Lesbian, Gay, Bisexual, and Transgender (LGBT) View it Differently Than Non-LGBT: Exposure to Tobacco-related Couponing, E-cigarette Advertisements, and Anti-tobacco Messages on Social and Traditional Media.

BACKGROUND: LGBT populations use tobacco at disparately higher rates nationwide, compared to national averages. The tobacco industry has a history targeting LGBT with marketing efforts, likely contributing to this disparity. This study explores whether exposure to tobacco content on traditional and social media is associated with tobacco use among LGBT and non-LGBT. METHODS: This study reports results from LGBT (N = 1092) and non-LGBT (N = 16430) respondents to a 2013 nationally representative cross-sectional online survey of US adults (N = 17522). Frequency and weighted prevalence were estimated and adjusted logistic regression analyses were conducted. RESULTS: LGBT reported significantly higher rates of past 30-day tobacco media exposure compared to non-LGBT, this effect was strongest among LGBT who were smokers (p < .05). LGBT more frequently reported exposure to, searching for, or sharing messages related to tobacco couponing, e-cigarettes, and anti-tobacco on new or social media (eg, Twitter, Facebook, etc.) than did non-LGBT (p < .05). Non-LGBT reported more exposure from traditional media sources such as television, most notably anti-tobacco messages (p = .0088). LGBT had higher odds of past 30-day use of cigarettes, e-cigarettes, and cigars compared to non-LGBT, adjusting for past 30-day media exposure and covariates (p ≤ .0001). CONCLUSIONS: LGBT (particularly LGBT smokers) are more likely to be exposed to and interact with tobacco-related messages on new and social media than their non-LGBT counterparts. Higher levels of tobacco media exposure were significantly associated with higher likelihood of tobacco use. This suggests tobacco control must work toward reaching LGBT across a variety of media platforms, particularly new and social media outlets. IMPLICATIONS: This study provides important information about LGBT communities tobacco-related disparities in increased exposure to pro-tobacco messages via social media, where the tobacco industry has moved since the MSA. Further, LGBT when assessed as a single population appear to identify having decreased exposure to anti-tobacco messages via traditional media, where we know a large portion of tobacco control and prevention messages are placed. The study points to the need for targeted and tailored approaches by tobacco control to market to LGBT using on-line resources and tools in order to help reduce LGBT tobacco-related health disparities. Although there have been localized campaigns, only just recently have such LGBT-tailored national campaigns been developed by the CDC, FDA, and Legacy, assessment of the content, effectiveness, and reach of both local and national campaigns will be important next steps.

Transgender Use of Cigarettes, Cigars, and E-Cigarettes in a National Study.

INTRODUCTION: Tobacco use among transgender adults continues to be an area of research with few reported findings. The limited literature indicates higher cigarette use among transgender adults, compared with the general population. This national study is the first to report on cigarettes, cigars, and e-cigarettes by examining differences in transgender tobacco use independent of sexual orientation. METHODS: Data were collected in 2013 using a nationally cross-sectional online survey of U.S. adults (cisgender, n=17,164; transgender, n=168) and analyzed in 2015. Past 30-day tobacco use point estimates and adjusted logistic regression while controlling for false discovery rate were reported for transgender and cisgender respondents. RESULTS: Transgender adults reported higher past 30-day use of any cigarette/cigar/e-cigarette product (39.7% vs 25.1%) and current use of cigarettes (35.5% vs 20.7%), cigars (26.8% vs 9.3%), and e-cigarettes (21.3% vs 5.0%) compared with cisgender adults (all p-values ≤0.003). Transgender respondents had significantly higher odds of past 30-day tobacco product use for any cigarette/cigar/e-cigarette product (OR=1.97, 95% CI=1.25, 3.1), e-cigarettes (OR=5.15, 95% CI=3.36, 7.88), cigars (OR=3.56, 95% CI=2.27, 5.59), and cigarettes (OR=2.10, 95% CI=1.35, 3.28) versus cisgender respondents (all p-values ≤0.0035). CONCLUSIONS: Transgender adults are at higher risk for tobacco use than cisgender adults and risk of specific product use varies by gender. This is the first U.S. national study to assess differences in use of various tobacco products using questions that specifically ask for gender identity separately from sexual orientation. This study provides data that can inform targeted interventions to promote transgender health.

Intragroup Variance in Lesbian, Gay, and Bisexual Tobacco Use Behaviors: Evidence That Subgroups Matter, Notably Bisexual Women.

INTRODUCTION: Emerging evidence suggests bisexual populations are at increased risk for a variety of negative health outcomes, including tobacco use. Lesbian, gay, and bisexual (LGB) populations are at increased risk for cigarette smoking, but research on LGB subpopulations' use of tobacco products beyond cigarettes and tobacco use differences across LGB subgroups is in its infancy. This study explores differences in use of tobacco products across LGB subgroups, including gender differences among bisexuals. METHODS: This study reports results from a 2013 nationally-representative cross-sectional online survey of US adults (N = 17 087). Weighted tobacco use prevalence and adjusted logistic regression results are reported. RESULTS: LGB populations reported higher current use of any tobacco product (35.7%) and current use of cigarettes (32.0%), e-cigarettes (8.9%), regular (5.5%) and small cigars (11.6%), compared with non-LGB. Bisexual (odds ratio [OR] = 2.6, 95% confidence interval [CI]: 1.7-3.9) and lesbian (OR = 1.7, 95% CI: 1.0-2.7) women have higher odds of any tobacco use than heterosexual women; including greater odds of regular (OR = 2.9, 95% CI: 1.2-7.0 and OR = 2.2, 95% CI: 1.3-3.9; respectively) and small cigar use (OR = 2.4, 95% CI: 1.4-4.1 and OR = 3.2, 95% CI: 2.0-5.1; respectively). Gay men had lower odds of cigar use (OR = 0.4, 95% CI: 0.2-0.8) than heterosexual men. CONCLUSIONS: This is the first US adult population study to assess differences in use of various tobacco products across adult LGB subpopulations and by gender, confirming their increased risk of use and illuminating differences by subgroup and gender. Exploring LGB as a unified population appears inadequate to accurately characterize LGB tobacco use risk. Tobacco-related LGB health inequities, particularly among bisexual and lesbian women, may be greater than previously indicated. IMPLICATIONS: This manuscript provides important contributions to the field of tobacco control and prevention, and more specifically to LGB tobacco-related health disparities research. This is among the first population level studies to explore various tobacco use across LGB populations and across genders, comparing results to non-LGB populations in a national study. We provide novel evidence that bisexual women in particular, have a higher risk for use of various tobacco products, compared with other LGB subpopulations. In order to address this disparity, tobacco control professionals need to be made aware of these important differences in tobacco use behavior.

Receptivity to cigarette and tobacco control messages and adolescent smoking initiation.

BACKGROUND: Tobacco industry cigarette advertising is associated with increased adolescent smoking, while counter tobacco advertising is associated with reduced smoking. As these campaigns compete for influence, there is a need to understand their inter-relationship on youth smoking. METHODS: This study reports data from a national population of families (n=1036) with an oldest child aged 10-13 years, identified by random digit dialling. Parent and child dyads completed baseline questionnaires in 2003. Adolescents were resurveyed in 2007-2008 (response rate 74%). Adjusted logistic regression explores associations between receptivity to cigarette and tobacco control advertising and adolescent smoking initiation. RESULTS: In 2007-2008, 57.9% of adolescents reported a favourite tobacco control advertisement and 43.3% reported being receptive to cigarette advertisements. Thirty per cent reported receptivity to cigarette and tobacco control advertisements. Among those receptive to cigarette advertising, having a favourite anti-smoking advertisement had a borderline significant association with a 30% lower smoking rate. Anti-industry tobacco control messages were three times more likely to be favourites of those who were receptive to cigarette advertising than other tobacco control advertising. CONCLUSIONS: Receptivity to tobacco control advertising appeared to ameliorate the promotion of initiation from cigarette advertising. Anti-industry advertising appears to be the most effective counter for tobacco control and should be considered for wider use. A larger longitudinal study is needed to confirm these findings.

The association between home smoking restrictions and youth smoking behaviour: a review.

OBJECTIVE: To review the available evidence for home smoking restrictions as a useful tool in the prevention of youth smoking and to make recommendations for further research. METHODS: A PubMed search (1 January 1990 to 26 January 2010) identified studies involving youth ≤18 years using extensive criteria. In all, 17 studies relating home smoking restrictions to youth smoking behaviour were identified from titles, abstracts or the full text, as required. Two additional articles were identified by other means. KE, NS and EG reviewed the studies. Differences in interpretation were resolved by discussion, with EG making final decisions. RESULTS: Of the 19 studies, 16 (including the only 2 longitudinal studies) showed at least marginal evidence of an association of home smoking restrictions with reduced adolescent smoking behaviours. Associations were more numerous and stronger in homes without adult smokers, suggesting that even in such homes, lack of a smoke-free home may undermine the parental value of not smoking. Definitions of home smoking rules, adolescent smoking behaviour and treatment of parental smoking varied widely among studies. It is recommend that future research: (1) contrast smoke-free homes for everyone against all others, (2) included an interaction term for parental smoking and having a smoke-free home, or conduct separate analyses for homes with and without parental or other adults smokers and (3) examine early and later stages of the smoking uptake continuum. CONCLUSIONS: While the evidence is suggestive for an effect, further research is required to establish causality using longitudinal designs.