Sexual identity disparities in smoking and secondhand smoke exposure in California: 2003-2013

Background.  The lesbian, gay, and bisexual (LGB)-identified population in the US and in California is known to smoke at higher rates than the rest of the population.  Other smoking behaviors, such as daily vs. occasional smoking, and intensity of smoking, are less well understood in the LGB community.  It is unknown whether smoking prevalence and secondhand smoke (SHS) exposure have fallen in the LGB population as they have in the general population.  We determined smoking prevalence, smoking behavior patterns, and SHS exposure of LGB-identified Californians; compared these with heterosexuals; and analyzed changes in these behaviors over the last decade.

Methods. We analyzed the 2003-2013 California Health Interview Surveys, using multivariate logistic regression models to analyze the impact of sexual identity on smoking behaviors. We also conducted time trend analyses for each smoking-related outcome measure.

Results. Lesbian and bisexual women smoke at significantly higher rates than heterosexual women, and female bisexual smokers were less likely to be light smokers than heterosexuals.  Among men, smoking prevalence was higher among gays and bisexuals than among heterosexuals; and gay smokers were more likely to be daily smokers and bisexual smokers were more likely to be light smokers than heterosexuals.  Sexual minority men and women were more likely to be exposed to SHS at home than heterosexuals.  Current smoking prevalence and SHS exposure have fallen among sexual minorities.

Conclusions. Disparities in tobacco use and SHS exposure by sexual orientation exist in California. Bisexual women and men are particularly at risk; interventions should consider the unique needs of this group as well as all sexual minority smokers.