Background: National studies often examine associations between sexual identity and substance use at a single point in time and neglect to examine whether these associations change over time. The present study examines U.S. trends in the past-year prevalence of binge drinking, marijuana use, illicit drug use, and polysubstance use across sexual identity subgroups (gay, lesbian, bisexual and heterosexual). Methods: The data come from four independent, cross-sectional samples measured by the
Introduction This study examines the proportion of the United States adolescents and adults who are variable (ie, at least one change in gender identity) versus stable in their gender identities over time, and whether they differ significantly in their nicotine/tobacco use after adjusting for key covariates. Methods We fit multivariable logistic regression models to data from Waves 2–4 (2014/15–2016/18) of the Population Assessment of Tobacco and Health (PATH), a nationally representative study (n = 33 197 U.S. adolescents and adults aged ≥14 years). We examined associations of gender stability/variability over three waves with tobacco use at wave 4 (2016–2018). Differences in any past 30-day tobacco, cigarette, e-cigarette, other tobacco, and poly-tobacco use were assessed among cisgender-stable, transgender-stable, and gender-varying respondents. Results An estimated 1.0% of adolescents and adults were classified as gender-varying. Prevalence of any past 30-day tobacco use was higher among gender-varying individuals (42.7%) than among gender-stable individuals (transgender-stable, 37.8% and cisgender-stable, 26.7%). There were no significant differences in the odds of nicotine/tobacco use between the two gender-stable groups. However, gender-varying respondents had significant increased odds of any past 30-day tobacco use (adjusted odds ratio [AOR] = 2.0, 95% confidence interval [CI] = 1.3 to 3.0), cigarette use (AOR = 1.7, 95% CI = 1.1 to 2.5), e-cigarette use (AOR = 2.2, 95% CI = 1.4-3.5), other tobacco use (AOR = 2.2, 95% CI = 1.4 to 3.4), and poly-tobacco use (AOR = 2.0, 95% CI = 1.3 to 3.1) compared with cisgender-stable individuals. Conclusions Gender-varying individuals are at higher risk for nicotine/tobacco use, placing them at greater risk for tobacco-related health consequences. Implications Despite increased knowledge about transgender health in recent years, there remains a paucity of research about gender-varying individuals. This study is the first to examine the proportion of gender-varying individuals in the United States using a longitudinal, nationally representative sample and to explore differences in nicotine/tobacco use among gender-varying and gender-stable individuals. Our findings suggest that gender-varying people have an increased risk for nicotine/tobacco use, placing them at higher risk for tobacco-related health consequences. This study increases knowledge about nicotine/tobacco use among this under-represented population in research and underscores the importance of developing an awareness of gender diversity.
Introduction Tobacco use is more prevalent among sexual minority populations relative to heterosexual populations. Discrimination is a known risk factor for tobacco use. However, the relationship between exposure to different forms of discrimination, such as racial/ethnic discrimination and sexual orientation discrimination, and tobacco use disorder (TUD) severity has not been examined. Methods Using data from the 2012–2013 National Epidemiologic Survey of Alcohol and Related Conditions-III (n=36,309 U.S. adults), we conducted multivariable logistic regression analyses to examine the associations among racial/ethnic discrimination, sexual orientation discrimination, and TUD severity for lesbian/gay-, bisexual-, and heterosexual-identified adults. Consistent with the DSM-5, past-year moderate-to-severe TUD was defined as the presence of ≥4 DSM-5 TUD symptoms. Results Higher levels of lifetime racial/ethnic discrimination were associated with significantly greater odds of past-year moderate-to-severe TUD among sexual minorities (AOR=1.03, 95% CI=1.01-1.05) and heterosexuals (AOR=1.04, 95% CI=1.03-1.05). Stressful life events, mood disorder, and anxiety disorder had significant associations with moderate-to-severe TUD among sexual minorities (AOR range: 1.86-5.22, p<.005) and heterosexuals (AOR range: 1.71-3.53, p<.005). Among sexual minorities, higher levels of racial/ethnic and/or sexual orientation discrimination were associated with greater odds of any TUD (AOR=1.02, 95% CI=1.01-1.03). Conclusions Sexual minorities and heterosexuals who experience higher levels of racial/ethnic discrimination are at heightened risk of having moderate-to-severe TUD. Exposure to higher levels of discrimination also increases the risk of having any TUD among sexual minority adults. Health providers and tobacco cessation professionals should be cognizant of the minority stressors experienced by their clients and their potential impact on TUD severity. Implications This study is the first to show how experiences of racial/ethnic and sexual orientation discrimination are associated with DSM-5 tobacco use disorder severity among sexual minority and heterosexual populations. Individuals exposed to multiple minority stressors may have increased vulnerability for developing tobacco use disorder and related adverse health consequences. Our study underscores the importance of considering racial/ethnic discrimination and the multiple minority statuses that individuals may hold. Eliminating all forms of discrimination and developing interventions that are sensitive to the role that discrimination plays in tobacco use disorder severity may attenuate the tobacco use disparities between sexual minority and heterosexual adults.
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