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State-level tobacco environments and sexual orientation disparities in tobacco use and dependence in the USA
  1. Mark L Hatzenbuehler1,
  2. Katherine M Keyes2,
  3. Ava Hamilton2,
  4. Deborah S Hasin2,3
  1. 1Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
  2. 2Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
  3. 3Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA
  1. Correspondence to Dr Mark L Hatzenbuehler, Center for the Study of Social Inequalities and Health, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 549.B., New York, NY 10032, USA; mlh2101{at}columbia.edu

Abstract

Objective To describe relationships between tobacco-related environments and disparities in smoking by sexual orientation.

Methods We examined three aspects of state-level tobacco environments, which were derived from the ImpacTeen State Level Tobacco Control Policy and Prevalence Database: (1) tobacco price and tax data and tobacco control funding; (2) tobacco control policies and (3) tobacco prevalence and norms data. This information was linked to individual-level data on sexual orientation, tobacco use and nicotine dependence in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N=34 653; 577 LGB respondents), a cross-sectional, nationally representative survey of adults in the USA.

Results Lesbian, gay and bisexual (LGB) adults in states with more restrictive tobacco environments were less likely to have ever smoked (AOR=0.78, 95% CI 0.62 to 1.00) and to currently smoke (AOR=0.77, 95% CI 0.60 to 0.99) than LGB adults in more permissive tobacco environments. Further, sexual orientation disparities in past and current smoking, as well as in current nicotine dependence, were lower in states with the most restrictive tobacco environments. Results were robust to adjustment for confounders at the individual and state levels.

Conclusions Restrictive state-level tobacco environments are correlates of smoking behaviours among LGB adults in the USA; such environments could potentially reduce social inequalities in smoking based on sexual orientation.

  • Disparities
  • Priority/Special Populations
  • Public Policy

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