Sexual orientation identity and tobacco and hazardous alcohol use: findings from a cross-sectional English population survey

Abstract

ObjectivesTo assess the association between tobacco and hazardous alcohol use and sexual orientation and whether such an association could be explained by other sociodemographic characteristics.DesignCross-sectional household survey conducted in 2014–2016.SettingEngland, UK.ParticipantsRepresentative English population sample (pooled n=43 866).Main outcomesSexual orientation identity (lesbian/gay, bisexual, heterosexual, prefer-not-to-say); current tobacco and hazardous alcohol use (defined as Alcohol Use Disorders Identification Test Score ≥8). All outcomes were self-reported.ResultsDue to interactions between sexual orientation and gender for substance use, analyses were stratified by gender. Tobacco use prevalence was significantly higher among lesbian/gay (women: 24.9%, 95% CI 19.2% to 32.6%; men: 25.9%, 95% CI 21.3% to 31.0%) and bisexual participants (women: 32.4%, 95% CI 25.9% to 39.6%; men: 30.7%, 95% CI 23.7% to 30.7%) and significantly lower for prefer-not-to-say participants in women (15.5%, 95% CI 13.5% to 17.8%) but not men (22.7%, 95% CI 20.3% to 25.3%) compared with heterosexual participants (women: 17.5%, 95% CI 17.0% to 18.0%; men: 20.4%, 95% CI 19.9% to 21.0%; p<0.001 for omnibus test). Similarly, hazardous alcohol use was significantly more prevalent for lesbian/gay (women: 19.0%, 95% CI 14.0% to 25.3%; men: 30.0%, 25.2%–35.3%) and bisexual participants (women: 24.4%, 95% CI 18.7% to 31.3%; men: 24.3%, 95% CI 17.9% to 32.1%) and lower for prefer-not-to-say participants (women: 4.1%, 95% CI 3.0% to 5.4%; men: 13.7%; 95% CI 11.8% to 16.0%) compared with heterosexuals (women: 8.3%, 95% CI 7.9% to 8.7%; men: 18.4%, 95% CI 17.9% to 18.9%; p<0.001 for omnibus test). However, after adjusting for sociodemographic confounders, tobacco use was similar across all sexual orientation groups among both women and men. By contrast, sexual orientation differences in hazardous alcohol use remained even after adjustment among women but not for bisexual and gay men.ConclusionsIn England, higher rates of tobacco use among sexual minority men and women appear to be attributable to other sociodemographic factors. Higher rates of hazardous alcohol use among sexual minority men may also be attributable to these factors, whereas this is not the case for sexual minority women.

Health and Well-being Among Sexual Minority People

“…The rates of smoking in lesbians were 30.7% (95% confidence intervals (CI) 23.3% to 38.2%) and in bisexual women was 21.9% (95% CI 12.9% to 30.9%) compared to 17.3% (95% CI 16.6% to 17.9%) in heterosexual women. Other UK research has also found higher rates of smoking in younger men and women (Hagger-Johnson et al 2013), but this may be confounded by sociodemographic factors (Shahab et al 2017).…”

“…There are also higher rates of hazardous alcohol use, for example, UK sexual minority women tend to have higher hazardous alcohol use than heterosexual women (Shahab et al 2017). For a review of the US research on alcohol use in sexual minority populations, see Kralik and Skinner (2018).…”

The mental health and experiences of discrimination of LGBTQ+ people during the COVID-19 pandemic: Initial findings from the Queerantine Study

“…However, where evidence does exist, this overwhelmingly suggests that higher levels of pre-existing health conditions compared to cisgender and heterosexual populations, may place the LGBTQ+ community at additional risk of adverse prognosis. This includes long-term chronic illness, and higher rates of smoking and asthma among LGBTQ+ people [2][3][4][5][6][7][8]; higher rates of obesity, and alcohol consumption among lesbian, bisexual, and queer women [7 9 10]; and increased likelihood of being immunocompromised (e.g. HIV+ with a low CD4 cell count or with untreated HIV) among gay men and transgender people [11].…”

Health and socio-economic inequalities by sexual orientation among older women in the United Kingdom: findings from the UK Household Longitudinal Study

“…During the early life course, young sexual minority women are more likely than young heterosexual women to smoke (Hagger-Johnsonet al 2013). During adulthood they are at increased risk of being overweight or obese (Semlyen, Curtis and Varney 2019), and are more likely to have poor mental health (Elliottet al 2014, Kinget al 2003, King and Nazareth 2006, Semlyenet al 2016, misuse alcohol (King, McKeown, Warner, Ramsay, Johnson, Cort, Wright, Blizard and Davidson 2003, King and Nazareth 2006, Merceret al 2007, Shahabet al 2017, smoke (King and Nazareth 2006, Mercer, Bailey, Johnson, Erens, Wellings, Fenton and Copas 2007, Shahab, Brown, Hagger-Johnson, Michie, Semlyen, West and Meads 2017, and report poorer self-rated health (Elliott, Kanouse, Burkhart, Abel, Lyratzopoulos, Beckett, Schuster and Roland 2014). Much less is known about health inequalities and their underlying social determinants in the later stages of the life course.…”