Tobacco Use and Sexual Orientation in a National Cross-sectional Study: Age, Race/Ethnicity, and Sexual Identity–Attraction Differences

McCabe, Sean Esteban; Matthews, Alicia K.; Lee, Joseph G. L.; Veliz, Philip; Hughes, Tonda L.; Boyd, Carol J.

doi:10.1016/j.amepre.2018.03.009

Cited by 94 publications

(60 citation statements)

References 35 publications

(54 reference statements)

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“…Although the underlying argument for this approach is grounded in theoretical and empirical understandings of SM health inequities, 22,23 we illustrate the utility of this approach using nationally representative data that have been used to provide some of the more prominent findings regarding sexual orientation disparities in mental health and substance abuse. 8,10,[17][18][19] Similar to previous research, 3,4,8,10 our findings from unconditional models-models that do not adjust for sexual identity-showed different patterns of mental health and substance use disorders risk, across measures of sexual orientation, for both men and women. However, findings from conditional models-models adjusted for sexual identity-demonstrate the degree to which sexual identity plays both a unique and overlapping role in the relationship between sexual attraction/behavior and health, particularly among men.…”

Section: Discussionsupporting

confidence: 85%

“…[13][14][15][16], * As such, models that do not adjust for sexual identity when estimating associations between attraction and/or behavior and any given health outcome do not properly estimate health risk for heterosexual-identified SM people; for example, those with a heterosexual identity but same-sex attraction and/or same-sex behavior, the combination of which influences their day-to-day experiences, behaviors, and subsequently health. [15][16][17][18][19] In other words, not accounting for the unique and shared variance of sexual identity alongside other measures of sexual orientation obscures health differences across measures of attraction and behavior independent of that sexual identity. These two interrelated issues demonstrate how the approach to independently estimating sexual orientation differences in health risk across discrete measures of sexual orientation lacks specificity and limits the utility of the results drawn from this approach to make strong inferences about differential risk based on sexual identity, attraction, and behavior.…”

Section: Estimating Health Disparities Across Multiple Measures Of Sementioning

confidence: 99%

“…Importantly, minority stress theory can be applied broadly-including to those who have same-sex attractions or samesex behaviors independent of a non-heterosexual identitygiven that the absence of LGB identification does not inherently preclude exposure to anti-LGB stigma considering the pervasiveness of heteronormativity in the day-to-day social context. 22,23,25 However, SM people with same-sex attractions and/or behaviors who also adopt and assert a (stigmatized) LGB identity are uniquely vulnerable to enacted forms of stigma, 17,18,20,21 likely due to the public and visible nature of social identity. In other words, sexual identity may mediate, moderate, or confound { the degree to which attraction and behavior are related to health.…”

Section: Estimating Health Disparities Across Multiple Measures Of Sementioning

confidence: 99%

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Reconsidering Approaches to Estimating Health Disparities Across Multiple Measures of Sexual Orientation

Fish

Krueger

2020

LGBT Health

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Purpose: We propose a new theoretically grounded approach for estimating sexual orientation-related health risk that accounts for the unique and shared variance of sexual identity across other measures of sexual orientation (i.e., attraction and behavior). We argue and illustrate that this approach provides specificity not demonstrated by approaches that independently estimate and compare health risk based on sexual identity, attraction, and behavior. Methods: Data were from the National Epidemiologic Survey on Alcohol and Related Conditions-III, collected in 2012-2013 (N = 36,309, ages 18 and older). The Karlson-Holm-Breen method tested the degree to which attraction-and behavior-based disparities in mental health and substance use disorders change after adjusting for sexual identity. Results: Sexual attraction-and behavior-based disparities in mental health and substance use disorders statistically varied when comparing models that did and did not adjust for sexual identity. Adjusting for sexual identity appeared to have a larger influence on attraction-and behavior-based health associations among men; sexual minority and majority differences were attenuated on nearly every outcome after adjusting for sexual identity. This attenuation was less common among women. Among women, some behavior-based disparities were wider in sexual identity-adjusted models relative to unadjusted models. Conclusion: We demonstrate more accurate approaches to capturing and comparing sexual orientation-related health disparities across multiple measures of sexual orientation, which account for the shared variance between sexual identity and measures of attraction and behavior. Adjusted estimates provide more specificity regarding relative health risk across specific subgroups of sexual minority people, and the intervention and prevention strategies needed to address them.

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Section: Discussionsupporting

confidence: 85%

Section: Estimating Health Disparities Across Multiple Measures Of Sementioning

confidence: 99%

Section: Estimating Health Disparities Across Multiple Measures Of Sementioning

confidence: 99%

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Reconsidering Approaches to Estimating Health Disparities Across Multiple Measures of Sexual Orientation

Fish

Krueger

2020

LGBT Health

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“…46 No racial/ethnic differences in health behaviors were identified. With a few exceptions, 55 there is a paucity of research examining racial/ ethnic differences in psychosocial and behavioral risk factors for CVD in SMW. 6 Future studies should use intersectional approaches to examine which subgroups of SMW are most at risk for CVD.…”

Section: Discussionmentioning

confidence: 99%

Racial/Ethnic Differences in Cardiometabolic Risk in a Community Sample of Sexual Minority Women

2019

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To examine the intersection of sexual identity and race/ethnicity on self-reported cardiometabolic risk in sexual minority women (SMW). Methods: Data from the Chicago Health and Life Experiences of Women study were analyzed. Logistic regression models examined racial/ethnic differences in cardiometabolic risk (including obesity, hypertension, and diabetes) in SMW, accounting for psychosocial and behavioral factors. A variable accounting for the intersection of sexual identity and race/ethnicity was added to regression models (White lesbian women were the reference group). Results: The analytic sample included 601 SMW (237 White, 219 Black, 145 Latina). Black (adjusted odds ratio [AOR] 2.96, 95% confidence interval [CI] = 1.48-5.94) and Latina (AOR 2.30, 95% CI = 1.18-4.48) SMW had higher rates of lifetime trauma than White SMW. Black SMW reported higher rates of obesity (AOR 3.05, 95% CI = 1.91-4.88), hypertension (AOR 1.99, 95% CI = 1.08-3.66), and diabetes (AOR 3.77, 95% CI = 1.46-9.74) relative to White SMW. Intersectional analyses revealed that Black lesbian (AOR 2.94, 95% CI = 1.74-4.97) and Black bisexual (AOR 3.43, 95% CI = 1.69-6.96) women were more likely to be obese than White lesbian women. Black lesbian women also reported higher rates of hypertension (AOR 2.09, 95% CI = 1.08-4.04) and diabetes (AOR 3.31, 95% CI = 1.26-8.67) than White lesbian women. No differences in cardiometabolic risk were found between Latina and White SMW. Conclusion: This study extends previous research on racial/ethnic differences in cardiometabolic risk among SMW. Prevention strategies are needed to reduce cardiometabolic risk in Black SMW. Findings highlight the need for cardiovascular disease research in SMW that incorporates longitudinal designs and objective measures.

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“…However, SUD are not homogeneous among SM populations, and differences exist between male and female SM [3]. Although TUD is higher among all SM adults compared to heterosexual adults [5,6], SM women are more likely than SM men to use tobacco products [7,8]. Studies also have found AUD to be significantly higher among SM individuals [1,[8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Functional and structural social support, substance use and sexual orientation from a nationally representative sample of US adults

et al. 2019

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Background and Aims Sexual minority (SM) populations experience higher rates of substance use disorder (SUD) associated with increased sexual orientation‐related stress. Social support may moderate the impact of stress on SUD among SM adults. This study assessed associations between social support and DSM‐5 SUD by sex and sexual minority identity. Design Cross‐sectional study using data from the 2012–13 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC‐III). Setting and participants A nationally representative cross‐sectional sample of adults (n = 36 309) in the United States. Measurements SUD were defined based on the DSM‐5 criteria for alcohol use (AUD), tobacco use (TUD) and drug use (DUD) disorders. Structural social support was measured as the type and frequency of kin and non‐kin contact, and functional social support was measured by the Social Provision Scale. Findings SM adults had higher odds of all SUD compared to heterosexual adults [AUD = 1.535, 95% confidence interval (CI) = 1.782–1.844; TUD = 1.512, 95% CI = 1.234–1.854; DUD = 1.520, 95% CI = 1.139–2.028]; SM women experienced the highest proportion of all SUD (AUD = 27.1%, TUD = 29.1%, DUD = 10.9%). Type of social support was differentially associated with SUD by sex and sexual identity status. Higher social provision was associated with lower rates of AUD [adjusted odds ratio (aOR) = 0.771, 95% CI = 0.705–0.844], TUD (aOR = 0.747, 95% CI = 0.694–0.804] and DUD (aOR = 0.558, 95% CI = 0.490–0.636). Marriage was associated with lower SUD among heterosexual men (AUD, aOR = 0.500, 95% CI = 0.432–0.579; TUD, aOR = 0.603, 95% CI = 0.521–0.699; DUD, aOR = 0.504, 95% CI = 0.369–0.689) and women (AUD, aOR = 0.637, 95% CI = 0.529–0.767; TUD = 0.0.584, 95% CI = 0.507–0.671; DUD, aOR = 0.515, 95% CI = 0.372–0.712). Compared to heterosexual adults, SM women with at least one child under the age of 18 years had higher odds of TUD (aOR = 1.990, 95% CI = 1.325–2.988). SM‐related discrimination was not associated with SUD among some SM subgroups, but discrimination among male heterosexually identifying individuals reporting same‐sex attraction or behavior was associated AUD (aOR = 4.608, 95% CI = 1.615–13.14). Conclusions In the United States there are significant associations between functional support (quality or provision of support) and structural support (type and frequency of social networks) and substance use disorder (SUD) which differ by sex and sexual identity status.

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Tobacco Use and Sexual Orientation in a National Cross-sectional Study: Age, Race/Ethnicity, and Sexual Identity–Attraction Differences

Cited by 94 publications

References 35 publications

Reconsidering Approaches to Estimating Health Disparities Across Multiple Measures of Sexual Orientation

Reconsidering Approaches to Estimating Health Disparities Across Multiple Measures of Sexual Orientation

Racial/Ethnic Differences in Cardiometabolic Risk in a Community Sample of Sexual Minority Women

Functional and structural social support, substance use and sexual orientation from a nationally representative sample of US adults

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