Cigarette smoking, ENDS use and dual use among a national sample of lesbians, gays and bisexuals
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University of South Alabama, Mobile, United States
University of Virginia, Charlottesville, United States
American Heart Association Tobacco Regulation and Addiction Center (A-TRAC), Dallas, United States
University of Louisville, Louisville, United States
Northwestern University, Evanston, United States
University of Mississippi, Jackson, United States
Stanley L. Ridner   

University of South Alabama, Mobile, Alabama, United States
Publication date: 2019-12-23
Submission date: 2019-07-26
Final revision date: 2019-10-28
Acceptance date: 2019-11-14
Tob. Prev. Cessation 2019;5(December):51
Historically, lesbian, gay and bisexual (LGB) individuals have higher rates of cigarette smoking, often attributed to targeted tobacco advertising, exposure to stressors, and psychological distress. Elevated use of electronic nicotine delivery systems (ENDS) among LGB individuals has been documented recently. However, the LGB groups are not homogeneous and differences may exist between the use of tobacco by men and women within the LGB groups. The purpose of this research was to examine cigarette smoking, ENDS use and dual use (cigarettes plus ENDS) among LGB subgroups.

We classified 2087 participants completing a national online survey based on tobacco-use status (i.e. cigarette only, ENDS only, dual use) and sexual orientation. Multinomial logistic regression was employed to assess group differences.

After adjusting for demographics and socioeconomic status, bisexual women were 1.85 times (95% CI: 1.19–2.87) more likely to report current dual use, in contrast to cigarette only use, compared to heterosexual women. No significant differences were found between lesbian and heterosexual women, or between gay or bisexual men and their heterosexual counterparts.

This study describes significantly greater dual use by bisexual women and is one of the first reports of elevated dual use in this group compared to heterosexual women. These findings suggest that targeted health messages may be needed to raise awareness of risk in specific LGB groups and that future research with these populations is necessary to better understand differences in tobacco perceptions and use.

The authors have each completed and submitted an ICMJE form for disclosure of potential conflicts of interest. KLW reports grants from National Institutes of Health, outside the submitted work. AG, RLL and AK report grants from National Institutes of Health National Heart, Lung and Blood Institute and Food and Drug Administration Center for Tobacco Products, during the conduct of the study. JZM reports grants from National Institutes of Health National Heart, Lung and Blood Institute and Food and Drug Administration Center for Tobacco Products under Award Number P50HL120163, during the conduct of the study. RMR reports grants from National Institutes of Health National Heart, Lung and Blood Institute and Food and Drug Administration Center for Tobacco Products, and that she served as Deputy Chief Science and Medical Officer in American Heart Association, during the conduct of the study. ALG and JLH report grants from National Institutes of Health, during the conduct of the study. The rest of the authors have nothing to disclose.
Research reported in this publication was supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) and the Food & Drug Administration’s (FDA) Center for Tobacco Products (CTP) under Award Numbers P50HL120163 and U54HL120163. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, the FDA, or the American Heart Association. The funding sponsors had no role in study design; data collection, analyses, or interpretation; manuscript preparation; or the decision to publish the results.
Not commissioned; externally peer reviewed.
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