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Disparities in the prevalence of cigarette smoking among bisexual people: a systematic review, meta-analysis and meta-regression
  1. Mostafa Shokoohi1,
  2. Travis Salway2,3,4,
  3. Benjamin Ahn1,
  4. Lori E Ross1
  1. 1 Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  2. 2 Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
  3. 3 British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
  4. 4 Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Mostafa Shokoohi, Social and Behavioral Health Sciences Division, University of Toronto Dalla Lana School of Public Health, Toronto, ON M5T 3M7, Canada; mostafa.shokoohi{at}


Objective To review the bisexual-specific prevalence and likelihood of cigarette smoking relative to lesbian/gay and heterosexual individuals.

Data sources We searched MEDLINE, PsycInfo, CINAHL, Scopus and LGBT Life databases (from 1995 to September 2019) for studies reporting cigarette smoking among bisexuals versus their comparators.

Study selection Observational, quantitative, peer-reviewed studies providing estimates for lifetime, past 30 days or current cigarette smoking among bisexuals and any of the two comparators were selected.

Data extraction Data on sexual orientation groups, cigarette smoking, sample type and mechanism, data collection mode, country and median year, as well as gender and age groups were extracted.

Data synthesis Random-effects meta-analysis was used to estimate the pooled OR (95% CIs) of cigarette smoking. Meta-regression was used to examine the difference in the prevalence of cigarette smoking by study and sample characteristics. Of 4663 unduplicated records, 47 unique studies were included (14, 23 and 22 studies on lifetime, past 30 days and current cigarette smoking, respectively). Compared with lesbians/gays and heterosexuals, bisexuals were 1.25 (1.15 to 1.37) and 2.18 (1.84 to 2.59) times more likely to report lifetime smoking, 1.17 (1.08 to 1.27) and 2.49 (2.20 to 2.83) times more likely to report past 30 days smoking and 1.19 (1.00 to 1.43) and 2.26 (1.97 to 2.59) times more likely to report current smoking. Gender was a significant covariate in the meta-regression models.

Conclusions Cigarette smoking was more prevalent among bisexuals than lesbians/gays and heterosexuals, with the estimates showing a greater magnitude among bisexual women relative to all other sexual orientation/gender subgroups.

  • prevention
  • disparities
  • smoking caused disease

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  • Contributors LR conceptualised and oversaw all aspects of the study. Under the supervision of LR, MS and BA screened and reviewed all the identified records, assessed the eligibility criteria and extracted data from all of the included studies. MS conducted the statistical analysis and prepared the first draft of the manuscript. LR and TS contributed to the interpretation of the findings. All authors have reviewed and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.