Prevalence of Tobacco and Poly-Tobacco Use as a Function of Sexual Orientation Identity and Sex

Introduction: Limited research has characterized poly-tobacco use (i.e., use of at least two nicotine/tobacco products) among adults with sexual minoritized (SM) identities (i.e., lesbian, gay, and bisexual). Additional work is needed to examine disparities in use by sexual orientation identity and determine whether these disparities differ by sex. We aimed to examine the prevalence of tobacco product use and poly-tobacco use by sexual orientation identity and sex among a nationally representative sample of U.S. adults.

Methods: Data were drawn from 32,352 adult respondents (34.9% 18-24 years; 10.4% SM; 51.4% female) at Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health (PATH) Study. Logistic regression models tested main and interactive effects of sexual orientation identity and sex on tobacco product use and poly-tobacco use.

Results: SM (vs. heterosexual) participants were more likely to report use of cigarettes, e-cigarettes, hookah, filtered cigars, and cigarillos (ORs=1.71-3.27), and poly-tobacco use (OR=1.83). Male (vs. female) participants, regardless of sexual orientation identity, were more likely to report use of each tobacco product (ORs=1.30-28.73) and poly-tobacco use (OR=1.73). Significant interactions revealed stronger associations between sexual orientation identity and cigarette and e-cigarette use among SM females (vs. heterosexual females) and SM males (vs. heterosexual males; aORs=1.42-4.10). Tobacco use further varied within SM and heterosexual groups based on sex.

Conclusions: This study contributes to a growing literature demonstrating disparities in tobacco use among SM individuals. Findings underscore the need for comprehensive assessment of associations between sexual orientation identity and sex in tobacco use treatment.

Implications: This study examines the intersection of sexual orientation identity, sex, and tobacco use among a nationally representative sample of U.S. adults. Findings highlight tobacco-related disparities among sexual minoritized individuals and underscore the importance of routine monitoring and intervening to reduce the disproportionate prevalence of tobacco use among this population.