Smoking in a Sexual Minority Population: A Comparison of Two Adolescent Cohorts

Abstract

Mortality related to smoking continues to be one of the foremost preventable public health issues. Smoking amongst sexual minorities (those who have a sexual attraction to or sexual contact with people of the same sex and/or of both sexes or a sexual identity of gay/lesbian or bisexual) remains significantly greater than the general population and those with only opposite sex attractions or sexual contacts. While smoking prevalence has dropped since the late 1990's in the general population, smoking among sexual minorities remains disproportionately greater than heterosexuals. Methods: A secondary data analysis was completed using two United States data sets: the 2013 Youth Risk Behavior Survey (YRBS) and the first wave of the National Longitudinal Study of Adolescent to Adult Health (Add Health) dataset collected in 1994. The analyses focused on high school students, grades 9-12. The purpose was two-fold. First, the goal was to develop a profile of smoking indicators in sexual minority youth in the 1994 Add Health dataset and in the 2013 YRBS dataset. Profiles include six smoking-related indicators: 1) ever smoked; 2) age of first cigarette smoked; 3) current smoking; 4) frequent smoking; 5) daily smoking; and 6) attempts to quit smoking. Second, the goal was to compare sexual minority youth to their heterosexual peers within each data set to identify the scope of any disparities in smoking behaviors. Results: Disparities in smoking behaviors were found in both comparisons between the heterosexual and sexual minority youth. Prevalence of all smoking behaviors was greater for sexual minority youth in both data sets. The smoking disparities were greater in the sexual minority youth in the 2013 YRBS sample. Between the 1994 Add Health and 2013 YRBS samples, smoking behaviors in sexual minority youth showed a decrease in all smoking behaviors, but not as significant as their heterosexual peers. Youth who are attracted to both sexes or identify as bisexual consistently have a greater prevalence in smoking behaviors.Conclusion: A growing disparity exists between sexual minority youth and their heterosexual peers related to smoking behaviors. Public health policy and programming needs to focus on earlier prevention efforts related to psycho-sexual development with targeted policy and curriculum around the adoption of negative health behaviors in sexual minority youth, especially those who have both sex attractions, have sexual contact with both sexes or identify as bisexual.