Are Cigarette Smoking Disparities between Sexual Minority and Heterosexual Youth Decreasing? Findings from 10 Years of Population Data

Background. Tobacco use is the number one preventable cause of death in the US (Yoon et al., 2014). Though adolescent cigarette use has declined in recent decades (CDC, 2015), sexual minority youth (SMY) indicate elevated rates of use relative to their heterosexual peers (Marshall et al., 2008). Sexual orientation health disparities are largely driven by experiences with anti-LGB stigma (Meyer, 2003), yet there has been rapid changes to the political and social climate as it relates to the rights and protections of LGB people in the US. Considering the link between anti-LGB attitudes and elevated rates of substance use among SMY (Hatzenbuehler et al., 2014), we hypothesized that sexual orientation cigarette-use disparities would narrow as positive social attitudes towards LGB people in the US have increased. Specifically, we tested whether cigarette use disparities between heterosexual and three subgroups of SMY (i.e., lesbian/gay, bisexual, and unsure) have changed from 2005 to 2015 using data from five cohorts of the Youth Risk Behavior Survey.

Methods: The Youth Risk Behavior Survey (YRBS) is a biennial national survey conducted by the Centers for Disease Control and Prevention since 1991 to collect health data on students in grades 9-12. Local YRBS data were pooled across multiple jurisdictions (city and state) and years (biennially from 2005-2015): 114 jurisdiction-years assessed sexual identity. Students were excluded if they were missing any of the primary demographic variables of interest (race/ethnicity: 3.11%, sex: 0.67% and age 0.32%) resulting in a sample size 404,583 students. Following preliminary analyses, sex-stratified logistic regression with year-by-sexual-identity interactions terms, adjusted for age and race/ethnicity, tested whether disparities between heterosexual and SMY have changed (i.e., widened, narrowed, or maintained) from 2005 to 2015 using four cigarette-related outcomes: lifetime use (i.e., ever), early onset (i.e., before age 13), recent use (i.e., past 30-day), and heavy use (i.e., 20+ days in the past month).

Results. Linear trend comparisons by sexual orientation revealed that rates of cigarette use have significantly declined for heterosexual youth since 2005, but less consistently among SMY. Year-by-sexual-identity interactions indicated that, across 120 possible sexual orientation cigarette use disparities, 107 remained stable, 9 decreased, and 4 increased. Narrowing disparities were largely observed among boys, whereas widening disparities were only evidenced among girls.

Conclusions: SMY disparities in cigarette use persist despite increased acceptance of LGB people in the US. The implementation of policies and focused programs aimed at reducing SMY cigarette use are warranted