Disparities in tobacco smoke exposure by sexual orientation: Results from the National Health and Nutrition Examination Survey, 2001-2010

Background: In the US, the tobacco industry has increased marketing efforts targeting the lesbian, gay, and bisexual (LGB) communities, utilizing nightclub/bar promotions and event sponsorships among other strategies to increase visibility and promote the use of their products. Despite these inequalities in tobacco marketing and the three-fold smoking rates observed in LBG individuals as compared to heterosexuals in small population-based studies, limited research has been devoted to examining national self-reported and biologically-confirmed estimates of tobacco exposure. Methods: We pooled and analyzed data on 14,940 US adults ages 20-59 (representing an annual 5.2 million LGB adults) from the nationally representative 2001-2010 National Health and Nutrition Examination Survey (NHANES) who responded to questions about sexual orientation, smoking status, and had serum cotinine information. Results: Compared to heterosexuals, LGB adults had a significantly lower proportion of self-reported never-smokers (42.5±2.5% vs. 53.1±0.5%) and a significantly higher proportion of current smokers (38.9±2.4 vs. 26.4±0.4). No significant differences in secondhand smoke (SHS) (confirmed by serum cotinine) exposure were observed between LGB and heterosexuals. In a subgroup analysis of LGB adults, 34.0% of males and 42.8% of females were self-reported current smokers. There were, however, no statistically significant differences in self-reported smoking status by gender. Conclusions: The significantly smaller proportion of never-smoker LGB adults suggests that these sexual minorities engage in tobacco use more than heterosexuals. Additional surveillance efforts for LGB smokers are needed to further examine disparities in tobacco exposure and to inform the development of tailored tobacco control interventions.