No language restrictions were used. Abstracts were identified in the literature search (n = 734) and were independently read and coded for inclusion or exclusion by two reviewers. When agreement was not reached, a third reviewer acted as arbitrator. Abstracts were included if they presented data collected in the US from 1987 to May 2007 and reported prevalence or correlation of tobacco use with sexual minority status. Studies reporting data from HIV-positive samples were excluded. The identified articles (n = 46) were independently read by two reviewers who recorded key outcome measures, including prevalence and/or odds ratios of tobacco use, sample size and domain of sexuality (identity, behaviour, or desire). Factors relating to study design and methodology were used to assess study quality according to nine criteria. Results: In the 42 included studies, 119 measures of tobacco prevalence or association were reported. The available evidence points to disparities in smoking among sexual minorities that are significantly higher than among the general population. Conclusions: Ongoing, targeted interventions addressing smoking among sexual minorities are warranted in tobacco control programs.Tobacco use is a major contributor to morbidity and mortality in the US and throughout the world.1 2 The relative burden of tobacco-related disease will be affected by disparities in tobacco use among different socio-demographic groups. In the US, disparities in smoking prevalence have been demonstrated by age, educational attainment, race/ethnicity and gender. With respect to sexual minority populations (including individuals with gay, lesbian, bisexual and transgender identity, and individuals with same-sex relationships and/or attraction), past research has suggested that sexual minority status is associated with higher risk of smoking. In 2001, Ryan and colleagues 4 conducted the first systematic review of smoking among sexual minority populations and identified 12 studies reporting smoking prevalence by sexual orientation. Although the review found some evidence for higher smoking prevalence among sexual minorities, the strength of its conclusions was limited by poor sampling methodology in the identified articles as well as variations in definitions of sexual orientation and smoking. A more recent but limited review of smoking among sexual minority women identified 16 studies and came to similar conclusions. 5This article updates previous reviews and reports findings from 42 studies, many with rigorous sampling designs, identified through a systematic search of the published literature from 1987 to May 2007. The identified studies answer our key question: what is the prevalence of tobacco use in sexual minority populations compared to the general population? Our review includes information on gender, sampling methodology, and the domain of sexuality used to determine sexual minority status. Domain of sexuality has been shown to influence the measurement of smoking prevalence, 6 and can be divided into at least three cate...

Background Improving the health of lesbian, gay, and bisexual (LGB) individuals is a Healthy People 2020 goal; however, the IOM highlighted the paucity of information currently available about LGB populations. Purpose To compare health indicators by gender and sexual orientation statuses. Methods Data are from Behavioral Risk Factor Surveillance System surveys conducted January–December of 2010 with population-based samples of non-institutionalized U.S. adults aged over 18 years (N=93,414) in ten states that asked about respondents’ sexual orientation (response rates=41.1%–65.6%). Analyses were stratified by gender and sexual orientation to compare indicators of mental health, physical health, risk behaviors, preventive health behaviors, screening tests, health care utilization, and medical diagnoses. Analyses were conducted in March 2013. Results Overall, 2.4% (95% CI=2.2, 2.7) of the sample identified as LGB. All sexual minority groups were more likely to be current smokers than their heterosexual peers. Compared with heterosexual women, lesbian women had over 30% decreased odds of having an annual routine physical exam, and bisexual women had over 2.5 times the odds of not seeking medical care owing to cost. Compared with heterosexual men, gay men were less likely to be overweight or obese, and bisexual men were twice as likely to report a lifetime asthma diagnosis. Conclusions This study represents one of the largest samples of LGB adults and finds important health inequalities, including that bisexual women bear particularly high burdens of health disparities. Further work is needed to identify causes of and intervention for these disparities.

Objective Tobacco industry documents show systematic targeting by race, ethnicity, and income at the point of sale (POS). We sought to systematically review evidence of disparities in tobacco marketing at tobacco retailers by socio-demographic neighborhood characteristics. Methods We identified 43 relevant papers from 893 results of a systematic search in 10 databases updated on May 28, 2014. We found 148 associations of marketing (price, placement, promotion, or product availability) with a neighborhood demographic of interest (socioeconomic disadvantage, race, ethnicity, and urbanicity). We conducted a narrative review and present results stratified by neighborhood characteristics and types of tobacco product marketing. Results There are disparities in the marketing of tobacco products by neighborhood demographics. Socioeconomic disadvantage is associated with more tobacco marketing. Disparities in menthol marketing are starkly present, with targeting toward more urban neighborhoods and neighborhoods with more black residents. Smokeless tobacco products are targeted toward more rural neighborhoods and neighborhoods with more white residents. Differences in store type partially explain these disparities. Conclusion Geodemographic market targeting, a standard marketing practice across industries, represents an issue of social and environmental injustice for youth exposure to tobacco marketing and for smokers whose quit attempts may be stymied by disproportionate marketing in lower-income neighborhoods and neighborhoods with more black residents.

Objective To conduct a systematic review of the literature examining risk factors/correlates of cigarette smoking among lesbian, gay and bisexual (ie, sexual minority) populations. Methods Sets of terms relevant to sexual minority populations and cigarette smoking were used in a simultaneous search of 10 databases through EBSCOhost. The search was limited to the peer-reviewed literature up to January 2011, using no geographic or language limits. For inclusion, the paper was required to: (1) have been written in English, (2) have sexual minorities (defined by either attraction, behaviour, or identity) included in the study population and (3) have examined some form of magnitude of association for risk factors/correlates of any definition of cigarette smoking. A total of 386 abstracts were reviewed independently, with 26 papers meeting all inclusion criteria. Abstracts were reviewed and coded independently by authors JB and JGLL using nine codes derived from the inclusion/exclusion criteria. Results Studies used various measures of sexual orientation and of smoking. Risk factors that could be considered unique to sexual minorities included internalised homophobia and reactions to disclosure of sexual orientation. Some studies also indicated common smoking risk factors experienced at higher rates among sexual minorities, including stress, depression, alcohol use and victimisation. Conclusions This review identified risks that were associated with sexual minority status and common to the general population but experienced at potentially higher rates by sexual minorities. Government and foundation funds should be directed towards research on the origins of this disparity.

Empirical analysis of segregation and racial cancer disparities is a recent area of research. The literature is limited to 17 studies that focused primarily on breast cancer. Studies differed in their measure of segregation, yet segregation nonetheless contributed to cancer and to racial cancer disparities in 70% of analyses. This suggests the need for further research that uses valid measures of segregation, examines a variety of types of cancers, and explores the variables that may mediate the segregation effect.