by Bob Roehr
Studies have long shown that gays and lesbians are more likely to smoke than their heterosexual counterparts, however there have been concerns about the way that data was gathered.
A large new telephone survey from California is the first to confirm those findings, offering new details on the smoking patterns of gays and new insights into the very question of self-identity in terms of sexual orientation. It was published in the August issue of the American Journal of Public Health.
The massive study was led by Elisabeth P. Gruskin, a public health researcher with Kaiser Permanente, and supported by the California Department of Public Health. Between July, 2003 and March, 2004 it dialed 187,000 telephone numbers in California, screened 31,000 households for eligibility, and completed nearly 3,000 survey interviews with adults, comparing those with the results of existing surveys of all Californians.
The survey was somewhat unusual in that it differentiated between those who self-identified as gay/lesbian, bisexual, or who identified as heterosexual but engaged in some same-gender sexual activity after the age of 18.
The 898 women participating in the survey divided fairly evenly: lesbian 34.2 percent, bisexual 29.3 percent, and women who have sex with women (WSW) 36.5 percent. The 1052 men showed stark division, with 85.4 percent identifying as gay, 7 percent as bisexual, and 7.6 percent as men who have sex with men (MSM). This gender dichotomy reflects what seems to be a real difference in the way men and women experience sexual orientation.
Among the general population, 68 percent of women had never smoked, while in the study population those numbers were 43 percent of lesbians, 51.3 percent of bisexual women, and 21.5 percent of WSW.
Gay men were more likely to smoke than the general population (27.3 percent vs. 19.7 percent), while the smoking rates for bisexual and MSM did not differ significantly from the general population, though that may be due in part to the relatively small number of men in each category.
When data from the males and females were combined, the study participants were much more likely to be heavy daily smokers than the general population (G/L 22.2 percent, bisexual 22.6 percent, same-sex partners 29.7 percent).
Gruskin and her colleagues called the study "an important first step toward collecting standard tobacco measures using sophisticated and rigorous epidemiological surveillance methodology commonly employed in mainstream tobacco control efforts."
It noted the association within the LGB community between tobacco use and co-morbidities such as depression and substance abuse. It may be that treating those other conditions can lead to reduced use of tobacco products, or vice versa. The study likely will be useful in directing tobacco cessation funds toward organizations serving the LGB community.
Quitting
People 18 to 24 are more likely to smoke than those who are older (24 percent vs. 20 percent), but they are highly motivated to quit, says Susan Curry, director of the Institute for Health Research and Policy at the University of Illinois at Chicago.
However, when they do try to quit, they are only about half as likely to use proven pharmacotherapy – nicotine gum, patches, or bupropion – to help them do it (17 percent vs. 32 percent).
"Young adults are less likely to have health insurance, less likely to go to the doctor, and when they do go to the doctor they are much less likely to be asked about their smoking and be advised to quit," says Curry.
They also have misconceptions about treatment, such as believing that nicotine causes cancer – it does not; the tars and other carcinogens in cigarettes cause cancer, the nicotine is merely addictive – and so avoid nicotine products that can help them quit.
Curry said correcting these misperceptions and increasing access to health insurance or other programs that can supply stop smoking assistance will be important in reducing the levels of smoking among young adults.
A third paper in that same issue of the American Journal of Public Health documents the fact that exposure to secondhand smoke in the workplace can be deadly. The study by Michael Stark, with the Multnomah County (Portland, Oregon) Health Department, measured the exposure of the carcinogen NNK, which is not considered safe at any level.
It found that NNK showed up in the urine of nonsmoker employees at bars and restaurants that allowed smoking. It continued to increase at the rate of 6 percent an hour throughout the shift.
"The science shows that the threat of disease from secondhand smoke is no longer a distant threat," said Stark. "The amount of this carcinogen increases even within a single work shift."
