Cigarette smoking trajectories among lesbian, bisexual and heterosexual women in the Nurses' Health Study II from ages 14 to 64 years

The extant literature provides clear evidence that lesbians and bisexual women have disproportionately higher prevalence of smoking than heterosexual women. Little is known, however, about sexual-orientation disparities in longitudinal patterns of smoking, and studies prospectively examining sexual-orientation differences in smoking trajectories throughout the lifespan are sparse. This study aims to increase understanding of the burden of excess smoking among lesbian and bisexual women across their lifespan.                            

We used repeatedly measured data collected from more than 100,000 women participating in the Nurses’ Health Study II. Smoking data were collected from participants at baseline in 1989 (adolescent and current use) and in 11 additional follow-up assessments (current use) every 2 years. Approximately 1.5% of the cohort identified as lesbian or bisexual.

General growth mixture modeling was used to estimate smoking trajectories from adolescence through adulthood (ages 14-64 years). Multinomial logistic regression was used to determine associations of sexual orientation with smoking trajectory group membership.

Six smoking trajectory groups were identifıed and labeled based on mean number of cigarettes smoked within each group from baseline to the fınal follow-up: Group 1: Non-smokers; Group 2: light-smokers; Group 3: quit-at-late-20s; Group 4: quit-at-late-30s; Group 5: quit-at-50s; and 6. continuous-smokers. Lesbian and bisexual women showed consistently higher odds of membership in Groups 2–6 (adverse-smoking trajectories) versus Group 1 (the non-smokers trajectory) relative to heterosexual women.

Both lesbian and bisexual women were more likely than heterosexual women to experience adverse-smoking trajectories in adulthood. New research efforts are needed to understand and eliminate these pronounced disparities.