Review and special article
Smoking among lesbians, gays, and bisexuals: a review of the literature

https://doi.org/10.1016/S0749-3797(01)00331-2Get rights and content

Abstract

Objectives: To collect estimates of smoking prevalence among lesbian, gay, and bisexual people from the published literature and to compare with general population estimates.

Methods: Databases were searched for all studies published in English on tobacco use among lesbians, gays, and bisexuals. From 1987 through 2000, twelve studies were identified (four youth, eight adult): seven were based on convenience samples; one on a population-based probability sample; one involved random sampling within selected census tracts; one was based on a large multicenter clinical trial; and two were representative school-based samples. Study findings were compared to national survey data from the corresponding time period.

Results: Estimated smoking rates for lesbians, gays, and bisexuals ranged from 38% to 59% among youth and from 11% to 50% among adults. National smoking rates during comparable periods ranged from 28% to 35% for adolescents and were approximately 28% for adults.

Conclusions: While information in the published literature is limited, it appears that smoking rates are higher among adolescent and adult lesbians, gays, and bisexuals than in the general population. Steps should be taken to ensure representation of lesbians, gays, and bisexuals in tobacco-use surveillance and to collect data in order to understand the apparent high smoking rates in these groups. Attempts should be made to target prevention and cessation interventions to lesbians, gays, and bisexuals.

Introduction

Numerous factors suggest that lesbians, gays, and bisexuals may be at risk for high smoking prevalence. First, like other economically and socially marginalized communities, lesbians, gays, and bisexuals may face a disproportionate amount of daily stress due to homophobia and discrimination. Smoking has been found to be more prevalent among groups that experience high levels of stress.1, 2 Second, places where smoking is prevalent, such as bars, have historically been an important social focus for lesbians, gays, and bisexuals possibly because of a history of exclusion or discrimination in other social settings,3 and may continue to play an important role, at least for some segment of this population. Third, behaviors associated with smoking, such as alcohol and drug use,2 may be higher among lesbians, gays, and bisexuals than among their heterosexual counterparts.4, 5, 6 Finally, evidence suggests that since the 1980s, the tobacco industry has targeted the gay market through direct advertisement, sponsorship, and promotional events.7, 8, 9

The factors that influence smoking among lesbian, gay, and bisexual adolescents may be more complex than the factors influencing adults. Smoking among youth in general is related to the effects of modeling, social desirability, ready access to cigarettes, risk taking and rebelliousness, feelings of being unsupported, low self-esteem, negative mood states, and other mental health factors.10 Research suggests that lesbian, gay, and bisexual youth are more likely to be depressed or lonely, to attempt suicide, and to be physically and verbally victimized than heterosexual youth,11, 12, 13 factors that likely contribute to increased substance use. Although the role played by other factors has yet to be documented, additional reasons why smoking prevalence may be higher for lesbian, gay, and bisexual youth than youth in general include the possible and unique role that smoking may play during identity formation among lesbian, gay, and bisexual adolescents (e.g., assumption of masculinity for males, assertion of independence and power for females); the stresses of “coming out”; the potential lack of support from parents, other family members, and peers; feelings of isolation and loneliness; and anti-gay harassment or victimization.

Several recent studies have collected information on smoking in gays and lesbians, generally as a part of a broader examination of health-related issues and often based on convenience samples. The objective of this report is to critically review and summarize the published literature on smoking among adolescent and adult lesbians, gays, and bisexuals; to describe smoking prevalence among these groups; and to compare these estimates with national survey estimates.

Section snippets

Methods

Searches were carried out for articles published in English pertaining to tobacco use and lesbian, gay, and bisexual people. Databases that were searched included the Office on Smoking and Health database (1960–mid-2000), MEDLINE (1966–mid-2000), PsychInfo (1967–mid-2000), Current Contents/Life Sciences (1999–mid-2000), Current Contents/Social and Behavioral Science (1999–mid-2000), ERIC (1966–mid-2000), and EMBASE (1974–mid-2000). In addition, we reviewed the references of all articles

Adolescents/young adults

Four studies16, 17, 18, 19 examining smoking among lesbian, gay, and bisexual adolescents and young adults aged 13 to 21 were conducted between the early 1980s and 1995 (Table 1). Two of the studies were statewide school-based surveys conducted in Massachusetts,18, 19 and two recruited adolescents through advertisements or community-based agencies.16, 17 All included bisexual youth, but none reported separately on them. Two studies18, 19 used standard definitions of smoking for adolescents

Discussion

The amount of information available in the published literature on smoking among gays, lesbians, and bisexuals is limited. The definitions used to determine sexual orientation and tobacco use vary among studies. In addition, trend information is not available and information on transgender people is absent. Because the studies reviewed here were typically designed to collect information across a broad range of health and social issues, information on smoking was generally limited to prevalence

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