Disparities in adult cigarette smoking and smokeless tobacco use by sexual identity

Background: While there have been reductions in rates of tobacco use in the general population in recent years, rates remain high among sexual minority populations (SMP). Prior studies often group SMP as one category due to limited data. This study examined the association between sexual identity status and tobacco use (cigarette and smokeless tobacco use) among U.S. adults. Methods: Data from the 2014–2017 Behavioral Risk Factor Surveillance System were analyzed to examine the association between sexual identity (lesbian or gay, bisexual, other, not sure, and heterosexual or straight) and tobacco use. A propensity score analysis was conducted to address potential imbalance among group characteristics. Results: Lesbian/gay and bisexual groups had significantly higher odds of being an every day smoker (OR = 1.83, 95 % Confidence Interval (CI) 1.59–2.10; OR = 1.36, 95 % CI 1.19–1.55, respectively) and current smoker (every day or some days) (OR = 1.71, 95 % CI 1.52–1.93; OR = 1.44, 95 % CI 1.29–1.62, respectively) compared to straight adults. In terms of smokeless tobacco products, lesbian and gay adults had lower odds of every day and current use. However, significant differences were found in the separate analysis conducted for males and females. While gay and bisexual males had lower odds of smokeless tobacco use, lesbians had significantly higher odds when compared to the straight population. Bisexual females were also more likely to be current users of smokeless tobacco. Conclusions: Significant heterogeneity in tobacco use was found among sexual minority subgroups. Findings demonstrate the importance of subgroup analysis of SMP. These results have implications for prevention and cessation targeting.