Tob Control 18:275-282 doi:10.1136/tc.2008.028241
  • Research paper

Tobacco use among sexual minorities in the USA, 1987 to May 2007: a systematic review

  1. J G L Lee1,
  2. G K Griffin2,
  3. C L Melvin3
  1. 1
    Department of Maternal & Child Health, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
  2. 2
    Duke University School of Medicine, Durham, North Carolina, USA
  3. 3
    Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  1. J G L Lee, Tobacco Prevention and Evaluation Program, Department of Family Medicine, UNC School of Medicine, CB# 7595, 590 Manning Drive, Chapel Hill, North Carolina 27599 USA; jose.lee{at}
  • Received 21 October 2008
  • Accepted 30 January 2009
  • Published Online First 10 February 2009


Objectives: This paper examines the prevalence of tobacco use among sexual minorities in the US through a systematic review of literature from 1987 to May 2007.

Methods: Seven databases were searched for peer-reviewed research (Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library via Wiley InterScience, Education Resources Information Center (ERIC), Health Source: Nursing/Academic, Institute for Scientific Information (ISI) Web of Science, PsycINFO via EBSCO Host and PubMed). 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.


  • Funding: This work was partially supported by The Robert Wood Johnson Foundation’s Smoke-Free Families National Dissemination Office (grant no. 053311). The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the views of the Robert Wood Johnson Foundation.

  • Competing interests: None.

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