093/abm/kaaa079] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sexual minority populations in the United States have persistently higher rates of cigarette use than heterosexuals, partially driven by exposure to minority stressors (e.g., discrimination and victimization). Little is known about cigarette use across cohorts of sexual minority adults who came of age in distinctly different sociopolitical environments. PURPOSE To examine cigarette use and minority stressors across three age cohorts of U.S. sexual minority adults. METHODS We used data from the Generations Study, a nationally representative sample (N = 1,500) of White, Black, and Latino/a sexual minority adults in three age cohorts (younger: 18-25 years; middle: 34-41 years; and older: 52-59 years). Survey data were collected from March 2016 to March 2017. We used sex-stratified logistic regression models to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between age cohort, minority stressors (discrimination and victimization), and two indicators of cigarette smoking (lifetime use and current use). RESULTS Prevalence of current cigarette use in each age cohort was high (younger: 20%; middle: 33%; and older: 29%). Relative to the younger cohort, men and women in the middle- and older-age cohorts had significantly higher odds of lifetime and current smoking (e.g., men, current, aOR [95% CI]: middle = 2.47 [1.34, 4.52], older = 2.85 [1.66, 4.93]). Minority stressors were independently associated with higher odds of current smoking; when victimization was included, the magnitude of the association between age cohort and current smoking was diminished but remained significant. CONCLUSIONS Smoking cessation interventions must consider the role of minority stress and the unique needs of sexual minority people across the life course.
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Affiliation(s)
- Allegra R Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.,Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Jessica N Fish
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
| | - Wouter J Kiekens
- Department of Sociology/Interuniversity Center for Social Science Theory and Methodology (ICS), University of Groningen, Groningen, The Netherlands
| | - Marguerita Lightfoot
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - David M Frost
- Department of Social Science, University College London, London, UK
| | - Stephen T Russell
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, TX, USA
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Titus AR, Gamarel KE, Thrasher JF, Meza R, Fleischer NL. State-Level Structural Stigma and Smoking Among Sexual Minority Adults in the USA, 2012-2014. Ann Behav Med 2021; 55:557-570. [PMID: 33196079 PMCID: PMC8171797 DOI: 10.1093/abm/kaaa086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Exposure to structural stigma (i.e., societal norms and policies that constrain access to resources) may help explain poor health outcomes among sexual minority (SM) individuals in the USA. PURPOSE We examined the relationship between structural stigma and smoking prevalence among U.S. SM and heterosexual adults. METHODS We adapted an index to capture multiple state-level structural stigma indicators, including attitudes toward same-sex marriage; the geographical density of same-sex couples; and state-level policies toward SMs. The outcome variable was current smoking, derived from the National Adult Tobacco Survey (2012-2014). Poisson regression models stratified by SM status were used to assess the relationship between structural stigma and the prevalence ratio (PR) of current smoking. We included a squared term for stigma to explore nonlinear relationships between stigma and smoking. Interaction terms were used to examine effect modification by sex. RESULTS Adjusted models suggested a curvilinear PR relationship between stigma and smoking for both SM (linear PR = 1.03 [0.97-1.08]; quadratic PR = 0.98 [0.97-1.00]) and heterosexual (linear PR = 1.00 [0.99-1.02]; quadratic PR = 0.99 [0.988-0.995]) adults. The quadratic term was significant (p < .05) for both SM and heterosexual respondents, however, the change in probability of smoking associated with structural stigma was more pronounced among SM individuals. Specifically, the highest and lowest exposures to stigma were associated with the lowest probabilities of smoking. There was no apparent effect modification by sex. CONCLUSIONS Findings lend support to addressing SM structural stigma as a driver of smoking, particularly among SM adults.
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Affiliation(s)
- Andrea R Titus
- Center for Social Epidemiology & Population Health and Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Nancy L Fleischer
- Center for Social Epidemiology & Population Health and Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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24
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How can we meet the support needs of LGBT cancer patients in oncology? A systematic review. Radiography (Lond) 2021; 27:633-644. [DOI: 10.1016/j.radi.2020.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/05/2020] [Accepted: 07/10/2020] [Indexed: 12/19/2022]
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25
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LoSchiavo C, Acuna N, Halkitis PN. Evidence for the Confluence of Cigarette Smoking, Other Substance Use, and Psychosocial and Mental Health in a Sample of Urban Sexual Minority Young Adults: The P18 Cohort Study. Ann Behav Med 2021; 55:308-320. [PMID: 32720976 PMCID: PMC8025086 DOI: 10.1093/abm/kaaa052] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sexual minority men (SMM) and transgender women (TW) are more likely to smoke cigarettes than heterosexual and cisgender peers, which may exacerbate existing disparities in mental and psychosocial health and substance use. PURPOSE As few existing studies have examined the confluence of these factors, we sought to examine tobacco use in a diverse sample of SMM and TW and describe its relationship with other substance use and health. METHODS Data were drawn from a study of syndemic conditions among SMM and TW, which included measures assessing tobacco use, substance use, and mental, psychosocial, and general health. RESULTS A majority of the racially/ethnically and socioeconomically diverse sample (n = 665) reported ever smoking a cigarette, and more than half of them were current smokers. Current smoking was associated with more frequent recent substance use and poorer mental, psychosocial, and general health. In multivariable analyses, current smoking was predicted by more frequent substance use and more severe anxiety, when adjusting for demographic, substance use, and health factors. CONCLUSIONS A syndemic approach to health conditions such as substance use, mental health, and psychosocial burden dictates a framework of interrelation and mutual exacerbation. In doing so, we found that current cigarette use was associated with more frequent alcohol and marijuana use and more severe anxiety, suggesting a confluence of cigarette smoking, other substance use, and mental health burden. We recommend a holistic approach to treating tobacco use in sexual and gender minority populations that addresses both substance use and the myriad psychosocial burdens that sexual and gender minority communities experience.
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Affiliation(s)
- Caleb LoSchiavo
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers School of Public Health, Newark, NJ
- Department of Health Behavior, Society and Policy, School of Public Health, Rutgers University, Piscataway, NJ
| | - Nicholas Acuna
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers School of Public Health, Newark, NJ
- Departments of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ
| | - Perry N Halkitis
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers School of Public Health, Newark, NJ
- Departments of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ
- Department of Urban-Global Public Health, School of Public Health, Rutgers University, Newark, NJ
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26
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Li J, Berg CJ, Weber AA, Vu M, Nguyen J, Haardörfer R, Windle M, Goodman M, Escoffery C. Tobacco Use at the Intersection of Sex and Sexual Identity in the U.S., 2007-2020: A Meta-Analysis. Am J Prev Med 2021; 60:415-424. [PMID: 33218922 DOI: 10.1016/j.amepre.2020.09.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/26/2020] [Accepted: 09/14/2020] [Indexed: 12/19/2022]
Abstract
CONTEXT A 2009 systematic review synthesized data between 1987 and 2007 and revealed a higher prevalence of smoking among sexual minority populations than among heterosexuals. Subsequently, growing attention to tobacco use among sexual minority populations has spurred more literature on this issue because higher tobacco use prevalence has been found in certain sexual minority subgroups relative to others. However, a population-level synthesis of tobacco use prevalence by sexual minority subgroup has not been done for the past decade. EVIDENCE ACQUISITION Investigators conducted a meta-analysis by searching MEDLINE, Web of Science, EMBASE, and PsycINFO for U.S.-based studies published between 2007 and 2020 that specifically reported tobacco use prevalence among adults and separated the sexes and gays/lesbians versus bisexuals. Using random-effects models, meta-prevalence estimates, 95% CIs, and heterogeneity (I2) were calculated for each sexual minority subgroup. EVIDENCE SYNTHESIS A total of 30 studies were included in the meta-analysis. The highest current cigarette use prevalence estimates were found among bisexual women (37.7%), followed by lesbians (31.7%), gay men (30.5%), and bisexual men (30.1%). Heterosexual men (21.0%) and women (16.6%) had the lowest prevalence. CONCLUSIONS Tobacco use prevalence among sexual minorities during 2007-2020 remained at similarly high levels as those during 1987-2007, and tobacco use disparity between sexual minorities and heterosexuals persisted in the past decade. Significant heterogeneity existed in tobacco use across sexual minority subgroups, with bisexual women having the highest prevalence. These findings are critical for increasing decision maker's awareness and action to address sexual minorities' persistent high prevalence of tobacco use, particularly among bisexual women.
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Affiliation(s)
- Jingjing Li
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia; George Washington Cancer Center, George Washington University, Washington, District of Columbia
| | - Amber A Weber
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Milkie Vu
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Justin Nguyen
- Emory College of Arts and Sciences, Emory University, Atlanta, Georgia
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Michael Windle
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia.
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27
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Lipperman-Kreda S, Wilson I, Hunt GP, Annechino R, Antin TM. SUBSTANCE USE AMONG SEXUAL AND GENDER MINORITIES: ASSOCIATION WITH POLICE DISCRIMINATION AND POLICE MISTRUST. SEXUALITY, GENDER & POLICY 2020; 3:92-104. [PMID: 34651132 PMCID: PMC8513710 DOI: 10.1002/sgp2.12019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 05/06/2020] [Indexed: 11/11/2022]
Abstract
We investigated associations between experiences with police discrimination, police mistrust, and substance use in a convenience sample of 237 sexual and gender minority (SGM) adults in California. In a cross-sectional survey, collected between January 2016 and July 2017, participants reported substance use, lifetime experiences with SGM-related police discrimination, police mistrust, demographics and SGM visibility. In adjusted logistic regression models, we found a positive association between lifetime police discrimination and past-two-week heavy episodic drinking. Police mistrust also was positively associated with past-month marijuana use. Several significant interactions between lifetime police discrimination or police mistrust with other socially stigmatized identities including being African American, insecure housing, and being a gender minority on a few substance use outcomes suggest that effects of police discrimination and mistrust on substance use are stronger among participants with multiple stigmatized identities. Results suggest the importance of policies and interventions that focus on eliminating police discrimination and increasing police legitimacy to reduce risk of substance use among SGM individuals.
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Affiliation(s)
- Sharon Lipperman-Kreda
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
- Institute for Scientific Analysis, Alameda, CA, USA
| | - Ida Wilson
- Institute for Scientific Analysis, Alameda, CA, USA
| | - Geoffrey P. Hunt
- Institute for Scientific Analysis, Alameda, CA, USA
- Centre for Alcohol and Drug Research, Aarhus University, Denmark
| | - Rachelle Annechino
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
- Institute for Scientific Analysis, Alameda, CA, USA
| | - Tamar M.J Antin
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
- Institute for Scientific Analysis, Alameda, CA, USA
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28
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Shokoohi M, Salway T, Ahn B, Ross LE. Disparities in the prevalence of cigarette smoking among bisexual people: a systematic review, meta-analysis and meta-regression. Tob Control 2020; 30:e78-e86. [PMID: 32934092 DOI: 10.1136/tobaccocontrol-2020-055747] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/22/2020] [Accepted: 07/22/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To review the bisexual-specific prevalence and likelihood of cigarette smoking relative to lesbian/gay and heterosexual individuals. DATA SOURCES We searched MEDLINE, PsycInfo, CINAHL, Scopus and LGBT Life databases (from 1995 to September 2019) for studies reporting cigarette smoking among bisexuals versus their comparators. STUDY SELECTION Observational, quantitative, peer-reviewed studies providing estimates for lifetime, past 30 days or current cigarette smoking among bisexuals and any of the two comparators were selected. DATA EXTRACTION Data on sexual orientation groups, cigarette smoking, sample type and mechanism, data collection mode, country and median year, as well as gender and age groups were extracted. DATA SYNTHESIS Random-effects meta-analysis was used to estimate the pooled OR (95% CIs) of cigarette smoking. Meta-regression was used to examine the difference in the prevalence of cigarette smoking by study and sample characteristics. Of 4663 unduplicated records, 47 unique studies were included (14, 23 and 22 studies on lifetime, past 30 days and current cigarette smoking, respectively). Compared with lesbians/gays and heterosexuals, bisexuals were 1.25 (1.15 to 1.37) and 2.18 (1.84 to 2.59) times more likely to report lifetime smoking, 1.17 (1.08 to 1.27) and 2.49 (2.20 to 2.83) times more likely to report past 30 days smoking and 1.19 (1.00 to 1.43) and 2.26 (1.97 to 2.59) times more likely to report current smoking. Gender was a significant covariate in the meta-regression models. CONCLUSIONS Cigarette smoking was more prevalent among bisexuals than lesbians/gays and heterosexuals, with the estimates showing a greater magnitude among bisexual women relative to all other sexual orientation/gender subgroups.
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Affiliation(s)
- Mostafa Shokoohi
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.,British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Benjamin Ahn
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lori E Ross
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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29
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Trends in smoking prevalence over time and space: A comparison between sexual minority and heterosexual populations. Health Place 2020; 65:102421. [PMID: 32889389 DOI: 10.1016/j.healthplace.2020.102421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/03/2020] [Accepted: 08/14/2020] [Indexed: 11/22/2022]
Abstract
Research has suggested that lesbian, gay and bisexual (LGB) individuals are more likely to smoke tobacco than heterosexual individuals, but specific geographic patterns have not been examined frequently. We analysed change in smoking prevalence over time across Great Britain for LGB and heterosexual populations, comparing models for men and women. Smoking prevalence remained greater for sexual minority (SM) women over time than for other groups. Across Great Britain, decreases in smoking prevalence in urban areas were more pronounced for SM men compared with SM women. Future anti-smoking policies should consider sexuality and its association with place to eradicate smoking inequalities.
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30
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Siegel SD, Lerman C, Flitter A, Schnoll RA. The Use of the Nicotine Metabolite Ratio as a Biomarker to Personalize Smoking Cessation Treatment: Current Evidence and Future Directions. Cancer Prev Res (Phila) 2020; 13:261-272. [PMID: 32132120 PMCID: PMC7080293 DOI: 10.1158/1940-6207.capr-19-0259] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/20/2019] [Accepted: 07/01/2019] [Indexed: 12/15/2022]
Abstract
The nicotine metabolite ratio (NMR), a genetically informed biomarker of rate of nicotine metabolism, has been validated as a tool to select the optimal treatment for individual smokers, thereby improving treatment outcomes. This review summarizes the evidence supporting the development of the NMR as a biomarker of individual differences in nicotine metabolism, the relationship between the NMR and smoking behavior, the clinical utility of using the NMR to personalize treatments for smoking cessation, and the potential mechanisms that underlie the relationship between NMR and smoking cessation. We conclude with a call for additional research necessary to determine the ultimate benefits of using the NMR to personalize treatments for smoking cessation. These future directions include measurement and other methodologic considerations, disseminating this approach to at-risk subpopulations, expanding the NMR to evaluate its efficacy in predicting treatment responses to e-cigarettes and other noncigarette forms of nicotine, and implementation science including cost-effectiveness analyses.See all articles in this Special Collection Honoring Paul F. Engstrom, MD, Champion of Cancer Prevention.
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Affiliation(s)
- Scott D Siegel
- Value Institute and Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, Delaware.
| | - Caryn Lerman
- Department of Psychiatry and Norris Cancer Center, University of Southern California, Los Angeles, California
| | - Alex Flitter
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert A Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
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31
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Glasser AM, Barton A, Rath J, Simard B, Rose SW, Hair E, Vallone D. Perceptions of Use Patterns and Health Consequences Associated With Mentholated Cigarettes Among U.S. Adults. HEALTH EDUCATION & BEHAVIOR 2020; 47:284-292. [PMID: 32003242 DOI: 10.1177/1090198119897608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite declines in overall cigarette smoking in the United States, menthol cigarette smoking prevalence has increased among young adults (18-25 years) and remains constant among older adults (26 years and older). Disparities in menthol cigarette use exist, with higher prevalence among younger adult smokers and among racial/ethnic minority populations. Menthol in cigarettes has been shown to play a role in increasing smoking initiation and making it more difficult to quit smoking. Little research focuses on perceptions of the addictive potential and health consequences of menthol cigarette use. This analysis uses data from a national panel of U.S. adults (n = 1,303) surveyed in 2016. Participants were asked to what extent they agreed with various statements regarding menthol use among demographic and tobacco use subgroups. These data reveal disparities in perceptions of the impact of menthol use, with Black, non-Hispanic, and Hispanic adults and adults with lower income and less education misperceiving the health effects and addiction potential of menthol in cigarettes. Determining how and to what extent population subgroups understand the effect of menthol cigarette use can inform public education strategies and, in turn, policy efforts to ban or restrict menthol cigarette availability.
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Affiliation(s)
- Allison M Glasser
- New York University, New York, NY, USA.,The Ohio State University, Columbus, OH, USA
| | - Alexis Barton
- Truth Initiative Schroeder Institute, Washington, DC, USA
| | - Jessica Rath
- Truth Initiative Schroeder Institute, Washington, DC, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bethany Simard
- Truth Initiative Schroeder Institute, Washington, DC, USA
| | | | - Elizabeth Hair
- Truth Initiative Schroeder Institute, Washington, DC, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Donna Vallone
- New York University, New York, NY, USA.,Truth Initiative Schroeder Institute, Washington, DC, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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32
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Li DJ, Chen SL, Chang YP, Yen CF. Factors Affecting Painkillers, Sedatives/Hypnotics, Nicotine, and Unhealthy Alcohol Use Among Gay and Bisexual Men in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E851. [PMID: 32013262 PMCID: PMC7038077 DOI: 10.3390/ijerph17030851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 01/29/2023]
Abstract
Substance use has become a major health problem globally for sexual minorities. However, few studies have explored multi-dimensional factors associated with smoking, drinking, and prescription drug use. We aimed to investigate the factors affecting painkiller, sedative/hypnotic, nicotine and unhealthy alcohol use among gay and bisexual men in Taiwan. We recruited 500 gay or bisexual men and assessed their experiences of using painkillers, sedatives/hypnotics, nicotine, alcohol and multi-dimensional factors with self-reported questionnaires. Multivariate logistic regression with a forward stepwise model was used to verify the factors associated with substance use. Overall, 9.4%, 5.4%, and 13.8% of the participants reported using painkillers, sedatives/hypnotics, and nicotine, respectively, and 5.6% reported unhealthy alcohol use. Victims of traditional homophobic bullying in childhood and adolescence were more likely to report nicotine use, sedative/hypnotic use, and unhealthy alcohol use in early adulthood than non-victims. Missing classes or truancy at senior high school was associated with painkiller and sedative/hypnotic use in early adulthood. Traditional homophobic bullying and missing classes or truancy in childhood and adolescence predicted substance use in early adulthood among the gay and bisexual men in this study. Timely preventions and interventions for substance use are crucial for gay and bisexual men, especially for those who experience homophobic bullying and missing classes or truancy.
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Affiliation(s)
- Dian-Jeng Li
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung 80276, Taiwan
| | - Shiou-Lan Chen
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Yu-Ping Chang
- School of Nursing, The State University of New York, University at Buffalo, New York, NY14214–3079, USA;
| | - Cheng-Fang Yen
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
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33
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Schuler MS, Collins RL. Sexual minority substance use disparities: Bisexual women at elevated risk relative to other sexual minority groups. Drug Alcohol Depend 2020; 206:107755. [PMID: 31810051 PMCID: PMC6980764 DOI: 10.1016/j.drugalcdep.2019.107755] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/02/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Prior studies characterizing sexual minority substance use disparities have primarily compared lesbian/gay and bisexual individuals, respectively or in combination, to heterosexual individuals. In light of emerging evidence that bisexual individuals may have particularly elevated substance use risk, we examine differences in recent substance use between bisexual and lesbian/gay individuals using national survey data. METHODS Data on 126,463 adults (including 8241 LGB adults) were from the 2015-2017 National Survey on Drug Use and Health. Substance use outcomes included binge drinking, cigarette smoking, cigar smoking, marijuana use, illicit drug use, opioid misuse, alcohol use disorder, nicotine dependence, and substance use disorder. Logistic regression was used to estimate sexual identity- and gender-specific odds ratios, controlling for demographic characteristics. Of particular interest were estimates comparing bisexual and lesbian/gay individuals of the same gender. RESULTS Both male and female sexual minority adults had significantly elevated rates of substance use compared to heterosexual adults. Furthermore, relative to lesbian/gay women, bisexual women had significantly elevated odds of binge drinking (aOR = 1.29), marijuana use (aOR = 1.42), illicit drug use (aOR = 1.55), opioid misuse (aOR = 1.53), and alcohol use disorder (aOR = 1.48). Relative to gay men, bisexual men had significantly elevated cigar use (aOR = 1.64). CONCLUSIONS Bisexual women were at significantly greater risk for multiple substance use behaviors relative to lesbian/gay women. We did not observe any substance use behaviors for which bisexual individuals had significantly lower risk than their lesbian/gay peers. These disparities may be explained, in part, by unique risk factors for substance use experienced by bisexual individuals, particularly bisexual women.
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34
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Azagba S, Shan L, Latham K, Qeadan F. Disparities in adult cigarette smoking and smokeless tobacco use by sexual identity. Drug Alcohol Depend 2020; 206:107684. [PMID: 31753730 DOI: 10.1016/j.drugalcdep.2019.107684] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND While there have been reductions in rates of tobacco use in the general population in recent years, rates remain high among sexual minority populations (SMP). Prior studies often group SMP as one category due to limited data. This study examined the association between sexual identity status and tobacco use (cigarette and smokeless tobacco use) among U.S. adults. METHODS Data from the 2014-2017 Behavioral Risk Factor Surveillance System were analyzed to examine the association between sexual identity (lesbian or gay, bisexual, other, not sure, and heterosexual or straight) and tobacco use. A propensity score analysis was conducted to address potential imbalance among group characteristics. RESULTS Lesbian/gay and bisexual groups had significantly higher odds of being an every day smoker (OR = 1.83, 95 % Confidence Interval (CI) 1.59-2.10; OR = 1.36, 95 % CI 1.19-1.55, respectively) and current smoker (every day or some days) (OR = 1.71, 95 % CI 1.52-1.93; OR = 1.44, 95 % CI 1.29-1.62, respectively) compared to straight adults. In terms of smokeless tobacco products, lesbian and gay adults had lower odds of every day and current use. However, significant differences were found in the separate analysis conducted for males and females. While gay and bisexual males had lower odds of smokeless tobacco use, lesbians had significantly higher odds when compared to the straight population. Bisexual females were also more likely to be current users of smokeless tobacco. CONCLUSIONS Significant heterogeneity in tobacco use was found among sexual minority subgroups. Findings demonstrate the importance of subgroup analysis of SMP. These results have implications for prevention and cessation targeting.
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Affiliation(s)
- Sunday Azagba
- Department of Family and Preventive Medicine, University of Utah School of Medicine, United States.
| | - Lingpeng Shan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, United States
| | - Keely Latham
- Department of Family and Preventive Medicine, University of Utah School of Medicine, United States
| | - Fares Qeadan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, United States
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Hequembourg AL, Blayney JA, Bostwick W, Van Ryzin M. Concurrent Daily Alcohol and Tobacco Use among Sexual Minority and Heterosexual Women. Subst Use Misuse 2020; 55:66-78. [PMID: 31446825 DOI: 10.1080/10826084.2019.1656252] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Studies show that sexual minority women (SMW) report more hazardous alcohol use patterns and higher rates of tobacco use than exclusively heterosexual women. Despite the public health implications of drinking and smoking, especially when they co-occur, little is known about SMW's daily use patterns or the factors that may facilitate concurrent use. Objectives: The present study seeks to identify patterns of daily concurrent alcohol and tobacco use among SMW and heterosexual women, including socio-environmental drinking contexts of concurrent use. Methods: Data come from a community sample of lesbian, bisexual, and heterosexual women (N = 246) who completed up to 84 consecutive days of web-based reports about substance use. Results: Participants reported 4,012 drinking days (24%), 2,019 smoking days (12%), and 769 concurrent drinking and smoking days (5%). No differences were found between SMW and heterosexual women in the proportion of drinking days; however, SMW consumed more drinks on drinking days. SMW also reported a greater proportion of smoking days, more cigarettes smoked on smoking days, and a greater proportion of concurrent drinking and smoking days. Reciprocal daily relationships between alcohol and tobacco use were identified, and these relationships were strongest for bisexual women. Socio-environmental factors-including certain locations, situations, and companions-increased the likelihood of concurrent use for all women; however, few sexual identity differences were found in concurrent use contexts. Importance: Results expand our understanding about daily concurrent alcohol and tobacco use risk among SMW, and potentially inform treatment research to better address the unique experiences of this vulnerable group.
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Affiliation(s)
- Amy L Hequembourg
- Research Institute on Addictions, University at Buffalo, The State University of New York, Buffalo, New York, USA.,School of Nursing, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Jessica A Blayney
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Wendy Bostwick
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
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Aleshire ME, Fallin-Bennett A, Bucher A, Hatcher J. LGBT friendly healthcare providers' tobacco treatment practices and recommendations. Perspect Psychiatr Care 2019; 55:546-553. [PMID: 31093993 DOI: 10.1111/ppc.12395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/09/2019] [Accepted: 03/24/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE This study aimed to describe lesbian, gay, bisexual, and transgender (LGBT) friendly providers' (1) smoking cessation recommendations to LGBT patients and (2) tobacco treatment practices for transgender patients. DESIGN AND METHODS In-depth, semistructured phone interviews were conducted with 13 healthcare providers. FINDINGS Four overarching themes emerged: (1) providing tobacco treatment services for LGBT patients; (2) barriers to LGBT smoking cessation; (3) prescribing practices for transgender individuals taking estrogen hormone therapy; (4) provider community outreach to promote LGBT smoking cessation. PRACTICE IMPLICATIONS Holistic tobacco treatment services are needed to address LGBT-specific barriers to tobacco cessation, such as stress, identity-related factors, and inadequate healthcare access.
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Affiliation(s)
- Mollie E Aleshire
- School of Nursing, University of North Carolina at Greensboro, Greensboro, North Carolina
| | | | - Amanda Bucher
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Jennifer Hatcher
- College of Public Health, University of Arizona-Phoenix, Phoenix, Arizona
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Davies M, Lewis NM, Moon G. Differential pathways into smoking among sexual orientation and social class groups in England: A structural equation model. Drug Alcohol Depend 2019; 201:1-7. [PMID: 31154238 DOI: 10.1016/j.drugalcdep.2019.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/19/2019] [Accepted: 04/01/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Previous research has shown that lesbian, gay and bisexual (LGB) populations smoke more than their heterosexual counterparts. Little is known about the pathways into smoking among LGB populations in England relative to the lower social class populations that are the focus of the current Tobacco Control Plan (TCP). METHODS Using the 2013/2014 waves of the Health Survey for England (HSE), we created a structural equation model to analyze pathways and interactions between sexual orientation, social class, and the number of cigarettes smoked daily. The path analysis assessed whether three intervening factors-age of initiation, mental wellbeing score, and exposure to smoke-are implicated similarly in smoking among LGB and lower social class populations, and whether interaction between sexual orientation and class is further associated with smoking. RESULTS Bivariate analysis showed that LGB-identified individuals and individuals in lower occupational classes smoke more cigarettes daily, respectively, than heterosexual individuals and those in professional/managerial-class populations. Path analysis showed that the number of cigarettes smoked daily was mediated by age of initiation, mental wellbeing score and weekly exposure to smoke among routine and manual workers; by mental wellbeing score and exposure to smoke among intermediate class workers, and by mental wellbeing score in the LGB population. Interactions between sexual orientation and social class were not significant. CONCLUSIONS The differential nature of pathways into smoking for lower social classes and LGB populations in England suggests the need for tailored prevention and cessation efforts, with programming for LGB populations focused on the distinct stressors they face.
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Affiliation(s)
- Megan Davies
- Department of Geography and Environment, University of Southampton, Shackleton Building, Highfield Campus, SO17 1BJ, Southampton, UK.
| | - Nathaniel M Lewis
- Department of Geography and Environment, University of Southampton, Shackleton Building, Highfield Campus, SO17 1BJ, Southampton, UK.
| | - Graham Moon
- Department of Geography and Environment, University of Southampton, Shackleton Building, Highfield Campus, SO17 1BJ, Southampton, UK.
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Smith NG, Winderman K, King B, Obasi EM, Reitzel LR. The Association of Lesbian, Gay, and Bisexual Identity Facets With Smoking Dependence Motives. Nicotine Tob Res 2019; 20:388-392. [PMID: 28340125 DOI: 10.1093/ntr/ntx061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/06/2017] [Indexed: 11/14/2022]
Abstract
Introduction Lesbian, gay, and bisexual (LGB) adults have higher rates of smoking than heterosexual adults. LGB individuals face unique stressors, including challenges associated with having a LGB identity. The extent to which these unique stressors are related to dependence motives in LGB adult smokers, however, has not been previously explored. The current study was conducted to redress these gaps. Methods Participants (N = 52; Mage = 42.8; 55.8% Black/African American) were recruited from the local community. Identity facets were measured by the Lesbian, Gay, and Bisexual Identity Scale (LGBIS). Dependence motives were measured by the Brief Wisconsin Inventory of Smoking Dependence Motives. Linear multiple regressions were calculated with the predictors of seven LGBIS subscales for primary and secondary dependence motives, respectively. Results Primary dependence motives (core nicotine dependence features) were predicted by affirmation of LGB identity (β = 0.44). Secondary dependence motives (eg, taste, cognitive/affective enhancement) were predicted by uncertainty of LGB identity (β = 0.43). Conclusions LGB identity affirmation was associated with primary dependence motives, suggesting that a positive view of one's sexual orientation is a risk factor for dependence. It may be that identity affirmation is related to stronger involvement with the LGB community, which has smoking-friendly norms. Identity uncertainty was associated with secondary dependence motives; this unique identity challenge may represent a stressor contributing to smoking dependence. Findings can help explain the higher rate of smoking in LGB populations and offer avenues to better tailor smoking cessation interventions. Implications The current study is the first to examine multidimensional aspects of LGB identity in explaining smoking dependence motives among LGB adults. Results reveal that LGB identity challenges are associated with dependence motives, suggesting that interventions targeting these challenges may be help reduce LGB smoking disparities. Specifically, reducing identity uncertainty may help reduce smoking dependence. Though identity affirmation was a smoking dependence correlate, it is counterproductive to reduce affirmation, given its association with other positive health outcomes. Rather, interventions to change LGB community norms around smoking appear warranted, given the documented high overlap between affirmation and community affiliation.
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Affiliation(s)
- Nathan Grant Smith
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, TX
| | - Kate Winderman
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, TX
| | - Brooke King
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, TX
| | - Ezemenari M Obasi
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, TX
| | - Lorraine R Reitzel
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, TX
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McQuoid J, Thrul J, Ozer E, Ramo D, Ling PM. Tobacco use in the sexual borderlands: The smoking contexts and practices of bisexual young adults. Health Place 2019; 58:102069. [PMID: 30639203 PMCID: PMC6620170 DOI: 10.1016/j.healthplace.2018.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 11/29/2022]
Abstract
Little is known about why bisexual people use tobacco at higher rates than any other sexual identity group. Non-binary sexualities, such as bisexuality, exist within the socially constructed borderland between homosexuality and heterosexuality. Exploration of the everyday smoking contexts and practices of bisexual individuals may reveal unique mechanisms driving tobacco use. We employed a novel mixed method, integrating real-time, smartphone-administered surveys of (non)smoking situations, location tracking, spatial visualization of participant data, and subsequent map-led interviews. Participants (n = 17; ages 18-26, California) identified as bisexual, pansexual, and/or queer. Most were cisgender women. Survey smoking patterns and situational predictors were similar to other young adults'. However, interviews revealed unique roles of tobacco use in participants' navigation of differently sexualized spaces in everyday life: 1) stepping away from uncomfortable situations related to bisexual identity; 2) facilitating belonging to LGBTQ+ community; and 3) recovering from bisexual identity perception management. Similar studies can examine the place-embedded practices and spatio-temporal patterns of other substance use and other stigmatized identity experiences.
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Affiliation(s)
- Julia McQuoid
- Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Ave, Suite 366, San Francisco, CA 94143, United States.
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkin s University, 624 N. Broadway, Baltimore, MD 21205, United States.
| | - Emily Ozer
- School of Public Health, University of California, Berkeley, 529 University Hall, Berkeley, CA 94720, United States.
| | - Danielle Ramo
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States.
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Ave, Suite 366, San Francisco, CA 94143, United States.
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Praeger R, Roxburgh A, Passey M, Mooney-Somers J. The prevalence and factors associated with smoking among lesbian and bisexual women: Analysis of the Australian National Drug Strategy Household Survey. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 70:54-60. [PMID: 31082663 DOI: 10.1016/j.drugpo.2019.03.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 02/22/2019] [Accepted: 03/15/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND In many countries, sexual minority women smoke at higher rates than their heterosexual counterparts. Analyses tend to combine lesbian and bisexual women, preventing an understanding of relevant factors associated with smoking for each group. This analysis used a representative sample of the Australian population to compare tobacco use between heterosexual, lesbian and bisexual women, and examine factors associated with smoking among these groups. METHODS In a secondary analysis of data from the National Drug Strategy Household Survey (N = 23,855), descriptive statistics were produced for heterosexual (n = 11,776), lesbian (n = 135) and bisexual (n = 167) women. Multivariate logistic regression modelling was undertaken to assess which factors were associated with current smoking among the different groups. RESULTS Compared to heterosexual women, lesbian and bisexual women were more likely to be current smokers (OR 2.9(1.8,4.5) and OR 3.6(2.4, 5.4) respectively). Employment, income and psychological distress were significant factors associated with smoking for lesbian women. Recent illicit drug use was the only significant factor associated with smoking for bisexual women. CONCLUSIONS We need to better understand the psychological, social and cultural factors that influence initiation, and sustain smoking among lesbian and bisexual women. Our findings demonstrate that sexual minority women in Australia warrant specific policy attention in a national framework.
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Affiliation(s)
- Ruth Praeger
- University of Sydney, Faculty of Medicine and Health, Sydney Health Ethics, Level 1 Medical Foundation Building, 91-97 Parramatta Road, Camperdown, NSW, 2050, Australia.
| | - Amanda Roxburgh
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Megan Passey
- University of Sydney, Faculty of Medicine and Health, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW, 2480, Australia.
| | - Julie Mooney-Somers
- University of Sydney, Faculty of Medicine and Health, Sydney Health Ethics, Level 1 Medical Foundation Building, 91-97 Parramatta Road, Camperdown, NSW, 2050, Australia.
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Abstract
OBJECTIVES To examine associations between sleep duration and health outcomes among distinct groups of sexual minority adults. METHODS Using data from the 2014 Behavioral Risk Factor Surveillance System, we compared sleep duration (very short: ≤ 5 hr; short: 6 hr; normal: 7-8 hr; and long: ≥ 9 hr per day) between cisgender straight adults and distinct groups of sexual minorities. We further examined associations between sleep duration and 10 chronic health conditions among sexual minorities. RESULTS Of 146,893 respondents, 142,507 (96.2%) were cisgender straight, and 4,386 (3.8%) were lesbian, gay, bisexual, transgender (LGBT). Overall, 17.3% of LGBT respondents reported very short sleep per day, compared with 12.2% for cisgender straight respondents (p < 0.0001). Among LGBT populations, the prevalence of very short sleep varied significantly among distinct groups, ranging from 13.2% among transgender female to male adults to 35.5% among transgender gender nonconforming adults. Very short sleep was further associated with increased odds of having stroke (aOR = 4.1, 95% CI [2.2-7.6]), heart attack (aOR = 3.0, CI [1.6-5.8]), coronary heart disease (aOR = 3.1, 95% CI [1.5-6.2]), asthma (aOR = 1.7, 95% CI [1.1-2.4]), chronic obstructive pulmonary disease (aOR = 2.5, CI [1.5-4.0]), arthritis (aOR = 2.1, CI [1.4-3.0]), and cancer (aOR = 1.8, 95% CI [1.0-3.2]) among sexual minorities. Disparities in the prevalence of stroke, heart attack, coronary health disease, COPD, diabetes, obesity, arthritis, and cancer were found among LGBT populations. CONCLUSIONS Sexual minorities have a higher prevalence of sleep deprivation as compared with their straight counterparts. Sleep deprivation varies by sexual identity and gender. Very short sleep duration is associated with some chronic health conditions among LGBT populations. Promotion of sleep health education and routine medical assessment of sleep disorders are critically needed for sexual minority adults.
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Affiliation(s)
- Hongying Dai
- a Health Services & Outcomes Research , Children's Mercy Hospital , Kansas City , Missouri.,b Department of Biomedical & Health Informatics , University of Missouri , Kansas City , Missouri.,c Department of Pediatrics , University of Missouri , Kansas City , Missouri
| | - Jianqiang Hao
- d College of Business, Bellevue University , Omaha , Nebraska
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Hinds JT, Loukas A, Perry CL. Explaining sexual minority young adult cigarette smoking disparities. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 33:371-381. [PMID: 30958013 DOI: 10.1037/adb0000465] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sexual minority (SM) young adults, such as those who identify as lesbian, gay, or bisexual (LGB), have well documented smoking disparities compared to heterosexual young adults. However, no studies have simultaneously tested the role of three risk factors (depressive symptoms, recalling tobacco marketing in bars, and cigarette-related social norms) to explain SM tobacco use disparities. Longitudinal structural equation modeling was used to explore if the association between SM identity and past 30-day cigarette smoking one year later was mediated by these three risk factors. Starting in fall 2015, three surveys were administered every 6 months to 3,972 young adult college students. Surveys assessed SM identity, depressive symptoms, tobacco marketing in bars, normative perceptions of cigarettes, and tobacco use behaviors. Greater depressive symptoms, recalling more tobacco marketing in bars, and more accepting cigarette-related social norms were each hypothesized to explain a unique portion of the association between SM identity and subsequent cigarette use. SM young adults reported higher prevalence of cigarette use, depressive symptom scores reflecting elevated risk for major depressive disorder, and more accepting cigarette-related social norms than their heterosexual peers. Results indicated that only cigarette-related social norms mediated the association between SM identity and subsequent past 30-day smoking, while controlling for depressive symptoms, recalling tobacco marketing in bars, sociodemographic factors, and previous tobacco use. Findings reflect a need for tailored tobacco control messaging that shift the more accepting cigarette-related norms of SM young adults, as doing so may ultimately lead to decreased smoking for this high-risk subgroup. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Josephine T Hinds
- Department of Kinesiology and Health Education, The University of Texas at Austin
| | - Alexandra Loukas
- Department of Kinesiology and Health Education, The University of Texas at Austin
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Parent MC, Arriaga AS, Gobble T, Wille L. Stress and substance use among sexual and gender minority individuals across the lifespan. Neurobiol Stress 2019; 10:100146. [PMID: 30937352 PMCID: PMC6430403 DOI: 10.1016/j.ynstr.2018.100146] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/23/2018] [Accepted: 12/26/2018] [Indexed: 11/25/2022] Open
Abstract
Sexual and gender minority (SGM) individuals face marked disparities in substance use. The present narrative review explores research on substance use in SGM communities using a minority stress theory lens. We define the SGM population and minority stress, and explore stresses and substance use disparities in adolescence, adulthood, and older age. Though research on this topic is beginning to highlight the relationship between stress and substance use for SGM individuals, more work is needed on older SGM populations and in translating research findings to effective interventions.
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Affiliation(s)
- Mike C. Parent
- University of Texas at Austin, Department of Educational Psychology, Sanchez 262H, Austin, TX, 78749, USA
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Assari S. Education Attainment and Obesity:Differential Returns Based on Sexual Orientation. Behav Sci (Basel) 2019; 9:E16. [PMID: 30699932 PMCID: PMC6406256 DOI: 10.3390/bs9020016] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 02/06/2023] Open
Abstract
Background: Although high educational attainment is linked to better health and lower health risk behaviors, this effect may be systemically smaller for racial and ethnic minority groups compared to Whites. However, it is still unknown whether these diminished returns also apply to marginalization based on sexual orientation. Aims: In a national sample of adults which was composed of people of color, we compared straight and homosexual people for the association between education attainment and obesity. Methods: The Social Justice Sexuality Project (SJS-2010) is a cross-sectional national survey of health and wellbeing of predominantly people of color who identify as homosexual. The current analysis included 2884 adults (age 24 or more) who were either heterosexual (n = 260) or homosexual (n = 2624). The predictor variable was education attainment, and the outcome variable was obesity status (body mass index larger than 30 kg/m² [kilograms per meter squared]). Demographic factors (age and gender), household income, nativity (US born vs. immigrant), and health (self-rated health and current smoking) were the covariates. Sexual orientation was the moderator. Results: In the pooled sample, high education attainment was protective against obesity status. Sexual orientation interacted with education attainment on odds of obesity, which was suggestive of stronger protective effects of high education attainment against obesity for heterosexual than homosexual individuals. Conclusion: High education attainment better protects heterosexual than homosexual people against obesity, a pattern similar to what has been observed for comparison of Whites and non-Whites. Smaller protective effects of education attainment on health behaviors of marginalized people are possibly, due to prejudice and discrimination that they experience. Discrimination may minimize stigmatized individuals' abilities to mobilize their economic and human resources and translate them to tangible outcomes. This finding extends the Minorities' Diminished Returns theory, suggesting that it is not just race/ethnicity but possibly any marginalizing and stigmatizing social identity that results in diminished returns of socioeconomic status resources.
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Affiliation(s)
- Shervin Assari
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109-2700, USA.
- Center for Research on Ethnicity, Culture, and Health (CRECH), University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA.
- Department of Psychology, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA.
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Dai H, Meyer IH. A Population Study of Health Status Among Sexual Minority Older Adults in Select U.S. Geographic Regions. HEALTH EDUCATION & BEHAVIOR 2019; 46:426-435. [DOI: 10.1177/1090198118818240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. This study seeks to examine the health disparities of sexual minority older adults. Method. We used a probability sample of adults older than 50 years in select U.S. regions from the 2014, 2015, and 2016 Behavioral Risk Factor Surveillance System with administration of the sexual orientation question ( n = 350,778). Binary and multinomial logistic regression models were performed to examine health disparities in general health conditions, lifetime chronic health conditions, limitations in activities, substance use, access to care and preventive health behaviors by sexual minority status (straight, gay/lesbian, bisexual, other, and nonresponse), stratified by sex (male vs. female) and age group (50-64 vs. 65+ years). Results. Compared with their straight peers, sexual minority older adults had disparities in some health outcomes, including a higher prevalence of depressive disorder and substance use. However, the disparities were not uniform across gender and age groups. Both men and women sexual minorities had some advantages as well, related to preventive health behaviors (e.g., HIV testing), as compared with their straight peers. Nonrespondents in sexual orientation generally had better health outcomes than their straight peers. Conclusions. This study identifies health disparities among subgroups of lesbians, gay men, and bisexuals older adults and highlights the need to assess variability related to gender, sexual identity, and age of this high-risk population.
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Affiliation(s)
- Hongying Dai
- University of Nebraska Medical Center, Omaha, NE, USA
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Li J, Haardörfer R, Vu M, Windle M, Berg CJ. Sex and sexual orientation in relation to tobacco use among young adult college students in the US: a cross-sectional study. BMC Public Health 2018; 18:1244. [PMID: 30409179 PMCID: PMC6225637 DOI: 10.1186/s12889-018-6150-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/25/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Sexual minority young adults represent a high-risk population for tobacco use. This study examined cigarette and alternative tobacco product (ATP) use prevalence across sexual orientation (heterosexual, gay/lesbian, and bisexual) among college-attending young adult men and women, respectively. METHODS Baseline data from a two-year longitudinal study of 3386 young adult college students aged 18-25 in Georgia were analyzed. Correlates examined included sociodemographics (age, sex, sexual orientation, race/ethnicity, college type, and parental education). Outcomes included past 30-day use of tobacco (cigarette, little cigars/cigarillos [LCCs], e-cigarettes, hookah, any tobacco product used, and number of tobacco products used, respectively). Two-group, multivariate multiple regression models were used to examine predictors of tobacco use among men and women, respectively. RESULTS Among men (N = 1207), 34.7% used any tobacco product; 18.6% cigarettes; 12.3% LCCs; 16.8% e-cigarettes; and 14.7% hookah. Controlling for sociodemographics, gay sexual orientation (OR = 1.62, p = 0.012) was associated with higher odds of cigarette use; no other significant associations were found between sexual orientation and tobacco use. Among women (N = 2179), 25.3% used any tobacco product; 10.4% cigarettes; 10.6% LCCs; 7.6% e-cigarettes; and 10.8% hookah. Being bisexual was associated with cigarette (p < 0.001), LCC (p < 0.001), and e-cigarette use (p = 0.006). Lesbian sexual orientation was associated with cigarette (p = 0.032) and LCC use (p < 0.001). Being bisexual predicted any tobacco product used (p = 0.002), as well as number of tobacco products used (p = 0.004). Group comparisons showed that the effect of sexual minority status on LCC use was significantly different for men versus women. CONCLUSION Sexual minority women, especially bisexual women, are at higher risk for using specific tobacco products compared to heterosexual women; homosexual men are at increased risk of cigarette use compared to heterosexual men. These nuances in tobacco use should inform interventions targeting sexual minorities.
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Affiliation(s)
- Jingjing Li
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Room 524, Atlanta, GA 30322 USA
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Room 524, Atlanta, GA 30322 USA
| | - Milkie Vu
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Room 524, Atlanta, GA 30322 USA
| | - Michael Windle
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Room 524, Atlanta, GA 30322 USA
| | - Carla J. Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Room 524, Atlanta, GA 30322 USA
- Winship Cancer Institute, Emory University, Atlanta, USA
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Hoffman L, Delahanty J, Johnson SE, Zhao X. Sexual and gender minority cigarette smoking disparities: An analysis of 2016 Behavioral Risk Factor Surveillance System data. Prev Med 2018; 113:109-115. [PMID: 29763683 DOI: 10.1016/j.ypmed.2018.05.014] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 05/08/2018] [Accepted: 05/11/2018] [Indexed: 11/29/2022]
Abstract
We examined the association between lesbian, gay, bisexual, and transgender (LGBT) identity, cigarette and e-cigarette use, and potential risk factors in the United States. Using data from 198,057 adults in 26 states in the 2016 Behavioral Risk Factor Surveillance System (BRFSS), we estimated the prevalence of cigarette use, e-cigarette use, and potential risk factors by gender identity and sexual identity. Overall and sex-stratified bivariate and multivariate logistic regressions examined whether the relationship between sexual and gender identity and cigarette and e-cigarette use persisted after adjusting for demographics, socio-economic status, and other unhealthy behaviors. After adjusting for covariates, gender minority identity was no longer associated with increased likelihood of currently smoking cigarettes and ever use of e-cigarettes. Sexual minority identity continued to be significant after adjusting for covariates, indicating that sexual identity disparities in cigarette and e-cigarette use are not fully explained by these factors. Findings varied by identity. Compared to their straight peers, likelihood of tobacco product use among LGB individuals varied between sexes, by product, and by sexual identity (gay/lesbian versus bisexual). More research is needed to understand the mechanisms that influence diverse patterns of cigarette and e-cigarette use among sexual and gender minority adults.
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Affiliation(s)
- Leah Hoffman
- The Center for Tobacco Products at the Food and Drug Administration, United States.
| | - Janine Delahanty
- The Center for Tobacco Products at the Food and Drug Administration, United States.
| | - Sarah E Johnson
- The Center for Tobacco Products at the Food and Drug Administration, United States.
| | - Xiaoquan Zhao
- The Center for Tobacco Products at the Food and Drug Administration, United States; Department of Communication, George Mason University, Fairfax, VA, United States.
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Lipperman-Kreda S, Antin TM, Hunt GP. The Role of Multiple Social Identities in Discrimination and Perceived Smoking-Related Stigma among Sexual and Gender Minority Current or Former Smokers. DRUGS (ABINGDON, ENGLAND) 2018; 26:475-483. [PMID: 34262244 PMCID: PMC8276780 DOI: 10.1080/09687637.2018.1490391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
AIMS We investigated how intersections of being a racial minority (i.e. being African American) and economically-disadvantaged (i.e. housing insecurity) may influence experiences with discrimination and perceptions of smoking-related stigma among sexual and gender minority (SGM) current and former smokers. Methods: Survey data were collected from 227 SGM current and former smokers in California (19-65 years old), oversampling African American participants. Participants reported their race, ethnicity, past month housing insecurity, number of lifetime experiences with SGM discrimination, and perceptions of smoking-related stigma. FINDINGS Using univariate General Linear Models and controlling for age, ethnicity, and SGM visibility, we found a significant interaction between being African American and facing housing insecurity on experiences with SGM discrimination [F(1,220)=7.21, p=0.01], perceived smoker stigma [F(1,220)=5.48, p=0.02], perceived differential treatment due to smoking [F(1,220)=10.03, p=0.00], and social withdrawal from non-smokers [F(1,220)=6.18, p=0.01]. These interactions suggest that economically-disadvantaged African American SGM current or former smokers experience increased levels of discrimination and perceive more smoking-related stigma compared to other SGM current and former smokers. Conclusions: Results suggest that people's multiple identities intersect to intensify oppression and inequities for some people and raise questions about the unintended consequences of stigmatizing smokers for reducing smoking among SGM adults.
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Affiliation(s)
- Sharon Lipperman-Kreda
- Prevention Research Center, Pacific Institute for Research and Evaluation 180 Grand Avenue, Suite 1200, Oakland, CA 94612
| | - Tamar M.J Antin
- Prevention Research Center, Pacific Institute for Research and Evaluation 180 Grand Avenue, Suite 1200, Oakland, CA 94612
- Institute for Scientific Analysis 1150 Ballena Blvd, Suite 211, Alameda, CA 94501
| | - Geoffrey P. Hunt
- Institute for Scientific Analysis 1150 Ballena Blvd, Suite 211, Alameda, CA 94501
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Ganz O, Johnson AL, Cohn AM, Rath J, Horn K, Vallone D, Villanti AC. Tobacco harm perceptions and use among sexual and gender minorities: findings from a national sample of young adults in the United States. Addict Behav 2018; 81:104-108. [PMID: 29454177 DOI: 10.1016/j.addbeh.2018.01.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 01/22/2018] [Accepted: 01/22/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In the United States, the prevalence of tobacco use among sexual and gender minorities (SGM) is higher compared to their non-SGM counterparts. Tobacco harm perceptions have gone largely unexamined as a potential mechanism supporting disproportionate tobacco use among this population. The purpose of this study was to examine differences between SGM and non-SGM young adults in harm perceptions of various tobacco products and tobacco use behavior and whether low tobacco-related harm perceptions moderate the relationship between identifying as a SGM and tobacco use behavior. METHODS This study used data from Wave 10 of the Truth Initiative Young Adult Cohort Study, a sample of U.S. young adults (ages 18-34). Data were collected from September to October 2016 and the study sample included 3089 individuals. Demographics, past 30-day use of cigarettes, little cigars/cigarillos/bidis and electronic cigarettes were assessed. Absolute and relative harm perceptions of these products were also examined. RESULTS Identifying as a SGM and low tobacco harm perceptions were found to be positively associated with past 30-day tobacco use. There was no interaction between SGM status and harm perceptions on past 30-day tobacco use CONCLUSIONS: Findings confirm that SGM young adults continue to disproportionately use tobacco products, compared to non-SGM young adults. More research is needed to understand moderators of the relationship between SGM status and tobacco use in young adults.
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Affiliation(s)
- Ollie Ganz
- Schroeder Institute at Truth Initiative, Washington, DC, United States; Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States.
| | - Amanda L Johnson
- Schroeder Institute at Truth Initiative, Washington, DC, United States
| | - Amy M Cohn
- Schroeder Institute at Truth Initiative, Washington, DC, United States; Department of Oncology, Georgetown Medical Center, Cancer Prevention and Control Program, Washington, DC, United States
| | - Jessica Rath
- Schroeder Institute at Truth Initiative, Washington, DC, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kimberly Horn
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States
| | - Donna Vallone
- Schroeder Institute at Truth Initiative, Washington, DC, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; College of Global Public Health, New York University, New York, NY, United States
| | - Andrea C Villanti
- Schroeder Institute at Truth Initiative, Washington, DC, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT, United States
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Drescher CF, Lopez EJ, Griffin JA, Toomey TM, Eldridge ED, Stepleman LM. Mental Health Correlates of Cigarette Use in LGBT Individuals in the Southeastern United States. Subst Use Misuse 2018; 53:891-900. [PMID: 29303396 DOI: 10.1080/10826084.2017.1418087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Smoking prevalence for lesbian, gay, bisexual, and transgender (LGBT) individuals is higher than for heterosexual, cisgender individuals. Elevated smoking rates have been linked to psychiatric comorbidities, substance use, poverty, low education levels, and stress. OBJECTIVES This study examined mental health (MH) correlates of cigarette use in LGBT individuals residing in a metropolitan area in the southeastern United States. METHODS Participants were 335 individuals from an LGBT health needs assessment (mean age 34.7; SD = 13.5; 63% gay/lesbian; 66% Caucasian; 81% cisgender). Demographics, current/past psychiatric diagnoses, number of poor MH days in the last 30, the Patient Health Questionnaire (PHQ) 2 depression screener, the Three-Item Loneliness Scale, and frequency of cigarette use were included. Analyses included bivariate correlations, analysis of variance (ANOVA), and regression. RESULTS Multiple demographic and MH factors were associated with smoker status and frequency of smoking. A logistic regression indicated that lower education and bipolar disorder were most strongly associated with being a smoker. For smokers, a hierarchical regression model including demographic and MH variables accounted for 17.6% of the variance in frequency of cigarette use. Only education, bipolar disorder, and the number of poor MH days were significant contributors in the overall model. Conclusions/Importance: Less education, bipolar disorder, and recurrent poor MH increase LGBT vulnerability to cigarette use. Access to LGBT-competent MH providers who can address culturally specific factors in tobacco cessation is crucial to reducing this health disparities.
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Affiliation(s)
- Christopher F Drescher
- a Department of Psychiatry and Health Behavior , Augusta University , Augusta , Georgia , USA
| | - Eliot J Lopez
- b Department of Psychiatry , The University of Texas Health Science Center at San Antonio , San Antonio , Texas , USA
| | - James A Griffin
- a Department of Psychiatry and Health Behavior , Augusta University , Augusta , Georgia , USA
| | - Thomas M Toomey
- c Educational Innovation Institute , Augusta University , Augusta , Georgia , USA
| | - Elizabeth D Eldridge
- a Department of Psychiatry and Health Behavior , Augusta University , Augusta , Georgia , USA
| | - Lara M Stepleman
- a Department of Psychiatry and Health Behavior , Augusta University , Augusta , Georgia , USA.,c Educational Innovation Institute , Augusta University , Augusta , Georgia , USA
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