Adolescent sexual orientation and smoking: Intersections with age, race/ethnicity, and gender

Sexual-minority adolescents are more likely to smoke cigarettes than heterosexual adolescents. However, relatively little is known about how age, race/ethnicity, and gender influence sexual-orientation disparities in smoking, but this information could assist with developing interventions to reduce smoking. Using Youth Risk Behavior Survey data pooled from 14 locations and 2 years (weighted N>34,000), we examined how age, race/ethnicity, and gender modified relationships between sexual orientation and smoking. Results suggested a complex pattern of interactions. With respects to positive histories of smoking, sexual-minority females (69%) were more likely to have ever smoked than sexual-minority males (58%), while gender differences in heterosexuals were negligible (females=45%, males=46%; p_interaction<.0001). Additionally, sexual-orientation disparities in ever smoking were accentuated in younger relative to older adolescents (p_interaction<.01). With regards to patterns of current smoking (mean number of cigarettes smoked in the past month), disparities were larger in sexual-minority males (e.g., bisexuals=55 cigarettes, unsure=23) than females (bisexuals=34, unsure=10) relative to gender differences in heterosexuals (males=13, females=8) (p_interactions<.001). Similarly, sexual-orientation disparities in the number of cigarettes smoked in the past month were accentuated in older relative to younger adolescents (p_interaction<.0001) and in whites relative to Blacks, Asian/Pacific Islanders, and Latinos (p_interactions<.001). Findings suggest that female and younger sexual-minority adolescents have higher relative-risks for histories of smoking, but male, white, and older sexual-minority adolescents have relatively higher amounts of current smoking. Our findings that sexual-orientation disparities in the amount of current smoking are accentuated in males and older adolescents diverge from some prior evidence. Findings related to race/ethnicity are novel.